WorldWideScience

Sample records for hospital care usage

  1. Intranet usage and potential in acute care hospitals in the United States: survey-2000.

    Science.gov (United States)

    Hatcher, M

    2001-12-01

    This paper provides the results of the Survey-2000 measuring Intranet and its potential in health care. The survey measured the levels of Internet and Intranet existence and usage in acute care hospitals. Business-to-business electronic commerce and electronic commerce for customers were measured. Since the Intranet was not studied in survey-1997, no comparisons could be made. Therefore the results were presented and discussed. The Intranet data were compared with the Internet data and statistically significant differences were presented and analyzed. This information will assist hospitals to plan Internet and Intranet technology. This is the third of three articles based upon the results of the Survey-2000. Readers are referred to prior articles by the author, which discusses the survey design and provides a tutorial on technology transfer in acute care hospitals.(1) The first article based upon the survey results discusses technology transfer, system design approaches, user involvement, and decision-making purposes. (2) The second article based upon the survey results discusses distribution of Internet usage and rating of Internet usage applied to specific applications. Homepages, advertising, and electronic commerce are discussed from an Internet perspective.

  2. Internet usage and potential impact for acute care hospitals: survey in the United States.

    Science.gov (United States)

    Hatcher, M

    1998-12-01

    These survey results are from a national survey of acute care hospitals. A random sample of 813 hospitals was selected with 115 responding and 33 incorrect addresses resulting in a 15% response rate. The purpose of the study was to measure the extent of information systems integration in the financial, medical, and administrative systems of the hospitals. Internet usage including homepages and advertising was measured. Other selected telecommunication applications are analyzed. As demonstration projects from the literature are compared to the survey results, the potential for hospitals is tremendous. Resulting cost savings could be equally impressive. This information will provide a benchmark for hospitals to determine their position relative to Internet technology and to set goals.

  3. Usage of unscheduled hospital care by homeless individuals in Dublin, Ireland: a cross-sectional study.

    Science.gov (United States)

    Ní Cheallaigh, Clíona; Cullivan, Sarah; Sears, Jess; Lawlee, Ann Marie; Browne, Joe; Kieran, Jennifer; Segurado, Ricardo; O'Carroll, Austin; O'Reilly, Fiona; Creagh, Donnacha; Bergin, Colm; Kenny, Rose Anne; Byrne, Declan

    2017-12-01

    Homeless people lack a secure, stable place to live and experience higher rates of serious illness than the housed population. Studies, mainly from the USA, have reported increased use of unscheduled healthcare by homeless individuals.We sought to compare the use of unscheduled emergency department (ED) and inpatient care between housed and homeless hospital patients in a high-income European setting in Dublin, Ireland. A large university teaching hospital serving the south inner city in Dublin, Ireland. Patient data are collected on an electronic patient record within the hospital. We carried out an observational cross-sectional study using data on all ED visits (n=47 174) and all unscheduled admissions under the general medical take (n=7031) in 2015. The address field of the hospital's electronic patient record was used to identify patients living in emergency accommodation or rough sleeping (hereafter referred to as homeless). Data on demographic details, length of stay and diagnoses were extracted. In comparison with housed individuals in the hospital catchment area, homeless individuals had higher rates of ED attendance (0.16 attendances per person/annum vs 3.0 attendances per person/annum, respectively) and inpatient bed days (0.3 vs 4.4 bed days/person/annum). The rate of leaving ED before assessment was higher in homeless individuals (40% of ED attendances vs 15% of ED attendances in housed individuals). The mean age of homeless medical inpatients was 44.19 years (95% CI 42.98 to 45.40), whereas that of housed patients was 61.20 years (95% CI 60.72 to 61.68). Homeless patients were more likely to terminate an inpatient admission against medical advice (15% of admissions vs 2% of admissions in homeless individuals). Homeless patients represent a significant proportion of ED attendees and medical inpatients. In contrast to housed patients, the bulk of usage of unscheduled care by homeless people occurs in individuals aged 25-65 years. © Article author

  4. Perception, attitude and usage of complementary and alternative medicine among doctors and patients in a tertiary care hospital in India.

    Science.gov (United States)

    Roy, Vandana; Gupta, Monica; Ghosh, Raktim Kumar

    2015-01-01

    Complementary and alternative medicine (CAM) has been practiced in India for thousands of years. The aim of this study was to determine the extent of use, perception and attitude of doctors and patients utilizing the same healthcare facility. This study was conducted among 200 doctors working at a tertiary care teaching Hospital, India and 403 patients attending the same, to determine the extent of usage, attitude and perception toward CAM. The use of CAM was more among doctors (58%) when compared with the patients (28%). Among doctors, those who had utilized CAM themselves, recommended CAM as a therapy to their patients (52%) and enquired about its use from patients (37%) to a greater extent. CAM was used concomitantly with allopathic medicine by 60% patients. Very few patients (7%) were asked by their doctors about CAM use, and only 19% patients voluntarily informed their doctors about the CAM they were using. Most patients who used CAM felt it to be more effective, safer, less costly and easily available in comparison to allopathic medicines. CAM is used commonly by both doctors and patients. There is a lack of communication between doctors and patients regarding CAM, which may be improved by sensitization of doctors and inclusion of CAM in the medical curriculum.

  5. [Usage of antibiotics in hospitals].

    Science.gov (United States)

    Ternák, G; Almási, I

    1996-12-29

    The authors publish the results of a survey conducted among hospital records of patients discharged from eight inpatient's institutes between 1-31st of January 1995 to gather information on the indications and usage of antibiotics. The institutes were selected from different part of the country to represent the hospital structure as much as possible. Data from the 13,719 documents were recorded and analysed by computer program. It was found that 27.6% of the patients (3749 cases) received antibiotic treatment. 407 different diagnosis and 365 different surgical procedures (as profilaxis) were considered as indications of antibiotic treatment (total: 4450 indications for 5849 antibiotic treatment). The largest group of patients receiving antibiotics was of antibiotic profilaxis (24.56%, 1093 cases), followed by lower respiratory tract infections (19.89%, 849 cases), uroinfections (10.53%, 469 cases) and upper respiratory tract infections. Relatively large group of patients belonged to those who had fever or subfebrility without known reason (7.35%, 327 cases) and to those who did not have any proof in their document indicating the reasons of antibiotic treatment (6.4%, 285 cases). We can not consider the antibiotic indications well founded in those groups of patients (every sixth or every fifth cases). The most frequently used antibiotics were of [2-nd] generation cefalosporins. The rate of nosocomial infections were found as 6.78% average. The results are demonstrated on diagrams and table.

  6. Antibiotic Usage Profile after Antibiotic Stewardship Program Implementation in Intensive Care Unit of dr. Ramelan Naval Hospital Surabaya

    Directory of Open Access Journals (Sweden)

    Stefanie Setiawan

    2018-03-01

    Full Text Available Antibiotic Stewardship Program (ASP is mandatory to all Indonesian hospitals, in accordance to the 2015 Minister of Health Decree No. 8. Dr. Ramelan Naval Hospital Surabaya is one among the many hospitals in Indonesia that has implemented the ASP. The study objective was to describe quantitative-qualitatively the use of antibiotics, along with clinical and microbiological outcomes observed in an Intensive Care Unit (ICU after ASP implementation in dr. Ramelan Naval Hospital Surabaya. The design was a 3-month (February–May 2016 cross-sectional observational study. Quantitative description was reported using Days of Therapy (DOT/100 patient-days, the qualitative description was reviewed using Gyssens’ flowchart. Clinical outcomes observed include nosocomial infection, infection-related mortality, and average length of stay (LOS. Microbiological outcome was observed through the occurences of multi-drug resistant organism. The results showed overall antibiotic use was 151.63 DOT/100 patient-days. Quality of antibiotic use were 52.73% definitely appropriate; 8.18% inappropriate regarding dose, intervals, durations, and timing; 7.27% no indication; and no mutual agreement in 31.82% (κ=0.59; p<0.05. Hospital Acquired Pneumonias (HAPs/Ventilator Associated Pneumonias (VAPs were the most observed nosocomial infection, infection-related mortality rate was 44.68%; and average LOS were 7.17±1.9 days (p<0.05. No incidents of Methicillin-resistant Staphylococcus aureus (MRSA or Extended Spectrum Beta-Lactamase (ESBL have been found, but there were two cases of Multi Drug Resistant (MDR Acinetobacter baumannii.

  7. Antimicrobial usage in German acute care hospitals: results of the third national point prevalence survey and comparison with previous national point prevalence surveys.

    Science.gov (United States)

    Aghdassi, Seven Johannes Sam; Gastmeier, Petra; Piening, Brar Christian; Behnke, Michael; Peña Diaz, Luis Alberto; Gropmann, Alexander; Rosenbusch, Marie-Luise; Kramer, Tobias Siegfried; Hansen, Sonja

    2018-04-01

    Previous point prevalence surveys (PPSs) revealed the potential for improving antimicrobial usage (AU) in German acute care hospitals. Data from the 2016 German national PPS on healthcare-associated infections and AU were used to evaluate efforts in antimicrobial stewardship (AMS). A national PPS in Germany was organized by the German National Reference Centre for Surveillance of Nosocomial Infections in 2016 as part of the European PPS initiated by the ECDC. The data were collected in May and June 2016. Results were compared with data from the PPS 2011. A total of 218 hospitals with 64 412 observed patients participated in the PPS 2016. The prevalence of patients with AU was 25.9% (95% CI 25.6%-26.3%). No significant increase or decrease in AU prevalence was revealed in the group of all participating hospitals. Prolonged surgical prophylaxis was found to be common (56.1% of all surgical prophylaxes on the prevalence day), but significantly less prevalent than in 2011 (P < 0.01). The most frequently administered antimicrobial groups were penicillins plus β-lactamase inhibitors (BLIs) (23.2%), second-generation cephalosporins (12.9%) and fluoroquinolones (11.3%). Significantly more penicillins plus BLIs and fewer second-generation cephalosporins and fluoroquinolones were used in 2016. Overall, an increase in the consumption of broad-spectrum antimicrobials was noted. For 68.7% of all administered antimicrobials, the indication was documented in the patient notes. The current data reaffirm the points of improvement that previous data identified and reveal that recent efforts in AMS in German hospitals require further intensification.

  8. Tutorial on technology transfer and survey design and data collection for measuring Internet and Intranet existence, usage, and impact (survey-2000) in acute care hospitals in the United States.

    Science.gov (United States)

    Hatcher, M

    2001-02-01

    This paper provides a tutorial of technology transfer for management information systems in health care. Additionally it describes the process for a national survey of acute care hospitals using a random sample of 813 hospitals. The purpose of the survey was to measure the levels of Internet and Intranet existence and usage in acute care hospitals. The depth of the survey includes e-commerce for both business to business and with customers. The relationships with systems approaches, user involvement, user satisfaction and decision-making will be studied. Changes with results of a prior survey conducted in 1997 can be studied and enabling and inhabiting factors identified. This information will provide benchmarks for hospitals to plan their network technology position and to set goals.

  9. RFID Continuance Usage Intention in Health Care Industry.

    Science.gov (United States)

    Iranmanesh, Mohammad; Zailani, Suhaiza; Nikbin, Davoud

    Radio-frequency identification (RFID) has been proved to be an effective tool both for improving operational efficiency and for gaining competitive advantage in the health care industry despite its relatively low-usage rate in hospitals. The sustained use of RFID by health care professionals will promote its development in the long term. This study evaluates the acceptance continuance of RFID among health care professionals through technology continuance theory (TCT). Data were collected from 178 medical professionals in Malaysia and were then analyzed using the partial least squares technique. The analysis showed that the TCT model provided not only a thorough understanding of the continuance behavior of health care professionals toward RFID but also the attitudes, satisfaction, and perceived usefulness of professionals toward it. The results of this study are expected to assist policy makers and managers in the health care industry in implementing the RFID technology in hospitals by understanding the determinants of continuance of RFID usage intention.

  10. Social media usage among health care providers.

    Science.gov (United States)

    Surani, Zoya; Hirani, Rahim; Elias, Anita; Quisenberry, Lauren; Varon, Joseph; Surani, Sara; Surani, Salim

    2017-11-29

    The objective of this study was to evaluate the use of social media among healthcare workers in an attempt to identify how it affects the quality of patient care. An anonymous survey of 35 questions was conducted in South Texas, on 366 healthcare workers. Of the 97% of people who reported owning electronic devices, 87.9% indicated that they used social media. These healthcare workers indicated that they spent approximately 1 h on social media every day. The healthcare workers below the age of 40 were more involved in social media compared to those above 40 (p social media among physicians and nurses was noted to be identical (88% for each group), and both groups encouraged their patients to research their clinical conditions on social media (p social media policy in their hospital compared to nurses (p < 0.05). However, a large proportion of healthcare workers (40%) were unaware of their workplace policy, which could potentially cause a privacy breach of confidential medical information. Further studies are required to evaluate specific effects of these findings on the quality of patient care.

  11. BARRIERS, FACILITATORS AND SOCIO-DEMOGRAPHIC CHARACTERISTICS ASSOCIATED WITH CONDOM USAGE AMONGST MALE HIV INTEGRATED COUNSELLING AND TESTING CENTRE ATTENDEES AT THE GOVERNMENT HOSPITAL OF THORACIC MEDICINE, AN HIV TERTIARY CARE CENTRE IN CHENNAI

    Directory of Open Access Journals (Sweden)

    D Mahajan

    2013-06-01

    Full Text Available Background: HIV is transmitted largely through sexual route which can be prevented by using condoms. The objectives of this study were to describe condom usage with various barriers, facilitators and to determine association between different socioeconomic characteristics among male Integrated Counselling and Testing Centre (ICTC attendees. Methods: This is a hospital based cross sectional study (n=300. Clients (18-45years attending ICTC for first time, between June-October ‘2010, were interviewed with structured questionnaire after obtaining informed consent. Description of demographic characteristics of respondents; univariate, multivariate logistic regression analyses were performed for estimation of association. Results: Among respondents, awareness of HIV and condom were 80% and 85.3% respectively; Knowledge of prevention from STI/HIV (97.7% was most common facilitator while forgetfulness after drinking alcohol (64.1% was most common barrier to use condom; Respondents who had education up to secondary or above level were more associated with condom usage (AOR 2.9,95%CI1.34-6.24, after adjusting for income compared to non educated respondents; considering less than Indian rupee (INR 3000 per month as reference category, there were association of condom usage among relatively higher income groups between INR.3000 to 5000 per month (AOR 2.6, 95%CI 1.38-5.0,adjusting education and income above INR5000 per month (AOR 2.85,95%CI1.37-5.9, adjusting education. Conclusions: Condom usage was independently associated with education and income level of respondents. Forgetfulness after drinking alcohol was main barrier; knowledge of prevention from HIV was main facilitator of condom usage. Dissemination of knowledge regarding facilitator of condom usage and implementation of Rapid Needs Assessment Tool for Condom Programming can encourage condom use.

  12. [Trends in hospital care].

    Science.gov (United States)

    Vecina Neto, Gonzalo; Malik, Ana Maria

    2007-01-01

    This paper analyses trends in the delivery of hospital services in Brazil, considering the setting, the current situation and its challenges, examining what still remains to be done. The variables studied for the analysis of the setting are: demography, epidemiological profile, human resources, technology, medicalization, costs, review of the role of the citizen, legislation, equity, hospital-centricity and regionalization, care fractioning and bed availability. The Brazilian setting was studied through the supplementary healthcare model, financing and the healthcare area production chain. The observations of the current situation present external evaluation models, outsourcing, public-private relationships, de-hospitalization and financing. The analysis of the challenges examines the need for long range planning, the quest for new legal models for the 'business', the use of information and information systems, cost controls and the need for enhanced efficiency and compliance with legal directives, guaranteed universal access to full healthcare facilities, the inclusion of primary prevention in healthcare procedures, integrating the public and private sectors and engaging physicians in solving problems.

  13. Usage Patterns of a Mobile Palliative Care Application.

    Science.gov (United States)

    Zhang, Haipeng; Liu, David; Marks, Sean; Rickerson, Elizabeth M; Wright, Adam; Gordon, William J; Landman, Adam

    2018-06-01

    Fast Facts Mobile (FFM) was created to be a convenient way for clinicians to access the Fast Facts and Concepts database of palliative care articles on a smartphone or tablet device. We analyzed usage patterns of FFM through an integrated analytics platform on the mobile versions of the FFM application. The primary objective of this study was to evaluate the usage data from FFM as a way to better understand user behavior for FFM as a palliative care educational tool. This is an exploratory, retrospective analysis of de-identified analytics data collected through the iOS and Android versions of FFM captured from November 2015 to November 2016. FFM App download statistics from November 1, 2015, to November 1, 2016, were accessed from the Apple and Google development websites. Further FFM session data were obtained from the analytics platform built into FFM. FFM was downloaded 9409 times over the year with 201,383 articles accessed. The most searched-for terms in FFM include the following: nausea, methadone, and delirium. We compared frequent users of FFM to infrequent users of FFM and found that 13% of all users comprise 66% of all activity in the application. Demand for useful and scalable tools for both primary palliative care and specialty palliative care will likely continue to grow. Understanding the usage patterns for FFM has the potential to inform the development of future versions of Fast Facts. Further studies of mobile palliative care educational tools will be needed to further define the impact of these educational tools.

  14. Usage pattern of personal care products in California households.

    Science.gov (United States)

    Wu, Xiangmei May; Bennett, Deborah H; Ritz, Beate; Cassady, Diana L; Lee, Kiyoung; Hertz-Picciotto, Irva

    2010-11-01

    Given the concern over the potential for health risks associated with certain ingredients (e.g., phthalates) in personal care products, usage patterns of ∼30 types of personal care products (e.g., shampoo, sunscreen, fragrance, etc.) were collected in 604 California households through a telephone interview. Preferences in selecting products, e.g., scented or unscented, aerosol, and brand loyalty, were also investigated. Participants were recruited in three age groups, children (mostly preschoolers), their parents, and adults age 55 or older. Use frequencies of various product types varied by sex, age group, race, education, and climatic region. Product use by parent and child from the same household were correlated. Use frequencies of products in the same class (e.g., skincare) were moderately correlated, which may impact aggregate exposures. Use frequencies observed in this study were generally in the same range as those reported in the EPA Exposure Factor Handbook, but we found differences for some individual products. Our study provides additional data on population-based usage patterns of a large collection of commonly used personal care products pertaining to several age groups and socio-demographic strata. This information will be valuable for exposure and risk assessments. Copyright © 2010 Elsevier Ltd. All rights reserved.

  15. [Toward innovative hospital care].

    Science.gov (United States)

    Loudcher, Rose-Marie; Tebib-Chibani, Yasmine

    2017-10-01

    For healthcare financing to remain profitable and to continue to function, the care system must be innovative in terms of patient care. Work organisation has changed with the pricing system for medical acts. The system of enhanced recovery after surgery helps to reduce hospitalisation times and to reflect on organisation. Nurses are on the front line. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  16. Big data modeling to predict platelet usage and minimize wastage in a tertiary care system.

    Science.gov (United States)

    Guan, Leying; Tian, Xiaoying; Gombar, Saurabh; Zemek, Allison J; Krishnan, Gomathi; Scott, Robert; Narasimhan, Balasubramanian; Tibshirani, Robert J; Pham, Tho D

    2017-10-24

    Maintaining a robust blood product supply is an essential requirement to guarantee optimal patient care in modern health care systems. However, daily blood product use is difficult to anticipate. Platelet products are the most variable in daily usage, have short shelf lives, and are also the most expensive to produce, test, and store. Due to the combination of absolute need, uncertain daily demand, and short shelf life, platelet products are frequently wasted due to expiration. Our aim is to build and validate a statistical model to forecast future platelet demand and thereby reduce wastage. We have investigated platelet usage patterns at our institution, and specifically interrogated the relationship between platelet usage and aggregated hospital-wide patient data over a recent consecutive 29-mo period. Using a convex statistical formulation, we have found that platelet usage is highly dependent on weekday/weekend pattern, number of patients with various abnormal complete blood count measurements, and location-specific hospital census data. We incorporated these relationships in a mathematical model to guide collection and ordering strategy. This model minimizes waste due to expiration while avoiding shortages; the number of remaining platelet units at the end of any day stays above 10 in our model during the same period. Compared with historical expiration rates during the same period, our model reduces the expiration rate from 10.5 to 3.2%. Extrapolating our results to the ∼2 million units of platelets transfused annually within the United States, if implemented successfully, our model can potentially save ∼80 million dollars in health care costs.

  17. Hospital usage of marketing research over a ten year period.

    Science.gov (United States)

    Sanchez, P M

    1995-01-01

    The acceptance and use of marketing techniques and concepts in the health care area is a phenomenon well known to most marketers. Prior to 1979, marketing in the health care field was relatively unknown. Since that time, however, the growth of health care marketing has not been accompanied by commensurate growth in marketing research efforts.

  18. Computer usage among nurses in rural health-care facilities in South Africa: obstacles and challenges.

    Science.gov (United States)

    Asah, Flora

    2013-04-01

    This study discusses factors inhibiting computer usage for work-related tasks among computer-literate professional nurses within rural healthcare facilities in South Africa. In the past two decades computer literacy courses have not been part of the nursing curricula. Computer courses are offered by the State Information Technology Agency. Despite this, there seems to be limited use of computers by professional nurses in the rural context. Focus group interviews held with 40 professional nurses from three government hospitals in northern KwaZulu-Natal. Contributing factors were found to be lack of information technology infrastructure, restricted access to computers and deficits in regard to the technical and nursing management support. The physical location of computers within the health-care facilities and lack of relevant software emerged as specific obstacles to usage. Provision of continuous and active support from nursing management could positively influence computer usage among professional nurses. A closer integration of information technology and computer literacy skills into existing nursing curricula would foster a positive attitude towards computer usage through early exposure. Responses indicated that change of mindset may be needed on the part of nursing management so that they begin to actively promote ready access to computers as a means of creating greater professionalism and collegiality. © 2011 Blackwell Publishing Ltd.

  19. Difficulty in the usage of nuclides in hospitals

    International Nuclear Information System (INIS)

    Ueda, Hideo

    1980-01-01

    In Japan, the uses of radioisotopes in hospitals are increasing year after year. Therefore, the problems of the treatment and disposal of radioactive wastes are important. The liquid and gaseous wastes with radioactivity concentrations below the maximum permissible levels are allowed to be disposed of on the sites by the law. However, high-level liquid wastes and solid wastes cannot be disposed of on the sites. These wastes stored in steel drums are collected by Japan Radioisotope Association, and finally treated and disposed of on the site of Japan Atomic Energy Research Institute. The nuclides used in hospitals are principally Tc-99m, and also 131 I, 198 Au, 125 I and 3 H. The following matters are described: the present situation, radioactive wastes from medical treatments, and the management of radioactive solid, liquid and gaseous wastes from hospitals. (J.P.N.)

  20. Analysis of Internet Usage Among Cancer Patients in a County Hospital Setting: A Quality Improvement Initiative

    Science.gov (United States)

    Lilley, Lisa; Lodrigues, William; Dreadin-Pulliam, Julie; Xie, Xian-Jin; Mathur, Sakshi; Rao, Madhu; Harvey, Valorie; Leitch, Ann Marilyn; Rao, Roshni

    2014-01-01

    Background Cancer is one of the most common diseases that patients research on the Internet. The Commission on Cancer (CoC) recommended that Parkland Memorial Hospital (PMH) improve the oncology services website. PMH is Dallas County’s public health care facility, serving a largely uninsured, minority population. Most research regarding patient Internet use has been conducted in insured, Caucasian populations, raising concerns that the needs of PMH patients may not be extrapolated from available data. The PMH Cancer Committee, therefore, adopted a quality improvement initiative to understand patients’ Internet usage. Objective The objective of the study was to obtain and analyze data regarding patients’ Internet usage in order to make targeted improvements to the oncology services section of the institutional website. Methods A task force developed an 11-question survey to ascertain what proportion of our patients have Internet access and use the Internet to obtain medical information as well as determine the specific information sought. Between April 2011 and August 2011, 300 surveys were administered to newly diagnosed cancer patients. Multivariate analyses were performed. Results Of 300 surveys, 291 were included. Minorities, primarily African-American and Hispanic, represented 78.0% (227/291) of patients. Only 37.1% (108/291) of patients had Internet access, most (256/291, 87.9%) having access at home. Younger patients more commonly had Internet access, with a mean age of 47 versus 58 years for those without (PInternet research was to develop questions for discussion with one’s physician. Patients most frequently sought information regarding cancer treatment options, outcomes, and side effects. Conclusions Less than one-half of PMH oncology patients have Internet access. This is influenced by age, educational level, and ethnicity. Those with access use it to obtain information related to their cancer diagnosis. The most effective way of addressing our

  1. National Hospital Ambulatory Medical Care Survey

    Data.gov (United States)

    U.S. Department of Health & Human Services — The National Hospital Ambulatory Medical Care Survey (NHAMCS) is designed to collect data on the utilization and provision of ambulatory care services in hospital...

  2. Pediatric CT scan usage in Japan. Results of a hospital survey

    Energy Technology Data Exchange (ETDEWEB)

    Ghotbi, N; Morishita, Mariko; Norimatsu, Nana; Namba, Hiroyuki; Yamashita, Shunichi [Nagasaki Univ., Graduate School of Biomedical Sciences, Nagasaki, Nagasaki (Japan); Ohtsuru, Akira [Nagasaki Univ., Hospital, Takashi Nagai Memorial International Hibakusha Medical Center, Nagasaki, Nagaski (Japan); Ogawa, Yoji; Uetani, Masataka; Moriuchi, Hiroyuki [Nagasaki Univ., Hospital, Nagasaki, Nagasaki (Japan)

    2006-10-15

    The aim of this study was to examine the usage parameters of diagnostic computed tomography (CT) in children because of concerns of possible overuse in Japanese hospitals, including the ''technical'' CT exposure settings and the ''clinical'' grounds for CT requests. We examined the methodology at the radiology department to reduce radiation exposure to children and performed a retrospective study on pediatric CT requests during a 1-year period at Nagasaki University Hospital. The parameters of diagnostic CT usage for minor head trauma and acute appendicitis were studied in detail. CT radiation dose settings are adjusted for children based on guidelines issued by the Japan Radiological Society, with few limitations. CT requests were made for 62% of minor head trauma cases and 76% of cases clinically suspected to be acute appendicitis. These figures are considerably higher than those reported by studies in the United Kingdom, Canada, or the United States. No specific guidelines are advocated regarding CT usage for minor head trauma. The diagnosis of acute appendicitis in children is almost routinely referred for confirmation'' by CT. CT radiation risks to children at Japanese hospitals need to be considered more seriously. Physicians should be encouraged to follow diagnostic algorithms that help avoid unnecessary CT usage in children. (author)

  3. Pediatric CT scan usage in Japan. Results of a hospital survey

    International Nuclear Information System (INIS)

    Ghotbi, N.; Morishita, Mariko; Norimatsu, Nana; Namba, Hiroyuki; Yamashita, Shunichi; Ohtsuru, Akira; Ogawa, Yoji; Uetani, Masataka; Moriuchi, Hiroyuki

    2006-01-01

    The aim of this study was to examine the usage parameters of diagnostic computed tomography (CT) in children because of concerns of possible overuse in Japanese hospitals, including the ''technical'' CT exposure settings and the ''clinical'' grounds for CT requests. We examined the methodology at the radiology department to reduce radiation exposure to children and performed a retrospective study on pediatric CT requests during a 1-year period at Nagasaki University Hospital. The parameters of diagnostic CT usage for minor head trauma and acute appendicitis were studied in detail. CT radiation dose settings are adjusted for children based on guidelines issued by the Japan Radiological Society, with few limitations. CT requests were made for 62% of minor head trauma cases and 76% of cases clinically suspected to be acute appendicitis. These figures are considerably higher than those reported by studies in the United Kingdom, Canada, or the United States. No specific guidelines are advocated regarding CT usage for minor head trauma. The diagnosis of acute appendicitis in children is almost routinely referred for confirmation'' by CT. CT radiation risks to children at Japanese hospitals need to be considered more seriously. Physicians should be encouraged to follow diagnostic algorithms that help avoid unnecessary CT usage in children. (author)

  4. Hospitals and health care establishments

    International Nuclear Information System (INIS)

    1999-01-01

    These guidelines have been drown up to assist all those involved in the management and maintenance of hospitals and health care establishments. Compliance with this guidance should minimise the risk of pollution occurring. The guidelines are jointly produced by the Environment Agency for England and Wales, the Scottish Environment Protection Agency and the Environment and Heritage Service for Northern Ireland, referred to as the Agency or Agencies. It includes guidelines on site drainage, sewage and waste water disposal, treatment of surface water drainage and waste management

  5. Impact of Health Literacy on Senior Citizen Engagement in Health Care IT Usage

    Directory of Open Access Journals (Sweden)

    Alice M. Noblin PhD, RHIA, CCS

    2017-04-01

    Full Text Available Objective: Patient engagement in health care information technology (IT is required for government reimbursement programs. This research surveyed one older adult group to determine their willingness to use health information from a variety of sources. Health literacy was also measured using the Newest Vital Sign (NVS and eHealth Literacy Scale (eHEALS tools. Method: Regression models determined engagement in health care IT usage and impact of literacy levels based on survey data collected from the group. Results: Although most participants have adequate literacy, they are not more likely to use health care IT than those with limited literacy scores. Knowledge of how to use the Internet to answer questions about health was statistically associated with IT usage. Discussion: Health care IT usage is important for healthy aging. The ability of older adults to understand information provided to them can impact population health including medication usage and other important factors.

  6. Impact of Health Literacy on Senior Citizen Engagement in Health Care IT Usage.

    Science.gov (United States)

    Noblin, Alice M; Rutherford, Ashley

    2017-01-01

    Objective: Patient engagement in health care information technology (IT) is required for government reimbursement programs. This research surveyed one older adult group to determine their willingness to use health information from a variety of sources. Health literacy was also measured using the Newest Vital Sign (NVS) and eHealth Literacy Scale (eHEALS) tools. Method: Regression models determined engagement in health care IT usage and impact of literacy levels based on survey data collected from the group. Results: Although most participants have adequate literacy, they are not more likely to use health care IT than those with limited literacy scores. Knowledge of how to use the Internet to answer questions about health was statistically associated with IT usage. Discussion: Health care IT usage is important for healthy aging. The ability of older adults to understand information provided to them can impact population health including medication usage and other important factors.

  7. Optimizing antibiotic usage in hospitals: a qualitative study of the perspectives of hospital managers.

    Science.gov (United States)

    Broom, A; Gibson, A F; Broom, J; Kirby, E; Yarwood, T; Post, J J

    2016-11-01

    Antibiotic optimization in hospitals is an increasingly critical priority in the context of proliferating resistance. Despite the emphasis on doctors, optimizing antibiotic use within hospitals requires an understanding of how different stakeholders, including non-prescribers, influence practice and practice change. This study was designed to understand Australian hospital managers' perspectives on antimicrobial resistance, managing antibiotic governance, and negotiating clinical vis-à-vis managerial priorities. Twenty-three managers in three hospitals participated in qualitative semi-structured interviews in Australia in 2014 and 2015. Data were systematically coded and thematically analysed. The findings demonstrate, from a managerial perspective: (1) competing demands that can hinder the prioritization of antibiotic governance; (2) ineffectiveness of audit and monitoring methods that limit rationalization for change; (3) limited clinical education and feedback to doctors; and (4) management-directed change processes are constrained by the perceived absence of a 'culture of accountability' for antimicrobial use amongst doctors. Hospital managers report considerable structural and interprofessional challenges to actualizing antibiotic optimization and governance. These challenges place optimization as a lower priority vis-à-vis other issues that management are confronted with in hospital settings, and emphasize the importance of antimicrobial stewardship (AMS) programmes that engage management in understanding and addressing the barriers to change. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  8. Home care, hospitalizations and doctor visits

    OpenAIRE

    Gonçalves Judite; Weaver France

    2014-01-01

    This study estimates the effects of formal home care on hospitalizations and doctor visits. We compare the effects of medically- and non-medically-related home care and investigate heterogeneous effects by age group and informal care availability. Two-part models are estimated, using data from Switzerland. In this federal country, home care policy is decentralized into cantons (i.e. states). The endogeneity of home care is addressed by using instrumental variables, canton and time fixed effec...

  9. 78 FR 15882 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2013-03-13

    ... Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and... Register entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals...

  10. Beyond the clinic: redefining hospital ambulatory care.

    Science.gov (United States)

    Rogut, L

    1997-07-01

    Responding to changes in health care financing, government policy, technology, and clinical judgment, and the rise of managed care, hospitals are shifting services from inpatient to outpatient settings and moving them into the community. Institutions are evolving into integrated delivery systems, developing the capacity to provide a continuum of coordinated services in an array of settings and to share financial risk with physicians and managed care organizations. Over the past several years, hospitals in New York City have shifted considerable resources into ambulatory care. In their drive to expand and enhance services, however, they face serious challenges, including a well-established focus on hospitals as inpatient centers of tertiary care and medical education, a heavy reliance upon residents as providers of medical care, limited access to capital, and often inadequate physical plants. In 1995, the United Hospital Fund awarded $600,000 through its Ambulatory Care Services Initiative to support hospitals' efforts to meet the challenges of reorganizing services, compete in a managed care environment, and provide high-quality ambulatory care in more efficient ways. Through the initiative, 12 New York City hospitals started projects to reorganize service delivery and build an infrastructure of systems, technology, and personnel. Among the projects undertaken by the hospitals were:--broad-based reorganization efforts employing primary care models to improve and expand existing ambulatory care services, integrate services, and better coordinate care;--projects to improve information management, planning and testing new systems for scheduling appointments, registering patients, and tracking ambulatory care and its outcomes;--training programs to increase the supply of primary care providers (both nurse practitioners and primary care physicians), train clinical and support staff in the skills needed to deliver more efficient and better ambulatory care, prepare staff

  11. [Hospitality as an expression of nursing care].

    Science.gov (United States)

    Barra, Daniela Couto Carvalho; Waterkemper, Roberta; Kempfer, Silvana Silveira; Carraro, Telma Elisa; Radünz, Vera

    2010-01-01

    Qualitative research whose purpose was to reflect and argue about the relationship between hospitality, care and nursing according to experiences of PhD students. The research was developed from theoretic and practical meeting carried through by disciplines "the care in Nursing and Health" of PhD nursing Program at Santa Catarina Federal University. Its chosen theoretical frame of Hospitality perspective while nursing care. Data were collected applying a semi-structured questionnaire at ten doctoral students. The analysis of the data was carried through under the perspective of the content analysis according to Bardin. Hospitality it is imperative for the individuals adaptation in the hospital context or any area where it is looking for health care.

  12. Hospital medicine (Part 2): what would improve acute hospital care?

    LENUS (Irish Health Repository)

    Kellett, John

    2009-09-01

    There are so many obvious delays and inefficiencies in our traditional system of acute hospital care; it is clear that if outcomes are to be improved prompt accurate assessment immediately followed by competent and efficient treatment is essential. Early warning scores (EWS) help detect acutely ill patients who are seriously ill and likely to deteriorate. However, it is not known if any EWS has universal applicability to all patient populations. The benefit of Rapid Response Systems (RRS) such as Medical Emergency Teams has yet to be proven, possibly because doctors and nurses are reluctant to call the RRS for help. Reconfiguration of care delivery in an Acute Medical Assessment Unit has been suggested as a "proactive" alternative to the "reactive" approach of RRS. This method ensures every patient is in an appropriate and safe environment from the moment of first contact with the hospital. Further research is needed into what interventions are most effective in preventing the deterioration and\\/or resuscitating seriously ill patients. Although physicians expert in hospital care decrease the cost and length of hospitalization without compromising outcomes hospital care will continue to be both expensive and potentially dangerous.

  13. Is hospital 'community benefit' charity care?

    Science.gov (United States)

    Bakken, Erik; Kindig, David A

    2012-10-01

    The Affordable Care Act is drawing increased attention to the Internal Revenue Service (IRS) Community Benefit policy. To qualify for tax exemption, the IRS requires nonprofit hospitals to allocate a portion of their operating expenses to certain "charitable" activities, such as providing free or reduced care to the indigent. To determine the total amount of community benefit reported by Wisconsin hospitals using official IRS tax return forms (Form 990), and examine the level of allocation across allowable activities. Primary data collection from IRS 990 forms submitted by Wisconsin hospitals for 2009. Community benefit reported in absolute dollars and as percent of overall hospital expenditures, both overall and by activity category. For 2009, Wisconsin hospitals reported $1.064 billion in community benefits, or 7.52% of total hospital expenditures. Of this amount, 9.1% was for charity care, 50% for Medicaid subsidies, 11.4% for other subsidized services, and 4.4% for Community Health Improvement Services. Charity care is not the primary reported activity by Wisconsin hospitals under the IRS Community Benefit requirement. Opportunities may exist for devoting increasing amounts to broader community health improvement activities.

  14. Timely and Effective Care - Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — Timely and Effective Care measures - provider data. This data set includes provider-level data for measures of cataract surgery outcome, colonoscopy follow-up, heart...

  15. 75 FR 60640 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2010-10-01

    ...; RIN 0938-AP33 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Changes and FY 2011 Rates; Provider... Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective...

  16. 77 FR 4908 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2012-02-01

    ... Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal... the final rule entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates...

  17. 77 FR 65495 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2012-10-29

    ... Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and... Federal Register entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates...

  18. Usage patterns of personal care products: Important factors for exposure assessment

    NARCIS (Netherlands)

    Biesterbos, J.W.H.; Dudzina, T.; Delmaar, C.J.; Bakker, M.I.; Russel, F.G.M.; Goetz, N. von; Scheepers, P.T.J.; Roeleveld, N.

    2013-01-01

    Complete information regarding the use of personal care products (PCPs) by consumers is limited, but such information is crucial for realistic consumer exposure assessment. To fill this gap, a database was created with person-oriented information regarding usage patterns and circumstances of use for

  19. Antimicrobial usage in an intensive care unit: a prospective analysis.

    LENUS (Irish Health Repository)

    Conrick-Martin, I

    2012-01-31

    Antimicrobial therapies in the Intensive Care Unit (ICU) need to be appropriate in both their antimicrobial cover and duration. We performed a prospective observational study of admissions to our semi-closed ICU over a three-month period and recorded the indications for antimicrobial therapy, agents used, duration of use, changes in therapy and reasons for changes in therapy. A change in therapy was defined as the initiation or discontinuation of an antimicrobial agent. There were 51 patients admitted during the three-month study period and all received antimicrobial therapy. There were 135 changes in antimicrobial therapy. 89 (66%) were made by the ICU team and 32 (24%) were made by the primary team. Changes were made due to a deterioration or lack of clinical response in 41 (30%) cases, due to the completion of prescribed course in 36 (27%) cases, and in response to a sensitivity result in 25 (19%) cases. Prophylactic antibiotic courses (n=24) were of a duration greater than 24 hours in 15 (63%) instances. In conclusion, the majority of changes in antimicrobial therapy were not culture-based and the duration of surgical prophylaxis was in excess of current recommended guidelines.

  20. Pharmaceutical care in Kuwait: hospital pharmacists' perspectives.

    Science.gov (United States)

    Katoue, Maram G; Awad, Abdelmoneim I; Schwinghammer, Terry L; Kombian, Samuel B

    2014-12-01

    Pharmaceutical care practice has been championed as the primary mission of the pharmacy profession, but its implementation has been suboptimal in many developing countries including Kuwait. Pharmacists must have sufficient knowledge, skills, and positive attitudes to practise pharmaceutical care, and barriers in the pharmacy practice model must be overcome before pharmaceutical care can be broadly implemented in a given healthcare system. To investigate hospital pharmacists' attitudes towards pharmaceutical care, perceptions of their preparedness to provide pharmaceutical care, and the barriers to its implementation in Kuwait. Six general hospitals, eight specialized hospitals and seven specialized health centers in Kuwait. A descriptive, cross-sectional survey was distributed to all pharmacists working in the governmental hospitals in Kuwait (385 pharmacists). Data were collected via a pre-tested self-administered questionnaire. Descriptive statistics including percentages, medians and means Likert scale rating (standard deviations) were calculated and compared using statistical package for social sciences, version 20. Statistical significance was accepted at a p value of Kuwait. Completed surveys were received from 250 (64.9%) of the 385 pharmacists. Pharmacists expressed overall positive attitudes towards pharmaceutical care. They felt well prepared to implement the various aspects of pharmaceutical care, with the least preparedness in the administrative/management aspects. Pharmacists with more practice experience expressed significantly more positive attitudes towards pharmaceutical care (p = 0.001) and they felt better prepared to provide pharmaceutical care competencies (p Kuwait advocate implementation of pharmaceutical care while also appreciating the organizational, technical and professional barriers to its widespread adoption. Collaborative efforts between health authorities and educational institutions, and the integration of innovative approaches in

  1. Pre-hospital Emergency Care

    African Journals Online (AJOL)

    20 Apr 1974 ... lance services, training programmes that are not geared to the needs of these personnel and, not least, a lack of interest on the part of the medical profession, with a few notable exceptions, in the whole question of emergency care. There is a re- luctance on the part of many doctors to assist in the training of ...

  2. Mechanical ventilators in US acute care hospitals.

    Science.gov (United States)

    Rubinson, Lewis; Vaughn, Frances; Nelson, Steve; Giordano, Sam; Kallstrom, Tom; Buckley, Tim; Burney, Tabinda; Hupert, Nathaniel; Mutter, Ryan; Handrigan, Michael; Yeskey, Kevin; Lurie, Nicole; Branson, Richard

    2010-10-01

    The supply and distribution of mechanical ventilation capacity is of profound importance for planning for severe public health emergencies. However, the capability of US health systems to provide mechanical ventilation for children and adults remains poorly quantified. The objective of this study was to determine the quantity of adult and pediatric mechanical ventilators at US acute care hospitals. A total of 5,752 US acute care hospitals included in the 2007 American Hospital Association database were surveyed. We measured the quantities of mechanical ventilators and their features. Responding to the survey were 4305 (74.8%) hospitals, which accounted for 83.8% of US intensive care unit beds. Of the 52,118 full-feature mechanical ventilators owned by respondent hospitals, 24,204 (46.4%) are pediatric/neonatal capable. Accounting for nonrespondents, we estimate that there are 62,188 full-feature mechanical ventilators owned by US acute care hospitals. The median number of full-feature mechanical ventilators per 100,000 population for individual states is 19.7 (interquartile ratio 17.2-23.1), ranging from 11.9 to 77.6. The median number of pediatric-capable device full-feature mechanical ventilators per 100,000 population younger than 14 years old is 52.3 (interquartile ratio 43.1-63.9) and the range across states is 22.1 to 206.2. In addition, respondent hospitals reported owning 82,755 ventilators other than full-feature mechanical ventilators; we estimate that there are 98,738 devices other than full-feature ventilators at all of the US acute care hospitals. The number of mechanical ventilators per US population exceeds those reported by other developed countries, but there is wide variation across states in the population-adjusted supply. There are considerably more pediatric-capable ventilators than there are for adults only on a population-adjusted basis.

  3. Hospital System Readmissions: A Care Cycle Approach

    Directory of Open Access Journals (Sweden)

    Cody Mullen

    2012-01-01

    Full Text Available Hospital readmission rates can be used as an indicator of the quality of health care services and can highlight high-priority research areas to ensure better health. A readmission is defined as when a patient is discharged from an acute care hospital and is admitted back to an acute care hospital in a set amount of days, with 30 days being the current national standard. On average, 19.6% of Medicare patients are readmitted to the hospital within 30 days of discharge and 56.1% within a year (Jencks, Williams, & Coleman, 2009. The hypothesis of this study was that the discharge location, or where a patient went immediately after discharge, would not have a significant effect on readmissions. A data set with all admission records was obtained from a major health provider. These data contain all hospital patients’ demographic and diagnosis information. General, women’s, and children’s hospitals were looked at from a system perspective to study the discharge location of patients as well as the effects of patient demographics on discharge location. By using a z-significance test in Microsoft Excel and SAS 9.2, it was discovered that patients discharged to home have a significantly lower likelihood of readmission. Generally, patients who are discharged to an extended care or intermediate care facility or patients with home health carerelated services had a significantly higher likelihood of being readmitted. The findings may indicate a possible need for an institution-to-institution intervention as well as institution-to-patient intervention. Future work will develop potential interventions in partnership with hospital staff.

  4. 78 FR 38679 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2013-06-27

    ... Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Proposed... Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and... regarding MS-DRG classifications and new technology add-on payments. Eva Fung (410) 786-7539, for...

  5. 75 FR 34614 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and...

    Science.gov (United States)

    2010-06-17

    ... Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and Fiscal Year 2010 Rates and to the Long- Term Care Hospital Prospective Payment System and Rate Year 2010 Rates... Prospective Payment Systems for Acute Care Hospitals and Fiscal Year 2010 Rates and to the Long-Term Care...

  6. The health care market: can hospitals survive?

    Science.gov (United States)

    Goldsmith, J C

    1980-01-01

    Does it sound familiar? Resources are scarce, competition is tough, and government regulations and a balanced budget are increasingly hard to meet at the same time. This is not the automobile or oil industry but the health care industry, and hospital managers are facing the same problems. And, maintains the author of this article, they must borrow some proven marketing techniques from business to survive in the new health care market. He first describes the features of the new market (the increasing economic power of physicians, new forms of health care delivery, prepaid health plans, and the changing regulatory environment) and then the possible marketing strategies for dealing with them (competing hard for physicians who control the patient flow and diversifying and promoting the mix of services). He also describes various planning solutions that make the most of a community's hospital facilities and affiliations.

  7. Characterisation of antimicrobial usage in cats and dogs attending UK primary care companion animal veterinary practices.

    Science.gov (United States)

    Buckland, E L; O'Neill, D; Summers, J; Mateus, A; Church, D; Redmond, L; Brodbelt, D

    2016-11-12

    There is scant evidence describing antimicrobial (AM) usage in companion animal primary care veterinary practices in the UK. The use of AMs in dogs and cats was quantified using data extracted from 374 veterinary practices participating in VetCompass. The frequency and quantity of systemic antibiotic usage was described.Overall, 25 per cent of 963,463 dogs and 21 per cent of 594,812 cats seen at veterinary practices received at least one AM over a two-year period (2012-2014) and 42 per cent of these animals were given repeated AMs. The main agents used were aminopenicillin types and cephalosporins. Of the AM events, 60 per cent in dogs and 81 per cent in cats were AMs classified as critically important (CIAs) to human health by the World Health Organisation. CIAs of highest importance (fluoroquinolones, macrolides, third-generation cephalosporins) accounted for just over 6 per cent and 34 per cent of AMs in dogs and cats, respectively. The total quantity of AMs used within the study population was estimated to be 1473 kg for dogs and 58 kg for cats.This study has identified a high frequency of AM usage in companion animal practice and for certain agents classified as of critical importance in human medicine. The study highlights the usefulness of veterinary practice electronic health records for studying AM usage. British Veterinary Association.

  8. Acute sports injuries requiring hospital care.

    OpenAIRE

    Sandelin, J

    1986-01-01

    The present investigation reports 138 consecutive patients injured in sports, who needed treatment as in-patients in a one year period. More injuries were sustained in soccer than in other sports. The lower extremity was the site of most injuries, fractures and dislocations being the most common type of injury. At follow-up 50% of the patients complained of discomfort. The average stay in hospital after a sports injury requiring hospital care was 6 days. In 52% of the patients the duration of...

  9. Surgical care in the isolated military hospital.

    Science.gov (United States)

    Lukish, J R; Gill, G G; McCoy, T R

    2001-01-01

    To maintain the health of service members and their families throughout the world, the Department of Defense has established several isolated military hospitals (IHs). The operational environment of IHs is such that illness and traumatic injury requiring surgical intervention is common. This study sought to examine the general and orthopedic surgical experience at an IH to determine whether surgical care could be provided in an effective and safe manner. All patients evaluated by the general and orthopedic surgeon at Guantanamo Bay Naval Hospital from October 1, 1998, to April 1, 1999, were included in this study. The following data were retrospectively reviewed: patient demographic data, diagnosis, initial and follow-up care, medical evacuation data, operative procedures, and complications. There were 336 patients who presented for surgical evaluation, resulting in 660 follow-up appointments during the study period. There were 31 medical evacuations (3 emergent). The surgical services performed 122 major operative procedures. There were 58 inpatient admissions. There was 1 death, and surgical complications occurred in 2 patients, for an overall morbidity and mortality of 1.4% and 0.7%, respectively. Our data show that an IH is capable of providing surgical care, including care for traumatic injuries, in a safe manner. This is the first study that provides objective evidence that general and orthopedic surgery at an IH can be provided within the standard of care.

  10. Association of ertapenem and antipseudomonal carbapenem usage and carbapenem resistance in Pseudomonas aeruginosa among 12 hospitals in Queensland, Australia.

    Science.gov (United States)

    McDougall, David A J; Morton, Anthony P; Playford, E Geoffrey

    2013-02-01

    The objective of this study was to determine the association between ertapenem and antipseudomonal carbapenem use and carbapenem resistance in Pseudomonas aeruginosa in 12 hospitals in Queensland, Australia. Data on usage of ertapenem and other antipseudomonal carbapenems, measured in defined daily doses per 1000 occupied bed-days, were collated using statewide pharmacy dispensing and distribution software from January 2007 until June 2011. The prevalence of unique carbapenem-resistant P. aeruginosa isolates derived from statewide laboratory information systems was collected for the same time period. Mixed-effects models were used to determine any relationship between ertapenem and antipseudomonal carbapenem usage and carbapenem resistance among P. aeruginosa isolates in the 12 hospitals analysed. No relationship between ertapenem usage and P. aeruginosa carbapenem resistance was observed. The introduction of ertapenem did not replace antipseudomonal carbapenem prescribing to any significant extent. However, an association between greater usage of antipseudomonal carbapenems and greater P. aeruginosa carbapenem resistance was demonstrated. It is likely that the only mechanism by which ertapenem can improve P. aeruginosa resistance patterns is by being used as a substitute for, rather than in addition to, antipseudomonal carbapenems.

  11. Health care usage among immigrants and native-born elderly populations in eleven European countries: results from SHARE

    Science.gov (United States)

    Guillén, Montserrat; Crimmins, Eileen M.

    2013-01-01

    Differences in health care utilization of immigrants 50 years of age and older relative to the native-born populations in eleven European countries are investigated. Negative binomial and zero-inflated Poisson regression are used to examine differences between immigrants and native-borns in number of doctor visits, visits to general practitioners, and hospital stays using the 2004 Survey of Health, Ageing, and Retirement in Europe database. In the pooled European sample and in some individual countries, older immigrants use from 13 to 20% more health services than native-borns after demographic characteristics are controlled. After controlling for the need for health care, differences between immigrants and native-borns in the use of physicians, but not hospitals, are reduced by about half. These are not changed much with the incorporation of indicators of socioeconomic status and extra insurance coverage. Higher country-level relative expenditures on health, paying physicians a fee-for-service, and physician density are associated with higher usage of physician services among immigrants. PMID:21660564

  12. Assessing the effect of increased managed care on hospitals.

    Science.gov (United States)

    Mowll, C A

    1998-01-01

    This study uses a new relative risk methodology developed by the author to assess and compare certain performance indicators to determine a hospital's relative degree of financial vulnerability, based on its location, to the effects of increased managed care market penetration. The study also compares nine financial measures to determine whether hospital in states with a high degree of managed-care market penetration experience lower levels of profitability, liquidity, debt service, and overall viability than hospitals in low managed care states. A Managed Care Relative Financial Risk Assessment methodology composed of nine measures of hospital financial and utilization performance is used to develop a high managed care state Composite Index and to determine the Relative Financial Risk and the Overall Risk Ratio for hospitals in a particular state. Additionally, financial performance of hospitals in the five highest managed care states is compared to hospitals in the five lowest states. While data from Colorado and Massachusetts indicates that hospital profitability diminishes as the level of managed care market penetration increases, the overall study results indicate that hospitals in high managed care states demonstrate a better cash position and higher profitability than hospitals in low managed care states. Hospitals in high managed care states are, however, more heavily indebted in relation to equity and have a weaker debt service coverage capacity. Moreover, the overall financial health and viability of hospitals in high managed care states is superior to that of hospitals in low managed care states.

  13. In-hospital care and post-hospital followup.

    Science.gov (United States)

    Tanner, L M; Blackmon, H E; Stanley, I; English, N K

    1971-12-01

    Guidelines are given for nurses and social workers involved in abortion care before and after the in-hospital procedure. The California Nurses' Association Maternity Conference Group established guidelines for such care in October, 1970 as follows. The nurse should keep the patient informed of all aspects of the procedure, provide a supportive presence, perform standard physical monitoring during the operation and afterwards, provide contraceptive counseling, and act as a sounding board for discussion of interpersonal relationships and future plans. High quality nursing requires understanding the physical and psychosocial aspects of abortion reflecting the nurse's recognition of the cultural, religious, and socioeconomic factors involved. This requires a nurse who is fully aware of her own feelings and can adapt or defer them to the patient's needs. In cases of suction or dilation abortions, these actions are particularly important, since the patient is in the hospital only a short time and can be easily ignored. In cases of saline infusion, the nurse should be fully aware of possible complications, including retained placentae, hemorrhage, infection, or uterine perforation. If the patient is readmitted for any of these complications, the nurse should continue to play the informative, supportive role. The nurse and social worker should also be aware of the possible psychological sequelae of abortion and watch for mental health problems. It is concluded that postabortion counseling is the best time for contraceptive counseling. Conscientious professional support along these guidelines should insure a positive experience for the abortion patient.

  14. Improving stroke care for patients at Cavan hospital [poster

    LENUS (Irish Health Repository)

    Murugasu, G Dr.

    2013-07-01

    Under the Quality and Continuing Care Directorate (QCCD) in stroke care Cavan General Hospital was identified as a hospital that received a large number of stroke and TIA patients. A programme was established to improve services to this population.

  15. Hospital information technology in home care.

    Science.gov (United States)

    Zhang, Xiao-Ying; Zhang, Pei-Ying

    2016-10-01

    The utilization of hospital information technology (HIT) as a tool for home care is a recent trend in health science. Subjects gaining benefits from this new endeavor include middle-aged individuals with serious chronic illness living at home. Published data on the utilization of health care information technology especially for home care in chronic illness patients have increased enormously in recent past. The common chronic illnesses reported in these studies were primarily on heart and lung diseases. Furthermore, health professionals have confirmed in these studies that HIT was beneficial in gaining better access to information regarding their patients and they were also able to save that information easily for future use. On the other hand, some health professional also observed that the use of HIT in home care is not suitable for everyone and that individuals cannot be replaced by HIT. On the whole it is clear that the use of HIT could complement communication in home care. The present review aims to shed light on these latest aspects of the health care information technology in home care.

  16. Data Access and Usage Practices Across a Cohort of Researchers at a Large Tertiary Pediatric Hospital: Qualitative Survey Study.

    Science.gov (United States)

    Ho, Hoi Ki Kiki; Görges, Matthias; Portales-Casamar, Elodie

    2018-05-14

    Health and health-related data collected as part of clinical care is a foundational component of quality improvement and research. While the importance of these data is widely recognized, there are many challenges faced by researchers attempting to use such data. It is crucial to acknowledge and identify barriers to improve data sharing and access practices and ultimately optimize research capacity. To better understand the current state, explore opportunities, and identify barriers, an environmental scan of investigators at BC Children's Hospital Research Institute (BCCHR) was conducted to elucidate current local practices around data access and usage. The Clinical and Community Data, Analytics and Informatics group at BCCHR comprises over 40 investigators with diverse expertise and interest in data who share a common goal of facilitating data collection, usage, and access across the community. Semistructured interviews with 35 of these researchers were conducted, and data were summarized qualitatively. A total impact score, considering both frequency with which a problem occurs and the impact of the problem, was calculated for each item to prioritize and rank barriers. Three main themes for barriers emerged: the lengthy turnaround time before data access (18/35, 51%), inconsistent and opaque data access processes (16/35, 46%), and the inability to link data (15/35, 43%) effectively. Less frequent themes included quality and usability of data, ethics and privacy review barriers, lack of awareness of data sources, and efforts required duplicating data extraction and linkage. The two main opportunities for improvement were data access facilitation (14/32, 44%) and migration toward a single data platform (10/32, 31%). By identifying the current state and needs of the data community onsite, this study enables us to focus our resources on combating the challenges having the greatest impact on researchers. The current state parallels that of the national landscape. By

  17. Primary care referral management: a marketing strategy for hospitals.

    Science.gov (United States)

    Bender, A D; Geoghegan, S S; Lundquist, S H; Cantone, J M; Krasnick, C J

    1990-06-01

    With increasing competition among hospitals, primary care referral development and management programs offer an opportunity for hospitals to increase their admissions. Such programs require careful development, the commitment of the hospital staff to the strategy, an integration of hospital activities, and an understanding of medical practice management.

  18. Using scientific evidence to improve hospital library services: Southern Chapter/Medical Library Association journal usage study.

    Science.gov (United States)

    Dee, C R; Rankin, J A; Burns, C A

    1998-07-01

    Journal usage studies, which are useful for budget management and for evaluating collection performance relative to library use, have generally described a single library or subject discipline. The Southern Chapter/Medical Library Association (SC/MLA) study has examined journal usage at the aggregate data level with the long-term goal of developing hospital library benchmarks for journal use. Thirty-six SC/MLA hospital libraries, categorized for the study by size as small, medium, or large, reported current journal title use centrally for a one-year period following standardized data collection procedures. Institutional and aggregate data were analyzed for the average annual frequency of use, average costs per use and non-use, and average percent of non-used titles. Permutation F-type tests were used to measure difference among the three hospital groups. Averages were reported for each data set analysis. Statistical tests indicated no significant differences between the hospital groups, suggesting that benchmarks can be derived applying to all types of hospital libraries. The unanticipated lack of commonality among heavily used titles pointed to a need for uniquely tailored collections. Although the small sample size precluded definitive results, the study's findings constituted a baseline of data that can be compared against future studies.

  19. Improving Patient Safety in Hospitals through Usage of Cloud Supported Video Surveillance

    Directory of Open Access Journals (Sweden)

    Predrag Dašić

    2017-03-01

    CONCLUSION: Patient safety is a growing issue which can be improved with the usage of high-end centralised surveillance systems allowing the staff to focus more on treating health issues rather that keeping a watchful eye on potential incidents.

  20. Inter-regional competition and quality in hospital care.

    Science.gov (United States)

    Aiura, Hiroshi

    2013-06-01

    This study analyzes the effect of episode-of-care payment and patient choice on waiting time and the comprehensive quality of hospital care. The study assumes that two hospitals are located in two cities with different population sizes and compete with each other. We find that the comprehensive quality of hospital care as well as waiting time of both hospitals improve with an increase in payment per episode of care. However, we also find that the extent of these improvements differs according to the population size of the cities where the hospitals are located. Under the realistic assumptions that hospitals involve significant labor-intensive work, we find the improvements in comprehensive quality and waiting time in a hospital located in a small city to be greater than those in a hospital located in a large city. The result implies that regional disparity in the quality of hospital care decreases with an increase in payment per episode of care.

  1. Teamwork and Patient Care Teams in an Acute Care Hospital.

    Science.gov (United States)

    Rochon, Andrea; Heale, Roberta; Hunt, Elena; Parent, Michele

    2015-06-01

    The literature suggests that effective teamwork among patient care teams can positively impact work environment, job satisfaction and quality of patient care. The purpose of this study was to determine the perceived level of nursing teamwork by registered nurses, registered practical nurses, personal support workers and unit clerks working on patient care teams in one acute care hospital in northern Ontario, Canada, and to determine if a relationship exists between the staff scores on the Nursing Teamwork Survey (NTS) and participant perception of adequate staffing. Using a descriptive cross-sectional research design, 600 staff members were invited to complete the NTS and a 33% response rate was achieved (N=200). The participants from the critical care unit reported the highest scores on the NTS, whereas participants from the inpatient surgical (IPS) unit reported the lowest scores. Participants from the IPS unit also reported having less experience, being younger, having less satisfaction in their current position and having a higher intention to leave. A high rate of intention to leave in the next year was found among all participants. No statistically significant correlation was found between overall scores on the NTS and the perception of adequate staffing. Strategies to increase teamwork, such as staff education, among patient care teams may positively influence job satisfaction and patient care on patient care units. Copyright © 2015 Longwoods Publishing.

  2. Integrated hospital emergency care improves efficiency.

    Science.gov (United States)

    Boyle, A A; Robinson, S M; Whitwell, D; Myers, S; Bennett, T J H; Hall, N; Haydock, S; Fritz, Z; Atkinson, P

    2008-02-01

    There is uncertainty about the most efficient model of emergency care. An attempt has been made to improve the process of emergency care in one hospital by developing an integrated model. The medical admissions unit was relocated into the existing emergency department and came under the 4-hour target. Medical case records were redesigned to provide a common assessment document for all patients presenting as an emergency. Medical, surgical and paediatric short-stay wards were opened next to the emergency department. A clinical decision unit replaced the more traditional observation unit. The process of patient assessment was streamlined so that a patient requiring admission was fully clerked by the first attending doctor to a level suitable for registrar or consultant review. Patients were allocated directly to specialty on arrival. The effectiveness of this approach was measured with routine data over the same 3-month periods in 2005 and 2006. There was a 16.3% decrease in emergency medical admissions and a 3.9% decrease in emergency surgical admissions. The median length of stay for emergency medical patients was reduced from 7 to 5 days. The efficiency of the elective surgical services was also improved. Performance against the 4-hour target declined but was still acceptable. The number of bed days for admitted surgical and medical cases rose slightly. There was an increase in the number of medical outliers on surgical wards, a reduction in the number of incident forms and formal complaints and a reduction in income for the hospital. Integrated emergency care has the ability to use spare capacity within emergency care. It offers significant advantages beyond the emergency department. However, improved efficiency in processing emergency patients placed the hospital at a financial disadvantage.

  3. 77 FR 63751 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2012-10-17

    ... [CMS-1588-F2] RIN 0938-AR12 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates..., 2012 Federal Register entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for...

  4. [Continuity of care from the acute care hospital: Results].

    Science.gov (United States)

    Solé-Casals, Montserrat; Chirveches-Pérez, Emilia; Alsina-Ribas, Anna; Puigoriol-Juvanteny, Emma; Oriol-Ruscalleda, Margarita; Subirana-Casacuberta, Mireia

    2015-01-01

    To describe the profile of patients treated by a Continuity of Care Manager in an acute-care center during the first six months of its activity, as well as the profile of patients treated and the resource allocation. A prospective cross-sectional study was conducted on patients with complex care needs requiring continuity of care liaison, and who were attended by the Continuity of Care Nurse during the period from October 2013 to March 2014. Patient characteristics, their social environment and healthcare resource allocation were registered and analyzed. A total of 1,034 cases of demand that corresponded to 907 patients (women 55.0%; age 80.57±10.1; chronic 47.8%) were analyzed, of whom 12.2% were readmitted. In the multivariate model, it was observed that the variables associated with readmission were polypharmacy (OR: 1.86; CI: 1.2-2.9) and fall history prior to admission (OR: 0.586; CI: 0.36-2-88). Patients treated by a Continuity of Care Nurse are over 80 years, with comorbidities, geriatric syndromes, complex care, and of life needs, to whom an alternative solution to hospitalization is provided, thus preventing readmissions. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.

  5. Antibiotic Usage Prior and During Hospitalization for Clinical Severe Pneumonia in Children under Five Years of Age in Rabat, Morocco

    Directory of Open Access Journals (Sweden)

    Joaquim Ruiz

    2013-09-01

    Full Text Available Scarce and limited epidemiological, clinical and microbiological data are available regarding pediatric respiratory tract infections in the Kingdom of Morocco, a middle-income country in Northwestern Africa. Data on antibiotic usage for such infections are also scarce. A good understanding of pre-admission and intra-hospital usage of antibiotics in children with respiratory infections linked with an adequate surveillance of the antibiotic susceptibility from circulating pathogens could help policy makers improve their recommendations on management of respiratory infections. We hereby present data on antibiotic usage prior and during admission and antibiotic susceptibility of major circulating respiratory pathogens in children under five years of age admitted to the Hôpital d’Enfants de Rabat, Morocco, with a diagnosis of clinical severe pneumonia (using World Health Organization (WHO standardized case definitions during a period of 14 months (November 2010–December 2011, as part of a larger hospital-based surveillance study designed to understand the etiology and epidemiology of severe pneumonia cases among children.

  6. PRE-HOSPITAL EMERGENCY CARE IN SWEDEN

    Directory of Open Access Journals (Sweden)

    Ulf BJÖRNSTIG

    2004-01-01

    In Sweden (9 million inhabitants, a sparsely populated country with sometimes long transportation distances to the nearest trauma hospital, 800 ambulances, 7 ambulance helicopters and 3–5 fixed wing ambulance aircraft are the available transport resources. In case of a mass casualty or disaster situation, inside or outside the country, a governmental project (Swedish National Medevac aims to convert a passenger aircraft from Scandinavian Airlines System (SAS to a qualified medical resource for long distance transport, with capacity to nurse six intensive care patients and an additional 6–20 lieing or seated patients during transport.

