Question

List the business trade-offs inherent in the various methods of acquiring systems.

• Describe which systems acquisition approach is appropriate for the medical staff of the cardiac ward at your hospital.

Answer 1

* business trade-offs : We study the presence and the magnitudes of trade-offs between health outcomes and hospitals’ efficiency using a data set from Lombardy, Italy, for the period 2008–2011. Our goal is to analyze whether the pressures for cost containment may affect hospital performance in terms of population health status. Unlike previous work in this area, we analyze hospitals at the ward level so comparisons can be made across more homogeneous treatments. We focus on two different health outcomes: mortality and readmission rates. We find that there is a trade-off between mortality rates and efficiency, as more efficient hospitals have higher mortality rates. We also find, however, that more efficient hospitals have lower readmission rates. Moreover, we show that focusing the analysis at the ward level is essential, since there is evidence of higher mortality rates in general medicine and surgery, while in oncology mortality is lower in more efficient hospitals. Furthermore, we find that consideration
spatial processes is important since mortality rates are higher for hospitals subject to high degree of horizontal competition, but lower for those hospitals having strong competition but high efficiency. This implies that the interplay of efficient resource allocation and hospital competition is important for the sustainability and effectiveness of regional health care systems.

--> The Affordable Care Act, with its subsidies, demonstrations, commissions, and study groups, embodies a considerable amount of regulatory and policy pressure on markets to improve the quality of health care. However, it is possible that this government-led movement will lead to a lot of talk about quality but not necessarily much improvement. A better strategy may be found through “disruptive innovation,” a market-driven approach that has balanced cost and quality in other industries. An example would be to provide lower-cost substitutes for some aspects of primary physician care, in the form of care at a retail clinic. Consumers might not perceive a clinic as a perfect substitute for physician care, but they might prefer the greater convenience and lower cost. Perhaps a little less quality for a lot less money might be acceptable to consumers and taxpayers, as we work to keep medical spending from siphoning off funds required for other needs.

At least two things that are related to the basic market requirements noted above. First is the willingness and ability of consumers to “vote with their feet,” meaning that consumers of medical care don’t always respond to variations in price or quality in the way that one would expect. This may be because often there are only a few options (just one hospital in town) and because buyers are poorly informed and passive. Moreover, insurance confuses the process by which price influences consumers’ behavior in health care: The presence of insurance shields the consumer from the full effect of prices, which means that the party who decides what service to use (the patient) is not responsible for paying its full price.

The upshot is that we must consider alternative strategies to determine and ensure appropriate medical quality to account for the peculiarities of the market for health care.

* Describe which systems acquisition approach is appropriate for the medical staff of the cardiac ward at your hospital ?

-->The Cardiac and Thoracic Critical Care Unit (CTCCU) is a specialist unit. We admit patients with a range of cardiac, thoracic and vascular problems, both surgical and medical

There are two sides to the unit; one for patients with acute cardiac medical problems (Coronary Care Unit), and one for patients who have undergone cardiac and thoracic surgery (Cardiothoracic Critical Care).

-- Coronary Care Unit :-

The Coronary Care Unit (CCU) cares for patients who have heart disease and occasionally other medical or surgical problems.

Conditions such as myocardial infarction (heart attack), angina (chest pain), left ventricular failure (LVF) and arrhythmias (abnormal heart beats) are common reasons to be admitted to CCU.

A patient having a heart attack may be admitted directly to the CCU, transferred to the Cardiac Angiography Suite for a primary coronary (cardiac) angioplasty and then returned to the CCU for ongoing care. Patients with cardiac chest pain, but not having a heart attack, may be admitted to the CCU before and/or after the placement of stents in coronary blood vessels.

Patients with acute shortness of breath as a result of the heart not pumping efficiently (LVF), are given medication and helped to breathe. A patient with an abnormally fast, slow or irregular heart beat may be admitted to the CCU so that we can monitor heart rate and rhythm and provide treatment.

The CCU can monitor the heart's rhythm, blood pressure and oxygen levels continuously, and the nursing team record and interpret heart traces (electrocardiogram/ECG). While a patient is in the CCU a cardiologist may perform a specialised test, such as echocardiography, which looks at the pumping function of the heart.

Most patients in the CCU can breathe without the assistance of a machine (ventilator) - though some will need oxygen (either by nasal prongs or mask). Patients who need additional support from a ventilator will be transferred to the intensive care unit.

-- Cardiothoracic Critical Care :

Patients are admitted if they need intensive monitoring and care following cardiothoracic surgical procedures.
These include:

1)coronary artery bypass grafting
2)aortic or mitral valve replacements/repairs
3)complex thoracic aortic surgery
4)thoracic surgery
5)'ventricular assist device' implantation A mechanical pump that takes over the function of the damaged ventricle of the heart and restores normal blood flow.

Patients are admitted immediately from theatre and each is cared for by their own nurse until they are able to come off the ventilator.

Once they are stable, they are moved to the High Dependency Unit (HDU), and from there to the Cardiothoracic Ward to continue their recovery.

Patients who develop complications may stay for many days, or occasionally months. They may require long-term support with drugs or devices that support their heart.

Patients who come to the unit have either been on the waiting list for surgery or come as emergencies. Patients are referred from within the Oxford University Hospitals by local district general hospitals and also from further afield for some specialist surgery.