Implementing Patient Safety Initiatives in Rural Hospitals

Science.gov (United States)

Klingner, Jill; Moscovice, Ira; Tupper, Judith; Coburn, Andrew; Wakefield, Mary

2009-01-01

Implementation of patient safety initiatives can be costly in time and energy. Because of small volumes and limited resources, rural hospitals often are not included in nationally driven patient safety initiatives. This article describes the Tennessee Rural Hospital Patient Safety Demonstration project, whose goal was to strengthen capacity for…

The financial performance of rural hospitals and implications for elimination of the Critical Access Hospital program.

Science.gov (United States)

Holmes, George M; Pink, George H; Friedman, Sarah A

2013-01-01

To compare the financial performance of rural hospitals with Medicare payment provisions to those paid under prospective payment and to estimate the financial consequences of elimination of the Critical Access Hospital (CAH) program. Financial data for 2004-2010 were collected from the Healthcare Cost Reporting Information System (HCRIS) for rural hospitals. HCRIS data were used to calculate measures of the profitability, liquidity, capital structure, and financial strength of rural hospitals. Linear mixed models accounted for the method of Medicare reimbursement, time trends, hospital, and market characteristics. Simulations were used to estimate profitability of CAHs if they reverted to prospective payment. CAHs generally had lower unadjusted financial performance than other types of rural hospitals, but after adjustment for hospital characteristics, CAHs had generally higher financial performance. Special payment provisions by Medicare to rural hospitals are important determinants of financial performance. In particular, the financial condition of CAHs would be worse if they were paid under prospective payment. © 2012 National Rural Health Association.

Rural hospitals: an asset in the continuum of care.

Science.gov (United States)

Arduino, Kelly

2015-11-01

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

The Rural Inpatient Mortality Study: Does Urban-Rural County Classification Predict Hospital Mortality in California?

Science.gov (United States)

Linnen, Daniel T; Kornak, John; Stephens, Caroline

2018-03-28

Evidence suggests an association between rurality and decreased life expectancy. To determine whether rural hospitals have higher hospital mortality, given that very sick patients may be transferred to regional hospitals. In this ecologic study, we combined Medicare hospital mortality ratings (N = 1267) with US census data, critical access hospital classification, and National Center for Health Statistics urban-rural county classifications. Ratings included mortality for coronary artery bypass grafting, stroke, chronic obstructive pulmonary disease, heart attack, heart failure, and pneumonia across 277 California hospitals between July 2011 and June 2014. We used generalized estimating equations to evaluate the association of urban-rural county classifications on mortality ratings. Unfavorable Medicare hospital mortality rating "worse than the national rate" compared with "better" or "same." Compared with large central "metro" (metropolitan) counties, hospitals in medium-sized metro counties had 6.4 times the odds of rating "worse than the national rate" for hospital mortality (95% confidence interval = 2.8-14.8, p centers may contribute to these results, a potential factor that future research should examine.

Infection prevention needs assessment in Colorado hospitals: rural and urban settings.

Science.gov (United States)

Reese, Sara M; Gilmartin, Heather; Rich, Karen L; Price, Connie S

2014-06-01

The purpose of our study was to conduct a needs assessment for infection prevention programs in both rural and urban hospitals in Colorado. Infection control professionals (ICPs) from Colorado hospitals participated in an online survey on training, personnel, and experience; ICP time allocation; and types of surveillance. Responses were evaluated and compared based on hospital status (rural or urban). Additionally, rural ICPs participated in an interview about resources and training. Surveys were received from 62 hospitals (77.5% response); 33 rural (75.0% response) and 29 urban (80.6% response). Fifty-two percent of rural ICPs reported multiple job responsibilities compared with 17.2% of urban ICPs. Median length of experience for rural ICPs was 4.0 years compared with 11.5 years for urban ICPs (P = .008). Fifty-one percent of rural ICPs reported no access to infectious disease physicians (0.0% urban) and 81.8% of rural hospitals reported no antimicrobial stewardship programs (31.0% urban). Through the interviews it was revealed that priorities for rural ICPs were training and communication. Our study revealed numerous differences between infection prevention programs in rural versus urban hospitals. An infection prevention outreach program established in Colorado could potentially address the challenges faced by rural hospital infection prevention departments. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Deepening the quality of clinical reasoning and decision-making in rural hospital nursing practice.

Science.gov (United States)

Sedgwick, M G; Grigg, L; Dersch, S

2014-01-01

Rural acute care nursing requires an extensive breadth and depth of knowledge as well as the ability to quickly reason through problems in order to make sound clinical decisions. This reasoning often occurs within an environment that has minimal medical or ancillary support. Registered nurses (RN) new to rural nursing, and employers, have raised concerns about patient safety while new nurses make the transition into rural practice. In addition, feeling unprepared for the rigors of rural hospital nursing practice is a central issue influencing RN recruitment and retention. Understanding how rural RNs reason is a key element for identifying professional development needs and may support recruitment and retention of skilled rural nurses. The purpose of this study was to explore how rural RNs reason through clinical problems as well as to assess the quality of such reasoning. This study used a non-traditional approach for data collection. Fifteen rural acute care nurses with varying years of experience working in southern Alberta, Canada, were observed while they provided care to patients of varying acuity within a simulated rural setting. Following the simulation, semi-structured interviews were conducted using a substantive approach to critical thinking. Findings revealed that the ability to engage in deep clinical reasoning varied considerably among participants despite being given the same information under the same circumstances. Furthermore, the number of years of experience did not seem to be directly linked to the ability to engage in sound clinical reasoning. Novice nurses, however, did rely heavily on others in their decision making in order to ensure they were making the right decision. Hence, their relationships with other staff members influenced their ability to engage in clinical reasoning and decision making. In situations where the patient's condition was deteriorating quickly, regardless of years of experience, all of the participants depended on

The potential migration effect of rural hospital closures

DEFF Research Database (Denmark)

Sørensen, Jens Fyhn Lykke

2008-01-01

to out-migration, although the hypothetical way of questioning leaves uncertainty about the actual scale of out-migration. Child families appear to be the most likely out-migrants. Elderly people may be hardest hit by a hospital closure, being most reliant on health care and least inclined to move away.......Rural hospital closures are high on the current health care agenda in Denmark. One raised concern is that rural hospital closures may further decrease population numbers in rural areas, as closures may induce some residents to move away from affected areas, i.e. closer to health care services...

Rurality and nursing home quality: evidence from the 2004 National Nursing Home Survey.

Science.gov (United States)

Kang, Yu; Meng, Hongdao; Miller, Nancy A

2011-12-01

To evaluate the impact of rural geographic location on nursing home quality of care in the United States. The study used cross-sectional observational design. We obtained resident- and facility-level data from 12,507 residents in 1,174 nursing homes from the 2004 National Nursing Home Survey. We used multilevel regression models to predict risk-adjusted rates of hospitalization, influenza and pneumococcal vaccination, and moderate to severe pain while controlling for resident and facility characteristics. Adjusting for covariates, residents in rural facilities were more likely to experience hospitalization (odds ratio [OR] = 1.50, 95% confidence interval [CI] = 1.16-1.94) and moderate to severe pain (OR = 1.68, 95% CI = 1.35-2.09). Significant facility-level predictors of higher quality included higher percentage of Medicaid beneficiaries, accreditation status, and special care programs. Medicare payment findings were mixed. Significant resident-level predictors included dementia diagnosis and being a "long-stay" resident. Rural residents were more likely to reside in facilities without accreditations or special care programs, factors that increased their odds of receiving poorer quality of care. Policy efforts to enhance Medicare payment approaches as well as increase rural facilities' accreditation status and provision of special care programs will likely reduce quality of care disparities in facilities.

Meaningful Use of Health Information Technology by Rural Hospitals

Science.gov (United States)

McCullough, Jeffrey; Casey, Michelle; Moscovice, Ira; Burlew, Michele

2011-01-01

Purpose: This study examines the current status of meaningful use of health information technology (IT) in Critical Access Hospitals (CAHs), other rural, and urban US hospitals, and it discusses the potential role of Medicare payment incentives and disincentives in encouraging CAHs and other rural hospitals to achieve meaningful use. Methods: Data…

Rural emergency medical technician pre-hospital electrocardiogram transmission.

Science.gov (United States)

Powell, A M; Halon, J M; Nelson, J

2014-01-01

Emergent care of the acute heart attack patient continues to be at the forefront of quality and cost reduction strategies throughout the healthcare industry. Although the average cardiac door-to-balloon (D2B) times have decreased substantially over the past few years, there are still vast disparities found in D2B times in populations that reside in rural areas. Such disparities are mostly related to prolonged travel time and subsequent delays in cardiac catherization lab team activation. Urban ambulance companies that are routinely staffed with paramedic level providers have been successful in the implementation of pre-hospital 12-lead electrocardiogram (ECG) protocols as a strategy to reduce D2B times. The authors sought to evaluate the evidence related to the risk and benefits associated with the replication of an ECG transmission protocol in a small rural emergency medical service. The latter is staffed with emergency medical technician-basics (EMT-B), emergency medical technician-advanced (EMT-A), and emergency medical technician-intermediate (EMT-I) level. The evidence reviewed was limited to studies with relevant data regarding the challenges and complexities of the ECG transmission process, the difficulties associated with ECG transmission in rural settings, and ECG transmission outcomes by provider level. The evidence supports additional research to further evaluate the feasibility of ECG transmission at the non-paramedic level. Multiple variables must be investigated including equipment cost, utilization, and rural transmission capabilities. Clearly, pre-hospital ECG transmission and early activation of the cardiac catheterization laboratory are critical components to successfully decreasing D2B times.

Rural hospital wages

Science.gov (United States)

Hendricks, Ann M.

1989-01-01

Average fiscal year 1982 wages from 2,302 rural American hospitals were used to test for a gradient descending from hospitals in counties adjacent to metropolitan areas to those not adjacent. Considerable variation in the ratios of adjacent to nonadjacent averages existed. No statistically significant difference was found, however. Of greater importance in explaining relative wages within States were occupational mix, mix of part-time and full-time workers, case mix, presence of medical residencies, and location in a high-rent county within the State. Medicare already adjusts payments for only two of these variables. PMID:10313454

The Maternity Care Nurse Workforce in Rural U.S. Hospitals.

Science.gov (United States)

Henning-Smith, Carrie; Almanza, Jennifer; Kozhimannil, Katy B

To describe the maternity care nurse staffing in rural U.S. hospitals and identify key challenges and opportunities in maintaining an adequate nursing workforce. Cross-sectional survey study. Maternity care units within rural hospitals in nine U.S. states. Maternity care unit managers. We calculated descriptive statistics to characterize the rural maternity care nursing workforce by hospital birth volume and nursing staff model. We used simple content analysis to analyze responses to open-ended questions and identified themes related to challenges and opportunities for maternity care nursing in rural hospitals. Of the 263 hospitals, 51% were low volume (maternity care nurses. They did, however, identify significant challenges related to recruiting nurses, maintaining adequate staffing during times of census variability, orienting and training nurses, and retaining experienced nurses. Rural maternity care unit managers recognize the importance of nursing and have varied staffing needs. Policy implementation and programmatic support to ameliorate challenges may help ensure that an adequate nursing staff can be maintained, even in small-volume rural hospitals. Copyright © 2017 AWHONN, the Association of Women’s Health, Obstetric and Neonatal Nurses. Published by Elsevier Inc. All rights reserved.

Rural Hospital Wages and the Area Wage Index

Science.gov (United States)

Dalton, Kathleen; Slifkin, Rebecca T.; Howard, Hilda A.

2002-01-01

We examined data on hospital hourly wages and the prospective payment system (PPS) wage index from 1990 to 1997, to determine if incremental changes to the index have improved its precision and equity as a regional cost adjuster. The differential between average rural and urban PPS hourly wages has declined by almost one-fourth over the 8-year study period. Nearly one-half of the decrease is attributable to regulatory and reporting changes in the annual hospital wage survey. Patterns of within-market wage variation across rural-urban continuum codes identify three separate sub-markets within the State-level aggregates defining rural labor markets. Geographic reclassification decisions appear to eliminate one of the three. Remaining systematic within-market rural wage differences work to the reimbursement advantage of hospitals in the smaller and more isolated communities. PMID:12545604

42 CFR 440.20 - Outpatient hospital services and rural health clinic services.

Science.gov (United States)

2010-10-01

... Definitions § 440.20 Outpatient hospital services and rural health clinic services. (a) Outpatient hospital... services that are not generally furnished by most hospitals in the State. (b) Rural health clinic services... 42 Public Health 4 2010-10-01 2010-10-01 false Outpatient hospital services and rural health...

