220 results on '"Clinical Competence economics"'
Search Results
2. A systematic review of low-cost simulators in ENT surgery.
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Pankhania R, Pelly T, Bowyer H, Shanmugathas N, and Wali A
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- COVID-19 diagnosis, COVID-19 epidemiology, COVID-19 virology, Clinical Competence economics, Clinical Competence statistics & numerical data, Computer Simulation statistics & numerical data, Curriculum, Databases, Factual, Humans, Models, Biological, SARS-CoV-2 isolation & purification, Simulation Training methods, United Kingdom epidemiology, Computer Simulation economics, Otolaryngology education, Simulation Training economics, Surgeons education
- Abstract
Background: Simulation training has become a key part of the surgical curriculum over recent years. Current trainees face significantly reduced operating time as a result of the coronavirus disease 2019 pandemic, alongside increased costs to surgical training, thus creating a need for low-cost simulation models., Methods: A systematic review of the literature was performed using multiple databases. Each model included was assessed for the ease and expense of its construction, as well as its validity and educational value., Results: A total of 18 low-cost simulation models were identified, relating to otology, head and neck surgery, laryngeal surgery, rhinology, and tonsil surgery. In only four of these models (22.2 per cent) was an attempt made to demonstrate the educational impact of the model. Validation was rarely formally assessed., Conclusion: More efforts are required to standardise validation methods and demonstrate the educational value of the available low-cost simulation models in otorhinolaryngology.
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- 2021
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3. Building regional anesthesia capacity in limited-resource settings: a pilot study evaluating a 4-week curriculum.
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Moll V, Schmidt PC, Amos C, Workneh RS, Tadesse M, Mulugeta E, and Abate A
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- Adult, Anesthesia, Conduction economics, Capacity Building economics, Clinical Competence economics, Ethiopia, Global Health, Humans, Internship and Residency economics, Pilot Projects, Anesthesia, Conduction methods, Capacity Building standards, Clinical Competence standards, Curriculum standards, Internship and Residency methods
- Abstract
Aim: To pilot a 4-week regional anesthesia curriculum for limited-resource settings. Intervention: A baseline needs assessment and knowledge test were deployed. The curriculum included lectures and hands-on teaching, followed by knowledge attainment tests. Results: Scores on the knowledge test improved from a mean of 37.1% (SD 14.7%) to 50.9% (SD 18.6%) (p = 0.017) at 4 weeks and 49% at 24 months. An average of 1.7 extremity blocks per month was performed in 3 months prior to the curriculum, compared with an average of 4.1 per month in 8 months following. Conclusion: This collaborative curriculum appeared to have a positive impact on the knowledge and utilization of regional anesthesia.
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- 2021
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4. Preparing Trainees to Deliver High-Value and Cost-Conscious Care in Hematology.
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Nagle SJ and Aakhus E
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- Attitude of Health Personnel, Cost-Benefit Analysis, Curriculum, Hematology economics, Hematology standards, Humans, Medical Overuse prevention & control, Clinical Competence economics, Clinical Competence standards, Education, Medical, Graduate economics, Education, Medical, Graduate standards, Health Care Costs standards, Hematology education, Quality Indicators, Health Care economics, Quality Indicators, Health Care standards
- Abstract
Purpose of Review: Despite national-level directives to reduce healthcare waste and promote high-value care (HVC), clinical educators struggle to equip trainees with the knowledge and skills needed to practice value-based care. In this review, we analyze ongoing efforts in graduate medical education (GME) to enhance trainee competence in delivery of high-value and cost-conscious care., Recent Findings: Surveys of residents and program directors have shown that while many training programs want to offer formal training in high-value care delivery, few succeed. Although several studies suggest that trainees model stewardship behaviors after clinical preceptors, there remains a shortage of faculty role models skilled in providing HVC. Preparing future hematologist-oncologists to provide cost-conscious care will require significant cultural change at the institutional and program levels and will depend heavily on the development of skilled clinical role models.
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- 2020
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5. Use of a Low-Cost Portable 3D Virtual Reality Gesture-Mediated Simulator for Training and Learning Basic Psychomotor Skills in Minimally Invasive Surgery: Development and Content Validity Study.
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Alvarez-Lopez F, Maina MF, and Saigí-Rubió F
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- Adult, Female, Humans, Psychomotor Performance, Clinical Competence economics, Computer Simulation economics, Costs and Cost Analysis methods, Imaging, Three-Dimensional methods, Minimally Invasive Surgical Procedures education, Virtual Reality
- Abstract
Background: Simulation in virtual environments has become a new paradigm for surgeon training in minimally invasive surgery (MIS). However, this technology is expensive and difficult to access., Objective: This study aims first to describe the development of a new gesture-based simulator for learning skills in MIS and, second, to establish its fidelity to the criterion and sources of content-related validity evidence., Methods: For the development of the gesture-mediated simulator for MIS using virtual reality (SIMISGEST-VR), a design-based research (DBR) paradigm was adopted. For the second objective, 30 participants completed a questionnaire, with responses scored on a 5-point Likert scale. A literature review on the validity of the MIS training-VR (MIST-VR) was conducted. The study of fidelity to the criterion was rated using a 10-item questionnaire, while the sources of content-related validity evidence were assessed using 10 questions about the simulator training capacity and 6 questions about MIS tasks, and an iterative process of instrument pilot testing was performed., Results: A good enough prototype of a gesture-based simulator was developed with metrics and feedback for learning psychomotor skills in MIS. As per the survey conducted to assess the fidelity to the criterion, all 30 participants felt that most aspects of the simulator were adequately realistic and that it could be used as a tool for teaching basic psychomotor skills in laparoscopic surgery (Likert score: 4.07-4.73). The sources of content-related validity evidence showed that this study's simulator is a reliable training tool and that the exercises enable learning of the basic psychomotor skills required in MIS (Likert score: 4.28-4.67)., Conclusions: The development of gesture-based 3D virtual environments for training and learning basic psychomotor skills in MIS opens up a new approach to low-cost, portable simulation that allows ubiquitous learning and preoperative warm-up. Fidelity to the criterion was duly evaluated, which allowed a good enough prototype to be achieved. Content-related validity evidence for SIMISGEST-VR was also obtained., (©Fernando Alvarez-Lopez, Marcelo Fabián Maina, Francesc Saigí-Rubió. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 14.07.2020.)
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- 2020
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6. A Structured Compensation Plan Results in Equitable Physician Compensation: A Single-Center Analysis.
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Hayes SN, Noseworthy JH, and Farrugia G
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- Academic Medical Centers economics, Academic Medical Centers statistics & numerical data, Clinical Competence economics, Ethnicity, Female, Humans, Leadership, Male, Models, Econometric, Physicians, Women economics, Physicians, Women standards, United States, Physician Incentive Plans statistics & numerical data, Physicians classification, Physicians economics, Physicians statistics & numerical data, Salaries and Fringe Benefits classification, Salaries and Fringe Benefits statistics & numerical data, Sex Factors
- Abstract
Objective: To assess adherence to and individual or systematic deviations from predicted physician compensation by gender or race/ethnicity at a large academic medical center that uses a salary-only structured compensation model incorporating national benchmarks and clear standardized pay steps and increments., Participants and Methods: All permanent staff physicians employed at Mayo Clinic medical practices in Minnesota, Arizona, and Florida who served in clinical roles as of January 2017. Each physician's pay, demographics, specialty, full-time equivalent status, benchmark pay for the specialty, leadership role(s), and other factors that may influence compensation within the plan were collected and analyzed. For each individual, the natural log of pay was used to determine predicted pay and 95% CI based on the structured compensation plan, compared with their actual salary., Results: Among 2845 physicians (861 women, 722 nonwhites), pay equity was affirmed in 96% (n=2730). Of the 80 physicians (2.8%) with higher and 35 (1.2%) with lower than predicted pay, there was no interaction with gender or race/ethnicity. More men (31.4%; 623 of 1984) than women (15.9%; 137 of 861) held or had held a compensable leadership position. More men (34.7%; 688 of 1984) than women (20.5%; 177 of 861) were represented in the most highly compensated specialties., Conclusion: A structured compensation model was successfully applied to all physicians at a multisite large academic medical system and resulted in pay equity. However, achieving overall gender pay equality will only be fully realized when women achieve parity in the ranks of the most highly compensated specialties and in leadership roles., (Copyright © 2019. Published by Elsevier Inc.)
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- 2020
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7. Incorporating High Value Care Into Gastroenterology Fellowship Training.
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Shah BJ and Jou JH
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- Clinical Competence economics, Education, Medical, Graduate standards, Gastroenterology economics, Gastroenterology education, Humans, Patient Care economics, Quality of Health Care economics, Clinical Competence standards, Fellowships and Scholarships standards, Gastroenterology standards, Patient Care standards, Quality of Health Care standards
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- 2020
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8. Cost-Efficient Medical Education: An Innovative Approach to Creating Educational Products.
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Kaplovitch E, Otremba M, Morgan M, and Devine LA
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- Canada, Clinical Competence economics, Cost-Benefit Analysis, Humans, Paracentesis methods, Spinal Puncture methods, Teaching, Computer-Assisted Instruction economics, Education, Medical, Graduate economics, Internal Medicine education, Internship and Residency economics
- Abstract
Background: Cost is a barrier to creating educational resources, and new educational initiatives are often limited in distribution. Medical training programs must develop strategies to create and implement cost-effective educational programming., Objective: We developed high-quality medical programming in procedural instruction with efficient economics, reaching the most trainees at the lowest cost., Methods: The Just-In-Time online procedural program was developed at the University of Toronto in Canada, aiming to teach thoracentesis, paracentesis, and lumbar puncture skills to internal medicine trainees. Commercial vendors quoted between CAD $50,000 and $100,000 to create 3 comprehensive e-learning procedural modules-a cost that was prohibitive. Modules were therefore developed internally, utilizing 4 principles aimed at decreasing costs while creating efficiencies: targeting talent, finding value abroad, open source expansion, and extrapolating efficiency., Results: Procedural modules for thoracentesis, paracentesis, and lumbar puncture were created for a total cost of CAD $1,200, less than 3% of the anticipated cost in utilizing traditional commercial vendors. From November 2016 until October 2018, 1800 online instructional sessions have occurred, with over 3600 pageviews of content utilized. While half of the instructional sessions occurred within the city of Toronto, utilization was documented in 10 other cities across Canada., Conclusions: The Just-in-Time online instructional program successfully created 3 procedural modules at a fraction of the anticipated cost and appeared acceptable to residents based on website utilization., Competing Interests: Conflict of interest: The authors declare they have no competing interests., (Accreditation Council for Graduate Medical Education 2019.)
