Henry O’Lawrence and Rohan Chowlkar
The purpose of this paper is to determine the cost effectiveness of palliative care on patients in a home health and hospice setting. Secondary data set was utilized to test the…
Abstract
Purpose
The purpose of this paper is to determine the cost effectiveness of palliative care on patients in a home health and hospice setting. Secondary data set was utilized to test the hypotheses of this study. Home health care and hospice care services have the potential to avert hospital admissions in patients requiring palliative care, which significantly affects medicare spending. With the aging population, it has become evident that demand of palliative care will increase four-fold. It was determined that current spending on end-of-life care is radically emptying medicare funds and fiscally weakening numerous families who have patients under palliative care during life-threatening illnesses. The study found that a majority of people registering for palliative and hospice care settings are above the age group of 55 years old.
Design/methodology/approach
Different variables like length of stay, mode of payment and disease diagnosis were used to filter the available data set. Secondary data were utilized to test the hypothesis of this study. There are very few studies on hospice and palliative care services and no study focuses on the cost associated with this care. Since a very large number of the USA, population is turning 65 and over, it is very important to analyze the cost of care for palliative and hospice care. For the purpose of this analysis, data were utilized from the National Home and Hospice Care Survey (NHHCS), which has been conducted periodically by the Centers for Disease Control and Prevention’s National Center for Health Statistics. Descriptive statistics, χ2 tests and t-tests were used to test for statistical significance at the p<0.05 level.
Findings
The Statistical Package for Social Sciences (SPSS) was utilized for this result. H1 predicted that patients in the age group of 65 years and up have the highest utilization of home and hospice care. This study examined various demographic variables in hospice and home health care which may help to evaluate the cost of care and the modes of payments. This section of the result presents the descriptive analysis of dependent, independent and covariate variables that provide the overall national estimates on differences in use of home and hospice care in various age groups and sex.
Research limitations/implications
The data set used was from the 2007 NHHCS survey, no data have been collected thereafter, and therefore, gap in data analysis may give inaccurate findings. To compensate for this gap in the data set, recent studies were reviewed which analyzed cost in palliative care in the USA. There has been a lack of evidence to prove the cost savings and improved quality of life in palliative/hospice care. There is a need for new research on the various cost factors affecting palliative care services as well as considering the quality of life. Although, it is evident that palliative care treatment is less expensive as compared to the regular care, since it eliminates the direct hospitalization cost, but there is inadequate research to prove that it improves the quality of life. A detailed research is required considering the additional cost incurred in palliative/hospice care services and a cost-benefit analysis of the same.
Practical implications
While various studies reporting information applicable to the expenses and effect of family caregiving toward the end-of-life were distinguished, none of the previous research discussed this issue as their central focus. Most studies addressed more extensive financial effect of palliative and end-of-life care, including expenses borne by the patients themselves, the medicinal services framework and safety net providers or beneficent/willful suppliers. This shows a significant hole in the current writing.
Social implications
With the aging population, it has become evident that demand of palliative/hospice care will increase four-fold. The NHHCS have stopped keeping track of the palliative care requirements after 2007, which has a negative impact on the growing needs. Cost analysis can only be performed by analyzing existing data. This review has recognized a huge niche in the evidence base with respect to the cost cares of giving care and supporting a relative inside a palliative/hospice care setting.
Originality/value
The study exhibited that cost diminishments in aggressive medications can take care of the expenses of palliative/hospice care services. The issue of evaluating result in such a physically measurable way is complicated by the impalpable nature of large portions of the individual components of outcome. Although physical and mental well-being can be evaluated to a certain degree, it is significantly more difficult to gauge in a quantifiable way, the social and profound measurements of care that help fundamentally to general quality of care.
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Henry O’Lawrence and Michell Poyaoan-Linzaga
The purpose of this paper is to determine the association between patients who talked to their doctor about their risk of falling, or occurrence of balance problem. This study…
Abstract
Purpose
The purpose of this paper is to determine the association between patients who talked to their doctor about their risk of falling, or occurrence of balance problem. This study analyzed a secondary data set based on the Medicare Health Outcomes Survey (HOS) for the Medicare Advantage patients of 65 years and older. This study guided by two hypotheses that: patients who talked to their doctor about falling or balance problem are more likely to have fallen in the past than those who did not talk to their doctor about their fall risk; and patients talking to their doctor about a fall or balance problem are more likely to receive an early intervention such as patient education to prevent a future fall.
