Does a healthy health care workplace produce higher-quality care?

BACKGROUND: The multiagency Quality Interagency Coordination Task Force (QuIC) coordinates activities and plans for quality measurement and improvement across all the U.S. federal agencies involved in health care. One of its working groups focuses on the health care workforce and ways to improve the quality of care that it provides. In October 1999 four government agencies, under the aegis of the QuIC, convened a conference to examine how health care workplace quality influences the quality of care. A healthy workplace is one in which workers will be able to deliver higher-quality care and in which worker health and patients' high-quality care are mutually supportive. In October 2000 a follow-up conference was held to focus on a specific aspect of health care quality-patient safety. WHAT WE STILL NEED TO KNOW: Although enough is known to justify some initiatives to improve the quality of the health care workplace, participants in both meetings agreed that the evidence to prove these associations is weak and that there has been too little research to evaluate the impact of interventions intended to improve quality through improvements in the health care workplace. New evidence-based information is needed to test the theory of the nature of the relationship between working conditions and care quality. CONCLUSION: The tradition of evidence-based decision making needs to be applied to health care management as it has in medicine and nursing, to show how staffing, environment, organization, and culture can each can affect the quality of care.     

Identification of the important variables for prediction of individual medical costs billed by health insurance

The cost of health care insurance is one of the most important factors in the health care development. To establish a better health care system, there is a need to estimate the cost of health insurance. The prediction of the cost is one possibility to improve health care development. There is a need for more advanced methods other than traditional regression approaches, because the prediction of the health insurance costs are now a big data problem. To simplify the prediction process in this study, a selection procedure was performed to identify the most important factors for the prediction of the health care insurance costs. Artificial neural network, namely adaptive neuro fuzzy inference system (ANFIS), was used for the identification procedure. ANFIS architecture was employed to model nonlinear relationships between data samples. Five input factors were considered in the analyzing (age of primary beneficiary, insurance contractor gender, Body mass index, Number of children covered by health insurance, and smoking). The obtained results showed that smoking has the highest impact on the cost of health insurance. Moreover, prediction accuracy is acceptable and could be used for future management of health care development.     

针对老年慢性病的参与式社区医疗服务设计方法探究

目的探究老年人参与式的慢性病社区医疗服务设计方法及流程。方法以老年慢性病的社区医疗为背景,结合用户参与模式从服务设计的层面对社区医疗的设计方法及设计流程进行探讨。结果得出在用户参与模式指导下的服务设计方法及流程,并以老年慢性病的社区医疗为背景进行方法探究。结论通过用户参与模式的社区医疗服务设计理论框架的建立,提高了服务设计过程中的用户参与度,通过引导老年人参与到慢性病社区医疗的服务设计过程中,提高社区医疗服务的合理性和设计结果的适用性,为相关领域的服务设计活动提供了可借鉴的理论依据和参考。     

From production systems to health care delivery systems: a retrospective look on similarities,difficulties and opportunities

Manufacturing systems have attracted substantial research attentions during the last 50 years. In recent years, there has been growing interest in health care systems research to improve efficiency, safety and care quality. The similarities identified between manufacturing systems and health care delivery systems heighten the importance of transferring the experience and knowledge in manufacturing to health care. In this paper, based on the lessons we learned and the experience we obtained during our journey from production systems research to health care delivery systems study, we discuss the similarities between production systems and health care delivery systems in system modelling, design, performance evaluation and continuous improvements and investigate the differences and difficulties that stem from variability, constraints, dynamics and human behaviour. Building upon these, the opportunities encompassing care operations, planning and scheduling, patient transitions, and safety and teamwork in health care delivery systems are discussed. Finally, the challenges and future directions are proposed. We expect this work to serve as a catalyst to stimulate more in-depth and comprehensive studies.     

