5 results
Search Results
2. Analytics and Lean Health Care to Address Nurse Care Management Challenges for Inpatients in Emerging Economies.
- Author
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Moreno‐Fergusson, María Elisa, Guerrero Rueda, William Javier, Ortiz Basto, Germán A., Arevalo Sandoval, Indira Alba Lucia, and Sanchez–Herrera, Beatriz
- Subjects
NURSING audit ,HOSPITALS ,MEDICAL quality control ,KEY performance indicators (Management) ,META-analysis ,RESEARCH methodology ,NURSING services administration ,QUANTITATIVE research ,MEDICAL care ,PATIENTS ,ARTIFICIAL intelligence ,MATHEMATICAL variables ,PSYCHOLOGY of nurses ,QUALITY assurance ,EMPLOYEES' workload ,CLINICAL medicine ,QUESTIONNAIRES ,DESCRIPTIVE statistics ,MANAGEMENT ,BARTHEL Index ,ELECTRONIC health records ,NURSE-patient ratio ,NURSING records - Abstract
Purpose: Prescriptive and predictive analytics and artificial intelligence (AI) provide tools to analyze data with objectivity. In this paper, we provide an overview of how these techniques can improve nursing care, and we detail a quantitative model to afford managerial insights about care management in a Hospital in Colombia. Our main purpose is to provide tools to improve key performance indicators for the care management of inpatients which includes the nurse workload. Methods: The optimal nurse‐to‐patient assignment problem is addressed using analytics, lean health care, and AI. Also, we propose a new mathematical model to optimize the nurse‐to‐patient assignment decisions considering several variables about the patient state such as the Barthel index, their risks, the complexity of the care, and the mental state. Findings: Our results show that there are several processes inherent to compassionate nursing care that can be improved using technology. By using data analytics, we can also provide insights about the high variability of the care requirements and, by using models, find nurse‐to‐patient assignments that are nearly perfectly balanced. Conclusions: We illustrated this improvement with a pilot test that makes the equitable distribution of nursing workload the functionality of this strategy. The findings can be useful in highly complex hospitals in Latin America. Clinical Relevance: The proposed model presents an opportunity to make near perfectly balanced nurse‐to‐patient assignments according to the number of patients and their health conditions using technology. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
3. Factors associated with suffering from dying in patients with cancer: a cross-sectional analytical study among bereaved caregivers.
- Author
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Arango-Gutiérrez, Angélica, Moreno, Socorro, Rondón, Martín, Arroyo, Lucía I, Ardila, Liliana, Leal Arenas, Fabián Alexander, Calvache, José A, and de Vries, Esther
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TUMOR treatment ,DEATH & psychology ,HOSPITALS ,CANCER patient psychology ,RESEARCH ,LIFE support systems in critical care ,CONFIDENCE intervals ,OUTPATIENT medical care ,CROSS-sectional method ,PLACE of death ,MULTIVARIATE analysis ,AGE distribution ,RURAL conditions ,HOME care services ,POPULATION geography ,SPOUSES ,PATIENTS' attitudes ,COMPARATIVE studies ,PSYCHOLOGY of caregivers ,PATIENT-family relations ,SUFFERING ,TUMORS ,PSYCHOLOGY of the terminally ill ,SOCIODEMOGRAPHIC factors ,LOGISTIC regression analysis ,METROPOLITAN areas ,ODDS ratio ,BEREAVEMENT ,PROXY ,RELIGION ,PALLIATIVE treatment - Abstract
Background: In Colombia, cancer incidence is increasing, as is the demand for end-of-life care. Understanding how patients who die from cancer experience this phase will allow the identification of factors associated with greater suffering and actions to improve end-of-life care. We aimed to explore associations between the level of suffering of patients who died from cancer and were cared for in three Colombian hospitals with patient, tumor, treatment, and care characteristics and provided information. Methods: Data on the last week of life and level of suffering were collected through proxies: Bereaved caregivers of patients who died from cancer in three participating Colombian hospitals. Bereaved caregivers participated in a phone interview and answered a series of questions regarding the last week of the patient's life. An ordinal logistic regression model explored the relationship between the level of suffering reported by bereaved caregivers with the patient's demographic and clinical characteristics, the bereaved caregivers, and the care received. Multivariate analyses were adjusted for place of death, treatments to prolong of life, prolongation of life during the dying process, suffering due to prolongation of life, type of cancer, age, if patient had partner, rural/urban residence of patient, importance of religion for the caregiver, caregivers´ relationship with the patient, and co-living with the patient. Results: A total of 174 interviews were included. Median age of the deceased patients was 64 years (IQR 52–72 years), and 93 patients were women (53.4%). Most caregivers had rated the level of suffering of their relative as "moderately to extremely" (n = 139, 80%). In multivariate analyses, factors associated with a higher level of suffering were: unclear information about the treatment and the process before death Odds Ratio (OR) 2.26 (90% CI 1.21–4.19), outpatient palliative care versus home care OR 3.05 (90% CI 1.05–8.88), procedures inconsistent with the patient's wishes OR 2.92 (90% CI 1.28–6.70), and a younger age (18–44 years) at death versus the oldest age group (75–93 years) OR 3.80 (90% CI 1.33–10.84, p = 0.04). Conclusion: End-of-life care for cancer patients should be aligned as much as possible with patients´ wishes, needs, and capacities. A better dialogue between doctors, family members, and patients is necessary to achieve this. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
