Michele Manzoli , Stefano Bergamasco *, Roberto Belliato * - - PowerPoint PPT Presentation
Michele Manzoli , Stefano Bergamasco *, Roberto Belliato * Universit degli Studi di Trieste, Dipartimento Servizi Condivisi dellA.O.U. di Udine, * TBS Group SpA 1 Stages of diffusion and maturity : Future
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Stages of diffusion and maturity:
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(Med J Aust 2009) Exploring policy-makers’ perspectives on disinvestment from ineffective healthcare practices (IJTAHC 2008)
Building the evidence base for disinvestment from ineffective health care practices: a case study in obstructive sleep apnea syndrome
(Ph.D. thesis - University of Adelaide 2007)
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Equipment Intended purpose Diagnostic-therapeutic pathway
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A) Analysis of Costs associated with the use B) Reimbursment according DRG C) Economic return of disposal D) Available human resources analysis E) Hospital length of stay F) Operating theatre use
Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Do not change anything Costs
DRG + B + B + B + B + B + B Amortization
depreciation charge ) Disinvest Costs DRG Disposal ± C Amortization
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Literature: 4 kinds of economic assessment: 1) Cost-minimization analysis 2) Cost-effectiveness analysis 3) Cost-utility analysis 4) Cost-benefit analysis FAIL END OF THE STORY PASS
Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Do not change anything Old costs
Old DRG + B + B + B + B + B + B Old amortization
charge ) Disinvest + new equipment New costs
New DRG I I I I I I Disposal ± C Old amortization
New amortization
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[workflow based on the one created by Policlinico Gemelli’s UVT]
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Medicus Mundi Attrezzature
Donor hospital Donor hospital Donor hospital Donor hospital Donor hospital Recipient hospital Recipient hospital Recipient hospital Recipient hospital
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http://www.memua.it/
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"Through a virtuous circle that allows the recovery of otherwise discarded materials and equipment with high costs for public and private health institutions and consequent social costs imposed on all citizens, MEDICUS MUNDI ATTREZZATURE's objective is to ensure the promotion of human dignity, assuring the inalienable right to health and to life and the social integration of socially disadvantaged people through a rehabilitation and reintegration project"
Main managed activities:
medical equipment and plants;
cooperation projects;
and plants, as well as post-installation support;
equipment in order to impart efficiency, quality and safety;
cooperation projects in the social-health field.
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1.
Equipment suitability for donation
Simplicity of operation
Accessories and supplies
Operating and service manuals
Safety
Technical support from the OEM
Volunteers and employees, with critical thinking, understand the extent to
which they can restore and refurbish the more complex equipment.
The manuals often can not be found, and the good is taken without
documentation "technical library" of the Cooperative
In absence of adequate testing equipment, safety testing is done by third
parties
The Cooperative remains the interlocutor of the recipient
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2.
Recipient’s active engagement
Preparing and using checklists to ensure that donations are appropriate
Sharing with potential donors the priority lists, policies and checklists
Providing feedback to the donor during the donation process as well as final
Refusing unsolicited or inappropriate donations
Donation recipients are associations, religious congregations, NGOs, Caritas,
International Cooperation Organizations. These subjects take care of health facilities in developing countries and promote projects for this purpose
They address subjects like MeMuA in order to get equipment and establish
collaborative arrangements
Once the donation process is over, the give a feedback in order to improve
future collaborations
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3.
Evaluation of potential recipients
The donor should demand from the potential recipient the following information:
which and how many procedures will be performed (clinical need)
properly trained physicians, nurses and technicians
available facilities to install and operate the requested equipment
human, material and financial resources available to service and maintain the requested equipment
The Cooperative assures that the recipient really needs the equipment required for the project it aims to achieve, and has the means to use and maintain it. It can be useful - in the case of major installations - to organize an inspection tour In addition to equipment, it is often necessary: to install photovoltaic panels for electricity, pumps for water, voltage stabilizers, and to know the type of sockets used and obtain appropriate adapters
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4.
Pre-donation planning
The donor needs to provide detailed information regarding:
the installation (e.g. floor loading capacity, space and power requirements)
the operation requirement (e.g. cables, reagents, test equipment)
required training for operation and maintenance
maintenance requirement (e.g. special tools, PM frequency and materials)
who will cover the costs of international and local transport, freight and insurance, warehousing, customs clearance, storage and handling, installation and ongoing support costs
Much information can be found on the manuals All arrangements are made before the equipment shipment
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5.
Donation implementation
Decontaminated equipment, fragile parts packaged with great care. If available,
procedures or recommendation for periodic inspection, maintenance and calibration should be provided
The recipient inspects all containers and content for damage and verifies that
nothing is missing; any irregularities is reported immediately to the donor
Installation is performed; after that, verification of proper and safe operation
must be performed
A program of periodic inspection, maintenance and calibration is implemented
The packaging for shipping is a critical step because, if done not properly,
may affect the success of the project
If the equipment has been disassembled, the assembling should not be too
difficult and there should be all the necessary hardware components (since it is often difficult to find them)
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6.
Follow-up evaluation
The donor and the recipient assess the level of operational success or failure of
the equipment donated; this assessment encourages the continued support of the donor and allows both parties to learn to improve from previous experience
MeMuA and the recipient confront each other with respect to the success
requirement
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Components n. € Notes
Stabilizer control group 380V 30V
1 290,00
Rack cabinet with two doors
1 0 Reclaimed
Painted doors
2 130,00
Transformer 30 KVA
1 0 Reclaimed
Cuttable fuse box 3
1 15,60
Cylindrical Fuse GG BRC 10,3x38 32 A
3 2,04
Circuit breaker 24-32
2 147,80
1 5,00
Neutral terminal 10 sq.mm
1 3,00
Standard terminal 10 sq.mm
6 18,00
Protection terminal 10 sq mm
1 3,00
Insulation tube
1 0 Reclaimed
Cable 1.5 m
1 13,00
Consumables
1 10,00
Design
1 43,00
Labor
1 100,00 Total 780,44
and ultrasound images storage
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light
michele.manzoli@gmail.com stefano.bergamasco@tbsgroup.com roberto.belliato@tbsgroup.com
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(Chinese proverb)