PubMed Health⌕ Search

Biomedical subjects

M L Kilgore

Publications and source records attributed to M L Kilgore.

9 recordsLinked to original sources
PubMed2001

Measuring the incremental cost of clinical cancer research.

PURPOSE: To summarize evidence on the costs of treating patients in clinical trials and to describe the Cost of Cancer Treatment Study, an ongoing effort to produce generalizable estimates of the incremental costs of government-sponsored cancer trials. METHODS: A retrospective study of costs will be conducted with 1,500 cancer patients recruited from a randomly selected sample of institutions in the United States. Patients accrued to either phase II or phase III National Cancer Institute-sponsored clinical trials during a 15-month period will be asked to participate in a study of their health care utilization (n = 750). Costs will be measured approximately 1 year after their trial enrollment from a combination of billing records, medical records, and an in-person survey questionnaire. Similar data will be collected for a comparable group of cancer patients not in trials (n = 750) to provide an estimate of the incremental cost. RESULTS: Evidence suggests insurers limit access to trials because of cost concerns. Public and private efforts are underway to change these policies, but their permanent status is unclear. Previous studies found that treatment costs in clinical trials are similar to costs of standard therapy. However, it is difficult to generalize from these studies because of the unique practice settings, insufficient sample sizes, and the exclusion of potentially important costs. CONCLUSION: Denials of coverage for treatment in a clinical trial limit patient access to trials and could impede clinical research. Preliminary estimates suggest changes to these policies would not be expensive, but these results are not generalizable. The Cost of Cancer Treatment Study is an ongoing effort to provide generalizable estimates of the incremental treatment cost of phase II and phase III cancer trials. The results should be of great interest to insurers and the research community as they consider permanent ways to finance cancer trials.

Clinical Trials as Topic↗
PubMed1999

Continuous quality improvement for point-of-care testing using background monitoring of duplicate specimens.

CONTEXT: Despite compliance with quality control standards, concerns remain as to the accuracy and reliability of point-of-care testing. OBJECTIVE: To assess a practical method for quality improvement using the context in which point-of-care testing is done. DESIGN: Quality measures for point-of-care testing, making use of natural duplication of results obtained by other testing methods, were used to monitor testing quality and evaluate quality improvement interventions. SETTING: Five adult intensive care units (total of 88 beds) in a large academic medical center, using point-of-care testing for blood gases, electrolytes, and hematocrit levels. PARTICIPANTS: Nurses performing bedside testing and laboratory personnel assigned the responsibility for supervising their performance. INTERVENTIONS: Quality of testing was monitored continuously, and, where problems were identified, training and support interventions implemented, and their effects evaluated. MAIN OUTCOME MEASURES: Improvement in correlation coefficients and regression parameters of point-of-care hematocrit and potassium testing results compared with contemporaneous results from the core laboratory. RESULTS: The initial survey found point-of-care potassium levels were tightly correlated with core laboratory results (r = 0.958). Baseline correlation coefficients and regression parameters for point-of-care hematocrit levels compared with core laboratory values varied widely from unit to unit. The intensive care units with the highest variances of bedside vs core laboratory testing received targeted interventions. Follow-up yielded evidence of dramatic improvement; 1 unit experienced an increase in correlation from 0.50 to 0.95. CONCLUSIONS: The findings suggest that, when point-of-care testing is highly dependent on operator technique, targeted interventions can resolve problems and provide reliable results at the bedside.

Blood Gas Analysis↗
PubMed1998

Shed mediastinal blood transfusion after cardiac operations: a cost-effectiveness analysis.

BACKGROUND: Cardiac surgical patients consume a significant fraction of the annual volume of allogeneic blood transfused. Scavenged autologous blood may serve as a cost-effective means of conserving donated blood and avoiding transfusion-related complications. METHODS: This study examines 834 patients after cardiac operations at the University of Alabama Hospital. Data were collected on patients receiving unwashed, filtered, autologous transfusions from shed mediastinal drainage and those receiving allogeneic transfusions. The data were incorporated into clinical decision models; confidence intervals for parameters were estimated by bootstrapping sample statistics. Costs were estimated for transfusing both allogeneic and autologous blood. RESULTS: The study found a 54% reduction in transfusion risk or a mean reduction of 1.41 allogeneic units per case (95% confidence interval, 1.04 to 1.79 units). The process saved between $49 and $62 per case. CONCLUSIONS: The use of autologous blood has the potential to significantly reduce the costs and risks associated with transfusing allogeneic blood after cardiac operations.

