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OBJECTIVES: This study aims at evaluating the chronic disease risk related to prolonged work in long-hour schedules for eight major chronic diseases: heart disease, non-skin cancer, arthritis, diabetes, chronic lung disease, asthma, chronic depression, and hypertension. METHODS: The study used data from the National Longitudinal Survey of Youth, 1979 covering 32 years of job history (1978 to 2009) for 7492 respondents. Logistic regression analyses were performed to test the relationship between average weekly work hours, and the reported prevalence of those conditions for each individual. RESULTS: Regularly working long hours over 32 years was significantly associated with elevated risks of heart disease, non-skin cancer, arthritis, and diabetes. The observed risk was much larger among women than among men. CONCLUSIONS: Working long-hour schedules over many years increases the risk for some specific chronic diseases, especially for women.
Assuntos
Doença Crônica/epidemiologia , Admissão e Escalonamento de Pessoal , Tolerância ao Trabalho Programado , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de RiscoRESUMO
Appointment wait times are a neglected dimension of children's access to psychiatry. We systematically examined how long an adolescent waits for a new patient appointment with a psychiatrist for routine medication management. From state directories, we identified 578 providers of adolescent psychiatric care in Ohio. Researchers posing as parents telephoned randomly selected offices, seeking care for a hypothetical 14-year-old patient under different scenarios. Overall, we measured 498 wait times at 140 unique offices. The median wait time was 50 days (interquartile range = 29-81 days). In adjusted models, adolescents with Medicaid waited longer than those with private insurance, especially during the spring (geometric mean = 50.9 vs. 41.9 days; p = 0.02). Wait times also varied markedly by region, with geometric means ranging from 22.4 to 75.1 days (p < 0.01). This study demonstrates that adolescents often experience lengthy wait times for routine care. This methodology represents a useful approach to real-time monitoring of psychiatric services.
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Agendamento de Consultas , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Transtornos Mentais/terapia , Listas de Espera , Adolescente , Assistência Ambulatorial/organização & administração , Criança , Feminino , Acessibilidade aos Serviços de Saúde/organização & administração , Humanos , Masculino , Ohio , Características de Residência , População Rural , Telefone , Estados Unidos , População UrbanaRESUMO
OBJECTIVE: Regular use of recommended preventive health services can promote good health and prevent disease. However, individuals may forgo obtaining preventive care when they are busy with competing activities and commitments. This study examined whether time pressure related to work obligations creates barriers to obtaining needed preventive health services. METHODS: Data from the 2002-2010 Medical Expenditure Panel Survey (MEPS) were used to measure the work hours of 61,034 employees (including 27,910 females) and their use of five preventive health services (flu vaccinations, routine check-ups, dental check-ups, mammograms and Pap smear). Multivariable logistic regression analyses were performed to test the association between working hours and use of each of those five services. RESULTS: Individuals working long hours (>60 per week) were significantly less likely to obtain dental check-ups (OR=0.81, 95% CI: 0.72-0.91) and mammograms (OR=0.47, 95% CI: 0.31-0.73). Working 51-60 h weekly was associated with less likelihood of receiving Pap smear (OR=0.67, 95% CI: 0.46-0.96). No association was found for flu vaccination. CONCLUSIONS: Time pressure from work might create barriers for people to receive particular preventive health services, such as breast cancer screening, cervical cancer screening and dental check-ups. Health practitioners should be aware of this particular source of barriers to care.
Assuntos
Emprego/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Serviços Preventivos de Saúde/estatística & dados numéricos , Adolescente , Adulto , Serviços de Saúde Bucal/estatística & dados numéricos , Detecção Precoce de Câncer/estatística & dados numéricos , Emprego/organização & administração , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Vacinas contra Influenza/administração & dosagem , Cobertura do Seguro/legislação & jurisprudência , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/legislação & jurisprudência , Modelos Logísticos , Masculino , Mamografia/estatística & dados numéricos , Pessoa de Meia-Idade , Teste de Papanicolaou/estatística & dados numéricos , Patient Protection and Affordable Care Act/normas , Admissão e Escalonamento de Pessoal , Fatores de Tempo , Estados Unidos , Adulto JovemRESUMO
OBJECTIVE: This study examines the effect of taking a health risk assessment (HRA) on health care costs, utilization, and member health risks over a 3-year period. METHODS: This retrospective cohort study examined changes utilization, costs, and health risks among a random sample of 500 employees completing an HRA compared with a matched group of 500 employees who did not complete an HRA. RESULTS: The HRA group accessed services more frequently and at a lower overall cost, was more likely to utilize primary care and preventive services after the HRA, and improved on seven out of eight health risk measures. CONCLUSIONS: This study demonstrates that significant and sustained improvement in health risks and lower health care costs may be achievable with efforts such as an HRA that seeks to engage employees in health improvement efforts.
