Bergenholtz, Heidi; Jarlbæk, Lene; Hølge-Hazelton, Bibi
Background: It can be challenging to provide generalist palliative care in hospitals, owing to difficulties in integrating disease-orientedtreatment with palliative care and the influences of cultural and organisational conditions. However, knowledge on the interactionsthat occur is sparse. Aim......: To investigate the interactions between organisation and culture as conditions for integrated palliative care in hospital and, ifpossible, to suggest workable solutions for the provision of generalist palliative care. Design: A convergent parallel mixed-methods design was chosen using two independent studies...... hospital with 29 department managements and one hospital management. Results: Two overall themes emerged: (1) ‘generalist palliative care as a priority at the hospital’, suggesting contrasting issues regardingprioritisation of palliative care at different organisational levels, and (2) ‘knowledge and use...
U.S. Department of Health & Human Services — The National Hospital Ambulatory Medical Care Survey (NHAMCS) is designed to collect data on the utilization and provision of ambulatory care services in hospital...
Mann, J; Melnick, G; Bamezai, A; Zwanziger, J
This Data Watch examines the impact of hospital competition, the Medicare prospective payment system (PPS), and Medi-Cal selective contracting on the provision of uncompensated care by private hospitals in California during 1980-1989. It finds that hospitals subject to more intense competition and greater fiscal pressure from Medicare and Medi-Cal reduced their provision of uncompensated care relative to hospitals facing less pressure from these sources. We estimate that had hospitals not been subjected to increasing price competition from growth of managed care plans and financial tightening in public programs, they would have provided 36 percent more uncompensated care than was actually provided in 1989.
U.S. Department of Health & Human Services — Timely and Effective Care measures - provider data. This data set includes provider-level data for measures of heart attack care, heart failure care, pneumonia care,...
Quality improvement can not focus exclusively on peer review and the scientific evaluation of medical care processes. These essential elements have to be complemented with a focus on individual patient needs and preferences. Only then will hospitals create the competitive advantage needed to survive in an increasingly market-driven hospital industry. Hospital managers can identify these patients' needs by 'living the patient experience' and should then set the hospital's quality objectives according to its target patients and their needs. Excellent quality program design, however, is not sufficient. Successful implementation of a quality improvement program further requires fundamental changes in pivotal jobholders' behavior and mindset and in the supporting organizational design elements.
Barra, Daniela Couto Carvalho; Waterkemper, Roberta; Kempfer, Silvana Silveira; Carraro, Telma Elisa; Radünz, Vera
Qualitative research whose purpose was to reflect and argue about the relationship between hospitality, care and nursing according to experiences of PhD students. The research was developed from theoretic and practical meeting carried through by disciplines "the care in Nursing and Health" of PhD nursing Program at Santa Catarina Federal University. Its chosen theoretical frame of Hospitality perspective while nursing care. Data were collected applying a semi-structured questionnaire at ten doctoral students. The analysis of the data was carried through under the perspective of the content analysis according to Bardin. Hospitality it is imperative for the individuals adaptation in the hospital context or any area where it is looking for health care.
E.K.A. van Doorslaer (Eddy); R.C.J.A. van Vliet (René)
textabstractIn this article we want to confront some of the results of the theoretical literature on aggregation with the empirical consequences of aggregation in the context of the analysis of demand for hospital care. There has been an evolution in the estimation of hospital demand functions from
E.K.A. van Doorslaer (Eddy); R.C.J.A. van Vliet (René)
textabstractIn this article we want to confront some of the results of the theoretical literature on aggregation with the empirical consequences of aggregation in the context of the analysis of demand for hospital care. There has been an evolution in the estimation of hospital demand functions from
There are so many obvious delays and inefficiencies in our traditional system of acute hospital care; it is clear that if outcomes are to be improved prompt accurate assessment immediately followed by competent and efficient treatment is essential. Early warning scores (EWS) help detect acutely ill patients who are seriously ill and likely to deteriorate. However, it is not known if any EWS has universal applicability to all patient populations. The benefit of Rapid Response Systems (RRS) such as Medical Emergency Teams has yet to be proven, possibly because doctors and nurses are reluctant to call the RRS for help. Reconfiguration of care delivery in an Acute Medical Assessment Unit has been suggested as a "proactive" alternative to the "reactive" approach of RRS. This method ensures every patient is in an appropriate and safe environment from the moment of first contact with the hospital. Further research is needed into what interventions are most effective in preventing the deterioration and\\/or resuscitating seriously ill patients. Although physicians expert in hospital care decrease the cost and length of hospitalization without compromising outcomes hospital care will continue to be both expensive and potentially dangerous.
Proserpio, Tullio; Piccinelli, Claudia; Clerici, Carlo Alfredo
This literature review investigates the potential contribution of the pastoral care provided in hospitals by hospital chaplains, as part of an integrated view of patient care, particularly in institutions dealing with severe disease. A search was conducted in the Medline database covering the last 10 years. Ninety-eight articles were considered concerning the modern hospital chaplains' relationships and the principal procedures and practices associated with their roles, i.e., their relations with the scientific world, with other religious figures in the community, with other faiths and religious confessions, with other public health professionals and operators, with colleagues in professional associations and training activities, and with the hospital organization as a whole, as well as their patient assessment activities and the spiritual-religious support they provide, also for the patients' families. Improvements are needed on several fronts to professionalize the pastoral care provided in hospitals and modernize the figure of the hospital chaplain. These improvements include better relations between modern chaplains and the hospital organization and scientific world; more focus on a scientific approach to their activities and on evaluating the efficacy of pastoral care activities; greater clarity in the definition of the goals, methods and procedures; the design of protocols and a stance on important ethical issues; respect for the various faiths, different cultures and both religious and nonreligious or secularized customs; greater involvement in the multidisciplinary patient care teams, of which the hospital chaplains are an integral part; stronger integration with public health operators and cooperation with the psychosocial professions; specific training on pastoral care and professional certification of chaplains; and the development of shared ethical codes for the profession.
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.
Seferdjeli, Laurence; Terraneo, Fabienne
In a context in which sanitary institutions have transparency obligations toward authorities and patients, quality management and best practices--defined according to scientific standards--have become major concerns with respect to in-house management. While protocols and prescriptions are necessary for orienting work, they don't apply by themselves. Given that these various documents provide standardized and stabilized work descriptions, they contribute to hide what workers effectively do in unstable and variable situations in which numerous, sometimes contradictory, elements need to be simultaneously considered. In the present work, we follow this claim held by the French ergonomics stream and we consider the serious and irreducible gap between "prescribed work" and "real effective work". Such an understanding based on research evidence appears more adapted to professional realities and provides (valued) resources in nursing education. Based on information collected in three work analysis studies conducted by our team in hospital settings, we deepen these notions and their implication for practice and education.
... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Aid for hospital care. 17... to States for Care of Veterans in State Homes § 17.196 Aid for hospital care. Aid may be paid to the designated State official for hospital care furnished in a recognized State home for any veteran if: (a) The...
... Hospital Deductible and Hospital and Extended Care Services Coinsurance Amounts for CY 2011 AGENCY: Centers... inpatient hospital deductible and the hospital and extended care services coinsurance amounts for services... (c) $141.50 for the 21st through 100th day of extended care services in a skilled nursing facility...
Marlos Victor Fonsêca de Lima
Full Text Available This study aimed to identify the profile of external causes in the emergency room of a public reference hospital in the state. Descriptive research document with a quantitative approach. The data analysis revealed that from January to December 2009 were made 4464 external causes. The higher frequency of injuries occurred in individuals aged 21 to 40 years (37.70%, males (68.6%. Regarding the causes, falls (29% was the biggest variable, followed by motorcycle accidents (17.98%, domestic accidents (16.53%, physical abuse (10.43% and bicycle accident (8, 84%. It was observed that 23.3% of the visits made to the emergency room were the people coming from surrounding municipalities. The study revealed the need to improve the quality of information about the grievances motivated by external causes, which are major causes of hospitalization and health care expenses.
... Assistance Program No. 93.773, Medicare--Hospital Insurance; and Program No. 93.774, Medicare-- Supplementary... 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; Hospitals' Resident...
Mowll, C A
This study uses a new relative risk methodology developed by the author to assess and compare certain performance indicators to determine a hospital's relative degree of financial vulnerability, based on its location, to the effects of increased managed care market penetration. The study also compares nine financial measures to determine whether hospital in states with a high degree of managed-care market penetration experience lower levels of profitability, liquidity, debt service, and overall viability than hospitals in low managed care states. A Managed Care Relative Financial Risk Assessment methodology composed of nine measures of hospital financial and utilization performance is used to develop a high managed care state Composite Index and to determine the Relative Financial Risk and the Overall Risk Ratio for hospitals in a particular state. Additionally, financial performance of hospitals in the five highest managed care states is compared to hospitals in the five lowest states. While data from Colorado and Massachusetts indicates that hospital profitability diminishes as the level of managed care market penetration increases, the overall study results indicate that hospitals in high managed care states demonstrate a better cash position and higher profitability than hospitals in low managed care states. Hospitals in high managed care states are, however, more heavily indebted in relation to equity and have a weaker debt service coverage capacity. Moreover, the overall financial health and viability of hospitals in high managed care states is superior to that of hospitals in low managed care states.
Murugasu, G Dr.
Under the Quality and Continuing Care Directorate (QCCD) in stroke care Cavan General Hospital was identified as a hospital that received a large number of stroke and TIA patients. A programme was established to improve services to this population.
Zhang, Xiao-Ying; Zhang, Pei-Ying
The utilization of hospital information technology (HIT) as a tool for home care is a recent trend in health science. Subjects gaining benefits from this new endeavor include middle-aged individuals with serious chronic illness living at home. Published data on the utilization of health care information technology especially for home care in chronic illness patients have increased enormously in recent past. The common chronic illnesses reported in these studies were primarily on heart and lung diseases. Furthermore, health professionals have confirmed in these studies that HIT was beneficial in gaining better access to information regarding their patients and they were also able to save that information easily for future use. On the other hand, some health professional also observed that the use of HIT in home care is not suitable for everyone and that individuals cannot be replaced by HIT. On the whole it is clear that the use of HIT could complement communication in home care. The present review aims to shed light on these latest aspects of the health care information technology in home care.
Bender, A D; Geoghegan, S S; Lundquist, S H; Cantone, J M; Krasnick, C J
With increasing competition among hospitals, primary care referral development and management programs offer an opportunity for hospitals to increase their admissions. Such programs require careful development, the commitment of the hospital staff to the strategy, an integration of hospital activities, and an understanding of medical practice management.
Solé-Casals, Montserrat; Chirveches-Pérez, Emilia; Alsina-Ribas, Anna; Puigoriol-Juvanteny, Emma; Oriol-Ruscalleda, Margarita; Subirana-Casacuberta, Mireia
To describe the profile of patients treated by a Continuity of Care Manager in an acute-care center during the first six months of its activity, as well as the profile of patients treated and the resource allocation. A prospective cross-sectional study was conducted on patients with complex care needs requiring continuity of care liaison, and who were attended by the Continuity of Care Nurse during the period from October 2013 to March 2014. Patient characteristics, their social environment and healthcare resource allocation were registered and analyzed. A total of 1,034 cases of demand that corresponded to 907 patients (women 55.0%; age 80.57±10.1; chronic 47.8%) were analyzed, of whom 12.2% were readmitted. In the multivariate model, it was observed that the variables associated with readmission were polypharmacy (OR: 1.86; CI: 1.2-2.9) and fall history prior to admission (OR: 0.586; CI: 0.36-2-88). Patients treated by a Continuity of Care Nurse are over 80 years, with comorbidities, geriatric syndromes, complex care, and of life needs, to whom an alternative solution to hospitalization is provided, thus preventing readmissions. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.
Paradiso, M A; Alvaro, M R; Liotta, G
In the Lazio Region (Central Italy) the Emergency Care network has been recently re-arranged in order to improve the effectiveness of care. The aim of this paper is to assess the impact of stroke patient care on both cost and organization of the hospital of Palestrina (Lazio Region). An analysis of cost and path of care of all stroke patients (239) with stroke attending the hospital in 2010 has been carried out. The care was more expensive than the one offered to the stroke patients attending the “Hospital at Home” service managed by the San Giovanni Battista Hospital in Turin; moreover the care was incomplete because of the lack of rehabilitation services in the hospital catchment area. The care model offered to stroke patient hit by stroke in Palestrina needs to be deeply revised.
... Program No. 93.773, Medicare--Hospital Insurance; and Program No. 93.774, Medicare-- Supplementary Medical...-AR53 and 0938-AR73 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...
Kimberly K. Garner
Full Text Available Hospital executives are key stakeholders in the hospital setting. However, despite extensive medical and nursing literature on the importance of end-of-life (EOL care in hospitals, little is known about hospital executives’ perceptions of the provision of EOL care in their facilities. The objective of this study was to capture hospital executives’ perceptions of the provision of EOL care in the hospital setting. This descriptive, naturalistic phenomenological, qualitative study utilized in-person interviews to explore executives’ opinions and beliefs. The sample consisted of 14 individuals in the roles of medical center directors, chiefs of staff, chief medical officers, hospital administrators, hospital risk managers, and regional counsel in Arkansas, Louisiana and Texas. An interview guide was developed and conducted utilizing a global question followed by probes concerning perceptions of EOL care provision. Hospital executives acknowledged that EOL care was a very important issue, and more attention should be paid to it in the hospital setting. Their comments and suggestions for improvement focused on (a current EOL care, (b barriers to changing EOL care, and (c enhancing provision of EOL care in the hospital setting. The findings of this study suggest that hospital executives although key change agents, may have insufficient EOL information to implement steps toward cultural and infrastructural change and should therefore be included in any EOL discussions and education.
de Castro, Edna Aparecida Barbosa; de Camargo Junior, Kenneth Rochel
This paper presents an analysis of how Clifford Geertz' anthropological approach contributes to studies and investigations on health care. Geertz' approach relies basically on a semiotic conception of culture adopting thick description as the axis for interpretive elaborations and defending cultural interpretation as a science allowing to understand processes and to construct knowledge. We will present an overview of some constitutive elements of that author's thoughts we consider relevant for understanding the human experience of dealing with the disease/health process. The challenging question is how families deal with the need to provide care to a diseased relative after hospital discharge. We use this issue as an excuse for expounding this theoretical approach, interweaving the two areas. The micro-focus is the kind of healthcare that takes place outside the cultural environment where the technical forms of care based on scientific knowledge occur. We will briefly discuss how this question becomes evident in an object of study, and how it can be investigated according to the ethnography proposed by Geertz (op. cit.), allowing, in the end, for some considerations that further contribute to the construction of knowledge in public health.
This article discusses an ignored problem--the plight of infants and toddlers in foster care who find themselves hospitalized. A majority of the children in foster care will be hospitalized for medical treatment while in foster care because they are more likely to have serious medical problems or developmental disabilities than their age peers.…
This article discusses an ignored problem--the plight of infants and toddlers in foster care who find themselves hospitalized. A majority of the children in foster care will be hospitalized for medical treatment while in foster care because they are more likely to have serious medical problems or developmental disabilities than their age peers.…
Sorensen, Ros; Iedema, Rick
The care of people who die in hospitals is often suboptimal. Involving patients in decisions about their care is seen as one way to improve care outcomes. Federal and state government policymakers in Australia are promoting shared decision making in acute care hospitals as a means to improve the quality of end-of-life care. If policy is to be…
Simoens, Steven; Kutten, Betty; Keirse, Emmanuel; Berghe, Paul Vanden; Beguin, Claire; Desmedt, Marianne; Deveugele, Myriam; Léonard, Christian; Paulus, Dominique; Menten, Johan
In addition to the effectiveness of hospital care models for terminal patients, policy makers and health care payers are concerned about their costs. This study aims to measure the hospital costs of treating terminal patients in Belgium from the health care payer perspective. Also, this study compares the costs of palliative and usual care in different types of hospital wards. A multicenter, retrospective cohort study compared costs of palliative care with usual care in acute hospital wards and with care in palliative care units. The study enrolled terminal patients from a representative sample of hospitals. Health care costs included fixed hospital costs and charges relating to medical fees, pharmacy and other charges. Data sources consisted of hospital accountancy data and invoice data. Six hospitals participated in the study, generating a total of 146 patients. The findings showed that palliative care in a palliative care unit was more expensive than palliative care in an acute ward due to higher staffing levels in palliative care units. Palliative care in an acute ward is cheaper than usual care in an acute ward. This study suggests that palliative care models in acute wards need to be supported because such care models appear to be less expensive than usual care and because such care models are likely to better reflect the needs of terminal patients. This finding emphasizes the importance of the timely recognition of the need for palliative care in terminal patients treated in acute wards.
Boyington, T; Williams, D
After a brief outline of past developments in the training of ambulance personnel, this paper traces the adoption in the UK of Pre-Hospital Trauma Life Support (PHTLS) courses from the US. The 1991 World Student Games in Sheffield, UK led to liaison between training staff from South Yorkshire Metropolitan Ambulance and Paramedic Service (SYMAPS) and from Western New York Medical Training Institute. As a result, the trauma care policy of SYMAPS was altered from aiming to stabilise the patient at the scene of the accident to emphasising rapid and thorough assessment, packaging and transport. This is a resume of the scope of the PHTLS provider course. The course concentrates on the principles of PHTLS for the multisystems trauma victim.
Pollyanna Kássia de Oliveira Borges
Full Text Available Objective: to check the profile of sensitive causes hospitalizations for primary care. Methods: this is an ecological, epidemiological study. Data was collected in the Hospital Information System at the Department of Health System Information, grouped according to the admissions list for Sensitive to Primary Causes of Health System. Results: there were 227,014 hospitalizations, 25.8% of them were sensitive to Primary care. The illnesses which caused sensitive admissions were pneumonia (n=19,832; 33.7%, heart failure (n=6,688, 11.3%, and gastroenteritis (n=6,287, 10.7%. Conclusion: sensitive hospitalizations for primary care have decreasing historical trend in the study area. Primary care services, with guidelines and principles, well conducted could minimize the risk of exacerbation of chronic conditions and also endorse lower rates of infection transmitted diseases.
Hsieh, Hui-Min; Bazzoli, Gloria J
This study examines the association between hospital uncompensated care and reductions in Medicaid Disproportionate Share Hospital (DSH) payments resulting from the 1997 Balanced Budget Act. We used data on California hospitals from 1996 to 2003 and employed two-stage least squares with a first-differencing model to control for potential feedback effects. Our findings suggest that nonprofit hospitals did reduce provision of uncompensated care in response to reductions in Medicaid DSH, but the response was inelastic in value. Policymakers need to continue to monitor uncompensated care as sources of support for indigent care change with the Patient Protection and Affordable Care Act (ACA).
McCormick, Barry; White, Jonathan
The national picture of the comparative costs and diagnoses of hospitalised homeless patients are examined using the 'no fixed abode' flag in English hospital statistics. Comparable studies sample patients in single cities, eg New York and Toronto. The most common diagnosis is substance misuse; the share of homeless NHS patients with this diagnosis is rising, and now equals that found in North American cities. About half of the cost of homeless patients relates to diagnoses of mental illness, although these comprise a much smaller share of homeless patients than in North America. Hospital costs for homeless patients - both total and per admission - have fallen significantly in recent years, primarily because of fewer admissions and shorter lengths of stay for mentally ill patients. Aims to reduce NHS costs at the level of individual institutions have often shaped policy. Broader policy to prevent and reduce homelessness offers substantial long-term reductions in the cost of chronic care. © Royal College of Physicians 2016. All rights reserved.
Ali, Manhal; Salehnejad, Reza; Mansur, Mohaimen
A major feature of health care systems is substantial variation in health care quality across hospitals. The quality of stroke care widely varies across NHS hospitals. We investigate factors that may explain variations in health care quality using measures of quality of stroke care. We combine NHS trust data from the National Sentinel Stroke Audit with other data sets from the Office for National Statistics, NHS and census data to capture hospitals' human and physical assets and organisational characteristics. We employ a class of non-parametric methods to explore the complex structure of the data and a set of correlated random effects models to identify key determinants of the quality of stroke care. The organisational quality of the process of stroke care appears as a fundamental driver of clinical quality of stroke care. There are rich complementarities amongst drivers of quality of stroke care. The findings strengthen previous research on managerial and organisational determinants of health care quality.
Hospital Protocol RSD/CRPS Patients: Handle With Care! Reflex Sympathetic Dystrophy (RSD) also known as Complex Regional ... taken care of solely through use of the hospital’s pharmacy. Some medications may not be part of ...
Taylor, Janie J; Hodgson, Jennifer L; Kolobova, Irina; Lamson, Angela L; Sira, Natalia; Musick, David
Hospital chaplaincy and spiritual care services are important to patients' medical care and well-being; however, little is known about healthcare providers' experiences receiving spiritual support. A phenomenological study examined the shared experience of spiritual care between hospital chaplains and hospital-based healthcare providers (HBHPs). Six distinct themes emerged from the in-depth interviews: Awareness of chaplain availability, chaplains focus on building relationships with providers and staff, chaplains are integrated in varying degrees on certain hospital units, chaplains meet providers' personal and professional needs, providers appreciate chaplains, and barriers to expanding hospital chaplains' services. While HBHPs appreciated the care received and were able to provide better patient care as a result, participants reported that administrators may not recognize the true value of the care provided. Implications from this study are applied to hospital chaplaincy clinical, research, and training opportunities.
Hospital leaders are being challenged to become more consumer-oriented, more interprofessional in their approach to care and more focused on outcome measures and continuous quality improvement. The concept of the learning organization could provide the conceptual framework necessary for understanding and addressing these various challenges in a systematic way. The paper aims to discuss these issues. A scan of the literature reveals that this concept has been applied to hospitals and other health care institutions, but it is not known to what extent this concept has been linked to hospitals and with what outcomes. To bridge this gap, the question of whether learning organizations are the answer to improving hospital care needs to be considered. Hospitals are knowledge-intensive organizations in that there is a need for constant updating of the best available evidence and the latest medical techniques. It is widely acknowledged that learning may become the only sustainable competitive advantage for organizations, including hospitals. With the increased demand for accountability for quality care, fiscal responsibility and positive patient outcomes, exploring hospitals as learning organizations is timely and highly relevant to senior hospital administrators responsible for integrating best practices, interprofessional care and quality improvement as a primary means of achieving these outcomes. To date, there is a dearth of research on hospitals as learning organizations as it relates to improving hospital care.
Chappell, Neena L.; Blandford, Audrey A.
Examined effect of adult day care (ADC) on utilization of health care practitioner and inpatient hospital services. Data from three separate ADC studies revealed that, when operative for some time, ADC may result in dramatic decreases in hospital inpatient stays. Findings warrant further research. (Author/NB)
... research purposes. 17.45 Section 17.45 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.45 Hospital care for research purposes... of Veterans Affairs research project and there are insufficient veteran-patients suitable for...
Marcos, Luis R.; Gil, Rosa M.
Analyzes the interaction between psychiatric services in public general hospitals and in other institutional settings. A one-day census of patients in a New York general hospital showed the hospital was providing care to a large number of patients in need of other, less intensive institutional settings. (BH)
Akubue, B. N.; Anikweze, G. U.
The purpose of this study was to investigate the health care practices for medical textiles in government hospitals Enugu State, Nigeria. Specifically, the study determined the availability and maintenance of medical textiles in government hospitals in Enugu State, Nigeria. A sample of 1200 hospital personnel were studied. One thousand two hundred…
Hansson, Eva Helena; Kjaergaard, H; Schmiegelow, K
. Our study highlights the importance of providing hospital-based home care with consideration for the family members' need for the sense of security achieved by home care by experienced paediatric oncology nurses and regular contact with the doctor. In future studies, interviews with children......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...
McHugh, Matthew D; Stimpfel, Amy Witkoski
As the primary providers of round-the-clock bedside care, nurses are well positioned to report on hospital quality of care. Researchers have not examined how nurses' reports of quality correspond with standard process or outcomes measures of quality. We assess the validity of evaluating hospital quality by aggregating hospital nurses' responses to a single item that asks them to report on quality of care. We found that a 10% increment in the proportion of nurses reporting excellent quality of care was associated with lower odds of mortality and failure to rescue; greater patient satisfaction; and higher composite process of care scores for acute myocardial infarction, pneumonia, and surgical patients. Nurse reported quality of care is a useful indicator of hospital performance. Copyright © 2012 Wiley Periodicals, Inc.
the hospital fixed effect and adjust for hospital characteristics such as number of patients treated, factor prices and number of specialties involved in diabetes care. We rank hospitals by their adjusted fixed effect, which measures the extent to which their costs vary from the average after controlling......Background: Many diabetic patients are admitted to hospital, where care is costly and where there may be scope to improve efficiency. Aims: We analyse the costs and characteristics of diabetic patients admitted to English hospitals and aim to assess what proportions of cost variation are explained...... by patient and hospital characteristics. Methods: We apply a multilevel approach recognising that patients are clustered in hospitals. We first analyse the relationship between patient costs and their characteristics, such as HRG, age, gender, diagnostic markers and socio-economic status. We derive...
Aij, Kjeld Harald; Aernoudts, René L M C; Joosten, Gepke
This paper aims to assess the impact of the leadership traits of chief executive officers (CEOs) on hospital performance in the USA. The effectiveness and efficiency of the CEO is of critical importance to the performance of any organization, including hospitals. Management systems and manager behaviours (traits) are of crucial importance to any organization because of their connection with organizational performance. To identify key factors associated with the quality of care delivered by hospitals, the authors gathered perceptions of manager traits from chief executive officers (CEOs) and followers in three groups of US hospitals delivering different levels of quality of care performance. Three high- and three low-performing hospitals were selected from the top and bottom 20th percentiles, respectively, using a national hospital ranking system based on standard quality of care performance measures. Three lean hospitals delivering intermediate performance were also selected. A survey was used to gather perceptions of manager traits (providing a modern or lean management system inclination) from CEOs and their followers in the three groups, which were compared. Four traits were found to be significantly different (alpha performing hospitals. The different perceptions between these two hospital groups were all held by followers in the low-performing hospitals and not the CEOs, and all had a modern management inclination. No differences were found between lean (intermediate-) and high-performing hospitals, or between high- and low-performing hospitals. These findings support a need for hospital managers to acquire appropriate traits to achieve lean transformation, support a benefit of measuring manager traits to assess progress towards lean transformation and lend weight to improved quality of care that can be delivered by hospitals adopting a lean system of management.
U.S. Department of Health & Human Services — Payment measures and value of care displays â provider data. This data set includes provider data for the payment measures and value of care displays associated...
White, K R; Thompson, J M; Patel, U B
The hospital marketing function has been widely adopted as a way to learn about markets, attract sufficient resources, develop appropriate services, and communicate the availability of such goods to those who may be able to purchase such services. The structure, tasks, and effectiveness of the marketing function have been the subject of increased inquiry by researchers and practitioners alike. A specific understanding of hospital marketing in a growing managed care environment and the relationship between marketing and managed care processes in hospitals is a growing concern. Using Kotler and Clarke's framework for assessing marketing orientation, we examined the marketing orientation of hospitals in a single state at two points in time--1993 and 1999. Study findings show that the overall marketing orientation score decreased from 1993 to 1999 for the respondent hospitals. The five elements of the Kotler and Clarke definition of marketing orientation remained relatively stable, with slightly lower scores related to customer philosophy. In addition, we evaluated the degree to which selected managed care activities are carried out as part of its marketing function. A significant (p managed care processes coordinated with the formal marketing function was evident from 1993 to 1999. With increasing numbers of managed care plan enrollees, hospitals are likely focusing on organizational buyers as important customers. In order to appeal to organizational buyers, hospital executives may be focusing more on clinical quality and cost efficiency in the production of services, which will improve a hospital's position with organizational buyers.
Timian, Alex; Rupcic, Sonia; Kachnowski, Stan; Luisi, Paloma
With the growth of Facebook, public health researchers are exploring the platform's uses in health care. However, little research has examined the relationship between Facebook and traditional hospital quality measures. The authors conducted an exploratory quantitative analysis of hospitals' Facebook pages to assess whether Facebook "Likes" were associated with hospital quality and patient satisfaction. The 30-day mortality rates and patient recommendation rates were used to quantify hospital quality and patient satisfaction; these variables were correlated with Facebook data for 40 hospitals near New York, NY. The results showed that Facebook "Likes" have a strong negative association with 30-day mortality rates and are positively associated with patient recommendation. These exploratory findings suggest that the number of Facebook "Likes" for a hospital may serve as an indicator of hospital quality and patient satisfaction. These findings have implications for researchers and hospitals looking for a quick and widely available measure of these traditional indicators.
NSGIC GIS Inventory (aka Ramona) — This Hospitals dataset, was produced all or in part from Published Reports/Deeds information as of 2006. It is described as 'care facility attribute'. Data by this...
Gautam, K; Campbell, C; Arrington, B
This article describes the changing profile of hospitals initiating managed care contracts as of 1992. Based on statistical tests, early contractors rank higher on profitability, case mix, bed size, affiliation, and urban location. In contrast, recent and noncontractors are predominantly rural, freestanding hospitals with low case mix, low profitability, high subacute services, and government ownership. A number of lessons for the future are drawn and a stage-by-stage approach to studying managed care issues is proposed.
Introduction: Malnutrition adversely affects clinical outcome of hospitalized patients. This observational prospective study was done to assess the prevalence of malnutrition and its grade among patients admitted in a mixed intensive care unit (ICU) of a tertiary care hospital in order to help devise a comprehensive nutrition program for the malnourished. Materials and Methods: A total of 500 sequential patients admitted to the ICU were screened on admission over a year period for malnutritio...
Khosravan, Shahla; Mazlom, Behnam; Abdollahzade, Naiemeh; Jamali, Zeinab; Mansoorian, Mohammad Reza
Background: Few studies, especially in Iran, have assessed the status of family participation in the care of the hospitalized patients. Objectives: This study was conducted to assess why family members partake in caregiving of their patients in hospitals, the type of care that family provide, and the outcomes of the participation in the opinions of nurses and family members. Patients and Methods: In this comparative-descriptive study, data was collected by a two- version researcher-developed ...
Koch, Abby; Checkley, William
Since the inception of critical care as a formal discipline in the late 1950s, we have seen rapid specialization to many types of intensive care units (ICUs) to accommodate evolving life support technologies and novel therapies in various disciplines of medicine. Indeed, the field has expanded such that specialized ICUs currently exist to address critical care problems in medicine, cardiology, neurology and neurosurgery, trauma, burns, organ transplant and cardiothoracic surgeries. Specializa...
Mosallam, Rasha A; Guirguis, Wafaa W; Hassan, Mona Ha
This study aimed at estimating the percentage of hospital discharges and days of care accounted for by Ambulatory Care Sensitive Conditions (ACSCs) at Health Insurance Organization (HIO) hospitals in Alexandria, calculating hospitalization rates for ACSCs among HIO population and identifying determinants of hospitalization for those conditions. A sample of 8300 medical records of patients discharged from three hospitals affiliated to HIO at Alexandria was reviewed. The rate of monthly discharges for ACSCs was estimated on the basis of counting number of combined ACSCs detected in the three hospitals and the hospitals' average monthly discharges. ACSCs accounted for about one-fifth of hospitalizations and days of care at HIO hospitals (21.8% and 20.8%, respectively). Annual hospitalization rates for ACSCs were 152.5 per 10,000 insured population. The highest rates were attributed to cellulitis/abscess (47.3 per 10,000 population), followed by diabetes complications and asthma (42.8 and 20.8 per 10,00 population). Logistic regression indicated that age, number of previous admissions, and admission department are significant predictors for hospitalization for an ACSC. Copyright © 2014 John Wiley & Sons, Ltd.
Botje, D.; Plochg, T.; Klazinga, N.; Wagner, C.
Context: In European countries policy briefs are stressing the importance of hospital governance for the quality of care. When governing towards quality it is essential for Hospital Boards to receive the proper information to do so. In the Netherlands, the national association for medical
Botje, D.; Plochg, T.; Klazinga, N.; Wagner, C.
Context: In European countries policy briefs are stressing the importance of hospital governance for the quality of care. When governing towards quality it is essential for Hospital Boards to receive the proper information to do so. In the Netherlands, the national association for medical specialist
C. Fischer (Claudia)
markdownabstractAbstract Hospital quality indicators are widely implemented for purposes such as accountability, transparency and the overarching aim of quality improvement. However, it is not clear whether currently used hospital quality indicators actually reflect quality of care. The aim of
Lomborg, Kirsten; Bjoern, Agnes; Dahl, Ronald
Aim. The paper gives a theoretical account of experiences of assisted personal body care (APBC) in hospitalized patients with severe chronic obstructive pulmonary disease (COPD). Background. Body care has been identified as a central but underestimated area of nursing. Hospitalized patients...... with severe COPD suffer from breathlessness on exertion and are dependent on help with personal body care. Studies have described patient strategies for managing breathlessness and preferences regarding nursing care during hospitalization. Yet the problems that patients can experience because...... observation of sessions of APBC, in-depth interviews after the observed sessions and measurement of breathlessness perceived by patients before and after the sessions. Findings. The patients perceived body care as a significant daily activity that needed to be carried out in order to preserve their integrity...
Interpretation & conclusions: This study highlights the effect of HAI on costs for PICU patients, especially costs due to prolongation of hospital stay, and suggests the need to develop effective strategies for prevention of HAI to reduce costs of health care.
Escarce, J J; Shea, J A; Chen, W
Commercially insured and Medicare patients who are not in health maintenance organizations (HMOs) tend to use different hospitals than HMO patients use. This phenomenon, called market segmentation, raises important questions about how hospitals that treat many HMO patients differ from those that treat few HMO patients, especially with regard to quality of care. This study of patients undergoing coronary artery bypass graft surgery found no evidence that HMOs in southeast Florida systematically channel their patients to high-volume or low-mortality hospitals. These findings are consistent with other evidence that in many areas of the country, incentives for managed care plans to reduce costs may outweigh incentives to improve quality.
Mas, Núria; Seinfeld, Janice
As health care costs increase, cost-control mechanisms become more widespread and it is crucial to understand their implications for the health care market. This paper examines the effect that managed care activity (based on the aim to control health care expenditure) has on the adoption of technologies by hospitals. We use a hazard rate model to investigate whether higher levels of managed care market share are associated with a decrease on medical technology adoption during the period 1982-1995. We analyze annual data on 5390 US hospitals regarding the adoption of 13 different technologies. Our results are threefold: first, we find that managed care has a negative effect on hospitals' technology acquisition for each of the 13 medical technologies in our study, and its effect is stronger for those technologies diffusing in the 1990s, when the managed care sector is at its largest. If managed care enrollment had remained at its 1984 level, there would be 5.3%, 7.3% and 4.1% more hospitals with diagnostic radiology, radiation therapy and cardiac technologies, respectively. Second, we find that the rise in managed care leads to long-term reductions in medical cost growth. Finally, we take into account that profitability analysis is one of the main dimensions considered by hospitals when deciding about the adoption of new technologies. In order to determine whether managed care affects technologies differently if they have a different cost-reimbursement ratio (CRR), we have created a unique data set with information on the cost-reimbursement for each of the 13 technologies and we find that managed care enrollment has a considerably larger negative effect on the adoption of less profitable technologies.
Tibaldi, Vittoria; Aimonino Ricauda, Nicoletta; Rocco, Maurizio; Bertone, Paola; Fanton, Giordano; Isaia, Giancarlo
Advances in the miniaturization and portability of diagnostic technologies, information technologies, remote monitoring, and long-distance care have increased the viability of home-based care, even for patients with serious conditions. Telemedicine and teleradiology projects are active at the Hospital at Home Service of Torino.
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.
Full Text Available The care provided to the victims of burn injury immediately after sustaining burns can largely affect the extent and depth of the wound. Although standard guidelines have been formulated by various burn associations, they are still not well known to public at large in our country. In burn injuries, most often, the bystanders are the first care providers. The swift implementation of the measures described in this article for first aid in thermal, chemical, electrical and inhalational injuries in the practical setting, within minutes of sustaining the burn, plays a vital role and can effectively reduce the morbidity and mortality to a great extent. In case of burn disasters, triage needs to be carried out promptly as per the defined protocols. Proper communication and transport from the scene of the accident to the primary care centre and onto the burn care facility greatly influences the execution of the management plans
Full Text Available Centralization of intensive care units (ICUs is a concept that has been around for several decades and the OECD countries have led the way in adopting this in their operations. Singapore Hospital was built in 1981, before the concept of centralization of ICUs took off. The hospital's ICUs were never centralized and were spread out across eight different blocks with the specialization they were associated with. Coupled with the acquisitions of the new concept of centralization and its benefits, the hospital recognizes the importance of having a centralized ICU to better handle major disasters. Using simulation models, this paper attempts to study the feasibility of centralization of ICUs in Singapore Hospital, subject to space constraints. The results will prove helpful to those who consider reengineering the intensive care process in hospitals.
Bie Bogh, Søren; Falstie-Jensen, Anne Mette; Hollnagel, Erik;
OBJECTIVE: To assess changes over time in quality of hospital care in relation to the first accreditation cycle in Denmark. DESIGN, SETTING AND PARTICIPANTS: We performed a multi-level, longitudinal, stepped-wedge, nationwide study of process performance measures to evaluate the impact of a manda......OBJECTIVE: To assess changes over time in quality of hospital care in relation to the first accreditation cycle in Denmark. DESIGN, SETTING AND PARTICIPANTS: We performed a multi-level, longitudinal, stepped-wedge, nationwide study of process performance measures to evaluate the impact...... of a mandatory accreditation programme in all Danish public hospitals. Patient-level data (n = 1 624 518 processes of care) on stroke, heart failure, ulcer, diabetes, breast cancer and lung cancer care were obtained from national clinical quality registries. INTERVENTION: The Danish Healthcare Quality Programme...... was introduced in 2009, aiming to create a framework for continuous quality improvement. MAIN OUTCOME: Changes in week-by-week trends of hospital care during the study period of 269 weeks prior to, during and post-accreditation. RESULTS: The quality of hospital care improved over time throughout the study period...
Bakker, F.C.; Olde Rikkert, M.G.M.
Much of the acute care provided in hospitals is for elderly people. Frailty is a common clinical condition among these patients. Frail patients are vulnerable to undergoing adverse events, to developing geriatric syndromes and to experiencing functional decline during or due to hospitalization. The
The Act to Partially Amend the Act on Mental Health and Welfare for the Mentally Disabled was passed on June 13, 2013. Major amendments regarding hospitalization for medical care and protection include the points listed below. The guardianship system will be abolished. Consent by a guardian will no longer be required in the case of hospitalization for medical care and protection. In the case of hospitalization for medical care and protection, the administrators of the psychiatric hospital are required to obtain the consent of one of the following persons: spouse, person with parental authority, person responsible for support, legal custodian, or curator. If no qualified person is available, consent must be obtained from the mayor, etc. of the municipality. The following three obligations are imposed on psychiatric hospital administrators. (1) Assignment of a person, such as a psychiatric social worker, to provide guidance and counseling to patients hospitalized for medical care and protection regarding their postdischarge living environment. (2) Collaboration with community support entities that consult with and provide information as necessary to the person hospitalized, their spouse, a person with parental authority, a person responsible for support, or their legal custodian or curator. (3) Organizational improvements to promote hospital discharge. With regard to requests for discharge, the revised law stipulates that, in addition to the person hospitalized with a mental disorder, others who may file a request for discharge with the psychiatric review board include: the person's spouse, a person with parental authority, a person responsible for support, or their legal custodian or curator. If none of the above persons are available, or if none of them are able to express their wishes, the mayor, etc. of the municipality having jurisdiction over the place of residence of the person hospitalized may request a discharge. In order to promote transition to life in the
McDermott, D R; Little, M W
Based on responses from 52 hospital administrators, four areas of managerial concern have been addressed, including: (1) decision-making factors; (2) hospital service offerings: current and future; (3) marketing strategy and service priorities; and (4) health care industry challenges. Of the total respondents, 35 percent indicate a Director of Marketing has primary responsibility for making marketing-related decisions in their hospital, and 19 percent, a Vice-President of Marketing, thus demonstrating the increased priority of the marketing function. The continued importance of the physician being the primary market target is highlighted by 70 percent of the administrators feeling physician referrals will be more important regarding future admissions than in the past, compared to only two percent feeling the physicians' role will be less important. Of primary importance to patients selecting a hospital, as perceived by the administrators, are the physician's referral, the patient's previous experience, the hospital's reputation, and the courtesy of the staff. The clear majority of the conventional-care hospitals surveyed offer out-patient surgery, a hospital pharmacy, obstetrics/maternity care, and diabetic services. The future emphasis on expanding services is evidenced by some 50 percent of the hospital administrators indicating they either possibly or definitely plan to offer long-term nursing care, out-patient substance abuse programs, and cancer clinics by 1990. In addition, some one-third of the respondents are likely to expand their offerings to include wellness/fitness centers, in-patient substance abuse programs, remote or satellite primary care clinics, and diabetic services. Other areas having priority for future offerings include services geared specifically toward women and the elderly. Perceived as highest in priority by the administrators regarding how their hospital can achieve its goals in the next three years are market development strategies
Full Text Available Background Prolonged hospitalization in the intensive care unit (ICU can impose long-term psychological effects on patients. One of the most significant psychological effects from prolonged hospitalization is delirium. Objectives The aim of this study was to assess the effect of prolonged hospitalization of patients and subsequent delirium in the intensive care unit. Patients and Methods This conventional content analysis study was conducted in the General Intensive Care Unit of the Shariati Hospital of Tehran University of Medical Sciences, from the beginning of 2013 to 2014. All prolonged hospitalized patients and their families were eligible participants. From the 34 eligible patients and 63 family members, the final numbers of actual patients and family members were 9 and 16, respectively. Several semi-structured interviews were conducted face-to-face with patients and their families in a private room and data were gathered. Results Two main themes from two different perspectives emerged, 'patients' perspectives' (experiences during ICU hospitalization and 'family members' perspectives' (supportive-communicational experiences. The main results of this study focused on delirium, Patients' findings were described as pleasant and unpleasant, factual and delusional experiences. Conclusions Family members are valuable components in the therapeutic process of delirium. Effective use of family members in the delirium caring process can be considered to be one of the key non-medical nursing components in the therapeutic process.
Full Text Available The in-hospital mortality (MIH is used as a performance indicator and quality healthcare in hospital. However, the majority of deaths resulted from an inevitable disease process (severity of cases and / or co-morbidity, and not medical errors or changes in the quality of care. This work aims to make a distribution of deaths in the Regional Hospital of Eastern, Al Farabi hospital and to highlight that more studies on the MIH are required consistently with detailed clinical data at the admission. The MIH showed its limitation as a health care indicator. The overall rate of in-hospital deaths within the Al Farabi hospital has averaged 2.4%, with 8.4% in the emergency unit, 28% in intensive care unit, 22% Neonatology unit, 1.6% in pediatric unit. The MIH may depend, firstly, on the condition of patients before hospitalization and secondly, on the conditions of their transfer from one institution to another that supports them as a last resort. Al Farabi hospital supports patients transferred from the provinces of the eastern region. Thus, 6% of patients who died in 2014 come from Berkane, 2% from Nador, 2% from Bouarfa, 4% from Taourirt and 2% from Jerrada. One might question about the procedures and the conditions of such transfers. In conclusion, the overall MIH measured from routine data do not allow proper comparison between hospitals or the assessment of the quality of care and patient safety in the hospital. To do so, we should ideally have detailed clinical data on admission (e.g. type of admission, age of patient, sex, comorbidity, .... The MIH is however an important indicator to consider as a tool to detect potential problems related to admission procedures and to suspect an area of "non-quality" in healthcare . The MIH is interesting for the patient and for the hospital because it serves the improvement of quality healthcare.
Unni Alice Dahl
Full Text Available Introduction: Intermediate care is an organisational approach to improve the coordination of health care services between health care levels. In Central Norway an intermediate care hospital was established in a municipality to improve discharge from a general hospital to primary health care. The aim of this study was to investigate how health professionals experienced hospital discharge of elderly patients to primary health care with and without an intermediate care hospital. Methods: A qualitative study with data collected through semi-structured focus groups and individual interviews.Results: Discharge via the intermediate care hospital was contrasted favourably compared to discharge directly from hospital to primary health care. Although increased capacity to receive patients from hospital and prepare them for discharge to primary health care was viewed as a benefit, professionals still requested better communication with the preceding care level concerning further treatment and care for the elderly patients.Conclusions: The intermediate care hospital reduced the coordination challenges during discharge of elderly patients from hospital to primary health care. Nevertheless, the intermediate care was experienced more like an extension of hospital than an included part of primary health care and did not meet the need for communication across care levels.
Unni Alice Dahl
Full Text Available Introduction: Intermediate care is an organisational approach to improve the coordination of health care services between health care levels. In Central Norway an intermediate care hospital was established in a municipality to improve discharge from a general hospital to primary health care. The aim of this study was to investigate how health professionals experienced hospital discharge of elderly patients to primary health care with and without an intermediate care hospital. Methods: A qualitative study with data collected through semi-structured focus groups and individual interviews. Results: Discharge via the intermediate care hospital was contrasted favourably compared to discharge directly from hospital to primary health care. Although increased capacity to receive patients from hospital and prepare them for discharge to primary health care was viewed as a benefit, professionals still requested better communication with the preceding care level concerning further treatment and care for the elderly patients. Conclusions: The intermediate care hospital reduced the coordination challenges during discharge of elderly patients from hospital to primary health care. Nevertheless, the intermediate care was experienced more like an extension of hospital than an included part of primary health care and did not meet the need for communication across care levels.
de Jesus, Fábio Santos; Paim, Daniel de Macedo; Brito, Juliana de Oliveira; Barros, Idiel de Araujo; Nogueira, Thiago Barbosa; Martinez, Bruno Prata; Pires, Thiago Queiroz
Objective To evaluate the variation in mobility during hospitalization in an intensive care unit and its association with hospital mortality. Methods This prospective study was conducted in an intensive care unit. The inclusion criteria included patients admitted with an independence score of ≥ 4 for both bed-chair transfer and locomotion, with the score based on the Functional Independence Measure. Patients with cardiac arrest and/or those who died during hospitalization were excluded. To measure the loss of mobility, the value obtained at discharge was calculated and subtracted from the value obtained on admission, which was then divided by the admission score and recorded as a percentage. Results The comparison of these two variables indicated that the loss of mobility during hospitalization was 14.3% (p < 0.001). Loss of mobility was greater in patients hospitalized for more than 48 hours in the intensive care unit (p < 0.02) and in patients who used vasopressor drugs (p = 0.041). However, the comparison between subjects aged 60 years or older and those younger than 60 years indicated no significant differences in the loss of mobility (p = 0.332), reason for hospitalization (p = 0.265), SAPS 3 score (p = 0.224), use of mechanical ventilation (p = 0.117), or hospital mortality (p = 0.063). Conclusion There was loss of mobility during hospitalization in the intensive care unit. This loss was greater in patients who were hospitalized for more than 48 hours and in those who used vasopressors; however, the causal and prognostic factors associated with this decline need to be elucidated. PMID:27410406
Tan, Charlie; Vermeulen, Marian; Wang, Xuesong; Zvonar, Rosemary; Garber, Gary; Daneman, Nick
Antibiotic stewardship is a required organizational practice for Canadian acute care hospitals, yet data are scarce regarding the quantity and composition of antibiotic use across facilities. We sought to examine the variability, and risk-adjusted variability, in antibiotic use across acute care hospitals in Ontario, Canada's most populous province. Antibiotic purchasing data from IMS Health, previously demonstrated to correlate strongly with internal antibiotic dispensing data, were acquired for 129 Ontario hospitals from January to December 2014 and linked to patient day (PD) denominator data from administrative datasets. Hospital variation in DDDs/1000 PDs was determined for overall antibiotic use, class-specific use and six practices of clinical or ecological significance. Multivariable risk adjustment for hospital and patient characteristics was used to compare observed versus expected utilization. There was 7.4-fold variability in the quantity of antibiotic use across the 129 acute care hospitals, from 253 to 1873 DDDs/1000 PDs. Variation was evident within hospital subtypes, exceeded that explained by hospital and patient characteristics, and included wide variability in proportion of broad-spectrum antibiotics (IQR 36%-48%), proportion of fluoroquinolones among respiratory antibiotics (IQR 40%-62%), proportion of ciprofloxacin among urinary anti-infectives (IQR 44%-60%), proportion of antibiotics with highest risk for Clostridium difficile (IQR 29%-40%), proportion of 'reserved-use' antibiotics (IQR 0.8%-3.5%) and proportion of anti-pseudomonal antibiotics among antibiotics with Gram-negative coverage (IQR 26%-40%). There is extensive variability in antibiotic use, and risk-adjusted use, across acute care hospitals. This could motivate, focus and benchmark antibiotic stewardship efforts. © The Author 2016. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please email
Sousa, Paula; Antunes, Ana; Carvalho, Joana; Casey, Anne
To increase understanding of parents' perspectives on the negotiation of care. A translated and validated questionnaire was completed by 444 parents of children admitted over a 16-month period to one hospital in Portugal. The overwhelming majority of participating parents believed that parents should always stay with their child in hospital and provide basic care, including being woken in the night to do so. However, over one third thought that their participation might disrupt the nurses' routines and a similar percentage felt uncomfortable telling nurses if they did not want to participate in care. Parents with higher levels of education and those aged over 30 were more likely to report good communication with the nursing team. Communication between parents and nurses is essential to partnership in care. Effective negotiation requires a clear definition of nurses' and parents' roles, as well as agreement on the level of participation in care by parents.
Full Text Available Abstract Background Chronic heart failure (CHF is a major public health problem characterised by progressive deterioration with disabling symptoms and frequent hospital admissions. To influence hospitalisation rates it is crucial to identify precipitating factors. To characterise patients with CHF who seek an emergency department (ED because of worsening symptoms and signs and to explore the reasons why they are admitted to hospital. Method Patients (n = 2,648 seeking care for dyspnoea were identified at the ED, Sahlgrenska University Hospital/Östra. Out of 2,648 patients, 1,127 had a previous diagnosis of CHF, and of these, 786 were included in the present study with at least one sign and one symptom of worsening CHF. Results Although several of the patients wanted to go home after acute treatment in the ED, only 2% could be sent home. These patients were enrolled in an interventional study, which evaluated the acute care at home compared to the conventional, in hospital care. The remaining patients were admitted to hospital because of serious condition, including pneumonia/respiratory disease, myocardial infarction, pulmonary oedema, anaemia, the need to monitor cardiac rhythm, pathological blood chemistry and difficulties to communicate. Conclusion The vast majority of patients with worsening CHF seeking the ED required hospital care, predominantly because of co-morbidities. Patients with CHF with symptomatic deterioration may be admitted to hospital without additional emergency room investigations.
Tania Cristina Morais Santa Barbara Rehem
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.
Loubeau, P R; Jantzen, R
Marketing is a central activity of modern organizations. To survive and succeed, organizations must know their markets, attract sufficient resources, convert these resources into appropriate services, and communicate them to various consuming publics. In the hospital industry, a marketing orientation is currently recognized as a necessary management function in a highly competitive and resource-constrained environment. Further, the literature supports a marketing orientation as superior to other orientation types, namely production, product and sales. In this article, the results of the first national cross-sectional study of the marketing orientation of U.S. hospitals in a managed care environment are reported. Several key lessons for hospital executives have emerged. First, to varying degrees, U.S. hospitals have adopted a marketing orientation. Second, hospitals that are larger, or that have developed strong affiliations with other providers that involve some level of financial interdependence, have the greatest marketing orientation. Third, as managed care organizations have increased their presence in a state, hospitals have become less marketing oriented. Finally, contrary to prior findings, for-profit institutions are not intrinsically more marketing oriented than their not-for-profit counterparts. This finding is surprising because of the traditional role of marketing in non-health for-profit enterprises and management's greater emphasis on profitability. An area of concern for hospital executives arises from the finding that as managed care pressure increases, hospital marketing orientation decreases. Although a marketing orientation is posited to lead to greater customer satisfaction and improved business results, a managed care environment seems to force hospitals to focus more on cost control than on customer satisfaction. Hospital executives are cautioned that cost-cutting, the primary focus in intense managed care environments, may lead to short
Ahmed M. Abbas
Conclusions: Preeclampsia and PPH, as well as their complications are the leading causes of death in one of the biggest tertiary care university hospitals in Egypt. However, there are other important avoidable predisposing factors that should be dealt with including lack of patient education, delayed transfer from other hospitals, and substandard practice. [Int J Reprod Contracept Obstet Gynecol 2016; 5(5.000: 1466-1471
In the context of healthcare reforms in post-socialist Serbia, this research analyses the reconfiguration of acute care hospitals from the aspect of the spatial distribution of hospital beds among and within state-owned hospitals. The research builds a relationship between the macro or national level and the micro or hospital level of the spatial distribution of hospital beds. The aim of the study is to point out that a high level of efficiency in hospital functionality is difficult to achieve within the current hospital network and architectural-urban patterns of hospitals, and to draw attention to the necessity of a strategically planned hospital spatial reconfiguration, conducted simultaneously with other segments of the healthcare system reform. The research analyses published and unpublished data presented in tables and diagrams. The theoretical platform of the research covers earlier discussions of the Yugoslav healthcare system, its post-socialist reforms and the experiences of developed countries. The results show that the hospital bed distribution has not undergone significant changes, while the hospital spatial reconfiguration has either not been carried out at all or, if it has, only on a small scale. All this has contributed to overall inadequate, inflexible, inefficient, defragmented and unequal bed distribution. Copyright © 2016 John Wiley & Sons, Ltd. Copyright © 2016 John Wiley & Sons, Ltd.
