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- 118 - TABLE 2-Example of the Determination of Program Value for Incarceration EVALUATION TECHNIQUES IN HEALTH SERVICE (1) (2) (3) (4) (5) ((?5 (6 (6) (9) Index ol Poss. Change Pgm. Value Previous 12 Group Ave. Avg. ol Admission Discharge Index od (Discharge Pgm. Value Pos»sab Month's Earn. Annual Earn. (1) & (2) Level Level Change Level od None) (3) x (6> (3) x (7) Individual 1. 7.400 11 000 9.200 Mod. Severe - 30% a 70% -2.760 6.440 Individual 2 4,680' 4,680 4,680 Sev. Mod. +40% + 100% 1,872 4,680 Individual 3 5,100 6,500 5,800 Slight None +400% + 40% 2,320 2,320 Total (T) 1,432 13,440 Avg. = T/3 477 4,480 *Based on a minimum wage dl $2.00 per hour. ioxili;calioln. ;lilhough lnot exremenly cllictivc iii tcl's oí' ils potential. is ani exlrmnicly elliciien prograin. Wc mighl thercfore mniove o cxpand t'realment hoeilos al Ihe expense of' incarceralion aínd try to improve the etlectiveness o ni mehadoane deloxilicaiion. 1' ablc 3 c.an also givc overall ellicicnlcyaiid cll'clivenccss indices for the agency's four programs. These are lound by multiplying each program index by the number of patients in that program (column 1) und then dividing by the tolal group sizc: Overall Agency Elliciency .82x3 + 1.16x57 + I.28X81 + .76x 163 3 + 57 + 81 + 163 = .97 Overall .11 x3 + .6X x57 + .34x81 + .26x 163 Agency 3 + 57 + 81 + 163 Effectiveness = .36 The poor performance of incarceration is minimized in the overall indices due to the small number of patients in that program. In terrns of efficiency. the agency is saving almost as much. in terms of patient productivity. as the program cost. The cellectiveness ol' .36 indicales Ihail they are achieving about onc-third of the maximum possible achievablenot necessarily a poor showing. 'I'his cxaimple has comparetd Jill'cent progrants hbu Ihe same model can also be applied to the same program al dillerent time periods or lo grouLps of patients categorized by means other Ihan treatment programs: e.g.. by sex. age. or diagnosis. Ha;lper'n and Binner 4 point out une of' the inevitable argu- AJPH November, 1976, Vol. 66, No. 11 mcnis agauinst the index evailiaition model when they) stite 1hil; "... .. ileao ;tlllilI liillof ¡ . a f it iieieil1 Ihe;illih proglra;il mi;ly not he able to mnax;inmize his 'relurn oni investment. In fiac. he maiy have lo follow s;ctleics thhail lower hi. reliurn. if he is lo serve those who need his hclp most." IThis. of course. raises a tlinidamclal;l quelilon: WVlo hlhold 'cl ccive tihe hem:fit of ¡he program's limited res'ui'ccs For exaimple. bhould ¡he patient who can utilize them the niost receive the resources or the patient who needs them the most? There are no meth- Mlological or technical answers to such moral and ethical quest ions. Tlie M'ra'kov Ciin MoIdel TABLE 3-Drug Treatment Program Evaluation índices (Hypothetical) ' Eyman's' 1 siatistical evaluation model. the lMarkov Chain. differs significantly fiom that of H:alpcrn and Binner in that it focuses exclusively on the functional level of ¡he patient. using it as the measure of chainge and ihe basis lor cvallation. T'he Markov model delineates. via contingeicy tables. the movement of the patient (or groups of patients) along a scale in terms of the patient's initial position on the scale. Eyman used the Marlkov model io evaluaate the efl:ctiveness of a school progranm antd ain inteinsive treatment program" in a hospital for the mentally retarded. I-owever. the Markov modcl is much more powerl'ul than these limited applicalions suggest. FoI example. as ,¡ill be shown. program costs can be included in the model so that it has the potential of being combined with the index model advanced by Halpern and Binner. In addition. under very general condilions the model has been used' s to predict the probable time- (1) (2) (3) (4) (5) (6) No. ol Pgm. Program Pgm. Eliciency Ellectiveness Program Palienis Value Value Poss. Cost Index = {2)/(4) Index = (2)/(3) Incarceration 3 477 4.480 583 .82 .11 Treatment Home 57 1.510 2,205 1,300 1.16 .68 Methadone Detroaification 81 975 2,870 760 1.28 .34 Methadone Maintenance 163' 450 1,753 590 .76 .26
I MEREDITH - 119 - varying oulcome of a trealment program on a patient. Furthermorc. the modcl can handie more than one treatment progralm ll a lime so as sequential varia
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L 00111111 MASTER COPY - NO TOCAR B
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- ii - liancock, W., D. Magerlein y
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FOREWORD These last years, PAHO wit
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Workshop .- Education in Operationa
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-3. The format of the workshop was
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-5- 2. Programs for bringing togeth
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II. R.commendations -7- A series of
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-9- there are technically trained i
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-11- and selected individuals who h
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-13- 6. In order to improve the qua
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-15- cnve!opment will typically be
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-17- 16. All participants sbould pr
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A. Short Courses -19- Short courses
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-21- 4. Presentation of a case to b
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Topic Introduction to Systems Analy
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-25- 12. Elementary Statistics ior
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-27- 8. Applications of data proces
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-29- problems. The graduate should
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-31- Lblo-w. Also given is that typ
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- 33 -' -Case Mix Definition by Dia
