October-December 2017Number 4Volume 8
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SCOPUS IJPHRD CITATION SCORE
Indian Journal of Public Health Research and Development
Scopus coverage years: from 2010 to 2016 Publisher:
R.K. Sharma, Institute of Medico-Legal Publications
ISSN:0976-0245E-ISSN: 0976-5506 Subject area: Medicine:
Public Health, Environmental and Occupational Health
CiteScore 2015- 0.02
SJR 2015- 0.105
SNIP 2015- 0.034
Cite Score 2017- 0.03SJR 2017- 0.108SNIP 2017- 0.047
Indian Journal of Public Health Research & DevelopmentEXECUTIVE EDITOR
Prof Vidya SurwadeAssociate Professor, Dr Baba Saheb Ambedkar,Medical College & Hospital, Rohinee, Delhi
INTERNATIONAL EDITORIAL ADVISORY BOARD1. Dr. Abdul Rashid Khan B. Md Jagar Din, (Associate Professor) Department of Public Health Medicine, Penang Medical College, Penang, Malaysia2. Dr. V Kumar (Consulting Physician) Mount View Hospital, Las Vegas, USA3. Basheer A. Al-Sum, Botany and Microbiology Deptt, College of Science, King Saud University,
Riyadh, Saudi Arabia4. Dr. Ch Vijay Kumar (Associate Professor) Public Health and Community Medicine, University of Buraimi, Oman5. Dr. VMC Ramaswamy (Senior Lecturer)
Department of Pathology, International Medical University, Bukit Jalil, Kuala Lumpur6. Kartavya J. Vyas (Clinical Researcher)
Department of Deployment Health Research, Naval Health Research Center, San Diego, CA (USA)
7. Prof. PK Pokharel (Community Medicine) BP Koirala Institute of Health Sciences, Nepal
NATIONAL SCIENTIFIC COMMITTEE1. Dr. Anju Ade (Associate Professor)
Navodaya Medical College, Raichur,Karnataka2. Dr. E. Venkata Rao (Associate Professor) Community Medicine,
Institute of Medical Sciences & SUM Hospital, Bhubaneswar, Orissa.3. Dr. Amit K. Singh (Associate Professor) Community Medicine,
VCSG Govt. Medical College, Srinagar – Garhwal, Uttarakhand4. Dr. R G Viveki (Professor & Head) Community Medicine,
Belgaum Institute of Medical Sciences, Belgaum, Karnataka5. Dr. Santosh Kumar Mulage (Assistant Professor)
Anatomy, Raichur Institute of Medical Sciences Raichur(RIMS), Karnataka6. Dr. Gouri Ku. Padhy (Associate Professor) Community and Family
Medicine, AII India Institute of Medical Sciences, Raipur7. Dr. Ritu Goyal (Associate Professor)
Anaesthesia, Sarswathi Institute of Medical Sciences, Panchsheel Nagar8. Dr. Anand Kalaskar (Associate Professor)
Microbiology, Prathima Institute of Medical Sciences, AP9. Dr. Md. Amirul Hassan (Associate Professor)
Community Medicine, Government Medical College, Ambedkar Nagar, UP10. Dr. N. Girish (Associate Professor) Microbiology, VIMS&RC, Bangalore11. Dr. BR Hungund (Associate Professor) Pathology, JNMC, Belgaum.12. Dr. Sartaj Ahmad (Assistant Professor),
Medical Sociology, Department of Community Medicine, Swami Vivekananda Subharti University, Meerut,Uttar Pradesh, India
13. Dr Sumeeta Soni (Associate Professor) Microbiology Department, B.J. Medical College, Ahmedabad, Gujarat,India
NATIONAL EDITORIAL ADVISORY BOARD1. Prof. Sushanta Kumar Mishra (Community Medicine)
GSL Medical College – Rajahmundry, Karnataka2. Prof. D.K. Srivastava (Medical Biochemistry)
Jamia Hamdard Medical College, New Delhi3. Prof. M Sriharibabu (General Medicine) GSL Medical College, Rajahmundry,
Andhra Pradesh4. Prof. Pankaj Datta (Principal & Prosthodentist)
Indraprastha Dental College, Ghaziabad
NATIONAL EDITORIAL ADVISORY BOARD5. Prof. Samarendra Mahapatro (Pediatrician)
Hi-Tech Medical College, Bhubaneswar, Orissa6. Dr. Abhiruchi Galhotra (Additional Professor) Community and Family
Medicine, AII India Institute of Medical Sciences, Raipur7. Prof. Deepti Pruthvi (Pathologist) SS Institute of Medical Sciences &
Research Center, Davangere, Karnataka8. Prof. G S Meena (Director Professor)
Maulana Azad Medical College, New Delhi9. Prof. Pradeep Khanna (Community Medicine)
Post Graduate Institute of Medical Sciences, Rohtak, Haryana10. Dr. Sunil Mehra (Paediatrician & Executive Director)
MAMTA Health Institute of Mother & Child, New Delhi
11. Dr Shailendra Handu, Associate Professor, Phrma, DM (Pharma, PGI Chandigarh)
12. Dr. A.C. Dhariwal: Directorate of National Vector Borne Disease Control Programme, Dte. DGHS, Ministry of Health Services, Govt. of India, Delhi
Print-ISSN: 0976-0245-Electronic-ISSN: 0976-5506, Frequency: Quarterly (Four issues per volume)Indian Journal of Public Health Research & Development is a double blind peer reviewed international journal. It deals with all aspects of Public Health including Community Medicine, Public Health, Epidemiology, Occupational Health, Environmental Hazards, Clinical Research, and Public Health Laws and covers all medical specialties concerned with research and development for the masses. The journal strongly encourages reports of research carried out within Indian continent and South East Asia.