Bailey Kerry A
Full Text Available Abstract Background Antiretroviral treatment services delivered in hospital settings in Africa increasingly lack capacity to meet demand and are difficult to access by patients. We evaluate the effectiveness of nurse led primary care based antiretroviral treatment by comparison with usual hospital care in a typical rural sub Saharan African setting. Methods We undertook a prospective, controlled evaluation of planned service change in Lubombo, Swaziland. Clinically stable adults with a CD4 count > 100 and on antiretroviral treatment for at least four weeks at the district hospital were assigned to either nurse led primary care based antiretroviral treatment care or usual hospital care. Assignment depended on the location of the nearest primary care clinic. The main outcome measures were clinic attendance and patient experience. Results Those receiving primary care based treatment were less likely to miss an appointment compared with those continuing to receive hospital care (RR 0·37, p p = 0·001. Those receiving primary care based, nurse led care were more likely to be satisfied in the ability of staff to manage their condition (RR 1·23, p = 0·003. There was no significant difference in loss to follow-up or other health related outcomes in modified intention to treat analysis. Multilevel, multivariable regression identified little inter-cluster variation. Conclusions Clinic attendance and patient experience are better with nurse led primary care based antiretroviral treatment care than with hospital care; health related outcomes appear equally good. This evidence supports efforts of the WHO to scale-up universal access to antiretroviral treatment in sub Saharan Africa.
Nabirye, Rose C.; Beinempaka, Florence; Okene, Cindrella; Groves, Sara
Background A serious shortage of nurses and midwives in public hospitals has been reported in Uganda. In addition, over 80% of the nurses and midwives working in public hospitals have been found to have job stress and only 17% to be satisfied on the job. Stress and lack of job satisfaction affect quality of nursing and midwifery care and puts patients’ lives at risk. This is coupled with rampant public outcry about the deteriorating nursing and midwifery care in Ugandan public hospitals. Objective To explore factors that result in poor quality of midwifery care and strategies to improve this care from the perspective of the midwives. Method It was a qualitative exploratory design. Participants were midwives and their supervisors working in four Regional Referral hospitals in Uganda. Data was collected by FGDs and KIIs. Content analysis was used to analyze the transcribed data from the voice recordings. Results Four major themes emerged from the study. They were organizational (poor work environment and lack of materials/equipment), professional (midwives’ attitudes, lack of supervision), public/consumer issues (interference) and policy issues (remuneration, promotion and retirement). Conclusions and implications for Practice Midwives love their work but they need support to provide quality care. Continuous neglect of midwives’ serious concerns will lead to more shortages as more dissatisfied midwives leave service.
Sutherland, Jason M
The Canadian province of British Columbia (BC) is adding financial incentives to increase the volume of surgeries provided by hospitals using a marginal pricing approach. The objective of this study is to calculate marginal costs of surgeries based on assumptions regarding hospitals' availability of labor and equipment. This study is based on observational clinical, administrative and financial data generated by hospitals. Hospital inpatient and outpatient discharge summaries from the province are linked with detailed activity-based costing information, stratified by assigned case mix categorizations. To reflect a range of operating constraints governing hospitals' ability to increase their volume of surgeries, a number of scenarios are proposed. Under these scenarios, estimated marginal costs are calculated and compared to prices being offered as incentives to hospitals. Existing data can be used to support alternative strategies for pricing hospital care. Prices for inpatient surgeries do not generate positive margins under a range of operating scenarios. Hip and knee surgeries generate surpluses for hospitals even under the most costly labor conditions and are expected to generate additional volume. In health systems that wish to fine-tune financial incentives, setting prices that create incentives for additional volume should reflect knowledge of hospitals' underlying cost structures. Possible implications of mis-pricing include no response to the incentives or uneven increases in supply. Copyright © 2015 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.
... to be active in your care at the hospital is supported by American Association of Diabetes Educators ... to be active in your care at the hospital The Joint Commission is the largest health care ...
Bruyneel, Luk; Li, Baoyue; Ausserhofer, Dietmar; Lesaffre, Emmanuel; Dumitrescu, Irina; Smith, Herbert L; Sloane, Douglas M; Aiken, Linda H; Sermeus, Walter
This study integrates previously isolated findings of nursing outcomes research into an explanatory framework in which care left undone and nurse education levels are of key importance. A moderated mediation analysis of survey data from 11,549 patients and 10,733 nurses in 217 hospitals in eight European countries shows that patient care experience is better in hospitals with better nurse staffing and a more favorable work environment in which less clinical care is left undone. Clinical care left undone is a mediator in this relationship. Clinical care is left undone less frequently in hospitals with better nurse staffing and more favorable nurse work environments, and in which nurses work less overtime and are more experienced. Higher proportions of nurses with a bachelor's degree reduce the effect of worse nurse staffing on more clinical care left undone. © The Author(s) 2015.
Amy J. Thurston
Full Text Available A descriptive-comparative study was undertaken to examine current end-of-life care needs and practices in hospital. A chart review for all 1,018 persons who died from August 1, 2008 through July 31, 2009 in two full-service Canadian hospitals was conducted. Most decedents were elderly (73.8% and urbanite (79.5%, and cancer was the most common diagnosis (36.2%. Only 13.8% had CPR performed at some point during this hospitalization and 8.8% had CPR immediately preceding death, with 87.5% having a DNR order and 30.8% providing an advance directive. Most (97.3% had one or more life-sustaining technologies in use at the time of death. These figures indicate, when compared to those in a similar mid-1990s Canadian study, that impending death is more often openly recognized and addressed. Technologies continue to be routinely but controversially used. The increased rate of end-stage CPR from 2.9% to 8.8% could reflect a 1994+ shift of expected deaths out of hospital.
Recent discussions on improving health outcomes in the hospital setting have emphasized the importance of classification of mistakes in health care institutions These discussions indicate that the existence of a shared classificatory scheme among members of the health team indicates that errors in patient care are recognised as significant events that require systematic action as opposed to defensive, one-dimensional behaviours within the health institution. In Nigeria discussions of errors in patient care are rare in the literature. Discussions of the classification of errors in patient care are even more rare. This study represents a first attempt to deal with this significant problem and examines whether and how mistakes in patient care are classified across five professional health groups in one of Nigeria's largest tertiary health care institutions. The study shows that there are wide variations within and between professional health groups in the classification of errors in patient care. The implications of the absence of a classificatory scheme for errors in patient care for service improvement and organisational learning in the hospital environment are discussed.
This study aims at evaluating hospital information systems (HIS) acceptance factors among nurses, in order to provide suggestions for successful HIS implementation. The study used mainly quantitative survey methods to collect data directly from nurses through a questionnaire. The availability of computers in the hospital was one of the most influential factors, with a special emphasis on the unavailability of laptop computers and computers on wheels to facilitate immediate data entry and retrieval when nurses are at the point of care. Nurses believed that HIS might frequently slow down the process of care delivery and increase the time spent by patients inside the hospital especially during slow performance and responsiveness phases. Recommendations were classified into three main areas; improving system performance and availability of computers in the hospital, increasing organizational support in the form of providing training and protected time for nurses' to learn and enhancing users' feedback by listening to their complaints and considering their suggestions.
Bray, Jennifer; Evans, Simon; Bruce, Mary; Carter, Christine; Brooker, Dawn; Milosevic, Sarah; Thompson, Rachel; Woods, Catherine
This is the fourth and final article in a short series that presents case study examples of the positive work achieved by trusts who participated in the Royal College of Nursing's development programme to improve dementia care in acute hospitals. Dementia training in hospitals is often inadequate and staff do not always have sufficient knowledge of dementia to provide appropriate care. It can also be difficult for them to identify when patients with dementia are in pain, especially when their communication skills deteriorate. The case studies presented illustrate how two NHS trusts have worked to ensure that their staff are fully equipped to care for people with dementia in hospital. Basildon and Thurrock University Hospitals NHS Foundation Trust in Essex made dementia training a priority by including dementia awareness in staff induction across a range of roles and providing additional training activities tailored to meet staff needs. Nottingham University Hospitals NHS Trust focused on pain assessment, aiming to standardise its approach for patients with dementia. The pain assessment in advanced dementia tool was chosen and piloted, and is being implemented across the trust after a positive response.
Persi, Joe; Sisson, Megan
Although it is generally accepted that foster children are at greater risk for mental health problems than are children in the general population, very little is known about the smaller group of foster children admitted to psychiatric hospitals. The present study sought to determine whether foster children admitted to inpatient care are a distinct…
A.M. van Dishoeck (Anne-Margreet)
markdownabstractAbstract This thesis addresses two major topics in measuring, comparing and improving quality of care. We found considerable influence of random variation and case-mix in comparing hospitals using performance indicators. Although we found a significant relation between outcome
Hansson, Helena; Hallström, Inger; Kjaergaard, Hanne
Hospital-based home care (HBHC) is widely applied in Pediatric Oncology. We reviewed the potential effect of HBHC on children's physical health and risk of adverse events, parental and child satisfaction, quality of life of children and their parents, and costs. A search of PubMed, CINAHL...... for children with cancer....
Modern hospitals are facing several challenges and, over the last decade in particular, many of these institutions have become dysfunctional. Paradoxically as medicine has become more successful the demand for acute hospital care has increased, yet there is no consensus on what conditions or complaints require hospital admission and there is wide variation in the mortality rates, length of stay and possibly standards of care between different units. Most acutely ill patients are elderly and instead of one straightforward diagnosis are more likely to have a complex combination of multiple co-morbid conditions. Any elderly patient admitted to hospital is at considerable risk which must be balanced against the possible benefits. Although most of the patients in hospital die from only approximately ten diagnoses, obvious life saving treatment is often delayed by a junior doctor in-training first performing an exhaustive complete history and physical, and then ordering a number of investigations before consulting a senior colleague. Following this traditional hierarchy delays care with several "futile cycles" of clinical activity thoughtlessly directed at the patient without any benefit being delivered. If acute hospital medicine is to be improved changes in traditional assumptions, attitudes, beliefs and practices are needed.
Cohen, Jeffrey R; Gerrish, William; Galvin, J Robert
The recent federal Health Care Reform Act signed into law by President Obama is expected to lead to greater patient volumes at non-profit hospitals in Connecticut (and throughout the country). The financial implications for these hospitals depend on how the costs per patient are expected to change in response to the anticipated higher patient volumes. Using a regression analysis of costs with annual data on 30 Connecticut hospitals over the period 2006 to 2008, we find that there are considerable differences between outpatient and inpatient unit cost structures at these hospitals. Based on the results of our analysis, and assuming health care reform leads to an overall increase in the number of outpatients, we would expect Connecticut hospitals to experience lower costs per outpatient treated (economies of scale). On the other hand, an influx of additional inpatients would be expected to raise unit costs (diseconomies of scale). After controlling for other cost determinants, we find that the marginal cost of an inpatient is about $8,000 while the marginal cost of an outpatient is about $44. This disparity may provide an explanation for our finding that the effect of additional patient volumes overall (combining inpatient and outpatient) is an increase in hospitals' unit costs.
Carpenter, Joan G
Although palliative care consultation teams are common in U.S. hospitals, follow up and outcomes of consultations for frail older adults discharged to nursing facilities are unclear. To summarize and critique research on the care of patients discharged to nursing facilities following a hospital-based palliative care consult, a systematic search of PubMed, CINAHL, Ageline, and PsycINFO was conducted in February 2016. Data from the articles (N = 12) were abstracted and analyzed. The results of 12 articles reflecting research conducted in five countries are presented in narrative form. Two studies focused on nurse perceptions only, three described patient/family/caregiver experiences and needs, and seven described patient-focused outcomes. Collectively, these articles demonstrate that disruption in palliative care service on hospital discharge and nursing facility admission may result in high symptom burden, poor communication, and inadequate coordination of care. High mortality was also noted. [Res Gerontol Nurs. 2017; 10(1):25-34.].
Full Text Available Formulary is a continually revised compilation of pharmaceuticals (plus important ancillary information that reflects the current clinical judgment of medical staff. Kasturba Hospital is a 1400 bedded tertiary care teaching hospital with different specialties, having more than 3000 brands and ancillary products in use. The hospital does not have a formulary of any kind. Present study involved development of a formulary for the hospital and comparing it with WHO Model Formulary. Monographs of the drugs were prepared as per the recommendation of Pharmacy and Therapeutic Committee of the hospital. Prepared hospital formulary consisted of 476 generic drugs of various categories and 95 fixed dose combinations. Availability of brands varied from single to many. About 75 medicines recommended by the essential medicine list were not present in the prepared hospital formulary. The drugs to be avoided or used with caution in renal failure, hepatic failure and in pregnancy were categorized and included in the formulary as additional information. The prepared hospital formulary was recommended for implementation in the hospital, which could thereby help as a tool to promote rational drug use.
Peña-Segura, J L; López-Pisón, J; Marco-Olloqui, M; Mateos-Hernández, J; Adrados-Razola, I; Jiménez-Bustos, J M
Influenced by medical, scientific and social advances, the changes that have taken place in the needs of the population have given rise to a growing demand for health care in neuropaediatric pathology. The aim of this study was to determine the neuropaediatric health care requirements at the Hospital General Universitario de Guadalajara, a secondary care hospital that is a reference centre for the province of Guadalajara. We studied the children up to the age of 10 years with a neurological pathology attended at the Hospital General Universitario de Guadalajara over an 8-year period, since the Neuropaediatric unit was opened on 1 July 1992. In all 1,236 children were evaluated, which represents 8.45% of all the children below the age of 10 in the province of Guadalajara, with an average of 154.5 new patients per year. There was a predominance of males, 56.4%, and a high percentage of very young children: 26.05% under the age of 1 year and 50.56% under the age of 3. There has been a progressive increase in the number of Neuropaediatric outpatients, which in the year 2000 accounted for 20% of first visits and 16% of the total number (first and successive) of Paediatric outpatients. 12.94% of the patients in our series had also been examined in different tertiary care hospitals. There is a very high demand for neuropaediatric care in Guadalajara and it is growing in a significant and progressive manner. We suggest it would be advisable to have a tertiary reference hospital available to help cope with this situation.
Medeiros, Renata Marien Knupp; Teixeira, Renata Cristina; Nicolini, Ana Beatriz; Alvares, Aline Spanevello; Corrêa, Áurea Christina de Paula; Martins, Débora Prado
to evaluate the care provided at an Antepartum, Intrapartum, Postpartum (AIP) unit at a teaching hospital following the inclusion of obstetric nurses. transversal study, performed at a AIP unit at a teaching hospital in the capital of the Brazilian state of Mato Grosso. The sample comprised data regarding the 701 childbirths that took place between 2014 and 2016. The data were organized using Excel and analyzed using version 7 of Epi Info software. the results suggest that including obstetric nurses contributed towards qualifying the care provided during labor and childbirth, followed by a reduction in the number of interventions, such as episiotomy caesareans sections, and resulting in encouragement to employ practices that do not interfere in the physiology of the parturition process, which in turn generate good perinatal results. inserting these nurses collaborated towards humanizing obstetric and neonatal care.
Lomborg, Kirsten; Bjoern, Agnes; Dahl, Ronald
with severe COPD suffer from breathlessness on exertion and are dependent on help with personal body care. Studies have described patient strategies for managing breathlessness and preferences regarding nursing care during hospitalization. Yet the problems that patients can experience because...... of their inability to manage personal body care by themselves have not previously been explored. This study explored patients' experiences of being assisted with personal body care. Methods. A grounded theory methodology was used with a convenience sample of 12 patients. Data were gathered from participant....... Dependency and breathlessness, however, impeded the performance of body care activities and patients were struggling for self-preservation. They managed APBC by using a threefold strategy of not letting go, coping with dependency, and minimizing the risk of escalating breathlessness. Two dilemmas were...
Camilleri, D; O'Callaghan, M
The study applies the principles behind the SERVQUAL model and uses Donabedian's framework to compare and contrast Malta's public and private hospital care service quality. Through the identification of 16 service quality indicators and the use of a Likert-type scale, two questionnaires were developed. The first questionnaire measured patient pre-admission expectations for public and private hospital service quality (in respect of one another). It also determined the weighted importance given to the different service quality indicators. The second questionnaire measured patient perceptions of provided service quality. Results showed that private hospitals are expected to offer a higher quality service, particularly in the "hotel services", but it was the public sector that was exceeding its patients' expectations by the wider margin. A number of implications for public and private hospital management and policy makers were identified.
Boockvar, Kenneth S; Burack, Orah R
To identify organizational factors and hospital and nursing home organizational relationships associated with more-effective processes of care during hospital-nursing home patient transfer. Mailed survey. Medicare- or Medicaid-certified nursing homes in New York State. Nursing home administrators, with input from other nursing home staff. Key predictor variables were travel time between the hospital and the nursing home, affiliation with the same health system, same corporate owner, trainees from the same institution, pharmacy or laboratory agreements, continuous physician care, number of beds in the hospital, teaching status, and frequency of geriatrics specialty care in the hospital. Key dependent variables were hospital-to-nursing home communication, continuous adherence to healthcare goals, and patient and family satisfaction with hospital care. Of 647 questionnaires sent, 229 were returned (35.4%). There was no relationship between hospital-nursing home interorganizational relationships and communication, healthcare goal adherence, and satisfaction measures. Geriatrics specialty care in the hospital (r=0.157; P=.04) and fewer hospital beds (r=-0.194; P=.01) were each associated with nursing homes more often receiving all information needed to care for patients transferred from the hospital. Teaching status (r=0.230; P=.001) and geriatrics specialty care (r=0.185; P=.01) were associated with hospital care more often consistent with healthcare goals established in the nursing home. No management-level organizational relationship between nursing home and hospital was associated with better hospital-to-nursing home transfer process of care. Geriatrics specialty care and characteristics of the hospital were associated with better hospital-to-nursing home transfer processes.
Tholin, Helena; Forsberg, Anette
Despite recent improvements in Swedish stroke care some patients still experience a lack of support and follow-up after discharge from hospital. In order to provide good care according to the National Board of Health and Welfare, systematic evaluations of stroke care must be performed. Quality indicators in the national guidelines could be useful when measuring quality of care in all parts of the stroke care chain. To investigate how people with stroke experienced their care, rehabilitation, support, and participation from hospital to community care. Qualitative interviews were performed with 11 people in 2009-2010 covering their experiences of care, rehabilitation, support, and participation. The interviews were analysed with qualitative content analysis. The interviewees were satisfied with their hospital care, but reported both positive and negative experiences of the continuing care. Most of them appreciated intense, specific, and professional rehabilitation, and had experienced these qualities in the rehabilitation they received in most parts of the stroke care chain. Those who received support from the community services expressed satisfaction with the staff, but also felt that autonomy was lost. Several did not feel involved in the health care planning, but instead relied on the judgement of the staff. To ensure high quality throughout the whole stroke care chain, people with stroke must be invited to participate in the care and the planning of care. To offer evidence-based stroke rehabilitation, it is important that the rehabilitation is specific, intense, and performed by professionals, regardless of where the rehabilitation is performed. A changed view of the patient's autonomy in residential community services should be developed, and this process must start from the staff and residents. © 2014 Nordic College of Caring Science.
Hernández Miguel, María Victoria; Martín Martínez, María Auxiliadora; Corominas, Héctor; Sanchez-Piedra, Carlos; Sanmartí, Raimon; Fernandez Martinez, Carmen; García-Vicuña, Rosario
To describe the variability of the day care hospital units (DCHUs) of Rheumatology in Spain, in terms of structural resources and operating processes. Multicenter descriptive study with data from a self-completed questionnaire of DCHUs self-assessment based on DCHUs quality standards of the Spanish Society of Rheumatology. Structural resources and operating processes were analyzed and stratified by hospital complexity (regional, general, major and complex). Variability was determined using the coefficient of variation (CV) of the variable with clinical relevance that presented statistically significant differences when was compared by centers. A total of 89 hospitals (16 autonomous regions and Melilla) were included in the analysis. 11.2% of hospitals are regional, 22,5% general, 27%, major and 39,3% complex. A total of 92% of DCHUs were polyvalent. The number of treatments applied, the coordination between DCHUs and hospital pharmacy and the post graduate training process were the variables that showed statistically significant differences depending on the complexity of hospital. The highest rate of rheumatologic treatments was found in complex hospitals (2.97 per 1,000 population), and the lowest in general hospitals (2.01 per 1,000 population). The CV was 0.88 in major hospitals; 0.86 in regional; 0.76 in general, and 0.72 in the complex. there was variability in the number of treatments delivered in DCHUs, being greater in major hospitals and then in regional centers. Nonetheless, the variability in terms of structure and function does not seem due to differences in center complexity. Copyright © 2016 Elsevier España, S.L.U. and Sociedad Española de Reumatología y Colegio Mexicano de Reumatología. All rights reserved.
Y. van Ierland (Yvette)
markdownabstract__Abstract__ Children constitute a substantial part of the workload of physicians in primary care and hospital emergency care. In the Netherlands, about 70% of the 3.9 million inhabitants less than 20 years of age had one or more contacts with their general practitioner (GP) in 2011
Risa Fukuda; Yasuko Shimizu; Natsuko Seto
Objective: Dementia is a major public health problem. More and more patients with dementia are being admitted to acute care hospitals for treatment of comorbidities. Issues associated with care of patients with dementia in acute care hospitals have not been adequately clarified. This study aimed to explore the challenges nurses face in providing care to patients with dementia in acute care hospitals in Japan. Methods: This was a qualitative study using focus group interviews (FGIs). The setti...
Mayhew, Leslie; Lawrence, David
Intermediate care is part of a package of initiatives introduced by the UK Government mainly to relieve pressure on acute hospital beds and reduce delayed discharge (bed blocking). Intermediate care involves caring for patients in a range of settings, such as in the home or community or in nursing and residential homes. This paper considers the scope of intermediate care and its role in relation to acute hospital services. In particular, it develops a framework that can be used to inform decisions about the most cost-effective care pathways for given clinical situations, and also for wider planning purposes. It does this by providing a model for evaluating the costs of intermediate care services provided by different agencies and techniques for calibrating the model locally. It finds that consistent application of the techniques over a period of time, coupled with sound planning and accounting, should result in savings to the health economy.
Gray, Amy Zigrida; Soukaloun, Douangdao; Soumphonphakdy, Bandith; Duke, Trevor
To evaluate the impact of implementing a multifaceted intervention based on the WHO Pocketbook of Hospital Care for Children on the quality of case management of common childhood illnesses in hospitals in Lao PDR. The quality of case management of four sentinel conditions was assessed in three central hospitals before and after the implementation of the WHO Pocketbook as part of a broader mixed-methods study. Data on performance of key steps in case management in more than 600 admissions were collected by medical record abstraction pre- and post-intervention, and change was measured according to the proportion of cases which key steps were performed as well as an overall score of case management for each condition. Improvements in mean case management scores were observed post-intervention for three of the four conditions, with the greatest change in pneumonia (53-91%), followed by diarrhoea and low birthweight. Rational drug prescribing, appropriate use of IV fluids and appropriate monitoring all occurred more frequently post-intervention. Non-recommended practices such as prescription of antitussives became less frequent. A multifaceted intervention based on the WHO Pocketbook of Hospital Care for children led to better paediatric care in central Lao hospitals. The degree of improvement was dependent on the condition assessed. © 2014 John Wiley & Sons Ltd.
Full Text Available To review the challenges and countermeasures in the hospital care for Wenchuan earthquake casualties and draw lessons for the protective response in the future. Medical records and laboratory findings of the victims admitted in West China Hospital (WCH were retrospectively analyzed. Related data were compared between beforemath and aftermath of the earthquake and between WCH and frontier county hospitals. One thousand and thirty-one earthquake survivors were hospitalized, 1 358 victims underwent surgery and 142 victims were transferred to intensive care unit. The incidence of infection, crush syndrome and multiple organ dysfunction syndrome (MODS was 39.6%, 20.7% and 2.3% respectively. Wound classification showed that the incidence of extremity damage was 72%, while the incidence of chest trauma, abdominal trauma and brain trauma was less than 10% respectively. Isolating rates of environmental pathogens were increased in the aftermath of earthquake, and the spectrum of the pathogens and related antibiotic sensitivities were quite different from those in the beforemath of earthquake. The social economic and population conditions in the earthquake-stricken areas affected the composition of the victims and the geographic features restricted the efficiency of rescue. Trauma-induced MODS, crush syndrome and severe infections all constituted the dilemma for the hospital care, to resolve whether the multidiscipline team work was proved to be an optimizing choice. For a more effective disaster protective response in the future, the study on rescue plan and the ladder therapies for massive casualties should be potentiated.
Full Text Available Abstract Background and aims Chronic obstructive pulmonary disease (COPD is currently the 5th cause of morbidity and mortality in the developed world and represents a substantial economic and social burden. The aim of this study is to report on hospital admissions and related costs of hospital treatment for COPD in the Puglia Region of Italy in the years 2005-2007. Materials and methods Patients were selected who were hospitalized between 01/01/2005 and 31/12/2007 with ICD-9-CM code: 490.xx: bronchitis not specified as acute or chronic; 491.xx: chronic bronchitis; 492.xx: emphysema; 493.xx: asthma; 494.xx: bronchiectasis; 496.xx: chronic airway obstruction not elsewhere classified; 518.81: acute respiratory failure as principal or secondary diagnosis. Results In the period 2005-2007, there were 73,721 hospital admissions for COPD registered in Puglia (25,690 in 2005; 24,153 in 2006 and 23,878 in 2007 of which 34.3% were women, with no significant variation in the three years. There appears to be a negative trend in hospitalisations in Puglia for chronic bronchitis with ratios decreasing from 359.4 per 100,000 population in 2005 to 307.9 per 100,000 in 2007. The overall cost of COPD for Apulian hospital trusts was €272,293,182.85 over the 3-year period. Conclusions Analysis of the data for hospital care, its costs and performance may be an important indicator of the efficacy of community care. In particular, the lack of reduction in admissions for COPD should lead decision makers to question both the appropriateness and quality of the care given.
... New Technology Add-On Payments a. Auto Laser Interstitial Thermal Therapy (AutoLITT TM ) System b... Neutrality Adjustment for the Rural and Imputed Floors 3. Floor for Area Wage Index for Hospitals in Frontier... Affordable Care Act returning the rural floor budget neutrality to a uniform national adjustment.) Table...
Full Text Available Introduction: Malnutrition adversely affects clinical outcome of hospitalized patients. This observational prospective study was done to assess the prevalence of malnutrition and its grade among patients admitted in a mixed intensive care unit (ICU of a tertiary care hospital in order to help devise a comprehensive nutrition program for the malnourished. Materials and Methods: A total of 500 sequential patients admitted to the ICU were screened on admission over a year period for malnutrition using the Subjective Global Nutritional Assessment (SGNA score. Distribution of the degree of malnutrition according to co-morbidities was also documented. Results: Of the total, 198 (39.6% patients were malnourished, including one patient qualifying as severely malnourished; 68% patients were male, however, there was no statistically significant difference between nutrition status between sexes. Hypertension, diabetes, and cancer were the three most commonly encountered co-morbidities among the malnourished. A total of 86% of all cancer patients admitted were malnourished against only 12% of trauma patients. Conclusion: This study showed that almost two-fifth of the patients admitted were malnourished in this tertiary care hospital and that there is an urgent need to develop a comprehensive nutritional care program in many such Indian ICUs.
Kertesz, Stefan G; Posner, Michael A; O'Connell, James J; Swain, Stacy; Mullins, Ashley N; Shwartz, Michael; Ash, Arlene S
Medical respite programs offer medical, nursing, and other care as well as accommodation for homeless persons discharged from acute hospital stays. They represent a community-based adaptation of urban health systems to the specific needs of homeless persons. This article examines whether post-hospital discharge to a homeless medical respite program was associated with a reduced chance of 90-day readmission compared to other disposition options. Adjusting for imbalances in patient characteristics using propensity scores, respite patients were the only group that was significantly less likely to be readmitted within 90 days compared to those released to Own Care. Respite programs merit attention as a potentially efficacious service for homeless persons leaving the hospital.
Mittal, V; David, W; Young, S; McKendrick, A; Gentile, T; Casalou, R
We created an ambulatory resident clinic in a community teaching hospital to improve the continuity of care in a surgery residency program. A retrospective chart review analysis. A community hospital, general surgery residency training program, and its ambulatory practice. Providence Hospital, Southfield, Mich, has established a new model, the Surgical Associates of Michigan, which is an association comprising private practice physicians serving as full-time faculty in the Department of Surgery. In addition to clarification of teaching requirements and reimbursement for educational activities, the most dramatic feature is the relocation of private practice offices and the staff surgical office to one central location within the hospital. The proximity of the staff and private surgical offices facilitates closer interaction of attending physicians, residents, and patients. Compliance rates of continuity of patient care provided by the same resident, as presented by the Surgery Residency Review Committee, including confirmation of diagnosis, provision of preoperative care, discussion with attending physician, selection and provision of intervention, direction of postoperative care, and postdischarge follow-up. Since the inception of this arrangement at our institution, surgical residents have seen 229 staff patients and 465 private patients in the offices under supervision. Compliance rate of continuity of care was defined as patient follow-up with the same senior surgical resident who performed an operation or evaluated the patient on initial presentation to the emergency department or offices. We achieved a compliance rate of 92.8% (169/182) in the staff surgical clinics. A compliance rate of 63.5% (205/323) for private general surgical patients and 70.4% (100/142) for vascular surgical patients was obtained. With the establishment of the teaching faculty group and the relocation of offices, we were able to achieve a dramatic improvement in continuity of care. In
Quinn, Barbara; Baker, Dian L; Cohen, Shannon; Stewart, Jennifer L; Lima, Christine A; Parise, Carol
Nonventilator hospital-acquired pneumonia (NV-HAP) is an underreported and unstudied disease, with potential for measurable outcomes, fiscal savings, and improvement in quality of life. The purpose of our study was to (a) identify the incidence of NV-HAP in a convenience sample of U.S. hospitals and (b) determine the effectiveness of reliably delivered basic oral nursing care in reducing NV-HAP. A descriptive, quasi-experimental study using retrospective comparative outcomes to determine (a) the incidence of NV-HAP and (b) the effectiveness of enhanced basic oral nursing care versus usual care to prevent NV-HAP after introduction of a basic oral nursing care initiative. We used the International Statistical Classification of Diseases and Related Problems (ICD-9) codes for pneumonia not present on admission and verified NV-HAP diagnosis using the U.S. Centers for Disease Control and Prevention diagnostic criteria. We completed an evidence-based gap analysis and designed a site-specific oral care initiative designed to reduce NV-HAP. The intervention process was guided by the Influencer Model (see Figure) and participatory action research. We found a substantial amount of unreported NV-HAP. After we initiated our oral care protocols, the rate of NV-HAP per 100 patient days decreased from 0.49 to 0.3 (38.8%). The overall number of cases of NV-HAP was reduced by 37% during the 12-month intervention period. The avoidance of NV-HAP cases resulted in an estimated 8 lives saved, $1.72 million cost avoided, and 500 extra hospital days averted. The extra cost for therapeutic oral care equipment was $117,600 during the 12-month intervention period. Cost savings resulting from avoided NV-HAP was $1.72 million. Return on investment for the organization was $1.6 million in avoided costs. NV-HAP should be elevated to the same level of concern, attention, and effort as prevention of ventilator-associated pneumonia in hospitals. Nursing needs to lead the way in the design and
Fink, Anne M
This article highlights the historic precedence of early discharge practices and the debate regarding length of stay for new mothers and newborns in the United States. Although the documented effects of early discharge on maternal and newborn health are inconsistent, research findings universally support follow-up care for mothers and infants within 1 week of hospital discharge. Research is needed to identify the components and timing of follow-up care to optimize maternal and newborn outcomes. © 2011 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.
Full Text Available Purpose: This article reviews the impact of successive experiments in the development of primary care organisations in England and assesses the long-term importance of English primary care groups for the integration of health and community and health and social care and the deinstitutionalisation of hospital care. Theory: Governments in a number of Western countries are attempting to improve the efficiency, appropriateness and equity of their health systems. One of the main ways of doing this is to devolve provision and commissioning responsibility from national and regional organisations to more local agencies based in primary care. Such primary care organisations are allocated budgets that span both primary and secondary (hospital services and also, potentially, social care. Method: This article is based on a systematic review of the literature forthcoming from the UK Government's Department of Health-funded evaluations of successive primary care organisational developments. These include total purchasing pilots, GP commissioning group pilots, personal medical services pilots and primary care groups and trusts. Results: Primary care organisations in England have proved to be a catalyst in facilitating the development of integrated care working between primary and community health services. Conversely, primary care organisations have proved less effective in promoting integration between health and social care agencies where most progress has been made at the strategic commissioning level. The development of primary care trusts in England is heralding an end to traditional community hospitals. Conclusions: The development of primary care groups in England are but an intermediate step of a policy progression towards future primary care-based organisations that will functionally integrate primary and community health services with local authority services under a single management umbrella.
Sakashita, Akihiro; Kishino, Megumi; Nakazawa, Yoko; Yotani, Nobuyuki; Yamaguchi, Takashi; Kizawa, Yoshiyuki
To clarify how highly active hospital palliative care teams can provide efficient and effective care regardless of the lack of full-time palliative care physicians. Semistructured focus group interviews were conducted, and content analysis was performed. A total of 7 physicians and 6 nurses participated. We extracted 209 codes from the transcripts and organized them into 3 themes and 21 categories, which were classified as follows: (1) tips for managing palliative care teams efficiently and effectively (7 categories); (2) ways of acquiring specialist palliative care expertise (9 categories); and (3) ways of treating symptoms that are difficult to alleviate (5 categories). The findings of this study can be used as a nautical chart of hospital-based palliative care team (HPCT) without full-time PC physician. Full-time nurses who have high management and coordination abilities play a central role in resource-limited HPCTs. © The Author(s) 2015.
de Lima, Regina Aparecida Garcia; Azevedo, Eliete Farias; Nascimento, Lucila Castanheira; Rocha, Semiramis Melani Melo
Hospitalization can be a very traumatic experience for children and their family members. The purpose of this study was to explore the experience of using clown theater art in the care for hospitalized children, starting with an activity developed by undergraduate students in the healthcare area. Data were obtained by observing 20 children and 11 students, characters in the clown theater interacting in the pediatric clinic in a school hospital in the state of São Paulo. The empirical data were analyzed with the thematic content analysis, which were grouped around the following themes: artistic expressions as a form of communication, participation of the binomial child and accompanying partner, and the clown as a therapeutic resource. The results show that this experience was a concrete intervention, emphasizing the children's development process, since it opens up a space for fantasy, laughter, happiness and the appropriation of the hospital routine; it is an example of widening the diagnostic and therapeutic process with the incorporation of intervention focusing on the affective, emotional and cultural necessities of the child and the family, in the search for non-traumatic care.
Revilla-López, Concha; Calderón-Larrañaga, Amaia; Enríquez-Martín, Natalia; Prados-Torres, Alexandra
To measure the diagnostic agreement between Primary Care (PC) and hospital information systems, in order to assess the usefulness of health care records for research purposes. Cross-sectional retrospective study integrating PC and hospital diagnostic information for the Aragon population admitted to hospital in 2010. 75.176 patients were analysed. Similarities, differences and the kappa index were calculated for each of the diagnoses recorded in both information systems. The studied diseases included COPD, diabetes, hypertension, cerebrovascular disease, ischaemic heart disease, asthma, epilepsy, and heart failure. Diagnostic concordance was higher in men and between 45 and 64 years. Diabetes was the condition showing the highest concordance (kappa index: 0.75), while asthma had the lowest values (kappa index: 0.34). The low concordance between the diagnostic information recorded in PC and in the hospital setting calls for urgent measures to ensure that healthcare professionals have a comprehensive picture of patient's health problems. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.
Disease Management is a transsectoral, population-based form of health care, which addresses groups of patients with particular clinical entities and risk factors. It refers both to an evidence-based knowledge base and corresponding guidelines, evaluates outcome as a continuous quality improvement process and usually includes active participation of patients. In Germany, the implementation of disease management is associated with financial transactions for risk adjustment between health care assurances [para. 137 f, Book V of Social Code (SGB V)] and represents the second kind of transsectoral care, besides a program designed as integrated health care according to para. 140 a ff f of Book V of Social Code. While in the USA and other countries disease management programs are made available by several institutions involved in health care, in Germany these programs are offered by health care insurers. Assessment of disease management from the hospital perspective will have to consider three questions: How large is the risk to compensate inadequate quality in outpatient care? Are there synergies in internal organisational development? Can the risk of inadequate funding of the global "integrated" budget be tolerated? Transsectoral quality assurance by valid performance indicators and implementation of a quality improvement process are essential. Internal organisational changes can be supported, particularly in the case of DRG introduction. The economic risk and financial output depends on the kind of disease being focussed by the disease management program. In assessing the underlying scientific evidence of their cost effectiveness, societal costs will have to be precisely differentiated from hospital-associated costs.
Persson, Eva; Määttä, Sylvia
To illuminate patients' experiences of being cared for and nurses' experiences of caring for patients in a multiple-bed hospital room. Many patients and healthcare personnel seem to prefer single-bed hospital rooms. However, certain advantages of multiple-bed hospital rooms (MBRs) have also been described. Eight men and eight women being cared for in a multiple-bedroom were interviewed, and two focus-group interviews (FGI) with 12 nurses were performed. A qualitative content analysis was used. One theme--Creating a sphere of privacy--and three categories were identified based on the patient interviews. The categories were: Being considerate, Having company and The patients' area. In the FGI, one theme--Integrating individual care with care for all--and two categories emerged: Experiencing a friendly atmosphere and Providing exigent care. Both patients and nurses described the advantages and disadvantages of multiple-bed rooms. The patient culture of taking care of one another and enjoying the company of room-mates were considered positive and gave a sense of security of both patients and nurses. The advantages were slight and could easily become disadvantages if, for example, room-mates were very ill or confused. The patients tried to maintain their privacy and dignity and claimed that there were small problems with room-mates listening to conversations. In contrast, the nurses stressed patient integrity as a main disadvantage and worked to protect the integrity of individual patients. Providing care for all patients simultaneously had the advantage of saving time. The insights gained in the present study could assist nurses in reducing the disadvantages and taking advantage of the positive elements of providing care in MBRs. Health professionals need to be aware of how attitudes towards male and female patients, respectively, could affect care provision. © 2012 The Authors. Scandinavian Journal of Caring Sciences © 2012 Nordic College of Caring Science.
Full Text Available Abstract Background Delivery by a skilled birth attendant (SBA in a hospital is advocated to improve maternal health; however, hospital expenses for delivery care services are a concern for women and their families, particularly for women who pay out-of-pocket. Although health insurance is now implemented in Lao PDR, it is not universal throughout the country. The objectives of this study are to estimate the total health care expenses for vaginal delivery and caesarean section, to determine the association between health insurance and family income with health care expenditure and assess the effect of health insurance from the perspectives of the women and the skilled birth attendants (SBAs in Lao PDR. Methods A cross-sectional study was carried out in two provincial hospitals in Lao PDR, from June to October 2010. Face to face interviews of 581 women who gave birth in hospital and 27 SBAs was carried out. Both medical and non-medical expenses were considered. A linear regression model was used to assess influencing factors on health care expenditure and trends of medical and non-medical expenditure by monthly family income stratified by mode of delivery were assessed. Results Of 581 women, 25% had health care insurance. Health care expenses for delivery care services were significantly higher for caesarean section (270 USD than for vaginal delivery (59 USD. After adjusting for the effect of hospital, family income was significantly associated with all types of expenditure in caesarean section, while it was associated with non-medical and total expenditures in vaginal delivery. Both delivering women and health providers thought that health insurance increased the utilisation of delivery care. Conclusions Substantially higher delivery care expenses were incurred for caesarean section compared to vaginal delivery. Three-fourths of the women who were not insured needed to be responsible for their own health care payment. Women who had higher family
... hospital care. 405.1206 Section 405.1206 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT... Hospital Discharges § 405.1206 Expedited determination procedures for inpatient hospital care. (a... expedited determination by the QIO when a hospital (acting directly or through its utilization review...
... or equipped to perform, and transfer to a public or private hospital which has the necessary staff or... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Hospital care and medical... VETERANS AFFAIRS MEDICAL Use of Public Or Private Hospitals § 17.52 Hospital care and medical services in...
Full Text Available Abstract Background A variety of approaches have been used to contain escalating hospital costs. One approach is intensifying price competition. The increase in price based competition, which changes the incentives hospitals face, coupled with the fact that consumers can more easily evaluate the quality of hotel services compared with the quality of clinical care, may lead hospitals to allocate more resources into hotel rather than clinical services. Methods To test this hypothesis we studied hospitals in California in 1982 and 1989, comparing resource allocations prior to and following selective contracting, a period during which the focus of competition changed from quality to price. We estimated the relationship between clinical outcomes, measured as risk-adjusted-mortality rates, and resources. Results In 1989, higher competition was associated with lower clinical expenditures levels compared with 1982. The trend was stronger for non-profit hospitals. Lower clinical resource use was associated with worse risk adjusted mortality outcomes. Conclusions This study raises concerns that cost reductions may be associated with increased mortality.
Hansson, Eva Helena; Kjaergaard, Hanne; Johansen, Christoffer
BACKGROUND: To assess the feasibility and psychosocial impact of a hospital-based home care (HBHC) program for children with cancer. PROCEDURE: A HBHC program was carried out with 51 children (0-18 years) with cancer to assess its feasibility in terms of satisfaction, care preferences, safety, an...... and the psychosocial burden on the family does not increase. Pediatr Blood Cancer © 2013 Wiley Periodicals, Inc.......BACKGROUND: To assess the feasibility and psychosocial impact of a hospital-based home care (HBHC) program for children with cancer. PROCEDURE: A HBHC program was carried out with 51 children (0-18 years) with cancer to assess its feasibility in terms of satisfaction, care preferences, safety......, and cost. A controlled trial was conducted to assess children's health-related quality of life (HRQOL) using the parent-reported and self-reported PedsQL Generic Core Scale and PedsQL Cancer Module, and the psychosocial impact on the family by PedsQL Family Impact Module comprising a subsample of 28...
Postma, Maarten; Kornarou, H; Paparizos, V; Leidl, R M; Tolley, K; Kyriopoulos, J; Jager, Johannes C
This paper compares AIDS hospital care in several European-Union countries. For this purpose hospital-care utilisation studies on inpatient days and outpatient contacts were analysed in a generic approach controlling for severity stages of AIDS. Lifetime hospital-care needs for AIDS are derived, pro
... hospital care authorized under 38 U.S.C. 1703 and 38 CFR 17.52 of this part or under 38 U.S.C. 1728 and 38... shall pay the transferring hospital an amount calculated by the HCFA PRICER for each patient day of care... public or private hospital care. 17.55 Section 17.55 Pensions, Bonuses, and Veterans' Relief...
... hospital care. 831.7001-4 Section 831.7001-4 Federal Acquisition Regulations System DEPARTMENT OF VETERANS... and Procedures 831.7001-4 Medical services and hospital care. (a) VA may pay the customary student... Government. (b) When the customary student's health fee does not cover medical services or hospital care, but...
Postma, Maarten; Kornarou, H; Paparizos, V; Leidl, R M; Tolley, K; Kyriopoulos, J; Jager, Johannes C
This paper compares AIDS hospital care in several European-Union countries. For this purpose hospital-care utilisation studies on inpatient days and outpatient contacts were analysed in a generic approach controlling for severity stages of AIDS. Lifetime hospital-care needs for AIDS are derived, pro
J.M. Cramm (Jane); M.M.H. Strating (Mathilde); A.P. Nieboer (Anna)
textabstractTo date, researchers have lacked a validated instrument to measure stroke caregivers' satisfaction with hospital care. We adjusted a validated patient version of satisfaction with hospital care for stroke caregivers and tested the 11-item caregivers' satisfaction with hospital care
Rodríguez-Calero, Miguel Ángel; Julià-Mora, Joana María; Prieto-Alomar, Araceli
Previous to wider prevalence studies, we designed the present pilot study to assess concordance and time invested in patient evaluations using a palliative care needs assessment tool. We also sought to estimate the prevalence of palliative care needs in an acute care hospital unit. A cross-sectional study was carried out, 4 researchers (2 doctors and 2 nurses) independently assessed all inpatients in an acute care hospital unit in Manacor Hospital, Mallorca (Spain), using the validated tool NECPAL CCOMS-ICO©, measuring time invested in every case. Another researcher revised clinical recordings to analise the sample profile. Every researcher assessed 29 patients, 15 men and 14 women, mean age 74,03 ± 10.25 years. 4-observer concordance was moderate (Kappa 0,5043), tuning out to be higher between nurses. Mean time per patient evaluation was 1.9 to 7.72 minutes, depending on researcher. Prevalence of palliative care needs was 23,28%. Moderate concordance lean us towards multidisciplinary shared assessments as a method for future research. Avarage of time invested in evaluations was less than 8 minutes, no previous publications were identified regarding this variable. More than 20% of inpatients of the acute care unit were in need of palliative care. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.
M Hajjaji Darouiche
Full Text Available Blood and body fluid Exposure is a major occupational safety problems for health care workers. Therefore, we conducted a descriptive and retrospective study to identify the characteristics of blood exposure accidents in health care settings which lasted five years (2005-2009 at the two university hospitals of Sfax. We have 593 blood exposure accidents in health care settings 152 (25.6% health personnel and 441 (74.4% trainees' doctors, nurses and health technicians. The mechanism of blood and body fluid exposure was accidental needle-stick injury in 78.9% of health staff, and 81% of trainees, accidental cut in 14.7% of health workers and 10.2% of trainees. The increasing severity of blood exposure accidents is linked to the lack of safe behavior against this risk.
Hajjaji Darouiche, M; Chaabouni, T; Jmal Hammami, K; Messadi Akrout, F; Abdennadher, M; Hammami, A; Karray, H; Masmoudi, M L
Blood and body fluid Exposure is a major occupational safety problems for health care workers. Therefor We conducted a descriptive and retrospective study to identify the characteristics of blood exposure accidents in health care settings which lasted five years (2005-2009) at the two university hospitals of Sfax. We have 593 blood exposure accidents in health care settings 152 (25.6%) health personnel and 441 (74.4%) trainees' doctors, nurses and health technicians. The mechanism of blood and body fluid exposure was accidental needle-stick injury in 78.9% of health staff, and 81% of trainees, accidental cut in 14.7% of health workers and 10.2% of trainees. The increasing severity of blood exposure accidents is linked to the lack of safe behavior against this risk.
Catharina J van Oostveen
Full Text Available BACKGROUND: Hospitals are constantly being challenged to provide high-quality care despite ageing populations, diminishing resources, and budgetary restraints. While the costs of care depend on the patients' needs, it is not clear which patient characteristics are associated with the demand for care and inherent costs. The aim of this study was to ascertain which patient-related characteristics or models can predict the need for medical and nursing care in general hospital settings. METHODS: We systematically searched MEDLINE, Embase, Business Source Premier and CINAHL. Pre-defined eligibility criteria were used to detect studies that explored patient characteristics and health status parameters associated to the use of hospital care services for hospitalized patients. Two reviewers independently assessed study relevance, quality with the STROBE instrument, and performed data analysis. RESULTS: From 2,168 potentially relevant articles, 17 met our eligibility criteria. These showed a large variety of factors associated with the use of hospital care services; models were found in only three studies. Age, gender, medical and nursing diagnoses, severity of illness, patient acuity, comorbidity, and complications were the characteristics found the most. Patient acuity and medical and nursing diagnoses were the most influencing characteristics. Models including medical or nursing diagnoses and patient acuity explain the variance in the use of hospital care services for at least 56.2%, and up to 78.7% when organizational factors were added. CONCLUSIONS: A larger variety of factors were found to be associated with the use of hospital care services. Models that explain the extent to which hospital care services are used should contain patient characteristics, including patient acuity, medical or nursing diagnoses, and organizational and staffing characteristics, e.g., hospital size, organization of care, and the size and skill mix of staff. This would
Mauer, Uwe Max; Freude, Gregor; Schulz, Chris; Kunz, Ulrich; Mathieu, Rene
Background and Study Objectives Children are commonly found among the injured in war settings. Prognosis often depends on the presence of brain injury. Not all neurosurgery departments of German Armed Forces hospitals, however, have experience in the care of children with neurosurgical conditions. Against this background, we assessed the group of pediatric neurosurgical patients in a German (Role 3) field hospital in Mazar-e-Sharif, Afghanistan. Patients/Materials and Methods We analyzed the operative logbooks from January 1, 2008, to December 31, 2013, to assess the number of neurosurgical procedures that were performed on children (study period, 327 neurosurgical procedures were performed at the German field hospital. Of these, 29 (9%) were performed on children. The mean age of the pediatric patients (7 girls and 22 boys) was 11.7 years (median age: 12 years; range: 5-17 years). Only three procedures were performed for conditions other than trauma. Pediatric patients accounted for almost 10% of all patients who underwent neurosurgery during a recent military deployment in Mazar-e-Sharif. This percentage is similar to those reported by other nations. These findings show that a considerable number of children underwent neurosurgical treatment. Conclusions Military planners should be aware that Role 3 medical treatment facilities must provide care for pediatric emergencies and must therefore be staffed and equipped accordingly. For military hospitals at home, this means that the management of pediatric patients is an opportunity for medical personnel to receive important pediatric training that enables them to provide care to children in deployed medical facilities. Georg Thieme Verlag KG Stuttgart · New York.
Johanna E. Eygelaar
Full Text Available Currently barriers exist in delivering quality health care. This study aimed to investigate such barriers in the eight rural district hospitals of the West Coast Winelands Region, three type A and five type B hospitals. A quantitative descriptive design was applied which included the total population of nursing staff (n = 340 working at the time of data collection. A self-administered questionnaire was distributed with a response rate of 82%.Reliability of the instrument was verified using the Cronbach alpha coefficient and a pilot study. The validity, specifically construct and content validity, were assured by means of an extensive literature review, pilot study and use of experts. Ethics approval was obtained from the relevant stakeholders.Results showed that 272 participants (97% disagreed that provision of staff was adequate, with staff above 40 years of age more likely to disagree (p = <0.01. A statistically significant association was shown between availability of doctors and staff not being able to cope with emergencies (p = <0.01. Most participants (n =212; 76% indicated that they were not receiving continuing education, with the registered nurses more likely to disagree (χ² test, p = 0.02. Participants in both hospital types A (n = 131; 82% and B (n = 108; 91% also disagreed that provision of equipment and consumables was adequate.The research showed that inadequacies relating to human resources, professional development, consumables and equipment influenced the quality of patient care. Urgent attention should be given to the problems identified to ensure quality of patient care in rural hospitals.
Full Text Available Rates of hospital-acquired infections, such as methicillin-resistant Staphylococcus aureus (MRSA, are increasingly used as quality indicators for hospital hygiene. Alternatively, these rates may vary between hospitals, because hospitals differ in admission and referral of potentially colonized patients. We assessed if different referral patterns between hospitals in health care networks can influence rates of hospital-acquired infections like MRSA. We used the Dutch medical registration of 2004 to measure the connectedness between hospitals. This allowed us to reconstruct the network of hospitals in the Netherlands. We used mathematical models to assess the effect of different patient referral patterns on the potential spread of hospital-acquired infections between hospitals, and between categories of hospitals (University medical centers, top clinical hospitals and general hospitals. University hospitals have a higher number of shared patients than teaching or general hospitals, and are therefore more likely to be among the first to receive colonized patients. Moreover, as the network is directional towards university hospitals, they have a higher prevalence, even when infection control measures are equally effective in all hospitals. Patient referral patterns have a profound effect on the spread of health care-associated infections like hospital-acquired MRSA. The MRSA prevalence therefore differs between hospitals with the position of each hospital within the health care network. Any comparison of MRSA rates between hospitals, as a benchmark for hospital hygiene, should therefore take the position of a hospital within the network into account.
King, D N
Hospital health sciences libraries represent, for the vast majority of health professionals, the most accessible source for library information and services. Most health professionals do not have available the specialized services of a clinical medical librarian, and rely instead upon general information services for their case-related information needs. The ability of the hospital library to meet these needs and the impact of the information on quality patient care have not been previously examined. A study was conducted in eight hospitals in the Chicago area as a quality assurance project. A total of 176 physicians, nurses, and other health professionals requested information from their hospital libraries related to a current case or clinical situation. They then assessed the quality of information received, its cognitive value, its contribution to patient care, and its impact on case management. Nearly two-thirds of the respondents asserted that they would definitely or probably handle their cases differently as a result of the information provided by the library. Almost all rated the libraries' performance and response highly. An overview of the context and purpose of the study, its methods, selected results, limitations, and conclusions are presented here, as is a review of selected earlier research.
