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2.
BMC Health Serv Res ; 19(1): 1007, 2019 Dec 28.
Artigo em Inglês | MEDLINE | ID: mdl-31883510

RESUMO

BACKGROUND: Atrial fibrillation (AF) represents the most common sustained cardiac arrhythmia. A service evaluation was carried out at an anticoagulation clinic in Newcastle upon-Tyne to explore the efficacy of introducing self-testing of anticoagulation status for AF patients on warfarin. The analysis presented aims to assess the potential cost savings and clinical outcomes associated with introducing self-testing at a clinic in the Northeast of England, and to determine the cost-effectiveness of a redesigned treatment pathway including genetic testing and self-testing components. METHODS: Questionnaires were administered to individuals participating in the service evaluation to understand the patient costs associated with clinical monitoring (139 patients), and quality-of-life before and after the introduction of self-testing (varying numbers). Additionally, data on time in therapeutic range (TTR) were captured at multiple time points to identify any change in outcome. Finally, an economic model was developed to assess the cost-effectiveness of introducing a redesigned treatment pathway, including genetic testing and self-testing, for AF patients. RESULTS: The average cost per patient of attending the anticoagulation clinic was £16.24 per visit (including carer costs). Costs were higher amongst patients tested at the hospital clinic than those tested at the community clinic. Improvements in quality-of-life across all psychological topics, and improved TTR, were seen following the introduction of self-testing. Results of the cost-effectiveness analysis showed that the redesigned treatment pathway was less costly and more effective than current practice. CONCLUSIONS: Allowing AF patients on warfarin to self-test, rather than attend clinic to have their anticoagulation status assessed, has the potential to reduce patient costs. Additionally, self-testing may result in improved quality-of-life and TTR. Introducing genetic testing to guide patient treatment based on sensitivity to warfarin, and applying this in combination with self-testing, may also result in improved patient outcomes and reduced costs to the health service in the long-term.


Assuntos
Anticoagulantes/uso terapêutico , Fibrilação Atrial/tratamento farmacológico , Análise Custo-Benefício , Qualidade da Assistência à Saúde/economia , Resultado do Tratamento , Idoso , Inglaterra , Feminino , Humanos , Modelos Econômicos , Acidente Vascular Cerebral/complicações , Inquéritos e Questionários , Varfarina/uso terapêutico
3.
Medicine (Baltimore) ; 98(37): e17131, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31517851

RESUMO

Unexplained fever is one of the most common and difficult diagnostic problems faced daily by clinicians. This study evaluated the differences in health service utilization, health care expenditures, and quality of care provided to patients with unexplained fever before and after global budget (GB) implementation in Taiwan.The National Health Insurance Research Database was used for analyzing the health care expenditures and quality of care before and after implementation of the GB system. Patients diagnosed as having unexplained fever during 2000-2001 were recruited; their 2000-2001 and 2004-2005 data were considered baseline and postintervention data, respectively.Data of 259 patients with unexplained fever were analyzed. The mean lengths of stay (LOSs) before and after GB system implementation were 4.22 ±â€Š0.35 days and 5.29 ±â€Š0.70 days, respectively. The mean costs of different health care expenditures before and after implementation of the GB system were as follows: the mean diagnostic, drug, therapy, and total costs increased respectively from New Taiwan Dollar (NT$) 1440.05 ±â€ŠNT$97.43, NT$3249.90 ±â€ŠNT$1108.27, NT$421.03 ±â€ŠNT$100.03, and NT$13,866.77 ±â€ŠNT$2,114.95 before GB system implementation to NT$2224.34 ±â€ŠNT$238.36, NT$4272.31 ±â€ŠNT$1466.90, NT$2217.03 ±â€ŠNT$672.20, and NT$22,856.41 ±â€ŠNT$4,196.28 after implementation. The mean rates of revisiting the emergency department within 3 days and readmission within 14 days increased respectively from 10.5% ±â€Š2.7% and 8.3% ±â€Š2.4% before implementation to 6.3% ±â€Š2.2% and 4.0% ±â€Š1.7% after implementation.GB significantly increased LOS and incremental total costs for patients with unexplained fever; but improved the quality of care.


