Dissertations / Theses on the topic 'Hospital utilization'
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Khaskina, Yelena. "Using simulation to reduce length of stay in a hospital emergency department." Full text available online (restricted access), 1996. http://images.lib.monash.edu.au/ts/theses/Khaskina.pdf.
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Gong, Zhiping. "Developing casemix classification for acute hospital inpatients in Chengdu, China /." Access full text, 2004. http://www.lib.latrobe.edu.au/thesis/public/adt-LTU20050314.195349/index.html.
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Submitted to the School of Public Health, Faculty of Health Sciences. Thesis (Ph.D.) -- La Trobe University, 2004.Includes bibliographical references (leaves 320-329). Also available via the World Wide Web.
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Drager, Katrina A. "Inpatient psychiatric length of stay and readmission rates." Menomonie, WI : University of Wisconsin--Stout, 2007. http://www.uwstout.edu/lib/thesis/2007/2007dragerk.pdf.
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Elo, Jyrki A. I. "The impact of surgical day care on hospital inpatient utilization in a paediatric population." Thesis, University of British Columbia, 1987. http://hdl.handle.net/2429/27876.
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Day care surgical services have been marketed as a cost saving alternative for inpatient care. There is evidence that the cost per episode of day care surgery is 50-70 percent less than a comparable episode in an inpatient ward. In addition, avoiding hospitalization has particular relevance for paediatrics, because of the undesirable effects of hospital stay on children. However, both cost savings and the quality-based need to decrease hospitalizations of children will be fullfilled only if each patient cared for in a day care surgery unit would otherwise have been an inpatient and the bed vacated by day care surgery use would not be filled in by other patients.
In a previous B.C. study based on the total population a significant component of day care surgery was found to augment total utilization, suggesting generation of surgical activity rather than substitution. The present study was designed to examine the substitution/generation issue in the paediatric (0-14 years) population, both because experts questioned the generalizability of the findings to the paediatric population, and because of the dramatic reduction in paediatric utilization in Canada during the period since the mid-1960s. The contention was that the introduction of day care surgery may have been an important factor in this downtrend.
The relationship between paediatric day care surgery use and hospital inpatient utilization was analyzed in B.C. in each of the years 1968-1976 and 1981/82-1982/83 and using a time series/cross-section study design. The data frame consisted of all B.C. school districts, in each of the study years, yielding 825 data points. Using a multivariate regression analysis, it was possible to estimate what hospital utilization patterns would have been in the absence of day care surgery capacity, and hence isolate estimates of the net impact of day care surgery on paediatric inpatient use.
Findings on the relationship between day care surgery use and paediatric medical/surgical and surgical inpatient utilization strongly support the view that paediatric day care surgery has been largely an add-on to the total hospital care system. Statistically significant substitution effect was revealed only for the most narrowly defined inpatient surgery category which more closely resembled day care surgery-type cases, after controlling for potential confounding effects of age and sex, paediatric bed capacity, different socioeconomic characteristics and time- and district-specific factors. Even here, less than 10 percent of day care surgery represented substitution for inpatient surgery and over 90 percent appeared to be generation of new activity to the hospital system as a whole. Furthermore, paediatric beds which were "saved" by day care surgery use were filled with increased utilization by non-day care surgery eligible surgical patients and by medical cases. The main driving force behind hospital utilization in the 0-14 year age group was paediatric bed availability even after standardization for age, sex, physician stock, measures of socioeconomic status, and other district- and year-specific effects.
According to this study paediatric day care surgery has not been a cost saving alternative for inpatient care in B.C. in 1968-1982/83. Neither has it reduced overall hospitalizations in the paediatric population.Medicine, Faculty of
Population and Public Health (SPPH), School of
Graduate
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Wiggins, Sandra. "Utilization management of acute care services : evaluation of the SWITCH index system." Thesis, University of British Columbia, 1988. http://hdl.handle.net/2429/28355.
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In recent years, concern about the rising costs of health care has prompted the development of programs aimed at reducing utilization of hospital services and facilities while maintaining an acceptable standard of care. One of the major strategies that has emerged in the effort to accomplish these dual objectives, is utilization management. Although there are a number of different approaches, the primary aim of all utilization management programs is to identify and eliminate unnecessary and inappropriate hospital use.
To date, most of the utilization research and program development has taken place in the United States. To a great extent, this effort has focussed on the development and use of norms for utilization based on a breakdown of length of stay data by diagnostic-related groups (DRG's). Canadian interest in this type of approach is reflected in the recent development of data bases defined by case-mix groups (CMG's). However, while continued efforts are being made to refine these schemes, they have been vulnerable to the criticism that they do not provide adequately objective criteria for establishing what constitutes appropriate patterns of hospital use. In addition, because they are based on statistically derived norms, they have been criticized as lacking sufficient clinical relevance to encourage physician support. Since hospital utilization is largely determined by the medical staff, utilization management programs that fail to obtain physician support are unlikely to succeed.
An alternative approach, which appears to be gaining in popularity, involves the formulation of criteria which can be used to determine what constitutes appropriate and necessary hospital use. Essentially, it is argued that by directly identifying the source and nature of misutilization, it should be possible to develop more effective strategies for the resolution of identified problems. The American Appropriateness Evaluation Protocol designed by Gertman & Restuccia (1981) is one of the earliest and most highly tested examples of a criterion-based system. In Canada, interest in this type of approach is more recent and, consequently, little attention has as yet been focussed on the development and use of clinical criteria in utilization review and management.
One exception, however, is the SWITCH Index System. This system, which was developed and implemented in 1984 by the Peace Arch District Hospital (White Rock, B.C.), makes a direct attempt to identify and eliminate days of hospital stay during which no appropriate acute care services are being provided. The criteria used in this system are classified under the headings Signs, Wind, Intramuscular Therapy, Tubes, Consultant, and Hospice. Patients are considered to be appropriately placed in the hospital if, on any given day, at least one of the specified criteria are met. Otherwise they are classified as Off-Index and action is taken to identify the source of the problem and to initiate corrective action.
Since a major objective of the SWITCH system is to identify and eliminate inappropriate use, an observable outcome, if the program is successful, should be a reduction in length of stay. The present study investigated this hypothesis by comparing pre- and post- intervention length of stay trends at the Peace Arch District Hospital. In addition, to take into account any general secular trends in length of stay over time, the Peace Arch length of stay was compared to the length of stay observed for a control group of three peer-group member hospitals. Although data covering the four year period 1982 to 1985, indicated that the length of stay at the Peace Arch District Hospital had been decreasing over time, no component of this general decline could be attributed to the SWITCH Index System. Time series regression analyses failed to detect changes in either the slope or the height of the estimated response curve. However, limitations in the study design do not permit any conclusions regarding the potential effectiveness of this system. Characteristics specific to the Peace Arch District Hospital may have prevented the detection of an effect. In addition, because it is likely that there would be a lag between when the program was implemented and when it might be expected to effect a reduction in length of stay, the follow-up period of eleven months may have been too short for the determination of the program's effectiveness.Medicine, Faculty of
Population and Public Health (SPPH), School of
Graduate
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Heartfield, Marie. "Governing recovery : a discourse analysis of hospital stay length /." Connect to thesis, 2002. http://eprints.unimelb.edu.au/archive/00001712.
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Covington, Charles M. "The utilization of symbols and banners as aids to worship in a clinical setting." Theological Research Exchange Network (TREN), 1995. http://www.tren.com.
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Yang, Lin. "Disease burden and seasonality of influenza in subtropical Hong Kong." Click to view the E-thesis via HKUTO, 2008. http://sunzi.lib.hku.hk/hkuto/record/B41508828.
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Piterman, Hannah, and Hannah Piterman@med monash edu au. "Tensions around introducing co-ordinated care a case study of co-ordinated care trial." Swinburne University of Technology, 2000. http://adt.lib.swin.edu.au./public/adt-VSWT20050418.092951.
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The aim of the research was to analyse the organisational dynamics surrounding a health care reform implementation process associated with the introduction of coordinated care, which is an Australian Government initiative to introduce structural changes to the funding and delivery of health-care in response to rising health care costs. A longitudinal case study of an implementation team was studied. This included the perceptions and experiences of individuals and institutions within hospitals, the general practice community and Divisions of General Practice. Furthermore, the case study explored organisational structures, decision-making processes and management systems of the Project and included an examination of the difficulties and conflicts that ensued. The broader context of health care reform was also considered.