  7. Experts: hospitals can improve care, save health care dollars by cracking down on unnecessary blood transfusions.

    Science.gov (United States)

    2013-01-01

    Leading health care quality organizations say that blood transfusions are among the most overused treatments. The problem wastes a precious resource as well as health care dollars, continues to stretch what is known to be in short supply in some parts of the country. Part of the problem is continued adherence to an outdated medical practice that calls for transfusions when they are not medically necessary. Also, experts say many guidelines are vague regarding hemoglobin triggers. However, education coupled with IT-driven interventions can help hospitals make dramatic improvements in their blood usage, potentially preserving blood products for patients who really need them. The American Red Cross says that blood use rose by 40% in the United States between 1994 and 2008. Studies show there is wide variation regarding when blood transfusions are called for by practitioners. The latest research suggests hemoglobin thresholds of 7 or 8 grams per deciliter are acceptable, although practitioners often call for transfusions when hemoglobin is at 10 grams per deciliter. Of particular importance to EDs, the lower hemoglobin triggers don't always apply to actively bleeding patients. Through a comprehensive blood conservation program, Eastern Maine Medical Center in Bangor, ME, has been able to nearly halve the number of patients who now receive transfusions without negatively impacting patient care. Also, the program has saved the hospital more than $5 million in blood costs.

  8. An early view of the impact of deregulation and managed care on hospital profitability and net worth.

    Science.gov (United States)

    Jordan, W J

    2001-01-01

    This study shows the impact of the removal of hospital rate regulation followed by the growth of managed care on hospitals' profitability and net worth. New Jersey emerged from a regulated prospective payment system in 1992. The transition to a freely competitive market structure had a negative impact on hospital profitability, net worth, patient length of stay, and other measures of capacity utilization. Similarly, the doubling of the HMO penetration rate in the state between 1995 and 1997 is shown to have negatively influenced hospital financial viability. Hospitals have responded in part by increasing usage of outpatient services. The use of discounted fee-for-service instead of per diem reimbursement for outpatient services provides an incentive for hospitals to favor outpatient over inpatient services. The effect of these changes is detailed, along with data showing that the larger discounts given by hospitals to managed care organizations, Medicare, and Medicaid played an important role in explaining the diminished profitability of hospitals.

  9. MONITORING OF THE CEPHALOSPORINS CONSUMPTION IN THE TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Radmila Veličković-Radovanović

    2015-06-01

    Full Text Available Irrational antibiotic consumption, especially in the case when there is no appropriate indication for its usage, may be one of the most crucial global issues for public health care, leading to bacterial resistance and the increase of indirect medical expenses. According to the report of the European program for the monitoring of the antibiotic consumption, Serbia is on the fifth place among the countries which are not members of EU. The goal of this work is the evaluation of antibiotic consumption in the Clinical Centre Niš, from 2007 to 2013, with the focus on the monitoring of the cephalosporins utilization, as they are one of the most prescribed groups of antibiotics in the tertiary health care. The utilization of antibiotics in the Clinical Center Niš in the observed period was obtained from the computerized database of the Department of Pharmacotherapy and expressed as defined daily dose (DDD per 100 bed/days (DBD. Our results showed that there was an increase in antibiotic use of the whole group of cephalosporins and penicillin as well as a reduction of quinolones consumption within the observed period. Our analysis showed that ceftriaxone was the most frequently prescribed cephalosporin, followed by cefuroxime. Although antibiotic therapy and prophylaxis in our hospital are in keeping with the recommended guidelines, the obtained results may suggest that cephalosporin consumption, and especially ceftriaxone consumption is higher than in other European countries.

  10. Contraceptive usage and awareness among postpartum mothers in urban field practice area of a tertiary hospital

    Directory of Open Access Journals (Sweden)

    Tanvir Kaur Sidhu

    2015-03-01

    Full Text Available Background: To study contraceptive usage and awareness among postpartum mothers. Objective: To assess prevalence of postpartum contraception and factors affecting the usage of contraceptives in Urban area. Material and Methods: A cross-sectional descriptive study was carried out in the Urban Field practice area of Adesh Institute of Medical Sciences & Research, Bathinda. All females who delivered within last one year were included in the study. A pre-structured questionnaire was used to collect socio-demographic and other details. A total of 92 females were included. The appropriate statistical analysis was done to present the results. Results: 30.4% females had adopted one or the other postpartum contraceptive measure. Condom was the most common method used. Usage of postpartum contraception was significantly associated with women’s and husband’s education, type of delivery and availing of antenatal and postnatal visits. The main reason for not using postpartum contraception was lack of knowledge and access. 16.3% females had unmet need of postpartum contraception. Conclusions: Overall usage of postpartum contraception was low and mainly related to lack of awareness and knowledge.

  11. Usages of Computers and Smartphones to Develop Dementia Care Education Program for Asian American Family Caregivers.

    Science.gov (United States)

    Lee, Jung-Ah; Nguyen, Hannah; Park, Joan; Tran, Linh; Nguyen, Trang; Huynh, Yen

    2017-10-01

    Families of ethnic minority persons with dementia often seek help at later stages of the disease. Little is known about the effectiveness of various methods in supporting ethnic minority dementia patients' caregivers. The objective of the study was to identify smartphone and computer usage among family caregivers of dementia patients (i.e., Korean and Vietnamese Americans) to develop dementia-care education programs for them. Participants were asked various questions related to their computer or smartphone usage in conjunction with needs-assessment interviews. Flyers were distributed at two ethnic minority community centers in Southern California. Snowball recruitment was also utilized to reach out to the families of dementia patients dwelling in the community. Thirty-five family caregivers, including 20 Vietnamese and 15 Korean individuals, participated in this survey. Thirty participants (30 of 35, 85.7%) were computer users. Among those, 76.7% (23 of 30) reported daily usage and 53% (16 of 30) claimed to use social media. A majority of the participants (31 of 35, 88.6%) reported that they owned smartphones. More than half of smartphone users (18 of 29, 62%) claimed to use social media applications. Many participants claimed that they could not attend in-class education due to caregiving and/or transportation issues. Most family caregivers of dementia patients use smartphones more often than computers, and more than half of those caregivers communicate with others through social media apps. A smartphone-app-based caregiver intervention may serve as a more effective approach compared to the conventional in-class method. Multiple modalities for the development of caregiver interventions should be considered.

  12. Cost and usage patterns of antibiotics in a tertiary care neurosurgical unit

    Directory of Open Access Journals (Sweden)

    Manish Singh Sharma

    2012-01-01

    Full Text Available Objectives: The routine use of prophylactic antibiotics in neurosurgery has been shown to significantly reduce surgical site infection rates. The documentation of non-surgical site, nosocomial infections in neurosurgical patients remains limited, despite this being a stimulus for prolific antibiotic usage. The actual quantum of antibiotic use in neurosurgery and its role in infection control remain both undocumented and controversial. The authors address this issue with a cost-effectiveness study using historical controls. Materials and Methods: Bacteriologically positive body fluid samples were used to quantify infection rates in the year 2006 and compared with those in the year 1997. Itemized drug lists obtained from dedicated neurosurgical intensive care units and wards were used to quantify antibiotic usage and calculate their costs. Results were compared using both historical and internal controls. The monetary conversion factor used was INR 40=US$1. Results: A total of 3114 consecutive elective and emergency neurosurgical procedures were performed during the study period. 329 patients (10.6% were recorded to have bacteriologically positive body fluid samples, and 100,250 units of antibiotics were consumed costing Rs. 14,378,227.5 ($359,455.7. On an average, an operated patient received 32.2 units of antibiotics valued at Rs. 4,617 ($115.4. The crude infection rates were recorded to have reduced significantly in comparison to 1997, but did not differ between mirror intra-departmental units with significantly different antibiotic usage. Conclusions: Antibiotics accounted for 31% of the per capita cost of consumables for performing a craniotomy in the year 2006. This estimate should be factored into projecting future package costs.

  13. Severe maternal morbidity in Zanzibar's referral hospital: Measuring the impact of in-hospital care

    NARCIS (Netherlands)

    Herklots, T.; Acht, L. van; Meguid, T.; Franx, A.; Jacod, B.C.

    2017-01-01

    OBJECTIVE: to analyse the impact of in-hospital care on severe maternal morbidity using WHO's near-miss approach in the low-resource, high mortality setting of Zanzibar's referral hospital. SETTING: Mnazi Mmoja Hospital, a tertiary care facility, in Zanzibar, Tanzania. METHODS: We identified all

  14. Costs of terminal patients who receive palliative care or usual care in different hospital wards.

    Science.gov (United States)

    Simoens, Steven; Kutten, Betty; Keirse, Emmanuel; Berghe, Paul Vanden; Beguin, Claire; Desmedt, Marianne; Deveugele, Myriam; Léonard, Christian; Paulus, Dominique; Menten, Johan

    2010-11-01

    In addition to the effectiveness of hospital care models for terminal patients, policy makers and health care payers are concerned about their costs. This study aims to measure the hospital costs of treating terminal patients in Belgium from the health care payer perspective. Also, this study compares the costs of palliative and usual care in different types of hospital wards. A multicenter, retrospective cohort study compared costs of palliative care with usual care in acute hospital wards and with care in palliative care units. The study enrolled terminal patients from a representative sample of hospitals. Health care costs included fixed hospital costs and charges relating to medical fees, pharmacy and other charges. Data sources consisted of hospital accountancy data and invoice data. Six hospitals participated in the study, generating a total of 146 patients. The findings showed that palliative care in a palliative care unit was more expensive than palliative care in an acute ward due to higher staffing levels in palliative care units. Palliative care in an acute ward is cheaper than usual care in an acute ward. This study suggests that palliative care models in acute wards need to be supported because such care models appear to be less expensive than usual care and because such care models are likely to better reflect the needs of terminal patients. This finding emphasizes the importance of the timely recognition of the need for palliative care in terminal patients treated in acute wards.

  15. Missing dosages and neuroleptic usage may prolong length of stay in hospitalized Parkinson's disease patients.

    Directory of Open Access Journals (Sweden)

    Daniel Martinez-Ramirez

    Full Text Available Parkinson's disease patients are more likely to be hospitalized, have higher rates of hospital complications, and have an increased risk of deterioration during hospitalization. Length of stay is an important underlying factor for these increased risks. We aimed to investigate potential medication errors that may occur during hospitalization and its impact on length of hospital stay.A cross-sectional chart review of 339 consecutive hospital encounters from 212 PD subjects was performed. Medication errors were defined as wrong timing or omission of administration for dopaminergic drugs and administration of contraindicated dopamine blockers. An analysis of covariance was applied to examine whether these medication errors were related to increased length of hospital stays.A significant effect for dopaminergic administration (p<0.01 on length of hospital stay was observed. Subjects who had delayed administration or missed at least one dose stayed longer (M=8.2 days, SD=8.9 vs. M=3.6 days SD=3.4. Contraindicated dopamine blocking agents were administered in 23% (71/339 of cases, and this was also significantly related to an increased length of stay (M=8.2 days, SD=8.9 vs. M=3.6 days SD=3.4, p<0.05. Participants who received a contraindicated dopamine blocker stayed in the hospital longer (M=7.5 days, SD=9.1 compared to those who did not (M=5.9 days, SD=6.8. Neurologists were consulted in 24.5% of encounters. Specialty consultation had no effect on the medication related errors.Missing dopaminergic dosages and administration of dopamine blockers occur frequently in hospitalized Parkinson's disease patients and this may impact length of stay. These potentially modifiable factors may reduce the risk of a longer stay related to hospitalization.

  16. Usage of Complementary and Alternative Medicine (CAM) among osteoarthritis patients attending an urban multi-specialist hospital in Lagos, Nigeria.

    Science.gov (United States)

    Obalum, D C; Ogo, C N

    2011-03-01

    Osteoarthritis (OA), a chronic degenerative disease of synovial joints is characterised by pain and stiffness. Aim of treatment is pain relief. Complementary and alternative medicine (CAM) refers to practices which are not an integral part of orthodox medicine. To determine the pattern of usage of CAM among OA patients in Nigeria. Consecutive patients with OA attending orthopaedic clinic of Havana Specialist Hospital, Lagos, Nigeria were interviewed over a 6- month period st st of 1 May to 31 October 2007 on usage of CAM. Structured and open-ended questions were used. Demographic data, duration of OA and treatment as well as compliance to orthodox medications were documented. One hundred and sixty four patients were studied.120 (73.25%) were females and 44(26.89%) were males. Respondents age range between 35-74 years. 66(40.2%) patients used CAM. 35(53.0%) had done so before presenting to the hospital. The most commonly used CAM were herbal products used by 50(75.8%) of CAM users. Among herbal product users, 74.0% used non- specific local products, 30.0% used ginger, 36.0% used garlic and 28.0% used Aloe Vera. Among CAM users, 35(53.0%) used local embrocation and massage, 10(15.2%) used spiritual methods. There was no significant difference in demographics, clinical characteristics and pain control among CAM users and non-users. Many OA patients receiving orthodox therapy also use CAM. Medical doctors need to keep a wary eye on CAM usage among patients and enquire about this health-seeking behaviour in order to educate them on possible drug interactions, adverse effects and long term complications.

  17. Providing quality nutrition care in acute care hospitals: perspectives of nutrition care personnel.

    Science.gov (United States)

    Keller, H H; Vesnaver, E; Davidson, B; Allard, J; Laporte, M; Bernier, P; Payette, H; Jeejeebhoy, K; Duerksen, D; Gramlich, L

    2014-04-01

    Malnutrition is common in acute care hospitals worldwide and nutritional status can deteriorate during hospitalisation. The aim of the present qualitative study was to identify enablers and challenges and, specifically, the activities, processes and resources, from the perspective of nutrition care personnel, required to provide quality nutrition care. Eight hospitals participating in the Nutrition Care in Canadian Hospitals study provided focus group data (n = 8 focus groups; 91 participants; dietitians, dietetic interns, diet technicians and menu clerks), which were analysed thematically. Five themes emerged from the data: (i) developing a nutrition culture, where nutrition practice is considered important to recovery of patients and teams work together to achieve nutrition goals; (ii) using effective tools, such as screening, evidence-based protocols, quality, timely and accurate patient information, and appropriate and quality food; (iii) creating effective systems to support delivery of care, such as communications, food production and delivery; (iv) being responsive to care needs, via flexible food systems, appropriate menus and meal supplements, up to date clinical care and including patient and family in the care processes; and (v) uniting the right person with the right task, by delineating roles, training staff, providing sufficient time to undertake these important tasks and holding staff accountable for their care. The findings of the present study are consistent with other work and provide guidance towards improving the nutrition culture in hospitals. Further empirical work on how to support successful implementation of nutrition care processes is needed. © 2013 The British Dietetic Association Ltd.

  18. Department of Defense Timely & Effective Care Data – military hospitals

    Data.gov (United States)

    U.S. Department of Health & Human Services — This file contains U.S. military hospital data for timely & effective care (process of care) measures collected by the Department of Defense (DoD). DoD collects...

  19. Hospital heterogeneity: what drives the quality of health care.

    Science.gov (United States)

    Ali, Manhal; Salehnejad, Reza; Mansur, Mohaimen

    2018-04-01

    A major feature of health care systems is substantial variation in health care quality across hospitals. The quality of stroke care widely varies across NHS hospitals. We investigate factors that may explain variations in health care quality using measures of quality of stroke care. We combine NHS trust data from the National Sentinel Stroke Audit with other data sets from the Office for National Statistics, NHS and census data to capture hospitals' human and physical assets and organisational characteristics. We employ a class of non-parametric methods to explore the complex structure of the data and a set of correlated random effects models to identify key determinants of the quality of stroke care. The organisational quality of the process of stroke care appears as a fundamental driver of clinical quality of stroke care. There are rich complementarities amongst drivers of quality of stroke care. The findings strengthen previous research on managerial and organisational determinants of health care quality.

  20. Business intelligence and information systems in hospitals--distribution and usage of BI and HIS in German hospitals.

    Science.gov (United States)

    Bartsch, Patrick; Lux, Thomas; Wagner, Alexander; Gabriel, Roland

    2013-01-01

    This paper shows the results of a short survey taken place in February 2013 within German Hospitals. The present studies view is bottom-up and the interviews are done directly with the hospitals CIOs. There are some effects like the G-DRG implementation in Germany that are evident in the results. The survey indicates also the different methods of adapting the solutions, either by having an all-in-one solution by a single provider or by using a modular solution from multiple providers.

  1. Postpartum care attendance at a rural district hospital in Zambia

    NARCIS (Netherlands)

    J. Lagro (Joep); A. Liche (Agnes); J. Mumba (John); R. Ntebeka (Ruth); J. van Roosmalen (Jos)

    2006-01-01

    textabstractPostpartum care is an important tool in both preventive and promotive maternal health care. We studied the postpartum care attendance rate in 540 women who delivered at a district hospital in Zambia. Forty-two percent of the women attended postpartum care within six weeks of delivery.

  2. Benchmarking antibiotic use in Finnish acute care hospitals using patient case-mix adjustment.

    Science.gov (United States)

    Kanerva, Mari; Ollgren, Jukka; Lyytikäinen, Outi

    2011-11-01

    It is difficult to draw conclusions about the prudence of antibiotic use in different hospitals by directly comparing usage figures. We present a patient case-mix adjustment model of antibiotic use to rank hospitals while taking patient characteristics into account. Data on antibiotic use were collected during the national healthcare-associated infection (HAI) prevalence survey in 2005 in Finland in all 5 tertiary care, all 15 secondary care and 10 (25% of 40) other acute care hospitals. The use of antibiotics was measured using use-days/100 patient-days during a 7day period and the prevalence of patients receiving at least two antimicrobials during the study day. Case-mix-adjusted antibiotic use was calculated by using multivariate models and an indirect standardization method. Parameters in the model included age, sex, severity of underlying diseases, intensive care, haematology, preceding surgery, respirator, central venous and urinary catheters, community-associated infection, HAI and contact isolation due to methicillin-resistant Staphylococcus aureus. The ranking order changed one position in 12 (40%) hospitals and more than two positions in 13 (43%) hospitals when the case-mix-adjusted figures were compared with those observed. In 24 hospitals (80%), the antibiotic use density observed was lower than expected by the case-mix-adjusted use density. The patient case-mix adjustment of antibiotic use ranked the hospitals differently from the ranking according to observed use, and may be a useful tool for benchmarking hospital antibiotic use. However, the best set of easily and widely available parameters that would describe both patient material and hospital activities remains to be determined.

  3. Estimating Uncompensated Care Charges at Rural Hospital Emergency Departments

    Science.gov (United States)

    Bennett, Kevin J.; Moore, Charity G.; Probst, Janice C.

    2007-01-01

    Context: Rural hospitals face multiple financial burdens. Due to federal law, emergency departments (ED) provide a gateway for uninsured and self-pay patients to gain access to treatment. It is unknown how much uncompensated care in rural hospitals is due to ED visits. Purpose: To develop a national estimate of uncompensated care from patients…

  4. Health Care Practices for Medical Textiles in Government Hospitals

    Science.gov (United States)

    Akubue, B. N.; Anikweze, G. U.

    2015-01-01

    The purpose of this study was to investigate the health care practices for medical textiles in government hospitals Enugu State, Nigeria. Specifically, the study determined the availability and maintenance of medical textiles in government hospitals in Enugu State, Nigeria. A sample of 1200 hospital personnel were studied. One thousand two hundred…

  5. The consequences upon patient care of moving Brits Hospital: A ...

    African Journals Online (AJOL)

    Background. In 2001, North West Province took the decision to increase bed capacity at Brits Hospital from 66 beds to 267 beds. After careful consideration of costs and an assessment of available land, it was decided to demolish the existing hospital and rebuild the new hospital on the same site. It was planned that during ...

  6. Tuberculosis in hospital department health care workers

    Directory of Open Access Journals (Sweden)

    Sandra Saleiro

    2007-11-01

    Full Text Available Introduction: Tuberculosis (TB is considered an occupational disease in health care workers (HCW and its transmission in health care facilities is an important concern. Some hospital departments are at higher risk of infection. Objective: To describe TB cases detected after TB screening in HCW from a hospital department (Ear, Nose and Throat – ENT who had had contact with active TB cases. Material and methods: All HCW (73 from Hospital São João's ENT Unit who had been in contact with two in-patients with active TB underwent TB screening. Those who had symptoms underwent chest X-ray and mycobacteriological sputum exam. Results: Of 73 HCW who underwent TB screening, TB diagnosis was established in 9 (8 female; median age: 30 years; 1 doctor, 6 nurses, 2 nursing auxiliaries. Pulmonary TB was found in 8 and extra- -pulmonary TB in 1. Microbiology diagnosis was obtained in 7 cases by sputum smear, n = 2; culture exam in bronchial lavage, n = 4 and histological exam of pleural tissue, n = 1. In 4 cases, Mycobacterium tuberculosis genomic DNA was extracted from cultures and molecular typing was done. All cases had identical MIRU types, which allowed identification of the epidemiological link. Conclusion: Nosocomial TB is prominent and efforts should be made to implement successful infection control measures in health care facilities and an effective TB screening program in HCW. Molecular typing of Mycobacterium tuberculosis facilitates cluster identification. Resumo: Introdução: A tuberculose é considerada uma doença ocupacional nos profissionais de saúde e a sua transmissão, nas instituições de saúde, constitui um problema importante. Alguns serviços hospitalares estão particularmente expostos a risco de infecção. Objectivo: Caracterizar os casos de tuberculose detectados na sequência de um rastreio efectuado aos profissionais de saúde de um serviço hospitalar

  7. Post–Acute Care Use and Hospital Readmission after Sepsis

    Science.gov (United States)

    Jones, Tiffanie K.; Fuchs, Barry D.; Small, Dylan S.; Halpern, Scott D.; Hanish, Asaf; Umscheid, Craig A.; Baillie, Charles A.; Kerlin, Meeta Prasad; Gaieski, David F.

    2015-01-01

    Rationale: The epidemiology of post–acute care use and hospital readmission after sepsis remains largely unknown. Objectives: To examine the rate of post–acute care use and hospital readmission after sepsis and to examine risk factors and outcomes for hospital readmissions after sepsis. Methods: In an observational cohort study conducted in an academic health care system (2010–2012), we compared post–acute care use at discharge and hospital readmission after 3,620 sepsis hospitalizations with 108,958 nonsepsis hospitalizations. We used three validated, claims-based approaches to identify sepsis and severe sepsis. Measurements and Main Results: Post–acute care use at discharge was more likely after sepsis, driven by skilled care facility placement (35.4% after sepsis vs. 15.8%; P Readmission rates at 7, 30, and 90 days were higher postsepsis (P readmission risk was present regardless of sepsis severity (27.3% after sepsis and 26.0–26.2% after severe sepsis). After controlling for presepsis characteristics, the readmission risk was found to be 1.51 times greater (95% CI, 1.38–1.66) than nonsepsis hospitalizations. Readmissions after sepsis were more likely to result in death or transition to hospice care (6.1% vs. 13.3% after sepsis; P readmissions after sepsis hospitalizations included age, malignancy diagnosis, hospitalizations in the year prior to the index hospitalization, nonelective index admission type, one or more procedures during the index hospitalization, and low hemoglobin and high red cell distribution width at discharge. Conclusions: Post–acute care use and hospital readmissions were common after sepsis. The increased readmission risk after sepsis was observed regardless of sepsis severity and was associated with adverse readmission outcomes. PMID:25751120

  8. Managed Care, Distance Traveled, and Hospital Market Definition

    OpenAIRE

    Frech, Ted E

    1998-01-01

    Most scholars and antitrust cases have defined hospital service markets as primarily local. But, two recent decisions have greatly expanded geographic markets, incorporating hospitals as far as 100 miles apart. Managed care plans, now important in most markets, were believed to shift patients to distant hospitals to capture lower prices. We examine distance traveled and its connection to managed care penetration. In contrast to earlier literature, we examine both direct and indirect effects. ...

  9. Information System Training, Usage, and Satisfaction: An Exploratory Study of the Hospitality Industry.

    Science.gov (United States)

    Gardner, William L., III; Gundersen, David E.

    1995-01-01

    Discusses use of a mail survey to study the extent to which the hospitality industry employs various information technologies, including computer-mediated communication systems. Finds that hotel/motel size and chain affiliation are related to information system complexity, and that chain-affiliated hotels provide less computer and…

  10. Defining a caring hospital by using currently implemented survey tools.

    Science.gov (United States)

    Jennings, Nancy

    2010-09-01

    Health care organizations are constantly striving to provide a more cost-effective and higher quality treatment within a caring environment. However, balancing the demands of regulatory agencies with the holistic needs of the patient is challenging. Further challenging is how to define those hospitals that provide an exceptional caring environment for their patients. By using survey tools that are already being administered in hospital settings, the opportunity exists to analyze the results obtained from these tools to define a hospital as a caring organization without the added burden of separate data collection.

  11. The impact of HMOs on hospital-based uncompensated care.

    Science.gov (United States)

    Thorpe, K E; Seiber, E E; Florence, C S

    2001-06-01

    Managed care in general and HMOs in particular have become the vehicle of choice for controlling health care spending in the private sector. By several accounts, managed care has achieved its cost-containment objectives. At the same time, the percentage of Americans without health insurance coverage continues to rise. For-profit and not-for-profit hospitals have traditionally financed care for the uninsured from profits derived from patients with insurance. Thus the relationship between growth in managed care and HMOs, hospital "profits," and care for the uninsured represent an important policy question. Using national data over an eight-year period, we find that a ten-percentage point increase in managed care penetration is associated with a two-percentage point reduction in hospital total profit margin and a 0.6 percentage point decrease in uncompensated care.

  12. Gauging food and nutritional care quality in hospitals

    Directory of Open Access Journals (Sweden)

    Diez-Garcia Rosa

    2012-09-01

    Full Text Available Abstract Background Food and nutritional care quality must be assessed and scored, so as to improve health institution efficacy. This study aimed to detect and compare actions related to food and nutritional care quality in public and private hospitals. Methods Investigation of the Hospital Food and Nutrition Service (HFNS of 37 hospitals by means of structured interviews assessing two quality control corpora, namely nutritional care quality (NCQ and hospital food service quality (FSQ. HFNS was also evaluated with respect to human resources per hospital bed and per produced meal. Results Comparison between public and private institutions revealed that there was a statistically significant difference between the number of hospital beds per HFNS staff member (p = 0.02 and per dietitian (p  Conclusions Food and nutritional care in hospital is still incipient, and actions concerning both nutritional care and food service take place on an irregular basis. It is clear that the design of food and nutritional care in hospital indicators is mandatory, and that guidelines for the development of actions as well as qualification and assessment of nutritional care are urgent.

  13. Manager traits and quality-of-care performance in hospitals.

    Science.gov (United States)

    Aij, Kjeld Harald; Aernoudts, René L M C; Joosten, Gepke

    2015-07-06

    This paper aims to assess the impact of the leadership traits of chief executive officers (CEOs) on hospital performance in the USA. The effectiveness and efficiency of the CEO is of critical importance to the performance of any organization, including hospitals. Management systems and manager behaviours (traits) are of crucial importance to any organization because of their connection with organizational performance. To identify key factors associated with the quality of care delivered by hospitals, the authors gathered perceptions of manager traits from chief executive officers (CEOs) and followers in three groups of US hospitals delivering different levels of quality of care performance. Three high- and three low-performing hospitals were selected from the top and bottom 20th percentiles, respectively, using a national hospital ranking system based on standard quality of care performance measures. Three lean hospitals delivering intermediate performance were also selected. A survey was used to gather perceptions of manager traits (providing a modern or lean management system inclination) from CEOs and their followers in the three groups, which were compared. Four traits were found to be significantly different (alpha management inclination. No differences were found between lean (intermediate-) and high-performing hospitals, or between high- and low-performing hospitals. These findings support a need for hospital managers to acquire appropriate traits to achieve lean transformation, support a benefit of measuring manager traits to assess progress towards lean transformation and lend weight to improved quality of care that can be delivered by hospitals adopting a lean system of management.

  14. The Impact of Medicaid Disproportionate Share Hospital Payment on Provision of Hospital Uncompensated Care

    Science.gov (United States)

    Hsieh, Hui-Min; Bazzoli, Gloria J.

    2012-01-01

    This study examines the association between hospital uncompensated care (UC) and reductions in Medicaid Disproportionate Share Hospital (DSH) payments resulting from the 1997 Balanced Budget Act. Data on California hospitals from 1996 to 2003 were examined using two-stage least squares with a first-differencing model to control for potential feedback effects. Our findings suggest that not-for-profit hospitals did reduce UC provision in response to reductions in Medicaid DSH, but the response was inelastic in value. Policy makers need to continue to monitor how UC changes as sources of support for indigent care change with the Patient Protection and Affordable Care Act (PPACA). PMID:23230705

  15. 78 FR 50495 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2013-08-19

    ... Connective Tissue) a. Reverse Shoulder Procedures b. Total Ankle Replacement Procedures 6. MDC 15 (Newborns... specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric... Issues. James Poyer, (410) 786-2261, PPS-Exempt Cancer Hospital Quality Reporting Issues. Allison Lee...

  16. LDS hospital, a facility of Intermountain Health Care, Salt Lake City, Utah.

    Science.gov (United States)

    Peck, M; Nelson, N; Buxton, R; Bushnell, J; Dahle, M; Rosebrock, B; Ashton, C A

    1997-01-01

    On-line documentation by nurses and a comprehensive text management system are functional in several facilities of intermountain Health Care (IHC). The following articles detail factors in the design and implementation of this computerized network as experienced at LDS Hospital, part of the IHC system. Areas discussed are the system's applications for medical decision support, communication, patient classification, nurse staffing versus cost, emergency department usage, patient problem/event recording, clinical outcomes, and text publication. Users express satisfaction with the time saving, consistency of reporting, and cohesiveness of these applications.

  17. Hospital-based home care for children with cancer

    DEFF Research Database (Denmark)

    Hansson, Eva Helena; Kjaergaard, H; Schmiegelow, K

    2012-01-01

    , as it decreased the strain on the family and the ill child, maintained normality and an ordinary everyday life and fulfilled the need for safety and security. According to family members of children with cancer, hospital-based home care support enhanced their quality of life during the child's cancer trajectory......The study aims to describe the experiences of a hospital-based home care programme in the families of children with cancer. Fourteen parents, representing 10 families, were interviewed about their experiences of a hospital-based home care programme during a 4-month period in 2009 at a university...... hospital in Denmark. Five children participated in all or part of the interview. The interviews were transcribed verbatim and analysed using qualitative content analysis. The findings indicate that hospital-based home care enabled the families to remain intact throughout the course of treatment...

  18. Managed care, vertical integration strategies and hospital performance.

    Science.gov (United States)

    Wang, B B; Wan, T T; Clement, J; Begun, J

    2001-09-01

    The purpose of this study is to examine the association of managed care with hospital vertical integration strategies, as well as to observe the relationships of different types of vertical integration with hospital efficiency and financial performance. The sample consists of 363 California short-term acute care hospitals in 1994. Linear structure equation modeling is used to test six hypotheses derived from the strategic adaptation model. Several organizational and market factors are controlled statistically. Results suggest that managed care is a driving force for hospital vertical integration. In terms of performance, hospitals that are integrated with physician groups and provide outpatient services (backward integration) have better operating margins, returns on assets, and net cash flows (p < 0.01). These hospitals are not, however, likely to show greater productivity. Forward integration with a long-term-care facility, on the other hand, is positively and significantly related to hospital productivity (p < 0.001). Forward integration is negatively related to financial performance (p < 0.05), however, opposite to the direction hypothesized. Health executives should be responsive to the growth of managed care in their local market and should probably consider providing more backward integrated services rather than forward integrated services in order to improve the hospital's financial performance in today's competitive health care market.

  19. Do HMO penetration and hospital competition impact quality of hospital care?

    Science.gov (United States)

    Rivers, P A; Fottler, M D

    2004-11-01

    This study examines the impact of HMO penetration and competition on hospital markets. A modified structure-conduct-performance paradigm was applied to the health care industry in order to investigate the impact of HMO penetration and competition on risk-adjusted hospital mortality rates (i.e. quality of hospital care). Secondary data for 1957 acute care hospitals in the USA from the 1991 American Hospital Association's Annual Survey of Hospitals were used. The outcome variables were risk-adjusted mortality rates in 1991. Predictor variables were market characteristics (i.e. managed care penetration and hospital competition). Control variables were environmental, patient, and institutional characteristics. Associations between predictor and outcome variables were investigated using statistical regression techniques. Hospital competition had a negative relationship with risk-adjusted mortality rates (a negative indicator of quality of care). HMO penetration, hospital competition, and an interaction effect of HMO penetration and competition were not found to have significant effects on risk-adjusted mortality rates. These findings suggest that when faced with intense competition, hospitals may respond in ways associated with reducing their mortality rates.

  20. Care of HIV-infected adults at Baragwanath Hospital, Soweto

    African Journals Online (AJOL)

    and associated costs, in order to inform clinical practice, health service ... Setting. The outpatient department of a public sector, academic hospital in Soweto, South Africa. Design. ... primary care leveL The average cost per consultation was. R112.03. ... HIV-related illness, care strategies and costs of HIVlAJDS care is ...

  1. Cost variation in diabetes care delivered in English hospitals

    DEFF Research Database (Denmark)

    Kristensen, Troels

    2009-01-01

    the hospital fixed effect and adjust for hospital characteristics such as number of patients treated, factor prices and number of specialties involved in diabetes care. We rank hospitals by their adjusted fixed effect, which measures the extent to which their costs vary from the average after controlling......Background: Many diabetic patients are admitted to hospital, where care is costly and where there may be scope to improve efficiency. Aims: We analyse the costs and characteristics of diabetic patients admitted to English hospitals and aim to assess what proportions of cost variation are explained...... by patient and hospital characteristics. Methods: We apply a multilevel approach recognising that patients are clustered in hospitals. We first analyse the relationship between patient costs and their characteristics, such as HRG, age, gender, diagnostic markers and socio-economic status. We derive...

  2. The impact of managed care penetration and hospital quality on efficiency in hospital staffing.

    Science.gov (United States)

    Mobley, Lee R; Magnussen, Jon

    2002-01-01

    The state of California has recently mandated minimum nurse-staffing ratios, raising concerns about possible affects on hospital efficiency. In this study, we examine how market factors and quality were related to staffing levels in California hospitals in 1995 (prior to implementation of the new law). We are particularly interested in the affect of managed care penetration on this aspect of hospital efficiency because the call to legislative action was predicated on fears that hospitals were reducing staffing below optimal levels in response to managed care pressures. We derive a unique measure of excess staffing in hospitals based on a data envelopment analysis (DEA) production function model, which explicitly includes ancillary care among the inputs and outputs. This careful specification of production is important because ancillary care use has risen relative to daily hospital services, with the spread of managed care and advances in medical technology. We find that market share (adjusted for size) and market concentration are the major determinants of excess staffing while managed care penetration is insignificant. We also find that poor quality (outcomes worse than expected) is associated with less efficient staffing. These findings suggest that the larger, more efficient urban hospitals will be penalized more heavily under binding staffing ratios than smaller, less-urban hospitals.

  3. Quality-quantity decomposition of income elasticity of U.S. hospital care expenditure using state-level panel data.

    Science.gov (United States)

    Chen, Weiwei; Okunade, Albert; Lubiani, Gregory G

    2014-11-01

    Economic theory suggests that income growth could lead to changes in consumption quantity and quality as the spending on a commodity changes. Similarly, the volume and quality of healthcare consumption could rise with incomes because of demographic changes, usage of innovative medical technologies, and other factors. Hospital healthcare spending is the largest component of aggregate US healthcare expenditures. The novel contribution of our paper is estimating and decomposing the income elasticity of hospital care expenditures (HOCEXP) into its quantity and quality components. By using a 1999-2008 panel dataset of the 50 US states, results from the seemingly unrelated regressions model estimation reveal the income elasticity of HOCEXP to be 0.427 (std. error=0.044), with about 0.391 (calculated std. error=0.044) arising from care quality improvements and 0.035 (std. error=0.050) emanating from the rise in usage volume. Our novel research findings suggest the following: (i) the quantity part of hospital expenditure is inelastic to income change; (ii) almost the entire income-induced rise in hospital expenditure comes from care quality changes; and (iii) the 0.427 income elasticity of HOCEXP, the largest component of total US healthcare expenditure, makes hospital care a normal commodity and a much stronger technical necessity than aggregate healthcare. Policy implications are discussed. Copyright © 2013 John Wiley & Sons, Ltd.

  4. Is there an improvement of antibiotic use in China? Evidence from the usage analysis of combination antibiotic therapy for type I incisions in 244 hospitals.

    Science.gov (United States)

    Zhou, Wen-Juan; Luo, Zhen-Ni; Tang, Chang-Min; Zou, Xiao-Xu; Zhao, Lu; Fang, Peng-Qian

    2016-10-01

    The improvement of antibiotic rational use in China was studied by usage analysis of combination antibiotic therapy for type I incisions in 244 hospitals. Five kinds of hospitals, including general hospital, maternity hospital, children's hospital, stomatological hospital and cancer hospital, from 30 provinces were surveyed. A systematic random sampling strategy was employed to select outpatient prescriptions and inpatient cases in 2011 and 2012. A total of 29 280 outpatient prescriptions and 73 200 inpatient cases from 244 hospitals in each year were analyzed. Data were collected with regards to the implementation of the national antibiotic stewardship program (NASP), the overall usage and the prophylactic use of antibiotic for type I incisions. Univariate analysis was used for microbiological diagnosis rate before antimicrobial therapy, prophylactic use of antibiotics for type I incision operation, and so on. For multivariate analysis, the use of antibiotics was dichotomized according to the guidelines, and entered as binary values into logistic regression analysis. The results were compared with the corresponding criteria given by the guidelines of this campaign. The antibiotic stewardship in China was effective in that more than 80% of each kind of hospitals achieved the criteria of recommended antibiotics varieties. Hospital type appeared to be a factor statistically associated with stewardship outcome. The prophylactic use of antibiotics on type I incision operations decreased by 16.22% (Pbench marking. More efforts addressing the root cause of antibiotics abuse would continue to improve the rational use of antibiotics in China.

  5. [Anesthesia practice in Catalan hospitals and other health care facilities].

    Science.gov (United States)

    Villalonga, Antonio; Sabaté, Sergi; Campos, Juan Manuel; Fornaguera, Joan; Hernández, Carmen; Sistac, José María

    2006-05-24

    The aim of this arm of the ANESCAT study was to characterize anesthesia practice in the various types of health care facilities of Catalonia, Spain, in 2003. We analyzed data from the survey according to a) source of a facility's funding: public hospitals financed by the Catalan Public Health Authority (ICS), the network of subsidized hospitals for public use (XHUP), or private hospitals; b) size: facilities without hospital beds, hospitals with fewer than 250 beds, those with 251 to 500, and those with over 500; and c) training accreditation status: whether or not a facility gave medical resident training. A total of 131 facilities participated (11 under the ICS, 47 from the XHUP, and 73 private hospitals). Twenty-six clinics had no hospital beds, 78 facilities had fewer than 250, 21 had 251 to 500, and 6 had more than 500. Seventeen hospitals trained medical residents. XHUP hospitals performed 44.3% of all anesthetic procedures, private hospitals 36.7%, and ICS facilities 18.5%. Five percent of procedures were performed in clinics without beds, 42.9% in facilities with fewer than 250 beds, 35% in hospitals with 251 to 500, and 17.1% in hospitals with over 500. Anesthetists in teaching hospitals performed 35.5% of all procedures. The mean age of patients was lower in private hospitals, facilities with fewer than 250 beds, and hospitals that did not train medical residents. The physical status of patients was worse in ICS hospitals, in facilities with over 500 beds, and in teaching hospitals. It was noteworthy that 25% of anesthetic procedures were performed on an emergency basis in XHUP and ICS hospitals, in facilities with more than 250 beds, and in teaching hospitals. Anesthesia for outpatient procedures accounted for 40% of the total in private hospitals and 31% of the practice in ICS and XHUP hospitals. The duration of anesthesia and postanesthetic recovery was longer in ICS hospitals, in facilities with over 500 beds, and in those with medical resident

  6. [Communication between the primary care physician, hospital staff and the patient during hospitalization].

    Science.gov (United States)

    Menahem, Sasson; Roitgarz, Ina; Shvartzman, Pesach

    2011-04-01

    HospitaL admission is a crisis for the patient and his family and can interfere with the continuity of care. It may lead to mistakes due to communication problems between the primary care physician and the hospital medical staff. To explore the communication between the primary care physician, the hospital medical staff, the patient and his family during hospitalization. A total of 269 questionnaires were sent to all Clalit Health Services-South District, primary care physicians; 119 of these questionnaires (44.2%) were completed. Half of the primary care physicians thought that they should, always or almost always, have contact with the admitting ward in cases of internal medicine, oncology, surgery or pediatric admissions. However, the actual contact rate, according to their report, was only in a third of the cases. A telephone contact was more common than an actual visit of the patient in the ward. Computer communication between the hospital physicians and the primary care physicians is still insufficiently developed, although 96.6% of the primary care physicians check, with the aid of computer software, for information on their hospitalized patients. The main reasons to visit the hospitalized patient were severe medical conditions or uncertainty about the diagnosis; 79% of the physicians thought that visiting their patients strengthened the level of trust between them and their patients. There are sometimes communication difficulties and barriers between the primary care physicians and the ward's physicians due to partial information delivery and rejection from the hospital physicians. The main barriers for visiting admitted patients were workload and lack of pre-allocated time on the work schedule. No statistically significant differences were found between communication variables and primary care physician's personal and demographic characteristics. The communication between the primary care physician and the hospital physicians should be improved through

  7. Maternity Care Services Provided by Family Physicians in Rural Hospitals.

    Science.gov (United States)

    Young, Richard A

    The purpose of this study was to describe how many rural family physicians (FPs) and other types of providers currently provide maternity care services, and the requirements to obtain privileges. Chief executive officers of rural hospitals were purposively sampled in 15 geographically diverse states with significant rural areas in 2013 to 2014. Questions were asked about the provision of maternity care services, the physicians who perform them, and qualifications required to obtain maternity care privileges. Analysis used descriptive statistics, with comparisons between the states, community rurality, and hospital size. The overall response rate was 51.2% (437/854). Among all identified hospitals, 44.9% provided maternity care services, which varied considerably by state (range, 17-83%; P maternity care, a mean of 271 babies were delivered per year, 27% by cesarean delivery. A mean of 7.0 FPs had privileges in these hospitals, of which 2.8 provided maternity care and 1.8 performed cesarean deliveries. The percentage of FPs who provide maternity care (mean, 48%; range, 10-69%; P maternity care who are FPs (mean, 63%; range, 10-88%; P maternity care services in US rural hospitals, including cesarean deliveries. Some family medicine residencies should continue to train their residents to provide these services to keep replenishing this valuable workforce. © Copyright 2017 by the American Board of Family Medicine.

  8. Processes of early stroke care and hospital costs.

    Science.gov (United States)

    Svendsen, Marie Louise; Ehlers, Lars H; Hundborg, Heidi H; Ingeman, Annette; Johnsen, Søren P

    2014-08-01

    The relationship between processes of early stroke care and hospital costs remains unclear. We therefore examined the association in a population based cohort study. We identified 5909 stroke patients who were admitted to stroke units in a Danish county between 2005 and 2010.The examined recommended processes of care included early admission to a stroke unit, early initiation of antiplatelet or anticoagulant therapy, early computed tomography/magnetic resonance imaging (CT/MRI) scan, early physiotherapy and occupational therapy, early assessment of nutritional risk, constipation risk and of swallowing function, early mobilization,early catheterization, and early thromboembolism prophylaxis.Hospital costs were assessed for each patient based on the number of days spent in different in-hospital facilities using local hospital charges. The mean costs of hospitalization were $23 352 (standard deviation 27 827). The relationship between receiving more relevant processes of early stroke care and lower hospital costs followed a dose–response relationship. The adjusted costs were $24 566 (95% confidence interval 19 364–29 769) lower for patients who received 75–100% of the relevant processes of care compared with patients receiving 0–24%. All processes of care were associated with potential cost savings, except for early catheterization and early thromboembolism prophylaxis. Early care in agreement with key guidelines recommendations for the management of patients with stroke may be associated with hospital savings.

  9. Home-based intermediate care program vs hospitalization

    Science.gov (United States)

    Armstrong, Catherine Deri; Hogg, William E.; Lemelin, Jacques; Dahrouge, Simone; Martin, Carmel; Viner, Gary S.; Saginur, Raphael

    2008-01-01

    OBJECTIVE To explore whether a home-based intermediate care program in a large Canadian city lowers the cost of care and to look at whether such home-based programs could be a solution to the increasing demands on Canadian hospitals. DESIGN Single-arm study with historical controls. SETTING Department of Family Medicine at the Ottawa Hospital (Civic campus) in Ontario. PARTICIPANTS Patients requiring hospitalization for acute care. Participants were matched with historical controls based on case-mix, most responsible diagnosis, and level of complexity. INTERVENTIONS Placement in the home-based intermediate care program. Daily home visits from the nurse practitioner and 24-hour access to care by telephone. MAIN OUTCOME MEASURES Multivariate regression models were used to estimate the effect of the program on 5 outcomes: length of stay in hospital, cost of care substituted for hospitalization (Canadian dollars), readmission for a related diagnosis, readmission for any diagnosis, and costs incurred by community home-care services for patients following discharge from hospital. RESULTS The outcomes of 43 hospital admissions were matched with those of 363 controls. Patients enrolled in the program stayed longer in hospital (coefficient 3.3 days, P costs of home-based care were not significantly different from the costs of hospitalization (coefficient -$501, P = .11). CONCLUSION While estimated cost savings were not statistically significant, the limitations of our study suggest that we underestimated these savings. In particular, the economic inefficiencies of a small immature program and the inability to control for certain factors when selecting historical controls affected our results. Further research is needed to determine the economic effect of mature home-based programs. PMID:18208958

  10. Trends in bednet ownership and usage, and the effect of bednets on malaria hospitalization in the Kilifi Health and Demographic Surveillance System (KHDSS): 2008-2015.

    Science.gov (United States)

    Kamau, Alice; Nyaga, Victoria; Bauni, Evasius; Tsofa, Benjamin; Noor, Abdisalan M; Bejon, Philip; Scott, J Anthony G; Hammitt, Laura L

    2017-11-15

    Use of bednets reduces malaria morbidity and mortality. In Kilifi, Kenya, there was a mass distribution of free nets to children malaria hospitalization in children Malaria admissions (i.e. admissions to hospital with P. falciparum > 2500 parasitemia per μl) among children malaria among children that reported using a bednet compared to those who did not. We observed 63% and 62% mean bednet ownership and usage, respectively, over the eight-survey period. Among children malaria hospitalization per 1000 child-years was 2.91 compared to 4.37 among those who did not (HR = 0.67, 95% CI: 0.52, 0.85 [p = 0.001]). On longitudinal surveillance, increasing bednet ownership and usage corresponded to mass distribution campaigns; however, this method of delivering bednets did not result in sustained improvements in coverage. Among children malaria hospitalization.

  11. Introducing Namaste Care to the hospital environment: a pilot study.

    Science.gov (United States)

    St John, Kimberley; Koffman, Jonathan

    2017-10-01

    The rising prevalence of dementia is impacting on acute hospitals and placing increased expectations on health and social care professionals to improve the support and services they are delivering. It has been recommended that good practice in dementia care relies on adopting a palliative approach to care and meeting people's physical, psychological, social and spiritual needs. Increased dementia training for staff that includes initiatives that promote dignity; enhancing communication skills and recognizing that a person with dementia may be approaching the end of their lives are needed. Our study aim was to explore whether Namaste Care is an acceptable and effective service for people with advanced dementia being cared for on an acute hospital ward. This was an exploratory qualitative interview, pilot study. Individual, semi-structured, face-to-face interviews were conducted with hospital healthcare staff working in an area of the hospital where Namaste Care had been implemented. Data were analysed using the framework approach. Eight interviews were completed with members of the multidisciplinary ward team. Two themes were identified: (I) difficulties establishing relationships with people with dementia in hospital (subthemes: lack of time and resources, lack of confidence leading to fear and anxiety); (II) the benefits of a Namaste Care service in an acute hospital setting (subthemes: a reduction in agitated behavior; connecting and communicating with patients with dementia using the senses; a way of showing people with dementia they are cared for and valued). This small-scale study indicates that Namaste Case has the potential to improve the quality of life of people with advanced dementia being cared for in an acute hospital setting. However, further research is required to explore more specifically its benefits in terms of improved symptom management and wellbeing of people with dementia on acute hospitals wards.

  12. No Exit: Identifying Avoidable Terminal Oncology Intensive Care Unit Hospitalizations

    Science.gov (United States)

    Hantel, Andrew; Wroblewski, Kristen; Balachandran, Jay S.; Chow, Selina; DeBoer, Rebecca; Fleming, Gini F.; Hahn, Olwen M.; Kline, Justin; Liu, Hongtao; Patel, Bhakti K.; Verma, Anshu; Witt, Leah J.; Fukui, Mayumi; Kumar, Aditi; Howell, Michael D.; Polite, Blase N.

    2016-01-01

    Purpose: Terminal oncology intensive care unit (ICU) hospitalizations are associated with high costs and inferior quality of care. This study identifies and characterizes potentially avoidable terminal admissions of oncology patients to ICUs. Methods: This was a retrospective case series of patients cared for in an academic medical center’s ambulatory oncology practice who died in an ICU during July 1, 2012 to June 30, 2013. An oncologist, intensivist, and hospitalist reviewed each patient’s electronic health record from 3 months preceding terminal hospitalization until death. The primary outcome was the proportion of terminal ICU hospitalizations identified as potentially avoidable by two or more reviewers. Univariate and multivariate analysis were performed to identify characteristics associated with avoidable terminal ICU hospitalizations. Results: Seventy-two patients met inclusion criteria. The majority had solid tumor malignancies (71%), poor performance status (51%), and multiple encounters with the health care system. Despite high-intensity health care utilization, only 25% had documented advance directives. During a 4-day median ICU length of stay, 81% were intubated and 39% had cardiopulmonary resuscitation. Forty-seven percent of these hospitalizations were identified as potentially avoidable. Avoidable hospitalizations were associated with factors including: worse performance status before admission (median 2 v 1; P = .01), worse Charlson comorbidity score (median 8.5 v 7.0, P = .04), reason for hospitalization (P = .006), and number of prior hospitalizations (median 2 v 1; P = .05). Conclusion: Given the high frequency of avoidable terminal ICU hospitalizations, health care leaders should develop strategies to prospectively identify patients at high risk and formulate interventions to improve end-of-life care. PMID:27601514

  13. Shifting hospital care to primary care: An evaluation of cardiology care in a primary care setting in the Netherlands.

    Science.gov (United States)

    Quanjel, Tessa C C; Struijs, Jeroen N; Spreeuwenberg, Marieke D; Baan, Caroline A; Ruwaard, Dirk

    2018-05-09

    In an attempt to deal with the pressures on the healthcare system and to guarantee sustainability, changes are needed. This study is focused on a cardiology Primary Care Plus intervention in which cardiologists provide consultations with patients in a primary care setting in order to prevent unnecessary referrals to the hospital. This study explores which patients with non-acute and low-complexity cardiology-related health complaints should be excluded from Primary Care Plus and referred directly to specialist care in the hospital. This is a retrospective observational study based on quantitative data. Data collected between January 1 and December 31, 2015 were extracted from the electronic medical record system. Logistic regression analyses were used to select patient groups that should be excluded from referral to Primary Care Plus. In total, 1525 patients were included in the analyses. Results showed that male patients, older patients, those with the referral indication 'Stable Angina Pectoris' or 'Dyspnoea' and patients whose reason for referral was 'To confirm disease' or 'Screening of unclear pathology' had a significantly higher probability of being referred to hospital care after Primary Care Plus. To achieve efficiency one should exclude patient groups with a significantly higher probability of being referred to hospital care after Primary Care Plus. NTR6629 (Data registered: 25-08-2017) (registered retrospectively).

  14. Home hospitalization in the spectrum of community geriatric care.

    Science.gov (United States)

    Stessman, J; Hammerman-Rozenberg, R; Cohen, A

    1997-04-01

    The Home Hospitalization Programme was initiated in Jerusalem in 1991 to provide intensive medical care at home in order to prevent or shorten hospitalizations. The programme was based upon regular home visits by physicians, and nursing assessment to determine the need for regular nursing care. Primary-care physicians and nurses were renumerated by a global monthly fee, and were on 24-h call in addition to their periodic visits. Patients were recruited by senior geriatric physicians from acute hospital wards, as well as from the community, at the family doctor's request. Ancillary services available to the home hospitalization team included laboratory and electrocardiographic testing, specialty consultations, physical occupational or speech therapy, social work and home help up to 3 h daily. Monthly visits by a senior physician provided oversight and further consultation. Home hospitalization grew out of the continuing care division of the Clalit Sick Fund, a health maintenance organization providing umbrella medical insurance and ambulatory care. The programme grew synergistically with the other facilities of continuing care to encompass a network of comprehensive services to acute, subacute and chronic patients both at home and in institutional settings. In 4 years this network succeeded in establishing the focus of subacute intensive care in the community, achieving high levels of patient and family satisfaction, as well as striking economic advantages. In its first 2 years of operation home hospitalization saved S4 million due to reduced hospital utilization, and preliminary data for the subsequent 2 years indicated that this trend continued. Home hospitalization became the hub of a far-reaching system of supportive, intensive and humane care in the community.

  15. Factors Contributing to Readmission of Seniors into Acute Care Hospitals

    Science.gov (United States)

    DeCoster, Vaughn; Ehlman, Katie; Conners, Carolyn

    2013-01-01

    Medicare spending is expected to increase by 79% between the years 2010 and 2020, caused, in-part, by hospital readmissions within 30 days of discharge. This study identified factors contributing to hospital readmissions in a midwest heath service area (HSA), using Coleman's Transition Care Model as the theoretical framework. The researchers…

  16. Hospital marketing orientation and managed care processes: are they coordinated?

    Science.gov (United States)

    White, K R; Thompson, J M; Patel, U B

    2001-01-01

    The hospital marketing function has been widely adopted as a way to learn about markets, attract sufficient resources, develop appropriate services, and communicate the availability of such goods to those who may be able to purchase such services. The structure, tasks, and effectiveness of the marketing function have been the subject of increased inquiry by researchers and practitioners alike. A specific understanding of hospital marketing in a growing managed care environment and the relationship between marketing and managed care processes in hospitals is a growing concern. Using Kotler and Clarke's framework for assessing marketing orientation, we examined the marketing orientation of hospitals in a single state at two points in time--1993 and 1999. Study findings show that the overall marketing orientation score decreased from 1993 to 1999 for the respondent hospitals. The five elements of the Kotler and Clarke definition of marketing orientation remained relatively stable, with slightly lower scores related to customer philosophy. In addition, we evaluated the degree to which selected managed care activities are carried out as part of its marketing function. A significant (p marketing function was evident from 1993 to 1999. With increasing numbers of managed care plan enrollees, hospitals are likely focusing on organizational buyers as important customers. In order to appeal to organizational buyers, hospital executives may be focusing more on clinical quality and cost efficiency in the production of services, which will improve a hospital's position with organizational buyers.

  17. Processes of early stroke care and hospital costs

    DEFF Research Database (Denmark)

    Svendsen, Marie Louise; Ehlers, Lars H; Hundborg, Heidi H

    2014-01-01

    Background: The relationship between processes of early stroke care and hospital costs remains unclear. Aims: We therefore examined the association in a population-based cohort study. Methods: We identified 5909 stroke patients who were admitted to stroke units in a Danish county between 2005...... of hospitalization were $23352 (standard deviation 27827). The relationship between receiving more relevant processes of early stroke care and lower hospital costs followed a dose-response relationship. The adjusted costs were $24566 (95% confidence interval 19364-29769) lower for patients who received 75......-100% of the relevant processes of care compared with patients receiving 0-24%. All processes of care were associated with potential cost savings, except for early catheterization and early thromboembolism prophylaxis. Conclusions: Early care in agreement with key guidelines recommendations for the management...

  18. Future health care technology and the hospital

    NARCIS (Netherlands)

    Banta, H.D.

    1990-01-01

    The past decades have been a time of rapid technological change in health care, but technological change will probably accelerate during the next decade or so. This will bring problems, but it will also present certain opportunities. In particular, the health care system is faced with the need to

  19. Healthcare associated infections in Paediatric Intensive Care Unit of a tertiary care hospital in India: Hospital stay & extra costs

    Directory of Open Access Journals (Sweden)

    Jitender Sodhi

    2016-01-01

    Interpretation & conclusions: This study highlights the effect of HAI on costs for PICU patients, especially costs due to prolongation of hospital stay, and suggests the need to develop effective strategies for prevention of HAI to reduce costs of health care.

  20. Segmentation of hospital markets: where do HMO enrollees get care?

    Science.gov (United States)

    Escarce, J J; Shea, J A; Chen, W

    1997-01-01

    Commercially insured and Medicare patients who are not in health maintenance organizations (HMOs) tend to use different hospitals than HMO patients use. This phenomenon, called market segmentation, raises important questions about how hospitals that treat many HMO patients differ from those that treat few HMO patients, especially with regard to quality of care. This study of patients undergoing coronary artery bypass graft surgery found no evidence that HMOs in southeast Florida systematically channel their patients to high-volume or low-mortality hospitals. These findings are consistent with other evidence that in many areas of the country, incentives for managed care plans to reduce costs may outweigh incentives to improve quality.

  1. Workarounds Emerging From Electronic Health Record System Usage: Consequences for Patient Safety, Effectiveness of Care, and Efficiency of Care.

    Science.gov (United States)

    Blijleven, Vincent; Koelemeijer, Kitty; Wetzels, Marijntje; Jaspers, Monique

    2017-10-05

    Health care providers resort to informal temporary practices known as workarounds for handling exceptions to normal workflow unintendedly imposed by electronic health record systems (EHRs). Although workarounds may seem favorable at first sight, they are generally suboptimal and may jeopardize patient safety, effectiveness of care, and efficiency of care. Research into the scope and impact of EHR workarounds on patient care processes is scarce. This paper provides insight into the effects of EHR workarounds on organizational workflows and outcomes of care services by identifying EHR workarounds and determining their rationales, scope, and impact on health care providers' workflows, patient safety, effectiveness of care, and efficiency of care. Knowing the rationale of a workaround provides valuable clues about the source of origin of each workaround and how each workaround could most effectively be resolved. Knowing the scope and impact a workaround has on EHR-related safety, effectiveness, and efficiency provides insight into how to address related concerns. Direct observations and follow-up semistructured interviews with 31 physicians, 13 nurses, and 3 clerks and qualitative bottom-up coding techniques was used to identify, analyze, and classify EHR workarounds. The research was conducted within 3 specialties and settings at a large university hospital. Rationales were associated with work system components (persons, technology and tools, tasks, organization, and physical environment) of the Systems Engineering Initiative for Patient Safety (SEIPS) framework to reveal their source of origin as well as to determine the scope and the impact of each EHR workaround from a structure-process-outcome perspective. A total of 15 rationales for EHR workarounds were identified of which 5 were associated with persons, 4 with technology and tools, 4 with the organization, and 2 with the tasks. Three of these 15 rationales for EHR workarounds have not been identified in prior

  2. Assessment of Hypertension Care in a Nigerian Hospital | Chiazor ...

    African Journals Online (AJOL)

    Assessment of Hypertension Care in a Nigerian Hospital. ... (BMI) and their knowledge of hypertension in a Nigerian secondary health care facility. ... overweight or obese, 107 (53.5 %) had blood pressure ≥ 160/100 mmHg (Stage 2); 150 (75 ...

  3. Vertical integration and diversification of acute care hospitals: conceptual definitions.

    Science.gov (United States)

    Clement, J P

    1988-01-01

    The terms vertical integration and diversification, although used quite frequently, are ill-defined for use in the health care field. In this article, the concepts are defined--specifically for nonuniversity acute care hospitals. The resulting definitions are more useful than previous ones for predicting the effects of vertical integration and diversification.

  4. Classification of Mistakes in Patient Care in a Nigerian Hospital ...

    African Journals Online (AJOL)

    The study shows that there are wide variations within and between professional health groups in the classification of errors in patient care. The implications of the absence of a classificatory scheme for errors in patient care for service improvement and organisational learning in the hospital environment are discussed.

  5. Self-reported "communication technology" usage in patients attending a cardiology outpatient clinic in a remote regional hospital.

    Science.gov (United States)

    Gandiya, Tariro; Dua, Anahita; King, Gerry; Mazzocco, Thomas; Hussain, Amir; Leslie, Stephen J

    2012-04-01

    This study assessed the perceived usage of, and attitudes toward, communication technologies (mobile phone and texting, e-mail, and the World Wide Web) in patients attending a cardiology clinic with a view to guiding future health service redesign. This was performed in a remote regional hospital serving both urban and rural populations. A self-completion questionnaire was completed by a convenience sample of 221 patients attending a general cardiology clinic. The questions asked about patients' access to and use of technology at home. Data collected also included age, gender, travel time to the clinic, mode of travel, and whether the respondent was accompanied to the clinic. Appropriate statistical tests were used with significance taken at the 0.05 level. Age was the strongest predictor of use of communication technologies, with younger patients more likely to use e-mail, Web, mobile phone, and texting. However, frequency of use of e-mail was not related to age. It is encouraging that over 99% of patients used at least one communication technology. This study has highlighted that there may be several potential barriers to the widespread implementation of communication technologies in general cardiology patients. Cognizance should be taken of these findings when attempting service redesign.

  6. Collaboration between physicians and a hospital-based palliative care team in a general acute-care hospital in Japan

    Directory of Open Access Journals (Sweden)

    Nishikitani Mariko

    2010-06-01

    Full Text Available Abstract Background Continual collaboration between physicians and hospital-based palliative care teams represents a very important contributor to focusing on patients' symptoms and maintaining their quality of life during all stages of their illness. However, the traditionally late introduction of palliative care has caused misconceptions about hospital-based palliative care teams (PCTs among patients and general physicians in Japan. The objective of this study is to identify the factors related to physicians' attitudes toward continual collaboration with hospital-based PCTs. Methods This cross-sectional anonymous questionnaire-based survey was conducted to clarify physicians' attitudes toward continual collaboration with PCTs and to describe the factors that contribute to such attitudes. We surveyed 339 full-time physicians, including interns, employed in a general acute-care hospital in an urban area in Japan; the response rate was 53% (N = 155. We assessed the basic characteristics, experience, knowledge, and education of respondents. Multiple logistic regression analysis was used to determine the main factors affecting the physicians' attitudes toward PCTs. Results We found that the physicians who were aware of the World Health Organization (WHO analgesic ladder were 6.7 times (OR = 6.7, 95% CI = 1.98-25.79 more likely to want to treat and care for their patients in collaboration with the hospital-based PCTs than were those physicians without such awareness. Conclusion Basic knowledge of palliative care is important in promoting physicians' positive attitudes toward collaboration with hospital-based PCTs.

  7. SCI Hospital in Home Program: Bringing Hospital Care Home for Veterans With Spinal Cord Injury.

    Science.gov (United States)

    Madaris, Linda L; Onyebueke, Mirian; Liebman, Janet; Martin, Allyson

    2016-01-01

    The complex nature of spinal cord injury (SCI) and the level of care required for health maintenance frequently result in repeated hospital admissions for recurrent medical complications. Prolonged hospitalizations of persons with SCI have been linked to the increased risk of hospital-acquired infections and development or worsening pressure ulcers. An evidence-based alternative for providing hospital-level care to patients with specific diagnoses who are willing to receive that level of care in the comfort of their home is being implemented in a Department of Veterans Affairs SCI Home Care Program. The SCI Hospital in Home (HiH) model is similar to a patient-centered interdisciplinary care model that was first introduced in Europe and later tested as part of a National Demonstration and Evaluation Study through Johns Hopkins School of Medicine and School of Public Health. This was funded by the John A. Hartford Foundation and the Department of Veterans Affairs. The objectives of the program are to support veterans' choice and access to patient-centered care, reduce the reliance on inpatient medical care, allow for early discharge, and decrease medical costs. Veterans with SCI who are admitted to the HiH program receive daily oversight by a physician, daily visits by a registered nurse, access to laboratory services, oxygen, intravenous medications, and nursing care in the home setting. In this model, patients may typically access HiH services either as an "early discharge" from the hospital or as a direct admit to the program from the emergency department or SCI clinic. Similar programs providing acute hospital-equivalent care in the home have been previously implemented and are successfully demonstrating decreased length of stay, improved patient access, and increased patient satisfaction.

  8. Hospital-based home care for children with cancer

    DEFF Research Database (Denmark)

    Hansson, Eva Helena; Kjaergaard, Hanne; Johansen, Christoffer

    2013-01-01

    BACKGROUND: To assess the feasibility and psychosocial impact of a hospital-based home care (HBHC) program for children with cancer. PROCEDURE: A HBHC program was carried out with 51 children (0-18 years) with cancer to assess its feasibility in terms of satisfaction, care preferences, safety...... children and 43 parents in the home care group, and 47 children and 66 parents receiving standard hospital care. RESULTS: All parents in the HBHC program were satisfied and preferred home care. There were no serious adverse events associated with HBHC, and costs did not increase. When adjusting for age......, gender, diagnosis and time since diagnosis, we found significant higher HRQOL scores in parent-reported physical health (P = 0.04; 95% confidence interval (CI): -0.2-19.5) and worry (P = 0.04; 95% CI: -0.4-20.6) in the home-care group indicating better physical health and less worry for children...

  9. Nursing Care with the Skin of Hospitalized Newborns: Integrative Review

    Directory of Open Access Journals (Sweden)

    Ana Dulce Amorim Santos Soares

    2017-05-01

    Full Text Available The objective was to analyze the scientific collection on nursing care with the skin of hospitalized newborns. In order to reach the objective, an integrative review was conducted. The search for primary studies was performed in the databases LILACS, MEDLINE, BDENF and PUBMED. The included studies (n=10 were grouped into thematic categories: risk factors for skin lesions in hospitalized newborns and their consequences; and nursing care to promote the integrity of the skin of hospitalized newborns. The main care identified were lubrication with emollient agents, use of hydrocolloids and transparent film, changes in decubitus, hygiene techniques, phototherapy and invasive procedures. The results of the review offer guidance for the conduction of researches that investigate interventions that are more effective in the prevention and treatment of skin injuries and their consequences. Key words: Nursing Care, Newborn, Skin.

