Browsing by Subject "Efficiency, Organizational"

Now showing 1 - 6 of 6
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    Development and initial testing of the stroke rapid-treatment readiness tool.
    (J Neurosci Nurs, 2014-10) Olson, DaiWai M; Cox, Margueritte; Constable, Mark; Britz, Gavin W; Lin, Cheryl B; Zimmer, Louise O; Fonarow, Gregg C; Schwamm, Lee H; Peterson, Eric D
    No instruments are currently available to help health systems identify target areas for reducing door-to-needle times for the administration of intravenous tissue plasminogen activator to eligible patients with ischemic stroke. A 67-item Likert-scale survey was administered by telephone to stroke personnel at 252 U.S. hospitals participating in the "Get With The Guidelines-Stroke" quality improvement program. Factor analysis was used to refine the instrument to a four-factor 29-item instrument that can be used by hospitals to assess their readiness to administer intravenous tissue plasminogen activator within 60 minutes of patient hospital arrival.
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    Do specialty courts achieve better outcomes for children in foster care than general courts?
    (Eval Rev, 2013-02) Sloan, Frank A; Gifford, Elizabeth J; Eldred, Lindsey M; Acquah, Kofi F; Blevins, Claire E
    OBJECTIVE: This study assessed the effects of unified family and drug treatment courts (DTCs) on the resolution of cases involving foster care children and the resulting effects on school performance. METHOD: The first analytic step was to assess the impacts of presence of unified and DTCs in North Carolina counties on time children spent in foster care and the type of placement at exit from foster care. In the second step, the same data on foster care placements were merged with school records for youth in Grades 3-8 in public schools. The effect of children's time in foster care and placement outcomes on school performance as measured by math and reading tests, grade retention, and attendance was assessed using child fixed-effects regression. RESULTS: Children in counties with unified family courts experienced shorter foster care spells and higher rates of reunification with parents or primary caregivers. Shorter foster care spells translated into improved school performance measured by end-of-grade reading and math test scores. Adult DTCs were associated with lower probability of reunification with parents/primary caregivers. CONCLUSION: The shortened time in foster care implies an efficiency gain attributable to unified family courts, which translate into savings for the court system through the use of fewer resources. Children also benefit through shortened stays in temporary placements, which are related to some improved educational outcomes.
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    Effectiveness of mentoring programs for youth: a meta-analytic review.
    (Am J Community Psychol, 2002-04) DuBois, David L; Holloway, Bruce E; Valentine, Jeffrey C; Cooper, Harris
    We used meta-analysis to review 55 evaluations of the effects of mentoring programs on youth. Overall, findings provide evidence of only a modest or small benefit of program participation for the average youth. Program effects are enhanced significantly, however, when greater numbers of both theory-based and empirically based "best practices" are utilized and when strong relationships are formed between mentors and youth. Youth from backgrounds of environmental risk and disadvantage appear most likely to benefit from participation in mentoring programs. Outcomes for youth at-risk due to personal vulnerabilities have varied substantially in relation to program characteristics, with a noteworthy potential evident for poorly implemented programs to actually have an adverse effect on such youth. Recommendations include greater adherence to guidelines for the design and implementation of effective mentoring programs as well as more in-depth assessment of relationship and contextual factors in the evaluation of programs.
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    Implications of practice setting on clinical outcomes and efficiency of care in the delivery of physical therapy services.
    (J Orthop Sports Phys Ther, 2014-12) Childs, John D; Harman, Jeffrey S; Rodeghero, Jason R; Horn, Maggie; George, Steven Z
    STUDY DESIGN: Retrospective analysis of episodes of care. OBJECTIVE: To assess the implications of practice setting (hospital outpatient settings versus private practice) on clinical outcomes and efficiency of care in the delivery of physical therapy services. BACKGROUND: Many patients with musculoskeletal conditions benefit from care provided by physical therapists. The majority of physical therapists deliver services in either a private practice setting or in a hospital outpatient setting. There have not been any recent studies comparing whether clinical outcomes or efficiency of care differ based on practice setting. METHODS: Practices that use the Focus On Therapeutic Outcomes, Inc system were surveyed to determine the specific type of setting in which outcomes were collected in patients with musculoskeletal impairments. Patient outcome data over 12 months (2011-2012) were extracted from the database and analyzed to identify differences in the functional status achieved and the efficiency of the care delivery process between private practices and hospital outpatient settings. RESULTS: The data suggest that patients experience more efficient care when receiving physical therapy in hospital outpatient settings compared to private practice settings, as demonstrated by 3.1 points of greater improvement in functional status over 2.9 fewer physical therapy visits. However, the difference in improvement between settings is less than the minimum clinically important difference of 9 points in functional status outcome score. CONCLUSION: In this cohort, our data suggest that more efficient care was delivered in the hospital outpatient setting compared to the private practice setting. However, we cannot conclude that care delivered in the hospital setting is more cost-effective, because it is possible that any difference in efficiency of care favoring the hospital outpatient setting is more than offset by higher costs of care.
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    Improving the Efficiency of Care for Pediatric Patients Hospitalized With Asthma.
    (Hospital pediatrics, 2017-01) Bartlett, Kathleen W; Parente, Victoria M; Morales, Vanessa; Hauser, Jillian; McLean, Heather S
    Asthma exacerbations are a leading cause of hospitalization among children. Despite the existence of national pediatric asthma guidelines, significant variation in care persists. At Duke Children's Hospital, we determined that our average length of stay (ALOS) and cost for pediatric asthma admissions exceeded that of our peers. Our aim was to reduce the ALOS of pediatric patients hospitalized with asthma from 2.9 days to 2.6 days within 12 months by implementing an asthma pathway within our new electronic health record.We convened a multidisciplinary committee charged with reducing variability in practice, ALOS, and cost of inpatient pediatric asthma care, while adhering to evidence-based guidelines. Interventions were tested through multiple "plan-do-study-act" cycles. Control charts of the ALOS were constructed and annotated with interventions, including testing of an asthma score, implementation of order sets, use of a respiratory therapy-driven albuterol treatment protocol, and provision of targeted education. Order set usage was audited as a process measure. Readmission rates were monitored as a balancing measure.The ALOS of pediatric patients hospitalized with asthma decreased significantly from 2.9 days to 2.3 days. Comparing baseline with intervention variable direct cost data revealed a savings of $1543 per case. Improvements occurred in the context of high compliance with the asthma pathway order sets. Readmission rates remained stable throughout the study period.Implementation of an asthma care pathway based on the electronic health record improved the efficiency and variable direct costs of hospital care, reduced variability in practice, and ensured adherence to high-quality national guidelines.
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    Population segmentation based on healthcare needs: a systematic review.
    (Systematic reviews, 2019-08-13) Chong, Jia Loon; Lim, Ka Keat; Matchar, David Bruce