The study found that an effective change management strategy requires clarity around the definition of primary task in health care delivery, particularly when the task is complex and the environment uncertain. This requires a management and support structure able to accommodate the tensions that exists between providing care and managing cost, in a changing and complex system. The case study indicated that where tensions were not managed the functions of providing care and managing costs became disconnected, undermining the integrity of the task and impacting on the effective facilitation of the change process and hence, the capacity of stakeholders to embrace the model of co-ordinated care. Moreover, the micro dynamics of the project team seemed to parallel the macro dynamics of the broader system where economic and health care provision imperatives clash. Through its close analysis of change dynamics, the study provides suggestions for the improved engagement of stakeholders in health care change.
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Kou, Maybelle Antonia Maria. "Quantitative and qualitative drug utilization studies in a university teaching hospital in Hong Kong." Thesis, [Hong Kong : University of Hong Kong], 1994. http://sunzi.lib.hku.hk/hkuto/record.jsp?B14436711.
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El-Sharo, Moh'd Ragheb A. "Predicting hospital admissions from emergency department using artificial neural networks and time series analysis." Diss., Online access via UMI:, 2009.
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Thesis (M.S.)--State University of New York at Binghamton, Thomas J. Watson School of Engineering and Applied Science, Department of Systems Science and Industrial Engineering, 2009.Includes bibliographical references.
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Ertel, Audrey E. "Hospital Utilization of Nationally Shared Liver Allografts from 2009-2012." University of Cincinnati / OhioLINK, 2015. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1428065067.
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Leung, Chi-hang Vincent. "Consultation pattern of non-urgent patients of Accident & Emergency Department." Click to view the E-thesis via HKUTO, 2005. http://sunzi.lib.hku.hk/hkuto/record/b39724189.
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Dulka, Iryna M. 1953. "Interdisciplinary discharge planning rounds : impact on timing of social work intervention, length of stay and readmission." Thesis, McGill University, 1993. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=69711.
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This study examined the effect of interdisciplinary discharge planning rounds on timing of social work intervention, length of stay (LOS), and readmission for patients aged 65 and over. Data sources were the medical charts of 449 patients discharged during two corresponding 28 day periods (one before end one after the implementation of rounds) supplemented by Discharge Planning Committee minutes (DPCM) and interviews with four key informants. No significant differences in the timing of social work intervention, LOS, or readmissions were found between the two samples. Qualitative research revealed that essential components were either missing (physician participation), or not uniformly included (family participation) in rounds, and that staff felt that rounds improved communication among the disciplines and contributed to improved efficiency in planning hospital and posthospital services. These findings highlight the need to further study all aspects of the complex discharge planning process to identify factors that would reduce LOS and readmissions.
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Lemaire, Diana C. "The effect of home care utilization on acute care hospital readmission." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk2/ftp01/MQ28607.pdf.
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Af, Darmansyah Siriwan Grisurapong. "Nursing process utilization among registered nurses in Siriraj Hospital Bangkok, Thailand /." Abstract, 2000. http://mulinet3.li.mahidol.ac.th/thesis/2543/43E-Darmansyah-AF.pdf.
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Chery, Joseph Erol. "Adjusting to random demands of patient care : a predictive model for nursing staff scheduling at Naval Medical Center San Diego /." Thesis, Monterey, Calif. : Naval Postgraduate School, 2008. http://edocs.nps.edu/npspubs/scholarly/theses/2008/Sept/08Sep%5FChery.pdf.
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Thesis (M.S. in Operations Research)--Naval Postgraduate School, September 2008.Thesis Advisor(s): Fricker, Ronald D. "September 2008." Description based on title screen as viewed on November 5, 2008. Includes bibliographical references (p. 43-46). Also available in print.
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Rund, Robin Lindsay. "Study of elective surgical blood usage at Groote Schuur Hospital." Thesis, University of Cape Town, 1992. http://hdl.handle.net/11427/25796.
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Wong, Oi-ling Irene. "Medical ecology of inpatient service utilization in Hong Kong a population survey /." Click to view the E-thesis via HKUTO, 2003. http://sunzi.lib.hku.hk/hkuto/record/B31971337.
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Schoonover, Heather Diane. "Barriers to research utilization among registered nurses working in a community hospital." Online access for everyone, 2006. http://www.dissertations.wsu.edu/Thesis/Spring2006/H%5FSchoonover%5F033106.pdf.
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Fernandes, Diina. "Midwives' experiences regarding the utilization of partographs in a Namibian Regional Hospital." Thesis, Nelson Mandela Metropolitan University, 2015. http://hdl.handle.net/10948/d1021158.
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Labour has been characterized as the most dangerous journey a woman undertakes. The reason being, that although it is a natural process, many labouring women suffer complications during labour and childbirth including prolonged or obstructed labour. These complications can result in maternal and infant morbidity and mortality. The partograph is a monitoring tool that can provide a continuous pictorial overview and is essential to monitor and manage labour. It is recommended by the WHO for use universally by midwives while monitoring labour. However partographs are poorly utilized and most parameters on the partograph are not monitored and findings after reviewing a labouring woman are not documented on the partograph. It is unclear how midwives working in Namibian Health services experience and utilize the partograph during the monitoring of a woman in labour. These may be the factors that hinder the effective utilization of the partograph. The objective of this study was to explore and describe the experiences of midwives regarding the utilization of the partograph for monitoring a labouring woman in a Namibian regional hospital in order to develop guidelines based on the findings to improve the use of the partograph by midwives in order to improve the management of labour. The research design was qualitative, descriptive, explorative and contextual in nature. The research population consisted of midwives working in a regional hospital in Namibia. A purposive and convenient sampling method was used to select participants. Specific inclusion criteria were met and consent was obtained from the participants and from the Regional Health Directorate Management of the hospital where the research was conducted. Interviews were conducted by an independent interviewer within the Department of Health to ensure an unbiased viewpoint. Data were collected by means of semi-structured in depth interviews with a guide, using an audio tape recorder. Field notes were used to record non- verbal communication. As soon as data were saturated, the interviews were stopped. They were then transcribed, verbatim and analysed using the Tesch’s approach as described in (Creswell, 2009:186). The service of an independent coder was utilized to ensure trustworthiness. Trustworthiness was further ensured by using the strategies suggested by Lincoln and Guba’s model, namely credibility, transferability, dependability and confirmability. Ethical considerations were honoured throughout by adhering to ethical principles during the study. These included ensuring that the participants` rights were respected, they were not harmed and fairness were ensured. On completion of the data analysis a literature control was conducted and existing literature was compared to the findings in order to identify similarities and differences and to verify whether the literature supported the findings. Four main themes that emerged during data analysis are: Theme 1.Midwives found it a positive experience to use the partograph when caring for a woman in labour. Theme 2. When a midwife experienced problems in using the partograph, it may lead to detrimental outcomes. Theme 3. Utilizing the partograph evoked differing emotions in midwives. Theme 4. Midwives` knowledge and skills in the utilization of the partograph should be updated regularly. By describing the lived experienced of midwives in the maternity ward on the use of the partograph, the midwives had a positive attitude to using the partograph, but they also found it difficult to utilize the instrument as was directed by the (WHO) due to challenges experienced such as: unrealistic staff/patient ratio, shortage of staff, time consuming, insufficient knowledge and skills among midwives and lack of appropriate equipment. There is a specific need to prevent further negative emotions by addressing the challenges experienced. Based on the findings, guidelines for partograph utilization which aimed at improving the midwifery care were developed. Recommendations were made regarding midwifery education, clinical midwifery care and midwifery research.
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Dow, Gordon C. K. "Diabetes mellitus and hospital utilization in the province of Manitoba 1991/1992." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape9/PQDD_0006/MQ45148.pdf.
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silva, Monica Valero da. "Influência da reutilização na biocompatibilidade de materiais médico-hospitalares de uso único." Universidade de São Paulo, 2002. http://www.teses.usp.br/teses/disponiveis/9/9139/tde-14062016-185833/.
