Showing papers on "Cost effectiveness published in 1993"

Downsizing: What do we know? What have we learned?

Abstract: Executive Overview Downsizing, the planned elimination of positions or jobs, is a phenomenon that has affected hundreds of companies and millions of workers since the late 1980s. While there is no shortage of articles on “How To” or “How Not To” downsize, the current article attempts to synthesize what is known in terms of the economic and organizational consequences of downsizing. We argue that in many firms anticipated economic benefits fail to materialize, for example, lower expense ratios, higher profits, increased return-on-investment, and boosted stock prices. Likewise, many anticipated organizational benefits do not develop, such as lower overhead, smoother communications, greater entrepreneurship, and increases in productivity. To a large extent, this is a result of a failure to break out of the traditional approach to organization design and management—an approach founded on the principles of command, control, and compartmentalization. For long-term. sustained improvements in efficiency, reductio...

Handbook for Digital Signal Processing

Abstract: From the Publisher: Digital signal processing (DSP) revolutionized the electronics industry. Its flexibility, cost effectiveness, grammability, precision and broad range of applications - including applications in telecommunications, consumer electronics, radar, sonar, and more - have made it the methodology of choice over analog signal processing. Over the past two decades, advances in DSP technology have been so rapid and so massive that, until now, no single volume has offered comprehensive theoretical coverage of this fascinating field along with practical DSP applications. Handbook for Digital Signal Processing is the definitive source of detailed information on all important topics in modern digital signal processing. The only up-to-date handbook of its kind, it fills the needs of practicing engineers and designers of hardware, systems, and software. Written and edited by internationally known authorities on DSP, Handbook for Digital Signal Processing is supplemented with hundreds of informative tables and illustrations. For professional engineers, designers, and researchers in electronics and telecommunications, this book will be an indispensable reference, now and for years to come.

Quality of life assessment : key issues in the 1990s

Abstract: Part 1 Philosophies, concepts and key instruments involved in assessing quality of life: the new era of quality of life assessment assessing health-related quality of life for clinical decision making the quality of well-being scale - rationale for a single quality of life index development, testing and use of the sickness impact profile the Nottingham health profile the McMaster health index auestionaire - an update a health index and output measure the index of health-related QOL (IHQL) - a new tool for audit and cost-per-QALY analysis 15D measure of health-related quality of life and its applications the Euroqol quality of life project a WHO method for the assessment of health-related quality of life (WHOQOL) indices versus profiles - advantages and disadvantages the on-line guide to quality of life assessment (OGLA) - a resource for selectiong quality of life assessments. Part 2 Assessing quality of life in major disease areas: measuring the quality of life - patients with caner, patients with rheumatoid arthritis, patients with Parkinson's diseasse, patients with respiratory disease, patients with hypertension, patients with angina measuring the quality of life in psychiatry measuring the quality of life in dermatology. Part 3 Viewpoints and perspectives: ethical questions and policy decisions - their implications for quality of life studies industry perspectives on quality of life a regulatory view the cost effectiveness of pharmaceuticals requirements for health care purchasers the importance of quality of life in policy decisions.

An analysis of public opinion toward undocumented immigration

Abstract: Public opinion toward illegal migration to the United States varies considerably across different segments of the population, but little is known about why some individuals hold more liberal attitudes than others. Several hypotheses are scattered throughout the research literature, but they have not been brought together in one place and tested using a common data set. Nor have the limited tests been satisfactory from a methodological standpoint. Instead of using multiple regression, typically analysts have relied on cross-tabulations of the data. This paper tests five hypotheses about attitudes toward illegal immigration and undocumented migrants using public opinion data from southern California. Only weak support is found for a labor market competition hypothesis. There is firmer evidence for hypotheses relating to cultural affinity between respondents and undocumented migrants and to the role of education. Respondents' evaluations of tangible costs and benefits to themselves also influence their assessments of illegal immigration. Finally, the results of this analysis provide additional support for a symbolic politics model of opinion formation when the model is extended to the issue of undocumented migration to the United States.

