The role of daclizumab in balancing resources for inpatient and outpatient transplant services

Transplant professionals have the dual responsibility of achieving acceptable clinical outcomes and controlling costs. One approach transplant centers have used to control transplant-related costs has been to decrease patients' length of stay, and thus it has decreased significantly in the last 6 years. This reduction in resource consumption has been accomplished by increased efficiency in providing transplantation services, expanding the number of outpatient services available, and integrating new technologies. Future cost containment measures by payers, especially Medicare, will continue to require that transplant centers manage resources and meet financial objectives while achieving acceptable clinical outcomes. Daclizumab, a new immunosuppressive drug, is used as an example in this article, which assesses its value in helping meet resource management and financial goals.

The Role of Daclizumab in Balancing Resources for Inpatient and Outpatient Transplant Services

Transplant professionals have the dual responsibility of achieving acceptable clinical outcomes and controlling costs. One approach transplant centers have used to control transplant-related costs has been to decrease patients' length of stay, and thus it has decreased significantly in the last 6 years. This reduction in resource consumption has been accomplished by increased efficiency in providing transplantation services, expanding the number of outpatient services available, and integrating new technologies. Future cost containment measures by payers, especially Medicare, will continue to require that transplant centers manage resources and meet financial objectives while achieving acceptable clinical outcomes.

Daclizumab, a new immunosuppressive drug, is used as an example in this article, which assesses its value in helping meet resource management and financial goals.

Current efforts toward implementation of an urban health strategy: the Henry Ford Health System

The Henry Ford Health System is one of the nation's major comprehensive nonprofit health systems. Though it serves seven counties in southeastern Michigan, it is based in the heart of the city of Detroit. Detroit, like many of the nation's largest cities, has high rates of poverty, single-parent households, unemployment, and violence. The health status of the population is well below national norms and Healthy People 2000 goals. Through the combined efforts of public and private organizations and the people of southeastern Michigan, Detroit is experiencing a renaissance. Henry Ford Health System is contributing to this renaissance and is working to define its role in improving the health status and quality of life of Detroit's residents. The system's current strategy centers on moving beyond civic projects and philanthropic efforts to the incorporation of care for the uninsured and underinsured in its core operations and plans for growth. To make this change, we have developed a systemwide process that focuses on designing and implementing new delivery models, on partnership development with a variety of organizations, and on managing the care of populations. Our efforts are a work in progress, but they are having an impact on our patients, our organization, and our community.

Probabilities and lifetime durations of short-stay hospital and nursing home use in the United States, 1985

OBJECTIVES

The authors present a four-state increment-decrement life table model from which estimates of the risk and duration of nursing home and short-term hospital stays in the United States are derived.

METHODS

Survival analysis was used to generate various transition probabilities while controlling for population heterogeneity. In addition, a newly developed algorithm was applied to construct the multistate life table specifically for health-care use.

RESULTS

The results reveal that in 1985, a US civilian is expected to spend 72.35 years in the community, 59.5 days in short-stay hospitals, and 2.28 years in nursing homes throughout his or her lifetime.

CONCLUSIONS

The single-year risk of nursing home and short-stay hospital use is shown to be an increasing function of age, especially for the older adults.

Prospective, randomized, double-blind, controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal, mild, and moderate endometriosis

OBJECTIVE

To assess the efficacy of laser laparoscopic surgery in the treatment of pain associated with minimal, mild, and moderate endometriosis.

DESIGN

A prospective, randomized, double-blind, and controlled clinical study.

SETTING

Royal Surrey County Hospital, Guildford, United Kingdom, a referral center for the laser laparoscopic treatment of endometriosis.

PATIENTS

Sixty-three patients with pain (dysmenorrhoea, pelvic pain, or dyspareunia) and minimal to moderate endometriosis.

INTERVENTIONS

The patients were randomized at the time of laparoscopy to laser ablation of endometriotic deposits and laparoscopic uterine nerve ablation or expectant management. Pain symptoms were recorded subjectively and by visual analogue scale. The women were unaware of the treatment allocated as was the nurse who assessed them at 3 and 6 months after surgery.

MAIN OUTCOME MEASURE

Improvement or resolution of pain symptoms assessed subjectively and by visual analogue score.

RESULTS

Laser laparoscopy results in statistically significant pain relief compared with expectant management at 6 months after surgery. Sixty-two and a half percent of the lasered patients reported improvement or resolution of symptoms compared with 22.6% in the expectant group. Results were poorest for minimal disease and, if patients with mild and moderate disease only are included, 73.7% of patients achieved pain relief. There were no operative or laser complications.

CONCLUSIONS

Laser laparoscopy is a safe, simple, and effective treatment in alleviating pain symptoms in women with stages I, II, and III endometriosis.

The structure of self-reported physical health among the aged in the United States and Japan

This article attempts to extend the generalizability of a three-dimensional model of self-reported physical health among the aged to a nonwestern culture. Consisting of three interrelated dimensions, chronic illness, functional status, and self-rated health, this model was empirically evaluated by using national data on the aged gathered in the United States and Japan. The three-dimensional specification was found to apply equally well to U.S. and Japanese elderly. In addition to examining the internal structure of this three-dimensional model, the study assessed the model's relationships with a set of selected exogenous variables including age, sex, marital status, and education. The relationships between the selected exogenous variables and physical health dimensions are largely similar in both countries. However, clear differences appeared in at least three instances.