Exploring example models of cross-sector, sessional employment of pharmacists to improve medication management and pharmacy support in rural hospitals.

Science.gov (United States)

Tan, Amy Cw; Emmerton, Lynne M; Hattingh, Laetitia; La Caze, Adam

2015-01-01

Many rural hospitals in Australia are not large enough to sustain employment of a full-time pharmacist, or are unable to recruit or retain a full-time pharmacist. The absence of a pharmacist may result in hospital nurses undertaking medication-related roles outside their scope of practice. A potential solution to address rural hospitals' medication management needs is contracted part-time ('sessional') employment of a local pharmacist external to the hospital ('cross-sector'). The aim of this study was to explore the roles and experiences of pharmacists in their provision of sessional services to rural hospitals with no on-site pharmacist and explore how these roles could potentially address shortfalls in medication management in rural hospitals. A qualitative study was conducted to explore models with pharmacists who had provided sessional services to a rural hospital. A semi-structured interview guide was informed by a literature review, preliminary research and stakeholder consultation. Participants were recruited via advertisement and personal contacts. Consenting pharmacists were interviewed between August 2012 and January 2013 via telephone or Skype for 40-55 minutes. Thirteen pharmacists with previous or ongoing hospital sessional contracts in rural communities across Australia and New Zealand participated. Most commonly, the pharmacists provided weekly services to rural hospitals. All believed the sessional model was a practical solution to increase hospital access to pharmacist-mediated support and to address medication management gaps. Roles perceived to promote quality use of medicines were inpatient consultation services, medicines information/education to hospital staff, assistance with accreditation matters and system reviews, and input into pharmaceutical distribution activities. This study is the first to explore the concept of sessional rural hospital employment undertaken by pharmacists in Australia and New Zealand. Insights from participants

Rural hospital ownership: medical service provision, market mix, and spillover effects.

Science.gov (United States)

Horwitz, Jill R; Nichols, Austin

2011-10-01

To test whether nonprofit, for-profit, or government hospital ownership affects medical service provision in rural hospital markets, either directly or through the spillover effects of ownership mix. Data are from the American Hospital Association, U.S. Census, CMS Healthcare Cost Report Information System and Prospective Payment System Minimum Data File, and primary data collection for geographic coordinates. The sample includes all nonfederal, general medical, and surgical hospitals located outside of metropolitan statistical areas and within the continental United States from 1988 to 2005. We estimate multivariate regression models to examine the effects of (1) hospital ownership and (2) hospital ownership mix within rural hospital markets on profitable versus unprofitable medical service offerings. Rural nonprofit hospitals are more likely than for-profit hospitals to offer unprofitable services, many of which are underprovided services. Nonprofits respond less than for-profits to changes in service profitability. Nonprofits with more for-profit competitors offer more profitable services and fewer unprofitable services than those with fewer for-profit competitors. Rural hospital ownership affects medical service provision at the hospital and market levels. Nonprofit hospital regulation should reflect both the direct and spillover effects of ownership. © Health Research and Educational Trust.

The adoption of provider-based rural health clinics by rural hospitals: a study of market and institutional forces.

Science.gov (United States)

Krein, S L

1999-04-01

To examine the response of rural hospitals to various market and organizational signals by determining the factors that influence whether or not they establish a provider-based rural health clinic (RHC) (a joint Medicare/Medicaid program). Several secondary sources for 1989-1995: the AHA Annual Survey, the PPS Minimum Data Set and a list of RHCs from HCFA, the Area Resource File, and professional associations. The analysis includes all general medical/surgical rural hospitals operating in the United States during the study period. A longitudinal design and pooled cross-sectional data were used, with the rural hospital as the unit of analysis. Key variables were examined as sets and include measures of competitive pressures (e.g., hospital market share), physician resources, nurse practitioner/physician assistant (NP/PA) practice regulation, hospital performance pressures (e.g., operating margin), innovativeness, and institutional pressure (i.e., the cumulative force of adoption). Adoption of provider-based RHCs by rural hospitals appears to be motivated less as an adaptive response to observable economic or internal organizational signals than as a reaction to bandwagon pressures. Rural hospitals with limited resources may resort to imitating others because of uncertainty or a limited ability to fully evaluate strategic activities. This can result in actions or behaviors that are not consistent with policy objectives and the perceived need for policy changes. Such activity in turn could have a negative effect on some providers and some rural residents.

Financially fragile rural hospitals: mergers and closures.

Science.gov (United States)

Holmes, Mark

2015-01-01

Rural hospitals serve as major sources of health care and employment for their communities, but recently they have been under increased financial stress. What are the causes of this stress, and how have hospitals and their communities responded?

Estimating Uncompensated Care Charges at Rural Hospital Emergency Departments

Science.gov (United States)

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

2007-01-01

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

Rural Hospital Employment of Physicians and Use of Cesareans and Nonindicated Labor Induction.

Science.gov (United States)

Prasad, Shailendra; Hung, Peiyin; Henning-Smith, Carrie; Casey, Michelle; Kozhimannil, Katy

2018-02-01

Workforce issues constrain obstetric care services in rural US hospitals, and one strategy hospitals use is to employ physicians to provide obstetric care. However, little is known about the relationship between hospital employment of maternity care physicians and use of obstetric care procedures in rural hospitals. We examined the association between obstetric physician employment and use of cesareans and nonindicated labor induction. We conducted a cross-sectional analysis of a telephone survey of all 306 rural hospitals providing obstetric care in 9 states from November 2013 to March 2014 and linked the survey data (N = 263, 86% response rate) to all-payer childbirth data on maternity care utilization from 2013 Statewide Inpatient Database (SID) hospital discharge data. Using logistic regression models, we assessed the proportion of a hospital's maternity care physicians employed by the hospital and estimated its association with utilization of low-risk and nonindicated cesareans, and nonindicated labor induction. Rural hospitals that employed family physicians but not obstetricians had lower cesarean rates among low-risk pregnancies. Rural hospitals that employed only obstetricians did not show a relationship between employment and procedure utilization. Across hospitals with both obstetricians and family physicians, a 10% higher proportion of obstetricians employed was associated with 4.6% higher low-risk cesarean rates (4.6% [0.7%-8.4%]), while no significant relationship was found for the proportion of family physicians employed by a hospital. In rural US hospitals, associations between physician employment and obstetric procedure use differed by physician mix and the types of physicians employed. © 2017 National Rural Health Association.

Improving paediatric and neonatal care in rural district hospitals in the highlands of Papua New Guinea: a quality improvement approach.

Science.gov (United States)

Sa'avu, Martin; Duke, Trevor; Matai, Sens

2014-05-01

In developing countries such as Papua New Guinea (PNG), district hospitals play a vital role in clinical care, training health-care workers, implementing immunization and other public health programmes and providing necessary data on disease burdens and outcomes. Pneumonia and neonatal conditions are a major cause of child admission and death in hospitals throughout PNG. Oxygen therapy is an essential component of the management of pneumonia and neonatal conditions, but facilities for oxygen and care of the sick newborn are often inadequate, especially in district hospitals. Improving this area may be a vehicle for improving overall quality of care. A qualitative study of five rural district hospitals in the highlands provinces of Papua New Guinea was undertaken. A structured survey instrument was used by a paediatrician and a biomedical technician to assess the quality of paediatric care, the case-mix and outcomes, resources for delivery of good-quality care for children with pneumonia and neonatal illnesses, existing oxygen systems and equipment, drugs and consumables, infection-control facilities and the reliability of the electricity supply to each hospital. A floor plan was drawn up for the installation of the oxygen concentrators and a plan for improving care of sick neonates, and a process of addressing other priorities was begun. In remote parts of PNG, many district hospitals are run by under-resourced non-government organizations. Most hospitals had general wards in which both adults and children were managed together. Paediatric case-loads ranged between 232 and 840 patients per year with overall case-fatality rates (CFR) of 3-6% and up to 15% among sick neonates. Pneumonia accounts for 28-37% of admissions with a CFR of up to 8%. There were no supervisory visits by paediatricians, and little or no continuing professional development of staff. Essential drugs were mostly available, but basic equipment for the care of sick neonates was often absent or

Rural Hospital Mergers and Acquisitions: Which Hospitals Are Being Acquired and How Are They Performing Afterward?.

Science.gov (United States)

Noles, Marissa J; Reiter, Kristin L; Boortz-Marx, Jonathan; Pink, George

2015-01-01

The number of stand-alone rural hospitals has been shrinking as larger health systems target these hospitals for mergers and acquisitions (M and As). However, little research has focused specifically on rural hospital M and A transactions. Using data from Irving Levin Associates' Healthcare M and A Report and Medicare Cost Reports from 2005 to 2012, we examined two research questions: (1) What were the characteristics of rural hospitals that merged or were acquired, and (2) were there changes in rural hospital financial performance, staffing, or services after an M and A transaction? We used logistic regression to identify factors predictive of merger, and we used multiple regression to examine various hospital measures after an M or A. Study results showed that hospitals with weaker financial performance but lower staffing levels and staffing costs were more likely to merge or be acquired. Statistically weak evidence suggested that operating margins declined after the merger; stronger evidence suggested reductions in salary expense. There was no statistically significant evidence of changes to the number of full-time equivalent (FTE) employees, the service lines that were included in the study, capital expenditures, or the amount of debt financing among the hospitals that merged or were acquired. M and A may not result in a rapid influx of capital, a relief of debt burden, or an improvement in bottom-line profitability. However, M and A may be a viable option for maintaining the hospital and the access to care it provides.

Maternity Care Services Provided by Family Physicians in Rural Hospitals.

Science.gov (United States)

Young, Richard A

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

Application of smart phone and supporting set for fundus imaging in primary hospital of rural area

Directory of Open Access Journals (Sweden)

Yong-Feng Jing

2018-01-01

Full Text Available AIM: To describe the application of smart phone and supporting set for acquiring fundus images with slitlamp examination and non-contact lens in primary hospital of the rural area. METHODS: The supporting set for smart phone was purchased from taobao and securely connected to the ocular lens of slitlamp microscopy. The fundus photos were imaged with assistance of non-contact slitlamp lens from Volk. RESULTS: High quality images of various retinal diseases could be successfully taken with smart phone and supporting set by slitlamp examination. The fundus images were send to patients with Wechat as medical records or used for telconsultant. CONCLUSION: High resolution smart phones are wildly used nowadays and supporting sets are very accessible; thus high quality of images could be obtained with minimal cost in rural hospitals. The digital fundus images will be beneficial for medical record and rapid diagnosis with telconsultant.

Do Older Rural and Urban Veterans Experience Different Rates of Unplanned Readmission to VA and Non-VA Hospitals?

Science.gov (United States)

Weeks, William B.; Lee, Richard E.; Wallace, Amy E.; West, Alan N.; Bagian, James P.

2009-01-01

Context: Unplanned readmission within 30 days of discharge is an indicator of hospital quality. Purpose: We wanted to determine whether older rural veterans who were enrolled in the VA had different rates of unplanned readmission to VA or non-VA hospitals than their urban counterparts. Methods: We used the combined VA/Medicare dataset to examine…

The Rural Obstetric Workforce in US Hospitals: Challenges and Opportunities

Science.gov (United States)

Kozhimannil, Katy B.; Casey, Michelle M.; Hung, Peiyin; Han, Xinxin; Prasad, Shailendra; Moscovice, Ira S.

2015-01-01

Purpose The purpose of this study was to describe the types and combinations of clinicians who are delivering babies in rural hospitals, their employment status, the relationship between hospital birth volume and staffing models, and the staffing challenges faced by rural hospitals. Methods We conducted a telephone survey of 306 rural hospitals in 9 states: Colorado, Iowa, Kentucky, New York, North Carolina, Oregon, Vermont, Washington, and Wisconsin, from November 2013-March 2014 to assess their obstetric workforce. Bivariate associations between hospitals’ annual birth volume and obstetric workforce characteristics were examined, as well as qualitative analysis of workforce changes and staffing challenges. Findings Hospitals with lower birth volume (< 240 births per year) are more likely to have family physicians and general surgeons attending deliveries, while those with a higher birth volume more frequently have obstetricians and midwives attending deliveries. Reported staffing challenges include scheduling, training, census fluctuation, recruitment and retention, and intra-hospital relationships. Conclusions Individual hospitals working in isolation may struggle to address staffing challenges. Federal and state policy makers, regional collaboratives, and health care delivery systems can facilitate solutions through programs such as telehealth, simulation training, and interprofessional education. PMID:25808202

The WAMI Rural Hospital Project. Part 3: Building health care leadership in rural communities.

