Making the right moves to get to the top

It's no secret that there are fewer top slots available for healthcare executives in hospitals today. So if you have your sights set on the number one or two spot, it's never too soon to plot your course of action.     

Smartcards. Smart move

European nations outside the UK use smartcards to speed up reimbursements. France has had a card since 1998 and this may soon include health data. The UK is at present only issuing smartcards for healthcare staff's use.     

Emergency contraception in South Africa: knowledge, attitudes, and use among public sector primary healthcare clients

To determine knowledge of, attitudes toward, and use of emergency contraception (EC), interviews were held with 1068 clients of 89 public sector primary healthcare facilities in two urban and two rural areas of South Africa. Only 22.8% of the clients had heard of EC. Awareness was significantly lower in the most rural area and among older, less educated women. Knowledge of EC was superficial, with 47.1% unsure of the appropriate interval between unprotected intercourse and starting EC and 56.6% not knowing whether it was available at the clinic. Few (9.1%) of those who knew of EC had used it. After explaining EC, attitudes toward its use were found to be positive, with 90.3% indicating that they would use it if needed. Awareness was lower than in developed countries, but higher than in other developing countries. Findings indicate that if women know of EC, where to get it, and how soon to take it, they would use it if needed.     

Loyal clients. Despite Arthur Andersen's indictment, healthcare companies aren't defecting

In contrast to about 50 defections by public companies, many healthcare clients of Andersen are standing by the troubled auditor--at least for now. Saying that it's too soon to judge, clients such as the Catholic Health Association are sitting tight to see what the fallout is from the Enron scandal before making any decisions. And even if many part ways with Andersen, there's a host of consultants to take its place.     

Demand management may help stem costs

Technology may soon reduce consumers' need for and use of the most expensive healthcare services, thereby controlling costs and even improving overall health status. It's called the science of 'demand management'.     

Sláintecare – A ten-year plan to achieve universal healthcare in Ireland

In May 2017, an Irish cross-party parliamentary committee published the ‘Houses of the Oireachtas Committee on the Future of Healthcare “Sláintecare” report’. The report, known as ‘Sláintecare’, is unique and historic as it is the first time there has been a cross-party political consensus on major health reform in Ireland.Sláintecare sets out a high level policy roadmap to deliver whole system reform and universal healthcare, phased over a ten year period and costed.Sláintecare details reform proposals which, if delivered, will establish; a universal, single-tier health service where patients are treated solely on the basis of health need; the reorientation of the health system ‘towards integrated primary and community care, consistent with the highest quality of patient safety in as short a time-frame as possible’.Sláintecare has five interrelated components: population health; entitlements and access to healthcare; integrated care; funding; and implementation.In this article, the authors use documents in the public domain (parliamentary reports, public hearings, submissions to the Committee, media coverage, the final report of the Committee, speeches by Committee members) to describe the policy process and the main contents of the proposed Sláintecare reforms.It is too soon tell if the political consensus in the policy formation can hold for its implementation.     

Los Alamos rolls out technology transfer project for radiology

Los Alamos National Laboratory in New Mexico has targeted the healthcare sector for defense technology conversion for peace-time use. As part of that transfer, a new teleradiology repository and network may soon give pulmonary specialists a powerful new information weapon to fight tuberculosis and other lung diseases.     

Teaching future healthcare financial managers to use evidence

There is a growing movement toward evidence-based management in healthcare. This movement extends to healthcare financial management. However, there are barriers to the use of evidence by healthcare financial managers. These barriers are largely the result of culture (management culture is substantially different from clinical culture) and education. If healthcare financial managers are to become better at generating and using evidence, educators must do a better job of preparing them to do so. If we provide more education regarding the goals of research and about the different types of research methods, then healthcare financial managers canbecome educated consumers of evidence. If we provide more examples of evidence that has been generated by research in our classes, and if we give the students experience in gathering evidence, we have a chance of increasing the use of evidence-based management in healthcare.     

