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4 results on '"Gospodarevskaya, Elena V."'

1. Economic evaluation of a clinical protocol for diagnosing emergency patients with suspected pulmonary embolism

Author

Wolfe Rory, de Campo John F, Chan Thomas, Harris Anthony H, Goergen Stacy K, Gospodarevskaya Elena V, Gan Eng T, Wheeler Michael B, and McKay John

Subjects
Medicine (General), R5-920
Abstract

Abstract Background The objective of this paper is to estimate the amount of cost-savings to the Australian health care system from implementing an evidence-based clinical protocol for diagnosing emergency patients with suspected pulmonary embolism (PE) at the Emergency department of a Victorian public hospital with 50,000 presentations in 2001–2002. Methods A cost-minimisation study used the data collected in a controlled clinical trial of a clinical protocol for diagnosing patients with suspected PE. Thenumber and type of diagnostic tests in a historic cohort of 185 randomly selected patients, who presented to the emergency department with suspectedPE during an eight month period prior to the clinical trial (January 2002 -August 2002) were compared with the number and type of diagnostic tests in745 patients, who presented to the emergency department with suspected PE from November 2002 to August 2003. Current Medicare fees per test were usedas unit costs to calculate the mean aggregated cost of diagnostic investigation per patient in both study groups. A t-test was used to estimate the statistical significance of the difference in the cost of resources used for diagnosing PE in the control and in the intervention group. Results The trial demonstrated that diagnosing PE using an evidence-based clinical protocol was as effective as the existing clinical practice. The clinical protocol offers the advantage of reducing the use of diagnostic imaging, resulting in an average cost savings of at least $59.30 per patient. Conclusion Extrapolating the observed cost-savings of $59.30 per patient to the wholeof Australia could potentially result in annual savings between $3.1 million to $3.7 million.

Published
2006
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4. Process performance indicators in redesigning the patient care process

Author

Elena Gospodarevskaya, Leonid Churilov, Gospodarevskaya, Elena V, and Churilov, L

Subjects
Knowledge management, Core business, Interview, business.industry, Computer science, Process (engineering), Australia, Business process reengineering, health care, service delivery systems, ethnographic case study, Health care, Business, Management and Accounting (miscellaneous), Observational study, Performance indicator, hospital management, process performance indicators, Business and International Management, business, Research question, process redesign
Abstract

PurposeThe purpose of this paper is to investigate the regulator's attempt at redesigning the patient care process (PCP) – a core business process in public hospitals – by introducing dichotomous process performance indicators as an innovative management tool intended to align the State health care policy with the everyday management of operations at a hospital ward.Design/methodology/approachThe paper presents an ethnographic case study of redesigning the PCP according to the strategy originating outside the organization. The study employs competing theories that represent alternative epistemological and ontological views of the world in order to produce a tentative explanation of why the intended redesign of the PCP has not fully eventuated. Observational data and opportunistic interviewing are used to answer the research question of whether and how the information and operational flows on the ward were affected by introduction of process performance indicators. A business process redesign framework was employed for data analysis since it better reflects the objectives of the State‐wide initiative and offers a convenient tool in dealing with data complexity.FindingsIntroduction of the process performance indicators did not result in redesigning of the PCP as intended by health care authorities. Out of four process performance indicators, only one was consistently implemented, which merely produced a duplication of the previously collected information, therefore adding no value to the PCP. On a theoretical level, the results indicate that the emergent theory rather than the rational agent theory demonstrated a greater fidelity to the empirical observations.Originality/valueThe paper assessed the feasibility of using innovative dichotomous process performance indicators as a tool for redesigning the business process at the ward level, in order to achieve macro‐level policy objectives. The failure to successfully implement a top‐down universal approach to redesigning business processes in health care is likely to reflect a lack of appreciation of emergent rationality that characterizes essential aspects of the PCP.

Published
2011

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