A Probabilistic Method for Computing Quantitative Risk Indexes from Medical Injuries Compensation Claims

2013 ◽  
Vol 52 (05) ◽  
pp. 374-381
Author(s):  
S. Dalle Carbonare ◽  
F. Folli ◽  
E. Patrini ◽  
P. Giudici ◽  
R. Bellazzi
Keyword(s):  
Health Care ◽  
Risk Management ◽  
Adverse Events ◽  
Health Care Services ◽  
Care Delivery ◽  
Probabilistic Method ◽  
Parametric Modeling ◽  
Risk Level ◽  
Loss Distribution ◽  
Compensation Claims

SummaryBackground: The increasing demand of health care services and the complexity of health care delivery require Health Care Organizations (HCOs) to approach clinical risk management through proper methods and tools. An important aspect of risk management is to exploit the analysis of medical injuries compensation claims in order to reduce adverse events and, at the same time, to optimize the costs of health insurance policies.Objectives: This work provides a probabilistic method to estimate the risk level of a HCO by computing quantitative risk indexes from medical injury compensation claims.Methods: Our method is based on the estimate of a loss probability distribution from compensation claims data through para -metric and non-parametric modeling and Monte Carlo simulations. The loss distribution can be estimated both on the whole dataset and, thanks to the application of a Bayesian hierarchical model, on stratified data. The approach allows to quantitatively assessing the risk structure of the HCO by analyzing the loss distribution and deriving its expected value and percentiles.Results: We applied the proposed method to 206 cases of injuries with compensation requests collected from 1999 to the first se -mester of 2007 by the HCO of Lodi, in the Northern part of Italy. We computed the risk indexes taking into account the different clinical departments and the different hospitals involved.Conclusions: The approach proved to be useful to understand the HCO risk structure in terms of frequency, severity, expected and unexpected loss related to adverse events.

A Scoping Review of Telehealth-Assisted Case Management for Chronic Illnesses

2021 ◽  
pp. 019394592110089
Author(s):  
Jee Young Joo ◽  
Megan F. Liu
Keyword(s):  
Health Care ◽  
Case Management ◽  
Scoping Review ◽  
Access To Health Care ◽  
Health Care Services ◽  
Care Delivery ◽  
Management Practice ◽  
Empirical Studies ◽  
Chronic Illnesses ◽  
Future Research

This scoping review aimed to examine telehealth-assisted case management for chronic illnesses and assess its overall impact on health care delivery. Guided by the PRISMA statement, this review included 36 empirical studies published between 2011 and 2020. This study identified three weaknesses and four strengths of telehealth-assisted case management. While the weaknesses were negative feelings about telehealth, challenges faced by patients in learning and using telehealth devices, and increased workload for case managers, the strengths included efficient and timely care, increased access to health care services, support for patients’ satisfaction, and cost savings. Future research can be designed and conducted for overcoming the weaknesses of telehealth-assisted case management. Additionally, the strengths identified by this review need to be translated from research into case management practice for chronic illness care. This review not only describes the value of such care strategy, but also provides implications for future nursing practice and research.

scholarly journals Analysis of Facilitators and Barriers to the Delivery of Routine Care during the COVID-19 Global Pandemic: A Systematic Review

Healthcare ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 528
Author(s):  
Cristian Lieneck ◽  
Brooke Herzog ◽  
Raven Krips
Keyword(s):  
Systematic Review ◽  
Health Care ◽  
Health Care Services ◽  
Care Delivery ◽  
Routine Care ◽  
Future Research ◽  
Healthcare Organizations ◽  
Care Services ◽  
Global Pandemic ◽  
Facilitators And Barriers

The delivery of routine health care during the COVID-19 global pandemic continues to be challenged as public health guidelines and other local/regional/state and other policies are enforced to help prevent the spread of the virus. The objective of this systematic review is to identify the facilitators and barriers affecting the delivery of routine health care services during the pandemic to provide a framework for future research. In total, 32 articles were identified for common themes surrounding facilitators of routine care during COVID-19. Identified constructed in the literature include enhanced education initiatives for parents/patients regarding routine vaccinations, an importance of routine vaccinations as compared to the risk of COVID-19 infection, an enhanced use of telehealth resources (including diagnostic imagery) and identified patient throughput/PPE initiatives. Reviewers identified the following barriers to the delivery of routine care: conservation of medical providers and PPE for non-routine (acute) care delivery needs, specific routine care services incongruent the telehealth care delivery methods, and job-loss/food insecurity. Review results can assist healthcare organizations with process-related challenges related to current and/or future delivery of routine care and support future research initiatives as the global pandemic continues.