Developer-User Interaction and User Satisfaction in Internal Technology Transfer

Abstract: Effective internal technology transfer—the implementation of technical systems developed and disseminated to operational subunits within a single organization—depends not only upon the cost, qualit...

Introducing physician order entry at a major academic medical center: I. Impact on organizational culture and behavior.

Abstract: In 1988 the University of Virginia Medical Center began implementation of a medical information system based on mandatory physician order entry. The implementation process was much more difficult than expected. The program experienced considerable delays, and cost much more than was originally estimated. Although there were some legitimate questions concerning the user-friendliness of the new technology, these were less significant than the cultural and behavioral problems encountered. The new system challenged basic institutional assumptions; it disturbed traditional patterns of conduct and forced people to modify established practice routines. Real progress toward the integration of the system into the center's operational culture occurred only after a senior management team representing important sectors of the hospital staff and administration began meeting regularly to address the institution-wide issues that had been raised. The author describes the problems that occurred and the organizational behaviors on which they were based, analyzes the lessons learned, documents the progress that has been achieved, and outlines the challenges that remain. The center's experience provides insight into the issue of technology-driven organizational transformation in academic medical centers. Recommendations for successful introduction of similar agents of institutional change are presented.

Some guidelines on the use of cost effectiveness league tables.

Abstract: Decisions to allocate resources in health care are increasingly influenced by relative cost effectiveness. To warn decision makers of some of the pitfalls currently found in cost effectiveness league tables and to suggest how meaningful comparisons may be made between health care technologies a published league table was scrutinised by examining its sources. This showed some of the methodological problems surrounding such tables and how such difficulties could be reduced in future. The source studies in the table featured different years of origin, discount rates, health state evaluations, settings, and types of comparison programmes; all of these differences may raise problems for meaningful comparison. Decision makers need to assess the relative value for money of competing health care interventions. In the absence of systematic comparisons such assessments are likely to take place informally. This will probably have a worse risk-benefit trade off than the formalized use of league tables.

Incremental clustering for dynamic information processing

Abstract: Clustering of very large document databases is useful for both searching and browsing. The periodic updating of clusters is required due to the dynamic nature of databases. An algorithm for incremental clustering is introduced. The complexity and cost analysis of the algorithm together with an investigation of its expected behavior are presented. Through empirical testing it is shown that the algorithm achieves cost effectiveness and generates statistically valid clusters that are compatible with those of reclustering. The experimental evidence shows that the algorithm creates an effective and efficient retrieval environment.

Cost effectiveness of clozapine in neuroleptic-resistant schizophrenia.

Abstract: Objective The goal of this study was to determine whether clozapine is a cost-effective treatment for treatment-resistant schizophrenia. Method Data were collected on 96 treatment-resistant patients with schizophrenia for 2 years before they entered a clozapine treatment study and for at least 2 years after they entered the study. Information about the cost of inpatient and outpatient treatment, housing costs, other costs, and family burden through direct interview or questionnaire of these patients and their families were available for 47 of the 96 patients. Data on lost income and Social Security disability insurance were also obtained. Outcome measures included psychopathology, quality of life, global functioning, work function, and rehospitalization. Results The cost of treatment was significantly decreased in the patients who continued clozapine treatment for at least 2 years. This was primarily due to a dramatic decrease in the frequency and cost of rehospitalization. Costs were nonsignificantly lower in patients who dropped out of treatment. The estimated total 2-year cost for the 59 patients who continued clozapine treatment, the 34 patients who dropped out, and the three who interrupted treatment decreased from $7,390,206 to $5,719,463, a savings of $8,702/year per patient. There was a decrease in total costs of $22,936/year for the 37 patients who continued clozapine treatment for whom cost data were available. There were no significant changes in lost income or Social Security disability insurance payments in either group. Clozapine produced a marked improvement in Brief Psychiatric Rating Scale total scores as well as positive negative symptom scores, Global Assessment Scale scores, Quality of Life Scale scores, work functioning, capacity for independent living, and rehospitalization rates. Conclusions Clozapine is a cost-effective treatment for treatment-resistant schizophrenic patients. Cost savings result almost exclusively from the reduced cost of hospitalization.

