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Health Services Insights

Tagore Sunkara, Emmanuel Ofori, Vadim Zarubin, Megan E Caughey, Vinaya Gaduputi, Madhavi Reddy
Direct oral anticoagulants (DOACs) are in wide use among patients requiring both short- and long-term anticoagulation, mainly due to their ease of use and the lack of monitoring requirements. With growing use of DOACs, it is imperative that physicians be able to manage patients on these medications, especially in the perioperative period. We aim to provide guidance on the management of DOACs in the perioperative period. In this review, we performed an extensive literature search summarizing the management of patients on direct-acting anticoagulants in the perioperative period...
2016: Health Services Insights
Samuel H LiPuma, Joseph P DeMarco
The National Hospice and Palliative Care Organization (NHPCO) upholds policies prohibiting practices that deliberately hasten death. We find these policies overly restrictive and unreasonable. We argue that under specified circumstances it is both reasonable and morally sound to allow for treatments that may deliberately hasten death; these treatments should be part of the NHPCO guidelines. Broadening such policies would be more consistent with the gold standard of bioethical principles, ie, respecting the autonomy of competent adults...
2016: Health Services Insights
Gilda Diaz-Fuentes, Hafiz Rizwan Talib Hashmi, Sindhaghatta Venkatram
This review describes the perioperative management of patients with suspected or established pulmonary conditions undergoing non-cardiothoracic surgery, with a focus on common pulmonary conditions such as obstructive airway disease, pulmonary hypertension, obstructive sleep apnea, and chronic hypoxic respiratory conditions. Considering that postoperative pulmonary complications are common and given the increasing number of surgical procedures and the size of the aging population, familiarity with current guidelines for preoperative risk assessment and intra- and postoperative patient management is recommended to decrease the morbidity and mortality...
2016: Health Services Insights
Hassan Tariq, Rafeeq Ahmed, Salil Kulkarni, Sana Hanif, Omesh Toolsie, Hafsa Abbas, Sridhar Chilimuri
Lee first described the concept of preoperative assessment testing (PAT) clinic in 1949. An efficiently run clinic is associated with increased cost-effectiveness by lowering preoperative admission time and thus reducing the length of stay and the associated costs. The setup of the PAT clinic should be based on the needs, culture, and resources of the institution. Various models for the setup of PAT clinic have been described, including the concept of a perioperative surgical home, which is a patient-centered model designed to improve health and the delivery of health care and to reduce the cost of care...
2016: Health Services Insights
Ugochukwu U Onyeonoro, Okechukwu S Ogah, Andrew U Ukegbu, Innocent I Chukwuonye, Okechukwu O Madukwe, Akhimiem O Moses
BACKGROUND: Understanding the differences in care-seeking pattern is key in designing interventions aimed at improving health-care service delivery, including prevention and control of noncommunicable diseases. The aim of this study was to identify the differences and determinants of care-seeking patterns of urban and rural residents in Abia State in southeast Nigeria. METHODS: This was a cross-sectional, community-based, study involving 2999 respondents aged 18 years and above...
2016: Health Services Insights
Christopher S Hollenbeak, Ruth S Weinstock, Donald Cibula, Linda M Delahanty, Paula M Trief
BACKGROUND: The Support, Health Information, Nutrition, and Exercise (SHINE) trial recently showed that a telephone adaptation of the Diabetes Prevention Program (DPP) lifestyle intervention was effective in reducing weight among patients with metabolic syndrome. The aim of this study is to determine whether a conference call (CC) adaptation was cost effective relative to an individual call (IC) adaptation of the DPP lifestyle intervention in the primary care setting. METHODS: We performed a stochastic cost-effectiveness analysis alongside a clinical trial comparing two telephone adaptations of the DPP lifestyle intervention...
2016: Health Services Insights
Charlene Harrington, John F Schnelle, Margaret McGregor, Sandra F Simmons
Many U.S. nursing homes have serious quality problems, in part, because of inadequate levels of nurse staffing. This commentary focuses on two issues. First, there is a need for higher minimum nurse staffing standards for U.S. nursing homes based on multiple research studies showing a positive relationship between nursing home quality and staffing and the benefits of implementing higher minimum staffing standards. Studies have identified the minimum staffing levels necessary to provide care consistent with the federal regulations, but many U...
2016: Health Services Insights
Erin K Greenleaf, Amanda B Cooper, Christopher S Hollenbeak
BACKGROUND: Marital status is a known prognostic factor in overall and disease-specific survival in several types of cancer. The impact of marital status on survival in patients with carcinoid tumors remains unknown. We hypothesized that married patients have higher rates of survival than similar unmarried patients with carcinoid tumors. METHODS: Using the Surveillance, Epidemiology, and End Results database, we identified 23,126 people diagnosed with a carcinoid tumor between 2000 and 2011 and stratified them according to marital status...
2016: Health Services Insights
Charles D Phillips
A variety of new treatments for dementia are awaiting or undergoing randomized clinical trails. These trials focus on outcomes such as changes in cognitive function, physical function, or amyloid plaques. What is quite important and is too often missing from these trials are estimates of the impact of these treatments on the social and individual costs of providing care for those facing dementia. Until outcomes such as family caregiver time and caregiver burden are included in trails of dementia treatments, the picture of how well these treatments work will be distressingly incomplete...
2016: Health Services Insights
Charles D Phillips
Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large state in the USA. Using classification and regression tree analyses, a case-mix model for long-term pediatric home care was developed...
