scholarly journals Hospitals Bending the Cost Curve With Increased Quality: A Scoping Review into Integrated Hospital Strategies

2021 ◽  
Author(s):  
Erik Wackers ◽  
Niek Stadhouders ◽  
Anthony Heil ◽  
Gert Westert ◽  
Simone van Dulmen ◽  
...  
Keyword(s):  
Case Studies ◽  
Clinical Pathways ◽  
Quality Care ◽  
Grey Literature ◽  
Management Strategies ◽  
Evaluation Research ◽  
Cochrane Library ◽  
Successful Implementation ◽  
Cost Curve ◽  
The Cost

Background: A lack of knowledge exists on real world hospital strategies that seek to improve quality, while reducing or containing costs. The aim of this study is to identify hospitals that have implemented such strategies and determine factors influencing the implementation. Methods: We searched PubMed, EMBASE, Web of Science, Cochrane Library and EconLit for case studies on hospital-wide strategies aiming to increase quality and reduce costs. Additionally, grey literature databases, Google and selected websites were searched. We used inductive coding to identify factors relating to implementation of the strategies. Results: The literature search identified 4198 papers, of which our included 17 papers describe 19 case studies from five countries, mostly from the US. To accomplish their goals, hospitals use different management strategies, such as continuous quality improvement, clinical pathways, Lean, Six Sigma and value-based healthcare. Reported effects on both quality and costs are predominantly positive. Factors identified to be relevant for implementation were categorized in eleven themes: 1) strategy, 2) leadership, 3) engagement, 4) reorganization, 5) finances, 6) data and information technology (IT), 7) projects, 8) support, 9) skill development, 10) culture, and 11) communication. Recurring barriers for implementation are a lack of physician engagement, insufficient financial support, and poor data collection. Conclusion: Hospital strategies that explicitly aim to provide high quality care at low costs may be a promising option to bend the cost curve while improving quality. We found a limited amount of studies, and varying contexts across case studies. This underlines the importance of integrated evaluation research. When implementing a quality enhancing, cost reducing strategy, we recommend considering eleven conditions for successful implementation that we were able to derive from the literature.

Reducing the Cost of Cancer Care: How to Bend the Curve Downward

2012 ◽  
pp. e46-e51 ◽  
Author(s):  
Thomas J. Smith ◽  
Bruce E. Hillner ◽  
Ronan J. Kelly
Keyword(s):  
Cancer Care ◽  
Clinical Pathways ◽  
Cost Curve ◽  
Evidence Based ◽  
Curative Therapy ◽  
Appropriate Care ◽  
Insurance Costs ◽  
Oncology Care ◽  
The Cost ◽  
Care Costs

Overview: Health care and cancer care costs are rising unsustainably such that insurance costs have doubled in 10 years. Oncologists find themselves both victims of high costs and the cause of high-cost care by what we do and what we do not do. We previously outlined five ways that oncologists could personally bend the cost curve downward and five societal attitudes that would require change to lower costs. Here, we present some practical ways to reduce costs while maintaining or improving quality, including: 1) evidence-based surveillance after curative therapy; 2) reduced use of white cell stimulating factors (filgrastim and pegfilgrastim); 3) better integration of palliative care into usual oncology care; and 4) use of evidence-based, cost-conscious clinical pathways that allow appropriate care and lead to equal or better outcomes at one-third lower cost.

scholarly journals Applied Criteria of Hospital Information Systems in Organizational Evaluation: A Systematic Review Protocol

2018 ◽  
Vol 3 (2) ◽  
pp. 52
Author(s):  
Saeed Eslami ◽  
Hamidreza Dehghan ◽  
Mahdieh Namayandeh ◽  
Arezo Dehghani ◽  
Saeed Hajian Dashtaki ◽  
...  
Keyword(s):  
Information System ◽  
Information Systems ◽  
Hospital Information System ◽  
Data Extraction ◽  
Grey Literature ◽  
Organizational Factors ◽  
Hospital Information Systems ◽  
Cochrane Library ◽  
Successful Implementation ◽  
The Impact