Revising the ERDs for the 21st Century

2021 ◽  
Vol 46 (8) ◽  
pp. 1-2
Author(s):  
John F. Brehany ◽  
Keyword(s):  
United States ◽  
Health Care ◽  
21St Century ◽  
Health Care Services ◽  
Care Delivery ◽  
The United States ◽  
Care Services ◽  
Moral Tradition ◽  
Modern Health Care ◽  
Catholic Health Care

Since their inception in 1948, The Ethical and Religious Directives for Catholic Health Care Services (ERDs) have guided Catholic health care ministries in the United States, aiding in the application of Catholic moral tradition to modern health care delivery. The ERDs have undergone two major revisions in that time, with about twenty years separating each revision. The first came in 1971 and the second came twenty-six years ago, in 1995. As such, a third major revision is due and will likely be undertaken soon.

Perceptions of Health Education of Selected Health and Social Service Providers in the Bahamas

1982 ◽  
Vol 3 (3) ◽  
pp. 279-290
Author(s):  
Audrey Marie Deveaux ◽  
William A. Darity
Keyword(s):  
Health Care ◽  
Health Education ◽  
Social Service ◽  
Health Care Services ◽  
Service Providers ◽  
Care Delivery ◽  
Future Research ◽  
The Bahamas ◽  
Social Service Providers ◽  
Education And Health

Health education is a new component of the health care delivery system in the Bahamas. In the past, confusion and uncertainty was expressed regarding the contribution of health education to the health care services. The intention of this study was to investigate the perceptions of selected health and social service providers to health problems, their most likely solutions, and to health education and health education related issues in the Bahamas. A questionnaire was either mailed or hand delivered to 412 selected health and social service providers in New Providence and the Family Islands in the Bahamas. Of these 127 (31%) usable questionnaires were returned. A discussion of the study findings, study limitations, implications for health education and suggestions for future research are presented. The survey results showed that a majority of respondents indicated consistent support for health education and health education related issues. This support was evident even when responses were crosstabulated with such variables as age, profession, and years of experience in present occupation.

When Clock Time Governs Interaction: How Time Influences Health Professionals’ Intersectoral Collaboration

2018 ◽  
Vol 28 (13) ◽  
pp. 2059-2070 ◽  
Author(s):  
Anne Bendix Andersen ◽  
Kirsten Beedholm ◽  
Raymond Kolbæk ◽  
Kirsten Frederiksen
Keyword(s):  
Health Care ◽  
Elderly Patients ◽  
Health Care Delivery ◽  
Health Professionals ◽  
Health Care Services ◽  
Care Delivery ◽  
Intersectoral Collaboration ◽  
Clock Time ◽  
Care Services ◽  
Patient Pathways

When setting up patient pathways that cross health care sectors, professionals in emergency units strive to fulfill system requirements by creating efficient patient pathways that comply with standards for length of stay. We conducted an ethnographic field study, focusing on health professionals’ collaboration, of 10 elderly patients with chronic illnesses, following them from discharge to their home or other places where they received health care services. We found that clock time not only governed the professionals’ ways of collaborating, but acceleration of patient pathways also became an overall goal in health care delivery. Professionals’ efforts to save time came to represent a “monetary value,” leading to speedier planning of patient pathways and consequent risks of disregarding important issues when treating and caring for elderly patients. We suggest that such issues are significant to the future planning and improvement of patient pathways that involve elderly citizens who are in need of intersectoral health care delivery.