  10. Using In-Hospital Mortality as an Indicator of Quality Care and Hospital Performance

    Directory of Open Access Journals (Sweden)

    Badia BISBIS

    2016-06-01

    Full Text Available The in-hospital mortality (MIH is used as a performance indicator and quality healthcare in hospital. However, the majority of deaths resulted from an inevitable disease process (severity of cases and / or co-morbidity, and not medical errors or changes in the quality of care. This work aims to make a distribution of deaths in the Regional Hospital of Eastern, Al Farabi hospital and to highlight that more studies on the MIH are required consistently with detailed clinical data at the admission. The MIH showed its limitation as a health care  indicator. The overall rate of in-hospital deaths within the Al Farabi hospital has averaged 2.4%, with 8.4% in the emergency unit, 28% in intensive care unit, 22% Neonatology unit, 1.6% in pediatric unit. The MIH may depend, firstly, on the condition of patients before hospitalization and secondly, on the conditions of their transfer from one institution to another that supports them as a last resort. Al Farabi hospital supports patients transferred from the provinces of the eastern region. Thus, 6% of patients who died in 2014 come from Berkane, 2% from  Nador, 2% from Bouarfa, 4% from  Taourirt and 2% from Jerrada. One might question about  the procedures and the conditions of such transfers. In conclusion, the overall MIH measured from routine data do not allow proper comparison between hospitals or the assessment of the quality of care and patient safety in the hospital. To do so, we should ideally have detailed clinical data on admission (e.g. type of admission, age of patient, sex, comorbidity, .... The MIH is however an important indicator to consider as a tool to detect potential  problems related to admission procedures and to suspect an area of "non-quality" in healthcare . The MIH is interesting for the patient and for the hospital because it serves the improvement of quality healthcare.

  11. Hospital administrator's perspectives regarding the health care industry.

    Science.gov (United States)

    McDermott, D R; Little, M W

    1988-01-01

    Based on responses from 52 hospital administrators, four areas of managerial concern have been addressed, including: (1) decision-making factors; (2) hospital service offerings: current and future; (3) marketing strategy and service priorities; and (4) health care industry challenges. Of the total respondents, 35 percent indicate a Director of Marketing has primary responsibility for making marketing-related decisions in their hospital, and 19 percent, a Vice-President of Marketing, thus demonstrating the increased priority of the marketing function. The continued importance of the physician being the primary market target is highlighted by 70 percent of the administrators feeling physician referrals will be more important regarding future admissions than in the past, compared to only two percent feeling the physicians' role will be less important. Of primary importance to patients selecting a hospital, as perceived by the administrators, are the physician's referral, the patient's previous experience, the hospital's reputation, and the courtesy of the staff. The clear majority of the conventional-care hospitals surveyed offer out-patient surgery, a hospital pharmacy, obstetrics/maternity care, and diabetic services. The future emphasis on expanding services is evidenced by some 50 percent of the hospital administrators indicating they either possibly or definitely plan to offer long-term nursing care, out-patient substance abuse programs, and cancer clinics by 1990. In addition, some one-third of the respondents are likely to expand their offerings to include wellness/fitness centers, in-patient substance abuse programs, remote or satellite primary care clinics, and diabetic services. Other areas having priority for future offerings include services geared specifically toward women and the elderly. Perceived as highest in priority by the administrators regarding how their hospital can achieve its goals in the next three years are market development strategies

  12. Patients with worsening chronic heart failure who present to a hospital emergency department require hospital care

    Directory of Open Access Journals (Sweden)

    Shafazand Masoud

    2012-03-01

    Full Text Available Abstract Background Chronic heart failure (CHF is a major public health problem characterised by progressive deterioration with disabling symptoms and frequent hospital admissions. To influence hospitalisation rates it is crucial to identify precipitating factors. To characterise patients with CHF who seek an emergency department (ED because of worsening symptoms and signs and to explore the reasons why they are admitted to hospital. Method Patients (n = 2,648 seeking care for dyspnoea were identified at the ED, Sahlgrenska University Hospital/Östra. Out of 2,648 patients, 1,127 had a previous diagnosis of CHF, and of these, 786 were included in the present study with at least one sign and one symptom of worsening CHF. Results Although several of the patients wanted to go home after acute treatment in the ED, only 2% could be sent home. These patients were enrolled in an interventional study, which evaluated the acute care at home compared to the conventional, in hospital care. The remaining patients were admitted to hospital because of serious condition, including pneumonia/respiratory disease, myocardial infarction, pulmonary oedema, anaemia, the need to monitor cardiac rhythm, pathological blood chemistry and difficulties to communicate. Conclusion The vast majority of patients with worsening CHF seeking the ED required hospital care, predominantly because of co-morbidities. Patients with CHF with symptomatic deterioration may be admitted to hospital without additional emergency room investigations.

  13. Record of hospitalizations for ambulatory care sensitive conditions: validation of the hospital information system.

    Science.gov (United States)

    Rehem, Tania Cristina Morais Santa Barbara; de Oliveira, Maria Regina Fernandes; Ciosak, Suely Itsuko; Egry, Emiko Yoshikawa

    2013-01-01

    To estimate the sensitivity, specificity and positive and negative predictive values of the Unified Health System's Hospital Information System for the appropriate recording of hospitalizations for ambulatory care-sensitive conditions. The hospital information system records for conditions which are sensitive to ambulatory care, and for those which are not, were considered for analysis, taking the medical records as the gold standard. Through simple random sampling, a sample of 816 medical records was defined and selected by means of a list of random numbers using the Statistical Package for Social Sciences. The sensitivity was 81.89%, specificity was 95.19%, the positive predictive value was 77.61% and the negative predictive value was 96.27%. In the study setting, the Hospital Information System (SIH) was more specific than sensitive, with nearly 20% of care sensitive conditions not detected. There are no validation studies in Brazil of the Hospital Information System records for the hospitalizations which are sensitive to primary health care. These results are relevant when one considers that this system is one of the bases for assessment of the effectiveness of primary health care.

  14. Record of hospitalizations for ambulatory care sensitive conditions: validation of the hospital information system

    Directory of Open Access Journals (Sweden)

    Tania Cristina Morais Santa Barbara Rehem

    2013-09-01

    Full Text Available OBJECTIVE: to estimate the sensitivity, specificity and positive and negative predictive values of the Unified Health System's Hospital Information System for the appropriate recording of hospitalizations for ambulatory care-sensitive conditions. METHOD: the hospital information system records for conditions which are sensitive to ambulatory care, and for those which are not, were considered for analysis, taking the medical records as the gold standard. Through simple random sampling, a sample of 816 medical records was defined and selected by means of a list of random numbers using the Statistical Package for Social Sciences. RESULT: the sensitivity was 81.89%, specificity was 95.19%, the positive predictive value was 77.61% and the negative predictive value was 96.27%. In the study setting, the Hospital Information System (SIH was more specific than sensitive, with nearly 20% of care sensitive conditions not detected. CONCLUSION: there are no validation studies in Brazil of the Hospital Information System records for the hospitalizations which are sensitive to primary health care. These results are relevant when one considers that this system is one of the bases for assessment of the effectiveness of primary health care.

  15. Drug usage analysis and health care resources consumption in naïve patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Sangiorgi D

    2015-11-01

    Full Text Available Diego Sangiorgi,1 Maurizio Benucci,2 Carmela Nappi,3 Valentina Perrone,1 Stefano Buda,1 Luca Degli Esposti11CliCon S.r.l., Health, Economics and Outcomes Research, Ravenna, 2Unit of Rheumatology, S. Giovanni di Dio Hospital, Florence, 3Bristol Myers Squibb S.r.l., Rome, ItalyObjectives: The use of biologic agents has revolutionized the management of rheumatoid arthritis (RA in the past 2 decades. These biologic agents directly target molecules and cells involved in the pathogenesis of RA. The purpose of this study was to assess the usage of biologic agents in terms of persistence to treatment, dose escalation, and consumption of health care resources (hospitalizations, drugs, and outpatients service in the real clinical practice in naïve patients with RA.Methods: We conducted a real-world, retrospective, observational cohort study based on data obtained from administrative databases of three Local Health Units in Italy. The population included adults diagnosed with RA who had at least one prescription between January 1, 2009 and December 31, 2011, for a biologic that was approved for treatment of RA. The patients were followed for 12 months after enrollment. The clinical characteristics of the patients enrolled in this study were also investigated in the 1-year period before the index date. The main and secondary endpoints were evaluated only in biologic-naïve patients without switches. The overall health care costs for patients were evaluated.Results: A total of 594 patients met the study criteria (mean age 53.5±13.5, female:male ratio =3:1. Thirty-nine percent received etanercept, 25% adalimumab, 14% infliximab, 10% abatacept, 9% tocilizumab, and 3% golimumab. After 1 year of observation, patients showed similar use of other RA-related medication. For the naïve patients without switches, the persistence levels were: 78% for etanercept, 72% for tocilizumab, 71% for adalimumab, 69% for infliximab, and 64% for abatacept. For all agents, dose

  16. The tremendous cost of seeking hospital obstetric care in Bangladesh.

    Science.gov (United States)

    Afsana, Kaosar

    2004-11-01

    In Bangladesh, maternal mortality is estimated to be 320 per 100,000 live births, among the highest in the world, and most deliveries in rural areas occur at home. Women with obstetric complications fear to seek hospital care for various reasons; one of which is the tremendous cost. This paper shows how cost impedes rural, poor women's access to emergency obstetric care. The data are from a larger ethnographic study of childbirth practices in 2000--01 in Apurbabari village, the adjacent sub-district health complex and more distant tertiary hospitals at district level. Families had to spend what for them added up to a fortune for a caesarean section and other surgery, medicines, laboratory investigations, blood transfusion, food, travel and other expenses. Corruption in the form of demands for under-the-table payments to obtain these aspects of essential care is rife. Adequate resources should be allocated to the different health facilities, including for emergency obstetric treatment. Thana health complexes (sub-district hospitals) should be upgraded to provide comprehensive obstetric care. The system for prescribing drugs should be reformed and the causes of corruption investigated and addressed. Hospital care should not be allowed to further impoverish the poor. Addressing these issues will help to encourage rural, poor women to seek skilled delivery and post-partum care, particularly in emergency situations.

  17. Constructing Episodes of Inpatient Care: How to Define Hospital Transfer in Hospital Administrative Health Data?

    Science.gov (United States)

    Peng, Mingkai; Li, Bing; Southern, Danielle A; Eastwood, Cathy A; Quan, Hude

    2017-01-01

    Hospital administrative health data create separate records for each hospital stay of patients. Treating a hospital transfer as a readmission could lead to biased results in health service research. This is a cross-sectional study. We used the hospital discharge abstract database in 2013 from Alberta, Canada. Transfer cases were defined by transfer institution code and were used as the reference standard. Four time gaps between 2 hospitalizations (6, 9, 12, and 24 h) and 2 day gaps between hospitalizations [same day (up to 24 h), ≤1 d (up to 48 h)] were used to identify transfer cases. We compared the sensitivity and positive predictive value (PPV) of 6 definitions across different categories of sex, age, and location of residence. Readmission rates within 30 days were compared after episodes of care were defined at the different time gaps. Among the 6 definitions, sensitivity ranged from 93.3% to 98.7% and PPV ranged from 86.4% to 96%. The time gap of 9 hours had the optimal balance of sensitivity and PPV. The time gaps of same day (up to 24 h) and 9 hours had comparable 30-day readmission rates as the transfer indicator after defining episode of care. We recommend the use of a time gap of 9 hours between 2 hospitalizations to define hospital transfer in inpatient databases. When admission or discharge time is not available in the database, a time gap of same day (up to 24 h) can be used to define hospital transfer.

  18. Health care waste management practice in a hospital.

    Science.gov (United States)

    Paudel, R; Pradhan, B

    2010-10-01

    Health-care waste is a by-product of health care. Its poor management exposes health-care workers, waste handlers and the community to infections, toxic effects and injuries including damage of the environment. It also creates opportunities for the collection of disposable medical equipment, its re-sale and potential re-use without sterilization, which causes an important burden of disease worldwide. The purpose of this study was to find out health care waste management practice in hospital. A cross-sectional study was conducted in Narayani Sub-Regional Hospital, Birgunj from May to October 2006 using both qualitative and quantitative methods. Study population was four different departments of the hospital (Medical/Paediatric, Surgical/Ortho, Gynae/Obstetric and Emergency), Medical Superintendent, In-charges of four different departments and all sweepers. Data was collected using interview, group discussion, observation and measurement by weight and volume. Total health-care waste generated was 128.4 kg per day while 0.8 kg per patient per day. The composition of health care waste was found to be 96.8 kg (75.4%) general waste, 24.1 kg (8.8%) hazardous waste and 7.5 kg (5.8%) sharps per day by weight. Health staffs and sweepers were not practicing the waste segregation. Occupational health and safety was not given due attention. Majority of the sweepers were unaware of waste management and need of safety measures to protect their own health. Health care waste management practice in the hospital was unsatisfactory because of the lack of waste management plan and carelessness of patients, visitors and staffs. Therefore the hospital should develop the waste management plan and strictly follow the National Health Care Waste Management Guideline.

  19. Toddler Developmental Delays After Extensive Hospitalization: Primary Care Practitioner Guidelines.

    Science.gov (United States)

    Lehner, Dana C; Sadler, Lois S

    2015-01-01

    This review investigated developmental delays toddlers may encounter after a lengthy pediatric hospitalization (30 days or greater). Physical, motor, cognitive, and psychosocial development of children aged 1 to 3 years was reviewed to raise awareness of factors associated with developmental delay after extensive hospitalization. Findings from the literature suggest that neonatal and pediatric intensive care unit (NICU/PICU) graduates are most at risk for developmental delays, but even non-critical hospital stays interrupt development to some extent. Primary care practitioners (PCPs) may be able to minimize risk for delays through the use of formal developmental screening tests and parent report surveys. References and resources are described for developmental assessment to help clinicians recognize delays and to educate families about optimal toddler development interventions. Pediatric PCPs play a leading role in coordinating health and developmental services for the young child following an extensive hospital stay.

  20. Patient satisfaction and quality of surgical care in US hospitals.

    Science.gov (United States)

    Tsai, Thomas C; Orav, E John; Jha, Ashish K

    2015-01-01

    The relationship between patient satisfaction and surgical quality is unclear for US hospitals. Using national data, we examined if hospitals with high patient satisfaction have lower levels of performance on accepted measures of the quality and efficiency of surgical care. Federal policymakers have made patient satisfaction a core measure for the way hospitals are evaluated and paid through the value-based purchasing program. There is broad concern that performance on patient satisfaction may have little or even a negative correlation with the quality of surgical care, leading to potential trade-offs in efforts to improve patient experience with other surgical quality measures. We used the Hospital Consumer Assessment of Healthcare Providers and Systems survey data from 2010 and 2011 to assess performance on patient experience. We used national Medicare data on 6 common surgical procedures to calculate measures of surgical efficiency and quality: risk-adjusted length of stay, process score, risk-adjusted mortality rate, risk-adjusted readmission rate, and a composite z score across all 4 metrics. Multivariate models adjusting for hospital characteristics were used to assess the independent relationships between patient satisfaction and measures of surgical efficiency and quality. Of the 2953 US hospitals that perform one of these 6 procedures, the median patient satisfaction score was 69.5% (interquartile range, 63%-75.5%). Length of stay was shorter in hospitals with the highest levels of patient satisfaction (7.1 days vs 7.7 days, P patient satisfaction had the higher process of care performance (96.5 vs 95.5, P patient satisfaction also had a higher composite score for quality across all measures (P patient satisfaction provided more efficient care and were associated with higher surgical quality. Our findings suggest there need not be a trade-off between good quality of care for surgical patients and ensuring a positive patient experience.

  1. RELIGION & CARE INTERTWINED; NURSING IN CATHOLIC HOSPITALS 1950-1965.

    Science.gov (United States)

    Anthony, Maureen

    2016-01-01

    This qualitative study explores how Catholicism influenced nursing in Catholic hospitals and how nurses met the religious needs of Catholic patients in the 1950s and early 1960s. Six nurses were interviewed who graduated from Catholic schools of nursing between 1952 and 1965 and worked in Catholic hospitals. Results indicate that nursing care was inexorably entwined with meeting the religious needs of Catholic patients. Religious practices were predictable and largely linked to the Holy Sacraments.

  2. Modelling multiple hospital outcomes: the impact of small area and primary care practice variation

    Directory of Open Access Journals (Sweden)

    Congdon Peter

    2006-11-01

    Full Text Available Abstract Background: Appropriate management of care – for example, avoiding unnecessary attendances at, or admissions to, hospital emergency units when they could be handled in primary care – is an important part of health strategy. However, some variations in these outcomes could be due to genuine variations in health need. This paper proposes a new method of explaining variations in hospital utilisation across small areas and the general practices (GPs responsible for patient primary care. By controlling for the influence of true need on such variations, one may identify remaining sources of excess emergency attendances and admissions, both at area and practice level, that may be related to the quality, resourcing or organisation of care. The present paper accordingly develops a methodology that recognises the interplay between population mix factors (health need and primary care factors (e.g. referral thresholds, that allows for unobserved influences on hospitalisation usage, and that also reflects interdependence between hospital outcomes. A case study considers relativities in attendance and admission rates at a North London hospital involving 149 small areas and 53 GP practices. Results: A fixed effects model shows variations in attendances and admissions are significantly related (positively to area and practice need, and nursing home patients, and related (negatively to primary care access and distance of patient homes from the hospital. Modelling the impact of known factors alone is not sufficient to produce a satisfactory fit to the observations, and random effects at area and practice level are needed to improve fit and account for overdispersion. Conclusion: The case study finds variation in attendance and admission rates across areas and practices after controlling for need, and remaining differences between practices may be attributable to referral behaviour unrelated to need, or to staffing, resourcing, and access issues. In

  3. Pricing hospital care: Global budgets and marginal pricing strategies.

    Science.gov (United States)

    Sutherland, Jason M

    2015-08-01

    The Canadian province of British Columbia (BC) is adding financial incentives to increase the volume of surgeries provided by hospitals using a marginal pricing approach. The objective of this study is to calculate marginal costs of surgeries based on assumptions regarding hospitals' availability of labor and equipment. This study is based on observational clinical, administrative and financial data generated by hospitals. Hospital inpatient and outpatient discharge summaries from the province are linked with detailed activity-based costing information, stratified by assigned case mix categorizations. To reflect a range of operating constraints governing hospitals' ability to increase their volume of surgeries, a number of scenarios are proposed. Under these scenarios, estimated marginal costs are calculated and compared to prices being offered as incentives to hospitals. Existing data can be used to support alternative strategies for pricing hospital care. Prices for inpatient surgeries do not generate positive margins under a range of operating scenarios. Hip and knee surgeries generate surpluses for hospitals even under the most costly labor conditions and are expected to generate additional volume. In health systems that wish to fine-tune financial incentives, setting prices that create incentives for additional volume should reflect knowledge of hospitals' underlying cost structures. Possible implications of mis-pricing include no response to the incentives or uneven increases in supply. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  4. Responding to financial pressures. The effect of managed care on hospitals' provision of charity care.

    Science.gov (United States)

    Mas, Núria

    2013-06-01

    Healthcare financing and insurance is changing everywhere. We want to understand the impact that financial pressures can have for the uninsured in advanced economies. To do so we focus on analyzing the effect of the introduction in the US of managed care and the big rise in financial pressures that it implied. Traditionally, in the US safety net hospitals have financed their provision of unfunded care through a complex system of cross-subsidies. Our hypothesis is that financial pressures undermine the ability of a hospital to cross-subsidize and challenges their survival. We focus on the impact of price pressures and cost-controlling mechanisms imposed by managed care. We find that financial pressures imposed by managed care disproportionately affect the closure of safety net hospitals. Moreover, amongst those hospitals that remain open, in areas where managed care penetration increases the most, they react by closing the health services most commonly used by the uninsured.

  5. Patients' Care Needs: Documentation Analysis in General Hospitals.

    Science.gov (United States)

    Paans, Wolter; Müller-Staub, Maria

    2015-10-01

    The purpose of the study is (a) to describe care needs derived from records of patients in Dutch hospitals, and (b) to evaluate whether nurses employed the NANDA-I classification to formulate patients' care needs. A stratified cross-sectional random-sampling nursing documentation audit was conducted employing the D-Catch instrument in 10 hospitals comprising 37 wards. The most prevalent nursing diagnoses were acute pain, nausea, fatigue, and risk for impaired skin integrity. Most care needs were determined in physiological health patterns and few in psychosocial patterns. To perform effective interventions leading to high-quality nursing-sensitive outcomes, nurses should also diagnose patients' care needs in the health management, value-belief, and coping stress patterns. © 2014 NANDA International, Inc.

  6. Nurse led, primary care based antiretroviral treatment versus hospital care: a controlled prospective study in Swaziland

    Directory of Open Access Journals (Sweden)

    Bailey Kerry A

    2010-08-01

    Full Text Available Abstract Background Antiretroviral treatment services delivered in hospital settings in Africa increasingly lack capacity to meet demand and are difficult to access by patients. We evaluate the effectiveness of nurse led primary care based antiretroviral treatment by comparison with usual hospital care in a typical rural sub Saharan African setting. Methods We undertook a prospective, controlled evaluation of planned service change in Lubombo, Swaziland. Clinically stable adults with a CD4 count > 100 and on antiretroviral treatment for at least four weeks at the district hospital were assigned to either nurse led primary care based antiretroviral treatment care or usual hospital care. Assignment depended on the location of the nearest primary care clinic. The main outcome measures were clinic attendance and patient experience. Results Those receiving primary care based treatment were less likely to miss an appointment compared with those continuing to receive hospital care (RR 0·37, p p = 0·001. Those receiving primary care based, nurse led care were more likely to be satisfied in the ability of staff to manage their condition (RR 1·23, p = 0·003. There was no significant difference in loss to follow-up or other health related outcomes in modified intention to treat analysis. Multilevel, multivariable regression identified little inter-cluster variation. Conclusions Clinic attendance and patient experience are better with nurse led primary care based antiretroviral treatment care than with hospital care; health related outcomes appear equally good. This evidence supports efforts of the WHO to scale-up universal access to antiretroviral treatment in sub Saharan Africa.

  7. AN AUDIT OF PRESCRIPTION FOR ANTIBIOTIC IN A TERTIARY CARE HOSPITAL IN KOLKATA, INDIA

    Directory of Open Access Journals (Sweden)

    Anjan Adhikari

    2012-12-01

    Full Text Available Antibiotics are most commonly prescribed drugs in tertiary care hospitals; more than 30% of the hospitalised patients were treated with antibiotics. Rational use of antibiotics is very important to ensure the optimum treatment outcomes and to limit the emergence of bacterial resistance. Present study is a hospital based cross-sectional study carried out for a period of three months in different clinical departments of a tertiary care hospital to find out the antibiotics prescribing pattern. Out of total 551 evaluated prescriptions, an antibiotic was prescribed in 45.5% cases. The most commonly prescribed antibiotics were Moxifloxacin 19.5%, Metronidazole 10.4% and Amoxicillin+Cloxacillin 10.2%, broad spectrum antibiotics usage was higher & 87.7% of the antibiotics were prescribed by brand names. The appropriate use of antibiotic is a greatest need of the current situation all over the world. The rising antibiotic resistance is a global problem which is directly related with the irrational prescription of antibiotics.

  8. Day hospital and psychosocial care center: Expanding the discussion of partial hospitalization in mental health

    Directory of Open Access Journals (Sweden)

    César Augusto Trinta Weber

    Full Text Available Summary Introduction: Since the second half of the twentieth century the discussions about mental patient care reveal ongoing debate between two health care paradigms: the biomedical/biopsychosocial paradigm and the psychosocial paradigm. The struggle for hegemony over the forms of care, on how to deal optimally with the experience of becoming ill is underpinned by an intentionality of reorganizing knowledge about the health/disease dichotomy, which is reflected in the models proposed for the implementation of actions and services for the promotion, prevention, care and rehabilitation of human health. Objective: To discuss the guidelines of care in mental health day hospitals (MHDH in contrast to type III psychosocial care centers (CAPS III. Method: Review of mental health legislation from 1990 to 2014. Results: A definition of therapeutic project could not be found, as well as which activities and techniques should be employed by these health services. Conclusion: The MHDH and PCC III are services that replace psychiatric hospital admission and are characterized by their complementarity in the care to the mentally ill. Due to their varied and distinctive intervention methods, which operate synergistically, the contributions from both models of care are optimized. Discussions on the best mental health care model reveal polarization between the biomedical/biopsychosocial and psychosocial paradigms. This reflects the supremacy of the latter over the former in the political-ideological discourse that circumscribes the reform of psychiatric care, which may hinder a better clinical outcome for patients and their families.

  9. Uptake and Usage of IntelliCare: A Publicly Available Suite of Mental Health and Well-Being Apps.

    Science.gov (United States)

    Lattie, Emily G; Schueller, Stephen M; Sargent, Elizabeth; Stiles-Shields, Colleen; Tomasino, Kathryn Noth; Corden, Marya E; Begale, Mark; Karr, Chris J; Mohr, David C

    2016-05-01

    Treatments for depression and anxiety have several behavioral and psychological targets and rely on varied strategies. Digital mental health treatments often employ feature-rich approaches addressing several targets and strategies. These treatments, often optimized for desktop computer use, are at odds with the ways people use smartphone applications. Smartphone use tends to focus on singular functions with easy navigation to desired tools. The IntelliCare suite of apps was developed to address the discrepancy between need for diverse behavioral strategies and constraints imposed by typical app use. Each app focuses on one strategy for a limited subset of clinical aims all pertinent to depression and anxiety. This study presents the uptake and usage of apps from the IntelliCare suite following an open deployment on a large app marketplace. Thirteen lightweight apps, including 12 interactive apps and one Hub app that coordinates use across those interactive apps, were developed and made free to download on the Google Play store. De-identified app usage data from the first year of IntelliCare suite deployment were analyzed for this study. In the first year of public availability, 5,210 individuals downloaded one or more of the IntelliCare apps, for a total of 10,131 downloads. Nearly a third of these individuals (31.8%) downloaded more than one of these apps. The modal number of launches for each of the apps was 1, however the mean number of app launches per app ranged from 3.10 to 16.98, reflecting considerable variability in the use of each app. The use rate of the IntelliCare suite of apps is higher than public deployments of other comparable digital resources. Our findings suggest that people will use multiple apps and provides support for the concept of app suites as a useful strategy for providing diverse behavioral strategies.

  10. Current End-of-Life Care Needs and Care Practices in Acute Care Hospitals

    Directory of Open Access Journals (Sweden)

    Amy J. Thurston

    2011-01-01

    Full Text Available A descriptive-comparative study was undertaken to examine current end-of-life care needs and practices in hospital. A chart review for all 1,018 persons who died from August 1, 2008 through July 31, 2009 in two full-service Canadian hospitals was conducted. Most decedents were elderly (73.8% and urbanite (79.5%, and cancer was the most common diagnosis (36.2%. Only 13.8% had CPR performed at some point during this hospitalization and 8.8% had CPR immediately preceding death, with 87.5% having a DNR order and 30.8% providing an advance directive. Most (97.3% had one or more life-sustaining technologies in use at the time of death. These figures indicate, when compared to those in a similar mid-1990s Canadian study, that impending death is more often openly recognized and addressed. Technologies continue to be routinely but controversially used. The increased rate of end-stage CPR from 2.9% to 8.8% could reflect a 1994+ shift of expected deaths out of hospital.

  11. Hospitalization for uncomplicated hypertension: an ambulatory care sensitive condition.

    Science.gov (United States)

    Walker, Robin L; Chen, Guanmin; McAlister, Finlay A; Campbell, Norm R C; Hemmelgarn, Brenda R; Dixon, Elijah; Ghali, William; Rabi, Doreen; Tu, Karen; Jette, Nathalie; Quan, Hude

    2013-11-01

    Hospitalizations for ambulatory care sensitive conditions (ACSC) represent an indirect measure of access and quality of community care. This study explored hospitalization rates for 1 ACSC, uncomplicated hypertension, and the factors associated with hospitalization. A cohort of patients with incident hypertension, and their covariates, was defined using validated case definitions applied to International Classification of Disease administrative health data in 4 Canadian provinces between fiscal years 1997 and 2004. We applied the Canadian Institute for Health Information's case definition to detect all patients who had an ACSC hospitalization for uncomplicated hypertension. We employed logistic regression to assess factors associated with an ACSC hospitalization for uncomplicated hypertension. The overall rate of hospitalizations for uncomplicated hypertension in the 4 provinces was 3.7 per 1000 hypertensive patients. The risk-adjusted rate was lowest among those in an urban setting (2.6 per 1000; 95% confidence interval [CI], 2.3-2.7), the highest income quintile (3.4 per 1000; 95% CI, 2.8-4.2), and those with no comorbidities (3.6 per 1000; 95% CI, 3.2-3.9). Overall, Newfoundland had the highest adjusted rate (5.7 per 1000; 95% CI, 4.9-6.7), and British Columbia had the lowest (3.7 per 1000; 95% CI, 3.4-4.2). The adjusted rate declined from 5.9 per 1000 in 1997 to 3.7 per 1000 in 2004. We found that the rate of hospitalizations for uncomplicated hypertension has decreased over time, which might reflect improvements in community care. Geographic variations in the rate of hospitalizations indicate disparity among the provinces and those residing in rural regions. Copyright © 2013 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.

  12. Distribution of variable vs fixed costs of hospital care.

    Science.gov (United States)

    Roberts, R R; Frutos, P W; Ciavarella, G G; Gussow, L M; Mensah, E K; Kampe, L M; Straus, H E; Joseph, G; Rydman, R J

    1999-02-17

    Most strategies proposed to control the rising cost of health care are aimed at reducing medical resource consumption rates. These approaches may be limited in effectiveness because of the relatively low variable cost of medical care. Variable costs (for medication and supplies) are saved if a facility does not provide a service while fixed costs (for salaried labor, buildings, and equipment) are not saved over the short term when a health care facility reduces service. To determine the relative variable and fixed costs of inpatient and outpatient care for a large urban public teaching hospital. Cost analysis. A large urban public teaching hospital. All expenditures for the institution during 1993 and for each service were categorized as either variable or fixed. Fixed costs included capital expenditures, employee salaries and benefits, building maintenance, and utilities. Variable costs included health care worker supplies, patient care supplies, diagnostic and therapeutic supplies, and medications. In 1993, the hospital had nearly 114000 emergency department visits, 40000 hospital admissions, 240000 inpatient days, and more than 500000 outpatient clinic visits. The total budget for 1993 was $429.2 million, of which $360.3 million (84%) was fixed and $68.8 million (16%) was variable. Overall, 31.5% of total costs were for support expenses such as utilities, employee benefits, and housekeeping salaries, and 52.4% included direct costs of salary for service center personnel who provide services to individual patients. The majority of cost in providing hospital service is related to buildings, equipment, salaried labor, and overhead, which are fixed over the short term. The high fixed costs emphasize the importance of adjusting fixed costs to patient consumption to maintain efficiency.

  13. Development and Validation of the Spiritual Care Needs Inventory for Acute Care Hospital Patients in Taiwan.

    Science.gov (United States)

    Wu, Li-Fen; Koo, Malcolm; Liao, Yu-Chen; Chen, Yuh-Min; Yeh, Dah-Cherng

    2016-12-01

    Spiritual care is increasingly being recognized as an integral aspect of nursing practice. The aim of this study was to develop a new instrument, Spiritual Care Needs Inventory (SCNI), for measuring spiritual care needs in acute care hospital patients with different religious beliefs. The 21-item instrument was completed by 1,351 adult acute care patients recruited from a medical center in Taiwan. Principal components analysis of the SCNI revealed two components, (a) meaning and hope and (b) caring and respect, which together accounted for 66.2% of the total variance. The internal consistency measures for the two components were 0.96 and 0.91, respectively. Furthermore, younger age, female sex, Christian religion, and regularly attending religious activities had significantly higher mean total scores in both components. The SCNI was found to be a simple instrument with excellent internal consistency for measuring the spiritual care needs in acute care hospital patients. © The Author(s) 2015.

  14. The effects of hospital competition on inpatient quality of care.

    Science.gov (United States)

    Mutter, Ryan L; Wong, Herbert S; Goldfarb, Marsha G

    2008-01-01

    Existing empirical studies have produced inconclusive, and sometimes contradictory, findings on the effects of hospital competition on inpatient quality of care. These inconsistencies may be due to the use of different methodologies, hospital competition measures, and hospital quality measures. This paper applies the Quality Indicator software from the Agency for Healthcare Research and Quality to the 1997 Healthcare Cost and Utilization Project State Inpatient Databases to create three versions (i.e., observed, risk-adjusted, and "smoothed") of 38 distinct measures of inpatient quality. The relationship between 12 different hospital competition measures and these quality measures are assessed, using ordinary least squares, two-step efficient generalized method of moments, and negative binomial regression techniques. We find that across estimation strategies, hospital competition has an impact on a number of hospital quality measures. However, the effect is not unidirectional: some indicators show improvements in hospital quality with greater levels of competition, some show decreases in hospital quality, and others are unaffected. We provide hypotheses based on emerging areas of research that could explain these findings, but inconsistencies remain.

  15. Hospital Medicine (Part 1): what is wrong with acute hospital care?

    LENUS (Irish Health Repository)

    Kellett, John

    2009-09-01

    Modern hospitals are facing several challenges and, over the last decade in particular, many of these institutions have become dysfunctional. Paradoxically as medicine has become more successful the demand for acute hospital care has increased, yet there is no consensus on what conditions or complaints require hospital admission and there is wide variation in the mortality rates, length of stay and possibly standards of care between different units. Most acutely ill patients are elderly and instead of one straightforward diagnosis are more likely to have a complex combination of multiple co-morbid conditions. Any elderly patient admitted to hospital is at considerable risk which must be balanced against the possible benefits. Although most of the patients in hospital die from only approximately ten diagnoses, obvious life saving treatment is often delayed by a junior doctor in-training first performing an exhaustive complete history and physical, and then ordering a number of investigations before consulting a senior colleague. Following this traditional hierarchy delays care with several "futile cycles" of clinical activity thoughtlessly directed at the patient without any benefit being delivered. If acute hospital medicine is to be improved changes in traditional assumptions, attitudes, beliefs and practices are needed.

  16. Healthcare associated infections in Paediatric Intensive Care Unit of a tertiary care hospital in India: Hospital stay & extra costs.

    Science.gov (United States)

    Sodhi, Jitender; Satpathy, Sidhartha; Sharma, D K; Lodha, Rakesh; Kapil, Arti; Wadhwa, Nitya; Gupta, Shakti Kumar

    2016-04-01

    Healthcare associated infections (HAIs) increase the length of stay in the hospital and consequently costs as reported from studies done in developed countries. The current study was undertaken to evaluate the impact of HAIs on length of stay and costs of health care in children admitted to Paediatric Intensive Care Unit (PICU) of a tertiary care hospital in north India. This prospective study was done in the seven bedded PICU of a large multi-specialty tertiary care hospital in New Delhi, India. A total of 20 children with HAI (cases) and 35 children without HAI (controls), admitted to the PICU during the study period (January 2012 to June 2012), were matched for gender, age, and average severity of illness score. Each patient's length of stay was obtained prospectively. Costs of healthcare were estimated according to traditional and time driven activity based costing methods approach. The median extra length of PICU stay for children with HAI (cases), compared with children with no HAI (controls), was seven days (IQR 3-16). The mean total costs of patients with and without HAI were ' 2,04,787 (US$ 3,413) and ' 56,587 (US$ 943), respectively and the mean difference in the total cost between cases and controls was ' 1,48,200 (95% CI 55,716 to 2,40,685, pcosts for PICU patients, especially costs due to prolongation of hospital stay, and suggests the need to develop effective strategies for prevention of HAI to reduce costs of health care.

  17. A protocol for sustained reduction of Total Parenteral Nutrition and cost savings by improvement of nutritional care in hospitals.

    Science.gov (United States)

    van Schaik, Rian; Van den Abeele, Kurt; Melsens, Glenn; Schepens, Peter; Lanssens, Truus; Vlaemynck, Bernadette; Devisch, Maria; Niewold, Theo A

    2016-10-01

    Malnutrition and the use of Total Parenteral Nutrition (TPN) contribute considerably to hospital costs. Recently, we reported on the introduction of malnutrition screening and monitoring of TPN use in our hospital, which resulted in a large (40%) reduction in TPN and improved quality of nutritional care in two years (2011/12). Here, we aimed to assure continuation of improved care by developing a detailed malnutrition screening and TPN use protocol involving instruction tools for hospital staff, while monitoring the results in the following two years (2013/14). A TPN decision tree for follow up of TPN in patients and a TP-EN instruction card for caregivers was introduced, showing TPN/EN introduction schedules based on the energy needs of patients according to EB guidelines, also addressing the risk of refeeding syndrome. TPN patients were monitored by dietitians and TPN usage and costs were presented to the (medical) staff. Screening and treatment of malnourished patients by dietitians is simultaneously ongoing. In 2014 48% of patients, hospitalized for at least 48 h, were screened on malnutrition, 17% of them were diagnosed at risk, 7.9% malnourished and treated by dietitians. TPN usage dropped by 53% and cost savings of 51% were obtained due to 50% decrease of TPN users in 2014 versus 2010. TPN over EN ratio dropped from 2.4 in 2010 to 1.2 in 2014. Sustained improvement of nutritional care and reduction of TPN usage and costs is possible by introduction of procedures embedded in the existing structures. Copyright © 2016 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights reserved.

  18. Residential aged care residents and components of end of life care in an Australian hospital.

    Science.gov (United States)

    Leong, Laurence Jee Peng; Crawford, Gregory Brian

    2018-06-09

    With ageing of Australians, the numbers of residential aged care (RAC) residents is rising. This places a spotlight on decisions about appropriate care for this population, including hospitalisation and end-of-life (EOL) care. The aim was to study a sample of RAC residents who attended and died in hospital, to quantify measurable components of EOL care so as to describe the extent of palliative care required. A retrospective case-note review of hospital records was conducted in Adelaide, Australia. Participants were 109 RAC residents who attended from July 2013 to June 2014 and died in hospital. Measurements were advance care planning, health care input from the RAC facilities to hospital and components of EOL care. Residents with and without advanced dementia were compared. Advance care directives (ACDs) were present from 11 to 50%, and advance care plans (ACPs) at 60%. There were more ACPs, resuscitation orders (for/against) and do-not-hospitalise orders in residents with advanced dementia than those without. General practitioner (GP) and extended care paramedic (ECP) input on decisions for hospital transfer were 30% and 1 %. Mean hospital stay to death was 5.2 days. For residents admitted under non-palliative care teams, specialist palliative care (SPC) was needed for phone advice in 5%, consultation in 45%, transfer to palliative care unit in 37%, and takeover by SPC team in 19%. Mean number of documented goals-of-care discussions with family/caregiver was 1.7. In the last 3 days of life, the mean daily number of doses of EOL medications was 4.2. Continuous subcutaneous infusion was commenced in 35%. Staff in RAC need to be adequately resourced to make complex decisions about whether to transfer to hospital. RAC nurses are mainly making these decisions as GP and ECP input were suboptimal. Ways to support nurses and optimise decision-making are needed. Advance care planning can be improved, especially documentation of EOL wishes and hospitalisation orders. By

  19. Antibiotic control measures in Dutch secondary care hospitals.

    NARCIS (Netherlands)

    Schouten, J.A.; Hulscher, M.E.J.L.; Natsch, S.S.; Grol, R.P.T.M.; Meer, J.W.M. van der

    2005-01-01

    Control measures for the use of antibiotics are essential because of the potential harmful consequences of side effects. Various methods have been developed to help curb undesirable antibiotic prescription. We performed a survey in Dutch secondary care hospitals (response rate 73%) to make an

  20. Hospitality and Facility Care Services. Ohio's Competency Analysis Profile.

    Science.gov (United States)

    Ohio State Univ., Columbus. Vocational Instructional Materials Lab.

    Developed through a modified DACUM (Developing a Curriculum) process involving business, industry, labor, and community agency representatives in Ohio, this document is a comprehensive and verified employer competency profile for hospitality and facility care occupations. The list contains units (with and without subunits), competencies, and…

  1. Hospital-based home care for children with cancer

    DEFF Research Database (Denmark)

    Hansson, Helena; Hallström, Inger; Kjaergaard, Hanne

    2011-01-01

    Hospital-based home care (HBHC) is widely applied in Pediatric Oncology. We reviewed the potential effect of HBHC on children's physical health and risk of adverse events, parental and child satisfaction, quality of life of children and their parents, and costs. A search of PubMed, CINAHL...

  2. Status of hospital infection control measures at seven major tertiary care hospitals of northern Punjab

    International Nuclear Information System (INIS)

    Ikram, A.; Shah, S.I.H.; Naseem, S.; Absar, S.A.; Safi-Ullah; Ambreen, T.

    2010-01-01

    To determine the availability and implementation of various hospital infection control measures at tertiary care hospitals. Study Design: Survey. Place and Duration of Study: National Institute of Science and Technology, Islamabad, from June through August 2008. Methodology: Seven tertiary care very busy hospitals were selected; one from Islamabad, 5 from Rawalpindi, and one from Lahore. A detailed proforma was designed addressing all the issues pertaining to hospital infection control measures. Air sampling was done and growth yielded was identified by standard methods. Results: Analyses revealed that all of the hospitals had an Infection Control Committee. Microbiological diagnostic facilities were adequate at all the hospitals and overall microorganism yield was very high. Antibiotic policy was claimed by most, not available on ground. Majority of the operation theatres were without proper air flow system and autoclaves were not being regularly monitored. There was no proper disposal for sharps and needles. Incineration was not the usual mode for infectious waste. Conclusion: The results of the present study imply availability of proper hospital infection control policies with need of strict implementation of such measures. (author)

  3. Information and communication technologies in hospital nursing care

    Directory of Open Access Journals (Sweden)

    Luís Felipe Pissaia

    2017-10-01

    Full Text Available Justification and objective: This study has the objective check the use of Information and Communication Technologies (ICT in care processes of nursing through the methodology of Systematization of Nursing Assistance (SNA in a hospital in the interior of Rio Grande do Sul, Brasil. Methods: Descriptive and exploratory study with a qualitative approach carried out six nurses of a hospital service. Results: The lack of knowledge about the importance of ICT, the deficit in the provision of continuing education to professionals and cultural prejudice to new working methods were list as existing weaknesses. Contributions are relate to organizing and planning your activities, as well as an effective personnel management based on the principles of comprehensive care provided to the client. Conclusion: This study demonstrated that ICT help in the implementation of processes and implementation of SNA, promoting new models of work to nurses and encouraging compliance by the hospitals.

  4. Taiwanese women's experiences of hospital midwifery care: a phenomenological study.

    Science.gov (United States)

    Kuo, Su-Chen; Wu, Cheng Jing; Mu, Pei-Fan

    2010-08-01

    to explore women's experiences in interaction with their midwives during their antenatal checks and during labour. a qualitative study using a phenomenological approach. Data were collected via tape-recorded interviews. All interviews were transcribed verbatim. Data were analysed using Colaizzi's method for data analysis. the homes of the study participants in the district of a Taipei (Taiwan) teaching hospital. a purposive sample of 11 Taiwanese women, one primipara, and 10 multiparae, who were one to three months post-childbirth at the time of interview. five major themes revealed the essence of women's experiences of their interaction with a midwife during pregnancy and childbirth: (1) being respected, (2) being accompanied, (3) trust, (4) being satisfied, and (5) professional competence. the women recognised the service model of the midwife; they treasured their mutual relationships and the benefits that women derived from midwifery care during childbirth. In Taiwan, the government is mandated to offer midwifery models of care in hospitals, and to allow women to choose different types of care provider. an awareness of women's experiences will help identify the caring behaviours as recognised by the women and may help health-care professionals provide better support and care for women during the pregnancy and childbirth periods. These findings can serve as references for future midwifery practice models and improvements in quality of care. Crown Copyright 2008. Published by Elsevier Ltd. All rights reserved.

  5. Severe maternal morbidity in Zanzibar’s referral hospital : Measuring the impact of in-hospital care

    NARCIS (Netherlands)

    Herklots, Tanneke; Van Acht, Lieke; Meguid, Tarek; Franx, Arie; Jacod, Benoit

    2017-01-01

    Objective: to analyse the impact of in-hospital care on severe maternal morbidity using WHO’s near-miss approach in the low-resource, high mortality setting of Zanzibar’s referral hospital. Setting: Mnazi Mmoja Hospital, a tertiary care facility, in Zanzibar, Tanzania. Methods: We identified all

  6. [Day hospital in internal medicine: A chance for ambulatory care].

    Science.gov (United States)

    Grasland, A; Mortier, E

    2018-04-16

    Internal medicine is an in-hospital speciality. Along with its expertise in rare diseases, it shares with general medicine the global care of patients but its place in the ambulatory shift has yet to be defined. The objective of our work was to evaluate the benefits of an internal medicine day-hospital devoted to general medicine. Named "Centre Vi'TAL" to underline the link between the city and the hospital, this novel activity was implemented in order to respond quickly to general practitioners having difficulties to synthesize their complex patients or facing diagnostic or therapeutic problems. Using preferentially email for communication, the general practitioners can contact an internist who is committed to respond on the same day and take over the patient within 7 days if day-hospital is appropriate for his condition. The other patients are directed either to the emergency department, consultation or full hospitalization. In 14 months, the center has received 213 (144 women, 69 men) patients, mean age 53.6, addressed by 88 general practitioners for 282 day-hospital sessions. Requests included problem diagnoses (n=105), synthesis reviews for complex patients (n=65), and treatment (n=43). In the ambulatory shift advocated by the authorities, this experience shows that internal medicine should engage in the recognition of day-hospital as a place for diagnosis and synthesis reviews connected with the city while leaving the general practitioners coordinator of their patient care. This activity of synthesis in day-hospital is useful for the patients and efficient for our healthcare system. Copyright © 2018 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

  7. Environmental cleaning resources and activities in Canadian acute care hospitals.

    Science.gov (United States)

    Zoutman, Dick E; Ford, B Douglas; Sopha, Keith

    2014-05-01

    Environmental cleaning interventions have increased cleaning effectiveness and reduced antibiotic-resistant organisms in hospitals. This study examined cleaning in Canadian acute care hospitals with the goal of developing strategies to improve cleaning and reduce antibiotic-resistant organism rates. Managers most responsible for environmental services (EVS) completed an extensive online survey that assessed EVS resources and cleaning practices. The response rate was 50.5%; 96 surveys were completed, representing 103 of 204 hospitals. Whereas 86.3% (82/95) of managers responsible for EVS reported their staff was adequately trained and 76.0% (73/96) that supplies and equipment budgets were sufficient, only 46.9% (45/96) reported that EVS had enough personnel to satisfactorily clean their hospital. A substantial minority (36.8%, 35/95) of EVS departments did not audit the cleaning of medical surgical patient rooms on at least a monthly basis. Cleaning audits of medical surgical patient rooms frequently included environmental marking methods in only one third (33.3%, 31/93) of hospitals and frequently included the measurement of residual bioburden in only 13.8% (13/94). There was a general need for increased and improved auditing of environmental cleaning in Canadian hospitals, and there were perceived EVS staffing deficits in the majority of hospitals. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

  8. Improving Service Quality in Long-term Care Hospitals: National Evaluation on Long-term Care Hospitals and Employees Perception of Quality Dimensions

    OpenAIRE

    Kim, Jinkyung; Han, Woosok

    2012-01-01

    Objectives To investigate predictors for specific dimensions of service quality perceived by hospital employees in long-term care hospitals. Methods Data collected from a survey of 298 hospital employees in 18 long-term care hospitals were analysed. Multivariate ordinary least squares regression analysis with hospital fixed effects was used to determine the predictors of service quality using respondents? and organizational characteristics. Results The most significant predictors of employee-...

  9. A taxonomy of nursing care organization models in hospitals.

    Science.gov (United States)

    Dubois, Carl-Ardy; D'Amour, Danielle; Tchouaket, Eric; Rivard, Michèle; Clarke, Sean; Blais, Régis

    2012-08-28

    Over the last decades, converging forces in hospital care, including cost-containment policies, rising healthcare demands and nursing shortages, have driven the search for new operational models of nursing care delivery that maximize the use of available nursing resources while ensuring safe, high-quality care. Little is known, however, about the distinctive features of these emergent nursing care models. This article contributes to filling this gap by presenting a theoretically and empirically grounded taxonomy of nursing care organization models in the context of acute care units in Quebec and comparing their distinctive features. This study was based on a survey of 22 medical units in 11 acute care facilities in Quebec. Data collection methods included questionnaire, interviews, focus groups and administrative data census. The analytical procedures consisted of first generating unit profiles based on qualitative and quantitative data collected at the unit level, then applying hierarchical cluster analysis to the units' profile data. The study identified four models of nursing care organization: two professional models that draw mainly on registered nurses as professionals to deliver nursing services and reflect stronger support to nurses' professional practice, and two functional models that draw more significantly on licensed practical nurses (LPNs) and assistive staff (orderlies) to deliver nursing services and are characterized by registered nurses' perceptions that the practice environment is less supportive of their professional work. This study showed that medical units in acute care hospitals exhibit diverse staff mixes, patterns of skill use, work environment design, and support for innovation. The four models reflect not only distinct approaches to dealing with the numerous constraints in the nursing care environment, but also different degrees of approximations to an "ideal" nursing professional practice model described by some leaders in the

  10. A taxonomy of nursing care organization models in hospitals

    Science.gov (United States)

    2012-01-01

    Background Over the last decades, converging forces in hospital care, including cost-containment policies, rising healthcare demands and nursing shortages, have driven the search for new operational models of nursing care delivery that maximize the use of available nursing resources while ensuring safe, high-quality care. Little is known, however, about the distinctive features of these emergent nursing care models. This article contributes to filling this gap by presenting a theoretically and empirically grounded taxonomy of nursing care organization models in the context of acute care units in Quebec and comparing their distinctive features. Methods This study was based on a survey of 22 medical units in 11 acute care facilities in Quebec. Data collection methods included questionnaire, interviews, focus groups and administrative data census. The analytical procedures consisted of first generating unit profiles based on qualitative and quantitative data collected at the unit level, then applying hierarchical cluster analysis to the units’ profile data. Results The study identified four models of nursing care organization: two professional models that draw mainly on registered nurses as professionals to deliver nursing services and reflect stronger support to nurses’ professional practice, and two functional models that draw more significantly on licensed practical nurses (LPNs) and assistive staff (orderlies) to deliver nursing services and are characterized by registered nurses’ perceptions that the practice environment is less supportive of their professional work. Conclusions This study showed that medical units in acute care hospitals exhibit diverse staff mixes, patterns of skill use, work environment design, and support for innovation. The four models reflect not only distinct approaches to dealing with the numerous constraints in the nursing care environment, but also different degrees of approximations to an “ideal” nursing professional practice

  11. 38 CFR 17.35 - Hospital care and medical services in foreign countries.

    Science.gov (United States)

    2010-07-01

    ... VETERANS AFFAIRS MEDICAL Hospital Or Nursing Home Care and Medical Services in Foreign Countries § 17.35 Hospital care and medical services in foreign countries. The Secretary may furnish hospital care and... associated with and held to be aggravating a service-connected disability; (b) If the care is furnished to a...

  12. Distraction: an assessment of smartphone usage in health care work settings

    Directory of Open Access Journals (Sweden)

    Gill PS

    2012-08-01

    Full Text Available Preetinder S Gill,1 Ashwini Kamath,2 Tejkaran S Gill31College of Technology, Eastern Michigan University, Ypsilanti, MI, USA; 2School of Information, University of Texas, Austin, TX, USA; 3College of Engineering, University of Michigan, Ann Arbor, MI, USAAbstract: Smartphone use in health care work settings presents both opportunities and challenges. The benefits could be severely undermined if abuse and overuse are not kept in check. This practice-focused research paper examines the current panorama of health software applications. Findings from existing research are consolidated to elucidate the level and effects of distraction in health care work settings due to smartphone use. A conceptual framework for crafting guidelines to regulate the use of smartphones in health care work settings is then presented. Finally, specific guidelines are delineated to assist in creating policies for the use of smartphones in a health care workplace.Keywords: smartphone, health care, distraction, workplace, mobile apps, health informatics

  13. Kenya Hospices and Palliative Care Association: integrating palliative care in public hospitals in Kenya.

    Science.gov (United States)

    Ali, Zipporah

    2016-01-01

    In Kenya, cancers as a disease group rank third as a cause of death after infectious and cardiovascular diseases. It is estimated that the annual incidence of cancer is about 37,000 new cases with an annual mortality of 28,000 cases (Kenya National Cancer Control Strategy 2010). The incidence of non-communicable diseases accounts for more than 50% of total hospital admissions and over 55% of hospital deaths (Kenya National Strategy for the Prevention and Control of Non Communicable Diseases 2015-2020). The prevalence of HIV is 6.8 (KIAS 2014). Most of these patients will benefit from palliative care services, hence the need to integrate palliative care services in the public healthcare system. The process of integrating palliative care in public hospitals involved advocacy both at the national level and at the institutional level, training of healthcare professionals, and setting up services within the hospitals that we worked with. Technical support was provided to each individual institution as needed. Eleven provincial hospitals across the country have now integrated palliative care services (Palliative Care Units) and are now centres of excellence. Over 220 healthcare providers have been trained, and approximately, over 30,000 patients have benefited from these services. Oral morphine is now available in the hospital palliative care units. As a success of the pilot project, Kenya Hospices and Palliative Care Association (KEHPCA) is now working with the Ministry of Health Kenya to integrate palliative care services in 30 other county hospitals across the country, thus ensuring more availability and access to more patients. Other developing countries can learn from Kenya's successful experience.

  14. Post-Hospital Medical Respite Care and Hospital Readmission of Homeless Persons

    Science.gov (United States)

    Kertesz, Stefan G.; Posner, Michael A.; O’Connell, James J.; Swain, Stacy; Mullins, Ashley N.; Michael, Shwartz; Ash, Arlene S.

    2009-01-01

    Medical respite programs offer medical, nursing, and other care as well as accommodation for homeless persons discharged from acute hospital stays. They represent a community-based adaptation of urban health systems to the specific needs of homeless persons. This paper examines whether post-hospital discharge to a homeless medical respite program was associated with a reduced chance of 90-day readmission compared to other disposition options. Adjusting for imbalances in patient characteristics using propensity scores, Respite patients were the only group that was significantly less likely to be readmitted within 90 days compared to those released to Own Care. Respite programs merit attention as a potentially efficacious service for homeless persons leaving the hospital. PMID:19363773

  15. Enhancing early postnatal care: findings from a major reform of maternity care in three Australian hospitals.

    Science.gov (United States)

    Yelland, Jane; Krastev, Ann; Brown, Stephanie

    2009-08-01

    four hospitals comprising a health network in Melbourne, Australia, implemented a range of initiatives aimed at enhancing women's experiences of postnatal maternity care. to compare women's views and experiences of early postnatal care before and after implementation of maternity enhancement initiatives. 'before and after' study design incorporating two postal surveys of recent mothers (baseline and post-implementation). four hospitals in Melbourne, Australia. Analysis of postnatal outcomes was confined to three hospitals where the initiatives were fully operational. 1256 women participated in the baseline survey in 1999 (before implementing the initiative) and 1050 women responded to the post-implementation survey in 2001. the response to the 1999 baseline survey was 65.3% (1256/1922) and to the 2001 post-implementation survey 57.4% (1050/1829). Comparative analysis revealed a statistically significant improvement in overall ratings of hospital postnatal care; the level of advice and support received in relation to discharge and going home; the sensitivity of caregivers; and the proportion of women receiving domiciliary care after discharge. There was little change in the time women spent in hospital after birth between the two survey time-points. Over 90% of women reported one or more health problems in the first 3 months postpartum. The proportion of women reporting physical or emotional health problems between the two surveys did not change. mainstream maternity care can be restructured to improve women's experiences of early postnatal care. maternity service providers should consider a multi-faceted approach to reorienting postnatal services and improving women's experiences of care. Approaches worthy of consideration include attempts to ensure consistency and continuity of care through staffing arrangements, guidelines and protocols; an emphasis on planning for postnatal care during pregnancy; the use of evidence to inform both consumer information and advice

  16. [Noise level in a care and teaching hospital institution].

    Science.gov (United States)

    Mendoza-Sánchez, R S; Roque-Sánchez, R H; Moncada-González, B

    1996-01-01

    Noise in the environment is increasing over the years. Disturbances produced by noise are varied, some lead to serious health consequences. Noise level was registered in a teaching hospital. Levels in the wards were between 50 and 59 dB. In the Intensive Care Unit, main hallways and outpatients department levels were higher than 59 dB. Isolated peaks up to 90.0 dB (Pediatrics) were detected. The noise level recommended for a hospital is under 50.0 dB. We found that the principal source of noise came from the medical and nursing staff.

  17. Approaches and challenges to optimising primary care teams’ electronic health record usage

    Directory of Open Access Journals (Sweden)

    Nancy Pandhi

    2014-07-01

    Full Text Available Background Although the presence of an electronic health record (EHR alone does not ensure high quality, efficient care, few studies have focused on the work of those charged with optimising use of existing EHR functionality.Objective To examine the approaches used and challenges perceived by analysts supporting the optimisation of primary care teams’ EHR use at a large U.S. academic health care system.Methods A qualitative study was conducted. Optimisation analysts and their supervisor were interviewed and data were analysed for themes.Results Analysts needed to reconcile the tension created by organisational mandates focused on the standardisation of EHR processes with the primary care teams’ demand for EHR customisation. They gained an understanding of health information technology (HIT leadership’s and primary care team’s goals through attending meetings, reading meeting minutes and visiting with clinical teams. Within what was organisationally possible, EHR education could then be tailored to fit team needs. Major challenges were related to organisational attempts to standardise EHR use despite varied clinic contexts, personnel readiness and technical issues with the EHR platform. Forcing standardisation upon clinical needs that current EHR functionality could not satisfy was difficult.Conclusions Dedicated optimisation analysts can add value to health systems through playing a mediating role between HIT leadership and care teams. Our findings imply that EHR optimisation should be performed with an in-depth understanding of the workflow, cognitive and interactional activities in primary care.

  18. Concerns about usage of smartphones in operating room and critical care scenario

    OpenAIRE

    Attri, JP; Khetarpal, R; Chatrath, V; Kaur, J

    2016-01-01

    Smartphones and tablets have taken a central place in the lives of health care professionals. Their use has dramatically improved the communication and has become an important learning tool as the medical information can be assessed online at anytime. In critical care settings, use of smartphone facilitates quick passage of information through E-mail messaging and getting feedback from the concerned physician quickly, thereby reducing medical errors. However, in addition to the benefits offer...

  19. Singing and Vocal Interventions in Palliative and Cancer Care: Music Therapists' Perceptions of Usage.

    Science.gov (United States)

    Clements-Cortés, Amy

    2017-11-01

    Music therapists in palliative and cancer care settings often use singing and vocal interventions. Although benefits for these interventions are emerging, more information is needed on what type of singing interventions are being used by credentialed music therapists, and what goal areas are being addressed. To assess music therapists' perceptions on how they use singing and vocal interventions in palliative and cancer care environments. Eighty credentialed music therapists from Canada and the United States participated in this two-part convergent mixed-methods study that began with an online survey, followed by individual interviews with 50% (n = 40) of the survey participants. In both palliative and cancer care, singing client-preferred music and singing for relaxation were the most frequently used interventions. In palliative care, the most commonly addressed goals were to increase self-expression, improve mood, and create a feeling of togetherness between individuals receiving palliative care and their family. In cancer care, the most commonly addressed goals were to support breathing, improve mood, and support reminiscence. Seven themes emerged from therapist interviews: containing the space, connection, soothing, identity, freeing the voice within, letting go, and honoring. Music therapists use singing to address the physical, emotional, social, and spiritual goals of patients, and described singing interventions as accessible and effective. Further research is recommended to examine intervention efficacy and identify factors responsible that contribute to clinical benefit. © the American Music Therapy Association 2017. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  20. ABC-VED analysis of expendable medical stores at a tertiary care hospital.

    Science.gov (United States)

    Kumar, Sushil; Chakravarty, A

    2015-01-01

    The modern system of medicine has evolved into a complex, sophisticated and expensive treatment modality in terms of cost of medicines and consumables. In any hospital, approximately 33% of total annual budget is spent on buying materials and supplies including medicines. ABC (Always, Better Control)-VED (Vital, Essential, Desirable) analysis of medical stores of a large teaching, tertiary care hospital of the Armed Forces was carried out to identify the categories of drugs needing focused managerial control. Annual consumption and expenditure data of expendable medical stores for one year was extracted from the drug expense book, followed by classification on its annual usage value. Subsequently, the factor of criticality was applied to arrive at a decision matrix for understanding the need for selective managerial control. The study revealed that out of 1536 items considered for the study, 6.77% (104), 19.27% (296) and 73.95% (1136) items were found to be A, B and C category items respectively. VED analysis revealed that vital items (V) accounted for 13.14% (201), essential items (E) for 56.37% (866) and desirable accounted for 30.49% items (469). ABC-VED matrix analysis of the inventory reveals that only 322 (21%) items out of an inventory of 1536 drugs belonging to category I will require maximum attention. Scientific inventory management tools need to be applied routinely for efficient management of medical stores, as it contributes to judicious use of limited resources and resultant improvement in patient care.

  1. Incidence and risk factors of ventilator associated pneumonia in a tertiary care hospital.

    Science.gov (United States)

    Charles, Mv Pravin; Easow, Joshy M; Joseph, Noyal M; Ravishankar, M; Kumar, Shailesh; Umadevi, Sivaraman

    2013-01-01

    Ventilator associated pneumonia (VAP) is a type of nosocomial pneumonia associated with increased morbidity and mortality. Knowledge about the incidence and risk factors is necessary to implement preventive measures to reduce mortality in these patients. A prospective study was conducted at a tertiary care teaching hospital for a period of 20 months from November 2009 to July 2011. Patients who were on mechanical ventilation (MV) for more than 48 hours were monitored at frequent intervals for development of VAP using clinical and microbiological criteria until discharge or death. Of the 76 patients, 18 (23.7%) developed VAP during their ICU stay. The incidence of VAP was 53.25 per 1,000 ventilator days. About 94% of VAP cases occurred within the first week of MV. Early-onset and late-onset VAP was observed in 72.2% and 27.8%, respectively. Univariate analysis showed chronic lung failure, H2 blockers usage, and supine head position were significant risk factors for VAP. Logistic regression revealed supine head position as an independent risk factor for VAP. VAP occurred in a sizeable number of patients on MV. Chronic lung failure, H2 blockers usage, and supine head position were the risk factors associated with VAP. Awareness about these risk factors can be used to inform simple and effective preventive measures.

  2. Cost-effectiveness of improving pediatric hospital care in Nicaragua.

    Science.gov (United States)

    Broughton, Edward I; Gomez, Ivonne; Nuñez, Oscar; Wong, Yudy

    2011-11-01

    To determine the costs and cost-effectiveness of an intervention to improve quality of care for children with diarrhea or pneumonia in 14 hospitals in Nicaragua, based on expenditure data and impact measures. Hospital length of stay (LOS) and deaths were abstracted from a random sample of 1294 clinical records completed at seven of the 14 participating hospitals before the intervention (2003) and 1505 records completed after two years of intervention implementation ("post-intervention"; 2006). Disability-adjusted life years (DALYs) were derived from outcome data. Hospitalization costs were calculated based on hospital and Ministry of Health records and private sector data. Intervention costs came from project accounting records. Decision-tree analysis was used to calculate incremental cost-effectiveness. Average LOS decreased from 3.87 and 4.23 days pre-intervention to 3.55 and 3.94 days post-intervention for diarrhea (P = 0.078) and pneumonia (P = 0.055), respectively. Case fatalities decreased from 45/10 000 and 34/10 000 pre-intervention to 30/10 000 and 27/10 000 post-intervention for diarrhea (P = 0.062) and pneumonia (P = 0.37), respectively. Average total hospitalization and antibiotic costs for both diagnoses were US$ 451 (95% credibility interval [CI]: US$ 419-US$ 482) pre-intervention and US$ 437 (95% CI: US$ 402-US$ 464) post-intervention. The intervention was cost-saving in terms of DALYs (95% CI: -US$ 522- US$ 32 per DALY averted) and cost US$ 21 per hospital day averted (95% CI: -US$ 45- US$ 204). After two years of intervention implementation, LOS and deaths for diarrhea decreased, along with LOS for pneumonia, with no increase in hospitalization costs. If these changes were entirely attributable to the intervention, it would be cost-saving.

  3. The development of hospitalbased palliative care services in public hospitals in the Western Cape South Africa

    Directory of Open Access Journals (Sweden)

    L Gwyther

    2018-02-01

    Full Text Available With the recent approval of a South African (SA National Policy Framework and Strategy for Palliative Care by the National Health Council, it is pertinent to reflect on initiatives to develop palliative care services in public hospitals. This article reviews the development of hospital-based palliative care services in the Western Cape, SA. Palliative care services in SA started in the non-governmental sector in the 1980s. The first SA hospital-based palliative care team was established in Charlotte Maxeke Johannesburg Academic Hospital in 2001. The awareness of the benefit of palliative care in the hospital setting led to the development of isolated pockets of excellence providing palliative care in the public health sector in SA. This article describes models for palliative care at tertiary, provincial and district hospital level, which could inform development of hospital-based palliative care as the national policy for palliative care is implemented in SA.

