A cost-effectiveness analysis of three staffing models for the delivery of low-risk prenatal care.

BACKGROUND. Health care costs are increasing at more than twice the rate of inflation, thus, public officials are seeking safe and economic methods to deliver quality prenatal care to poor pregnant women. This study was undertaken to determine the relationship between the cost and effectiveness of three prenatal clinic staffing models: physician based, mixed staffing, and clinical nurse specialist with physicians available for consultation. METHODS. Maternal and neonatal physiological outcome data were obtained from the hospital clinical records of 156 women attending these clinics. The women were then interviewed concerning their satisfaction with their prenatal care clinic. The financial officer from each clinic provided data on the clinic staffing costs and hours of service. RESULTS. There were no differences in outcomes for the maternal-neonatal physiological variables, although newborn admission to the Neonatal Intensive Care Unit (NICU) approached significance among the clinics. The clinic staffed by clinical nurse specialists had the greatest client satisfaction and the lowest cost per visit. CONCLUSIONS. The use of clinical nurse specialists might substantially reduce the cost of providing prenatal care while maintaining quality, and might thereby save valuable resources.     

The cost of care: boutique practices offer an alternative to fast-paced healthcare delivery

The healthcare industry is in the unenviable position of having a perception of declining customer service. Reimbursement for professional services continues to decrease while the volume of patients needed to sustain a viable practice increases. As a result, many providers are concerned about not having the time to provide the high level of care they once did, and patients are frustrated with--and focused on--customer service issues that affect the well-being of the medical office, staff and patient relations. To improve the service provided to patients, some offices are turning to the boutique model as an option that will financially support rising overhead and allow the provider and staff to improve the services offered to each individual patient. These practices are met with different opinions, however, and providers choosing to move in this direction need to plan carefully and assess the long-term effects. Feelings can be strong regarding the rising cost of healthcare, yet the boutique model likely is not the right fit for many providers and patients.     

Organized systems of care. A vision of a future healthcare delivery system

Policymakers no longer question that healthcare system reform will occur; rather they differ on the timing and direction of change. The Washington Business Group on Health envisions a future healthcare delivery system called an organized system of care (OSC). An OSC is an integrated financing and delivery system that uses a panel of providers selected on the basis of quality and cost management criteria to furnish members with comprehensive healthcare services. The most important system attribute of the OSC will be the commitment of all involved to the mission of promoting the health of system members. To accomplish this mission, OSCs will incorporate the principles of continuous quality improvement. Care will be delivered through care management teams, which integrate the physical, psychological, and administrative needs of the member. Such teams might be made up of primary care physicians, nurses, and mental health professionals. Although the entire team would be responsible for the OSC member, one team member would be assigned primary responsibility for overseeing and planning care with the member.     

The power of the soul. Business expertise is not enough; executives in Catholic health care must be spiritual leaders,too

After more than 20 years in health care, including at least a decade in leadership, this day was perhaps my darkest on the job. Since becoming chief operating officer of this Catholic hospital, I, with the help of my management team, had struggled to find answers to apparently overwhelming financial and operational challenges. I had been forced to make tough decisions in the pursuit of financial stability. In round-the-clock meetings, my team and I (with the assistance of a consulting firm whose specialty was turnarounds) had dissected every aspect of the operation. I had compared the performance of the hospital to industry benchmarks, never wanting to be unfair in expecting more from my staff than others had accomplished. In fact, in every decision I made I tried to be fair, weighing the different interests at stake before choosing a course of action--all the while knowing that, no matter what, I would make someone angry. Those around me, instead of recognizing my efforts to be fair, seemed to feel they had been betrayed. The whole organization was dispirited. My medical staff support was eroding as physicians refocused their practices at other facilities not faced with the challenges I had to address. Local leaders roundly criticized me for what they saw as abandoning the community's needs in the interest of serving the hospital and its bottom line. Then came the most hurtful news of all. My employees had filed a petition for representation by a union. It was not that I had a problem with organized labor. But how could an organization that I led have come to a place where the staff felt so abandoned by my leadership that they needed someone else to represent and protect their interest? Hadn't I tried hard to educate the staff about the changes in health care reimbursement? Hadn't I told them that the very existence of the hospital was at stake? Didn't they see how hard I worked, how much I cared? What was I to do now?     

