Healthcare outcomes

Acting as a resource in the formation of public policy relevant to pharmacoeconomics, healthcare outcomes assessment, and related issues of public concern. 

American Journal of Managed Care. Jamesburg, NJ American Medical Publishing. Monthly. ISSN 1088-0224. Original, peer-reviewed clinical studies that emphasize healthcare outcomes, clinical- and cost-effectiveness, new technologies, quality management and clinical information systems, physician and patient behavior, and health policy. 

Adis PharmacoEconomics and Outcomes News 1994-. Chester, U.K. Adis International Limited. Daily. Adis Phar-macoEconomics and Outcomes News is a full text database and is the online equivalent to the weekly newsletter of the same name. It presents up-to-date analyses on world pharmacoeconomics and healthcare outcomes news, views, and practical application. More than 2000 major international medical, biomedical, and pharmacoeconomic journals are routinely scanned for inclusion. Available online. 

A three-year health project conducted by the OECD examining the performance of healthcare systems in different countries highlighted examples where the highest spending countries did not necessarily achieve the best healthcare outcome (12). 

The potential of expensive new technologies to improve healthcare outcomes and reduce expenses over time was recognized, but it was felt their benefits would need to be carefully assessed in the long term (13). 

The likelihood of a successful resuscitation outcome is enhanced if each of four critical elements in the chain of survival is implemented promptly (1) early recognition of the emergency and activation of emergency medical services (2) early bystander basic life support and CPR (3) early delivery of a shock with a defibrillator and (4) early ACLS followed by resuscitation care delivered by healthcare professionals. 

Depression, a treatable condition that affects nearly five million seniors, also goes undetected by some healthcare providers. Some healthcare professionals view depression as just part of getting old. Untreated, this illness can have serious, even fatal consequences. According to the National Institute of Mental Health, older Ameri-(40) cans account for a disproportionate share of suicide deaths, making up 18% of suicide deaths in 2000. Healthcare providers could play a vital role in preventing this outcome—several studies have shown that up to 75 % of seniors who die by suicide visited a primary care physician within a month of their death. 

High quality, patient-centered healthcare with best processes and proven outcomes Strategy ... 

There is no doubt that the continuing evaluation of the safety of medicines into the post-marketing period is an expanding and stiU developing area of research. Matters relating to safety spread over into efficacy, which together imply risks and benefits which, in the present international climate of healthcare provision, have consequences for outcomes and costs. A whole new field of research - pharmacoeconomics - is in the process of development and it is to be anticipated that many of the methods used for safety evaluation will be modified and applied in this area. 

The assessment of the clinical benefit of medicines is generally understood by clinicians, regulatory authorities and reimbursement authorities alike. Everyone instinctively understands the clinical benefit of decreasing a hypertensive patient s blood pressure to 130/90 or the benefit in reducing the number of strokes. However, in an era of increasing healthcare costs and funding decisions, there is a need not only to illustrate the clinical benefit of a drug, but to translate that clinical outcome into an economic benefit. 

Morgan S. and B. MacGibbon (2007). Pharmaceutical use and outcomes Always a need for a sober second look. Healthcare Policy 3 10-15. 

The current system is in crisis. The system has failed to address the needs of the developing world and it is in danger of failing to address the needs of the developed world too. But we know from the loM s report on the healthcare delivery system and from observations on the way complex adaptive systems behave that all the components of a system must share a goal in order to achieve it. So we know that reframing the obligations of one component of the system, the pharmaceuticals, will not be enough to achieve the outcomes we want. 

Suri R, Grieve R, Normand C, et al. Effects of hypertonic saline, alternate day and daily rhDNase on healthcare use, costs and outcomes in children with cystic fibrosis. Thorax. 2002 57 841-846. 

There is a complex web of interactions between traditional medicine, biodiversity conservation, protection of indigenous rights, encouraging research and development investment, improving access to medicines and enhancing healthcare. Placing tension at one point in that delicate web can dramatically alter the interactions and the outcomes of natural product research. 

Many trials combine events in their primary outcome measure. This can produce a useful measure of the overall effect of treatment on all the relevant outcomes, and it usually affords greater statistical power, but the outcome that is most important to a particular patient may be affected differently by treatment than the combined outcome. Composite outcomes also sometimes combine events of very different severity, and treatment effects can be driven by the least important outcome, which is often the most frequent. Equally problematic is the composite of definite clinical events and episodes of hospitalization. The fact that a patient is in a trial will probably affect the likelihood of hospitalization and it will certainly vary between different healthcare systems. 

VA, 363 male military veterans were randomly sampled and found to have a current prevalence of 32% for full PTSD and 10% for partial PTSD. Prevalence of PTSD varied as a function of risk and protective factors, including volunteering, physical symptoms during the tests, and prohibited disclosure. Veterans with full PTSD reported poorer physical health, a higher likelihood of several chronic illnesses and health-related disability, greater functional impairment, and higher likelihood of healthcare use than those with no PTSD. Veterans with partial PTSD also had poorer outcomes than did veterans with no PTSD in a subset of these domains. 

Accidental ingestion of a small piece or less than a few pellets can be adequately managed at home by Poison Control Centers, or by a healthcare professional with home observation and parent education. Usually, these types of exposures do not require any medical intervention or routine follow-up laboratory studies. Gastric decontamination has no effect on the clinical outcome after taste amounts are ingested by children (Kanabar and Volans, 2002 Mullins et al, 2000 Shepherd et al, 2002). 

These factors should be assessed for each supplier being considered, so that the best balance of business fit and compliance can be achieved. An example supplier evaluation matrix is provided in Figure 7.4. Of course, identifying a clear winner in the selection process is seldom clear-cut, and the winner rarely meets all the selection criteria. Some pharmaceutical and healthcare companies weigh the importance of various factors and for the outcome compare the sum totals for each supplier. A summary of the supplier selection process applied to larger systems should be retained for possible subsequent inspection. ... 

---