A Hierarchy of Management Training Requirements: The Competency Domain Model:

Abstract: The triple threat to most organizations today, both public and private sector, are the simultaneous demands for improved quality, reduced costs, and constant innovation. For those in leadership roles - executives, managers, supervisors - this translates into a need to constantly upgrade knowledge and skills. And in turn, this means that training professionals must be able to respond to these skills and knowledge training needs accurately, quickly and cost effectively. Faced with this complex demand, the temptation for trainers is often to go with 'flavor of the month' training programs that are currently popular. Or they may rely on tried and true programs that seem to have worked for the last decade or two. While both approaches may provide some people with some needed training, neither is a sufficient approach to the challenges outlined above. Aside from a high quality crystal ball, what works? As one large organization discovered, the best solution seems to be a comprehensive framework that delineates a distinct hierarchy of skills and knowledge, or competencies, needed by managers in an organization. The Situation The organization found itself with a large number of middle managers and supervisors reaching retirement age, with no organized plan for replacing them. As there were a number of retirement options available to these individuals, it was difficult to predict when over an eight year period any or all of them might leave. Because of a policy of promotion from within and also because of the unique technical nature of the work, it was determined that internal development of existing staff was the best option. The mandate given to the training team charged with designing internal staff development programs included: 1. Development of multi-skilled supervisors and managers who could fit a variety of positions because the exact types of vacancies could not be identified ahead of time. 2. Identification of the knowledge and skills (competencies) required for each type of managerial job. Existing job descriptions addressed responsibilities and authorities, not competencies. 3. Delineation of the hierarchy of managerial competencies within each group of managerial jobs. 4. Identification of competencies common across job groups at different managerial levels. 5. Development of appropriate training responses for each job group, incorporating on-job competency development through coaching, job competency profiles, job learning assignments and workshop seminars. Cost effectiveness was also a critical requirement. Training and development provided to managers had to: * Provide relevant training to those who needed it, not to those who did not. Old 'broad brush' training efforts wasted a lot of time and money on irrelevant training. * Provide job useful learning, with an emphasis on practical strategies and skills, not on theory. * Be provided to managers prior to or early on in any career shifts, to avoid the cost of untrained managers making unfortunate mistakes. Fortunately, some research work had already been done in this organization on the development of job profiles for managerial positions. The job profile development process was initially guided by Robert Katz's concept of a hierarchy of managerial skills. From this initial field research on job profiles emerged an expanded version of Katz's original three level model, both of which are discussed below. The Competency Domain Model: Background The competency domain model described in this article follows a line of research and thought that goes back to Robert Katz's 1955 work "Skills of an Effective Administrator".(1) Katz identified a hierarchy of skills needed by managers at different levels in organizations. Three fundamental skill areas - Technical, Human, Conceptual - were identified as having varying degrees of relevance for supervisors, managers and executives. …

Cost-effectiveness of laparoscopic cholecystectomy versus open cholecystectomy

Abstract: To assess the cost-effectiveness of laparoscopic cholecystectomy versus open cholecystectomy from the payer's perspective, we estimated the probabilities of potential outcomes of each procedure, associated quality-of-life effects, and related direct medical charges and incorporated these estimates into a computerized simulation model. The model projects that laparoscopic cholecystectomy will be more effective than open surgery in terms of total mortality and quality-adjusted survival, for both sexes and all ages. Projected 5-year cumulative charges are lower for laparoscopic cholecystectomy than for open cholecystectomy ($5,354 versus $5,525 for 45-year-old women; $6,036 versus $6,830 for 45-year-old men), and the differences increase substantially with increasing age. We concluded that laparoscopic cholecystectomy is likely to be less costly and more effective than open cholecystectomy for most patients, as long as it does not routinely require preoperative cholangiography and is not associated with increased professional fees or increased risks of retained stones or bile duct injury.