2015: Health Services Insights
Ugochukwu U Onyeonoro, Joseph N Chukwu, Charles C Nwafor, Anthony O Meka, Babatunde I Omotowo, Nelson O Madichie, Chidubem Ogbudebe, Joy N Ikebudu, Daniel C Oshi, Ngozi Ekeke, Nsirimobu I Paul, Chukwuma B Duru
OBJECTIVE: Knowing tuberculosis (TB) patients' satisfaction enables TB program managers to identify gaps in service delivery and institute measures to address them. This study is aimed at evaluating patients' satisfaction with TB services in southern Nigeria. MATERIALS AND METHODS: A total of 378 patients accessing TB care were studied using a validated Patient Satisfaction (PS-38) questionnaire on various aspects of TB services. Factor analysis was used to identify eight factors related to TB patient satisfaction...
2015: Health Services Insights
Charles D Phillips, Catherine Hawes
The vast majority of assessment instruments developed to assess children facing special healthcare challenges were constructed to assess children within a limited age range or children who face specific conditions or impairments. In contrast, the interRAI Pediatric Home Care (PEDS HC) Assessment Form was specifically designed to assess the long-term community-based service and support needs of children and youth aged from four to 20 years who face a wide range of chronic physical or behavioral health challenges...
2015: Health Services Insights
Christopher S Hollenbeak, Eric W Schaefer, Janice Penrod, Susan J Loeb, Carol A Smith
Little is known about the efficiency of health care in correction settings. This article reports an efficiency analysis of health care in state correctional institutions (SCIs) in a single, mid-Atlantic state from 2003 to 2006. A two-stage data envelopment analysis was used to estimate the technical efficiency of prison health care and determine inmate and institutional characteristics that were associated with efficiency. Our output variable was the number of infirmary inpatient days for each year of study...
2015: Health Services Insights
Andrew S Camarata, Dana C Nickleach, Ashesh B Jani, Peter J Rossi
Surveillance, Epidemiologic, and End Results (SEER) registry data abstracted from a priority 2 or higher reporting source from 2006 to 2008 were used to compare treatment patterns in 45-64-year old men diagnosed with locoregional prostate cancer (LRPC) across states with or without radiation therapy-directed certificate of need (CON) laws and across independent cancer centers (ICCs) compared to large multi-specialty groups (LMSGs). Adjusted treatment percentages for the five most common LRPC treatments (surgery, external beam radiation therapy (EBRT), combination brachytherapy with EBRT, brachytherapy, and observation) were compared using cross-sectional logistic regression between CON-unregulated and -regulated states and between LMSGs and ICCs...
2015: Health Services Insights
Antoine Kossaify, Nicolas Moussallem
Scientific societies in medicine theoretically aim to improve a medical field as a science; however, this role is expanding nowadays to seeking also the improved practice of a certain medical field. In this regard, the current Lebanese Society of Cardiology (2013-2015) has laid many plans and considered many perspectives. These concern mainly, but not exclusively, the increase of public awareness regarding prevention, investment in research, implementation of guidelines, support of continuous medical education, organization of cardiology symposia and congresses, and achievement of national registries regarding main cardiac conditions, as well as the society's main objective of decreasing the burden of cardiovascular diseases in Lebanon...
2014: Health Services Insights
Ashagre Molla, Netsanet Fentahun
Health insurance schemes are increasingly recognized as tools to finance health care provision in low-income countries. The main objective of this study was to find out the awareness of and demand for health insurance and to identify those reasons that influence the demand in Jimma town, southwest Ethiopia. We conducted a community-based cross-sectional quantitative study on 741 households from December 1 to December 31, 2012. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 16...
2014: Health Services Insights
Nava Blum, Dafna Halperin, Youssef Masharawi
This review article compares ambulatory and hospital-based quality improvement methods in Israel. Data were collected from: reports of the National Program for Quality Indicators in community, the National Program for Quality Indicators in Hospitals, and from the Organization for Economic Cooperation and Development (OECD) Reviews of Health Care Quality.
2014: Health Services Insights
Daniel W Karlsberg, Read G Pierce
Many teaching hospitals employ a care team structure composed of a broad range of healthcare providers with different skill sets. Each member of this team has a distinct role and a different level of training ranging from attending physician to resident, intern, and medical student. Often times, these different roles lead to greater complexity and confusion for both patients and nursing staff. It has been demonstrated that patients have a great degree of difficulty in identifying members of their care team...
2014: Health Services Insights
Seira Ito, Noriko Sudo, Yoko Fujiwara
Mass care feeding for disaster evacuees is an important component of public health preparedness. If universities that offer a training course for registered dietitians could provide food assistance to the evacuated people in their campus, it could contribute to maintain their health. Many universities are expected to become a base of support activities for people affected by disaster. This study aimed to reveal disaster preparedness in a university that offers a training course for registered dietitians, from the aspect of provision of mass care feeding...
2014: Health Services Insights
Wadi B Alonazi, Shane A Thomas
The aim of this study was to explore the impact of quality of care (QoC) on patients' quality of life (QoL). In a cross-sectional study, two domains of QoC and the World Health Organization Quality of Life-Bref questionnaire were combined to collect data from 1,059 pre-discharge patients in four accredited hospitals (ACCHs) and four non-accredited hospitals (NACCHs) in Saudi Arabia. Health and well-being are often restricted to the characterization of sensory qualities in certain settings such as unrestricted access to healthcare, effective treatment, and social welfare...
2014: Health Services Insights
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