Health care resource utilization in Newfoundland

• Main Author: Butler, John Spencer
• Format: Thesis
• Language: English
• Published: Memorial University of Newfoundland 1995
• Subjects: Newfoundland
• Online Access: https://research.library.mun.ca/5656/; https://research.library.mun.ca/5656/1/Butler_JohnS.pdf; https://research.library.mun.ca/5656/3/Butler_JohnS.pdf

Health care delivery is not subject to the economic forces which achieve productive and allocative efficiencies in competitive markets. Allocative efficiency is addressed in the context of a methods review for measuring hospital bed utilization. Productive efficiency is addressed by examining the utilization of ciprofloxacin, an expensive antibiotic. -- The reliability and validity of several methods of measuring hospital bed utilization were assessed. Nurse (A) prospectively collected data on the clinical condition and care plans of 80 patients at an acute care hospital, and identified and classified inappropriate days using her clinical judgement. In the same way, a second nurse (B), experienced in appropriateness evaluation, independently rated the same cases as did a third nurse (C), using a modified version of the Appropriateness Evaluation Protocol (AEP). Nurse A's data was also independently rated by a panel (P). Agreement for the number of inappropriate hospital days per case as measured using the Intraclass Correlation Coefficient (Rx) was excellent: Nurse A v P = 0.95, Nurse A v C = 0.87, P vs C = 0.88, B v A = 0.87, B v P = 0.79, B v C = 0.72. Reliable and valid judgements of inappropriateness can thus be made by any of these methods. -- In the second study, an academic panel and an industry panel used guidelines to assess the appropriateness of 278 ciprofloxacin prescriptions which were generated through chart review and interview of 72 physicians. Ciprofloxacin was considered to be appropriately prescribed in 42% of cases by the academic panel, and in 62% by the industry panel. The only diagnoses where the two panels differed significantly were nursing home-acquired pneumonia (p < 0.0005) and acute exacerbation of chronic bronchitis (AECB) (p < 0.0001). Agreement between the two panels was fair (K = 0.36), but agreement increased to moderate when cases of nursing home-acquired pneumonia and AECB were removed (K = 0.58). -- Inappropriate prescription of ciprofloxacin inhibits productive ...