  4. Care adjustments for people with learning disabilities in hospitals.

    Science.gov (United States)

    Blair, Jim

    2011-12-01

    Health inequalities start early in life for people with learning disabilities. In the UK, they can arise from various barriers that people experience when trying to access care that should be appropriate, timely and effective. Inequalities in health care are likely to result in many NHS organisations breaching their legal responsibilities, as outlined in the Disability Discrimination Acts 1995 and 2005, the Equality Act 2010 and the Mental Capacity Act 2005 (Emerson and Baines 2010). This article seeks to help nurses, healthcare professionals and hospital managers ensure that better services are delivered by encouraging them to explore how reasonable adjustments can improve outcomes for people with learning disabilities.

  5. Basic nursing care to prevent nonventilator hospital-acquired pneumonia.

    Science.gov (United States)

    Quinn, Barbara; Baker, Dian L; Cohen, Shannon; Stewart, Jennifer L; Lima, Christine A; Parise, Carol

    2014-01-01

    Nonventilator hospital-acquired pneumonia (NV-HAP) is an underreported and unstudied disease, with potential for measurable outcomes, fiscal savings, and improvement in quality of life. The purpose of our study was to (a) identify the incidence of NV-HAP in a convenience sample of U.S. hospitals and (b) determine the effectiveness of reliably delivered basic oral nursing care in reducing NV-HAP. A descriptive, quasi-experimental study using retrospective comparative outcomes to determine (a) the incidence of NV-HAP and (b) the effectiveness of enhanced basic oral nursing care versus usual care to prevent NV-HAP after introduction of a basic oral nursing care initiative. We used the International Statistical Classification of Diseases and Related Problems (ICD-9) codes for pneumonia not present on admission and verified NV-HAP diagnosis using the U.S. Centers for Disease Control and Prevention diagnostic criteria. We completed an evidence-based gap analysis and designed a site-specific oral care initiative designed to reduce NV-HAP. The intervention process was guided by the Influencer Model (see Figure) and participatory action research. We found a substantial amount of unreported NV-HAP. After we initiated our oral care protocols, the rate of NV-HAP per 100 patient days decreased from 0.49 to 0.3 (38.8%). The overall number of cases of NV-HAP was reduced by 37% during the 12-month intervention period. The avoidance of NV-HAP cases resulted in an estimated 8 lives saved, $1.72 million cost avoided, and 500 extra hospital days averted. The extra cost for therapeutic oral care equipment was $117,600 during the 12-month intervention period. Cost savings resulting from avoided NV-HAP was $1.72 million. Return on investment for the organization was $1.6 million in avoided costs. NV-HAP should be elevated to the same level of concern, attention, and effort as prevention of ventilator-associated pneumonia in hospitals. Nursing needs to lead the way in the design and

  6. [The characteristics of medical technologies in emergency medical care hospital].

    Science.gov (United States)

    Murakhovskiĭ, A G; Babenko, A I; Bravve, Iu I; Tataurova, E A

    2013-01-01

    The article analyzes the implementation of major 12 diagnostic and 17 treatment technologies applied during medical care of patients with 12 key nosology forms of diseases in departments of the emergency medical care hospital No 2 of Omsk. It is established that key groups of technologies in the implementation of diagnostic process are the laboratory clinical diagnostic analyses and common diagnostic activities at reception into hospital and corresponding departments. The percentage of this kind of activities is about 78.3% of all diagnostic technologies. During the realization of treatment process the priority technologies are common curative and rehabilitation activities, intensive therapy activities and clinical diagnostic monitoring activities. All of them consist 80.1% of all curative technologies.

  7. Hospital-at-home Integrated Care Program for Older Patients With Orthopedic Processes: An Efficient Alternative to Usual Hospital-Based Care.

    Science.gov (United States)

    Closa, Conxita; Mas, Miquel À; Santaeugènia, Sebastià J; Inzitari, Marco; Ribera, Aida; Gallofré, Miquel

    2017-09-01

    To compare outcomes and costs for patients with orthogeriatric conditions in a home-based integrated care program versus conventional hospital-based care. Quasi-experimental longitudinal study. An acute care hospital, an intermediate care hospital, and the community of an urban area in the North of Barcelona, in Southern Europe. In a 2-year period, we recruited 367 older patients attended at an orthopedic/traumatology unit in an acute hospital for fractures and/or arthroplasty. Patients were referred to a hospital-at-home integrated care unit or to standard hospital-based postacute orthogeriatric unit, based on their social support and availability of the resource. We compared home-based care versus hospital-based care for Relative Functional Gain (gain/loss of function measured by the Barthel Index), mean direct costs, and potential savings in terms of reduction of stay in the acute care hospital. No differences were found in Relative Functional Gain, median (Q25-Q75) = 0.92 (0.64-1.09) in the home-based group versus 0.93 (0.59-1) in the hospital-based group, P =.333. Total health service direct cost [mean (standard deviation)] was significantly lower for patients receiving home-based care: €7120 (3381) versus €12,149 (6322), P home-based care [10.1 (7)] than in patients discharged to the postacute orthogeriatric hospital-based unit [15.3 (12) days, P home integrated care program was suitable for managing older patients with orthopedic conditions who have good social support for home care. It provided clinical care comparable to the hospital-based model, and it seems to enable earlier acute hospital discharge and lower direct costs. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  8. Nurses' medication administration practices at two Singaporean acute care hospitals.

    Science.gov (United States)

    Choo, Janet; Johnston, Linda; Manias, Elizabeth

    2013-03-01

    This study examined registered nurses' overall compliance with accepted medication administration procedures, and explored the distractions they faced during medication administration at two acute care hospitals in Singapore. A total of 140 registered nurses, 70 from each hospital, participated in the study. At both hospitals, nurses were distracted by personnel, such as physicians, radiographers, patients not under their care, and telephone calls, during medication rounds. Deviations from accepted medication procedures were observed. At one hospital, the use of a vest during medication administration alone was not effective in avoiding distractions during medication administration. Environmental factors and distractions can impact on the safe administration of medications, because they not only impair nurses' level of concentration, but also add to their work pressure. Attention should be placed on eliminating distractions through the use of appropriate strategies. Strategies that could be considered include the conduct of education sessions with health professionals and patients about the importance of not interrupting nurses while they are administering medications, and changes in work design. © 2013 Wiley Publishing Asia Pty Ltd.

  9. The evaluation of primary care unit of Mahasarakham Hospital.

    Science.gov (United States)

    Asavatanabodee, Paibool

    2010-02-01

    To evaluate the one-year performance outcome of Community Medical Care Unit (CMU) in Mahasarakham Hospital. This cross-sectional descriptive study used the CIPP model. The target population was divided into two groups. The first group consisted of the executive committee of Mahasarakham Hospital including one director, five Vice-directors, and 16 CMU paramedical personnel and public health administrators. The second group consisted of 281 randomized people in the service area of CMU, Mahasarakham Hospital. The overall outcome evaluation of both groups was high with mean of 3.53 and 3.86, respectively. The evaluation of context, input, and output was ranked high in both groups while the process ranking was moderate in the first group and high in the other group. The present study proposed that project guidelines be explicit policies, improvement in behavioral service, appropriate workload, adequate parking lot, and network sharing of hospital data bank. The quality and efficiency of CMU project are dependent upon explicit policy, well-planned structure of organization, efficient-informative systems, good development plan, and adequate manpower. The personnel should plan the project process and continuously improve the system. CMU project would be neither successful nor beneficial for the development ofpublic health care system if it lacked the participation of the people in the community and associated networks. The results of the present study might be the useful data for improving and developing the pattern of community healthcare service in urban area.

  10. The Great Recession in Portugal: impact on hospital care use.

    Science.gov (United States)

    Perelman, Julian; Felix, Sónia; Santana, Rui

    2015-03-01

    The Great Recession started in Portugal in 2009, coupled with severe austerity. This study examines its impact on hospital care utilization, interpreted as caused by demand-side effects (related to variations in population income and health) and supply-side effects (related to hospitals' tighter budgets and reduced capacity). The database included all in-patient stays at all Portuguese NHS hospitals over the 2001-2012 period (n=17.7 millions). We analyzed changes in discharge rates, casemix index, and length of stay (LOS), using a before-after methodology. We additionally measured the association of health care indicators to unemployment. A 3.2% higher rate of discharges was observed after 2009. Urgent stays increased by 2.5%, while elective in-patient stays decreased by 1.4% after 2011. The LOS was 2.8% shorter after the crisis onset, essentially driven by the 4.5% decrease among non-elective stays. A one percentage point increase in unemployment rate was associated to a 0.4% increase in total volume, a 2.3% decrease in day cases, and a 0.1% decrease in LOS. The increase in total and urgent cases may reflect delayed out-patient care and health deterioration; the reduced volume of elective stays possibly signal a reduced capacity; finally, the shorter stays may indicate either efficiency-enhancing measures or reduced quality. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

  11. Discussion on the environmental protection acceptance method and the critical issues of the completion of projects about radiation usage in the hospitals

    International Nuclear Information System (INIS)

    Wang Wei

    2014-01-01

    It is widely used in the world that the hospitals take advantages of radiation technology. Practically it is involved radioactive isotope, sealed source and the usage of ray device. Based on the environmental protection acceptance of the finished projects, this article is aimed at the actual characteristics of the medical practice and differentiating the major factors of environmental effects, choosing the monitoring criteria and method of environmental protection acceptance and exploring the critical issues in the course of acceptance. Finally this essay is intended to provide theory evidence and technical support in the acceptance of the above projects. (author)

  12. Use of antibacterial agents in an intensive care unit in a hospital in Brazil.

    Science.gov (United States)

    dos Santos, E F; Lauria-Pires, L; Pereira, M G; Silva, A E; Rodrigues, I P; Maia, M O

    2007-06-01

    It is essential to monitor the utilisation of antibacterial drugs in order to establish appropriate measures for their control. The pattern of usage of antibacterial drugs, and its association with indicators of hospital infection, has been investigated in a non-specialized adult intensive care unit (ICU) located in Santa Luzia Hospital (Brasília, DF, Brazil). The study was conducted between January 2001 and June 2004. Data concerning the utilisation of systemic antibacterial drugs, classified according to the Anatomical Therapeutic Chemical/Defined Daily Dose (ATC/DDD) system, and indicators of hospital infection, defined according to the National Nosocomial Infections Surveillance (NNIS) system, were obtained from appropriate hospital archives. During the study period, the average utilisation of antibacterial drugs was 1918.5 DDD units per 1000 patient-day (DDD(1000)). The three most used drugs were penicillins/beta-lactamase inhibitors (535.3 DDD(1000)), third generation cephalosporins (239.1 DDD(1000)) and quinolones (212.5 DDD(1000)). The total utilisation of antibacterial drugs was correlated significantly with the incidence of hospital infection (R = 0.62; p < 0.01) and the index of invasive procedures (R = 0.41; p < 0.01). Furthermore, the latter two indicators were significantly and positively correlated with the use of recently commercialized, broad spectrum antibacterial drugs (except for carbapenems). It is concluded that improved infection control procedures, together with more rigorous criteria regarding the use of invasive procedures, should be implemented by the ICU studied in order to diminish the utilisation of antibacterial drugs.

  13. How to Manage Hospital-Based Palliative Care Teams Without Full-Time Palliative Care Physicians in Designated Cancer Care Hospitals: A Qualitative Study.

    Science.gov (United States)

    Sakashita, Akihiro; Kishino, Megumi; Nakazawa, Yoko; Yotani, Nobuyuki; Yamaguchi, Takashi; Kizawa, Yoshiyuki

    2016-07-01

    To clarify how highly active hospital palliative care teams can provide efficient and effective care regardless of the lack of full-time palliative care physicians. Semistructured focus group interviews were conducted, and content analysis was performed. A total of 7 physicians and 6 nurses participated. We extracted 209 codes from the transcripts and organized them into 3 themes and 21 categories, which were classified as follows: (1) tips for managing palliative care teams efficiently and effectively (7 categories); (2) ways of acquiring specialist palliative care expertise (9 categories); and (3) ways of treating symptoms that are difficult to alleviate (5 categories). The findings of this study can be used as a nautical chart of hospital-based palliative care team (HPCT) without full-time PC physician. Full-time nurses who have high management and coordination abilities play a central role in resource-limited HPCTs. © The Author(s) 2015.

  14. Development of a hospital-based care coordination program for children with special health care needs.

    Science.gov (United States)

    Petitgout, Janine M; Pelzer, Daniel E; McConkey, Stacy A; Hanrahan, Kirsten

    2013-01-01

    A hospital-based Continuity of Care program for children with special health care needs is described. A family-centered team approach provides care coordination and a medical home. The program has grown during the past 10 years to include inpatients and outpatients from multiple services and outreach clinics. Improved outcomes, including decreased length of stay, decreased cost, and high family satisfaction, are demonstrated by participants in the program. Pediatric nurse practitioners play an important role in the medical home, collaborating with primary care providers, hospital-based specialists, community services, and social workers to provide services to children with special health care needs. Copyright © 2013 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

  15. [The hospital perspective: disease management and integrated health care].

    Science.gov (United States)

    Schrappe, Matthias

    2003-06-01

    Disease Management is a transsectoral, population-based form of health care, which addresses groups of patients with particular clinical entities and risk factors. It refers both to an evidence-based knowledge base and corresponding guidelines, evaluates outcome as a continuous quality improvement process and usually includes active participation of patients. In Germany, the implementation of disease management is associated with financial transactions for risk adjustment between health care assurances [para. 137 f, Book V of Social Code (SGB V)] and represents the second kind of transsectoral care, besides a program designed as integrated health care according to para. 140 a ff f of Book V of Social Code. While in the USA and other countries disease management programs are made available by several institutions involved in health care, in Germany these programs are offered by health care insurers. Assessment of disease management from the hospital perspective will have to consider three questions: How large is the risk to compensate inadequate quality in outpatient care? Are there synergies in internal organisational development? Can the risk of inadequate funding of the global "integrated" budget be tolerated? Transsectoral quality assurance by valid performance indicators and implementation of a quality improvement process are essential. Internal organisational changes can be supported, particularly in the case of DRG introduction. The economic risk and financial output depends on the kind of disease being focussed by the disease management program. In assessing the underlying scientific evidence of their cost effectiveness, societal costs will have to be precisely differentiated from hospital-associated costs.

  16. Data mining usage in health care management: literature survey and decision tree application

    Directory of Open Access Journals (Sweden)

    Dijana Ćosić

    2008-02-01

    Full Text Available Aim To show the benefits of data mining in health care management.In this example, we are going to show a way to raise awarenessof women in terms of contraceptive methods they use (do notuse.Methods Goal of the data mining analysis was to determine ifthere are common characteristics of the women according to theirchoice of contraception (typical classification problem. Therefore,we decided to use decision trees. We have generated a CHAIDmodel in “Statistica”, based on the database that was formed as aresult of an Indonesian research that was conducted in 1987. Thesample contains married women who were either not pregnant ordid not know if they were pregnant at the time of the interview.The database consists of 1473 cases. Also, an extensive internetsearch was conducted in order to detect a number of articles citedin scientific databases published on the subject of data mining inhealth care management.Results It has shown that the most important variable in case ofwomen’s choice of contraceptive methods is – a husband’s profession.Also we retrieved 221 articles published on the application ofdata mining in health care.Conclusion The goal of the paper is achieved in two ways: first,retrieving 221 articles published on the subject we have proved thebenefits of data mining in the health care management. Second,the decision tree method is successfully applied in explanation ofwomen’s choice of contraceptive methods.

  17. Caring for the new uninsured: Hospital charity care for older people without coverage.

    Science.gov (United States)

    DeLia, Derek

    2006-12-01

    Despite near-universal coverage through Medicare, a number of elderly residents in the United States do not have health insurance coverage. To the author's knowledge, this study is the first to document trends in the use of hospital charity care by uninsured older people. Data from the New Jersey Charity Care Program, which subsidizes hospitals for services provided to low-income uninsured people, were used to analyze trends in charity care utilization by older people from 1999 to 2004. Charity care charges are standardized to uniform Medicaid reimbursement rates and inflation adjusted using the Medical Care Consumer Price Index. From 1999 to 2004, use of charity care by older people grew much faster than it did for younger patients. As a result, older people now account for a greater share of hospital charity care in New Jersey than children. Elderly users of charity care generated higher costs per patient than their younger counterparts. Cost differences were especially salient at the upper end of the distribution, where high-cost elderly patients used significantly more resources than high-cost patients in other age groups. These results highlight an emerging source of strain on the healthcare safety net and point to a growing population of uninsured residents who have costly and complex medical needs. Similar experiences are likely to be found in other states, especially those that have growing populations of elderly immigrants who are likely to lack health insurance.

  18. Development and usage of wiki-based software for point-of-care emergency medical information.

    Science.gov (United States)

    Donaldson, Ross I; Ostermayer, Daniel G; Banuelos, Rosa; Singh, Manpreet

    2016-11-01

    To describe the creation and evaluate the usage of the first medical wiki linked to dedicated mobile applications. With the support of multiple current and past contributors, we developed an emergency medicine wiki linked to offline mobile applications (WikEM) in 2009. First deployment was at the Harbor-UCLA Medical Center emergency medicine residency program, with the wiki later opened to public use. To evaluate the project, we performed a post hoc analysis of system use and surveyed 8 years of current and past residents. Outcomes included website and application analytics, as well as survey analysis by composite response categories. Over the 6-year period of this project, the wiki grew to over 7250 pages and 45 500 edits. The website receives more than 85 000 user sessions per month, with over 150 million page views to date. There have been over 200 000 installs of the mobile applications, progressing to produce over 5000 mobile sessions daily. Of potential survey respondents, 87.7% (107) completed the Internet-based survey. Among those who contributed to the wiki, 74.6% reported that it benefited their understanding of core emergency medicine content. Of program graduates, the vast majority reported use of the wiki as a resource after residency (93.8%) along with improvement in clinical efficiency (89.7%). Residents reported higher use and a more favorable opinion of wiki usefulness compared to graduates (P mobile applications is beneficial for resident education and useful in post-residency clinical practice. © The Author 2016. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  19. Patterns of Health Care Usage in the Year Before Suicide: A Population-Based Case-Control Study.

    Science.gov (United States)

    Chock, Megan M; Bommersbach, Tanner J; Geske, Jennifer L; Bostwick, J Michael

    2015-11-01

    To compare the type and frequency of health care visits in the year before suicide between decedents and controls. Cases (n=86) were Olmsted County, Minnesota, residents whose death certificates listed "suicide" as the cause of death from January 1, 2000, through December 31, 2009. Each case had 3 age- and sex-matched controls (n=258). Demographic, diagnostic, and health care usage data were abstracted from medical records. Conditional logistic regression was used to analyze differences in the likelihood of having had psychiatric and nonpsychiatric visits in the year before death, as well as in visit types and frequencies 12 months, 6 months, and 4 weeks before death. Cases and controls did not significantly differ in having had any health care exposure (P=.18). Suicide decedents, however, had a significantly higher number of total visits in the 12 months, 6 months, and 4 weeks before death (all P<.001), were more likely to have carried psychiatric diagnoses in the previous year (odds ratio [OR], 8.08; 95% CI, 4.31-15.17; P<.001), and were more likely to have had outpatient and inpatient mental health visits (OR, 1.24; 95% CI, 1.05-1.47; P=.01 and OR 6.76; 95% CI, 1.39-32.96; P=.02, respectively). Only cases had had emergency department mental health visits; no control did. Given that suicide decedents did not differ from controls in having had any health care exposure in the year before death, the fact alone that decedents saw a doctor provides no useful information about risk. Compared with controls, however, decedents had more visits of all types including psychiatric ones. Higher frequencies of health care contacts were associated with elevated suicide risk. Copyright © 2015 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

  20. Hospital competition, resource allocation and quality of care

    Directory of Open Access Journals (Sweden)

    Zwanziger Jack

    2002-05-01

    Full Text Available Abstract Background A variety of approaches have been used to contain escalating hospital costs. One approach is intensifying price competition. The increase in price based competition, which changes the incentives hospitals face, coupled with the fact that consumers can more easily evaluate the quality of hotel services compared with the quality of clinical care, may lead hospitals to allocate more resources into hotel rather than clinical services. Methods To test this hypothesis we studied hospitals in California in 1982 and 1989, comparing resource allocations prior to and following selective contracting, a period during which the focus of competition changed from quality to price. We estimated the relationship between clinical outcomes, measured as risk-adjusted-mortality rates, and resources. Results In 1989, higher competition was associated with lower clinical expenditures levels compared with 1982. The trend was stronger for non-profit hospitals. Lower clinical resource use was associated with worse risk adjusted mortality outcomes. Conclusions This study raises concerns that cost reductions may be associated with increased mortality.

  1. Projected lifetime risks and hospital care expenditure for traumatic injury.

    Science.gov (United States)

    Chang, David C; Anderson, Jamie E; Kobayashi, Leslie; Coimbra, Raul; Bickler, Stephen W

    2012-08-01

    The lifetime risk and expected cost of trauma care would be valuable for health policy planners, but this information is currently unavailable. The cumulative incidence rates methodology, based on a cross-sectional population analysis, offers an alternative approach to prohibitively costly prospective cohort studies. Retrospective analysis of the California Office of Statewide Health Planning and Development (OSHPD) database was performed for 2008. Trauma admissions were identified by ICD-9 primary diagnosis codes 800-959, with certain exclusions. Cumulative incidence rates were calculated as the cumulative summation of incidence risks sequentially across age groups. A total of 2.2 million admissions were identified, with mean age of 63.8 y, 49.6% men, 82.8% Whites, 5.7% Blacks, 11.3% Hispanics, and 3.1% Asians. The cumulative incidence rate for patients older than age 85 y was 1119 per 10,000 people, with the majority of risk in the elderly, compared with 24,325 per 10,000 people for all-cause hospitalizations. The rates were 946 for men, 1079 for women, 999 for non-Hispanic Whites, 568 for Blacks, 577 for Hispanics, and 395 for Asians, per 10,000 population. The cumulative expected hospital charge was $6538, compared with $81,257 for all-cause hospitalizations. The cumulative lifetime risk of trauma/injury requiring hospitalization for a person living to age 85 y in California is 11.2%, accounting for 4.6% of expected lifetime hospitalizations, but accounting for 8.0% of expected lifetime hospital expenditures. Risk of trauma is significant in the elderly. The total expenditure for all trauma hospitalizations in California was $7.62 billion in 2008. Copyright © 2012 Elsevier Inc. All rights reserved.

  2. An intervention to improve care and reduce costs for high-risk patients with frequent hospital admissions: a pilot study

    Directory of Open Access Journals (Sweden)

    Kostrowski Shannon

    2011-10-01

    Full Text Available Abstract Background A small percentage of high-risk patients accounts for a large proportion of Medicaid spending in the United States, which has become an urgent policy issue. Our objective was to pilot a novel patient-centered intervention for high-risk patients with frequent hospital admissions to determine its potential to improve care and reduce costs. Methods Community and hospital-based care management and coordination intervention with pre-post analysis of health care utilization. We enrolled Medicaid fee-for-service patients aged 18-64 who were admitted to an urban public hospital and identified as being at high risk for hospital readmission by a validated predictive algorithm. Enrolled patients were evaluated using qualitative and quantitative interview techniques to identify needs such as transportation to/advocacy during medical appointments, mental health/substance use treatment, and home visits. A community housing partner initiated housing applications in-hospital for homeless patients. Care managers facilitated appropriate discharge plans then worked closely with patients in the community using a harm reduction approach. Results Nineteen patients were enrolled; all were male, 18/19 were substance users, and 17/19 were homeless. Patients had a total of 64 inpatient admissions in the 12 months before the intervention, versus 40 in the following 12 months, a 37.5% reduction. Most patients (73.3% had fewer inpatient admissions in the year after the intervention compared to the prior year. Overall ED visits also decreased after study enrollment, while outpatient clinic visits increased. Yearly study hospital Medicaid reimbursements fell an average of $16,383 per patient. Conclusions A pilot intervention for high-cost patients shows promising results for health services usage. We are currently expanding our model to serve more patients at additional hospitals to see if the pilot's success can be replicated. Trial registration

  3. The long term importance of English primary care groups for integration in primary health care and deinstitutionalisation of hospital care.

    Science.gov (United States)

    Goodwin, N

    2001-01-01

    This article reviews the impact of successive experiments in the development of primary care organisations in England and assesses the long-term importance of English primary care groups for the integration of health and community and health and social care and the deinstitutionalisation of hospital care. Governments in a number of Western countries are attempting to improve the efficiency, appropriateness and equity of their health systems. One of the main ways of doing this is to devolve provision and commissioning responsibility from national and regional organisations to more local agencies based in primary care. Such primary care organisations are allocated budgets that span both primary and secondary (hospital) services and also, potentially, social care. This article is based on a systematic review of the literature forthcoming from the UK Government's Department of Health-funded evaluations of successive primary care organisational developments. These include total purchasing pilots, GP commissioning group pilots, personal medical services pilots and primary care groups and trusts. Primary care organisations in England have proved to be a catalyst in facilitating the development of integrated care working between primary and community health services. Conversely, primary care organisations have proved less effective in promoting integration between health and social care agencies where most progress has been made at the strategic commissioning level. The development of primary care trusts in England is heralding an end to traditional community hospitals. The development of primary care groups in England are but an intermediate step of a policy progression towards future primary care-based organisations that will functionally integrate primary and community health services with local authority services under a single management umbrella.

  4. The long term importance of English primary care groups for integration in primary health care and deinstitutionalisation of hospital care

    Directory of Open Access Journals (Sweden)

    Nick Goodwin

    2001-03-01

    Full Text Available Purpose: This article reviews the impact of successive experiments in the development of primary care organisations in England and assesses the long-term importance of English primary care groups for the integration of health and community and health and social care and the deinstitutionalisation of hospital care. Theory: Governments in a number of Western countries are attempting to improve the efficiency, appropriateness and equity of their health systems. One of the main ways of doing this is to devolve provision and commissioning responsibility from national and regional organisations to more local agencies based in primary care. Such primary care organisations are allocated budgets that span both primary and secondary (hospital services and also, potentially, social care. Method: This article is based on a systematic review of the literature forthcoming from the UK Government's Department of Health-funded evaluations of successive primary care organisational developments. These include total purchasing pilots, GP commissioning group pilots, personal medical services pilots and primary care groups and trusts. Results: Primary care organisations in England have proved to be a catalyst in facilitating the development of integrated care working between primary and community health services. Conversely, primary care organisations have proved less effective in promoting integration between health and social care agencies where most progress has been made at the strategic commissioning level. The development of primary care trusts in England is heralding an end to traditional community hospitals. Conclusions: The development of primary care groups in England are but an intermediate step of a policy progression towards future primary care-based organisations that will functionally integrate primary and community health services with local authority services under a single management umbrella.

  5. To provide care and be cared for in a multiple-bed hospital room.

    Science.gov (United States)

    Persson, Eva; Määttä, Sylvia

    2012-12-01

    To illuminate patients' experiences of being cared for and nurses' experiences of caring for patients in a multiple-bed hospital room. Many patients and healthcare personnel seem to prefer single-bed hospital rooms. However, certain advantages of multiple-bed hospital rooms (MBRs) have also been described. Eight men and eight women being cared for in a multiple-bedroom were interviewed, and two focus-group interviews (FGI) with 12 nurses were performed. A qualitative content analysis was used. One theme--Creating a sphere of privacy--and three categories were identified based on the patient interviews. The categories were: Being considerate, Having company and The patients' area. In the FGI, one theme--Integrating individual care with care for all--and two categories emerged: Experiencing a friendly atmosphere and Providing exigent care. Both patients and nurses described the advantages and disadvantages of multiple-bed rooms. The patient culture of taking care of one another and enjoying the company of room-mates were considered positive and gave a sense of security of both patients and nurses. The advantages were slight and could easily become disadvantages if, for example, room-mates were very ill or confused. The patients tried to maintain their privacy and dignity and claimed that there were small problems with room-mates listening to conversations. In contrast, the nurses stressed patient integrity as a main disadvantage and worked to protect the integrity of individual patients. Providing care for all patients simultaneously had the advantage of saving time. The insights gained in the present study could assist nurses in reducing the disadvantages and taking advantage of the positive elements of providing care in MBRs. Health professionals need to be aware of how attitudes towards male and female patients, respectively, could affect care provision. © 2012 The Authors. Scandinavian Journal of Caring Sciences © 2012 Nordic College of Caring Science.

  6. Health care expenditure for hospital-based delivery care in Lao PDR

    Directory of Open Access Journals (Sweden)

    Douangvichit Daovieng

    2012-01-01

    Full Text Available Abstract Background Delivery by a skilled birth attendant (SBA in a hospital is advocated to improve maternal health; however, hospital expenses for delivery care services are a concern for women and their families, particularly for women who pay out-of-pocket. Although health insurance is now implemented in Lao PDR, it is not universal throughout the country. The objectives of this study are to estimate the total health care expenses for vaginal delivery and caesarean section, to determine the association between health insurance and family income with health care expenditure and assess the effect of health insurance from the perspectives of the women and the skilled birth attendants (SBAs in Lao PDR. Methods A cross-sectional study was carried out in two provincial hospitals in Lao PDR, from June to October 2010. Face to face interviews of 581 women who gave birth in hospital and 27 SBAs was carried out. Both medical and non-medical expenses were considered. A linear regression model was used to assess influencing factors on health care expenditure and trends of medical and non-medical expenditure by monthly family income stratified by mode of delivery were assessed. Results Of 581 women, 25% had health care insurance. Health care expenses for delivery care services were significantly higher for caesarean section (270 USD than for vaginal delivery (59 USD. After adjusting for the effect of hospital, family income was significantly associated with all types of expenditure in caesarean section, while it was associated with non-medical and total expenditures in vaginal delivery. Both delivering women and health providers thought that health insurance increased the utilisation of delivery care. Conclusions Substantially higher delivery care expenses were incurred for caesarean section compared to vaginal delivery. Three-fourths of the women who were not insured needed to be responsible for their own health care payment. Women who had higher family

  7. Using mHealth to Improve Usage of Antenatal Care, Postnatal Care, and Immunization: A Systematic Review of the Literature

    OpenAIRE

    Watterson, Jessica L.; Walsh, Julia; Madeka, Isheeta

    2015-01-01

    Mobile health (mHealth) technologies have been implemented in many low- and middle-income countries to address challenges in maternal and child health. Many of these technologies attempt to influence patients', caretakers', or health workers' behavior. The purpose of this study was to conduct a systematic review of the literature to determine what evidence exists for the effectiveness of mHealth tools to increase the coverage and use of antenatal care (ANC), postnatal care (PNC), and childhoo...

  8. Concerns about usage of smartphones in operating room and critical care scenario.

    Science.gov (United States)

    Attri, J P; Khetarpal, R; Chatrath, V; Kaur, J

    2016-01-01

    Smartphones and tablets have taken a central place in the lives of health care professionals. Their use has dramatically improved the communication and has become an important learning tool as the medical information can be assessed online at anytime. In critical care settings, use of smartphone facilitates quick passage of information through E-mail messaging and getting feedback from the concerned physician quickly, thereby reducing medical errors. However, in addition to the benefits offered, these devices have become a significant source of nosocomial infections, distraction for medical professionals and interfere with medical equipments. They may also put privacy and security of patients at stake. The benefits could be severely undermined if abuse and over use are not kept in check. This review article focuses on various applications of smartphones in healthcare practices, drawback of the use of these devices and the recommendations regarding the safe use of these devices.

  9. Concerns about usage of smartphones in operating room and critical care scenario

    Directory of Open Access Journals (Sweden)

    J P Attri

    2016-01-01

    Full Text Available Smartphones and tablets have taken a central place in the lives of health care professionals. Their use has dramatically improved the communication and has become an important learning tool as the medical information can be assessed online at anytime. In critical care settings, use of smartphone facilitates quick passage of information through E-mail messaging and getting feedback from the concerned physician quickly, thereby reducing medical errors. However, in addition to the benefits offered, these devices have become a significant source of nosocomial infections, distraction for medical professionals and interfere with medical equipments. They may also put privacy and security of patients at stake. The benefits could be severely undermined if abuse and over use are not kept in check. This review article focuses on various applications of smartphones in healthcare practices, drawback of the use of these devices and the recommendations regarding the safe use of these devices.

  10. Perceptions of mothers and hospital staff of paediatric care in 13 public hospitals in northern Tanzania

    DEFF Research Database (Denmark)

    Mwangi, Rose; Chandler, Clare; Nasuwa, Fortunata

    2008-01-01

    User and provider perceptions of quality of care are likely to affect both use and provision of services. However, little is known about how health workers and mothers perceive the delivery of care in hospital paediatric wards in Africa. Paediatric staff and mothers of paediatric inpatients were...... interviewed to explore their opinions and experience of the admission process and conditions on the ward. Overcrowding, unsanitary conditions and lack of food were major concerns for mothers on the ward, who were deterred from seeking treatment earlier due to fears that hospital admission posed a significant...... risk of exposure to infection. While most staff were seen as being sympathetic and supportive to mothers, a minority were reported to be judgemental and authoritarian. Health workers identified lack of trained staff, overwork and low pay as major concerns. Staff shortages, lack of effective training...

  11. Occupational Blood Exposure among Health Care Personnel and Hospital Trainees

    Directory of Open Access Journals (Sweden)

    M Hajjaji Darouiche

    2014-01-01

    Full Text Available Blood and body fluid Exposure is a major occupational safety problems for health care workers. Therefore, we conducted a descriptive and retrospective study to identify the characteristics of blood exposure accidents in health care settings which lasted five years (2005-2009 at the two university hospitals of Sfax. We have 593 blood exposure accidents in health care settings 152 (25.6% health personnel and 441 (74.4% trainees' doctors, nurses and health technicians. The mechanism of blood and body fluid exposure was accidental needle-stick injury in 78.9% of health staff, and 81% of trainees, accidental cut in 14.7% of health workers and 10.2% of trainees. The increasing severity of blood exposure accidents is linked to the lack of safe behavior against this risk.

  12. Hospital care for persons with AIDS in European-Union countries; a cross-country comparison

    NARCIS (Netherlands)

    Postma, Maarten; Kornarou, H; Paparizos, V; Leidl, R M; Tolley, K; Kyriopoulos, J; Jager, Johannes C

    This paper compares AIDS hospital care in several European-Union countries. For this purpose hospital-care utilisation studies on inpatient days and outpatient contacts were analysed in a generic approach controlling for severity stages of AIDS. Lifetime hospital-care needs for AIDS are derived,

  13. Medicare managed care plan performance: a comparison across hospitalization types.

    Science.gov (United States)

    Basu, Jayasree; Mobley, Lee Rivers

    2012-01-01

    The study evaluates the performance of Medicare managed care (Medicare Advantage [MA]) Plans in comparison to Medicare fee-for-service (FFS) Plans in three states with historically high Medicare managed care penetration (New York, California, Florida), in terms of lowering the risks of preventable or ambulatory care sensitive conditions (ACSC) hospital admissions and providing increased referrals for admissions for specialty procedures. Using 2004 hospital discharge files from the Healthcare Cost and Utilization Project (HCUP-SID) of the Agency for Healthcare Research and Quality, ACSC admissions are compared with 'marker' admissions and 'referral-sensitive' admissions, using a multinomial logistic regression approach. The year 2004 represents a strategic time to test the impact of MA on preventable hospitalizations, because the HMOs dominated the market composition in that time period. MA enrollees in California experienced 22% lower relative risk (RRR= 0.78, p<0.01), those in Florida experienced 16% lower relative risk (RRR= 0.84, p<0.01), while those in New York experienced 9% lower relative risk (RRR=0.91, p<0.01) of preventable (versus marker) admissions compared to their FFS counterparts. MA enrollees in New York experienced 37% higher relative risk (RRR=1.37, p<0.01) and those in Florida had 41% higher relative risk (RRR=1.41, p<0.01)-while MA enrollees in California had 13% lower relative risk (RRR=0.87, p<0.01)-of referral-sensitive (versus marker) admissions compared to their FFS counterparts. While MA plans were associated with reductions in preventable hospitalizations in all three states, the effects on referral-sensitive admissions varied, with California experiencing lower relative risk of referral-sensitive admissions for MA plan enrollees. The lower relative risk of preventable admissions for MA plan enrollees in New York and Florida became more pronounced after accounting for selection bias.

  14. Developing a typology of mobile phone usage in social care: A critical review of the literature.

    Science.gov (United States)

    Saltiel, David; Steels, Stephanie; Fenney, Deborah

    2017-07-31

    The ways in which mobile phones have transformed the boundaries of time and space and the possibilities of communication have profoundly affected our lives. However, there is little research on the use of mobiles in social care though evidence is emerging that mobile phones can play an important role in delivering services. This paper is based on a scoping review of the international literature in this area. A typology of mobile interventions is suggested. While most mobile phone interventions remain unidirectional and sit within traditional social care service provider-service user relationships, a minority are bi- or multidirectional and contain within them the potential to transform these traditional relationships by facilitating a collective development of social networks and social capital. Such transformations are accompanied by a range of issues and dilemmas that have made many service providers reluctant to engage with new technologies. We suggest that our typology is a useful model to draw on when researching the use of mobile phones in social care to support and empower isolated, marginalised and vulnerable service users. © 2017 John Wiley & Sons Ltd.

  15. Patient referral patterns and the spread of hospital-acquired infections through national health care networks.

    Directory of Open Access Journals (Sweden)

    Tjibbe Donker

    2010-03-01

    Full Text Available Rates of hospital-acquired infections, such as methicillin-resistant Staphylococcus aureus (MRSA, are increasingly used as quality indicators for hospital hygiene. Alternatively, these rates may vary between hospitals, because hospitals differ in admission and referral of potentially colonized patients. We assessed if different referral patterns between hospitals in health care networks can influence rates of hospital-acquired infections like MRSA. We used the Dutch medical registration of 2004 to measure the connectedness between hospitals. This allowed us to reconstruct the network of hospitals in the Netherlands. We used mathematical models to assess the effect of different patient referral patterns on the potential spread of hospital-acquired infections between hospitals, and between categories of hospitals (University medical centers, top clinical hospitals and general hospitals. University hospitals have a higher number of shared patients than teaching or general hospitals, and are therefore more likely to be among the first to receive colonized patients. Moreover, as the network is directional towards university hospitals, they have a higher prevalence, even when infection control measures are equally effective in all hospitals. Patient referral patterns have a profound effect on the spread of health care-associated infections like hospital-acquired MRSA. The MRSA prevalence therefore differs between hospitals with the position of each hospital within the health care network. Any comparison of MRSA rates between hospitals, as a benchmark for hospital hygiene, should therefore take the position of a hospital within the network into account.

  16. Improving sexual health for HIV patients by providing a combination of integrated public health and hospital care services; a one-group pre- and post test intervention comparison

    Directory of Open Access Journals (Sweden)

    Dukers-Muijrers Nicole HTM

    2012-12-01

    Full Text Available Abstract Background Hospital HIV care and public sexual health care (a Sexual Health Care Centre services were integrated to provide sexual health counselling and sexually transmitted infections (STIs testing and treatment (sexual health care to larger numbers of HIV patients. Services, need and usage were assessed using a patient perspective, which is a key factor for the success of service integration. Methods The study design was a one-group pre-test and post-test comparison of 447 HIV-infected heterosexual individuals and men who have sex with men (MSM attending a hospital-based HIV centre serving the southern region of the Netherlands. The intervention offered comprehensive sexual health care using an integrated care approach. The main outcomes were intervention uptake, patients’ pre-test care needs (n=254, and quality rating. Results Pre intervention, 43% of the patients wanted to discuss sexual health (51% MSM; 30% heterosexuals. Of these patients, 12% to 35% reported regular coverage, and up to 25% never discussed sexual health topics at their HIV care visits. Of the patients, 24% used our intervention. Usage was higher among patients who previously expressed a need to discuss sexual health. Most patients who used the integrated services were new users of public health services. STIs were detected in 13% of MSM and in none of the heterosexuals. The quality of care was rated good. Conclusions The HIV patients in our study generally considered sexual health important, but the regular counselling and testing at the HIV care visit was insufficient. The integration of public health and hospital services benefited both care sectors and their patients by addressing sexual health questions, detecting STIs, and conducting partner notification. Successful sexual health care uptake requires increased awareness among patients about their care options as well as a cultural shift among care providers.

  17. Promoting accountability: hospital charity care in California, Washington state, and Texas.

    Science.gov (United States)

    Sutton, Janet P; Stensland, Jeffrey

    2004-05-01

    Debate as to whether private hospitals meet their charitable obligations is heated. This study examines how alternative state approaches for ensuring hospital accountability to the community affects charitable expenditures and potentially affects access to care for the uninsured. Descriptive and multivariate analyses were used to compare private California hospitals' charity care expenditures with those of hospitals in Texas and Washington state. The key finding from this study is that net of hospital characteristics, market characteristics and community need, Texas hospitals were estimated to provide over 3 times more charity care and Washington hospitals were estimated to provide 66% more charity care than California hospitals. This finding suggests that more prescriptive community benefit or charity care requirements may be necessary to ensure that private hospitals assume a larger role in the care of the uninsured.

  18. [Treatment of eating disorders during hospitalization: presentation of a hospital intensive care program in pediatric age].

    Science.gov (United States)

    D'Argenio, L; Zaccagnino, M; Donati, C; Perini, A; Fazzi, E

    2013-04-01

    The aim of this study was to present a hospital intensive care program for patients affected by a severe eating disorders, with a significant loss of weight (BMI110 bpm or inability to sustain core body temperature), abnormal laboratory data, especially electrolyte imbalance and refusal to take food and fluids. In our study we reported 2 year follow-up of 16 patients treated with the hospital intensive care program between 2007 and 2008 in our department. The proposed program was proved an efficient method in a critical phase of the alimentary behavior disorders. It was possible for all the patients to avoid alternative feeding techniques (enteral or parenteral) and to obtain a correct alimentation with a satisfactory improvement of clinical conditions. Eight patients (50%) fully recovered. 5 patients (31.25%) had a significant improvement reaching a BMI>18.5 and one of them had a regular menstrual cycle, too. However in this group of patients a strict modality to alimentation and concern about weight and physical appearance remain. In 3 patients (18.5%) the BMI is still low and amenorrhea persists. The hospital intensive care program, inspired by the cognitive-behavioral model, through a food rehabilitation and a psychotherapeutic and psychoeducational help, lets the patients and their family understand and modify the dysfunctional patterns, experimenting a right modality to approach alimentation, with a satisfactory improvement in clinical conditions.

  19. Risks predicting prolonged hospital discharge boarding in a regional acute care hospital.

    Science.gov (United States)

    Shaikh, Sajid A; Robinson, Richard D; Cheeti, Radhika; Rath, Shyamanand; Cowden, Chad D; Rosinia, Frank; Zenarosa, Nestor R; Wang, Hao

    2018-01-30

    management timely consultation, and disposition to discharge dwell time affect boarding and patient flow in a tertiary acute care hospital. Efficiency of the discharge process did not affect patient satisfaction relative to the perceived quality of discharge instruction and follow-up plan explanations. Prolonged disposition to discharge intervals result in unnecessary hospital bed occupancy thereby negatively impacting hospital finances while delivering no direct benefit to patients.

  20. Trends in bednet ownership and usage, and the effect of bednets on malaria hospitalization in the Kilifi Health and Demographic Surveillance System (KHDSS: 2008–2015

    Directory of Open Access Journals (Sweden)

    Alice Kamau

    2017-11-01

    Full Text Available Abstract Background Use of bednets reduces malaria morbidity and mortality. In Kilifi, Kenya, there was a mass distribution of free nets to children  2500 parasitemia per μl among children < 5 years were captured using a system of continuous vital registration that links admissions at Kilifi County Hospital to the KHDSS population register. Survival analysis was used to assess relative risk of hospitalization with malaria among children that reported using a bednet compared to those who did not. Results We observed 63% and 62% mean bednet ownership and usage, respectively, over the eight-survey period. Among children < 5 years, reported bednet ownership in October–December 2008 was 69% and in March–August 2009 was 73% (p < 0.001. An increase was also observed following the mass distribution campaigns in 2012 (62% in May–July 2012 vs 90% in May–October 2013, p < 0.001 and 2015 (68% in June–September 2015 vs 93% in October–November 2015, p < 0.001. Among children <5 years who reported using a net the night prior to the survey, the incidence of malaria hospitalization per 1000 child-years was 2.91 compared to 4.37 among those who did not (HR = 0.67, 95% CI: 0.52, 0.85 [p = 0.001]. Conclusion On longitudinal surveillance, increasing bednet ownership and usage corresponded to mass distribution campaigns; however, this method of delivering bednets did not result in sustained improvements in coverage. Among children < 5 years old bednet use was associated with a 33% decreased incidence of malaria hospitalization.

  1. Fall prevention in acute care hospitals: a randomized trial.

    Science.gov (United States)

    Dykes, Patricia C; Carroll, Diane L; Hurley, Ann; Lipsitz, Stuart; Benoit, Angela; Chang, Frank; Meltzer, Seth; Tsurikova, Ruslana; Zuyov, Lyubov; Middleton, Blackford

    2010-11-03

    Falls cause injury and death for persons of all ages, but risk of falls increases markedly with age. Hospitalization further increases risk, yet no evidence exists to support short-stay hospital-based fall prevention strategies to reduce patient falls. To investigate whether a fall prevention tool kit (FPTK) using health information technology (HIT) decreases patient falls in hospitals. Cluster randomized study conducted January 1, 2009, through June 30, 2009, comparing patient fall rates in 4 urban US hospitals in units that received usual care (4 units and 5104 patients) or the intervention (4 units and 5160 patients). The FPTK integrated existing communication and workflow patterns into the HIT application. Based on a valid fall risk assessment scale completed by a nurse, the FPTK software tailored fall prevention interventions to address patients' specific determinants of fall risk. The FPTK produced bed posters composed of brief text with an accompanying icon, patient education handouts, and plans of care, all communicating patient-specific alerts to key stakeholders. The primary outcome was patient falls per 1000 patient-days adjusted for site and patient care unit. A secondary outcome was fall-related injuries. During the 6-month intervention period, the number of patients with falls differed between control (n = 87) and intervention (n = 67) units (P=.02). Site-adjusted fall rates were significantly higher in control units (4.18 [95% confidence interval {CI}, 3.45-5.06] per 1000 patient-days) than in intervention units (3.15 [95% CI, 2.54-3.90] per 1000 patient-days; P = .04). The FPTK was found to be particularly effective with patients aged 65 years or older (adjusted rate difference, 2.08 [95% CI, 0.61-3.56] per 1000 patient-days; P = .003). No significant effect was noted in fall-related injuries. The use of a fall prevention tool kit in hospital units compared with usual care significantly reduced rate of falls. clinicaltrials.gov Identifier: NCT

  2. Out-of-hospital emergency care providers' work and challenges in a changing care environment.

    Science.gov (United States)

    Mikkola, Riitta; Paavilainen, Eija; Salminen-Tuomaala, Mari; Leikkola, Päivi

    2018-03-01

    Acutely ill patients are often treated on site instead of being transported to hospital, so wide-ranging professional competence is required from staff. The aim of this study was to describe and produce new information about out-of-hospital emergency care providers' competence, skills and willingness to engage in self-development activities, and to uncover challenges experienced by care providers in the midst of changing work practices. A quantitative questionnaire was sent to out-of-hospital emergency care providers (N = 142, response rate 53%) of one Finnish hospital district. Data were analysed using spss for Windows 22 software. Almost all respondents found their work interesting and their ability to work independently sufficient. The majority found the work meaningful. Almost 20% felt that work was dominated by constant rush, and 40%, more than half of 25-year-olds but <10% of over 45-years-olds, found the work physically straining. The majority indicated that they had a sufficient theoretical-practical basis to perform their regular duties, and more than one-third felt that they had sufficient skills to deal with multiple patient or disaster situations. Over 20% stated that they were unsure about performing new or infrequent procedures. A number of factors experienced as challenging were revealed. The results provide a basis for improving care providers' initial and further training. © 2017 Nordic College of Caring Science.

  3. From acute care to home care: the evolution of hospital responsibility and rationale for increased vertical integration.

    Science.gov (United States)

    Dilwali, Prashant K

    2013-01-01

    The responsibility of hospitals is changing. Those activities that were once confined within the walls of the medical facility have largely shifted outside them, yet the requirements for hospitals have only grown in scope. With the passage of the Patient Protection and Affordable Care Act (ACA) and the development of accountable care organizations, financial incentives are focused on care coordination, and a hospital's responsibility now includes postdischarge outcomes. As a result, hospitals need to adjust their business model to accommodate their increased need to impact post-acute care settings. A home care service line can fulfill this role for hospitals, serving as an effective conduit to the postdischarge realm-serving as both a potential profit center and a risk mitigation offering. An alliance between home care agencies and hospitals can help improve clinical outcomes, provide the necessary care for communities, and establish a potentially profitable product line.

  4. 42 CFR 412.534 - Special payment provisions for long-term care hospitals within hospitals and satellites of long...

    Science.gov (United States)

    2010-10-01

    ... standardized amount— (i) Is adjusted for the applicable hospital inpatient prospective payment system DRG... applicable hospital inpatient prospective payment system DRG weighting factors; (ii) Is adjusted by the... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care...

  5. Prevalence of mobile phones and factors influencing usage by caregivers of young children in daily life and for health care in rural China: a mixed methods study.

    Science.gov (United States)

    van Velthoven, Michelle Helena; Li, Ye; Wang, Wei; Chen, Li; Du, Xiaozhen; Wu, Qiong; Zhang, Yanfeng; Rudan, Igor; Car, Josip

    2015-01-01

    To capitalise on mHealth, we need to understand the use of mobile phones both in daily life and for health care. To assess the prevalence and factors that influence usage of mobile phones by caregivers of young children. A mixed methods approach was used, whereby a survey (N=1854) and semi-structured interviews (N=17) were conducted concurrently. The quantitative and qualitative data obtained were compared and integrated. Participants were caregivers of young children in Zhao County, Hebei Province, China. Four main themes were found: (i) trends in mobile phone ownership; (ii) usage of mobile phone functions; (iii) factors influencing replying to text messages; and (iv) uses of mobile phones for health care. The majority of 1,854 survey participants (1,620; 87.4%) used mobile phones, but usage was much higher among mothers (1,433; 92.6%) and fathers (41; 100.0%) compared to grandparents (142; 54.6%). Parents were able to send text messages, grandparents often not. Factors influencing the decision to reply to text messages in daily life were checking the mobile phone, trusting the sender, emotion or feeling when receiving a text message, the importance of replying and ease of use of text messages. Of 1,620 survey participants who used a mobile phone, about one in four (432; 26.7%) had used it for health care in the past three months and most (1,110; 93.5%) of 1,187 who had not wished to use their phone to receive health information. We found that usage of mobile phones is high, several factors influencing usage and an interest of caregivers to use phones for health care in Zhao County, rural China, which can be used to inform studies in settings with similar characteristics. Future work needs to assess factors influencing mobile phone usage in-depth to optimize experiences of users for specific mHealth-based interventions.

  6. Severe maternal morbidity in Zanzibar's referral hospital: Measuring the impact of in-hospital care.

    Directory of Open Access Journals (Sweden)

    Tanneke Herklots

    Full Text Available to analyse the impact of in-hospital care on severe maternal morbidity using WHO's near-miss approach in the low-resource, high mortality setting of Zanzibar's referral hospital.Mnazi Mmoja Hospital, a tertiary care facility, in Zanzibar, Tanzania.We identified all cases of morbidity and mortality in women admitted within 42 days after the end of pregnancy at Mnazi Mmoja Hospital in the period from April to October 2016. The severity of complications was classified using WHO's near-miss approach definitions: potentially life-threatening condition (PLTC, maternal near-miss (MNM or maternal death (MD. Quality of in-hospital care was assessed using the mortality index (MI defined as ratio between mortality and severe maternal outcome (SMO where SMO = MD + MNM, cause-specific case facility rates and comparison with predicted mortality based on the Maternal Severity Index model.5551 women were included. 569 (10.3% had a potentially life-threatening condition and 65 (1.2% a severe maternal outcome (SMO: 37 maternal near-miss cases and 28 maternal deaths. The mortality index was high at 0.43 and similar for women who developed a SMO within 12 hours of admission and women who developed a SMO after 12 hours. A standardized mortality ratio of 6.03 was found; six times higher than that expected in moderate maternal mortality settings given the same severity of cases. Obstetric haemorrhage was found to be the main cause of SMO. Ruptured uterus and admission to ICU had the highest case-fatality rates. Maternal death cases seemed to have received essential interventions less often.WHO's near-miss approach can be used in this setting. The high mortality index observed shows that in-hospital care is not preventing progression of disease adequately once a severe complication occurs. Almost one in two women experiencing life-threatening complications will die. This is six times higher than in moderate mortality settings.

  7. Nursing Care Systematization: A Study At A Teaching Hospital

    Directory of Open Access Journals (Sweden)

    Louise Passos Vigolvino Macêdo

    2017-03-01

    Full Text Available Objective: Investigate the understanding of nurses who work at a teaching hospital, in relation to NCS and the nursing process; ascertain facilities/difficulties related to the applicability of the nursing process in that service; and verify the opinions of those professionals for the improvement and/or effectiveness of the nursing process at the hospitalization units of the hospital. Method: Exploratory, descriptive study, with a qualitative approach. The sample consisted of 42 nurses who answered a questionnaire. The empirical material was analyzed and categorized based on the content analysis technique and discussed in the light of the literature. Results: From the participants' discourses, two categories of analysis emerged: 1 understanding of NCS as a tool to organize the Nursing work process and improve the quality of care; and 2 applicability of the nursing process at the various hospitalization units of the institution. Conclusion: The implementation and applicability of that method depend on not only the knowledge and motivation of the nursing professionals, but also on a strategic planning involving management and staff, from the recognition of their importance in order to obtain adherence and effective operationalization in practice. Descriptors: Nursing; Nursing Process; Professional Practice.

  8. Inpatient satisfaction and usage patterns of personalized smart bedside station system for patient-centered service at a tertiary university hospital.

    Science.gov (United States)

    Ryu, Borim; Kim, Seok; Lee, Kee-Hyuck; Hwang, Hee; Yoo, Sooyoung

    2016-11-01

    Bedside stations, also known as bedside terminals, are in place to enhance the quality and experience of a hospital's healthcare service delivery. The purpose of this study was to identify information needs and overall satisfaction with the personalized patient bedside system, called Smart Bedside Station (SBS) system, embedded in a tertiary general university hospital. End-user responses on the satisfaction survey and system usage logs of the SBS system were collected and analyzed. For the user opinion survey, 156 nurses and 1914 patients, their family members, or caregivers participated during the evaluation period of 2013 to 2014 in this study. All working nurses in the SBS-installed ward were answered the paper-based evaluation, for complete enumeration survey. Inpatients were voluntary participated to deliver the online questionnaire on the SBS menu. We also explored system log data including page calls and usage time from December 2013 to 2015. Regarding the relationship of overall satisfaction of the SBS with patient's characteristics, patient's education status and degree of familiarity with the smart device were statistically significant. From the analysis of system logs, Personalized My Menu(28.0%) was the most frequently used menu item (except for TV and Internet entertainment service use of 62.7%),it provides individual health information, such as laboratory test results, hospital fee check, message logs, daily medication information, and meal information. Next frequently used menus were information support(4.9%) which deliver hospital guide and health information and convenience service ordering(4.4%) such as meal order, bed sheet change. Satisfaction survey results and log data results show that the personalized service enhances the user satisfaction during hospital admission. Our post-implementation experience and subsequent assessment of SBS system is capable of providing insights into improving the hospital information system and service contents

  9. Time to standardise levels of care amongst Out-of-Hospital Emergency Care providers in Africa

    OpenAIRE

    Mould-Millman, N.K.; Stein, C.; Wallis, L.A.

    2016-01-01

    The African Federation for Emergency Medicine’s Out-of-Hospital Emergency Care (OHEC) Committee convened 15 experts from various OHEC systems in Africa to participate in a consensus process to define levels of care within which providers in African OHEC systems should safely and effectively function. The expert panel concluded that four provider levels were relevant for African OHEC systems: (i) first aid, (ii) basic life support, (iii) intermediate life support, and (iv) advanced life suppor...

  10. Using mHealth to Improve Usage of Antenatal Care, Postnatal Care, and Immunization: A Systematic Review of the Literature.

    Science.gov (United States)

    Watterson, Jessica L; Walsh, Julia; Madeka, Isheeta

    2015-01-01

    Mobile health (mHealth) technologies have been implemented in many low- and middle-income countries to address challenges in maternal and child health. Many of these technologies attempt to influence patients', caretakers', or health workers' behavior. The purpose of this study was to conduct a systematic review of the literature to determine what evidence exists for the effectiveness of mHealth tools to increase the coverage and use of antenatal care (ANC), postnatal care (PNC), and childhood immunizations through behavior change in low- and middle-income countries. The full text of 53 articles was reviewed and 10 articles were identified that met all inclusion criteria. The majority of studies used text or voice message reminders to influence patient behavior change (80%, n = 8) and most were conducted in African countries (80%, n = 8). All studies showed at least some evidence of effectiveness at changing behavior to improve antenatal care attendance, postnatal care attendance, or childhood immunization rates. However, many of the studies were observational and further rigorous evaluation of mHealth programs is needed in a broader variety of settings.

  11. Using mHealth to Improve Usage of Antenatal Care, Postnatal Care, and Immunization: A Systematic Review of the Literature

    Directory of Open Access Journals (Sweden)

    Jessica L. Watterson

    2015-01-01

    Full Text Available Mobile health (mHealth technologies have been implemented in many low- and middle-income countries to address challenges in maternal and child health. Many of these technologies attempt to influence patients’, caretakers’, or health workers’ behavior. The purpose of this study was to conduct a systematic review of the literature to determine what evidence exists for the effectiveness of mHealth tools to increase the coverage and use of antenatal care (ANC, postnatal care (PNC, and childhood immunizations through behavior change in low- and middle-income countries. The full text of 53 articles was reviewed and 10 articles were identified that met all inclusion criteria. The majority of studies used text or voice message reminders to influence patient behavior change (80%, n=8 and most were conducted in African countries (80%, n=8. All studies showed at least some evidence of effectiveness at changing behavior to improve antenatal care attendance, postnatal care attendance, or childhood immunization rates. However, many of the studies were observational and further rigorous evaluation of mHealth programs is needed in a broader variety of settings.

  12. Care control and collaborative working in a prison hospital.

    Science.gov (United States)

    Foster, John; Bell, Linda; Jayasinghe, Neil

    2013-03-01

    This paper reports findings from a qualitative research project, using interviews, focus groups and participant observations, which sought to investigate "good practice" in a nurse-led prison hospital wing for male prisoners. The study raised issues about tensions between "caring" and "control" of prisoners from the perspectives of professionals working or visiting the wing. This paper discusses collaborative working between professionals from different backgrounds, including nurses and healthcare (prison) officers who were based on the wing and others who visited such as probation, medical, Inreach team or Counselling Advice, Referral, Assessment and Through Care team staff (CARAT). The key finding was that there is a balance between therapy and security/risk. In order to maintain this, the two main groups based on the hospital wing--nurses and prison officers--moved between at times cooperating, coordinating and collaborating with each other to maintain this balance. Other themes were care and control, team working, individual and professional responsibilities and communication issues. Enhancing the role of nurses should be encouraged so that therapy remains paramount, and we conclude with some recommendations to encourage collaborative working in prison healthcare settings to ensure that therapy continues to be paramount while security and safety are maintained.

  13. Becoming Food Aware in Hospital: A Narrative Review to Advance the Culture of Nutrition Care in Hospitals

    OpenAIRE

    Laur, Celia; McCullough, James; Davidson, Bridget; Keller, Heather

    2015-01-01

    The Nutrition Care in Canadian Hospitals (2010–2013) study identified the prevalence of malnutrition on admission to medical and surgical wards as 45%. Nutrition practices in the eighteen hospitals, including diagnosis, treatment and monitoring of malnourished patients, were ad hoc. This lack of a systematic approach has demonstrated the need for the development of improved processes and knowledge translation of practices aimed to advance the culture of nutrition care in hospitals. A narrativ...

  14. Moving Towards the Age-friendly Hospital: A Paradigm Shift for the Hospital-based Care of the Elderly.

    Science.gov (United States)

    Huang, Allen R; Larente, Nadine; Morais, Jose A

    2011-12-01

    Care of the older adult in the acute care hospital is becoming more challenging. Patients 65 years and older account for 35% of hospital discharges and 45% of hospital days. Up to one-third of the hospitalized frail elderly loses independent functioning in one or more activities of daily living as a result of the 'hostile environment' that is present in the acute hospitals. A critical deficit of health care workers with expertise and experience in the care of the elderly also jeopardizes successful care delivery in the acute hospital setting. We propose a paradigm shift in the culture and practice of event-driven acute hospital-based care of the elderly which we call the Age-friendly Hospital concept. Guiding principles include: a favourable physical environment; zero tolerance for ageism throughout the organization; an integrated process to develop comprehensive services using the geriatric approach; assistance with appropriateness decision-making and fostering links between the hospital and the community. Our current proposed strategy is to focus on delirium management as a hospital-wide condition that both requires and highlights the Geriatric Medicine specialist as an expert of content, for program development and of evaluation. The Age-friendly Hospital concept we propose may lead the way to enable hospitals in the fast-moving health care system to deliver high-quality care without jeopardizing risk-benefit, function, and quality of life balances for the frail elderly. Recruitment and retention of skilled health care professionals would benefit from this positive 'branding' of an institution. Convincing hospital management and managing change are significant challenges, especially with competing priorities in a fiscal environment with limited funding. The implementation of a hospital-wide delirium management program is an example of an intervention that embodies many of the principles in the Age-friendly Hospital concept. It is important to change the way

  15. Nursing care documentation practice: The unfinished task of nursing care in the University of Gondar Hospital.

    Science.gov (United States)

    Kebede, Mihiretu; Endris, Yesuf; Zegeye, Desalegn Tegabu

    2017-09-01

    Even though nursing care documentation is an important part of nursing practice, it is commonly left undone. The objective of this study was to assess nursing care documentation practice and the associated factors among nurses who are working at the University of Gondar Hospital. An institution-based cross-sectional study was conducted among 220 nurses working at the University of Gondar Hospital inpatient wards from March 20 to April 30, 2014. Data were collected using a structured and pre-tested self-administered questionnaire. Data were entered into Epi Info version 7 and analyzed with SPSS version 20. Descriptive statistics, bivariate, and multivariate logistic regression analyses were carried out. Two hundred and six nurses returned the questionnaire. Good nursing care documentation practice among nurses was 37.4%. A low nurse-to-patient ratio AOR = 2.15 (95%CI [1.155, 4.020]), in-service training on standard nursing process AOR = 2.6 (95%CI[1.326, 5.052]), good knowledge AOR = 2.156(95% CI [1.092, 4.254]), and good attitude toward nursing care documentation AOR = 2.22 (95% CI [1.105, 4.471] were significantly associated with nursing care documentation practice. Most of the nursing care provided remains undocumented. Nurse-to-patient ratio, in-service training, knowledge, and attitude of nurses toward nursing care documentation were factors associated with nursing care documentation practice.

  16. Influence of a non-hospital medical care facility on antimicrobial resistance in wastewater.

    Directory of Open Access Journals (Sweden)

    Mathias Bäumlisberger

    Full Text Available The global widespread use of antimicrobials and accompanying increase in resistant bacterial strains is of major public health concern. Wastewater systems and wastewater treatment plants are considered a niche for antibiotic resistance genes (ARGs, with diverse microbial communities facilitating ARG transfer via mobile genetic element (MGE. In contrast to hospital sewage, wastewater from other health care facilities is still poorly investigated. At the instance of a nursing home located in south-west Germany, in the present study, shotgun metagenomics was used to investigate the impact on wastewater of samples collected up- and down-stream in different seasons. Microbial composition, ARGs and MGEs were analyzed using different annotation approaches with various databases, including Antibiotic Resistance Ontologies (ARO, integrons and plasmids. Our analysis identified seasonal differences in microbial communities and abundance of ARG and MGE between samples from different seasons. However, no obvious differences were detected between up- and downstream samples. The results suggest that, in contrast to hospitals, sewage from the nursing home does not have a major impact on ARG or MGE in wastewater, presumably due to much less intense antimicrobial usage. Possible limitations of metagenomic studies using high-throughput sequencing for detection of genes that seemingly confer antibiotic resistance are discussed.

  17. Optimizing antibiotic usage in adults admitted with fever by a multifaceted intervention in an Indonesian governmental hospital.

