Copyright (c) 2013 Purdue University All rights reserved. http://docs.lib.purdue.edu/rche_rp Recent documents in RCHE Publications en-us Mon, 11 Feb 2013 10:41:12 PST 3600 http://docs.lib.purdue.edu/rche_rp/57 http://docs.lib.purdue.edu/rche_rp/57 Thu, 25 Sep 2008 12:36:41 PDT Few would dispute that the rapidly escalating cost of health care is one of the most pressing issues facing our nation today. Even a cursory review of the media reveals intense public concern over a healthcare system that can use the most advanced technology to miraculous therapeutic effect, but whose emergent behavior is far from ideal. Rapidly rising healthcare costs threaten the competitiveness of U. S. manufacturing and service companies in the global econmy, creating intense pressure to move offshore. Indeed one can make the case that the best way to help competitiveness prospects for U. S. industries as a whole is to improve healthcare delivery.

]]> Stephen Roberts et al. http://docs.lib.purdue.edu/rche_rp/55 http://docs.lib.purdue.edu/rche_rp/55 Wed, 20 Aug 2008 04:54:18 PDT This paper uses economic modeling to examine the controversial role that Group Purchasing Organizations (GPOs) play in the supply chains for healthcare products. Among the controversies, perhaps the most fundamental one is whether or not GPO-contracted prices are the lowest available. However, the fiercest controversy is around the "Contract Administration Fees (CAFs)" that GPOs charge to manufacturers. We examine these and other controversies using a Hotelling duopoly model.

]]> Qiaohai Hu et al. http://docs.lib.purdue.edu/rche_rp/54 http://docs.lib.purdue.edu/rche_rp/54 Fri, 01 Aug 2008 04:35:54 PDT To determine the cognitive and functional consequences of dual use of cholinesterase inhibitors (ChIs) and the bladder anticholinergics oxybutynin or tolterodine.

]]> Kaycee M. Sink et al. http://docs.lib.purdue.edu/rche_rp/53 http://docs.lib.purdue.edu/rche_rp/53 Fri, 01 Aug 2008 04:35:50 PDT Medicaid waiver home and community-based long-term care services (HCBS) may provide a partial solution to the escalating costs of long-term care. Persons with dementia can have complex caregiving needs; it is unknown whether their expenditures and resource utilization differ between community-based versus institutional settings.

]]> Laura P. Sands et al. http://docs.lib.purdue.edu/rche_rp/52 http://docs.lib.purdue.edu/rche_rp/52 Thu, 31 Jul 2008 13:12:44 PDT This study estimated the prevalence of diagnosed dementia among Indiana Medicaid beneficiaries in 2004. The dependence of prevalence estimates upon use of several patient selection criteria to identify patients with dementia also was evaluated.

]]> Murtuza F. Bharmal et al. http://docs.lib.purdue.edu/rche_rp/51 http://docs.lib.purdue.edu/rche_rp/51 Mon, 14 Jul 2008 08:03:19 PDT Significant concerns exist over the ability of the healthcare and public health systems to meet the surge demands that would result from an event such as an influenza pandemic. Current guidance for public health planners is largely based on expert opinion and may lack connection to the problems of street-level public health practice. To identify the problems of local planners and prepare a state-level planning template for increasing health care surge capacity that accounted for these issues,a study was conducted of local pandemic planning efforts in thirteen counties, finding that cognitive biases, coordination problems, institutional structures in the healthcare system, and resource shortfalls are significant barriers to preparing and implementing a surge capacity plan. In addition, local planners identify patient demand management through triage and education efforts as a viable means of ensuring adequate capacity, in contrast to guidance proposing an increased supply of care as a primary tool.

]]> George H. Avery et al. http://docs.lib.purdue.edu/rche_rp/50 http://docs.lib.purdue.edu/rche_rp/50 Mon, 30 Jun 2008 13:02:28 PDT Nurses are the primary hospital caregivers. Increasing the efficiency and effectiveness of nursing care is essential to hospital function and the delivery of safe patient care.

]]> Ann Hendrich et al. http://docs.lib.purdue.edu/rche_rp/49 http://docs.lib.purdue.edu/rche_rp/49 Tue, 17 Jun 2008 08:37:06 PDT On May 2-3, 2006, Purdue University, BlueCross BlueShield Association, and WellPoint, Inc. hosted 24 CEO-level healthcare executives representing a diverse cross section of the healthcare supply chain to design the U.S. healthcare-delivery system for the next generation. Participants were challenged to envision the ideal system for the future, without regard to the constraints of today’s technologies, infrastructure, or financial systems. The Regenstrief Center for Healthcare Engineering at Purdue University was tasked to present the summit discussion in the form of a white paper that represents the view of the summit participants.

