Comparison of Reverse Triage with National Early Warning Score, Sequential Organ Failure Assessment and Charlson Comorbidity Index to classify medical inpatients of an Italian II level hospital according to their resource's need.

Resource allocation in our overcrowded hospitals would require classification of inpatients according to the severity of illness, the evolving risk and the clinical complexity. Reverse triage (RT) is a method used in disasters to identify inpatients according to their use of hospital resources. The aim of this observational prospective study is to evaluate the use of RT in medical inpatients of an Italian Hospital and to compare the RT score with National Early Warning Score, Sequential Organ Failure Assessment and Charlson Comorbidity Index. Cluster sampling was performed on high dependency unit (HDU), geriatrics (Ger) and internal medicine (IM) wards. We calculate RT, NEWS, SOFA and CCI from inpatient charts. Length of stay (LOS), transfer to a higher level of care, death and discharge date were collected after 30 days. We obtained demographics, comorbidities, severity and clinical complexity of 260 inpatients. We highlighted differences in NEWS, SOFA and CCI in the three divisions. On the contrary RT score was uniformly high (median 7), with 85% of patients with RT = 8. NEWS, SOFA and CCI were higher in patients with higher RT score. We used the sum of the interventions listed by RT (RT sum) as a proxy of the level of care needed. RT-sum showed moderate correlation with NEWS (r = 0.52 Spearman, p < 0.001). RT-sum was the highest in HDU, related to the evolving severity of HDU patients. Ger patients that showed the highest CCI score (with all patients in the CCI ≥ 3 category) had the second highest RT-sum. RT score showed similar values in the majority of the inpatients regardless of differences in NEWS, SOFA and CCI in different ward subgroups. RT-sum is related both to evolving severity (NEWS) and to clinical complexity (CCI). RT and NEWS could predict inpatient level of care and resource need associated with CCI.

A Rural Taxonomy of Population and Health-Resource Characteristics.

This policy brief reports the newly developed taxonomy of rural places based on relevant population and health-resource characteristics; and discusses how this classification tool can be utilized by policy makers and rural communities. Key Findings. (1) We classified 10 distinct types of rural places based on characteristics related to both demand (population) and supply (health resources) sides of the health services market. (2) In descending order, the most significant dimensions in our classification were facility resources, provider resources, economic resources, and age distribution. (3) Each type of rural place was distinct from other types of places based on one or two defining dimensions.

A work time study analysing differences in resource use between psychiatric inpatients.

PURPOSE: Judgement about the adequacy of reimbursement schemes requires an understanding of differences in resource use between patient groups. The aim of this study was to analyse staff time allocation of psychiatrists, psychologists and nurses in inpatient mental health care and to use these data to analyse differences in per diem resource use between patient groups. METHODS: A self-reporting work-sampling study was carried out at a psychiatric teaching hospital. All of 36 psychiatrists, 23 psychologists and 106 nurses involved in clinical care during the study period participated in a two-week measurement of their work time. RESULTS: A total of 20,380 observations were collected, representing about 10,190 h of work or 6.2 full-time-equivalent years. The average resource use in minutes of staff time per patient day was 227 min, representing 138 of staff costs. The most resource intensive care was provided at the Psychiatric Intensive Care Unit and for geriatric patients with 334 and 266 min per patient day (192 and 162 ), respectively. The least resource intensive care was provided for patients with substance-related disorders (197 min, 116 ). Substantial shares of clinical work time were dedicated to tasks without patient contact (58 %). Nursing time was the main driver of total resource use, representing 70 % of staff time and 60 % of costs. CONCLUSION: Presented differences in per diem resource use should inform discussions about the adequacy of reimbursement schemes. Tasks in the absence of the patient, such as documentation and administration, should be reduced to free resources for direct patient care.

Heart failure in primary care: co-morbidity and utilization of health care resources.