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- 35 - Acknowledgment The authors w
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ML ICAL CAE1 Februurl 1980, Vol. XV
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X;' VIII, No. 2. Suippllce,t - 39 -
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- 41 - dMLDICAL C.ARE '.Fcbrtanj 19
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\'nKV 111,I No. 2, IIIJ·,ri - 43 -
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?Vol. XVIII. No. 2. Sttilluleareilt
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.'yo. XVIII. No. 2, Supplentcsit Si
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.V'oL XVIII. No. 2. Stpphlidary dia
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Vol..'XVlII, No. 2, Supplement - 55
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- 57 - MEDICAL CARE Febiuary 1980,
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- 59 - .SlDiCL ( :AL.. FcbnartlrJ p
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- 65 - £.¡EDCAL CARE ebrNuarV 1;9
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Page 109 and 110: GREENLAND ET AL - 103 - the case (p
Page 111 and 112: CREENLAND iT AL - 105 - TABLE 2. Fi
Page 113 and 114: GREENLAND ET AL. 3. Cornfleld J, Ha
Page 115 and 116: 160 I indicates the flow of patient
Page 117 and 118: 162 CONGESTION POINTS ANU CONTROL.A
Page 119 and 120: 164 c 8o Table 4. The cffect of cha
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Page 129 and 130: %,I. XIX, No. 3 iclnts. It should d
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Page 139 and 140: V Xl. IX, No. 3 - 133 - PERFORMANCE
Page 141 and 142: - 135 - The fourth requirement is l
Page 143 and 144: - 137 - Systems and Procedures of P
Page 145 and 146: - 139 - 2. ldentify problemn areas
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Page 149 and 150: u. o a.- 1 W. LZi - 143 - c c S C.
Page 151 and 152: - 145 - Thc cu rrent appointmren t-
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Page 167 and 168: .Recomme;tded systenz - 161 - .;any
Page 169 and 170: - 163 - system, there is nr'. :vste
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Page 173 and 174: - 167 - T1c Iteole of Olieraionls R
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- 169 - Larry J. Shumc- Harvey Wolf
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- 171 - '- ionoal Heolth Ploanning
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- 173 - Regional Health Planning ar
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- 175 - Regio.,oi Health Planning w
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- 177 - Regionao rfeclth Planning l
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A^CJonoal neonah ronning 21. 1'. F.
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- .,1 - Programming, Budgeting, and
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- 183 - the health care industí ,
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- 185 - was apparently no scarcity.
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ut, u a. íL ._c E 0 t42 a .. 0m u
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plex stochastic distribution of arr
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- 191 cumulated according to any or
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- 193 - Step 2 represents the heart
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ÍA en .aa
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- 197 - analysis, forecasting, and
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Budgeting Attitudes - 199 - The pla
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- 201 Health Services Research most
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a. - 203 - Health Services Research
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- 205 - DESIGN OF ALTERNATIVE PROVI
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- 207 - 1. A change in the immigrat
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- 209 - accessibility of health car
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- 211 - dimensional graph to illust
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- 213 - Primary Care Health Service
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- 215 - different health and educat
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- 217 - The tasks that were rated "
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IC1 o -a - i - w im W..i C -J M. -
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0 z 0 u _ I- 0 Ut. I,, uj CD Q U- ,
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TABLE 3 TASK ANALYSIS OF MALNUTRITI
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11 - 225 - TASK ANALYSIS OF MALNUTR
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- 227 - 12. Reisman, A., F.Staub, B
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- 229 - METHODS Parameters Affectin
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- 231 - ~HNCOCK Fig. 1. Daily censu
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- 233 - HANCOCK Table 1. Parameters
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- 235 - Fig. 3. Maximum average occ
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- 237 - HANCOCK ET AL Fig. 4. Maxim
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- 239 - AECOCL. Table 2. Eflect of
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- 241 - HANCOCK Discussion ET AL Th
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#12 Estinating the Need for Additio
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Pri c= arvicc a ia Indina. - 245 -
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. 1' - - IIINDLE Algorithmn for Det
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- 249 - HINDLE that all tlie primar
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- 251 - HINDLE 6. Computc Mhe Avail
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- 253 - HINDLA Tablek Meamm of Zfic
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HINDLE Tr AL HIALTH falvCU - 255 -
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- 257 - HIiDLZ 26. Ado, An . ad L.