]]> http://docs.lib.purdue.edu/rche_rp/48 http://docs.lib.purdue.edu/rche_rp/48 Fri, 14 Mar 2008 11:32:47 PDT Since the 2000 publication of the Institute of Medicine report, "To Err is Human" the issue of healthcare quality has been one of the foremost issues in healthcare. According to this report, as many as 99,000 preventable deaths occur annually due to medical errors. Most of these are believed to occur as a result of system errors rather than failure of an individual provider.

]]> George H. Avery http://docs.lib.purdue.edu/rche_rp/47 http://docs.lib.purdue.edu/rche_rp/47 Fri, 18 Jan 2008 11:16:26 PST BACKGROUND: In a highly publicized joint report, the National Academy of Engineering and the Institute of Medicine recently recommended the systematic application of systems engineering approaches for reforming our health care delivery system. For this to happen,‎ medical professionals and managers need to understand and appreciate the power that systems engineering concepts and tools can bring to redesigning and improving health care environments and practices.‎ OBJECTIVE: To present and discuss fundamental concepts and tools of systems engineering and important parallels between systems engineering, health services, and implementation research as it pertains to the care of complex patients.‎ DESIGN: An exploratory, qualitative review of systems engineering concepts and overview of ongoing applications of these concepts in the areas of hemodialysis,‎ radiation therapy, and patient flow modeling.‎ RESULTS: In this paper, we describe systems engineering as the process of identifying the system of interest,‎ choosing appropriate performance measures, selecting the best modeling tool, studying model properties and behavior under a variety of scenarios, and making design and operational decisions for implementation.‎

]]> Renata Kopach-Konrad MSc et al. http://docs.lib.purdue.edu/rche_rp/46 http://docs.lib.purdue.edu/rche_rp/46 Sat, 29 Sep 2007 08:52:53 PDT With start-up funding provided by the Regenstrief Foundation,Purdue University has created the Regenstrief Center for Healthcare Engineering (RCHE) ‎to design, implement and sustain interdisciplinary solutions to improve the safety, ‎quality, efficiency and accessibility of healthcare delivery systems. RCHE’s primary ‎goal is to bring a systems-analysis approach to improving the processes of healthcare ‎delivery, not to provide tools or techniques for medical research, diagnosis, or treatment. ‎This article will describe RCHE’s business model; that is, how RCHE ‘engineers’ ‎interdisciplinary solutions, using the multiple perspectives of healthcare and multiple ‎project time scales to organize and leverage healthcare delivery transformation. We then ‎illustrate the model through the description of projects conducted with RCHE’s ‎‎‘partnerships’ with various healthcare delivery organizations. We conclude with a ‎discussion of future directions for RCHE. ‎

]]> Steve Witz http://docs.lib.purdue.edu/rche_rp/45 http://docs.lib.purdue.edu/rche_rp/45 Mon, 27 Aug 2007 14:56:34 PDT This study examines online health information quality (relevance and clarity) and the perceived value of online health information search (social, utilitarian and epistemic) and how they relate to cunsumers' satisfaction with their online health information search experience. The resulting intention to repeat a health information search over the internet is also included in a conceptual model to illustrate what drives the process.

]]> Lynn Goetzinger et al. http://docs.lib.purdue.edu/rche_rp/44 http://docs.lib.purdue.edu/rche_rp/44 Mon, 27 Aug 2007 14:56:32 PDT The purpose of this reserach ewas to develop a computer simulation model that represents the porcess through which physicians enter orders into a hospital information system(HIS).

]]> James Anderson et al. http://docs.lib.purdue.edu/rche_rp/43 http://docs.lib.purdue.edu/rche_rp/43 Mon, 27 Aug 2007 09:57:24 PDT The purpose of this reserach ewas to develop a computer simulation model that represents the porcess through which physicians enter orders into a hospital information system(HIS).

]]> James Anderson et al. http://docs.lib.purdue.edu/rche_rp/42 http://docs.lib.purdue.edu/rche_rp/42 Mon, 27 Aug 2007 09:44:42 PDT The purpose of this study was (1) to investigate the frequency, type and severity of medication errors in a large midwestern private teaching hospital; (2) to assess the impact of the use of pharmacists to detect and correct medication errors; (3) and to construct a computer simulation model to study the problem of medication errors in a hospital.

]]> James Anderson http://docs.lib.purdue.edu/rche_rp/41 http://docs.lib.purdue.edu/rche_rp/41 Fri, 17 Aug 2007 16:05:26 PDT It is estimated that over three-quarters of a million people are injured or die in hospitals ‎each year from adverse drug events (ADE’s). The majority of medical errors result form ‎poorly designed healthcare systems rather than from negligence on the part of healthcare ‎providers. In general, healthcare systems rely on voluntary reporting, which seriously ‎underestimates the number of medication errors and ADE’s by as much as 90%. This ‎paper reviews the causes and impact of medication errors and ADE's. It also reports ‎studies that have used information technology (IT) to detect and prevent medication ‎errors and ADE’s. Significant reduction of medication errors and ADE’s requires ‎systemic implementation of IT, improvements in the reporting of errors, and integration ‎of the components of the healthcare systems’ information systems. At the present time, ‎most healthcare systems should be able to use IT to detect and prevent ADE’s. ‎

]]> James G. Anderson http://docs.lib.purdue.edu/rche_rp/40 http://docs.lib.purdue.edu/rche_rp/40 Fri, 17 Aug 2007 16:05:24 PDT This study describes a computer model that has beed developed to explore organizational changes required to improve patient safety based on a medication error reporting system.