BACKGROUND: In order to ensure proper management of primary care (PC) services, the efficiency of the health professionals tasked with such services must be known. Patients with heart failure (HF) are characterized by advanced age, high co-morbidity and high resource utilization. OBJECTIVE: To ascertain PC resource utilization by HF patients and variability in the management of such patients by GPs. METHODS: Descriptive, cross-sectional study targeting a population attended by 129 GPs over the course of 1 year. All patients with diagnosis of HF in their clinical histories were included, classified using the Adjusted Clinical Group system and then grouped into six resource utilization bands (RUBs). Resource utilization and Efficiency Index were both calculated. RESULTS: One hundred per cent of patients with HF were ranked in RUBs 3, 4 and 5. The highest GP visit rate was 20 and the lowest in excess of 10 visits per year. Prescription drug costs for these patients ranged from €885 to €1422 per patient per year. Health professional efficiency varied notably, even after adjustment for co-morbidity (Efficiency Index Variation Ratio of 28.27 for visits and 404.29 for prescription drug cost). CONCLUSIONS: Patients with HF register a high utilization of resources, and there is great variability in the management of such patients by health professionals, which cannot be accounted for by the degree of case complexity.

Using the RUG-III classification system for understanding the resource intensity of persons with intellectual disability residing in nursing homes.

Since 1991, the Minimum Data Set 2.0 (MDS 2.0) has been the mandated assessment in US nursing homes. The Resource Utilization Groups III (RUG-III) case-mix system provides person-specific means of allocating resources based on the variable costs of caring for persons with different needs. Retrospective analyses of data collected on a sample of 9707 nursing home residents (2.4% had an intellectual disability) were used to examine the fit of the RUG-III case-mix system for determining the cost of supporting persons with intellectual disability (intellectual disability). The RUG-III system explained 33.3% of the variance in age-weighted nursing time among persons with intellectual disability compared to 29.6% among other residents, making it a good fit among persons with intellectual disability in nursing homes. The RUG-III may also serve as the basis for the development of a classification system that describes the resource intensity of persons with intellectual disability in other settings that provide similar types of support.

Influenza vaccine production for Brazil: A classic example of successful North–South bilateral technology transfer

Technology transfer is a promising approach to increase vaccine production at an affordable price in developing countries. In the case of influenza, it is imperative that developing countries acquire the technology to produce pandemic vaccines through the transfer of know-how, as this will be the only way for the majority of these countries to face the huge demand for vaccine created by influenza pandemics. Access to domestically produced influenza vaccine in such health crises is thus an important national defence strategy. However, technology transfer is not a simple undertaking. It requires a committed provider who is willing to transfer a complete production process, and not just the formulation and fill-finish parts of the process. It requires a recipient with established experience in vaccine production for human use and the ability to conduct research into new developments. In addition, the country of the recipient should preferably have sufficient financial resources to support the undertaking, and an internal market for the new vaccine. Technology transfer should create a solid partnership that results in the joint development of new competency, improvements to the product, and to further innovation.The Instituto Butantan–sanofi pasteur partnership can be seen as a model for successful technology transfer and has led to the technological independence of the Instituto Butantan in the use a strategic public health tool.

Using multi-terminology indexing for the assignment of MeSH descriptors to health resources in a French online catalogue.

BACKGROUND: To assist with the development of a French online quality-controlled health gateway(CISMeF), an automatic indexing tool assigning MeSH descriptors to medical text in French was created. The French Multi-Terminology Indexer (FMTI) relies on a multi-terminology approach involving four prominent medical terminologies and the mappings between them. OBJECTIVE: In this paper,we compare lemmatization and stemming as methods to process French medical text for indexing. We also evaluate the multi-terminology approach implemented in F-MTI. METHODS: The indexing strategies were assessed on a corpus of 18,814 resources indexed manually. RESULTS: There is little difference in the indexing performance when lemmatization or stemming is used. However, the multi-terminology approach outperforms indexing relying on a single terminology in terms of recall. CONCLUSION: F-MTI will soon be used in the CISMeF production environment and in a Health MultiTerminology Server in French.

