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Biomedical subjects

W C Faubion

Publications and source records attributed to W C Faubion.

5 recordsLinked to original sources
PubMed1993

A clinician-driven home care delivery system.

The financial, entrepreneurial, administrative, and legal forces acting within the home care arena make it difficult for clinicians to develop and operate home care initiatives within an academic setting. HomeMed is a clinician-initiated and -directed home care delivery system wholly owned by the University of Michigan. The advantages of a clinician-directed system include: Assurance that clinical and patient-based factors are the primary determinants of strategic and procedural decisions; Responsiveness of the system to clinician needs; Maintenance of an important role for the referring physician in home care; Economical clinical research by facilitation of protocol therapy in ambulatory and home settings; Reduction of lengths of hospital stays through clinician initiatives; Incorporation of outcome analysis and other research programs into the mission of the system; Clinician commitment to success of the system; and Clinician input on revenue use. Potential disadvantages of a clinician-based system include: Entrepreneurial, financial, and legal naivete; Disconnection from institutional administrative and data management resources; and Inadequate clinician interest and commitment. The University of Michigan HomeMed experience demonstrates a model of clinician-initiated and -directed home care delivery that has been innovative, profitable, and clinically excellent, has engendered broad physician, nurse, pharmacist, and social worker enthusiasm, and has supported individual investigator clinical protocols as well as broad outcomes research initiatives. It is concluded that a clinician-initiated and -directed home care program is feasible and effective, and in some settings may be optimal.

Comprehensive Health Care↗
PubMedDate not supplied

Home parenteral nutrition: a hospital-based program with commercial logistic support.

Since home parenteral nutrition was introduced in the 1970's, a number of medical centers have formed successful home parenteral nutrition programs which have reduced expenses to the patient and third party payers by 50 to 73% over in hospital costs. However, the cost of maintaining these programs for training and follow-up has largely been absorbed by the hospital as a nonreimbursable teaching expense. To offset the costs of our growing program in these times of budget "caps," we have established an agreement between our hospital and commercial home care company which provides for patient instruction and follow-up by the hospital parenteral and enteral nutrition team and logistic support by the home care company. We used the average cost of our first five patients to establish a fee schedule which the commercial company agreed to pay the hospital parenteral and enteral nutrition team for its services. This agreement reduces the number of nurses and pharmacists that the commercial company would otherwise have to hire for teaching and follow-up of home care patients, and supports the concept of regional care in medical centers where parenteral and enteral nutrition teams maintain quality control, continuity of care, and efficient teaching programs for patients requiring home parenteral nutrition.

Delivery of Health Care↗
PubMedDate not supplied

Association of parenteral nutrition catheter sepsis with urinary tract infections.

The infection rate (IR) of central venous catheters (CVCs) used for parenteral nutrition (PN) was prospectively evaluated over a 12-month period, with emphasis on the relationship between CVC sepsis and preexisting sites of infection. Sepsis was presumed if the CVC tip or blood culture was positive, or if defervescence followed CVC removal. Four hundred seventy-three CVCs were placed for PN for a total of 5,422 patient days, with a mean length of stay of 11.5 days. Twenty two CVCs led to sepsis for an IR of 4.65% or 4.06 infections per 1000 patient days. Twenty of the 22 septic CVCs were in patients with other sites of infection. The IR was 12.0% (20/166) when other sites of infection were present and 0.65% (2/307) in the absence of a second site. The mean length of stay was 13.2 days for CVCs with other sites of infection and 10.3 days for CVCs with no other site of infection. Fifty nine percent of septic CVCs had secondary sites of infection that included urinary tract infections (UTI). Of all septic CVCs, 22.7% had no site of infection other than UTI. The presence of UTI appears to present a high risk of CVC sepsis. Appropriate identification and treatment of UTI prior to CVC insertion is recommended.

Catheters, Indwelling↗
PubMedDate not supplied

Total parenteral nutrition catheter sepsis: impact of the team approach.

For a period of 32 months from the inception of the Parenteral and Enteral Nutrition (PEN) Team at the University of Michigan, the infection rate (IR) related to central venous catheters (CVCs) for total parenteral nutrition (TPN) was prospectively evaluated. Six hundred twenty-two catheters were placed in 377 patients for a total of 9,200 patient days. The length of CVC stay ranged from 2 to 108 days with a mean of 14.5. CVC longevity was longer on units where certification of nurses by the PEN team was mandatory (mean 20.4 days, IR 3.5%) vs comparable units which utilized informal instruction (mean 14.4 days, IR 3.5%). Twenty-two catheters led to patient sepsis for a rate of 3.5%, or 2.39 CVC-related infections per 1000 patient days. The preteam infection rate was 24.0%, as determined by a 6-month prospective study. Infection rates for CVCs used for TPN only and those used for parenteral nutrition (PN) plus blood products, antibiotics, and CVP measurements were identical, 3.5%. The team approach can effectively increase PN catheter longevity and reduce infection rates. Conservative cost accounting of best and worst case scenarios determined a range of $3,700 to $8,900 per episode of catheter sepsis.

Catheters, Indwelling↗