The journal has been assigned International Standards Serial Number (ISSN) and is indexed with Index Copernicus (Poland). It is also brought to notice that the journal is being covered by many international databases. The journal is covered by EBSCO (USA), Embase, EMCare & Scopus database. The journal is now part of DST, CSIR, and UGC consortia.
Website : www.ijphrd.com©All right reserved. The views and opinions expressed are of the authors and not of the Indian Journal of Public Health Research & Development. The journal does not guarantee directly or indirectly the quality or efcacy of any product or service featured in the advertisement in the journal, which are purely commercial.
EditorDr. R.K. Sharma
Institute of Medico-legal Publications
Printed, published and owned byDr. R.K. Sharma
Institute of Medico-legal Publications
Published atInstitute of Medico-legal Publications
I
1. A Study of Financial Counselling and Estimation of Variance Between Estimated Bill and Actual Bill of Cardiac Cath Lab ............................................................................................................................... 1
(Brig) A P Pandit, Harshada Tambe
2. Alienation, Attachment Style, and Alcohol Addiction “A Study of Young Women Habitual Drinkers” ...... 9Bhawani Singh Rathore1, Uma Joshi2
3. Challenging Issues in Health Economics .................................................................................................... 15S. N. Sugumar, C. K. Gomathi
Kalinganagar Industrial Estate, Odisha, India ............................................................................................. 20Chandrakanta Sahoo, Shukadeb Naik
Addicted Collegiate ..................................................................................................................................... 26D. Malarvizhi, A. Abinaya
Divya Nitin Lad, S. Anandh
Lactobacillus Casei Shirota Strain Dental Caries ............................................................................................................................................... 36
Mary Byju, c, Neeta Shetty, Ramya Shenoy, Shrikala Baliga
8. Health Expectancy Under Dynamic Set Up for India and its Selected States ............................................ 42Mompi Sharma
Naveen Kumar, SN Panda, Preethi Pradhan, Rajesh Kaushal
Undergoing Chemotherapy ......................................................................................................................... 51Neelam Tejani, S. Anandh
Kanmani J, Laly KG, Nila KM
Aditya Shetty, Payal Garg, Mithra N. Hegde, Lakshmi Nidhi Rao, Chitharanjan Shetty, Shishir Shetty
I
Indian Journal of Public Health Research &
Development
www.ijphrd.com
Volume 8 Number 4 October-December 2017
1. Detention, Nepotism and Truancy as Predictors of Workplace Deviance in.....................................................................01
Service Organizations: India's Experience
Sainath Malisetty, K Vasanthi Kumari
2. A Comparative Study of Satisfaction of Midwives and Mothers of Adherence to Patient Rights..................................07
Maryam Soheily, Akram Peyman, Beheshteh Tabarsy
3. Indian Diabetes Risk Score for Screening of Undiagnosed Diabetes...................................................................................13
Individuals of Eluru City, Andhra Pradesh, India
Chandrasekhar Vallepalli, K Chandra Sekhar, U Vijaya Kumar, P G Deotale
4. Awareness and Predictors of PCOD among Undergraduate Students ..............................................................................18
CAnn Mary Nelson, Lekha Viswanath, Anju Philip T
5. The Effectiveness of Mindfulness on the Reduction of Anxiety...........................................................................................23
and Depression of Divorced Women
Yasamin Hojatifar, Mina Hosein Zadeh, Fariborz Dortaj
6. A Study on Clinical Profile and Trend in Suicide Attempters in Psychiatry Consultation...............................................28
D Naveen Kumar
7. A Study of Organo-phosphorous Compound Poisoning with Reference to....................................................................33
Blood Sugar and Pseudocholinesterase Levels
Nithinkumar S Kadakol, Sunilkumar S Biradar, Smitha M, Mallikarjun KBiradar
8. Prevalence of Intestinal Parasitic Infections in School Going Children in...........................................................................37
Rural Areas of Hapur District, UP, India
KamyaVerma, Krati R Varshney, Sanjeev Dimri, S P Garg
9. Study of Osteoporosis in Women of Malwa Region of Punjab............................................................................................41
