Hospital Value-Based Purchasing

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U.S. Department of Health & Human Services — Hospital Value-Based Purchasing (VBP) is part of the Centers for Medicare and Medicaid Services (CMS) long-standing effort to link Medicares payment system to a...

The architecture of enterprise hospital information system.

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Lu, Xudong; Duan, Huilong; Li, Haomin; Zhao, Chenhui; An, Jiye

2005-01-01

Because of the complexity of the hospital environment, there exist a lot of medical information systems from different vendors with incompatible structures. In order to establish an enterprise hospital information system, the integration among these heterogeneous systems must be considered. Complete integration should cover three aspects: data integration, function integration and workflow integration. However most of the previous design of architecture did not accomplish such a complete integration. This article offers an architecture design of the enterprise hospital information system based on the concept of digital neural network system in hospital. It covers all three aspects of integration, and eventually achieves the target of one virtual data center with Enterprise Viewer for users of different roles. The initial implementation of the architecture in the 5-year Digital Hospital Project in Huzhou Central hospital of Zhejiang Province is also described.

Rule Based Expert System for Monitoring Real Time Drug Supply in Hospital Using Radio Frequency Identification Technology

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Driandanu, Galih; Surarso, Bayu; Suryono

2018-02-01

A radio frequency identification (RFID) has obtained increasing attention with the emergence of various applications. This study aims to examine the implementation of rule based expert system supported by RFID technology into a monitoring information system of drug supply in a hospital. This research facilitates in monitoring the real time drug supply by using data sample from the hospital pharmacy. This system able to identify and count the number of drug and provide warning and report in real time. the conclusion is the rule based expert system and RFID technology can facilitate the performance in monitoring the drug supply quickly and precisely.

Evaluation of the in-hospital hemovigilance by introduction of the information technology-based system.

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Fujihara, Harumi; Yamada, Chiaki; Furumaki, Hiroaki; Nagai, Seiya; Shibata, Hiroki; Ishizuka, Keiko; Watanabe, Hiroko; Kaneko, Makoto; Adachi, Miwa; Takeshita, Akihiro

2015-12-01

Hemovigilance is an important aspect of transfusion medicine. However, the frequency of the adverse reactions often varies using different reporters. Recently, we have employed a new information technology (IT)-based in-hospital hemovigilance system. Here, we evaluated changes in practice after implementation of an IT-based reporting system. We compared the rate of frequency and details of blood transfusion-related adverse reactions 3 years before and after introduction of the IT-based reporting system. Contents and severity of the adverse reactions were reported in a paper-based reporting system, but input by selecting items in an IT-based reporting system. The details of adverse reactions are immediately sent to the blood transfusion unit online. After we introduced the IT-based reporting system, the reported rate of transfusion-related adverse reactions increased approximately 10-fold from 0.20% to 2.18% (p introduction of an IT-based reporting system. © 2015 AABB.

Impact of a DRG-based hospital financing system on quality and outcomes of care in Italy.

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Louis, D Z; Yuen, E J; Braga, M; Cicchetti, A; Rabinowitz, C; Laine, C; Gonnella, J S

1999-01-01

OBJECTIVE: To examine potential changes in quality of care associated with a recent financing system implementation in Italy: in 1995, hospital financing reform implemented in Italy included the introduction of a DRG-based hospital financing system with the goals of controlling the growth of hospital costs and making hospitals more accountable for their productivity. DATA SOURCES: Hospital discharge abstract data from 1993 through 1996 for all hospitals (N=32) in the Friuli-Venezia-Giulia region of Italy. Regional population data were used to calculate rates. STUDY DESIGN: Changes between 1993 and 1996 in hospital admissions, length of stay, mortality rates, severity of illness, and readmission rates were studied for nine common medical and surgical conditions: appendicitis, diabetes mellitus, colorectal cancer, cholecystitis, bronchitis/chronic obstructive pulmonary disease (COPD), bacterial pneumonia, coronary artery disease, cerebrovascular disease, and hip fracture. PRINCIPAL FINDINGS: The total number of ordinary hospital admissions decreased from 244,581 to 204,054 between 1993 and 1996, a population-based decrease of 17.3 percent (p<.001). The mean length of stay decreased from 9.1 days to 8.8 days, resulting in a 21.1 percent decrease in hospital bed days (p<.001). Day hospital use increased sevenfold from 16,871 encounters in 1993 to 108,517 encounters in 1996. The largest decrease in hospital admissions among study conditions was a 41 percent decrease for diabetes (from 2.25 per 1,000 in 1993 to 1.31 in 1996, p<.001). For eight of the nine conditions, severity of illness increased. Differences between severity-adjusted expected and observed in-hospital mortality rates were small. CONCLUSIONS: Observed trends showed a decrease in ordinary hospital admissions, an increase in day hospital admissions, and a greater severity of illness among hospitalized patients. There was little or no change in mortality and readmission rates. Administrative data can be used

A Classification System for Hospital-Based Infection Outbreaks

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Paul S. Ganney

2010-01-01

Full Text Available Outbreaks of infection within semi-closed environments such as hospitals, whether inherent in the environment (such as Clostridium difficile (C.Diff or Methicillinresistant Staphylococcus aureus (MRSA or imported from the wider community (such as Norwalk-like viruses (NLVs, are difficult to manage. As part of our work on modelling such outbreaks, we have developed a classification system to describe the impact of a particular outbreak upon an organization. This classification system may then be used in comparing appropriate computer models to real outbreaks, as well as in comparing different real outbreaks in, for example, the comparison of differing management and containment techniques and strategies. Data from NLV outbreaks in the Hull and East Yorkshire Hospitals NHS Trust (the Trust over several previous years are analysed and classified, both for infection within staff (where the end of infection date may not be known and within patients (where it generally is known. A classification system consisting of seven elements is described, along with a goodness-of-fit method for comparing a new classification to previously known ones, for use in evaluating a simulation against history and thereby determining how ‘realistic’ (or otherwise it is.

A classification system for hospital-based infection outbreaks.

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Ganney, Paul S; Madeo, Maurice; Phillips, Roger

2010-12-01

Outbreaks of infection within semi-closed environments such as hospitals, whether inherent in the environment (such as Clostridium difficile (C.Diff) or Methicillin-resistant Staphylococcus aureus (MRSA) or imported from the wider community (such as Norwalk-like viruses (NLVs)), are difficult to manage. As part of our work on modelling such outbreaks, we have developed a classification system to describe the impact of a particular outbreak upon an organization. This classification system may then be used in comparing appropriate computer models to real outbreaks, as well as in comparing different real outbreaks in, for example, the comparison of differing management and containment techniques and strategies. Data from NLV outbreaks in the Hull and East Yorkshire Hospitals NHS Trust (the Trust) over several previous years are analysed and classified, both for infection within staff (where the end of infection date may not be known) and within patients (where it generally is known). A classification system consisting of seven elements is described, along with a goodness-of-fit method for comparing a new classification to previously known ones, for use in evaluating a simulation against history and thereby determining how 'realistic' (or otherwise) it is.

Hospital payment systems based on diagnosis-related groups: experiences in low- and middle-income countries

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Wittenbecher, Friedrich

2013-01-01

Abstract Objective This paper provides a comprehensive overview of hospital payment systems based on diagnosis-related groups (DRGs) in low- and middle-income countries. It also explores design and implementation issues and the related challenges countries face. Methods A literature research for papers on DRG-based payment systems in low- and middle-income countries was conducted in English, French and Spanish through Pubmed, the Pan American Health Organization’s Regional Library of Medicine and Google. Findings Twelve low- and middle-income countries have DRG-based payment systems and another 17 are in the piloting or exploratory stage. Countries have chosen from a wide range of imported and self-developed DRG models and most have adapted such models to their specific contexts. All countries have set expenditure ceilings. In general, systems were piloted before being implemented. The need to meet certain requirements in terms of coding standardization, data availability and information technology made implementation difficult. Private sector providers have not been fully integrated, but most countries have managed to delink hospital financing from public finance budgeting. Conclusion Although more evidence on the impact of DRG-based payment systems is needed, our findings suggest that (i) the greater portion of health-care financing should be public rather than private; (ii) it is advisable to pilot systems first and to establish expenditure ceilings; (iii) countries that import an existing variant of a DRG-based system should be mindful of the need for adaptation; and (iv) countries should promote the cooperation of providers for appropriate data generation and claims management. PMID:24115798

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

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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.

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

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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.

Hospital Prices Increase in California, Especially Among Hospitals in the Largest Multi-hospital Systems

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Glenn A. Melnick PhD

2016-06-01

Full Text Available A surge in hospital consolidation is fueling formation of ever larger multi-hospital systems throughout the United States. This article examines hospital prices in California over time with a focus on hospitals in the largest multi-hospital systems. Our data show that hospital prices in California grew substantially (+76% per hospital admission across all hospitals and all services between 2004 and 2013 and that prices at hospitals that are members of the largest, multi-hospital systems grew substantially more (113% than prices paid to all other California hospitals (70%. Prices were similar in both groups at the start of the period (approximately $9200 per admission. By the end of the period, prices at hospitals in the largest systems exceeded prices at other California hospitals by almost $4000 per patient admission. Our study findings are potentially useful to policy makers across the country for several reasons. Our data measure actual prices for a large sample of hospitals over a long period of time in California. California experienced its wave of consolidation much earlier than the rest of the country and as such our findings may provide some insights into what may happen across the United States from hospital consolidation including growth of large, multi-hospital systems now forming in the rest of the rest of the country.

Integrated processing of ECG's in a hospital information system

NARCIS (Netherlands)

Helder, J.C.; Schram, P.H.; Verwey, H.; Meijler, F.L.; Robles de Medina, E.O.

The ECG handling in the University Hospital of Utrecht is composed by a system consisting of acquisition and storage of ECG signals, computer analysis, data management, and storage of readings in a patient data base. The last two modules are part of a Hospital Information System (HIS). The modular

The implementation of DRG-based hospital reimbursement in Switzerland: A population-based perspective.

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Busato, André; von Below, Georg

2010-10-16

Switzerland introduces a DRG (Diagnosis Related Groups) based system for hospital financing in 2012 in order to increase efficiency and transparency of Swiss health care. DRG-based hospital reimbursement is not simultaneously realized in all Swiss cantons and several cantons already implemented DRG-based financing irrespective of the national agenda, a setting that provides an opportunity to compare the situation in different cantons. Effects of introducing DRGs anticipated for providers and insurers are relatively well known but it remains less clear what effects DRGs will have on served populations. The objective of the study is therefore to analyze differences of volume and major quality indicators of care between areas with or without DRG-based hospital reimbursement from a population based perspective. Small area analysis of all hospitalizations in acute care hospitals and of all consultations reimbursed by mandatory basic health insurance for physicians in own practice during 2003-2007. The results show fewer hospitalizations and a relocation of resources to outpatient care in areas with DRG reimbursement. Overall burden of disease expressed as per capita DRG cost weights was almost identical between the two types of hospital reimbursement and no distinct temporal differences were detected in this respect. But the results show considerably higher 90-day rehospitalization rates in DRG areas. The study provides evidence of both desired and harmful effects related to the implementation of DRGs. Systematic monitoring of outcomes and quality of care are therefore essential elements to maintain in the Swiss health system after DRG's are implemented on a nationwide basis in 2012.

[Hospital organizational analysis based on the Mintzberg model: the case of Sheikh Zayed Hospital, Rabat].

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Makhloufi, Imane; Saadi, Janad; El Hiki, Lahcen; El Hassani, Amine

2012-01-01

The new system of hospital governance requires health institutions to develop new managerial, financial and social skills beyond their public service duties. As part of this new approach, the organizational modernization of hospitals involves introducing good management practices. However, managing the transition requires taking into account the specificities of existing organizational systems. Organizational systems are generally difficult to model and involve diverse and sometimes competing interests, concerns, habits, languages, cultures, tools and representations. This explains the high failure rate observed in hospital development projects at an organizational level. A number of organizational theories from a range of disciplines (sociology, biology, history, etc.) have examined the question of organization in hospitals. The many theories developed in this area are not incompatible. Rather, they form a set of useful tools for the analysis of organizational management. The purpose of this study was to conduct an organizational analysis of Sheikh Zayed Hospital (Rabat) based on the Mintzberg model as a prerequisite for the development and implementation of a restructuring plan.

The Use of Hospital Information Systems Data Base with Word Processing and Other Medical Records System Applications

OpenAIRE

Rusnak, James E.

1982-01-01

The approach frequently used to introduce computer technology into a hospital Medical Records Department is to implement a Word Processing System. Word processing is a form of computer system application that is intended to improve the department's productivity by improving the medical information transcription process. The effectiveness of the Word Processing System may be further enhanced by installing system facilities to provide access to data processing file information in the Hospital's...

Maturity of hospital information systems: Most important influencing factors.

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Vidal Carvalho, João; Rocha, Álvaro; Abreu, António

2017-07-01

Maturity models facilitate organizational management, including information systems management, with hospital organizations no exception. This article puts forth a study carried out with a group of experts in the field of hospital information systems management with a view to identifying the main influencing factors to be included in an encompassing maturity model for hospital information systems management. This study is based on the results of a literature review, which identified maturity models in the health field and relevant influencing factors. The development of this model is justified to the extent that the available maturity models for the hospital information systems management field reveal multiple limitations, including lack of detail, absence of tools to determine their maturity and lack of characterization for stages of maturity structured by different influencing factors.

TRICARE revision to CHAMPUS DRG-based payment system, pricing of hospital claims. Final rule.

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2014-05-21

This Final rule changes TRICARE's current regulatory provision for inpatient hospital claims priced under the DRG-based payment system. Claims are currently priced by using the rates and weights that are in effect on a beneficiary's date of admission. This Final rule changes that provision to price such claims by using the rates and weights that are in effect on a beneficiary's date of discharge.

Information Systems Evaluation: A Study in Hospital Organizations

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Laís Coelho Ayala

2012-06-01

Full Text Available Given increasing demand for timely and accurate information to support decision making, hospitals, a particularly complex type of service organization, have increasingly resorted to a wide range of tools such as the Clinical Information Systems (CIS. However, research has shown that such systems do not always meet hospital managers’ needs, and assessment processes are necessary both before and after CIS implementation. Aiming to identify whether the CIS do meet hospital managers’ information needs and do fit in the specificities of such organizations, this paper reports on the assessment of four CIS based on the perspective of their users in four hospitals in the Metropolitan Region of Belo Horizonte, State of Minas Gerais, Brazil. The data was collected by means of semi-structured interviews and non-obtrusive observation. On the one hand, the result shows that the four organizations have difficulties in using their systems, such as accessibility problems, inadequate training and system underutilization. On the other hand, they also benefit from such systems, as they make processes faster and enable information control. One can say that the results from this research contribute to a better understanding of evaluating information systems in hospitals. Managers of such organizations can benefit from these results when seeking to evaluate and improve their information systens.

Balanced scorecard-based performance evaluation of Chinese county hospitals in underdeveloped areas.

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Gao, Hongda; Chen, He; Feng, Jun; Qin, Xianjing; Wang, Xuan; Liang, Shenglin; Zhao, Jinmin; Feng, Qiming

2018-05-01

Objective Since the Guangxi government implemented public county hospital reform in 2009, there have been no studies of county hospitals in this underdeveloped area of China. This study aimed to establish an evaluation indicator system for Guangxi county hospitals and to generate recommendations for hospital development and policymaking. Methods A performance evaluation indicator system was developed based on balanced scorecard theory. Opinions were elicited from 25 experts from administrative units, universities and hospitals and the Delphi method was used to modify the performance indicators. The indicator system and the Topsis method were used to evaluate the performance of five county hospitals randomly selected from the same batch of 2015 Guangxi reform pilots. Results There were 4 first-level indicators, 9 second-level indicators and 36 third-level indicators in the final performance evaluation indicator system that showed good consistency, validity and reliability. The performance rank of the hospitals was B > E > A > C > D. Conclusions The performance evaluation indicator system established using the balanced scorecard is practical and scientific. Analysis of the results based on this indicator system identified several factors affecting hospital performance, such as resource utilisation efficiency, medical service price, personnel structure and doctor-patient relationships.

Implementation of quality management systems: the role of hospital (management) boards.

NARCIS (Netherlands)

Botje, D.; Klazinga, N.S.; Suñol, R.; Wagner, C.

2013-01-01

Objectives: Hospitals are putting tremendous efforts in implementing evidence-based management systems and organisational innovations for patient-centred care. Having a hospital quality management system is a prerequisite to successfully implement these innovations. Previous studies showed that the

Trust-based or performance-based management: a study of employment contracting in hospitals.

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Pettersen, Inger Johanne

2011-01-01

Hospitals are frequently changing managerial practices due to numerous public sector reforms taking place. In general, these reforms include the making and monitoring of contracts that regulate relations between the hospitals and their professional staffs. The aim of this paper is to discuss some main characteristics of the contracts that regulate the perceived relations between physicians as employees and the public hospital as employer. The theoretical framework is based on a contract theory approach. The empirical data is based on survey data from full-time employed physicians in the medical and surgical divisions in one of the largest university hospitals in Norway. This study shows that perceived obligations and psychological contracts indicate high degree of relational contracts between the hospital and the physicians. These socio-cultural elements should be recognized as important mechanisms of coordination and communication when policy makers and hospital managers are designing hospital management control systems. Copyright © 2009 John Wiley & Sons, Ltd.

A study on building data warehouse of hospital information system.

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Li, Ping; Wu, Tao; Chen, Mu; Zhou, Bin; Xu, Wei-guo

2011-08-01

Existing hospital information systems with simple statistical functions cannot meet current management needs. It is well known that hospital resources are distributed with private property rights among hospitals, such as in the case of the regional coordination of medical services. In this study, to integrate and make full use of medical data effectively, we propose a data warehouse modeling method for the hospital information system. The method can also be employed for a distributed-hospital medical service system. To ensure that hospital information supports the diverse needs of health care, the framework of the hospital information system has three layers: datacenter layer, system-function layer, and user-interface layer. This paper discusses the role of a data warehouse management system in handling hospital information from the establishment of the data theme to the design of a data model to the establishment of a data warehouse. Online analytical processing tools assist user-friendly multidimensional analysis from a number of different angles to extract the required data and information. Use of the data warehouse improves online analytical processing and mitigates deficiencies in the decision support system. The hospital information system based on a data warehouse effectively employs statistical analysis and data mining technology to handle massive quantities of historical data, and summarizes from clinical and hospital information for decision making. This paper proposes the use of a data warehouse for a hospital information system, specifically a data warehouse for the theme of hospital information to determine latitude, modeling and so on. The processing of patient information is given as an example that demonstrates the usefulness of this method in the case of hospital information management. Data warehouse technology is an evolving technology, and more and more decision support information extracted by data mining and with decision-making technology is

Evaluation of a Web-based Error Reporting Surveillance System in a Large Iranian Hospital.

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Askarian, Mehrdad; Ghoreishi, Mahboobeh; Akbari Haghighinejad, Hourvash; Palenik, Charles John; Ghodsi, Maryam

2017-08-01

Proper reporting of medical errors helps healthcare providers learn from adverse incidents and improve patient safety. A well-designed and functioning confidential reporting system is an essential component to this process. There are many error reporting methods; however, web-based systems are often preferred because they can provide; comprehensive and more easily analyzed information. This study addresses the use of a web-based error reporting system. This interventional study involved the application of an in-house designed "voluntary web-based medical error reporting system." The system has been used since July 2014 in Nemazee Hospital, Shiraz University of Medical Sciences. The rate and severity of errors reported during the year prior and a year after system launch were compared. The slope of the error report trend line was steep during the first 12 months (B = 105.727, P = 0.00). However, it slowed following launch of the web-based reporting system and was no longer statistically significant (B = 15.27, P = 0.81) by the end of the second year. Most recorded errors were no-harm laboratory types and were due to inattention. Usually, they were reported by nurses and other permanent employees. Most reported errors occurred during morning shifts. Using a standardized web-based error reporting system can be beneficial. This study reports on the performance of an in-house designed reporting system, which appeared to properly detect and analyze medical errors. The system also generated follow-up reports in a timely and accurate manner. Detection of near-miss errors could play a significant role in identifying areas of system defects.

Advantages of a Web-Based Real-Time Bed-Management System for Hospital Admission Monitoring in Iran.

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Abedian, Somayeh; Bitaraf, Ehsan; Askari, Marjan

2018-01-01

Lack of up-to-date information of hospitals beds, specifically in emergencies, is a significant problem in many large countries; The Ministry of Health and Medical Education of Iran (MOHME) designed and implemented a dynamic system that reports the status of beds in 2012. This system created great opportunities for national bed management, including real-time hospital admission monitoring, especially for emergency departments, ICUs and CCUs. Therefore, an additional online system was planned to be implemented for monitoring hospital admissions, including a national alert system. Prior to the design of this system, a study was done using literature study and expert opinion to investigate the advantages and features that this monitoring system was required to have. We used the MoSCoW method to prioritize the requirements of the system. This system was designed to have the following advantages, among other things: the hospitals as well as government should be able to track the patients, manage patient distribution in healthcare centers, and make policy for supplying extra beds. It should also be possible for the hospitals executive board, as well as the government, to monitor the performance of the hospitals regarding patient admissions (i.e., the rate of rejection of patients with severe conditions).

Activity-based costing and its application in a Turkish university hospital.

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Yereli, Ayşe Necef

2009-03-01

Resource management in hospitals is of increasing importance in today's global economy. Traditional accounting systems have become inadequate for managing hospital resources and accurately determining service costs. Conversely, the activity-based costing approach to hospital accounting is an effective cost management model that determines costs and evaluates financial performance across departments. Obtaining costs that are more accurate can enable hospitals to analyze and interpret costing decisions and make more accurate budgeting decisions. Traditional and activity-based costing approaches were compared using a cost analysis of gall bladder surgeries in the general surgery department of one university hospital in Manisa, Turkey. Copyright (c) AORN, Inc, 2009.

Demographic factors and hospital size predict patient satisfaction variance--implications for hospital value-based purchasing.

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McFarland, Daniel C; Ornstein, Katherine A; Holcombe, Randall F

2015-08-01

Hospital Value-Based Purchasing (HVBP) incentivizes quality performance-based healthcare by linking payments directly to patient satisfaction scores obtained from Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Lower HCAHPS scores appear to cluster in heterogeneous population-dense areas and could bias Centers for Medicare & Medicaid Services (CMS) reimbursement. Assess nonrandom variation in patient satisfaction as determined by HCAHPS. Multivariate regression modeling was performed for individual dimensions of HCAHPS and aggregate scores. Standardized partial regression coefficients assessed strengths of predictors. Weighted Individual (hospital) Patient Satisfaction Adjusted Score (WIPSAS) utilized 4 highly predictive variables, and hospitals were reranked accordingly. A total of 3907 HVBP-participating hospitals. There were 934,800 patient surveys by the most conservative estimate. A total of 3144 county demographics (US Census) and HCAHPS surveys. Hospital size and primary language (non-English speaking) most strongly predicted unfavorable HCAHPS scores, whereas education and white ethnicity most strongly predicted favorable HCAHPS scores. The average adjusted patient satisfaction scores calculated by WIPSAS approximated the national average of HCAHPS scores. However, WIPSAS changed hospital rankings by variable amounts depending on the strength of the predictive variables in the hospitals' locations. Structural and demographic characteristics that predict lower scores were accounted for by WIPSAS that also improved rankings of many safety-net hospitals and academic medical centers in diverse areas. Demographic and structural factors (eg, hospital beds) predict patient satisfaction scores even after CMS adjustments. CMS should consider WIPSAS or a similar adjustment to account for the severity of patient satisfaction inequities that hospitals could strive to correct. © 2015 Society of Hospital Medicine.

Implementation of an advanced clinical and administrative hospital information system.

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Vegoda, P R; Dyro, J F

1986-01-01

Over the last six years since University Hospital opened, the University Hospital Information System (UHIS) has continued to evolve to what is today an advanced administrative and clinical information system. At University Hospital UHIS is the way of conducting business. A wide range of patient care applications are operational including Patient Registration, ADT for Inpatient/Outpatient/Emergency Room visits, Advanced Order Entry/Result Reporting, Medical Records, Lab Automated Data Acquisition/Quality Control, Pharmacy, Radiology, Dietary, Respiratory Therapy, ECG, EEG, Cardiology, Physical/Occupational Therapy and Nursing. These systems and numerous financial systems have been installed in a highly tuned, efficient computer system. All applications are real-time, on-line, and data base oriented. Each system is provided with multiple data security levels, forward file recovery, and dynamic transaction backout of in-flight tasks. Sensitive medical information is safeguarded by job function passwords, identification codes, need-to-know master screens and terminal keylocks. University Hospital has an IBM 3083 CPU with five 3380 disk drives, four dual density tape drives, and a 3705 network controller. The network of 300 terminals and 100 printers is connected to the computer center by an RF broadband cable. The software is configured around the IBM/MVS operating system using CICS as the telecommunication monitor, IMS as the data base management system and PCS/ADS as the application enabling tool. The most extensive clinical system added to UHIS is the Physiological Monitoring/Patient Data Management System with serves 92 critical care beds. In keeping with the Hospital's philosophy of integrated computing, the PMS/PDMS with its network of minicomputers was linked to the UHIS system. In a pilot program, remote access to UHIS through the IBM personal computer has been implemented in several physician offices in the local community, further extending the communications

STUDY ON WASTEWATER TREATMENT SYSTEMS IN HOSPITALS OF IRAN

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M. Majlesi Nasr, A. R. Yazdanbakhsh

2008-07-01

Full Text Available Nowadays, water resources shortage is one of the most important issues for environmental engineers and managers as well as its conservation due to population growth and ever-increasing water demands. Besides, hospital wastewater has the same quality as municipal wastewater, but may also potentially contain various hazardous components. In this paper, physical and chemical specifications of produced wastewater in hospitals of Iran were investigated experiments. Results were compared with the effluent parameters of wastewater standards of Iranian Department of the Environment. 70 governmental hospitals from different provinces of Iran were selected by purposive (non-random sampling method. For data analysis, SPSS and EXCEL softwares were applied. The findings of the study showed that 52% of the surveyed hospitals were not equipped and 48% were equipped with wastewater treatment systems. The mean of Biochemical Oxygen Demand, Chemical Oxygen Demand and Total Suspended Solids of the effluent of wastewater treatment systems were reported as 113, 188 and 99 mg/L respectively. Comparison of the indicators between effluents of wastewater treatment systems and the standards of Departments of the Environment, showed the inefficiency in these systems and it was concluded that despite the recent improvements in hospital wastewater treatment systems, they should be upgraded based on the remarks in this paper.

Study of Development for RFID System to Hospital Environment.

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Hong, Seung Kwon; Sung, Myung-Whun

2015-01-01

RFID/USN develops information systems for anytime, anywhere to anybody access Electronic Medical Records (EMR). The goal of the present study is to develop a RFID/USN-based information system for the hospital environment. First, unable to recognize, second, able to recognize as a pursuit of place and suppose the time of medical examination. A retrospective analysis of 235 RFID monitoring results, from four ENT ambulatory clinics of Seoul National University Hospital were extracted by a reader program and monitoring of RFID tag (2006.11.16~2006.12.16). RFID detection for sensing reader of this study has been put into representing "place" and "spending time" of patients for medical history taking and examination. Through the RFID of detection for specific place and spending time of medical examination, RFID/USN develops information system progressing in the EMR of hospital system.

Admission rates in a general practitioner-based versus a hospital specialist based, hospital-at-home model

DEFF Research Database (Denmark)

Mogensen, Christian Backer; Ankersen, Ejnar Skytte; Lindberg, Mats J

2018-01-01

. CONCLUSIONS: The GP based HaH model was more effective than the hospital specialist model in avoiding hospital admissions within 7 days among elderly patients with an acute medical condition with no differences in mental or physical recovery rates or deaths between the two models. REGISTRATION: No. NCT......BACKGROUND: Hospital at home (HaH) is an alternative to acute admission for elderly patients. It is unclear if should be cared for a primarily by a hospital intern specialist or by the patient's own general practitioner (GP). The study assessed whether a GP based model was more effective than...... Denmark, including + 65 years old patients with an acute medical condition that required acute hospital in-patient care. The patients were randomly assigned to hospital specialist based model or GP model of HaH care. Five physical and cognitive performance tests were performed at inclusion and after 7...

Three-tiered integration of PACS and HIS toward next generation total hospital information system.

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Kim, J H; Lee, D H; Choi, J W; Cho, H I; Kang, H S; Yeon, K M; Han, M C

1998-01-01

The Seoul National University Hospital (SNUH) started a project to innovate the hospital information facilities. This project includes installation of high speed hospital network, development of new HIS, OCS (order communication system), RIS and PACS. This project aims at the implementation of the first total hospital information system by seamlessly integrating these systems together. To achieve this goal, we took three-tiered systems integration approach: network level, database level, and workstation level integration. There are 3 loops of networks in SNUH: proprietary star network for host computer based HIS, Ethernet based hospital LAN for OCS and RIS, and ATM based network for PACS. They are linked together at the backbone level to allow high speed communication between these systems. We have developed special communication modules for each system that allow data interchange between different databases and computer platforms. We have also developed an integrated workstation in which both the OCS and PACS application programs run on a single computer in an integrated manner allowing the clinical users to access and display radiological images as well as textual clinical information within a single user environment. A study is in progress toward a total hospital information system in SNUH by seamlessly integrating the main hospital information resources such as HIS, OCS, and PACS. With the three-tiered systems integration approach, we could successfully integrate the systems from the network level to the user application level.

Defining Reported Errors on Web-based Reporting System Using ICPS From Nine Units in a Korean University Hospital

Directory of Open Access Journals (Sweden)

Chul-Hoon Kim, DDS, PhD

2009-12-01

Conclusion: The web-based error reporting system using ICPS proved to be an easy, feasible system for hospitals in Korea. This system will be helpful for inducing general agreement upon errors within clinical nursing practice and bring more attention to any errors made or near misses. Also, it will be able to ameliorate the punitive culture for errors and transform error reporting into a habit for healthcare providers.

Design criteria for a data base management system for a PACS at Georgetown University Hospital

International Nuclear Information System (INIS)

Fahey, F.H.; Wang, P.C.; Mun, S.K.; Choyke, P.L.; Benson, H.R.; Duerinckx, A.; Elliott, L.P.

1986-01-01

A major goal of a radiologic picture archival and communication system (PACS) is to increase the availability of the data to the users who require access to them. This is done by providing the data in a digital form which can be readily communicated and archived. In this manner, the PACS can be seen as a specific example of a data base managements system (DBMS). The PACS/DBMS should organize the data base in such a way as to provide its users with the data they require in a timely and efficient manner. The ability to integrate the variety of data into common data base should lead to a more complete and relevant representation of the available information. A PACS/DBMS is not only unique in the types of data contained in the data base and its different users but also in the volume of data that are entered into the system and transferred within the system each day. Consideration of these characteristics leads to the definition of functional criteria for the PACS/DBMS. This report discusses the criteria that will be used in the design of a DBMS for a PACS at Georgetown University Hospital. (Auth.)

Pattern of congenital malformations in newborn: a hospital-based study

Directory of Open Access Journals (Sweden)

Mohamed El Koumi

2013-02-01

Full Text Available Background: Birth defects, encountered frequently by pediatricians, are important causes of childhood morbidity and mortality. Birth defects can be classified based on their severity, pathogenic mechanism or whether they involve a single system or multiple systems. This hospital based prospective descriptive study highlights the prevalence of congenital anomalies (CAs in one year, among liveborn neonates delivered in a university hospital. Design and methods: All women giving birth to babies were included. Demographic details, associated risk factors and the type of CAs in babies were recorded. Diagnosis of CAs was based on clinical evaluation, radiographic examination and chromosomal analysis of newborn whenever recommended. Results: The overall incidence of CAs among liveborn neonates was 2.5%, as most of the cases were referred to Zagazig University Hospital for delivery. The musculoskeletal system (23% was the most commonly involved; followed by central nervous system (20.3%. Involvement of more than one system was observed in (28.6% cases. Out of the maternal and fetal risk factors, parental consanguinity, maternal undernutrition and obesity, positive history of an anomaly in the family, low birth weight(LBW, and prematurity were significantly associated with higher frequency of CAs(p <0.05, with non-significant differences for maternal age and the sex of the neonates. Conclusion : The current study highlighted the point prevalence of congenital anomalies in one year in zagazig university hospital in Egypt. The present study revealed a high prevalence of congenital anomalies in our locality and stressed upon the importance of carrying out a thorough clinical examination of all neonates at birth.

42 CFR 419.20 - Hospitals subject to the hospital outpatient prospective payment system.

Science.gov (United States)

2010-10-01

... prospective payment system. 419.20 Section 419.20 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEM FOR HOSPITAL... Outpatient Prospective Payment System § 419.20 Hospitals subject to the hospital outpatient prospective...

Quality Management Systems Implementation Compared With Organizational Maturity in Hospital.

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Moradi, Tayebeh; Jafari, Mehdi; Maleki, Mohammad Reza; Naghdi, Seyran; Ghiasvand, Hesam

2015-07-27

A quality management system can provide a framework for continuous improvement in order to increase the probability of customers and other stakeholders' satisfaction. The test maturity model helps organizations to assess the degree of maturity in implementing effective and sustained quality management systems; plan based on the current realities of the organization and prioritize their improvement programs. We aim to investigate and compare the level of organizational maturity in hospitals with the status of quality management systems implementation. This analytical cross sectional study was conducted among hospital administrators and quality experts working in hospitals with over 200 beds located in Tehran. In the first step, 32 hospitals were selected and then 96 employees working in the selected hospitals were studied. The data were gathered using the implementation checklist of quality management systems and the organization maturity questionnaire derived from ISO 10014. The content validity was calculated using Lawshe method and the reliability was estimated using test - retest method and calculation of Cronbach's alpha coefficient. The descriptive and inferential statistics were used to analyze the data using SPSS 18 software. According to the table, the mean score of organizational maturity among hospitals in the first stage of quality management systems implementation was equal to those in the third stage and hypothesis was rejected (p-value = 0.093). In general, there is no significant difference in the organizational maturity between the first and third level hospitals (in terms of implementation of quality management systems). Overall, the findings of the study show that there is no significant difference in the organizational maturity between the hospitals in different levels of the quality management systems implementation and in fact, the maturity of the organizations cannot be attributed to the implementation of such systems. As a result, hospitals

Demographic Factors and Hospital Size Predict Patient Satisfaction Variance- Implications for Hospital Value-Based Purchasing

Science.gov (United States)

McFarland, Daniel C.; Ornstein, Katherine; Holcombe, Randall F.

2016-01-01

Background Hospital Value-Based Purchasing (HVBP) incentivizes quality performance based healthcare by linking payments directly to patient satisfaction scores obtained from Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys. Lower HCAHPS scores appear to cluster in heterogeneous population dense areas and could bias CMS reimbursement. Objective Assess nonrandom variation in patient satisfaction as determined by HCAHPS. Design Multivariate regression modeling was performed for individual dimensions of HCAHPS and aggregate scores. Standardized partial regression coefficients assessed strengths of predictors. Weighted Individual (hospital) Patient Satisfaction Adjusted Score (WIPSAS) utilized four highly predictive variables and hospitals were re-ranked accordingly. Setting 3,907 HVBP-participating hospitals. Patients 934,800 patient surveys, by most conservative estimate. Measurements 3,144 county demographics (U.S. Census), and HCAHPS. Results Hospital size and primary language (‘non-English speaking’) most strongly predicted unfavorable HCAHPS scores while education and white ethnicity most strongly predicted favorable HCAHPS scores. The average adjusted patient satisfaction scores calculated by WIPSAS approximated the national average of HCAHPS scores. However, WIPSAS changed hospital rankings by variable amounts depending on the strength of the predictive variables in the hospitals’ locations. Structural and demographic characteristics that predict lower scores were accounted for by WIPSAS that also improved rankings of many safety-net hospitals and academic medical centers in diverse areas. Conclusions Demographic and structural factors (e.g., hospital beds) predict patient satisfaction scores even after CMS adjustments. CMS should consider WIPSAS or a similar adjustment to account for the severity of patient satisfaction inequities that hospitals could strive to correct. PMID:25940305

Electronic health systems: challenges faced by hospital-based providers.

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Agno, Christina Farala; Guo, Kristina L

2013-01-01

The purpose of this article is to discuss specific challenges faced by hospitals adopting the use of electronic medical records and implementing electronic health record (EHR) systems. Challenges include user and information technology support; ease of technical use and software interface capabilities; compliance; and financial, legal, workforce training, and development issues. Electronic health records are essential to preventing medical errors, increasing consumer trust and use of the health system, and improving quality and overall efficiency. Government efforts are focused on ways to accelerate the adoption and use of EHRs as a means of facilitating data sharing, protecting health information privacy and security, quickly identifying emerging public health threats, and reducing medical errors and health care costs and increasing quality of care. This article will discuss physician and nonphysician staff training before, during, and after implementation; the effective use of EHR systems' technical features; the selection of a capable and secure EHR system; and the development of collaborative system implementation. Strategies that are necessary to help health care providers achieve successful implementation of EHR systems will be addressed.

Hospital Value-Based Purchasing Performance: Do Organizational and Market Characteristics Matter?

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Spaulding, Aaron; Edwardson, Nick; Zhao, Mei

The hospital value-based purchasing (HVBP) program of the Centers for Medicare & Medicaid Services challenges hospitals to deliver high-quality care or face a reduction in Medicare payments. How do different organizational structures and market characteristics enable or inhibit successful transition to this new model of value-based care? To address that question, this study employs an institutional theory lens to test whether certain organizational structures and market characteristics mediate hospitals' ability to perform across HVBP domains.Data from the 2014 American Hospital Association Annual Survey Database, Area Health Resource File, the Medicare Hospital Compare Database, and the association between external environment and hospital performance are assessed through multiple regression analysis. Results indicate that hospitals that belong to a system are more likely than independent hospitals to score highly on the domains associated with the HVBP incentive arrangement. However, varying and sometimes counterintuitive market influences bring different dimensions to the HVBP program. A hospital's ability to score well in this new value arrangement may be heavily based on the organization's ability to learn from others, implement change, and apply the appropriate amount of control in various markets.

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...

[Document management systems to support quality management systems at university hospitals - an interview-based study].

Science.gov (United States)

Holderried, Martin; Bökel, Ann-Catrin; Ochsmann, Elke

2018-05-01

In order to save and control the processes and quality of medical services, a suitable steering system of all relevant documents is essential from the point of view of clinical quality management. Systems supporting an automated steering system of documents are called document management systems (DMS), and they also enter the healthcare sector. The use of DMS in the German healthcare sector has hardly been investigated so far. To close this knowledge gap, interviews were carried out with German university hospitals over a six-month period and subjected to a qualitative content analysis according to Mayring. In total, 25 university hospitals agreed to participate in this study, 19 of which have been working with a digital DMS for about six years on average. There was a great variety among the IT systems used. Document management and usability of the DMS as well as its integration into existing IT structures were key decision-making criteria for the selection of a digital DMS. In general, the long-term usability of the DMS is supported by regular evaluation of one's own requirements for the system, administration and training programs. In addition, DMS have a positive effect on patient safety and the quality of medical care. Copyright © 2018. Published by Elsevier GmbH.

Charting a path forward: policy analysis of China's evolved DRG-based hospital payment system.

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Liu, Rui; Shi, Jianwei; Yang, Beilei; Jin, Chunlin; Sun, Pengfei; Wu, Lingfang; Yu, Dehua; Xiong, Linping; Wang, Zhaoxin

2017-09-01

At present, the diagnosis-related groups-based prospective payment system (DRG-PPS) that has been implemented in China is merely a prototype called the simplified DRG-PPS, which is known as the 'ceiling price for a single disease'. Given that studies on the effects of a simplified DRG-PPS in China have usually been controversial, we aim to synthesize evidence examining whether DRGs can reduce medical costs and length of stay (LOS) in China. Data were searched from both Chinese [Wan Fang and China National Knowledge Infrastructure Database (CNKI)] and international databases (Web of Science and PubMed), as well as the official websites of Chinese health departments in the 2004-2016 period. Only studies with a design that included both experimental (with DRG-PPS implementation) and control groups (without DRG-PPS implementation) were included in the review. The studies were based on inpatient samples from public hospitals distributed in 12 provinces of mainland China. Among them, 80.95% (17/21) revealed that hospitalization costs could be reduced significantly, and 50.00% (8/16) indicated that length of stay could be decreased significantly. In addition, the government reports showed the enormous differences in pricing standards and LOS in various provinces, even for the same disease. We conclude that the simplified DRGs are useful in controlling hospitalization costs, but they fail to reduce LOS. Much work remains to be done in China to improve the simplified DRG-PPS. © The Author 2017. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene.

Value-based purchasing and hospital acquired conditions: are we seeing improvement?

Science.gov (United States)

Spaulding, Aaron; Zhao, Mei; Haley, D Rob

2014-12-01

To determine if the Value-Based Purchasing Performance Scoring system correlates with hospital acquired condition quality indicators. This study utilizes the following secondary data sources: the American Hospital Association (AHA) annual survey and the Centers for Medicare and Medicaid (CMS) Value-Based Purchasing and Hospital Acquired Conditions databases. Zero-inflated negative binomial regression was used to examine the effect of CMS total performance score on counts of hospital acquired conditions. Hospital structure variables including size, ownership, teaching status, payer mix, case mix, and location were utilized as control variables. The secondary data sources were merged into a single database using Stata 10. Total performance scores, which are used to determine if hospitals should receive incentive money, do not correlate well with quality outcome in the form of hospital acquired conditions. Value-based purchasing does not appear to correlate with improved quality and patient safety as indicated by Hospital Acquired Condition (HAC) scores. This leads us to believe that either the total performance score does not measure what it should, or the quality outcome measurements do not reflect the quality of the total performance scores measure. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

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...

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...

Analysis and design of hospital management information system based on UML

Science.gov (United States)

Ma, Lin; Zhao, Huifang; You, Shi Jun; Ge, Wenyong

2018-05-01

With the rapid development of computer technology, computer information management system has been utilized in many industries. Hospital Information System (HIS) is in favor of providing data for directors, lightening the workload for the medical workers, and improving the workers efficiency. According to the HIS demand analysis and system design, this paper focus on utilizing unified modeling language (UML) models to establish the use case diagram, class diagram, sequence chart and collaboration diagram, and satisfying the demands of the daily patient visit, inpatient, drug management and other relevant operations. At last, the paper summarizes the problems of the system and puts forward an outlook of the HIS system.

An analysis of the adoption of managerial innovation: cost accounting systems in hospitals.

Science.gov (United States)

Glandon, G L; Counte, M A

1995-11-01

The adoption of new medical technologies has received significant attention in the hospital industry, in part, because of its observed relation to hospital cost increases. However, few comprehensive studies exist regarding the adoption of non-medical technologies in the hospital setting. This paper develops and tests a model of the adoption of a managerial innovation, new to the hospital industry, that of cost accounting systems based upon standard costs. The conceptual model hypothesizes that four organizational context factors (size, complexity, ownership and slack resources) and two environmental factors (payor mix and interorganizational dependency) influence hospital adoption of cost accounting systems. Based on responses to a mail survey of hospitals in the Chicago area and AHA annual survey information for 1986, a sample of 92 hospitals was analyzed. Greater hospital size, complexity, slack resources, and interorganizational dependency all were associated with adoption. Payor mix had no significant influence and the hospital ownership variables had a mixed influence. The logistic regression model was significant overall and explained over 15% of the variance in the adoption decision.

Health systems: changes in hospital efficiency and profitability.

Science.gov (United States)

Büchner, Vera Antonia; Hinz, Vera; Schreyögg, Jonas

2016-06-01

This study investigates potential changes in hospital performance after health system entry, while differentiating between hospital technical and cost efficiency and hospital profitability. In the first stage we obtained (bootstrapped) data envelopment analysis (DEA) efficiency scores. Then, genetic matching is used as a novel matching procedure in this context along with a difference-in-difference approach within a panel regression framework. With the genetic matching procedure, independent and health system hospitals are matched along a number of environmental and organizational characteristics. The results show that health system entry increases hospital technical and cost efficiency by between 0.6 and 3.4 % in four alternative post-entry periods, indicating that health system entry has not a transitory but rather a permanent effect on hospital efficiency. Regarding hospital profitability, the results reveal an increase in hospital profitability only 1 year after health system entry, and the estimations suggest that this effect is a transitional phenomenon. Overall, health system entry may serve as an appropriate management instrument for decision makers to increase hospital performance.

