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Using technology assessment as the picture archiving and communication system spreads outside radiology to the enterprise

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JOURNAL OF DIGITAL IMAGING 2000年第2期13卷 114-116页

作者： Maliff, RP Launders, J ECRI Hlth Devices Grp Plymouth Meeting PA 19462 USA ECRI Hlth Syst Grp Plymouth Meeting PA 19462 USA

Picture archiving and communication systems (PACS) are being implemented within radiology departments, and many facilities are entering the next stage of PACS use by deploying PACS to departments outside of radiology and to other facilities located at a distance. Many PACS vendors and department administrators have based cost-justification analyses on the anticipated savings from expanding PACS to these areas. However, many of these cost-savings analyses can be highly suspect in their assumptions and findings. Technology assessment (TA) at the hospital/health system level is an organized, systematic approach to examining the efficacy of a technology in relation to the health system's mission and clinical needs. It can be an organized and unifying approach to aid in the distribution of limited capital resources. As extra-radiology PACS deployment is a costly endeavor, TA may be used to plan for PACS implementation throughout the enterprise. In many organizations, PACS is thought of as a radiology domain as its first uses were centered on this image-producing service. Now, as PACS technology spreads to other service areas, such as cardiology, dermatology, pathology, orthopedics, obstetrics, etc, the need to incorporate other viewpoints in a system-based PACS is necessary to avoid having independent PACS that may duplicate archives and may not communicate with each other. How to meet the diverse PACS needs of clinical services can be a challenging task;a TA program has been demonstrated to effectively handle the clinical needs, demands, and timeframes of PACS planning and support throughout hospitals and health systems. A hospital-based TA program can assist health care organizations to present PACS as a system-wide need and program rather than a radiology-based program gobbling up the capital budget. Submitting PACS to the TA review process can identify essential elements in planning and help avoid many of the pitfalls of PACS implementation and operations. Thorough c

关键词：费用节省/统计学和数值数据可行性研究医院间共用服务/经济学放射学信息系统/经济学技术评估生物医学/经济学人类

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Cost savings associated with changes in routine laboratory tests ordered for victims of trauma

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AMERICAN SURGEON 2000年第6期66卷 579-584页

作者： Jacobs, IA Kelly, K Valenziano, C Chevinsky, AH Pawar, J Jones, C Morristown Mem Hosp Dept Surg Div Trauma Surg Morristown NJ 07962 USA

Not all trauma victims evaluated by the trauma service require a full complement of laboratory tests upon admission. This study set out to determine the cost savings and safety of limited laboratory testing of trauma victims. Before 1998, our admission trauma protocol included 11 laboratory tests for all trauma victims. In 1998, we created two categories: Trauma Blue--severe injury likely (Glasgow Coma Score <13;systolic blood pressure <100 mm Hg at any time;significant head, chest, abdominal, or proximal long bone injury;or clinical suspicion of need for operative or intensive care unit management) and Trauma Yellow--severe injury unlikely. The triage decision was made by the team leader or attending physician. Trauma Blue laboratory tests included an arterial blood gas, blood alcohol, type and screen or crossmatch, and urine dipstick. All patients who did not meet Trauma Blue criteria were entered in the Trauma Yellow group. There were only two tests for the Trauma Yellow group, a venous blood gas and blood alcohol. All arterial and venous blood gases measured pH, pO(2), pCO(2,) HCO3, base deficit, hemoglobin, sodium, potassium, and ionized calcium. Other laboratory tests were done if requested by the trauma team leader or attending physician. All trauma admissions for a S-month period were entered into this prospective study. The admitting trauma surgeon was surveyed after each admission to evaluate any problems in patient care. The test group was compared with a historical control of 100 consecutive patients under the original laboratory trauma protocol. One hundred and forty-eight (148) patients were entered into the study. Average laboratory cost per patient was $29.82 less with the study protocol. No patient care problem was identified. A cost savings of $29.82 per patient or $20,000.00 a year was realized for our institution, with no change in the quality of patient care. Trauma protocols designed to reflect a patient's potential for serious injury can resul