Science.gov (United States)

Elder, W G; Amundson, B A

1991-01-01

The WAMI Rural Hospital Project (RHP) intervention combined aspects of community development, strategic planning and organizational development to address the leadership issues in six Northwest rural hospitals. Hospitals and physicians, other community health care providers and local townspeople were involved in this intervention, which was accomplished in three phases. In the first phase, extensive information about organizational effectiveness was collected at each site. Phase two consisted of 30 hours of education for the physician, board, and hospital administrator community representatives covering management, hospital board governance, and scope of service planning. In the third phase, each community worked with a facilitator to complete a strategic plan and to resolve conflicts addressed in the management analyses. The results of the evaluation demonstrated that the greatest change noted among RHP hospitals was improvement in the effectiveness of their governing boards. All boards adopted some or all of the project's model governance plan and had successfully completed considerable portions of their strategic plans by 1989. Teamwork among the management triad (hospital, board, and medical staff) was also substantially improved. Other improvements included the development of marketing plans for the three hospitals that did not initially have them and more effective use of outside consultants. The project had less impact on improving the functioning of the medical chief of staff, although this was not a primary target of the intervention. There was also relatively less community interest in joining regional health care associations. The authors conclude that an intervention program tailored to address specific community needs and clearly identified leadership deficiencies can have a positive effect on rural health care systems.

Prolonged labour as indication for emergency caesarean section: a quality assurance analysis by criterion-based audit at two Tanzanian rural hospitals.

Science.gov (United States)

Maaløe, N; Sorensen, B L; Onesmo, R; Secher, N J; Bygbjerg, I C

2012-04-01

To audit the quality of obstetric management preceding emergency caesarean sections for prolonged labour. A quality assurance analysis of a retrospective criterion-based audit supplemented by in-depth interviews with hospital staff. Two Tanzanian rural mission hospitals. Audit of 144 cases of women undergoing caesarean sections for prolonged labour; in addition, eight staff members were interviewed. Criteria of realistic best practice were established, and the case files were audited and compared with these. Hospital staff were interviewed about what they felt might be the causes for the audit findings. Prevalence of suboptimal management and themes emerging from an analysis of the transcripts. Suboptimal management was identified in most cases. Non-invasive interventions to potentially avoid operative delivery were inadequately used. When deciding on caesarean section, in 26% of the cases labour was not prolonged, and in 16% the membranes were still intact. Of the women with genuine prolonged labour, caesarean sections were performed with a fully dilated cervix in 36% of the cases. Vacuum extraction was not considered. Amongst the hospital staff interviewed, the awareness of evidence-based guidelines was poor. Word of mouth, personal experience, and fear, especially of HIV transmission, influenced management decisions. The lack of use and awareness of evidence-based guidelines led to misinterpretation of clinical signs, fear of simple interventions, and an excessive rate of emergency caesarean sections. © 2012 The Authors BJOG An International Journal of Obstetrics and Gynaecology © 2012 RCOG.

The Successful Implementation of Electronic Health Records at Small Rural Hospitals

Science.gov (United States)

Richardson, Daniel

2016-01-01

Electronic health records (EHRs) have been in use since the 1960s. U.S. rural hospital leaders and administrators face significant pressure to implement health information technology because of the American Recovery and Reinvestment Act of 2009. However, some leaders and managers of small rural hospital lack strategies to develop and implement…

The price of 'free'. Quantifying the costs incurred by rural residents attending publically funded outpatient clinics in rural and base hospitals.

Science.gov (United States)

Fearnley, David; Kerse, Ngaire; Nixon, Garry

2016-09-01

INTRODUCTION Rural living is associated with increased costs in many areas, including health care. However, there is very little local data to quantify these costs, and their unknown quantity means that costs are not always taken into account in health service planning and delivery. AIM The aim of this study was to calculate the average time and travel costs of attending rural and base hospital outpatient clinics for rural Central Otago residents. METHODS A survey of 51 people attending rural hospital outpatient clinics. Individual costs in terms of travel and time were quantified and an average cost of both rural and base hospital attendance was calculated. RESULTS The average travel and lost time cost of attending a rural outpatient clinic was NZ$182 and 61% of respondents reported this cost had a significant effect on their weekly budget. The average cost incurred by residents associated with a base hospital attendance in Dunedin was NZ$732. DISCUSSION This study data show that costs are substantial and probably higher than most people might expect for both rural and base hospital attendances. It seems likely that these costs are a potential barrier to service access. However, the full implications of the personal costs incurred by rural residents in accessing health services are largely unstudied and therefore remain unknown in New Zealand.

Beliefs and expectations of rural hospital practitioners towards a developing trauma system: A qualitative case study.

Science.gov (United States)

Adams, Ryan D F; Cole, Elaine; Brundage, Susan I; Morrison, Zoe; Jansen, Jan O

2018-03-22

An understanding of stakeholders' views is key to the successful development and operation of a rural trauma system. Scotland, which has large remote and rural areas, is currently implementing a national trauma system. The aim of this study was to identify key barriers and enablers to the development of an effective trauma system from the perspective of rural healthcare professionals. This is a qualitative study, which was conducted in rural general hospitals (RGH) in Scotland, from April to June 2017. We used an opportunistic sampling strategy to include hospital providers of rural trauma care across the region. Semi-structured interviews were conducted, recorded, and transcribed. Thematic analysis was used to identify and group participant perspectives on key barriers and enablers to the development of the new trauma system. We conducted 15 interviews with 18 participants in six RGHs. Study participants described barriers and enablers across three themes: 1) quality of care, 2) interfaces within the system and 3) interfaces with the wider healthcare system. For quality of care, enablers included confidence in basic trauma management, whilst a perceived lack of change from current management was seen as a barrier. The theme of interfaces within the system identified good interaction with other services and a single point of contact for referral as enablers. Perceived barriers included challenges in referring to tertiary care. The final theme of interfaces with the wider healthcare system included an improved transport system, increased audit resource and coordinated clinical training as enablers. Perceived barriers included a rural staffing crisis and problematic patient transfer to further care. This study provides insight into rural professionals' perceptions regarding the implementation of a trauma system in rural Scotland. Barriers included practical issues, such as retrieval, transfer and referral processes. Importantly, there is a degree of uncertainty

The hub-and-spoke organization design revisited: a lifeline for rural hospitals.

Science.gov (United States)

Elrod, James K; Fortenberry, John L

2017-12-13

Characterized by declining populations, high poverty, reduced employment opportunities, and high numbers of uninsured residents, rural communities pose significant challenges for healthcare providers desirous of addressing these medically underserved areas. Such difficult environments, in fact, have forced the closure of many rural hospitals across America, with scores facing the same threat, compelling intensive efforts to identify pathways which will yield an improved future. Collaborations with stronger urban or suburban healthcare institutions offer a prudent avenue for rural hospitals to continue serving their patients. Such relationships can be structured in many different ways, but Willis-Knighton Health System found that its use of the hub-and-spoke organization design set the stage for the institution to cast a vital lifeline to neighboring rural hospitals, affording the relatively seamless integration and assimilation of partner facilities into its network, ensuring continuity of services in remote regions. This article supplies an overview of the hub-and-spoke network and discusses Willis-Knighton Health System's use of it to facilitate the establishment of productive partnerships with rural hospitals. The delivery of healthcare services in rural environments is essential, but with small community hospitals increasingly being under threat, the outlook is not particularly attractive. Partnerships with better positioned healthcare entities offer significant hope, but care must be taken to structure these arrangements optimally. Willis-Knighton Health System found utility and value in its hub-and-spoke organization design, with the insights presented in this account potentially offering a pathway for others to follow as they go about addressing the healthcare needs of rural populations.

Can hospitals compete on quality? Hospital competition.

Science.gov (United States)

Sadat, Somayeh; Abouee-Mehrizi, Hossein; Carter, Michael W

2015-09-01

In this paper, we consider two hospitals with different perceived quality of care competing to capture a fraction of the total market demand. Patients select the hospital that provides the highest utility, which is a function of price and the patient's perceived quality of life during their life expectancy. We consider a market with a single class of patients and show that depending on the market demand and perceived quality of care of the hospitals, patients may enjoy a positive utility. Moreover, hospitals share the market demand based on their perceived quality of care and capacity. We also show that in a monopoly market (a market with a single hospital) the optimal demand captured by the hospital is independent of the perceived quality of care. We investigate the effects of different parameters including the market demand, hospitals' capacities, and perceived quality of care on the fraction of the demand that each hospital captures using some numerical examples.

A survey of rural hospitals' perspectives on health information technology outsourcing.

Science.gov (United States)

Johnson, Nicholas; Murphy, Alison; McNeese, Nathan; Reddy, Madhu; Purao, Sandeep

2013-01-01

A survey of rural hospitals was conducted in the spring of 2012 to better understand their perspectives on health information technology (HIT) outsourcing and the role that hospital-to-hospital HIT partnerships (HHPs) can play as an outsourcing mechanism. The survey sought to understand how HHPs might be leveraged for HIT implementation, as well as the challenges with forming them. The results suggest that HHPs have the potential to address rural hospitals' slow rate of HIT adoption, but there are also challenges to creating these partnerships. These issues, as well as avenues for further research, are then discussed.

Drinking water quality assessment and corrosion mitigation in the hospital water supply system of Chacas Village (Peru

Directory of Open Access Journals (Sweden)

Riccardo Bigoni

2014-07-01

Full Text Available Rural hospitals in developing countries often lack appropriate water treatments to assure their water needs. In these facilities, due to water different uses and its use with medical equipment, water quality problems can cause very hazardous situations. In particular, corrosion of water distribution systems is a common issue that can cause unwanted changes in water quality and failures of the distribution system’s pipes. These considerations suggest that a complete monitoring program and water treatments to control and guarantee the water quality would be required in each health-care facility. This study assessed the quality of the water at the rural hospital of Chacas (Peru as measured via specific physical-chemical and microbiological parameters. The results show that the chemical and microbiological qualities of the water generally worsen from catchment to the hospital’s taps. Moreover, this work investigated the effects of a dolomite limestone filter installed to adjust the quality of the water distributed at the hospital and thereby mitigate the water’s corrosiveness. Corrosion indices were calculated to provide useful information on the water’s corrosiveness and positive results were obtained in reducing corrosiveness after the installation of the dolomite filter.

Relationships Between Agritourism and Certified Quality Food in Italian Rural Areas

Directory of Open Access Journals (Sweden)

NICOLA GALLUZZO

2015-06-01

Full Text Available Since the early 1960, farms are one of the alternatively forms of hospitality in few Italian regions located predominately in the north and in the centre of peninsula. In 1985, Italian government promulgated a law in order to regulate this non-conventional form of tourism, by delegating to the regions the direct management of administrative procedures and inspections in farms. Nowadays, Italian agritourist farms represent a good chance to give value in favour of farm by the diversification of agrarian activities and also by holistically promoting local food in a direct connection to local gastronomy, rural heritage and tradition, with positive effects on the endogenous development in rural areas. The aim of the paper was to assess the role of agritourism in raising the socio-economic development of rural space by the diffusion of certified quality food using a quantitative approach and to assess if agritourist and certified quality food were tools able to implement the living conditions in the countryside. The findings have disclosed that tourists from abroad have increased the level of farmer income giving value towards high quality food and farm holidays farms. Instead, the impact of Italian agritourists has been relatively poor because of the economic crisis.

42 CFR 485.603 - Rural health network.

Science.gov (United States)

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Rural health network. 485.603 Section 485.603... Participation: Critical Access Hospitals (CAHs) § 485.603 Rural health network. A rural health network is an... quality assurance with at least— (1) One hospital that is a member of the network when applicable; (2) One...

Patient Safety Outcomes in Small Urban and Small Rural Hospitals

Science.gov (United States)

Vartak, Smruti; Ward, Marcia M.; Vaughn, Thomas E.

2010-01-01

Purpose: To assess patient safety outcomes in small urban and small rural hospitals and to examine the relationship of hospital and patient factors to patient safety outcomes. Methods: The Nationwide Inpatient Sample and American Hospital Association annual survey data were used for analyses. To increase comparability, the study sample was…

Unique factors rural Veterans' Affairs hospitals face when implementing health care-associated infection prevention initiatives.