The effects of age,gender, and crash types on drivers’ injury-related health care costs

There are many studies that evaluate the effects of age, gender, and crash types on crash related injury severity. However, few studies investigate the effects of those crash factors on the crash related health care costs for drivers that are transported to hospital. The purpose of this study is to examine the relationships between drivers’ age, gender, and the crash types, as well as other crash characteristics (e.g., not wearing a seatbelt, weather condition, and fatigued driving), on the crash related health care costs. The South Carolina Crash Outcome Data Evaluation System (SC CODES) from 2005 to 2007 was used to construct six separate hierarchical linear regression models based on drivers’ age and gender. The results suggest that older drivers have higher health care costs than younger drivers and male drivers tend to have higher health care costs than female drivers in the same age group. Overall, single vehicle crashes had the highest health care costs for all drivers. For males older than 64-years old sideswipe crashes are as costly as single vehicle crashes. In general, not wearing a seatbelt, airbag deployment, and speeding were found to be associated with higher health care costs. Distraction-related crashes are more likely to be associated with lower health care costs in most cases. Furthermore this study highlights the value of considering drivers in subgroups, as some factors have different effects on health care costs in different driver groups. Developing an understanding of longer term outcomes of crashes and their characteristics can lead to improvements in vehicle technology, educational materials, and interventions to reduce crash-related health care costs.     

The impact of quality report cards on choice of physicians, hospitals, and HMOs: a midcourse evaluation

BACKGROUND: Increasing competition in health care markets and ongoing pressures to contain costs raise concerns about possible deterioration in the quality of medical care. Publicly disseminated quality report cards are designed to inform consumers' choice of providers and health plans, thus counteracting incentives to provide low-quality care and improving the functioning of health care markets. METHODS: This article reviews and evaluates the published evidence on the impact of quality report cards on patients' choice of health care providers and health plans. RESULTS: Studies found only minimal effect of quality report cards on patient referral choices. These findings can be explained by several study design issues and by the economic forces governing health care markets. They cannot be construed to imply that quality report cards are not effective. DISCUSSION: Whether report cards are effective or not is still an unanswered question. Further efforts to improve the information contained in report cards and to make them more understandable could increase their effectiveness.     

Identifying and using tools for reducing risks to patients and health care workers: a nursing perspective

BACKGROUND: Research efforts and policy initiatives in health care errors and injury to health care workers have attracted increasing attention in recent years. An emerging theme in both these areas is the importance of organizational and other systems factors in the occurrence of medical error and health care worker injury. These commonalities call for the identification of common research efforts and, when appropriate, policy efforts. MOVING FROM HYPOTHESIS TO CONCLUSION: The proposition that health care error and worker injury are linked to the same organizational variables requires further research and deserves the same type of human factors approach that has characterized much of the investigative efforts that have occurred in the patient safety arena during the past decade. Serious problems exist with respect to access to data on staffing levels, skill mix, consecutive work hours, and other information that is crucial to examining the link between practice conditions, health care error, and health care worker injury. HUMAN FACTORS: One important resource in identifying effective approaches to prevent error and health care worker injury is the field of human factors, the discipline concerned with the design of tools, machines, and systems that takes into account human capabilities, limitations, and characteristics. CONCLUSION: The potential benefits of linking patient safety and health care worker safety efforts are significant. The research, experience, and successful practices from multiple disciplines must be utilized in identifying areas of common interest and concern in advancing work in both of these important areas.     