Hospital-based school for children with chronic illness in Taiwan.

Science.gov (United States)

Chen, Der-Fang; Tsai, Tsuen-Chiuan; Su, Yu-Tsun; Lin, Chi-Wei

2015-10-01

To provide educational support and avoid unwanted damage that may impede learning for children with chronic illness, the learning environment should be friendly and safe. There is a need to establish schools inside hospitals, however, which may be neglected in a highly efficient health care system. A study was conducted to identify hospital-based schools for sick children in Taiwan, and to explore the barriers for implementation. The data were collected by structured telephone interview and retrieval of hospital web information. The study targeted social workers and nurses in the pediatric wards of 29 hospitals, plus officials from the Education Bureau in Taiwan. The interviewers inquired about the availability of a formal educational program inside hospitals and the barriers (if any) in providing educational supports. Taiwan has only one hospital-based informal school and eight hospitals with rotating bedside teachers. Education inside hospitals occurs mostly through voluntary teaching in informal education models. Information about special educational resources has not been widely distributed to patients and health care providers. Professional personnel in Taiwan are not well aware of the needs to establish a hospital-based school. The educational needs of children with chronic illness can be easily neglected even in an industrialized country. The establishment of policy and the enrichment of professional education on advocacy are necessary to eliminate educational inequities and benefit sick children. Copyright © 2014. Published by Elsevier B.V.

Evaluating hospital information systems from the point of view of the medical records section users in Medical-Educational Hospitals of Kermanshah 2014.

Science.gov (United States)

Rostami, S; Sarmad, A; Mohammadi, M; Cheleie, M; Amiri, S; Zardoei Golanbary, S H

2015-01-01

Evaluating hospital information systems leads to the improvement and devotion based on the users' needs, especially the medical records section users in hospitals, which are in contact with this system from the moment the patient enters the hospital until his/ her release and after that. The present research aimed to evaluate the hospital information systems from the point of view of the medical record section employees. Materials and method : The current research was applicative-descriptive analytical and the research society included 70 users of the medical history section in the educational-medical centers of Kermanshah city. The data-gathering tool was the 10th part of 9241/ 10 Isometric standard questionnaire of evaluating hospital information systems, with 75 specific questions in 7 bases, with the five spectra Likertt scale, its conceptual admissibility being confirmed in previous researches. 22 SPSS statistical software analyzed its permanency in the present study, which was also confirmed by Cronbach's's alpha test, which equaled to 0.89, and the data. Findings : The highest level of the employees' satisfaction, based on gained scores median, was respectively the incompatibility with the users' expectations, measuring 3.55, self-description measuring 3.54 and controllability - 3.51, which in total presented the average scores of 3.39, the lowest level of satisfaction being related to useful learning , whose value was 3.19. Discussion and conclusion : Hospital information systems' users believe that it is more desirable that the existing systems are based on the measures and consider them proper for making them non-governmental and useful for undesired learning. Considering the long distance of the existing information systems with the desired performance, it is essential that "these systems pay more attention to a more complete and deeper recognition and awareness of users' opinions and requirements in their road. The movement and development is to

Efficacy of computer-based endoscope cleaning and disinfection using a hospital management information system.

Science.gov (United States)

Wang, Caixia; Chen, Yuanyuan; Yang, Feng; Ren, Jie; Yu, Xin; Wang, Jiani; Sun, Siyu

2016-08-01

The present study aimed to assess the efficacy of computer-based endoscope cleaning and disinfection using a hospital management information system (HMIS). A total of 2,674 gastroscopes were eligible for inclusion in this study. For the processes of disinfection management, the gastroscopes were randomly divided into 2 groups: gastroscope disinfection HMIS (GD-HMIS) group and manual group. In the GD-HMIS group, an integrated circuit card (IC card) chip was installed to monitor and record endoscope cleaning and disinfection automatically and in real time, whereas the endoscope cleaning and disinfection in the manual group was recorded manually. The overall disinfection progresses for both groups were recorded, and the total operational time was calculated. For the GD-HMIS group, endoscope disinfection HMIS software was successfully developed. The time to complete a single session of cleaning and disinfecting on a gastroscope was 15.6 minutes (range, 14.3-17.2 minutes) for the GD-HMIS group and 21.3 minutes (range, 20.2-23.9 minutes) for the manual group. Failure to record information, such as the identification number of the endoscope, occasionally occurred in the manual group, which affected the accuracy and reliability of manual recording. Computer-based gastroscope cleaning and disinfection using a hospital management information system could monitor the process of gastroscope cleaning and disinfection in real time and improve the accuracy and reliability, thereby ensuring the quality of gastroscope cleaning and disinfection. Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

The definition, selection and implementation of a new Clinical Information System to prepare the hospital for the electronic future : an example of project-based education

NARCIS (Netherlands)

Spil, Antonius A.M.; van de Meeberg, Henk J.; Sikkel, Nicolaas

The software supplier of a large hospital has been taken over. The hospital gets notice that the central hospital information system (HIS) will no longer be maintained, starting next year. This problem, not uncommon in business today, is used as a real-life case in a project-based course for first

Impact of a Local Low-Cost Ward-Based Response System in a Canadian Tertiary Care Hospital

Directory of Open Access Journals (Sweden)

Andrea Blotsky

2016-01-01

Full Text Available Background. Medical emergency teams (METs or rapid response teams (RRTs facilitate early intervention for clinically deteriorating hospitalized patients. In healthcare systems where financial resources and intensivist availability are limited, the establishment of such teams can prove challenging. Objectives. A low-cost, ward-based response system was implemented on a medical clinical teaching unit in a Montreal tertiary care hospital. A prospective before/after study was undertaken to examine the system’s impact on time to intervention, code blue rates, and ICU transfer rates. Results. Ninety-five calls were placed for 82 patients. Median time from patient decompensation to intervention was 5 min (IQR 1–10, compared to 3.4 hours (IQR 0.6–12.4 before system implementation (p<0.001. Total number of ICU admissions from the CTU was reduced from 4.8/1000 patient days (±2.2 before intervention to 3.3/1000 patient days (±1.4 after intervention (IRR: 0.82, p=0.04 (CI 95%: 0.69–0.99. CTU code blue rates decreased from 2.2/1000 patient days (±1.6 before intervention to 1.2/1000 patient days (±1.3 after intervention (IRR: 0.51, p=0.02 (CI 95%: 0.30–0.89. Conclusion. Our local ward-based response system achieved a significant reduction in the time of patient decompensation to initial intervention, in CTU code blue rates, and in CTU to ICU transfers without necessitating additional usage of financial or human resources.

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...

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...

The utilization of activity-based cost accounting in hospitals.

Science.gov (United States)

Emmett, Dennis; Forget, Robert

2005-01-01

Healthcare costs are being examined on all fronts. Healthcare accounts for 11% of the gross national product and will continue to rise as the "babyboomers" reach retirement age. While ascertaining costs is important, most research shows that costing methods have not been implemented in hospitals. This study is concerned with the use of costing methods; particularly activity-based cost accounting. A mail survey of CFOs was undertaken to determine the type of cost accounting method they use. In addition, they were asked whether they were aware of activity-based cost accounting and whether they had implemented it or were planning to implement it. Only 71.8% were aware of it and only 4.7% had implemented it. In addition, only 52% of all hospitals report using any cost accounting systems. Education needs to ensure that all healthcare executives are cognizant of activity-based accounting and its importance in determining costs. Only by determining costs can hospitals strive to contain them.

Sociotechnical factors influencing unsafe use of hospital information systems: A qualitative study in Malaysian government hospitals.

Science.gov (United States)

Salahuddin, Lizawati; Ismail, Zuraini; Hashim, Ummi Rabaah; Raja Ikram, Raja Rina; Ismail, Nor Haslinda; Naim Mohayat, Mohd Hariz

2018-03-01

The objective of this study is to identify factors influencing unsafe use of hospital information systems in Malaysian government hospitals. Semi-structured interviews with 31 medical doctors in three Malaysian government hospitals implementing total hospital information systems were conducted between March and May 2015. A thematic qualitative analysis was performed on the resultant data to deduce the relevant themes. A total of five themes emerged as the factors influencing unsafe use of a hospital information system: (1) knowledge, (2) system quality, (3) task stressor, (4) organization resources, and (5) teamwork. These qualitative findings highlight that factors influencing unsafe use of a hospital information system originate from multidimensional sociotechnical aspects. Unsafe use of a hospital information system could possibly lead to the incidence of errors and thus raises safety risks to the patients. Hence, multiple interventions (e.g. technology systems and teamwork) are required in shaping high-quality hospital information system use.

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...

A technology ecosystem perspective on hospital management information systems: lessons from the health literature.

Science.gov (United States)

Bain, Christopher A; Standing, Craig

2009-01-01

Hospital managers have a large range of information needs including quality metrics, financial reports, access information needs, educational, resourcing and decision support needs. Currently these needs involve interactions by managers with numerous disparate systems, both electronic such as SAP, Oracle Financials, PAS' (patient administration systems) like HOMER, and relevant websites; and paper-based systems. Hospital management information systems (HMIS) can be thought of sitting within a Technology Ecosystem (TE). In addition, Hospital Management Information Systems (HMIS) could benefit from a broader and deeper TE model, and the HMIS environment may in fact represents its own TE (the HMTE). This research will examine lessons from the health literature in relation to some of these issues, and propose an extension to the base model of a TE.

A Computerized Hospital Patient Information Management System

Science.gov (United States)

Wig, Eldon D.

1982-01-01

The information processing needs of a hospital are many, with varying degrees of complexity. The prime concern in providing an integrated hospital information management system lies in the ability to process the data relating to the single entity for which every hospital functions - the patient. This paper examines the PRIMIS computer system developed to accommodate hospital needs with respect to a central patient registry, inpatients (i.e., Admission/Transfer/Discharge), and out-patients. Finally, the potential for expansion to permit the incorporation of more hospital functions within PRIMIS is examined.

Acceptance model of a Hospital Information System.

Science.gov (United States)

Handayani, P W; Hidayanto, A N; Pinem, A A; Hapsari, I C; Sandhyaduhita, P I; Budi, I

2017-03-01

The purpose of this study is to develop a model of Hospital Information System (HIS) user acceptance focusing on human, technological, and organizational characteristics for supporting government eHealth programs. This model was then tested to see which hospital type in Indonesia would benefit from the model to resolve problems related to HIS user acceptance. This study used qualitative and quantitative approaches with case studies at four privately owned hospitals and three government-owned hospitals, which are general hospitals in Indonesia. The respondents involved in this study are low-level and mid-level hospital management officers, doctors, nurses, and administrative staff who work at medical record, inpatient, outpatient, emergency, pharmacy, and information technology units. Data was processed using Structural Equation Modeling (SEM) and AMOS 21.0. The study concludes that non-technological factors, such as human characteristics (i.e. compatibility, information security expectancy, and self-efficacy), and organizational characteristics (i.e. management support, facilitating conditions, and user involvement) which have level of significance of p<0.05, significantly influenced users' opinions of both the ease of use and the benefits of the HIS. This study found that different factors may affect the acceptance of each user in each type of hospital regarding the use of HIS. Finally, this model is best suited for government-owned hospitals. Based on the results of this study, hospital management and IT developers should have more understanding on the non-technological factors to better plan for HIS implementation. Support from management is critical to the sustainability of HIS implementation to ensure HIS is easy to use and provides benefits to the users as well as hospitals. Finally, this study could assist hospital management and IT developers, as well as researchers, to understand the obstacles faced by hospitals in implementing HIS. Copyright © 2016

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

Is the system really the solution? Operating costs in hospital systems.

Science.gov (United States)

Burns, Lawton Robert; McCullough, Jeffrey S; Wholey, Douglas R; Kruse, Gregory; Kralovec, Peter; Muller, Ralph

2015-06-01

Hospital system formation has recently accelerated. Executives emphasize scale economies that lower operating costs, a claim unsupported in academic research. Do systems achieve lower costs than freestanding facilities, and, if so, which system types? We test hypotheses about the relationship of cost with membership in systems, larger systems, and centralized and local hub-and-spoke systems. We also test whether these relationships have changed over time. Examining 4,000 U.S. hospitals during 1998 to 2010, we find no evidence that system members exhibit lower costs. However, members of smaller systems are lower cost than larger systems, and hospitals in centralized systems are lower cost than everyone else. There is no evidence that the system's spatial configuration is associated with cost, although national system hospitals exhibit higher costs. Finally, these results hold over time. We conclude that while systems in general may not be the solution to lower costs, some types of systems are. © The Author(s) 2015.

Case Mix Management Systems: An Opportunity to Integrate Medical Records and Financial Management System Data Bases

Science.gov (United States)

Rusnak, James E.

1987-01-01

Due to previous systems selections, many hospitals (health care facilities) are faced with the problem of fragmented data bases containing clinical, demographic and financial information. Projects to select and implement a Case Mix Management System (CMMS) provide an opportunity to reduce the number of separate physical files and to migrate towards systems with an integrated data base. The number of CMMS candidate systems is often restricted due to data base and system interface issues. The hospital must insure the CMMS project provides a means to implement an integrated on-line hospital information data base for use by departments in operating under a DRG-based Prospective Payment System. This paper presents guidelines for use in selecting a Case Mix Mangement System to meet the hospital's financial and operations planning, budgeting, marketing, and other management needs, while considering the data base implications of the implementation.

A Web-Based, Hospital-Wide Health Care-Associated Bloodstream Infection Surveillance and Classification System: Development and Evaluation.

Science.gov (United States)

Tseng, Yi-Ju; Wu, Jung-Hsuan; Lin, Hui-Chi; Chen, Ming-Yuan; Ping, Xiao-Ou; Sun, Chun-Chuan; Shang, Rung-Ji; Sheng, Wang-Huei; Chen, Yee-Chun; Lai, Feipei; Chang, Shan-Chwen

2015-09-21

Surveillance of health care-associated infections is an essential component of infection prevention programs, but conventional systems are labor intensive and performance dependent. To develop an automatic surveillance and classification system for health care-associated bloodstream infection (HABSI), and to evaluate its performance by comparing it with a conventional infection control personnel (ICP)-based surveillance system. We developed a Web-based system that was integrated into the medical information system of a 2200-bed teaching hospital in Taiwan. The system automatically detects and classifies HABSIs. In this study, the number of computer-detected HABSIs correlated closely with the number of HABSIs detected by ICP by department (n=20; r=.999 Psystem performed excellently with regard to sensitivity (98.16%), specificity (99.96%), positive predictive value (95.81%), and negative predictive value (99.98%). The system enabled decreasing the delay in confirmation of HABSI cases, on average, by 29 days. This system provides reliable and objective HABSI data for quality indicators, improving the delay caused by a conventional surveillance system.

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...

SCM: a practical tool to implement hospital-based syndromic surveillance.

Science.gov (United States)

Ye, Chuchu; Li, Zhongjie; Fu, Yifei; Lan, Yajia; Zhu, Weiping; Zhou, Dinglun; Zhang, Honglong; Lai, Shengjie; Buckeridge, David L; Sun, Qiao; Yang, Weizhong

2016-06-18

Syndromic surveillance has been widely used for the early warning of infectious disease outbreaks, especially in mass gatherings, but the collection of electronic data on symptoms in hospitals is one of the fundamental challenges that must be overcome during operating a syndromic surveillance system. The objective of our study is to describe and evaluate the implementation of a symptom-clicking-module (SCM) as a part of the enhanced hospital-based syndromic surveillance during the 41st World Exposition in Shanghai, China, 2010. The SCM, including 25 targeted symptoms, was embedded in the sentinels' Hospital Information Systems (HIS). The clinicians used SCM to record these information of all the visiting patients, and data were collated and transmitted automatically in daily batches. The symptoms were categorized into seven targeted syndromes using pre-defined criteria, and statistical algorithms were applied to detect temporal aberrations in the data series. SCM was deployed successfully in each sentinel hospital and was operated during the 184-day surveillance period. A total of 1,730,797 patient encounters were recorded by SCM, and 6.1 % (105,352 visits) met the criteria of the seven targeted syndromes. Acute respiratory and gastrointestinal syndromes were reported most frequently, accounted for 92.1 % of reports in all syndromes, and the aggregated time-series presented an obvious day-of-week variation over the study period. In total, 191 aberration signals were triggered, and none of them were identified as outbreaks after verification and field investigation. SCM has acted as a practical tool for recording symptoms in the hospital-based enhanced syndromic surveillance system during the 41st World Exposition in Shanghai, in the context of without a preexisting electronic tool to collect syndromic data in the HIS of the sentinel hospitals.

Capital Investment by Independent and System-Affiliated Hospitals.

Science.gov (United States)

Carroll, Nathan W; Smith, Dean G; Wheeler, John R C

2015-01-01

Capital expenditures are a critical part of hospitals' efforts to maintain quality of patient care and financial stability. Over the past 20 years, finding capital to fund these expenditures has become increasingly challenging for hospitals, particularly independent hospitals. Independent hospitals struggling to find ways to fund necessary capital investment are often advised that their best strategy is to join a multi-hospital system. There is scant empirical evidence to support the idea that system membership improves independent hospitals' ability to make capital expenditures. Using data from the American Hospital Association and Medicare Cost Reports, we use difference-in-difference methods to examine changes in capital expenditures for independent hospitals that joined multi-hospital systems between 1997 and 2008. We find that in the first 5 years after acquisition, capital expenditures increase by an average of almost $16,000 per bed annually, as compared with non-acquired hospitals. In later years, the difference in capital expenditure is smaller and not statistically significant. Our results do not suggest that increases in capital expenditures vary by asset age or the size of the acquiring system. © The Author(s) 2015.

Efficiency and hospital effectiveness in improving Hospital Consumer Assessment of Healthcare Providers and Systems ratings.

Science.gov (United States)

Al-Amin, Mona; Makarem, Suzanne C; Rosko, Michael

2016-01-01

Efficiency has emerged as a central goal to the operations of health care organizations. There are two competing perspectives on the relationship between efficiency and organizational performance. Some argue that organizational slack is a waste and that efficiency contributes to organizational performance, whereas others maintain that slack acts as a buffer, allowing organizations to adapt to environmental demands and contributing to organizational performance. As value-based purchasing becomes more prevalent, health care organizations are incented to become more efficient and, at the same time, improve their patients' experiences and outcomes. Unused slack resources might facilitate the timely implementation of these improvements. Building on previous research on organizational slack and inertia, we test whether efficiency and other organizational factors predict organizational effectiveness in improving Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings. We rely on data from the American Hospital Association and HCAHPS. We estimate hospital cost-efficiency by Stochastic Frontier Analysis and use regression analysis to determine whether efficiency, competition, hospital size, and other organizational factors are significant predictors of hospital effectiveness. Our findings indicate that efficiency and hospital size have a significant negative association with organizational ability to improve HCAHPS ratings. Although achieving organizational efficiency is necessary for health care organizations, given the changes that are currently occurring in the U.S. health care system, it is important for health care managers to maintain a certain level of slack to respond to environmental demands and have the resources needed to improve their performance.

Mount Sinai Hospital's approach to Ontario's Health System Funding Reform.

Science.gov (United States)

Chalk, Tyler; Lau, Davina; Morgan, Matthew; Dietrich, Sandra; Beduz, Mary Agnes; Bell, Chaim M

2014-01-01

In April 2012, the Ontario government introduced Health System Funding Reform (HSFR), a transformational shift in how hospitals are funded. Mount Sinai Hospital recognized that moving from global funding to a "patient-based" model would have substantial operational and clinical implications. Adjusting to the new funding environment was set as a top corporate priority, serving as the strategic basis for re-examining and redesigning operations to further improve both quality and efficiency. Two years into HSFR, this article outlines Mount Sinai Hospital's approach and highlights key lessons learned. Copyright © 2014 Longwoods Publishing.

Application of Kanban System on a hospital pharmacy.

Science.gov (United States)

Mitka, Eleftheria

2015-01-01

This is a brief overview of principles, views and methods, of the Kanban System for the pharmacy of a general hospital. The main goal is the reduction of stores managed by the pharmacy, as well as improvement of the mode of operation. Solutions to problems, such as inadequate storage space, the delay in serving patients or clinics and the expiration of various pharmaceutical formulations, stored for so long time, are provided. The philosophy behind the Kanban procurement System and specifically its applicability to a pharmacy underperforming in terms of efficiency, in Greece, are described. Based on the analysis of stock requirement, item stock prices and demand, it is concluded that a significant percentage of the stocked drugs can be procured using the Kanban System. Significant cost savings and operational advantages following the Kanban System will take place. The challenging endeavor is the analysis, design and application of a system that supports the proposed procurement method. Hospital pharmacies in Greece and in other countries that face an economic crisis may largely benefit after using the Kanban System.

[Monitoring evaluation system for high-specialty hospitals].

Science.gov (United States)

Fajardo Dolci, Germán; Aguirre Gas, Héctor G; Robledo Galván, Héctor

2011-01-01

Hospital evaluation is a fundamental process to identify medical units' objective compliance, to analyze efficiency of resource use and allocation, institutional values and mission alignment, patient safety and quality standards, contributions to research and medical education, and the degree of coordination among medical units and the health system as a whole. We propose an evaluation system for highly specialized regional hospitals through the monitoring of performance indicators. The following are established as base thematic elements in the construction of indicators: safe facilities and equipment, financial situation, human resources management, policy management, organizational climate, clinical activity, quality and patient safety, continuity of care, patients' and providers' rights and obligations, teaching, research, social responsibility, coordination mechanisms. Monitoring refers to the planned and systematic evaluation of valid and reliable indicators, aimed at identifying problems and opportunity areas. Moreover, evaluation is a powerful tool to strengthen decision-making and accountability in medical units.

Availability of software services for a hospital information system.

Science.gov (United States)

Sakamoto, N

1998-03-01

Hospital information systems (HISs) are becoming more important and covering more parts in daily hospital operations as order-entry systems become popular and electronic charts are introduced. Thus, HISs today need to be able to provide necessary services for hospital operations for a 24-h day, 365 days a year. The provision of services discussed here does not simply mean the availability of computers, in which all that matters is that the computer is functioning. It means the provision of necessary information for hospital operations by the computer software, and we will call it the availability of software services. HISs these days are mostly client-server systems. To increase availability of software services in these systems, it is not enough to just use system structures that are highly reliable in existing host-centred systems. Four main components which support availability of software services are network systems, client computers, server computers, and application software. In this paper, we suggest how to structure these four components to provide the minimum requested software services even if a part of the system stops to function. The network system should be double-protected in stratus using Asynchronous Transfer Mode (ATM) as its base network. Client computers should be fat clients with as much application logic as possible, and reference information which do not require frequent updates (master files, for example) should be replicated in clients. It would be best if all server computers could be double-protected. However, if that is physically impossible, one database file should be made accessible by several server computers. Still, at least the basic patients' information and the latest clinical records should be double-protected physically. Application software should be tested carefully before introduction. Different versions of the application software should always be kept and managed in case the new version has problems. If a hospital

Longitudinal analysis on utilization of medical document management system in a hospital with EPR implementation.

Science.gov (United States)

Kuwata, Shigeki; Yamada, Hitomi; Park, Keunsik

2011-01-01

Document management systems (DMS) have widespread in major hospitals in Japan as a platform to digitize the paper-based records being out of coverage by EPR. This study aimed to examine longitudinal trends of actual use of DMS in a hospital in which EPR had been in operation, which would be conducive to planning the further information management system in the hospital. Degrees of utilization of electronic documents and templates with DMS were analyzed based on data extracted from a university-affiliated hospital with EPR. As a result, it was found that the number of electronic documents as well as scanned documents circulating at the hospital tended to increase. The result indicated that replacement of paper-based documents with electronic documents did not occur. Therefore it was anticipated that the need for DMS would continue to increase in the hospital. The methods used this study to analyze the trend of DMS utilization would be applicable to other hospitals with with a variety of DMS implementation, such as electronic storage by scanning documents or paper preservation that is compatible with EPR.

Factors Affecting Acceptance of Hospital Information Systems Based on Extended Technology Acceptance Model: A Case Study in Three Paraclinical Departments.

Science.gov (United States)

Nadri, Hamed; Rahimi, Bahlol; Lotfnezhad Afshar, Hadi; Samadbeik, Mahnaz; Garavand, Ali

2018-04-01

 Regardless of the acceptance of users, information and communication systems can be considered as a health intervention designed to improve the care delivered to patients. This study aimed to determine the adoption and use of the extended Technology Acceptance Model (TAM2) by the users of hospital information system (HIS) in paraclinical departments including laboratory, radiology, and nutrition and to investigate the key factors of adoption and use of these systems.  A standard questionnaire was used to collect the data from nearly 253 users of these systems in paraclinical departments of eight university hospitals in two different cities of Iran. A total of 202 questionnaires including valid responses were used in this study (105 in Urmia and 97 in Khorramabad). The data were processed using LISREL and SPSS software and statistical analysis technique was based on the structural equation modeling (SEM).  It was found that the original TAM constructs had a significant impact on the staffs' behavioral intention to adopt HIS in paraclinical departments. The results of this study indicated that cognitive instrumental processes (job relevance, output quality, result demonstrability, and perceived ease of use), except for result demonstrability, were significant predictors of intention to use, whereas the result revealed no significant relationship between social influence processes (subjective norm, voluntariness, and image) and the users' behavioral intention to use the system.  The results confirmed that several factors in the TAM2 that were important in previous studies were not significant in paraclinical departments and in government-owned hospitals. The users' behavior factors are essential for successful usage of the system and should be considered. It provides valuable information for hospital system providers and policy makers in understanding the adoption challenges as well as practical guidance for the successful implementation of information

Factors Affecting Successful Implementation of Hospital Information Systems.

Science.gov (United States)

Farzandipur, Mehrdad; Jeddi, Fatemeh Rangraz; Azimi, Esmaeil

2016-02-01

Today, the use of information systems in health environments, like any other fields, is necessary and organizational managers are convinced to use these systems. However, managers' satisfaction is not the only factor in successfully implementing these systems and failed information technology projects (IT) are reported despite the consent of the directors. Therefore, this study aims to determine the factors affecting the successful implementation of a hospital information system. The study was carried out as a descriptive method in 20 clinical hospitals that the hospital information system (HIS) was conducted in them. The clinical and paraclinical users of mentioned hospitals are the study group. 400 people were chosen as samples in scientific method and the data was collected using a questionnaire consisted of three main human, managerial and organizational, and technological factors, by questionnaire and interview. Then the data was scored in Likert scale (score of 1 to 5) and were analyzed using the SPSS software. About 75 percent of the population were female, with average work experience of 10 years and the mean age was 30 years. The human factors affecting the success of hospital information system implementation achieved the mean score of 3.5, both organizational and managerial factors 2.9 and technological factors the mean of 3. Human factors including computer skills, perceiving usefulness and perceiving the ease of a hospital information system use are more effective on the acceptance and successful implementation of hospital information systems; then the technological factors play a greater role. It is recommended that for the successful implementation of hospital information systems, most of these factors to be considered.

Depiction of Trends in Administrative Healthcare Data from Hospital Information System.

Science.gov (United States)

Kalankesh, Leila R; Pourasghar, Faramarz; Jafarabadi, Mohammad Asghari; Khanehdan, Negar

2015-06-01

administrative healthcare data are among main components of hospital information system. Such data can be analyzed and deployed for a variety of purposes. The principal aim of this research was to depict trends of administrative healthcare data from HIS in a general hospital from March 2011 to March 2014. data set used for this research was extracted from the SQL database of the hospital information system in Razi general hospital located in Marand. The data were saved as CSV (Comma Separated Values) in order to facilitate data cleaning and analysis. The variables of data set included patient's age, gender, final diagnosis, final diagnosis code based on ICD-10 classification system, date of hospitalization, date of discharge, LOS(Length of Stay), ward, and survival status of the patient. Data were analyzed and visualized after applying appropriate cleansing and preparing techniques. morbidity showed a constant trend over three years. Pregnancy, childbirth and the puerperium were the leading category of final diagnosis (about 32.8 %). The diseases of the circulatory system were the second class accounting for 13 percent of the hospitalization cases. The diseases of the digestive system had the third rank (10%). Patients aged between 14 and 44 constituted a higher proportion of total cases. Diseases of the circulatory system was the most common class of diseases among elderly patients (age≥65). The highest rate of mortality was observed among patients with final diagnosis of the circulatory system diseases followed by those with diseases of the respiratory system, and neoplasms. Mortality rate for the ICU and the CCU patients were 62% and 33% respectively. The longest average of LOS (7.3 days) was observed among patients hospitalized in the ICU while patients in the Obstetrics and Gynecology ward had the shortest average of LOS (2.4 days). Multiple regression analysis revealed that LOS was correlated with variables of surgery, gender, and type of payment, ward, the

Capital Investment by Independent and System-Affiliated Hospitals

Science.gov (United States)

Carroll, Nathan W.; Smith, Dean G.; Wheeler, John R. C.

2015-01-01

Capital expenditures are a critical part of hospitals’ efforts to maintain quality of patient care and financial stability. Over the past 20 years, finding capital to fund these expenditures has become increasingly challenging for hospitals, particularly independent hospitals. Independent hospitals struggling to find ways to fund necessary capital investment are often advised that their best strategy is to join a multi-hospital system. There is scant empirical evidence to support the idea that system membership improves independent hospitals’ ability to make capital expenditures. Using data from the American Hospital Association and Medicare Cost Reports, we use difference-in-difference methods to examine changes in capital expenditures for independent hospitals that joined multi-hospital systems between 1997 and 2008. We find that in the first 5 years after acquisition, capital expenditures increase by an average of almost $16 000 per bed annually, as compared with non-acquired hospitals. In later years, the difference in capital expenditure is smaller and not statistically significant. Our results do not suggest that increases in capital expenditures vary by asset age or the size of the acquiring system. PMID:26105571

Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2018 Rates; Quality Reporting Requirements for Specific Providers; Medicare and Medicaid Electronic Health Record (EHR)

Science.gov (United States)

2017-08-14

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2018. Some of these changes implement certain statutory provisions contained in the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, the 21st Century Cures Act, and other legislation. We also are making changes relating to the provider-based status of Indian Health Service (IHS) and Tribal facilities and organizations and to the low-volume hospital payment adjustment for hospitals operated by the IHS or a Tribe. In addition, we are providing the market basket update that will apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2018. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2018. In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities). We also are establishing new requirements or revising existing requirements for eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) participating in the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program. We also are making changes relating to transparency of accrediting organization survey

Longitudinal analysis on the development of hospital quality management systems in the Netherlands.

NARCIS (Netherlands)

Dückers, M.; Makai, P.; Vos, L.; Groenewegen, P.; Wagner, C.

2009-01-01

OBJECTIVE: Many changes have been initiated in the Dutch hospital sector to optimize health-care delivery: national agenda-setting, increased competition and transparency, a new system of hospital reimbursement based on diagnosis-treatment combinations, intensified monitoring of quality and a

Is There a Relationship Between Value-Based Purchasing and Hospital Profitability? An Exploratory Study of Missouri Hospitals.

Science.gov (United States)

Turner, Jason S; Broom, Kevin D; Counte, Michael A

2015-01-01

Recent US legislation is attempting to transition inpatient Medicare payments to a value-based purchasing (VBP) program. The VBP program is a pay-for-performance (P4P) system that incentivizes hospitals to improve patient satisfaction, health outcomes, and adherence to clinical protocols while simultaneously holding down costs. Our study evaluates (1) the impact of financial performance on the VBP adjustments and (2) whether there is a correlation between the VBP adjustment and the financial performance of Missouri hospitals that opted into the program. While upward and downward adjustments to the inpatient base rate may be related to hospital financial performance, prior financial performance may also be related to the adjustments. Financial health may allow facilities to invest and position the hospital for favorable future P4P adjustments. The results of our analysis indicate the VBP adjustment to the inpatient base rate is very small (±0.18%), clustered around zero, and is not correlated with financial performance. We also find that financial performance and improvement in the years prior to the adjustment are not related to the VBP adjustment or its respective components. This suggests that CMS is avoiding penalizing less profitable facilities, but the adjustment is also so small and tightly clustered around zero that it is failing to provide an adequate incentive to hospitals. The costs of improving patient satisfaction, clinical process adherence, health care outcomes, and efficiency above that of peers coupled with the growing number of metrics being used to calculate the VBP adjustments call into question the financial incentives of the hospital VBP program.

Managerial innovation in the hospital: an analysis of the diffusion of hospital cost-accounting systems.

Science.gov (United States)

Counte, M A; Glandon, G L

1988-01-01

Currently much interest is focused on the uses of cost-accounting systems within the hospital industry. Proponents frequently contend that such systems will help hospitals successfully adapt to new methods of financial reimbursement because they are essential to a number of major management functions, including competitive bidding, cost management, pricing, and profitability assessment. This article reports the results of a study conducted to examine the extent to which hospitals in a major market are actually beginning to use standard cost-accounting systems and identify factors that either aid or hinder the diffusion of these methods. Chief financial officers from 94 hospitals (83 percent response rate) participated in the study during the summer of 1986 where less than half of the hospitals (43 percent) had recently purchased a cost-accounting system. Detailed information about the interface of cost-accounting systems with other application systems and their specific management uses is reported.

Is mobile teleconsulting equivalent to hospital-based telestroke services?

Science.gov (United States)

Audebert, Heinrich J; Boy, Sandra; Jankovits, Ralf; Pilz, Philipp; Klucken, Jochen; Fehm, Nando P; Schenkel, Johannes

2008-12-01

Telemedicine is increasingly used to provide acute stroke expertise for hospitals without full-time neurological services. Teleconsulting through mobile laptop computers may offer more flexibility compared with hospital-based services, but concerns about quality and technical reliability remain. We conducted a controlled trial, allocating hospital-based or mobile teleconsulting in a shift-by-shift sequence and evaluating technical parameters, acceptability, and impact on immediate clinical decisions. Both types of telemedicine workstations were equipped with DICOM (Digital-Imaging-and-Communications-in-Medicine) viewer and videoconference software. The laptop connected by asymmetrical broadband UMTS (Universal-Mobile-Telecommunication-Systems) technology with a one-way spoke-to-hub video transmission, whereas the hospital-based device used landline symmetrical telecommunication, including a 2-way videoconference. One hundred twenty-seven hospital-based and 96 mobile teleconsultations were conducted within 2 months without any technical breakdown. The rates per allocated time were similar with 3.8 and 4.0 per day. No significant differences were found for durations of videoconference (mean: 11+/-3 versus 10+/-3 minutes, P=0.07), DICOM download (3+/-3 versus 4+/-3 minutes, P=0.19), and total duration of teleconsultations (44+/-19 versus 45+/-21 minutes, P=0.98). Technical quality of mobile teleconsultations was rated worse on both sides, but this did not affect the ability to make remote clinical decisions like initiating thrombolysis (17% versus 13% of all, P=0.32). Teleconsultation using a laptop workstation and broadband mobile telecommunication was technically stable and allowed remote clinical decision-making. There remain disadvantages regarding videoconference quality on the hub side and lack of video transmission to the spoke side.

A European benchmarking system to evaluate in-hospital mortality rates in acute coronary syndrome: the EURHOBOP project.

Science.gov (United States)

Dégano, Irene R; Subirana, Isaac; Torre, Marina; Grau, María; Vila, Joan; Fusco, Danilo; Kirchberger, Inge; Ferrières, Jean; Malmivaara, Antti; Azevedo, Ana; Meisinger, Christa; Bongard, Vanina; Farmakis, Dimitros; Davoli, Marina; Häkkinen, Unto; Araújo, Carla; Lekakis, John; Elosua, Roberto; Marrugat, Jaume

2015-03-01

Hospital performance models in acute myocardial infarction (AMI) are useful to assess patient management. While models are available for individual countries, mainly US, cross-European performance models are lacking. Thus, we aimed to develop a system to benchmark European hospitals in AMI and percutaneous coronary intervention (PCI), based on predicted in-hospital mortality. We used the EURopean HOspital Benchmarking by Outcomes in ACS Processes (EURHOBOP) cohort to develop the models, which included 11,631 AMI patients and 8276 acute coronary syndrome (ACS) patients who underwent PCI. Models were validated with a cohort of 55,955 European ACS patients. Multilevel logistic regression was used to predict in-hospital mortality in European hospitals for AMI and PCI. Administrative and clinical models were constructed with patient- and hospital-level covariates, as well as hospital- and country-based random effects. Internal cross-validation and external validation showed good discrimination at the patient level and good calibration at the hospital level, based on the C-index (0.736-0.819) and the concordance correlation coefficient (55.4%-80.3%). Mortality ratios (MRs) showed excellent concordance between administrative and clinical models (97.5% for AMI and 91.6% for PCI). Exclusion of transfers and hospital stays ≤1day did not affect in-hospital mortality prediction in sensitivity analyses, as shown by MR concordance (80.9%-85.4%). Models were used to develop a benchmarking system to compare in-hospital mortality rates of European hospitals with similar characteristics. The developed system, based on the EURHOBOP models, is a simple and reliable tool to compare in-hospital mortality rates between European hospitals in AMI and PCI. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Process-based organization design and hospital efficiency.

Science.gov (United States)

Vera, Antonio; Kuntz, Ludwig

2007-01-01

The central idea of process-based organization design is that organizing a firm around core business processes leads to cost reductions and quality improvements. We investigated theoretically and empirically whether the implementation of a process-based organization design is advisable in hospitals. The data came from a database compiled by the Statistical Office of the German federal state of Rheinland-Pfalz and from a written questionnaire, which was sent to the chief executive officers (CEOs) of all 92 hospitals in this federal state. We used data envelopment analysis (DEA) to measure hospital efficiency, and factor analysis and regression analysis to test our hypothesis. Our principal finding is that a high degree of process-based organization has a moderate but significant positive effect on the efficiency of hospitals. The main implication is that hospitals should implement a process-based organization to improve their efficiency. However, to actually achieve positive effects on efficiency, it is of paramount importance to observe some implementation rules, in particular to mobilize physician participation and to create an adequate organizational culture.

Simple Scoring System to Predict In-Hospital Mortality After Surgery for Infective Endocarditis.

Science.gov (United States)

Gatti, Giuseppe; Perrotti, Andrea; Obadia, Jean-François; Duval, Xavier; Iung, Bernard; Alla, François; Chirouze, Catherine; Selton-Suty, Christine; Hoen, Bruno; Sinagra, Gianfranco; Delahaye, François; Tattevin, Pierre; Le Moing, Vincent; Pappalardo, Aniello; Chocron, Sidney

2017-07-20

Aspecific scoring systems are used to predict the risk of death postsurgery in patients with infective endocarditis (IE). The purpose of the present study was both to analyze the risk factors for in-hospital death, which complicates surgery for IE, and to create a mortality risk score based on the results of this analysis. Outcomes of 361 consecutive patients (mean age, 59.1±15.4 years) who had undergone surgery for IE in 8 European centers of cardiac surgery were recorded prospectively, and a risk factor analysis (multivariable logistic regression) for in-hospital death was performed. The discriminatory power of a new predictive scoring system was assessed with the receiver operating characteristic curve analysis. Score validation procedures were carried out. Fifty-six (15.5%) patients died postsurgery. BMI >27 kg/m 2 (odds ratio [OR], 1.79; P =0.049), estimated glomerular filtration rate 55 mm Hg (OR, 1.78; P =0.032), and critical state (OR, 2.37; P =0.017) were independent predictors of in-hospital death. A scoring system was devised to predict in-hospital death postsurgery for IE (area under the receiver operating characteristic curve, 0.780; 95% CI, 0.734-0.822). The score performed better than 5 of 6 scoring systems for in-hospital death after cardiac surgery that were considered. A simple scoring system based on risk factors for in-hospital death was specifically created to predict mortality risk postsurgery in patients with IE. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Aetiologies of central nervous system infection in Viet Nam: a prospective provincial hospital-based descriptive surveillance study.

Directory of Open Access Journals (Sweden)

Nghia Ho Dang Trung

Full Text Available Infectious diseases of the central nervous system (CNS remain common and life-threatening, especially in developing countries. Knowledge of the aetiological agents responsible for these infections is essential to guide empiric therapy and develop a rational public health policy. To date most data has come from patients admitted to tertiary referral hospitals in Asia and there is limited aetiological data at the provincial hospital level where most patients are seen.We conducted a prospective Provincial Hospital-based descriptive surveillance study in adults and children at thirteen hospitals in central and southern Viet Nam between August 2007-April 2010. The pathogens of CNS infection were confirmed in CSF and blood samples by using classical microbiology, molecular diagnostics and serology.We recruited 1241 patients with clinically suspected infection of the CNS. An aetiological agent was identified in 640/1241 (52% of the patients. The most common pathogens were Streptococcus suis serotype 2 in patients older than 14 years of age (147/617, 24% and Japanese encephalitis virus in patients less than 14 years old (142/624, 23%. Mycobacterium tuberculosis was confirmed in 34/617 (6% adult patients and 11/624 (2% paediatric patients. The acute case fatality rate (CFR during hospital admission was 73/617 (12% in adults and to 42/624 (7% in children.Zoonotic bacterial and viral pathogens are the most common causes of CNS infection in adults and children in Viet Nam.

Planning Study Hospital, Cape Town The Hospital Information at ...

African Journals Online (AJOL)

Tile HOspital Information Plan- ning Study ... Hospital, and based on. the Business Systems Plan- ... technology can be of considerable benefit in dealing with these issues. .... coherenr, flexible information systems with a minimum of data.

Hospital information systems: experience at the fully digitized Seoul National University Bundang Hospital.

Science.gov (United States)

Yoo, Sooyoung; Hwang, Hee; Jheon, Sanghoon

2016-08-01

The different levels of health information technology (IT) adoption and its integration into hospital workflow can affect the maximization of the benefits of using of health IT. We aimed at sharing our experiences and the journey to the successful adoption of health IT over 13 years at a tertiary university hospital in South Korea. The integrated system of comprehensive applications for direct care, support care, and smart care has been implemented with the latest IT and a rich user information platform, achieving the fully digitized hospital. The users experience design methodology, barcode and radio-frequency identification (RFID) technologies, smartphone and mobile technologies, and data analytics were integrated into hospital workflow. Applications for user-centered electronic medical record (EMR) and clinical decision support (CDS), closed loop medication administration (CLMA), mobile EMR and dashboard system for care coordination, clinical data warehouse (CDW) system, and patient engagement solutions were designed and developed to improve quality of care, work efficiency, and patient safety. We believe that comprehensive electronic health record systems and patient-centered smart hospital applications will go a long way in ensuring seamless patient care and experience.

Participatory simulation in hospital work system design

DEFF Research Database (Denmark)

Andersen, Simone Nyholm

When ergonomic considerations are integrated into the design of work systems, both overall system performance and employee well-being improve. A central part of integrating ergonomics in work system design is to benefit from emplo y-ees’ knowledge of existing work systems. Participatory simulation...... (PS) is a method to access employee knowledge; namely employees are involved in the simulation and design of their own future work systems through the exploration of models representing work system designs. However, only a few studies have investigated PS and the elements of the method. Yet...... understanding the elements is essential when analyzing and planning PS in research and practice. This PhD study investigates PS and the method elements in the context of the Danish hospital sector, where PS is applied in the renewal and design of public hospitals and the work systems within the hospitals...

Hidden Costs of Hospital Based Delivery from Two Tertiary Hospitals in Western Nepal.

Directory of Open Access Journals (Sweden)

Jeevan Acharya

Full Text Available Hospital based delivery has been an expensive experience for poor households because of hidden costs which are usually unaccounted in hospital costs. The main aim of this study was to estimate the hidden costs of hospital based delivery and determine the factors associated with the hidden costs.A hospital based cross-sectional study was conducted among 384 post-partum mothers with their husbands/house heads during the discharge time in Manipal Teaching Hospital and Western Regional Hospital, Pokhara, Nepal. A face to face interview with each respondent was conducted using a structured questionnaire. Hidden costs were calculated based on the price rate of the market during the time of the study.The total hidden costs for normal delivery and C-section delivery were 243.4 USD (US Dollar and 321.6 USD respectively. Of the total maternity care expenditures; higher mean expenditures were found for food & drinking (53.07%, clothes (9.8% and transport (7.3%. For postpartum women with their husband or house head, the total mean opportunity cost of "days of work loss" were 84.1 USD and 81.9 USD for normal delivery and C-section respectively. Factors such as literate mother (p = 0.007, employed house head (p = 0.011, monthly family income more than 25,000 NRs (Nepalese Rupees (p = 0.014, private hospital as a place of delivery (p = 0.0001, C-section as a mode of delivery (p = 0.0001, longer duration (>5days of stay in hospital (p = 0.0001, longer distance (>15km from house to hospital (p = 0.0001 and longer travel time (>240 minutes from house to hospital (p = 0.007 showed a significant association with the higher hidden costs (>25000 NRs.Experiences of hidden costs on hospital based delivery and opportunity costs of days of work loss were found high. Several socio-demographic factors, delivery related factors (place and mode of delivery, length of stay, distance from hospital and travel time were associated with hidden costs. Hidden costs can be a

Hidden Costs of Hospital Based Delivery from Two Tertiary Hospitals in Western Nepal.