    NARCIS (Netherlands)

    Hadi, U.; Keuter, M.; Asten, H.A.G.H. van; Broek, P. van den

    2008-01-01

    OBJECTIVE: To optimize antimicrobial treatment of patients with fever upon admission to the department of internal medicine of Dr Soetomo Hospital in Surabaya, Indonesia. METHOD: Prospective intervention study. The intervention comprised development of a consensus guideline, an official declaration

  18. A Novel Information Retrieval Tool to Find Hospital Care Team Members: Development and Usability Study.

    Science.gov (United States)

    Morawski, Kyle; Monsen, Craig; Takhar, Sukhjit; Landman, Adam

    2018-04-16

    Hospital communication among members of a patient's care team is a central part of clinical workflow and consumes a large amount of a health care provider's time. Oftentimes the complexity of hospital care leads to difficulty in finding the appropriate contact, which can lead to inefficiencies and frustration. Squire is a Web-based information retrieval app created to improve the speed and efficiency in reaching the appropriate team member during the care of a hospitalized patient. The objective of the study was to design and develop Squire and to evaluate the usage, usability, and perceived effect of the app on finding the correct contact within a hospital. We used a mixed-methods design using a before-after survey methodology combined with one-on-one interviews to understand the perceived effect of Squire. The study took place at an academic medical center with internal medicine resident physicians. We surveyed residents on demographics, as well as time and efficiency of hospital communication before and after the use of Squire. After using Squire, participants were also asked to evaluate Squire's Net Promoter Score (NPS). A subset of voluntary participants participated in one-on-one interviews and completed the System Usability Scale (SUS). We performed descriptive statistics on participant characteristics, app usage data, and responses to surveys. Survey results were compared before and after Squire adoption using the Wilcoxon rank-sum test and a general linear model. Interview data were analyzed using content analysis with a qualitative description approach to review and categorize feedback from participants. There was a 67.9% (74/109) response rate to the pre-Squire survey and 89.9% (98/109) response rate to the post-Squire survey. At baseline, there was an average of 22.2 (95% CI 18.4-26.0) minutes/day spent searching for the right contact, and this decreased to 16.3 (95% CI 13.9-18.7) minutes/day after Squire was launched (P=.01). There were favorable

  19. Examining financial performance indicators for acute care hospitals.

    Science.gov (United States)

    Burkhardt, Jeffrey H; Wheeler, John R C

    2013-01-01

    Measuring financial performance in acute care hospitals is a challenge for those who work daily with financial information. Because of the many ways to measure financial performance, financial managers and researchers must decide which measures are most appropriate. The difficulty is compounded for the non-finance person. The purpose of this article is to clarify key financial concepts and describe the most common measures of financial performance so that researchers and managers alike may understand what is being measured by various financial ratios.

  20. Neurologic continuum of care: Evidence-based model of a post-hospital system of care.

    Science.gov (United States)

    Lewis, Frank D; Horn, Gordon J

    2015-01-01

    There is increasing need for a well-organized continuum of post-hospital rehabilitative care to reduce long term disability resulting from acquired brain injury. This study examined the effectiveness of four levels of post-hospital care (active neurorehabilitation, neurobehavioral intensive, day treatment, and supported living) and the functional variables most important to their success. Participants were 1276 adults with acquired brain injury who were being treated in one of the four program levels. A Repeated Measures MANOVA was used to evaluate change from admission to discharge on the Mayo Portland Adaptability Inventory-4 T-scores. Regression analyses were used to identify predictors of outcome. Statistical improvement on the MPAI-4 was observed at each program level. Self-care and Initiation were the strongest predictors of outcome. The results support the effectiveness of a continuum of care for acquired brain injury individuals beyond hospitalization and acute in-hospital rehabilitation. It is particularly noteworthy that reduction in disability was achieved for all levels of programming even with participants whose onset to admission exceeded 7 years post-injury.

  1. Anaerobic antibiotic usage for pneumonia in the medical intensive care unit.

    Science.gov (United States)

    Kioka, Mutsumi J; DiGiovine, Bruno; Rezik, Mohamed; Jennings, Jeffrey H

    2017-11-01

    Pneumonia is a common admitting diagnosis in the intensive care unit (ICU). When aspiration is suspected, antibiotics to cover anaerobes are frequently used, but in the absence of clear risk factors, current guidelines have questioned their role. It is unknown how frequently these guidelines are followed. We conducted a single-centre observational study on practice patterns of anaerobic antibiotic use in consecutive patients admitted to the ICU with aspiration pneumonia (Asp), community-acquired pneumonia (CAP) and healthcare-associated pneumonia (HCAP). A total of 192 patients were studied (Asp: 20, HCAP: 107, CAP: 65). Overall, 59 patients received anaerobic antibiotics (Asp: 90%, HCAP: 28%, CAP 17%) but a significant proportion of these patients did not meet criteria to receive them. Inappropriate anaerobic antibiotic use was 12/20 for Asp, 27/107 for HCAP and 9/65 for CAP. Mortality probability model III at zero hours (MPM0) score and a diagnosis of Asp were predictors of receiving inappropriate anaerobic antibiotics. Receiving inappropriate anaerobic antibiotics was associated with a longer ICU length of stay (LOS; 7 days (interquartile range (IQR): 7-21) vs 4 days (IQR:2-9), P = 0.017). For patients in the ICU admitted with pneumonia, there is a high occurrence of inappropriately prescribed anaerobic antibiotics, the use of which was associated with a longer ICU LOS. © 2017 Asian Pacific Society of Respirology.

  2. Information vs advertising in the market for hospital care.

    Science.gov (United States)

    Montefiori, Marcello

    2008-09-01

    Recent health care reforms have introduced prospective payments and have allowed patients to choose their preferred providers. The expected outcome is efficiency in production and an increase in the quality level. The former objective should be obtained by the prospective payment scheme; the latter by the demand mechanism, through the competition between providers. Unfortunately, because of asymmetry of information, patients are unable to observe the true quality and the demand for health care services depends on a perceived quality as influenced by the hospital advertising. Inefficiency in the resource allocation and social welfare loss are the two likely effects. In this paper we show how the purchaser can implement effective policies to overcome these undesired effects.

  3. Annual survey on the level and extent of usage of electronic health records in government-related hospitals in Eastern Province, Saudi Arabia.

    Science.gov (United States)

    Bah, Sulaiman; Alharthi, Hana; El Mahalli, Azza Ali; Jabali, Abdelkaream; Al-Qahtani, Mona; Al-kahtani, Nouf

    2011-01-01

    This study aims to determine the level and extent of usage of electronic health records (EHRs) in government-related hospitals in Eastern Province, Saudi Arabia. Another aim is to develop a Web site to serve as a forum of exchange on the development of EHRs in Saudi Arabia. All government hospitals (n = 19) in the province were included. The information technology (IT) managers in those hospitals made up the target population. An online questionnaire was developed, and the IT managers in all 19 government hospitals were invited to participate in the survey. The responses from the online survey were downloaded and analyzed using descriptive statistics. Of the 19 hospitals, only three (15.8 percent) use EHRs. These hospitals were established in 1984, 1995, and 2005. All three of these hospitals have implemented the same EHR software and were using it successfully, and all three were using the three core features of laboratory, radiology, and pharmacy electronic modules. Some modules were present in the EHR system but were underutilized. Some of the main challenges faced by the IT managers in implementing EHRs in their hospitals were related to the uncooperative attitudes of some physicians and nurses toward EHRs. In fulfillment of the second aim of the study, a Web site, http://ehr2011.weebly.com, was developed to serve as a forum for exchange of information on the development of EHRs in Saudi Arabia. The government of Saudi Arabia has prioritized the development of eHealth (health information technology) and allocated committed funding for it during 2008-2011. During this period, some sectors of government made highly commendable efforts in developing eHealth services. Along these lines, we had hoped to see higher uptake of EHRs than the 15.8 percent found in this study. The rate of implementing EHRs in government hospitals should be accelerated. The aim should be on achieving some basic EHR functionality in these hospitals, and once this has been achieved

  4. Long-term acute care hospitals and Georgia Medicaid: Utilization, outcomes, and cost

    Directory of Open Access Journals (Sweden)

    Evan S. Cole

    2016-09-01

    Full Text Available Objectives: Because most research on long-term acute care hospitals has focused on Medicare, the objective of this research is to describe the Georgia Medicaid population who received care at a long-term acute care hospital, the type and volume of services provided by these long-term acute care hospitals, and the costs and outcomes of these services. For those with select respiratory conditions, we descriptively compare costs and outcomes to those of patients who received care for the same services in acute care hospitals. Methods: We describe Georgia Medicaid recipients admitted to a long-term acute care hospital between 2011 and 2012. We compare them to a population of Georgia Medicaid recipients admitted to an acute care hospital for one of five respiratory diagnosis-related groups. Measurements used include patient descriptive information, admissions, diagnosis-related groups, length of stay, place of discharge, 90-day episode costs, readmissions, and patient risk scores. Results: We found that long-term acute care hospital admissions for Medicaid patients were fairly low (470 90-day episodes and restricted to complex cases. We also found that the majority of long-term acute care hospital patients were blind or disabled (71.2%. Compared to patients who stayed at an acute care hospital, long-term acute care hospital patients had higher average risk scores (13.1 versus 9.0, lengths of stay (61 versus 38 days, costs (US$143,898 versus US$115,056, but fewer discharges to the community (28.4% versus 51.8%. Conclusion: We found that the Medicaid population seeking care at long-term acute care hospitals is markedly different than the Medicare populations described in other long-term acute care hospital studies. In addition, our study revealed that Medicaid patients receiving select respiratory care at a long-term acute care hospital were distinct from Medicaid patients receiving similar care at an acute care hospital. Our findings suggest that

  5. Different usage of the same oncology information system in two hospitals in Sydney--lessons go beyond the initial introduction.

    Science.gov (United States)

    Yu, Ping; Gandhidasan, Senthilkumar; Miller, Alexis A

    2010-06-01

    The experience of clinicians at two public hospitals in Sydney, Australia, with the introduction and use of an oncology information system (OIS) was examined to extract lessons to guide the introduction of clinical information systems in public hospitals. Semi-structured interviews were conducted with 12 of 15 radiation oncologists employed at the two hospitals. The personnel involved in the decision making process for the introduction of the system were contacted and their decision making process revisited. The transcribed data were analyzed using NVIVO software. Themes emerged included implementation strategies and practices, the radiation oncologists' current use and satisfaction with the OIS, project management and the impact of the OIS on clinical practice. The hospitals had contrasting experiences in their introduction and use of the OIS. Hospital A used the OIS in all aspects of clinical documentation. Its implementation was associated with strong advocacy by the Head of Department, input by a designated project manager, and use and development of the system by all staff, with timely training and support. With no vision of developing a paperless information system, Hospital B used the OIS only for booking and patient tracking. A departmental policy that data entry for the OIS was centrally undertaken by administrative staff distanced clinicians from the system. All the clinicians considered that the OIS should continuously evolve to meet changing clinical needs and departmental quality improvement initiatives. This case study indicates that critical factors for the successful introduction of clinical information systems into hospital environment were an initial clear vision to be paperless, strong clinical leadership and management at the departmental level, committed project management, and involvement of all staff, with appropriate training. Clinician engagement is essential for post-adoption evolution of clinical information systems. Copyright 2010

  6. Participation of informal caregivers in the hospital care of elderly patients and their evaluations of the care given: pilot study in three different hospitals.

    Science.gov (United States)

    Laitinen, P

    1992-10-01

    This action research is an ongoing study which will last from 1991 to 1993. The main purpose of the study is to increase the participation of informal caregivers in the hospital care of elderly patients without decreasing the quality of care. The data reported here are from a pilot study. This study had three aims: (a) to test reliability and validity of the measure used, (b) to investigate the current participation of informal caregivers in the hospital care of elderly patients (aged over 75), and (c) to evaluate and compare the quality of care from both the patients' and the informal caregivers' point of view in three different hospitals. The measure of quality of care was developed on the basis of need theories, mainly those of Maslow and Alderfer. Patients and caregivers were also asked to rate the participation of the caregivers in the hospital care of elderly patients. Participation consisted of 18 activities of daily living. The pilot test with 18 elderly hospital patients and seven family members or significant others showed differences between the two groups in perception of care received. Statistically significant differences (P needs, psychic and spiritual needs and totals. The results supported earlier findings that elderly patients are satisfied with and do not criticize their care. The younger generation (i.e. their children) is more demanding and has precise perceptions about the care given. Relatives could be used more in planning, evaluation and even implementation of care; however, their current participation in patient hospital care is minimal.

  7. Impacts of market and organizational characteristics on hospital efficiency and uncompensated care.

    Science.gov (United States)

    Hsieh, Hui-Min; Clement, Dolores G; Bazzoli, Gloria J

    2010-01-01

    Hospitals have confronted a difficult financial environment given many factors, including expansion of managed care, changes in public policy, growing market competition for certain services, and growth in the number of uninsured. Policy makers have expressed concern that hospitals may forgo providing care to the indigent as a means to reduce costs and become more efficient when faced with financial pressures. This article examined the effects of environmental pressures on two dimensions of hospital performance: hospital efficiency and uncompensated care provision. Longitudinal data for the Commonwealth of Virginia from 1998 to 2004 were analyzed. Data Envelopment Analysis and bivariate probit were used to examine the factors associated with efficiency and uncompensated care. The results indicated that a positive relationship between hospital efficiency and uncompensated care provision exists. That is, hospitals that are categorized as efficient are likely to provide more uncompensated care. We also found that hospitals tended to provide more uncompensated care when increased demand for these services occurred in a market. Increases in Medicare or Medicaid patient share reduced the provision of uncompensated care. In relation to hospital efficiency, the results indicated that HMO penetration and Medicaid patient share reduced hospital efficiency. This study found that efficient hospitals tend to provide more uncompensated care over time. The findings also suggest that hospitals alter their efficiency and provision of uncompensated care in response to a number of environmental pressures, but it may depend on the type of pressures or uncertainties encountered.

  8. Differentiating innovation priorities among stakeholder in hospital care.

    Science.gov (United States)

    Lambooij, Mattijs S; Hummel, Marjan J

    2013-08-16

    Decisions to adopt a particular innovation may vary between stakeholders because individual stakeholders may disagree on the costs and benefits involved. This may translate to disagreement between stakeholders on priorities in the implementation process, possibly explaining the slow diffusion of innovations in health care. In this study, we explore the differences in stakeholder preferences for innovations, and quantify the difference in stakeholder priorities regarding costs and benefits. The decision support technique called the analytic hierarchy process was used to quantify the preferences of stakeholders for nine information technology (IT) innovations in hospital care. The selection of the innovations was based on a literature review and expert judgments. Decision criteria related to the costs and benefits of the innovations were defined. These criteria were improvement in efficiency, health gains, satisfaction with care process, and investments required. Stakeholders judged the importance of the decision criteria and subsequently prioritized the selected IT innovations according to their expectations of how well the innovations would perform for these decision criteria. The stakeholder groups (patients, nurses, physicians, managers, health care insurers, and policy makers) had different preference structures for the innovations selected. For instance, self-tests were one of the innovations most preferred by health care insurers and managers, owing to their expected positive impacts on efficiency and health gains. However, physicians, nurses and patients strongly doubted the health gains of self-tests, and accordingly ranked self-tests as the least-preferred innovation. The various stakeholder groups had different expectations of the value of the nine IT innovations. The differences are likely due to perceived stakeholder benefits of each innovation, and less to the costs to individual stakeholder groups. This study provides a first exploratory quantitative

  9. [Support to spiritual needs in hospital care. Integration perspective in modern hospitals].

    Science.gov (United States)

    Proserpio, Tullio; Piccinelli, Claudia; Arice, Carmine; Petrini, Massimo; Mozzanica, Mario; Veneroni, Laura; Clerici, Carlo Alfredo

    2014-01-01

    Within the course of medical care in the most advanced health care settings, an increasing attention is being paid to the so-called care humanization. According to this perspective, we try to integrate the usual care pathways with aspects related to the spiritual and religious dimension of all people and their families, as well as the employees themselves. It is clearly important to establish this kind of practices on the basis of scientific evidences. That is the reason why it's a necessity to improve the knowledge about the importance that spiritual assistance can offer within the current health service. The aim of this work is to show the relevance of the integration of spiritual perspectives in the hospital setting according to a multidisciplinary point of view. In this work many data that emerge from the international scientific literature, as well as the definition that is given to the concept of "spirituality" are analyzed; about this definition in fact there is not unanimous consent even today. It is also analyzed the legal situation in force within the European territory according to the different laws and social realities. Finally, the possible organizational practices related to spiritual support are described and the opportunity to specific accreditation pathways and careful training of chaplains able to integrate traditional religious practices with modern spiritual perspectives is discussed.

  10. Barriers to quality patient care in rural district hospitals

    Directory of Open Access Journals (Sweden)

    Johanna E. Eygelaar

    2012-05-01

    Reliability of the instrument was verified using the Cronbach alpha coefficient and a pilot study. The validity, specifically construct and content validity, were assured by means of an extensive literature review, pilot study and use of experts. Ethics approval was obtained from the relevant stakeholders. Results showed that 272 participants (97% disagreed that provision of staff was adequate, with staff above 40 years of age more likely to disagree (p = <0.01. A statistically significant association was shown between availability of doctors and staff not being able to cope with emergencies (p = <0.01. Most participants (n =212; 76% indicated that they were not receiving continuing education, with the registered nurses more likely to disagree (χ² test, p = 0.02. Participants in both hospital types A (n = 131; 82% and B (n = 108; 91% also disagreed that provision of equipment and consumables was adequate. The research showed that inadequacies relating to human resources, professional development, consumables and equipment influenced the quality of patient care. Urgent attention should be given to the problems identified to ensure quality of patient care in rural hospitals.

  11. Characteristics of zero-absenteeism in hospital care.

    Science.gov (United States)

    Schreuder, J A H; Roelen, C A M; van der Klink, J J L; Groothoff, J W

    2013-06-01

    Literature on sickness presenteeism is emerging, but still little is known about employees who are never absent from work due to injuries or illness. Insight into the determinants and characteristics of such zero-absentees may provide clues for preventing sickness absence. To investigate the characteristics of zero-absentees, defined as employees without sickness absence over a period of 5 years. A mixed-method qualitative study comprising semi-structured interviews and focus groups for which Azjen and Fishbein's theory of planned behaviour was used as a framework. Zero-absentees working in hospital care were invited for semi-structured interviews until saturation was reached. The results of semi-structured interviews were validated in two focus groups. Of 1053 hospital employees, 47 were zero-absentees of whom 31 (66%) agreed to participate in the study. After 16 semi-structured interviews, no new insights or information were gathered from the interviews. The remaining 15 employees were invited to two (n = 8 and n = 7) focus groups. Personal attitudes and self-efficacy were more important in zero-absenteeism than social pressures of managers, colleagues or patients. Zero-absentees were found to be intrinsically motivated to try attending work when ill. In the present study population of hospital employees, we found indications that zero-absenteeism and sickness presenteeism might be different types of work attendance. Managers should realize that zero-absentees are driven by intrinsic motivation rather than social pressures to attend work.

  12. Pattern of drug eruptions in a tertiary care hospital

    International Nuclear Information System (INIS)

    Tahir, Z.; Nadeem, N.; Aman, S.; Kazmi, A.H.

    2013-01-01

    Background: An adverse drug reaction is unintentional which occurs at doses used for prophylaxis, diagnosis or treatment. Objectives: To determine the frequency of various cutaneous drug eruptions that occur in patients in a tertiary care hospital setting. Patients and Methods: All patients with cutaneous drug eruptions seen at the Dermatology Department of Mayo Hospital, Lahore, over 6 months were enrolled and the pattern of drug eruptions like urticaria, angioedema, fixed drug eruption, maculopapular rash, erythema multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis etc. were recorded, along with drugs that caused it. Results:A total of 160 patients (86 males, 74 females) were included in the study. Mean age of patients was 30.7+-15.4 years. Major eruptions were fixed drug eruption (21.3%) followed by urticaria without angioedema (10%), maculopapular rash (9.3%), lichenoid drug eruption (8.7%), acneiform drug eruption (7.5%), Stevens-Johnson syndrome (6.9%), vesiculobullous eruption (5.6%), erythema multiforme and eczematous eruption (5% each). Common drugs causing eruptions were sulfonamides (16.3%), followed by NSAIDs (14.4%), herbal and homeopathic medications (12.5%), penicillins (9.3%), tetracyclines (8.7%), antituberculous drugs, cephalosporins and antiepileptics (6.3% each). Conclusion: Fixed drug eruption and urticaria without angioedema were commonest eruptions while, sulfonamides and NSAIDs were the major causative drugs. Policy message: Reporting of adverse drug reactions is not done in Pakistan and needs to be done in each hospital. (author)

  13. CLINICAL STUDY OF APPENDICULAR PERFORATION IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Venkata Anantha Lakshmi Manabala

    2016-06-01

    Full Text Available INTRODUCTION Acute Appendicitis is the commonest abdominal surgical emergency in young adults all over the world. In early 1900s, Ochsner in Chicago and Sherren at the London Hospital were both advocates of conservative treatment in late cases. Appendicular perforation is a serious complication in view of the ensuing peritonitis with the consequent sequelae and morbidity. AIM To study the incidence, morbidity and sequelae of appendicular perforation. MATERIALS & METHODS This is a prospective study done in our hospital where 110 cases of peritonitis due to appendicular perforation were selected for our study. All the cases where peritonitis was due to appendicular perforation at laparotomy were included. The study period was from January 2014 to December 2015. The cases of peritonitis due to other causes like duodenal, gastric, enteric perforation were excluded. Patients with acute abdominal emergency with clinical diagnosis of peritonitis were examined carefully with detailed history and clinical examination. Necessary investigations were done and patients taken up for emergency surgery. CONCLUSIONS Acute Appendicitis is the commonest abdominal surgical emergency in young adults all over the world. Age incidence of appendicular perforation is maximum in the age group of 21–30 years. Next common age group is 31–40 yrs. Incidence is more in males. Male to female ratio is 2.4:1. Pain abdomen, vomiting, fever and anorexia were common symptoms in all the patients. Majority of the patients came late to the hospital accounting for the cause of perforation and subsequent mortality and morbidity.

  14. Factors and models associated with the amount of hospital care services as demanded by hospitalized patients: a systematic review.

    NARCIS (Netherlands)

    Oostveen, C.J. van; Ubbink, D.T.; Huis in het Veld, J.G.; Bakker, P.J.; Vermeulen, H.

    2014-01-01

    Background: Hospitals are constantly being challenged to provide high-quality care despite ageing populations, diminishing resources, and budgetary restraints. While the costs of care depend on the patients' needs, it is not clear which patient characteristics are associated with the demand for care

  15. Factors and models associated with the amount of hospital care services as demanded by hospitalized patients: a systematic review

    NARCIS (Netherlands)

    van Oostveen, Catharina J.; Ubbink, Dirk T.; Huis In Het Veld, Judith G.; Bakker, Piet J.; Vermeulen, Hester

    2014-01-01

    Hospitals are constantly being challenged to provide high-quality care despite ageing populations, diminishing resources, and budgetary restraints. While the costs of care depend on the patients' needs, it is not clear which patient characteristics are associated with the demand for care and

  16. Goals of care discussions among hospitalized long-term care residents: Predictors and associated outcomes of care.

    Science.gov (United States)

    Wong, Hannah J; Wang, Jamie; Grinman, Michelle; Wu, Robert C

    2016-12-01

    There are limited data on the occurrence, predictors, and impact of goals of care (GOC) discussions during hospitalization for seriously ill elderly patients, particularly for long-term care (LTC) residents. The study was a retrospective chart review of 200 randomly sampled LTC residents hospitalized via the emergency department and admitted to the general internal medicine service of 2 Canadian academic hospitals, from January 2012 through December 2012. We applied logistic regression models to identify factors associated with, and outcomes of, these discussions. Overall, 9.4% (665 of 7084) of hospitalizations were patients from LTC. In the sample of 200 patients, 37.5% had a documented discussion. No baseline patient characteristic was associated with GOC discussions. Low Glasgow Coma Scale, high respiratory rate, and low oxygen saturation were associated with discussions. Patients with discussions had higher rates of orders for no resuscitation (80% vs 55%) and orders for comfort measures only (7% vs 0%). In adjusted analyses, patients with discussions had higher odds of in-hospital death (52.0, 95% confidence interval [CI]: 6.2-440.4) and 1-year mortality (4.1, 95% CI: 1.7-9.6). Nearly 75% of patients with a change in their GOC did not have this documented in the discharge summary. In hospitalized LTC patients, GOC discussions occurred infrequently and appeared to be triggered by illness severity. Orders for advance directives, in-hospital death, and 1-year mortality were associated with discussions. Rates of GOC documentation in the discharge summary were poor. This study provides direction for developing education and practice standards to improve GOC discussion rates and their communication back to LTC. Journal of Hospital Medicine 2015;11:824-831. © 2015 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

  17. Platelet transfusion practice in a tertiary care hospital

    International Nuclear Information System (INIS)

    Rehman, Z.; Alam, M.

    2002-01-01

    Objective: Pakistan is a developing country where platelet concentrates are prepared and administered to patients in only a few large centres of the country. A study was designed for appraisal of the current situation and to review the progress made so far. Design: It was a prospective, non-interventional study. Place and duration of study: The study was conducted at PNS Shifa, Karachi from January, 1995 to December, 1998. Subjects and Methods: During this study 588 random donor platelet concentrates were transfused to 66 patients 148 occasions. Random donor platelet concentrates were prepared by fractionation of whole blood using triple blood collecting bags. Pre-transfusion and one hour posttransfusion platelet counts of the patients were done. The efficacy of the platelet transfusion was monitored by noting the clinical response as well as doing one hour posttransfusion corrected counts increment (CCI).Results: On 114 (77%) occasions platelets were transfused prophylactically and 34 (23%) times therapeutically to stop major bleeding episodes. The mean pre-transfusion platelet count varied from 15.5 x 10/sup 9/1 to 28.5 x 10/sup 9/l in different clinical conditions. On average, 4 random donor platelet concentrates were administered on each occasion. The best response was observed in patients of aplastic anaemia and worst in cases of disseminated intravascular coagulation (DIC). Conclusion: Platelet concentrates administration was inappropriate in significant number of patients, therefore, each hospital should form transfusion committee to review transfusion practices guidelines for blood components usage and compliance to these guidelines by the clinicians. (author)

  18. Pediatric Surgical Care in a Dutch Military Hospital in Afghanistan.

    Science.gov (United States)

    Idenburg, Floris J; van Dongen, Thijs T C F; Tan, Edward C T H; Hamming, Jaap H; Leenen, Luke P H; Hoencamp, Rigo

    2015-10-01

    From August 2006-August 2010, as part of the ISAF mission, the Armed Forces of the Netherlands deployed a role 2 enhanced Medical Treatment Facility (R2E-MTF) to Uruzgan province, Afghanistan. Although from the principle doctrine not considered a primary task, care was delivered to civilians, including many children. Humanitarian aid accounted for a substantial part of the workload, necessitating medical, infrastructural, and logistical adaptations. Particularly pediatric care demanded specific expertise and equipment. In our pre-deployment preparations this aspect had been undervalued. Because these experiences could be influential in future mission planning, we analyzed our data and compared them with international reports. This is a retrospective, descriptive study. Using the hospital's electronic database, all pediatric cases, defined as patients Afghanistan were analyzed. Of the 2736 admissions, 415 (15.2 %) were pediatric. The majority (80.9 %, 336/415) of these admissions were for surgical, often trauma-related, pathology and required 610 surgical procedures, being 26 % of all procedures. Mean length of stay was 3.1 days. The male to female ratio was 70:30. Girls were significantly younger of age than boys. In-hospital mortality was 5.3 %. Pediatric patients made up a considerable part of the workload at the Dutch R2E-MTF in Uruzgan, Afghanistan. This is in line with other reports from the recent conflicts in Iraq and Afghanistan, but used definitions in reported series are inconsistent, making comparisons difficult. Our findings stress the need for a comprehensive, prospective, and coalition-wide patient registry with uniformly applied criteria. Civilian disaster and military operational planners should incorporate reported patient statistics in manning documents, future courses, training manuals, logistic planning, and doctrines, because pediatric care is a reality that cannot be ignored.

  19. Case Study: Evidence-Based Interventions Enhancing Diabetic Foot Care Behaviors among Hospitalized DM Patients

    Directory of Open Access Journals (Sweden)

    Titis Kurniawan

    2011-01-01

    Full Text Available Background: Improving diabetic patients’ foot care behaviors is one of the most effective strategies in minimizing diabetic foot ulceration and its further negative impacts, either in diabetic hospitalized patients or outpatients.Purpose: To describe foot care knowledge and behaviors among hospitalized diabetic patients, to apply selected foot care knowledge and behaviors improvement evidence, and to evaluate its effectiveness.Method: Four diabetic patients who were under our care for at least three days and could communicate in Thai language were selected from a surgical ward in a university hospital. The authors applied educational program based on patients’ learning needs, provided diabetic foot care leaflet, and assisted patients to set their goal and action plans. In the third day of treatment, we evaluated patients’ foot care knowledge and their goal and action plan statements in improving foot care behaviors.Result: Based on the data collected among four hospitalized diabetic patients, it was shown that all patients needed foot care behaviors improvement and the educational program improved hospitalized patients’ foot care knowledge and their perceived foot care behaviors. The educational program that combined with goal setting and action plans method was easy, safe, and seemed feasibly applicable for diabetic hospitalized patients.Conclusion: The results of this study provide valuable information for improvement of hospitalized diabetic patients’ foot care knowledge and behaviors. The authors recommend nurses to use this evidence-based practice to contribute in improving the quality of diabetic care.Keywords: Intervention, diabetic foot care, hospitalized diabetic patients

  20. In California, not-for-profit hospitals spent more operating expenses on charity care than for-profit hospitals spent.

    Science.gov (United States)

    Valdovinos, Erica; Le, Sidney; Hsia, Renee Y

    2015-08-01

    In exchange for sizable tax exemptions, not-for-profit hospitals must engage in activities that meet the Internal Revenue Service's community benefit standard. The provision of charity care-free care to those unable to pay-can help meet that standard. Bad debt, the other form of uncompensated care, cannot be used to meet the standard, although Medicaid shortfalls can. However, the ACA lacks guidelines for providing charity care, and federal law sets no minimum requirements for community benefit activities. Using data from California, we examined whether the levels of charity and uncompensated care provided differed across general acute care hospitals by profit status and other characteristics during 2011-13. The mean proportion of total operating expenses spent on charity care differed significantly between not-for-profit (1.9 percent) and for-profit hospitals (1.4 percent), in contrast to the mean proportion spent on uncompensated care. Both types of spending varied widely across hospitals. Policy makers should consider measures that remove disincentives to meeting the persistent considerable need for charity care-for example, increasing supports to offset rising Medicaid shortfalls resulting from program expansion-and facilitate the tracking of ACA impacts on the distribution of charity care and uncompensated care delivery. Project HOPE—The People-to-People Health Foundation, Inc.

  1. Survey of advanced radiation technologies used at designated cancer care hospitals in Japan

    International Nuclear Information System (INIS)

    Shikama, Naoto; Tsujino, Kayoko; Nakamura, Katsumasa; Ishikura, Satoshi

    2014-01-01

    Our survey assessed the use of advanced radiotherapy technologies at the designated cancer care hospitals in Japan, and we identified several issues to be addressed. We collected the data of 397 designated cancer care hospitals, including information on staffing in the department of radiation oncology (e.g. radiation oncologists, medical physicists and radiation therapists), the number of linear accelerators and the implementation of advanced radiotherapy technologies from the Center for Cancer Control and Information Services of the National Cancer Center, Japan. Only 53% prefectural designated cancer care hospitals and 16% regional designated cancer care hospitals have implemented intensity-modulated radiotherapy for head and neck cancers, and 62% prefectural designated cancer care hospitals and 23% regional designated cancer care hospitals use intensity-modulated radiotherapy for prostate cancer. Seventy-four percent prefectural designated cancer care hospitals and 40% regional designated cancer care hospitals employ stereotactic body radiotherapy for lung cancer. Our multivariate analysis of prefectural designated cancer care hospitals which satisfy the institute's qualifications for advanced technologies revealed the number of radiation oncologists (P=0.01) and that of radiation therapists (P=0.003) were significantly correlated with the implementation of intensity-modulated radiotherapy for prostate cancer, and the number of radiation oncologists (P=0.02) was correlated with the implementation of stereotactic body radiotherapy. There was a trend to correlate the number of medical physicists with the implementation of stereotactic body radiotherapy (P=0.07). Only 175 (51%) regional designated cancer care hospitals satisfy the institute's qualification of stereotactic body radiotherapy and 76 (22%) satisfy that of intensity-modulated radiotherapy. Seventeen percent prefectural designated cancer care hospitals and 13% regional designated cancer care hospitals

  2. Evaluation of an aged care nurse practitioner service: quality of care within a residential aged care facility hospital avoidance service.

    Science.gov (United States)

    Dwyer, Trudy; Craswell, Alison; Rossi, Dolene; Holzberger, Darren

    2017-01-13

    Reducing avoidable hospitialisation of aged care facility (ACF) residents can improve the resident experience and their health outcomes. Consequently many variations of hospital avoidance (HA) programs continue to evolve. Nurse practitioners (NP) with expertise in aged care have the potential to make a unique contribution to hospital avoidance programs. However, little attention has been dedicated to service evaluation of this model and the quality of care provided. The purpose of this study was to evaluate the quality of an aged care NP model of care situated within a HA service in a regional area of Australia. Donabedian's structure, process and outcome framework was applied to evaluate the quality of the NP model of care. The Australian Nurse Practitioner Study standardised interview schedules for evaluating NP models of care guided the semi-structured interviews of nine health professionals (including ACF nurses, medical doctors and allied health professionals), four ACF residents and their families and two NPs. Theory driven coding consistent with the Donabedian framework guided analysis of interview data and presentation of findings. Structural dimensions identified included the 'in-reach' nature of the HA service, distance, limitations of professional regulation and the residential care model. These dimensions influenced the process of referring the resident to the NP, the NPs timely response and interactions with other professionals. The processes where the NPs take time connecting with residents, initiating collaborative care plans, up-skilling aged care staff and function as intra and interprofessional boundary spanners all contributed to quality outcomes. Quality outcomes in this study were about timely intervention, HA, timely return home, partnering with residents and family (knowing what they want) and resident and health professional satisfaction. This study provides valuable insights into the contribution of the NP model of care within an aged care

  3. Comparison of childbirth care models in public hospitals, Brazil.

    Science.gov (United States)

    Vogt, Sibylle Emilie; Silva, Kátia Silveira da; Dias, Marcos Augusto Bastos

    2014-04-01

    To compare collaborative and traditional childbirth care models. Cross-sectional study with 655 primiparous women in four public health system hospitals in Belo Horizonte, MG, Southeastern Brazil, in 2011 (333 women for the collaborative model and 322 for the traditional model, including those with induced or premature labor). Data were collected using interviews and medical records. The Chi-square test was used to compare the outcomes and multivariate logistic regression to determine the association between the model and the interventions used. Paid work and schooling showed significant differences in distribution between the models. Oxytocin (50.2% collaborative model and 65.5% traditional model; p relief (85.0% collaborative model and 78.9% traditional model; p = 0.042). The association between the collaborative model and the reduction in the use of oxytocin, artificial rupture of membranes and episiotomy remained after adjustment for confounding. The care model was not associated with complications in newborns or mothers neither with the use of spinal or epidural analgesia. The results suggest that collaborative model may reduce interventions performed in labor care with similar perinatal outcomes.

  4. Effect of socioeconomic disadvantage, remoteness and Indigenous status on hospital usage for Western Australian preterm infants under 12 months of age: a population-based data linkage study.

    Science.gov (United States)

    Strobel, Natalie A; Peter, Sue; McAuley, Kimberley E; McAullay, Daniel R; Marriott, Rhonda; Edmond, Karen M

    2017-01-18

    Our primary objective was to determine the incidence of hospital admission and emergency department presentation in Indigenous and non-Indigenous preterm infants aged postdischarge from birth admission to 11 months in Western Australia. Secondary objectives were to assess incidence in the poorest infants from remote areas and to determine the primary causes of hospital usage in preterm infants. Prospective population-based linked data set. All preterm babies born in Western Australia during 2010 and 2011. All-cause hospitalisations and emergency department presentations. There were 6.9% (4211/61 254) preterm infants, 13.1% (433/3311) Indigenous preterm infants and 6.5% (3778/57 943) non-Indigenous preterm infants born in Western Australia. Indigenous preterm infants had a higher incidence of hospital admission (adjusted incident rate ratio (aIRR) 1.24, 95% CI 1.08 to 1.42) and emergency department presentation (aIRR 1.71, 95% CI 1.44 to 2.02) compared with non-Indigenous preterm infants. The most disadvantaged preterm infants (7.8/1000 person days) had a greater incidence of emergency presentation compared with the most advantaged infants (3.1/1000 person days) (aIRR 1.61, 95% CI 1.30 to 2.00). The most remote preterm infants (7.8/1000 person days) had a greater incidence of emergency presentation compared with the least remote preterm infants (3.0/1000 person days; aIRR 1.82, 95% CI 1.49 to 2.22). In Western Australia, preterm infants have high hospital usage in their first year of life. Infants living in disadvantaged areas, remote area infants and Indigenous infants are at increased risk. Our data highlight the need for improved postdischarge care for preterm infants. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  5. Usage Center

    DEFF Research Database (Denmark)

    Kleinaltenkamp, Michael; Plewa, Carolin; Gudergan, Siegfried

    2017-01-01

    Purpose: The purpose of this paper is to advance extant theorizing around resourceintegration by conceptualizing and delineating the notion of a usage center. Ausage center consists of a combination of interdependent actors that draw onresources across their individual usage processes to create v...

  6. Exploring relationships between patient safety culture and patients' assessments of hospital care.

    Science.gov (United States)

    Sorra, Joann; Khanna, Kabir; Dyer, Naomi; Mardon, Russ; Famolaro, Theresa

    2014-10-01

    The purpose of this study was to examine relationships among 2 Agency for Healthcare Research and Quality measures of hospital patient safety and quality, which reflect different perspectives on hospital performance: the Hospital Survey on Patient Safety Culture (Hospital SOPS)--a hospital employee patient safety culture survey--and the Consumer Assessment of Healthcare Providers and Systems Hospital Survey (CAHPS Hospital Survey)--a survey of the experiences of adult inpatients with hospital care and services. Our hypothesis was that these 2 measures would be positively related. We performed multiple regressions to examine the relationships between the Hospital SOPS measures and CAHPS Hospital Survey measures, controlling for hospital bed size and ownership. Analyses were conducted at the hospital level with each survey's measures using data from 73 hospitals that administered both surveys during similar periods. Higher overall Hospital SOPS composite average scores were associated with higher overall CAHPS Hospital Survey composite average scores (r = 0.41, P G 0.01). Twelve of 15 Hospital SOPS measures were positively related to the CAHPS Hospital Survey composite average score after controlling for bed size and ownership, with significant standardized regression coefficients ranging from 0.25 to 0.38. None of the Hospital SOPS measures were significantly correlated with either of the two single-item CAHPS Hospital Survey measures (hospital rating and willingness to recommend). This study found that hospitals where staff have more positive perceptions of patient safety culture tend to have more positive assessments of care from patients. This finding helps validate both surveys and suggests that improvements in patient safety culture may lead to improved patient experience with care. Further research is needed to determine the generalizability of these results to larger sets of hospitals, to hospital units, and to other settings of care.

  7. Impact of Home Health Care on Health Care Resource Utilization Following Hospital Discharge: A Cohort Study.

    Science.gov (United States)

    Xiao, Roy; Miller, Jacob A; Zafirau, William J; Gorodeski, Eiran Z; Young, James B

    2018-04-01

    As healthcare costs rise, home health care represents an opportunity to reduce preventable adverse events and costs following hospital discharge. No studies have investigated the utility of home health care within the context of a large and diverse patient population. A retrospective cohort study was conducted between 1/1/2013 and 6/30/2015 at a single tertiary care institution to assess healthcare utilization after discharge with home health care. Control patients discharged with "self-care" were matched by propensity score to home health care patients. The primary outcome was total healthcare costs in the 365-day post-discharge period. Secondary outcomes included follow-up readmission and death. Multivariable linear and Cox proportional hazards regression were used to adjust for covariates. Among 64,541 total patients, 11,266 controls were matched to 6,363 home health care patients across 11 disease-based Institutes. During the 365-day post-discharge period, home health care was associated with a mean unadjusted savings of $15,233 per patient, or $6,433 after adjusting for covariates (p Home health care independently decreased the hazard of follow-up readmission (HR 0.82, p home health care most benefited patients discharged from the Digestive Disease (death HR 0.72, p home health care was associated with significant reduction in healthcare utilization and decreased hazard of readmission and death. These data inform development of value-based care plans. Copyright © 2018 Elsevier Inc. All rights reserved.

  8. Patient Satisfaction with Hospital Inpatient Care: Effects of Trust, Medical Insurance and Perceived Quality of Care.

    Science.gov (United States)

    Shan, Linghan; Li, Ye; Ding, Ding; Wu, Qunhong; Liu, Chaojie; Jiao, Mingli; Hao, Yanhua; Han, Yuzhen; Gao, Lijun; Hao, Jiejing; Wang, Lan; Xu, Weilan; Ren, Jiaojiao

    2016-01-01

    Deteriorations in the patient-provider relationship in China have attracted increasing attention in the international community. This study aims to explore the role of trust in patient satisfaction with hospital inpatient care, and how patient-provider trust is shaped from the perspectives of both patients and providers. We adopted a mixed methods approach comprising a multivariate logistic regression model using secondary data (1200 people with inpatient experiences over the past year) from the fifth National Health Service Survey (NHSS, 2013) in Heilongjiang Province to determine the associations between patient satisfaction and trust, financial burden and perceived quality of care, followed by in-depth interviews with 62 conveniently selected key informants (27 from health and 35 from non-health sectors). A thematic analysis established a conceptual framework to explain deteriorating patient-provider relationships. About 24% of respondents reported being dissatisfied with hospital inpatient care. The logistic regression model indicated that patient satisfaction was positively associated with higher level of trust (OR = 14.995), lower levels of hospital medical expenditure (OR = 5.736-1.829 as compared with the highest quintile of hospital expenditure), good staff attitude (OR = 3.155) as well as good ward environment (OR = 2.361). But patient satisfaction was negatively associated with medical insurance for urban residents and other insurance status (OR = 0.215-0.357 as compared with medical insurance for urban employees). The qualitative analysis showed that patient trust-the most significant predictor of patient satisfaction-is shaped by perceived high quality of service delivery, empathic and caring interpersonal interactions, and a better designed medical insurance that provides stronger financial protection and enables more equitable access to health care. At the core of high levels of patient dissatisfaction with hospital care is the lack of trust. The

  9. Smoking trends amongst young doctors of a tertiary care hospital - Mayo Hospital, Lahore - Pakistan

    International Nuclear Information System (INIS)

    Chudhary, M.K.; Younis, M.; Bukhari, M.H.

    2011-01-01

    The World Health Organization cites tobacco use as one of the biggest public health threats the world has ever faced. Tobacco is the number one preventable cause of disability and death. Tobacco has many negative health effects which many of the smokers know them well. In Pakistan tobacco use is common in general public and the health professionals don't lack behind this habit. To study the smoking trends amongst young doctors of Mayo Hospital. Questionnaire based descriptive study. This study was conducted at the Institute of Chest Medicine, Mayo Hospital - A tertiary care hospital affiliated with King Edward Medical University, Lahore. Out of 250 doctors, 180 (72%) were males and 70 (28%) were female. Amongst 180 male doctors 97 (53.88%) were smokers and 83 (46.21%) were non smokers. Amongst 70 female doctors 8 (11.43%) were smokers and 62 (88.57%) were non smokers. Smoking is common among male young doctors but it is less common in female doctors. (author)

  10. Development and Validation of the Geriatric In-Hospital Nursing Care Questionnaire

    NARCIS (Netherlands)

    Persoon, Anke; Bakker, Franka C.; van der Wal-Huisman, Hanneke; Rikkert, Marcel G. M. Olde

    ObjectivesTo develop a questionnaire, the Geriatric In-hospital Nursing Care Questionnaire (GerINCQ), to measure, in an integrated way, the care that older adults receive in the hospital and nurses' attitudes toward and perceptions about caring for older adults. DesignQuestionnaire development.

  11. Hospital-based palliative care: A case for integrating care with cure

    Directory of Open Access Journals (Sweden)

    Priya Darshini Kulkarni

    2011-01-01

    Full Text Available The reason that probably prompted Dame Cicely Saunders to launch the palliative care movement was the need to move away from the impersonal, technocratic approach to death that had become the norm in hospitals after the Second World War. Palliative care focuses on relieving the suffering of patients and families. Not limited to just management of pain, it includes comprehensive management of any symptom, which affects the quality of life. Care is optimized through early initiation and comprehensive implementation throughout the disease trajectory. Effective palliative care at the outset can help accelerate a positive clinical outcome. At the end of life, it can enhance the opportunity for the patient and family to achieve a sense of growth, resolve differences, and find a comfortable closure. It helps to reduce the suffering and fear associated with dying and prepares the family for bereavement.

  12. Do private hospitals outperform public hospitals regarding efficiency, accessibility, and quality of care in the European Union? A literature review.

    Science.gov (United States)

    Kruse, Florien M; Stadhouders, Niek W; Adang, Eddy M; Groenewoud, Stef; Jeurissen, Patrick P T

    2018-03-02

    European countries have enhanced the scope of private provision within their health care systems. Privatizing services have been suggested as a means to improve access, quality, and efficiency in health care. This raises questions about the relative performance of private hospitals compared with public hospitals. Most systematic reviews that scrutinize the performance of the private hospitals originate from the United States. A systematic overview for Europe is nonexisting. We fill this gap with a systematic realist review comparing the performance of public hospitals to private hospitals on efficiency, accessibility, and quality of care in the European Union. This review synthesizes evidence from Italy, Germany, the United Kingdom, France, Greece, Austria, Spain, and Portugal. Most evidence suggests that public hospitals are at least as efficient as or are more efficient than private hospitals. Accessibility to broader populations is often a matter of concern in private provision: Patients with higher social-economic backgrounds hold better access to private hospital provision, especially in private parallel systems such as the United Kingdom and Greece. The existing evidence on quality of care is often too diverse to make a conclusive statement. In conclusion, the growth in private hospital provision seems not related to improvements in performance in Europe. Our evidence further suggests that the private (for-profit) hospital sector seems to react more strongly to (financial) incentives than other provider types. In such cases, policymakers either should very carefully develop adequate incentive structures or be hesitant to accommodate the growth of the private hospital sector. Copyright © 2018 John Wiley & Sons, Ltd.

  13. [Patient-related complexity in nursing care - Collective case studies in the acute care hospital].

    Science.gov (United States)

    Gurtner, Caroline; Spirig, Rebecca; Staudacher, Diana; Huber, Evelyn

    2018-06-04

    Patient-related complexity in nursing care - Collective case studies in the acute care hospital Abstract. Patient-related complexity of nursing is defined by the three characteristics "instability", "uncertainty", and "variability". Complexity increased in the past years, due to reduced hospital length of stay and a growing number of patients with chronic and multiple diseases. We investigated the phenomenon of patient-related complexity from the point of view of nurses and clinical nurse specialists in an acute care hospital. In the context of a collective case study design, nurses and clinical nurse specialists assessed the complexity of nursing situations with a questionnaire. Subsequently, we interviewed nurses and clinical nurse specialists about their evaluation of patient-related complexity. In a within-case-analysis we summarized data inductively to create case narratives. By means of a cross-case-analysis we compared the cases with regard to deductively derived characteristics. The four cases exemplarily showed that the degree of complexity depends on the controllability and predictability of clinical problems. Additionally, complexity increases or decreases, according to patients' individual resources. Complex patient situations demand professional expertise, experience, communicative competencies and the ability for reflection. Beginner nurses would benefit from support and advice by experienced nurses to develop these skills.

  14. Improving immediate newborn care practices in Philippine hospitals: impact of a national quality of care initiative 2008-2015.

    Science.gov (United States)

    Silvestre, Maria Asuncion A; Mannava, Priya; Corsino, Marie Ann; Capili, Donna S; Calibo, Anthony P; Tan, Cynthia Fernandez; Murray, John C S; Kitong, Jacqueline; Sobel, Howard L

    2018-03-31

    To determine whether intrapartum and newborn care practices improved in 11 large hospitals between 2008 and 2015. Secondary data analysis of observational assessments conducted in 11 hospitals in 2008 and 2015. Eleven large government hospitals from five regions in the Philippines. One hundred and seven randomly sampled postpartum mother-baby pairs in 2008 and 106 randomly sampled postpartum mothers prior to discharge from hospitals after delivery. A national initiative to improve quality of newborn care starting in 2009 through development of a standard package of intrapartum and newborn care services, practice-based training, formation of multidisciplinary hospital working groups, and regular assessments and meetings in hospitals to identify actions to improve practices, policies and environments. Quality improvement was supported by policy development, health financing packages, health facility standards, capacity building and health communication. Sixteen intrapartum and newborn care practices. Between 2008 and 2015, initiation of drying within 5 s of birth, delayed cord clamping, dry cord care, uninterrupted skin-to-skin contact, timing and duration of the initial breastfeed, and bathing deferred until 6 h after birth all vastly improved (P<0.001). The proportion of newborns receiving hygienic cord handling and the hepatitis B birth dose decreased by 11-12%. Except for reduced induction of labor, inappropriate maternal care practices persisted. Newborn care practices have vastly improved through an approach focused on improving hospital policies, environments and health worker practices. Maternal care practices remain outdated largely due to the ineffective didactic training approaches adopted for maternal care.

  15. Implementation of national palliative care guidelines in Swedish acute care hospitals: A qualitative content analysis of stakeholders' perceptions.

    Science.gov (United States)

    Lind, S; Wallin, L; Brytting, T; Fürst, C J; Sandberg, J

    2017-11-01

    In high-income countries a large proportion of all deaths occur in hospitals. A common way to translate knowledge into clinical practice is developing guidelines for different levels of health care organisations. During 2012, national clinical guidelines for palliative care were published in Sweden. Later, guidance for palliative care was issued by the National Board of Health and Welfare. The aim of this study was two-fold: to investigate perceptions regarding these guidelines and identify obstacles and opportunities for implementation of them in acute care hospitals. Interviews were conducted with local politicians, chief medical officers and health professionals at acute care hospitals. The Consolidated Framework for Implementation Research was used in a directed content analysis approach. The results showed little knowledge of the two documents at all levels of the health care organisation. Palliative care was primarily described as end of life care and only few of the participants talked about the opportunity to integrate palliative care early in a disease trajectory. The environment and culture at hospitals, characterised by quick decisions and actions, were perceived as obstacles to implementation. Health professionals' expressed need for palliative care training is an opportunity for implementation of clinical guidelines. There is a need for further implementation of palliative care in hospitals. One option for further research is to evaluate implementation strategies tailored to acute care. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Generalist palliative care in hospital - Cultural and organisational interactions. Results of a mixed-methods study.

    Science.gov (United States)

    Bergenholtz, Heidi; Jarlbaek, Lene; Hølge-Hazelton, Bibi

    2016-06-01

    It can be challenging to provide generalist palliative care in hospitals, owing to difficulties in integrating disease-oriented treatment with palliative care and the influences of cultural and organisational conditions. However, knowledge on the interactions that occur is sparse. To investigate the interactions between organisation and culture as conditions for integrated palliative care in hospital and, if possible, to suggest workable solutions for the provision of generalist palliative care. A convergent parallel mixed-methods design was chosen using two independent studies: a quantitative study, in which three independent datasets were triangulated to study the organisation and evaluation of generalist palliative care, and a qualitative, ethnographic study exploring the culture of generalist palliative nursing care in medical departments. A Danish regional hospital with 29 department managements and one hospital management. Two overall themes emerged: (1) 'generalist palliative care as a priority at the hospital', suggesting contrasting issues regarding prioritisation of palliative care at different organisational levels, and (2) 'knowledge and use of generalist palliative care clinical guideline', suggesting that the guideline had not reached all levels of the organisation. Contrasting issues in the hospital's provision of generalist palliative care at different organisational levels seem to hamper the interactions between organisation and culture - interactions that appear to be necessary for the provision of integrated palliative care in the hospital. The implementation of palliative care is also hindered by the main focus being on disease-oriented treatment, which is reflected at all the organisational levels. © The Author(s) 2015.

  17. Nurses’ Burnout in Oncology Hospital Critical Care Unit

    Directory of Open Access Journals (Sweden)

    Yeliz İrem Tunçel

    2014-08-01

    Full Text Available Objective: Burnout is common in intensive care units (ICU because of high demands and difficult working conditions. The aim of this study was to analyse nurses’ burnout in our oncology ICU and to determine which factors are associated with. Material and Method: The study was carried out in Ankara Oncology Hospital ICU. A self- reporting questionnaire in an envelope was used for the evaluation of burnout (Turkish- language version of Maslach Burnout Inventory and depression (Beck Depression Scale. Results: From a total of 37 ICU nurses, 35 participated in the study (%94,5 response rate. High levels of emotional exhaustion in 82% and depersonalization in 51,4% of nurses was determined. Personal accomplishment was higher at 80%. Mild to moderate emotional state and mild anxiety was revealed. Years in profession,finding salary insufficient, finding the profession in its proper, choosing the profession of his own accord, work environment satisfaction and finding the social activity adequate were associated with burnout (p≤0.05. Conclusion: In our study, intensive care unit nurses’ burnout scores were found to be higher. Burnout was rare in nurses that choose the profession of his own accord, find the nursing profession in its proper, and social activity adequate and are satisfied with the work environment. Therefore, we believe that attention should be given to individual needs and preferences in the selection of ICU staff.

  18. Use of herbal medicine among pregnant women on antenatal care at nekemte hospital, Western ethiopia.

    Science.gov (United States)

    Bayisa, Bodena; Tatiparthi, Ramanjireddy; Mulisa, Eshetu

    2014-11-01

    Investigations across the world confirm dramatic increment in the use of complementary and alternative medicine in pregnant women. The most important aspect is lack of awareness of pregnant women about potential effects of using traditional medicine on fetus; some herbal products may be teratogenic in human and animal models. In this area, so far, no research has been conducted in Ethiopia to assess traditional medicine use in pregnant women. Therefore, the main objective of this study was to investigate the prevalence and use of herbal drugs among pregnant women attending Nekemte Hospital to provide baseline information for future studies. A cross-sectional descriptive study was conducted by quantitative and qualitative approaches to identify the prevalence of using herbal medicines among pregnant women. About 50.4% of study participants used herbal drugs during their pregnancy. The proportion of herbal drug usage was gradually decreased along with the first, second and third trimesters of pregnancy. The most and least commonly used herbs were ginger (44.36%) and tenaadam (9.15 %), respectively. The common indications of herbal remedies use during pregnancy were nausea (23.90%) and morning sickness (21.05%). The result of the present study confirmed wide use of herbal drugs use during pregnancy that need to report the safety concerns of these drugs during pregnancy. To achieve the requirements of pregnant women, it is vital for health care workers to be familiar with the effect of herbal medicine in pregnancy.

  19. Prevalence of Mobile Phones and Factors Influencing Usage by Caregivers of Young Children in Daily Life and for Health Care in Rural China: A Mixed Methods Study

    Science.gov (United States)

    Wang, Wei; Chen, Li; Du, Xiaozhen; Wu, Qiong; Zhang, Yanfeng; Rudan, Igor; Car, Josip

    2015-01-01

    Introduction To capitalise on mHealth, we need to understand the use of mobile phones both in daily life and for health care. Objective To assess the prevalence and factors that influence usage of mobile phones by caregivers of young children. Materials and Methods A mixed methods approach was used, whereby a survey (N=1854) and semi-structured interviews (N=17) were conducted concurrently. The quantitative and qualitative data obtained were compared and integrated. Participants were caregivers of young children in Zhao County, Hebei Province, China. Results Four main themes were found: (i) trends in mobile phone ownership; (ii) usage of mobile phone functions; (iii) factors influencing replying to text messages; and (iv) uses of mobile phones for health care. The majority of 1,854 survey participants (1,620; 87.4%) used mobile phones, but usage was much higher among mothers (1,433; 92.6%) and fathers (41; 100.0%) compared to grandparents (142; 54.6%). Parents were able to send text messages, grandparents often not. Factors influencing the decision to reply to text messages in daily life were checking the mobile phone, trusting the sender, emotion or feeling when receiving a text message, the importance of replying and ease of use of text messages. Of 1,620 survey participants who used a mobile phone, about one in four (432; 26.7%) had used it for health care in the past three months and most (1,110; 93.5%) of 1,187 who had not wished to use their phone to receive health information. Conclusion We found that usage of mobile phones is high, several factors influencing usage and an interest of caregivers to use phones for health care in Zhao County, rural China, which can be used to inform studies in settings with similar characteristics. Future work needs to assess factors influencing mobile phone usage in-depth to optimize experiences of users for specific mHealth-based interventions. PMID:25789477

  20. Impact of an antimicrobial stewardship programme on antibiotic usage and resistance in a tertiary hospital in China.

    Science.gov (United States)

    Zhang, Z-G; Chen, F; Ou, Y

    2017-10-01

    Antimicrobial misuse has been commonly observed in China. This phenomenon can cause antibiotic resistance. This study was designed to evaluate the impact of an antimicrobial stewardship programme implemented in a tertiary hospital in China from 2011 to 2014. The antimicrobial stewardship programme began in 2011. Data on the consumption of antibiotics and antimicrobial resistance between 2011 and 2014 were collected. Comparison of the 2011 data with those of 2014 showed that antibiotic defined daily doses/per 100 patient-days decreased from 92.5±2.8 to 35.8±1.2 (Padministrative management, especially information management, was effective in reducing antibiotic consumption and lessening antibiotic resistance. © 2017 John Wiley & Sons Ltd.

  1. The Affordable Care Act and hospital chaplaincy: re-visioning spiritual care, re-valuing institutional wholeness.

    Science.gov (United States)

    Frierdich, Matthew D

    2015-01-01

    This article focuses on the institutional dimensions of spiritual care within hospital settings in the context of the Patient Protection and Affordable Care Act of 2010 (ACA), applying policy information and systems theory to re-imagine the value and function of chaplaincy to hospital communities. This article argues that chaplaincy research and practice must look beyond only individual interventions and embrace chaplain competencies of presence, ritual, and communication as foundational tools for institutional spiritual care.

  2. A Business Case Analysis of the Special Care Unit at Moncrief Army Community Hospital

    National Research Council Canada - National Science Library

    Unruh, Charles

    2002-01-01

    The goal of this project is to develop and evaluate four courses of action (COA) in order to determine the most efficient and effective method to care for Moncrief Army Community Hospitals Special Care Unit (SCU) inpatients...

  3. Recommended next care following hospital-treated self-harm: Patterns and trends over time.

    LENUS (Irish Health Repository)

    Arensman, Ella

    2018-01-01

    The specific objectives of this study were to examine variation in the care of self-harm patients in hospital settings and to identify the factors that predict recommended next care following self-harm.

  4. Complementary effect of patient volume and quality of care on hospital cost efficiency.

    Science.gov (United States)

    Choi, Jeong Hoon; Park, Imsu; Jung, Ilyoung; Dey, Asoke

    2017-06-01

    This study explores the direct effect of an increase in patient volume in a hospital and the complementary effect of quality of care on the cost efficiency of U.S. hospitals in terms of patient volume. The simultaneous equation model with three-stage least squares is used to measure the direct effect of patient volume and the complementary effect of quality of care and volume. Cost efficiency is measured with a data envelopment analysis method. Patient volume has a U-shaped relationship with hospital cost efficiency and an inverted U-shaped relationship with quality of care. Quality of care functions as a moderator for the relationship between patient volume and efficiency. This paper addresses the economically important question of the relationship of volume with quality of care and hospital cost efficiency. The three-stage least square simultaneous equation model captures the simultaneous effects of patient volume on hospital quality of care and cost efficiency.

  5. Becoming Food Aware in Hospital: A Narrative Review to Advance the Culture of Nutrition Care in Hospitals

    Directory of Open Access Journals (Sweden)

    Celia Laur

    2015-06-01

    Full Text Available The Nutrition Care in Canadian Hospitals (2010–2013 study identified the prevalence of malnutrition on admission to medical and surgical wards as 45%. Nutrition practices in the eighteen hospitals, including diagnosis, treatment and monitoring of malnourished patients, were ad hoc. This lack of a systematic approach has demonstrated the need for the development of improved processes and knowledge translation of practices aimed to advance the culture of nutrition care in hospitals. A narrative review was conducted to identify literature that focused on improved care processes and strategies to promote the nutrition care culture. The key finding was that a multi-level approach is needed to address this complex issue. The organization, staff, patients and their families need to be part of the solution to hospital malnutrition. A variety of strategies to promote the change in nutrition culture have been proposed in the literature, and these are summarized as examples for others to consider. Examples of strategies at the organizational level include developing policies to support change, use of a screening tool, protecting mealtimes, investing in food and additional personnel (healthcare aides, practical nurses and/or diet technicians to assist patients at mealtimes. Training for hospital staff raises awareness of the issue, but also helps them to identify their role and how it can be modified to improve nutrition care. Patients and families need to be aware of the importance of food to their recovery and how they can advocate for their needs while in hospital, as well as post-hospitalization. It is anticipated that a multi-level approach that promotes being “food aware” for all involved will help hospitals to achieve patient-centred care with respect to nutrition.

  6. Becoming Food Aware in Hospital: A Narrative Review to Advance the Culture of Nutrition Care in Hospitals.

    Science.gov (United States)

    Laur, Celia; McCullough, James; Davidson, Bridget; Keller, Heather

    2015-06-01

    The Nutrition Care in Canadian Hospitals (2010-2013) study identified the prevalence of malnutrition on admission to medical and surgical wards as 45%. Nutrition practices in the eighteen hospitals, including diagnosis, treatment and monitoring of malnourished patients, were ad hoc. This lack of a systematic approach has demonstrated the need for the development of improved processes and knowledge translation of practices aimed to advance the culture of nutrition care in hospitals. A narrative review was conducted to identify literature that focused on improved care processes and strategies to promote the nutrition care culture. The key finding was that a multi-level approach is needed to address this complex issue. The organization, staff, patients and their families need to be part of the solution to hospital malnutrition. A variety of strategies to promote the change in nutrition culture have been proposed in the literature, and these are summarized as examples for others to consider. Examples of strategies at the organizational level include developing policies to support change, use of a screening tool, protecting mealtimes, investing in food and additional personnel (healthcare aides, practical nurses and/or diet technicians) to assist patients at mealtimes. Training for hospital staff raises awareness of the issue, but also helps them to identify their role and how it can be modified to improve nutrition care. Patients and families need to be aware of the importance of food to their recovery and how they can advocate for their needs while in hospital, as well as post-hospitalization. It is anticipated that a multi-level approach that promotes being "food aware" for all involved will help hospitals to achieve patient-centred care with respect to nutrition.

  7. Follow-up analysis of federal process of care data reported from three acute care hospitals in rural Appalachia

    Directory of Open Access Journals (Sweden)

    Sills ES

    2013-03-01

    Full Text Available E Scott Sills,1,2 Liubomir Chiriac,3 Denis Vaughan,4 Christopher A Jones,5 Shala A Salem11Division of Reproductive Endocrinology, Pacific Reproductive Center, Irvine, CA, USA; 2Graduate School of Life Sciences, University of Westminster, London, UK; 3Department of Mathematics, California Institute of Technology, Pasadena, CA, USA; 4Department of Obstetrics and Gynaecology, School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; 5Global Health Economics Unit and Department of Surgery, Center for Clinical and Translational Science, University of Vermont College of Medicine, Burlington, VT, USABackground: This investigation evaluated standardized process of care data collected on selected hospitals serving a remote rural section of westernmost North Carolina.Methods: Centers for Medicare and Medicaid Services data were analyzed retrospectively for multiple clinical parameters at Fannin Regional Hospital, Murphy Medical Center, and Union General Hospital. Data were analyzed by paired t-test for individual comparisons among the three study hospitals to compare the three facilities with each other, as well as with state and national average for each parameter.Results: Centers for Medicare and Medicaid Services “Hospital Compare” data from 2011 showed Fannin Regional Hospital to have significantly higher composite scores on standardized clinical process of care measures relative to the national average, compared with Murphy Medical Center (P = 0.01 and Union General Hospital (P = 0.01. This difference was noted to persist when Fannin Regional Hospital was compared with Union General Hospital using common state reference data (P = 0.02. When compared with national averages, mean process of care scores reported from Murphy Medical Center and Union General Hospital were both lower but not significantly different (−3.44 versus −6.07, respectively, P = 0.54.Conclusion: The range of process of care scores submitted by acute care

  8. Geriatrics and the triple aim: defining preventable hospitalizations in the long-term care population.

    Science.gov (United States)

    Ouslander, Joseph G; Maslow, Katie

    2012-12-01

    Reducing preventable hospitalizations is fundamental to the "triple aim" of improving care, improving health, and reducing costs. New federal government initiatives that create strong pressure to reduce such hospitalizations are being or will soon be implemented. These initiatives use quality measures to define which hospitalizations are preventable. Reducing hospitalizations could greatly benefit frail and chronically ill adults and older people who receive long-term care (LTC) because they often experience negative effects of hospitalization, including hospital-acquired conditions, morbidity, and loss of functional abilities. Conversely, reducing hospitalizations could mean that some people will not receive hospital care they need, especially if the selected measures do not adequately define hospitalizations that can be prevented without jeopardizing the person's health and safety. An extensive literature search identified 250 measures of preventable hospitalizations, but the measures have not been validated in the LTC population and generally do not account for comorbidity or the capacity of various LTC settings to provide the required care without hospitalization. Additional efforts are needed to develop measures that accurately differentiate preventable from necessary hospitalizations for the LTC population, are transparent and fair to providers, and minimize the potential for gaming and unintended consequences. As the new initiatives take effect, it is critical to monitor their effect and to develop and disseminate training and resources to support the many community- and institution-based healthcare professionals and emergency department staff involved in decisions about hospitalization for this population. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.

