Nurs Econ
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As the health care industry refines quality assurance and quality improvement standards, the accountability of individual care providers is intensifying. Care providers work within a system of interdependent roles and functions and collaborate to attain the common goal of quality care. A conceptual model was developed which relates the achievement of specific outcomes to nurses' independent, dependent, and interdependent roles and functions. ⋯ Outcomes associated with nurses' independent role functions included the prevention of complications, clinical outcomes, knowledge of diseases and treatments, satisfaction, and cost outcomes. Outcomes associated with nurses' dependent role included adverse incidents which caused problems or prolonged hospital stays. Outcomes associated with nurses' interdependent role included interdisciplinary team functioning.
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Comparative Study
Comparing nursing costs for preterm infants receiving conventional vs. developmental care.
The incremental costs incurred by VLBW (less than 1,500 grams) infants during the first year of life accounted for one-third of the $11.4 billion spent in the U. S. on health care. ⋯ When compared to 60 VLBW infants receiving conventional NICU care, improved physiologic stability measures and fewer days in the NICU were recorded for the 60 VLBW infants cared for by nurses and trained developmental care specialists. Because the move from the NICU to the transitional unit occurred earlier for the developmental group of VLBW infants, and their nursing intensity needs were lower, the average cost savings achieved for this group was $4,340 per infant during the first 35 days of life or less if discharged.
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Data regarding the cost of staff training associated with restructuring are scarce and incomplete, with little measurement of how staff performed after training. Effectiveness of staff education efforts are hampered by staff resistance to change, dysfunctional interdisciplinary team work, and existing system "glitches." The key criteria for successful education efforts related to restructuring are: development of measurable desired outcomes of training efforts, determination of solution appropriateness and resource needs, the thoughtful timing of interventions, and a high level of ongoing organizational support. Changes in teamwork effectiveness can be measured by examining variances in quality outcomes, timely and appropriate discharge planning, and resource cost measures such as use of overtime and absenteeism. Recommendations for effective use of training dollars include acknowledging resistance and providing forums which permit time (and a process) for re-education.
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The issues of orphan products include an inadequate definition of orphan status that hampers implementation of the legislation, difficulties in evaluating the products themselves in order to ensure safety and effectiveness, neglect in developing orphan devices, and conflict over creating unnecessary monopolies and excessive profits. However, it has been demonstrated that the ODA is effective in stimulating the development of these much needed drugs and devices. The next efforts therefore can be directed toward increasing the effectiveness and ensuring the equity of the program.