Assuntos
Comportamentos Relacionados com a Saúde , Custos de Cuidados de Saúde , Promoção da Saúde , Saúde Ocupacional , Serviços Preventivos de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Serviços Preventivos de Saúde/economia , Atenção Primária à Saúde/economia , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Fatores de TempoRESUMO
BACKGROUND: Many health care facilities have developed electronic reporting systems for identifying and reporting adverse events (AEs), so that measures can be taken to improve patient safety. Although several studies have examined AEs in surgical settings, there has not previously been a systematic assessment of the variations in adverse event rates among different types of surgery, nor an identification of the particular types of AEs that are most common within each surgical category. Additionally, this study will identify the AE severity level associated with each of the AE category types. METHODS: This retrospective observational study was conducted at three Midwestern hospitals that are part of a large integrated healthcare system. Data from 2006 through 2009 were analyzed to determine the rates of reported adverse events (per 1,000 hospitalizations involving a surgical procedure) for 96 categories of surgery as classified according to the ICD-9-CM procedural coding system. Univariate and bivariate summary statistics were compiled for AEs by type, severity, and patient age. RESULTS: During the four-year study period, there was a total of 82,784 distinct hospitalizations involving at least one surgical procedure at these three hospitals. At least one adverse event was reported at 5,368 (6.5%) of those hospitalizations. The mean rate of AEs among all surgical procedure groups was 82.8 AEs per 1,000 hospitalizations. Adverse event rates varied widely among surgical categories with a high of 556.7 AEs per 1,000 hospitalizations for operations on the heart and pericardium. The most common type of adverse event involved care management, followed by medication events and events related to invasive procedures. CONCLUSIONS: Detecting variations in AEs among surgical categories can be useful for surgeons and for hospital quality assurance personnel. Documenting the specific AE incidence rates among the most common types of surgical categories, and determining AE severity and age distributions within surgical categories will enable officials to better identify specific patient safety needs and develop appropriately targeted interventions for improvement.
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BACKGROUND: A standardized process using data from the Occupational Information Network (O*NET) is applied to estimate the association between long-term aggregated occupational exposure and the risk of contracting chronic diseases later in life. We demonstrate this process by analyzing relationships between O*NET physical work demand ratings and arthritis onset over a 32-year period. METHODS: The National Longitudinal Survey of Youth provided job histories and chronic disease data. Five O*NET job descriptors were used as surrogate measures of physical work demands. Logistic regression measured the association between those demands and arthritis occurrence. RESULTS: The risk of arthritis was significantly associated with handling and moving objects, kneeling, crouching, and crawling, bending and twisting, working in a cramped or awkward posture, and performing general physical activities. CONCLUSION: This study demonstrates the utility of using O*NET job descriptors to estimate the aggregated long-term risks for osteoarthritis and other chronic diseases when no actual exposure data is available.
Assuntos
Doenças Profissionais/epidemiologia , Exposição Ocupacional/estatística & dados numéricos , Osteoartrite/epidemiologia , Carga de Trabalho/estatística & dados numéricos , Doença Crônica , Bases de Dados Factuais , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
OBJECTIVE: This study uses 32 years of longitudinal job history to analyze the long-term effect of exposure to specific workplace conditions on the risk of contracting asthma or chronic lung disease later in life. Our approach allows for the estimation of occupational respiratory risks even in the absence of direct environmental monitoring. METHODS: We employ a novel methodology utilizing data from the National Longitudinal Survey of Youth 1979 (NLSY79), and ratings of job exposures from the Occupational Information Network (O*NET), which are based on 70 years of empirical data compiled by the U.S. Department of Labor. A series of multivariable logistic regression analyses are performed to determine how long-term exposure to a particular occupational O*NET indicator (e.g., working in an extremely hot or cold environment) is related to asthma and COPD risk. RESULTS: The risk of contracting COPD was significantly associated with long-term work in very hot or cold temperatures (OR = 1.50, CI: 1.07-2.10), performing physically demanding activities (OR = 1.65, CI:1.20-2.28), working outdoors exposed to weather (OR = 1.45, CI:1.06-1.99), and workplace exposure to contaminants (OR = 1.42, CI:1.05-1.96). In general, the effects of exposure were greater for COPD than for asthma. With respect to contracting asthma, only exposure to work in very hot or cold temperatures (OR = 1.35, CI:1.08-1.70) and performing physically demanding activities (OR = 1.23, CI:1.00-1.52) were statistically significant. CONCLUSIONS: Use of O*NET job descriptors as surrogate measures of workplace exposures can provide a useful way of analyzing the risk of occupationally-related respiratory disease in situations where direct exposure measurement is not feasible.
