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- 310 - reponed. Thec Nutional Heart, Lung and Blood Institute Resources Panel in its 1973 recommendations, which were a major factor in formulating the National Blood Policy [4], stated that: One of ihe strongect arguliculs I'ivoring tihe introduction ol s)'slcins management lo blood service is that it will result in improved service. in more economical utilization of ihe blood resources, and most important. in iniproved effectiveness and efficiency. For these reasons ii is recommended ihat emphiasis be placed on developing micasures of activity und relalting thcse io objectives. Only ii ihis wa;y will it bc Ipossiblc to oill;lio secire antl credillc cvaluatioin of the chaigcs lo ble mi'dc. This study addressed these issues by: (1) creating a model for relating measures of blood banking activity to availability and utilization; (2) developing a management tool called the Programmed Blood Distribution System (PBDS) to implement a regional blood distribution strategy that is based upon this model; (3) evalluating the effectiveness of PBDS in a prototype region (LIBS). Complexity of the problemn The complexity of the blood distribution problenm is primarily due lo the perish.able characteristics of blood, to the uncertainties involved in its availability to the RBC, and in the variable daily demand and usage for it at each of the HBB's. Thc situation is complicated by the large variation in the size of the HBB's supplied, the incidence of the different blood groups, and the rcquircments for wholc blood and red blood celis at individull hospitals. Since it is a national policy for blood to be derived from volunteer donors, its availability is uncertain and is a function of a number of factors thait canniot be controlled by the RBC. The demand and usage of blood at HBB's arc also unicerlain and vary from day to day and between hospital facilities. The HBB's within a region may range from those transfusing a few hundred units per year to those transfusing tens of thousands of units per year. The most frequently occurring blood type (0 positive) occurs in approximately 39% of the population, while the least frequently occurring blood type (AB negative) occurs'in only about 0.5% of the population. While most medical authorities agree that at least 90% of all blood trans.fusions could be in the form of red blood cellis, sonme hospitals transfuse almost cntirely red blood cells while others transfuse entirely whole blood with the ratio of whole blood to red blood cells frequently changing with time as transfusion practices improve. Approach The transfusion services throughout the nation are characterized by diversity. Each RBC has independently evolved its own philosophies and tcchniques for blood distribution. Each region strives for "self-sufficiency" iii supplying the blood nceds of the hospitais in its region from donors who also reside in approximately the same area. Because of these factors, it is essential that any strategy devised be defensible from the point of view of both the RBC and caclh of the wide range of HiB13's that it serves. Furthermore, any strategy that involves interactions between RBC's niust provide for clearly defined benefits for all participants. In addition, it is desirable that INTERFACES November 1979
-311 - the implemented strategy he c hitaraileri/cd h ixo imauaqgeii ment cn tcepis: rotation o l blood producis between HBB¾.. aínd irc.ilhCeduLId deliveries to ¡he HBB's. Any strategy Iha¡t aill>oeaes hltoitl Iprnnd itct, tio he retained t until ransfused or outdated will result in low uili.zation. cspciiaill in the case of tiie small usage HBB's which, in aggregate. aecoun
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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, Supplenent - 45
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'Vol. XVIII. No. 2, Supplemient - 4
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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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Vol. XVIII, No. 2, Suppletiment - 6
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Vol. XVIII, No. 2, Supplenwt - 63 -
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- 65 - £.¡EDCAL CARE ebrNuarV 1;9
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Vol. XVIII, No. 2, Sn",,phl- steal
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VoL XVIII. No. 2, Supplemnlent - 69
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'XVII. No. 2. Supplement - 71 - P)i
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;.'. 'Vol. XVIII. No. 2. Siupplemen
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:`". XVIII, No. 2. Stupplenent - 75
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,VoL XVIII, No. 2, Supplement Major
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.. Vol. XVIII, No. 2. Supl|lemcent
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i,..X VIII. No. 2. Supplemeiint - 8
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T XVIII. No. 2. S.pphlts"t .i¿jor
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·. ¥XVIII. No. 2 Supplement )i, "
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- 87 - 'i1. XVIII. No. -. Supplemne
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Vl. \'ll. No. 2. Sntiít'ult.uit M.
