The strategic use of outcome information.

BACKGROUND: Most health care executives see outcome measurement as a technical or tactical matter rather than as a strategic tool. Accordingly, provider investment in outcome measurement and management is relatively small. Nevertheless, outcome information can be key to achieving an organization's strategic objectives. Advances in risk adjustment and improvements in technology for data collection and analysis have made outcome measurement a practical tool for individual hospital use. CASE STUDIES: Strategically integrated outcome measurement efforts can give providers a competitive advantage over organizations that only use outcomes tactically. One of the best examples of an acute care provider that has used outcome information for strategic advantage is Intermountain Health Care (IHC; Salt Lake City). In 1997 IHC made clinical quality and outcomes the primary focus of its five-year strategic plan. To support the new strategy IHC's board of trustees approved the development of an outcome information system that generated data along clinical processes of care and the creation of a new management structure to use these data to hold professionals accountable and to set and achieve clinical improvement goals. From 1996 to 1999, IHC's share of the commercial health care market in Utah increased from roughly 50% to about 62% of the market, with the result that it has stopped actively marketing its services. DISCUSSION: Health care executives will not willingly invest in outcomes until they believe that they have business value. Therefore, making the business case for outcomes can help improve the quality of health care and the lives of individuals.

Long-term acute care: meeting the strategic needs for outcomes information.

Nursing home quality improvement has historically relied on annual surveys conducted by state agencies for its impetus. Such reviews play an important role for assuring that minimum standards are met. However, we need to search for incentives that will make it in the best interest of nursing homes to improve beyond the minimum. This article explores incentives that may play that role.

Improving outcomes while reducing utilization: an ICU case study.

New computerized severity scoring and outcomes measurement systems promise to help clinicians reduce the costs of critical care without affecting clinical quality. Using these tools, a growing number of hospitals are achieving dramatic results.

Reducing ICU costs with computerized tools.

A significant opportunity for cost savings in health care lies in managing ICU utilization. Computerized tools that collect data about patient severity of illness, monitor ICU utilization, and track patient outcomes have the potential to help hospitals lower costs by changing practice patterns and treating patients in appropriate, less-expensive settings.

The expanding role of ICU medical directors: from patient management to unit management.

Over the past three decades the focus of physicians delivering intensive care has been on patient management whereas the management of critical care units has been done primarily by nurses. This article reviews existing literature and the arguments supporting a more active role for physicians in the management of critical care units.

Improving charge capture to increase net revenue.

Although a decreasing percentage of hospital revenue continues to be based on total charges, providers can still significantly increase net revenue through a process of evaluating and improving current charge structures, charge capture procedures, and service delivery methods. After reviewing various reasons why hospitals fail to capture charges adequately, the authors present a systematic methodology for reviewing all revenue producing departments to identify opportunities for successfully addressing charge capture problems. This methodology, known as the clinical pricing approach, can improve the accuracy of internal cost accounting and have a positive net revenue impact of from one percent to three percent of gross revenue.

Evaluation of a Rapid Test for Antibiotic Residue in Milk Using Spores of Bacillus stearothermophilus var. calidolactis 1.

Eleven analysts tested contaminated reconstituted (1:10) dry milk powders for penicillin residues using spores of Bacillus stearothermophilus var. calidolacris (Delvotest P method). Three types of responses were noted: positive, negative, and questionable. Prediction equations indicated that 95% of the time, analysts unfamiliar with the technique could detect positive results if penicillin concentrations in samples were 0.010 unit/ml or higher and positive and questionable results if the penicillin concentrations were 0.008 unit/ml. Increasing the reconstitution ratio from 1/11 to 1/4 increased the chances of detecting penicillin in milk powder. Penicillinase added to reconstituted penicillin-contaminated milks in all instances produced negative responses.

Prolonged Salmonella contamination of a recreational lake by runoff waters.

In the summer and fall of 1968, various Salmonella serotypes were isolated from a portion of Lake Mendota, the major recreational lake for Madison Wis. The apparent sources of these organisms were a residential storm sewer and a University of Wisconsin Experimental Farms' washwater drain. Salmonellae were isolated with regularity from a swimming beach located approximately 0.5 mile (0.8 km) from these sources.