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Rogers MM, Friebert S, Williams CSP, Humphrey L, Thienprayoon R, Klick JC. Pediatric Palliative Care Programs in US Hospitals. Pediatrics 2021; 148:peds.2020-021634. [PMID: 34183362 DOI: 10.1542/peds.2020-021634] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/01/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Pediatric palliative care (PPC) is integral to the care of children living with serious illnesses. Despite the growth in the number of established palliative care programs over the past decade, little is known about the current operational features of PPC programs across the country. METHODS The National Palliative Care Registry collects annualized data on palliative care programs' structures, processes, and staffing. Using data from the 2018 registry survey, we report on the operational features of inpatient PPC programs across the United States. RESULTS Fifty-four inpatient PPC programs submitted data about their operations. Programs reported a median of 3.8 full-time equivalent staff per 10 000 hospital admissions (range 0.7-12.1) across the core interdisciplinary team, yet few (37%) met the minimum standards of practice for staffing. Programs provided more annual consults if they were longer-standing, had more interdisciplinary full-time equivalent staff, offered 24/7 availability for patients and families, or were at larger hospitals. The majority of programs reported concern for burnout (63%) and an inability to meet clinical demand with available staffing (60%). CONCLUSIONS There is considerable variability in PPC program operations and structure in hospitals. This study affirms the need for updated program standards and guidelines, as well as research that describes how different care delivery models impact outcomes for patients, families, staff, and health care systems. Future studies that further define the clinical demand, workload, and sustainability challenges of PPC programs are necessary to foster the provision of high-quality PPC and maintain a vital clinical workforce.
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Affiliation(s)
- Maggie M Rogers
- Center to Advance Palliative Care at the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sarah Friebert
- Division of Pediatric Palliative Care, Department of Pediatrics and Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, Ohio
| | - Conrad S P Williams
- Palliative Care Program and Department of Pediatrics, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Lisa Humphrey
- Division of Hospice and Palliative Medicine, Department of Pediatrics, Nationwide Children's Hospital, The Ohio State University School of Medicine, Columbus, Ohio
| | - Rachel Thienprayoon
- Department of Anesthesia, Division of Palliative Care, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Jeffrey C Klick
- Department of Palliative Care, Children's Healthcare of Atlanta and Division of Palliative Care, Department of Pediatrics, School of Medicine, Emory University, Atlanta, Georgia
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Rogers MM, Sinclair S, Silvers A, Bowman BA, Heitner R, Aldridge M, Kelley AS, Meier DE. Response to Kavalieratos: Directing the Narrative to Define and Present Standardization in Palliative Care (DOI: 10.1089/jpm.2019.0548). J Palliat Med 2021; 24:327-328. [PMID: 33650910 DOI: 10.1089/jpm.2020.0710] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Maggie M Rogers
- Center to Advance Palliative Care of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Stacie Sinclair
- Center to Advance Palliative Care of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Allison Silvers
- Center to Advance Palliative Care of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brynn A Bowman
- Center to Advance Palliative Care of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Rachael Heitner
- Center to Advance Palliative Care of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Melissa Aldridge
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA.,James J. Peters VA Medical Center, Bronx, New York, USA
| | - Amy S Kelley
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Diane E Meier
- Center to Advance Palliative Care of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Rogers MM, Meier DE, Morrison RS, Moreno J, Aldridge M. Factors Associated with the Adoption and Closure of Hospital Palliative Care Programs in the United States. J Palliat Med 2021; 24:712-718. [PMID: 33058737 PMCID: PMC8064954 DOI: 10.1089/jpm.2020.0282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2020] [Indexed: 11/13/2022] Open
Abstract
Background: In the United States, the percentage of hospitals over 50 beds with palliative care programs has risen substantially from 7% of hospitals in 2001 to 72% in 2017. Yet the dynamic nature of program adoption and closure over time is not known. Objective: To examine the rate of palliative care program adoption and closure and associated hospital and geographic characteristics in a national sample of U.S. hospitals. Design: Adoption and closure rates were calculated for 3696 U.S. hospitals between 2009 and 2017. We used multivariable logistic regression models to examine the association between adoption and closure status and hospital, geographic, and community characteristics. Setting/Subjects: All nonfederal general medical and surgical, cancer, heart, and obstetric or gynecological hospitals, of all sizes, in the United States in operation in both 2009 and 2017. Results: By 2017, 34.9% (812/2327) of the hospitals without palliative care in 2009 had adopted palliative care programs, and 15.0% (205/1369) of the hospitals with programs had closed them. In multivariable models, hospitals in metropolitan areas, nonprofit and public hospitals (compared to for-profit hospitals), and those with residency training approval by the Accreditation Council for Graduate Medical Education were significantly more likely to adopt and significantly less likely to close palliative care programs during the study period. Conclusions: This study indicates that palliative care is not equitably adopted nor sustained by hospitals in the United States. Federal and state interventions may be required to ensure that high-quality care is available to our nation's sickest patients.
