In this study, the authors examined causes of deaths or hospitalizations of adult home care patients during an 18-month period using a retrospective medical record audit. The site of the study was the home care program of a three-hospital system. Of 4,303 cases, 101 adult patients met study criteria of hospitalization or death. The death rate in the sample was 0.48%, and the hospitalization rate was 1.9%. Wound deterioration and falling accidents were principal causes for rehospitalizing patients. Increasing age and number of medications were significantly correlated with falls resulting in hospitalization. Patients who died were found to suffer from terminal illnesses and frailty, with care providers having little influence over outcomes. Opportunities to improve clinical care processes (e.g., discharge planning, patient status monitoring, signs and symptoms reporting, interdisciplinary communicating and coordinating) were also identified. The authors concluded that nearly 21% of hospitalizations were potentially preventable.
Shorter overall clinic visit duration, infusion process, and RA medication infusion times were observed for GLM-IV compared to IFX. A shorter duration in infusion time was associated with higher patient and clinic personnel satisfaction ratings.
This case study concerns relocating rheumatology patients at Duke University Medical Center to a new infusion center located in a physician based treatment setting. The case study follows the managerial decision-making process as it describes how the infusion center treatment site was chosen, how it was set up, how it functions, and what benefits to patient care it provides. A successful site-of-car relocation requires strong managers who are able to weigh objectively alternative courses of action. Moreover, the project champion must be able to distinguish key factors inside and outside the organization and chart the project's course accordingly.
Comprehensive measurement of the effort associated with a procedure, treatment, or project involves a myriad of planned observations and analyses. When accurately synthesized, these measurements show the amount of resources or the level of effort required for the intervention. In an era of unprecedented healthcare cost scrutiny, it is imperative for clinicians to understand and apply these components and methods to program development, budget management, staffing, and cost-to-outcome analysis. Through a series of on-site observations and interviews at in-office infusion centers providing a nonchemotherapeutic biologic therapy, specifically infliximab (Remicade), the investigators were able to isolate and assign value to the multiple factors that contribute to the cost of this procedure. The investigators also were able to establish a process model for clinicians who are inevitably involved in the "business" of healthcare.
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