Introduction: Through new and expanding technologies, the development of health information technology in today’s society is indisputable, and the use of this technology has led to the production of various products with a variety of capabilities. One of these products is the Hospital Information System. Regarding the impact of organizational factors on the successful implementation of hospital information systems and the lack of comprehensive criteria for assessing them, the purpose of this study was to determine the criteria of hospital information systems involved in organizational evaluation.Methods: Data sources included the following databases: pubmed, scopus and cochrane library. In addition, other sources were searched for ongoing studies and grey literature. Studies were independently screened for eligibility by 2 reviewers and data extraction was done by 2 people. The language limitations for article wasn’t considered, the reference of the articles that selected, review and related articles were selected. After completing the search, all the articles were entered in to EndNote, and duplicates were deleted. The Prisma protocol was used to report.Results and Dissemination: A specific and precise checklist was being prepared and developed, which is an appropriate guide to assess hospital information system from an organizational dimension in health technology assessment. The results of the study were published in a peer-reviewed journal and presented at relevant conferences. Policy makers and healthcare decision-makers can use these results.

scholarly journals Comparison of enteral and parenteral nutrition in critically ill patient of Intensive Care Unit: a systematic review

2019 ◽  
Vol 5 (4) ◽  
pp. 126
Author(s):  
Eirini-Chrysovalanto Patsiou ◽  
Erofili Rousou ◽  
Martha Kelesi ◽  
Georgia Fasoi
Keyword(s):  
Systematic Review ◽  
Parenteral Nutrition ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Nutritional Support ◽  
Grey Literature ◽  
Cochrane Library ◽  
Gastrointestinal Complications ◽  
First Choice ◽  
The Cost

Background: The enteral nutrition (EN) is the first choice of  nutritional support for  critically ill patients. Despite the fact that the most common practice is choosing continuous EN, there is a controversy about which is the safest and most effective method of nutrition.Aim: The aim of this systematic review was the analysis of the effect of EN compared to PN for patients that are hospitalized in ICUs, as a function of to the cost and the time of hospitalisation, the hospital-acquired infections, complications and mortality.Material and Methods: A systematic literature search was conducted in English and Greek language, of published articles during the past 5 years. Articles were unidentified in electronic databases of PubMed, Cochrane Library and Iatrotek using keywords. Grey literature was also taken involved. Finally, 4 studies were included in the systematic review, after the application of exclusion and inclusion criteria.Results: Eight hundred thirty-eight articles (838) were recovered using keywords. The studies that were finally included and further analysed consisted of 2 systematic reviews and meta-analyses, one randomised clinical trial, a multicentre controlled randomised trial and a systematic review. The method of nutrition (enteral or parenteral) is not related to mortality. The EN is related to less blood bacterial infections and reduction in the time of hospitalization. On the other hand, it causes more gastrointestinal complications. On average, the cost of parenteral nutrition is higher than intestinal.Conclusions: The EN is indicated to be the primary nutritional support of ICU-treated patients, with the advantage of reduced haematogenous infections and organ failure, beside the fact that it still is a challenging procedure. Critically ill patients are a heterogeneous group, in which each patient needs a personalised diet, depending on the diagnosis, the time spent in the ICU and the variety of possible complications. 

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

THEORETICAL PRINCIPLES OF FORECASTING THE COST OF A SOFTWARE PRODUCT

2017 ◽  
Author(s):  
Pavlo Rodionov ◽  
◽  
Anna Ploskonos ◽  
Lesya Gavrutenko ◽  
◽  
...  
Keyword(s):  
Selection Process ◽  
Individual Characteristics ◽  
Successful Implementation ◽  
Software Products ◽  
Software Product ◽  
Continue Research ◽  
Cocomo Model ◽  
Factors Of Influence ◽  
The Individual ◽  
The Cost

The paper analyzes the factors that affect the amount of effort required to create a mobile application and its cost. It is established that the main factors of influence are the design of the application, its functionality, the type of mobile platform, the availability and level of testing and support, as well as the individual characteristics of the developer. Based on the analysis of information sources, the main methods and approaches to forecasting the cost of software products are identified, which include the COCOMO model, Price-to-win method, expert evaluation, algorithmic methods and the method of analogies. It is proposed to consider the method of analogies as a tool that allows you to make predictions about the cost of resources required for the successful implementation of IT projects based on the experience of similar projects. It is proved that the advantages of this method are the simplicity of its implementation and the clarity of the results obtained, which follows from the practical orientation of this tool. Among the limitations of the method of analogy is the mandatory need for reliable data relating to similar projects, as well as the difficulty of taking into account unspecified indicators. Taking into account the mentioned limitations of the method of analogies and on the basis of the analysis of scientific sources the possible directions of its optimization are determined. Thus, among the ways to improve the effectiveness of this method are those aimed at optimizing the project selection process, the data for which are used as a basis for forecasting. Attempts to improve the method of analogies by including parameters that were previously ignored by this technique seem promising. This in turn can lead to an expansion of the scope of the method of analogies and increase the accuracy of forecasts. As prospects for further research, the need to continue research in the field of optimization of the method of analogies with the subsequent practical verification of theoretical positions on the data of real projects.

