A Cost-Benefit Analysis of a State-Funded Healthy Homes Program for Residents With Asthma: Findings From the New York State Healthy Neighborhoods Program.

CONTEXT: Despite considerable evidence that the economic and other benefits of asthma home visits far exceed their cost, few health care payers reimburse or provide coverage for these services. OBJECTIVE: To evaluate the cost and savings of the asthma intervention of a state-funded healthy homes program. DESIGN: Pre- versus postintervention comparisons of asthma outcomes for visits conducted during 2008-2012. SETTING: The New York State Healthy Neighborhoods Program operates in select communities with a higher burden of housing-related illness and associated risk factors. PARTICIPANTS: One thousand households with 550 children and 731 adults with active asthma; 791 households with 448 children and 551 adults with asthma events in the previous year. INTERVENTION: The program provides home environmental assessments and low-cost interventions to address asthma trigger-promoting conditions and asthma self-management. Conditions are reassessed 3 to 6 months after the initial visit. MAIN OUTCOME MEASURES: Program costs and estimated benefits from changes in asthma medication use, visits to the doctor for asthma, emergency department visits, and hospitalizations over a 12-month follow-up period. RESULTS: For the asthma event group, the per person savings for all medical encounters and medications filled was $1083 per in-home asthma visit, and the average cost of the visit was $302, for a benefit to program cost ratio of 3.58 and net benefit of $781 per asthma visit. For the active asthma group, per person savings was $613 per asthma visit, with a benefit to program cost ratio of 2.03 and net benefit of $311. CONCLUSION: Low-intensity, home-based, environmental interventions for people with asthma decrease the cost of health care utilization. Greater reductions are realized when services are targeted toward people with more poorly controlled asthma. While low-intensity approaches may produce more modest benefits, they may also be more feasible to implement on a large scale. Health care payers, and public payers in particular, should consider expanding coverage, at least for patients with poorly controlled asthma or who may be at risk for poor asthma control, to include services that address triggers in the home environment.

[The implementation of the week surgery in an orthopedic and urology ward and assessment of its impact]. / L'introduzione della week surgery in urologia e ortopedia e valutazione dell'impatto.

SUMMARY: The implementation of the week surgery in an orthopedic and urology ward and the assessment of its impact. INTRODUCTION: The week surgery (WS) is one of the models organized according the intensity of care that allows the improvement of the appropriateness of the hospital admissions. AIM: To describe the implementation and the impact of the WS on costs and levels of care. METHODS: The WS was gradually implemented in an orthopedic and urology ward. The planning of the surgeries was modified, the wards where patients would have been transferred during the week-end where identified, the nurses were supported by expert nurses to learn new skills and clinical pathways were implemented. The periods January-June 2012 and 2013 were compared identifying a set of indicators according to the health technology assessment method. RESULTS: The nurses were able to take vacations according to schedule; the cost of outsourcing services were reduced (-4.953 Euros) as well as those of consumables. The nursing care could be guaranteed employing less (-5) full-time nurses; the global clinical performance of the ward did not vary. Unfortunately several urology patients could not be discharged during the week-ends. CONCLUSIONS: A good planning of the surgeries according to the patients' length of staying, together with interventions to increase the staff-skill mix, and the clinical pathways allowed an effective and efficient implementation of the WS model without jeopardizing patients' safety.

Primary care of chronic dyspnea in adults.

Chronic dyspnea is the presence of shortness of breath lasting for a minimum of 4 weeks. It is a common complaint associated with many of the cardiopulmonary diseases seen in primary care. This article provides a systematic, evidence-based, and cost-effective approach to the evaluation of this complex symptom.

What are consulting services worth?: applying cost analysis techniques to evaluate effectiveness.

Occupational health nurse consultants, whether internal or external to the organization, must document the benefit and effectiveness of services provided. In today's business environment, it is imperative that occupational health nurse consultants demonstrate their contribution to the corporate business mission and goals. Both qualitative and quantitative methods provide appropriate techniques that can be used for this purpose. These techniques measure value in monetary terms such as cost-benefit and cost-effective analysis tools, as well as through interviews, focus groups, and case examples. Regardless of how skillfully a service is provided, the value must be demonstrated, documented, and effectively communicated.

The effect of high nursing surveillance on hospital cost.