Veerendra Choudhary
10. The Effectiveness of Mindfulness-Based Group Therapy on Reducing Internet...............................................................44
Addiction and Increasing the General Health of Adolescent Girls
Nasrin Rahimi Shadbad
11. Role of Social Support and Coping Styles in Mental Health of Women Who Apply for Divorce..................................49
Farhad Asghari, Hajar Ramazannia
Contents
Volume 10, Number 3
II
Prakash Boralingiah, Dennis Chauhan
14. Language Profciency among Higher Secondary Students with Respect to Psychological Factors ............ 72R. Jeyanthi, S. Arockiadoss
Raghuram V, Shankar S, Betty Janice A, Brammamuthu S, Chezhian V M, Elango. S
S. Chandrachud, P. Suganya Devi, D. Anitha Kumari
A. Sravan Krishna Reddy, S. Shrinuvasan, S. Sajith, R. Chidambaram
18. Patterns and Distribution of Dental Caries and Dental Fluorosis in School Children of Sivakasi ............. 88A. Ashwatha Pratha, S. Gheena
Neha Verma, Sadhana Awasthi, Chandramohan Singh Rawat, Rajesh Kumar Singh, Bithorai Basumatary
20. Sustainable Agriculture and of Irrigation Practices in India ....................................................................... 98Arasheethbanu
21. A Study to Assess the Knowledge Regarding Cervical Cancer Screening and Prevention among Women in
Shankar. S, Raghuram V, Elango, Sowndarya S, Sharumathi R R, Sasirekha P
Shankar S., Raghuram V, Elango, N. Leka jothi, K. Madhubala
23. Study to Assess Knowledge, Practice and Attitude of about Self Breast Examination among
Raghuram V, Shankar S, Suganya S, Suganthi S, Suhaanth G, Tharan Kumar S, Elango S
Shankar S, Raghuram V, Swarnalatha P, Thendral Vasan P, Swathi S, Elango S
Amit A Mane, Sujata V Patil, P M Durgawale, S V Kakade
T.Sarumathi, Krishnan Mahalakshmi, S. Raghavendra Jayesh, B. Krishna Prasanth, Sindhu Poovannan
B. Saravanakumar, A. Julius, S. Raghavendra Jayesh, T. Sarumathi, B. Krishna Prasanth
28. Workplace Spirituality and its Impact on Organizational Commitment and Employees’ Job Satisfaction
Dayal Sandhu
III
Dhanashree More, Pramod Shaha, Sonesh kumar Chougule, Utkarsha Patil, Kapil Sawarkar, Ria Rai, Dhirajkumar Mane
Utkarsha Patil, PramodShaha, Omkar Patil, Dhanashree More, Dhirajkumar Mane
Nayana Prabhu, Gayathri Krishnamoorthy, Vidhi Goyal, Srikanth
Prashaanthi Nagaraj, Geo Mani
Anusree M., Gokul K. C., Girish S
An in Vivo Study ....................................................................................................................................... 167Sumit Singh Phukela, Ashish Dabas, Reshu Madan, Shefali Phogat, Manoti Sehgal, Jaiveer Singh Yadav
S. Saravanan, M. Ramesh, S. N. Sugumar, S. Sudha, Prof. Teluswarna, Prof. Rajarethinam Emmanuel
Ballabhgarh Block, Faridabad ................................................................................................................... 175Neha Bajaj, Meena Jain, Nisha Rani Yadav, Souryaa Poudel, Ankur Sharma, Vishal Jain
P Radhika, P Suresh Verma, N. Lakshmi Kalyani, P. Rama Krishna, M. Santosh Kumar
Pallavi A. Potdar
Sushmita Mitra, Kalyani Bhate, Santhosh kumar S. N., Kapil Kshirsagar, Bhagyashree Jagtap, Pradnya Kakodkar
Priya. M, Vidyadhari Pedaprolu
A Brief Overview Contributors ................................................................................................................. 198Priyesh Kumar Singh, Naveen, Prof. Tara Singh, Prof. Vijay N. Mishra, Trayambak Tiwari, Prof. Rameshwar N. Chaurasia
Education Sector ........................................................................................................................................ 203R. Priya, J. John Adaikalam
43. A Comprehensive Study on Novel Hybrid Approach for Decision Support System in Disease Diagnosis 208K. Sharmila, C. Shanthi, R. Devi, T. Kamala Kannan
Shreya Hegde, Swathi Pai, Roma M
S. Gunaseelan, N. Kesavan
S. Sandhiya, Y. Kalpana
Prashant Nigam, P. K. Patra, Lakhan Singh, Ramnesh Murthy
Rose Ann Roy, Suchetha S Rao, Prasanna Mithra
Shebna A Khader, Suchetha S Rao, Nutan Kamath
T Dolkar, V K Mehta, J T Wangdi
T. Arun Prasanna, K. Vaithianathan
Joshi Bhavna Pramod, Tayade Deepak Narayan
Yogesh Chhaparwal, Shubha Chhaparwal, Navin Patil
Mamatha Shivananda Pai, Binu Margaret E, Yashoda S, Sheela Shetty
Admitted in NICU vs Postnatal Ward ....................................................................................................... 266Prof. Violin Sheeba1, T. Radha Bai Prabu2
Shayhana Ganesh
Shayhana Ganesh
Shayhana Ganesh
Wahyu Gito Putro
IV