Applying the domain management model in treating patients with chronic diseases

BACKGROUND: In the health care system in the United States, the management of chronic health conditions and their functional consequences challenge and frustrate patients, caregivers/families, health care providers, and physicians. Contributing factors include a lack of physician and health care provider training and a health system that emphasizes diagnosis and management of acute illnesses. A broader patient care model is required for patients with chronic disease(s). USING THE DOMAIN MANAGEMENT MODEL (DMM) TO CLASSIFY PATIENTS' CLINICAL PROBLEMS: The DMM is a synthesis of approaches used in internal medicine, geriatric medicine, and physical medicine and rehabilitation. All clinical problems, their treatments, and their outcomes can be classified and followed over time in a multiaxial model with four domains-medical/surgical issues, mental status/emotions/coping, physical function, and living environment. APPLICATIONS OF THE DMM IN MEDICAL RECORD TEMPLATES: Use of the four domain headings in standard templates can lead to an improved awareness of all the relevant issues in the management of chronic illnesses. This awareness precedes a physician's implementation of better care processes. Also, good patient care decisions require good information. MANAGEMENT OF FUNCTIONAL PROBLEMS: The DMM can be used to educate care providers and organize care in terms of important and common functional problem (for example, trouble walking, which lacks a standard approach in health care). CONCLUSION: This common framework for the organization, documentation, and communication of patients' care over time will help teach systematic mangement of chronic health conditions and help with future research on complex patient management.     

The impact of staffing and the organization of work on patient outcomes and health care workers in health care organizations

BACKGROUND: Numerous reports in the popular press express concern about the restructuring or lowering of staffing levels in health care organizations and the impact on the quality of patient care. Overtime and other extended shifts also represent work stresses for health care workers. This article reviews the research literature on the relationships among staffing, organization of work, and patient outcomes, and it discusses research findings on the relationship between staffing and the health of health care workers. RESEARCH ON STAFFING, ORGANIZATION, AND PATIENT OUTCOMES/STAFF WELL-BEING: Safe staffing level requirements have been identified for nursing homes, but only in extremely limited cases for hospitals, home care, or other health settings. There is little information about the impact of staffing levels and the organization of work on health personnel or on patient outcomes. There is almost no information about staffing and patient outcomes in home health and ambulatory care. Much of the research on staffing and quality has been discipline specific; future research should reflect the interdisciplinary nature of health care delivery rather than the impact of a particular occupation. RESEARCH USE: Research is conducted to increase the scientific base per se and to inform decision making. Who should decide staffing levels and the organization of work? Professionals, employers/owners, the government, and consumers all have significant interest in staffing levels and the organization of care. Improving health care quality requires research about the critical staffing and organization of work variables. This requires obtaining appropriate data, conducting the research, and widely disseminating the findings.     

Occupational stress, social support, and the costs of health care.

Relationships among health care costs, social support, and occupational stress are investigated. Health care cost data were collected over two years for 260 working individuals. Multiple regression analyses were used to control for initial health care costs, age, and gender in predicting later costs; independent variables were stress, strain, social support, and their interactions. Main effects and interactions each accounted for significant proportions of the variance in various health care costs.     

Applying quality improvement principles to achieve healthy work organizations

BACKGROUND: Health care has used total quality management (TQM)/quality improvement (QI) methods to improve quality of care and patient safety. Research on healthy work organizations (HWOs) shows that some of the same work organization factors that affect employee outcomes such as quality of life and safety can also affect organizational outcomes such as profits and performance. An HWO is an organization that has both financial success and a healthy workforce. For a health care organization to have financial success it must provide high-quality care with efficient use of scarce resources. To have a healthy workforce, the workplace must be safe, provide good ergonomic design, and provide working conditions that help to mitigate the stress of health care work. INTEGRATING TQM/QI INTO THE HWO PARADIGM: If properly implemented and institutionalized, TQM/QI can serve as the mechanism by which to transform a health care organization into an HWO. To guide future research, a framework is proposed that links research on QI with research on HWOs in the belief that QI methods and interventions might be an effective means by which to create an HWO. Specific areas of research should focus on identifying the work organization, cultural, technological, and environmental factors that affect care processes; affect patient health, safety, and satisfaction; and indirectly affect patient health, safety, and satisfaction through their effects on staff and care process variables. SUMMARY: Integrating QI techniques within the paradigm of the HWO paradigm will make it possible to achieve greater improvements in the health of health care organizations and the populations they serve.     

