ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

In response to an increase in the number of elderly people and increasing medical costs, the Japanese government implemented the Long-Term Care Insurance (LTCI) system for the elderly in April 2000. Three years have passed since the LTCI was initiated. The purpose of this paper is to describe the framework, current situation and issues of this system, and the challenges and roles of the LTCI in the future.The numbers of service agencies, institutions, and LTCI service users have been steadily increasing. The waiting list for institutions has also increased, and only half of the users have reached the upper cost limit. Most users were satisfied with the LTCI services. However, the decisions made by the elderly on the types of services to use within the LTCI system are sometimes influenced by their families. The system has some problems regarding the lack of support that is provided to the elderly with respect to their access, choice and use of the LTCI services. Often, care managers cannot devote enough time to the care management process. As a result, important elements of care management, such as conducting home visits to assess users’ conditions, monitoring the care that is received by users, and meeting with other service providers to discuss adequacy of care, are sometimes lacking. Private companies have promoted the quality and efficiency of the home care and long-term care market. The total amount of yearly medical expenses for elderly people in Japan has decreased following the implementation of the LTCI system, compared with that prior to the initiation of the system. LTCI premiums differ among municipalities. The questionnaire that has been used to assess the care requirements of the elderly was deficient in some areas of health. However, in 2003, some amendments were made to this questionnaire in an attempt to address these deficiencies. Furthermore, the LTCI system should have relieved some of the burden on the elderly patient’s family; however, since the implementation of the LTCI, its impact on the burden on the family has not been addressed sufficiently.Although there have been amendments to the system, several challenges of the LTCI system must be considered:ensuring the future financing of LTCI services is met;providing countermeasures to promote the use of home-care services and to alleviate the care burden to family caregivers;providing adequate support and advocacy of rights and decision-making for the elderly;providing educational activities to disseminate knowledge about LTCI programs; andensuring the availability of activities to promote health for the elderly and to prevent them from becoming bedridden.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

Predictive modeling in healthcare has been gaining more interest and utilization in recent years. The tools for doing this have become more sophisticated with increasingly higher accuracy. We present a case study of how artificial intelligence (AI) can be used for a high quality predictive modeling process, and how this process is used to improve the quality and efficiency of healthcare. In this case study, MEDai, Inc. provides the analytical tools for the predictive modeling, and Sentara Healthcare uses these predictions to determine which members can be helped the most by actively looking for ways to prevent future severe outcomes. Most predictive methodologies implement rule-based systems or regression techniques. There are many pitfalls of these techniques when applied to medical data, where many variables and many interactive variable combinations exist necessitating modeling with AI. When comparing the R2statistic (the commonly accepted measurement of how accurate a predictive model is) of traditional techniques versus AI techniques, the resulting accuracy more than doubles. The cited publications show a range of raw R2values from 0.10 to 0.15. In contrast, the R2value obtained from AI techniques implemented at Sentara is 0.34. Once the predictions are generated, data are displayed and analytical programs utilized for data mining and analysis. With this tool, it is possible to examine sub-groups of the data, or data mine to the member level. Risk factors can be determined and individual members/member groups can be analyzed to help make the decisions of what changes can be made to improve the level of medical care that people receive.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

The heightened awareness of substantial racial and ethnic disparities in health outcomes has major implications for how healthcare providers effectively manage health conditions among diverse populations. This report identifies five dimensions that address the major causes of disparities that can exert significant influence over the success and quality of the patient-physician relationship, treatment plans, and health outcomes. These five dimensions arebiological and genetic influences;differential access to care;quality of care disparities;clinical-patient perceptions and realities; andlanguage and communication barriers.Recommended disease management actions for health practitioners and healthcare organizations focus on promoting more effective interactions between both the patient and the physician in the clinical encounter, methods for improving patient understanding, and education and information to improve treatment adherence and outcome. Educational strategies include: adapting existing protocols in the clinical setting; using communities, the internet and other sources of information; recognizing the importance of racial and ethnic concordance; and assuring competent communication and interpretation in the clinical encounter. Governments also perform several critical functions in addressing racial and ethnic disparities, such as setting the tone and offering leadership, guidance and support for practitioners and their healthcare settings.Ultimately, effective disease management will require practitioners, as well as healthcare organizations and agencies to integrate knowledge and actions around the multiple causes of ethnic and racial disparities into clinical regimens through training, on-site services and resource development.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

