Direct cost comparison of totally endoscopic versus open ear surgery.

Science.gov (United States)

Patel, N; Mohammadi, A; Jufas, N

2018-02-01

Totally endoscopic ear surgery is a relatively new method for managing chronic ear disease. This study aimed to test the null hypothesis that open and endoscopic approaches have similar direct costs for the management of attic cholesteatoma, from an Australian private hospital setting. A retrospective direct cost comparison of totally endoscopic ear surgery and traditional canal wall up mastoidectomy for the management of attic cholesteatoma in a private tertiary setting was undertaken. Indirect and future costs were excluded. A direct cost comparison of anaesthetic setup and resources, operative setup and resources, and surgical time was performed between the two techniques. Totally endoscopic ear surgery has a mean direct cost reduction of AUD$2978.89 per operation from the hospital perspective, when compared to canal wall up mastoidectomy. Totally endoscopic ear surgery is more cost-effective, from an Australian private hospital perspective, than canal wall up mastoidectomy for attic cholesteatoma.

Direct and Indirect Healthcare Resource Utilization and Costs Among Migraine Patients in the United States.

Science.gov (United States)

Bonafede, Machaon; Sapra, Sandhya; Shah, Neel; Tepper, Stewart; Cappell, Katherine; Desai, Pooja

2018-05-01

clinical characteristics. A second analysis, conducted among the migraine patients only, compared the odds of having a short-term disability claim between (1) patients treated with acute or preventive migraine medications only during the baseline period and patients with no migraine treatment during baseline and (2) patients treated with both acute and preventive migraine medications during the baseline period and patients with no migraine treatment during baseline, after controlling for patient demographic and clinical characteristics. Migraine patients had total annual direct plus indirect costs that were $8924 (in 2014 United States dollars) higher than those of demographically similar individuals without evidence of migraine. Migraine patients' mean annual direct all-cause healthcare costs were $6575 higher than those of matched patients without migraine ($11,010 [standard deviation = $19,663] vs $4436 [standard deviation=$13,081]; P costs were $2350 higher in the migraine cohort than in the matched no migraine patients ($11,294 vs $8945. Migraine patients were 2.0 times more likely as their nonmigraine counterparts to use opioids (45.5% vs 21.9%; P cost burden in the United States. Compared to matched nonmigraine patients, migraine patients were more likely to have work loss and longer periods of work loss, leading to significantly higher indirect costs. Migraine patients also had higher levels of healthcare utilization, despite the relatively stable prevalence of migraine and the available acute and preventive treatment options for migraine management. © 2018 American Headache Society.

The impact of diabetes mellitus on healthcare costs in Italy.

Science.gov (United States)

Giorda, Carlo B; Manicardi, Valeria; Diago Cabezudo, Jesús

2011-12-01

Diabetes mellitus is an increasingly common chronic disease that has a great impact not only in terms of clinical effects, but also in terms of economic burden worldwide. Expenditures due to diabetes derive essentially from direct and indirect costs. Current estimates of global healthcare expenditures due to diabetes are US$376 billion and are expected to increase to US$490 billion by 2030. In particular, costs associated with diabetes-related complications represent the most relevant part of the national healthcare expenditure for diabetes and are higher than the costs of managing diabetes itself. The major expenditure depends on the type and the number of complications: cardiovascular complications increase direct costs, especially for hospitalization. Moreover, diabetic comorbidity has a greater economic impact on the health expenditure in comparison with those patients without diabetes. In Europe, the CODE-2 study was the first attempt to evaluate the costs of diabetes: the annual costs per patient were estimated at €2384 and the highest value, €2991, was registered in Italy. This indicates an overall annual cost of €5170 million for the whole Italian population with diabetes. Current estimates for 2010 healthcare expenditure for diabetes are US$105 billion (10% of total healthcare expenditure, US$2046 per person) for the whole European region, and US$11 billion (9% of total healthcare expenditure, US$2087 per person) for Italy. More studies are needed in order to better define the real significance of the healthcare costs of diabetes in Italy. An effective therapy with a good metabolic control can reduce the risk of complications and represents a valid strategy from an economic point of view.

RFID-enabled healthcare applications, issues and benefits: an archival analysis (1997-2011).

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Fosso Wamba, Samuel

2012-12-01

In this paper, a comprehensive review of articles published between 1997 and 2011 in the Journal of Medical Systems (JMS) on RFID technology is presented. A total of 22 papers are analyzed using a classification framework that has three dimensions: RFID-enabled healthcare applications, RFID-enabled healthcare issues, and RFID-enabled healthcare benefits. In addition, an invitation sent to all authors of the papers accepted for the special issue on RFID for the JMS allows them to position their various papers within the classification framework. Finally, a list of future research directions is presented.

Effect of Direct-to-Consumer Advertising on Asthma Medication Sales and Healthcare Use

Science.gov (United States)

Daubresse, Matthew; Hutfless, Susan; Kim, Yoonsang; Kornfield, Rachel; Qato, Dima M.; Huang, Jidong; Miller, Kay; Emery, Sherry L.

2015-01-01

Rationale: The United States is one of only two countries that permit direct-to-consumer advertising (DTCA) of prescription drugs, and many questions remain regarding its effects. Objectives: To quantify the association between asthma-related DTCA, pharmacy sales, and healthcare use. Methods: This was an ecological study from 2005 through 2009 using linked data from Nielsen (DTCA television ratings), the IMS Health National Prescription Audit (pharmacy sales), and the MarketScan Commercial Claims data (healthcare use) for 75 designated market areas in the United States. We used multilevel Poisson regression to model the relationship between DTCA and rates of prescriptions and use within and across designated market areas. Main outcome measures include (1) volume of total, new, and refilled prescriptions for advertised products based on pharmacy sales; (2) prescription claims for asthma medications; and asthma-related (3) emergency department use, (4) hospitalizations, and (5) outpatient encounters among the commercially insured. Measurements and Main Results: Four Food and Drug Administration–approved asthma medicines were advertised during the period examined: (1) fluticasone/salmeterol (Advair), (2) mometasone furoate (Asmanex), (3) montelukast (Singulair), and (4) budesonide/formoterol (Symbicort). After adjustment, each additional televised advertisement was associated with 2% (incident rate ratio, 1.02; 95% confidence interval, 1.01–1.03) higher pharmacy sales rate from 2005 through 2009, although this effect varied across the three consistently advertised therapies examined. Among the commercially insured, DTCA was positively and significantly associated with emergency room visits related to asthma (incident rate ratio, 1.02; 95% confidence interval, 1.01–1.04), but there was no relationship with hospitalizations or outpatient encounters. Conclusions: Among this population, DTCA was associated with higher prescription sales and asthma-related emergency

Direct healthcare cost of obesity in brazil: an application of the cost-of-illness method from the perspective of the public health system in 2011.

Science.gov (United States)

de Oliveira, Michele Lessa; Santos, Leonor Maria Pacheco; da Silva, Everton Nunes

2015-01-01

Obesity is a global public health problem and a risk factor for several diseases that financially impact healthcare systems. To estimate the direct costs attributable to obesity (body mass index {BMI} ≥ 30 kg/m2) and morbid obesity (BMI ≥ 40 kg/m2) in adults aged ≥ 20 incurred by the Brazilian public health system in 2011. Public hospitals and outpatient care. A cost-of-illness method was adopted using a top-down approach based on prevalence. The proportion of the cost of each obesity-associated comorbidity was calculated and obesity prevalence was used to calculate attributable risk. Direct healthcare cost data (inpatient care, bariatric surgery, outpatient care, medications and diagnostic procedures) were extracted from the Ministry of Health information systems, available on the web. Direct costs attributable to obesity totaled US$ 269.6 million (1.86% of all expenditures on medium- and high-complexity health care). The cost of morbid obesity accounted for 23.8% (US$ 64.2 million) of all obesity-related costs despite being 18 times less prevalent than obesity. Bariatric surgery costs in Brazil totaled US$ 17.4 million in 2011. The cost of morbid obesity in women was five times higher than it was in men. The cost of morbid obesity was found to be proportionally higher than the cost of obesity. If the current epidemic were not reversed, the prevalence of obesity in Brazil will increase gradually in the coming years, as well as its costs, having serious implications for the financial sustainability of the Brazilian public health system.

What part of the total care consumed by type 2 diabetes patients is directly related to diabetes? Implications for disease management programs

Directory of Open Access Journals (Sweden)

Christel van Dijk

2011-12-01

Full Text Available Background: Disease management programs (DMP aim at improving coordination and quality of care and reducing healthcare costs for specific chronic diseases. This paper investigates to what extent total healthcare utilization of type 2 diabetes patients is actually related to diabetes and its implications for diabetes management programs.Research design and methods: Healthcare utilization for diabetes patients was analyzed using 2008 self-reported data (N=316 and data from electronic medical records (EMR (N=9023, and divided whether or not care was described in the Dutch type 2 diabetes multidisciplinary healthcare standard.Results: On average 4.3 different disciplines of healthcare providers were involved in the care for diabetes patients. 96% contacted a GP-practice and 63% an ophthalmologist, 24% an internist, 32% a physiotherapist and 23% a dietician. Diabetes patients had on average 9.3 contacts with GP-practice of which 53% were included in the healthcare standard. Only a limited part of total healthcare utilization of diabetes patients was included in the healthcare standard and therefore theoretically included in DMPs.Conclusion: Organizing the care for diabetics in a DMP might harm the coordination and quality of all healthcare for diabetics. DMPs should be integrated in the overall organization of care.

A direct healthcare cost analysis of the cryopreserved versus fresh transfer policy at the blastocyst stage.

Science.gov (United States)

Papaleo, Enrico; Pagliardini, Luca; Vanni, Valeria Stella; Delprato, Diana; Rubino, Patrizia; Candiani, Massimo; Viganò, Paola

2017-01-01

A cost analysis covering direct healthcare costs relating to IVF freeze-all policy was conducted. Normal- and high- responder patients treated with a freeze-all policy (n = 63) compared with fresh transfer IVF (n = 189) matched by age, body mass index, duration and cause of infertility, predictive factors for IVF (number of oocytes used for fertilization) and study period, according to a 1:3 ratio were included. Total costs per patient (€6952 versus €6863) and mean costs per live birth were similar between the freeze-all strategy (€13,101, 95% CI 10,686 to 17,041) and fresh transfer IVF (€15,279, 95% CI 13,212 to 18,030). A mean per live birth cost-saving of €2178 (95% CI -1810 to 6165) resulted in a freeze-all strategy owing to fewer embryo transfer procedures (1.29 ± 0.5 versus 1.41 ± 0.7); differences were not significant. Sensitivity analysis revealed that the freeze-all strategy remained cost-effective until the live birth rate is either higher or only slightly lower (≥-0.59%) in the freeze-all group compared with fresh cycles. A freeze-all policy does not increase costs compared with fresh transfer, owing to negligible additional expenses, i.e. vitrification, endometrial priming and monitoring, against fewer embryo transfer procedures required to achieve pregnancy. Copyright © 2016 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.

Correlation of total, diffuse, and direct solar radiation

Science.gov (United States)

Buyco, E. H.; Namkoong, D.

1977-01-01

Present requirements for realistic solar energy system evaluations necessitate a comprehensive body of solar-radition data. The data should include both diffuse and direct solar radiation as well as their total on an hourly (or shorter) basis. In general, however, only the total solar radiation values were recorded. This report presents a correlation that relates the diffuse component of an hourly total solar radiation value to the total radiation ratio of the maximum value attainable. The data used were taken at the Blue Hill Observatory in Milton, Massachusetts, for the period 1952. The relation - in the form of the data plots - can be used in situations in which only the hourly total radiation data are available but the diffuse component is desired.

Incidence, risk factors and the healthcare cost of falls postdischarge after elective total hip and total knee replacement surgery: protocol for a prospective observational cohort study

Science.gov (United States)

Hill, Anne-Marie; Ross-Adjie, Gail; McPhail, Steven M; Monterosso, Leanne; Bulsara, Max; Etherton-Beer, Christopher; Powell, Sarah-Jayne; Hardisty, Gerard

2016-01-01

Introduction The number of major joint replacement procedures continues to increase in Australia. The primary aim of this study is to determine the incidence of falls in the first 12 months after discharge from hospital in a cohort of older patients who undergo elective total hip or total knee replacement. Methods and analyses A prospective longitudinal observational cohort study starting in July 2015, enrolling patients aged ≥60 years who are admitted for elective major joint replacement (n=267 total hip replacement, n=267 total knee replacement) and are to be discharged to the community. Participants are followed up for 12 months after hospital discharge. The primary outcome measure is the rate of falls per thousand patient-days. Falls data will be collected by 2 methods: issuing a falls diary to each participant and telephoning participants monthly after discharge. Secondary outcomes include the rate of injurious falls and health-related quality of life. Patient-rated outcomes will be measured using the Oxford Hip or Oxford Knee score. Generalised linear mixed modelling will be used to examine the falls outcomes in the 12 months after discharge and to examine patient and clinical characteristics predictive of falls. An economic evaluation will be conducted to describe the nature of healthcare costs in the first 12 months after elective joint replacement and estimate costs directly attributable to fall events. Ethics and dissemination The results will be disseminated through local site networks and will inform future services to support older people undergoing hip or knee joint replacement and also through peer-reviewed publications and medical conferences. This study has been approved by The University of Notre Dame Australia and local hospital human research ethics committees. Trial registration number ACTRN12615000653561; Pre-results. PMID:27412102

Totally Connected Healthcare with TV White Spaces.

Science.gov (United States)

Katzis, Konstantinos; Jones, Richard W; Despotou, Georgios

2017-01-01

Recent technological advances in electronics, wireless communications and low cost medical sensors generated a plethora of Wearable Medical Devices (WMDs), which are capable of generating considerably large amounts of new, unstructured real-time data. This contribution outlines how this data can be propagated to a healthcare system through the internet, using long distance Radio Access Networks (RANs) and proposes a novel communication system architecture employing White Space Devices (WSD) to provide seamless connectivity to its users. Initial findings indicate that the proposed communication system can facilitate broadband services over a large geographical area taking advantage of the freely available TV White Spaces (TVWS).

French government to trim direct stake in Total

International Nuclear Information System (INIS)

Anon.

1992-01-01

This paper reports that the French government has decided to slash its direct stake in partly state owned oil company Total to 5% from 31.7%, a surprise move expected to raise 10 billion francs ($1.8 billion). At the same time, other state owned entities will be asked to boost their combined 2.2% stake in Total to 10%, leaving the government with a net 15% interest in Total vs. the current 34%. Initially, state owned insurance companies Groupe des Assurances Nationales and Assurances Generale de France will be asked to hike their stakes in Total, but others could be asked to join if needed to meet the 10% target. The government the its phase-down of participation in Total, established in 1924 to manage French interests in Iraq Petroleum Co., was prompted by the evolution of the oil context, which differs greatly from what had prompted a significant stake of the state in Total's capital

The direct health-care burden of valvular heart disease: evidence from US national survey data

Directory of Open Access Journals (Sweden)

Moore M

2016-10-01

Full Text Available Matt Moore,1 Jie Chen,2 Peter J Mallow,3 John A Rizzo4 1Global Health Economic Strategy, Edwards Lifesciences Inc, Irvine, CA, 2Department of Health Services and Administration, University of Maryland, College Park, MD, 3Health Economics and Outcomes Research, CTI Clinical Trial & Consulting Services Inc, Cincinnati, OH, 4Department of Preventive Medicine and Economics, Stony Brook University, Stony Brook, NY, USA Purpose: This study quantified the overall effects of aortic valve disease (AVD and mitral valve disease (MVD by disease severity on direct health-care costs to insurers and patients.Materials and methods: Based on 1996–2011 data from the Medical Expenditure Panel Survey (MEPS, a large, nationally representative US database, multivariate analyses were performed to assess the relationship between AVD and MVD and direct annual health-care costs to insurers and patients, at individual and US-aggregate levels. Adults aged 18 years and over with diagnosis codes for AVD or MVD based on International Classification of Diseases (ninth revision diagnosis codes were identified. Subjects were further classified as symptomatic AVD, asymptomatic AVD, symptomatic MVD, and asymptomatic MVD. These classifications were determined with clinical assistance and based in part on data availability in the MEPS.Results: The MEPS database included 148 patients with AVD: 53 patients with symptomatic AVD, 95 patients with asymptomatic AVD, and 1,051 with MVD, including 315 patients with symptomatic MVD and 736 patients with asymptomatic MVD. Symptomatic AVD had the largest incremental effect on annual per patient health-care expenditure: $12,789 for symptomatic AVD, $10,816 for asymptomatic AVD, $5,163 for symptomatic MVD, and $1,755 for asymptomatic MVD. When aggregated to the US population, heart-valve disease accounted for an incremental annual cost of $23.4 billion. The largest aggregate annual costs were incurred by patients with symptomatic MVD ($7

2016 Writing Contest Undergraduate Winner: The Relationship Between Medication Adherence and Total Healthcare Expenditures by Race/Ethnicity in Patients with Diabetes in Hawai'i.

Science.gov (United States)

Sutton, Cori X; Carpenter, Dee-Ann; Sumida, Wesley; Taira, Deborah

2017-07-01

Diabetes is a costly, chronic disease that is becoming increasingly prevalent worldwide. Studies show that Native Hawaiians suffer from higher rates of diabetes and lower rates of medication adherence compared to Caucasians and Japanese. This study compared total annual healthcare expenditures of patients with diabetes in Hawai'i by race and ethnicity and determined whether any existing differences persisted after controlling for medication adherence and demographic factors. The study population consisted of 30,445 individuals, using administrative claims data from a large health plan in Hawai'i. Filipinos, Native Hawaiians, and Other Pacific Islanders had significantly lower medication adherence rates compared to other groups. These ethnic groups also had the lowest median healthcare costs. In contrast, Caucasians had one of the highest medication adherence rates coupled with the highest median annual healthcare expenditures at $5,132. Generalized linear regression models showed that after controlling for demographic factors and medication adherence, Japanese (RR=0.86, 95%CI [0.78, 0.94]), Chinese (RR=0.83, 95%CI [0.73, 0.95]), Filipinos (RR=0.74, 95%CI [0.67, 0.82]), and Native Hawaiians (RR=0.74, 95%CI [0.67, 0.82]) had significantly lower total healthcare costs compared to Caucasians. Costs for Other Pacific Islanders were not significantly different from those of Caucasians. This study provides evidence that total health-related cost is associated with a multitude of factors that further research may reveal.

Making Choices: Self-Directed Teams or Total Quality Management?

Science.gov (United States)

Holpp, Lawrence

1992-01-01

Describes differences between total quality management and self-directed teams in terms of job design, decision making, flexibility, supervision, labor relations, quality, customers, and training. Offers suggestions for which method to choose when. (SK)

Why healthcare providers merge.

Science.gov (United States)

Postma, Jeroen; Roos, Anne-Fleur

2016-04-01

In many OECD countries, healthcare sectors have become increasingly concentrated as a result of mergers. However, detailed empirical insight into why healthcare providers merge is lacking. Also, we know little about the influence of national healthcare policies on mergers. We fill this gap in the literature by conducting a survey study on mergers among 848 Dutch healthcare executives, of which 35% responded (resulting in a study sample of 239 executives). A total of 65% of the respondents was involved in at least one merger between 2005 and 2012. During this period, Dutch healthcare providers faced a number of policy changes, including increasing competition, more pressure from purchasers, growing financial risks, de-institutionalisation of long-term care and decentralisation of healthcare services to municipalities. Our empirical study shows that healthcare providers predominantly merge to improve the provision of healthcare services and to strengthen their market position. Also efficiency and financial reasons are important drivers of merger activity in healthcare. We find that motives for merger are related to changes in health policies, in particular to the increasing pressure from competitors, insurers and municipalities.

Episode-Based Payment and Direct Employer Purchasing of Healthcare Services: Recent Bundled Payment Innovations and the Geisinger Health System Experience.

Science.gov (United States)

Slotkin, Jonathan R; Ross, Olivia A; Newman, Eric D; Comrey, Janet L; Watson, Victoria; Lee, Rachel V; Brosious, Megan M; Gerrity, Gloria; Davis, Scott M; Paul, Jacquelyn; Miller, E Lynn; Feinberg, David T; Toms, Steven A

2017-04-01

One significant driver of the disjointed healthcare often observed in the United States is the traditional fee-for-service payment model which financially incentivizes the volume of care delivered over the quality and coordination of care. This problem is compounded by the wide, often unwarranted variation in healthcare charges that purchasers of health services encounter for substantially similar episodes of care. The last 10 years have seen many stakeholder organizations begin to experiment with novel financial payment models that strive to obviate many of the challenges inherent in customary quantity-based cost paradigms. The Patient Protection and Affordable Care Act has allowed many care delivery systems to partner with Medicare in episode-based payment programs such as the Bundled Payments for Care Improvement (BPCI) initiative, and in patient-based models such as the Medicare Shared Savings Program. Several employer purchasers of healthcare services are experimenting with innovative payment models to include episode-based bundled rate destination centers of excellence programs and the direct purchasing of accountable care organization services. The Geisinger Health System has over 10 years of experience with episode-based payment bundling coupled with the care delivery reengineering which is integral to its ProvenCare® program. Recent experiences at Geisinger have included participation in BPCI and also partnership with employer-purchasers of healthcare through the Pacific Business Group on Health (representing Walmart, Lowe's, and JetBlue Airways). As the shift towards value-focused care delivery and patient experience progresses forward, bundled payment arrangements and direct purchasing of healthcare will be critical financial drivers in effecting change. Copyright © 2017 by the Congress of Neurological Surgeons.

Directions in healthcare research: pointers from retailing and services marketing.

Science.gov (United States)

Van Rompay, Thomas L J; Tanja-Dijkstra, Karin

2010-01-01

Although the importance of the environment in relation to healing processes has been well established, empirical evidence for environmental effects on patient well-being and behavior is sparse. In addition, few attempts have been made to integrate insights from related fields of research such as retailing and services marketing with findings from healthcare studies. In this paper, relevant findings and insights from these domains are discussed. What insights and findings from retailing and services marketing are (potentially) of interest to the healthcare context, and how should one interpret and follow up on these results in healthcare environments? Research in retailing and services marketing indicates that physical environmental factors (i.e., music and scent) and social environmental factors (i.e., crowded conditions) may affect consumer satisfaction and well-being. In addition, environmental effects have been shown to vary with contextual factors (e.g., the type of environment) and consumer needs (e.g., the extent to which consumers value social contact or stimulation in a specific setting). Although the evidence base for environmental factors in health environments is steadily growing, few attempts have been made to integrate findings from both domains. The findings presented indicate that environmental variables such as music and scent can contribute to patient well-being and overall satisfaction. In addition, findings suggest that these variables may be used to counteract the negative effects resulting from crowded conditions in different healthcare units. Taking into account recent developments in the healthcare industry, the importance of creating memorable and pleasant patient experiences is likely to grow in the years to come. Hence, the finding that subtle and relatively inexpensive manipulations may affect patient well-being in profound ways should inspire follow-up research aimed at unraveling the specifics of environmental influences in health

When direct health-care professional communications have an impact on inappropriate and unsafe use of medicines : A retrospective analysis of determinants of impact of safety warnings

NARCIS (Netherlands)

Reber, K.C.; Piening, S.; Wieringa, J.E.; Straus, S.M.J.M.; Raine, J.M.; de Graeff, Pauline; Haaijer-Ruskamp, F.M.; Mol, Peter G. M.

Serious safety issues relating to drugs are communicated to health-care professionals via Direct Health-Care Professional Communications (DHPCs). We explored which characteristics determined the impact of DHPCs issued in the Netherlands for ambulatory-care drugs (2001-2008). With multiple linear

Independent and inverse association of healthcare utilisation with physical activity in older adults with multiple chronic conditions.

Science.gov (United States)

Liu-Ambrose, T Y L; Ashe, M C; Marra, C

2010-11-01

In this study, whether physical activity is independently associated with direct healthcare costs in community-dwelling older adults with multiple chronic conditions was examined. Cross-sectional analysis. Research laboratory. 299 community-dwelling men and women volunteers aged 65 years and older with chronic conditions. None. Primary dependent variable was direct healthcare costs incurred in the previous 3 months. Participants completed the Health Resource Utilisation (HRU) questionnaire. To estimate HRU, direct costs in the previous 3 months were calculated using the three-party payer perspective of the British Columbia Ministry of Health, deemed representative of the Canadian healthcare system costs. For medications, the Retail Pharmacy Dispensed prescription cost tables were used. Primary independent variables were (1) self-report current level of physical activity as assessed by the Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) and (2) general balance and mobility as assessed by the National Institute on Aging Balance Scale. The mean number of chronic conditions per participant was six. Current level of physical activity was independently and inversely associated with HRU. Age, sex, number of chronic conditions, global cognitive function, body mass index, and general balance and mobility together accounted for 24.3% of the total variance. Adding the PASIPD score resulted in an R2 change of 3.3% and significantly improved the model. The total variance accounted by the final model was 27.6%. Physical activity promotion may reduce healthcare costs in older adults with chronic conditions.

Direct analysis of biological samples by total reflection X-ray fluorescence

International Nuclear Information System (INIS)

Lue M, Marco P.; Hernandez-Caraballo, Edwin A.

2004-01-01

The technique of total reflection X-ray fluorescence (TXRF) is well suited for the direct analysis of biological samples due to the low matrix interferences and simultaneous multi-element nature. Nevertheless, biological organic samples are frequently analysed after digestion procedures. The direct determination of analytes requires shorter analysis time, low reactive consumption and simplifies the whole analysis process. On the other hand, the biological/clinical samples are often available in minimal amounts and routine studies require the analysis of large number of samples. To overcome the difficulties associated with the analysis of organic samples, particularly of solid ones, different procedures of sample preparation and calibration to approach the direct analysis have been evaluated: (1) slurry sampling, (2) Compton peak standardization, (3) in situ microwave digestion, (4) in situ chemical modification and (5) direct analysis with internal standardization. Examples of analytical methods developed by our research group are discussed. Some of them have not been previously published, illustrating alternative strategies for coping with various problems that may be encountered in the direct analysis by total reflection X-ray fluorescence spectrometry

Total, direct, and indirect effects of paan on oral cancer.

Science.gov (United States)

Merchant, Anwar T; Pitiphat, Waranuch

2015-03-01

Paan (betel leaf and betel nut quid) used with or without tobacco has been positively associated with oral cancer. Oral submucous fibrosis (OSMF), a precancerous condition caused by paan, lies on the causal pathway between paan use and oral cancer. The purpose of this analysis was to estimate the effect of paan consumption on oral cancer risk when it is mediated by OSMF. We used mediation methods proposed by VanderWeele, which are based on causal inference principles, to characterize the total, direct, and indirect effects of paan, consumed with and without tobacco, on oral cancer mediated by OSMF. We reanalyzed case-control data collected from three hospitals in Karachi, Pakistan, between July 1996 and March 1998. For paan without tobacco, the total effect on oral cancer was OR 7.39, 95 % CI 1.01, 38.11, the natural indirect effect (due to OSMF among paan users) was OR 2.48, 95 % CI 0.99, 10.44, and the natural direct effect (due to paan with OSMF absent) was OR 3.32, 95 % CI 0.68, 10.07. For paan with tobacco, the total direct effect was OR 15.68, 95 % CI 3.00, 54.90, the natural indirect effect was OR 2.18, 95 % CI 0.82, 5.52, and the natural direct effect was OR 7.27, 95 % CI 2.15, 20.43. Paan, whether or not it contained tobacco, raised oral cancer risk irrespective of OSMF. Oral cancer risk was higher among those who used paan with tobacco.

Impact on healthcare resource utilization of multiple sclerosis in Spain.

Science.gov (United States)

Sicras-Mainar, Antoni; Ruíz-Beato, Elena; Navarro-Artieda, Ruth; Maurino, Jorge

2017-12-29

Multiple sclerosis (MS) is a chronic disease with a high socioeconomic impact. The aim of this study was to assess healthcare resources utilization and costs in a sample of patients with MS. A retrospective, cohort study was conducted using electronic medical records from 19 primary care centres in Asturias and Catalonia, Spain. Adult patients diagnosed with MS were distributed into two groups according to the Expanded Disability Status Scale (EDSS) score: 0-3.5 (no-moderate disability) and 4-9.5 (severe disability). Healthcare (direct cost) and non-healthcare costs (work productivity losses) were analysed. An analysis of covariance (ANCOVA) was used for correction, p < 0.05. A multiple regression model was performed to obtain the variables associated with costs. A total of 222 patients were analyzed; mean (SD) age: 45.5 (12.5) years, 64.4% female, and 62.2% presented a diagnosis of relapsing-remitting MS. Median EDSS score was 2.5, with 68.5% of the patients with no to moderate disability. The mean annual cost per MS patient was €25,103. For no-moderate and severe disability, the ANCOVA-adjusted mean annual cost was €23,157 and €29,242, respectively (p = 0.013). Direct costs and MS disease-modifying therapy accounted for 39.4% and 31.7% of the total costs, respectively. The total costs were associated with number of relapses (β = 0.135, p = 0.001), time since diagnosis (β = 0.281, p = 0.023), and age (β = 0.198, p = 0.037). Multiple sclerosis imposes a substantial economic burden on the Spanish National Health System, patients and society as a whole. Costs significantly correlated with disease progression.

Future Directions of Applying Healthcare Cloud for Home-based Chronic Disease Care

OpenAIRE

Hu, Yan; Eriksén, Sara; Lundberg, Jenny

2017-01-01

The care of chronic disease has become the main challenge for healthcare institutions around the world. To meet the growing needs of patients, moving the front desk of healthcare from hospital to home is essential. Recently, cloud computing has been applied to healthcare domain; however, adapting to and using this technology effectively for home-based care is still in its initial phase. We have proposed a conceptual hybrid cloud model for home-based chronic disease care, and have evaluated it...

Peripartum hysterectomy: an economic analysis of direct healthcare costs using routinely collected data.

Science.gov (United States)

Achana, F A; Fleming, K M; Tata, L J; Sultan, A A; Petrou, S

2017-10-03

To estimate resource use and costs associated with peripartum hysterectomy for the English National Health Service. Analysis of linked Clinical Practice Research Datalink and Hospital Episodes Statistics (CPRD-HES) data. Women undergoing peripartum hysterectomy between 1997 and 2013 and matched controls. Inverse probability weighted generalised estimating equations were used to model the non-linear trend in healthcare service use and costs over time, accounting for missing data, adjusting for maternal age, body mass index, delivery year, smoking and socio-economic indicators. Primary care, hospital outpatient and inpatient attendances and costs (UK 2015 prices). The study sample included 1362 women (192 cases and 1170 controls) who gave birth between 1997 and 2013; 1088 (153 cases and 935 controls) of these were deliveries between 2003 and 2013 when all categories of hospital resource use were available. Based on the 2003-2013 delivery cohort, peripartum hysterectomy was associated with a mean adjusted additional total cost of £5380 (95% CI £4436-6687) and a cost ratio of 1.76 (95% CI 1.61-1.98) over 5 years of follow up compared with controls. Inpatient costs, mostly incurred during the first year following surgery, accounted for 78% excluding or 92% including delivery-related costs. Peripartum hysterectomy is associated with increased healthcare costs driven largely by increased post-surgery hospitalisation rates. To reduce healthcare costs and improve outcomes for women who undergo hysterectomy, interventions that reduce avoidable repeat hospitalisations following surgery such as providing active follow up, treatment and support in the community should be considered. A large amount of NHS data on peripartum hysterectomy suggests active community follow up could reduce costs, #HealthEconomics. © 2017 Royal College of Obstetricians and Gynaecologists.

Total, Direct, and Indirect Effects in Logit Models

DEFF Research Database (Denmark)

Karlson, Kristian Bernt; Holm, Anders; Breen, Richard

It has long been believed that the decomposition of the total effect of one variable on another into direct and indirect effects, while feasible in linear models, is not possible in non-linear probability models such as the logit and probit. In this paper we present a new and simple method...... average partial effects, as defined by Wooldridge (2002). We present the method graphically and illustrate it using the National Educational Longitudinal Study of 1988...

Direct and indirect healthcare costs of rheumatoid arthritis patients in Turkey.

Science.gov (United States)

Hamuryudan, Vedat; Direskeneli, Haner; Ertenli, Ihsan; Inanc, Murat; Karaaslan, Yasar; Oksel, Fahrettin; Ozbek, Suleyman; Pay, Salih; Terzioglu, Ender; Balkan Tezer, Dilara; Hacibedel, Basak; Akkoc, Nurullah

2016-01-01

To estimate the annual cost of rheumatoid arthritis (RA) in Turkey by obtaining real-world data directly from patients. In this cross-sectional study, RA patients from the rheumatology outpatient clinics of 10 university hospitals were interviewed with a standardised questionnaire on RA-related healthcare care costs. The study included 689 RA patients (565 females) with a mean age of 51.2±13.2 years and mean disease duration of 9.4±7.8 years. The mean scores of the Routine Assessment of Patient Index Data 3 and the Health Assessment Questionnaire-Disability Index (5.08±2.34 and 1.08±0.68, respectively) indicated moderate disease activity and severity for the whole group. One-third of the patients were on biologic agents and 12% had co-morbid conditions. The mean number of annual outpatient visits was 11.7±9.6 per patient. Of the patients, 15% required hospitalisation and 4% underwent surgery. The mean annual direct cost was € 4,954 (median, € 1,805), whereas the mean annual indirect cost was € 2,802 (median, € 608). Pharmacy costs accounted for the highest expenditure (mean, € 2,777; median, € 791), followed by the RA-related consultations and expenses (mean, € 1,600; median, € 696). RA has a substantial economic burden in Turkey, direct costs being higher than indirect costs. Although both direct and indirect costs are lower in Turkey than in Europe with respect to nominal Euro terms, they are higher from the perspectives of purchasing power parity and gross domestic product. Early diagnosis and treatment of RA may positively affect the national economy considering the positive correlation between health care utilisations and increased cost with disease severity.

Healthcare liquid waste management.

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Sharma, D R; Pradhan, B; Pathak, R P; Shrestha, S C

2010-04-01

The management of healthcare liquid waste is an overlooked problem in Nepal with stern repercussions in terms of damaging the environment and affecting the health of people. This study was carried out to explore the healthcare liquid waste management practices in Kathmandu based central hospitals of Nepal. A descriptive prospective study was conducted in 10 central hospitals of Kathmandu during the period of May to December 2008. Primary data were collected through interview, observation and microbiology laboratory works and secondary data were collected by records review. For microbiological laboratory works,waste water specimens cultured for the enumeration of total viable counts using standard protocols. Evidence of waste management guidelines and committees for the management of healthcare liquid wastes could not be found in any of the studied hospitals. Similarly, total viable counts heavily exceeded the standard heterotrophic plate count (p=0.000) with no significant difference in such counts in hospitals with and without treatment plants (p=0.232). Healthcare liquid waste management practice was not found to be satisfactory. Installation of effluent treatment plants and the development of standards for environmental indicators with effective monitoring, evaluation and strict control via relevant legal frameworks were realized.

Data mining applications in healthcare.

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Koh, Hian Chye; Tan, Gerald

2005-01-01

Data mining has been used intensively and extensively by many organizations. In healthcare, data mining is becoming increasingly popular, if not increasingly essential. Data mining applications can greatly benefit all parties involved in the healthcare industry. For example, data mining can help healthcare insurers detect fraud and abuse, healthcare organizations make customer relationship management decisions, physicians identify effective treatments and best practices, and patients receive better and more affordable healthcare services. The huge amounts of data generated by healthcare transactions are too complex and voluminous to be processed and analyzed by traditional methods. Data mining provides the methodology and technology to transform these mounds of data into useful information for decision making. This article explores data mining applications in healthcare. In particular, it discusses data mining and its applications within healthcare in major areas such as the evaluation of treatment effectiveness, management of healthcare, customer relationship management, and the detection of fraud and abuse. It also gives an illustrative example of a healthcare data mining application involving the identification of risk factors associated with the onset of diabetes. Finally, the article highlights the limitations of data mining and discusses some future directions.

The future of e-learning in healthcare professional education: some possible directions

Directory of Open Access Journals (Sweden)

Kieran Walsh

2014-12-01

Full Text Available E-learning in healthcare professional education still seems like it is a new innovation but the reality is that e-learning has been around for as long as the internet has been around. This is approximately twenty years and so it is probably appropriate to now take stock and consider what the future of e-learning in healthcare professional education might be. One likely occurrence is that there will be more formats, more interactive technology, and sometimes game-based learning. Another future of healthcare professional education will likely be in simulation. Like other forms of technology outside of medicine, the cost of e-learning in healthcare professional education will fall rapidly. E-learning will also become more adaptive in the future and so will deliver educational content based on learners' exact needs. The future of e-learning will also be mobile. Increasingly in the future e-learning will be blended with face to face education.

Preventing occupational stress in healthcare workers

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Jani H. Ruotsalainen

Full Text Available ABSTRACT: BACKGROUND: Healthcare workers can suffer from occupational stress which may lead to serious mental and physical health problems. OBJECTIVES: To evaluate the effectiveness of work and person-directed interventions in preventing stress at work in healthcare workers. METHODS: Search methods: We searched the Cochrane Depression Anxiety and Neurosis Group trials Specialised Register, MEDLINE, PsychInfo and Cochrane Occupational Health Field database. Selection criteria: Randomised controlled clinical trials (RCT of interventions aimed at preventing psychological stress in healthcare workers. For work-directed interventions interrupted time series and prospective cohort were also eligible. Data collection and analysis: Two authors independently extracted data and assessed trial quality. Meta-analysis and qualitative synthesis were performed where appropriate. MAIN RESULTS: We identified 14 RCTs, three cluster-randomised trials and two crossover trials, including a total of 1,564 participants in intervention groups and 1,248 controls. Two trials were of high quality. Interventions were grouped into 1 person-directed: cognitive-behavioural, relaxation, music-making, therapeutic massage and multicomponent; and 2 work-directed: attitude change and communication, support from colleagues and participatory problem solving and decision-making, and changes in work organisation. There is limited evidence that person-directed interventions can reduce stress (standardised mean difference or SMD -0.85; 95% CI -1.21, -0.49; burnout: Emotional Exhaustion (weighted mean difference or WMD -5.82; 95% CI -11.02, -0.63 and lack of Personal Accomplishment (WMD -3.61; 95% CI -4.65, -2.58; and anxiety: state anxiety (WMD -9.42; 95% CI -16.92, -1.93 and trait anxiety (WMD -6.91; 95% CI -12.80, -1.01. One trial showed that stress remained low a month after intervention (WMD -6.10; 95% CI -8.44, -3.76. Another trial showed a reduction in Emotional Exhaustion (Mean

Assessing international trade in healthcare services

OpenAIRE

Herman, Lior

2009-01-01

Growing evidence indicates that international trade in healthcare services is growing. Nevertheless, a major literature gap exists with regard to the nature of international healthcare trade and its extent. Taking a comprehensive approach, this research examines the magnitude, directions, patterns of specialisation, growth and other aspects related to international trade in healthcare services. Within this framework, trade is analysed with regard to cross border trade, consumption of healthca...

Reinventing Emergency Department Flow via Healthcare Delivery Science.

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DeFlitch, Christopher; Geeting, Glenn; Paz, Harold L

2015-01-01

Healthcare system flow resulting in emergency departments (EDs) crowding is a quality and access problem. This case study examines an overcrowded academic health center ED with increasing patient volumes and limited physical space for expansion. ED capacity and efficiency improved via engineering principles application, addressing patient and staffing flows, and reinventing the delivery model. Using operational data and staff input, patient and staff flow models were created, identifying bottlenecks (points of inefficiency). A new flow model of emergency care delivery, physician-directed queuing, was developed. Expanding upon physicians in triage, providers passively evaluate all patients upon arrival, actively manage patients requiring fewer resources, and direct patients requiring complex resources to further evaluation in ED areas. Sustained over time, ED efficiency improved as measured by near elimination of "left without being seen" patients and waiting times with improvement in door to doctor, patient satisfaction, and total length of stay. All improvements were in the setting on increased patient volume and no increase in physician staffing. Our experience suggests that practical application of healthcare delivery science can be used to improve ED efficiency. © The Author(s) 2015.

Informatics and Nursing in a Post-Nursing Informatics World: Future Directions for Nurses in an Automated, Artificially Intelligent, Social-Networked Healthcare Environment.

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Booth, Richard G

2016-01-01

The increased adoption and use of technology within healthcare and society has influenced the nursing informatics specialty in a multitude of fashions. Namely, the nursing informatics specialty currently faces a range of important decisions related to its knowledge base, established values and future directions - all of which are in need of development and future-proofing. In light of the increased use of automation, artificial intelligence and big data in healthcare, the specialty must also reconceptualize the roles of both nurses and informaticians to ensure that the nursing profession is ready to operate within future digitalized healthcare ecosystems. To explore these goals, the author of this manuscript outlines an examination of technological advancements currently taking place within healthcare, and also proposes implications for the nursing role and the nursing informatics specialty. Finally, recommendations and insights towards how the roles of nurses and informaticians might evolve or be shaped in the growing post-nursing informatics era are presented. Copyright © 2016 Longwoods Publishing.

Healthcare Costs Associated with an Adequate Intake of Sugars, Salt and Saturated Fat in Germany: A Health Econometrical Analysis.

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Toni Meier

Full Text Available Non-communicable diseases (NCDs represent not only the major driver for quality-restricted and lost life years; NCDs and their related medical treatment costs also pose a substantial economic burden on healthcare and intra-generational tax distribution systems. The main objective of this study was therefore to quantify the economic burden of unbalanced nutrition in Germany--in particular the effects of an excessive consumption of fat, salt and sugar--and to examine different reduction scenarios on this basis. In this study, the avoidable direct cost savings in the German healthcare system attributable to an adequate intake of saturated fatty acids (SFA, salt and sugar (mono- & disaccharides, MDS were calculated. To this end, disease-specific healthcare cost data from the official Federal Health Monitoring for the years 2002-2008 and disease-related risk factors, obtained by thoroughly searching the literature, were used. A total of 22 clinical endpoints with 48 risk-outcome pairs were considered. Direct healthcare costs attributable to an unbalanced intake of fat, salt and sugar are calculated to be 16.8 billion EUR (CI95%: 6.3-24.1 billion EUR in the year 2008, which represents 7% (CI95% 2%-10% of the total treatment costs in Germany (254 billion EUR. This is equal to 205 EUR per person annually. The excessive consumption of sugar poses the highest burden, at 8.6 billion EUR (CI95%: 3.0-12.1; salt ranks 2nd at 5.3 billion EUR (CI95%: 3.2-7.3 and saturated fat ranks 3rd at 2.9 billion EUR (CI95%: 32 million-4.7 billion. Predicted direct healthcare cost savings by means of a balanced intake of sugars, salt and saturated fat are substantial. However, as this study solely considered direct medical treatment costs regarding an adequate consumption of fat, salt and sugars, the actual societal and economic gains, resulting both from direct and indirect cost savings, may easily exceed 16.8 billion EUR.

Healthcare Costs Associated with an Adequate Intake of Sugars, Salt and Saturated Fat in Germany: A Health Econometrical Analysis.

Science.gov (United States)

Meier, Toni; Senftleben, Karolin; Deumelandt, Peter; Christen, Olaf; Riedel, Katja; Langer, Martin

2015-01-01

Non-communicable diseases (NCDs) represent not only the major driver for quality-restricted and lost life years; NCDs and their related medical treatment costs also pose a substantial economic burden on healthcare and intra-generational tax distribution systems. The main objective of this study was therefore to quantify the economic burden of unbalanced nutrition in Germany--in particular the effects of an excessive consumption of fat, salt and sugar--and to examine different reduction scenarios on this basis. In this study, the avoidable direct cost savings in the German healthcare system attributable to an adequate intake of saturated fatty acids (SFA), salt and sugar (mono- & disaccharides, MDS) were calculated. To this end, disease-specific healthcare cost data from the official Federal Health Monitoring for the years 2002-2008 and disease-related risk factors, obtained by thoroughly searching the literature, were used. A total of 22 clinical endpoints with 48 risk-outcome pairs were considered. Direct healthcare costs attributable to an unbalanced intake of fat, salt and sugar are calculated to be 16.8 billion EUR (CI95%: 6.3-24.1 billion EUR) in the year 2008, which represents 7% (CI95% 2%-10%) of the total treatment costs in Germany (254 billion EUR). This is equal to 205 EUR per person annually. The excessive consumption of sugar poses the highest burden, at 8.6 billion EUR (CI95%: 3.0-12.1); salt ranks 2nd at 5.3 billion EUR (CI95%: 3.2-7.3) and saturated fat ranks 3rd at 2.9 billion EUR (CI95%: 32 million-4.7 billion). Predicted direct healthcare cost savings by means of a balanced intake of sugars, salt and saturated fat are substantial. However, as this study solely considered direct medical treatment costs regarding an adequate consumption of fat, salt and sugars, the actual societal and economic gains, resulting both from direct and indirect cost savings, may easily exceed 16.8 billion EUR.

Healthcare service quality: towards a broad definition.

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Mosadeghrad, Ali Mohammad

2013-01-01

The main purpose of this study is to define healthcare quality to encompass healthcare stakeholder needs and expectations because healthcare quality has varying definitions for clients, professionals, managers, policy makers and payers. This study represents an exploratory effort to understand healthcare quality in an Iranian context. In-depth individual and focus group interviews were conducted with key healthcare stakeholders. Quality healthcare is defined as "consistently delighting the patient by providing efficacious, effective and efficient healthcare services according to the latest clinical guidelines and standards, which meet the patient's needs and satisfies providers". Healthcare quality definitions common to all stakeholders involve offering effective care that contributes to the patient well-being and satisfaction. This study helps us to understand quality healthcare, highlighting its complex nature, which has direct implications for healthcare providers who are encouraged to regularly monitor healthcare quality using the attributes identified in this study. Accordingly, they can initiate continuous quality improvement programmes to maintain high patient-satisfaction levels. This is the first time a comprehensive healthcare quality definition has been developed using various healthcare stakeholder perceptions and expectations.

Direct medical cost of stroke in Singapore.

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Ng, Charmaine Shuyu; Toh, Matthias Paul Han Sim; Ng, Jiaying; Ko, Yu

2015-10-01

Globally, stroke is recognized as one of the main causes of long-term disability, accounting for approximately 5·7 million deaths each year. It is a debilitating and costly chronic condition that consumes about 2-4% of total healthcare expenditure. To estimate the direct medical cost associated with stroke in Singapore in 2012 and to determine associated predictors. The National Healthcare Group Chronic Disease Management System database was used to identify patients with stroke between the years 2006 and 2012. Estimated stroke-related costs included hospitalizations, accident and emergency room visits, outpatient physician visits, laboratory tests, and medications. A total of 700 patients were randomly selected for the analyses. The mean annual direct medical cost was found to be S$12 473·7, of which 93·6% were accounted for by inpatient services, 4·9% by outpatient services, and 1·5% by A&E services. Independent determinants of greater total costs were stroke types, such as ischemic stroke (P = 0·005), subarachnoid hemorrhage (P costs. Efforts to reduce inpatient costs and to allocate health resources to focus on the primary prevention of stroke should become a priority. © 2015 World Stroke Organization.

Near-term Forecasting of Solar Total and Direct Irradiance for Solar Energy Applications

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Long, C. N.; Riihimaki, L. D.; Berg, L. K.

2012-12-01

Integration of solar renewable energy into the power grid, like wind energy, is hindered by the variable nature of the solar resource. One challenge of the integration problem for shorter time periods is the phenomenon of "ramping events" where the electrical output of the solar power system increases or decreases significantly and rapidly over periods of minutes or less. Advance warning, of even just a few minutes, allows power system operators to compensate for the ramping. However, the ability for short-term prediction on such local "point" scales is beyond the abilities of typical model-based weather forecasting. Use of surface-based solar radiation measurements has been recognized as a likely solution for providing input for near-term (5 to 30 minute) forecasts of solar energy availability and variability. However, it must be noted that while fixed-orientation photovoltaic panel systems use the total (global) downwelling solar radiation, tracking photovoltaic and solar concentrator systems use only the direct normal component of the solar radiation. Thus even accurate near-term forecasts of total solar radiation will under many circumstances include inherent inaccuracies with respect to tracking systems due to lack of information of the direct component of the solar radiation. We will present examples and statistical analyses of solar radiation partitioning showing the differences in the behavior of the total/direct radiation with respect to the near-term forecast issue. We will present an overview of the possibility of using a network of unique new commercially available total/diffuse radiometers in conjunction with a near-real-time adaptation of the Shortwave Radiative Flux Analysis methodology (Long and Ackerman, 2000; Long et al., 2006). The results are used, in conjunction with persistence and tendency forecast techniques, to provide more accurate near-term forecasts of cloudiness, and both total and direct normal solar irradiance availability and

Association between medication supplies and healthcare costs in older adults from an urban healthcare system.

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Stroupe, K T; Murray, M D; Stump, T E; Callahan, C M

2000-07-01

The amount of medication dispensed to older adults for the treatment of chronic disease must be balanced carefully. Insufficient medication supplies lead to inadequate treatment of chronic disease, whereas excessive supplies represent wasted resources and the potential for toxicity. We used an electronic medical record system to determine the distribution of medications supplied to older urban adults and to examine the correlations of these distributions with healthcare costs and use. A cross-sectional study using data acquired over 3 years (1994-1996). A tax-supported urban public healthcare system consisting of a 300-bed hospital, an emergency department, and a network of community-based ambulatory care centers. Patients were >60 years of age and had at least one prescription refill and at least two ambulatory visits or one hospitalization during the 3-year period. Focusing on 12 major categories of drugs used to treat chronic diseases, we determined the amounts and direct costs of these medications dispensed to older adult patients. Amounts of medications that were needed by patients to medicate themselves adequately were compared with the medication supply actually dispensed considering all sources of care (primary, emergency, and inpatient). We calculated the excess drug costs attributable to oversupply of medication (>120% of the amount needed) and the drug cost reduction caused by undersupply of medication (120% of the supply needed. The total direct cost of targeted medications for 3 years was $1.96 million or, on average, $654,000 annually. During the 3-year period, patients receiving >120% of their needed medications had excess direct medication costs of $279,084 or $144 per patient, whereas patients receiving <80% of drugs needed had reduced medication costs of $423,438 or $634 per patient. Multivariable analyses revealed that both under- and over-supplies of medication were associated with a greater likelihood of emergency department visits and hospital

Healthcare Scheduling by Data Mining: Literature Review and Future Directions

Directory of Open Access Journals (Sweden)

Maria M. Rinder

2012-01-01

Full Text Available This article presents a systematic literature review of the application of industrial engineering methods in healthcare scheduling, with a focus on the role of patient behavior in scheduling. Nine articles that used mathematical programming, data mining, genetic algorithms, and local searches for optimum schedules were obtained from an extensive search of literature. These methods are new approaches to solve the problems in healthcare scheduling. Some are adapted from areas such as manufacturing and transportation. Key findings from these studies include reduced time for scheduling, capability of solving more complex problems, and incorporation of more variables and constraints simultaneously than traditional scheduling methods. However, none of these methods modeled no-show and walk-ins patient behavior. Future research should include more variables related to patient and/or environment.

The future of e-learning in healthcare professional education: some possible directions. Commentary.

Science.gov (United States)

Walsh, Kieran

2014-01-01

E-learning in healthcare professional education still seems like it is a new innovation but the reality is that e-learning has been around for as long as the internet has been around. This is approximately twenty years and so it is probably appropriate to now take stock and consider what the future of e-learning in healthcare professional education might be. One likely occurrence is that there will be more formats, more interactive technology, and sometimes game-based learning. Another future of healthcare professional education will likely be in simulation. Like other forms of technology outside of medicine, the cost of e-learning in healthcare professional education will fall rapidly. E-learning will also become more adaptive in the future and so will deliver educational content based on learners' exact needs. The future of e-learning will also be mobile. Increasingly in the future e-learning will be blended with face to face education.

Healthcare avoidance: a critical review.

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Byrne, Sharon K

2008-01-01

The purpose of this study is to provide a critical review and synthesis of theoretical and research literature documenting the impact of avoidance on healthcare behaviors, identify the factors that influence healthcare avoidance and delay in the adult population, and propose a direction for future research. The Theory of Reasoned Action, Theory of Planned Behavior, Theory of Care-Seeking Behavior, the Transtheoretical Model, and the Behavioral Model of Health Services Use/Utilization are utilized to elaborate on the context within which individual intention to engage in healthcare behaviors occurs. Research literature on the concept of healthcare avoidance obtained by using computerized searches of CINAHL, MEDLINE, PSYCH INFO, and HAPI databases, from 1995 to 2007, were reviewed. Studies were organized by professional disciplines. Healthcare avoidance is a common and highly variable experience. Multiple administrative, demographic, personal, and provider factors are related to healthcare avoidance, for example, distrust of providers and/or the science community, health beliefs, insurance status, or socioeconomic/income level. Although the concept is recognized by multiple disciplines, limited research studies address its impact on healthcare decision making. More systematic research is needed to determine correlates of healthcare avoidance. Such studies will help investigators identify patients at risk for avoidant behaviors and provide the basis for health-promoting interventions. Methodological challenges include identification of characteristics of individuals and environments that hinder healthcare behaviors, as well as, the complexity of measuring healthcare avoidance. Studies need to systematically explore the influence of avoidance behaviors on specific healthcare populations at risk.

Concurrence of big data analytics and healthcare: A systematic review.

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Mehta, Nishita; Pandit, Anil

2018-06-01

The application of Big Data analytics in healthcare has immense potential for improving the quality of care, reducing waste and error, and reducing the cost of care. This systematic review of literature aims to determine the scope of Big Data analytics in healthcare including its applications and challenges in its adoption in healthcare. It also intends to identify the strategies to overcome the challenges. A systematic search of the articles was carried out on five major scientific databases: ScienceDirect, PubMed, Emerald, IEEE Xplore and Taylor & Francis. The articles on Big Data analytics in healthcare published in English language literature from January 2013 to January 2018 were considered. Descriptive articles and usability studies of Big Data analytics in healthcare and medicine were selected. Two reviewers independently extracted information on definitions of Big Data analytics; sources and applications of Big Data analytics in healthcare; challenges and strategies to overcome the challenges in healthcare. A total of 58 articles were selected as per the inclusion criteria and analyzed. The analyses of these articles found that: (1) researchers lack consensus about the operational definition of Big Data in healthcare; (2) Big Data in healthcare comes from the internal sources within the hospitals or clinics as well external sources including government, laboratories, pharma companies, data aggregators, medical journals etc.; (3) natural language processing (NLP) is most widely used Big Data analytical technique for healthcare and most of the processing tools used for analytics are based on Hadoop; (4) Big Data analytics finds its application for clinical decision support; optimization of clinical operations and reduction of cost of care (5) major challenge in adoption of Big Data analytics is non-availability of evidence of its practical benefits in healthcare. This review study unveils that there is a paucity of information on evidence of real-world use of

Nurses' use of pliable and directed strategies when encountering children in child and school healthcare.

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Harder, Maria; Enskär, Karin; Golsäter, Marie

2017-03-01

Nurses in Swedish child and school healthcare need to balance their assignment of promoting children's health and development based on the national health-monitoring programme with their responsibility to consider each child's needs. In this balancing act, they encounter children through directed and pliable strategies to fulfil their professional obligations. The aim of this study was to analyse the extent to which nurses use different strategies when encountering children during their recurrent health visits throughout childhood. A quantitative descriptive content analysis was used to code 30 video recordings displaying nurses' encounters with children (3-16 years of age). A constructed observation protocol was used to identify the codes. The results show that nurses use pliable strategies (58%) and directed strategies (42%) in encounters with children. The action they use the most within the pliable strategy is encouraging (51%), while in the directed strategy, the action they use most is instructing (56%). That they primarily use these opposing actions can be understood as trying to synthesize their twofold assignment. However, they seem to act pliably to be able to fulfil their public function as dictated by the national health-monitoring programme, rather than to meet each child's needs.

The impact of total quality service (TQS) on healthcare and patient satisfaction: an empirical study of Turkish private and public hospitals.

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Bakan, Ismail; Buyukbese, Tuba; Ersahan, Burcu

2014-01-01

This paper attempts to measure patients' perceptions of the quality of services in public and private healthcare centers in Turkey. The main aim was to examine the impact of the dimensions of patient-perceived total quality service (TQS) on patients' satisfaction. The research framework and hypotheses are derived from a literature review of service quality and quality in the healthcare industry. The research data were collected through questionnaires and then statistically analyzed using descriptive statistics, Pearson product moment correlation and linear regression. The results suggest that service quality perceptions positively influence patient satisfaction with overall hospital care (SOHC). The most important factors identified in the regression model regarding patient SOHC are the quality of the hospital's social responsibility, administrative processes and overall experience of medical care received. These factors explain 74% of the variance in SOHC. The findings of the study can be used to improve TQS in both private and public hospitals. Copyright © 2013 John Wiley & Sons, Ltd.

MARKETING PLANNING IN HEALTHCARE INDUSTRY

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Bobeica Ana Amaria

2013-04-01

Full Text Available The purpose of this paper is to develop a perspective on what is important or critical to the discipline of healthcare marketing by analyzing the marketing plan from the institutional (or organizational perspective. This “salience issue” is complicated by the structural problems in healthcare such as new advertising programs, advances in medical technology, and the escalating costs of care in the recent economic situation of world economic crisis. Reviewing a case study, the paper examines how marketing managers face increasingly difficult management and it emphasizes one more time the importance of marketing in the internal organizational structure. Also it shows the direct connection between the marketing strategy, the Quality of Healthcare and marketing planning in the internal organization of Private Healthcare Practice in Romania. Also it concludes that marketing planning in healthcare has to be very precised in order to achieve some major objectives: customer care, financial stability, equilibrium between stakeholders and shareholders and future improvement in communication to customers. The marketing strategies and programs discussed in this paper follow the analysis of the 4Ps of Healthcare Marketing Services and propose call to action plans and possibilities that might result in a more particular case study analysis of the Romanian Healthcare Market.

Stress and Burnout in Health-Care Workers after the 2009 L’Aquila Earthquake: A Cross-Sectional Observational Study

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Mattei, Antonella; Fiasca, Fabiana; Mazzei, Mariachiara; Necozione, Stefano; Bianchini, Valeria

2017-01-01

Burnout is a work-related mental health impairment, which is now recognized as a real problem in the context of the helping professions due to its adverse health outcomes on efficiency. To our knowledge, the literature on the postdisaster scenario in Italy is limited by a focus on mental health professionals rather than other health-care workers. Our cross-sectional study aims to evaluate the prevalence of burnout and psychopathological distress in different categories of health-care workers, i.e., physicians, nurses, and health-care assistants, working in different departments of L’Aquila St. Salvatore General Hospital 6 years after the 2009 earthquake in order to prevent and reduce work-related burnout. With a two-stage cluster sampling, a total of 8 departments out of a total of 28 departments were selected and the total sample included 300 health-care workers. All the participants completed the following self-reporting questionnaires: a sociodemographic data form, a Maslach Burnout Inventory and a General Health Questionnaire 12 Items (GHQ-12). Statistically significant differences emerged between the total scores of the GHQ-12: post hoc analysis showed that the total average scores of the GHQ-12 were significantly higher in doctors than in health-care assistants. A high prevalence of burnout among doctors (25.97%) emerged. Using multivariate analysis, we identified a hostile relationship with colleagues, direct exposure to the L’Aquila earthquake and moderate to high levels of distress as being burnout predictors. Investigating the prevalence of burnout and distress in health-care staff in a postdisaster setting and identifying predictors of burnout development such as stress levels, time-management skills and work-life balance will contribute to the development of preventative strategies and better organization at work with a view to improving public health efficacy and reducing public health costs, given that these workers live in the disaster

Stress and Burnout in Health-Care Workers after the 2009 L'Aquila Earthquake: A Cross-Sectional Observational Study.

