Control of communicable disease at district level.
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As nonlabor costs in health care increase disproportionately, changes in storeroom operations will become an important cost containment tool.
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Growing concern about the sustainability of the Canada Pension Plan has led to a closer look at the disability benefits it provides. The federal auditor general reported recently that the number of recipients has almost doubled in the past 10 years, and disability payments have more than tripled, to $3 billion annually. This article looks at the role physicians play in determining whether an applicant is disabled.
Operating rooms require a storage, dispensing and accounting system for restricted drugs which satisfies narcotics control authorities and is compatible with efficient care of patients. We describe narcotic kits containing fentanyl-morphine-midazolam, alfentanil-midazolam and sufentanil-midazolam, for general operating rooms, and two kits with larger quantities of fentanyl and sufentanil for cardiac operating rooms. The container for each kit is a video cassette holder which has a foam-rubber liner with sculpted depressions for each ampoule. Sealed kits are delivered each morning from pharmacy to the locked narcotics cupboard in the recovery room. On request, the recovery room nurse unlocks the cupboard and the anaesthetist signs out the required kit(s) for the day. A drug utilization form is enclosed with each kit, on which the anaesthetist records the amount of drug administered to each patient, and before returning the kit to the locked narcotics cupboard, the total amount of each drug used, discarded, and returned. Used kits are collected the following morning by a pharmacy technician who reconciles the contents and drug form of each kit. More than 40 staff anaesthetists and a similar number of residents have used the system for seven years, during which time 130,000 patients have passed through the operating rooms. Detection of one case of drug diversion by a staff anaesthetist was made partly by the control system, but mainly by behavioural changes. The system is simple, inexpensive, and effective and has been well received by the departments of pharmacy, anaesthesia, and nursing.
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BACKGROUND: Patients with ovarian cancer often report having symptoms for months before diagnosis, but such findings are subject to recall bias. The aim of this study was to provide an objective evaluation of symptoms that precede a diagnosis of ovarian cancer. METHODS: Medicare provider claims linked to records in the California Surveillance, Epidemiology, and End Results data base were utilized to extract diagnosis and procedure codes for 1985 women age 68 years or older who resided in California with ovarian cancer, 6024 elderly women with localized breast cancer, and 10,941 age-matched, Medicare-enrolled women without cancer. Prevalence of rates of symptom-related diagnoses and procedure codes in Medicare claims records were obtained during 3-month periods up to 36 months before diagnosis of ovarian cancer. RESULTS: From 1 month to 3 months before patients were diagnosed with ovarian cancer, the frequency and adjusted odds ratios (ORs) with 95% confidence intervals (95%CIs) for 4 "target symptom" code groups were: abdominal pain (frequency, 30.6%; OR, 6.0; 95%CI, 5.1-6.9), abdominal swelling (frequency, 16.5%; OR, 30.9; 95%CI, 21.4-44.8), gastrointestinal symptoms (frequency, 8.4%; OR, 2.3; 95%CI, 1.8-3.0), and pelvic pain (frequency, 5.4%; OR, 4.3; 95%CI, 2.8-6.7). The adjusted odds for abdominal swelling codes was elevated 10-12 months before diagnosis (OR, 2.4; 95%CI, 1.2-4.6) for abdominal pain codes 7-9 months before diagnosis (OR, 1.3; 95%CI, 1.1-1.7). Abdominal imaging (frequency, 7.0%; OR, 1.3; 95%CI, 1.0-1.7) and pelvic imaging/CA125 (frequency, 3.7%; OR, 2.4; 95%CI, 1.7-3.4) showed an elevated frequency and adjusted odds 4-6 months before diagnosis. Patients with claims codes for "target symptoms" 4-36 months before diagnosis were more likely to have abdominal imaging (61.1%) or gastrointestinal procedures (30.8%) than pelvic imaging/CA125 (25.3%). CONCLUSIONS: Patients with ovarian cancer were more likely than patients with breast cancer and women in a cancer-free control group to have target symptom codes (particularly abdominal swelling and pain) > 6 months before diagnosis. The evaluation of women with unexplained "target symptoms" should include pelvic imaging and/or CA125.
This study compares the characteristics of 492 patients discharged against medical advice from the Istituto Dermopatico dell'Immacolata, a Research Hospital (335 beds) in Rome specialized in Dermatology, Vascular Surgery and Plastic Surgery between 1995 and 1998, with those of 43,110 control patients discharged with physicians' approval according to a case-control model. In the multivariate analysis, male gender (OR 1.65; 95% CI 1.37-1.98) and residence in Rome area (OR 1.22; 95% CI 1.02-1.47) increased the odds of discharge against medical advice. The odds of such discharge decreased with increasing age (OR 0.994 per year; 95% CI 0.990-0.999). The proportion of patients discharged against medical advice decreased from 1.4% in 1995 to 0.4% in 1998. The average length of stay decreased from 1995 to 1998, with the exception of the Plastic Surgery unit. A retrospective review of the charts of 45 patients discharged against medical advice (AMA) within 48 hours from admission ascertained some of the stated reasons for discharge. Personal and family problems or refusal of treatment were reported for 35% of the patients. Of the 25 patients who gave no reasons, 11 asked again for hospitalization and 5 of these were rehospitalized by IDI within 10 days. This study also identified that the information on the medical record of patients who left against medical advice was generally poor. A standardized form for AMA discharges, including patient's understanding of the diagnosis, treatment, alternative therapies, consequences of refusing treatment and stated reasons for leaving against medical advice, might be of benefit to patients, physicians and hospital managers.
Recent anti-fraud enforcement policies across the US health-care system have led to widespread speculation about the effectiveness of increased penalties for overcharging practices adopted by health-care service organizations. Severe penalties, including imprisonment, suggest that fraudulent billing, and related misclassification of services provided to patients, would be greatly reduced or eliminated as a result of increased government investigation and reprisal. This study sought to measure the extent to which health information managers reported being influenced by superiors to manipulate coding and classification of patient data. Findings from a nationwide survey of managers suggest that such practices are still pervasive, despite recent counter-fraud legislation and highly visible prosecution of fraudulent behaviors. Examining variation in influences exerted from both within and external to specific service delivery settings, results suggest that pressure to alter classification codes occurred both within and external to the provider setting. We also examine how optimization influences vary across demographic, practice setting, and market characteristics, and find significant variation in influence across practice settings and market types. Implications for reimbursement programs and evidence-based health care are discussed.
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An evaluation of the quarterly Infectious Disease Report for Northumberland was undertaken by postal questionnaire. The response to the survey was encouraging, suggesting that this method of communicating local information is not only acceptable, but also effective and perceived as having a positive impact on practice.
You've cut and cut and cut costs; sometimes it feels that if your cut any more, you'd hit bone. But the financial pressures haven't relented, and there's no sign they will any time soon. So hospitals are recognizing that cost-cutting is fine as far as it goes, but the time has come to cultivate new sources of revenue. They're looking under all the usual rocks--coding their reimbursement claims more effectively, negotiating better contracts with managed care companies and stepping up collection efforts--and seeking ways to reemphasize profitable services.
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