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Support and supervision in palliative care research

PALLIATIVE MEDICINE 2000年第5期14卷 441-446页

作者： Clark, D Ingleton, C Seymour, J Univ Sheffield Sch Nursing & Midwifery Sheffield S10 2JF S Yorkshire England Univ Sheffield Dept Palliat Med Sheffield S10 2JF S Yorkshire England

Discusses the impact of palliative care research on researchers. Elements that need to be considered when thinking about research support; Natural history of the research project; Ethical considerations; Data collecti... 详细信息

关键词：数据收集伦理学卫生服务研究/方法卫生服务研究/标准职业间关系姑息疗法研究设计/标准研究设计/发展趋势研究人员/心理学人类

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A comparison of four approaches for measuring clinician time use

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HEALTH POLICY AND PLANNING 1999年第4期14卷 374-381页

作者： Bratt, JH Foreit, J Chen, PL West, C Janowitz, B De Vargas, T Family Hlth Int Hlth Serv Res Res Triangle Pk NC 27709 USA Populat Council FRONTIERS Project New York NY 10021 USA

Concern about rapid growth in demand for reproductive health services in developing countries has created interest in productivity and costs of existing programmes. Staff costs usually constitute the largest share of total service costs, meriting special effort to ensure that they are measured accurately. Several techniques have been used in the literature to analyze staff activity, but these techniques have not been validated. This paper reports on a study conducted in three Ecuadoran clinics. The study uses an observational time-motion (TM) technique as a benchmark, and compares results from three other techniques to those obtained using TM. None of the alternative techniques produces estimates that agreed with TM estimates;deviations from TM are particularly large for non-contact time, defined as clinician activities carried out when clients are not present. Implications of these findings for productivity and cost studies are discussed, and possible avenues for future research are proposed.

关键词：厄瓜多尔计划生育服务卫生服务研究/方法多元分析医师诊疗模式作业完成和分析

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National Health Accounts development: lessons from Thailand

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HEALTH POLICY AND PLANNING 1999年第4期14卷 342-353页

作者： Tangcharoensathien, V Laixuthai, A Vasavit, J Tantigate, NA Prajuabmoh-Ruffolo, W Vimolkit, D Lertiendumrong, J Hlth Syst Res Inst Nonthaburi 11000 Thailand Chulalongkorn Univ Bangkok 10330 Thailand

National Health Accounts (NHA) are an important tool to demonstrate how a country's health resources are spent, on what services, and who pays for them. NHA are used by policy-makers for monitoring health expenditure patterns;policy instruments to re-orientate the pattern can then be further introduced. The National Economic and Social Development Board (NESDB) of Thailand produces aggregate health expenditure data but its estimation methods have several limitations. This has led to the research and development of an NHA prototype in 1994, through an agreed definition of health expenditure and methodology, in consultation with peer and other stakeholders. This is an initiative by local researchers without external support, with an emphasis on putting the system into place. It involves two steps: firstly, the flow of funds from ultimate sources of finance to financing agencies;and secondly, the use of funds by financing agencies. Five ultimate sources and 12 financing agencies (seven public and five private) were identified. Use of consumption expenditures was listed under four main categories and 32 sub-categories. Using 1994 figures, we estimated a total health expenditure of 128 305.11 million Baht;84.07% consumption and 15.93% capital formation. Of total consumption expenditure, 36.14% was spent on purchasing care from public providers, with 32.35% on private providers, 5.93% on administration and 9.65% on all other public health programmes. Public sources of finance were responsible for 48.79% and private 51.21% of the total 1994 health expenditure. Total health expenditure accounted for 3.56% of GDP (consumption expenditure at 3.00% of GDP and capital formation at 0.57% of GDP). The NESDB consumption expenditure estimate in 1994 was 180 516 million Baht or 5.01% of GDP, of which private sources were dominant (82.17%) and public sources played a minor role (17.83%). The discrepancy of consumption expenditure between the two estimates is 2.01% of GDP There is als

关键词：数据收集/方法卫生保健公平提供卫生经费支出/统计学和数值数据健康计划/方法卫生服务研究/方法泰国人类

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Probabilistic linkage of computerized ambulance and inpatient hospital discharge records: A potential tool for evaluation of emergency medical services

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ANNALS OF EMERGENCY MEDICINE 2001年第6期37卷 616-626页

作者： Dean, JM Vernon, DD Cook, L Nechodom, P Reading, J Suruda, A Univ Utah Sch Med Dept Pediat Intermt Injury Control Res Ctr Salt Lake City UT USA Univ Utah Sch Med Dept Family & Prevent Med Intermt Injury Control Res Ctr Salt Lake City UT USA