Science.gov (United States)

Mattei, Antonella; Fiasca, Fabiana; Mazzei, Mariachiara; Necozione, Stefano; Bianchini, Valeria

2017-01-01

Burnout is a work-related mental health impairment, which is now recognized as a real problem in the context of the helping professions due to its adverse health outcomes on efficiency. To our knowledge, the literature on the postdisaster scenario in Italy is limited by a focus on mental health professionals rather than other health-care workers. Our cross-sectional study aims to evaluate the prevalence of burnout and psychopathological distress in different categories of health-care workers, i.e., physicians, nurses, and health-care assistants, working in different departments of L'Aquila St. Salvatore General Hospital 6 years after the 2009 earthquake in order to prevent and reduce work-related burnout. With a two-stage cluster sampling, a total of 8 departments out of a total of 28 departments were selected and the total sample included 300 health-care workers. All the participants completed the following self-reporting questionnaires: a sociodemographic data form, a Maslach Burnout Inventory and a General Health Questionnaire 12 Items (GHQ-12). Statistically significant differences emerged between the total scores of the GHQ-12: post hoc analysis showed that the total average scores of the GHQ-12 were significantly higher in doctors than in health-care assistants. A high prevalence of burnout among doctors (25.97%) emerged. Using multivariate analysis, we identified a hostile relationship with colleagues, direct exposure to the L'Aquila earthquake and moderate to high levels of distress as being burnout predictors. Investigating the prevalence of burnout and distress in health-care staff in a postdisaster setting and identifying predictors of burnout development such as stress levels, time-management skills and work-life balance will contribute to the development of preventative strategies and better organization at work with a view to improving public health efficacy and reducing public health costs, given that these workers live in the disaster

Stress and Burnout in Health-Care Workers after the 2009 L’Aquila Earthquake: A Cross-Sectional Observational Study

Directory of Open Access Journals (Sweden)

Antonella Mattei

2017-06-01

Full Text Available Burnout is a work-related mental health impairment, which is now recognized as a real problem in the context of the helping professions due to its adverse health outcomes on efficiency. To our knowledge, the literature on the postdisaster scenario in Italy is limited by a focus on mental health professionals rather than other health-care workers. Our cross-sectional study aims to evaluate the prevalence of burnout and psychopathological distress in different categories of health-care workers, i.e., physicians, nurses, and health-care assistants, working in different departments of L’Aquila St. Salvatore General Hospital 6 years after the 2009 earthquake in order to prevent and reduce work-related burnout. With a two-stage cluster sampling, a total of 8 departments out of a total of 28 departments were selected and the total sample included 300 health-care workers. All the participants completed the following self-reporting questionnaires: a sociodemographic data form, a Maslach Burnout Inventory and a General Health Questionnaire 12 Items (GHQ-12. Statistically significant differences emerged between the total scores of the GHQ-12: post hoc analysis showed that the total average scores of the GHQ-12 were significantly higher in doctors than in health-care assistants. A high prevalence of burnout among doctors (25.97% emerged. Using multivariate analysis, we identified a hostile relationship with colleagues, direct exposure to the L’Aquila earthquake and moderate to high levels of distress as being burnout predictors. Investigating the prevalence of burnout and distress in health-care staff in a postdisaster setting and identifying predictors of burnout development such as stress levels, time-management skills and work-life balance will contribute to the development of preventative strategies and better organization at work with a view to improving public health efficacy and reducing public health costs, given that these workers live in the

Preferences for Advance Directives in Korea

Directory of Open Access Journals (Sweden)

So-Sun Kim

2012-01-01

Full Text Available Background. The goal of advance directives is to help patients retain their dignity and autonomy by making their own decisions regarding end-stage medical treatment. The purpose of this study was to examine preferences of advance directives among general population in Korea. Method. A descriptive cross-sectional survey was performed from October 2007 to June 2008 in Seoul, Korea. A total of 336 city-dwelling adults self-administered the questionnaire and returned it via mail. Data analyses were conducted using SPSS 17.0. Results. Subjects reported the need for healthcare providers' detailed explanations and recommendations regarding end-of-life care. When there is no hope of recovery and death is imminent, most subjects did not want to receive cardiopulmonary resuscitation nor an IV or tube feeding. However, most of the subjects wanted pain management care. Conclusions. The present study showed that many Korean people have an interest in advance directives. The results show that the autonomy and dignity of patient have increased in importance. To provide better end-of-life care, there is a need to educate patients on the definition and intent of an advance directive. Additional proactive communication between patients and their caregivers should be educated to healthcare providers.

Use of speech-to-text technology for documentation by healthcare providers.

Science.gov (United States)

Ajami, Sima

2016-01-01

Medical records are a critical component of a patient's treatment. However, documentation of patient-related information is considered a secondary activity in the provision of healthcare services, often leading to incomplete medical records and patient data of low quality. Advances in information technology (IT) in the health system and registration of information in electronic health records (EHR) using speechto- text conversion software have facilitated service delivery. This narrative review is a literature search with the help of libraries, books, conference proceedings, databases of Science Direct, PubMed, Proquest, Springer, SID (Scientific Information Database), and search engines such as Yahoo, and Google. I used the following keywords and their combinations: speech recognition, automatic report documentation, voice to text software, healthcare, information, and voice recognition. Due to lack of knowledge of other languages, I searched all texts in English or Persian with no time limits. Of a total of 70, only 42 articles were selected. Speech-to-text conversion technology offers opportunities to improve the documentation process of medical records, reduce cost and time of recording information, enhance the quality of documentation, improve the quality of services provided to patients, and support healthcare providers in legal matters. Healthcare providers should recognize the impact of this technology on service delivery.

Tolerance to bovine clinical mastitis: Total, direct, and indirect milk losses.

Science.gov (United States)

Detilleux, J

2018-04-01

The objectives of this paper were to estimate direct and indirect milk losses associated with mastitis. Indirect losses, linked to indirect tolerance, are mediated by the increase in milk somatic cell count (SCC) in response to bacterial infection. Direct losses, linked to weak direct tolerance, are not mediated by the increase in SCC. So far, studies have evaluated milk loss associated with clinical mastitis without considering both components, which may lead to biased estimates of their sum; that is, the total loss in milk. A total of 43,903 test-day records on milk and SCC from 3,716 cows and 5,858 lactations were analyzed with mediation mixed models and health trajectories to estimate the amount of direct, indirect, and total milk losses after adjustment for known and potentially unmeasured (sensitivity analyses) confounding factors. Estimates were formalized under the counterfactual causal theory of causation. In this study, milk losses were mostly mediated by an increase in SCC. They were highest in the first month of lactation, when SCC were highest. Milk losses were estimated at 0.5, 0.8, and 1.1 kg/d in first, second, and third and greater parity, respectively. Two phases described how changes in milk were associated with changes in SCC: on average, one occurred before and one after the day preceding the clinical diagnosis. In both phases, changes in milk were estimated at 1 mg/d per 10 3 cells/mL. After adjusting for known confounders, cow effect accounted for 20.7 and 64.2% of the variation in milk in the first and second phases, respectively. This suggests that deviations from the resilient path were highest during the second phase of inflammation and that selection for cows more tolerant to mastitis is feasible. As discussed herein, epigenetic regulation of macrophage polarization may contribute to the variation in milk observed in the second phase. Copyright © 2018 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Optimal healthcare delivery to care homes in the UK: a realist evaluation of what supports effective working to improve healthcare outcomes.

Science.gov (United States)

Gordon, Adam L; Goodman, Claire; Davies, Sue L; Dening, Tom; Gage, Heather; Meyer, Julienne; Schneider, Justine; Bell, Brian; Jordan, Jake; Martin, Finbarr C; Iliffe, Steve; Bowman, Clive; Gladman, John R F; Victor, Christina; Mayrhofer, Andrea; Handley, Melanie; Zubair, Maria

2018-01-05

care home residents have high healthcare needs not fully met by prevailing healthcare models. This study explored how healthcare configuration influences resource use. a realist evaluation using qualitative and quantitative data from case studies of three UK health and social care economies selected for differing patterns of healthcare delivery to care homes. Four homes per area (12 in total) were recruited. A total of 239 residents were followed for 12 months to record resource-use. Overall, 181 participants completed 116 interviews and 13 focus groups including residents, relatives, care home staff, community nurses, allied health professionals and General Practitioners. context-mechanism-outcome configurations were identified explaining what supported effective working between healthcare services and care home staff: (i) investment in care home-specific work that legitimises and values work with care homes; (ii) relational working which over time builds trust between practitioners; (iii) care which 'wraps around' care homes; and (iv) access to specialist care for older people with dementia. Resource use was similar between sites despite differing approaches to healthcare. There was greater utilisation of GP resource where this was specifically commissioned but no difference in costs between sites. activities generating opportunities and an interest in healthcare and care home staff working together are integral to optimal healthcare provision in care homes. Outcomes are likely to be better where: focus and activities legitimise ongoing contact between healthcare staff and care homes at an institutional level; link with a wider system of healthcare; and provide access to dementia-specific expertise. © The Author(s) 2018. Published by Oxford University Press on behalf of the British Geriatrics Society.

The healthcare costs of secondhand smoke exposure in rural China.

Science.gov (United States)

Yao, Tingting; Sung, Hai-Yen; Mao, Zhengzhong; Hu, Teh-wei; Max, Wendy

2015-10-01

The goal of this study was to assess the healthcare costs attributable to secondhand smoke (SHS) exposure among non-smoking adults (age ≥ 19) in rural China. We analysed data from the 2011 National Rural Household Survey which was conducted among adults in five provinces and one municipality in China (N=12,397). Respondents reported their smoking status, health conditions and healthcare expenditures. Relative risks were obtained from published sources. Healthcare costs included annual outpatient and inpatient hospitalisation expenditures for five SHS-related diseases: asthma, breast cancer (female only), heart disease, lung cancer and tuberculosis. SHS-attributable healthcare costs were estimated using a prevalence-based annual cost approach. The total healthcare costs of SHS exposure in rural China amounted to $1.2 billion in 2011, including $559 million for outpatient visits and $612.4 million for inpatient hospitalisations. The healthcare costs for women and men were $877.1 million and $294.3 million, respectively. Heart disease was the most costly condition for both women ($701.7 million) and men ($180.6 million). The total healthcare costs of SHS exposure in rural China accounted to 0.3% of China's national healthcare expenditures in 2011. Over one-fifth of the total healthcare costs of SHS exposure in rural China were paid by health insurance. The out-of-pocket expenditures per person accounted for almost half (47%) of their daily income. The adverse health effects of SHS exposure result in a large economic burden in China. Tobacco control policies that reduce SHS exposure could have an impact on reducing healthcare costs in China. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Measurement of integrated healthcare delivery: a systematic review of methods and future research directions

Directory of Open Access Journals (Sweden)

Martin Strandberg-Larsen

2009-02-01

Full Text Available Background: Integrated healthcare delivery is a policy goal of healthcare systems. There is no consensus on how to measure the concept, which makes it difficult to monitor progress. Purpose: To identify the different types of methods used to measure integrated healthcare delivery with emphasis on structural, cultural and process aspects. Methods: Medline/Pubmed, EMBASE, Web of Science, Cochrane Library, WHOLIS, and conventional internet search engines were systematically searched for methods to measure integrated healthcare delivery (published – April 2008. Results: Twenty-four published scientific papers and documents met the inclusion criteria. In the 24 references we identified 24 different measurement methods; however, 5 methods shared theoretical framework. The methods can be categorized according to type of data source: a questionnaire survey data, b automated register data, or c mixed data sources. The variety of concepts measured reflects the significant conceptual diversity within the field, and most methods lack information regarding validity and reliability. Conclusion: Several methods have been developed to measure integrated healthcare delivery; 24 methods are available and some are highly developed. The objective governs the method best used. Criteria for sound measures are suggested and further developments should be based on an explicit conceptual framework and focus on simplifying and validating existing methods.

Using a logical information model-driven design process in healthcare.

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Cheong, Yu Chye; Bird, Linda; Tun, Nwe Ni; Brooks, Colleen

2011-01-01

A hybrid standards-based approach has been adopted in Singapore to develop a Logical Information Model (LIM) for healthcare information exchange. The Singapore LIM uses a combination of international standards, including ISO13606-1 (a reference model for electronic health record communication), ISO21090 (healthcare datatypes), SNOMED CT (healthcare terminology) and HL7 v2 (healthcare messaging). This logic-based design approach also incorporates mechanisms for achieving bi-directional semantic interoperability.

The direct and indirect costs of Dravet Syndrome.

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Whittington, Melanie D; Knupp, Kelly G; Vanderveen, Gina; Kim, Chong; Gammaitoni, Arnold; Campbell, Jonathan D

2018-03-01

The objective of this study was to estimate the annual direct and indirect costs associated with Dravet Syndrome (DS). A survey was electronically administered to the caregivers of patients with DS treated at Children's Hospital Colorado. Survey domains included healthcare utilization of the patient with DS and DS caregiver work productivity and activity impairment. Patient healthcare utilization was measured using modified questions from the National Health Interview Survey; caregiver work productivity and activity impairment were measured using modified questions from the Work Productivity and Activity Impairment questionnaire. Direct costs were calculated by multiplying the caregiver-reported healthcare utilization rates by the mean unit cost for each healthcare utilization category. Indirect costs included lost productivity, income loss, and lost leisure time. The indirect costs were a function of caregiver-reported hours spent caregiving and an hourly unit cost. The survey was emailed to 60 DS caregivers, of which 34 (57% response rate) responded. Direct costs on average were $27,276 (95% interval: $15,757, $41,904) per patient with DS. Hospitalizations ($11,565 a year) and in-home medical care visits ($9894 a year) were substantial cost drivers. Additionally, caregivers reported extensive time spent providing care to an individual with DS. This caregiver time resulted in average annual indirect costs of $81,582 (95% interval: $57,253, $110,151), resulting in an average total annual financial burden of $106,378 (95% interval: $78,894, $137,906). Dravet Syndrome results in substantial healthcare utilization, financial burden, and time commitment. Establishing evidence on the financial burden of DS is essential to understanding the overall impact of DS, identifying potential areas for support needs, and assessing the impact of novel treatments as they become available. Based on the study findings, in-home visits, hospitalizations, and lost productivity and

Factors affecting the adoption of healthcare information technology.

Science.gov (United States)

Phichitchaisopa, Nisakorn; Naenna, Thanakorn

2013-01-01

In order to improve the quality and performance of healthcare services, healthcare information technology is among the most important technology in healthcare supply chain management. This study sets out to apply and test the Unified Theory of Acceptance and Use of Technology (UTAUT), to examine the factors influencing healthcare Information Technology (IT) services. A structured questionnaire was developed and distributed to healthcare representatives in each province surveyed in Thailand. Data collected from 400 employees including physicians, nurses, and hospital staff members were tested the model using structural equation modeling technique. The results found that the factors with a significant effect are performance expectancy, effort expectancy and facilitating conditions. They were also found to have a significant impact on behavioral intention to use the acceptance healthcare technology. In addition, in Thai provincial areas, positive significance was found with two factors: social influence on behavioral intention and facilitating conditions to direct using behavior. Based on research findings, in order for healthcare information technology to be widely adopted and used by healthcare staffs in healthcare supply chain management, the healthcare organizational management should improve healthcare staffs' behavioral intention and facilitating conditions.

Factors affecting the adoption of healthcare information technology

Science.gov (United States)

Phichitchaisopa, Nisakorn; Naenna, Thanakorn

2013-01-01

In order to improve the quality and performance of healthcare services, healthcare information technology is among the most important technology in healthcare supply chain management. This study sets out to apply and test the Unified Theory of Acceptance and Use of Technology (UTAUT), to examine the factors influencing healthcare Information Technology (IT) services. A structured questionnaire was developed and distributed to healthcare representatives in each province surveyed in Thailand. Data collected from 400 employees including physicians, nurses, and hospital staff members were tested the model using structural equation modeling technique. The results found that the factors with a significant effect are performance expectancy, effort expectancy and facilitating conditions. They were also found to have a significant impact on behavioral intention to use the acceptance healthcare technology. In addition, in Thai provincial areas, positive significance was found with two factors: social influence on behavioral intention and facilitating conditions to direct using behavior. Based on research findings, in order for healthcare information technology to be widely adopted and used by healthcare staffs in healthcare supply chain management, the healthcare organizational management should improve healthcare staffs' behavioral intention and facilitating conditions. PMID:26417235

How 'healthy' are healthcare organizations? Exploring employee healthcare utilization rates among Dutch healthcare organizations.

Science.gov (United States)

Bronkhorst, Babette

2017-08-01

Occupational health and safety research rarely makes use of data on employee healthcare utilization to gain insight into the physical and mental health of healthcare staff. This paper aims to fill this gap by examining the prevalence of two relevant types of healthcare utilization among staff working in healthcare organizations: physical therapy and mental healthcare utilization. The paper furthermore explores what role employee and organizational characteristics play in explaining differences in healthcare utilization between organizations. A Dutch healthcare insurance company provided healthcare utilization records for a sample of 417 organizations employing 136,804 healthcare workers in the Netherlands. The results showed that there are large differences between and within healthcare industries when it comes to employee healthcare utilization. Multivariate regression analyses revealed that employee characteristics such as age and gender distributions, and healthcare industry, explain some of the variance between healthcare organizations. Nevertheless, the results of the analyses showed that for all healthcare utilization indicators there is still a large amount of unexplained variance. Further research into the subject of organizational differences in employee healthcare utilization is needed, as finding possibilities to influence employee health and subsequent healthcare utilization is beneficial to employees, employers and society as a whole.

Does a medical home mediate racial disparities in unmet healthcare needs among children with special healthcare needs?

Science.gov (United States)

Bennett, Amanda C; Rankin, Kristin M; Rosenberg, Deborah

2012-12-01

This study extends mediation analysis techniques to explore whether and to what extent differential access to a medical home explains the black/white disparity in unmet healthcare needs among children with special healthcare needs (CSHCN). Data were obtained from the 2007 National Survey of Children's Health, with analyses limited to non-Hispanic white and black CSHCN (n = 14,677). The counterfactual approach to mediation analysis was used to estimate odds ratios for the natural direct and indirect effects of race on unmet healthcare needs. Overall, 43.0 % of white CSHCN and 60.4 % of black CSHCN did not have a medical home. Additionally, 8.8 % of white CSHCN and 15.3 % of black CSHCN had unmet healthcare needs. The natural indirect effect indicates that the odds of unmet needs among black CSHCN are elevated by approximately 20 % as a result of their current level of access to the medical home rather than access at a level equal to white CSHCN (OR(NIE) = 1.2, 95 % CI = 1.1, 1.3). The natural direct effect indicates that even if black CSHCN had the same level of access to a medical home as white CSHCN, blacks would still have 60 % higher odds of unmet healthcare needs than whites (OR(NDE) = 1.6, 95 % CI = 1.1, 2.4). The racial disparity in unmet healthcare needs among CSHCN is only partially explained by disparities in having a medical home. Ensuring all CSHCN have equal access to a medical home may reduce the racial disparity in unmet needs, but will not completely eliminate it.

Direct and correlated responses to selection for total weight of lamb ...

African Journals Online (AJOL)

Unknown

productivity and that each of these components can be used as a selection criterion, as each has a direct impact on total ewe ... of lamb weaned per ewe joined is more efficient than selection for number of lambs born, number of lambs weaned or weaning ... The estimated grazing capacity is 5.5 ha per small stock unit.

Work-related injury among direct care occupations in British Columbia, Canada.

Science.gov (United States)

Alamgir, Hasanat; Cvitkovich, Yuri; Yu, Shicheng; Yassi, Annalee

2007-11-01

To examine how injury rates and injury types differ across direct care occupations in relation to the healthcare settings in British Columbia, Canada. Data were derived from a standardised operational database in three BC health regions. Injury rates were defined as the number of injuries per 100 full-time equivalent (FTE) positions. Poisson regression, with Generalised Estimating Equations, was used to determine injury risks associated with direct care occupations (registered nurses [RNs], licensed practical nurses [LPNs) and care aides [CAs]) by healthcare setting (acute care, nursing homes and community care). CAs had higher injury rates in every setting, with the highest rate in nursing homes (37.0 injuries per 100 FTE). LPNs had higher injury rates (30.0) within acute care than within nursing homes. Few LPNs worked in community care. For RNs, the highest injury rates (21.9) occurred in acute care, but their highest (13.0) musculoskeletal injury (MSI) rate occurred in nursing homes. MSIs comprised the largest proportion of total injuries in all occupations. In both acute care and nursing homes, CAs had twice the MSI risk of RNs. Across all settings, puncture injuries were more predominant for RNs (21.3% of their total injuries) compared with LPNs (14.4%) and CAs (3.7%). Skin, eye and respiratory irritation injuries comprised a larger proportion of total injuries for RNs (11.1%) than for LPNs (7.2%) and CAs (5.1%). Direct care occupations have different risks of occupational injuries based on the particular tasks and roles they fulfil within each healthcare setting. CAs are the most vulnerable for sustaining MSIs since their job mostly entails transferring and repositioning tasks during patient/resident/client care. Strategies should focus on prevention of MSIs for all occupations as well as target puncture and irritation injuries for RNs and LPNs.

Toxoplasmosis and Toxocariasis: An Assessment of Human Immunodeficiency Virus Comorbidity and Health-Care Costs in Canada.

Science.gov (United States)

Schurer, Janna M; Rafferty, Ellen; Schwandt, Michael; Zeng, Wu; Farag, Marwa; Jenkins, Emily J

2016-07-06

Toxoplasma gondii and Toxocara spp. are zoonotic parasites with potentially severe long-term consequences for those infected. We estimated incidence and investigated distribution, risk factors, and costs associated with these parasites by examining hospital discharge abstracts submitted to the Canadian Institute for Health Information (2002-2011). Annual incidence of serious toxoplasmosis and toxocariasis was 0.257 (95% confidence interval [CI]: 0.254-0.260) and 0.010 (95% CI: 0.007-0.014) cases per 100,000 persons, respectively. Median annual health-care costs per serious case of congenital, adult-acquired, and human immunodeficiency virus (HIV)-associated toxoplasmosis were $1,971, $763, and $5,744, respectively, with an overall cost of C$1,686,860 annually (2015 Canadian dollars). However, the total economic burden of toxoplasmosis is likely much higher than these direct health-care cost estimates. HIV was reported as a comorbidity in 40% of toxoplasmosis cases and accounted for over half of direct health-care costs associated with clinical toxoplasmosis. A One Health approach, integrating physician and veterinary input, is recommended for increasing public awareness and decreasing the economic burden of these preventable zoonoses. © The American Society of Tropical Medicine and Hygiene.

Social Responsibility and Healthcare in Finland.

Science.gov (United States)

Ahola-Launonen, Johanna

2016-07-01

This article examines current trends and prospects in Finnish healthcare literature and discussion. The Finnish healthcare system was long considered to manifest an equal, universal, and solidaristic welfare scheme. However, recent data reveals structural inequalities in access to healthcare that result in health differences among socioeconomic groups. The political will aims at tackling these inequalities, but the ideological trend toward responsibilization of the individual taking place across political spheres elsewhere in Europe creates potential challenges to this goal. The applications of this trend have a theoretical background in the responsibility-sensitive egalitarian-or luck egalitarian-tradition. The theory, which is unfit for real-life policy applications, has explicit appeal in considerations aiming at the responsibilization of the individual within the healthcare sector. It remains to be seen in which direction the Finnish welfare schemes will continue to develop.

Financial risks associated with healthcare consumption in Jinja ...

African Journals Online (AJOL)

... of hospitalization (OR 3, 95% 1.7-6.5). Conclusion: A high burden of healthcare needs, disproportionately affect children and women among households in Jinja. Direct payments for healthcare still occur in spite of the abolishment of user fees at public health facilities and tax based financing of health services in Uganda.

Simulation Modelling in Healthcare: An Umbrella Review of Systematic Literature Reviews.

Science.gov (United States)

Salleh, Syed; Thokala, Praveen; Brennan, Alan; Hughes, Ruby; Booth, Andrew

2017-09-01

Numerous studies examine simulation modelling in healthcare. These studies present a bewildering array of simulation techniques and applications, making it challenging to characterise the literature. The aim of this paper is to provide an overview of the level of activity of simulation modelling in healthcare and the key themes. We performed an umbrella review of systematic literature reviews of simulation modelling in healthcare. Searches were conducted of academic databases (JSTOR, Scopus, PubMed, IEEE, SAGE, ACM, Wiley Online Library, ScienceDirect) and grey literature sources, enhanced by citation searches. The articles were included if they performed a systematic review of simulation modelling techniques in healthcare. After quality assessment of all included articles, data were extracted on numbers of studies included in each review, types of applications, techniques used for simulation modelling, data sources and simulation software. The search strategy yielded a total of 117 potential articles. Following sifting, 37 heterogeneous reviews were included. Most reviews achieved moderate quality rating on a modified AMSTAR (A Measurement Tool used to Assess systematic Reviews) checklist. All the review articles described the types of applications used for simulation modelling; 15 reviews described techniques used for simulation modelling; three reviews described data sources used for simulation modelling; and six reviews described software used for simulation modelling. The remaining reviews either did not report or did not provide enough detail for the data to be extracted. Simulation modelling techniques have been used for a wide range of applications in healthcare, with a variety of software tools and data sources. The number of reviews published in recent years suggest an increased interest in simulation modelling in healthcare.

Data warehousing as a healthcare business solution.

Science.gov (United States)

Scheese, R

1998-02-01

Because of the trend toward consolidation in the healthcare field, many organizations have massive amounts of data stored in various information systems organizationwide, but access to the data by end users may be difficult. Healthcare organizations are being pressured to provide managers easy access to the data needed for critical decision making. One solution many organizations are turning to is implementing decision-support data warehouses. A data warehouse instantly delivers information directly to end users, freeing healthcare information systems staff for strategic operations. If designed appropriately, data warehouses can be a cost-effective tool for business analysis and decision support.

Six Sigma in healthcare delivery.

Science.gov (United States)

Liberatore, Matthew J

2013-01-01

The purpose of this paper is to conduct a comprehensive review and assessment of the extant Six Sigma healthcare literature, focusing on: application, process changes initiated and outcomes, including improvements in process metrics, cost and revenue. Data were obtained from an extensive literature search. Healthcare Six Sigma applications were categorized by functional area and department, key process metric, cost savings and revenue generation (if any) and other key implementation characteristics. Several inpatient care areas have seen most applications, including admission, discharge, medication administration, operating room (OR), cardiac and intensive care. About 42.1 percent of the applications have error rate as their driving metric, with the remainder focusing on process time (38 percent) and productivity (18.9 percent). While 67 percent had initial improvement in the key process metric, only 10 percent reported sustained improvement. Only 28 percent reported cost savings and 8 percent offered revenue enhancement. These results do not favorably assess Six Sigma's overall effectiveness and the value it offers healthcare. Results are based on reported applications. Future research can include directly surveying healthcare organizations to provide additional data for assessment. Future application should emphasize obtaining improvements that lead to significant and sustainable value. Healthcare staff can use the results to target promising areas. This article comprehensively assesses Six Sigma healthcare applications and impact.

Healthcare professionals' perspectives on environmental sustainability.

Science.gov (United States)

Dunphy, Jillian L

2014-06-01

Human health is dependent upon environmental sustainability. Many have argued that environmental sustainability advocacy and environmentally responsible healthcare practice are imperative healthcare actions. What are the key obstacles to healthcare professionals supporting environmental sustainability? How may these obstacles be overcome? Data-driven thematic qualitative analysis of semi-structured interviews identified common and pertinent themes, and differences between specific healthcare disciplines. A total of 64 healthcare professionals and academics from all states and territories of Australia, and multiple healthcare disciplines were recruited. Institutional ethics approval was obtained for data collection. Participants gave informed consent. All data were de-identified to protect participant anonymity. Qualitative analysis indicated that Australian healthcare professionals often take more action in their personal than professional lives to protect the environment, particularly those with strong professional identities. The healthcare sector's focus on economic rationalism was a substantial barrier to environmentally responsible behaviour. Professionals also feared conflict and professional ostracism, and often did not feel qualified to take action. This led to healthcare professionals making inconsistent moral judgements, and feeling silenced and powerless. Constraints on non-clinical employees within and beyond the sector exacerbated these difficulties. The findings are consistent with the literature reporting that organisational constraints, and strong social identification, can inhibit actions that align with personal values. This disparity can cause moral distress and residue, leading to feelings of powerlessness, resulting in less ethical behaviour. The data highlight a disparity between personal and professional actions to address environmental sustainability. Given the constraints Australian healthcare professionals encounter, they are unlikely to

The Puerto Rico Healthcare Crisis.

Science.gov (United States)

Roman, Jesse

2015-12-01

The Commonwealth of Puerto Rico is an organized nonincorporated territory of the United States with a population of more than 3.5 million U.S. citizens. The island has been the focus of much recent attention due to the recent default on its debt (estimated at more than $70 billion), high poverty rates, and increasing unemployment. Less attention, however, has been given to the island's healthcare system, which many believe is on the verge of collapsing. Healthcare makes up 20% of the Puerto Rican economy, and this crisis affects reimbursement rates for physicians while promoting the disintegration of the island's healthcare infrastructure. A major contributor relates to a disparity in federal funding provided to support the island's healthcare system when compared with that provided to the states in the mainland and Hawaii. Puerto Rico receives less federal funding for healthcare than the other 50 states and the District of Columbia even though it pays its share of social security and Medicare taxes. To make matters worse, the U.S. Center for Medicaid and Medicare Services is planning soon to implement another 11% cut in Medical Advantage reimbursements. This disparity in support for healthcare is considered responsible for ∼$25 billion of Puerto Rico's total debt. The impact of these events on the health of Puerto Ricans in the island cannot be entirely predicted, but the loss of healthcare providers and diminished access to care are a certainty, and quality care will suffer, leading to serious implications for those with chronic medical disorders including respiratory disease.

Healthcare-associated infection in Burkina Faso: an assessment in a district hospital

Directory of Open Access Journals (Sweden)

Hervé Hien

2012-12-01

Full Text Available In developing countries, few data are available on healthcare-associated infections. In Burkina Faso, there has been a failure to take into account risk management and patient safety in the quality assurance program. The main objective of our study was to carry out an assessment of healthcare-associated infection in a first level hospital. We conducted a crosssectional study in June 2011 in the care units of Ziniaré District Hospital (Ziniaré, Burkina Faso. The hospital has been divided in three components: i hospital population (care providers, in-patients and patients’ guardians; ii healthcare and services organization; iii hospital environment. We included: care providers of the clinical services, hospital inpatients and patients’ guardians, hospitalization infrastructure and nursing units, and all the documents relating to standards and protocols. Data collection has been done by direct observation, interviews and biological samples taken at different settings. In hospital population, care providers and patients’ guardians represented a high source of infection: adherence to hygiene practice on the part of care providers was low (12/19, and no patients’ guardian experienced good conditions of staying in the hospital. In healthcare and services organization, healthcare waste management represented a high-risk source of infection. In hospital environment, hygiene level of the infrastructure in the hospital rooms was low (6.67%. Prevalence of isolated bacteria was 71.8%. Urinary-tract catheters infections were the most significant in our sample, followed by surgical-site infections. In total, 56.26% (9/19 of germs were -Lactamase producers (ESBL. They were represented by Escherichia coli and Klebsiella pneumoniae. Our analysis identified clearly healthcare-associated infection as a problem in Ziniaré district hospital. Hence, a national program of quality assurance in the hospitals should now integrate the risk infectious management

A Lexical-Ontological Resource for Consumer Healthcare

Science.gov (United States)

Cardillo, Elena; Serafini, Luciano; Tamilin, Andrei

In Consumer Healthcare Informatics it is still difficult for laypeople to find, understand and act on health information, due to the persistent communication gap between specialized medical terminology and that used by healthcare consumers. Furthermore, existing clinically-oriented terminologies cannot provide sufficient support when integrated into consumer-oriented applications, so there is a need to create consumer-friendly terminologies reflecting the different ways healthcare consumers express and think about health topics. Following this direction, this work suggests a way to support the design of an ontology-based system that mitigates this gap, using knowledge engineering and semantic web technologies. The system is based on the development of a consumer-oriented medical terminology that will be integrated with other medical domain ontologies and terminologies into a medical ontology repository. This will support consumer-oriented healthcare systems, such as Personal Health Records, by providing many knowledge services to help users in accessing and managing their healthcare data.

Diet, exercise and mental-wellbeing of healthcare professionals (doctors, dentists and nurses in Pakistan

Directory of Open Access Journals (Sweden)

Waqas Ahmad

2015-09-01

Full Text Available Background. “Health is wealth” is a time tested adage. Health becomes more relevant when it comes to professionals whose job is to provide people with services that maintain an optimum state of mental, physical and social well-being. Healthcare professionals (HCP differ from general population in regards to the nature of their work, stress, burnout etc. which begs the need to have a robust state of health for the ones who provide it to others. We initiated this study to see if healthcare professionals “practice what they preach others.”Methods. We employed a cross-sectional study design with convenience-sampling technique. Questionnaires were administered directly to the three groups of healthcare professionals (Doctors, Dentists and Nurses across the province Punjab after their consent. 1,319 healthcare professionals took part in the study (response rate of 87.35. Warwick Edinburg Mental Wellbeing Scale (WEMWBS was used to assess mental wellbeing. USDA Dietary Guidelines-2010 were employed to quantify diet. American Heart Association (AHA guidelines were employed for the analysis of exercise.Results. A total of 1,190 healthcare professionals formed the final sample with doctors and nurses forming the major proportion. Out of 1,190 participants only one healthcare professional was found to eat according to USDA Dietary Guidelines; others ate more of protein group and less of fruits, dairy and vegetable groups. 76% did not perform any exercise. 71.5% worked >48 h/week. More than 50% of healthcare professionals were sleeping <7 h/day. WEMWBS score of the entire sample was 47.97 ± 9.53 S.D.Conclusion. Our findings suggest that healthcare professionals do not practice what they preach. Their mental wellbeing, diet and exercise habits are not up to the mark and should be improved to foster the whole healthcare system for individual and community benefits.

Work load and management in the delivery room: changing the direction of healthcare policy.

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Sfregola, Gianfranco; Laganà, Antonio Simone; Granese, Roberta; Sfregola, Pamela; Lopinto, Angela; Triolo, Onofrio

2017-02-01

Nurse staffing, increased workload and unstable nursing unit environments are linked to negative patient outcomes including falls and medication errors on medical/surgical units. Considering this evidence, the aim of our study was to overview midwives' workload and work setting. We created a questionnaire and performed an online survey. We obtained information about the type and level of hospital, workload, the use of standardised procedures, reporting of sentinel and 'near-miss' events. We reported a severe understaffing in midwives' work settings and important underuse of standard protocols according to the international guidelines, especially in the South of Italy. Based on our results, we strongly suggest a change of direction of healthcare policy, oriented to increase the number of employed midwives, in order to let them fulfil their duties according to the international guidelines (especially one-to-one care). On the other hand, we encourage the adoption of standardised protocols in each work setting.

Development of healthcare waste management in Serbia and challenges in the improvement of the quality of healthcare services

Directory of Open Access Journals (Sweden)

Jovanović Verica S.

2014-01-01

Full Text Available Proper Healthcare Waste Management (HCWM was introduced in the Republic of Serbia in 2007 with the support of the European Union. Since then, the amounts of waste treated, prior to landfill, have steadily increased and more and more healthcare institutions adopted HCWM systems. In parallel large numbers of healthcare workers were trained in proper HCWM. This study quantifies the progress made. The study analyzed the period 2009 to 2012 using three methods of data collection. On basis of data collected, it has been established that with a population of just over seven million, Serbia generates between 4,500 and 5,000 tones of infectious waste on an annual basis of which some 20% originates from the treatment of out-patients, 75% from the treatment of in-patients and 5% from micro-biological laboratory tests. While in 2009 only one third of this waste was treated prior to disposal, this fraction has increased to two thirds in 2011. The data also show that more than 90% of healthcare facilities have developed individual healthcare waste management plans up from less than 20% in 2009. In every healthcare facility there are at least 2 people trained in healthcare waste management, and in total there are approximately 3000 staff members who received formal HCWM training provided through the Institute for Public Health. Healthcare waste management is continuously improving in the Republic of Serbia and is well established in more than 85% of healthcare facilities. There are still issues to be improved especially regarding treatment on healthcare waste other than infectious waste.

Inequality in healthcare costs between residing and non-residing patients: evidence from Vietnam.

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Nguyen, Hieu M

2017-05-12

Place of residence has been shown to impact health. To date, however, previous studies have only focused on the variability in health outcomes and healthcare costs between urban and rural patients. This study takes a different approach and investigates cost inequality facing non-residing patients - patients who do not reside in the regions in which the hospitals are located. Understanding the sources for this inequality is important, as they are directly related to healthcare accessibility in developing countries. The causal impact of residency status on individual healthcare spending is documented with a quasi-experimental design. The propensity score matching method is applied to a unique patient-level dataset (n = 900) collected at public general and specialist hospitals across North Vietnam. Propensity score matching shows that Vietnamese patients who do not reside in the regions in which the hospitals are located are expected to pay about 15 million Vietnamese dongs (approximately 750 USD) more than those who do, a sizable gap, given the distribution of total healthcare costs for the overall sample. This estimate is robust to alternative matching specifications. The obtained discrepancy is empirically attributable to the differences in three potential contributors, namely spending on accompanying relatives, "courtesy funds," and days of hospitalization. The present study finds that there is significant inequality in healthcare spending between residing and non-residing patients at Vietnamese hospitals and that this discrepancy can be partially explained by both institutional and non-institutional factors. These factors signal practical channels through which policymakers can improve healthcare accessibility.

Distribution Pattern of Healthcare Facilities in Osun State, Nigeria ...

African Journals Online (AJOL)

In this paper we employed the use of locational quotient, which is a measure of spatial pattern of services, to examine the distribution pattern of healthcare facilities in the thirty local government areas in Osun State, Nigeria. Twelve indices, representing the totality of healthcare delivery by State and local governments in the ...

Patient-centredness in integrated healthcare delivery systems - needs, expectations and priorities for organised healthcare systems.

Science.gov (United States)

Juhnke, Christin; Mühlbacher, Axel C

2013-01-01

Patient-centred healthcare is becoming a more significant success factor in the design of integrated healthcare systems. The objective of this study is to structure a patient-relevant hierarchy of needs and expectations for the design of organised healthcare delivery systems. A questionnaire with 84 items was conducted with N = 254 healthcare experts and N = 670 patients. Factor analyses were performed using SPSS©18. The number of factors retained was controlled by Kaiser's criterion, validation of screeplots and interpretability of the items. Cronbach's α was used to assess the internal consistency of the subscales. Exploratory factor analysis led to 24 factors in the expert sample and 20 in the patient sample. After analysing the screeplots, confirmatory factor analyses were computed for 7-factor solutions accounting for 42.963% of the total variance and Kaiser-Meyer-Olkin of 0.914 for the patients (experts: 38.427%, Kaiser-Meyer-Olkin = 0.797). Cronbach's α ranged between 0.899 and 0.756. Based on the analysis, coordinated care could be differentiated into seven dimensions: access, data and information, service and infrastructure, professional care, interpersonal care, individualised care, continuity and coordination. The study provides insight into patient and experts expectations towards the organisation of integrated healthcare delivery systems. If providers and payers can take into account patient needs and expectations while implementing innovative healthcare delivery systems, greater acceptance and satisfaction will be achieved. In the best case, this will lead to better adherence resulting in better clinical outcomes.

Healthcare in Disasters and the Role of RFID.

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Madanian, Samaneh; Parry, David; Norris, Tony

2015-01-01

Disasters either natural or man-made are inevitable, and therefore disaster management has always been an important function of government. Since during a disaster healthcare is often adversely affected, a lot of effort has been made in terms of researching effective responses and ways of improving the quality of delivered care to direct casualties and the rest of the community. In this regard, information technology plays an important role to help healthcare systems achieve this goal. One of these technologies that has become popular recently is Radio-Frequency Identification (RFID). This paper explores the relationship between emergency management and disaster healthcare and examines the role of RFID. It is suggested that RFID will become an integral part of disaster healthcare and a means of improving response performance.

Generation Y in healthcare: leading millennials in an era of reform.

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Piper, Llewellyn E

2012-01-01

The healthcare workforce has grown with the addition of a new group of physicians, nurses, allied health professionals, administrators, and support staff who belong to America's youngest generation now in the workforce-generation Y, or the millennials. This generation consists of more than 70 million people, the oldest of whom are now in their late 20s and early 30s. With traits and workplace expectations that differ from those observed in other generations, and with a size that threatens to overtake the total number of baby boomers, generation Yers are positioned to influence (if not drastically change) current leadership approaches. The common traits that define or are associated with generation Y workers are often regarded as barriers yet provide healthcare leaders with a clear guide to understanding these employees and drawing out their best qualities and performance. For the organization to fulfill its social contract to provide high-quality, cost-effective, and safe healthcare, it must satisfy the needs and manage the expectations of those who directly deliver these services. This is especially important in today's environment, which is marked by the still-fluid stipulations of the Affordable Care Act (ACA), changed consumer expectations, and public demands for transparency and accountability.

Mindful Application of Aviation Practices in Healthcare.

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Powell-Dunford, Nicole; Brennan, Peter A; Peerally, Mohammad Farhad; Kapur, Narinder; Hynes, Jonny M; Hodkinson, Peter D

2017-12-01

Evidence supports the efficacy of incorporating select recognized aviation practices and procedures into healthcare. Incident analysis, debrief, safety brief, and crew resource management (CRM) have all been assessed for implementation within the UK healthcare system, a world leader in aviation-based patient safety initiatives. Mindful application, in which aviation practices are specifically tailored to the unique healthcare setting, show promise in terms of acceptance and long-term sustainment. In order to establish British healthcare applications of aviation practices, a PubMed search of UK authored manuscripts published between 2005-2016 was undertaken using search terms 'aviation,' 'healthcare,' 'checklist,' and 'CRM.' A convenience sample of UK-authored aviation medical conference presentations and UK-authored patient safety manuscripts were also reviewed. A total of 11 of 94 papers with UK academic affiliations published between 2005-2016 and relevant to aviation modeled healthcare delivery were found. The debrief process, incident analysis, and CRM are the primary practices incorporated into UK healthcare, with success dependent on cultural acceptance and mindful application. CRM training has gained significant acceptance in UK healthcare environments. Aviation modeled incident analysis, debrief, safety brief, and CRM training are increasingly undertaken within the UK healthcare system. Nuanced application, in which the unique aspects of the healthcare setting are addressed as part of a comprehensive safety approach, shows promise for long-term success. The patient safety brief and aviation modeled incident analysis are in earlier phases of implementation, and warrant further analysis.Powell-Dunford N, Brennan PA, Peerally MF, Kapur N, Hynes JM, Hodkinson PD. Mindful application of aviation practices in healthcare. Aerosp Med Hum Perform. 2017; 88(12):1107-1116.

A Systematic Review of Healthcare Applications for Smartphones

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Mosa Abu Saleh

2012-07-01

Full Text Available Abstract Background Advanced mobile communications and portable computation are now combined in handheld devices called “smartphones”, which are also capable of running third-party software. The number of smartphone users is growing rapidly, including among healthcare professionals. The purpose of this study was to classify smartphone-based healthcare technologies as discussed in academic literature according to their functionalities, and summarize articles in each category. Methods In April 2011, MEDLINE was searched to identify articles that discussed the design, development, evaluation, or use of smartphone-based software for healthcare professionals, medical or nursing students, or patients. A total of 55 articles discussing 83 applications were selected for this study from 2,894 articles initially obtained from the MEDLINE searches. Results A total of 83 applications were documented: 57 applications for healthcare professionals focusing on disease diagnosis (21, drug reference (6, medical calculators (8, literature search (6, clinical communication (3, Hospital Information System (HIS client applications (4, medical training (2 and general healthcare applications (7; 11 applications for medical or nursing students focusing on medical education; and 15 applications for patients focusing on disease management with chronic illness (6, ENT-related (4, fall-related (3, and two other conditions (2. The disease diagnosis, drug reference, and medical calculator applications were reported as most useful by healthcare professionals and medical or nursing students. Conclusions Many medical applications for smartphones have been developed and widely used by health professionals and patients. The use of smartphones is getting more attention in healthcare day by day. Medical applications make smartphones useful tools in the practice of evidence-based medicine at the point of care, in addition to their use in mobile clinical communication. Also

A systematic review of healthcare applications for smartphones.

Science.gov (United States)

Mosa, Abu Saleh Mohammad; Yoo, Illhoi; Sheets, Lincoln

2012-07-10

Advanced mobile communications and portable computation are now combined in handheld devices called "smartphones", which are also capable of running third-party software. The number of smartphone users is growing rapidly, including among healthcare professionals. The purpose of this study was to classify smartphone-based healthcare technologies as discussed in academic literature according to their functionalities, and summarize articles in each category. In April 2011, MEDLINE was searched to identify articles that discussed the design, development, evaluation, or use of smartphone-based software for healthcare professionals, medical or nursing students, or patients. A total of 55 articles discussing 83 applications were selected for this study from 2,894 articles initially obtained from the MEDLINE searches. A total of 83 applications were documented: 57 applications for healthcare professionals focusing on disease diagnosis (21), drug reference (6), medical calculators (8), literature search (6), clinical communication (3), Hospital Information System (HIS) client applications (4), medical training (2) and general healthcare applications (7); 11 applications for medical or nursing students focusing on medical education; and 15 applications for patients focusing on disease management with chronic illness (6), ENT-related (4), fall-related (3), and two other conditions (2). The disease diagnosis, drug reference, and medical calculator applications were reported as most useful by healthcare professionals and medical or nursing students. Many medical applications for smartphones have been developed and widely used by health professionals and patients. The use of smartphones is getting more attention in healthcare day by day. Medical applications make smartphones useful tools in the practice of evidence-based medicine at the point of care, in addition to their use in mobile clinical communication. Also, smartphones can play a very important role in patient education

Outcome of 7-S, TQM technique for healthcare waste management.

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Ullah, Junaid Habib; Ahmed, Rashid; Malik, Javed Iqbal; Khan, M Amanullah

2011-12-01

To assess the present waste management system of healthcare facilities (HCFs) attached with Shalamar Hospital, Lahore by applying the 7-S technique of Total Quality Management (TQM) and to find out the outcome after imparting training. Interventional quasi-experimental study. The Shalamar Hospital, Lahore, Punjab, Pakistan, November, 2009 to November, 2010. Mckinsey's 7-S, technique of TQM was applied to assess the 220 HCFs from Lahore, Gujranwala and Sheikhupura districts for segregation, collection, transportation and disposal (SCTD) of hospital waste. Direct interview method was applied. Trainings were provided in each institution. After one year action period, the status of four areas of concern was compared before and after training. The parameters studied were segregation, collection, transportation and disposal systems in the 220 HCFs. Each of these were further elaborated by strategy, structure, system, staff, skill, style and stakeholder/shared value factors. Standard error of difference of proportion was applied to assess significance using 95% confidence level. There was marked improvement in all these areas ranging from 20% to 77% following a training program of 3 months. In case of disposal of the waste strategy, structure and system an increase of 60%, 65% and 75% was observed after training. The 7-S technique played a vital role in assessing the hospital waste management system. Training for the healthcare workers played a significant role in healthcare facilities.

Data Hemorrhages in the Health-Care Sector

Science.gov (United States)

Johnson, M. Eric

Confidential data hemorrhaging from health-care providers pose financial risks to firms and medical risks to patients. We examine the consequences of data hemorrhages including privacy violations, medical fraud, financial identity theft, and medical identity theft. We also examine the types and sources of data hemorrhages, focusing on inadvertent disclosures. Through an analysis of leaked files, we examine data hemorrhages stemming from inadvertent disclosures on internet-based file sharing networks. We characterize the security risk for a group of health-care organizations using a direct analysis of leaked files. These files contained highly sensitive medical and personal information that could be maliciously exploited by criminals seeking to commit medical and financial identity theft. We also present evidence of the threat by examining user-issued searches. Our analysis demonstrates both the substantial threat and vulnerability for the health-care sector and the unique complexity exhibited by the US health-care system.

Readiness of healthcare providers for eHealth: the case from primary healthcare centers in Lebanon.

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Saleh, Shadi; Khodor, Rawya; Alameddine, Mohamad; Baroud, Maysa

2016-11-10

change efficacy; and between frequency of computer use and change efficacy. The implementation of eHealth cannot be achieved without the readiness of healthcare providers. This study demonstrates that the majority of healthcare providers at PHC centers across Lebanon are ready for eHealth implementation. The findings of this study can be considered by decision makers to enhance and scale-up the use of eHealth in PHC centers nationally. Efforts should be directed towards capacity building for healthcare providers.

Estimates of state-level health-care expenditures associated with disability.

Science.gov (United States)

Anderson, Wayne L; Armour, Brian S; Finkelstein, Eric A; Wiener, Joshua M

2010-01-01

We estimated state-level disability-associated health-care expenditures (DAHE) for the U.S. adult population. We used a two-part model to estimate DAHE for the noninstitutionalized U.S. civilian adult population using data from the 2002-2003 Medical Expenditure Panel Survey and state-level data from the Behavioral Risk Factor Surveillance System. Administrative data for people in institutions were added to generate estimates for the total adult noninstitutionalized population. Individual-level data on total health-care expenditures along with demographic, socioeconomic, geographic, and payer characteristics were used in the models. The DAHE for all U.S. adults totaled $397.8 billion in 2006, with state expenditures ranging from $598 million in Wyoming to $40.1 billion in New York. Of the national total, the DAHE were $118.9 billion for the Medicare population, $161.1 billion for Medicaid recipients, and $117.8 billion for the privately insured and uninsured populations. For the total U.S. adult population, 26.7% of health-care expenditures were associated with disability, with proportions by state ranging from 16.9% in Hawaii to 32.8% in New York. This proportion varied greatly by payer, with 38.1% for Medicare expenditures, 68.7% for Medicaid expenditures, and 12.5% for nonpublic health-care expenditures associated with disability. DAHE vary greatly by state and are borne largely by the public sector, and particularly by Medicaid. Policy makers need to consider initiatives that will help reduce the prevalence of disabilities and disability-related health disparities, as well as improve the lives of people with disabilities.

Benchmarking and Learning in Public Healthcare

DEFF Research Database (Denmark)

Buckmaster, Natalie; Mouritsen, Jan

2017-01-01

This research investigates the effects of learning-oriented benchmarking in public healthcare settings. Benchmarking is a widely adopted yet little explored accounting practice that is part of the paradigm of New Public Management. Extant studies are directed towards mandated coercive benchmarking...

Patient-centeredness in Integrated healthcare delivery systems - Needs, expectations and priorities for organized healthcare systems

Directory of Open Access Journals (Sweden)

Christin Juhnke

2013-11-01

Full Text Available Introduction: Patient-centred healthcare is becoming a more significant success factor in the design of integrated healthcare systems. The objective of this study is to structure a patient-relevant hierarchy of needs and expectations for the design of organised healthcare delivery systems. Methods: A questionnaire with 84 items was conducted with N = 254 healthcare experts and N = 670 patients. Factor analyses were performed using SPSS©18. The number of factors retained was controlled by Kaiser's criterion, validation of screeplots and interpretability of the items. Cronbach's α was used to assess the internal consistency of the subscales. Results: Exploratory factor analysis led to 24 factors in the expert sample and 20 in the patient sample. After analysing the screeplots, confirmatory factor analyses were computed for 7-factor solutions accounting for 42.963% of the total variance and Kaiser–Meyer–Olkinof 0.914 for the patients (experts: 38.427%, Kaiser–Meyer–Olkin = 0.797. Cronbach's α ranged between 0.899 and 0.756. Based on the analysis, coordinated care could be differentiated into seven dimensions: access, data and information, service and infrastructure, professional care, interpersonal care, individualised care, continuity and coordination. Conclusion and Discussion: The study provides insight into patient and experts expectations towards the organisation of integrated healthcare delivery systems. If providers and payers can take into account patient needs and expectations while implementing innovative healthcare delivery systems, greater acceptance and satisfaction will be achieved. In the best case, this will lead to better adherence resulting in better clinical outcomes.

Patient-centeredness in Integrated healthcare delivery systems - Needs, expectations and priorities for organized healthcare systems

Directory of Open Access Journals (Sweden)

Christin Juhnke

2013-11-01

Full Text Available Introduction: Patient-centred healthcare is becoming a more significant success factor in the design of integrated healthcare systems. The objective of this study is to structure a patient-relevant hierarchy of needs and expectations for the design of organised healthcare delivery systems.Methods: A questionnaire with 84 items was conducted with N = 254 healthcare experts and N = 670 patients. Factor analyses were performed using SPSS©18. The number of factors retained was controlled by Kaiser's criterion, validation of screeplots and interpretability of the items. Cronbach's α was used to assess the internal consistency of the subscales.Results: Exploratory factor analysis led to 24 factors in the expert sample and 20 in the patient sample. After analysing the screeplots, confirmatory factor analyses were computed for 7-factor solutions accounting for 42.963% of the total variance and Kaiser–Meyer–Olkinof 0.914 for the patients (experts: 38.427%, Kaiser–Meyer–Olkin = 0.797. Cronbach's α ranged between 0.899 and 0.756. Based on the analysis, coordinated care could be differentiated into seven dimensions: access, data and information, service and infrastructure, professional care, interpersonal care, individualised care, continuity and coordination.Conclusion and Discussion: The study provides insight into patient and experts expectations towards the organisation of integrated healthcare delivery systems. If providers and payers can take into account patient needs and expectations while implementing innovative healthcare delivery systems, greater acceptance and satisfaction will be achieved. In the best case, this will lead to better adherence resulting in better clinical outcomes.

U.S. healthcare fix: leveraging the lessons from the food supply chain.

Science.gov (United States)

Kumar, Sameer; Blair, John T

2013-01-01

U.S. healthcare costs consistently outpace inflation, causing growing problems of affordability. This trend cannot be sustained indefinitely. The purpose of this study is to use supply-chain tools for macro-level examination of the U.S. healthcare as a business system and identify options and best use practices. We compare the important and successful U.S. food industry to the essential but problematic U.S. healthcare industry. Supply chain strategies leading to food business operations success are examined and healthcare applications suggested. We emphasize "total cost of ownership" which includes all costs incurred by all stakeholders of U.S. healthcare, including maintenance and cleanup, not just the initial purchase price. U.S. hospitals and clinics can use supply chain strategies in a total cost of ownership framework to reduce healthcare costs while maintaining patient care quality. Supply chain strategies of resource pooling, mass customization, centralized logistics, specialization, postponement and continuous improvement that have been successfully used in the U.S. food industry should be more widely applied to the U.S. healthcare industry. New and growing areas of telemedicine and medical tourism should be included in the supply chain analysis of U.S. healthcare. Valid statistical analysis of results in all areas of U.S. healthcare is an important part of the process. U.S. healthcare industry problems are systematic operational and supply chain problems rather than problems with workforce or technology. Examination of the U.S. healthcare industry through a supply chain framework should lead to significant operational improvement in both prevention and treatment of acute and chronic ailments. A rational and unemotional reorganization of the U.S. healthcare system operations, using supply chain strategies, should help reduce healthcare costs while maintaining quality and increasing accessibility.

Beyond patient care: the impact of healthcare reform on job satisfaction in the Ethiopian public healthcare sector.

Science.gov (United States)

Manyazewal, Tsegahun; Matlakala, Mokgadi C

2017-02-03

While healthcare reform has been a central attention for local governments, its impact on job satisfaction is poorly understood. This study aimed to determine the impact of healthcare reform on job satisfaction in the public healthcare sector in Ethiopia. The study was designed as a facility-based cross-sectional survey of healthcare professionals and carried out in all public hospitals in central Ethiopia which have been implementing healthcare reform (n = 5). All healthcare professionals in the hospitals who were involved in the reform from the inception (n = 476) were purposively sourced to complete a self-administered questionnaire adapted from a framework proposed for measuring job satisfaction of health professionals in sub-Saharan Africa. Kaiser-Meyer-Olkin and Bartlett's tests were conducted to measure sampling adequacy and sphericity for factor analysis. Likert's transformation formula was used to numerically analyse the satisfaction level of the respondents and to determine the cut-off value of satisfaction levels. Non-parametric and multiple logistic regression analysis were conducted to determine predictors of job satisfaction. A total of 410 healthcare professionals completed the survey, representing an 88% response rate. The median and mean job satisfaction scores were 50 and 49, respectively, on a scale 1-100, which was equivalent to 'Job dissatisfied' on the Likert scale. Only 25% of respondents perceived job satisfaction due to implementation of the reform. Moral satisfaction (adjusted odds ratio (aOR), 177.65; 95% confidence interval (CI), 59.54-530.08), management style (aOR, 4.02; 95% CI, 1.49-10.83), workload (aOR, 2.42; 95% CI, 0.93-6.34), and task (aOR, 5.49; 95% CI, 2.31-13.07) were the most significant predictors. Job satisfaction results were significantly different among the study hospitals (χ 2  = 30.56, p < .001). The healthcare reform significantly and negatively influences public healthcare professionals' job

Ethical Issues of Social Media Usage in Healthcare

OpenAIRE

Denecke, Kerstin; Bamidis, Panagiotis D.; Bond, Carol; Gabarron, Elia; Househ, M; Lau, A. Y. S.; Mayer, Miguel A.; Merolli, Mark; Hansen, Margareth

2015-01-01

Accepted manuscript version. This article is not an exact copy of the original published article in The IMIA Yearbook of Medical Informatics. The definitive publisher-authenticated version of "Ethical Issues of Social Media Usage in Healthcare" is available online at http://doi.org/10.15265/IY-2015-001. OBJECTIVE: Social media, web and mobile technologies are increasingly used in healthcare and directly support patientcentered care. Patients benefit from disease self-management tools, ...

Setting priorities for EU healthcare workforce IT skills competence improvement.

Science.gov (United States)

Li, Sisi; Bamidis, Panagiotis D; Konstantinidis, Stathis Th; Traver, Vicente; Car, Josip; Zary, Nabil

2017-04-01

A major challenge for healthcare quality improvement is the lack of IT skills and knowledge of healthcare workforce, as well as their ambivalent attitudes toward IT. This article identifies and prioritizes actions needed to improve the IT skills of healthcare workforce across the EU. A total of 46 experts, representing different fields of expertise in healthcare and geolocations, systematically listed and scored actions that would improve IT skills among healthcare workforce. The Child Health and Nutrition Research Initiative methodology was used for research priority-setting. The participants evaluated the actions using the following criteria: feasibility, effectiveness, deliverability, and maximum impact on IT skills improvement. The leading priority actions were related to appropriate training, integrating eHealth in curricula, involving healthcare workforce in the eHealth solution development, improving awareness of eHealth, and learning arrangement. As the different professionals' needs are prioritized, healthcare workforce should be actively and continuously included in the development of eHealth solutions.

Healthcare Resource Uses and Out-of-Pocket Expenses Associated with Pulmonary TB Treatment in Thailand.

