Patient Mobility, Health Care Quality and Welfare.

Patient mobility is a key issue in the EU who recently passed a new law on patients’right to EU-wide provider choice. In this paper we use a Hotelling model with two regions that differ in technology to study the impact of patient mobility on health care quality, health care financing and welfare. A decentralised solution without patient mobility leads to too low (high) quality and too few (many) patients being treated in the high-skill (low-skill) region. A centralised solution with patient mobility implements the first best, but the low-skill region would not be willing to transfer authority as its welfare is lower than without mobility. In a decentralised solution, the effects of patient mobility depend on the transfer payment. If the payment is below marginal cost, mobility leads to a ‘race-to-the-bottom’in quality and lower welfare in both regions. If the payment is equal to marginal cost, quality and welfare remain unchanged in the high-skill region, but the low-skill region bene…ts. For a socially optimal payment, which is higher than marginal cost, quality levels in the two regions are closer to (but not at) the …rst best, but welfare is lower in the low-skill region. Thus, patient mobility can have adverse effects on quality provision and welfare unless an appropriate transfer payment scheme is implemented.Patient mobility; Health care quality; Regional and global welfare.

Health mobility: implications for efficiency and equity in priority setting

Adverse Health mobility is a statistical measure of inter-temporal fluctuations in health of a group of individuals. Increased availability of panel data has led to a number of studies which analyse and compare health mobility across subgroups. Mobility can differ systematically across patient subgroups, even if prevalence measured at one point in time is the same. There is a lack of discussion regarding whether health mobility is a relevant concept for resource allocation decisions. In this think piece, we explore whether and how health mobility is incorporated in cost-effectiveness analysis (CEA). CEA takes health mobility into account where it matters in terms of efficiency and -depending on treatment programs- either favours groups with low mobility or gives equal priority to groups of differing levels of mobility. However, CEA fails to take into account the equity dimension of mobility. There is qualitative research to suggest that some members of the public find that patient groups with low health mobility should be given priority even if some efficiency was sacrificed. Results also indicate that this may depend on the nature of the condition, the actual lengths involved and the magnitude of the efficiency sacrifice. Health mobility may also have political implications which affect resource allocation decisions, possibly in opposing directions. Further research is required to investigate the extent to which the public is concerned with health mobility, to determine conditions for which health mobility matters most, and to explore ways of how the equity dimension of health mobility can be incorporated into CEA.Health mobility, health dynamics, panel data, resource allocation, cost effectiveness analysis, equity

Leveraging RFID in hospitals: patient life cycle and mobility perspectives

The application of Radio Frequency Identification (RFID) to patient care in hospitals and healthcare facilities has only just begun to be accepted. This article develops a set of frameworks based on patient life cycle and time-and-motion perspectives for how RFID can be leveraged atop existing information systems to offer many benefits for patient care and hospital operations. It examines how patients are processed from admission to discharge, and considers where RFID can be applied. From a time-and-motion perspective, it shows how hospitals can apply RFID in three ways: fixed RFID readers interrogate mobile objects; mobile, handheld readers interrogate fixed objects; and mobile, handheld readers interrogate mobile objects. Implemented properly, RFID can significantly aid the medical staff in performing their duties. It can greatly reduce the need for manual entry of records, increase security for both patient and hospital, and reduce errors in administering medication. Hospitals are likely to encounter challenges, however, when integrating the technology into their day-to-day operations. What we present here can help hospital administrators determine where RFID can be deployed to add the most value

Chest wall stretching exercise as an adjunct modality in post operative pulmonary management.

Emphysematous pyelonephritis is a form of infection of the kidney. Chest physiotherapy was executed on a 15-year-old girl who had complications such as secretion retention and pleural effusion following percutaneous pigtail nephrostomy in addition to oxygen therapy and medical management to promote respiratory functions. The processes to increase chest wall mobility includes particular passive stretching and mobilization. Chest mobility exercises composed of an intercostal stretch on a determined intercostal space using index fingers, thoracic rotation and anterior compression with stretching in sitting position to improve respiratory functions. These exercises were suggested to the patient as a regular daily treatment along with low-level incentive spirometry breathing exercises. Following 9th sessions of treatment patient demonstrated satisfactory improvement by means of increasing in chest expansion and reduction in dyspnea level without using supplemental oxygen. The results expressed a substantial clinical improvement in reduction of dyspnea level and improvement in chest expansion