Implantación de la gestión de procesos en el tratamiento de la fractura de cadera / Implementation of a database for monitoring the results of quality objective agreed on by hospital servieces

Objetivo: La fractura de cadera es una de las patologías quirúrgicas tratadas con más frecuencia en los diferentes centros hospitalarios de los países desarrollados y representa un elevado consumo de recursos sanitarios. Por este motivo se eligió esta patología para implantar la gestión de procesos clínicos en el contexto de un plan de calidad total llevado a cabo por la Fundación Hospital de Manacor a partir de 1999.Metodología: Se utilizó el sistema Plan Do Check Act (PDCA) para analizar el proceso actual fractura de cadera, con el fin de identificar posibles áreas de problemas, a través de la definición de 11 indicadores susceptibles de medición. Posteriormente, se creó un equipo de mejora encargado de analizar las áreas problemáticas e implantar las posibles soluciones.Resultados: Desde marzo a octubre de 2000 se analizó a 106 pacientes con fractura de cadera. La estancia global media fue de 6.5 días y la estancia preoperatoria de 1,2 días. El 89 per cent del total de pacientes eran capaces de deambular al alta hospitalaria. Se determinaron cinco áreas de posibles problemas que fueron la profilaxis antitrombótica, la reserva de hemoderivados preoperatoria, la ubicación de los pacientes en el área de urgencias, la planificación quirúrgica preoperatoria y la necesidad de informatización de la toma de datos. Se ha editado un manual en el que se han introducido todos los protocolos y formularios utilizados en el desarrollo del proceso, que se está actualizando de forma permanente.Conclusiones: La gestión por procesos en la fractura de cadera ha permitido unificar criterios entre los diferentes servicios implicados en el tratamiento de esta patología, disminuyendo la variabilidad en el manejo de estos pacientes y permitiendo un mejor y más racional aprovechamiento de los recursos sanitarios. Por otra parte, a través de la edición de un manual del proceso fractura de cadera, el personal sanitario puede familiarizarse con la metodología de trabajo y presenta asimismo potenciales ventajas desde el punto de vista docente (AU)

Developing a nursing management practice atlas: Part 1, Methodological approaches to ensure data consistency.

Challenges associated with the use of secondary data sources for benchmarking in nursing administration research are identified. A methodological approach for ensuring data consistency is presented in part one of this two-part series. Part two (September 2000) will provide an analysis of the nursing management data, based on a set of nursing and financial resource benchmarking variables identified by the senior nurse executives of these sites. Initial findings show evidence of data consistency across similar hospitals.

[Rally-resources. The integration of community principles]. / Le rallye-ressources. L'intégration des principes communautaires.

PROBLEM BEING ADDRESSED: Family medicine training programs are required to teach the four principles of family medicine, two of which deal with community responsibilities. Teachers in the Family Practice Unit at the Centre hospitalier de Québec, pavillon St-François d'Assise (UMF-SFA) have developed a learning activity that introduces residents to community agencies in the area. OBJECTIVE OF PROGRAM: To introduce family medicine residents to community aspects of the principles of family medicine, to help them identify community resources in the area served by UMF-SFA, to discuss these services so that they can use them effectively, and to offer new residents an opportunity to become better acquainted with these services and with the UMF-SFA team. MAIN COMPONENTS OF PROGRAM: In early September, a half-day is set aside for a rally during which mixed teams of supervisors and residents (four to eight to a team) visit about 10 community agencies in the vicinity of UMF-SFA. Walking from place to place, the teams spend 15 to 20 minutes with staff or users of each agency. The informal tone of the rally makes it easier for residents to understand these agencies. CONCLUSION: Each year for the past 10 years, all UMF-SFA members have taken part in a rally that introduces residents to the community-based resources of family medicine.

Secondary data bases and their use in outcomes research: a review of the area resource file and the Healthcare Cost and Utilization Project.

Secondary data sources are being used more frequently than ever in outcomes research. The speed and relative low cost of these data bases makes them ideal for analyzing outcomes. Today's researcher has numerous secondary data bases available for use. Few publications exist to help researchers locate the ideal data set for their needs. Herein, two national secondary data bases are reviewed: the Area Resource File (ARF) and the Healthcare Cost and Utilization Project (HCUP). These two data sets represent the two types of secondary data: aggregate and individual. ARF represents an aggregate data set and HCUP represents an individual data set. The advantages of each type of secondary data will also be reviewed.

The development of Healthcare Resource Groups--Version 3.