Study objectives: Emergency medical services (EMS) is an important part of the health care system. The effect of EMS on morbidity, mortality, and costs of illness is difficult to evaluate because hospital information is not available in out-of-hospital databases. We used probabilistic linkage to create such a database from ambulance and inpatient data and demonstrate the potential for linkage to facilitate evaluation of EMS responses resulting in hospital admission. Methods: Statewide ambulance and inpatient hospital discharge records were available for 1994 through 1946. Ambulance records indicating admission to the emergency department or hospital (165,649 records) were linked to inpatient hospital records indicating emergency admission (146,292 records) by using probabilistic linkage. Out-of-hospital data (dispatch code, treatments rendered, and ages), linkage rates, and inpatient data (discharge status, charges, length of stay, and payer category) were analyzed. Results: We linked 24,299 (14.7%) ambulance events to inpatient hospital discharges. If we had used exact linkage methods, we would have only linked 14,621 record pairs, a loss of nearly 40%. linkage rates were relatively constant between years (approximately 15%) but differed by ambulance dispatch codes. Out-of-hospital dispatch codes with high linkage rates included breathing problems (22.6%), chest pain (21.5%), diabetic problems (16.9%), drowning incidents (14.9%), falls (19.2%), strokes (32.8%), and unconsciousness or fainting episodes (16.1%). Linkage to the hospital record provided access to hospital outcome data. Inpatient mortality was 6.8%. Survivors were discharged home (60.7%), transferred to other acute-care facilities (3.6%) or intermediate-care facilities (23.3%), or discharged with home health care provision (4.9%). The median length of stay was 3 days, and median charges were $6,620;total inpatient charges were $286,737,067. Conclusion: Probabilistic linkage enables ambulance and hospita

关键词：救护车/组织和管理数据库管理系统可行性研究卫生服务研究/方法医院收费/统计学和数值数据医院死亡率信息系统/组织和管理住院病人/统计学和数值数据保险健康/统计学和数值数据住院时间/统计学和数值数据病案连锁/方法病案系统计算机化/组织和管理年患病率结果评价(卫生保健) 病人出院/统计学和数值数据病人转诊/统计学和数值数据概率存活率分析犹他/流行病学青少年成年人老年人老年人 80以上儿童儿童学龄前女(雌)性人类婴儿男(雄)性中年人

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The cost-effectiveness of forty health interventions in Guinea

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HEALTH POLICY AND PLANNING 1998年第3期13卷 249-262页

作者： Jha, P Bangoura, O Ranson, K World Bank Human Dev Network Washington DC 20433 USA London Sch Hyg & Trop Med London WC1 England

Addressing diseases of a high burden with the most cost-effective interventions could do much to reduce disease in the population. We conducted a cost-effectiveness analysis of 40 health interventions in Guinea, a low-income country in sub-Saharan Africa, using local data. Interventions were selected from treatment protocols at health centres, first referral hospitals and national programmes in Guinea, based upon consultation with health care providers and government plans. For each intervention, we calculated the costs (comprising labour, drugs, supplies, equipment, and overhead) in relation to years of life saved, discounted at 3%. The results show that the per capita costs and effectiveness of any intervention vary considerably. Average costs show no clear pattern by level of care, but effectiveness is generally highest for curative hospital interventions. Several interventions have a cost-effectiveness of US$100 per year of life saved (LYS) or less, and address more than 5% of total years of life lost. These include health centre interventions such as: treatment of childhood pneumonia ($3/LYS);rehydration therapy for diarrhoea ($7/LYS);integrated management of childhood pneumonia, malaria and diarrhoea ($8/LYS);short-course treatment of tuberculosis ($12/LYS);treatment of childhood malaria ($13/LYS), and childhood vaccination ($25/LYS). Outreach programmes for impregnated bed nets against malaria cost $43/LYS. Maternal and perinatal diseases, have slightly less cost-effective interventions: integrated family planning, prenatal and delivery care at health centres ($109/LYS) or outreach programmes to provide prenatal and delivery care ($283/LYS). A minimum package of health services would cost approximately $13 per capita, and would address a large proportion (69%) of major causes of premature mortality. This minimum package would cost about three times the current public spending on health, suggesting that health spending needs to rise to achieve good health outc

关键词：费用效益分析发展中国家几内亚卫生保健费用/统计学和数值数据卫生服务研究/方法结果评价(卫生保健)/经济学结果评价(卫生保健)/统计学和数值数据预防卫生服务/经济学方案评价质量校正寿命生命价值人类

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Primary care research: ends and means

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FAMILY PRACTICE 2000年第1期17卷 1-4页

作者： Jones, R Guys Kings & St Thomas Sch Med London SE11 6SP England

In the UK, research in primary care has become a priority for support within the National Health Service and other funding agencies, such as the Medical Research Council. This has resulted in the creation of a range of interventions aimed at contributing to research activity, capacity and utilization in primary care. Reflects on the appropriateness and effectiveness of these interventions and considers what the desired outcomes (ends) of primary care research are, and how these can best be achieved (means). (Quotes from original text)

关键词：预测大不列颠卫生服务研究/分类卫生服务研究/方法卫生服务研究/发展趋势初级卫生保健/标准专业业务卫生保健质量人类

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The use of conjoint analysis to study patient satisfaction

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EVALUATION & THE HEALTH PROFESSIONS 1999年第3期22卷 371-378页

作者： Markham, FW Diamond, JJ Hermansen, CL Thomas Jefferson Univ Jefferson Med Coll Dept Family Med Philadelphia PA 19107 USA

Previous research has identified aspects of the outpatient interactions between patients and physicians that are important for patient satisfaction. III this study, conjoint analysis was used to determine the relative importance of these factors to patients. This study found the perceived skill of the physician to he the most important factor and waiting time in the office the least important. The use of cojoint analysis should help both patients and physicians to maximize patient satisfaction while minimizing costs as much as possible. (C) 1999 Sage Publications, Inc.

