Interim Realities

Abstract

This paper presents findings from a study of information technology implementation practices in National Health Service hospitals in England. The results suggest that there is a general direction of travel, which involves the progressive linking together of individual systems, so that they are interoperable. We argue that the findings are consistent with meta-governance arguments, but that it is necessary to complement this perspective with an understanding of the nature of information technologies in order to understand them properly. We suggest that ‘interim systems’ will be the reality on the ground for many health care organizations for the foreseeable future.     

Adalimumab,etanercept, and infliximab utilization patterns and drug costs among rheumatoid arthritis patients

Abstract

Objectives:

To evaluate the utilization patterns of the anti-tumor necrosis factor (anti-TNF) agents Humira (adalimumab), Enbrel (etanercept), and Remicade (infliximab) in patients with rheumatoid arthritis (RA) and compare medication costs during the first year of treatment. (Humira is a registered trademark of Abbott Laboratories, IL; Enbrel is a registered trademark of Immunex Corporation, CA; and Remicade is a registered trademark of Janssen Biotech, Inc., PA).

Methods:

This retrospective analysis of medical and pharmacy claims included patients who were aged ≥18 years, had ≥2 RA diagnosis codes, and had ≥365 days of persistence with the index anti-TNF. Patients excluded had claims for anti-TNF agents within 6 months before the index date. Refill patterns for adalimumab and etanercept, number of infliximab infusions, time between infusions, and dose per infusion were analyzed for 12 months. Direct anti-TNF medication costs were compared among anti-TNFs for the initial treatment year.

Results:

Infliximab-treated patients (n?=?457) were significantly older than adalimumab- (n?=?337) or etanercept-treated patients (n?=?902). Time between refills was longer than recommended for 28% and 30% of adalimumab and etanercept refill periods, respectively. Potential cumulative time without therapy was 33 days for adalimumab and 43 days for etanercept. Statistically significant differences in mean per-patient anti-TNF medication costs for the first year were reported for adalimumab, etanercept, and infliximab ($14,991, $13,361, and $18,139, respectively; p?<?0.0001); however, a cost assessment using labeled dosing of the anti-TNF agents with optimal treatment compliance yielded comparable annual medication costs.

Limitations:

This analysis only evaluated utilization patterns for selected anti-TNF agents and was not inclusive of other medications that patients may have been using for RA. Absolute patient adherence could not be assessed due to lack of information on how patients were self-administering adalimumab and etanercept or if samples of the agents were made available.

Conclusions:

This study identified gaps in patients’ refills compared with prescriber recommendations. The infliximab-treated group had infusion patterns consistent with prescribing information. Potential clinical and economic implications of dose attenuation with adalimumab and etanercept should be explored further.     

制度环境约束下的农村合作医疗制度分析

农村合作医疗制度变迁的路径选择以及制度绩效的发挥,除了取决于制度本身的特点之外,在很大程度上也会受到所处的制度环境的影响.对新农村合作医疗制度的评价,不能脱离其所依赖的制度环境.为保证新型农村合作医疗制度能够得到良好的实行效果,除了要对制度本身进行不断的优化设计外,也要注意进一步改善影响制度运行的制度环境因素.     

Comparative analysis of health care costs in Japan and the United States: a simulation of productivity and savings behavior

Japan and the United States, though contrastive in terms of the percentage of the elderly in their population and the ratio of their health care costs to GDP, both face soaring medical expenditures. Sato et al. [Health Care Systems in Japan and the United States: A Simulation Studies and Policy Analysis. Kluwer Academic Publishers, Hingham, MA] developed a model to solve this problem by increasing the productivity of the non-health care sector. This study has applied that model to estimate national savings, and compared these savings with estimated health care costs. The results show that in order for savings to exceed expenditures the US needs to have a higher savings rate and a higher interest rate than Japan.     

