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"Equipment and Supplies economics."
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The impact of free medical supplies and regular telephonic contact on glycemic control in Indian children and adolescents with type 1 diabetes
Background/Objective The effect of economic assistance to underprivileged families with type 1 diabetes has never been described. Such a study is relevant as logistic and cultural factors may preclude an anticipated good outcome. The objective of the study is to determine the impact of economic and educational intervention on hemoglobin A1c (HbA1c) and diabetes knowledge. Methods Eighty‐five consecutive participants were prospectively provided insulin and glucose strips for 1 year. From the 6th to 12th month, patients were randomized such that half of them (telephone group) received proactive telephonic advice by a diabetes educator, while the non‐telephone group received usual care. HbA1c and diabetes knowledge were measured at baseline, 6 and 12 months. Results Significant improvement was seen in HbA1c with provision of free diabetes supplies, when patients were compared with their own HbA1c values during the prior 36 months (baseline [8.38 ± 2.0%], at 3 months [8.0 ± 1.6%] and at 6 months [8.1 ± 1.5%, P = 0.0106]). Knowledge score increased from baseline (48 ± 15) to 6 months (58 ± 13, P < 0.001). No difference was seen between the telephone and non‐telephone groups in HbA1c from the 6th to 9th and 12th month. The knowledge score showed significant improvement in the telephone group during the proactive telephonic advice study compared with the non‐telephone group (P = 0.002). Conclusions The provision of free medical supplies improved HbA1c and diabetes knowledge. Intensive telephone contact improved knowledge, not HbA1c. These results provide important background for policy makers and diabetes management teams.
Journal Article
Materialities of care : encountering health and illness through artefacts and architecture
\"Materialities of Care addresses the role of material culture within health and social care encounters, including everyday objects, dress, furniture and architecture. Makes visible the mundane and often unnoticed aspects of material culture and attends to interrelations between materials and care in practice. Examines material practice across a range of clinical and non-clinical spaces including hospitals, hospices, care homes, museums, domestic spaces and community spaces such as shops and tenement stairwells. Addresses fleeting moments of care, as well as choreographed routines that order bodies and materials. Focuses on practice and relations between materials and care as ongoing, emergent and processual International contributions from leading scholars draw attention to methodological approaches for capturing the material and sensory aspects of health and social care encounters\"--Provided by publisher.
Book
Pen Torch Transillumination: Difficult Venepuncture Made Easy
Introduction
Our novel technique of pen torch transillumination (PTI) uses a cheap and easily available instrument (Penlite-LP212
®
, Energizer
®
, Missouri, USA) to visualize superficial veins invisible to the naked eye. We evaluate the efficacy of PTI in improving venepuncture success rate (SR) for patients with poor venous access.
Methods
This prospective randomized controlled trial looked at adult patients (
n
= 69) aged 21–90 with difficult venous access (history of ≥3 consecutive attempts required for successful cannulation during the current admission) requiring non-emergent venepuncture. Patients underwent venepuncture over the upper-limb using one of the following: conventional venepuncture (control); Veinlite
®
EMS (TransLite
®
, Texas, USA), a commercial transillumination device; PTI. Outcome measures were: successful cannulation within 2 attempts and total duration of venepuncture. Fisher’s exact and Kruskal–Wallis tests were performed.
Results
A significantly larger number of patients had successful venepuncture within 2 attempts using PTI (22/23, 95.7%) and Veinlite (23/23, 100%), compared to the controls (7/23, 30.4%) (
p
< 0.05). The total duration required for successful venepuncture was significantly shorter for Veinlite (mean 3.7 min, 1.0–5.3 min) and PTI (mean 8.5 min, range 1.08–27 min) compared to the controls (mean 23.2 min, range 1.88–46.5 min) (
p
< 0.05).
Conclusions
PTI allows users to visualize veins invisible to the naked eye. Thrombosed/tortuous veins, branch points and valves, are easily identified and avoided. It has comparable efficacy to Veinlite
®
and is cheaper (Veinlite
®
-USD 227 vs. Penlite-LP212
®
-USD 7.00) and more easily available. PTI improves patient care, especially in developing regions where costs are a concern.
Journal Article
The business of healthcare innovation
\"The Business of Healthcare Innovation is a wide-ranging analysis of business trends in the manufacturing segment of the healthcare industry. It provides a thorough overview and introduction to the innovative sectors fueling improvements in healthcare: pharmaceuticals, biotechnology, platform technology, medical devices and information technology. For each sector, the book examines the basis and trends in scientific innovation, the business and revenue models pursued to commercialize that innovation, the regulatory constraints within which each sector must operate and the growing issues posed by more activist payers and consumers. Specific topics include market structure and competition, the economics and rationale of product development, pricing, sales and marketing, contract negotiations with buyers, alliances versus mergers, business strategies and prospects for growth. Written by professors of the Wharton School and industry executives, the book shows why healthcare sectors are such an important source of growth in any nation's economy\"--Provided by publisher.
Book
The Impact on Endoscopic Resource Utilization After a Targeted Intervention for Cost-Minimization of EGD and Colonoscopy
The need to define the cost of endoscopic procedures becomes increasingly important in an era of providing low-cost, high-quality care. We examined the impact of informing endoscopists of the cost of accessories and pathology specimens as a cost-minimization strategy.
We conducted a prospective observational cohort study of therapeutic outpatient esophagogastroduodenoscopy (EGD) and colonoscopy. During the pre-intervention phase (phase 1), the endoscopists were not briefed on the cost of accessories or pathology specimens obtained during the procedure. During a 3-week intervention phase and the post-intervention phase (phase 2) endoscopists were informed of the dollar value of accessories and pathology specimens after the completion of all procedures. In all cases the institutional costs (not charges) were used. The endoscopists were blinded to their observation.