Acute coronary syndromes (ACS) comprising acute myocardial infarction and unstable angina pectoris are prevalent causes for patient admission to hospital. Research has disclosed variations in the quality of in-hospital care of such patients as measured by levels of adherence to evidence-based management recommendations. This review aimed to identify:the patient characteristics and system of care factors which reliably predict an increased likelihood of suboptimal care; andeffective strategies for optimizing care.A systematic review was undertaken of studies that evaluated the relationship between predictor-of-quality variables (patient or hospital characteristic or quality improvement intervention [QII]) and care processes and/or outcomes.With regards to patient characteristics, increasing age and the co-existence of diabetes mellitus, renal disease, chronic obstructive lung disease, major mental health disorders, and significant co-morbidity burden were associated with underuse of effective therapies, as was the presence of congestive heart failure as a complication of ACS and the absence of chest pain as presenting symptom. Studies of sex-, race- or socioeconomically-related differences in care yielded inconsistent results.In terms of system of care factors, risk-adjusted studies suggested that there was no relationship between quality of care and the specialty of the admitting clinician (cardiologist versus non-cardiologist). However, the admission to tertiary, urban or high volume hospitals predicted higher-quality care compared with admissions to non-tertiary, rural, or low volume hospitals, while the presence or absence of on-site invasive facilities was not a reliable predictor. No consistent differences in quality were noted between managed care and fee-for-service arrangements, or between Veterans Health Administration and Medicare funding systems.The determination of effectiveness of QIIs is constrained by a paucity of rigorous evidence. The most effective interventions appear to be multifaceted, guideline-based quality improvement programs led by clinician leaders that target multiple key care processes and include repeated performance feedback. Single interventions that appear useful include clinical pathways in emergency departments and coronary care units, nurse-mediated thrombolysis protocols, clinical pharmacist-mediated academic detailing, checklist-based patient feedback to clinicians, and system re-design based on process analysis. The impact on quality of nationally released practice guidelines published by professional organizations was minimal in the absence of localized methods of implementation.Certain patient and system of care factors predispose patients to receive suboptimal care which, if known to the individual clinician, allows for greater vigilance of personal practice when he or she is confronted with such circumstances. For professional groups and health institutions, this information when combined with knowledge of effective strategies for improving care provides opportunities for optimizing both clinical care and patient outcomes.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS

摘要:

ObjectiveTo evaluate the relationship between adherence to antidepressant therapy and economic outcomes.DesignRetrospective database analysis using pharmacy and medical claims from a pharmacy benefit and medical management company serving a large managed care organization (MCO) that provides healthcare coverage for approximately 3.5 million members.ParticipantsPatient selection was based on the following criteria:newly started on antidepressant therapy between 1 April 1999 through 30 June 1999;titrated to a usual antidepressant dosage level within 6 months of the initiation of therapy;continuously enrolled in the health plan between 1 January 1999 through 31 December 1999; and>18 years of age.Outcome measuresAntidepressant adherence was calculated as a ratio of the total number of day’s supply during the 180-day follow-up period divided by 180 days. Patients were defined as adhering to treatment if they had a ratio of ≥0.70. The means of pharmacy ingredient costs, medical charges and total healthcare charges incurred during the follow-up period were compared. Adjusted means (least squares means) were calculated after adjusting for potential confounding factors that may have influenced relevant outcomes.ResultsOf the total cohort (14 190 patients), 39.7% (n = 5638) of patients were deemed to be adhering (≥70.0% completion) to their treatment. Adherent patients were significantly more advanced in age (55.2 vs 54.3 years, p < 0.01) and had a higher mean Chronic Disease Score (3.80 vs 3.47, p < 0.0001). After adjusting for confounding factors, adherent patients incurred lower total healthcare charges ($US11 327 vs $US11 815, p = 0.433) significantly lower medical charges ($US9411 vs $US10 692, p = 0.039) and significantly higher pharmacy charges ($US1915 vs $US1123, p < 0.0001) than non-adherent patients during the initial 6 months of therapy (all 1999 values).ConclusionIn this MCO, patients who were adherent with antidepressant therapy possessed significantly lower medical charges. These findings indicate that patient adherence with antidepressant therapy significantly improved the economic outcomes. It is suggested that there is a need for raising awareness about the importance of patient adherence as well as to improve methods of detecting individuals with depression in order to gain the economic benefits associated with adherence.

ISSN:1173-8790    

出版商:ADIS    

年代:2003

数据来源: ADIS