Science.gov (United States)

Acharya, Jeevan; Kaehler, Nils; Marahatta, Sujan Babu; Mishra, Shiva Raj; Subedi, Sudarshan; Adhikari, Bipin

2016-01-01

Hospital based delivery has been an expensive experience for poor households because of hidden costs which are usually unaccounted in hospital costs. The main aim of this study was to estimate the hidden costs of hospital based delivery and determine the factors associated with the hidden costs. A hospital based cross-sectional study was conducted among 384 post-partum mothers with their husbands/house heads during the discharge time in Manipal Teaching Hospital and Western Regional Hospital, Pokhara, Nepal. A face to face interview with each respondent was conducted using a structured questionnaire. Hidden costs were calculated based on the price rate of the market during the time of the study. The total hidden costs for normal delivery and C-section delivery were 243.4 USD (US Dollar) and 321.6 USD respectively. Of the total maternity care expenditures; higher mean expenditures were found for food & drinking (53.07%), clothes (9.8%) and transport (7.3%). For postpartum women with their husband or house head, the total mean opportunity cost of "days of work loss" were 84.1 USD and 81.9 USD for normal delivery and C-section respectively. Factors such as literate mother (p = 0.007), employed house head (p = 0.011), monthly family income more than 25,000 NRs (Nepalese Rupees) (p = 0.014), private hospital as a place of delivery (p = 0.0001), C-section as a mode of delivery (p = 0.0001), longer duration (>5days) of stay in hospital (p = 0.0001), longer distance (>15km) from house to hospital (p = 0.0001) and longer travel time (>240 minutes) from house to hospital (p = 0.007) showed a significant association with the higher hidden costs (>25000 NRs). Experiences of hidden costs on hospital based delivery and opportunity costs of days of work loss were found high. Several socio-demographic factors, delivery related factors (place and mode of delivery, length of stay, distance from hospital and travel time) were associated with hidden costs. Hidden costs can be a

[Hospital clinical engineer orientation and function in the maintenance system of hospital medical equipment].

Science.gov (United States)

Li, Bin; Zheng, Yunxin; He, Dehua; Jiang, Ruiyao; Chen, Ying; Jing, Wei

2012-03-01

The quantity of medical equipment in hospital rise quickly recent year. It provides the comprehensive support to the clinical service. The maintenance of medical equipment becomes more important than before. It is necessary to study on the orientation and function of clinical engineer in medical equipment maintenance system. Refer to three grade health care system, the community doctors which is called General practitioner, play an important role as the gatekeeper of health care system to triage and cost control. The paper suggests that hospital clinical engineer should play similar role as the gatekeeper of medical equipment maintenance system which composed by hospital clinical engineer, manufacture engineer and third party engineer. The hospital clinical engineer should be responsible of guard a pass of medical equipment maintenance quality and cost control. As the gatekeeper, hospital clinical engineer should take the responsibility of "General engineer" and pay more attention to safety and health of medical equipment. The responsibility description and future transition? development of clinical engineer as "General Engineer" is discussed. More attention should be recommended to the team building of hospital clinical engineer as "General Engineer".

[Nordic accident classification system used in the Danish National Hospital Registration System to register causes of severe traumatic brain injury].

Science.gov (United States)

Engberg, Aase Worsaa; Penninga, Elisabeth Irene; Teasdale, Thomas William

2007-11-05

The purpose was to illustrate the use of the accident classification system worked out by the Nordic Medico-Statistical Committee (NOMESCO). In particular, registration of causes of severe traumatic brain injury according to the system as part of the Danish National Hospital Registration System was studied. The study comprised 117 patients with very severe traumatic brain injury (TBI) admitted to the Brain Injury Unit of the University Hospital in Hvidovre, Copenhagen, from 1 October 2000 to 30 September 2002. Prospective NOMESCO coding at discharge was compared to independent retrospective coding based on hospital records, and to coding from other wards in the Danish National Hospital Registration System. Furthermore, sets of codes in the Danish National Hospital Registration System for consecutive admissions after a particular accident were compared. Identical results of prospective and independent retrospective coding were found for 65% of 588 single codes, and complete sets of codes for the same accident were identical only in 28% of cases. Sets of codes for the first admission in a hospital course corresponded to retrospective coding at the end of the course in only 17% of cases. Accident code sets from different wards, based on the same injury, were identical in only 7% of cases. Prospective coding by the NOMESCO accident classification system proved problematic, both with regard to correctness and completeness. The system--although logical--seems too complicated compared to the resources invested in the coding. The results of this investigation stress the need for better management and for better instruction to those who carry out the registration.

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...

Networking Hospital ePrescribing: A Systemic View of Digitalization of Medicines' Use in England.

Science.gov (United States)

Lichtner, Valentina; Hibberd, Ralph; Cornford, Tony

2016-01-01

Medicine management is at the core of hospital care and digitalization of prescribing and administration of medicines is often the focus of attention of health IT programs. This may be conveyed to the public in terms of the elimination of paper-based drug charts and increased readability of doctors' prescriptions. Based on analysis of documents about hospital medicines supply and use (including systems' implementation) in the UK, in this conceptual paper electronic prescribing and administration are repositioned as only one aspect of an important wider transformation in medicine management in hospital settings, involving, for example, procurement, dispensing, auditing, waste management, research and safety vigilance. Approaching digitalization from a systemic perspective has the potential to uncover the wider implications of this transformation for patients, the organization and the wider health care system.

Performance evaluation of public hospital information systems by the information system success model.

Science.gov (United States)

Cho, Kyoung Won; Bae, Sung-Kwon; Ryu, Ji-Hye; Kim, Kyeong Na; An, Chang-Ho; Chae, Young Moon

2015-01-01

This study was to evaluate the performance of the newly developed information system (IS) implemented on July 1, 2014 at three public hospitals in Korea. User satisfaction scores of twelve key performance indicators of six IS success factors based on the DeLone and McLean IS Success Model were utilized to evaluate IS performance before and after the newly developed system was introduced. All scores increased after system introduction except for the completeness of medical records and impact on the clinical environment. The relationships among six IS factors were also analyzed to identify the important factors influencing three IS success factors (Intention to Use, User Satisfaction, and Net Benefits). All relationships were significant except for the relationships among Service Quality, Intention to Use, and Net Benefits. The results suggest that hospitals should not only focus on systems and information quality; rather, they should also continuously improve service quality to improve user satisfaction and eventually reach full the potential of IS performance.

Multiple physical signs detection and decision support system for hospitalized older adults

International Nuclear Information System (INIS)

Baig, Mirza Mansoor; GholamHosseini, Hamid; Connolly, Martin J

2015-01-01

Health monitoring systems have rapidly evolved during the past two decades and have the potential to change the way healthcare is currently delivered. Smart monitoring systems automate patient monitoring tasks and thereby improve patient workflow management. Moreover, expert systems have the potential to assist clinicians and improve their performance by accurately executing repetitive tasks, to which humans are ill-suited. Clinicians working in hospital wards are responsible for conducting a multitude of tasks which require constant vigilance, and thus the need for a smart decision support system has arisen. In particular, wireless patient monitoring systems are emerging as a low cost, reliable and accurate means of healthcare delivery.Vital signs monitoring systems are rapidly becoming part of today’s healthcare delivery. The paradigm has shifted from traditional and manual recording to computer-based electronic records and, further, to handheld devices as versatile and innovative healthcare monitoring systems. The current study focuses on interpreting multiple physical signs and early warning for hospitalized older adults so that severe consequences can be minimized. Data from a total of 30 patients have been collated in New Zealand hospitals under local and national ethics approvals. The system records blood pressure, heart rate (pulse), oxygen saturation (SpO2), ear temperature and blood glucose levels from hospitalized patients and transfers this information to a web-based software application for remote monitoring and further interpretation. Ultimately, this system is aimed to achieve a high level of agreement with clinicians’ interpretation when assessing specific physical signs such as bradycardia, tachycardia, hypertension, hypotension, hypoxaemia, fever and hypothermia to generate early warnings. The performance of the vital signs interpretation system was validated through off-line as well as real-time tests with a high level of agreement between

Demonstration of Advanced Technologies for Multi-Load Washers in Hospitality and Healthcare -- Ozone Based Laundry Systems

Energy Technology Data Exchange (ETDEWEB)

Boyd, Brian K. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Parker, Graham B. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Petersen, Joseph M. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Sullivan, Greg [Efficiency Solutions, LLC (United States); Goetzler, W. [Navigant Consulting, Inc. (United States); Sutherland, T. A. [Navigant Consulting, Inc. (United States); Foley, K. J. [Navigant Consulting, Inc. (United States)

2014-08-14

The objective of this demonstration project was to evaluate market-ready retrofit technologies for reducing the energy and water use of multi-load washers in healthcare and hospitality facilities. Specifically, this project evaluated laundry wastewater recycling technology in the hospitality sector and ozone laundry technology in both the healthcare and hospitality sectors. This report documents the demonstration of ozone laundry system installations at the Charleston Place Hotel in Charleston, South Carolina, and the Rogerson House assisted living facility in Boston, Massachusetts.

Assessing Performance of Botswana’s Public Hospital System: The Use of the World Health Organization Health System Performance Assessment Framework

Directory of Open Access Journals (Sweden)

Onalenna Seitio-Kgokgwe

2014-09-01

Full Text Available Background Very few studies have assessed performance of Botswana public hospitals. We draw from a large research study assessing performance of the Botswana Ministry of Health (MoH to evaluate the performance of public hospital system using the World Health Organization Health Systems Performance Assessment Framework (WHO HSPAF. We aimed to evaluate performance of Botswana public hospital system; relate findings of the assessment to the potential for improvements in hospital performance; and determine the usefulness of the WHO HSPAF in assessing performance of hospital systems in a developing country. Methods This article is based on data collected from document analysis, 54 key informants comprising senior managers and staff of the MoH (N= 40 and senior officers from stakeholder organizations (N= 14, and surveys of 42 hospital managers and 389 health workers. Data from documents and transcripts were analyzed using content and thematic analysis while data analysis for surveys was descriptive determining proportions and percentages. Results The organizational structure of the Botswana’s public hospital system, authority and decision-making are highly centralized. Overall physical access to health services is high. However, challenges in the distribution of facilities and inpatient beds create inequities and inefficiencies. Capacity of the hospitals to deliver services is limited by inadequate resources. There are significant challenges with the quality of care. Conclusion While Botswana invested considerably in building hospitals around the country resulting in high physical access to services, the organization and governance of the hospital system, and inadequate resources limit service delivery. The ongoing efforts to decentralize management of hospitals to district level entities should be expedited. The WHO HSPAF enabled us to conduct a comprehensive assessment of the public hospital system. Though relatively new, this approach proved

Effects of scanning and eliminating paper-based medical records on hospital physicians' clinical work practice.

Science.gov (United States)

Laerum, Hallvard; Karlsen, Tom H; Faxvaag, Arild

2003-01-01

It is not automatically given that the paper-based medical record can be eliminated after the introduction of an electronic medical record (EMR) in a hospital. Many keep and update the paper-based counterpart, and this limits the use of the EMR system. The authors have evaluated the physicians' clinical work practices and attitudes toward a system in a hospital that has eliminated the paper-based counterpart using scanning technology. Combined open-ended interviews (8 physicians) and cross-sectional survey (70 physicians) were conducted and compared with reference data from a previous national survey (69 physicians from six hospitals). The hospitals in the reference group were using the same EMR system without the scanning module. The questionnaire (English translation available as an online data supplement at ) covered frequency of use of the EMR system for 19 defined tasks, ease of performing them, and user satisfaction. The interviews were open-ended. The physicians routinely used the system for nine of 11 tasks regarding retrieval of patient data, which the majority of the physicians found more easily performed than before. However, 22% to 25% of the physicians found retrieval of patient data more difficult, particularly among internists (33%). Overall, the physicians were equally satisfied with the part of the system handling the regular electronic data as that of the physicians in the reference group. They were, however, much less satisfied with the use of scanned document images than that of regular electronic data, using the former less frequently than the latter. Scanning and elimination of the paper-based medical record is feasible, but the scanned document images should be considered an intermediate stage toward fully electronic medical records. To our knowledge, this is the first assessment from a hospital in the process of completing such a scanning project.

Can hospital-based doctors change their working hours? Evidence from Australia.

Science.gov (United States)

Norman, R; Hall, J

2014-07-01

To explore factors predicting hospital-based doctors' desire to work less, and then their success in making that change. Consecutive waves of an Australian longitudinal survey of doctors (Medicine in Australia-Balancing Employment and Life). There were 6285 and 6337 hospital-based completers in the two waves, consisting of specialists, hospital-based non-specialists and specialist registrars. Forty-eight per cent stated a preference to reduce hours. Predictive characteristics were being female and working more than 40 h/week (both P less likely to state the preference. Factors associated with not wanting to reduce working hours were being in excellent health and being satisfied with work (both P working hours, only 32% successfully managed to do so in the subsequent year (defined by a reduction of at least 5 h/week). Predictors of successfully reducing hours were being older, female and working more than 40 h/week (all P hours and then their subsequent success in doing so. Designing policies that seek to reduce attrition may alleviate some of the ongoing pressures in the Australian hospital system. © 2014 The Authors; Internal Medicine Journal © 2014 Royal Australasian College of Physicians.

Models of governance in multihospital systems. Implications for hospital and system-level decision-making.

Science.gov (United States)

Morlock, L L; Alexander, J A

1986-12-01

This study utilizes data from a national survey of 159 multihospital systems in order to describe the types of governance structures currently being utilized, and to compare the policy making process for various types of decisions in systems with different approaches to governance. Survey results indicate that multihospital systems most often use one of three governance models. Forty-one percent of the systems (including 33% of system hospitals) use a parent holding company model in which there is a system-wide corporate governing board and separate governing boards for each member hospital. Twenty-two percent of systems in the sample (but 47% of all system hospitals) utilize what we have termed a modified parent holding company model in which there is one system-wide governing board, but advisory boards are substituted for governing boards at the local hospital level. Twenty-three percent of the sampled systems (including 11% of system hospitals) use a corporate model in which there is one system-wide governing board but no other governing or advisory boards at either the divisional, regional or local hospital levels. A comparison of systems using these three governance approaches found significant variation in terms of system size, ownership and the geographic proximity of member hospitals. In order to examine the relationship between alternative approaches to governance and patterns of decision-making, the three model types were compared with respect to the percentages of systems reporting that local boards, corporate management and/or system-wide corporate boards have responsibility for decision-making in a number of specific issue areas. Study results indicate that, regardless of model type, corporate boards are most likely to have responsibility for decisions regarding the transfer, pledging and sale of assets; the formation of new companies; purchase of assets greater than $100,000; changes in hospital bylaws; and the appointment of local board members. In

Barriers to participation in a hospital-based falls assessment clinic programme: an interview study with older people

DEFF Research Database (Denmark)

Evron, L.; Schultz-Larsen, K.; Fristrup, T.

2009-01-01

Aims: To gain new knowledge about barriers to participation in hospital-based falls assessment. Methods: Semi-structured interviews with 20 older people referred to falls assessment at a hospital-based clinic were conducted. A convenience sample of 10 refusers and 10 accepters was collected. Thos...... the findings of this study to a public health message, we have to consider moving the focus of falls prevention strategies from disease control to the domain of health promotion in order to engage older adults in preventive healthcare Udgivelsesdato: 2009/9......Aims: To gain new knowledge about barriers to participation in hospital-based falls assessment. Methods: Semi-structured interviews with 20 older people referred to falls assessment at a hospital-based clinic were conducted. A convenience sample of 10 refusers and 10 accepters was collected. Those...... system taking over their life. Conclusions: This study indicates that older at-risk patients acknowledge their falls problem, but refuse to participate in hospital-based assessment programmes because they expect to lose their authority and to be caught up in the healthcare system. In order to transform...

Barriers to participation in a hospital-based falls assessment clinic programme: an interview study with older people

DEFF Research Database (Denmark)

Evron, Lotte; Schultz-Larsen, Kirsten; Fristrup, Tine

2009-01-01

Aims: To gain new knowledge about barriers to participation in hospital-based falls assessment. Methods: Semi-structured interviews with 20 older people referred to falls assessment at a hospital-based clinic were conducted. A convenience sample of 10 refusers and 10 accepters was collected. Thos...... the findings of this study to a public health message, we have to consider moving the focus of falls prevention strategies from disease control to the domain of health promotion in order to engage older adults in preventive healthcare.......Aims: To gain new knowledge about barriers to participation in hospital-based falls assessment. Methods: Semi-structured interviews with 20 older people referred to falls assessment at a hospital-based clinic were conducted. A convenience sample of 10 refusers and 10 accepters was collected. Those...... system taking over their life. Conclusions: This study indicates that older at-risk patients acknowledge their falls problem, but refuse to participate in hospital-based assessment programmes because they expect to lose their authority and to be caught up in the healthcare system. In order to transform...

Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and Fiscal Year 2014 rates; quality reporting requirements for specific providers; hospital conditions of participation; payment policies related to patient status. Final rules.

Science.gov (United States)

2013-08-19

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2013. We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes that were applied to the LTCH PPS by the Affordable Care Act. Generally, these updates and statutory changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. In addition, we are making a number of changes relating to direct graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or have revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program and the Hospital Readmissions Reduction Program. In addition, we are revising the conditions of participation (CoPs) for hospitals relating to the

Hospital System Performance within Veterans Affairs

Data.gov (United States)

Department of Veterans Affairs — Strategic Analytics for Improvement and Learning Value Model or SAIL, is a system for summarizing hospital system performance within Veterans Health Administration...

Assessing the Performance of Imaging Health Systems in Five Selected Hospitals in Uganda

Directory of Open Access Journals (Sweden)

Michael G Kawooya

2012-01-01

Full Text Available Objectives : The first objective of the study was to develop an index termed as the ′Imaging Coverage′ (IC, for measuring the performance of the imaging health systems. This index together with the Hospital-Based Utilization (HBU would then be calculated for five Ugandan hospitals. Second, was to relate the financial resources and existing health policy to the performance of the imaging systems. Materials and Methods: This was a cross-sectional survey employing the triangulation methodology, conducted in Mulago National Referral Hospital. The qualitative study used cluster sampling, in-depth interviews, focus group discussions, and self-administered questionnaires to explore the non-measurable aspects of the imaging systems′ performances. Results: The IC developed and tested as an index for the imaging system′s performance was 36%. General X-rays had the best IC followed by ultrasound. The Hospital-Based Utilization for the five selected hospitals was 186 per thousand and was the highest for general radiography followed by ultrasound. Conclusion: The IC for the five selected hospitals was 36% and the HBU was 186 per thousand, reflecting low performance levels, largely attributable to inadequate funding. There were shortfalls in imaging requisitions and inefficiencies in the imaging systems, financing, and health policy. Although the proportion of inappropriate imaging was small, reducing this inappropriateness even further would lead to a significant total saving, which could be channeled into investigating more patients. Financial resources stood out as the major limitation in attaining the desired performance and there is a need to increase budget funding so as to improve the performance of the imaging health systems.

Hospital Outpatient Prospective Payment System (OPPS) Lim...

Data.gov (United States)

U.S. Department of Health & Human Services — Hospital Outpatient Prospective Payment System (OPPS) Limited Data Set This file contains select claim level data and is derived from 2010 hospital outpatient PPS...

Automated Epileptic Seizure Detection Based on Wearable ECG and PPG in a Hospital Environment.

Science.gov (United States)

Vandecasteele, Kaat; De Cooman, Thomas; Gu, Ying; Cleeren, Evy; Claes, Kasper; Paesschen, Wim Van; Huffel, Sabine Van; Hunyadi, Borbála

2017-10-13

Electrocardiography has added value to automatically detect seizures in temporal lobe epilepsy (TLE) patients. The wired hospital system is not suited for a long-term seizure detection system at home. To address this need, the performance of two wearable devices, based on electrocardiography (ECG) and photoplethysmography (PPG), are compared with hospital ECG using an existing seizure detection algorithm. This algorithm classifies the seizures on the basis of heart rate features, extracted from the heart rate increase. The algorithm was applied to recordings of 11 patients in a hospital setting with 701 h capturing 47 (fronto-)temporal lobe seizures. The sensitivities of the hospital system, the wearable ECG device and the wearable PPG device were respectively 57%, 70% and 32%, with corresponding false alarms per hour of 1.92, 2.11 and 1.80. Whereas seizure detection performance using the wrist-worn PPG device was considerably lower, the performance using the wearable ECG is proven to be similar to that of the hospital ECG.

Automated Epileptic Seizure Detection Based on Wearable ECG and PPG in a Hospital Environment

Directory of Open Access Journals (Sweden)

Kaat Vandecasteele

2017-10-01

Full Text Available Electrocardiography has added value to automatically detect seizures in temporal lobe epilepsy (TLE patients. The wired hospital system is not suited for a long-term seizure detection system at home. To address this need, the performance of two wearable devices, based on electrocardiography (ECG and photoplethysmography (PPG, are compared with hospital ECG using an existing seizure detection algorithm. This algorithm classifies the seizures on the basis of heart rate features, extracted from the heart rate increase. The algorithm was applied to recordings of 11 patients in a hospital setting with 701 h capturing 47 (fronto-temporal lobe seizures. The sensitivities of the hospital system, the wearable ECG device and the wearable PPG device were respectively 57%, 70% and 32%, with corresponding false alarms per hour of 1.92, 2.11 and 1.80. Whereas seizure detection performance using the wrist-worn PPG device was considerably lower, the performance using the wearable ECG is proven to be similar to that of the hospital ECG.

A Comprehensive Program to Reduce Rates of Hospital-Acquired Pressure Ulcers in a System of Community Hospitals.

Science.gov (United States)

Englebright, Jane; Westcott, Ruth; McManus, Kathryn; Kleja, Kacie; Helm, Colleen; Korwek, Kimberly M; Perlin, Jonathan B

2018-03-01

The prevention of hospital-acquired pressure ulcers (PrUs) has significant consequences for patient outcomes and the cost of care. Providers are challenged with evaluating available evidence and best practices, then implementing programs and motivating change in various facility environments. In a large system of community hospitals, the Reducing Hospital Acquired-PrUs Program was developed to provide a toolkit of best practices, timely and appropriate data for focusing efforts, and continuous implementation support. Baseline data on PrU rates helped focus efforts on the most vulnerable patients and care situations. Facilities were empowered to use and adapt available resources to meet local needs and to share best practices for implementation across the system. Outcomes were measured by the rate of hospital-acquired PrUs, as gathered from patient discharge records. The rate of hospital-acquired stage III and IV PrUs decreased 66.3% between 2011 and 2013. Of the 149 participating facilities, 40 (27%) had zero hospital-acquired stage III and IV PrUs and 77 (52%) had a reduction in their PrU rate. Rates of all PrUs documented as present on admission did not change during this period. A comparison of different strategies used by the most successful facilities illustrated the necessity of facility-level flexibility and recognition of local workflows and patient demographics. Driven by the combination of a repository of evidence-based tools and best practices, readily available data on PrU rates, and local flexibility with processes, the Reducing Hospital Acquired-PrUs Program represents the successful operationalization of improvement in a wide variety of facilities.

Changing patient classification system for hospital reimbursement in Romania.

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Radu, Ciprian-Paul; Chiriac, Delia Nona; Vladescu, Cristian

2010-06-01

To evaluate the effects of the change in the diagnosis-related group (DRG) system on patient morbidity and hospital financial performance in the Romanian public health care system. Three variables were assessed before and after the classification switch in July 2007: clinical outcomes, the case mix index, and hospital budgets, using the database of the National School of Public Health and Health Services Management, which contains data regularly received from hospitals reimbursed through the Romanian DRG scheme (291 in 2009). The lack of a Romanian system for the calculation of cost-weights imposed the necessity to use an imported system, which was criticized by some clinicians for not accurately reflecting resource consumption in Romanian hospitals. The new DRG classification system allowed a more accurate clinical classification. However, it also exposed a lack of physicians' knowledge on diagnosing and coding procedures, which led to incorrect coding. Consequently, the reported hospital morbidity changed after the DRG switch, reflecting an increase in the national case-mix index of 25% in 2009 (compared with 2007). Since hospitals received the same reimbursement over the first two years after the classification switch, the new DRG system led them sometimes to change patients' diagnoses in order to receive more funding. Lack of oversight of hospital coding and reporting to the national reimbursement scheme allowed the increase in the case-mix index. The complexity of the new classification system requires more resources (human and financial), better monitoring and evaluation, and improved legislation in order to achieve better hospital resource allocation and more efficient patient care.

Evaluation of hospital information systems of the teaching hospitals affiliated to Shiraz University of Medical Sciences, based on the American College of Physicians Criteria

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E Emami

2014-01-01

Full Text Available Introduction: Hospital information system (HIS is a computerized system used for management of hospital information as an electronic device and has an indispensible role in the field of qualified healthcare services. Nevertheless, compared to other industrial and commercial systems, this information system is lagged in using the information technology and applying the controlling standards for satisfying the customers. Therefore, the present study aimed to evaluate HIS, identify its strength and weak points, and improve it in the teaching hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. Method: The present descriptive, cross-sectional study was conducted in the 8 teaching hospitals of Shiraz University of Medical Sciences which used HIS in 2011. The study data were collected through interview and direct observation using the criteria of American Physician College check-list. Finally, SPSS statistical software was used to analyze the data through descriptive statistics. Results: The study results showed that laboratory and medical records had respectively the most %43.5 and the least %21.03 conformity to the criteria of American College of Physicians. Also, Faghihi and Zeinabiye hospitals respectively had the most %41.8 and the least %25.2 conformity to the American College of Physicians’ criteria. In pharmacy, data entrance mechanism and presentation of reports had complete conformity to the scales of American College of Physicians, while drug interactions showed no conformity. In laboratory, data entrance mechanism had complete conformity to the above-mentioned criteria and keeping the test history had %87.5 conformity. The possibility of receiving information from centers out of laboratory had no conformity to the desired criteria. In the radiology department, data entrance mechanism had complete conformity to the above-mentioned criteria and keeping the test history had %87.5 conformity. Besides, the possibility

Hospital accreditation, reimbursement and case mix: links and insights for contractual systems.

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Ammar, Walid; Khalife, Jade; El-Jardali, Fadi; Romanos, Jenny; Harb, Hilda; Hamadeh, Ghassan; Dimassi, Hani

2013-12-05

Resource consumption is a widely used proxy for severity of illness, and is often measured through a case-mix index (CMI) based on Diagnosis Related Groups (DRGs), which is commonly linked to payment. For countries that do not have DRGs it has been suggested to use CMIs derived from International Classification of Diseases (ICD). Our research objective was to use ICD-derived case-mix to evaluate whether or not the current accreditation-based hospital reimbursement system in Lebanon is appropriate. Our study population included medical admissions to 122 hospitals contracted with the Lebanese Ministry of Public Health (MoPH) between June 2011 and May 2012. Applying ICD-derived CMI on principal diagnosis cost (CMI-ICDC) using weighing similar to that used in Medicare DRG CMI, analyses were made by hospital accreditation, ownership and size. We examined two measures of 30-day re-admission rate. Further analysis was done to examine correlation between principal diagnosis CMI and surgical procedure cost CMI (CMI-CPTC), and three proxy measures on surgical complexity, case complexity and surgical proportion. Hospitals belonging to the highest accreditation category had a higher CMI than others, but no difference was found in CMI among the three other categories. Private hospitals had a higher CMI than public hospitals, and those more than 100 beds had a higher CMI than smaller hospitals. Re-admissions rates were higher in accreditation category C hospitals than category D hospitals. CMI-ICDC was fairly correlated with CMI-CPTC, and somehow correlated with the proposed proxies. Our results indicate that the current link between accreditation and reimbursement rate is not appropriate, and leads to unfairness and inefficiency in the system. Some proxy measures are correlated with case-mix but are not good substitutes for it. Policy implications of our findings propose the necessity for changing the current reimbursement system by including case mix and outcome indicators in

The impact of health system reform plan on the hospital\\'s performance indicators of Lorestan University of Medical Sciences

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Reza Dadgar

2017-10-01

Conclusion: The health system  reform plan has been positive changes in indicators of hospital performance. Therefore, while considering the current trend of continuous improvement, the continuity of the project was advised based on the results of this study.

The Hospital Information Planning Study at Groote Schuur Hospital ...

African Journals Online (AJOL)

Information is an increasingly important resource in an academic hospital. Effective planning and control of this resource are essential in order to maximize its usefulness. Tile HOspital Information Planning Study (HIPS) undertaken at Groote Schuur Hospital, and based on. the Business Systems Planning (BSP) ...

A Hospital Is Not Just a Factory, but a Complex Adaptive System-Implications for Perioperative Care.

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Mahajan, Aman; Islam, Salim D; Schwartz, Michael J; Cannesson, Maxime

2017-07-01

Many methods used to improve hospital and perioperative services productivity and quality of care have assumed that the hospital is essentially a factory, and therefore, that industrial engineering and manufacturing-derived redesign approaches such as Six Sigma and Lean can be applied to hospitals and perioperative services just as they have been applied in factories. However, a hospital is not merely a factory but also a complex adaptive system (CAS). The hospital CAS has many subsystems, with perioperative care being an important one for which concepts of factory redesign are frequently advocated. In this article, we argue that applying only factory approaches such as lean methodologies or process standardization to complex systems such as perioperative care could account for difficulties and/or failures in improving performance in care delivery. Within perioperative services, only noncomplex/low-variance surgical episodes are amenable to manufacturing-based redesign. On the other hand, complex surgery/high-variance cases and preoperative segmentation (the process of distinguishing between normal and complex cases) can be viewed as CAS-like. These systems tend to self-organize, often resist or react unpredictably to attempts at control, and therefore require application of CAS principles to modify system behavior. We describe 2 examples of perioperative redesign to illustrate the concepts outlined above. These examples present complementary and contrasting cases from 2 leading delivery systems. The Mayo Clinic example illustrates the application of manufacturing-based redesign principles to a factory-like (high-volume, low-risk, and mature practice) clinical program, while the Kaiser Permanente example illustrates the application of both manufacturing-based and self-organization-based approaches to programs and processes that are not factory-like but CAS-like. In this article, we describe how factory-like processes and CAS can coexist within a hospital and how

Target marketing for the hospital-based wellness center.

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Cangelosi, J D

1997-01-01

The American population is aging, medical technology is advancing, and life expectancies are on the rise. At the same time hospitals are looking for additional sources of income due to the pressures of government regulations and managed care. One of the options for hospitals looking for additional sources of income is the hospital-based but free-standing comprehensive wellness and fitness center. Such centers go beyond the facilities, programs and services offered by traditional health and fitness centers. In addition to physical fitness programs, hospital-based wellness centers offer programs in CPR, nutrition, weight control and many other programs of interest to an aging but active American populace. This research documents the hospital industry, wellness industry and the prospects of success or failure for he hospital attempting such a venture. The focus of the research is the experience of a particular hospital with regard to the programs, facilities and services deemed most important by its target market.

Economic analysis of cloud-based desktop virtualization implementation at a hospital.

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Yoo, Sooyoung; Kim, Seok; Kim, Taeki; Baek, Rong-Min; Suh, Chang Suk; Chung, Chin Youb; Hwang, Hee

2012-10-30

Cloud-based desktop virtualization infrastructure (VDI) is known as providing simplified management of application and desktop, efficient management of physical resources, and rapid service deployment, as well as connection to the computer environment at anytime, anywhere with any device. However, the economic validity of investing in the adoption of the system at a hospital has not been established. This study computed the actual investment cost of the hospital-wide VDI implementation at the 910-bed Seoul National University Bundang Hospital in Korea and the resulting effects (i.e., reductions in PC errors and difficulties, application and operating system update time, and account management time). Return on investment (ROI), net present value (NPV), and internal rate of return (IRR) indexes used for corporate investment decision-making were used for the economic analysis of VDI implementation. The results of five-year cost-benefit analysis given for 400 Virtual Machines (VMs; i.e., 1,100 users in the case of SNUBH) showed that the break-even point was reached in the fourth year of the investment. At that point, the ROI was 122.6%, the NPV was approximately US$192,000, and the IRR showed an investment validity of 10.8%. From our sensitivity analysis to changing the number of VMs (in terms of number of users), the greater the number of adopted VMs was the more investable the system was. This study confirms that the emerging VDI can have an economic impact on hospital information system (HIS) operation and utilization in a tertiary hospital setting.

Economic analysis of cloud-based desktop virtualization implementation at a hospital

Directory of Open Access Journals (Sweden)

Yoo Sooyoung

2012-10-01

Full Text Available Abstract Background Cloud-based desktop virtualization infrastructure (VDI is known as providing simplified management of application and desktop, efficient management of physical resources, and rapid service deployment, as well as connection to the computer environment at anytime, anywhere with anydevice. However, the economic validity of investing in the adoption of the system at a hospital has not been established. Methods This study computed the actual investment cost of the hospital-wide VDI implementation at the 910-bed Seoul National University Bundang Hospital in Korea and the resulting effects (i.e., reductions in PC errors and difficulties, application and operating system update time, and account management time. Return on investment (ROI, net present value (NPV, and internal rate of return (IRR indexes used for corporate investment decision-making were used for the economic analysis of VDI implementation. Results The results of five-year cost-benefit analysis given for 400 Virtual Machines (VMs; i.e., 1,100 users in the case of SNUBH showed that the break-even point was reached in the fourth year of the investment. At that point, the ROI was 122.6%, the NPV was approximately US$192,000, and the IRR showed an investment validity of 10.8%. From our sensitivity analysis to changing the number of VMs (in terms of number of users, the greater the number of adopted VMs was the more investable the system was. Conclusions This study confirms that the emerging VDI can have an economic impact on hospital information system (HIS operation and utilization in a tertiary hospital setting.

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

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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

Reimbursement in hospital-based vascular surgery: Physician and practice perspective.

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Perri, Jennifer L; Zwolak, Robert M; Goodney, Philip P; Rutherford, Gretchen A; Powell, Richard J

2017-07-01

The purpose of this study was to determine change in value of a vascular surgery division to the health care system during 6 years at a hospital-based academic practice and to compare physician vs hospital revenue earned during this period. Total revenue generated by the vascular surgery service line at an academic medical center from 2010 through 2015 was evaluated. Total revenue was measured as the sum of physician (professional) and hospital (technical) net revenue for all vascular-related patient care. Adjustments were made for work performed, case complexity, and inflation. To reflect the effect of these variables, net revenue was indexed to work relative value units (wRVUs), case mix index, and consumer price index, which adjusted for work, case complexity, and inflation, respectively. Differences in physician and hospital net revenue were compared over time. Physician work, measured in RVUs per year, increased by 4%; case complexity, assessed with case mix index, increased by 10% for the 6-year measurement period. Despite stability in payer mix at 64% to 69% Medicare, both physician and hospital vascular-related revenue/wRVU decreased during this period. Unadjusted professional revenue/wRVU declined by 14.1% (P = .09); when considering case complexity, physician revenue/wRVU declined by 20.6% (P = .09). Taking into account both case complexity and inflation, physician revenue declined by 27.0% (P = .04). Comparatively, hospital revenue for vascular surgery services decreased by 13.8% (P = .07) when adjusting for unit work, complexity, and inflation. At medical centers where vascular surgeons are hospital based, vascular care reimbursement decreased substantially from 2010 to 2015 when case complexity and inflation were considered. Physician reimbursement (professional fees) decreased at a significantly greater rate than hospital reimbursement for vascular care. This trend has significant implications for salaried vascular surgeons in hospital-based

Challenges of using Hospital Information Systems by nurses: comparing academic and non-academic hospitals.

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Ahmadian, Leila; Dorosti, Nafise; Khajouei, Reza; Gohari, Sadrieh Hajesmaeel

2017-06-01

Hospital Information Systems (HIS) are used for easy access to information, improvement of documentation and reducing errors. Nonetheless, using these systems is faced with some barriers and obstacles. This study identifies the challenges and the obstacles of using these systems in the academic and non-academic hospitals in Kerman. This is a cross-sectional study which was carried out in 2015. The statistical population in this study consisted of the nurses who had been working in the academic and non-academic hospitals in Kerman. A questionnaire consisting of two sections was used. The first section consisted of the demographic information of the participants and the second section comprised 34 questions about the challenges of HIS use. Data were analyzed by the descriptive and statistical analysis (t-test, and ANOVA) using SPSS 19 software. The most common and important challenges in the academic hospitals were about human environment factors, particularly "negative attitude of society toward using HIS". In the non-academic hospitals, the most common and important challenges were related to human factors, and among them, "no incentive to use system" was the main factor. The results of the t-test method revealed that there was a significant relationship between gender and the mean score of challenges related to the organizational environment category in the academic hospitals and between familiarity with HIS and mean score of human environment factors (pinformation systems are the factors related to the human environment and the human factors. The results of this study can bring a good perspective to the policy makers and the managers regarding obstacles of using HISs from the nurses' perspective, so that they can solve their problems and can successfully implement these systems.

Impacts of hospitals' innovativeness on information system outsourcing decisions.

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Park, Jae Sung

2014-04-01

The purpose of this study was to identify the effects of hospitals' innovativeness on outsourcing decision-making regarding four information system (IS) functions, namely, software programs, network maintenance, hardware systems, and PC/printer maintenance. Using the 2011 roster of the Korean Hospital Association, this study selected 311 general hospitals as a study population. After identifying the managers who were in charge of outsourcing, this study administered questionnaires. A total of 103 hospitals responded. Of the responding hospitals, 55.34% outsourced at least one IS function, whereas 88.35% outsourced at least one managerial function. IS outsourcing was motivated by the need for outside experts, but other managerial functions were outsourced for cost savings. Innovative and early adopter hospitals were 4.52 and 4.91 times more likely to outsource IS functions related with work processes (i.e., software and network maintenance) than early and late majority hospitals, respectively. IT outsourcing effectiveness significantly influenced the outsourcing decisions regarding four IS functions. Hospitals that had perceived more risks of outsourcing significantly preferred non-outsourcing on their hardware systems, but the risks of outsourcing were not significant for outsourcing decisions regarding the other IS functions. Hospitals' innovativeness also significantly explained the quantity of innovation adoptions. Innovative and early adopter hospitals did more outsourcing than early and late majority hospitals. Hospitals' innovativeness influences decision-making regarding outsourcing. Innovative hospitals are more likely to outsource their work-process-related IS functions. Thus, organizational traits, especially hospitals' innovativeness, should be considered as a key success factor for IS management.

Impacts of Hospitals' Innovativeness on Information System Outsourcing Decisions

Science.gov (United States)

2014-01-01

Objectives The purpose of this study was to identify the effects of hospitals' innovativeness on outsourcing decision-making regarding four information system (IS) functions, namely, software programs, network maintenance, hardware systems, and PC/printer maintenance. Methods Using the 2011 roster of the Korean Hospital Association, this study selected 311 general hospitals as a study population. After identifying the managers who were in charge of outsourcing, this study administered questionnaires. A total of 103 hospitals responded. Results Of the responding hospitals, 55.34% outsourced at least one IS function, whereas 88.35% outsourced at least one managerial function. IS outsourcing was motivated by the need for outside experts, but other managerial functions were outsourced for cost savings. Innovative and early adopter hospitals were 4.52 and 4.91 times more likely to outsource IS functions related with work processes (i.e., software and network maintenance) than early and late majority hospitals, respectively. IT outsourcing effectiveness significantly influenced the outsourcing decisions regarding four IS functions. Hospitals that had perceived more risks of outsourcing significantly preferred non-outsourcing on their hardware systems, but the risks of outsourcing were not significant for outsourcing decisions regarding the other IS functions. Hospitals' innovativeness also significantly explained the quantity of innovation adoptions. Innovative and early adopter hospitals did more outsourcing than early and late majority hospitals. Conclusions Hospitals' innovativeness influences decision-making regarding outsourcing. Innovative hospitals are more likely to outsource their work-process-related IS functions. Thus, organizational traits, especially hospitals' innovativeness, should be considered as a key success factor for IS management. PMID:24872912

Hospital branding in Italy: A pilot study based on the case method.

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Esposito, Annamaria

2017-01-01

The article investigates if, and in affirmative case how, Italian hospitals are managing corporate brand communication. Thanks to results of qualitative research, this article offers insights on Italian hospital branding. The pilot study based in the case method is to be considered a starting point for wider investigations on this topic, and it is useful for managers and practitioners who want to understand the role of corporate brand in hospital communication management and to connect health care professionals with the audience in a meaningful way in those countries in which the health care system is a mix of both public and private institutions.

Tripartite Evolutionary Game Analysis on Selection Behavior of Trans-Regional Hospitals and Patients in Telemedicine System

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Yuxuan Gao

2017-01-01

Full Text Available This study applies the game theory to the discussion and analysis of trans-regional Telemedicine System, builds the game model of the selection strategies of trans-regional hospitals and patients and analyzes evolving paths, equilibrium states and influencing factors of the three parties. It is derived that medical insurance reimbursement proportion of specialized hospitals, government support for general hospitals and medical expenses in specialized hospitals, operating costs of general hospitals are the influential factors in the Telemedicine System. Finally, a numerical stimulation is conducted with Matlapb based on the data from ligChina Health and Family Planning Statistical Yearbook 2015l/ig.

Hospital accounting and information systems: a critical assessment.

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Macintosh, N B

1991-01-01

Public sector organisations seem to be caught up in the global wave of 'neo-Thatcherism'. As such, they are being held 'accountable' today by their respective government finance departments for the costs and benefits of the services they provide to the general public. As the public purse tightens, hospitals (and related health service units) more and more compete with other public sector organisations (old-age pensions and services, post-secondary education, day-care centres, port authorities, unemployment insurance, parks and recreation, elite sport programs, aboriginal peoples aid and development, and so on) for a diminishing piece of what seems a smaller and smaller pie. In this 'fight-for-funding', hospitals seem particularly vulnerable. Sky-rocketing costs, public resentment of doctors' high income and a deliberate restriction and limiting of medical school places, among other things, contribute to general public antagonism. The message for hospitals is that cost-effective accountability will loom large when hospitals come begging at the public trough. Even left-wing politicians today seem to be heeding the words of free-market economists like Freedman of Chicago. 'Privatisation' is the constant threat for those deemed inefficient. As a consequence, hospital administrators around the world, caught up in this trend, seem to be stampeding to 'boot-up' some kind of new accounting information system. For example, at my own university hospital (Queen's University, Kingston, Canada), the hospital administrators are in the process of introducing a version of the Johns Hopkins Hospital (Baltimore, Maryland) case-mix-loading cost-accumulation system. In other parts of the world they are known by other fancy names such as 'patient-costing', 'diagnosis-related-groups' (or DRGs). Trendy accounting systems seem to be the order of the day, a sort of panacea for the current plague of problems hospitals face. As the new systems become operational, however, traditional

Evaluation of the medical records system in an upcoming teaching hospital-a project for improvisation.

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Kumar, B Deepak; Kumari, C M Vinaya; Sharada, M S; Mangala, M S

2012-08-01

The medical records system of an upcoming teaching hospital in a developing nation was evaluated for its accessibility, completeness, physician satisfaction, presence of any lacunae, suggestion of necessary steps for improvisation and to emphasize the importance of Medical records system in education and research work. The salient aspects of the medical records department were evaluated based on a questionnaire which was evaluated by a team of 40 participants-30 doctors, 5 personnel from Medical Records Department and 5 from staff of Hospital administration. Most of the physicians (65%) were partly satisfied with the existing medical record system. 92.5% were of the opinion that upgradation of the present system is necessary. The need of the hour in the present teaching hospital is the implementation of a hospital-wide patient registration and medical records re-engineering process in the form of electronic medical records system and regular review by the audit commission.

[The development of hospital medical supplies information management system].