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Affiliation(s)
- Maggie M. Rogers
- Center to Advance Palliative Care of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Diane E. Meier
- Center to Advance Palliative Care of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - R. Sean Morrison
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- James J. Peters VA Medical Center, Bronx, New York, USA
| | - Jaison Moreno
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Melissa Aldridge
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- James J. Peters VA Medical Center, Bronx, New York, USA
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Rogers MM, Chambers B, Esch A, Meier DE, Bowman B. Use of an Online Palliative Care Clinical Curriculum to Train U.S. Hospital Staff: 2015-2019. J Palliat Med 2020; 24:488-495. [PMID: 33306934 DOI: 10.1089/jpm.2020.0514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Most clinicians in the United States do not receive pre-professional education in pain and symptom management, communication skills, and caregiver support. The use of these skills by clinicians improves the quality of care for persons living with serious illness and enables the specialty-trained palliative care workforce to focus on patients whose needs are most complex. Objective: To review current trends in hospital use of the Center to Advance Palliative Care (CAPC) online clinical training curriculum. Description: Launched in 2015, CAPC clinical curriculum educates clinicians in the knowledge and skills necessary to improve care for patients with serious illness. CAPC currently offers 43 clinical courses and 4 Designations in recognition of successful completion of training by topic. Results: From January 15, 2015, to August 31, 2019, 26,535 clinicians working in hospitals completed 172,684 clinical courses. Registered nurses represented half of learners, and advanced practice providers were most likely to seek Designation. Physicians made up 22% of all learners; 85% of physician learners came from specialties beyond palliative care. Two of every five U.S. hospitals with more than 300 beds had at least one learner. In post-course evaluations, 84% reported that they will make practice changes as a result, and 70% reported that the content was new. Conclusions: The CAPC clinical curriculum is a widely used and valued method for education in clinical skills specific to the care of people living with serious illness. Findings suggest that an increasing number of hospital leaders recognize the importance of these skills in caring for patients with serious illness and support the necessary training.
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Affiliation(s)
- Maggie M Rogers
- Center to Advance Palliative Care of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brittany Chambers
- Center to Advance Palliative Care of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Andrew Esch
- Center to Advance Palliative Care of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Diane E Meier
- Center to Advance Palliative Care of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Brynn Bowman
- Center to Advance Palliative Care of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Rogers MM, Kamal AH, Rodgers PE, Meier DE, Pantilat SZ. Response to Bharadwaj et al., Challenges of Promoting Uniformity in Programs within a Health Care System (DOI: 10.1089/jpm.2019.0404). J Palliat Med 2020; 23:884-885. [PMID: 32196403 DOI: 10.1089/jpm.2020.0094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Maggie M Rogers
- Center to Advance Palliative Care of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Arif H Kamal
- Duke Cancer Institute and the Fuqua School of Business, Duke University, Durham, North Carolina, USA
| | - Phillip E Rodgers
- Adult Palliative Medicine Program, Departments of Family Medicine and Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Diane E Meier
- Center to Advance Palliative Care of the Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Steven Z Pantilat
- Division of Palliative Medicine, Department of Medicine, University of California San Francisco, San Francisco, California, USA
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Pruett T, Rogers MM, Axelrod DA. Patient Safety Reporting: Lessons From the Blind Men and the Elephant. Am J Transplant 2015; 15:3021-3. [PMID: 26560444 DOI: 10.1111/ajt.13531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 08/30/2015] [Accepted: 08/30/2015] [Indexed: 01/25/2023]
Affiliation(s)
- T Pruett
- Department of Surgery, University of Minnesota, Minneapolis, MN
| | - M M Rogers
- LifeSource Organ and Tissue Donation, Minneapolis, MN
| | - D A Axelrod
- Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH
