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Management Data (management + data)
Selected AbstractsAdult Emergency Department Patients with Sickle Cell Pain Crisis: A Learning Collaborative Model to Improve Analgesic ManagementACADEMIC EMERGENCY MEDICINE, Issue 4 2010Paula Tanabe PhD Abstract Objectives:, The objectives were to report the baseline (prior to quality improvement interventions) patient and visit characteristics and analgesic management practices for each site participating in an emergency department (ED) sickle cell learning collaborative. Methods:, A prospective, multisite longitudinal cohort study in the context of a learning-collaborative model was performed in three midwestern EDs. Each site formed a multidisciplinary team charged with improving analgesic management for patients with sickle cell disease (SCD). Each team developed a nurse-initiated analgesic protocol for SCD patients (implemented after a baseline data collection period of 3.5 months at one site and 10 months at the other two sites). All sites prospectively enrolled adults with an acute pain crisis and SCD. All medical records for patients meeting study criteria were reviewed. Demographic, health services, and analgesic management data were abstracted, including ED visit frequency data, ED disposition, arrival and discharge pain score, and name and route of initial analgesic administered. Ten interviews per quarter per site were conducted with patients within 14 days of their ED discharge, and subjects were queried about the highest level of pain acceptable at discharge. The primary outcome variable was the time to initial analgesic administration. Variable data were described as means and standard deviations (SDs) or medians and interquartile ranges (IQR) for nonnormal data. Results:, A total of 155 patients met study criteria (median age = 32 years, IQR = 24,40 years) with a total of 701 ED visits. Eighty-six interviews were conducted. Most patients (71.6%) had between one and three visits to the ED during the study period. However, after removing Site 3 from the analysis because of the short data enrollment period (3.5 months), which influenced the mean number of visits for the entire cohort, 52% of patients had between one and three ED visits over 10 months, 21% had four to nine visits, and 27% had between 10 and 67 visits. Fifty-nine percent of patients were discharged home. The median time to initial analgesic for the cohort was 74 minutes (IQR = 48,135 minutes). Differences between choice of analgesic agent and route selected were evident between sites. For the cohort, 680 initial analgesic doses were given (morphine sulfate, 42%; hydromorphone, 46%; meperidine, 4%; morphine sulfate and ibuprofen or ketorolac, 7%) using the following routes: oral (2%), intravenous (67%), subcutaneous (3%), and intramuscular (28%). Patients reported a significantly lower targeted discharge pain score (mean ± SD = 4.19 ± 1.18) compared to the actual documented discharge pain score within 45 minutes of discharge (mean ± SD = 5.77 ± 2.45; mean difference = 1.58, 95% confidence interval = .723 to 2.44, n = 43). Conclusions:, While half of the patients had one to three ED visits during the study period, many patients had more frequent visits. Delays to receiving an initial analgesic were common, and post-ED interviews reveal that sickle cell pain patients are discharged from the ED with higher pain scores than what they perceive as desirable. ACADEMIC EMERGENCY MEDICINE 2010; 17:399,407 © 2010 by the Society for Academic Emergency Medicine [source] Opportunities to work at home in the context of work-life balanceHUMAN RESOURCE MANAGEMENT JOURNAL, Issue 1 2002Alan Felstead Discussion of ,work-life balance' and ,family-friendly' employment is much in vogue among politicians and business leaders. Often, but not always, working at home is included within such practices. However, the concepts of work-life balance and family-friendly are commonly left ill-defined by researchers and policymakers alike. In this article we outline formal definitions of these terms, which place spatial issues - and hence working at home - at the heart of the debate. This leads us on to examine working at home through the theoretical lens offered by attempts to explain the rise of work-life balance arrangements. Twelve hypotheses emerge from the literature and are tested on the management data contained in the 1998 Workplace Employee Relations Survey or WERS98. Many of these hypotheses pass weak statistical tests but fail on stronger logistic regression tests. The article shows that the option to work at home is more likely to be available in the public sector, large establishments and work environments in which individuals are responsible for the quality of their own output. These workplaces are typically less unionised but not especially feminised. [source] Balancing the funds in the New Cooperative Medical Scheme in rural China: determinants and influencing factors in two provincesINTERNATIONAL JOURNAL OF HEALTH PLANNING AND MANAGEMENT, Issue 2 2010Luying Zhang Abstract In recent years, the central government in China has been leading the re-establishment of its rural health insurance system, but local government institutions