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- 2019
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9. A nurse-led implantable loop recorder service is safe and cost effective.
- Author
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Lim WY, Papageorgiou N, Sukumar SM, Alexiou S, Srinivasan NT, Monkhouse C, Daw H, Caldeira H, Harvie H, Kuriakose J, Baca M, Ahsan SY, Chow AW, Hunter RJ, Finlay M, Lambiase PD, Schilling RJ, Earley MJ, and Providencia R
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- Adult, Aged, Clinical Competence economics, Cost Savings, Cost-Benefit Analysis, Databases, Factual, Female, Humans, Male, Middle Aged, Monitoring, Ambulatory instrumentation, Predictive Value of Tests, Remote Sensing Technology instrumentation, Retrospective Studies, Workflow, Ambulatory Care economics, Health Care Costs, Monitoring, Ambulatory economics, Monitoring, Ambulatory nursing, Nurse's Role, Physician's Role, Remote Sensing Technology economics, Remote Sensing Technology nursing
- Abstract
Introduction: Implantable loop recorders (ILR) are predominantly implanted by cardiologists in the catheter laboratory. We developed a nurse-delivered service for the implantation of LINQ (Medtronic; Minnesota) ILRs in the outpatient setting. This study compared the safety and cost-effectiveness of the introduction of this nurse-delivered ILR service with contemporaneous physician-led procedures., Methods: Consecutive patients undergoing an ILR at our institution between 1st July 2016 and 4th June 2018 were included. Data were prospectively entered into a computerized database, which was retrospectively analyzed., Results: A total of 475 patients underwent ILR implantation, 271 (57%) of these were implanted by physicians in the catheter laboratory and 204 (43%) by nurses in the outpatient setting. Six complications occurred in physician-implants and two in nurse-implants (P = .3). Procedural time for physician-implants (13.4 ± 8.0 minutes) and nurse-implants (14.2 ± 10.1 minutes) were comparable (P = .98). The procedural cost was estimated as £576.02 for physician-implants against £279.95 with nurse-implants, equating to a 57.3% cost reduction. In our center, the total cost of ILR implantation in the catheter laboratory by physicians was £10 513.13 p.a. vs £6661.55 p.a. with a nurse-delivered model. When overheads for running, cleaning, and maintaining were accounted for, we estimated a saving of £68 685.75 was performed by moving to a nurse-delivered model for ILR implants. Over 133 catheter laboratory and implanting physician hours were saved and utilized for other more complex procedures., Conclusion: ILR implantation in the outpatient setting by suitably trained nurses is safe and leads to significant financial savings., (© 2019 Wiley Periodicals, Inc.)
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- 2019
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10. Development and Implementation of an Inexpensive, Easily Producible, Time Efficient External Ventricular Drain Simulator Using 3-Dimensional Printing and Image Registration.
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Bow H, He L, Raees MA, Pruthi S, and Chitale R
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- Cost-Benefit Analysis standards, Drainage economics, Drainage standards, Humans, Imaging, Three-Dimensional economics, Imaging, Three-Dimensional standards, Internship and Residency economics, Internship and Residency methods, Internship and Residency standards, Neurosurgical Procedures economics, Neurosurgical Procedures standards, Time Factors, Tomography, X-Ray Computed economics, Tomography, X-Ray Computed methods, Tomography, X-Ray Computed standards, Clinical Competence economics, Clinical Competence standards, Cost-Benefit Analysis methods, Drainage methods, Imaging, Three-Dimensional methods, Neurosurgical Procedures methods, Printing, Three-Dimensional economics, Printing, Three-Dimensional standards
- Abstract
Background: External ventricular drain (EVD) placement is one of the most commonly performed procedures in neurosurgery, frequently by the junior neurosurgery resident. Simulators for EVD placement are often costly, time-intensive to create, and complicated to set up., Objective: To describe creation of a simulator that is inexpensive, time-efficient, and simple to set up., Methods: This simulator involves printing a hollow head using a desktop 3-dimensional (3D) printer. This head is registered to a commercially available image-guidance system. A total of 11 participants volunteered for this simulation module. EVD placement was assessed at baseline, after verbal teaching, and after live 3D view instruction., Results: Accurate placement of an EVD on the right side at the foramen of Monro or the frontal horn of the lateral ventricle increased from 44% to 98% with training. Similarly, accurate placement on the left increased from 42% to 85% with training., Conclusion: During participation in the simulation, accurate placement of EVDs increased significantly. All participants believed that they had a better understanding of ventricular anatomy and that this module would be useful as a teaching tool for neurosurgery interns., (Copyright © 2018 by the Congress of Neurological Surgeons.)
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- 2019
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11. Time for a Renaissance of the Clinical Nurse Specialist Role in Critical Care?
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Davidson PM and Rahman A
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- Adult, Female, Humans, Male, Middle Aged, United States, Clinical Competence economics, Clinical Competence standards, Critical Care economics, Critical Care standards, Nurse Clinicians economics, Nurse Clinicians standards, Nurse's Role
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- 2019
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12. The Match: To Thine Own Self Be True.
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Prober CG
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- Algorithms, Canada, Career Choice, Educational Measurement, Humans, Internship and Residency economics, United States, Clinical Competence economics, Internship and Residency standards, Students, Medical psychology
- Abstract
The residency match process, culminating with the Match Day celebration, plays out in medical schools across the United States and Canada every year. The process may seem strange and mysterious for observers outside of medicine. The notion that each graduating student's employer for the next several years is first revealed to thousands of people, all at the same moment, through the opening of an envelope is surreal. The emotional reactions accompanying the process range from jubilance to deep disappointment. Much attention and care have been given to developing the algorithm underpinning the Match, and the process seems just: Optimization favors applicants over training programs. Witnessing students as they progress to their next stage of medical training is special for those involved in medical education. Faculty are filled with pride. But the process is far from perfect. The author of this Invited Commentary notes several concerns about the Match: the arduous process that students undergo to maximize their chances of success; the costs attendant to the travel and related expenses of multiple, geographically dispersed interviews; and the metrics that students and their medical schools use to judge the outcomes. The author worries that for some students, the "ideal" match may not be the one driven by their dreams and aspirations but, rather, by an amalgamation of those of many well-meaning friends, family members, and faculty. Medical students should seek advice and guidance, but the author hopes that, ultimately, students follow their own drumbeat and are true first to themselves.
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- 2019
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13. Higher Volume Surgeons Have Lower Medicare Payments, Readmissions, and Mortality After THA.
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Murphy WS, Cheng T, Lin B, Terry D, and Murphy SB
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- Arthroplasty, Replacement, Hip adverse effects, Arthroplasty, Replacement, Hip mortality, Clinical Competence economics, Cost-Benefit Analysis, Databases, Factual, Humans, Quality Improvement economics, Quality Indicators, Health Care economics, Retrospective Studies, Time Factors, Treatment Outcome, United States, Arthroplasty, Replacement, Hip economics, Fee-for-Service Plans economics, Hospital Costs, Hospitals, High-Volume, Medicare economics, Outcome and Process Assessment, Health Care economics, Patient Readmission economics, Value-Based Health Insurance economics, Value-Based Purchasing economics
- Abstract
Background: The advent of value-based care, in which surgeons and hospitals accept more responsibility for clinical and financial results, has increased the focus on surgeon- and hospital-specific outcomes. However, methods to identify high-quality, low-cost surgeons are not well developed., Questions/purposes: (1) Is there an association between surgeon THA volume and 90-day Centers for Medicare & Medicaid Services (CMS) Part A payments, readmissions, or mortality? (2) What proportion of THAs in the United States is performed by low- and high-volume surgeons?, Methods: We performed a retrospective analysis of the CMS Limited Data Set on all primary elective THAs performed in the United States (except Maryland) between January 2013 and June 2016 on patients insured by Medicare. This represented 409,844 THAs totaling more than USD 7.7 billion in direct CMS expenditures. Surgeons were divided into five groups based on annualized volume of CMS elective THAs over the study period. Using linear and logistic regression, we calculated and compared 90-day CMS Part A payments, readmissions, and mortality among the groups. For each episode, demographic information (age, sex, and race), geographic location, and Elixhauser comorbidities were calculated to control for major confounding factors in the regression., Results: When compared with the highest volume group, each lower volume group had increased payments, increased readmission rates, and increased mortality rates in a stepwise fashion when controlling for patient-specific variables including Elixhauser comorbidity index, demographic information, region, and background trend. The lowest volume group resulted in 27.2% more CMS payments per case (p < 0.001; 95% confidence interval [CI], 26.6%-27.8%), had an increased readmission odds ratio (OR) of 1.8 (p < 0.001; 95% CI, 1.7-1.9), and an increased mortality OR of 4.7 (p < 0.001; 95% CI, 4.0-5.5) when compared with the highest volume group. There was also variation within volume groups: some lower volume surgeons had lower payments, readmissions, and mortality than some higher volume surgeons despite the general trend. In terms of CMS volume, surgeons who were at least moderate volume (11+ annual cases) performed 78% of THAs and represented 26% of operating surgeons. The low- and lowest volume surgeons (10 or fewer annual cases) performed only 22% of THAs in the United States while representing 74% of unique operating surgeons., Conclusions: There is a strong association between a surgeon's Medicare volume and lower CMS payments, readmissions, and mortality. Furthermore, the majority of Medicare THAs in the United States are performed by surgeons who perform > 10 CMS operations annually. Compared with previous work, these results suggest a trend toward higher volume surgeons in the Medicare population. The results also suggest a benefit to the shift toward higher volume surgeons in reducing payments, readmissions, and mortality for elective THA in the United States. However, given that payments, readmission, and mortality of surgeons varied widely, it is important to note that available individual CMS data can be used to directly evaluate each individual surgeon based on their actual results well as through association with volume., Level of Evidence: Level III, therapeutic study.
