Search

The United States spends more for intensive care units (ICUs) than do other high-income countries. We used time-driven activity-based costing (TDABC) to analyze ICU costs for initiation of veno-venous extracorporeal membrane oxygenation (VV ECMO) for respiratory failure to estimate how much of the higher ICU costs at 1 US site can be attributed to the higher prices paid to ICU personnel, and how much is caused by the US site's use of a higher cost staffing model. We accompanied our TDABC approach with narrative review of the ECMO programs, at Cedars-Sinai (Los Angeles), Hôpital Pitié-Salpêtrière (Paris), and The Alfred Hospital (Melbourne) from 2017 to 2019. Our primary outcome was daily ECMO cost, and we hypothesized that cost differences among the hospitals could be explained by the efficiencies and skill mix of involved clinicians and prices paid for personnel, equipment, and consumables. Our results are presented relative to Los Angeles' total personnel cost per VV ECMO patient day, indexed at 100. Los Angeles' total indexed daily cost of care was 147 (personnel: 100, durables: 5, and disposables: 42). Paris' total cost was 39 (26% of Los Angeles) (personnel: 12, durables: 1, and disposables: 26). Melbourne's total cost was 53 (36% of Los Angeles) (personnel: 32, durables: 2, and disposables: 19) (rounded). The higher personnel prices at Los Angeles explained only 26% of its much higher personnel costs than Paris, and 21% relative to Melbourne. Los Angeles' higher staffing levels accounted for 49% (36%), and its costlier mix of personnel accounted for 12% (10%) of its higher personnel costs relative to Paris (Melbourne). Unadjusted discharge rates for ECMO patients were 46% in Los Angeles (46%), 56% in Paris, and 52% in Melbourne. We found that personnel salaries explained only 30% of the higher personnel costs at 1 Los Angeles hospital. Most of the cost differential was caused by personnel staffing intensity and mix. This study demonstrates how TDABC may be used in ICU administration to quantify the savings that 1 US hospital could achieve by delivering the same quality of care with fewer and less-costly mix of clinicians compared to a French and Australian site. Narrative reviews contextualized how the care models evolved at each site and helped identify potential barriers to change., Competing Interests: Conflicts of Interest: See Disclosures at the end of the article., (Copyright © 2022 International Anesthesia Research Society.)

Objective: Women's health has demanded more attention from employers as women integrated into the workforce. Traditionally male-dominant fields and occupations require special attention to workplace design, physical standards for entry, employment practices, equipment, and health monitoring. This editorial summarizes the Defense Health Board's (DHB) review of Active Duty Women's Health and its recommendations grounded in a woman's career life-cycle., Methods: The DHB reviewed the Department of Defense and foreign militaries' current women's health services, relevant policies and practices, peer-reviewed scientific literature, and subject matter expert interviews., Results: The DHB's recommendations centered on a comprehensive approach to education, health care access and treatment, professional workforce development, workplace standards and equipment, and accountable outcomes metrics to guide improvement., Conclusions: Employers can learn how to reduce morbidity, leading to a healthier and more productive female workforce., Competing Interests: Conflict of Interest: R.S.K., V.S.L., C.B.G., K.L.M., G.A.A., and M.D.P. are former members of the Defense Health Board. R.S.K. is affiliated with Avant-garde Health, Palladium, Stern Strategy Group, and Geigsen Group. V.S.L. is affiliated with the New England Journal of Medicine (Editorial Board)., (Copyright © 2022 American College of Occupational and Environmental Medicine.)

Competing Interests: The authors report no conflicts of interest.

Competing Interests: The authors report no conflicts of interest.

We describe a quality improvement initiative aimed at achieving interdisciplinary consensus about the appropriate delivery of extracorporeal membrane oxygenation (ECMO). Interdisciplinary rounds were implemented for all patients on ECMO and addressed whether care was consistent with a patient's minimally acceptable outcome, maximally acceptable burden, and relative likelihood of achieving either. The rounding process was associated with decreased days on venoarterial ECMO, from a median of 6 days in 2014 (first quartile [Q1]-third quartile [Q3], 3-10) to 5 days in 2015 (Q1-Q3, 2.5-8) and in 2016 (Q1-Q3, 1-8). Our statistical methods do not allow us to conclude that this change was due to our intervention, and it is possible that the observed decreases would have occurred whether or not the rounding process was implemented.

