David P. Paul

African American Participation in Clinical Trials: Recruitment Difficulties and Potential Remedies

(2003). African American Participation in Clinical Trials: Recruitment Difficulties and Potential Remedies. Hospital Topics: Vol. 81, No. 2, pp. 33-38.

Primary care physicians’ attitudes toward direct‐to‐consumer advertising of prescription drugs: still crazy after all these years

Based upon a national random sample of primary care physicians, this study updates earlier investigations of direct‐to‐consumer (DTC) advertising of prescription pharmaceutical drugs, in light of the explosive growth of such advertising since the late 1990s. The attitudes of the majority of primary care physicians surveyed remain strongly negative, with particular concern about the overstatement of efficacy/exaggerated benefit claims and inadequate risk information. There is, however, a minority of primary care physicians who might be favorably disposed toward DTC prescription drug advertising, provided the pharmaceutical industry addresses the expressed concerns of the medical profession.

A business case for tele-intensive care units.

OBJECTIVES A tele-intensive care unit (tele-ICU) uses telemedicine in an intensive care unit (ICU) setting, applying technology to provide care to critically ill patients by off-site clinical resources. The purpose of this review was to examine the implementation, adoption, and utilization of tele-ICU systems by hospitals to determine their efficiency and efficacy as identified by cost savings and patient outcomes. METHODS This literature review examined a large number of studies of implementation of tele-ICU systems in hospitals. RESULTS The evidence supporting cost savings was mixed. Implementation of a tele-ICU system was associated with cost savings, shorter lengths of stay, and decreased mortality. However, two studies suggested increased hospital cost after implementation of tele-ICUs is initially expensive but eventually results in cost savings and better clinical outcomes. CONCLUSIONS Intensivists working these systems are able to more effectively treat ICU patients, providing better clinical outcomes for patients at lower costs compared with hospitals without a tele-ICU.

What Is the “Best” Approach for Measuring Service Quality of Periodontists?

Abstract Although consumers find it difficult to evaluate the quality of healthcare services in general and dental services in particular, they do make such evaluations. Previous research examined measurement of perceived service quality of general dentists, comparing the two predominant service quality measurement tools—SERVQUAL and SERVPERF. This research extends this line of research to a particular dental specialty—periodontists (dentists who limit their practices to “gum treatment”)—while modifying the survey approach to eliminate some previously noted methodological concerns.AbstractAlthough consumers find it difficult to evaluate the quality of healthcare services in general and dental services in particular, they do make such evaluations. Previous research examined measurement of perceived service quality of general dentists, comparing the two predominant service quality measurement tools—SERVQUAL and SERVPERF. This research extends this line of research to a particular dental specialty—periodontists (dentists who limit their practices to “gum treatment”)—while modifying the survey approach to eliminate some previously noted methodological concerns.

Hospitals' Movements toward the Electronic Medical Record: Implications for Nurses

33 he business world is changing from a paper-based, handwritten record system to a computerized record maintenance system, and the ability to use information technology effectively “is essential to the successful operation of most organizations” (Reynolds 1995, 1). Healthcare in the twenty-first century is realizing the substantial potential benefits found in computerizing patient data, perhaps the most important of which is the ability to make better and timely decisions (Orr et al. 2001). Such systems improve quality (Blendon et al. 2004; Carr and Dimitrakakis 2003; Devers 2002; Mullan 2002) by reducing medication errors and adverse drug events and by improving overall patient care (Bates 2000; Bates et al. 2001, and cost structure (Andrews, DiFrancesco, and Gilliam 2003; Roan and Clark 2002). Perhaps because of the potential of huge initial expenses—for example, the British National Health Service plans to spend over 3 billion pounds during the next three years developing electronic health records for all British subjects (Stevens 2004)—actual implementation of such systems remains limited. It is of interest to know that only about 5% of U.S. hospitals have a fully integrated electronic medical record system (Abrahamsen 2003) despite the fact that hospitals have spent more than

