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1 – 10 of over 12000Physician profiling is the comparison of physician practice patterns to determine the existence and effects of significant differences in outcomes. To optimize care quality, these…
Abstract
Physician profiling is the comparison of physician practice patterns to determine the existence and effects of significant differences in outcomes. To optimize care quality, these comparisons can be used to influence provider behavior through awareness when outcomes are poor or do not warrant provider expenditures. To maximize the value of such a technique, the underlying bases for comparison and the uses of derived data must be understood. Several factors must be considered or controlled for when determining comparable providers. Additionally, the worth or significance of findings must also be understood. This paper seeks to provide information in these two areas for the benefit of those responsible for managing care at all levels.
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Mathew Mackenzie, Iain Carpenter and Kathy Kotiadis
This paper demonstrates that three intermediate care services in Shepway, East Kent each cater for distinct patient groups, and that data from a single assessment process (SAP…
Abstract
This paper demonstrates that three intermediate care services in Shepway, East Kent each cater for distinct patient groups, and that data from a single assessment process (SAP) tool can be used to differentiate between them. By applying statistical techniques, inferences can be made about the likelihood of admission to a particular service, given specific health characteristics. In conclusion, we highlight the utility of standardised assessment as a means of providing data for audit and planning, and stress the importance of the SAP as a means of developing care services.
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This paper seeks to present an analysis of the literature examining objective information concerning the subject of customer service, as it applies to the current medical…
Abstract
Purpose
This paper seeks to present an analysis of the literature examining objective information concerning the subject of customer service, as it applies to the current medical practice. Hopefully, this information will be synthesized to generate a cogent approach to correlate customer service with quality.
Design/methodology/approach
Articles were obtained by an English language search of MEDLINE from January 1976 to July 2005. This computerized search was supplemented with literature from the author's personal collection of peer‐reviewed articles on customer service in a medical setting. This information was presented in a qualitative fashion.
Findings
There is a significant lack of objective data correlating customer service objectives, patient satisfaction and quality of care. Patients present predominantly for the convenience of emergency department care. Specifics of satisfaction are directed to the timing, and amount of “caring”. Demographic correlates including symptom presentation, practice style, location and physician issues directly impact on satisfaction. It is most helpful to develop a productive plan for the “difficult patient”, emphasizing communication and empathy. Profiling of the customer satisfaction experience is best accomplished by examining the specifics of satisfaction, nature of the ED patient, demographic profile, symptom presentation and physician interventions emphasizing communication – especially with the difficult patient.
Originality/value
The current emergency medicine customer service dilemmas are a complex interaction of both patient and physician factors specifically targeting both efficiency and patient satisfaction. Awareness of these issues particular to the emergency patient can help to maximize efficiency, minimize subsequent medicolegal risk and improve patient care if a tailored management plan is formulated.
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Noor Fadzlina Mohd Fadhil, Say Yen Teoh, Leslie W. Young and Nilmini Wickramasinghe
This study investigated two key aspects: (1) how a hospital bundles limited resources for preventive care performance and (2) how to develop IS capabilities to enhance preventive…
Abstract
Purpose
This study investigated two key aspects: (1) how a hospital bundles limited resources for preventive care performance and (2) how to develop IS capabilities to enhance preventive care performance.
Design/methodology/approach
A case study method was adopted to examine how a hospital integrates its limited resources which leads to the need for resource bundles and an understanding of IS capabilities development to understand how they contribute to the delivery of preventive care in a Malaysian hospital.
Findings
This research proposes a comprehensive framework outlining resource-bundling and IS capabilities development to improve preventive care.
Research limitations/implications
We acknowledge that the problem of transferring and generalizing results has been a common criticism of a single case study. However, our objective was to enhance the reader’s understanding by including compelling, detailed narratives demonstrating how our research results offer practical examples that can be generalized theoretically. The findings also apply to similar-sized public hospitals in Malaysia and other developing countries, facing challenges like resource constraints, HIS adoption levels, healthcare workforce shortages, cultural and linguistic diversity, bureaucratic hurdles, and specific patient demographics and health issues. Further, lessons from this context can be usefully applied to non-healthcare service sector domains.
Practical implications
This study provides a succinct strategy for enhancing preventive care in Malaysian public hospitals, focusing on system integration and alignment with hospital strategy, workforce diversity through recruitment and mentorship, and continuous training for health equity and inclusivity. This approach aims to improve resource efficiency, communication, cultural competence, and healthcare outcomes.
