ABSTRACT
PURPOSE OF STUDY: To estimate time allocation and labor cost for care coordinators (CCs), community health workers (CHWs), and mental health workers (MHWs) to conduct care coordination tasks in a pediatric care coordination program. PRIMARY PRACTICE SETTING: A public tertiary academic medical center in Chicago, IL. METHODOLOGY AND SAMPLE: A work-sampling study was conducted using a text message-based survey on 5 CCs, 20 CHWs, and 4 MHWs who volunteered to participate. Workers were randomly sampled within working hours to collect information on who was the subject of interaction and what service was being delivered over a 6-month period. Time allocation of workers to different subjects and services was summarized using descriptive statistics. RESULTS: Care coordinators allocated 41% of their time to managing CHW teams. Community health workers allocated 37% of time providing services directly to children and 26% to the parent/caregiver. Mental health workers allocated 16% of time providing services to children and 29% to the parent/caregiver. The care coordination program serviced 5,965 patients, with a total annual labor cost of $1,455,353. IMPLICATIONS FOR CASE MANAGEMENT PRACTICE: Community health workers spent the majority of time working with patients and their families to conduct assessments. Mental health workers primarily addressed children's needs through their caregivers. Care coordinators primarily supported CHWs in coordinating care. Results may be used to inform development of such programs by determining services most often utilized, and labor cost may be used to inform program implementation and reimbursement.
Subject(s)
Pediatric Nursing/economics , Pediatric Nursing/statistics & numerical data , Primary Health Care/economics , Primary Health Care/statistics & numerical data , Therapies, Investigational/statistics & numerical data , Time and Motion Studies , Academic Medical Centers/economics , Academic Medical Centers/statistics & numerical data , Adolescent , Adult , Caregivers/economics , Caregivers/statistics & numerical data , Case Managers/economics , Case Managers/statistics & numerical data , Chicago , Child , Child, Preschool , Chronic Disease/economics , Chronic Disease/therapy , Female , Hospitals, Public/economics , Hospitals, Public/statistics & numerical data , Humans , Infant , Infant, Newborn , Male , Middle Aged , Nursing Staff, Hospital/economics , Nursing Staff, Hospital/statistics & numerical data , Sampling Studies , Tertiary Care Centers/economics , Tertiary Care Centers/statistics & numerical data , Therapies, Investigational/economicsABSTRACT
AIMS: Recent years have seen an increasing shift towards providing care in the community, epitomised by the role of Children's Community Nursing (CCN) teams. However, there have been few attempts to use robust evaluative methods to interrogate the impact of such services. This study sought to evaluate whether reduction in secondary care costs, resulting from the introduction of 2 CCN teams, was sufficient to offset the additional cost of commissioning. METHODS: Among the potential benefits of the CCN teams is a reduction in the burden placed on secondary care through the delivery of care at home; it is this potential reduction which is evaluated in this study via a 2-part analytical method. Firstly, an interrupted time series analysis used Hospital Episode Statistics data to interrogate any change in total paediatric bed days as a result of the introduction of 2 teams. Secondly, a costing analysis compared the cost savings from any reduction in total bed days with the cost of commissioning the teams. This study used a retrospective longitudinal study design as part of the transforming children's community services trial, which was conducted between June 2012 and June 2015. RESULTS: A reduction in hospital activity after introduction of the 2 nursing teams was found, (9634 and 8969 fewer bed days), but this did not reach statistical significance. The resultant cost saving to the National Health Service was less than the cost of employing the teams. CONCLUSION: The study represents an important first step in understanding the role of such teams as a means of providing a high quality of paediatric care in an era of limited resource. While the cost saving from released paediatric bed days was not sufficient to demonstrate cost-effectiveness, the analysis does not incorporate wider measures of health care utilisation and nonmonetary benefits resulting from the CCN teams.
Subject(s)
Community Health Services/organization & administration , Community Health Services/statistics & numerical data , National Health Programs/organization & administration , Pediatric Nursing/organization & administration , Pediatric Nursing/statistics & numerical data , Bed Occupancy/economics , Bed Occupancy/statistics & numerical data , Community Health Services/economics , Cost-Benefit Analysis , Humans , Interrupted Time Series Analysis , Longitudinal Studies , National Health Programs/economics , Pediatric Nursing/economics , Retrospective StudiesSubject(s)
Insurance, Nursing Services/legislation & jurisprudence , National Health Programs/legislation & jurisprudence , Pediatric Nursing/legislation & jurisprudence , Activities of Daily Living/classification , Adolescent , Child , Child, Preschool , Disability Evaluation , Germany , Home Health Nursing/economics , Home Health Nursing/legislation & jurisprudence , Home Nursing/economics , Home Nursing/legislation & jurisprudence , Humans , Infant , Insurance, Nursing Services/economics , National Health Programs/economics , Pediatric Nursing/economicsABSTRACT
WHEN BARNSLEY council put out its tender for the 0-19 service last autumn, it laid down strict criteria. A ceiling of £4.8 million a year was put on any bids for the service, which incorporates school nursing teams and health visitors. That represented a cut of more than £1 million on the existing contract.
