Novel quality improvement method to reduce cost while improving the quality of patient care: retrospective observational study

2020 ◽  
Vol 29 (7) ◽  
pp. 586-594
Author(s):  
Kedar S Mate ◽  
Jeffrey Rakover ◽  
Kay Cordiner ◽  
Amy Noble ◽  
Noura Hassan
Keyword(s):  
Quality Improvement ◽  
Management Strategies ◽  
Scale Up ◽  
Primary Outcome Measure ◽  
Cost Of Care ◽  
Improve Efficiency ◽  
Management Board ◽  
Number Of Patients ◽  
Lean Accounting ◽  
The Cost

BackgroundHealthcare cost management strategies are limited in number and resource intensive. Budget constraints in the National Health Service Scotland (NHS Scotland) apply pressure on regional health boards to improve efficiency while preserving quality.MethodsWe developed a technical method to assist health systems to reduce operating costs, called continuous value management (CVM). Derived from lean accounting and employing quality improvement (QI) methods, the approach allows for management to reduce or repurpose resources to improve efficiency. The primary outcome measure was the cost per patient admitted to the ward in British pounds (£).InterventionsThe first step of CVM is developing a standard care model. Teams then track system performance weekly using a tool called the ‘box score’, and improve performance using QI methods with results displayed on a visual management board. A 29-bed inpatient respiratory ward in a mid-sized hospital in NHS Scotland pilot tested the method.ResultsWe included 5806 patients between October 2016 and May 2018. During the 18-month pilot, the ward realised a 21.8% reduction in cost per patient admitted to the ward (from an initial average level of £807.70 to £631.50 as a new average applying Shewhart control chart rules, p<0.0001), and agency nursing spend decreased by 30.8%. The ward realised a 28.9% increase in the number of patients admitted to the ward per week. Other quality measures (eg, staff satisfaction) were sustained or improved.ConclusionCVM methods reduced the cost of care while improving quality. Most of the reduction came by way of reduced bank nursing spend. Work is under way to further test CVM and understand leadership behaviours supporting scale-up.

scholarly journals Cost of care and support services for PLHA: Implications for the financial sustainability of nongovernmental organizations

2002 ◽  
Author(s):  
Keyword(s):  
Nongovernmental Organizations ◽  
Support Services ◽  
South India ◽  
Scale Up ◽  
Cost Of Care ◽  
People Living With Hiv ◽  
Indian States ◽  
Care And Support ◽  
The Cost ◽  
Hiv Aids

As HIV/AIDS prevalence increases, providers of care and support services will face greater demand for their services. The ability of nongovernmental organizations (NGOs) to help meet this increased demand will be influenced in part by their ability to control the cost of their services while generating sufficient revenue to meet expenses. The Y.R. Gaitonde Centre for AIDS Research and Education (YRG CARE) in Chennai, India, was one of the earliest providers of integrated care and support services in South India and currently serves clients from the four South Indian states. This brief highlights the key findings of a study that investigated the cost of People Living with HIV/AIDS (PLHA) services offered by YRG CARE. This research is part of a larger study conducted by YRG CARE and Horizons that examines the scale-up of care and support services in South India.

Care and Compensation for Civilian Victims of War

2021 ◽  
pp. 138-156
Author(s):  
Michael L. Gross
Keyword(s):  
Military Medicine ◽  
Cost Of Care ◽  
Medical Attention ◽  
Medical Necessity ◽  
Military Hospitals ◽  
Medical Need ◽  
Number Of Patients ◽  
The Cost ◽  
Military Status ◽  
Associative Duties

Lacking bed space, Coalition military hospitals in Iraq and Afghanistan declined to admit any civilian except those injured by multinational forces. There are, however, no firm moral grounds for granting collateral casualties a special right to medical attention. Military necessity justifies preferential care for civilians who can contribute to a counterinsurgency, not those suffering collateral damage. Money, not medicine, is a better vehicle to assuage resentment among wounded civilians. Considering the rights of compatriots, allies, civilians, and detainees, five ethical principles govern the distribution of medical care during war: military-medical necessity, associative duties, liability for collateral or accidental harm, beneficence, and urgent medical need. Judging by the number of patients each principle reaches, the cost of care, and the feasibility of implementation, necessity and associative duties best serve military medicine. Once patients assemble by identity and military status, urgent medical need governs care within each group.