Science.gov (United States)

Cao, Shaoping; Gu, Hongqing; Zhang, Peng; Wang, Qiang

2010-05-01

The information management of medical materials by using high-tech computer, in order to improve the efficiency of the consumption of medical supplies, hospital supplies and develop a new technology way to manage the hospital and material support. Using C # NET, JAVA techniques to develop procedures for the establishment of hospital material management information system, set the various management modules, production of various statistical reports, standard operating procedures. The system is convenient, functional and strong, fluent statistical functions. It can always fully grasp and understand the whole hospital supplies run dynamic information, as a modern and effective tool for hospital materials management.

Evaluation of a Cyber Security System for Hospital Network.

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Faysel, Mohammad A

2015-01-01

Most of the cyber security systems use simulated data in evaluating their detection capabilities. The proposed cyber security system utilizes real hospital network connections. It uses a probabilistic data mining algorithm to detect anomalous events and takes appropriate response in real-time. On an evaluation using real-world hospital network data consisting of incoming network connections collected for a 24-hour period, the proposed system detected 15 unusual connections which were undetected by a commercial intrusion prevention system for the same network connections. Evaluation of the proposed system shows a potential to secure protected patient health information on a hospital network.

Implementing an evidence-based computerized decision support system to improve patient care in a general hospital: the CODES study protocol for a randomized controlled trial.

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Moja, Lorenzo; Polo Friz, Hernan; Capobussi, Matteo; Kwag, Koren; Banzi, Rita; Ruggiero, Francesca; González-Lorenzo, Marien; Liberati, Elisa Giulia; Mangia, Massimo; Nyberg, Peter; Kunnamo, Ilkka; Cimminiello, Claudio; Vighi, Giuseppe; Grimshaw, Jeremy; Bonovas, Stefanos

2016-07-07

Computerized decision support systems (CDSSs) are information technology-based software that provide health professionals with actionable, patient-specific recommendations or guidelines for disease diagnosis, treatment, and management at the point-of-care. These messages are intelligently filtered to enhance the health and clinical care of patients. CDSSs may be integrated with patient electronic health records (EHRs) and evidence-based knowledge. We designed a pragmatic randomized controlled trial to evaluate the effectiveness of patient-specific, evidence-based reminders generated at the point-of-care by a multi-specialty decision support system on clinical practice and the quality of care. We will include all the patients admitted to the internal medicine department of one large general hospital. The primary outcome is the rate at which medical problems, which are detected by the decision support software and reported through the reminders, are resolved (i.e., resolution rates). Secondary outcomes are resolution rates for reminders specific to venous thromboembolism (VTE) prevention, in-hospital all causes and VTE-related mortality, and the length of hospital stay during the study period. The adoption of CDSSs is likely to increase across healthcare systems due to growing concerns about the quality of medical care and discrepancy between real and ideal practice, continuous demands for a meaningful use of health information technology, and the increasing use of and familiarity with advanced technology among new generations of physicians. The results of our study will contribute to the current understanding of the effectiveness of CDSSs in primary care and hospital settings, thereby informing future research and healthcare policy questions related to the feasibility and value of CDSS use in healthcare systems. This trial is seconded by a specialty trial randomizing patients in an oncology setting (ONCO-CODES). ClinicalTrials.gov, https://clinicaltrials.gov/ct2

Implementing a nationwide criteria-based emergency medical dispatch system

DEFF Research Database (Denmark)

Andersen, Mikkel S; Johnsen, Søren Paaske; Sørensen, Jan Nørtved

2013-01-01

A criteria-based nationwide Emergency Medical Dispatch (EMD) system was recently implemented in Denmark. We described the system and studied its ability to triage patients according to the severity of their condition by analysing hospital admission and case-fatality risks.......A criteria-based nationwide Emergency Medical Dispatch (EMD) system was recently implemented in Denmark. We described the system and studied its ability to triage patients according to the severity of their condition by analysing hospital admission and case-fatality risks....

Hospital incident command system (HICS performance in Iran; decision making during disasters

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Djalali Ahmadreza

2012-02-01

Full Text Available Abstract Background Hospitals are cornerstones for health care in a community and must continue to function in the face of a disaster. The Hospital Incident Command System (HICS is a method by which the hospital operates when an emergency is declared. Hospitals are often ill equipped to evaluate the strengths and vulnerabilities of their own management systems before the occurrence of an actual disaster. The main objective of this study was to measure the decision making performance according to HICS job actions sheets using tabletop exercises. Methods This observational study was conducted between May 1st 2008 and August 31st 2009. Twenty three Iranian hospitals were included. A tabletop exercise was developed for each hospital which in turn was based on the highest probable risk. The job action sheets of the HICS were used as measurements of performance. Each indicator was considered as 1, 2 or 3 in accordance with the HICS. Fair performance was determined as Results None of the participating hospitals had a hospital disaster management plan. The performance according to HICS was intermediate for 83% (n = 19 of the participating hospitals. No hospital had a high level of performance. The performance level for the individual sections was intermediate or fair, except for the logistic and finance sections which demonstrated a higher level of performance. The public hospitals had overall higher performances than university hospitals (P = 0.04. Conclusions The decision making performance in the Iranian hospitals, as measured during table top exercises and using the indicators proposed by HICS was intermediate to poor. In addition, this study demonstrates that the HICS job action sheets can be used as a template for measuring the hospital response. Simulations can be used to assess preparedness, but the correlation with outcome remains to be studied.

Development of hospital data warehouse for cost analysis of DPC based on medical costs.

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Muranaga, F; Kumamoto, I; Uto, Y

2007-01-01

To develop a data warehouse system for cost analysis, based on the categories of the diagnosis procedure combination (DPC) system, in which medical costs were estimated by DPC category and factors influencing the balance between costs and fees. We developed a data warehouse system for cost analysis using data from the hospital central data warehouse system. The balance data of patients who were discharged from Kagoshima University Hospital from April 2003 to March 2005 were determined in terms of medical procedure, cost per day and patient admission in order to conduct a drill-down analysis. To evaluate this system, we analyzed cash flow by DPC category of patients who were categorized as having malignant tumors and whose DPC category was reevaluated in 2004. The percentages of medical expenses were highest in patients with acute leukemia, non-Hodgkin's lymphoma, and particularly in patients with malignant tumors of the liver and intrahepatic bile duct. Imaging tests degraded the percentages of medical expenses in Kagoshima University Hospital. These results suggested that cost analysis by patient is important for hospital administration in the inclusive evaluation system using a case-mix index such as DPC.

Patient flow based allocation of hospital resources.

Science.gov (United States)

Vissers, J M

1995-01-01

The current practice of allocating resources within a hospital introduces peaks and troughs in the workloads of departments and leads therefore to loss of capacity. This happens when requirements for capacity coordination are not adequately taken into account in the decision making process of allocating resources to specialties. The first part of this research involved an analysis of the hospital's production system on dependencies between resources, resulting in a number of capacity coordination requirements that need to be fulfilled for optimized resource utilization. The second, modelling, part of the study involved the development of a framework for resource management decision making, of a set of computer models to support hospital managerial decision making on resource allocation issues in various parts of the hospital, and of an implementation strategy for the application of the models to concrete hospital settings. The third part of the study was devoted to a number of case-studies, illustrating the use of the models when applied in various resource management projects, such as a reorganization of an operating theatre timetable, or the development of a master plan for activities of a group of general surgeons serving two locations of a merged hospital system. The paper summarizes the main findings of the study and concludes with a discussion of results obtained with the new allocation procedure and with recommendations for future research.

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.

Conversations with the community: the Methodist Hospital System's experience with social media.

Science.gov (United States)

Angelle, Denny; Rose, Clare L

2011-01-01

The Methodist Hospital System has maintained a social media presence on Facebook, Twitter, and YouTube since 2009. After initial unofficial excursions into the world of social media, we discovered that social media can be a useful tool to extend a conversation with our patients and the community at large and share our hospital's culture with a larger base of like-minded people. But with this new power comes a heightened responsibility--platforms that can potentially reach millions of viewers and readers also provide a potential for misuse that can jeopardize patient privacy and place hospitals at risk. Because of their unique restrictions, even hospitals that use the tools regularly have much left to learn about social media. With constant monitoring and stewardship and a commitment to educating staff, hospitals can effectively use social media tools for marketing and education.

A personalized mobile patient guide system for a patient-centered smart hospital: Lessons learned from a usability test and satisfaction survey in a tertiary university hospital.

Science.gov (United States)

Yoo, Sooyoung; Jung, Se Young; Kim, Seok; Kim, Eunhye; Lee, Kee-Hyuck; Chung, Eunja; Hwang, Hee

2016-07-01

The present study focused on the design, implementation, and evaluation of a personalized mobile patient guide system that utilizes smart phones, indoor navigation technology and a hospital information system (HIS) to address the difficulties that outpatients face in finding hospital facilities, recognizing their daily treatment schedule, and accessing personalized medical and administrative information. The present study was conducted in a fully digitized tertiary university hospital in South Korea. We developed a real-time location-based outpatient guide system that consists of Bluetooth access points (APs) for indoor navigation, an Android-based guide application, a guide server, and interfaces with the HIS. A total of 33 subjects and 43 outpatients participated in the usability test (UT) and the satisfaction survey, respectively. We confirmed that the indoor navigation feature can be applied to outpatient departments with precision using a position error test. The participants in the UT completed each scenario with an average success rate of 67.4%. According to the results, we addressed the problems and made improvements to the user interface by providing users with context-based guidance information. The satisfaction rating of the system was high, with an average score of 4.0 out of 5.0, showing its utility as a patient-centered hospital service. The innovative mobile patient guide system for outpatients is feasible and can be successfully implemented to provide personalized information with high satisfaction. Additionally, the issues identified and lessons learned from our experiences regarding task scheduling, indoor navigation, and usability should be considered when developing the system. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

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' resident caps for graduate medical education payment purposes; quality reporting requirements for specific providers and for ambulatory surgical centers. final rule.

Science.gov (United States)

2012-08-31

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2012. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes made by the Affordable Care Act. Generally, these changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. In addition, we are implementing changes relating to determining a hospital's full-time equivalent (FTE) resident cap for the purpose of graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We also are establishing new administrative, data completeness, and extraordinary circumstance waivers or extension requests requirements, as well as a reconsideration process, for quality reporting by ambulatory surgical centers

Performance of interventional procedures in a day-hospital system

International Nuclear Information System (INIS)

Bae, Jae Ik; Park, Auh Whan; Cho, Hye Seon; Park, Eun Hee; Choi, Gap Suk; Lee, Seon Ju; Kim, Yong Woo; Juhn, Je Ryang

2007-01-01

We wanted to describe the practice and results of applying the day-hospital system in an interventional radiology clinic. From Oct. 2004 to Dec. 2005, the day-hospital system was applied to various interventional procedures with using a part of the recovery room of an angiography suite as a facility for hospital admission. The study included 91 cases in 73 patients. The source of the patient referral, the procedures, hospital courses and complications were analyzed and questionnaire surveys were conducted for the available 55 patients. Among the patients, 70% (n=64) were referred form other departments, 5% (n=5) from other hospitals, 5% (n=4) were new patients and 20% (n=18) were re-admissions. The procedures included gastrointestinal, biliary, urinary, hemodialysis related-and implantable port related interventions. 96% (n=87) of the patients were successfully discharged in a day and admission to the general ward was only 4% (n=4). Minor complications occurred after discharges in 3% (n=3). The questionnaire survey revealed that 96% (n=53) of the patients were satisfied with the service and they were not anxious after discharge. Most of common interventional procedures were safely done under the day-hospital system with the patients being highly satisfied. The day-hospital system can be a good tool for establishing admitting privileges for an interventional radiology clinic

Adoption of medication alert systems in hospital outpatient departments in Taiwan.

Science.gov (United States)

Kuo, Yu-Chun; Cheng, Shou-Hsia

2017-06-01

The adoption of medication alert systems in the health care sector varies among regions. In Taiwan, the health authority introduced policies in 2005 to encourage the adoption of medication alert systems in hospitals. This study aimed to understand the adoption of medication alert systems in the outpatient departments of hospitals in Taiwan using a nationwide survey. A questionnaire was developed and mailed to 380 accredited general hospitals in Taiwan in 2013. The information collected from the questionnaire concerning the outpatient department included (1) the time of adoption of a medication alert system; (2) the operation of individual alert functions: availability, management, and stability; and (3) hospital characteristics: accreditation level, teaching status, ownership, and number of beds. A total of 216 hospitals completed and returned the questionnaire, corresponding to a response rate of 56.8%. The adoption rate of medication alert systems in hospital outpatient departments increased from less than 10% in 1997-95.83% in 2012. Approximately two-thirds of the hospitals developed and maintained the alert systems independently or collaboratively with vendors. Teaching and large hospitals tended to develop more advanced alert functions such as drug-drug interaction functions. Improving the safety and quality of pharmaceutical services and meeting the policy requirements are reasons for hospitals to establish medication alert systems. The adoption rate of medication alert systems reached 95% in accredited general hospitals in Taiwan. Government policy and available health information professionals and vendors may somewhat contribute to the high adoption rate. Copyright © 2017 Elsevier B.V. All rights reserved.

Impacts of Hospitals' Innovativeness on Information System Outsourcing Decisions

OpenAIRE

Park, Jae Sung

2014-01-01

Objectives The purpose of this study was to identify the effects of hospitals' innovativeness on outsourcing decision-making regarding four information system (IS) functions, namely, software programs, network maintenance, hardware systems, and PC/printer maintenance. Methods Using the 2011 roster of the Korean Hospital Association, this study selected 311 general hospitals as a study population. After identifying the managers who were in charge of outsourcing, this study administered questio...

Use of and attitudes to a hospital information system by medical secretaries, nurses and physicians deprived of the paper-based medical record: a case report

Directory of Open Access Journals (Sweden)

Karlsen Tom H

2004-10-01

Full Text Available Abstract Background Most hospitals keep and update their paper-based medical records after introducing an electronic medical record or a hospital information system (HIS. This case report describes a HIS in a hospital where the paper-based medical records are scanned and eliminated. To evaluate the HIS comprehensively, the perspectives of medical secretaries and nurses are described as well as that of physicians. Methods We have used questionnaires and interviews to assess and compare frequency of use of the HIS for essential tasks, task performance and user satisfaction among medical secretaries, nurses and physicians. Results The medical secretaries use the HIS much more than the nurses and the physicians, and they consider that the electronic HIS greatly has simplified their work. The work of nurses and physicians has also become simplified, but they find less satisfaction with the system, particularly with the use of scanned document images. Conclusions Although the basis for reference is limited, the results support the assertion that replacing the paper-based medical record primarily benefits the medical secretaries, and to a lesser degree the nurses and the physicians. The varying results in the different employee groups emphasize the need for a multidisciplinary approach when evaluating a HIS.

System-Level Shared Governance Structures and Processes in Healthcare Systems With Magnet®-Designated Hospitals: A Descriptive Study.

Science.gov (United States)

Underwood, Carlisa M; Hayne, Arlene N

The purpose was to identify and describe structures and processes of best practices for system-level shared governance in healthcare systems. Currently, more than 64.6% of US community hospitals are part of a system. System chief nurse executives (SCNEs) are challenged to establish leadership structures and processes that effectively and efficiently disseminate best practices for patients and staff across complex organizations, geographically dispersed locations, and populations. Eleven US healthcare SCNEs from the American Nurses Credentialing Center's repository of Magnet®-designated facilities participated in a 35-multiquestion interview based on Kanter's Theory of Organizational Empowerment. Most SCNEs reported the presence of more than 50% of the empowerment structures and processes in system-level shared governance. Despite the difficulties and complexities of growing health systems, SCNEs have replicated empowerment characteristics of hospital shared governance structures and processes at the system level.

Evaluation of real-time location systems in their hospital contexts.

Science.gov (United States)

Fisher, Jill A; Monahan, Torin

2012-10-01

The purpose of the research was to assess real-time location systems (RTLS) that have been implemented in U.S. hospitals. We examined the type of uses to which RTLS have been put, the degree of functionality of the various technologies and software, and the organizational effects of implementing RTLS. The project was a 3-year qualitative study of 23 U.S. hospitals that had implemented RTLS for the purpose of tracking assets, personnel, and/or patients. We observed the systems in use and conducted 80 semi-structured interviews with hospital personnel and vendors. In order to protect the confidentiality of the hospitals and vendors in our sample, we conducted an aggregate analysis of our findings rather than providing evaluations of specific technologies or hospital case studies. The most important findings from our research were (1) substandard functionality of most real-time location systems in use and (2) serious obstacles to effective deployment of the systems due to the material and organizational constraints of the hospitals themselves. We found that the current best use of RTLS is for asset tracking, but importantly it requires whole-hospital deployment as well as centralized control of the system, preferably by materials management or biomedical engineering departments. There are serious technological, material, and organizational barriers to the implementation of RTLS, and these barriers need to be overcome if hospitals are to maximize the potential benefits of these systems. In addition to considering the available technological options, hospitals must assess their unique environments, including the myriad material and organizational constraints that will affect the success of RTLS implementation. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

A simulation model of hospital management based on cost accounting analysis according to disease.

Science.gov (United States)

Tanaka, Koji; Sato, Junzo; Guo, Jinqiu; Takada, Akira; Yoshihara, Hiroyuki

2004-12-01

Since a little before 2000, hospital cost accounting has been increasingly performed at Japanese national university hospitals. At Kumamoto University Hospital, for instance, departmental costs have been analyzed since 2000. And, since 2003, the cost balance has been obtained according to certain diseases for the preparation of Diagnosis-Related Groups and Prospective Payment System. On the basis of these experiences, we have constructed a simulation model of hospital management. This program has worked correctly at repeated trials and with satisfactory speed. Although there has been room for improvement of detailed accounts and cost accounting engine, the basic model has proved satisfactory. We have constructed a hospital management model based on the financial data of an existing hospital. We will later improve this program from the viewpoint of construction and using more various data of hospital management. A prospective outlook may be obtained for the practical application of this hospital management model.

Comparative analysis of the current payment system for hospital services in Serbia and projected payments under diagnostic related groups system in urology.

Science.gov (United States)

Babić, Uroš; Soldatović, Ivan; Vuković, Dejana; Milićević, Milena Šantrić; Stjepanović, Mihailo; Kojić, Dejan; Argirović, Aleksandar; Vukotić, Vinka

2015-03-01

Global budget per calendar year is a traditional method of funding hospitals in Serbia. Diagnose related groups (DGR) is a method of hospital payment based on classification of patients into groups with clinically similar problems and similar utilization of hospital resources. The aim of this study was to compare current methods of hospital services payment with the projected costs by DRG payment method in urology. The data were obtained from the information system used in the Clinical Hospital Center "Dr. Dragiša Mišović"--Dedinje in Belgrade, Serbia. The implemented hospital information system was the main criterion for selection of healthcare institutions. The study included 994 randomly selected patients treated surgically and conservatively in 2012. Average costs under the current payment method were slightly higher than those projected by DRG, however, the variability was twice as high (54,111 ± 69,789 compared to 53,434 ± 32,509, p payment method as well as with the projected one by DRG was observed in relation to the number of days of hospitalization (ρ = 0.842, p payment system (β = 0.843, p payment system (β = 0.737, p payment method and the pro- jected DRG payment methods (β = 0.501, p Payment under the DRG system is administratively more complex because it requires detailed and standardized coding of diagnoses and procedures, as well as the information on the average consumption of resources (costs) per DRG. Given that aggregate costs of treatment under two hospital payment methods compared in the study are not significantly different, the focus on minor surgeries both under the current hospital payment method and under the introduced DRG system would be far more cost-effective for a hospital as great variations in treatment performance (reductions of days of hospitalization and complications), and consequently invoiced amounts would be reduced.

42 CFR 412.73 - Determination of the hospital-specific rate based on a Federal fiscal year 1982 base period.

Science.gov (United States)

2010-10-01

... & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR... System for Inpatient Operating Costs § 412.73 Determination of the hospital-specific rate based on a... under the Social Security Act as in effect on April 19, 1983. (e) DRG adjustment. The applicable...

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...

The information security needs in radiological information systems-an insight on state hospitals of Iran, 2012.

Science.gov (United States)

Farhadi, Akram; Ahmadi, Maryam

2013-12-01

Picture Archiving and Communications System (PACS) was originally developed for radiology services over 20 years ago to capture medical images electronically. Medical diagnosis methods are based on images such as clinical radiographs, ultrasounds, CT scans, MRIs, or other imaging modalities. Information obtained from these images is correlated with patient information. So with regards to the important role of PACS in hospitals, we aimed to evaluate the PACS and survey the information security needed in the Radiological Information system. First, we surveyed the different aspects of PACS that should be in any health organizations based on Department of Health standards and prepared checklists for assessing the PACS in different hospitals. Second, we surveyed the security controls that should be implemented in PACS. Checklists reliability is affirmed by professors of Tehran Science University. Then, the final data are inputted in SPSS software and analyzed. The results indicate that PACS in hospitals can transfer patient demographic information but they do not show route of information. These systems are not open source. They don't use XML-based standard and HL7 standard for exchanging the data. They do not use DS digital signature. They use passwords and the user can correct or change the medical information. PACS can detect alternation rendered. The survey of results demonstrates that PACS in all hospitals has the same features. These systems have the patient demographic data but they do not have suitable flexibility to interface network or taking reports. For the privacy of PACS in all hospitals, there were passwords for users and the system could show the changes that have been made; but there was no water making or digital signature for the users.

Hospital charitable lotteries: taking a gamble on systems thinking.

Science.gov (United States)

Reynolds, Jennifer

2013-12-01

The presence of lotteries can be witnessed worldwide. Charitable lotteries are often portrayed as 'good works', and recently, hospitals have utilized them as a popular fundraising vehicle to raise necessary funds to help achieve organizational goals and objectives. Research indicates that lotteries contribute to gambling-related harms; however, research into charitable lotteries has been underdeveloped. Both the gambling and the health care industries are complex and evolving, consisting of many interacting stakeholders with often different and competing interests. This article seeks to present systems thinking as a conceptual framework to help fill the gap in understanding the use of gambling within hospitals and its possible benefits and unforeseen negative consequences. Addressing the gap in knowledge is important to help inform decision making aimed at reducing gambling-related harms. This article proposes how the school of systems thinking, specifically framing hospitals as complex adaptive systems and system dynamics modelling, can be utilized to understand the policy implications of the adoption of lotteries as a revenue source for hospitals. Hospitals have a duty to care, inform and protect. Hospital charitable lotteries have become big business; however, its incorporation into critical funding strategies needs to be carefully understood. Systems thinking theory and methodologies provide an integrated approach to examine this dynamic and evolving fundraising initiative. Findings from this article can inform the development of action strategies, including policy development at multiple levels. © 2013 John Wiley & Sons Ltd.

Protocol for hospital based-surveillance of cerebral palsy (CP) in Hanoi using the Paediatric Active Enhanced Disease Surveillance mechanism (PAEDS-Vietnam): a study towards developing hospital-based disease surveillance in Vietnam.

Science.gov (United States)

Khandaker, Gulam; Van Bang, Nguyen; Dũng, Trịnh Quang; Giang, Nguyen Thi Huong; Chau, Cao Minh; Van Anh, Nguyen Thi; Van Thuong, Nguyen; Badawi, Nadia; Elliott, Elizabeth J

2017-11-09

The epidemiology, pathogenesis, management and outcomes of cerebral palsy (CP) in low-income and middle-income countries including Vietnam are unknown because of the lack of mechanisms for standardised collection of data. In this paper, we outline the protocol for developing a hospital-based surveillance system modelled on the Paediatric Active Enhanced Disease Surveillance (PAEDS) system in Australia. Using PAEDS-Vietnam we will define the aetiology, motor function and its severity, associated impairments, and nutritional and rehabilitation status of children with CP in Hanoi, Vietnam. These essential baseline data will inform future health service planning, health professional education and training, and family support. This is a hospital-based prospective surveillance of children with CP presenting to the rehabilitation, neurology and general paediatric services at the National Children's Hospital and St Paul Hospital in Hanoi. We will use active, prospective daily case-finding for all children with CP aged CP, known risk factors for CP, and nutrition, immunisation, education and rehabilitation status. This study was approved by the Hanoi Medical University Institutional Review Board (decision no 1722) and The University of Sydney Human Research Ethics Committee (approval no 2016/456). Establishment of PAEDS-Vietnam will enable hospital-based surveillance of CP for the first time in Vietnam. It will identify preventable causes of CP, patient needs and service gaps, and facilitate early diagnosis and intervention. Study findings will be disseminated through local and international conferences and peer-reviewed publications. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Assessment of pharmacy information system performance in selected hospitals in isfahan city during 2011.

Science.gov (United States)

Saqaeian Nejad Isfahani, Sakineh; Mirzaeian, Razieh; Habibi, Mahbobe

2013-01-01

In supporting a therapeutic approach and medication therapy management, pharmacy information system acts as one of the central pillars of information system. This ensures that medication therapy is being supported and evaluated with an optimal level of safety and quality similar to other treatments and services. This research aims to evaluate the performance of pharmacy information system in three types of teaching, private and social affiliated hospitals. The present study is an applied, descriptive and analytical study which was conducted on the pharmacy information system in use in the selected hospitals. The research population included all the users of pharmacy information systems in the selected hospitals. The research sample is the same as the research population. Researchers collected data using a self-designed checklist developed following the guidelines of the American Society of Health-System Pharmacists, Australia pharmaceutical Society and Therapeutic guidelines of the Drug Commission of the German Medical Association. The checklist validity was assessed by research supervisors and pharmacy information system pharmacists and users. To collect data besides observation, the questionnaires were distributed among pharmacy information system pharmacists and users. Finally, the analysis of the data was performed using the SPSS software. Pharmacy information system was found to be semi-automated in 16 hospitals and automated in 3 ones. Regarding the standards in the guidelines issued by the Society of Pharmacists, the highest rank in observing the input standards belonged to the Social Services associated hospitals with a mean score of 32.75. While teaching hospitals gained the highest score both in processing standards with a mean score of 29.15 and output standards with a mean score of 43.95, and the private hospitals had the lowest mean scores of 23.32, 17.78, 24.25 in input, process and output standards respectively. Based on the findings, the studied

Hospital Quality Systems - working mechanisms unraveled.

NARCIS (Netherlands)

Schoten, S. van; Groenewegen, P.; Wagner, C.

2015-01-01

Context: Quality systems were implemented in healthcare institutions to assure and improve the quality of care. Despite the fact that all Dutch hospitals have implemented a quality system, incidents persist to surface. How could this be explained? The current research was set out to gain thorough

Introduction of voluntary environmental management systems into the Spanish hospital network: current state (2015

Directory of Open Access Journals (Sweden)

Sergio García Vicente

2016-12-01

Full Text Available Hospitals produce vast amounts of waste and are large consumers of energy and natural resources. However, do they worry about environmental health? With this question in mind, and in order to approach hospital environmental practices, the introduction into the Spanish hospital network of the most accepted certified environmental management systems (CEMS, such as ISO 14001 and EMAS, was evaluated so as to obtain a point of reference for environmental practices in our National Health System as no up-to-date, specific official register exists. To this end, a list of hospitals by Spanish Autonomous Community having CEMS in force in 2015 was drawn up using official databases, evaluating information and conducting fieldwork. We found that 18.9 % of hospitals had CEMS (ISO 14001 in all cases: 149 out of 787 hospitals, in the National Hospitals Catalogue, especially in Madrid (40 and Andalusia (37. Eighty-one of the certified hospitals are private. Only 23 had EMAS: 12 are public and 11 private. The resulting “map” shows the main references in order for the need to offer citizens a balance between healthcare and environmental friendliness, to be compared and envisaged based on hospital activity, considering hospitals socially responsible, environmentally friendly organisations, that seek leadership in the field of environmental sustainability together with other sectors (environmental, engineering, industrial.

The proton therapy system for Massachusetts General Hospital's Northeast Proton Therapy Center

International Nuclear Information System (INIS)

Jongen, Y.

1996-01-01

In 1989, two companies, Ion Beam Applications in Belgium (IBA) and Sumitomo Heavy Industries in Japan (SHI) started to design proton therapy equipments based on cyclotrons. In 1991, SHI and IBA decided to join their development efforts in this field. In 1993, the Massachusetts General Hospital (MGH), pioneer in the field of proton therapy, launched an international request for proposals for the procurement of an in-hospital proton therapy facility. The 18 may 1994, the contract was signed with a team of industries led by IBA, including also SHI and General Atomics (GA) of California. The proposed system is based on a fixed energy, isochronous cyclotron, followed by an energy degrader and an energy selection system. The variable energy beam can be rapidly switched in any one of three treatment rooms. Two rooms are equipped with large isocentric gantries and robotic patient positioners allowing to direct the proton beam within the patient from any direction. The third room is equipped with fixed horizontal beam. The complete system is computer controlled by a distributed network of computers, programmable logic controllers and workstations. This computer control allows to change the energy in one treatment room is less than two second, a performance matching or exceeding the flexibility offered by synchrotrons. The system is now built and undergoing factory tests. The beam has been accelerated to full energy in the cyclotron, and beam extraction tests are underway. Installation in the hospital building will take place in 1997. (author)

System for radiation emergency medicine. Activities of tertiary radiation emergency hospitals

International Nuclear Information System (INIS)

Kamiya, Kenji; Tanigawa, Koichi; Hosoi, Yoshio

2011-01-01

Japanese system for radiation emergency medicine is primarily built up by Cabinet Nuclear Safety Commission in 2001 based on previous Tokai JCO Accident (1999) and is composed from the primary, secondary and tertiary medical organizations. This paper describes mainly about roles and actions of the tertiary facilities at Fukushima Nuclear Power Plant Accident and tasks to be improved in future. The primary and secondary organizations in the system above are set up in the prefectures with or neighboring the nuclear facility, and tertiary ones, in two parts of western and eastern Japan. The western organization is in Hiroshima University having its cooperating 7 hospitals, and is responsible for such patients as exposed to high dose external radiation, having serious complication, and difficult to treat in the primary/secondary hospitals. The eastern is in National Institute of Radiological Sciences (NIRS) with 6 cooperating hospitals and responsible for patients with internal radiation exposure difficult to treat, with contaminated body surface with difficulty in decontamination and/or with causable of secondary contamination, and difficult to treat in the secondary hospitals. The tertiary organizations have made efforts for the education and training of medical staff, for network construction among the primary, secondary and other medicare facilities, for establishment of transferring system of patients, and for participation to the international network by global organizations like Response Assistance Network (RANET) in International Atomic Energy Agency (IAEA), and Radiation Emergency Preparedness and Network (REMPAN) in World Health Organization (WHO). At the Fukushima Accident, staffs of the two tertiary hospitals began to conduct medicare on site (Mar. 12-) and learned following tasks to be improved in future: the early definition of medicare and its network system, and Emergency Planning Zone (EPZ); urgent evacuation of residents weak to disaster like elderly

Impact of a Patient Navigator Program on Hospital-Based and Outpatient Utilization Over 180 Days in a Safety-Net Health System.

Science.gov (United States)

Balaban, Richard B; Zhang, Fang; Vialle-Valentin, Catherine E; Galbraith, Alison A; Burns, Marguerite E; Larochelle, Marc R; Ross-Degnan, Dennis

2017-09-01

With emerging global payment structures, medical systems need to understand longer-term impacts of care transition strategies. To determine the effect of a care transition program using patient navigators (PNs) on health service utilization among high-risk safety-net patients over a 180-day period. Randomized controlled trial conducted October 2011 through April 2013. Patients admitted to the general medicine service with ≥1 readmission risk factor: (1) age ≥ 60; (2) in-network inpatient admission within prior 6 months; (3) index length of stay ≥ 3 days; or (4) admission diagnosis of heart failure or (5) chronic obstructive pulmonary disease. The analytic sample included 739 intervention patients, 1182 controls. Through hospital visits and 30 days of post-discharge telephone outreach, PNs provided coaching and assistance with medications, appointments, transportation, communication with primary care, and self-care. Primary outcomes: (1) hospital-based utilization, a composite of ED visits and hospital admissions; (2) hospital admissions; (3) ED visits; and (4) outpatient visits. We evaluated outcomes following an index discharge, stratified by patient age (≥ 60 and safety-net patients differentially impacted patients based on age, and among younger patients, outcomes varied over time. Our findings highlight the importance for future research to evaluate care transition programs among different subpopulations and over longer time periods.

[Development of Hospital Equipment Maintenance Information System].

Science.gov (United States)

Zhou, Zhixin

2015-11-01

Hospital equipment maintenance information system plays an important role in improving medical treatment quality and efficiency. By requirement analysis of hospital equipment maintenance, the system function diagram is drawed. According to analysis of input and output data, tables and reports in connection with equipment maintenance process, relationships between entity and attribute is found out, and E-R diagram is drawed and relational database table is established. Software development should meet actual process requirement of maintenance and have a friendly user interface and flexible operation. The software can analyze failure cause by statistical analysis.

Hospital and Pre-Hospital Triage Systems in Disaster and Normal Conditions; a Review Article

Directory of Open Access Journals (Sweden)

Saeed Safari

2015-02-01

Full Text Available Triage is a priority classification system based on the severity of problem to do the best therapeutic proceedings for patients in the less time. A triage system should be performed in a way which can make a decision with high accuracy and in the least time for each patient. Simplicity and reliability of the performance are the most important features of a standard triage system. An appropriate triage causes to increase the quality of health care services and patients’ satisfaction rate, decrease the waiting time as well as mortality rate, and increase the yield and efficiency of emergency wards along with reducing the related expenses. Considering to the above statements, in the present study the history of triage formation was evaluated and categorizing of all triage systems regarding prehospital and hospital as well as triage in normal and critical conditions were assessed, too.

[Newly Designed Water Treatment Systems for Hospital Effluent].

Science.gov (United States)

Azuma, Takashi

2018-01-01

　Pharmaceuticals are indispensable to contemporary life. Recently, the emerging problem of pharmaceutical-based pollution of river environments, including drinking water sources and lakes, has begun to receive significant attention worldwide. Because pharmaceuticals are designed to perform specific physiological functions in targeted regions of the human body, there is increasing concern regarding their toxic effects, even at low concentrations, on aquatic ecosystems and human health, via residues in drinking water. Pharmaceuticals are consistently employed in hospitals to treat disease; and Japan, one of the most advanced countries in medical treatment, ranks second worldwide in the quantity of pharmaceuticals employed. Therefore, the development of technologies that minimize or lessen the related environmental risks for clinical effluent is an important task as well as that for sewage treatment plants (STPs). However, there has been limited research on clinical effluent, and much remains to be elucidated. In light of this, we are investigating the occurrence of pharmaceuticals, and the development of water treatment systems for clinical effluent. This review discusses the current research on clinical effluent and the development of advanced water treatment systems targeted at hospital effluent, and explores strategies for future environmental risk assessment and risk management.

A smartphone-based system for the automated management of point-of-care test results in hospitals.

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Jang, Dasom; Shin, Soo-Yong; Seo, Dong-Woo; Joo, Segyeong; Huh, Soo-Jin

2015-04-01

Managing test results is an important issue in hospitals because of the increasing use of point-of-care testing (POCT). Here, we propose a smartphone-based system for automatically managing POCT test results. We developed the system to provide convenience to the medical staffs. The system recognizes the patient identification or prescription number of the test by reading barcodes and provides a countdown to indicate when the results will be ready. When the countdown in finished, a picture of the test result is transferred to the electronic medical record server using the Health Level 7 protocol. Human immunodeficiency virus (HIV) kits were selected in this research because HIV is a life-threatening infectious virus, especially for the medical staff who treat undiagnosed patients. The performance of the system was verified from a survey of the users. The performance of the system was tested at the emergency room (ER) for 10 months using commercially available POCT kits for detecting HIV. The survey showed that, in total, 80% and 0% of users reported positive or negative feedback, respectively. The staff also reported that the system reduced total processing time by approximately 32 min, in addition to reducing workload. The developed automated management system was successfully tested at an ER for 10 months. The survey results show that the system is effective and that medical staff members who used the system are satisfied with using the system at the ER.

An energy saving system for hospital laundries

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Katsanis, J.S.; Tsarabaris, P.T.; Polykrati, A.D.; Proios, A.N. [National Technical Univ. of Athens, Athens (Greece). School of Electrical and Computer Engineering; Koufakis, E.I. [Public Power Corp. S.A., Crete (Greece)

2009-07-01

Hospital laundries are one of the largest consumers of water and electrical and thermal energy. This paper examined the energy savings achieved by a system using the hot wastewater from the washing process. Hospital laundries consume thermal energy using steam, which is produced in boilers by burning diesel oil or natural gas. Electrical energy for the mechanical drives, ventilation and also the lighting required in the laundry area are big consumers of energy. The paper presented the proposed system and discussed the parameters of the system and system dimensioning. The paper also provided and discussed an interpretation of steam and energy savings. The proposed system was considered to be economically viable, simple in its construction, installation and operation. From the application of the suggested system, the cost savings resulted in a satisfactory payback period for the capital invested of approximately three to five years. 14 refs., 4 tabs., 2 figs.

Application of the Activity-Based Costing Method for Unit-Cost Calculation in a Hospital

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Javid, Mahdi; Hadian, Mohammad; Ghaderi, Hossein; Ghaffari, Shahram; Salehi, Masoud

2016-01-01

Background: Choosing an appropriate accounting system for hospital has always been a challenge for hospital managers. Traditional cost system (TCS) causes cost distortions in hospital. Activity-based costing (ABC) method is a new and more effective cost system. Objective: This study aimed to compare ABC with TCS method in calculating the unit cost of medical services and to assess its applicability in Kashani Hospital, Shahrekord City, Iran. Methods: This cross-sectional study was performed on accounting data of Kashani Hospital in 2013. Data on accounting reports of 2012 and other relevant sources at the end of 2012 were included. To apply ABC method, the hospital was divided into several cost centers and five cost categories were defined: wage, equipment, space, material, and overhead costs. Then activity centers were defined. ABC method was performed into two phases. First, the total costs of cost centers were assigned to activities by using related cost factors. Then the costs of activities were divided to cost objects by using cost drivers. After determining the cost of objects, the cost price of medical services was calculated and compared with those obtained from TCS. Results: The Kashani Hospital had 81 physicians, 306 nurses, and 328 beds with the mean occupancy rate of 67.4% during 2012. Unit cost of medical services, cost price of occupancy bed per day, and cost per outpatient service were calculated. The total unit costs by ABC and TCS were respectively 187.95 and 137.70 USD, showing 50.34 USD more unit cost by ABC method. ABC method represented more accurate information on the major cost components. Conclusion: By utilizing ABC, hospital managers have a valuable accounting system that provides a true insight into the organizational costs of their department. PMID:26234974

Application of the Activity-Based Costing Method for Unit-Cost Calculation in a Hospital.

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Javid, Mahdi; Hadian, Mohammad; Ghaderi, Hossein; Ghaffari, Shahram; Salehi, Masoud

2015-05-17

Choosing an appropriate accounting system for hospital has always been a challenge for hospital managers. Traditional cost system (TCS) causes cost distortions in hospital. Activity-based costing (ABC) method is a new and more effective cost system. This study aimed to compare ABC with TCS method in calculating the unit cost of medical services and to assess its applicability in Kashani Hospital, Shahrekord City, Iran.‎ This cross-sectional study was performed on accounting data of Kashani Hospital in 2013. Data on accounting reports of 2012 and other relevant sources at the end of 2012 were included. To apply ABC method, the hospital was divided into several cost centers and five cost categories were defined: wage, equipment, space, material, and overhead costs. Then activity centers were defined. ABC method was performed into two phases. First, the total costs of cost centers were assigned to activities by using related cost factors. Then the costs of activities were divided to cost objects by using cost drivers. After determining the cost of objects, the cost price of medical services was calculated and compared with those obtained from TCS.‎ The Kashani Hospital had 81 physicians, 306 nurses, and 328 beds with the mean occupancy rate of 67.4% during 2012. Unit cost of medical services, cost price of occupancy bed per day, and cost per outpatient service were calculated. The total unit costs by ABC and TCS were respectively 187.95 and 137.70 USD, showing 50.34 USD more unit cost by ABC method. ABC method represented more accurate information on the major cost components. By utilizing ABC, hospital managers have a valuable accounting system that provides a true insight into the organizational costs of their department.

An Evaluation of the Management Information System and Technology in Hospitals (GESITI/Hospitals

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Antonio José Balloni

2017-02-01

Full Text Available The research project "Management of System and Information Technology in Hospitals" (GESITI/Hospitals has the purpose of mapping out the management of Information Systems (IS and Information Technology (IT in hospitals. By applying a multifocal prospective questionnaire in hospitals, the research aims to identify the hospitals need and demand, prospecting for unfolding, and generate a public integrated research report for supporting public and/or private decisions-makings. The ultimate result from this GESITI/Health research project should be a significant improvement on the hospital management and on the decisions-makings, which must reflect on peoples more satisfied regarding a better health care. Therefore, this paper aims to publish the main ideas of the GESITI/Health project i.e., its "Methodology & original Prospective Questionnaire (PQ". The methodology used is the Interpretative (or Introspective. About the PQ, we do not known, up to this date, who have developed a multifocal broad field tool -the PQ-, aiming wide hospitals management-. From 2010-16 the "methodology and PQ" have been implemented by about forty -40- universities -and increasing-, from Brazil and Abroad and, forty local research reports were generated. A book, published by the Brazilian Minister of Health [1], presents the results of a pilot project carried out by nineteen -19- out of these forty -40- universities, to know: sixteen Brazilian, one Mexican, one Argentina, one from Slovakia and one from Portugal. The chapter 25 of this book [1.A] presents an integrated research from all nineteen chapters -an integrated research report-. Finally, in the oral presentation, we will briefly present the "Methodology and the PQ" presented in this paper and, also, we will present an integrated comparative analyzes -main results got with the field application of the PQ- regarding the case studies accomplished by the universities from Brazil and Abroad.

Recognition of medical errors' reporting system dimensions in educational hospitals.

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Yarmohammadian, Mohammad H; Mohammadinia, Leila; Tavakoli, Nahid; Ghalriz, Parvin; Haghshenas, Abbas

2014-01-01

Nowadays medical errors are one of the serious issues in the health-care system and carry to account of the patient's safety threat. The most important step for achieving safety promotion is identifying errors and their causes in order to recognize, correct and omit them. Concerning about repeating medical errors and harms, which were received via theses errors concluded to designing and establishing medical error reporting systems for hospitals and centers that are presenting therapeutic services. The aim of this study is the recognition of medical errors' reporting system dimensions in educational hospitals. This research is a descriptive-analytical and qualities' study, which has been carried out in Shahid Beheshti educational therapeutic center in Isfahan during 2012. In this study, relevant information was collected through 15 face to face interviews. That each of interviews take place in about 1hr and creation of five focused discussion groups through 45 min for each section, they were composed of Metron, educational supervisor, health officer, health education, and all of the head nurses. Concluded data interviews and discussion sessions were coded, then achieved results were extracted in the presence of clear-sighted persons and after their feedback perception, they were categorized. In order to make sure of information correctness, tables were presented to the research's interviewers and final the corrections were confirmed based on their view. The extracted information from interviews and discussion groups have been divided into nine main categories after content analyzing and subject coding and their subsets have been completely expressed. Achieved dimensions are composed of nine domains of medical error concept, error cases according to nurses' prospection, medical error reporting barriers, employees' motivational factors for error reporting, purposes of medical error reporting system, error reporting's challenges and opportunities, a desired system

Using a New Measurement to Evaluate Pain Relief Among Cancer Inpatients with Clinically Significant Pain Based on a Nursing Information System: A Three-Year Hospital-Based Study.

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Wang, Wei-Yun; Chu, Chi-Ming; Sung, Chun-Sung; Ho, Shung-Tai; Wu, Yi-Syuan; Liang, Chun-Yu; Wang, Kwua-Yun

2016-11-01

Developing a new measurement index is the first step in evaluating pain relief outcomes. Although the percentage difference in pain intensity (%PID) is the most popular indicator, this indicator does not take into account the goal of pain relief. Therefore, the aims of this study were to develop a pain relief index (PRI) for outcome evaluation and to examine the index using demographic characteristics of cancer inpatients with clinically significant pain. Retrospective cohort study. A national hospital. All cancer inpatients. Pain intensity was assessed using a numerical rating scale, a faces pain scale or the Face, Legs, Activity, Cry, Consolability (FLACC) Behavioral Tool. Using a nursing information system, a pain score database containing data from 2011 through 2013 was analyzed. Cancer patients representing 93,812 hospitalizations were considered in this study. We focused on cancer patients for whom the worst pain intensity (WPI) was ≥ 4 points. PRI values of -62.02% to -72.55% were observed in the WPI ≥ 7 and 4 ≤ WPI ≤ 6 groups. Significant (P 65 years old, those who were admitted to the medicine or gynecology and those who had a hospital stay > 30 days. This hospital-based study demonstrated that the PRI is an effective and valid measure for evaluating outcome data using an electronic nursing information system. We will further define the meaningful range of percentage difference in PRI from various perspectives. © 2016 American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Evaluation of aviation-based safety team training in a hospital in The Netherlands.