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- 2019
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14. Konkurrenz unter Radiologen – zur Anwendbarkeit des Wettbewerbsrechts zwischen Teilnehmern an der vertragsärztlichen Versorgung.
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- Clinical Competence economics, Clinical Competence legislation & jurisprudence, Contract Services economics, Economic Competition economics, Germany, Humans, National Health Programs economics, Radiology economics, Contract Services legislation & jurisprudence, Economic Competition legislation & jurisprudence, National Health Programs legislation & jurisprudence, Radiology legislation & jurisprudence
- Abstract
Competing Interests: Disclosure The authors report no conflicts of interest in this work.
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- 2018
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15. Multiparametrische MRT-Untersuchung der Prostata (mpMR-Prostatografie).
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- Certification economics, Clinical Competence economics, Germany, Humans, Magnetic Resonance Imaging economics, Male, Prostatic Neoplasms economics, Quality Assurance, Health Care economics, Insurance Coverage economics, Magnetic Resonance Imaging methods, National Health Programs economics, Prostate diagnostic imaging, Prostatic Neoplasms diagnostic imaging
- Abstract
Competing Interests: Disclosure The authors report no conflicts of interest in this work.
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- 2018
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16. Value-based Healthcare: Measuring What Matters-Engaging Surgeons to Make Measures Meaningful and Improve Clinical Practice.
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Winegar AL, Moxham J, Erlinger TP, and Bozic KJ
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- Attitude of Health Personnel, Cost-Benefit Analysis, Health Knowledge, Attitudes, Practice, Humans, Leadership, Orthopedic Surgeons psychology, Quality Assurance, Health Care economics, Quality Indicators, Health Care economics, Clinical Competence economics, Fee-for-Service Plans economics, Health Care Costs, Orthopedic Surgeons economics, Patient Care Bundles economics, Value-Based Health Insurance economics, Value-Based Purchasing economics
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- 2018
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17. Measuring the value of endoscopic retrograde cholangiopancreatography activity: an opportunity to stratify endoscopists on the basis of their value.
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Parihar V, Moran C, Maheshwari P, Cheriyan D, O'Toole A, Murray F, Patchett SE, and Harewood GC
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- Cholangiopancreatography, Endoscopic Retrograde adverse effects, Clinical Competence economics, Cost-Benefit Analysis, Databases, Factual, Humans, Models, Economic, Prospective Studies, Retrospective Studies, Tertiary Care Centers economics, Time Factors, Cholangiopancreatography, Endoscopic Retrograde economics, Gastroenterologists economics, Health Care Costs, Quality Indicators, Health Care economics, Value-Based Health Insurance economics
- Abstract
Introduction: As finite healthcare resources come under pressure, the value of physician activity is assuming increasing importance. The value in healthcare can be defined as patient health outcomes achieved per monetary unit spent. Even though some attempts have been made to quantify the value of clinician activity, there is little in the medical literature describing the importance of endoscopists' activity. This study aimed to characterize the value of endoscopic retrograde cholangiopancreatography (ERCP) performance of five gastroenterologists., Patients and Methods: We carried out a retrospective-prospective cohort study using the databases of patients undergoing ERCP between September 2014 and March 2017. We collected data from 1070 patients who underwent ERCP comparing value among the ERCPists at index ERCP. Procedure value was calculated using the formula Q/(T/C), where Q is the quality of procedure, T is the duration of procedure and C is the adjusted for complexity level. Quality and complexity were derived on a 1-4 Likert scale on the basis of American Society for Gastrointestinal Endoscopy criteria; time was recorded (in min) from intubation to extubation. Endoscopist time calculated from procedure time was considered a surrogate marker of cost as individual components of procedure cost were not itemized., Results: In total, 590 procedures were analysed: 465 retrospectively over 24 months and 125 prospectively over 6 months. There was a 32% variation in the value of endoscopist activity in a more substantial retrospective cohort, with an even more considerable 73% variation in a smaller prospective arm., Conclusion: In an analysis of greater than 1000 ERCPs by a small cohort of experienced ERCPists, there was a wide variation in the value of endoscopist activity. Although the precision of estimating procedural costs needs further refinement, these findings show the ability to stratify ERCPists on the basis of the value their activity. As healthcare costs are scrutinized more closely, such value measurements are likely to become more relevant.
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- 2018
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18. Cost-effective analysis of teaching pelvic examination skills using Gynaecology Teaching Associates (GTAs) compared with manikin models (The CEAT Study).
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Janjua A, Roberts T, Okeahialam N, and Clark TJ
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- Clinical Competence economics, Cost-Benefit Analysis, Education, Medical, Undergraduate economics, Education, Medical, Undergraduate methods, Female, Gynecological Examination methods, Gynecology economics, Humans, Gynecological Examination economics, Gynecology education, Manikins, Patient Simulation
- Abstract
Objective: To determine the cost-effectiveness of Gynaecology Teaching Associate (GTA) teaching versus conventional pelvic model (manikin) teaching of pelvic examination skills for final year medical students within a UK undergraduate obstetrics and gynaecology (O&G) curriculum., Methods: An economic evaluation was carried out alongside a randomised controlled trial involving 492 final year medical students. 240 students received manikin teaching, and 241 GTA-led teaching. 418 (85%) students completed their assessment. Proficiency in gynaecological pelvic examination on GTAs was estimated by a senior clinical examiner, blinded to the method of teaching, using a standardised assessment tool. University of Birmingham Medical School thresholds were applied to determine proficiency levels; competence (pass) 50%, merit 60% and distinction 70%. Costs incurred in the delivery of both the educational pathways (control and intervention) were combined. All costs are reported in 2013-2014 prices and earlier costs adjusted using inflation indices., Outcome Measures: Cost per student competent in pelvic examination at completion of a 5-week clinical O&G placement., Results: GTA teaching was more effective compared with conventional teaching with 12 more students considered competent at pass level and 28 more students competent at merit and distinction levels, respectively. However, the average cost of GTA teaching was £45.06 per student compared with £7.40 per student for conventional teaching, with an increased cost of £37.66 per student. The incremental cost-effectiveness ratio demonstrated that it cost an additional £640.20 per competent student and £274.37 per student competent at merit level and £274.37 at distinction level compared with conventional manikin-based teaching., Conclusions: GTA teaching of female pelvic examination at the start of undergraduate medical student O&G clinical placements is shown to cost more and be more effective. GTA teaching is likely to be considered cost-effective in the context of other tests, and over the lifespan of a competent doctor's career., Trial Registration Number: NCT01944592., Competing Interests: Competing interests: GTAs are currently employed by BWH where TJC is Director of Academy., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
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- 2018
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19. Oncologists' Perceptions of Drug Affordability Using NCCN Evidence Blocks: Results from a National Survey.
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Shah-Manek B, Wong W, Ravelo A, and DiBonaventura M
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- Adult, Aged, Antineoplastic Agents therapeutic use, Clinical Competence economics, Cross-Sectional Studies, Female, Health Care Costs, Humans, Male, Middle Aged, Models, Economic, Neoplasms economics, Neoplasms epidemiology, Oncologists psychology, Perception, Prevalence, Surveys and Questionnaires, United States, Antineoplastic Agents economics, Fees, Pharmaceutical statistics & numerical data, Health Expenditures statistics & numerical data, Neoplasms drug therapy, Oncologists statistics & numerical data
- Abstract
Background: The increasing prevalence of cancer coupled with approvals of new drugs and technologies used in therapy have brought increased scrutiny to the cost and value of treatments in oncology. To address the rising concern about oncology drug costs, several organizations have developed value frameworks to help assess the value of oncology regimens. The objective of this study was to assess oncologists' perceptions, awareness, and knowledge of all oncology value frameworks in the United States and to understand oncologists' perceptions of affordability in the context of National Comprehensive Cancer Network (NCCN) Evidence Blocks., Objectives: To (a) assess oncologists' awareness, knowledge, perceptions, and ratings of the American Society of Clinical Oncology Value Framework (AVF), the Institute for Clinical and Economic Review (ICER) value framework, NCCN Evidence Blocks, and Memorial Sloan Kettering Cancer Center's DrugAbacus; (b) assess oncologists' knowledge and perceptions of drug affordability as defined by the NCCN Evidence Blocks methodology; and (c) determine the factors that influence drug affordability ratings., Methods: Data were collected from an electronic cross-sectional survey of 200 U.S.-based oncologists from a variety of practice settings. Oncologists were asked about their knowledge and perceptions of 4 value frameworks-NCCN Evidence Blocks, AVF, the ICER value framework, and DrugAbacus. Using NCCN Evidence Blocks, oncologists were asked to rate a variety of hypothetical cancer therapies and assign costs (in U.S. dollars) to the 5 levels of affordability. Additional questions that assessed perceived patient out-of-pocket (OOP) costs and comfort level in assessing affordability were also included in the survey., Results: Oncologists were most familiar with NCCN Evidence Blocks (90%), followed by the AVF (84%), ICER value framework (57%), and DrugAbacus (56%). Oncologists rated affordability higher (mean rating 3: moderately expensive) versus the actual NCCN panel affordability rating (mean rating 1: very expensive). The affordability rating was similar across a variety of hypothetical cancer therapies and tumor types (rating: 3). Oncologists estimated the costs for this rating of 3 to range from $4,600 to $6,000 per month, which was inconsistent with actual drug costs. Oncologists estimated the mean monthly OOP costs for patients with insurance to range from $1,260 for a new oral medication to $1,700 for a new infused medication. Only 26% of oncologists were comfortable or very comfortable with rating costs associated with affordability levels., Conclusions: Surveyed oncologists rated cancer therapies as more affordable (per NCCN Evidence Blocks criteria) than NCCN panel ratings. Costs associated with affordability were not consistent with actual treatment costs; however, most oncologists were not comfortable with rating affordability. Patient OOP costs had the biggest influence on affordability ratings; however, physicians overestimated patient OOP costs significantly. There is an opportunity to improve the value frameworks, especially with regard to affordability assessment., Disclosures: This study was funded by Genentech. Shah-Manek is employed by Ipsos Healthcare, a health care consulting company that received funding from Genentech to conduct this study. DiBonaventura was employed by Ipsos Healthcare at the time of this study. Wong and Ravelo are employed by Genentech. Shah-Manek has consulted with Genentech, Merck, Alkermes, Avanis, Alnylam, Novo Nordisk, Teva, Lilly, and BMS. This work was presented as an oral presentation at the ASCO 2017 Annual Meeting in Chicago, Illinois, on June 2-6, 2017.
