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2.
Am J Bioeth ; 19(11): 13-24, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31647757

RESUMO

Transplantation programs commonly rely on clinicians' judgments about patients' social support (care from friends or family) when deciding whether to list them for organ transplantation. We examine whether using social support to make listing decisions for adults seeking transplantation is morally legitimate, drawing on recent data about the evidence-base, implementation, and potential impacts of the criterion on underserved and diverse populations. We demonstrate that the rationale for the social support criterion, based in the principle of utility, is undermined by its reliance on tenuous evidence. Moreover, social support requirements may reinforce transplant inequities, interfere in patients' personal relationships, and contribute to biased and inconsistent listing procedures. As such, accommodating the needs of patients with limited social support would better balance ethical commitments to equity, utility, and respect for persons in transplantation. We suggest steps for researchers, transplantation programs, and policymakers to improve fair use of social support in transplantation.


Assuntos
Alocação de Recursos para a Atenção à Saúde/ética , Equidade em Saúde , Transplante de Órgãos/ética , Seleção de Pacientes/ética , Apoio Social , Adulto , Viés , Tomada de Decisão Clínica/ética , Tomada de Decisão Clínica/métodos , Alocação de Recursos para a Atenção à Saúde/métodos , Política de Saúde , Humanos
3.
PLoS One ; 14(3): e0212918, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30893382

RESUMO

Development of simple, valid and reliable instruments to determine nursing care rationing is a subject of ongoing research. One such instrument, which is gaining popularity worldwide and has significant research applicability, is the Basel Extent of Rationing of Nursing Care (BERNCA) and its revised version, the BERNCA-R. The aim of this study was to translate and adapt the BERNCA-R into a Polish-language version and to assess its reliability and validity in evaluating the level of implicit rationing of nursing care in Poland. Standard methodological requirements were followed during translation and cultural adaptation of the English version of the BERNCA-R questionnaire into Polish. The cross-sectional validation study was conducted between May and September 2017, which included 175 nurses undergoing specialisation and qualification courses at the European Postgraduate Education Centre in Wroclaw, Poland. Cronbach's alpha and inter-item correlations were used to analyse the internal consistency of the Polish BERNCA-R questionnaire. The mean total BERNCA-R score was 1.9 points (SD = 0.74) on a scale of 0-4. Cronbach's alpha for the unidimensional scale was 0.96. The mean inter-item correlation was 0.4 (range 0.1-0.84), which indicates high internal consistency. A single-factor solution demonstrated stable loadings above 0.5 for almost all items of the Polish BERNCA-R questionnaire. The study using the Polish BERNCA-R questionnaire demonstrated that the instrument is valid and reliable for use in investigating care rationing in groups of Polish nurses.


Assuntos
Alocação de Recursos para a Atenção à Saúde/métodos , Cuidados de Enfermagem/organização & administração , Inquéritos e Questionários , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros , Polônia , Reprodutibilidade dos Testes , Tradução , Adulto Jovem
4.
Transplant Proc ; 51(1): 190-193, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30736973

RESUMO

BACKGROUND: Lung transplantation is an established therapeutic option for patients with end-stage pulmonary disease. In May 2005, the lung allocation score (LAS) was introduced in the United States to maximize the benefit to the recipient population and reduce waiting list mortality. The LAS has been applied in a region of Italy since March 2016 on a provisional basis. The aims of the study were describing waiting list characteristics and short-term outcomes after lung transplantation before and after LAS introduction. METHODS: All the patients who received transplants between January 1, 2011, and March 15, 2017, were included in our retrospective study. The study population was divided into 2 cohorts (historical cohort and post-LAS cohort) and a comparison among the main perioperative data was performed. RESULTS: The historical cohort consisted of 415 patients on the waiting list with 91 deaths and 199 lung transplants; the post-LAS cohort consisted of 134 patients with 10 deaths on the waiting list and 51 transplants. Median waiting time and mortality on the list decreased from 223 to 106 days (P = .03) and from 11.2% to 7.5% (P > .05), respectively. The transplantation rate increased from 25% to 38% (P = .001) and the probability to receive a transplant in the first year in the post-LAS era increased significantly (P = .004). CONCLUSIONS: The results of the introduction of the LAS system in our region are encouraging and have not shown any adverse short-term effects. The regional coordination decided to prolong the experimental application of LAS in order to accumulate more data and to evaluate medium-term outcomes.


