共查询到20条相似文献,搜索用时 62 毫秒
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O. Ommen C. Janssen H. Pfaff R. Lefering E. Neugebauer 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2008,393(6):985-994
Background and aims Health services research (HSR) investigates the translation of clinical studies into the practice of health care in relation
to quality and efficiency from the individual and socioeconomic perspective. Given the fact that HSR has become increasingly
popular during the last decade, this article aims at providing an overview of the significance and benefit of HSR in general
and especially in the field of surgery.
Results The first part of the overview provides various definitions that apply to the field, gives a brief historical overview of
the development in Germany in contrast to the USA and Great Britain, and describes relevant theoretical frameworks and methods.
In the second part it deals with gaps in patient care, patient-related outcomes, registry research, the integration of clinical
and ambulatory surgery, and research on implementation of guidelines into practice.
Conclusions This overview shows that HSR is by now regarded as an essential field, at least in developed countries, and that we are just
at the beginning to understand why demonstrated effective strategies in the clinical context do not or rarely translate into
routine patient’s care. 相似文献
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O.V. Grosjean 《Acta chirurgica Belgica》2013,113(1):4-14
Rather than our routinely blamed ageing demography, pharmaceutical promotion and the medical business, not research, are responsible for our ever growing health bill. To keep essential health care affordable, only what has been proved necessary and cost effective should be financed by some kind of risk mutualisation system. Hedonistic care should be left to the free market.From conception to death, a devastating culture of medicalization and therapeutic agressivity has turned naturally inexpensive processes, such as conception, birth, ageing and death, into over-priced medical achievements. The increasing lack of personal and social responsibility triggered by the market, such as junk food, tobacco, drugs, sedentarity or trash media, multiply life-threatening illnesses such as diabetes 2, obesity, cardiovascular diseases and all kinds of cancers.Screenings require millions of participants and intense statistical analysis to prove any efficacy. Screenings, testings and proactive practices make people sick and produce more patients than they save lives, while generating exceptional returns on investments thanks to state and insurance financing; they should be put under public control. New drugs are unaffordable in spite of their dubious efficacy which often relies on biased and underpowered studies. Because they target desperate, debilitating, up to now incurable diseases like metastatic cancers, multiple sclerosis, Alzheimer, polyarthritis, Crohn disease, patients and their families want them by any means and at any price. The answer to the North-South health gap is in a global deal: a declining demographic trend, already well under way and free circulation not only of goods but also of people which would in the long run shape up the age pyramid of a progressively mixed population. That could also save lives at both ends of the human chain: those who die from starvation and those who die from overfeeding. 相似文献
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Health Care Costs for Patients With Chronic Spinal Cord Injury in the Veterans Health Administration
Dustin D. French PhD Robert R. Campbell JD MPH PhD Sunil Sabharwal MD Audrey L. Nelson PhD RN FAAN Polly A. Palacios MSPH Deborah Gavin-Dreschnack PhD 《The journal of spinal cord medicine》2013,36(5):477-481
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Chelsea S Wilgenbusch Peter W Dust Ian R Sunderland 《CANADIAN JOURNAL OF PLASTIC SURGERY》2015,23(3):195-198
BACKGROUND:
The acute care surgery model has gained favour in general surgery, but has yet to be widely adopted in other specialties. An Acute Care Plastic Surgery (ACS) Service was recently implemented in the Saskatoon Health Region in an effort to improve trauma care.OBJECTIVE:
To evaluate the impact of ACS on the management of flexor tendon lacerations. The authors hypothesize that ACS has resulted in more timely intervention, improved outcomes and decreased ‘after hours’ surgery.METHODS:
A retrospective review of patients treated for flexor tendon lacerations from 2007 to 2013 was performed. Patients were stratified into two groups based on whether they received treatment before (group A) or after (group B) ACS implementation. Variables included dates and times of patient referral, consultation and tendon repair; postoperative complications; and admissions. A surgeon survey was administered on the perceived impact of ACS.RESULTS:
Group A was more likely to have surgery performed after hours (P=0.0019) and be admitted to hospital (P=0.0211) compared with group B. Time from referral to consultation and injury-to-surgery interval were slightly increased post-ACS (Group B). Surgeons were highly satisfied with the new system, citing benefits to patients and surgeons.CONCLUSION:
ACS was designed to improve trauma care, while favourably impacting surgeon workload. Surprisingly, the injury-to-surgery interval was slightly increased. However, this was not clinically significant and did not lead to increased postoperative complications. This finding was likely due to a favourable change in practice patterns observed after ACS implementation. ACS has resulted in fewer hospital admissions, decreased after-hours surgeries and improved surgeon satisfaction. 相似文献15.
The U.S. health care system continues to evolve toward value-based payment, rewarding providers based upon outcomes per dollar spent. To date, payment innovation has largely targeted primary care, with little consideration for the role of surgical specialists. As such, there remains appropriate uncertainty surrounding the optimal role of the urologic oncologist in alternative payment models. This commentary summarizes the context of U.S. health care reform and offers insights into supply-side innovations including accountable care organizations and bundled payments. Additionally, and importantly, we discuss the implications of rising out-of-pocket health care expenditures giving rise to health care consumerism and the implications therein. 相似文献
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Karen R. Borman 《American journal of surgery》2009,198(6):736-741
Our health care system continues to undergo transformation in a context of extreme financial pressures. New models of care delivery and financing challenge us to rethink our practices as individual surgeons and as system participants. Understanding the fiscal realities of health care and how we are perceived by health care policy makers can help us to be meaningful participants in channeling reform to create better delivery systems for our patients. This article presents some background information about health care in America with a focus on government programs, and shares insights from my health care policy colleagues. 相似文献
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David F. Friedlander Quoc-Dien Trinh Anna Krasnova Stuart R. Lipsitz Maxine Sun Paul L. Nguyen Adam S. Kibel Toni K. Choueiri Joel S. Weissman Mani Menon Firas Abdollah 《European urology》2018,73(3):445-451