Cost of care for adult patients with relapsed acute lymphoblastic leukemia (rALL) in Germany.

2017 ◽  
Vol 35 (15_suppl) ◽  
pp. e18504-e18504
Author(s):  
Yun Su ◽  
Sarah Schmitter ◽  
Ana Navarro ◽  
Lukas Mayerhoff ◽  
Sigurd Prieur ◽  
...  
Keyword(s):  
Lymphoblastic Leukemia ◽  
Cost Of Care ◽  
Adult Patients ◽  
Inpatient Cost ◽  
German Population ◽  
Cell Transplant ◽  
Term Survival ◽  
Number Of Patients ◽  
The Cost ◽  
The Impact

e18504 Background: Adult ALL is a rare but progressive frequently fatal disease. For those who survive and respond to initial therapy, many experience relapse. For relapse ALL (rALL), stem cell transplant (SCT) is potentially curative. This retrospective observational study investigates the cost of care and the impact of SCT on total cost for rALL. Methods: A representative sample of German claims data covering approximately 7 million of the German population was used to identify patients 18 years and older with a new diagnosis of ALL (ICD-10-GM code: C91.0*) between Jan 2011 and Dec 2015 who had a relapse after remission to initial treatment. Mean health care cost per patient per quarter were determined by whether or not SCT was received after relapse. Costs were from the perspective of German statutory health insurance and included prescription, outpatient and inpatient treatment costs. Results: Of the total 116 incident adult ALL patients identified, 29 (25%) were determined to have had a relapse, 11 underwent SCT after the relapse (38%). Patients with a SCT appear to incur higher cost than those without SCT in each of the quarters after relapse was diagnosed (Table), with the highest in the first quarter, but decreasing in subsequent quarters. Inpatient cost accounted for the majority of the cost for the first three quarters for both SCT and non-SCT patients (64% in Q2 to 86% in Q1). The number of patients in the SCT cohort remained relatively stable, while the non-SCT cohort had only half the patients left by the third quarter post relapse. Conclusions: Current results inform the magnitude of cost in Germany associated with adult patients with rALL with or without a SCT after relapse. It would be important to determine the magnitude of benefit such as long-term survival associated with SCT as well. The cost estimates provide a benchmark against which new treatment options for rALL can be compared. [Table: see text]

Health professionals donating work hours: an initiative for improving access to healthcare in Brazil: case study and initial results

2020 ◽  
Vol 6 (4) ◽  
pp. 177-183
Author(s):  
João Paulo Nogueira Ribeiro ◽  
Rachel Riera
Keyword(s):  
Low Income ◽  
Health Professionals ◽  
Physical Therapists ◽  
Healthcare Services ◽  
Access To Healthcare ◽  
Cost Of Care ◽  
Number Of Patients ◽  
Therapeutic Procedures ◽  
The Cost ◽  
Initial Results

BackgroundEven with a universal public health system, the Brazilian population faces inequalities on access to healthcare. Long queues for medical appointments, caused by lack of professionals, space and equipment, are barriers for those who cannot pay for treatments. However, health professionals working in the private sector may have free hours at their clinics which they can donate.ObjectivesWe report the implementation of a non-governmental initiative for connecting health professionals willing to volunteer and patients needing healthcare services, and present the initial results concerning access to healthcare.MethodsThe network ‘Horas da Vida’ was created in Brazil to connect health professionals and patients. We analysed the number of patients and professionals involved, specialties, visits and services provided, and economic values.ResultsIn 2016, 1748 professionals were involved with the network. 6967 services were provided (1831 consultations) to 1974 patients, most of whom were unemployed and with low income, and 20% were illiterate. Medical, dental, nutritional, physical therapy or psychological consults, simple therapeutic procedures, eyeglasses, and educational services were provided by psychologists (29%), dentists (6%), nutritionists (5%) and physical therapists (5%). Only 5% of physicians were general practitioners. We calculated the cost of care at R$985 979.21 in 2016 (or US$314 446.74 on 18 September 2017).ConclusionsThe Horas da Vida network made it easy to organise a schedule and identify free hours in the clinics that could be used for volunteering and for providing health assistance to a large number of socially deprived and economically vulnerable patients.