浅析输液室观察对腹痛待查的意义

文章从腹痛的知识点和腹痛的观察要点出发,从护理人员的自身查找原因,重视对腹痛待查病人的观察与护理,提高诊疗水平,不延误重症患者的抢救时机。     

浅议如何在企业思想政治工作中加入人文关怀

人文关怀是我国传统文化中的精华,如果能够将人文关怀融入到企业的管理中去,无疑将给企业的管理,尤其是企业的思想政治工作带来新的活力。本文通过分析人文关怀在企业管理中的重要作用,进一步说明如何在企业思想政治工作中融入人文关怀。     

Satisfaction of disabled rural elders and adults with the quality of community‐based long‐term care services

This study estimates the probability of being satisfied with community‐based health care services in a rural area and compares the formation of satisfaction for elders and younger disabled adults. Using data from a state in New England, USA, a multivariate binomial logit model was used to estimate the probability of being satisfied. The formation of satisfaction differs for rural disabled adults and elders. Two out of five need characteristics were found to influence satisfaction with quality of care, and four out of six enabling characteristics were found to influence satisfaction. The impact of these characteristics differs for disabled elders and adults, pointing to the need to differentiate the disabled population when developing systems of home‐based care.     

Efficiency of health care delivery systems: effects of health insurance coverage

Health insurance expansions may increase the demand for care-creating incentives for health systems to increase input consumption. The possibility remains that added capacity and personnel will have little effect on health outcomes, decreasing the technical efficiency of health care delivery systems. We estimate that a 1 percentage point increase in health insurance coverage decreases the technical efficiency of health care delivery by 1.3 percentage points, translating into approximately 50 billion dollars in additional health expenditures. This finding uncovers a previously unexplored consequence of changes in health insurance on the supply side of health care markets suggesting one avenue through which health care costs growth may occur.     

Healthcare costs associated with nephrology care in pre-dialysis chronic kidney disease patients

Abstract

Objective:

To compare the healthcare costs of pre-dialysis chronic kidney disease (CKD) patients cared for in a nephrology clinic setting versus other care settings.

Methods:

An analysis of health claims between 01/2002 and 09/2007 from the Ingenix Impact Database was conducted. Inclusion criteria were ≥18 years of age, ≥1 ICD-9 claim for CKD, and ≥1 estimated glomerular filtration rate (eGFR) value of <60?mL/min/1.73?m². Patients were classified in the nephrology care cohort if they were treated in a nephrology clinic setting at least once during the study period. Univariate and multivariate analyses were conducted to compare average annualized healthcare costs of patients in nephrology care versus other care settings.

Results:

Among the 20,135 patients identified for analysis, 1,547 patients were cared for in a nephrology clinic setting. Nephrology care was associated with lower healthcare costs with an unadjusted cost savings of $3,049 ($11,303 vs. $14,352, p?=?0.0014) and a cost ratio of 0.8:1 relative to other care settings. After adjusting for covariates, nephrology care remained associated with lower costs (adjusted cost savings: $2,742, p?=?0.006).

Limitations:

Key limitations included potential inaccuracies of claims data, the lack of control for patients’ ethnicity in the calculation of eGFR values, and the presence of potential biases due to the observational design of the study.

Conclusions:

The current study demonstrated that pre-dialysis CKD patients treated in nephrology clinics were associated with significantly lower healthcare costs compared with patients treated in other healthcare settings.     

Ownership Sentiments Towards the Customer Care Function in E-Business Situations

ABSTRACT

Effective management of customer care is critically important for successful electronic commerce. The executive in charge of the customer care function in a business based on e-commerce might have a technical IT background, a marketing background, or be from general management. This empirical study examined the degrees to which a sample of 86 marketing and IT managers responsible for customer care in e-commerce environments felt they “owned” the customer care function, and the antecedents and consequences of powerful ownership sentiments. It emerged that heads of department with marketing backgrounds reported significantly stronger feelings of ownership of customer care than heads with IT backgrounds. The level of ownership sentiment varied with respect to the extent of the personal investment a manager had devoted to developing the customer care function, the belief that he or she was an expert in customer care, the person's commitment to the organisation as a whole (rather than to a specific function within it), and the degree of centralisation of the firm's decision making. People who felt strongly that they owned their company's customer care function experienced a heavy sense of responsibility for its effective management. However, the same individuals were more likely to be in conflict with managers of other departments and to resist change.