Subject(s)
Budgets , Child Health Services/economics , Healthcare Financing , Pediatric Nursing/economics , State Medicine/economics , Adolescent , Child , Child, Preschool , Humans , Infant , Infant, Newborn , Public Health Nursing/economics , School Nursing/economics , United Kingdom , Young AdultSubject(s)
Curriculum/trends , Education, Nursing/economics , Education, Nursing/organization & administration , Geriatric Nursing/economics , Geriatric Nursing/education , Health Care Reform/economics , Health Care Reform/legislation & jurisprudence , Legislation, Nursing/economics , Legislation, Nursing/trends , Pediatric Nursing/economics , Pediatric Nursing/education , Cost-Benefit Analysis/economics , Cost-Benefit Analysis/legislation & jurisprudence , Education, Nursing/legislation & jurisprudence , Geriatric Nursing/legislation & jurisprudence , Germany , Health Care Reform/organization & administration , Humans , Pediatric Nursing/legislation & jurisprudence , Quality Assurance, Health Care/economics , Quality Assurance, Health Care/legislation & jurisprudence , Quality Assurance, Health Care/trendsSubject(s)
Patient-Centered Care/economics , Pediatric Nursing/economics , Quality of Health Care , Accountable Care Organizations/economics , Adult , Child , Child, Preschool , Female , Humans , Male , Nurse's Role , Patient-Centered Care/organization & administration , Pediatric Nursing/methods , Pediatrics/economics , Pediatrics/standards , United StatesSubject(s)
Financing, Government/economics , Financing, Government/organization & administration , National Health Programs/economics , Pediatric Nursing/economics , Pediatric Nursing/organization & administration , Refugees , Adolescent , Child , Child, Preschool , Female , Financing, Government/trends , Forecasting , Germany , Health Care Costs/statistics & numerical data , Health Care Costs/trends , Health Services Needs and Demand/economics , Health Services Needs and Demand/organization & administration , Health Services Needs and Demand/trends , Hospital Bed Capacity/economics , Hospital Bed Capacity/statistics & numerical data , Hospitalization/economics , Hospitalization/statistics & numerical data , Hospitalization/trends , Humans , Infant , Infant, Newborn , Male , Morbidity/trends , National Health Programs/trends , Pediatric Nursing/statistics & numerical data , Pediatric Nursing/trends , Population Forecast , Poverty/economics , Poverty/statistics & numerical data , Poverty/trends , Pregnancy , Prevalence , Refugees/statistics & numerical dataSubject(s)
Adolescent Health Services/economics , Child Health Services/economics , Financing, Government/economics , National Health Programs/economics , Refugees/statistics & numerical data , Adolescent , Child , Child, Preschool , Costs and Cost Analysis/economics , Emergency Service, Hospital/economics , Financial Management, Hospital/economics , Financing, Personal/economics , Germany , Health Services Accessibility/economics , Health Services Needs and Demand/economics , Humans , Infant , Insurance, Nursing Services/economics , Pediatric Nursing/economics , Poverty/economics , Taxes/economicsSubject(s)
Home Health Nursing/economics , Home Health Nursing/organization & administration , Pediatric Nursing/economics , Pediatric Nursing/organization & administration , Adolescent , Child , Child, Preschool , Cost Savings , Humans , Infant , Length of Stay/economics , Patient Readmission/economics , Randomized Controlled Trials as Topic , Treatment OutcomeABSTRACT
AIM: This literature review offers a response to the current paediatric palliative care literature that will punctuate the need for a framework (i.e. the three world view) that can serve as an evaluative lens for nurse managers who are in the planning or evaluative stages of paediatric palliative care programmes. BACKGROUND: The complexities in providing paediatric palliative care extend beyond clinical practices to operational policies and financial barriers that exist in the continuum of services for patients. EVALUATION: This article offers a review of the literature and a framework in order to view best clinical practices, operational/policy standards and financial feasibility when considering the development and sustainability of paediatric palliative care programmes. KEY ASPECTS: Fifty-four articles were selected as representative of the current state of the literature as it pertains to the three world view (i.e. clinical, operational and financial factors) involved in providing paediatric palliative care. CONCLUSION: In developing efficient paediatric palliative care services, clinical, operational and financial resources and barriers need to be identified and addressed. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing management plays a crucial role in addressing the clinical, operational and financial needs and concerns that are grounded in paediatric palliative care literature.
