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Results for “Forms and Records Control”

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At least 433 records · Page 24Linked to original sources

PubMed1999

Practical methods to increase use of advance medical directives.

OBJECTIVE: To compare the effectiveness of two means for increasing the use of advance medical directives: written materials only versus written materials and an educational videotape. DESIGN: Population-based, randomized controlled trial with 3-month follow up. SETTING: Kaiser Permanente Colorado Region, a not-for-profit group-model health maintenance organization. PARTICIPANTS: A population-based sample of all 1,302 members aged 75 years and older who used the Franklin Medical Office, excluding 55 persons who died or disenrolled during the study period or were identified by their physicians as blind or cognitively impaired. INTERVENTIONS: All subjects were mailed a 10-page cartoon-illustrated educational pamphlet on patient choices, a selection of Colorado advance medical directive forms, and a guide to their completion; 619 subjects also were mailed a 20-minute videotape on advance directives. Both groups had access to a study nurse for assistance in completing and placing advance medical directives. MEASUREMENTS AND MAIN RESULTS: The main outcome measure is the proportion of subjects who placed a directive in their medical record for the first time. Placement rates increased almost identically, from 21.2% to 35.0% in the written materials-only group and from 18.9% to 32.6% in the group receiving the videotape (95% confidence interval for difference -0.04, 0.04, p =.952). CONCLUSIONS: In an elderly population with a substantial baseline placement rate, mailing of written materials substantially increased placement of an advance directive in the medical record, but the addition of a videotape did not. Mailing the video did increase the use of treatment trials and made patients more aware of reasons not to use advance directives.

Advance Directives↗

PubMed2001

Charge-process strategies for outpatient prospective payment.

One of the most important strategies for operating successfully under the outpatient prospective payment system is to establish an effective charging process. Achieving control of the process begins with a thorough assessment of chargemaster coding, how charges are structured in the chargemaster, and how hospital departments use the charges. Once problems are identified and corrected, the next step is to develop a system to maintain and monitor both the chargemaster and the charging process. Perhaps the most important component of the monitoring system is to include a mechanism to provide the necessary feedback to departments regarding errors related to the charge process.

Ambulatory Care↗

PubMed2004

A two-step medically based injury surveillance system--experiences from the Oslo injury register.

This paper presents a two-step injury surveillance system. In the first step, limited data (a minimum data set) on all (or a representative sample of all) injuries to residents and non-residents within a defined geographical area were obtained using routine collection procedures within the medical care system. The second step involved periodically sampling of specific injuries, injured persons, or places for in-depth investigations from the database established by the first step, or selecting relevant injured persons seeking treatment in the medical care system, to collect many data (an expanded data set) on a limited number of injuries. This system was implemented in Oslo. Data from about 48,000 injuries were collected annually. Two in-depth investigations of serious occupational injuries were carried out. The first involved 223 cases and the second, 50 cases. Some in-site studies were included. Experiences from the implementation in Oslo suggest that this system can function in the medical care system and provide data required for making estimates of injury incidence rates, establishing trends, and on contributing factors to injuries. A crucial factor in the success of the first part of such a system is to have enough resources for continuous quality control and feedback to personnel involved in the registration of data. Combining the registered data from general practitioners, accident and emergency departments, hospitals and notifications of fatalities in Oslo, and on assessments of the number of injuries treated by private clinics and occupational health centres in Oslo, and in the health care system outside of Oslo, leads to the conclusion that 11.9% of the residents of Oslo will annually be treated for an injury.

Epidemiologic Methods↗

PubMed2001

The application of statistical process control charts to the detection and monitoring of hospital-acquired infections.

The monitoring of infection control indicators including hospital-acquired infections is an established part of quality maintenance programmes in many health-care facilities. However, surveillance data use can be frustrated by the infrequent nature of many infections. Traditional methods of analysis often provide delayed identification of increasing infection occurrence, placing patients at preventable risk. The application of Shewhart, Cumulative Sum (CUSUM) and Exponentially Weighted Moving Average (EWMA) statistical process control charts to the monitoring of indicator infections allows continuous real-time assessment. The Shewhart chart will detect large changes, while CUSUM and EWMA methods are more suited to recognition of small to moderate sustained change. When used together, Shewhart and EWMA methods are ideal for monitoring bacteraemia and multiresistant organism rates. Shewhart and CUSUM charts are suitable for surgical infection surveillance.

Australia↗

PubMed1993

Antibiotic surveillance: the results of a clinical pharmacy intervention program.

One of the major goals of any medical center is to provide safe, cost-effective drug therapy. To ensure rational antimicrobial therapy and control hospital drug costs, a criteria-based antibiotic surveillance program was developed. This method of antibiotic restriction provided exceptional cost savings in our institution. Clinical pharmacy interventions resulted in physician education and an 18% increase in compliance with the program criteria producing in a one-year period a $43,000 cost avoidance for antibiotic expenditures.