Open colectomy versus laparoscopic colectomy: Are there differences?

Abstract: Laparoscopic colectomy has been increasingly reported as an option for the treatment of colonic pathology However, there is very little information regarding perioperative morbidity and the cost effectiveness of this technique The purpose of this study is to review our first year of experience with laparoscopic colon resection Data collected includes: age, technique (open laparotomy, laparoscopic, laparoscopiclconverted open), Karnofsky score, complications, specimen sizelnodes, OR time, hospital stay, and cost This is a consecutive series of 140 elective colonic resections including 102 open laparotomies (O) and 38 laparoscopic (L) cases

Health care CBA/CEA: an update on the growth and composition of the literature.

Abstract: Cost-benefit (CBA) and cost-effectiveness analyses (CEA) are methods that enumerate the costs and consequences associated with health-related technologies, services, and programs. This article examines the trends in published CBA and CEA of personal health services from 1979 through 1990. It is based on a bibliography that was compiled to help address the immense need for information on the variation and effectiveness of medical practices, particularly as researchers expand their analysis to a study of the cost effectiveness of medical and surgical interventions, health care technologies, preventive practices, and other health programs. A systematic search was conducted for all articles under the heading "cost-benefit analysis" (which includes cost-effectiveness analysis) and "costs and cost analysis." Data sources included the MEDLARS (National Library of Medicine) database, other bibliographies in specialized areas, reference lists in key articles, and contacts with researchers in the field. All titles and abstracts were scanned to determine if the articles pertained to personal health services and if both costs and consequences were assessed. If both criteria were met, the article was included in the bibliography. This search resulted in 3,206 eligible CBA/CEA publications from 1979 through 1990. The publications were subdivided into two major categories: reports of studies and "other" publications, including reviews, descriptions of methodology, letters, and editorials. Reports of studies and "other" publications were classified into approximately 250 different topic areas. The studies were further classified by parameters, such as study type, publication vehicle, and medical function. This article describes the results of this classification and describes trends during 1979 to 1990 compared with 1966 to 1978. The classification of study reports and "other" publications into 250 topic areas is presented in Appendix A. The entire bibliography is reproduced in Appendix B. Detailed tables of findings are presented in Appendix C, and the results are illustrated graphically in Appendix D. Appendix E provides the coding scheme used in the bibliography's data base.

After-Hours Telephone Coverage: The Application of an Area-Wide Telephone Triage and Advice System for Pediatric Practices