Social implications
Efficiently using limited resources through HIS investment is essential to improve preventive care and reduce chronic diseases, which cause approximately nine million deaths annually in Southeast Asia, according to WHO. This issue has significantly impacted the socioeconomic development of developing countries.
Originality/value
This research refines resource orchestration theory with new mechanisms for resource mobilization, extends IS literature by identifying how strategic bundling forms specialized healthcare IS capabilities, enriches preventive care literature through actionable resource-bundling activities, and adds to HIS literature by advocating for an integrated, preventive care focus from the alignment of HIS design, people and institutional policies to address concerns raised by other research regarding the utilization of HIS in improving the quality of preventive care.
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Public reports of provider-specific patient outcomes aim to help consumers select suppliers of medical services. Yet, in an environment of rapidly changing medical technology and…
Abstract
Public reports of provider-specific patient outcomes aim to help consumers select suppliers of medical services. Yet, in an environment of rapidly changing medical technology and increasingly heterogeneous patient populations, and because they necessarily reflect the experience of other patients who received care in the past, such reports may be of limited value in helping patients forecast the probability of an adverse outcome for each provider they are considering. I propose that providers underwrite insurance policies that promptly pay patients a predetermined sum after an adverse outcome. Patients can use such outcome warranties to infer quality differences among providers easily and reliably. In addition, outcome warranties efficiently reward both providers and patients for reducing the risk of adverse outcomes and thereby improve the safety and affordability of health care. As such, outcome warranties help advance four important goals of health care management: reduction of financial risk, recruitment and retention of physicians, remediation of adverse outcomes, and raising the provider's reputation.
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Prince Chikwere and Reginald Adjetey Annan
– The purpose of this paper was to review evidence spanning the relation of dietary habits and other lifestyles to the lipid profile of type 2 diabetes patients.
Abstract
Purpose
The purpose of this paper was to review evidence spanning the relation of dietary habits and other lifestyles to the lipid profile of type 2 diabetes patients.
Design/methodology/approach
Search was done in PubMed, Biomed, Cochrane and Nutrition and Metabolism databases from 20 to 29 June 2013 for studies published on dietary intakes and lifestyle effect on lipid profile of type 2 diabetes patients.
Findings
A total of 54 studies met the inclusion criteria for this review. These included observational, randomized control trials, prospective, cross-sectional and retrospective studies. Studies obtained covered macronutrients, micronutrients, dietary pattern, specific foods and lifestyle (alcohol intake, smoking, physical activity level and fasting).
Research limitations/implications
The review did not consider unpublished articles/findings, and only studies in the English language and on humans were considered.
Practical implications
The results of the review evidenced limited data on the lifestyle pattern of type 2 diabetes patients.
Social implications
Dietary habits and other lifestyle patterns for a good lipid profile among type 2 diabetes patients have not been established.
Originality/value
The review demonstrates the need for studies in dietary pattern and other lifestyle patterns in relation to lipid profile of type 2 diabetes patients.
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Roman Mennicken, Ludwig Kuntz and Christoph Schwierz
Hospital managers are confronted with decisions that have to account for multiple objectives, which may be in conflict with regard to efficiency and quality of care. In empirical…
Abstract
Purpose
Hospital managers are confronted with decisions that have to account for multiple objectives, which may be in conflict with regard to efficiency and quality of care. In empirical studies occupancy and staffing ratios as well as in‐hospital mortality are frequently used measures for efficiency and quality‐of‐care, respectively. Efficiency and quality measures vary on a daily basis. However, most empirical studies fail to take this variation into account, especially because data of daily staffing levels are lacking. The paper seeks to exploit the notion that staffing levels are planned according to expected occupancy levels, i.e. estimated daily occupancy levels account for unobserved daily staffing levels.
Design/methodology/approach
Using administrative data from 2004 for a sample of 62 departments in 33 German hospitals, the relation between daily occupancy levels and in‐hospital mortality count on the department level is analyzed. In an OLS‐framework the paper estimates daily occupancy level for all departments and then uses the predicted occupancy levels in a zero‐inflated Poisson (ZIP) regression framework to explain in‐hospital mortality count.
Findings
The results show a potential trade‐off relation between predicted occupancy rates and mortality. More specifically, the paper finds that the trade‐off relation is less pronounced in hospitals with a higher number of available staff per bed.