Assuntos
Orçamentos , Febre/economia , Febre/terapia , Hospitalização/economia , Medicina Estatal/economia , Adolescente , Feminino , Febre/epidemiologia , Febre/etiologia , Custos de Cuidados de Saúde , Humanos , Pacientes Internados , Masculino , Qualidade da Assistência à Saúde/economia , Fatores de Risco , Taiwan , Adulto Jovem
4.
Anesth Analg ; 129(3): 726-734, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31425213

RESUMO

The convergence of multiple recent developments in health care information technology and monitoring devices has made possible the creation of remote patient surveillance systems that increase the timeliness and quality of patient care. More convenient, less invasive monitoring devices, including patches, wearables, and biosensors, now allow for continuous physiological data to be gleaned from patients in a variety of care settings across the perioperative experience. These data can be bound into a single data repository, creating so-called data lakes. The high volume and diversity of data in these repositories must be processed into standard formats that can be queried in real time. These data can then be used by sophisticated prediction algorithms currently under development, enabling the early recognition of patterns of clinical deterioration otherwise undetectable to humans. Improved predictions can reduce alarm fatigue. In addition, data are now automatically queriable on a real-time basis such that they can be fed back to clinicians in a time frame that allows for meaningful intervention. These advancements are key components of successful remote surveillance systems. Anesthesiologists have the opportunity to be at the forefront of remote surveillance in the care they provide in the operating room, postanesthesia care unit, and intensive care unit, while also expanding their scope to include high-risk preoperative and postoperative patients on the general care wards. These systems hold the promise of enabling anesthesiologists to detect and intervene upon changes in the clinical status of the patient before adverse events have occurred. Importantly, however, significant barriers still exist to the effective deployment of these technologies and their study in impacting patient outcomes. Studies demonstrating the impact of remote surveillance on patient outcomes are limited. Critical to the impact of the technology are strategies of implementation, including who should receive and respond to alerts and how they should respond. Moreover, the lack of cost-effectiveness data and the uncertainty of whether clinical activities surrounding these technologies will be financially reimbursed remain significant challenges to future scale and sustainability. This narrative review will discuss the evolving technical components of remote surveillance systems, the clinical use cases relevant to the anesthesiologist's practice, the existing evidence for their impact on patients, the barriers that exist to their effective implementation and study, and important considerations regarding sustainability and cost-effectiveness.


Assuntos
Anestesiologia/métodos , Informática Médica/métodos , Qualidade da Assistência à Saúde , Tecnologia de Sensoriamento Remoto/métodos , Anestesiologia/economia , Anestesiologia/normas , Análise Custo-Benefício/métodos , Análise Custo-Benefício/normas , /normas , Humanos , Informática Médica/economia , Informática Médica/normas , Qualidade da Assistência à Saúde/economia , Qualidade da Assistência à Saúde/normas , Tecnologia de Sensoriamento Remoto/economia , Tecnologia de Sensoriamento Remoto/normas , Fatores de Tempo
5.
Med Care ; 57(8): 584-591, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31295188

RESUMO

BACKGROUND: The effects of Medicare payment reforms aiming to improve the efficiency and quality of care by establishing greater financial accountability for providers may vary based on the extent and types of other coverage for their patient populations. Providers who are more resource constrained due to a less favorable payer mix face greater financial risks under such reforms. The impact of the expanded Medicare dialysis prospective payment system (PPS) on quality of care in independent dialysis facilities may vary based on the extent of higher payments from private insurers available for managing increased risks. OBJECTIVES: To evaluate whether anemia outcomes for dialysis patients in independent facilities differ under the Medicare PPS based on facility payer mix. DESIGN: We examined changes in anemia outcomes for 122,641 Medicare dialysis patients in 921 independent facilities during 2009-2014 among facilities with differing levels of employer insurance (EI). We performed similar analyses of facilities affiliated with large dialysis organizations, whose practices were not expected to change based on facility-specific payer mix. RESULTS: Among independent facilities, similar modeled trends in low hemoglobin for all 3 facility EI groups in 2009-2010 were followed by increased low hemoglobin during 2012-2014 for facilities with lower EI (P<0.01). Post-PPS standardized blood transfusion ratios were 9% higher for lower EI versus higher EI independent facilities (P<0.01). Among large dialysis organizations facilities, there was no divergence in low hemoglobin by payer mix under the PPS. CONCLUSIONS: There is evidence of poorer quality of care for anemia under the PPS in independent facilities with lower versus higher EI. Provider responses to payment reform may vary based on attributes such as payer mix that could have implications for health disparities.