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Gilbert BC, Shulman HB, Fischer LA, Rogers MM. The Pregnancy Risk Assessment Monitoring System (PRAMS): methods and 1996 response rates from 11 states. Matern Child Health J 1999; 3:199-209. [PMID: 10791360 DOI: 10.1023/a:1022325421844] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To determine if the Pregnancy Risk Assessment Monitoring System (PRAMS) is a unique and valuable MCH data source and an effective mechanism for states to collect MCH data, and to assess if recent changes in it have improved efficiency and flexibility. METHODS Each component of the PRAMS methodology is described: sampling and stratification, data collection, questionnaire, and data management and weighting. To assess effectiveness, we calculated response rates, contact rates, cooperation rates, refusal rates, and questionnaire completion rates. Logistic regression was used to examine the relationship between maternal and infant characteristics and the likelihood of response. Four criteria were defined to measure improvement in PRAMS functioning. RESULTS Overall response rates for the 11 states in 1996 ranged from 66% to 80%. Cooperation rates were high (85-99%), with contact rates somewhat lower (73-87%). Response rates were higher for women who were older, White, married, had more education, were first-time mothers, and had a normal-birthweight infant. In all states, parity and education were the most consistent predictors of response, followed by marital status and race. Between 1988-1990 and 1996-1999, the number of states and areas participating in PRAMS increased from 6 to 23, response rates improved, and the time for a state to start data collection and to obtain a weighted dataset both decreased. CONCLUSIONS PRAMS is a unique and valuable MCH data source. The mail/telephone methodology used in PRAMS is an effective means of reaching most women who have recently given birth in the 11 states examined; however, some population subgroups are not reached as well as others. The system has become more efficient and flexible over time and more states now participate.
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Affiliation(s)
- B C Gilbert
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Rogers MM, Broughton AK. Helping physicians cope with RBRVS. Hosp Top 1999; 71:27-31. [PMID: 10131259 DOI: 10.1080/00185868.1993.10543730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Hospital administrators have long recognized the importance of strong ties with medical staff. Implementation of the resource-based relative value scale (RBRVS) has disrupted the normal practice of physicians and has placed renewed stress upon the hospital-physician relationship. Hospital administrators can use their expertise to help physicians offset revenue losses incurred under this payment reform. Such an approach is logical and will benefit all parties involved, because it will enhance physician-facility relations and augment facility credibility. In this article, RBRVS is examined in terms of its impact on physicians, hospitals, and the relationship between the two. Financial management strategies are identified that can assist physicians to increase practice efficiency and cost containment to remedy potential revenue reductions caused by the implementation of RBRVS.
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Affiliation(s)
- M M Rogers
- Graduate Program of Health Administration, Xavier University, Cincinnati
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Affiliation(s)
- M M Rogers
- Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA 30341, USA
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Abstract
PURPOSE This study evaluated the impact of a resource mothers program (RMP) on prenatal care use, low birth weight (LBW), and preterm birth (PTB). The intervention used paraprofessional women to provide social support to pregnant teenagers through home visiting. METHODS Data were obtained by linking RMP, health department, and birth certificate data. Outcomes for primiparous teenagers were compared across two main study groups: a RMP group (n = 1,901) and a comparison group from counties in which the program was not offered (n = 4,613). Multiple logistic regression was used to estimate the effects of program participation with simultaneous adjustment for age, race, marital status, and previous pregnancies. Odds ratios (OR) and 95% confidence intervals (CI) were calculated. RESULTS Resource mothers program teenagers were more likely to initiate prenatal care early (OR = 1.48; CI = 1.32-1.66) and to receive adequate prenatal care (OR = 1.58; CI = 1.40-1.78) than teenagers in the other counties. The program had no significant effect on LBW, but unmarried teenagers in the RMP group were less likely to have a PTB than unmarried teenagers in the other counties with an OR of 0.81 (CI = 0.70-0.95). These findings were supported by analyses using a second comparison group. CONCLUSIONS Given that PTB contributes heavily to infant mortality, the program's effect on PTB is promising.