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Asma/epidemiologia , Asma/etiologia , Exposição Ocupacional/efeitos adversos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/etiologia , Medição de Risco/métodos , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-IdadeRESUMO
Increasing emphasis is being placed on measuring return on research investment and determining the true impacts of biomedical research for medical practice and population health. This article describes initial progress on development of a new standardized tool for identifying and measuring impacts across research sites. The Translational Research Impact Scale (TRIS) is intended to provide a systematic approach to assessing impact levels using a set of 72 impact indicators organized into three broad research impact domains and nine subdomains. A validation process was conducted with input from a panel of 31 experts in translational research, who met to define and standardize the measurement of research impacts using the TRIS. Testing was performed to estimate the reliability of the experts' ratings. The reliability was found to be high (ranging from .75 to .94) in all of the domains and most of the subdomains. A weighting process was performed assigning item weights to the individual indicators, so that composite scores can be derived.
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Avaliação do Impacto na Saúde/normas , Pesquisa Translacional Biomédica/normas , Avaliação do Impacto na Saúde/métodos , Humanos , Modelos Logísticos , National Institutes of Health (U.S.) , Avaliação de Programas e Projetos de Saúde/métodos , Avaliação de Programas e Projetos de Saúde/normas , Reprodutibilidade dos Testes , Pesquisa Translacional Biomédica/métodos , Pesquisa Translacional Biomédica/organização & administração , Estados UnidosRESUMO
A coalition of employers in the hotel and restaurant industries collaborated with community-based organizations to undertake a unique demonstration project, called the Employed Latino Health Initiative, aimed at improving access to basic health care services for low-wage Latino workers in Columbus, Ohio. With grant funding from the Robert Wood Johnson Foundation, the project developed and tested protocols allowing Latino workers from participating companies to obtain basic health care screenings, referrals to medical providers, health education training, and the services of a qualified community health navigator. Data from the pilot project indicated high screening participation rates, extensive referrals to providers for follow-up care, and a substantial need for facilitation services by community health navigators. The project provides a model for how employers can potentially promote their own interests in boosting work productivity through facilitating expanded access to basic medical services among vulnerable workers, despite the absence of conventional health insurance coverage.
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Planos de Assistência de Saúde para Empregados , Acessibilidade aos Serviços de Saúde , Hispânico ou Latino , Cobertura do Seguro , Feminino , Humanos , Masculino , Ohio , Projetos Piloto , Pesquisa QualitativaAssuntos
Agendamento de Consultas , Acessibilidade aos Serviços de Saúde , Serviços de Saúde Mental/estatística & dados numéricos , Adolescente , Adulto , Criança , Comportamento do Consumidor , Feminino , Pesquisas sobre Atenção à Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Seguro Saúde , Masculino , Medicaid , Ohio , Avaliação de Programas e Projetos de Saúde/métodos , Telefone , Estados Unidos , Listas de EsperaRESUMO
Over the past 20 years, states have increasingly moved away from centrally financed, state-operated facilities to financing models built around community-based service delivery mechanisms. This paper identifies four important broad factors to consider when developing a funding formula to allocate state funding for community mental health services to local boards in an equitable manner, based on local community need: (1) funding factors used by other states; (2) state specific legislative requirements; (3) data availability; and (4) local variation of factors in the funding formula. These considerations are illustrated with the recent experience of Ohio using available evidence and data sources to develop a new community-based allocation formula. We discuss opportunities for implementing changes in formula based mental health funding related to Medicaid expansions for low income adults scheduled to go into effect under the new Patient Protection and Affordable Care Act.