Design/methodology/approach
This study utilized a secondary data set to test its hypotheses. The Centers for Medicare and Medicaid Services (CMS) is dedicated to monitoring the quality of care provided to Medicare population in a managed care setting. Inter-University Consortium for Political and Social Research conducts the HOS to measure outcomes of quality improvement interventions developed by CMS in collaboration with the National Committee for Quality Assurance for Medicare Advantage Organizations (MAOs). The measures are focused on assessing the physical functioning and mental health being of Medicare beneficiaries and are aligned with reporting evidence of standards of care. Medicare HOS is administered in each Spring surveying a random sample of Medicare beneficiaries from MAOs that have a minimum of 500 enrollees; the cohort is surveyed again two years later as a follow-up measurement.
Findings
Reporting of a fall or balance problem is a critical component in fall prevention strategies. This study analyzed the distribution of beneficiaries who talked with their doctor about a fall or balance problem to understand if personal disposition (i.e. social class – educational level, gender, and race) would have been a factor in patients communicating with their doctor about their risk factors. The study found that 67.77 percent of patients who talked with their doctor about a fall or balance problem have at least a high school education compared with 32.23 percent who have less than a high school education or GED.
Research limitations/implications
All patients who responded to the survey and fulfilled the inclusion criteria were included in the study. Therefore, the data presented a limitation due to a self-report of no doctor visits, which could indicate inopportunity for provider-patient communication to take place. Additionally, such an information on fall or balance problem, including actual fall occurrence in the past 12 months, was based on self-report that could present inaccuracy since the elderly population tend to have diminished or poor memory, which may also be problematic.
Practical implications
Although this specific interaction starts with patient reporting of a health problem such as a fall or balance problem, provider must take a proactive approach in deploying prevention strategies, such as to conduct a comprehensive fall-risk assessment regardless of a report of a fall history by the patient. Further investigation of this study is recommended to ascertain pre-dispositional factors that affect patient communication, in order to address any barriers that could impede patient-provider collaboration. Nonetheless, enhancing patient-provider communication is fundamental to any quality intervention strategies such as fall prevention.
Social implications
Another key finding in this study is that patient communication facilitates fall prevention. Patients who talked to their doctor about their fall or gait problem were provided with patient education on how to prevent falls by their doctor. The provider is informed on patient’s balance problem, which leads to further evaluation of patient health status in order to identify other related factors since a comprehensive fall-risk assessment would have been likely conducted providing adequate information beyond the fall occurrence. This affirms the need for provider-patient communication to serve as catapult for effective care coordination, which is effectual in any intervention strategies.
Originality/value
Fall prevention is increasingly drawing attention and gaining momentum among healthcare organizations (including non-managed care) since falls and fall-related injuries are easily preventable (Lach et al., 2011). Efforts that can identify and accurately analyze patient health status, including intrinsic and extrinsic risk factors, promote effective interaction between patient and provider. This study has shown the positive effect of patient communication in order to allow doctors to effectively intervene (i.e. prevent a future fall) through the provision of patient education.
