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1 – 10 of 226Susan J. Gregoroff, Robert S. McKelvie and Sylvia Szabo
This study of 216 congestive heart failure (CHF) patients at a large teaching hospital in south‐central Ontario was undertaken to determine whether the patients managed in an…
Abstract
This study of 216 congestive heart failure (CHF) patients at a large teaching hospital in south‐central Ontario was undertaken to determine whether the patients managed in an outpatient heart failure clinic used fewer hospital resources (as expressed in number of admissions, complexity of admission, and length of stay (LOS)) than a matched cohort who were not managed in an outpatient clinic. Statistical significance of LOS opportunities could not be demonstrated (owing to sample size), however, the heart failure clinic is making a positive impact on all types of admissions (CHF and non‐CHF) in terms of LOS and suggests that management in an outpatient setting for chronic disease states is important for acute care hospitals to consider.
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Eugene Kroch, Raj Shah, Douglas Fisher, Evan Loh and J. Sanford Schwartz
This investigation focuses on patients hospitalized with congestive heart failure (CHF) to evaluate the effects of insurance status on resource utilization (costs and procedure…
Abstract
This investigation focuses on patients hospitalized with congestive heart failure (CHF) to evaluate the effects of insurance status on resource utilization (costs and procedure intensity), and the process of inpatient care (length of stay). Data include hospital discharge claims from fourteen states across the U.S. for 88,000 primary and another 135,000 secondary CHF patients under age 65. Risk adjustment methods control for clinical, demographic, and risk selection factors in order to isolate the effects of insurance status on the variables of interest.Results indicate that insurance status significantly affects the type and intensity of care. Lengths of stay are shortest for privately managed patients and longest for patient in public programs. Nonetheless access to high intensity treatment procedures favors private payors, especially those covered by indemnity plans. Overall hospitalization and treatment costs are less sensitive to payor status than length of stay and appear to be driven by high intensity procedure utilization. The marginal effects of CHF are substantial, raising length of stay and treatment cost by up to 40% and reinforcing the insurance status effect on length of stay and utilization found in patients hospitalized with CHF as a primary diagnosis. Despite these process-of-care differences, no significant inpatient mortality/morbidity differences were ascertained in either the primary or secondary analyses.
Michelle Louise Gatt, Maria Cassar and Sandra C. Buttigieg
The purpose of this paper is to identify and analyse the readmission risk prediction tools reported in the literature and their benefits when it comes to healthcare organisations…
Abstract
Purpose
The purpose of this paper is to identify and analyse the readmission risk prediction tools reported in the literature and their benefits when it comes to healthcare organisations and management.
Design/methodology/approach
Readmission risk prediction is a growing topic of interest with the aim of identifying patients in particular those suffering from chronic diseases such as congestive heart failure, chronic obstructive pulmonary disease and diabetes, who are at risk of readmission. Several models have been developed with different levels of predictive ability. A structured and extensive literature search of several databases was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-analysis strategy, and this yielded a total of 48,984 records.
Findings
Forty-three articles were selected for full-text and extensive review after following the screening process and according to the eligibility criteria. About 34 unique readmission risk prediction models were identified, in which their predictive ability ranged from poor to good (c statistic 0.5–0.86). Readmission rates ranged between 3.1 and 74.1% depending on the risk category. This review shows that readmission risk prediction is a complex process and is still relatively new as a concept and poorly understood. It confirms that readmission prediction models hold significant accuracy at identifying patients at higher risk for such an event within specific context.
Research limitations/implications
Since most prediction models were developed for specific populations, conditions or hospital settings, the generalisability and transferability of the predictions across wider or other contexts may be difficult to achieve. Therefore, the value of prediction models remains limited to hospital management. Future research is indicated in this regard.
Originality/value
This review is the first to cover readmission risk prediction tools that have been published in the literature since 2011, thereby providing an assessment of the relevance of this crucial KPI to health organisations and managers.