Science.gov (United States)

Tanvejsilp, Pimwara; Loeb, Mark; Dushoff, Jonathan; Xie, Feng

2017-08-22

In Thailand, pharmaceutical care has been recently introduced to a tertiary hospital as an approach to improve adherence to tuberculosis (TB) treatment in addition to home visit and modified directly observed therapy (DOT). However, the economic impact of pharmaceutical care is not known. The aim of this study was to estimate healthcare resource uses and costs associated with pharmaceutical care compared with home visit and modified DOT in pulmonary TB patients in Thailand from a healthcare sector perspective inclusive of out-of-pocket expenditures. We conducted a retrospective study using data abstracted from the hospital billing database associated with pulmonary TB patients who began treatment between 2010 and 2013 in three hospitals in Thailand. We used generalized linear models to compare the costs by accounting for baseline characteristics. All costs were converted to international dollars (Intl$) RESULTS: The mean direct healthcare costs to the public payer were $519.96 (95%confidence interval [CI] 437.31-625.58) associated with pharmaceutical care, $1020.39 (95% CI 911.13-1154.11) for home visit, and $887.79 (95% CI 824.28-955.91) for modified DOT. The mean costs to patients were $175.45 (95% CI 130.26-230.48) for those receiving pharmaceutical care, $53.77 (95% CI 33.25-79.44) for home visit, and $49.33 (95% CI 34.03-69.30) for modified DOT. After adjustment for baseline characteristics, pharmaceutical care was associated with lower total direct costs compared with home visit (-$354.95; 95% CI -285.67 to -424.23) and modified DOT (-$264.61; 95% CI -198.76 to -330.46). After adjustment for baseline characteristics, pharmaceutical care was associated with lower direct costs compared with home visit and modified DOT.

Medication supply, healthcare outcomes and healthcare expenses: longitudinal analyses of patients with type 2 diabetes and hypertension.

Science.gov (United States)

Chen, Chi-Chen; Blank, Robert H; Cheng, Shou-Hsia

2014-09-01

Patients with chronic conditions largely depend on proper medications to maintain health. This study aims to examine, for patients with diabetes and hypertension, whether the appropriateness of the quantity of drug obtained is associated with favorable healthcare outcomes and lower expenses. This study utilized a longitudinal design with a seven-year follow-up period from 2002 to 2009 under a universal health insurance program in Taiwan. The patients under study were those aged 18 years or older and newly diagnosed with type 2 diabetes or hypertension in 2002. Generalized estimating equations were performed to examine the relationship between medication supply and health outcomes as well as expenses. The results indicate that while compared with patients with an appropriate medication supply, patients with either an undersupply or an oversupply of medications tended to have poorer healthcare outcomes. The study also found that an excess supply of medications for patients with diabetes or hypertension resulted in higher total healthcare expenses. Either an undersupply or an oversupply of medication was associated with unfavorable healthcare outcomes, and that medication oversupply was associated with the increased consumption of health resources. Our findings suggest that improving appropriate medication supply is beneficial for the healthcare system. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Waste management in primary healthcare centres of Iran.

Science.gov (United States)

Mesdaghinia, Alireza; Naddafi, Kazem; Mahvi, Amir Hossein; Saeedi, Reza

2009-06-01

The waste management practices in primary healthcare centres of Iran were investigated in the present study. A total of 120 primary healthcare centres located across the country were selected using the cluster sampling method and the current situation of healthcare waste management was determined through field investigation. The quantities of solid waste and wastewater generation per outpatient were found to be 60 g outpatient(-1) day(-1) and 26 L outpatient(-1) day(-1), respectively. In all of the facilities, sharp objects were separated almost completely, but separation of other types of hazardous healthcare solid waste was only done in 25% of the centres. The separated hazardous solid waste materials were treated by incineration, temporary incineration and open burning methods in 32.5, 8.3 and 42.5% of the healthcare centres, respectively. In 16.7% of the centres the hazardous solid wastes were disposed of without any treatment. These results indicate that the management of waste materials in primary healthcare centres in Iran faced some problems. Staff training and awareness, separation of healthcare solid waste, establishment of the autoclave method for healthcare solid waste treatment and construction of septic tanks and disinfection units in the centres that were without access to a sewer system are the major measures that are suggested for improvement of the waste management practices.

Improving our understanding of multi-tasking in healthcare: Drawing together the cognitive psychology and healthcare literature.

Science.gov (United States)

Douglas, Heather E; Raban, Magdalena Z; Walter, Scott R; Westbrook, Johanna I

2017-03-01

Multi-tasking is an important skill for clinical work which has received limited research attention. Its impacts on clinical work are poorly understood. In contrast, there is substantial multi-tasking research in cognitive psychology, driver distraction, and human-computer interaction. This review synthesises evidence of the extent and impacts of multi-tasking on efficiency and task performance from health and non-healthcare literature, to compare and contrast approaches, identify implications for clinical work, and to develop an evidence-informed framework for guiding the measurement of multi-tasking in future healthcare studies. The results showed healthcare studies using direct observation have focused on descriptive studies to quantify concurrent multi-tasking and its frequency in different contexts, with limited study of impact. In comparison, non-healthcare studies have applied predominantly experimental and simulation designs, focusing on interleaved and concurrent multi-tasking, and testing theories of the mechanisms by which multi-tasking impacts task efficiency and performance. We propose a framework to guide the measurement of multi-tasking in clinical settings that draws together lessons from these siloed research efforts. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

STRATEGIC ANALYSIS OF THE STATE-PRIVATE PARTNERSHIP INSTITUTE IN THE HEALTHCARE

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V. L. Adzhienko

2017-01-01

Full Text Available Management decisions, both at the enterprise level and at the industry level as a whole, is impossible without carrying out a strategic analysis, which is regarded as the performance of a corresponding management function that is perspective-oriented and has a high level of uncertainty. Strategic analysis involves researching the system of factors that determine the future state of the public-private partnership (PPP in the development of health care. The strategic analysis of PPP in the healthcare sector as a complex study of positive and negative factors that may affect the efficiency of the development of the PPP institution in the development of the healthcare is under consideration in the article. A number of new components complementing the system of strategic analysis of PPPs in the healthcare were proposed, and generalizations and conclusions were made.The aim of the research is to study the impact of the strategic analysis of PPPs in the sphere of healthcare on the formation of strategic directions for increasing the efficiency of using the PPP institution in healthcare.Materials and methods. In the process of achieving the research goal, methods of strategic and integrated economic analysis were used.Results and discussion. In our strategic analysis of PPP in the healthcare, it was revealed that under the conditions of underfunding national economy, medical institutions based on PPPs are being established in order to modernize and improve the quality of public services. PPP is an effective mechanism for attracting long-term investments aimed at the development of the health sector. The results of our analysis of PPP in the sphere of Russian healthcare made it possible to reveal that at present there are more than 70 projects in the process of implementation, 61 projects are already under construction and operation. Within the framework of the PPP-implemented healthcare projects, it is planned to attract investments of 61 billion rubles

Undue industry influences that distort healthcare research, strategy, expenditure and practice: a review.

Science.gov (United States)

Stamatakis, Emmanuel; Weiler, Richard; Ioannidis, John P A

2013-05-01

Expenditure on industry products (mostly drugs and devices) has spiraled over the last 15 years and accounts for substantial part of healthcare expenditure. The enormous financial interests involved in the development and marketing of drugs and devices may have given excessive power to these industries to influence medical research, policy, and practice. Review of the literature and analysis of the multiple pathways through which the industry has directly or indirectly infiltrated the broader healthcare systems. We present the analysis of the industry influences at the following levels: (i) evidence base production, (ii) evidence synthesis, (iii) understanding of safety and harms issues, (iv) cost-effectiveness evaluation, (v) clinical practice guidelines formation, (vi) healthcare professional education, (vii) healthcare practice, (viii) healthcare consumer's decisions. We located abundance of consistent evidence demonstrating that the industry has created means to intervene in all steps of the processes that determine healthcare research, strategy, expenditure, practice and education. As a result of these interferences, the benefits of drugs and other products are often exaggerated and their potential harms are downplayed, and clinical guidelines, medical practice, and healthcare expenditure decisions are biased. To serve its interests, the industry masterfully influences evidence base production, evidence synthesis, understanding of harms issues, cost-effectiveness evaluations, clinical practice guidelines and healthcare professional education and also exerts direct influences on professional decisions and health consumers. There is an urgent need for regulation and other action towards redefining the mission of medicine towards a more objective and patient-, population- and society-benefit direction that is free from conflict of interests. © 2013 Stichting European Society for Clinical Investigation Journal Foundation. Published by Blackwell Publishing Ltd.

Article Commentary: Integral Healthcare: The Benefits and Challenges of Integrating Complementary and Alternative Medicine with a Conventional Healthcare Practice

Directory of Open Access Journals (Sweden)

Christina L. Ross PhD

2009-01-01

Full Text Available Today's medicine is in the midst of an undeniable crisis. Calls to reform healthcare are in the forefront of economic and political discussions worldwide. Economic pressures reduce the amount of time physicians can spend with patients contributing to burnout among medical staff and endangering the patient iatrogenically. Politicians are getting involved as the public is calling for more affordable healthcare. A new paradigm must be embraced in order to address all aspects of this dilemma. It is clear that science and technology have resulted in vastly improved understanding, diagnosis, and treatment of disease, but the emphasis on science and technology to the exclusion of other elements of healing has also served to limit the development of a model that humanizes healthcare. The healing of a patient must include more than the biology and chemistry of their physical body; by necessity, it must include the mental, emotional and spiritual aspects. Because of these challenges, the development of an integral healthcare system that is rooted in appropriate regulation and supported by rigorous scientific evidence is the direction that many models of integrative healthcare are moving towards in the 21st century.

Irritable bowel symptoms, use of healthcare, costs, sickness and disability pension benefits

DEFF Research Database (Denmark)

Poulsen, Chalotte H; Eplov, Lene F; Hjorthøj, Carsten

2018-01-01

OBJECTIVES: Irritable bowel syndrome (IBS) is associated with increased healthcare use and work absenteeism. We aimed to investigate long-term use of healthcare services and social benefits across IBS symptom groups. Additionally, we estimated excess healthcare costs. METHODS: A longitudinal...... between symptom groups and total healthcare costs were statistically significant. CONCLUSIONS: IBS symptoms influence the long-term use and costs of healthcare, as well as the use of social benefits in the general population. Mental vulnerability explained some, but not all, of the use of healthcare...... and mental vulnerability. RESULTS: IBS symptom groups compared to no IBS symptoms were associated with an increased number of contacts with primary and secondary healthcare, as well as weeks on sickness and disability benefits. Accounting for mental vulnerability decreased the estimates and all but two...

Healthcare professionals' organisational barriers to health information technologies-a literature review.

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Lluch, Maria

2011-12-01

This literature review identifies and categorises, from an organisational management perspective, barriers to the use of HIT or ICT for health. Based on the review, it offers policy interventions. This systematic literature review was carried out during December 2009 and January 2010. Additional on-going reviews of updates through automated system alerts took place up until this paper was submitted. A total of thirty-one sources were searched including nine software platforms/databases, fifteen specialised websites/targeted databases, Google Scholar, ISI Science Citation Index and five journals hand-searched. The study covers seventy-nine articles on organisational barriers to ICT adoption by healthcare professionals. These are categorised under five main headings - (I) Structure of healthcare organisations; (II) Tasks; (III) People policies; (IV) Incentives; and (V) Information and decision processes. A total of ten subcategories are also identified. By adopting an organisational management approach, some recommendations to remove organisational management barriers are made. Despite their apparent promise, health information technologies (HIT) have proved difficult to implement. This systematic review reveals the implementation barriers associated to organisational management and their interrelations. Several important future directions in the field are also suggested: (1) there is a need for further research providing evidence of HIT cost-effectiveness as well as the development of optimal HIT applications; (2) more information is needed regarding organisational change, incentives, liability issues, end-users HIT competences and skills, structure and work process issues involved in realising the benefits from HIT. Future policy interventions should consider the five dimensions identified when addressing the impact of HIT in healthcare organisational systems, and how the impact of an intervention aimed at a particular dimension would interrelate with others. 2011

Board Governance: Transformational Approaches Under Healthcare Reform.

Science.gov (United States)

Zastocki, Deborah K

2015-01-01

Previous successes of healthcare organizations and effective governance practices in the pre-reform environment are not predictive of future success. Healthcare has been through numerous phases of growth and development using tried-and-true strategies. The challenge is that our toolbox does not contain what is needed to build the future healthcare delivery systems required in the post-reform world. Healthcare has had a parochial focus at the local level, with some broadening of horizons at the state and national levels. But healthcare delivery is now a global issue that requires a totally different perspective, and many countries are confronting similar issues. US healthcare reform initiatives have far-reaching implications. Compounding the reform dynamics are the simultaneously occurring, gamechanging accelerants such as enabling information technologies and mobile health, new providers of healthcare, increased consumer demands, and limited healthcare dollars, to name a few. Operating in this turbulent environment requires transformational board, executive, and physician leadership because traditional ways of planning for incremental change and attempting to time those adjustments can prove disastrous. Creating the legacy healthcare system for tomorrow requires governing boards and executive leadership to act today as they would in the desired future system. Boards need to create a culture that fosters.innovation with a tolerance for risk and some failure. To provide effective governance, boards must essentially develop new skills, expertise, and ways of thinking. The rapid rate of change requires board members to possess certain capabilities, including the ability to deal with ambiguity and uncertainty while demonstrating flexibility and adaptability, all with a driving commitment to metrics and results. This requires development plans for both individual members and the overall board. In short, the board needs to function differently, particularly regarding the

TQM implementation for the healthcare sector.

Science.gov (United States)

Chiarini, Andrea; Vagnoni, Emidia

2017-07-03

Purpose The purpose of this paper is to enlarge the debate on total quality management (TQM) implementation in the healthcare sector and to evaluate how and whether leadership can affect TQM implementation. Design/methodology/approach This paper is based on findings from a literature review of TQM and leadership. The authors analysed these findings to categorise causes of a lack of leadership in TQM programme implementations. Findings The authors propose three categories of causes of a lack of leadership in TQM programme implementation. The first cause is well-known: a lack of senior managers' involvement and commitment. The second category is the "combined leadership" that occurs in large healthcare organisations; and the third category is the influence of an external "political leadership" on public healthcare. Research limitations/implications This paper presents researchers with three categories of causes of failure of leadership in TQM implementation that can be investigated. It also encourages reflections from practitioners concerning TQM leadership in the healthcare sector. Practical implications The authors request that practitioners reflect on ways to create or sustain a "monolithic" leadership, especially in large organisations, to ensure a common vision, values and attitude for unitary TQM governance. Originality/value In an original way, this paper analyses and proposes three categories of causes linked to a lack of TQM leadership in the healthcare sector.

Components of Maternal Healthcare Delivery System Contributing to ...

African Journals Online (AJOL)

Components of Maternal Healthcare Delivery System Contributing to Maternal Deaths ... transcripts were analyzed using a directed approach to content analysis. Excerpts were categorized according to three main components of the maternal ...

Healthcare waste management: current practices in selected healthcare facilities, Botswana.

Science.gov (United States)

Mbongwe, Bontle; Mmereki, Baagi T; Magashula, Andrew

2008-01-01

Healthcare waste management continues to present an array of challenges for developing countries, and Botswana is no exception. The possible impact of healthcare waste on public health and the environment has received a lot of attention such that Waste Management dedicated a special issue to the management of healthcare waste (Healthcare Wastes Management, 2005. Waste Management 25(6) 567-665). As the demand for more healthcare facilities increases, there is also an increase on waste generation from these facilities. This situation requires an organised system of healthcare waste management to curb public health risks as well as occupational hazards among healthcare workers as a result of poor waste management. This paper reviews current waste management practices at the healthcare facility level and proposes possible options for improvement in Botswana.

The Cuban National Healthcare System: Characterization of primary healthcare services.

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Keli Regina DAL PRÁ

2015-10-01

Full Text Available This article presents a report on the experience of healthcare professionals in Florianópolis, who took the course La Atención Primaria de Salud y la Medicina Familiar en Cuba [Primary Healthcare and Family Medicine in Cuba], in 2014. The purpose of the study is to characterize the healthcare units and services provided by the Cuban National Healthcare System (SNS and to reflect on this experience/immersion, particularly on Cuba’s Primary Healthcare Service. The results found that in comparison with Brazil’s Single Healthcare System (SUS Cuba’s SNS Family Healthcare (SF service is the central organizing element of the Primary Healthcare Service. The number of SF teams per inhabitant is different than in Brazil; the programs given priority in the APS are similar to those in Brazil and the intersectorial nature and scope of the services prove to be effective in the resolution of healthcare problems.

The development of intelligent healthcare in China.

Science.gov (United States)

Zheng, Xiaochen; Rodríguez-Monroy, Carlos

2015-05-01

Intelligent healthcare (IH) is proposed with the fast application of Internet of Things technology in the healthcare area in recent years. It is considered as an expansion of e-health and telemedicine. As the largest developing country, China is investing large amounts of resources to push forward the development of IH. It is one of the centerpieces of the country's New Healthcare Reform, and great expectation is placed on it to help solve the conflict between limited healthcare resources and the large patient population. Essential policies, milestones, standards, and specifications from the Chinese government since the 1990s were reviewed to show the brief development history of IH in China. Some typical cases and products have been analyzed to present the current situation. The main problems and future development directions have been summarized. The IH industry in China has great potential and is growing very fast, but a lot of challenges also exist. In the future both government support and the active participation of nongovernmental capital are needed to push forward the whole industry.

Some perspectives on affordable healthcare systems in China.

Science.gov (United States)

Zhang, Y T; Yan, Y S; Poon, C C Y

2007-01-01

Consistent with the global population trend, China is becoming an aging society. Over one-fifth of the world's elderly population (aged 65 and over) lives in China. Statistics show that the elderly populace in China constitutes 8% of the total population in 2006 and the percentage will be tripled to become 24% in 2050. As a result, there is inevitably an increase in the prevalence of chronic disease that accounted for almost 80% of all deaths in China in 2005. On the other hand, from 1978 to 2003, the total expenditure on healthcare in China increased from 11.02 billion RMB up to 658.41 billion RMB, and in terms of GDP, it is an increase from 3.04% to 5.62%. The annual average increase (12.1%) in healthcare investment is therefore even higher than the annual rate of GDP increase (9.38%) during the last two decades. Meeting the long-term healthcare needs of this growing elderly population and escalating healthcare expenditure pose a grim challenge to the current Chinese healthcare system and the solvency of state budgets. In fact, the healthcare services in China have become less accessible since the early 1980s when its costs soared up. The rising costs have prevented many Chinese people from seeking early medical care. The phenomenon has created a wide disparity in seeking healthcare between urban and rural areas. These trends are of particular concern to the elderly, who have higher healthcare needs yet lesser means to afford the services. Furthermore, according to the 3rd National Health Service Survey, 79.1% of rural residents and 44.8% of urban citizens did not have any form of medical insurance. Such a low percentage of coverage of medical insurance indicates that many people may not be able to afford medical services when they suffer from severe diseases. Therefore, there is a great need of a more effective and low-cost healthcare system. A new system that can allow multi-level, multi-dimensional and standardized healthcare services for urban and rural

Study The Validity of The Direct Mathematical Method For Calculation The Total Efficiency Using Point And Disk Sources

International Nuclear Information System (INIS)

Hagag, O.M.; Nafee, S.S.; Naeem, M.A.; El Khatib, A.M.

2011-01-01

The direct mathematical method has been developed for calculating the total efficiency of many cylindrical gamma detectors, especially HPGe and NaI detector. Different source geometries are considered (point and disk). Further into account is taken of gamma attenuation from detector window or any interfacing absorbing layer. Results are compared with published experimental data to study the validity of the direct mathematical method to calculate total efficiency for any gamma detector size.

Data mining in healthcare: decision making and precision

Directory of Open Access Journals (Sweden)

Ionuţ ŢĂRANU

2016-05-01

Full Text Available The trend of application of data mining in healthcare today is increased because the health sector is rich with information and data mining has become a necessity. Healthcare organizations generate and collect large volumes of information to a daily basis. Use of information technology enables automation of data mining and knowledge that help bring some interesting patterns which means eliminating manual tasks and easy data extraction directly from electronic records, electronic transfer system that will secure medical records, save lives and reduce the cost of medical services as well as enabling early detection of infectious diseases on the basis of advanced data collection. Data mining can enable healthcare organizations to anticipate trends in the patient's medical condition and behaviour proved by analysis of prospects different and by making connections between seemingly unrelated information. The raw data from healthcare organizations are voluminous and heterogeneous. It needs to be collected and stored in organized form and their integration allows the formation unite medical information system. Data mining in health offers unlimited possibilities for analyzing different data models less visible or hidden to common analysis techniques. These patterns can be used by healthcare practitioners to make forecasts, put diagnoses, and set treatments for patients in healthcare organizations.

[Autonomy for financial management in public and private healthcare facilities in Brazil].

Science.gov (United States)

Santos, Maria Angelica Borges dos; Madeira, Fátima Carvalho; Passos, Sonia Regina Lambert; Bakr, Felipe; Oliveira, Klivia Brayner de; Andreazzi, Marco Antonio Ratzsch de

2014-01-01

Autonomy in financial management is an advantage in public administration. A 2009 National Healthcare Facility Survey showed that 3.9% of Brazil's 52,055 public healthcare facilities had some degree of financial autonomy. Such autonomy was more common in inpatient facilities (17.8%), those managed by State governments (26.3%), and in Southern Brazil (6.6%). Autonomy was mainly partial (for resources in specific areas, relating to small outlays, consumables and capital goods, and outsourced services or personnel). 74.3% of 2,264 public facilities with any financial autonomy were under direct government administration. Financial autonomy in public healthcare facilities appears to be linked to local political decisions and not necessarily to the facility's specific legal and administrative status. However, legal status displays distinct scopes of autonomy - those under direct government administration tend to be less autonomous, and those under private businesses more autonomous; 85.8% of the 45,394 private healthcare facilities reported that they were financially autonomous.

Healthcare resources and needs in anticoagulant therapy for patients with nonvalvular atrial fibrillation. SAMOA Study.

Science.gov (United States)

Barrios, V; Egocheaga-Cabello, M I; Gállego-Culleré, J; Ignacio-García, E; Manzano-Espinosa, L; Martín-Martínez, A; Mateo-Arranz, J; Polo-García, J; Vargas-Ortega, D

2017-05-01

To determine, in the various medical specialties, the healthcare process for anticoagulated patients with nonvalvular atrial fibrillation, to determine the available and necessary resources and to identify potential areas of improvement in the care of these patients. We performed a cross-sectional survey of primary care and specialised physicians involved in the care of anticoagulated patients. The questionnaires referred to the healthcare process, the indication and prescription of anticoagulant therapy and the barriers and deficiencies present for these patients. A total of 893 physicians participated in the study, 437 of whom worked in primary care and 456 of whom were specialists (mostly cardiologists). Forty-two percent of the family doctors indicated that they assessed and prescribed anticoagulant therapy, and 66% performed the regular follow-up of these patients. In both healthcare settings, the physicians noted the lack of standardised protocols. There was also a lack of quality control in the treatment. The role of primary care in managing anticoagulated patients has grown compared with previous reports. The responses of the participating physicians suggest marked gaps in the standardisation of the healthcare process and several areas for improvement in these patients' follow-up. The promotion of training in direct-acting anticoagulant drugs remains pivotal. Copyright © 2017 Elsevier España, S.L.U. and Sociedad Española de Medicina Interna (SEMI). All rights reserved.

Healthcare Utilization and Costs of Systemic Lupus Erythematosus in Medicaid

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Hong J. Kan

2013-01-01

Full Text Available Objective. Healthcare utilization and costs associated with systemic lupus erythematosus (SLE in a US Medicaid population were examined. Methods. Patients ≥ 18 years old with SLE diagnosis (ICD-9-CM 710.0x were extracted from a large Medicaid database 2002–2009. Index date was date of the first SLE diagnosis. Patients with and without SLE were matched. All patients had a variable length of followup with a minimum of 12 months. Annualized healthcare utilization and costs associated with SLE and costs of SLE flares were assessed during the followup period. Multivariate regressions were conducted to estimate incremental healthcare utilization and costs associated with SLE. Results. A total of 14,777 SLE patients met the study criteria, and 14,262 were matched to non-SLE patients. SLE patients had significantly higher healthcare utilization per year than their matched controls. The estimated incremental annual cost associated with SLE was $10,984, with the highest increase in inpatient costs (P<0.001. Cost per flare was $11,716 for severe flares, $562 for moderate flares, and $129 for mild flares. Annual total costs for patients with severe flares were $49,754. Conclusions. SLE patients had significantly higher healthcare resource utilization and costs than non-SLE patients. Patients with severe flares had the highest costs.

Outsourcing in private healthcare organisations: a Greek perspective.

Science.gov (United States)

Moschuris, Socrates J; Kondylis, Michael N

2007-01-01

The purpose of this paper is to present a study carried out to investigate the extent of outsourcing, the decision-making process, the impact of outsourcing, and the future trend of outsourcing in private healthcare organisations in Greece. A survey instrument was designed and mailed to a random sample of 100 private healthcare organisations in Greece. A total of 25 usable questionnaires were received, representing a response rate of 25 percent. The survey instrument focused on the extent to which private healthcare organisations outsource services, the decision-making process for choosing an external service provider, the impact of outsourcing, and the future trend of outsourcing. Private healthcare organisations in Greece outsource a variety of activities. Cost savings, customisation, and customer satisfaction are the main factors affecting the outsourcing decision. The cooperation with a contract service provider has led to an improvement in customer satisfaction and to a cost reduction. Most users are highly satisfied with the performance of these companies and believe that there will be a future increase in the usage of these services. The paper provides a framework regarding outsourcing in private healthcare organisations. This research fills the gap in the area of outsourcing in private healthcare organisations in Greece.

Improving and analyzing signage within a healthcare setting.

Science.gov (United States)

Rousek, J B; Hallbeck, M S

2011-11-01

Healthcare facilities are increasingly utilizing pictograms rather than text signs to help direct people. The purpose of this study was to analyze a wide variety of standardized healthcare pictograms and the effects of color contrasts and complexity for participants with both normal and impaired vision. Fifty (25 males, 25 females) participants completed a signage recognition questionnaire and identified pictograms while wearing vision simulators to represent specific visual impairment. The study showed that certain color contrasts, complexities and orientations can help or hinder comprehension of signage for people with and without visual impairment. High contrast signage with consistent pictograms involving human figures (not too detailed or too abstract) is most identifiable. Standardization of healthcare signage is recommended to speed up and aid the cognitive thought process in detecting signage and determining meaning. These fundamental signage principles are critical in producing an efficient, universal wayfinding system for healthcare facilities. Copyright © 2011 Elsevier Ltd and The Ergonomics Society. All rights reserved.

Big Data Analytics in Medicine and Healthcare.

Science.gov (United States)

Ristevski, Blagoj; Chen, Ming

2018-05-10

This paper surveys big data with highlighting the big data analytics in medicine and healthcare. Big data characteristics: value, volume, velocity, variety, veracity and variability are described. Big data analytics in medicine and healthcare covers integration and analysis of large amount of complex heterogeneous data such as various - omics data (genomics, epigenomics, transcriptomics, proteomics, metabolomics, interactomics, pharmacogenomics, diseasomics), biomedical data and electronic health records data. We underline the challenging issues about big data privacy and security. Regarding big data characteristics, some directions of using suitable and promising open-source distributed data processing software platform are given.

Healthcare professionals' perceptions of neglect of older people in Mexico: A qualitative secondary analysis.

Science.gov (United States)

Caceres, Billy A; Bub, Linda; Negrete, Maria Isabel; Giraldo Rodríguez, Liliana; Squires, Allison P

2018-03-01

To describe healthcare professionals' perceptions of neglect of older people in Mexico. Mistreatment of older people, particularly neglect, has emerged as a significant public health concern worldwide. However, few studies have been conducted to examine neglect of older people in low- and middle-income countries. Most research has focused on estimating the prevalence of neglect in older populations with little emphasis on the perceptions of healthcare professionals and their role in addressing neglect of older people. Qualitative secondary analysis. The parent study consisted of nine focus groups conducted with healthcare professionals at five public hospitals in Mexico. The purpose of the parent study was to perform a needs assessment to determine the feasibility of adapting the Nurses Improving Care for Healthsystem Elders programme to Mexico. A qualitative secondary analysis with directed content analysis approach was used to extract data related to neglect of older people. A total of 89 participants representing healthcare professionals from several disciplines were interviewed. Three themes emerged: (i) The main point is not here; (ii) We feel hopeless; and (iii) We need preparation. Participants reported distress and hopelessness related to neglect of older people. Lack of community-based resources was noted as contributing to neglect. Increased education regarding care of older people for both caregivers and healthcare professionals and greater interdisciplinary collaboration were identified as potential solutions to combat neglect. Community-based services and resource allocation need to be re-evaluated to improve the care of older Mexicans. Interdisciplinary models of care should be developed to address concerns related to neglect of older people. Neglect negatively impacts healthcare professionals' ability to adequately care for older patients. There is a need to invest in community-based services and models of care to address these concerns. © 2017

Distribution and Determinants of Out-of-pocket Healthcare Expenditures in Bangladesh.

Science.gov (United States)

Mahumud, Rashidul Alam; Sarker, Abdur Razzaque; Sultana, Marufa; Islam, Ziaul; Khan, Jahangir; Morton, Alec

2017-03-01

As in many low-income and middle-income countries, out-of-pocket (OOP) payments by patients or their families are a key healthcare financing mechanism in Bangladesh that leads to economic burdens for households. The objective of this study was to identify whether and to what extent socioeconomic, demographic, and behavioral factors of the population had an impact on OOP expenditures in Bangladesh. A total of 12 400 patients who had paid to receive any type of healthcare services within the previous 30 days were analyzed from the Bangladesh Household Income and Expenditure Survey data, 2010. We employed regression analysis for identify factors influencing OOP health expenditures using the ordinary least square method. The mean total OOP healthcare expenditures was US dollar (USD) 27.66; while, the cost of medicines (USD 16.98) was the highest cost driver (61% of total OOP healthcare expenditure). In addition, this study identified age, sex, marital status, place of residence, and family wealth as significant factors associated with higher OOP healthcare expenditures. In contrary, unemployment and not receiving financial social benefits were inversely associated with OOP expenditures. The findings of this study can help decision-makers by clarifying the determinants of OOP, discussing the mechanisms driving these determinants, and there by underscoring the need to develop policy options for building stronger financial protection mechanisms. The government should consider devoting more resources to providing free or subsidized care. In parallel with government action, the development of other prudential and sustainable risk-pooling mechanisms may help attract enthusiastic subscribers to community-based health insurance schemes.

Assessment of Healthcare Waste Generation Rate and Its ...

African Journals Online (AJOL)

2018-03-01

Mar 1, 2018 ... reliable records of the quantity and nature of healthcare wastes ... construction, and 224 health posts, totally 272 health facilities ..... Procedia - Social and Behavioral. Sciences. 2012 ... Asian Journal Of Applied Science And.

Patterns of nonemergent visits to different healthcare facilities on the same day: a nationwide analysis in Taiwan.

Science.gov (United States)

Wu, Meng-Hsuan; Wu, Meng-Ju; Chou, Li-Fang; Chen, Tzeng-Ji

2014-01-01

Doctor shopping is a common phenomenon in many countries. However, patterns of switching healthcare facilities on the same day were little known. The data were obtained from the longitudinal cohort datasets (LHID2010) of Taiwan's National Health Insurance Research Database in 2010. Of 1,000,000 persons of the cohort with 13,276,928 nonemergent visits, 185,347 patients had visited different healthcare facilities within one day, with a total of 672,478 visits and 337,260 switches between facilities in 329,073 patient-days. While 63.0% (n = 212,590) of all switches occurred between facilities of the same accreditation level, 14.1% (n = 47,664) moved from lower to higher level, and 22.8% (n = 77,006) moved in the opposite direction. In 33,689 switches, patients moved to the same specialty of another facility. In 48,324 switches, patients moved to another facility with the same diagnosis, and the most frequent diagnoses were diseases of the digestive system (11,148) and diseases of the respiratory system (10,393). In a densely populated country without strict referral regulation, a high percentage of Taiwanese people had the experience of visiting different healthcare facilities on the same day. The system of family physicians as personal doctors and gatekeepers to healthcare might ameliorate the harmful impact.

Customer perceived service quality, satisfaction and loyalty in Indian private healthcare.

Science.gov (United States)

Kondasani, Rama Koteswara Rao; Panda, Rajeev Kumar

2015-01-01

The purpose of this paper is to analyse how perceived service quality and customer satisfaction lead to loyalty towards healthcare service providers. In total, 475 hospital patients participated in a questionnaire survey in five Indian private hospitals. Descriptive statistics, factor analysis, regression and correlation statistics were employed to analyse customer perceived service quality and how it leads to loyalty towards service providers. Results indicate that the service seeker-service provider relationship, quality of facilities and the interaction with supporting staff have a positive effect on customer perception. Findings help healthcare managers to formulate effective strategies to ensure a better quality of services to the customers. This study helps healthcare managers to build customer loyalty towards healthcare services, thereby attracting and gaining more customers. This paper will help healthcare managers and service providers to analyse customer perceptions and their loyalty towards Indian private healthcare services.

[Parental beliefs on medication and satisfaction with child healthcare].

Science.gov (United States)

Fernández-Castillo, Antonio; Vílchez-Lara, María José

2015-01-01

The aim of this study is to explore a possible significant relationship between parental beliefs about medication and satisfaction with the medical care their children receive in two different healthcare settings. The study included a total of 1,517 parents whose children were being treated either in pediatric primary care or pediatric emergency centers in eastern Andalusia. Of these, 489 were men and 1,028 women. The research instruments used were the Beliefs about Medicines Questionnaire (BMQ) and the Scale of Satisfaction with Health Care Services. Our results indicate that high levels of negative beliefs about medication were significantly associated with lower levels of parent satisfaction with healthcare received. Satisfaction with pediatric healthcare depends on aspects relating to the healthcare system, but certainly personal psychological and social variables like beliefs and parent’s previous expectations may play an important role too.

The health of healthcare, Part II: patient healthcare has cancer.

Science.gov (United States)

Waldman, Deane

2013-01-01

In this article, we make the etiologic diagnosis for a sick patient named Healthcare: the cancer of greed. When we explore the two forms of this cancer--corporate and bureaucratic--we find the latter is the greater danger to We the Patients. The "treatments" applied to patient Healthcare by the Congressional "doctors" have consistently made the patient worse, not better. At the core of healthcare's woes is the government's diversion of money from healthcare services to healthcare bureaucracy. As this is the root cause, it is what we must address in order to cure, not sedate or palliate, patient Healthcare.

Peering beyond the walls of healthcare institutions: a catalyst for innovation.

Science.gov (United States)

Elrod, James K; Fortenberry, John L

2017-07-11

Healthcare providers operate in a unique industry characterized by pursuit of perhaps the most noble of missions: the delivery of vital health and medical services to those in need. Distinguishing features abound, differentiating the healthcare industry from others, with such facets having the potential to compel those serving in health and medical establishments to focus exclusively on their selected industry. But directing attention solely within can result in missed opportunities, especially regarding innovation. Many innovations which are well suited for healthcare establishments emerge externally, making at least some exposure beyond the healthcare industry essential for institutions desirous of operating on the innovation frontier. True innovation emerges from broad worldviews, allowing healthcare providers to comprehensively understand the current state of the art. With such an understanding, novel tools, techniques, and approaches, regardless of industry of origin, can be examined for their potential to elevate the status and stature of efforts within health and medical establishments. It is this very open, inquisitive mindset that permitted Willis-Knighton Health System to identify and incorporate a range of innovations which originated outside of the healthcare industry. Its embracement of and associated successes with the repurposing approach known as adaptive reuse, the delivery of complex medical services via centers of excellence, and the structuring of operations using the hub-and-spoke organization design, for example, would never have occurred had executives not directed attention externally in search of innovations that could be used within. Innovations offer key pathways for healthcare providers to enhance the depth and breadth of health and medical services offered in their establishments and communities. By peering beyond the walls of healthcare institutions, providers amplify opportunities to discover novel methods and approaches that

Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria

OpenAIRE

Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Winifred, Ekezie; Kelechi, Ohiri

2016-01-01

Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected...

Dysfunctional Effects of a Conflict in a Healthcare Organization.

Science.gov (United States)

Raykova, Ekaterina L; Semerjieva, Mariya A; Yordanov, Georgi Y; Cherkezov, Todor D

2015-01-01

Conflicts in healthcare settings are quite common events because of the continuous changes and transformations today's healthcare organizations are undergoing and the vigorous interaction between the medical professionals working in them. To survey the opinions of medical professionals about the possible destructive effects of conflicts on them in the workplace. We conducted a direct individual survey of 279 medical employees at four general hospitals. We used a set of questions that reflect the negative effects and consequences of conflict on healthcare professionals as direct or indirect participants. All data were analysed using the descriptive statistics and non-parametric analysis at a significance level for the null hypothesis of p Workplace conflicts contribute a lot to the stress, psychological tension and emotional exhaustion medical professionals are exposed to. The confrontation the conflict brings the participants into acts as a catalyst of the conflict and enhances the manifestation of hostile actions. A conflict generates a situation which has an impact on the behaviour of all participants involved in it giving rise to emotional states such as anger, aggression and reproaches. The destructive consequences resulting from a conflict are seen in the reduced work satisfaction and demotivation to perform the work activity. The contradictions that arise as a result affect negatively the team cooperation and obstruct the collaborative efforts in solving the problems in the healthcare setting. A conflict in a healthcare setting exerts a considerable destructive effect on an employee, therefore it requires prompt identification and effective intervention to minimise its unfavourable outcomes.

Healthcare performance data turned into decision support

DEFF Research Database (Denmark)

Sørup, Christian Michel; Jacobsen, Peter

2012-01-01

This paper has focused on identifying the determinants having direct impact on levels of employee absence in a healthcare organization seen from a practical viewpoint. Exploiting the acquired knowledge, a management framework is proposed giving hospital managers an overview of the determinant’s r...

Direct medical cost of type 2 diabetes in singapore.

Directory of Open Access Journals (Sweden)

Charmaine Shuyu Ng

Full Text Available Due to the chronic nature of diabetes along with their complications, they have been recognised as a major health issue, which results in significant economic burden. This study aims to estimate the direct medical cost associated with type 2 diabetes mellitus (T2DM in Singapore in 2010 and to examine both the relationship between demographic and clinical state variables with the total estimated expenditure. The National Healthcare Group (NHG Chronic Disease Management System (CDMS database was used to identify patients with T2DM in the year 2010. DM-attributable costs estimated included hospitalisations, accident and emergency (A&E room visits, outpatient physician visits, medications, laboratory tests and allied health services. All charges and unit costs were provided by the NHG. A total of 500 patients with DM were identified for the analyses. The mean annual direct medical cost was found to be $2,034, of which 61% was accounted for by inpatient services, 35% by outpatient services, and 4% by A&E services. Independent determinants of total costs were DM treatments such as the use of insulin only (p<0.001 and the combination of both oral medications and insulin (p=0.047 as well as having complications such as cerebrovascular disease (p<0.001, cardiovascular disease (p=0.002, peripheral vascular disease (p=0.001, and nephropathy (p=0.041. In this study, the cost of DM treatments and DM-related complications were found to be strong determinants of costs. This finding suggests an imperative need to address the economic burden associated with diabetes with urgency and to reorganise resources required to improve healthcare costs.

Workplace Violence and Job Performance among Community Healthcare Workers in China: The Mediator Role of Quality of Life.

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Lin, Wei-Quan; Wu, Jiang; Yuan, Le-Xin; Zhang, Sheng-Chao; Jing, Meng-Juan; Zhang, Hui-Shan; Luo, Jia-Li; Lei, Yi-Xiong; Wang, Pei-Xi

2015-11-20

To explore the impact of workplace violence on job performance and quality of life of community healthcare workers in China, especially the relationship of these three variables. From December 2013 to April 2014, a total of 1404 healthcare workers were recruited by using the random cluster sampling method from Community Health Centers in Guangzhou and Shenzhen. The workplace violence scale, the job performance scale and the quality of life scale (SF-36) were self-administered. The structural equation model constructed by Amos 17.0 was employed to assess the relationship among these variables. Our study found that 51.64% of the respondents had an experience of workplace violence. It was found that both job performance and quality of life had a negative correlation with workplace violence. A positive association was identified between job performance and quality of life. The path analysis showed the total effect (β = -0.243) of workplace violence on job performance consisted of a direct effect (β = -0.113) and an indirect effect (β = -0.130), which was mediated by quality of life. Workplace violence among community healthcare workers is prevalent in China. The workplace violence had negative effects on the job performance and quality of life of CHCs' workers. The study suggests that improvement in the quality of life may lead to an effective reduction of the damages in job performance caused by workplace violence.

Minimizing deviant behavior in healthcare organizations: the effects of supportive leadership and job design.

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Chullen, C Logan; Dunford, Benjamin B; Angermeier, Ingo; Boss, R Wayne; Boss, Alan D

2010-01-01

In an era when healthcare organizations are beset by intense competition, lawsuits, and increased administrative costs, it is essential that employees perform their jobs efficiently and without distraction. Deviant workplace behavior among healthcare employees is especially threatening to organizational effectiveness, and healthcare managers must understand the antecedents of such behavior to minimize its prevalence. Deviant employee behavior has been categorized into two major types, individual and organizational, according to the intended target of the behavior. Behavior directed at the individual includes such acts as harassment and aggression, whereas behavior directed at the organization includes such acts as theft, sabotage, and voluntary absenteeism, to name a few (Robinson and Bennett 1995). Drawing on theory from organizational behavior, we examined two important features of supportive leadership, leader-member exchange (LMX) and perceived organizational support (POS), and two important features of job design, intrinsic motivation and depersonalization, as predictors of subsequent deviant behavior in a sample of over 1,900 employees within a large US healthcare organization. Employees who reported weaker perceptions of LMX and greater perceptions of depersonalization were more likely to engage in deviant behavior directed at the individual, whereas employees who reported weaker perceptions of POS and intrinsic motivation were more likely to engage in deviant behavior directed at the organization. These findings give rise to specific prescriptions for healthcare managers to prevent or minimize the frequency of deviant behavior in the workplace.

Are female students in general and nursing students more ready for teamwork and interprofessional collaboration in healthcare?

Directory of Open Access Journals (Sweden)

Timpka Toomas

2011-04-01

Full Text Available Abstract Background Interprofessional Education (IPE is now spreading worldwide and many universities are now including IPE in their curricula. The aim of this study was to investigate whether or not such student characteristics as gender, previous working experience in healthcare, educational progress and features of the learning environment, such as educational programmes and curriculum design, have an impact on their open-mindedness about co-operation with other professions. Methods Medical and nursing students at two Swedish universities were invited to fill in the Readiness for Interprofessional Learning Scale (RIPLS. Totally, 955 students were invited and 70.2% (n = 670 participated in the study. A factor analysis of the RIPLS revealed four item groupings (factors for our empirical data, but only one had sufficient internal consistency. This factor was labelled "Team Player". Results Regardless of the educational programme, female students were more positive to teamwork than male students. Nursing students in general displayed more positive beliefs about teamwork and collaboration than medical students. Exposure to different interprofessional curricula and previous exposure to interprofessional education were only to a minor extent associated with a positive attitude towards teamwork. Educational progress did not seem to influence these beliefs. Conclusions The establishment of interprofessional teamwork is a major challenge for modern healthcare. This study indicates some directions for more successful interprofessional education. Efforts should be directed at informing particularly male medical students about the need for teamwork in modern healthcare systems. The results also imply that study of other factors, such as the student's personality, is needed for fully understanding readiness for teamwork and interprofessional collaboration in healthcare. We also believe that the RIPL Scale still can be further adjusted.

Are female students in general and nursing students more ready for teamwork and interprofessional collaboration in healthcare?

Science.gov (United States)

Wilhelmsson, Margaretha; Ponzer, Sari; Dahlgren, Lars-Ove; Timpka, Toomas; Faresjö, Tomas

2011-04-21

Interprofessional Education (IPE) is now spreading worldwide and many universities are now including IPE in their curricula. The aim of this study was to investigate whether or not such student characteristics as gender, previous working experience in healthcare, educational progress and features of the learning environment, such as educational programmes and curriculum design, have an impact on their open-mindedness about co-operation with other professions. Medical and nursing students at two Swedish universities were invited to fill in the Readiness for Interprofessional Learning Scale (RIPLS). Totally, 955 students were invited and 70.2% (n=670) participated in the study. A factor analysis of the RIPLS revealed four item groupings (factors) for our empirical data, but only one had sufficient internal consistency. This factor was labelled "Team Player". Regardless of the educational programme, female students were more positive to teamwork than male students. Nursing students in general displayed more positive beliefs about teamwork and collaboration than medical students. Exposure to different interprofessional curricula and previous exposure to interprofessional education were only to a minor extent associated with a positive attitude towards teamwork. Educational progress did not seem to influence these beliefs. The establishment of interprofessional teamwork is a major challenge for modern healthcare. This study indicates some directions for more successful interprofessional education. Efforts should be directed at informing particularly male medical students about the need for teamwork in modern healthcare systems. The results also imply that study of other factors, such as the student's personality, is needed for fully understanding readiness for teamwork and interprofessional collaboration in healthcare. We also believe that the RIPL Scale still can be further adjusted.

Preservation of the articular capsule and short lateral rotator in direct anterior approach to total hip arthroplasty.

Science.gov (United States)

Kanda, Akio; Kaneko, Kazuo; Obayashi, Osamu; Mogami, Atsuhiko; Morohashi, Itaru

2018-03-09

In total hip arthroplasty via a direct anterior approach, the femur must be elevated at the time of femoral implant placement. For adequate elevation, division of the posterior soft tissues is necessary. However, if we damage and separate the posterior muscle tissue, we lose the benefits of the intermuscular approach. Furthermore, damage to the posterior soft tissue can result in posterior dislocation. We investigate that protecting the posterior soft tissue increases the joint stability in the early postoperative period and results in a lower dislocation rate. We evaluated muscle strength recovery by measuring the maximum width of the internal obturator muscle on CT images (GE-Healthcare Discovery CT 750HD). We compared the maximum width of the muscle belly preoperatively versus 10 days and 6 months postoperatively. As clinical evaluations, we also investigated the range of motion of the hip joint, hip joint function based on the Japanese Orthopaedic Association hip score (JOA score), and the dislocation rate 6 months after surgery. The width of the internal obturator muscle increased significantly from 15.1 ± 3.1 mm before surgery to 16.4 ± 2.8 mm 6 months after surgery. The JOA score improved significantly from 50.8 ± 15.1 points to 95.6 ± 7.6 points. No dislocations occurred in this study. We cut only the posterosuperior articular capsule and protected the internal obturator muscle to preserve muscle strength. We repaired the entire posterosuperior and anterior articular capsule. These treatments increase joint stability in the early postoperative period, thus reducing the dislocation rate. Therapeutic, Level IV.

A time-driven activity-based costing model to improve health-care resource use in Mirebalais, Haiti.

Science.gov (United States)

Mandigo, Morgan; O'Neill, Kathleen; Mistry, Bipin; Mundy, Bryan; Millien, Christophe; Nazaire, Yolande; Damuse, Ruth; Pierre, Claire; Mugunga, Jean Claude; Gillies, Rowan; Lucien, Franciscka; Bertrand, Karla; Luo, Eva; Costas, Ainhoa; Greenberg, Sarah L M; Meara, John G; Kaplan, Robert

2015-04-27

delivery at HUM was US$62 and the direct cost of a caesarean delivery was US$249. The direct costs of breast cancer care (including diagnostics, chemotherapy, and mastectomy) totalled US$1393. A mastectomy, including post-anaesthesia recovery and inpatient stay, totalled US$282 in direct costs. Indirect costs comprised 26-38% of total costs, and salaries were the largest percentage of total costs (51-72%). Accurate costing of health services is vital for financial officers and funders. TDABC showed opportunities at HUM to optimise use of resources and reduce costs-for instance, by streamlining sterilisation procedures and redistributing certain tasks to improve teamwork. TDABC has also improved budget forecasting and informed financing decisions. HUM leadership recognised its value to improve health-care delivery and expand access in low-resource settings. Boston Children's Hospital, Harvard Business School, and Partners in Health. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Healthcare value chain: a model for the Brazilian healthcare system].

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Pedroso, Marcelo Caldeira; Malik, Ana Maria

2012-10-01

This article presents a model of the healthcare value chain which consists of a schematic representation of the Brazilian healthcare system. The proposed model is adapted for the Brazilian reality and has the scope and flexibility for use in academic activities and analysis of the healthcare sector in Brazil. It places emphasis on three components: the main activities of the value chain, grouped in vertical and horizontal links; the mission of each link and the main value chain flows. The proposed model consists of six vertical and three horizontal links, amounting to nine. These are: knowledge development; supply of products and technologies; healthcare services; financial intermediation; healthcare financing; healthcare consumption; regulation; distribution of healthcare products; and complementary and support services. Four flows can be used to analyze the value chain: knowledge and innovation; products and services; financial; and information.

The perspective of healthcare providers and patients on health literacy: a systematic review of the quantitative and qualitative studies.

Science.gov (United States)

Rajah, Retha; Ahmad Hassali, Mohamed Azmi; Jou, Lim Ching; Murugiah, Muthu Kumar

2018-03-01

Health literacy (HL) is a multifaceted concept, thus understanding the perspective of healthcare providers, patients, and the system is vital. This systematic review examines and synthesises the available studies on HL-related knowledge, attitude, practice, and perceived barriers. CINAHL and Medline (via EBSCOhost), Google Scholar, PubMed, ProQuest, Sage Journals, and Science Direct were searched. Both quantitative and/or qualitative studies in the English language were included. Intervention studies and studies focusing on HL assessment tools and prevalence of low HL were excluded. The risk of biasness reduced with the involvement of two reviewers independently assessing study eligibility and quality. A total of 30 studies were included, which consist of 19 quantitative, 9 qualitative, and 2 mixed-method studies. Out of 17 studies, 13 reported deficiency of HL-related knowledge among healthcare providers and 1 among patients. Three studies showed a positive attitude of healthcare providers towards learning about HL. Another three studies demonstrated patients feel shame exposing their literacy and undergoing HL assessment. Common HL communication techniques reported practiced by healthcare providers were the use of everyday language, teach-back method, and providing patients with reading materials and aids, while time constraint was the most reported HL perceived barriers by both healthcare providers and patients. Significant gaps exists in HL knowledge among healthcare providers and patients that needs immediate intervention. Such as, greater effort placed in creating a health system that provides an opportunity for healthcare providers to learn about HL and patients to access health information with taking consideration of their perceived barriers.

Effects of librarian-provided services in healthcare settings: a systematic review.

Science.gov (United States)

Perrier, Laure; Farrell, Ann; Ayala, A Patricia; Lightfoot, David; Kenny, Tim; Aaronson, Ellen; Allee, Nancy; Brigham, Tara; Connor, Elizabeth; Constantinescu, Teodora; Muellenbach, Joanne; Epstein, Helen-Ann Brown; Weiss, Ardis

2014-01-01

To assess the effects of librarian-provided services in healthcare settings on patient, healthcare provider, and researcher outcomes. Medline, CINAHL, ERIC, LISA (Library and Information Science Abstracts), and the Cochrane Central Register of Controlled Trials were searched from inception to June 2013. Studies involving librarian-provided services for patients encountering the healthcare system, healthcare providers, or researchers were eligible for inclusion. All librarian-provided services in healthcare settings were considered as an intervention, including hospitals, primary care settings, or public health clinics. Twenty-five articles fulfilled our eligibility criteria, including 22 primary publications and three companion reports. The majority of studies (15/22 primary publications) examined librarians providing instruction in literature searching to healthcare trainees, and measured literature searching proficiency. Other studies analyzed librarian-provided literature searching services and instruction in question formulation as well as the impact of librarian-provided services on patient length of stay in hospital. No studies were found that investigated librarians providing direct services to researchers or patients in healthcare settings. Librarian-provided services directed to participants in training programs (eg, students, residents) improve skills in searching the literature to facilitate the integration of research evidence into clinical decision-making. Services provided to clinicians were shown to be effective in saving time for health professionals and providing relevant information for decision-making. Two studies indicated patient length of stay was reduced when clinicians requested literature searches related to a patient's case. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The Technology-Enabled Patient Advocate: A Valuable Emerging Healthcare Partner.

Science.gov (United States)

Kent, Susan M; Yellowlees, Peter

2015-12-01

The U.S. healthcare system is changing and is becoming more patient-centered and technology-supported, with greater emphasis on population health outcomes and team-based care. The roles of healthcare providers are changing, and new healthcare roles are developing such as that of the patient advocate. This article reviews the history of this type of role, the changes that have taken place over time, the technological innovations in service delivery that further enable the role, and how the role could increasingly be developed in the future. Logical future extensions of the current typical patient advocate are the appearance of a virtual or avatar-driven care navigator, using telemedicine and related information technologies, as healthcare provision moves increasingly in a hybrid direction, with care being given both in-person and online.

Healthcare resource use, direct and indirect costs of hypoglycemia in type 1 and type 2 diabetes, and nationwide projections. Results of the HYPOS-1 study.

Science.gov (United States)

Giorda, C B; Rossi, M C; Ozzello, O; Gentile, S; Aglialoro, A; Chiambretti, A; Baccetti, F; Gentile, F M; Romeo, F; Lucisano, G; Nicolucci, A

2017-03-01

To obtain an accurate picture of the total costs of hypoglycemia, including the indirect costs and comparing the differences between type 1 (T1DM) and type 2 diabetes mellitus (T2DM). HYPOS-1 was a multicenter, retrospective cohort study which analyzed the data of 2229 consecutive patients seen at 18 diabetes clinics. Data on healthcare resource use and indirect costs by diabetes type were collected via a questionnaire. The domains of inpatient admission and hospital stay, work days lost, and third-party assistance were also explored. Resource utilization was reported as estimated incidence rates (IRs) of hypoglycemic episodes per 100 person-years and estimated costs as IRs per person-years. For every 100 patients with T1DM, 9 emergency room (ER) visits and 6 emergency medical service calls for hypoglycemia were required per year; for every 100 patients with T2DM, 3 ER visits and 1 inpatient admission were required, with over 3 nights spent in hospital. Hypoglycemia led to 58 work days per 100 person-years lost by the patient or a family member in T1DM versus 19 in T2DM. The costs in T1DM totaled €90.99 per person-year and €62.04 in T2DM. Direct and indirect costs making up the total differed by type of diabetes (60% indirect costs in T1DM versus 43% in T2DM). The total cost associated with hypoglycemia in Italy is estimated to be €107 million per year. Indirect costs meaningfully contribute to the total costs associated with hypoglycemia. As compared with T1DM, T2DM requires fewer ER visits and incurs lower indirect costs but more frequent hospital use. Copyright © 2016 The Italian Society of Diabetology, the Italian Society for the Study of Atherosclerosis, the Italian Society of Human Nutrition, and the Department of Clinical Medicine and Surgery, Federico II University. Published by Elsevier B.V. All rights reserved.

Lean healthcare.

Science.gov (United States)

Weinstock, Donna

2008-01-01

As healthcare organizations look for new and improved ways to reduce costs and still offer quality healthcare, many are turning to the Toyota Production System of doing business. Rather than focusing on cutting personnel and assets, "lean healthcare" looks to improve patient satisfaction through improved actions and processes.

Education on human rights and healthcare: evidence from Serbia.

Science.gov (United States)

Vranes, Aleksandra Jovic; Mikanovic, Vesna Bjegovic; Vukovic, Dejana; Djikanovic, Bosiljka; Babic, Momcilo

2015-03-01

Ensuring and enforcing human rights in patient care are important to promote health and to provide quality and appropriate healthcare services. Therefore, continued medical education (CME) is essential for healthcare professionals to utilize their sphere of influence to affect change in healthcare practice. A total of 123 participants attended three CME courses. Course topics covered: (i) the areas of human rights and healthcare, (ii) rights, obligations and responsibilities of healthcare professionals in relation to human rights and the rights of patients, (iii) healthcare of vulnerable groups and (iv) access to essential medical services. Evaluation of the CME courses involved two components: evaluation of participants' performance and the participants' evaluation of the teaching process. The participants were assessed at the beginning and end of each course. Each of the courses was evaluated by the participants through a questionnaire distributed at the end of each course. Descriptive statistics was used for data interpretation. Knowledge of the healthcare professionals improved at the end of all the three courses. The participants assessed several aspects of the courses, including the course topics, educational methods, the course methods, organization, duration and dynamics as well as the physical environment and the technical facilities of the course, and rated each very highly. Our results corroborate the importance and necessity of courses to heighten awareness of the state of current healthcare and human rights issues to increase the involvement of healthcare professionals both locally and globally. © The Author 2014. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

Population ageing and healthcare demand: The case of Slovenia.

Science.gov (United States)

Vrhovec, Jure; Tajnikar, Maks

2016-11-01

The aim of this paper is to explore the consequences of demographic ageing on healthcare demand in Slovenia for primary care, secondary care, hospital day-care treatments, and hospitalisations. In the paper, we develop a model for making projections of the total number of treatments using the age-group projection method with the scenario approach. The model allows the number of treatments to be observed with respect to medical services, age groups and main disease groups. The results are presented for the cross-section years 2015, 2025 and 2035. The smallest increase in the number of treatments occurs in primary care, a larger one for secondary care, and the largest for hospital day-care services and hospitalisations (up to 29.9%). The structure of demand will also change. Demand for healthcare services for children and infants will decrease while demand for diseases associated with older age groups will increase, particularly for diseases of the circulatory system, eye and adnexa, and diseases of the blood and blood-forming organs. The results presented in this paper can help improve understanding of similar processes in other countries for total healthcare demand and for changes in the structure of demand. The results show that the healthcare system in Slovenia will face a major additional burden in the next 20 years. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Distribution and Determinants of Out-of-pocket Healthcare Expenditures in Bangladesh

Directory of Open Access Journals (Sweden)

Rashidul Alam Mahumud

2017-03-01

Full Text Available Objectives As in many low-income and middle-income countries, out-of-pocket (OOP payments by patients or their families are a key healthcare financing mechanism in Bangladesh that leads to economic burdens for households. The objective of this study was to identify whether and to what extent socioeconomic, demographic, and behavioral factors of the population had an impact on OOP expenditures in Bangladesh. Methods A total of 12 400 patients who had paid to receive any type of healthcare services within the previous 30 days were analyzed from the Bangladesh Household Income and Expenditure Survey data, 2010. We employed regression analysis for identify factors influencing OOP health expenditures using the ordinary least square method. Results The mean total OOP healthcare expenditures was US dollar (USD 27.66; while, the cost of medicines (USD 16.98 was the highest cost driver (61% of total OOP healthcare expenditure. In addition, this study identified age, sex, marital status, place of residence, and family wealth as significant factors associated with higher OOP healthcare expenditures. In contrary, unemployment and not receiving financial social benefits were inversely associated with OOP expenditures. Conclusions The findings of this study can help decision-makers by clarifying the determinants of OOP, discussing the mechanisms driving these determinants, and there by underscoring the need to develop policy options for building stronger financial protection mechanisms. The government should consider devoting more resources to providing free or subsidized care. In parallel with government action, the development of other prudential and sustainable risk-pooling mechanisms may help attract enthusiastic subscribers to community-based health insurance schemes.

Architecture of personal healthcare information system in ubiquitous healthcare

NARCIS (Netherlands)

Bhardwaj, S.; Sain, M.; Lee, H.-J.; Chung, W.Y.; Slezak, D.; et al., xx

2009-01-01

Due to recent development in Ubiquitous Healthcare now it’s time to build such application which can work independently and with less interference of Physician. In this paper we are try to build the whole architecture of personal Healthcare information system for ubiquitous healthcare which also

Care-Seeking Patterns and Direct Economic Burden of Injuries in Bangladesh.

