摘要:

Moving from a paper-based prescribing system to a system in which physicians prescribe directly into computers represents an important but challenging transition. This article addresses 5 issues related to computerised prescribing.The first issue is that paper-based prescribing systems do not work. Rates of errors and inappropriate prescriptions are unacceptably high. Using computers to structure and check prescriptions holds great promise for ameliorating this situation.The second issue is that computerised prescribing represents a battleground in a ‘contest’ over control and content of medical practice. Eight key stakeholders with conflicting interests are vying to shape electronic prescribing. Patient, prescriber and pharmacist interest converge around key design characteristics.The third issue is that the success of electronic prescription-writing hinges on integration with clinical data and processes. While computer prescribing programs are proliferating, few have the requisite linkages required to fundamentally transform the prescribing process. Linkages with laboratory data, diagnoses and scheduling are especially critical.The fourth issue is that feedback to prescribers is vital. Computers enable advanced learning from drug-experience outcomes and should be deployed to facilitate this capability.Finally, progress depends on breakthroughs in 10 current ‘tension’ areas. Trade-offs in these tension areas can be conceptually illustrated by receiver-operating characteristic curves which show new operating characteristics required for genuine progress.While the path to electronic prescribing will be challenging, the rewards will be great. To ensure optimal results, it is critical that health professionals play a leading role in developing, designing and implementing such systems.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

Healthcare professionals are increasingly held accountable for the standards of care that they provide. The focus of control for this accountability can be either internal or external activity to the professional body and can use implicit or explicit quality assessment techniques. The science of performance measurement and performance management of professional activity is a new and rapidly expanding one. Advocates of an actively managed approach to quality improvement often underestimate the tensions associated with promoting change amongst traditionally autonomous professionals who work in complex organisations. This tension has tended to result in polarised opinions about complex issues rather than legitimate debate.There is considerable uncertainty about the most effective ways of measuring professional performance and the relationship between measurement and quality improvement. This article examines some of the important issues in measuring clinical performance and using such measures to manage healthcare activity and promote quality improvement. This article is intended to shed light on the rapidly changing, data-rich environment within which healthcare systems now operate, and it highlights a number of questions that need to be addressed before the full potential of performance management in healthcare can be realised.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

As care for HIV/AIDS becomes more concentrated within specific providers and organisations, it would be useful to have indicators to describe the quality of care. This paper reviews concepts related to quality of care, and practical issues including sampling and risk adjustment. Indicators can be collected using a combination of administrative, chart review and survey data to reflect clinical, patient and societal perspectives. We suggest that for adults with HIV/AIDS, indicators might include measures of health status and patient satisfaction, and essential care processes. Health status measures could include CD4+ T-lymphocyte count and HIV-RNA, progression to AIDS, symptom scores, health-related quality of life scores, patient utility and disability days. Essential care processes could include receipt of acceptable antiretroviral treatment, CD4+ and HIV-RNA monitoring, screening for opportunistic infections, prophylaxis againstPneumocystis cariniipneumonia, handling of symptoms and pneumococcal vaccination. For those at increased risk for HIV, potential indicators include screening for HIV risk behaviours and HIV testing. Data from indicators such as these could be used by individuals to select among providers, purchasers of care to select among health plans and payors to hold provider groups accountable. In addition, data could be used by groups of providers to improve the quality of care.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS

摘要:

ObjectiveTo assess and compare the costs and effectiveness of different vaccination strategies against hepatitis B in Switzerland.DesignA birth cohort of 85 000 individuals was followed over their lifetime, using a decision-tree analysis. Published data were used to simulate the risk of hepatitis B virus (HBV) infection in the cohort, the consecutive clinical outcomes and the associated costs. Five new vaccination scenarios were assessed and compared with a baseline strategy of vaccination of high-risk groups. The 5 new vaccination scenarios were: (i) systematic prenatal screening and vaccination of newborns at risk; (ii) universal vaccination of infants; (iii) universal vaccination of school children; (iv) universal vaccination of infants and school children; and (v) universal vaccination of infants, school children and adolescents.ResultsThe incremental cost per year of life saved for systematic prenatal screening and vaccination of newborns at risk compared with the baseline scenario was estimated to be 23 350 Swiss francs (SwF; 1996 values). The 4 universal vaccination scenarios had a much larger impact on the number of chronic infections and deaths prevented. The incremental cost per year of life saved for universal vaccination compared with systematic prenatal screening and vaccination of newborns at risk ranged from SwF6120 (infant vaccination strategy) to SwF10 200 (school children vaccination strategy). In the sensitivity analysis, prevalence, vaccine price and discount rate were key elements.ConclusionIncremental cost-effectiveness ratios are lower with universal vaccination strategies than with selective vaccination. Furthermore, with universal vaccination strategies, increasingly ambitious strategies result in higher costs but also in more incremental years of life saved.

ISSN:1173-8790    

出版商:ADIS    

年代:2000

数据来源: ADIS