Assuntos
Alocação de Recursos para a Atenção à Saúde/métodos , Transplante de Pulmão , Listas de Espera , Adulto , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Transplantes/provisão & distribução , Estados Unidos , Listas de Espera/mortalidade
5.
Gac. sanit. (Barc., Ed. impr.) ; 33(1): 60-65, ene.-feb. 2019. ilus, tab
Artigo em Espanhol | IBECS | ID: ibc-183628

RESUMO

Objetivo: Comparar la concordancia de los pesos de complejidad entre los estratificadores Clinical Risk Groups (CRG) y los grupos de morbilidad ajustada (GMA), determinar cuál de ellos es el mejor predictor de ingreso hospitalario y optimizar el método para seleccionar el 0,5% de pacientes de más alta complejidad que se incluirán en un protocolo de intervención. Método: Estudio analítico transversal en 18 zonas de salud de Canarias, con una población a estudio de 385.049 personas, usando variables sociodemográficas procedentes de la tarjeta sanitaria, los diagnósticos y el uso de los recursos asistenciales obtenidos de la historia electrónica de salud de atención primaria (HSAP) y del conjunto mínimo básico de datos hospitalario, el estado funcional registrado en la HSAP y los fármacos prescritos en el sistema de receta electrónica. A partir de esos datos se estimó la concordancia entre estratificadores, se evaluó la capacidad de cada estratificador para predecir ingresos y se construyeron modelos para optimizar la predicción. Resultados: La concordancia entre los pesos de complejidad de los estratificadores fue fuerte (rho = 0,735) y la concordancia entre categorías de complejidad fue moderada (Kappa ponderado = 0,515). El peso de complejidad GMA predice el ingreso hospitalario mejor que el del CRG (área bajo la curva [AUC]: 0,696 [0,695-0,697] vs. 0,692 [0,691-0,693]). Se añadieron otras variables predictivas al peso GMA, obteniendo la mejor AUC (0,708 [0,707-0,708]) el modelo compuesto por GMA, sexo, edad, escalas de Pfeiffer y Barthel, existencia de reingreso y número de grupos terapéuticos prescritos. Conclusiones: Se constató una fuerte concordancia entre estratificadores y una mayor capacidad predictiva de los ingresos por parte de los GMA, que puede aumentarse añadiendo otras dimensiones


Objective: To compare the concordance of complexity weights between Clinical Risk Groups (CRG) and Adjusted Morbidity Groups (AMG). To determine which one is the best predictor of patient admission. To optimise the method used to select the 0.5% of patients of higher complexity that will be included in an intervention protocol. Method: Cross-sectional analytical study in 18 Canary Island health areas, 385,049 citizens were enrolled, using sociodemographic variables from health cards; diagnoses and use of healthcare resources obtained from primary health care electronic records (PCHR) and the basic minimum set of hospital data; the functional status recorded in the PCHR, and the drugs prescribed through the electronic prescription system. The correlation between stratifiers was estimated from these data. The ability of each stratifier to predict patient admissions was evaluated and prediction optimisation models were constructed. Results: Concordance between weights complexity stratifiers was strong (rho = 0.735) and the correlation between categories of complexity was moderate (weighted kappa = 0.515). AMG complexity weight predicts better patient admission than CRG (AUC: 0.696 [0.695-0.697] versus 0.692 [0.691-0.693]). Other predictive variables were added to the AMG weight, obtaining the best AUC (0.708 [0.707-0.708]) the model composed by AMG, sex, age, Pfeiffer and Barthel scales, re-admissions and number of prescribed therapeutic groups. Conclusions: strong concordance was found between stratifiers, and higher predictive capacity for admission from AMG, which can be increased by adding other dimensions


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Seleção de Pacientes , Alocação de Recursos para a Atenção à Saúde/métodos , Risco Ajustado/métodos , Doença Crônica/classificação , Estudos Transversais , Índice de Gravidade de Doença , Hospitalização/estatística & dados numéricos , Admissão do Paciente/normas
7.
Thorax ; 74(1): 60-68, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30282722