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A prática da reutilização de produtos médico-hospitalares de uso único vem sendo aplicada desde meados da década de setenta. A principal razão que tem contribuído para disseminação desta conduta pelas instituições hospitalares radicadas tanto nos países em desenvolvimento como naqueles considerados ricos, tem sido a aparente economia de custos. Apesar dos riscos relacionados com a prática da reutilização, como reações pirogênicas, danos ocasionados por bactérias consideradas patogênicas em pacientes imunologicamente comprometidos, danos na integridade fisica dos produtos, assim como aumento do período de permanência dos pacientes no hospital, têm despertado o interesse em avaliar aspectos fisicos e biológicos dos produtos médico-hospitalares reutilizados. Baseando-se nestas considerações foram aplicados desafios com esporos de Bacillus Subtilis varo niger ATCC 9372 e endotoxina bacteriana E. coli 055:B5. Os produtos desafiados foram cateteres intravenosos, torneira três vias e tubos de traqueostomia. A possível presença microbiana foi investigada após contaminação intencional dos esporos de B. Subtillis (107 ufc/unid.) com submissão das unidades contaminadas à limpeza e posterior esterilização, utilizando óxido de etileno/CFC na proporção 12:88. Os ciclos de reprocessamentos simulados de produtos médico-hospitalares consistiram de contaminação de cada unidade teste com carga microbiana, lavagem com detergente enzimático, secagem e esterilização. Ao término de cada ciclo de reprocessamento foram separadas unidades representativas para avaliação por contagem microbiana (pour plate), testes de esterilidade por inoculação direta e indireta, citotoxidade por cultura de células e microscopia eletrônica de varredura. A eficiência da esterilidade foi avaliada tanto por contagem microbiana como pelos testes de esterilidade, que resultaram em níveis microbianos de 103 ufc/unid. e detecção de contaminação até o 6° ciclo de reprocessamento nos cateteres intravenosos, tubos de traqueostomia e torneiras três vias. A segurança dos reprocessamentos dos produtos médico-hospitalares foi avaliada pela cultura de células de fibroblastos de camundongo (NCTC clone 929), as quais não apresentaram toxicidade. Entretanto, os resultados obtidos durante microscopia eletrônica de varredura comprovaram presença de carga microbiana após 10° ciclo de reprocessamento, assim como danos na superficie polimérica. Durante desafio com endotoxina bacteriana, que consistiu em contaminar as unidades com 200 UE, secagem e exposição ao ciclo de esterilização com óxido de etileno/CFC (12:88), verificou-se que após ciclos de reprocessamentos simulados, totalizando dez ciclos, foi possível detectar valores de recuperação de endotoxina em torno de 100%. Os cateteres-guia que foram adquiridos em instituição hospitalar após quatro reutilizações, apresentaram níveis de contaminação de 105 ufc/unid., assim como presença de bactérias consideradas patogênicas em pacientes comprometidos imunologicamente, já a detecção de endotoxina bacteriana nestes cateteres não foi considerada significativa. Logo, as avaliações aplicadas nas unidades submetidas aos ciclos de reprocessamentos simulados, assim como nos cateteres-guia reprocessados e reutilizados quatro vezes, refletiram a realidade de algumas instituições no âmbito nacional e internacional que praticam a reutilização de produtos médico-hospitalares de uso-único. Os resultados obtidos vêm enfatizar objeções quanto à prática da reutilização, considerando que a ausência de segurança pode ocasionar em danos ao paciente.The practices of reutilization of single use hospital medical devices came into practice since mid seventies. The main reason that has contributed for dissemination of this practice by institutional hospitals in underdeveloped as well as those considered as rich countries has been the appellant economy of costs. Despite well known risks related with the practice of reutilization, such as pyrogenic reactions, damages caused by bacteria\'s considered pathogenic in patients immunologically compromised, damages to the physical integrity of the materials, as well as prolonged permanence of the patient in the hospital, has raised interests in the evaluation of physical and biological aspects of the reused medical device. Based on these considerations, challenges had been applied with spores of Bacillus Subtilis varo niger 9372 ATCC and bacterial endotoxin E. coli 055:B5. The selected materials includes, intravenous catheters, three-way stopcocks and traqueostomy tubes. The possible presence of bacteria was investigated after intentional contamination with spores of B. Subtillis (107 cfu/unit) followed by submission of the inoculated units to the cleaning process and posterior sterilization using ethylene oxide at 12:88. The simulated reprocessing cycles of the medical device had consisted of contamination of each test unit with predetermined microbial load, washing with enzymatic detergent, drying and sterilization. At the end of each reprocessing cycle, representative sarnples had been segregated to evaluate microbial count (pour plate), terility test through direct and indirect inoculation, cytotoxicity test through cell culture and scanning electron microscopy. The efficiency of the sterility was evaluated through microbial count, as for the sterility tests, that had resulted in microbial count of 103 cfu/unit and detection of contamination until the 6th cycle of reprocessing in the intravenous catheters, three-way stopcocks and traqueostomy tubes. The safety of these reprocessed medical devices was evaluated by mouse fibroblasts cell culture (NCTC clone 929), which didn\'t presented significant toxicity. However, the results obtained by scanning electron microscopy proved the presence of microbial load after 10th reprocessing cycle, as well as damages to the polymeric surface. During challenge with bacterial endotoxin, that consisted of contaminating the units with 200 EU, drying and submission to sterilization cycles with ethylene oxide/cfe (12:88), it was verified that after ten simulated reprocessing cycles, it was possible to recover around 100% of endotoxin. The catheter guide that were acquired from institutional hospital after four times reuse, had presented levels of contamination of 105 cfu/unit, as well as presenee of bacteria considered pathogenic in patients immunologically compromised, on the other hand the detention of bacterial endotoxin in these catheters was not considered significant. The evaluations studies condueted with the units submitted to the simulated reprocessing cycles, as well as the catheter guide reprocessed and reused four times, had reflected the reality of some national and foreign hospitais which reutilize single use medical device. The results obtained lead us to raise objections to the reusing practice, considering the absence of adequate patients safety.
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Wiechman, Shelley A. "The effect of substance abuse on pain management for traumatic patients /." Thesis, Connect to this title online; UW restricted, 2000. http://hdl.handle.net/1773/9060.
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Tobias, Cynthia Lee 1945. "HUMAN FACTORS ASPECTS OF A GRAPH THEORETIC MODEL FOR HOSPITAL FACILITY LAYOUT." Thesis, The University of Arizona, 1986. http://hdl.handle.net/10150/275549.
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Hanshew, Michael. "Inpatient Utilization of Computed Tomography: the Influence of Market, Hospital, and Patient Characteristics." VCU Scholars Compass, 2018. https://scholarscompass.vcu.edu/etd/5290.
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The use of computed tomography (CT) in the care of patients has grown dramatically since its introduction over 30 years ago. The vast majority of the utilization research has focused on factors associated with the variable use in the outpatient and emergency department settings. This has left much of the inpatient use and variation understudied. This study has multiple aims. The first is to characterize the inpatient variation across multiple states and markets. The second is to evaluate the relationship between inpatient CT use and commercial payers across these areas. The third is to develop a model to evaluate the relationship between inpatient CT use and the characteristics of markets, hospitals, and patients.
The study uses a four-state convenience sample of cross-sectional data for hospitals. It included non-Federal, acute care hospitals that reported the performance of inpatient CT exams during 2015 (N=181). The literature review was used to justify the inclusion of variables in the study. The descriptive analyses were used to justify the appropriateness of the variables and methodology for testing.
A comparison of means demonstrated the significant differences for inpatient utilization between states. A univariate general linear model demonstrated a negative relationship with a hospital’s proportion of commercially insured patients and the inpatient utilization rate. An ordinary least squares multivariate linear regression was used to test for variable significance within each of three constructs: markets, hospitals, and patients. The results indicated that inpatient CT rates were positively associated with higher level of insurer concentration (market), positively associated with system centralization (hospitals), and negatively associated with a hospital’s increasing proportion of minority patient discharges (patients).
The study serves an important function in identifying varying patterns of CT utilization across the full spectrum of inpatients across multiple states, regardless of payer. It also creates new knowledge about how the characteristics of these markets, hospitals, and patients are related to inpatient use. It also provides implications for administrators, researchers, and policy makers. The additional knowledge and understanding provided by this research have the potential to lead to improvements in the appropriate and equitable use of inpatient CT exams.
