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Biomedical subjects

B W Chaffee

Publications and source records attributed to B W Chaffee.

8 recordsLinked to original sources
PubMed2000

Pharmacy database for tracking drug costs and utilization.

A pharmacy database for tracking drug costs and physician prescribing trends is described. Accuracy problems plagued data systems used to make drug-use-policy decisions at a tertiary care teaching hospital because of structural deficiencies within the systems and their nonclinical orientation. To resolve these problems, a programmer analyst, a clinical supervisor, and a clinical pharmacist developed a hierarchical database of drug costs. The database was designed to be valid for tracking drug costs according to patterns of clinical use. Internal controls were created that could identify and correct cost-tabulation errors arising within the ordering, order-entry, and billing processes. The database was able to tabulate drug costs according to the clinical service on which the patient was being treated at the time so that reports could compare aggregate prescribing trends from one time period to another for the same service. Similarly, the database could track and report drug use by disease or financial classification. Flagging elements were introduced to the database for cancer chemotherapy and antimicrobial drug products to enable reporting by these categories and by therapeutic subcategories within the antimicrobial category. Routine monthly reports were distributed to end users. Development of a database for tracking drug costs and utilization allowed a teaching hospital to derive the cost of medications from billing-charge information and to report data to health care professionals on the basis of important factors like clinical services.

Academic Medical Centers↗
PubMed2000

Pharmacoeconomic evaluation of flumazenil for routine outpatient EGD.

BACKGROUND: Flumazenil is a benzodiazepine antagonist indicated for reversal of the sedative effects of benzodiazepines. Previous studies suggest that flumazenil may shorten recovery time after endoscopy, but there are few data on actual recovery room times and charges. METHODS: Fifty patients undergoing routine upper endoscopy were sedated with midazolam alone in the usual titrated manner. Patients were randomized in a double-blind fashion to receive either flumazenil or saline immediately after procedure. Assessments of responsiveness, speech, facial expression, and ptosis (Observer's Assessment of Alertness/Sedation [OAA/S] scale) were made before procedure, immediately after procedure and every 15 minutes thereafter. The patient was discharged from the recovery room when vital signs and OAA/S scale reached preprocedure levels. Recovery room times and charges were recorded. RESULTS: The flumazenil group demonstrated shorter recovery room times and recovery room charges than the placebo group (p < 0.001). The difference in recovery room charges was not statistically different when flumazenil charges were included (p = 0.09). CONCLUSIONS: The routine use of flumazenil after midazolam sedation for upper endoscopy significantly shortened recovery time and charges but did not statistically reduce overall charges.

Adult↗
PubMed1998

Evaluating and improving the delivery of heart care: the University of Michigan experience.

With increasing pressure to curb escalating costs in medical care, there is particular emphasis on the delivery of cardiovascular services, which account for a substantial portion of the current healthcare dollar spent in the United States. A variety of tools were used to improve performance at the University of Michigan Health System, one of the oldest university-affiliated hospitals in the United States. The tools included initiatives to understand outcomes after coronary bypass operations and coronary angioplasty through use of proper risk-adjusted models. Critical pathways and guidelines were implemented to streamline care and improve quality in interventional cardiology, management of myocardial infarction, and preoperative assessment of patients undergoing vascular operations. Strategies to curb unnecessary costs included competitive bidding of vendors for expensive cardiac commodities, pharmacy cost reductions, and changes in nursing staff. Methods were instituted to improve guest services and partnerships with the community in disease prevention and health promotion.

Cardiology Service, Hospital↗
PubMed1995

Development of a continuous quality improvement/total quality management program for medication use monitoring.

The design of institutional medication use programs that are effective and meet regulatory and accreditation standards is becoming increasingly dependent upon a thorough understanding of the principles and applications of continuous quality improvement (CQI) and total quality management (TQM). Both the Joint Commission on Accreditation of Healthcare Organizations and the federal government have recently begun to make significant attempts to transform our existing quality assurance programs into indicator-based quality improvement management systems that are based on the principles of CQI and TQM. The article outlines and illustrates an effective approach for developing and implementing a comprehensive CQI/TQM program for medication use monitoring.

Drug Monitoring↗
PubMed1991

Evaluation of direct pharmacist intervention on conversion from parenteral to oral histamine H2-receptor antagonist therapy.

A program in which pharmacists were authorized to change parenteral histamine H2-receptor antagonist (H2RA) therapy to the oral route without first contacting the prescriber was evaluated on cost and appropriateness of use of the parenteral route. Parenteral therapy was received by 264 and 244 patients in the study and comparison groups, respectively. Length of parenteral H2RA therapy was less in the study group (4.8 vs. 7.5 d) as was length of total (parenteral + oral) therapy (8.4 vs. 12.1 d). Parenteral H2RA drug acquisition savings were $6225 in the six-week study period or $53,950 when annualized. Decreased oral therapy contributed additional savings. There was a significant decrease in the number of inappropriate parenteral doses of ranitidine per patient, the drug used in more than 80 percent of the patients. In addition to the direct effect of pharmacists' interventions, there appeared to be an indirect effect of the program, as physicians initiated route of administration changes on their own.

Administration, Oral↗
PubMed1989

Retrospective evaluation of piperacillin use in a university hospital.

A retrospective review was conducted to evaluate the appropriateness of empiric and definitive piperacillin use and to determine if less expensive, more appropriate antibiotics could have been used. The criteria were approved by the chief of infectious diseases and the drug utilization review committee at this institution. One hundred courses of piperacillin use in adult patients were reviewed. Therapy was categorized as appropriate in 78 of the 100 courses: 21 were appropriate empiric, 32 were appropriate empiric changed to definitive due to culture and sensitivity reports, and 25 were appropriate definitive. Reasons for this high percentage of appropriate use include: 1) 40% of the infections involved Pseudomonas aeruginosa; 2) 18% of the organisms that were sensitive to piperacillin were resistant to ticarcillin and mezlocillin; and 3) 64% of the courses of therapy involved critically ill patients with diagnoses such as neutropenia secondary to cancer chemotherapy, burns, sepsis, and hospital-acquired pneumonia. Although only 19.7% of the 11,845 grams of piperacillin used were categorized as inappropriate, the cost is relatively high (annualized to $19,648) and cost savings could be realized if piperacillin use were monitored more closely.

Adolescent↗
PubMed1989

Appropriate but not cost effective ceftazidime use in a university hospital.

An evaluation of ceftazidime use at a university hospital was performed. Drug utilization evaluations usually categorize therapies as appropriate or inappropriate, with the inappropriate category including all regimens which are not cost effective. This may be misleading since therapy which is therapeutically appropriate may be labeled as inappropriate. Therefore, ceftazidime use was classified as appropriate, appropriate but not cost effective, or inappropriate. Clinical pharmacists reviewed the charts of 72 patients over a 1 month period. Courses of therapy were first categorized as empiric or definitive and as appropriate or inappropriate. Those that were appropriate were further analyzed to determine cost effectiveness. When a more cost effective regimen was available, the difference in cost was calculated; the cost of inappropriate therapy was compared to that of an appropriate alternative regimen. Ceftazidime use was appropriate and cost effective in 22% of courses, appropriate but not cost effective in 66%, and inappropriate in 11%. Annual savings of up to $72,000 could be realized in our 550 bed hospital by intervention into appropriate but not cost effective therapy and inappropriate therapy.

Ceftazidime↗