RESUMO

BACKGROUND: The demand for lung transplantation vastly exceeds the availability of donor organs. This translates into long waiting times and high waiting list mortality. We set out to examine factors influencing patient outcomes from the time of listing for lung transplantation in the UK, examining for differences by patient characteristics, lung disease category and transplant centre. METHODS: Data were obtained from the UK Transplant Registry held by NHS Blood and Transplant for adult lung-only registrations between 1January 2004 and 31 March 2014. Pretransplant and post-transplant outcomes were evaluated against lung disease category, blood group and height. RESULTS: Of the 2213 patient registrations, COPD comprised 28.4%, pulmonary fibrosis (PF) 26.2%, cystic fibrosis (CF) 25.4% and other lung pathologies 20.1%. The chance of transplantation after listing differed by the combined effect of disease category and centre (p<0.001). At 3 years postregistration, 78% of patients with COPD were transplanted followed by 61% of patients with CF, 59% of other lung pathology patients and 48% of patients with PF, who also had the highest waiting list mortality (37%). The chance of transplantation also differed by height with taller patients having a greater chance of transplant (HR: 1.03, 95% CI: 1.02 to 1.04, p<0.001). Patients with blood group O had the highest waiting mortality at 3 years postregistration compared with all other blood groups (27% vs 20%, p<0.001). CONCLUSIONS: The way donor lungs were allocated in the UK resulted in discrepancies between the risk profile and probability of lung transplantation. A new donor lung allocation scheme was introduced in 2017 to try to address these shortcomings.


Assuntos
Sistema do Grupo Sanguíneo ABO , Pneumopatias/sangue , Pneumopatias/cirurgia , Transplante de Pulmão/estatística & dados numéricos , Listas de Espera , Aloenxertos/provisão & distribução , Estatura , Fibrose Cística/sangue , Fibrose Cística/cirurgia , Alocação de Recursos para a Atenção à Saúde/métodos , Instalações de Saúde/estatística & dados numéricos , Humanos , Período Pós-Operatório , Período Pré-Operatório , Doença Pulmonar Obstrutiva Crônica/sangue , Doença Pulmonar Obstrutiva Crônica/cirurgia , Fibrose Pulmonar/sangue , Fibrose Pulmonar/cirurgia , Sistema de Registros , Taxa de Sobrevida , Tempo para o Tratamento , Reino Unido/epidemiologia , Listas de Espera/mortalidade
9.
J Nurs Manag ; 27(2): 371-380, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30221436

RESUMO

AIMS: To explore nurses' perceptions of factors affecting workloads and their impact on patient care. BACKGROUND: Fiscal restraints and unpredictable patient illness trajectories challenge the provision of care. Cost containment affects the number of staff employed and the skill-mix for care provision. While organisations may acknowledge explicit rationing of care, implicit rationing takes place at the point of service as nurses are forced to make decisions about what care they can provide. METHOD: A self-report cross sectional study was conducted using an on-line survey with 2,397 nurses in Queensland, Australia. RESULTS: Twenty to forty per cent reported being unable to provide care in the time available; having insufficient staff; and an inadequate skill-mix. The respondents reported workload and skill-mix issues leading to implicit care rationing. Over 60% believed that the processes to address workload issues were inadequate. CONCLUSIONS: Institutional influences on staffing levels and skill-mix are resulting in implicit care rationing. IMPLICATIONS FOR NURSE MANAGERS: Adequate staffing should be based on patient acuity and the skill-mix required for safe care. Managers should be more assertive about adequate clinical workloads, involve staff in decision-making, and adopt a systematic planning approach. Failure to do so results in implicit care rationing impacting on patient safety.