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- 2018
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20. Quality Payment Program year 2.
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Rathbun J, Johnson B, Woo K, and Copeland TP
- Subjects
- Clinical Competence economics, Government Regulation, Health Policy, Humans, Medicare legislation & jurisprudence, Medicare standards, Medicare Access and CHIP Reauthorization Act of 2015 legislation & jurisprudence, Medicare Access and CHIP Reauthorization Act of 2015 standards, Quality Improvement economics, Quality Indicators, Health Care legislation & jurisprudence, Quality Indicators, Health Care standards, Reimbursement, Incentive legislation & jurisprudence, Reimbursement, Incentive standards, United States, Health Care Costs legislation & jurisprudence, Health Care Costs standards, Medicare economics, Medicare Access and CHIP Reauthorization Act of 2015 economics, Quality Indicators, Health Care economics, Reimbursement, Incentive economics
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- 2018
- Full Text
- View/download PDF
21. Complications and patient-injury after ankle fracture surgery. -A closed claim analysis with data from the Patient Compensation Association in Denmark.
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Bjørslev N, Ebskov LB, Mersø C, and Wong C
- Subjects
- Adult, Aged, Clinical Competence economics, Denmark epidemiology, Female, Fracture Fixation, Internal legislation & jurisprudence, Humans, Insurance Claim Review, Insurance, Liability, Liability, Legal, Male, Medical Errors economics, Middle Aged, Reoperation economics, Retrospective Studies, Ankle Fractures surgery, Clinical Competence standards, Fracture Fixation, Internal adverse effects, Iatrogenic Disease economics, Medical Errors legislation & jurisprudence, Postoperative Complications economics
- Abstract
Background: The Patient Compensation Association (PCA) receives claims for financial compensation from patients who believe they have sustained damage from their treatment in the Danish health care system. In this study, we have analysed closed claims in which patients suffered injuries due to the surgical treatment of their ankle fracture. We identified causalities contributing to these injuries and malpractices, as well as the economic consequences of these damages., Methods: Fifty-one approved closed claims from the PCA database from the years 2004-2009 were analysed in a retrospective systematic review. All patients were adults with an iatrogenic injury, and received compensation. A root cause analysis was performed to identify whether the patient suffered the damage preoperatively, during surgery or postoperatively, and to determine the level of education of the injurious doctor. Economic compensation, co-morbidities and end-result complications were registered., Results: In 9 of the cases the injuries happened preoperatively, but the majority of the injuries, namely 34 occurred during surgery. In 21 of the cases the damage happened postoperatively. Thirty percentages of the patients were mistreated in more than one phase. Level of competence was medical specialists in 2/3 and junior doctors in 1/3 of the cases. In the preoperative phase both groups were equally responsible for the inflicted damage. In the perioperative- and postoperative group, medical specialists inflicted the majority of damages. General recommendations regarding ORIF were not followed in 21/49 of the perioperative damages. The pronation fracture was the most common. The patients received a total average compensation of 17.561 USD each., Conclusion: Managing the complex ankle fracture, requires considerable experience. This study indicates that extra attention should be paid to the most technically demanding fractures as the pronation-external-rotation-, diabetic- and fragility fractures. Surgeons should follow the recommendations for ORIF. Emphasis should also focus on adequate postoperative plans. This study finds a high readmission-burden, re-operation rate and great expenses in form of compensation., (Copyright © 2017 Elsevier Ltd. All rights reserved.)
- Published
- 2018
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- View/download PDF
22. Acceptability and feasibility of the standardized direct observation assessment tool in the emergency department in Qatar.
- Author
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Farook S, Chaudhry S, Al Kahlout B, Irfan FB, and Pathan SA
- Subjects
- Behavior, Clinical Competence economics, Educational Measurement methods, Educational Measurement standards, Employee Performance Appraisal standards, Feasibility Studies, Humans, Internship and Residency, Qatar, Reference Standards, Work Performance standards, Workplace, Attitude of Health Personnel, Behavior Observation Techniques methods, Behavior Observation Techniques standards, Emergency Service, Hospital standards, Employee Performance Appraisal methods, Students, Medical psychology
- Published
- 2017
- Full Text
- View/download PDF
23. 40-4-40: educational and economic outcomes of a free, international surgical training event.
- Author
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Glasbey J, Sinclair P, Mohan H, and Harries R
- Subjects
- Adolescent, Adult, Aged, Career Choice, Curriculum, Education, Medical economics, Educational Measurement, Humans, Ireland, Middle Aged, Surveys and Questionnaires, United Kingdom, Clinical Competence economics, Education, Medical organization & administration, General Surgery education, Internationality, Models, Educational
- Abstract
Purpose of Study: To demonstrate a model for delivery of an international surgical training event, and demonstrate its educational and economic outcomes., Study Design: The Association of Surgeons in Training (ASiT) ran a course series on 16 January 2016 across the UK and Ireland. A mandatory, self-reported, online questionnaire collected delegate feedback, using 5-point Likert Scales, and a NetPromoter feedback tool. Precourse and postcourse matched questionnaires were collected for 'Foundation Skills in Surgery' (FSS) courses. Paired economic analysis was performed. Statistical analysis was carried out using RStudio (V.3.1.1 Boston, Massachusetts, USA)., Results: Forty courses were held across the UK and Ireland (65.0% technical, 35.0% non-technical), with 184 faculty members. Of 570 delegates, 529 fully completed the feedback survey (92.8% response rate); 56.5% were male. The median age was 26 years (range: 18-67 years). The mean overall course NetPromoter Score was 8.7 out of 10. On logistic regression high NetPromoter Score was associated with completing a Foundation Skills in Surgery course (R=0.44, OR: 1.49, p=0.025) and having clear learning outcomes (R=0.72, OR: 2.04, p=0.029) but not associated with specialty, course style or teaching style. For Foundation Skills in Surgery courses, delegates reported increased commitment to a career in surgery (p<0.001), confidence with basic surgical skills (p<0.001) and confidence with assisting in theatre (p<0.001). A comparable cost saving of £231,462.37 was calculated across the 40 courses., Conclusion: The ASiT '40-4-40' event demonstrated the diversity and depth of surgical training, with 40 synchronous technical and non-technical courses, demonstrable educational benefit and a significant cost saving to surgical trainees., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
- Published
- 2017
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24. Cross-sectional study of the financial cost of training to the surgical trainee in the UK and Ireland.
- Author
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O'Callaghan J, Mohan HM, Sharrock A, Gokani V, Fitzgerald JE, Williams AP, and Harries RL
- Subjects
- Adult, Clinical Competence economics, Cross-Sectional Studies, Female, Humans, Ireland, Male, Mandatory Programs economics, Middle Aged, Prospective Studies, Surveys and Questionnaires, United Kingdom, Young Adult, Career Choice, Students, Medical, Surgeons economics, Surgeons education
- Abstract
Objectives: Applications for surgical training have declined over the last decade, and anecdotally the costs of training at the expense of the surgical trainee are rising. We aimed to quantify the costs surgical trainees are expected to cover for postgraduate training., Design: Prospective, cross-sectional, questionnaire-based study., Setting/participants: A non-mandatory online questionnaire for UK-based trainees was distributed nationally. A similar national questionnaire was distributed for Ireland, taking into account differences between the healthcare systems. Only fully completed responses were included., Results: There were 848 and 58 fully completed responses from doctors based in the UK and Ireland, respectively. Medical students in the UK reported a significant increase in debt on graduation by 55% from £17 892 (2000-2004) to £27 655 (2010-2014) (p<0.01). 41% of specialty trainees in the UK indicated that some or all of their study budget was used to fund mandatory regional teaching. By the end of training, a surgical trainee in the UK spends on average £9105 on courses, £5411 on conferences and £4185 on exams, not covered by training budget. Irish trainees report similarly high costs. Most trainees undertake a higher degree during their postgraduate training. The cost of achieving the mandatory requirements for completion of training ranges between £20 000 and £26 000 (dependent on specialty), except oral and maxillofacial surgery, which is considerably higher (£71 431)., Conclusions: Medical students are graduating with significantly larger debt than before. Surgical trainees achieve their educational requirements at substantial personal expenditure. To encourage graduates to pursue and remain in surgical training, urgent action is required to fund the mandatory requirements and annual training costs for completion of training and provide greater transparency to inform doctors of what their postgraduate training costs will be. This is necessary to increase diversity in surgery, reduce debt load and ensure surgery remains a popular career choice., Competing Interests: Competing interests: The authors are either current or previous surgical trainees, and current or past elected members of the Council of the Association of Surgeons in Training (registered charity no 274841). JEF is an employee of KPMG Global Health Practice, honorary clinical advisor to the Lifebox Foundation Charity and a trustee of the SURG Foundation Research Charity. The authors have no other relevant financial or personal conflicts of interest to declare in relation to this paper., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)
- Published
- 2017
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25. Costs and benefits of different methods of esophagectomy for esophageal cancer.