Professional values,technology and future health care: The view of health care professionals in The Netherlands

Perceptions and values of care professionals are critical in successfully implementing technology in health care. The aim of this study was threefold: (1) to explore the main values of health care professionals, (2) to investigate the perceived influence of the technologies regarding these values, and (3) the accumulated views of care professionals with respect to the use of technology in the future. In total, 51 professionals were interviewed. Interpretative phenomenological analysis was applied. All care professionals highly valued being able to satisfy the needs of their care recipients. Mutual inter-collegial respect and appreciation of supervisors was also highly cherished. The opportunity to work in a careful manner was another important value. Conditions for the successful implementation of technology involved reliability of the technology at hand, training with team members in the practical use of new technology, and the availability of a help desk. Views regarding the future of health care were mainly related to financial cut backs and with a lower availability of staff. Interestingly, no spontaneous thoughts about the role of new technology were part of these views. It can be concluded that professionals need support in relating technological solutions to care recipients' needs. The role of health care organisations, including technological expertise, can be crucial here.     

Articulating care and responsibility in design: A study on the reasoning processes guiding health innovators' ‘care-making’ practices

This article explores how health innovation designers articulate care and responsibility when designing new health technologies. Towards this end, we draw on Tronto's ethic of care framework and Responsible Research and Innovation (RRI) scholarship to analyse interviews with Canadian health innovators (n = 31). Our findings clarify how respondents: 1) direct their attention to needs and ways to improve care; 2) mobilise their skill set to take care of problems; 3) engage in what we call ‘care-making’ practices by prioritising key material qualities; and 4) operationalise responsiveness to caregivers and care-receivers through user-centred design. We discuss the inclusion of health innovation designers within the care relationship as ‘care-makers’ as well as the tensions underlying their ways of caring and their conflicting responsibilities.     

Episodes of care: theoretical frameworks versus current operational realities

BACKGROUND: Fundamental changes in the structure of the health care industry have stimulated the need for improved definitions of output and for better methods of organizing utilization data into appropriate units. Although the "episode of care" concept has existed since the 1960s, its recognition as integral to the management of health care cost and utilization is relatively recent. Conceptually, episodes of care represent a meaningful unit of analysis for assessing the full range of primary and specialty services provided in treating a particular health problem. Proprietary episode software grouper products are currently being used by health care organizations for the purposes of provider profiling, clinical benchmarking, disease management, and quality measurement. DESCRIPTION OF EPISODE GROUPER SOFTWARE PRODUCTS: Four episode grouper products are described that use a computerized approach for developing episodes of care from administrative data. They are compared on several characteristics, including purpose, case-mix adjustment, comprehensiveness, and clinical flexibility. Their differences in episode construction, such as how the start points and endpoints of an episode are defined, are also delineated. CONCLUSIONS: Episode groupers are critical to the analysis of health care delivery, since they focus on the entire process of care. Although all the groupers reviewed have many strengths, much developmental work still needs to occur in order to standardize the measurement and operationalization of episodes of care as units of analysis. Furthermore, until the data sources used are more valid and reliable, they will at best remain gross screening measures of quality.     

Developing performance indicators that reflect an expanded view of health: findings from the use of an innovative methodology

BACKGROUND: The increasing presence of managed health care in the United States has been accompanied by the widespread use of performance indicators to assess health plans along various dimensions of quality. Current performance indicator sets virtually ignore psychosocial and behavioral factors in the prevention and management of illness, especially chronic illness, in spite of documented evidence in the medical literature of the importance of these factors. Instead, current indicator sets focus primarily on biomedical interventions to prevent, treat, and manage illness. METHODOLOGY: In a novel method for developing performance indicators--the use of a storytelling methodology--eight interdisciplinary panels, composed of health care experts at the community, state, and national levels, each completed two stories about patients with chronic illnesses. The first story described experiences a patient might have in the health care system as it is today; the second story retold the events that might transpire if attention to psychosocial and behavioral factors were integrated into the health care system. FINDINGS: Differences between the two sets of stories developed by the panels revealed common themes and specific areas where indicator development might prove fruitful. Performance indicators were identified from these themes, and work is underway to operationalize them; to identify barriers and opportunities for their inclusion in indicator sets; and to further document their potential health and cost-effectiveness. DISCUSSION: Although not scientifically rigorous, the storytelling method was found to provide consistent results and may be applied to many aspects of the health care planning process, health education, and quality improvement efforts.     

