Improving Health in the Community A Role for Performance Monitoring (1997) / Chapter Skim
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A.5 Health Care Resource Allocation
A.5 Health Care Resource Allocation
Pages 262-275
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From page 262... ...
Rather, the United States faces a challenge of how to allocate its resources more efficiently to improve the health of the entire population. Efficiency in health care entails achieving greater value -- improved health status and increased satisfaction for a given expenditure.
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From page 263... ...
From this perspective, the failure to provide childhood immunizations, adequate prenatal care, or appropriate screening for the early diagnosis of cervical cancer would all be evidence of an inefficient allocation of health care resources. A third form of inefficiency is found when one examines differences in expenditures for the performance of specific health carerelated tasks in a defined population (i.e., process inefficiency)
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From page 264... ...
, encompasses measures in several categories, including quality of care for both prevention services and treatment, utilization of services, members' access to and satisfaction with services, and organization and operation of the health plan. Measures, chosen to produce information that promotes quality improvement within health plans, are reviewed and revised on a periodic basis.
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From page 265... ...
Examining the proportion of inpatient deaths that occur in the absence of a completed advance directive acknowledges that hospitals and physicians have an important role in influencing this specific individual behavior. Patients with advance directives are significantly more likely to participate in end-of-life decisions and to limit medical treatment when facing a terminal disease (Weeks et al., 1994)
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Substantial evidence documents the improved outcomes and lower costs that are achieved when patients receive coronary artery bypass graft surgery in high-volume regional centers (Luft et al., 1990; Hannan et al., 1991)
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Healthy People 2000 (USDHHS, 1991) includes an objective calling for 90 percent of the population to be served by a local health department that effectively caries out the core public health functions of assessment, policy development, and assurance.
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A set of 10 public health practices have been used as a basis for developing survey instruments for assessing local health department effectiveness in performing the core functions (Miller et al., 1994; Turnock et al., 1994)
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Existing data from the American Hospital Association and physician organizations such as the American Medical Association (AMA) and the American Osteopathic Association can be used to determine the local supply of beds and physicians, while Medicare data or a state's hospital discharge data set can be used to adjust for border crossing and differences in age and sex across areas.
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Information about prenatal care is available on birth certificates and from vital statistics at the state or local health department.
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From page 271... ...
Again, the local medical community or the AMA is a source of data. The proposed indicator set includes measures of individual behavior (advance directives and smoking)
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1991. Coronary Artery Bypass Surgery: The Relationship between In hospital Mortality Rate and Surgical Volume after Controlling for Clinical Risk Factors.
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1996. A Detailed Description of Physician Services for the Elderly in the United States and Canada.
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TABLE A.5-1 Field Model Mapping for Sample Indicator Set: Health Care Resource Allocation 274 Field Model Domain Construct Sample Indicators Data Sources Disease, See community health profile Use to select benchmark Health and communitiesa Function, Prosperity, Well-being Individual Use of advance directives Percentage of inpatients 65 and over Chart review of selected Behavior who die without an advance directiveb records Health risk behavior Percentage of health plan enrollees Chart review, HEDIS who smoke Physical Inadequate regionalization Number of hospitals with low volume of Statewide hospital discharge Environment of surgery CABG surgery database, Medicare databases Inadequate regionalization Number of infants weighing <1,500 Vital statistics of high-risk care grams born in hospitals without an advanced care nursery Avoidable hospitalizations Number of inpatient hospitalizations Statewide hospital discharge for asthma and diabetes database, hospital records Health Care Underprovision of basic Percentage of births without first Vital statistics, state health services trimester care department Percentage of individuals without BRFSS a usual source of care IMPROVING HEALTH IN THE COMMUNITY
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From page 275... ...
defining brand names that fall within that class, and (3) obtaining computerized pharmacy records for analysis.
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