PURPOSE: The purpose of this study was to determine the cost of one nursing treatment, surveillance, for older, hospitalized adults at risk for falling. DESIGN: An observational study using information from data repositories at one Midwestern tertiary hospital. The inclusion criteria included patients age>60 years, admitted to the hospital between July 1, 1998 and June 31, 2002, at risk for falls or received the nursing treatment of fall prevention. METHODS: Data came from clinical and administrative data repositories that included Nursing Interventions Classification (NIC). The nursing treatment of interest was surveillance and total hospital cost associated with surveillance was the dependent variable. Propensity-score analysis and generalized estimating equations (GEE) were used as methods to analyze the data. Independent variables related to patient characteristics, clinical conditions, nurse staffing, medical treatments, pharmaceutical treatments, and other nursing treatments were controlled for statistically. FINDINGS: The total median cost per hospitalization was $9,274 for this sample. The median cost was different (p=0.050) for patients who received high versus low surveillance. High surveillance delivery cost $191 more per hospitalization than did low surveillance delivery. CONCLUSION: Propensity scores were applied to determine the cost of surveillance among hospitalized adults at risk for falls in this observational study. The findings show the effect of high surveillance delivery on total hospital cost compared to low surveillance delivery and provides an example of a useful method of determining cost of nursing care rather than including it in the room rate. More studies are needed to determine the effects of nursing treatments on cost and other patient outcomes in order for nurses to provide cost-effective care. Propensity scores were a useful method for determining the effect of nursing surveillance on hospital cost in this observational study. CLINICAL RELEVANCE: The results of this study along with possible clinical benefits would indicate that frequent nursing surveillance is important and might support the need for additional nursing staff to deliver frequent surveillance.

The balancing act: patient care time versus cost.

BACKGROUND: With demands to improve patients' clinical outcomes and decrease the escalating costs of inpatient care, nurse executives are focusing on how nurses spend their time rather than just raising staffing levels to positively impact patient outcomes. Because nursing wages constitute a high proportion of a hospital's budget, understanding the costs of nursing activities is critical to managing them. METHODS: An activity-based costing approach was used in 14 medical-surgical nursing units to study nursing activities and their related costs. Time use for 4 patient care activities (assess, teach, treat, provide psychosocial support) and 2 support activities (coordinate care and manage clinical records) including the percent of non-value-added (NVA) time for each of these activities was identified through focus groups, interviews, and timed observations. Annualized wage costs were assigned to these activities to determine average wage-related costs of each activity as well as NVA-related costs. RESULTS: More than one-third of nurses' time was considered NVA, averaging dollars 757,000 per nursing unit in wage costs annually. Nurses spent more time on support activities (56%) than in providing patient care (44%), with the least amount of time being spent on patient teaching and psychosocial support. CONCLUSION: Findings indicate a huge opportunity to both improve clinical outcomes in these units and, at the same time, reduce costs by focusing on processes to reduce the high amount time spent performing NVA and support activities and increase patient care time, particularly patient teaching and psychosocial support.

Standardized screening and assessment of older patients in the emergency department: a survey of implementation in Quebec.

Cost-effective methods have been developed to help busy emergency department (ED) staff cope with the growing number of older patients, including quick screening and assessment tools to identify those at high risk and note their specific needs. This survey, from a sample of key informants from all EDs (n = 111) in the province of Quebec (participation rate of 88.2%), investigated the implementation of these tools and barriers to implementation. Questionnaires (administered either by telephone or by self-completion) included characteristics of the ED, characteristics of the respondent, use of tools, and method of implementation. Barriers to the implementation of these tools included lack of resources for screening and follow-up, misunderstandings of the difference between screening and assessment tools, and need for adaptation of the tools to the local context. Education of staff and pre-implementation adaptation and testing are needed for successful implementation.

A psychometric analysis of the Epworth Sleepiness Scale.

Psychometric performance of the Epworth Sleepiness Scale (ESS) has not been evaluated in groups of workers. This study evaluated its use in a sample of 843 long-haul truckers. Interitem correlations and Cronbach's alpha were conducted. Correlation of the ESS with the sleep problems subscale of the Trucker Strain Monitor (TSM) was performed. Dimensionality was evaluated using factor analysis. Cronbach's alpha (.79) was strong. Interitem correlations were significant. A weak but significant correlation between the ESS and TSM sleep problems subscale (r = .18, p = < .001) was shown. Factor analysis yielded two factors that explained 56.2% of scale variance. The ESS performed well in the current sample. It is an inexpensive, time/cost-effective instrument. It should be considered for use in studies of workers in naturalistic settings.