Risky Business: Proposed Reform of the Antitrust Laws As Applied to Health Care Provider Networks

1998 ◽  
Vol 24 (1) ◽  
pp. 59-87
Author(s):  
Natalie Marjancik
Keyword(s):  
Health Care ◽  
Health Care Provider ◽  
Health Care Providers ◽  
Care Provider ◽  
Health Care Services ◽  
Care Delivery ◽  
Antitrust Enforcement ◽  
Care Providers ◽  
Antitrust Laws ◽  
Provider Networks

Because the health care industry comprises over thirteen percent of the American economy, law enforcers increasingly apply antitrust law to all aspects of health care delivery and financing. Through antitrust enforcement, consumers receive the benefits of lower health care costs and improved health care services. To achieve further cost savings, health care providers are forming, as well as joining, many different types of provider network joint ventures. Providers form networks, expect ing “them to generate efficiencies, reduce excess capacity, improve utilization, permit greater specialization and enhance quality.” However, because they organize competing physicians and enable them to collaborate on prices and set fee schedules, provider networks raise serious antitrust concerns. Consequently, the federal government and courts are increasingly focusing their antitrust enforcement efforts on the formation and anticompetitive activities of provider networks.In Part I, this Note addresses the degree to which network providers must be economically and financially integrated to legally collaborate and set prices. Part II briefly explains the procedures one may use to enforce the federal antitrust laws. Following this explanation of antitrust enforcement procedures, Part III discusses the relevant statutory and case law applicable to health care provider networks.

iKure Techsoft: Providing Technology Enabled Affordable Health Care in Rural India

2018 ◽  
Vol 22 (02) ◽  
pp. 385-411
Author(s):  
Atanu Chaudhuri ◽  
Venkatramanaiah Saddikutti ◽  
Thim Prætorius
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Health Workers ◽  
Care Delivery ◽  
Rural India ◽  
Medical Team ◽  
Hub And Spoke ◽  
Care Services ◽  
Primary Health ◽  
Care Delivery Model

iKure Techsoft was established in 2010 with the main objective to provide affordable and high quality primary health care to the rural population in India and to build a sustainable for-profit business model. To that end, iKure’s cloud based, and patent pending, Wireless Health Incident Monitoring System (WHIMS) technology along with their hub-and-spoke operating model are central, but also essential to exploit and explore further if iKure is to scale-up. iKure provides primary health care services through three hub clinics and 28 rural health centres (RHCs). Each hub clinic employs between one and up to six medical teams (each consisting of 1 doctor, 1 nurse, 1 paramedic and 2 health workers stationed at the hub) & 1 mobile medical team (1 doctor, 1 paramedic, 2 health workers) for catering to the RHCs). Each medical team manages six RHCs. Paramount in iKure’s health care delivery model is their self-developed software called WHIMS, which is a cloud-based award-winning application that runs on low internet bandwidths. WHIMS allow for (a) centralized monitoring of key metrics such as doctor’s attendance, treatment prescribed, patient record management, pharmacy stock management, and (b) supports effective communication, integration and contact that connects RHCs with hub clinics, but also city-based multi-specialty hospitals with whom iKure has formal tie-ups. iKure, moreover, also works extensively with Non-Governmental Organizations (NGOs). Collaboration with local NGOs in the target areas helps to build trust with the rural villagers and their local knowledge and access helps to assess service demand. NGOs also provide the necessary local logistical support and basic infrastructure in the rural areas where iKure works. Moreover, collaboration, for example, with corporate organizations are central as they contribute with part of their corporate social responsibility (CSR) funds to support iKure initiatives. At present, iKure is planning to add diagnostic services to its six hub clinics as well as expand its presence in other parts of West Bengal and other states across India. Expanding rural health care services even with the technology support of WHIMS is challenging because, for example, health is a very local issue (due to, among other things, local customs and languages) and it requires investing significant amount of time and resources to build relationship with the rural people as well as collaborators such as NGOs and corporates. The accompanying case describes iKure’s journey so far in terms of understanding: (a) the state of health care and government health care services provided in rural India, (b) the establishment and evolution of the iKure business and health care model, (c) iKure’s operations and health care delivery model including the WHIMS technology solution and hub-and-spoke set-up of operations, (d) the collaborative model which relies on NGOs and private corporates, and (e) finally iKure’s challenges related to scaling-up.