Science.gov (United States)

Harrod, Molly; Manojlovich, Milisa; Kowalski, Christine P; Saint, Sanjay; Krein, Sarah L

2014-01-01

Health care-associated infection (HAI) is costly to hospitals and potentially life-threatening to patients. Numerous infection prevention programs have been implemented in hospitals across the United States. Yet, little is known about infection prevention practices and implementation in rural hospitals. The purpose of this study was to understand the infection prevention practices used by rural Veterans' Affairs (VA) hospitals and the unique factors they face in implementing these practices. This study used a sequential, mixed methods approach. Survey data to identify the HAI prevention practices used by rural VA hospitals were collected, analyzed, and used to inform the development of a semistructured interview guide. Phone interviews were conducted followed by site visits to rural VA hospitals. We found that most rural VA hospitals were using key recommended infection prevention practices. Nonetheless, a number of challenges with practice implementation were identified. The 3 most prominent themes were: (1) lack of human capital including staff with HAI expertise; (2) having to cultivate needed resources; and (3) operating as a system within a system. Rural VA hospitals are providing key infection prevention services to ensure a safe environment for the veterans they serve. However, certain factors, such as staff expertise, limited resources, and local context impacted how and when these practices were used. The creative use of more accessible alternative resources as well as greater flexibility in implementing HAI-related initiatives may be important strategies to further improve delivery of these important services by rural VA hospitals. Published 2013. This article is a U.S. Government work and is in the public domain in the USA.

Surgical referral coordination from a first-level hospital: a prospective case study from rural Nepal.

Science.gov (United States)

Fleming, Matthew; King, Caroline; Rajeev, Sindhya; Baruwal, Ashma; Schwarz, Dan; Schwarz, Ryan; Khadka, Nirajan; Pande, Sami; Khanal, Sumesh; Acharya, Bibhav; Benton, Adia; Rogers, Selwyn O; Panizales, Maria; Gyorki, David; McGee, Heather; Shaye, David; Maru, Duncan

2017-09-25

Patients in isolated rural communities typically lack access to surgical care. It is not feasible for most rural first-level hospitals to provide a full suite of surgical specialty services. Comprehensive surgical care thus depends on referral systems. There is minimal literature, however, on the functioning of such systems. We undertook a prospective case study of the referral and care coordination process for cardiac, orthopedic, plastic, gynecologic, and general surgical conditions at a district hospital in rural Nepal from 2012 to 2014. We assessed the referral process using the World Health Organization's Health Systems Framework. We followed the initial 292 patients referred for surgical services in the program. 152 patients (52%) received surgery and four (1%) suffered a complication (three deaths and one patient reported complication). The three most common types of surgery performed were: orthopedics (43%), general (32%), and plastics (10%). The average direct and indirect cost per patient referred, including food, transportation, lodging, medications, diagnostic examinations, treatments, and human resources was US$840, which was over 1.5 times the local district's per capita income. We identified and mapped challenges according to the World Health Organization's Health Systems Framework. Given the requirement of intensive human capital, poor quality control of surgical services, and the overall costs of the program, hospital leadership decided to terminate the referral coordination program and continue to build local surgical capacity. The results of our case study provide some context into the challenges of rural surgical referral systems. The high relative costs to the system and challenges in accountability rendered the program untenable for the implementing organization.

Does a hospital's quality depend on the quality of other hospitals? A spatial econometrics approach.

Science.gov (United States)

Gravelle, Hugh; Santos, Rita; Siciliani, Luigi

2014-11-01

We examine whether a hospital's quality is affected by the quality provided by other hospitals in the same market. We first sketch a theoretical model with regulated prices and derive conditions on demand and cost functions which determine whether a hospital will increase its quality if its rivals increase their quality. We then apply spatial econometric methods to a sample of English hospitals in 2009-10 and a set of 16 quality measures including mortality rates, readmission, revision and redo rates, and three patient reported indicators, to examine the relationship between the quality of hospitals. We find that a hospital's quality is positively associated with the quality of its rivals for seven out of the sixteen quality measures. There are no statistically significant negative associations. In those cases where there is a significant positive association, an increase in rivals' quality by 10% increases a hospital's quality by 1.7% to 2.9%. The finding suggests that for some quality measures a policy which improves the quality in one hospital will have positive spillover effects on the quality in other hospitals.

Quality of communication about medicines in United States hospitals: A national retrospective study.

Science.gov (United States)

Mullings, Lauren; Sankaranarayanan, Jayashri

Despite the benefits of improving transitions across care, literature is very limited on inpatient "Communication about Medicines" (ComMed) by staff across United States (U.S.) hospitals. To evaluate ComMed quality variations by hospital characteristics. In a cross-sectional, retrospective study of publicly available U.S. Medicare's Hospital Consumer Assessment of Health Care Plans Survey (HCAHPS) data (January 2013-September 2014), ComMed quality (high = above average/excellent vs. low = average/below average/poor star ratings) of 3125 hospitals were compared across region, rural-urban location, and health information technology (HIT) infrastructure giving providers access to patients' electronic medical records. Multivariate logistic regression analysis was conducted with adjusting for confounders (hospital - bed size, ownership, type, ED services, the number of completed HCAHPS surveys). After adjusting for other characteristics, Midwest versus Western region hospitals (OR = 1.55, 95% CI: 1.21-1.98, p=quality. Hospitals' small bed-size, physician/non-profit ownership, critical-access type, absent ED services, and 100-299 HCAHPS completed surveys were more likely to be associated with high ComMed quality. One of the first national studies found significant variations in ComMed quality across U.S. hospitals by location (high in Midwest and low in Northeast regions and urban areas) and by access to HIT infrastructure (high) after controlling for other hospital characteristics. With this baseline data, hospital providers and policymakers can design, implement, and evaluate service programs with pharmacists and HIT to enhance ComMed quality in the future delivery of patient-centered care. Copyright © 2016 Elsevier Inc. All rights reserved.

Power quality of small rural industries

International Nuclear Information System (INIS)

Koval, D.O.; Leonard, J.J.; Licsko, Z.J.

1991-01-01

Successful and economical operation of small rural industries (e.g., grain, dairy, irrigation, pig, poultry, beef feedlots, etc.) is a fundamental objective of society. However, when the performance and life expectancy of industrial electronic and electrical equipment is significantly affected by power supply anomalies caused by polluting loads at an industrial site and by utility normal operational activities, the economic benefits of this technology are quickly eradicated. This paper will present the results of a detailed power quality survey of 23 small rural industries sponsored by the Canadian Electrical Association and provides a knowledge base on rural power quality and the possible origins of power supply problems experienced at the various industrial sites. The results of the survey provide a basis for mitigating actions by the utilities and their rural industrial customers to design and operate their electrical systems to minimize the effects of power supply anomalies

Nile Crossings: Hospitality and Revenge in Egyptian Rural Narratives

OpenAIRE

Granara, William E.

2010-01-01

This essay looks at acts of hospitality and revenge as constituent elements of a broad social code in rural Egyptian narratives. By looking at five stories in particular, I argue that hospitality and revenge work in complementarity, and that they often trespass and blur each other’s social and literary borders, creating ambiguity and complexity in the stories. The traditional rules that govern hospitality are at times challenged or inverted by hostile intentions, and revenge may be exacted fo...

Strategic activity and financial performance of U.S. rural hospitals: a national study, 1983 to 1988.

Science.gov (United States)

Mick, S S; Morlock, L L; Salkever, D; de Lissovoy, G; Malitz, F; Wise, C G; Jones, A

1994-01-01

This study examines the effect of 13 strategic management activities on the financial performance of a national sample of 797 U.S. rural hospitals during the period of 1983-1988. Controlled for environment-market, geographic-region, and hospital-related variables, the results show almost no measurable effect of strategic adoption on rural hospital profitability and liquidity. Where statistically significant relationships existed, they were more often negative than positive. These findings were not expected; it was hypothesized that positive effects across a broad range of strategies would emerge, other things being equal. Discussed are possible explanations for these findings as well as their implication for a rural health policy relying on individual rural hospital strategic adaptation to environmental change.

Introduction of Tele-ICU in rural hospitals: Changing organisational culture to harness benefits.

Science.gov (United States)

Goedken, Cassie Cunningham; Moeckli, Jane; Cram, Peter M; Reisinger, Heather Schacht

2017-06-01

This study evaluates rural hospital staff perceptions of a telemedicine ICU (Tele-ICU) before and after implementation. We conducted a longitudinal qualitative study utilising semistructured group or individual interviews with staff from three rural ICU facilities in the upper Midwest of the United States that received Tele-ICU support. Interviews occurred pre-implementation and at two time points post-implementation. Interviews were conducted with: ICU administrators (n=6), physicians (n=3), nurses (n=9), respiratory therapists (n=5) and other (n=1) from July 2011 to May 2013. Transcripts were analysed for thematic content. Overall, rural ICU staff viewed Tele-ICU as a welcome benefit for their facility. Major themes included: (1) beneficial where recruitment and retention of staff can be challenging; (2) extra support for day shifts and evening, night and weekend shifts; (3) reduction in the number of transfers larger tertiary hospitals in the community; (4) improvement in standardisation of care; and (5) organisational culture of rural ICUs may lead to under-utilisation. ICU staff at rural facilities view Tele-ICU as a positive, useful tool to provide extra support and assistance. However, more research is needed regarding organisational culture to maximise the potential benefits of Tele-ICU in rural hospitals. Published by Elsevier Ltd.

Lessons from tele-emergency: improving care quality and health outcomes by expanding support for rural care systems.

Science.gov (United States)

Mueller, Keith J; Potter, Andrew J; MacKinney, A Clinton; Ward, Marcia M

2014-02-01

Tele-emergency services provide immediate and synchronous audio/video connections, most commonly between rural low-volume hospitals and an urban "hub" emergency department. We performed a systematic literature review to identify tele-emergency models and outcomes. We then studied a large tele-emergency service in the upper Midwest. We sent a user survey to all seventy-one hospitals that used the service and received 292 replies. We also conducted telephone interviews and site visits with ninety clinicians and administrators at twenty-nine of these hospitals. Participants reported that tele-emergency improves clinical quality, expands the care team, increases resources during critical events, shortens time to care, improves care coordination, promotes patient-centered care, improves the recruitment of family physicians, and stabilizes the rural hospital patient base. However, inconsistent reimbursement policy, cross-state licensing barriers, and other regulations hinder tele-emergency implementation. New value-based payment systems have the potential to reduce these barriers and accelerate tele-emergency expansion.

Small rural hospitals: an example of market segmentation analysis.

Science.gov (United States)

Mainous, A G; Shelby, R L

1991-01-01

In recent years, market segmentation analysis has shown increased popularity among health care marketers, although marketers tend to focus upon hospitals as sellers. The present analysis suggests that there is merit to viewing hospitals as a market of consumers. Employing a random sample of 741 small rural hospitals, the present investigation sought to determine, through the use of segmentation analysis, the variables associated with hospital success (occupancy). The results of a discriminant analysis yielded a model which classifies hospitals with a high degree of predictive accuracy. Successful hospitals have more beds and employees, and are generally larger and have more resources. However, there was no significant relationship between organizational success and number of services offered by the institution.

Rural Tourism – Evaluating the Quality of Destination

Directory of Open Access Journals (Sweden)

Ryglová Kateřina

2017-12-01

Full Text Available This paper concerns the topic of rural destination quality from the viewpoint of tourism development. The research exploring crucial quality factors from the viewpoint of demand is presented. Rural tourism participants attribute the highest significance to Destination cleanliness and Sense of security. The evaluation of the importance of most research quality factors is not dependent on gender and on the contrary, the importance of 16 quality factors depends on the visitor´s age. In the case of the factor of “Friendly acceptance by the locals”, the most significant influence on the visitor´s return to the destination was confirmed. On the contrary, this impact was not proven for the factor of “Level of prices of services and goods in the destination”. The research and the successive factor analysis revealed 6 dimensions representing the rural destination quality: Services, Image, Transportation, Well-being, Information/Communication and Attractions/ Experiences; Well-being was identified as the most important. This was consecutively confirmed by the analysis of the quality factors’ impact on the visitor´s overall satisfaction and loyalty to the destination. The research findings provide the theory with topical destination quality dimensions as well as contribute to better understanding of visitor´s behavioural mechanisms in rural areas.

The changing nature of nursing work in rural and small community hospitals.