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Deng, Yihong. "Evaluating and Improving the Utilization of Automated Dispensing Cabinets (ADCs) in a Pediatric Hospital." University of Cincinnati / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1544101403433017.
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Bridges, Sharon. "Duplicated laboratory tests : a hospital audit and evaluation of a computerized alert intervention." Doctoral diss., University of Central Florida, 2011. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/4695.
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Laboratory testing is necessary when it contributes to the overall clinical management of the patient. Redundant testing, however, is often unnecessary and expensive and contributes to overall reductions in healthcare system efficiency. The purpose of this study is two-fold. First, to evaluate the frequency of ordering duplicate laboratory tests in hospitalized patients and the costs associated with this practice. Second, it was designed to determine if the use of a computerized alert or prompt will reduce the total number of unnecessarily duplicated Acute Hepatitis Profile (AHP) laboratory tests. Methods This two-phase study took place in an inpatient facility that was part of a large tertiary care hospital system in Florida. A retrospective descriptive design was used during Phase 1 was to evaluate six laboratory tests and the frequency of ordering duplicate laboratory tests in hospitalized patients and to determine the associated costs of this practice for a 12-month time period in 2010. A test was considered a duplicate or an unnecessarily repeated test if it followed a previous test of the same type during the patient*s length of stay in the hospital and one in which any change in their values likely would not be clinically significant. A quasi-experimental pre- and post-test design was used during phase 2 was to determine the proportion of duplication of the AHP test before and after the implementation of a computerized alert intervention implemented as part of a system quality improvement process on January 5th, 2011. Data were compared for two 3-month time periods, pre- and post-alert implementation. The AHP test was considered redundant if it followed a previous test of the same type within 15 days of the initial test being final and present in the medical record. Results In phase 1, including each of the six tests examined, there were a total amount of 53, 351 test ordered, with 10, 375 (19.4%) of these cancelled.
Out of the total amount of result final tests (n = 42,976), including each of the six tests examined, 4.6-8.7% were redundant. Results of the proportion of duplication of the six selected tests are as follows: AHP 196/2514 (7.8%), Antinuclear Antibody (ANA) 120/2594 (4.6%), B12/Folate level 396/5874 (6.7%), Thyroid Stimulating Hormone (TSH) 1893/21595 (8.7%), Ferritin 384/5171 (7.4%), and Iron/Total iron binding capacity (TIBC) 316/5155 (6.1%). The overall associated yearly cost of redundant testing of these six selected tests was an estimated $419, 218. The largest proportion of redundant tests was the Thyroid Stimulating Hormone level, costing a yearly estimated $300, 987. In Phase 2, prior to introduction of the alert, 674 AHP tests were performed. Of these, 53 (7.9%) were redundant. During the intervention period, 692 AHP tests were performed, of these 18 (2.6%) were redundant. The implementation of the computerized alert was shown to significantly reduce the proportion of AHP tests (Chi-Square: [chi]2 = df 1, p [less than or equal to] 0.001). The differences in the associated costs of duplicated AHP were $5238 dollars in 2010 as compared to $1746 in 2011 post-alert and these differences were significant (Mann Whitney U, Z = -4.04, p [less than or equal to]; 0.001). Conclusion Although the proportions of unnecessarily repeated diagnostic tests that were observed during Phase 1 of this study were small, the associated costs could adversely affect hospital revenue and overall healthcare efficiency. The implementation of the AHP computerized alert demonstrated a drop in the proportion of redundant AHP tests and subsequent associated cost savings. It is necessary to perform further research to evaluate computerized alerts on other tests with evidence-based test-specific time intervals, and to determine if such reductions post-implementation of AHP alerts are sustained over time.D.N.P.
Doctorate
Nursing
College of Nursing
Nursing Practice DNP
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Albano, Filipa Maria Marques. "Do hospitals react to random demand pressure by early discharges?" Master's thesis, NSBE - UNL, 2012. http://hdl.handle.net/10362/9534.
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A Work Project, presented as part of the requirements for the Award of a Masters Degree in Economics from the NOVA – School of Business and EconomicsThis project tries to assess whether hospitals react to random demand pressure by discharging patients earlier than expected. As a matter of fact, combining an unpredictable demand for medical services with limited and, to some extent, fixed medical resources, generates strong incentives to discharge patients earlier than expected when demand is high - increasing the risk of readmission and decreasing the benefit from treatment. This work was conducted as a way to determine whether those incentives actually affect discharging decisions. Analysis of Portuguese hospitals data shows that hospital utilization levels at the time of admission, prior to the admission and post admission do have a negative impact over the length of stay in hospital, although this impact is quantitatively irrelevant. More than that, larger utilization levels have a positive impact over the probability of being discharged at certain days of the week, indicating that an early discharges problem may exist.
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Walton, Marilyn. "The Relationship Between Asthma Education and the Number of Hospital Visits of Asthmatic Children." Youngstown State University / OhioLINK, 2000. http://rave.ohiolink.edu/etdc/view?acc_num=ysu1007754892.
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Lines, Lisa M. "Outpatient Emergency Department Utilization: Measurement and Prediction: A Dissertation." eScholarship@UMMS, 2014. https://escholarship.umassmed.edu/gsbs_diss/710.
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Approximately half of all emergency department (ED) visits are primary-care sensitive (PCS) – meaning that they could potentially be avoided with timely, effective primary care. Reducing undesirable types of healthcare utilization (including PCS ED use) requires the ability to define, measure, and predict such use in a population.
In this retrospective, observational study, we quantified ED use in 2 privately insured populations and developed ED risk prediction models. One dataset, obtained from a Massachusetts managed-care network (MCN), included data from 2009-11. The second was the MarketScan database, with data from 2007-08. The MCN study included 64,623 individuals enrolled for at least 1 base-year month and 1 prediction-year month in Massachusetts whose primary care provider (PCP) participated in the MCN. The MarketScan study included 15,136,261 individuals enrolled for at least 1 base-year month and 1 prediction-year month in the 50 US states plus DC, Puerto Rico, and the US Virgin Islands.
We used medical claims to identify principal diagnosis codes for ED visits, and scored each according to the New York University Emergency Department algorithm. We defined primary-care sensitive (PCS) ED visits as those in 3 subcategories: nonemergent, emergent but primary-care treatable, and emergent but preventable/avoidable.
We then: 1) defined and described the distributions of 3 ED outcomes: any ED use; number of ED visits; and a new outcome, based on the NYU algorithm, that we call PCS ED use; 2) built and validated predictive models for these outcomes using administrative claims data; 3) compared the performance of models predicting any ED use, number of ED visits, and PCS ED use; 4) enhanced these models by adding enrollee characteristics from electronic medical records, neighborhood characteristics, and payor/provider characteristics, and explored differences in performance between the original and enhanced models.
In the MarketScan sample, 10.6% of enrollees had at least 1 ED visit, with about half of utilization scored as PCS. For the top risk group (those in the 99.5th percentile), the model’s sensitivity was 3.1%, specificity was 99.7%, and positive predictive value (PPV) was 49.7%. The model predicting PCS visits yielded sensitivity of 3.8%, specificity of 99.7%, and PPV of 40.5% for the top risk group.
In the MCN sample, 14.6% (±0.1%) had at least 1 ED visit during the prediction period, with an overall rate of 18.8 (±0.2) visits per 100 persons and 7.6 (±0.1) PCS ED visits per 100 persons. Measuring PCS ED use with a threshold-based approach resulted in many fewer visits counted as PCS, discarding information unnecessarily. Out of 45 practices, 5 to 11 (11-24%) had observed values that were statistically significantly different from their expected values. Models predicting ED utilization using age, sex, race, morbidity, and prior use only (claims-based models) had lower R2 (ranging from 2.9% to 3.7%) and poorer predictive ability than the enhanced models that also included payor, PCP type and quality, problem list conditions, and covariates from the EMR, Census tract, and MCN provider data (enhanced model R2 ranged from 4.17% to 5.14%). In adjusted analyses, age, claims-based morbidity score, any ED visit in the base year, asthma, congestive heart failure, depression, tobacco use, and neighborhood poverty were strongly associated with increased risk for all 3 measures (all P<.001).