scholarly journals Physiotherapy management of low back pain - a review of surveys

2011 ◽  
Vol 67 (1) ◽  
Author(s):  
A. Basson
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Patient Outcomes ◽  
Best Practice ◽  
Management Strategies ◽  
Cost Of Care ◽  
Evidence Based ◽  
Low Back ◽  
The Cost ◽  
Improve Patient

Low back pain (LBP) is an increasingly debilitating and costly problem. One of the research focuses in LBP is an attempt to improve patient outcomes. It is believed that the promotion of evidence based practice (EBP) should improve patient outcomes and also reduce the cost of care. There seems to be a need to establish how physiotherapists manage LBP and whether management is in accordance with best practice based on published research evidence. The aim of this study was to determine what management strategies physiotherapists employ in the management of LBP by performing a review of the literature and to compare this with recent guidelines Fourteen studies were included for the review.  The treatments most frequently reported as being used for the management of LBP were education/ advice, exercise, spinal mobilisation and electrotherapy. Over a 14 year period there were no major changes in the way physiotherapists manage LBP. Physiotherapist use interventions that are evidence based as well as interventions with little evidence in the management of LBP.

scholarly journals Resourcing issues

2004 ◽  
Vol 151 (Suppl_2) ◽  
pp. T9-11 ◽  
Author(s):  
JJ Gagliardino
Keyword(s):  
Diabetes Care ◽  
Management Strategies ◽  
Cardiovascular Complications ◽  
Cost Of Care ◽  
Educational Approach ◽  
Community Healthcare ◽  
Care Givers ◽  
Education Of Patients ◽  
Chronic Progressive Disease ◽  
The Cost

Diabetes is a chronic, progressive disease and achieving appropriate control of glycaemia and the other associated cardiovascular risk factors is essential to prevent its long-term complications. Currently, recovery and rehabilitation from the cardiovascular complications of diabetes are the major focus of diabetes care rather than primary and secondary prevention of diabetes and its complications. This focus, coupled with limited funding and other resource issues, means that diabetes care and outcomes are generally suboptimal. More efficient and effective management strategies, primarily based upon a broad educational approach including both those with diabetes and their care-givers will be essential in reducing the cost of diabetes and diabetes-related complications. Continuous education of patients and providers increases the quality of care and improves clinical and metabolic outcomes as well as reducing the cost of care and optimising human and financial resources. Thus, education will be a key strategy in minimising the growing burden of diabetes on society. Making these changes will require the co-operation of patients, their families, the community, healthcare policy makers, national governments and the pharmaceutical industry. Medical schools must also place more emphasis on educating doctors about chronic disease management using not only recovery and rehabilitation, but also prevention strategies, emphasising the importance of helping patients to participate in the control of their disease.

Addressing on-farm management to enhance pasture productivity and persistence

2013 ◽  
pp. 241-244
Author(s):  
W.N. Reynolds
Keyword(s):  
Management Strategies ◽  
Dairy Farm ◽  
Stocking Rate ◽  
Pasture Management ◽  
Pasture Production ◽  
Operating Profit ◽  
The North ◽  
The Cost ◽  
On Farm ◽  
Attention To Detail

Following the 2007/08 drought, we experienced poor pasture production and persistence on our dairy farm in north Waikato, leading to decreased milksolids production and a greater reliance on bought-in feed. It is estimated that the cost of this to our farming operation was about $1300 per hectare per year in lost operating profit. While climate and black beetle were factors, they did not explain everything, and other factors were also involved. In the last 3 years we have changed our management strategies to better withstand dry summers, the catalyst for which was becoming the DairyNZ Pasture Improvement Focus Farm for the north Waikato. The major changes we made were to reduce stocking rate, actively manage pastures in summer to reduce over-grazing, and pay more attention to detail in our pasture renewal programme. To date the result has been a reduced need for pasture renewal, a lift in whole farm performance and increased profitability. Keywords: Focus farm, over-grazing, pasture management, pasture persistence, profitability