Science.gov (United States)

Montour, Amy; Baumann, Andrea; Blythe, Jennifer; Hunsberger, Mabel

2009-01-01

The nursing literature includes descriptions of rural nursing workforces in Canada, the United States of America and Australia. However, inconsistent definitions of rural demography, diverse employment conditions and health care system reorganization make comparisons of these data difficult. In 2007, the Ministry of Health and Long-term Care in Ontario, Canada, transferred responsibility for decision-making and funding to 14 regional governing bodies known as Local Health Integration Networks (LHINs). Little is known about rural-urban variations in the nursing workforces in the LHINs because existing data repositories do not describe them. This study investigated the influence of demographic characteristics, provincial policies, organizational changes and emerging practice challenges on nursing work in a geographically unique rural region. The purpose was to describe the nature of nursing work from the perspective of rural nurse executives and frontline nurses. The study was conducted in 7 small rural and community hospitals in the Hamilton Niagara Haldimand Brant LHIN. Data collection occurred between August and November 2007. A qualitative descriptive study design was chosen to facilitate exploration of nursing in the rural setting. Study participants were identified through purposive snowball sampling. All nurses, nurse managers and nurse executives currently employed in the 7 study hospitals were eligible to participate. Data collection included the use of questionnaires and semi-structured interviews. Memos were also created to describe the relevance and applicability of concepts, categories and properties emerging from the data. Themes were compared across interviews to determine relevance and value. Twenty-one nurses from 7 different hospitals participated. The nurses reflect the aging trend in the provincial and regional workforces of Ontario. All study participants anticipate a substantial increase in retirements during the next decade, which will alter

Rural Bypass of Critical Access Hospitals in Iowa: Do Visiting Surgical Specialists Make a Difference?

Science.gov (United States)

Weigel, Paula A M; Ullrich, Fred; Ward, Marcia M

2018-02-01

Rural bypass for elective surgical procedures is a challenge for critical access hospitals, yet there are opportunities for rural hospitals to improve local retention of surgical candidates through alternative approaches to developing surgery lines of business. In this study we examine the effect of visiting surgical specialists on the odds of rural bypass. Discharge data from the 2011 State Inpatient Databases and State Ambulatory Surgery Databases for Iowa were linked to outreach data from the Office of Statewide Clinical Education Programs and Iowa Physician Information System to model the effect of surgeon specialist supply on rural patients' decision to bypass rural critical access hospitals. Patients in rural communities with a local general surgeon were more likely to be retained in a community than to bypass. Those in communities with visiting general surgeons were more likely to bypass, as were those in communities with visiting urologists and obstetricians. Patients in communities with visiting ophthalmologists and orthopedic surgeons were at higher odds of being retained for their elective surgeries. In addition to known patient and local hospital factors that have an influence on bypass behavior among rural patients seeking elective surgery, availability of surgeon specialists also plays an important role in whether patients bypass or not. Visiting ophthalmologists and orthopedic surgeons were associated with less bypass, as was having local general surgeons. Visiting general surgeons, urologists, and obstetricians were associated with greater odds of bypass. © 2016 National Rural Health Association.

Factors that influence quality of life in rural children with asthma and their parents.

Science.gov (United States)

Walker, Jennifer; Winkelstein, Marilyn; Land, Cassia; Lewis-Boyer, Lapricia; Quartey, Ruth; Pham, Luu; Butz, Arlene

2008-01-01

Among rural children with asthma and their parents, this study examined the relationship between parental and child reports of quality of life and described the relationship of several factors such as asthma severity, missed days of work, and asthma education on their quality of life. Two hundred one rural families with asthma were enrolled in a school-based educational program. Intervention parents and children participated in interactive asthma workshop(s) and received asthma devices and literature. Parent and child quality of life measurements were obtained before and after the intervention using Juniper's Paediatric Caregivers Quality of Life and Juniper's Paediatric Quality of Life Questionnaires. Asthma severity was measured using criteria from the National Asthma Education and Prevention Program guidelines. There was no association between parent and child total quality of life scores, and mean parental total quality of life scores were higher at baseline and follow-up than those of the children. All the parents' quality of life scores were correlated with parental reports of missed days of work. For all children, emotional quality of life (EQOL) was significantly associated with parental reports of school days missed (P = .03) and marginally associated with parental reports of hospitalizations due to asthma (P = .08). Parent's EQOL and activity quality of life (AQOL) were significantly associated with children's asthma severity (EQOL, P = .009; AQOL, P = .03), but not the asthma educational intervention. None of the child quality of life measurements was associated with asthma severity. Asthma interventions for rural families should help families focus on gaining and maintaining low asthma severity levels to enjoy an optimal quality of life. Health care providers should try to assess the child's quality of life at each asthma care visit independently of the parents.

Injuries treated in hospital among urban and rural inhabitants of eastern Poland.

Science.gov (United States)

Kos, Marek; Drop, Bartłomiej; Dziewa, Agnieszka; Jędrych, Marian

2017-09-21

Injuries are a serious medical and social problem, especially when accompanied by distant or deferred effects, often causing serious dysfunctions and permanent disability for life. The study aimed at presenting the incidence of injuries of urban and rural population treated in a district hospital in eastern Poland. The study was carried out in the Independent Public Health Care Institution in Kraśnik in 2011 among patients hospitalized in the Department of Trauma Surgery and Orthopedic Unit who sustained injuries. Medical records of 795 patients - 326 women and 469 men, aged 10-99 years, were analyzed. During the period considered among those hospitalized due to injuries, men (59%), those aged 50-59 years (19.0%), and living in rural areas (72.7%) predominated. Injuries most commonly affected the head (18.87%), elbow and forearm (16.86%), knee and lower leg (16.60%), and the hip and thigh (13.96%). Average hospital stay was 5.65 days and was the longest for hip and thigh injuries (11.86 days). Injuries occurred most frequently in the population of patients living in rural areas, often among men, usually on weekdays and in the morning.

Rural-Urban Differences in Preventable Hospitalizations among Community-Dwelling Veterans with Dementia

Science.gov (United States)

Thorpe, Joshua M.; Van Houtven, Courtney H.; Sleath, Betsy L.; Thorpe, Carolyn T.

2010-01-01

Context: Alzheimer's patients living in rural communities may face significant barriers to effective outpatient medical care. Purpose: We sought to examine rural-urban differences in risk for ambulatory care sensitive hospitalizations (ACSH), an indicator of access to outpatient care, in community-dwelling veterans with dementia. Methods: Medicare…

Exploring Diet Quality between Urban and Rural Dwelling Women of Reproductive Age.

Science.gov (United States)

Martin, Julie C; Moran, Lisa J; Teede, Helena J; Ranasinha, Sanjeeva; Lombard, Catherine B; Harrison, Cheryce L

2017-06-08

Health disparities, including weight gain and obesity exist between urban and rural dwelling women. The primary aim was to compare diet quality in urban and rural women of reproductive age, and secondary analyses of the difference in macronutrient and micronutrient intake in urban and rural women, and the predictors of diet quality. Diet quality was assessed in urban ( n = 149) and rural ( n = 394) women by a modified version of the Dietary Guideline Index (DGI) energy, macronutrient and micronutrient intake from a food frequency questionnaire (FFQ) and predictors of diet quality. Diet quality did not significantly differ between urban and rural women (mean ± standard deviation (SD), 84.8 ± 15.9 vs. 83.9 ± 16.5, p = 0.264). Rural women reported a significantly higher intake of protein, fat, saturated fat, monounsaturated fat, cholesterol and iron and a higher score in the meat and meat alternatives component of the diet quality tool in comparison to urban women. In all women, a higher diet quality was associated with higher annual household income (>$Australian dollar (AUD) 80,000 vs. urban and rural women; however, a higher macronutrient consumption pattern was potentially related to a higher lean meat intake in rural women. Women who are unemployed and on a lower income are an important target group for future dietary interventions aiming to improve diet quality.

Using Quality Tools and Methodologies to Improve a Hospital's Quality Position.

Science.gov (United States)

Branco, Daniel; Wicks, Angela M; Visich, John K

2017-01-01

The authors identify the quality tools and methodologies most frequently used by quality-positioned hospitals versus nonquality hospitals. Northeastern U.S. hospitals in both groups received a brief, 12-question survey. The authors found that 93.75% of the quality hospitals and 81.25% of the nonquality hospitals used some form of process improvement methodologies. However, there were significant differences between the groups regarding the impact of quality improvement initiatives on patients. The findings indicate that in quality hospitals the use of quality improvement initiatives had a significantly greater positive impact on patient satisfaction and patient outcomes when compared to nonquality hospitals.

Concurrent alcohol and medication poisoning hospital admissions among older rural and urban residents.

Science.gov (United States)

Zanjani, Faika; Smith, Rachel; Slavova, Svetla; Charnigo, Richard; Schoenberg, Nancy; Martin, Catherine; Clayton, Richard

2016-07-01

Alcohol and medication interactions are projected to increase due to the growth of older adults that are unsafely consuming alcohol and medications. Plus, aging adults who reside in rural areas are at the highest risk of experiencing medication interactions. Estimate concurrent alcohol and medication (alcohol/medication) hospitalizations in adults 50+ years, comparing age groups and rural/urban regions. Kentucky nonfederal, acute care inpatient hospital discharge electronic records for individuals aged 50+ years from 2001 to 2012 were examined. Rate differences were estimated across age and regional strata. Differences in the underlying principal diagnosis, intent, and medications were also examined. There were 2168 concurrent alcohol/medication hospitalizations among 50+ year olds identified. There was a 187% increase in alcohol/medication hospitalizations from 2001 (n = 104) to 2012 (n = 299). The per capita alcohol/medication hospitalization rate increased from 8.91 (per 100,000) in 2001 to 19.98 (per 100,000) in 2012, a 124% increase. The characteristics of the hospitalizations included 75% principal diagnosis as medication poisoning, self-harm as the primary intent (55%) in 50-64-year olds, and unintentional intent (41%) in 65+ adults. Benzodiazepines were most often involved in the poisonings (36.5%). Concurrent alcohol/medication hospitalizations in Kentucky are increasing among aging adults. Greater increases in rural areas and the 65+ aged adults were seen, although there were also higher alcohol/medication hospitalizations in urban and 50-64 aged adults. These findings indicate the need for public-health prevention and clinical intervention to better educate and manage alcohol consuming older adults on safe medication and alcohol practices.

Performing well in financial management and quality of care: evidence from hospital process measures for treatment of cardiovascular disease.

Science.gov (United States)

Dong, Gang Nathan

2015-02-01

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.

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

Directory of Open Access Journals (Sweden)

Sills ES

2013-03-01

hospitals in western North Carolina is considerable. Centers for Medicare and Medicaid Services “Hospital Compare” information suggests that process of care measurements at Fannin Regional Hospital are significantly higher than at either Murphy Medical Center or Union General Hospital, relative to state and national benchmarks. Further investigation is needed to determine what impact these differences in process of care may have on hospital volume and/or market share in this region. Additional research is planned to identify process of care trends in this demographic and geographically rural area.Keywords: process of care, hospital quality, North Carolina, rural

Common geriatric emergencies in a rural hospital in South‑Eastern ...

African Journals Online (AJOL)

Common geriatric emergencies in a rural hospital in South‑Eastern Nigeria. ... by emergency health conditions that predispose them to higher risk of disability and ... The geriatric patients seen within the study period who met the selection ...

Exploring Diet Quality between Urban and Rural Dwelling Women of Reproductive Age

Directory of Open Access Journals (Sweden)

Julie C. Martin

2017-06-01

Full Text Available Health disparities, including weight gain and obesity exist between urban and rural dwelling women. The primary aim was to compare diet quality in urban and rural women of reproductive age, and secondary analyses of the difference in macronutrient and micronutrient intake in urban and rural women, and the predictors of diet quality. Diet quality was assessed in urban (n = 149 and rural (n = 394 women by a modified version of the Dietary Guideline Index (DGI energy, macronutrient and micronutrient intake from a food frequency questionnaire (FFQ and predictors of diet quality. Diet quality did not significantly differ between urban and rural women (mean ± standard deviation (SD, 84.8 ± 15.9 vs. 83.9 ± 16.5, p = 0.264. Rural women reported a significantly higher intake of protein, fat, saturated fat, monounsaturated fat, cholesterol and iron and a higher score in the meat and meat alternatives component of the diet quality tool in comparison to urban women. In all women, a higher diet quality was associated with higher annual household income (>$Australian dollar (AUD 80,000 vs. <$AUD80,000 p = 0.013 and working status (working fulltime/part-time vs. unemployed p = 0.043. Total diet quality did not differ in urban and rural women; however, a higher macronutrient consumption pattern was potentially related to a higher lean meat intake in rural women. Women who are unemployed and on a lower income are an important target group for future dietary interventions aiming to improve diet quality.

Non-adherence to standard treatment guidelines in a rural paediatric hospital in Sierra Leone.