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De Korne, Dirk F; Van Wijngaarden, Jeroen D H; Van Dyck, Cathy; Hiddema, U Francis; Klazinga, Niek S

2014-01-01

The purpose of this paper is to evaluate the implementation of a broad-scale team resource management (TRM) program on safety culture in a Dutch eye hospital, detailing the program's content and procedures. Aviation-based TRM training is recognized as a useful approach to increase patient safety, but little is known about how it affects safety culture. Pre- and post-assessments of the hospitals' safety culture was based on interviews with ophthalmologists, anesthesiologists, residents, nurses, and support staff. Interim observations were made at training sessions and in daily hospital practice. The program consisted of safety audits of processes and (team) activities, interactive classroom training sessions by aviation experts, a flight simulator session, and video recording of team activities with subsequent feedback. Medical professionals considered aviation experts inspiring role models and respected their non-hierarchical external perspective and focus on medical-technical issues. The post-assessment showed that ophthalmologists and other hospital staff had become increasingly aware of safety issues. The multidisciplinary approach promoted social (team) orientation that replaced the former functionally-oriented culture. The number of reported near-incidents greatly increased; the number of wrong-side surgeries stabilized to a minimum after an initial substantial reduction. The study was observational and the hospital's variety of efforts to improve safety culture prevented us from establishing a causal relation between improvement and any one specific intervention. Aviation-based TRM training can be a useful to stimulate safety culture in hospitals. Safety and quality improvements are not single treatment interventions but complex socio-technical interventions. A multidisciplinary system approach and focus on "team" instead of "profession" seems both necessary and difficult in hospital care.

A Multi-Modal Digital Game-Based Learning Environment for Hospitalized Children with Chronic Illnesses.

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Chin, Jui-Chih; Tsuei, Mengping

2014-01-01

The aim of this study was to explore the digital game-based learning for children with chronic illnesses in the hospital settings. The design-based research and qualitative methods were applied. Three eight-year-old children with leukemia participated in this study. In the first phase, the multi-user game-based learning system was developed and…

Hospital information system utilization in Iran: a qualitative study.

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Mohammad Ali Abbasi Moghadam

2014-11-01

Full Text Available Hospital information system (HIS should ideally allow different forms of data to be stored and used for decision making by clinicians and managers alike. This system has been developed since the early 1980's, and many hospitals gradually converted from an unrelated system into an integrated one. In successful implementation of HIS plans, the role of human factors, either individually or as a group, is expected to be very important and decisive. In this phenomenological qualitative research, in-depth personal interviews were conducted with the hospital's senior managers, and discussions were conducted in six to eight member focus groups. To include participants for interviews, purposive sampling was used in an Iranian hospital among doctors, nurses and other healthcare providers who had experience in using HIS. Data collection continued until saturation stage. The meetings took about 90 to 120 minutes, in which the participants were asked about discovering needs as well as facilitating and inhibiting factors regarding HIS application. Two members of the research team independently analyzed the interview transcripts.  As a result, problems in HIS isolation were reported to be related to the following: software, hardware, manpower, management and training. About the last point, it was stated that adequate continuing professional development programs did not exist for proper use of computers in the hospital. To achieve the ultimate goal of HISs (e.g. increasing patient satisfaction and decreasing hospital costs, it is necessary to create basic changes in the training system, and to get feedback from hospital personnel. Other steps include addressing software and hardware shortcomings as well as moving towards reinforcing the facilitating factors and refraining from inhibiting ones discovered in this study.

Hospitalization flow in the public and private systems in the state of Sao Paulo, Brazil.

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Rocha, Juan Stuardo Yazlle; Monteiro, Rosane Aparecida; Moreira, Marizélia Leão

2015-01-01

OBJECTIVE To describe the migration flows of demand for public and private hospital care among the health regions of the state of Sao Paulo, Brazil.METHODS Study based on a database of hospitalizations in the public and private systems of the state of Sao Paulo, Southeastern Brazil, in 2006. We analyzed data from 17 health regions of the state, considering people hospitalized in their own health region and those who migrated outwards (emigration) or came from other regions (immigration). The index of migration effectiveness of patients from both systems was estimated. The coverage (hospitalization coefficient) was analyzed in relation to the number of inpatient beds per population and the indexes of migration effectiveness.RESULTS The index of migration effectiveness applied to the hospital care demand flow allowed characterizing health regions with flow balance, with high emigration of public and private patients, and with high attraction of public and private patients.CONCLUSIONS There are differences in hospital care access and opportunities among health regions in the state of Sao Paulo, Brazil.

Use of closed systems in the Hospital Pharmacy

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María Forte Pérez-Minayo

2016-03-01

Full Text Available Objective: In the setting of the increasing use of closed systems for reconstitution and preparation of these drugs, we intend to analyze the correct use of these systems in the Hospital Pharmacy, with the objective to minimize the risks of exposure not only for those professionals directly involved, but also for all the staff in the unit, taking also into account efficiency criteria. Method: Since some systems protect against aerosol formation but not from vapours, we decided to review which cytostatics should be prepared using an awl with an air inlet valve, in order to implement a new working procedure. We reviewed the formulations available in our hospital, with the following criteria: method of administration, excipients, and potential hazard for the staff handling them. We measured the diameters of the vials. We selected drugs with Level 1 Risk and also those including alcohol-based excipients, which could generate vapours. Outcomes: Out of the 66 reviewed formulations, we concluded that 11 drugs should be reconstituted with this type of awl: busulfan, cabazitaxel, carmustine, cyclophosphamide, eribulin, etoposide, fotemustine, melphalan, paclitaxel, temsirolimus and thiotepa; these represented an 18% of the total volume of formulations. Conclusions: The selection of healthcare products must be done at the Hospital Pharmacy, because the use of a system with an air valve inlet only for those drugs selected led to an outcome of savings and a more efficient use of materials. In our experience, we confirmed that the use of the needle could only be avoided when the awl could adapt to the different formulations of cytostatics, and this is only possible when different types of awls are available. Besides, connections were only really closed when a single awl was used for each vial. The change in working methodology when handling these drugs, as a result of this study, will allow us to start different studies about environmental contamination as a

How CEOs use management information systems for strategy implementation in hospitals.

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Naranjo-Gil, David; Hartmann, Frank

2007-04-01

Institutional and market changes seem to force hospitals across the Western world to revitalize their corporate strategies towards more cost efficiency on the one hand, and more flexibility towards customer demands on the other hand. Hospitals, however, apparently differ in the extent to which they are able to implement such strategies effectively. This paper explores whether these different levels of effectiveness depend on how hospitals' top managers' use of the available management information systems (MIS). Based on data obtained from the 218 CEOs of public hospitals in Spain, we analyze how CEOs' professional and educational backgrounds affect their use of MIS, and how the use of the MIS subsequently supports or inhibits the implementation of these strategic goals. The results indicate that CEOs with a predominant clinical background focus more on non-financial information for decision-making and prefer an interactive style of using MIS, which together support flexibility strategies. CEOs with a predominant administrative background seem more effective in establishing cost-reduction strategies, through their larger inclination to emphasize financial information in combination with a diagnostic use of the MIS. Implications for the strategic management of hospitals are outlined.

Impact of the Local Public Hospital Reform on the Efficiency of Medium-Sized Hospitals in Japan: An Improved Slacks-Based Measure Data Envelopment Analysis Approach.

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Zhang, Xing; Tone, Kaoru; Lu, Yingzhe

2018-04-01

To assess the change in efficiency and total factor productivity (TFP) of the local public hospitals in Japan after the local public hospital reform launched in late 2007, which was aimed at improving the financial capability and operational efficiency of hospitals. Secondary data were collected from the Ministry of Internal Affairs and Communications on 213 eligible medium-sized hospitals, each operating 100-400 beds from FY2006 to FY2011. The improved slacks-based measure nonoriented data envelopment analysis models (Quasi-Max SBM nonoriented DEA models) were used to estimate dynamic efficiency score and Malmquist Index. The dynamic efficiency measure indicated an efficiency gain in the first several years of the reform and then was followed by a decrease. Malmquist Index analysis showed a significant decline in the TFP between 2006 and 2011. The financial improvement of medium-sized hospitals was not associated with enhancement of efficiency. Hospital efficiency was not significantly different among ownership structure and law-application system groups, but it was significantly affected by hospital location. The results indicate a need for region-tailored health care policies and for a more comprehensive reform to overcome the systemic constraints that might contribute to the decline of the TFP. © Health Research and Educational Trust.

Reforming reimbursement of public hospitals in Greece during the economic crisis: Implementation of a DRG system.

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Polyzos, Nikolaos; Karanikas, Haralampos; Thireos, Eleftherios; Kastanioti, Catherine; Kontodimopoulos, Nick

2013-01-01

Until recently, in-patient NHS hospital care in Greece was reimbursed via an anachronistic and under-priced retrospective per diem system, which has been held primarily responsible for continuous budget deficits. The purpose of this paper is to present the efforts of the Ministry of Health (MoH) to implement a new DRG-based payment system. As in many countries, the decision was to adopt a patient classification from abroad and to refine it for use in Greece with national data. Pricing was achieved with a combination of activity-based costing with data from selected Greek hospitals, and "imported" cost weights. Data collection, IT support and monitoring are provided via ESY.net, a web-based facility developed and implemented by the MoH. After an initial pilot testing of the classification in 20 hospitals, complete DRG reimbursement data was reported by 113 hospitals (85% of total) for the fourth quarter of 2011. The recorded monthly increase in patient discharges billed with the new system and in revenue implies increasing adaptability by the hospitals. However, the unfavorable inlier vs. outlier distribution of discharges and revenue observed in some health regions signifies the need for corrective actions. The importance of this reimbursement reform is discussed in light of the current crisis faced by the Greek economy. There is yet much to be done and many projects are currently in progress to support this effort; however the first cost containment results are encouraging. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Performance assessment of EMR systems based on post-relational database.

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Yu, Hai-Yan; Li, Jing-Song; Zhang, Xiao-Guang; Tian, Yu; Suzuki, Muneou; Araki, Kenji

2012-08-01

Post-relational databases provide high performance and are currently widely used in American hospitals. As few hospital information systems (HIS) in either China or Japan are based on post-relational databases, here we introduce a new-generation electronic medical records (EMR) system called Hygeia, which was developed with the post-relational database Caché and the latest platform Ensemble. Utilizing the benefits of a post-relational database, Hygeia is equipped with an "integration" feature that allows all the system users to access data-with a fast response time-anywhere and at anytime. Performance tests of databases in EMR systems were implemented in both China and Japan. First, a comparison test was conducted between a post-relational database, Caché, and a relational database, Oracle, embedded in the EMR systems of a medium-sized first-class hospital in China. Second, a user terminal test was done on the EMR system Izanami, which is based on the identical database Caché and operates efficiently at the Miyazaki University Hospital in Japan. The results proved that the post-relational database Caché works faster than the relational database Oracle and showed perfect performance in the real-time EMR system.

Does family-based treatment reduce the need for hospitalization in adolescent anorexia nervosa?

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Lock, James; Agras, W Stewart; Bryson, S W; Brandt, Harry; Halmi, Katherine A; Kaye, Walter; Wilfley, Denise; Woodside, Blake; Pajarito, Sarah; Jo, Booil

2016-09-01

We examined the timing and number of days of hospitalization during the course of treatment, hospitalization effects on outcome, and predictors and moderators of the use of hospitalization in adolescents with anorexia nervosa (AN). Data used in this study were collected from 158 adolescents (ages 12 to 18 years of age) who met DSM-IVTR criteria for AN (exclusive of the amenorrhea criteria) randomized to receive either Family Based Treatment (FBT) or Systemic Family Therapy (SyFT) in a 7 site study. The trajectory of hospital day use is similar in the first 5 weeks irrespective of treatment allocation. However, days of hospitalization continued to increase throughout SyFT but leveled off in FBT after ∼5 weeks of treatment. Early hospitalization was a negative predictor for improvements in percent weight change for both treatment groups (t(1)=2.6, p = 0.011). Co-morbid psychopathology predicted early hospital use in both treatments. Higher levels of eating related obsessions and depression moderated hospitalization rates suggesting that FBT reduces early hospitalization rates compared to SyFT for these subgroups. These data support and extend findings from previous studies by identifying patterns of hospital use, and predictors and moderators of treatment effect for early hospitalization use in adolescent AN. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:891-894). © 2016 Wiley Periodicals, Inc.

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

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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.

New indicators based on personnel cost for management efficiency in a hospital.

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Nakagawa, Yoshiaki; Yoshihara, Hiroyuki; Nakagawa, Yoshinobu

2011-08-01

A simple and fair benchmarking system or financial indicators for use on the clinical department level have been lacking to evaluate the management efficiency and activity of each clinical department or division of a hospital. New financial indicators have therefore been developed based on personnel costs. Indicator 1: The ratio of marginal profit after personnel cost per personnel cost (RMP). Indicator 2: The ratio of investment (=indirect cost) per personnel cost (RIP). The difference between RMP and RIP demonstrates the operation profit in US Dollars for personnel cost (OPP). A turning point in profitability similar to the break-even point (BEP) and break-even ratio (BER) could be also defined by the combination of the RMP and RIP. The merits of these two indicators are not only the ability to indicate the relationship between the medical profit and the investments in the hospital, but also the capability to demonstrate such indicators as BEP, BER and OPP on a single graph. The two indicators were applied to the hospitals in the National Hospital Organization and to the clinical department in one hospital. Using these two indicators, it was possible to evaluate the management efficiency and medical activity not only in the whole hospital but also in each department and DPC/DRG group. This will be of use to a manager of a hospital in checking the management efficiency of his/her hospital despite the variations among hospitals, departments and divisions.

CLINICAL SURFACES - Activity-Based Computing for Distributed Multi-Display Environments in Hospitals

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Bardram, Jakob E.; Bunde-Pedersen, Jonathan; Doryab, Afsaneh; Sørensen, Steffen

A multi-display environment (MDE) is made up of co-located and networked personal and public devices that form an integrated workspace enabling co-located group work. Traditionally, MDEs have, however, mainly been designed to support a single “smart room”, and have had little sense of the tasks and activities that the MDE is being used for. This paper presents a novel approach to support activity-based computing in distributed MDEs, where displays are physically distributed across a large building. CLINICAL SURFACES was designed for clinical work in hospitals, and enables context-sensitive retrieval and browsing of patient data on public displays. We present the design and implementation of CLINICAL SURFACES, and report from an evaluation of the system at a large hospital. The evaluation shows that using distributed public displays to support activity-based computing inside a hospital is very useful for clinical work, and that the apparent contradiction between maintaining privacy of medical data in a public display environment can be mitigated by the use of CLINICAL SURFACES.

A new framework for assessing hospital crisis management based on resilience engineering approach.

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Shirali, Gh A; Azadian, Sh; Saki, A

2016-06-14

In recent years, an increasing number of natural and man-made disasters have exposed many people and properties to various disasters. This has resulted in approximately 75,000 deaths worldwide every year due to disasters. Crisis management is becoming increasingly important to cope effectively with the magnitude and potential damage resulting from disasters. Hospitals, as the final point in the rescue chain, have a key role in the crisis management and need to be resilient against disasters. The purpose of this paper is to present a new framework for assessing the crisis management based on resilience principles in hospital infrastructure of a developing country. A questionnaire was developed and completed by 310 staff (nurses and managers) of eight hospitals in Iran. The findings indicate that the eight hospitals included in the study have moderate conditions in general, while hospitals X3, X4, and X7 have poor conditions in the crisis management. Consequently, it seems that the crisis management system was not resilient in all these hospitals in general. Using resilience engineering in assessing crisis management can improve and develop the ability of the hospitals' management to cope with any type of disaster.

Comparative analysis of current payment system for hospital services in Serbia and projected payments under diagnostic related groups system in urology

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Babić Uroš

2015-01-01

Full Text Available Background/Aim. Global budget per calendar year is a traditional method of funding hospitals in Serbia. Diagnose related groups (DGR is a method of hospital payment based on classification of patients into groups with clinically similar problems and similar utilization of hospital resources. The aim of this study was to compare current methods of hospital services payment with the projected costs by DRG payment method in urology. Methods. The data were obtained from the information system used in the Clinical Hospital Center “Dr. Dragiša Mišović” - Dedinje in Belgrade, Serbia. The implemented hospital information system was the main criterion for selection of healthcare institutions. The study included 994 randomly selected patients treated surgically and conservatively in 2012. Results. Average costs under the current payment method were slightly higher than those projected by DRG, however, the variability was twice as high (54,111 ± 69,789 compared to 53,434 ± 32,509, p < 0,001 respectively. The univariate analysis showed that the highest correlation with the current payment method as well as with the projected one by DRG was observed in relation to the number of days of hospitalization (ρ = 0.842, p < 0.001, and ρ = 0.637, p < 0.001, respectively. Multivariate regression models confirmed the influence of the number of hospitalization days to costs under the current payment system (β = 0.843, p < 0.001 as well as under the projected DRG payment system (β = 0.737, p < 0.001. The same predictor was crucial for the difference in the current payment method and the projected DRG payment methods (β = 0.501, p <0.001. Conclusion. Payment under the DRG system is administratively more complex because it requires detailed and standardized coding of diagnoses and procedures, as well as the information on the average consumption of resources (costs per DRG. Given that aggregate costs of treatment under two hospital payment methods compared

Status of costing hospital nursing work within Australian casemix activity-based funding policy.

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Heslop, Liza

2012-02-01

Australia has a long history of patient level costing initiated when casemix funding was implemented in several states in the early 1990s. Australia includes, to some extent, hospital payment based on nursing intensity adopted within casemix funding policy and the Diagnostic Related Group system. Costing of hospital nursing services in Australia has not changed significantly in the last few decades despite widespread introduction of casemix funding policy at the state level. Recent Commonwealth of Australia National Health Reform presents change to the management of the delivery of health care including health-care costing. There is agreement for all Australian jurisdictions to progress to casemix-based activity funding. Within this context, nurse costing infrastructure presents contemporary issues and challenges. An assessment is made of the progress of costing nursing services within casemix funding models in Australian hospitals. Valid and reliable Australian-refined nursing service weights might overcome present cost deficiencies and limitations. © 2012 Blackwell Publishing Asia Pty Ltd.

Hospital information system institutionalization processes in indonesian public, government-owned and privately owned hospitals.

Science.gov (United States)

Handayani, P W; Hidayanto, A N; Ayuningtyas, Dumilah; Budi, Indra

2016-11-01

The Hospital Information System (HIS) could help hospitals as a public entity to provide optimal health services. One of the main challenges of HIS implementation is an institutional change. Using institutional theory as the analytical lens, this study aims to explain the institutionalization of HIS as an instance of e-health initiatives in Indonesia. Furthermore, this paper aims for hospital management and researchers to improve the understanding of the social forces that influence hospital personnel's HIS acceptance within an organizational context. We use case studies from four public, government-owned hospitals and four privately owned (public and specialty) hospitals to explain the HIS institutionalization process by exploring the three concepts of institutional theory: institutional isomorphism, institutional logic, and institutional entrepreneurship. This study reveals that differences exist between public, government-owned and private hospitals with regard to the institutionalization process: public, government-owned hospitals' management is more motivated to implement HIS to comply with the regulations, while private hospitals' management views HIS as an urgent requirement that must be achieved. The study findings also reveal that various institutional isomorphism mechanisms and forms of institutional logic emerge during the process. Finally, three factors-self-efficacy, social influence, and management support-have a significant influence on the individual acceptance of HIS. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

The deployment of information systems and information technology in field hospitals.

Science.gov (United States)

Crowe, Ian R J; Naguib, Raouf N G

2010-01-01

Information systems and related technologies continue to develop and have become an integral part of healthcare provision and hospital care in particular. Field hospitals typically operate in the most austere and difficult of conditions and have yet to fully exploit related technologies. This paper addresses those aspects of healthcare informatics, healthcare knowledge management and lean healthcare that can be applied to field hospitals, with a view to improving patient care. The aim is to provide a vision for the deployment of information systems and information technology in field hospitals, using the British Army's field hospital as a representative model.

Airflow and Contaminant Distribution in Hospital Wards with a Displacement Ventililation System

DEFF Research Database (Denmark)

Qian, H.; Nielsen, Peter Vilhelm; Li, Y.

2004-01-01

Airflow and Contaminant Distribution in Hospital Wards with a Displacement Ventilalation System. The 2nd International Conference on Build Environment and Public Health, BEPH 2004, Shenzhen , China . ABSTRACT Displacement ventilation has not been considered to be an applicable system for hospital...... to accurately predict three-dimensional distribution of air velocity, temperature, and contaminant concentration in the ward. Indoor airflow in a displacement ventilation system involves a combination of different flow streams such as the gravity currents and thermal plumes. It is important to choose...... ventilation system in hospital wards. It is for this purpose that we study the performance of displacement ventilation in hospital wards as one of the steps to optimize the ventilation design. When the prospect of applying displacement ventilation system in a hospital ward is examined, it should be necessary...

A Trial of Nursing Cost Accounting using Nursing Practice Data on a Hospital Information System.

Science.gov (United States)

Miyahira, Akiko; Tada, Kazuko; Ishima, Masatoshi; Nagao, Hidenori; Miyamoto, Tadashi; Nakagawa, Yoshiaki; Takemura, Tadamasa

2015-01-01

Hospital administration is very important and many hospitals carry out activity-based costing under comprehensive medicine. However, nursing cost is unclear, because nursing practice is expanding both quantitatively and qualitatively and it is difficult to grasp all nursing practices, and nursing cost is calculated in many cases comprehensively. On the other hand, a nursing information system (NIS) is implemented in many hospitals in Japan and we are beginning to get nursing practical data. In this paper, we propose a nursing cost accounting model and we simulate a cost by nursing contribution using NIS data.

Picture archiving and communication systems (PACS) for hospitals, a survey

International Nuclear Information System (INIS)

Haar Romeny, B.M. ter; Graaf, C.N. de; Waes, P.F.G.M. van; Rijk, P.P. van; Helder, J.C.; Valk, J.P.J. de

1985-01-01

In this article a survey is given for Picture Archiving and Communication Systems (PACS). Several aspects of PACS are treated, as image management, the introduction of the system, expenses etc. Special reference is made to the component parts of PACS: image stations, memory, network, software and coupling to the hospital information system. The introduction of PACS in Dutch hospitals is described. (Auth.)

Data that drive: Closing the loop in the learning hospital system.

Science.gov (United States)

Liu, Vincent X; Morehouse, John W; Baker, Jennifer M; Greene, John D; Kipnis, Patricia; Escobar, Gabriel J

2016-11-01

The learning healthcare system describes a vision of US healthcare that capitalizes on science, information technology, incentives, and care culture to drive improvements in the quality of health care. The inpatient setting, one of the most costly and impactful domains of healthcare, is an ideal setting in which to use data and information technology to foster continuous learning and quality improvement. The rapid digitization of inpatient medicine offers incredible new opportunities to use data from routine care to generate new discovery and thus close the virtuous cycle of learning. We use an object lesson-sepsis care within the 21 hospitals of the Kaiser Permanente Northern California integrated healthcare delivery system-to offer insight into the critical elements necessary for developing a learning hospital system. We then describe how a hospital-wide data-driven approach to inpatient care can facilitate improvements in the quality of hospital care. Journal of Hospital Medicine 2016;11:S11-S17. © 2016 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

Optimized biofilm-based systems for removal of pharmaceuticals from hospital waste water

DEFF Research Database (Denmark)

Andersen, Henrik R; Chhetri, Ravi; Hansen, Kamilla

Discharge of hospital wastewater is of increasing concern, as hospitals are identified as chemical pollution source due to pharmaceutical content. This project seeks to develop the most efficient and economically feasible technology to remove pharmaceuticals from wastewater, regardless of the poi...

Hospital Management Software Development

OpenAIRE

sobogunGod, olawale

2012-01-01

The purpose of this thesis was to implement a hospital management software which is suitable for small private hospitals in Nigeria, especially for the ones that use a file based system for storing information rather than having it stored in a more efficient and safer environment like databases or excel programming software. The software developed within this thesis project was specifically designed for the Rainbow specialist hospital which is based in Lagos, the commercial neurological cente...

Hospital managers need management information systems.

Science.gov (United States)

Davis, S; Freeman, J R

1976-01-01

A new hospital director seeking to bring his institution to the brink of solvency found himself with ten pounds of data but no "information"--at least, not the kind of information he could use as a basis for management decisions. What he needed was a system that would not only present data, but the meaning of the data. Such a system is the integrated MIS.

Coding response to a case-mix measurement system based on multiple diagnoses.

Science.gov (United States)

Preyra, Colin

2004-08-01

To examine the hospital coding response to a payment model using a case-mix measurement system based on multiple diagnoses and the resulting impact on a hospital cost model. Financial, clinical, and supplementary data for all Ontario short stay hospitals from years 1997 to 2002. Disaggregated trends in hospital case-mix growth are examined for five years following the adoption of an inpatient classification system making extensive use of combinations of secondary diagnoses. Hospital case mix is decomposed into base and complexity components. The longitudinal effects of coding variation on a standard hospital payment model are examined in terms of payment accuracy and impact on adjustment factors. Introduction of the refined case-mix system provided incentives for hospitals to increase reporting of secondary diagnoses and resulted in growth in highest complexity cases that were not matched by increased resource use over time. Despite a pronounced coding response on the part of hospitals, the increase in measured complexity and case mix did not reduce the unexplained variation in hospital unit cost nor did it reduce the reliance on the teaching adjustment factor, a potential proxy for case mix. The main implication was changes in the size and distribution of predicted hospital operating costs. Jurisdictions introducing extensive refinements to standard diagnostic related group (DRG)-type payment systems should consider the effects of induced changes to hospital coding practices. Assessing model performance should include analysis of the robustness of classification systems to hospital-level variation in coding practices. Unanticipated coding effects imply that case-mix models hypothesized to perform well ex ante may not meet expectations ex post.

Coding Response to a Case-Mix Measurement System Based on Multiple Diagnoses

Science.gov (United States)

Preyra, Colin

2004-01-01

Objective To examine the hospital coding response to a payment model using a case-mix measurement system based on multiple diagnoses and the resulting impact on a hospital cost model. Data Sources Financial, clinical, and supplementary data for all Ontario short stay hospitals from years 1997 to 2002. Study Design Disaggregated trends in hospital case-mix growth are examined for five years following the adoption of an inpatient classification system making extensive use of combinations of secondary diagnoses. Hospital case mix is decomposed into base and complexity components. The longitudinal effects of coding variation on a standard hospital payment model are examined in terms of payment accuracy and impact on adjustment factors. Principal Findings Introduction of the refined case-mix system provided incentives for hospitals to increase reporting of secondary diagnoses and resulted in growth in highest complexity cases that were not matched by increased resource use over time. Despite a pronounced coding response on the part of hospitals, the increase in measured complexity and case mix did not reduce the unexplained variation in hospital unit cost nor did it reduce the reliance on the teaching adjustment factor, a potential proxy for case mix. The main implication was changes in the size and distribution of predicted hospital operating costs. Conclusions Jurisdictions introducing extensive refinements to standard diagnostic related group (DRG)-type payment systems should consider the effects of induced changes to hospital coding practices. Assessing model performance should include analysis of the robustness of classification systems to hospital-level variation in coding practices. Unanticipated coding effects imply that case-mix models hypothesized to perform well ex ante may not meet expectations ex post. PMID:15230940

What happens in hospitals does not stay in hospitals: antibiotic-resistant bacteria in hospital wastewater systems.

Science.gov (United States)

Hocquet, D; Muller, A; Bertrand, X

2016-08-01

Hospitals are hotspots for antimicrobial-resistant bacteria (ARB) and play a major role in both their emergence and spread. Large numbers of these ARB will be ejected from hospitals via wastewater systems. In this review, we present quantitative and qualitative data of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli, vancomycin-resistant enterococci and Pseudomonas aeruginosa in hospital wastewaters compared to community wastewaters. We also discuss the fate of these ARB in wastewater treatment plants and in the downstream environment. Published studies have shown that hospital effluents contain ARB, the burden of these bacteria being dependent on their local prevalence. The large amounts of antimicrobials rejected in wastewater exert a continuous selective pressure. Only a few countries recommend the primary treatment of hospital effluents before their discharge into the main wastewater flow for treatment in municipal wastewater treatment plants. Despite the lack of conclusive data, some studies suggest that treatment could favour the ARB, notably ESBL-producing E. coli. Moreover, treatment plants are described as hotspots for the transfer of antibiotic resistance genes between bacterial species. Consequently, large amounts of ARB are released in the environment, but it is unclear whether this release contributes to the global epidemiology of these pathogens. It is reasonable, nevertheless, to postulate that it plays a role in the worldwide progression of antibiotic resistance. Antimicrobial resistance should now be seen as an 'environmental pollutant', and new wastewater treatment processes must be assessed for their capability in eliminating ARB, especially from hospital effluents. Copyright © 2016. Published by Elsevier Ltd.

Using DRG to analyze hospital production: a re-classification model based on a linear tree-network topology

Directory of Open Access Journals (Sweden)

Achille Lanzarini

2014-09-01

Full Text Available Background: Hospital discharge records are widely classified through the Diagnosis Related Group (DRG system; the version currently used in Italy counts 538 different codes, including thousands of diagnosis and procedures. These numbers reflect the considerable effort of simplification, yet the current classification system is of little use to evaluate hospital production and performance.Methods: As the case-mix of a given Hospital Unit (HU is driven by its physicians’ specializations, a grouping of DRGs into a specialization-driven classification system has been conceived through the analysis of HUs discharging and the ICD-9-CM codes. We propose a three-folded classification, based on the analysis of 1,670,755 Hospital Discharge Cards (HDCs produced by Lombardy Hospitals in 2010; it consists of 32 specializations (e.g. Neurosurgery, 124 sub-specialization (e.g. skull surgery and 337 sub-sub-specialization (e.g. craniotomy.Results: We give a practical application of the three-layered approach, based on the production of a Neurosurgical HU; we observe synthetically the profile of production (1,305 hospital discharges for 79 different DRG codes of 16 different MDC are grouped in few groups of homogeneous DRG codes, a more informative production comparison (through process-specific comparisons, rather than crude or case-mix standardized comparisons and a potentially more adequate production planning (considering the Neurosurgical HUs of the same city, those produce a limited quote of the whole neurosurgical production, because the same activity can be realized by non-Neurosugical HUs.Conclusion: Our work may help to evaluate the hospital production for a rational planning of available resources, blunting information asymmetries between physicians and managers. 

Integrating hospital information systems in healthcare institutions: a mediation architecture.

Science.gov (United States)

El Azami, Ikram; Cherkaoui Malki, Mohammed Ouçamah; Tahon, Christian

2012-10-01

Many studies have examined the integration of information systems into healthcare institutions, leading to several standards in the healthcare domain (CORBAmed: Common Object Request Broker Architecture in Medicine; HL7: Health Level Seven International; DICOM: Digital Imaging and Communications in Medicine; and IHE: Integrating the Healthcare Enterprise). Due to the existence of a wide diversity of heterogeneous systems, three essential factors are necessary to fully integrate a system: data, functions and workflow. However, most of the previous studies have dealt with only one or two of these factors and this makes the system integration unsatisfactory. In this paper, we propose a flexible, scalable architecture for Hospital Information Systems (HIS). Our main purpose is to provide a practical solution to insure HIS interoperability so that healthcare institutions can communicate without being obliged to change their local information systems and without altering the tasks of the healthcare professionals. Our architecture is a mediation architecture with 3 levels: 1) a database level, 2) a middleware level and 3) a user interface level. The mediation is based on two central components: the Mediator and the Adapter. Using the XML format allows us to establish a structured, secured exchange of healthcare data. The notion of medical ontology is introduced to solve semantic conflicts and to unify the language used for the exchange. Our mediation architecture provides an effective, promising model that promotes the integration of hospital information systems that are autonomous, heterogeneous, semantically interoperable and platform-independent.

Design of a robotic automation system for transportation of goods in hospitals

DEFF Research Database (Denmark)

Özkil, Ali Gürcan; Sørensen, Torben; Fan, Zhun

2007-01-01

Hospitals face with heavy traffic of goods everyday, where transportation tasks are mainly carried by human. Analysis of the current situation of transportation in a typical hospital showed several transportation tasks are suitable for automation. This paper presents a system, consisting of a fleet...... of robot vehicles, automatic stations and smart containers for automation of transportation of goods in hospitals. Design of semi-autonomous robot vehicles, containers and stations are presented and the overall system architecture is described. Implementing such a system in an existing hospital showed...

Home-Based versus Hospital-Based Rehabilitation Program after Total Knee Replacement

Directory of Open Access Journals (Sweden)

Remedios López-Liria

2015-01-01

Full Text Available Objectives. To compare home-based rehabilitation with the standard hospital rehabilitation in terms of improving knee joint mobility and recovery of muscle strength and function in patients after a total knee replacement. Materials and Methods. A non-randomised controlled trial was conducted. Seventy-eight patients with a prosthetic knee were included in the study and allocated to either a home-based or hospital-based rehabilitation programme. Treatment included various exercises to restore strength and joint mobility and to improve patients’ functional capacity. The primary outcome of the trial was the treatment effectiveness measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC. Results. The groups did not significantly differ in the leg side (right/left or clinical characteristics (P>0.05. After the intervention, both groups showed significant improvements (P<0.001 from the baseline values in the level of pain (visual analogue scale, the range of flexion-extension motion and muscle strength, disability (Barthel and WOMAC indices, balance, and walking. Conclusions. This study reveals that the rehabilitation treatments offered either at home or in hospital settings are equally effective.

Risk factors and therapy for goat mastitis in a hospital-based case-control study in Bangladesh.

Science.gov (United States)

Koop, Gerrit; Islam, Md Nurul; Rahman, Md Mizanur; Khatun, Momena; Ferdous, Jinnat; Sayeed, Md Abu; Islam, Shariful; Ahaduzzaman, Md; Akter, Sazeda; Mannan, Abdul; Hassan, Mohammad Mahmudul; Dissanayake, Ravi; Hoque, Md Ahasanul

2016-02-01

Bangladesh has a large population of goats, which contribute to the income, nutrition and welfare of the households of many families. Mastitis in goats has a low incidence, but is often very severe, making veterinary care necessary. The aim of this study was to identify seasonality and risk factors for goat mastitis in a hospital-based matched case-control study in a teaching veterinary hospital in Chittagong, Bangladesh and to describe the range of antimicrobial treatments applied in this situation. Cases of mastitis and controls were drawn from the hospital patient recording system, along with their risk factor status. Multiple imputation was applied to deal with the missing values in the data analysis. Mastitis occurred somewhat more in the rainy season, and comprised about 3% of all goats admitted to the hospital during January 2011-June 2014. Free-ranging farming system, poor body condition score and non-native goat breeds were significantly associated with case status. Treatment of clinical mastitis was variable and unsystematic, but the use of gentamicin was commonly recorded. The need for more prudent and evidence-based antimicrobial therapies is discussed. Copyright © 2015 Elsevier B.V. All rights reserved.

Hospital-based shootings in the United States: 2000 to 2011.

Science.gov (United States)

Kelen, Gabor D; Catlett, Christina L; Kubit, Joshua G; Hsieh, Yu-Hsiang

2012-12-01

Workplace violence in health care settings is a frequent occurrence. Emergency departments (EDs) are considered particularly vulnerable. Gunfire in hospitals is of particular concern; however, information about such workplace violence is limited. Therefore, we characterize US hospital-based shootings from 2000 to 2011. Using LexisNexis, Google, Netscape, PubMed, and ScienceDirect, we searched reports for acute care hospital shooting events in the United States for 2000 through 2011. All hospital-based shootings with at least 1 injured victim were analyzed. Of 9,360 search "hits," 154 hospital-related shootings were identified, 91 (59%) inside the hospital and 63 (41%) outside on hospital grounds. Shootings occurred in 40 states, with 235 injured or dead victims. Perpetrators were overwhelmingly men (91%) but represented all adult age groups. The ED environs were the most common site (29%), followed by the parking lot (23%) and patient rooms (19%). Most events involved a determined shooter with a strong motive as defined by grudge (27%), suicide (21%), "euthanizing" an ill relative (14%), and prisoner escape (11%). Ambient society violence (9%) and mentally unstable patients (4%) were comparatively infrequent. The most common victim was the perpetrator (45%). Hospital employees composed 20% of victims; physician (3%) and nurse (5%) victims were relatively infrequent. Event characteristics that distinguished the ED from other sites included younger perpetrator, more likely in custody, and unlikely to have a personal relationship with the victim (ill relative, grudge, coworker). In 23% of shootings within the ED, the weapon was a security officer's gun taken by the perpetrator. Case fatality inside the hospital was much lower in the ED setting (19%) than other sites (73%). Although it is likely that not every hospital-based shooting was identified, such events are relatively rare compared with other forms of workplace violence. The unpredictable nature of this type of

Sensitivity of the Dengue Surveillance System in Brazil for Detecting Hospitalized Cases

Science.gov (United States)

2016-01-01

We evaluated the sensitivity of the dengue surveillance system in detecting hospitalized cases in ten capital cities in Brazil from 2008 to 2013 using a probabilistic record linkage of two independent information systems hospitalization (SIH-SUS) adopted as the gold standard and surveillance (SINAN). Sensitivity was defined as the proportion of cases reported to the surveillance system amid the suspected hospitalized cases registered in SIH-SUS. Of the 48,174 hospitalizations registered in SIH-SUS, 24,469 (50.7%) were reported and registered in SINAN, indicating an overall sensitivity of 50.8% (95%CI 50.3–51.2). The observed sensitivity for each of the municipalities included in the study ranged from 22.0% to 99.1%. The combination of the two data sources identified 71,161 hospitalizations, an increase of 97.0% over SINAN itself. Our results allowed establishing the proportion of underreported dengue hospitalizations in the public health system in Brazil, highlighting the use of probabilistic record linkage as a valuable tool for evaluating surveillance systems. PMID:27192405

Are hospitals ready to response to disasters? Challenges, opportunities and strategies of Hospital Emergency Incident Command System (HEICS).

Science.gov (United States)

Yarmohammadian, Mohammad Hossein; Atighechian, Golrokh; Shams, Lida; Haghshenas, Abbas

2011-08-01

Applying an effective management system in emergency incidents provides maximum efficiency with using minimum facilities and human resources. Hospital Emergency Incident Command System (HEICS) is one of the most reliable emergency incident command systems to make hospitals more efficient and to increase patient safety. This research was to study requirements, barriers, and strategies of HEICS in hospitals affiliated to Isfahan University of Medical Sciences (IUMS). This was a qualitative research carried out in Isfahan Province, Iran during 2008-09. The study population included senior hospital managers of IUMS and key informants in emergency incident management across Isfahan Province. Sampling method was in non-random purposeful form and snowball technique was used. The research instrument for data collection was semi-structured interview; collected data was analyzed by Colaizzi Technique. Findings of study were categorized into three general categories including requirements (organizational and sub-organizational), barriers (internal and external) of HEICS establishment, and providing short, mid and long term strategies. These categories are explained in details in the main text. Regarding the existing barriers in establishment of HEICS, it is recommended that responsible authorities in different levels of health care system prepare necessary conditions for implementing such system as soon as possible via encouraging and supporting systems. This paper may help health policy makers to get reasonable framework and have comprehensive view for establishing HEICS in hospitals. It is necessary to consider requirements and viewpoints of stakeholders before any health policy making or planning.

Front-Line Physicians' Satisfaction with Information Systems in Hospitals.

Science.gov (United States)

Peltonen, Laura-Maria; Junttila, Kristiina; Salanterä, Sanna

2018-01-01

Day-to-day operations management in hospital units is difficult due to continuously varying situations, several actors involved and a vast number of information systems in use. The aim of this study was to describe front-line physicians' satisfaction with existing information systems needed to support the day-to-day operations management in hospitals. A cross-sectional survey was used and data chosen with stratified random sampling were collected in nine hospitals. Data were analyzed with descriptive and inferential statistical methods. The response rate was 65 % (n = 111). The physicians reported that information systems support their decision making to some extent, but they do not improve access to information nor are they tailored for physicians. The respondents also reported that they need to use several information systems to support decision making and that they would prefer one information system to access important information. Improved information access would better support physicians' decision making and has the potential to improve the quality of decisions and speed up the decision making process.

Hospital-based health technology assessment in France: A focus on medical devices.

Science.gov (United States)

Martelli, Nicolas; Puc, Cyril; Szwarcensztein, Karine; Beuscart, Régis; Coulonjou, Hélène; Degrassat-Théas, Albane; Dutot, Camille; Epis de Fleurian, Anne-Aurélie; Favrel-Feuillade, Florence; Hounliasso, Iliona; Lechat, Philippe; Luigi, Emmanuel; Mairot, Laurent; Nguyen, Thao; Piazza, Laurent; Roussel, Christophe; Vienney, Cécile

2017-02-01

Hospital-based health technology assessment (HTA) guides decisions as to whether new healthcare products should be made available within hospital structures. Its extension to medical devices (MDs) makes it possible to analyse several relevant aspects of these healthcare products in addition to their clinical value, and such evaluations are of interest to national health authorities, other healthcare establishments and industry. The aim of this work was to formulate several recommendations for a blueprint for hospital-based HTA for MDs in France. Five themes based on the work of the European Adopting hospital-based HTA in the EU (AdHopHTA) project were defined. Each member of the roundtable was then allocated a documentation task based on their experience of the theme concerned, and a literature review was carried out. An inventory of hospital-based HTA was performed and six recommendations aiming to strengthen and improve this approach were put forward: (1) encouragement of the spread of the hospital-based HTA culture and participation in communications and the promotion of this approach to hospital decision-makers; (2) adaptation of hospital-based HTA to the needs of decision-makers, taking into account the financial timetable and strategic objectives of the healthcare establishment; (3) harmonisation of the dossiers requested from industry between healthcare establishments, based on a common core; (4) promotion of the sharing of hospital-based HTA data under certain conditions, with data dissociable from the HTA report and the use of a validated methodology for the literature review; (5) creation of a composite indicator reflecting data production effort and the sharing of HTA activities, to be taken into account in the distribution of funds allocated for teaching, research and innovation missions considered of general interest; (6) the transmission of information directly from local to national level by pioneering centres. This work highlights the major issues

Is it good to be too light? Birth weight thresholds in hospital reimbursement systems.

Science.gov (United States)

Reif, Simon; Wichert, Sebastian; Wuppermann, Amelie

2018-02-02

Birth weight manipulation has been documented in per-case hospital reimbursement systems, in which hospitals receive more money for otherwise equal newborns with birth weight just below compared to just above specific birth weight thresholds. As hospitals receive more money for cases with weight below the thresholds, having a (reported) weight below a threshold could benefit the newborn. Also, these reimbursement thresholds overlap with diagnostic thresholds that have been shown to affect the quantity and quality of care that newborns receive. Based on the universe of hospital births in Germany from the years 2005-2011, we investigate whether weight below reimbursement relevant thresholds triggers different quantity and quality of care. We find that this is not the case, suggesting that hospitals' financial incentives with respect to birth weight do not directly impact the care that newborns receive. Copyright © 2018 Elsevier B.V. All rights reserved.

Marketing and reputation aspects of neonatal safeguards and hospital-security systems.

Science.gov (United States)

Smith, Alan D

2009-01-01

Technological advancements have migrated from personal-use electronics into the healthcare setting for security enhancements. Within maternity wards and nurseries, technology was seen as one of best way to protect newborns from abduction. The present study is a focus on what systems and methods are used in neonatal security, the security arrangements, staff training, and impacts outside the control of the hospital, customer satisfaction and customer relations management. Through hypothesis-testing and exploratory analysis, gender biases and extremely high levels of security were found within a web-enabled and professional sample of 200 respondents. The factor-based constructs were found to be, in order of the greatest explained variance: security concerns, personal technology usage, work technology applications, and demographic maturity concerns, resulting in four factor-based scores with significant combined variance of 61.5%. It was found that through a better understanding on the importance and vital need for hospitals to continue to improve on their technology-based security policies significantly enhanced their reputation in the highly competitive local healthcare industry.