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Lines, Lisa M. "Outpatient Emergency Department Utilization: Measurement and Prediction: A Dissertation." eScholarship@UMMS, 2004. http://escholarship.umassmed.edu/gsbs_diss/710.
Full textAbstract:
Approximately half of all emergency department (ED) visits are primary-care sensitive (PCS) – meaning that they could potentially be avoided with timely, effective primary care. Reducing undesirable types of healthcare utilization (including PCS ED use) requires the ability to define, measure, and predict such use in a population.
In this retrospective, observational study, we quantified ED use in 2 privately insured populations and developed ED risk prediction models. One dataset, obtained from a Massachusetts managed-care network (MCN), included data from 2009-11. The second was the MarketScan database, with data from 2007-08. The MCN study included 64,623 individuals enrolled for at least 1 base-year month and 1 prediction-year month in Massachusetts whose primary care provider (PCP) participated in the MCN. The MarketScan study included 15,136,261 individuals enrolled for at least 1 base-year month and 1 prediction-year month in the 50 US states plus DC, Puerto Rico, and the US Virgin Islands.
We used medical claims to identify principal diagnosis codes for ED visits, and scored each according to the New York University Emergency Department algorithm. We defined primary-care sensitive (PCS) ED visits as those in 3 subcategories: nonemergent, emergent but primary-care treatable, and emergent but preventable/avoidable.
We then: 1) defined and described the distributions of 3 ED outcomes: any ED use; number of ED visits; and a new outcome, based on the NYU algorithm, that we call PCS ED use; 2) built and validated predictive models for these outcomes using administrative claims data; 3) compared the performance of models predicting any ED use, number of ED visits, and PCS ED use; 4) enhanced these models by adding enrollee characteristics from electronic medical records, neighborhood characteristics, and payor/provider characteristics, and explored differences in performance between the original and enhanced models.
In the MarketScan sample, 10.6% of enrollees had at least 1 ED visit, with about half of utilization scored as PCS. For the top risk group (those in the 99.5th percentile), the model’s sensitivity was 3.1%, specificity was 99.7%, and positive predictive value (PPV) was 49.7%. The model predicting PCS visits yielded sensitivity of 3.8%, specificity of 99.7%, and PPV of 40.5% for the top risk group.
In the MCN sample, 14.6% (±0.1%) had at least 1 ED visit during the prediction period, with an overall rate of 18.8 (±0.2) visits per 100 persons and 7.6 (±0.1) PCS ED visits per 100 persons. Measuring PCS ED use with a threshold-based approach resulted in many fewer visits counted as PCS, discarding information unnecessarily. Out of 45 practices, 5 to 11 (11-24%) had observed values that were statistically significantly different from their expected values. Models predicting ED utilization using age, sex, race, morbidity, and prior use only (claims-based models) had lower R2 (ranging from 2.9% to 3.7%) and poorer predictive ability than the enhanced models that also included payor, PCP type and quality, problem list conditions, and covariates from the EMR, Census tract, and MCN provider data (enhanced model R2 ranged from 4.17% to 5.14%). In adjusted analyses, age, claims-based morbidity score, any ED visit in the base year, asthma, congestive heart failure, depression, tobacco use, and neighborhood poverty were strongly associated with increased risk for all 3 measures (all P<.001).
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Dilworth, Joyce Carroll. "The relationship of nutritional status to unreimbursable costs and length of hospital stay." CSUSB ScholarWorks, 1992. https://scholarworks.lib.csusb.edu/etd-project/721.
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Seeley, Susan. "The Utilization of Outpatient Laboratory Resources at Ireland Army Community Hospital After Implementation of Tricare." TopSCHOLAR®, 1999. http://digitalcommons.wku.edu/theses/757.
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The purpose of this study was to compare out patient laboratory utilization patterns of active duty and retired military personnel and their dependents before and after the implementation of TRICARE. A stratified random sample was taken of patient test results over a two year period resulting in a sample size of 104 observations. The Complete Blood Count (CBC) results were used as indicators for the study. Data was gathered on the patient's rank, active duty/retiree status, age, dependent status, and gender. Additionally, the total number of tests were recorded for the year prior to the introduction of TRICARE and after implementation of TRICARE at Ireland Army Hospital in Fort Knox, Kentucky. It was determined that there was a dramatic decrease in the utilization patterns of the retiree population. The mean age of the year 2 group was much younger, and changes in enlisted personnel utilization were noted. A decrease in the number of tests performed was also noted. These results are relevant to the Laboratory Director and the Commander of the installation.
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Cheung, Ignatius W. K. "The impact of computed tomography on the utilization of neurological tests at a community hospital." Thesis, University of British Columbia, 1986. http://hdl.handle.net/2429/25861.
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One of the major issues in the health care industry is the continual rise in total health care expenditures relative to the Gross National Product. A significant portion of this rise has been attributed to the increasing use of medical technologies. As an increasing number of technological innovations are being developed for health care, and such new technologies are often complicated and expensive, the need for properly conducted evaluative studies becomes very important. It is essential to know whether a new technology is a substitute for less effective ones or is merely an add-on. Clear guidelines on under what conditions the new technology is applicable should be developed. For a diagnostic technology, the ideal model of evaluation should involve assessments of technical capability and safety, diagnostic accuracy, diagnostic impact, therapeutic impact, patient outcome, economic impact and availability.
In the relatively short period since 1971, when computed tomography (CT) was first used clinically, it has become an important part of medical practice. This study attempts to assess the impact of CT on the utilization of related neurological tests at the Lions Gate Hospital. This is a community hospital serving a population of approximately 140,000 people. This study is a retrospective, before-after comparison of the utilization of neurological tests before and after the introduction of CT. Two groups of neurological patients, who were hospitalized during the study period 1973 to 1983/4, were assessed. These were the brain tumour group (ICD-9: 191, 198 and 225) and the cerebrovascular disease group (ICD-9: 430 to 438).
The results of this study suggest that, for both groups of patients, CT is a complete replacement for pneumoencephalography and nuclear brain scanning, and is a partial replacement for electroencephalography and plain skull radiography. However, CT has had little impact on cerebral angiography which fell marginally in the brain tumour group and rose significantly in the cerebrovascular disease group.
It has also been estimated that, over the study period, the average total cost of neurological tests (based on 1983/4 fee-dollars), on a per patient basis, remained the same for the brain tumour group but rose by 92% for the cerebrovascular disease group.Medicine, Faculty of
Population and Public Health (SPPH), School of
Graduate
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Weeks, William Brinson. "Geographic variation in the supply and utilization of hospital services : Economic motives and policy implications." Thesis, Aix-Marseille, 2015. http://www.theses.fr/2015AIXM2002/document.
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Dans l’ensemble de la thèse, nous avons appliqué des techniques de ‘mesure des variations spatiales’ pour l'étude des variations géographiques de taux d'hospitalisation en France. La thèse est composée de 4 études :Étude 1 : « Variation géographique des recours aux procédures chirurgicales en France en 2008-2010 et comparaison avec les États-Unis et la Grande-Bretagne ».Étude 2 : « Variation géographique des admissions pour les prothèses du genou, de la hanche et la fracture de la hanche en France : existence d’une demande induite dans le secteur des hôpitaux à but lucratif et dans les hôpitaux public et privés à but non-lucratif »Étude 3 : « Caractéristiques et tendances des admissions non urgentes à but lucratif et sans but lucratif hôpitaux en France en 2009 et 2010 ». Étude 4 : « Taux d'admission pour des ’hospitalisations évitables par le système ambulatoire’ (ACSC) en France en 2009-2010 : tendances, variation géographique, coûts et comparaison internationale »For all of this work, we applied ‘small-area variation’ techniques to the study of geographic variations in hospitalization rates in France. We conducted four studies:Study 1: Geographic variation in rates of common surgical procedures in France in 2008-2010 and comparison to the US and BritainStudy 2: Geographic variation in admissions for knee replacement, hip replacement, and hip fracture in France: evidence of supplier-induced demand in for-profit and not-for profit hospitalsStudy 3: Characteristics and patterns of elective admissions to for-profit and not-for-profit hospitals in France in 2009 and 2010Study 4: Rates of admission for ambulatory care sensitive conditions in France in 2009-2010: trends, geographic variation, costs, and an international comparison
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Mulpuru, Sunita. "Does Respiratory Viral Testing in Adult Hospitalized Patients Impact Hospital Resource Utilization and Improve Patient Outcomes?" Thèse, Université d'Ottawa / University of Ottawa, 2014. http://hdl.handle.net/10393/31165.