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Serviços Comunitários de Saúde Mental/economia , Financiamento Governamental/organização & administração , Programas Governamentais/economia , Desenvolvimento de Programas/economia , Alocação de Recursos , Planos Governamentais de Saúde/economia , Adulto , Humanos , Medicaid/economia , Ohio , Características de Residência , Alocação de Recursos/estatística & dados numéricos , Estados UnidosRESUMO
BACKGROUND: This study aims to identify the statistical software applications most commonly employed for data analysis in health services research (HSR) studies in the U.S. The study also examines the extent to which information describing the specific analytical software utilized is provided in published articles reporting on HSR studies. METHODS: Data were extracted from a sample of 1,139 articles (including 877 original research articles) published between 2007 and 2009 in three U.S. HSR journals, that were considered to be representative of the field based upon a set of selection criteria. Descriptive analyses were conducted to categorize patterns in statistical software usage in those articles. The data were stratified by calendar year to detect trends in software use over time. RESULTS: Only 61.0% of original research articles in prominent U.S. HSR journals identified the particular type of statistical software application used for data analysis. Stata and SAS were overwhelmingly the most commonly used software applications employed (in 46.0% and 42.6% of articles respectively). However, SAS use grew considerably during the study period compared to other applications. Stratification of the data revealed that the type of statistical software used varied considerably by whether authors were from the U.S. or from other countries. CONCLUSIONS: The findings highlight a need for HSR investigators to identify more consistently the specific analytical software used in their studies. Knowing that information can be important, because different software packages might produce varying results, owing to differences in the software's underlying estimation methods.
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Interpretação Estatística de Dados , Pesquisa sobre Serviços de Saúde/estatística & dados numéricos , Software , Humanos , Projetos de Pesquisa , Estados UnidosRESUMO
This study presents the results of a pilot study of mandatory pre-release testing for sexually transmitted disease (STD) and a behavioral risk survey for male inmates at an Ohio prison. Approximately 4-6 weeks prior to scheduled release, inmates took part in a mandatory blood test and optional genital swab and physical examination to test for STDs. At the time of testing, a voluntary behavioral and knowledge survey was administered to inmates. Pre-release testing identified 53 new cases of STDs among the 916 inmates (5.5%) scheduled for release during the pilot study period. Trichomoniasis and hepatitis C were the most common infections identified through pre-release testing. Nearly all inmates participated in the required blood test. Participation rates for the other testing methods averaged less than 45%. Inmates reported engaging in various risky behaviors during incarceration such as having sex (12.1%), tattooing (36.5%), and drug use (19.5%). Pre-release testing identified several new cases of STDs not identified through existing intake and for-cause testing procedures. Substantial useful information about the prevalence of STD risk behaviors can be obtained through a pre-release survey.
Assuntos
Prisioneiros/psicologia , Prisões/estatística & dados numéricos , Assunção de Riscos , Infecções Sexualmente Transmissíveis/diagnóstico , Adolescente , Adulto , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos Epidemiológicos , Hepatite C Crônica/diagnóstico , Hepatite C Crônica/epidemiologia , Humanos , Masculino , Ohio/epidemiologia , Projetos Piloto , Prisioneiros/estatística & dados numéricos , Medição de Risco/métodos , Infecções Sexualmente Transmissíveis/epidemiologia , Estatística como Assunto , Fatores de Tempo , Tricomoníase/diagnóstico , Tricomoníase/epidemiologia , Adulto JovemRESUMO
Depression occurring concurrently with cardiovascular diseases is associated with poor outcomes. Several review articles have examined the link between established indices of depression and prognosis in individuals with known coronary heart disease (CHD). These studies have demonstrated relatively consistent results and suggest an important connection between cardiovascular morbidity and mortality in patients with depressive symptoms or major depression. This article discusses the current best practices for the screening, identification, and treatment of depression in patients with CHD and coronary heart failure, as well as the financial aspects associated with care management.