关键词：临床方案费用节省/统计学和数值数据诊断试验常规/经济学诊断试验常规/利用新泽西创伤诊治中心/经济学创伤严重度指数伤病员分拣/经济学伤病员分拣/方法美国创伤和损伤/分类创伤和损伤/经济学人类

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Relation between length of hospital stay and costs of care for patients with community-acquired pneumonia

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AMERICAN JOURNAL OF MEDICINE 2000年第5期109卷 378-385页

作者： Fine, MJ Pratt, HM Obrosky, DS Lave, JR McIntosh, LJ Singer, DE Coley, CM Kapoor, WN Univ Pittsburgh Grad Sch Publ Hlth Div Gen Internal Med Dept Med Pittsburgh PA USA Univ Pittsburgh Grad Sch Publ Hlth Ctr Res Hlth Care Pittsburgh PA USA Univ Pittsburgh Grad Sch Publ Hlth Dept Hlth Serv Adm Pittsburgh PA USA Massachusetts Gen Hosp Div Gen Med Dept Med Boston MA 02114 USA Harvard Univ Sch Med Boston MA USA

PURPOSE: Patients with pneumonia often remain hospitalized after becoming clinically stable, without demonstrated benefits on outcome. The purposes of this study were to assess the relation between length of hospital stay and daily medical care costs and to estimate the potential cost savings associated with a reduced length of stay for patients with pneumonia. SUBJECTS AND METHODS: As part of a prospective study of adults hospitalized with community-acquired pneumonia at a community hospital and two university teaching hospitals, daily medical care costs were estimated by multiplying individual charges by department-specific cost-to-charge ratios obtained from each hospital's Medicare cost reports. RESULTS: The median total cost of hospitalization for all 982 inpatients was $5,942, with a median daily cost of $836, including $491 (59%) for room and $345 (41%) for non-room costs. Average daily non-room costs were 282% greater on the first hospital day, 59% greater on the second day, and 19% greater on the third day than the average daily cost throughout the hospitalization (all P < 0.05), and were 14% to 72% lower on the last 3 days of hospitalization. Average daily room costs remained relatively constant throughout the hospital stay, with the exception of the day of discharge. A projected mean savings of $680 was associated with a 1-day reduction in length of stay. CONCLUSIONS: Despite institutional differences in total costs, patterns of daily resource use throughout hospitalization were similar at all institutions. A 1-day reduction in length of stay might yield substantial cost-savings. (C) 2000 by Excerpta Medica, Inc.

关键词：波士顿队列研究社区获得性感染/经济学费用节省/统计学和数值数据医院费用/统计学和数值数据住院时间/经济学住院时间/统计学和数值数据多元分析新斯科舍宾夕法尼亚肺炎/经济学过程评价(卫生保健) 疾病严重程度指数成年人老年人女(雌)性人类男(雄)性中年人

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Determining cost savings from attempted cephalic version in an inner city delivering population

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Health Care Management Science 2000年第3期3卷 185-192页

作者： Adams, E. Kathleen Mauldin, Patrick D. Mauldin, Jill G. Mayberry, Robert M. Rollins School of Public Health Emory University Atlanta GA 30322 United States Medical University of South Carolina Charleston SC United States Medical Treatment Effectiveness Center Morehouse School of Medicine Atlanta GA United States

The use of external cephalic version (ECV) is increasingly seen as an important clinical management strategy for breech presentation infants. Currently, 75% of women with breech presentation at term undergo Cesarean delivery risking adverse outcomes and incurring higher costs. ECV, if successful, reduces the rate of breech presentation at delivery and the need for Cesarean delivery. Data from an inner-city population of delivering women were examined to determine the effectiveness of ECV among these minority, low income women. Hospital clinical and Medicaid claims data for 679 deliveries with breech presentation were studied. Decision tree analysis indicated ECV was successful for 48% of those attempted. Based on amounts billed Medicaid, attempting ECV reduced the use of resources by a little over $3,000 per delivery. Sensitivity analysis showed, however, that the savings may be as low as $906. Multivariate analysis confirmed the independent effect of attempting ECV on the probability of Cesarean delivery. © Baltzer Science Publishers BV.