Science.gov (United States)

De Bruycker, M; Van den Bergh, R; Dahmane, A; Khogali, M; Schiavetti, B; Nzomukunda, Y; Alders, P; Allaouna, M; Cloquet, C; Enarson, D A; Satyarayanan, S; Magbity, E; Zachariah, R

2013-06-21

A rural paediatric hospital in Bo, Sierra Leone. To assess the level of adherence to standard treatment guidelines among clinicians prescribing treatment for children admitted with a diagnosis of malaria and/or lower respiratory tract infection (LRTI), and determine the association between (non) adherence and hospital outcomes, given that non-rational use of medicines is a serious global problem. Secondary analysis of routine programme data. Data were collected for 865 children admitted with an entry diagnosis of malaria and 690 children with LRTI during the period January to April 2011; some patients were classified in both categories. Non-adherence to guidelines comprised use of non-standard drug regimens, dosage variations, non-standard frequency of administration and treatment duration. Cumulative non-adherence to guidelines for LRTI cases was 86%. For malaria, this involved 12% of patients. Potentially harmful non-adherence was significantly associated with an unfavourable hospital outcome, both for malaria and for LRTI cases. Overall non-adherence to standard treatment guidelines by clinicians in a routine hospital setting is very high and influences hospital outcomes. This study advocates for the implementation of routine measures to monitor and improve rational drug use and the quality of clinical care in such hospitals.

Challenges faced in rural hospitals: the experiences of nurse managers in Uganda.

Science.gov (United States)

Kakyo, T A; Xiao, L D

2018-04-19

The aim of this study was to understand nurse ward managers perceived challenges in the rural healthcare setting in Uganda. The health workforce, essential medicines and equipment and political unrest are the main factors affecting the international community in addressing the hefty disease burden in World Health Organization African regions. Nurse ward managers have an important role to play to mitigate these factors in health facilities in these regions through leadership, supervision and support for staff. This study utilized interpretive phenomenology based on Gadamer's hermeneutical principles. Eleven nurse managers from two rural public hospitals in Uganda were interviewed. Those with more than a 2-year experience in their management role were invited to participate in the study. Nurse managers pointed out four major challenges with staffing, while they worked in the rural healthcare settings. These are summarized into themes: 'Numbers do matter'; 'I cannot access them when I need them at work'; 'Challenges in dealing with negative attitudes'; and 'Questioning own ability to manage health services'. Health facilities in rural areas face extremely low staff-to-patient ratio, a high level of workload, lack of essential medicines and equipment, low salaries and delayed payment for staff. Nurse managers demonstrated situation-based performance to minimize the impact of these challenges on the quality and safety of patient care, but they had less influence on policy and resource development. It is imperative to mobilize education for nurse ward managers to enable them to improve leadership, management skills and to have a greater impact on policy and resource development. © 2018 International Council of Nurses.

The maintenance of competence of rural district hospital medical ...

African Journals Online (AJOL)

District hospital doctors are likely to have educational needs covering surgery, emergency and trauma, in-patient as well as out-patient care at primary service level, an understanding of the rural context and role of other health workers, public-health skills, and teamwork. Given such a broad curriculum, some prioritisation ...

Management of snakebites at a rural South African hospital ...

African Journals Online (AJOL)

... snakebites at this rural hospital where they were treated frequently. It is crucial for primary care physicians to be familiar with the most common venomous snakes in South Africa and the management of their bites in humans. Elevation of the affected limb, administration of intravenous fluids and administration of analgesia, ...

Does delivery mode affect women's postpartum quality of life in rural China?

Science.gov (United States)

Huang, Kun; Tao, Fangbiao; Liu, Liu; Wu, Xiaoyan

2012-06-01

To explore the impact of delivery mode on women's postpartum quality of life in rural China and probe factors influencing postnatal quality of life. Childbirth significantly affects puerpera's physical, psychological and social domains of quality of life. Under the circumstance of increasing high caesarean section rate in rural China, the impact of delivery mode on postnatal quality of life remains unclear. Cross-sectional study design. Women residing in rural areas and in their 0-12 months after childbirth from 30 rural townships participated in a household survey. A structured questionnaire was used to evaluate women's socio-demographic characteristics, previous pregnant experiences, foetal characteristics and use of maternal health services. The scale for rural postnatal quality of life was adopted to assess postnatal quality of life from six dimensions: physical complaints and pain, sleep and energy, sex satisfaction, interpersonal communication, self-evaluated living stress and perceived life satisfaction. The overall caeserean section rate was 70·0% (962/1375), and most of them (59·7%) were selected by maternal request. None of six dimensions and total score of quality of life displayed significant difference between women with normal delivery and cesaerean section. It was found that postnatal home visit related to good postnatal quality of life and lower husband education level, male gender of infant were associated with poor quality of life. Delivery mode did not affect postpartum quality of life in rural China. Socio-cultural determinants may contribute more in influencing postnatal quality of life. Null findings in impact of delivery mode on postpartum quality of life may cause more difficulties in maternal decision-making for vaginal delivery in rural China. The importance of postnatal home visit could justify available and quality postnatal care in improving postpartum quality of life. Further research needs to explore the effective prevention

Total quality management in the hospital setting.

Science.gov (United States)

Ernst, D F

1994-01-01

With the increasing demands on hospitals for improved quality and lower costs, hospitals have been forced to reevaluate their manner of operation and quality assurance (QA) programs. Hospitals have been faced with customer dissatisfaction with services, escalating costs, intense competition, and reduced reimbursement for services. As a result, many hospitals have incorporated total quality management (TQM), also known as continuous quality improvement (CQI) and quality improvement (QI), to improve quality care and decrease costs. This article examines the concept of TQM, its rationale, and how it can be implemented in a hospital. A comparison of TQM and QA is made. Examples of hospital implementation of TQM and problems and issues associated with TQM in the hospital setting are explored.

Rural district hospitals - essential cogs in the district health system - and primary healthcare re-engineering.

Science.gov (United States)

le Roux, K W D P; Couper, I

2015-06-01

The re-engineering of primary healthcare (PHC) is regarded as an essential precursor to the implementation of National Health Insurance in South Africa, but improvements in the provision of PHC services have been patchy. The authors contend that the role of well- functioning rural district hospitals as a hub from which PHC services can be most efficiently managed has been underestimated, and that the management of district hospitals and PHC clinics need to be co-located at the level of the rural district hospital, to allow for proper integration of care and effective healthcare provision.

Promoting Action on Research Implementation in Health Services framework applied to TeamSTEPPS implementation in small rural hospitals.

Science.gov (United States)

Ward, Marcia M; Baloh, Jure; Zhu, Xi; Stewart, Greg L

A particularly useful model for examining implementation of quality improvement interventions in health care settings is the PARIHS (Promoting Action on Research Implementation in Health Services) framework developed by Kitson and colleagues. The PARIHS framework proposes three elements (evidence, context, and facilitation) that are related to successful implementation. An evidence-based program focused on quality enhancement in health care, termed TeamSTEPPS (Team Strategies and Tools to Enhance Performance and Patient Safety), has been widely promoted by the Agency for Healthcare Research and Quality, but research is needed to better understand its implementation. We apply the PARIHS framework in studying TeamSTEPPS implementation to identify elements that are most closely related to successful implementation. Quarterly interviews were conducted over a 9-month period in 13 small rural hospitals that implemented TeamSTEPPS. Interview quotes that were related to each of the PARIHS elements were identified using directed content analysis. Transcripts were also scored quantitatively, and bivariate regression analysis was employed to explore relationships between PARIHS elements and successful implementation related to planning activities. The current findings provide support for the PARIHS framework and identified two of the three PARIHS elements (context and facilitation) as important contributors to successful implementation. This study applies the PARIHS framework to TeamSTEPPS, a widely used quality initiative focused on improving health care quality and patient safety. By focusing on small rural hospitals that undertook this quality improvement activity of their own accord, our findings represent effectiveness research in an understudied segment of the health care delivery system. By identifying context and facilitation as the most important contributors to successful implementation, these analyses provide a focus for efficient and effective sustainment of Team

Trend of urban-rural disparities in hospital admissions and medical expenditure in China from 2003 to 2011.

Science.gov (United States)

Fu, Rong; Wang, Yupeng; Bao, Han; Wang, Zhiqiang; Li, Yongquan; Su, Shaofei; Liu, Meina

2014-01-01

To assess the trend of urban-rural disparities in hospital admissions and medical expenditure between 2003 and 2011 in the context of Chinese health-care system reform. The data were from three different national surveys: the Third National Health Services Survey in 2003, the Fourth National Health Services Survey in 2008 and the national health-care reform phased assessment survey in 2011. There were 151421, 143380 and 48356 respondents aged 15 years or older in 2003, 2008 and 2011, respectively. The health insurance coverage expanded considerably from 27.7% in 2003 to 96.4% in 2011 among respondents aged 15 years or older. Hospitalization rate increased rapidly from 4.1% in 2003 to 9.6% in 2011. Urban respondents had higher hospital admissions than rural respondents, and the RR (95% CI) of hospitalization was 1.23 (1.17-1.30), 1.06 (1.02-1.10) and 1.16 (1.10-1.23) in 2003, 2008 and 2011, respectively. The urban-rural disparity in hospital admissions significantly narrowed over time. Urban respondents had a higher admission rate if insured and a lower admission if not insured than their rural counterparts. Of the six medical expenditure measures, the disparities in reimbursement rate and the proportion of hospitalization direct cost to the total consumer spending significantly narrowed. The health insurance coverage has been continually expanding and health service utilization has been substantially improved. Urban-rural disparities have been narrowed but still exist. Therefore, policy-makers should focus on increasing investment and reimbursement levels, developing a uniform standard health insurance system for urban and rural residents and improving the medical assistance system.

Effects of modifiable prehospital factors on survival after out-of-hospital cardiac arrest in rural versus urban areas.

Science.gov (United States)

Mathiesen, Wenche Torunn; Bjørshol, Conrad Arnfinn; Kvaløy, Jan Terje; Søreide, Eldar

2018-04-18

The modifiable prehospital system factors, bystander cardiopulmonary resuscitation (CPR), emergency medical services (EMS), response time, and EMS physician attendance, may affect short- and long-term survival for both rural and urban out-of-hospital cardiac arrest (OHCA) patients. We studied how such factors influenced OHCA survival in a mixed urban/rural region with a high survival rate after OHCA. We analyzed the association between modifiable prehospital factors and survival to different stages of care in 1138 medical OHCA patients from an Utstein template-based cardiac arrest registry, using Kaplan-Meier type survival curves, univariable and multivariable logistic regression and mortality hazard plots. We found a significantly higher probability for survival to hospital admission (OR: 1.84, 95% CI 1.43-2.36, p rural group. In patients receiving bystander CPR before EMS arrival, the odds of survival to hospital discharge increased more than threefold (OR: 3.05, 95% CI 2.00-4.65, p rural areas, patients with EMS physician attendance had an overall better survival to hospital discharge (survival probability 0.17 with EMS physician vs. 0.05 without EMS physician, p = 0.019). Adjusted for modifiable factors, the survival differences remained. Overall, OHCA survival was higher in urban compared to rural areas, and the effect of bystander CPR, EMS response time and EMS physician attendance on survival differ between urban and rural areas. The effect of modifiable factors on survival was highest in the prehospital stage of care. In patients surviving to hospital admission, there was no significant difference in in-hospital mortality or in 1 year mortality between OHCA in rural versus urban areas.

In-Hospital Mortality among Rural Medicare Patients with Acute Myocardial Infarction: The Influence of Demographics, Transfer, and Health Factors

Science.gov (United States)

Muus, Kyle J.; Knudson, Alana D.; Klug, Marilyn G.; Wynne, Joshua

2011-01-01

Context/Purpose: Most rural hospitals can provide medical care to acute myocardial infarction (AMI) patients, but a need for advanced cardiac care requires timely transfer to a tertiary hospital. There is little information on AMI in-hospital mortality predictors among rural transfer patients. Methods: Cross-sectional retrospective analyses on…

Obstetric referrals from a rural clinic to a community hospital in Honduras.

Science.gov (United States)

Josyula, Srirama; Taylor, Kathryn K; Murphy, Blair M; Rodas, Dairamise; Kamath-Rayne, Beena D

2015-11-01

referrals between health care facilities are important in low-resource settings, particularly in maternal and child health, to transfer pregnant patients to the appropriate level of obstetric care. Our aim was to characterise the obstetrical referrals from a rural clinic to a community referral hospital in Honduras, to identify barriers in effective transport/referral, and to describe subsequent patient outcomes. we performed a descriptive retrospective study of patients referred during a 9-month period. We reviewed patient charts to review diagnosis, referral, and treatment times at both sites to understand the continuity of care. ninety-two pregnant patients were referred from the rural clinic to the community hospital. Twenty six pregnant patients (28%) did not have complete and accurate medical records and were excluded from the study. The remaining 66 patients were our study population. Of the 66 patients, 54 (82%) received antenatal care with an average of 5.5±2.4 visits. The most common diagnoses requiring referral were non-reassuring fetal status, hypertensive disorders of pregnancy, and preterm labour. The time spent in the rural clinic until transfer was 7.35±8.60 hours, and transport times were 4.42±1.07 hours. Of the 66 women transferred, 24 (36%) had different primary diagnoses and 16 (24%) had additional diagnoses after evaluation in the community hospital, whereas the remaining 26 (40%) had diagnoses that remained the same. No system was in place to give feedback to the referring clinic doctors regarding their primary diagnoses. our results demonstrate challenges seen in obstetric transport from a rural clinic to a community hospital in Honduras. Further research is needed for reform of emergency obstetric care management, targeting both healthcare personnel and medical referral infrastructure. The example of Honduras can be taken to motivate change in other resource-limited areas. Copyright © 2015 Elsevier Ltd. All rights reserved.

