Health Technology, Quality, Law, and Ethics

Tulchinsky, Theodore H.; Varavikova, Elena A.

doi:10.1016/b978-0-12-415766-8.00015-x

Cited by 7 publications

(5 citation statements)

References 49 publications

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“…Before introducing the diagnosis-related group payment model, hospitals were reimbursed using a days-of-care model. 25 Since then, Centers for Medicare and Medicaid Services has increasingly implemented financial disincentive programs such as the Hospital-Acquired Condition Reduction Program and Hospital Value-Based Purchasing to attempt to control health care costs by holding back reimbursements to low-performing hospitals. 26 In response, health care systems have increased pressure on surgeons to control SSI rates.…”

Section: Discussionmentioning

confidence: 99%

“…The measurement of LOS as a health system metric began in the 1980s with the introduction of the diagnosis-related group payments model by the Centers for Medicare and Medicaid Services, which introduced fixed-rate payments to hospitals. Before introducing the diagnosis-related group payment model, hospitals were reimbursed using a days-of-care model 25 . Since then, Centers for Medicare and Medicaid Services has increasingly implemented financial disincentive programs such as the Hospital-Acquired Condition Reduction Program and Hospital Value-Based Purchasing to attempt to control health care costs by holding back reimbursements to low-performing hospitals 26 .…”

Section: Discussionmentioning

confidence: 99%

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To close or not to close? Wound management in emergent colorectal surgery, an EAST Multicenter prospective cohort study

Feather,

Rehrig,

Allen

et al. 2024

J Trauma Acute Care Surg

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Background To determine the clinical impact of wound management technique on surgical site infection (SSI), hospital length of stay (LOS) and mortality in emergent colorectal surgery. Methods A prospective observational study (2021-2023) of urgent or emergent colorectal surgery patients at 15 institutions was conducted. Pediatric patients and traumatic colorectal injuries were excluded. Patients were classified by wound closure technique: skin closed (SC), skin loosely closed (SLC), or skin open (SO). Primary outcomes were SSI, hospital LOS and in-hospital mortality rates. Multivariable regression was used to assess the effect of wound closure on outcomes after controlling for demographics, patient characteristics, ICU admission, vasopressor use, procedure details and wound class. A priori power analysis indicated that 138 patients per group were required to detect a 10% difference in mortality rates. Results In total, 557 patients were included (SC n = 262, SLC n = 124, SO n = 171). Statistically significant differences in BMI, race/ethnicity, ASA scores, EBL, ICU admission, vasopressor therapy, procedure details, and wound class were observed across groups (Table 1). Overall, average LOS was 16.9 ± 16.4 days, and rates of in-hospital mortality and SSI were 7.9% and 18.5%, respectively, with the lowest rates observed in the SC group (Table 2). After risk adjustment, SO was associated with increased risk of mortality (OR = 3.003, p = 0.028 in comparison to the SC group. SLC was associated with increased risk of superficial SSI (OR = 3.439, p = 0.014), after risk adjustment. Conclusion When compared to the SC group, the SO group was associated with mortality, but comparable when considering all other outcomes, while the SLC was associated with increased superficial SSI. Complete skin closure may be a viable wound management technique in emergent colorectal surgery. Study Type Level III Therapeutic/Care Management

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

To close or not to close? Wound management in emergent colorectal surgery, an EAST Multicenter prospective cohort study

Feather,

Rehrig,

Allen

et al. 2024

J Trauma Acute Care Surg

View full text Add to dashboard Cite

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“…10 The preferential attention for participation of public providers may lead to questionable objectivity and conflict of interest as the government may soften the standards or surveying for the facilities they own. 11 This bias manifests more when there is a high proportion of private providers such that standards may not be set too high so that public providers can be accredited, leading to palpable inequalities in perceived quality among the two major groups. 10 Health insurance companies have the strongest link to incentivization but the risk of under-utilization of services for efficiency gains may undermine the quality assured by the accreditation process.…”