The use of casemix classifications to assist in the analysis of patient-based information is becoming more widespread and routine in the management of the National Health Service (NHS). This paper details the process of modification of and the results of modifications to Healthcare Resource Groups (HRGs), an in-patient classification tailor-made for the English healthcare system. Clinical expertise and extensive statistical analysis of national data were combined to identify areas of HRGs Version 2 where improvement could be made. The ensuing changes were then reviewed by professional associations and the wider NHS before being incorporated into grouping software. Extensive changes were made to the classification, with significant gains in statistical performance. Analysis shows that the revised groupings perform better on English data than other available systems.

Public hospital resource allocations in El Salvador: accounting for the case mix of patients.

National hospitals in developing countries command a disproportionate share of medical care budgets, justified on the grounds that they have a more difficult patient case mix and higher occupancy rates than decentralized district hospitals or clinics. This paper empirically tests the hypothesis by developing direct measures of the severity of patient illness, hospital case-mix and a resource intensity index for each of El Salvador's public hospitals. Based on an analysis of inpatient care staffing requirements, national hospitals are found to receive funding far in excess of what case-mix and case-load considerations would warrant. The findings suggest that significant system-wide efficiency gains can be realized by allocating hospital budgets on the bases of performance-related criteria which incorporate the case-mix approach developed here.

Resource Intensity Weights and Canadian hospital costs: some preliminary data.

Different types of inpatients "consume" differing amounts of hospital resources, and it is important to be able to measure these differences in resource consumption. An equitable methodology for funding hospitals must take into account differences in case mix between facilities. An ability to examine these differences in case mix and resource utilization allows hospitals to focus efforts to improve efficiency. A standardized methodology for measuring resource consumption is critical to funding and resource allocation both at a global and organizational level. This study was undertaken to determine whether or not the Canadian system for measuring resource consumption, Canadian Institute for Health Information (CIHI) RIWs, was reflective of the relative cost differences between inpatient cases at the Greater Victoria Hospital Society (GVHS) and to identify RIWs with a significant difference in comparison to GVHS cost weights. A regression analysis was performed on the more than 30,000 inpatient cost profile records from the GVHS 1995-96 cost and patient activity data. The scope of the analysis was restricted to the 424 Case Mix Groups (CMGs) that had a minimum composition of five patient profiles. Comparisons of GVHS cost weights to CIHI RIWs yielded mostly positive results. With the noted exception of about 20 CMGs, there was a high correlation between the CIHI RIW and the GVHS actual cost weights. Hence, the GVHS cost weights can be viewed with confidence as representative of the relative cost differences between typical RIW value CMGs and actual costs.

Predicting nursing home length of stay and outcome with a resource-based classification system.

The anticipated demographic changes with an increasing number of elderly force us to plan and use health care resources more efficiently. In this study we have used the components of a case-mix measure for nursing homes; the Resource Utilization Groups (RUG-II), to predict length of stay (LOS) and outcome in geriatric institutions. We have shown that the RUG categories and an activities of daily living (ADL) index differ significantly in both respects, but that other variables might be of more clinical value when establishing a prospective payment system, based on LOS in geriatric institutions.

Health information reform issues for Eastern Europe.

This paper reflects on issues related to health information reform in countries of Eastern Europe. Drawing on recent health information systems planning initiatives in central and eastern Europe, the evolution of health information in Canada, and other international developments, as well as consulting experiences in Poland, Belarus, and Ukraine over the past four years, observations and recommendations are offered for assisting health information reform. Definitions of health and health information, a model for allocating resources for health services, and a conceptual framework for community health information used in Canada are presented.

Acuity systems and control charting.

The strengths of control charting and other statistical process control (SPC) tools have not previously been applied to acuity systems. Intermountain Health Care, Salt Lake City, Utah, developed a new acuity system that relies heavily upon control charting for an array of purposes, including immediate feedback to caregivers regarding decisions, ongoing feedback to managers regarding decision patterns, and longer-term feedback regarding trends and budget-relevant information. The use of control charts has eliminated the need for auditing acuity-based staffing and has maintained the reliability of classifications at levels above 95 percent. Implications for other novel applications are offered.