Science.gov (United States)

Alfonso, Natalia Y; Alonge, Olakunle; Hoque, Dewan Md Emdadul; Baset, Kamran Ul; Hyder, Adnan A; Bishai, David

2017-04-29

This study provides a comprehensive review of the care-seeking patterns and direct economic burden of injuries from the victims' perspective in rural Bangladesh using a 2013 household survey covering 1.17 million people. Descriptive statistics and bivariate analyses were used to derive rates and test the association between variables. An analytic model was used to estimate total injury out-of-pocket (OOP) payments and a multivariate probit regression model assessed the relationship between financial distress and injury type. Results show non-fatal injuries occur to 1 in 5 people in our sample per year. With average household size of 4.5 in Bangladesh--every household has an injury every year. Most non-fatally injured patients sought healthcare from drug sellers. Less than half of fatal injuries sought healthcare and half of those with care were hospitalized. Average OOP payments varied significantly (range: $8-$830) by injury type and outcome (fatal vs. non-fatal). Total injury OOP expenditure was $$355,795 and $5000 for non-fatal and fatal injuries, respectively, per 100,000 people. The majority of household heads with injuries reported financial distress. This study can inform injury prevention advocates on disparities in healthcare usage, OOP costs and financial distress. Reallocation of resources to the most at risk populations can accelerate reduction of preventable injuries and prevent injury related catastrophic payments and impoverishment.

Testing for causality between the foreign direct investment, current account deficit, GDP and total credit: Evidence from G7

Directory of Open Access Journals (Sweden)

Akbas Yusuf Ekrem

2013-01-01

Full Text Available In this study, countries were analyzed between 1990 and 2011 in order to determine whether a causal relationship exists among current account deficit, GDP, foreign direct investment, and total credits of G7. Analysis took into account the cross-sectional dependence and was applied to test the causality among the variables form the panel. Firstly, panel unit root tests were used for determining stationary of variables. As a result of the panel unit root tests, it was found that GDP and foreign direct investment have a stationary structure and that total credits and current account deficit contain unit root. In order to see whether there is a long-term relationship among the variables or not, the panel co-integration test was used. As a result of the test, it was concluded that there is a co-integration relationship among the series. The possibility of a causal relationship was analyzed among the variables using the causality test developed by Elena Ivona Dumitrescu and Christophe Hurlin (2012. Results of the analysis showed a unidirectional causal relationship from current account deficit and foreign direct investment to GDP. Bidirectional causality was found between current account deficit and total credits. Finally, a unidirectional relationship was found from foreign direct investment to current account deficit and total credits.

A research model of health-care competition and customer satisfaction.

Science.gov (United States)

Asoh, Derek A; Rivers, Patrick A

2007-11-01

In all industries, competition among businesses has long been encouraged as a mechanism to increase value for customers. In other words, competition ensures the provision of better products and services to satisfy the needs of customers. Various perspectives of competition, the nature of service quality, health-care system costs and customer satisfaction in health care are examined. A model of the relationship among these variables is developed. The model depicts customer satisfaction as an outcome measure directly dependent on competition. Quality of care and health-care system costs, while also directly dependent on competition, are considered as determinants of customer satisfaction as well. The model is discussed in the light of propositions for empirical research.

Prevalence of experienced abuse in healthcare and associated obstetric characteristics in six European countries

DEFF Research Database (Denmark)

Lukasse, Mirjam; Schroll, Anne-Mette; Karro, Helle

2015-01-01

OBJECTIVES: To assess the prevalence and current suffering of experienced abuse in healthcare, to present the socio-demographic background for women with a history of abuse in healthcare and to assess the association between abuse in healthcare and selected obstetric characteristics. DESIGN: Cross......-sectional study. SETTING: Routine antenatal care in six European countries. POPULATION: In total 6923 pregnant women. METHODS: Cross-tabulation and Pearson's chi-square was used to study prevalence and characteristics for women reporting abuse in healthcare. Associations with selected obstetric factors were...

Total quality management in American industry.

Science.gov (United States)

Widtfeldt, A K; Widtfeldt, J R

1992-07-01

The definition of total quality management is conformance to customer requirements and specifications, fitness for use, buyer satisfaction, and value at an affordable price. The three individuals who have developed the total quality management concepts in the United States are W.E. Deming, J.M. Juran, and Philip Crosby. The universal principles of total quality management are (a) a customer focus, (b) management commitment, (c) training, (d) process capability and control, and (e) measurement through quality improvement tools. Results from the National Demonstration Project on Quality Improvement in Health Care showed the principles of total quality management could be applied to healthcare.

Corporate culture: the missing piece of the healthcare puzzle.

Science.gov (United States)

Waldman, J Deane; Smith, Howard L; Hood, Jacqueline N

2003-01-01

The U.S. healthcare system requires radical, not incremental, change. Management issues in healthcare delivery are fundamentally different from those in the business world. Systems thinking forces a focus on corporate culture, about which there is little hard data. The use of cost/benefit analysis suffers from the lack of any accepted measure of long-term "benefit." The authors make four observations: (1) corporate culture is both part of the cause and part of the cure for healthcare; (2) long-term financial and functional measures are necessary to make evidence-based decisions; (3) valid, nationwide data must be developed regarding the corporate culture of medicine; and (4) direct (unmodified) application of management theory or practices will not achieve sustainable improvements.

Telemental health: responding to mandates for reform in primary healthcare.

Science.gov (United States)

Myers, Kathleen M; Lieberman, Daniel

2013-06-01

Telemental health (TMH) has established a niche as a feasible, acceptable, and effective service model to improve the mental healthcare and outcomes for individuals who cannot access traditional mental health services. The Accountability Care Act has mandated reforms in the structure, functioning, and financing of primary care that provide an opportunity for TMH to move into the mainstream healthcare system. By partnering with the Integrated Behavioral Healthcare Model, TMH offers a spectrum of tools to unite primary care physicians and mental health specialist in a mind-body view of patients' healthcare needs and to activate patients in their own care. TMH tools include video-teleconferencing to telecommute mental health specialists to the primary care setting to collaborate with a team in caring for patients' mental healthcare needs and to provide direct services to patients who are not progressing optimally with this collaborative model. Asynchronous tools include online therapies that offer an efficient first step to treatment for selected disorders such as depression and anxiety. Patients activate themselves in their care through portals that provide access to their healthcare information and Web sites that offer on-demand information and communication with a healthcare team. These synchronous and asynchronous TMH tools may move the site of mental healthcare from the clinic to the home. The evolving role of social media in facilitating communication among patients or with their healthcare team deserves further consideration as a tool to activate patients and provide more personalized care.

Healthcare and healthcare systems: inspiring progress and future prospects.

Science.gov (United States)

Durrani, Hammad

2016-01-01

growth will occur in the urban areas of poor countries. The rapid, unplanned and unsustainable style of urban development will make developing countries cities the key focal points for emerging environmental and health hazards. Changes will be seen in design, culture and practices of hospitals to better meet the needs of patients, families and providers. Top driving factors of global healthcare system for next 30 years will be leading causes of mortalities, non-health factors (impact of nutrition, sanitation and women's empowerment), investment in health workforce and growth of medical tourism in future healthcare scenario. Evaluating the patterns of previous 30 years and predicting the progress and challenges of future health system are no rocket science. Medical care will be more self-directed in a more tech-savvy population as information will be more accessible and user friendly with higher quality. Health driving factors such as clean water, sanitation and food will take the center stage in humanities struggle and even increase population size.

Barriers and facilitators to using NHS Direct: a qualitative study of 'users' and 'non-users'.

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Cook, Erica J; Randhawa, Gurch; Large, Shirley; Guppy, Andy; Chater, Angel M; Ali, Nasreen

2014-10-25

NHS Direct, introduced in 1998, has provided 24/7 telephone-based healthcare advice and information to the public in England and Wales. National studies have suggested variation in the uptake of this service amongst the UK's diverse population. This study provides the first exploration of the barriers and facilitators that impact upon the uptake of this service from the perspectives of both 'users' and 'non- users'. Focus groups were held with NHS Direct 'users' (N = 2) from Bedfordshire alongside 'non-users' from Manchester (N = 3) and Mendip, Somerset (N = 4). Each focus group had between five to eight participants. A total of eighty one people aged between 21 and 94 years old (M: 58.90, SD: 22.70) took part in this research. Each focus group discussion lasted approximately 90 minutes and was audiotape-recorded with participants' permission. The recordings were transcribed verbatim. A framework approach was used to analyse the transcripts. The findings from this research uncovered a range of barriers and facilitators that impact upon the uptake of NHS Direct. 'Non-users' were unaware of the range of services that NHS Direct provided. Furthermore, 'non-users' highlighted a preference for face-to face communication, identifying a lack of confidence in discussing healthcare over the telephone. This was particularly evident among older people with cognitive difficulties. The cost to telephone a '0845' number from a mobile was also viewed to be a barrier to access NHS Direct, expressed more often by 'non-users' from deprived communities. NHS Direct 'users' identified that awareness, ease of use and convenience were facilitators which influenced their decision to use the service. An understanding of the barriers and facilitators which impact on the access and uptake of telephone-based healthcare is essential to move patients towards the self-care model. This research has highlighted the need for telephone-based healthcare services to increase public awareness; through

Healthcare providers' perceptions of barriers in implementing of home telecare in Taiwan: a qualitative study.

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Chiang, Kuei-Feng; Wang, Hsiu-Hung; Chien, I-Kuang; Liou, Jhao-Kun; Hung, Chung-Lieh; Huang, Chien-Min; Yang, Feng-Yueh

2015-04-01

Telecare has not only brought down medical expenses, but has also become an important tool to address healthcare needs. In recent years, the Taiwanese government has been concerned about this healthcare issue. However, only a few hospitals provide telecare. This study aims at investigating the barriers that healthcare providers face while implementing home telecare in Taiwan. A qualitative research design was employed in this study, with semi-structured in-depth interviews. The sample was obtained from five hospitals, including three medical centers and two regional hospitals. A total of 31 healthcare providers were interviewed, including case managers (n=11), administrators (n=7), physicians (n=7), and nurses (n=6). The results were summarized into five themes, including: (1) unsuitable laws and vague policies, (2) the policy implementation fails to meet public needs, (3) lack of organizational support, (4) lack of quality and convenience of the system, and (5) inadequate public perception and attitudes. Obstacles in policy and regulations are the most fundamental difficulties for telecare implementation, therefore the government should provide a clear direction by planning policies, legislate appropriate regulations, and incorporate telecare into the scope of medical insurance, in order to improve the environment and stimulate the telecare service market. In order to improve the success rate of telecare, administrators should be able to identify an appropriate cost-benefit model to build a humane system to satisfy public needs and to provide staff with resources and support. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

The role of the surface environment in healthcare-associated infections.

Science.gov (United States)

Weber, David J; Anderson, Deverick; Rutala, William A

2013-08-01

This article reviews the evidence demonstrating the importance of contamination of hospital surfaces in the transmission of healthcare-associated pathogens and interventions scientifically demonstrated to reduce the levels of microbial contamination and decrease healthcare-associated infections. The contaminated surface environment in hospitals plays an important role in the transmission of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), Clostridium difficile, Acinetobacter spp., and norovirus. Improved surface cleaning and disinfection can reduce transmission of these pathogens. 'No-touch' methods of room disinfection (i.e., devices which produce ultraviolet light or hydrogen peroxide) and 'self-disinfecting' surfaces (e.g., copper) also show promise to decrease contamination and reduce healthcare-associated infections. Hospital surfaces are frequently contaminated with important healthcare-associated pathogens. Contact with the contaminated environment by healthcare personnel is equally as likely as direct contact with a patient to lead to contamination of the healthcare provider's hands or gloves that may result in patient-to-patient transmission of nosocomial pathogens. Admission to a room previously occupied by a patient with MRSA, VRE, Acinetobacter, or C. difficile increases the risk for the subsequent patient admitted to the room to acquire the pathogen. Improved cleaning and disinfection of room surfaces decreases the risk of healthcare-associated infections.

NUFFT-Based Iterative Image Reconstruction via Alternating Direction Total Variation Minimization for Sparse-View CT

Directory of Open Access Journals (Sweden)

Bin Yan

2015-01-01

Full Text Available Sparse-view imaging is a promising scanning method which can reduce the radiation dose in X-ray computed tomography (CT. Reconstruction algorithm for sparse-view imaging system is of significant importance. The adoption of the spatial iterative algorithm for CT image reconstruction has a low operation efficiency and high computation requirement. A novel Fourier-based iterative reconstruction technique that utilizes nonuniform fast Fourier transform is presented in this study along with the advanced total variation (TV regularization for sparse-view CT. Combined with the alternating direction method, the proposed approach shows excellent efficiency and rapid convergence property. Numerical simulations and real data experiments are performed on a parallel beam CT. Experimental results validate that the proposed method has higher computational efficiency and better reconstruction quality than the conventional algorithms, such as simultaneous algebraic reconstruction technique using TV method and the alternating direction total variation minimization approach, with the same time duration. The proposed method appears to have extensive applications in X-ray CT imaging.

Minor mental disorders in Taiwanese healthcare workers and the associations with psychosocial work conditions

OpenAIRE

Cheng, Wan-Ju; Cheng, Yawen

2017-01-01

Healthcare workers face multiple psychosocial work hazards intrinsic to their work, including heavy workloads and shift work. However, how contemporary adverse psychosocial work conditions, such as workplace justice and insecurity, may contribute to increased mental health risks has rarely been studied. This study aimed to search for modifiable psychosocial work factors associated with mental health disorders in Taiwanese healthcare workers. Methods: A total of 349 healthcare workers were ...

Correlates of healthcare and financial decision making among older adults without dementia.

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Stewart, Christopher C; Yu, Lei; Wilson, Robert S; Bennett, David A; Boyle, Patricia A

2018-03-22

Healthcare and financial decision making among older persons has been previously associated with cognition, health and financial literacy, and risk aversion; however, the manner by which these resources support decision making remains unclear, as past studies have not systematically investigated the pathways linking these resources with decision making. In the current study, we use path analysis to examine the direct and indirect pathways linking age, education, cognition, literacy, and risk aversion with decision making. We also decomposed literacy into its subcomponents, conceptual knowledge and numeracy, in order to examine their associations with decision making. Participants were 937 community-based older adults without dementia from the Rush Memory and Aging Project who completed a battery of cognitive tests and assessments of healthcare and financial decision making, health and financial literacy, and risk aversion. Age and education exerted effects on decision making, but nearly two thirds of their effects were indirect, working mostly through cognition and literacy. Cognition exerted a strong direct effect on decision making and a robust indirect effect working primarily through literacy. Literacy also exerted a powerful direct effect on decision making, as did its subcomponents, conceptual knowledge and numeracy. The direct effect of risk aversion was comparatively weak. In addition to cognition, health and financial literacy emerged as independent and primary correlates of healthcare and financial decision making. These findings suggest specific actions that might be taken to optimize healthcare and financial decision making and, by extension, improve health and well-being in advanced age. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Redefining the Core Competencies of Future Healthcare Executives under Healthcare Reform

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Love, Dianne B.; Ayadi, M. Femi

2015-01-01

As the healthcare industry has evolved over the years, so too has the administration of healthcare organizations. The signing into law of the Patient Protection and Affordable Care Act (ACA) has brought additional changes to the healthcare industry that will require changes to the healthcare administration curriculum. The movement toward a…

The global impact of non-communicable diseases on healthcare spending and national income: a systematic review.

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Muka, Taulant; Imo, David; Jaspers, Loes; Colpani, Veronica; Chaker, Layal; van der Lee, Sven J; Mendis, Shanthi; Chowdhury, Rajiv; Bramer, Wichor M; Falla, Abby; Pazoki, Raha; Franco, Oscar H

2015-04-01

The impact of non-communicable diseases (NCDs) in populations extends beyond ill-health and mortality with large financial consequences. To systematically review and meta-analyze studies evaluating the impact of NCDs (including coronary heart disease, stroke, type 2 diabetes mellitus, cancer (lung, colon, cervical and breast), chronic obstructive pulmonary disease and chronic kidney disease) at the macro-economic level: healthcare spending and national income. Medical databases (Medline, Embase and Google Scholar) up to November 6th 2014. For further identification of suitable studies, we searched reference lists of included studies and contacted experts in the field. We included randomized controlled trials, systematic reviews, cohorts, case-control, cross-sectional, modeling and ecological studies carried out in adults assessing the economic consequences of NCDs on healthcare spending and national income without language restrictions. All abstracts and full text selection was done by two independent reviewers. Any disagreements were resolved through consensus or consultation of a third reviewer. Data were extracted by two independent reviewers using a pre-designed data collection form. Studies evaluating the impact of at least one of the selected NCDs on at least one of the following outcome measures: healthcare expenditure, national income, hospital spending, gross domestic product (GDP), gross national product, net national income, adjusted national income, total costs, direct costs, indirect costs, inpatient costs, outpatient costs, per capita healthcare spending, aggregate economic outcome, capital loss in production levels in a country, economic growth, GDP per capita (per capita income), percentage change in GDP, intensive growth, extensive growth, employment, direct governmental expenditure and non-governmental expenditure. From 4,364 references, 153 studies met our inclusion criteria. Most of the studies were focused on healthcare related costs of NCDs

Healthcare Services Expenditure: A Case Study in Isfahan Province, Iran

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Ferdosi

2015-01-01

Full Text Available Background Determining and understanding of healthcare costs and its financing method is one of the most important subjects understatement of which can cause such major problems as excessive health costs for households due to the high rate of out-of-pocket expenses. Objectives The current study aimed to analyze the healthcare costs and determine the share of Isfahan province, Iran, from the total healthcare costs of the country from 2006 to 2011. Materials and Methods It was a retrospective and descriptive-analytical study. The required statistical data were gathered from statistical yearbooks of the country and the province, the website of the World Bank, the statistics provided by the Healthcare Department of Isfahan and Kashan Universities of Medical Sciences and the statistical data provided by Iran Statistics Center in 2011, all covering the period of six years from 2006 to 2011. Excel software was used for data analysis and computations of the research. Results During this period, the annual growth average of healthcare and treatment costs were 12% and 20%, respectively. The share of the healthcare sector declined from 33% in 2006 to 25.4% in 2011. In other words, healthcare cost per capita, being about one second of the treatment cost per capita, reduced to a third of treatment per capita in 2011. Conclusions Efficient allocation of financial resources in the healthcare system based on specific goals and strategies, coordination of public and private sectors in providing healthcare services, the rising share of the healthcare sector in GDP of the province and the country, and the preference of prevention over treatment measures can affect achieving the healthcare system goals and surmount challenges such as pay-out-of-pocket and rising healthcare costs, particularly the costs of integrated treatment with full performance.

Patterns of Nonemergent Visits to Different Healthcare Facilities on the Same Day: A Nationwide Analysis in Taiwan

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Meng-Hsuan Wu

2014-01-01

Full Text Available Doctor shopping is a common phenomenon in many countries. However, patterns of switching healthcare facilities on the same day were little known. The data were obtained from the longitudinal cohort datasets (LHID2010 of Taiwan’s National Health Insurance Research Database in 2010. Of 1,000,000 persons of the cohort with 13,276,928 nonemergent visits, 185,347 patients had visited different healthcare facilities within one day, with a total of 672,478 visits and 337,260 switches between facilities in 329,073 patient-days. While 63.0% (n=212,590 of all switches occurred between facilities of the same accreditation level, 14.1% (n=47,664 moved from lower to higher level, and 22.8% (n=77,006 moved in the opposite direction. In 33,689 switches, patients moved to the same specialty of another facility. In 48,324 switches, patients moved to another facility with the same diagnosis, and the most frequent diagnoses were diseases of the digestive system (11,148 and diseases of the respiratory system (10,393. In a densely populated country without strict referral regulation, a high percentage of Taiwanese people had the experience of visiting different healthcare facilities on the same day. The system of family physicians as personal doctors and gatekeepers to healthcare might ameliorate the harmful impact.

Intercultural health and ethnobotany: how to improve healthcare for underserved and minority communities?

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Vandebroek, Ina

2013-07-30

The present conceptual review explores intercultural healthcare--defined as the integration of traditional medicine and biomedicine as complementary healthcare systems--in minority and underserved communities. This integration can take place at different levels: individuals (patients, healers, biomedical healthcare providers), institutions (health centers, hospitals) or society (government policy). Contemporary ethnobotany research of traditional medicine has primarily dealt with the botanical identification of plants commonly used by local communities, and the identification of health conditions treated with these plants, whereas ethnopharmacology has focused on the bioactivity of traditional remedies. On the other hand, medical anthropology seems to be the scholarship more involved with research into patients' healthcare-seeking itineraries and their interaction with traditional versus biomedical healthcare systems. The direct impact of these studies on public health of local communities can be contested. To compare and discuss the body of scholarly work that deals with different aspects of traditional medicine in underserved and minority communities, and to reflect on how gaps identified in research can be bridged to help improve healthcare in these communities. The literature covers a broad range of information of relevance to intercultural healthcare. This information is fragmented across different scientific and clinical disciplines. A conceptual review of these studies identifies a clear need to devote more attention to ways in which research on traditional medicine can be more effectively applied to improve local public health in biomedical resource-poor settings, or in geographic areas that have disparities in access to healthcare. Scholars studying traditional medicine should prioritize a more interdisciplinary and applied perspective to their work in order to forge a more direct social impact on public health in local communities most in need of

Household catastrophic healthcare expenditure and impoverishment due to rotavirus gastroenteritis requiring hospitalization in Malaysia.

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Tharani Loganathan

Full Text Available While healthcare costs for rotavirus gastroenteritis requiring hospitalization may be burdensome on households in Malaysia, exploration on the distribution and catastrophic impact of these expenses on households are lacking.We assessed the economic burden, levels and distribution of catastrophic healthcare expenditure, the poverty impact on households and inequities related to healthcare payments for acute gastroenteritis requiring hospitalization in Malaysia.A two-year prospective, hospital-based study was conducted from 2008 to 2010 in an urban (Kuala Lumpur and rural (Kuala Terengganu setting in Malaysia. All children under the age of 5 years admitted for acute gastroenteritis were included. Patients were screened for rotavirus and information on healthcare expenditure was obtained.Of the 658 stool samples collected at both centers, 248 (38% were positive for rotavirus. Direct and indirect costs incurred were significantly higher in Kuala Lumpur compared with Kuala Terengganu (US$222 Vs. US$45; p<0.001. The mean direct and indirect costs for rotavirus gastroenteritis consisted 20% of monthly household income in Kuala Lumpur, as compared with only 5% in Kuala Terengganu. Direct medical costs paid out-of-pocket caused 141 (33% households in Kuala Lumpur to experience catastrophic expenditure and 11 (3% households to incur poverty. However in Kuala Terengganu, only one household (0.5% experienced catastrophic healthcare expenditure and none were impoverished. The lowest income quintile in Kuala Lumpur was more likely to experience catastrophic payments compared to the highest quintile (87% vs 8%. The concentration index for out-of-pocket healthcare payments was closer to zero at Kuala Lumpur (0.03 than at Kuala Terengganu (0.24.While urban households were wealthier, healthcare expenditure due to gastroenteritis had more catastrophic and poverty impact on the urban poor. Universal rotavirus vaccination would reduce both disease burden and health

Water, sanitation and hygiene in Jordan's healthcare facilities.

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Khader, Yousef Saleh

2017-08-14

Purpose The purpose of this paper is to determine water availability, sanitation and hygiene (WSH) services, and healthcare waste management in Jordan healthcare facilities. Design/methodology/approach In total, 19 hospitals (15 public and four private) were selected. The WSH services were assessed in hospitals using the WSH in health facilities assessment tool developed for this purpose. Findings All hospitals (100 percent) had a safe water source and most (84.2 percent) had functional water sources to provide enough water for users' needs. All hospitals had appropriate and sufficient gender separated toilets in the wards and 84.2 percent had the same in outpatient settings. Overall, 84.2 percent had sufficient and functioning handwashing basins with soap and water, and 79.0 percent had sufficient showers. Healthcare waste management was appropriately practiced in all hospitals. Practical implications Jordan hospital managers achieved major achievements providing access to drinking water and improved sanitation. However, there are still areas that need improvements, such as providing toilets for patients with special needs, establishing handwashing basins with water and soap near toilets, toilet maintenance and providing sufficient trolleys for collecting hazardous waste. Efforts are needed to integrate WSH service policies with existing national policies on environmental health in health facilities, establish national standards and targets for the various healthcare facilities to increase access and improve services. Originality/value There are limited WSH data on healthcare facilities and targets for basic coverage in healthcare facilities are also lacking. A new assessment tool was developed to generate core WSH indicators and to assess WSH services in Jordan's healthcare facilities. This tool can be used by a non-WSH specialist to quickly assess healthcare facility-related WSH services and sanitary hazards in other countries. This tool identified some areas

Comparative health technology assessment of robotic-assisted, direct manual laparoscopic and open surgery: a prospective study.

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Turchetti, Giuseppe; Pierotti, Francesca; Palla, Ilaria; Manetti, Stefania; Freschi, Cinzia; Ferrari, Vincenzo; Cuschieri, Alfred

2017-02-01

Despite many publications reporting on the increased hospital cost of robotic-assisted surgery (RAS) compared to direct manual laparoscopic surgery (DMLS) and open surgery (OS), the reported health economic studies lack details on clinical outcome, precluding valid health technology assessment (HTA). The present prospective study reports total cost analysis on 699 patients undergoing general surgical, gynecological and thoracic operations between 2011 and 2014 in the Italian Public Health Service, during which period eight major teaching hospitals treated the patients. The study compared total healthcare costs of RAS, DMLS and OS based on prospectively collected data on patient outcome in addition to healthcare costs incurred by the three approaches. The cost of RAS operations was significantly higher than that of OS and DMLS for both gynecological and thoracic operations (p DMLS. Total costs of general surgery RAS were significantly higher than those of OS (p DMLS general surgery. Indirect costs were significantly lower in RAS compared to both DMLS general surgery and OS gynecological surgery due to the shorter length of hospital stay of RAS approach (p < 0.001). Additionally, in all specialties compared to OS, patients treated by RAS experienced a quicker recovery and significantly less pain during the hospitalization and after discharge. The present HTA while confirming higher total healthcare costs for RAS operations identified significant clinical benefits which may justify the increased expenditure incurred by this approach.

Healthcare

Science.gov (United States)

Carnevale, Anthony P.; Smith, Nicole; Gulish, Artem; Beach, Bennett H.

2012-01-01

This report, provides detailed analyses and projections of occupations in healthcare fields, and wages earned. In addition, the important skills and work values associated with workers in those fields of healthcare are discussed. Finally, the authors analyze the implications of research findings for the racial, ethnic, and class diversity of the…

Total direct cost, length of hospital stay, institutional discharges and their determinants from rehabilitation settings in stroke patients.

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Saxena, S K; Ng, T P; Yong, D; Fong, N P; Gerald, K

2006-11-01

Length of hospital stay (LOHS) is the largest determinant of direct cost for stroke care. Institutional discharges (acute care and nursing homes) from rehabilitation settings add to the direct cost. It is important to identify potentially preventable medical and non-medical reasons determining LOHS and institutional discharges to reduce the direct cost of stroke care. The aim of the study was to ascertain the total direct cost, LOHS, frequency of institutional discharges and their determinants from rehabilitation settings. Observational study was conducted on 200 stroke patients in two rehabilitation settings. The patients were examined for various socio-demographic, neurological and clinical variables upon admission to the rehabilitation hospitals. Information on total direct cost and medical complications during hospitalization were also recorded. The outcome variables measured were total direct cost, LOHS and discharges to institutions (acute care and nursing home facility) and their determinants. The mean and median LOHS in our study were 34 days (SD = 18) and 32 days respectively. LOHS and the cost of hospital stay were significantly correlated. The significant variables associated with LOHS on multiple linear regression analysis were: (i) severe functional impairment/functional dependence Barthel Index institutional discharges (22 to acute care and 17 to nursing homes). On multivariate analysis the significant predictors of discharges to institutions from rehabilitation hospitals were medical complications (OR = 4.37; 95% CI 1.01-12.53) and severe functional impairment/functional dependence. (OR = 5.90, 95% CI 2.32-14.98). Length of hospital stay and discharges to institutions from rehabilitation settings are significantly determined by medical complications. Importance of adhering to clinical pathway/protocol for stroke care is further discussed.

Improving Healthcare through Lean Management: Experiences from the Danish healthcare system

DEFF Research Database (Denmark)

Edwards, Kasper; Nielsen, Anders Paarup

still is in its infancy and it is just a matter of letting sufficient time pass in order have a successful implementation of lean in all areas of healthcare. The second hypothesis states that a major barrier to lean management in healthcare simply is lacking understanding of the lean concepts leading......The ideas and principles from lean management are now widely being adopted within the healthcare sector. The analysis in this paper shows that organizations within healthcare most often only implement a limited set of tools and methods from the lean tool-box. Departing from a theoretical analysis...... of the well-known and universal lean management principles in the context of the healthcare this paper will attempt to formulate and test four hypotheses about possible barriers to the successful implementation of lean management in healthcare. The first hypothesis states that lean management in healthcare...

Workplace Violence and Job Performance among Community Healthcare Workers in China: The Mediator Role of Quality of Life

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Lin, Wei-Quan; Wu, Jiang; Yuan, Le-Xin; Zhang, Sheng-Chao; Jing, Meng-Juan; Zhang, Hui-Shan; Luo, Jia-Li; Lei, Yi-Xiong; Wang, Pei-Xi

2015-01-01

Objective: To explore the impact of workplace violence on job performance and quality of life of community healthcare workers in China, especially the relationship of these three variables. Methods: From December 2013 to April 2014, a total of 1404 healthcare workers were recruited by using the random cluster sampling method from Community Health Centers in Guangzhou and Shenzhen. The workplace violence scale, the job performance scale and the quality of life scale (SF-36) were self-administered. The structural equation model constructed by Amos 17.0 was employed to assess the relationship among these variables. Results: Our study found that 51.64% of the respondents had an experience of workplace violence. It was found that both job performance and quality of life had a negative correlation with workplace violence. A positive association was identified between job performance and quality of life. The path analysis showed the total effect (β = −0.243) of workplace violence on job performance consisted of a direct effect (β = −0.113) and an indirect effect (β = −0.130), which was mediated by quality of life. Conclusions: Workplace violence among community healthcare workers is prevalent in China. The workplace violence had negative effects on the job performance and quality of life of CHCs’ workers. The study suggests that improvement in the quality of life may lead to an effective reduction of the damages in job performance caused by workplace violence. PMID:26610538

Risk of tuberculosis transmission among healthcare workers.

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Diel, Roland; Niemann, Stefan; Nienhaus, Albert

2018-04-01

Data from a prospective molecular-epidemiological study (1997-2015) of patients with culture-confirmed tuberculosis in Hamburg, Germany, were evaluated to assess the occupational risk of Mycobacterium tuberculosis complex transmission in a low-incidence setting. Isolates of M. tuberculosis complex were genotyped using IS6110 restriction fragment length polymorphism analysis. Results of structured questionnaires, geographical mapping and additional patient interviews were used for confirming epidemiological links. Out of the 2393 cases, 918 (38.4%) were classified into 224 clusters comprising 2-70 patients per cluster. Among the 918 cluster members, epidemiological links could be confirmed in 340 (37.0%) patients. In total, 55 (2.3%) patients were healthcare workers; 26 healthcare workers remained unclustered, but 29 healthcare workers belonged to cluster groups. Conventional contact tracing performed before genotyping to identify sources of the reported index cases detected only 73 (3.1%) patients. Logistic regression analysis confirmed work in the healthcare sector as strongest predictor for clustering of patients with verified epidemiological links (odds ratio (OR) 3.1, 95% CI 1.6-5.9), followed by alcoholism (OR 2.3, 95% CI 1.7-3.2) and sputum smear positivity (OR 1.8, 95% CI 1.4-2.3). Immigrants were more likely to be cluster nonmembers (OR 0.3, 95% CI 0.3-0.5). Recent transmission in Hamburg within the 19-year study period was found to be strongly associated with working in a healthcare facility. Although clusters also include many "imported" strains from abroad or regional highly prevalent M. tuberculosis strains with no evident epidemiological connection, routine molecular-epidemiological survey is indispensable to optimising and controlling the effectiveness of TB control strategies in German healthcare settings.

Security issues in healthcare applications using wireless medical sensor networks: a survey.

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Kumar, Pardeep; Lee, Hoon-Jae

2012-01-01

Healthcare applications are considered as promising fields for wireless sensor networks, where patients can be monitored using wireless medical sensor networks (WMSNs). Current WMSN healthcare research trends focus on patient reliable communication, patient mobility, and energy-efficient routing, as a few examples. However, deploying new technologies in healthcare applications without considering security makes patient privacy vulnerable. Moreover, the physiological data of an individual are highly sensitive. Therefore, security is a paramount requirement of healthcare applications, especially in the case of patient privacy, if the patient has an embarrassing disease. This paper discusses the security and privacy issues in healthcare application using WMSNs. We highlight some popular healthcare projects using wireless medical sensor networks, and discuss their security. Our aim is to instigate discussion on these critical issues since the success of healthcare application depends directly on patient security and privacy, for ethic as well as legal reasons. In addition, we discuss the issues with existing security mechanisms, and sketch out the important security requirements for such applications. In addition, the paper reviews existing schemes that have been recently proposed to provide security solutions in wireless healthcare scenarios. Finally, the paper ends up with a summary of open security research issues that need to be explored for future healthcare applications using WMSNs.

Security Issues in Healthcare Applications Using Wireless Medical Sensor Networks: A Survey

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Hoon-Jae Lee

2011-12-01

Full Text Available Healthcare applications are considered as promising fields for wireless sensor networks, where patients can be monitored using wireless medical sensor networks (WMSNs. Current WMSN healthcare research trends focus on patient reliable communication, patient mobility, and energy-efficient routing, as a few examples. However, deploying new technologies in healthcare applications without considering security makes patient privacy vulnerable. Moreover, the physiological data of an individual are highly sensitive. Therefore, security is a paramount requirement of healthcare applications, especially in the case of patient privacy, if the patient has an embarrassing disease. This paper discusses the security and privacy issues in healthcare application using WMSNs. We highlight some popular healthcare projects using wireless medical sensor networks, and discuss their security. Our aim is to instigate discussion on these critical issues since the success of healthcare application depends directly on patient security and privacy, for ethic as well as legal reasons. In addition, we discuss the issues with existing security mechanisms, and sketch out the important security requirements for such applications. In addition, the paper reviews existing schemes that have been recently proposed to provide security solutions in wireless healthcare scenarios. Finally, the paper ends up with a summary of open security research issues that need to be explored for future healthcare applications using WMSNs.

Fairness in healthcare finance and delivery: what about Tunisia?

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Abu-Zaineh, Mohammad; Arfa, Chokri; Ventelou, Bruno; Ben Romdhane, Habiba; Moatti, Jean-Paul

2014-07-01

Anecdotal evidence on hidden inequity in health care in North African countries abounds. Yet firm empirical evidence has been harder to come by. This article fills the gap. It presents the first analysis of equity in the healthcare system using the particular case of Tunisia. Analyses are based on an unusually rich source of data taken from the Tunisian HealthCare Utilization and Morbidity Survey. Payments for health care are derived from the total amount of healthcare spending which was incurred by households over the last year. Utilization of health care is measured by the number of physical units of two types of services: outpatient and inpatient. The measurement of need for health care is apprehended through a rich set of ill-health indicators and demographics. Findings are presented and compared at both the aggregate level, using the general summary index approach, and the disaggregate level, using the distribution-free stochastic dominance approach. The overall picture is that direct out-of-pocket payments, which constitute a sizeable share in the current financing mix, emerge to be a progressive means of financing health care overall. Interestingly, however, when statistical testing is applied at the disaggregate level progressivity is retained over the top half of the distribution. Further analyses of the distributions of need for--and utilization of--two types of health care--outpatient and inpatient--reveal that the observed progressivity is rather an outcome of the heavy use, but not need, for health care at the higher income levels. Several policy relevant factors are discussed, and some recommendations are advanced for future reforms of the health care in Tunisia. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine © The Author 2013; all rights reserved.

Effects of an incinerator project on a healthcare-waste management system.

Science.gov (United States)

Khammaneechan, Patthanasak; Okanurak, Kamolnetr; Sithisarankul, Pornchai; Tantrakarnapa, Kraichat; Norramit, Poonsup

2011-10-01

This evaluative research study aimed to assess the effects of the central healthcare incinerator project on waste management in Yala Province. The study data were collected twice: at baseline and during the operational phase. A combination of structured interview and observation were used during data collection. The study covered 127 healthcare facilities: government hospitals, healthcare centres, and private clinics. The results showed 63% of healthcare risk waste (HCRW) handlers attended the HCRW management training. Improvements in each stage of the HCRW management system were observed in all groups of facilities. The total cost of the HCRW management system did not change, however; the costs for hospitals decreased, whereas those for clinics increased significantly. It was concluded that the central healthcare waste incinerator project positively affected HCRW management in the area, although the costs of management might increase for a particular group. However, the benefits of changing to a more appropriately managed HCRW system will outweigh the increased costs.

Exploiting direct and indirect methods for the detection of the total carotenoid content in dried pasta

NARCIS (Netherlands)

Doka, O.; Bicanic, D.D.; Végvári, G.; Buijnsters, J.G.; Spruijt, R.B.; Luterotti, S.

2010-01-01

The total carotenoid concentration (TCC) of several commercially available dried pastas prepared with or without eggs was assessed by means of the two well-established destructive approaches [spectrophotometry (SP) and high-performance liquid chromatography (HPLC)] and three non-destructive, direct

Significant components of service brand equity in healthcare sector.

Science.gov (United States)

Chahal, Hardeep; Bala, Madhu

2012-01-01

The purpose of the study is to examine three significant components of service brand equity--i.e. perceived service quality, brand loyalty, and brand image--and analyze relationships among the components of brand equity and also their relationship with brand equity, which is still to be theorized and developed in the healthcare literature. Effective responses were received from 206 respondents, selected conveniently from the localities of Jammu city. After scale item analysis, the data were analyzed using factor analysis, correlations, t-tests, multiple regression analysis and path modeling using SEM. The findings of the study support that service brand equity in the healthcare sector is greatly influenced by brand loyalty and perceived quality. However, brand image has an indirect effect on service brand equity through brand loyalty (mediating variable). The research can be criticized on the ground that data were selected conveniently from respondents residing in the city of Jammu, India. But at the same time the respondents were appropriate for the study as they have adequate knowledge about the hospitals, and were associated with the selected hospital for more than four years. Furthermore, the validity and reliability of the data are strong enough to take care of the limitations of the convenience sampling selection method. The study has unique value addition to the service marketing vis-à-vis healthcare literature, from both theoretical and managerial perspectives. The study establishes a direct and significant relationship between service brand equity and its two components, i.e. perceived service quality and brand loyalty in the healthcare sector. It also provides directions to healthcare service providers in creating, enhancing, and maintaining service brand equity through service quality and brand loyalty, to sustain competitive advantage.

Emotions in relation to healthcare encounters affecting self-esteem.

Science.gov (United States)

Räty, Lena; Gustafsson, Barbro

2006-02-01

This study identifies emotions in patients with epilepsy as a result of confirming and disconfirming healthcare experiences. A discussion of emotions as a motive for patients' goal-directed actions was a further aim of this study. The critical incident method was used for data collection. Emotions occurring in confirming and disconfirming healthcare encounters were analyzed using the Belief-Desire Theory of Emotions and were categorized as basic, complex, or self-evaluating. Confirming encounters aroused emotions like hope, a feeling of security, joy, relief, and pride, while disconfirming encounters aroused emotions like despair, fear, unrest, resignation, shame, and guilt. The emotions identified in the healthcare encounters were recognized as motives for action. An emotion such as a feeling of security aroused a desire in the patients to strengthen their positive self and motivated them to have a constructive and sympathetic attitude toward the healthcare experience. An emotion such as anger caused patients to strive to maintain their self-respect either by avoiding difficult situations and ignoring the problem (patients with a low self-esteem) or by trying to re-create a positive self-image (patients with a high self-esteem). Healthcare encounters between patient and caregiver considerably affect the patient's emotional status and thereby his or her well-being. The importance of establishing healthcare encounters that evoke positive emotions that strengthen patients' resources must be addressed in future nursing care.

Electronic healthcare information security

CERN Document Server

Dube, Kudakwashe; Shoniregun, Charles A

2010-01-01

The ever-increasing healthcare expenditure and pressing demand for improved quality and efficiency of patient care services are driving innovation in healthcare information management. The domain of healthcare has become a challenging testing ground for information security due to the complex nature of healthcare information and individual privacy. ""Electronic Healthcare Information Security"" explores the challenges of e-healthcare information and security policy technologies. It evaluates the effectiveness of security and privacy implementation systems for anonymization methods and techniqu

Barriers to healthcare for transgender individuals.

Science.gov (United States)

Safer, Joshua D; Coleman, Eli; Feldman, Jamie; Garofalo, Robert; Hembree, Wylie; Radix, Asa; Sevelius, Jae

2016-04-01

Transgender persons suffer significant health disparities and may require medical intervention as part of their care. The purpose of this manuscript is to briefly review the literature characterizing barriers to healthcare for transgender individuals and to propose research priorities to understand mechanisms of those barriers and interventions to overcome them. Current research emphasizes sexual minorities' self-report of barriers, rather than using direct methods. The biggest barrier to healthcare reported by transgender individuals is lack of access because of lack of providers who are sufficiently knowledgeable on the topic. Other barriers include: financial barriers, discrimination, lack of cultural competence by providers, health systems barriers, and socioeconomic barriers. National research priorities should include rigorous determination of the capacity of the US healthcare system to provide adequate care for transgender individuals. Studies should determine knowledge and biases of the medical workforce across the spectrum of medical training with regard to transgender medical care; adequacy of sufficient providers for the care required, larger social structural barriers, and status of a framework to pay for appropriate care. As well, studies should propose and validate potential solutions to address identified gaps.

Attitudes and Perceptions of Healthcare Providers and Medical ...

African Journals Online (AJOL)

Purpose: To explore healthcare providers' (HCPs) and medical students' attitudes to, and perceptions of the pharmaceutical services that clinical pharmacists can provide in United Arab Emirates. Methods: A total of 535 participants (265 HCPs and 270 medical students) were asked to complete a questionnaire over a ...

Patient Experience: The New Heart of Healthcare Leadership.

Science.gov (United States)

Wolf, Jason A

2017-01-01

In a healthcare world in which consumerism is no longer a question and value has claimed its place at center stage, leaders are called to think differently about how they operate and manage their organizations. Priorities are curving in new directions with shifts in policy, direction of dollars, and evolution of practice. At the center of this transition is an opportunity for healthcare leaders to recognize that patient experience is the new heart of healthcare leadership.To address quality, safety, service, cost, and population health outcomes, leaders must rethink how they understand and engage in experience efforts overall. An intentional and clear strategic line of sight and purpose are required, including how patient experience is defined, the core concepts it comprises and is influenced by, and the outcomes it ultimately helps achieve. The challenge for leaders is to reconceive how this maximum potential can be achieved as compared with how experience has been traditionally managed through tactical efforts.Quick lists of effective tactics are relatively easy to come by, and leaders are already aware of many, if not most, of them. So why do so many organizations applying these tactics today struggle to maintain the results they seek? The reason is that tactics are only as useful as the framework in which they are applied and as robust as the foundation on which they are implemented. The intent of this article is to stir a dialogue on how to reframe the issue of patient experience.In reframing a collective view about what patient experience is, the way leaders choose to address it must change. This adjustment requires balancing the work of defining patient experience with the strategic intent behind what organizations ultimately aim to achieve. In changing the conversation on patient experience, we move it from an idea that lurks at the edges of healthcare, or that stands as just one of many strategic pillars, to the central call to action for healthcare

Healthcare Data Gateways: Found Healthcare Intelligence on Blockchain with Novel Privacy Risk Control.

Science.gov (United States)

Yue, Xiao; Wang, Huiju; Jin, Dawei; Li, Mingqiang; Jiang, Wei

2016-10-01

Healthcare data are a valuable source of healthcare intelligence. Sharing of healthcare data is one essential step to make healthcare system smarter and improve the quality of healthcare service. Healthcare data, one personal asset of patient, should be owned and controlled by patient, instead of being scattered in different healthcare systems, which prevents data sharing and puts patient privacy at risks. Blockchain is demonstrated in the financial field that trusted, auditable computing is possible using a decentralized network of peers accompanied by a public ledger. In this paper, we proposed an App (called Healthcare Data Gateway (HGD)) architecture based on blockchain to enable patient to own, control and share their own data easily and securely without violating privacy, which provides a new potential way to improve the intelligence of healthcare systems while keeping patient data private. Our proposed purpose-centric access model ensures patient own and control their healthcare data; simple unified Indicator-Centric Schema (ICS) makes it possible to organize all kinds of personal healthcare data practically and easily. We also point out that MPC (Secure Multi-Party Computing) is one promising solution to enable untrusted third-party to conduct computation over patient data without violating privacy.

Direct radioimmunoassay (RIA) of salivary testosterone: correlation with free and total serium testosterone

International Nuclear Information System (INIS)

Vittek, J.; L'Hommedieu, D.G.; Gordon, G.G.; Rappaport, S.C.; Southren, A.L.

1985-01-01

Simple and sensitive direct RIA for determination of salivary testosterone was developed by using RSL NOSOLVEX TM (125 1) kit produced by Radioassay System Laboratories (Carcon, California). In addition, a relationship between salivary and serum free and total testosterone concentrations was studied in randomly selected 45 healthy subjects, 5 females on oral contraceptive pills and 28 hypertensive patients on various treatment regimens. The lowest weight of testosterone detectable by the modified method was equivalent to 1 pg/ml of saliva, taking into account analytical variability. Intra- and interassay coefficients of variation were 5.09 +/- 2.7% and 8.2 +/- 5.9% respectively. Statistically significant correlations were found between salivary and serum free testosterone (r = 0.97) and salivary and serum total testosterone concentrations (r = 0.70 - 0.87). The exception to this was a group of hypertensive females in which no correlation (r = 0.14) between salivary and total serum testosterone was found. It is also of interest that, while salivary testosterone was significantly increased in subjects taking oral contraceptives and most of the hypertensive patients, the total serum testosterone concentration was in normal range. These findings suggest that the determination of salivary testosterone is a reliable method to detect changes in the concentration of available biologically active hormone in the circulation. 21 references, 4 figures, 1 table

Management of health-care waste in Izmir, Turkey

Directory of Open Access Journals (Sweden)

Ahmet Soysal

2010-01-01

Full Text Available The aim of this study was to evaluate health-care waste in the 18 districts of metropolitan municipality of the third biggest city in Turkey. This cross-sectional study was carried out with 825 health institutions established in the 18 districts of Izmir metropolitan municipality, in 2007. The total amount of health-care waste collected was 4841 tons and 621 kilograms per patient's bed in 2007. Most of the medical wastes were collected from Konak, Karsiyaka and Bornova districts and were 2308, 272 and 1020 tons, respectively. Regarding to overpopulation, the number of health institutions in these districts are more than the number of health institutions in the other administrative districts. There was a statistically significant, positive correlation between the amount of health-care waste collected and population of the 18 districts (r = 0.79, p < 0.001, and number of beds/patients (r = 0.83, p < 0.001. To provide a safe health-care waste management metropolitan municipality must provide hazardous waste separation in health institutions, establish sterilization units for infectious waste, and provide the last storage of medical waste in completely different, safe and special areas apart from the municipal waste storage areas.

Innovative use of the integrative review to evaluate evidence of technology transformation in healthcare.

Science.gov (United States)

Phillips, Andrew B; Merrill, Jacqueline A

2015-12-01

Healthcare is in a period significant transformational activity through the accelerated adoption of healthcare technologies, new reimbursement systems that emphasize shared savings and care coordination, and the common place use of mobile technologies by patients, providers, and others. The complexity of healthcare creates barriers to transformational activity and has the potential to inhibit the desired paths toward change envisioned by policymakers. Methods for understanding how change is occurring within this complex environment are important to the evaluation of delivery system reform and the role of technology in healthcare transformation. This study examines the use on an integrative review methodology to evaluate the healthcare literature for evidence of technology transformation in healthcare. The methodology integrates the evaluation of a broad set of literature with an established evaluative framework to develop a more complete understanding of a particular topic. We applied this methodology and the framework of punctuated equilibrium (PEq) to the analysis of the healthcare literature from 2004 to 2012 for evidence of technology transformation, a time during which technology was at the forefront of healthcare policy. The analysis demonstrated that the established PEq framework applied to the literature showed considerable potential for evaluating the progress of policies that encourage healthcare transformation. Significant inhibitors to change were identified through the integrative review and categorized into ten themes that describe the resistant structure of healthcare delivery: variations in the environment; market complexity; regulations; flawed risks and rewards; change theories; barriers; ethical considerations; competition and sustainability; environmental elements, and internal elements. We hypothesize that the resistant nature of the healthcare system described by this study creates barriers to the direct consumer involvement and engagement

ERP (enterprise resource planning) systems can streamline healthcare business functions.

Science.gov (United States)

Jenkins, E K; Christenson, E

2001-05-01

Enterprise resource planning (ERP) software applications are designed to facilitate the systemwide integration of complex processes and functions across a large enterprise consisting of many internal and external constituents. Although most currently available ERP applications generally are tailored to the needs of the manufacturing industry, many large healthcare systems are investigating these applications. Due to the significant differences between manufacturing and patient care, ERP-based systems do not easily translate to the healthcare setting. In particular, the lack of clinical standardization impedes the use of ERP systems for clinical integration. Nonetheless, an ERP-based system can help a healthcare organization integrate many functions, including patient scheduling, human resources management, workload forecasting, and management of workflow, that are not directly dependent on clinical decision making.

Healthcare Robotics

OpenAIRE

Riek, Laurel D.

2017-01-01

Robots have the potential to be a game changer in healthcare: improving health and well-being, filling care gaps, supporting care givers, and aiding health care workers. However, before robots are able to be widely deployed, it is crucial that both the research and industrial communities work together to establish a strong evidence-base for healthcare robotics, and surmount likely adoption barriers. This article presents a broad contextualization of robots in healthcare by identifying key sta...

Compassion, Mindfulness, and the Happiness of Healthcare Workers.

Science.gov (United States)

Benzo, Roberto P; Kirsch, Janae L; Nelson, Carlie

Decreased well-being of healthcare workers expressed as stress and decreased job satisfaction influences patient safety, patient satisfaction, and cost containment. Self-compassion has garnered recent attention due to its positive association with well-being and happiness. Discovering novel pathways to increase the well-being of healthcare workers is essential. This study sought to explore the influence of self-compassion on employee happiness in healthcare professionals. A total of 400 participants (mean age = 45 ± 14, 65% female) healthcare workers at a large teaching hospital were randomly asked to complete questionnaires assessing their levels of happiness and self-compassion, life conditions, and habits. Participants completed the Happiness Scale and Self-Compassion Scales, the Five Facet Mindfulness Questionnaire as well as variables associated with well-being: relationship status, the number of hours spent exercising a week, attendance at a wellness facility, and engagement in a regular spiritual practice. Self-compassion was significantly and independently associated with perceived happiness explaining 39% of its variance after adjusting for age, marital status, gender, time spent exercising, and attendance to an exercise facility. Two specific subdomains of self-compassion from the instrument used, coping with isolation and mindfulness, accounted for 95% of the self-compassion effect on happiness. Self-compassion is meaningfully and independently associated with happiness and well-being in healthcare professionals. Our results may have practical implications by providing specific self-compassion components to be targeted in future programs aimed at enhancing well-being in healthcare professionals. Copyright © 2017 Elsevier Inc. All rights reserved.

Functional results-oriented healthcare leadership: a novel leadership model.

Science.gov (United States)

Al-Touby, Salem Said

2012-03-01

This article modifies the traditional functional leadership model to accommodate contemporary needs in healthcare leadership based on two findings. First, the article argues that it is important that the ideal healthcare leadership emphasizes the outcomes of the patient care more than processes and structures used to deliver such care; and secondly, that the leadership must strive to attain effectiveness of their care provision and not merely targeting the attractive option of efficient operations. Based on these premises, the paper reviews the traditional Functional Leadership Model and the three elements that define the type of leadership an organization has namely, the tasks, the individuals, and the team. The article argues that concentrating on any one of these elements is not ideal and proposes adding a new element to the model to construct a novel Functional Result-Oriented healthcare leadership model. The recommended Functional-Results Oriented leadership model embosses the results element on top of the other three elements so that every effort on healthcare leadership is directed towards attaining excellent patient outcomes.

Direct Costs of Very Old Persons with Subsyndromal Depression: A 5-Year Prospective Study.

Science.gov (United States)

Ludvigsson, Mikael; Bernfort, Lars; Marcusson, Jan; Wressle, Ewa; Milberg, Anna

2018-03-15

This study aimed to compare, over a 5-year period, the prospective direct healthcare costs and service utilization of persons with subsyndromal depression (SSD) and non-depressive persons (ND), in a population of very old persons. A second aim was to develop a model that predicts direct healthcare costs in very old persons with SSD. A prospective population-based study was undertaken on 85-year-old persons in Sweden. Depressiveness was screened with the Geriatric Depression Scale at baseline and at 1-year follow-up, and the results were classified into ND, SSD, and syndromal depression. Data on individual healthcare costs and service use from a 5-year period were derived from national database registers. Direct costs were compared between categories using Mann-Whitney U tests, and a prediction model was identified with linear regression. For persons with SSD, the direct healthcare costs per month of survival exceeded those of persons with ND by a ratio 1.45 (€634 versus €436), a difference that was significant even after controlling for somatic multimorbidity. The final regression model consisted of five independent variables predicting direct healthcare costs: male sex, activities of daily living functions, loneliness, presence of SSD, and somatic multimorbidity. SSD among very old persons is associated with increased direct healthcare costs independently of somatic multimorbidity. The associations between SSD, somatic multimorbidity, and healthcare costs in the very old need to be analyzed further in order to better guide allocation of resources in health policy. Copyright © 2018 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

Factors Influencing Healthcare Service Quality

Directory of Open Access Journals (Sweden)

Ali Mohammad Mosadeghrad

2014-07-01

Full Text Available Background The main purpose of this study was to identify factors that influence healthcare quality in the Iranian context. Methods Exploratory in-depth individual and focus group interviews were conducted with 222 healthcare stakeholders including healthcare providers, managers, policy-makers, and payers to identify factors affecting the quality of healthcare services provided in Iranian healthcare organisations. Results Quality in healthcare is a production of cooperation between the patient and the healthcare provider in a supportive environment. Personal factors of the provider and the patient, and factors pertaining to the healthcare organisation, healthcare system, and the broader environment affect healthcare service quality. Healthcare quality can be improved by supportive visionary leadership, proper planning, education and training, availability of resources, effective management of resources, employees and processes, and collaboration and cooperation among providers. Conclusion This article contributes to healthcare theory and practice by developing a conceptual framework that provides policy-makers and managers a practical understanding of factors that affect healthcare service quality.

Volume and Value of Big Healthcare Data.

Science.gov (United States)

Dinov, Ivo D

Modern scientific inquiries require significant data-driven evidence and trans-disciplinary expertise to extract valuable information and gain actionable knowledge about natural processes. Effective evidence-based decisions require collection, processing and interpretation of vast amounts of complex data. The Moore's and Kryder's laws of exponential increase of computational power and information storage, respectively, dictate the need rapid trans-disciplinary advances, technological innovation and effective mechanisms for managing and interrogating Big Healthcare Data. In this article, we review important aspects of Big Data analytics and discuss important questions like: What are the challenges and opportunities associated with this biomedical, social, and healthcare data avalanche? Are there innovative statistical computing strategies to represent, model, analyze and interpret Big heterogeneous data? We present the foundation of a new compressive big data analytics (CBDA) framework for representation, modeling and inference of large, complex and heterogeneous datasets. Finally, we consider specific directions likely to impact the process of extracting information from Big healthcare data, translating that information to knowledge, and deriving appropriate actions.

How Competent Are Healthcare Professionals in Working According to a Bio-Psycho-Social Model in Healthcare? The Current Status and Validation of a Scale.

Directory of Open Access Journals (Sweden)

Dominique Van de Velde

Full Text Available Over the past decades, there has been a paradigm shift from a purely biomedical towards a bio-psycho-social (BPS conception of disability and illness, which has led to a change in contemporary healthcare. However, there seems to be a gap between the rhetoric and reality of working within a BPS model. It is not clear whether healthcare professionals show the necessary skills and competencies to act according to the BPS model.The aim of this study was (1 to develop a scale to monitor the BPS competencies of healthcare professionals, (2 to define its factor-structure, (3 to check internal consistency, (4 test-retest reliability and (5 feasibility.Item derivation for the BPS scale was based on qualitative research with seven multidisciplinary focus groups (n = 58 of both patients and professionals. In a cross-sectional study design, 368 healthcare professionals completed the BPS scale through a digital platform. An exploratory factor analysis was performed to determine underlying dimensions. Statistical coherence was expressed in item-total correlations and in Cronbach's α coefficient. An intra-class-correlation coefficient was used to rate the test-retest reliability.The qualitative study revealed 45 items. The exploratory factor analysis showed five underlying dimensions labelled as: (1 networking, (2 using the expertise of the client, (3 assessment and reporting, (4 professional knowledge and skills and (5 using the environment. The results show a good to strong homogeneity (item-total ranged from 0.59 to 0.79 and a strong internal consistency (Cronbach's α ranged from 0.75 to 0.82. ICC ranged between 0.82 and 0.93.The BPS scale appeared to be a valid and reliable measure to rate the BPS competencies of the healthcare professionals and offers opportunities for an improvement in the healthcare delivery. Further research is necessary to test the construct validity and to detect whether the scale is responsive and able to detect changes over time.

How Business Cycles Affect the Healthcare Sector: A Cross-country Investigation.

Science.gov (United States)

Cleeren, Kathleen; Lamey, Lien; Meyer, Jan-Hinrich; De Ruyter, Ko

2016-07-01

The long-term relationship between the general economy and healthcare expenditures has been extensively researched, to explain differences in healthcare spending between countries, but the midterm (i.e., business cycle) perspective has been overlooked. This study explores business cycle sensitivity in both public and private parts of the healthcare sector across 32 countries. Responses to the business cycle vary notably, both across spending sources and across countries. Whereas in some countries, consumers and/or governments cut back, in others, private and/or public healthcare buyers tend to spend more. We also assess long-term consequences of business cycle sensitivity and show that public cost cutting during economic downturns deflates the mortality rates, whereas private cut backs increase the long-term growth in total healthcare expenditures. Finally, multiple factors help explain variability in cyclical sensitivity. Private cost cuts during economic downturns are smaller in countries with a predominantly publicly funded healthcare system and more preventive public activities. Public cut backs during contractions are smaller in countries that rely more on tax-based resources rather than social health insurances. Copyright © 2015 John Wiley & Sons, Ltd. Copyright © 2015 John Wiley & Sons, Ltd.

Determinants of elevated healthcare utilization in patients with COPD

Directory of Open Access Journals (Sweden)

Bernhard-Scharf Barbara J

2011-01-01

Full Text Available Abstract Background Chronic obstructive pulmonary disease (COPD imparts a substantial economic burden on western health systems. Our objective was to analyze the determinants of elevated healthcare utilization among patients with COPD in a single-payer health system. Methods Three-hundred eighty-nine adults with COPD were matched 1:3 to controls by age, gender and area of residency. Total healthcare cost 5 years prior recruitment and presence of comorbidities were obtained from a computerized database. Health related quality of life (HRQoL indices were obtained using validated questionnaires among a subsample of 177 patients. Results Healthcare utilization was 3.4-fold higher among COPD patients compared with controls (p Conclusion Comorbidity burden determines elevated utilization for COPD patients. Decision makers should prioritize scarce health care resources to a better care management of the "most costly" patients.

Healthcare delivery systems: designing quality into health information systems.

Science.gov (United States)

Joyce, Phil; Green, Rosamund; Winch, Graham

2007-01-01

To ensure that quality is 'engineered in' a holistic, integrated and quality approach is required, and Total Quality Management (TQM) principles are the obvious foundations for this. This paper describes a novel approach to viewing the operations of a healthcare provider where electronic means could be used to distribute information (including electronic fund settlements), building around the Full Service Provider core. Specifically, an approach called the "triple pair flow" model is used to provide a view of healthcare delivery that is integrated, yet detailed, and that combines the strategic enterprise view with a business process view.

