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31	The Effect Of Physician Ownership On Quality Of Care For Outpatient Procedures Liu, Xinliang 06 November 2012 (has links) Ambulatory surgery centers (ASCs) play an important role in providing surgical and diagnostic services in an outpatient setting. They can be owned by physicians who staff them. Previous studies focused on patient “cherry picking” and over-utilization of services due to physician ownership. Few studies examined the relationship between physician ownership and quality of care. Using a retrospective cohort of patients who underwent colonoscopy, this study examined the effect of physician ownership of ASCs on the occurrence of adverse events after outpatient colonoscopy. Agency theory is used to as a conceptual framework. Depending on the extent to which consumers are able to assess quality of care differences across health care settings, physician ownership can function as a mechanism to improve quality or as a deterrent to quality. Four adverse event measures are used in this study: same day ED visit or hospitalization, 30-day serious gastrointestinal events resulting in ED visit or hospitalization, 30-day other gastrointestinal events resulting in ED visit or hospitalization, and 30-day non-gastrointestinal events resulting in ED visit or hospitalization. Physician ownership status is determined based on a court decision in California in 2007. Data sources include the State Ambulatory Surgery Databases (SASD), State Inpatient Databases (SID), Emergency Department Databases (SEDD), State Utilization Data Files, the Area Resource File (ARF), and HMO/PPO data from Health Leaders. After controlling for confounding factors, the study found that colonoscopy patients treated at a physician-owned ASC had similar odds of experiencing same day ED visit or hospitalization and 30-day non-gastrointestinal events resulting in ED visit or hospitalization as those treated in a hospital-based outpatient facility. But the former had significantly higher odds of experiencing 30-day serious gastrointestinal events and 30-day other gastrointestinal events resulting in ED visit or hospitalization. The results are robust to changes in propensity score adjustment approach and to the inclusion of a lagged quality indicator. They suggest that physician ownership of ASCs was not associated with better quality of care for colonoscopy patients. As more complex procedures are shifted from hospital-based outpatient facilities to ASCs, expanded efforts to monitor and report quality of care will be worthwhile. Ambulatory surgery centers Hospital-based outpatient facility Physician ownership Colonoscopy Outpatient surgery Quality of care Patient outcomes California Medicine and Health Sciences
32	Implementación de una clínica de cirugía de día en el distrito de Los Olivos / Implementation of a day surgery clinic in the district of Los Olivos Cuba Díaz, Liliana Melchorita, Ochoa Cholán, Verónica Isidora 24 August 2021 (has links) La Cirugía de Día, tiene múltiples ventajas como lograr una mejor programación quirúrgica, los pacientes retornan precozmente a sus actividades habituales, disminuye los costos en salud, manteniendo la calidad de atención y la seguridad para los pacientes. Antes de la Pandemia por COVID ya existía una lista de Espera Quirúrgica (LEQ) prolongada no gestionadas en hospitales públicos y ahora por la Pandemia la LEQ se ha prolongado más, motivo por el cual los pacientes acuden a centros privados por temor a contagiarse por COVID y además para evitar complicaciones derivadas de la postergación de cirugía. Siendo esta nuestra ventana de oportunidad, la “Implementación de una clínica de cirugía de día en el distrito de Los Olivos”, cuya propuesta de valor es “Ofrecer una Gestión Integral para el Servicio de Cirugía de Día y Procedimientos de forma Eficaz, Segura y de Calidad Superior a través de Paquetes Quirúrgicos en el Distrito de Los Olivos en el horario de 12 h por 365 días”, asegurando el alta el mismo día. Hemos realizado un análisis exhaustivo de la rentabilidad, bajo un escenario conservador de la demanda estimada al 50% en los primeros 4 años, luego al 70% los siguientes 4 años y en los últimos dos años se estimó alcanzar el 90% de capacidad instalada máxima, obteniéndose un VAN (Valor Actual Neto) de 24.7 millones de soles y una TIR (Tasa Interna de Retorno) de 33% al décimo año, por lo mencionado nuestro proyecto es viable. / Day Surgery has multiple advantages such as achieving a better surgical schedule, patients returning to their usual activities early, reducing health costs, maintaining quality of care and safety for patients. Before the COVID Pandemic, there was already a prolonged Surgical Waiting List (LEQ) not managed in public hospitals and now, due to the Pandemic, the LEQ has been extended more, which is why patients go to private centers for fear of being infected by COVID and also to avoid complications derived from postponement of surgery. This being our window of opportunity, the " Implementation of a day surgery clinic in the district of Los Olivos", whose value proposition is "Offer a Comprehensive Management for the Service of Day Surgery and Procedures in an Efficient, Safe and of Superior Quality through Surgical Packages in the Los Olivos District from 12 noon for 365 days”, ensuring discharge the same day. We have carried out an exhaustive analysis of profitability, under a conservative scenario of demand estimated at 50% in the first 4 years, then at 70% in the next 4 years and in the last two years it was estimated to reach 90% of maximum installed capacity, obtaining a NPV (Net Present Value) of 24.7 million soles and an IRR (Internal Rate of Return) of 33% in the tenth year, therefore our project is viable. / Trabajo de investigación Cirugía ambulatoria Cirugía Plan de negocio Gestión integral Ambulatory surgery Surgery Business plan Integral management