Digestive system complications among hospitalized children with ...

African Journals Online (AJOL)

USER

least common complication, occurring in one (3.3%) of the cases studied. Conclusion: Acute ... Keywords: Acute abdominal crisis, children, haemoglobin, hospitalization, multi-systemic ... improvement of the management of such children.

Inertial Sensor-Based Robust Gait Analysis in Non-Hospital Settings for Neurological Disorders

Directory of Open Access Journals (Sweden)

Can Tunca

2017-04-01

Full Text Available The gold standards for gait analysis are instrumented walkways and marker-based motion capture systems, which require costly infrastructure and are only available in hospitals and specialized gait clinics. Even though the completeness and the accuracy of these systems are unquestionable, a mobile and pervasive gait analysis alternative suitable for non-hospital settings is a clinical necessity. Using inertial sensors for gait analysis has been well explored in the literature with promising results. However, the majority of the existing work does not consider realistic conditions where data collection and sensor placement imperfections are imminent. Moreover, some of the underlying assumptions of the existing work are not compatible with pathological gait, decreasing the accuracy. To overcome these challenges, we propose a foot-mounted inertial sensor-based gait analysis system that extends the well-established zero-velocity update and Kalman filtering methodology. Our system copes with various cases of data collection difficulties and relaxes some of the assumptions invalid for pathological gait (e.g., the assumption of observing a heel strike during a gait cycle. The system is able to extract a rich set of standard gait metrics, including stride length, cadence, cycle time, stance time, swing time, stance ratio, speed, maximum/minimum clearance and turning rate. We validated the spatio-temporal accuracy of the proposed system by comparing the stride length and swing time output with an IR depth-camera-based reference system on a dataset comprised of 22 subjects. Furthermore, to highlight the clinical applicability of the system, we present a clinical discussion of the extracted metrics on a disjoint dataset of 17 subjects with various neurological conditions.

Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Policy Changes and Fiscal Year 2016 Rates; Revisions of Quality Reporting Requirements for Specific Providers, Including Changes Related to the Electronic Health Record Incentive Program; Extensions of the Medicare-Dependent, Small Rural Hospital Program and the Low-Volume Payment Adjustment for Hospitals. Final rule; interim final rule with comment period.

Science.gov (United States)

2015-08-17

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital related costs of acute care hospitals to implement changes arising from our continuing experience with these systems for FY 2016. Some of these changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act), the Pathway for Sustainable Growth Reform(SGR) Act of 2013, the Protecting Access to Medicare Act of 2014, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Medicare Access and CHIP Reauthorization Act of 2015, and other legislation. We also are addressing the update of the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2016.As an interim final rule with comment period, we are implementing the statutory extensions of the Medicare dependent,small rural hospital (MDH)Program and changes to the payment adjustment for low-volume hospitals under the IPPS.We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2016 and implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014.In addition, we are establishing new requirements or revising existing requirements for quality reporting by specific providers (acute care hospitals,PPS-exempt cancer hospitals, and LTCHs) that are participating in Medicare, including related provisions for eligible hospitals and critical access hospitals participating in the Medicare Electronic Health Record (EHR)Incentive Program. We also are updating policies relating to the

Combined PACS and intranet information system in a University Hospital

International Nuclear Information System (INIS)

Heiss, D.; Pfluger, T.; Pfeifer, K.J.; Hahn, K.; Koenig, A.; Endres, S.

2000-01-01

Purpose: The Department of Radiology at the University Hospital Innenstadt Munich provides all clinical departments of a large university hospital with several radiology units at different locations. During the last four years all units have been fully digitalized with a stepwise installation of a PACS. The PACS also processes images from the Nuclear Medicine Department. Methods: As image modalities, archive systems and review workstations, we use devices from multiple vendors, which are integrated into a consistent system using the DICOM standard. The hospital has developed its own RIS and an intranet information system, which provides access to all reports and images from radiology for all clinical departments inside the hospital. Additionally, other clinical information such as laboratory results or ECG examinations are available through the system. Results: After one year of operation, the system succeeded in the clinical routine work as the primary source for radiological reports and images as well as for laboratory values. Conclusion: The advantages of digitalization were, besides reduction of film cost, especially optimizations of work flow with access to digital images from every where at any time. (orig.) [de

Hospital Malnutrition: Prevalence, Identification and Impact on Patients and the Healthcare System

Science.gov (United States)

Barker, Lisa A.; Gout, Belinda S.; Crowe, Timothy C.

2011-01-01

Malnutrition is a debilitating and highly prevalent condition in the acute hospital setting, with Australian and international studies reporting rates of approximately 40%. Malnutrition is associated with many adverse outcomes including depression of the immune system, impaired wound healing, muscle wasting, longer lengths of hospital stay, higher treatment costs and increased mortality. Referral rates for dietetic assessment and treatment of malnourished patients have proven to be suboptimal, thereby increasing the likelihood of developing such aforementioned complications. Nutrition risk screening using a validated tool is a simple technique to rapidly identify patients at risk of malnutrition, and provides a basis for prompt dietetic referrals. In Australia, nutrition screening upon hospital admission is not mandatory, which is of concern knowing that malnutrition remains under-reported and often poorly documented. Unidentified malnutrition not only heightens the risk of adverse complications for patients, but can potentially result in foregone reimbursements to the hospital through casemix-based funding schemes. It is strongly recommended that mandatory nutrition screening be widely adopted in line with published best-practice guidelines to effectively target and reduce the incidence of hospital malnutrition. PMID:21556200

Hospital Malnutrition: Prevalence, Identification and Impact on Patients and the Healthcare System

Directory of Open Access Journals (Sweden)

Timothy C. Crowe

2011-02-01

Full Text Available Malnutrition is a debilitating and highly prevalent condition in the acute hospital setting, with Australian and international studies reporting rates of approximately 40%. Malnutrition is associated with many adverse outcomes including depression of the immune system, impaired wound healing, muscle wasting, longer lengths of hospital stay, higher treatment costs and increased mortality. Referral rates for dietetic assessment and treatment of malnourished patients have proven to be suboptimal, thereby increasing the likelihood of developing such aforementioned complications. Nutrition risk screening using a validated tool is a simple technique to rapidly identify patients at risk of malnutrition, and provides a basis for prompt dietetic referrals. In Australia, nutrition screening upon hospital admission is not mandatory, which is of concern knowing that malnutrition remains under-reported and often poorly documented. Unidentified malnutrition not only heightens the risk of adverse complications for patients, but can potentially result in foregone reimbursements to the hospital through casemix-based funding schemes. It is strongly recommended that mandatory nutrition screening be widely adopted in line with published best-practice guidelines to effectively target and reduce the incidence of hospital malnutrition.

Applied patent RFID systems for building reacting HEPA air ventilation system in hospital operation rooms.

Science.gov (United States)

Lin, Jesun; Pai, Jar-Yuan; Chen, Chih-Cheng

2012-12-01

RFID technology, an automatic identification and data capture technology to provide identification, tracing, security and so on, was widely applied to healthcare industry in these years. Employing HEPA ventilation system in hospital is a way to ensure healthful indoor air quality to protect patients and healthcare workers against hospital-acquired infections. However, the system consumes lots of electricity which cost a lot. This study aims to apply the RFID technology to offer a unique medical staff and patient identification, and reacting HEPA air ventilation system in order to reduce the cost, save energy and prevent the prevalence of hospital-acquired infection. The system, reacting HEPA air ventilation system, contains RFID tags (for medical staffs and patients), sensor, and reacting system which receives the information regarding the number of medical staff and the status of the surgery, and controls the air volume of the HEPA air ventilation system accordingly. A pilot program was carried out in a unit of operation rooms of a medical center with 1,500 beds located in central Taiwan from Jan to Aug 2010. The results found the air ventilation system was able to function much more efficiently with less energy consumed. Furthermore, the indoor air quality could still keep qualified and hospital-acquired infection or other occupational diseases could be prevented.

Impact of 2015 earthquakes on a local hospital in Nepal: A prospective hospital-based study.

Science.gov (United States)

Giri, Samita; Risnes, Kari; Uleberg, Oddvar; Rogne, Tormod; Shrestha, Sanu Krishna; Nygaard, Øystein Petter; Koju, Rajendra; Solligård, Erik

2018-01-01

Natural disasters pose a great challenge to the health systems and individual health facilities. In low-resource settings, disaster preparedness systems are often limited and not been well described. Two devastating earthquakes hit Nepal within a 17-days period in 2015. This study aims to describe the burden and distribution of emergency cases to a local hospital. This is a prospective observational study of patients presenting to a local hospital for a period of 21 days following the earthquake on April 25, 2015. Demographic and clinical information was prospectively registered for all patients in the systematic emergency registry. Systematic telephone interviews were conducted in a random sample of the patients 90 days after admission to the hospital. A total of 2,003 emergency patients were registered during the period. The average daily number of emergency patients during the first five days was almost five times higher (n = 150) than the pre-incident daily average (n = 35). The majority of injuries were fractures (58%), 348 (56%) in the lower extremities. A total of 345 surgical procedures were performed and the hospital treated 111 patients with severe injuries related to the earthquake (compartment syndrome, crush injury, and internal injury). Among those with follow-up interviews, over 90% reported that they had been severely affected by the earthquakes; complete house damage, living in temporary shelter, or loss of close family member. The hospital experienced a very high caseload during the first days, and the majority of patients needed orthopaedic services. The proportion of severely injured and in-hospital deaths were relatively low, probably indicating that the most severely injured did not reach the hospital in time. The experiences underline the need for robust and easily available local health services that can respond to disasters.

Review of Application Development and the Patient Encounter Concept within the University of Iowa Hospital Information System

Science.gov (United States)

Wagner, James R.; Wood, David E.

1982-01-01

The logical structure of the patient data base supporting the University of Iowa Hospital Information System has produced significant management reporting capabilities. A technique is discussed for grouping information concerning the services provided by the hospital during each Patient Encounter that allows subsequent analysis by Medical Episode and Financial Account. The implementation of this data organization structure is discussed in the context of the 13 major health care applications implemented at the University of Iowa Hospitals and Clinics.

Financial Performance of Hospitals in the Mississippi Delta Region Under the Hospital Readmissions Reduction Program and Hospital Value-based Purchasing Program.

Science.gov (United States)

Chen, Hsueh-Fen; Karim, Saleema; Wan, Fei; Nevola, Adrienne; Morris, Michael E; Bird, T Mac; Tilford, J Mick

2017-11-01

Previous studies showed that the Hospital Readmissions Reduction Program (HRRP) and the Hospital Value-based Purchasing Program (HVBP) disproportionately penalized hospitals caring for the poor. The Mississippi Delta Region (Delta Region) is among the most socioeconomically disadvantaged areas in the United States. The financial performance of hospitals in the Delta Region under both HRRP and HVBP remains unclear. To compare the differences in financial performance under both HRRP and HVBP between hospitals in the Delta Region (Delta hospitals) and others in the nation (non-Delta hospitals). We used a 7-year panel dataset and applied difference-in-difference models to examine operating and total margin between Delta and non-Delta hospitals in 3 time periods: preperiod (2008-2010); postperiod 1 (2011-2012); and postperiod 2 (2013-2014). The Delta hospitals had a 0.89% and 4.24% reduction in operating margin in postperiods 1 and 2, respectively, whereas the non-Delta hospitals had 1.13% and 1% increases in operating margin in postperiods 1 and 2, respectively. The disparity in total margins also widened as Delta hospitals had a 1.98% increase in postperiod 1, but a 0.30% reduction in postperiod 2, whereas non-Delta hospitals had 1.27% and 2.28% increases in postperiods 1 and 2, respectively. The gap in financial performance between Delta and non-Delta hospitals widened following the implementation of HRRP and HVBP. Policy makers should modify these 2 programs to ensure that resources are not moved from the communities that need them most.

The Effect of Activating Early Warning System on Motahari Hospital Preparedness

Directory of Open Access Journals (Sweden)

Vahid Delshad

2015-10-01

Full Text Available Background: One of the important aspects of hospital preparedness in disasters is its rapid early warning system. In this study, the activation of early warning system was evaluated under the monitoring of disasters workgroup of the Ministry of Health based on the national program of “hospitals preparedness in disasters” in Shahid Motahari Hospital.  Materials and Methods: The sample was composed of 801 adults exposed to the earthquake. Two months after the earthquake, all subjects were surveyed with measures administrated in a standard order as follows: demographic data sheet, disaster experiences scale (DES, general health questionnaire (GHQ, and symptom checklist 90-revised (SCL-90-R. Results: The results revealed that 23% of the survivors in the exposed group had ASD, 10% had anxiety symptoms, 7.5% depression, 4% MADD, 5% psychosomatic disorders, 10% phobia, 7% aggressive behavior, and 10% insomnia. Conclusion: This article has summarized the current status of information on mental disorders caused by experiencing or witnessing a life threatening severe earthquake. The experience of fear, helplessness, and panic during the earthquake, and the appraisal by the victims of serious psychological, social, as well as demographical consequences after the earthquake, were positively related to the subscale scores and the total score of GHQ, SCL-90-R, and DES.

Pre-hospital care after a seizure: Evidence base and United Kingdom management guidelines.

Science.gov (United States)

Osborne, Andrew; Taylor, Louise; Reuber, Markus; Grünewald, Richard A; Parkinson, Martin; Dickson, Jon M

2015-01-01

Seizures are a common presentation to pre-hospital emergency services and they generate significant healthcare costs. This article summarises the United Kingdom (UK) Ambulance Service guidelines for the management of seizures and explores the extent to which these guidelines are evidence-based. Summary of the Clinical Practice Guidelines of the UK Joint Royal Colleges Ambulance Liaison Committee relating to the management of seizures. Review of the literature relating to pre-hospital management of seizure emergencies. Much standard practice relating to the emergency out of hospital management of patients with seizures is drawn from generic Advanced Life Support (ALS) guidelines although many patients do not need ALS during or after a seizure and the benefit of many ALS interventions in seizure patients remains to be established. The majority of studies identified pertain to medical treatment of status epilepticus. These papers show that benzodiazepines are safe and effective but it is not possible to draw definitive conclusions about the best medication or the optimal route of administration. The evidence base for current pre-hospital guidelines for seizure emergencies is incomplete. A large proportion of patients are transported to hospital after a seizure but many of these may be suitable for home management. However, there is very little research into alternative care pathways or criteria that could be used to help paramedics avoid transport to hospital. More research is needed to improve care for people after a seizure and to improve the cost-effectiveness of the healthcare systems within which they are treated. Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

Performance of freestanding inpatient rehabilitation hospitals before and after the rehabilitation prospective payment system.

Science.gov (United States)

Thompson, Jon M; McCue, Michael J

2010-01-01

Inpatient rehabilitation hospitals provide important services to patients to restore physical and cognitive functioning. Historically, these hospitals have been reimbursed by Medicare under a cost-based system; but in 2002, Medicare implemented a rehabilitation prospective payment system (PPS). Despite the implementation of a PPS for rehabilitation, there is limited published research that addresses the operating and financial performance of these hospitals. We examined operating and financial performance in the pre- and post-PPS periods for for-profit and nonprofit freestanding inpatient rehabilitation hospitals to test for pre- and post-PPS differences within the ownership groups. We identified freestanding inpatient rehabilitation hospitals from the Centers for Medicare and Medicaid Services Health Care Cost Report Information System database for the first two fiscal years under PPS. We excluded facilities that had fiscal years less than 270 days, facilities with missing data, and government facilities. We computed average values for performance variables for the facilities in the two consecutive fiscal years post-PPS. For the pre-PPS period, we collected data on these same facilities and, once facilities with missing data and fiscal years less than 270 days were excluded, computed average values for the two consecutive fiscal years pre-PPS. Our final sample of 140 inpatient rehabilitation facilities was composed of 44 nonprofit hospitals and 96 for-profit hospitals both pre- and post-PPS. We utilized a pairwise comparison test (t-test comparison) to measure the significance of differences on each performance variable between pre- and post-PPS periods within each ownership group. Findings show that both nonprofit and for-profit freestanding inpatient rehabilitation hospitals reduced length of stay, increased discharges, and increased profitability. Within the for-profit ownership group, the percentage of Medicare discharges increased and operating expense per

76 FR 41178 - Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for...

Science.gov (United States)

2011-07-13

... Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment...; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates'' which appeared in the...

Are hospitals ready to response to disasters? Challenges, opportunities and strategies of Hospital Emergency Incident Command System (HEICS

Directory of Open Access Journals (Sweden)

Mohammad Hossein Yarmohammadian

2011-01-01

Full Text Available Background: Applying an effective management system in emergency incidents provides maximum efficiency with using minimum facilities and human resources. Hospital Emergency Incident Command System (HEICS is one of the most reliable emergency incident command systems to make hospitals more efficient and to increase patient safety. This research was to study requirements, barriers, and strategies of HEICS in hospitals affiliated to Isfahan University of Medical Sciences (IUMS. Methods: This was a qualitative research carried out in Isfahan Province, Iran during 2008-09. The study population included senior hospital managers of IUMS and key informants in emergency incident management across Isfahan Province. Sampling method was in non-random purposeful form and snowball technique was used. The research in-strument for data collection was semi-structured interview; collected data was analyzed by Colaizzi Technique. Results: Findings of study were categorized into three general categories including requirements (organizational and sub-organizational, barriers (internal and external of HEICS establishment, and providing short, mid and long term strategies. These categories are explained in details in the main text. Conclusions: Regarding the existing barriers in establishment of HEICS, it is recommended that responsible authori-ties in different levels of health care system prepare necessary conditions for implementing such system as soon as possible via encouraging and supporting systems. This paper may help health policy makers to get reasonable frame-work and have comprehensive view for establishing HEICS in hospitals. It is necessary to consider requirements and viewpoints of stakeholders before any health policy making or planning.

Is the Australian hospital system adequately prepared for terrorism?

Science.gov (United States)

Rosenfeld, Jeffrey V; Fitzgerald, Mark; Kossmann, Thomas; Pearce, Andrew; Joseph, Anthony; Joseph, Andrew; Tan, Gim; Gardner, Michele; Shapira, Shmuel

Australian hospitals need to be prepared to deal with mass casualties from terrorist strikes, including bomb blasts and chemical, biological and radiation injury. Injuries from bomb explosions are more severe than those commonly seen in Australian hospitals. In disasters involving mass casualties in urban areas, many of the injured make their own way to hospital, often arriving before the more seriously injured casualties. Major hospitals in Australia should plan for large numbers of undifferentiated and potentially contaminated casualties arriving with minimal warning. It is critical that experienced and trained senior medical officers perform the triage of casualties in emergency departments, with frequent reassessment to detect missed injuries (especially pulmonary blast injury). Hospitals require well developed standard operating procedures for mass casualty events, reinforced by regular drills. Preparing for a major event includes training staff in major incident management, setting up an operational/control unit, nominating key personnel, ensuring there is an efficient intra-hospital communication system, and enhancing links with other emergency services and hospitals.

Installation and testing of a hospital-based cyclotron for radiation therapy and isotope production

International Nuclear Information System (INIS)

Almond, P.R.; Marbach, J.R.; Otte, V.A.

1983-01-01

A hospital based cyclotron is under installation at The University of Texas M.D. Anderson Hospital in Houston. This machine will be used for the production of radioactive isotopes and for the generation of neutrons for the radiotherapy treatment of cancer. It is a Cyclotron Corporation CP-42 negative proton accelerator. For neutron production the protons are transported through an isocentrically mounted beam transport system that can be rotated around the patient. The shielding requirements of this facility will be described as will the initial measurements on the characteristics of the neutron beam

Thrombus-in-Transit: A Case for a Multidisciplinary Hospital-Based Pulmonary Embolism System of Care.

Science.gov (United States)

Pappas, Anthony J; Knight, Stephen W; McLean, Katherine Zanyk; Bork, Susan; Kurz, Michael C; Sawyer, Kelly N

2016-09-01

Venous thromboembolism, including pulmonary embolism (PE), is a common disease identified in the emergency department that carries significant morbidity and mortality. In its most severe form, PE is fulminant and characterized by cardiac arrest and death. In the midst of risk-stratifying PE by using echocardiography to assess right ventricular function, thrombus-in-transit (free-floating clot in the right atrium or ventricle) may be seen. We present a case of a 49-year-old man diagnosed with an acute saddle PE who was incidentally found to have a thrombus-in-transit and patent foramen ovale and required open thrombectomy. Identification of these additional potentially life-threatening features was possible only due to our availability of risk-stratification resources, specifically bedside echocardiography. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: Albeit rare, with a reported incidence estimated at 4%, the presence of thrombus-in-transit may change emergent clinical management. A multidisciplinary team of resources should be considered emergently as part of a hospital-based PE system of care. Copyright © 2016 Elsevier Inc. All rights reserved.

Hospital Consumer Assessment of Healthcare Providers and Systems: An Ethical Leadership Dilemma to Satisfy Patients.

Science.gov (United States)

Piper, Llewellyn E; Tallman, Erin

2016-01-01

This article examines the parameters and the dynamics of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) that create an ethical leadership dilemma to satisfy patients in the hospital setting while still ensuring appropriate care for quality clinical outcomes. Under the Affordable Care Act, hospitals and health care systems are in a high-stakes struggle of winners and losers based on HCAHPS scores. This high-stakes struggle creates unintended consequences of an ethical dilemma of doing what is right for the patient versus doing whatever it takes to please the patient in order to achieve high scores of satisfaction that are tied to better reimbursements. This article also reports the results of a national survey of 500 chief executive officers by the authors about the attitudes and frustrations of chief executive officers confronting the wild unrest caused by HCAHPS.

Comparing systems for costing hospital treatments. The case of stable angina pectoris.

Science.gov (United States)

Larsen, Jytte; Skjoldborg, Ulla Slothuus

2004-03-01

This paper demonstrates the basic properties in the systems most commonly considered for costing treatments in the Danish hospitals. The differences between the traditional charge system, the DRG system and the ABC system are analysed, and difficulties encountered in comparing these systems are discussed. A sample of patients diagnosed with stable angina pectoris (SAP) at Odense University Hospital was used to compare the three systems when costing an entire treatment path, costing single hospitalisations and studying the effects of length of stay. Furthermore, it is illustrated that the main idea behind each system is reflected in how the systems over- or underestimate costs. Implications when managing the hospitals, particularly reimbursement, are discussed.

Home-Based Telehealth Hospitalization for Exacerbation of Chronic Obstructive Pulmonary Disease

DEFF Research Database (Denmark)

Jakobsen, Anna Svarre; Laursen, Lars C; Rydahl-Hansen, Susan

2015-01-01

Background: Telehealth interventions for patients with chronic obstructive pulmonary disease (COPD) have focused primarily on stable outpatients. Telehealth designed to handle the acute exacerbation that normally requires hospitalization could also be of interest. The aim of this study...... was to compare the effect of home-based telehealth hospitalization with conventional hospitalization for exacerbation in severe COPD. Materials and Methods: A two-center, noninferiority, randomized, controlled effectiveness trial was conducted between June 2010 and December 2011. Patients with severe COPD...... admitted because of exacerbation were randomized 1:1 either to home-based telehealth hospitalization or to continue standard treatment and care at the hospital. The primary outcome was treatment failure defined as re-admission due to exacerbation in COPD within 30 days after initial discharge...

Actuarial assessment of violence risk in hospital-based partner assault clinics.

Science.gov (United States)

Hilton, N Zoe; Harris, Grant T; Holder, Norah

2008-12-01

Hospital-based partner assault clinics are a relatively recent addition to the community response to partner violence. In this study, 66% of 111 women attending hospital clinics for partner assault were physically injured and 43% reported death threats. Few concurrently used other services (shelters or police) and most relied on female friends and relatives for help. Many participants who currently lived with the perpetrator were contemplating leaving but only a third had made plans to do so. Participants faced an unusually high risk of future assault, according to both victim interview using the ODARA actuarial risk assessment and their own perceptions. Findings imply an important role for partner assault clinics and the feasibility of the victim service sector's using the same actuarial risk assessments as the criminal justice system.

Information system maturity and the hospitality enterprise performance

Directory of Open Access Journals (Sweden)

Daniela Garbin Pranicevic

2015-01-01

Full Text Available The purpose of this paper is to empirically evaluate the relationship between the maturity of hotels’ information systems and their performance. This study uses customized models of information system (IS maturity and hotel performance measurement. Since we wanted to include the intangible aspects of performance, we opted for an adapted application of the Balanced Scorecard model. In the empirical part of the paper, fundamental constructs of the model are verified, while the individual items are further evaluated by employing discriminant analysis to distinguish hotels with relatively low and high performance levels. The findings demonstrate the existence of a significant and positive relationship between IS maturity and two dimensions of performance in the hospitality industry – process quality and guest relationships. The level of employee development and financial performance do not seem to be related to IS maturity. Although representative, the sample is relatively small, and the primary data were collected in a single country. The paper provides a framework of IS maturity items in the hospitality industry which seem to contribute to hotels’ business performances. As such, it can serve as a practical framework relevant for IT management in tourism and hospitality. The paper addresses a topic already discussed in a range of industries, although it does not seem to have been empirically evaluated by many studies of the tourism and hospitality industry. In addition, a new theoretical model of IT maturity in tourism and hospitality is proposed.

42 CFR 412.20 - Hospital services subject to the prospective payment systems.

Science.gov (United States)

2010-10-01

... payment systems. 412.20 Section 412.20 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES MEDICARE PROGRAM PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Hospital Services Subject to and Excluded From the Prospective Payment Systems for Inpatient...

The optimality of hospital financing system: the role of physician-manager interactions.

Science.gov (United States)

Crainich, David; Leleu, Hervé; Mauleon, Ana

2008-12-01

The ability of a prospective payment system to ensure an optimal level of both quality and cost reducing activities in the hospital industry has been stressed by Ma (Ma, J Econ Manage Strategy 8(2):93-112, 1994) whose analysis assumes that decisions about quality and costs are made by a single agent. This paper examines whether this result holds when the main decisions made within the hospital are shared between physicians (quality of treatment) and hospital managers (cost reduction). Ma's conclusions appear to be relevant in the US context (where the hospital managers pay the whole cost of treatment). Nonetheless, when physicians partly reimburse hospitals for the treatment cost as it is the case in many European countries, we show that the ability of a prospective payment system to achieve both objectives is sensitive to the type of interaction (simultaneous, sequential or joint decision-making) between the agents. Our analysis suggests that regulation policies in the hospital sector should not be exclusively focused on the financing system but should also take the interaction between physicians and hospital managers into account.

Development and piloting of the Fiji Injury Surveillance in Hospitals System (TRIP Project-1).

Science.gov (United States)

Wainiqolo, I; Kafoa, B; McCaig, E; Kool, B; McIntyre, R; Ameratunga, S

2013-01-01

Whilst more than 90% of injury related deaths are estimated to occur in low-and-middle-income countries (LMICs), the epidemiology of fatal and hospitalised injuries in Pacific Island Countries has received scant attention. This study describes the development and piloting of a population-based trauma registry in Fiji to address this gap in knowledge. The Fiji Injury Surveillance in Hospitals (FISH) system was an active surveillance system designed to identify injuries resulting in death or a hospital admission in Viti Levu, Fiji. During the pilot conducted over five months in 2005, Accident and Emergency registers, admission folders and morgue registers from 8 of Viti Levu's 12 hospitals, and an additional 3 hospitals in other parts of the country were reviewed by hospital staff and medical students to identify cases and extract a minimum data set that included demographic factors; the mechanism, nature and context of injury; substance use; and discharge outcomes. The system was audited to identify and redress difficulties with data quality in a manner that also supported local capacity development and training in injury surveillance and data management. This pilot study demonstrated the potential to collect high quality data on injuries that can pose a significant threat to life in Fiji using a mechanism that also increased the capability of health professionals to recognise the significance of injury as a public health issue. The injury surveillance system piloted provides the opportunity to inform national injury control strategies in Fiji and increase the capacity for injury prevention and more focused research addressing risk factors in the local context. Copyright © 2011 Elsevier Ltd. All rights reserved.

Review of Diagnosis-Related Group-Based Financing of Hospital Care

Directory of Open Access Journals (Sweden)

Natasa Mihailovic

2016-05-01

Full Text Available Since the 1990s, diagnosis-related group (DRG-based payment systems were gradually introduced in many countries. The main design characteristics of a DRG-based payment system are an exhaustive patient case classification system (ie, the system of diagnosis-related groupings and the payment formula, which is based on the base rate multiplied by a relative cost weight specific for each DRG. Cases within the same DRG code group are expected to undergo similar clinical evolution. Consecutively, they should incur the costs of diagnostics and treatment within a predefined scale. Such predictability was proven in a number of cost-of-illness studies conducted on major prosperity diseases alongside clinical trials on efficiency. This was the case with risky pregnancies, chronic obstructive pulmonary disease, diabetes, depression, alcohol addiction, hepatitis, and cancer. This article presents experience of introduced DRG-based payments in countries of western and eastern Europe, Scandinavia, United States, Canada, and Australia. This article presents the results of few selected reviews and systematic reviews of the following evidence: published reports on health system reforms by World Health Organization, World Bank, Organization for Economic Co-operation and Development, Canadian Institute for Health Information, Canadian Health Services Research Foundation, and Centre for Health Economics University of York. Diverse payment systems have different strengths and weaknesses in relation to the various objectives. The advantages of the DRG payment system are reflected in the increased efficiency and transparency and reduced average length of stay. The disadvantage of DRG is creating financial incentives toward earlier hospital discharges. Occasionally, such polices are not in full accordance with the clinical benefit priorities.

Hospitalization Rate and Population-Based Incidence of Hospitalization for Community-Acquired Pneumonia Among Children in Suzhou, China.

Science.gov (United States)

Shan, Wei; Shi, Ting; Zhang, Xiyan; Xue, Jian; Wang, Yin; Yu, Jia; Huang, Yukai; Lin, Sheng; Zhao, Genming; Tian, Jianmei; Zhang, Tao

2018-03-22

Data on hospitalization burden of CAP in children is very limited in China. This study aimed to estimate the hospitalization rate and population-based incidence of hospitalization of CAP for children <15 years of age in Suzhou, China. This was a retrospective study of children hospitalized in Soochow University Affiliated Children's Hospital (SCH) from January 2010 to December 2014. Children who were residents of downtown Suzhou, 29 days to <15 years of age, with discharge diagnosis codes (ICD-10) including J09 to J18 and J20 to J22 were included. All-cause clinical community-acquired pneumonia (CCAP) and radiographically confirmed pneumonia (RCAP) were identified based on individual medical chart review. The hospitalization rate (HR) and population-based cumulative incidence of hospitalization (HI) were calculated. Among 184,734 children <15 years old admitted to SCH during the study period, 31,302 children were identified as having CCAP, and 24,218 (77.4%) children confirmed as having RCAP. CCAP hospitalization occurred year round and peaked during winter and early spring. The overall HRs for CCAP and RCAP were 189.0 (95%CI, 187.1-190.9) and 146.2 (95%CI, 144-148) per 1,000 hospitalizations respectively, and the HIs per 100,000 children annually were CCAP, 3,235.8 (95%CI, 3207.3-3264.2) and RCAP, 2,503.5 (95%CI, 2,478.3-2,528.6). For children <5 years old, the HR for CCAP was 248.4 (95%CI, 245.9-250.9) and RCAP 194.0 (95%CI, 191.4-196.3) per 1,000 hospitalizations; the HI for CCAP was 6,956.2 (95%CI: 6,892.8-7,019.6) and 5,431.9 (95%CI: 5,375.4-5,488.4) per 100,000 children for RCAP. The highest HR and HI were observed in children 29 days to <6 months old: HR for CCAP was 407.4 (95%CI: 400.9-413.9) per 1,000 hospitalizations and HI for CCAP was 11,203.7 (95%CI: 11,026.8-11,380.6) per 100,000 children annually. There is a considerable burden of CAP among children <15 years of age in Suzhou, particularly among children 29 days to <6 months of age and during winter

Policies and practices related to information system adoption in hospitals owned by Ministries of Health in the Arab Gulf.

Science.gov (United States)

Nabali, H M

1992-07-01

This is a discussion paper based on the findings from a study of the factors affecting the adoption of computer-based hospital information systems (CBHIS) in the Arabian Gulf. The study involved on-site visits to hospitals in Bahrain, Kingdom of Saudi Arabia, Kuwait, Qatar and the United Arab Emirates as well as visits to ministries of health in these countries. The focus of this paper is on the adoption of CBHIS by ministry of health (MOH) hospitals, in specific, because of the main role that ministries of health play as providers of health care in the Region. Prior to describing CBHIS adoption practices, an overview of the Region in terms of its economic development and its health care delivery systems is presented. Next, the research setting along with the major findings are briefly described followed by a discussion of the advantages and disadvantages of centralized CBHIS adoptions. Finally, management guidelines related to the adoption of CBHIS by multi-hospital institutions are proposed.

[Microbial air purity in hospitals. Operating theatres with air conditioning system].

Science.gov (United States)

Krogulski, Adam; Szczotko, Maciej

2010-01-01

The aim of this study was to show the influence of air conditioning control for microbial contamination of air inside the operating theatres equipped with correctly working air-conditioning system. This work was based on the results of bacteria and fungi concentration in hospital air obtained since 2001. Assays of microbial air purity conducted on atmospheric air in parallel with indoor air demonstrated that air filters applied in air-conditioning systems worked correctly in every case. To show the problem of fluctuation of bacteria concentration more precisely, every sequences of single results from successive measure series were examined independently.

Automated surveillance system for hospital-acquired urinary tract infections in Denmark

DEFF Research Database (Denmark)

Condell, Orla; Gubbels, Sophie; Nielsen, J

2016-01-01

BACKGROUND: The Danish Hospital-Acquired Infections Database (HAIBA) is an automated surveillance system using hospital administrative, microbiological, and antibiotic medication data. AIM: To define and evaluate the case definition for hospital-acquired urinary tract infection (HA-UTI) and to de......BACKGROUND: The Danish Hospital-Acquired Infections Database (HAIBA) is an automated surveillance system using hospital administrative, microbiological, and antibiotic medication data. AIM: To define and evaluate the case definition for hospital-acquired urinary tract infection (HA-UTI......) and to describe surveillance data from 2010 to 2014. METHODS: The HA-UTI algorithm defined a laboratory-diagnosed UTI as a urine culture positive for no more than two micro-organisms with at least one at ≥10(4)cfu/mL, and a probable UTI as a negative urine culture and a relevant diagnosis code or antibiotic...... treatment. UTI was considered hospital-acquired if a urine sample was collected ≥48h after admission and UTI was calculated per 10,000 risk-days. For validation, prevalence was calculated for each day and compared to point prevalence survey (PPS) data. FINDINGS: HAIBA...

An investigation on physicians' acceptance of hospital information systems: a case study.

Science.gov (United States)

Chen, Rai-Fu; Hsiao, Ju-Ling

2012-12-01

Information technology is used to support a wide range of highly specified healthcare tasks and services. There is, therefore, a need to understand the factors affecting the acceptance of this technology by healthcare professionals. Physicians are key providers of healthcare services and are among the principal users of hospital information systems. Their acceptance of hospital information systems is hence of great significance when evaluating the success of those systems. The survey methodology was employed to targeted physicians in the selected case hospital for investigating factors affecting physicians' acceptance of hospital information systems. A total of 202 questionnaires were sent out, with 124 completed copies returned, indicating a valid response rate of 61.4%. We used structural equation modeling to analyze the data. The results indicated that top management support (γ=0.431, psystem quality (γ=0.369, pinformation systems. Physicians' perceptions of the usefulness (β=0.132, pinformation systems had a significant impact on the acceptance of the systems, accounting for 81.4% of total explained variance. Through the understanding of the identified critical factors affecting physicians' HIS acceptance, the planners and managers should ensure that hospital information systems to be introduced into a hospital are useful and ease to use. Effort should be focuses on providing sufficient top management support, selecting qualified project team members, and delivering higher system quality in addressing physicians' clinical needs. Thus, our research results can help planners and managers understand key considerations affecting HIS development and use, and may be used as a reference for system design, development and implementation. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

Determinants of quality management systems implementation in hospitals.

Science.gov (United States)

Wardhani, Viera; Utarini, Adi; van Dijk, Jitse Pieter; Post, Doeke; Groothoff, Johan Willem

2009-03-01

To identify the problems and facilitating factors in the implementation of quality management system (QMS) in hospitals through a systematic review. A search strategy was performed on the Medline database for articles written in English published between 1992 and early 2006. Using the thesaurus terms 'Total Quality Management' and 'Quality Assurance Health Care', combined with the term 'hospital' and 'implement*', we identified 533 publications. The screening process was based on empirical articles describing organization-wide QMS implementation. Fourteen empirical articles fulfilled the inclusion criteria and were reviewed in this paper. An organization culture emphasizing standards and values associated with affiliation, teamwork and innovation, assumption of change and risk taking, play as the key success factor in QMS implementation. This culture needs to be supported by sufficient technical competence to apply a scientific problem-solving approach. A clear distribution of QMS function within the organizational structure is more important than establishing a formal quality structure. In addition to management leadership, physician involvement also plays an important role in implementing QMS. Six supporting and limiting factors determining QMS implementation are identified in this review. These are the organization culture, design, leadership for quality, physician involvement, quality structure and technical competence.

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.

Optimizing Travel Time to Outpatient Interventional Radiology Procedures in a Multi-Site Hospital System Using a Google Maps Application.

Science.gov (United States)

Mandel, Jacob E; Morel-Ovalle, Louis; Boas, Franz E; Ziv, Etay; Yarmohammadi, Hooman; Deipolyi, Amy; Mohabir, Heeralall R; Erinjeri, Joseph P

2018-02-20

The purpose of this study is to determine whether a custom Google Maps application can optimize site selection when scheduling outpatient interventional radiology (IR) procedures within a multi-site hospital system. The Google Maps for Business Application Programming Interface (API) was used to develop an internal web application that uses real-time traffic data to determine estimated travel time (ETT; minutes) and estimated travel distance (ETD; miles) from a patient's home to each a nearby IR facility in our hospital system. Hypothetical patient home addresses based on the 33 cities comprising our institution's catchment area were used to determine the optimal IR site for hypothetical patients traveling from each city based on real-time traffic conditions. For 10/33 (30%) cities, there was discordance between the optimal IR site based on ETT and the optimal IR site based on ETD at non-rush hour time or rush hour time. By choosing to travel to an IR site based on ETT rather than ETD, patients from discordant cities were predicted to save an average of 7.29 min during non-rush hour (p = 0.03), and 28.80 min during rush hour (p travel time when more than one location providing IR procedures is available within the same hospital system.

The interRAI Acute Care instrument incorporated in an eHealth system for standardized and web-based geriatric assessment: strengths, weaknesses, opportunities and threats in the acute hospital setting

Science.gov (United States)

2013-01-01

Background The interRAI Acute Care instrument is a multidimensional geriatric assessment system intended to determine a hospitalized older persons’ medical, psychosocial and functional capacity and needs. Its objective is to develop an overall plan for treatment and long-term follow-up based on a common set of standardized items that can be used in various care settings. A Belgian web-based software system (BelRAI-software) was developed to enable clinicians to interpret the output and to communicate the patients’ data across wards and care organizations. The purpose of the study is to evaluate the (dis)advantages of the implementation of the interRAI Acute Care instrument as a comprehensive geriatric assessment instrument in an acute hospital context. Methods In a cross-sectional multicenter study on four geriatric wards in three acute hospitals, trained clinical staff (nurses, occupational therapists, social workers, and geriatricians) assessed 410 inpatients in routine clinical practice. The BelRAI-system was evaluated by focus groups, observations, and questionnaires. The Strengths, Weaknesses, Opportunities and Threats were mapped (SWOT-analysis) and validated by the participants. Results The primary strengths of the BelRAI-system were a structured overview of the patients’ condition early after admission and the promotion of multidisciplinary assessment. Our study was a first attempt to transfer standardized data between home care organizations, nursing homes and hospitals and a way to centralize medical, allied health professionals and nursing data. With the BelRAI-software, privacy of data is guaranteed. Weaknesses are the time-consuming character of the process and the overlap with other assessment instruments or (electronic) registration forms. There is room for improving the user-friendliness and the efficiency of the software, which needs hospital-specific adaptations. Opportunities are a timely and systematic problem detection and continuity of

Health care information systems and formula-based reimbursement: an empirical study.

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Palley, M A; Conger, S

1995-01-01

Current initiatives in health care administration use formula-based approaches to reimbursement. Examples of such approaches include capitation and diagnosis related groups (DRGs). These approaches seek to contain medical costs and to facilitate managerial control over scarce health care resources. This article considers various characteristics of formula-based reimbursement, their operationalization on hospital information systems, and how these relate to hospital compliance costs.

Pervasive Computing Support for Hospitals: An Overview of the Activity-Based Computing Project

DEFF Research Database (Denmark)

Christensen, Henrik Bærbak; Bardram, Jakob E

2007-01-01

The activity-based computing project researched pervasive computing support for clinical hospital work. Such technologies have potential for supporting the mobile, collaborative, and disruptive use of heterogeneous embedded devices in a hospital......The activity-based computing project researched pervasive computing support for clinical hospital work. Such technologies have potential for supporting the mobile, collaborative, and disruptive use of heterogeneous embedded devices in a hospital...

Case Mix Management Systems: An Opportunity to Integrate Medical Records and Financial Management System Data Bases

OpenAIRE

Rusnak, James E.

1987-01-01

Due to previous systems selections, many hospitals (health care facilities) are faced with the problem of fragmented data bases containing clinical, demographic and financial information. Projects to select and implement a Case Mix Management System (CMMS) provide an opportunity to reduce the number of separate physical files and to migrate towards systems with an integrated data base. The number of CMMS candidate systems is often restricted due to data base and system interface issues. The h...

THE IMPACT OF HOSPITAL BASED INTEGRATED MANAGEMENT OF CHILDHOOD ILLNESS TRAINING ON PEDIATRIC NURSE COMPETENCY

Directory of Open Access Journals (Sweden)

Fitri Haryanti

2018-02-01

Full Text Available Background: Although the WHO strategy integrated management of childhood illness (IMCI for primary care has been implemented in over 100 countries, there is less global experience with hospital-based IMCI training. Until recently, no training had been done in Indonesia, and globally there has been limited experience of the role of IMCI in rebuilding health systems after complex emergencies. Objective: We aimed to examine the effect of hospital-based IMCI training on pedicatric nurse competency and explore the perception of Indonesian doctors, nurse managers and paediatricians about IMCI training and its development in West Aceh, a region that was severely affected by the South-Asian tsunami in December 2004. Methods: This study used stepped wedge design. Training was conducted for 39 nurses staff, 13 midwifes, 6 Head nurses, 5 manager of nurses, 5 doctors, 1 paediatricians, and 3 support facilities (nutritionist, pharmacist, laboratory in Cut Nyak Dien (CND Hospital in Meulaboh, West Aceh, Indonesia. The IMCI training was developed based on the WHO Pocketbook of Hospital Care for Children. A nurses competency questionnaire was used based on the guideline of assessment of the quality of child health services at the first level reference hospitals in districts / municipalities issued by the Ministry of Health in 2007. A linear mixed model was used for data analysis. Results: The hospital based IMCI training improved the competences of nurses paediatric in assessing emergency signs of the sick children, management of cough and difficulty breathing, diarrhoea, fever, nutritional problems, supportive care, monitoring, discharge planning and follow up. The assessment highlighted several problems in adaptation process of material training, training process and implementation in an environment soon after a major disaster. Conclusion: Hospital based IMCI training can be implemented in a setting after major disasters or internal conflict as part of a

The Role of Hospital Information Systems in Universal Health Coverage Monitoring in Rwanda.

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Karara, Gustave; Verbeke, Frank; Nyssen, Marc

2015-01-01

In this retrospective study, the authors monitored the patient health coverage in 6 Rwandan hospitals in the period between 2011 and 2014. Among the 6 hospitals, 2 are third level hospitals, 2 district hospitals and 2 private hospitals. Patient insurance and financial data were extracted and analyzed from OpenClinic GA, an open source hospital information system (HIS) used in those 6 hospitals. The percentage of patients who had no health insurer globally decreased from 35% in 2011 to 15% in 2014. The rate of health insurance coverage in hospitals varied between 75% in private hospitals and 84% in public hospitals. The amounts paid by the patients for health services decreased in private hospitals to 25% of the total costs in 2014 (-7.4%) and vary between 14% and 19% in public hospitals. Although the number of insured patients has increased and the patient share decreased over the four years of study, the patients' out-of-pocket payments increased especially for in-patients. This study emphasizes the value of integrated hospital information systems for this kind of health economics research in developing countries.