Subject(s)
Palliative Care/methods , Pediatric Nursing/methods , Child , Health Plan Implementation/economics , Health Plan Implementation/methods , Humans , Nurse Administrators , Palliative Care/economics , Pediatric Nursing/economicsABSTRACT
The children's national service framework advocates children's services being designed and delivered around the needs of the child. This article details parental perception of and satisfaction with a paediatric community matron service that aims to reduce emergency admission of children aged 0-16 with respiratory disease. Parents valued the individualised holistic relationship formed between the community matron, child and family. One in four said their child's hospital attendance was reduced.
Subject(s)
Community Health Services/economics , Consumer Behavior , Nurse Administrators , Nurses, Community Health , Parents/psychology , Pediatric Nursing , State Medicine , Adolescent , Child , Child, Preschool , Cost Savings , Health Services Research , Humans , Infant , Nurse Administrators/economics , Patient Admission/economics , Patient Admission/statistics & numerical data , Pediatric Nursing/economics , State Medicine/economics , Surveys and Questionnaires , United KingdomABSTRACT
INTRODUCTION: The development of paediatrics is characterised by several changes in the past few years, concerning, in particular holistic treatments or preventive check-ups, but also the transfer of treatment from the inpatient to the outpatient sector. There are no reference values for assessing emerging health insurance expenses. The aim of this study was to obtain a frame of reference for the costs of the treatment for neonates, infants, and young children using the example of the expenditures of one health insurance fund. METHODS: The individual health insurance expenditures were analysed for the first five years of life of children insured with the AOK PLUS in Saxony, Germany, in 2005. Costs of hospital treatment, ambulatory care, remedies, tools, medicines and care were included. RESULTS: The costs per insured child and year amounted to approximately 1,277 Euro (N = 11,147), with the highest costs arising in the first two years. 858 Euro were spent annually for an "average" child; 5,691 Euro per year incurred for a child with special medical needs. DISCUSSION: The present cost analysis describes both the height and structure of a health insurance's spendings on children within the first five years of their life in consideration of regional medical care offers. The question of whether this analysis provides valid reference values for other health insurances or other service areas will have to be answered by other analyses.
Subject(s)
Child Health Services/economics , Health Expenditures/statistics & numerical data , National Health Programs/economics , Ambulatory Care/economics , Birth Weight , Child , Child, Preschool , Cohort Studies , Drug Costs/statistics & numerical data , Female , Germany , Hospitalization/economics , Humans , Infant , Infant, Low Birth Weight , Infant, Newborn , Infant, Premature, Diseases/economics , Infant, Premature, Diseases/mortality , Infant, Very Low Birth Weight , Male , Pediatric Nursing/economics , Survival RateSubject(s)
Nursing Staff, Hospital/economics , Nursing Staff, Hospital/legislation & jurisprudence , Operating Room Nursing/economics , Operating Room Nursing/legislation & jurisprudence , Pediatric Nursing/economics , Pediatric Nursing/legislation & jurisprudence , Personnel Staffing and Scheduling/economics , Personnel Staffing and Scheduling/legislation & jurisprudence , Salaries and Fringe Benefits/economics , Salaries and Fringe Benefits/legislation & jurisprudence , Surgical Attire/economics , Surgical Attire/legislation & jurisprudence , Adult , Child , Germany , Humans , WorkflowSubject(s)
Child Health Services/legislation & jurisprudence , Health Policy , Nurse Practitioners , Pediatric Nursing , Societies, Nursing/legislation & jurisprudence , Adolescent , Child , Child Health Services/economics , Child, Preschool , Female , Health Promotion , Humans , Infant , Infant, Newborn , Male , Pediatric Nursing/economics , Pediatric Nursing/legislation & jurisprudence , Societies, Nursing/economics , United States/epidemiologyABSTRACT
OBJECTIVE: The purpose of this study was to evaluate the effectiveness of bedside nursing report implementation on a pediatric neuroscience unit. BACKGROUND: The change-of-shift nursing report often involves only nurse-to-nurse communication, occurs far away from the patient's bedside, and includes little or no patient/family involvement. Studies show that the bedside nursing report is a more comprehensive and patient-centered approach (C. D. Anderson & R. R. Mangino, 2006). METHODS: Patient and nurse satisfaction and nursing overtime were measured 6 months before and 6 months after the implementation of bedside reporting. Data were analyzed using paired t test, chi-square test, and Fisher's exact tests to determine significant changes. RESULTS: Patients, families, and nurses reported an increase in satisfaction after the implementation of bedside reporting. Overtime decreased and represented a potential cost savings of nearly $13,000 annually. CONCLUSIONS: Bedside reporting saves money, improves patient and nurse satisfaction, and is a more comprehensive approach to change-of-shift reporting.