Anti-Bacterial Agents↗

PubMed1994

Security Audit Center--a suggested model for effective audit strategies in health care informatics.

As dependence upon interorganizational and international health care informatics becomes absolute, and with increased vulnerability of information networks and applications and the cunning sophistication of computer criminals, it becomes imperative to implement tight information systems security to ward off any possible threat to these vital life-dependent information systems. In a rapidly decentralizing environment, the author proposes centralized security control, implemented in a Security Audit Center under the direct supervision of an Information Systems Security Manager who is a high-ranking organization staff member. Of the various components of the Security Audit Center, the most significant is the security audit expert systems which analyze audit data files according to security rules and present a precise status of systems security and realtime suspicion alert of the various breaches and intrusions.

Automation↗

PubMed1998

Proper coding and billing for office services.

The information revolution has effected tumultuous change in the process by which physicians receive compensation for their services. In an effort to predict and control costs, a labyrinthine coding system, together with multilayered rules and regulations, has been developed to pinpoint medical function. Computerization of the insurance industry allows vigilant scrutiny of the physicians claims. Since noncompliance with payment rules now carries legal or monetary consequences, physicians need to pay careful attention to payer methodology, not only to fulfill the requirements of the law but also to receive accurate and optimal reimbursement. This article is designed to help practitioners unscramble these exacting mandates and stay in alignment.

Fees and Charges↗

PubMed2001

Maltreatment perpetrators: a 54-month analysis of recidivism.

OBJECTIVE: This study compared recidivism rates for alleged maltreatment perpetrators whose initial report was substantiated and those whose initial report was not substantiated, to determine whether they returned to the child welfare system at differing rates. METHOD: Statewide administrative child welfare services data over a period of 4 1/2 years was analyzed. The sample included 31,531 perpetrators of intrafamilial maltreatment. Separate analyses were conducted for each type of maltreatment (sexual abuse, physical abuse, and neglect). RESULTS: Bivariate relationships (substantiation status and recidivism) were analyzed using survival curves, and the study found that recidivism patterns differed by type of maltreatment and by substantiation status at the index event. Multivariate analyses using Cox Proportional Hazards models found that bivariate relationships held true even when controlling for neighborhood mean income, ethnicity, and gender. CONCLUSIONS: The study's finding that perpetrators whose index event was not substantiated return to the child welfare system at a high rate suggests the need to learn how to discriminate those unsubstantiated alleged perpetrators who are most at risk for recidivism. The finding of frequent cross-type recidivism indicates that intervention should focus on common themes across maltreatment types.

Adolescent↗

PubMed2006

Improving preventive service delivery at adult complete health check-ups: the Preventive health Evidence-based Recommendation Form (PERFORM) cluster randomized controlled trial.

BACKGROUND: To determine the effectiveness of a single checklist reminder form to improve the delivery of preventive health services at adult health check-ups in a family practice setting. METHODS: A prospective cluster randomized controlled trial was conducted at four urban family practice clinics among 38 primary care physicians affiliated with the University of Toronto. Preventive Care Checklist Forms were created to be used by family physicians at adult health check-ups over a five-month period. The sex-specific forms incorporate evidence-based recommendations on preventive health services and documentation space for routine procedures such as physical examination. The forms were used in two intervention clinics and two control clinics. Rates and relative risks (RR) of the performance of 13 preventive health maneuvers at baseline and post-intervention and the percentage of up-to-date preventive health services delivered per patient were compared between the two groups. RESULTS: Randomly-selected charts were reviewed at baseline (n = 509) and post-intervention (n = 608). Baseline rates for provision of preventive health services ranged from 3% (fecal occult blood testing) to 93% (blood pressure measurement), similar to other settings. The percentage of up-to-date preventive health services delivered per patient at the end of the intervention was 48.9% in the control group and 71.7% in the intervention group. This is an overall 22.8% absolute increase (p = 0.0001), and 46.6% relative increase in the delivery of preventive health services per patient in the intervention group compared to controls. Eight of thirteen preventive health services showed a statistically significant change (p < 0.05) in favor of the intervention (adjusted RR (95% C.I.)): counseling on brushing/flossing teeth (9.2 (4.3-19.6)), folic acid counseling (7.5 (2.7-20.8)), fecal occult blood testing (6.7 (1.9-24.1)), smoking cessation counseling (3.9 (2.2-7.2)), tetanus immunization (3.0 (1.7-5.2)), history of alcohol intake (1.33 (1.2-1.5)), history of smoking habits (1.28 (1.2-1.4)) and blood pressure measurement (1.05 (1.00-1.10)). CONCLUSION: This simple, low cost, clinically relevant intervention improves the delivery of preventive health services by prompting physicians of evidence-based recommendations in a checklist format that incorporates existing practice patterns. Periodic updates of the Preventive Care Checklist Forms will allow a feasible and easy-to-use tool for primary care physicians to provide evidence-based preventive health services to adults at routine health check-ups. The forms can also be incorporated into an electronic health record. The Preventive Care Checklist Forms are accessible in English and French at the College of Family Physicians of Canada web site.

