Cost effectiveness analysis of anesthesia providers.

Anesthesiologists and certified registered nurse anesthetists provide high-quality, efficacious anesthesia care to the U.S. population. This research and analyses indicate that CRNAs are less costly to train than anesthesiologists and have the potential for providing anesthesia care efficiently. Anesthesiologists and CRNAs can perform the same set of anesthesia services, including relatively rare and difficult procedures such as open heart surgeries and organ transplantations, pediatric procedures, and others. CRNAs are generally salaried, their compensation lags behind anesthesiologists, and they generally receive no overtime pay. As the demand for health care continues to grow, increasing the number of CRNAs, and permitting them to practice in the most efficient delivery models, will be a key to containing costs while maintaining quality care.

Distinguishing the economic costs associated with type 1 and type 2 diabetes.

The objective was to estimate the economic costs of diagnosed type 1 (T1DM) and type 2 (T2DM) diabetes mellitus in the United States in 2007. Medical claims were analyzed to estimate the proportion of diagnosed diabetes cases and excess medical costs by diabetes type. Indirect costs associated with T1DM and T2DM were estimated by using findings from the literature on diagnosed diabetes, as well as differences in health per case of T1DM and T2DM. This study builds on the Cost of Diabetes Model developed for the American Diabetes Association to estimate the economic burden of diagnosed diabetes. T1DM accounts for an estimated 5.7% (1.0 million) of the 17.5 million people with diagnosed diabetes. Approximately $14.9 billion (8.6%) of the economic burden of diagnosed diabetes is associated with T1DM, including medical costs of $10.5 billion and indirect costs of $4.4 billion. Costs associated with T2DM are $159.5 billion, including medical costs of $105.7 billion and indirect costs of $53.8 billion. The economic burden per case of diabetes is greater for T1DM than for T2DM, and the difference increases with age. The prevalence of T2DM is significantly greater than the prevalence of T1DM, so T2DM is responsible for most of the economic burden of diabetes. Estimates for T1DM are sensitive to the criteria used to identify people with diabetes using claims data; estimates for T2DM are relatively stable. Improved coding of diabetes type in medical claims and identification of diabetes type in survey data could lead to more precise estimates of the economic burden by diabetes type.

The economic value of professional nursing.

BACKGROUND: Improved understanding of the economic value of registered nurse services can help inform staffing decisions and policies. OBJECTIVES: To quantify the economic value of professional nursing. METHODS: We synthesize findings from the literature on the relationship between registered nurse staffing levels and nursing-sensitive patient outcomes in acute care hospitals. Using hospital discharge data to estimate incidence and cost of these patient outcomes together with productivity measures, we estimate the economic implications of changes in registered nurse staffing levels. SUBJECTS: Medical and surgical patients in nonfederal acute care hospitals. Data come from a literature review, and hospital discharge data from the 2005 Nationwide Inpatient Sample. MEASURES: Patient nosocomial complications, healthcare expenditures, and national productivity. RESULTS: As nurse staffing levels increase, patient risk of nosocomial complications and hospital length of stay decrease, resulting in medical cost savings, improved national productivity, and lives saved. CONCLUSIONS: Only a portion of the services that professional nurses provide can be quantified in pecuniary terms, but the partial estimates of economic value presented illustrate the economic value to society of improved quality of care achieved through higher staffing levels.

Dimensions of caring: psychometric evaluation of the caring assessment tool.

The increase in relationship-centered professional practice models has expanded the interest in the measurement of caring. Using a cross-sectional descriptive study of 557 adults from 5 acute care institutions, a factor analysis and reliability statistics were used to revise the Caring Assessment Tool. Eight independent factors (mutual problem solving, attentive reassurance, human respect, encouraging manner, appreciation of unique meanings, healing environment, affiliation needs, and basic human needs) explained 62.6% of the variance in caring. The findings provide insight into patients' assessment of caring in nursing and offer a baseline evaluation of the psychometric properties of the Caring Assessment Tool.

Older adults using cellular telephones for diabetes management: a pilot study.

A Web-based telecommunications system can prompt patients to adhere to medication and self-care regimens, and to record medically relevant information. Because the system extends patient contact with health care providers, it facilitates communication and feedback. The results of a 3-month pilot study on the use of the system with older patients diagnosed with Type 2 diabetes are described.