Benefits and Constraints of Telepsychiatry Utilization in the United States

This conference presentation describes the benefits and constraints of utilizing telemedicine primarily focusing on the field of psychiatry in the United States with the current system of healthcare. The utilization of telemedicine in the field of psychiatry is believed to provide better access, quality and care to the patients who necessitate psychiatric care in their overall medical care. Telemedicine has been a successfully integrated program into psychiatric facilities reaching rural, prisons or city facilities based on that it has increased the volume of patients in which physicians can reach out to and diagnose, as well as treat patients with limitations in his or her mobility

Physician Incentives: Managed Care and Ethics

The authors review the principle features of the managed care system in an effort to understand the ethical assumptions inherent in managed care. The interrelationships among physician incentives, responsibilities of patients and the physician-patient relationship are examined in light of the ethical concerns identified in the managed care system. The managed care system creates ethical tensions for those who influence the allocation of scare resources. Managed care\u27s administrative controls have increasingly changed the doctor-patient relationship to the businessperson-consumer relationship. Managed care goals of quality and access demand that physicians be both patient advocate and organizational advocate, even though these roles seem to conflict. A reemphasis of managed care\u27s moral mission is essential for enabling physicians, patients, payers and policymakers to fulfill their new role and to preserve the fidelity of the doctor-patient relationship

Case Studies in Medical Futility

Technology has provided means to sustain life and provide care regardless of whether the treatment is appropriate and compassionate given the condition of the patient. This study presents two case histories, compiled from historical patient charts, staff notes and observations, that illustrate the variety of ethical issues involved and the role culture plays in the decision making process related to possible futile medical treatment. Ethical and cultural issues related to the cases are discussed and processes are presented that can help hospitals to avoid, or decrease the level of, medically futile care, and improve the cultural appropriateness of medical care and relationships with patients

Comparative Cost Analysis of CRRT in ICU/CCU Patients Undergoing Cardiovascular Surgery vs. Other Procedures at a Texas Hospital

The purpose of this study was to conduct a comparative analysis of hospital costs incurred by patients undergoing Cardiovascular Surgery (CVS) and patients undergoing other medical procedures who received Continuous Renal Replacement Therapy (CRRT) in a teaching hospital. A total of 117 patients were identified through review of medical charts for the period of January 1999 to August 2002. Twenty one percent of them were identified having CVS. Eighty-eight percent of the CVS patients admitted to the ICU for CRRT died compared to 67% for non-CVS patients (p=0.047). Average actual costs of hospitalization were $47,225 for CVS patients and$51,724 for non-CVS patients. The mean length of stay (LOS) was 12.8 days for the CVS patients and 18.1 days for other patients (p=0.03). Mean LOS for patients who survived was 23.1 days whereas the average LOS for patients who died was 14.5 days (p=0.06). The differences found between patients who had CVS with CRRT as compared to non-CVS patients with CRRT in terms of mortality and length of stay raise ethical as well cost effectiveness questions of the procedure

Organizational Culture in a Terminally Ill Hospital

This study analyzed an organizational culture in a community hospital in Texas to measure organizational culture change and its impact on Patient Satisfaction (PS). The study employed primary and secondary data, combining quantitative and qualitative methods for a case study. Participant observation was used and archival data were collected to provide a better understanding of the organizational culture and the context in which change was taking place. This study also applied a “Shared Vision” of the organization as the central process in bringing forth the knowledge shared by members of the community hospital who were both subjects and research participants. The results from the study suggest an increase in PS due to the shared vision of one subculture within the hospital. There were powerful subcultures in this organization based on occupation and specialization, and their interests and functional orientations were not conducive to a systems approach. Hospital management was conducted in “silos” and there was lack of feedback between organizational levels of the hospital, especially in financial management, with organizational dysfunctionality in reacting and adapting to the health care market

Use of Smartphones in Hospitals

Mobile technology has begun to change the landscape of the medical profession with more than two-thirds of physicians regularly using smart phones. Smartphones have allowed healthcare professionals and the general public to communicate more efficiently, collect data and facilitate the clinical decision making. The methodology for this study was a qualitative literature review following a systematic approach of the smartphone usage among physicians in hospitals. Fifty-one articles were selected for this study based on inclusion criteria. The findings were classified and described into seven categories: use of smartphone in obstetrics, pediatrics, surgery, internal medicine, radiology, and dermatology which were chosen based on the documented use of smartphone application in different healthcare practices. A last section of patient safety and issues with confidentiality is also described. This study suggest that smartphones have been playing an increasingly important role in healthcare. Medical professionals have become more dependent upon medical smartphone applications. However, concerns of patient safety and confidentiality will likely lead to increased oversight of mobile device use by regulatory agencies and accrediting bodies

Racial/Ethnic Differences in Exposure to Environmental Volatile Organic Compounds in the U.S. General Population: The National Health and Nutrition Examination Survey 1999–2000

Background: Exposure to volatile organic compounds (VOCs) has been associated with many health disorders. A better understanding of unequal health risk from exposure to environmental VOCs is critical to the elimination of health disparities. Objective: The goal of this study was to investigate racial/ethnic differentials in exposure to airborne VOCs within a national sample of the U.S. population and assessed socio-demographic determinants that may contribute to these racial differences. Methods: We used data from a stratified sample of 576 participants (aged 20–59 years) who provided personal air samples for VOC measurements in the National Health and Nutrition Examination Survey (NHANES) in 1999–2000. We used Analysis of Variance (ANOVA) and multiple regression models for statistical analyses. Results: Compared to the exposure of the majority populations in the United States, a disproportionate burden of exposure to airborne VOCs fell on minority populations: The levels of total VOC exposure were 52% and 37% higher in Mexican Americans and non-Hispanic blacks, respectively, than in non-Hispanic whites after adjusting for socioeconomic and other covariates (p\u3c 0.001). Socio-demographic and lifestyle factors, including education, tobacco exposure, presence or absence of a window for ventilation inside the home, and gasoline use/storage, also affected levels of personal exposure to VOCs. Discussion and Conclusion: This research study demonstrates that race/ethnicity is associated with VOC exposure independent of socioeconomic and other demographic factors. To help promote public health for communities and individuals, further efforts should be made to investigate underlying causes of racial/ethnic disparities in exposure to environmental VOCs

Relationship between the Hospital Readmission Reduction Program and Readmissions, Postoperative Complications, and Cost

Hospital readmissions have contributed significantly to rising healthcare costs in the United States. To curb rising costs, the Centers for Medicare and Medicaid Services introduced the Hospital Readmissions Reduction Program (HRRP), a penalty-based program designed to decrease healthcare costs. This research aims to determine if the HRRP has successfully reduced healthcare costs and increased quality outcomes associated with total knee arthroplasty (TKA) or total hip arthroplasty (THA) as defined by a reduction in readmission rates, postoperative complications, and overall costs. Although a positive correlation has been shown between outcomes and costs post-HRRP, more research is needed to tease out the impact of HRRP on these findings, given that these indicators were already positively trending before implementation

ICD-10 implementation: Is the workforce ready?

After many delays, the U.S. finally implemented ICD-10-CM/PCS on October 1, 2015, bringing the U.S. into line with other industrialized nations, most of which have been using ICD-10 for many years. We outline the benefits and challenges to the preparatory activities of the ICD-10-CM/PCS implementation for the U.S. healthcare industry. To ease the transition, CMS allowed healthcare facilities to submit test claims prior to the implementation date, and delivered feedback on the acceptability of those claims. Early results indicated a relatively smooth transition, although some questions regarding the available data remain. Additional data, especially data concerning outcomes, is required