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Affiliation(s)
- M M Rogers
- Bureau of Maternal and Child Health, Department of Health and Environmental Control, Columbia, South Carolina 29211, USA
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Sappenfield WM, Rogers MM, Younghaus PF, Barton B, Meglen MC. The health of women and children in South Carolina: success or crisis? J S C Med Assoc 1996; 92:103-13. [PMID: 8881605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- W M Sappenfield
- Bureau of Maternal and Child Health, Office of Planning and Evaluation, Columbia, SC 29211, USA
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Rogers MM, Peoples-Sheps MD, Sorenson JR. Translating research into MCH service: comparison of a pilot project and a large-scale resource mothers program. Public Health Rep 1995; 110:563-9; discussion 562. [PMID: 7480610 PMCID: PMC1381632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
This study examines the process and effect of translating a pilot research project into a large-scale service program. In a pilot resource mothers program for pregnant teenagers, participants had fewer low birth weight infants than teenagers in the comparison group. In the corresponding large-scale service program, a similarly positive effect on low birth weight was not seen. In an effort to understand how these differences occurred, the evaluation methodologies and key characteristics that describe the background, infrastructure, components, and service providers of the two projects were compared. Important differences between the pilot project and the service program were seen in funding stability, diversity of staff, community versus health department ownership of the program, caseloads, and levels of training and supervision. It seems probable that these differences brought about changes in the intensity and character of the intervention from the pilot to the service program, leading to a reduction of the intervention's efficacy in reducing the number of low birth weight infants. The implications of these findings for researchers and program planners are discussed.
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Affiliation(s)
- M M Rogers
- Bureau of Maternal and Child Health, South Carolina Department of Health and Environmental Control, Columbia, SC 29211, USA
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Rogers MM. The capital expenditure process for the health care supervisor. Health Care Superv 1993; 12:17-24. [PMID: 10130075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
Competition for health care capital dollars has increased as third-party and government reimbursement decreases, patient volume decreases, and alternative services increase. Given this rationing situation, it is more important than ever that the health care supervisor carefully document and present a capital expenditure request. This request should outline skillfully the benefits and costs of undertaking a new service or replacing an old asset. A supervisor who can quantify the costs and benefits of a project and utilize one of the four common capital budgeting techniques: payback period, net present value, profitability index, or internal rate of return, will certainly be taking a step in the right direction for ensuring a serious evaluation of his or her proposal. This article attempts to explain this process using both narrative and quantitative examples.
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Affiliation(s)
- M M Rogers
- Graduate Program of Health Administration, Xavier University, Cincinnati, OH
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Rogers MM, Schwartz J. Healthcare for the homeless. A public health agency, a business, and a Catholic provider open a clinic. Health Prog 1993; 74:58-60. [PMID: 10130096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Abstract
In some communities, hospital emergency departments are the only places that provide healthcare services to homeless persons. In Dayton, OH, homeless persons have another option--the Samaritan: A Healthcare Clinic for the Homeless. The clinic is a collaborative venture involving the area's public health department, a Fortune 500 business, and a Catholic hospital. In 1991 Dayton's public health department, the Combined Health District (CHD) of Montgomery County, received an anonymous $50,000 donation to provide primary healthcare services to homeless persons. With the goal of generating a number of stakeholders to invest in the community (which would translate into additional volunteers and donations), CHD asked Good Samaritan Hospital, Dayton, if it would become a partner in launching the clinic. Good Samaritan agreed, seeing this as an opportunity to provide a much-needed community service and to fulfill its mission of providing care to the area's needy citizens. In addition, the project was consistent with the hospital's increased focus on primary care. Sponsors of the Samaritan: A Healthcare Clinic for the Homeless anticipate three outcomes resulting from this collaborative effort. First, the cost of healthcare for Dayton's citizens should decrease. Second, providing healthcare services to the homeless enhances the possibility of breaking the cycle of homelessness. Finally, it is critical that healthcare for the homeless become a community focus.
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Rogers MM, Rothe K. Integrating capital budgeting techniques. Health Care Strateg Manage 1993; 11:7-10. [PMID: 10123827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
A.J. Hogan, in "Capital Expenditure Planning: The Value of Information to Hospitals," published in 1987 in Hospital and Health Services Administration, illustrated the value of information to the expenditure process. He noted that knowing what your competitors are up to, as well as where your facility stands in the market, can enable all concerned to make better judgments. One of the likely outcomes of good judgments is the efficient use of all resources. Unfortunately, Hogan's model draws on a non-existent computerized regional planning agency with the authority to approve or deny proposals. Integrated strategic financial planning also illustrates the value of information. In this case, information is readily available. The sources are the administrators: finance, accounting, marketing, and planning experts, doctors, nurses, statisticians, and epidemiologists. Each can make a unique contribution to the process, and together they can effectively guide the organization's capital budgeting programs. We have illustrated that there does exist a planning model that can work with the plurality of viewpoints in today's hospitals to produce the "most informed" decisions with known sensitivity to the decision criteria used.
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