Mustafa Fadil Mohammed, Mohammed A. Abdalqader, Mohammed Abdelfatah Alhoot, Mohanad R. Alwan, Mohammed FaezAbobakr, Asha Binti Abd. Rahman
Orapin Laosee, Ratana Somrongthong
Noorce Christiani Berek, Qomariyatus Sholihah
Ratih Damayanti, Erwin Dyah Nawawinetu
Ibtihaj Ahmed kadhim
Salwa G. Turki, Suad A. Brakhas, Wesam H. Ahmed
Abbas Toma Joda
Normal Population .................................................................................................................................... 324Abdulraheem A. Almalki, Khalaf F. Alsharif, Osama M. Al-Amer, AbdulAziz A. Almalki, Ahmed S. Abdel-Moneim
Syamsul Firdaus, Anggi Setyowati, Endang Sri Purwatiningsih
Annisa Ullya Rasyida, Iswari Hariastuti, Kuntoro, Haryono Suyono, Sri Widati
Athraa Y. Al-Hijazi, Abdul Karim A Al-Mahammadawy, Imad K. Abbas Al-Rifae, Basim M Khashman, Alaa Wael Izzat
Escherichia ColiDewi Susanna1, Yvonne M. Indrawani1, Zakianis1, Tris Eryando1, Aria Kusuma2
Consumption of Salted Fish and Hypertension in the Area of Salted Fish Industry 349Dewi Susanna1, Arni Widiarsih2, Tris Eryando3, Nopa Arlianti2, Ayu Indriyani2
Spousal Communication on Family Planning and Contraceptive Adoption in Indonesia 354Dian K. Irawaty1, Hadi Pratomo2
V
VI
Athraa Essa Ahmed1, Azeez Mohammed Ali Azeez2
Streptococcus sp Bacteria in Air at Sarijadi Urban Village Sub district of Bandung 364Elanda Fikri1, Novita Sekar Ayu Prabono2, Pujiono2
1, Evi Martha1, Sela Fasya1
Fadhil Khaddam Fuliful1, Adnan M. Mansoor Al-Saeedi2, Hind K. Abbas3
Mahmoud Khudair Yaseen1, Faiq I. Gorial2
1, Farapti Farapti2
Ansari Saleh Banjarmasin 389Febriyanti1 2, Bahrul Ilmi3, Husaini4, Meitria Syahadatina Noor2
Fulath Abdul-Redah Muhsin1
District, Indonesia 398Nelson Tanjung1, Mido Ester J Sitorus2, Risnawati Tanjung1, Haripin Togap Sinaga3
Camellia SinensisBroiler 402Khawla A. Salman1, Sunbul J. Hamodi1, Luma K. Al-Bandr1
It’s Indicating Factors 407Saba Jassim Alheshimi1, Aqeela Hayder Majeed2, Kawakeb N Abdulla3, Hiba Ali Rassme4, Nawras Khairi Fadhil5, Hayder Adnan Fawzi6
Mohammed Abd-Kadhim1, Mohammad Abd-Alrida Hussein2, Hayder Adnan Fawzi3
Wisam Mahmood Aziz
Sun Ok Lee1, Hee Kyung Kim2, Jung Suk Park3
Heni Nurhaeni1, Suryati Badrin1
Ramlah1, Bahtiar1
Satiti Palupi1, Zaimah2, Siti Murtini3, M. Atoillah4
Adherence to the National Immunization Schedule for the
Esraa Abd Al-Muhsen Ali1, Hussein Fadhil Musa Aljawadi1
Ika Yuni Widyawati1, Nursalam2, Kusnanto3, Rachmat Hargono4
Yulaida Maya Sari1, Baiduri Widanarko1
Ummul Hairat1, Budi Hartono2
Accident Compensation and Disability Cash Compensation Utilization of Workers with Disabilities Due to an Accident 464Indriati Paskarini1, Tri Martiana2, Tjipto Suwandi2, Firman Suryadi Rahman3
Darmayanti1, M. Mukhtar1, A. Rizani1, Tut Barkinah1, Mahpolah1, Mahdalena1
Wejdi A. Al –Fatlawy
Detection Enteric Viral in the Newborn Causes Diarrhea in
Ihasan Adnan Hashim1, Mohammed Abdulrazzaq Assi1,2, Hayder Ali Muhammed3
Rural Area in Shimla, Himachal Pradesh, India 484Jinu K. Rajan
Ex vivo Acanthamoeba keratitis and Use of E. coli in Parasitic Culture 490Mohenned A. Alsaadawi1, Naer Alkaabi2, Sura Alkhuzaie3, Simon Kilvington4
Ira Nurmala1, Elisa Dwi P1, Muthmainnah1, Riris Diana R1
Ammar Adil Jasim1, Abbas Abdullah Mohammed1 2
Khalid k. Hussein
Jakarta 510Robiana Modjo1, Haris Muzakir1
HCV in Children Receiving Blood or Blood
VII
Safa A. Faraj1, Ahmed I. Ansaf2, Hasanein H. Ghali3, Naeem m. mohsen4
School of Pangkep District 521Arlin Adam1, Sukri Palutturi2
Teti Tejayanti1, Budi Utomo2 3
Hyalomma spp. 533Ihsan M. Sulbi1, Rana A. Jawad1, Rana F. Mousa1, Yasser J. Jameel1, Abbeer F. Abd-Al-Hussain2
Saba J. Ajeena1, Suhayla K. Mohammed1, Zahraa H. Raheem1
Najiha M. Bari1, Maryem A. Hasoon1, Abbas G. Hamza1
Jassim M. Albozachri1, Hayder N. Alkhalissi1, Namir I. Mohammed1, Yasser Jameel1
Bacillus subtilis
Rafal A. Hussain1, Wafaa K. Jasim1, Yasser J. Jameel1
Abdul Qadar Punagi1, Stella Fitrianty Attu1, Sutji Pratiwi Rahardjo1, Firdaus Hamid2, Ilham Jaya Patellongi3
Nurzakiah Hasan1,2, Veni Hadju3, Nurhaedar Jafar3, Ridwan Mochtar Thaha3
Yusriani1
Ahmed Mohammed Fahmi1, Sajjad Mohemmed Atiyah2, Arcelan S. Sadiq3
A Study of Financial Counselling and Estimation of Variance Between Estimated Bill and Actual Bill of Cardiac Cath Lab
(Brig) A P Pandit1, Harshada Tambe2
1Prof & HOD, MBA (HHM), 2Student, MBA (HHM), Symbiosis Institute of Health Sciences, S B Road, PUNE
ABSTRACT
Cardiac cath lab is one of the major revenue generating department of the hospital, so it must be managed properly.
estimated bill
Preexisting conditions
No of stents
Surgeons charges
Room charges
ALOS
applying six sigma tools and following SOPs.