Assuntos
Anemia/terapia , Reforma dos Serviços de Saúde/organização & administração , Medicare/organização & administração , Sistema de Pagamento Prospectivo/organização & administração , Diálise Renal/economia , Adolescente , Adulto , Idoso , Anemia/economia , Anemia/etiologia , Eritropoetina/uso terapêutico , Feminino , Custos de Cuidados de Saúde , Reforma dos Serviços de Saúde/economia , Hemoglobinas/análise , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/economia , Falência Renal Crônica/terapia , Masculino , Medicare/economia , Pessoa de Meia-Idade , Sistema de Pagamento Prospectivo/economia , Qualidade da Assistência à Saúde/economia , Qualidade da Assistência à Saúde/organização & administração , Diálise Renal/normas , Estados Unidos , Adulto Jovem
6.
N Engl J Med ; 381(3): 252-263, 2019 07 18.
Artigo em Inglês | MEDLINE | ID: mdl-31314969

RESUMO

BACKGROUND: Population-based global payment gives health care providers a spending target for the care of a defined group of patients. We examined changes in spending, utilization, and quality through 8 years of the Alternative Quality Contract (AQC) of Blue Cross Blue Shield (BCBS) of Massachusetts, a population-based payment model that includes financial rewards and penalties (two-sided risk). METHODS: Using a difference-in-differences method to analyze data from 2006 through 2016, we compared spending among enrollees whose physician organizations entered the AQC starting in 2009 with spending among privately insured enrollees in control states. We examined quantities of sentinel services using an analogous approach. We then compared process and outcome quality measures with averages in New England and the United States. RESULTS: During the 8-year post-intervention period from 2009 to 2016, the increase in the average annual medical spending on claims for the enrollees in organizations that entered the AQC in 2009 was $461 lower per enrollee than spending in the control states (P<0.001), an 11.7% relative savings on claims. Savings on claims were driven in the early years by lower prices and in the later years by lower utilization of services, including use of laboratory testing, certain imaging tests, and emergency department visits. Most quality measures of processes and outcomes improved more in the AQC cohorts than they did in New England and the nation in unadjusted analyses. Savings were generally larger among subpopulations that were enrolled longer. Enrollees of organizations that entered the AQC in 2010, 2011, and 2012 had medical claims savings of 11.9%, 6.9%, and 2.3%, respectively, by 2016. The savings for the 2012 cohort were statistically less precise than those for the other cohorts. In the later years of the initial AQC cohorts and across the years of the later-entry cohorts, the savings on claims exceeded incentive payments, which included quality bonuses and providers' share of the savings below spending targets. CONCLUSIONS: During the first 8 years after its introduction, the BCBS population-based payment model was associated with slower growth in medical spending on claims, resulting in savings that over time began to exceed incentive payments. Unadjusted measures of quality under this model were higher than or similar to average regional and national quality measures. (Funded by the National Institutes of Health.).


Assuntos
Planos de Seguro Blue Cross Blue Shield , Gastos em Saúde/tendências , Qualidade da Assistência à Saúde , Reembolso de Incentivo/economia , Planos de Seguro Blue Cross Blue Shield/organização & administração , Massachusetts , Qualidade da Assistência à Saúde/economia , Qualidade da Assistência à Saúde/tendências , Encaminhamento e Consulta/tendências , Mecanismo de Reembolso , Estados Unidos
7.
PLoS One ; 14(6): e0217353, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31216286