  9. Patient perception of pain care in hospitals in the United States

    Directory of Open Access Journals (Sweden)

    Anita Gupta

    2009-11-01

    Full Text Available Anita Gupta1, Sarah Daigle2, Jeffrey Mojica3, Robert W Hurley41Pain Management Division, Department of Anesthesiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA; 2Department of Anesthesiology and Critical Care, 3Department of Anesthesiology and Critical Care, Division of Pain Medicine, University of Pennsylvania, Philadelphia, PA, USA; 4Medical Director of the Johns Hopkins Pain Treatment Center, Division of Pain Medicine, Deparment of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USAStudy objective: Assessment of patients’ perception of pain control in hospitals in the United States.Background: Limited data are available regarding the quality of pain care in the hospitalized patient. This is particularly valid for data that allow for comparison of pain outcomes from one hospital to another. Such data are critical for numerous reasons, including allowing patients and policy-makers to make data-driven decisions, and to guide hospitals in their efforts to improve pain care. The Hospital Quality Alliance was recently created by federal policy makers and private organizations in conjunction with the Centers for Medicare and Medicare Services to conduct patient surveys to evaluate their experience including pain control during their hospitalization.Methods: In March 2008, the results of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS survey was released for review for health care providers and researchers. This survey includes a battery of questions for patients upon discharge from the hospital including pain-related questions and patient satisfaction that provide valuable data regarding pain care nationwide. This study will review the results from the pain questions from this available data set and evaluate the performance of these hospitals in pain care in relationship to patient satisfaction. Furthermore, this analysis will be providing valuable

  10. Burnout in the staff of a chronic care hospital

    Science.gov (United States)

    Merino-Plaza, Maria Jose; Carrera-Hueso, Francisco Javier; Arribas-Boscá, Nuria; Martínez-Asensi, Amparo; Trull-Maravilla, Emilia; Fikri-Benbrahim, Narjis

    2018-01-01

    ABSTRACT OBJECTIVE To estimate the prevalence of Burnout in a medium or long-stay hospital, to monitor its evolution and to highlight the importance of cut-off points used to avoid distortions in the interpretation of the results. METHODS Two cross-sectional studies (2013–2016) were carried out, applying the Spanish version of the Maslach Burnout Inventory to the staff of a chronic care hospital (n = 323). Result variables were: Burnout prevalence and a high degree of affectation of the subscales and predictor variables: sociodemographic characteristics and factors that trigger and modulate the syndrome. The association between variables was quantified using odds ratio. RESULTS The participation rate went from 31.5% to 39.3%. The professionals presented a mean level of Burnout in both moments, observing a lower degree of affectation of the depersonalization subscales and personal accomplishment in the 2016 cut-off. The average score of the subscales in 2016 was 21.5 for emotional fatigue, 4.7 for depersonalization and 41.7 for personal fulfillment, compared to the values of emotional fatigue = 21.6, depersonalization = 6.9 and personal fulfillment = 36.3 obtained in 2013. The emotional fatigue score was slightly higher than the mean value of the national studies (19.9), while the rest of the values were similar to the mean values of the studies considered. The prevalence of Burnout and the interpretation of the results varied significantly according to the cut-off points considered. In both studies, sociodemographic variables showed little significance, while social support and interpersonal relationships were associated with the degree of burnout among professionals. CONCLUSIONS Our prevalence of Burnout was similar to that of other studies consulted, although the emotional component is more marked in our environment. The interpretation of the results varied significantly according to the cut-off points applied, due to the cross-cultural differences. PMID

  11. Male hypogonadism at a tertiary care hospital in Karachi, Pakistan.

    Science.gov (United States)

    Ram, Nanik; Asghar, Ali; Hashmi, Fauzan; Islam, Najmul

    2012-01-01

    Male hypogonadism is defined as 'inadequate gonadal function, manifested by deficiency in gametogenesis and/or secretion of gonadal hormones'. Signs and symptoms of hypogonadism depend primarily on the age of onset. It can be classified according to the site primarily involved: the gonads, the hypothalamus, or the pituitary gland. The objective this study was to determine the presentation and aetiology of male hypogonadism seen in a tertiary care hospital. This cross-sectional study was conducted at Endocrine Clinics, Aga Khan University Hospital Karachi. Data of male patients with hypogonadism who attended clinics during January 2009 to August 2011 were reviewed. All male patients with clinical and biochemical evidence of hypogonadism were included in the study. Patients with Diabetes Mellitus, Metabolic Syndrome, Andropause, AIDS, Chronic Renal Failure, and Cirrhosis were excluded. Mean +/- SD were computed for quantitative variables. Frequency and percentages were computed for qualitative variables. Aetiology of male hypogonadism was categorised as primary and secondary hypogonadism. A total of 85 patients with male hypogonadism attended the endocrine clinic. Mean age of patients was 25 +/- 10 years. Clinical presentations were small genitalia (65%), absent secondary sexual characteristics (53%), not attained puberty (47%), infertility (53%), erectile dysfunction (41%) and loss of libido (29%). Seventy-three (86%) patients had hypogonadotrophic hypogonadism (secondary hypogonadism) and 12 (14%) patients had hypergonadotrophic hypogonadism (primary hypogonadism). Among the patients with hypogonadotrophic hypogonadism 38 had idiopathic hypogonadotrophic hypogonadsim, 7 had pituitary adenoma, 6 had empty sella syndrome, 3 had Kallman's syndrome, and 1 patient had haemosiderosis due to thalassaemia major; 18 patients did not undergo brain imaging. Small genitalia, absent secondary sexual characteristics and infertility were the main presenting features of hypogonad

  12. Nurses' Perspectives on the Geriatric Nursing Practice Environment and the Quality of Older People's Care in Ontario Acute Care Hospitals.

    Science.gov (United States)

    Fox, Mary T; Sidani, Souraya; Butler, Jeffrey I; Tregunno, Deborah

    2017-06-01

    Background Cultivating hospital environments that support older people's care is a national priority. Evidence on geriatric nursing practice environments, obtained from studies of registered nurses (RNs) in American teaching hospitals, may have limited applicability to Canada, where RNs and registered practical nurses (RPNs) care for older people in predominantly nonteaching hospitals. Purpose This study describes nurses' perceptions of the overall quality of care for older people and the geriatric nursing practice environment (geriatric resources, interprofessional collaboration, and organizational value of older people's care) and examines if these perceptions differ by professional designation and hospital teaching status. Methods A cross-sectional survey, using Dillman's tailored design, that included Geriatric Institutional Assessment Profile subscales, was completed by 2005 Ontario RNs and registered practical nurses to assess their perceptions of the quality of care and geriatric nursing practice environment. Results Scores on the Geriatric Institutional Assessment Profile subscales averaged slightly above the midpoint except for geriatric resources which was slightly below. Registered practical nurses rated the quality of care and geriatric nursing practice environment higher than RNs; no significant differences were found by hospital teaching status. Conclusions Nurses' perceptions of older people's care and the geriatric nursing practice environment differ by professional designation but not hospital teaching status. Teaching and nonteaching hospitals should both be targeted for geriatric nursing practice environment improvement initiatives.

  13. Fungal Profile of Vulvovaginal Candidiasis in a Tertiary Care Hospital.

    Science.gov (United States)

    Kalaiarasan, Krishnapriya; Singh, Rakesh; Chaturvedula, Latha

    2017-03-01

    Vulvovaginal Candidiasis (VVC) is a common medical health problem of adult women. It is most commonly caused by Candida albicans . But there is a change in fungal profile. Sabouraud's Dextrose Agar (SDA) is the most common culture medium used where mixed fungal infection may be missed. It can be detected easily by using chromogenic culture medium. To know the fungal profile of vulvovaginal candidiasis using Candida CHROMagar and antifungal susceptibility pattern in patients attending tertiary care hospital. Culture confirmed cases of VVC presented at Department of Obstetrics and Gynaecology of Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India, from July 2015 to December 2015 were included in the cross-sectional study. Two high vaginal swabs were collected and inoculated on SDA and Candida CHROMagar (Hi-Media, Mumbai, India). After overnight incubation the colonies were counted and colour of the colonies were recorded from Candida CHROMagar. Candida spp. were identified by sugar fermentation and assimilation tests and other conventional tests. Antifungal susceptibility tests were performed by the disc diffusion method using fluconazole (25 μg) and voriconazole (1μg) as per the Clinical and Laboratory Standards Institute (CLSI - M44-A2) guidelines. A total of 50 culture confirmed (23.7%) cases were detected from 211 clinically suspected VVC cases. Candida glabrata (45.1%) was the most common isolate, followed by Candida tropicalis (23.5%) , Candida albicans (17.6%) , Candida krusei (9.8%) and Candida parapsilosis (3.9%) . One mixed infection of C. glabrata and C. albicans was identified on Candida CHROMagar. Mixed fungal infection was observed in 2% of positive culture and 0.5% of VVC cases. The antifungal susceptibility testing revealed that 15.7% and 9.8% isolates of Candida spp. were resistant and Susceptible Dose Dependent (S-DD) respectively to fluconazole. The increase resistant against fluconazole was because of

  14. PAEDIATRIC OCULAR INJURIES IN A TERTIARY CARE HOSPITAL

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    K. Vinayagamurthy

    2017-08-01

    Full Text Available BACKGROUND Childhood blindness constitutes a burden on the economy of the country and produces psychosocial and emotional disturbance to the child and family at large. Similar to the visual impairment produced by vitamin deficiency state in children, ocular injuries form another group which if identified early and treated promptly can reduce irreversible damage. Eye injuries are responsible for the large scale ocular morbidity worldwide. At extremes of age, the incidence of eye injuries are common because of the negligence in their care. The aim of the study is to determine the prevalence, various mechanisms, agents of injury and environmental influence causing eye injuries in children brought to Ophthalmic Outpatient Department of Chengalpattu Medical College in Kanchipuram District, Tamilnadu. MATERIALS AND METHODS A retrospective review of medical records of 230 children who attended Ophthalmic Outpatient in Chengalpattu Medical College Hospital between 01.09.2015 to 30.09.2016. Records of children of both genders between the age group of (0 to 12 years who attended the Ophthalmic Outpatient Department with history of ocular injury coming from both rural and urban areas of the district. Their data was collected and analysed and tabulated based on demography, mechanism and place of injury. RESULTS School going age groups (5-12 years, 84% sustained injuries more commonly. Children from rural areas sustained 54.7% injuries. Blunt trauma accounted for 65% injuries. 52.6% injuries occurred at home. 41.7% were due to stick and wood. Children were admitted to hospital for a mean of 4 days, range (1-25 days, 96% >6/12 v/a, 3% children had v/a (6/18-6/60, 1% blind 6/60 vision. Bilateral blindness was not reported. 1% visual impairment registered. CONCLUSION This study showed that rural children suffered more ocular injuries;commonest were injuries due to sticks followed by cracker injuries. Home-based injuries were more common. Visual prognosis was

  15. The activities of hospital nursing unit managers and quality of patient care in South African hospitals: a paradox?

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    Susan J. Armstrong

    2015-05-01

    Full Text Available Background: Improving the quality of health care is central to the proposed health care reforms in South Africa. Nursing unit managers play a key role in coordinating patient care activities and in ensuring quality care in hospitals. Objective: This paper examines whether the activities of nursing unit managers facilitate the provision of quality patient care in South African hospitals. Methods: During 2011, a cross-sectional, descriptive study was conducted in nine randomly selected hospitals (six public, three private in two South African provinces. In each hospital, one of each of the medical, surgical, paediatric, and maternity units was selected (n=36. Following informed consent, each unit manager was observed for a period of 2 hours on the survey day and the activities recorded on a minute-by-minute basis. The activities were entered into Microsoft Excel, coded into categories, and analysed according to the time spent on activities in each category. The observation data were complemented by semi-structured interviews with the unit managers who were asked to recall their activities on the day preceding the interview. The interviews were analysed using thematic content analysis. Results: The study found that nursing unit managers spent 25.8% of their time on direct patient care, 16% on hospital administration, 14% on patient administration, 3.6% on education, 13.4% on support and communication, 3.9% on managing stock and equipment, 11.5% on staff management, and 11.8% on miscellaneous activities. There were also numerous interruptions and distractions. The semi-structured interviews revealed concordance between unit managers’ recall of the time spent on patient care, but a marked inflation of their perceived time spent on hospital administration. Conclusion: The creation of an enabling practice environment, supportive executive management, and continuing professional development are needed to enable nursing managers to lead the provision

  16. Discontinued Information and Communication Technology Usage among Older Adults in Continuing Care Retirement Communities in the United States.

    Science.gov (United States)

    Rikard, R V; Berkowsky, Ronald W; Cotten, Shelia R

    2018-01-01

    Older adults are increasingly using information and communication technologies (ICTs). Recent studies show beneficial effects of using ICTs for older adults, particularly in terms of reducing loneliness and depression. However, little is known about the factors that may prevent discontinued ICT use in populations that may be at greater risk, such as those in continuing care retirement communities (CCRCs). The purpose of this study is to examine a range of factors that may influence discontinued (1) ICT use, (2) searching for health information, and (3) searching for general information over time among CCRC residents. We use longitudinal data from a randomized controlled trial conducted with residents of 19 CCRCs. We use flexible parametric models to estimate the hazard ratio or hazard rate over 5 waves of data to determine what factors significantly predict discontinued (1) ICT use, (2) health information searching, and (3) general information searching. The analysis reveals that independent living residents who took part in an 8-week ICT training intervention were less likely to stop using ICTs. Age and the number of instrumental activities of daily living (IADL) impairments significantly predicted an increased likelihood of stopping ICT use. When examining specific ICT-related activities, the analysis reveals that independent living residents who took part in the ICT training intervention were less likely to stop searching for health information and general information online. In addition, age and the number of IADL impairments were associated with increased likelihood of discontinued health information searches and discontinued general information searches. ICT training interventions may motivate residents of CCRCs to stay connected by increasing the ICT skill level and promoting confidence, thus decreasing the probability that they will discontinue using ICTs and searching for general information. However, the effects of ICT training on motivating continued ICT

  17. Drug utilization study in a burn care unit of a tertiary care hospital

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    Santoshkumar R Jeevangi

    2011-03-01

    Full Text Available Objective: To evaluate drug utilization and associated costs for the treatment of patients admitted in burn care unit of a tertiary care hospital. Methods: A prospective cross sectional study was conducted for a period of 15 months at Basaweshwara Teaching and General Hospital (BTGH, Gulbarga and the data collected was analyzed for various drug use indicators. Results: A total of 100 prescriptions were collected with 44% belonging to males and 56% to females. The average number of drugs per prescription ranged from 4.5 to 9.5. 9.5% of generics and 92% of essential drugs were prescribed. The opioid analgesics and sedatives were prescribed to all the patients who were admitted in burn care unit. The (Defined daily dose DDD/1 000/day for amikacin (359 was the highest followed by diclofenac sodium (156, pantoprazole (144, diazepam (130, ceftazidime (124, tramadol (115, ceftriaxone (84 and for paracetamol (4 which was the lowest. Conclusions: Significant amount of the money was spent on procurement of drugs. Most of the money was spent on prescribed antibiotics. The prescription of generic drugs should be promoted, for cost effective treatment. Hence the results of the present study indicate that there is a considerable scope for improvement in the prescription pattern.

  18. The financial burden of cancer: Estimates from patients undergoing cancer care in a tertiary care hospital

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    Zaidi Adnan A

    2012-10-01

    Full Text Available Abstract Introduction The emotional burden associated with the diagnosis of cancer is sometimes overshadowed by financial burden sustained by patient and the family. This is especially relevant for a developing country as there is limited state support for cancer treatment. We conducted this study to estimate the cost of cancer care for two major types of cancer and to assess the perception of patients and families regarding the burden of the cost for undergoing cancer treatment at a private tertiary care hospital. Methods This cross-sectional study was conducted at day care and radiotherapy unit of Aga Khan University, Hospital (AKUH Karachi, Pakistan. All adult patients with breast and head & neck cancers diagnosed for 3 months or more were included. Data was collected using a structured questionnaire and analysed using SPSS. Results Sixty seven patients were interviewed during the study period. The mean and median monthly income of these patients was 996.4 USD and 562.5 USD respectively. Comparatively the mean and median monthly cost of cancer care was 1093.13 USD and 946.42 USD respectively. The cost of the treatment either fully or partially was borne by the family in most cases (94%. The financial burden of cancer was perceived as significant by 28 (42% patients and unmanageable by 18 (27% patients. This perceived level of burden was associated significantly with average monthly income (p = Conclusion Our study indicates that the financial burden of cancer care is substantial and can be overwhelming. There is a desperate need for treatment support programs either by the government or other welfare organisations to support individuals and families who are already facing a difficult and challenging situation.

  19. Mothers’ experiences of labour in a tertiary care hospital

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    M S Maputle

    2008-11-01

    Full Text Available The purpose of the study was to explore and describe experiences of mothers during childbirth in a tertiary hospital in the Limpopo Province. This was achieved through a qualitative research study which was exploratory, descriptive, contextual and inductive in nature. A sample of 24 mothers participated in this study. Data obtained from unstructured in-depth interviews were analysed according to the protocol by Tesch (1990, cited in Cresswell, 1994:155. Five themes were identified, namely mutual participation and responsibility sharing, dependency and decision-making; information sharing and empowering autonomy and informed choices; open communication and listening; accommodative/non-accommodative midwifery actions; and maximising human and material infrastructure. The themes indicated experiences that foster or promote dependency on midwifery care. Guidelines on how to transform this dependency into a mother-centered care approach during childbirth are provided. Opsomming Die doel van die studie was om moeders se belewenis van kindergeboorte in ’n tersiêre hospitaal in die Limpopo Provinsie te verken en te beskryf. Dit is gedoen deur middel van kwalitatiewe navorsing wat verkennend, beskrywend, en kontekstueel was. ‘n Steekproef van 24 moeders het aan die studie deelgeneem. Inligting is verkry deur middel van ongestruktureerde in-diepte onderhoude. Hierdie inligting is geanaliseer aan die hand van Tesch (1990: aangehaal in Creswell, 1994:155 se protokol. Die volgende kategorieë is geïdentifiseer, wedersydse deelname en gedeelde verantwoordelik- hede, afhanklikheid en besluitneming, deel van inligting, bemagtiging tot outonomie en ingeligte keuse, oop kommunikasie en luister, akkommoderende/nie-akkommoderende vroedvrou-aksies en bevordering van menslike en materiële infrastrukture. Die resultate van die onderhoude het belewenisse blootgelê wat dui op die bevordering van afhanklikheid in vroedvrouversorging. Riglyne om hierdie

  20. Care complexity in the general hospital - Results from a European study

    NARCIS (Netherlands)

    de Jonge, P; Huyse, FJ; Slaets, JPJ; Herzog, T; Lobo, A; Lyons, JS; Opmeer, BC; Stein, B; Arolt, [No Value; Balogh, N; Cardoso, G; Fink, P; Rigatelli, M; van Dijck, R; Mellenbergh, GJ

    2001-01-01

    There is increasing pressure to effectively treat patients with complex care needs from the moment of admission to the general hospital. In this study, the authors developed a measurement strategy for hospital-based care complexity. The authors' four-factor model describes the interrelations between

  1. Quantifying the demand for hospital care services: a time and motion study.

    Science.gov (United States)

    van Oostveen, Catharina J; Gouma, Dirk J; Bakker, Piet J; Ubbink, Dirk T

    2015-01-22

    The actual amount of care hospitalised patients need is unclear. A model to quantify the demand for hospital care services among various clinical specialties would avail healthcare professionals and managers to anticipate the demand and costs for clinical care. Three medical specialties in a Dutch university hospital participated in this prospective time and motion study. To include a representative sample of patients admitted to clinical wards, the most common admission diagnoses were selected from the most recent update of the national medical registry (LMR) of ICD-10 admission diagnoses. The investigators recorded the time spent by physicians and nurses on patient care. Also the costs involved in medical and nursing care, (surgical) interventions, and diagnostic procedures as an estimate of the demand for hospital care services per hospitalised patient were calculated and cumulated. Linear regression analysis was applied to determine significant factors including patient and healthcare outcome characteristics. Fifty patients on the Surgery (19), Pediatrics (17), and Obstetrics & Gynecology (14) wards were monitored during their hospitalization. Characteristics significantly associated with the demand for healthcare were: polypharmacy during hospitalization, complication severity level, and whether a surgical intervention was performed. A set of predictors of the demand for hospital care services was found applicable to different clinical specialties. These factors can all be identified during hospitalization and be used as a managerial tool to monitor the patients' demand for hospital care services and to detect trends in time.

  2. New directions for hospital strategic management: the market for efficient care.

    Science.gov (United States)

    Chilingerian, J A

    1992-01-01

    An analysis of current trends in the health care industry points to buyers seeking high quality, yet efficient, care as an emerging market segment. To target this market segment, hospitals must be prepared to market the efficient physicians. In the coming years, hospitals that can identify and market their best practicing providers will achieve a competitive advantage.

  3. The need for hospital care of patients with clinically localized prostate cancer managed by noncurative intent

    DEFF Research Database (Denmark)

    Brasso, Klaus; Friis, S; Juel, K

    2000-01-01

    We studied the need for hospital care of patients 74 years old or younger with clinically localized prostate cancer managed by deferred endocrine therapy.......We studied the need for hospital care of patients 74 years old or younger with clinically localized prostate cancer managed by deferred endocrine therapy....

  4. ANALYSIS OF ORGANOPHOSPHORUS POISONING, AT TERTIARY CARE HOSPITAL: A REPORT

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    Shakuntala

    2015-01-01

    Full Text Available BACKGROUND: Organophosphorus (OP compounds are the most common suicidal poison in developing countries and mortality continues to be high. The present study was aimed to know the pattern and outcome of the OP poisoning. METHODOLOGY: A record based retrospective study from January 2013 - December 2013 was Conducted in a tertiary care hospital and data regarding age, gender, domicile, type of poison, manner of poisoning, seasonal trends, marital status, motive behind poisoning , socio - economic status and outcome was collected in a pre - structured Performa. All data were documented, analyzed and interpreted as per the laid down protocol. RESULTS : out of total 1575 cases of OP compound poisoning, 71.73% (1130 were male, 28.27% (445 were female, 34.6% were in the age group 21 - 30 years, 70.95% were of low socio - economic status, Occupation wise agricultural workers were on top of the list (70.07%, The commonest (93.78% motive behind poisoning was suicidal in both males and females, Financial problem was one of the commonest (51.22% reasons of poisoning. The mortality rate in our study was 13.47%. CONCLUSION : Y oung and adult males of Low socio - economic class, rural, both literate and illiterate agriculturists commonly abuse this substance to commit suicide

  5. CLINICAL PROFILE OF ANAEMIA IN A TERTIARY CARE HOSPITAL

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    Ather Akhtar

    2016-04-01

    22 and the morphology was normocytic normochromic in 20 cases. Tuberculosis leading to anaemia was seen in 24, Internal haemorrhoids/Fissures 5, Taenia infestation in 3, Haematological Malignancies 2, GI Malignancies 3, Connective tissues disorders 3, Nutritional iron deficiency 8 and Anaemia of chronic diseases in remaining cases. Among the 22 cases having macrocytic anaemia, 11 had vitamin B 12 deficiency, 6 had subclinical hypothyroidism, 5 had alcoholism. Among the 20 patients having normocytic normochromic blood picture, 4 had haemolytic anaemia, 1 had aplastic anaemia and remaining were having anaemia of chronic disease mainly chronic kidney disease. Regarding treatment, 23 patients were transfused blood. Out of total 100 patients included in the study, in-hospital mortality was 10. CONCLUSIONS Anaemia is associated with a variety of diseases. As Tuberculosis and B 12 Deficiency are among the leading causes of anaemia, hypochromic and microcytic picture was the predominant picture in peripheral blood smear. Among the patients having normocytic normochromic blood picture, majority were having chronic kidney disease which may be due to the fact that our hospital is a tertiary referral centre for chronic renal failure. In-hospital mortality due to anaemia alone is lower in tertiary care centres, but the mortality in our study is due to associated comorbid conditions like chronic renal failure and malignancy.

  6. Professional responses to post bureaucratic hospital reforms and their impact on care provision

    DEFF Research Database (Denmark)

    Johnsen, Helle

    2015-01-01

    Background Post bureaucracy is increasingly shaping how health care professionals work. Within hospital settings, post bureaucracy is frequently connected to loss of professional autonomy and protocol-based care. However, this development also affects relationships between care providers and care......, performativity demands, litigation risks and rising administrative obligations are liable to challenge the provision of woman centred care. These changes may also result in increased inequity in maternity care by affecting some groups of women more than others.......Background Post bureaucracy is increasingly shaping how health care professionals work. Within hospital settings, post bureaucracy is frequently connected to loss of professional autonomy and protocol-based care. However, this development also affects relationships between care providers and care...... of patients. ‘Managerial control of work’ which described rising administrative demands, engaging in protective measures, younger professionals pressured by documentation obligations and fear of disciplinary procedures. Conclusion The institutional context appears to play a key role shaping care practices...

  7. The association of debt financing with not-for-profit hospitals' provision of uncompensated care.

    Science.gov (United States)

    Magnus, Stephen A; Smith, Dean G; Wheeler, John R C

    2004-01-01

    Not-for-profit hospitals undertook unprecedented amounts of debt in the mid to late 1990s. Corporate finance theory and the literature on hospital financing suggest that debt may constrain hospitals' capacity to deliver uncompensated care. Using data from audited financial statements for a sample of hospitals, this article explores whether debt financing is associated with hospitals' provision of uncompensated care, an output central to many hospitals' service missions. Contrary to expectations, our analysis finds that higher debt is associated with higher levels of uncompensated care. However, the results may reflect the unusual economic and stock-market conditions prevailing in the mid 1990s, and they are consistent with the views of hospital financial managers and other practitioners whom we interviewed.

  8. Cost and Predictors of Hospitalizations for Ambulatory Care - Sensitive Conditions Among Medicaid Enrollees in Comprehensive Managed Care Plans

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    William N. Mkanta

    2016-09-01

    Full Text Available Introduction: Preventable hospitalizations are responsible for increasing the cost of health care and reflect ineffectiveness of the health services in the primary care setting. The objective of this study was to assess expenditure for hospitalizations and utilize expenditure differentials to determine factors associated with ambulatory care - sensitive conditions (ACSCs hospitalizations. Methods: A cross-sectional study of hospitalizations among Medicaid enrollees in comprehensive managed care plans in 2009 was conducted. A total of 25 581 patients were included in the analysis. Expenditures on hospitalizations were examined at the 50th, 75th, 90th, and 95th expenditure percentiles both at the bivariate level and in the logistic regression model to determine the impact of differing expenditure on ACSC hospitalizations. Results: Compared with patients without ACSC admissions, a larger proportion of patients with ACSC hospitalizations required advanced treatment or died on admission. Overall mean expenditures were higher for the ACSC group than for non-ACSC group (US$18 070 vs US$14 452. Whites and blacks had higher expenditures for ACSC hospitalization than Hispanics at all expenditure percentiles. Patient’s age remained a consistent predictor of ACSC hospitalization across all expenditure percentiles. Patients with ACSC were less likely to have a procedure on admission; however, the likelihood decreased as expenditure percentiles increased. At the median expenditure, blacks and Hispanics were more likely than other race/ethnic groups to have ACSC hospitalizations (odds ratio [OR]: 1.307, 95% confidence interval [CI]: 1.013-1.686 and OR 1.252, 95% CI: 1.060-1.479, respectively. Conclusion: Future review of delivery and monitoring of services at the primary care setting should include managed care plans in order to enhance access and overall quality of care for optimal utilization of the resources.

  9. AFEM Consensus Conference, 2013. AFEM Out-of-Hospital Emergency Care Workgroup Consensus Paper: Advancing Out-of-Hospital Emergency Care in Africa-Advocacy and Development

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    N.K. Mould-Millman

    2014-06-01

    Future directions of the AFEM Out-of-Hospital Emergency Care Workgroup include creating an online Toolkit. This will serve as a repository of template documents to guide implementation and development of clinical care, education, transportation, public access, policy and governance.

  10. Intrapartum and Postpartum Transfers to a Tertiary Care Hospital from Out-of-Hospital Birth Settings: A Retrospective Case Series.

    Science.gov (United States)

    Lundeen, Tiffany

    2016-01-01

    This study describes the reasons for and outcomes of maternal transfers from private homes and freestanding birthing suites to a large academic hospital in order to better understand and meet the needs of transferring women and their families. The convenience sample included all adult women admitted to the labor and birth unit or emergency room within a 5-year period who: 1) had planned to give birth out-of-hospital but developed complications at term before the onset of labor and were admitted to the hospital for labor induction; 2) had planned to give birth at home or in a birthing suite but transferred to the hospital during labor; or 3) arrived at the hospital for care within 24 hours after a planned birth at home or in a birthing suite. Descriptive data for each transfer were obtained from the medical record. Fifty-one transfers were identified: 11 prior to labor, 38 during labor, and 2 postpartum. Only 4 transfers were considered urgent by the referring provider. The most common reasons for intrapartum transfer were prolonged labor (n = 19) and desire for epidural analgesia (n = 10). Only 25% of the medical records had documentation that the referring provider accompanied the woman to the hospital during the care transition or was involved in her hospital course; however, the prenatal and/or intrapartum records had been delivered by the referring provider, were referenced in the hospital admission note, and had become part of the permanent hospital medical record for 85% of the women. On average, one transfer per year was complicated by neonatal morbidity, and one transfer per year involved significant disagreement between hospital providers and the women presenting for care. Collecting and reviewing data about a facility's perinatal transfer events can help the local multi-stakeholder group appraise current practice and plan for quality improvement. © 2016 by the American College of Nurse-Midwives.

  11. Cost variation in diabetes care delivered in English hospitals

    DEFF Research Database (Denmark)

    Kristensen, Troels; Laudicella, Mauro; Ejersted, Charlotte

    2010-01-01

    are transferred between hospitals, suffer infections and other complications, or for those who die in hospital. Even so, around 8-9% of the variation in costs is related to the hospital in which the patient is treated, with geographical variation in factor prices being the prime reason for this variation...

  12. Rural hospitals: an asset in the continuum of care.

    Science.gov (United States)

    Arduino, Kelly

    2015-11-01

    When embarking on a partnership or acquisition, a rural hospital and a larger health system can accomplish a smooth transition, as long as they both keep in mind: > The fundamental (and financial) differences between urban and rural hospitals > The areas where the rural hospital in the partnership or acquisition is profitable > The importance of a clinic strategy in a partnership.

  13. Insular pathways to health care in the city: a multilevel analysis of access to hospital care in urban Kerala, India.

    Science.gov (United States)

    Levesque, Jean-Frédéric; Haddad, Slim; Narayana, Delampady; Fournier, Pierre

    2007-07-01

    To identify individual and urban unit characteristics associated with access to inpatient care in public and private sectors in urban Kerala, and to discuss policy implications of inequalities in access. We analysed the NSSO survey (1995-1996) for urban Kerala with regard to source and trajectories of hospitalization. Multinomial multilevel regression models were built for 695 cases nested in 24 urban units. Private sector accounts for 62% of hospitalizations. Only 31% of hospitalizations are in free wards and 20% of public hospitalizations involve payment. Hospitalization pathways suggest a segmentation of public and private health markets. Members of poor and casual worker households have lower propensity of hospitalization in paying public wards or private hospitals. There were important variations between cities, with higher odds of private hospitalization in towns with fewer hospital beds overall and in districts with high private-public bed ratios. Cities from districts with better economic indicators and dominance of private services have higher proportion of private hospitalizations. The private sector is the predominant source of inpatient care in urban Kerala. The public sector has an important role in providing access to care for the poor. Investing in the quality of public services is essential to ensure equity in access.

  14. A smartphone-enabled communication system to improve hospital communication: usage and perceptions of medical trainees and nurses on general internal medicine wards.

    Science.gov (United States)

    Wu, Robert; Lo, Vivian; Morra, Dante; Appel, Eva; Arany, Teri; Curiale, Beth; Ryan, Joanne; Quan, Sherman

    2015-02-01

    There is increasing interest in the use of information and communication technologies to improve how clinicians communicate in hospital settings. We implemented a communication system with support for physician handover and secure messaging on 2 general internal medicine wards. We measured usage and surveyed physicians and nurses on perceptions of the system's effects on communication. Between May 2011 and August 2012, a clinical teaching team received, on average, 14.8 messages per day through the system. Messages were typically sent as urgent (69.1%) and requested a text reply (76.5%). For messages requesting a text reply, 8.6% did not receive a reply. For those messages that did receive a reply, the median response time was 2.3 minutes, and 84.5% of messages received a reply within 15 minutes. Of those who completed the survey, 95.3% were medical residents (82 of 86) and 81.7% were nurses (83 of 116). Medical trainees (82.8%) and nursing staff (78.3%) agreed or strongly agreed that the system helped to speed up their daily work tasks. Overall, 67.1% of the trainees and 73.2% of nurses agreed or strongly agreed that the system made them more accountable in their clinical roles. Only 35.8% of physicians and 26.3% of nurses agreed or strongly agreed that the system was useful for communicating complex issues. In summary, with a system designed to improve communication, we found that there was high uptake and that users perceived that the system improved efficiency and accountability but was not appropriate for communicating complex issues. © 2014 Society of Hospital Medicine.

  15. Hospital-Based Acute Care After Total Hip and Knee Arthroplasty: Implications for Quality Measurement.

    Science.gov (United States)

    Trimba, Roman; Laughlin, Richard T; Krishnamurthy, Anil; Ross, Joseph S; Fox, Justin P

    2016-03-01

    Although hospital readmissions are being adopted as a quality measure after total hip or knee arthroplasty, they may fail accurately capture the patient's postdischarge experience. We studied 272,853 discharges from 517 hospitals to determine hospital emergency department (ED) visit and readmission rates. The hospital-level, 30-day, risk-standardized ED visit (median = 5.6% [2.4%-13.7%]) and hospital readmission (5.0% [2.6%-9.2%]) rates were similar and varied widely. A hospital's risk-standardized ED visit rate did not correlate with its readmission rate (r = -0.03, P = .50). If ED visits were included in a broader "readmission" measure, 246 (47.6%) hospitals would change perceived performance groups. Including ED visits in a broader, hospital-based, acute care measure may be warranted to better describe postdischarge health care utilization. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Toward estimating the impact of changes in immigrants' insurance eligibility on hospital expenditures for uncompensated care

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    Curtis Lesley H

    2003-01-01

    Full Text Available Abstract Background The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA of 1996 gave states the option to withdraw Medicaid coverage of nonemergency care from most legal immigrants. Our goal was to assess the effect of PRWORA on hospital uncompensated care in the United States. Methods We collected the following state-level data for the period from 1994 through 1999: foreign-born, noncitizen population and health uninsurance rates (US Census Current Population Survey; percentage of teaching hospitals (American Hospital Association Annual Survey of Hospitals; and each state's decision whether to implement the PRWORA Medicaid bar for legal permanent residents or to continue offering nonemergency Medicaid coverage using state-only funds (Urban Institute. We modeled uncompensated care expenditures by state (also from the Annual Survey of Hospitals in both univariate and multivariable regression analyses. Results When measured at the state level, there was no significant relationship between uncompensated care expenditures and states' percentage of noncitizen immigrants. Uninsurance rates were the only significant factor in predicting uncompensated hospital care expenditures by state. Conclusions Reducing the number of uninsured patients would most surely reduce hospital expenditures for uncompensated care. However, data limitations hampered our efforts to obtain a monetary estimate of hospitals' financial losses due specifically to the immigrant eligibility changes in PRWORA. Quantifying the impact of these provisions on hospitals will require better data sources.

  17. Quality of care and patient satisfaction in hospitals with high concentrations of black patients.

    Science.gov (United States)

    Brooks-Carthon, J Margo; Kutney-Lee, Ann; Sloane, Douglas M; Cimiotti, Jeannie P; Aiken, Linda H

    2011-09-01

    To examine the influence of nursing-specifically nurse staffing and the nurse work environment-on quality of care and patient satisfaction in hospitals with varying concentrations of Black patients. Cross-sectional secondary analysis of 2006-2007 nurse survey data collected across four states (Florida, Pennsylvania, New Jersey, and California), the Hospital Consumer Assessment of Healthcare Providers and Systems survey, and administrative data. Global analysis of variance and linear regression models were used to examine the association between the concentration of Black patients on quality measures (readiness for discharge, patient or family complaints, health care-associated infections) and patient satisfaction, before and after accounting for nursing and hospital characteristics. Nurses working in hospitals with higher concentrations of Blacks reported poorer confidence in patients' readiness for discharge and more frequent complaints and infections. Patients treated in hospitals with higher concentrations of Blacks were less satisfied with their care. In the fully adjusted regression models for quality and patient satisfaction outcomes, the effects associated with the concentration of Blacks were explained in part by nursing and structural hospital characteristics. This study demonstrates a relationship between nursing, structural hospital characteristics, quality of care, and patient satisfaction in hospitals with high concentrations of Black patients. Consideration of nursing factors, in addition to other important hospital characteristics, is critical to understanding and improving quality of care and patient satisfaction in minority-serving hospitals. © 2011 Sigma Theta Tau International.

  18. Knowledge gap regarding dementia care among nurses in Taiwanese acute care hospitals: A cross-sectional study.

    Science.gov (United States)

    Lin, Pei-Chao; Hsieh, Mei-Hui; Chen, Meng-Chin; Yang, Yung-Mei; Lin, Li-Chan

    2018-02-01

    The quality of dementia care in hospitals is typically substandard. Staff members are underprepared for providing care to older people with dementia. The objective of the present study was to examine dementia care knowledge, attitude and behavior regarding self-education about dementia care among nurses working in different wards. This was a descriptive cross-sectional study. The present study was carried out from July 2013 to December 2013. In total, 387 nurses working in different wards were recruited from two hospitals in Taiwan by using convenience sampling. The nurses completed a self-report questionnaire on demographic data, experience and learning behavior, and attitude towards dementia care, and a 16-item questionnaire on dementia care knowledge. Descriptive and inferential statistics were used to analyze the status and differences in dementia care knowledge among nurse in different wards. The average dementia care knowledge score was 10.46 (SD 2.13), with a 66.5% mean accuracy among all nurses. Dementia care knowledge was significantly associated with age, nursing experience, possession of a registered nurse license, holding a bachelor's degree, work unit, training courses and learning behavior towards dementia care. The dementia care knowledge of the emergency room nurses was significantly lower than that of the psychiatric and neurology ward nurses. A significantly lower percentage of emergency room nurses underwent dementia care training and actively searched for information on dementia care, compared with the psychiatric and neurology ward nurses. Hospital nurses show a knowledge gap regarding dementia care, especially emergency room nurses. Providing dementia care training to hospital nurses, particularly emergency room nurses, is crucial for improving the quality of care for patients with dementia. Geriatr Gerontol Int 2018; 18: 276-285. © 2017 Japan Geriatrics Society.

  19. Does state budget pressure matter for uncompensated care spending in hospitals? Findings from Texas and California.

    Science.gov (United States)

    Chang, Jongwha; Patel, Isha; Suh, Won S; Lin, Hsien-Chang; Kim, Sunjung; Balkrishnan, Rajesh

    2012-01-01

    This study examined the impact of state budget cuts on uncompensated care at general acute care hospital organizations. This study capitalized on the variations in the states of Texas and California to form a natural experiment testing the joint impact of budget cut status on uncompensated care costs, as well as specific charity care costs and bad debt expenses from indigent patients. Budget cuts in the state of Texas occurred in the year 2004. Information was obtained from the Texas Department of Health and the California Department of Health Services regarding financial characteristics of hospitals and from the American Hospital Directory annual survey regarding organizational characteristics of hospitals. We created three dependent variables: R(UC) (the ratio of total uncompensated care costs to gross patient revenue), R(CC) (the ratio of charity care to total patient revenue) and R(BD) (the ratio of bad debt expenses to gross patient revenue). Using a two-period panel data set and individual hospital fixed effects, we captured hospital uncompensated care spending that could also have influenced budget cut status. Additionally, the impact of the state budget cut status on hospitals' uncompensated care spending, charity care spending and bad debt expenses was also estimated using the similar methodology. In this study, we included 416 (in Texas) and 352 (in California) public, not-for-profit (NFP) and for-profit (FP) hospitals that completed the annual survey during the study period 2002-2005. For the state of Texas, results from the fixed effect model confirmed that the year 2005 was directly related to increased R(UC) and R(CC) . The coefficients of 2005 were significantly and positively associated with R(UC) (0.43, p budget cut pressure on uncompensated care provided in Texas general acute care hospitals. Copyright © 2012 John Wiley & Sons, Ltd.

  20. Organisation and Evaluation of General Palliative Care in a Danish Hospital

    DEFF Research Database (Denmark)

    Bergenholtz, Heidi; Hølge-Hazelton, Bibi; Jarlbæk, Lene

    2015-01-01

    and evaluation of generalist palliative care in hospitals. Therefore the aim of the study was to investigate the organization and evaluation of generalist palliative care in a large regional hospital by comparing results from existing evaluations. Methods: Results from three different data sets, all aiming...... of palliative care in order to identify concordances and/or discrepancies. Results: The triangulation indicated poor validity of the results from existing methods used to evaluate palliativecare in hospitals. When the datasets were compared, several discrepancies occurred with regard to the organizationand...... the performance of generalist palliative care. Five types of discrepancies were found in 35 out of 56 sections inthe fulfilment of the national accreditation standard for palliative care. Responses from the hospital management and the department managements indicated that generalist palliative care was organized...

  1. Identifying Challenges Associated With the Care Transition Workflow From Hospital to Skilled Home Health Care: Perspectives of Home Health Care Agency Providers.

    Science.gov (United States)

    Nasarwanji, Mahiyar; Werner, Nicole E; Carl, Kimberly; Hohl, Dawn; Leff, Bruce; Gurses, Ayse P; Arbaje, Alicia I

    2015-01-01

    Older adults discharged from the hospital to skilled home health care (SHHC) are at high risk for experiencing suboptimal transitions. Using the human factors approach of shadowing and contextual inquiry, we studied the workflow for transitioning older adults from the hospital to SHHC. We created a representative diagram of the hospital to SHHC transition workflow, we examined potential workflow variations, we categorized workflow challenges, and we identified artifacts developed to manage variations and challenges. We identified three overarching challenges to optimal care transitions-information access, coordination, and communication/teamwork. Future investigations could test whether redesigning the transition from hospital to SHHC, based on our findings, improves workflow and care quality.

  2. Knowledge about complementary, alternative and integrative medicine (CAM) among registered health care providers in Swedish surgical care: a national survey among university hospitals.

    Science.gov (United States)

    Bjerså, Kristofer; Stener Victorin, Elisabet; Fagevik Olsén, Monika

    2012-04-12

    Previous studies show an increased interest and usage of complementary and alternative medicine (CAM) in the general population and among health care workers both internationally and nationally. CAM usage is also reported to be common among surgical patients. Earlier international studies have reported that a large amount of surgical patients use it prior to and after surgery. Recent publications indicate a weak knowledge about CAM among health care workers. However the current situation in Sweden is unknown. The aim of this study was therefore to explore perceived knowledge about CAM among registered healthcare professions in surgical departments at Swedish university hospitals. A questionnaire was distributed to 1757 registered physicians, nurses and physiotherapists in surgical wards at the seven university hospitals in Sweden from spring 2010 to spring 2011. The questionnaire included classification of 21 therapies into conventional, complementary, alternative and integrative, and whether patients were recommended these therapies. Questions concerning knowledge, research, and patient communication about CAM were also included. A total of 737 (42.0%) questionnaires were returned. Therapies classified as complementary; were massage, manual therapies, yoga and acupuncture. Alternative therapies; were herbal medicine, dietary supplements, homeopathy and healing. Classification to integrative therapy was low, and unfamiliar therapies were Bowen therapy, iridology and Rosen method. Therapies recommended by > 40% off the participants were massage and acupuncture. Knowledge and research about CAM was valued as minor or none at all by 95.7% respectively 99.2%. Importance of possessing knowledge about it was valued as important by 80.9%. It was believed by 61.2% that more research funding should be addressed to CAM research, 72.8% were interested in reading CAM-research results, and 27.8% would consider taking part in such research. Half of the participants (55.8%) were

  3. Knowledge about complementary, alternative and integrative medicine (CAM among registered health care providers in Swedish surgical care: a national survey among university hospitals

    Directory of Open Access Journals (Sweden)

    Bjerså Kristofer

    2012-04-01

    Full Text Available Abstract Background Previous studies show an increased interest and usage of complementary and alternative medicine (CAM in the general population and among health care workers both internationally and nationally. CAM usage is also reported to be common among surgical patients. Earlier international studies have reported that a large amount of surgical patients use it prior to and after surgery. Recent publications indicate a weak knowledge about CAM among health care workers. However the current situation in Sweden is unknown. The aim of this study was therefore to explore perceived knowledge about CAM among registered healthcare professions in surgical departments at Swedish university hospitals. Method A questionnaire was distributed to 1757 registered physicians, nurses and physiotherapists in surgical wards at the seven university hospitals in Sweden from spring 2010 to spring 2011. The questionnaire included classification of 21 therapies into conventional, complementary, alternative and integrative, and whether patients were recommended these therapies. Questions concerning knowledge, research, and patient communication about CAM were also included. Result A total of 737 (42.0% questionnaires were returned. Therapies classified as complementary; were massage, manual therapies, yoga and acupuncture. Alternative therapies; were herbal medicine, dietary supplements, homeopathy and healing. Classification to integrative therapy was low, and unfamiliar therapies were Bowen therapy, iridology and Rosen method. Therapies recommended by > 40% off the participants were massage and acupuncture. Knowledge and research about CAM was valued as minor or none at all by 95.7% respectively 99.2%. Importance of possessing knowledge about it was valued as important by 80.9%. It was believed by 61.2% that more research funding should be addressed to CAM research, 72.8% were interested in reading CAM-research results, and 27.8% would consider taking part in

  4. [Dementia friendly care services in general hospitals : Representative results of the general hospital study (GHoSt)].

    Science.gov (United States)

    Hendlmeier, Ingrid; Bickel, Horst; Hessler, Johannes Baltasar; Weber, Joshua; Junge, Magdalena Nora; Leonhardt, Sarah; Schäufele, Martina

    2017-11-06

    Mostly model projects report on special care services and procedures for general hospital patients with cognitive impairment. The objective of this study was to determine the frequency of special care services and procedures in general hospitals on the basis of a representative cross-sectional study. From a list of all general hospitals in southern Germany we randomly selected a specified number of hospitals und somatic wards. The hospitals were visited and all older patients on the selected wards on that day were included in the study. Information about care services and their utilization was collected with standardized instruments. A total of 33 general hospitals and 172 wards participated in the study. The patient sample included 1469 persons over 65 (mean age 78.6 years) and 40% of the patients showed cognitive impairments. The staff reported that the most frequent measures for patients with cognitive impairments concerned patients with wandering behavior (63.1%), efforts to involve the patients' relatives to help with their daily care (60.1%), conducting nonintrusive interviews to identify cognitive impairments (59.9%), allocation to other rooms (58%) and visual aids for place orientation of patients (50.6%). In accordance with earlier studies our results show that other dementia friendly services implemented in pilot projects were rare. The existing special services for patients with cognitive impairment were rarely used by the patients or their relatives. The results demonstrate the urgent need to improve special care services and routines for identification of elderly patients with cognitive impairment and risk of delirium in general hospitals.

  5. Determinants of care outcomes for patients who die in hospital in Ireland: a retrospective study.

    LENUS (Irish Health Repository)

    McKeown, Kieran

    2015-04-18

    More people die in hospital than in any other setting which is why it is important to study the outcomes of hospital care at end of life. This study analyses what influenced outcomes in a sample of patients who died in hospital in Ireland in 2008\\/9. The study was undertaken as part of the Irish Hospice Foundation\\'s Hospice Friendly Hospitals Programme (2007-2012).

  6. Study of radiation safety education practices in acute care Texas hospitals

    International Nuclear Information System (INIS)

    Lemley, A.A.; Hedl, J.J. Jr.; Griffin, E.E.

    1987-01-01

    A survey study was performed to assess the extent of radiation safety education and training in acute care Texas hospitals for radiologic technologists and other hospital personnel. The findings revealed a self-perceived need by hospital administrative personnel and were interpreted to suggest a quantitative need for increased radiation safety education for several classes of hospital personnel. The findings are discussed relative to potential certification requirements for technologists and implications for the training of other personnel

  7. Rising Billing for Intermediate Intensive Care among Hospitalized Medicare Beneficiaries between 1996 and 2010.

    Science.gov (United States)

    Sjoding, Michael W; Valley, Thomas S; Prescott, Hallie C; Wunsch, Hannah; Iwashyna, Theodore J; Cooke, Colin R

    2016-01-15

    Intermediate care (i.e., step-down or progressive care) is an alternative to the intensive care unit (ICU) for patients with moderate severity of illness. The adoption and current use of intermediate care is unknown. To characterize trends in intermediate care use among U.S. hospitals. We examined 135 million acute care hospitalizations among elderly individuals (≥65 yr) enrolled in fee-for-service Medicare (U.S. federal health insurance program) from 1996 to 2010. We identified patients receiving intermediate care as those with intensive care or coronary care room and board charges labeled intermediate ICU. In 1996, a total of 960 of the 3,425 hospitals providing critical care billed for intermediate care (28%), and this increased to 1,643 of 2,783 hospitals (59%) in 2010 (P billed for intermediate care, but billing steadily increased to 22.8% by 2010 (P billed for ICU care and ward-only care declined. Patients billed for intermediate care had more acute organ failures diagnoses codes compared with general ward patients (22.4% vs. 15.8%). When compared with patients billed for ICU care, those billed for intermediate care had fewer organ failures (22.4% vs. 43.4%), less mechanical ventilation (0.9% vs. 16.7%), lower mean Medicare spending ($8,514 vs. $18,150), and lower 30-day mortality (5.6% vs. 16.5%) (P billing increased markedly between 1996 and 2010. These findings highlight the need to better define the value, specific practices, and effective use of intermediate care for patients and hospitals.

  8. Observations of oral hygiene care interventions provided by nurses to hospitalized older people.

    Science.gov (United States)

    Coker, Esther; Ploeg, Jenny; Kaasalainen, Sharon; Carter, Nancy

    Dependent older hospitalized patients rely on nurses to assist them with the removal of plaque from their teeth, dentures, and oral cavities. Oral care interventions by 25 nurses on post-acute units, where patients have longer hospital stays, were observed during evening care. In addition to efforts to engage patients in oral care, nurses provided the following interventions: (a) supporting the care of persons with dentures; (b) supporting the care of natural teeth; (c) cleansing the tongue and oral cavity; and (d) moisturizing lips and oral tissues. Patients' oral hygiene care was supported in just over one-third of encounters. Denture care was inconsistently performed, and was infrequently followed by care of the oral cavity. Nurses did not encourage adequate self-care of natural teeth by patients, and infrequently moisturized tissues. Evidence-based oral hygiene care standards are required to assist nurses to support patients in achieving optimal oral hygiene outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Uncompensated care provided by for-profit, not-for-profit, and government owned hospitals.

    Science.gov (United States)

    Cram, Peter; Bayman, Levent; Popescu, Ioana; Vaughan-Sarrazin, Mary S; Cai, Xueya; Rosenthal, Gary E

    2010-04-07

    There is growing concern certain not-for-profit hospitals are not providing enough uncompensated care to justify their tax exempt status. Our objective was to compare the amount of uncompensated care provided by not-for-profit (NFP), for-profit (FP) and government owned hospitals. We used 2005 state inpatient data (SID) for 10 states to identify patients hospitalized for three common conditions: acute myocardial infarction (AMI), coronary artery bypass grafting (CABG), or childbirth. Uncompensated care was measured as the proportion of each hospital's total admissions for each condition that were classified as being uninsured. Hospitals were categorized as NFP, FP, or government owned based upon data obtained from the American Hospital Association. We used bivariate methods to compare the proportion of uninsured patients admitted to NFP, FP and government hospitals for each diagnosis. We then used generalized linear mixed models to compare the percentage of uninsured in each category of hospital after adjusting for the socioeconomic status of the markets each hospital served. Our cohort consisted of 188,117 patients (1,054 hospitals) hospitalized for AMI, 82,261 patients (245 hospitals) for CABG, and 1,091,220 patients for childbirth (793 hospitals). The percentage of admissions classified as uninsured was lower in NFP hospitals than in FP or government hospitals for AMI (4.6% NFP; 6.0% FP; 9.5% government; P < .001), CABG (2.6% NFP; 3.3% FP; 7.0% government; P < .001), and childbirth (3.1% NFP; 4.2% FP; 11.8% government; P < .001). In adjusted analyses, the mean percentage of AMI patients classified as uninsured was similar in NFP and FP hospitals (4.4% vs. 4.3%; P = 0.71), and higher for government hospitals (6.0%; P < .001 for NFP vs. government). Likewise, results demonstrated similar proportions of uninsured patients in NFP and FP hospitals and higher levels of uninsured in government hospitals for both CABG and childbirth. For the three conditions studied NFP

  10. [Evaluations by hospital-ward physicians of patient care management quality for patients hospitalized after an emergency department admission].

    Science.gov (United States)

    Bartiaux, M; Mols, P

    2017-01-01

    patient management in the acute and sub-acute setting of an Emergency Department is challenging. An assessment of the quality of provided care enables an evaluation of failings. It contributes to the identification of areas for improvement. to obtain an analysis, by hospital-ward physicians, of adult patient care management quality, as well as of the correctness of diagnosis made during emergency admissions. To evaluate the consequences of inadequate patient care management on morbidity, mortality and cost and duration of hospitalization. prospective data analysis obtained between the 1/12/2009 and the 21/12/2009 from physicians using a questionnaire on adult-patient emergency admissions and subsequent hospitalization. questionnaires were completed for 332 patients. Inadequate management of patient care were reported for 73/332 (22 %) cases. Incorrect diagnoses were reported for 20/332 (6 %) cases. 35 cases of inadequate care management (10.5 % overall) were associated with morbidity (34 cases) or mortality (1 case), including 4 cases (1.2 % ) that required emergency intensive-care or surgical interventions. this quality study analyzed the percentage of patient management cases and incorrect diagnoses in the emergency department. The data for serious outcome and wrong diagnosis are comparable with current literature. To improve performance, we consider the process for establishing a diagnosis and therapeutic care.

  11. Demand-driven care and hospital choice. Dutch health policy toward demand-driven care: results from a survey into hospital choice.

    Science.gov (United States)

    Lako, Christiaan J; Rosenau, Pauline

    2009-03-01

    In the Netherlands, current policy opinion emphasizes demand-driven health care. Central to this model is the view, advocated by some Dutch health policy makers, that patients should be encouraged to be aware of and make use of health quality and health outcomes information in making personal health care provider choices. The success of the new health care system in the Netherlands is premised on this being the case. After a literature review and description of the new Dutch health care system, the adequacy of this demand-driven health policy is tested. The data from a July 2005, self-administered questionnaire survey of 409 patients (response rate of 94%) as to how they choose a hospital are presented. Results indicate that most patients did not choose by actively employing available quality and outcome information. They were, rather, referred by their general practitioner. Hospital choice is highly related to the importance a patient attaches to his or her physician's opinion about a hospital. Some patients indicated that their hospital choice was affected by the reputation of the hospital, by the distance they lived from the hospital, etc. but physician's advice was, by far, the most important factor. Policy consequences are important; the assumptions underlying the demand-driven model of patient health provider choice are inadequate to explain the pattern of observed responses. An alternative, more adequate model is required, one that takes into account the patient's confidence in physician referral and advice.

  12. Experience of vascular trauma in a tertiary care hospital

    International Nuclear Information System (INIS)

    Imtiaz, N.

    2010-01-01

    To highlight the presentation and management of various vascular injuries and their outcome. Thirty nine cases of vascular trauma were referred to vascular surgeon CMH Rawalpindi, in the above mentioned period. These cases were evaluated for mechanism of injury, age, gender and time of presentation. Out of these, only thirty cases were found suitable for surgical intervention. These thirty cases were evaluated for site of vascular injury, associated injuries, type of surgery performed and the outcome. Blunt trauma was the predominant cause of vascular injuries in our study 16/39 (41%). Fourteen cases (35.8%) had gun shot wounds. Only thirty patients (76.9 %) underwent various surgical procedures. Primary end to end anastomosis was possible in only 5/30 cases (16.6%) while reversed venous graft was used in 13/30 cases (43.3%). Wound infection occurred in 2/30(6.6%) cases out of which 1 case (3.3%) ultimately had an amputation. The time period between injury and surgical intervention ranged between 1 to 20 hours for most of the vascular injuries while delayed presentation in the form of traumatic arteriovenous fistula or pseudoaneurysm was between 48 hours to 3 months. There are reasonable numbers of vascular trauma cases being referred to a tertiary care hospital. Most of these cases reach us quite late due to unnecessary investigations, delayed referral and transportation. Early intervention and revascularization definitely reduces amputation and complication rate. All gunshot wounds not only require thorough surrounding soft tissue debridement but also liberal excision of traumatised vessel itself, resulting in interposition graft repair. (author)

  13. Clinical profile of cerebral malaria at a secondary care hospital

    Directory of Open Access Journals (Sweden)

    Jency Maria Koshy

    2014-01-01

    Full Text Available Introduction: Cerebral malaria (CM is one of the most common causes for non-traumatic encephalopathy in the world. It affects both the urban and rural population. It is a challenge to treat these patients in a resource limited setting; where majority of these cases present. Materials and Methods: This was a prospective study carried out from September 2005 to December 2006 at Jiwan Jyoti Christian Hospital in Eastern Uttar Pradesh in India. This is a secondary level care with limited resources. We studied the clinical profile, treatment and outcome of all the patients above the age of 14 years diagnosed with CM. Results: There were a total of 53 patients with CM of which 38 (71.7% of them were females. Among them, 35 (66% patients were less than 30 years of age. The clinical features noted were seizure (39.62%, anemia (84.9%, icterus (16.98%, hypotension (13.2%, bleeding (3.7%, hepatomegaly (5.66%, splenomegaly (5.66%, non-cardiogenic pulmonary edema (16.98% and renal dysfunction (37.36%. Co-infection with Plasmodium vivax was present in 13 (24.53% of them. Treatment received included artesunin compounds or quinine. Median time of defervescence was 2 (interquartile range1-3. Complete recovery was achieved in 43 (81% of them. Two (3.7% of them died. Conclusion: CM, once considered to be a fatal disease has shown remarkable improvement in the outcome with the wide availability of artesunin and quinine components. To combat the malaria burden, physicians in resource limited setting should be well trained to manage these patients especially in the endemic areas. The key to management is early diagnosis and initiation of treatment based on a high index of suspicion. Anticipation and early recognition of the various complications are crucial.

  14. Health Care Delivery Meets Hospitality: A Pilot Study in Radiology.

    Science.gov (United States)

    Steele, Joseph Rodgers; Jones, A Kyle; Clarke, Ryan K; Shoemaker, Stowe

    2015-06-01

    The patient experience has moved to the forefront of health care-delivery research. The University of Texas MD Anderson Cancer Center Department of Diagnostic Radiology began collaborating in 2011 with the University of Houston Conrad N. Hilton College of Hotel and Restaurant Management, and in 2013 with the University of Nevada, Las Vegas, William F. Harrah College of Hotel Administration, to explore the application of service science to improving the patient experience. A collaborative pilot study was undertaken by these 3 institutions to identify and rank the specific needs and expectations of patients undergoing imaging procedures in the MD Anderson Department of Diagnostic Radiology. We first conducted interviews with patients, providers, and staff to identify factors perceived to affect the patient experience. Next, to confirm these factors and determine their relative importance, we surveyed more than 6,000 patients by e-mail. All factors considered important in the interviews were confirmed as important in the surveys. The surveys showed that the most important factors were acknowledgment of the patient's concerns, being treated with respect, and being treated like a person, not a "number"; these factors were more important than privacy, short waiting times, being able to meet with a radiologist, and being approached by a staff member versus having one's name called out in the waiting room. Our work shows that it is possible to identify and rank factors affecting patient satisfaction using techniques employed by the hospitality industry. Such factors can be used to measure and improve the patient experience. Copyright © 2015 American College of Radiology. Published by Elsevier Inc. All rights reserved.

  15. FAT MYRINGOPLASTY IN A TERTIARY CARE GOVERNMENT HOSPITAL

    Directory of Open Access Journals (Sweden)

    Paidi Ramesh Chandra

    2017-12-01

    Full Text Available BACKGROUND Myringoplasty is the surgical procedure performed for the closure of perforations of pars tensa of the tympanic membrane. Various graft materials are used such as temporalis fascia, periosteum, perichondrium, vein, dura and adipose tissue (fat. Fat myringoplasty is a simple, cost effective and outpatient procedure. This study is performed to evaluate the operative outcome of fat myringoplasty in patients with Chronic Suppurative Otitis Media (CSOM. The aim of the study is to assess graft uptake to assess hearing improvement and to assess the operative outcome in relation to the site of perforation after fat myringoplasty. MATERIALS AND METHODS This study was performed in Government ENT Hospital, Andhra Medical College, Visakhapatnam. A total of 20 patients between the age group of 18-50 years suffering from tubotympanic type of chronic suppurative otitis media were taken up for study. The study period was for 18 months from October 2015 to March 2017. RESULTS Results were analysed in terms of graft uptake and hearing improvement. Average audiometric gain after 6 months was 10.58 dB. Successful closure of perforation was achieved in 90% cases. Perforations involving posterior quadrant showed 100% graft uptake, compared to anterior quadrant perforations, which showed 75% graft uptake. No major postoperative complications were noted. CONCLUSION Fat myringoplasty can be safely performed in dry, small central perforations of tympanic membrane especially belonging to posterior quadrant. Ear lobule constitutes convenient source of fat graft. The procedure can be performed as a day care surgery. Proper selection of cases is necessary to obtain good results.

  16. 78 FR 27485 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...

    Science.gov (United States)

    2013-05-10

    ... Readmission 5. MDC 8 (Diseases and Disorders of the Musculoskeletal System and Connective Tissue) a. Reverse... hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are..., (410) 786-2261, PPS-Exempt Cancer Hospital Quality Reporting Issues. Allison Lee, (410) 786-8691 and...

  17. Private psychiatric hospitals, mental health care management, and wellness: an interface with industry.

    Science.gov (United States)

    Baker, J W

    1986-01-01

    Hospitals doing business is good business. Hospitals that use their professional staff to enhance their interface with industry are usually pleased with the outcome. Health care professionals must reach beyond their doors and be willing to understand the needs of a large corporate bureaucracy and the aspiring entrepreneur. Using hospital professionals in a consultative model with gatekeepers of industry is an ideal way to market and enhance the hospital's image in the community. Professionals employed by private hospitals are usually quite willing to expand their roles into the community as trainers, consultants, educators, diagnosticians, and treatment resource consultants to the business world. Business people understand business problems, and health care is a business issue as well as a humanitarian issue. In the current climate of cost containment, the hospital's ability to help the business work with paying for health care, if properly presented, will be welcomed.

  18. A prospective study on the characteristics and subjects of pediatric palliative care case management provided by a hospital based palliative care team

    NARCIS (Netherlands)

    Jagt-van Kampen, Charissa T.; Kars, Marijke C.; Colenbrander, Derk A.; Bosman, Diederik K.; Grootenhuis, Martha A.; Caron, Huib N.; Schouten-van Meeteren, Antoinette Y. N.

    2017-01-01

    Case management is a subject of interest within pediatric palliative care. Detailed descriptions of the content of this type of case management are lacking. We aim to describe the contents of care provided, utilization of different disciplines, and times of usage of a pediatric palliative care case

  19. Shifting hospital-hospice boundaries: historical perspectives on the institutional care of the dying.

    Science.gov (United States)

    Risse, Guenter B; Balboni, Michael J

    2013-06-01

    Social forces have continually framed how hospitals perceive their role in care of the dying. Hospitals were originally conceived as places of hospitality and spiritual care, but by the 18th century illness was an opponent, conquered through science. Medicalization transformed hospitals to places of physical cure and scientific prowess. Death was an institutional liability. Equipped with new technologies, increased public demand, and the establishment of Medicare in 1965, modern hospitals became the most likely place for Americans to die--increasing after the 1940s and spiking in the 1990s. Medicare's 1983 hospice benefit began to reverse this trend. Palliative care has more recently proliferated, suggesting an institutional shift of alignment with traditional functions of care toward those facing death.

  20. Investigating the health care delivery system in Japan and reviewing the local public hospital reform

    Directory of Open Access Journals (Sweden)

    Zhang X

    2016-03-01

    Full Text Available Xing Zhang, Tatsuo Oyama National Graduate Institute for Policy Studies, Tokyo, Japan Abstract: Japan's health care system is considered one of the best health care systems in the world. Hospitals are one of the most important health care resources in Japan. As such, we investigate Japanese hospitals from various viewpoints, including their roles, ownership, regional distribution, and characteristics with respect to the number of beds, staff, doctors, and financial performance. Applying a multivariate analysis and regression model techniques, we show the functional differences between urban populated prefectures and remote ones; the equality gap among all prefectures with respect to the distribution of the number of beds, staff, and doctors; and managerial differences between private and public hospitals. We also review and evaluate the local public hospital reform executed in 2007 from various financial aspects related to the expenditure and revenue structure by comparing public and private hospitals. We show that the 2007 reform contributed to improving the financial situation of local public hospitals. Strategic differences between public and private hospitals with respect to their management and strategy to improve their financial situation are also quantitatively analyzed in detail. Finally, the remaining problems and the future strategy to further improve the Japanese health care system are described. Keywords: health care system, health care resource, public hospital, multivariate regression model, financial performance

  1. Quantifying the demand for hospital care services: a time and motion study

    NARCIS (Netherlands)

    van Oostveen, Catharina J.; Gouma, Dirk J.; Bakker, Piet J.; Ubbink, Dirk T.