关键词：臀先露费用节省/统计学和数值数据决策支持技术佐治亚医院市区/经济学 Medicaid/统计学和数值数据妇产科医院/经济学贫困市区人口倒转术胎位/经济学女(雌)性人类妊娠

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Potential savings from generic prescribing and generic substitution in South Africa

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HEALTH POLICY AND PLANNING 1996年第2期11卷 198-202页

作者： Karim, SSA Pillai, G ZiqubuPage, TT Cassimjee, MH Morar, MS MRC CTR EPIDEMIOL RES S AFRICADURBANSOUTH AFRICA UNIV DURBAN WESTVILLE DEPT PHARMACOLDURBAN 4000SOUTH AFRICA UNIV NATAL DEPT FAMILY MEDDURBAN 4001SOUTH AFRICA

Generic prescribing and generic substitution are mechanisms for reducing the cost Df drugs. The purpose of this study was to assess the extent to which generic prescribing by private medical practitioners and generic substitution by private pharmacists is practised in South Africa and to estimate the potential savings from these two practices. Prescriptions from 10 pharmacists were collected on four randomly selected days. Computer printouts of all the prescriptions dispensed on these four days together with the original doctor's prescription were priced using a commercially available pharmacy dispensing computer package. A total of 1570 prescriptions with a total number of 4086 items were reviewed. Of the total prescriptions, 45.7% had at least one item for which there was a generic equivalent. Of the 961 drugs which had generic equivalents, 202 (21%) were prescribed using the generic name of the drug. Only 0.3% of prescribers prohibited generic substitution. The cost of the prescription as dispensed was 1.4% (mean cost: R116.19 vs R117.84) below that of the original doctor's prescriptions, indicating the marginal benefit from the current low substitution rate of 13.9% by pharmacists. About 6.8% of the cost of the original doctor's prescriptions (mean cost: R117.84) could have been saved if total generic substitution (mean cost: R109.65) was practised. The cost of the prescriptions with only brand name items (mean cost: R120.49) would have been 9.9% higher than if generic drugs were used. Current restrictive prescribing and dispensing practices result in marginal cost savings from generic prescribing and generic substitution. Both these practices have a potential to reduce drug costs, if actively encouraged and practised to maximum capacity. It is noteworthy, however, that the potential savings from generic prescribing and substitution are at mast 9.9% in the absence of any changes in types of drugs prescribed.

关键词：费用节省/统计学和数值数据药费支出/统计学和数值数据药费支出/发展趋势药物通用名/经济学药学服务/经济学处方药物/经济学私人开业/经济学私营部门南非

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Constant observation practices in the general hospital setting -: A national survey

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PSYCHOSOMATICS 2000年第4期41卷 301-310页

作者： Worley, LLM Kunkel, EJS Gitlin, DF Menefee, LA Conway, G Univ Arkansas Med Sci Dept Psychiat Little Rock AR 72205 USA Thomas Jefferson Univ Dept Psychiat & Human Behav Philadelphia PA 19107 USA Univ Massachusetts Med Ctr Dept Psychiat Amherst MA 01003 USA

The authors conducted a national survey of 355 general medical/surgical hospitals to assess constant observation (CO) practices. The authors assessed overall use, expense, staffing patterns, funding strategies, and cost-saving interventions. Virtually all responding hospitals (N=102) reported using some form of CO. Several hospitals reported significant decreases in CO expenditures after the implementation of cost-saving interventions (the largest annual decrease reported was $340,000). Cost-saving interventions included utilizing consolidated bed spaces, relocating patients near nursing stations, placing at-risk patients in bed enclosure devices, and regularly assisting patients to the toilet. In addition, less costly personnel were hip-ed, and volunteers and/or patient family members provided CO (or were required to assist with the cost of CO). Finally, hospital staff were educated about the costs and the appropriate use of CO. They were also taught to recognize and effectively treat delirium.

关键词：费用节省/统计学和数值数据谵妄痴呆遗忘认知障碍/经济学医院费用/统计学和数值数据医院综合病人医疗护理计划/经济学病人医疗小组/经济学精神病科医院/经济学安全/经济学美国人类

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Financial modeling of extramural programs: do they generate net savings?

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Journal of dental education 1999年第12期63卷 890-895页

作者： Dodge, W.W. Hardigan, J. Comer, R.W. University of Texas San Antonio 78229-3900 USA.

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