Assuntos
Alocação de Recursos para a Atenção à Saúde/métodos , Enfermeiras e Enfermeiros/psicologia , Percepção , Carga de Trabalho/normas , Estudos Transversais , Alocação de Recursos para a Atenção à Saúde/normas , Humanos , Satisfação no Emprego , Inovação Organizacional , Admissão e Escalonamento de Pessoal/normas , Pesquisa Qualitativa , Queensland , Alocação de Recursos/métodos , Alocação de Recursos/normas , Inquéritos e Questionários , Carga de Trabalho/psicologia
10.
Nurs Ethics ; 26(5): 1528-1539, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29607703

RESUMO

Driven by interests in workforce planning and patient safety, a growing body of literature has begun to identify the reality and the prevalence of missed nursing care, also specified as care left undone, rationed care or unfinished care. Empirical studies and conceptual considerations have focused on structural issues such as staffing, as well as on outcome issues - missed care/unfinished care. Philosophical and ethical aspects of unfinished care are largely unexplored. Thus, while internationally studies highlight instances of covert rationing/missed care/care left undone - suggesting that nurses, in certain contexts, are actively engaged in rationing care - in terms of the nursing and nursing ethics literature, there appears to be a dearth of explicit decision-making frameworks within which to consider rationing of nursing care. In reality, the assumption of policy makers and health service managers is that nurses will continue to provide full care - despite reducing staffing levels and increased patient turnover, dependency and complexity of care. Often, it would appear that rationing/missed care/nursing care left undone is a direct response to overwhelming demands on the nursing resource in specific contexts. A discussion of resource allocation and rationing in nursing therefore seems timely. The aim of this discussion paper is to consider the ethical dimension of issues of resource allocation and rationing as they relate to nursing care and the distribution of the nursing resource.


Assuntos
Alocação de Recursos para a Atenção à Saúde/ética , Cuidados de Enfermagem/normas , Alocação de Recursos/ética , Alocação de Recursos para a Atenção à Saúde/métodos , Humanos , Irlanda , Cuidados de Enfermagem/métodos , Alocação de Recursos/métodos , Inquéritos e Questionários
11.
J Surg Res ; 231: 395-402, 2018 11.
Artigo em Inglês | MEDLINE | ID: mdl-30278959

RESUMO

BACKGROUND: Liver-lung transplantation (LLT) is a rare procedure performed for patients with end-stage liver and lung disease. The lung allocation score (LAS), introduced in 2005, guides lung allocation including those receiving LLT. However, the impact of the LAS on outcomes in LLT is currently unknown. MATERIALS AND METHODS: The OPTN/United Network for Organ Sharing STAR file was queried for LLT candidates and recipients from 1988 to 2016. Demographic characteristics before (historic) and after (modern) the LAS were compared. Survival was analyzed with the Kaplan-Meier method and log-rank test. RESULTS: In total, 167 candidates were listed for LLT, and 62 underwent LLT. The historic cohort had a higher FEV1% (48.22% versus 29.82%, P = 0.014), higher creatinine (1.22 versus 0.72, P < 0.001), and a higher percentage with pulmonary hypertension as the indication for transplantation (40% versus 0%, P = 0.003) compared with the modern cohort. LLT candidates in the historic cohort had a lower rate of transplant per 100 candidates (10.87 versus 33.33, P < 0.0001) and worse waitlist survival (1 y: 69.6% versus 80.9%, 3 y: 39.1% versus 66.8%, P = 0.004). Post-transplant survival was significantly lower in the historic cohort (1 y: 50.0% versus 82.7%, 5 y: 40.0% versus 69.0%, 10 y: 20.0% versus 55.5%, P = 0.0099). CONCLUSIONS: Most analyses of LLT have included patients before and after the introduction of the LAS. Our study shows that LLT candidates and recipients before the modern allocation system had distinct baseline characteristics and worse overall survival. Although many factors contributed to recent improved outcomes, these cohorts are significantly different and should be treated as such in future studies.