33	Postoperativt förlopp efter dagkirurgisk ljumskbråcksoperation- uppföljningssamtal som grund för kvalitetsutveckling Degaardt, Maria, Rubensson, Monica January 2010 (has links) Degaardt, M & Rubensson, M. Postoperativt förlopp efter dagkirurgiskljumskbråcksoperation. Uppföljningssamtal som grund för kvalitetsutveckling.Examensarbete i omvårdnad 15 högskolepoäng. Malmö högskola: Hälsa ochsamhälle, Utbildningsområde omvårdnad, 2010.Syftet med denna studie var att göra en bedömning av den postoperativa förloppeti hemmet hos dagkirurgiska ljumskbråcksopererade patienter. Data insamlademed hjälp av högstrukturerade telefonintervjuer. En enkät med standardiseradefrågor och ikryssbara svarsalternativ som kommer har använts vidtelefonintervjuerna. Resultaten från de 52 intervjuerna visade att de flestapatienter inte överskred Numerical Rating Scale (NRS) 3 i vila eller rörelse dagett. På dag tre hade de flesta mer smärta vid rörelse än dag ett. De flestapatienterna följde ordinationen de fick av läkaren avseende smärtstillandetabletter. Generellt sett visade studien på få postoperativa komplikationer och högtillfredsställelse ur operationssynpunkt hos patienterna. / Degaardt, M. & Rubensson, M. Post-operative progress after one-day surgicalinguinal hernia operation. Follow-up interviews as a means for qualitydevelopment. Degree project in nursing, 15 credit points. Malmö University:Faculty of health and society, Department of nursing, 2010.The purpose of this study was to evaluate the post-operative progress for one-daysurgical inguinal hernia patients. Data was collected using structured telephoneinterviews three days after surgery. A questionnaire with standardized questionsand multiple-choice response opions was used. The results from the 52 interviewsshowed that most patients did not exceed Numerical Rating Scale (NRS) 3 dayone when at rest or moving around. On day three most patients had more painwhile moving than day 1. Most patients complied with the doctor’s prescription ofpainkillers. Generally the follow-up study showed the patients had fewcomplications and felt high satisfaction post surgery. Ambulatory surgery Follow up studies Inguinal hernia operation post-operative pain dagkirurgi uppföljningssamtal laparoskopisk ljumskbråcksoperation postoperativ smärta telefonintervjuer Social Sciences Samhällsvetenskap
34	Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital Lucas, D. Pulane 24 April 2013 (has links) Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs. Disruptive Disruptive Innovation Theory Disruptive Transformations Disruptive Innovation Innovation Technology Technological Innovation Medical Innovation Medical Technology Medical Advancement Laparoscopy Laparoscopic Surgery open surgery appendectomy cholecystectomy bariatric surgery weight loss surgery appendectomies cholecystectomies inpatient outpatient ambulatory ambulatory surgery ambulatory surgery center acute care general hospital hospital acute care hospital general hospital health care healthcare hospital industry health care industry Clayton Christensen Clayton M Christensen Michael Porter Harvard Business School Virginia Commonwealth University CMS Health policy public policy public administration organizational theory organization theory Population Ecology Theory Competitive Strategy policy analysis John Kimberly Organization Size Structural Inertia liability of smallness health spending health care cost specialty medical facility open system niche width dynamic outpatient department technology shift surgical setting surgical setting shift medical facility shift substitution threat health system system level analysis Ecological Approach hospital trends ambulatory surgery trends reimbursement rate Medicare CMS coverage decision P J DiMaggio DiMaggio and Powell w w Powell Hannan and Freeman M T Hannan Organizational change minimally invasive surgery less invasive surgery Prospective Payment System Outpatient Prospective Payment System entreprenuerial physician health care organization health care management Roice Luke Carl Ameringer new technology surgical utilization elective surgery Medicare Payment Advisory Commission MedPAC coverage decision trends in surgery abdominal surgery surgical variation physician-owned physician ownership physician autonomy outpatient clinic utilization trends unnecessary surgery Pfeffer Salancik technology diffusion redefining health care interdisciplinary research health care delivery panel design diffusion of hospital technology state variation regional variation local health care market government intervention medical facility health care capacity focused factory advances in health care physician organization relationship hospital competition medical specialization hospital expansion medical arms race integrated care integrated health system J E Wennberg health care transformation reimbursement scheme surgical volume Florida Wisconsin policy making health policy analysis competitive dynamics center of excellence intervening factor service line competition service-line competition surgical reimbursement innovative business model innovative technology environmental influence established firm new market entrant patient safety sophisticated technology Harvard Divinity School Social and Behavioral Sciences

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