Picture archiving and communications system (PACS) in the context of an outpatient trauma care center asks for a high level of interaction between information systems to guarantee rapid image acquisition and distribut...
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Picture archiving and communications system (PACS) in the context of an outpatient trauma care center asks for a high level of interaction between information systems to guarantee rapid image acquisition and distribution to the surgeon. During installation of the Innsbruck PACS, special aspects of traumatology had to be realized, such as imaging of unconscious patients without identification, and transferred to the electronic environment. Even with up-to-date PACS hardware and software, special solutions had to be developed in-house to tailor the PACS/hospital information system (HIS)/radiology information system (RIS) interface to the needs of radiologic and clinical users, An ongoing workflow evaluation is needed to realize the needs of radiolgists and clinicians. These needs have to be realized within a commercially available PACS, whereby full integration of information systems may sometimes only be achieved by special in-house solutions. Copyright (C) 1999 by W.B. Saunders Company.
Outsourcing of diabetes disease state management services by MCOs is a good thing for enrollees with diabetes. It is a good mechanism for MCOs that are striving to cut the costs of diabetes care, and it is a trend tha...
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Outsourcing of diabetes disease state management services by MCOs is a good thing for enrollees with diabetes. It is a good mechanism for MCOs that are striving to cut the costs of diabetes care, and it is a trend that the authors expect to see continue in an accelerated way, given the new diagnostic guidelines released by the American Diabetes Association and the epidemic of diabetes among older persons. Through a partnership with a quality, freestanding, outpatient diabetes disease state management center staffed by CDEs, MCOs with a vision can expect to profit now and pay less later for devastating, expensive diabetes complications that lead to increased hospitalizations.
We studied all patients attending a free-standing minor accident and treatment service (MATS) run by emergency nurse practitioners (ENPs). In a six-month period, 5563 patients were seen in the MATS, of whom 2843 (51%)...
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We studied all patients attending a free-standing minor accident and treatment service (MATS) run by emergency nurse practitioners (ENPs). In a six-month period, 5563 patients were seen in the MATS, of whom 2843 (51%) were new attenders. A teleconsultation was carried out with 150 of these patients (2.7% of all cases). The most common reason (39%) was to discuss a radiograph with an accident and emergency consultant. The accuracy of the telemedicine-assisted radiographic diagnosis was checked subsequently by a review panel. The ENPs' working diagnoses (made by viewing the films) had a sensitivity of 90% and a specificity of 96%;this was improved by telemedicine assistance to 97% and 99%, respectively. The telemedicine patients were also surveyed several months after being seen in the MATS;their replies indicated that the telemedicine diagnoses had been correct.
We investigated whether new patients attending a neurological outpatient clinic could be safely managed by neurologists at a distance, using a video-link. In Northern Ireland, a video-link, transmitting at 384 kbit/s,...
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We investigated whether new patients attending a neurological outpatient clinic could be safely managed by neurologists at a distance, using a video-link. In Northern Ireland, a video-link, transmitting at 384 kbit/s, was set up between a neurological centre and a small rural hospital 140 km away. Twenty-five unselected patients who had been referred by their family doctor were assessed by a neurologist using the telemedicine link and then immediately by another neurologist face to face. Examiners were blinded to the results of each other's assessment. In 24 cases the diagnoses made after the telemedicine and face-to-face examinations were identical. There were minor differences between the type and number of investigations requested, and the requirements for treatment and follow-up between the two groups. Disposal method was the same in 21 of the cases. No major organizational difficulties were encountered during the study. The study showed that neurologists can deliver outpatient neurological care to distant patients using telemedicine. This has the potential to allow access to assessment for the large number of neurological outpatients who might otherwise be denied it.
Background: Same-day cancellation of appointments and nonattendance by patients can disrupt management of certain aspects of medical delivery and lead to inefficient allocation of resources and lost revenue. The frequ...
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Background: Same-day cancellation of appointments and nonattendance by patients can disrupt management of certain aspects of medical delivery and lead to inefficient allocation of resources and lost revenue. The frequency of cancellation and nonattendance at dermatology clinics has not been well documented. Objective: We measured same-day cancellation and nonattendance in a university dermatology clinic. Methods: We tabulated clinic attendees, same-day cancellations, and nonattendance for a 6-month period. We examined distribution by gender, type of payer, and clinic visit type (initial or follow-up). Results: Total same-day cancellation rate was 8.3%. Female patients canceled more frequently than male patients (9.2% vs 7.3%, P =.02). Cancellation rates were similar for initial and follow-up visits. The nonattendance rate was 17% with the highest rates found in state-supported categories (26%) and the lowest in commercial insurance programs (13%). Nonattendance rates did not vary significantly by gender or visit type. Conclusion: Same-day cancellation and clinic nonattendance is a significant factor in the efficient fiscally sound management of a busy dermatology clinic. The risk of nonattendance is assumed by physicians and seems to be correlated with payer type.