国家卫生系统绩效测量与统计指标的概念框架

卫生系统绩效评价是2000年世界卫生组织提出的先进的卫生系统绩效评价方法,建立绩效测量与统计指标的概念框架是完善国家卫生服务系统功能的基础.定义衡量目标实现进度的关键绩效指标（KPI）,并建立KPI测量标准和标尺是得出绩效评分和位次的主要步骤.本研究根据国家卫生信息标准基础框架——国家卫生信息数据模型,对模型中的超级实体“卫生业务”中的“绩效目标”子实体做了扩展,兼顾国际可比性和我国的实用性,提出了由8个KPI组成的国家卫生系统绩效测量指标集,并阐述了指标的内容、测量标准及其意义,同时还简要讨论了数据元的标准化、指标标尺的制定等有关问题.     

Rural connections. Iowa hospitals are establishing communications link to better serve rural areas

The Sisters of Mercy Health Corporation, with 14 hospitals in Iowa, and the Mercy Health Centers of Central Iowa, with 13 hospitals in the state, believe fiber-optic technology may provide solutions to the inadequacies inherent in the rural healthcare delivery system. Since 1989, Iowa has committed more than $100 million toward the development and installation of a statewide fiber-optic communication network. The Iowa Communication Network (ICN) was originally envisioned as a means of providing voice, data, and interactive video capabilities to state government agencies, libraries, schools, and colleges. Currently, only hospitals with medical education programs are authorized to use the network, but others are expected to be allowed to soon. Realizing the potential benefits telemedicine and the ICN posed, in June 1993 the Sisters of Mercy Health Corporation and the Mercy Health Centers of Central Iowa jointly established the Midwest Rural Telemedicine Consortium (MRTC) to enhance rural residents' access to primary healthcare through integrated communications systems. The MRTC is trying to secure federal funding to conduct a demonstration project in eight hospitals. The project's goal is to determine how the use of telemedicine applications, specifically fiber-optic applications, affects access, quality, and costs in providing specialty healthcare services to rural patients.     

膳食健康教育食物手测量概述

平衡膳食需要控制食物的摄入量,营养学理论判断饮食量多寡是根据食物的能量。目前的膳食健康教育涉及食物量时:如果使用生重计量,公众常不知道食物的能量;如果使用能量大卡计量,公众常不知道食物有多少生重。更主要的是,现代人多数不是亲自做饭,因此不知道餐桌上的熟食是多少生重食物烹饪的以及能量是多少,达不到健康教育“一听就懂、一懂就用、一用就有效”的目的,使得平衡膳食健康教育流于形式。笔者经过多年的研究,提出了“平衡膳食食物手测量法则”,在膳食健康教育实践中受到公众欢迎,并得到学术界的肯定。     

Are longer hospital stays beneficial for the elderly?

Utilization review is a way to manage healthcare costs and is widespread in Canada, as managers attempt to use available acute-care beds in a best practice manner. As we reduce beds and decrease length of stay, we often wonder if the outcomes for patients are affected, particularly if the patients are elderly.     

The Internet and hospital marketing strategy: a survey

This project, which was conducted in the U.S. using a large number of healthcare organizations, is an attempt to discover if we can find any evidence of the impact of marketing theories on the real world of healthcare organizations. This paper addresses three major themes: Do healthcare organizations have an Internet strategy? Are they using the Internet in a strategic fashion? Can we identify any difference among the sectors concerning the strategic use of the Internet? Finally, implications for further research and health care practices are highlighted as well.     

Traversing the paperless frontier: using information technology to improve quality care

When it comes to information technology (IT), healthcare has lagged behind. Most healthcare transactions still are conducted via a paper route. Only a fraction of hospitals and physicians' offices have implemented a comprehensive electronic health record. With computerized provider order entry systems, the story has been much the same, with only about 10% of hospitals using them to transmit patient orders. But this may be changing soon. This issue of The Quality Letter for Healthcare Leaders looks at what is in store for healthcare IT and what these trends will mean to the healthcare community.     

A woman's place is in...healthcare, as Modern Healthcare's Top 25 Women connote explosive growth in the number of female executives in C-suites

More women are moving into C-suites across the healthcare industry, and this year's Top 25 Women in Healthcare represent some of the highest-profile females to make the move. Angela Braly, shown center, with co-workers, becomes the first woman CEO of WellPoint in June, and says the trend will soon be a nonstory, "because there are going to be so many women leaders in healthcare".     