Microcomputer-based workforce scheduling for hospital porters.

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Lin, C K

1999-01-01

This paper focuses on labour scheduling for hospital porters who are the major workforce providing routine cleansing of wards, transportation and messenger services. Generating an equitable monthly roster for porters while meeting the daily minimum demand is a tedious task scheduled manually by a supervisor. In considering a variety of constraints and goals, a manual schedule was usually produced in seven to ten days. To be in line with the strategic goal of scientific management of an acute care regional hospital in Hong Kong, a microcomputer-based algorithm was developed to schedule the monthly roster. The algorithm, coded in Digital Visual Fortran 5.0 Professional, could generate a monthly roster in seconds. Implementation has been carried out since September 1998 and the results proved to be useful to hospital administrators and porters. This paper discusses both the technical and human issues involved during the computerization process.

Implementation of a radiology information system in an University Hospital

International Nuclear Information System (INIS)

Marques, Paulo Mazzoncini de Azevedo; Santos, Antonio Carlos; Elias Junior, Jorge; Trad, Clovis Simao; Goes, Wilson Moraes; Castro, Carlos Roberto de

2000-01-01

This paper describes a radiology information system (RIS) developed and in the process of implementation in an University Hospital (Hospital das Clinicas da Faculdade de Medicina de Ribeirao Preto - Universidade de Sao Paulo) which integrates a plan for a 'filmless' radiology facility. (author)

Talking about quality: exploring how 'quality' is conceptualized in European hospitals and healthcare systems.

Science.gov (United States)

Wiig, Siri; Aase, Karina; von Plessen, Christian; Burnett, Susan; Nunes, Francisco; Weggelaar, Anne Marie; Anderson-Gare, Boel; Calltorp, Johan; Fulop, Naomi

2014-10-11

Conceptualization of quality of care - in terms of what individuals, groups and organizations include in their meaning of quality, is an unexplored research area. It is important to understand how quality is conceptualised as a means to successfully implement improvement efforts and bridge potential disconnect in language about quality between system levels, professions, and clinical services. The aim is therefore to explore and compare conceptualization of quality among national bodies (macro level), senior hospital managers (meso level), and professional groups within clinical micro systems (micro level) in a cross-national study. This cross-national multi-level case study combines analysis of national policy documents and regulations at the macro level with semi-structured interviews (383) and non-participant observation (803 hours) of key meetings and shadowing of staff at the meso and micro levels in ten purposively sampled European hospitals (England, the Netherlands, Portugal, Sweden, and Norway). Fieldwork at the meso and micro levels was undertaken over a 12-month period (2011-2012) and different types of micro systems were included (maternity, oncology, orthopaedics, elderly care, intensive care, and geriatrics). The three quality dimensions clinical effectiveness, patient safety, and patient experience were incorporated in macro level policies in all countries. Senior hospital managers adopted a similar conceptualization, but also included efficiency and costs in their conceptualization of quality. 'Quality' in the forms of measuring indicators and performance management were dominant among senior hospital managers (with clinical and non-clinical background). The differential emphasis on the three quality dimensions was strongly linked to professional roles, personal ideas, and beliefs at the micro level. Clinical effectiveness was dominant among physicians (evidence-based approach), while patient experience was dominant among nurses (patient

An evaluation of systemic reforms of public hospitals: the Sanming model in China.

Science.gov (United States)

Fu, Hongqiao; Li, Ling; Li, Mingqiang; Yang, Chunyu; Hsiao, William

2017-10-01

Low- and middle-income countries (LMICs) have been searching for effective strategies to reform their inefficient and wasteful public hospitals. Recently, China developed a model of systemic reforms called the Sanming model to address the inefficiency and waste at public hospitals. In this article, we explain and evaluate how the Sanming model reformed its 22 public hospitals in 2013 by simultaneously restructuring the hospital governance structure, altering the payment system to hospitals, and realigning physicians' incentives. By employing the difference-in-difference (DID) method and using the hospital-level data from 187 public hospitals in Fujian province, we find that the Sanming model has reduced medical costs significantly without measurably sacrificing clinical quality and productive efficiency. The systemic reform, on average, has reduced the medical care cost per outpatient visit and per inpatient admission by 6.1% (P-value = 0.0445) and 15.4% (P-value transformation of public hospitals, where the governance structure, payment system and physician compensation methods are aligned, are crucial to improving their performance; it holds critical lessons for China and other LMICs. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

[Relationship between cost systems and hospital expenditure].

Science.gov (United States)

García-Cornejo, Beatriz; Pérez-Méndez, José A

To analyze the relationship between the degree of development of hospital cost systems (CS) implemented by the regional health services (RHS) and the variation in unit cost of hospitals in Spanish National Health Service (NHS) between 2010 and 2013 and to identify other explanatory factors of this variation. A database of NHS hospitals was constructed from exclusively public sources. Using a multilevel regression model, explaining factors of the variation in unit cost (cost per weighted unit of activity [WAU]) of a sample of 170 hospitals were analyzed. The variables representative of the degree of development of CS are associated in a negative and significant way with the variation of the cost per WAU. It is observed that if a high-level development CS is used the cost variation per WAU would be reduced by close to 3.2%. There is also a negative and significant relationship between the variation in the cost per WAU and the variations in the percentage of high technology and the hospital occupancy rate. On the other hand, the variations in the average cost of personnel and in the number of workers per 100 beds are associated in a positive and significant way with the variation of the cost per WAU. In the period analysed, during which the main health expenditure adjustment was made, the control in hospital unit cost is associated not only with spending cuts but also with aspects related to their management, such as the implementation of more developed CS. Copyright © 2017 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

76 FR 39006 - Medicare Program; Hospital Inpatient Value-Based Purchasing Program; Correction

Science.gov (United States)

2011-07-05

... and 480 [CMS-3239-CN] RIN 0938-AQ55 Medicare Program; Hospital Inpatient Value-Based Purchasing... Value-Based Purchasing Program.'' DATES: Effective Date: These corrections are effective on July 1, 2011... for the hospital value-based purchasing program. Therefore, in section III. 6. and 7. of this notice...

Hospital distribution in a metropolitan city: assessment by a geographical information system grid modelling approach

Directory of Open Access Journals (Sweden)

Kwang-Soo Lee

2014-05-01

Full Text Available Grid models were used to assess urban hospital distribution in Seoul, the capital of South Korea. A geographical information system (GIS based analytical model was developed and applied to assess the situation in a metropolitan area with a population exceeding 10 million. Secondary data for this analysis were obtained from multiple sources: the Korean Statistical Information Service, the Korean Hospital Association and the Statistical Geographical Information System. A grid of cells measuring 1 × 1 km was superimposed on the city map and a set of variables related to population, economy, mobility and housing were identified and measured for each cell. Socio-demographic variables were included to reflect the characteristics of each area. Analytical models were then developed using GIS software with the number of hospitals as the dependent variable. Applying multiple linear regression and geographically weighted regression models, three factors (highway and major arterial road areas; number of subway entrances; and row house areas were statistically significant in explaining the variance of hospital distribution for each cell. The overall results show that GIS is a useful tool for analysing and understanding location strategies. This approach appears a useful source of information for decision-makers concerned with the distribution of hospitals and other health care centres in a city.

Ranking Hospitals Based on Colon Surgery and Abdominal Hysterectomy Surgical Site Infection Outcomes: Impact of Limiting Surveillance to the Operative Hospital.

Science.gov (United States)

Yokoe, Deborah S; Avery, Taliser R; Platt, Richard; Kleinman, Ken; Huang, Susan S

2018-03-16

Hospital-specific surgical site infection (SSI) performance following colon surgery and abdominal hysterectomies can impact hospitals' relative rankings around quality metrics used to determine financial penalties. Current SSI surveillance largely focuses on SSI detected at the operative hospital. Retrospective cohort study to assess the impact on hospitals' relative SSI performance rankings when SSI detected at non-operative hospitals are included. We utilized data from a California statewide hospital registry to assess for evidence of SSI following colon surgery or abdominal hysterectomies performed 3/1/2011-11/30/2013 using previously validated claims-based SSI surveillance methods. Risk-adjusted hospital-specific rankings based on SSI detected at operative hospitals versus any California hospital were generated. Among 60,059 colon surgeries at 285 hospitals and 64,918 abdominal hysterectomies at 270 hospitals, 5,921 (9.9%) colon surgeries and 1,481 (2.3%) abdominal hysterectomies received a diagnosis code for SSI within the 30 days following surgery. 7.2% of colon surgery and 13.4% of abdominal hysterectomy SSI would have been missed by operative hospital surveillance alone. The proportion of individual hospital's SSI detected during hospitalizations at other hospitals varied widely. Including non-operative hospital SSI resulted in improved relative ranking of 11 (3.9%) colon surgery and 13 (4.8%) hysterectomy hospitals so that they were no longer in the worst performing quartile, mainly among hospitals with relatively high surgical volumes. Standard SSI surveillance that mainly focuses on infections detected at the operative hospital causes varying degrees of SSI under-estimation, leading to inaccurate assignment or avoidance of financial penalties for approximately one in eleven to sixteen hospitals.

Is the Colombian health system reform improving the performance of public hospitals in Bogotá?

Science.gov (United States)

McPake, Barbara; Yepes, Francisco Jose; Lake, Sally; Sanchez, Luz Helena

2003-06-01

Many countries are experimenting with public hospital reform - both increasing the managerial autonomy with which hospitals conduct their affairs, and separating 'purchaser' and 'provider' sides of the health system, thus increasing the degree of market pressure brought to bear on hospitals. Evidence suggesting that such reform will improve hospital performance is weak. From a theoretical perspective, it is not clear why public hospitals should be expected to behave like firms and seek to maximize profits as this model requires. Empirically, there is very slight evidence that such reforms may improve efficiency, and reason to be concerned about their equity implications. In Colombia, an ambitious reform programme includes among its measures the attempt to universalize a segmented health system, the creation of a purchaser-provider split and the transformation of public hospitals into 'autonomous state entities'. By design, the Colombian reform programme avoids the forces that produce equity losses in other developing countries. This paper reports the results of a study that has tried to track hospital performance in other dimensions in the post-reform period in Bogotá. Trends in hospital inputs, production and productivity, quality and patient satisfaction are presented, and qualitative data based on interviews with hospital workers are analyzed. The evidence we have been able to collect is capable of providing only a partial response to the study question. There is some evidence of increased activity and productivity and sustained quality despite declining staffing levels. Qualitative data suggest that hospital workers have noticed considerable changes, which include greater responsiveness to patients but also a heavier administrative burden. It is difficult to attribute specific causality to all of the changes measured and this reflects the inherent difficulty of judging the effects of large-scale reform programmes as well as weaknesses and gaps in the data

Hospital medication errors in a pharmacovigilance system in Colombia

Directory of Open Access Journals (Sweden)

Jorge Enrique Machado-Alba

2015-11-01

Full Text Available Objective: this study analyzes the medication errors reported to a pharmacovigilance system by 26 hospitals for patients in the healthcare system of Colombia. Methods: this retrospective study analyzed the medication errors reported to a systematized database between 1 January 2008 and 12 September 2013. The medication is dispensed by the company Audifarma S.A. to hospitals and clinics around Colombia. Data were classified according to the taxonomy of the National Coordinating Council for Medication Error Reporting and Prevention (NCC MERP. The data analysis was performed using SPSS 22.0 for Windows, considering p-values < 0.05 significant. Results: there were 9 062 medication errors in 45 hospital pharmacies. Real errors accounted for 51.9% (n = 4 707, of which 12.0% (n = 567 reached the patient (Categories C to I and caused harm (Categories E to I to 17 subjects (0.36%. The main process involved in errors that occurred (categories B to I was prescription (n = 1 758, 37.3%, followed by dispensation (n = 1 737, 36.9%, transcription (n = 970, 20.6% and administration (n = 242, 5.1%. The errors in the administration process were 45.2 times more likely to reach the patient (CI 95%: 20.2–100.9. Conclusions: medication error reporting systems and prevention strategies should be widespread in hospital settings, prioritizing efforts to address the administration process.

Does Hospitalization Predict the Disease Course in Ulcerative Colitis? Prevalence and Predictors of Hospitalization and Re-Hospitalization in Ulcerative Colitis in a Population-based Inception Cohort (2000-2012).

Science.gov (United States)

Golovics, Petra A; Lakatos, Laszlo; Mandel, Michael D; Lovasz, Barbara D; Vegh, Zsuzsanna; Kurti, Zsuzsanna; Szita, Istvan; Kiss, Lajos S; Balogh, Mihaly; Pandur, Tunde; Lakatos, Peter L

2015-09-01

Limited data are available on the hospitalization rates in population-based studies. Since this is a very important outcome measure, the aim of this study was to analyze prospectively if early hospitalization is associated with the later disease course as well as to determine the prevalence and predictors of hospitalization and re-hospitalization in the population-based ulcerative colitis (UC) inception cohort in the Veszprem province database between 2000 and 2012. Data of 347 incident UC patients diagnosed between January 1, 2000 and December 31, 2010 were analyzed (M/F: 200/147, median age at diagnosis: 36, IQR: 26-50 years, follow-up duration: 7, IQR 4-10 years). Both in- and outpatient records were collected and comprehensively reviewed. Probabilities of first UC-related hospitalization were 28.6%, 53.7% and 66.2% and of first re-hospitalization were 23.7%, 55.8% and 74.6% after 1-, 5- and 10- years of follow-up, respectively. Main UC-related causes for first hospitalization were diagnostic procedures (26.7%), disease activity (22.4%) or UC-related surgery (4.8%), but a significant percentage was unrelated to IBD (44.8%). In Kaplan-Meier and Cox-regression analysis disease extent at diagnosis (HR extensive: 1.79, p=0.02) or at last follow-up (HR: 1.56, p=0.001), need for steroids (HR: 1.98, p<0.001), azathioprine (HR: 1.55, p=0.038) and anti-TNF (HR: 2.28, p<0.001) were associated with the risk of UC-related hospitalization. Early hospitalization was not associated with a specific disease phenotype or outcome; however, 46.2% of all colectomies were performed in the year of diagnosis. Hospitalization and re-hospitalization rates were relatively high in this population-based UC cohort. Early hospitalization was not predictive for the later disease course.

Incidences and variations of hospital acquired venous thromboembolism in Australian hospitals: a population-based study.

Science.gov (United States)

Assareh, Hassan; Chen, Jack; Ou, Lixin; Hillman, Ken; Flabouris, Arthas

2016-09-22

Data on hospital-acquired venous thromboembolism (HA-VTE) incidence, case fatality rate and variation amongst patient groups and health providers is lacking. We aim to explore HA-VTE incidences, associated mortality, trends and variations across all acute hospitals in New South Wales (NSW)-Australia. A population-based study using all admitted patients (aged 18-90 with a length of stay of at least two days and not transferred to another acute care facility) in 104 NSW acute public and private hospitals during 2002-2009. Poisson mixed models were used to derive adjusted rate ratios (IRR) in presence of patient and hospital characteristics. Amongst, 3,331,677 patients, the incidence of HA-VTE was 11.45 per 1000 patients and one in ten who developed HA-VTE died in hospital. HA-VTE incidence, initially rose, but subsequently declined, whereas case fatality rate consistently declined by 22 % over the study period. Surgical patients were 128 % (IRR = 2.28, 95 % CI: 2.19-2.38) more likely to develop HA-VTE, but had similar case fatality rates compared to medical patients. Private hospitals, in comparison to public hospitals had a higher incidence of HA-VTE (IRR = 1.76; 95 % CI: 1.42-2.18) for medical patients. However, they had a similar incidence (IRR = 0.91; 95 % CI: 0.75-1.11), but a lower mortality (IRR = 0.59; 95 % CI: 0.47-0.75) amongst surgical patients. Smaller public hospitals had a lower HA-VTE incidence rate compared to larger hospitals (IRR  1.71). Hospitals with a lower reported HA-VTE incidence tended to have a higher HA-VTE case fatality rate. Despite the decline in HA-VTE incidence and case fatality, there were large variations in incidents between medical and surgical patients, public and private hospitals, and different hospital groups. The causes of such differences warrant further investigation and may provide potential for targeted interventions and quality improvement initiatives.

Hyper Hospital on the satellite multi-media network.

Science.gov (United States)

Yamaguchi, T

1997-01-01

We have been developing the Hyper Hospital, a network based VR mediated medical care system. The Hyper Hospital is composed of two seamlessly integrated environments, that is, the virtual and the real worlds. Of them, its virtual environment expands the conventional medical care system using the virtual reality technology as a principal human interface and a collaboration tool, in the present study, an attempt to extend the Hyper Hospital system to various modalities of communication network is reported. A satellite communication based multi-media network using Internet protocols with the WWW interface is used. Data transmission rate and other performances were measured under various conditions and the satellite network was shown to be suitable to the Hyper Hospital network.

Service Robots for Hospitals: A Case Study of Transportation Tasks in a Hospital

DEFF Research Database (Denmark)

Özkil, Ali Gürcan; Fan, Zhun; Dawids, Steen

2009-01-01

In this paper, the need for automated transportation systems for hospitals is investigated. Among other alternatives, mobile robots stand out as the most prominent means of automation of transportation tasks in hospitals. Existing transportation routines of a hospital are analyzed in order...... to verify the need for automation and identify possible areas of improvement. The analysis shows that most of the existing transportation is carried out manually, and hospitals can greatly benefit from automated transportation. Based on the results of the analysis, three alternatives are derived...... for implementing mobile service robots for transportation tasks in hospitals....

Do Robotic Surgical Systems Improve Profit Margins? A Cross-Sectional Analysis of California Hospitals.

Science.gov (United States)

Shih, Ya-Chen Tina; Shen, Chan; Hu, Jim C

2017-09-01

The aim of this study was to examine the association between ownership of robotic surgical systems and hospital profit margins. This study used hospital annual utilization data, annual financial data, and discharge data for year 2011 from the California Office of Statewide Health Planning and Development. We first performed bivariate analysis to compare mean profit margin by hospital and market characteristics and to examine whether these characteristics differed between hospitals that had one or more robotic surgical systems in 2011 and those that did not. We applied the t test and the F test to compare mean profit margin between two groups and among three or more groups, respectively. We then conducted multilevel logistic regression to determine the association between ownership of robotic surgical systems and having a positive profit margin after controlling for other hospital and market characteristics and accounting for possible correlation among hospitals located within the same market. The study sample included 167 California hospitals with valid financial information. Hospitals with robotic surgical systems tended to report more favorable profit margins. However, multilevel logistic regression showed that this relationship (an association, not causality) became only marginally significant (odds ratio [OR] = 6.2; P = 0.053) after controlling for other hospital characteristics, such as ownership type, teaching status, bed size, and surgical volumes, and market characteristics, such as total number of robotic surgical systems owned by other hospitals in the same market area. As robotic surgical systems become widely disseminated, hospital decision makers should carefully evaluate the financial and clinical implications before making a capital investment in this technology. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

The effects of for-profit multihospital system ownership on hospital financial and operating performance.

Science.gov (United States)

Lynch, J R; McCue, M J

1990-11-01

The financial and operating performance of independent not-for-profit hospitals acquired by US for-profit multi-hospital systems in 10 Southern states between the years 1978 and 1982 was explored. The impact of system ownership on acquired hospitals was investigated by comparing the average financial performance of hospitals in the two years immediately prior to acquisition to the average for 1984 and 1985 and by comparing changes in the performance of acquired hospitals with changes in matched independent facilities. Findings suggest that for-profit multi-hospital systems were able to improve many of the financial and operating problems of acquired facilities. In comparison to independent not-for-profit hospitals, acquired hospitals were found to increase access to long-term debt, make improvements to plant and equipment, improve profitability, and increase efficiency to a greater extent. Prices in acquired hospitals rose more than those in independents and liquidity decreased to a greater extent.

Characterization of hospitalizations due to external causes in the public health system, Brazil, 2011.

Science.gov (United States)

Mascarenhas, Márcio Dênis Medeiros; Barros, Marilisa Berti de Azevedo

2015-01-01

The aim of this work is to describe the characteristics of hospital admissions owing to external causes in the public health system in Brazil in 2011. Data from the Hospital Information System of the Unified Health System (SIH/SUS) were analyzed to obtain the frequency, coefficient of hospitalization, and hospital morbidity indicators. Of the 973,015 admissions, falls (38.4%) predominated, followed by traffic accidents (15.8%). The estimated coefficient of hospitalization owing to external causes increased with the age, and it was higher in male patients and in the midwest region of the country. The average stay was higher in hospitalizations for traffic accidents (6.1 days) and assaults (6.0 days), while the hospital mortality rate reached higher values in hospitalizations for assaults (4.7%) and self-harms (4.0%). It is evident from the knowledge of the characteristics described the usefulness of hospital morbidity data for planning care actions and prevention of the external causes.

The Economic Standpoint of Referral System at Using Tertiary Hospital Services in Iran

Directory of Open Access Journals (Sweden)

Samad Rouhani

2017-03-01

Full Text Available Background and purpose: Although, economically, referral systems make utilization of health facilities at different levels sound, in many countries caretakers often bypass primary care facilities that are regularly costlier for caretakers and health care systems. The main objective of the current study was to assess the utilization of hospital services with more emphasis on economic point of view.  Materials and methods: The present study was a facility-based cross-sectional study. A researcher developed questionnaire was used to collect the data. The samples were randomly selected and interviewed on their consent. SPSS Software was also used to analyze the collected data through Chi-2, correlation, and t-test. Results: Just 29.4 percent of the attendees to the hospital were carrying out a referral slip from their family medicine. Five variables including type of care, type of attending, appointment arrangement, satisfaction with family medicine, and vising family medicine were statistically analyzed and found significantly related to carrying referral slip. Conclusion: Because of dysfunction of referral system, Iran’s health care system was found to be far from achieving economic advantages of a referral based DHS. It is actually an inappropriate use of limited health resources in a country like Iran that seriously suffers from shortage of financial and health system resources. This is likely due to deficiencies in the components of its referral system, therefore, a full revision of current reforms and appropriate remedies for deficiencies in the components of referral system was found to be in top priority in Iran.

Activity-based costs of blood transfusions in surgical patients at four hospitals.

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Shander, Aryeh; Hofmann, Axel; Ozawa, Sherri; Theusinger, Oliver M; Gombotz, Hans; Spahn, Donat R

2010-04-01

Blood utilization has long been suspected to consume more health care resources than previously reported. Incomplete accounting for blood costs has the potential to misdirect programmatic decision making by health care systems. Determining the cost of supplying patients with blood transfusions requires an in-depth examination of the complex array of activities surrounding the decision to transfuse. To accurately determine the cost of blood in a surgical population from a health system perspective, an activity-based costing (ABC) model was constructed. Tasks and resource consumption (materials, labor, third-party services, capital) related to blood administration were identified prospectively at two US and two European hospitals. Process frequency (i.e., usage) data were captured retrospectively from each hospital and used to populate the ABC model. All major process steps, staff, and consumables to provide red blood cell (RBC) transfusions to surgical patients, including usage frequencies, and direct and indirect overhead costs contributed to per-RBC-unit costs between $522 and $1183 (mean, $761 +/- $294). These exceed previously reported estimates and were 3.2- to 4.8-fold higher than blood product acquisition costs. Annual expenditures on blood and transfusion-related activities, limited to surgical patients, ranged from $1.62 to $6.03 million per hospital and were largely related to the transfusion rate. Applicable to various hospital practices, the ABC model confirms that blood costs have been underestimated and that they are geographically variable and identifies opportunities for cost containment. Studies to determine whether more stringent control of blood utilization improves health care utilization and quality, and further reduces costs, are warranted.

A Novel Health Information Technology Communication System to Increase Caregiver Activation in the Context of Hospital-Based Pediatric Hematopoietic Cell Transplantation: A Pilot Study.

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Maher, Molly; Hanauer, David A; Kaziunas, Elizabeth; Ackerman, Mark S; Derry, Holly; Forringer, Rachel; Miller, Kristen; O'Reilly, Dennis; An, Lawrence; Tewari, Muneesh; Choi, Sung Won

2015-10-27

Pediatric hematopoietic cell transplantation (HCT), commonly referred to as blood and marrow transplantation (BMT), is an intense treatment modality that requires the involvement of engaged caregivers during the patient's (child's) prolonged hospitalization. The ubiquity of electronic health records (EHRs) and a trend toward patient-centered care could allow a novel health information technology (IT) system to increase parental engagement. The paucity of research on acute care, hospital-based (inpatient) health IT applications for patients or caregivers provides an opportunity for testing the feasibility of such applications. The pediatric BMT population represents an ideal patient group to conduct an evaluation due to the lengthy inpatient stays and a heightened need for patient activation. The primary objective of this study is to assess the feasibility of implementing the BMT Roadmap in caregivers as an intervention during their child's inpatient hospitalization. The BMT Roadmap is an inpatient portal prototype optimized for tablet with a user-centered design. It integrates patient-specific laboratory and medication data from the EHR in real-time and provides support in terms of discharge goals, home care education, and other components. Feasibility will be proven if (1) the BMT Roadmap functions and can be managed by the study team without unexpected effort, (2) the system is accessed by users at a defined minimum threshold, and (3) the qualitative and quantitative research conducted provides quality data that address the perceived usefulness of the BMT Roadmap and could inform a study in a larger sample size. This will be a single-arm, nonrandomized feasibility study. We aim to enroll 10 adult caregivers (age ≥ 18 years) of pediatric patients (aged 0-25 years) undergoing autologous (self-donor) or allogeneic (alternative donor) BMT. Assenting minors (aged 10-18) will also be invited to participate. Recruitment of study participants will take place in the

Validity of a hospital-based obstetric register using medical records as reference

DEFF Research Database (Denmark)

Brixval, Carina Sjöberg; Thygesen, Lau Caspar; Johansen, Nanna Roed

2015-01-01

BACKGROUND: Data from hospital-based registers and medical records offer valuable sources of information for clinical and epidemiological research purposes. However, conducting high-quality epidemiological research requires valid and complete data sources. OBJECTIVE: To assess completeness...... and validity of a hospital-based clinical register - the Obstetric Database - using a national register and medical records as references. METHODS: We assessed completeness of a hospital-based clinical register - the Obstetric Database - by linking data from all women registered in the Obstetric Database...... Database therefore offers a valuable source for examining clinical, administrative, and research questions....

Study on the standardization of hospital information system for medical image information sharing

International Nuclear Information System (INIS)

Kim, Seon Chil; Kwon, Su Ja

2001-01-01

As the adoption of PACS and hospital information system among university hospitals and hospital level institutions grows bigger, the need of sharing and transferring medical information among medical institutions is rising. For the medical information, which is saved in the hospital medical system, to be transferred within the same hospital, domestic, or foreign medical institutions, a standard protocol is necessary. But realistically, most of the domestic hospitals do not abide by H7L which is the HIS standard and so, information transferring is not possible as of present. As such, the purpose of this research is to implement the information between HIS and PACS to an international standard by constructing HL7 messages through HL7 Interface, which will eventually make possible information transferring between different hospitals. Our research team has developed a method which will make the PACS equip hospitals that do not follow HL7 standard which will make possible to transfer information between HIS and PACS through HL7 Message. By constructing message files, which follow the form of HL7 Message in the HL7 Interface, they can be transferred to PACS through the ftp protocol. The realization of the HIS/OCS Interface through HL7 enables data transferring between domestic and foreign medical institutions possible by implementing the international standard in the PACS and HIS data transferring process. The HL7 that our research team has developed made patient data transfer between medical institutions possible. The Interface is for a specific system model and in order for the data transfer between different systems to be realized, interfaces that are fit for each system must be needed. If the Interface is improvised and implemented to each hospital's information system, the data sharing among medical institutions can be broadened

Development and implementation of a hospital-based patient safety program

International Nuclear Information System (INIS)

Frush, Karen S.; Alton, Michael; Frush, Donald P.

2006-01-01

Evidence from numerous studies indicates that large numbers of patients are harmed by medical errors while receiving health-care services in the United States today. The 1999 Institute of Medicine report on medical errors recommended that hospitals and health-care agencies ''establish safety programs to act as a catalyst for the development of a culture of safety'' [1]. In this article, we describe one approach to successful implementation of a hospital-based patient safety program. Although our experience at Duke University Health System will be used as an example, the needs, principles, and solutions can apply to a variety of other health-care practices. Key components include the development of safety teams, provision of tools that teams can use to support an environment of safety, and ongoing program modification to meet patient and staff needs and respond to changing priorities. By moving patient safety to the forefront of all that we do as health-care providers, we can continue to improve our delivery of health care to children and adults alike. This improvement is fostered when we enhance the culture of safety, develop a constant awareness of the possibility of human and system errors in the delivery of care, and establish additional safeguards to intercept medical errors in order to prevent harm to patients. (orig.)

Implementation of integrated heterogeneous electronic electrocardiography data into Maharaj Nakorn Chiang Mai Hospital Information System.

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Khumrin, Piyapong; Chumpoo, Pitupoom

2016-03-01

Electrocardiography is one of the most important non-invasive diagnostic tools for diagnosing coronary heart disease. The electrocardiography information system in Maharaj Nakorn Chiang Mai Hospital required a massive manual labor effort. In this article, we propose an approach toward the integration of heterogeneous electrocardiography data and the implementation of an integrated electrocardiography information system into the existing Hospital Information System. The system integrates different electrocardiography formats into a consistent electrocardiography rendering by using Java software. The interface acts as middleware to seamlessly integrate different electrocardiography formats. Instead of using a common electrocardiography protocol, we applied a central format based on Java classes for mapping different electrocardiography formats which contains a specific parser for each electrocardiography format to acquire the same information. Our observations showed that the new system improved the effectiveness of data management, work flow, and data quality; increased the availability of information; and finally improved quality of care. © The Author(s) 2014.

HOSPITAL KANBAN SYSTEM IMPLEMENTATION: EVALUATING SATISFACTION OF NURSING PERSONNEL

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Aguilar-Escobar, Víctor G.

2015-09-01

Full Text Available Literature on healthcare supply chain management has shown that the kanban system can provide significant benefits. However, very few benefits have been empirically demonstrated and the extent of each remains unknown. This study aims to measure nurses’ satisfaction with kanban systems in logistics of medical consumables and assesses possible advantages and differences among user groups through an anonymous survey at Hospital Universitario Virgen Macarena of Seville, Spain. Treatment of responses included an exploratory factor analysis, and a CAPTCA analysis. The results showed a high level of satisfaction for each aspect of the kanban system. Moreover, it highlighted the differences of opinion between groups of individuals according to workplace, nursing units, job category, seniority, age and kanban training. The exploratory factor analysis revealed that two factors underlie the collected assessments: the inherent advantages of a kanban system, and the logistics system performance as a whole. Thus, hospital managers should promote the implementation of kanban systems, since it increases nurses’ satisfaction and provides significant benefits.

Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Short Inpatient Hospital Stays; Transition for Certain Medicare-Dependent, Small Rural Hospitals Under the Hospital Inpatient Prospective Payment System; Provider Administrative Appeals and Judicial Review. Final rule with comment period; final rule.

Science.gov (United States)

2015-11-13

This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2016 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. Further, this document includes certain finalized policies relating to the hospital inpatient prospective payment system: Changes to the 2-midnight rule under the short inpatient hospital stay policy; and a payment transition for hospitals that lost their status as a Medicare-dependent, small rural hospital (MDH) because they are no longer in a rural area due to the implementation of the new Office of Management and Budget delineations in FY 2015 and have not reclassified from urban to rural before January 1, 2016. In addition, this document contains a final rule that finalizes certain 2015 proposals, and addresses public comments received, relating to the changes in the Medicare regulations governing provider administrative appeals and judicial review relating to appropriate claims in provider cost reports.

Problems facing the radiologist tendering for a hospital wide PACS system

International Nuclear Information System (INIS)

Pilling, John

1999-01-01

As PACS becomes a reality the practical difficulties of installing the new technology become evident. The practical issues of developing a strategy, understanding the market, writing a business case, and an outline based specification are considered. The complexities of European procurement, the evaluation of responses, the contracting process and the problems of implementation, training, assessing the benefits and foreseeing the problems are covered. Provided there is careful attention to detail a hospital can expect to implement a successful PACS system

RFID-based information visibility for hospital operations: exploring its positive effects using discrete event simulation.

Science.gov (United States)

Asamoah, Daniel A; Sharda, Ramesh; Rude, Howard N; Doran, Derek

2016-10-12

Long queues and wait times often occur at hospitals and affect smooth delivery of health services. To improve hospital operations, prior studies have developed scheduling techniques to minimize patient wait times. However, these studies lack in demonstrating how such techniques respond to real-time information needs of hospitals and efficiently manage wait times. This article presents a multi-method study on the positive impact of providing real-time scheduling information to patients using the RFID technology. Using a simulation methodology, we present a generic scenario, which can be mapped to real-life situations, where patients can select the order of laboratory services. The study shows that information visibility offered by RFID technology results in decreased wait times and improves resource utilization. We also discuss the applicability of the results based on field interviews granted by hospital clinicians and administrators on the perceived barriers and benefits of an RFID system.

Electronically implemented clinical indicators based on a data warehouse in a tertiary hospital: its clinical benefit and effectiveness.

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Yoo, Sooyoung; Kim, Seok; Lee, Kee-Hyuck; Jeong, Chang Wook; Youn, Sang Woong; Park, Kyoung Un; Moon, So Young; Hwang, Hee

2014-07-01

Assessing and monitoring care and service using clinical indicators (CIs) can allow the measurement of and lead to improvements in the quality of care. However, the management and maintenance of CI data has been shown to be difficult because the data are usually collected and provided manually. In this study, for the purpose of efficient managing quality indicators, a data warehouse (DW)-based CI monitoring system was developed. The clinical effectiveness and efficiency of a DW-based CI monitoring was investigated through several case studies of the system's operation at a tertiary hospital. This study analyzed the CIs that have been developed over the past 8 years at a 1340-bed tertiary general university hospital in South Korea to improve and monitor the quality of care and patient safety. The hospital was opened as a fully digital hospital in 2003, and the CIs were computerized in 2005 by implementing a DW-based CI monitoring system. We classified the computerized CIs and evaluated the monitoring results for several representative CIs, such as the optimal prescribing of preventive antibiotics, the average length of stay, the mortality rate, and the rehospitalization rate. During the development of the system in 2005, 12 of 19 CIs were computerized, and this number gradually increased until 299 of 335 CIs were computerized by 2012. In addition, among the CIs built computationally through the CI task force team, focal CIs subject to monitoring were selected annually, and the results of this monitoring were shared with all of the staff or the related department and its staff. By providing some examples of our CI monitoring results, we showed the feasibility of improving the quality of care, and maintaining the optimum level of patient care with less labor. The results of this study provide evidence regarding the clinical effectiveness and efficiency as well as the systems operation experience of a DW-based CI monitoring system. These findings may aid medical

A new accounting system for financial balance based on personnel cost after the introduction of a DPC/DRG system.

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Nakagawa, Yoshiaki; Takemura, Tadamasa; Yoshihara, Hiroyuki; Nakagawa, Yoshinobu

2011-04-01

A hospital director must estimate the revenues and expenses not only in a hospital but also in each clinical division to determine the proper management strategy. A new prospective payment system based on the Diagnosis Procedure Combination (DPC/PPS) introduced in 2003 has made the attribution of revenues and expenses for each clinical department very complicated because of the intricate involvement between the overall or blanket component and a fee-for service (FFS). Few reports have so far presented a programmatic method for the calculation of medical costs and financial balance. A simple method has been devised, based on personnel cost, for calculating medical costs and financial balance. Using this method, one individual was able to complete the calculations for a hospital which contains 535 beds and 16 clinics, without using the central hospital computer system.

Information security risk management for computerized health information systems in hospitals: a case study of Iran.

Science.gov (United States)

Zarei, Javad; Sadoughi, Farahnaz

2016-01-01

In recent years, hospitals in Iran - similar to those in other countries - have experienced growing use of computerized health information systems (CHISs), which play a significant role in the operations of hospitals. But, the major challenge of CHIS use is information security. This study attempts to evaluate CHIS information security risk management at hospitals of Iran. This applied study is a descriptive and cross-sectional research that has been conducted in 2015. The data were collected from 551 hospitals of Iran. Based on literature review, experts' opinion, and observations at five hospitals, our intensive questionnaire was designed to assess security risk management for CHISs at the concerned hospitals, which was then sent to all hospitals in Iran by the Ministry of Health. Sixty-nine percent of the studied hospitals pursue information security policies and procedures in conformity with Iran Hospitals Accreditation Standards. At some hospitals, risk identification, risk evaluation, and risk estimation, as well as risk treatment, are unstructured without any specified approach or methodology. There is no significant structured approach to risk management at the studied hospitals. Information security risk management is not followed by Iran's hospitals and their information security policies. This problem can cause a large number of challenges for their CHIS security in future. Therefore, Iran's Ministry of Health should develop practical policies to improve information security risk management in the hospitals of Iran.

Intra-hospital use of a telepathology system.

Science.gov (United States)

Ongürü, O; Celasun, B

2000-01-01

Utilization of telepathology systems to cover distant geographical areas has increased recently. However, the potential usefulness of similar systems for closer distances does not seem to be widely appreciated. In this study, we present data on the use of a simple telepathology system connecting the pathology department and the intra-operative consultation room within the operating theaters of the hospital. Ninety-eight frozen section cases from a past period have been re-evaluated using a real-time setup. Forty-eight of the cases have been re-evaluated in the customary fashion; allowing both ends to communicate and cooperate freely. Fifty of the cases, however, were evaluated by the consultant while the operating room end behaved like a robot; moving the stage of the microscope, changing and focusing the objectives. The deferral rate was lower than the original frozen section evaluations. Overall, the sensitivity was 100%, specificity 98%, negative predictive value 96, 5% and positive predictive value 100%. No significant difference was found for the diagnostic performances between the cooperative and robotic simulation methods.Our results strengthen the belief that telepathology is a valuable tool in offering pathology services to remote areas. The far side of a hospital building can also be a remote area and a low cost system can be helpful for intraoperative consultations. Educational value of such a system is also commendable.

Patient, hospital, and local health system characteristics associated with the use of observation stays in veterans health administration hospitals, 2005 to 2012.

Science.gov (United States)

Wright, Brad; OʼShea, Amy M J; Glasgow, Justin M; Ayyagari, Padmaja; Vaughan-Sarrazin, Mary

2016-09-01

Recent studies have documented that a significant increase in the use of observation stays along with extensive variation in patterns of use across hospitals.The objective of this longitudinal observational study was to examine the extent to which patient, hospital, and local health system characteristics explain variation in observation stay rates across Veterans Health Administration (VHA) hospitals.Our data came from years 2005 to 2012 of the nationwide VHA Medical SAS inpatient and enrollment files, American Hospital Association Survey, and Area Health Resource File. We used these data to estimate linear regression models of hospitals' observation stay rates as a function of hospital, patient, and local health system characteristics, while controlling for time trends and Veterans Integrated Service Network level fixed effects.We found that observation stay rates are inversely related to hospital bed size and that hospitals with a greater proportion of younger or rural patients have higher observation stay rates. Observation stay rates were nearly 15 percentage points higher in 2012 than 2005.Although we identify several characteristics associated with variation in VHA hospital observation stay rates, many factors remain unmeasured.

The growth of corporate private hospitals in Malaysia: policy contradictions in health system pluralism.

Science.gov (United States)

Barraclough, S

1997-01-01

The rapid growth of corporate investment in the Malaysian private hospital sector has had a considerable impact on the health care system. Sustained economic growth, the development of new urban areas, an enlarged middle class, and the inclusion of hospital insurance in salary packages have all contributed to a financially lucrative investment environment for hospital entrepreneurs. Many of Malaysia's most technologically advanced hospitals employing leading specialists are owned and operated as corporate business ventures. Corporate hospital investment has been actively encouraged by the government, which regards an expanded private sector as a vital complement to the public hospital system. Yet this rapid growth of corporately owned private hospitals has posed serious contradictions for health care policy in terms of issues such as equity, cost and quality, the effect on the wider health system, and the very role of the state in health care provision. This article describes the growth of corporate investment in Malaysia's private hospital sector and explores some of the attendant policy contradictions.

A web-based appointment system to reduce waiting for outpatients: a retrospective study.

Science.gov (United States)

Cao, Wenjun; Wan, Yi; Tu, Haibo; Shang, Fujun; Liu, Danhong; Tan, Zhijun; Sun, Caihong; Ye, Qing; Xu, Yongyong

2011-11-22

Long waiting times for registration to see a doctor is problematic in China, especially in tertiary hospitals. To address this issue, a web-based appointment system was developed for the Xijing hospital. The aim of this study was to investigate the efficacy of the web-based appointment system in the registration service for outpatients. Data from the web-based appointment system in Xijing hospital from January to December 2010 were collected using a stratified random sampling method, from which participants were randomly selected for a telephone interview asking for detailed information on using the system. Patients who registered through registration windows were randomly selected as a comparison group, and completed a questionnaire on-site. A total of 5641 patients using the online booking service were available for data analysis. Of them, 500 were randomly selected, and 369 (73.8%) completed a telephone interview. Of the 500 patients using the usual queuing method who were randomly selected for inclusion in the study, responses were obtained from 463, a response rate of 92.6%. Between the two registration methods, there were significant differences in age, degree of satisfaction, and total waiting time (P0.05). Being ignorant of online registration, not trusting the internet, and a lack of ability to use a computer were three main reasons given for not using the web-based appointment system. The overall proportion of non-attendance was 14.4% for those using the web-based appointment system, and the non-attendance rate was significantly different among different hospital departments, day of the week, and time of the day (Pweb-based appointment system could significantly increase patient's satisfaction with registration and reduce total waiting time effectively. However, further improvements are needed for broad use of the system.

Japanese hospitals--culture and competition: a study of ten hospitals.

Science.gov (United States)

Anbäcken, O

1994-01-01

Japanese health care is characterized by a pluralistic system with a high degree of private producers. Central government regulates the prices and the financing system. All citizens are covered by a mandatory employment-based health insurance operating on a non-profit basis. The consumer has a free choice of physician and hospital. A comparison between Japan, Sweden and some other countries shows significant dissimilarities in the length of stay, number of treatments per hospital bed and year and the staffing of hospitals. About 80 per cent of the hospitals and 94 per cent of the clinics are privately owned. The typical private hospital owned by a physician has less than 100 beds. In this paper, data collected (1992/93) in an empirical study of Japanese hospitals and their leadership is presented. Also discussed are the hospitals' style of management, tools and strategies for competition and competences--personal and formal skills required of the leadership in the hospital. There follows a study of ten hospitals, among which hospital directors and chief physicians were interviewed. Interviews are also made with key persons in the Ministry of Health and Welfare and other organizations in the health care field. The result is also analysed from a cultural perspective--'what kind of impact does the Japanese culture have on the health care organization?' and/or 'what kind of sub-culture is developed in the Japanese hospitals'. Some comparisons are made with Sweden, USA, Canada and Germany. The different roles of the professions in the hospital are included in the study as well as the incentives for different kinds of strategies--specialization, growing in size, investments in new equipment, different kind of ownership and hospitals. Another issue discussed is the attempt to uncover whether there is an implicit distribution of specialties--silent agreements between hospitals, etc.

The relationship between social capital and quality management systems in European hospitals: a quantitative study.