Many rape crisis centers (RCCs) that were founded as autonomous organizations have affiliated with other organizations. The relationship of affiliation type and effectiveness is examined in a sample of 25 RCCs in Flor...
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Many rape crisis centers (RCCs) that were founded as autonomous organizations have affiliated with other organizations. The relationship of affiliation type and effectiveness is examined in a sample of 25 RCCs in Florida. Effectiveness is defined in terms of range of services for rape victims and involvement in rape prevention (social change) activities. The data show that 23 RCCs are affiliated with six types of organizations and two are free-standing. Each affiliation type has advantages and disadvantages but, overall, free-standing RCCs appear to be most effective and RCCs affiliated with community mental health centers, least effective. Of the seven types, free-standing agencies are most involved in rape prevention activities aimed at social change.
Patient education is widely regarded as an essential component of chronic disease care and effective health promotion. Nevertheless, the patient education process is seldom the subject of systematic investigation. In ...
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Patient education is widely regarded as an essential component of chronic disease care and effective health promotion. Nevertheless, the patient education process is seldom the subject of systematic investigation. In a previous study we determined that only a minimal amount of patients' time was devoted to education in a multidisciplinary diabetes clinic. The present study was designed to assess whether organizational manipulations would influence the delivery of patient education. Nurses' responsibility for management of patient flow was reduced, and an education checklist was included in the medical record. These simple modifications of clinic operation to increase the availability of professional time for patient education and to stimulate educational interactions were successful in significantly increasing patient education time. Time spent in assessing patient need increased by about one half (P less than 0.05) and in instruction by about two thirds (P less than 0.05). The process of patient education can be facilitated at low cost to the facility through targeted attention to organizational issues other than providers' knowledge or interest.
Traditional evaluation of health care quality usually involves the measurement of the structure, process, and outcome of care. Most quality improvement programs involve a cycle that includes a setting of goals, a meas...
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Traditional evaluation of health care quality usually involves the measurement of the structure, process, and outcome of care. Most quality improvement programs involve a cycle that includes a setting of goals, a measurement of either process or outcomes, and a real-time or retrospective feedback of the results of data measurement. Benchmarking, a well-known efficient business technology, can lead to practice innovations necessary to survive in an environment that has a need for decreasing cost and increasing quality. The purpose of this article is to present a novel use of benchmarking in managed ambulatory behavioral health care and its application in a model collaborative outcome management project at more than 16 sites and nine states in the United States.
With more than 5 million patient visits annually, certified nurse-midwives (CNMs) substantially contribute to women's health care in the United States. The objective of this study was to describe ambulatory visits...
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With more than 5 million patient visits annually, certified nurse-midwives (CNMs) substantially contribute to women's health care in the United States. The objective of this study was to describe ambulatory visits and practices of CNMs, and compare the ln with those of obstetrician-gynecologists (OB/ GYNs), Sources of population-based data used to compare characteristics of provider visits were three national surveys of CNMs and two National Ambulatory Medical Care Surveys of physicians. When a subset of 4,305 visits to CNMs in 1991 and 1992 were compared to 5,473 visits to OB/GYNs in similar office-based ambulatory care settings in 1989 and 1990, it was found that a larger proportion of CNM visits were made by women who were publicly insured and below age 25. The majority of visits to CNMs were for maternity care;the majority of visits to OB/GYNs were for gynecologic and/or family planning concerns. Face-to-face visit time was longer for CNMs, and involved more client education or counseling. This population-based comparison suggests that CNMs and OB/GYNs provide ambulatory care for women with diverse demographic characteristics and differing clinical service needs. Enhancing collaborative practice could improve health care access for women, which would be especially beneficial for those who are underserved and vulnerable.(C) 2000 by the American College of Nurse-Midwives.
Aim: We examined the cost effectiveness of a single consultation strategy to manage patients referred with TIA or stroke to our cerebrovascular disease (CVD) clinic, where all relevant investigations (blood tests, CT ...
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Aim: We examined the cost effectiveness of a single consultation strategy to manage patients referred with TIA or stroke to our cerebrovascular disease (CVD) clinic, where all relevant investigations (blood tests, CT brain scan and carotid Dopplers) were obtained prior to the clinic appointment. Design: Retrospective study of patients referred to the CVD clinic at St George's Hospital, London between October 1995 and 1996. Results: Of 211 new patients seen in the clinic, 73% had CVD;146 (68%) patients had imaging studies prior to clinic attendance. Of these, 132 (90%) were managed with a single consultation, This strategy cost pound5,700 less than if these patients had been followed up. Conclusion: Performing all relevant investigations prior to clinic attendance allowed a fully informed discussion with the patient at a single consultation and was cost effective.
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