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Yanasoot A, Yolsuriyanwong K, Ruangsin S, Laohawiriyakamol S, and Sunpaweravong S
- Subjects
- Adult, Aged, Aged, 80 and over, Blood Loss, Surgical prevention & control, Blood Transfusion economics, Clinical Competence economics, Cost Savings, Cost-Benefit Analysis, Esophagectomy adverse effects, Female, Hospitals, University economics, Humans, Laparoscopy adverse effects, Learning Curve, Length of Stay economics, Male, Middle Aged, Operative Time, Pain, Postoperative etiology, Thailand, Thoracoscopy adverse effects, Time Factors, Treatment Outcome, Esophageal Neoplasms economics, Esophageal Neoplasms surgery, Esophagectomy economics, Esophagectomy methods, Hospital Costs, Laparoscopy economics, Process Assessment, Health Care economics, Thoracoscopy economics
- Abstract
Background A minimally invasive approach to esophagectomy is being used increasingly, but concerns remain regarding the feasibility, safety, cost, and outcomes. We performed an analysis of the costs and benefits of minimally invasive, hybrid, and open esophagectomy approaches for esophageal cancer surgery. Methods The data of 83 consecutive patients who underwent a McKeown's esophagectomy at Prince of Songkla University Hospital between January 2008 and December 2014 were analyzed. Open esophagectomy was performed in 54 patients, minimally invasive esophagectomy in 13, and hybrid esophagectomy in 16. There were no differences in patient characteristics among the 3 groups Minimally invasive esophagectomy was undertaken via a thoracoscopic-laparoscopic approach, hybrid esophagectomy via a thoracoscopic-laparotomy approach, and open esophagectomy by a thoracotomy-laparotomy approach. Results Minimally invasive esophagectomy required a longer operative time than hybrid or open esophagectomy ( p = 0.02), but these patients reported less postoperative pain ( p = 0.01). There were no significant differences in blood loss, intensive care unit stay, hospital stay, or postoperative complications among the 3 groups. Minimally invasive esophagectomy incurred higher operative and surgical material costs than hybrid or open esophagectomy ( p = 0.01), but there were no significant differences in inpatient care and total hospital costs. Conclusion Minimally invasive esophagectomy resulted in the least postoperative pain but the greatest operative cost and longest operative time. Open esophagectomy was associated with the lowest operative cost and shortest operative time but the most postoperative pain. Hybrid esophagectomy had a shorter learning curve while sharing the advantages of minimally invasive esophagectomy.
- Published
- 2017
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26. Analysis of patients' willingness to be mobile, taking into account individual characteristics and two exemplary indications.
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Augustin J, Schäfer I, Augustin M, and Zander N
- Subjects
- Attitude to Health, Clinical Competence statistics & numerical data, Cross-Sectional Studies, Educational Status, Germany epidemiology, Humans, Middle Aged, Skin Diseases diagnosis, Skin Diseases therapy, Socioeconomic Factors, Clinical Competence economics, Clinical Decision-Making methods, Fees and Charges statistics & numerical data, Patient Acceptance of Health Care statistics & numerical data, Skin Diseases epidemiology, Travel economics
- Abstract
Background: With respect to health care planning, it is commonly assumed that patients consult the nearest physician. In reality, however, patients frequently accept great-er efforts/expenses than necessary to see a physician. The objective of the present study was to determine under which circumstances patients were willing to accept additional efforts/expenses, and which role sociodemographic and clinical characteristics play in this regard., Methods: Data collection was carried out in the context of a multicenter cross-sectional study among office-based and hospital-affiliated (University Medical Center Hamburg-Eppendorf) dermatologists. Patients (n = 309) with psoriasis and chronic wounds were surveyed about their mobility patterns and disease severity. Data analysis was performed using descriptive and multivariate methods., Results: The willingness to accept additional efforts/expenses is primarily determined by a physician's expertise and service portfolio. Comparing both diagnoses showed that psoriasis patients usually traveled longer distances than wound patients. Among psoriasis patients, one significant predictor for accepting additional efforts/expenses was the level of education. With regard to wound patients, key factors included wound size (severity)., Conclusion: The present study revealed complex mobility patterns among patients, which are affected by numerous personal as well as clinical factors. Depending on the diagnosis and individual preferences, additional efforts/expenses can - among other things - be explained by disease severity. Further studies are required to obtain more conclusive data., (© 2017 Deutsche Dermatologische Gesellschaft (DDG). Published by John Wiley & Sons Ltd.)
- Published
- 2017
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27. [Complications and costs in primary knee replacement surgery in an endoprosthetics centre : Influence of state of training].
- Author
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Windisch C, Brodt S, Röhner E, and Matziolis G
- Subjects
- Adult, Age Distribution, Aged, Aged, 80 and over, Arthroplasty, Replacement, Knee statistics & numerical data, Educational Status, Female, Germany epidemiology, Humans, Incidence, Length of Stay statistics & numerical data, Male, Middle Aged, Orthopedic Surgeons education, Postoperative Complications epidemiology, Prevalence, Risk Factors, Sex Distribution, Treatment Outcome, Arthroplasty, Replacement, Knee economics, Clinical Competence economics, Education, Medical, Continuing economics, Health Care Costs statistics & numerical data, Length of Stay economics, Orthopedic Surgeons economics, Postoperative Complications economics
- Abstract
Background: This work examines the hypothesis that in endoprosthesis implantation there are differences between experienced primary and senior caregivers (S-Op) and less experienced follow-up assistants (T-Op) with respect to process-relevant parameters. The main hypothesis is that compared to S‑Op, T‑Op cause significantly longer surgery times and thus additional operating theatre costs. As sub-hypotheses, differences in various perioperative (p-o) parameters between T‑Op and S‑Op were examined., Materials and Methods: The status of the operator (senior and/or senior main operator [S-Op]) and/or postoperative CRP, perioperative blood loss, the amount of transfused erythrocyte concentrates, patient age, gender, ASA risk classification (American Society of Anesthesiologists), duration of surgery and blood transfusion, duration of inpatient stay, as well as the rates of early revision surgery and complications were recorded. A comparison of patients who had been operated by an S‑Op and those who had been operated by a T‑Op was made for all parameters., Results: Significant differences were found with respect to the duration of surgery, the duration of the hospital stay, and CRP on the third p‑o day. The T‑Op required an average of 11 min more than the S‑Op. CRP was significantly higher in the T‑Op group only on the third p‑o day, by 18 mg/l. In contrast, in the T‑Op group, a blood loss of 181 ml was lower than in the S‑Op group. This corresponded to a reduction of 0.26 transfused erythrocyte concentrates. There were no significant differences in complication rates between S‑Op and T‑Op., Discussion: In the setting of a certified endoprosthetics centre, the comparison of T‑Op with S‑Op showed that the use of the former with at a non-increased complication rate led to a significant extension of the operating time. This leads to additional training costs in the amount of an estimated 3% of the current DRG remuneration. These additional costs are not represented adequately in the current remuneration system.
- Published
- 2017
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- View/download PDF
28. Implications of Clinical Documentation (In)Accuracy: A Pilot Study Among General Surgery Residents.
- Author
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Garcia A, Revere L, Sharath S, and Kougias P
- Subjects
- Documentation economics, Documentation statistics & numerical data, General Surgery economics, General Surgery instrumentation, Humans, Medical Errors prevention & control, Medical Records standards, Medical Records statistics & numerical data, Pilot Projects, Retrospective Studies, Workforce, Clinical Competence economics, Clinical Competence standards, Documentation standards, General Surgery education, Internship and Residency standards
- Abstract
Accurate and reliable medical records are necessary for assessing, improving, and reimbursing healthcare services. Clear and concise physician documentation is essential to assuring accurate and reliable medical records. Yet, prior literature reveals surgery residents do not receive adequate, beneficial education on medical record documentation and coding. This is concerning because the evaluation of and reimbursement for healthcare service delivery relies on the physician's ability to produce appropriate medical records, which then get translated into billable codes. This pilot study suggests hospitals may incur significant financial loss in revenue due to inaccurate clinical documentation by residents. Thus, educational training for medical residents in the area of clinical documentation and hospital-specific coding practices may prove financially advantageous.
- Published
- 2017
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29. Students and Doctors are Unaware of the Cost of Drugs they Frequently Prescribe.
- Author
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Schutte T, Tichelaar J, Nanayakkara P, Richir M, and van Agtmael M
- Subjects
- Cross-Sectional Studies, Drugs, Generic economics, Education, Medical, Undergraduate, Humans, Netherlands epidemiology, Physicians, Students, Medical, Surveys and Questionnaires, Attitude of Health Personnel, Clinical Competence economics, Drug Prescriptions economics, Fees, Pharmaceutical, Practice Patterns, Physicians' economics, Prescription Drugs economics
- Abstract
Given the increasing healthcare costs of an ageing population, there is growing interest in rational prescribing, which takes costs of medication into account. We aimed to gain insight into the attitude to and knowledge of medication costs of medical students and doctors in daily practice. This was a cross-sectional electronic survey among medical students (bachelor/master) and doctors (consultants/registrars). Attitude to costs was evaluated using a cost-consciousness scale. In open questions, the participants estimated the cost of commonly prescribed (generic/non-generic) drugs (including separate pharmacy dispensing costs). They were asked where they could find information about drug costs. Overall, a reasonable cost-consciousness was found. Students were less conscious of the cost than were doctors (15.56 SD 3.25 versus 17.81 SD 2.25; scale 0-24; p = 0.001). In contrast to this consciousness, actual estimated drug costs were within a 25% margin for only 5.4% of generic and 13.7% of proprietary drugs (Wilcoxon signed-rank, p < 0.001). The price of generic drugs was frequently overestimated (77.5%) and that of proprietary drugs was underestimated (51.4%). The dispensing costs were estimated correctly for 30% of the drugs. Most doctors (84%) and a minority of students (40%) were able to identify at least one source of information about drug costs. While doctors and students considered it important to be aware of the cost of drugs, this attitude is not reflected in their ability to estimate the cost of frequently prescribed drugs. Cost awareness is important in therapeutic reasoning and cost-effective prescribing. Both should be better addressed in (undergraduate) pharmacotherapy education., (© 2016 The Authors. Basic & Clinical Pharmacology & Toxicology published by John Wiley & Sons Ltd on behalf of Nordic Association for the Publication of BCPT (former Nordic Pharmacological Society).)