Mendizabal, Adys; Thibault, Dylan P; Willis, Allison W
(1) To describe patient adverse events (PAEs) experienced by hospitalized individuals with epilepsy and examine the association of an epilepsy diagnosis on risk of specific PAEs; (2) to examine the impact of a PAE on (a) length of stay (LOS), (b) inpatient death, and (c) use of institutional post-acute care. We applied the Agency for Healthcare Research and Quality (AHRQ) Patient Safety Indicator (PSI) software to the National Inpatient Sample database to identify potential medical and postoperative PAEs among >72 million hospitalizations of adults in the United States from 2000 to 2010. Logistic regression models compared the odds of experiencing each PAE between hospitalizations of persons with epilepsy (PWE) and the general inpatient population. We also examined the impact of experiencing a PAE on LOS, inpatient death, and discharge disposition. Hospitalized PWEs were at increased risk for specific postoperative PAEs: fall with hip fracture (Adjusted Odds Ratio, AOR 1.90, 1.21-2.99), respiratory failure (AOR 2.64, 2.43-2.87), sepsis (AOR 1.41, 1.21-1.63), and preventable postoperative death (AOR 1.25, 1.15-1.36). The odds of perioperative pulmonary embolism/deep vein thrombosis (AOR 1.65, 1.57-1.73), skin pressure ulcer (AOR 1.25, 1.22-1.29), and central venous catheter-related bloodstream infections (AOR 1.24, 1.17-1.32) were also greater among hospitalizations of PWEs. Experiencing a PAE was associated with a prolonged mean length of stay (15 days vs. 5 days, t-test p < 0.001), a 416% increase in the odds of inpatient death (AOR 4.16, 3.95-4.38), and a 282% increase in use of high-level post-acute care (AOR 2.82, 2.72-2.93). Hospitalized adults with epilepsy are vulnerable to specific safety-related adverse events, and these potential patient safety failures substantially impact outcomes and resource use. Efforts to reduce long-term disability and improve the value of care delivered to PWEs may need to consider provider-level interventions to reduce adverse
Chang, Wen-Yin; Ma, Jui-Chu; Chiu, Hsiao-Ting; Lin, Kuan-Chia; Lee, Pi-Hsia
This paper is a report of a study conducted to compare levels of job satisfaction and perceptions of the quality of patient care, collaboration and teamwork among healthcare professionals in four acute care hospitals and to determine the factors associated with job satisfaction for physicians, nurses and other healthcare professionals. Positive inter-professional relationships improve quality of patient care and staff job satisfaction. Understanding how healthcare professionals perceive their relationships with each other, and identifying factors that affect their job satisfaction and perceptions of the quality patient care, inform quality improvements. This cross-sectional survey study was conducted in four hospitals in Taiwan. Data were collected in 2007 and analysed using descriptive statistics, one-way anova with the Games-Howell post hoc test and stepwise regression analysis. The survey was completed by 1475 respondent, giving a response rate of 52.2% (180 physicians, 1019 nurses and 276 other healthcare professionals). Physicians were more satisfied with their jobs (F = 26.75, P collaborative relationships than did physicians or other healthcare professionals (F = 279.51, P collaborative relationships were the most important predictors of job satisfaction for healthcare providers. These findings provide important clues for improving interdisciplinary collaboration and ensuring quality patient care through good job satisfaction and teamwork among healthcare professionals in acute care hospitals.
Kamper-Jørgensen, Mads; Andersen, Lise Geisler; Simonsen, Jacob;
The objective was to study the effect of age at first enrollment into child care and other child care-related factors on the risk for hospitalization from gastrointestinal infection.......The objective was to study the effect of age at first enrollment into child care and other child care-related factors on the risk for hospitalization from gastrointestinal infection....
Full Text Available Objective: To determine the nature and types of medication errors (MEs, to evaluate occurrence of drug-drug interactions (DDIs, and assess rationality of prescription orders in a tertiary care teaching hospital. Materials and Methods: A prospective, observational study was conducted in General Medicine and Pediatric ward of Civil Hospital, Ahmedabad during October 2012 to January 2014. MEs were categorized as prescription error, dispensing error, and administration error (AE. The case records and treatment charts were reviewed. The investigator also accompanied the staff nurse during the ward rounds and interviewed patients or care taker to gather information, if necessary. DDIs were assessed by Medscape Drug Interaction Checker software (version 4.4. Rationality of prescriptions was assessed using Phadke′s criteria. Results: A total of 1109 patients (511 in Medicine and 598 in Pediatric ward were included during the study period. Total number of MEs was 403 (36% of which, 195 (38% were in Medicine and 208 (35% were in Pediatric wards. The most common ME was PEs 262 (65% followed by AEs 126 (31%. A potential significant DDIs were observed in 191 (17% and serious DDIs in 48 (4% prescriptions. Majority of prescriptions were semirational 555 (53% followed by irrational 317 (30%, while 170 (17% prescriptions were rational. Conclusion: There is a need to establish ME reporting system to reduce its incidence and improve patient care and safety.
textabstractThe Dutch government has started a process of reformation in the Dutch healthcare. The goal of this reformation is cost efficient healthcare in the Netherlands. Hospitals and health insurance companies in the Netherlands experience changes in regulations and funding. They are expected to negotiate about the price and quantities of hospital care. A product-price system for hospital care, called DBC, has been introduced by the government to support these negotiations. This study sho...
Wong, Carolyn; Hogan, David B.
Background A common scenario that may pose challenges to primary care providers is when an older patient has been discharged from hospital. The aim of this pilot project is to examine the experiences of patients’ admission to hospital through to discharge back home, using analysis of patient narratives to inform the strengths and weaknesses of the process. Methods For this qualitative study, we interviewed eight subjects from the Sheldon M. Chumir Central Teaching Clinic (CTC). Interviews were analyzed for recurring themes and phenomena. Two physicians and two resident learners employed at the CTC were recruited as a focus group to review the narrative transcripts. Results Narratives generally demonstrated moderate satisfaction among interviewees with respect to their hospitalization and follow-up care in the community. However, the residual effects of their hospitalization surprised five patients, and five were uncertain about their post-discharge management plan. Conclusion Both secondary and primary care providers can improve on communicating the likely course of recovery and follow-up plans to patients at the time of hospital discharge. Our findings add to the growing body of research advocating for the implementation of quality improvement measures to standardize the discharge process. PMID:27729948
L. Bruyneel (Luk); B. Li (Baoyue); D. Ausserhofer (Dietmar); E.M.E.H. Lesaffre (Emmanuel); I. Dumitrescu (Irina); H.L. Smith (Herbert L.); D.M. Sloane (Douglas M.); L.H. Aiken (Linda); W. Sermeus (Walter)
textabstractThis study integrates previously isolated findings of nursing outcomes research into an explanatory framework in which care left undone and nurse education levels are of key importance. A moderated mediation analysis of survey data from 11,549 patients and 10,733 nurses in 217 hospitals
L. Bruyneel (Luk); B. Li (Baoyue); D. Ausserhofer (Dietmar); E.M.E.H. Lesaffre (Emmanuel); I. Dumitrescu (Irina); H.L. Smith (Herbert L.); D.M. Sloane (Douglas M.); L.H. Aiken (Linda); W. Sermeus (Walter)
textabstractThis study integrates previously isolated findings of nursing outcomes research into an explanatory framework in which care left undone and nurse education levels are of key importance. A moderated mediation analysis of survey data from 11,549 patients and 10,733 nurses in 217 hospitals
Watanabe, Reina; Shimoda, Tomoko; Yano, Rika; Hayashi, Yasuhiro; Nakamura, Shinji; Matsuo, Junji; Yamaguchi, Hiroyuki
Hospital cleanliness in hospitals with a tendency toward long-term care in Japan remains unevaluated. We therefore visualized hospital cleanliness in Japan over a 2-month period by two distinct popular methods: ATP bioluminescence (ATP method) and the standard stamp agar method (stamp method). The surfaces of 752 sites within nurse and patient areas in three hospitals located in a central area of Sapporo, Japan were evaluated by the ATP and stamp methods, and each surface was sampled 8 times in 2 months. These areas were located in different ward units (Internal Medicine, Surgery, and Obstetrics and Gynecology). Detection limits for the ATP and stamp methods were determined by spike experiments with a diluted bacterial solution and a wipe test on student tables not in use during winter vacation, respectively. Values were expressed as the fold change over the detection limit, and a sample with a value higher than the detection limit by either method was defined as positive. The detection limits were determined to be 127 relative light units (RLU) per 100 cm2 for the ATP method and 5.3 colony-forming units (CFU) per 10 cm2 for the stamp method. The positive frequency of the ATP and stamp methods was 59.8% (450/752) and 47.7% (359/752), respectively, although no significant difference in the positive frequency among the hospitals was seen. Both methods revealed the presence of a wide range of organic contamination spread via hand touching, including microbial contamination, with a preponderance on the entrance floor and in patient rooms. Interestingly, the data of both methods indicated considerable variability regardless of daily visual assessment with usual wiping, and positive surfaces were irregularly seen. Nurse areas were relatively cleaner than patient areas. Finally, there was no significant correlation between the number of patients or medical personnel in the hospital and organic or microbiological contamination. Ongoing daily hospital cleanliness is not
Scott, Kirstin W; Orav, E John; Cutler, David M; Jha, Ashish K
Growing evidence shows that hospitals are increasingly employing physicians. To examine changes in U.S. acute care hospitals that reported employment relationships with their physicians and to determine whether quality of care improved after the hospitals switched to this integration model. Retrospective cohort study of U.S. acute care hospitals between 2003 and 2012. U.S. nonfederal acute care hospitals. 803 switching hospitals compared with 2085 nonswitching control hospitals matched for year and region. Hospitals' conversion to an employment relationship with any of their privileged physicians. Risk-adjusted hospital-level mortality rates, 30-day readmission rates, length of stay, and patient satisfaction scores for common medical conditions. In 2003, approximately 29% of hospitals employed members of their physician workforce, a number that rose to 42% by 2012. Relative to regionally matched controls, switching hospitals were more likely to be large (11.6% vs. 7.1%) or major teaching hospitals (7.5% vs. 4.5%) and less likely to be for-profit institutions (8.8% vs. 19.9%) (all P values Hospital Association annual questionnaire, yet this measure has been used by others to examine effects of integration. The study examined performance up to 2 years after evidence of switching to an employment model; however, beneficial effects may have taken longer to appear. During the past decade, hospitals have increasingly become employers of physicians. The study's findings suggest that physician employment alone probably is not a sufficient tool for improving hospital care. Agency for Healthcare Research and Quality and National Science Foundation Graduate Research Fellowship.
Burkhardt, Jeffrey H; Wheeler, John R C
Measuring financial performance in acute care hospitals is a challenge for those who work daily with financial information. Because of the many ways to measure financial performance, financial managers and researchers must decide which measures are most appropriate. The difficulty is compounded for the non-finance person. The purpose of this article is to clarify key financial concepts and describe the most common measures of financial performance so that researchers and managers alike may understand what is being measured by various financial ratios.
Patel, Vaidehi Rajnikant; Gajjar, Maitrey; Bhatnagar, Nidhi; Shah, Mamta; Shah, Megha; Lahre, Saurabh
Aims & Objectives: 1) To evaluate the usage of plasma in a tertiary care hospital. 2) To evaluate reasons for inappropriate transfusion of plasma. Introduction: FFP contains plasma proteins and all the coagulation factors, including the labile factors V and VIII. There exist only a few firm indications for fresh frozen plasma transfusions and there is a growing consensus that most of the time this blood product is used inappropriately and without any scientific rationale.FFP transfu...
Escobar, Gabriel J; Greene, John D; Gardner, Marla N; Marelich, Gregory P; Quick, Bryon; Kipnis, Patricia
Patients who experience intra-hospital transfers to a higher level of care (eg, ward to intensive care unit [ICU]) are known to have high mortality. However, these findings have been based on single-center studies or studies that employ ICU admissions as the denominator. To employ automated bed history data to examine outcomes of intra-hospital transfers using all hospital admissions as the denominator. Retrospective cohort study. A total of 19 acute care hospitals. A total of 150,495 patients, who experienced 210,470 hospitalizations, admitted to these hospitals between November 1st, 2006 and January 31st, 2008. Predictors were age, sex, admission type, admission diagnosis, physiologic derangement on admission, and pre-existing illness burden; outcomes were: 1) occurrence of intra-hospital transfer, 2) death following admission to the hospital, 3) death following transfer, and 4) total hospital length of stay (LOS). A total of 7,868 hospitalizations that began with admission to either a general medical surgical ward or to a transitional care unit (TCU) had at least one transfer to a higher level of care. These hospitalizations constituted only 3.7% of all admissions, but accounted for 24.2% of all ICU admissions, 21.7% of all hospital deaths, and 13.2% of all hospital days. Models based on age, sex, preadmission laboratory test results, and comorbidities did not predict the occurrence of these transfers. Patients transferred to higher level of care following admission to the hospital have excess mortality and LOS. Copyright © 2010 Society of Hospital Medicine.
Touati, Mohamed; Lamarsalle, Ludovic; Moreau, Stéphane; Vergnenègre, Françoise; Lefort, Sophie; Brillat, Catherine; Jeannet, Laetitia; Lagarde, Aline; Daulange, Annick; Jaccard, Arnaud; Vergnenègre, Alain; Bordessoule, Dominique
At home injectable chemotherapy for patients receiving treatment for hematological diseases is still in debate. Given the expense of new innovative medicines, at home treatment has been proposed as a suitable option for improving patient quality of life and decreasing treatment costs. We decided to assess the cost of bortezomib administration in France among multiple myeloma patients from an economic standpoint. Patients in this study were treated within a regional hematological network combining outpatient hospital care and Hospital care at Home administration. To make the cost comparison, our team simulated outpatient hospital care expenses. Fifty-four consecutive multiple myeloma patients who received at least one injection of bortezomib in Hospital care at Home from January 2009 to December 2011 were included in the study. The median number of injections was 12 (range 1-44) at home and 6 (range 0-30) in the outpatient care unit. When compared with the cost simulation of outpatient hospital care alone, bortezomib administration with combined care was significantly less expensive for the National Health Insurance (NHI) budget. The mean total cost per patient and per injection was 954.20 € for combined outpatient and Hospital care at Home vs 1143.42 € for outpatient hospital care alone. This resulted in an estimated 16.5 % cost saving (Wilcoxon signed-rank test, p multiple myeloma patients treated with bortezomib in routine practice in a large rural area.
Full Text Available Abstract
Background: Hospitalization may often be prevented by timely and effective outpatient care either by preventing the onset of an illness, controlling an acute illness or managing a chronic disease with an appropriate follow-up. The objective of the study is to examine the variability of hospital admissions within Italian regions for Ambulatory Care Sensitive Conditions (ACSCs, and their relationship with primary care supply.
Methods: Hospital discharge data aggregated at a regional level collected in 2005 were analysed by type of ACS conditions. Main outcome measures were regional hospital admission rates for ACSCs. Negative binomial models were used to analyse the association with individual risk factors (age and gender and regional risk factors (propensity to hospitalisation and prevalence of specific conditions.
Non-parametric correlation indexes between standardised hospital admission rates and quantitative measures of primary care services were calculated.
Results: ACSC admissions accounted for 6.6% of total admissions, 35.7% were classified as acute conditions and 64.3% as chronic conditions. Admission rates for ACSCs varied widely across Italian regions with different patterns for chronic and acute conditions. Southern regions showed significantly higher rates for chronic conditions and North-eastern regions for acute conditions. We found a significant negative association between the provision of ambulatory specialist services and standardised hospitalization rates
(SHR for ACS chronic conditions (r=-0.50; p=0.02 and an inverse correlation among SHR for ACS acute conditions and the rate of GPs per 1,000 residents, although the latter was not statistically significant.
Conclusions: In Italy, about 480,000 inpatient hospital admissions in 2005 were attributable to ACSCs. Even
adjusting for potential confounders
Buurman, Bianca M.; Parlevliet, Juliette L.; Allore, Heather G.; Blok, Willem; van Deelen, Bob A. J.; van Charante, Eric P. Moll; de Haan, Rob J.; de Rooij, Sophia E.
IMPORTANCE Older adults acutely hospitalized are at risk of disability. Trials on comprehensive geriatric assessment (CGA) and transitional care present inconsistent results. OBJECTIVE To test whether an intervention of systematic CGA, followed by the transitional care bridge program, improved activ
Oostveen, C.J. van; Ubbink, D.T.; Huis in het Veld, J.G.; Bakker, P.J.; Vermeulen, H.
Background: Hospitals are constantly being challenged to provide high-quality care despite ageing populations, diminishing resources, and budgetary restraints. While the costs of care depend on the patients' needs, it is not clear which patient characteristics are associated with the demand for care
Romero-Huesca, Andrés; Ramírez-Bollas, Julio
After the Conquest, the indigenous populations of New Spain were left unprotected by the new government. Thus the Royal Hospital of Naturals (RHN) was created, offering care to the indigenous population for health and with hospitality, as well as religious aid. However, later solely care was provided. The RHN had great support from the Spanish Crown and became a suitable place for clinical investigation that on the peninsula and in all of Europe was forbidden: the autopsies, that in indigenous population are carried out without sanction, only needing authorization of local authorities for their accomplishment, considering the indigenous as inferior to Spaniards. In addition, the RHN was the best place for foundation of the Royal Surgery School of Mexico in the XVIII century. The contribution of the RHN was the fusion of indigenous medicine with European medicine, increasing the therapeutic resource array, as well as the opportunity of carrying clinic investigation through autopsy's for better clinic correlation, and matchless learning for the era in the art of out surgery, this being an important point in the development of the medicine and surgery of Mexico.
Mikhael, Michel; Cleary, John P; Dhar, Vijay; Chen, Yanjun; Nguyen, Danh V; Chang, Anthony C
Objective The aim of this article is to examine characteristics of birth tourism (BT) neonates admitted to a neonatal intensive care unit (NICU). Methods This was a retrospective review over 3 years; BT cases were identified, and relevant perinatal, medical, social, and financial data were collected and compared with 100 randomly selected non-birth tourism neonates. Results A total of 46 BT neonates were identified. They were more likely to be born to older women (34 vs. 29 years; p < 0.001), via cesarean delivery (72 vs. 48%; p = 0.007), and at a referral facility (80 vs. 32%; p < 0.001). BT group had longer hospital stay (15 vs. 7 days; p = 0.02), more surgical intervention (50 vs. 21%; p < 0.001), and higher hospital charges (median $287,501 vs. $103,105; p = 0.003). One-third of BT neonates were enrolled in public health insurance program and four BT neonates (10%) were placed for adoption. Conclusion Families of BT neonates admitted to the NICU face significant challenges. Larger studies are needed to better define impacts on families, health care system, and society.
Nagahama, Elizabeth Eriko Ishida; Santiago, Silvia Maria
The aim of this study was to characterize hospital care for childbirth in two hospitals affiliated with the Unified National Health System in Maringá, Paraná, Brazil, and identify both obstacles and facilitating factors for the implementation of humanized care, based on women's perception of the care received. This was an exploratory and descriptive study with a cross-sectional design, analyzing hospital patient charts and interviews with 569 women who gave birth at the two hospitals from March 2005 to February 2006. Hospital care was characterized on the basis of WHO quality-of-care guidelines for labor and delivery. The data pointed to a healthcare model marked by the hygienist legacy in physician-centered hospital protocols and professional practices. Institutional factors, identified as difficulties in institutional and infrastructure organization, hospital protocols, and health professionals' individual practices and stances, denote barriers that jointly hinder the implementation of a humanized model for childbirth care.
Correa-Casado, Matías; Granero-Molina, José; Hernández-Padilla, José Manuel; Fernández-Sola, Cayetano
To know the experience of case-manager nurses with regard to transferring palliative-care patients from the hospital to their homes. Qualitative phenomenological study carried out in 2014-2015. Poniente and Almería health districts, which referral hospitals are Poniente Hospital and Torrecárdenas Hospital, respectively. A purposive sample comprised of 12 case-manager nurses was recruited from the aforementioned setting. Theoretical data saturation was achieved after performing 7 in-depth individual interviews and 1 focus group. Data analysis was performed following Colaizzi's method. Three themes emerged: (1) 'Case-management nursing as a quality, patient-centred service' (2) 'Failures of the information systems', with the subthemes "patients" insufficient and inadequate previous information" and "ineffective between-levels communication channels for advanced nursing"; (3) 'Deficiencies in discharge planning', with the subthemes "deficient management of resources on admission", "uncertainty about discharge" and "insufficient human resources to coordinate the transfer". Case-manager nurses consider themselves a good-quality service. However, they think there are issues with coordination, information and discharge planning of palliative patients from hospital. It would be useful to review the communication pathways of both care and discharge reports, so that resources needed by palliative patients are effectively managed at the point of being transferred home. Copyright © 2016 Elsevier España, S.L.U. All rights reserved.
Dwyer, Trudy; Craswell, Alison; Rossi, Dolene; Holzberger, Darren
Reducing avoidable hospitialisation of aged care facility (ACF) residents can improve the resident experience and their health outcomes. Consequently many variations of hospital avoidance (HA) programs continue to evolve. Nurse practitioners (NP) with expertise in aged care have the potential to make a unique contribution to hospital avoidance programs. However, little attention has been dedicated to service evaluation of this model and the quality of care provided. The purpose of this study was to evaluate the quality of an aged care NP model of care situated within a HA service in a regional area of Australia. Donabedian's structure, process and outcome framework was applied to evaluate the quality of the NP model of care. The Australian Nurse Practitioner Study standardised interview schedules for evaluating NP models of care guided the semi-structured interviews of nine health professionals (including ACF nurses, medical doctors and allied health professionals), four ACF residents and their families and two NPs. Theory driven coding consistent with the Donabedian framework guided analysis of interview data and presentation of findings. Structural dimensions identified included the 'in-reach' nature of the HA service, distance, limitations of professional regulation and the residential care model. These dimensions influenced the process of referring the resident to the NP, the NPs timely response and interactions with other professionals. The processes where the NPs take time connecting with residents, initiating collaborative care plans, up-skilling aged care staff and function as intra and interprofessional boundary spanners all contributed to quality outcomes. Quality outcomes in this study were about timely intervention, HA, timely return home, partnering with residents and family (knowing what they want) and resident and health professional satisfaction. This study provides valuable insights into the contribution of the NP model of care within an aged care
...-26685] [FR Doc No: 2010-11177] DEPARTMENT OF VETERANS AFFAIRS 38 CFR Part 17 RIN 2900-AN41 Hospital and... its regulations to authorize VA to provide hospital and outpatient care to a veteran in a program that... 2900-AN41 Hospital and Outpatient Care for Veterans Released from Incarceration to Transitional...
Full Text Available Xavier-Yves Zendjidjian,1,2 Karine Baumstarck,1 Pascal Auquier,1 Anderson Loundou,1 Christophe Lançon,1,2 Laurent Boyer11Public Health, Chronic Diseases and Quality of Life Research Unit, Aix-Marseille Université, 2Department of Psychiatry, La Conception Hospital, Marseille, FranceBackground: The aim of this study was to determine the relationship between inpatient satisfaction and health outcomes, quality of life, and adherence to treatment in a sample of patients with schizophrenia, while considering key sociodemographic and clinical confounding factors.Methods: This cross-sectional study was conducted in the psychiatric departments of two public university hospitals in France. The data collected included sociodemographic information, clinical characteristics, quality of life (using the 36-Item Short Form Health Survey, nonadherence to treatment (Medication Adherence Report Scale, and satisfaction (a specific self-administered questionnaire based exclusively on patient point of view [Satispsy-22] and a generic questionnaire for hospitalized patients [QSH]. Multiple linear regressions were performed to assess the associations between satisfaction and quality of life and between satisfaction and nonadherence. Two sets of models were performed, ie, scores on the Satispsy-22 and scores on the QSH.Results: Ninety-one patients with schizophrenia were enrolled. After adjustment for confounding factors, patients with better personal experience during hospitalization (Satispsy-22 had a better psychological quality of life (SF36-mental composite score, β=0.37; P=0.004, and patients with higher levels of satisfaction with quality of care (Satispsy-22 showed better adherence to treatment (Medication Adherence Report Scale total score, β=−0.32; P=0.021. Higher QSH scores for staff and structure index were linked to better adherence with treatment (respectively, β=−0.33; P=0.019 and β=−0.30; P=0.032, but not with quality of life
Hume, S K
Establishing relationships with hospitals may be critical for long-term care facilities facing financial pressures and uncertain futures. One option is to initiate collaborative efforts to develop hospital-based skilled nursing facilities (SNFs). Hospitals, under pressure to move patients to less intensive settings and to diversify, are naturally drawn to long-term care as a related business where they can make limited personnel and financial commitments and extend their continuum of care. Before approaching hospitals to initiate collaborative efforts, long-term care providers should understand how they think and what their strengths and weaknesses are. Long-term and acute care providers have many options for collaboration, including management contracts and joint ventures. In a traditional management contract, the long-term care provider furnishes the administrator and a few key staff in exchange for direct reimbursement for those staff plus a management fee. Another option is for the long-term care facility to provide all the staff for a fee or percentage of revenue. Joint venture options are to form a subsidiary corporation to renovate a floor of the hospital or to have the hospital buy a large percentage of the long-term care facility and share the profits. All these options have potential pitfalls, including differing financial expectations and the threat of unionization at the SNF. Nevertheless, for long-term care facilities struggling under reimbursement cutbacks and other pressures, the benefits may outweigh the risks.
Wu, Qunhong; Liu, Chaojie; Jiao, Mingli; Hao, Yanhua; Han, Yuzhen; Gao, Lijun; Hao, Jiejing; Wang, Lan; Xu, Weilan; Ren, Jiaojiao
Objective Deteriorations in the patient-provider relationship in China have attracted increasing attention in the international community. This study aims to explore the role of trust in patient satisfaction with hospital inpatient care, and how patient-provider trust is shaped from the perspectives of both patients and providers. Methods We adopted a mixed methods approach comprising a multivariate logistic regression model using secondary data (1200 people with inpatient experiences over the past year) from the fifth National Health Service Survey (NHSS, 2013) in Heilongjiang Province to determine the associations between patient satisfaction and trust, financial burden and perceived quality of care, followed by in-depth interviews with 62 conveniently selected key informants (27 from health and 35 from non-health sectors). A thematic analysis established a conceptual framework to explain deteriorating patient-provider relationships. Findings About 24% of respondents reported being dissatisfied with hospital inpatient care. The logistic regression model indicated that patient satisfaction was positively associated with higher level of trust (OR = 14.995), lower levels of hospital medical expenditure (OR = 5.736–1.829 as compared with the highest quintile of hospital expenditure), good staff attitude (OR = 3.155) as well as good ward environment (OR = 2.361). But patient satisfaction was negatively associated with medical insurance for urban residents and other insurance status (OR = 0.215–0.357 as compared with medical insurance for urban employees). The qualitative analysis showed that patient trust—the most significant predictor of patient satisfaction—is shaped by perceived high quality of service delivery, empathic and caring interpersonal interactions, and a better designed medical insurance that provides stronger financial protection and enables more equitable access to health care. Conclusion At the core of high levels of patient dissatisfaction
Hall, Jane P; van Gool, Kees C
Economic theory predicts that changing financial rewards will change behaviour. This is valid in terms of service use; higher costs reduce health care use. It should follow that paying more for quality should improve quality; however, the research evidence thus far is equivocal, particularly in terms of better health outcomes. One reason is that "financial incentives" encompass a range of payment types and sizes of reward. The design of financial incentives should take into account the desired change and the context of existing payment structures, as well as other strategies for improving quality; further, financial incentives should be fair in rewarding effort. Financial incentives may have unintended consequences, including rewarding hospitals for selecting patients with lower risks, diverting attention from the overall patient population to specific conditions, gaming, and "crowding out" or displacing intrinsic motivation. Managers and clinicians can only respond to financial incentives if they have the data, tools and skills to effect changes. Australia should not adopt widespread use of financial incentives for improving quality in health care without careful consideration of their design and context, the potential for unintended effects (particularly beyond their immediate targets), and evaluation of outcomes. The relative cost-effectiveness of financial incentives compared with, or in concert with, other strategies should also be considered.
Persoon, Anke; Bakker, Franka C.; van der Wal-Huisman, Hanneke; Rikkert, Marcel G. M. Olde
ObjectivesTo develop a questionnaire, the Geriatric In-hospital Nursing Care Questionnaire (GerINCQ), to measure, in an integrated way, the care that older adults receive in the hospital and nurses' attitudes toward and perceptions about caring for older adults. DesignQuestionnaire development.
Financial pressures are forcing the closure of some teaching hospitals and retrenchment using such strategies as development of ambulatory care and satellite facilities, merging with or acquiring other hospitals, and shortening patient hospital stays. A table lists revenues and profit margins for the 20 largest university-owned teaching hospitals.…
Bergenholtz, Heidi; Hølge-Hazelton, Bibi; Jarlbaek, Lene
Hospitals have a responsibility to ensure that palliative care is provided to all patients with life-threatening illnesses. Generalist palliative care should therefore be acknowledged and organized as a part of the clinical tasks. However, little is known about the organization and evaluation of generalist palliative care in hospitals. Therefore the aim of the study was to investigate the organization and evaluation of generalist palliative care in a large regional hospital by comparing results from existing evaluations. Results from three different data sets, all aiming to evaluate generalist palliative care, were compared retrospectively. The data-sets derived from; 1. a national accreditation of the hospital, 2. a national survey and 3. an internal self-evaluation performed in the hospital. The data were triangulated to investigate the organization and evaluation of palliative care in order to identify concordances and/or discrepancies. The triangulation indicated poor validity of the results from existing methods used to evaluate palliative care in hospitals. When the datasets were compared, several discrepancies occurred with regard to the organization and the performance of generalist palliative care. Five types of discrepancies were found in 35 out of 56 sections in the fulfilment of the national accreditation standard for palliative care. Responses from the hospital management and the department managements indicated that generalist palliative care was organized locally--if at all--within the various departments and with no overall structure or policy. This study demonstrates weaknesses in the existing evaluation methods for generalist palliative care and highlights the lack of an overall policy, organization and goals for the provision of palliative care in the hospital. More research is needed to focus on the organization of palliative care and to establish indicators for high quality palliative care provided by the hospital. The lack of valid indicators
Kim, Jinkyung; Han, Woosok
To investigate predictors for specific dimensions of service quality perceived by hospital employees in long-term care hospitals. Data collected from a survey of 298 hospital employees in 18 long-term care hospitals were analysed. Multivariate ordinary least squares regression analysis with hospital fixed effects was used to determine the predictors of service quality using respondents' and organizational characteristics. The most significant predictors of employee-perceived service quality were job satisfaction and degree of consent on national evaluation criteria. National evaluation results on long-term care hospitals and work environment also had positive effects on service quality. The findings of the study show that organizational characteristics are significant determinants of service quality in long-term care hospitals. Assessment of the extent to which hospitals address factors related to employeeperceived quality of services could be the first step in quality improvement activities. Results have implications for efforts to improve service quality in longterm care hospitals and designing more comprehensive national evaluation criteria.
markdownabstract__Abstract__ Background: It is known that interprofessional collaboration is crucial for integrated care delivery, yet we are still unclear about the underlying mechanisms explaining effectiveness of integrated care delivery to older patients. In addition, we lack research comparing integrated care delivery between hospitals. Therefore, this study aims to (i) provide insight into the underlying components 'relational coordination' and 'situational awareness' of integrated care...
Mullen-Fortino, Margaret; Sites, Frank D; Soisson, Michael; Galen, Julie
Tele-intensive care units (ICUs) typically provide remote monitoring for ICUs of acute care, short-stay hospitals. As part of a joint venture project to establish a long-term acute level of care, Good Shepherd Penn Partners became the first facility to use tele-ICU technology in a nontraditional setting. Long-term acute care hospitals care for patients with complex medical problems. We describe describes the benefits and challenges of integrating a tele-ICU program into a long-term acute care setting and the impact this model of care has on patient care outcomes.
Maheshwari, Vinay; Paioli, Daniela; Rothaar, Robert; Hill, Nicholas S
...) in the United States. Accordingly, we performed a survey on the use of NPPV at acute care hospitals in a region of the United States to determine variations in utilization and between hospitals, the reasons for lower...
Vivancos, Raquel Bosquim Zavanella; Leite, Adriana Moraes; Furtado, Maria Cândida de Carvalho; Góes, Fernanda dos Santos Nogueira de; Haas, Vanderlei José; Scochi, Carmen Gracinda Silvan
OBJECTIVE: To characterize how babies are fed during their hospital stay and after hospital discharge from a Baby-Friendly Health Care Institution, using indicators proposed by the World Health Organization. METHODS...
Walker, Anne F.
ACCESSIBILITY OF HOSPITAL EMERGENCY SERVICES HAS BEEN an issue of increasing concern and was recently brought into public focus in Ontario by the tragic death of Joshua Fleuelling, whose ambulance was redirected from the nearest hospital. As will be reviewed, the limited case law has identified a legal duty for physicians and hospitals to provide treatment to people in need of emergency care, a duty that should be considered when formulating hospital policies. The impact of this duty of care ...
Purpose: The purpose of this paper is to explore and compare hospital and home care nurses’ assessment of their information management at patients’ discharge from hospital to home care before and after the hospital implemented an electronic nursing discharge note. Theory: This paper draws on the concept of inter-organizational continuity of care, and specifically addresses the contribution of the implementation of an electronic patient record (EPR). Methods: The study has a prospective descri...
R. W. Díez García; A. A.; de Souza; R. P. C. Proença
Establishing criteria for hospital nutrition care ensures that quality care is delivered to patients. The responsibility of the Hospital Food and Nutrition Service (HFNS) is not always well defined, despite efforts to establish guidelines for patient clinical nutrition practice. This study describes the elaboration of an Instrument for Evaluation of Food and Nutritional Care (IEFNC) aimed at directing the actions of the Hospital Food and Nutrition Service. This instrument was qualified by mea...
Krag, Aleksander; Teglbjerg, LS; Malchow-Moller, A
BACKGROUND: Overuse of acid suppressive therapy in the hospital setting and in primary care is well documented. AIM: To describe interactions between prescriptions of acid suppressive therapy in hospital and in primary care. METHODS: All patients admitted to hospital over a 24-month period were...... suppressive therapy within the following 12 months. Of all subjects treated with acid suppressive therapy in the hospital catchment area, 7.8% were seen in our department. CONCLUSIONS: Decisions about acid suppressive therapy prescribing in hospital has little influence on prescribing in primary care....
Rita Maria Rodrigues-Bastos
Full Text Available OBJECTIVE To analyze hospitalization rates and the proportion of deaths due to ambulatory care-sensitive hospitalizations and to characterize them according to coverage by the Family Health Strategy, a primary health care guidance program. METHODS An ecological study comprising 853 municipalities in the state of Minas Gerais, under the purview of 28 regional health care units, was conducted. We used data from the Hospital Information System of the Brazilian Unified Health System. Ambulatory care-sensitive hospitalizations in 2000 and 2010 were compared. Population data were obtained from the demographic censuses. RESULTS The number of ambulatory care-sensitive hospitalizations declined from 20.75/1,000 inhabitants [standard deviation (SD = 10.42 in 2000 to 14.92/thousand inhabitants (SD = 10.04 in 2010 Heart failure was the most frequent cause in both years. Hospitalizations rates for hypertension, asthma, and diabetes mellitus, decreased, whereas those for angina pectoris, prenatal and birth disorders, kidney and urinary tract infections, and other acute infections increased. Hospitalization durations and the proportion of deaths due to ambulatory care-sensitive hospitalizations increased significantly. CONCLUSIONS Mean hospitalization rates for sensitive conditions were significantly lower in 2010 than in 2000, but no correlation was found with regard to the expansion of the population coverage of the Family Health Strategy. Hospitalization rates and proportion of deaths were different between the various health care regions in the years evaluated, indicating a need to prioritize the primary health care with high efficiency and quality.
Chen, Hsueh-Fen; Bazzoli, Gloria J; Harless, David W; Clement, Jan P
There are many studies examining the effects of financial pressure from different payment sources on hospital quality of care, but most have assumed that quality of care is a public good in that payment changes from one payer will affect all hospital patients rather than just those directly associated with the payer. Although quality of hospital care can be either a public or private good, few studies have tested which of these scenarios are more likely to hold. To examine whether the change in the magnitude of in-hospital mortality for Medicare and managed care patients is different based on financial pressure resulting from the Balanced Budget Act and growing managed care market penetration; and to examine what role hospital competition may play in affecting these changes. The unit of analysis for the study was the hospital. Multiple data sources were used including the Agency for Healthcare Research and Quality State Inpatient Databases, American Hospital Association Annual Surveys, Area Resource File, and health maintenance organization data from InterStudy. A difference-in-difference-in-difference model was applied for a 2-period panel design. In general, Balanced Budget Act financial pressure and managed care market share did not magnify the difference in in-hospital mortality rates between Medicare and managed care patients. The results suggest that quality of cardiac care in the hospital setting is more likely to be a public good; however, more investigation using other quality indicators and the role of hospital competition under different payment systems is recommended.
Emil OLTEANU; Attila TAMAS SZORA; Iulian Bogdan DOBRA
In our scientific approach we tried to develop a model with which to highlight the effect of financing hospital health care providers using the hospital 's Diagnosis Related Groups (DRG) and Mean Relative Values (MRV). The econometric model used is simple linear regression model form. Development of the model was performed by using the EViews 7 to the municipal hospitals in Romania during 2010 - 2012, being considered DRG dependent variable and independent variabl...
Frierdich, Matthew D
This article focuses on the institutional dimensions of spiritual care within hospital settings in the context of the Patient Protection and Affordable Care Act of 2010 (ACA), applying policy information and systems theory to re-imagine the value and function of chaplaincy to hospital communities. This article argues that chaplaincy research and practice must look beyond only individual interventions and embrace chaplain competencies of presence, ritual, and communication as foundational tools for institutional spiritual care.
Yeliz İrem Tunçel
Full Text Available Objective: Burnout is common in intensive care units (ICU because of high demands and difficult working conditions. The aim of this study was to analyse nurses’ burnout in our oncology ICU and to determine which factors are associated with. Material and Method: The study was carried out in Ankara Oncology Hospital ICU. A self- reporting questionnaire in an envelope was used for the evaluation of burnout (Turkish- language version of Maslach Burnout Inventory and depression (Beck Depression Scale. Results: From a total of 37 ICU nurses, 35 participated in the study (%94,5 response rate. High levels of emotional exhaustion in 82% and depersonalization in 51,4% of nurses was determined. Personal accomplishment was higher at 80%. Mild to moderate emotional state and mild anxiety was revealed. Years in profession,finding salary insufficient, finding the profession in its proper, choosing the profession of his own accord, work environment satisfaction and finding the social activity adequate were associated with burnout (p≤0.05. Conclusion: In our study, intensive care unit nurses’ burnout scores were found to be higher. Burnout was rare in nurses that choose the profession of his own accord, find the nursing profession in its proper, and social activity adequate and are satisfied with the work environment. Therefore, we believe that attention should be given to individual needs and preferences in the selection of ICU staff.
Smits, A; Mansfield, S; Singh, S
To complement the role of primary care teams working with patients with HIV disease and AIDS within greater London and to ease the load on the special hospital units a home support team was developed. It comprises six specialist nurses, a general practitioner trained medical officer, and a receptionist and is funded from regional and district sources and charities. A nurse is available for out of hours and emergency weekend calls, with support from the patient's general practitioner or the attached medical officer. During the first 18 months 249 patients were seen; the mean duration of care was five months. Nearly a third (18/50, 30%) of patients who were terminally ill died at home. The team's activities included practical nursing care, emotional support for carers and patients, and advice and guidance to primary care teams. Problems in providing care in patients' homes included issues relating to confidentiality and 24 hour cover. With the increasing incidence of HIV infection the home support team may be a useful model for care of large numbers of patients with symptomatic HIV disease, especially in large urban areas. PMID:2106936
Paul, D P; Honeycutt, E D
For many years hospitals have viewed patients paternalistically and failed to address many customers' needs and wants in the health care market. Early attempts at marketing by hospitals were haphazard and focused primarily upon advertising and public relations. Through a review and discussion of documented hospital marketing practices, the hospital-patient marketing relationship is examined. Conclusions about hospital marketing practices and suggestions for future research are also provided.
Livingston, James D.; Nijdam-Jones, Alicia; Brink, Johann
Several questions remain unanswered regarding the extent to which the principles and practices of patient-centered care are achievable in the context of a forensic mental health hospital. This study examined patient-centered care from the perspectives of patients and providers in a forensic mental health hospital. Patient-centered care was assessed using several measures of complementary constructs. Interviews were conducted with 30 patients and surveys were completed by 28 service providers in a forensic mental health hospital. Patients and providers shared similar views of the therapeutic milieu and recovery orientation of services; however, providers were more likely to perceive the hospital as being potentially unsafe. Overall, the findings indicated that characteristics of patient-centered care may be found within a forensic mental health hospital. The principles of patient-centered care can be integrated into service delivery in forensic mental health hospitals, though special attention to providers’ perceptions of safety is needed. PMID:22815648
Vaughan-Sarrazin Mary S
Full Text Available Abstract Background There is growing concern certain not-for-profit hospitals are not providing enough uncompensated care to justify their tax exempt status. Our objective was to compare the amount of uncompensated care provided by not-for-profit (NFP, for-profit (FP and government owned hospitals. Methods We used 2005 state inpatient data (SID for 10 states to identify patients hospitalized for three common conditions: acute myocardial infarction (AMI, coronary artery bypass grafting (CABG, or childbirth. Uncompensated care was measured as the proportion of each hospital's total admissions for each condition that were classified as being uninsured. Hospitals were categorized as NFP, FP, or government owned based upon data obtained from the American Hospital Association. We used bivariate methods to compare the proportion of uninsured patients admitted to NFP, FP and government hospitals for each diagnosis. We then used generalized linear mixed models to compare the percentage of uninsured in each category of hospital after adjusting for the socioeconomic status of the markets each hospital served. Results Our cohort consisted of 188,117 patients (1,054 hospitals hospitalized for AMI, 82,261 patients (245 hospitals for CABG, and 1,091,220 patients for childbirth (793 hospitals. The percentage of admissions classified as uninsured was lower in NFP hospitals than in FP or government hospitals for AMI (4.6% NFP; 6.0% FP; 9.5% government; P Conclusions For the three conditions studied NFP and FP hospitals appear to provide a similar amount of uncompensated care while government hospitals provide significantly more. Concerns about the amount of uncompensated care provided by NFP hospitals appear warranted.
Full Text Available Objective: Dementia is a major public health problem. More and more patients with dementia are being admitted to acute care hospitals for treatment of comorbidities. Issues associated with care of patients with dementia in acute care hospitals have not been adequately clarified. This study aimed to explore the challenges nurses face in providing care to patients with dementia in acute care hospitals in Japan. Methods: This was a qualitative study using focus group interviews (FGIs. The setting was six acute hospitals with surgical and medical wards in the western region of Japan. Participants were nurses in surgical and internal medicine wards, excluding intensive care units. Nurses with less than 3 years working experience, those without experience in dementia patient care in their currently assigned ward, and head nurses were excluded from participation. FGIs were used to collect data from February to December 2008. Interviews were scheduled for 1–1.5 h. The qualitative synthesis method was used for data analysis. Results: In total, 50 nurses with an average experience of 9.8 years participated. Eight focus groups were formed. Issues in administering care to patients with dementia at acute care hospitals were divided into seven groups. Three of these groups, that is, problematic patient behaviors, recurrent problem, and problems affecting many people equally, interact to result in a burdensome cycle. This cycle is exacerbated by lack of nursing experience and lack of organization in hospitals. In coping with this cycle, the nurses develop protection plans for themselves and for the hospital. Conclusions: The two main issues experienced by nurses while administering care to patients with dementia in acute care hospitals were as follows: (a the various problems and difficulties faced by nurses were interactive and caused a burdensome cycle, and (b nurses do their best to adapt to these conditions despite feeling conflicted.
Fukuda, Risa; Shimizu, Yasuko; Seto, Natsuko
Dementia is a major public health problem. More and more patients with dementia are being admitted to acute care hospitals for treatment of comorbidities. Issues associated with care of patients with dementia in acute care hospitals have not been adequately clarified. This study aimed to explore the challenges nurses face in providing care to patients with dementia in acute care hospitals in Japan. This was a qualitative study using focus group interviews (FGIs). The setting was six acute hospitals with surgical and medical wards in the western region of Japan. Participants were nurses in surgical and internal medicine wards, excluding intensive care units. Nurses with less than 3 years working experience, those without experience in dementia patient care in their currently assigned ward, and head nurses were excluded from participation. FGIs were used to collect data from February to December 2008. Interviews were scheduled for 1-1.5 h. The qualitative synthesis method was used for data analysis. In total, 50 nurses with an average experience of 9.8 years participated. Eight focus groups were formed. Issues in administering care to patients with dementia at acute care hospitals were divided into seven groups. Three of these groups, that is, problematic patient behaviors, recurrent problem, and problems affecting many people equally, interact to result in a burdensome cycle. This cycle is exacerbated by lack of nursing experience and lack of organization in hospitals. In coping with this cycle, the nurses develop protection plans for themselves and for the hospital. The two main issues experienced by nurses while administering care to patients with dementia in acute care hospitals were as follows: (a) the various problems and difficulties faced by nurses were interactive and caused a burdensome cycle, and (b) nurses do their best to adapt to these conditions despite feeling conflicted.
Full Text Available E Scott Sills,1,2 Liubomir Chiriac,3 Denis Vaughan,4 Christopher A Jones,5 Shala A Salem11Division of Reproductive Endocrinology, Pacific Reproductive Center, Irvine, CA, USA; 2Graduate School of Life Sciences, University of Westminster, London, UK; 3Department of Mathematics, California Institute of Technology, Pasadena, CA, USA; 4Department of Obstetrics and Gynaecology, School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland; 5Global Health Economics Unit and Department of Surgery, Center for Clinical and Translational Science, University of Vermont College of Medicine, Burlington, VT, USABackground: This investigation evaluated standardized process of care data collected on selected hospitals serving a remote rural section of westernmost North Carolina.Methods: Centers for Medicare and Medicaid Services data were analyzed retrospectively for multiple clinical parameters at Fannin Regional Hospital, Murphy Medical Center, and Union General Hospital. Data were analyzed by paired t-test for individual comparisons among the three study hospitals to compare the three facilities with each other, as well as with state and national average for each parameter.Results: Centers for Medicare and Medicaid Services “Hospital Compare” data from 2011 showed Fannin Regional Hospital to have significantly higher composite scores on standardized clinical process of care measures relative to the national average, compared with Murphy Medical Center (P = 0.01 and Union General Hospital (P = 0.01. This difference was noted to persist when Fannin Regional Hospital was compared with Union General Hospital using common state reference data (P = 0.02. When compared with national averages, mean process of care scores reported from Murphy Medical Center and Union General Hospital were both lower but not significantly different (−3.44 versus −6.07, respectively, P = 0.54.Conclusion: The range of process of care scores submitted by acute care
Mainous, Arch G; Diaz, Vanessa A; Everett, Charles J; Knoll, Michele E
PURPOSE Some studies suggest proprietary (for-profit) hospitals are maximizing financial margins from patient care by limiting therapies or decreasing length of stay for uninsured patients. This study examines the role of insurance related to length of stay once the patient is in the hospital and risk for mortality, particularly in a for-profit environment. METHODS We undertook an analysis of hospitalizations in the National Hospital Discharge Survey (NHDS) of the 5-year period of 2003 to 2007 for patients aged 18 to 64 years (unweighted n = 849,866; weighted n = 90 million). The analysis included those who were hospitalized with both ambulatory care-sensitive conditions (ACSCs), hospitalizations considered to be preventable, and non-ACSCs. We analyzed the transformed mean length of stay between individuals who had Medicaid or all other insurance types while hospitalized and those who were hospitalized without insurance. This analysis was stratified by hospital ownership. We also examined the relationship between in-hospital mortality and insurance status. RESULTS After controlling for comorbidities; age, sex, and race/ethnicity; and hospitalizations with either an ACSC or non-ACSC diagnosis, patients without insurance tended to have a significantly shorter length of stay. Across all hospital types, the mean length of stay for ACSCs was significantly shorter for individuals without insurance (2.77 days) than for those with either private insurance (2.89 days, P = .04) or Medicaid (3.19, P hospitalizations for ACSCs, in-hospital mortality rate for individuals with either private insurance or Medicaid was not significantly different from the mortality rate for those without insurance. CONCLUSIONS Patients without insurance have shorter lengths of stay for both ACSCs and non-ACSCs. Future research should examine whether patients without insurance are being discharged prematurely.
Full Text Available Anita Gupta1, Sarah Daigle2, Jeffrey Mojica3, Robert W Hurley41Pain Management Division, Department of Anesthesiology, University of Pennsylvania School of Medicine, Philadelphia, PA, USA; 2Department of Anesthesiology and Critical Care, 3Department of Anesthesiology and Critical Care, Division of Pain Medicine, University of Pennsylvania, Philadelphia, PA, USA; 4Medical Director of the Johns Hopkins Pain Treatment Center, Division of Pain Medicine, Deparment of Anesthesiology and Critical Care Medicine, Johns Hopkins School of Medicine, Baltimore, MD, USAStudy objective: Assessment of patients’ perception of pain control in hospitals in the United States.Background: Limited data are available regarding the quality of pain care in the hospitalized patient. This is particularly valid for data that allow for comparison of pain outcomes from one hospital to another. Such data are critical for numerous reasons, including allowing patients and policy-makers to make data-driven decisions, and to guide hospitals in their efforts to improve pain care. The Hospital Quality Alliance was recently created by federal policy makers and private organizations in conjunction with the Centers for Medicare and Medicare Services to conduct patient surveys to evaluate their experience including pain control during their hospitalization.Methods: In March 2008, the results of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS survey was released for review for health care providers and researchers. This survey includes a battery of questions for patients upon discharge from the hospital including pain-related questions and patient satisfaction that provide valuable data regarding pain care nationwide. This study will review the results from the pain questions from this available data set and evaluate the performance of these hospitals in pain care in relationship to patient satisfaction. Furthermore, this analysis will be providing valuable
Menec, Verena H.; Bruce, Sharon; MacWilliam, Leonard R.
Hospital overcrowding has plagued Winnipeg and other Canadian cities for years. This study explored factors related to overcrowding. Hospital files were used to examine patterns of hospital use from fiscal years 1996/1997 to 1999/2000. Chart reviews were conducted to examine appropriateness of admissions and hospital stays during one pressure…
Ouslander, Joseph G; Maslow, Katie
Reducing preventable hospitalizations is fundamental to the "triple aim" of improving care, improving health, and reducing costs. New federal government initiatives that create strong pressure to reduce such hospitalizations are being or will soon be implemented. These initiatives use quality measures to define which hospitalizations are preventable. Reducing hospitalizations could greatly benefit frail and chronically ill adults and older people who receive long-term care (LTC) because they often experience negative effects of hospitalization, including hospital-acquired conditions, morbidity, and loss of functional abilities. Conversely, reducing hospitalizations could mean that some people will not receive hospital care they need, especially if the selected measures do not adequately define hospitalizations that can be prevented without jeopardizing the person's health and safety. An extensive literature search identified 250 measures of preventable hospitalizations, but the measures have not been validated in the LTC population and generally do not account for comorbidity or the capacity of various LTC settings to provide the required care without hospitalization. Additional efforts are needed to develop measures that accurately differentiate preventable from necessary hospitalizations for the LTC population, are transparent and fair to providers, and minimize the potential for gaming and unintended consequences. As the new initiatives take effect, it is critical to monitor their effect and to develop and disseminate training and resources to support the many community- and institution-based healthcare professionals and emergency department staff involved in decisions about hospitalization for this population. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.
Full Text Available The Nutrition Care in Canadian Hospitals (2010–2013 study identified the prevalence of malnutrition on admission to medical and surgical wards as 45%. Nutrition practices in the eighteen hospitals, including diagnosis, treatment and monitoring of malnourished patients, were ad hoc. This lack of a systematic approach has demonstrated the need for the development of improved processes and knowledge translation of practices aimed to advance the culture of nutrition care in hospitals. A narrative review was conducted to identify literature that focused on improved care processes and strategies to promote the nutrition care culture. The key finding was that a multi-level approach is needed to address this complex issue. The organization, staff, patients and their families need to be part of the solution to hospital malnutrition. A variety of strategies to promote the change in nutrition culture have been proposed in the literature, and these are summarized as examples for others to consider. Examples of strategies at the organizational level include developing policies to support change, use of a screening tool, protecting mealtimes, investing in food and additional personnel (healthcare aides, practical nurses and/or diet technicians to assist patients at mealtimes. Training for hospital staff raises awareness of the issue, but also helps them to identify their role and how it can be modified to improve nutrition care. Patients and families need to be aware of the importance of food to their recovery and how they can advocate for their needs while in hospital, as well as post-hospitalization. It is anticipated that a multi-level approach that promotes being “food aware” for all involved will help hospitals to achieve patient-centred care with respect to nutrition.
Santoshkumar R Jeevangi
Full Text Available Objective: To evaluate drug utilization and associated costs for the treatment of patients admitted in burn care unit of a tertiary care hospital. Methods: A prospective cross sectional study was conducted for a period of 15 months at Basaweshwara Teaching and General Hospital (BTGH, Gulbarga and the data collected was analyzed for various drug use indicators. Results: A total of 100 prescriptions were collected with 44% belonging to males and 56% to females. The average number of drugs per prescription ranged from 4.5 to 9.5. 9.5% of generics and 92% of essential drugs were prescribed. The opioid analgesics and sedatives were prescribed to all the patients who were admitted in burn care unit. The (Defined daily dose DDD/1 000/day for amikacin (359 was the highest followed by diclofenac sodium (156, pantoprazole (144, diazepam (130, ceftazidime (124, tramadol (115, ceftriaxone (84 and for paracetamol (4 which was the lowest. Conclusions: Significant amount of the money was spent on procurement of drugs. Most of the money was spent on prescribed antibiotics. The prescription of generic drugs should be promoted, for cost effective treatment. Hence the results of the present study indicate that there is a considerable scope for improvement in the prescription pattern.
