A Framework for Assessing the Performance of Integrated Health Delivery Systems

1997 ◽  
Vol 10 (1) ◽  
pp. 11-18 ◽  
Author(s):  
Sandra G. Leggat ◽  
Peggy Leatt
Keyword(s):  
Health Care ◽  
Health Care System ◽  
The United States ◽  
Delivery Systems ◽  
Health Delivery ◽  
Integrated Health ◽  
Integrated Delivery ◽  
The Impact ◽  
Care System ◽  
Health Delivery Systems

Competing demands for resources within the health care system require health care providers to ensure the most effective and efficient use of resources. The evidence from the United States, the United Kingdom and other jurisdictions suggests that integrated health delivery systems (IDS) may be a cost-effective way to meet the health care needs of a population. This article introduces a framework for use in monitoring and evaluating the performance of an integrated delivery system. The establishment of a consistently used evaluation framework for integrated delivery systems will provide the government, governing bodies and other evaluators with an effective assessment tool that will enable greater understanding of the impact of the IDS on the health care system. It will also provide information to enable ongoing performance improvements within the system.

Book Reviews: Coddington et al. - The Crisis in Health Care: Costs, Choices, and StrategiesDean C. Coddington, David J. Keen, Keith D. Moore, and Richard L. Clarke San Francisco: Jossey-Bass, 1991, 303 pp. US$30.95 cloth. ISBN 1-55542-273-X. Jossey-Bass Publishers, 350 Sansome St., San Francisco, CA 94104, USA.

1992 ◽  
Vol 11 (2) ◽  
pp. 274-275
Author(s):  
Andrea L. Bonnicksen
Keyword(s):  
Health Care ◽  
San Francisco ◽  
Health Care System ◽  
The United States ◽  
Economic Research ◽  
Present System ◽  
Cost Shifting ◽  
Hospital Administrators ◽  
The Impact ◽  
Care System

PrécisThe authors assume that costs can no longer be contained in the United States health care system and that the present system cannot be sustained beyond the near future. Three of the authors are affiliated with an applied economic research and consulting firm, and the fourth is president of the Healthcare Financial Management Association. They are trained in business and city planning. The bibliography lists articles from such journals as Hospitals, Business & Health, Business Insurance, and Medical Economics.The book is directed to members of hospital governing boards and other hospital administrators, but it will be of interest to students of health policy. Part I highlights tensions between what the authors call the worlds of doctors and hospital administrators struggling to survive, on the one hand, and health care planners worried about spiraling costs on the other. Part II contains five chapters that suggest reasons for growing costs and that criticize cost shifting as a remedy.In Part III the authors evaluate alternative health care systems by presenting four future scenarios: incremental change, universal access, consumer choice model, and single payer system. In these chapters they also approach the fundamental purpose of the book—to “help physicians, hospitals, and health plans take the next steps to position themselves for the future.” While not highly analytical, the book is a readable and thoughtful supplement to more abstract critiques of the impact of today's health care system on distributive justice.

Governing Integrated Health Delivery Systems: Meeting Accountability Requirements

1997 ◽  
Vol 10 (4) ◽  
pp. 12-18 ◽  
Author(s):  
Peggy Leatt ◽  
Sandra G. Leggatt
Keyword(s):  
United States ◽  
Health Care Systems ◽  
Target Population ◽  
The United States ◽  
Delivery Systems ◽  
Financing System ◽  
Health Delivery ◽  
Integrated Health ◽  
Care Systems ◽  
Health Delivery Systems

Many Canadian provincial governments are exploring methods to increase the integration of health services in an effort to improve the care provided, while maintaining or reducing the costs. Integrated health delivery systems are being implemented in the United States, Britain and other European countries. Such systems aim to provide a full continuum of care to a defined target population under a financing system of capitation. This article explores the issues associated with the governance accountabilities of an IDS. A review of potential governance models is completed, and the factors that influence the choice of a governance model for an integrated delivery system are presented. In 1987, Ewell identified governing boards as the weakest link in the integrated health care systems of the United States. It is suggested that early attention to governance in the development of IDS models in Canada may improve the effectiveness of these systems.

scholarly journals Effect of a Health Care System Respiratory Fluoroquinolone Restriction Program To Alter Utilization and Impact Rates of Clostridium difficile Infection

2017 ◽  
Vol 61 (6) ◽  
Author(s):  
Katherine M. Shea ◽  
Athena L. V. Hobbs ◽  
Theresa C. Jaso ◽  
Jack D. Bissett ◽  
Christopher M. Cruz ◽  
...  
Keyword(s):  
Health Care ◽  
Clostridium Difficile ◽  
Health Care System ◽  
Acquisition Cost ◽  
The United States ◽  
Content Type ◽  
Days Of Therapy ◽  
Segmented Regression Analysis ◽  
The Impact ◽  
Care System

ABSTRACT Fluoroquinolones are one of the most commonly prescribed antibiotic classes in the United States despite their association with adverse consequences, including Clostridium difficile infection (CDI). We sought to evaluate the impact of a health care system antimicrobial stewardship-initiated respiratory fluoroquinolone restriction program on utilization, appropriateness of quinolone-based therapy based on institutional guidelines, and CDI rates. After implementation, respiratory fluoroquinolone utilization decreased from a monthly mean and standard deviation (SD) of 41.0 (SD = 4.4) days of therapy (DOT) per 1,000 patient days (PD) preintervention to 21.5 (SD = 6.4) DOT/1,000 PD and 4.8 (SD = 3.6) DOT/1,000 PD posteducation and postrestriction, respectively. Using segmented regression analysis, both education (14.5 DOT/1,000 PD per month decrease; P = 0.023) and restriction (24.5 DOT/1,000 PD per month decrease; P < 0.0001) were associated with decreased utilization. In addition, the CDI rates decreased significantly (P = 0.044) from preintervention using education (3.43 cases/10,000 PD) and restriction (2.2 cases/10,000 PD). Mean monthly CDI cases/10,000 PD decreased from 4.0 (SD = 2.1) preintervention to 2.2 (SD = 1.35) postrestriction. A significant increase in appropriate respiratory fluoroquinolone use occurred postrestriction versus preintervention in patients administered at least one dose (74/130 [57%] versus 74/232 [32%]; P < 0.001), as well as in those receiving two or more doses (47/65 [72%] versus 67/191 [35%]; P < 0.001). A significant reduction in the annual acquisition cost of moxifloxacin, the formulary respiratory fluoroquinolone, was observed postrestriction compared to preintervention within the health care system ($123,882 versus $12,273; P = 0.002). Implementation of a stewardship-initiated respiratory fluoroquinolone restriction program can increase appropriate use while reducing overall utilization, acquisition cost, and CDI rates within a health care system.

scholarly journals The Evolving Relationships Between Hospital, Physician and Patient in Modern American Healthcare

2012 ◽  
Vol 3 (1) ◽  
pp. 150-158
Author(s):  
C B Garner ◽  
D McCabe
Keyword(s):  
United States ◽  
Health Care ◽  
Health Care System ◽  
The United States ◽  
Hospital Physician ◽  
American Health Care System ◽  
The Past ◽  
American Health Care ◽  
The Impact ◽  
Care System

This article explores the ways in which health care has evolved over the past few years for patients, doctors and hospitals in the United States, and the impact these changes have made on modern American health care. As the amount of money the nation spends on health care continues to increase at alarming rates, patients, doctors, and hospitals all appear to have greater struggles than before.This inherent disconnection between the changes in American health care system and the satisfaction of patients and providers leaves much to be desired and considered. Before a solution can be found, however, we must first understand the problem.

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