Science.gov (United States)

Hammer, Antje; Arah, Onyebuchi A; Dersarkissian, Maral; Thompson, Caroline A; Mannion, Russell; Wagner, Cordula; Ommen, Oliver; Sunol, Rosa; Pfaff, Holger

2013-01-01

Strategic leadership is an important organizational capability and is essential for quality improvement in hospital settings. Furthermore, the quality of leadership depends crucially on a common set of shared values and mutual trust between hospital management board members. According to the concept of social capital, these are essential requirements for successful cooperation and coordination within groups. We assume that social capital within hospital management boards is an important factor in the development of effective organizational systems for overseeing health care quality. We hypothesized that the degree of social capital within the hospital management board is associated with the effectiveness and maturity of the quality management system in European hospitals. We used a mixed-method approach to data collection and measurement in 188 hospitals in 7 European countries. For this analysis, we used responses from hospital managers. To test our hypothesis, we conducted a multilevel linear regression analysis of the association between social capital and the quality management system score at the hospital level, controlling for hospital ownership, teaching status, number of beds, number of board members, organizational culture, and country clustering. The average social capital score within a hospital management board was 3.3 (standard deviation: 0.5; range: 1-4) and the average hospital score for the quality management index was 19.2 (standard deviation: 4.5; range: 0-27). Higher social capital was associated with higher quality management system scores (regression coefficient: 1.41; standard error: 0.64, p=0.029). The results suggest that a higher degree of social capital exists in hospitals that exhibit higher maturity in their quality management systems. Although uncontrolled confounding and reverse causation cannot be completely ruled out, our new findings, along with the results of previous research, could have important implications for the work of

Acceptability of picture archiving and communication system (PACS) among hospital healthcare personnel based on a unified theory of acceptance and use of technology.

Science.gov (United States)

Ahmadi, Maryam; Mehrabi, Nahid; Sheikhtaheri, Abbas; Sadeghi, Mojtaba

2017-09-01

The picture archiving and communication system (PACS) is a healthcare system technology which manages medical images and integrates equipment through a network. There are some theories about the use and acceptance of technology by people to describe the behavior and attitudes of end users towards information technologies. We investigated the influential factors on users' acceptance of PACS in the military hospitals of Tehran. In this applied analytical and cross-sectional study, 151 healthcare employees of military hospitals who had experience in using the PACS system were investigated. Participants were selected by census. The following variables were considered: performance expectancy, efforts expectancy, social influence, facilitating conditions and behavioral intention. Data were gathered using a questionnaire. Its validity and reliability were approved by a panel of experts and was piloted with 30 hospital healthcare staff (Cronbach's alpha =0.91). Spearman correlation coefficient and multiple linear regression analysis were used in analyzing the data. Expected performance, efforts expectancy, social impact and facilitating conditions had a significant relationship with behavioral intention. The multiple regression analysis indicated that only performance expectancy can predict the user's behavioral intentions to use PACS technology. Performance and effort expectancies are quite influential in accepting the use of PACS in hospitals. All healthcare personnel should become aware that using such technology is necessary in a hospital. Knowing the influencing factors that affect the acceptance of using new technology can help in improving its use, especially in a healthcare system. This can improve the offered healthcare services' quality.

Frequency of legionella contamination in conditional & water distribution systems of Tehran hospitals

Directory of Open Access Journals (Sweden)

Davod Esmaieli

2008-09-01

Full Text Available Background: Legionella species are ubiquitous in natural aquatic environments, capable of existing in waters with varied temperatures, PH levels, and nutrient and oxygen contents. Of 49 known legionella species, 20 species have been linked to pneumonia in humans. Contamination by legionella has occurred in the distribution systems of many hospitals. Aerosol-generating systems such as faucets, showerheads, cooling towers, and nebulizers are responsible for their transmission from water to air. Methods: A total of 113 water samples were gathered from different wards of 32 hospitals in different geographical regions of Tehran city. These samples were concentrated by filtration, treated with the acid and temperature buffers, and isolated on a BCYE agar culture medium. Results: A total of 22 hospitals out of 33 (26.5% were contaminated by legionella species, and 30 samples (26.5% out of 113 were positive. Chlorine concentration and pH level of the water samples were 0.18-2.2 mg/l and 6.6-7.6, respectively. Conclusion: The high rate of waste water contamination in Tehran hospitals with Legionella indicates the resistance of this microorganism to chlorine and other disinfectants, or inadequate disinfection process, representing the insufficiency of the current decontamination of hospital water distribution system. Thus identifying legionella species and their controlling in water distribution system of hospitals is of great importance.

A study on periodontal disease and systemic disease relationship a hospital based study in Bangalore

Directory of Open Access Journals (Sweden)

Sukhvinder Singh Oberoi

2013-01-01

Full Text Available Background: Periodontal deterioration has been reported to be associated with various systemic conditions like Cardiovascular disease, Diabetes, Respiratory disease, Liver cirrhosis, Bacterial Pneumonia, Nutritional deficiencies and adverse pregnancy outcomes. Aim: To assess the periodontal disease among patients with systemic disease/conditions. Materials and Method: A total of 500 patients with systemic disease/conditions (Diabetes, Cardiovascular disease, Respiratory disease and Renal disease and 500-age and gender matched controls without systemic disease/conditions were selected from the Government Hospitals in Bangalore City. The medical conditions were recorded and the periodontal status of the study population was assessed using the CPITN index. Results: The prevalence of CPITN Code 4 was found to be more among the patients with systemic disease/conditions (46.2%. The mean number of sextants with CPITN code 3 and 4 were more among the patients with systemic disease/conditions. The prevalence of CPITN code was found to be more among the patients with Respiratory disease whereas the mean number of sextants was found to be more among the patients with Diabetes, Cardiovascular and Renal disease. Conclusion: It may be concluded that the systemic diseases/conditions are associated with higher severity of periodontal disease.

A Comprehensive Evaluation System for Military Hospitals' Response Capability to Bio-terrorism.

Science.gov (United States)

Wang, Hui; Jiang, Nan; Shao, Sicong; Zheng, Tao; Sun, Jianzhong

2015-05-01

The objective of this study is to establish a comprehensive evaluation system for military hospitals' response capacity to bio-terrorism. Literature research and Delphi method were utilized to establish the comprehensive evaluation system for military hospitals' response capacity to bio-terrorism. Questionnaires were designed and used to survey the status quo of 134 military hospitals' response capability to bio-terrorism. Survey indicated that factor analysis method was suitable to for analyzing the comprehensive evaluation system for military hospitals' response capacity to bio-terrorism. The constructed evaluation system was consisted of five first-class and 16 second-class indexes. Among them, medical response factor was considered as the most important factor with weight coefficient of 0.660, followed in turn by the emergency management factor with weight coefficient of 0.109, emergency management consciousness factor with weight coefficient of 0.093, hardware support factor with weight coefficient of 0.078, and improvement factor with weight coefficient of 0.059. The constructed comprehensive assessment model and system are scientific and practical.

Workarounds to hospital electronic prescribing systems: a qualitative study in English hospitals.

Science.gov (United States)

Cresswell, Kathrin M; Mozaffar, Hajar; Lee, Lisa; Williams, Robin; Sheikh, Aziz

2017-07-01

Concerns with the usability of electronic prescribing (ePrescribing) systems can lead to the development of workarounds by users. To investigate the types of workarounds users employed, the underlying reasons offered and implications for care provision and patient safety. We collected a large qualitative data set, comprising interviews, observations and project documents, as part of an evaluation of ePrescribing systems in five English hospitals, which we conceptualised as case studies. Data were collected at up to three different time points throughout implementation and adoption. Thematic analysis involving deductive and inductive approaches was facilitated by NVivo 10. Our data set consisted of 173 interviews, 24 rounds of observation and 17 documents. Participating hospitals were at various stages of implementing a range of systems with differing functionalities. We identified two types of workarounds: informal and formal. The former were informal practices employed by users not approved by management, which were introduced because of perceived changes to professional roles, issues with system usability and performance and challenges relating to the inaccessibility of hardware. The latter were formalised practices that were promoted by management and occurred when systems posed threats to patient safety and organisational functioning. Both types of workarounds involved using paper and other software systems as intermediaries, which often created new risks relating to a lack of efficient transfer of real-time information between different users. Assessing formal and informal workarounds employed by users should be part of routine organisational implementation strategies of major health information technology initiatives. Workarounds can create new risks and present new opportunities for improvement in system design and integration. 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/.

The development of a national surveillance system for monitoring blood use and inventory levels at sentinel hospitals in South Korea.

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Lim, Y A; Kim, H H; Joung, U S; Kim, C Y; Shin, Y H; Lee, S W; Kim, H J

2010-04-01

We developed a web-based program for a national surveillance system to determine baseline data regarding the supply and demand of blood products at sentinel hospitals in South Korea. Sentinel hospitals were invited to participate in a 1-month pilot-test. The data for receipts and exports of blood from each hospital information system were converted into comma-separated value files according to a specific conversion rule. The daily data from the sites could be transferred to the web-based program server using a semi-automated submission procedure: pressing a key allowed the program to automatically compute the blood inventory level as well as other indices including the minimal inventory ratio (MIR), ideal inventory ratio (IIR), supply index (SI) and utilisation index (UI). The national surveillance system was referred to as the Korean Blood Inventory Monitoring System (KBIMS) and the web-based program for KBIMS was referred to as the Blood Inventory Monitoring System (BMS). A total of 30 256 red blood cell (RBC) units were submitted as receipt data, however, only 83% of the receipt data were submitted to the BMS server as export data (25 093 RBC units). Median values were 2.67 for MIR, 1.08 for IIR, 1.00 for SI, 0.88 for UI and 5.33 for the ideal inventory day. The BMS program was easy to use and is expected to provide a useful tool for monitoring hospital inventory levels. This information will provide baseline data regarding the supply and demand of blood products in South Korea.

Reliability Electrical Power System of Hospital as Cold Standby System

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Grabski Franciszek

2016-07-01

Full Text Available The probabilistic model of a hospital electrical power system consisting of mains, an emergency power system and the automatic transfer switch with the generator starter are discussed in this paper. The reliability model is semi-Markov process describing two different units renewable cold standby system and switch. The embedded Semi-Markov processes concept is applied for description of the system evolution. Time to failure of the system is represented by a random variable denoting the first passage time of the process from the given state to the subset of states. The appropriate theorems of the Semi-Markov processes theory allow us to evaluate the reliability function and some reliability characteristics.

Reorganization of a hospital catering system increases food intake in patients with inadequate intake

DEFF Research Database (Denmark)

Freil, M.; Nielsen, M. A.; Biltz, C.

2006-01-01

Background: Low food intake is a frequent problem in undernourished hospital patients. Objective: To study whether a reorganization of a hospital catering system enabling patients to choose their evening meal individually, in combination with an increase in the energy density of the food, increases......: Reorganization of a hospital catering system can increase energy and protein intake and reduce waste substantially. Keywords: hospital food; nutritional risk; undernutrition...

Direct costs of emergency medical care: a diagnosis-based case-mix classification system.

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Baraff, L J; Cameron, J M; Sekhon, R

1991-01-01

To develop a diagnosis-based case mix classification system for emergency department patient visits based on direct costs of care designed for an outpatient setting. Prospective provider time study with collection of financial data from each hospital's accounts receivable system and medical information, including discharge diagnosis, from hospital medical records. Three community hospital EDs in Los Angeles County during selected times in 1984. Only direct costs of care were included: health care provider time, ED management and clerical personnel excluding registration, nonlabor ED expense including supplies, and ancillary hospital services. Indirect costs for hospitals and physicians, including depreciation and amortization, debt service, utilities, malpractice insurance, administration, billing, registration, and medical records were not included. Costs were derived by valuing provider time based on a formula using annual income or salary and fringe benefits, productivity and direct care factors, and using hospital direct cost to charge ratios. Physician costs were based on a national study of emergency physician income and excluded practice costs. Patients were classified into one of 216 emergency department groups (EDGs) on the basis of the discharge diagnosis, patient disposition, age, and the presence of a limited number of physician procedures. Total mean direct costs ranged from $23 for follow-up visit to $936 for trauma, admitted, with critical care procedure. The mean total direct costs for the 16,771 nonadmitted patients was $69. Of this, 34% was for ED costs, 45% was for ancillary service costs, and 21% was for physician costs. The mean total direct costs for the 1,955 admitted patients was $259. Of this, 23% was for ED costs, 63% was for ancillary service costs, and 14% was for physician costs. Laboratory and radiographic services accounted for approximately 85% of all ancillary service costs and 38% of total direct costs for nonadmitted patients

Hospital information system: reusability, designing, modelling, recommendations for implementing.

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Huet, B

1998-01-01

The aims of this paper are to precise some essential conditions for building reuse models for hospital information systems (HIS) and to present an application for hospital clinical laboratories. Reusability is a general trend in software, however reuse can involve a more or less part of design, classes, programs; consequently, a project involving reusability must be precisely defined. In the introduction it is seen trends in software, the stakes of reuse models for HIS and the special use case constituted with a HIS. The main three parts of this paper are: 1) Designing a reuse model (which objects are common to several information systems?) 2) A reuse model for hospital clinical laboratories (a genspec object model is presented for all laboratories: biochemistry, bacteriology, parasitology, pharmacology, ...) 3) Recommendations for generating plug-compatible software components (a reuse model can be implemented as a framework, concrete factors that increase reusability are presented). In conclusion reusability is a subtle exercise of which project must be previously and carefully defined.

An inexpensive, interdisciplinary, methodology to conduct an impact study of homeless persons on hospital based services.

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Parker, R David; Regier, Michael; Brown, Zachary; Davis, Stephen

2015-02-01

Homelessness is a primary concern for community health. Scientific literature on homelessness is wide ranging and diverse. One opportunity to add to existing literature is the development and testing of affordable, easily implemented methods for measuring the impact of homeless on the healthcare system. Such methodological approaches rely on the strengths in a multidisciplinary approach, including providers, both healthcare and homeless services and applied clinical researchers. This paper is a proof of concept for a methodology which is easily adaptable nationwide, given the mandated implementation of homeless management information systems in the United States and other countries; medical billing systems by hospitals; and research methods of researchers. Adaptation is independent of geographic region, budget restraints, specific agency skill sets, and many other factors that impact the application of a consistent methodological science based approach to assess and address homelessness. We conducted a secondary data analysis merging data from homeless utilization and hospital case based data. These data detailed care utilization among homeless persons in a small, Appalachian city in the United States. In our sample of 269 persons who received at least one hospital based service and one homeless service between July 1, 2012 and June 30, 2013, the total billed costs were $5,979,463 with 10 people costing more than one-third ($1,957,469) of the total. Those persons were primarily men, living in an emergency shelter, with pre-existing disabling conditions. We theorize that targeted services, including Housing First, would be an effective intervention. This is proposed in a future study.

Comparative analytics of infusion pump data across multiple hospital systems.

Science.gov (United States)

Catlin, Ann Christine; Malloy, William X; Arthur, Karen J; Gaston, Cindy; Young, James; Fernando, Sudheera; Fernando, Ruchith

2015-02-15

A Web-based analytics system for conducting inhouse evaluations and cross-facility comparisons of alert data generated by smart infusion pumps is described. The Infusion Pump Informatics (IPI) project, a collaborative effort led by research scientists at Purdue University, was launched in 2009 to provide advanced analytics and tools for workflow analyses to assist hospitals in determining the significance of smart-pump alerts and reducing nuisance alerts. The IPI system allows facility-specific analyses of alert patterns and trends, as well as cross-facility comparisons of alert data uploaded by more than 55 participating institutions using different types of smart pumps. Tools accessible through the IPI portal include (1) charts displaying aggregated or breakout data on the top drugs associated with alerts, numbers of alerts per device or care area, and override-to-alert ratios, (2) investigative reports that can be used to characterize and analyze pump-programming errors in a variety of ways (e.g., by drug, by infusion type, by time of day), and (3) "drill-down" workflow analytics enabling users to evaluate alert patterns—both internally and in relation to patterns at other hospitals—in a quick and efficient stepwise fashion. The formation of the IPI analytics system to support a community of hospitals has been successful in providing sophisticated tools for member facilities to review, investigate, and efficiently analyze smart-pump alert data, not only within a member facility but also across other member facilities, to further enhance smart pump drug library design. Copyright © 2015 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

[Hospitalizations for ambulatory care-sensitive conditions: validation study at a Hospital Information System (SIH) in the Federal District, Brazil, in 2012].

Science.gov (United States)

Cavalcante, Danyelle Monteiro; de Oliveira, Maria Regina Fernandes; Rehem, Tânia Cristina Morais Santa Bárbara

2016-03-01

This study analyzes hospitalizations due to ambulatory care-sensitive conditions with a focus on infectious and parasitic diseases (IPDs) and validates the Hospital Information System, Brazilian Unified National Health System (SIH/SUS) for recording hospitalizations due to ambulatory care-sensitive conditions in a hospital in the Federal District, Brazil, in 2012. The study estimates the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the SIH for recording hospitalizations due to ambulatory care-sensitive conditions, with the patient's medical file as the gold standard. There were 1,604 hospitalizations for hospitalizations due to ambulatory care-sensitive conditions (19.6%, 95%CI: 18.7-20.5), and the leading IPDs were renal and urinary tract infection, infection of the skin and subcutaneous tissue, and infectious gastroenteritis. IPDs were the leading cause of hospitalization in the 20 to 29-year age bracket and caused 28 deaths. Sensitivity was 70.1% (95%CI: 60.5-79.7), specificity 88.4% (95%CI: 85.6-91.2), PPV = 51.7% (95%CI: 42.7-60.7), and NPV = 94.3% (95%CI: 92.2-96.4). The findings for admissions due to ACSCs in this hospital were similar to those of other studies, featuring admissions for IPDs. The SIH/SUS database was more specific than sensitive.

Biodegradation of pharmaceuticals in hospital wastewater by a hybrid biofilm and activated sludge system (Hybas)

DEFF Research Database (Denmark)

Escola Casas, Monica; Chhetri, Ravi Kumar; Ooi, Gordon Tze Hoong

2015-01-01

TM is a hybrid process, based on the integrated fixed-film activated sludge technology, where plastic carriers for biofilm growth are suspended within activated sludge. To investigate the potential of a hybrid system for the removal of pharmaceuticals in hospital wastewater a pilot plant consisting of a series...

Comparing antiretroviral treatment outcomes between a prospective community-based and hospital-based cohort of HIV patients in rural Uganda

Directory of Open Access Journals (Sweden)

Alibhai Arif

2011-11-01

Full Text Available Abstract Background Improved availability of antiretroviral therapy in sub-Saharan Africa is intended to benefit all eligible HIV-infected patients; however in reality antiretroviral services are mainly offered in urban hospitals. Poor rural patients have difficulty accessing the drugs, making the provision of antiretroviral therapy inequitable. Initial tests of community-based treatment programs in Uganda suggest that home-based treatment of HIV/AIDS may equal hospital-based treatment; however the literature reveals limited experiences with such programs. The research This intervention study aimed to; 1 assess the effectiveness of a rural community-based ART program in a subcounty (Rwimi of Uganda; and 2 compare treatment outcomes and mortality in a rural community-based antiretroviral therapy program with a well-established hospital-based program. Ethics approvals were obtained in Canada and Uganda. Results and outcomes Successful treatment outcomes after two years in both the community and hospital cohorts were high. All-cause mortality was similar in both cohorts. However, community-based patients were more likely to achieve viral suppression and had good adherence to treatment. The community-based program was slightly more cost-effective. Per capita costs in both settings were unsustainable, representing more than Uganda’s Primary Health Care Services current expenditures per person per year for all health services. The unpaid community volunteers showed high participation and low attrition rates for the two years that this program was evaluated. Challenges and successes Key successes of this study include the demonstration that antiretroviral therapy can be provided in a rural setting, the creation of a research infrastructure and culture within Kabarole’s health system, and the establishment of a research collaboration capable of enriching the global health graduate program at the University of Alberta. Challenging questions about the

Implications of an emerging EHR monoculture for hospitals and healthcare systems.

Science.gov (United States)

Koppel, Ross; Lehmann, Christoph U

2015-03-01

In many hospitals and health systems, a 'new' electronic health record means a shift to one vendor: Epic, a vendor that dominates in large and medium hospital markets and continues its success with smaller institutions and ambulatory practices. Our paper examines the implications of this emerging monoculture: its advantages and disadvantages for physicians and hospitals and its role in innovation, professional autonomy, implementation difficulties, workflow, flexibility, cost, data standards, interoperability, and interactions with other information technology (IT) systems. © The Author 2014. Published by Oxford University Press on behalf of the American Medical Informatics Association. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A novel system to tackle hospital acquired pressure ulcers.

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Renganathan, B S; Preejith, S P; Nagaiyan, Sridhar; Joseph, Jayaraj; Sivaprakasam, Mohanasankar

2016-08-01

Hospital acquired pressure ulcers (HAPUs) is a major problem that affects around one in twenty patients who are admitted in hospital with sudden illness. These ulcers often occur when patients have limited mobility and cannot change positions in bed on their own. Traditionally, the occurrence of HAPUs has been minimized by turning the patient every 2 hours to alternating lateral and supine positions, and by using pressure redistributing mattresses. In many healthcare facilities, such a patient repositioning schedule is not always maintained owing to low caregiver compliance to turning protocols. Difficulty in monitoring patient position continuously, lack of turn reminders/alerts and suboptimal caregiver staffing ratio increases the occurrence of HAPUs. A novel method to address the need for improved pressure ulcer prevention is presented. The proposed method consists of a wearable device which continuously monitors the patient's position and communicates wirelessly with a tablet which enables alerts to be sent to the caregiver when a patient turn is due in accordance with the protocol adopted by the hospital. The patient's position is continuously monitored and the turning procedure carried out is logged and updated on the hospital's cloud system, thereby enabling centralized monitoring. Under a controlled setting, system was able to continuously monitor patient's position and can accurately detect standard patient positions.

A data-capture system for post-marketing surveillance of drugs that integrates with hospital electronic health records

Directory of Open Access Journals (Sweden)

Yamamoto K

2011-04-01

Full Text Available Keiichi Yamamoto1, Shigemi Matsumoto2, Kazuhiro Yanagihara2, Satoshi Teramukai1, Masanori Fukushima1,2,31Department of Clinical Trial Design and Management, Translational Research Center, Kyoto University Hospital, Kyoto, Japan; 2Outpatient Oncology Unit, Kyoto University Hospital, Kyoto, Japan; 3Translational Research Informatics Center, Foundation for Biomedical Research and Innovation, Kobe, JapanPurpose: In conventional clinical studies, the cost of data management for the purposes of quality control tend to be high and collecting paper-based case report forms (CRFs can be burdensome, because paper-based CRFs must be developed and filled out for each clinical study protocol. Use of electronic health records (EHRs for this purpose could reduce costs and improve data quality in clinical studies. Kyoto University Hospital launched an EHR system in January 2005. At the same time, a replicate of that database was established for other purposes. At the Outpatient Oncology Unit of Kyoto University Hospital we developed a data-capture system that includes a cancer clinical database system and a data warehouse for outcomes studies. This system allows us to accumulate data at low cost and apply it to various uses in clinical or outcomes studies. Here we report on the application of this system to the post-marketing surveillance of drugs.Methods: We evaluated the availability of this system and identified problems for future development. With this system investigators can register cases for post-marketing surveillance, and the registered cases are listed on a screen. When CRFs for a particular case are required, data can be extracted from the list and CRFs are produced in PDF format.Results and conclusion: In this study we confirmed the applicability of our new system to post-marketing surveillance in providing prompt and efficient data exchange. We expect it to reduce the cost of data management and analysis and to improve the quality of data in post

Understanding the context of balanced scorecard implementation: a hospital-based case study in Pakistan.

Science.gov (United States)

Rabbani, Fauziah; Lalji, Sabrina Nh; Abbas, Farhat; Jafri, Sm Wasim; Razzak, Junaid A; Nabi, Naheed; Jahan, Firdous; Ajmal, Agha; Petzold, Max; Brommels, Mats; Tomson, Goran

2011-03-31

As a response to a changing operating environment, healthcare administrators are implementing modern management tools in their organizations. The balanced scorecard (BSC) is considered a viable tool in high-income countries to improve hospital performance. The BSC has not been applied to hospital settings in low-income countries nor has the context for implementation been examined. This study explored contextual perspectives in relation to BSC implementation in a Pakistani hospital. Four clinical units of this hospital were involved in the BSC implementation based on their willingness to participate. Implementation included sensitization of units towards the BSC, developing specialty specific BSCs and reporting of performance based on the BSC during administrative meetings. Pettigrew and Whipp's context (why), process (how) and content (what) framework of strategic change was used to guide data collection and analysis. Data collection methods included quantitative tools (a validated culture assessment questionnaire) and qualitative approaches including key informant interviews and participant observation. Method triangulation provided common and contrasting results between the four units. A participatory culture, supportive leadership, financial and non-financial incentives, the presentation of clear direction by integrating support for the BSC in policies, resources, and routine activities emerged as desirable attributes for BSC implementation. The two units that lagged behind were more involved in direct inpatient care and carried a considerable clinical workload. Role clarification and consensus about the purpose and benefits of the BSC were noted as key strategies for overcoming implementation challenges in two clinical units that were relatively ahead in BSC implementation. It was noted that, rather than seeking to replace existing information systems, initiatives such as the BSC could be readily adopted if they are built on existing infrastructures and data

Understanding the context of balanced scorecard implementation: a hospital-based case study in pakistan

Directory of Open Access Journals (Sweden)

Ajmal Agha

2011-03-01

Full Text Available Abstract Background As a response to a changing operating environment, healthcare administrators are implementing modern management tools in their organizations. The balanced scorecard (BSC is considered a viable tool in high-income countries to improve hospital performance. The BSC has not been applied to hospital settings in low-income countries nor has the context for implementation been examined. This study explored contextual perspectives in relation to BSC implementation in a Pakistani hospital. Methods Four clinical units of this hospital were involved in the BSC implementation based on their willingness to participate. Implementation included sensitization of units towards the BSC, developing specialty specific BSCs and reporting of performance based on the BSC during administrative meetings. Pettigrew and Whipp's context (why, process (how and content (what framework of strategic change was used to guide data collection and analysis. Data collection methods included quantitative tools (a validated culture assessment questionnaire and qualitative approaches including key informant interviews and participant observation. Results Method triangulation provided common and contrasting results between the four units. A participatory culture, supportive leadership, financial and non-financial incentives, the presentation of clear direction by integrating support for the BSC in policies, resources, and routine activities emerged as desirable attributes for BSC implementation. The two units that lagged behind were more involved in direct inpatient care and carried a considerable clinical workload. Role clarification and consensus about the purpose and benefits of the BSC were noted as key strategies for overcoming implementation challenges in two clinical units that were relatively ahead in BSC implementation. It was noted that, rather than seeking to replace existing information systems, initiatives such as the BSC could be readily adopted if

Barriers to participation in a hospital-based falls assessment clinicprogramme

DEFF Research Database (Denmark)

Evron, Lotte; Schultz-Larsen, Kirsten; Fristrup, Tine

2009-01-01

Aims: To gain new knowledge about barriers to participation in hospital-based falls assessment. Methods: Semi-structured interviews with 20 older people referred to falls assessment at a hospital-based clinic were conducted. A convenience sample of 10 refusers and 10 accepters was collected. Those...... of knowledge were expected, owing to accepters' participation in the programme. Interview transcriptions were thematically analysed. The analysis was directed towards identification of barriers to falls assessment. Results: Barriers to participation were categorized as being either within or outside the falls...

Assessment of Pharmacy Information System Performance in Three Hospitals in Eastern Province, Saudi Arabia.

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El Mahalli, Azza; El-Khafif, Sahar H; Yamani, Wid

2016-01-01

The pharmacy information system is one of the central pillars of a hospital information system. This research evaluated a pharmacy information system according to six aspects of the medication process in three hospitals in Eastern Province, Saudi Arabia. System administrators were interviewed to determine availability of functionalities. Then, system users within the hospital were targeted to evaluate their level of usage of these functionalities. The study was cross-sectional. Two structured surveys were designed. The overall response rate of hospital users was 31.7 percent. In all three hospitals studied, the electronic health record is hybrid, implementation has been completed and the system is running, and the systems have computerized provider order entry and clinical decision support. Also, the pharmacy information systems are integrated with the electronic health record, and computerized provider order entry and almost all prescribing and transcription functionalities are available; however, drug dispensing is a mostly manual process. However, the study hospitals do not use barcode-assisted medication administration systems to verify patient identity and electronically check dose administration, and none of them have computerized adverse drug event monitoring that uses the electronic health record. The numbers of users who used different functionalities most or all of the time was generally low. The highest frequency of utilization was for patient administration records (56.8 percent), and the lowest was for linkage of the pharmacy information system to pharmacy stock (9.1 percent). Encouraging users to use different functionalities was highly recommended.

The effects of ownership and system affiliation on the economic performance of hospitals.

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Renn, S C; Schramm, C J; Watt, J M; Derzon, R A

1985-01-01

We investigated differences among five types of hospitals, defined by ownership (investor-owned or not-for-profit), system affiliation (system-affiliated or freestanding), and government sponsorship on 24 measures of economic performance. Using multivariate analysis of 1980 Medicare cost report and other data from a national sample of 561 hospitals, we found that investor-owned chain hospitals charged significantly more, and were more profitable, than all other types of hospitals except freestanding for-profits; there were no differences in productive efficiency that could be attributed to ownership or affiliation; the investor-owned hospitals had higher debt-to-asset ratios, less-capital-intensive plants, and greater capital costs as a percentage of operating costs than the not-for-profits; and there were no consistent case-mix differences among the hospitals.

Factors influencing nurses' acceptance of hospital information systems in Iran: application of the Unified Theory of Acceptance and Use of Technology.

Science.gov (United States)

Sharifian, Roxana; Askarian, Fatemeh; Nematolahi, Mohtaram; Farhadi, Payam

User acceptance is a precondition for successful implementation of hospital information systems (HISs). Increasing investment in information technology by healthcare organisations internationally has made user acceptance an important issue in technology implementation and management. Despite the increased focus on hospital information systems, there continues to be user resistance. The present study aimed to investigate the factors affecting hospital information systems nurse-user acceptance of HISs, based on the Unified Theory of Acceptance and Use of Technology (UTAUT), in the Shiraz University of Medical Sciences teaching hospitals. A descriptive-analytical research design was employed to study nurses' adoption and use of HISs. Data collection was undertaken using a cross-sectional survey of nurses (n=303). The research model was examined using the LISREL path confirmatory modeling. The results demonstrated that the nurses' behavioural intention (BI) to use hospital information systems was predicted by Performance Expectancy (PE) (β= 2.34, pExpectancy (EE) (β= 2.21, pexpectancy, effort expectancy, social influence and facilitating conditions, with performance expectancy having the strongest effect on user intention.

Information security risk management for computerized health information systems in hospitals: a case study of Iran

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Zarei, Javad; Sadoughi, Farahnaz

2016-01-01

Background In recent years, hospitals in Iran – similar to those in other countries – have experienced growing use of computerized health information systems (CHISs), which play a significant role in the operations of hospitals. But, the major challenge of CHIS use is information security. This study attempts to evaluate CHIS information security risk management at hospitals of Iran. Materials and methods This applied study is a descriptive and cross-sectional research that has been conducted in 2015. The data were collected from 551 hospitals of Iran. Based on literature review, experts’ opinion, and observations at five hospitals, our intensive questionnaire was designed to assess security risk management for CHISs at the concerned hospitals, which was then sent to all hospitals in Iran by the Ministry of Health. Results Sixty-nine percent of the studied hospitals pursue information security policies and procedures in conformity with Iran Hospitals Accreditation Standards. At some hospitals, risk identification, risk evaluation, and risk estimation, as well as risk treatment, are unstructured without any specified approach or methodology. There is no significant structured approach to risk management at the studied hospitals. Conclusion Information security risk management is not followed by Iran’s hospitals and their information security policies. This problem can cause a large number of challenges for their CHIS security in future. Therefore, Iran’s Ministry of Health should develop practical policies to improve information security risk management in the hospitals of Iran. PMID:27313481

Hospitals with higher nurse staffing had lower odds of readmissions penalties than hospitals with lower staffing.

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McHugh, Matthew D; Berez, Julie; Small, Dylan S

2013-10-01

The Affordable Care Act's Hospital Readmissions Reduction Program (HRRP) penalizes hospitals based on excess readmission rates among Medicare beneficiaries. The aim of the program is to reduce readmissions while aligning hospitals' financial incentives with payers' and patients' quality goals. Many evidence-based interventions that reduce readmissions, such as discharge preparation, care coordination, and patient education, are grounded in the fundamentals of basic nursing care. Yet inadequate staffing can hinder nurses' efforts to carry out these processes of care. We estimated the effect that nurse staffing had on the likelihood that a hospital was penalized under the HRRP. Hospitals with higher nurse staffing had 25 percent lower odds of being penalized compared to otherwise similar hospitals with lower staffing. Investment in nursing is a potential system-level intervention to reduce readmissions that policy makers and hospital administrators should consider in the new regulatory environment as they examine the quality of care delivered to US hospital patients.

National Survey of Emergency Physicians Concerning Home-Based Care Options as Alternatives to Emergency Department-Based Hospital Admissions.

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Stuck, Amy R; Crowley, Christopher; Killeen, James; Castillo, Edward M

2017-11-01

Emergency departments (EDs) in the United States play a prominent role in hospital admissions, especially for the growing population of older adults. Home-based care, rather than hospital admission from the ED, provides an important alternative, especially for older adults who have a greater risk of adverse events, such as hospital-acquired infections, falls, and delirium. The objective of the survey was to understand emergency physicians' (EPs) perspectives on home-based care alternatives to hospitalization from the ED. Specific goals included determining how often EPs ordered home-based care, what they perceive as the barriers and motivators for more extensive ordering of home-based care, and the specific conditions and response times most appropriate for such care. A group of 1200 EPs nationwide were e-mailed a six-question survey. Participant response was 57%. Of these, 55% reported ordering home-based care from the ED within the past year as an alternative to hospital admission or observation, with most doing so less than once per month. The most common barrier was an "unsafe or unstable home environment" (73%). Home-based care as a "better setting to care for low-acuity chronic or acute disease exacerbation" was the top motivator (79%). Medical conditions EPs most commonly considered for home-based care were cellulitis, urinary tract infection, diabetes, and community-acquired pneumonia. Results suggest that EPs recognize there is a benefit to providing home-based care as an alternative to hospitalization, provided they felt the home was safe and a process was in place for dispositioning the patient to this setting. Better understanding of when and why EPs use home-based care pathways from the ED may provide suggestions for ways to promote wider adoption. Copyright © 2017 The Author(s). Published by Elsevier Inc. All rights reserved.

The Relationship between Social Capital and Quality Management Systems in European Hospitals: A Quantitative Study

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Hammer, Antje; Arah, Onyebuchi A.; DerSarkissian, Maral; Thompson, Caroline A.; Mannion, Russell; Wagner, Cordula; Ommen, Oliver; Sunol, Rosa; Pfaff, Holger

2013-01-01

Background Strategic leadership is an important organizational capability and is essential for quality improvement in hospital settings. Furthermore, the quality of leadership depends crucially on a common set of shared values and mutual trust between hospital management board members. According to the concept of social capital, these are essential requirements for successful cooperation and coordination within groups. Objectives We assume that social capital within hospital management boards is an important factor in the development of effective organizational systems for overseeing health care quality. We hypothesized that the degree of social capital within the hospital management board is associated with the effectiveness and maturity of the quality management system in European hospitals. Methods We used a mixed-method approach to data collection and measurement in 188 hospitals in 7 European countries. For this analysis, we used responses from hospital managers. To test our hypothesis, we conducted a multilevel linear regression analysis of the association between social capital and the quality management system score at the hospital level, controlling for hospital ownership, teaching status, number of beds, number of board members, organizational culture, and country clustering. Results The average social capital score within a hospital management board was 3.3 (standard deviation: 0.5; range: 1-4) and the average hospital score for the quality management index was 19.2 (standard deviation: 4.5; range: 0-27). Higher social capital was associated with higher quality management system scores (regression coefficient: 1.41; standard error: 0.64, p=0.029). Conclusion The results suggest that a higher degree of social capital exists in hospitals that exhibit higher maturity in their quality management systems. Although uncontrolled confounding and reverse causation cannot be completely ruled out, our new findings, along with the results of previous research, could

Association of bond, market, operational, and financial factors with multi-hospital system bond issues.

Science.gov (United States)

Carpenter, C E; McCue, M J; Hossack, J B

2001-01-01

Despite the growth of multi-hospital systems in the 1990s, their performance in the tax-exempt bond market has not been adequately evaluated. The purpose of this study is to compare bonds issued by multi-hospital systems to those issued by individual hospitals in terms of bond, market, operational, and financial characteristics. The study sample includes 2,078 newly issued, tax-exempt, revenue bonds between 1991 and 1997. The findings indicate that multi-hospital systems issued larger amounts of debt at a lower cost, were more likely to be insured, had higher debt service coverage and higher operating margins.

Commissioning of accelerator based boron neutron capture therapy system

International Nuclear Information System (INIS)

Nakamura, S.; Wakita, A.; Okamoto, H.; Igaki, H.; Itami, J.; Ito, M.; Abe, Y.; Imahori, Y.

2017-01-01

Boron neutron capture therapy (BNCT) is a treatment method using a nuclear reaction of 10 B(n, α) 7 Li. BNCT can be deposited the energy to a tumor since the 10 B which has a higher cross-section to a neutron is high is concentrated on the tumor. It is different from conventional radiation therapies that BNCT expects higher treatment effect to radiation resistant tumors since the generated alpha and lithium particles have higher radiological biological effectiveness. In general, BNCT has been performed in research nuclear reactor. Thus, BNCT is not widely applied in a clinical use. According to recent development of accelerator-based boron neutron capture therapy system, the system has an adequate flux of neutrons. Therefore, National Cancer Canter Hospital, Tokyo, Japan is planning to install accelerator based BNCT system. Protons with 2.5 MeV are irradiated to a lithium target system to generate neutrons. As a result, thermal load of the target is 50 kW since current of the protons is 20.0 mA. Additionally, when the accelerator-based BNCT system is installed in a hospital, the facility size is disadvantage in term of neutron measurements. Therefore, the commissioning of the BNCT system is being performed carefully. In this article, we report about the commissioning. (author)

Impact of the Japanese Diagnosis Procedure Combination-based Payment System on cardiovascular medicine-related costs.

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Yasunaga, Hideo; Ide, Hiroo; Imamura, Tomoaki; Ohe, Kazuhiko

2005-09-01

In 2003, a lump-sum payment system based on Diagnosis Procedure Combinations (DPC) was introduced to 82 specific function hospitals in Japan. While the US DRG/PPS system is a "per case payment" system, the DPC based payment system adopts a "per day payment." It is generally believed that the Japanese system provides as much of an incentive as the DRG/PPS system to shorten the average length of stay (LOS). We performed an empirical analysis of the effect of LOS shortening on hospital revenue and expenditure under the DPC-based payment system, particularly in cardiovascular diseases. We also point out fundamentally controversial aspects of the current system. A total 109 cases were selected from patients hospitalized at the University of Tokyo Hospital from May to July, 2003 and classified into one of three categories: (1) cardiac catheter interventions, (2) cardiac catheter examinations, and (3) other conservative treatments. We analyzed the changes in profit per day in cases of a reduction in average LOS and an increase in the number of cases. In category (1) profit increased significantly in conjunction with reduced LOS. In category (2) profit increased only minimally. In category (3), profit increased rarely and sometimes decreased. In cases of conservative treatment, profits sometimes decreased because an increase in material costs exceeded the increase in revenue. It therefore became clear that the DPC-based payment system does not decisively provide an economic incentive to reduce LOS in cardiovascular medicine.

Ensuring the security and availability of a hospital wireless LAN system.

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Hanada, Eisuke; Kudou, Takato; Tsumoto, Shusaku

2013-01-01

Wireless technologies as part of the data communication infrastructure of modern hospitals are being rapidly introduced. Even though there are concerns about problems associated with wireless communication security, the demand is remarkably large. Herein we discuss security countermeasures that must be taken and issues concerning availability that must be considered to ensure safe hospital/business use of wireless LAN systems, referring to the procedures introduced at a university hospital. Security countermeasures differ according to their purpose, such as preventing illegal use or ensuring availability, both of which are discussed. The main focus of the availability discussion is on signal reach, electromagnetic noise elimination, and maintaining power supply to the network apparatus. It is our hope that this information will assist others in their efforts to ensure safe implementation of wireless LAN systems, especially in hospitals where they have the potential to greatly improve information sharing and patient safety.

HTA decision support system for sustainable business continuity management in hospitals. The case of surgical activity at the University Hospital in Florence.

Science.gov (United States)

Miniati, Roberto; Dori, Fabrizio; Cecconi, Giulio; Gusinu, Roberto; Niccolini, Fabrizio; Gentili, Guido Biffi

2013-01-01

A fundamental element of the social and safety function of a health structure is the need to guarantee continuity of clinical activity through the continuity of technology. This paper aims to design a Decision Support System (DSS) for medical technology evaluations based on the use of Key Performance Indicators (KPI) in order to provide a multi-disciplinary valuation of a technology in a health structure. The methodology used in planning the DSS followed the following key steps: the definition of relevant KPIs, the development of a database to calculate the KPIs, the calculation of the defined KPIs and the resulting study report. Finally, the clinical and economic validation of the system was conducted though a case study of Business Continuity applied in the operating department of the Florence University Hospital AOU Careggi in Italy. A web-based support system was designed for HTA in health structures. The case study enabled Business Continuity Management (BCM) to be implemented in a hospital department in relation to aspects of a single technology and the specific clinical process. Finally, an economic analysis of the procedure was carried out. The system is useful for decision makers in that it precisely defines which equipment to include in the BCM procedure, using a scale analysis of the specific clinical process in which the equipment is used. In addition, the economic analysis shows how the cost of the procedure is completely covered by the indirect costs which would result from the expenses incurred from a broken device, hence showing the complete auto-sustainability of the methodology.

Factors for change in maternal and perinatal audit systems in Dar es Salaam hospitals, Tanzania.

Science.gov (United States)

Nyamtema, Angelo S; Urassa, David P; Pembe, Andrea B; Kisanga, Felix; van Roosmalen, Jos

2010-06-03

Effective maternal and perinatal audits are associated with improved quality of care and reduction of severe adverse outcome. Although audits at the level of care were formally introduced in Tanzania around 25 years ago, little information is available about their existence, performance, and practical barriers to their implementation. This study assessed the structure, process and impacts of maternal and perinatal death audit systems in clinical practice and presents a detailed account on how they could be improved. A cross sectional descriptive study was conducted in eight major hospitals in Dar es Salaam in January 2009. An in-depth interview guide was used for 29 health managers and members of the audit committees to investigate the existence, structure, process and outcome of such audits in clinical practice. A semi-structured questionnaire was used to interview 30 health care providers in the maternity wards to assess their awareness, attitude and practice towards audit systems. The 2007 institutional pregnancy outcome records were reviewed. Overall hospital based maternal mortality ratio was 218/100,000 live births (range: 0 - 385) and perinatal mortality rate was 44/1000 births (range: 17 - 147). Maternal and perinatal audit systems existed only in 4 and 3 hospitals respectively, and key decision makers did not take part in audit committees. Sixty percent of care providers were not aware of even a single action which had ever been implemented in their hospitals because of audit recommendations. There were neither records of the key decision points, action plan, nor regular analysis of the audit reports in any of the facilities where such audit systems existed. Maternal and perinatal audit systems in these institutions are poorly established in structure and process; and are less effective to improve the quality of care. Fundamental changes are urgently needed for successful audit systems in these institutions.

Hospital employs TQM principles to rework its evaluation system.

Science.gov (United States)

Burda, D

1992-02-24

One Kansas hospital has taken the traditional employee evaluation process--with all its performance criteria, point systems and rankings--and turned it on its head. The new system employs total quality management principles and promotes personal development, education and teamwork. And everyone gets the same raise.

The role of non-financial performance measures in predicting hospital financial performance: the case of for-profit system hospitals.

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Vélez-González, Heltie; Pradhan, Rohit; Weech-Maldonado, Robert

2011-01-01

Non-financial measures have found increasing acceptance in the business world--however, their application in the health care industry remains limited. The purpose of this article is to understand the influence of non-financial measures (efficiency, productivity, and quality) on the financial performance of for-profit system hospitals. The sample consists of 499 for-profit system hospitals in the United States from 1999 to 2002. Data analyzed include the American Hospital Association's Annual Survey, Medicare Cost Reports, Joint Commission's quality scores, and the Centers for Medicare & Medicaid Services' Hospital Case Mix Index. Dependent variables consist of financial measures (operating and total margins), while independent variables include measures of efficiency, productivity, and quality. Our results suggest the influence of non-financial performance measures on financial performance; occupancy rate positively influences financial performance while greater labor intensity may have negative implications for financial performance. In addition, we show that quality positively influences financial performance thereby offering a potential business case for quality. This result has important managerial and policy implications as it may incentivize capital and human resource investments required to improve hospital quality of care.