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Stephen Buetow and Gregor Coster
There is little evidence that treatment advances have improved the prognosis of heart failure in the community. One explanation is the failure of doctors to undertake necessary…
Abstract
There is little evidence that treatment advances have improved the prognosis of heart failure in the community. One explanation is the failure of doctors to undertake necessary prescribing. Reports elsewhere how a modified Delphi approach, based on the RAND Health Services utilisation study method, was used to produce audit criteria for necessary prescribing for systolic heart failure in New Zealand (NZ) general practice. Reports experience of applying these criteria in late 1999 to the medical notes of a random sample of 70 patients with heart failure, as defined by a recorded diagnosis in 30 practices in central Auckland, NZ. Use of the audit criteria was feasible and appears valid, although the methods used to apply them need to be simplified to be of use as a practical means of promoting clinical governance. The small patient sample demands caution in interpreting the results. However, uncommon yet plausible findings, such as the high frequency of ACE inhibitor prescribing for heart failure, deserve further investigation.
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John Øvretveit, Robin Gillies, Thomas G. Rundall, Stephen M. Shortell and Mats Brommels
The purpose of this paper is to discover the extent to which evidence‐based practices and computer systems for managing chronic illness are used within Swedish primary health care.
Abstract
Purpose
The purpose of this paper is to discover the extent to which evidence‐based practices and computer systems for managing chronic illness are used within Swedish primary health care.
Design/methodology/approach
The methodology was a replication of a similar national USA survey study and an interview study.
Findings
The findings show large variations and an under‐use of a number of evidence‐based care management practices and of IT for managing depression, heart disease, asthma, and diabetes in Sweden. Follow‐up interview studies with heads of primary care centres gathered their views about the factors which helped and hindered improving care and prevention for these patient groups.
Research limitations/implications
The study data identify actions which would significantly improve the quality of care for people suffering from chronic illnesses. Effective prevention and management of chronic illness in primary care can reduce unnecessary patient suffering and lower costs of care.
Originality/value
Evidence of effective methods for managing these illnesses has been reported, but it is not known how widely these methods or information technology are used in primary care outside the USA. The paper gives the first comprehensive nation‐wide data on the use of evidence‐based practices and computer systems for managing chronic illness in primary care in a European public health care system. It provides information allowing targeted actions which would improve quality of care which are low cost and high cost saving in the long term.
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Malatree Khouenkoup, Arunrat Srichantaranit and Wanida Sanasuttipun
This study aimed to determine mothers' knowledge of children with congenital heart disease (CHD) and to examine the relationship between types of CHD, the duration of treatments…
Abstract
Purpose
This study aimed to determine mothers' knowledge of children with congenital heart disease (CHD) and to examine the relationship between types of CHD, the duration of treatments, the perception of the severity of illness and the mothers' knowledge.
Design/methodology/approach
A correlation study was conducted among 84 mothers of children (from infancy to six years old) with CHD who had attended pediatric cardiology clinics and pediatric units in three tertiary hospitals in Bangkok, Thailand. The two questionnaires aimed to evaluate the mothers' knowledge and perceptions of the severity of illness. Descriptive statistics, Spearman's rank-order correlation and Fisher's exact test were used to analyze the data.
Findings
Knowledge levels of mothers of children with CHD were at a high level with a mean score of 34.79 (SD = 8.23), but the knowledge domain of preventing complications was at a low level with a mean score of 14.95 (SD = 5.28). The types of CHD and the perceptions of illness were not correlated with the mothers' knowledge, but the duration of treatments was significantly correlated (r = 0.271, p < 0.05).
Originality/value
Healthcare professionals, especially nurses, should emphasize proper health education on complication prevention and the duration of treatments for children. Moreover, mothers should be supported to nurture children with CHD to reduce possible complications and prepare for cardiac surgery where needed.