Study of bacterial flora associated with mobile phones of healthcare workers and non-healthcare workers.

Science.gov (United States)

Morubagal, Raghavendra Rao; Shivappa, Sowmya Govindanahalli; Mahale, Rashmi Padmanabha; Neelambike, Sumana Mhadevaiah

2017-06-01

Despite improvements in modern diagnosis and therapies, hospital acquired infections remain a leading problem of global health systems. Healthcare workers mobile phones is a reservoir for potential pathogens. Despite the high possibility of being contaminated, mobile phones are rarely clean and are often touched during or after examination of patients and handling of specimens without proper hand washing. The main objective of the present study was to isolate, identify different types of bacteria and their antibiotic sensitivity from mobile phones of healthcare workers and non-health-care workers. Samples were collected aseptically by rolling over the exposed surfaces of the mobile phones inoculated on the agar plates and incubated aerobically. After incubation, plates were examined for growth. Bacteria were identified and antibiotic sensitivity was tested as per standard microbiological procedures. In this study a total of 175 samples were examined, out of which 125 samples were from healthcare workers (HCWs), 50 samples were from non-healthcare workers (non-HCWs). Among the mobile phones of HCW's from ICUs, Acinetobacter baumannii (36.84%) was the predominant organism isolated followed by methicillin resistant Staphylococcus aureus (MRSA) (21.05%). Predominant organism isolated from HCW's in operation theater theater was MRSA (46.66%). Out of 50 worker's non-HCWs mobile phones samples cultured, 23 (46.00%) samples yielded growth of six different types of bacteria. Our study reveals that there is definite colonization of bacteria on mobile phones of the HCWs. It is not only capable of transferring message but also disease-producing microbes. In order to reduce incidence of nosocomial infections, there should be implementation of hand washing practices and regulations around the use of mobile telephones in hospital settings.

Rate of Compliance with Hand Hygiene by Dental Healthcare Personnel (DHCP) within a Dentistry Healthcare First Aid Facility.

Science.gov (United States)

de Amorim-Finzi, Marcília Batista; Cury, Mauro Vieira Cezar; Costa, Cláudio Rodrigues R; Dos Santos, Angelis Costa; de Melo, Geraldo Batista

2010-07-01

To evaluate the compliance with the opportunities of hand hygiene by dentistry school healthcare professionals, as well as the higher choice products. Through direct observation, the oral healthcare team-professors, oral and maxillofacial surgery residents, graduation students-for daily care were monitored: before performing the first treatment of the shift, after snacks and meals, and after going to the bathroom (initial opportunities) as well as between patients' care, and after ending the shift (following opportunities). The professors' category profited 78.4% of all opportunities while residents and graduation students did not reach 50.0% of compliance. Statistically significant data (Pwater and soap (82.2%), followed by 70% alcohol (10.2%), and both (7.6%). Although gloves were worn in all procedures, we concluded that the hygiene compliance by these professionals was under the expectation.

Balancing influence between actors in healthcare decision making

Directory of Open Access Journals (Sweden)

Babad Yair M

2011-04-01

Full Text Available Abstract Background Healthcare costs in most developed countries are not clearly linked to better patient and public health outcomes, but are rather associated with service delivery orientation. In the U.S. this has resulted in large variation in healthcare availability and use, increased cost, reduced employer participation in health insurance programs, and reduced overall population health outcomes. Recent U.S. healthcare reform legislation addresses only some of these issues. Other countries face similar healthcare issues. Discussion A major goal of healthcare is to enhance patient health outcomes. This objective is not realized in many countries because incentives and structures are currently not aligned for maximizing population health. The misalignment occurs because of the competing interests between "actors" in healthcare. In a simplified model these are individuals motivated to enhance their own health; enterprises (including a mix of nonprofit, for profit and government providers, payers, and suppliers, etc. motivated by profit, political, organizational and other forces; and government which often acts in the conflicting roles of a healthcare payer and provider in addition to its role as the representative and protector of the people. An imbalance exists between the actors, due to the resources and information control of the enterprise and government actors relative to the individual and the public. Failure to use effective preventive interventions is perhaps the best example of the misalignment of incentives. We consider the current Pareto efficient balance between the actors in relation to the Pareto frontier, and show that a significant change in the healthcare market requires major changes in the utilities of the enterprise and government actors. Summary A variety of actions are necessary for maximizing population health within the constraints of available resources and the current balance between the actors. These actions include

Balancing influence between actors in healthcare decision making.

Science.gov (United States)

Kaplan, Robert M; Babad, Yair M

2011-04-19

Healthcare costs in most developed countries are not clearly linked to better patient and public health outcomes, but are rather associated with service delivery orientation. In the U.S. this has resulted in large variation in healthcare availability and use, increased cost, reduced employer participation in health insurance programs, and reduced overall population health outcomes. Recent U.S. healthcare reform legislation addresses only some of these issues. Other countries face similar healthcare issues. A major goal of healthcare is to enhance patient health outcomes. This objective is not realized in many countries because incentives and structures are currently not aligned for maximizing population health. The misalignment occurs because of the competing interests between "actors" in healthcare. In a simplified model these are individuals motivated to enhance their own health; enterprises (including a mix of nonprofit, for profit and government providers, payers, and suppliers, etc.) motivated by profit, political, organizational and other forces; and government which often acts in the conflicting roles of a healthcare payer and provider in addition to its role as the representative and protector of the people. An imbalance exists between the actors, due to the resources and information control of the enterprise and government actors relative to the individual and the public. Failure to use effective preventive interventions is perhaps the best example of the misalignment of incentives. We consider the current Pareto efficient balance between the actors in relation to the Pareto frontier, and show that a significant change in the healthcare market requires major changes in the utilities of the enterprise and government actors. A variety of actions are necessary for maximizing population health within the constraints of available resources and the current balance between the actors. These actions include improved transparency of all aspects of medical decision

Rectal culture-directed antibiotic prophylaxis before transrectal prostate biopsy: Reduced infectious complications and healthcare costs.

Science.gov (United States)

Baldissera-Aradas, J V; Rodríguez-Villamil, L; Blanco-Fernández, R; Pérez-García, C; Viejo de la Guerra, G; González-Rodríguez, I; Mosquera-Madera, J

2018-01-10

Transrectal ultrasound-guided prostate biopsy (TUPB) is associated with infectious complications (ICs), which are related to a greater prevalence of ciprofloxacin-resistant bacteria (CRB) in rectal flora. We examined the ICs that occurred in 2 groups: A guided antibiotic prophylaxis (GP) group and an empiric prophylaxis (EP) group. We assessed the financial impact of GP. The GP group was studied prospectively (June 2013 to July 2014). We collected rectal cultures (RCs) before the TUPB, which were seeded on selective media with ciprofloxacin to determine the presence of CRB. The patients with sensitive bacteria were administered ciprofloxacin. Patients with resistant bacteria were administered GP according to the RC antibiogram. The EP group was studied retrospectively (January 2011 to June 2009). RCs were not performed, and all patients were treated with ciprofloxacin as prophylaxis. The ICs in both groups were recorded during a period no longer than 30 days following TUPB (electronic medical history). Three hundred patients underwent TUPB, 145 underwent GP, and 155 underwent EP. In the GP group, 23 patients (15.86%) presented CRB in the RCs. Only one patient (0.7%) experienced a UTI. In the EP group, 26 patients (16.8%) experienced multiple ICs (including 2 cases of sepsis) (P<.005). The estimated total cost, including the management of the ICs, was €57,076 with EP versus €4802.33 with GP. The average cost per patient with EP was €368.23 versus €33.11 with GP. GP achieved an estimated total savings of €52,273.67. Six patients had to undergo GP to prevent an IC. GP is associated with a marked decrease in the incidence of ICs caused by CRB and reduced healthcare costs. Copyright © 2017 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

Examining Children's Healthcare Experiences through Drawings

Science.gov (United States)

Burns-Nader, Sherwood

2017-01-01

This study examines children's anxieties about healthcare experiences using drawings. Fifty children, either experiencing a doctor's appointment or hospitalization, completed a drawing of a person in the hospital. Using the Child Drawing: Hospital (CD:H), drawings were scored on individual items which were summed for a total score of projected…

Exploring Healthcare Consumer Acceptance of Personal Health Information Management Technology through Personal Health Record Systems

Science.gov (United States)

Wu, Huijuan

2013-01-01

Healthcare technologies are evolving from a practitioner-centric model to a patient-centric model due to the increasing need for technology that directly serves healthcare consumers, including healthy people and patients. Personal health information management (PHIM) technology is one of the technologies designed to enhance an individual's ability…

Healthcare Expenditures Associated with Depression Among Individuals with Osteoarthritis: Post-Regression Linear Decomposition Approach.

Science.gov (United States)

Agarwal, Parul; Sambamoorthi, Usha

2015-12-01

Depression is common among individuals with osteoarthritis and leads to increased healthcare burden. The objective of this study was to examine excess total healthcare expenditures associated with depression among individuals with osteoarthritis in the US. Adults with self-reported osteoarthritis (n = 1881) were identified using data from the 2010 Medical Expenditure Panel Survey (MEPS). Among those with osteoarthritis, chi-square tests and ordinary least square regressions (OLS) were used to examine differences in healthcare expenditures between those with and without depression. Post-regression linear decomposition technique was used to estimate the relative contribution of different constructs of the Anderson's behavioral model, i.e., predisposing, enabling, need, personal healthcare practices, and external environment factors, to the excess expenditures associated with depression among individuals with osteoarthritis. All analysis accounted for the complex survey design of MEPS. Depression coexisted among 20.6 % of adults with osteoarthritis. The average total healthcare expenditures were $13,684 among adults with depression compared to $9284 among those without depression. Multivariable OLS regression revealed that adults with depression had 38.8 % higher healthcare expenditures (p regression linear decomposition analysis indicated that 50 % of differences in expenditures among adults with and without depression can be explained by differences in need factors. Among individuals with coexisting osteoarthritis and depression, excess healthcare expenditures associated with depression were mainly due to comorbid anxiety, chronic conditions and poor health status. These expenditures may potentially be reduced by providing timely intervention for need factors or by providing care under a collaborative care model.

Benchmarking and Learning in Public Healthcare

DEFF Research Database (Denmark)

Buckmaster, Natalie; Mouritsen, Jan

2017-01-01

This research investigates the effects of learning-oriented benchmarking in public healthcare settings. Benchmarking is a widely adopted yet little explored accounting practice that is part of the paradigm of New Public Management. Extant studies are directed towards mandated coercive benchmarking...... applications. The present study analyses voluntary benchmarking in a public setting that is oriented towards learning. The study contributes by showing how benchmarking can be mobilised for learning and offers evidence of the effects of such benchmarking for performance outcomes. It concludes that benchmarking...... can enable learning in public settings but that this requires actors to invest in ensuring that benchmark data are directed towards improvement....

Lifestyle factors, direct and indirect costs for a Brazilian airline company

Science.gov (United States)

Rabacow, Fabiana Maluf; Luiz, Olinda do Carmo; Malik, Ana Maria; Burdorf, Alex

2014-01-01

OBJECTIVE To analyze lifestyle risk factors related to direct healthcare costs and the indirect costs due to sick leave among workers of an airline company in Brazil. METHODS In this longitudinal 12-month study of 2,201 employees of a Brazilian airline company, the costs of sick leave and healthcare were the primary outcomes of interest. Information on the independent variables, such as gender, age, educational level, type of work, stress, and lifestyle-related factors (body mass index, physical activity, and smoking), was collected using a questionnaire on enrolment in the study. Data on sick leave days were available from the company register, and data on healthcare costs were obtained from insurance records. Multivariate linear regression analysis was used to investigate the association between direct and indirect healthcare costs with sociodemographic, work, and lifestyle-related factors. RESULTS Over the 12-month study period, the average direct healthcare expenditure per worker was US$505.00 and the average indirect cost because of sick leave was US$249.00 per worker. Direct costs were more than twice the indirect costs and both were higher in women. Body mass index was a determinant of direct costs and smoking was a determinant of indirect costs. CONCLUSIONS Obesity and smoking among workers in a Brazilian airline company were associated with increased health costs. Therefore, promoting a healthy diet, physical activity, and anti-tobacco campaigns are important targets for health promotion in this study population. PMID:26039398

Lifestyle factors, direct and indirect costs for a Brazilian airline company.

Science.gov (United States)

Rabacow, Fabiana Maluf; Luiz, Olinda do Carmo; Malik, Ana Maria; Burdorf, Alex

2014-12-01

OBJECTIVE To analyze lifestyle risk factors related to direct healthcare costs and the indirect costs due to sick leave among workers of an airline company in Brazil. METHODS In this longitudinal 12-month study of 2,201 employees of a Brazilian airline company, the costs of sick leave and healthcare were the primary outcomes of interest. Information on the independent variables, such as gender, age, educational level, type of work, stress, and lifestyle-related factors (body mass index, physical activity, and smoking), was collected using a questionnaire on enrolment in the study. Data on sick leave days were available from the company register, and data on healthcare costs were obtained from insurance records. Multivariate linear regression analysis was used to investigate the association between direct and indirect healthcare costs with sociodemographic, work, and lifestyle-related factors. RESULTS Over the 12-month study period, the average direct healthcare expenditure per worker was US$505.00 and the average indirect cost because of sick leave was US$249.00 per worker. Direct costs were more than twice the indirect costs and both were higher in women. Body mass index was a determinant of direct costs and smoking was a determinant of indirect costs. CONCLUSIONS Obesity and smoking among workers in a Brazilian airline company were associated with increased health costs. Therefore, promoting a healthy diet, physical activity, and anti-tobacco campaigns are important targets for health promotion in this study population.

Lifestyle factors, direct and indirect costs for a Brazilian airline company

Directory of Open Access Journals (Sweden)

Fabiana Maluf Rabacow

2014-12-01

Full Text Available OBJECTIVE To analyze lifestyle risk factors related to direct healthcare costs and the indirect costs due to sick leave among workers of an airline company in Brazil. METHODS In this longitudinal 12-month study of 2,201 employees of a Brazilian airline company, the costs of sick leave and healthcare were the primary outcomes of interest. Information on the independent variables, such as gender, age, educational level, type of work, stress, and lifestyle-related factors (body mass index, physical activity, and smoking, was collected using a questionnaire on enrolment in the study. Data on sick leave days were available from the company register, and data on healthcare costs were obtained from insurance records. Multivariate linear regression analysis was used to investigate the association between direct and indirect healthcare costs with sociodemographic, work, and lifestyle-related factors. RESULTS Over the 12-month study period, the average direct healthcare expenditure per worker was US$505.00 and the average indirect cost because of sick leave was US$249.00 per worker. Direct costs were more than twice the indirect costs and both were higher in women. Body mass index was a determinant of direct costs and smoking was a determinant of indirect costs. CONCLUSIONS Obesity and smoking among workers in a Brazilian airline company were associated with increased health costs. Therefore, promoting a healthy diet, physical activity, and anti-tobacco campaigns are important targets for health promotion in this study population.

Total and Direct Correlation Function Integrals from Molecular Simulation of Binary Systems

DEFF Research Database (Denmark)

Wedberg, Nils Hejle Rasmus Ingemar; O’Connell, John P.; Peters, Günther H.J.

2011-01-01

The possibility for obtaining derivative properties for mixtures from integrals of spatial total and direct correlation functions obtained from molecular dynamics simulations is explored. Theoretically well-supported methods are examined to extend simulation radial distribution functions to long...... are consistent with an excess Helmholtz energy model fitted to available simulations. In addition, simulations of water/methanol and water/t-butanol mixtures have been carried out. The method yields results for partial molar volumes, activity coefficient derivatives, and individual correlation function integrals...... in reasonable agreement with smoothed experimental data. The proposed method for obtaining correlation function integrals is shown to perform at least as well as or better than two previously published approaches....

Reducing Length of Stay, Direct Cost, and Readmissions in Total Joint Arthroplasty Patients With an Outcomes Manager-Led Interprofessional Team.

Science.gov (United States)

Arana, Melissa; Harper, Licia; Qin, Huanying; Mabrey, Jay

The purpose of this quality improvement project was to determine whether an outcomes manager-led interprofessional team could reduce length of stay and direct cost without increasing 30-day readmission rates in the total joint arthroplasty patient population. The goal was to promote interprofessional relationships combined with collaborative practice to promote coordinated care with improved outcomes. Results from this project showed that length of stay (total hip arthroplasty [THA] reduced by 0.4 days and total knee arthroplasty [TKA] reduced by 0.6 days) and direct cost (THA reduced by $1,020 per case and TKA reduced by $539 per case) were significantly decreased whereas 30-day readmission rates of both populations were not significantly increased.

Design Quality in the Context of Healthcare Environments: A Scoping Review.

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Anåker, Anna; Heylighen, Ann; Nordin, Susanna; Elf, Marie

2017-07-01

We explored the concept of design quality in relation to healthcare environments. In addition, we present a taxonomy that illustrates the wide range of terms used in connection with design quality in healthcare. High-quality physical environments can promote health and well-being. Developments in healthcare technology and methodology put high demands on the design quality of care environments, coupled with increasing expectations and demands from patients and staff that care environments be person centered, welcoming, and accessible while also supporting privacy and security. In addition, there are demands that decisions about the design of healthcare architecture be based on the best available information from credible research and the evaluation of existing building projects. The basic principles of Arksey and O'Malley's model of scoping review design were used. Data were derived from literature searches in scientific databases. A total of 18 articles and books were found that referred to design quality in a healthcare context. Design quality of physical healthcare environments involves three different themes: (i) environmental sustainability and ecological values, (ii) social and cultural interactions and values, and (iii) resilience of the engineering and building construction. Design quality was clarified herein with a definition. Awareness of what is considered design quality in relation to healthcare architecture could help to design healthcare environments based on evidence. To operationalize the concept, its definition must be clear and explicit and able to meet the complex needs of the stakeholders in a healthcare context, including patients, staff, and significant others.

Occupational skin diseases in Czech healthcare workers from 1997 to 2009.

Science.gov (United States)

Machovcová, A; Fenclová, Z; Pelclová, D

2013-04-01

The healthcare sector ranked in second place among economic sectors in the Czech Republic, with about 11.4 % of all occupational diseases in 2009. Skin diseases constituted about 20 % of all occupational diseases. The aim of this study was to analyze the causes and trends in allergic and irritant-induced skin diseases in the healthcare sector. The data concerning occupational skin diseases (Chapter IV of the Czech List of Occupational Diseases, non-infectious skin illnesses) in the healthcare sector were analyzed from the Czech National Registry of Occupational Diseases from 1997 until 2009. The trends in the total counts and most frequent causes were evaluated. During the past 13 years, a total of 545 skin diseases were acknowledged in healthcare workers. Allergic contact dermatitis was diagnosed in 464 (85 %), irritant contact dermatitis in 71 (13 %) and contact urticaria in 10 subjects (2 %). Ninety-five percent of the patients were females. The overall incidence in individual years varied between 1.0 and 2.9 cases per 10,000 full-time employees per year. Disinfectants were the most frequent chemical agents causing more than one third of all allergic skin diseases (38 %), followed by rubber components (32 %) and cleaning agents (10 %). A general downward trend of diagnosed cases of occupational skin diseases in heath care workers in the Czech Republic over the past 13 years was demonstrated.

Has the Reform of the Japanese Healthcare Provision System Improved the Value in Healthcare? A Cost-Consequence Analysis of Organized Care for Hip Fracture Patients.

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Fukuda, Haruhisa; Shimizu, Sayuri; Ishizaki, Tatsuro

2015-01-01

To assess the value of organized care by comparing the clinical outcomes and healthcare expenditure between the conventional Japanese "integrated care across specialties within one hospital" mode of providing healthcare and the prospective approach of "organized care across separate facilities within a community". Retrospective cohort study. Two groups of hospitals were categorized according to healthcare delivery approach: the first group included 3 hospitals autonomously providing integrated care across specialties, and the second group included 4 acute care hospitals and 7 rehabilitative care hospitals providing organized care across separate facilities. Patients aged 65 years and above who had undergone hip fracture surgery. Regression models adjusting for patient characteristics and clinical variables were used to investigate the impact of organized care on the improvements to the mobility capability of patients before and after hospitalization and the differences in healthcare resource utilization. The sample for analysis included 837 hip fracture surgery cases. The proportion of patients with either unchanged or improved mobility capability was not statistically associated with the healthcare delivery approaches. Total adjusted mean healthcare expenditure for integrated care and organized care were US$28,360 (95% confidence interval: 27,787-28,972) and US$21,951 (21,511-22,420), respectively, indicating an average increase of US$6,409 in organized care. Our cost-consequence analysis underscores the need to further investigate the actual contribution of organized care to the provision of efficient and high-quality healthcare.

Health-care utilization and associated factors in Gauteng province, South Africa.

Science.gov (United States)

Abera Abaerei, Admas; Ncayiyana, Jabulani; Levin, Jonathan

2017-01-01

More than a billion people, mainly in low- and middle-income countries, are unable to access needed health-care services for a variety of reasons. Possible factors influencing health-care utilization include socio-demographic and economic factors such as age, sex, education, employment and income. However, different studies have showed mixed results. Moreover, there are limited studies on health-care utilization. This study aimed to determine health-care utilization and associated factors among all residents aged 18 or over in Gauteng province, South Africa. A cross-sectional study was conducted from data collected for a Quality of Life survey which was carried out by Gauteng City-Region Observatory in 2013. Simple random sampling was used to select participants. A total of 27,490 participants have been interviewed. Data were collected via a digital data collection instrument using an open source system called Formhub. Coarsened Exact Matching (CEM) was used to improve estimation of causal effects. Stepwise multiple logistic regression was employed to identify factors associated with health-care utilization. Around 95.7% reported usually utilizing health-care services while the other 4.3% reported not having sought health-care services of any type. Around 75% of participants reported reduced quality of public health services as a major reason not to visit them. Higher odds of reported health-care utilization were associated with being female (OR = 2.18, 95% CI: 1.88-2.53; p immigrant (OR = 0.61, 95% CI: 0.53-0.70; p < 0.001). The results indicated that there is a need to improve the quality of public health-care services and perception towards them as improved health-care quality increases the choice of health-care providers.

Tuberculosis and latent tuberculosis infection among healthcare workers in Kisumu, Kenya.

Science.gov (United States)

Agaya, Janet; Nnadi, Chimeremma D; Odhiambo, Joseph; Obonyo, Charles; Obiero, Vincent; Lipke, Virginia; Okeyo, Elisha; Cain, Kevin; Oeltmann, John E

2015-12-01

To assess prevalence and occupational risk factors of latent TB infection and history of TB disease ascribed to work in a healthcare setting in western Kenya. We conducted a cross-sectional survey among healthcare workers in western Kenya in 2013. They were recruited from dispensaries, health centres and hospitals that offer both TB and HIV services. School workers from the health facilities' catchment communities were randomly selected to serve as the community comparison group. Latent TB infection was diagnosed by tuberculin skin testing. HIV status of participants was assessed. Using a logistic regression model, we determined the adjusted odds of latent TB infection among healthcare workers compared to school workers; and among healthcare workers only, we assessed work-related risk factors for latent TB infection. We enrolled 1005 healthcare workers and 411 school workers. Approximately 60% of both groups were female. A total of 22% of 958 healthcare workers and 12% of 392 school workers tested HIV positive. Prevalence of self-reported history of TB disease was 7.4% among healthcare workers and 3.6% among school workers. Prevalence of latent TB infection was 60% among healthcare workers and 48% among school workers. Adjusted odds of latent TB infection were 1.5 times higher among healthcare workers than school workers (95% confidence interval 1.2-2.0). Healthcare workers at all three facility types had similar prevalence of latent TB infection (P = 0.72), but increasing years of employment was associated with increased odds of LTBI (P Kenya which offer TB and HIV services are at increased risk of latent TB infection, and the risk is similar across facility types. Implementation of WHO-recommended TB infection control measures are urgently needed in health facilities to protect healthcare workers. © 2015 John Wiley & Sons Ltd.

Language awareness in the bilingual healthcare setting: a national survey.

Science.gov (United States)

Roberts, Gwerfyl Wyn; Irvine, Fiona Elizabeth; Jones, Peter Reece; Spencer, Llinos Haf; Baker, Colin Ronald; Williams, Cen

2007-09-01

The significance of effective interpersonal communication in healthcare is well established, as is the importance of overcoming language barriers. This has a particular bearing for minority language speakers, where denying language choice can compromise the quality of healthcare provision. Nevertheless, there is limited empirical research exploring language awareness in healthcare and the factors that influence language choice for minority language speakers. This paper reports on the nurses, midwives and health visitors (NMHV) data set of the first phase of a large-scale national study, commissioned by the Welsh Assembly Government, to examine the nature and extent of Welsh language awareness amongst healthcare professionals in Wales, UK. The study involved a questionnaire survey of healthcare professionals working in the public, private and voluntary sectors of healthcare. A stratified random sample of 3358 healthcare professionals was surveyed, of which 1842 (55%) were nurses, midwives and health visitors. The researcher-designed self-administered questionnaire was distributed by post to participants between July and September 2003. A total of 1042 (57%) NMHV returned their questionnaires for analysis. A strong positive correlation is identified between the NMHV use of the Welsh language in practice and their Welsh language proficiency (planguage attitudes (planguage region (planguage attitude scores are more positive than expected, particularly amongst those with limited Welsh language proficiency and those working in regions with the lowest proportions of Welsh speakers. In view of the universal drive for culturally and linguistically appropriate healthcare practice, the findings have important implications for bilingual and multilingual healthcare settings worldwide. The evidence emerging from this survey confirms that cross-cultural communication is enhanced by NMHV language attitudes as well as their proficiency levels. Language awareness training is

Healthcare. Executive Summary

Science.gov (United States)

Carnevale, Anthony P.; Smith, Nicole; Gulish, Artem; Beach, Bennett H.

2012-01-01

This executive summary highlights several findings about healthcare. These are: (1) Healthcare is 18 percent of the U.S. economy, twice as high as in other countries; (2) There are two labor markets in healthcare: high-skill, high-wage professional and technical jobs and low-skill, low-wage support jobs; (3) Demand for postsecondary education in…

[Fostering LGBT-friendly healthcare services].

Science.gov (United States)

Wei, Han-Ting; Chen, Mu-Hong; Ku, Wen-Wei

2015-02-01

LGBT (lesbian, gay, bisexual, transgender) patients suffer from stigma and discrimination when seeking healthcare. A large LGBT healthcare survey revealed that 56% of gay patients and 70% of transgender patients suffered some type of discrimination while seeking healthcare in 2014. The fostering of LGBT-friendly healthcare services is not just an advanced step of gender mainstreaming but also a fulfillment of health equality and equity. Additionally, LGBT-friendly healthcare services are expected to provide new opportunities for healthcare workers. Therefore, proactive government policies, education, research, and clinical practice should all encourage the development of these healthcare services. We look forward to a well-developed LGBT-friendly healthcare system in Taiwan.

Healthcare Providers' Responses to Narrative Communication About Racial Healthcare Disparities.

Science.gov (United States)

Burgess, Diana J; Bokhour, Barbara G; Cunningham, Brooke A; Do, Tam; Gordon, Howard S; Jones, Dina M; Pope, Charlene; Saha, Somnath; Gollust, Sarah E

2017-10-25

We used qualitative methods (semi-structured interviews with healthcare providers) to explore: 1) the role of narratives as a vehicle for raising awareness and engaging providers about the issue of healthcare disparities and 2) the extent to which different ways of framing issues of race within narratives might lead to message acceptance for providers' whose preexisting beliefs about causal attributions might predispose them to resist communication about racial healthcare disparities. Individual interviews were conducted with 53 providers who had completed a prior survey assessing beliefs about disparities. Participants were stratified by the degree to which they believed providers contributed to healthcare inequality: low provider attribution (LPA) versus high provider attribution (HPA). Each participant read and discussed two differently framed narratives about race in healthcare. All participants accepted the "Provider Success" narratives, in which interpersonal barriers involving a patient of color were successfully resolved by the provider narrator, through patient-centered communication. By contrast, "Persistent Racism" narratives, in which problems faced by the patient of color were more explicitly linked to racism and remained unresolved, were very polarizing, eliciting acceptance from HPA participants and resistance from LPA participants. This study provides a foundation for and raises questions about how to develop effective narrative communication strategies to engage providers in efforts to reduce healthcare disparities.

Virtual reality training for health-care professionals.

Science.gov (United States)

Mantovani, Fabrizia; Castelnuovo, Gianluca; Gaggioli, Andrea; Riva, Giuseppe

2003-08-01

Emerging changes in health-care delivery are having a significant impact on the structure of health-care professionals' education. Today it is recognized that medical knowledge doubles every 6-8 years, with new medical procedures emerging everyday. While the half-life of medical information is so short, the average physician practices 30 years and the average nurse 40 years. Continuing education thus represents an important challenge to face. Recent advances in educational technology are offering an increasing number of innovative learning tools. Among these, Virtual Reality represents a promising area with high potential of enhancing the training of health-care professionals. Virtual Reality Training can provide a rich, interactive, engaging educational context, thus supporting experiential learning-by-doing; it can, in fact, contribute to raise interest and motivation in trainees and to effectively support skills acquisition and transfer, since the learning process can be settled within an experiential framework. Current virtual training applications for health-care differ a lot as to both their technological/multimedia sophistication and to the types of skills trained, varying for example from telesurgical applications to interactive simulations of human body and brain, to virtual worlds for emergency training. Other interesting applications include the development of immersive 3D environments for training psychiatrists and psychologists in the treatment of mental disorders. This paper has the main aim of discussing the rationale and main benefits for the use of virtual reality in health-care education and training. Significant research and projects carried out in this field will also be presented, followed by discussion on key issues concerning current limitations and future development directions.

Value-of-Information Analysis to Reduce Decision Uncertainty Associated with the Choice of Thromboprophylaxis after Total Hip Replacement in the Irish Healthcare Setting.

LENUS (Irish Health Repository)

McCullagh, Laura

2012-06-05

Background: The National Centre for Pharmacoeconomics, in collaboration with the Health Services Executive, considers the cost effectiveness of all new medicines introduced into Ireland. Health Technology Assessments (HTAs) are conducted in accordance with the existing agreed Irish HTA guidelines. These guidelines do not specify a formal analysis of value of information (VOI). Objective: The aim of this study was to demonstrate the benefits of using VOI analysis in decreasing decision uncertainty and to examine the viability of applying these techniques as part of the formal HTA process for reimbursement purposes within the Irish healthcare system. Method: The evaluation was conducted from the Irish health payer perspective. A lifetime model evaluated the cost effectiveness of rivaroxaban, dabigatran etexilate and enoxaparin sodium for the prophylaxis of venous thromboembolism after total hip replacement. The expected value of perfect information (EVPI) was determined directly from the probabilistic analysis (PSA). Population-level EVPI (PEVPI) was determined by scaling up the EVPI according to the decision incidence. The expected value of perfect parameter information (EVPPI) was calculated for the three model parameter subsets: probabilities, preference weights and direct medical costs. Results: In the base-case analysis, rivaroxaban dominated both dabigatran etexilate and enoxaparin sodium. PSA indicated that rivaroxaban had the highest probability of being the most cost-effective strategy over a threshold range of &U20AC;0-&U20AC;100 000 per QALY. At a threshold of &U20AC;45 000 per QALY, the probability that rivaroxaban was the most cost-effective strategy was 67%. At a threshold of &U20AC;45 000 per QALY, assuming a 10-year decision time horizon, the PEVPI was &U20AC;11.96 million and the direct medical costs subset had the highest EVPPI value (&U20AC;9.00 million at a population level). In order to decrease uncertainty, a more detailed costing

Current National Approach to Healthcare ICT Standardization: Focus on Progress in New Zealand.

Science.gov (United States)

Park, Young-Taek; Atalag, Koray

2015-07-01

Many countries try to efficiently deliver high quality healthcare services at lower and manageable costs where healthcare information and communication technologies (ICT) standardisation may play an important role. New Zealand provides a good model of healthcare ICT standardisation. The purpose of this study was to review the current healthcare ICT standardisation and progress in New Zealand. This study reviewed the reports regarding the healthcare ICT standardisation in New Zealand. We also investigated relevant websites related with the healthcare ICT standards, most of which were run by the government. Then, we summarised the governance structure, standardisation processes, and their output regarding the current healthcare ICT standards status of New Zealand. New Zealand government bodies have established a set of healthcare ICT standards and clear guidelines and procedures for healthcare ICT standardisation. Government has actively participated in various enactments of healthcare ICT standards from the inception of ideas to their eventual retirement. Great achievements in eHealth have already been realized, and various standards are currently utilised at all levels of healthcare regionally and nationally. Standard clinical terminologies, such as International Classification of Diseases (ICD) and Systematized Nomenclature of Medicine - Clinical Terms (SNOMED-CT) have been adopted and Health Level Seven (HL7) standards are actively used in health information exchanges. The government to New Zealand has well organised ICT institutions, guidelines, and regulations, as well as various programs, such as e-Medications and integrated care services. Local district health boards directly running hospitals have effectively adopted various new ICT standards. They might already be benefiting from improved efficiency resulting from healthcare ICT standardisation.

Smartphone threshold audiometry in underserved primary health-care contexts.

Science.gov (United States)

Sandström, Josefin; Swanepoel, De Wet; Carel Myburgh, Hermanus; Laurent, Claude

2016-01-01

To validate a calibrated smartphone-based hearing test in a sound booth environment and in primary health-care clinics. A repeated-measure within-subject study design was employed whereby air-conduction hearing thresholds determined by smartphone-based audiometry was compared to conventional audiometry in a sound booth and a primary health-care clinic environment. A total of 94 subjects (mean age 41 years ± 17.6 SD and range 18-88; 64% female) were assessed of whom 64 were tested in the sound booth and 30 within primary health-care clinics without a booth. In the sound booth 63.4% of conventional and smartphone thresholds indicated normal hearing (≤15 dBHL). Conventional thresholds exceeding 15 dB HL corresponded to smartphone thresholds within ≤10 dB in 80.6% of cases with an average threshold difference of -1.6 dB ± 9.9 SD. In primary health-care clinics 13.7% of conventional and smartphone thresholds indicated normal hearing (≤15 dBHL). Conventional thresholds exceeding 15 dBHL corresponded to smartphone thresholds within ≤10 dB in 92.9% of cases with an average threshold difference of -1.0 dB ± 7.1 SD. Accurate air-conduction audiometry can be conducted in a sound booth and without a sound booth in an underserved community health-care clinic using a smartphone.

 Functional Results-Oriented Healthcare Leadership: A Novel Leadership Model

Directory of Open Access Journals (Sweden)

Salem Said Al-Touby

2012-03-01

Full Text Available  This article modifies the traditional functional leadership model to accommodate contemporary needs in healthcare leadership based on two findings. First, the article argues that it is important that the ideal healthcare leadership emphasizes the outcomes of the patient care more than processes and structures used to deliver such care; and secondly, that the leadership must strive to attain effectiveness of their care provision and not merely targeting the attractive option of efficient operations. Based on these premises, the paper reviews the traditional Functional Leadership Model and the three elements that define the type of leadership an organization has namely, the tasks, the individuals, and the team. The article argues that concentrating on any one of these elements is not ideal and proposes adding a new element to the model to construct a novel Functional Result-Oriented healthcare leadership model. The recommended Functional-Results Oriented leadership model embosses the results element on top of the other three elements so that every effort on healthcare leadership is directed towards attaining excellent patient outcomes.

Determinants of patient loyalty to healthcare providers: An integrative review.

Science.gov (United States)

Zhou, Wei-Jiao; Wan, Qiao-Qin; Liu, Cong-Ying; Feng, Xiao-Lin; Shang, Shao-Mei

2017-08-01

Patient loyalty is key to business success for healthcare providers and also for patient health outcomes. This study aims to identify determinants influencing patient loyalty to healthcare providers and propose an integrative conceptual model of the influencing factors. PubMed, CINAHL, OVID, ProQuest and Elsevier Science Direct databases were searched. Publications about determinants of patient loyalty to health providers were screened, and 13 articles were included. Date of publication, location of the research, sample details, objectives and findings/conclusions were extracted for 13 articles. Thirteen studies explored eight determinants: satisfaction, quality, value, hospital brand image, trust, commitment, organizational citizenship behavior and customer complaints. The integrated conceptual model comprising all the determinants demonstrated the significant positive direct impact of quality on satisfaction and value, satisfaction on trust and commitment, trust on commitment and loyalty, and brand image on quality and loyalty. This review identifies and models the determinants of patient loyalty to healthcare providers. Further studies are needed to explore the influence of trust, commitment, and switching barriers on patient loyalty. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

Advancing indigent healthcare services through adaptive reuse: repurposing abandoned buildings as medical clinics for disadvantaged populations.

Science.gov (United States)

Elrod, James K; Fortenberry, John L

2017-12-13

Challenges abound for healthcare providers engaged in initiatives directed toward disadvantaged populations, with financial constraints representing one of the most prominent hardships. Society's less fortunate typically lack the means to pay for healthcare services and even when they are covered by government health insurance programs, reimbursement shortcomings often occur, placing funding burdens on the shoulders of establishments dedicated to serving those of limited means. For such charitably-minded organizations, efficiencies are required on all fronts, including one which involves significant operational costs: the physical space required for care provision. Newly constructed buildings, whether owned or leased, are expensive, consuming a significant percentage of funds that otherwise could be directed toward patient care. Such costs can even prohibit the delivery of services to indigent populations altogether. But through adaptive reuse-the practice of repurposing existing, abandoned buildings, placing them back into service in pursuit of new missions-opportunities exist to economize on this front, allowing healthcare providers to acquire operational space at a discount. In an effort to shore up related knowledge, this article profiles Willis-Knighton Health System's development of Project NeighborHealth, an indigent clinic network which was significantly bolstered by the economies associated with adaptive reuse. Despite its potential to bolster healthcare initiatives directed toward the medically underserved by presenting more affordable options for acquiring operational space, adaptive reuse remains relatively obscure, diminishing opportunities for providers to take advantage of its many benefits. By shedding light on this repurposing approach, healthcare providers will have a better understanding of adaptive reuse, enabling them to make use of the practice to improve the depth and breadth of healthcare services available to disadvantaged populations.

A clear case for conscience in healthcare practice.

Science.gov (United States)

Birchley, Giles

2012-01-01

The value of conscience in healthcare ethics is widely debated. While some sources present it as an unquestionably positive attribute, others question both the veracity of its decisions and the effect of conscientious objection on patient access to health care. This paper argues that the right to object conscientiously should be broadened, subject to certain previsos, as there are many benefits to healthcare practice in the development of the consciences of practitioners. While effects such as the preservation of moral integrity are widely considered to benefit practitioners, this paper draws on the work of Hannah Arendt to offer several original arguments in defence of conscience that may more directly benefit patients, namely that a pang of conscience may be useful in rapidly unfolding situations in which there is no time to reflect satisfactorily upon activities and that, given the hierarchical nature of healthcare institutions, a right to defy authority on the basis of conscience may benefit junior staff who lack the institutional power to challenge the orders of superiors.

[Healthcare mistreatment attributed to discrimination among mapuche patients and discontinuation of diabetes care].

Science.gov (United States)

Ortiz, Manuel S; Baeza-Rivera, María José; Salinas-Oñate, Natalia; Flynn, Patricia; Betancourt, Héctor

2016-10-01

The negative impact of perceived discrimination on health outcomes is well established. However, less attention has been directed towards understanding the effect of perceived discrimination on health behaviors relevant for the treatment of diabetes in ethnic minorities. To examine the effects of healthcare mistreatment attributed to discrimination on the continuity of Type 2 Diabetes (DM2) care among mapuche patients in a southern region of Chile. A non-probabilistic sample of 85 mapuche DM2 patients were recruited from public and private health systems. Eligibility criteria included having experienced at least one incident of interpersonal healthcare mistreatment. All participants answered an instrument designed to measure healthcare mistreatment and continuity of diabetes care. Healthcare mistreatment attributed to ethnic discrimination was associated with the discontinuation of diabetes care. Healthcare mistreatment attributed to discrimination negatively impacted the continuity of diabetes care, a fact which may provide a better understanding of health disparities in ethnic minorities.

Managing today's complex healthcare business enterprise: reflections on distinctive requirements of healthcare management education.

Science.gov (United States)

Welton, William E

2004-01-01

In early 2001, the community of educational programs offering master's-level education in healthcare management began an odyssey to modernize its approach to the organization and delivery of healthcare management education. The community recognized that cumulative long-term changes within healthcare management practice required a careful examination of healthcare management context and manpower requirements. This article suggests an evidence-based rationale for defining the distinctive elements of healthcare management, thus suggesting a basis for review and transformation of master's-level healthcare management curricula. It also suggests ways to modernize these curricula in a manner that recognizes the distinctiveness of the healthcare business enterprise as well as the changing management roles and careers within these complex organizations and systems. Through such efforts, the healthcare management master's-level education community would be better prepared to meet current and future challenges, to increase its relevance to the management practice community, and to allocate scarce faculty and program resources more effectively.

Stakeholders' Perceptions on Shortage of Healthcare Workers in Primary Healthcare in Botswana: Focus Group Discussions.

Directory of Open Access Journals (Sweden)

Oathokwa Nkomazana

Full Text Available An adequate health workforce force is central to universal health coverage and positive public health outcomes. However many African countries have critical shortages of healthcare workers, which are worse in primary healthcare. The aim of this study was to explore the perceptions of healthcare workers, policy makers and the community on the shortage of healthcare workers in Botswana.Fifteen focus group discussions were conducted with three groups of policy makers, six groups of healthcare workers and six groups of community members in rural, urban and remote rural health districts of Botswana. All the participants were 18 years and older. Recruitment was purposive and the framework method was used to inductively analyse the data.There was a perceived shortage of healthcare workers in primary healthcare, which was believed to result from an increased need for health services, inequitable distribution of healthcare workers, migration and too few such workers being trained. Migration was mainly the result of unfavourable personal and family factors, weak and ineffective healthcare and human resources management, low salaries and inadequate incentives for rural and remote area service.Botswana has a perceived shortage of healthcare workers, which is worse in primary healthcare and rural areas, as a result of multiple complex factors. To address the scarcity the country should train adequate numbers of healthcare workers and distribute them equitably to sufficiently resourced healthcare facilities. They should be competently managed and adequately remunerated and the living conditions and rural infrastructure should also be improved.

Improving water, sanitation and hygiene in health-care facilities, Liberia.

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Abrampah, Nana Mensah; Montgomery, Maggie; Baller, April; Ndivo, Francis; Gasasira, Alex; Cooper, Catherine; Frescas, Ruben; Gordon, Bruce; Syed, Shamsuzzoha Babar

2017-07-01

The lack of proper water and sanitation infrastructures and poor hygiene practices in health-care facilities reduces facilities' preparedness and response to disease outbreaks and decreases the communities' trust in the health services provided. To improve water and sanitation infrastructures and hygiene practices, the Liberian health ministry held multistakeholder meetings to develop a national water, sanitation and hygiene and environmental health package. A national train-the-trainer course was held for county environmental health technicians, which included infection prevention and control focal persons; the focal persons acted as change agents. In Liberia, only 45% of 701 surveyed health-care facilities had an improved water source in 2015, and only 27% of these health-care facilities had proper disposal for infectious waste. Local ownership, through engagement of local health workers, was introduced to ensure development and refinement of the package. In-county collaborations between health-care facilities, along with multisectoral collaboration, informed national level direction, which led to increased focus on water and sanitation infrastructures and uptake of hygiene practices to improve the overall quality of service delivery. National level leadership was important to identify a vision and create an enabling environment for changing the perception of water, sanitation and hygiene in health-care provision. The involvement of health workers was central to address basic infrastructure and hygiene practices in health-care facilities and they also worked as stimulators for sustainable change. Further, developing a long-term implementation plan for national level initiatives is important to ensure sustainability.

Healthcare financing systems for increasing the use of tobacco dependence treatment.

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van den Brand, Floor A; Nagelhout, Gera E; Reda, Ayalu A; Winkens, Bjorn; Evers, Silvia M A A; Kotz, Daniel; van Schayck, Onno Cp

2017-09-12

Tobacco smoking is the leading preventable cause of death worldwide, which makes it essential to stimulate smoking cessation. The financial cost of smoking cessation treatment can act as a barrier to those seeking support. We hypothesised that provision of financial assistance for people trying to quit smoking, or reimbursement of their care providers, could lead to an increased rate of successful quit attempts. This is an update of the original 2005 review. The primary objective of this review was to assess the impact of reducing the costs for tobacco smokers or healthcare providers for using or providing smoking cessation treatment through healthcare financing interventions on abstinence from smoking. The secondary objectives were to examine the effects of different levels of financial support on the use or prescription of smoking cessation treatment, or both, and on the number of smokers making a quit attempt (quitting smoking for at least 24 hours). We also assessed the cost effectiveness of different financial interventions, and analysed the costs per additional quitter, or per quality-adjusted life year (QALY) gained. We searched the Cochrane Tobacco Addiction Group Specialised Register in September 2016. We considered randomised controlled trials (RCTs), controlled trials and interrupted time series studies involving financial benefit interventions to smokers or their healthcare providers, or both. Two reviewers independently extracted data and assessed the quality of the included studies. We calculated risk ratios (RR) for individual studies on an intention-to-treat basis and performed meta-analysis using a random-effects model. In the current update, we have added six new relevant studies, resulting in a total of 17 studies included in this review involving financial interventions directed at smokers or healthcare providers, or both.Full financial interventions directed at smokers had a favourable effect on abstinence at six months or longer when compared

Factors affecting Japanese retirees' healthcare service utilisation in Malaysia: a qualitative study.

Science.gov (United States)

Kohno, Ayako; Nik Farid, Nik Daliana; Musa, Ghazali; Abdul Aziz, Norlaili; Nakayama, Takeo; Dahlui, Maznah

2016-03-22

While living overseas in another culture, retirees need to adapt to a new environment but often this causes difficulties, particularly among those elderly who require healthcare services. This study examines factors affecting healthcare service utilisation among Japanese retirees in Malaysia. We conducted 6 focus group discussions with Japanese retirees and interviewed 8 relevant medical services providers in-depth. Guided by the Andersen Healthcare Utilisation Model, we managed and analysed the data, using QSR NVivo 10 software and the directed content analysis method. We interviewed participants at Japan Clubs and their offices. 30 Japanese retirees who live in Kuala Lumpur and Ipoh, and 8 medical services providers. We identified health beliefs, medical symptoms and health insurance as the 3 most important themes, respectively, representing the 3 dimensions within the Andersen Healthcare Utilisation Model. Additionally, language barriers, voluntary health repatriation to Japan and psychological support were unique themes that influence healthcare service utilisation among Japanese retirees. The healthcare service utilisation among Japanese retirees in Malaysia could be partially explained by the Andersen Healthcare Utilisation Model, together with some factors that were unique findings to this study. Healthcare service utilisation among Japanese retirees in Malaysia could be improved by alleviating negative health beliefs through awareness programmes for Japanese retirees about the healthcare systems and cultural aspects of medical care in Malaysia. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Licensed Healthcare Facilities

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California Natural Resource Agency — The Licensed Healthcare Facilities point layer represents the locations of all healthcare facilities licensed by the State of California, Department of Health...

Social media use in healthcare: A systematic review of effects on patients and on their relationship with healthcare professionals.

Science.gov (United States)

Smailhodzic, Edin; Hooijsma, Wyanda; Boonstra, Albert; Langley, David J

2016-08-26

Since the emergence of social media in 2004, a growing percentage of patients use this technology for health related reasons. To reflect on the alleged beneficial and potentially harmful effects of social media use by patients, the aim of this paper is to provide an overview of the extant literature on the effects of social media use for health related reasons on patients and their relationship with healthcare professionals. We conducted a systematic literature review on empirical research regarding the effects of social media use by patients for health related reasons. The papers we included met the following selection criteria: (1) published in a peer-reviewed journal, (2) written in English, (3) full text available to the researcher, (4) contain primary empirical data, (5) the users of social media are patients, (6) the effects of patients using social media are clearly stated, (7) satisfy established quality criteria. Initially, a total of 1,743 articles were identified from which 22 were included in the study. From these articles six categories of patients' use of social media were identified, namely: emotional, information, esteem, network support, social comparison and emotional expression. The types of use were found to lead to seven identified types of effects on patients, namely improved self-management and control, enhanced psychological well-being, and enhanced subjective well-being, diminished subjective well-being, addiction to social media, loss of privacy, and being targeted for promotion. Social media use by patients was found to affect the healthcare professional and patient relationship, by leading to more equal communication between the patient and healthcare professional, increased switching of doctors, harmonious relationships, and suboptimal interaction between the patient and healthcare professional. Our review provides insights into the emerging utilization of social media in healthcare. In particular, it identifies types of use by patients

Healthcare Stereotype Threat in Older Adults in the Health and Retirement Study.

Science.gov (United States)

Abdou, Cleopatra M; Fingerhut, Adam W; Jackson, James S; Wheaton, Felicia

2016-02-01

Healthcare stereotype threat is the threat of being personally reduced to group stereotypes that commonly operate within the healthcare domain, including stereotypes regarding unhealthy lifestyles and inferior intelligence. The objective of this study was to assess the extent to which people fear being judged in healthcare contexts on several characteristics, including race/ethnicity and age, and to test predictions that experience of such threats would be connected with poorer health and negative perceptions of health care. Data were collected as part of the 2012 Health and Retirement Study (HRS). A module on healthcare stereotype threat, designed by the research team, was administered to a random subset (n=2,048 of the total 20,555) of HRS participants. The final sample for the present healthcare stereotype threat experiment consists of 1,479 individuals. Logistic regression was used to test whether healthcare stereotype threat was associated with self-rated health, reported hypertension, and depressive symptoms, as well as with healthcare-related outcomes, including physician distrust, dissatisfaction with health care, and preventative care use. Seventeen percent of respondents reported healthcare stereotype threat with respect to one or more aspects of their identities. As predicted, healthcare stereotype threat was associated with higher physician distrust and dissatisfaction with health care, poorer mental and physical health (i.e., self-rated health, hypertension, and depressive symptoms), and lower odds of receiving the influenza vaccine. The first of its kind, this study demonstrates that people can experience healthcare stereotype threat on the basis of various stigmatized aspects of social identity, and that these experiences can be linked with larger health and healthcare-related outcomes, thereby contributing to disparities among minority groups. Copyright © 2016. Published by Elsevier Inc.

E-commerce for healthcare supply procurement.

Science.gov (United States)

Arbietman, D; Lirov, E; Lirov, R; Lirov, Y

2001-01-01

The total investment of the more than fifty e-commerce startups that entered healthcare supply chain management in the past three years has surpassed $500 million. However, none of these early entrants has delivered on the initial promise of restructuring the entire supply chain, replacing the traditional intermediaries, or at least achieving substantial revenue. This article offers a new business-to-business (B2B) e-commerce solution classification paradigm and uses it to analyze the functional requirements for an effective and, efficient healthcare supply chain marketplace. The analysis exposes several fundamental B2B market complexities that prevent the early entrants from creating a solid customer base and reaching desired liquidity goals. It also identifies several technological solutions to the problems mentioned. These new technologies create a comprehensive and symmetric order-matching engine that is capable of aggregating buy orders, requesting quotes from multiple vendors simultaneously, and negotiating along multiple criteria.

Covariates of depression and high utilizers of healthcare: Impact on resource use and costs.

Science.gov (United States)

Robinson, Rebecca L; Grabner, Michael; Palli, Swetha Rao; Faries, Douglas; Stephenson, Judith J

2016-06-01

To characterize healthcare costs, resource use, and treatment patterns of survey respondents with a history of depression who are high utilizers (HUds) of healthcare and to identify factors associated with high utilization. Adults with two or more depression diagnoses identified from the HealthCore Integrated Research Database were invited to participate in the CODE study, which links survey data with 12-month retrospective claims data. Patient surveys provided data on demographics, general health, and symptoms and/or comorbidities associated with depression. Similar clinical conditions also were identified from the medical claims. Factors associated with high utilization were identified using logistic regression models. Of 3132 survey respondents, 1921 were included, 193 of whom were HUds (defined as those who incurred the top 10% of total all-cause costs in the preceding 12months). Mean total annual healthcare costs were eightfold greater for HUds than for non-HUds ($US56,145 vs. $US6,954; pcosts/resource use. HUds were prescribed twice as many medications (total mean: 16.86 vs. 8.32; psychotropic mean: 4.11 vs. 2.61; both pcosts in patients with depression. Copyright © 2016 Eli Lilly and Company. Published by Elsevier Inc. All rights reserved.

Healthcare financing in Croatia

Directory of Open Access Journals (Sweden)

Nevenka Kovač

2013-12-01

Full Text Available Healthcare financing system is of crucial importance for the functioning of any healthcare system, especially because there is no country in the world that is able to provide all its residents with access to all the benefits afforded by modern medicine. Lack of resources in general and rising healthcare expenditures are considered a difficult issue to solve in Croatia as well. Since Croatia gained its independence, its healthcare system has undergone a number of reforms, the primary objective of which was to optimize healthcare services to the actual monetary capacity of the Croatian economy. The objectives of the mentioned re - forms were partially achieved. The solutions that have been offered until now, i.e. consolidation measures undertaken in the last 10 years were necessary; however, they have not improved the operating conditions. There is still the issue of the deficit from the previous years, i.e. outstanding payments, the largest in the last decade. Analysis of the performance of healthcare institutions in 2011 shows that the decision makers will have to take up a major challenge of finding a solution to the difficulties the Croatian healthcare system has been struggling with for decades, causing a debt of 7 billion kuna. At the same time, they will need to uphold the basic principles of the Healthcare Act, i.e. to provide access to healthcare and ensure its continuity, comprehensiveness and solidarity, keeping in mind that the National Budget Act and Fiscal Responsibility Act have been adopted.

The Integration of Two Healthcare Systems: A Common Healthcare Problem.

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Cassatly, Hannah; Cassatly, Michael

2015-01-01

The change in reimbursement mandated by the Affordable Care Act is causing a rapid consolidation of the marketplace as well as the delivery of clinical care in a team-based model. This case report examines the successful joining of two clinical teams concurrent with the merger of two healthcare organizations and discusses some of the difficulties encountered. A subsequent discussion focuses on the resolution: the need for physicians to embrace the team concept of healthcare delivery and for healthcare systems to facilitate this transition with team and leadership coaching.

Healthcare waste management practices and safety indicators in Nigeria.

Science.gov (United States)

Oyekale, Abayomi Samuel; Oyekale, Tolulope Olayemi

2017-09-25

Adequate management of healthcare waste (HCW) is a prerequisite for efficient delivery of healthcare services. In Nigeria, there are several constraints militating against proper management of HCW. This is raising some environmental concerns among stakeholders in the health sector. In this study, we analyzed the practices of HCW management and determinants of risky/safe indices of HCW disposal. The study used the 2013/2014 Service Delivery Indicator (SDI) data that were collected from 2480 healthcare facilities in Nigeria. Descriptive statistics, Principal Component Analysis (PCA) and Ordinary Least Square (OLS) regression were used to analyze the data. The results showed that 52.20% and 38.21% of the sampled healthcare facilities from Cross River and Bauchi states possessed guidelines for HCW management, respectively. Trainings on management of HCW were attended by 67.18% and 53.19% of the healthcare facilities from Cross River and Imo states, respectively. Also, 32.32% and 29.50% of healthcare facilities from rural and urban areas previously sent some of their staff members for trainings on HCW management, respectively. Sharp and non-sharp HCW were burnt in protected pits in 45.40% and 45.36% of all the sampled healthcare facilities, respectively. Incinerators were reported to be functional in only 2.06% of the total healthcare facilities. In Bauchi and Kebbi states, 23.58% and 21.05% of the healthcare facilities respectively burnt sharp HCW without any protection. Using PCA, computed risky indices for disposal of sharp HCW were highest in Bayelsa state (0.3070) and Kebbi state (0.2172), while indices of risky disposal of non-sharp HCW were highest in Bayelsa state (0.2868) and Osun state (0.2652). The OLS results showed that at 5% level of significance, possession of medical waste disposal guidelines, staff trainings on HCW management, traveling hours from the facilities to local headquarters and being located in rural areas significantly influenced indices of

Healthcare waste management practices and safety indicators in Nigeria

Directory of Open Access Journals (Sweden)

Abayomi Samuel Oyekale

2017-09-01

Full Text Available Abstract Background Adequate management of healthcare waste (HCW is a prerequisite for efficient delivery of healthcare services. In Nigeria, there are several constraints militating against proper management of HCW. This is raising some environmental concerns among stakeholders in the health sector. In this study, we analyzed the practices of HCW management and determinants of risky/safe indices of HCW disposal. Methods The study used the 2013/2014 Service Delivery Indicator (SDI data that were collected from 2480 healthcare facilities in Nigeria. Descriptive statistics, Principal Component Analysis (PCA and Ordinary Least Square (OLS regression were used to analyze the data. Results The results showed that 52.20% and 38.21% of the sampled healthcare facilities from Cross River and Bauchi states possessed guidelines for HCW management, respectively. Trainings on management of HCW were attended by 67.18% and 53.19% of the healthcare facilities from Cross River and Imo states, respectively. Also, 32.32% and 29.50% of healthcare facilities from rural and urban areas previously sent some of their staff members for trainings on HCW management, respectively. Sharp and non-sharp HCW were burnt in protected pits in 45.40% and 45.36% of all the sampled healthcare facilities, respectively. Incinerators were reported to be functional in only 2.06% of the total healthcare facilities. In Bauchi and Kebbi states, 23.58% and 21.05% of the healthcare facilities respectively burnt sharp HCW without any protection. Using PCA, computed risky indices for disposal of sharp HCW were highest in Bayelsa state (0.3070 and Kebbi state (0.2172, while indices of risky disposal of non-sharp HCW were highest in Bayelsa state (0.2868 and Osun state (0.2652. The OLS results showed that at 5% level of significance, possession of medical waste disposal guidelines, staff trainings on HCW management, traveling hours from the facilities to local headquarters and being located in

The current total economic burden of diabetes mellitus in the Netherlands.

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Peters, M L; Huisman, E L; Schoonen, M; Wolffenbuttel, B H R

2017-09-01

Insight into the total economic burden of diabetes mellitus (DM) is essential for decision makers and payers. Currently available estimates for the Netherlands only include part of the total burden or are no longer up-to-date. Therefore, this study aimed to determine the current total economic burden of DM and its complications in the Netherlands, by including all the relevant cost components. The study combined a systematic literature review to identify all relevant published information and a targeted review to identify relevant information in the grey literature. The identified evidence was then combined to estimate the current total economic burden. In 2016, there were an estimated 1.1 million DM patients in the Netherlands, of whom approximately 10% had type 1 and 90% had type 2 DM. The estimated current total economic burden of DM was € 6.8 billion in 2016. Healthcare costs (excluding costs of complications) were € 1.6 billion, direct costs of complications were € 1.3 billion and indirect costs due to productivity losses, welfare payments and complications were € 4.0 billion. DM and its complications pose a substantial economic burden to the Netherlands, which is expected to rise due to changing demographics and lifestyle. Indirect costs, such as welfare payments, accounted for a large portion of the current total economic burden of DM, while these cost components are often not included in cost estimations. Publicly available data for key cost drivers such as complications were scarce.

Changing effects of direct-to-consumer broadcast drug advertising information sources on prescription drug requests.