Finney, John W; Humphreys, Keith; Kivlahan, Daniel R; Harris, Alex H S
Studies finding weak or nonexistent relationships between hospital performance on providing recommended care and hospital-level clinical outcomes raise questions about the value and validity of process of care performance measures. Such findings may cause clinicians to question the effectiveness of the care process presumably captured by the performance measure. However, one cannot infer from hospital-level results whether patients who received the specified care had comparable, worse or superior outcomes relative to patients not receiving that care. To make such an inference has been labeled the "ecological fallacy," an error that is well known among epidemiologists and sociologists, but less so among health care researchers and policy makers. We discuss such inappropriate inferences in the health care performance measurement field and illustrate how and why process measure-outcome relationships can differ at the patient and hospital levels. We also offer recommendations for appropriate multilevel analyses to evaluate process measure-outcome relationships at the patient and hospital levels and for a more effective role for performance measure bodies and research funding organizations in encouraging such multilevel analyses.
Chauhan, Ashok; Kumar, Parbodh
Aim The present study was undertaken to study the spectrum and pattern of various oral cavity lesions in a tertiary care hospital in Rohilkhand region of Uttar Pradesh, India. Background Oral cavity is one of the most common sites for tumour and tumour like lesions especially in males. It has been observed that benign lesions are more common than malignant ones. Materials and Methods A retrospective study was carried out in a tertiary care hospital during the period of two years from June 2012 to May 2014. The study included 133 cases of oral cavity lesions. The parameters included in the study were age, gender, site of the lesion and histopathological diagnosis. Special stains and Immunohistochemical markers were applied as and when required. Data collected were analysed. Results A total of 133 cases were included in the present study. The age ranged from 8 to 80 years. Males were affected more often than females with a Male: Female ratio of 3.3:1. The most common involved site was tongue 39 (29.32%) followed by tonsil in 30 (22.56%), buccal mucosa 27(20.32%), floor of mouth 14 (10.53%), palate 12(9.02%), lower lip 8 (6.02%), upper lip 2(1.50%) and vestibule in 1 (0.75%) cases. Of the 133 cases, 63 cases (47.36%) were malignant, 52 non-neoplastic (39.10%) and 18 cases (13.53%) of benign neoplasias. The various lesions included - Squamous cell carcinoma, Verrucous carcinoma, Carcinoma-in-situ, Leukoplakia, Fibroma, Lipoma, Squamous cell papilloma, Lymphoid hyperplasia, Pseudoepitheliomatous hyperplasia, Haemangioma, Schwannoma, Atypical Pleomor -phic adenoma, Pleomorphic adenoma, Epidermal cyst, Retention cyst, Parasitic infestation, Tubercular pathology, Granulation tissue, Chronic Sialadenitis and Chronic non-specific inflammatory pathology. A larger epidemiopathological study in this region needs to be carried out for detailed statistical analysis. Conclusion Benign lesions were the predominant pathology. Squamous cell carcinoma was the commonest malignant
Hebert, Paul L; Howell, Elizabeth A; Wong, Edwin S; Hernandez, Susan E; Rinne, Seppo T; Sulc, Christine A; Neely, Emily L; Liu, Chuan-Fen
To compare two approaches to measuring racial/ethnic disparities in the use of high-quality hospitals. Simulated data. Through simulations, we compared the "minority-serving" approach of assessing differences in risk-adjusted outcomes at minority-serving and non-minority-serving hospitals with a "fixed-effect" approach that estimated the reduction in adverse outcomes if the distribution of minority and white patients across hospitals was the same. We evaluated each method's ability to detect and measure a disparity in outcomes caused by minority patients receiving care at poor-quality hospitals, which we label a "between-hospital" disparity, and to reject it when the disparity in outcomes was caused by factors other than hospital quality. The minority-serving and fixed-effect approaches correctly identified between-hospital disparities in quality when they existed and rejected them when racial differences in outcomes were caused by other disparities; however, the fixed-effect approach has many advantages. It does not require an ad hoc definition of a minority-serving hospital, and it estimated the magnitude of the disparity accurately, while the minority-serving approach underestimated the disparity by 35-46 percent. Researchers should consider using the fixed-effect approach for measuring disparities in use of high-quality hospital care by vulnerable populations. © Health Research and Educational Trust.
M S Maputle
Full Text Available The purpose of the study was to explore and describe experiences of mothers during childbirth in a tertiary hospital in the Limpopo Province. This was achieved through a qualitative research study which was exploratory, descriptive, contextual and inductive in nature. A sample of 24 mothers participated in this study. Data obtained from unstructured in-depth interviews were analysed according to the protocol by Tesch (1990, cited in Cresswell, 1994:155. Five themes were identified, namely mutual participation and responsibility sharing, dependency and decision-making; information sharing and empowering autonomy and informed choices; open communication and listening; accommodative/non-accommodative midwifery actions; and maximising human and material infrastructure. The themes indicated experiences that foster or promote dependency on midwifery care. Guidelines on how to transform this dependency into a mother-centered care approach during childbirth are provided. Opsomming Die doel van die studie was om moeders se belewenis van kindergeboorte in ’n tersiêre hospitaal in die Limpopo Provinsie te verken en te beskryf. Dit is gedoen deur middel van kwalitatiewe navorsing wat verkennend, beskrywend, en kontekstueel was. ‘n Steekproef van 24 moeders het aan die studie deelgeneem. Inligting is verkry deur middel van ongestruktureerde in-diepte onderhoude. Hierdie inligting is geanaliseer aan die hand van Tesch (1990: aangehaal in Creswell, 1994:155 se protokol. Die volgende kategorieë is geïdentifiseer, wedersydse deelname en gedeelde verantwoordelik- hede, afhanklikheid en besluitneming, deel van inligting, bemagtiging tot outonomie en ingeligte keuse, oop kommunikasie en luister, akkommoderende/nie-akkommoderende vroedvrou-aksies en bevordering van menslike en materiële infrastrukture. Die resultate van die onderhoude het belewenisse blootgelê wat dui op die bevordering van afhanklikheid in vroedvrouversorging. Riglyne om hierdie
... Definitions § 440.140 Inpatient hospital services, nursing facility services, and intermediate care facility... 42 Public Health 4 2010-10-01 2010-10-01 false Inpatient hospital services, nursing facility services, and intermediate care facility services for individuals age 65 or older in institutions...
Hesselink, G.; Schoonhoven, L.; Barach, P.; Spijker, A.; Gademan, P.; Kalkman, C.; Liefers, J.; Vernooij-Dassen, M.J.F.J.; Wollersheim, H.
BACKGROUND: Evidence shows that suboptimum handovers at hospital discharge lead to increased rehospitalizations and decreased quality of health care. PURPOSE: To systematically review interventions that aim to improve patient discharge from hospital to primary care. DATA SOURCES: PubMed, CINAHL, Psy
de Jonge, P; Huyse, FJ; Slaets, JPJ; Herzog, T; Lobo, A; Lyons, JS; Opmeer, BC; Stein, B; Arolt, [No Value; Balogh, N; Cardoso, G; Fink, P; Rigatelli, M; van Dijck, R; Mellenbergh, GJ
There is increasing pressure to effectively treat patients with complex care needs from the moment of admission to the general hospital. In this study, the authors developed a measurement strategy for hospital-based care complexity. The authors' four-factor model describes the interrelations between
Brasso, Klaus; Friis, S; Juel, K;
We studied the need for hospital care of patients 74 years old or younger with clinically localized prostate cancer managed by deferred endocrine therapy.......We studied the need for hospital care of patients 74 years old or younger with clinically localized prostate cancer managed by deferred endocrine therapy....
Meret-Hanke, Louise A.
Purpose of the Study: This study evaluates the effects of the Program of All-Inclusive Care for the Elderly (PACE) on hospital use. PACE's capitated financing creates incentives to reduce the use of costly services. Furthermore, its emphasis on preventative care and regular monitoring by provides a mechanism for reducing unnecessary hospital use…
Chilingerian, J A
An analysis of current trends in the health care industry points to buyers seeking high quality, yet efficient, care as an emerging market segment. To target this market segment, hospitals must be prepared to market the efficient physicians. In the coming years, hospitals that can identify and market their best practicing providers will achieve a competitive advantage.
Meret-Hanke, Louise A.
Purpose of the Study: This study evaluates the effects of the Program of All-Inclusive Care for the Elderly (PACE) on hospital use. PACE's capitated financing creates incentives to reduce the use of costly services. Furthermore, its emphasis on preventative care and regular monitoring by provides a mechanism for reducing unnecessary hospital use…
Wulff, Christian N; Vedsted, Peter; Søndergaard, Jens
BACKGROUND: Case management (CM) models based on experienced nurses are increasingly used to improve coordination and continuity of care for patients with complex health care needs. Anyway, little is known about the effects of hospital-based CM in cancer care.Aim.To analyse the effects of hospital......-based CM on (i) GPs' evaluation of information from the hospital and collaboration with the hospital staff and (ii) patients' contacts with GPs during daytime and out of hours. DESIGN: A randomized controlled trial allocated 280 colorectal cancer patients 1:1 to either a control group or CM intervention...
Podsevatkin, V G; Blinov, D S; Podsevatkin, D V; Podsevatkina, S V; Smirnova, O A
The new technology of hospital psychiatric care, developed and implemented in the Mordovia republican clinical hospital, permits resolving problems of hospitalism, lethality, pharmaceutical resistance and others. The essence of this technology is in staging of hospital care under condition of intensification and standardization of curative diagnostic process, implementation of complex approach to treatment of psychiatric disorders. The patient sequentially passes through three stages: intensive diagnostics and intensive treatment (intensive care department, intensive therapy department), supportive therapy (general psychiatric department); rehabilitation measures (curative rehabilitative department). The concentration of resources at the first stage, application of intensive therapy techniques permit in the shortest period to arrest acute psychotic symptomatic. The described new technology of hospital psychiatric care permits enhancing effectiveness of treatment, significantly shorten period of hospitalization (37.5 days), to obtain lasting and qualitative remission, to rehabilitate most fully social working status of patient and to significantly decrease lethality.
Dijs-Elsinga, J.; Otten, W.; Versluijs, M.; Smeets, H.J.; Kievit, J.; Vree, R.; Made, W.J. van der; Marang-Van De Mheen, P.J.
OBJECTIVE: To assess whether patients use information on quality of care when choosing a hospital for surgery compared with more general hospital information. METHODS: In this cross-sectional study in 3 Dutch hospitals, questionnaires were sent to 2122 patients who underwent 1 of 6 elective surgical
Ince, Elif E.; Rubin, David; Christian, Cindy W.
Objective: To determine whether a suspicion or diagnosis of child abuse during hospitalization influences parental perceptions of hospital care in families of children admitted with traumatic injuries. Method: Parents of children younger than 6 years of age admitted with traumatic injuries to a large urban children's hospital were recruited to…
... Myself: A Guide for When I Leave the Hospital To use this guide you should: I Talk with the hospital staff about each of the items that are ... to care for yourself since you left the hospital. This guide is adapted from Project Re-Engineered ...
Pierskalla, W P; Woods, D
This article discusses the current state of informations systems in hospital management. Decision Support Systems (DSS) for the management, administrative and patient care units of the hospital are described. These DSS's include market planning, nurse scheduling and blood screening systems. Trends for future uses of information systems in the hospital environment are addressed.
Dijs-Elsinga, J.; Otten, W.; Versluijs, M.; Smeets, H.J.; Kievit, J.; Vree, R.; Made, W.J. van der; Marang-Van De Mheen, P.J.
OBJECTIVE: To assess whether patients use information on quality of care when choosing a hospital for surgery compared with more general hospital information. METHODS: In this cross-sectional study in 3 Dutch hospitals, questionnaires were sent to 2122 patients who underwent 1 of 6 elective surgical
Future directions of the AFEM Out-of-Hospital Emergency Care Workgroup include creating an online Toolkit. This will serve as a repository of template documents to guide implementation and development of clinical care, education, transportation, public access, policy and governance.
Kinjo, Kentaro; Sairenji, Tomoko; Koga, Hidenobu; Osugi, Yasuhiro; Yoshida, Shin; Ichinose, Hidefumi; Nagai, Yasunori; Imura, Hiroshi; South-Paul, Jeannette E; Meyer, Mark; Honda, Yoshihisa
Physician-led home visit care with medical teams (Zaitaku care) has been developed on a national scale to support those who wish to stay at home at the end of life, and promote a system of community-based integrated care in Japan. Medical care at the end of life can be expensive, and is an urgent socioeconomic issue for aging societies. However medical costs of physician-led home visits care have not been well studied. We compared the medical costs of Zaitaku care and hospital care at the end of life in a rapidly aging community in a rural area in Japan. A cross-sectional study was performed to compare the total medical costs during patients' final days of life (30 days or less) between Zaitaku care and hospital care from September 2012 to August 2013 in Fukuoka Prefecture, Japan. Thirty four patients died at home under Zaitaku care, and 72 patients died in the hospital during this period. The average daily cost of care during the last 30 days did not differ significantly between the two groups. Although Zaitaku care costs were higher than hospital care costs in the short-term (≦10 days, Zaitaku care $371.2 vs. Hospital care $202.0, p = 0.492), medical costs for Zaitaku care in the long-term care (≧30 days) were less than that of hospital care ($155.8 vs. $187.4, p = 0.055). Medical costs of Zaitaku care were less compared with hospital care if incorporated early for long term care, but it was high if incorporated late for short term care. For long term care, medical costs for Zaitaku care was 16.7% less than for hospitalization at the end of life. This physician-led home visit care model should be an available option for patients who wish to die at home, and may be beneficial financially over time.
Chang, Dong W; Shapiro, Martin F
Maximizing the value of critical care services requires understanding the relationship between intensive care unit (ICU) utilization, clinical outcomes, and costs. To examine whether hospitals had consistent patterns of ICU utilization across 4 common medical conditions and the association between higher use of the ICU and hospital costs, use of invasive procedures, and mortality. Retrospective cohort study of 156 842 hospitalizations in 94 acute-care nonfederal hospitals for diabetic ketoacidosis (DKA), pulmonary embolism (PE), upper gastrointestinal bleeding (UGIB), and congestive heart failure (CHF) in Washington state and Maryland from 2010 to 2012. Hospitalizations for DKA, PE, UGIB, and CHF were identified from the presence of compatible International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Multilevel logistic regression models were used to determine the predicted hospital-level ICU utilization during hospitalizations for the 4 study conditions. For each condition, hospitals were ranked based on the predicted ICU utilization rate to examine the variability in ICU utilization across institutions. The primary outcomes were associations between hospital-level ICU utilization rates and risk-adjusted hospital mortality, use of invasive procedures, and hospital costs. The 94 hospitals and 156 842 hospitalizations included in the study represented 4.7% of total hospitalizations in this study. ICU admission rates ranged from 16.3% to 81.2% for DKA, 5.0% to 44.2% for PE, 11.5% to 51.2% for UGIB, and 3.9% to 48.8% for CHF. Spearman rank coefficients between DKA, PE, UGIB, and CHF showed significant correlations in ICU utilization for these 4 medical conditions among hospitals (ρ ≥ 0.90 for all comparisons; P utilization rate was not associated with hospital mortality. Use of invasive procedures and costs of hospitalization were greater in institutions with higher ICU utilization for all 4 conditions. For medical
Bergenholtz, H; Hølge-Hazelton, B; Jarlbæk, Lene
Background Hospitals have a responsibility to ensure that palliative care is provided to all patients with life-threatening illnesses. Generalist palliative care should therefore be acknowledged and organized as a part of the clinical tasks. However, little is known about the organization...... and evaluation of generalist palliative care in hospitals. Therefore the aim of the study was to investigate the organization and evaluation of generalist palliative care in a large regional hospital by comparing results from existing evaluations. Methods Results from three different data sets, all aiming...... to evaluate generalist palliative care, were compared retrospectively. The data-sets derived from; 1. a national accreditation of the hospital, 2. a national survey and 3. an internal self-evaluation performed in the hospital. The data were triangulated to investigate the organization and evaluation...
Full Text Available BACKGROUND: Organophosphorus (OP compounds are the most common suicidal poison in developing countries and mortality continues to be high. The present study was aimed to know the pattern and outcome of the OP poisoning. METHODOLOGY: A record based retrospective study from January 2013 - December 2013 was Conducted in a tertiary care hospital and data regarding age, gender, domicile, type of poison, manner of poisoning, seasonal trends, marital status, motive behind poisoning , socio - economic status and outcome was collected in a pre - structured Performa. All data were documented, analyzed and interpreted as per the laid down protocol. RESULTS : out of total 1575 cases of OP compound poisoning, 71.73% (1130 were male, 28.27% (445 were female, 34.6% were in the age group 21 - 30 years, 70.95% were of low socio - economic status, Occupation wise agricultural workers were on top of the list (70.07%, The commonest (93.78% motive behind poisoning was suicidal in both males and females, Financial problem was one of the commonest (51.22% reasons of poisoning. The mortality rate in our study was 13.47%. CONCLUSION : Y oung and adult males of Low socio - economic class, rural, both literate and illiterate agriculturists commonly abuse this substance to commit suicide
Steele, Joseph Rodgers; Jones, A Kyle; Clarke, Ryan K; Shoemaker, Stowe
The patient experience has moved to the forefront of health care-delivery research. The University of Texas MD Anderson Cancer Center Department of Diagnostic Radiology began collaborating in 2011 with the University of Houston Conrad N. Hilton College of Hotel and Restaurant Management, and in 2013 with the University of Nevada, Las Vegas, William F. Harrah College of Hotel Administration, to explore the application of service science to improving the patient experience. A collaborative pilot study was undertaken by these 3 institutions to identify and rank the specific needs and expectations of patients undergoing imaging procedures in the MD Anderson Department of Diagnostic Radiology. We first conducted interviews with patients, providers, and staff to identify factors perceived to affect the patient experience. Next, to confirm these factors and determine their relative importance, we surveyed more than 6,000 patients by e-mail. All factors considered important in the interviews were confirmed as important in the surveys. The surveys showed that the most important factors were acknowledgment of the patient's concerns, being treated with respect, and being treated like a person, not a "number"; these factors were more important than privacy, short waiting times, being able to meet with a radiologist, and being approached by a staff member versus having one's name called out in the waiting room. Our work shows that it is possible to identify and rank factors affecting patient satisfaction using techniques employed by the hospitality industry. Such factors can be used to measure and improve the patient experience.
Full Text Available Background: Accidental needle stick injuries (NSIs are an occupational hazard for healthcare workers (HCWs. A recent increase in NSIs in a tertiary care hospital lead to a 1-year review of the pattern of injuries, with a view to determine risk factors for injury and potential interventions for prevention. Methods: We reviewed 1-year (July 2006-June 2007 of ongoing surveillance of NSIs. Results: The 296 HCWs reporting NSIs were 84 (28.4% nurses, 27 (9.1% nursing interns, 45 (21.6% cleaning staff, 64 (21.6% doctors, 47 (15.9% medical interns and 24 (8.1% technicians. Among the staff who had NSIs, 147 (49.7% had a work experience of less than 1 year ( P < 0.001. The devices responsible for NSIs were mainly hollow bore needles ( n = 230, 77.7%. In 73 (24.6% of the NSIs, the patient source was unknown. Recapping of needles caused 25 (8.5% and other improper disposal of the sharps resulted in 55 (18.6% of the NSIs. Immediate post-exposure prophylaxis for HCWs who reported injuries was provided. Subsequent 6-month follow-up for human immunodeficiency virus showed zero seroconversion. Conclusion: Improved education, prevention and reporting strategies and emphasis on appropriate disposal are needed to increase occupational safety for HCWs.
Kawal Preet Kaur
Full Text Available Objective: To determine the prevalence of syphilis in a tertiary care hospital situated in Hisar, Haryana. Methods: The study is a five year study (Jan 2006 to Dec 2010, in which a total of 1550 sera obtained from clinically suspected cases of syphilis and pregnant females were screened for cardiolipin antibodies by the rapid plasma reagin (RPR test. The total number of males was 650 while the total number of females was 900. Results: The RPR test was positive in 48 patients (3.09%. Out of a total of 850 pregnant females, 10 (1.18% were tested positive through RPR test. Among the remaining 38 positive patients, males were 35 and females were 3. The most common age group affected was 19-24 years in both the sexes. Conclusions: Our findings showed that there is a substantial benefit of using an economical test like RPR for the diagnosis of syphilis in resource-poor setting. Great importance should be given to the screening of pregnant females for syphilis.
Dai, Yang; Lokhandwala, Sharukh; Long, William; Mark, Roger; Lehman, Li-wei H.
Among critically-ill patients, hypotension represents a failure in compensatory mechanisms and may lead to organ hypoperfusion and failure. In this work, we adopt a data-driven approach for phenotype discovery and visualization of patient similarity and cohort structure in the intensive care unit (ICU). We used Hierarchical Dirichlet Process (HDP) as a nonparametric topic modeling technique to automatically learn a d-dimensional feature representation of patients that captures the latent “topic” structure of diseases, symptoms, medications, and findings documented in hospital discharge summaries. We then used the t-Distributed Stochastic Neighbor Embedding (t-SNE) algorithm to convert the d-dimensional latent structure learned from HDP into a matrix of pairwise similarities for visualizing patient similarity and cohort structure. Using discharge summaries of a large patient cohort from the MIMIC II database, we evaluated the clinical utility of the discovered topic structure in phenotyping critically-ill patients who experienced hypotensive episodes. Our results indicate that the approach is able to reveal clinically interpretable clustering structure within our cohort and may potentially provide valuable insights to better understand the association between disease phenotypes and outcomes. PMID:28630951
Mitu, F; Leon, Maria-Magdalena
Cardiovascular disease is the leading cause of death in our country. The number of young people with hypertension grow up quickly, so a good control of dyslipidemia and blood pressure (BP) is essential in prevention of cardiovascular disease. To investigate the prevalence of HTA at young people and established the corelation with another risk factors like smoke, colesterol, obesity and heredity, few data are available on the blood pressure characteristics of young patients. It has been investigate 366 young people between 19-25 years old, in ambulatory system and 350 younger with the same age, in hospital. Blood pressure was measured according to standard procedures, and was considered well-controlled if it was colesterol and 2.1 at men with big colesterol. The relation between HTA--obesity is proven in our study, the incidence of HTA is 2.6 bigger at the obeses patients. These arguments should also promote further research in primary care on the control and the therapeutic behavior of the physicians.
Nashrath, Mariyam; Akkadechanunt, Thitinut; Chontawan, Ratanawadee
The present study explored nurses' and patients' expectations of nursing service quality, their perception of performance of nursing service quality performed by nurses, and compared nursing service quality, as perceived by nurses and patients. The sample consisted of 162 nurses and 383 patients from 11 inpatient wards/units in a tertiary care hospital in the Maldives. Data were collected using the Service Quality scale, and analyzed using descriptive statistics and the Mann-Whitney U-test. The results indicated that the highest expected dimension and perceived dimension for nursing service quality was Reliability. The Responsiveness dimension was the least expected dimension and the lowest performing dimension for nursing service quality as perceived by nurses and patients. There was a statistically significant difference between nursing service quality perceived by nurses and patients. The study results could be used by nurse administrators to develop strategies for improving nursing service quality so that nursing service delivery process can be formulated in such a way as to reduce differences of perception between nurses and patients regarding nursing service quality. © 2011 Blackwell Publishing Asia Pty Ltd.
22 and the morphology was normocytic normochromic in 20 cases. Tuberculosis leading to anaemia was seen in 24, Internal haemorrhoids/Fissures 5, Taenia infestation in 3, Haematological Malignancies 2, GI Malignancies 3, Connective tissues disorders 3, Nutritional iron deficiency 8 and Anaemia of chronic diseases in remaining cases. Among the 22 cases having macrocytic anaemia, 11 had vitamin B 12 deficiency, 6 had subclinical hypothyroidism, 5 had alcoholism. Among the 20 patients having normocytic normochromic blood picture, 4 had haemolytic anaemia, 1 had aplastic anaemia and remaining were having anaemia of chronic disease mainly chronic kidney disease. Regarding treatment, 23 patients were transfused blood. Out of total 100 patients included in the study, in-hospital mortality was 10. CONCLUSIONS Anaemia is associated with a variety of diseases. As Tuberculosis and B 12 Deficiency are among the leading causes of anaemia, hypochromic and microcytic picture was the predominant picture in peripheral blood smear. Among the patients having normocytic normochromic blood picture, majority were having chronic kidney disease which may be due to the fact that our hospital is a tertiary referral centre for chronic renal failure. In-hospital mortality due to anaemia alone is lower in tertiary care centres, but the mortality in our study is due to associated comorbid conditions like chronic renal failure and malignancy.
Watson, Diane; Finlayson, Greg; Jacobs, Philip
This paper presents comparative financial ratios that can be adopted by health system administrators and policy analysts to begin to evaluate the performance of acute care hospitals. We combined financial, statistical and clinical information for 73 acute care hospitals in Manitoba for fiscal 1997/98 to calculate 15 indicators of financial performance. Our findings suggest that there is variability between hospital types in their average costs per weighted case, cost structure and financial performance.
Restuccia Joseph D
Full Text Available Abstract Background Recently, there has been considerable effort to promote the use of health information technology (HIT in order to improve health care quality. However, relatively little is known about the extent to which HIT implementation is associated with hospital patient care quality. We undertook this study to determine the association of various HITs with: hospital quality improvement (QI practices and strategies; adherence to process of care measures; risk-adjusted inpatient mortality; patient satisfaction; and assessment of patient care quality by hospital quality managers and front-line clinicians. Methods We conducted surveys of quality managers and front-line clinicians (physicians and nurses in 470 short-term, general hospitals to obtain data on hospitals’ extent of HIT implementation, QI practices and strategies, assessments of quality performance, commitment to quality, and sufficiency of resources for QI. Of the 470 hospitals, 401 submitted complete data necessary for analysis. We also developed measures of hospital performance from several publicly data available sources: Hospital Compare adherence to process of care measures; Medicare Provider Analysis and Review (MEDPAR file; and Hospital Consumer Assessment of Healthcare Providers and Systems HCAHPS® survey. We used Poisson regression analysis to examine the association between HIT implementation and QI practices and strategies, and general linear models to examine the relationship between HIT implementation and hospital performance measures. Results Controlling for potential confounders, we found that hospitals with high levels of HIT implementation engaged in a statistically significant greater number of QI practices and strategies, and had significantly better performance on mortality rates, patient satisfaction measures, and assessments of patient care quality by hospital quality managers; there was weaker evidence of higher assessments of patient care quality by
Background: Intercultural differences influence acute inpatient psychiatric care systems. Aims: To evaluate characteristics of acute inpatient care in a German and a Japanese hospital. Method: Based on a sample of 465 admissions to the Psychiatric State Hospital Regensburg (BKR) and 91 admissions to the Hirakawa Hospital (HH) over a six-month period in 2008, data from the psychiatric basic documentation system (BADO) were analysed with regard to socio-demographic characteristics, treatm...
Kristensen, Troels; Laudicella, Mauro; Ejersted, Charlotte;
Aims: We analyse the in-hospital costs of diabetic patients admitted to English hospitals and aim to assess what proportions of cost variation are explained by patient and hospital characteristics. Methods: We use Hospital Episode Statistics and reference costs for all patients admitted to diabetes...... after controlling for patient characteristics. Second, we explore why these average costs vary across hospitals. Results: Much of the variation in the costs of controlling diabetes is driven by the Healthcare Resource Group to which the patient is allocated, but costs are also higher for patients who...... are transferred between hospitals, suffer infections and other complications, or for those who die in hospital. Even so, around 8-9% of the variation in costs is related to the hospital in which the patient is treated, with geographical variation in factor prices being the prime reason for this variation...
This study describes the reasons for and outcomes of maternal transfers from private homes and freestanding birthing suites to a large academic hospital in order to better understand and meet the needs of transferring women and their families. The convenience sample included all adult women admitted to the labor and birth unit or emergency room within a 5-year period who: 1) had planned to give birth out-of-hospital but developed complications at term before the onset of labor and were admitted to the hospital for labor induction; 2) had planned to give birth at home or in a birthing suite but transferred to the hospital during labor; or 3) arrived at the hospital for care within 24 hours after a planned birth at home or in a birthing suite. Descriptive data for each transfer were obtained from the medical record. Fifty-one transfers were identified: 11 prior to labor, 38 during labor, and 2 postpartum. Only 4 transfers were considered urgent by the referring provider. The most common reasons for intrapartum transfer were prolonged labor (n = 19) and desire for epidural analgesia (n = 10). Only 25% of the medical records had documentation that the referring provider accompanied the woman to the hospital during the care transition or was involved in her hospital course; however, the prenatal and/or intrapartum records had been delivered by the referring provider, were referenced in the hospital admission note, and had become part of the permanent hospital medical record for 85% of the women. On average, one transfer per year was complicated by neonatal morbidity, and one transfer per year involved significant disagreement between hospital providers and the women presenting for care. Collecting and reviewing data about a facility's perinatal transfer events can help the local multi-stakeholder group appraise current practice and plan for quality improvement. © 2016 by the American College of Nurse-Midwives.
Curtis Lesley H
Full Text Available Abstract Background The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA of 1996 gave states the option to withdraw Medicaid coverage of nonemergency care from most legal immigrants. Our goal was to assess the effect of PRWORA on hospital uncompensated care in the United States. Methods We collected the following state-level data for the period from 1994 through 1999: foreign-born, noncitizen population and health uninsurance rates (US Census Current Population Survey; percentage of teaching hospitals (American Hospital Association Annual Survey of Hospitals; and each state's decision whether to implement the PRWORA Medicaid bar for legal permanent residents or to continue offering nonemergency Medicaid coverage using state-only funds (Urban Institute. We modeled uncompensated care expenditures by state (also from the Annual Survey of Hospitals in both univariate and multivariable regression analyses. Results When measured at the state level, there was no significant relationship between uncompensated care expenditures and states' percentage of noncitizen immigrants. Uninsurance rates were the only significant factor in predicting uncompensated hospital care expenditures by state. Conclusions Reducing the number of uninsured patients would most surely reduce hospital expenditures for uncompensated care. However, data limitations hampered our efforts to obtain a monetary estimate of hospitals' financial losses due specifically to the immigrant eligibility changes in PRWORA. Quantifying the impact of these provisions on hospitals will require better data sources.
Wright, Brad; Jung, Hye-Young; Feng, Zhanlian; Mor, Vincent
Objective To examine the association between hospital, patient, and local health system characteristics and the likelihood, prevalence, and duration of observation care among fee-for-service Medicare beneficiaries. Data Sources The 100 percent Medicare inpatient and outpatient claims and enrollment files for 2009, supplemented with 2007 American Hospital Association Survey and 2009 Area Resource File data. Study Design Using a lagged cross-sectional design, we model the likelihood of a hospital providing any observation care using logistic regression and the conditional prevalence and duration of observation care using linear regression, among 3,692 general hospitals in the United States. Principle Findings Critical access hospitals (CAHs) have 97 percent lower odds of providing observation care compared to other hospitals, and they conditionally provide three fewer observation stays per 1,000 visits. The provision of observation care is negatively associated with the proportion of racial minority patients, but positively associated with average patient age, proportion of outpatient visits occurring in the emergency room, and diagnostic case mix. Duration is between 1.5 and 2.8 hours shorter at government-owned, for-profit hospitals, and CAHs compared to other nonprofit hospitals. Conclusions Variation in observation care depends primarily on hospital characteristics, patient characteristics, and geographic measures. By contrast, local health system characteristics are not a factor. PMID:24611617
When embarking on a partnership or acquisition, a rural hospital and a larger health system can accomplish a smooth transition, as long as they both keep in mind: > The fundamental (and financial) differences between urban and rural hospitals > The areas where the rural hospital in the partnership or acquisition is profitable > The importance of a clinic strategy in a partnership.
Tran, Diem; Davis, Aileen; McGillis Hall, Linda; Jaglal, Susan B
The objective of this study was to compare hospital and home care employers' rankings of both the importance and the feasibility of workforce strategies for recruiting and retaining rehabilitation professionals. An online self-administered questionnaire was distributed to all employers of rehabilitation professionals in Ontario hospitals (n=144) and Community Care Access Centre home care providers (n=34). Importance and feasibility rankings were based on the percentage of high ratings; 95% CIs were used to determine significant differences between hospital and home care rankings of recruitment and retention strategies. The response rate was 50% (72/144) from hospitals and 73.5% (25/34) from home-care settings. The recruitment and retention strategies considered most important and feasible for rehabilitation therapists, regardless of setting, were communication between employer and worker, compensation packages, access to research, and professional development in budget planning. Tangible resources, support personnel, work safety, and marketing rehabilitation careers to high school students were ranked significantly higher by hospitals than by home care providers. Similarities exist between hospital and home care employers in terms of the importance and feasibility of recruitment and retention strategies for rehabilitation professionals. However, when developing a rehabilitation health human resources plan, the strategies identified as different between hospital and home care settings should be taken into account.
Ford, Jane B.; Hindmarsh, Diane M; Browne, Kim M; Todd, Angela L.
Background Surveys of satisfaction with maternity care have been conducted using overnight inpatient surveys and dedicated maternity surveys in a number of Australian settings, however none have been used to report on satisfaction with maternity care among women in New South Wales. The aims of this study were to investigate the association between: 1) parity (first and subsequent births) and patient experience of hospital care at birth, and 2) other patient, birth and hospital characteristics...
Gardiner, C.; Cobb, M.; Gott, M.; Ingleton, C.
Background: the need for access to high-quality palliative care at the end of life is becoming of increasing public health concern. The majority of deaths in the UK occur in acute hospitals, and older people are particularly likely to die in this setting. However, little is known about the barriers to palliative care provision for older people within acute hospitals.\\ud \\ud Objective: to explore the perspectives of health professionals regarding barriers to optimal palliative care for older p...
Seema Bibi; Saima Ghaffar; Shazia Memon; Shaneela Memon
Background: Postpartum period is the critically important part of obstetric care but most neglected period for majority of Pakistani women. Only life threatening complications compel them to seek for tertiary hospital care. We describe the nature of these obstetric morbidities in order to help policymakers in improving prevailing situation. Objective: To find out the frequency and causes of severe post-partum maternal morbidity requiring tertiary hospital care and to identify the demographic ...
More people die in hospital than in any other setting which is why it is important to study the outcomes of hospital care at end of life. This study analyses what influenced outcomes in a sample of patients who died in hospital in Ireland in 2008\\/9. The study was undertaken as part of the Irish Hospice Foundation\\'s Hospice Friendly Hospitals Programme (2007-2012).
Every Nathan R
Full Text Available Abstract Background Few studies report on the effect of organizational factors facilitating transfer between primary and tertiary care hospitals either within an integrated health care system or outside it. In this paper, we report on the relationship between degree of clinical integration of cardiology services and transfer rates of acute coronary syndrome (ACS patients from primary to tertiary hospitals within and outside the Veterans Health Administration (VHA system. Methods Prospective cohort study. Transfer rates were obtained for all patients with ACS diagnoses admitted to 12 primary VHA hospitals between 1998 and 1999. Binary variables measuring clinical integration were constructed for each primary VHA hospital reflecting: presence of on-site VHA cardiologist; referral coordinator at the associated tertiary VHA hospital; and/or referral coordinator at the primary VHA hospital. We assessed the association between the integration variables and overall transfer from primary to tertiary hospitals, using random effects logistic regression, controlling for clustering at two levels and adjusting for patient characteristics. Results Three of twelve hospitals had a VHA cardiologist on site, six had a referral coordinator at the tertiary VHA hospital, and four had a referral coordinator at the primary hospital. Presence of a VHA staff cardiologist on site and a referral coordinator at the tertiary VHA hospital decreased the likelihood of any transfer (OR 0.45, 95% CI 0.27–0.77, and 0.46, p = 0.002, CI 0.27–0.78. Conversely, having a referral coordinator at the primary VHA hospital increased the likelihood of transfer (OR 6.28, CI 2.92–13.48. Conclusions Elements of clinical integration are associated with transfer, an important process in the care of ACS patients. In promoting optimal patient care, clinical integration factors should be considered in addition to patient characteristics.
Sales, Anne E; Pineros, Sandra L; Magid, David J; Every, Nathan R; Sharp, Nancy D; Rumsfeld, John S
Background Few studies report on the effect of organizational factors facilitating transfer between primary and tertiary care hospitals either within an integrated health care system or outside it. In this paper, we report on the relationship between degree of clinical integration of cardiology services and transfer rates of acute coronary syndrome (ACS) patients from primary to tertiary hospitals within and outside the Veterans Health Administration (VHA) system. Methods Prospective cohort study. Transfer rates were obtained for all patients with ACS diagnoses admitted to 12 primary VHA hospitals between 1998 and 1999. Binary variables measuring clinical integration were constructed for each primary VHA hospital reflecting: presence of on-site VHA cardiologist; referral coordinator at the associated tertiary VHA hospital; and/or referral coordinator at the primary VHA hospital. We assessed the association between the integration variables and overall transfer from primary to tertiary hospitals, using random effects logistic regression, controlling for clustering at two levels and adjusting for patient characteristics. Results Three of twelve hospitals had a VHA cardiologist on site, six had a referral coordinator at the tertiary VHA hospital, and four had a referral coordinator at the primary hospital. Presence of a VHA staff cardiologist on site and a referral coordinator at the tertiary VHA hospital decreased the likelihood of any transfer (OR 0.45, 95% CI 0.27–0.77, and 0.46, p = 0.002, CI 0.27–0.78). Conversely, having a referral coordinator at the primary VHA hospital increased the likelihood of transfer (OR 6.28, CI 2.92–13.48). Conclusions Elements of clinical integration are associated with transfer, an important process in the care of ACS patients. In promoting optimal patient care, clinical integration factors should be considered in addition to patient characteristics. PMID:15649313
Gardiner, Clare; Cobb, Mark; Gott, Merryn; Ingleton, Christine
the need for access to high-quality palliative care at the end of life is becoming of increasing public health concern. The majority of deaths in the UK occur in acute hospitals, and older people are particularly likely to die in this setting. However, little is known about the barriers to palliative care provision for older people within acute hospitals. to explore the perspectives of health professionals regarding barriers to optimal palliative care for older people in acute hospitals. fifty-eight health professionals participated in eight focus groups and four semi-structured interviews. participants identified various barriers to palliative care provision for older people, including attitudinal differences to the care of older people, a focus on curative treatments within hospitals and a lack of resources. Participants also reported differing understandings of whose responsibility it was to provide palliative care for older people, and uncertainly over the roles of specialist and generalist palliative care providers in acute hospitals. numerous barriers exist to the provision of high-quality palliative care for older people within acute hospital settings. Additional research is now required to further explore age-related issues contributing to poor access to palliative care.
Whitaker, Rebecca Garr; Holmes, G Mark; Pink, George H
The low-volume hospital (LVH) payment adjustment established in the Patient Protection and Affordable Care Act (ACA) of 2010 is scheduled to sunset on October 1, 2017. The purpose of this analysis was: (1) to estimate the effect of the ACA LVH adjustment on qualifying hospitals' profitability margins; and (2) to examine hospital and market characteristics of the hospitals that would be most adversely affected by the loss of the ACA LVH adjustment. 2004-2015 data from the Hospital Cost Report Information System, Hospital Market Service Area File and Nielsen-Claritas Pop-Facts file were used to estimate difference-in-difference regression models with hospital-level random effects in order to determine whether the ACA LVH adjustment improved qualifying rural hospitals' profitability margins. Recycled predictions estimated the effect of losing the ACA LVH adjustment on profitability margins. Bivariate analyses explored associations between the predicted profitability margins and hospital and market characteristics. The ACA LVH adjustment significantly improved Sole Community Hospitals' Medicare inpatient margins in the year they received the adjustment, and it had a large but statistically insignificant effect on the profitability margins of other rural hospitals. Hospitals that would be the most adversely affected by loss of the ACA LVH adjustment were more likely to be small, located in the South, and in high-poverty markets with higher proportions of black and uninsured individuals. Elimination of the ACA LVH adjustment would have differential effects on subgroups of hospitals, and those located in markets serving historically underserved populations would be the most adversely affected. © 2016 National Rural Health Association.
Zisberg, Anna; Zlotnick, Cheryl; Gur-Yaish, Nurit; Admi, Hanna; Sinoff, Gary; Shadmi, Efrat
Around hospitalization, older adults often experience functional decline which can be a reflection of their need for nursing care. Given a shortage of nurses, determining the relationship between functional change and patients' satisfaction with nursing care can help to gauge the need for care. We assessed this relationship in a mixed prospective-correlational cohort study with 393 patients, 70 years or older. The art, tangible aspects and general satisfaction with nursing care were measured through interviews conducted at discharge. Patients' functional status was assessed at admission and discharge. Decline in functioning during hospitalization was the most powerful predictor of higher satisfaction with art and tangible aspects of nursing care in multivariate regression (β = 0.17-0.19, P patients whose functioning deteriorates during hospitalization, have a greater need for and more contact with professional nursing care, and therefore report higher satisfaction with specific aspects of nursing care.
Full Text Available Xing Zhang, Tatsuo Oyama National Graduate Institute for Policy Studies, Tokyo, Japan Abstract: Japan's health care system is considered one of the best health care systems in the world. Hospitals are one of the most important health care resources in Japan. As such, we investigate Japanese hospitals from various viewpoints, including their roles, ownership, regional distribution, and characteristics with respect to the number of beds, staff, doctors, and financial performance. Applying a multivariate analysis and regression model techniques, we show the functional differences between urban populated prefectures and remote ones; the equality gap among all prefectures with respect to the distribution of the number of beds, staff, and doctors; and managerial differences between private and public hospitals. We also review and evaluate the local public hospital reform executed in 2007 from various financial aspects related to the expenditure and revenue structure by comparing public and private hospitals. We show that the 2007 reform contributed to improving the financial situation of local public hospitals. Strategic differences between public and private hospitals with respect to their management and strategy to improve their financial situation are also quantitatively analyzed in detail. Finally, the remaining problems and the future strategy to further improve the Japanese health care system are described. Keywords: health care system, health care resource, public hospital, multivariate regression model, financial performance
Cramm, Jane M; Strating, Mathilde M H; Nieboer, Anna P
To date, researchers have lacked a validated instrument to measure stroke caregivers' satisfaction with hospital care. We adjusted a validated patient version of satisfaction with hospital care for stroke caregivers and tested the 11-item caregivers' satisfaction with hospital care (C-SASC hospital scale) on caregivers of stroke patients admitted to nine stroke service facilities in the Netherlands. Stroke patients were identified through the stroke service facilities; caregivers were identified through the patients. We collected admission demographic data from the caregivers and gave them the C-SASC hospital scale. We tested the instrument by means of structural equation modeling and examined its validity and reliability. After the elimination of three items, the confirmatory factor analyses revealed good indices of fit with the resulting eight-item C-SASC hospital scale. Cronbach's α was high (0.85) and correlations with general satisfaction items with hospital care ranged from 0.594 to 0.594 (convergent validity). No significant relations were found with health and quality of life (divergent validity). Such results indicate strong construct validity. We conclude that the C-SASC hospital scale is a promising instrument for measuring stroke caregivers' satisfaction with hospital stroke care.
Rosano, A.; Peschel, P.; Kugler, J.; Zee, J. van der; Ricciardi, W.; Guasticchi, G.
Background: Hospitalization may often be prevented by timely and effective outpatient care. For Italy we found that the type and density of primary-care facilities, among other factors, influence admission rates. However, results from Italy may not be valid for other types of health-care systems, e.
Wakefield, Douglas S.; Ward, Marcia; Miller, Thomas; Ohsfeldt, Robert; Jaana, Mirou; Lei, Yang; Tracy, Roger; Schneider, John
Obtaining meaningful information from statistically valid and reliable measures of the quality of care for disease-specific care provided in small rural hospitals is limited by small numbers of cases and different definitive care capacities. An alternative approach may be to aggregate and analyze patient services that reflect more generalized care…
Jusela, Cheryl; Struble, Laura; Gallagher, Nancy Ambrose; Redman, Richard W; Ziemba, Rosemary A
HOW TO OBTAIN CONTACT HOURS BY READING THIS ARTICLE INSTRUCTIONS 1.3 contact hours will be awarded by Villanova University College of Nursing upon successful completion of this activity. A contact hour is a unit of measurement that denotes 60 minutes of an organized learning activity. This is a learner-based activity. Villanova University College of Nursing does not require submission of your answers to the quiz. A contact hour certificate will be awarded once you register, pay the registration fee, and complete the evaluation form online at http://goo.gl/gMfXaf. To obtain contact hours you must: 1. Read the article, "Communication Between Acute Care Hospitals and Skilled Nursing Facilities During Care Transitions: A Retrospective Chart Review" found on pages 19-28, carefully noting any tables and other illustrative materials that are included to enhance your knowledge and understanding of the content. Be sure to keep track of the amount of time (number of minutes) you spend reading the article and completing the quiz. 2. Read and answer each question on the quiz. After completing all of the questions, compare your answers to those provided within this issue. If you have incorrect answers, return to the article for further study. 3. Go to the Villanova website listed above to register for contact hour credit. You will be asked to provide your name; contact information; and a VISA, MasterCard, or Discover card number for payment of the $20.00 fee. Once you complete the online evaluation, a certificate will be automatically generated. This activity is valid for continuing education credit until February 29, 2020. CONTACT HOURS This activity is co-provided by Villanova University College of Nursing and SLACK Incorporated. Villanova University College of Nursing is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center's Commission on Accreditation. ACTIVITY OBJECTIVES 1. Discuss problematic barriers during care transitions
Tinetti, Mary E; Charpentier, Peter; Gottschalk, Margaret; Baker, Dorothy I
To compare readmissions of Medicare recipients of usual home care and a matched group of recipients of a restorative model of home care. Quasiexperimental; matched and unmatched. Community, home care. Seven hundred seventy individuals receiving care from a large home care agency after hospitalization. A restorative care model based on principles adapted from geriatric medicine, nursing, rehabilitation, goal attainment, chronic care management, and behavioral change theory. Hospital readmission, length of home care episode. Among the matched pairs, 13.2% of participants who received restorative care were readmitted to an acute hospital during the episode of home care, versus 17.6% of those who received usual care. Individuals receiving the restorative model of home care were 32% less likely to be readmitted than those receiving usual care (conditional odds ratio = 0.68, 95% confidence interval = 0.43-1.08). The mean length of home care episodes was 20.3 ± 14.8 days in the restorative care group and 29.1 ± 31.7 days in the usual care group (P < .001). Results were similar in unmatched analyses. Although statistical significance was marginal, results suggest that the restorative care model offers an effective approach to reducing the occurrence of avoidable readmissions. It was previously shown that the restorative model of home care was associated with better functional recovery, fewer emergency department visits, and shorter episodes of home care. This model could be incorporated into usual home care practices and care delivery redesign. © 2012, Copyright the Authors Journal compilation © 2012, The American Geriatrics Society.
Forster Della A
Full Text Available Abstract Background Concerns have been raised in Australia and internationally regarding the quality and effectiveness of hospital postnatal care, although Australian women receiving postnatal care in the private maternity sector rate their satisfaction with care more highly than women receiving public maternity care. In Victoria, Australia, two-thirds of women receive their maternity care in the public sector and the remainder in private health care sector. A statewide review of public hospital postnatal care in Victoria from the perspective of care providers found many barriers to care provision including the busyness of postnatal wards, inadequate staffing and priority being given to other episodes of care; however the study did not include private hospitals. The aim of this study was replicate the review in the private sector, to explore the structure and organisation of postnatal care in private hospitals and identify those aspects of care potentially impacting on women's experiences and maternal and infant care. This provides a more complete overview of the organisational structures and processes in postnatal care in all Victorian hospitals from the perspective of care providers. Methods A mixed method design was used. A structured postal survey was sent to all Victorian private hospitals (n = 19 and key informant interviews were undertaken with selected clinical midwives, maternity unit managers and obstetricians (n = 11. Survey data were analysed using descriptive statistics and interview data analysed thematically. Results Private hospital care providers report that postnatal care is provided in very busy environments, and that meeting the aims of postnatal care (breastfeeding support, education of parents and facilitating rest and recovery for women following birth was difficult in the context of increased acuity of postnatal care; prioritising of other areas over postnatal care; high midwife-to-woman ratios; and the number and
Jha, Ashish K; DesRoches, Catherine M; Shields, Alexandra E; Miralles, Paola D; Zheng, Jie; Rosenbaum, Sara; Campbell, Eric G
Some hospitals that disproportionately care for poor patients are falling behind in adopting electronic health records (EHRs). Data from a national survey indicate early evidence of an emerging digital divide: U.S. hospitals that provide care to large numbers of poor patients also had minimal use of EHRs. These same hospitals lagged others in quality performance as well, but those with EHR systems seemed to have eliminated the quality gap. These findings suggest that adopting EHRs should be a major policy goal of health reform measures targeting hospitals that serve large populations of poor patients.
Walker, Anne F
Accessibility of hospital emergency services has been an issue of increasing concern and was recently brought into public focus in Ontario by the tragic death of Joshua Fleuelling, whose ambulance was redirected from the nearest hospital. As will be reviewed, the limited case law has identified a legal duty for physicians and hospitals to provide treatment to people in need of emergency care, a duty that should be considered when formulating hospital policies. The impact of this duty of care on the existing standard of medical practice will be considered.
Patients visit multiple healthcare providers, obtain medications from multiple pharmacies and transition between settings, all of which can lead to inaccurate medication information and thus medication errors. To improve continuity of care, transitional pharmaceutical care programs are needed. These
Japan is far behind Western nations in emergency care, such as the United States where paramedics are placed under the M-ICU system and France in which the SAMU system is in force. This paper is an attempt to introduce developments in the delivery of emergency care in the Japanese rural setting and the present state of emergency care delivered at our hospitals, while checking them against national policy.
...) The hospital must not seek payment for posthospital SNF care after the end of the 5 day period... provides for payment for posthospital SNF care furnished by rural hospitals and CAHs having a swing-bed... SNF care furnished in general routine inpatient beds in rural hospitals and CAHs is paid in...
Alhadidi, Majdi M B; Abdalrahim, Maysoon S; Al-Hussami, Mahmoud
Nurses working in psychiatric hospitals need to acquire the skills of therapeutic communication and empathy, and have higher levels of caring. The present study aims to investigate the level of caring and empathy among nurses working in psychiatric hospitals. A cross-sectional survey was utilized to collect data from 205 nurses recruited from three psychiatric hospitals in Jordan. The Background Information Questionnaire, Modified Caring Dimensions Inventory, and Toronto Empathy Questionnaire were administered to the recruited participants. The findings revealed that the sampled nurses had a high level of caring and empathy. Significant correlations were found between caring and having a specialized training in mental health nursing, and having organizational and managerial support. However, no significant correlations were found between empathy and participants' characteristics. Specialized training in mental health nursing, having organizational and managerial support, and empathy were found predictors for caring. © 2016 Australian College of Mental Health Nurses Inc.
Fugate, D L; Decker, P J
Health care has entered an era of rapid change. Most observers agree that important long-term changes will fundamentally reshape health care as we know it. To that end, health care providers should consider the benefits of operating vertically integrated marketing system with hospitals as the channel leader. Whether an administered VMS (hospitals have the power to gain compliance) or a corporate VMS (hospitals own successive levels of care providers), integrated channel management holds the promise of cost containment and quality patient care for the future. However, a great deal of integrating work must be done before VMSs will become a practical solution. Research studies are needed on each of the issues just discussed. As marketers, it is time we make a transition from treating health care marketing as a disjointed entity and instead treat it as an industry where all marketing principles are considered including channel management.
Smith, Pamela C
The study examines whether the level of charity care and financial stability contribute to a nonprofit hospital's motivation for partnering with a for-profit hospital through a joint venture. The Internal Revenue Service (IRS) has heightened its scrutiny of joint ventures within the health care sector. Considering recent calls to investigate the merit of the tax-exempt status of hospitals engaged in joint ventures, this research will assist policy makers in the evaluation of nonprofit hospitals. Constituents will continue to question whether joint ventures contribute to a reduced focus on charitable activities. Results indicate that the propensity to engage in a joint venture significantly increases with increased levels of charity care. Furthermore, nonprofit hospitals with lower profitability are more likely to engage in joint ventures. These results are useful to policy makers when evaluating the level of charity care provided by hospitals seeking alternative strategic alliances. Considering many critics allege hospitals are reducing the provision of charity care to the community, it is imperative for management to be conscious of the impact of joint ventures on the provision of charity care.
Hilderjane Carla da Silva
Full Text Available Objective: to identify the prevalence of trauma in elderly people and how they accessed the health system through pre-hospital care. Method: documentary and retrospective study at a mobile emergency care service, using a sample of 400 elderly trauma victims selected through systematic random sampling. A form validated by experts was used to collect the data. Descriptive statistical analysis was applied. The chi-square test was used to analyze the association between the variables. Results: Trauma was predominant among women (52.25% and in the age range between 60 and 69 years (38.25%, average age 74.19 years (standard deviation±10.25. Among the mechanisms, falls (56.75% and traffic accidents (31.25% stood out, showing a significant relation with the pre-hospital care services (p<0.001. Circulation, airway opening, cervical control and immobilization actions were the most frequent and Basic Life Support Services (87.8% were the most used, with trauma referral hospitals as the main destination (56.7%. Conclusion: trauma prevailed among women, victims of falls, who received pre-hospital care through basic life support services and actions and were transported to the trauma referral hospital. It is important to reorganize pre-hospital care, avoiding overcrowded hospitals and delivering better care to elderly trauma victims.