Aferição do tempo e do custo médio do trabalho da enfermeira na consulta de enfermagem / Time and mean cost rate of a nurse’s work in nursing consultation

Neste estudo, a autora objetivou caracterizar os atendimentos de Consulta de Enfermagem, segundo pacientes pré-cirúrgicos do Programa de Coronária, estimar o tempo e o custo médio do trabalho de enfermeira na realização da Consulta de Enfermagem, estudar a existência de associação/correlação entre o tempo, o custo e outras variáveis de interesse. O desenvolvimento da consulta seguiu as fases da Sistematização da Assistência de Enfermagem (SAE). A amostra foi constituída de 44 pacientes, sendo que 37 (84%) foram atendidos em consultas novas e 7 (16%) em consultas de seguimento. Os resultados alcançados foram: tempo médio igual a 48,91 minutos para as consultas novas e 22,14 minutos para as de seguimento, com um custo médio de cerca de R$ 18,01 para as consultas novas e de R$ 8,15 para as de seguimento. Os resultados mostram que o tempo médio de consultas novas superam de forma estatisticamente significativa o tempo médio das consultas de seguimento e, conseqüentemente, os custos.

In this study, the author aimed atcharacterizing Nursing Consultationattendances according to presurgicalpatients of the CoronaryProgram, estimating the nurse’saverage time and work mean costin performing it, and studying theexistence of association/ correlationbetween time, cost and othervariables of interest. The developmentof the consultationfollowed the phases of theAssistance Systemization Nursing(ASN). The sample was comprisedof 44 patients, of which37 (84%) were attended in newconsultations and 7 (16%) infollow up consultations. Resultsobtained from the coronaryprogram were mean time of 48.91minutes for new consultationsand 22.14 minutes for follow ups,with a mean cost of around R$18.01 for new consultations andR$ 8.15 for follow ups. Thesefigures show that new consultationsmean time exceeds withstatistical significance follow upconsultations mean time and,consequently, so do costs

Este estudio tuvo como objetivocaracterizar las atenciones de laConsulta de Enfermería según lospacientes pre quirúrgicos delPrograma de Coronaria, estimarel tiempo y el costo medio deltrabajo de la enfermera en larealización de la Consulta deEnfermería, analizar la existenciade asociación/correlación entre eltiempo, el costo y otras variablesde interés. El desarrollo de laConsulta de Enfermería siguió lasfases de la Sistematización de laAsistencia de Enfermería (SAE).La muestra incluyó 44 pacientes,37(84%) fueron atendidos ennuevas consultas y 7 (16%) enconsultas de seguimiento. Losresultados alcanzados fueron:tiempo medio de 48,91 minutospara las nuevas consultas y de22,14 minutos para las deseguimiento, con un costo mediode aproximadamente R$ 18,01para las nuevas consultas y R$8,15 para las de seguimiento. Losresultados muestran que eltiempo medio de nuevas consultassupera de forma estadísticamentesignificativa el tiempomedio de las consultas de seguimientoy, consecuentemente, loscostos

From costly treatment to cost-effective prevention: using Waterlow.

The Waterlow pressure ulcer risk assessment system has been in use for 20 years. In this article, Judy Waterlow describes how it can be used in the community, discusses the recent update to the system and explains how pressure ulcer risk assessments should be conducted.

Nursing telephonic case management and pregnancy outcomes of mothers and infants.

Limited success has been achieved in identifying high-risk pregnant women via prenatal risk identification tools. The purposes of this study were to examine a risk assessment and nursing telephonic case management protocol used to identify high-risk mothers and infants, and to evaluate the costs and benefits of the protocol. This study involved a retrospective review of insurance data held by a large managed care organization (MCO). Analyzed data included information about current and past medical problems, and current lifestyle risk factors. Data analysis included frequencies, chi2, t tests, and logistic regression analysis. Pregnant MCO members experienced fewer high-risk conditions versus nonmembers. The overall pregnancy cost for a member was 1,818 dollars versus 4,587 dollars for a nonmember. Members experienced 2.5 times fewer babies hospitalized in the NICU, and significantly fewer mothers with high-risk conditions. The MCO program reduces costs and promotes better maternal and infant outcomes.