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Lee, Annisa Lai

2009-06-01

This study tracks the changes of the effects of 4 information sources for direct-to-consumer drug advertising on patients' requests for prescription drugs from physicians since the inception of the "Guidance for Industry about Consumer-directed Broadcast Advertisements." The Guidance advises pharmaceuticals to use four information sources for consumers to seek further information to supplement broadcast drug advertisements: small-print information, the Internet, a toll-free number, and health-care providers (nurses, doctors, and pharmacists). Logistic models were created by using survey data collected by the Food and Drug Administration in 1999 and 2002. Results show that throughout the years, health-care providers remain the most used and strongest means associated with patients' direct requests for nonspecific and specific prescription drugs from doctors. The small-print information source gains power and changes from an indirect means associated with patients' discussing drugs with health-care providers to a direct means associated with patients' asking about nonspecific and specific drugs from their doctors. The Internet is not directly related to drug requests, but the effect of its association with patients seeking information from health-care providers grew 11-fold over the course of the study. The toll-free number lost its power altogether for both direct request for a prescription drug and further discussion with health-care providers. Patient demographics will be considered for specific policy implications.

Private investment in hospitals : A comparison of three healthcare systems and possible implications for real estate strategies

NARCIS (Netherlands)

van der Zwart, J.; de Jonge, H.; van der Voordt, Theo; van de Zwart, J; Jonge, H

2009-01-01

Subject/Research problem
Healthcare is both important and expensive, and is likely to become even more expensive in the future. To keep healthcare affordable in the future, the Dutch government is currently in the process of changing legislation in order to move from a centrally directed system

Predicting nurses' use of healthcare technology using the technology acceptance model: an integrative review.

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Strudwick, Gillian

2015-05-01

The benefits of healthcare technologies can only be attained if nurses accept and intend to fully use them. One of the most common models utilized to understand user acceptance of technology is the Technology Acceptance Model. This model and modified versions of it have only recently been applied in the healthcare literature among nurse participants. An integrative literature review was conducted on this topic. Ovid/MEDLINE, PubMed, Google Scholar, and CINAHL were searched yielding a total of 982 references. Upon eliminating duplicates and applying the inclusion and exclusion criteria, the review included a total of four dissertations, three symposium proceedings, and 13 peer-reviewed journal articles. These documents were appraised and reviewed. The results show that a modified Technology Acceptance Model with added variables could provide a better explanation of nurses' acceptance of healthcare technology. These added variables to modified versions of the Technology Acceptance Model are discussed, and the studies' methodologies are critiqued. Limitations of the studies included in the integrative review are also examined.

Fostering the development of effective person-centered healthcare communication skills: an interprofessional shared learning model.

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Cavanaugh, James T; Konrad, Shelley Cohen

2012-01-01

To describe the implementation of an interprofessional shared learning model designed to promote the development of person-centered healthcare communication skills. Master of social work (MSW) and doctor of physical therapy (DPT) degree students. The model used evidence-based principles of effective healthcare communication and shared learning methods; it was aligned with student learning outcomes contained in MSW and DPT curricula. Students engaged in 3 learning sessions over 2 days. Sessions involved interactive reflective learning, simulated role-modeling with peer assessment, and context-specific practice of communication skills. The perspective of patients/clients was included in each learning activity. Activities were evaluated through narrative feedback. Students valued opportunities to learn directly from each other and from healthcare consumers. Important insights and directions for future interprofessional learning experiences were gleaned from model implementation. The interprofessional shared learning model shows promise as an effective method for developing person-centered communication skills.

The Quality Adjusted Life Year: A Total-Utility Perspective.

Science.gov (United States)

Firth, Steven J

2018-04-01

Given that a properly formed utilitarian response to healthcare distribution issues should evaluate cost effectiveness against the total utility increase, it follows that any utilitarian cost-effectiveness metric should be sensitive to increases in both individual and social utility afforded by a given intervention. Quality adjusted life year (QALY) based decisionmaking in healthcare cannot track increases in social utility, and as a result, the QALY cannot be considered a strict utilitarian response to issues of healthcare distribution. This article considers arguments against, and a possible defence of, the QALY as a utilitarian concept; in response, the article offers a similar - but properly formed - utilitarian metric called the (IALY). This article also advances a tool called the 'glee factor' (GF) on which the IALY may lean in a similar way to which the QALY leans on the Rosser Index.

Tuberculosis in healthcare workers and infection control measures at primary healthcare facilities in South Africa.

Science.gov (United States)

Claassens, Mareli M; van Schalkwyk, Cari; du Toit, Elizabeth; Roest, Eline; Lombard, Carl J; Enarson, Donald A; Beyers, Nulda; Borgdorff, Martien W

2013-01-01

Challenges exist regarding TB infection control and TB in hospital-based healthcare workers in South Africa. However, few studies report on TB in non-hospital based healthcare workers such as primary or community healthcare workers. Our objectives were to investigate the implementation of TB infection control measures at primary healthcare facilities, the smear positive TB incidence rate amongst primary healthcare workers and the association between TB infection control measures and all types of TB in healthcare workers. One hundred and thirty three primary healthcare facilities were visited in five provinces of South Africa in 2009. At each facility, a TB infection control audit and facility questionnaire were completed. The number of healthcare workers who had had TB during the past three years was obtained. The standardised incidence ratio of smear positive TB in primary healthcare workers indicated an incidence rate of more than double that of the general population. In a univariable logistic regression, the infection control audit score was significantly associated with reported cases of TB in healthcare workers (OR=1.04, 95%CI 1.01-1.08, p=0.02) as was the number of staff (OR=3.78, 95%CI 1.77-8.08). In the multivariable analysis, the number of staff remained significantly associated with TB in healthcare workers (OR=3.33, 95%CI 1.37-8.08). The high rate of TB in healthcare workers suggests a substantial nosocomial transmission risk, but the infection control audit tool which was used did not perform adequately as a measure of this risk. Infection control measures should be monitored by validated tools developed and tested locally. Different strategies, such as routine surveillance systems, could be used to evaluate the burden of TB in healthcare workers in order to calculate TB incidence, monitor trends and implement interventions to decrease occupational TB.

Tuberculosis in Healthcare Workers and Infection Control Measures at Primary Healthcare Facilities in South Africa

Science.gov (United States)

Claassens, Mareli M.; van Schalkwyk, Cari; du Toit, Elizabeth; Roest, Eline; Lombard, Carl J.; Enarson, Donald A.; Beyers, Nulda; Borgdorff, Martien W.

2013-01-01

Background Challenges exist regarding TB infection control and TB in hospital-based healthcare workers in South Africa. However, few studies report on TB in non-hospital based healthcare workers such as primary or community healthcare workers. Our objectives were to investigate the implementation of TB infection control measures at primary healthcare facilities, the smear positive TB incidence rate amongst primary healthcare workers and the association between TB infection control measures and all types of TB in healthcare workers. Methods One hundred and thirty three primary healthcare facilities were visited in five provinces of South Africa in 2009. At each facility, a TB infection control audit and facility questionnaire were completed. The number of healthcare workers who had had TB during the past three years was obtained. Results The standardised incidence ratio of smear positive TB in primary healthcare workers indicated an incidence rate of more than double that of the general population. In a univariable logistic regression, the infection control audit score was significantly associated with reported cases of TB in healthcare workers (OR=1.04, 95%CI 1.01-1.08, p=0.02) as was the number of staff (OR=3.78, 95%CI 1.77-8.08). In the multivariable analysis, the number of staff remained significantly associated with TB in healthcare workers (OR=3.33, 95%CI 1.37-8.08). Conclusion The high rate of TB in healthcare workers suggests a substantial nosocomial transmission risk, but the infection control audit tool which was used did not perform adequately as a measure of this risk. Infection control measures should be monitored by validated tools developed and tested locally. Different strategies, such as routine surveillance systems, could be used to evaluate the burden of TB in healthcare workers in order to calculate TB incidence, monitor trends and implement interventions to decrease occupational TB. PMID:24098461

[Interdisciplinary healthcare centres--a way of organising healthcare in the future from a health insurer's perspective].

Science.gov (United States)

Hecke, Torsten L; Hoyer, Jens Martin

2009-01-01

The German healthcare system modernization act enables healthcare providers to fund interdisciplinary healthcare centres. The Techniker Krankenkasse (TK) is a statutory health sickness fund that has contracted with some of the interdisciplinary healthcare centres named ATRIO-MED to achieve high-quality medical care and healthcare management. A range of patient-centred services is described in the cooperation agreement; in addition to central medical patient records one of the core competencies includes integrated pathways for defined diagnosis. The concept of the interdisciplinary healthcare centre is highly accepted among patients. It will serve as a platform for future TK healthcare policies.

Missed opportunities in child healthcare

Directory of Open Access Journals (Sweden)

Linda Jonker

2014-01-01

Full Text Available Background: Various policies in health, such as Integrated Management of Childhood Illnesses, were introduced to enhance integrated service delivery in child healthcare. During clinical practice the researcher observed that integrated services may not be rendered.Objectives: This article describes the experiences of mothers that utilised comprehensive child health services in the Cape Metropolitan area of South Africa. Services included treatment for diseases; preventative interventions such as immunisation; and promotive interventions, such as improvement in nutrition and promotion of breastfeeding.Method: A qualitative, descriptive phenomenological approach was applied to explore the experiences and perceptions of mothers and/or carers utilising child healthcare services. Thirty percent of the clinics were selected purposively from the total population. A convenience purposive non-probability sampling method was applied to select 17 mothers who met the criteria and gave written consent. Interviews were conducted and recorded digitally using an interview guide. The data analysis was done using Tesch’s eight step model.Results: Findings of the study indicated varied experiences. Not all mothers received information about the Road to Health book or card. According to the mothers, integrated child healthcare services were not practised. The consequences were missed opportunities in immunisation, provision of vitamin A, absence of growth monitoring, feeding assessment and provision of nutritional advice.Conclusion: There is a need for simple interventions such as oral rehydration, early recognition and treatment of diseases, immunisation, growth monitoring and appropriate nutrition advice. These services were not offered diligently. Such interventions could contribute to reducing the incidence of child morbidity and mortality.

The gap between behavioral risk status and willingness to change behavior among healthcare professionals.

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Kasila, K; Hallman, M; Kautiainen, H; Vanhala, M; Kettunen, T

2018-01-01

This study explored behavioral health risk factors among healthcare professionals and investigated the at-risk persons' satisfaction with their health habits and ongoing change attempts. The study was based on a cross-sectional web-based survey directed at the nurses and physicians ( N = 1233) in Finnish healthcare. Obesity, low physical activity, smoking, and risky alcohol drinking were used as behavioral health risk factors. In all, 70% of the participants had at least one behavioral risk factor, and a significant number of at-risk persons were satisfied with their health habits and had no ongoing change process. Good self-rated health and good self-rated work ability were significantly associated with whether a participant had a behavioral health risk factor. Overall, unhealthy behaviors and a lack of ongoing change attempts were commonly observed among healthcare professionals. Work in healthcare is demanding, and healthy lifestyles can support coping. Thus, healthy lifestyle programs should also be targeted to healthcare professionals.

Healthcare costs in psoriasis and psoriasis sub-groups over time following psoriasis diagnosis.

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Al Sawah, Sarah; Foster, Shonda A; Goldblum, Orin M; Malatestinic, William N; Zhu, Baojin; Shi, Nianwen; Song, Xue; Feldman, Steven R

2017-09-01

To quantify healthcare costs in patients with psoriasis overall and in psoriasis patient sub-groups, by level of disease severity, presence or absence of psoriatic arthritis, or use of biologics. Administrative data from Truven Health Analytics MarketScan Research Database were used to select adult patients with psoriasis from January 2009 to January 2014. The first psoriasis diagnosis was set as the index date. Patients were required to have ≥6 months of continuous enrollment with medical and pharmacy benefits pre-index and ≥12 months post-index. Patients were followed from index until the earliest of loss to follow-up or study end. All-cause healthcare costs and outpatient pharmacy costs were calculated for the overall psoriasis cohort and for the six different psoriasis patient sub-groups: (a) patients with moderate-to-severe disease and mild disease, (b) patients with psoriatic arthritis and those without, and (c) patients on biologics and those who are not. Costs are presented per-patient-per-year (PPPY) and by years 1, 2, 3, 4, and 5 of follow-up, expressed in 2014 US dollars. A total of 108,790 psoriasis patients were selected, with a mean age of 46.0 years (52.7% females). Average follow-up was 962 days. All-cause healthcare costs were $12,523 PPPY. Outpatient pharmacy costs accounted for 38.6% of total costs. All-cause healthcare costs were highest for patients on biologics ($29,832), then for patients with psoriatic arthritis ($23,427) and those with moderate-to-severe disease ($21,481). Overall, all-cause healthcare costs and outpatient pharmacy costs presented an upward trend over a 5-year period. Psoriasis is associated with significant economic burden, which increases over time as the disease progresses. Patients with moderate-to-severe psoriasis, those with psoriatic arthritis, or use of biologics contributes to higher healthcare costs. Psoriasis-related pharmacy expenditure is the largest driver of healthcare costs in patients with psoriasis.

Readiness factors for lean implementation in healthcare settings--a literature review.

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Al-Balushi, S; Sohal, A S; Singh, P J; Al Hajri, A; Al Farsi, Y M; Al Abri, R

2014-01-01

The purpose of this paper is to determine the readiness factors that are critical to the application and success of lean operating principles in healthcare organizations through a review of relevant literature. A comprehensive review of literature focussing on lean and lean healthcare was conducted. Leadership, organizational culture, communication, training, measurement, and reward systems are all commonly attributed readiness factors throughout general change management and lean literature. However, directly related to the successful implementation of lean in healthcare is that a setting is able to authorize a decentralized management style and undertake an end-to-end process view. These can be particularly difficult initiatives for complex organizations such as healthcare settings. The readiness factors identified are based on a review of the published literature. The external validity of the findings could be enhanced if tested using an empirical study. The readiness factors identified will enable healthcare practitioners to be better prepared as they begin their lean journeys. Sustainability of the lean initiative will be at stake if these readiness factors are not addressed. To the best of the knowledge, this is the first paper that provides a consolidated list of key lean readiness factors that can guide practice, as well as future theory and empirical research.

Acetone enhances the direct analysis of total condensed tannins in plant tissues by the butanol-HCl-iron assay

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The butanol-HCl spectrophotometric assay is widely used to quantify extractable and insoluble forms of condensed tannin (CT, syn. proanthocyanidin) in foods, feeds, and foliage of herbaceous and woody plants. However, this method underestimates total CT content when applied directly to plant materia...

Exploring the Association of Homicides in Northern Mexico and Healthcare Access for US Residents.

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Geissler, Kimberley H; Becker, Charles; Stearns, Sally C; Thirumurthy, Harsha; Holmes, George M

2015-08-01

Many legal residents in the United States (US)-Mexico border region cross from the US into Mexico for medical treatment and pharmaceuticals. We analyzed whether recent increases in homicides in Mexico are associated with reduced healthcare access for US border residents. We used data on healthcare access, legal entries to the US from Mexico, and Mexican homicide rates (2002-2010). Poisson regression models estimated associations between homicide rates and total legal US entries. Multivariate difference-in-difference linear probability models evaluated associations between Mexican homicide rates and self-reported measures of healthcare access for US residents. Increased homicide rates were associated with decreased legal entries to the US from Mexico. Contrary to expectations, homicides did not have significant associations with healthcare access measures for legal residents in US border counties. Despite a decrease in border crossings, increased violence in Mexico did not appear to negatively affect healthcare access for US border residents.

Directional Total Generalized Variation Regularization for Impulse Noise Removal

DEFF Research Database (Denmark)

Kongskov, Rasmus Dalgas; Dong, Yiqiu

2017-01-01

this regularizer for directional images is highly advantageous. In order to estimate directions in impulse noise corrupted images, which is much more challenging compared to Gaussian noise corrupted images, we introduce a new Fourier transform-based method. Numerical experiments show that this method is more...

Migrants' access to healthcare

DEFF Research Database (Denmark)

Norredam, Marie

2011-01-01

There are strong pragmatic and moral reasons for receiving societies to address access to healthcare for migrants. Receiving societies have a pragmatic interest in sustaining migrants' health to facilitate integration; they also have a moral obligation to ensure migrants' access to healthcare...... according to international human rights principles. The intention of this thesis is to increase the understanding of migrants' access to healthcare by exploring two study aims: 1) Are there differences in migrants' access to healthcare compared to that of non-migrants? (substudy I and II); and 2) Why...... are there possible differences in migrants' access to healthcare compared to that of non-migrants? (substudy III and IV). The thesis builds on different methodological approaches using both register-based retrospective cohort design, cross-sectional design and survey methods. Two different measures of access were...

A three-model comparison of the relationship between quality, satisfaction and loyalty: an empirical study of the Chinese healthcare system

Directory of Open Access Journals (Sweden)

Lei Ping

2012-11-01

Full Text Available Abstract Background Previous research has addressed the relationship between customer satisfaction, perceived quality and customer loyalty intentions in consumer markets. In this study, we test and compare three theoretical models of the quality–satisfaction–loyalty relationship in the Chinese healthcare system. Methods This research focuses on hospital patients as participants in the process of healthcare procurement. Empirical data were obtained from six Chinese public hospitals in Shanghai. A total of 630 questionnaires were collected in two studies. Study 1 tested the research instruments, and Study 2 tested the three models. Confirmatory factor analysis was used to assess the scales’ construct validity by testing convergent and discriminant validity. A structural equation model (SEM specified the distinctions between each construct. A comparison of the three theoretical models was conducted via AMOS analysis. Results The results of the SEM demonstrate that quality and satisfaction are distinct concepts and that the first model (satisfaction mediates quality and loyalty is the most appropriate one in the context of the Chinese healthcare environment. Conclusions In this study, we test and compare three theoretical models of the quality–satisfaction–loyalty relationship in the Chinese healthcare system. Findings show that perceived quality improvement does not lead directly to customer loyalty. The strategy of using quality improvement to maintain patient loyalty depends on the level of patient satisfaction. This implies that the measurement of patient experiences should include topics of importance for patients’ satisfaction with health care services.

A three-model comparison of the relationship between quality, satisfaction and loyalty: an empirical study of the Chinese healthcare system.

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Lei, Ping; Jolibert, Alain

2012-11-30

Previous research has addressed the relationship between customer satisfaction, perceived quality and customer loyalty intentions in consumer markets. In this study, we test and compare three theoretical models of the quality-satisfaction-loyalty relationship in the Chinese healthcare system. This research focuses on hospital patients as participants in the process of healthcare procurement. Empirical data were obtained from six Chinese public hospitals in Shanghai. A total of 630 questionnaires were collected in two studies. Study 1 tested the research instruments, and Study 2 tested the three models. Confirmatory factor analysis was used to assess the scales' construct validity by testing convergent and discriminant validity. A structural equation model (SEM) specified the distinctions between each construct. A comparison of the three theoretical models was conducted via AMOS analysis. The results of the SEM demonstrate that quality and satisfaction are distinct concepts and that the first model (satisfaction mediates quality and loyalty) is the most appropriate one in the context of the Chinese healthcare environment. In this study, we test and compare three theoretical models of the quality-satisfaction-loyalty relationship in the Chinese healthcare system. Findings show that perceived quality improvement does not lead directly to customer loyalty. The strategy of using quality improvement to maintain patient loyalty depends on the level of patient satisfaction. This implies that the measurement of patient experiences should include topics of importance for patients' satisfaction with health care services.

A three-model comparison of the relationship between quality, satisfaction and loyalty: an empirical study of the Chinese healthcare system

Science.gov (United States)

2012-01-01

Background Previous research has addressed the relationship between customer satisfaction, perceived quality and customer loyalty intentions in consumer markets. In this study, we test and compare three theoretical models of the quality–satisfaction–loyalty relationship in the Chinese healthcare system. Methods This research focuses on hospital patients as participants in the process of healthcare procurement. Empirical data were obtained from six Chinese public hospitals in Shanghai. A total of 630 questionnaires were collected in two studies. Study 1 tested the research instruments, and Study 2 tested the three models. Confirmatory factor analysis was used to assess the scales’ construct validity by testing convergent and discriminant validity. A structural equation model (SEM) specified the distinctions between each construct. A comparison of the three theoretical models was conducted via AMOS analysis. Results The results of the SEM demonstrate that quality and satisfaction are distinct concepts and that the first model (satisfaction mediates quality and loyalty) is the most appropriate one in the context of the Chinese healthcare environment. Conclusions In this study, we test and compare three theoretical models of the quality–satisfaction–loyalty relationship in the Chinese healthcare system. Findings show that perceived quality improvement does not lead directly to customer loyalty. The strategy of using quality improvement to maintain patient loyalty depends on the level of patient satisfaction. This implies that the measurement of patient experiences should include topics of importance for patients’ satisfaction with health care services. PMID:23198824

Do senior management cultures affect performance? Evidence from Italian public healthcare organizations.

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Prenestini, Anna; Lega, Federico

2013-01-01

Healthcare organizations are often characterized by diffuse power, ambiguous goals, and a plurality of actors. In this complex and pluralistic context, senior healthcare managers are expected to provide strategic direction and lead their organizations toward their goals and performance targets. The present work explores the relationship between senior management team culture and performance by investigating Italian public healthcare organizations in the Tuscany region. Our assessment of senior management culture was accomplished through the use of an established framework and a corresponding tool, the competing values framework, which supports the idea that specific aspects of performance are related to a dominant management culture. Organizational performance was assessed using a wide range of measures collected by a multidimensional performance evaluation system, which was developed in Tuscany to measure the performance of its 12 local health authorities (LHAs) and four teaching hospitals (THs). Usable responses were received from 80 senior managers of 11 different healthcare organizations (two THs and nine LHAs). Our findings show that Tuscan healthcare organizations are characterized by various dominant cultures: developmental, clan, rational, and hierarchical. These variations in dominant culture were associated with performance measures. The implications for management theory, professional practice, and public policy are discussed.

Data collection automation and total quality management: case studies in the health-service industry.

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Smith, Alan D; Offodile, O Felix

2008-01-01

The limitations, immeasurable, and seemly unquantifiable aspects of the healthcare service industry, make it imperative that quality assurance programs include total quality management (TQM) and automatic identification and data capture (AIDC)-related technologies. Most of standards used in TQM and AIDC require data, to measure improvement and achieve standardization. Major difference between managing a service firm and managing a product-manufacturing firm is the difficulty of achieving consistently high quality. Examination of two different healthcare service providers in the Pittsburgh, Pennsylvania area offers different views as to the implementation and practice of total quality management techniques and AIDC integration. Since the healthcare service industry must take into account its high customization needs, there are positive steps to make the hospital structure itself more patient friendly and quality related; hence improving its heath-marketing strategies to the general public.

Healthcare leadership's diversity paradox.

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Silver, Reginald

2017-02-06

Purpose The purpose of this research study was to obtain healthcare executives' perspectives on diversity in executive healthcare leadership. The study focused on identifying perspectives about diversity and its potential impact on the access of healthcare services by people of color. The study also identified perspectives about factors that influence the attainment of executive healthcare roles by people of color. Design/methodology/approach A convenience sample of healthcare executives was obtained. The executives identified themselves as belonging to one of two subgroups, White healthcare executives or executives of color. Participants were interviewed telephonically in a semi-structured format. The interviews were transcribed and entered into a qualitative software application. The data were codified and important themes were identified. Findings The majority of the study participants perceive that diversity of the executive healthcare leadership team is important. There were differences in perspective among the subgroups as it relates to solutions to improve access to healthcare by people of color. There were also differences in perspective among the subgroups, as it relates to explaining the underrepresentation of people of color in executive healthcare leadership roles. Research limitations/implications This research effort benefited from the subject matter expertise of 24 healthcare executives from two states. Expansion of the number of survey participants and broadening the geographical spread of where participants were located may have yielded more convergence and/or more divergence in perspectives about key topics. Practical implications The findings from this research study serve to add to the existing body of literature on diversity in executive healthcare leadership. The findings expand on the importance of key elements in contemporary literature such as diversity, cultural competency and perspectives about the need for representation of people of

Advancing adolescent health and health services in Saudi Arabia: exploring health-care providers' training, interest, and perceptions of the health-care needs of young people

Directory of Open Access Journals (Sweden)

AlBuhairan FS

2014-09-01

Full Text Available Fadia S AlBuhairan,1–3 Tina M Olsson3,4 1Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia; 2King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; 3King Abdullah International Medical Research Center, Riyadh, Saudi Arabia; 4School of Social Work, Lund University, Lund, Sweden Background: Adolescent health is regarded as central to global health goals. Investments made in adolescent health and health services protect the improvements witnessed in child health. Though Saudi Arabia has a large adolescent population, adolescent health-care only began to emerge in recent years, yet widespread uptake has been very limited. Health-care providers are key in addressing and providing the necessary health-care services for adolescents, and so this study was conducted with the aim of identifying opportunities for the advancement of knowledge transfer for adolescent health services in Saudi Arabia. Methods: This Web-based, cross-sectional study was carried out at four hospitals in Saudi Arabia. Physicians and nurses were invited to participate in an online survey addressing their contact with adolescent patients, and training, knowledge, and attitudes towards adolescent health-care. Results: A total of 232 professionals participated. The majority (82.3% reported sometimes or always coming into contact with adolescent patients. Less than half (44%, however, had received any sort of training on adolescent health during their undergraduate or postgraduate education, and only 53.9% reported having adequate knowledge about the health-care needs of adolescents. Nurses perceived themselves as having more knowledge in the health-care needs of adolescents and reported feeling more comfortable in communicating with adolescents as compared with physicians. The majority of participants were interested in gaining further skills and knowledge in adolescent health-care and agreed or strongly agreed that adolescents have

Asset retirement obligations: a reporting concern for healthcare facilities.

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Berg, Gary G; Bayes, Paul E; Morgan, Robert G

2008-11-01

FASB statements and SEC guidelines give direction as to how healthcare organizations should account for their asset retirement obligations (AROs) where environmental issues are concerned. A key consideration is that current costs associated with environmental problems, such as encapsulating asbestos, are to be accounted for as part of an asset's cost and depreciated over the asset's remaining life.

The US healthcare workforce and the labor market effect on healthcare spending and health outcomes.

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Pellegrini, Lawrence C; Rodriguez-Monguio, Rosa; Qian, Jing

2014-06-01

The healthcare sector was one of the few sectors of the US economy that created new positions in spite of the recent economic downturn. Economic contractions are associated with worsening morbidity and mortality, declining private health insurance coverage, and budgetary pressure on public health programs. This study examines the causes of healthcare employment growth and workforce composition in the US and evaluates the labor market's impact on healthcare spending and health outcomes. Data are collected for 50 states and the District of Columbia from 1999-2009. Labor market and healthcare workforce data are obtained from the Bureau of Labor Statistics. Mortality and health status data are collected from the Centers for Disease Control and Prevention's Vital Statistics program and Behavioral Risk Factor Surveillance System. Healthcare spending data are derived from the Centers for Medicare and Medicaid Services. Dynamic panel data regression models, with instrumental variables, are used to examine the effect of the labor market on healthcare spending, morbidity, and mortality. Regression analysis is also performed to model the effects of healthcare spending on the healthcare workforce composition. All statistical tests are based on a two-sided [Formula: see text] significance of [Formula: see text] .05. Analyses are performed with STATA and SAS. The labor force participation rate shows a more robust effect on healthcare spending, morbidity, and mortality than the unemployment rate. Study results also show that declining labor force participation negatively impacts overall health status ([Formula: see text] .01), and mortality for males ([Formula: see text] .05) and females ([Formula: see text] .001), aged 16-64. Further, the Medicaid and Medicare spending share increases as labor force participation declines ([Formula: see text] .001); whereas, the private healthcare spending share decreases ([Formula: see text] .001). Public and private healthcare spending also

Increased Burden of Healthcare Utilization and Cost Associated with Opioid-Related Constipation Among Patients with Noncancer Pain

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Fernandes, Ancilla W.; Kern, David M.; Datto, Catherine; Chen, Yen-Wen; McLeskey, Charles; Tunceli, Ozgur

2016-01-01

Background Opioids are widely accepted as treatment for moderate to severe pain, and opioid-induced constipation is one of the most common side effects of opioids. This side effect negatively affects pain management and patients’ quality of life, which could result in increased healthcare utilization and costs. Objective To assess healthcare utilization and costs (all-cause, constipation-related, and pain-related) for individuals with and without opioid-induced constipation during the 12 months after initiation of opioid therapy for noncancer pain. Methods This retrospective cohort study was conducted using administrative claims data from HealthCore Integrated Research Environment between January 1, 2006, and June 30, 2014. The analysis was limited to patients aged ≥18 years who filled a prescription for continuous opioid treatment (≥28 days) for noncancer pain. Propensity scores were used to match opioid users with constipation (cohort 1) and opioid users without constipation (cohort 2), using a 1:1 ratio. Generalized linear models were used to estimate all-cause, constipation-related, and pain-related healthcare utilization and costs during the 12 months after the initiation of opioid therapy. Results After matching and balancing for all prespecified variables, 17,384 patients were retained in each cohort (mean age, 56 years; 63% female). Opioid users with constipation were twice as likely as those without constipation to have ≥1 inpatient hospitalizations (odds ratio, 2.28; 95% confidence interval [CI], 2.17–2.39) during the 12 months. The total mean adjusted overall costs per patient during the study period were $12,413 higher for patients with constipation versus those without it (95% CI, $11,726–$13,116). The total mean adjusted overall pain-related costs per patient were $6778 (95% CI, $6293–$7279) higher for the patients with constipation than those without. Among patients using opioids for noncancer pain, the annual mean constipation

Injustice to transsexual women in a hetero-normative healthcare system.

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Newman-Valentine, Douglas; Duma, Sinegugu

2014-11-21

Transsexual women who are on the journey of sexual re-alignment will experience various health problems. These problems are related directly to the treatment regime that they are following in order to attain and maintain their physical embodiment as a woman. They are forced to negotiate a hetero-normative healthcare system in order to receive assistance and care for their health problems related to their sexual re-alignment process. The questions posed were: What are the unique health problems that transsexual women experience whilst on the journey of sexual re-alignment? What is the current context of the South African healthcare system in which transsexual women should negotiate healthcare? These questions were asked in order to explore the health problems with which transsexual women are faced and to describe the hetero-normative healthcare system in South Africa. An electronic literature search was executed via the EBSCO host with specific inclusion and exclusion criteria. The search words that were used were: Transsexual/s and Health/Healthcare. All studies had to be peer reviewed and published in the English language, from January 1972 up until February 2013. Literature on transsexual children was excluded. Transsexual women have the potential to suffer significant side-effects from their sexual re-alignment treatment, including cardio-vascular problems, endocrine problems and mental ill-health. They are also vulnerable to HIV infection. They have poor access to quality holistic healthcare and this may lead an increase in the mortality and morbidity figures of women. A hetero-normative healthcare system has a negative impact on the health of transsexual women and will cause them to be marginalised. This could contribute to both homo- and trans-phobia that will in turn strengthen the belief that transsexual women are un-African.

Analysis of Anterior Cervical Discectomy and Fusion Healthcare Costs via the Value-Driven Outcomes Tool.

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Reese, Jared C; Karsy, Michael; Twitchell, Spencer; Bisson, Erica F

2018-04-11

Examining the costs of single- and multilevel anterior cervical discectomy and fusion (ACDF) is important for the identification of cost drivers and potentially reducing patient costs. A novel tool at our institution provides direct costs for the identification of potential drivers. To assess perioperative healthcare costs for patients undergoing an ACDF. Patients who underwent an elective ACDF between July 2011 and January 2017 were identified retrospectively. Factors adding to total cost were placed into subcategories to identify the most significant contributors, and potential drivers of total cost were evaluated using a multivariable linear regression model. A total of 465 patients (mean, age 53 ± 12 yr, 54% male) met the inclusion criteria for this study. The distribution of total cost was broken down into supplies/implants (39%), facility utilization (37%), physician fees (14%), pharmacy (7%), imaging (2%), and laboratory studies (1%). A multivariable linear regression analysis showed that total cost was significantly affected by the number of levels operated on, operating room time, and length of stay. Costs also showed a narrow distribution with few outliers and did not vary significantly over time. These results suggest that facility utilization and supplies/implants are the predominant cost contributors, accounting for 76% of the total cost of ACDF procedures. Efforts at lowering costs within these categories should make the most impact on providing more cost-effective care.

Health information technology vendor selection strategies and total factor productivity.

Science.gov (United States)

Ford, Eric W; Huerta, Timothy R; Menachemi, Nir; Thompson, Mark A; Yu, Feliciano

2013-01-01

The aim of this study was to compare health information technology (HIT) adoption strategies' relative performance on hospital-level productivity measures. The American Hospital Association's Annual Survey and Healthcare Information and Management Systems Society Analytics for fiscal years 2002 through 2007 were used for this study. A two-stage approach is employed. First, a Malmquist model is specified to calculate hospital-level productivity measures. A logistic regression model is then estimated to compare the three HIT adoption strategies' relative performance on the newly constructed productivity measures. The HIT vendor selection strategy impacts the amount of technological change required of an organization but does not appear to have either a positive or adverse impact on technical efficiency or total factor productivity. The higher levels in technological change experienced by hospitals using the best of breed and best of suite HIT vendor selection strategies may have a more direct impact on the organization early on in the process. However, these gains did not appear to translate into either increased technical efficiency or total factor productivity during the period studied. Over a longer period, one HIT vendor selection strategy may yet prove to be more effective at improving efficiency and productivity.

Prevalence of experienced abuse in healthcare and associated obstetric characteristics in six European countries.

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Lukasse, Mirjam; Schroll, Anne-Mette; Karro, Helle; Schei, Berit; Steingrimsdottir, Thora; Van Parys, An-Sofie; Ryding, Elsa Lena; Tabor, Ann

2015-05-01

To assess the prevalence and current suffering of experienced abuse in healthcare, to present the socio-demographic background for women with a history of abuse in healthcare and to assess the association between abuse in healthcare and selected obstetric characteristics. Cross-sectional study. Routine antenatal care in six European countries. In total 6923 pregnant women. Cross-tabulation and Pearson's chi-square was used to study prevalence and characteristics for women reporting abuse in healthcare. Associations with selected obstetric factors were estimated using multiple logistic regression analysis. Abuse in healthcare, fear of childbirth and preference for birth by cesarean section. One in five pregnant women attending routine antenatal care reported some lifetime abuse in healthcare. Prevalence varied significantly between the countries. Characteristics for women reporting abuse in healthcare included a significantly higher prevalence of other forms of abuse, economic hardship and negative life events as well as a lack of social support, symptoms of post-traumatic stress and depression. Among nulliparous women, abuse in healthcare was associated with fear of childbirth, adjusted odds ratio 2.25 (95% CI 1.23-4.12) for severe abuse in healthcare. For multiparous women only severe current suffering from abuse in healthcare was significantly associated with fear of childbirth, adjusted odds ratio 4.04 (95% CI 2.08-7.83). Current severe suffering from abuse in healthcare was significantly associated with the wish for cesarean section, and counselling for fear of childbirth for both nulli- and multiparous women. Abuse in healthcare among women attending routine antenatal care is common and for women with severe current suffering from abuse in healthcare, this is associated with fear of childbirth and a wish for cesarean section. © 2015 Nordic Federation of Societies of Obstetrics and Gynecology.

Direct measurement of the total decay width of the top quark.

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Aaltonen, T; Amerio, S; Amidei, D; Anastassov, A; Annovi, A; Antos, J; Apollinari, G; Appel, J A; Arisawa, T; Artikov, A; Asaadi, J; Ashmanskas, W; Auerbach, B; Aurisano, A; Azfar, F; Badgett, W; Bae, T; Barbaro-Galtieri, A; Barnes, V E; Barnett, B A; Barria, P; Bartos, P; Bauce, M; Bedeschi, F; Behari, S; Bellettini, G; Bellinger, J; Benjamin, D; Beretvas, A; Bhatti, A; Bland, K R; Blumenfeld, B; Bocci, A; Bodek, A; Bortoletto, D; Boudreau, J; Boveia, A; Brigliadori, L; Bromberg, C; Brucken, E; Budagov, J; Budd, H S; Burkett, K; Busetto, G; Bussey, P; Butti, P; Buzatu, A; Calamba, A; Camarda, S; Campanelli, M; Canelli, F; Carls, B; Carlsmith, D; Carosi, R; Carrillo, S; Casal, B; Casarsa, M; Castro, A; Catastini, P; Cauz, D; Cavaliere, V; Cavalli-Sforza, M; Cerri, A; Cerrito, L; Chen, Y C; Chertok, M; Chiarelli, G; Chlachidze, G; Cho, K; Chokheli, D; Clark, A; Clarke, C; Convery, M E; Conway, J; Corbo, M; Cordelli, M; Cox, C A; Cox, D J; Cremonesi, M; Cruz, D; Cuevas, J; Culbertson, R; d'Ascenzo, N; Datta, M; de Barbaro, P; Demortier, L; Deninno, M; D'Errico, M; Devoto, F; Di Canto, A; Di Ruzza, B; Dittmann, J R; Donati, S; D'Onofrio, M; Dorigo, M; Driutti, A; Ebina, K; Edgar, R; Elagin, A; Erbacher, R; Errede, S; Esham, B; Farrington, S; Fernández Ramos, J P; Field, R; Flanagan, G; Forrest, R; Franklin, M; Freeman, J C; Frisch, H; Funakoshi, Y; Galloni, C; Garfinkel, A F; Garosi, P; Gerberich, H; Gerchtein, E; Giagu, S; Giakoumopoulou, V; Gibson, K; Ginsburg, C M; Giokaris, N; Giromini, P; Giurgiu, G; Glagolev, V; Glenzinski, D; Gold, M; Goldin, D; Golossanov, A; Gomez, G; Gomez-Ceballos, G; Goncharov, M; González López, O; Gorelov, I; Goshaw, A T; Goulianos, K; Gramellini, E; Grinstein, S; Grosso-Pilcher, C; Group, R C; Guimaraes da Costa, J; Hahn, S R; Han, J Y; Happacher, F; Hara, K; Hare, M; Harr, R F; Harrington-Taber, T; Hatakeyama, K; Hays, C; Heinrich, J; Herndon, M; Hocker, A; Hong, Z; Hopkins, W; Hou, S; Hughes, R E; Husemann, U; Hussein, M; Huston, J; Introzzi, G; Iori, M; Ivanov, A; James, E; Jang, D; Jayatilaka, B; Jeon, E J; Jindariani, S; Jones, M; Joo, K K; Jun, S Y; Junk, T R; Kambeitz, M; Kamon, T; Karchin, P E; Kasmi, A; Kato, Y; Ketchum, W; Keung, J; Kilminster, B; Kim, D H; Kim, H S; Kim, J E; Kim, M J; Kim, S H; Kim, S B; Kim, Y J; Kim, Y K; Kimura, N; Kirby, M; Knoepfel, K; Kondo, K; Kong, D J; Konigsberg, J; Kotwal, A V; Kreps, M; Kroll, J; Kruse, M; Kuhr, T; Kurata, M; Laasanen, A T; Lammel, S; Lancaster, M; Lannon, K; Latino, G; Lee, H S; Lee, J S; Leo, S; Leone, S; Lewis, J D; Limosani, A; Lipeles, E; Lister, A; Liu, H; Liu, Q; Liu, T; Lockwitz, S; Loginov, A; Lucchesi, D; Lucà, A; Lueck, J; Lujan, P; Lukens, P; Lungu, G; Lys, J; Lysak, R; Madrak, R; Maestro, P; Malik, S; Manca, G; Manousakis-Katsikakis, A; Marchese, L; Margaroli, F; Marino, P; Martínez, M; Matera, K; Mattson, M E; Mazzacane, A; Mazzanti, P; McNulty, R; Mehta, A; Mehtala, P; Mesropian, C; Miao, T; Mietlicki, D; Mitra, A; Miyake, H; Moed, S; Moggi, N; Moon, C S; Moore, R; Morello, M J; Mukherjee, A; Muller, Th; Murat, P; Mussini, M; Nachtman, J; Nagai, Y; Naganoma, J; Nakano, I; Napier, A; Nett, J; Neu, C; Nigmanov, T; Nodulman, L; Noh, S Y; Norniella, O; Oakes, L; Oh, S H; Oh, Y D; Oksuzian, I; Okusawa, T; Orava, R; Ortolan, L; Pagliarone, C; Palencia, E; Palni, P; Papadimitriou, V; Parker, W; Pauletta, G; Paulini, M; Paus, C; Phillips, T J; Piacentino, G; Pianori, E; Pilot, J; Pitts, K; Plager, C; Pondrom, L; Poprocki, S; Potamianos, K; Pranko, A; Prokoshin, F; Ptohos, F; Punzi, G; Ranjan, N; Redondo Fernández, I; Renton, P; Rescigno, M; Rimondi, F; Ristori, L; Robson, A; Rodriguez, T; Rolli, S; Ronzani, M; Roser, R; Rosner, J L; Ruffini, F; Ruiz, A; Russ, J; Rusu, V; Sakumoto, W K; Sakurai, Y; Santi, L; Sato, K; Saveliev, V; Savoy-Navarro, A; Schlabach, P; Schmidt, E E; Schwarz, T; Scodellaro, L; Scuri, F; Seidel, S; Seiya, Y; Semenov, A; Sforza, F; Shalhout, S Z; Shears, T; Shepard, P F; Shimojima, M; Shochet, M; Shreyber-Tecker, I; Simonenko, A; Sliwa, K; Smith, J R; Snider, F D; Song, H; Sorin, V; St Denis, R; Stancari, M; Stentz, D; Strologas, J; Sudo, Y; Sukhanov, A; Suslov, I; Takemasa, K; Takeuchi, Y; Tang, J; Tecchio, M; Teng, P K; Thom, J; Thomson, E; Thukral, V; Toback, D; Tokar, S; Tollefson, K; Tomura, T; Tonelli, D; Torre, S; Torretta, D; Totaro, P; Trovato, M; Ukegawa, F; Uozumi, S; Vázquez, F; Velev, G; Vellidis, C; Vernieri, C; Vidal, M; Vilar, R; Vizán, J; Vogel, M; Volpi, G; Wagner, P; Wallny, R; Wang, S M; Waters, D; Wester, W C; Whiteson, D; Wicklund, A B; Wilbur, S; Williams, H H; Wilson, J S; Wilson, P; Winer, B L; Wittich, P; Wolbers, S; Wolfe, H; Wright, T; Wu, X; Wu, Z; Yamamoto, K; Yamato, D; Yang, T; Yang, U K; Yang, Y C; Yao, W-M; Yeh, G P; Yi, K; Yoh, J; Yorita, K; Yoshida, T; Yu, G B; Yu, I; Zanetti, A M; Zeng, Y; Zhou, C; Zucchelli, S

2013-11-15

We present a measurement of the total decay width of the top quark using events with top-antitop quark pair candidates reconstructed in the final state with one charged lepton and four or more hadronic jets. We use the full Tevatron run II data set of sqrt[s]=1.96  TeV proton-antiproton collisions recorded by the CDF II detector. The top quark mass and the mass of the hadronically decaying W boson are reconstructed for each event and compared with distributions derived from simulated signal and background samples to extract the top quark width (Γtop) and the energy scale of the calorimeter jets with in situ calibration. For a top quark mass Mtop=172.5  GeV/c2, we find 1.10<Γtop<4.05  GeV at 68% confidence level, which is in agreement with the standard model expectation of 1.3 GeV and is the most precise direct measurement of the top quark width to date.

EVALUATION OF THE METERED-DOSE INHALER TECHNIQUE AMONG HEALTHCARE PROVIDERS

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E. Nadi F. Zeraati

2005-07-01

Full Text Available Poor inhaler technique is a common problem both in asthmatic patients and healthcare providers, which contributes to poor asthma control. This study was performed to evaluate the adequacy of metered-dose inhaler (MDI technique in a sample of physicians and nurses practicing in hospitals of Hamadan University of Medical Sciences. A total of 173 healthcare providers voluntary participated in this study. After the participants answered a questionnaire aimed at identifying their involvement in MDI prescribing and counseling, a trained observer assessed their MDI technique using a checklist of nine steps. Of the 173 participants, 35 (20.2% were physicians and 138 (79.8% were nurses. Only 12 participants (6.93% performed all steps correctly. Physicians performed essential steps significantly better than nurses (85.7% vs. 63.8%, P < 0.05. The majority of healthcare providers responsible for instructing patients on the correct MDI technique were unable to perform this technique correctly, indicating the need for regular formal training programs on inhaler techniques.

Comorbidity and the concentration of healthcare expenditures in older patients with heart failure.

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Zhang, James X; Rathouz, Paul J; Chin, Marshall H

2003-04-01

To examine comorbidity and concentration of healthcare expenditures in older patients with heart failure (HF) in the Medicare program. Retrospective analysis of older fee-for-service HF patients, using the 1996 Medicare Current Beneficiary Survey and linked Medicare claims. Variety of clinical settings. One thousand two hundred sixty-six older HF patients from a nationally representative survey. Medicare expenditure per person and by types of healthcare services, prevalence of comorbid conditions, and multivariate regression on the association between comorbidities and healthcare expenditure. Medicare spent an average of 16,514 dollars on medical reimbursement for each HF patient in 1996. Eighty-one percent of patients had one or more comorbid diseases according to a 17-disease grouping index. The top 20% of HF patients accounted for 63% of total expenditure. Comorbidity was associated with significantly higher Medicare expenditure. HF patients with more-expensive comorbidities included those with peripheral vascular disease (24% of patients, mean total expenditure 26,954 dollars), myocardial infarction (16% of patients, mean total expenditure 29,867 dollars), renal disease (8% of patients, mean total expenditure 33,014 dollars), and hemiplegia or paraplegia (5% of patients, mean total expenditure 33,234 dollars). Diseases and disorders other than heart failure constituted a significant fraction of the causes of inpatient admissions. Comorbid conditions were more likely to be associated with expensive inpatient care, and patients with these diseases were more likely to spend more overall and more on other types of Medicare services including home health aid, skilled nursing facility, and hospice care. Disease management should consider comorbid conditions for improving care and reducing expenditures in older patients with HF.

Reducing stigma in healthcare and law enforcement: a novel approach to service provision for street level sex workers.

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Bodkin, Kate; Delahunty-Pike, Alannah; O'Shea, Tim

2015-04-09

Providing services for street level sex workers requires a multidisciplinary approach, addressing both health and safety concerns typical of their age and gender and those that arise specific to their line of work. Despite being a diverse population, studies have identified some specific health needs for sex workers including addictions treatment, mental health. Additionally, studies have shown a higher risk of physical and sexual assault for this population. The Persons at Risk program (PAR) in London, Ontario, Canada was started in 2005 to address the specific needs of street level sex workers by using a harm-reduction model for policing and healthcare provision. This qualitative study evaluated this model of care in terms of improving access to healthcare and essential police services for street level sex workers. A total of 14 semi-structured interviews were conducted with current and former female street level sex workers enrolled in the PAR program. In addition, 3 semi-structured interviews were conducted with health and law enforcement professionals. The research team then analyzed and coded the transcripts using qualitative description to identify key themes in the data. Results indicated that participants represent a vulnerable population with increased safety concerns and healthcare needs relating to addictions, mental health and infectious disease. Despite this, participants reported avoiding healthcare workers and police officers in the past because of fear of stigma or repercussions. All participants identified the harm reduction approach of the PAR program as being essential to their continued engagement with the program. Other important aspects included flexible hours, the location of the clinic, streamlined access to mental health and addictions treatment and the female gender of the police and healthcare worker. The PAR program provides sex workers access to much needed primary healthcare that is flexible and without judgment. In addition, they are

"Like finding a unicorn": Healthcare preferences among lesbian, gay, and bisexual people in the United States.

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Martos, Alexander J; Wilson, Patrick A; Gordon, Allegra R; Lightfoot, Marguerita; Meyer, Ilan H

2018-05-07

Lesbian, gay, and bisexual (LGB) peoples' healthcare preferences are often developed in response to social and institutional factors that can ultimately deter them from care. Prior qualitative explorations of LGB healthcare preferences have been limited in their ability to identify and compare patterns across age cohort, gender, and race/ethnicity. The current study examines qualitative data from 186 modified Life Story Interviews with three age cohorts of LGB people from New York City, NY, San Francisco, CA, Tucson, AZ, and Austin, TX to understand the factors influencing LGB people's healthcare preferences. Data are analyzed using a directed content analysis approach. Five key themes emerged regarding influences on healthcare preferences: Stigma, provider expertise, identity, service type, and access. Findings suggest that healthcare preferences among LGB people are both complex and closely linked to social changes over time. Healthcare preferences among LGB people are both complex and closely linked to social changes over time. Copyright © 2018 Elsevier Ltd. All rights reserved.

Exercise physiologists emerge as allied healthcare professionals in the era of non-communicable disease pandemics: a report from Australia, 2006-2012.

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Cheema, Birinder S; Robergs, Robert A; Askew, Christopher D

2014-07-01

Exercise can be prescribed to prevent, manage, and treat many leading non-communicable diseases (NCDs) and underlying risk factors. However, surprisingly, Australia is one of only a few countries where allied healthcare professionals with specialized university education and training in exercise prescription and delivery provide services within a government-run healthcare system (Medicare). This article presents data on Medicare-funded services provided by accredited exercise physiologists (AEPs) from the inclusion of the profession in the allied healthcare model (January, 2006) to the end of 2012. We conceptualize these data in relation to current NCD trends, and outline recommendations that can potentially help curtail the current chronic disease burden through the further integration of exercise professionals into the healthcare system in Australia, and internationally. From 2006 to 2012, the number of AEPs in Australia has increased 563 %. This rise in AEPs has been paralleled by increased delivery of services for eligible patients with a chronic medical condition (+614 %), type 2 diabetes mellitus (+211 to 230 %), and of Aboriginal and Torres Strait Islander descent (+343 %). These trends, which were developed through the "early years" of the profession, are encouraging and suggest that AEPs have taken up a vital position within the healthcare system. However, the total number of services provided by AEPs currently remains very low in relation to the prevalence of overweight-obesity and type 2 diabetes in Australia. Furthermore, services for Aboriginal Australians are very low considering the extreme burden of chronic diseases in these vulnerable populations. We provide some recommendations that may help the exercise physiology profession play a greater role in tackling the NCD burden and shift the healthcare model in a direction that is more proactive and focused on disease prevention and health, including the early identification and treatment of major

Organizational culture in the primary healthcare setting of Cyprus.

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Zachariadou, Theodora; Zannetos, Savvas; Pavlakis, Andreas

2013-03-24

The concept of organizational culture is important in understanding the behaviour of individuals in organizations as they manage external demands and internal social changes. Cyprus healthcare system is under restructuring and soon a new healthcare scheme will be implemented starting at the Primary Healthcare (PHC) level. The aim of the study was to investigate the underlying culture encountered in the PHC setting of Cyprus and to identify possible differences in desired and prevailing cultures among healthcare professionals. The population of the study included all general practitioners (GPs) and nursing staff working at the 42 PHC centres throughout the island. The shortened version of the Organizational Culture Profile questionnaire comprising 28 statements on organizational values was used in the study. The instrument was already translated and validated in Greek and cross-cultural adaptation was performed. Participants were required to indicate the organization's characteristic cultural values orientation along a five-point Likert scale ranging from "Very Much = 1" to "Not at all= 5". Statistical analysis was performed using SPSS 16.0. Student t-test was used to compare means between two groups of variables whereas for more than two groups analysis of variance (ANOVA) was applied. From the total of 306 healthcare professionals, 223 participated in the study (72.9%). The majority of participants were women (75.3%) and mean age was 42.6 ± 10.7 years. Culture dimension "performance orientation" was the desired culture among healthcare professionals (mean: 1.39 ± 0.45). "Supportiveness" and "social responsibility" were the main cultures encountered in PHC (means: 2.37 ± 0.80, 2.38 ± 0.83). Statistical significant differences were identified between desired and prevailing cultures for all culture dimensions (p= 0.000). This was the first study performed in Cyprus assessing organizational culture in the PHC setting. In the forthcoming health system reform

[Healthcare professionals' knowledge, attitudes and practices in relation to standard hospital precautions].

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Mandana Bambenongama, Norbert; Losimba Likwela, Joris

2013-01-01

The infectious risk in the healthcare setting is potentially ubiquitous. Several infectious agents may be transmitted to healthcare professionals, most of which are carried by blood and body fluids. The aim of this study was to assess knowledge, attitudes and practices of healthcare workers in delivery rooms and operating theatres about standard precautions in healthcare settings in order to deduce the actions to be implemented to improve their security. A descriptive cross-sectional survey was conducted in September 2011. A questionnaire was sent to 96 people using the direct interview technique. Only 20% of study subjects were familiar with the main bloodborne viruses (HBV, HCV and HIV). 67.8% of them considered that standard precautions must be applied only to women in labour and suspected HIV-positive patients. Almost all respondents (91.1%) had already been subject to at least one AES during the last 12 months. Respondents appeared to have a poor knowledge of the recommended actions following an AES. Recapping of needles after care is a practice reported by 55.6% of respondents. Routine use of protective barriers is unsatisfactory. The frequent failure of systematic application of standard precautions in healthcare settings by healthcare workers in the city of Isiro should lead the Ministry of Health to implement a process designed to increase awareness about standard precautions and improve the equipment necessary for strict compliance with these precautions.

Ethical issues in healthcare financing.

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Maharaj, S R; Paul, T J

2011-07-01

The four goals of good healthcare are to relieve symptoms, cure disease, prolong life and improve quality of life. Access to healthcare has been a perpetual challenge to healthcare providers who must take into account important factors such as equity, efficiency and effectiveness in designing healthcare systems to meet the four goals of good healthcare. The underlying philosophy may designate health as being a basic human right, an investment, a commodity to be bought and sold, a political demand or an expenditure. The design, policies and operational arrangements will usually reflect which of the above philosophies underpin the healthcare system, and consequently, access. Mechanisms for funding include fee-for-service, cost sharing (insurance, either private or government sponsored) free-of-fee at point of delivery (payments being made through general taxes, health levies, etc) or cost-recovery. For each of these methods of financial access to healthcare services, there are ethical issues which can compromise the four principles of ethical practices in healthcare, viz beneficence, non-maleficence, autonomy and justice. In times of economic recession, providing adequate healthcare will require governments, with support from external agencies, to focus on poverty reduction strategies through provision of preventive services such as immunization and nutrition, delivered at primary care facilities. To maximize the effect of such policies, it will be necessary to integrate policies to fashion an intersectoral approach.

Angles of total shifts and angles of maxumum crop during development of faces diagonal to seam strike directions

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Н. А. Колесник

2017-06-01

Full Text Available When predicting deformations and determining measures to protect underworked objects, angular parameters are used: the boundary angles, the angles of total shift, the angle of maximum crop. The values of these angular parameters are given in the normative documents, but only for sections across and along the strike of the formation. However, at present, longwall face mining is mainly being carried out along a diagonal direction to the strike of the formation. In connection with this, the determination of the values of the angular parameters for such conditions is a topical task.The method of determination and the analytical dependences of the angles of total shifts and angles of maximum crop in sections of the longitudinal and transverse axes of coal-mining faces developed along diagonal directions to the strike of the formation are proposed. These angular parameters are used for prognosis of deformations of the earth's surface and for determining the characteristic zones of influence of mine workings on the local places.

Recommended Vaccines for Healthcare Workers

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... Vaccination Resources for Healthcare Professionals Recommended Vaccines for Healthcare Workers Recommend on Facebook Tweet Share Compartir On ... for More Information Resources for Those Vaccinating HCWs Healthcare workers (HCWs) are at risk for exposure to ...

Minority mothers' healthcare beliefs, commonly used alternative healthcare practices, and potential complications for infants and children.

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Hannan, Jean

2015-06-01

Complementary and alternative healthcare practices have increased substantially in the United States especially with low-income ethnic minority mothers. These mothers often have provider mistrust, language barriers, differing health belief systems, and as a result are less likely to seek preventive health screening, access healthcare services, and use alternative remedies for their infants and children that are potentially harmful or lethal. Therefore, the purpose of this article is to examine healthcare beliefs, commonly used alternative healthcare practices, and their potential complications for infants and children. A search of CINAHL and PubMed (1980-2012) was conducted using the following terms: alternative healthcare practice, mothers' health beliefs, cultural health beliefs, folk remedies, and infant health practices. Given the changing U.S. population and an increasing immigrant population, examining alternative healthcare practices mothers use for their infants and children is especially important for providers in addressing healthcare for this group. The use of alternative healthcare practices is rarely discussed by parents with healthcare providers for fear of disapproval. When interviewing ethnic minority mothers and caregivers questions should include the use of alternative healthcare practices for infants and children and information regarding the potential dangers should be provided to them. ©2014 American Association of Nurse Practitioners.

The Role of Healthcare Technology Management in Facilitating Medical Device Cybersecurity.

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Busdicker, Mike; Upendra, Priyanka

2017-09-02

This article discusses the role of healthcare technology management (HTM) in medical device cybersecurity and outlines concepts that are applicable to HTM professionals at a healthcare delivery organization or at an integrated delivery network, regardless of size. It provides direction for HTM professionals who are unfamiliar with the security aspects of managing healthcare technologies but are familiar with standards from The Joint Commission (TJC). It provides a useful set of recommendations, including relevant references for incorporating good security practices into HTM practice. Recommendations for policies, procedures, and processes referencing TJC standards are easily applicable to HTM departments with limited resources and to those with no resource concerns. The authors outline processes from their organization as well as best practices learned through information sharing at AAMI, National Health Information Sharing and Analysis Center (NH-ISAC), and Medical Device Innovation, Safety, and Security Consortium (MDISS) conferences and workshops.

[Patient safety in education and training of healthcare professionals in Germany].

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Hoffmann, Barbara; Siebert, H; Euteneier, A

2015-01-01

In order to improve patient safety, healthcare professionals who care for patients directly or indirectly are required to possess specific knowledge and skills. Patient safety education is not or only poorly represented in education and examination regulations of healthcare professionals in Germany; therefore, it is only practiced rarely and on a voluntary basis. Meanwhile, several training curricula and concepts have been developed in the past 10 years internationally and recently in Germany, too. Based on these concepts the German Coalition for Patient Safety developed a catalogue of core competencies required for safety in patient care. This catalogue will serve as an important orientation when patient safety is to be implemented as a subject of professional education in Germany in the future. Moreover, teaching staff has to be trained and educational and training activities have to be evaluated. Patient safety education and training for (undergraduate) healthcare professional will require capital investment.

Conceptualisation of job-related wellbeing, stress and burnout among healthcare workers in rural Ethiopia: a qualitative study.

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Selamu, Medhin; Thornicroft, Graham; Fekadu, Abebaw; Hanlon, Charlotte

2017-06-19

Wellbeing of healthcare workers is important for the effective functioning of health systems. The aim of this study was to explore the conceptualisations of wellbeing, stress and burnout among healthcare workers in primary healthcare settings in rural Ethiopia in order to inform the development of contextually appropriate interventions. A qualitative study was conducted in a rural zone of southern Ethiopia. A total of 52 frontline primary healthcare workers participated in in-depth interviews (n = 18) or Focus Group Discussions (FGDs) (4 groups, total n = 34). There were 35 facility based healthcare professionals and 17 community-based health workers. Data were analysed using thematic analysis. Most participants conceptualised wellbeing as absence of stress rather than as a positive state. Many threats to wellbeing were identified. For facility-based workers, the main stressors were inadequate supplies leading to fears of acquiring infection and concerns about performance evaluation. For community health workers, the main stressor was role ambiguity. Workload and economic self-sufficiency were a concern for both groups. Burnout and its symptoms were recognised and reported by most as a problem of other healthcare workers. Derogatory and stigmatising terms, such as "chronics", were used to refer to those who had served for many years and who appeared to have become drained of all compassion. Most participants viewed burnout as inevitable if they continued to work in their current workplace without career progression. Structural and environmental aspects of work emerged as potential targets to improve wellbeing, combined with tackling stigmatising attitudes towards mental health problems. An unmet need for intervention for healthcare workers who develop burnout or emotional difficulties was identified. Ethiopian primary healthcare workers commonly face job-related stress and experience features of burnout, which may contribute to the high turnover of staff and

Lean six sigma in healthcare.