]]> James G. Anderson http://docs.lib.purdue.edu/rche_rp/39 http://docs.lib.purdue.edu/rche_rp/39 Fri, 17 Aug 2007 16:05:22 PDT Background: The annual cost of morbidity and mortality due to medication errors‎ in the U.S. has been estimated at $76.6 billion. Information technology implemented systematically has the potential to significantly reduce medication errors that result in adverse drug events ‎(ADEs).‎ Objective: To develop a computer simulation model that can be used to evaluate the effectiveness‎ of information technology applications designed to detect and prevent medication errors that result in adverse drug effects.‎ Methods: A computer simulation model was constructed representing the medication delivery‎ system in a hospital. STELLA, a continuous simulation software package, was used to construct the model. Parameters of the model were estimated from a study of prescription errors on two hospital medical/surgical units and used in the baseline simulation. Five prevention strategies were simulated based on information obtained from the literature.‎ Results: The model simulates the four stages of the medication delivery system: prescribing, transcribing,‎ dispensing, and administering drugs. We simulated interventions that have been demonstrated in prior studies to decrease error rates. The results suggest that an integrated medication delivery system can save up to 1,226 days of excess hospitalization and $1.4 million in associated costs annually in a large hospital. The results of the analyses regarding the effects of the interventions‎ on the additional hospital costs associated with ADEs are somewhat sensitive to the distribution of errors in the hospital, more sensitive to the costs of an ADE, and most sensitive to the proportion of medication errors resulting in ADEs.‎ Conclusions: The results suggest that clinical information systems are potentially a cost-effective means of preventing ADEs in hospitals and demonstrate the importance of viewing medication errors from a systems perspective. Prevention efforts that focus on a single stage of the process had limited impact on the overall error rate. This study suggests that system-wide changes to the medication delivery system are required to drastically reduce mediation errors that may result in ADEs in a hospital setting.‎

]]> James G. Anderson et al. http://docs.lib.purdue.edu/rche_rp/38 http://docs.lib.purdue.edu/rche_rp/38 Fri, 17 Aug 2007 15:43:52 PDT Data-sharing systems—where healthcare providers jointly implement a common reporting system to promote voluntary reporting, information sharing, and learning—are emerging as an important regional, statelevel,‎ and national strategy for improving patient safety[1]. Currently, over 24 states have mandated some form of incident reporting. Also, there has been a steady increase in the number of regional coalitions of providers, payers, and employers working to improve patient safety. More recently, the President signed into law the Healthcare Information Exchange Act, which envisages such data sharing at a national level. The objective of this presentation is to review the evidence regarding the effectiveness of these data-sharing systems and to report on the results of an analysis of data from‎ one program.‎

]]> James G. Anderson http://docs.lib.purdue.edu/rche_rp/37 http://docs.lib.purdue.edu/rche_rp/37 Fri, 17 Aug 2007 15:35:19 PDT Data-sharing systems—where healthcare providers jointly implement a common ‎reporting system to promote voluntary reporting, information sharing, and learning—are ‎emerging as an important regional, state-level, and national strategy for improving ‎patient safety. The objective of this chapter is to review the evidence regarding the ‎effectiveness of these data-sharing systems and to report on the results of an analysis of ‎data from the Pittsburgh Regional Healthcare Initiative (PRHI). PRHI consists of 42 ‎hospitals, purchasers and insurers in southwestern Pennsylvania that implemented ‎Medmarx, an on-line medication error reporting systems. Analysis of data from the PRHI ‎hospitals indicated that the number of errors and corrective actions reported initially ‎varied widely with organizational characteristics such as hospital size, JCAHO ‎accreditation score and teaching status. But the subsequent trends in reporting errors ‎and reporting actions were different. Whereas the number of reported errors increased ‎significantly, and at similar rates, across the participating hospitals, the number of ‎corrective actions reported per error remained mostly unchanged over the 12month ‎period. A computer simulation model was developed to explore organizational changes ‎designed to improve patient safety. Four interventions were simulated involving the ‎implementation of computerized physician order entry, decision support systems and a ‎clinical pharmacist on hospital rounds. The results of this study carry implications for the ‎design and assessment of data-sharing systems. Improvements in patient safety require ‎more than voluntary reporting and clinical initiatives. Organizational changes are ‎essential in order to significantly reduce medical errors and adverse events.‎

]]> James G. Anderson