Quality control analysis at the hospital

International Nuclear Information System (INIS)

Kristensen, K.

1979-01-01

Quality control analysis is an integral part of quality assurance. In a system as with radiopharmaceuticals where part of the finishing of the product takes place at individual hospitals, the need for quality control analysis at the hospital can be discussed. Data are presented that stresses the importance of quality control by the manufacturer as a basis for limitation of such work at hospitals. A simplified programme is proposed

A review of stroke admissions at a tertiary hospital in rural ...

African Journals Online (AJOL)

2011-06-15

Jun 15, 2011 ... The disease is expected to increase in low- and middle-income countries like Nigeria. ... and examine the rural-urban variation of stroke hospitalization in Nigeria. ..... Strasser T. Cerebrovascular disease in the community:.

Traumatic brain injury in a rural and an urban Tanzanian hospital--a comparative, retrospective analysis based on computed tomography.

Science.gov (United States)

Maier, Daniel; Njoku, Innocent; Schmutzhard, Erich; Dharsee, Jaffer; Doppler, Magdalena; Härtl, Roger; Winkler, Andrea Sylvia

2014-01-01

In a resource-poor environment such as rural East Africa, expensive medical devices such as computed tomographic (CT) scanners are rare. The CT scanner at the rural Haydom Lutheran Hospital (HLH) in Tanzania therefore offers a unique chance to observe possible differences with urban medical centers in the disease pattern of trauma-related cranial pathologies. The purpose of this study was to compare traumatic brain injuries (TBIs) between a rural and an urban area of Tanzania. HLH has 350 beds and one CT scanner. The urban Aga Khan Hospital is a private hospital with 80 beds and one CT scanner. This was a retrospective study. Data of 248 patients at HLH and of 432 patients at Aga Khan Hospital with TBI could be collected. The prevalence of TBI was significantly higher in the rural area compared to the urban area (34.2% vs. 21.9%, P workplace is primarily urban or rural. Copyright © 2014 Elsevier Inc. All rights reserved.

Effects of competition on hospital quality: an examination using hospital administrative data.

Science.gov (United States)

Palangkaraya, Alfons; Yong, Jongsay

2013-06-01

This paper investigates the effects of competition on hospital quality using hospital administration data from the State of Victoria, Australia. Hospital quality is measured by 30-day mortality rates and 30-day unplanned readmission rates. Competition is measured by Herfindahl-Hirschman index and the numbers of competing public and private hospitals. The paper finds that hospitals facing higher competition have lower unplanned admission rates. However, competition is related negatively to hospital quality when measured by mortality, albeit the effects are weak and barely statistically significant. The paper also finds that the positive effect of competition on quality as measured by unplanned readmission differs greatly depending on whether the hospital is publicly or privately owned.

The effect of health insurance and health facility-upgrades on hospital deliveries in rural Nigeria: a controlled interrupted time-series study.

Science.gov (United States)

Brals, Daniëlla; Aderibigbe, Sunday A; Wit, Ferdinand W; van Ophem, Johannes C M; van der List, Marijn; Osagbemi, Gordon K; Hendriks, Marleen E; Akande, Tanimola M; Boele van Hensbroek, Michael; Schultsz, Constance

2017-09-01

Access to quality obstetric care is considered essential to reducing maternal and new-born mortality. We evaluated the effect of the introduction of a multifaceted voluntary health insurance programme on hospital deliveries in rural Nigeria. We used an interrupted time-series design, including a control group. The intervention consisted of providing voluntary health insurance covering primary and secondary healthcare, including antenatal and obstetric care, combined with improving the quality of healthcare facilities. We compared changes in hospital deliveries from 1 May 2005 to 30 April 2013 between the programme area and control area in a difference-in-differences analysis with multiple time periods, adjusting for observed confounders. Data were collected through household surveys. Eligible households ( n = 1500) were selected from a stratified probability sample of enumeration areas. All deliveries during the 4-year baseline period ( n = 460) and 4-year follow-up period ( n = 380) were included. Insurance coverage increased from 0% before the insurance was introduced to 70.2% in April 2013 in the programme area. In the control area insurance coverage remained 0% between May 2005 and April 2013. Although hospital deliveries followed a common stable trend over the 4 pre-programme years ( P = 0.89), the increase in hospital deliveries during the 4-year follow-up period in the programme area was 29.3 percentage points (95% CI: 16.1 to 42.6; P health insurance but who could make use of the upgraded care delivered significantly more often in a hospital during the follow-up period than women living in the control area ( P = 0.04). Voluntary health insurance combined with quality healthcare services is highly effective in increasing hospital deliveries in rural Nigeria, by improving access to healthcare for insured and uninsured women in the programme area. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and

Impact of rural residence and health system structure on quality of liver care.

Directory of Open Access Journals (Sweden)

Catherine Rongey

Full Text Available Specialist physician concentration in urban areas can affect access and quality of care for rural patients. As effective drug treatment for hepatitis C (HCV becomes increasingly available, the extent to which rural patients needing HCV specialists face access or quality deficits is unknown. We sought to determine the influence of rural residency on access to HCV specialists and quality of liver care.The study used a national cohort of 151,965 Veterans Health Administration (VHA patients with HCV starting in 2005 and followed to 2009. The VHA's constant national benefit structure reduces the impact of insurance as an explanation for observed disparities. Multivariate cox proportion regression models for each quality indicator were performed.Thirty percent of VHA patients with HCV reside in rural and highly rural areas. Compared to urban residents, highly rural (HR 0.70, CI 0.65-0.75 and rural (HR 0.96, CI 0.94-0.97 residents were significantly less likely to access HCV specialty care. The quality indicators were more mixed. While rural residents were less likely to receive HIV screening, there were no significant differences in hepatitis vaccinations, endoscopic variceal and hepatocellular carcinoma screening between the geographic subgroups. Of note, highly rural (HR 1.31, CI 1.14-1.50 and rural residents (HR 1.06, CI 1.02-1.10 were more likely to receive HCV therapy. Of those treated for HCV, a third received therapy from a non-specialist provider.Rural patients have less access to HCV specialists, but this does not necessarily translate to quality deficits. The VHA's efforts to improve specialty care access, rural patient behavior and decentralization of HCV therapy beyond specialty providers may explain this contradiction. Lessons learned within the VHA are critical for US healthcare systems restructuring into accountable care organizations that acquire features of integrated systems.

Prevention of Clostridium difficile infection in rural hospitals.

Science.gov (United States)

Haun, Nicholas; Hofer, Adam; Greene, M Todd; Borlaug, Gwen; Pritchett, Jenny; Scallon, Tina; Safdar, Nasia

2014-03-01

Prevention of Clostridium difficile infection (CDI) remains challenging across the spectrum of health care. There are limited data on prevention practices for CDI in the rural health care setting. An electronic survey was administered to 21 rural facilities in Wisconsin, part of the Rural Wisconsin Health Cooperative. Data were collected on hospital characteristics and practices to prevent endemic CDI. Fifteen facilities responded (71%). Nearly all respondent facilities reported regular use of dedicated patient care items, use of gown and gloves, private patient rooms, hand hygiene, and room cleaning. Facilities in which the infection preventionist thought the support of his/her leadership to be "Very good" or "Excellent" employed significantly more CDI practices (13.3 ± 2.4 [standard deviation]) compared with infection preventionists who thought there was less support from leadership (9.8 ± 3.0, P = .033). Surveillance for CDI was highly variable. The most frequent barriers to implementation of CDI prevention practices included lack of adequate resources, lack of a physician champion, and difficulty keeping up with new recommendations. Although most rural facilities in our survey reported using evidence-based practices for prevention of CDI, surveillance practices were highly variable, and data regarding the impact of these practices on CDI rates were limited. Future efforts that correlate CDI prevention initiatives and CDI incidence will help develop evidence-based practices in these resource-limited settings. Published by Mosby, Inc.

Using quality measures for quality improvement: the perspective of hospital staff.

Directory of Open Access Journals (Sweden)

Asgar Aghaei Hashjin

Full Text Available RESEARCH OBJECTIVE: This study examines the perspectives of a range of key hospital staff on the use, importance, scientific background, availability of data, feasibility of data collection, cost benefit aspects and availability of professional personnel for measurement of quality indicators among Iranian hospitals. The study aims to facilitate the use of quality indicators to improve quality of care in hospitals. STUDY DESIGN: A cross-sectional study was conducted over the period 2009 to 2010. Staff at Iranian hospitals completed a self-administered questionnaire eliciting their views on organizational, clinical process, and outcome (clinical effectiveness, patient safety and patient centeredness indicators. POPULATION STUDIED: 93 hospital frontline staff including hospital/nursing managers, medical doctors, nurses, and quality improvement/medical records officers in 48 general and specialized hospitals in Iran. PRINCIPAL FINDINGS: On average, only 69% of respondents reported using quality indicators in practice at their affiliated hospitals. Respondents varied significantly in their reported use of organizational, clinical process and outcome quality indicators. Overall, clinical process and effectiveness indicators were reported to be least used. The reported use of indicators corresponded with their perceived level of importance. Quality indicators were reported to be used among clinical staff significantly more than among managerial staff. In total, 74% of the respondents reported to use obligatory indicators, while this was 68% for voluntary indicators (p<0.05. CONCLUSIONS: There is a general awareness of the importance and usability of quality indicators among hospital staff in Iran, but their use is currently mostly directed towards external accountability purposes. To increase the formative use of quality indicators, creation of a common culture and feeling of shared ownership, alongside an increased uptake of clinical process and

Quality of Colonoscopy Performed in Rural Practice: Experience From the Clinical Outcomes Research Initiative and the Oregon Rural Practice-Based Research Network.

Science.gov (United States)

Holub, Jennifer L; Morris, Cynthia; Fagnan, Lyle J; Logan, Judith R; Michaels, LeAnn C; Lieberman, David A

2018-02-01

Colon cancer screening is effective. To complete screening in 80% of individuals over age 50 years by 2018 will require adequate colonoscopy capacity throughout the country, including rural areas, where colonoscopy providers may have less specialized training. Our aim was to study the quality of colonoscopy in rural settings. The Clinical Outcomes Research Initiative (CORI) and the Oregon Rural Practice-based Research Network (ORPRN) collaborated to recruit Oregon rural practices to submit colonoscopy reports to CORI's National Endoscopic Database (NED). Ten ORPRN sites were compared to non-ORPRN rural (n = 11) and nonrural (n = 43) sites between January 2009 and October 2011. Established colonoscopy quality measures were calculated for all sites. No ORPRN physicians were gastroenterologists compared with 82% of nonrural physicians. ORPRN practices reached the cecum in 87.4% of exams compared with 89.3% of rural sites (P = .0002) and 90.9% of nonrural sites (P 9mm 16.6% vs 18.7% (P = .106). ORPRN sites performed well on most colonoscopy quality measures, suggesting that high-quality colonoscopy can be performed in rural settings. © 2016 National Rural Health Association.

Sustainable Community Sanitation for a Rural Hospital in Haiti

Directory of Open Access Journals (Sweden)

Jason Jawidzik

2012-12-01

Full Text Available A fully sustainable sanitation system was developed for a rural hospital in Haiti. The system operates by converting human waste into biogas and fertilizer without using external energy. It is a hybrid anaerobic/aerobic system that maximizes methane production while producing quality compost. The system first separates liquid and solid human waste at the source to control carbon to nitrogen ratio and moisture content to facilitate enhanced biodegradation. It will then degrade human waste through anaerobic digestion and capture the methane gas for on-site use as a heating fuel. For anaerobic decomposition and methane harvesting a bioreactor with two-stage batch process was designed. Finally, partially degraded human waste is extracted from the bioreactor with two-stage batch process and applied to land farming type aerobic composter to produce fertilizer. The proposed system is optimized in design by considering local conditions such as waste composition, waste generation, reaction temperature, residence time, construction materials, and current practice. It is above ground with low maintenance requirements.