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Doença da Artéria Coronariana/complicações , Depressão/diagnóstico , Insuficiência Cardíaca/complicações , Adaptação Psicológica , Doença da Artéria Coronariana/psicologia , Depressão/etiologia , Depressão/psicologia , Progressão da Doença , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/psicologia , Humanos , Prevalência , Prognóstico , Psicometria , Fatores de Risco , Estresse Psicológico , Inquéritos e Questionários , Estados UnidosRESUMO
A recent meeting of leading workers' compensation (WC) researchers was held in Washington, DC to consider ways of improving the use of WC data for injury and illness prevention. Participants identified specific deficiencies that limit the application of WC data for research purposes. For example, commercial insurers are often reluctant to provide claims records to research organizations. Unlike many other countries, the Unites States lacks a comprehensive national system for compiling and analyzing WC data, or mechanisms for linking WC data with other health care, employment, and disability records. Many of these deficiencies can be traced to historical circumstances surrounding the early development of WC laws in the United States. Inconsistencies among states developed in the absence of a federal WC system. Opportunities exist for using WC data more broadly to support public health research aimed at improving the health of populations and communities.
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Saúde Ocupacional/história , Indenização aos Trabalhadores , Acidentes de Trabalho , História do Século XX , Humanos , Saúde Ocupacional/legislação & jurisprudência , Estados Unidos , Indenização aos Trabalhadores/economia , Indenização aos Trabalhadores/história , Indenização aos Trabalhadores/legislação & jurisprudência , Indenização aos Trabalhadores/organização & administração , Ferimentos e Lesões/economiaRESUMO
This article describes a preliminary economic feasibility study estimating the costs involved in ensuring basic services and adequate provider capacity as a first step in creating a patient-centered medical home model in Franklin County, Ohio. The initial feasibility study estimated the costs involved in: 1) increasing the number of primary care providers in the county, 2) increasing care capacity at existing federally qualified health centers, and 3) increasing capacity to provide a set of comprehensive care services involving care coordination and availability of specialists and prescription drugs. Cost estimates based on providing services to children and adults below 400% of the federal poverty level in the county ranged from $2.4 million to $212.9 million, depending on the features included in each approach for ensuring adequate provider and service capacity. Major factors affecting the cost estimates included population characteristics, the supply of primary care providers (MD or non-MD), availability of prescription drug coverage, capacity at existing federally qualified health centers, and whether the medical home model involved expanding Medicaid eligibility and enrollment.
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Serviços de Saúde Comunitária/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Assistência Centrada no Paciente/economia , Médicos de Família/economia , Atenção Primária à Saúde/economia , Adulto , Criança , Serviços de Saúde Comunitária/organização & administração , Assistência Integral à Saúde/economia , Estudos de Viabilidade , Financiamento Governamental , Humanos , Modelos Econômicos , Ohio , Assistência Centrada no Paciente/organização & administração , Médicos de Família/provisão & distribuição , Medicamentos sob Prescrição , Atenção Primária à Saúde/organização & administração , EspecializaçãoRESUMO
This study's goal was to identify the strongest predictors of satisfaction with a health plan offered to employees at a large university in the Midwestern United States. Survey responses from 1533 employees were analyzed (response rate of 51.2%). Unadjusted odds ratios (ORs) were calculated to identify factors that were statistically associated with plan satisfaction. Multivariate logistic regression analyses followed by likelihood ratio testing were conducted to assess the predictive value of particular variables. The strongest predictors of satisfaction with the health plan were the perceived quality of the plan's wellness and prevention services (OR = 3.69), having a personal doctor or nurse (OR = 2.70), being satisfied with the cost of the health plan (OR = 2.18), and having claims handled correctly (OR = 1.90). The factors that have the greatest individual effect on these findings were the quality of the plan's prevention and wellness services and how effectively the plan communicated how much particular services or visits would cost.