Sakihama, Tomoko; Honda, Hitoshi; Saint, Sanjay; Fowler, Karen E; Shimizu, Taro; Kamiya, Toru; Sato, Yumiko; Arakawa, Soichi; Lee, Jong Ja; Iwata, Kentaro; Mihashi, Mutsuko; Tokuda, Yasuharu
Although proper hand hygiene among health care workers is an important component of efforts to prevent health care-associated infection, there are few data available on adherence to hand hygiene practices in Japan. The aim of this study was to examine hand hygiene adherence at teaching hospitals in Japan. An observational study was conducted from July to November 2011 in 4 units (internal medicine, surgery, intensive care, and/or emergency department) in 4 geographically diverse hospitals (1 university hospital and 3 community teaching hospitals) in Japan. Hand hygiene practice before patient contact was assessed by an external observer. In a total of 3545 health care worker-patient observations, appropriate hand hygiene practice was performed in 677 (overall adherence, 19%; 95% confidence interval, 18%-20%). Subgroup rates of hand hygiene adherence were 15% among physicians and 23% among nurses. The ranges of adherence were 11% to 25% between hospitals and 11% to 31% between units. Adherence of the nurses and the physicians to hand hygiene was correlated within each hospital. There was a trend toward higher hand hygiene adherence in hospitals with infection control nurses, compared with hospitals without them (29% versus 16%). The hand hygiene adherence in Japanese teaching hospitals in our sample was low, even lower than reported mean values from other international studies. Greater adherence to hand hygiene should be encouraged in Japan.
Chapman, Rose; Rahman, Asheq; Courtney, Mary; Chalmers, Cheyne
Investigate effects of teamwork on missed nursing care across a healthcare network in Australia. Missed care is universally used as an indicator of quality nursing care, however, little is known about mitigating effects of teamwork on these events. A descriptive exploratory study. Missed Care and Team Work surveys were completed by 334 nurses. Using Stata software, nursing staff demographic information and components of missed care and teamwork were compared across the healthcare network. Statistical tests were performed to identify predicting factors for missed care. The most commonly reported components of missed care were as follows: ambulation three times per day (43·3%), turning patient every two hours (29%) and mouth care (27·7%). The commonest reasons mentioned for missed care were as follows: inadequate labour resources (range 69·8-52·7%), followed by material resources (range 59·3-33·3%) and communication (range 39·3-27·2%). There were significant differences in missed care scores across units. Using the mean scores in regression correlation matrix, the negative relationship of missed care and teamwork was supported (r = -0·34, p teamwork alone accounted for about 9% of missed nursing care. Similar to previous international research findings, our results showed nursing teamwork significantly impacted on missed nursing care. Teamwork may be a mitigating factor to address missed care and future research is needed. These results may provide administrators, educators and clinicians with information to develop practices and policies to improve patient care internationally. © 2016 John Wiley & Sons Ltd.
Aleksic Dejan; Bukonjic Andriana; Stefanovic Srdjan
The aim of this study was to determine the amount of non-opioid analgesics consumed at the surgical departments of a secondary care hospital in Serbia, a developing country undergoing a socioeconomic transition that thus lacks sufficient funds to finance and invest in the healthcare system.
Full Text Available The aim of this study was to determine the amount of non-opioid analgesics consumed at the surgical departments of a secondary care hospital in Serbia, a developing country undergoing a socioeconomic transition that thus lacks sufficient funds to finance and invest in the healthcare system.
Kook, Janet L; Chao, Stephanie R; Le, Jennifer; Robinson, Philip A
A retrospective, quasi-experimental cohort study compared antibiotic use before and after implementation of a procalcitonin assay at a community acute care hospital. This study demonstrated that the implementation of the procalcitonin assay was associated with a decrease in antibiotic days of therapy in adult patients with pneumonia.
Bana, Shazia; Yakoob, Javed; Jivany, Nourin; Faisal, Asima; Jawed, Humeira; Awan, Safia
Health seeking behaviour refers to the behaviour of people towards seeking their own health through provided health services. The medical professionals are at a higher risk of avoiding health seeking behaviour because they believe they are aware of the diseases and their symptoms as well as the pharmaceutical management of the disease. The aim of this study was to understand the healthcare seeking behaviour of nurses and doctors as well as the factors affecting it in hospitals of a major city in a developing country. A cross-sectional study was designed and a self-report questionnaire was distributed to healthcare workers at four tertiary care hospitals from July, 2012 to December, 2014. A total of 1015 participants responded. There were 234 (23%) doctors, 664 (65%) nurses, 60 (6%) pharmacist and 57 (6%) paramedical staff. The doctors 194 (83%) had a greater access to medical facilities compared to nurses 278 (42%) (phealth compared to doctors 102 (44%) (phealth check-ups compared to doctor 234 (100%) (pseek healthcare when they get sick. Self-medication is common in both groups.
Syed Masuma Rizvi
Full Text Available Background: Obstructed labour is still a major cause of maternal morbidity and mortality and adverse outcome of newborn in low income countries. It is the leading cause of hospitalization, comprising of 39% of all obstetric patients in developing countries. Objectives: To study frequency, causes outcome and complications of obstructed labour. Methods: 402 patients admitted with feature of obstructed labour were studied. Detailed history included sociodemographic factors, obstetric history, features of obstruction, intrapartum events were recorded. Condition of patients, mode of delivery, preoperative and postoperative complications, maternal and fetal outcomes was recorded. Results: A total of 23381 deliveries were conducted during one year, 402 cases of obstructed labour were found with incidence of 1.71%. 86.5 % of the patients were from rural areas and 78.1 % of patients were unbooked and73.3% patients were primigravida. The commonest cause of obstructed labour was cephalopelvic disproportion (55% followed by Malposition (22.9% and Malpresentation (17.9%. The commonest mode of delivery was cesarean section (83.8%. Instrumental deliveries were conducted in 10.5% of cases. Destructive procedures are discouraged in out set up. Rupture uterus was seen in 16 cases (4.16% out of which repair was done in 11 cases and subtotal hysterectomy was performed in 5 patients. The common maternal complications were sepsis [pyrexia (15.1%, wound infections (12.8%, urinary tract infection (7%, abdominal distention (11.2%, postpartum hemorrhage (9.7%. Perinatal mortality was 107/402 (26.6%, live birth rate 316/402 (78.7%, still birth rate 86/402 (21.3%. Perinatal morbidity was most commonly due to birth asphyxia (28.8%, jaundice (16.9%, septicemia (14.75%, meconium aspiration syndrome (9.9%. Conclusions: Obstructed labour is a preventable condition prevalent in developing countries. Improving nutrition, antenatal care, early diagnosis and timely intervention may
Leistner, K; Stier-Jarmer, M; Berleth, B; Braun, J; Koenig, E; Liman, W; Lüttje, D; Meindl, R; Pientka, L; Weber, G; Stucki, G
As a result of the continuing development in recent medicine, and improvements of emergency services, an increasing number of patients are surviving serious disease and injury. This has increased the need for rehabilitation, starting already during the acute hospital stay. Early identification and rehabilitation may reduce overall costs and help patients to regain independence earlier. Since the eighties specialized early post-acute rehabilitation units have been increasingly implemented in German hospitals. With book 9 of the German Social Code (SGB IX) coming into effect in July 2001, early post-acute rehabilitation care in hospitals became accepted as a social right. However, the specifics of early rehabilitation care have not been defined. There is a lack of generally accepted indication criteria for early rehabilitation services. Similarly, the aims, objectives and methods need to be specified. It was the objective of a group of interested experts from different fields and backgrounds to achieve an interdisciplinary consensus in terms of conceptual definitions and terminology for all early rehabilitation care services in the acute hospital. The development of the definitions and criteria was achieved by using a modified Delphi-technique. By publishing this paper the group is providing information about its activities and results. Examples of typical cases from the various fields of early rehabilitation care were identified and described. Furthermore, the report points out a number of other problems in the area of early rehabilitation care, which have yet to be solved.
Punchik, Boris; Komarov, Roman; Gavrikov, Dmitry; Semenov, Anna; Freud, Tamar; Kagan, Ella; Goldberg, Yury
Background Congestive heart failure (CHF), a common problem in adults, is associated with multiple hospitalizations, high mortality rates and high costs. Purpose To evaluate whether home care for homebound patients with CHF reduces healthcare service utilization and overall costs. Methods A retrospective study of healthcare utilization among homebound patients who received home care for CHF from 2012–1015. The outcome measures were number of hospital admissions per month, total number of hospitalization days and days for CHF only, emergency room visits, and overall costs. A comparison was conducted between the 6-month period prior to entry into home care and the time in home care. Results Over the study period 196 patients were treated by home care for CHF with a mean age of 79.4±9.5 years. 113 (57.7%) were women. Compared to the six months prior to home care, there were statistically significant decreases in hospitalizations (46.3%), in the number of total in-hospital days (28.7%), in the number of in-hospital days for CHF (66.7%), in emergency room visits (47%), and in overall costs (23.9%). Conclusion Home care for homebound adults with CHF can reduce healthcare utilization and healthcare costs. PMID:28753675
Roberto NardI; Vincenzo Arienti; Carlo Nozzoli; Antonino Mazzone
IntroductionThe extreme variability of clinical severity in medical admitted patients is diluted in a “average” standard of care, that may be stronger than the real needs for someone, but clearly inadequate, sometimes even dangerous, for other ones, critically ill.DiscussionThe model of a differentiated intensity of hospital care can be defined as the organizational model structured to areas/sectors dedicated to patients with homogeneous needs of care. The intermediate care unit (“High depend...
The National Clinical Programme for Paediatrics and Neonatology is proposing a model of care that will determine the future delivery of children’s health services in Ireland1. The focus is on the provision of an integrated service with improved co-ordination between primary, secondary, and tertiary level facilities. A parallel goal is improvements in chronic care and medical care in the home. An expanded role for ambulatory care and hospital at home schemes with a reduced reliance on inpatient care is proposed in line with international best practice. Achieving these goals requires a paradigm shift in delivery of children’s health care, and reconfiguration of current services to deliver multidisciplinary care in hospital and at home. The recently approved planning application for the new children’s hospital provides an opportunity and heralds a change in the structure of paediatric services in Ireland. It will act as the nexus of paediatric care throughout Ireland; supporting paediatric services nationally through outreach programmes, and ensuring children are treated as close to home as possible. A Hospital-in-the-Home (HITH) program would help meet these objectives; and could provide home based acute paediatric care, leading to economic benefits, and the delivery of quality family-centred care.
Doyle, Joseph; Graves, John; Gruber, Jonathan
Medicare spending exceeds 4% of GDP in the US each year, and there are concerns that moral hazard problems have led to overspending. This paper considers whether hospitals that treat patients more aggressively and receive higher payments from Medicare improve health outcomes for their patients. An innovation is a new lens to compare hospital performance for emergency patients: plausibly exogenous variation in ambulance-company assignment among patients who live near one another. Using Medicare data from 2002–2010, we show that ambulance company assignment importantly affects hospital choice for patients in the same ZIP code. Using data for New York State from 2000–2006 that matches exact patient addresses to hospital discharge records, we show that patients who live very near each other but on either side of ambulance service area boundaries go to different types of hospitals. Both identification strategies show that higher-cost hospitals achieve better patient outcomes for a variety of emergency conditions. Using our Medicare sample, the estimates imply that a one standard deviation increase in Medicare reimbursement leads to a 4 percentage point reduction in mortality (10% compared to the mean). Taking into account one-year spending after the health shock, the implied cost per at least one year of life saved is approximately $80,000. These results are found across different types of hospitals and patients, as well across both identification strategies. PMID:25750459
We assessed the effect of medical staff role models and the number of health-care worker sinks on hand-hygiene compliance before and after construction of a new hospital designed for increased access to handwashing sinks. We observed health-care worker hand hygiene in four nursing units that provided similar patient care in both the old and new hospitals: medical and surgical intensive care, hematology/oncology, and solid organ transplant units. Of 721 hand-hygiene opportunities, 304 (42%) we...
Parsons, R J; Woller, G M; Neubauer, G; Rothaemel, F T; Zelle, B
Microcomparison, or single-component analysis, of health care systems offers a potentially better basis for reform than traditional macrocomparison analysis of aggregate elements. Using macroanalysis, available evidence shows that Germany provides cheaper but more effective hospital care than the United States. To find the causes for this outcome, we developed a microanalytic model of hospital administrators' perceptions, financial ratios, medical outcomes, and pharmaceutical costs. However, only data on pharmaceutical costs were available, and these were similar in both countries. Our significant outcome was development of a microcomparative model that gives world medical care providers new criteria for analyzing and improving cost to care ratios.
Schmier, Jordana K; Hulme-Lowe, Carolyn K; Semenova, Svetlana; Klenk, Juergen A; DeLeo, Paul C; Sedlak, Richard; Carlson, Pete A
Health care-associated infections (HAIs) pose a significant health care and cost burden. This study estimates annual HAI hospital costs in the US avoided through use of health care antiseptics (health care personnel hand washes and rubs; surgical hand scrubs and rubs; patient preoperative and preinjection skin preparations). A spreadsheet model was developed with base case inputs derived from the published literature, supplemented with assumptions when data were insufficient. Five HAIs of interest were identified: catheter-associated urinary tract infections, central line-associated bloodstream infections, gastrointestinal infections caused by Clostridium difficile, hospital- or ventilator-associated pneumonia, and surgical site infections. A national estimate of the annual potential lost benefits from elimination of these products is calculated based on the number of HAIs, the proportion of HAIs that are preventable, the proportion of preventable HAIs associated with health care antiseptics, and HAI hospital costs. The model is designed to be user friendly and to allow assumptions about prevention across all infections to vary or stay the same. Sensitivity analyses provide low- and high-end estimates of costs avoided. Low- and high-end estimates of national, annual HAIs in hospitals avoided through use of health care antiseptics are 12,100 and 223,000, respectively, with associated hospital costs avoided of US$142 million and US$4.25 billion, respectively. The model presents a novel approach to estimating the economic impact of health care antiseptic use for HAI avoidance, with the ability to vary model parameters to reflect specific scenarios. While not all HAIs are avoidable, removing or limiting access to an effective preventive tool would have a substantial impact on patient well-being and infection costs. HAI avoidance through use of health care antiseptics has a demonstrable and substantial impact on health care expenditures; the costs here are exclusive of
Kleweno, Conor P; OʼToole, Robert V; Ballreich, Jeromie; Pollak, Andrew N
To determine the relative profitability for a hospital of treatment of common fractures within a state-regulated reimbursement system. Retrospective cohort. Regional trauma referral center with state-regulated hospital reimbursement system. We reviewed hospital medical and financial records of 1228 patients admitted from 2008 through 2012 with a principle diagnosis of acute traumatic fracture requiring surgical treatment. Patients whose principle diagnosis fit into 1 of 6 common anatomic categories were included. Sixty-five pelvic, 275 acetabular, 277 hip, 255 femoral shaft, 148 tibial shaft, and 208 ankle fractures were identified. Patients with a different principle diagnosis were excluded. Net revenue, total cost of inpatient care, and direct margin for each patient's acute inpatient hospital course were recorded. Direct margins, costs. Per patient, the overall mean net revenue was $39,813, overall mean cost of inpatient care was $21,231, and overall mean direct margin (profitability) was $18,582. Mean direct variable expense was $14,898 per patient, and mean direct fixed expense was $6333 per patient. Factors most influencing cost included length of stay, supplies, and operating room use. Of 1228 patients, 46 (3.7%) had a negative direct margin (net loss to hospital). The most profitable diagnosis was pelvic fracture (mean direct margin, $21,767). The state-regulated reimbursement system allows analysis of hospital profitability in the context of a normalized revenue stream that should approximate the overall fiscal realities of other states. Providing orthopaedic trauma care can be economically feasible and profitable for a hospital. Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Full Text Available Background: Diabetic foot syndrome is one of the most common and devastating preventable complications of diabetes resulting in major economic consequences for the patients, their families, and the society. Aims & Objectives: The present study was carried out to assess knowledge, attitude and practices of Diabetic Foot Wound Care among the patients suffering from Diabetic Foot and to correlate them with the socio-demographic parameters. Material & Methods: It was a Hospital based cross-sectional study involving clinically diagnosed adult (>18 years patients of Diabetic Foot visiting the Surgery and Medicine OPDs at Teerthankar Mahaveer Medical College & Research Centre, Moradabad, India. Results: Significant association KAP (Knowledge, Attitude and Practices score was seen with age of the patient, education, addiction, family history of Diabetes Mellitus, prior receipt of information regarding Diabetic foot-care practices, compliance towards the treatment and the type of foot wear used. Conclusions: The results highlight areas especially Health education, use of safe footwear and life style adjustments, where efforts to improve knowledge and practice may contribute to the prevention of development of Foot ulcers and amputation.
Full Text Available Aim: Advanced cancer, irrespective of the site of the cancer, is characterized by a number of associated symptoms that impair the quality of life of patients. The management of these symptoms guides palliative care. The present study aims to describe the symptoms and appropriate palliation provided in patients with advanced cancer in a tertiary care hospital in Uttarakhand. Methods: This was an observational study. A total of 100 patients with advanced cancer were included in the study. The data obtained from the patients included symptoms reported by the patients, currently prescribed treatments and the site of cancer. Results: The average number of symptoms reported per patient was 5.33 ± 0.67 (mean ± SE. The most common symptoms were pain, weakness/fatigue, anorexia, insomnia, nausea/vomiting, dyspnea, constipation and cough. Polypharmacy was frequent. Patients consumed approximately 8.7 ± 0.38 (mean ± SE drugs on average during the 2-month period of follow-up. Conclusion: The result gives insight into the varied symptomatology of patients with advanced cancer. Polypharmacy was quite common in patients with advanced cancer, predisposing them to complicated drug interactions and adverse drug reactions.
U.S. Department of Health & Human Services — The Prospective Payment System (PPS)-Exempt Cancer Hospital Quality Reporting (PCHQR) Program currently uses five oncology care measures. The resulting PPS-Exempt...
Full Text Available BACKGROUND: Although documentation of children’s pain by health care professionals is frequently undertaken, few studies have explored the nature of the language used to describe pain in the medical records of hospitalized children.
Dudevich, Alexey; Chen, Allie; Gula, Cheryl; Fagbemi, Josh
Cancer is the leading cause of death in Canada, and the number of new cases is expected to increase as the population ages and grows. This study examined the use of hospital services in the last month of life by adult cancer patients who died in Canadian acute care hospitals in fiscal year 2012-2013. Almost 25,000 Canadian cancer patients - excluding those in Quebec - died in acute care hospitals, representing approximately 45% of the estimated cancer deaths in 2012-2013. The proportion of in-hospital deaths varied across jurisdictions. Twenty-three percent of these patients were admitted to acute care multiple times in their last 28 days of life, with a higher percentage for rural (29%) compared to urban (21%) patients. Relatively few patients used intensive care units or received inpatient chemotherapy in their last 14 days of life.
Ben Oumlil, A; Rao, C P
Health care service markets in general and hospital care service markets in particular are characterized by many competitive developments. Hence, hospital marketing managers are forced to respond to these emerging competitive pressures. However, in formulating appropriate marketing management strategies, hospital managers need to have detailed knowledge about consumers and their behaviors in the marketplace. This paper focuses on the Nutrition Care division of the Department of Nutrition Service at a hospital and its venture into new service development. This case study is intended to emphasize the significance of acquiring adequate knowledge of customers in the health care services industry. It particularly emphasizes the critical role that this type of information concerning customer behavior plays in the development and implementation of an appropriate business expansion strategy. Furthermore, the aim of this case study is to help the reader to relate the acquired marketing information to the problem at hand, and make the appropriate marketing management decision.
Original Research: The pattern of sharps injury to health care workers at Witbank Hospital. 148. Vol 51 No 2. SA Fam Pract 2009. Abstract. Background: The aim of this study was to identify procedures, areas of activity, .... General sugery.
Tilden, Ellen L; Emeis, Cathy L; Caughey, Aaron B; Weinstein, Sarah R; Futernick, Sarah B; Lee, Christopher S
Group prenatal care, an alternate model of prenatal care delivery, has been associated with various improved perinatal outcomes in comparison to standard, individual prenatal care. One important maternity care process measure that has not been explored among women who receive group prenatal care versus standard prenatal care is the phase of labor (latent vs active) at hospital admission. A retrospective case-control study was conducted comparing 150 women who selected group prenatal care with certified nurse-midwives (CNMs) versus 225 women who chose standard prenatal care with CNMs. Analyses performed included descriptive statistics to compare groups and multivariate regression to evaluate the contribution of key covariates potentially influencing outcomes. Propensity scores were calculated and included in regression models. Women within this sample who received group prenatal care were more likely to be in active labor (≥ 4 cm of cervical dilatation) at hospital admission (odds ratio [OR], 1.73; 95% confidence interval [CI], 1.03-2.99; P = .049) and were admitted to the hospital with significantly greater cervical dilatation (mean [standard deviation, SD] 5.7 [2.5] cm vs. 5.1 [2.3] cm, P = .005) compared with women who received standard prenatal care, controlling for potential confounding variables and propensity for group versus individual care selection. Group prenatal care may be an effective and safe intervention for decreasing latent labor hospital admission among low-risk women. Neither group prenatal care nor active labor hospital admission was associated with increased morbidity. © 2016 by the American College of Nurse-Midwives.
Full Text Available Background Pandemic influenza A (H1N1 virus emerged and spread globally in the spring of 2009. We describe the clinical features of the patients who were hospitalized with 2009 H1N1 influenza July 2009 to June 2010 in a tertiary care hospital in Khamis Mushyt, Saudi Arabia. We analyzed the clinical and laboratory variables in order to determine predictors of poor outcome Methods We performed a prospective study in all patients who were hospitalized for at least 48 hours and with a positive test for 2009 H1N1 virus through RT-PCR(real time polymerase chain reaction. Their epidemiological, clinical, biochemical characteristics were collected and the hospital course of the patients with eventual outcome (discharge or death was observed. We applied a logistic regression analysis to determine the best predictor of death.
Kristensen, Troels; Rose Olsen, Kim
, socioeconomic covariates, municipality classifications and case mix measure in terms of the charlson index and costs of care in primary care and secondary care. Results: There was a significant link between POCT of HbA1c among diabetes patients in general practice and an ACSC-measure of preventable out......Background: Point-of-care testing (POCT) of HbA1c may result in improved diabetic control, better patient outcomes and enhanced clinical efficiency with fewer patient visits and subsequent reductions in hospitalizations and costs. In 2008, the Danish regulators agreed to create a new tariff...... for the remuneration of POCT of HbA1c in primary care. Aim: The aim of this study is to assess whether there is an association between the use of POCT of HbA1c and preventable hospital admissions among diabetes patients in general practice. Method: We apply logistic regression analyses to examine whether...
U.S. Department of Health & Human Services — The Medicare Provider Analysis and Review (MEDPAR) file contains records for 100 percent of Medicare beneficiaries who received hospital inpatient services at a LTCH...
Results: In all the hospitals surveyed, staff raised a number of ... problem cited by most of the staff and lastly but not the least the lack of ... retention of trainees with adequate incentives .... human subject's physical participation and no monetary.
U.S. Department of Health & Human Services — The Medicare Provider Analysis and Review (MEDPAR) file contains records for 100 percent of Medicare beneficiaries who received hospital inpatient services at a LTCH...
Rocha, Thiago Augusto Hernandes; da Silva, Núbia Cristina; Amaral, Pedro Vasconcelos; Barbosa, Allan Claudius Queiroz; Rocha, João Victor Muniz; Alvares, Viviane; de Almeida, Dante Grapiuna; Thumé, Elaine; Thomaz, Erika Bárbara Abreu Fonseca; de Sousa Queiroz, Rejane Christine; de Souza, Marta Rovery; Lein, Adriana; Lopes, Daniel Paulino; Staton, Catherine A; Vissoci, João Ricardo Nickenig; Facchini, Luiz Augusto
Unequal distribution of emergency care services is a critical barrier to be overcome to assure access to emergency and surgical care. Considering this context it was objective of the present work analyze geographic access barriers to emergency care services in Brazil. A secondary aim of the study is to define possible roles to be assumed by small hospitals in the Brazilian healthcare network to overcome geographic access challenges. The present work can be classified as a cross-sectional ecological study. To carry out the present study, data of all 5843 Brazilian hospitals were categorized among high complexity centers and small hospitals. The geographical access barriers were identified through the use of two-step floating catchment area method. Once concluded the previous step an evaluation using the Getis-Ord-Gi method was performed to identify spatial clusters of municipalities with limited access to high complexity centers but well covered by well-equipped small hospitals. The analysis of accessibility index of high complexity centers highlighted large portions of the country with nearly zero hospital beds by inhabitant. In contrast, it was possible observe a group of 1595 municipalities with high accessibility to small hospitals, simultaneously with a low coverage of high complexity centers. Among the 1595 municipalities with good accessibility to small hospitals, 74% (1183) were covered by small hospitals with at least 60% of minimum emergency service requirements. The spatial clusters analysis aggregated 589 municipalities with high values related to minimum emergency service requirements. Small hospitals in these 589 cities could promote the equity in access to emergency services benefiting more than eight million people. There is a spatial disequilibrium within the country with prominent gaps in the health care network for emergency services. Taking this challenge into consideration, small hospitals could be a possible solution and foster equity in access
Scott, I; Youlden, D; Coory, M
Background: Hospital performance reports based on administrative data should distinguish differences in quality of care between hospitals from case mix related variation and random error effects. A study was undertaken to determine which of 12 diagnosis-outcome indicators measured across all hospitals in one state had significant risk adjusted systematic (or special cause) variation (SV) suggesting differences in quality of care. For those that did, we determined whether SV persists within hospital peer groups, whether indicator results correlate at the individual hospital level, and how many adverse outcomes would be avoided if all hospitals achieved indicator values equal to the best performing 20% of hospitals. Methods: All patients admitted during a 12 month period to 180 acute care hospitals in Queensland, Australia with heart failure (n = 5745), acute myocardial infarction (AMI) (n = 3427), or stroke (n = 2955) were entered into the study. Outcomes comprised in-hospital deaths, long hospital stays, and 30 day readmissions. Regression models produced standardised, risk adjusted diagnosis specific outcome event ratios for each hospital. Systematic and random variation in ratio distributions for each indicator were then apportioned using hierarchical statistical models. Results: Only five of 12 (42%) diagnosis-outcome indicators showed significant SV across all hospitals (long stays and same diagnosis readmissions for heart failure; in-hospital deaths and same diagnosis readmissions for AMI; and in-hospital deaths for stroke). Significant SV was only seen for two indicators within hospital peer groups (same diagnosis readmissions for heart failure in tertiary hospitals and inhospital mortality for AMI in community hospitals). Only two pairs of indicators showed significant correlation. If all hospitals emulated the best performers, at least 20% of AMI and stroke deaths, heart failure long stays, and heart failure and AMI readmissions could be avoided
Background: Stillbirth is an indicator of maternal health and maternal health care services. Developing countries have high stillbirth rate. Documentation and evaluation of the risk factors for stillbirth is required for management of the risk factors and to devise plan in maternal health sector. Methods: It was a hospital based retrospective study carried out in a tertiary care hospital. Inclusion criteria were a case of fetal death with gestational age and #8805;20 weeks or fetal weight...
Chun-Chuan Shih; Hsun-Hua Lee; Ta-Liang Chen; Chin-Chuan Tsai; Hsin-Long Lane; Wen-Ta Chiu; Chien-Chang Liao
Background. Little research exists on acupuncture treatment's effect on patients with traumatic brain injury (TBI). Methods. Using Taiwan's National Health Insurance Research Database, we conducted a cohort study to compare the use of emergency care and hospitalization in TBI patients with and without acupuncture treatment in the first year after TBI. The adjusted relative risks (RRs) and 95% confidence intervals (CIs) of high use of emergency care and hospitalization associated with acupunct...
Full Text Available Paul Y Takahashi,1 Lindsey R Haas,2 Stephanie M Quigg,1 Ivana T Croghan,1 James M Naessens,2 Nilay D Shah,2 Gregory J Hanson11Division of Primary Care Internal Medicine, Department of Medicine, 2Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USAPurpose: Patients leaving the hospital are at increased risk of functional decline and hospital readmission. The Employee and Community Health service at Mayo Clinic in Rochester developed a care transition program (CTP to provide home-based care services for medically complex patients. The study objective was to determine the relationship between CTP use, 30-day hospital readmission, and Emergency Room (ER visits for adults over 60 years with high Elder Risk Assessment scores.Patients and methods: This was a pilot prospective cohort study that included 20 patients that used the CTP and 20 patients discharged from the hospital without using the CTP. The medically complex study patients were drawn from the department of Employee and Community Health population between October 14, 2011 and September 27, 2012. The primary outcomes were 30-day hospital readmission or ER visit after discharge from the hospital. The secondary outcomes were within-group changes in grip strength, gait speed, and quality of life (QOL. Patients underwent two study visits, one at baseline and one at 30 days postbaseline. The primary analysis included time-to-event from baseline to rehospitalization or ER visit. Paired t-tests were used for secondary outcomes, with continuous scores.Results: Of the 40 patients enrolled, 36 completed all study visits. The 30-day hospital readmission rates for usual care patients were 10.5% compared with no readmissions for CTP patients. There were 31.6% ER visits in the UC group and 11.8% in the CTP group (P = 0.37. The secondary analysis showed some improvement in physical QOL scores (pre: 32.7; post: 39.4 for the CTP participants (P < 0.01 and no differences in gait speed or
Fica, Alberto; Weitzel, Thomas
Acute fascioliasis (FA), cystic echinococcosis (CE) and neurocysticercosis (NCC) are three endemic parasitic diseases in Chile for whom there is scarce information about the economic impact they represent during management at the hospital. To quantify and compare hospital care expenses caused by these three endemic helminth infections in a Chilean hospital. Retrospective analysis of hospital costs at a referral hospital in Santiago between 2006 and 2010. Hospital databases were used to identify patients with the corresponding infections, and those with sufficient data on hospital costs were included. A total of 16 patients representing 21 cases were identified and analyzed: four with AF, eleven with CE, and six with NCC. Median hospital expenses for cases with AF were US$ 1799 and mainly caused by bed-day costs. Median hospital costs for cases of CE were US$ 4707 and the most important costs components were medications, bed-day costs and consumables. NCC patients had median costs of US$ 1293, which were mainly due to bed-day costs. Non-parenchymatous or mixed forms of NCC showed a trend toward higher hospital costs compared with parenchymatous forms. Although helminth infections in Chile, an upper middle income country, are declining and considered rare in routine clinical practice, hospital care expenses caused by patients with AF, CE, and NCC are high and might still present an important economic burden to the Chilean healthcare system.
The responsibility of the state for ensuring the provision of hospital care services to its citizens derives from the welfare state principle laid down in Sect. 20 para. 1 GG (Grundgesetz, i.e., the German constitutional law). The state fulfils this responsibility by means of planning and funding regulations in the Hospital Funding Act (KHG), the Hospital Remuneration Act (KHEntG), the National Ordinance on Hospital Rates (BPflV), the Hospital Laws of the German federal states and other supplementary legislation. The funding of hospitals is based on a dual funding system, meaning that hospital investment costs generally need to be borne by the German federal states as required, while operating costs will have to be funded through the remuneration for hospital treatments. Because of the tight budget situation of the German federal states a considerable backlog of investment has built up. After a transition period (between 2005 and 2009) operating costs are now funded on the basis of the so-called DRG system (DRG=Diagnosis Related Groups)--irrespective of the actual costs incurred by each individual hospital, which has led to a commodification of hospital care services. Whether this commodification avoids bottlenecks in the provision of health services to hospital patients or creates additional bottlenecks, is a controversial issue.
Dijs-Elsinga, Joyce; Otten, Wilma; Versluijs, Martine M; Smeets, Harm J; Kievit, Job; Vree, Robbert; van der Made, Wendeline J; Marang-van de Mheen, Perla J
To assess whether patients use information on quality of care when choosing a hospital for surgery compared with more general hospital information. In this cross-sectional study in 3 Dutch hospitals, questionnaires were sent to 2122 patients who underwent 1 of 6 elective surgical procedures in 2005-2006 (aorta reconstruction [for treatment of aneurysm], cholecystectomy, colon resection, inguinal hernia repair, esophageal resection, thyroid surgery). Patients were asked which information they had used to choose this hospital and which information they intended to use if they would need similar surgical treatment in the future. In total, 1329 questionnaires were available for analysis (response rate 62.6%). Most patients indicated having used the hospital's good reputation (69.1%) and friendly hospital atmosphere (63.3%) to choose a hospital. For future choices, most patients intended to use the fact that they were already treated in that hospital (79.3%) and the hospital's good reputation (74.1%). Regarding quality-of-care information, patients preferred a summary measure (% patients with ''textbook outcome'') over separate more detailed measures (52.1% v. 38.0%, χ2 = 291, P value that they were already treated in that hospital or a hospital's good reputation even more.
del Saz Moreno, Vicente; Alberquilla Menéndez-Asenjo, Ángel; Camacho Hernández, Ana M; Lora Pablos, David; Enríquez de Salamanca Lorente, Rafael; Magán Tapia, Purificación
To determine if the process of care in primary health, affects the risk of avoidable hospitalizations for ambulatory care sensitive conditions (ACSH) for heart failure (HF). Case-control study analyzing the risk of hospitalization for HF. The exposure factor was the process of care for HF in primary health. Health area of the region of Madrid (n=466.901). There were included all adult patients (14 years or older) with a documented diagnosis of HF in the electronic medical record of primary health (n=3.277). The cases were patients who were hospitalized for HF while the controls did not require admission, during 2007. risk of ACSH for HF related to the process of care considered both overall and for each separate standard of appropiate care. Differences in clinical complexity of the groups were measured using the Adjusted Clinical Group (ACG) classification system. 227 cases and 3.050 controls. Clinical complexity was greater in cases. The standards of appropriate care were met to a greater degree in the control group, but none of the two groups met all the standards that would define a process of care as fully appropriate. A significantly lower risk of ACSH was seen for only two standards of appropriate care. For each additional standard of appropriate care not met, the probability of admission was significantly greater (OR: 1,33, 95% CI: 1,19-1,49). Higher quality in the process of care in primary health was associated with a lower risk of hospitalization for HF. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.
Fleiner, Tim; Dauth, Hannah; Gersie, Marleen; Zijlstra, Wiebren; Haussermann, Peter
BACKGROUND: The primary objective of this trial is to investigate the effects of a short-term exercise program on neuropsychiatric signs and symptoms in acute hospital dementia care. METHODS: Within a hospital-based randomized controlled trial, the intervention group conducted a 2-week exercise
Witbrodt, Jane; Bond, Jason; Kaskutas, Lee Ann; Weisner, Constance; Jaeger, Gary; Pating, David; Moore, Charles
Male and female managed care clients randomized to day hospital (n=154) or community residential treatment (n=139) were compared on substance use outcomes at 6 and 12 months. To address possible bias in naturalistic studies, outcomes were also examined for clients who self-selected day hospital (n=321) and for clients excluded from randomization…
In the last decades many different policy changes have been initiated in the Dutch hospital sector to optimise health care delivery: national agenda-setting, increased competition and transparency, a new system of hospital reimbursement based on diagnosis-treatment-combinations, intensified
Li, Hong; Morrow-Howell, Nancy; Proctor, Enola K.
After inpatient hospitalization, many elderly patients with congestive heart failure (CHF) are discharged home and receive post-acute home care from informal (family) caregivers and formal service providers. Hospital readmission rates are high among elderly patients with CHF, and it is thought that use of informal and formal services may reduce…
Ensing, Hendrik T; Koster, Ellen S; Stuijt, Clementine C M; van Dooren, Ad A; Bouvy, Marcel L
Bridging the gap between hospital and primary care is important as transition from one healthcare setting to another increases the risk on drug-related problems and consequent readmissions. To reduce those risks, pharmacist interventions during and after hospitalization have been frequently studied,
In the last decades many different policy changes have been initiated in the Dutch hospital sector to optimise health care delivery: national agenda-setting, increased competition and transparency, a new system of hospital reimbursement based on diagnosis-treatment-combinations, intensified monitori
Berthiaume, John T; Chung, Richard S; Ryskina, Kira L; Walsh, Jim; Legorreta, Antonio P
This article describes the structure, implementation, and early results of a performance-based hospital incentive program designed by a large nonprofit health plan. The Hospital Quality Service and Recognition program, developed by the Hawaii Medical Service Association, was launched in 2001 to reward high-quality medical care at the hospital level. This pay-for-performance program used administrative claims data, survey data, and hospital-reported information to assess hospital performance in risk-adjusted complications and risk-adjusted length of stay (LOS), patient satisfaction, and hospital processes of care measures. Financial incentives were provided to participating hospitals based on their performance on these measures. Preliminary outcomes of the program evaluated over a 4-year period after implementation revealed improvements in aggregated rates of risk-adjusted surgical complications and efficiency of care as evidenced by a substantial decrease in risk-adjusted average LOS for several surgical procedures. Quality improvement was demonstrated in several other program components including emergency department satisfaction. This quality incentive program offers an innovative approach for encouraging delivery of high-quality and service-oriented care in a statewide network of participating hospitals.
An, Jeff; Keshavjee, Karim; Mirza, Kashif; Vassanji, Karim; Greiver, Michelle
Healthcare costs are driven by a surprisingly small number of patients. Predicting who is likely to require care in the near future could help reduce costs by pre-empting use of expensive health care resources such as emergency departments and hospitals. We describe the design of an architecture for a joint hospital-primary care data warehouse (JDW) that can monitor the effectiveness of in-hospital interventions in reducing readmissions and predict which patients are most likely to be admitted to hospital in the near future. The design identifies the key governance elements, the architectural principles, the business case, the privacy architecture, future work flows, the IT infrastructure, the data analytics and the high level implementation plan for realization of the JDW. This architecture fills a gap in bridging data from two separate hospital and primary care organizations, not a single managed care entity with multiple locations. The JDW architecture design was well received by the stakeholders engaged and by senior leadership at the hospital and the primary care organization. Future plans include creating a demonstration system and conducting a pilot study.
Post bureaucracy is increasingly shaping how health care professionals work. Within hospital settings, post bureaucracy is frequently connected to loss of professional autonomy and protocol-based care. However, this development also affects relationships between care providers and care receivers. To explore experiences of post bureaucratic hospital reforms and their impact on care provision. Data builds on nine mini group interviews with midwives (n=three), nurses (n=three) and physiotherapists (n=three), in all thirty participants. Data was analysed using existing theories of professionalism and post bureaucracy. Two overarching themes were identified: 'Time, tasks and institutional duties' which referred to transformations in care practices, increased use of screening procedures, efficiency requirements and matching linear time to the psychosocial needs of patients. 'Managerial control of work' which described rising administrative demands, engaging in protective measures, younger professionals pressured by documentation obligations and fear of disciplinary procedures. The institutional context appears to play a key role shaping care practices. Although midwives, nurses and physiotherapists share similar experiences of post bureaucratic hospital reforms, changes in care provision can impact these professions in different ways. As a discipline, midwifery is founded on relationships between women and midwives. Standardised clinical care, performativity demands, litigation risks and rising administrative obligations are liable to challenge the provision of woman centred care. These changes may also result in increased inequity in maternity care by affecting some groups of women more than others. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
Krol, M.W.; Boer, D. de; Sixma, H.; Hoek, L. van der; Rademakers, J.J.D.J.M.; Delnoij, D.M.
Objective: To examine the added value of measuring and possibly presenting patient experiences at the department level, in addition to the hospital level, and to explore the possibility that patient experiences differ according to the ‘type’ of hospital department. Design: Secondary analysis of data
Coller, Ryan J; Nelson, Bergen B; Klitzner, Thomas S; Saenz, Adrianna A; Shekelle, Paul G; Lerner, Carlos F; Chung, Paul J
Interventions to reduce disproportionate hospital use among children with medical complexity (CMC) are needed. We conducted a rigorous, structured process to develop intervention strategies aiming to reduce hospitalizations within a complex care program population. A complex care medical home program used 1) semistructured interviews of caregivers of CMC experiencing acute, unscheduled hospitalizations and 2) literature review on preventing hospitalizations among CMC to develop key drivers for lowering hospital utilization and link them with intervention strategies. Using an adapted version of the RAND/UCLA Appropriateness Method, an expert panel rated each model for effectiveness at impacting each key driver and ultimately reducing hospitalizations. The complex care program applied these findings to select a final set of feasible intervention strategies for implementation. Intervention strategies focused on expanding access to familiar providers, enhancing general or technical caregiver knowledge and skill, creating specific and proactive crisis or contingency plans, and improving transitions between hospital and home. Activities aimed to facilitate family-centered, flexible implementation and consideration of all of the child's environments, including school and while traveling. Tailored activities and special attention to the highest utilizing subset of CMC were also critical for these interventions. A set of intervention strategies to reduce hospitalizations among CMC, informed by key drivers, can be created through a structured, reproducible process. Both this process and the results may be relevant to clinical programs and researchers aiming to reduce hospital utilization through the medical home for CMC. Copyright © 2017 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
Junqueira, Rozania Maria Pereira; Duarte, Elisabeth Carmen
To analyze hospitalization rates due to ambulatory care-sensitive conditions. The study used data from the Hospital Database of the Brazilian National Health System corresponding to the Federal District in the year of 2008. The main diagnosis for hospitalization was analyzed based on the International Classification of Diseases, and absolute frequency, proportion and coefficient were calculated according to causes, age groups and sex. The ambulatory care-sensitive conditions (ACSC) represented approximately 20% of the hospital admissions in the National Health System. The most frequent conditions were: gastroenteritis (2.4%), heart failure (2.3%), and kidney and urinary tract infection (2.1%). The following aspects were verified: significant hospitalization rates due to ACSC in the infant group (< 1 year of age), an important reduction in the following age groups (1 to 29 years), and a gradual increase until the more advanced ages. Compared to men, hospitalization rates were slightly higher among young women (20 to 29 years) and lower among women older than 49 years. Hospitalizations due to ACSC represented 19.5% of all hospital admissions in the Federal District (2008), and the main causes of hospitalizations were gastroenteritis, heart failure and kidney and urinary tract infection. The effectiveness of primary health care in preventing these events in the Federal District is discussed.
M. Berghout (Mathilde); N.J.A. van Exel (Job); L. Leensvaart (Laszlo); J.M. Cramm (Jane)
textabstractBackground: Patient-centered care (PCC) is a main determinant of care quality. Research has shown that PCC is a multi-dimensional concept, and organizations that provide PCC well report better patient and organizational outcomes. However, little is known about the relative importance of
Weech-Maldonado, Robert; Elliott, Marc N.; Pradhan, Rohit; Schiller, Cameron; Hall, Allyson; Hays, Ron D.
Background Cultural competency has been espoused as an organizational strategy to reduce health disparities in care. Objective To examine the relationship between hospital cultural competency and inpatient experiences with care. Research Design The first model predicted Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores from hospital random effects, plus fixed effects for hospital cultural competency, individual race/ethnicity/language, and case-mix variables. The second model tested if the association between a hospital’s cultural competency and HCAHPS scores differed for minority and non-Hispanic white patients. Subjects The National CAHPS® Benchmarking Database’s (NCBD) HCAHPS Surveys and the Cultural Competency Assessment Tool of Hospitals (CCATH) Surveys for California hospitals were merged, resulting in 66 hospitals and 19,583 HCAHPS respondents in 2006. Measures Dependent variables include ten HCAHPS measures: six composites (communication with doctors, communication with nurses, staff responsiveness, pain control, communication about medications, and discharge information), two individual items (cleanliness, and quietness of patient rooms), and two global items (overall hospital rating, and whether patient would recommend hospital). Results Hospitals with greater cultural competency have better HCAHPS scores for doctor communication, hospital rating, and hospital recommendation. Furthermore, HCAHPS scores for minorities were higher at hospitals with greater cultural competency on four other dimensions: nurse communication, staff responsiveness, quiet room, and pain control. Conclusions Greater hospital cultural competency may improve overall patient experiences, but may particularly benefit minorities in their interactions with nurses and hospital staff. Such effort may not only serve longstanding goals of reducing racial/ethnic disparities in inpatient experience, but may also contribute to general quality improvement
Knierim, Kyle; Hall, Tristen; Fernald, Douglas; Staff, Thomas J; Buscaj, Emilie; Allen, Jessica Cornett; Onysko, Mary; Dickinson, W Perry
Most primary care residency training practices have close financial and administrative relationships with teaching hospitals and health systems. Many residency practices have begun integrating the core principles of the patient-centered medical home (PCMH) into clinical workflows and educational experiences. Little is known about how the relationships with hospitals and health systems affect these transformation efforts. Data from the Colorado Residency PCMH Project were analyzed. Results show that teaching hospitals and health systems have significant opportunities to influence residency practices' transformation, particularly in the areas of supporting team-based care, value-based payment reforms, and health information technology.
Dias, Casimiro; Escoval, Ana
The perspective of innovation as the strategic lever of organizational performance has been widespread in the hospital sector. While public value of innovation can be significant, it is not evident that innovation always ends up in higher levels of performance. Within this context, the purpose of the article was to critically analyze the relationship between innovation and performance,taking into account the specificities of the hospital sector. This article pulls together primary data on organizational flexibility, innovation, and performance from 95 hospitals in Portugal,collected through a survey, data from interviews to hospital administration boards, and a panel of 15 experts. The diversity of data sources allowed for triangulation. The article uses mixed methods to explore the relationship between innovation and performance in the hospital sector in Portugal. The relationship between innovation and performance is analyzed through cluster analysis, supplemented with content analysis of interviews and the technical nominal group. The main findings reveal that the cluster of efficient innovators has twice the level of performance than other clusters. Organizational flexibility and external cooperation are the 2 major factors explaining these differences. The article identifies various organizational strategies to use innovation in order to enhance hospital performance. Overall, it proposes the alignment of perspectives of different stakeholders on the value proposition of hospital services, the embeddedness of information loops, and continuous adjustments toward high-value services.
Georgia K. Gerogianni
Full Text Available Family has a significant role in hospital treatment of patients, since it can provide effective psychological and emotional support to patients undergoing treatment to hospital. Additionally, the above role of family is not only significant for adults but also for children and pregnant women, who need their husbands during their childbirth. Consequently, the medical and nursing staff need to maintain a continuous contact with parents and relatives of patients, and provide them with the appropriate information concerning the condition of their patient and the progress of the therapeutic program. This can make them capable of providing effective psychological support to their patient.
Moolchandani, Kailash; Deepashree, R; Sistla, Sujatha; Harish, BN; Mandal, Jharna
Introduction Hospital Acquired Infections (HAIs) are the rising threat in the health care facilities across the globe. As most Intesive Care Unit (ICU) patients are frequently on broad spectrum antimicrobials, this induces selective antibiotic pressure which leads to development of Antimicrobial Resistance (AMR) among the microorganisms of ICUs. Aim To study the occurrence of different types of HAIs in patients admitted to various ICUs of JIPMER and the AMR pattern of the bacterial pathogens isolated from them. Materials and Methods The record based retrospective data of culture reports of the patients admitted to all the ICUs of JIPMER during the period from April 2015 to March 2016 were collected. A total of 3,090 isolates were obtained from the clinical specimens of 1,244 patients. Data on various factors like demographic characters, type of ICU, infecting organism, site of infection, type of HAI’s and AMR including co-resistance were collected and analysed using Microsoft Excel. Results Most common culture positive clinical specimen received was tracheal aspirate (29.9%) followed by exudate (22.7%). Acinetobacter spp from tracheal aspirate and Pseudomonas spp from blood specimens were the most common organisms isolated; whereas Escherichia coli was the predominant organism found in urine, exudate and sterile fluid specimens. About 22.2% infections were HAIs, out of which pneumonia (6.24%) was the most common. Analysis of antimicrobial susceptibility pattern revealed that most of Gram-Negative Bacilli (GNB) was Multi Drug Resistant (MDR) i.e., resistant to three or more class of antibiotics such as cephalosporins, carbapenems, aminoglycosides, tetracyclines and fluoroquinolones. The prevalence of Methicillin- resistant Staphylococcus aureus (MRSA) and Vancomycin- resistant Enterococci (VRE) were found to be 40.6% and 11.9% respectively. Conclusion The increasing trend AMR among the hospital acquired pathogens such as MDR-GNBs, MRSA and VRE pose a great threat
Vos, L.; Oostenbrugge, R.J. van; Limburg, M.; Merode, G.G. van; Groothuis, S.
Dutch hospitals are in the midst of a transition towards process-oriented organisation to realise optimal and undisturbed care processes. Between 2004 and 2007, the University Hospital of Maastricht conducted a case study implementing process-oriented in-hospital stroke unit care. The case study
Izumi, Shigeko; Baggs, Judith G.; Knafl, Kathleen A.
The quality of nursing care as perceived by hospitalized patients with advanced illness has not been examined. A concept of quality nursing care for this population was developed by integrating the literature on constructs defining quality nursing care with empirical findings from interviews of 16 patients with advanced illness. Quality nursing care was characterized as competence and personal caring supported by professionalism and delivered with an appropriate demeanor. Although the attributes of competence, caring, professionalism, and demeanor were identified as common components of quality care across various patient populations, the caring domain increased in importance when patients with advanced illness perceived themselves as vulnerable. Assessment of quality nursing care for patients with advanced illness needs to include measures of patient perceptions of vulnerability. PMID:20572095
Rosse, F. van; Suurmond, J.; Wagner, C.; Bruijne, M. de; Essink-Bot, M.L.
Objective Relatives of ethnic minority patients often play an important role in the care process during hospitalisation. Our objective was to analyse the role of these relatives in relation to the safety of patients during hospital care. Setting Four large urban
Spitzer, William J.; Burke, Laurie
Reviews individual and institutional effects of critical-incident stress on health care delivery and use of stress education, defusings, and debriefings as effective interventions with health care personnel. Presents successful efforts of social work department using these techniques in major university hospital system as model for replication in…
A large scale study on maternity care in the Netherlands, describing many facets of midwifery care in relation to the preferred place of birth (at home or in hospital), the obstetric result, and the experiences of childbirth. In the Netherlands only women with low risk pregnancies are free to cho
Bredenhoff, E.; Bredenhoff, Eelco; van Lent, W.A.M.; van Harten, Willem H.
Background: Focusing on specific treatments or diseases is proposed as a way to increase the efficiency of hospital care. The definition of "focus" or "focused factory", however, lacks clarity. Examples in health care literature relate to very different organizations. Our aim was to explore the
They're the designated drivers of inpatient care, cutting hospital stays by 19 percent on average. Yet as venture capital firms infuse hospitalist startup companies, some primary care doctors complain that their sickest patients are being taken away from them.
Rosse, F. van; Suurmond, J.; Wagner, C.; Bruijne, M. de; Essink-Bot, M.L.
Objective Relatives of ethnic minority patients often play an important role in the care process during hospitalisation. Our objective was to analyse the role of these relatives in relation to the safety of patients during hospital care. Setting Four large urban hos
Baldwin, Laura-Mae; Chan, Leighton; Andrilla, C. Holly A.; Huff, Edwin D.; Hart, L. Gary
Background: In the mid-1990s, significant gaps existed in the quality of acute myocardial infarction (AMI) care between rural and urban hospitals. Since then, overall AMI care quality has improved. This study uses more recent data to determine whether rural-urban AMI quality gaps have persisted. Methods: Using inpatient records data for 34,776…
Atul Khajuria; Ashok Kumar Praharaj; Mahadevan Kumar; Naveen Grover
Objective. To detect genes encoding carbapenem resistance among Enterobacter species in a tertiary care hospital in central India. Methods. Bacterial identification of Enterobacter spp. isolates from various clinical specimens in patients admitted to intensive care units was performed by routine conventional microbial culture and biochemical tests using standard recommended techniques. Antibiotic sensitivity test was performed by standard Kirby Bauer disc diffusion technique. PCR amplificat...
Kilsdonk, M.J.; Siesling, S.; Otter, R.; Harten, van W.H.
External peer review was introduced in general hospitals in the Netherlands in 1994 to assess and improve the multidisciplinary team approach in cancer care. This paper aims to explore the value, perceived impact, and (future) role of external peer review in cancer care. Semistructured interviews we
Baldwin, Laura-Mae; Chan, Leighton; Andrilla, C. Holly A.; Huff, Edwin D.; Hart, L. Gary
Background: In the mid-1990s, significant gaps existed in the quality of acute myocardial infarction (AMI) care between rural and urban hospitals. Since then, overall AMI care quality has improved. This study uses more recent data to determine whether rural-urban AMI quality gaps have persisted. Methods: Using inpatient records data for 34,776…
Rosse, F. van; Suurmond, J.; Wagner, C.; Bruijne, M. de; Essink-Bot, M.L.
Objective Relatives of ethnic minority patients often play an important role in the care process during hospitalisation. Our objective was to analyse the role of these relatives in relation to the safety of patients during hospital care. Setting Four large urban hos
Lange, Jean W; Yellen, Elaine
This study was designed to improve the psychometrics of English and Spanish measures of hospitalized patients' satisfaction with nursing care. One hundred Spanish-speaking participants in the northeastern and southwestern United States completed a new 20-item Spanish version; 64 of the same participants also completed the English version. Correlations between item pairs (p satisfaction with nursing care.
