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K Simpson

Publications and source records attributed to K Simpson.

152 records · Page 9Linked to original sources
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Applying total quality management concepts to public health organizations.

Total quality management (TQM) is a participative, systematic approach to planning and implementing a continuous organizational improvement process. Its approach is focused on satisfying customers' expectations, identifying problems, building commitment, and promoting open decision-making among workers. TQM applies analytical tools, such as flow and statistical charts and check sheets, to gather data about activities within an organization. TQM uses process techniques, such as nominal groups, brainstorming, and consensus forming to facilitate communication and decision making. TQM applications in the public sector and particularly in public health agencies have been limited. The process of integrating TQM into public health agencies complements and enhances the Model Standards Program and assessment methodologies, such as the Assessment Protocol for Excellence in Public Health (APEX-PH), which are mechanisms for establishing strategic directions for public health. The authors examine the potential for using TQM as a method to achieve and exceed standards quickly and efficiently. They discuss the relationship of performance standards and assessment methodologies with TQM and provide guidelines for achieving the full potential of TQM in public health organizations. The guidelines include redefining the role of management, defining a common corporate culture, refining the role of citizen oversight functions, and setting realistic estimates of the time needed to complete a task or project.

Humans↗
PubMedDate not supplied

Urea monitoring during dialysis: the wave of the future. A tale of two cities.

The National Cooperative Dialysis Study (NCDS) suggested that the removal of small molecules controls the adequacy of the dialysis prescription, and it would seem appropriate that renal units regularly carry out formal urea kinetic modeling to ensure that the adequacy of dialysis is provided. Current methods of calculating Kt/V (urea) are complex and require the accurate measurement of dialyzer urea clearance and calculation of the volume of distribution of urea. This may be done by the direct measurement of total urea removed or by the use of computer programs that examine plasma urea and weight changes over time. Both methods have inherent problems, and this has stimulated the search for easier "bedside" formulas for the calculation of Kt/V. These newer formulas involve examination of the percentage reduction in blood urea concentration during hemodialysis. Two such formulas were examined and applied to 78 patients undergoing hemodialysis in two centers. One center routinely carried out formal urea kinetic modeling; the other did not. In the first center, it was found that the majority of patients were receiving more dialysis than necessary to achieve Kt/V (urea) = 1 when the latter was judged by those formulas. This suggested the possibility of time savings, with considerable implications for cost efficiency. In the second center, the majority of patients required more dialysis. It was concluded that intermittent formal urea kinetic modeling tends to overshoot the necessary prescription to allow for occasional "imperfect" dialyses and also that it is impossible to base dialysis prescriptions on routine pre-dialysis blood work and a "feel" for patients' needs.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMedDate not supplied

Health-care expenditures for tuberculosis in the United States.

BACKGROUND: The resurgence of tuberculosis (TB) and the increase in multidrug-resistant TB prompted this study, which estimates direct expenditures for TB treatment and public health activities in the United States. METHODS: This retrospective cost of illness study estimated 1991 direct expenditures for TB-related outpatient and inpatient diagnosis and treatment, screening, preventive therapy, contact investigations, surveillance, and outbreak investigations. Existing databases at the Centers for Disease Control and Prevention (Atlanta, Ga) and the Codman Research Group, Lebanon, NH, were supplemented by surveys of state and local TB programs and interviews of organizations that conduct large-scale screening. No estimates of indirect costs were made. RESULTS: The direct medical expenditures for TB in 1991 were estimated at $703.1 million. This cost includes $423.8 million for inpatient care, $182.3 million for outpatient care, $72.1 million for screening, $3.4 million for contact investigations, $17.9 for preventive therapy, and $3.6 million for surveillance and outbreak investigations. Sensitivity analyses yielded a range of expenditures between $515.7 million and $934.5 million. CONCLUSIONS: Treatment accounted for more than 86% of all TB-related expenditures; inpatient treatment accounted for 60% of the total. Prevention activities made up only 14% of all costs. Direct medical expenditures may be underestimated because of limitations in the database on hospital expenditures and health department cost-accounting systems and because of the lack of a national database on screening activities. Greater emphasis should be placed on outpatient treatment and prevention in high-risk populations, and improved cost-accounting systems should be developed in state and local health department TB control programs to facilitate economic evaluation and improve the allocation of health dollars.

Cost of Illness↗