Assuntos
Doença Hepática Terminal/cirurgia , Alocação de Recursos para a Atenção à Saúde/métodos , Transplante de Fígado/métodos , Pneumopatias/cirurgia , Transplante de Pulmão/métodos , Seleção de Pacientes , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Doença Hepática Terminal/mortalidade , Feminino , Alocação de Recursos para a Atenção à Saúde/normas , Humanos , Transplante de Fígado/mortalidade , Pneumopatias/mortalidade , Transplante de Pulmão/mortalidade , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Estados Unidos/epidemiologia , Listas de Espera/mortalidade , Adulto Jovem
12.
J Occup Health ; 60(6): 502-514, 2018 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-30232301

RESUMO

OBJECTIVES: To clarify the priority given to periodical medical examination items among occupational physicians in Japan. METHODS: Sixty-two occupational physicians who participated in this study selected statutory and non-statutory items within two types of budget plans: one lower (8,500 yen) than the total fee of statutory medical examinations (9,250 and 11,290 yen), and the other higher (12,000 yen) than the total fee. Medical fee points were used to set the cost of each medical examination item. A three round Delphi method was used from May to July 2016 to clarify the consensus opinion of occupational physicians. RESULTS: The statutory items (selection rate: between 66 and 100%), except for waist circumference (15%) and sputum examination (0%), and serum creatinine (58%, non-statutory item) were included in the smaller budget plan (8,500 yen). In the larger budget plan (12,000 yen), the statutory items (selection rate: between 92 and 100%), except for waist circumference (39%) and sputum examination (0%), and some non-statutory items, namely serum creatinine (95%), leukocytes (92%), uric acid (89%), and fecal occult blood reaction (81%), had a selection rate over 80%. In addition, statutory items with higher accuracy were preferred, which included the following: air conduction pure-tone audiometry (92%), imaging diagnosis of thoracic X-ray examinations by a specialist (97%), glycated hemoglobin levels (98%), and electrocardiogram assessment by a specialist (100%). CONCLUSION: The statutory items, except for waist circumference and sputum examination, and some of the non-statutory items (e.g., serum creatinine) were given higher priority among occupational physicians in Japan.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Alocação de Recursos para a Atenção à Saúde/economia , Médicos do Trabalho/economia , Exame Físico/economia , Padrões de Prática Médica/economia , Adulto , Custos e Análise de Custo , Técnica Delfos , Feminino , Alocação de Recursos para a Atenção à Saúde/métodos , Humanos , Japão , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Saúde do Trabalhador , Médicos do Trabalho/psicologia , Medicina do Trabalho , Exame Físico/métodos , Gravidez , Inquéritos e Questionários
13.
J Surg Res ; 230: 117-124, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30100026

RESUMO

BACKGROUND: Unplanned visits to the emergency department (ED) and inpatient setting are expensive and associated with poor outcomes in thoracic surgery. We assessed 30-d postoperative ED visits and inpatient readmissions following thoracotomy, a high morbidity procedure. MATERIALS AND METHODS: We retrospectively analyzed inpatient and ED administrative data from California, Florida, and New York, 2010-2011. "Return to care" was defined as readmission to inpatient facility or ED within 30 d of discharge. Factors associated with return to care were analyzed via multivariable logistic regressions with a fixed effect for hospital variability. RESULTS: Of 30,154 thoracotomies, 6.3% were admitted to the ED and 10.2% to the inpatient setting within 30 d of discharge. Increased risk of inpatient readmission was associated with Medicare (odds ratio [OR] 1.30; P < 0.001) and Medicaid (OR 1.31; P < 0.0001) insurance status compared to private insurance and black race (OR 1.18; P = 0.02) compared to white race. Lung cancer diagnosis (OR 0.83; P < 0.001) and higher median income (OR 0.89; P = 0.04) were associated with decreased risk of inpatient readmission. Postoperative ED visits were associated with Medicare (OR 1.24; P < 0.001) and Medicaid insurance status (OR 1.59; P < 0.001) compared to private insurance and Hispanic race (OR 1.19; P = 0.04) compared to white race. CONCLUSIONS: Following thoracotomy, postoperative ED visits and inpatient readmissions are common. Patients with public insurance were at high risk for readmission, while patients with underlying lung cancer diagnosis had a lower readmission risk. Emphasizing postoperative management in at-risk populations could improve health outcomes and reduce unplanned returns to care.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Neoplasias Pulmonares/cirurgia , Readmissão do Paciente/estatística & dados numéricos , Complicações Pós-Operatórias/terapia , Toracotomia/efeitos adversos , Idoso , California , Serviço Hospitalar de Emergência/economia , Feminino , Florida , Alocação de Recursos para a Atenção à Saúde/economia , Alocação de Recursos para a Atenção à Saúde/métodos , Humanos , Masculino , Pessoa de Meia-Idade , New York , Readmissão do Paciente/economia , Seleção de Pacientes , Pleurisia/cirurgia , Pneumonia/cirurgia , Pneumotórax/cirurgia , Cuidados Pós-Operatórios/economia , Cuidados Pós-Operatórios/métodos , Complicações Pós-Operatórias/economia , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Atelectasia Pulmonar/cirurgia , Melhoria de Qualidade/economia , Estudos Retrospectivos , Toracotomia/economia
14.
Adv Ther ; 35(10): 1686-1696, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30143957