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The report recently issued by the joint committee, appointed by various Administrative Counties and County Boroughs in the North of England, to inquire into the subject of milk…
Abstract
The report recently issued by the joint committee, appointed by various Administrative Counties and County Boroughs in the North of England, to inquire into the subject of milk contamination, is an important document to which reference was made in the last number of this journal. Unfortunately little permanent good is likely to result from such reports unless the circumstances which have given rise to the grave faults to which attention is called be dealt with by authority. Such reports are admittedly of great interest. They contain much valuable and important matter, and are full of first‐hand and reliable evidence collected by experts at the expenditure of much time and trouble. As a general rule, however, they are too technical in their wording to appeal directly either to the general public or to the ordinary milk dealer. Still, the bearing of the matters they refer to on the every‐day life and health of the nation is so great that they should not be allowed to sink into oblivion by failure to bring their essential features before the wider public to which they are in tended to appeal. On these grounds the suggestion contained in the report that a pamphlet, should he issued containing the results of the committee's investigations is an excellent one. The means that are taken from time to time to rouse public interest in the important and allied questions of meat and milk are unfortunately characterised by their spasmodic, if vigorous, nature. The agitation dies down after a time and is not renewed until perhaps the original question again rises in a sufficiently acute form. The work has then to be done over again. It is necessary to bring home to the public the importance of, say, a pure milk supply, but to produce a permanent impression it is needful to proceed by an educational process and not by one that is based on unorganised agitation. The methods pursued in the United States in relation to food questions are not always to be commended, but in relation to the educational methods to which reference has just been made we may usefully consider the means adopted by the State authorities of the Republic. They are in the first place nothing if not practical. There, as here, the greatest hope of a would‐be reformer lies in his being able to rouse up public opinion. Hence we find questions such as these are kept steadily to the front by the authorities, by means of official publications and the public press, with the avowed object of enlisting the trade on the side of the law to aid in keeping food products up to reasonable standards of quality. In a report recently issued by the State Agricultural Station of Kentucky dealing with the question of the milk supplied to the town of Louisville it is said that the result of inquiries instituted by the station showed “the large majority of dairymen to be anxious to co‐operate with the officials in the enforcement of all fair regulations; that they need help in an educational way and are eager for any practical information which will help them to better their plants; that to accomplish this both the State and the city should maintain, not at the dairyman's expense, sufficient experts in dairying science, and veterinarians to constantly inspect the districts, helping wherever possible, not only pointing out deficiencies, but suggesting remedies, and, finally, reporting for prosecution or withdrawing the permit of the dairyman not complying with the regulations necessary to produce wholesome milk.” What is said in this report might equally well apply to affairs on this side of the water as regards the milk supply. The authorities in Kentucky have had exactly the same problems to face and deal with as those referred to in the report of the Joint Committee. The same want of attention to cleanliness, to light, ventilation, and drainage in the cowshed; the same unpleasant methods of dealing with the milk during the process of transport; and the same want of cleanliness in the shop characterised many of the small and large dealers in Kentucky as in this country. For all that we cannot assume the milk dealer or cowkeeper to be invariably in the wrong through malice aforethought. The Kentucky report just quoted states that the time and money spent in telling the cowkeeper and dairyman not to do this or that would be in many cases better spent by showing him how to do things. “Most dairymen would be willing to make improvements if they knew exactly how to go about it.” It appears that three‐fourths of the dairymen who supply Louisville with milk are co‐operating with the health authorities in the task of “cleaning up.” We must not assume that the British cowkeeper or dairyman is less willing to do the right thing than is his American confrére. The position of such an institution as a State Experiment Station is probably peculiar to the United States. It is in intimate touch with the requirements of every farmer in the State. It deals with all problems relating to the rearing and diseases of cattle, their housing, food and treatment; with the products of the dairy, farm, and stockyard. It is consulted by farmers on all conceivable subjects affecting their business at all times. The interests of the station do not end here. Not only is it concerned with the cattle and their products as such, but the Experiment Station is authorised by the legislature to concern itself with the distribution and sale of all dairy produce including, of course, milk and allied substances, with the hygienic and veterinary inspection of buildings and cattle, as well as with the conditions prevailing in dairies and milkshops. Moreover, the inspection of food products of all kinds and their analysis under the Pure Food Law of the State is frequently placed by the State in the hands of the experts attached to the Experiment Station. Under these circumstances such an institution is exceptionally well qualified to judge the requirements or faults of any process or institution affecting the food supply. In the case under review the Experiment Station sent round a circular letter to all cowkeepers and dairymen concerned, pointing out what it proposed to do, and asking for comments and suggestions. The object, in fact, was to make all farmers and dairymen feel that in the authorities of the Experiment Station they had to deal with a friendly body and not one whose desire was merely to catch them tripping. This they have apparently succeeded in doing, and with good results. The position of affairs in this country seems rather to suggest that public authorities and the milk trade occupy two hostile camps, and if this be so the fact is regrettable.
