Has DRG payment influenced the technical efficiency and productivity of diagnostic technologies in Portuguese public hospitals? An empirical analysis using parametric and non���parametric methods

The use of Diagnosis Related Groups (DRG) as a mechanism for hospital financing is a currently debated topic in Portugal. The DRG system was scheduled to be initiated by the Health Ministry of Portugal on January 1, 1990 as an instrument for the allocation of public hospital budgets funded by the National Health Service (NHS), and as a method of payment for other third party payers (e.g., Public Employees (ADSE), private insurers, etc.). Based on experience from other countries such as the United States, it was expected that implementation of this system would result in more efficient hospital resource utilisation and a more equitable distribution of hospital budgets. However, in order to minimise the potentially adverse financial impact on hospitals, the Portuguese Health Ministry decided to gradually phase in the use of the DRG system for budget allocation by using blended hospitalspecific and national DRG casemix rates. Since implementation in 1990, the percentage of each hospitals budget based on hospital specific costs was to decrease, while the percentage based on DRG casemix was to increase. This was scheduled to continue until 1995 when the plan called for allocating yearly budgets on a 50% national and 50% hospitalspecific cost basis. While all other nonNHS third party payers are currently paying based on DRGs, the adoption of DRG casemix as a National Health Service budget setting tool has been slower than anticipated. There is now some argument in both the political and academic communities as to the appropriateness of DRGs as a budget setting criterion as well as to their impact on hospital efficiency in Portugal. This paper uses a twostage procedure to assess the impact of actual DRG payment on the productivity (through its components, i.e., technological change and technical efficiency change) of diagnostic technology in Portuguese hospitals during the years 1992���1994, using both parametric and nonparametric frontier models. We find evidence that the DRG payment system does appear to have had a positive impact on productivity and technical efficiency of some commonly employed diagnostic technologies in Portugal during this time span.

Using patient knowledge for better health systems

Purpose ��� This paper describes a ���work in progress��� research project being carried out with a public health care provider in the UK, a large NHS hospital Trust. Enhanced engagement with patients is one of the Trust���s core principles, but it is recognised that much more needs to be done to achieve this, and that ICT systems may be able to provide some support. The project is intended to find ways to better capture and evaluate the ���voice of the patient��� in order to lead to improvements in health care quality, safety and effectiveness. Design/methodology/approach ��� We propose to investigate the use of a patient-orientated knowledge management system (KMS) in managing knowledge about and from patients. The study is a mixed methods (quantitative and qualitative) investigation based on traditional action research, intended to answer the following three research questions: (1) How can a KMS be used as a mechanism to capture and evaluate patient experiences to provoke patient service change (2) How can the KMS assist in providing a mechanism for systematising patient engagement? (3) How can patient feedback be used to stimulate improvements in care, quality and safety? Originality/value ���This methodology aims to involve patients at all phases of the study from its initial design onwards, thus leading to an understanding of the issues associated with using a KMS to manage knowledge about and for patients that is driven by the patients themselves. Practical implications ��� The outcomes of the project for the collaborating hospital will be firstly, a system for capturing and evaluating knowledge about and from patients, and then as a consequence, improved outcomes for both the patients and the service provider. More generally, it will produce a set of guidelines for managing patient knowledge in an NHS hospital that have been tested in one case example.

Application of the Artificial Intelligence Algorithms for System Analysis of Multi Dimension Physiological Data for Developing Polyparametric Information System of Public Health Diagnostics

The polyparametric intelligence information system for diagnostics human functional state in medicine and public health is developed. The essence of the system consists in polyparametric describing of human functional state with the unified set of physiological parameters and using the polyparametric cognitive model developed as the tool for a system analysis of multitude data and diagnostics of a human functional state. The model is developed on the basis of general principles geometry and symmetry by algorithms of artificial intelligence systems. The architecture of the system is represented. The model allows analyzing traditional signs - absolute values of electrophysiological parameters and new signs generated by the model ��� relationships of ones. The classification of physiological multidimensional data is made with a transformer of the model. The results are presented to a physician in a form of visual graph ��� a pattern individual functional state. This graph allows performing clinical syndrome analysis. A level of human functional state is defined in the case of the developed standard (���ideal���) functional state. The complete formalization of results makes it possible to accumulate physiological data and to analyze them by mathematics methods.

Forging professional public health nursing in a southern state: Florida's public health nurses, 1889-1934

From 1889 to 1934, Florida's nurses belonging to a new group of professional women ushered in a pioneering phase of public health nursing in Florida. During this era, the nurses' ability to confront health and professional issues varied a great deal but in quiet and forceful ways they tackled cultural and environmental problems to assist people who were ill or help prevent people from becoming ill. This dissertation places the development of professional public health nursing in its social context by uncovering the relationships public health nurses formed with clubwomen, the medical profession, city leaders, midwives, and others. In 1888, there were few graduate nurses in the state, no state board of health and no organized nursing service to respond to Jacksonville's great yellow fever epidemic. By 1934, national and state leaders of public health nursing had built up the profession to become an essential part of the State Board of Health's service to the community. Between these milestones, in the era of white supremacy and Jim Crow, public health nurses combined their professional training with a pioneer spirit of innovation and risk-taking. In the predominately rural state, the public health nurses' resolve to overcome environmental hazards and cultural obstacles stands out as they attempted to reach those who were unserved or underserved by modern medicine.

Review of dietary assessment methods in public health

This report provides a descriptive summary of tools to measure dietary intake and dietary behaviours - exploring the application, reliability and validity of the various tools.

Healthy Food, Healthy Iowans, Healthy Communities Public Health Tools to Advance Healthy, Sustainable Food Systems, June 2014

The purposes of the Healthy Food, Healthy Iowans, Healthy communities Series are to demonstrate the interconnectedness of the food system to public health issues (Part 1) and to provide tools to local public health agencies for assessing, planning, implementing and evaluating food system initiatives (Part 2).