RESUMO

INTRODUCTION: The objective was to estimate, from the perspective of a managed care organization in the United States, the budget impact and effect on health outcomes of expanded use of vagus nerve stimulation [VNS (VNS Therapy®)] among patients aged ≥ 12 years with drug-resistant epilepsy (DRE) with partial-onset seizures. METHODS: An Excel model was developed to compare the costs of continued anti-epileptic drug (AED) treatment with the costs of VNS plus AED treatment. The number of people eligible for VNS was estimated using published prevalence data and an estimate of the percentage of eligible patients currently without VNS. Costs included VNS device, placement, programming, and battery changes; adverse events associated with VNS (cough, voice alteration, device removal resulting from surgical site infection); AEDs; and seizure-related costs affected by seizure frequency, which affects resource utilization (i.e., hospitalizations, emergency department visits, neurologist visits). To estimate the potential savings with VNS due to a reduction in seizure frequency, the budget impact model uses the results of an underlying Markov model to estimate seizure-related costs by seizure frequency. Transitions occurred among four health states, defined by number of seizures per month (i.e., seizure-free, ≤ 1, > 1 to < 10, ≥ 10) on a 3-month cycle based on published clinical trials and registry data. RESULTS: VNS resulted in an estimated net cost savings, on average, over 5 years, due to the expected reduction in seizure frequency. The initial cost of the VNS device, placement, and programming was estimated to be offset 1.7 years after VNS device placement. Reductions in hospitalizations were the main contributor to the cost savings with VNS. CONCLUSIONS: VNS is a proven intervention that offers a long-term solution for patients with DRE by reducing seizure frequency, which leads to lower resource utilization and lower costs. FUNDING: LivaNova PLC.


Assuntos
Orçamentos , Epilepsia , Alocação de Recursos para a Atenção à Saúde/métodos , Estimulação do Nervo Vago , Adolescente , Adulto , Redução de Custos/métodos , Custos e Análise de Custo , Resistência a Medicamentos , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Epilepsia/economia , Epilepsia/epidemiologia , Epilepsia/etiologia , Epilepsia/terapia , Feminino , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Estados Unidos/epidemiologia , Estimulação do Nervo Vago/efeitos adversos , Estimulação do Nervo Vago/economia , Estimulação do Nervo Vago/métodos
15.
ANZ J Surg ; 88(12): 1279-1283, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30117634

RESUMO

BACKGROUND: The prioritization of elective surgical wait-lists remains a contentious issue. Multiple new tools and systems have been developed to attempt to reliably prioritize patients. This study pilots one such system, the General Surgery Prioritization Tool and compares it to the existing triage system of clinical judgement. The aim was to determine if the new tool reflects clinical judgement. Secondary aims were to assess for any bias in its application to different patient groups or its application by different scorers. METHOD: A cohort of 392 patients was identified who were wait-listed for non-cancer elective surgery between July 2015 and February 2016. The General Surgery Prioritization Tool was applied after traditional prioritization using clinical judgement. The scores produced by the new tool were compared to the clinical judgement categories. Differences in scores based on gender, ethnicity, age, surgical condition and surgeon were then analysed. RESULTS: There was statistically significant correlation in the new tool scores with traditional triage groups (P < 0.0001). There were no statistically significant differences in mean scores attributable to gender, age or ethnicity. There were minimal differences in mean scores between common surgical conditions. Except for one outlier the mean scores were consistent across 17 surgeons. CONCLUSION: This pilot study has found the General Surgery Prioritization Tool to reflect clinical judgement and to be generalizable by age, gender, ethnicity and prioritizing surgeon. The tool is at least as clinically reliable as traditional methods in the triage for elective general surgery with the advantage of being a more explicit process.