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Irina Farquhar, Alan Sorkin, Kent Summers and Earl Weir
We study changes in age-specific diabetes-related mortality and annual health care utilization. We find that half of the estimated 16% increase of diabetic mortality falls within…
Abstract
We study changes in age-specific diabetes-related mortality and annual health care utilization. We find that half of the estimated 16% increase of diabetic mortality falls within employable age groups. We estimate that disease combination-specific increase in case fatality has resulted in premature diabetic mortality costing $3.2 billion annually. The estimated annual direct cost of treating high-risk diabetics reaches $36 billion, of which Medicare and Other Federal Programs compensate 54%. Respiratory conditions among diabetics comprise the same proportion of high-risk diabetics as do the disease combinations including coronary heart diseases. Treating of general diabetic conditions has become more efficient as indicated by the estimated declines in per unit health care costs.
Nadeem Rais, Akash Ved, Mohd. Shadab, Rizwan Ahmad and Mohammad Shahid
Taurine (2-aminoethane sulfonic acid; C2H7NO3S) is a nonprotein sulfur-containing β-amino acid present in nearly all mammalian tissues and the most ubiquitous free endogenous…
Abstract
Purpose
Taurine (2-aminoethane sulfonic acid; C2H7NO3S) is a nonprotein sulfur-containing β-amino acid present in nearly all mammalian tissues and the most ubiquitous free endogenous biomolecule in human cells. Taurine is commonly known as a conditionally essential amino acid because taurine is one of the few amino acids that are not incorporated in protein synthesis. The purpose of this study is to review the existing articles related to taurine and to give an account how useful is taurine to the different body systems. In this thorough overview, taurine is covered in terms of its essentiality, sources, advantages for neonates and the elderly, the effects of taurine deficiency, and the safety and toxicity of taurine supplements.
Design/methodology/approach
This is a narrative review into the subject matter. Published articles were searched on different portals like PubMed, EMBASE, Scopus, Google Scholar, PubChem etc. The authors also evaluated the availability of taurine in commercially available energy drinks.
Findings
This comprehensive review, presents the potential clinical benefits and functional properties of taurine as a conditionally essential amino acid. Energy drinks containing taurine (and their concentration) are also reported in this review.
Originality/value
This is the first data that the authors are aware of that shows taurine content in a variety of energy drinks on the market.
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Petra Kokko and Harri Laihonen
The article seeks to explain whether and how value-based healthcare principles lead to hybridization. The public management literature has been increasingly interested in hybrid…
Abstract
Purpose
The article seeks to explain whether and how value-based healthcare principles lead to hybridization. The public management literature has been increasingly interested in hybrid forms of governance and hybrid performance management, but empirical studies are still rare. Further, the article studies the design of performance management and accounting systems as healthcare organizations reorganize their care processes applying value-based healthcare principles.
Design/methodology/approach
This article first connects the theoretical discussions on value-based healthcare and performance management for hybrids. The conceptual understanding of performance management in hybrid healthcare uses a case study of a Finnish healthcare organization with documentary data and transcribed interviews with healthcare professionals from both the strategic and operative levels of healthcare.
Findings
The article illustrates and analyses how new policy-level objectives and principles of value-based healthcare led to hybridity in healthcare, manifest in mixed ownership of a particular care path and new forms of social and financial control. Further, the article provides empirical evidence of how increased hybridity necessitated new organizational modes and roles, new managerial tools for performance management and created a need to develop the capability to account and measure entire integrated care processes. Important enabling factors for the integration of care and hybrid performance management were commitment created in dialogue, voluntary-based trust and technology to generate factual shared information.
Practical implications
The study is informative for stakeholders, funders and managers of healthcare organizations, namely new knowledge for the discussion of hybrid governance in healthcare, including a critical account of the applicability and impact of a hybrid service model in healthcare management. Moreover, the article illustrates what needs to be reconsidered in performance management and accounting practices when reorganizing care processes according to the principles of value-based healthcare.
Originality/value
The article extends the analysis of performance management in hybrids and sheds new light on hybridization in healthcare. It also provides much-needed empirical evidence on the processes and practices of accounting and performance management after implementing a value-based healthcare strategy.
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