Adult↗
PubMed1998

Evaluating stat testing options in an academic health center: therapeutic turnaround time and staff satisfaction.

We compared centralized vs distributed methods for delivering "stat" test results for blood gas, glucose, and electrolyte assays. The parameters for comparison were as follows: (a) laboratory turnaround time (TAT), (b) therapeutic TAT, and (c) staff satisfaction. Therapeutic TAT, defined as the time from the initiating order to the receipt of the result and the implementation of any indicated change in treatment, was obtained by direct observation of testing procedures at the bedside and timing each step in the process. Observing therapeutic TAT yields information on the impact of laboratory testing methods in the context of clinical decision making. Therapeutic TAT was 1-2 min shorter for bedside testing compared with a satellite laboratory and 9-14 min shorter in the satellite laboratory compared with centralized testing. Satellite laboratories received the highest staff satisfaction scores, followed by bedside testing, with the central laboratory receiving the lowest scores.

Blood Chemical Analysis↗
PubMedDate not supplied

Using patient satisfaction as an indicator of the quality of laboratory services. Applying social science methods to evaluate outcomes in laboratory medicine.

The authors discuss methods of outcomes research using patient satisfaction as a quality indicator for evaluating point-of-care (POC) laboratory methods. After commenting on the rationale for using this approach, we focus on specific techniques for developing questionnaires, collecting survey response data, and building a database for analysis. We also address problems that arise in incorporating data from medical records into a research database and the linkage of records from disparate sources. Approaches to cost analysis are discussed, including problems with the use of financial and billing records. Preliminary results thus far show no significant effects from the use of POC prothrombin time testing on hospital inpatient evaluations of their overall care. Using laboratory charges and total reimbursements for treatment as proxies for cost, we found a significant (p < 0.0001) difference in the costs for POC testing over those for testing in the central laboratory.

Alabama↗
PubMedDate not supplied

Cost analysis for decision support: the case of comparing centralized versus distributed methods for blood gas testing.

Distributed testing, performed in satellite laboratories or at the bedside, is proliferating within healthcare systems. Users prefer it, and it is fast and convenient. A quick look at marginal costs, however, suggests that cost differentials between distributed and centralized testing may be prohibitive. Sound decision making on the part of health system administrators requires a broader understanding of the costs and benefits of testing options. This study illustrates an approach to cost analysis for decision support where opportunity costs (the costs associated with the next best alternative) provide the basis for decision making. Health system administrators need to understand the opportunity costs involved in their decisions to avoid being misled by analyses that omit important cost elements from consideration. We describe approaches to determining the costs of "stat" laboratory testing options. The costs of various blood gas testing options are compared among a central blood gas laboratory, two satellite laboratories, and point-of-care analysis. Opportunity costs were determined by modeling the substitution of one testing process for another. The cost analysis finds that a judicious mix of alternate-site testing methods can generate annual savings of between $250,000 and $330,000, and at the same time reduce test reporting times. In other words, technology that superficially appears more costly can deliver better service with lower costs.

Alabama↗
PubMedDate not supplied

Estimating costs and turnaround times: presenting a user-friendly tool for analyzing costs and performance.

A review of the literature finds wide variation in the costs and turnaround times associated with central laboratories, satellite laboratories, and point-of-care testing. The greatest variation occurs when comparing options for blood gas and electrolyte testing. Some variation can be attributed to costing methods, but substantial variation arises from circumstances under which testing is undertaken in specific sites. These circumstances include the site-specific costs of resources used in testing, volumes of testing conducted, and performance requirements demanded by the users of laboratory information.

Alabama↗