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de Koning, Henk; Verver, John P S; van den Heuvel, Jaap; Bisgaard, Soren; Does, Ronald J M M

2006-01-01

Healthcare, as with any other service operation, requires systematic innovation efforts to remain competitive, cost efficient, and up-to-date. This article outlines a methodology and presents examples to illustrate how principles of Lean Thinking and Six Sigma can be combined to provide an effective framework for producing systematic innovation efforts in healthcare. Controlling healthcare cost increases, improving quality, and providing better healthcare are some of the benefits of this approach.

Clinical Ethics Support for Healthcare Personnel: An Integrative Literature Review.

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Rasoal, Dara; Skovdahl, Kirsti; Gifford, Mervyn; Kihlgren, Annica

2017-12-01

This study describes which clinical ethics approaches are available to support healthcare personnel in clinical practice in terms of their construction, functions and goals. Healthcare personnel frequently face ethically difficult situations in the course of their work and these issues cover a wide range of areas from prenatal care to end-of-life care. Although various forms of clinical ethics support have been developed, to our knowledge there is a lack of review studies describing which ethics support approaches are available, how they are constructed and their goals in supporting healthcare personnel in clinical practice. This study engages in an integrative literature review. We searched for peer-reviewed academic articles written in English between 2000 and 2016 using specific Mesh terms and manual keywords in CINAHL, MEDLINE and Psych INFO databases. In total, 54 articles worldwide described clinical ethics support approaches that include clinical ethics consultation, clinical ethics committees, moral case deliberation, ethics rounds, ethics discussion groups, and ethics reflection groups. Clinical ethics consultation and clinical ethics committees have various roles and functions in different countries. They can provide healthcare personnel with advice and recommendations regarding the best course of action. Moral case deliberation, ethics rounds, ethics discussion groups and ethics reflection groups support the idea that group reflection increases insight into ethical issues. Clinical ethics support in the form of a "bottom-up" perspective might give healthcare personnel opportunities to think and reflect more than a "top-down" perspective. A "bottom-up" approach leaves the healthcare personnel with the moral responsibility for their choice of action in clinical practice, while a "top-down" approach risks removing such moral responsibility.

Computer-assisted surgery simulations and directed practice of total knee arthroplasty: educational benefits to the trainee.

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Myden, C A; Anglin, C; Kopp, G D; Hutchison, C R

2012-01-01

Orthopaedic residents typically learn to perform total knee arthroplasty (TKA) through an apprenticeship-type model, which is a necessarily slow process. Surgical skills courses, using artificial bones, have been shown to improve technical and cognitive skills significantly within a couple of days. The addition of computer-assisted surgery (CAS) simulations challenges the participants to consider the same task in a different context, promoting cognitive flexibility. We designed a hands-on educational intervention for junior residents with a conventional tibiofemoral TKA station, two different tibiofemoral CAS stations, and a CAS and conventional patellar resection station, including both qualitative and quantitative analyses. Qualitatively, structured interviews before and after the course were analyzed for recurring themes. Quantitatively, subjects were evaluated on their technical skills before and after the course, and on a multiple-choice knowledge test and error detection test after the course, in comparison to senior residents who performed only the testing. Four themes emerged: confidence, awareness, deepening knowledge and changed perspectives. The residents' attitudes to CAS changed from negative before the course to neutral or positive afterwards. The junior resident group completed 23% of tasks in the pre-course skills test and 75% of tasks on the post-test (peducational interventions, promoting cognitive flexibility, would benefit trainees, attending surgeons, the healthcare system and patients.

Prevalence and factors associated with occupational burnout among HIV/AIDS healthcare workers in China: a cross-sectional study

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Zhengxue Qiao

2016-04-01

Full Text Available Abstract Background Burnout is a psychosomatic syndrome characterized by three dimensions (emotional exhaustion [EE], feelings of depersonalization [DP], and reduced personal accomplishment [PA]. We determined the prevalence of burnout and mental health status between HIV/AIDS healthcare workers and other healthcare workers, and determined the factors associated with burnout of HIV/AIDS healthcare workers. Methods All participants were asked to complete a self-administered questionnaire. The participants were recruited from the departments of infectious diseases in four hospitals which treated HIV/AIDS. The questionnaire included demographics, the Maslach Burnout Inventory-General Survey (MBI-GS, the Symptom Checklist 90 (SCL-90, the Eysenck Personality Questionnaire (EPQ, and the Trait Coping Style Questionnaire (TCSQ. Results A total of 512 questionnaires were distributed; 501 questionnaires were completed and collected (the response rate was 97.9 %. After eliminating nine invalid questionnaires (1.80 %, 264 physicians and nurses caring for HIV/AIDS and 228 physicians and nurses caring for other infectious diseases provided valid responses (98.2 %. The HIV/AIDS healthcare workers’ scores on the emotional exhaustion (F = 6.350, p = 0.012 and depersonalization dimensions (F = 8.533, p = 0.004 were significantly higher than other healthcare workers. The HIV/AIDS healthcare workers had higher total scores and positive items on the Symptom Checklist 90 (SCL-90 compared with other healthcare workers. Low job satisfaction, serious somatization, interpersonal sensitivity, poor quality of sleep, high psychoticism scores, and use of negative coping styles were frequently associated with burnout. Conclusions Burnout was shown to be highly prevalent in HIV/AIDS healthcare workers, 76.9 % of whom met the accepted criteria for burnout. In addition, compared with other healthcare workers, HIV/AIDS healthcare workers experienced lower

Career choice and perceptions of nursing among healthcare students in higher educational institutions.

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Liaw, Sok Ying; Wu, Ling Ting; Chow, Yeow Leng; Lim, Siriwan; Tan, Khoon Kiat

2017-05-01

Due to the ageing population and competition from other healthcare courses, a greater demand in the healthcare workforce has made it challenging for educational institutions to attract school leavers to enter nursing courses. Understanding the considerations of students who have chosen non-nursing healthcare courses and their perceptions of nursing can help identify specific strategies to enhance the attractiveness of nursing course. This study aims to examine the differences between healthcare career choices and perceptions of nursing as a career choice among first-year non-nursing healthcare students. A descriptive survey design was conducted at the beginning of the healthcare courses of seven healthcare groups and from four higher educational institutions in Singapore. A total of 451 students responded, yielding an overall response rate of 52.7%. The online survey was administered using a valid and reliable 35-item parallel scale, known as the Healthcare Career Choice and Nursing Career Choice. The participants perceived prior healthcare exposure as the most influential factor and self-efficacy as the least influential factor when choosing nursing as a career. In comparison to their own healthcare career choices, nursing was perceived to have greater gender stigma and, as nurses, they would be less likely to achieve higher qualifications and career advancements, and they would be less likely to enjoy fulfilling careers. They also perceived that they would be less likely to gain their parents' support to pursue nursing and to make their parents proud. This study provides educators and policy-makers with vital information to develop key strategies to improve nursing enrolment in educational institutions. These strategies include early exposure to nursing as a rewarding career during school years, addressing the issue of gender stigma, and promoting information on the career and educational advancement of a registered nurse to parents of school leavers. Copyright �

Perceptions of telecare training needs in home healthcare services: a focus group study.

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Guise, Veslemøy; Wiig, Siri

2017-02-23

The implementation and use of telecare requires significant changes to healthcare service organisation and delivery, including new ways of working for staff. Competency development and training for healthcare professionals is therefore required to enable necessary adaptation of clinical practice and ensure competent provision of telecare services. It is however unclear what skills healthcare staff need when providing care at a distance and there is little empirical evidence on effective training strategies for telecare practice. Training should however emphasise the experiences and preferences of prospective trainees to ensure its relevance to their educational needs. The aim of this study was to explore healthcare professionals' perceptions of training related to the general use of telecare, and to identify specific training needs associated with the use of virtual visits in the home healthcare services. Six focus group interviews were held with a total of 26 participants working in the home healthcare services in Norway, including registered nurses, enrolled nurses, physiotherapists, occupational therapists, social workers, health workers, and healthcare assistants. The data material was analysed by way of systematic text condensation. The analysis resulted in five categories relevant to telecare training for healthcare professionals: Purposeful training creates confidence and changes attitudes; Training needs depend on ability to cope with telecare; The timing of training; Training must facilitate practical insight into the patients' perspective; and Training content must focus on the telecare process. Findings are discussed in light of implications for the form and content of a training program for healthcare professionals on how to undertake virtual home healthcare visits. Appropriate preparation and training for telecare use is important for healthcare professionals and must be taken seriously by healthcare organisations. To facilitate the knowledge, skills

Use of healthcare resources and costs associated to the start of treatment with injectable drugs in patients with type 2 diabetes mellitus.

Science.gov (United States)

Sicras-Mainar, Antoni; Navarro-Artieda, Ruth; Morano, Raúl; Ruíz, Lucía

2016-12-01

The main objective was to assess resource use and costs of starting treatment with insulin or injectable GLP-1 receptor analogues (GLP-1 RAs) in a Spanish population of patients with type 2 diabetes mellitus. Treatment adherence and persistence were also determined for both treatment groups. A retrospective, non-interventional, observational study was conducted. Patients aged ≥20 years who started treatment with insulin or GLP-1 RAs in the 2010-2012 period were recruited. Use of healthcare resources was estimated to evaluate healthcare costs in these two groups of patients (medical visits, hospital stay, emergency visits, diagnostic or treatment requests, medication). Clinical information including body mass index (BMI, kg/m 2 ), metabolic control (HbA1c), adherence, persistence, and complications (hypoglycemia, and cardiovascular events (CVE) was collected. The follow-up period was 12 months. Only direct healthcare costs were considered. A total of 1301 patients with a mean age of 67.6 years (51.6% males) were recruited. Of these, 71.9% and 28.1% were on treatment with insulin and GLP-1 RA respectively. After one year of follow-up, patients treated with GLP-1 RAs were found less visits to primary care (8 vs. 11; P<.001) and specialized care (1.0 vs. 1.8; P<.001), hospital stays (0.3 vs. 0.7; P=.030) and less visits to the emergency room (0.8 vs. 1.6; P<.001). Patients treated with GLP-1 showed greater adherence (88.1% vs. 82.7%; P<.001) and persistence (62.0% vs. 55.9%; P=.046), and had less hypoglycemia episodes (13.4% vs. 18.7%; P=.022), with similar metabolic control (HbA1c: 7.2% vs. 7.4%; P=.049), BMI (29.1 vs. 30.9kg/m 2 ), and CVE rate (9.1% vs. 11.5%; P=.330) respectively. The mean corrected direct healthcare cost per patient was €1787 vs. €2005 (P=.046.) CONCLUSIONS: Patients treated with GLP-1 RAs caused lower direct healthcare costs for the National Health System than patients treated with insulin. The results may be explained by greater treatment

Procedural aspects of healthcare quality control in Latvia and its effect on legal protection of patients

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Liepins A.

2018-01-01

Full Text Available According to the European Commission data, 8–12% of patients cared for in hospitals throughout the European Union have suffered accidents related to the healthcare provided for them. The Directive 2011/24/EU of the European Parliament and Council of 9th March 2011 on the application of patients’ rights in cross-border healthcare provides that the Member States shouldensurethat patients have easily accessible and transparent appeal procedures and mechanisms that provide possibilities for legal remedies in cases of inflicted harm during medical treatment according to regulations of the respective Member State. Healthcare quality control mechanisms are intended for two major purposes: to identify accidents that have occurred during medical treatment and to prevent similar accidents from reoccurring in the future. The aim of this article is to evaluate, firstly, the procedural aspects of healthcare quality control mechanisms in Latvia and, secondly, how healthcare quality control mechanisms have been affected with the implementation of the Directive 2011/24/EU in Latvian legal order, providing for a specific legal remedy – the newly created Medical risk fund. Conclusions are made on the procedural nature of the patients’ right to submit complaints and also the developments in Latvian court practice related to the healthcare quality control. The authors have also analysed regulations related to the Medical risk fund, its influence on the civil liability mechanisms of medical practitioners, as well as the patient’s right to obtainjust compensation for the harm inflicted to his health and the legal nature of opinions of the Health Inspectorate of Latvia.

Improving Healthcare through Lean Management

DEFF Research Database (Denmark)

Nielsen, Anders Paarup; Edwards, Kasper

2011-01-01

The ideas and principles from lean management are now widely being adopted within the healthcare sector. The analysis in this paper shows that organizations within healthcare most often only implement a limited set of tools and methods from the lean tool-box. Departing from a theoretical analysis...... of the well-known and universal lean management principles in the context of the healthcare this paper will attempt to formulate and test four hypotheses about possible barriers to the successful implementation of lean management in healthcare. The first hypothesis states that lean management in healthcare....... The paper concludes by discussing the implications of hypothesis two, three, and four for the successful application of lean management within healthcare. Is it concluded that this requires a transformative and contingent approach to lean management where the universal principles of the lean philosophy...

Innovation in medicine and healthcare 2015

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Torro, Carlos; Tanaka, Satoshi; Howlett, Robert; Jain, Lakhmi

2016-01-01

Innovation in medicine and healthcare is an interdisciplinary research area, which combines the advanced technologies and problem solving skills with medical and biological science. A central theme of this proceedings is Smart Medical and Healthcare Systems (modern intelligent systems for medicine and healthcare), which can provide efficient and accurate solution to problems faced by healthcare and medical practitioners today by using advanced information communication techniques, computational intelligence, mathematics, robotics and other advanced technologies. The techniques developed in this area will have a significant effect on future medicine and healthcare.    The volume includes 53 papers, which present the recent trend and innovations in medicine and healthcare including Medical Informatics; Biomedical Engineering; Management for Healthcare; Advanced ICT for Medical and Healthcare; Simulation and Visualization/VR for Medicine; Statistical Signal Processing and Artificial Intelligence; Smart Medic...

Levelling vs competition – political trend reversal in the German healthcare system?

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Sascha Wolf

2014-12-01

Full Text Available For almost 20 years, the German federal government has declared that competition is the key to ensuring the financial sustainability of the healthcare system. The aim of this paper is to investigate if German government indeed has followed a direct path to enhancing competition. For this purpose, a qualitative analysis of the most important healthcare reform acts has been conducted. In conclusion, especially since the introduction of the Health Fund in 2009, a clear trend towards more levelling and regulation can be observed. This trend is confirmed by the most recent healthcare reform act in June 2014. The abolishment of flat-rate premiums is the expression of the government’s fear that competitive pressure could endanger the solvency and viability of sickness funds (statutory health insurance funds. In contrast, on the market for selective contracts, an ambivalent picture emerges. On the one hand, several possibilities for establishing new forms of healthcare and strengthening competition have been introduced. On the other hand, sickness funds as well as service providers are often reluctant to enter into selective contracts.

Interactive, technology-enhanced self-regulated learning tools in healthcare education: a literature review.

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Petty, Julia

2013-01-01

Learning technology is increasingly being implemented for programmes of blended learning within nurse education. With a growing emphasis on self-directed study particularly in post-basic education, there is a need for learners to be guided in their learning away from practice and limited classroom time. Technology-enabled (TE) tools which engage learners actively can play a part in this. The effectiveness and value of interactive TE learning strategies within healthcare is the focus of this paper. To identify literature that explores the effectiveness of interactive, TE tools on knowledge acquisition and learner satisfaction within healthcare with a view to evaluating their use for post-basic nurse education. A Literature Review was performed focusing on papers exploring the comparative value and perceived benefit of TE tools compared to traditional modes of learning within healthcare. The Databases identified as most suitable due to their relevance to healthcare were accessed through EBSCOhost. Primary, Boolean and advanced searches on key terms were undertaken. Inclusion and exclusion criteria were applied which resulted in a final selection of 11 studies for critique. Analysis of the literature found that knowledge acquisition in most cases was enhanced and measured learner satisfaction was generally positive for interactive, self-regulated TE tools. However, TE education may not suit all learners and this is critiqued in the light of the identified limitations. Interactive self regulation and/or testing can be a valuable learning strategy that can be incorporated into self-directed programmes of study for post-registration learners. Whilst acknowledging the learning styles not suited to such tools, the concurrent use of self-directed TE tools with those learning strategies necessitating a more social presence can work together to support enhancement of knowledge required to deliver rationale for nursing practice. Copyright © 2012 Elsevier Ltd. All rights

Barriers of six sigma in healthcare organizations

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Serkan Deniz

2018-09-01

Full Text Available Six Sigma approach is based on decreasing defects and variations in the products and processes, and it provides important benefits to healthcare organizations. This study aims to identify managers’ opinions, who work in private healthcare organizations, about the reasons behind not using Six Sigma in their organizations. The research was performed between December 2016 and March 2018 in private healthcare organizations (private hospitals and medical centers operating in Turkey and not using Six Sigma approach. Data were collected from managers, who have knowledge about Six Sigma, through using surveys. In this study, survey methodology was used to collect data. According to the results, the biggest barrier related to not using Six Sigma is based on the lack of knowledge about Six Sigma. The other important barrier about the diffusion of Six Sigma within this organizations is related to the lack of support from top management and leaders. Another finding about the reasons of not applying Six Sigma approach is that there is not a statistically significant difference among managers in terms of their managerial position. In order to overcome the lack of knowledge about Six Sigma, it is advised that managers should take steps in the direction of promoting Six Sigma within their current organization, and provide necessary support and leadership about the process.

Strategies for healthcare information systems

NARCIS (Netherlands)

Stegwee, R.A.; Spil, Antonius A.M.

2001-01-01

Information technologies of the past two decades have created significant fundamental changes in the delivery of healthcare services by healthcare provider organizations. Many healthcare organizations have been in search of ways and strategies to keep up with continuously emerging information

International aid and natural disasters: a pre- and post-earthquake longitudinal study of the healthcare infrastructure in Leogane, Haiti.

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Kligerman, Maxwell; Barry, Michele; Walmer, David; Bendavid, Eran

2015-02-01

The reconstruction of healthcare systems in developing countries after natural disasters is poorly understood. Using data collected before and after the 2010 Haiti earthquake, we detail the response of aid agencies and their interaction with local healthcare providers in Leogane, the city closest to the epicenter. We find that the period after the earthquake was associated with an increase in the total number of healthcare facilities, inpatient beds, and surgical facilities and that international aid has been a driving force behind this recovery. Aid has funded 12 of 13 new healthcare facilities that have opened since the earthquake as well as the reconstruction of 7 of 8 healthcare facilities that have been rebuilt. Despite increases in free, aid-financed healthcare, private Haitian healthcare facilities have remained at a constant number. The planned phase-out of several aid-financed facilities, however, will leave Leogane with fewer inpatient beds and healthcare services compared with the pre-earthquake period. © The American Society of Tropical Medicine and Hygiene.

Awareness of the healthcare system and rights to healthcare in the Colombian population.

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Delgado Gallego, María Eugenia; Vázquez-Navarrete, María Luisa

2013-01-01

To analyze changes in users' awareness of the healthcare system and of their rights to healthcare in Colombia in the last 10 years, as well as the factors that influence users' awareness. We carried out a descriptive study to compare the results of two cross-sectional studies based on two surveys of users of the Colombian healthcare system. The first survey was performed in 2000 and the second in 2010. The municipalities of Tuluá (urban area) and Palmira (rural area) were surveyed. In both surveys, a stratified, multistage probability sample was selected. There were 1497 users in the first sample and 1405 in the second. Changes in awareness of the healthcare system and associated factors in each year were assessed through multivariate logistic regressions. Users' awareness of the healthcare system was limited in 2000 and was significantly lower in 2010, except for that relating to health insurers and providers. In contrast, more than 90% of users in both surveys perceived themselves as having healthcare rights. The factors consistently associated with greater awareness were belonging to a high socioeconomic stratum and having higher education. The most underprivileged users were less likely to be aware of the healthcare system, hampering their ability to make informed decisions and to exercise their health rights. To correct this situation, health institutions and the government should act decisively to reduce social inequalities. Copyright © 2012 SESPAS. Published by Elsevier Espana. All rights reserved.

Irritable bowel symptoms, use of healthcare, costs, sickness and disability pension benefits: A long-term population-based study.

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Poulsen, Chalotte H; Eplov, Lene F; Hjorthøj, Carsten; Hastrup, Lene H; Eliasen, Marie; Dantoft, Thomas M; Schröder, Andreas; Jørgensen, Torben

2018-05-01

Irritable bowel syndrome (IBS) is associated with increased healthcare use and work absenteeism. We aimed to investigate long-term use of healthcare services and social benefits across IBS symptom groups. Additionally, we estimated excess healthcare costs. A longitudinal population-based study comprising two 5-year follow-up studies: The Danish part of the Multinational Monitoring of Trends and Determinants in Cardiovascular Disease (Dan-MONICA) 1 (1982-1987) and Inter99 (1999-2004) recruited from the western part of Copenhagen County. The total study population ( n = 7278) was divided into symptom groups according to degree of IBS definition fulfillment at baseline and/or 5-year follow-up and was followed until 31 December 2013 in Danish central registries. Poisson regression was used for the analyses adjusting for age, sex, length of education, comorbidity, cohort membership and mental vulnerability. IBS symptom groups compared to no IBS symptoms were associated with an increased number of contacts with primary and secondary healthcare, as well as weeks on sickness and disability benefits. Accounting for mental vulnerability decreased the estimates and all but two associations between IBS symptom groups and outcomes remained statistically significant. The two associations that became insignificant were contacts with psychiatric hospitals and weeks on disability pension. The excess unadjusted healthcare costs for IBS were 680 Euros per year and the overall association between symptom groups and total healthcare costs were statistically significant. IBS symptoms influence the long-term use and costs of healthcare, as well as the use of social benefits in the general population. Mental vulnerability explained some, but not all, of the use of healthcare and social benefits.

Spirituality and healthcare: Towards holistic people-centred healthcare in South Africa

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Andre de la Porte

2016-07-01

Full Text Available Healthcare in South Africa is in a crisis. Problems with infrastructure, management, human resources and the supply of essential medicines are at a critical level. This is compounded by a high burden of disease and disparity in levels of service delivery, particularly between public and private healthcare. The government has put ambitious plans in place, which are part of the National Development Plan to ward 2030. In the midst of this we find the individual person and their family and community staggering under the suffering caused by disease, poverty, crime and violence. There is a more than 70% chance that this person and their family and community are trying to make sense of this within a spiritual framework and that they belong to a faith-based community. This article explores the valuable contribution of spirituality, spiritual and pastoral work, the faith-based community (FBC and faith-based organisations (FBOs to holistic people-centred healthcare in South Africa. Keywords: Healthcare; Spirituality; Clinical Spiritual Counselling

Innovation in healthcare services – creating a Combined Contingency Theory and Ecosystems Approach

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Engelseth, Per; Kritchanchai, Duangpun

2018-04-01

The purpose of this conceptual paper is to develop an analytical framework used for process development in healthcare services. Healthcare services imply a form of operations management demanding an adapted research approach. This study therefore highlights first in the introduction challenges of healthcare services as a reasoning of this study. It is a type of service that has high societal and therefore ethical concern, but at the same time needs to be carried out efficiently to economise service production resource use. Combined business and ethics concerns need to be balanced in this service supply system. In the literature review that is the bulk of this paper, first, particularities of the service industry processes are considered. This is followed by considering literature on contingency theory to consider the nature of the supply chain context of the healthcare service processes highlighting interdependencies and appropriate technology use. This developed view is then expanded to consider an ecosystems approach to encompass the environment expanding analyses to considering in balanced manner features of business, society and nature. A research model for directing both further researches on the healthcare service industry an innovation of such services in practice is introduced.

Household catastrophic healthcare expenditure and impoverishment due to rotavirus gastroenteritis requiring hospitalization in Malaysia.

Science.gov (United States)

Loganathan, Tharani; Lee, Way-Seah; Lee, Kok-Foo; Jit, Mark; Ng, Chiu-Wan

2015-01-01

While healthcare costs for rotavirus gastroenteritis requiring hospitalization may be burdensome on households in Malaysia, exploration on the distribution and catastrophic impact of these expenses on households are lacking. We assessed the economic burden, levels and distribution of catastrophic healthcare expenditure, the poverty impact on households and inequities related to healthcare payments for acute gastroenteritis requiring hospitalization in Malaysia. A two-year prospective, hospital-based study was conducted from 2008 to 2010 in an urban (Kuala Lumpur) and rural (Kuala Terengganu) setting in Malaysia. All children under the age of 5 years admitted for acute gastroenteritis were included. Patients were screened for rotavirus and information on healthcare expenditure was obtained. Of the 658 stool samples collected at both centers, 248 (38%) were positive for rotavirus. Direct and indirect costs incurred were significantly higher in Kuala Lumpur compared with Kuala Terengganu (US$222 Vs. US$45; pMalaysia.

The Relationship Between Job Satisfaction and Job Performance Among Midwives Working in Healthcare Centers of Mashhad, Iran

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Zahra Hadizadeh Talasaz

2014-07-01

Full Text Available Background and Aim: Job satisfaction represents individuals' positive or negative attitude towards their occupation. Job satisfaction is of high significance in health care field and could affects the quality of patients' health care and satisfaction. Every organization should pay considerable attention to job satisfaction and performance and continually monitor these indices. Therefore, we aimed to determine the relationship between job satisfaction and job performance of midwives, employed in health care centers of Mashhad, Iran. Methods: This descriptive correlational study was performed on 90 midwives, working in healthcare centers of Mashhad, Iran, in 2014 who were selected through multistage sampling from five healthcare centers. Data collection tools included a questionnaire to record demographic, personal and occupational data, Minnesota Job Satisfaction Questionnaire (MSQ as well as a self-structured observational checklist to measure the quality of educational, care, and communicative job performance of midwives. SPSS version 19 was used to analyze data through descriptive statistics, and also Spearman and Kruskal-Wallis tests. Results: The mean age of the participants was 39.63±6.92 years. Spearman correlation test showed a direct correlation between job satisfaction and the total score of job performance (P

An international survey of cleaning and disinfection practices in the healthcare environment.

Science.gov (United States)

Kenters, Nikki; Gottlieb, Thomas; Hopman, Joost; Mehtar, Shaheen; Schweizer, Marin L; Tartari, Ermira; Huijskens, E G W; Voss, Andreas

2018-05-14

Antimicrobial resistance has become an urgent global health priority. Basic hygiene practices and cleaning and disinfection of the hospital environment are key in preventing pathogen cross-transmission. To our knowledge no studies have assessed the worldwide differences in cleaning and disinfection practices in healthcare facilities. The electronic survey described here was developed in order to evaluate differences in healthcare facility cleaning practices around the world. The International Society of Antimicrobial Chemotherapy (ISAC, formerly ISC), Infection Prevention and Control work group developed a survey with 30 multiple-choice questions. The questions were designed to assess the current cleaning practices in healthcare settings around the world. A total of 110 healthcare professionals, representing 23 countries participated in the online survey. In 96% of the facilities a written cleaning policy was present. Training of cleaning staff occurred in 70% of the facilities at the start of employment. Cleaning practices and monitoring of these practices varied. In summary, the survey enabled assessment and recognition of widely differing global practices in approaches to environmental cleaning and disinfection. Development of guideline recommendations for cleaning and disinfection could improve practices and set minimum standards worldwide. Copyright © 2018 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

Healthcare costs in the Danish randomised controlled lung cancer CT-screening trial

DEFF Research Database (Denmark)

Rasmussen, J.F.; Siersma, V.; Pedersen, Jesper H.

2014-01-01

: This registry study was nested in a randomised controlled trial (DLCST). 4104 participants, current or former heavy smokers, aged 50-70 years were randomised to five annual low dose CT scans or usual care during 2004-2010. Total healthcare costs and healthcare utilisation data for both the primary...... and the secondary healthcare sector were retrieved from public registries from randomisation - September 2011 and compared between (1) the CT-screening group and the control group and, (2) the control group and each of the true-positive, false-positive and true-negative groups. RESULTS: The median annual costs per...... participant were significantly higher in the CT-screening group (Euros [EUR] 1342, interquartile range [IQR] 750-2980) compared with the control group (EUR 1190, IQR 590-2692) (pcost of the CT-screening programme was excluded, there was no longer a statistically significant difference...

Health technology assessment and its role in the future development of the Indian healthcare sector

OpenAIRE

Hass, Bastian; Pooley, Jayne; Feuring, Martin; Suvarna, Viraj; Harrington, Adrian E.

2012-01-01

Public expenditure on healthcare in India is low by international comparison, and access to essential treatment pushes many uninsured citizens below the poverty line. In many countries, policymakers utilize health technology assessment (HTA) methodologies to direct investments in healthcare, to obtain the maximum benefit for the population as a whole. With rising incomes and a commitment from the Government of India to increase the proportion of gross domestic product spent on health, this is...

Healthcare is primary

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Raman Kumar

2015-01-01

Full Text Available India is undergoing a rapid transformation in terms of governance, administrative reforms, newer policy develoment, and social movements. India is also considered one of the most vibrant economies in the world. The current discourse in public space is dominated by issues such as economic development, security, corruption free governance, gender equity, and women safety. Healthcare though remains a pressing need of population; seems to have taken a backseat. In the era of decreasing subsidies and cautious investment in social sectors, the 2 nd National Conference on Family Medicine and Primary Care 2015 (FMPC brought a focus on "healthcare" in India. The theme of this conference was "Healthcare is Primary." The conference participants discussed on the theme of why healthcare should be a national priority and why strong primary care should remain at the center of healthcare delivery system. The experts recommended that India needs to strengthen the "general health system" instead of focusing on disease based vertical programs. Public health system should have capacity and skill pool to be able to deliver person centered comprehensive health services to the community. Proactive implementation of policies towards human resource in health is the need of the hour. As the draft National Health Policy 2015 is being debated, "family medicine" (academic primary care, the unfinished agenda of National Health Policy 2002, remains a priority area of implementation.

Self-medication among healthcare and non-healthcare students at University of Ljubljana, Slovenia.

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Klemenc-Ketis, Zalika; Hladnik, Ziga; Kersnik, Janko

2010-01-01

To determine the incidence of self-medication among University of Ljubljana students and the effect of the type of curriculum on the pattern of self-medication. The study included a sample of 1,294 students who freely accessed a self-administered web-based questionnaire in the Slovene language that consisted of a preliminary letter introducing the term 'self-treatment' and 2 sections about self-medication. The preliminary letter asked participants to report the practice of self-treatment during the past year. The main outcome measures were percentages of those reporting self-medication during the past year, which were then used to compare healthcare and non-healthcare students. A majority of students (1,195, 92.3%), both healthcare and non-healthcare, reported the use of some sort of self-medication during the study period. More healthcare students in their senior year (353, 94.1%) than those in their junior year (245, 89.4%) used self-medication (p = 0.04). Healthcare students (p = 0.05) thought that self-medication without improvement of the symptoms should last for 1 week or less. They acquired the drugs for self-medication from pharmacies; thought that previous doctors' advice in a similar situation was a more important reason for self-medication; would seek the advice of a physician or pharmacist for different ways of self-treatment, and quite interestingly thought that self-medication was not very safe. On the other hand, non-healthcare students acquired the drugs from healers and friends. The study showed that self-medication was common among all University of Ljubljana students, but that healthcare-related education in students and young adults led to more responsible use of self-medication. Copyright 2010 S. Karger AG, Basel.

Healthcare Engineering Defined: A White Paper.

Science.gov (United States)

Chyu, Ming-Chien; Austin, Tony; Calisir, Fethi; Chanjaplammootil, Samuel; Davis, Mark J; Favela, Jesus; Gan, Heng; Gefen, Amit; Haddas, Ram; Hahn-Goldberg, Shoshana; Hornero, Roberto; Huang, Yu-Li; Jensen, Øystein; Jiang, Zhongwei; Katsanis, J S; Lee, Jeong-A; Lewis, Gladius; Lovell, Nigel H; Luebbers, Heinz-Theo; Morales, George G; Matis, Timothy; Matthews, Judith T; Mazur, Lukasz; Ng, Eddie Yin-Kwee; Oommen, K J; Ormand, Kevin; Rohde, Tarald; Sánchez-Morillo, Daniel; Sanz-Calcedo, Justo García; Sawan, Mohamad; Shen, Chwan-Li; Shieh, Jiann-Shing; Su, Chao-Ton; Sun, Lilly; Sun, Mingui; Sun, Yi; Tewolde, Senay N; Williams, Eric A; Yan, Chongjun; Zhang, Jiajie; Zhang, Yuan-Ting

2015-01-01

Engineering has been playing an important role in serving and advancing healthcare. The term "Healthcare Engineering" has been used by professional societies, universities, scientific authors, and the healthcare industry for decades. However, the definition of "Healthcare Engineering" remains ambiguous. The purpose of this position paper is to present a definition of Healthcare Engineering as an academic discipline, an area of research, a field of specialty, and a profession. Healthcare Engineering is defined in terms of what it is, who performs it, where it is performed, and how it is performed, including its purpose, scope, topics, synergy, education/training, contributions, and prospects.

Romanian healthcare system at a glance

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Christiana Balan

2013-04-01

Full Text Available The Romanian healthcare system is facing constant challenges to produce high quality care with low costs. Objectives The paper aims to analyze the efficiency of the Romanian healthcare system in terms of resources allocation. The evaluation and the dimension of healthcare system efficiency are important for identifying a balance between the resources required and the health outcomes. Prior Work Previous studies describe the Romanian healthcare system as a system in transition. This study focuses on the relationship between the inputs and outputs of the system. Approach In order to assess the efficiency of the Romanian healthcare system we use Data Envelopment Analysis approach. Both input and output healthcare indicators are observed for the period 1999-2010 and the years when healthcare inputs have been used efficiently are identified. Results The results show that human, financial, and technological resources have been used at maximum capacity in 1999, 2003, 2004, 2007 and 2010. Implications Though efficiency is defined differently by diverse stakeholders, healthcare policies should focus on rising the responsibility of communities and individuals for better treatments and services and better access to information on healthcare providers. Value The paper is an empirically based study of the healthcare resources allocation in Romania.

Ethical Issues of Social Media Usage in Healthcare.

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Denecke, K; Bamidis, P; Bond, C; Gabarron, E; Househ, M; Lau, A Y S; Mayer, M A; Merolli, M; Hansen, M

2015-08-13

Social media, web and mobile technologies are increasingly used in healthcare and directly support patientcentered care. Patients benefit from disease self-management tools, contact to others, and closer monitoring. Researchers study drug efficiency, or recruit patients for clinical studies via these technologies. However, low communication barriers in socialmedia, limited privacy and security issues lead to problems from an ethical perspective. This paper summarizes the ethical issues to be considered when social media is exploited in healthcare contexts. Starting from our experiences in social-media research, we collected ethical issues for selected social-media use cases in the context of patient-centered care. Results were enriched by collecting and analyzing relevant literature and were discussed and interpreted by members of the IMIA Social Media Working Group. Most relevant issues in social-media applications are confidence and privacy that need to be carefully preserved. The patient-physician relationship can suffer from the new information gain on both sides since private information of both healthcare provider and consumer may be accessible through the Internet. Physicians need to ensure they keep the borders between private and professional intact. Beyond, preserving patient anonymity when citing Internet content is crucial for research studies. Exploiting medical social-media in healthcare applications requires a careful reflection of roles and responsibilities. Availability of data and information can be useful in many settings, but the abuse of data needs to be prevented. Preserving privacy and confidentiality of online users is a main issue, as well as providing means for patients or Internet users to express concerns on data usage.

[Role of Visiting Nursing Care in Japanese Home Healthcare].

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Yu, Sang-Ju

2018-02-01

Taiwan's rapidly aging society is expected to make it a super-aged society in 2026. By 2060, people aged 65 or older will account for 40% of the population, a ratio that will approximate that in Japan. In Japan, the elderly population was 27.3% in 2016. By 2025, when the baby-boomers become 75 years old in Japan, issues of long-term care and end-of-life care will be more important and challenging. Since 1976, more Japanese have died in hospital settings than in home settings. Although the percentage of people dying at home increased slightly to 12.7% in 2016, after the recent introduction and promotion of home healthcare, Japan will face a significant challenge to deal with the healthcare 'tsunami' of high natural death rates, which is expected to impose a heavy death burdened on society by 2040, when the death rate is expected to reach 1,670,000/year. Therefore, the Japanese authorities have begun to promote the Community-based Integrated Care System, in which home healthcare and visiting nursing play crucial roles. This article summarizes the historical trend and current situation of visiting nursing in Japan. Japan uses a hybrid payment system for visiting nursing that is financially supported both through private medical insurance policies and Kaigo insurance (Japanese long-term care insurance). The total of 8613 visiting nursing stations that were active in community settings in 2016 cooperated with 14,000 support clinics for home healthcare and cared for 570,000 patients in home settings. We believe that visiting nursing will play an important role in home healthcare in Taiwan in the future.

Direct EUV/X-Ray Modulation of the Ionosphere During the August 2017 Total Solar Eclipse

Science.gov (United States)

Mrak, Sebastijan; Semeter, Joshua; Drob, Douglas; Huba, J. D.

2018-05-01

The great American total solar eclipse of 21 August 2017 offered a fortuitous opportunity to study the response of the atmosphere and ionosphere using a myriad of ground instruments. We have used the network of U.S. Global Positioning System receivers to examine perturbations in maps of ionospheric total electron content (TEC). Coherent large-scale variations in TEC have been interpreted by others as gravity wave-induced traveling ionospheric disturbances. However, the solar disk had two active regions at that time, one near the center of the disk and one at the edge, which resulted in an irregular illumination pattern in the extreme ultraviolet (EUV)/X-ray bands. Using detailed EUV occultation maps calculated from the National Aeronautics and Space Administration Solar Dynamics Observatory Atmospheric Imaging Assembly images, we show excellent agreement between TEC perturbations and computed gradients in EUV illumination. The results strongly suggest that prominent large-scale TEC disturbances were consequences of direct EUV modulation, rather than gravity wave-induced traveling ionospheric disturbances.

Improving healthcare practice behaviors: an exploratory study identifying effective and ineffective behaviors in healthcare.

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Van Fleet, David D; Peterson, Tim O

2016-01-01

The purpose of this paper is to present the results of exploratory research designed to develop an awareness of healthcare behaviors, with a view toward improving the customer satisfaction with healthcare services. It examines the relationship between healthcare providers and their consumers/patients/clients. The study uses a critical incident methodology, with both effective and ineffective behavioral specimens examined across different provider groups. The effects of these different behaviors on what Berry (1999) identified as the common core values of service organizations are examined, as those values are required to build a lasting service relationship. Also examined are categories of healthcare practice based on the National Quality Strategy priorities. The most obvious is the retrospective nature of the method used. How accurate are patient or consumer memories? Are they capable of making valid judgments of healthcare experiences (Berry and Bendapudi, 2003)? While an obvious limitation, such recollections are clearly important as they may be paramount in following the healthcare practitioners' instructions, loyalty for repeat business, making recommendations to others and the like. Further, studies have shown retrospective reports to be accurate and useful (Miller et al., 1997). With this information, healthcare educators should be in a better position to improve the training offered in their programs and practitioners to better serve their customers. The findings would indicate that the human values of excellence, innovation, joy, respect and integrity play a significant role in building a strong service relationship between consumer and healthcare provider. Berry (1999) has argued that the overriding importance in building a lasting service business is human values. This exploratory study has shown how critical incident analysis can be used to determine both effective and ineffective practices of different medical providers. It also provides guidelines as

Blind image fusion for hyperspectral imaging with the directional total variation

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Bungert, Leon; Coomes, David A.; Ehrhardt, Matthias J.; Rasch, Jennifer; Reisenhofer, Rafael; Schönlieb, Carola-Bibiane

2018-04-01

Hyperspectral imaging is a cutting-edge type of remote sensing used for mapping vegetation properties, rock minerals and other materials. A major drawback of hyperspectral imaging devices is their intrinsic low spatial resolution. In this paper, we propose a method for increasing the spatial resolution of a hyperspectral image by fusing it with an image of higher spatial resolution that was obtained with a different imaging modality. This is accomplished by solving a variational problem in which the regularization functional is the directional total variation. To accommodate for possible mis-registrations between the two images, we consider a non-convex blind super-resolution problem where both a fused image and the corresponding convolution kernel are estimated. Using this approach, our model can realign the given images if needed. Our experimental results indicate that the non-convexity is negligible in practice and that reliable solutions can be computed using a variety of different optimization algorithms. Numerical results on real remote sensing data from plant sciences and urban monitoring show the potential of the proposed method and suggests that it is robust with respect to the regularization parameters, mis-registration and the shape of the kernel.

Healthcare. State Report

Science.gov (United States)

Carnevale, Anthony P.; Smith, Nicole; Gulish, Artem; Beach, Bennett H.

2012-01-01

This report projects education requirements linked to forecasted job growth in healthcare by state and the District of Columbia from 2010 through 2020. It complements a larger national report which projects educational demand for healthcare for the same time period. The national report shows that with or without Obamacare, the United States will…

Machine Learning for Healthcare: On the Verge of a Major Shift in Healthcare Epidemiology.

Science.gov (United States)

Wiens, Jenna; Shenoy, Erica S

2018-01-06

The increasing availability of electronic health data presents a major opportunity in healthcare for both discovery and practical applications to improve healthcare. However, for healthcare epidemiologists to best use these data, computational techniques that can handle large complex datasets are required. Machine learning (ML), the study of tools and methods for identifying patterns in data, can help. The appropriate application of ML to these data promises to transform patient risk stratification broadly in the field of medicine and especially in infectious diseases. This, in turn, could lead to targeted interventions that reduce the spread of healthcare-associated pathogens. In this review, we begin with an introduction to the basics of ML. We then move on to discuss how ML can transform healthcare epidemiology, providing examples of successful applications. Finally, we present special considerations for those healthcare epidemiologists who want to use and apply ML. © The Author(s) 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.

Managing resources and reducing waste in healthcare settings.

Science.gov (United States)

Minogue, Virginia; Wells, Bill

2016-05-18

The NHS is under pressure to increase its effectiveness and productivity. Nurses are tasked with delivering effective and efficient care, as well as improving patient safety, experiences and results. The reduction of waste in service delivery, care and treatment can release time and resources for nurses to engage in direct patient care. Nurses have an important role in reducing waste and influencing other professionals in the healthcare environment to increase their efficiency and productivity.

The Hazards of Data Mining in Healthcare.

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Househ, Mowafa; Aldosari, Bakheet

2017-01-01

From the mid-1990s, data mining methods have been used to explore and find patterns and relationships in healthcare data. During the 1990s and early 2000's, data mining was a topic of great interest to healthcare researchers, as data mining showed some promise in the use of its predictive techniques to help model the healthcare system and improve the delivery of healthcare services. However, it was soon discovered that mining healthcare data had many challenges relating to the veracity of healthcare data and limitations around predictive modelling leading to failures of data mining projects. As the Big Data movement has gained momentum over the past few years, there has been a reemergence of interest in the use of data mining techniques and methods to analyze healthcare generated Big Data. Much has been written on the positive impacts of data mining on healthcare practice relating to issues of best practice, fraud detection, chronic disease management, and general healthcare decision making. Little has been written about the limitations and challenges of data mining use in healthcare. In this review paper, we explore some of the limitations and challenges in the use of data mining techniques in healthcare. Our results show that the limitations of data mining in healthcare include reliability of medical data, data sharing between healthcare organizations, inappropriate modelling leading to inaccurate predictions. We conclude that there are many pitfalls in the use of data mining in healthcare and more work is needed to show evidence of its utility in facilitating healthcare decision-making for healthcare providers, managers, and policy makers and more evidence is needed on data mining's overall impact on healthcare services and patient care.

A moral framework for multicultural education in healthcare.

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Vaught, Wayne

2003-01-01

The goal of this paper is two-fold. First, I begin by reviewing several of the major points of emphasis among health educators as they begin to incorporate multicultural issues into healthcare education. I then consider the role of moral relativism, which is currently being endorsed by some health educators, as the foundation for resolving cross-cultural conflicts in healthcare. I argue that moral relativism is ultimately inconsistent with the stated goals in multicultural curricular proposals and fails to provide an effective framework for considering moral conflicts in cross-cultural settings. Instead, I propose that those methods seeking to establish a common morality, built upon mutually shared values, offer the most promising means of resolving cross-cultural conflicts. This leads to my second goal, to compare recent work in moral pragmatism with what is now widely known in bioethics as moral "principlism." I argue that while proponents of principlism and pragmatism each seek to establish a common foundation for moral deliberation, they fail to appreciate significant similarities between their respective approaches. Instead of offering two completely unique and independent methods of moral deliberation, I suggest that principlism and pragmatism embrace common themes that point us in a positive direction, providing an effective framework useful for considering cross-cultural conflicts in healthcare.

Data Privacy in Cloud-assisted Healthcare Systems: State of the Art and Future Challenges.

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Sajid, Anam; Abbas, Haider

2016-06-01

The widespread deployment and utility of Wireless Body Area Networks (WBAN's) in healthcare systems required new technologies like Internet of Things (IoT) and cloud computing, that are able to deal with the storage and processing limitations of WBAN's. This amalgamation of WBAN-based healthcare systems to cloud-based healthcare systems gave rise to serious privacy concerns to the sensitive healthcare data. Hence, there is a need for the proactive identification and effective mitigation mechanisms for these patient's data privacy concerns that pose continuous threats to the integrity and stability of the healthcare environment. For this purpose, a systematic literature review has been conducted that presents a clear picture of the privacy concerns of patient's data in cloud-assisted healthcare systems and analyzed the mechanisms that are recently proposed by the research community. The methodology used for conducting the review was based on Kitchenham guidelines. Results from the review show that most of the patient's data privacy techniques do not fully address the privacy concerns and therefore require more efforts. The summary presented in this paper would help in setting research directions for the techniques and mechanisms that are needed to address the patient's data privacy concerns in a balanced and light-weight manner by considering all the aspects and limitations of the cloud-assisted healthcare systems.

Learner-Adaptive Educational Technology for Simulation in Healthcare: Foundations and Opportunities.

Science.gov (United States)

Lineberry, Matthew; Dev, Parvati; Lane, H Chad; Talbot, Thomas B

2018-06-01

Despite evidence that learners vary greatly in their learning needs, practical constraints tend to favor ''one-size-fits-all'' educational approaches, in simulation-based education as elsewhere. Adaptive educational technologies - devices and/or software applications that capture and analyze relevant data about learners to select and present individually tailored learning stimuli - are a promising aid in learners' and educators' efforts to provide learning experiences that meet individual needs. In this article, we summarize and build upon the 2017 Society for Simulation in Healthcare Research Summit panel discussion on adaptive learning. First, we consider the role of adaptivity in learning broadly. We then outline the basic functions that adaptive learning technologies must implement and the unique affordances and challenges of technology-based approaches for those functions, sharing an illustrative example from healthcare simulation. Finally, we consider future directions for accelerating research, development, and deployment of effective adaptive educational technology and techniques in healthcare simulation.

Cell engineering: spearheading the next generation in healthcare

International Nuclear Information System (INIS)

Jayasinghe, Suwan N

2008-01-01

Manipulating living mammalian cells present fascinating possibilities for a plethora of applications within our healthcare. These imply several possibilities in tissue engineering and regenerative medicine, to those of a therapeutic nature. The physical sciences are increasingly playing a pivotal role in this endeavour by both advancing existing cell engineering technology and pioneering new protocols for the creation of biologically viable structures. In this paper, the author introduces several direct needle/channel/orifice-based cell engineering protocols, currently undergoing intense investigation for a whole host of bio-applications. Hence, each protocol's advantages and disadvantages are clearly identified, whilst recognizing their future biological and engineering challenges. In conclusion, a few selected biotechnological applications present possibilities where these protocols could undergo focused exploration. Successful development of these bio-protocols sees the emergence of unique future strategies within a clinical environment having far-reaching consequences for our healthcare

Cell engineering: spearheading the next generation in healthcare

Energy Technology Data Exchange (ETDEWEB)

Jayasinghe, Suwan N [BioPhysics Group, Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE (United Kingdom)], E-mail: s.jayasinghe@ucl.ac.uk

2008-09-01

Manipulating living mammalian cells present fascinating possibilities for a plethora of applications within our healthcare. These imply several possibilities in tissue engineering and regenerative medicine, to those of a therapeutic nature. The physical sciences are increasingly playing a pivotal role in this endeavour by both advancing existing cell engineering technology and pioneering new protocols for the creation of biologically viable structures. In this paper, the author introduces several direct needle/channel/orifice-based cell engineering protocols, currently undergoing intense investigation for a whole host of bio-applications. Hence, each protocol's advantages and disadvantages are clearly identified, whilst recognizing their future biological and engineering challenges. In conclusion, a few selected biotechnological applications present possibilities where these protocols could undergo focused exploration. Successful development of these bio-protocols sees the emergence of unique future strategies within a clinical environment having far-reaching consequences for our healthcare.

Cell engineering: spearheading the next generation in healthcare.

Science.gov (United States)

Jayasinghe, Suwan N

2008-09-01

Manipulating living mammalian cells present fascinating possibilities for a plethora of applications within our healthcare. These imply several possibilities in tissue engineering and regenerative medicine, to those of a therapeutic nature. The physical sciences are increasingly playing a pivotal role in this endeavour by both advancing existing cell engineering technology and pioneering new protocols for the creation of biologically viable structures. In this paper, the author introduces several direct needle/channel/orifice-based cell engineering protocols, currently undergoing intense investigation for a whole host of bio-applications. Hence, each protocol's advantages and disadvantages are clearly identified, whilst recognizing their future biological and engineering challenges. In conclusion, a few selected biotechnological applications present possibilities where these protocols could undergo focused exploration. Successful development of these bio-protocols sees the emergence of unique future strategies within a clinical environment having far-reaching consequences for our healthcare.

Healthcare information technology and medical-surgical nurses: the emergence of a new care partnership.

Science.gov (United States)

Moore, An'Nita; Fisher, Kathleen

2012-03-01

Healthcare information technology in US hospitals and ambulatory care centers continues to expand, and nurses are expected to effectively and efficiently utilize this technology. Researchers suggest that clinical information systems have expanded the realm of nursing to integrate technology as an element as important in nursing practice as the patient or population being served. This study sought to explore how medical surgical nurses make use of healthcare information technology in their current clinical practice and to examine the influence of healthcare information technology on nurses' clinical decision making. A total of eight medical surgical nurses participated in the study, four novice and four experienced. A conventional content analysis was utilized that allowed for a thematic interpretation of participant data. Five themes emerged: (1) healthcare information technology as a care coordination partner, (2) healthcare information technology as a change agent in the care delivery environment, (3) healthcare information technology-unable to meet all the needs, of all the people, all the time, (4) curiosity about healthcare information technology-what other bells and whistles exist, and (5) Big Brother is watching. The results of this study indicate that a new care partnership has emerged as the provision of nursing care is no longer supplied by a single practitioner but rather by a paired team, consisting of nurses and technology, working collaboratively in an interdependent relationship to achieve established goals.

Optimizing Patient Surgical Management Using WhatsApp Application in the Italian Healthcare System.

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Nardo, Bruno; Cannistrà, Marco; Diaco, Vincenzo; Naso, Agostino; Novello, Matteo; Zullo, Alessandra; Ruggiero, Michele; Grande, Raffaele; Sacco, Rosario

2016-09-01

Smartphones changed the method by which doctors communicate with each other, offer modern functionalities sensitive to the context of use, and can represent a valuable ally in the healthcare system. Studies have shown that WhatsApp™ application can facilitate communication within the healthcare team and provide the attending physician a constant oversight of activities performed by junior team members. The aim of the study was to use WhatsApp between two distant surgical teams involved in a program of elective surgery to verify if it facilitates communication, enhances learning, and improves patient care preserving their privacy. We conducted a focused group of surgeons over a 28-month period (from March 2013 to July 2015), and from September 2014 to July 2015, a group of selected specialists communicated healthcare matters through the newly founded "WhatsApp Surgery Group." Each patient enrolled in the study signed a consent form to let the team communicate his/her clinical data using WhatsApp. Communication between team members, response times, and types of messages were evaluated. Forty six (n = 46) patients were enrolled in the study. A total of 1,053 images were used with an average of 78 images for each patient (range 41-143). 125 h of communication were recorded, generating 354 communication events. The expert surgeon had received the highest number of questions (P, 0.001), while the residents asked clinical questions (P, 0.001) and were the fastest responders to communications (P, 0.001). Our study investigated how two distant clinical teams may exploit such a communication system and quantifies both the direction and type of communication between surgeons. WhatsApp is a low cost, secure, and fast technology and it offers the opportunity to facilitate clinical and nonclinical communications, enhance learning, and improve patient care preserving their privacy.

Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria

Science.gov (United States)

Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Kelechi, Ohiri

2016-01-01

Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System—AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Result: Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement (t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group. Conclusion: The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities. PMID:28462280

Discourses of healthcare professionals about health surveillance actions for Tuberculosis control

Directory of Open Access Journals (Sweden)

Fernando Mitano

Full Text Available Abstract OBJECTIVE To analyze the meanings produced in the Health Surveillance actions for tuberculosis control, carried out by healthcare professionals in Mozambique. METHOD Qualitative study using the theoretical and methodological framework of the French Discourse Analysis. RESULTS A total of 15 healthcare professionals with more than one year of experience in disease control actions participated in the study. Four discursive blocks have emerged from the analysis: tuberculosis diagnosis process; meeting, communication and discussion of treatment; local strategies for tuberculosis control; involvement of family and community leaders in the tuberculosis control. CONCLUSION The statements of the healthcare professionals suggest, as Health Surveillance actions, practices that include collecting sputum in the patient's home and sending it to the laboratory; deployment of the medical team with a microscope for tuberculosis testing; and testing for diseases that may be associated with tuberculosis. In this context, the actions of Health Surveillance for tuberculosis control involve valuing all actors: family, community leaders, patients and health professionals.

The healthcare off-shoring industry in developing economies--institutional and economic foundations: an Indian case.

Science.gov (United States)

Kshetri, Nir

2011-01-01

Industrialized world-based healthcare providers are increasingly off-shoring low-end healthcare services such as medical transcription, billing and insurance claims. High-skill medical jobs such as tele-imaging and tele-pathology are also being sub-contracted to developing countries. Despite its importance, little theory or research exists to explain what factors affect industry growth. The article's goals, therefore, are to examine economic processes associated with developing economies' shift from low- to high-value information technology enabled healthcare services, and to investigate how these differ in terms of legitimacy from regulative, normative and cognitive institutions in the sending country and how healthcare services differ from other services. This research is conceptual and theory-building. Broadly, its approach can be described as a positivistic epistemology. Anti off-shoring regulative, normative and cognitive pressures in the sending country are likely to be stronger in healthcare than in most business process outsourcing. Moreover, such pressures are likely to be stronger in high-value rather than in low-value healthcare off-shoring. The findings also indicate that off-shoring low-value healthcare services and emergent healthcare industries in a developing economy help accumulate implicit and tacit knowledge required for off-shoring high-value healthcare services. The approach lacks primary data and empirical documentation. The article helps in understanding industry drivers and its possible future direction. The findings help in understanding the lens through which various institutional actors in a sending country view healthcare service off-shoring. The article's value stems from its analytical context, mechanisms and processes associated with developing economies' shift to high-value healthcare off-shoring services.

A Taiwan Study Abroad Program on Aging, Culture, and Healthcare

Science.gov (United States)

Hou, Su-I

2018-01-01

This article introduces a Taiwan Study Abroad program on aging, culture, and healthcare. The program is a short-term academic summer program (6 credits) to bring U.S. students to Taiwan. During 2011 ~ 2015, a total of four groups including over 54 students and faculty members participated. This program partnered with multiple universities,…

Healthcare costs and resource utilization of patients with binge-eating disorder and eating disorder not otherwise specified in the Department of Veterans Affairs.

Science.gov (United States)

Bellows, Brandon K; DuVall, Scott L; Kamauu, Aaron W C; Supina, Dylan; Babcock, Thomas; LaFleur, Joanne

2015-12-01

The objective of this study was to compare the one-year healthcare costs and utilization of patients with binge-eating disorder (BED) to patients with eating disorder not otherwise specified without BED (EDNOS-only) and to matched patients without an eating disorder (NED). A natural language processing (NLP) algorithm identified adults with BED from clinical notes in the Department of Veterans Affairs (VA) electronic health record database from 2000 to 2011. Patients with EDNOS-only were identified using ICD-9 code (307.50) and those with NLP-identified BED were excluded. First diagnosis date defined the index date for both groups. Patients with NED were randomly matched 4:1, as available, to patients with BED on age, sex, BMI, depression diagnosis, and index month. Patients with cost data (2005-2011) were included. Total healthcare, inpatient, outpatient, and pharmacy costs were examined. Generalized linear models were used to compare total one-year healthcare costs while adjusting for baseline patient characteristics. There were 257 BED, 743 EDNOS-only, and 823 matched NED patients identified. The mean (SD) total unadjusted one-year costs, in 2011 US dollars, were $33,716 ($38,928) for BED, $37,052 ($40,719) for EDNOS-only, and $19,548 ($35,780) for NED patients. When adjusting for patient characteristics, BED patients had one-year total healthcare costs $5,589 higher than EDNOS-only (p = 0.06) and $18,152 higher than matched NED patients (p < 0.001). This study is the first to use NLP to identify BED patients and quantify their healthcare costs and utilization. Patients with BED had similar one-year total healthcare costs to EDNOS-only patients, but significantly higher costs than patients with NED. © 2015 Wiley Periodicals, Inc.

Big Data, Big Problems: A Healthcare Perspective.

Science.gov (United States)

Househ, Mowafa S; Aldosari, Bakheet; Alanazi, Abdullah; Kushniruk, Andre W; Borycki, Elizabeth M

2017-01-01

Much has been written on the benefits of big data for healthcare such as improving patient outcomes, public health surveillance, and healthcare policy decisions. Over the past five years, Big Data, and the data sciences field in general, has been hyped as the "Holy Grail" for the healthcare industry promising a more efficient healthcare system with the promise of improved healthcare outcomes. However, more recently, healthcare researchers are exposing the potential and harmful effects Big Data can have on patient care associating it with increased medical costs, patient mortality, and misguided decision making by clinicians and healthcare policy makers. In this paper, we review the current Big Data trends with a specific focus on the inadvertent negative impacts that Big Data could have on healthcare, in general, and specifically, as it relates to patient and clinical care. Our study results show that although Big Data is built up to be as a the "Holy Grail" for healthcare, small data techniques using traditional statistical methods are, in many cases, more accurate and can lead to more improved healthcare outcomes than Big Data methods. In sum, Big Data for healthcare may cause more problems for the healthcare industry than solutions, and in short, when it comes to the use of data in healthcare, "size isn't everything."

Tuberculosis in healthcare workers and infection control measures at primary healthcare facilities in South Africa

NARCIS (Netherlands)

Claassens, Mareli M.; van Schalkwyk, Cari; du Toit, Elizabeth; Roest, Eline; Lombard, Carl J.; Enarson, Donald A.; Beyers, Nulda; Borgdorff, Martien W.

2013-01-01

Challenges exist regarding TB infection control and TB in hospital-based healthcare workers in South Africa. However, few studies report on TB in non-hospital based healthcare workers such as primary or community healthcare workers. Our objectives were to investigate the implementation of TB

Demand for private healthcare in a universal public healthcare system: empirical evidence from Sri Lanka.

