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At least 199 records · Page 11Linked to original sources
PubMed1999

Is outpatient laparoscopic cholecystectomy safe and cost-effective? A model to study transition of care.

BACKGROUND: There is increasing pressure to perform traditional inpatient surgical procedures in an outpatient setting. The aim of the current trial was to determine the safety and cost savings of performing laparoscopic cholecystectomy in an outpatient setting using a "mock" outpatient setting. METHODS: Patients who were scheduled for laparoscopic cholecystectomy by four attending surgeons and for whom operating time was available in the outpatient center were studied. All patients received a standardized anesthetic, including ondansetron, and were discharged from the outpatient postanesthesia care unit if appropriate. At discharge, all patients were admitted to a clinical research center where they were observed in a "mock home" setting and monitored for complications that would have necessitated readmission. A decision analysis was created assuming all patients underwent outpatient surgery with either direct admission or discharge to home and readmission if complications developed. RESULTS: Of 99 patients who were enrolled in this study, 96 patients would have met the discharge criteria for home. No major complications were observed in these 96 patients. Eleven patients experienced postoperative nausea and vomiting, 3 of whom required an additional 24 h of hospital observation. In the decision model, the optimal strategy would be to perform the procedure on an outpatient basis and readmit patients only for complications, with an average baseline cost savings of $742/patient. CONCLUSIONS: The results show that outpatient laparoscopic cholecystectomy is safe and cost-effective in selected patients, and that the mock home setting provides a means of studying the safety of transition of care.

Adult↗
PubMedDate not supplied

An educational program to prepare acute care nurses for a transition to home health care nursing.

This article describes a continuing education program that prepares nurses with experience in acute care nursing for the transition to home health care nursing. The program is a 12-credit hour, two semester college program consisting of 8 hours of theory and 4 hours of clinical practicum. A coalition of hospitals, home health agencies and an educational institution designed the program to maintain the economic welfare of nurses in an era of hospital layoffs, promote professional development and enhance the transition of nurses to home health nursing.

Acute Disease↗
PubMed2005

Lithuanian health care in transitional state: ethical problems.

BACKGROUND: Throughout the economic and political reforms in post-communist countries, significant changes have also occurred in public morality. One of the tasks of the Lithuanian health policy is to create mechanisms for strengthening the significance of ethical considerations in the decision-making processes concerning health care of individuals and groups of individuals, as well as considering the positions of physicians and the health care system itself in a general way. Thus, health care ethics could be analyzed at two levels: the micro level (the ethics of doctor-patient relationships) and the macro level (the ethics of health policy-making, which can be realized by applying the principles of equal access, reasonable quality, affordable care and shared responsibilities). To date, the first level remains dominant, but the need arises for our attention to refocus now from the micro level to the patterns of managing and delivering care, managing the health care resources, and conducting business practices. DISCUSSION: In attempting to increase the efficiency of health services in Lithuania, a common strategy has been in place for the last fifteen years. Decentralization and privatization have been implemented as part of its policy to achieve greater efficiency. Although decentralization in theory is supposed to improve efficiency, in practice the reform of decentralization has still to be completely implemented in Lithuania. Debates on health policy in Lithuania also include the issue of private versus public health care. Although the approach of private health care is changing in a positive way, it is obvious that reduced access to health services is the most vulnerable aspect. In the Lithuanian Health Program adopted in July 1998, the target of equity was stressed, stating that by 2010, differences in health and health care between various socio-economic groups should be reduced by 25%. SUMMARY: The restructuring of health care system in Lithuania should be based on a balance between decentralization and centralization, and between public and private health care sectors. Successful transition requires a balanced role of the government. Today it is obvious in Lithuania that continuous encouragement to make sacrifices was not enough to induce the system to function well, and in an ethical manner.

Decision Making, Organizational↗
PubMed1989

Easing transitions in care delivery with a core training group.

A collaborative approach was used by the nursing staff of a state psychiatric hospital to make a transition from traditional nursing services to a self-care model on one ward. The core training group, including representatives from all levels of nursing staff, developed and evaluated a personal hygiene protocol for 30 patients with chronic mental illness. Underwood's adaptation of Orem's self-care model of nursing was modified to provide the framework for this protocol. Evaluation of the project demonstrated both improved personal hygiene for the patients and greater job satisfaction for the nursing staff. The collaborative core training group approach was effective in facilitating the transition to the self-care nursing model.

Hospital Bed Capacity, 300 to 499↗
PubMed2003

APN-directed transitional home care model: achieving positive outcomes for patients with COPD.