Background: The objective of this study was to evaluate how different measures of adiposity are related to both arterial inflammation and the risk of subsequent cardiovascular events., Methods and Results: We included individuals who underwent (18)F-fluorodeoxyglucose positron emission tomography/computed tomography imaging for oncological evaluation. Subcutaneous adipose tissue (SAT) volume, visceral adipose tissue (VAT) volume, and VAT/SAT ratio were determined. Additionally, body mass index, metabolic syndrome, and aortic (18)F-fluorodeoxyglucose uptake (a measure of arterial inflammation) were determined. Subsequent development of cardiovascular disease (CVD) events was adjudicated. The analysis included 415 patients with a median age of 55 (P25-P75: 45-65) and a median body mass index of 26.4 (P25-P75: 23.4-30.9) kg/m(2). VAT and SAT volume were significantly higher in obese individuals. VAT volume (r=0.290; P<0.001) and VAT/SAT ratio (r=0.208; P<0.001) were positively correlated with arterial inflammation. Thirty-two subjects experienced a CVD event during a median follow-up of 4 years. Cox proportional hazard models showed that VAT volume and VAT/SAT ratio were associated with CVD events (hazard ratio [95% confidence interval]: 1.15 [1.06-1.25]; P<0.001; 3.60 [1.88-6.92]; P<0.001, respectively). Body mass index, metabolic syndrome, and SAT were not predictive of CVD events., Conclusions: Measures of visceral fat are positively related to arterial inflammation and are independent predictors of subsequent CVD events. Individuals with higher measures of visceral fat as well as elevated arterial inflammation are at highest risk for subsequent CVD events. The findings suggest that arterial inflammation may explain some of the CVD risk associated with adiposity., (© 2016 American Heart Association, Inc.)

This article illustrates the application of the Balanced Scorecard, a method more commonly associated with the business world, to a nonprofit multisector National Women's Health Quality Initiative (NWHQI). The article delineates the following multiple uses of the Balanced Scorecard for the NWHQI effort: Set NWHQI strategy and structure. Provide the framework and principles to implement NWHQI's strategy. Develop a measurement system to assess the progress and success of NWHQI's strategy. Serve as a collaboration mechanism for multisector stakeholders. Advance women's health knowledge base. This article concludes by sharing key insights regarding the utility of the Balanced Scorecard to promote the success of this nationwide women's health quality initiative.

A materials management system capable of inventory control, accounting and the automatic recording of supplies for a clinical department has been developed for the George Washington University Hospital Department of Anesthesia. This system combines a microprocessor-based computer for data storage and a hand-held bar code reader to record the bar code scan of each item in the inventory. A relational software program with easy-to-use menus and help keys was written. Bar code information stored for each item includes item number, quantity, date and time of issue. Accumulated bar code scans are loaded into the computer by use of a serial port and then used to update current inventory in the computer. Comparison between current inventory and reorder levels by the computer will initiate automatic printing of appropriate purchase orders. Reorder levels are adjusted regularly, by comparing previous year or month usage to current needs; items already on order, items on back order and delivery lag time are also taken into account.

Pharmacists are thought to play a central role in providing information and advice on health to lower income and other socially disadvantaged groups. However, recent evidence suggests that social biases exist in the spatial distribution of urban pharmacies. Such biases would severely limit the accessibility of the poor and the nonwhite to pharmacy services. To test the general nature of this evidence, we used multiple regression techniques to assess the simultaneous influence of several ecological and socioeconomic variables on the location of pharmacies in Pittsburgh and Omaha. After controlling for the influence of physicians, hospitals, commercial activity, population, and other variables thought to affect pharmacy location, we were unable to detect any evidence of a direct association between pharmacy location and the socioeconomic or demographic (other than total population) characteristics of areas in either city.