关键词：临床工作能力卫生服务研究/方法多元分析病人满意度医生病人关系心理测定学问卷调查随机分配时间因素成年人人类

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Intervention research in rational use of drugs: a review

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HEALTH POLICY AND PLANNING 1999年第2期14卷 89-102页

作者： Le Grand, A Van Hogerzeil, H Haaijer-Ruskamp, FM World Hlth Org Action Programme Essential Drugs Geneva Switzerland Univ Groningen Dept Clin Pharmacol WHO Collaborating Ctr Teaching & Training NL-9700 AB Groningen Netherlands

Many studies have been done to document drug use patterns, and indicate that overprescribing, multi-drug prescribing, misuse of drugs, use of unnecessary expensive drugs and overuse of antibiotics and injections are the most common problems of irrational drug use by prescribers as well as consumers. Improving drug use would have important financial and public health benefits. Many efforts have been undertaken to improve drug use, but few evaluations have been done in this field. This article provides an overview of 50 intervention studies to improve drug use in developing countries. It highlights what type of interventions exist and what is known about their impact. It reveals that commonly used interventions, such as an essential drug list and standard treatment guidelines, have rarely been systematically evaluated so far. The majority of intervention studies are focused on prescribers in a public health setting, while irrational use of drugs is also widespread in the private sector. Furthermore, the magnitude of inappropriate drug use at community level is often overlooked and few interventions address drug use from a consumer's perspective. More research on different types of intervention strategies in various health care settings is needed to draw conclusions on the effectiveness of a specific intervention strategy. Also more research is needed on socio-cultural factors influencing the impact of drug use interventions, particularly from a user perspective. To enhance evaluative research, more technical support will be needed for researchers in developing countries. The design of available studies from developing countries is generally weak, only six of the 50 studies included in this overview were randomized controlled studies. In order to provide technical support and coordination of future intervention research the establishment of an international resource centre for drug use intervention research is recommended.

关键词：发展中国家药费支出药物利用评审/方法教育医学继续处方集卫生服务研究/方法干预性研究人类

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A framework for evaluating underutilization of health care services

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AMERICAN JOURNAL OF MEDICAL QUALITY 1999年第2期14卷 89-97页

作者： Fetterolf, DE Highmark Inc Pittsburgh PA 15222 USA

Underutilization is becoming increasingly recognized as an area of importance in managed care, where aggressive measures to control overutilization are creating concern among the general public. The author sought solid definition of underutilization and methods for its evaluation in the medical literature but was impressed at the small number of peer reviewed articles on the subject. A review of key issues is discussed, including a number of methods a health plan may use to approach the identification of underutilization within its domain. Methods include the use of "gold standard" population health requirements;statistically defined underutilization;second-order, combined variables;and socially defined underutilization. Sample statistics identified within the author's plan are identified, and recommendations for their implementation and use are made.

关键词：坚持准则卫生服务易得程度卫生服务滥用/统计学和数值数据卫生服务研究/方法管理医疗规划/利用质量指标卫生保健转诊和会诊/统计学和数值数据美国利用情况审核/方法人类

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Sustainability of health care: a framework for analysis

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HEALTH POLICY AND PLANNING 1998年第3期13卷 287-295页

作者： Olsen, IT DiS Ctr Partnership Dev N-0319 Oslo Norway

This paper introduces a conceptual framework which can be used to study the sustainability of health services in developing countries. A health service is considered sustainable when operated by an organizational system with the long-term ability to mobilize and allocate sufficient resources for activities that meet individual or public health needs. The framework includes three clusters: (1) contextual factors, which outline the task and general environment of the services;(2) an activity profile, which describes the services delivered and the activities carried out to deliver them;and (3) organizational capacity, which shows the carrying ability (capability) of the organization in broad terms. In this framework, health care provision is seen as an open system model where five main factors determine how inputs are converted to outputs, linking them through feedback loops. These factors are aims, technology, structure, culture and process. The framework has proven useful in analyzing factors critical to sustainability, and in describing structures and processes both in basic public services and in private not-for-profit services. It should also be tested on more complex systems, such as national health care.

关键词：卫生保健提供/组织和管理发展中国家卫生保健公平提供卫生服务研究/方法模型组织管理私营部门/组织和管理过程评价(卫生保健) 公共卫生管理社会价值人类

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