Abstract: Background. After-hours telephone calls are a stressful and frustrating aspect of pediatric practice. At the request of private practice pediatricians in Denver, a metropolitan area-wide system was created to manage after-hours pediatric telephone calls and after-hours patient care. This system, the After-Hours Program (AHP), uses specially trained pediatric nurses with standardized protocols to provide after-hours telephone triage and advice for the patients of 92 Denver pediatricians, representing 56 practices. Objectives. This report describes the AHP, presents data from 4 years9 experience with the program, and describes results of our evaluation of the following aspects of the program: subscribing physician satisfaction, parent satisfaction, the accuracy and appropriateness of telephone triage, and program costs. Methods. After-Hours Program records (including quality assurance data) for all 4 years of operation were retrospectively reviewed, tabulated, and analyzed. The results of two subscribing physician surveys and one parent caller satisfaction survey are presented. A retrospective review of after-hours patient care encounter forms assessed the necessity for after-hours visits triaged by the AHP. An analysis of the total cost of this program to 10 randomly selected subscribing physicians was conducted using current AHP data and a survey of the 10 physicians. Results. In 4 years, 107 938 calls have been successfully managed without an adverse clinical outcome. Minor errors in using protocols occurred in one call out of 1450 after-hours calls. After-hours phone calls necessitated an after-hours patient visit 20% of the time and generated one after-hours hospital admission out of every 88 calls. Just over half of the patients were managed with home care advice only, and 28% were given home care advice after-hours and seen the next day in the primary physician9s office. Of all patients directed by the telephone triage nurses to be seen after hours, 78% were determined to have a condition necessitating after-hours care. Data are presented regarding call volumes by time of day, day of week, patient age, and patient9s initial complaint. The 6 most common complaints accounted for more than one half of the calls, and 38 complaints accounted for more than 95% of all after-hours calls. Utilization by subscribing physicians is described. Satisfaction among subscribing pediatricians was 100%, and among parents was 96% to 99% on a variety of issues. The total cost to participating Denver pediatricians (which includes revenues "given up" as a result of not seeing patients after hours) ranged from 1% to 12% of their annual net income, depending on a variety of factors. Conclusions. Large-scale after-hours telephone coverage systems can be effective and well-received by patients, parents, and primary physicians. Data presented in this report can assist in planning the training of personnel who provide after-hours telephone advice and triage. Controversies associated with this type of program are discussed. Suggestions are made regarding the direction of future programs and research.

Clinical Utility and Cost-effectiveness of an Air Suspension Bed in the Prevention of Pressure Ulcers

Abstract: Objective. —To determine, in critically ill patients at risk, both the clinical utility and cost-effectiveness of using an air suspension bed in the prevention of pressure ulcers. Design. —Randomized, parallel group, controlled clinical trial with accompanying cost-effectiveness analysis. Setting. —30-bed multidisciplinary intensive care unit. Patients. —100 consecutive patients at risk for the development of pressure ulcers randomly assigned to receive treatment on either an air suspension bed or a standard intensive care unit bed. Patients considered at risk were those at least 17 years of age with an Acute Physiology and Chronic Health Evaluation II (APACHE II) score greater than 15 who had an expected intensive care unit stay of at least 3 days. Main Outcome Measures. —The development of pressure ulcers by site and severity and the costs associated with each of the two programs. Results. —The air suspension bed was associated with fewer patients developing single, multiple, or severe pressure ulcers. In patients at risk, the use of an air suspension bed in the prevention of pressure ulcers was a cost-effective therapy. Conclusions. —Despite intense nursing care, pressure ulcers are more prevalent in the critically ill patient population than in the general hospital population. Air suspension therapy provides a clinically effective means of preventing pressure ulcers in these patients. In patients at risk, air suspension therapy was a cost-effective means of managing pressure ulcers compared with the standard hospital bed. ( JAMA . 1993;269:1139-1143)

Cost-effectiveness of breast cancer screening: preliminary results of a systematic review of the literature.

Abstract: There is now considerable concern that universal access to health care within realistic resource constraints requires some sort of cost-effectiveness analysis of given medical procedures and interventions. One such intervention is routine mammographic screening for breast cancer. Here, we report preliminary results from an ongoing project to conduct a systematic and comprehensive review and comparison of the published cost-effectiveness analyses of screening for the early detection of breast cancer. We examine 16 such studies, and compare two studies in detail to explain how differences in assumptions and in consideration of down-stream effects have caused the published results for apparently comparable breast cancer screening programs to span a broad range.

The impact of early learning on children's later development a review prepared for the RSA inquiry ‘start right’

Abstract: SUMMARY Most research shows that early learning experiences have immediate, measurable gains on the cognitive and social development of preschool children. When preschool education is of high quality it leads to lasting enhancement of educational performance and later employment. It does this through encouraging high aspirations, motivation to learn and feelings of task efficacy, especially for children from disadvantaged backgrounds. It is suggested that preschool education is effective because it shapes the cognitions that children construct for explaining success and failure in school. Early learning can foster the belief in children that attainment is not innate but is, instead, achieved in part by effort. Early learning occurs in day care as well as nursery school. Research shows that high quality day care provision leads to successful social and educational outcomes. There is a strong case for investment in high quality early learning on economic as well as social grounds. Cost benefit analyses carr...