    Background

    Healthcare needs-based population segmentation is a promising approach for enabling the development and evaluation of integrated healthcare service models that meet healthcare needs. However, healthcare policymakers interested in understanding adult population healthcare needs may not be aware of suitable population segmentation tools available for use in the literature and barring better-known alternatives, may reinvent the wheel by creating and validating their own tools rather than adapting available tools in the literature. Therefore, we undertook a systematic review to identify all available tools which operationalize healthcare need-based population segmentation, to help inform policymakers developing population-level health service programmes.

    Methods

    Using search terms reflecting concepts of population, healthcare need and segmentation, we systematically reviewed and included articles containing healthcare need-based adult population segmentation tools in PubMed, CINAHL and Web of Science databases. We included tools comprising mutually exclusive segments with prognostic value for clinically relevant outcomes. An updated secondary search on the PubMed database was also conducted as the last search was conducted 2 years ago. All identified tools were characterized in terms of segment formulation, segmentation base, whether they received peer-reviewed validation, requirement for comprehensive electronic medical records, proprietary status and number of segments.

    Results

    A total of 16 unique tools were identified from systematically reviewing 9970 articles. Peer-reviewed validation studies were found for 9 of these tools.

    Discussion and conclusions

    The underlying segmentation basis of most identified tools was found to be conceptually comparable to each other which suggests a broad recognition of archetypical patient overall healthcare need profiles. While many tools operate based on administrative record data, it is noted that healthcare systems without comprehensive electronic medical records would benefit from tools which segment populations through primary data collection. Future work could therefore include development and validation of such primary data collection-based tools. While this study is limited by exclusion of non-English literature, the identified and characterized tools will nonetheless facilitate efforts by policymakers to improve patient-centred care through development and evaluation of services tailored for specific populations segmented by these tools.