have considerable flexibility in the specific design and management of schemes. Maintaining a reasonable balance of funds is critical to ensure that the schemes are sustainable and effective in offering financial protection to members. This paper explores the financial management of the NCMS in China through a case study of the balance of funds and the factors influencing this, in six counties in two Chinese provinces. The main data source is NCMS management data from each county from 2003 to 2005, supplemented by: a household questionnaire survey, qualitative interviews and focus group discussions with all local stakeholders and policy document analysis. The study found that five out of six counties held a large fund surplus, whilst enrolees obtained only partial financial protection. However, in one county greater risk pooling for enrolees was accompanied by relatively high utilisation levels, resulting in a fund deficit. The opportunities to sustainably increase the financial protection offered to NCMS enrolees are limited by the financial pressures on local government, specific political incentives and low technical capacities at the county level and below. Our analysis suggests that in the short term, efforts should be made to improve the management of the current NCMS design, which should be supported through capacity building for NCMS offices. However, further medium-term initiatives may be required including changes to the design of the schemes. Copyright © 2009 John Wiley & Sons, Ltd. [source] Improving the organization of consultation departments in university hospitalsJOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 6 2007Agnès Dechartres MD Abstract Rationale, Changes in the demography of doctors require changes in care practices. Objectives, The aim of this study was to identify factors associated with doctors' workload in the ophthalmology consultation department of a university hospital, with a view to developing methods to improve the organization of hospital outpatient clinics. Methods, A 10-day cross-sectional survey was carried out in an ophthalmology outpatient clinic (in- and outpatient consultations, including emergencies) specializing in the uveitis care. Demographic and management data for each patient were collected on a structured form. The doctor's workload was assessed, using a scale taking into account the duration of the consultation and the number of diagnostic tests performed, as a function of management complexity. Results, Of the 861 consultations studied, 39.7% were highly complex. The level of complexity of consultations was correlated with the type of referral (phi = 0.602), consultation duration (phi = 0.545), the number of consultations in the previous year (phi = 0.499), and the number of diagnostic tests performed (phi = 0.445). Consultations were longer and diagnostic tests were more frequently performed if patients had been referred by an ophthalmologist, consulted a faculty doctor or a fellow, or presented with uveitis. Consultations were also more complex for patients with at least four previous consultations in the past year. Conclusions, Type of referral, status of the attending doctor and number of consultations within the course of 1 year were associated with doctors' workload and could be taken into account to predict the duration of complexity of consultations when scheduling appointments. [source] Retrospective evaluation of pain assessment and treatment for acute vasoocclusive episodes in children with sickle cell diseasePEDIATRIC BLOOD & CANCER, Issue 2 2008William T. Zempsky MD Abstract Background This study was conducted to assess the care of pediatric patients hospitalized for sickle cell disease-related vasoocclusive episodes (VOE). The aim of this research was to illustrate the course of pain scores and methods of therapeutic intervention during hospitalization. Procedure Retrospective medical chart reviews were conducted to collect pain assessment and management data about children hospitalized during a 2-year period at an urban children's hospital. T tests and Chi-square analyses were used to identify differences in demographic variables, pain scores and opiate utilization. Results There were 59 children with 134 hospitalizations for VOE in a 2-year period. 50.8% of the patients were male; the mean age was 11.5,±,4.9 years. The average length of hospitalization was 4.6,±,2.7 days (range 1,19 days). Older patients stayed in the hospital significantly longer than younger patients (P,=,0.002). Pain scores remained in the moderate to severe range (,5 out of 10) for many days in the majority of patients. Results failed to reveal significant differences in pain scores and opiate utilization between patients who had short versus extended hospitalizations, and for those patients with frequent versus infrequent hospitalizations for pain. Conclusions Despite opiate dosing within recommended guidelines, mean pain scores remain in the moderate to severe range for several days following hospitalization for VOE. Future research should explore the factors which influence pain scores, as well as improved pain assessment and management techniques. Pediatr Blood Cancer 2008;51:265,268. © 2008 Wiley-Liss, Inc. [source] | ||||||||||