Schultz Timothy J
Full Text Available Abstract Background This study set out to achieve three objectives: to test the application of a context assessment tool in an acute hospital in South Australia; to use the tool to compare context in wards that had undergone an evidence implementation process with control wards; and finally to test for relationships between demographic variables (in particular experience of nurses being studied (n = 422 with the dimensions of context. Methods The Alberta Context Tool (ACT was administered to all nursing staff on six control and six intervention wards. A total of 217 (62% were returned (67% from the intervention wards and 56% from control wards. Data were analysed using Stata (v9. The effect of the intervention was analysed using nested (hierarchical analysis of variance; relationships between nurses' experience and context was examined using canonical correlation analysis. Results Results confirmed the adaptation and fit of the ACT to one acute care setting in South Australia. There was no difference in context scores between control and intervention wards. However, the tool identified significant variation between wards in many of the dimensions of context. Though significant, the relationship between nurses' experience and context was weak, suggesting that at the level of the individual nurse, few factors are related to context. Conclusions Variables operating at the level of the individual showed little relationship with context. However, the study indicated that some dimensions of context (e.g., leadership, culture vary at the ward level, whereas others (e.g., structural and electronic resources do not. The ACT also raised a number of interesting speculative hypotheses around the relationship between a measure of context and the capability and capacity of staff to influence it. We propose that context be considered to be dependent on ward- and hospital-level factors. Additionally, questions need to be considered about the unit of measurement
Spencer, Christine S; Gaskin, Darrell J; Roberts, Eric T
In attempting to explain why hospitals vary in the quality of care delivered to patients, a considerable body of health policy research points to differences in hospital characteristics such as ownership, safety-net status, and geographic location as the most important contributing factors. This article examines the extent to which a patient's type or lack of insurance may also play a role in determining the quality of care received at any given hospital. We compared within-hospital quality, as measured by risk-adjusted mortality rates, for patients according to their insurance status. We examined the Agency for Healthcare Research and Quality's innovative Inpatient Quality Indicators and pooled 2006-08 State Inpatient Database records from eleven states. We found that privately insured patients had lower risk-adjusted mortality rates than did Medicare enrollees for twelve out of fifteen quality measures examined. To a lesser extent, privately insured patients also had lower risk-adjusted mortality rates than those in other payer groups. Medicare patients appeared particularly vulnerable to receiving inferior care. These findings suggest that to help reduce care disparities, public payers and hospitals should measure care quality for different insurance groups and monitor differences in treatment practices within hospitals.
Full Text Available Background. Little research exists on acupuncture treatment’s effect on patients with traumatic brain injury (TBI. Methods. Using Taiwan’s National Health Insurance Research Database, we conducted a cohort study to compare the use of emergency care and hospitalization in TBI patients with and without acupuncture treatment in the first year after TBI. The adjusted relative risks (RRs and 95% confidence intervals (CIs of high use of emergency care and hospitalization associated with acupuncture treatment were calculated in multivariate Poisson regression models with generalized estimating equation. Results. The means of medical visits of emergency care and hospitalization were lower in TBI patients with acupuncture treatment than in those without acupuncture treatment. After adjustment, acupuncture treatment was associated with decreased risk of high emergency care visits (beta = −0.0611, P=0.0452 and hospitalization (beta = −0.0989, P<0.0001. The RRs of high medical visits and expenditure for hospitalization associated with acupuncture treatment were 0.62 (95% CI = 0.50–0.76 and 0.66 (95% CI = 0.53–0.83, respectively. Conclusion. Patients with TBI who receive acupuncture treatment have reduced the use of emergency care and hospitalization in the first year after injury. The mechanisms of effects of acupuncture on TBI warrant further investigations.
Jansen, Michele Ferraz; dos Santos, Rosane Maria; Favero, Luciane
It is a qualitative research study, descriptive-exploratory in nature, which aims to verify the benefits from the use of toys during nursing care to hospitalized children. Ten subjects participated in the study: three children and seven mothers of hospitalized children. Data were collected between May and July, 2008 by means of specific instruments for each age group and further organized in thematic categories: the use of toys to lessen hospitalization stress; toys facilitating understanding and acceptance of procedures; and the experience of using toys and hospitalization process. The results show that the use of toys is an excellent nursing resource to render care to admitted children. The features of the toys facilitated communication, participation, acceptance of procedure and child motivation, what enabled them to keep their individuality, lessen the stress and the possibility to implement children's and families' non-traumatic care.
Kaldal, Maiken Holm; Kristiansen, Jette; Uhrenfeldt, Lisbeth
REVIEW QUESTION / OBJECTIVE The objective of this systematic review is to identify, appraise and synthesize the best available evidence on nursing students’ experiences of professional patient care encounters in a hospital unit. More specifically the research questions are: How do nursing students...... describe their experiences of professional patient care in a hospital unit? What kinds of experiences do nursing students have in professional patient care encounters? INCLUSION CRITERIA Types of participants This review will consider studies that include undergraduate and postgraduate nursing students...... experiences of professional patient care encounters where students engage with patients and provide nursing care within the basic principles of nursing care relating to the patients’ physiological and psychological needs. Studies that reflect nursing students’ comprehension of or attitudes towards nursing...
van Rosse, F.
This thesis shows the first results of Dutch studies on the relation between ethnicity and patient safety. We used mixed methods to identify patient safety outcomes and patient safety risks in a cohort study in 4 urban hospitals among 763 Dutch patients and 576 ethnic minority patients. In a record
This manual is intended for young people with spinal cord injuries who are receiving rehabilitation services within the Spinal Cord Injury Unit at Shriners Hospital (San Francisco, California). An introduction describes the rehabilitation program, which includes family conferences, an individualized program, an independent living program,…
Postma, Maarten; Tolley, K; Leidl, R M; Downs, A M; Beck, E J; Tramarin, A M; Flori, Y A; Santin, M; Antoñanzas, F; Kornarou, H; Paparizos, V C; Dijkgraaf, M G; Borleffs, J; Luijben, A J; Jager, J C
This study estimates the current and future hospital resources for AIDS patients in the European Union (EU), using multinational scenario analysis (EU Concerted Action BMH1-CT-941723). In collaboration with another EU-project ('Managing the Costs of HIV Infection'), six national European studies on
Postma, Maarten; Tolley, K; Leidl, R M; Downs, A M; Beck, E J; Tramarin, A M; Flori, Y A; Santin, M; Antoñanzas, F; Kornarou, H; Paparizos, V C; Dijkgraaf, M G; Borleffs, J; Luijben, A J; Jager, J C
This study estimates the current and future hospital resources for AIDS patients in the European Union (EU), using multinational scenario analysis (EU Concerted Action BMH1-CT-941723). In collaboration with another EU-project ('Managing the Costs of HIV Infection'), six national European studies on
George G Zhanel
Full Text Available OBJECTIVE: To determine the prevalence of vancomycin-resistant enterococci (VRE bowel colonization in hospitalized patients in Manitoba who had stool specimens collected for Clostridium difficile toxin and/or culture testing.
Green, John; Young, John; Forster, Anne; Mallinder, Karen; Bogle, Sue; Lowson, Karin; Small, Neil
Objective To determine the effects on independence in older people needing rehabilitation in a locality based community hospital compared with care on a ward for elderly people in a district general hospital. Design Randomised controlled trial. Setting Care in a community hospital and district general hospital in Bradford, England. Participants 220 patients needing rehabilitation after an acute illness that required hospital admission. Interventions Patients were randomly allocated to a locality based community hospital or to remain within a department for the care of elderly people in a district general hospital. Main outcome measures Primary outcomes were Nottingham extended activities of daily living scale and general health questionnaire 28 (carer). Secondary outcomes were activities of daily living (Barthel index), Nottingham health profile, hospital anxiety and depression scale, mortality, destination after discharge, satisfaction with services, carer strain index, and carer's satisfaction with services. Results The median length of stay was 15 days for both the community hospital and the district general hospital groups (interquartile range: community hospital 9-25 days; district general hospital 9-24 days). Independence at six months was greater in the community hospital group (adjusted mean difference 5.30, 95% confidence interval 0.64 to 9.96). Results for the secondary outcome measures, including care satisfaction and measures of carer burden, were similar for both groups. Conclusions Care in a locality based community hospital is associated with greater independence for older people than care in wards for elderly people in a district general hospital. PMID:15994660
Mikkelsen, Gitte; Frederiksen, Kirsten
mikkelsen g. & frederiksen k. (2011) Family-centred care of children in hospital - a concept analysis. Journal of Advanced Nursing67(5), 1152-1162. ABSTRACT: Aim. This paper reports a concept analysis of family-centred nursing care of hospitalized children. Background. Family-centred care...... and scientific maturity of the concept. Findings. There is good agreement on the defining attributes of the concept, but they are described by sub concepts in need of clarification. The relationship between family and professionals is characterized by a mutual dependency and shared responsibility for the child...... include the perspective of the sick child....
Full Text Available Recently, the Centers for Medicare and Medicaid Services (CMS released nationwide data on hospital charges and CMS payments for the top 100 disease-related groups (DRG. Data obtained from the CMS website was examined for 23 common pulmonary and critical care DRG charges and payments to hospitals in the Southwest United States (Arizona, New Mexico and Colorado. Similar to nationwide trends, charges vastly exceeded payments and varied widely. Normalizing the data to the state average for each DRG, the percent over/under the state average revealed a negative correlation between charges and payments. Urban hospitals billed more but did not receive significantly higher payments. Hospitals that were primary hospitals for residencies did not bill significantly more but did receive higher payments. These data demonstrate that charges and payments for respiratory and critical care DRGs in the Southwest mirror nationwide trends in large overcharges.
Helene Kjøllesdal Eide
Full Text Available This article assesses nutritional care in identifying and treating nutritional risk in elderly hospitalized patients. A cross-sectional study was conducted at a large Norwegian University hospital in the period 2011 to 2013. Data on nutritional risk and care for elderly patients (≥70 years without dementia were collected at 20 wards by 173 second-year nursing students in acute-care clinical studies. A stratified sampling technique was utilized to improve the representativeness of the sample. In total, 508 patients (48.8% women with a mean age of 79.6 years participated. The internationally and nationally recommended nutritional care was not implemented at the hospital, suggesting that nutritional care for elderly hospitalized patients was not adequate. This implies that the majority of the elderly patients nutritionally at risk are neither identified nor treated according to their needs. The article highlights the importance of having systematic nutritional care practices to make it possible for the hospital ward staff to routinely identify nutritional risk and initiate appropriate nutritional treatment measures.
Park, Dong Won; Moon, Jae Young; Ku, Eun Yong; Kim, Sun Jong; Koo, Young-Mo; Kim, Ock-Joo; Lee, Soon Haeng; Jo, Min-Woo; Lim, Chae-Man; Armstrong, John David; Koh, Younsuck
This research aimed to investigate the changes in ethical issues in everyday clinical practice recognized by critical care nurses during two observation periods. We conducted a retrospective analysis of data obtained by prospective questionnaire surveys of nurses in the intensive care units (ICU) of a tertiary university-affiliated hospital in Seoul, Korea. Data were collected prospectively during two different periods, February 2002-January 2003 (Period 1) and August 2011-July 2012 (Period 2...
Kadhim J Sulaiman
Full Text Available Background: There is paucity of data on heart failure (HF in the Gulf Middle East. The present paper describes the rationale, design, methodology and hospital characteristics of the first Gulf acute heart failure registry (Gulf CARE. Materials and Methods: Gulf CARE is a prospective, multicenter, multinational registry of patients >18 year of age admitted with diagnosis of acute HF (AHF. The data collected included demographics, clinical characteristics, etiology, precipitating factors, management and outcomes of patients admitted with AHF. In addition, data about hospital readmission rates, procedures and mortality at 3 months and 1-year follow-up were recorded. Hospital characteristics and care provider details were collected. Data were entered in a dedicated website using an electronic case record form. Results: A total of 5005 consecutive patients were enrolled from February 14, 2012 to November 13, 2012. Forty-seven hospitals in 7 Gulf States (Oman, Saudi Arabia, Yemen, Kuwait, United Gulf Emirates, Qatar and Bahrain participated in the project. The majority of hospitals were community hospitals (46%; 22/47 followed by non-University teaching (32%; 15/47 and University hospitals (17%. Most of the hospitals had intensive or coronary care unit facilities (93%; 44/47 with 59% (28/47 having catheterization laboratory facilities. However, only 29% (14/47 had a dedicated HF clinic facility. Most patients (71% were cared for by a cardiologist. Conclusions: Gulf CARE is the first prospective registry of AHF in the Middle East, intending to provide a unique insight into the demographics, etiology, management and outcomes of AHF in the Middle East. HF management in the Middle East is predominantly provided by cardiologists. The data obtained from this registry will help the local clinicians to identify the deficiencies in HF management as well as provide a platform to implement evidence based preventive and treatment strategies to reduce the burden
Hosseinian, Masoumeh; Mirbagher Ajorpaz, Neda; Esalat Manesh, Soophia
Background: Despite the paramount importance of the patient’s satisfaction, there are limited data on mothers’ satisfaction with the nursing care provided to their children in Iranian clinical settings. Objectives: This study aimed to evaluate mothers’ satisfaction with two systems of providing care to their hospitalized children. Patients and Methods: This research was a two-group quasi-experimental study. Primarily, the basics of the case method and the functional care delivery systems were...
Frey, P W; Littleton, E M
In an effort to improve nutrition care in a small community hospital with one registered dietitian (R.D.), a system using a nutrition care profile (NCP) and a certified dietetic assistant (C.D.A.) was developed. The NCP includes criteria recognized in the literature or through clinical experience to be indicators of nutrition care needs. The profile is completed by the C.D.A. and reviewed by the R.D., who determines priorities for the patient's nutrition care needs. The NCP has proved to be an effective and efficient tool for prioritizing and systematizing follow-up of nutrition care needs. Indeed, because the NCP form is itself so effective as a follow-up tool for dietary records, the R.D. has found she must make a conscious effort to document nutrition care in the medical record.
Allen, Jacqueline; Hutchinson, Alison M; Brown, Rhonda; Livingston, Patricia M
This meta-synthesis aimed to improve understanding of user experience of older people, carers, and health providers; and care integration in the care of older people transitioning from hospital to home. Following our systematic search, we identified and synthesized 20 studies, and constructed a comprehensive framework. We derived four themes: (1) 'Who is taking care of what? Trying to work together"; (2) 'Falling short of the mark'; (3) 'A proper discharge'; and (4) 'You adjust somehow.' The themes that emerged from the studies reflected users' experience of discharge and transitional care as a social process of 'negotiation and navigation of independence (older people/carers), or dependence (health providers).' Users engaged in negotiation and navigation through the interrogative strategies of questioning, discussion, information provision, information seeking, assessment, and translation. The derived themes reflected care integration that facilitated, or a lack of care integration that constrained, users' experiences of negotiation and navigation of independence/dependence. © The Author(s) 2016.
Juliana Coelho Pina
Full Text Available OBJECTIVE: to analyze the presence and extent of the primary health care attributes among children hospitalized for pneumonia.METHOD: observational and retrospective study with hospital-based case-control design, developed in three hospitals associated to the Brazilian Unified Health System, located in a city of the State of São Paulo, Brazil. The study included 690 children under five years old, with 345 cases and 345 controls.RESULTS: both groups scored high for access to health services. In contrast, high scores for attributes such as longitudinality and coordination of care were observed for the controls. Despite low scores, integrality and family counseling were also high for the controls.CONCLUSION: knowledge of the aspects involving the primary health care attributes and its provision for child care are very important because they have the potential to support professionals and managers of the Brazilian Unified Health System in the organization of health services.
Cline, Daniel D; Rosenberg, Marie-Claire; Kovner, Christine T; Brewer, Carol
The purpose of this study was to explore early-career registered nurses' perceptions of high-quality nursing care in hospitals. The study findings contribute to ongoing work intended to explore and define what quality nursing care is and how it ultimately impacts patients. The final sample analyzed for this article consisted of 171 narrative responses from hospital-based registered nurses. We used Krippendorff's technique for qualitative content analysis to identify themes. Three themes emerged as integral to high quality nursing care: registered nurse presence, developing relationships, and facilitating the flow of knowledge and information. Development of nursing quality indicators should focus on nursing processes in addition to patient outcomes. Such a focus would better capture the complexity of hospital nursing care.
Sorensen, Bjarke Lund; Elsass, Peter; Nielsen, Brigitte Bruun
OBJECTIVE: (i) To identify clinical causes of maternal deaths at a regional hospital in Tanzania and through confidential enquiry (CE) assess major substandard care and make a comparison to the findings of the internal maternal deaths audits (MDAs); (ii) to describe hospital staff reflections...... on causes of substandard care. METHODS: A CE into maternal deaths was conducted based on information available from written sources supplemented with participatory observations and interviews with staff. The compiled information was summarized and presented anonymously for external expert review to assess...... for major substandard care. Hospital based maternal deaths between 2006 and 2008 (35 months) were included. Of 68 registered maternal deaths sufficient information for reviewing was retrieved for 62 cases (91%). As a supplement, in-depth interviews with staff about the underlying causes of substandard care...
Harlan, Gregory A; Nkoy, Flory L; Srivastava, Rajendu; Lattin, Gena; Wolfe, Doug; Mundorff, Michael B; Colling, Dayvalena; Valdez, Angelika; Lange, Shay; Atkinson, Sterling D; Cook, Lawrence J; Maloney, Christopher G
Delays, omissions, and inaccuracy of discharge information are common at hospital discharge and put patients at risk for adverse outcomes. We assembled an interdisciplinary team of stakeholders to evaluate our current discharge process between hospitalists and primary care providers (PCPs). We used a fishbone diagram to identify potential causes of suboptimal discharge communication to PCPs. Opportunities for improvement (leverage points) to achieve optimal transfer of discharge information were identified using tally sheets and Pareto charts. Quality improvement strategies consisted of training and implementation of a new discharge process including: (1) enhanced PCP identification at discharge, (2) use of an electronic discharge order and instruction system, and (3) autofaxing discharge information to PCPs. The new discharge process's impact was evaluated on 2,530 hospitalist patient discharges over a 34-week period by measuring: (1) successful transfer of discharge information (proportion of discharge information sheets successfully faxed to PCPs), (2) timeliness (proportion of sheets faxed within 2 days of discharge), and (3) content (presence of key clinical elements in discharge sheets). Postintervention, success, and timeliness of discharge information transfer between pediatric hospitalists and PCPs significantly improved while content remained high.
Full Text Available Background: Rooming-in, motivated by World Health Organization (WHO strategies and baby-friendly hospital policies, is a practice followed in many maternity hospitals of Iran. Mother-infant dyad may easily be damaged by the separation caused by medical and surgical problems, which result in hospital stay. Regarding this, the aim of this study was to investigate the effects of the rooming-in practice in icteric newborns admitted to Mofid Children's Hospital of Tehran, Iran. Methods: This study was conducted on 220 neonates admitted to Mofid Children's Hospital with the complaint of jaundice. Out of the 220 newborns, 124 cases were assigned into the intervention group (the rooming-in care and 96 neonates were categorized into the control group (the routine-care. The two groups were compared in terms of the length of hospital stay, maternal satisfaction, nursing care time, and hospital stay complications. The data were collected by some trained mid-wives using a validated questionnaire. Data analysis was performed using paired sample t-test through SPSS version 16. Results: According to the results of the study, about 55% of the neonates were male. The neonatal mean ages of the intervention and control groups were 6.6 ±3.7 and 7 ± 3.8 days, respectively. Maternal satisfaction with neonatal care and maternal comfort during hospital stay were significantly higher in the intervention group (P=0.027. Furthermore, the two groups had no significant difference regarding the complications of hospital stay (P=0.655. Conclusion: As the findings of the present study demonstrated, in spite of the similarities of the health issues, nursery essentials, and hospital stay complications between the two groups, the rooming-in was more favorable according to the mothers’ viewpoints.
Full Text Available In our scientific approach we tried to develop a model with which to highlight the effect of financing hospital health care providers using the hospital 's Diagnosis Related Groups (DRG and Mean Relative Values (MRV. The econometric model used is simple linear regression model form. Development of the model was performed by using the EViews 7 to the municipal hospitals in Romania during 2010 - 2012, being considered DRG dependent variable and independent variables: C and MRV. Analyzing in detail the results recorded by providers following simple regression model is observed that there are units which, although recorded low values in the number of patients discharged, they were able to achieve a relatively high VRM or to contract a level of TAC over average of the entire sample.
Ortega López, Angela; Morales Asencio, José Miguel; Rengel Díaz, Cristóbal; Peñas Cárdenas, Eloísa María; González Rodríguez, María José; Prado de la Sierra, Rut
To determine the opinions of infectious diseases professionals on the possibilities of monitoring patients with HIV in Primary Care. Qualitative study using in-depth interviews. Infectious Diseases Unit in the University Hospital "Virgen de la Victoria" in Málaga. Health professionals with more than one year experience working in infectious diseases. A total of 25 respondents: 5 doctors, 15 nurses and 5 nursing assistants. Convenience sample. Semi-structured interviews were used that were later transcribed verbatim. Content analysis was performed according to the Taylor and Bogdan approach with computer support. Validation of information was made through additional analysis, expert participation, and feedback of part of the results to the participants. Hospital care professionals considered the disease-related complexity of HIV, treatment and social aspects that may have an effect on the organizational level of care. Professionals highlighted the benefits of specialized care, although opinions differed between doctors and nurses as regards follow up in Primary Care. Some concerns emerged about the level of training, confidentiality and workload in Primary Care, although they mentioned potential advantages related to accessibility of patients. Physicians perceive difficulties in following up HIV patients in Primary Care, even for those patients with a good control of their disease. Nurses and nursing assistants are more open to this possibility due to the proximity to home and health promotion in Primary Care. Copyright © 2013 Elsevier España, S.L. All rights reserved.
Background: (1) To assess pattern of antibiotic use among in-patients of medicine unit in a tertiary care hospital, (2) to determine the frequency of adverse drug reactions (ADR) among the inpatients receiving antibiotics in medicine unit. Methods: The study was prospective and based on the daily review of patient records for 2 months (June, July) of study period, including all the inpatients of medicine unit 1 receiving antimicrobials. The general information of the patients, infection, a...
Amadi-Obi, Ahjoku; Gilligan, Peadar; Owens, Niall; O'Donnell, Cathal
The right person in the right place and at the right time is not always possible; telemedicine offers the potential to give audio and visual access to the appropriate clinician for patients. Advances in information and communication technology (ICT) in the area of video-to-video communication have led to growth in telemedicine applications in recent years. For these advances to be properly integrated into healthcare delivery, a regulatory framework, supported by definitive high-quality research, should be developed. Telemedicine is well suited to extending the reach of specialist services particularly in the pre-hospital care of acute emergencies where treatment delays may affect clinical outcome. The exponential growth in research and development in telemedicine has led to improvements in clinical outcomes in emergency medical care. This review is part of the LiveCity project to examine the history and existing applications of telemedicine in the pre-hospital environment. A search of electronic databases including Medline, Excerpta Medica Database (EMBASE), Cochrane, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for relevant papers was performed. All studies addressing the use of telemedicine in emergency medical or pre-hospital care setting were included. Out of a total of 1,279 articles reviewed, 39 met the inclusion criteria and were critically analysed. A majority of the studies were on stroke management. The studies suggested that overall, telemedicine had a positive impact on emergency medical care. It improved the pre-hospital diagnosis of stroke and myocardial infarction and enhanced the supervision of delivery of tissue thromboplasminogen activator in acute ischaemic stroke. Telemedicine presents an opportunity to enhance patient management. There are as yet few definitive studies that have demonstrated whether it had an effect on clinical outcome.
Full Text Available Background and aim: As a result of New Public Management, a number of industrial models of quality management have been implemented in health care, mainly in hospitals. At the same time, the concept of integrated care has been developed within other parts of the health sector. The aim of the article is to discuss the relevance of integrated care for hospitals.Theory and methods: The discussion is based on application of a conceptual framework outlining a number of organizational models of integrated care. These models are illustrated in a case study of a Danish university hospital implementing a new organization for improving the patient flows of the hospital. The study of the reorganization is based mainly on qualitative data from individual and focus group interviews.Results: The new organization of the university hospital can be regarded as a matrix structure combining a vertical integration of clinical departments with a horizontal integration of patient flows. This structure has elements of both interprofessional and interorganizational integration. A strong focus on teamwork, meetings and information exchange is combined with elements of case management and co-location.Conclusions: It seems that integrated care can be a relevant concept for a hospital. Although the organizational models may challenge established professional boundaries and financial control systems, this concept can be a more promising way to improve the quality of care than the industrial models that have been imported into health care. This application of the concept may also contribute to widen the field of integrated care.
Yoon, Jean; Rose, Danielle E; Canelo, Ismelda; Upadhyay, Anjali S; Schectman, Gordon; Stark, Richard; Rubenstein, Lisa V; Yano, Elizabeth M
As the Veterans Health Administration (VHA) reorganizes providers into the patient-centered medical home, questions remain whether this model of care can demonstrate improved patient outcomes and cost savings. We measured adoption of medical home features by VHA primary care clinics prior to widespread implementation of the patient-centered medical home and examined if they were associated with lower risk and costs of potentially avoidable hospitalizations. Secondary patient data was linked to clinic administrative and survey data. Patient and clinic factors in the baseline year (FY2009) were used to predict patient outcomes in the follow-up year. 2,853,030 patients from 814 VHA primary care clinics Patient outcomes were measured by hospitalizations for an ambulatory care sensitive condition (ACSC) and their costs and identified through diagnosis and procedure codes from inpatient records. Clinic adoption of medical home features was obtained from the American College of Physicians Medical Home Builder®. The overall mean home builder score in the study clinics was 88 (SD = 13) or 69%. In adjusted analyses an increase of 10 points in the medical home adoption score in a clinic decreased the odds of an ACSC hospitalization for patients by 3% (P = 0.032). By component, higher access and scheduling (P = 0.004) and care coordination and transitions (P = 0.020) component scores were related to lower risk of an ACSC hospitalization, and higher population management was related to higher risk (P = 0.023). Total medical home features was not related to ACSC hospitalization costs among patients with at least one (P = 0.074). Greater adoption of medical home features by VHA primary care clinics was found to be significantly associated with lower risk of avoidable hospitalizations with access and scheduling and care coordination/transitions in care as key factors.
Full Text Available Background and aim: As a result of New Public Management, a number of industrial models of quality management have been implemented in health care, mainly in hospitals. At the same time, the concept of integrated care has been developed within other parts of the health sector. The aim of the article is to discuss the relevance of integrated care for hospitals. Theory and methods: The discussion is based on application of a conceptual framework outlining a number of organizational models of integrated care. These models are illustrated in a case study of a Danish university hospital implementing a new organization for improving the patient flows of the hospital. The study of the reorganization is based mainly on qualitative data from individual and focus group interviews. Results: The new organization of the university hospital can be regarded as a matrix structure combining a vertical integration of clinical departments with a horizontal integration of patient flows. This structure has elements of both interprofessional and interorganizational integration. A strong focus on teamwork, meetings and information exchange is combined with elements of case management and co-location. Conclusions: It seems that integrated care can be a relevant concept for a hospital. Although the organizational models may challenge established professional boundaries and financial control systems, this concept can be a more promising way to improve the quality of care than the industrial models that have been imported into health care. This application of the concept may also contribute to widen the field of integrated care.
Patient satisfaction is an important measure of service quality (SQ) in health care organizations. Patients' satisfaction and their expectations of care are valid indicators of quality nursing care. This article reports the results of a survey patient satisfaction with nursing care, administered by interview to 422 adults discharged from a university hospital in Turkey. The direct measurement of patient satisfaction with nursing care is a new phenomenon for this university hospital, and this was the first time that such an evaluation had been done in this particular hospital. In this study, SERVQUAL scale was used for determining patient satisfaction with nursing care. Weighted scores in dimensions of SERVQUAL were generally low, and there were statistically significant differences in means paired t-tests (p SERVQUAL (p < 0.5). According to results, the SQ gap scores for five dimensions were negative to meet expectations. The negative scores for tangibles, reliability, responsiveness, assurance, and empathy indicate areas needing improvement. In this hospital, results of this study support the need for nurses to take steps to improve patient satisfaction with nursing care.
Fisher, Kimberly; Smith, Kelly; Gallagher, Thomas; Burns, Laura; Morales, Crystal; Mazor, Kathleen
There is increasing recognition that patients have critical insights into care experiences, including breakdowns in care. Harnessing patient perspectives for hospital improvement requires an in-depth understanding of the types of breakdowns patients identify and the impact of these events. We interviewed a broad sample of patients during hospitalization and postdischarge to elicit patient perspectives on breakdowns in care. Through an iterative process, we developed a categorization of patient-perceived breakdowns called the Patient Experience Coding Tool. Of 979 interviewees, 386 (39.4%) believed they had experienced at least one breakdown in care. The most common reported breakdowns involved information exchange (n = 158, 16.1%), medications (n = 120, 12.3%), delays in admission (n = 90, 9.2%), team communication (n = 65, 6.6%), providers' manner (n = 62, 6.3%), and discharge (n = 56, 5.7%). Of the 386 interviewees who reported a breakdown, 140 (36.3%) perceived associated harm. Patient- perceived harms included physical (eg, pain), emotional (eg, distress, worry), damage to relationship with providers, need for additional care or prolonged hospital stay, and life disruption. We found higher rates of reporting breakdowns among younger ( patients (45.4% vs 34.5%, patient (53.4% vs 37.8%, = 0.002). When asked directly, almost 4 out of 10 hospitalized patients reported a breakdown in their care. Patient- perceived breakdowns in care are frequently associated with perceived harm, illustrating the importance of detecting and addressing these events.
Islam, M Saiful; Luby, Stephen P; Sultana, Rebeca; Rimi, Nadia Ali; Zaman, Rashid Uz; Uddin, Main; Nahar, Nazmun; Rahman, Mahmudur; Hossain, M Jahangir; Gurley, Emily S
Family caregivers are integral to patient care in Bangladeshi public hospitals. This study explored family caregivers' activities and their perceptions and practices related to disease transmission and prevention in public hospitals. Trained qualitative researchers conducted a total of 48 hours of observation in 3 public tertiary care hospitals and 12 in-depth interviews with family caregivers. Family caregivers provided care 24 hours a day, including bedside nursing, cleaning care, and psychologic support. During observations, family members provided 2,065 episodes of care giving, 75% (1,544) of which involved close contact with patients. We observed family caregivers washing their hands with soap on only 4 occasions. The majority of respondents said diseases are transmitted through physical contact with surfaces and objects that have been contaminated with patient secretions and excretions, and avoiding contact with these contaminated objects would help prevent disease. Family caregivers are at risk for hospital-acquired infection from their repeated exposure to infectious agents combined with their inadequate hand hygiene and knowledge about disease transmission. Future research should explore potential strategies to improve family caregivers' knowledge about disease transmission and reduce family caregiver exposures, which may be accomplished by improving care provided by health care workers. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. All rights reserved.
Lindqvist, Rikard; Smeds Alenius, Lisa; Griffiths, Peter; Runesdotter, Sara; Tishelman, Carol
To investigate whether hospital characteristics not readily susceptible to change (i.e. hospital size, university status, and geographic location) are associated with specific self-reported nurse outcomes. Research often focuses on factors within hospitals (e.g. work environment), which are susceptible to change, rather than on structural factors in their own right. However, numerous assumptions exist about the role of structural factors that may lead to a sense of pessimism and undermine efforts at constructive change. Data was derived from survey questions on assessments of work environment and satisfaction, intention to leave, quality of care and burnout (measured by the Maslach Burnout Inventory), from a population-based sample of 11 000 registered nurses in Sweden. Mixed model regressions were used for analysis. Registered nurses in small hospitals were slightly more likely to rank their working environment and quality of nursing care better than others. For example 23% of staff in small hospitals were very satisfied with the work environment compared with 20% in medium-sized hospitals and 21% in large hospitals. Registered nurses in urban areas, who intended to leave their job, were more likely to seek work in another hospital (38% vs. 32%). While some structural factors were related to nurse-reported outcomes in this large sample, the associations were small or of questionable importance. The influence of structural factors such as hospital size on nurse-reported outcomes is small and unlikely to negate efforts to improve work environment. © 2013 John Wiley & Sons Ltd.
... determining his or her eligibility for hospitalization, notwithstanding the fact that the Department of... surgical treatment, or of hospitalization in a VA health care facility or of participation in a... hospital or nursing home care under § 17.47(a), a veteran will be determined unable to defray the expenses...
... providers of long-term care services (“swing-beds”). A hospital that has a Medicare provider agreement must... extended care services, as specified in § 409.30 of this chapter, and be reimbursed as a swing-bed hospital... eligibility requirements: (1) The facility has fewer than 100 hospital beds, excluding beds for newborns and...
Orthner, Helmuth; Mazza, Giovanni; Mazza, Giovanni Giorgio; Shenvi, Rohit; Battles, Marcie
The traditional communication infrastructure of the pre-hospital Emergency Medical System (EMS) is limited to voice communication using radio or cell phone technologies. With the emergence of 3rd Generation wireless networks (3G) and enhanced mobile devices capable of data communication (e.g., mobile tablets, PDAs with cell phones, or cell phones with PDA capabilities), the voice communication can be enhanced with interactive data messaging and perhaps even with interactive video communication. However, video requires substantially more bandwidth which 4th Generation (4G) systems are promising. However, their availability is limited. We present an infrastructure that allows dynamic selection of the best data transport mode in the pre-hospital EMS environment.
de Menezes, Fernanda Souza; Leite, Heitor Pons; Fernandez, Juliana; Benzecry, Silvana Gomes; de Carvalho, Werther Brunow
The aims of this study were to estimate the occurrence of hypophosphatemia and to identify potential risk factors and outcome measures associated with this disturbance in children admitted to a pediatric intensive care unit. Data concerning 42 children admitted consecutively to 1 pediatric intensive care unit over a 1-year period were examined. Serum phosphorus levels were measured on the third day of admission, where levels below 3.8 mg/dL were considered indicative of hypophosphatemia. Hypophosphatemia was found in 32 children (76%), and there was a significant association between this disturbance and malnutrition (P = .04). Of the potential risk factors such as sepsis, diuretic/steroid therapy, starvation (over 3 days), and Pediatric Index of Mortality, none discriminated for hypophosphatemia. There were no associations between hypophosphatemia and mortality, length of stay in the pediatric intensive care unit, or time on mechanical lung ventilation. Hypophosphatemia was a common finding in critically ill children and was associated with malnutrition.
Christensen, Marit Bergheim
Background Pharmaceutical care as a health care service has already made its mark and been shown to make an important contribution to the health care system. However, there is still a demand from the NHS among others, that pharmacist to a greater extent must document their provision of pharmaceutical care. Tested out in this project, is the application of a Care Issue Categorisation System. Aims To compare two clinical settings in terms of the profile of pharmaceutical care deli...
Ben-Tovim, David I; Bassham, Jane E; Bolch, Denise; Martin, Margaret A; Dougherty, Melissa; Szwarcbord, Michael
Lean thinking is a method for organising complex production processes so as to encourage flow and reduce waste. While the principles of lean thinking were developed in the manufacturing sector, there is increasing interest in its application in health care. This case history documents the introduction and development of Redesigning Care, a lean thinking-based program to redesign care processes across a teaching general hospital. Redesigning Care has produced substantial benefits over the first two-and-a-half years of its implementation, making care both safer and more accessible. Redesigning Care has not been aimed at changing the specifics of clinical practice. Rather, it has been concerned with improving the flow of patients through clinical and other systems. Concepts that emerged in the manufacturing sector have been readily translatable into health care. Lean thinking may play an important role in the reform of health care in Australia and elsewhere.
M.S. Maputle; Nolte, A.
The purpose of the study was to explore and describe experiences of mothers during childbirth in a tertiary hospital in the Limpopo Province. This was achieved through a qualitative research study which was exploratory, descriptive, contextual and inductive in nature. A sample of 24 mothers participated in this study. Data obtained from unstructured in-depth interviews were analysed according to the protocol by Tesch (1990, cited in Cresswell, 1994:155). Five themes were identified, namely mu...
Barbusca, A; Cleek, M
Hospitals have responded to industry consolidation by increasing productivity with nonmanagement, group-incentive compensation, known as gain sharing. A nationwide study conducted to obtain quantitative performance data for gain-sharing programs revealed that they are most successful during the initial stages of the program. Many variables affect the size of employee bonuses and the duration of employee support. Employers must identify how to appropriately install their gain-sharing program so that employee motivation, participation, and trust in management are maximized.
Full Text Available Background A growing number of elderly patients are hospitalized for various causes and age has been described inconsistently as a risk factor for acquiring nosocomial infections with a subsequent higher mortality rate compared to younger patients. Objectives To describe the incidence, type, and microbiological characteristics of nosocomial infections in elderly and non-elderly patients. Patients and Methods Retrospective analysis of all hospital-acquired infections (HAIs in an academic community hospital. Patients were stratified into two groups: non-elderly (18 - 64 years and elderly (> 65 years. Results A total of 18469 patients were included (108555 hospital days in this study. About 79.6% of HAI were infected non-elderly and 20.3% elderly (P 0.05. Hospital mortality increased with every HAI diagnosed per patient. Conclusions The study showed that HAIs were more frequent in elderly population predominately with respect to VAP and infections by Gram-negative pathogens. Overall mortally was greater in the elderly group although the odds ratio for death was higher in younger patients and increased with every HAI diagnosed.
K. P. Mohana Sundari
Conclusions: Majority of maternal deaths can be prevented by adopting improved standards in early identification of preeclampsia, anemia and its management and early referral. Routine iron and folic acid supplementation to be done in an effective way. Proper antenatal care, emergency obstetrics care and routine audits are very much essential to decrease the maternal mortality as well as to know the trends of maternal deaths to develop subsequent management protocols. [Int J Reprod Contracept Obstet Gynecol 2016; 5(11.000: 3659-3662
Huber, Evelyn; Kleinknecht-Dolf, Michael; Müller, Marianne; Kugler, Christiane; Spirig, Rebecca
To define the concept of patient-related complexity of nursing care in acute care hospitals and to operationalize it in a questionnaire. The concept of patient-related complexity of nursing care in acute care hospitals has not been conclusively defined in the literature. The operationalization in a corresponding questionnaire is necessary, given the increased significance of the topic, due to shortened lengths of stay and increased patient morbidity. Hybrid model of concept development and embedded mixed-methods design. The theoretical phase of the hybrid model involved a literature review and the development of a working definition. In the fieldwork phase of 2015 and 2016, an embedded mixed-methods design was applied with complexity assessments of all patients at five Swiss hospitals using our newly operationalized questionnaire 'Complexity of Nursing Care' over 1 month. These data will be analysed with structural equation modelling. Twelve qualitative case studies will be embedded. They will be analysed using a structured process of constructing case studies and content analysis. In the final analytic phase, the quantitative and qualitative data will be merged and added to the results of the theoretical phase for a common interpretation. Cantonal Ethics Committee Zurich judged the research programme as unproblematic in December 2014 and May 2015. Following the phases of the hybrid model and using an embedded mixed-methods design can reach an in-depth understanding of patient-related complexity of nursing care in acute care hospitals, a final version of the questionnaire and an acknowledged definition of the concept. © 2016 John Wiley & Sons Ltd.
Full Text Available Background and Objective: Caring is the core of nursing however, different individules have different perceptions of it. Continuous assessment and measurement of caring behaviors results in the identification of their problems. The careful planning of interventions and problem solving will improve care. The aim of this study was to identify nurses' perception of caring behaviors in the intensive care units. Materials and Method: In this descriptive-analytic study, 140 nurses were selected from intensive care units of hospitals affiliated to Lorestan University of Medical Sciences, Iran, using the census method in 2012. The data collection tool was the Caring Behaviors Inventory for Elders (CBI-E. This questionnaire consisted of two parts including demographic information and 28 items related to care. Face and content validity of the Persian version of the questionnaire were provided by professionals, and after deletion of 4 items a 24-item questionnaire was provided. Cronbach's alpha coefficient was calculated to assess reliability (&alpha = 0.71. Data were analyzed using SPSS software version 18 and descriptive-analytic statistics (Kruskal-Wallis test and Mann-Whitney test. Results: Based on the findings, nurses paid more attention to the physical–technical aspects (95.71 ± 12.76 of care in comparison to its psychosocial aspects (75.41 ± 27.91. Nurses had the highest score in care behavior of "timely performance of medical procedures and medication administration". Conclusion: Since nurses paid more attention to the technical aspects of care than its psychosocial aspects, by providing nurses with a correct perception of care, patients can be provided with needs-based care. This will increase patient satisfaction with nursing care, and indirectly result in the positive attitude of patients and society toward the nursing profession and its services. Moreover, nursing education officials can use these results to assist nurses in meeting
Capuzzo, Maurizia; Volta, Carlo; Tassinati, Tania; Moreno, Rui; Valentin, Andreas; Guidet, Bertrand; Iapichino, Gaetano; Martin, Claude; Perneger, Thomas; Combescure, Christophe; Poncet, Antoine; Rhodes, Andrew
The aim of the study was to assess whether adults admitted to hospitals with both Intensive Care Units (ICU) and Intermediate Care Units (IMCU) have lower in-hospital mortality than those admitted to ICUs without an IMCU. An observational multinational cohort study performed on patients admitted to participating ICUs during a four-week period. IMCU was defined as any physically and administratively independent unit open 24 hours a day, seven days a week providing a level of care lower than an ICU but higher than a ward. Characteristics of hospitals, ICUs and patients admitted to study ICUs were recorded. The main outcome was all-cause in-hospital mortality until hospital discharge (censored at 90 days). One hundred and sixty-seven ICUs from 17 European countries enrolled 5,834 patients. Overall, 1,113 (19.1%) patients died in the ICU and 1,397 died in hospital, with a total of 1,397 (23.9%) deaths. The illness severity was higher for patients in ICUs with an IMCU (median Simplified Acute Physiology Score (SAPS) II: 37) than for patients in ICUs without an IMCU (median SAPS II: 29, P hospital characteristics, the odds ratio of mortality was 0.63 (95% CI 0.45 to 0.88, P = 0.007) in favour of the presence of IMCU. The protective effect of the IMCU was absent in patients who were admitted for basic observation, for example, after surgery (odds ratio 1.15, 95% CI 0.65 to 2.03, P = 0.630) but was strong in patients admitted to an ICU for other reasons (odds ratio 0.54, 95% CI 0.37 to 0.80, P = 0.002). The presence of an IMCU in the hospital is associated with significantly reduced adjusted hospital mortality for adults admitted to the ICU. This effect is relevant for the patients requiring full intensive treatment. Clinicaltrials.gov NCT01422070. Registered 19 August 2011.
Jiang, H Joanna; Friedman, Bernard; Jiang, Shenyi
Managed care substantially transformed the U.S. healthcare sector in the last two decades of the twentieth century, injecting price competition among hospitals for the first time in history. However, total HMO enrollment has declined since 2000. This study addresses whether managed care and hospital competition continued to show positive effects on hospital cost and quality performance in the "post-managed care era." Using data for 1,521 urban hospitals drawn from the Healthcare Cost and Utilization Project, we examined hospital cost per stay and mortality rate in relation to HMO penetration and hospital competition between 2001 and 2005, controlling for patient, hospital, and other market characteristics. Regression analyses were employed to examine both cross-sectional and longitudinal variation in hospital performance. We found that in markets with high HMO penetration, increase in hospital competition over time was associated with decrease in mortality but no change in cost. In markets without high HMO penetration, increase in hospital competition was associated with increase in cost but no change in mortality. Overall, hospitals in high HMO penetration markets consistently showed lower average costs, and hospitals in markets with high hospital competition consistently showed lower mortality rates. Hospitals in markets with high HMO penetration also showed lower mortality rates in 2005 with no such difference found in 2001. Our findings suggest that while managed care may have lost its strength in slowing hospital cost growth, differences in average hospital cost associated with different levels of HMO penetration across markets still persist. Furthermore, these health plans appear to put quality of care on a higher priority than before.
Venous thromboembolism (VTE) is a major cause of preventable morbidity and mortality in hospitalized patients. In spite of guidelines, VTE prophylaxis continues to be underutilised, and hospital acquired thrombosis (HAT) continues to be a problem. This study was conducted to estimate the incidence of HAT in a tertiary referral centre and to examine whether VTE risk assessment and thromboprophylaxis (TP) were implemented. Patients 18 years and above, with a radiologically-confirmed acute VTE during the study period of 15 weeks were included. Acute VTE was diagnosed in 100 patients and HAT was diagnosed in 48. There were 12,024 admissions over the study period, therefore the incidence of HAT was 0.4%. TP was prescribed in only 35% of patients, and 65% did not receive any or appropriate TP. Hospitals without active implementation of a formal risk assessment tool and TP policy are likely to continue to have increased incidence of HAT.
Bernet, Patrick M; Moises, James; Valdmanis, Vivian Grace
The efficiency of hospital services and patients' access to hospitals are both important health care policy issues. In the past, research has relied on studying these topics separately. In this article, we measure both efficiency and access at the same time using data envelopment analysis (DEA). By including both the technically efficient use of resources, as well as the patients' travel distances, we found increases in social efficiency when patients' travel distances were taken into account. When compared with patients with nonurgent conditions, we found that patients suffering from conditions requiring urgent attention were treated at closer hospitals, increasing the social efficiency. Insurance coverage and hospital ownership were also examined. Our findings corroborated past literature in the hospital and travel distance literature and set out a framework for future research. Perhaps most important, we demonstrate the techniques needed to incorporate broader measures of social costs into studies of hospital efficiency.
Macías, Marta; Zornoza, Carmen; Rodriguez, Elena; García, José A; Fernández, José A; Luque, Rafaela; Collado, Rosa
The time of admission to a hospital, especially when unplanned, has been reported as the most stressful moment of hospitalization for both parents and children (Odievre, 2001). This qualitative study explored parents and hospital staff's perceptions and experiences related to the process of admission to a pediatric unit. Focus groups, two with parents (total n = 12) and one with health care professionals (n = 6), were conducted, and content analysis inspired by Graneheim and Lundman (2004) was performed. Parents identified four categories of perceptions: 1) management of an uncertain situation at the time of admission, 2) feelings related to the child's illness, 3) parent perception of professional's performance, and 4) parent experience of their role. Health care professionals identified two categories: 1) hospital admission as a continuous care process, and 2) undertaking improvements in the admission process. A common theme emerged about the importance of parents' trust in professionals in order to build a therapeutic relationship. Findings underscore the need for strategies to improve the hospital pediatric admission process based on a parent-professional relationship of trust and confidence through continuous quality communication and support. These strategies would include providing a nurse in charge of the admission process to assure continuity of care throughout the child's hospitalization.
HAO Zhen-feng; AO Jun-hong; HAO Fei; YANG Rong-ya; ZHU He; ZHANG Jie
Background Invasive fungal infections have constituted an increasingly important cause of morbidity and mortality in immunocompromised patients. In this study, a surveillance project was conducted in three different intensive care units of two large tertiary hospitals in China.Methods A one-year surveillance project was conducted in two tertiary hospitals which located in northern China and southwest China respectively. Air, surfaces and tap water were sampled twice a month in a central intensive care unit, a bone marrow transplant unit, a neurosurgery intensive care unit and a live transplant department. Environmental conditions such as humidity, temperature and events taking place, for example the present of the visitors, healthcare staff and cleaning crew were also recorded at the time of sampling.Results The air fungal load was 91.94 cfu/m3 and 71.02 cfu/m3 in the southwest China hospital and the northern China hospital respectively. The five most prevalent fungi collected from air and surfaces were Penicillium spp., Cladospcrium spp., Altemaria spp., Aspergillus spp. and Saccharomyces spp. in the southwest China hospital, meanwhile Penicillium spp., Fusarium spp., Aspergillus spp., Altemaria spp. and Cladospcrium spp. in the northern China hospital. The least contaminated department was intensive care units, and the heaviest contaminated department was neurosurgery intensive care unit. Seventy-three percent of all surfaces examined in the northern China hospital and eighty-six percent in the southwest China hospital yielded fungi. Fifty-four percent of water samples from the northern China hospital and forty-nine percent from the southwest China hospital yielded fungi.Conclusions These findings suggested that the fungus exist in the environment of the hospital including air, surface and water. Air and surface fungal load fluctuated over the year. Air fungal load was lower in winter and higher In summer and autumn, but seldom exceeded acceptable level. The
Idenburg, Floris J.; Van Dongen, Thijs T C F; Tan, Edward C T H; Hamming, Jaap H.; Leenen, Luke P H; Hoencamp, Rigo
Background From August 2006–August 2010, as part of the ISAF mission, the Armed Forces of the Netherlands deployed a role 2 enhanced Medical Treatment Facility (R2E-MTF) to Uruzgan province, Afghanistan. Although from the principle doctrine not considered a primary task, care was delivered to civi
Surekha K. Chavan
Conclusions: Not a single case of anaphylactic reactions, TRALI, acute immune hemolytic transfusion reaction, and Sepsis was observed. This can be an underestimation of the true incidence because of under reporting which can be improved by proper hemovigilence system to provide better patient care. [Int J Res Med Sci 2016; 4(6.000: 2402-2407
Oct 12, 2015 ... Study Design. A questionnaire ... and North-West geopolitical regions of the country. Table 2 Shows the ... (40.7%) level II, and 5 (9.3%) level III class of neonatal care. The highest ..... mortality in North Carolina, 1968–. 1994.
Borofsky, Michael S; Walter, Dawn; Li, Huilin; Shah, Ojas; Goldfarb, David S; Sosa, R Ernest; Makarov, Danil V
Delivering the recommended care is an important quality measure that has been insufficiently studied in urology. Obstructive pyelonephritis is a suitable case study for this focus because many patients do not receive such care, although guidelines advocate decompression. We determined the influence of hospital factors, particularly familiarity with urolithiasis, on the likelihood of decompression in such patients. We used the NIS from 2002 to 2011 to retrospectively identify patients admitted to community hospitals with severe infection and ureteral calculi. Hospital familiarity with nephrolithiasis was estimated by calculating hospital stone volume (divided into quartiles) and hospital treatment intensity (the decompression rate in patients with ureteral calculi and no infection). After calculating national estimates we performed logistic regression to determine the association between the receipt of decompression and hospital stone volume, controlling for treatment intensity and other covariates thought to be associated with receiving recommended care. Of an estimated 107,848 patients with obstructive pyelonephritis 27.4% failed to undergo decompression. Discrepancies were greatest between hospitals with the highest and lowest stone volumes (76% vs 25%, OR 2.77, 95% CI 1.94-3.96, p <0.01) as well as high and low treatment intensity (78% vs 37%, p <0.01). High hospital stone volume and treatment intensity were associated with an increased likelihood of receiving decompression. Such findings might be useful to identify hospitals and regions where access to quality urological care should be augmented. Copyright © 2015 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.
Intensive care remains an area of high acuity and high mortality across the globe. With a rapidly aging population, the disease burden requiring intensive care is growing. The cost of critical care also is rising with new technology becoming available rapidly. We present the all-cause mortality results of 5 years database established in a restructured, large public hospital in Singapore, looking at all three types of Intensive Care Units present in our hospital. These include medical, surgical, and coronary care units.
..., domiciliary or nursing home care of persons discharged or released from active military, naval, or air service... Hospital, Domiciliary and Nursing Home Care § 17.46 Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from active military, naval, or air service. (a) In...
Lu, W.L.; Jansen, L.; Schaapveld, M.; Baas, P.C.; Wiggers, T.; de Bock, G.H.
Background: After primary treatment for breast cancer, patients are recommended to use hospital follow-up care routinely. Long-term data on the utilization of this follow-up care are relatively rare. Methods: Information regarding the utilization of routine hospital follow-up care was retrieved from
Carmel, Amanda S; Steel, Peter; Tanouye, Robert; Novikov, Aleksey; Clark, Sunday; Sinha, Sanjai; Tung, Judy
Hospital admissions from the emergency department (ED) now account for approximately 50% of all admissions. Some patients admitted from the ED may not require inpatient care if outpatient care could be optimized. However, access to primary care especially immediately after ED discharge is challenging. Studies have not addressed the extent to which hospital admissions from the ED may be averted with access to rapid (next business day) primary care follow-up. We evaluated the impact of an ED-to-rapid-primary-care protocol on avoidance of hospitalizations in a large, urban medical center. We conducted a retrospective review of patients referred from the ED to primary care (Weill Cornell Internal Medicine Associates - WCIMA) through a rapid-access-to-primary-care program developed at New York-Presbyterian / Weill Cornell Medical Center. Referrals were classified as either an avoided admission or not, and classifications were performed by both emergency physician (EP) and internal medicine physician reviewers. We also collected outcome data on rapid visit completion, ED revisits, hospitalizations and primary care engagement. EPs classified 26 (16%) of referrals for rapid primary care follow-up as avoided admissions. Of the 162 patients referred for rapid follow-up, 118 (73%) arrived for their rapid appointment. There were no differences in rates of ED revisits or subsequent hospitalizations between those who attended the rapid follow-up and those who did not attend. Patients who attended the rapid appointment were significantly more likely to attend at least one subsequent appointment at WCIMA during the six months after the index ED visit [N=55 (47%) vs. N=8 (18%), P=0.001]. A rapid-ED-to-primary-care-access program may allow EPs to avoid admitting patients to the hospital without risking ED revisits or subsequent hospitalizations. This protocol has the potential to save costs over time. A program such as this can also provide a safe and reliable ED discharge option
... long-term care hospital within 3 days of the discharge from the long-term care hospital. The 3-day or... discharge to an acute care hospital, the applicable fixed day period is between 4 and 9 consecutive days. The counting of the days begins on the date of discharge from the long-term care hospital and......
