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Volume 51, Number 4
July/August 2006

  • INTERVIEW
    Interview with Larry Sanders, chairman and chief executive officer, Columbus Regional Healthcare System, Kyle L. Grazier
  • PAY FOR PERFORMANCE
    Patient-Centered Pay for Performance: Are We Missing the Target? Kaveh Safavi
  • COMPETENCIES
    Professionalism, Andrew N. Garman, Rupert Evans, Mary Katherine Krause, Janis Anfossi
  • ACHE STUDENT ESSAYS
  • The Importance of Middle Managers in Healthcare Organizations, Mari K. Embertson
  • The Aging Nursing Workforce: How to Retain Experienced Nurses, Jeremye D. Cohen
  • ARTICLES
  • Performance Metrics for Advanced Access, Diwakar Gupta, Sandra Potthoff, Donald Blowers, and John Corlett
  • Nonclinical Outcomes of Hospital-Based Palliative Care, Kenneth R. White, Kristie G. Stover, J. Brian Cassel, and Thomas J. Smith
  • FELLOW PROJECT
    Response of a Community Hospital in West Virginia to the Medical Malpractice Crisis,
    Daniel J. Lauffer

 

Executive Summary

Performance Metrics for Advanced Access, Diwakar Gupta, Sandra Potthoff, Donald Blowers, and John Corlett

 Advanced access is an outpatient scheduling technique that aims to provide same-day appointment access. It is designed to reduce the time patients must wait for a scheduled appointment and to improve continuity of care by matching daily appointment supply and demand. Factors that make it difficult to sustain initial success in achieving supply-demand balance include different practice styles of doctors, differences in panel compositions and patient preferences, and time-varying demand patterns. This article proposes several performance measures that can help clinic directors monitor and evaluate their advanced access implementation. We also discuss strategies for sustaining advanced access in the long run.

 Executive Summary

Nonclinical Outcomes of Hospital-Based Palliative Care, Kenneth R. White, Kristie G. Stover, J. Brian Cassel, and Thomas J. Smith

 Evidence-based outcomes are commonly used in making decisions about clinical care. For healthcare executives, evidence-based outcomes also can be useful in making decisions about hospital services. Finkler and Ward (2003) suggest a model whereby cost measurement, cost control, and value assessment can be used as nonclinical, evidence-based outcome measures to provide decision support and to guide management decisions. The Finkler and Ward framework is used to understand the financial implications of establishing an inpatient palliative care unit (PCU).

A longitudinal study was conducted to examine the nonclinical outcomes associated with opening and operating an inpatient PCU at a large academic medical center during the first four years of the unit’s operation. First, the cost of providing inpatient palliative care was measured. Results indicated that the cost per day to care for patients hospitalized in the last 20 days leading up to their death was significantly less on the PCU than on intensive care units and non-PCUs.

Average daily total charges exceeded reimbursement on the ICU and non-PCUs, but the cost on the PCU for the same population was equal to or below the average daily total charges. Second, ways to control costs when operating an inpatient PCU were identified and measured. Evidence from one organization suggests that costs can effectively be controlled by admitting patients directly to the PCU and by appropriate use of hospital resources, including staff, ancillary services, and pharmaceuticals. Third, the study assessed the value to the institution of operating an inpatient PCU. Results indicated that the inpatient PCU yielded a cost savings of nearly $1 million by the third year of operations.

This study highlights the nonclinical outcomes of one institution’s inpatient PCU and provides guidelines for healthcare executives and managers to use in making decisions about adopting such programs.