Keywords:
INTRODUCTION
pain, show signs of blocked arteries or have atypical stress test results. It enables doctors to more precisely pinpoint potential heart problems such as coronary artery, aortic or valve disease and provides critical answers needed to determine the best course of action and establish a treatment plan.
role in achieving—or hindering the ability to achieve—the highest possible reimbursement for their hospital.
positive care and patient satisfaction measures can
position to be a provider of choice, and can help prepare
is among the highest revenue generators for the hospital,
Aim of the study: estimated bill and actual bill
Objectives of the study 1. Accuracy of estimation of billing
REVIEW OF LITERATUREHealthcare delivery costs continue to rise due to
increased demand for patient services. Various hospital
2 Indian Journal of Public Health Research & Development, March 2019, Vol.10, No. 3
radiology department, Cardiac cath lab and pharmacy represent a small sample of such departments facing high patient demand. On the other hand, there exist
improvement in the operation of these departments.1
patient outcomes, and negatively impact the program as a whole by fostering low morale, high turnover and
organization’s bottom line. Overcoming communication
relationships to be established.2
the process of manipulating or rearranging the data or information in existing accounts in order to obtain the
to furnish the necessary data for making more informed decisions concerning operations and infrastructure investments. If structured accurately, cost data can provide information on operational performance by cost
performance expectations in order to identify problem
give management the material to evaluate and modify
a schedule of charges for patient services. A hospital cannot set rates and charges which are realistically
allocates both direct and indirect costs to the appropriate
of value to management in ensuring that costs do not exceed available revenues and subsidies.3
by a hospital manager are allocated costs by cost center and the unit cost of hospital services. A unit of hospital services may be as small as one meal, or as
calculations precisely, the hospital needs an accurate and
hospitals, however, existing accounting systems have gaps, such as excluding some costs or lacking the data
estimates are needed. It is organized based on seven steps for computing unit costs.
3. Identify the full cost for each input.
4. Assign inputs to cost centers.
center.
7. Report results.4
What are the services or departments for which you are
want to know the unit cost for all inpatient services, or
Purpose of the Analysis:of certain hospital departments by computing costs department wise & then predict the variation between projected cost & actual cost incurred by the patient
Type of Data Available: Our ability to compute unit costs will be constrained by how aggregate or disaggregate the available data are for both costs and utilization. For example, in order to compute unit costs by ward, you would need to have at minimum utilization
In some cases, it may be unclear whether to compute a separate unit cost for a certain activity, or allocate its costs to some other output. For example, some studies have computed separate unit costs for lab and radiology departments, thereby excluding those costs from the cost per inpatient day or discharge. Others have treated lab and radiology as intermediate outputs, and fully allocated their costs to the inpatient cost centers. Again, the desirability of each approach depends on the purpose of the analysis, but it is important to be consistent.
costs is to determine the centers of activity in the hospital
Indian Journal of Public Health Research & Development, March 2019, Vol.10, No. 3 3
major direct cost categories of most departments include
depreciation and allocated costs of other departments.
correspond with the hospital’s organizational and/or accounting structure is managerial. Hospitals are organized into departments and, since we want to strengthen the management of these departments, it is useful to have cost centers that correspond to the
each center. Following this road map shows individual managers how they are using available resources in relation to what has been budgeted and the services that they are providing.
From an administrative standpoint, cost centers can be distinguished based on the nature of their
overhead centers. As explained below, some costs
as housekeeping, laundry, maintenance, and the many other tasks necessary for the satisfactory operation of a complex organization like a hospital.
Identify the Full Cost for Each Input: An important part of computing unit costs is to make sure that you have cost data which are as complete as possible.
determining which expenditures should be counted as costs based on an economic sense of resources used
have developed ways to impute or approximate cost when existing data are problematic.
Assignment of Inputs to Cost Centers: At this point, you have presumably gathered information about the hospital’s total costs, whatever the source of payment.
identifying which line items account for most of cost and whether this is changing over time. However, to compute
costs from each line item to the relevant cost centers. Allocation of All Costs to Final Cost Centers
overhead costs incurred in producing an admission, day or visit, not just direct costs. Indirect costs will include
cost centers at an earlier stage. In some hospitals, this will only comprise services such as administration and laundry. In others, intermediate services such as pharmacy and radiology may also need allocating at this point, with little or no information about how much of their workload was generated by each of the medical departments.5
Computing Unit Cost for Each Cost Center: At this point you know the total costs that were incurred at
incorporating utilization data into the analysis.
In reality, you will have used the utilization data already by this point, for example in order to allocate
However, this is the point at which any problems with the utilization data become particularly important, because they directly alter the unit costs.6
Several studies encountered problems with utilization data. In some cases, the number of admissions seemed accurate, but admission and discharge dates had not been carefully recorded, causing measurement
occupied in every ward, every 24 hours at the same time of day. Once you have obtained the utilization data, the unit cost can be computed.