Hospital staffing, organization, and quality of care: cross-national findings.

OBJECTIVE: To examine the effects of nurse staffing and organizational support for nursing care on nurses' dissatisfaction with their jobs, nurse burnout, and nurse reports of quality of patient care in an international sample of hospitals. DESIGN: Multisite cross-sectional survey. SETTING: Adult acute-care hospitals in the United States (Pennsylvania), Canada (Ontario and British Columbia), England, and Scotland. STUDY PARTICIPANTS: 10 319 nurses working on medical and surgical units in 303 hospitals across the five jurisdictions. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Nurse job dissatisfaction, burnout, and nurse-rated quality of care. RESULTS: Dissatisfaction, burnout, and concerns about quality of care were common among hospital nurses in all five sites. Organizational/managerial support for nursing had a pronounced effect on nurse dissatisfaction and burnout, and both organizational support for nursing and nurse staffing were directly, and independently, related to nurse-assessed quality of care. Multivariate results imply that nurse reports of low quality care were three times as likely in hospitals with low staffing and support for nurses as in hospitals with high staffing and support. CONCLUSION: Adequate nurse staffing and organizational/managerial support for nursing are key to improving the quality of patient care, to diminishing nurse job dissatisfaction and burnout and, ultimately, to improving the nurse retention problem in hospital settings.     

Characteristics of labor and delivery care in three healthcare models within the Unified National Health System in Belo Horizonte, Minas Gerais State, Brazil

This cross-sectional study of 831 low-risk pregnancies compared the management of labor and delivery in a birthing center, a hospital that had previously won the "Galba de Araújo" Award (for excellence in obstetric and neonatal care), and a standard-protocol maternity facility. The rates for use of ocytocin during labor were 27.9%, 59.5%, and 40.1%, while amniotomy was performed in 67.6%, 73.6%, and 82.2% of the women, respectively. Episiotomy rates were lower in the first two facilities, which have adopted patient-centered obstetric practices (7.2% at the birthing center and 14.8% at the award-winning hospital) as compared to 54.9% at the standard maternity facility. The liberal offer of epidural anesthesia at the awarding-winning hospital resulted in a higher anesthesia rate (54.4%) as compared to the standard facility (7.7%). Forceps delivery and neonatal admission rates were higher in the standard hospital, but there were no differences in mean Apgar or cesarean rates. The findings suggest resistance to selective use of interventions in all three models of obstetric care, although favoring the birthing center as a strategy for controlling interventions during labor and childbirth in low-risk pregnancies, with no resulting harm to the mothers or newborns.     

Competition in health care markets and the development of alternative forms of service delivery.

This paper examines whether alternative forms of health care delivery locate in highly competitive health service markets. The analysis uses cross-sectional Florida data on the penetration of HMOs, ambulatory surgery centers, urgent care centers, hospices and home health programs in local markets characterized by varying levels of competitiveness among hospitals and among physicians. The results show generally that the development of these newer forms of service delivery are not systematically linked to inter-hospital competition but are influenced by physician supply and insurance demand. The potential contribution of such development to cost-containment efforts is thus questioned.     

Patient care. Time for tea. As insurance kicks in and patient demand grows, alternative therapy is hard to ignore

A growing number of hospitals--and payers--are giving thumbs up to alternative therapies as a way to treat ailing patients. But not everyone agrees that the techniques are legitimate solutions.     

Uphill battle. As number of uninsured rises, effort to repeal healthcare overhaul gets tougher

The latest Census Bureau figures on the number of uninsured Americans gave more fuel to those behind the new healthcare law. The statistics show 50.7 million had no health insurance in 2009. "The economic downturn has affected everyone so it is not surprising that more people are without insurance," says Richard Umbdenstock, left, of the AHA.