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- 2017
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30. [Trust and reliability in surgery].
- Author
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Weigel TF, Hanisch E, Buia A, and Hessler C
- Subjects
- Cross-Cultural Comparison, Germany, Health Care Costs standards, Humans, National Health Programs economics, National Health Programs standards, Quality Assurance, Health Care standards, Reimbursement Mechanisms economics, Reimbursement Mechanisms standards, Clinical Competence economics, Clinical Competence standards, Communication, Physician-Patient Relations, Surgeons economics, Surgeons psychology, Trust psychology
- Abstract
Social interactions are hardly possible without trust. Medical and in particular surgical actions can change the lives of people directly and indirectly existentially. Thus, the relationship between doctor and patient is a special form of social interaction, and will be hard to find anywhere else. The nature of the doctor-patient relationship also determines the success of a treatment. The core and the importance of trust, as a central part of this relationship, will be reconstructed in the present paper. The increasing possibilities of information acquisition in modern societies, and the ever-present need for transparency, impact more and more on the doctor-patient relationship. At first glance, concepts of trust seem to be of secondary importance. The current developments regarding the remuneration of services in the medical system likewise bear the risk to increasingly determine the importance of trust in the doctor-patient relationship. However, it is necessary to delineate reliability from trust. Due to the conditions which are constitutive for the operational disciplines, a climate of trust, even in a modern information society, is more necessary than ever.
- Published
- 2017
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- View/download PDF
31. [RELATIONSHIP BETWEEN SURGICAL PROCEDURES AND THEIR SURGEON’S FEE].
- Author
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Iwanaka T
- Subjects
- Income, Clinical Competence economics, Surgical Procedures, Operative economics, Surgical Procedures, Operative methods
- Published
- 2017
32. Analysis of Compensation Disparities between Junior Academic and Private Practice Vascular Surgeons.
- Author
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Prakash S and Satiani B
- Subjects
- Academies and Institutes trends, Clinical Competence economics, Educational Status, Humans, Medical Staff, Hospital trends, Private Practice trends, Salaries and Fringe Benefits trends, Surgeons trends, Time Factors, Vascular Surgical Procedures trends, Academies and Institutes economics, Medical Staff, Hospital economics, Private Practice economics, Salaries and Fringe Benefits economics, Surgeons economics, Vascular Surgical Procedures economics
- Abstract
Background: Compensation may be a significant factor for academic vascular surgeons seeking or changing employment. We compared compensation for academic and private practice vascular surgeons practicing for approximately similar duration., Methods: Compensation data for academic and private practice vascular surgeons were obtained from the Association of American Medical Colleges (AAMC) and Medical Group Management Association (MGMA), respectively. Comparisons of nominal annual compensation data were made between Group 1 (assistant professor vascular surgeons versus private practice vascular surgeons in practice for 1-7 years), Group 2 (associate professor vascular surgeons versus private practice vascular surgeons in practice for 8-17 years), and Group 3 (professor vascular surgeons versus private practice vascular surgeons in practice for ≥18 years) from 2003 to 2012., Results: In Group 1, there was a $54,500 difference in 2003 (P = 0.043) which increased to $110,500 by 2012 (P = 0.001). In Group 2, there was a $44,200 difference in 2007 (P = 0.016) which increased to $53,400 by 2010 (P = 0.034). In Group 3, there was no statistically significant difference in compensation (P ≥ 0.999)., Conclusions: There is a significant and increasing disparity in compensation in favor of private practice vascular surgeons compared with assistant professor vascular surgeon faculty. Differences equalized with increasing seniority and experience. Compensation plans should be market based and in line with nonacademic benchmarks as well., (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Published
- 2017
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33. Community-based implementation of trauma-focused interventions for youth: Economic impact of the learning collaborative model.
- Author
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Dopp AR, Hanson RF, Saunders BE, Dismuke CE, and Moreland AD
- Subjects
- Adolescent, Evidence-Based Practice, Humans, Models, Organizational, Southeastern United States, Clinical Competence economics, Clinical Competence standards, Cognitive Behavioral Therapy economics, Cognitive Behavioral Therapy methods, Cognitive Behavioral Therapy standards, Community Mental Health Services economics, Community Mental Health Services methods, Community Mental Health Services standards, Cost-Benefit Analysis, Outcome Assessment, Health Care methods, Outcome Assessment, Health Care standards, Stress Disorders, Traumatic therapy
- Abstract
This study investigated the economics of the learning collaborative (LC) model in the implementation of Trauma-Focused Cognitive-Behavioral Therapy (TF-CBT), an evidence-based intervention for traumatic stress in youth. We evaluated the cost-effectiveness of the LC model based on data from 13 LCs completed in the southeastern United States. Specifically, we calculated cost-effectiveness ratios (CERs) for 2 key service outcomes: (a) clinician TF-CBT competence, based on pre- and post-LC self-ratings (n = 574); and (b) trauma-related mental health symptoms (i.e., traumatic stress and depression), self- and caregiver-reported, for youth who received TF-CBT (n = 1,410). CERs represented the cost of achieving 1 standard unit of change on a measure (i.e., d = 1.0). The results indicated that (a) costs of $18,679 per clinician were associated with each unit increase in TF-CBT competency and (b) costs from $5,318 to $6,548 per youth were associated with each unit decrease in mental health symptoms. Thus, although the impact of LC participation on clinician competence did not produce a favorable CER, subsequent reductions in youth psychopathology demonstrated high cost-effectiveness. Clinicians and administrators in community provider agencies should consider these findings in their decisions about implementation of evidence-based interventions for youth with traumatic stress disorders. (PsycINFO Database Record, ((c) 2017 APA, all rights reserved).)
- Published
- 2017
- Full Text
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34. Critical factors for optimising skill-grade-mix based on principles of Lean Management - a qualitative substudy
- Author
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Inauen A, Rettke H, Fridrich A, Spirig R, and Bauer GF
- Subjects
- Attitude of Health Personnel, Cost Savings economics, Cost Savings methods, Education organization & administration, Focus Groups, Hospitals, University economics, Hospitals, University organization & administration, Humans, Organizational Innovation economics, Retrospective Studies, Switzerland, Clinical Competence economics, Health Care Rationing economics, Health Care Rationing organization & administration, National Health Programs economics, National Health Programs organization & administration, Nursing, Team economics, Nursing, Team organization & administration
- Abstract
Background: Due to scarce resources in health care, staff deployment has to meet the demands. To optimise skill-grade-mix, a Swiss University Hospital initiated a project based on principles of Lean Management. The project team accompanied each participating nursing department and scientifically evaluated the results of the project. Aim: The aim of this qualitative sub-study was to identify critical success factors of this project. Method: In four focus groups, participants discussed their experience of the project. Recruitment was performed from departments assessing the impact of the project retrospectively either positive or critical. In addition, the degree of direct involvement in the project served as a distinguishing criterion. Results: While the degree of direct involvement in the project was not decisive, conflicting opinions and experiences appeared in the groups with more positive or critical project evaluation. Transparency, context and attitude proved critical for the project’s success. Conclusions: Project managers should ensure transparency of the project’s progress and matching of the project structure with local conditions in order to support participants in their critical or positive attitude towards the project.
- Published
- 2017
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35. BUILDING CAPACITY IN REFLECTIVE PRACTICE: A TIERED MODEL OF STATEWIDE SUPPORTS FOR LOCAL HOME-VISITING PROGRAMS.
- Author
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Watson CL, Bailey AE, and Storm KJ
- Subjects
- Adult, Burnout, Professional, Communication, Health Knowledge, Attitudes, Practice, Humans, Interviews as Topic, Mental Health Services economics, Mental Health Services standards, Middle Aged, Mindfulness, Models, Theoretical, Qualitative Research, Surveys and Questionnaires, Thinking, Clinical Competence economics, Clinical Competence standards, Health Personnel economics, Health Personnel standards, House Calls, Maternal-Child Health Services economics, Maternal-Child Health Services standards
- Abstract
This preliminary study examines an initiative to further develop capacity in reflective practice among public health home visitors and their supervisors. A Maternal, Infant, and Early Childhood Home Visiting (MIECHV) Expansion Grant to the Minnesota Department of Health funded the development of a tiered structure to support reflective practice within county public health agencies throughout the state. Study data revealed a general consensus among individuals at all levels of the county programs that state supports were adequate to implement reflective practice. Although there were no significant changes in home-visitor and supervisor scores on a standardized measure linked to reflective functioning and reflective practice, a majority of home visitors and supervisors perceived that their knowledge and skills in reflective practice had increased during the evaluation period. A standardized measure of employee burnout did not reveal significant changes in either "depersonalization" (indicating burnout) or "personal accomplishment" (a mitigating factor in burnout) subscales; however, home visitor "emotional exhaustion" subscale scores did increase over the evaluation period. In contrast to the subscale results, home visitors reported a sense of accomplishment in their reflective work and that they value "releasing" emotions in a safe environment during reflective supervision., (© 2016 Michigan Association for Infant Mental Health.)
- Published
- 2016
- Full Text
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36. Cost-effective and low-technology options for simulation and training in neonatology.