REPORTING RESULTS
At this point it is important to remind yourself and any readers what items are and are not included in the unit costs you have calculated. For example, your
In today’s economy, getting the most value from your Cath Lab—in terms of operational throughput,
4 Indian Journal of Public Health Research & Development, March 2019, Vol.10, No. 3
crucial to survival in the increasingly competitive market for cardiovascular services. In the case of a growing or expanding program, understanding the complex
elbow with the cardiologist in a collaborative setting to provide care in an often intense clinical situation.
in this environment is not always easy.7
In order to maximize teamwork, performing a detailed, comprehensive operational assessment is
creating a competitive edge in terms of clinical outcomes, 8
In any assessment process it is important to
also those that could use improvement. Despite the
for ‘best practice’ at all hospitals, making change can
can be performed internally, though the process is best completed with a neutral third party. Often, an external consultant is needed to make those “tough” recommendations and bring fresh ideas to the table for improvement and/or change.9
An example of a simple problem that often involves
and sustainable solutions can be elusive. A root cause analysis can bring hard data to what often becomes
between the Cath Lab and the patient care areas.10
Another important element to assess is how
11
Part of a thorough Operations Assessment includes
program. Examples include a facility design that is
that takes a crucial role in the program development.
unavoidable obstacles that will need addressed.
and can lead to potentially increased revenue and better care delivery.
from a competitive or regulatory standpoint.12
Although the investments to create a CCL are high, hospitals were historically been able to achieve their economic return of investment rapidly because of the
procedures performed within the department.13 During the last decade, realizing a return of this investment has become increasingly challenging.14 Hospital
decreased level of public founding have put an enormous cost pressure on hospitals in many industrial countries.15 In response, healthcare providers developed marketing strategies to increase patient number and throughput.16 Furthermore, the importance of cost control instruments has increasingly been recognized.17
METHODOLOGY
identify improvement areas and to make implementation recommendations for the overall Cardiac cath lab system
approach to identify potential areas of improvement and to suggest recommendations aiming at an overall
system
studies and collect all relevant system related data
process improvements
Indian Journal of Public Health Research & Development, March 2019, Vol.10, No. 3 5
implemented and followed methodically.
Duration of the study: duration of 3 months.
Data Collection:
historical data collection of 3 months
OBSERVATIONS & DISCUSSION
processes along with their corresponding departments. In order to better understand the complex nature due
inpatients, and emergency patients, individual process maps were developed for each type of patients
Figure 1: Process mapping
the total number of actual bills below and same as the estimated bills are analyzed with percentage.
Table 1: Variation between projected cost and actual cost
Seri
es N
o.
Mon
th
Perc
enta
ge o
f Fi
nanc
ial C
ouns
ellin
g G
iven
at N
HH
I
Tota
l Num
ber
of
Proc
edur
es D
one
Tota
l Num
ber
of
Proc
edur
es N
ot d
one
Tota
l Num
ber
of
actu
al B
ills a
bove
E
stim
ate
Perc
enta
ge o
f Tot
al
Num
ber
of a
ctua
l B
ills a
bove
Est
imat
e
Tota
l No.
of A
ctua
l bi
lls B
elow
Est
imat
e
Perc
enta
ge o
f Tot
al
No.
of A
ctua
l bill
s B
elow
Est
imat
e
Tota
l Num
ber
of
Act
ual B
ills S
ame
as
Est
imat
ePe
rcen
tage
of T
otal
N
umbe
r of
Act
ual
Bill
s Sam
e as
E
stim
ate
1. 130 35 111 18 12. 112 41 103 7 23. 123 40 107 11 6
Using the information from above table no 1, a pie chart can be plotted to get a better view of variance in the
6 Indian Journal of Public Health Research & Development, March 2019, Vol.10, No. 3
Figure 2: Total variance percentage of estimated and actual bills
Indian Journal of Public Health Research & Development, March 2019, Vol.10, No. 3 7
Gap Analysis
Table 2: GAP analysis between skill & errors
Sr. No. Error
1. Use of number of stents to be used is variable
depending on the blockage in each patient
2. Incorrect procedure following proper diagnostic
procedures and SOPs3. Repeat of
procedureCan be controlled by following SOPs and use of skilled labour
4. Human errors Errors which occur during entering information cannot be controlled
5. Lack of training and skill
Proper training should be imparted to personnel involved in giving estimates
6.infections
Can be controlled by
measures as laid down
Control Department of Hospital
7. Room charges Room can be upgraded if
of deluxe, second class and general.
8. Surgeon’s charges
Can be controlled by standardizing the charges
9. Consumablesuse is variable depending on each case
10.conditions
Depending on medical
conditions, the procedural cost may vary for each patient
11. Average length of stay
Can be controlled by
following SOPs
RECOMMENDATIONS
As high amount of variance is seen between estimated and actual bill following measures can be adopted
ensure that ALOS is maintained to the standard average.
Financial counseling should be done by trained professionals who can clarify patient that procedure charges may vary with certain percentage.
Repeat of procedures can be avoided by following SOPs and use of appropriate skilled force.
Department.
REFERENCES
1. Venkatesh A. Raghavan, Vikram Venkatadri, Varun Kesavakumaran, Shengyong Wang,
Srihari, Reengineering the Cardiac Catheterization
Healthcare Engineering · Vol. 1 · No. 1 · 2010
a manual for facility administrators and
recovery in public sector hospitals in Ecuador.
8 Indian Journal of Public Health Research & Development, March 2019, Vol.10, No. 3
Dominican case. Urban Institute, Washington D.C.
Caribbean States.
of Eastern Caribbean States.
analysis and selected options for privatization and user fees. Department of Health Services,
of Bhutan.