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Comportamento do Consumidor , Planos de Assistência de Saúde para Empregados , Universidades , Adolescente , Adulto , Idoso , Coleta de Dados , Feminino , Planos de Assistência de Saúde para Empregados/economia , Planos de Assistência de Saúde para Empregados/organização & administração , Humanos , Funções Verossimilhança , Masculino , Pessoa de Meia-Idade , Meio-Oeste dos Estados Unidos , Adulto JovemRESUMO
BACKGROUND: Acute appendicitis continues to be a common general surgical problem. Little is known about whether the contribution to margin has been affected by changes in technology. STUDY DESIGN: Patients undergoing appendectomy for acute appendicitis from June 2005 to May 2007 were evaluated for demographics, diagnostic and treatment alternatives, and outcomes. Financial outcomes were assessed. Efficiency, including admission to emergency department bed to incision (bed to knife time [BTK]), operative length, and hospital length of stay (LOS) were assessed. RESULTS: During the 2 years of the study, there were no differences in demographics, insurance status, case length, diagnostic accuracy, pathology, LOS, or outcomes. Both laparoscopy and CT use increased between the 2 study years (odds ratio [OR]: 1.68, p = 0.06; 95% CI, 0.98-2.89 and OR: 1.83, p = 0.06, CI, 0.98-3.45, respectively). Mean BTK time increased by about 1 hour: 465 minutes versus 521 minutes (p = 0.032; 95% CI, 0.08-1.78) in univariate analysis. However, multivariate analysis demonstrated no difference in BTK time between years (p = 0.136). After controlling for gender, year of operation, and insurance status, obtaining a CT study added 3.5 hours to BTK time (p < 0.001; 95% CI, 2.41-4.45). Women had BTK times 55 minutes longer than men when controlling for similar covariates (p = 0.027; 95% CI, 0.11-1.74). Laparoscopy contributed to shorter mean LOS (-0.78 days, p = 0.04), and gangrenous appendicitis (1.80 days, p < 0.001) and complications (4.23 days, p < 0.001) increased LOS. Mean contribution to margin decreased from $6,347 to $4,295 (p = 0.068). CONCLUSIONS: Increasing use of CT scanning in acute appendicitis increases cost of care, decreases contribution to margin, prolongs patient's stay in the emergency department, and delays time to operation.
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Apendicectomia/economia , Apendicite/diagnóstico , Apendicite/cirurgia , Custos de Cuidados de Saúde , Hospitalização/economia , Tomografia Computadorizada por Raios X/economia , Adolescente , Adulto , Apendicite/economia , Estudos de Coortes , Análise Custo-Benefício , Serviço Hospitalar de Emergência/economia , Feminino , Humanos , Laparoscopia/economia , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Estudos Retrospectivos , Adulto JovemRESUMO
BACKGROUND: Lean and Six Sigma are business management strategies commonly used in production industries to improve process efficiency and quality. During the past decade, these process improvement techniques increasingly have been applied outside the manufacturing sector, for example, in health care and in software development. This article concerns the potential use of Lean and Six Sigma in improving the processes involved in clinical and translational research. Improving quality, avoiding delays and errors, and speeding up the time to implementation of biomedical discoveries are prime objectives of the National Institutes of Health (NIH) Roadmap for Medical Research and the NIH's Clinical and Translational Science Award program. METHODS: This article presents a description of the main principles, practices, and methods used in Lean and Six Sigma. Available literature involving applications of Lean and Six Sigma to health care, laboratory science, and clinical and translational research is reviewed. Specific issues concerning the use of these techniques in different phases of translational research are identified. RESULTS: Examples of Lean and Six Sigma applications that are being planned at a current Clinical and Translational Science Award site are provided, which could potentially be replicated elsewhere. We describe how different process improvement approaches are best adapted for particular translational research phases. CONCLUSIONS: Lean and Six Sigma process improvement methods are well suited to help achieve NIH's goal of making clinical and translational research more efficient and cost-effective, enhancing the quality of the research, and facilitating the successful adoption of biomedical research findings into practice.
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Pesquisa Biomédica/organização & administração , Eficiência Organizacional , Pesquisa Translacional Biomédica/organização & administração , Animais , Humanos , National Institutes of Health (U.S.)/organização & administração , Admissão e Escalonamento de Pessoal/organização & administração , Garantia da Qualidade dos Cuidados de Saúde , Gestão de Riscos , Gestão da Segurança , Gestão da Qualidade Total , Estados UnidosRESUMO
OBJECTIVE: Employees working in nonstandard shifts and long-hour schedules have an increased risk for job-related injuries and illnesses. This study estimates the extent of that risk among various occupations and industries. METHODS: Longitudinal data for 13 years among a sample of nearly 11,000 employees aged 22 to 43 was used to calculate the risk of injury by occupation and industry for six types of demanding work schedules. Cox proportional hazard regression analyses were used to estimate risks within specific occupational and industrial classifications. RESULTS: The greatest risks of job-related injury were among 1) construction workers in evening shifts, 2) professional, technical, and managerial personnel working overtime schedules, and 3) employees working overtime shifts in the business and repair services sectors. CONCLUSIONS: Injury prevention efforts should be targeted toward employees in specific industries and occupations who work certain long-hour and shift work schedules.