- Author
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Bruno CJ and Glass KM
- Subjects
- Clinical Competence economics, Clinical Competence standards, Cost-Benefit Analysis, Educational Measurement, Humans, Infant, Newborn, Intensive Care Units, Neonatal standards, Intubation, Intratracheal, Neonatology economics, Computer Simulation economics, Intensive Care Units, Neonatal economics, Neonatology education
- Abstract
The purpose of this review is to explore low-cost options for simulation and training in neonatology. Numerous cost-effective options exist for simulation and training in neonatology. Lower cost options are available for teaching clinical skills and procedural training in neonatal intubation, chest tube insertion, and pericardiocentesis, among others. Cost-effective, low-cost options for simulation-based education can be developed and shared in order to optimize the neonatal simulation training experience., (Copyright © 2016 Elsevier Inc. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
37. [In process].
- Author
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Schuster T
- Subjects
- Career Choice, Clinical Competence economics, Cost Savings economics, Curriculum, Education, Nursing, Graduate economics, Germany, Humans, Education, Nursing, Graduate organization & administration, Hospital Costs organization & administration, National Health Programs economics, National Health Programs organization & administration, Nursing Staff, Hospital education, Nursing Staff, Hospital organization & administration, Personnel Administration, Hospital economics, Personnel Administration, Hospital methods
- Published
- 2016
38. [In process].
- Author
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Erlhoff J, Huisman F, and Mohrenstecher K
- Subjects
- Cost Control organization & administration, Cost Savings economics, Cost Savings methods, Germany, Health Services Accessibility economics, Health Services Accessibility organization & administration, Humans, Nursing Staff, Hospital economics, Nursing Staff, Hospital organization & administration, Personnel Management economics, Clinical Competence economics, Hospital Costs organization & administration, Interdisciplinary Communication, Intersectoral Collaboration, National Health Programs economics, Primary Nursing economics, Primary Nursing organization & administration
- Published
- 2016
39. Moving Toward 21st-Century Clinical Licensure Examinations in Dentistry.
- Author
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Friedrichsen SW
- Subjects
- Clinical Competence economics, Education, Dental economics, Education, Dental methods, Humans, Patient Care ethics, Patient Care standards, United States, Clinical Competence standards, Education, Dental standards, Licensure, Dental economics
- Published
- 2016
40. Simulation for Teaching Orthopaedic Residents in a Competency-based Curriculum: Do the Benefits Justify the Increased Costs?
- Author
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Nousiainen MT, McQueen SA, Ferguson P, Alman B, Kraemer W, Safir O, Reznick R, and Sonnadara R
- Subjects
- Cost-Benefit Analysis, Curriculum, Educational Status, Humans, Ontario, Program Evaluation, Teaching methods, Time Factors, Universities economics, Clinical Competence economics, Computer Simulation, Computer-Assisted Instruction economics, Education, Medical, Graduate economics, Internship and Residency economics, Orthopedic Procedures economics, Orthopedic Procedures education, Teaching economics
- Abstract
Background: Although simulation-based training is becoming widespread in surgical education and research supports its use, one major limitation is cost. Until now, little has been published on the costs of simulation in residency training. At the University of Toronto, a novel competency-based curriculum in orthopaedic surgery has been implemented for training selected residents, which makes extensive use of simulation. Despite the benefits of this intensive approach to simulation, there is a need to consider its financial implications and demands on faculty time., Questions/purposes: This study presents a cost and faculty work-hours analysis of implementing simulation as a teaching and evaluation tool in the University of Toronto's novel competency-based curriculum program compared with the historic costs of using simulation in the residency training program., Methods: All invoices for simulation training were reviewed to determine the financial costs before and after implementation of the competency-based curriculum. Invoice items included costs for cadavers, artificial models, skills laboratory labor, associated materials, and standardized patients. Costs related to the surgical skills laboratory rental fees and orthopaedic implants were waived as a result of special arrangements with the skills laboratory and implant vendors. Although faculty time was not reimbursed, faculty hours dedicated to simulation were also evaluated. The academic year of 2008 to 2009 was chosen to represent an academic year that preceded the introduction of the competency-based curriculum. During this year, 12 residents used simulation for teaching. The academic year of 2010 to 2011 was chosen to represent an academic year when the competency-based curriculum training program was functioning parallel but separate from the regular stream of training. In this year, six residents used simulation for teaching and assessment. The academic year of 2012 to 2013 was chosen to represent an academic year when simulation was used equally among the competency-based curriculum and regular stream residents for teaching (60 residents) and among 14 competency-based curriculum residents and 21 regular stream residents for assessment., Results: The total costs of using simulation to teach and assess all residents in the competency-based curriculum and regular stream programs (academic year 2012-2013) (CDN 155,750, USD 158,050) were approximately 15 times higher than the cost of using simulation to teach residents before the implementation of the competency-based curriculum (academic year 2008-2009) (CDN 10,090, USD 11,140). The number of hours spent teaching and assessing trainees increased from 96 to 317 hours during this period, representing a threefold increase., Conclusions: Although the financial costs and time demands on faculty in running the simulation program in the new competency-based curriculum at the University of Toronto have been substantial, augmented learner and trainer satisfaction has been accompanied by direct evidence of improved and more efficient learning outcomes., Clinical Relevance: The higher costs and demands on faculty time associated with implementing simulation for teaching and assessment must be considered when it is used to enhance surgical training.
- Published
- 2016
- Full Text
- View/download PDF
41. [Guideline-conform inpatient psychiatric psychotherapeutic treatment of chronic depression: Normative personnel requirements].
- Author
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Schnell K, Hochlehnert A, Berger M, Wolff J, Radtke M, Schramm E, Normann C, and Herpertz SC
- Subjects
- Adult, Aged, Chronic Disease, Clinical Competence economics, Clinical Competence standards, Depression economics, Depression psychology, Female, Germany epidemiology, Guideline Adherence economics, Guideline Adherence standards, Guideline Adherence statistics & numerical data, Hospitals, Psychiatric economics, Humans, Male, Middle Aged, Needs Assessment economics, Personnel Staffing and Scheduling economics, Practice Guidelines as Topic, Prevalence, Psychotherapy economics, Psychotherapy statistics & numerical data, Utilization Review, Workforce, Young Adult, Depression therapy, Hospitals, Psychiatric standards, Hospitals, Psychiatric statistics & numerical data, Personnel Staffing and Scheduling statistics & numerical data, Psychiatry economics, Psychiatry standards, Psychiatry statistics & numerical data, Psychotherapy standards
- Abstract
Background: Chronic depression is a frequent mental disorder representing a significant subjective and economic burden. Effective disorder-specific treatment of chronic depression presupposes sufficient funding of treatment resources., Objective: Definition of normative needs of personnel resources for guideline-compliant and evidence-based inpatient treatment of chronic depression based on treatment duration and intensity. The personnel resources determined were compared to the resources provided on the basis of the existing reimbursement system (Psych-PV) in Germany., Material and Methods: Resources determined according to national treatment guidelines and empirical evidence were compared to personnel resources dictated by the German Psych-PV reimbursement algorithm., Results: The current funding algorithm greatly underestimates the resources needed for a guideline-compliant and evidence-based treatment program, even if healthcare providers received 100 % reimbursement of the sum determined by the Psych-PV algorithm., Discussion: The results clearly show that even in the case of a full coverage of the current German reimbursement algorithm, funding allocation for evidence-based inpatient treatment of chronic depression is insufficient. In addition, the difficulties of specific coding of chronic depression in the ICD-10 system generates a major problem in the attempt to measure the current resources needed for sufficient treatment.
- Published
- 2016
- Full Text
- View/download PDF
42. Nursing performance under high workload: a diary study on the moderating role of selection, optimization and compensation strategies.
- Author
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Baethge A, Müller A, and Rigotti T
- Subjects
- Adult, Burnout, Professional psychology, Female, Germany, Humans, Male, Middle Aged, Nursing Staff psychology, Surveys and Questionnaires, Workload psychology, Young Adult, Attitude of Health Personnel, Burnout, Professional economics, Clinical Competence economics, Job Satisfaction, Nursing Staff economics, Workload economics
- Abstract
Aims: The aim of this study was to investigate whether selective optimization with compensation constitutes an individualized action strategy for nurses wanting to maintain job performance under high workload., Background: High workload is a major threat to healthcare quality and performance. Selective optimization with compensation is considered to enhance the efficient use of intra-individual resources and, therefore, is expected to act as a buffer against the negative effects of high workload., Design: The study applied a diary design. Over five consecutive workday shifts, self-report data on workload was collected at three randomized occasions during each shift. Self-reported job performance was assessed in the evening. Self-reported selective optimization with compensation was assessed prior to the diary reporting., Methods: Data were collected in 2010. Overall, 136 nurses from 10 German hospitals participated. Selective optimization with compensation was assessed with a nine-item scale that was specifically developed for nursing. The NASA-TLX scale indicating the pace of task accomplishment was used to measure workload. Job performance was assessed with one item each concerning performance quality and forgetting of intentions., Results: There was a weaker negative association between workload and both indicators of job performance in nurses with a high level of selective optimization with compensation, compared with nurses with a low level. Considering the separate strategies, selection and compensation turned out to be effective., Conclusion: The use of selective optimization with compensation is conducive to nurses' job performance under high workload levels. This finding is in line with calls to empower nurses' individual decision-making., (© 2015 John Wiley & Sons Ltd.)
- Published
- 2016
- Full Text
- View/download PDF
43. [Guideline-conform psychiatric psychotherapeutic treatment for patients with schizophrenia : A normative evaluation of necessary personnel requirements].