    2015-01-01

    The actual amount of care hospitalised patients need is unclear. A model to quantify the demand for hospital care services among various clinical specialties would avail healthcare professionals and managers to anticipate the demand and costs for clinical care. Three medical specialties in a Dutch

  2. Preventable hospitalization and the role of primary care: a comparison between Italy and Germany.

    NARCIS (Netherlands)

    Rosano, A.; Peschel, P.; Kugler, J.; Zee, J. van der; Ricciardi, W.; Guasticchi, G.

    2010-01-01

    Background: Hospitalization may often be prevented by timely and effective outpatient care. For Italy we found that the type and density of primary-care facilities, among other factors, influence admission rates. However, results from Italy may not be valid for other types of health-care systems,

  3. Cost-effectiveness of a transitional pharmaceutical care program for patients discharged from the hospital

    NARCIS (Netherlands)

    Karapinar-Çarkıt, Fatma; van der Knaap, Ronald; Bouhannouch, Fatiha; Borgsteede, Sander D; Janssen, Marjo J A; Siegert, Carl E H; Egberts, Toine C G; van den Bemt, Patricia M L A; van Wier, Marieke F; Bosmans, Judith E

    2017-01-01

    BACKGROUND: To improve continuity of care at hospital admission and discharge and to decrease medication errors pharmaceutical care programs are developed. This study aims to determine the cost-effectiveness of the COACH program in comparison with usual care from a societal perspective. METHODS: A

  4. Cost-effectiveness of a transitional pharmaceutical care program for patients discharged from the hospital

    NARCIS (Netherlands)

    F. Karapinar-Çarkit (Fatma); R. van der Knaap (Ronald); Bouhannouch, F. (Fatiha); S.D. Borgsteede (Sander); M.J.A. Janssen (Marjo); Siegert, C.E.H. (Carl E. H.); T.C.G. Egberts (Toine C.G.); P.M.L.A. van den Bemt (Patricia); M.F. van Wier (Marieke); J.E. Bosmans (Judith)

    2017-01-01

    textabstractBackground To improve continuity of care at hospital admission and discharge and to decrease medication errors pharmaceutical care programs are developed. This study aims to determine the cost-effectiveness of the COACH program in comparison with usual care from a societal perspective.

  5. Qualifying instrument for evaluation of food and nutritional care in hospital.

    Science.gov (United States)

    Díez García, R W; Souza, A A; Proença, R P C

    2012-01-01

    Establishing criteria for hospital nutrition care ensures that quality care is delivered to patients. The responsibility of the Hospital Food and Nutrition Service (HFNS) is not always well defined, despite efforts to establish guidelines for patient clinical nutrition practice. This study describes the elaboration of an Instrument for Evaluation of Food and Nutritional Care (IEFNC) aimed at directing the actions of the Hospital Food and Nutrition Service. This instrument was qualified by means of a comparative analysis of the categories related to hospital food and nutritional care, published in the literature. Elaboration of the IEFNC comprised the following stages: (a) a survey of databases and documents for selection of the categories to be used in nutrition care evaluation, (b) a study of the institutional procedures for nutrition practice at two Brazilian hospitals, in order to provide a description of the sequence of actions that should be taken by the HFNS as well as other services participating in nutrition care, (c) design of the IEFNC based on the categories published in the literature, adapted to the sequence of actions observed in the routines of the hospitals under study, (d) application of the questionnaire at two different hospitals that was mentioned in the item (b), in order to assess the time spent on its application, the difficulties in phrasing the questions, and the coverage of the instrument, and (e) finalization of the instrument. The IEFNC consists of 50 open and closed questions on two areas of food and nutritional care in hospital: inpatient nutritional care and food service quality. It deals with the characterization and structure of hospitals and their HFNS, the actions concerning the patients' nutritional evaluation and monitoring, the meal production system, and the hospital diets. "This questionnaire is a tool that can be seen as a portrait of the structure and characteristics of the HFNS and its performance in clinical and meal

  6. Hospital-Level Care at Home for Acutely Ill Adults: a Pilot Randomized Controlled Trial.

    Science.gov (United States)

    Levine, David M; Ouchi, Kei; Blanchfield, Bonnie; Diamond, Keren; Licurse, Adam; Pu, Charles T; Schnipper, Jeffrey L

    2018-05-01

    Hospitals are standard of care for acute illness, but hospitals can be unsafe, uncomfortable, and expensive. Providing substitutive hospital-level care in a patient's home potentially reduces cost while maintaining or improving quality, safety, and patient experience, although evidence from randomized controlled trials in the US is lacking. Determine if home hospital care reduces cost while maintaining quality, safety, and patient experience. Randomized controlled trial. Adults admitted via the emergency department with any infection or exacerbation of heart failure, chronic obstructive pulmonary disease, or asthma. Home hospital care, including nurse and physician home visits, intravenous medications, continuous monitoring, video communication, and point-of-care testing. Primary outcome was direct cost of the acute care episode. Secondary outcomes included utilization, 30-day cost, physical activity, and patient experience. Nine patients were randomized to home, 11 to usual care. Median direct cost of the acute care episode for home patients was 52% (IQR, 28%; p = 0.05) lower than for control patients. During the care episode, home patients had fewer laboratory orders (median per admission: 6 vs. 19; p Home patients were more physically active (median minutes, 209 vs. 78; p home patients, one occurred in control patients. Median direct cost for the acute care plus 30-day post-discharge period for home patients was 67% (IQR, 77%; p home-care services (22% vs. 55%; p = 0.08) and fewer readmissions (11% vs. 36%; p = 0.32). Patient experience was similar in both groups. The use of substitutive home-hospitalization compared to in-hospital usual care reduced cost and utilization and improved physical activity. No significant differences in quality, safety, and patient experience were noted, with more definitive results awaiting a larger trial. Trial Registration NCT02864420.

  7. The functions of hospital-based home care for people with severe mental illness in Taiwan.

    Science.gov (United States)

    Huang, Xuan-Yi; Lin, Mei-Jue; Yang, Tuz-Ching; Hsu, Yuan-Shan

    2010-02-01

    The purposes of this study were to understand the functions of hospital-based home care for people with severe mental illness in Taiwan, and the factors that affect functions of professionals who provide hospital-based home care. Hospital-based home care is a service which provides those people with serious mental illnesses who are in crisis and who are candidates for admission to hospital. Home care has been shown to have several advantages over inpatient treatment. However, there is a lack of knowledge about the functions of hospital-based home care for people with severe mental illness in Taiwan. This qualitative study was based on the grounded theory method of Strauss and Corbin. The study was conducted in six different hospital areas in central Taiwan in 2007-2008. Data were collected using semi-structured face-to-face interviews. Constant comparative analysis continued during the open, axial and selective coding processes until data saturation occurred. Participants were selected by theoretical sampling. When theoretical saturation was achieved, 21 clients with mental illness, 19 carers and 25 professionals were interviewed. Several functions were found when these professionals provided hospital-based home care services for people with severe mental illness in Taiwan, including stabilising the clients illness, supplying emergency care services, improving life-coping abilities, employment and welfare assistance, emotional support for both clients and carers, assistance with future and long-term arrangements and assistance with communication between carers and clients. Hospital-based home care provides several important services for helping clients and their families to live in the community. The recommendations based on the findings of this study can be used as a guide to improve the delivery of hospital-based home care services to community-dwelling clients with severe mental illness and their carers.

  8. Does hospital at home for palliative care facilitate death at home? Randomised controlled trial

    Science.gov (United States)

    Grande, Gunn E; Todd, Chris J; Barclay, Stephen I G; Farquhar, Morag C

    1999-01-01

    Objective To evaluate the impact on place of death of a hospital at home service for palliative care. Design Pragmatic randomised controlled trial. Setting Former Cambridge health district. Participants 229 patients referred to the hospital at home service; 43 randomised to control group (standard care), 186 randomised to hospital at home. Intervention Hospital at home versus standard care. Main outcome measures Place of death. Results Twenty five (58%) control patients died at home compared with 124 (67%) patients allocated to hospital at home. This difference was not significant; intention to treat analysis did not show that hospital at home increased the number of deaths at home. Seventy three patients randomised to hospital at home were not admitted to the service. Patients admitted to hospital at home were significantly more likely to die at home (88/113; 78%) than control patients. It is not possible to determine whether this was due to hospital at home itself or other characteristics of the patients admitted to the service. The study attained less statistical power than initially planned. Conclusion In a locality with good provision of standard community care we could not show that hospital at home allowed more patients to die at home, although neither does the study refute this. Problems relating to recruitment, attrition, and the vulnerability of the patient group make randomised controlled trials in palliative care difficult. While these difficulties have to be recognised they are not insurmountable with the appropriate resourcing and setting. Key messagesTerminally ill patients allocated to hospital at home were no more likely to die at home than patients receiving standard careAlthough the subsample of patients actually admitted to hospital at home did show a significant increase in likelihood of dying at home, whether this was due to the service itself or the characteristics of patients admitted to hospital at home could not be determinedThe need to

  9. Evidence of an emerging digital divide among hospitals that care for the poor.

    Science.gov (United States)

    Jha, Ashish K; DesRoches, Catherine M; Shields, Alexandra E; Miralles, Paola D; Zheng, Jie; Rosenbaum, Sara; Campbell, Eric G

    2009-01-01

    Some hospitals that disproportionately care for poor patients are falling behind in adopting electronic health records (EHRs). Data from a national survey indicate early evidence of an emerging digital divide: U.S. hospitals that provide care to large numbers of poor patients also had minimal use of EHRs. These same hospitals lagged others in quality performance as well, but those with EHR systems seemed to have eliminated the quality gap. These findings suggest that adopting EHRs should be a major policy goal of health reform measures targeting hospitals that serve large populations of poor patients.

  10. Recent hospital charity care controversies highlight ambiguities and outdated features of government regulations.

    Science.gov (United States)

    MacKelvie, Charles; Apolskis, Michael; Unland, James J

    2005-01-01

    For years the hospital industry has been embroiled in controversies involving pricing, charity care, and collection practices. Unfortunately, Medicare regulations and policies governing hospital charge-setting and collection practices have not helped bring much clarity to the situation, nor has related CMS and OIG guidance. Coordinated effort by hospitals and regulatory bodies can help clarify unclear government regulation of charity care, pricing, and collections and end potentially destructive controversies that sap valuable time, energy, and resources from efforts addressing much graver long-term threats to hospital viability.

  11. Organizing integrated care in a university hospital: application of a conceptual framework

    Science.gov (United States)

    Axelsson, Runo; Axelsson, Susanna Bihari; Gustafsson, Jeppe; Seemann, Janne

    2014-01-01

    Background and aim As a result of New Public Management, a number of industrial models of quality management have been implemented in health care, mainly in hospitals. At the same time, the concept of integrated care has been developed within other parts of the health sector. The aim of the article is to discuss the relevance of integrated care for hospitals. Theory and methods The discussion is based on application of a conceptual framework outlining a number of organizational models of integrated care. These models are illustrated in a case study of a Danish university hospital implementing a new organization for improving the patient flows of the hospital. The study of the reorganization is based mainly on qualitative data from individual and focus group interviews. Results The new organization of the university hospital can be regarded as a matrix structure combining a vertical integration of clinical departments with a horizontal integration of patient flows. This structure has elements of both interprofessional and interorganizational integration. A strong focus on teamwork, meetings and information exchange is combined with elements of case management and co-location. Conclusions It seems that integrated care can be a relevant concept for a hospital. Although the organizational models may challenge established professional boundaries and financial control systems, this concept can be a more promising way to improve the quality of care than the industrial models that have been imported into health care. This application of the concept may also contribute to widen the field of integrated care. PMID:24966806

  12. Organizing integrated care in a university hospital: application of a conceptual framework.

    Science.gov (United States)

    Axelsson, Runo; Axelsson, Susanna Bihari; Gustafsson, Jeppe; Seemann, Janne

    2014-04-01

    As a result of New Public Management, a number of industrial models of quality management have been implemented in health care, mainly in hospitals. At the same time, the concept of integrated care has been developed within other parts of the health sector. The aim of the article is to discuss the relevance of integrated care for hospitals. The discussion is based on application of a conceptual framework outlining a number of organizational models of integrated care. These models are illustrated in a case study of a Danish university hospital implementing a new organization for improving the patient flows of the hospital. The study of the reorganization is based mainly on qualitative data from individual and focus group interviews. The new organization of the university hospital can be regarded as a matrix structure combining a vertical integration of clinical departments with a horizontal integration of patient flows. This structure has elements of both interprofessional and interorganizational integration. A strong focus on teamwork, meetings and information exchange is combined with elements of case management and co-location. It seems that integrated care can be a relevant concept for a hospital. Although the organizational models may challenge established professional boundaries and financial control systems, this concept can be a more promising way to improve the quality of care than the industrial models that have been imported into health care. This application of the concept may also contribute to widen the field of integrated care.

  13. A statewide review of postnatal care in private hospitals in Victoria, Australia

    Directory of Open Access Journals (Sweden)

    Forster Della A

    2010-05-01

    Full Text Available Abstract Background Concerns have been raised in Australia and internationally regarding the quality and effectiveness of hospital postnatal care, although Australian women receiving postnatal care in the private maternity sector rate their satisfaction with care more highly than women receiving public maternity care. In Victoria, Australia, two-thirds of women receive their maternity care in the public sector and the remainder in private health care sector. A statewide review of public hospital postnatal care in Victoria from the perspective of care providers found many barriers to care provision including the busyness of postnatal wards, inadequate staffing and priority being given to other episodes of care; however the study did not include private hospitals. The aim of this study was replicate the review in the private sector, to explore the structure and organisation of postnatal care in private hospitals and identify those aspects of care potentially impacting on women's experiences and maternal and infant care. This provides a more complete overview of the organisational structures and processes in postnatal care in all Victorian hospitals from the perspective of care providers. Methods A mixed method design was used. A structured postal survey was sent to all Victorian private hospitals (n = 19 and key informant interviews were undertaken with selected clinical midwives, maternity unit managers and obstetricians (n = 11. Survey data were analysed using descriptive statistics and interview data analysed thematically. Results Private hospital care providers report that postnatal care is provided in very busy environments, and that meeting the aims of postnatal care (breastfeeding support, education of parents and facilitating rest and recovery for women following birth was difficult in the context of increased acuity of postnatal care; prioritising of other areas over postnatal care; high midwife-to-woman ratios; and the number and

  14. Training Spiritual Care in Palliative Care in Teaching Hospitals in the Netherlands (SPIRIT-NL) : A Multicentre Trial

    NARCIS (Netherlands)

    Geer, Joep van de; Zock, Tanja; Leget, Carlo; Veeger, Nic; Prins, Jelle; de Groot, Marieke; Vissers, Kris

    Background: In the Netherlands, the spiritual dimension in healthcare became marginal in the second part of the twentieth century. In the Dutch healthcare sys- tem, palliative care is not a medical specialization and teaching hospitals do not have specialist palliative care units with specialized

  15. Medicare: Reviews of Quality of Care at Participating Hospitals. Report to the Administrator, Health Care Financing Administration.

    Science.gov (United States)

    General Accounting Office, Washington, DC. Div. of Human Resources.

    This report concerns the Health Care Financing Administration's (HCFA) contracting with Utilization and Quality Control Peer Review Organizations (PROs) as a means of monitoring the medical necessity and quality of in-hospital care provided to Medicare beneficiaries. Findings from a HCFA survey of PROs in California, Florida, and Georgia are used…

  16. Obstetric intensive care admissions at a tertiary hospital in Limpopo ...

    African Journals Online (AJOL)

    mortality of between 1 and 5%,[2,12] while others have reported .... ICU, and the need for a critical care specialist should be considered. ... Madan I, Jain NJ, Grotegut C, Nelson D, Dandolu V. Characteristics of obstetric intensive care.

  17. Molecular epidemiology and spatiotemporal analysis of hospital-acquired Acinetobacter baumannii infection in a tertiary care hospital in southern Thailand.

    Science.gov (United States)

    Chusri, S; Chongsuvivatwong, V; Rivera, J I; Silpapojakul, K; Singkhamanan, K; McNeil, E; Doi, Y

    2017-01-01

    Acinetobacter baumannii is a major hospital-acquired pathogen in Thailand that has a negative effect on patient survival. The nature of its transmission is poorly understood. To investigate the genotypic and spatiotemporal pattern of A. baumannii infection at a hospital in Thailand. The medical records of patients infected with A. baumannii at an 800-bed tertiary care hospital in southern Thailand between January 2010 and December 2011 were reviewed retrospectively. A. baumannii was identified at the genomospecies level. Carbapenemase genes were identified among carbapenem-resistant isolates associated with A. baumannii infection. A spatiotemporal analysis was performed by admission ward, time of infection and pulsed-field gel electrophoresis (PFGE) groups of A. baumannii. Nine PFGE groups were identified among the 197 A. baumannii infections. All A. baumannii isolates were assigned to International Clonal Lineage II. bla OXA-23 was the most prevalent carbapenemase gene. Outbreaks were observed mainly in respiratory and intensive care units. The association between PFGE group and hospital unit was significant. Spatiotemporal analysis identified 20 clusters of single PFGE group infections. Approximately half of the clusters involved multiple hospital units simultaneously. A. baumannii transmitted both within and between hospital wards. Better understanding and control of the transmission of A. baumannii are needed. Copyright © 2016 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  18. Home Health Nursing Care and Hospital Use for Medically Complex Children.

    Science.gov (United States)

    Gay, James C; Thurm, Cary W; Hall, Matthew; Fassino, Michael J; Fowler, Lisa; Palusci, John V; Berry, Jay G

    2016-11-01

    Home health nursing care (HH) may be a valuable approach to long-term optimization of health for children, particularly those with medical complexity who are prone to frequent and lengthy hospitalizations. We sought to assess the relationship between HH services and hospital use in children. Retrospective, matched cohort study of 2783 hospitalized children receiving postdischarge HH services by BAYADA Home Health Care across 19 states and 7361 matched controls not discharged to HH services from the Children's Hospital Association Case Mix database between January 2004 and September 2012. Subsequent hospitalizations, hospital days, readmissions, and costs of hospital care were assessed over the 12-month period after the initial hospitalization. Nonparametric Wilcoxon signed rank tests were used for comparisons between HH and non-HH users. Although HH cases had a higher percentage of complex chronic conditions (68.5% vs 65.4%), technology assistance (40.5% vs 35.7%), and neurologic impairment (40.7% vs 37.3%) than matched controls (P ≤ .003 for all), 30-day readmission rates were lower in HH patients (18.3% vs 21.5%, P = .001). At 12 months after the index admission, HH patients averaged fewer admissions (0.8 vs 1.0, P < .001), fewer days in the hospital (6.4 vs 6.6, P < .001), and lower hospital costs ($22 511 vs $24 194, P < .001) compared with matched controls. Children discharged to HH care experienced less hospital use than children with similar characteristics who did not use HH care. Further investigation is needed to understand how HH care affects the health and health services of children. Copyright © 2016 by the American Academy of Pediatrics.

  19. Parental experiences of a developmentally focused care program for infants and children during prolonged hospitalization.

    Science.gov (United States)

    So, Stephanie; Rogers, Alaine; Patterson, Catherine; Drew, Wendy; Maxwell, Julia; Darch, Jane; Hoyle, Carolyn; Patterson, Sarah; Pollock-BarZiv, Stacey

    2014-06-01

    This study investigates parental experiences and perceptions of the care received during their child's prolonged hospitalization. It relates this care to the Beanstalk Program (BP), a develop-mentally focused care program provided to these families within an acute care hospital setting. A total of 20 parents (of children hospitalized between 1-15 months) completed the Measures of Processes of Care (MPOC-20) with additional questions regarding the BP. Scores rate the extent of the health-care provider's behaviour as perceived by the family, ranging from 'to a great extent' (7) to 'never' (1). Parents rated Respectful and Supportive Care (6.33) as highest, while Providing General Information (5.65) was rated lowest. Eleven parents participated in a follow-up, qualitative, semi-structured interview. Interview data generated key themes: (a) parents strive for positive and normal experiences for their child within the hospital environment; (b) parents value the focus on child development in the midst of their child's complex medical care; and (c) appropriate developmentally focused education helps parents shift from feeling overwhelmed with a medically ill child to instilling feelings of confidence and empowerment to care for their child and transition home. These results emphasize the importance of enhancing child development for hospitalized infants and young children through programs such as the BP. © The Author(s) 2013.

  20. Electronic health record use, intensity of hospital care, and patient outcomes.

    Science.gov (United States)

    Blecker, Saul; Goldfeld, Keith; Park, Naeun; Shine, Daniel; Austrian, Jonathan S; Braithwaite, R Scott; Radford, Martha J; Gourevitch, Marc N

    2014-03-01

    Previous studies have suggested that weekend hospital care is inferior to weekday care and that this difference may be related to diminished care intensity. The purpose of this study was to determine whether a metric for measuring intensity of hospital care based on use of the electronic health record was associated with patient-level outcomes. We performed a cohort study of hospitalizations at an academic medical center. Intensity of care was defined as the hourly number of provider accessions of the electronic health record, termed "electronic health record interactions." Hospitalizations were categorized on the basis of the mean difference in electronic health record interactions between the first Friday and the first Saturday of hospitalization. We used regression models to determine the association of these categories with patient outcomes after adjusting for covariates. Electronic health record interactions decreased from Friday to Saturday in 77% of the 9051 hospitalizations included in the study. Compared with hospitalizations with no change in Friday to Saturday electronic health record interactions, the relative lengths of stay for hospitalizations with a small, moderate, and large decrease in electronic health record interactions were 1.05 (95% confidence interval [CI], 1.00-1.10), 1.11 (95% CI, 1.05-1.17), and 1.25 (95% CI, 1.15-1.35), respectively. Although a large decrease in electronic health record interactions was associated with in-hospital mortality, these findings were not significant after risk adjustment (odds ratio 1.74, 95% CI, 0.93-3.25). Intensity of inpatient care, measured by electronic health record interactions, significantly diminished from Friday to Saturday, and this decrease was associated with length of stay. Hospitals should consider monitoring and correcting temporal fluctuations in care intensity. Copyright © 2014 Elsevier Inc. All rights reserved.

  1. Hand Hygiene Adherence Among Health Care Workers at Japanese Hospitals: A Multicenter Observational Study in Japan.

    Science.gov (United States)

    Sakihama, Tomoko; Honda, Hitoshi; Saint, Sanjay; Fowler, Karen E; Shimizu, Taro; Kamiya, Toru; Sato, Yumiko; Arakawa, Soichi; Lee, Jong Ja; Iwata, Kentaro; Mihashi, Mutsuko; Tokuda, Yasuharu

    2016-03-01

    Although proper hand hygiene among health care workers is an important component of efforts to prevent health care-associated infection, there are few data available on adherence to hand hygiene practices in Japan. The aim of this study was to examine hand hygiene adherence at teaching hospitals in Japan. An observational study was conducted from July to November 2011 in 4 units (internal medicine, surgery, intensive care, and/or emergency department) in 4 geographically diverse hospitals (1 university hospital and 3 community teaching hospitals) in Japan. Hand hygiene practice before patient contact was assessed by an external observer. In a total of 3545 health care worker-patient observations, appropriate hand hygiene practice was performed in 677 (overall adherence, 19%; 95% confidence interval, 18%-20%). Subgroup rates of hand hygiene adherence were 15% among physicians and 23% among nurses. The ranges of adherence were 11% to 25% between hospitals and 11% to 31% between units. Adherence of the nurses and the physicians to hand hygiene was correlated within each hospital. There was a trend toward higher hand hygiene adherence in hospitals with infection control nurses, compared with hospitals without them (29% versus 16%). The hand hygiene adherence in Japanese teaching hospitals in our sample was low, even lower than reported mean values from other international studies. Greater adherence to hand hygiene should be encouraged in Japan.

  2. Implementing a pediatric obesity care guideline in a freestanding children's hospital to improve child safety and hospital preparedness.

    Science.gov (United States)

    Porter, Renee M; Thrasher, Jodi; Krebs, Nancy F

    2012-12-01

    Medical and surgical care of children with severe obesity is complicated and requires recognition of the problem, appropriate equipment, and safe management. There is little literature describing patient, provider, and institutional needs for the severely obese pediatric patient. Nonetheless, the limited data suggest 3 broad categories of needs unique to this population: (a) airway management, (b) drug dosing and pharmacology, and (c) equipment and infrastructure. We describe an opportunity at the Children's Hospital Colorado to better prepare and optimize care for this patient population by creation of a Pediatric Obesity Care Guideline that focused on key areas of quality and safety. Copyright © 2012 Elsevier Inc. All rights reserved.

  3. An evaluation of charity care for tax-exempt hospitals engaging in joint ventures.

    Science.gov (United States)

    Smith, Pamela C

    2006-01-01

    The study examines whether the level of charity care and financial stability contribute to a nonprofit hospital's motivation for partnering with a for-profit hospital through a joint venture. The Internal Revenue Service (IRS) has heightened its scrutiny of joint ventures within the health care sector. Considering recent calls to investigate the merit of the tax-exempt status of hospitals engaged in joint ventures, this research will assist policy makers in the evaluation of nonprofit hospitals. Constituents will continue to question whether joint ventures contribute to a reduced focus on charitable activities. Results indicate that the propensity to engage in a joint venture significantly increases with increased levels of charity care. Furthermore, nonprofit hospitals with lower profitability are more likely to engage in joint ventures. These results are useful to policy makers when evaluating the level of charity care provided by hospitals seeking alternative strategic alliances. Considering many critics allege hospitals are reducing the provision of charity care to the community, it is imperative for management to be conscious of the impact of joint ventures on the provision of charity care.

  4. Channel leadership in health care marketing: a natural role for hospitals.

    Science.gov (United States)

    Fugate, D L; Decker, P J

    1990-01-01

    Health care has entered an era of rapid change. Most observers agree that important long-term changes will fundamentally reshape health care as we know it. To that end, health care providers should consider the benefits of operating vertically integrated marketing system with hospitals as the channel leader. Whether an administered VMS (hospitals have the power to gain compliance) or a corporate VMS (hospitals own successive levels of care providers), integrated channel management holds the promise of cost containment and quality patient care for the future. However, a great deal of integrating work must be done before VMSs will become a practical solution. Research studies are needed on each of the issues just discussed. As marketers, it is time we make a transition from treating health care marketing as a disjointed entity and instead treat it as an industry where all marketing principles are considered including channel management.

  5. Impact of teamwork on missed care in four Australian hospitals.

    Science.gov (United States)

    Chapman, Rose; Rahman, Asheq; Courtney, Mary; Chalmers, Cheyne

    2017-01-01

    Investigate effects of teamwork on missed nursing care across a healthcare network in Australia. Missed care is universally used as an indicator of quality nursing care, however, little is known about mitigating effects of teamwork on these events. A descriptive exploratory study. Missed Care and Team Work surveys were completed by 334 nurses. Using Stata software, nursing staff demographic information and components of missed care and teamwork were compared across the healthcare network. Statistical tests were performed to identify predicting factors for missed care. The most commonly reported components of missed care were as follows: ambulation three times per day (43·3%), turning patient every two hours (29%) and mouth care (27·7%). The commonest reasons mentioned for missed care were as follows: inadequate labour resources (range 69·8-52·7%), followed by material resources (range 59·3-33·3%) and communication (range 39·3-27·2%). There were significant differences in missed care scores across units. Using the mean scores in regression correlation matrix, the negative relationship of missed care and teamwork was supported (r = -0·34, p teamwork alone accounted for about 9% of missed nursing care. Similar to previous international research findings, our results showed nursing teamwork significantly impacted on missed nursing care. Teamwork may be a mitigating factor to address missed care and future research is needed. These results may provide administrators, educators and clinicians with information to develop practices and policies to improve patient care internationally. © 2016 John Wiley & Sons Ltd.

  6. Usage and Quality of Formal Child Care Services Experienced by Infants and Toddlers in Foster and Kinship Care: An Australian Study

    Science.gov (United States)

    Wise, Sarah

    2018-01-01

    This research uses data from the Early Childhood in Foster and Kinship Care (ECIFKC) study to identify the proportion of young children, under 2 years of age, in foster and kinship care who use formal child care; weekly hours of child care; predictors of weekly hours of child care; and quality of care experienced. The sample for these analyses…

  7. Primary health care quality and hospitalizations for ambulatory care sensitive conditions in the public health system in Porto Alegre, Brazil.

    Science.gov (United States)

    Gonçalves, Marcelo Rodrigues; Hauser, Lisiane; Prestes, Isaías Valente; Schmidt, Maria Inês; Duncan, Bruce Bartholow; Harzheim, Erno

    2016-06-01

    To investigate the relation of hospitalization for ambulatory care sensitive conditions (ACSC) with the quality of public primary care health services in Porto Alegre, Brazil. Cohort study constructed by probabilistic record linkage performed from August 2006 to December 2011 in a population ≥18 years of age that attended public primary care health services. The Primary Care Assessment Tool (PCATool-Brazil) was used for evaluation of primary care services. Of 1200 subjects followed, 84 were hospitalized for primary care sensitive conditions. The main causes of ACSC hospital admissions were cardiovascular (40.5%) and respiratory (16.2%) diseases. The PCATool average score was 5.3, a level considerably below that considered to represent quality care. After adjustment through Cox proportional hazard modelling for covariates, >60 years of age [hazard ratio (HR): 1.13; P = 0.001), lesser education (HR: 0.66; P = 0.02), ethnicity other than white (HR: 1.77; P = 0.01) and physical inactivity (HR: 1.65; P = 0.04) predicted hospitalization, but higher quality of primary health care did not. Better quality of health care services, in a setting of overwhelmingly low quality services not adapted to the care of chronic conditions, did not influence the rate of avoidable hospitalizations, while social and demographic characteristics, especially non-white ethnicity and lesser schooling, indicate that social inequities play a predominant role in health outcomes. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  8. How Differences Between Manager and Clinician Perceptions of Safety Culture Impact Hospital Processes of Care.

    Science.gov (United States)

    Richter, Jason; Mazurenko, Olena; Kazley, Abby Swanson; Ford, Eric W

    2017-11-04

    Evidenced-based processes of care improve patient outcomes, yet universal compliance is lacking, and perceptions of the quality of care are highly variable. The purpose of this study is to examine how differences in clinician and management perceptions on teamwork and communication relate to adherence to hospital processes of care. Hospitals submitted identifiable data for the 2012 Hospital Survey on Patient Safety Culture and the Centers for Medicare and Medicaid Services' Hospital Compare. The dependent variable was a composite, developed from the scores on adherence to acute myocardial infarction, heart failure, and pneumonia process of care measures. The primary independent variables reflected 4 safety culture domains: communication openness, feedback about errors, teamwork within units, and teamwork between units. We assigned each hospital into one of 4 groups based on agreement between managers and clinicians on each domain. Each hospital was categorized as "high" (above the median) or "low" (below) for clinicians and managers in communication and teamwork. We found a positive relationship between perceived teamwork and communication climate and processes of care measures. If managers and clinicians perceived the communication openness as high, the hospital was more likely to adhere with processes of care. Similarly, if clinicians perceived teamwork across units as high, the hospital was more likely to adhere to processes of care. Manager and staff perceptions about teamwork and communications impact adherence to processes of care. Policies should recognize the importance of perceptions of both clinicians and managers on teamwork and communication and seek to improve organizational climate and practices. Clinician perceptions of teamwork across units are more closely linked to processes of care, so managers should be cognizant and try to improve their perceptions.

  9. Pattern of nosocomial infection in two intensive care units of a tertiary care hospital in karachi

    International Nuclear Information System (INIS)

    Rizvi, M.F.; Hassan, Y.; Abdullah, M.; Shakeel, J.; Memon, A.R.; Razvi, M.F.; Saleem, S.; Shakeel, J.

    2007-01-01

    To determine the pattern of nosocomial infections in two ICUs' of a teaching hospital in terms of frequency, common sites of infection, the pathogens involved and the antibiotic sensitivity patterns. It was conducted in two medical ICUs (Neurology and Nephrology) of a public tertiary care hospital. Data was collected prospectively on patients suspected to have developed nosocomial infection after 48 hours of admission to the ICU according to objective. There were 101 cases of suspected nosocomial infection out of a total of 254 patients. The frequency of nosocomial infection was 39.7%. UTI developed in 44.6%, while 27% had blood stream infection, and 21% had pneumonia. Each of the three major sites of infection was strongly associated with the use of invasive devices. Escherichia (E.) coli was the most common organism isolated followed by Pseudomonas aeruginosa and Klebsiella. E. coli and Klebsiella showed a maximum sensitivity to Imipenem followed by Tazocin (pipericillin + tazobactam). Pseudomonas aeruginosa was sensitive to Amikacin and Fosfomycin. The high frequency of nosocomial infection suggests that more strict measures regarding invasive devices should be taken in future to control the infection and limit the emergence of antibiotic resistant organisms. (author)

  10. The Maternity Care Nurse Workforce in Rural U.S. Hospitals.

    Science.gov (United States)

    Henning-Smith, Carrie; Almanza, Jennifer; Kozhimannil, Katy B

    To describe the maternity care nurse staffing in rural U.S. hospitals and identify key challenges and opportunities in maintaining an adequate nursing workforce. Cross-sectional survey study. Maternity care units within rural hospitals in nine U.S. states. Maternity care unit managers. We calculated descriptive statistics to characterize the rural maternity care nursing workforce by hospital birth volume and nursing staff model. We used simple content analysis to analyze responses to open-ended questions and identified themes related to challenges and opportunities for maternity care nursing in rural hospitals. Of the 263 hospitals, 51% were low volume (maternity care nurses. They did, however, identify significant challenges related to recruiting nurses, maintaining adequate staffing during times of census variability, orienting and training nurses, and retaining experienced nurses. Rural maternity care unit managers recognize the importance of nursing and have varied staffing needs. Policy implementation and programmatic support to ameliorate challenges may help ensure that an adequate nursing staff can be maintained, even in small-volume rural hospitals. Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

  11. Oral hygiene and mouth care for older people in acute hospitals: part 1.

    Science.gov (United States)

    Steel, Ben J

    2017-10-31

    The oral health of older people in acute hospitals has rarely been studied. Hospital admission provides a prime opportunity for identification and rectification of problems, and oral health promotion. This two-part article explores oral hygiene and mouth care provision for older adults in acute hospitals. The first article presents the findings of a literature review exploring oral and dental disease in older adults, the importance of good oral health and mouth care, and the current situation. Searches of electronic databases and the websites of relevant professional health service bodies in the UK were undertaken to identify articles and guidelines. The literature shows a high prevalence of oro-dental disease in this population, with many known detrimental effects, combined with suboptimal oral hygiene and mouth care provision in acute hospitals. Several guidelines exist, although the emphasis on oral health is weaker than other aspects of hospital care. Older adults admitted to acute hospitals have a high burden of oro-dental disease and oral and mouth care needs, but care provision tends to be suboptimal. The literature is growing, but this area is still relatively neglected. Great potential exists to develop oral and mouth care in this context. The second part of this article explores clinical recommendations. ©2012 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.

  12. Feasibility of hospital-initiated non-facilitator assisted advance care planning documentation for patients with palliative care needs.

    Science.gov (United States)

    Kok, Maaike; van der Werff, Gertruud F M; Geerling, Jenske I; Ruivenkamp, Jaap; Groothoff, Wies; van der Velden, Annette W G; Thoma, Monique; Talsma, Jaap; Costongs, Louk G P; Gans, Reinold O B; de Graeff, Pauline; Reyners, Anna K L

    2018-05-24

    Advance Care Planning (ACP) and its documentation, accessible to healthcare professionals regardless of where patients are staying, can improve palliative care. ACP is usually performed by trained facilitators. However, ACP conversations would be more tailored to a patient's specific situation if held by a patient's clinical healthcare team. This study assesses the feasibility of ACP by a patient's clinical healthcare team, and analyses the documented information including current and future problems within the palliative care domains. This multicentre study was conducted at the three Groningen Palliative Care Network hospitals in the Netherlands. Patients discharged from hospital with a terminal care indication received an ACP document from clinical staff (non-palliative care trained staff at hospitals I and II; specialist palliative care nurses at hospital III) after they had held ACP conversations. An anonymised copy of this ACP document was analysed. Documentation rates of patient and contact details were investigated, and documentation of current and future problems were analysed both quantitatively and qualitatively. One hundred sixty ACP documents were received between April 2013 and December 2014, with numbers increasing for each consecutive 3-month time period. Advance directives were frequently documented (82%). Documentation rates of current problems in the social (24%), psychological (27%) and spiritual (16%) domains were low compared to physical problems (85%) at hospital I and II, but consistently high (> 85%) at hospital III. Of 545 documented anticipated problems, 92% were physical or care related in nature, 2% social, 5% psychological, and will improve identification and documentation of non-physical problems remains to be investigated.

  13. Measuring case-mix complexity of tertiary care hospitals using DRGs.

    Science.gov (United States)

    Park, Hayoung; Shin, Youngsoo

    2004-02-01

    The objectives of the study were to develop a model that measures and evaluates case-mix complexity of tertiary care hospitals, and to examine the characteristics of such a model. Physician panels defined three classes of case complexity and assigned disease categories represented by Adjacent Diagnosis Related Groups (ADRGs) to one of three case complexity classes. Three types of scores, indicating proportions of inpatients in each case complexity class standardized by the proportions at the national level, were defined to measure the case-mix complexity of a hospital. Discharge information for about 10% of inpatient episodes at 85 hospitals with bed size larger than 400 and their input structure and research and education activity were used to evaluate the case-mix complexity model. Results show its power to predict hospitals with the expected functions of tertiary care hospitals, i.e. resource intensive care, expensive input structure, and high levels of research and education activities.

  14. Male factor in infertility: study from a tertiary care hospital

    OpenAIRE

    Kalavathi D. Biradar

    2016-01-01

    Background: Infertility is a condition with important psychological, economic, demographic and medical implications. Male infertility refers to a male's inability to result pregnancy in a fertile female. Methods: The present hospital based study was conducted in the Department of Obstetrics and Gynaecology, East Point Hospital, Bangalore. Duration of the study was for 6 months from October 2015 to March 2016. A total of 250 infertile couples couple coming for evaluation to the outpatient d...

  15. Hospital-in-the-Home — essential to an integrated model of paediatric care

    LENUS (Irish Health Repository)

    Hensey, CC

    2017-01-01

    The National Clinical Programme for Paediatrics and Neonatology is proposing a model of care that will determine the future delivery of children’s health services in Ireland1. The focus is on the provision of an integrated service with improved co-ordination between primary, secondary, and tertiary level facilities. A parallel goal is improvements in chronic care and medical care in the home. An expanded role for ambulatory care and hospital at home schemes with a reduced reliance on inpatient care is proposed in line with international best practice. Achieving these goals requires a paradigm shift in delivery of children’s health care, and reconfiguration of current services to deliver multidisciplinary care in hospital and at home. The recently approved planning application for the new children’s hospital provides an opportunity and heralds a change in the structure of paediatric services in Ireland. It will act as the nexus of paediatric care throughout Ireland; supporting paediatric services nationally through outreach programmes, and ensuring children are treated as close to home as possible. A Hospital-in-the-Home (HITH) program would help meet these objectives; and could provide home based acute paediatric care, leading to economic benefits, and the delivery of quality family-centred care.

  16. Hospital Costs Associated With Agitation in the Acute Care Setting.

    Science.gov (United States)

    Cots, Francesc; Chiarello, Pietro; Pérez, Victor; Gracia, Alfredo; Becerra, Virginia

    2016-01-01

    The study determined hospital costs associated with a diagnosis of agitation among patients at 14 general hospitals in Spain. Data from discharge records of adult patients (2008-2012) with a diagnosis of agitation (ICD-9-CM code 293.0) were analyzed. Incremental hospital costs for agitated patients and a control group of patients without agitation were quantified, and the adjusted cost and incremental cost for both groups were compared by use of a recycled-predictions approach. The analysis included 355,496 hospital discharges, 5,334 of which were of patients with a diagnosis of agitation. Among patients with a diagnosis of agitation, hospital stays were significantly longer (12 days versus nine days). A significant difference in mean costs of €472 (95% confidence interval [CI]=€351-€593) was noted between patients with agitation and those in the control group. A recycled-predictions approach showed a difference of €1,593(CI=€1,556-€1,631). Findings indicate that agitation increased the use of hospital resources by at least 8%.

  17. Study of Marketing Components Affecting Health Care Services in Hospitals

    Directory of Open Access Journals (Sweden)

    Mohammad Javad Akbarian Bafghi

    2016-10-01

    Full Text Available Background: Hospitals, in extreme competition, have accepted principles of marketing designed for industrial goods and customers. One of the important factors in health services marketing is the type of services. Organizations, including health centers, require meeting the clients' needs in order to survive and try to promote the way of providing services effectively. The present study aims to identify effective components in providing clinical services in hospitals. Methods: This was a practical and cross-sectional study. Data were collected using a questionnaire completed through random sampling after confirming the validity and reliability. Data were analyzed by SPSS 21 and Lisrel 8.50 using descriptive statistics and factor analysis. Results: The results of this study indicated that nine components had the highest impact on providing health services. Confirmatory factor analysis showed that the quality of providing services in the hospital, offering distinctive services compared with other hospitals, and considering quality of service beyond the patient's expectation had the greatest impact on marketing services in the hospital. Conclusion: Providing quality and distinctive services beyond the patient's expectation enables hospitals to improve their marketing activities and, beside higher level of patient satisfaction, develop their clinical services market share.

  18. Oncology Care Measures – PPS-Exempt Cancer Hospital

    Data.gov (United States)

    U.S. Department of Health & Human Services — The Prospective Payment System (PPS)-Exempt Cancer Hospital Quality Reporting (PCHQR) Program currently uses five oncology care measures. The resulting PPS-Exempt...

  19. Quality Indicators for Quality of Care During Hospitalization for Vulnerable Elder Persons

    National Research Council Canada - National Science Library

    Kleerup, Eric

    2004-01-01

    .... While many of the above conditions, such as congestive heart failure, pressure ulcers, and ischemic heart disease, contain indicators for the quality of hospital care associated with that condition...

  20. Health Care Professionals’ Pain Narratives in Hospitalized Children’s Medical Records. Part 1: Pain Descriptors

    Directory of Open Access Journals (Sweden)

    Judy Rashotte

    2013-01-01

    Full Text Available BACKGROUND: Although documentation of children’s pain by health care professionals is frequently undertaken, few studies have explored the nature of the language used to describe pain in the medical records of hospitalized children.

  1. Implementation of nutrition care service development plan at Banning Memorial Hospital: a case study.

    Science.gov (United States)

    Ben Oumlil, A; Rao, C P

    1992-01-01

    Health care service markets in general and hospital care service markets in particular are characterized by many competitive developments. Hence, hospital marketing managers are forced to respond to these emerging competitive pressures. However, in formulating appropriate marketing management strategies, hospital managers need to have detailed knowledge about consumers and their behaviors in the marketplace. This paper focuses on the Nutrition Care division of the Department of Nutrition Service at a hospital and its venture into new service development. This case study is intended to emphasize the significance of acquiring adequate knowledge of customers in the health care services industry. It particularly emphasizes the critical role that this type of information concerning customer behavior plays in the development and implementation of an appropriate business expansion strategy. Furthermore, the aim of this case study is to help the reader to relate the acquired marketing information to the problem at hand, and make the appropriate marketing management decision.

  2. INFRASTRUCTURAL MECHANISMS LEADING TOWARD PRO-ACCOUNTABLE CARE ORGANISATION ORIENTATION: A SURVEY OF HOSPITAL MANAGERS

    Science.gov (United States)

    Wan, Thomas T.H.; Masri, Maysoun Dimachkie; Ortiz, Judith

    2013-01-01

    Organisations across the country are transforming the way they deliver care, in ways similar to the accountable care organisation (ACO) model supported by Medicare. ACOs modalities are varying in size, type, and financing structure. Little is known about how specific infrastructural mechanisms influence hospital managers’ pro-ACO orientation. Using an electronic-survey of hospital managers, this study explores how pro-ACO orientation, as a latent construct, is captured from the perceptions of hospital managers; and identify infrastructural mechanisms leading to the formation of pro-ACO orientation. Of the total hospital respondents, 58% are moving toward the establishment of ACOs; 56% are planning to join in the next two years; 48% are considering joining ACOs; while 25% had already participated in ACOs during 2012. Urban hospitals are more likely than rural hospitals to be engaged in ACO development. The health provider network size is one of the strongest indicators in predicting pro-ACO orientation. PMID:25374609

  3. Pre-hospital critical care by anaesthesiologist-staffed pre-hospital services in Scandinavia

    DEFF Research Database (Denmark)

    Krüger, A J; Lossius, H M; Mikkelsen, S

    2013-01-01

    All Scandinavian countries provide anaesthesiologist-staffed pre-hospital services. Little is known of the incidence of critical illness or injury attended by these services. We aimed to investigate anaesthesiologist-staffed pre-hospital services in Scandinavia with special emphasis on incidence...

  4. Hospital-acquired malnutrition in children at a tertiary care hospital

    African Journals Online (AJOL)

    Del-Rossi Sean Quadros

    As such, there is a need for hospitals to monitor its occurrence using cost- effective but accurate tools. Table 1: General .... Malades Hospital, France.2. Our study ... daily weight loss, which is the critical threshold for an adverse clinical outcome ...

  5. Interactional aspects of care during hospitalization: perspectives of family caregivers of psychiatrically ill in a tertiary care setting in India.

    Science.gov (United States)

    Dinakaran, P; Mehrotra, Seema; Bharath, Srikala

    2014-12-01

    There are very few studies on user-perspectives about mental health care services that explore perspectives of family caregivers in India. An exploratory study was undertaken to understand the perceived importance of various aspects of interactions with mental health service providers during hospitalization, from the perspectives of family caregivers. In addition, it also aimed at documenting their actual experience of interactional aspects of care during the hospitalization of their relatives. The study was conducted on fifty family caregivers of patients with varied psychiatric diagnoses hospitalized in a tertiary psychiatric care setting in South India. Measures of Interactional aspects of care were developed to assess perceived importance of six different interactional domains of care and the actual experience of care in these domains. Provision of informational inputs and addressing of concerns raised emerged as the domains of care given highest importance. The item pertaining to 'sharing with the caregiver about different alternatives for treatment' received negative ratings in terms of actual experience by maximum number of participants (18%). Significant differences on perceived importance of four domains of interactional aspects of care (dignity, confidentiality and fairness, addressing concerns raised, informational inputs and prompt attention and consistent care) emerged between caregiver subgroups based on educational level of the caregiver, socio-economic status, hospitalization history and broad diagnostic categories. In addition, the care givers of patients with psychoses assigned significantly more positive ratings on actual experience for all the domains of interactional aspects of care. The findings have implications for further research and practice. Copyright © 2014 Elsevier B.V. All rights reserved.

  6. The financial impact of multidisciplinary cleft care: an analysis of hospital revenue to advance program development.

    Science.gov (United States)

    Deleyiannis, Frederic W-B; TeBockhorst, Seth; Castro, Darren A

    2013-03-01

    The purpose of this study was to determine the financial impact of cleft care on the hospital and to evaluate trends in reimbursement over the past 6 years. Medical and accounting records of 327 consecutive infants undergoing cleft repair between 2005 and 2011 were reviewed. Charges, payments, and direct cost data were analyzed to illustrate hospital revenue and margins. Hospital payments for all inpatient services (cleft and noncleft) during the first 24 months of life were $9,483,168. Mean hospital payment varied from $5525 (Medicaid) to $10,274 (managed care) for a cleft lip repair (p < 0.0001) and from $6573 (Medicaid) to $12,933 (managed care) for a cleft palate repair (p < 0.0001). Hospital charges for a definitive lip or palate repair to both Medicaid and managed care more than doubled between 2005 and 2011 (p < 0.0001). Overall, mean hospital margins were $3904 and $3520, respectively, for a cleft lip repair and cleft palate repair. Medicaid physician payments for cleft lip and palate were, respectively, $588 and $646. From 2005 to 2006, 2007 to 2008, and 2009 to 2010, 41 percent, 43 percent, and 63 percent of patients, respectively, were enrolled in Medicaid. Cleft care generates substantial revenue for the hospital. For their mutual benefit, hospitals should join with their cleft teams to provide administrative support. Bolstered reimbursement figures, based on the overall value of cleft care to the hospital system, would better attract and retain skilled clinicians dedicated to cleft care. This may become particularly important if Medicaid enrollment continues to increase.

  7. Diabetic foot wound care practices among patients visiting a tertiary care hospital in north India

    Directory of Open Access Journals (Sweden)

    Samreen Khan

    2016-09-01

    Full Text Available Background: Diabetic foot syndrome is one of the most common and devastating preventable complications of diabetes resulting in major economic consequences for the patients, their families, and the society. Aims & Objectives: The present study was carried out to assess knowledge, attitude and practices of Diabetic Foot Wound Care among the patients suffering from Diabetic Foot and to correlate them with the socio-demographic parameters. Material & Methods: It was a Hospital based cross-sectional study involving clinically diagnosed adult (>18 years patients of Diabetic Foot visiting the Surgery and Medicine OPDs at Teerthankar Mahaveer Medical College & Research Centre, Moradabad, India. Results: Significant association KAP (Knowledge, Attitude and Practices score was seen with age of the patient, education, addiction, family history of Diabetes Mellitus, prior receipt of information regarding Diabetic foot-care practices, compliance towards the treatment and the type of foot wear used. Conclusions: The results highlight areas especially Health education, use of safe footwear and life style adjustments, where efforts to improve knowledge and practice may contribute to the prevention of development of Foot ulcers and amputation. 

  8. Palliative care in advanced cancer patients in a tertiary care hospital in Uttarakhand

    Directory of Open Access Journals (Sweden)

    Manisha Bisht

    2008-01-01

    Full Text Available Aim: Advanced cancer, irrespective of the site of the cancer, is characterized by a number of associated symptoms that impair the quality of life of patients. The management of these symptoms guides palliative care. The present study aims to describe the symptoms and appropriate palliation provided in patients with advanced cancer in a tertiary care hospital in Uttarakhand. Methods: This was an observational study. A total of 100 patients with advanced cancer were included in the study. The data obtained from the patients included symptoms reported by the patients, currently prescribed treatments and the site of cancer. Results: The average number of symptoms reported per patient was 5.33 ± 0.67 (mean ± SE. The most common symptoms were pain, weakness/fatigue, anorexia, insomnia, nausea/vomiting, dyspnea, constipation and cough. Polypharmacy was frequent. Patients consumed approximately 8.7 ± 0.38 (mean ± SE drugs on average during the 2-month period of follow-up. Conclusion: The result gives insight into the varied symptomatology of patients with advanced cancer. Polypharmacy was quite common in patients with advanced cancer, predisposing them to complicated drug interactions and adverse drug reactions.

  9. The trade-off between hospital cost and quality of care. An exploratory empirical analysis.

    Science.gov (United States)

    Morey, R C; Fine, D J; Loree, S W; Retzlaff-Roberts, D L; Tsubakitani, S

    1992-08-01

    The debate concerning quality of care in hospitals, its "value" and affordability, is increasingly of concern to providers, consumers, and purchasers in the United States and elsewhere. We undertook an exploratory study to estimate the impact on hospital-wide costs if quality-of-care levels were varied. To do so, we obtained costs and service output data regarding 300 U.S. hospitals, representing approximately a 5% cross section of all hospitals operating in 1983; both inpatient and outpatient services were included. The quality-of-care measure used for the exploratory analysis was the ratio of actual deaths in the hospital for the year in question to the forecasted number of deaths for the hospital; the hospital mortality forecaster had earlier (and elsewhere) been built from analyses of 6 million discharge abstracts, and took into account each hospital's actual individual admissions, including key patient descriptors for each admission. Such adjusted death rates have increasingly been used as potential indicators of quality, with recent research lending support for the viability of that linkage. The authors then utilized the economic construct of allocative efficiency relying on "best practices" concepts and peer groupings, built using the "envelopment" philosophy of Data Envelopment Analysis and Pareto efficiency. These analytical techniques estimated the efficiently delivered costs required to meet prespecified levels of quality of care. The marginal additional cost per each death deferred in 1983 was estimated to be approximately $29,000 (in 1990 dollars) for the average efficient hospital. Also, over a feasible range, a 1% increase in the level of quality of care delivered was estimated to increase hospital cost by an average of 1.34%. This estimated elasticity of quality on cost also increased with the number of beds in the hospital.

  10. Addressing geographic access barriers to emergency care services: a national ecologic study of hospitals in Brazil.

    Science.gov (United States)

    Rocha, Thiago Augusto Hernandes; da Silva, Núbia Cristina; Amaral, Pedro Vasconcelos; Barbosa, Allan Claudius Queiroz; Rocha, João Victor Muniz; Alvares, Viviane; de Almeida, Dante Grapiuna; Thumé, Elaine; Thomaz, Erika Bárbara Abreu Fonseca; de Sousa Queiroz, Rejane Christine; de Souza, Marta Rovery; Lein, Adriana; Lopes, Daniel Paulino; Staton, Catherine A; Vissoci, João Ricardo Nickenig; Facchini, Luiz Augusto

    2017-08-22

    Unequal distribution of emergency care services is a critical barrier to be overcome to assure access to emergency and surgical care. Considering this context it was objective of the present work analyze geographic access barriers to emergency care services in Brazil. A secondary aim of the study is to define possible roles to be assumed by small hospitals in the Brazilian healthcare network to overcome geographic access challenges. The present work can be classified as a cross-sectional ecological study. To carry out the present study, data of all 5843 Brazilian hospitals were categorized among high complexity centers and small hospitals. The geographical access barriers were identified through the use of two-step floating catchment area method. Once concluded the previous step an evaluation using the Getis-Ord-Gi method was performed to identify spatial clusters of municipalities with limited access to high complexity centers but well covered by well-equipped small hospitals. The analysis of accessibility index of high complexity centers highlighted large portions of the country with nearly zero hospital beds by inhabitant. In contrast, it was possible observe a group of 1595 municipalities with high accessibility to small hospitals, simultaneously with a low coverage of high complexity centers. Among the 1595 municipalities with good accessibility to small hospitals, 74% (1183) were covered by small hospitals with at least 60% of minimum emergency service requirements. The spatial clusters analysis aggregated 589 municipalities with high values related to minimum emergency service requirements. Small hospitals in these 589 cities could promote the equity in access to emergency services benefiting more than eight million people. There is a spatial disequilibrium within the country with prominent gaps in the health care network for emergency services. Taking this challenge into consideration, small hospitals could be a possible solution and foster equity in access

  11. Use of acute care hospital services by immigrant seniors in Ontario: A linkage study.

    Science.gov (United States)

    Ng, Edward; Sanmartin, Claudia; Tu, Jack; Manuel, Doug

    2014-10-01

    Seniors constitute the largest group of hospital users. The increasing share of immigrants in Canada's senior population can affect the demand for hospital care. This study used the linked 2006 Census-Hospital Discharge Abstract Database to examine hospitalization during the 2004-to-2006 period, by immigrant status, of Ontario seniors living in the community. Hospitalization was assessed with logistic regressions; cumulative length of stay, with zero-truncated negative binomial regressions. All-cause hospitalization and hospitalizations specific to circulatory and digestive diseases were examined. Immigrant seniors had significantly low age-/sex-adjusted odds of hospitalization, compared with Canadian-born seniors (OR = 0.81). The odds varied from 0.4 among East Asians to 0.89 among Europeans, and rose with length of time since arrival from 0.54 for recent (1994 to 2003) to 0.86 for long-term (before 1984) immigrants. Adjustment for demographic and socio-economic characteristics did not change the overall patterns. Immigrants' cumulated length of hospital stay tended to be shorter than or similar to that of Canadian-born seniors. Immigrant seniors, especially recent arrivals, had lower odds of hospitalization and similar time in hospital, compared with Canadian-born seniors. These patterns likely reflect differences in health status. Variations by world region and disease reflect the diverse health care needs of immigrant seniors.

  12. [Hospital care expenses caused by acute fascioliasis, cystic echinococcosis, and neurocysticercosis in Santiago, Chile].

    Science.gov (United States)

    Fica, Alberto; Weitzel, Thomas

    2014-08-01

    Acute fascioliasis (FA), cystic echinococcosis (CE) and neurocysticercosis (NCC) are three endemic parasitic diseases in Chile for whom there is scarce information about the economic impact they represent during management at the hospital. To quantify and compare hospital care expenses caused by these three endemic helminth infections in a Chilean hospital. Retrospective analysis of hospital costs at a referral hospital in Santiago between 2006 and 2010. Hospital databases were used to identify patients with the corresponding infections, and those with sufficient data on hospital costs were included. A total of 16 patients representing 21 cases were identified and analyzed: four with AF, eleven with CE, and six with NCC. Median hospital expenses for cases with AF were US$ 1799 and mainly caused by bed-day costs. Median hospital costs for cases of CE were US$ 4707 and the most important costs components were medications, bed-day costs and consumables. NCC patients had median costs of US$ 1293, which were mainly due to bed-day costs. Non-parenchymatous or mixed forms of NCC showed a trend toward higher hospital costs compared with parenchymatous forms. Although helminth infections in Chile, an upper middle income country, are declining and considered rare in routine clinical practice, hospital care expenses caused by patients with AF, CE, and NCC are high and might still present an important economic burden to the Chilean healthcare system.

  13. The Influence of Group Versus Individual Prenatal Care on Phase of Labor at Hospital Admission.

    Science.gov (United States)

    Tilden, Ellen L; Emeis, Cathy L; Caughey, Aaron B; Weinstein, Sarah R; Futernick, Sarah B; Lee, Christopher S

    2016-07-01

    Group prenatal care, an alternate model of prenatal care delivery, has been associated with various improved perinatal outcomes in comparison to standard, individual prenatal care. One important maternity care process measure that has not been explored among women who receive group prenatal care versus standard prenatal care is the phase of labor (latent vs active) at hospital admission. A retrospective case-control study was conducted comparing 150 women who selected group prenatal care with certified nurse-midwives (CNMs) versus 225 women who chose standard prenatal care with CNMs. Analyses performed included descriptive statistics to compare groups and multivariate regression to evaluate the contribution of key covariates potentially influencing outcomes. Propensity scores were calculated and included in regression models. Women within this sample who received group prenatal care were more likely to be in active labor (≥ 4 cm of cervical dilatation) at hospital admission (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.03-2.99; P = .049) and were admitted to the hospital with significantly greater cervical dilatation (mean [standard deviation, SD] 5.7 [2.5] cm vs. 5.1 [2.3] cm, P = .005) compared with women who received standard prenatal care, controlling for potential confounding variables and propensity for group versus individual care selection. Group prenatal care may be an effective and safe intervention for decreasing latent labor hospital admission among low-risk women. Neither group prenatal care nor active labor hospital admission was associated with increased morbidity. © 2016 by the American College of Nurse-Midwives.

  14. Care of the airways in a patient hospitalized at the ARO, JIP

    OpenAIRE

    Budaiová, Lucie

    2011-01-01

    Diplom thesis called "Caring for the airways of a patient hospitalized in DAR, ICU" cosists of two parts - a theoretical and empirical one. The theoretical part is focused on basic knowledge concerning airways. Also describes the anatomy and physiology of airways, caring of airways - ensuring a patient airways, monitoring of the respiratory system and respiratory physical therapy in adult patients hospitalized at DAR, ICU. Empirical part of thesis describes results of data obtained from the q...

  15. Varicella-related Primary Health-care Visits, Hospitalizations and Mortality in Norway, 2008-2014.

    Science.gov (United States)

    Mirinaviciute, Grazina; Kristensen, Erle; Nakstad, Britt; Flem, Elmira

    2017-11-01

    Norway does not currently implement universal varicella vaccination in childhood. We aimed to characterize health care burden of varicella in Norway in the prevaccine era. We linked individual patient data from different national registries to examine varicella vaccinations and varicella-coded primary care consultations, hospitalizations, outpatient hospital visits, deaths and viral infections of central nervous system in the whole population of Norway during 2008-2014. We estimated health care contact rates and described the epidemiology of medically attended varicella infection. Each year approximately 14,600 varicella-related contacts occurred within primary health care and hospital sector in Norway. The annual contact rate was 221 cases per 100,000 population in primary health care and 7.3 cases per 100,000 in hospital care. Both in primary and hospital care, the highest incidences were observed among children 1 year of age: 2,654 and 78.1 cases per 100,000, respectively. The annual varicella mortality was estimated at 0.06 deaths per 100,000 and in-hospital case-fatality rate at 0.3%. Very few (0.2-0.5%) patients were vaccinated against varicella. Among hospitalized varicella patients, 22% had predisposing conditions, 9% had severe-to-very severe comorbidities and 5.5% were immunocompromised. Varicella-related complications were reported in 29.3% of hospitalized patients. Varicella zoster virus was the third most frequent virus found among 16% of patients with confirmed viral infections of central nervous system. Varicella causes a considerable health care burden in Norway, especially among children. To inform the policy decision on the use of varicella vaccination, a health economic assessment of vaccination and mathematical modeling of vaccination impact are needed.

  16. Abstract: Evaluation of the Use and Value of Nursing Care Plans in ...

    African Journals Online (AJOL)

    ... of nursing care plans and evidence based practice among registered nurses. Knowledge and training will increase the utilization of care plans by nurses' usage ... will add to the existing quality improvement in clinical practice in the hospital.

  17. Medicare's prospective payment system for hospitals: new evidence on transitions among health care settings

    OpenAIRE

    Qian, Xufeng; Russell, Louise B.; Valiyeva, Elmira; Miller, Jane E.

    2007-01-01

    Previous studies of Medicare’s prospective payment system for hospitals (PPS), introduced in 1983, evaluated only its first few years, using data collected during the hospital stay to control for patients’ health. We examine transitions among health care settings over a full decade following implementation of PPS, using survival models and a national longitudinal survey with independent information on health. We find that the rate of discharge from hospitals to nursing homes continued to rise...

  18. Leadership as blended care: on daily work and habitus of nurse middle managers in hospitals

    NARCIS (Netherlands)

    Lalleman, P.C.B.

    2017-01-01

    This thesis describes the daily work of nurse middle managers at the frontline of patient care in general hospitals. Their clinical leadership is of the upmost importance in hospitals. It contributes to continuous quality improvement, patient safety practices, patient centeredness, support of

  19. Enhancing the IT Infrastructure at Saint Philip's Hospital: Point-of-Care Solutions

    Science.gov (United States)

    Naydenova, Iva; White, Bruce

    2013-01-01

    Healthcare has become a rapidly changing field. With the introduction of value-based purchasing to determine reimbursement of Medicare providers based on the quality of care in addition to outcomes in treatment, the environment is becoming ever more competitive. Saint Philip's Hospital is among the largest non-profit hospitals in the nation…

  20. A National Program to Expand Educational Opportunity in Hospital and Health Care Administration.

    Science.gov (United States)

    Association of Univ. Programs in Health Administration, Washington, DC.

    This report, prepared by the Association of University Programs in Hospital Administration (AUPHA), presents recommendations for increasing the representation of minorities in hospital and health-care administration careers on a nationwide basis. A short-term objective is to increase the representation of minorities in graduate degree programs…

  1. Changing hospital care: evaluation of a multi-layered organisational development and quality improvement programme

    NARCIS (Netherlands)

    Dückers, M.L.A

    2009-01-01

    In the last decades many different policy changes have been initiated in the Dutch hospital sector to optimise health care delivery: national agenda-setting, increased competition and transparency, a new system of hospital reimbursement based on diagnosis-treatment-combinations, intensified

  2. Setting up a child eye care centre: the Mercy Eye Hospital, Abak ...

    African Journals Online (AJOL)

    Aim: To document and share our experience in setting up a Child Eye Care Centre within a rural mission eye hospital and document subsequent development of services. Method: The location of the project was Mercy Eye Hospital (MEH) Abak, Akwa Ibom State in the South South zone of Nigeria). Consent to commence ...

  3. Maternal near miss and mortality in a tertiary care hospital in Rwanda

    NARCIS (Netherlands)

    Rulisa, S.; Umuziranenge, I.; Small, M; van Roosmalen, J.

    2015-01-01

    Background: To determine the prevalence and factors associated with severe ('near miss') maternal morbidity and mortality in the University Teaching Hospital of Kigali - Rwanda. Methods: We performed a cross sectional study of all women admitted to the tertiary care University Hospital in Kigali

  4. The Bromhead Care Home Service: the impact of a service for care home residents with dementia on hospital admission and dying in preferred place of care.

    Science.gov (United States)

    Garden, Gill; Green, Suzanne; Pieniak, Susan; Gladman, John

    2016-04-01

    People with dementia have worse outcomes associated with hospital admission, are more likely to have interventions and are less likely to be offered palliative care than people without dementia. Advance care planning for care home residents has been shown to reduce hospital admissions without increasing mortality. Studies have shown that staff confidence in managing delirium, a common reason for admission, improves with training. A service combining education for care home staff and advance care planning for care home residents with dementia was introduced to care homes in Boston, UK. There were improvements in staff confidence in recognition, prevention, management and knowledge of factors associated with delirium and dysphagia. 92% of carers rated the service >9/10. Admissions fell by 37% from baseline in the first year and 55% in the second and third years. All but one resident died in the preferred place of care. © 2016 Royal College of Physicians.