GSS 2011 Linked with TIFF: Exploring the Cost of Child Care in Canada and the Use of the Child Care Tax Benefit

2019 ◽  
Vol 12 (1) ◽  
pp. 81-103
Author(s):  
Leanne Findlay ◽  
Dafna Kohen
Keyword(s):  
Child Care ◽  
General Social Survey ◽  
Cost Of Care ◽  
Indigenous Identity ◽  
Social Survey ◽  
The Cost ◽  
Care Costs ◽  
Compare And Contrast ◽  
Employment Characteristics ◽  
Different Sources

Affordability of child care is fundamental to parents’, in particular, women’s decision to work. However, information on the cost of care in Canada is limited. The purpose of the current study was to examine the feasibility of using linked survey and administrative data to compare and contrast parent-reported child care costs based on two different sources of data. The linked file brings together data from the 2011 General Social Survey (GSS) and the annual tax files (TIFF) for the corresponding year (2010). Descriptive analyses were conducted to examine the socio-demographic and employment characteristics of respondents who reported using child care, and child care costs were compared. In 2011, parents who reported currently paying for child care (GSS) spent almost $6700 per year ($7,500 for children age 5 and under). According to the tax files, individuals claimed just over $3900 per year ($4,700). Approximately one in four individuals who reported child care costs on the GSS did not report any amount on their tax file; about four in ten who claimed child care on the tax file did not report any cost on the survey. Multivariate analyses suggested that individuals with a lower education, lower income, with Indigenous identity, and who were self-employed were less likely to make a tax claim despite reporting child care expenses on the GSS. Further examination of child care costs by province and by type of care are necessary, as is research to determine the most accurate way to measure and report child care costs.

Wastewater management strategies for the black sea coast of Turkey

1999 ◽  
Vol 39 (8) ◽  
pp. 169-176
Author(s):  
I. Ozturk ◽  
E. Yuksel ◽  
A. Tanik
Keyword(s):  
Black Sea ◽  
Management Strategy ◽  
Population Distribution ◽  
Management Strategies ◽  
The Black Sea ◽  
Wastewater Management ◽  
Black Sea Coast ◽  
The Cost ◽  
Solid Waste Landfills ◽  
Sea Coast

The Black Sea, surrounded by six riparian countries, is under the threat of severe pollution, giving rise to the need of taking precautions to protect it from further deterioration. In this paper, an effort putting forth a wastewater treatment and management strategy is outlined for the Black Sea coast of Turkey, including both the technical and financial aspects. The present situation of the coast in terms of land-based pollution and infrastructure is stated, followed by an applicable management strategy. The strategy developed for the coastal settlements involves various stagewise treatment schemes based on population distribution and densities along the coastline, and on the availability of land in a specified period of thirty years. Similar strategies are proposed for the control of pollution originating from industries, for those carried by rivers joining the sea, and for leachate of solid waste landfills. The cost estimations of various treatment schemes are also given in terms of population equivalents.

scholarly journals Surgical site infection metrics: Dissecting the differences between the National Health and Safety Network and the National Surgical Quality Improvement Program

2021 ◽  
Vol 1 (1) ◽  
Author(s):  
Alaia M. M. Christensen ◽  
Karen Dowler ◽  
Shira Doron
Keyword(s):  
Quality Improvement ◽  
Health And Safety ◽  
Surgical Site Infections ◽  
Cost Of Care ◽  
Quality Improvement Program ◽  
Surveillance Systems ◽  
Improvement Program ◽  
Surgical Quality ◽  
National Healthcare Safety Network ◽  
Hospital Acquired

Abstract Surgical site infections (SSIs) are associated with readmissions, reoperations, increased cost of care, and overall morbidity and mortality risk. The National Healthcare Safety Network (NHSN) and the National Surgical Quality Improvement Program (NSQIP) have developed an array of metrics to monitor hospital-acquired complications. The only metric collected by both is SSI, but performance as benchmarked against peer hospitals is often discordant between the 2 systems. In this commentary, we outline the differences between these 2 surveillance systems as they relate to this potential for discordance.

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