Originality/value
First, the paper shows evidence for a negative trade‐off between measures of managerial and medical performance on a day‐to‐day basis. Second, interactions between single measures of efficiency are modeled, namely predicted occupancy rate and staff per bed ratios, and policy implications are developed. Third, first empirical results in this respect using German data are presented.
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Matthew J. Chinman, Janis Symanski‐Tondora, Avon Johnson and Larry Davidson
This article describes a quality assurance effort aimed at defining the characteristics of the patient population of the Connecticut Mental Health Center, a state‐funded agency…
Abstract
This article describes a quality assurance effort aimed at defining the characteristics of the patient population of the Connecticut Mental Health Center, a state‐funded agency that provides comprehensive clinical and rehabilitative services to persons with mental illness. Also described is how this information guided management decisions in both caseload distribution and clinical service development. This “Patient Profile Project” was informed by research principles which view evaluation as continual, rather than terminal activity that involves key stakeholders from all levels within the mental health system of care and makes maximum use of data in ongoing performance improvement initiatives. The service‐need index that the project produced represents our first efforts to accurately capture service need and use it in clinical decision making. This review of the Connecticut Mental Health Center Patient Profile Project illustrates the utility of a continuous evaluation system in promoting improvements in a large mental health treatment system.
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Haiyan Qu, Elena A. Platonova, Karen Norman Kennedy and Richard M. Shewchuk
The aim of this study is to examine patient satisfaction with non‐physician staff as related to patient demographics, satisfaction with physician, and intentions to recommend…
Abstract
Purpose
The aim of this study is to examine patient satisfaction with non‐physician staff as related to patient demographics, satisfaction with physician, and intentions to recommend their physicians to others.
Design/methodology/approach
A survey was conducted at two internal medicine primary care clinics affiliated with a major university health system. A latent class analysis was used to detect patient subpopulations based on profiles of response for five satisfaction‐with‐staff indicators.
Findings
The response rate was 86.46 percent (479 of 554). Analyses revealed four patient subpopulation segments. Segment I (n=241) patients uniformly indicated a high level of satisfaction across the five satisfaction‐with‐staff indicators. These patients tended to be older and less educated, and have lower incomes relative to patients in other segments. Patients in Segment II (n=83) expressed satisfaction with staff caring and need accommodation, but dissatisfaction with access to their physicians. Patients in Segment III (n=51) indicated high levels of satisfaction with access and low levels of satisfaction with staff caring and need accommodation. Segment IV (n=104) patients uniformly expressed low levels of satisfaction across all indicators and generally were younger and more educated, as well as had higher incomes than other patients.
Originality/value
Patients have different expectations from their non‐physician staff, e.g. younger, more affluent, and educated patients expressed dissatisfaction with staff. This suggests that non‐physician staff should provide extra/further responsiveness to have these patients' needs met. Generally, approaches that are differentially targeted to specific patient subgroups are likely to be more efficient and patient‐oriented than undifferentiated approaches.
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Rodney Lambert, Woody Caan and Andrew McVicar
Current treatment guidelines for anxiety disorders, including panic disorder (PD), recommend either medication or cognitive behavioural therapy (CBT). There is currently a call…
Abstract
Current treatment guidelines for anxiety disorders, including panic disorder (PD), recommend either medication or cognitive behavioural therapy (CBT). There is currently a call through the Layard Report for significant investment to increase the availability of CBT resources. However, there are reported limitations to both medication and CBT in the treatment of anxiety, and it appears prudent to consider additional methods of treatment that may offer effective interventions. One such intervention is based around the evidence of altered sensitivity within a number of physiological body systems in anxiety patients (particularly those with PD), all of which are influenced in their function by habitual lifestyle behaviours. A randomised controlled trial compared a 16‐week occupational therapy‐led lifestyle intervention and routine general practice (GP) care for PD. At 20 weeks, 14 symptoms with ‘moderate’ to ‘very severe’ ratings were assessed in 36 GP and 31 lifestyle‐intervention patients. Composite symptom profiles, similar at baseline, were produced. The GP intervention produced modest improvements in most symptoms. The lifestyle intervention overall produced greater symptomatic relief (Wilcoxon signed ranks test, P= 0.008). The physiological and cognitive symptom profile also changed more with lifestyle intervention. Occupational therapists have developed their interventions based on their understanding of everyday occupation. Habitual lifestyle behaviours are characterised as being recurrent elements of everyday occupation and are, therefore, legitimate targets for occupational therapy interventions. They provide a vehicle through which to encourage patients to regain understanding and control of their own anxiety symptoms.
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