scholarly journals Value assessment frameworks: who is valuing the care in healthcare?

2021 ◽  
pp. medethics-2020-106503
Author(s):  
Jonathan Anthony Michaels
Keyword(s):  
New Technologies ◽  
Practical Implementation ◽  
Evidence Based ◽  
Value Assessment ◽  
Accountability For Reasonableness ◽  
Care Processes ◽  
Political Interests ◽  
Life Years ◽  
Decision Methods

Many healthcare agencies are producing evidence-based guidance and policy that may determine the availability of particular healthcare products and procedures, effectively rationing aspects of healthcare. They claim legitimacy for their decisions through reference to evidence-based scientific method and the implementation of just decision-making procedures, often citing the criteria of ‘accountability for reasonableness’; publicity, relevance, challenge and revision, and regulation. Central to most decision methods are estimates of gains in quality-adjusted life-years (QALY), a measure that combines the length and quality of survival. However, all agree that the QALY alone is not a sufficient measure of all relevant aspects of potential healthcare benefits, and a number of value assessment frameworks have been suggested. I argue that the practical implementation of these procedures has the potential to lead to a distorted assessment of value. Undue weight may be ascribed to certain attributes, particularly those that favour commercial or political interests, while other attributes that are highly valued by society, particularly those related to care processes, may be omitted or undervalued. This may be compounded by a lack of transparency to relevant stakeholders, resulting in an inability for them to participate in, or challenge, the decisions. The makes it likely that costly new technologies, for which inflated prices can be justified by the current value frameworks, are displacing aspects of healthcare that are highly valued by society.

scholarly journals An evidence-based, point-of-care tool to guide completion of asthma action plans in practice

2017 ◽  
Vol 49 (5) ◽  
pp. 1602238 ◽  
Author(s):  
Andrew Kouri ◽  
Louis-Philippe Boulet ◽  
Alan Kaplan ◽  
Samir Gupta
Keyword(s):  
Point Of Care ◽  
Healthcare Utilisation ◽  
Practical Implementation ◽  
Evidence Based ◽  
Action Plans ◽  
Dose Limits ◽  
Implementation Tool ◽  
Asthma Action Plans ◽  
Operational Guidance

Asthma action plans (AAPs) reduce healthcare utilisation, improve quality of life and are recommended across guidelines. However, fewer than 25% of patients receive an AAP, partly due to prescribers' inability to complete “yellow zone” instructions (how to intensify therapy for acute loss of control). We sought to review best evidence to develop a practical, evidence-based tool to facilitate yellow zone guidance in adults.We reviewed recent asthma guidelines and adult studies addressing acute loss of asthma control (January 2010 to March 2016). We developed evidence-based rules for yellow zone therapy and operational guidelines to maximise adherence and minimise errors.We reviewed three guidelines and 11 manuscripts (2486 abstracts screened). Recommendations were comparable but some areas lacked guidance. For 15/43 asthma regimens, the commonly recommended four- to five-fold yellow zone inhaled corticosteroid dose increase was problematic due to regulatory dose limits. We identified evidence-based alternatives for 8/15 regimens. Operational guidance included increasing to a maximum of four inhalations while maintaining baseline inhaler frequency and device in the yellow zone.We developed a practical implementation tool to facilitate AAP delivery at the point of care, addressing existing gaps and uncertainties. Our tool should be implemented as part of a multifaceted approach to augment AAP usage.

Databases, registries, and quality of care

2017 ◽  
Author(s):  
Nicolas Danchin ◽  
Fiona Ecarnot ◽  
François Schiele
Keyword(s):  
Clinical Trials ◽  
Quality Of Care ◽  
Evidence Based Medicine ◽  
Randomized Clinical Trials ◽  
Cardiac Care ◽  
Evidence Based ◽  
Care Processes ◽  
Based Medicine ◽  
Acute Cardiac Care

This chapter will describe what databases and registries can provide for clinicians and researchers. It will also describe the respective position of randomized clinical trials and databases/registries as complementary pillars of evidence-based medicine, and how they are of particular importance in the field of acute cardiac care. Finally, the importance of databases in quality of care processes will be discussed.

scholarly journals Cost-effectiveness of Initiating an Insulin Pump in T1D Adults Using Continuous Glucose Monitoring Compared with Multiple Daily Insulin Injections: The DIAMOND Randomized Trial

2018 ◽  
Vol 38 (8) ◽  
pp. 942-953 ◽  
Author(s):  
Wen Wan ◽  
M. Reza Skandari ◽  
Alexa Minc ◽  
Aviva G. Nathan ◽  
Parmida Zarei ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cost Effectiveness ◽  
Continuous Glucose Monitoring ◽  
New Technologies ◽  
Insulin Pump ◽  
Glucose Monitoring ◽  
Second Phase ◽  
Clinical Effects ◽  
Life Years