Light Still Shines in the Darkness

2010 ◽  
Vol 28 (4) ◽  
pp. 266-274 ◽  
Author(s):  
Ted Karpf ◽  
J. Todd Ferguson ◽  
Robin Y. Swift
Keyword(s):  
Health Care ◽  
Health Care Services ◽  
Care Delivery ◽  
Care Services ◽  
Care Giving ◽  
Basic Care ◽  
The People ◽  
British Military ◽  
Health Care Models ◽  
Care Models

Health care is in crisis at the global, national, and local levels, with hundreds of millions living without basic care, or with insufficient care. Current health care models seem to have ignored, muted, or excluded the voices of the people they were intended to serve, resulting in health systems and care delivery models that do not respond to the needs of the people. This article describes a values-based approach to health and health care services in which the voices of the people are heard and listened to, and in which individuals and communities are informed participants in their own care. We draw parallels between contemporary concerns for decency in care giving to Florence Nightingale’s path-breaking work, first with the British military medical system and then Great Britain as a whole.

scholarly journals Presumed adverse events in health care are a frequent indication for medico-legal autopsy in Finland

2019 ◽  
Vol 16 (1) ◽  
pp. 65-70
Author(s):  
Lasse Pakanen ◽  
Noora Keinänen ◽  
Paula Kuvaja
Keyword(s):  
Health Care ◽  
Risk Management ◽  
Adverse Event ◽  
Adverse Events ◽  
Gastrointestinal Surgery ◽  
Legal Protection ◽  
Clinical Risk Management ◽  
Data Set ◽  
Manner Of Death ◽  
Clinical Risk

AbstractThe medico-legal autopsy is an essential tool in investigating deaths caused by an adverse event in health care, for both clinical risk management and for professional liability issues. However, there are no statistics available regarding the frequency of autopsies performed due to suspected adverse events. This study aimed to determine the number of medico-legal autopsies done because of presumed adverse events, whether these events were unintentional, medical errors or cases in which malpractice was suspected. Furthermore, differences in treatment types, causes and manner of death were analyzed. The data was obtained from all medico-legal autopsies performed in Northern Finland and Lapland during 2014–2015 (n = 2027). Adverse events were suspected in 181 (8.9%) cases. The suspicions of an adverse event occurring were most often related to medication, gastrointestinal surgery and orthopedic surgery. The manner of death was classified as medical (or surgical) treatment or investigative procedure in 22 (12.2%) cases. The causes of death were completely unrelated to the suspected adverse event in 41 (22.7%) cases. In conclusion, the frequency of presumed adverse events was quite high in this data set, but in the majority of the cases, the suspicion of an adverse event causing death was disproved by an autopsy. Nonetheless, proper investigation of these cases is essential to ensure legal protection of the deceased, next of kin and health care personnel, as well as to support clinical risk management.

Postdischarge Adverse Events Among Patients Who Received Home Health Care Services

2019 ◽  
Vol 31 (4) ◽  
pp. 257-262
Author(s):  
Dennis Tsilimingras ◽  
Liying Zhang ◽  
Askar Chukmaitov
Keyword(s):  
Risk Factors ◽  
Health Care ◽  
Patient Safety ◽  
Adverse Events ◽  
Home Health Care ◽  
Health Care Services ◽  
Home Health ◽  
Health Concern ◽  
Care Services ◽  
Safety Research

Adverse events that occur in urban and rural adults during the posthospitalization period have become a major public health concern. However, postdischarge adverse events for patients receiving home health care have been understudied. The objective of this study was to identify the prevalence and risk factors associated with postdischarge adverse events for patients who received home health care services. We analyzed data from a prospective cohort study that was conducted among patients who were hospitalized in the Tallahassee Memorial Hospital from December 2011 to October 2012. Telephone interviews were conducted by trained nurses who contacted patients within 4 weeks after discharge. Physicians reviewed cases with possible adverse events that were triaged by the nurses. The adverse events that were identified were categorized as preventable, ameliorable, and nonpreventable/nonameliorable. Nearly 39% of 85 patients who received home health care experienced postdischarge adverse events that were predominantly preventable or ameliorable. The associated risk factors were living alone (odds ratio [OR] = 7.860, p = .020), insured by Medicare or Medicaid (OR = 6.402, p = .048), type 2 diabetes mellitus (OR = 6.323, p = .004), pneumonia (OR = 5.504, p = .004), and other infections (OR = 4.618, p = .031). This study was able to identify that nearly one in every two patients who received home health care after hospital discharge experienced an adverse event. Patient safety research needs to focus in the home by developing specific interventions to avert adverse events and improve patient safety during the delivery of home health care services.

Sign in / Sign up

Export Citation Format

Share Document