4. A comparison of resource use of insured and uninsured venezuelan migrants: evidence from the hospital setting.
- Author
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Prada, Sergio I., Pulgarín-Rodríguez, Edwin, Hincapié-Zapata, Lina, and Pizarro, Ana Beatriz
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IMMIGRANTS ,HOSPITALS ,HEALTH services accessibility ,MEDICAL care costs ,RETROSPECTIVE studies ,MEDICAL care use ,HEALTH insurance reimbursement ,HEALTH insurance ,COST analysis ,AT-risk people ,COST effectiveness ,HOSPITAL care - Abstract
Background: There is no characterization of resource use in the hospital setting for immigrants in Colombia, we aimed to describe the resource use by Venezuelan immigrants, comparing those enrolled in the national health insurance system with those with and without the ability to pay. Methods: Retrospective review in the billing data system of our Hospital from 2011 to 2020. We collected information for 6,837 hospital episodes associated with 1,022 Venezuelan patients, hospital's billing information for all services rendered was extracted. Results: The mean cost per patient event were 4,595 USD for those without the ability to pay, costing 2.37 times more than a legal resident insured. Care in the ICU, inpatient days, surgery, and OB-GYN department consume most resources provided to vulnerable migrants. Discussion: Enrolment in the national health insurance may allow better access to health services by vulnerable Venezuelan migrants and thus reduce resource use for the health system. [ABSTRACT FROM AUTHOR]
- Published
- 2023
- Full Text
- View/download PDF
5. Medical decisions concerning the end of life for cancer patients in three Colombian hospitals – a survey study.
- Author
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de Vries, Esther, Leal Arenas, Fabián Alexander, van der Heide, Agnes, Gempeler Rueda, Fritz E., Murillo, Raul, Morales, Olga, Diaz-Amado, Eduardo, Rodríguez, Nelcy, Gonzalez, Beatriz Juliana, Castilblanco Delgado, Danny Steven, and Calvache, Jose A.
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TERMINAL care laws ,HOSPITALS ,NARCOTICS ,RESEARCH ,ANALGESICS ,CROSS-sectional method ,RESEARCH methodology ,CANCER patients ,ADVANCE directives (Medical care) ,QUESTIONNAIRES ,DESCRIPTIVE statistics ,DECISION making in clinical medicine ,PASSIVE euthanasia - Abstract
Background: Cancer patients' end-of-life care may involve complex decision-making processes. Colombia has legislation regarding provision of and access to palliative care and is the only Latin American country with regulation regarding euthanasia. We describe medical end-of-life decision-making practices among cancer patients in three Colombian hospitals. Methods: Cancer patients who were at the end-of-life and attended in participating hospitals were identified. When these patients deceased, their attending physician was invited to participate. Attending physicians of 261 cancer patients (out of 348 identified) accepted the invitation and answered a questionnaire regarding end-of-life decisions: a.) decisions regarding the withdrawal or withholding of potentially life-prolonging medical treatments, b.) intensifying measures to alleviate pain or other symptoms with hastening of death as a potential side effect, and c.) the administration, supply or prescription of drugs with an explicit intention to hasten death. For each question addressing the first two decision types, we asked if the decision was fully or partially made with the intention or consideration that it may hasten the patient's death. Results: Decisions to withdraw potentially life-prolonging treatment were made for 112 (43%) patients, 16 of them (14%) with an intention to hasten death. For 198 patients (76%) there had been some decision to not initiate potentially life-prolonging treatment. Twenty-three percent of patients received palliative sedation, 97% of all patients received opioids. Six patients (2%) explicitly requested to actively hasten their death, for two of them their wish was fulfilled. In another six patients, medications were used with the explicit intention to hasten death without their explicit request. In 44% (n = 114) of all cases, physicians did not know if their patient had any advance care directives, 26% (n = 38) of physicians had spoken to the patient regarding the possibility of certain treatment decisions to hasten death where this applied. Conclusions: Decisions concerning the end of life were common for patients with cancer in three Colombian hospitals, including euthanasia and palliative sedation. Physicians and patients often fail to communicate about advance care directives and potentially life-shortening effects of treatment decisions. Specific end-of-life procedures, patients' wishes, and availability of palliative care should be further investigated. [ABSTRACT FROM AUTHOR]
- Published
- 2021
- Full Text
- View/download PDF
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