- Author
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Mehl S, Falkai P, Berger M, Löhr M, Rujescu D, Wolff J, and Kircher T
- Subjects
- Adult, Aged, Chronic Disease, Clinical Competence economics, Clinical Competence standards, Germany epidemiology, Guideline Adherence economics, Guideline Adherence standards, Guideline Adherence statistics & numerical data, Hospitals, Psychiatric economics, Humans, Middle Aged, Needs Assessment economics, Personnel Staffing and Scheduling economics, Practice Guidelines as Topic, Prevalence, Psychotherapy economics, Psychotherapy statistics & numerical data, Schizophrenia economics, Schizophrenic Psychology, Utilization Review, Workforce, Young Adult, Hospitals, Psychiatric standards, Hospitals, Psychiatric statistics & numerical data, Personnel Staffing and Scheduling statistics & numerical data, Psychiatry economics, Psychiatry standards, Psychiatry statistics & numerical data, Psychotherapy standards, Schizophrenia therapy
- Abstract
Background: Although national treatment guidelines and current publications of the German Federal Joint Committee (Gemeinsamer Bundesausschuss) recommend cognitive behavior therapy for all patients with schizophrenia, the implementation of these recommendations in current inpatient and outpatient treatment is only rudimentary., Objectives: The aim of this study was to systematically search randomized controlled studies (RCTs), meta-analyses and the guidelines of the German Association for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) and the British National Institute for Health and Clinical Excellence (NICE) in order to assess the number of personnel necessary for psychiatric and therapeutic inpatient treatment in line with present guidelines. Moreover, the number of staff required was compared with the personnel resources designated by the German psychiatry personnel regulations (Psych-PV)., Methods: The German and NICE guidelines, RCTs and meta-analyses were analyzed and an adequate weekly treatment plan for an inpatient unit was developed. Moreover, the number of personnel necessary to realize the treatment plan was calculated., Results: In order to realize adequate inpatient treatment approximately 107 min extra for medical psychotherapeutic personnel per patient and week (of which 72 min for psychotherapy) and another 60 min for nursing staff per patient and week are required in addition to the current Psych-PV regulations. Thus, implementation in an open ward with 20 inpatients would require 3.62 positions for physicians, 0.7 positions in psychology and 12.85 positions for nursing staff (including management positions and night shifts)., Discussion: These evidence-based recommendations for precise specifications of inpatient treatment should lead to improved inpatient treatment in line with present guidelines. Moreover, outpatients and day patients could be included in this treatment model. The results should be considered in the construction of the future prospective payment system for inpatient psychiatric healthcare in Germany.
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- 2016
- Full Text
- View/download PDF
44. [Normative definition of staff requirement for a guideline-adherent inpatient qualified detoxification treatment in alcohol dependence].
- Author
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Kiefer F, Koopmann A, Godemann F, Wolff J, Batra A, and Mann K
- Subjects
- Adult, Aged, Alcoholism economics, Alcoholism epidemiology, Chronic Disease, Clinical Competence economics, Clinical Competence standards, Germany epidemiology, Guideline Adherence economics, Guideline Adherence standards, Guideline Adherence statistics & numerical data, Hospitals, Psychiatric economics, Humans, Middle Aged, Needs Assessment economics, Personnel Staffing and Scheduling economics, Practice Guidelines as Topic, Prevalence, Psychotherapy economics, Psychotherapy statistics & numerical data, Utilization Review, Workforce, Young Adult, Alcoholism therapy, Hospitals, Psychiatric standards, Hospitals, Psychiatric statistics & numerical data, Personnel Staffing and Scheduling statistics & numerical data, Psychiatry economics, Psychiatry standards, Psychiatry statistics & numerical data, Psychotherapy standards
- Abstract
The central element of the "qualified withdrawal treatment" of alcohol dependence is - in addition to physical withdrawal treatment - psychotherapy. The treatment of the underlying addictive disorder that is displayed by intoxication, harmful behaviour and withdrawal symptoms is only possible with a combination of somatic and psychotherapeutic treatment elements. The successfully established multimodal therapy of the "qualified alcohol withdrawal treatment", postulated in the current S3-Treatment Guidelines, requires a multi-disciplinary treatment team with psychotherapeutic competence. The aim of the present work is to calculate the normative staff requirement of a guideline-based 21-day qualified withdrawal treatment and to compare the result with the staffing regulations of the German Institute for Hospital Reimbursement. The present data support the hypothesis that even in the case of a hundred per cent implementation of these data, adequate therapy of alcohol-related disorders, according to the guidelines, is not feasible. This has to be considered when further developing the finance compensation system based on the described superseded elements of the German Institute for Hospital Reimbursement.
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- 2016
- Full Text
- View/download PDF
45. Migration of skilled anaesthesiologists from low to high-income economies: Urgent action needed.
- Author
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Mitre C, Breazu C, Mitre I, and Filipescu D
- Subjects
- Developing Countries economics, Europe epidemiology, Humans, Romania epidemiology, Time Factors, Anesthesiology economics, Anesthesiology trends, Clinical Competence economics, Human Migration trends, Physicians economics, Physicians trends
- Published
- 2016
- Full Text
- View/download PDF
46. [Guideline-oriented inpatient psychiatric psychotherapeutic/psychosomatic treatment of anxiety disorders : How many personnel are need?].
- Author
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Bandelow B, Lueken U, Wolff J, Godemann F, Wolff-Menzler C, Deckert J, Ströhle A, Beutel M, Wiltink J, Domschke K, and Berger M
- Subjects
- Adult, Aged, Anxiety Disorders economics, Anxiety Disorders epidemiology, Chronic Disease, Clinical Competence economics, Clinical Competence standards, Germany epidemiology, Guideline Adherence economics, Guideline Adherence standards, Guideline Adherence statistics & numerical data, Hospitals, Psychiatric economics, Humans, Middle Aged, Needs Assessment economics, Personnel Staffing and Scheduling economics, Practice Guidelines as Topic, Prevalence, Psychotherapy economics, Psychotherapy statistics & numerical data, Utilization Review, Workforce, Young Adult, Anxiety Disorders therapy, Hospitals, Psychiatric standards, Hospitals, Psychiatric statistics & numerical data, Personnel Staffing and Scheduling statistics & numerical data, Psychiatry economics, Psychiatry standards, Psychiatry statistics & numerical data, Psychotherapy standards
- Abstract
Background/objectives: The reimbursement of inpatient psychiatric psychotherapeutic/psychosomatic hospital treatment in Germany is regulated by the German personnel ordinance for psychiatric hospitals (Psych-PV), which has remained unchanged since 1991. The aim of this article was to estimate the personnel requirements for guideline-adherent psychiatric psychotherapeutic hospital treatment., Methods: A normative concept for the required psychotherapeutic "dose" for anxiety disorders was determined based on a literature review. The required staffing contingent was compared to the resources provided by the Psych-PV based on category A1., Results: According to the German policy guidelines for outpatient psychotherapy, a quota of 25 sessions of 50 min each (as a rule plus 5 probatory sessions) is reimbursed. This approach is supported by studies on dose-response relationships. As patients undergoing inpatient treatment for anxiety disorders are usually more severely ill than outpatients, a contingent of 30 sessions for the average treatment duration of 5 weeks seems appropriate in order to fully exploit the costly inpatient treatment time (300 min per patient and week). In contrast, only 70 min are reimbursed according to the Psych-PV. The total personnel requirement for the normative concept is 624 min per patient and week. The Psych-PV only covers 488 min (78 %)., Conclusion: Currently, the time contingents for evidence-based psychiatric psychotherapeutic/psychosomatic hospital care are nowhere near sufficient. In the development of future reimbursement systems this needs to be corrected.
- Published
- 2016
- Full Text
- View/download PDF
47. Dissatisfaction with maintenance of certification in academic pediatrics.
- Author
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Ackerman KG, Lee B, and Kushner JA
- Subjects
- Certification economics, Clinical Competence economics, Cost-Benefit Analysis, Humans, Pediatricians economics, Pediatricians psychology, Pediatrics economics, Perception, Attitude of Health Personnel, Certification standards, Clinical Competence standards, Health Knowledge, Attitudes, Practice, Job Satisfaction, Pediatricians standards, Pediatrics standards
- Published
- 2016
- Full Text
- View/download PDF
48. Collecting the evidence for EBVM: who pays?
- Author
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Lanyon L
- Subjects
- Animals, Clinical Competence economics, Education, Veterinary, Humans, Professional-Patient Relations, Evidence-Based Medicine economics, Veterinary Medicine economics
- Published
- 2016
- Full Text
- View/download PDF
49. A Sensitivity Analysis and Opportunity Cost Evaluation of the Surgical Council on Resident Education Curriculum.
- Author
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Falcone JL and Feinn RS
- Subjects
- Sensitivity and Specificity, United States, Clinical Competence economics, Costs and Cost Analysis, Curriculum, Internship and Residency economics, Specialties, Surgical education, Specialty Boards
- Abstract
Objective: The study purpose is to evaluate the Surgical Council on Resident Education (SCORE) Curriculum regarding American Board of Surgery Qualifying Examination (ABS QE) outcomes. The goal is to perform effect size analyses, sensitivity analyses, and sample size analyses with opportunity cost estimates required to favor the SCORE Curriculum subscription regarding ABS QE outcomes., Methods: Published data were used to construct 2 × 2 matrices regarding ABS QE outcome (pass/fail) and SCORE subscription status (subscriber/nonsubscriber). Post hoc analyses of effect sizes and sample sizes, with opportunity cost estimates, were performed to evaluate ABS QE outcomes favoring SCORE subscription (2-tailed and 1-tailed tests) using an α = 0.05., Results: The absolute risk increase of SCORE subscription on ABS QE outcome was 1.6% (number needed to treat = 63). Sensitivity analyses showed that a pass rate difference of 4.9% to 7.5% was required to favor SCORE subscription (all p < 0.05). Sample size analyses required an 8- to 18-fold increase to favor SCORE subscription to achieve statistical significance with an opportunity cost of $6.0 to $13.5 million ($30,000-$67,000/program), not adjusting for inflation., Conclusions: The number needed to treat and pass rate differences required to favor SCORE subscription are large. The opportunity costs of SCORE subscription are substantial. Residency programs with more limited resources should determine if the subscription costs are financially sound., (Copyright © 2015 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2016
- Full Text
- View/download PDF
50. Reply.
- Author
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Khalifa YM
- Subjects
- Humans, Cataract Extraction economics, Cataract Extraction education, Clinical Competence economics, Costs and Cost Analysis, Educational Measurement methods, Internship and Residency, Ophthalmology education
- Published
- 2015
- Full Text
- View/download PDF
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