IMPROVEMENT OF INNOVATIVE ACTIVITY OF THE ENTERPRISE

2017 ◽  
Author(s):  
Nataliya Stoyanets ◽  
◽  
Mathias Onuh Aboyi ◽  
Keyword(s):  
Value Chain ◽  
Net Present Value ◽  
Successful Implementation ◽  
Innovative Development ◽  
Technological Equipment ◽  
Alliance Partner ◽  
Innovation Potential ◽  
Wide Range ◽  
Technological Platform ◽  
The Cost

The article defines that for the successful implementation of an innovative project and the introduction of a new product into production it is necessary to use advanced technologies and modern software, which is an integral part of successful innovation by taking into account the life cycle of innovations. It is proposed to consider the general potential of the enterprise through its main components, namely: production and technological, scientific and technical, financial and economic, personnel and actual innovation potential. Base for the introduction of technological innovations LLC "ALLIANCE- PARTNER", which provides a wide range of support and consulting services, services in the employment market, tourism, insurance, translation and more. To form a model of innovative development of the enterprise, it is advisable to establish the following key aspects: the system of value creation through the model of cooperation with partners and suppliers; creating a value chain; technological platform; infrastructure, determine the cost of supply, the cost of activities for customers and for the enterprise as a whole. The system of factors of influence on formation of model of strategic innovative development of the enterprise is offered. The expediency of the cost of the complex of technological equipment, which is 6800.0 thousand UAH, is economically calculated. Given the fact that the company plans to receive funds under the program of socio-economic development of Sumy region, the evaluation of the effectiveness of the innovation project, the purchase of technological equipment, it is determined that the payback period of the project is 3 years 10 months. In terms of net present value (NPV), the project under study is profitable. The project profitability index (PI) meets the requirements for a positive decision on project implementation> 1.0. The internal rate of return of the project (IRR) also has a positive value of 22% because it exceeds the discount rate.

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.

Dipeptidyl Peptidase IV Inhibitors for Nonalcoholic Fatty Liver Disease – Systematic Review and Metanalysis

2020 ◽  
Vol 16 ◽  
Author(s):  
Lucas Ribeiro dos Santos ◽  
Marcio Luis Duarte ◽  
Maria Stella Peccin ◽  
Antônio Ricardo de Toledo Gagliardi ◽  
Tamara Melnik
Keyword(s):  
Hepatic Steatosis ◽  
Grey Literature ◽  
Specific Treatment ◽  
Reducing Power ◽  
Dipeptidyl Peptidase ◽  
Dipeptidyl Peptidase Iv ◽  
Cochrane Library ◽  
Vast Number ◽  
Dpp Iv ◽  
Dipeptidyl Peptidase Iv Inhibitors

Introduction:: Hepatic steatosis is a frequent condition, that afflicts, especially, obese and insulin resistant patients; diagnosis is made, usually, through imaging tests. Despite the high prevalence and risk of complications, there is no specific treatment approved, though a vast number of medications have been tested. Objective:: To determine the efficacy of dipeptidyl peptidase IV inhibitors (i DPP-IV) in the treatment of NAFLD. Methods:: We searched the electronic databases of the Cochrane Library, MEDLINE, EMBASE and LILACS, as well as reference lists of the included studies and grey literature; 9 studies were selected for inclusion. Results:: 7 studies were used for metanalysis, for 3 outcomes. i DPP-IV showed an ALT-reducing power of MD -10.83 [95% CI 35.23 to 13.57] at 3 months and MD -9.27 [95% CI 10.92 to -7.62] at 6 months of intervention, as well as reduction of hepatic steatosis via MRI of SMD 0.10 [95% CI 0.31 to 0.50]; the overall incidence of adverse events was very low. The studies were considered of low and very low quality by the GRADE evaluation. Conclusion:: Because of the poor overall quality of the studies and heterogeneity of the population analyzed, i DPP-IV did not show efficacy on inflammatory markers or fibrosis in patients with NAFLD.

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