Section: Country Case Studies On Accreditation Systemsmentioning

confidence: 99%

“…10 However, it will still be the government that may have to bear most of the risk in financing, especially in situations where there is a wide government-led national health insurance program. 11 Lastly, the peer-led model where health or management professionals govern themselves according to quality of care is notable in the sense that professionals set the standards for their professional practice. Disagreements may be minimized as to the professional autonomy being perceived to be affected by models that are external to the professional bodies.…”

Section: Country Case Studies On Accreditation Systemsmentioning

confidence: 99%

“…10 Care must then be taken as this may theoretically heighten the standards beyond what is evidence-based and financially acceptable, especially when there is strong financial incentive for providers to be accredited. 11 Regardless of the model of the body, accreditation appears to improve quality across all facilities of the health care system regardless of the facility's accreditation status. 9 Majority of the literature provide evidence supporting the logical link between the organizational change of the facility and the respective outcomes measured.…”

Section: Country Case Studies On Accreditation Systemsmentioning

confidence: 99%

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Towards Universal Quality Health Care through an Independent Accreditation Agency: A Review

Borlongan¹,

Zarsuelo²,

Mendoza³

et al. 2020

Acta Med Philipp

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Background. Guaranteeing quality of health care services is part of the objectives of Republic Act No. 11223 or the Universal Health Care (UHC) Act of 2019. In assuring that quality services are delivered by health care providers, they must be accredited to participate in the National Health Insurance Program. The UHC Act mandates the Philippine Health Insurance Corporation (PhilHealth) to recognize third party mechanisms as basis of granting incentives for health facilities that deliver services of higher quality. This review aimed to identify lessons and experiences from literature that can be adopted and contextualized in the Philippine setting, for strategic policies on strengthening the national health facility accreditation system. Methods. A systematic review of literature was conducted to generate evidence-based recommendations from discussions on cross country experiences and local government initiatives towards improved accreditation system. Results. By virtue of the UHC Act, a form of strategic purchasing is further institutionalized through a rating system that incentivizes health facilities that provide better services in terms of quality, efficiency, and equity. It is imperative to consider the country’s previous and current gaps and challenges in accreditation and adopt the best practices of other countries, as appropriate to Philippine's local settings. A tool is proposed in creating a national hospital accreditation system using the domains of leadership and governance, financing and sustainability, standards development, program management, and continuing quality improvement. Conclusion and Recommendations. With the legitimacy of third party accreditation body mandated by the UHC Act, operationalization of the prescribed mechanisms and organizational structure must enjoin all pertinent stakeholders and be supported by sustainable funds and technical assistance by the government.

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Medtech innovation guide: an empiric model to support medical technology innovation

et al. 2022

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Innovation has become increasingly important for most industries to cope with rapid technological changes as well as changing societal needs. Even though there are many sectors with specific needs when it comes to supporting innovation, the medical technology sector is facing several unique challenges that both increases the lead-time from idea to finished product and decreases the number of innovations that are developed. This paper presents a proposed innovation guide that has been developed and evaluated as a support for the innovation process within medical technology research. The guide takes the unique characteristics of the medical technology sector into account and serves as a usable guide for the innovator. The complete guide contains both a structure for the process and a usable web application to support the journey from idea to finished products and services. The paper also includes a new readiness level, Sect. 4.2 to provide support both when developing and determining the readiness for clinical implementation of a medical technology innovation.

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Health Technology, Quality, Law, and Ethics

Cited by 7 publications

References 49 publications

To close or not to close? Wound management in emergent colorectal surgery, an EAST Multicenter prospective cohort study

To close or not to close? Wound management in emergent colorectal surgery, an EAST Multicenter prospective cohort study

Towards Universal Quality Health Care through an Independent Accreditation Agency: A Review

Medtech innovation guide: an empiric model to support medical technology innovation

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