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Respiratory viral testing in hospitalized patients is thought to improve quality of care by reducing the use of diagnostic tests, guiding infection control precautions, and rationalizing antimicrobial therapies. Few small published studies have tested these assumptions, and have demonstrated conflicting results.
We conducted a retrospective cohort study of 24,567 hospitalizations using administrative data to determine the associations between viral testing, patient outcomes, and process of care.
Viral testing was not associated with improved mortality or length of stay in hospital, and resulted in more resource utilization. The test result did not influence the duration of isolation precautions. This implies that health care providers may not use the results of testing in making management decisions, or in guiding the use of isolation precautions. This study provides the foundation for further scientific evaluation and reform of our current respiratory infection control policy.
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Kinney, Rebecca L. "Predictors of Patient Activation at ACS Hospital Discharge and Health Care Utilization in the Subsequent Year." eScholarship@UMMS, 2018. https://escholarship.umassmed.edu/gsbs_diss/992.
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Background. AHA guidelines have been established to reduce Acute Coronary Syndrome (ACS)-related morbidity, mortality and recurrent events post-discharge. These recommendations emphasize the patient as an engaged member of the health care team in secondary prevention efforts. Patients with high levels of activation are more likely to perform activities that will promote their own health and are more likely to have their health care needs met. Despite evidence and strong expert consensus supporting patients as active collaborators in their own ACS care, the complexity and unexpected realities of self-managing one’s care at home are often underestimated. This study seeks to examine the correlates of patient activation at hospital discharge and then identifies activation trajectories in this same cohort in subsequent months. Lastly, this study examines the association between patient activation and health care utilization in the year subsequent to an ACS event.
Methods. This study incorporates three aims: Aim 1, identification of the correlates of low patient activation post-discharge; Aim 2, identification of patient activation trajectories among this same cohort in the months following hospitalization; and Aim 3, examination of the association between patient activation and health utilization, post-discharge.
Results. Fifty-nine percent of ACS patients identified as being at the lowest two activation stages at the time of hospital discharge. Perceived stress (pidentified post-discharge: low, stable (T1), high, sharp decline (T2), and sharp improvement (T3). The majority of patients (67%) identified as being in T1. Those patients of older age (OR: 2.22; CI 1.4- 3.5), identifying as Black in race (OR: 2.14: CI 1.1- 4.3), and reporting moderate/high perceived stress (OR: 2.54: CI 1.4- 4.5) had increased odds of being in the low, stable trajectory. The bivariate analysis indicated a significant association (P=0.008) between low patient activation and self-reported hospital readmissions in the months following discharge. In the final model, moderate to severe depression (OR: 1.60; CI 1.1- 2.3) was the strongest predictor of readmissions in the 12 months subsequent to discharge.
Conclusions: Patients reported low activation at hospital discharge after an ACS event indicated that these patients were not prepared to take an active role in their own care. Correlates of low activation at discharge include moderate to high perceived stress, depression, and low social support. Furthermore, in the months following hospital discharge, the majority of these patients followed either a low/stable or a sharp decline activation trajectory. Hence, these results suggest that over time patients feel less and less confident to take an active role in self-management. Lastly, we found that patient activation may impact healthcare utilization in the year subsequent to hospital discharge, although patient self-reported depression appears to be the strongest predictor of utilization in the subsequent year. Future research is needed to better understand the relationship(s) among patient activation, depression, and health care utilization.
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Bosman, Michelle. "Assessment of the effectiveness of electronic gatekeeping as a utilization management tool at Groote Schuur Hospital." Master's thesis, Faculty of Health Sciences, 2018. http://hdl.handle.net/11427/30151.
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BACKGROUND: Utilization management ensures the appropriateness of laboratory testing by reducing the performance of tests which can be reasonably avoided with no adverse effects for the patient. Electronic gatekeeping, a utilization management tool, was introduced at Groote Schuur in 2010. Criteria were based on the minimum retesting interval, healthcare location, level of experience and discipline of the requesting clinician and specific ICD-10 codes.
METHODS: A retrospective observational study assessing the effectiveness of electronic gatekeeping at Groote Schuur Hospital (Cape Town, South Africa), by comparing the test request volumes by using absolute test numbers and pre-defined ratios in the year prior to gatekeeping, to the two years following implementation. A secondary aim is to apply selected ratios to the other national academic hospitals to determine the potential for cost saving. RESULTS: At the medical wards of Groote Schuur Hospital there was an overall decrease in number and cost of tests of 24% per inpatient day for 2011. The most dramatic difference in cost is seen for chloride (91%) followed by HbA1c (90%), FT3 (89%) and CRP (82%). The application of ratios to Groote Schuur Hospital show a decrease in 2011 in all ratios apart from PCT: FBC+WCC (0.003 vs 0.002) and Mg: Ca (0.86 vs 0.84). AST: ALT remained the same at 0.55. This suggests overall effectiveness of the eGK rules although there is ongoing panel requesting. If the GSH eGK rules were to be applied at all other national academic hospitals, it could translate into a potential cost saving of $13 411 873.96 (R103 196 838.80) per annum.
CONCLUSIONS: Electronic gatekeeping is an effective utilization management tool at Groote Schuur Hospital. It is relatively easy to implement and manage, and when combined with additional tools has the potential to result in larger reductions of unnecessary tests, cost savings and improved patient outcome.
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Lovell, Mariann Engelhard. "Factors associated with inpatient tertiary hospital utilization and home care referral in patients diagnosed with Cancer /." The Ohio State University, 1999. http://rave.ohiolink.edu/etdc/view?acc_num=osu1488191667181637.
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Wong, Oi-ling Irene, and 黃愛玲. "Medical ecology of inpatient service utilization in Hong Kong: a population survey." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2003. http://hub.hku.hk/bib/B31971337.
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Vellanky, Smitha. "Effect of computer decision support system on antibiotic utilization in a complex continuing care and rehabilitation hospital." Thesis, Kingston, Ont. : [s.n.], 2007. http://hdl.handle.net/1974/445.
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Santos, Djanilson Barbosa dos. "Drug utilization profile and monitoring of adverse reactions in pediatric patients in the Hospital Infantil Albert Sabin." Universidade Federal do CearÃ, 2002. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=438.