Assuntos
Técnicas de Apoio para a Decisão , Alocação de Recursos para a Atenção à Saúde/métodos , Seleção de Pacientes , Procedimentos Cirúrgicos Operatórios/normas , Triagem/métodos , Listas de Espera , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Projetos Piloto , Estudos Retrospectivos , Adulto Jovem
16.
Artigo em Inglês | MEDLINE | ID: mdl-30103454

RESUMO

The hierarchical medical treatment system is an efficient way to solve the problem of insufficient and unbalanced medical resources in China. Essentially, classifying the different degrees of diseases according to the doctor's diagnosis is a key step in pushing forward the hierarchical medical treatment system. This paper proposes a framework to solve the problem where diagnosis values are given as picture fuzzy numbers (PFNs). Point operators can reduce the uncertainty of doctor's diagnosis and get intensive information in the process of decision making, and the Choquet integral operator can consider correlations among symptoms. In order to take full advantage of these two kinds of operators, in this paper, we firstly define some point operators under the picture fuzzy environment, and further propose a new class of picture fuzzy point⁻Choquet integral aggregation operators. Moreover, some desirable properties of these operators are also investigated in detail. Then, a novel approach based on these operators for multiattribute decision-making problems in the picture fuzzy context is introduced. Finally, we give an example to illustrate the applicability of the new approach in assisting hierarchical medical treatment system. This is of great significance for integrating the medical resources of the whole society and improving the service efficiency of the medical service system.


Assuntos
Tomada de Decisão Clínica/métodos , Alocação de Recursos para a Atenção à Saúde/métodos , Modelos Teóricos , China , Lógica Fuzzy , Humanos
17.
Public Health ; 162: 118-125, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30029173

RESUMO

OBJECTIVES: Community health assessments (CHAs) have been promoted as a strategy for population health. This study uses the resource dependence theory (RDT) to examine how external market characteristics are associated with CHAs conducted by local health departments (LHDs) and subsequent partnering with hospitals for CHAs in the United States. STUDY DESIGN: The RDT was used to guide the conceptualization of the market in the context of local public health. RDT emphasizes that organizations are not in control of all the resources they need and, to some extent, must rely on the external environment to provide those necessary resources. Binary measures were used to examine whether LHDs conducted CHAs and whether they did so in partnership with a local hospital. Independent variables were identified to measure the RDT constructs of munificence (resource availability in the environment), complexity (level of heterogeneity), and dynamism (level of environmental turbulence). METHODS: Bivariate (Chi-squared and t-tests) and multivariate (logistic regression) cross-sectional analyses were conducted using secondary data from the National Association of County and City Health Officials 2013 Profile Survey, the 2013 County Health Rankings data set, and the Health Resources and Services Administration's Area Health Resource File. RESULTS: Two of three variables measuring munificence were positively associated with having conducted a CHA; one variable was also related to doing so in conjunction with a local hospital. One measure of market complexity was negatively associated with having conducted a CHA. No measure of dynamism was related to the dependent variables. CONCLUSIONS: Study results provide partial support for the use of RDT in understanding the relationship between market factors and LHDs' activities around CHAs. Local hospitals as partners and other market factors should be considered by LHDs when conducting CHAs. Findings from this work will be of interest to public health practitioners, policy-makers, and researchers interested in public health and population health improvement.


