A ten point Conventional Convenience Rating Scale (CCRS) was developed to classify and analyze differences in use of convenience food for menu items of selective regular and diabetic diets for seven days in eight active treatment hospitals. Statistical analysis showed that the CCRS score detected differences between six meal components, three meals and four areas of production within each diet type. The convenience hospital had generally highest CCRS scores for all meal components; dessert CCRS scores were primarily dependent on the presence or absence of a bakeshop on the premises. Breakfast had the highest mean meal CCRS scores and lunch the lowest. CCRS scores were lowest for menu items which were prepared in the chef's area and in the salad and sandwich area. There was a significant inverse relationship (r = 0.895) between mean hospital CCRS score and aggregate skill level of food production employees. No correlation was found between the mean hospital CCRS score and 1) meal-days per food production labour minute, 2) total food cost per meal-day and 3) food production labour cost per meal-day. Among other recommendations, this research suggests that further investigation be made to assess the adequacy of the standards of performance used in this study and commonly used as indicators of institutional foodservice efficiency.
Conventional treatment of epidermolysis bullosa is often unsuccessful. The Kozak protocol is an alternative that has been given considerable public support in Ontario. The incremental cost of this treatment program at the Hospital for Sick Children, Toronto, was examined. The departments of nursing, pharmacy and food services each kept records of salaries and supply costs applicable to the care of nine patients with epidermolysis bullosa who were treated in the fiscal year 1982-83. The selected direct costs to the hospital were compared with the projected costs if these patients had been treated in Dr. Kozak's clinic in West Germany or under the financial arrangements offered to Dr. Kozak by the Ontario minister of health. At a total incremental cost of +255.92 per patient-day, care at the Hospital for Sick Children may not currently be the least expensive means of offering the Kozak protocol to Ontario children. However, the major expense of the program, the nurses' salaries, could be reduced if the patients' parents were to assume many of the nursing tasks; this would make the hospital's program the most cost-effective method of treating children with epidermolysis bullosa.
Integrating scientific changes, citizens' needs and economic constraints has become a challenge. New types of cost-effective services, technologies and products must be found. Manufacturers, hospital administrators and health professionals must be capable of effectively documenting the benefits, risks and costs of their services to society and the quality of care to patients. Choices must be made to decide upon appropriate actions in allocating and using resources. The concepts of cost-benefit analysis and cost-effectiveness analysis should be understood. Identifying and valuing costs and benefits, measuring effectiveness, and assessing quality of life are complex and difficult issues. They are discussed in reference to Canadian studies on the cost-effectiveness of nutrition support. The need for further research to improve cost-effectiveness of nutrition support is stressed.
Fulfilling nutrition support cost-effectively encompasses consideration of the selection of appropriate patients, routes, products and equipment. Properly administered, nutrition support not only benefits the patient but undoubtedly provides a cost-saving to the institution. Data based on product specifications and nutrition needs should be considered in the selection of nutrition products. Standardization of a skeleton solution that can be modified for individual patient needs minimizes associated labour, contains costs and encourages appropriate patient monitoring. The co-ordination of nutrition care by a nutrition support service has been associated with reduced complication rates, improved nutrition therapy and major cost savings.