Chronic constipation in long stay elderly patients: a comparison of lactulose and a senna-fibre combination

Abstract: OBJECTIVES--To compare the efficacy and cost effectiveness of a senna-fibre combination and lactulose in treating constipation in long stay elderly patients. DESIGN--Randomised, double blind, cross over study. SETTING--Four hospitals in Northern Ireland, one hospital in England, and two nursing homes in England. SUBJECTS--77 elderly patients with a history of chronic constipation in long term hospital or nursing home care. INTERVENTION--A senna-fibre combination (10 ml daily) or lactulose (15 ml twice daily) with matching placebo for two 14 day periods, with 3-5 days before and between treatments. MAIN OUTCOME MEASURES--Stool frequency, stool consistency, and ease of evacuation; deviation from recommended dose; daily dose and cost per stool; adverse effects. RESULTS--Mean daily bowel frequency was greater with the senna-fibre combination (0.8, 95% confidence interval 0.7 to 0.9) than lactulose (0.6, 0.5 to 0.7; t = 3.51 p < or = 0.001). Scores for stool consistency and ease of evacuation were significantly higher for the senna-fibre combination than for lactulose. The recommended dose was exceeded more frequently with lactulose than the senna-fibre combination (chi 2 = 8.38, p or = 0.01). As an index of the standard daily dose, the dose per stool was 1.52 for lactulose and 0.97 for the senna-fibre combination, at a cost per stool of 39.7p for lactulose and 10.3p for senna-fibre. Adverse effects were no different for the two treatments. CONCLUSIONS--Both treatments were effective and well tolerated for chronic constipation in long stay elderly patients. The senna-fibre combination was significantly more effective than lactulose at a lower cost.

Development of Baits for Tsetse Flies (Diptera: Glossinidae) in Zimbabwe

Abstract: Analysis of host-oriented behavior of tsetse flies, Glossina morsitans morsitans Westw. and G. pallidipes Austen, led to a 10- to 1,000-fold improvement in the cost effectiveness of baits for surveys and control. Baits now are used widely to replace air and ground broadcasting of insecticides. Principles of behavioral analysis are discussed, with emphasis on the need to: confirm that the measurements made are the measurements required; assess the probability of flies executing single specific actions in response to each component of the overall stimulus from baits; count not only the flies that do one thing, but also the number that do the alternative(s); and use objective sampling devices of measured efficiency. The relevance to research with other flies is considered. The need for new tools to study continuously the field behavior of individual flies is stressed.

Treatment of Childhood Sleep Disorders: Generalization Across Disorders and Effects on Family Members

Abstract: Investigated the treatment of bedtime problems and its generalization to night wakings. Six children (M age = 35 months) and their parents participated in this study. A multiple-baseline design across subjects was employed and found that treatment instituted at bedtime was successful in relieving both bedtime disturbances and night wakings. Furthermore, significant positive changes in parental sleep and family satisfaction occurred following amelioration of the children's sleep problems. Data support recent work suggesting that chronic sleep problems in children are amenable to behavioral interventions. In addition, this method appears to be more cost-effective and less stressful for parents to implement than behavioral interventions that directly target night wakings.

Cost‐effectiveness of increased telephone contact for patients with osteoarthritis: A randomized, controlled trial

Abstract: Objective. To evaluate the cost-effectiveness of telephone intervention for patients with osteoarthritis. Methods. Randomized, controlled trial. Results. The intervention did not significantly increase health care costs. The annual costs for a 1-unit improvement in physical functioning and in pain, as measured by the Arthritis Impact Measurement Scales, were $70.86 and $31.00, respectively. Conclusion. Telephone contact is a potentially cost-effective intervention in osteoarthritis.