Value measurement in health care: a new perspective.

Vital to the success of any healthcare organization is the ability to obtain useful information and feedback about its performance. In particular, healthcare organizations need to begin to understand how non-value-adding work activities detract from their bottom lines. Additionally, financial managers and information systems need to provide data and reports throughout the continuum of care. Overall, healthcare organizations must align the management information and control systems with the planning and decision-making processes. The horizontal information system is a tool to manage three common problems facing today's healthcare managers: (1) the use of existing information to focus on control rather than improve business, (2) failure to focus on satisfying the customer, and (3) failure to combine their efforts with those of the employees by developing trust and a common focus.

Using information technology strategically in home care.

As home healthcare agencies examine new and innovative ways to deliver quality care more efficiently, the historical role of information technology as a way to automate clerical tasks will be significantly broadened to facilitate the true value of technology to home care providers. More importantly, a reduction in time spent on paperwork will allow agency caregivers to spend more time with clients. This article looks beyond the boundaries of desktop computing and examines the costs and benefits of network computing to develop strategic advantages for home healthcare agencies.

Multimedia training in nursing education.

The new developments in computer technology are changing the way training professionals look at computer-assisted instruction (CAI). Nursing educators and practitioners can plan on CAI capabilities that will be both possible and economical as well as within the reach of most organizations. Health care delivery may not be in a position to forego multimedia training as part of its repertoire. In this article, we review interactive video instruction as a multimedia tool in nursing education with an emphasis on the new developments in hardware and software technology. In particular, we examine the changing role of CD-ROM technology and how it has become a tool to change the face of CAI. We define the current status and future trends in CAI and interactive video instruction for nursing education. Several key definitions are introduced to reflect the new direction of multimedia in nursing education.

Multi inter-organizational information systems: competitive strategies for teaching hospitals in the 1990s.

As the environment surrounding the health care industry has changed, the ability of administrators to manage these relationships remains very limited due to their ever-increasing complexity. These organizational relationships offer both challenges and opportunities for innovative strategies that address the issues of coordination and control. As these environmental changes take place, the application of information systems technology becomes more important for managing these relationships and achieving competitive advantages. A theoretical model is presented to serve as a basis for empirical investigations into the role of information systems technology in health care organizations--more specifically teaching hospitals.

Hospital response variation to the demands of preadmission certification.

This paper reports findings from a study of the impact of preadmission certification programs from the perspective of the hospital--a deeply affected party. A series of field studies was undertaken to explore and delineate the range of hospital responses to the challenges posed by this third-party payer mandate and to identify factors associated with variation in responses. The evidence presented suggests wide variation in how hospitals chose to share responsibility for pre-certification with physicians and patients. The findings are broadly consistent with a proposed model that hospital response is determined by both external and internal considerations, but a larger scale hospital survey is necessary to test the hypotheses that can be derived from this study.

Geographic access to health care services: the case of maintenance hemodialysis.

A longitudinal study of the system for delivering maintenance hemodialysis services in St Louis, Missouri was conducted to determine the significance of geographic access in the selection and continued utilization of a treatment facility. Historically, center hemodialysis patients in this metropolitan area received care at four centrally located facilities. In 1981, two new, independent facilities were constructed; a satellite of an existing unit was opened in 1983. The data obtained in this study demonstrated that end-stage renal disease (ESRD) patients generally did not change their mode of maintenance therapy, their treatment facility, or the location of their personal residence. When such changes occurred, they were rarely precipitated by a desire to reduce travel time to treatment. Furthermore, the opportunity to improve geographic access by transferring to a closer unit was perceived by patients to be viable only if they could retain their physician. It was concluded, therefore, that travel time to treatment is a relatively unimportant aspect of the chronic care of center hemodialysis patients in a metropolitan area.

Treatment bias in the management of end-stage renal disease.

A study was conducted of 419 patients with end-stage renal disease (ESRD) being treated by center or home hemodialysis or by renal transplantation at four facilities located within 2.5 km of each other. The objectives were to examine the distribution of patients among the three modes of treatment and to analyze patient transfers to alternate modes of ESRD therapy. While white patients at each facility were comparable (P greater than 0.05) on age, sex, travel time to treatment, marital status, work or employment status, and the presence of diabetes mellitus, the distribution of patients among the treatment modes differed significantly (P less than 0.001) across the facilities. Similarly, the sociodemographic and diagnostic characteristics of the nonwhite patients were comparable at each of the facilities (P greater than 0.05); however, despite observable variation among the facilities in the distribution of these patients, the differences did not achieve statistical significance (P greater than 0.05). Patient transfers to alternate modes of ESRD therapy were infrequent, and among center hemodialysis patients, the distribution of transfers differed significantly across the facilities (P less than 0.001). It is concluded that the distribution of patients was dependent on the patient's initial mode of therapy and the staff attitudes at the individual facilities.