Medicare and the Affordable Care Act: Fraud Control Efforts and Results

7 billion on scanners, computers, and information systems (Anonymous 2003a). Much of the difficulty with patient records exists because part of the patient’s medical record is in an electronic format, and part exists as a “hard copy.” In a perfect world, the integration of all hospital paper documents into a computerized record would be an attainable goal. Perhaps the biggest fear about information technology for nurses is that such technology will make the nursing profession obsolete (Simpson 2003). However, nurses should realize that caring will never “go out of style,” and that improved information technology will increase data accuracy and raise nursing productivity, resulting in enhanced quality of care (Simpson 2000). Information technology certainly has the potential to relieve some of the redundancies and frustrations in clinical nursing (Mullan 2002). The potential impact for healthcare is huge. Currently, physicians are able to enter all patient orders, including orders for medication, into a computerized patient record. Accessing such patient information is critical to providing quality nursing care, and thus requires nurses to be competent with the new technology (Hobbs 2002). If hospitals were able to look beyond the substantial cost and effort associated with initial establishment of an electronic medical record and view the process instead as a series of interrelated steps, more rapid progress toward the eventual goal might be achieved. On the basis of this idea we present the two major components of an electronic medical record, computerized physician order entry and bar-code medication administration, designed to improve medication administration in the hope that disseminating more knowledge of these components of an electronic medical record will lead to more widespread development of such systems.

The PGP demonstrations: were they sufficient to justify accountable care organizations?

ABSTRACT Medicare fraud and abuse costs are estimated at 3–10% of overall Medicare spending, which is expected to expand considerably until 2024 and as such the amount of fraud dollars would be expected to increase proportionally. The purpose of this research was to determine how recent reforms, especially the Patient Protection and Accountable Care Act, may affect Medicare fraud and abuse and to uncover the best strategies to combat Medicare fraud. Methodology: the methodology for this qualitative study was a literature review. Seven electronic databases and five websites were utilized. Fifty-six sources were referenced for this literature review. The breadth of fraud and abuse within Medicare as well as recent reforms to fight fraud including legislative reforms, delivery system reforms, and other reforms including the formation of HEAT fraud fighting taskforces are examined. Legislative reforms are noted to be incompatible with the ACA’s new P4P delivery and reimbursement reforms. Medicare fraud requires comprehensive detection and prevention measures. Benefits of implementing this dual method of fraud fighting are discussed.

Satisfaction with HMO coverage: an empirical study of a medical school's faculty, staff, and administrators.

Abstract The Physician Group Practice (PGP) Demonstr-ation Project was designed to try to establish whether high-quality healthcare can be delivered to Medicare patients, while simultaneously lowering overall Medicare costs. In this project, participating healthcare organizations were provided a portion of any savings achieved, provided that certain quality goals were also achieved. The results of this project were used to provide evidence as to the feasibility of Accountable Care Organizations (ACOs), a healthcare delivery approach, which is rapidly becoming more prevalent. While the quality measures achieved by the vast majority of participants in the PGP Demonstration Project were widespread, the financial performance of these organizations was quite mixed. Many participating organizations received no shared savings whatsoever, while one received more “shared savings” payment that the others combined. Problems with the evidence supporting PGPs’ cost savings are discussed, and, based on these concerns, the future success of ACOs is questioned.

The potential impact of the North American Free Trade Agreement on American dental licensure: a European community model.

W ithout a doubt the evolution of managed care has changed the perceptions of patients toward healthcare providers (Nauert 2000). In particular, HMOs, which now enroll 80.9 million Americans (HMOSurvey.com 200 1 ), have experienced difficulties with customer satisfaction. Two trends appear to be important: HMOs have recently lost 430,000 members, and the HMO industry overall has recently experienced a 12 percent reduction in the overall number of HMOs in the United States (Benko 2001). Many of these lost subscribers may be dissatisfied with the type of care they are receiving or may be opting for less restrictive health plans than HMOs. These changes in overall satisfaction may be forcing the entire industry through a readjustment period. Even if the consolidation of the industry is completely independent of the satisfaction of its members with their plans, the HMOs that will survive are likely to be the ones that best satisfy their membership (Benko 200 1). Members’ satisfaction with their HMO coverage and plan administration is thus an important component of the market health of HMOs. Examination of H M O plan satisfaction has become an emergent area of interest for some time HMO dy of Staff, Lover a Medical page: a I

Costs, Staffing, and Services of Assisted Living in the United States: A Literature Review.

Abstract Appropriate licensure is a significant barrier to entry to the practice of dentistry. The history of dental licensure in the United States is briefly examined, and current dental licensure requirements in the United States and Mexico are noted. The impact that establishment of the European Community had on dental licensure in Europe is examined, noting that changes were the result of political, rather than professional, input. Requirements of NAFTA are examined to see how they will impact current American dental licensure requirements. Some migration of dental professionals between the United States and Mexico is expected as a result of NAFTA.