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CoordenaÃÃo de AperfeiÃoamento de NÃvel SuperiorCoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel Superior
INTRODUÃÃO: A populaÃÃo pediÃtrica se ressente dos poucos estudos que relacionem o perfil de utilizaÃÃo e ocorrÃncia de reaÃÃo adversa a medicamentos (RAM) em crianÃas hospitalizadas. OBJETIVOS: Descrever e avaliar a utilizaÃÃo de medicamentos e a ocorrÃncia de reaÃÃes adversas em pacientes pediÃtricos internados no Hospital Infantil Albert Sabin na perspectiva de contribuir para a reduÃÃo dos agravos decorrentes do uso de medicamentos em crianÃas hospitalizadas. METODOLOGIA: Estudo observacional longitudinal prospectivo, de seguimento de pacientes pediÃtricos hospitalizados por mais de 24 horas, em um hospital pÃblico de referÃncia. Pacientes de 1-173 meses de idade foram incluÃdos no estudo no perÃodo de 01 de agosto a 31 de dezembro de 2001. Foram realizadas visitas diÃrias à enfermaria para inclusÃo ou acompanhamento de pacientes; entrevistas com as mÃes por meio de um questionÃrio estruturado para levantar caracterÃsticas sÃcio demogrÃficas e antecedentes patolÃgicos dos entrevistados, familiares e das crianÃas, revisÃo das prescriÃÃes e dos prontuÃrios, conversa com mÃdicos, enfermeiras e farmacÃuticos quando necessÃrio. As suspeitas de RAM foram avaliadas pelo CEFACE conforme a metodologia recomendada pelo Programa de FarmacovigilÃncia da OMS. Na anÃlise estatÃstica foram utilizados o teste exato de Fisher, Student (t) e wilcoxon, considerando-se o nÃvel de significÃncia p < 0,05. RESULTADOS: Durante o perÃodo de estudo ocorreram 272 admissÃes predominantemente de crianÃas entre 1 e 23 meses de idade (47,4%); com mÃes de 1o grau completo ou incompleto de escolaridade (70,6%); famÃlias de renda familiar entre 1 e 5 salÃrios mÃnimos (61,0%). Dentre as crianÃas admitidas, 265 foram expostas a medicamentos no hospital (97%), recebendo em mÃdia 6,4 (1-18) medicamentos; a mÃdia de permanÃncia hospitalar foi de 14,7 (2-67) dias. O diagnÃstico mais freqÃente foi pneumonia (30%), a classe terapÃutica mais prescrita foi Antiinfecciosos de Uso SistÃmico (25,9%). Foram detectados 420 eventos adversos; destes, 33 foram classificados como RAM. A incidÃncia acumulada de RAM foi 12,5% (33/265) e a densidade de incidÃncia 0,8% (33/4042 pacientes-dia monitorizados). A pele foi o ÃrgÃo mais afetado (48,9%). O grupo terapÃutico mais implicado foi Antiinfecciosos de Uso SistÃmico (53,2%). As RAM foram leves ou moderadas em 97,9% dos casos, 57,5% ProvÃveis e a maioria foi dose independente (55,3%). Na anÃlise multivariada as chances de uma crianÃa hospitalizada apresentar uma RAM cresceram com o nÃmero de medicamentos administrados, entre aqueles do sexo masculino, com menor idade (< 2anos) e internada anteriormente de 3 a 4 vezes. CONCLUSÃO: Foi significativa a proporÃÃo de crianÃas menores de 2 anos usando medicamentos. A predominÃncia do uso de antimicrobianos à esperado e determina o perfil de RAM detectados. A identificaÃÃo de fatores de risco associado a RAM possibilita a seleÃÃo de subgrupos de pacientes pediÃtricos que requereriam maior racionalizaÃÃo terapÃutica e avaliaÃÃo da seguranÃa de medicamentos. PALAVRAS-CHAVE: farmacoepidemiologia; medicamentos; pediatria.
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Moreira, Leonardo Barbosa. "AdesÃo ao tratamento farmacolÃgico em doentes renais crÃnicos atendidos pelo ambulatÃrio do Hospital UniversitÃrio Walter CantÃdio." Universidade Federal do CearÃ, 2005. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=292.
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CoordenaÃÃo de AperfeiÃoamento de Pessoal de NÃvel SuperiorA doenÃa renal crÃnica (DRC) representa, atualmente, um importante problema de saÃde pÃblica. Em estÃgios mais avanÃados, a doenÃa pode levar à insuficiÃncia renal crÃnica terminal, que requer diÃlise ou transplante. O retardo da progressÃo da DRC depende da efetividade da farmacoterapia das doenÃas de base. A nÃo adesÃo ao tratamento farmacolÃgico prejudica o alcance dos resultados terapÃuticos. O estudo dos fatores associados à nÃo adesÃo à importante para que estratÃgias de intervenÃÃo bem sucedidas possam ser implementadas. O objetivo do presente trabalho à mensurar a prevalÃncia da nÃo adesÃo ao tratamento farmacolÃgico e identificar os fatores associados à nÃo adesÃo em doentes renais crÃnicos. O estudo foi realizado no ambulatÃrio de nefrologia do Hospital UniversitÃrio Walter CantÃdio, em Fortaleza (CE), entre novembro de 2004 e abril de 2005, com delineamento transversal. A amostra foi constituÃda por 130 pacientes com diagnÃstico de DRC, maiores de 18 anos, em uso contÃnuo de algum fÃrmaco anti-hipertensivo ou imunossupressor e que nÃo estivessem sendo submetidos a diÃlise ou transplante renal. A nÃo adesÃo foi medida atravÃs dos mÃtodos da entrevista com questionÃrio, das estimativas feitas pelos mÃdicos e da anÃlise dos resultados terapÃuticos, sendo considerados nÃo aderentes os pacientes assim classificados por, pelo menos, um dos mÃtodos. As variÃveis independentes estudadas estavam relacionadas Ãs caracterÃsticas sociodemogrÃficas, caracterÃsticas e percepÃÃes dos pacientes sobre a DRC, o tratamento e o atendimento oferecido e o nÃvel de informaÃÃo sobre o tratamento farmacolÃgico. O banco de dados e anÃlise bivariada foram feitos atravÃs do EPI-INFO versÃo 6.04d, utilizando o teste do qui-quadrado corrigido por Yates e o teste exato de Fisher. Foi realizada uma anÃlise multivariada por meio de um modelo de regressÃo logÃstica, utilizando-se o programa SPSS for Windows versÃo 10.0. Em todos os testes estatÃsticos adotou-se o nÃvel de significÃncia de p < 0,05 (bicaudal) em relaÃÃo ao erro alfa. A freqÃÃncia de pacientes nÃo aderentes, identificados por pelo menos um dos mÃtodos, foi de 61,3% (IC95% = 52,0 â 70,1%). Na anÃlise multivariada trÃs fatores apresentaram associaÃÃo estatisticamente significante com a nÃo adesÃo: tempo de diagnÃstico da DRC inferior a 5 anos (p = 0,015), relato do paciente sobre reaÃÃo adversa a algum medicamento prescrito (p = 0,015) e baixo nÃvel de informaÃÃo sobre o tratamento farmacolÃgico (p = 0,028). à medida que aumentou o nÃvel de informaÃÃo sobre o tratamento farmacolÃgico diminuiu a prevalÃncia da nÃo adesÃo. A prevalÃncia da nÃo adesÃo ao tratamento farmacolÃgico à alta entre os pacientes estudados. Os fatores que apresentaram associaÃÃo estatisticamente significante com a nÃo adesÃo sÃo possÃveis causas deste comportamento. IntervenÃÃes educativas e motivacionais sÃo necessÃrias para a diminuiÃÃo da magnitude do problema. Os resultados observados estÃo coerentes com outros trabalhos encontrados na literatura, entretanto, mais estudos sÃo necessÃrios para avaliar as causas da nÃo adesÃo ao tratamento farmacolÃgico da DRC e a efetividade das intervenÃÃes propostas.
Chronic kidney disease (CKD) is currently an important public health problem. At more advanced stages CKD can take to end-stage renal disease, that request dialysis or renal transplantation. Retard of the progression of CKD depends on the effectiveness of underlying conditions pharmacotherapy. Medication non-compliance harms reaching therapeutic goals. Non-compliance associated factors study is important so that well happened intervention strategies can be implemented. The objective of the present study is to measure the prevalence of medication noncompliance and to identify medication non-compliance related factors in CKD patients. A cross-sectional study was performed at renal outpatient care unit of the Academical Hospital Walter CantÃdio, in Fortaleza (CE), between 2004 november and 2005 april. The sample was constituted by 130 CKD patients, at least 18 years old, continuously taking some self-administered antihypertensive or immunosuppressive drug and not being submitted to dialysis or renal transplantation. Non-compliance was measured by questionnaire, physician assessment and outcomes methods, being considered non-compliant patients if non-compliance has been detected by any method. Independent variables studied were related to sociodemographic characteristics, characteristics and patientsâ perceptions on CKD, its treatment and offered service and information level about pharmacotherapy. Database and bivariate analysis were performed at EPI-INFO version 6.04d, using Yates corrected chi-square and isherâs exact tests. A multivariate analysis was conducted through a logistic regression model using SPSS for Windows version 10.0. Confidence level for all tests was p < 0,05 (two-tailed). Frequency of non-compliant patients, detected by any method, was 61,3% (95%CI = 52,0 â 70,1%). Multivariate analysis results showed that less than 5 years CKD diagnosis time (p = 0,015), selfreport of adverse drug reaction (p = 0,015) and low information level about pharmacotherapy (p = 0,028) presented statistically significant association with noncompliance. As greater the information level about pharmacotherapy smaller the noncompliance prevalence. Medication non-compliance prevalence is high among studied patients. Factors associated with non-compliance are possible causes of this comportment. Educational and motivational interventions are necessary for decrease problemâs magnitude. Observed results are coherent with literature, however, more studies are necessary to evaluate causes of the medication non-compliance on CKD and effectiveness of the proposed interventions.