Huynh, Dep K; Selvanderan, Shane P; Harley, Hugh A J; Holloway, Richard H; Nguyen, Nam Q
To evaluate the practice of nutritional assessment and management of hospitalised patients with cirrhosis and the impact of malnutrition on their clinical outcome. This was a retrospective cohort study on patients with liver cirrhosis consecutively admitted to the Department of Gastroenterology and Hepatology at the Royal Adelaide Hospital over 24 mo. Details were gathered related to the patients' demographics, disease severity, nutritional status and assessment, biochemistry and clinical outcomes. Nutritional status was assessed by a dietician and determined by subjective global assessment. Estimated energy and protein requirements were calculated by Simple Ratio Method. Intake was estimated from dietary history and/or food charts, and represented as a percentage of estimated daily requirements. Median duration of follow up was 14.9 (0-41.4) mo. Of the 231 cirrhotic patients (167 male, age: 56.3 ± 0.9 years, 9% Child-Pugh A, 42% Child-Pugh B and 49% Child-Pugh C), 131 (57%) had formal nutritional assessment during their admission and 74 (56%) were judged to have malnutrition. In-hospital caloric (15.6 ± 1.2 kcal/kg vs 23.7 ± 2.3 kcal/kg, P = 0.0003) and protein intake (0.65 ± 0.06 g/kg vs 1.01 ± 0.07 g/kg, P = 0.0003) was significantly reduced in patients with malnutrition. Of the malnourished cohort, 12 (16%) received enteral nutrition during hospitalisation and only 6 (8%) received ongoing dietetic review and assessment following discharge from hospital. The overall mortality was 51%, and was higher in patients with malnutrition compared to those without (HR = 5.29, 95%CI: 2.31-12.1; P nutritional assessment, however, is inadequate. This highlights the need for meticulous nutritional evaluation and management in these patients.
Bartick, Melissa; Stuebe, Alison; Shealy, Katherine R; Walker, Marsha; Grummer-Strawn, Laurence M
Evidence shows that hospital-based practices affect breastfeeding duration and exclusivity throughout the first year of life. However, a 2007 CDC survey of US maternity facilities documented poor adherence with evidence-based practice. Of a possible score of 100 points, the average hospital scored only 63 with great regional disparities. Inappropriate provision and promotion of infant formula were common, despite evidence that such practices reduce breastfeeding success. Twenty-four percent of facilities reported regularly giving non-breast milk supplements to more than half of all healthy, full-term infants. Metrics available for measuring quality of breastfeeding care, range from comprehensive Baby-Friendly Hospital Certification to compliance with individual steps such as the rate of in-hospital exclusive breastfeeding. Other approaches to improving quality of breastfeeding care include (1) education of hospital decision-makers (eg, through publications, seminars, professional organization statements, benchmark reports to hospitals, and national grassroots campaigns), (2) recognition of excellence, such as through Baby-Friendly hospital designation, (3) oversight by accrediting organizations such as the Joint Commission or state hospital authorities, (4) public reporting of indicators of the quality of breastfeeding care, (5) pay-for-performance incentives, in which Medicaid or other third-party payers provide additional financial compensation to individual hospitals that meet certain quality standards, and (6) regional collaboratives, in which staff from different hospitals work together to learn from each other and meet quality improvement goals at their home institutions. Such efforts, as well as strong central leadership, could affect both initiation and duration of breastfeeding, with substantial, lasting benefits for maternal and child health.
... record FAH Federation of Hospitals FDA Food and Drug Administration FFY Federal fiscal year FQHC... 2008, Public Law 110-275 MMA Medicare Prescription Drug, Improvement, and Modernization Act of 2003... (B) Antineoplastic Chemotherapy Induced Anemia (C) Cardiomyopathy and Congestive Heart Failure...
... Electronic medical record FAH Federation of Hospitals FDA Food and Drug Administration FFY Federal fiscal... for Patients and Providers Act of 2008, Public Law 110-275 MMA Medicare Prescription Drug, Improvement... Diagnosis Codes for FY 2013 (A) Protein-Calorie Malnutrition (B) Antineoplastic Chemotherapy Induced Anemia...
... entities include small businesses, nonprofit organizations, and small governmental jurisdictions. Most hospitals and most other providers and suppliers are small entities, either by nonprofit status or by having... and states are not included in the definition of a small entity. As discussed above, this...
... 50547 in Table 4J, we inadvertently omitted providers located in Tarrant County, TX that are eligible to... 360096 * 0.0011 COLUMBIANA 36140 670023 0.0054 TARRANT 45910 670042 0.0054 TARRANT 45910 670046 0.0054 TARRANT 45910 6. On pages 50593 and 50604, in Table 9A.--Hospital Reclassifications and...
Full Text Available Background: Biomedical waste (BMW is waste generated during diagnosis, treatment or immunization of human beings or animals. Approximately 10-25% of the Bio-Medical waste is hazardous and can be injurious to humans or animals and deleterious to environment. It is estimated that annually about 0.33 million tones of hospital waste are generated in India. Objectives: To assess the knowledge regarding hospital waste management amongst hospital staff. Material and Methods: The study comprises of assessment of the knowledge regarding BMW management. For this purpose, a 10% sample of each of the 4 categories of staff on roll was randomly selected for the study; the sample consisted of 110 respondents: 38 doctors, 44 nurses, 21 Lab-technicians and 7 waste handlers/supporting staff. Results: The knowledge of doctors about BMW management & handling rule was much better (92.1% as compared to nurses (54.5% and Lab-technicians (47.6% and it was statistically significant (p-value < 0.05. Conclusion: The doctors where observed to be good in theoretical knowledge. While in case of nurses and lab-technicians the reverse was true. Recommendation: The need of comprehensive training programs regarding Bio-Medical waste management is highly recommended to all hospital staff.
...) of the Act requires us to determine and publish each year the amount of the inpatient hospital... (see section 1886(b)(3)(B)(xii)(II) of the Act), and an adjustment based on changes in the economy-wide.... In addition, section 1102(b) of the Social Security Act requires us to prepare a regulatory impact...
Cormier, Scott; Wargo, Michael; Winslow, Walter
A health care emergency preparedness coalition (coalition) is a group of health care organizations, public safety agencies, and public health partners that join forces for the common cause of making their communities safer, healthier, and more resilient. Coalitions have been characterized as being focused on hospital systems instead of the health care of the community as a whole. We discuss 2 examples of coalition partners that use a more inclusive approach to planning, response, and recovery. The first is a large health care system spread across 23 states, and the other is a public safety agency in northeast Pennsylvania that took the lead to address the preparedness and response toward a large influx of burn patients and grew to encompass all aspects of community health care.
Steinman, Milton; Morbeck, Renata Albaladejo; Pires, Philippe Vieira; Abreu Filho, Carlos Alberto Cordeiro; Andrade, Ana Helena Vicente; Terra, Jose Claudio Cyrineu; Teixeira Junior, José Carlos; Kanamura, Alberto Hideki
To describe the impact of the telemedicine application on the clinical process of care and its different effects on hospital culture and healthcare practice. The concept of telemedicine through real time audio-visual coverage was implemented at two different hospitals in São Paulo: a secondary and public hospital, Hospital Municipal Dr. Moysés Deutsch, and a tertiary and private hospital, Hospital Israelita Albert Einstein. Data were obtained from 257 teleconsultations records over a 12-month period and were compared to a similar period before telemedicine implementation. For 18 patients (7.1%) telemedicine consultation influenced in diagnosis conclusion, and for 239 patients (92.9%), the consultation contributed to clinical management. After telemedicine implementation, stroke thrombolysis protocol was applied in 11% of ischemic stroke patients. Telemedicine approach reduced the need to transfer the patient to another hospital in 25.9% regarding neurological evaluation. Sepsis protocol were adopted and lead to a 30.4% reduction mortality regarding severe sepsis. The application is associated with differences in the use of health services: emergency transfers, mortality, implementation of protocols and patient management decisions, especially regarding thrombolysis. These results highlight the role of telemedicine as a vector for transformation of hospital culture impacting on the safety and quality of care.
Nelson, Katherine E; Hexem, Kari R; Feudtner, Chris
Trisomy 13 and trisomy 18 are generally considered fatal anomalies, with a majority of infants dying in the first year after birth. The inpatient hospital care that these patients receive has not been adequately described. This study characterized inpatient hospitalizations of children with trisomy 13 and trisomy 18 in the United States, including number and types of procedures performed. Retrospective repeated cross-sectional assessment of hospitalization data from the nationally representative US Kids' Inpatient Database, for the years 1997, 2000, 2003, 2006, and 2009. Included hospitalizations were of patients aged 0 to 20 years with a diagnosis of trisomy 13 or trisomy 18. The number of hospitalizations for each trisomy type ranged from 846 to 907 per year for trisomy 13 (P = .77 for temporal trend) and 1036 to 1616 per year for trisomy 18 (P < .001 for temporal trend). Over one-third (36%) of the hospitalizations were of patients older than 1 year of age. Patients underwent a total of 2765 major therapeutic procedures, including creation of esophageal sphincter (6% of hospitalizations; mean age 23 months), repair of atrial and ventricular septal defects (4%; mean age 9 months), and procedures on tendons (4%; mean age 8 years). Children with trisomy 13 and trisomy 18 receive significant inpatient hospital care. Despite the conventional understanding of these syndromes as lethal, a substantial number of children are living longer than 1 year and undergoing medical and surgical procedures as part of their treatment.
Nantsupawat, Apiradee; Srisuphan, Wichit; Kunaviktikul, Wipada; Wichaikhum, Orn-Anong; Aungsuroch, Yupin; Aiken, Linda H
To determine the impact of nurse work environment and staffing on nurse outcomes, including job satisfaction and burnout, and on quality of nursing care. Secondary data analysis of the 2007 Thai Nurse Survey. The sample consisted of 5,247 nurses who provided direct care for patients across 39 public hospitals in Thailand. Multivariate logistic regression was used to estimate the impact of nurse work environment and staffing on nurse outcomes and quality of care. Nurses cared for an average of 10 patients each. Forty-one percent of nurses had a high burnout score as measured by the Maslach Burnout Inventory; 28% of nurses were dissatisfied with their job; and 27% rated quality of nursing care as fair or poor. At the hospital level, after controlling for nurse characteristics (age, years in unit), the addition of each patient to a nurse's workload was associated with a 2% increase in the odds on nurses reporting high emotional exhaustion (odds ratio [OR] 1.02; 95% confidence interval [CI] 1.00-1.03; p work environments were about 30% less likely to report fair to poor care quality (OR 0.69; 95% CI 0.48-0.98; p work environments. The addition of each patient to a nurse's workload was associated with a 4% increase in the odds on nurses reporting quality of nursing care as fair or poor (OR 1.04; 95% CI 1.02-1.05; p work environments and nurse staffing in Thai hospitals holds promise for reducing nurse burnout, thus improving nurse retention at the hospital bedside as well as potentially improving the quality of care. Nurses should work with management and policymakers to achieve safe staffing levels and good work environments in hospitals throughout the world. © 2011 Sigma Theta Tau International.
Ebben, Steven F; Gieras, Izabella A; Gosbee, Laura Lin
Since the Institute of Medicine's well-publicized 1999 report To Err is Human, the healthcare patient safety movement has grown at an exponential pace. However, much more can be done to advance patient safety from a care process design vantage point-improving safety through effective care processes and technology integration. While progress is being made, the chasm between technology developers and caregivers remains a profound void. Why hasn't more been done to expand our view of patient safety to include technology design? Healthcare organizations have not consolidated their purchasing power to expect improved designs. This article will (1) provide an assessment of the present state of healthcare technology management and (2) provide recommendations for collaborative design of safe healthcare delivery systems.
Full Text Available Background: Ocular trauma is an important public health hazard. The objective of the study was to determine the pattern of ocular trauma among patients presenting in Mamata Medical College and Hospital, Khammam. Methods: Two years retrospective review of records of 120 patients with ocular trauma seen from Jan 2013 to Feb 2015 was done using a structured format. Results: Ocular trauma accounted for 1.2% of the total ocular patients seen at OPD and Emergency. Of the studied 120 cases, 74 patients were below 30 years of age. 17 (14.16% patients presented to hospital within 2-7 days of injury. Conclusion: Duration of presentation has significant association with the presence of infection and other complication. The cause of injury were road traffic accidents, occupation related and sports playing and recreational activities in 54(45%, 39(32.5% and 24(20% respectively. Closed globe injuries accounted for 38(31.66% and open globe for 58(48.33% and adenexal injuries constituted 24(20%. Delay in presentation was associated with complications. [Int J Res Med Sci 2015; 3(6.000: 1426-1430
Narang, Ritu; Polsa, Pia; Soneye, Alabi; Fuxiang, Wei
Healthcare service quality studies primarily examine the relationships between patients' perceived quality and satisfaction with healthcare services, clinical effectiveness, service use, recommendations and value for money. These studies suggest that patient-independent quality dimensions (structure, process and outcome) are antecedents to quality. The purpose of this paper is to propose an alternative by looking at the relationship between hospital atmosphere and healthcare quality with perceived outcome. Data were collected from Finland, India, Nigeria and the People's Republic of China. Regression analysis used perceived outcome as the dependent variable and atmosphere and healthcare service quality as independent variables. Findings - Results showed that atmosphere and healthcare service quality have a statistically significant relationship with patient perceived outcomes. The sample size was small and the sampling units were selected on convenience; thus, caution must be exercised in generalizing the findings. The study determined that service quality and atmosphere are considered significant for developing and developed nations. This result could have significant implications for policy makers and service providers developing healthcare quality and hospital atmosphere. Studies concentrate on healthcare outcome primarily regarding population health status, mortality, morbidity, customer satisfaction, loyalty, quality of life, customer behavior and consumption. However, the study exposes how patients perceive their health after treatment. Furthermore, the authors develop the healthcare service literature by considering atmosphere and perceived outcome.
BACKGROUND: Robust international data support the effectiveness of stroke unit (SU) care. Despite this, most stroke care in Ireland are provided outside of this setting. Limited data currently exist on the quality of care provided. AIM: The aim of this study is to examine the quality of care for patients with stroke in two care settings-Regional General Hospital (RGH) and Stroke Rehabilitation Unit (SRU). METHODS: A retrospective analysis of the stroke records of consecutive patients admitted to the SRU between May-November 2002 and April-November 2004 was performed applying the UK National Sentinel Audit of Stroke (NSAS) tool. RESULTS: The results of the study reveal that while SRU processes of care was 74% compliant with standards; compliance with stroke service organisational standards was only 15 and 43% in the RGH and SRU, respectively. CONCLUSION: The quality of stroke care in our area is deficient. Comprehensive reorganisation of stroke services is imperative.
Bonten, M J M
The Netherlands Health Care Inspectorate investigated the quality of medical microbiology laboratories in Dutch hospitals. By and large the laboratories fulfilled the requirements for appropriate care, although some processes were unsatisfactory and some were insufficiently formalised. In the Netherlands, laboratories for medical microbiology are integrated within hospitals and medical microbiologists are responsible for the diagnostic processes as well as for co-treatment of patients, infection prevention and research. This integrated model contrasts to the more industrialised model in many other countries, where such laboratories are physically distinct from hospitals with a strong focus on diagnostics. The Inspectorate also concludes that the current position of medical microbiology in Dutch hospitals is necessary for patient safety and that outsourcing of these facilities is considered unacceptable.
Pedersen, Mona Kyndi; Meyer, Gabriele; Uhrenfeldt, Lisbeth
summary and metasynthesis of the quantitative findings was conducted. RESULTS: Based on a review of nine studies from ten Western countries, we found several significant risk factors pertaining to readmission to an acute care hospital within one month of discharge in persons aged 65 years and over....... To allow health professionals to focus more intensively on patients at risk of readmission, there is a need to identify the characteristics of those patients. OBJECTIVES: To identify and synthesize the best available evidence on risk factors for acute care hospital readmission within one month of discharge...... in older persons in Western countries. INCLUSION CRITERIA TYPES OF PARTICIPANTS: Participants were older persons from Western countries, hospitalized and discharged home or to residential care facilities. TYPES OF INTERVENTION(S)/PHENOMENA OF INTEREST: The factors of interest considered generic factors...
Norlyk, Annelise; Haahr, Anita; Dreyer, Pia
and values from evidence-based medicine are being lost in the transformation into the current evidence-based hospital culture which potentially leads to a McDonaldization of nursing practice reflected as ‘one best way’. We argue for reviving ethics of care perspectives in today’s evidence practice...... as the fundamental values of nursing may potentially bridge conflicts between evidence-based practice and the ideals of patient participation thus preventing a practice of ‘McNursing’. Key words: nursing practice, evidence-based practice, nursing theory, nursing theorists, ethics of care, hospital culture, patient......Drawing on our previous empirical research, we provide an exemplary narrative to illustrate how patients have experienced hospital care organized according to evidence-based fast-track programmes. The aim of this paper is to analyse and discuss if and how it is possible to include patients...
Ensing, Hendrik T; Koster, Ellen S; Stuijt, Clementine C M; van Dooren, Ad A; Bouvy, Marcel L
Bridging the gap between hospital and primary care is important as transition from one healthcare setting to another increases the risk on drug-related problems and consequent readmissions. To reduce those risks, pharmacist interventions during and after hospitalization have been frequently studied, albeit with variable effects. Therefore, in this manuscript we propose a three phase approach to structurally address post-discharge drug-related problems. First, hospitals need to transfer up-todate medication information to community pharmacists. Second, the key phase of this approach consists of adequate follow-up at the patients' home. Pharmacists need to apply their clinical and communication skills to identify and analyze drug-related problems. Finally, to prevent and solve identified drug related problems a close collaboration within the primary care setting between pharmacists and general practitioners is of utmost importance. It is expected that such an approach results in improved quality of care and improved patient safety.
Pracht, Etienne E; Bass, Elizabeth
This paper explores the link between utilization of ambulatory care and the likelihood of rehospitalization for an avoidable reason in veterans served by the Veteran Health Administration (VA). The analysis used administrative data containing healthcare utilization and patient characteristics stored at the national VA data warehouse, the Corporate Franchise Data Center. The study sample consisted of 284 veterans residing in Florida who had been hospitalized at least once for an avoidable reason. A bivariate probit model with instrumental variables was used to estimate the probability of rehospitalization. Veterans who had at least 1 ambulatory care visit per month experienced a significant reduction in the probability of rehospitalization for the same avoidable hospitalization condition. The findings suggest that ambulatory care can serve as an important substitute for more expensive hospitalization for the conditions characterized as avoidable.
Burton, M Caroline; Warren, Mark; Cha, Stephen S; Stevens, Maria; Blommer, Megan; Kung, Simon; Lapid, Maria I
Identifying patients who will benefit from a palliative care approach is the first critical step in integrating palliative with curative therapy. Criteria are established that identify hospitalized medical patients who are near end of life, yet there are no criteria with respect to hospitalized patients with psychiatric disorders. The records of 276 consecutive patients admitted to a dedicated inpatient psychiatric unit were reviewed to identify prognostic criteria predictive of mortality. Mortality predictors were 2 or more admissions in the past year (P = .0114) and older age (P = .0006). Twenty-two percent of patients met National Hospice and Palliative Care Organization noncancer criteria for dementia. Palliative care intervention should be considered when treating inpatients with psychiatric disorders, especially older patients who have a previous hospitalization or history of dementia.
Full Text Available Kieran J Rothnie,1,2 Hana Müllerová,3 Sara L Thomas,2 Joht S Chandan,4 Liam Smeeth,2 John R Hurst,5 Kourtney Davis,3 Jennifer K Quint1,2 1Respiratory Epidemiology, Occupational Medicine and Public Health, National Heart and Lung Institute, Imperial College London, London, UK; 2Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; 3Respiratory Epidemiology, GlaxoSmithKline R&D, Uxbridge, London; 4Medical School, 5UCL Respiratory, University College London, London, UK Background: Accurate identification of hospitalizations for acute exacerbations of chronic obstructive pulmonary disease (AECOPD within electronic health care records is important for research, public health, and to inform health care utilization and service provision. We aimed to develop a strategy to identify hospitalizations for AECOPD in secondary care data and to investigate the validity of strategies to identify hospitalizations for AECOPD in primary care data. Methods: We identified patients with chronic obstructive pulmonary disease (COPD in the Clinical Practice Research Datalink (CPRD with linked Hospital Episodes Statistics (HES data. We used discharge summaries for recent hospitalizations for AECOPD to develop a strategy to identify the recording of hospitalizations for AECOPD in HES. We then used the HES strategy as a reference standard to investigate the positive predictive value (PPV and sensitivity of strategies for identifying AECOPD using general practice CPRD data. We tested two strategies: 1 codes for hospitalization for AECOPD and 2 a code for AECOPD other than hospitalization on the same day as a code for hospitalization due to unspecified reason. Results: In total, 27,182 patients with COPD were included. Our strategy to identify hospitalizations for AECOPD in HES had a sensitivity of 87.5%. When compared with HES, using a code suggesting hospitalization for AECOPD in CPRD resulted in a PPV of 50.2% (95
Full Text Available Abstract Access to timely and quality maternal health care remains to be a major development challenge in many developing economies particularly in Kenya. The countrys system of providing maternal health care also continue to be anchored on conventional methods of physical presence of the patient and the doctor in a hospital setup. The countrys ICT and health policies also place very little emphasis on the use of these platforms. This study therefore sought to establish the factors affecting the adoption of mHealth by focusing on maternal health in Nakuru Provincial General Hospital. Objectives of the study were to determine the extent to knowledge and awareness affects the adoption of mHealth in maternal health care at Nakuru PGH to identify the government policies affecting the adoption of mHealth in maternal health care at Nakuru PGH to assess how access to technology affects the adoption of mHealth in maternal healthcare to establish the effects of ICT infrastructure on the adoption of mHealth in maternal health care and to identify the cost aspects affecting the adoption of mHealth in maternal health care at Nakuru Provincial General Hospital. It is envisaged that the study could provide useful information on the adoption of mHealth in managing maternal health care in Nakuru Provincial General Hospital. Descriptive survey research design will be used where all the medical staff and patients of Nakuru Provincial General Hospital was surveyed. The study population therefore was made up of 24 medical staff and 3460 mothers visiting the antenatal clinic selected using clustered random sampling technique. The main instrument for primary data collection was the questionnaire. Data analysis was then done using both descriptive and inferential statistics. Descriptive statistics to be used include frequency counts percentages and measures of central tendency. Inferential statistics on the other hand include t-test analysis and spearman correlation
Dong, Gang Nathan
Fiscal constraints faced by U.S. hospitals as a result of the recent economic downturn are leading to business practices that reduce costs and improve financial and operational efficiency in hospitals. There naturally arises the question of how this finance-driven management culture could affect the quality of care. This paper attempts to determine whether the process measures of treatment quality are correlated with hospital financial performance. Panel study of hospital care quality and financial condition between 2005 and 2010 for cardiovascular disease treatment at acute care hospitals in the United States. Process measures for condition-specific treatment of heart attack and heart failure and hospital-level financial condition ratios were collected from the CMS databases of Hospital Compare and Cost Reports. There is a statistically significant relationship between hospital financial performance and quality of care. Hospital profitability, financial leverage, asset liquidity, operating efficiency, and costs appear to be important factors of health care quality. In general, public hospitals provide lower quality care than their nonprofit counterparts, and urban hospitals report better quality score than those located in rural areas. Specifically, the first-difference regression results indicate that the quality of treatment for cardiovascular patients rises in the year following an increase in hospital profitability, financial leverage, and labor costs. The results suggest that, when a hospital made more profit, had the capacity to finance investment using debt, paid higher wages presumably to attract more skilled nurses, its quality of care would generally improve. While the pursuit of profit induces hospitals to enhance both quantity and quality of services they offer, the lack of financial strength may result in a lower standard of health care services, implying the importance of monitoring the quality of care among those hospitals with poor financial health.
Tondatti, Paula Chadi; Corrêa, Ione
Objective. To identify and analyze scientific publications on the use of music and play in pediatric nursing care in the hospital context. Method. In this bibliographic study, papers were sought that were published in Portuguese or English between 2004 and 2009 and included the descriptors: hospitalized child, childhood, child recreation, nursing team, nursing, pediatric nursing, alternatives therapies, music, music therapy, play and playthings, play therapy, playing. For the review, the bibl...
A hospital based outcomes management system permits physicians, patients, administrators, and purchasers of care to evaluate treatment efficacy and provider quality. Current information technology available in most hospitals will permit institutions to implement outcomes management systems at moderate cost and with substantial benefits. The system must include patient demographics, diagnostic and procedural data, economic indicators, and long-term outcome information. This paper provides a br...
Full Text Available 2010 represented the moment when the reform was applied in the health field by decentralizing the management ofthe health units with beds (hospitals. This analysis points out the way hospital financing was carried out after that and the main problems the health care system of Romania has to deal with. In the end there are presented a few personal considerations on the main challenges for the future
Schwierz, Christoph; Wübker, Achim; Wübker, Ansgar; Kuchinke, Björn A
This paper shows that patients with private health insurance (PHI) are being offered significantly shorter waiting times than patients with statutory health insurance (SHI) in German acute hospital care. This behavior may be driven by the higher expected profitability of PHI relative to SHI holders. Further, we find that hospitals offering private insurees shorter waiting times when compared with SHI holders have a significantly better financial performance than those abstaining from or with less discrimination.
Milošević Ivana; Korać Miloš; Stevanović Goran; Jevtović Đorđe; Milošević Branko; Jovanović Milica; Dulović Olga; Pavlović Milorad
Bacground/Aim. Nosocomial infections (NIs) are an important cause of morbidity, mortality and prolonged hospitalizations. Fifty percent of NIs have been reported in Intensive Care Units. The aim of this study was to determine the frequency and type of NIs among critically ill patients treated in the University Hospital for Infectious and Tropical Diseases, Clinical Centre of Serbia, as well as risk factors for acquiring them. Methods. This prospective cohor...
Asghar, Zahid; Phung, Viet‐Hai
Abstract Objectives Few studies have investigated the quality of pre‐hospital care by ethnicity. We aimed to investigate ethnic differences in pre‐hospital ambulance care of patients with suspected cardiac pain. Methods We conducted a cross‐sectional analysis of retrospective electronic clinical data for patients with suspected cardiac pain over one year (August 2011 to July 2012) extracted from a single regional ambulance service. This included patient demographic data, clinical measurements, drugs administered and outcomes, such as transportation to hospital or referral to primary care. We used multivariate regression to investigate differences in care by ethnicity comparing non‐White with White patients. Results There were 7046 patients with suspected cardiac pain, with 4825 who had ethnicity recorded including 4661 (96.6%) White and 164 (3.4%) non‐White. After correcting for age, sex, socio‐economic status and whether transported to hospital, non‐White patients were significantly more likely to have temperature [odds ratio (OR) 2.96, P = 0.007], blood glucose (OR 3.95, P = 0.003), respiratory rate (OR 4.94, P = 0.03) and oxygen saturation (OR 2.43, P = 0.006) recorded. Non‐White patients were significantly less likely to be transported to hospital (OR 0.43, P = 0.03). Conclusion There were significant differences in pre‐hospital ambulance care for non‐White compared with White patients with suspected cardiac pain. These differences could be due to differences in clinical condition or case‐mix, language and cultural barriers, limited understanding of appropriate use of health care services, recording bias or true differences in provider management. Further analysis should involve larger and more complete data sets to explore ethnic differences in greater detail. PMID:26968133
Full Text Available IntroductionThe extreme variability of clinical severity in medical admitted patients is diluted in a “average” standard of care, that may be stronger than the real needs for someone, but clearly inadequate, sometimes even dangerous, for other ones, critically ill.DiscussionThe model of a differentiated intensity of hospital care can be defined as the organizational model structured to areas/sectors dedicated to patients with homogeneous needs of care. The intermediate care unit (“High dependency units”, “sub-intensive care areas” – “high care units” are particularly suitable for patients who have a lower risk compared to patients treated in intensive care, but liable to develop complications and needing a close monitoring much more than the “standard”, “routine” care. The implementation of the a new organizational model must be careful and consider the possible enlargement errors that can be made. The analysis of the context is necessary for assess prerequisites, excluding the elements opposed to the success of the proposed model (i.e.: wards congestion and overcrowding, with a consequential with increased risk of adverse events. Before implementing and admitting patients in new “models”, we have to define the epidemiological population characteristics, their level of complexity/criticality/instability and the current assessment tools.ConclusionsAny new proposal of hospital management change has, as first obligation, to explicit the basic visions and primary goals for “the added value” resulting to the patient and the whole organization, with the evidence of an “health technology assessment” approach, for the professional hospital overall governance. But without the presumption, or worse, the apodictic assertion, to proclaim the implementation of structures with “differentiated intensity of hospital care” organizations that are not.
Full Text Available Abstract Background Standardized patient surveys are widely used for assessing quality of healthcare from the patient perspective. An important purpose of such surveys is to identify disparities in care among different patient groups. The purpose of this study was to 1. evaluate aspects of the validity of the adapted Swedish version of the Picker Patient Care Experience -15 (PPE-15 survey and 2. examine the explanatory value of various socio-demographic and health characteristics in predicting patients’ care experiences. Methods A retrospective cross-sectional study design was used. Patients discharged from internal medicine wards at regional and university hospitals in different parts of Sweden during 2010 were invited to participate in the regularly administered national care-experience survey for hospital care. The internal validity of the PPE-15 was assessed with Cronbach’s alpha and item-scale correlations. Pearson product–moment correlation coefficients were used to compare PPE-15 total scores with overall care satisfaction ratings and Spearman correlation coefficients were used to compare PPE-15 total scores with various patient characteristics. Multiple linear regression analysis was performed to examine the influence of various patient characteristics on PPE-15 scores. Results The response rate was 66% (n = 34 603. Cronbach’s alpha was 0.87. The correlation between the PPE-15 total score and overall care satisfaction was high (0.62, p Conclusions Our results supported the internal validity of the Swedish adapted version of the PPE-15. The explanatory value of the examined patient socio-demographic and health characteristics was low, suggesting the need for exploring other patient-related determinants of care experiences. Our findings also suggest a care paradox: patients in greatest need of hospital care are least satisfied with the quality of the care they receive.
Ben-Josef, Gal; Ott, Lesli S; Spivack, Steven B; Wang, Changqin; Ross, Joseph S; Shah, Sachin J; Curtis, Jeptha P; Kim, Nancy; Krumholz, Harlan M; Bernheim, Susannah M
It is unknown whether hospitals with percutaneous coronary intervention (PCI) capability provide costlier care than hospitals without PCI capability for patients with acute myocardial infarction. The growing number of PCI hospitals and higher rate of PCI use may result in higher costs for episodes-of-care initiated at PCI hospitals. However, higher rates of transfers and postacute care procedures may result in higher costs for episodes-of-care initiated at non-PCI hospitals. We identified all 2008 acute myocardial infarction admissions among Medicare fee-for-service beneficiaries by principal discharge diagnosis and classified hospitals as PCI- or non-PCI-capable on the basis of hospitals' 2007 PCI performance. We added all payments from admission through 30 days postadmission, including payments to hospitals other than the admitting hospital. We calculated and compared risk-standardized payment for PCI and non-PCI hospitals using 2-level hierarchical generalized linear models, adjusting for patient demographics and clinical characteristics. PCI hospitals had a higher mean 30-day risk-standardized payment than non-PCI hospitals (PCI, $20 340; non-PCI, $19 713; Phospitals had higher PCI rates (39.2% versus 13.2%; Phospitals. Despite higher PCI and coronary artery bypass graft rates for Medicare patients initially presenting to PCI hospitals, PCI hospitals were only $627 costlier than non-PCI hospitals for the treatment of patients with acute myocardial infarction in 2008. © 2014 American Heart Association, Inc.
Wang, Xiuli; Pan, Jay
Background There is a great disparity in spatial accessibility to hospital care between ethnic minority and non-minority regions in China. Being one of the basic social demands, spatial access to hospital care in minority regions draws increasing attention in China in recent years. We performed this study to have a better understanding of spatial access to hospital care in ethnic minority region in China, and to guide the allocation of government investment in the future. Methods Sichuan Prov...
Solheim, K; Kjølseth, I; Nordal, H J; Molaug, M
Euthanasia, i.e. active termination of life in a seriously ill patient, is not performed in Norway at present. Between active and so-called passive euthanasia there is a "grey zone", and it is discussed where the border should be drawn, how and by whom. The decision to treat or not is becoming increasingly difficult, due to technical advances in the development of life-supporting devices. There is increasing sympathy for the view that it is not the duty of the medical profession to prolong the life of patients under all circumstances. The present paper discusses such problems in relation to hospitalized patients in an acute life-threatening situation, and in patients with, known, chronic disabling, or malignant disease.
Kodner, D L
In the next two decades, rapid, fundamental changes will take place in the way we finance, organize, and provide long-term care services. Because the elderly make up such a large portion of the patient population, America's hospitals should be concerned--and involved. There are six keys to the future of long-term care: a sharp increase in elderly population, a new generation of elderly, restrained government role, intergenerational strains, growing corporate concern, and the rise of "gerotechnology." These trends and countertrends will result in a new look in the long-term care landscape. By the year 2010, changes will include a true public-private financing system, provider reimbursement on the basis of capitation and prospective payment, coordinated access to services, dominant alternative delivery systems, a different breed of nursing homes, fewer staffing problems, patient-centered care, a new importance in housing, and an emphasis on prevention. For hospitals, this future vision of long-term care means that significant opportunities will open up to meet the needs of the elderly-at-risk and to achieve a competitive position in the burgeoning elderly care industry.
Sim, S K; Lim, S L; Lee, H K; Liew, D; Wong, A
Intensive care for severe head injury patients is very important in the prevention and treatment of secondary brain injury. However, in a resources constraint environment and limited availability of Intensive Care Unit (ICU) beds in the hospitals, not all severe head injury patients will receive ICU care. This prospective study is aimed to evaluate the outcome of severe head injured patients who received ICU and general ward care in Sarawak General Hospital (SGH) over a 6-month period. A total of thirty five severe head injury patients were admitted. Twenty three patients (65.7%) were ventilated in general ward whereas twelve patients (34.3%) were ventilated in ICU. Overall one month mortality in this study was 25.7%. Patients who received ICU care had a lower one month mortality than those who received general ward care (16.7% vs 30.4%), although it was not statistically different. Multivariate analysis revealed only GCS on admission (OR 0.731; 95% CI 0.460 to 0.877; P=0.042) as the independent predictive factor for one month mortality in this study.
Rubinson, Lewis; Nuzzo, Jennifer B; Talmor, Daniel S; O'Toole, Tara; Kramer, Bradley R; Inglesby, Thomas V
The Working Group on Emergency Mass Critical Care was convened by the Center for Biosecurity of the University of Pittsburgh Medical Center and the Society of Critical Care Medicine to provide recommendations to hospital and clinical leaders regarding the delivery of critical care services in the wake of a bioterrorist attack resulting in hundreds or thousands of critically ill patients. In these conditions, traditional hospital and clinical care standards in general, and critical care standards in particular, likely could no longer be maintained, and clinical guidelines for U.S. hospitals facing these situations have not been developed. The Working Group offers recommendations for this situation.
Full Text Available Wound infections are one of the leading causes of patient’s morbidity, which ends in financial loss to both patient and hospital. Delayed treatment drug resistance due to indiscriminate use of antibiotics is implicated as the cause of chronicity of wounds. Empirical treatment without culturing the causative agent somehow lessens the delay of treatment, but actually is leading to the rise of resistant strains in the community. It is obligatory to know the prevalence of causative agents to implicate the early treatments without wait for the culture reports. MATERIAL AND METHODS This study was done to identify the prevalent organisms of wounds and its susceptibility to antimicrobials. 100 pus samples from different wounds of 100 patients, both inpatients and outpatients attending Viswabharathi Medical College at Kurnool were collected. All the pus samples were processed by gram staining of the direct smear, inoculating on to nutrient agar, blood agar, and MacConkey agar and incubated overnight at 370c. Culture morphology and gram staining was done from the positive growth. Confirmation was done by biochemical reactions and necessary special tests. Results: 100 wound samples yielded 105 isolates. Among the total 105 isolates, the gram negative isolates were dominating and accounted for 53.33% and gram positive accounted for 46.66% only. In the overall study, Staphylococcus remained as predominant isolate and is 100% sensitive to vancomycin, Linezolid. CONCLUSION The accurate identification of culture isolates may be a useful tool to provide appropriate antibiotic and help in reducing the drug-resistant strains in wound infections. This study provides better guidance for the clinicians to cure wounds without delay and much waste of antibiotics that ultimately prevents the resistant strains and saves the economy of both patient as well as hospital.
Turner, Alex; Eccles, Fiona; Keady, John; Simpson, Jane; Elvish, Ruth
Deceptive practice has been shown to be endemic in long-term care settings. However, little is known about the use of deception in dementia care within general hospitals and staff attitudes towards this practice. This study aimed to develop understanding of the experiences of general hospital staff and explore their decision-making processes when choosing whether to tell the truth or deceive a patient with dementia. This qualitative study drew upon a constructivist grounded theory approach to analyse data gathered from semi-structured interviews with a range of hospital staff. A model, grounded in participant experiences, was developed to describe their decision-making processes. Participants identified particular triggers that set in motion the need for a response. Various mediating factors influenced how staff chose to respond to these triggers. Overall, hospital staff were reluctant to either tell the truth or to lie to patients. Instead, 'distracting' or 'passing the buck' to another member of staff were preferred strategies. The issue of how truth and deception are defined was identified. The study adds to the growing research regarding the use of lies in dementia care by considering the decision-making processes for staff in general hospitals. Various factors influence how staff choose to respond to patients with dementia and whether deception is used. Similarities and differences with long-term dementia care settings are discussed. Clinical and research implications include: opening up the topic for further debate, implementing staff training about communication and evaluating the impact of these processes.
Full Text Available BACKGROUND The burning of firecrackers during Diwali festival produces an adverse respiratory outcome. However, there are no published articles on the impact of fireworks on hospital admission due to acute respiratory issues, hospital stay, and respiratory mortality during Diwali in India. MATERIALS AND METHODS This was a prospective, open label, observational study. It was conducted in patients admitted to the pulmonary emergency unit with respiratory symptoms 15 days before and after Diwali. It was conducted after the approval of ethics committee and written informed consent. RESULTS The number of admissions post-Diwali were significantly more compared to pre-Diwali from both rural and urban locations (p<0.001. The mean duration of hospital stay was significantly less pre-Diwali (7.59±0.74 days compared to post-Diwali (9.46±0.44 days. Also, significantly increased number of patients required ventilator support post Diwali. CONCLUSION The findings from the present study validate the deterioration of respiratory health during Diwali festival in India. There should be more awareness campaigns about the harmful effects of fire-crackers. Patients suffering from respiratory problems should be advised to avoid heavy exposure to fireworks
Moreno-Martínez, Roberto; Martínez-Cruz, Rocío Alejandra
In recognition that the availability of resources in the medical facility forms part of the factors that influence the quality of healthcare, it is of vital importance to measure their outcome. The aim of this study was determine the efficiency of the medical facility through the use of beds in a secondary level hospital. Through the Health Information Management System (HIMS), we examined statistical reports from July 2012 to June 2013 including variables such as expenses, patient days, occupancy rate, average length of stay by specialty and medical division, results were obtained for each strategic indicator, and these results were related assumptions proposing to assess hospital efficiency. Overall, we identified optimal efficiency of the medical facility without analysis of services, leads to deteriorating and low efficiency. The overall outcome of the five indicators applied overlooked saturation of services within the medical unit. However, the overall analysis shows the problem, noting the advantage of evaluating the same scenario from different perspectives. The include indicators measuring hospital efficiency resource based bed, allows considering deficiencies identified, so that decision making is strengthened the decision making health.
Baatiema, Leonard; Otim, Michael; Mnatzaganian, George; Aikins, Ama De-Graft; Coombes, Judith; Somerset, Shawn
Stroke and other non-communicable diseases are important emerging public health concerns in sub-Saharan Africa where stroke-related mortality and morbidity are higher compared to other parts of the world. Despite the availability of evidence-based acute stroke interventions globally, uptake in low-middle income countries (LMIC) such as Ghana is uncertain. This study aimed to identify and evaluate available acute stroke services in Ghana and the extent to which these services align with global best practice. A multi-site, hospital-based survey was conducted in 11 major referral hospitals (regional and tertiary - teaching hospitals) in Ghana from November 2015 to April 2016. Respondents included neurologists, physician specialists and medical officers (general physicians). A pre-tested, structured questionnaire was used to gather data on available hospital-based acute stroke services in the study sites, using The World Stroke Organisation Global Stroke Services Guideline as a reference for global standards. Availability of evidence-based services for acute stroke care in the study hospitals were varied and limited. The results showed one tertiary-teaching hospital had a stroke unit. However, thrombolytic therapy (thrombolysis) using recombinant tissue plasminogen activator for acute ischemic stroke care was not available in any of the study hospitals. Aspirin therapy was administered in all the 11 study hospitals. Although eight study sites reported having a brain computed tomographic (CT) scan, only 7 (63.6%) were functional at the time of the study. Magnetic resonance imaging (MRI scan) services were also limited to only 4 (36.4%) hospitals (only functional in three). Acute stroke care by specialists, especially neurologists, was found in 36.4% (4) of the study hospitals whilst none of the study hospitals had an occupational or a speech pathologist to support in the provision of acute stroke care. This study confirms previous reports of limited and variable
Full Text Available : OBJECTIVE: To evaluate prescribing pattern in acne vulgaris cases at a tertiary care teaching hospital in south India. METHODS: Prescriptions of 120 patients of acne vulgaris who attended Dermatology OPD of a tertiary care teaching hospital were selected for study and their drug data were analyzed. RESULTS: Topical Benzoyl peroxide, adapalene, ketoconazole were prescribed as monotherapy, while aloevera, liquid paraffin and white soft paraffin as polytherapy. Azithromycin, antibiotics, anti histaminics were prescribed as systemic monotherapy and polytherapy. Statistical analysis revealed p-value was > 0.05. CONCLUSIONS: Prescription patterns were in consensus with the general guidelines, with few changes, in the choice of established therapeutic agents.
Labbadia, Lilian Lestingi; D'Innocenzo, Maria; Fogliano, Rosana Rodrigues Figueira; Silva, Gabriela Eneida Françolin; de Queiroz, Rita Marina Ribeiro Melo; Carmagnani, Maria Isabel Sampaio; Salvador, Maria Elisabete
Indicators are tools that permit to define parameters that will be used to make comparisons between a result and its expected value, as well as to add a value of judgement in this regard. The purpose of this study is to describe the experience of a group of nurses in the development of a computerized system to manage nursing care indicators at Hospital São Paulo. Four stages were used to implement the indicator management system: developing a nursing care indicator handbook; performing a manually registered pilot test; developing the computerized system; and performing the pilot test of the computerized system in eleven units at the hospital.
This study examines instances of discrimination that blind mothers in the USA have experienced at the hands of doctors, nurses and social workers during hospital postnatal care. The author identifies postnatal care as the time when blind mothers are likely to face the most stigmatising interactions with medical staff, as it is when scepticism about their competence as mothers is at its height. The author argues these interactions must be understood within their institutional context in which ideologies of risk and mother-blame are embedded in hospital postnatal practices. © 2015 Foundation for the Sociology of Health & Illness.
Pasquali, Sara; Capitoni, Enrica; Tiraboschi, Giuseppina; Alborghetti, Adriana; De Luca, Giuseppe; Di Mauro, Stefania
Eleven medical care units of nine Lombardy Region hospitals organized by levels of care model or by the traditional departmental model have been analyzed, in order to evaluate if methods for complexity of patient-care evaluation represent an index factor of nursing organizational effectiveness. Survey with nine Nurses in managerial position was conducted between Nov. 2013-Jan. 2014. The following factors have been described: context and nursing care model, staffing, complexity evaluation, patient satisfaction, staff well-being. Data were processed through Microsoft Excel. Among Units analysed ,all Units in levels of care and one organized by the departmental model systematically evaluate nursing complexity. Registered Nurses (RN) and Health Care Assistants (HCA) are on average numerically higher in Units that measure complexity (0.55/ 0.49 RN, 0.38/0.23 HCA - ratio per bed). Adopted measures in relation to changes in complexity are:rewarding systems, supporting interventions, such as moving personnel within different Units or additional required working hours; reduction in number of beds is adopted when no other solution is available. Patient satisfaction is evaluated through Customer Satisfaction questionnaires. Turnover, stress and rate of absenteeism data are not available in all Units. Complexity evaluation through appropriate methods is carried out in all hospitals organized in levels of care with personalized nursing care models, though complexity is detected with different methods. No significant differences in applied managerial strategies are present. Patient's satisfaction is evaluated everywhere. Data on staffing wellbeing is scarcely available. Coordinated regional actions are recommended in order to gather comparable data for research, improve decision making and effectiveness of Nursing care.
Luz María Tejada-Tayabas
Full Text Available OBJECTIVE: To examine, from the nursing perspective, the needs and challenges of coordinated hospital-home care for renal patients on hemodialysis. METHODS: A qualitative analysis was conducted with an ethnographic approach in a hemodialysis unit in San Luis Potosi, Mexico. Semistructured interviews were conducted with nine nurses, selected by purposeful sampling. Structured content analysis was used. RESULTS: Nurses recounted the needs and challenges involved in caring for renal patients. They also identified barriers that limit coordinated patient care in the hospital and the home, mainly the work overload at the hemodialysis unit and the lack of a systematic strategy for education and lifelong guidance to patients, their families and caregivers. CONCLUSIONS: This study shows the importance and necessity of establishing a strategy that goes beyond conventional guidance provided to caregivers of renal patients, integrating them into the multidisciplinary group of health professionals that provide care for these patients in the hospital to establish coordinated hospital-home care that increases therapeutic adherence, treatment substitution effectiveness and patient quality of life.
Camsooksai, Julie; Barnes, Helena; Reschreiter, Henrik
Until recently, research in critical care units has usually taken place in university teaching hospitals. The 'general' critical care unit patient population is broader than this and the research needs to reflect this. As a general critical care unit in a district general hospital we wanted to set-up research within our own department, as part of the critical care team and part of our culture. With extensive background communication, drive and hard work, the support of the hospital Research and Development department was gained and Comprehensive Local Research Network funding successfully applied for. A research team was established and a model for the Research Nurse role was developed and implemented. This model is described. Participation in national trials commenced and the research portfolio is growing. Networking with other teams also proved valuable. Research has been established as part of the 'culture' of the day-to-day work and the staff have embraced this. Dedicated Research Nurse posts and education of the whole team have ensured successful implementation and recruitment of the studies. Experiences of the first year are shared and discussed here. Sharing experience of developing research within a critical care unit in a district general hospital, and a suggested model for a new Research Nurse role, may benefit other similar units in their efforts to establish research.
Mira, José Joaquín; Carrillo, Irene; Lorenzo, Susana; Ferrús, Lena; Silvestre, Carmen; Pérez-Pérez, Pastora; Olivera, Guadalupe; Iglesias, Fuencisla; Zavala, Elena; Maderuelo-Fernández, José Ángel; Vitaller, Julián; Nuño-Solinís, Roberto; Astier, Pilar; ,
Background Adverse events (AEs) cause harm in patients and disturbance for the professionals involved in the event (second victims). This study assessed the impact of AEs in primary care (PC) and hospitals in Spain on second victims. Methods A cross-sectional study was conducted. We carried out a survey based on a random sample of doctors and nurses from PC and hospital settings in Spain. A total of 1087 health professionals responded, 610 from PC and 477 from hospitals. Results A total of 43...
Full Text Available Simon L Adamson,1 Jane Burns,1,2 Pat G Camp,1,2 Don D Sin,1,3 Stephan F van Eeden1,31The Centre for Heart Lung Innovation, St Paul’s Hospital, University of British Columbia, 2Department of Physical Therapy, 3Division of Respirology, Department of Medicine, University of British Columbia, Vancouver, BC, CanadaBackground: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD increase COPD morbidity and mortality and impose a great burden on health care systems. Early readmission following a hospitalization for AECOPD remains an important clinical problem. We examined how individualized comprehensive care influences readmissions following an index hospital admission for AECOPD.Methods: We retrospectively reviewed data of patients admitted for AECOPD to two inner-city teaching hospitals to determine the impact of a comprehensive and individualized care management strategy on readmissions for AECOPD. The control group consisted of 271 patients whose index AECOPD occurred the year before the comprehensive program, and the experimental group consisted of 191 patients who received the comprehensive care. The primary outcome measure was the total number of readmissions in 30- and 90-day postindex hospitalizations. Secondary outcome measures included the length of time between the index admission and first readmission and all-cause mortality.Results: The two groups were similar in terms of age, sex, forced expiratory volume in 1 second, body mass index (BMI, pack-years, and the number and types of comorbidities. Comprehensive care significantly reduced 90-day readmission rates in females (P=0.0205, corrected for age, BMI, number of comorbidities, substance abuse, and mental illness but not in males or in the whole group (P>0.05. The average times between index admission and first readmission were not different between the two groups. Post hoc multivariate analysis showed that substance abuse (P<0.01 increased 30- and 90-day
Kim, Eun Mi; Baek, Hee Joon
The Nutrition Care Process (NCP), developed by the American Dietetic Association, is a significant issue to dietetic professionals in many countries and there are rising needs for NCP implementation in Korea. We surveyed clinical nutrition managers of Korean general hospitals regarding the perception of NCP, the status of NCP implementation, and the opinions on NCP. The questionnaire was collected from 35 hospitals. Most clinical nutrition managers perceived NCP, but NCP implementation in hospital was at early stage. NCP was implemented in a fourth of the surveyed hospitals and many clinical nutrition managers responded that the lack of knowledge and the concern on increasing working time were major barriers to implementing NCP. To successfully implement NCP in Korean hospital, ongoing education and training programs should be developed to provide adequate knowledge and help dietitians to cope with the barriers.
Safran, E; Pittet, D; Borst, F; Thurler, G; Schulthess, P; Rebouillat, L; Lagana, M; Berney, J P; Berthoud, M; Copin, P
The Centre Informatique of Geneva University Hospital is developing, in the environment of its hospital information system, DIOGENE, a computerized alert system for surveillance of hospital infections. This hospital information system is based on an open distributed architecture and a relational database system, and covers many medical applications. This environment allows the development of alerts useful for detecting patients at risk. The alerts offer to clinicians a mean to control their efficacy in patient care. They are a new application of telematics for surveillance in clinical epidemiology, and are a tool for quality assurance. Two examples of alerts established for hospital infection control activities are presented. The first alert systematically detects all cases of patients colonized by or infected with methicillin-resistant Staphylococcus aureus (MRSA). The second alert helps to organize prospective surveillance of bloodstream infections in order to identify some risk factors for infection and propose preventive measures.
Elgueta N, Andrea; Parada E, Yolanda; Guzmán G, Wilma; Molina C, Paula; González A, Patricia
In February 2005 we performed an epidemiological study of an outbreak of scabies in a tertiary-care hospital which started from a crusted scabies case. We detected 10 secondary cases, 8 in healthcare workers and 2 in hospitalized patients. The attack rate was 4.1%. In contrast to previously described outbreaks, the crusted scabies case was recognized at admission. The outbreak causes were: lacking adherence to contact precautions, long stay of the primary case in the hospital ward and delay of specific treatment. The main control measures were: alerting the hospital services about the outbreak, performing epidemiologic surveillance, coordinating with the Hospital Direction and the Occupational Health Department, education of healthcare workers in control measures, implementation of isolation measures and treatment of cases and contacts with 5% permethrin topical lotion.
Full Text Available
Pandemic influenza A (H1N1 virus emerged and spread globally in the spring of 2009. We describe the clinical features of the patients who were hospitalized with 2009 H1N1 influenza July 2009 to June 2010 in a tertiary care hospital in Khamis Mushyt, Saudi Arabia. We analyzed the clinical and laboratory variables in order to determine predictors of poor outcome
We performed a prospective study in all patients who were hospitalized for at least 48 hours and with a positive test for 2009 H1N1 virus through RT-PCR(real time polymerase chain reaction. Their epidemiological, clinical, biochemical characteristics were collected and the hospital course of the patients with eventual outcome (discharge or death was observed. We applied a logistic regression analysis to determine the best predictor of death.
... Episode of Care for Acute Myocardial Infarction (AMI) Measure 7. Electronic Clinical Quality Measures 8... Osteopathic Association APR DRG All Patient Refined Diagnosis Related Group System APRN Advanced practice... percentage DRA Deficit Reduction Act of 2005, Public Law 109-171 DRG Diagnosis-related group...
... Episode-of-Care for Acute Myocardial Infarction (AMI) Measure 7. Electronic Clinical Quality Measures 8... All Patient Refined Diagnosis Related Group System APRN Advanced practice registered nurse ARRA... Deficit Reduction Act of 2005, Public Law 109-171 DRG Diagnosis-related group DSH Disproportionate...
Alharbi, Tariq Saleem J; Ekman, Inger; Olsson, Lars-Eric; Dudas, Kerstin; Carlström, Eric
Sweden has one of the oldest, most coherent and stable healthcare systems in the world. The culture has been described as conservative, mechanistic and increasingly standardized. In order to provide a care adjusted to the patient, person centered care (PCC) has been developed and implemented into some parts of the health care industry. The model has proven to decrease patient uncertainty. However, the impact of PCC has been limited in some clinics and hospital wards. An assumption is that organizational culture has an impact on desired outcomes of PCC, such as patient uncertainty. Therefore, in this study we identify the impact of organizational culture on patient uncertainty in five hospital wards during the implementation of PCC. Data from 220 hospitalized patients who completed the uncertainty cardiovascular population scale (UCPS) and 117 nurses who completed the organizational values questionnaire (OVQ) were investigated with regression analysis. The results seemed to indicate that in hospitals where the culture promotes stability, control and goal setting, patient uncertainty is reduced. In contrast to previous studies suggesting that a culture of flexibility, cohesion and trust is positive, a culture of stability can better sustain a desired outcome of reform or implementation of new care models such as person centered care. It is essential for health managers to be aware of what characterizes their organizational culture before attempting to implement any sort of new healthcare model. The organizational values questionnaire has the potential to be used as a tool to aid health managers in reaching that understanding. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
E. M. Kutyrev
Full Text Available With the development of technologies, and discovery of new methods of diagnostics and treatment of diseases, a shift of the disease towards chronic disease is observed. Growth in prosperity will increase average life expectancy and mean age of population. Year after year, the elderly sector grows, with several chronic diseases per person. This is especially true for St. Petersburg, where 25 % of the populations of over working age. Thus, the demand for specialized medical care, particularly outpatient, will increase. Given that outpatient care is more profitable than hospital care, particular attention should be paid to its organization and expansion (increase in area, number of personnel, logistics, and so on. The article attempts to analyze changes in the volume of specialized outpatient medical care delivered at the outpatient Advisory Department of St. Petersburg state establishment of healthcare Mariinsky hospital in the period from 2008 through 2013.
receivers. Question To explore experiences of post bureaucratic hospital reforms and their impact on care provision. Method Data builds on nine mini group interviews with midwives (n = three), nurses (n = three) and physiotherapists (n = three), in all thirty participants. Data was analysed using existing...... of patients. ‘Managerial control of work’ which described rising administrative demands, engaging in protective measures, younger professionals pressured by documentation obligations and fear of disciplinary procedures. Conclusion The institutional context appears to play a key role shaping care practices....... Although midwives, nurses and physiotherapists share similar experiences of post bureaucratic hospital reforms, changes in care provision can impact these professions in different ways. As a discipline, midwifery is founded on relationships between women and midwives. Standardised clinical care...