Background. The economic impact of both continuous glucose monitoring (CGM) and insulin pumps (continuous subcutaneous insulin infusion [CSII]) in type 1 diabetes (T1D) have been evaluated separately. However, the cost-effectiveness of adding CSII to existing CGM users has not yet been assessed. Objective. The aim of this study was to evaluate the societal cost-effectiveness of CSII versus continuing multiple daily injections (MDI) in adults with T1D already using CGM. Methods. In the second phase of the DIAMOND trial, 75 adults using CGM were randomized to either CGM+CSII or CGM+MDI (control) and surveyed at baseline and 28 weeks. We performed within-trial and lifetime cost-effectiveness analyses (CEAs) and estimated lifetime costs and quality-adjusted life-years (QALYs) via a modified Sheffield T1D model. Results. Within the trial, the CGM+CSII group had a significant reduction in quality of life from baseline (−0.02 ± 0.05 difference in difference [DiD]) compared with controls. Total per-person 28-week costs were $8,272 (CGM+CSII) versus $5,623 (CGM+MDI); the difference in costs was primarily attributable to pump use ($2,644). Pump users reduced insulin intake (−12.8 units DiD) but increased the use of daily number of test strips (+1.2 DiD). Pump users also increased time with glucose in range of 70 to 180 mg/dL but had a higher HbA1c (+0.13 DiD) and more nonsevere hypoglycemic events. In the lifetime CEA, CGM+CSII would increase total costs by $112,045 DiD, decrease QALYs by 0.71, and decrease life expectancy by 0.48 years. Conclusions. Based on this single trial, initiating an insulin pump in adults with T1D already using CGM was associated with higher costs and reduced quality of life. Additional evidence regarding the clinical effects of adopting combinations of new technologies from trials and real-world populations is needed to confirm these findings.

scholarly journals INTEGRATED TALENT MANAGEMENT - A CHALLENGE OR NECESSITY FOR PRESENT MANAGEMENT

2013 ◽  
Vol 6 (1) ◽  
pp. 4-6
Author(s):  
Dana Egerová
Keyword(s):  
Human Resources ◽  
Economic Performance ◽  
New Technologies ◽  
Knowledge Society ◽  
Talent Management ◽  
Business Environment ◽  
Human Resources Development ◽  
Practical Implementation ◽  
New Challenges

The current highly competitive and unstable business environment, the requirements of the knowledge society and the development of new technologies is a reality which presents new challenges directed at various areas of the society, including human resources, to organizations and their management. It is becoming increasingly evident that the quality of human capital and practical implementation of human resources development are ones of the decisive factors of organizations´ success and competitiveness and a key source that considerably determines the operation and economic performance of organizations.

Databases, registries, and quality of care

2015 ◽  
Author(s):  
Nicolas Danchin ◽  
Fiona Ecarnot ◽  
François Schiele
Keyword(s):  
Clinical Trials ◽  
Quality Of Care ◽  
Evidence Based Medicine ◽  
Randomized Clinical Trials ◽  
Cardiac Care ◽  
Evidence Based ◽  
Care Processes ◽  
Based Medicine ◽  
Acute Cardiac Care

This chapter will describe what databases and registries can provide for clinicians and researchers. It will also describe the respective position of randomized clinical trials and databases/registries as complementary pillars of evidence-based medicine, and how they are of particular importance in the field of acute cardiac care. Finally, the importance of databases in quality of care processes will be discussed.

Misophonia: An Evidence-Based Case Report

2020 ◽  
Vol 29 (4) ◽  
pp. 685-690
Author(s):  
C. S. Vanaja ◽  
Miriam Soni Abigail
Keyword(s):  
Quality Of Life ◽  
Case Report ◽  
Case History ◽  
Pure Tone ◽  
Physiological Responses ◽  
Evidence Based ◽  
Management Option ◽  
Pure Tone Audiogram

Purpose Misophonia is a sound tolerance disorder condition in certain sounds that trigger intense emotional or physiological responses. While some persons may experience misophonia, a few patients suffer from misophonia. However, there is a dearth of literature on audiological assessment and management of persons with misophonia. The purpose of this report is to discuss the assessment of misophonia and highlight the management option that helped a patient with misophonia. Method A case study of a 26-year-old woman with the complaint of decreased tolerance to specific sounds affecting quality of life is reported. Audiological assessment differentiated misophonia from hyperacusis. Management included retraining counseling as well as desensitization and habituation therapy based on the principles described by P. J. Jastreboff and Jastreboff (2014). A misophonia questionnaire was administered at regular intervals to monitor the effectiveness of therapy. Results A detailed case history and audiological evaluations including pure-tone audiogram and Johnson Hyperacusis Index revealed the presence of misophonia. The patient benefitted from intervention, and the scores of the misophonia questionnaire indicated a decrease in the severity of the problem. Conclusions It is important to differentially diagnose misophonia and hyperacusis in persons with sound tolerance disorders. Retraining counseling as well as desensitization and habituation therapy can help patients who suffer from misophonia.