Mobihealth: mobile health services based on body area networks

In this chapter we describe the concept of MobiHealth and the approach developed during the MobiHealth project (MobiHealth, 2002). The concept was to bring together the technologies of Body Area Networks (BANs), wireless broadband communications and wearable medical devices to provide mobile healthcare services for patients and health professionals. These technologies enable remote patient care services such as management of chronic conditions and detection of health emergencies. Because the patient is free to move anywhere whilst wearing the MobiHealth BAN, patient mobility is maximised. The vision is that patients can enjoy enhanced freedom and quality of life through avoidance or reduction of hospital stays. For the health services it means that pressure on overstretched hospital services can be alleviated

Differences in Perceived Patient Mobility Barriers Among Nurses from Various Departments and Location Work-Sites

Background: Hospitalized patients suffer negative outcomes related to lack of mobilization activities such as falls with injury or infection. Mobility requires a multi-disciplinary team approach including Registered Nurses (RNs), Certified Nursing Assistants (NA-Cs), and Physical/Occupational Therapists (PT/OTs) to promote best patient outcomes. The Johns Hopkins Culture of Mobility toolkit provides evidence-based practices for integrating multi-disciplinary mobilization efforts for hospitalized patients. This toolkit had not been implemented on a busy orthopedic post-operative nursing unit in one large hospital. Purpose/aims: To test the impact of the culture of mobility toolkit on caregiver perceptions of mobility barriers and evaluate the implementation of the toolkit on a surgical acute care unit. Methods/Approach: This quality improvement project was implemented on an orthopedic post-surgery inpatient unit in a large medical center in the Pacific Northwest. A pre-survey was administered to RNs, NA-C\u27s and PT/OTs prior to the implementation of this project, and those findings guided the development of an educational intervention. The education was a poster on the Johns Hopkins Culture of Mobility toolkit with focus on using the toolkit\u27s mobility screening tool presented to RN\u27s, NAC\u27s and PT/OT\u27s. Caregivers were also informed to complete a form each shift on the following: the patient\u27s Highest Level of Mobility score, the patient\u27s mobility goal for the shift, whether the patient met the personal goal, and barriers/facilitators to the patient\u27s ability to meet personal goals. Staff were directed to complete tracking sheets each shift for each patient during a 6-week period. After the intervention, all staff were invited to complete the post-survey to re-assess perceived mobility barriers. Results: More than 90 caregivers completed the pre-intervention perceived mobility barriers survey, which suggested that staff felt that patient mobilization efforts were time-intensive and posed an injury risk for caregivers. After the education was provided, over 240 mobility tracking sheet were submitted by mainly RN\u27s working night shift, and 65% of caregivers reported that the patient\u27s self-reported mobility goal was met by the end of the shift. Barriers to achieving patient-created mobility goals included inadequate symptom management, reduced patient-specific motivation to move, and lack of adequate resources to safely mobilize patients. A total of 32 caregivers responded to the post-project mobility survey, revealing a significant decrease in overall perceived mobility barriers from preintervention levels. PT/OTs reported significantly less barriers compared to nursing staff at both time points. Conclusion: This project demonstrated that multi-disciplinary staff working on a busy orthopedic postsurgical floor can adopt evidence-based practice tools to promote mobility which may facilitate increased patient mobilization activities. Future projects may include greater adoption of the toolkit throughout the medical center. Implications for practice: Hospital-based mobility programs such as the Johns Hopkins Culture of Mobility toolkit can mitigate functional decline of adults following hospitalization. Inpatient mobility activities may be enhanced by engaging patients to set and attain mobility goals each shift, partnering with PT/OTs, identifying patient motivation to mobilize, and optimizing symptom management.https://digitalcommons.psjhealth.org/prov_rn_conf_all/1035/thumbnail.jp

Modeling the consequences of tongue surgery on tongue mobility

This paper presents the current achievements of a long term project aiming at predicting and assessing the impact of tongue and mouth floor surgery on tongue mobility. The ultimate objective of this project is the design of a software with which surgeons should be able (1) to design a 3D biomechanical model of the tongue and of the mouth floor that matches the anatomical characteristics of each patient specific oral cavity, (2) to simulate the anatomical changes induced by the surgery and the possible reconstruction, and (3) to quantitatively predict and assess the consequences of these anatomical changes on tongue mobility and speech production after surgery