RESUMO

BACKGROUND: Across countries, a small group of patients accounts for the majority of health care spending. These patients are more likely than other patients to experience problems with quality and safety in their care, suggesting that efforts targeting efficiency and quality among this population might have significant payoffs for health systems. Better understanding of similarities and differences in patient characteristics and health care use in different countries may ultimately inform further efforts to improve care for HNHC patients in these health systems. METHODS: We conducted a cross-sectional descriptive study using one year of patient-level data on high-cost patients in seven high-income OECD member countries. Countries were selected based on availability of detailed information (large enough samples of claims, administrative, and survey data of high-cost patients). We studied concentration of spending among high-cost patients, characteristics of high-cost patients, and per capita spending on high-cost patients. FINDINGS: Cost-concentration of the top 5% of patients varied across countries, from 41% in Japan to 60% in Canada, driven primarily by variation in the top 1% of spenders. In general, high-cost patients were more likely to be female (57.7% on average), had a significant number of multi-morbidities (up to on average 10 major diagnostic categories (ICD chapters), and had a lower socioeconomic status. Characteristics of high-cost patients varied as well: median age ranged from 62 in the Netherlands to 75 in Germany and the difference in socioeconomic status is particularly stark in the US. Lastly, utilization, particularly for inpatient care, varied with an average number of inpatient days ranging from 6.6 nights (US) to 97.7 nights in Japan. INTERPRETATION: In this descriptive study, there is substantial variation in the cost concentration, characteristics, and per capita spending on high-cost patient populations across high-income countries. Differences in the way that health systems are structured likely explains some of this variation, which suggests the potential of cross-system learning opportunities. Our findings highlight the need for further studies including comparable performance metrics and institutional analysis.


Assuntos
Assistência à Saúde/economia , Qualidade da Assistência à Saúde/economia , Idoso , Custos e Análise de Custo , Estudos Transversais , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Espanha
8.
Continuum (Minneap Minn) ; 25(3): 845-849, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31162319

RESUMO

This article presents a hypothetical case of a patient with multiple sclerosis (MS), reviewing the use of clinical practice guidelines and incorporation of quality measures into practice. Appropriate diagnosis of MS is important to avoid the cost and consequences of a misdiagnosis. Ensuring that treatment discussion occurs when a patient with MS is receptive is good clinical practice and a guideline recommendation from the American Academy of Neurology. Continuing dialogue about disease-modifying therapy and ongoing monitoring are important for patient care and improved outcomes. Ultimately, cost-effective care in MS relates to using appropriate medicines in patients with active MS, ensuring adherence, and careful monitoring.


Assuntos
Anti-Inflamatórios/administração & dosagem , Análise Custo-Benefício/normas , Esclerose Múltipla/diagnóstico por imagem , Esclerose Múltipla/tratamento farmacológico , Guias de Prática Clínica como Assunto/normas , Qualidade da Assistência à Saúde/normas , Adulto , Anti-Inflamatórios/economia , Feminino , Humanos , Metilprednisolona/administração & dosagem , Metilprednisolona/economia , Esclerose Múltipla/economia , Qualidade da Assistência à Saúde/economia
9.
Inquiry ; 56: 46958019850732, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31104573

RESUMO

This special collection explores the organizational and environmental factors influencing nursing home performance. The papers in this special collection fall into 3 broad themes. The first theme addresses issues related to nursing home quality measures and public reporting. The second group of papers examines how organizational resources and the environment may influence nursing home performance. The third group of papers examines the relationships among management, strategy, and performance. Findings from this special collection can inform managers and policy makers on best practices and policies that can enhance organizational performance and ultimately ensure access to long-term care.


Assuntos
Meio Ambiente , Administração Financeira/economia , Casas de Saúde/economia , Objetivos Organizacionais , Qualidade da Assistência à Saúde/economia , Humanos , Medicaid , Medicare , Estados Unidos
10.
J Health Organ Manag ; 33(3): 304-322, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31122116

RESUMO

PURPOSE: The purpose of this paper is to identify the lean production (LP) practices applied in healthcare supply chain and the existing barriers related to their implementation. DESIGN/METHODOLOGY/APPROACH: To achieve that, a scoping review was carried out in order to consolidate the main practices and barriers, and also to evidence research gaps and directions according to different theoretical lenses. FINDINGS: The findings show that there is a consensus on the potential of LP practices implementation in healthcare supply chain, but most studies still report such implementation restricted to specific unit or value stream within a hospital. ORIGINALITY/VALUE: Healthcare organizations are under constant pressure to reduce costs and wastes, while improving services and patient safety. Further, its supply chain usually presents great opportunities for improvement, both in terms of cost reduction and quality of care increase. In this sense, the adaptation of LP practices and principles has been widely accepted in healthcare. However, studies show that most implementations fall far short from their goals because they are done in a fragmented way, and not from a system-wide perspective.