Advanced practice nurses (APNs) have not been widely used in home care, despite evidence of their effectiveness with a variety of patient groups. This study examined the use of the transitional model for home care patients with chronic obstructive pulmonary disease. The study found patients cared for by an APN-directed visit team had fewer nursing visits, rehospitalizations, and acute care visits. Depressive symptoms were also less, and functional abilities increased compared with patients cared for by a usual care model.

Cost-Benefit Analysis↗
PubMed1994

Primary care in transition.

It is generally agreed that too few physicians have chosen careers in primary care. The advent of managed care as a popular method of health care provision is now affecting primary care physicians in ways that may further discourage enthusiasm for the practice of primary care and have an unintended negative effect on the primary care physician supply. In addition, the early implementation of the resource-based relative value scale by Medicare and some insurance carriers has been less beneficial to primary care physicians than expected and may even have been harmful to general internists. Efforts to improve the position of primary care physicians in relation to payers and among peers are hindered by the fact that, as a group, primary care physicians are less affluent, less influential, and greatly outnumbered by their more specialized colleagues. Consequently, some of the support currently directed toward primary care may be more apparent than real. My proposals, which aim both to protect and to enhance primary care practice, are the creation of separate primary care fee schedules and separate primary care budgets within health plans, changes in consumer protection rules that intrude on primary care practice, and the development of statewide primary care associations for mutual support and greater bargaining power. Some aspects of contracting and gatekeeping require further study.

Career Choice↗
PubMedDate not supplied

[Health transition in Spain from 1900 to 1990].

BACKGROUND: The concept of health transition is intended to define, from a plural point of view, the changes in health conditions that have contributed to a decrease in mortality associated with the demographic transition. The purpose of the study is to analyse the health transition in Spain during this century (1900-1990). METHOD: The study of the different components of the health transition (epidemiological transition, risk transition and health care transition) has been based on historical series relating to Natural Population Changes. Annual Statistics and Housing Census Reports. RESULTS: Overall Mortality and Child Mortality rates have tended to decrease over the entire period: overall mortality has decreased by 70%, while child mortality has dropped by 96%. Life expectancy has increased by 42 years from 1900 (35) to 1990 (77), which in relative terms represents an increase of 120%. There has been a 95% decrease in infectious disease-related deaths and a 134% increase in non-infectious disease-related deaths. It can therefore be said that the epidemiological transition in Spain concluded in the fifties with the end of the previous pattern, mainly characterised by a high mortality rate (especially with respect to children), when the main cause of death was due to infectious diseases, then giving way to a new situation in which mortality rates dropped considerably and non-infectious diseases became the main cause of death (the turning point was in 1945). CONCLUSIONS: The new epidemiological trend that took place over the period studied appears to be the result of improved sanitary infrastructure and increased spending as well as better medical services, however also includes new health problems related to working conditions, massive urban development (particularly as of the sixties) and changes in lifestyle.

Adult↗
PubMed1984

Home care for life-supported persons: an approach to program development.

Eighteen ventilator-dependent children were returned to their homes from Illinois. Each candidate was selected according to physician-designated guidelines for medical stability as well as predetermined social-environmental and reimbursement criteria. Each individualized occurrence was organized according to a comprehensive home care plan. Unanticipated improvement in medical condition and psychosocial development has resulted at home. The children and families have returned to a safe environment that best promotes the health of all involved. In addition, initial cost savings were at least 70%. These demonstrations have evolved into an organized regional approach to the ventilator-dependent child which utilizes available resources. The required continuum of health care and personal services includes intermediate intensive care, respiratory rehabilitation, transitional care, home care, and community-oriented alternatives to home. Problems of the ventilator-dependent child are those encountered by all children with handicaps and their families. The appropriate solutions will provide models for other complex health care and societal issues.

Adolescent↗
PubMed1999

United States health care delivery system, reform, and transition to managed care.

The US health care delivery system, faced with an exponential increase in expenditures during the second part of the 20th century, was forced to explore ways to reduce costs and, at the same time, maintain a high quality of care. Managed care emerged as one of the answers and quickly became one of the predominant health care delivery models. While the cost of health care did go down, it remains unclear what the future holds. Currently, managed care is growing rapidly in publicly funded programs and the changes which are currently underway may be defining those programs in the time to come.

Delivery of Health Care↗
PubMed1988

A descriptive framework for new hospital roles in geriatric care.

Changes in demographics and in the operating environments of acute care hospitals have resulted in the development of new geriatric service products. Presented in this article is a framework for describing the variety of new services in terms of sponsor goals and core activities. Five broad types of geriatric service developments are described: geriatric medical care, post-acute care, transition management, chronic care, and information services. Assessing the implications of new services for the organizational functioning of hospitals is discussed, followed by an examination of the potential contributions of new geriatric services to the quality and accessibility of geriatric care.

Acute Disease↗