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Lu, Yi. "Directed visibility analysis: three case studies on the relationship between building layout, perception and behavior." Diss., Georgia Institute of Technology, 2011. http://hdl.handle.net/1853/39569.
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This is a study of the spatial affordances of buildings that allow them to organize and transmit cultural ideas and to support the performance of organizational roles. The particular affordances under consideration are those that arise from the manner in which buildings structure the visual fields that are potentially available to a situated observer.
In studying directed visibility patterns, supported by the development of appropriate analytical tools, we focus on a previously specified set of visual targets and ask how many become visible from each occupiable location. Parametric restrictions concerning the direction into which a subject faces and the viewing angle sustained by the target object are also taken into consideration. The aim is to demonstrate how such refinements of visibility analysis, lead to more precise and penetrating insights as to how building users tune their behavior to the spatial affordances of environment, and how the environment impacts their understanding in turn. Three different studies were presented. The fist used directed visibility measures to evaluate the affordances of different nursing-unit designs relative to how well nurses are able to survey patients in different rooms as they go about their duties. The second study focuses on the manner in which nurses and physicians position themselves in a Neuro Intensive Care Unit (ICU), particularly when interacting. The third study investigates how aware exhibition visitors become of the visual structure of environment and how the visibility structure of exhibitions affects the ability of visitors to conceptually group paintings according to their thematic content.
The case studies support the following conclusions.
1) The way in which people position themselves in an environment as they perform their assigned tasks is tuned to the way in which visual fields are structured.
2) The visual structure of environment is contingent upon the interaction between the underlying structure of visual fields and paths of movement.
3) Directed visibility analysis leads to stronger correlations with behavior and performance than generic visibility analysis. This implies that environments are layered. Their underlying spatial structure is charged by the distribution of the contents that are programmatically primary.
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Leung, Chi-hang Vincent, and 梁志鏗. "Consultation pattern of non-urgent patients of Accident & Emergency Department." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2005. http://hub.hku.hk/bib/B39724189.
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Nyambi, Rachel N. "Health care in Cameroon a rural hospital utilization /." 1996. http://catalog.hathitrust.org/api/volumes/oclc/47661858.html.
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Pitso, Kebinakwena Beauty. "Drug utilisation in the maternity ward of a district hospital in South Africa." Thesis, 2012.
Find full textAbstract:
Research report submitted to the Faculty of Health Sciences, University of the
Witswatersrand, in partial fulfilment of the requirements for the degree of Master of
Public Health in the field of Hospital ManagementBackground: Use of drugs in maternity unit plays a major role in maternal health service delivery. Therefore, drug use during pregnancy requires close monitoring which includes prescription of appropriate medication to their diagnosis, correct doses, and adequate period of time. Drugs are also one of the major cost drivers in health facilities. Although maternal health services are receiving increasing attention in South Africa, very few systematic studies have been done to analyze this important component (prescribing patterns and costs of drugs) of maternal health care services in a district hospital setting. Aims: The overall aim of the study is to assess the drugs utilized in a maternity ward at Pretoria West District Hospital (A district hospital in the Tshwane District in the Gauteng Province) and the factors that might influence its use and their cost over a period of one year. Methodology: Cross-section study design was used. Retrospective review of hospital records was undertaken for 2087 maternal patient deliveries during one year study period (01 January to December 2009) and no primary data was collected. Data was extracted for variables used in the study (quantity and cost of drug used, profile of patients). The study commenced after obtaining necessary approval from the Gauteng Department of Health and Social Development and University of the 2 Witwatersrand “Human Research Ethics Committee (Medical)’. Results: The study found that all the patients were prescribed iron supplements. The second most commonly prescribed drugs are uterotonics. Besides these two items other prescription drugs were prescribed to 7% of patients. Postnatal contraceptives were seldom used. The most commonly used antibiotic was Ceftriaxone. Bezylpenicillin was prescribed only for one RPR positive patient during one month. Only 13% HIV positive received antiretrovirals which is too low as compared to number of mothers delivered. The study found underprescription of anti-hypertensive drugs. Low use of parenteral analgesics signifies that probably patients were not given adequate pain relief during labour and this policy should be reviewed. The quantity of biological vaccines (BCG and oral polio) was prescribed routinely for all the newborn babies. However, the antiretrovirals (Zidovudine and Nevirapine syrups) were prescribed for fewer newborn babies (n= 51), in comparison to total number of babies born to a HIV positive mothers (n=266) and of concern. Total cost for the drugs used during one year study period was R 113,664.56. The average costs per mother and newborn babies were R 39.40 and R 15.08 respectively. Routine availability of affordable and effective drugs is one of the key indicators of quality health. The study showed that affordable and effective drugs were readily available in the Unit. Conclusion: This is probably the first study that documented the use of drugs in the maternity unit in a district hospital. Further prospective study would be able to provide more information in this important subject.
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"Hospital care utilization trends in patients with COPD and lung cancer in the 6 months prior to death." Thesis, 2014. http://hdl.handle.net/10388/ETD-2014-11-1816.
Full textAbstract:
Background: Hospital care utilization has been described as a key measurable indicator of care quality in patients with terminal respiratory diseases. Knowledge about patterns in service utilization for patients with advanced Chronic Obstructive Pulmonary Disease (COPD), however, is fairly limited. The goal of this study was to investigate health care utilization patterns in the last six months of life among patients who died with COPD compared with those who died of lung cancer, and also to examine variations in health care among individuals living with COPD between sex, age, comorbidity, and temporal trends.
Methods: We conducted a retrospective study using administrative health data in the province of Saskatchewan to identify indicators associated with greater hospital care utilization between 1997 and 2006. Those with either COPD or lung cancer as the underlying cause of death (UCOD) were included in this study. Characteristics examined in this study included socio-demographics, comorbidity, location of death, and use of institutional services. Multiple logistic regression was the primary method of analysis.
Results: Between 1997 and 2006, 7,114 persons covered by Saskatchewan Health were identified as having COPD (N=2,332) or lung cancer as the UCOD (N=4,782). Approximately 60% were males with an average age of 74.2 years (S.D. =10.1 years).
Half of the decedents were rural dwellers (47.0%), and were married or common law (51.6%). The majority had multiple comorbid conditions (60.3%), died in hospitals (73.5%), and had never received services from long-term supportive care institutions (74.3%). Compared with those who died from lung cancer, people dying from COPD were less likely to be admitted to hospitals (OR=0.71, 95%CI: 0.64-0.80 in the last six months of life; OR=0.81, 95%CI: 0.70- 0.93 in the last month of life) and had shorter LOS for each admission (OR=0.78, 95%CI: 0.70-0.87 in the six months of life; OR=0.67, 95%CI: 0.60-0.75 in the last month of life). However, persons with COPD were more likely to be managed in an intensive care settings (5.3% of COPD subjects vs. 1.7% of lung cancer subjects in the last six months of life; 4.3% of COPD subjects vs. 0.06% of lung cancer subjects in the last month of life) and had higher numbers of transfers between long-term care facilities (7.7% of COPD subjects vs. 3.2% of lung cancer subjects). Between 1997 and 2006, there was no significant change in the hospital utilization among patients who died of COPD or those who died of lung cancer.
Conclusions: Marked differences in terms of hospital service utilization in the last six months of life were observed between subjects dying with COPD and lung cancer. Our study results support previous work indicating that the nature of care management at the end of life for people who died of advanced COPD is different from those who died from lung cancer, which was reflected by reduced likelihood of hospital service usage, more ICU admissions, and frequent transfers between supportive care facilities. There is no significant change observed regarding the patterns of hospitalization over 10-year study period. We would suggest collecting more information on services managed in other care settings, such as emergency departments, out-patient settings, and clinics, etc. This would allow an in-depth examination regarding what types of institutional services influenced the usage of in-patient care. In addition, education of all health care professionals on the complex needs of patients living with respiratory illnesses is required.
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Atkinson, David A. "Performance measurement of non current assets /." 1998. http://arrow.unisa.edu.au:8081/1959.8/84562.
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