Assuntos
Controle de Custos/métodos , Assistência à Saúde/organização & administração , Eficiência Organizacional , Controle de Custos/organização & administração , Assistência à Saúde/economia , Assistência à Saúde/métodos , Humanos , Qualidade da Assistência à Saúde/economia , Qualidade da Assistência à Saúde/organização & administração
11.
Healthc Q ; 21(4): 43-47, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30946654

RESUMO

Since the Institute of Medicine's report in the USA in 1999 and the Baker-Norton report in Canada in 2004, academics have studied quality in areas such as governance, process improvement, measurement, patient engagement, physician and staff engagement and finance. Few, however, have offered a formal definition for their area or integrated each area's underlying assumptions to offer a shared definition of quality. This paper summarizes selected literature in each area, analyzes their contributions and compares common strands between each area to build a single integrated definition of health quality management which managers can apply in their health setting.


Assuntos
Melhoria de Qualidade/organização & administração , Qualidade da Assistência à Saúde/organização & administração , Pessoal de Saúde , Humanos , Satisfação do Paciente , Garantia da Qualidade dos Cuidados de Saúde/métodos , Qualidade da Assistência à Saúde/economia , Qualidade da Assistência à Saúde/normas
13.
Nurse Pract ; 44(4): 30-39, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30889108

RESUMO

The Centers for Medicare and Medicaid Services created the Quality Payment Program to award compensation to providers for offering evidence-based, high-value, and efficient care. This article outlines an information technology process improvement pilot project undertaken at a large primary care practice in western Florida to support readiness for Medicare Access and Children's Health Insurance Program (CHIP) Reauthorization Act of 2015 using new EHR quality indicator tracking features.


Assuntos
Children's Health Insurance Program/legislação & jurisprudência , Registros Eletrônicos de Saúde , Medicare/legislação & jurisprudência , Qualidade da Assistência à Saúde/economia , Mecanismo de Reembolso/organização & administração , Criança , Florida , Humanos , Projetos Piloto , Atenção Primária à Saúde , Estados Unidos
15.
J Nurs Adm ; 49(4): 176-178, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30882607

RESUMO

Health systems produce vast amounts of complex, multidimensional data. Health systems nurse leaders, informaticians, and nurse researchers must partner to turn these data into actionable information to drive quality clinical outcomes. The authors review health systems in the era of big data, identify opportunities for health systems-nursing research partnerships, and introduce emerging approaches to data science education in nursing.


Assuntos
Conjuntos de Dados como Assunto , Informática em Enfermagem , Recursos Humanos de Enfermagem no Hospital/economia , Qualidade da Assistência à Saúde/economia , Humanos , Pesquisa em Administração de Enfermagem
17.
Inquiry ; 56: 46958018825061, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30739512

RESUMO

High Medicaid nursing homes (85% and higher of Medicaid residents) operate in resource-constrained environments. High Medicaid nursing homes (on average) have lower quality and poorer financial performance. However, there is significant variation in performance among high Medicaid nursing homes. The purpose of this study is to examine the organizational and market factors that may be associated with better financial performance among high Medicaid nursing homes. Data sources included Long-Term Care Focus (LTCFocus), Centers for Medicare and Medicaid Services' (CMS) Medicare Cost Reports, CMS Nursing Home Compare, and the Area Health Resource File (AHRF) for 2009-2015. There were approximately 1108 facilities with high Medicaid per year. The dependent variables are nursing homes operating and total margin. The independent variables included size, chain affiliation, occupancy rate, percent Medicare, market competition, and county socioeconomic status. Control variables included staffing variables, resident quality, for-profit status, acuity index, percent minorities in the facility, percent Medicaid residents, metropolitan area, and Medicare Advantage penetration. Data were analyzed using generalized estimating equations with state and year fixed effects. Results suggest that organizational and market slack resources are associated with performance differentials among high Medicaid nursing homes. Higher financial performing facilities are characterized as having nurse practitioners/physician assistants, more beds, higher occupancy rate, higher Medicare and Medicaid census, and being for-profit and located in less competitive markets. Higher levels of Registered Nurse (RN) skill mix result in lower financial performance in high Medicaid nursing homes. Policy and managerial implications of the study are discussed.