Silvia da Silva Santos Passos
Full Text Available ABSTRACT OBJECTIVE Understand the quotidian relationships of accompanying family members in an environment of care, which are close to the metaphor of a tribe in hospital environment. METHODQualitative study with data gathered from semi-structured interviews and observations with 16 family members accompanying hospitalized individuals with dependence on self-care. Data were submitted to thematic analysis, and analyzed through the metaphor of "tribe" proposed by comprehensive sociology. RESULTS Family members build up social clusters around caring, where we find traits typical of tribes: emotional ambience; solidarity based on links of sympathy and mutual assistance; an affectual nebula in the process of interaction; a logic of fusion in tactile relations; and communion/religiosity in the process of connecting in a collective identity. CONCLUSION In the presence of tragedy, families build social clusters similar to tribes having care as a totem.
Alves, Daniela Fernanda Dos Santos; Guirardello, Edinêis de Brito
Objectives To describe the characteristics of the nursing work environment, safety attitudes, quality of care, measured by the nursing staff of the pediatric units, as well as to analyze the evolution of quality of care and hospital indicators. Methods Descriptive study with 136 nursing professionals at a paediatric hospital, conducted through personal and professional characterization form, Nursing Work Index - Revised, Safety Attitudes Questionnaire - Short Form 2006 and quality indicators. Results The professionals perceive the environment as favourable to professional practice, and consider good quality care that is also observed by reducing the incidence of adverse events and decreased length of stay. The domain job satisfaction was considered favourable to patient safety. Conclusions The work environment is favourable to nursing practice, the professionals nursing approve the quality of care and the indicators tended reducing adverse events and length of stay.
Lawrence, Justin; Delaney, Conor P
Evaluation of health care outcomes has become increasingly important as we strive to improve quality and efficiency while controlling cost. Many groups feel that analysis of large datasets will be useful in optimizing resource utilization; however, the ideal blend of clinical and administrative data points has not been developed. Hospitals and health care systems have several tools to measure cost and resource utilization, but the data are often housed in disparate systems that are not integrated and do not permit multisystem analysis. Systems Outcomes and Clinical Resources AdministraTive Efficiency Software (SOCRATES) is a novel data merging, warehousing, analysis, and reporting technology, which brings together disparate hospital administrative systems generating automated or customizable risk-adjusted reports. Used in combination with standardized enhanced care pathways, SOCRATES offers a mechanism to improve the quality and efficiency of care, with the ability to measure real-time changes in outcomes.
Meide, H. van der; Olthuis, G.J.; Leget, C.
The vulnerability of older hospital patients is increasingly understood in physical terms, often referred to as frailty. This reduces their vulnerability to the functioning body regardless of the psycho-socio-cultural context they are in, and it ignores the role of the hospital environment. This pap
Full Text Available Introduction: Many organizations, especially, service organizations, relative to their goals and mission, have a special view towards quality phenomena and its management and are turning to approaches such as TQM to help manage their business. This study examined the TQM indicators gap in Isfahan Khorshid hospital. As fuzzy set theory is better than the logical theory for estimating the linguistic factors, this paper tries to apply fuzzy approach to quality management in hospitals and analyzes the gap between personnel expectations and perception. Methods: This paper analyzes medical total quality management in a case (Internal Section of Khorshid Hospital, based on gap analysis model and fuzzy logic. A questionnaire was therefore applied to measure expectations and perceptions of hospital personnel. Results: This study results show that on the whole, there is a significant difference between TQM expectations and perceptions among K`horshid hospital personnel. Conclusions: Spurred by impressive results in other industries, this compelling and logical approach has begun to penetrate the thinking of health care accrediting agencies, business coalitions, private foundations and leading health care organizations. However, before making a commitment to TQM, hospital decision makers should thoroughly understand what it is they are committing to, and solve the main barriers such as the conflict between hospital management philosophies and TQM philosophies.
... specialty care provided at a specialty care clinic are radiology services requiring the immediate presence... ordered as part of the special registry examination) offered by VA to evaluate possible health risks... dental care provided under 38 U.S.C. 1712; (8) Readjustment counseling and related mental health services...
McMullan, Jason; Gerecht, Ryan; Bonomo, Jordan; Robb, Rachel; McNally, Bryan; Donnelly, John; Wang, Henry E
Optimal out of hospital cardiac arrest (OHCA) airway management strategies remain unclear. We compared OHCA outcomes between patients receiving endotracheal intubation (ETI) versus supraglottic airway (SGA), and between patients receiving [ETI or SGA] and those receiving no advanced airway. We studied adult OHCA in the Cardiac Arrest Registry to Enhance Survival (CARES). Primary exposures were ETI, SGA, or no advanced prehospital airway placed. Primary outcomes were sustained ROSC, survival to hospital admission, survival to hospital discharge, and neurologically-intact survival to hospital discharge (cerebral performance category 1-2). Propensity scores characterized the probability of receiving ETI, SGA, or no advanced airway. We adjusted for Utstein confounders. Multivariable random effects regression accounted for clustering by EMS agency. We compared outcomes between (1) ETI vs. SGA, and (2) [no advanced airway] vs. [ETI or SGA]. Of 10,691 OHCA, 5591 received ETI, 3110 SGA, and 1929 had no advanced airway. Unadjusted neurologically-intact survival was: ETI 5.4%, SGA 5.2%, no advanced airway 18.6%. Compared with SGA, ETI achieved higher sustained ROSC (OR 1.35; 95%CI 1.19-1.54), survival to hospital admission (1.36; 1.19-1.55), hospital survival (1.41; 1.14-1.76) and hospital discharge with good neurologic outcome (1.44; 1.10-1.88). Compared with [ETI or SGA], patients receiving no advanced airway attained higher survival to hospital admission (1.31; 1.16-1.49), hospital survival (2.96; 2.50-3.51) and hospital discharge with good neurologic outcome (4.24; 3.46-5.20). In CARES, survival was higher among OHCA receiving ETI than those receiving SGA, and for patients who received no advanced airway than those receiving ETI or SGA. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
This thesis discusses radio frequency identications (RFID) and its applications in hospital environment. RFID technology opens up possibilities to construct novel intelligent systems for monitoring and tracking purposes. Tracking systems can collect data on daily processes and care routines and this information can be used both for quality control and for improving care processes and logistics. The work consists of a literature review and an applied systems design. The literature review l...
A brief history of the Joint Commission on Accreditation of Hospitals (JCAH), as well as its structure, purpose and activities, is presented. The procedure for developing JCAH standards for health care facilities is discussed. Also presented are the survey and accreditation processes. It is concluded that as long as the United States values its tradition of voluntarism and believes in positive motivation, the JCAH will be an effective influence on improved health care services.
Yousef A Al-Turki
Conclusions: Complete (severe and partial erectile dysfunction was quite common among adult diabetic patients in a hospital-based primary care setting in Saudi Arabia. It is important for primary care physicians to diagnose erectile dysfunction in diabetic patients, and to counsel them early, as most patients are hesitant to discuss their concern during a consultation. Further studies are recommended to evaluate the effect of other risk factors on erectile dysfunction in diabetic patients.
Oliver, Mark A; Hillock, Sharon; Moore, Carol; Goble, Hannah; Asbury, Nicky
The Comfort Care Pack initiative is an innovation designed to enhance the inpatient experience of end-of-life patients and their carers. The carer is given a pleasantly decorated box containing a variety of items for use by the patient or the carer themselves: snacks, toiletries and items to promote comfort. This project set out to evaluate the impact of these packs by reviewing the returns of the feedback questionnaires included with the packs. From the first 220 packs, 58 questionnaires were returned, giving quantitative and qualitative data. The response to the packs was overwhelmingly positive and they were much valued by the carers. This was the case despite the fact that relatively few of the items were actually used by the recipients. It is suggested that the value of the packs to recipients lies in the gesture of being thought about during what is a difficult time for them. The implications of this are discussed.
Ganesamoni, Sivaram; Kate, Vikram; Sadasivan, Jagdish
The epidemiological pattern of burns varies widely in different parts of the world. To suggest effective preventive measures, an insight into the pattern of injury is desirable. However, data on burn victims and outcome is limited from this part of the world. This study was conducted in the Department of Surgery, from April 2006 to April 2007. All consecutive patients with major burns admitted for in-hospital treatment during the study period were included in the study. The data collected included age, gender, cause and mode of burns, presence or absence of inhalational injury, facial burns, time delay from burn injury to admission in the hospital, burns depth, total body surface area distribution of burns, associated injuries and co-morbid illness, microbiological profile and outcome. Inhalational injury was assessed by clinical examination as bronchoscopy was not available. A total of 222 consecutive patients admitted for in-hospital treatment of burn injury were included in the study. 177 patients were adults and 45 were burns were due to non-intentional injury and 43.9% were due to self-immolation. In patients patients had predominantly deep burns. The overall mortality was 60.8%. The predominant organisms colonizing the burn wound were Pseudomonas aeruginosa (81.1%) followed by Acinetobacter species and MRSA. Multivariate logistic regression analysis of factors predicting survival in patients with burn injury showed that TBSA>30%, age>20 years, female gender and presence of facial injury were statistically significant as predictors of risk of death. In patients with burns, total body surface area involvement more than 30%, age more than 20 years, female gender and presence of facial injury are statistically significant, as predictors of poor outcome and risk of death. The strongest association was seen with facial injury, which increased the risk of death by fourfold. Copyright 2009 Elsevier Ltd and ISBI. All rights reserved.
Leff, Bruce; Burton, Lynda; Mader, Scott L; Naughton, Bruce; Burl, Jeffrey; Koehn, Debbie; Clark, Rebecca; Greenough, William B; Guido, Susan; Steinwachs, Donald; Burton, John R
To compare differences in the stress experienced by family members of patients cared for in a physician-led substitutive Hospital at Home (HaH) and those receiving traditional acute hospital care. Survey questionnaire completed as a component of a prospective, nonrandomized clinical trial of a substitutive HaH care model. Three Medicare managed care health systems and a Veterans Affairs Medical Center. Two hundred fourteen community-dwelling elderly patients who required acute hospital admission for community-acquired pneumonia, exacerbation of chronic heart failure, exacerbation of chronic obstructive pulmonary disease, or cellulitis. Treatment in a substitutive HaH model. Fifteen-question survey questionnaire asking family members whether they experienced a potentially stressful situation and, if so, whether stress was associated with the situation while the patient received care. The mean and median number of experiences, of a possible 15, that caused stress for family members of HaH patients was significantly lower than for family members of acute care hospital patients (mean +/- standard deviation 1.7 +/- 1.8 vs 4.3 +/- 3.1, Pfamily member stress (adjusted odds ratio=0.12, 95% confidence interval=0.05-0.30). HaH is associated with lower levels of family member stress than traditional acute hospital care and does not appear to shift the burden of care from hospital staff to family members.
Dhawal H. Agrawal
Full Text Available Introduction: Pars planavitrectomy is the final step in management of many disease. Taking into consideration usefulness and necessity of Pars planavitrectomy in today's world we would like to do this study to evaluate the surgical outcome of 20 gauge pars planavitreoretinal surgery. Materials and methods: A hospital-based prospective interventional study of series of 46 patients was carried out in retina clinic of SMIMER, Surat, Gujarat, From July 2012 to November 2014 who underwent vitreo-retina surgeries were reviewed. Demography, duration of symptoms, risk factors and indications, preoperative and post-operative visual acuity, intra-operative and post-operative complications were analyzed. Results:Of 46 patients, preoperatively, 89 % had visual acuity of 2/60 to perception of light .The main indication for TPPV was nuclear drop, in 50 %.The visual acuity improved to better than 6/60 in 57% patients , whereas, overall, in 86.9 % of the subjects, it improved by 1 lines postoperatively. The commonest intra-operative complications was bleeding intraocularly(4.35%. Conclusion: Useful vision can be restored by pars planavitrectomy in the majority of the patients (p value <0.01. Timing of vitrectomy did not have influence on visual outcome in patients of nuclear drop. Progression of cataract is the commonest complication of TPPV(10.87%. Indications of vitrectomy does not have statistically significant influence on visual outcome after vitrectomy. [Natl J Med Res 2015; 5(2.000: 156-160
Benedita Maria Rêgo Deusdará Rodrigues
Full Text Available Objetivo: Apreender quais são os aspectos éticos que norteiam o cuidado prestado pelo enfermeiro à criança hospitalizada. Método: Estudo qualitativo com enfoque na fenomenologia sociológica de Alfred Schutz. Foram entrevistados 10 enfermeiros lotados nas unidades de internação de um hospital municipal, localizado na cidade do Rio de Janeiro, em 2011. A entrevista fenomenológica pautou-se na questão: Quais os aspectos éticos que norteiam o seu cuidado a criança hospitalizada? Resultados: A análise das falas possibilitou a apreensão de duas categorias discutidas à luz da fenomenologia sociológica que são: Respeito à privacidade da criança e Respeito à família da criança hospitalizada. Conclusões: O estudo permitiu o entendimento de que as ações do enfermeiro no que diz respeito à ética no cuidado à criança hospitalizada perpassam pelo reconhecimento da família como elemento indispensável na assistência de enfermagem. Aponta a necessidade de repensar sobre as práticas em saúde, como um modo ético de cuidar. Descritores: Ética, Saúde da criança, Cuidados de enfermagem.
Full Text Available Background: A woman is considered menopausal after 12 months of amenorrhea. The most feared symptom during menopause is postmenopausal bleeding which unless proved otherwise indicates genital malignancy. Objectives: To study Socio-demographic factors related to postmenopausal bleeding and to find time lapse between bleeding and reporting of these cases. Material and Methods: This cross sectional was done in the Department of Obstetrics & Gynecology, Pt. J. N. M. Medical College & DR. B. R. Ambedkar Memorial, Hospital, Raipur (C. G. The participants were 146 women who came with the complaint of postmenopausal bleeding. A detailed, preceded, pre-tested, structured, close ended questionnaire was used to collect the data. By interviewing these women, information was collected about different demographic factors like age, socio-economic status, parity etc. The collected data was put in the master chart and analyzed. Results: The proportion of postmenopausal bleeding cases was 3.5% .Maximum cases(50% with postmenopausal bleeding were found in the age group of 45-54yrs . 60 % of patients were from rural areas and 62% were illiterate. 65% of the patients were grand multipara (Parity4. Most of the patients belonged to lower socioeconomic strata. Almost half (48% of patients presented after, more than 6 months since the first episode of bleeding . Conclusions: The proportion of postmenopausal bleeding is high, requiring immediate investigation. Lack of awareness led to very late presentation of most of the patients, so education at community level is required to reduce this time lapse for earlier diagnosis and management
Muhammad Javed; Abdul Majid Memon
Objective:To study organisms in cases of early neonatal sepsis, and sensitivity patterns of these isolates. Methods: All pregnant mothers admitted from Jan 2006-Dec 2006 were registered. Neonates delivered at the hospital were examined upto 72 hours of birth, with special emphasis on the signs and symp-toms of suspected sepsis. Neonates with no maternal or neonatal risk factor were included in the study, blood examination and appropriate cultures were taken. Antibiotics as cephatexime and amikacin were started on em-pirical bases until final cultures report was received. In cases of negative cultures, antibiotics were stopped. Other wise it continued according to culture and sensitivity for 10 to 14 days. Results: Among these 257 ca-ses, 113 neonates full filled our criteria. Staph aureus being the commonest organism in our study (59.29%) followed by KlebsieUa pneumoniae (19.47%) and Entrococci (19.47%). These findings are not consistent with other studies in the country. Conclusion: Neonatal sepsis is a major cause of mortality and morbidity. Choice of antibiotic should depend on the local studies from time to time.
Huang, Lyen C; Tran, Thuy B; Ma, Yifei; Ngo, Justine V; Rhoads, Kim F
Previous studies suggest that minorities cluster in low-quality hospitals despite living close to better performing hospitals. This may contribute to persistent disparities in cancer outcomes. The purpose of this work was to examine how travel distance, insurance status, and neighborhood socioeconomic factors influenced minority underuse of high-volume hospitals for colorectal cancer. The study was a retrospective, cross-sectional, population-based study. All hospitals in California from 1996 to 2006 were included. Patients with colorectal cancer diagnosed and treated in California between 1996 and 2006 were identified using California Cancer Registry data. Multivariable logistic regression models predicting high-volume hospital use were adjusted for age, sex, race, stage, comorbidities, insurance status, and neighborhood socioeconomic factors. A total of 79,231 patients treated in 417 hospitals were included in the study. High-volume hospitals were independently associated with an 8% decrease in the hazard of death compared with other settings. A lower proportion of minorities used high-volume hospitals despite a higher proportion living nearby. Although insurance status and socioeconomic factors were independently associated with high-volume hospital use, only socioeconomic factors attenuated differences in high-volume hospital use of black and Hispanic patients compared with white patients. The use of cross-sectional data and racial and ethnic misclassifications were limitations in this study. Minority patients do not use high-volume hospitals despite improved outcomes and geographic access. Low socioeconomic status predicts low use of high-volume settings in select minority groups. Our results provide a roadmap for developing interventions to increase the use of and access to higher quality care and outcomes. Increasing minority use of high-volume hospitals may require community outreach programs and changes in physician referral practices.
Maheshwari, Vinay; Paioli, Daniela; Rothaar, Robert; Hill, Nicholas S
Little information is available on the utilization of noninvasive positive-pressure ventilation (NPPV) in the United States. Accordingly, we performed a survey on the use of NPPV at acute care hospitals in a region of the United States to determine variations in utilization and between hospitals, the reasons for lower rates of utilization, and the techniques used for application. Using survey methodology, we developed a questionnaire consisting of 19 questions and distributed it by mail to directors of respiratory care at all 82 acute care hospitals in Massachusetts and Rhode Island. Nonresponders were contacted by phone to complete the survey. Responses were analyzed using standard statistics, including t tests and Mann-Whitney U tests where appropriate. We obtained responses from 71 of the 82 hospitals (88%). The overall utilization rate for NPPV was 20% of ventilator starts, but we found enormous variation in the estimated utilization rates among different hospitals, from none to > 50%. The top two reasons given for lower utilization rates were a lack of physician knowledge and inadequate equipment. In the 19 hospitals that provided detailed information, COPD and congestive heart failure constituted 82% of the diagnoses of patients receiving NPPV, but NPPV was still used in only 33% of patients with these diagnoses receiving any form of mechanical ventilation. The utilization rates for NPPV vary enormously among different acute care hospitals within the same region. The perceived reasons for lower utilization rates include lack of physician knowledge, insufficient respiratory therapist training, and inadequate equipment. Educational programs directed at individual institutions may be useful to enhance utilization rates.
Chung, Kyusuk; Richards, Nicole; Burke, Sloane
In response to a 2011 finding that approximately 27% of Medicare-certified hospices do not provide a single day of general inpatient care (GIP), the authors explored the extent to which hospices have contracts with hospitals for GIP. Using the 2007 National Home and Hospice Care Survey, we estimated that 1119 (32%) agencies had no contract with any hospitals in 2007 and half of those with no contract did not have a contract with a skilled nursing facility (SNF) either. As a result, these hospices were unable to provide GIP referrals for those in need of inpatient care for acute pain and symptom management. More importantly, not having a contract with a hospital was just one of the factors influencing GIP provision. In the multivariate logistic model, after controlling for contract status with a hospital and other hospice characteristics, agencies in the second quartile of hospice patient census (12-29 vs 73 or more, adjusted odds ratio = 14.10; 95% confidence interval 4.26-46.62) were independently related to providing only routine home care. These hospices are more likely to rely solely on scatter beds for GIP provision. Given that a significant portion of hospices do not have a contract with a hospital, policy makers need to understand barriers to contracts with a hospital/SNF for GIP and consider a hospice's contract status as one of the standards for hospice certification. In addition, further research is necessary to understand why hospices that do have a contract with a hospital do not make GIP referral.
van Rosse, Floor; de Bruijne, Martine; Suurmond, Jeanine; Essink-Bot, Marie-Louise; Wagner, Cordula
A language barrier has been shown to be a threat for quality of hospital care. International studies highlighted a lack of adequate noticing, reporting, and bridging of a language barrier. However, studies on the link between language proficiency and patient safety are scarce, especially in Europe. The present study investigates patient safety risks due to language barriers during hospitalization, and the way language barriers are detected, reported, and bridged in Dutch hospital care. We combined quantitative and qualitative methods in a sample of 576 ethnic minority patients who were hospitalized on 30 wards within four urban hospitals. The nursing and medical records of 17 hospital admissions of patients with language barriers were qualitatively analyzed, and complemented by 12 in-depth interviews with care providers and patients and/or their relatives to identify patient safety risks during hospitalization. The medical records of all 576 patients were screened for language barrier reports. The results were compared to patients' self-reported Dutch language proficiency. The policies of wards regarding bridging language barriers were compared with the reported use of interpreters in the medical records. Situations in hospital care where a language barrier threatened patient safety included daily nursing tasks (i.e. medication administration, pain management, fluid balance management) and patient-physician interaction concerning diagnosis, risk communication and acute situations. In 30% of the patients that reported a low Dutch proficiency, no language barrier was documented in the patient record. Relatives of patients often functioned as interpreter for them and professional interpreters were hardly used. The present study showed a wide variety of risky situations in hospital care for patients with language barriers. These risks can be reduced by adequately bridging the language barrier, which, in the first place, demands adequate detecting and reporting of a
Pardo Crespo, M R; Pérez Iglesias, R; Llorca, J; Rodrigo Calabia, E; Alvarez Granda, L; Delgado-Rodríguez, M
To determine whether the structure of primary care teams on carrying out the healthy child health programme leads to a drop in the risk of admission to hospital of children under two, in comparison with the traditional clinic or out-clinic health system. Case-reference epidemiological study. 40% of the children under 24 months admitted to paediatric or neonate floors of the Marqués de Valdecilla University Hospital. Reference: 15% of the recently born children alive in this hospital. Information was gathered through face-to-face interview and by examining health cards. The study ran from April 1995 to May 1996. Children under two monitored habitually by a doctor belonging to a primary care team showed a drop in risk of hospital admission for all clinical diagnoses of 0.57 (95% CI, 0.35-0.93), after adjustment due to various confusion factors such as maternal education, social class, ethnic background, mother's age, mother's tobacco consumption, natural breast-feeding at birth, admission at birth. There was a drop of risk of hospital admission for high temperature without apparent cause in those children monitored habitually by a team doctor (adjusted RR = 0.41; 95% CI, 0.19-0.90). The advantages of the paediatric health care reform with the structuring of the primary care teams and the accompanying activities performed lead to a drop in the risk of hospital admission of those children under two years old who are habitually monitored by a doctor belonging to a primary care team.
Svetlana A. Mukhortova
Full Text Available Improving the quality of medical care is a priority in countries with developed and developing health care system. There are various approaches to improve the quality and safety of patient’s care, as well as various strategies to encourage hospitals to achieve this goal. The purpose of the presented literature review was to analyze existing experience of the implementation of technology of supportive supervision in health care facilities to improve the quality of hospital care delivery. The data sources for publication were obtained from the following medical databases: PubMed, Cochrane Library, Medscape, e-library, and books on the topic of the review written by experts. The article discusses the results of the research studies demonstrating the successes and failures of supportive supervision technology application. Implementation of supportive supervision in medical facilities based on generalized experience of different countries is a promising direction in improving the quality of medical care delivery. This technology opens up opportunities to improve skills and work quality of the staff at pediatric hospitals in the Russian Federation.
Full Text Available Purpose: This study examines care transition experiences of cancer patients and assesses barriers to effective transitions.Methods: Participants were adult Hebrew, Arabic, or Russian speaking oncology patients and health care providers from hospital and community settings. Qualitative (n=77 and quantitative (n=422 methods such as focus groups, interviews and self-administered questionnaires were used. Qualitative analysis showed that patients faced difficulties navigating a complex and fragmented healthcare system.Results: Mechanisms to overcome barriers included informal routes such as personal relationships, coordinating roles by nurse coordinators and the patients' general practitioners (GPs. The most significant variable was GPs involvement, which affected transition process quality as rated on the CTM (p<0.001. Our findings point to the important interpersonal role of oncology nurses to coordinate and facilitate the care transition process.Conclusion: Interventions targeted towards supporting the care transition process should emphasize ongoing counseling throughout a patient’s care, during and after hospitalization.-----------------------------------------Cite this article as: Admi H, Muller E, Shadmi E. Transition from Hospital to Community Care: The Experience of Cancer Patients. Int J Cancer Ther Oncol 2015; 3(4:34011.[This abstract was presented at the BIT’s 8th Annual World Cancer Congress, which was held from May 15-17, 2015 in Beijing, China.
Ana Paula Scoleze Ferrer
Full Text Available Introduction: Hospitalizations for ambulatory care-sensitive conditions (HACSC are considered an indicator of the effectiveness of primary health care (PHC. High rates of HACSC represent problems in the access or the quality of health care. In Brazil, HACSC rates are high and there are few studies on the factors associated with it. Objective: To evaluate the access to PHC offered to children and adolescents hospitalized due to ACSC and analyze the conditioning factors. Method: Cross-sectional study with a quantitative and qualitative approach. Five hundred and one (501 users (guardians/caregivers and 42 professionals of PHC units were interviewed over one year. Quantitative data were obtained using Primary Care Assessment Tool validated in Brazil (PCATool-Brazil, while qualitative data were collected by semi-structured interview. The independent variables were: age, maternal education, family income, type of diagnosis, and model of care offered, and the dependent variables were access and its components (accessibility and use of services. Results: Sixty-five percent (65.2% of hospitalizations were ACSC. From the perspective of both users and professionals, access and its components presented low scores. Age, type of diagnosis, and model of care affected the results. Conclusion: The proportion of HACSC was high in this population. Access to services is inappropriate due to: barriers to access, appreciation of the emergency services, and attitude towards health needs. Professional attitudes and opinions reinforce inadequate ideas of users reflecting on the pattern of service use.
The PASS ("Permanence d'Accès aux Soins de Santé") are hospital-based units providing primary care services to patients who lack health care coverage. Using a "whole person" approach and providing a combination of health and social care, the PASS offer an appropriately adapted response to complex health problems within a context of marked social vulnerability and contribute to reducing health inequalities. The PASS are an example of an interdisciplinary approach to health care which contrasts with the segmentary approach typical of conventional hospital departments. Operating at the interface between primary and secondary care, the PASS have the potential to become key players in developing models of patient pathways. Their presence reduces inappropriate emergency attendances and hospitalisation by offering medical care in a timely fashion, in an outpatient-type setting. The PASS can provide a resource for research into optimum models of health care, where the social context of health needs are fully recognized and inform medical treatment appropriately. According to their potential development, PASS are living labs of an innovative organizational model of care.
Dorairajan, Natarajan; Andappan, Anandi; Arun, B; Siddharth, Dorairajan; Meena, M
Day care surgery has generated a lot of interest, among both surgeons and the common people. This study aims to explore the management and advantages, including the cost benefits and cost effectiveness, of day care surgery in a government hospital setting. A prospective, single-center, single-unit study was carried out over 1 year from August 2006 to January 2008. The total number of patients studied was 327. Surgeries for hernia, hydrocele, fibroadenoma, fissure in ano, and phimosis were included. Patients were admitted on the day of surgery and were discharged the same day or evening. Patients were analyzed with respect to failure to discharge, wound infection, duration of stay in the ward, cost benefits, cost effectiveness, and postoperative pain. A total of 157 patients were treated for hernia, 61 for hydrocele, 52 for fibroadenoma, 34 for fissure in ano, and 23 for phimosis. Day care surgery is a fast growing and well accepted way of providing care to patients. Most of the patients studied had a favorable impression of the day care surgical procedure compared with inpatient care. In a country like India, in spite of problems of financial constraints and insufficient grants for health care, we are able to enjoy all the advantages of day care surgery, even in a government hospital setting.
Hagvall, Monica; Ehnfors, Margareta; Anderzén-Carlsson, Agneta
Parents of children with medical complexity have described being responsible for providing advanced care for the child. When the child is acutely ill, they must rely on the health-care services during short or long periods of hospitalization. The purpose of this study was to describe parental experiences of caring for their child with medical complexity during hospitalization for acute deterioration, specifically focussing on parental needs and their experiences of the attitudes of staff. Data were gathered through individual interviews and analyzed using qualitative content analysis. The care period can be interpreted as a balancing act between acting as a caregiver and being in need of care. The parents needed skilled staff who could relieve them of medical responsibility, but they wanted to be involved in the care and in the decisions taken. They needed support, including relief, in order to meet their own needs and to be able to take care of their children. It was important that the child was treated with respect in order for the parent to trust the staff. An approach where staff view parents and children as a single unit, as recipients of care, would probably make the situation easier for these parents and children.
Hanskamp-Sebregts, Mirelle; Zegers, Marieke; Boeijen, Wilma; Westert, Gert P; van Gurp, Petra J; Wollersheim, Hub
Auditing of patient safety aims at early detection of risks of adverse events and is intended to encourage the continuous improvement of patient safety. The auditing should be an independent, objective assurance and consulting system. Auditing helps an organisation accomplish its objectives by bringing a systematic, disciplined approach to evaluating and improving the effectiveness of risk management, control, and governance. Audits are broadly conducted in hospitals, but little is known about their effects on the behaviour of healthcare professionals and patient safety outcomes. This study was initiated to evaluate the effects of patient safety auditing in hospital care and to explore the processes and mechanisms underlying these effects. Our study aims to evaluate an audit system to monitor and improve patient safety in a hospital setting. We are using a mixed-method evaluation with a before-and-after study design in eight departments of one university hospital in the period October 2011-July 2014. We measure several outcomes 3 months before the audit and 15 months after the audit. The primary outcomes are adverse events and complications. The secondary outcomes are experiences of patients, the standardised mortality ratio, prolonged hospital stay, patient safety culture, and team climate. We use medical record reviews, questionnaires, hospital administrative data, and observations to assess the outcomes. A process evaluation will be used to find out which components of internal auditing determine the effects. We report a study protocol of an effect and process evaluation to determine whether auditing improves patient safety in hospital care. Because auditing is a complex intervention targeted on several levels, we are using a combination of methods to collect qualitative and quantitative data about patient safety at the patient, professional, and department levels. This study is relevant for hospitals that want to early detect unsafe care and improve patient
Burke, Robert E.; Whitfield, Emily A.; Hittle, David; Min, Sung-joon; Levy, Cari; Prochazka, Allan V.; Coleman, Eric A.; Schwartz, Robert; Ginde, Adit A.
Objectives Hospital discharges to post-acute care (PAC) facilities have increased rapidly. This increase may lead to more hospital readmissions from PAC facilities, which are common and poorly understood. We sought to determine the risk factors and timing for hospital readmission from PAC facilities and evaluate the impact of readmission on patient outcomes. Design Retrospective analysis of Medicare Current Beneficiary Survey (MCBS) from 2003–2009. Setting The MCBS is a nationally-representative survey of beneficiaries matched with claims data. Participants Community-dwelling beneficiaries who were hospitalized and discharged to a PAC facility for rehabilitation. Intervention/Exposure Potential readmission risk factors included patient demographics, health utilization, active medical conditions at time of PAC admission, and PAC characteristics. Measurements Hospital readmission during the PAC stay, return to community residence, and all-cause mortality. Results Of 3246 acute hospitalizations followed by PAC facility stays, 739 (22.8%) included at least 1 hospital readmission. The strongest risk factors for readmission included impaired functional status (HR 4.78, 95% CI 3.21–7.10), markers of increased acuity such as need for intravenous medications in PAC (1.63, 1.39–1.92), and for-profit PAC ownership (1.43, 1.21–1.69). Readmitted patients had a higher mortality rate at both 30 days (18.9 vs. 8.6%, p<0.001) and 100 days (39.9 vs. 14.5%, p<0.001) even after adjusting for age, comorbidities, and prior health care utilization (30 days: OR 2.01, 95% CI 1.60–2.54; 100 days: OR 3.79, 95% CI 3.13–4.59). Conclusions Hospital readmission from PAC facilities is common and associated with a high mortality rate. Readmission risk factors may signify inadequate transitional care processes or a mismatch between patient needs and PAC resources. PMID:26715357
Full Text Available Background The main purpose of any government from a healthcare reform is to improve the service quality and raised public satisfaction. Objectives As the important role of managerial human resources in any organizational changes, this paper tried to examine the point of view of this group about the recent reform in governmental hospitals of Qazvin. Patients and Methods This cross-sectional study was conducted in January 2015. The statistical population consisted of 50 executive managers of Qazvin teaching hospitals. The data gathering instrument was a research-made questionnaire with approved reliability and validity (α = 0.84. Data analyse was performed in SPSS version 20 using descriptive and analytic statistics (analysis of variance (ANOVA, Pearson correlation test and one sample t-test. Results A total of 43.2% of managers believed that this reform was a good restrictor for malpractices in healthcare and 31.8% believed that it will not be so useful to improve the society health status. The average score of resource preparation, insurance companies coordination, changing the routine workflows, and finally achieving the goals, had a meaningful difference (P ˂ 0.05 and the average score of these fields were upper than average. Conclusions The findings showed that based on the managers’ point of view, the reform plan was able to achieve its primary goals; however, it could not meet their exceptions in improving the society health status. Therefore, it is necessary to design some interventions for changing this perception.
Park, Dong Won; Moon, Jae Young; Ku, Eun Yong; Kim, Sun Jong; Koo, Young-Mo; Kim, Ock-Joo; Lee, Soon Haeng; Jo, Min-Woo; Lim, Chae-Man; Armstrong, John David; Koh, Younsuck
This research aimed to investigate the changes in ethical issues in everyday clinical practice recognized by critical care nurses during two observation periods. We conducted a retrospective analysis of data obtained by prospective questionnaire surveys of nurses in the intensive care units (ICU) of a tertiary university-affiliated hospital in Seoul, Korea. Data were collected prospectively during two different periods, February 2002-January 2003 (Period 1) and August 2011-July 2012 (Period 2). Significantly fewer cases with ethical issues were reported in Period 2 than in Period 1 (89 cases [2.1%] of 4,291 ICU admissions vs. 51 [0.5%] of 9,302 ICU admissions, respectively; P ethical issues in both Periods occurred in MICU. The major source of ethical issues in Periods 1 and 2 was behavior-related. Among behaviorrelated issues, inappropriate healthcare professional behavior was predominant in both periods and mainly involved resident physicians. Ethical issue numbers regarding end-oflife (EOL) care significantly decreased in the proportion with respect to ethical issues during Period 2 (P = 0.044). In conclusion, the decreased incidence of cases with identified ethical issues in Period 2 might be associated with ethical enhancement related with EOL and improvements in the ICU care environment of the studied hospital. However, behaviorrelated issues involving resident physicians represent a considerable proportion of ethical issues encountered by critical care nurses. A systemic approach to solve behavior-related issues of resident physicians seems to be required to enhance an ethical environment in the studied ICU.
Full Text Available Health care institutions are generating large amount of Bio-Medical Waste (BMW, which needs to be properly segregated and treated. With this concern, a questionnaire based cross-sectional study was done to determine the current status of awareness and practices regarding BMW Management (BMWM and areas of deficit amongst the HCWs in a tertiary care teaching hospital in New Delhi, India. The correct responses were graded as satisfactory (more than 80%, intermediate (50–80% and unsatisfactory (less than 50%. Some major areas of deficit found were about knowledge regarding number of BMW categories (17%, mercury waste disposal (37.56% and definition of BMW (47%.
Full Text Available Stroke is the third leading cause of death in the United States (US and a leading cause of serious, long-term disability. Incidence of ischemic stroke is higher than hemorrhagic stroke. The aim is to conduct pharmacoepidemiology study on cerebrovascular accident patient by evaluating the use and the effects of drugs, and quantification of adverse drug reactions, drug utilization studies to improve the quality and use of medicines. A prospective observational study was conducted in department of general medicine and ICU at Mallareddy hospital, data was collected from 130 patients and it was proposed to be conducted for 6 months. Among 130 patients 78(60% are males and 52(40% are females. Among all age groups major number of CVA patients was seen in 60-69 years (30%. Among them 92% of strokes are Ischemic majorly seen in both males and females and8% strokes are hemorrhagic. Ischemic stroke (94.87% is majorly seen in 60-69 yr age group. Among various risk factors Hypertension (36.43% is the major risk factor found in males (60% and females (40%.Antiplatelet drugs (25.75% are the highest number of drugs given in patients 71.27% in males and 28.72% in females. Highest numbers of drugs are given in 50-59yrs age group and are antiplatelets. As a clinical pharmacist 16 adverse drug reactions and 25 drug interactions are reported. Proper patient counselling is needed to reduce hypertension and to reduce the risk for cerebrovascular accident. Among all antiplatelet drugs are majorly given in males and lipid lowering drugs in females.
Hawkins, Jared B; Brownstein, John S; Tuli, Gaurav; Runels, Tessa; Broecker, Katherine; Nsoesie, Elaine O; McIver, David J; Rozenblum, Ronen; Wright, Adam; Bourgeois, Florence T; Greaves, Felix
Patients routinely use Twitter to share feedback about their experience receiving healthcare. Identifying and analysing the content of posts sent to hospitals may provide a novel real-time measure of quality, supplementing traditional, survey-based approaches. To assess the use of Twitter as a supplemental data stream for measuring patient-perceived quality of care in US hospitals and compare patient sentiments about hospitals with established quality measures. 404 065 tweets directed to 2349 US hospitals over a 1-year period were classified as having to do with patient experience using a machine learning approach. Sentiment was calculated for these tweets using natural language processing. 11 602 tweets were manually categorised into patient experience topics. Finally, hospitals with ≥50 patient experience tweets were surveyed to understand how they use Twitter to interact with patients. Roughly half of the hospitals in the US have a presence on Twitter. Of the tweets directed toward these hospitals, 34 725 (9.4%) were related to patient experience and covered diverse topics. Analyses limited to hospitals with ≥50 patient experience tweets revealed that they were more active on Twitter, more likely to be below the national median of Medicare patients (p<0.001) and above the national median for nurse/patient ratio (p=0.006), and to be a non-profit hospital (p<0.001). After adjusting for hospital characteristics, we found that Twitter sentiment was not associated with Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) ratings (but having a Twitter account was), although there was a weak association with 30-day hospital readmission rates (p=0.003). Tweets describing patient experiences in hospitals cover a wide range of patient care aspects and can be identified using automated approaches. These tweets represent a potentially untapped indicator of quality and may be valuable to patients, researchers, policy makers and hospital
Søholm, Helle; Kjaergaard, Jesper; Bro-Jeppesen, John
. The adjusted odds of predefined markers of level-of-care were higher in tertiary centers: admission to intensive care unit (odds ratio [OR], 1.8 [95% confidence interval, 1.2-2.5]), temporary pacemaker (OR, 6.4 [2.2-19]), vasoactive agents (OR, 1.5 [1.1-2.1]), acute (...-segment-elevation myocardial infarction in the Copenhagen area even after adjustment for prognostic factors including comorbidity. Level-of-care seems higher in tertiary centers both in the early phase, during the intensive care unit admission, and in the workup before discharge. The varying level-of-care may contribute......BACKGROUND: Studies have found higher survival rates after out-of-hospital cardiac arrest and admission to tertiary heart centers. The aim was to examine the level-of-care at tertiary centers compared with nontertiary hospitals and the association with outcome after out-of-hospital cardiac arrest...
SONG Li; YAN Hong-bing; HU Da-yi; YANG Jin-gang; SUN Yi-hong
Background Cumulative evidence demonstrates that primary percutaneous coronary intervention(PCI)is a mperfusion strategy for ST-elevation myocardial Infarction(STEMI).This study was undertaken to evaluate the pre-hospital care-seeking pathway and subsequent care quality in patients with STEMI in the Beijing health care system,which offers patients a choice between seeking care in a small community hospital(SH group)or a large hospital(LH group).Methods Between January 1 and December 31,2006, a cross-sectional and multicenter survey was conducted in 11 hospitals qualified as tertiary centers in Beijing and included consecutive patients with STEMI admitted within 24 hours after onset of symptoms.Results Among the 566 patients interviewed,28.3%first arnved at a small community hospitaI and were transferred to large hospitals with the ability to perform primary PCI.The median total pre-hospital delay in the SH group(n=160)was significantly longer than in the LH group(n=406)(225 vs.120 minutes,P<0.001).Multivariate analysis showed that interpreting symptoms to non-cardiac origin(OR,1.996;95%CI: 1.264-3.155),absence of history of myocardial infarction(OR,1.595;95%CI:1.086-3.347),non-health insuranca coverage(OR,1.931;95%Cl:1.079-3.012)and absence of sense of impending doom (OR,4.367;95%CI:1.279-1 4.925) were independent predictors for choosing small hospitals.After adjusting for demographics and medical history,patients in the SH group were 1.698 times(95% CI: 1.1 82-3.661) less likely to receive primary PCI compared with those in the LH group. Conclusions Above one fourth of the STEMI patients in Beijing experienced inter-hospital transfer.Factors including symptoms interpretation,symptoms,history of myocardial infarcUon,and insurance coverage were associated with the patients'pre-hospital care-seeking pathway.The patients who were transferred had longer pre-hospital delays and were less Iikely to receive primary PCI.
Full Text Available Today, hospitals offer surgical treatment within a short hospital admission. This brief interaction may challenge the well-being of old patients. The aim of this study was to explore how the well-being of old hospitalized patients was affected by the interaction with staff during a fast-track surgical treatment and hospital admission for colon cancer. We used an ethnographic methodology with field observations and unstructured interviews focusing on one patient at a time (n=9 during a full day; the hours ranging from 7:45 a.m. to 8 p.m. Participants were between 74 and 85 years of age and of both sexes. The study was reported to the Danish Data Protection Agency with reference number (2007-58-0010. The encounter between old patients and the staff was a main theme in our findings elucidating a number of care challenges. The identified care challenges illustrated “well-being as a matter of different perspectives,” “vulnerability in contrast to well-being,” and “staff mix influencing the care encounter.” The experience of well-being in old cancer patients during hospital admission was absent or challenged when staff did not acknowledge their individual vulnerability and needs.
Full Text Available Regional disparities in geographical access to hospital care are found throughout China. Understanding variations in the spatial accessibility of hospital care has the potential to provide decision support in healthcare planning. This study examines the hospital system in the Sichuan Province in China, which provides healthcare for more than 80 million people. We examine the impacts of accessibility characterisation via the conventional measurement approach by comparing the results to those derived using a floating catchment area approach. Employing a geographical information system based on population and hospital administrative data, we conducted a provincewide study of the spatial accessibility of hospital care in Sichuan Province, China. A shortest-path analysis and the enhanced two-step floating catchment area (E2SFCA method were implemented. Substantial differences between these two approaches were found, including a roughly 15% difference in the total number of under-served areas. Generally, spatial accessibility was higher in the eastern regions of Sichuan. More than 5.5 million people were found to have limited access, with large variations across the province. These results indicate that the official method used by policy makers in China may not capture the true nature of spatial accessibility throughout the region. We recommend that the E2SFCA method be implemented for health services research in China, providing decision makers with more accurate information when setting healthcare policies.
Robin L. Gabriels
Full Text Available Pediatric patients with autism spectrum disorders (ASD and/or intellectual disabilities (ID are at greater risk for psychiatric hospitalization compared to children with other disorders. However, general psychiatric hospital environments are not adapted for the unique learning styles, needs, and abilities of this population, and there are few specialized hospital-based psychiatric care programs in the United States. This paper compares patient outcomes from a specialized psychiatric hospital program developed for pediatric patients with an ASD and/or ID to prior outcomes of this patient population in a general psychiatric program at a children’s hospital. Record review data indicate improved outcomes for patients in the specialized program of reduced recidivism rates (12% versus 33% and decreased average lengths of inpatient stay (as short as 26 days versus 45 days. Available data from a subset of patients (=43 in the specialized program showed a decrease in irritability and hyperactivity behaviors from admission to discharge and that 35 previously undetected ASD diagnoses were made. Results from this preliminary study support specialized psychiatric care practices with this population to positively impact their health care outcomes.
Groppi, Lavinia; Somigliana, Edgardo; Pisani, Vincenzo; Ika, Michelina; Mabor, Joseph L; Akec, Henry N; Nhial, John A; Mading, Michel S; Scanagatta, Chiara; Manenti, Fabio; Putoto, Giovanni
To assess provision of emergency obstetric care (EmOC) in Greater Yirol, South Sudan, after implementation of a hospital-centered intervention with an ambulance referral system. In a descriptive study, data were prospectively recorded for all women referred to Yirol County Hospital for delivery in 2012. An ambulance referral system had been implemented in October 2011. Access to the hospital and ambulance use were free of charge. The number of deliveries at Yirol County Hospital increased in 2012 to 1089, corresponding to 13.3% of the 8213 deliveries expected to have occurred in the catchment area. Cesareans were performed for 53 (4.9%) deliveries, corresponding to 0.6% of the expected number of deliveries in the catchment area. Among 950 women who delivered a newborn weighing at least 2500 g at the hospital, 6 (0.6%) intrapartum or very early neonatal deaths occurred. Of 1232 women expected to have major obstetric complications in 2012 in the catchment area, 472 (38.3%) received EmOC at the hospital. Of 115 expected absolute obstetric indications, 114 (99.1%) were treated in the hospital. A hospital-centered approach with an ambulance referral system effectively improves the availability of EmOC in underprivileged remote settings. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
Salge, Torsten Oliver; Vera, Antonio
Hospitals around the world dedicate increasing attention and resources to innovation. However, surprisingly little is known about the nature of hospital innovativeness and its relationship with organizational performance. Given both the specific characteristics of the hospital sector and the rather mixed evidence from other industries, a positive innovation-performance link should not be taken for granted but requires empirical examination. The purposes of this study were to introduce a perspective of hospitals as vital generators of innovation, to unpack the concept of innovativeness, to propose a measurement model for hospital innovativeness, and to empirically investigate the innovativeness-performance relationship. We conducted a large-scale empirical study among the entire population of public hospital organizations that are part of the English National Health Service (n = 173) and analyzed the data using exploratory factor and regression analyses. Our analyses suggest a significant positive relationship between science- and practice-based innovativeness and clinical performance but provide less unambiguous support for the existence of such a relationship between innovativeness and administrative performance. In particular, we find that higher levels of innovativeness are rather associated with superior quality of care than with measurable bottom-line financial benefits. Hospitals investing in innovation-generating activities might find their efforts well rewarded in terms of tangible clinical performance improvements. However, to achieve measurable financial benefits, numerous hospitals have yet to discover and capture the commercial value of some of their innovations-a challenging task that requires a holistic innovation management and an effective network of complementary partners.
Ansmann, Lena; Wirtz, Markus; Kowalski, Christoph; Pfaff, Holger; Visser, Adriaan; Ernstmann, Nicole
Research on determinants of a good patient-physician interaction mainly disregards systemic factors, such as the work environment in healthcare. This study aims to identify stressors and resources within the work environment of hospital physicians that enable or hinder the physicians' provision of social support to patients. Four data sources on 35 German breast cancer center hospitals were matched: structured hospital quality reports and surveys of 348 physicians, 108 persons in hospital leadership, and 1844 patients. Associations between hospital structures, physicians' social resources as well as job demands and control and patients' perceived support from physicians have been studied in multilevel models. Patients feel better supported by their physicians in hospitals with high social capital, a high percentage of permanently employed physicians, and less physically strained physicians. The results highlight the importance of the work environment for a good patient-physician interaction. They can be used to develop interventions for redesigning the hospital work environment, which in turn may improve physician satisfaction, well-being, and performance and consequently the quality of care. Health policy and hospital management could create conditions conducive to better patient-physician interaction by strengthening the social capital and by increasing job security for physicians. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.
Full Text Available Decompensated cirrhosis is a common precipitant for hospitalization, and there is limited information concerning factors that influence the delivery of quality care in cirrhotic inpatients. We sought to determine the relation between physician specialty and inpatient quality care for decompensated cirrhosis.We reviewed 247 hospital admissions for decompensated cirrhosis, managed by hospitalists or intensivists, between 2009 and 2013. The primary outcome was quality care delivery, defined as adherence to all evidence-based specialty society practice guidelines pertaining to each specific complication of cirrhosis. Secondary outcomes included new complications, length-of-stay, and in-hospital death.Overall, 147 admissions (59.5% received quality care. Quality care was given more commonly by intensivists, compared with hospitalists (71.7% vs. 53.1%, P = .006, and specifically for gastrointestinal bleeding (72% vs. 45.8%, P = .03 and hepatic encephalopathy (100% vs. 63%, P = .005. Involvement of gastroenterology consultation was also more common in admissions in which quality care was administered (68.7% vs. 54.0%, P = .023. Timely diagnostic paracentesis was associated with reduced new complications in admissions for refractory ascites (9.5% vs. 46.6%, P = .02, and reduced length-of-stay in admissions for spontaneous bacterial peritonitis (5 days vs. 13 days, P = .02.Adherence to quality indicators for decompensated cirrhosis is suboptimal among hospitalized patients. Although quality care adherence appears to be higher among cirrhotic patients managed by intensivists than by hospitalists, opportunities for improvement exist in both groups. Rational and cost-effective strategies should be sought to achieve this end.
Kahn, Jeremy M.; Werner, Rachel M.; David, Guy; Have, Thomas R. Ten; Benson, Nicole M.; Asch, David A.
Background For patients recovering from severe acute illness, admission to a long-term acute care hospital (LTAC) is an increasingly common alternative to continued management in an intensive care unit. Objective To examine the effectiveness of LTAC transfer in patients with chronic critical illness. Research Design Retrospective cohort study in United States hospitals from 2002 to 2006. Subjects Medicare beneficiaries with chronic critical illness, defined as mechanical ventilation and at least 14 days of intensive care. Measures Survival, costs and hospital readmissions. We used multivariate analyses and instrumental variables to account for differences in patient characteristics, the timing of LTAC transfer and selection bias. Results A total of 234,799 patients met our definition of chronic critical illness. Of these, 48,416 (20.6%) were transferred to an LTAC. In the instrumental variable analysis, patients transferred to an LTAC experienced similar survival compared to patients who remained in an intensive care unit (adjusted hazard ratio = 0.99, 95% CI: 0.96 to 1.01, p=0.27). Total hospital-related costs in the 180 days following admission were lower among patients transferred to LTACs (adjusted cost difference = -$13,422, 95% CI: -26,662 to -223, p=0.046). This difference was attributable to a reduction in skilled nursing facility admissions (adjusted admission rate difference = -0.591 (95% CI: -0.728 to -0.454, p <0.001). Total Medicare payments were higher (adjusted cost difference = $15,592, 95% CI: 6,343 to 24,842, p=0.001). Conclusions Patients with chronic critical illness transferred to LTACs experience similar survival compared with patients who remain in intensive care units, incur fewer health care costs driven by a reduction in post-acute care utilization, but invoke higher overall Medicare payments. PMID:22874500
Bergquist-Beringer, Sandra; Dong, Lei; He, Jianghua; Dunton, Nancy
Most pressure ulcers can be prevented with evidence-based practice. Many studies describe the implementation of a pressure ulcer prevention program but few report the effect on outcomes across acute care facilities. Data on hospital-acquired pressure ulcers and prevention from the National Database of Nursing Quality Indicators 2010 Pressure Ulcer Surveys were linked to hospital characteristics and nurse staffing measures within the data set. The sample consisted of 1,419 hospitals from across the United States and 710,626 patients who had been surveyed for pressure ulcers in adult critical care, step-down, medical, surgical, and medical/surgical units. Hierarchical logistic regression analysis was performed to identify study variables associated with hospital-acquired pressure ulcers among patients at risk for these ulcers. The rate of hospital-acquired pressure ulcers was 3.6% across all surveyed patients and 7.9% among those at risk. Patients who received a skin and pressure ulcer risk assessment on admission were less likely to develop a pressure ulcer. Additional study variables associated with lower hospital-acquired pressure ulcer rates included a recent reassessment of pressure ulcer risk, higher Braden Scale scores, a recent skin assessment, routine repositioning, and Magnet or Magnet-applicant designation. Variables associated with a higher likelihood of hospital-acquired pressure ulcers included nutritional support, moisture management, larger hospital size, and academic medical center status. Results provide empirical support for pressure ulcer prevention guideline recommendations on skin assessment, pressure ulcer risk assessment, and routine repositioning, but the 7.9% rate of hospital-acquired pressure ulcers among at-risk patients suggests room for improvement in pressure ulcer prevention practice.