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- 91 - R. FRIRICHIS AND J. PRAWDA W
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- 93 - 414 R. FRRKICkIS AND J. PRAW
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- 95 - R. F'RERICItS'AND J. PRAWDA
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- 97 - R. F'RRICHS AND J. PRAWDA wh
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- 99 - 420 R. MFRIlC}IS AND J. PRAW
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V - 101 - McUCi. (:Au AWuu IMI. VoL
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GREENLAND ET AL - 103 - the case (p
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CREENLAND iT AL - 105 - TABLE 2. Fi
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GREENLAND ET AL. 3. Cornfleld J, Ha
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160 I indicates the flow of patient
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162 CONGESTION POINTS ANU CONTROL.A
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164 c 8o Table 4. The cffect of cha
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166 B. LEV etal. significant differ
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MEREDITH - 117 - ciety. However. ch
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I MEREDITH - 119 - varying oulcome
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MEDICAL CARE ,arch 1981, Vol. XIX,
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%,I. XIX, No. 3 iclnts. It should d
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n'ol. XIX, No. 3 - 125 - tailed exa
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1 Vol. XIX. No. 3 - 127 - tant for
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Vi. .XIX, No. 3 - 129 - tom' s reco
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- 131 - A \ ,,1. XIX, No. 3 PEHFOHR
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V Xl. IX, No. 3 - 133 - PERFORMANCE
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- 135 - The fourth requirement is l
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- 137 - Systems and Procedures of P
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- 139 - 2. ldentify problemn areas
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c 1 '-a
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u. o a.- 1 W. LZi - 143 - c c S C.
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- 145 - Thc cu rrent appointmren t-
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- 147 - A pure block appointment sy
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- 149 - ihe future. It was discover
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- 151 -
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- 153 - Figui.'¢ VII. Patient Arri
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- 155 - sonnel working in positions
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- 157 - 17. Keep the time span of t
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- 159 - TABLE I: Pnmary DesklConsul
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.Recomme;tded systenz - 161 - .;any
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- 163 - system, there is nr'. :vste
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- 165 - - A major problem with such
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- 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.
Page 265 and 266: - 259 - REISMIAN, DEAN, ESOOBUE, AG
Page 267 and 268: - 261 - REISMAN, DEAN, ESOGBUE, AGG
Page 269 and 270: - 263 - 1350 REISMiAN, DEAN, ESOOBU
Page 271 and 272: - 265 - REISMAN, DEAN, ESOOBUE, AGO
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Page 275 and 276: - 269 - William J. Abernothy and Jo
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Page 281 and 282: - 275 - William J. Abrnarthy and Jo
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Page 287 and 288: - 281 - 642 William J. Abernathy an
Page 289 and 290: Decmand in Mintu és/Day Numnlber o
Page 291 and 292: Disposal System 326 IIstlic I,',i,
Page 293 and 294: i Trays 334 Colorful pattenis anid
Page 295 and 296: tiie, gency L:ghting 347 ,i',., .:.
Page 297 and 298: - 296 - REVEI.LE we believe to be t
Page 299 and 300: - 293 R£VELLE is apparent in light
Page 301 and 302: - 295 - REVEt.EI. ET AL. poSJcd pro
Page 303 and 304: - 297 - RM.VELLE EL AL. of faciliti
Page 305 and 306: REVELLE ET AL. HALTOI SERVICUS RESE
Page 307 and 308: REVELLE ET Al.. - 301 - Fig. 4. Ano
Page 309 and 310: - 303 - REVet. ¡T AL Act of 1973.
Page 311 and 312: - 305 - REVELLE possible within ilh
Page 313 and 314: - 307 - RLVELI.E 29- Khumawala. a.
Page 315: - 309 - assuring thal the maxinmum
Page 319 and 320: - 313 - analytical approximalions w
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Page 323 and 324: - 317 - Controlling ¡he system The
Page 325 and 326: - 319 - The light pen techniques ar
Page 327 and 328: - 321 - shipnients have to be on ro
Page 329 and 330: - 323 THE CREATER NEIW' YORK BLOOD
Page 331 and 332: _,~ .- - 3. 2- - TABLE 1. PATIENT C
Page 333 and 334: TABLE 3. MEDICAL INTENSIVE CARE UNI
Page 335 and 336: Nursing Stalf Level (i of nurss/day
Page 337 and 338: Table 1. Factors ¡i denad for medi
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Page 341 and 342: ei, paid to these standards in cond
Page 343 and 344: O Emphasis u.on the explicit enumer
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Page 347 and 348: Therc are ihreec basic prcessecs fi
Page 349 and 350: - 343 - Forecasting Hcalth Care Ser
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Page 353 and 354: - 347 - I v,'N ti.K 1tHm.pi.l !, t1
Page 355 and 356: Ra.fo.renem.. aid %.hs '. - 31!9 -
Page 357 and 358: ; / larman u empirical research has
Page 359 and 360: I Klarman - >3 - benefits that for
Page 361 and 362: I Klaman Ctitena for Inchmion - 355
Page 363 and 364: IClarman - 37 - The prevailing tend
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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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