12. Jayne Kulpe,Key Steps of a Cardiac Cath Lab Operational Assessment, Cath lab Digest, 2008
analysis of direct catheterization laboratory costs
14. Building Revenue for Your Cath Lab, Allen
Capacity and Utilization, David Fuller, Cath lab
Prospective Lung Transplantation In Indonesia: Lung Donor Preparation, Preservation, and Allocation
1; Sari PurnamaHidayat2
1Division of Respiratory and Critical Illnes, 2Universitas Indonesia Cipto Mangunkusumo General Hospital, Jakarta
ABSTRACT
Increased morbidity and mortality of end stage pulmonary disease necessitates the availability of lung
for lung transplantation. In building the National organ donation system, the beliefs of diverse cultures and religionsshould be considered. Credible human sources is the key to succeed in the development of an
Keywords: Lung transplantation, organ donation, organ donation system, organ donor preservation, ethical issue.
Corresponding Author:
Division of Respiratory and Critical Illnes,
INTRODUCTION
Following the many advancements in lung transplantation, recipients today are able to obtain
life.1 Unfortunately, the number of health care facilities
current demand.2 One major problem reported by all lung transplant centers is the shortage in lung donors.3,4,5In
deceased organ donation and living lobar donation.6
involved.7,8On the other hand, not every countryhas the capacity to develop a deceased organ donation
support; supporting ICU; and strong legal support to declare brain death,and consent for organ donation.9
lungs are challenging processes, will be the same in a
aims to assess a suitable organ donation system for lung transplantation in Indonesia.
Donor for Lung Transplant: Developing a
transplantation center.10,11
suggested. However, the standard criteria is still used as preparation of suitable organs, as determined by the
facilities.7
Living lobar donation: A donor should be in excellent
donation. Furthermore, they may be parents, siblings, or extended family members of the recipient, or even unrelated individuals who have an emotional attachment to the patient, and are willing to accept the risks associated with organ donation, without coercion.7
Deceased organ donation: Deceased organ donors 12 Organs
12whereas donation
Indian Journal of Public Health Research & Development, March 2019, Vol.10, No. 3 283
following circulatory death or cardiac arrest is known as donation after the determination of cardiac/circulatory
commonly used than DCDD.12
DBD: Brain death is clinical diagnosis of an irreversible coma.13,14
pulmonary arrest induced by hypothermia has been
transient and did not impact patient prognosis.15Hence, the study suggested that in patients with hypothermia
considered, and a minimum observation period after rewarming should be completed before brain death testing is conducted.15
among countries. Some countries use only the clinical
13
Some countries in Europe and America even implement 14,16
deliver a reliable result. In contrast,the others countries
for the donor as a patient.14,16
DCD:transplantation remains controversial due to concerns
arrest, and the organ preservation procedure.8For predicting the possibility of injuries, DCD may be
In the practice of deceased organ donation, a
to provide information about the availability of potential donors.17Potential donors are reported to an organization that is responsible for organ preservation and distribution, which is known in many countries as
prospective donor, the procurement organization will search for evidence of organ donation status. If the donation status is not known, if possible the procurement organization then seeks the consent of donation from an authorized individual.10,17
OPO will coordinate with the Organ Procurement and
responsible to make a prioritized list of potential recipients from the national organ waiting list. OPO would inform
would then provide information to the OPO regarding
17. Organs or tissues that will be donated are procured by taking the necessary screening,
some cases for research and education purposes. All processes must be done expeditiously.17
Donor preparation
Donation consent: Consent for organ donation is ideally made by the correspondence during his/her life time. It maybe facilitated by several organizations or healthcare agents according to the laws in the country. Some countries use hospitals, organ procurement organizations, government organizations, etc, as an agent for collecting organ donation consent.17
obtaining oral consent.17For a deceased individual who made no lifetime choice regarding donation, the authorization for providing consent is referred to a list
should be regulated by the laws of the respective country. For example, the “anatomic gift act” implemented in the United States authorizesa variety of possible individuals to provide consent on behalf of the deceased.17 For a
members, or unrelated individuals with an emotional attachment to recipient.7If the donor is found to feel pressurized regarding donation after careful consultation and explanation, the donor status is denied, even though
recipient, and potential donor.7
Lung preservation: preservation process for brain death donors and
the organ preservation immediately after the death is determined to prevent any additional injury during the critical time. As brain death is determined, the patient has no right to receive further therapy, except for the purposes of organ preservation.
284 Indian Journal of Public Health Research & Development, March 2019, Vol.10, No. 3
Organ distribution: Organs are distributed based on
opportunity to access organs available for transplantation.