A total of 969 EGD, colonoscopy, and EGD+colonoscopy performed by 6 endoscopists were reviewed, 456 procedures in phase 1 and 513 procedures in phase 2. There was no significant difference between phases 1 and 2 in total device and pathology cost in dollars (188.8±151.4 vs. 188.9±151.8, P=0.99), total device cost (36.2±107.9 vs. 39.0±95.96, P=0.67) and total pathology cost (152.6±101.3 vs. 149.9±112.5, P=0.70). There was not a significant difference in total device and pathology cost when examined by specific procedures performed, or for any of the endoscopists between phases 1 and 2.
Making endoscopists more cost conscious by informing them of the costs of each procedure during EGD and colonoscopy does not result in lower procedural costs. Analysis of cost-minimization strategies involving procedures in other health-care settings and procedures using high-cost accessories are warranted.
Journal Article
Coffee for one : how the new way to make your morning brew became a tempest in a coffee pod
Coffee for One focuses on the revolution that made single serve such a popular way to consume coffee worldwide, and the competition and conflict that got us here.
Book
A French Value Set for the EQ-5D-5L
Objective
The objective of this study was to develop a French value set for the EQ-5D-5L, for academic and clinical research, and for regulatory requirements for price-setting of drugs and medical devices.
Method
This study used the standardized valuation protocol developed by EuroQol, using computer-assisted personal interview software. A representative sample of 1048 French residents were interviewed by a market research company, under the supervision of the research team. Health states were valued using composite time trade-off and a discrete choice experiment. Modeling was used to create values for the 3125 possible health states. The composite time trade-off data were modeled using a Tobit model with censored observations at −1 and correcting for heteroscedasticity. A conditional logit model was used for the discrete choice results, and both models were combined using a hybrid model. An adjusted hybrid model was tested to correct for imbalance in the sample on age and sex compared with the general population. A comparison with the 3-level (3L) value set was performed.
Results
The adjusted model was preferred to comply with the representativeness of the general population. It provided a value set for which all coefficients were logically consistent. Values ranged from − 0.525 to 1. The distribution of values presented a shift towards higher values versus the 3L value set. Ranking of dimensions changed. Pain and discomfort and mobility were the dimensions with the highest potential for disutility compared with mobility and self-care for the 3L instrument.
Conclusions
This study provides a value set based on societal preferences of the French population, using an improved descriptive instrument of health-related quality-of-life health states. It will contribute to improve the quality of cost-effectiveness analysis in the French context and help stimulate disease-specific quality-of-life references for academic-, institutional-, and industry-promoted studies.
Journal Article
Enhancing operational efficiency through overall equipment efficiency optimization and Kaizen initiatives
This case study aims to investigate the causes of low efficiency in a carton production line by calculating Overall Equipment Effectiveness (OEE). A typical carton factory has been chosen for this study, which has two production lines, namely finished goods and corrugated boards. The define, measure, analyze, improve, and control approach is applied while implementing Six Sigma principles such as Kaizen, fishbone diagrams, and 5W+1H as its systematic procedure. The analysis involves estimating four machines’ average OEE across 12 shifts. A cost-effective method is applied to resolve the problems that cause the lines to be less efficient. By applying the proposed method, the OEE becomes more efficient by 29% for finished goods and 9% for corrugated boards. Value stream mapping has been used to track the improvements. It is found that emphasizing higher OEE values enhances operational performance, leading to better efficiency, power usage, cycle time, and equipment repair.
Journal Article
Robotic-assisted versus laparoscopic unilateral inguinal hernia repair: a comprehensive cost analysis
BackgroundCost-effectiveness of robotic-assisted surgery is still debatable. Robotic-assisted inguinal hernia repair has no clear clinical benefit over laparoscopic repair. We performed a comprehensive cost-analysis comparison between the two approaches for evaluation of their cost-effectiveness in a large healthcare system in the Western United States.MethodsHealth records in 32 hospitals were queried for procedural costs of inguinal hernia repairs between January 2015 and March 2017. Elective robotic-assisted or laparoscopic unilateral inguinal hernia repairs were included. Cost calculations were done using a utilization-based costing model. Total cost included: fixed cost, which comprises medical device and personnel costs, and variable cost, which comprises disposables and reusable instruments costs. Other outcome measures were length of stay (LOS), conversion to open, and operative times. Statistics were done using t test for continuous variables and χ2 test for categorical variables. A p-value < 0.05 was considered significant.ResultsA total of 2405 cases, 734 robotic-assisted (633 Primary: 101 recurrent) and 1671 laparoscopic (1471 Primary: 200 recurrent), were included. The average total cost was significantly higher (p < 0.001) in the robotic-assisted group ( $5517) compared to the laparoscopic group ($ 3269). However, the average laparoscopic variable cost ( $1105) was significantly higher (p < 0.001) than the robotic-assisted cost ($ 933). Whereas there was no significant difference between the two groups for LOS and conversion to open, average operative times were significantly higher in the robotic-assisted group (p < 0.001). Subgroup analysis for primary and recurrent inguinal hernias matched the overall results.ConclusionsRobotic-assisted inguinal hernia repair has a significantly higher cost and significantly longer operative times, compared to the laparoscopic approach. The study has shown that only fixed cost contributes to the cost difference between the two approaches. Medical device cost plus the longer operative times are the main factors driving the cost difference. Laparoscopic unilateral inguinal hernia repair is more cost-effective compared to a robotic-assisted approach.
Journal Article