Coaching Teachers to Enhance the Implementation Quality of Evidence-Based Programs

2013 ◽  
Author(s):  
Kimberly D. Becker ◽  
Dana Darney ◽  
Celene Domitrovich ◽  
Catherine Bradshaw ◽  
Nicholas S. Ialongo
Keyword(s):  
Evidence Based ◽  
Implementation Quality ◽  
Quality Of Evidence ◽  
Evidence Based Programs

The implementation of test control methods for the improvement of the quality content of high education in medical higher educational institution

2018 ◽  
Vol 22 (2) ◽  
pp. 357-360
Author(s):  
S. A. Kolodii ◽  
Yu. V. Kordon ◽  
O. A. Nazarchuk ◽  
N.I. Osadchuk
Keyword(s):  
New Technologies ◽  
Educational Institution ◽  
Scientific Information ◽  
Cognitive Activity ◽  
Pedagogical Training ◽  
Highly Skilled ◽  
Medical University ◽  
Independent Work ◽  
Test Control

The integration of Ukrainian system of Higher education into the European one accompanies by a transformation processes. The main goal of Higher school in our country is to prepare competitive specialists. The pedagogues of medical universities implement modern educational technologies with the use of analytically-searching work and scientific information. The implementation of new technologies of teaching is the important task of modernization of pedagogical system of mastering highly skilled specialists. The aim — to ground the implementation of test control for the estimation of quality of knowledge of future doctors. Gaining knowledge in microbiology is very necessary for future doctors to understand the principals of diagnostics and struggling infectious diseases. Knowledge in microbiology is basis for better understanding of clinical disciplines, as it assists logical perception of clinical data, influences on the forming clinical thought without which it is impossible to become a highly skilled specialist. The implementation of modern methods of studies, control, providing the increase of creative activity of students, forming and developing in them professional thought is one of the effective way of the improvement of quality of pedagogical training of highly skilled doctors. The experience of applying of the test control of knowledge in students in the medical university at classes of Microbiology, Virology and Immunology has been presented in the manuscript. The use of different types of test control has been proved to be one of the effective methods for determining the level of knowledge among students. Test control promotes the activation of cognitive activity, forms students’ skills of independent work, develops their logical thinking. Test control of obtained knowledge should be used in conjunction with other methods of studying the subject. The analysis of the results of the writing of the KROK-1 qualification exam by the students of the stomatological department has been conducted. The use of different methods of estimation of control of knowledge is necessary for its improvement. The study of microbiology is the important base of forming fundamental knowledge in students. Therefore, test control in a complex with other pedagogical methods can be used as one of the important and optimal methods to improve estimation of the basic level of students’ knowledge.

Drug Utilization Studies – An Overview

2010 ◽  
Vol 3 (1) ◽  
pp. 803-810 ◽  
Author(s):  
Shalini S ◽  
Ravichandran V ◽  
Saraswathi R ◽  
BK Mohanty ◽  
Dhanaraj S K
Keyword(s):  
Drug Utilization ◽  
Evidence Based ◽  
Future Trends ◽  
Medical Prescription ◽  
Drug Usage ◽  
Current State ◽  
Patterns Of Use ◽  
Drug Utilization Studies ◽  
Drug Expenditures

 Aspire of the Drug Utilization Studies (DUS) is to appraise factors related to the prescribing, dispensing, administering and taking of medication, and it’s associated. Since the middle of twentieth century, interest in DUS has been escalating, first for market-only purposes, then for appraising the quality of medical prescription and comparing patterns of use of specific drugs. The scope of DUS is to evaluate the current state and future trends of drug usage, to estimate roughly disease pervasiveness, drug expenditures, aptness of prescriptions and adherence to evidence-based recommendations. The increasing magnitude of DUS as a valuable investigation resource in pharmacoepidemiology has been bridging it with other health allied areas, such as public health, rational use of drug, evidence based drug use, pharmacovigilance, pharmacoeconomics, eco-pharmacovigilance and pharmacogenetics.

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