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Western countries have invested considerable resources in efforts aimed at reducing the amount of cigarette smoking in their countries, along with its accompanying hazards. Canada…
Abstract
Western countries have invested considerable resources in efforts aimed at reducing the amount of cigarette smoking in their countries, along with its accompanying hazards. Canada is no exception to this challenge and takes pride in its participation in the global quest:
Sane and civilised people, capable of thinking clearly, now recognise that if the peace of the world is to be secured, and that if another and even greater cataclysm is to be…
Abstract
Sane and civilised people, capable of thinking clearly, now recognise that if the peace of the world is to be secured, and that if another and even greater cataclysm is to be prevented, the Huns and their accomplices must be crushed, and crushed so completely that their recovery of the power to do evil shall be rendered utterly impossible. The persons who are “Pro‐German” for reasons at present best known to themselves, and the peace‐at‐any‐price cranks, may be left out of consideration except in so far as the advisability of placing the former under lock and key and the latter in lunatic asylums demands attention. A premature and inconclusive peace which would make it possible for our abominable enemies to rise again and threaten civilised mankind is unthinkable, and the Allied Powers must of necessity carry on the war until the Thugs of Europe have bitten the dust and have been compelled to sue for peace without terms or conditions. When the “Central Powers” have been forced to their knees, and the Allied armies of occupation have made them taste the bitterness and humiliation of invasion, the surviving criminals will be placed at the bar to receive the sentence of their judges, while the populations who have approved and applauded their hideous acts must also have adequate punishment meted out to them. What form is that punishment to take? The long and ghastly account has got to be read out and settled—so far as it can be settled in this world. What is to be the settlement?
Mary C. Johnsson, Matthew Pepper, Oriana Milani Price and Lauren P. Richardson
Measurement practices have long been considered vital for informing the management of performance in organisations. Their application to local governments is a more recent, yet…
Abstract
Purpose
Measurement practices have long been considered vital for informing the management of performance in organisations. Their application to local governments is a more recent, yet multi-decade phenomenon facilitated by New Public Management trends. This paper aims to review the landscape of publications that discuss performance measurement (PM) practices in Australian and New Zealand local government contexts and identify implications for future research.
Design/methodology/approach
A systematic review methodology was used to identify a shortlist of publications. Next, a rating-based researcher appraisal process was applied. Multiple iterations of search and appraisal were conducted to form the basis for inductive thematic analysis and synthesis.
Findings
Analysing 65 PM publications, two interrelated themes, namely, discourses of performance as efficiency, accountability or strategic growth and change were identified, which influence the adoption of local PM tools and frameworks. As demands for strategic growth and more complex service delivery increase, strategic and localised adaptation of PMs may be required to integrate learning and communicative competencies with technical and operational capabilities.
Research limitations/implications
The systematic review methodology has been applied to address some of the limitations of publication and reporting biases in literature. This research provides a starting point for future investigations and broadening of discourse in local government contexts.
Originality/value
This paper represents the first systematic review of 1995–2020 publications on performance management practices used by local governments in Australia and New Zealand.
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Patient empowerment (PE) is a key public health policy tool globally which is seen as unproblematic, but contains a number of unwarranted assumptions and unrecognised challenges…
Abstract
Purpose
Patient empowerment (PE) is a key public health policy tool globally which is seen as unproblematic, but contains a number of unwarranted assumptions and unrecognised challenges to achieving effective implementation. Further, the theoretical foundations for understanding the impact of persuasive health communications on PE are weak. The purpose of this paper is to review these factors and to highlight major areas of concern.
Design/methodology/approach
First, the assumptions underpinning empowerment and the implicit theoretical foundations for active health information seeking behaviours are reviewed. This is then followed by a readability analysis of internet-based material relating to two general medical conditions, four chronic medical conditions and six patient information leaflets which was conducted to explore issues relation to the provision and readability of online health information.
Findings
The assumptions underpinning expectations of policy makers and health organisations regarding active health information seeking are shown to be problematic, with several potential impediments to effective PE implementation, including the fact that almost all of the online material reviewed is written in language too complex for the majority of the general public to comprehend, let alone act on.
Practical implications
Recommendations are made for guiding information seeking and a research agenda is outlined that would aid in strengthening theoretical underpinnings, expand knowledge and thereby help inform practice and policy debate regarding how PE can be improved.
Originality/value
This paper contributes to understanding of the challenges of effective health communication in the digital age by highlighting the need for a greater understanding of online health information seeking and the impact of limited health literacy and numeracy.