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The implementation of guidelines for budget control and cost calculation, and their effect on the quality of management of intensive care units in the countries of the European Union


BACKGROUND: The results of EURICUS-I have shown on 89 intensive care units (ICUs) in 12 countries of the European Union: a) a non-systematic diversity of budgeting procedures; b) whenever present, the cost accounting procedures were underdeveloped; c) there was a complete absence of standardised operationalisation of relevant financial concepts; d) there was often an enormous mismatch between provision and use of resources.
It was estimated that this mismatch was at the origin of the loss of a large percentage of the financial resources invested by the health care systems across Europe.

OBJECTIVES: a) to develop guidelines for the standardisation and harmonisation of budgeting and costing procedures on the ICUs of the countries of the European Union; b) to develop an instrument to assess quality of management in ICUs; c) to explore the effects of guidelines for budgeting and costing on the costeffectiveness of ICUs; d) to explore the effects of these guidelines on the quality of management of ICUs.

DESIGN: Prospective randomised controlled study.

SETTING: Three groups of about 30 ICUs each randomly extracted from a previously selected number of ICUs willing to participate: Groups 1: before and after measurements; Group 2: implementation of guidelines and after measurements; Group 3: before and after measurements, and implementation of guidelines.

INTERVENTIONS: a) a protocoled set of guidelines for budgeting and costing procedures, designed and prepared by a panel of experts will be implemented at the ICUs of the experimental group during a period of six months; b) the implementation of these guidelines will be preceded by an expert action of training and "indoctrination" of the management at ICU level by trained trainers, at country level. The implementation of the guidelines will be supervised and "coached" by the trainers and by the involved researchers during site visits to the ICUs; c) a protocoled questionnaire for assessing quality of management, designed and prepared by a panel of experts will be administered to the management of the ICUs.

MEASUREMENTS: a) before and after measurements concerning costs, cost-effectiveness and quality of management; b) case-mix, daily nursing workload and clinical outcome will be measured concerning the patients admitted during the period of intervention.

RESULTS EXPECTED: Besides those indicated above in objectives, it is expected that the programme will: a) stimulate the development of multidisciplinary management-teams including the various professionals involved with the management of the ICUs; b) the results of EURICUS-III will be easily extrapolated to other clinical departments of the hospital; c) strengthen and extend the existing network of researchers, providing the EU member-states with objective instruments for the harmonisation and standardisation of budgeting and costing procedures on clinical departments of the hospital.
KEY-WORDS: intensive care units, guidelines, budget, cost, managerial quality, cost-accounting, cost-effectiveness, budget control.

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Akademisch Ziekenhuis Groningen
59,ooster singel
9700 RB Groningen

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