Employer acquisition of health care facilities: a possible outcome of escalating premiums?

The price of health care is rising faster than most other prices; the increasing number of employer-financed health insurance plans means that insurance premiums are a significantly growing expense. Some companies might save money without sacrificing the quality of care by building or buying health care facilities. The authors analyze hospital costs and corporate experience with in-house care.     

The evolution of quality management in state Medicaid agencies: a national survey of states with comprehensive managed care programs

BACKGROUND: Concern has been expressed about whether managed care health plans can successfully meet the special needs of Medicaid beneficiaries. A 1996 survey indicated that state Medicaid agencies had just begun conducting quality oversight and management. Since then the federal government has released guidelines under the Quality improvement System for Managed Care (QISMC) program to assist states with quality management of managed care programs. In 1999 a follow-up telephone survey was conducted with representatives from 45 states to describe the current state of and changes in quality management activities by state Medicaid agencies for Medicaid beneficiaries enrolled in managed care. RESULTS: The 45 states represented a 50% increase between 1995 and 1999. The number of states enrolling the disabled had doubled (from 15 to 30). Most states collecting data on satisfaction and childhood immunizations fed it back to health plans, although feedback of other measures of access and quality occurred less frequently and fewer states provided information to beneficiaries choosing health plans. Fewer than 25% of states reported having even one health plan demonstrate improvement in individual measures of access and quality except for prenatal care (28%) and childhood immunizations (33%). Fewer than half of the states included contractual penalties in their contracts with health plans, and very few (three or fewer per penalty) had over invoked such penalties. CONCLUSIONS: State Medicaid agencies continue to adapt to their new roles as value-based purchasers of health care. Although increasing numbers of states collect data on satisfaction, access, and quality of care, few states have been able to document improved performance in the health plans they oversee.     

Using the Internet to teach consumers about quality care

BACKGROUND: The Internet is an important source of health information for consumers. Patients can learn about their diagnoses, review treatments and medications, and locate other health information for themselves and their families. Information about quality care can also be found on the Internet. Few consumers, though, use these Web sites for learning about quality care. SEARCH FOR WEB SITES ON QUALITY CARE: In 2000 the investigators searched the Internet and generated a list of approximately 90 relevant Internet documents under the broad heading of quality health care. They then pared the list to 34, by using the Health Information Technology Institute (HITI) criteria. TESTING OF INTERNET DOCUMENTS BY CONSUMERS: In the second phase of the project, 5 of the 34 Internet documents were tested by a convenience sample of 32 consumers. Most of the participants had experience in using the Internet, although generally not in the area of quality care. They found the Web sites easy to use and indicated that the Internet resources would help them assess the quality of care they receive from physicians, nurses, and others. DISCUSSION: Web sites need to be evaluated to ensure that the information they provide is accurate and current, among other criteria. All patients should understand their health benefits and the importance of making informed decisions about their health care, as well as how quality care is measured, how to use quality reports, how to choose providers and hospitals, how to assess the quality of their own care and be more involved in it, and what they should do when faced with new diagnoses.     

微型变压吸附制氧与氧疗保健

微型变压吸附制氧具有方便、灵活以及可长期连续供氧等特点,是家庭氧疗保健的最佳供氧方法。随着微型制氧技术的发展,微型变压吸附制氧机的各项性能指标逐步提高。微型变压吸附制氧应用于氧疗保健可以治疗病理性缺氧疾病,可以缓解生理性缺氧症状、环境性缺氧症状。随着人们对氧疗保健认识的深入和供氧设备的发展,氧疗保健将得到快速发展。