  5. A cross-sectional evaluation of computer literacy among medical students at a tertiary care teaching hospital in Mumbai (Bombay

    Directory of Open Access Journals (Sweden)

    T S Panchabhai

    2011-01-01

    Full Text Available Background: Computer usage capabilities of medical students for introduction of computer-aided learning have not been adequately assessed. Aim: Cross-sectional study to evaluate computer literacy among medical students. Settings and Design: Tertiary care teaching hospital in Mumbai, India. Materials and Methods: Participants were administered a 52-question questionnaire, designed to study their background, computer resources, computer usage, activities enhancing computer skills, and attitudes toward computer-aided learning (CAL. The data was classified on the basis of sex, native place, and year of medical school, and the computer resources were compared. The computer usage and attitudes toward computer-based learning were assessed on a five-point Likert scale, to calculate Computer usage score (CUS - maximum 55, minimum 11 and Attitude score (AS - maximum 60, minimum 12. The quartile distribution among the groups with respect to the CUS and AS was compared by chi-squared tests. The correlation between CUS and AS was then tested. Results: Eight hundred and seventy-five students agreed to participate in the study and 832 completed the questionnaire. One hundred and twenty eight questionnaires were excluded and 704 were analyzed. Outstation students had significantly lesser computer resources as compared to local students (P<0.0001. The mean CUS for local students (27.0±9.2, Mean±SD was significantly higher than outstation students (23.2±9.05. No such difference was observed for the AS. The means of CUS and AS did not differ between males and females. The CUS and AS had positive, but weak correlations for all subgroups. Conclusion: The weak correlation between AS and CUS for all students could be explained by the lack of computer resources or inadequate training to use computers for learning. Providing additional resources would benefit the subset of outstation students with lesser computer resources. This weak correlation between the attitudes

  6. Bridging a divide: architecture for a joint hospital-primary care data warehouse.

    Science.gov (United States)

    An, Jeff; Keshavjee, Karim; Mirza, Kashif; Vassanji, Karim; Greiver, Michelle

    2015-01-01

    Healthcare costs are driven by a surprisingly small number of patients. Predicting who is likely to require care in the near future could help reduce costs by pre-empting use of expensive health care resources such as emergency departments and hospitals. We describe the design of an architecture for a joint hospital-primary care data warehouse (JDW) that can monitor the effectiveness of in-hospital interventions in reducing readmissions and predict which patients are most likely to be admitted to hospital in the near future. The design identifies the key governance elements, the architectural principles, the business case, the privacy architecture, future work flows, the IT infrastructure, the data analytics and the high level implementation plan for realization of the JDW. This architecture fills a gap in bridging data from two separate hospital and primary care organizations, not a single managed care entity with multiple locations. The JDW architecture design was well received by the stakeholders engaged and by senior leadership at the hospital and the primary care organization. Future plans include creating a demonstration system and conducting a pilot study.

  7. Hospital cost of Clostridium difficile infection including the contribution of recurrences in French acute-care hospitals.

    Science.gov (United States)

    Le Monnier, A; Duburcq, A; Zahar, J-R; Corvec, S; Guillard, T; Cattoir, V; Woerther, P-L; Fihman, V; Lalande, V; Jacquier, H; Mizrahi, A; Farfour, E; Morand, P; Marcadé, G; Coulomb, S; Torreton, E; Fagnani, F; Barbut, F

    2015-10-01

    The impact of Clostridium difficile infection (CDI) on healthcare costs is significant due to the extra costs of associated inpatient care. However, the specific contribution of recurrences has rarely been studied. The aim of this study was to estimate the hospital costs of CDI and the fraction attributable to recurrences in French acute-care hospitals. A retrospective study was performed for 2011 on a sample of 12 large acute-care hospitals. CDI costs were estimated from both hospital and public insurance perspectives. For each stay, CDI additional costs were estimated by comparison to controls without CDI extracted from the national DRG (diagnosis-related group) database and matched on DRG, age and sex. When CDI was the primary diagnosis, the full cost of stay was used. A total of 1067 bacteriological cases of CDI were identified corresponding to 979 stays involving 906 different patients. Recurrence(s) were identified in 118 (12%) of these stays with 51.7% of them having occurred within the same stay as the index episode. Their mean length of stay was 63.8 days compared to 25.1 days for stays with an index case only. The mean extra cost per stay with CDI was estimated at €9,575 (median: €7,514). The extra cost of CDI in public acute-care hospitals was extrapolated to €163.1 million at the national level, of which 12.5% was attributable to recurrences. The economic burden of CDI is substantial and directly impacts healthcare systems in France. Copyright © 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.

  8. Improvement of hospital performance through innovation: toward the value of hospital care.

    Science.gov (United States)

    Dias, Casimiro; Escoval, Ana

    2013-01-01

    The perspective of innovation as the strategic lever of organizational performance has been widespread in the hospital sector. While public value of innovation can be significant, it is not evident that innovation always ends up in higher levels of performance. Within this context, the purpose of the article was to critically analyze the relationship between innovation and performance,taking into account the specificities of the hospital sector. This article pulls together primary data on organizational flexibility, innovation, and performance from 95 hospitals in Portugal,collected through a survey, data from interviews to hospital administration boards, and a panel of 15 experts. The diversity of data sources allowed for triangulation. The article uses mixed methods to explore the relationship between innovation and performance in the hospital sector in Portugal. The relationship between innovation and performance is analyzed through cluster analysis, supplemented with content analysis of interviews and the technical nominal group. The main findings reveal that the cluster of efficient innovators has twice the level of performance than other clusters. Organizational flexibility and external cooperation are the 2 major factors explaining these differences. The article identifies various organizational strategies to use innovation in order to enhance hospital performance. Overall, it proposes the alignment of perspectives of different stakeholders on the value proposition of hospital services, the embeddedness of information loops, and continuous adjustments toward high-value services.

  9. Effects of hospital care environment on patient mortality and nurse outcomes.

    Science.gov (United States)

    Aiken, Linda H; Clarke, Sean P; Sloane, Douglas M; Lake, Eileen T; Cheney, Timothy

    2008-05-01

    The objective of this study was to analyze the net effects of nurse practice environments on nurse and patient outcomes after accounting for nurse staffing and education. Staffing and education have well-documented associations with patient outcomes, but evidence on the effect of care environments on outcomes has been more limited. Data from 10,184 nurses and 232,342 surgical patients in 168 Pennsylvania hospitals were analyzed. Care environments were measured using the practice environment scales of the Nursing Work Index. Outcomes included nurse job satisfaction, burnout, intent to leave, and reports of quality of care, as well as mortality and failure to rescue in patients. Nurses reported more positive job experiences and fewer concerns with care quality, and patients had significantly lower risks of death and failure to rescue in hospitals with better care environments. Care environment elements must be optimized alongside nurse staffing and education to achieve high quality of care.

  10. Confidence in delegation and leadership of registered nurses in long-term-care hospitals.

    Science.gov (United States)

    Yoon, Jungmin; Kim, Miyoung; Shin, Juhhyun

    2016-07-01

    Effective delegation improves job satisfaction, responsibility, productivity and development. The ageing population demands more nurses in long-term-care hospitals. Delegation and leadership promote cooperation among nursing staff. However, little research describes nursing delegation and leadership style. We investigated the relationship between registered nurses' delegation confidence and leadership in Korean long-term-care hospitals. Our descriptive correlational design sampled 199 registered nurses from 13 long-term-care hospitals in Korea. Instruments were the Confidence and Intent to Delegate Scale and Multifactor Leadership Questionnaire. Confidence in delegation significantly aligned with current-unit clinical experience, length of total clinical-nursing experience, delegation-training experience and leadership. Transformational leadership was the most statistically significant factor influencing delegation confidence. When effective delegation integrates with efficient leadership, staff can deliver optimal care to long-term-care patients. © 2016 John Wiley & Sons Ltd.

  11. Making hospital mortality measurement more meaningful: incorporating advance directives and palliative care designations.

    Science.gov (United States)

    Kroch, Eugene A; Johnson, Mark; Martin, John; Duan, Michael

    2010-01-01

    Accounting for patients admitted to hospitals at the end of a terminal disease process is key to signaling care quality and identifying opportunities for improvement. This study evaluates the benefits and caveats of incorporating care-limiting orders, such as do not resuscitate (DNR) and palliative care (PC) information, in a general multivariate model of mortality risk, wherein the unit of observation is the patient hospital encounter. In a model of the mortality gap (observed - expected from the baseline model), DNR explains 8% to 24% of the gap variation. PC provides additional explanatory power to some disease groupings, especially heart and digestive diseases. One caveat is that DNR information, especially if associated with the later stages of hospital care, may mask opportunities to improve care for certain types of patients. But that is not a danger for PC, which is unequivocally valuable in accounting for patient risk, especially for certain subpopulations and disease groupings.

  12. Body care experienced by people hospitalized with severe respiratory disease

    DEFF Research Database (Denmark)

    Lomborg, Kirsten; Bjoern, Agnes; Dahl, Ronald

    2005-01-01

    of their inability to manage personal body care by themselves have not previously been explored. This study explored patients' experiences of being assisted with personal body care. Methods. A grounded theory methodology was used with a convenience sample of 12 patients. Data were gathered from participant...

  13. Generalist palliative care in hospital: cultural and organisational interactions

    DEFF Research Database (Denmark)

    Bergenholtz, Heidi; Jarlbaek, Lene; Hølge-Hazelton, Bibi

    2016-01-01

    : a quantitative study, in which three independent datasets were triangulated to study the organisation and evaluation of generalist palliative care, and a qualitative, ethnographic study exploring the culture of generalist palliative nursing care in medical departments. SETTING/PARTICIPANTS: A Danish regional...

  14. The critical care nursing workforce in Western Cape hospitals - a ...

    African Journals Online (AJOL)

    Background. A global shortage of registered nurses (RNs) has been reported internationally, and confirmed in South Africa by the National Audit of Critical Care services. Critical care nurses (CCNs) especially are in great demand and short supply. Purpose. The purpose of this study was to quantify the nursing workforce ...

  15. Care of HIV-infected adults at Baragwanath Hospital, Soweto ...

    African Journals Online (AJOL)

    Part I. Clinical management and costs of outpatient care. Objective. To provide a detailed breakdown of clinical presentations and management of outpatients with HIV. and associated costs, in order to inform clinical practice, health service planning and projections of the costs of HIV care in South Africa Setting.

  16. Current understanding of treatment and management protocol for adult diabetic in-patients at a tertiary care hospital

    International Nuclear Information System (INIS)

    Waki, N.; Memon, A.; Khan, M.O.; Masood, S.; Rouf, M.; Mirza, R.

    2012-01-01

    Objective: To assess the current understanding of treatment and management protocols for adult diabetic in-patients at a tertiary care hospital. Methods: This cross-sectional study, conducted at the Civil Hospital Karachi from July to September 2009, involved 450 participants, who were interviewed through a well-structured questionnaire regarding the patient's demography, clinical features, past medical history, type of diabetes mellitus, duration, associated complications, and also involved patient notes for laboratory tests and management. SPSSv15.0 was used for descriptive analysis. Results: The study population of 450 diabetics had 144 (32%) males and 306 (68%) females. Of the total, 435 (96.7%) patients had type 2 diabetes. There were 231 (51%) patients using insulin, 168 (37.3%) oral hypoglycaemic drugs, and 51 (11.3%) using both. Among patients using insulin, regular insulin usage stood at 30% followed by a combination of regular insulin and NPH (26.7%) and NPH alone at 6%. The most popular drug used was metformin (27.3%) and the least used drug was glitazones (4%). In the study population, 73.3% patients controlled their diabetes with diet, and 24.7% with regular exercise. Conclusion: Majority of the study population had type 2 diabetes with a female preponderance. Insulin was prescribed for half the patients. Metformin was the most frequently used oral hypoglycaemic drug. (author)

  17. [Analysis of the influence of the process of care in primary health care on avoidable hospitalizations for heart failure].

    Science.gov (United States)

    del Saz Moreno, Vicente; Alberquilla Menéndez-Asenjo, Ángel; Camacho Hernández, Ana M; Lora Pablos, David; Enríquez de Salamanca Lorente, Rafael; Magán Tapia, Purificación

    2016-02-01

    To determine if the process of care in primary health, affects the risk of avoidable hospitalizations for ambulatory care sensitive conditions (ACSH) for heart failure (HF). Case-control study analyzing the risk of hospitalization for HF. The exposure factor was the process of care for HF in primary health. Health area of the region of Madrid (n=466.901). There were included all adult patients (14 years or older) with a documented diagnosis of HF in the electronic medical record of primary health (n=3.277). The cases were patients who were hospitalized for HF while the controls did not require admission, during 2007. risk of ACSH for HF related to the process of care considered both overall and for each separate standard of appropiate care. Differences in clinical complexity of the groups were measured using the Adjusted Clinical Group (ACG) classification system. 227 cases and 3.050 controls. Clinical complexity was greater in cases. The standards of appropriate care were met to a greater degree in the control group, but none of the two groups met all the standards that would define a process of care as fully appropriate. A significantly lower risk of ACSH was seen for only two standards of appropriate care. For each additional standard of appropriate care not met, the probability of admission was significantly greater (OR: 1,33, 95% CI: 1,19-1,49). Higher quality in the process of care in primary health was associated with a lower risk of hospitalization for HF. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.

  18. [Characterization of a group of hospitalized elderly women and their caretakers keeping in mind the care after hospital discharge].

    Science.gov (United States)

    Marin, Maria José Sanches; Angerami, Emilia Luigia Saporiti

    2002-03-01

    In the present study 50 old women interned in a medical treatment unity and their respective caregivers were studied. It was verified that most of the women preseted various dependencies and, thErefore, they needed the presence of a caregiver for their survival. The caregivers, most of them female, belonged to the old women's family, had some scholarship degree and pointed out several difficulties en caring for the women. It is verified, consequently, that during hospitalization there is the need to take measures aiming at preparing the caregiver to take on the complex aid required by the old person, especially after hospital discharge.

  19. Professional responses to post bureaucratic hospital reforms and their impact on care provision.

    Science.gov (United States)

    Johnsen, Helle

    2015-06-01

    Post bureaucracy is increasingly shaping how health care professionals work. Within hospital settings, post bureaucracy is frequently connected to loss of professional autonomy and protocol-based care. However, this development also affects relationships between care providers and care receivers. To explore experiences of post bureaucratic hospital reforms and their impact on care provision. Data builds on nine mini group interviews with midwives (n=three), nurses (n=three) and physiotherapists (n=three), in all thirty participants. Data was analysed using existing theories of professionalism and post bureaucracy. Two overarching themes were identified: 'Time, tasks and institutional duties' which referred to transformations in care practices, increased use of screening procedures, efficiency requirements and matching linear time to the psychosocial needs of patients. 'Managerial control of work' which described rising administrative demands, engaging in protective measures, younger professionals pressured by documentation obligations and fear of disciplinary procedures. The institutional context appears to play a key role shaping care practices. Although midwives, nurses and physiotherapists share similar experiences of post bureaucratic hospital reforms, changes in care provision can impact these professions in different ways. As a discipline, midwifery is founded on relationships between women and midwives. Standardised clinical care, performativity demands, litigation risks and rising administrative obligations are liable to challenge the provision of woman centred care. These changes may also result in increased inequity in maternity care by affecting some groups of women more than others. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  20. Health care and social media platforms in hospitals.

    Science.gov (United States)

    McCarroll, Michele L; Armbruster, Shannon D; Chung, Jae Eun; Kim, Junghyun; McKenzie, Alissa; von Gruenigen, Vivian E

    2014-01-01

    The objective of this article is to illustrate user characteristics of a hospital's social media structure using analytics and user surveys. A 1-year retrospective analysis was conducted along with an Internet survey of users of the hospital's Facebook, Twitter, and blog. Of the survey respondents (n = 163), 95.7% are female and 4.3% are male; most are ages 50-59 years (31.5%) and 40-49 years (27.8%); and 93.2% are Caucasian. However, the hospital system database revealed 55% female and 37% minority population, respectively. Of the survey respondents, 61.4% reported having a bachelor's degree or higher, whereas only 11.7% reported having a high school degree/equivalent or lower. However, within the hospital patient databases, 93% of patients have a high school degree/equivalent or lower and only 3% have a bachelor's degree or higher in our women's services population. Social media were used to seek personal health information 68.7% (n = 112), to learn about hospital programming 27.6% (n = 45), and to seek family health information 25.2% (n = 41). Respondents younger than 49 years of age were more likely to seek personal health information using social media compared to those 50 years of age and older (p = .02). Respondents with a bachelor's degree or higher education were statistically less likely to search for physician information compared to those less educated individuals (p = .04). We conclude that social media may play an important role in personal health information, especially for young female respondents; however, the survey provides strong evidence that further research is needed to ensure that social network sites provided by hospitals are reaching the full spectrum of health system patients.

  1. Early Medicaid Expansion In Connecticut Stemmed The Growth In Hospital Uncompensated Care.

    Science.gov (United States)

    Nikpay, Sayeh; Buchmueller, Thomas; Levy, Helen

    2015-07-01

    As states continue to debate whether or not to expand Medicaid under the Affordable Care Act (ACA), a key consideration is the impact of expansion on the financial position of hospitals, including their burden of uncompensated care. Conclusive evidence from coverage expansions that occurred in 2014 is several years away. In the meantime, we analyzed the experience of hospitals in Connecticut, which expanded Medicaid coverage to a large number of childless adults in April 2010 under the ACA. Using hospital-level panel data from Medicare cost reports, we performed difference-in-differences analyses to compare the change in Medicaid volume and uncompensated care in the period 2007-13 in Connecticut to changes in other Northeastern states. We found that early Medicaid expansion in Connecticut was associated with an increase in Medicaid discharges of 7-9 percentage points, relative to a baseline rate of 11 percent, and an increase of 7-8 percentage points in Medicaid revenue as a share of total revenue, relative to a baseline share of 10 percent. Also, in contrast to the national and regional trends of increasing uncompensated care during this period, hospitals in Connecticut experienced no increase in uncompensated care. We conclude that uncompensated care in Connecticut was roughly one-third lower than what it would have been without early Medicaid expansion. The results suggest that ACA Medicaid expansions could reduce hospitals' uncompensated care burden. Project HOPE—The People-to-People Health Foundation, Inc.

  2. Japanese structure survey of radiation oncology in 2007 with special reference to designated cancer care hospitals

    International Nuclear Information System (INIS)

    Numasaki, Hodaka; Shibuya, Hitoshi; Nishio, Masamichi

    2011-01-01

    Background and Purpose: The structure of radiation oncology in designated cancer care hospitals in Japan was investigated in terms of equipment, personnel, patient load, and geographic distribution. The effect of changes in the health care policy in Japan on radiotherapy structure was also examined. Material and Methods: The Japanese Society of Therapeutic Radiology and Oncology surveyed the national structure of radiation oncology in 2007. The structures of 349 designated cancer care hospitals and 372 other radiotherapy facilities were compared. Results: Respective findings for equipment and personnel at designated cancer care hospitals and other facilities included the following: linear accelerators/facility: 1.3 and 1.0; annual patients/linear accelerator: 296.5 and 175.0; and annual patient load/full-time equivalent radiation oncologist was 237.0 and 273.3, respectively. Geographically, the number of designated cancer care hospitals was associated with population size. Conclusion: The structure of radiation oncology in Japan in terms of equipment, especially for designated cancer care hospitals, was as mature as that in European countries and the United States, even though the medical costs in relation to GDP in Japan are lower. There is still a shortage of manpower. The survey data proved to be important to fully understand the radiation oncology medical care system in Japan. (orig.)

  3. Utilization of inpatient care from private hospitals: trends emerging from Kerala, India.

    Science.gov (United States)

    Dilip, T R

    2010-09-01

    There is a gap in knowledge on the overall role and characteristics of private health care providers in India. This research is aimed at understanding changes in the consumption of inpatient care services from private hospitals between 1986 and 2004, with a particular focus on equitable outreach. Secondary analysis of National Sample Survey data on the utilization of inpatient care services in Kerala is performed for the periods 1986-87, 1995-96 and 2004. Household survey data are examined to understand the users of the private health system as there are limitations in obtaining reliable data from unregulated private health care providers. The annual hospitalization rate increased from 69 per 1000 population in 1986-87 to 126 per 1000 population by 2004. The proportion of persons seeking care from private rather than government hospitals increased from 55% in 1986-87 to 65% by 2004. Concentration indices revealed that the year 1995-96 witnessed the highest income inequality in hospitalization rates. A decline both in hospitalization rates and in the relative preference for private hospitals over government hospitals among the poorest two quintiles between 1986-87 and 1995-96 indicates that the poor avoided inpatient treatment. The rich-poor divide in care seeking from private hospitals was moderated by 2004. Improvements in the purchasing power of the population, and the strategy of private hospitals in this highly competitive market to generate revenue from the poorer quintiles by offering different pricing options, have reduced the observed rich-poor divide in the consumption of inpatient treatment from this sector. However, while this gap in utilization has closed, the burden of out-of-pocket expenditure is higher among the poor.

  4. [Commune prison camp's health care and Versailles military hospital share].

    Science.gov (United States)

    Delahaye, R P

    1995-01-01

    Between June 1871 and December 1872, about five thousand prisoners were kept in Versailles among some places of detention. This high death rate was indebted for worst hygienic states (individual or collective) and food wretched quality during first weeks. Military Health Service, under Hippolyte Larrey's management with Adolphe Thiers and staff assent involved living conditions owing to tubs and toilets not forgiving accurate clothes and well-balanced food. In every prison was fitted and infirmary managed by a military physician. Sick people were sent into hospital. Versailles city's archives show that, during 1871, 154 insurgent people died in the military hospital while the number dropped to 55 during 1872.

  5. 78 FR 64953 - Medicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services...

    Science.gov (United States)

    2013-10-30

    ... adjustment based on changes in the economy-wide productivity (the multifactor productivity (MFP) adjustment... notice and comment is unnecessary because the formulae used to calculate the inpatient hospital...

  6. 76 FR 67567 - Medicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services...

    Science.gov (United States)

    2011-11-01

    ... adjustment based on changes in the economy-wide productivity (the multifactor productivity (MFP) adjustment... notice and comment is unnecessary because the formulae used to calculate the inpatient hospital...

  7. Safety and cost savings of reducing adult dengue hospitalization in a tertiary care hospital in Singapore.

    Science.gov (United States)

    Lee, Linda K; Earnest, Arul; Carrasco, Luis R; Thein, Tun L; Gan, Victor C; Lee, Vernon J; Lye, David C; Leo, Yee-Sin

    2013-01-01

    Previously, most dengue cases in Singapore were hospitalized despite low incidence of dengue hemorrhagic fever (DHF) or death. To minimize hospitalization, the Communicable Disease Centre at Tan Tock Seng Hospital (TTSH) in Singapore implemented new admission criteria which included clinical, laboratory, and DHF predictive parameters in 2007. All laboratory-confirmed dengue patients seen at TTSH during 2006-2008 were retrospectively reviewed for clinical data. Disease outcome and clinical parameters were compared over the 3 years. There was a 33.0% mean decrease in inpatients after the new criteria were implemented compared with the period before (p hospitalization, yielding considerable cost savings. A minority of DHF patients with mild symptoms recovered uneventfully through outpatient management.

  8. Structure for prevention of health care-associated infections in Brazilian hospitals: A countrywide study.

    Science.gov (United States)

    Padoveze, Maria Clara; Fortaleza, Carlos Magno Castelo Branco; Kiffer, Carlos; Barth, Afonso Luís; Carneiro, Irna Carla do Rosário Souza; Giamberardino, Heloisa Ilhe Garcia; Rodrigues, Jorge Luiz Nobre; Santos Filho, Lauro; de Mello, Maria Júlia Gonçalves; Pereira, Milca Severino; Gontijo Filho, Paulo; Rocha, Mirza; de Medeiros, Eduardo Alexandrino Servolo; Pignatari, Antonio Carlos Campos

    2016-01-01

    Minimal structure is required for effective prevention of health care-associated infection (HAI). The objective of this study was to evaluate the structure for prevention of HAI in a sample of Brazilian hospitals. This was a cross-sectional study from hospitals in 5 Brazilian regions (n = 153; total beds: 13,983) classified according to the number of beds; 11 university hospitals were used as reference for comparison. Trained nurses carried out the evaluation by using structured forms previously validated. The evaluation of conformity index (CI) included elements of structure of the Health Care-Associated Prevention and Control Committee (HAIPCC), hand hygiene, sterilization, and laboratory of microbiology. The median CI for the HAIPCC varied from 0.55-0.94 among hospital categories. Hospitals with >200 beds had the worst ratio of beds to sinks (3.9; P hospitals with hospitals (3.3; P hospitals were more likely to have their own laboratory of microbiology than other hospitals. This study highlights the need for public health strategies aiming to improve the structure for HAI prevention in Brazilian hospitals. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

  9. Investing in Post-Acute Care Transitions: Electronic Information Exchange Between Hospitals and Long-Term Care Facilities.

    Science.gov (United States)

    Cross, Dori A; Adler-Milstein, Julia

    2017-01-01

    Electronic health information exchange (HIE) is expected to help improve care transitions from hospitals to long-term care (LTC) facilities. We know little about the prevalence of hospital LTC HIE in the United States and what contextual factors may motivate or constrain this activity. Cross-sectional analysis of U.S. acute-care hospitals responding to the 2014 AHA IT Supplement survey and with available readmissions data (n = 1,991). We conducted multivariate logistic regression to explore the relationship between hospital LTC HIE and selected IT and policy characteristics. Over half of the hospitals in our study (57.2%) reported engaging in some form of HIE with LTC providers: 33.9% send-only, 0.5% receive-only, and 22.8% send and receive. Hospitals that engaged in some form of LTC HIE were more likely than those that did not engage to have attested to meaningful use (odds ratio [OR], 1.87; P = .01 for stage 1 and OR, 2.05; P investing in electronic information exchange with LTCs as part of a general strategy to adopt EHRs and engage in HIE, but also potentially to strengthen ties to LTC providers and to reduce readmissions. To achieve widespread connectivity, continued focus on adoption of related health IT infrastructure and greater emphasis on aligning incentives for hospital-LTC care transitions would be valuable. Copyright © 2016 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  10. Liaison psychiatry professionals' views of general hospital care for patients with mental illness: The care of patients with mental illness in the general hospital setting.

    Science.gov (United States)

    Noblett, J; Caffrey, A; Deb, T; Khan, A; Lagunes-Cordoba, E; Gale-Grant, O; Henderson, C

    2017-04-01

    Explore the experiences of liaison psychiatry professionals, to gain a greater understanding of the quality of care patients with mental illness receive in the general hospital setting; the factors that affect the quality of care; and their insights on interventions that could improve care. A survey questionnaire and qualitative in depth interviews were used to collect data. Data collection took place at the Royal College of Psychiatrists Faculty of Liaison Psychiatry Annual conference. Qualitative analysis was done using thematic analysis. Areas of concern in the quality of care of patients with co-morbid mental illness included 'diagnostic overshadowing', 'poor communication with patient', 'patient dignity not respected' and 'delay in investigation or treatment'. Eleven contributing factors were identified, the two most frequently mentioned were 'stigmatising attitudes of staff towards patients with co-morbid mental illness' and 'complex diagnosis'. The general overview of care was positive with areas for improvement highlighted. Interventions suggested included 'formal education' and 'changing the liaison psychiatry team'. The cases discussed highlighted several areas where the quality of care received by patients with co-morbid mental illness is lacking, the consequences of which could be contributing to physical health disparities. It was acknowledged that it is the dual responsibility of both the general hospital staff and liaison staff in improving care. Copyright © 2017 Elsevier Inc. All rights reserved.

  11. Perceptions of health care providers in Mulago hospital on ...

    African Journals Online (AJOL)

    Objective: To explore knowledge, attitudes and practices of health workers in Mulago hospital towards domestic violence prevention and management, especially violence during pregnancy. Methods: From 5th to 25th March 2000, self-administered pre-coded questionnaires were given to a purposively selected sample of ...

  12. Ethnic inequalities in patient safety in Dutch hospital care

    NARCIS (Netherlands)

    van Rosse, F.

    2015-01-01

    This thesis shows the first results of Dutch studies on the relation between ethnicity and patient safety. We used mixed methods to identify patient safety outcomes and patient safety risks in a cohort study in 4 urban hospitals among 763 Dutch patients and 576 ethnic minority patients. In a record

  13. Shriners Hospital Spinal Cord Injury Self Care Manual.

    Science.gov (United States)

    Fox, Carol

    This manual is intended for young people with spinal cord injuries who are receiving rehabilitation services within the Spinal Cord Injury Unit at Shriners Hospital (San Francisco, California). An introduction describes the rehabilitation program, which includes family conferences, an individualized program, an independent living program,…

  14. Hospital care for persons with AIDS in the European Union

    NARCIS (Netherlands)

    Postma, Maarten; Tolley, K; Leidl, R M; Downs, A M; Beck, E J; Tramarin, A M; Flori, Y A; Santin, M; Antoñanzas, F; Kornarou, H; Paparizos, V C; Dijkgraaf, M G; Borleffs, J; Luijben, A J; Jager, J C

    This study estimates the current and future hospital resources for AIDS patients in the European Union (EU), using multinational scenario analysis (EU Concerted Action BMH1-CT-941723). In collaboration with another EU-project ('Managing the Costs of HIV Infection'), six national European studies on

  15. Economic analysis of an epilepsy outreach model of care in a university hospital setting.

    Science.gov (United States)

    Maloney, Eimer; McGinty, Ronan N; Costello, Daniel J

    2017-07-01

    The prevalence of epilepsy in people with intellectual disability is higher than in the general population and prevalence rates increase with increasing levels of disability. Prevalence rates of epilepsy are highest among those living in residential care. The healthcare needs of people with intellectual disability and epilepsy are complex and deserve special consideration in terms of healthcare provision and access to specialist epilepsy clinics, which are usually held in acute hospital campuses. This patient population is at risk of suboptimal care because of significant difficulties accessing specialist epilepsy care which is typically delivered in the environs of acute hospitals. In 2014, the epilepsy service at Cork University Hospital established an Epilepsy Outreach Service providing regular, ambulatory outpatient follow up at residential care facilities in Cork city and county in an effort to improve access to care, reduce the burden and expense of patient and carer travel to hospital outpatient appointments, and to provide a dedicated specialist phone service for epilepsy related queries in order to reduce emergency room visits when possible. We present the findings of an economic analysis of the outreach service model of care compared to the traditional hospital outpatient service and demonstrate significant cost savings and improved access to care with this model. Ideally these cost savings should be used to develop novel ways to enhance epilepsy care for persons with disability. We propose that this model of care can be more suitable for persons with disability living in residential care who are at risk of losing access to specialist epilepsy care. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Priorities for improving hospital-based trauma care in an African city.

    Science.gov (United States)

    London, J A; Mock, C N; Quansah, R E; Abantanga, F A; Jurkovich, G J

    2001-10-01

    This study sought to identify potential cost-effective methods to improve trauma care in hospitals in the developing world. Injured patients admitted to an urban hospital in Ghana over a 1-year period were analyzed prospectively for mechanism of injury, mode of transport to the hospital, injury severity, region of principal injury, operations performed, and mortality. In addition, time from injury until arrival at the hospital and time from arrival at the hospital until emergency surgery were evaluated. Mortality was 9.4%. Most deaths (65%) occurred within 24 hours of admission. Sixty percent of emergency operations were performed over 6 hours after arrival. Tube thoracostomy was performed on only 13 patients (0.6%). Only 58% of patients received intravenous crystalloid and only 3.6% received 1 or more units of blood. We identified several specific interventions as potential low-cost measures to improve hospital-based trauma care in this setting, including shorter times to emergency surgery and improvements in initial resuscitation. In addition to addressing each of these aspects of trauma care individually, quality improvement programs may represent a feasible and sustainable method to improve trauma care in hospitals in the developing world.

  17. Perceptions of patient-centred care at public hospitals in Nelson ...

    African Journals Online (AJOL)

    In South Africa, the quality of health care is directly related to the concept of patientcentred care and the enactment of the Batho Pele Principles and the Patients' Rights Charter. Reports in the media indicate that public hospitals in the Eastern Cape Province are on the brink of collapse, with many patients being treated in ...

  18. Variations in levels of care within a hospital provided to acute ...

    African Journals Online (AJOL)

    Variations in levels of care within a hospital provided to acute trauma patients. ... A scoring system was devised to classify the quality of the observations that each patient received in the different ... Observations in the intensive care unit (ICU) and operating theatre were uniformly excellent. In the ... HOW TO USE AJOL.

  19. Quality of hospital care for seriously ill children in less-developed countries

    NARCIS (Netherlands)

    Nolan, T; Angos, P; Cunha, AJLA; Muhe, L; Qazi, S; Simoes, EAF; Tamburlini, G; Weber, M; Pierce, NF

    2001-01-01

    Background improving the quality of care for sick children referred to hospitals in less-developed countries may lead to better outcomes, including reduced mortality. Data are lacking, however, on the quality of priority screening (triage), emergency care, diagnosis, and inpatient treatment in these

  20. Geriatric Inpatient Units in the Care of Hospitalized Frail Adults with a History of Heart Failure

    Directory of Open Access Journals (Sweden)

    Shahyar Michael Gharacholou

    2012-06-01

    Conclusion: Inpatient GEM was associated with better maintenance of physical function and basic ADLs at hospital discharge; however, no differences in HRQOL or survival were observed between GEM and UC at 1 year post randomization. Restructuring inpatient care models to incorporate inpatient GEM principles may be one method to optimize health-care delivery.

  1. Continuity and Change : Comparative Case Study of Hospital and Home Care Governance in The Netherlands

    NARCIS (Netherlands)

    Oomkens, Rosanne|info:eu-repo/dai/nl/314569286; Hoogenboom, Marcel|info:eu-repo/dai/nl/14667863X; Knijn, Trudie|info:eu-repo/dai/nl/072101032

    2015-01-01

    This article aims to understand the evolution of health care governance in the Dutch hospital and home care sector. We pay particular attention to how institutionalized governance structures shape policy reform. Professionally-dominated governance structures are likely to continue to exist to some

  2. Home or hospital birth: a prospective study of midwifery care in the Netherlands.

    NARCIS (Netherlands)

    Wiegers, T.A.

    1997-01-01

    A large scale study on maternity care in the Netherlands, describing many facets of midwifery care in relation to the preferred place of birth (at home or in hospital), the obstetric result, and the experiences of childbirth. In the Netherlands only women with low risk pregnancies are free to

  3. Modeling the effects of influenza vaccination of health care workers in hospital departments

    NARCIS (Netherlands)

    van den Dool, C.; Bonten, M. J. M.; Hak, E.; Wallinga, J.

    2009-01-01

    Nowadays health care worker (HCW) vaccination is widely recommended. Although the benefits of this strategy have been demonstrated in long-term care settings, no studies have been performed in regular hospital departments. We adapt a previously developed model of influenza transmission in a

  4. Standardised pre-hospital care of acute myocardial infarction patients: MISSION! guidelines applied in practice

    NARCIS (Netherlands)

    Atary, J. Z.; de Visser, M.; van den Dijk, R.; Bosch, J.; Liem, S. S.; Antoni, M. L.; Bootsma, M.; Viergever, E. P.; Kirchhof, C. J.; Padmos, I.; Sedney, M. I.; van Exel, H. J.; Verwey, H. F.; Atsma, D. E.; van der Wal, E. E.; Jukema, J. W.; Schalij, M. J.

    2010-01-01

    Background. To improve acute myocardial infarction (AMI) care in the region 'Hollands-Midden' (the Netherlands), a standardised guideline-based care program was developed (MISSION!). This study aimed to evaluate the outcome of the pre-hospital part of the MISSION! program and to study potential

  5. Hospital heavies. Venture capital bulks up companies that outsource medicine's newest specialty: inpatient-only care.

    Science.gov (United States)

    Huff, C

    They're the designated drivers of inpatient care, cutting hospital stays by 19 percent on average. Yet as venture capital firms infuse hospitalist startup companies, some primary care doctors complain that their sickest patients are being taken away from them.

  6. Exploring types of focused factories in hospital care: a multiple case study.

    NARCIS (Netherlands)

    Bredenhoff, E.; Bredenhoff, Eelco; van Lent, W.A.M.; van Harten, Willem H.

    2010-01-01

    Background: Focusing on specific treatments or diseases is proposed as a way to increase the efficiency of hospital care. The definition of "focus" or "focused factory", however, lacks clarity. Examples in health care literature relate to very different organizations. Our aim was to explore the

  7. Scope of neonatal care services in major Nigerian hospitals

    African Journals Online (AJOL)

    2015-10-12

    Oct 12, 2015 ... Quality of newborn care by level of services offered is a critical determinant of ... natal unit capacity, personnel, trainings in newborn cardio-pulmonary ... The availability of surfactant replacement service was also solicited.

  8. Superbugs causing ventilator associated pneumonia in a tertiary care hospital and the return of pre-antibiotic era!

    Directory of Open Access Journals (Sweden)

    S Qureshi

    2015-01-01

    Full Text Available The rise in super bugs causing Ventilator-Associated Pneumonia (VAP is a major cause of mortality and morbidity despite recent advances in management owing to the looming ′antibiotic apocalypse′. The aetiology and susceptibility pattern of the VAP isolates varies with patient population, type of intensive care unit (ICU and is an urgent diagnostic challenge. The present study carried out for a period of one year in a tertiary care hospital, enrolled patients on mechanical ventilation (MV for ≥48 hrs. Endotracheal aspirates (ETA from suspected VAP patients were processed by semi quantitative method. Staphylococus aureus, members of Enterobacteriaceae were more common in early onset VAP (EOVAP, while Nonfermenting Gram negative bacilli (NFGNB were significantly associated with late onset VAP (LOVAP. Most of the isolates were multi drug resistant (MDR super bugs. With limited treatment options left for this crisis situation like the pre-antibiotic era; it is an alarm for rational antibiotic therapy usage and intensive education programs.

  9. Out-of-pocket expenditure on maternity care for hospital births in Uttar Pradesh, India.

    Science.gov (United States)

    Goli, Srinivas; Rammohan, Anu; Moradhvaj

    2018-02-27

    The studies measured Out-of-Pocket Expenditure (OOPE) for hospital births previously suffer from serious data limitations. To overcome such limitations, we designed a hospital-based study for measuring the levels and factors of OOPE on maternity care for hospital births by its detailed components. Data were collected from women for non-complicated deliveries 24-h before the survey and complicated deliveries 48-h prior to the survey at the hospital settings in Uttar Pradesh, India during 2014. The simple random sampling design was used in the selection of respondents. Bivariate analyses were used to estimate mean expenditure on Antenatal care services (ANCs), Delivery care and Total Maternity Expenditure (TME). Multivariate linear regression was employed to examine the factor associated with the absolute and relative share of expenditure in couple's annual income on ANCs, delivery care, and TME. The findings show that average expenditure on maternal health care is high ($155) in the study population. Findings suggest that factors such as income, place, and number of ANCs, type, and place of institutional delivery are significantly associated with both absolute and relative expenditure on maternity care. The likelihood of incidence of catastrophic expenditure on maternity care is significantly higher for women delivered in private hospitals (β = 2.427, p maternity care for hospital births reported in this study is much higher as it was collected with a better methodology, although with smaller sample size. Therefore, ongoing maternity benefit scheme in India in general and Uttar Pradesh in particular need to consider the levels of OOPE on maternity care and demand-side and supply-side factors determining it for a more effective policy to reduce the catastrophic burden on households and help women to achieve better maternity health outcomes in poor regional settings like Uttar Pradesh in India.

  10. Another link to improving the working environment in acute care hospitals: registered nurses' spirit at work.

    Science.gov (United States)

    Urban, Ann-Marie; Wagner, Joan I

    2013-12-01

    Hospitals are situated within historical and socio-political contexts; these influence the provision of patient care and the work of registered nurses (RNs). Since the early 1990s, restructuring and the increasing pressure to save money and improve efficiency have plagued acute care hospitals. These changes have affected both the work environment and the work of nurses. After recognizing this impact, healthcare leaders have dedicated many efforts to improving the work environment in hospitals. Admirable in their intent, these initiatives have made little change for RNs and their work environment, and thus, an opportunity exists for other efforts. Research indicates that spirit at work (SAW) not only improves the work environment but also strengthens the nurse's power to improve patient outcomes and contribute to a high-quality workplace. In this paper, we present findings from our research that suggest SAW be considered an important component in improving the work environment in acute care hospitals.

  11. [Benefits from the use of toys during nursing care delivered to hospitalized children].

    Science.gov (United States)

    Jansen, Michele Ferraz; dos Santos, Rosane Maria; Favero, Luciane

    2010-06-01

    It is a qualitative research study, descriptive-exploratory in nature, which aims to verify the benefits from the use of toys during nursing care to hospitalized children. Ten subjects participated in the study: three children and seven mothers of hospitalized children. Data were collected between May and July, 2008 by means of specific instruments for each age group and further organized in thematic categories: the use of toys to lessen hospitalization stress; toys facilitating understanding and acceptance of procedures; and the experience of using toys and hospitalization process. The results show that the use of toys is an excellent nursing resource to render care to admitted children. The features of the toys facilitated communication, participation, acceptance of procedure and child motivation, what enabled them to keep their individuality, lessen the stress and the possibility to implement children's and families' non-traumatic care.

  12. How to implement process-oriented care: a case study on the implementation of process-oriented in-hospital stroke care.

    NARCIS (Netherlands)

    Vos, L.; Oostenbrugge, R.J. van; Limburg, M.; Merode, G.G. van; Groothuis, S.

    2009-01-01

    Dutch hospitals are in the midst of a transition towards process-oriented organisation to realise optimal and undisturbed care processes. Between 2004 and 2007, the University Hospital of Maastricht conducted a case study implementing process-oriented in-hospital stroke unit care. The case study

  13. The effect of financing hospital health care providers through updated Diagnosis Related Groups. Case studies: the municipal hospitals in Romania

    Directory of Open Access Journals (Sweden)

    Emil OLTEANU

    2014-11-01

    Full Text Available In our scientific approach we tried to develop a model with which to highlight the effect of financing hospital health care providers using the hospital 's Diagnosis Related Groups (DRG and Mean Relative Values (MRV. The econometric model used is simple linear regression model form. Development of the model was performed by using the EViews 7 to the municipal hospitals in Romania during 2010 - 2012, being considered DRG dependent variable and independent variables: C and MRV. Analyzing in detail the results recorded by providers following simple regression model is observed that there are units which, although recorded low values in the number of patients discharged, they were able to achieve a relatively high VRM or to contract a level of TAC over average of the entire sample.

  14. Factors affecting Polish nurses' willingness to recommend the hospital as a place of care.

    Science.gov (United States)

    Kózka, Maria; Brzostek, Tomasz; Cisek, Maria; Brzyski, Piotr; Przewoźniak, Lucyna; Gabryś, Teresa; Ogarek, Maria; Gajda, Krzysztof; Ksykiewicz-Dorota, Anna

    Nurses constitute the major professional group offering constant hospital patients' care. Willingness to recommend their hospital reflects confidence in the offered care, satisfaction and identification with the work place. The aim of the present study has been to investigate which elements of hospital environment and nurse personal related factors predict recommendation of the hospital as a place of care by employed nurses. Cross-sectional, correlation study was, based on 1723 self-reported, anonymous questionnaires of nurses working in 30 acute hospitals. Data was analyzed using the logistic regression model, with general estimation equations. About 25% of nurses were unwilling to recommend their hospital as the place of care. The odds ratio (OR) of the lack of willingness to recommend the hospital was related to assessment of patients' safety (OR = 0.28, 95% confidence interval (CI): 0.18-0.46, p = 0.00), decrease in the quality of patient care during the preceding year (OR = 0.62, 95% CI: 0.41-0.93, p = 0.02), overall work conditions (OR = 0.35, 95% CI: 0.22-0.57, p = 0.00), weak cooperation between nurses and physicians (OR = 0.37, 95% CI: 0.25-0.54, p = 0.00), poor work schedule flexibility (OR = 0.74, 95% CI: 0.55- 0.99, p = 0.04) and educational opportunities (OR = 0.71, 95% CI: 0.54-0.95, p = 0.02) and the level of nurses depersonalization (OR = 1.78, 95% CI: 1.18-1.68, p = 0.00). The hospital manager should consider strategies which improve patients' safety and the staff working conditions. Thanks to that they will also achieve better and more competitive image of the hospital in the local community. Med Pr 2016;67(4):447-454. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

  15. A Randomized Controlled Trial of Hospital-based Case Management in Cancer Care

    DEFF Research Database (Denmark)

    Wulff, Christian N; Vedsted, Peter; Søndergaard, Jens

    2012-01-01

    BACKGROUND: Case management (CM) models based on experienced nurses are increasingly used to improve coordination and continuity of care for patients with complex health care needs. Anyway, little is known about the effects of hospital-based CM in cancer care.Aim.To analyse the effects of hospital...... and out of hours were collected 9 months after recruitment and the data from the two groups were compared quarterly. RESULTS: CM was associated with an overall tendency towards more positive GP evaluations, which for 3 of 20 items reached statistical significance. Statistically significantly fewer GPs...

  16. Caring for homeless persons with serious mental illness in general hospitals.

    Science.gov (United States)

    Bauer, Leah K; Baggett, Travis P; Stern, Theodore A; O'Connell, Jim J; Shtasel, Derri

    2013-01-01

    The care of homeless persons with serious mental illness remains a common and challenging problem in general hospital settings. This article aims to review data on homelessness and its psychiatric comorbidities, and to expand the skills of providers who encounter homeless individuals in general hospital settings. Literature review reveals patient, provider, and systems factors that contribute to suboptimal health outcomes in homeless individuals. Diagnostic rigor, integrated medical and psychiatric care, trauma-informed interventions, special considerations in capacity evaluations, and health care reform initiatives can improve the treatment of homeless persons with serious mental illness. Copyright © 2013 The Academy of Psychosomatic Medicine. Published by Elsevier Inc. All rights reserved.

  17. The declining demand for hospital care as a rationale for duty hour reform.

    Science.gov (United States)

    Jena, Anupam B; DePasse, Jacqueline W; Prasad, Vinay

    2014-10-01

    The regulation of duty hours of physicians in training remains among the most hotly debated subjects in medical education. Although recent duty hour reforms have been chiefly motivated by concerns about resident well-being and medical errors attributable to resident fatigue, the debate surrounding duty hour reform has infrequently involved discussion of one of the most important secular changes in hospital care that has affected nearly all developed countries over the last 3 decades: the declining demand for hospital care. For example, in 1980, we show that resident physicians in US teaching hospitals provided, on average, 1,302 inpatient days of care per resident physician compared to 593 inpatient days in 2011, a decline of 54%. This decline in the demand for hospital care by residents provides an under-recognized economic rationale for reducing residency duty hours, a rationale based solely on supply and demand considerations. Work hour reductions and growing requirements for outpatient training can be seen as an appropriate response to the shrinking demand for hospital care across the health-care sector.

  18. Reductions in inpatient mortality following interventions to improve emergency hospital care in Freetown, Sierra Leone.

    Directory of Open Access Journals (Sweden)

    Matthew Clark

    Full Text Available BACKGROUND: The demand for high quality hospital care for children in low resource countries is not being met. This paper describes a number of strategies to improve emergency care at a children's hospital and evaluates the impact of these on inpatient mortality. In addition, the cost-effectiveness of improving emergency care is estimated. METHODS AND FINDINGS: A team of local and international staff developed a plan to improve emergency care for children arriving at The Ola During Children's Hospital, Freetown, Sierra Leone. Following focus group discussions, five priority areas were identified to improve emergency care; staff training, hospital layout, staff allocation, medical equipment, and medical record keeping. A team of international volunteers worked with local staff for six months to design and implement improvements in these five priority areas. The improvements were evaluated collectively rather than individually. Before the intervention, the inpatient mortality rate was 12.4%. After the intervention this improved to 5.9%. The relative risk of dying was 47% (95% CI 0.369-0.607 lower after the intervention. The estimated number of lives saved in the first two months after the intervention was 103. The total cost of the intervention was USD 29 714, the estimated cost per death averted was USD 148. There are two main limitation of the study. Firstly, the brevity of the study and secondly, the assumed homogeneity of the clinical cases that presented to the hospital before and after the intervention. CONCLUSIONS: This study demonstarted a signficant reductuion in inpatient mortality rate after an intervention to improve emergency hospital care If the findings of this paper could be reproduced in a larger more rigorous study, improving the quality of care in hospitals would be a very cost effective strategy to save children's lives in low resource settings.

  19. Risk factors for acute care hospital readmission in older persons in Western countries

    DEFF Research Database (Denmark)

    Pedersen, Mona Kyndi; Meyer, Gabriele; Uhrenfeldt, Lisbeth

    2017-01-01

    related to socio-demographics, health characteristics and clinical and organizational factors related to the care pathway. TYPES OF STUDIES: The current review considered analytical and descriptive epidemiological study designs that evaluated risk factors for acute care hospital readmission. OUTCOMES......: The outcome was readmission to an acute care hospital within one month of discharge. SEARCH STRATEGY: A three-step search was utilized to find published and unpublished studies in English, French, German, Norwegian, Swedish or Danish. Five electronic databases were searched from 2004 to 2013, followed...... summary and metasynthesis of the quantitative findings was conducted. RESULTS: Based on a review of nine studies from ten Western countries, we found several significant risk factors pertaining to readmission to an acute care hospital within one month of discharge in persons aged 65 years and over...

  20. Perceptions of patient-centred care at public hospitals in Nelson Mandela Bay

    Directory of Open Access Journals (Sweden)

    Sihaam Jardien-Baboo

    2016-10-01

    Full Text Available In South Africa, the quality of health care is directly related to the concept of patient-centred care and the enactment of the Batho Pele Principles and the Patients' Rights Charter. Reports in the media indicate that public hospitals in the Eastern Cape Province are on the brink of collapse, with many patients being treated in condemned hospitals which lacked piped water, electricity and essential medical equipment. Receiving quality care, and principally patient-centred care, in the face of such challenges is unlikely and consequently leads to the following question: “Are patients receiving patient-centred care in public hospitals?” A qualitative, explorative, descriptive and contextual study was conducted to explore and describe the perceptions of professional nurses regarding patient-centred care in public hospitals in Nelson Mandela Bay. Semi-structured interviews were conducted with a total of 40 purposively selected professional nurses working in public hospitals in Nelson Mandela Bay, Eastern Cape Province. Interviews were analysed according to the method described by Tesch in Creswell (2009:192. Professional nurses perceive patient-centred care as an awareness of the importance of the patient's culture, involving the patient's family, incorporating values of love and respect, optimal communication in all facets of patient care and accountability to the patient. Factors which enable patient-centred care were a positive work environment for staff, nursing manager's demonstrating exemplary professional leadership, continuous in service education for staff and collaborative teamwork within the interdisciplinary team. Barriers to patient-centred care were a lack of adequate resources, increased administrative work due to fear of litigation and unprofessional behaviour of nursing staff.

  1. Factors influencing the missed nursing care in patients from a private hospital

    Directory of Open Access Journals (Sweden)

    Raúl Hernández-Cruz

    Full Text Available ABSTRACT Objective: to determine the factors that influence the missed nursing care in hospitalized patients. Methods: descriptive correlational study developed at a private hospital in Mexico. To identify the missed nursing care and related factors, the MISSCARE survey was used, which measures the care missed and associated factors. The care missed and the factors were grouped in global and dimension rates. For the analysis, descriptive statistics, Spearman’s correlation and simple linear regression were used. Approval for the study was obtained from the ethics committee. Results: the participants were 71 nurses from emergency, intensive care and inpatient services. The global missed care index corresponded to M=7.45 (SD=10.74; the highest missed care index was found in the dimension basic care interventions (M=13.02, SD=17.60. The main factor contributing to the care missed was human resources (M=56.13, SD=21.38. The factors related to the care missed were human resources (rs=0.408, p<0.001 and communication (rs=0.418, p<0.001. Conclusions: the nursing care missed is mainly due to the human resource factor; these study findings will permit the strengthening of nursing care continuity.

  2. Addressing geographic access barriers to emergency care services: a national ecologic study of hospitals in Brazil

    OpenAIRE

    Rocha, Thiago Augusto Hernandes; da Silva, N?bia Cristina; Amaral, Pedro Vasconcelos; Barbosa, Allan Claudius Queiroz; Rocha, Jo?o Victor Muniz; Alvares, Viviane; de Almeida, Dante Grapiuna; Thum?, Elaine; Thomaz, Erika B?rbara Abreu Fonseca; de Sousa Queiroz, Rejane Christine; de Souza, Marta Rovery; Lein, Adriana; Lopes, Daniel Paulino; Staton, Catherine A.; Vissoci, Jo?o Ricardo Nickenig

    2017-01-01

    Background Unequal distribution of emergency care services is a critical barrier to be overcome to assure access to emergency and surgical care. Considering this context it was objective of the present work analyze geographic access barriers to emergency care services in Brazil. A secondary aim of the study is to define possible roles to be assumed by small hospitals in the Brazilian healthcare network to overcome geographic access challenges. Methods The present work can be classified as a c...

  3. Improving care transitions from hospital to home: standardized orders for home health nursing with remote telemonitoring.

    Science.gov (United States)

    Heeke, Sheila; Wood, Felecia; Schuck, Jennifer

    2014-01-01

    A task force at a multihospital health care system partnered with home health agencies to improve gaps during the discharge transition process. A standardized order template for home health nursing and remote telemonitoring was developed to decrease discrepancies in communication between hospital health care providers and home health nurses caring for patients with heart failure. Pilot results showed significantly improved communication with no readmissions, using the order template.

  4. Which cancer patients are referred to hospital at home for palliative care?

    OpenAIRE

    Grande, G. E.; McKerral, A.; Todd, C. J.

    2002-01-01

    Previous research has shown that palliative home care use is influenced by variables such as age, socioeconomic status, presence of an informal carer, diagnosis, and care dependency. However, there is little information on its association with other health service use. This study compared 121 cancer patients referred to Hospital at Home (HAH) for palliative care with a sample of 206 cancer patients not referred who died within the same period. Electronic record linkage of NHS databases enable...

  5. Ambient Noise Levels in Acute Neonatal Intensive Care Unit of a Tertiary Referral Hospital

    OpenAIRE

    Sonia R. B D'Souza; Leslie Edward Lewis; Vijay Kumar; Ramesh Bhat Y; Jayashree Purkayastha; Hari Prakash

    2017-01-01

    Background: Advances in neonatal care have resulted in improved survival of neonates admitted to the intensive care of the Neonatal Intensive Care Unit (NICU). However, the NCU may be an inappropriate milieu, with presence of overwhelming stimuli, most potent being the continuous presence of noise in the ambience of the NICU. Aim and Objectives: To determine and describe the ambient noise levels in the acute NICU of a tertiary referral hospital. Material and Methods...

  6. Work stress, burnout, and perceived quality of care: a cross-sectional study among hospital pediatricians.

    Science.gov (United States)

    Weigl, M; Schneider, A; Hoffmann, F; Angerer, P

    2015-09-01

    Poor hospital work environments affect physicians' work stress. With a focus on hospital pediatricians, we sought to investigate associations between work stress, burnout, and quality of care. A cross-sectional study was conducted in N = 96 pediatricians of a German academic children's hospital (response rate = 73.8 %). All variables were assessed with standardized questionnaires. Multivariate regression analyses were applied to investigate associations after adjusting for potential confounders. Critically high work stress (effort/reward ratio, ERR > 1.0) was reported by N = 25 (28.4 %) participants. Pediatricians in inpatient wards had significantly more work stress than their colleagues in intensive care units and outpatient wards; 10.2 % of surveyed pediatricians reported critically high burnout. Again, inpatient ward staff reported significantly increased emotional exhaustion. After controlling for several confounders, we found that pediatricians with high work stress and emotional exhaustion reported reduced quality of care. Mediation analyses revealed that especially pediatricians' emotional exhaustion partially mediated the effect of work stress on quality of care. Results demonstrate close relationships between increased work stress and burnout as well as diminished quality of care. High work stress environments in pediatric care influence mental health of pediatricians as well as quality of patient care. • The quality of pediatricians' work environment in the hospital is associated with their work stress and burnout. • The consequences of pediatricians' work life for the quality of care need to be addressed in order to inform interventions to improve work life and care quality. • Our study shows associations between increased work stress and burnout with mitigated quality of care. • Beyond indirect effects of work stress through emotional exhaustion on quality of care we also observed direct detrimental effects of pediatricians

  7. Incidence of Hospital Acquired Thrombosis (HAT) in a Tertiary Care Hospital.

    LENUS (Irish Health Repository)

    Khan, MI

    2017-04-01

    Venous thromboembolism (VTE) is a major cause of preventable morbidity and mortality in hospitalized patients. In spite of guidelines, VTE prophylaxis continues to be underutilised, and hospital acquired thrombosis (HAT) continues to be a problem. This study was conducted to estimate the incidence of HAT in a tertiary referral centre and to examine whether VTE risk assessment and thromboprophylaxis (TP) were implemented. Patients 18 years and above, with a radiologically-confirmed acute VTE during the study period of 15 weeks were included. Acute VTE was diagnosed in 100 patients and HAT was diagnosed in 48. There were 12,024 admissions over the study period, therefore the incidence of HAT was 0.4%. TP was prescribed in only 35% of patients, and 65% did not receive any or appropriate TP. Hospitals without active implementation of a formal risk assessment tool and TP policy are likely to continue to have increased incidence of HAT.

  8. Societal costs of home and hospital end-of-life care for palliative care patients in Ontario, Canada.

    Science.gov (United States)

    Yu, Mo; Guerriere, Denise N; Coyte, Peter C

    2015-11-01

    In Canada, health system restructuring has led to a greater focus on home-based palliative care as an alternative to institutionalised palliative care. However, little is known about the effect of this change on end-of-life care costs and the extent to which the financial burden of care has shifted from the acute care public sector to families. The purpose of this study was to assess the societal costs of end-of-life care associated with two places of death (hospital and home) using a prospective cohort design in a home-based palliative care programme. Societal cost includes all costs incurred during the course of palliative care irrespective of payer (e.g. health system, out-of-pocket, informal care-giving costs, etc.). Primary caregivers of terminal cancer patients were recruited from the Temmy Latner Centre for Palliative Care in Toronto, Canada. Demographic, service utilisation, care-giving time, health and functional status, and death data were collected by telephone interviews with primary caregivers over the course of patients' palliative trajectory. Logistic regression was conducted to model an individual's propensity for home death. Total societal costs of end-of-life care and component costs were compared between home and hospital death using propensity score stratification. Costs were presented in 2012 Canadian dollars ($1.00 CDN = $1.00 USD). The estimated total societal cost of end-of-life care was $34,197.73 per patient over the entire palliative trajectory (4 months on average). Results showed no significant difference (P > 0.05) in total societal costs between home and hospital death patients. Higher hospitalisation costs for hospital death patients were replaced by higher unpaid caregiver time and outpatient service costs for home death patients. Thus, from a societal cost perspective, alternative sites of death, while not associated with a significant change in total societal cost of end-of-life care, resulted in changes in the distribution of

  9. CLINICAL STUDY OF APPENDICULAR PERFORATION IN A TERTIARY CARE HOSPITAL

    OpenAIRE

    Venkata Anantha Lakshmi Manabala; Krishna Mohan Narayanrao

    2016-01-01

    INTRODUCTION Acute Appendicitis is the commonest abdominal surgical emergency in young adults all over the world. In early 1900s, Ochsner in Chicago and Sherren at the London Hospital were both advocates of conservative treatment in late cases. Appendicular perforation is a serious complication in view of the ensuing peritonitis with the consequent sequelae and morbidity. AIM To study the incidence, morbidity and sequelae of appendicular perforation. MATERIALS & METHODS ...

  10. The relative effectiveness of managed care penetration and the healthcare safety net in reducing avoidable hospitalizations.

    Science.gov (United States)

    Pracht, Etienne E; Orban, Barbara L; Comins, Meg M; Large, John T; Asin-Oostburg, Virginia

    2011-01-01

    Avoidable hospitalizations represent a key indicator for access to, and the quality of, primary care. Therefore, understanding their behavior is essential in terms of management of healthcare resources and costs. This analysis examines the affect of 2 healthcare strategies on the rate of avoidable hospitalization, managed care and the healthcare safety net. The avoidable hospitalizations definition developed by Weissman et al. (1992) was used to identify relevant inpatient episodes. A 2-stage simultaneous equations multivariate regression model with instrumental variables was used to estimate the relative influence of HMO penetration and the composition of local hospital markets on the rate of avoidable hospitalizations. Control variables in the model include healthcare supply and demand, demographic, socioeconomic, and health status characteristics. Increased market presence of public hospitals significantly reduced avoidable hospitalizations. HMO penetration did not influence the rate of avoidable hospitalizations. The results suggest that public investments in healthcare facilities and infrastructure are more effective in reducing avoidable hospitalizations. © 2011 National Association for Healthcare Quality.

  11. Structural characteristics of hospitals and nurse-reported care quality, work environment, burnout and leaving intentions.

    Science.gov (United States)

    Lindqvist, Rikard; Smeds Alenius, Lisa; Griffiths, Peter; Runesdotter, Sara; Tishelman, Carol

    2015-03-01

    To investigate whether hospital characteristics not readily susceptible to change (i.e. hospital size, university status, and geographic location) are associated with specific self-reported nurse outcomes. Research often focuses on factors within hospitals (e.g. work environment), which are susceptible to change, rather than on structural factors in their own right. However, numerous assumptions exist about the role of structural factors that may lead to a sense of pessimism and undermine efforts at constructive change. Data was derived from survey questions on assessments of work environment and satisfaction, intention to leave, quality of care and burnout (measured by the Maslach Burnout Inventory), from a population-based sample of 11 000 registered nurses in Sweden. Mixed model regressions were used for analysis. Registered nurses in small hospitals were slightly more likely to rank their working environment and quality of nursing care better than others. For example 23% of staff in small hospitals were very satisfied with the work environment compared with 20% in medium-sized hospitals and 21% in large hospitals. Registered nurses in urban areas, who intended to leave their job, were more likely to seek work in another hospital (38% vs. 32%). While some structural factors were related to nurse-reported outcomes in this large sample, the associations were small or of questionable importance. The influence of structural factors such as hospital size on nurse-reported outcomes is small and unlikely to negate efforts to improve work environment. © 2013 John Wiley & Sons Ltd.

  12. Hospital end-of-life care in haematological malignancies.

    Science.gov (United States)

    Beaussant, Yvan; Daguindau, Etienne; Chauchet, Adrien; Rochigneux, Philippe; Tournigand, Christophe; Aubry, Régis; Morin, Lucas

    2018-02-06

    To investigate patterns of care during the last months of life of hospitalised patients who died from different haematological malignancies. Nationwide register-based study, including all hospitalised adults ≥20 years who died from haematological malignancies in France in 2010-2013. Outcomes included use of invasive cancer treatments and referral to palliative care. Percentages are adjusted for sex and age using direct standardisation. Of 46 629 inpatients who died with haematological malignancies, 24.5% received chemotherapy during the last month before death, 48.5% received blood transfusion, 12.3% were under invasive ventilation and 18.1% died in intensive care units. We found important variations between haematological malignancies. The use of chemotherapy during the last month of life varied from 8.6% among patients with chronic myeloid leukaemia up to 30.1% among those with non-Hodgkin's lymphoma (Pcare units. A high proportion of patients who died from haematological malignancies receive specific treatments near the end of life. There is a need for a better and earlier integration of the palliative care approach in the standard practice of haematology. However, substantial variation according to the type of haematological malignancy suggests that the patients should not be considered as one homogeneous group. Implementation of palliative care should account for differences across haematological malignancies. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  13. Payments and quality of care in private for-profit and public hospitals in Greece.

    Science.gov (United States)

    Kondilis, Elias; Gavana, Magda; Giannakopoulos, Stathis; Smyrnakis, Emmanouil; Dombros, Nikolaos; Benos, Alexis

    2011-09-23

    Empirical evidence on how ownership type affects the quality and cost of medical care is growing, and debate on these topics is ongoing. Despite the fact that the private sector is a major provider of hospital services in Greece, little comparative information on private versus public sector hospitals is available. The aim of the present study was to describe and compare the operation and performance of private for-profit (PFP) and public hospitals in Greece, focusing on differences in nurse staffing rates, average lengths of stay (ALoS), and Social Health Insurance (SHI) payments for hospital care per patient discharged. Five different datasets were prepared and analyzed, two of which were derived from information provided by the National Statistical Service (NSS) of Greece and the other three from data held by the three largest SHI schemes in the country. All data referred to the 3-year period from 2001 to 2003. PFP hospitals in Greece are smaller than public hospitals, with lower patient occupancy, and have lower staffing rates of all types of nurses and highly qualified nurses compared with public hospitals. Calculation of ALoS using NSS data yielded mixed results, whereas calculations of ALoS and SHI payments using SHI data gave results clearly favoring the public hospital sector in terms of cost-efficiency; in all years examined, over all specialties and all SHI schemes included in our study, unweighted ALoS and SHI payments for hospital care per discharge were higher for PFP facilities. In a mixed healthcare system, such as that in Greece, significant performance differences were observed between PFP and public hospitals. Close monitoring of healthcare provision by hospital ownership type will be essential to permit evidence-based decisions on the future of the public/private mix in terms of healthcare provision.

  14. Organizing integrated care in a university hospital: application of a conceptual framework

    Directory of Open Access Journals (Sweden)

    Runo Axelsson

    2014-06-01

    Full Text Available Background and aim: As a result of New Public Management, a number of industrial models of quality management have been implemented in health care, mainly in hospitals. At the same time, the concept of integrated care has been developed within other parts of the health sector. The aim of the article is to discuss the relevance of integrated care for hospitals.Theory and methods: The discussion is based on application of a conceptual framework outlining a number of organizational models of integrated care. These models are illustrated in a case study of a Danish university hospital implementing a new organization for improving the patient flows of the hospital. The study of the reorganization is based mainly on qualitative data from individual and focus group interviews.Results: The new organization of the university hospital can be regarded as a matrix structure combining a vertical integration of clinical departments with a horizontal integration of patient flows. This structure has elements of both interprofessional and interorganizational integration. A strong focus on teamwork, meetings and information exchange is combined with elements of case management and co-location.Conclusions: It seems that integrated care can be a relevant concept for a hospital. Although the organizational models may