lung transplantation purposes.21However, if the national
transplantation maybe done electively.22
Principle of the LAS system is giving priority to recipients with higher transplant urgency and
6,21,23,24
number of days lived without transplant, whereas
one year are calculated to produce a number on a scale
optn.transplant.hrsa.govrepresented by a lowerscore.23
should be distributed based on the recipient suitability. Conventionally, ABO and HLA compatibility alone are used as the validating criteria for organ matching. However, many studies have reported that size,
transplantation outcome.5,25
survival rate within CF, IPF and single lung transplants,
lungs donor are associated with higher risk of mortality, regardless of the recipient race.5
World donation system: regulations regarding organ donation. Some use the “option in” system, while others use the “option out” system. In the “option in” system, organ donation is permitted only when an individual has agreed to donate their organs. In contrast, in the “option out” donation system, every individual has given “presumed consent” to donate their organs, unless refusal to be a donor is evident by a legal statement.16,26
Africa, the donation system varies depending on the laws and agreements in the associated country.17
Ethical issues: Similar to other medical practices, the transplantation and organ donation system should abide by the prevailing bioethics values. Addressing the urgent and growing controversies in illegal organ sales, transplant
meeting was held, and the Declaration of Istanbul was made, an International agreement with regard to organ donor and transplantation.27,28Every country has the authority to decide the organ donation system, though the system should be consistent with international standards, as stated in the Declaration of Istanbul.28
commercialism, and transplant tourism are now 27
to organ transfer from a living or deceased donor by means of the threat, force, or other forms of coercion, abduction, fraud, deception, abuse, power, or of the giving to, or the receiving of third party payments
potential donor, for the purpose of organ exploitation for transplantation.28
to the policy or practice in which an organ is treated as a commodity, including its purchase, sale, or use for material gain.28
transplant to patients from outside a country, involving
commercialism.28
Another important ethical issue is transplant
action in every process of organ distribution and
In addition to the Declaration of Istanbul, the
transplant and donation in 1991.28
updated in 2004 with regard to the issues and challenges in organ transplantation, as described above. In the WHO
over living organ donors due to the potential practice of unethical organ utilization of living organ donors.
to avoid any legal threats.27
increase the willingness of relatives or individuals close to the recipient to donate their organs.27
should ensure the presence of informed consent for all deceased and living donors, as a practice in the principle of autonomy. Informed consent can be attained from
prevailing regulations in the country.9,27
Indian Journal of Public Health Research & Development, March 2019, Vol.10, No. 3 285
Indonesia potentiation: Indonesia has the capacity to declare brain death since 2009.29
and transplantation purpose; 29
regulation No. 37 in year 2014 on the declaration of death, and organ utilization.30Brain death maybe declared following the examination of at least 3 doctors, including one neurologist and one anesthesiologist in the ICU. 29Unfortunately, in Indonesia, only a few hospitals have capacity to declare brain death due to the lack of facilities, including the absence of an ICU
some hospitals refuse to declare brain death despite
ability to declare brain death.
Less in infrastructure: independent organizations
listing and organ distribution; local hospital networking, supporting human sources; advanced organ procurement facilities; and organ transportations. Financial support is needed to build the supporting infrastructure, including the supply and maintenance of such facilities; for conducting meeting, training program, and workshop for involved human resources; building internal and external network system; funding donor organ removal and distribution processes before paid by the recipient/health insurance. Within the supporting infrastructure, the availability of appropriate human resources is the most important aspect of asuccess organ donation
10
In conclusion,the major challenge in developing a lung transplantation program is the shortage of organ
needed prior to the development of lung transplantation program. Deceased organ donation is prefered to living organ donation for lung transplantation purposes. Besides
sources is the main factor to succeed the development of
Source of Funding: Self
Nil
Ethical Clearance:no Ethical clearance
REFERENCES
1. International Society for Heart and Lung
2. Keller CA. Solid organ transplantation overview
regarding its major aspects. J Bras Pneumol.
4. International Society for Heart and Lung
2016 International Society for Heart Lung
healun.2015.10.023
5. Chaney J, Suzuki Y, Cantu E, van Berkel V.
1439.2014.03.24
lung transplantation provides similar survival to cadaveric lung transplantation even for very ill
9. Delmonico F. Ethics of organ donation and
[presentation in Seminar at University of Chicago www.youtube.com/
accessed on Oct12th, 2016.
286 Indian Journal of Public Health Research & Development, March 2019, Vol.10, No. 3
transplant center increases lung procurement rates.
criteria, pulmonary graft function validation, and
13. Shemie SD, Doig C, Dickens B, Byrne P,
neurological determination of death and organ
14. American Academy of Neurology. Practice
15. Webb AC, Samuels OB. Reversible brain death after cardiopulmonary arrest and induced hypothermia. Crit
16. Eurotransplant International Foundation. Legislation within the Eurotransplant region. In website www.eurotransplant.org/cms/index.
. Accessed on November 12, 2016
17. National conference of Commissioners on Uniform State Laws. Revised Uniform Anatomical
ctr.12680
on www.sgh.com.sg accessed on November 4, 2016
uploads/unos/Accessed on September 15, 2016.
sizing in thoracic organ transplantation. World J
10.5500/wjt.v6.il.155
Successful example of hpw to implement and develop a deceased organ donation system in
transproceed.2015.08.037
principles on human organ transplantation report of the regional meeting. Available on www.wpro.
accessed on November 15,2016.
Available on www.multivu.prnewswire.com access on November 12, 2016
tahun 2009 tentang kesehatan. Available on www.peraturan.go.id accessed on November 12,2016
30. Peraturan Kementrian KesehatanRepublik Indonesia No. 37 tahun 2014 tentang penentuan kematian dan pemanfaatan oragn donor. Available on www.sinforeg.litbang.depkes.go.id accessed on November 12,2016
Call for Papers/Article Submission
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Names of authors
Abstract
Keywords
Introduction or background
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Indian Journal of Public Heath Research & Development is a double blind peer reviewed international Journal. The frequency is Monthly. It deals with all aspects of Public Health including Community Medicine, Public Health, Epidemiology, Occupational Health, Environmental Hazards, Clinical Research, Public Health Laws and covers all medical specialties concerned with research and development for the masses. The Journal strongly encourages reports of research carried out within Indian continent and South East Asia.
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