Science.gov (United States)

Pallegedara, Asankha; Grimm, Michael

2017-11-01

This paper examines healthcare utilization behaviour in Sri Lanka with special emphasis on the choice between costly private and free public healthcare services. We use a data set that combines nationwide household survey data and district level healthcare supply data. Our findings suggest that even with universal public healthcare policy, richer people tend to use private sector healthcare services rather than public services. We also find significant regional and ethnic discrepancies in healthcare access bearing the risk of social tensions if these are further amplified. Latent class analysis shows in addition that the choice between private and public sector healthcare significantly differs between people with and without chronic diseases. We find in particular that chronically ill people rely for their day-to-day care on the public sector, but for their inpatient care they turn more often than non-chronically ill people to the private sector, implying an additional financial burden for the chronically ill. If the observed trend continues it may not only increase further the health-income gradient in Sri Lanka but also undermine the willingness of the middle class to pay taxes to finance public healthcare. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Healthcare Engineering Defined: A White Paper

Directory of Open Access Journals (Sweden)

Ming-Chien Chyu

2015-01-01

Full Text Available Engineering has been playing an important role in serving and advancing healthcare. The term “Healthcare Engineering” has been used by professional societies, universities, scientific authors, and the healthcare industry for decades. However, the definition of “Healthcare Engineering” remains ambiguous. The purpose of this position paper is to present a definition of Healthcare Engineering as an academic discipline, an area of research, a field of specialty, and a profession. Healthcare Engineering is defined in terms of what it is, who performs it, where it is performed, and how it is performed, including its purpose, scope, topics, synergy, education/training, contributions, and prospects.

Leveraging Digital Innovation in Healthcare

DEFF Research Database (Denmark)

Brown, Carol V.; Jensen, Tina Blegind; Aanestad, Margun

2014-01-01

Harnessing digital innovations for healthcare delivery has raised high expectations as well as major concerns. Several countries across the globe have made progress in achieving three common goals of lower costs, higher quality, and increased patient access to healthcare services through...... investments in digital infrastructures. New technologies are leveraged to achieve widespread 24x7 disease management, patients’ wellbeing, home-based healthcare and other patient-centric service innovations. Yet, digital innovations in healthcare face barriers in terms of standardization, data privacy...... landscapes in selected countries. Then panelists with expertise in digital data streams, cloud, and mobile computing will present concrete examples of healthcare service innovations that have the potential to address one or more of the global goals. ECIS attendees are invited to join a debate about...

Job Stress and Presenteeism among Chinese Healthcare Workers: The Mediating Effects of Affective Commitment.

Science.gov (United States)

Yang, Tianan; Guo, Yina; Ma, Mingxu; Li, Yaxin; Tian, Huilin; Deng, Jianwei

2017-08-29

Presenteeism affects the performance of healthcare workers. This study examined associations between job stress, affective commitment, and presenteeism among healthcare workers. To investigate the relationship between job stress, affective commitment, and presenteeism, structural equation modeling was used to analyze a sample of 1392 healthcare workers from 11 Class A tertiary hospitals in eastern, central, and western China. The mediating effect of affective commitment on the association between job stress and presenteeism was examined with the Sobel test. Job stress was high and the level of presenteeism was moderate among healthcare workers. Challenge stress and hindrance stress were strongly correlated (β = 0.62; p < 0.05). Affective commitment was significantly and directly inversely correlated with presenteeism (β = -0.27; p < 0.001). Challenge stress was significantly positively correlated with affective commitment (β = 0.15; p < 0.001) but not with presenteeism. Hindrance stress was significantly inversely correlated with affective commitment (β = -0.40; p < 0.001) but was significantly positively correlated with presenteeism (β = 0.26; p < 0.001). This study provides important empirical data on presenteeism among healthcare workers. Presenteeism can be addressed by increasing affective commitment and challenge stress and by limiting hindrance stress among healthcare workers in China.

Job Stress and Presenteeism among Chinese Healthcare Workers: The Mediating Effects of Affective Commitment

Directory of Open Access Journals (Sweden)

Tianan Yang

2017-08-01

Full Text Available Background: Presenteeism affects the performance of healthcare workers. This study examined associations between job stress, affective commitment, and presenteeism among healthcare workers. Methods: To investigate the relationship between job stress, affective commitment, and presenteeism, structural equation modeling was used to analyze a sample of 1392 healthcare workers from 11 Class A tertiary hospitals in eastern, central, and western China. The mediating effect of affective commitment on the association between job stress and presenteeism was examined with the Sobel test. Results: Job stress was high and the level of presenteeism was moderate among healthcare workers. Challenge stress and hindrance stress were strongly correlated (β = 0.62; p < 0.05. Affective commitment was significantly and directly inversely correlated with presenteeism (β = −0.27; p < 0.001. Challenge stress was significantly positively correlated with affective commitment (β = 0.15; p < 0.001 but not with presenteeism. Hindrance stress was significantly inversely correlated with affective commitment (β = −0.40; p < 0.001 but was significantly positively correlated with presenteeism (β = 0.26; p < 0.001. Conclusions: This study provides important empirical data on presenteeism among healthcare workers. Presenteeism can be addressed by increasing affective commitment and challenge stress and by limiting hindrance stress among healthcare workers in China.

[Frailty, disability and multi-morbidity: the relationship with quality of life and healthcare costs in elderly people].

Science.gov (United States)

Lutomski, Jennifer E; Baars, Maria A E; Boter, Han; Buurman, Bianca M; den Elzen, Wendy P J; Jansen, Aaltje P D; Kempen, Gertrudis I J M; Steunenberg, Bas; Steyerberg, Ewout W; Olde Rikkert, Marcel G M; Melis, René J F

2014-01-01

To assess the independent and combined impact of frailty, multi-morbidity, and activities of daily living (ADL) limitations on self-reported quality of life and healthcare costs in elderly people. Cross-sectional, descriptive study. Data came from The Older Persons and Informal Caregivers Minimum DataSet (TOPICS-MDS), a pooled dataset with information from 41 projects across the Netherlands from the Dutch national care for the Elderly programme. Frailty, multi-morbidity and ADL limitations, and the interactions between these domains, were used as predictors in regression analyses with quality of life and healthcare costs as outcome measures. Analyses were stratified by living situation (independent or care home). Directionality and magnitude of associations were assessed using linear mixed models. A total of 11,093 elderly people were interviewed. A substantial proportion of elderly people living independently reported frailty, multi-morbidity, and/or ADL limitations (56.4%, 88.3% and 41.4%, respectively), as did elderly people living in a care home (88.7%, 89.2% and 77,3%, respectively). One-third of elderly people living at home (31.9%) reported all three conditions compared with two-thirds of elderly people living in a care home (68.3%). In the multivariable analysis, frailty had a strong impact on outcomes independently of multi-morbidity and ADL limitations. Elderly people experiencing problems across all three domains reported the poorest quality-of-life scores and the highest healthcare costs, irrespective of their living situation. Frailty, multi-morbidity and ADL limitations are complementary measurements, which together provide a more holistic understanding of health status in elderly people. A multi-dimensional approach is important in mapping the complex relationships between these measurements on the one hand and the quality of life and healthcare costs on the other.

How do healthcare consumers process and evaluate comparative healthcare information? A qualitative study using cognitive interviews.

OpenAIRE

Damman, O.C.; Hendriks, M.; Rademakers, J.; Delnoij, D.; Groenewegen, P.

2009-01-01

Abstract Background To date, online public healthcare reports have not been effectively used by consumers. Therefore, we qualitatively examined how healthcare consumers process and evaluate comparative healthcare information on the Internet. Methods Using semi-structured cognitive interviews, interviewees (n = 20) were asked to think aloud and answer questions, as they were prompted with three Dutch web pages providing comparative healthcare information. Results We identified twelve themes fr...

Multigroup Path Analysis of the Influence of Healthcare Quality, by Different Health Insurance Types.

Science.gov (United States)

Hong, Yong-Rock; Holcomb, Derek; Ballard, Michael; Schwartz, Laurel

Winds of change have been blowing in the U.S. healthcare system since passage of the Affordable Care Act. Examining differences between individuals covered by different types of insurance is essential if healthcare executives are to develop new strategies in response to the emerging health insurance market. In this study, we used multigroup path analysis models to examine the moderating effects of health insurance on direct and indirect associations with general health status, satisfaction with received care, financial burden, and perceived value of the healthcare system. Data were obtained from the 2012 Medical Expenditure Panel Survey and analyzed according to the types of insurance: private, public, and military. With the satisfactory fit of the model (χ = 2,532.644, df = 96, p spending.

Healthcare Firms and the ERP Systems

Directory of Open Access Journals (Sweden)

A. Garefalakis

2016-04-01

Full Text Available With the continuous and drastic changes due to the economic crisis, along with the increasing market demands, major reforms are initiated in the healthcare sector in order to improve the quality of healthcare and operational efficiency, while reducing costs and optimizing back-end operations. ERP systems have been the basic technological infrastructure to many sectors as well as healthcare. The main objective of this study is to discuss how the adoption of ERP systems in healthcare organizations improves their functionality, simplifies their business processes, assure the quality of care services and helps their management accounting and controlling. This study presents also the stages required for the implementation of ERP system in healthcare organizations. This study utilizes a literature review in order to reach the research conclusions. Specifically, through related case studies and research, it examines how ERP systems are used to evaluate the better functionality of the healthcare organizations, addressing in parallel important problems, and possible malfunctions. The implementation of ERP systems in healthcare organizations promises to evolve and align strictly to the organizations’ corporate objectives and high-levels of healthcare quality. In order to accomplish this goal, the right decisions should be made by the managers of the healthcare organization regarding the choice of the appropriate ERP system following its installation and its application. Limited research exists on the significance ERP systems implementation in healthcare organizations, while possible dysfunctions and challenges during its installation and implementation are recorded. Therefore, new evidence in the significance of ERP systems in healthcare organization is provided.

Factors associated with Taiwanese lesbians' breast health-care behavior and intentions: Qualitative interview findings.

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Wang, Ya-Ching; Griffiths, Jane; Grande, Gunn

2017-09-01

This article presents the qualitative findings of a mixed-methods study that explored factors influencing lesbians' breast health-care behavior and intentions. A total of 37 semi-structured face-to-face interviews were conducted among women who self-identified as lesbians or women who partnered with the same gender who were aged 20 years or above in four areas of Taiwan (North, Central, South, and East Taiwan) between August 2012 and October 2012. Interviews were audio recorded with participants' consent. The interviews were analyzed using constant comparative analysis with Nvivo audio-coding support. Four themes were identified to be strongly associated with the lesbians' breast health-care behavior and their intentions, namely, gender identity, gender role expression, partners' support, and concerns about health-care providers' reactions. Important barriers to the women's breast health-care behavior and intentions were masculine identity ("T-identity" in Taiwan), masculine appearance, concerns about health-care providers' lack of knowledge of multiple gender diversity, and their attitudes toward lesbians. Conversely, their partners' support was a factor facilitating the women's breast health-care behavior and intentions, particularly for the T-identity lesbians. These findings suggest the significance of and need for culturally competent care and are important for improving Taiwanese lesbians' breast health.

Diffusion of novel healthcare technologies to resource poor settings.

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Malkin, Robert; von Oldenburg Beer, Kim

2013-09-01

A new product has completed clinical trials in a distant, resource poor hospital using a few dozen prototypes. The data looks great. The novel medical device solves a widely felt problem. The next goal is to integrate the device into the country's healthcare system and spread the device to other countries. But how? In order to be widely used, the device must be manufactured and distributed. One option is to license the intellectual property (IP) to an interested third party, if one can be found. However, it is possible to manage the manufacturing and distribution without licensing. There are at least two common means for manufacturing a novel medical device targeted to resource poor settings: (a) formal (contract) manufacturing and (b) informal (local) manufacturing. There are three primary routes to diffusion of novel medical devices in the developing world: (1) local distributors (2) direct international sales and (3) international donations. Perhaps surprisingly, the least effective mechanism is direct importation through donation. The most successful mechanism, the method used by nearly all working medical devices in resource-poor settings, is the use of contract manufacturing and a local distributor. This article is written for the biomedical innovator and entrepreneur who wishes to make a novel healthcare technology or product available and accessible to healthcare providers and patients in the developing world. There are very few documented cases and little formal research in this area. To this end, this article describes and explores the manufacturing and distribution options in order to provide insights into when and how each can be applied to scale up a novel technology to make a difference in a resource poor setting.

Communicating with Healthcare Professionals

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... at follow-up appointments by talking with your healthcare team about your concerns, asking questions and getting ... from the time you spend with all your healthcare providers, not just your doctor. Use the skills ...

Cadeia de valor da saúde: um modelo para o sistema de saúde brasileiro Healthcare value chain: a model for the Brazilian healthcare system

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Marcelo Caldeira Pedroso

2012-10-01

Full Text Available Este artigo apresenta um modelo de cadeia de valor da saúde que representa, de maneira esquemática, o sistema de saúde do Brasil. O modelo proposto tem como intuito apresentar uma adequação à realidade brasileira, bem como abrangência e flexibilidade para utilização em atividades acadêmicas e análises do setor de saúde do Brasil. O modelo coloca ênfase em três componentes: principais atividades dessa cadeia, agrupadas em elos verticais e horizontais; missão de cada um desses elos; e principais fluxos da cadeia. A cadeia proposta é formada por seis elos verticais e três horizontais, perfazendo um total de nove: desenvolvimento de conhecimento em saúde; fornecimento de produtos e tecnologias; serviços de saúde; intermediação financeira; financiamento da saúde; consumo de saúde; regulação; distribuição de produtos de saúde; e serviços de apoio e complementares. A análise da cadeia proposta pode ser realizada por meio de quatro fluxos: inovação e conhecimento; produtos e serviços; financeiro; e de informação.This article presents a model of the healthcare value chain which consists of a schematic representation of the Brazilian healthcare system. The proposed model is adapted for the Brazilian reality and has the scope and flexibility for use in academic activities and analysis of the healthcare sector in Brazil. It places emphasis on three components: the main activities of the value chain, grouped in vertical and horizontal links; the mission of each link and the main value chain flows. The proposed model consists of six vertical and three horizontal links, amounting to nine. These are: knowledge development; supply of products and technologies; healthcare services; financial intermediation; healthcare financing; healthcare consumption; regulation; distribution of healthcare products; and complementary and support services. Four flows can be used to analyze the value chain: knowledge and innovation; products and

The Economics of Healthcare Shape the Practice of Neuropsychology in the Era of Integrated Healthcare.

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Pliskin, Neil H

2018-05-01

The healthcare system in the United States is in the midst of a major transformation that has affected all healthcare specialties, including clinical psychology/neuropsychology. If this shift in the economics of healthcare reimbursement continues, it promises to impact clinical practice patterns for neuropsychologists far into the next decade.

Big Data and Analytics in Healthcare.

Science.gov (United States)

Tan, S S-L; Gao, G; Koch, S

2015-01-01

This editorial is part of the Focus Theme of Methods of Information in Medicine on "Big Data and Analytics in Healthcare". The amount of data being generated in the healthcare industry is growing at a rapid rate. This has generated immense interest in leveraging the availability of healthcare data (and "big data") to improve health outcomes and reduce costs. However, the nature of healthcare data, and especially big data, presents unique challenges in processing and analyzing big data in healthcare. This Focus Theme aims to disseminate some novel approaches to address these challenges. More specifically, approaches ranging from efficient methods of processing large clinical data to predictive models that could generate better predictions from healthcare data are presented.

Challenge or hindrance: Does job stress affect presenteeism among Chinese healthcare workers?

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Yang, Tianan; Ma, Mingxu; Zhu, Mingjing; Liu, Yuanling; Chen, Qian; Zhang, Shiyang; Deng, Jianwei

2018-03-27

We examined the effects of challenge stress and hindrance stress on general health and presenteeism among Chinese healthcare workers. Structural equation modeling was used to evaluate data from a national hospital survey in China (n = 1392). Job stress, general health, and presenteeism were measured by the Perceived Ability to Work Scale, the 8-item Short-Form Health Survey, and the Challenge- and Hindrance-Related Self-reported Stress Scale. Challenge stress and hindrance stress were significantly positively correlated (β = 0.62, SE = 0.021; p stress was directly negatively associated with presenteeism (β = -0.05, SE = 0.037; p stress was positively associated with presenteeism (β = 0.25, SE = 0.040; p health. Hospital managers should provide healthcare workers with an appropriate level of challenge, but employee health is the most important consideration. Further efforts targeting job stress and health of junior healthcare workers are required.

Healthcare seeking behaviour among Chinese elderly.

Science.gov (United States)

Lu, Hui; Wang, Wei; Xu, Ling; Li, Zhenhong; Ding, Yan; Zhang, Jian; Yan, Fei

2017-04-18

Purpose The Chinese population is rapidly ageing before they are rich. The purpose of this paper is to describe healthcare seeking behaviour and the critical factors associated with healthcare seeking behaviour. Design/methodology/approach Using a purposive sampling method, the authors recruited 44 adults aged 60 years or older from three provinces, representing the developed (Shanghai), undeveloped (Ningxia) regions and the regions in between (Hubei). From July to September 2008, using a semi-structured guide, the authors interviewed participants in focus group discussions. Findings The healthcare needs for chronic and catastrophic diseases were high; however, the healthcare demands were low and healthcare utilizations were even lower owing to the limited accessibility to healthcare services, particularly, in underdeveloped rural areas. "Too expensive to see a doctor" was a prime complaint, explaining substantial discrepancies between healthcare needs, demands and use. Care seeking behaviour varied depending on insurance availability, perceived performance, particularly hospital services, and prescription medications. Participants consistently rated increasing healthcare accessibility as a high priority, including offering financial aid, and improving service convenience. Improving social security fairness was the first on the elderly's wish list. Originality/value Healthcare demand and use were lower than needs, and were influenced by multiple factors, primarily, service affordability and efficiency, perceived performance and hospital service quality.

Activity Recognition Using Inertial Sensing for Healthcare, Wellbeing and Sports Applications: A Survey

NARCIS (Netherlands)

Avci, A.; Bosch, S.; Marin Perianu, Mihai; Marin Perianu, Raluca; Havinga, Paul J.M.

This paper surveys the current research directions of activity recognition using inertial sensors, with potential application in healthcare, wellbeing and sports. The analysis of related work is organized according to the five main steps involved in the activity recognition process: preprocessing,

75 FR 35497 - Updated Guidance: Prevention Strategies for Seasonal Influenza in Healthcare Settings

Science.gov (United States)

2010-06-22

..., students and trainees, contractual personnel, home healthcare personnel, and persons not directly involved... recipient persons, because droplets generally travel only short distances (approximately 6 feet or less... which aerosol-generating procedures are performed. Management of laundry, food service utensils, and...

Productivity changes in OECD healthcare systems: bias-corrected Malmquist productivity approach.

Science.gov (United States)

Kim, Younhee; Oh, Dong-Hyun; Kang, Minah

2016-10-01

This study evaluates productivity changes in the healthcare systems of 30 Organization for Economic Co-operation and Development (OECD) countries over the 2002-2012 periods. The bootstrapped Malmquist approach is used to estimate bias-corrected indices of healthcare performance in productivity, efficiency and technology by modifying the original distance functions. Two inputs (health expenditure and school life expectancy) and two outputs (life expectancy at birth and infant mortality rate) are used to calculate productivity growth. There are no perceptible trends in productivity changes over the 2002-2012 periods, but positive productivity improvement has been noticed for most OECD countries. The result also informs considerable variations in annual productivity scores across the countries. Average annual productivity growth is evenly yielded by efficiency and technical changes, but both changes run somewhat differently across the years. The results of this study assert that policy reforms in OECD countries have improved productivity growth in healthcare systems over the past decade. Countries that lag behind in productivity growth should benchmark peer countries' practices to increase performance by prioritizing an achievable trajectory based on socioeconomic conditions. For example, relatively inefficient countries in this study indicate higher income inequality, corresponding to inequality and health outcomes studies. Although income inequality and globalization are not direct measures to estimate healthcare productivity in this study, these issues could be latent factors to explain cross-country healthcare productivity for future research. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.

How do healthcare consumers process and evaluate comparative healthcare information? A qualitive study using cognitive interviews

NARCIS (Netherlands)

Damman, O.C.; Hendriks, M.; Rademakers, J.; Delnoij, D.M.J.; Groenewegen, P.P.

2009-01-01

Background: To date, online public healthcare reports have not been effectively used by consumers. Therefore, we qualitatively examined how healthcare consumers process and evaluate comparative healthcare information on the Internet. Methods: Using semi-structured cognitive interviews, interviewees

How do healthcare consumers process and evaluate comparative healthcare information? A qualitative study using cognitive interviews.

NARCIS (Netherlands)

Damman, O.C.; Hendriks, M.; Rademakers, J.; Delnoij, D.; Groenewegen, P.

2009-01-01

Background: To date, online public healthcare reports have not been effectively used by consumers. Therefore, we qualitatively examined how healthcare consumers process and evaluate comparative healthcare information on the Internet. Methods: Using semi-structured cognitive interviews, interviewees

Health behavior change in hearing healthcare: a discussion paper

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Vinaya K. C. Manchaiah

2012-02-01

Full Text Available Health behavior change (HBC refers to facilitating changes to habits and/or behavior related to health. In healthcare practice, it is quite common that the interactions between practitioner and patient involve conversations related to HBC. This could be mainly in relation to the practitioner trying to directly persuade the patients to make some changes in their health behavior. However, the patients may not be motivated to do so as they do not see this change as important. For this reason, direct persuasion may result in a breakdown of communication. In such instances, alternative approaches and means of indirect persuasion, such as empowering the patient and their family members, could be helpful. Furthermore, there are several models and/or theories proposed which explain the health behavior and also provide a structured framework for health behavior change. Many such models/approaches have been proven effective in facilitating HBC and health promotion in areas such as cessation of smoking, weight loss and so on. This paper provides an overview of main models/theories related to HBC and some insights into how these models/approaches could be adapted to facilitate behavior change in hearing healthcare, mainly in relation to: i hearing help-seeking and hearing-aid uptake; and ii hearing conservation in relation to music-induced hearing loss (MIHL. In addition, elements of current research related to this area and future directions are highlighted.

Impact of work-related cancers in Taiwan-Estimation with QALY (quality-adjusted life year) and healthcare costs.

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Lee, Lukas Jyuhn-Hsiarn; Lin, Cheng-Kuan; Hung, Mei-Chuan; Wang, Jung-Der

2016-12-01

This study estimates the annual numbers of eight work-related cancers, total losses of quality-adjusted life years (QALYs), and lifetime healthcare expenditures that possibly could be saved by improving occupational health in Taiwan. Three databases were interlinked: the Taiwan Cancer Registry, the National Mortality Registry, and the National Health Insurance Research Database. Annual numbers of work-related cancers were estimated based on attributable fractions (AFs) abstracted from a literature review. The survival functions for eight cancers were estimated and extrapolated to lifetime using a semi-parametric method. A convenience sample of 8846 measurements of patients' quality of life with EQ-5D was collected for utility values and multiplied by survival functions to estimate quality-adjusted life expectancies (QALEs). The loss-of-QALE was obtained by subtracting the QALE of cancer from age- and sex-matched referents simulated from national vital statistics. The lifetime healthcare expenditures were estimated by multiplying the survival probability with mean monthly costs paid by the National Health Insurance for cancer diagnosis and treatment and summing this for the expected lifetime. A total of 3010 males and 726 females with eight work-related cancers were estimated in 2010. Among them, lung cancer ranked first in terms of QALY loss, with an annual total loss-of-QALE of 28,463 QALYs and total lifetime healthcare expenditures of US$36.6 million. Successful prevention of eight work-related cancers would not only avoid the occurrence of 3736 cases of cancer, but would also save more than US$70 million in healthcare costs and 46,750 QALYs for the Taiwan society in 2010.

Gender differences in care-seeking behavior and healthcare consumption immediately after whiplash trauma.

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Artur Tenenbaum

Full Text Available The aim was to study gender differences in care-seeking behavior and treatment provided immediately after whiplash trauma.Participants were residents from a defined geographical area, Skaraborg County in the southwestern part of Sweden. A cohort of 3,368 persons exposed to whiplash trauma and attending a healthcare facility immediately after the trauma between 1999 and 2008 were identified in a database. Information about gender, age, time elapsed prior to seeking care, type of healthcare contact, initial treatment provided and eventual hospitalization time was retrieved.Women sought care later than men (p = 0.00074. Women consulted primary healthcare first more often than men, who more often first sought hospital care (p = 0.0060. There were no gender differences regarding the type of treatment after trauma. Women had longer hospital admission than men (p = 0.022, indicating their injuries were at least similar to or worse than men's.Women sought healthcare later than men after whiplash trauma. Although not directly investigated in this study, it raises the question if this may reduce their probability of getting financial compensation compared to men.

Accessing VA Healthcare During Large-Scale Natural Disasters.

Science.gov (United States)

Der-Martirosian, Claudia; Pinnock, Laura; Dobalian, Aram

2017-01-01

Natural disasters can lead to the closure of medical facilities including the Veterans Affairs (VA), thus impacting access to healthcare for U.S. military veteran VA users. We examined the characteristics of VA patients who reported having difficulty accessing care if their usual source of VA care was closed because of natural disasters. A total of 2,264 veteran VA users living in the U.S. northeast region participated in a 2015 cross-sectional representative survey. The study used VA administrative data in a complex stratified survey design with a multimode approach. A total of 36% of veteran VA users reported having difficulty accessing care elsewhere, negatively impacting the functionally impaired and lower income VA patients.

The healthcare system and provision of oral healthcare in European Union member states. Part 4: Greece.

Science.gov (United States)

Damaskinos, P; Koletsi-Kounari, H; Economou, C; Eaton, K A; Widström, E

2016-03-11

This paper presents a description of the healthcare system and how oral healthcare is organised and provided in Greece, a country in a deep economic and social crisis. The national health system is underfunded, with severe gaps in staffing levels and the country has a large private healthcare sector. Oral healthcare has been largely provided in the private sector. Most people are struggling to survive and have no money to spend on general and oral healthcare. Unemployment is rising and access to healthcare services is more difficult than ever. Additionally, there has been an overproduction of dentists and no development of team dentistry. This has led to under or unemployment of dentists in Greece and their migration to other European Union member states, such as the United Kingdom, where over 600 Greek dentists are currently working.

Influence of healthcare institution managers' proactive approach to communication activities on patient satisfaction

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Filipović Vinka

2010-01-01

Full Text Available Background/Aim. Over the recent years customer satisfaction program as a tool for patient satisfaction has been recognized as an important issue in healthcare services. The aim of this preliminary study was to explore an influence of healthcare institution managers' approach and attitudes to marketing and public relations activities (communication activities, in the context of implementation of customer satisfaction programs, on patient satisfaction. Methods. The study was conducted among managers from different state-owned healthcare institutions (healthcare centers, clinics, hospitals in Serbia. The structured questionnaire form, comprising both open and closed questions, was used as a main research tool. The total number of sent questionnaires was 120; 56 questionnaires were sent back, while 49 of them were valid. Results. It was shown that 42.9% of healthcare institutions apply proactive media approach, and that 35.7% of the organizations have a person who, besides his/her basic engagements, performs activities connected with marketing and public relations. Using Chi-square likelihood ratio test it is confirmed that these activities have a significant role in supporting customer satisfaction program implementation (p < 0.05. The results showed that in 69.4% cases, positive attitude of healthcare institutions managers toward marketing and public relations activities had positive influence on patient satisfaction (p < 0.05. Conclusion. Managers in healthcare sector in Serbia who used proactive approach toward media and who had already institutionalized communication activities with external stakeholders have a positive attitude to implementation of customer satisfaction program. Furthermore, managers' attitude toward communication activities has influence on patient satisfaction.

Mental health care: how can Family Health teams integrate it into Primary Healthcare?

Science.gov (United States)

Gryschek, Guilherme; Pinto, Adriana Avanzi Marques

2015-10-01

Mental health is one of the responsibilities of Brazil's Family Health system. This review of literature sought to understand what position Mental Health occupies in the practice of the Family Health Strategy. A search was made of the scientific literature in the database of the Virtual Health Library (Biblioteca Virtual de Saúde), for the keywords: 'Mental Health'; 'Family Health'; 'Primary Healthcare'. The criteria for inclusion were: Brazilian studies from 2009 through 2012 that contributed to understanding of the following question: "How to insert Mental health care into the routine of the Family Health Strategy?" A total of 11 articles were found, which identified difficulties and strategies of the professionals in Primary Healthcare in relation to mental health. Referral, and medicalization, were common practices. Matrix Support is the strategy of training and skill acquisition for teams that enables new approaches in mental health in the context of Primary healthcare. It is necessary for Management of the Health System to take an active role in the construction of healthcare networks in mental health.

Atomic energy in healthcare

International Nuclear Information System (INIS)

Gupta, Sudeep; Rangarajan, Venkatesh; Thakur, Meenakshi; Parmar, Vani; Jalali, Rakesh; Ashgar, Ali; Pramesh, C.S.; Shrivastava, Shyam; Badwe, Rajendra

2013-01-01

One of the socially important non-power programmes of the DAE is in the beneficial use of radiation and related techniques for healthcare. The diagnosis and therapy aspects of radiation based healthcare are discussed in this article. (author)

The economic impact of chronic fatigue syndrome in Georgia: direct and indirect costs

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Brimmer Dana J

2011-01-01

Full Text Available Abstract Background Chronic fatigue syndrome (CFS is a debilitating chronic illness affecting at least 4 million people in the United States. Understanding its cost improves decisions regarding resource allocation that may be directed towards treatment and cure, and guides the evaluation of clinical and community interventions designed to reduce the burden of disease. Methods This research estimated direct and indirect costs of CFS and the impact on educational attainment using a population-based, case-control study between September 2004 and July 2005, Georgia, USA. Participants completed a clinical evaluation to confirm CFS, identify other illnesses, and report on socioeconomic factors. We estimated the effect of CFS on direct medical costs (inpatient hospitalizations, provider visits, prescription medication spending, other medical supplies and services and loss in productivity (employment and earnings with a stratified sample (n = 500 from metropolitan, urban, and rural Georgia. We adjusted medical costs and earnings for confounders (age, sex, race/ethnicity, education, and geographic strata using econometric models and weighted estimates to reflect response-rate adjusted sampling rates. Results Individuals with CFS had mean annual direct medical costs of $5,683. After adjusting for confounding factors, CFS accounted for $3,286 of these costs (p Conclusions Study results indicate that chronic fatigue syndrome may lead to substantial increases in healthcare costs and decreases in individual earnings. Studies have estimated up to 2.5% of non-elderly adults may suffer from CFS. In Georgia, a state with roughly 5.5 million people age 18-59, illness could account for $452 million in total healthcare expenditures and $1.2 billion of lost productivity.

Inequalities in healthcare provision for individuals with substance use disorders : Perspectives from healthcare professionals and clients

NARCIS (Netherlands)

van Boekel, L.C.; Brouwers, E.P.M.; van Weeghel, J.; Garretsen, H.F.L.

2016-01-01

Background: Little is known about inequalities in healthcare provision for individuals with substance use disorders. The main objective of this study was to assess expectations and perceptions of inequalities in healthcare provision among healthcare professionals (HCPs) and clients in treatment for

Solidarity, justice and unconditional access to healthcare.

Science.gov (United States)

Gheaus, Anca

2017-03-01

Luck egalitarianism provides a reason to object to conditionality in health incentive programmes in some cases when conditionality undermines political values such as solidarity or inclusiveness. This is the case with incentive programmes that aim to restrict access to essential healthcare services. Such programmes undermine solidarity. Yet, most people's lives are objectively worse, in one respect, in non-solidary societies, because solidarity contributes both instrumentally and directly to individuals' well-being. Because solidarity is non-excludable, undermining it will deprive both the prudent and the imprudent citizens of its goods. Thereby, undermining solidarity can make prudent citizens worse off than they would have otherwise been, out of no fault or choice of their own, but rather as a result of somebody else's imprudent choice. This goes against the spirit of luck egalitarianism. Therefore (luck egalitarian) justice can require us to save the imprudent and avoid conditionality in access to essential healthcare services. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Fully integrated biochip platforms for advanced healthcare.

Science.gov (United States)

Carrara, Sandro; Ghoreishizadeh, Sara; Olivo, Jacopo; Taurino, Irene; Baj-Rossi, Camilla; Cavallini, Andrea; de Beeck, Maaike Op; Dehollain, Catherine; Burleson, Wayne; Moussy, Francis Gabriel; Guiseppi-Elie, Anthony; De Micheli, Giovanni

2012-01-01

Recent advances in microelectronics and biosensors are enabling developments of innovative biochips for advanced healthcare by providing fully integrated platforms for continuous monitoring of a large set of human disease biomarkers. Continuous monitoring of several human metabolites can be addressed by using fully integrated and minimally invasive devices located in the sub-cutis, typically in the peritoneal region. This extends the techniques of continuous monitoring of glucose currently being pursued with diabetic patients. However, several issues have to be considered in order to succeed in developing fully integrated and minimally invasive implantable devices. These innovative devices require a high-degree of integration, minimal invasive surgery, long-term biocompatibility, security and privacy in data transmission, high reliability, high reproducibility, high specificity, low detection limit and high sensitivity. Recent advances in the field have already proposed possible solutions for several of these issues. The aim of the present paper is to present a broad spectrum of recent results and to propose future directions of development in order to obtain fully implantable systems for the continuous monitoring of the human metabolism in advanced healthcare applications.

How Can Information and Communication Technology Improve Healthcare Inequalities and Healthcare Inequity? The Concept of Context Driven Care.

Science.gov (United States)

Yee, Kwang Chien; Bettiol, Silvana; Nash, Rosie; Macintyrne, Kate; Wong, Ming Chao; Nøhr, Christian

2018-01-01

Advances in medicine have improved health and healthcare for many around the world. The challenge is achieving the best outcomes of health via healthcare delivery to every individual. Healthcare inequalities exist within a country and between countries. Health information technology (HIT) has provided a mean to deliver equal access to healthcare services regardless of social context and physical location. In order to achieve better health outcomes for every individual, socio-cultural factors, such as literacy and social context need to consider. This paper argues that HIT while improves healthcare inequalities by providing access, might worsen healthcare inequity. In order to improve healthcare inequity using HIT, this paper argues that we need to consider patients and context, and hence the concept of context driven care. To improve healthcare inequity, we need to conceptually consider the patient's view and methodologically consider design methods that achieve participatory outcomes.

Reporting of Foodborne Illness by U.S. Consumers and Healthcare Professionals

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Steven Mandernach

2013-08-01

Full Text Available During 2009–2010, a total of 1,527 foodborne disease outbreaks were reported by the Centers for Disease Control and Prevention (CDC (2013. However, in a 2011 CDC report, Scallan et al. estimated about 48 million people contract a foodborne illness annually in the United States. Public health officials are concerned with this under-reporting; thus, the purpose of this study was to identify why consumers and healthcare professionals don’t report foodborne illness. Focus groups were conducted with 35 consumers who reported a previous experience with foodborne illness and with 16 healthcare professionals. Also, interviews with other healthcare professionals with responsibility of diagnosing foodborne illness were conducted. Not knowing who to contact, being too ill, being unsure of the cause, and believing reporting would not be beneficial were all identified by consumers as reasons for not reporting foodborne illness. Healthcare professionals that participated in the focus groups indicated the amount of time between patients’ consumption of food and seeking treatment and lack of knowledge were barriers to diagnosing foodborne illness. Issues related to stool samples such as knowledge, access and cost were noted by both groups. Results suggest that barriers identified could be overcome with targeted education and improved access and information about the reporting process.

Effectiveness of external inspection of compliance with standards in improving healthcare organisation behaviour, healthcare professional behaviour or patient outcomes

Science.gov (United States)

Flodgren, Gerd; Pomey, Marie-Pascale; Taber, Sarah A; Eccles, Martin P

2014-01-01

not possible, we produced a narrative results summary. Main results We identified one cluster-RCT involving 20 South African public hospitals (Salmon 2003) and one ITS involving all acute trusts in England (OPM 2009) for inclusion in this review. Salmon and colleagues (Salmon 2003) showed mixed effects of a hospital accreditation system on the compliance with COHSASA (the Council for Health Services Accreditation for South Africa) accreditation standards and eight indicators of hospital quality. Significantly improved total mean compliance score with COHSASA accreditation standards was found for 21/28 service elements: mean intervention effect (95% confidence interval (CI)) was 30% (23% to 57%) (P effect (range) for the indicators of hospital quality of care was 2.4 (−1.9 to +11.8) and only one of the eight indicators: ‘nurses perception of clinical quality, participation and teamwork’ was significantly improved (mean intervention effect 5.7, P = 0.03). Re-analysis of the MRSA (methicillin-resistant Staphylococcus aureus) data showed statistically non-significant effects of the Healthcare Commissions Infection Inspection programme. Authors’ conclusions We only identified two studies for inclusion in this review, which highlights the paucity of high-quality controlled evaluations of the effectiveness of external inspection systems. No firm conclusions could therefore be drawn about the effectiveness of external inspection on compliance with standards. PMID:22071861

Health-related quality of life and unmet healthcare needs in Huntington's disease.

Science.gov (United States)

van Walsem, Marleen R; Howe, Emilie I; Ruud, Gunvor A; Frich, Jan C; Andelic, Nada

2017-01-07

Huntington's disease (HD) is a rare neurodegenerative disorder with a prevalence of 6 per 100.000. Despite increasing research activity on HD, evidence on healthcare utilization, patients' needs for healthcare services and Health-Related Quality of Life (HRQoL) is still sparse. The present study describes HRQoL in a Norwegian cohort of HD patients, and assesses associations between unmet healthcare and social support service needs and HRQoL. In this cross-sectional population-based study, 84 patients with a clinical diagnosis of HD living in the South-East of Norway completed the HRQoL questionnaire EuroQol, EQ-5D-3L. Unmet needs for healthcare and social support services were assessed by the Needs and Provision Complexity Scale (NPCS). Furthermore, functional ability was determined using the Unified Huntington's Disease Rating Scale (UHDRS) Functional assessment scales. Socio-demographics (age, gender, marital status, occupation, residence, housing situation) and clinical characteristics (disease duration, total functional capacity, comorbidity) were also recorded. Descriptive statistics were used to describe the patients' HRQoL. Regression analyses were conducted in order to investigate the relationship between unmet healthcare needs and self-reported HRQoL. The patients were divided across five disease stages as follows: Stage I: n = 12 (14%), Stage II: n = 22 (27%), Stage III: n = 19 (23%), Stage IV: n = 14 (16%), and Stage V: n = 17 (20%). Overall HRQoL was lowest in patients with advanced disease (Stages IV and V), while patients in the middle phase (Stage III) showed the most varied health profile for the five EQ-5D-3L dimensions. The regression model including level of unmet needs, clinical characteristics and demographics (age and education) accounted for 42% of variance in HRQoL. A higher level of unmet needs was associated with lower HRQoL (β value - 0.228; p = 0.018) whereas a better total functional capacity corresponded to

Home-based Healthcare Technology

DEFF Research Database (Denmark)

Verdezoto, Nervo

of these systems target a specific treatment or condition and might not be sufficient to support the care management work at home. Based on a case study approach, my research investigates home-based healthcare practices and how they can inform future design of home-based healthcare technology that better account......Sustaining daily, unsupervised healthcare activities in non-clinical settings such as the private home can challenge, among others, older adults. To support such unsupervised care activities, an increasingly number of reminders and monitoring systems are being designed. However, most...

Turnover among healthcare professionals.

Science.gov (United States)

Wood, Ben D

2009-01-01

Turnover among healthcare professionals is a costly consequence. The existing body of knowledge on healthcare professional turnover is correlated with job satisfaction levels. A landmark study differentiated 2 areas of job satisfaction categories: satisfiers and dissatisfiers (intrinsic and extrinsic motivators). The aim of this article is to examine existing research on precursors of turnover, such as burnout behaviors experienced by healthcare professionals, job satisfaction levels, employee organizational commitment, health complications which precede turnover, some current strategies to reduce turnover, and some effects CEO turnover has on employee turnover intentions.

[Digital health as a motor for change towards new healthcare models and the relationship between patients and healthcare professionals. Disruption of healthcare processes].

Science.gov (United States)

Garcia-Cuyàs, Francesc; de San Pedro, Marc; Martínez Roldan, Jordi

2015-11-01

We find ourselves at the end of an era of asymmetry in the domain of health information where the majority of this data is in the hands of the healthcare system. Increasingly, the public are calling for a more central role in the new paradigm that enables them to duly exercise their right of access to their health data while availing of more reliable and safer technologies which contribute to the management of their condition and promote healthy lifestyles. So far, the TIC Salud strategic plan has been developed independently from the Generalitat de Catalunya Health Department's Healthcare Plan, which sets out health policy strategy in Catalonia. However, from its initial design stage the new Healthcare Plan (2016- 2020) envisages incorporating a new strategic Information and communications technology (ICT) line called "Digital Health". Incorporating ICT into the Health Plan will allow these technologies to become integral part of all strategic healthcare processes, acting as a driving force for a shift towards a new healthcare models and an innovative relationship between the public and healthcare professionals. The Digital Health implies a disruption in itself, by way of the convergence of several technologies and their positive impact on health and healthcare procedures, by way of the public's access to information concerning their health, and by creating new opportunities for promoting health and the salutogenic paradigm which empowers people to develop their health, welfare and quality of life. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

A novel automated direct measurement method for total antioxidant capacity using a new generation, more stable ABTS radical cation.

Science.gov (United States)

Erel, Ozcan

2004-04-01

To develop a novel colorimetric and automated direct measurement method for total antioxidant capacity (TAC). A new generation, more stable, colored 2,2'-azinobis-(3-ethylbenzothiazoline-6-sulfonic acid radical cation (ABTS(*+)) was employed. The ABTS(*+) is decolorized by antioxidants according to their concentrations and antioxidant capacities. This change in color is measured as a change in absorbance at 660 nm. This process is applied to an automated analyzer and the assay is calibrated with Trolox. The novel assay is linear up to 6 mmol Trolox equivalent/l, its precision values are lower than 3%, and there is no interference from hemoglobin, bilirubin, EDTA, or citrate. The method developed is significantly correlated with the Randox- total antioxidant status (TAS) assay (r = 0.897, P total antioxidant capacity.

Strategic alliances in healthcare: opportunities for the Veterans Affairs healthcare system.

Science.gov (United States)

Halverson, P K; Kaluzny, A D; Young, G J

1997-01-01

Strategic alliances are proving to be effective strategies for responding and adapting to changing environments, and as such they offer the U.S. Department of Veterans Affairs (VA) healthcare system valuable opportunities for accomplishing the goals of its major reorganization effort. This article begins with an examination of basic strategic-alliance structures that are employed across many different types of industries. Next, consideration is given to the ways in which these basic alliance structures may be adapted to the unique organizations and individuals that serve as providers, purchasers, and consumers of health services. Finally, this article explores how models of strategic alliance in healthcare can be tailored to the specific needs and constraints of the VA healthcare system through an examination of existing and potential alliance opportunities.

Deficiencies in postgraduate training for healthcare professionals who provide diabetes education and support

DEFF Research Database (Denmark)

Byrne, J. L.; Davies, Melanie J; Willaing, I.

2017-01-01

: The present study shows that healthcare professionals report being insufficiently equipped to provide diabetes self-management education, including emotional and psychological aspects of diabetes, and many are not receiving postgraduate training in any part (including medical care) of the management......Aims: To consider the global provision of self-management diabetes education and training for healthcare professionals using data from the second Diabetes Attitudes, Wishes and Needs (DAWN2) study. Methods: A total of 4785 healthcare professionals caring for people with diabetes were surveyed in 17.......6–70.6% variation). Training in psychological management was low (19.1%), ranging from 3.6 to 36.5%, while 20.4% (a range of 3.6–36.4% across countries) had received no postgraduate training. Overall, the greatest training need was in the management of psychological aspects of diabetes (59.5%). For some, training...

Minor mental disorders in Taiwanese healthcare workers and the associations with psychosocial work conditions.

Science.gov (United States)

Cheng, Wan-Ju; Cheng, Yawen

2017-04-01

Healthcare workers face multiple psychosocial work hazards intrinsic to their work, including heavy workloads and shift work. However, how contemporary adverse psychosocial work conditions, such as workplace justice and insecurity, may contribute to increased mental health risks has rarely been studied. This study aimed to search for modifiable psychosocial work factors associated with mental health disorders in Taiwanese healthcare workers. A total of 349 healthcare workers were identified from 19,641 employees who participated in a national survey of Taiwan. Minor mental disorder was assessed using the five-item brief symptom rating scale. We compared psychosocial work characteristics and the prevalence of minor mental disorder in healthcare workers with that in a sociodemographically matched sample, and examined the associations of psychosocial work conditions with mental health status. Healthcare workers were found to have a higher prevalence of minor mental disorder than general workers, and they were more likely to have longer working hours, heavier psychological job demands, higher job control, more workplace violence, and a higher prevalence of shift work. Among healthcare workers, experiences of workplace violence, lower workplace justice, heavier psychological job demands, and job insecurity were associated with a higher risk for minor mental disorder, even after controlling for working hours and shift work. Despite the fact that healthcare workers work longer hours and shift work, there were several modifiable psychosocial work conditions that should be targeted to improve their mental health. Copyright © 2016. Published by Elsevier B.V.

How social policies can improve financial accessibility of healthcare: a multi-level analysis of unmet medical need in European countries.

Science.gov (United States)

Israel, Sabine

2016-03-05

The article explores in how far financial accessibility of healthcare (FAH) is restricted for low-income groups and identifies social protection policies that can supplement health policies in guaranteeing universal access to healthcare. The article is aimed to advance the literature on comparative European social epidemiology by focussing on income-related barriers of healthcare take-up. The research is carried out on the basis of multi-level cross-sectional analyses using 2012 EU-SILC data for 30 European countries. The social policy data stems from EU-SILC beneficiary information. It is argued that unmet medical needs are a reality for many individuals within Europe - not only due to direct user fees but also due to indirect costs such as waiting time, travel costs, time not spent working. Moreover, low FAH affects not only the lowest income quintile but also the lower middle income class. The study observes that social allowance increases the purchasing power of both household types, thereby helping them to overcome financial barriers to healthcare uptake. Alongside healthcare system reform aimed at improving the pro-poor availability of healthcare facilities and financing, policies directed at improving FAH should aim at providing a minimum income base to the low-income quintile. Moreover, categorical policies should address households exposed to debt which form the key vulnerable group within the low-income classes.

Contact Allergy in Danish Healthcare Workers

DEFF Research Database (Denmark)

Schwensen, Jakob F; Menné, Torkil; Sommerlund, Mette

2016-01-01

Contact dermatitis in healthcare workers is a pan-European problem. We conducted a retrospective observational study of the patch-test results of 1402 healthcare workers and 1402 matched controls with contact dermatitis who were treated at 3 hospitals departments in Denmark between 2007 and 2014....... The primary objective was to determine whether healthcare work was associated with contact allergy to thiuram mix. Unadjusted univariate analyses revealed that healthcare work was significantly associated with occupational contact dermatitis and hand dermatitis. Contact allergy to thiuram mix was more common...... in healthcare workers was significantly associated with having occupational contact dermatitis, hand dermatitis and older age. In conclusion, we report here a potential problem of contact allergy to thiurams in healthcare workers with contact dermatitis. Legislative authorities may in the future focus...

Direct hospital costs of total laparoscopic hysterectomy compared with fast-track open hysterectomy at a tertiary hospital: a retrospective case-controlled study.

Science.gov (United States)

Rhou, Yoon J J; Pather, Selvan; Loadsman, John A; Campbell, Neil; Philp, Shannon; Carter, Jonathan

2015-12-01

To assess the direct intraoperative and postoperative costs in women undergoing total laparoscopic hysterectomy and fast-track open hysterectomy. A retrospective review of the direct hospital-related costs in a matched cohort of women undergoing total laparoscopic hysterectomy (TLH) and fast-track open hysterectomy (FTOH) at a tertiary hospital. All costs were calculated, including the cost of advanced high-energy laparoscopic devices. The effect of the learning curve on cost in laparoscopic hysterectomy was also assessed, as was the hospital case-weighted cost, which was compared with the actual cost. Fifty women were included in each arm of the study. TLH had a higher intraoperative cost, but a lower postoperative cost than FTOH (AUD$3877 vs AUD$2776 P funding model in our hospital is inaccurate when compared to directly calculated hospital costs. © 2013 The Authors ANZJOG © 2013 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Achieving compliance with healthcare waste management regulations : empirical evidence from small European healthcare units

OpenAIRE

Botelho, Anabela

2011-01-01

Healthcare units generate substantial amounts of hazardous or potentially hazardous wastes as by-products of their medical services. The inappropriate management of these wastes poses significant risks to people and the environment. In Portugal, as in other EU countries, the collection, storage, treatment and disposal of healthcare waste is regulated by law. Although legal provisions covering the safe management of healthcare waste date back to the 1990s, little is known about the compliance ...

Walking the history of healthcare.

Science.gov (United States)

Black, Nick

2007-12-01

The history of healthcare is complex, confusing and contested. In Walking London's medical history the story of how health services developed from medieval times to the present day is told through seven walks. The book also aims to help preserve our legacy, as increasingly former healthcare buildings are converted to other uses, and to enhance understanding of the current challenges we face in trying to improve healthcare in the 21st century. Each walk has a theme, ranging from the way hospitals merge or move and the development of primary care to how key healthcare trades became professions and the competition between the church, Crown and City for control of healthcare. While recognising the contributions of the 'great men of medicine', the book takes as much interest in the six ambulance stations built by the London County Council (1915) as the grandest teaching hospitals.

Governance mechanisms for healthcare apps

DEFF Research Database (Denmark)

Manikas, Konstantinos; Hansen, Klaus Marius; Kyng, Morten

2014-01-01

The introduction of the `app store' concept has challenged the way software is distributed and marketed: developers have easier access to customers, while customers have easy access to innovative applications. Apps today are increasingly focusing on more "mission-critical" areas like healthcare...... with the Apple AppStore counting more than 40,000 apps under the category "health & fitness". This rapid development of healthcare apps increases the necessity of governance as, currently, healthcare apps are not thoroughly governed. The U.S. Food and Drug Administration and the European Commission only have...... policies for apps that are medical devices.In this paper, we approach the problem of how to govern healthcare and medical apps by addressing the risks the use of these apps pose, while at the same time inviting for development of new apps. To do so we (i) analyze four cases of healthcare app governance...

Does advanced practice in radiography benefit the healthcare system? A literature review.

Science.gov (United States)

Thom, S E

2018-02-01

With ever-increasing demands on the National Health Service (NHS), members of staff are blurring their professional boundaries in the attempt to benefit the healthcare system. This review aims to establish whether advancing practice within radiography does benefit the healthcare system by examining published literature. Key words were input into databases such as: CINAHL, Science Direct and PubMed. Various filters were applied to narrow down the articles. Key themes were identified within the literature: cost, job satisfaction, patient benefits, restrictions and workload. Having advanced practitioners undertake some of the radiologists' workload was potentially cost effective whilst continuing/increasing the standard of quality. Patients benefitted from the quality of their examinations, the high accuracy of their reports and the speed those reports were attained. Evidence within the literature emphasises that advanced practice does benefit the healthcare system by means of: cost reduction, job satisfaction, patient benefits and workload. Crown Copyright © 2017. Published by Elsevier Ltd. All rights reserved.

PKI security in large-scale healthcare networks.

Science.gov (United States)

Mantas, Georgios; Lymberopoulos, Dimitrios; Komninos, Nikos

2012-06-01

During the past few years a lot of PKI (Public Key Infrastructures) infrastructures have been proposed for healthcare networks in order to ensure secure communication services and exchange of data among healthcare professionals. However, there is a plethora of challenges in these healthcare PKI infrastructures. Especially, there are a lot of challenges for PKI infrastructures deployed over large-scale healthcare networks. In this paper, we propose a PKI infrastructure to ensure security in a large-scale Internet-based healthcare network connecting a wide spectrum of healthcare units geographically distributed within a wide region. Furthermore, the proposed PKI infrastructure facilitates the trust issues that arise in a large-scale healthcare network including multi-domain PKI infrastructures.

Healthcare professionals' work engagement in Finnish university hospitals.

Science.gov (United States)

Lepistö, Sari; Alanen, Seija; Aalto, Pirjo; Järvinen, Päivi; Leino, Kaija; Mattila, Elina; Kaunonen, Marja

2017-10-10

Concerns about the sufficiency and dedication of the healthcare workforce have arisen as the baby boomer generation is retiring and the generation Y might have different working environment demands. To describe the association between work engagement of healthcare professionals' and its background factors at five Finnish university hospitals. Survey data were collected from nurses, physicians and administrative staff (n = 561) at all five university hospitals in Finland. Data were collected using an electronic questionnaire that comprised the Utrecht Work Engagement Scale (9 items) and 13 questions regarding the respondents' backgrounds. Descriptive and correlational analyses were used to examine the data. Most respondents were female (85%) and nursing staff (72%). Baby boomers (49%) were the largest generational cohort. The work engagement composite mean for the total sample was 5.0, indicating high work engagement. Significant differences in work engagement existed only among sex and age groups. The highest work engagement scores were among administrative staff. Work engagement among healthcare professionals in Finnish university hospitals is high. High work engagement might be explained by suitable job resources and challenges, as well as opportunities provided by a frontline care environment. Attention should especially be paid to meeting the needs of young people entering the workforce to strengthen their dedication and absorption. © 2017 Nordic College of Caring Science.

[Assessment of the patient-safety culture in a healthcare district].

Science.gov (United States)

Pozo Muñoz, F; Padilla Marín, V

2013-01-01

1) To describe the frequency of positive attitudes and behaviours, in terms of patient safety, among the healthcare providers working in a healthcare district; 2) to determine whether the level of safety-related culture differs from other studies; and 3) to analyse negatively valued dimensions, and to establish areas for their improvement. A descriptive, cross-sectional study based on the results of an evaluation of the safety-related culture was conducted on a randomly selected sample of 247 healthcare providers, by using the Spanish adaptation of the Hospital Survey on Patient Safety Culture (HSOPSC) designed by the Agency for Healthcare Research and Quality (AHRQ), as the evaluation tool. Positive and negative responses were analysed, as well as the global score. Results were compared with international and national results. A total of 176 completed survey questionnaires were analysed (response rate: 71.26%); 50% of responders described the safety climate as very good, 37% as acceptable, and 7% as excellent. Strong points were: «Teamwork within the units» (80.82%) and «Supervisor/manager expectations and actions» (80.54%). Dimensions identified for potential improvement included: «Staffing» (37.93%), «Non-punitive response to error» (41.67%), and «Frequency of event reporting» (49.05%). Strong and weak points were identified in the safety-related culture of the healthcare district studied, together with potential improvement areas. Benchmarking at the international level showed that our safety-related culture was within the average of hospitals, while at the national level, our results were above the average of hospitals. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

Healthcare costs of burn patients from homes without fire sprinklers.

Science.gov (United States)

Banfield, Joanne; Rehou, Sarah; Gomez, Manuel; Redelmeier, Donald A; Jeschke, Marc G

2015-01-01

The treatment of burn injuries requires high-cost services for healthcare and society. Automatic fire sprinklers are a preventive measure that can decrease fire injuries, deaths, property damage, and environmental toxins. This study's aim was to conduct a cost analysis of patients with burn or inhalation injuries caused by residential fires and to compare this with the cost of implementing residential automatic fire sprinklers. We conducted a cohort analysis of adult burn patients admitted to our provincial burn center (1995-2012). Patient demographics and injury characteristics were collected from medical records and clinical and coroner databases. Resource costs included average cost per day at our intensive care and rehabilitation program, transportation, and property loss. During the study period, there were 1557 residential fire-related deaths province-wide and 1139 patients were admitted to our provincial burn center as a result of a flame injury occurring at home. At our burn center, the average cost was CAN$84,678 per patient with a total cost of CAN$96,448,194. All resources totaled CAN$3,605,775,200. This study shows the considerable healthcare costs of burn patients from homes without fire sprinklers.

Colonization of patients, healthcare workers, and the environment with healthcare-associated Staphylococcus epidermidis genotypes in an intensive care unit: a prospective observational cohort study.

Science.gov (United States)

Widerström, Micael; Wiström, Johan; Edebro, Helén; Marklund, Elisabeth; Backman, Mattias; Lindqvist, Per; Monsen, Tor

2016-12-09

During the last decades, healthcare-associated genotypes of methicillin-resistant Staphylococcus epidermidis (HA-MRSE) have been established as important opportunistic pathogens. However, data on potential reservoirs on HA-MRSE is limited. The aim of the present study was to investigate the dynamics and to which extent HA-MRSE genotypes colonize patients, healthcare workers (HCWs) and the environment in an intensive care unit (ICU). Over 12 months in 2006-2007, swab samples were obtained from patients admitted directly from the community to the ICU and patients transferred from a referral hospital, as well as from HCWs, and the ICU environment. Patients were sampled every third day during hospitalization. Antibiotic susceptibility testing was performed according to EUCAST guidelines. Pulsed-field gel electrophoresis and multilocus sequence typing were used to determine the genetic relatedness of a subset of MRSE isolates. We identified 620 MRSE isolates from 570 cultures obtained from 37 HCWs, 14 patients, and 14 environmental surfaces in the ICU. HA-MRSE genotypes were identified at admission in only one of the nine patients admitted directly from the community, of which the majority subsequently were colonized by HA-MRSE genotypes within 3 days during hospitalization. Almost all (89%) of HCWs were nasal carriers of HA-MRSE genotypes. Similarly, a significant proportion of patients transferred from the referral hospital and fomites in the ICU were widely colonized with HA-MRSE genotypes. Patients transferred from a referral hospital, HCWs, and the hospital environment serve as important reservoirs for HA-MRSE. These observations highlight the need for implementation of effective infection prevention and control measures aiming at reducing HA-MRSE transmission in the healthcare setting.

Dutch virtual integration of healthcare information.

Science.gov (United States)

de Graaf, J C; Vlug, A E; van Boven, G J

2007-01-01

As information technology creates opportunities for cooperation which crosses the boundaries between healthcare institutions, it will become an integral part of the Dutch healthcare system. Along with many involved organizations in healthcare the National IT Institute for Healthcare in the Netherlands (NICTIZ) is working on the realization of a national IT infrastructure for healthcare and a national electronic patient record (EPR). An underlying national architecture is designed to enable the Dutch EPR virtually, not in a national database, nor on a patient's smartcard. The required secure infrastructure provides generic functions for healthcare applications: patient identification, authentication and authorization of healthcare professionals. The first national applications in the EPR program using a national index of where patient data is stored, are the electronic medication record and the electronic record for after hours GP services. The rollout of the electronic medication record and electronic record for after hours GP services has been started in 2007. To guarantee progress of electronic data exchange in healthcare in the Netherlands we have primarily opted for two healthcare applications: the electronic medication record and the electronic record for after hours GP services. The use of a national switch-point containing the registry of where to find what information, guarantees that the professional receives the most recent information and omits large databases to contain downloaded data. Proper authorization, authentication as well as tracing by the national switchpoint also ensures a secure environment for the communication of delicate information.

Lean in healthcare from employees' perspectives.

Science.gov (United States)

Drotz, Erik; Poksinska, Bozena

2014-01-01

The purpose of this paper is to contribute toward a deeper understanding of the new roles, responsibilities, and job characteristics of employees in Lean healthcare organizations. The paper is based on three cases studies of healthcare organizations that are regarded as successful examples of Lean applications in the healthcare context. Data were collected by methods including interviews, observations, and document studies. The implementation of Lean in healthcare settings has had a great influence on the roles, responsibilities, and job characteristics of the employees. The focus has shifted from healthcare professionals, where clinical autonomy and professional skills have been the guarding principles of patient care, to process improvement and teamwork. Different job characteristics may make it difficult to implement certain Lean practices in healthcare. Teamwork and decentralization of authority are examples of Lean practices that could be considered countercultural because of the strong professional culture and uneven power distribution, with doctors as the dominant decision makers. Teamwork, value flow orientation, and company-wide involvement in CI were associated with positive effects on the organizations' working environment, staff development, and organizational performance. In order to succeed with Lean healthcare, it is important to understand and recognize the differences in job characteristics between Lean manufacturing and healthcare. This paper provides insights into how Lean implementation changes the roles, responsibilities, and job characteristics of healthcare staff and the challenges and implications that may follow from this.

Overcoming information asymmetry in consumer-directed health plans.

Science.gov (United States)