Handling Value Added Tax (VAT) in Economic Evaluations

In health economic evaluations, value added tax is commonly treated as a transfer payment. Following this argument, resources are valued equal to their net-of-tax prices in economic evaluations applying a societal perspective. In this article we argue that if there is the possibility that a new healthcare intervention may expand the healthcare budget, the social cost of input factors should be the gross-of-tax prices and not the net-of-tax prices. The rising interest in cost-benefit analysis and the use of absolute thresholds, net benefit estimates and acceptability curves in cost-effectiveness analysis makes this argument highly relevant for an appropriate use of these tools in prioritisation.     

Managing strategic outsourcing in the healthcare industry

Hospitals and healthcare systems are facing increased financial difficulties because of the Balanced Budget Act of 1997 and managed care. As a result, healthcare executives face the challenge of reducing costs while maintaining quality patient care. One of the strategic tools healthcare executives use to meet this challenge is outsourcing. Even though outsourcing has many benefits, outsourcing will fail if not managed successfully. Senior executives must choose outsourcing managers who have the necessary leadership capabilities. Managing outsourcing requires an understanding of outsourcing strategy, the benefits and risks of outsourcing, the evaluation process, and the methods to managing strategically. With appropriate management, strategic outsourcing should provide healthcare executives with a viable strategy for controlling costs and maintaining quality patient care.     

Assessment of Clostridium difficile-associated disease surveillance definitions, North Carolina, 2005.

OBJECTIVE: To determine the timing of community-onset Clostridium difficile-associated disease (CDAD) relative to the patient's last healthcare facility discharge, the association of postdischarge cases with healthcare facility-onset cases, and the influence of postdischarge cases on overall rates and interhospital comparison of rates of CDAD. DESIGN: Retrospective cohort study for the period January 1, 2005, through December 31, 2005. SETTING: Catchment areas of 6 acute care hospitals in North Carolina. METHODS: We reviewed medical and laboratory records to determine the date of symptom onset, the dates of hospitalization, and stool C. difficile toxin assay results for patients with CDAD who had diarrhea and positive toxin-assay results. Cases were classified as healthcare facility-onset if they were diagnosed more than 48 hours after admission. Cases were defined as community-onset if they were diagnosed in the community or within 48 hours after admission, and were also classified on the basis of the time since the last discharge: if within 4 weeks, community-onset, healthcare facility-associated (CO-HCFA); if 4-12 weeks, indeterminate exposure; and if more than 12 weeks, community-associated. Pearson's correlation coefficient was used to assess the association between monthly rates of healthcare facility-onset, healthcare facility-associated (HO-HCFA) cases and CO-HCFA cases. We performed interhospital rate comparisons using HO-HCFA cases only and using both HO-HCFA and CO-HCFA cases. RESULTS: Of 1046 CDAD cases, 442 (42%) were HO-HCFA cases and 604 (58%) were community-onset cases. Of the 604 community-onset cases, 94 (15%) were CO-HCFA, 40 (7%) were of indeterminate exposure, and 208 (34%) community-associated. A modest correlation was found between monthly rates of HO-HCFA cases and CO-HCFA cases across the 6 hospitals (r = 0.63, P < .001). Interhospital rankings changed for 6 of 11 months if CO-HCFA cases were included. CONCLUSIONS: A substantial proportion of community-onset cases of CDAD occur less than 4 weeks after discharge from a healthcare facility, and inclusion of CO-HCFA cases influences interhospital comparisons. Our findings support the use of a proposed definition of healthcare facility-associated CDAD that includes cases that occur within 4 weeks after discharge.     

Smarter elder care? A cost-effectiveness analysis of implementing technology in elder care

Whereas in most sectors, technology has taken over trivial and labour consuming tasks, this transformation has been delayed in the healthcare sector. Although appropriate technology is available, there is general resistance to substituting 'warm' hands with 'cold' technology. In the future, this may change as the number of elderly people increases relative to the people in the work force. In combination with an increasing demand for healthcare services, there are calls for efforts to increase productivity in the sector. Based on experience data from previous studies on information and communication technology efforts in the healthcare sector, we quantitatively assess the use of smart house technology and video visits in home care. Having identified healthcare providers, hospitals and relatives as the main affected groups, we show that smart house technology is cost-effective, even if only relatives gain from it. Video visits, which have higher implementation costs, demand effects on both relatives and health care providers in order to be a cost-effective tool in home care. As the analysis is purely quantitative, these results need to be complemented with qualitative effects and with more thorough discussions of the ethical, medical and legal aspects of the use of technology in home care.