Adult↗

PubMed2006

The trials and tribulations of team-nursing.

AIM: The aim of this study was to review the team-nursing approach to care adopted by two general medical wards in a large private hospital. The delivery model of care was reviewed to determine the factors that enhance and/or hinder the timely delivery, continuity and communication of care. METHOD: All nursing and ancillary staff who worked on two medical wards at a private teaching hospital were invited to participate in the study. Thirty eight participants from the two wards took part in focus group discussions, individual interviews and completed the Staff Continuity of Care Questionnaire. FINDINGS: Findings indicated that achieving functionally sound teamwork is a complex task that is affected by the interplay of a number of organisational, patient and staff factors. Its smooth application is further affected by the uncertain and changing conditions on the wards, which are difficult to control and impact on the smooth delivery of patient care. The findings revealed strengths and weaknesses in teamwork, communication of care, documentation and discharge planning. The results also highlighted factors that enhance and hinder the smooth delivery of care. This paper details the factors that influence the delivery of care from the perspectives of nursing staff and makes recommendations to enhance the delivery of patient care using a team-nursing approach.

Attitude of Health Personnel↗

PubMed1992

Health care for all: a crisis of cost and access. A roundtable discussion: Part 1.

Primary care physicians are feeling the impact of a healthcare system in crisis. Many Americans have no health insurance, paperwork is consuming more and more of physicians' time, and concerns about controlling costs seem to overshadow the value of medical decision-making. Medicare protects the elderly, but low reimbursement fees act as a disincentive to accepting them as patients. Although there is a general consensus that reforms are needed, there are many different opinions on how this should be achieved. In this first part of a three-part roundtable discussion, seven experts in the fields of aging, medicine, and government discuss flaws in our current system and factors that are interfering with reform.

Canada↗

PubMed1995

Planning equipment acquisitions.

As the mire of healthcare reform continues to grow, many providers are developing an insatiable appetite for alternatives to the way they currently do business. For some, solutions come in the form of repackaging the same old stuff. Others have jumped recklessly into every managed, capitated, or reformed idea that has come along. Old-school thinkers are still awaiting government direction. Providers of quality healthcare face increasing demands on their shrinking capital funds. An aging population, indigent care, AIDS patients, medical waste disposal, nursing shortages, declining reimbursement, increasing labor costs, and the federal healthcare reform threat have negatively affected cash flow. Though previous cost-plus reimbursement encouraged wasteful spending, the threat of healthcare reform has already caused providers and suppliers alike to work together to cut costs even without government mandates. The impact has been the closure of over 600 facilities nationwide in the past ten years. More than 70,000 acute care hospital beds have been lost from the US healthcare system. Many healthcare facilities have merged into managed care systems, integrated delivery networks, and regional alliances whose costs can be consolidated and controlled. At the same time, new services and profit centers are also being created to increase revenue. A healthcare moves into alternative care environments--home care, ambulatory care, diagnostic testing--these providers need more capital equipment to serve an increased patient load. Coupled with an aging installed base of technology in the acute care environment, healthcare managers face an ever-growing need for capital equipment and creative financing programs to meet longer payment options.(ABSTRACT TRUNCATED AT 250 WORDS)

Capital Expenditures↗

PubMed2000

Quality improvement programme for cardiovascular disease risk factor recording in primary care.

OBJECTIVES: Evaluation of the effect of a quality improvement programme on cardiovascular disease (CVD) risk factor recording and risk factor levels in a controlled study at two primary health care centres serving 26,000 inhabitants in Northern Helsinki. METHODS: From a random sample of patient records from 1995 (n=1,066), 1996 (n=1,042), and 1997 (n=1,040) the frequency of CVD risk factor recording was measured and the changes in mean levels of total cholesterol, blood glucose, blood pressure, and body weight were monitored during the follow up period. The intervention programme (1995-1996) consisted of lectures and meetings of multiprofessional teams, development of local guidelines, and introduction of a structured risk factor recording sheet as part of the patient records. RESULTS: After the quality improvement period all risk factors were better recorded at the intervention station than at the control station (p<0.001). More high risk CVD patients were detected from the general population at the intervention station. The mean values of most measured risk factors changed during the intervention. During the follow up period differences were observed between the two health stations in the time trends for body weight, body mass index (BMI), total cholesterol, and glucose levels. Risk factor levels of high risk patients receiving CVD treatment decreased during the intervention. CONCLUSIONS: A simple quality improvement programme improved the practice of recording risk factors for CVD which resulted in earlier detection of patients with a high risk of developing the disease.