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- 259 - REISMIAN, DEAN, ESOOBUE, AG
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- 261 - REISMAN, DEAN, ESOGBUE, AGG
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- 263 - 1350 REISMiAN, DEAN, ESOOBU
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- 265 - REISMAN, DEAN, ESOOBUE, AGO
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- 267 - 1354 REISMAN, IEAN, ESOGCUE
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- 269 - William J. Abernothy and Jo
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- 271 - William J. Abernathy and Jo
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- 273 - William 1. Abernothy ond Jo
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- 275 - William J. Abrnarthy and Jo
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- 277 - William J. Abernathy and Jo
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- 279 - William J. Aberncthy and Jo
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- 281 - 642 William J. Abernathy an
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Decmand in Mintu és/Day Numnlber o
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Disposal System 326 IIstlic I,',i,
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i Trays 334 Colorful pattenis anid
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tiie, gency L:ghting 347 ,i',., .:.
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- 296 - REVEI.LE we believe to be t
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- 293 R£VELLE is apparent in light
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- 295 - REVEt.EI. ET AL. poSJcd pro
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- 297 - RM.VELLE EL AL. of faciliti
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REVELLE ET AL. HALTOI SERVICUS RESE
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REVELLE ET Al.. - 301 - Fig. 4. Ano
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- 303 - REVet. ¡T AL Act of 1973.
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- 305 - REVELLE possible within ilh
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- 307 - RLVELI.E 29- Khumawala. a.
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- 309 - assuring thal the maxinmum
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-311 - the implemented strategy he
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- 313 - analytical approximalions w
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- 315 - rcquired Ior shipping and o
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- 317 - Controlling ¡he system The
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- 319 - The light pen techniques ar
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- 321 - shipnients have to be on ro
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- 323 THE CREATER NEIW' YORK BLOOD
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_,~ .- - 3. 2- - TABLE 1. PATIENT C
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TABLE 3. MEDICAL INTENSIVE CARE UNI
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Nursing Stalf Level (i of nurss/day
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Table 1. Factors ¡i denad for medi
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e forecast. This section descijbcs
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ei, paid to these standards in cond
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O Emphasis u.on the explicit enumer
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*1 1 21 1 «i 1 1 1 1 - 331, -- For
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Therc are ihreec basic prcessecs fi
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- 343 - Forecasting Hcalth Care Ser
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#20 Jaime 1B. Henrs Rtxlnc. I.. Ro:
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- 347 - I v,'N ti.K 1tHm.pi.l !, t1
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Ra.fo.renem.. aid %.hs '. - 31!9 -
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; / larman u empirical research has
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I Klarman - >3 - benefits that for
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I Klaman Ctitena for Inchmion - 355
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IClarman - 37 - The prevailing tend
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1 Klarman Intargibl Benefits - .5 -
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Kllarman - 361 - thi prospects of r
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- 363 - Thua, it did not consider w
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I Klannan - 365 - again if the new
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Klarman - 367 - At the other pole,
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- 369 - seem worth exploring. Howev
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iKlarman - 371 - in the use of serv
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Kmnnan - 373 - REFERENCES 1. Havema
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- 375 - 59. Valr y, W. S. One eonoi
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- 377 - i aSll a _ . b, CuaMu L. L,
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WAHRNER ANI) I|UTTr)N The puroses I
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WARNER AND HUTfON - 381 - observers
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.AHNF:R AND IIl'TIoN - 383 - rare I
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WARNER AND HUTTrU., TABLE 1. Trenda
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W'AHNER AND IHUTTON - 387 - treatme
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AAHNER AND HU'TON - 389 - Several d
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WARNER AND HUTTON pal orientations
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w'ARNER AND UL'TTOit'u ' . N Engl I
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I,,qr *ir 'ilu.,i XV. Seplteri¡br
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In.lumin- i',)i.eIu XV. Seph.irhb'r
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In#unrvlVolutn XV. September 1978 h
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Problemas identificados - 401 - Dur
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Programas educativos 3 - 403 - 1. S
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- 405 - maestrfa, donde se supone q
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- 407 - presentación formal de inf
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- 409 - * Curso para ingenieros ind
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- 411 - ¢ 16. Hancock, W., D. Mage
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- 413 - 2. Barrenechea, J. J. La se
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- 415 - Curwso (8 a 16 horas) para
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- 417 - 4. Necesidades de los admin
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MOISES ARTEAGA DR. DAVID GOMEZ COVA
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