Assuntos
Serviços de Saúde Comunitária , Alocação de Recursos para a Atenção à Saúde/métodos , Determinação de Necessidades de Cuidados de Saúde , Administração em Saúde Pública , Estudos Transversais , Hospitais , Humanos , Governo Local , Estados Unidos
18.
Otol Neurotol ; 39(8): e651-e653, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30001278

RESUMO

INTRODUCTION: Cochlear reimplantation procedures account for approximately 5% of all implant cases and may be caused by internal device failure, skin flap complications, or an unexpected decline in auditory performance. This issue, in concert with changing demographics, expanded audiometric candidacy criteria, adult bilateral implantation, and implantation for unilateral hearing loss, all place escalating pressure on device availability and resource allocation in a publically funded health care system. OBJECTIVE: The predictable and problematic access to a scare medical resource requires rigor in establishing program priority and formal policy. We present a single cochlear implant center's working reflections and an attempt at a principled approach to rationing health care decisions. METHODS: Different approaches to health care rationing are examined and discussed. We describe a method of allocation that is currently employed by a large Canadian quaternary care center and ground this method in important principles of distributive justice as they apply to health care systems. RESULTS: We elect to recognize device failure as analogous to sudden sensorineural hearing loss, with the associated need to expedite reimplantation. We consider this an ethical approach grounded in the egalitarian principle of equality of opportunity within cohorts of patients. CONCLUSION: Porting the practice from sudden sensorineural hearing loss, the time-sensitive need for hearing restoration, and maximized communication outcomes, dictates prioritization for this patient population. The predicted evolution of health systems globally and the shape of future medical practice will be heavily influenced by both the macro and micro level resource-dependent decisions implant centers currently face.


Assuntos
Implante Coclear , Falha de Equipamento , Alocação de Recursos para a Atenção à Saúde/ética , Seleção de Pacientes/ética , Reoperação/ética , Adulto , Canadá , Implante Coclear/métodos , Implantes Cocleares , Feminino , Alocação de Recursos para a Atenção à Saúde/métodos , Perda Auditiva Neurossensorial/cirurgia , Humanos , Masculino , Pessoa de Meia-Idade
19.
Pediatr Transplant ; 22(5): e13228, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29785805

RESUMO

Children with severe intellectual disability have historically been excluded from solid organ transplantation. The purpose of this article was to review the arguments for excluding this population, including claims of poorer recipient and graft survival, a lower QoL as pediatric recipients become adults, and poorer outcomes for other, more deserving pediatric transplant candidates, and make the case that these arguments are no longer persuasive. We will argue that pediatric transplant centers for reasons of social justice, value of relationships, power differential, and fairness should generally not consider intellectual ability or disability as a criterion when making decisions regarding organ transplant eligibility.


Assuntos
Alocação de Recursos para a Atenção à Saúde/ética , Deficiência Intelectual , Transplante de Órgãos/ética , Seleção de Pacientes/ética , Justiça Social/ética , Criança , Alocação de Recursos para a Atenção à Saúde/métodos , Humanos , Transplante de Órgãos/métodos , Transplante de Órgãos/psicologia , Justiça Social/psicologia
20.
J Natl Compr Canc Netw ; 16(5S): 628-631, 2018 05.
Artigo em Inglês | MEDLINE | ID: mdl-29784742

RESUMO

The NCCN Framework aims to provide adapted guidelines for low- and middle-resource countries to improve the experience of patients with cancer. In particular, the NCCN Frameworks for Adult Cancer Pain and Palliative Care and were designed to help expand access to pain management and palliative care for patients in low-resource countries. The NCCN Framework is one of several tools that can improve cancer care in the developing world. The NCCN Harmonized Guidelines for Sub-Saharan Africa, a collaborative effort between NCCN, American Cancer Society, Clinton Health Access Initiative, and African Cancer Coalition, was developed to harmonize NCCN recommendations with local guidelines across Africa and to make best use of available services and resources.


Assuntos
Dor do Câncer/terapia , Alocação de Recursos para a Atenção à Saúde/métodos , Neoplasias/terapia , Manejo da Dor/economia , Cuidados Paliativos/economia , Adulto , Dor do Câncer/economia , Alocação de Recursos para a Atenção à Saúde/economia , Recursos em Saúde/economia , Recursos em Saúde/provisão & distribução , Humanos , Oncologia/normas , Neoplasias/complicações , Neoplasias/economia , Manejo da Dor/métodos , Manejo da Dor/normas , Cuidados Paliativos/métodos , Cuidados Paliativos/normas , Guias de Prática Clínica como Assunto , Sociedades Médicas/normas
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