Assuntos
Competição Econômica , Administração Financeira , Medicaid/economia , Medicare/economia , Medicare/organização & administração , Casas de Saúde/economia , Idoso , Humanos , Casas de Saúde/organização & administração , Qualidade da Assistência à Saúde/economia , Estados Unidos
18.
Front Health Serv Manage ; 35(3): 14-24, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30789371

RESUMO

Demonstrating value is essential to the future success of healthcare organizations. Health systems that disrupt traditional delivery models and meet consumer demands will lead the way. However, value depends on understanding the true cost of care. Until now, determining the total cost of care has not been addressed for three primary reasons: (1) tackling such a herculean effort was not necessary; (2) a lack of effective coding, accounting, and billing tools connected to clinical systems made it next to impossible; and (3) consumers did not pay as much for their healthcare as they do now.Diving headfirst into this challenge is Spectrum Health, a $6 billion system based in Grand Rapids, Michigan, with 14 hospitals, more than 225 service sites, a medical staff of 4,200 (about half of whom are members of its medical group), and a million-member health plan. Spectrum Health has transformed its care model and billing platform, transitioning to one electronic health record systemwide, because a high-performing, fully integrated approach ensures the highest-quality care and outcomes. At the same time, the cost of care directly correlates to what consumers pay through their insurance, and they want pricing information that can help lower their expenses. Spectrum Health's insurance entity, Priority Health, is making significant strides in offering leading-edge price transparency tools.This article outlines the challenges and opportunities in determining the total cost of care and ultimately reducing those costs. Equally important is translating this information into what consumers pay, as well as providing price transparency and other digital tools that engage consumers in their health and wellness.


Assuntos
Assistência à Saúde/economia , Assistência à Saúde/estatística & dados numéricos , Economia Hospitalar , Custos de Cuidados de Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/economia , Qualidade da Assistência à Saúde/estatística & dados numéricos , Humanos , Michigan
20.
PLoS One ; 14(2): e0212314, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30759147

RESUMO

In 2010, the UK embarked on a self-imposed programme of contractionary measures signalling the beginning of a so-called "age of austerity" for the country. It was argued that budgetary cuts were the most appropriate means of eliminating deficits and decreasing national debt as percentage of General Domestic Product (GDP). Although the budget for the National Health Service (NHS) was not reduced, a below-the-average increase in funding, and cuts in other areas of public spending, particularly in social care and welfare spending, impacted significantly on the NHS. One of the areas where the impact of austerity was most dramatically felt was in Accidents and Emergency Departments (A&E). A number of economic and statistical reports and quantitative studies have explored and documented the effects of austerity in healthcare in the UK, but there is a paucity of research looking at the effects of austerity from the standpoint of the healthcare professionals. In this paper, we report findings from a qualitative study with healthcare professionals working in A&E departments in England. The study findings are presented thematically in three sections. The main theme that runs through all three sections is the perceptions of austerity as shaping the functioning of A&E departments, of healthcare professions and of professionals themselves. The first section discusses the rising demand for services and resources, and the changed demographic of A&E patients-altering the meaning of A&E from 'Accidents and Emergencies' to the Department for 'Anything and Everything'. The second section in this study's findings, explores how austerity policies are perceived to affect the character of healthcare in A&E. It discusses how an increased focus on the procedures, time-keeping and the operationalisation of healthcare is considered to detract from values such as empathy in interactions with patients. In the third section, the effects of austerity on the morale and motivations of healthcare professionals themselves are presented. Here, the concepts of moral distress and burnout are used in the analysis of the experiences and feelings of being devalued. From these accounts and insights, we analyse austerity as a catalyst or mechanism for a significant shift in the practice and function of the NHS-in particular, a shift in what is counted, measured and valued at departmental, professional and personal levels in A&E.


Assuntos
Acidentes de Trânsito , Assistência à Saúde/economia , Recessão Econômica/estatística & dados numéricos , Serviços Médicos de Emergência/economia , Pessoal de Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Qualidade da Assistência à Saúde/economia , Inglaterra , Financiamento da Assistência à Saúde/ética , Humanos
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