Adolescent↗

PubMed1997

Maximizing physician performance: a systems approach.

Managed care organizations are aware of the importance of managing the quality of care and controlling costs associated with the delivery of care. By utilizing physician-level performance reporting, an organization can help its physicians manage the organization's resources across the continuum of care. Physician participation can be obtained by developing a multicomponent program that includes opportunities for physician input regarding resource allocation and benefit packages; by articulating and documenting the organization's goals and priorities; by providing physicians with systemwide data related to indicators of their performance levels; and by offering financial incentives.

Continuity of Patient Care↗

PubMed2001

Toward a model for the evaluation of clinical coding systems.

OBJECTIVE: To demonstrate an empirical method to evaluate the utility of clinical coding systems. To use this method to assess the predictive power of two codes. METHOD: Controlled trial of two coding systems. SETTING: The Read Clinical Codes, version II and the International Classification of Primary Care (ICPC). OUTCOME MEASURES: The association between codes and pharmaceuticals prescribed. RESULTS: The power of both codes to predict pharmaceuticals increased with their precision. ICPC performed better than Read at the same level of precision. CONCLUSION: ICPC may be a more efficient coding system to use than Read. Assessment of the predictive power of a code is central to assessing its utility.

Diagnosis-Related Groups↗

PubMed2004

Audit of rabies post-exposure prophylaxis in England and Wales in 1990 and 2000.

The objectives were to compare rabies post-exposure prophylaxis issued by the Public Health Laboratory Service (PHLS) in 1990 and in 2000, to evaluate their appropriateness, and to make recommendations for future issue of rabies post-exposure prophylaxis in England and Wales. The method was to review all rabies vaccine and immunoglobulin issues by PHLS in 1990 and 2000 with evaluation against Department of Health recommendations. The PHLS issued prophylaxis to 656 people in 1990 and 295 people in 2000. The fall is attributable to control measures in Western Europe leading to a lower risk of exposure in countries in the region. Vaccine was still issued for exposures in countries with a category of 'no risk' (15 individuals) including rabies immunoglobulin in six cases. Immunoglobulin was frequently not issued for exposures in high-risk countries but the reasons were not always evident from the information provided; in many cases treatment had probably been started abroad. Delay before contacting the PHLS fell between 1990 and 2000 (p = 0.003). Dogs continue to be the most common animal exposure reported, and their rabies status is generally unknown. The most frequent site of bite was the leg. Prophylaxis was issued for exposure to some animals which have never been known to transmit rabies. Successful control measures in Europe have reduced the need for rabies prophylaxis in UK residents who travel abroad. More detailed information should be collected in future on aspects such as pre-exposure vaccination and treatment started abroad to facilitate future audit of appropriateness of treatment. A repeat audit should be carried out to evaluate the impact of a death from European Bat Lyssavirus 2 infection in a UK bat handler in November 2002.

Adolescent↗

PubMedDate not supplied

Euglycemic control of gestational diabetes mellitus by specific dietary manipulation: a case study presentation.

Gestational diabetes is the most common complication of pregnancy. If maternal hyperglycemia is not well controlled, excess glucose is transmitted to the fetus, which can lead to fetal macrosomia and maternal and fetal complications. Dietary treatment for gestational diabetes varies among practitioners. A case review is presented of a 32-year-old white woman with gestational diabetes whose condition was complicated by her blood glucose intolerance to lactose in milk. By following a carefully monitored regimen using specific dietary manipulation to maintain normoglycemia, the woman was able to deliver a normal, healthy baby by spontaneous vaginal delivery.

Adult↗

PubMed1989

A state population-based statutory reporting of dementias.

Dementia registries have been legislated or are under discussion in at least seven states (California, Florida, Maryland, Michigan, South Carolina, Illinois, and Virginia). Future reporting requirements and recommendations for state mandated reporting systems were discussed in February 1988 at the first Alzheimer's Disease Registry Workgroup Meeting, sponsored by the University of South Carolina; Centers for Disease Control; and Alzheimer's Disease and Related Disorders Association (ADRDA). The discussion clearly demonstrated the involvement of medical record professionals in influencing future reporting decisions. As the first state population-based statutory dementia registry, the New York State Alzheimer's Disease and Other Dementias Registry has faced unique problems and developed unique solutions. Both the problems and solutions have been defined with the help of medical record professionals from a variety of reporting institutions. This input occurred through phone calls, correspondence, participation in field trials and through professional organizations. Medical record personnel will continue to play a vital role in both supplying data to the New York State registry and in conceptualizing the needs of future registries in other states.

Alzheimer Disease↗