Anaesthesia for Surgical Outreach in a Rural Nigerian Hospital | Ilori ...

African Journals Online (AJOL)

Background: Surgical outreach to rural areas is aimed at improving access to surgical treatment to a deprived community. The study reports the experience of a team consisting of specialist surgical and anaesthetic manpower during a five day surgical outreach at Ogoja General Hospital, Nigeria in 2010. This was on the ...

Quality of work life of rural emergency department nurses and physicians: a pilot study.

Science.gov (United States)

Bragard, Isabelle; Fleet, Richard; Etienne, Anne-Marie; Archambault, Patrick; Légaré, France; Chauny, Jean-Marc; Lévesque, Jean-Frédéric; Ouimet, Mathieu; Poitras, Julien; Dupuis, Gilles

2015-04-01

Information about recruitment and retention factors and quality of work life (QWL) in rural emergency departments (EDs) is limited. A pilot study was used to determine the feasibility of a large-scale study of these variables in Quebec EDs. Two EDs, approximately 10,000 and 30,000 patients per year respectively, were selected as convenience samples. An online survey containing the Quality of Work Life Systemic Inventory (QWLSI; 34 items) and the Recruitment and Retention Factors Questionnaire (39 items) was sent to ED nurses and physicians of these two EDs. Descriptive statistics of percentage, mean and standard deviation and correlations were used to analyse the data. Forty out of 64 eligible workers (62%) gave their consent to participate, but only 20 had completed both questionnaires. Participants' mean age was 42 years (SD = 11.6). The average participants satisfaction with their access to continuing education was low (Mean = 1.6, SD = 0.8). However, their satisfaction with technical resources (Mean = 2.4, SD = 0.7), pre-hospital and inter-hospital transfer services (Mean = 2.5, SD = 0.6), relationships with colleagues (Mean = 2.7, SD = 0.6) and managers (Mean = 2.2, SD = 0.7), work-life balance (Mean = 2.4, SD = 0.6) and emergency patient access to other departments (Mean = 3.7, SD = 0.6) was in the average. The impact of several aspects of the rural environment (e.g. tranquility) on quality of life was also in the average (Mean = 2.5, SD = 0.7). QWL was in the average, excepted subscale 'support offered to employee' for which the QWL was lower. Data collection was difficult and the larger study will require strategies to improve recruitment such as a paper alternative. The study showed globally good recruitment and retention factors and QWL for these ED nurses and physicians. These results will help hospital administrations better plan initiatives aimed at improving retention and QWL.

Quality of Vegetables Based on Total Phenolic Concentration Is Lower in More Rural Consumer Food Environments in a Rural American State.

Science.gov (United States)

Ahmed, Selena; Byker Shanks, Carmen

2017-08-17

While daily consumption of fruits and vegetables (FVs) is widely recognized to be associated with supporting nutrition and health, disparities exist in consumer food environments regarding access to high-quality produce based on location. The purpose of this study was to evaluate FV quality using total phenolic (TP) scores (a phytochemical measure for health-promoting attributes, flavor, appearance, and shelf-life) in consumer food environments along a rural to urban continuum in the rural state of Montana, United States. Significant differences were found in the means of the FV TP scores ( p vegetable TP scores ( p vegetable TP scores were highest for the least rural stores and lowest for the most rural stores. Results indicate an access gap to high-quality vegetables in more rural and more health-disparate consumer food environments of Montana compared to urban food environments. Findings highlight that food and nutrition interventions should aim to increase vegetable quality in rural consumer food environments in the state of Montana towards enhancing dietary quality and food choices. Future studies are called for that examine TP scores of a wide range of FVs in diverse food environments globally. Studies are further needed that examine linkages between FV quality, food choices, diets, and health outcomes towards enhancing food environments for public health.

Where do the rural poor deliver when high coverage of health facility delivery is achieved? Findings from a community and hospital survey in Tanzania.

Directory of Open Access Journals (Sweden)

Manuela Straneo

Full Text Available As part of maternal mortality reducing strategies, coverage of delivery care among sub-Saharan African rural poor will improve, with a range of facilities providing services. Whether high coverage will benefit all socio-economic groups is unknown. Iringa rural District, Southern Tanzania, with high facility delivery coverage, offers a paradigm to address this question. Delivery services are available in first-line facilities (dispensaries, health centres and one hospital. We assessed whether all socio-economic groups access the only comprehensive emergency obstetric care facility equally, and surveyed existing delivery services.District population characteristics were obtained from a household community survey (n = 463. A Hospital survey collected data on women who delivered in this facility (n = 1072. Principal component analysis on household assets was used to assess socio-economic status. Hospital population socio-demographic characteristics were compared to District population using multivariable logistic regression. Deliveries' distribution in District facilities and staffing were analysed using routine data.Women from the hospital compared to the District population were more likely to be wealthier. Adjusted odds ratio of hospital delivery increased progressively across socio-economic groups, from 1.73 for the poorer (p = 0.0031 to 4.53 (p<0.0001 for the richest. Remarkable dispersion of deliveries and poor staffing were found. In 2012, 5505/7645 (72% institutional deliveries took place in 68 first-line facilities, the remaining in the hospital. 56/68 (67.6% first-line facilities reported ≤100 deliveries/year, attending 33% of deliveries. Insufficient numbers of skilled birth attendants were found in 42.9% of facilities.Poorer women remain disadvantaged in high coverage, as they access lower level facilities and are under-represented where life-saving transfusions and caesarean sections are available. Tackling the challenges

Scaling-up access to antiretroviral therapy for children: a cohort study evaluating care and treatment at mobile and hospital-affiliated HIV clinics in rural Zambia.

Directory of Open Access Journals (Sweden)

Janneke H van Dijk

Full Text Available Travel time and distance are barriers to care for HIV-infected children in rural sub-Saharan Africa. Decentralization of care is one strategy to scale-up access to antiretroviral therapy (ART, but few programs have been evaluated. We compared outcomes for children receiving care in mobile and hospital-affiliated HIV clinics in rural Zambia.Outcomes were measured within an ongoing cohort study of HIV-infected children seeking care at Macha Hospital, Zambia from 2007 to 2012. Children in the outreach clinic group received care from the Macha HIV clinic and transferred to one of three outreach clinics. Children in the hospital-affiliated clinic group received care at Macha HIV clinic and reported Macha Hospital as the nearest healthcare facility.Seventy-seven children transferred to the outreach clinics and were included in the analysis. Travel time to the outreach clinics was significantly shorter and fewer caretakers used public transportation, resulting in lower transportation costs and fewer obstacles accessing the clinic. Some caretakers and health care providers reported inferior quality of service provision at the outreach clinics. Sixty-eight children received ART at the outreach clinics and were compared to 41 children in the hospital-affiliated clinic group. At ART initiation, median age, weight-for-age z-scores (WAZ and CD4(+ T-cell percentages were similar for children in the hospital-affiliated and outreach clinic groups. Children in both groups experienced similar increases in WAZ and CD4(+ T-cell percentages.HIV care and treatment can be effectively delivered to HIV-infected children at rural health centers through mobile ART teams, removing potential barriers to uptake and retention. Outreach teams should be supported to increase access to HIV care and treatment in rural areas.

The association between self-reported diet quality and health-related quality of life in rural and urban Australian adolescents.

Science.gov (United States)

Bolton, Kristy A; Jacka, Felice; Allender, Steven; Kremer, Peter; Gibbs, Lisa; Waters, Elizabeth; de Silva, Andrea

2016-10-01

This study examines the relationship between diet quality and health-related quality of life (HRQoL) in rural and urban Australian adolescents, and gender differences. Cross-sectional. Secondary schools. 722 rural and 422 urban students from 19 secondary schools. Self-report dietary-related behaviours, demographic information, HRQoL (AQoL-6D) were collected. Healthy and unhealthy diet quality scores were calculated; multiple linear regression investigated associations between diet quality and HRQoL. Compared to urban students, rural students had higher HRQoL, higher healthy diet score, lower unhealthy diet score, consumed less soft drink and less frequently, less takeaway and a higher proportion consumed breakfast (P health problems. Such interventions should consider gender and locality. © 2016 National Rural Health Alliance Inc.

Why do some hospitals achieve better care of severely malnourished children than others? Five-year follow-up of rural hospitals in Eastern Cape, South Africa.

Science.gov (United States)

Puoane, Thandi; Cuming, Katie; Sanders, David; Ashworth, Ann

2008-11-01

Staff at 11 rural hospitals in an under-resourced region of Eastern Cape Province, South Africa, participated in an intervention to improve the quality of care of severely malnourished children through training and support aimed at implementing the WHO case-management guidelines. Despite similar intervention inputs, some hospitals reduced their case-fatality rates by at least half, whereas others did not. The aim of this study was to investigate reasons for this disparity. Two successful and two poorly performing hospitals were purposively selected based on their case-fatality rates, which were 30% in those performing poorly. Comparative data were collected during June to October 2004 through structured observations of ward procedures, compilation of hospital data on case-loads and resources, and staff interviews and discussions related to attitudes, teamwork, training, supervision, managerial support and leadership. The four study hospitals had broadly similar resources, infrastructure and child:nurse ratios, and all had made changes to their clinical and dietary management following training. Case-management was broadly in line with WHO guidelines but the study revealed clear differences in institutional culture which influenced quality of care. Staff in the successful hospitals were more attentive and assiduous than staff in the poorly performing hospitals, especially in relation to rehydration procedures, feeding and the recording of vital signs. There was a strong emphasis on in-service training and induction of incoming staff in the successful hospitals and better supervision of junior staff and carers. Nurses had more positive attitudes towards malnourished children and their carers, and were less judgmental. Underlying factors were differences in leadership, teamwork, and managerial supervision and support. We conclude that unless there are supportive structures at managerial level, the potential benefits of efficacious interventions and related training

Health worker attrition at a rural district hospital in Rwanda: a need ...

African Journals Online (AJOL)

Health worker attrition at a rural district hospital in Rwanda: a need for improved placement and retention strategies. Jackline Odhiambo, Felix Cyamatare Rwabukwisi, Christian Rusangwa, Vincent Rusanganwa, Lisa Ruth Hirschhorn, Evrard Nahimana, Patient Ngamije, Bethany Lynn Hedt-Gauthier ...

Quality and rural-urban comparison of tuberculosis care in Rivers State, Nigeria.

Science.gov (United States)

Tobin-West, Charles Ibiene; Isodje, Anastasia

2016-01-01

Nigeria ranks among countries with the highest burden of tuberculosis. Yet evidence continues to indicate poor treatment outcomes which have been attributed to poor quality of care. This study aims to identify some of the systemic problems in order to inform policy decisions for improved quality of services and treatment outcomes in Nigeria. A comparative assessment of the quality of TB care in rural and urban health facilities was carried out between May and June 2013, employing the Donabedian model of quality assessment. Data was analysed using the SPSS software package version 20.0. The level of significance was set at p facility infrastructures were more constrained in the urban than rural settings. Both the urban and rural facilities lacked adequate facilities for infection control such as, running water, air filter respirators, hand gloves and extractor fans. Health education and HIV counselling and testing (HCT) were limited in rural facilities compared to urban facilities. Although anti-TB drugs were generally available in both settings, the DOTS strategy in patient care was completely ignored. Finally, laboratory support for diagnosis and patient monitoring was limited in the rural facilities. The study highlights suboptimal quality of TB care in Rivers State with limitations in health education and HCT of patients for HIV as well as laboratory support for TB care in rural health facilities. We, therefore, recommend that adequate infection control measures, strict observance of the DOTS strategy and sufficient laboratory support be provided to TB clinics in the State.

Remote eye care screening for rural veterans with Technology-based Eye Care Services: a quality improvement project.

Science.gov (United States)

Maa, April Y; Wojciechowski, Barbara; Hunt, Kelly; Dismuke, Clara; Janjua, Rabeea; Lynch, Mary G

2017-01-01

Veterans are at high risk for eye disease because of age and comorbid conditions. Access to eye care is challenging within the entire Veterans Hospital Administration's network of hospitals and clinics in the USA because it is the third busiest outpatient clinical service and growing at a rate of 9% per year. Rural and highly rural veterans face many more barriers to accessing eye care because of distance, cost to travel, and difficulty finding care in the community as many live in medically underserved areas. Also, rural veterans may be diagnosed in later stages of eye disease than their non-rural counterparts due to lack of access to specialty care. In March 2015, Technology-based Eye Care Services (TECS) was launched from the Atlanta Veterans Affairs (VA) as a quality improvement project to provide eye screening services for rural veterans. By tracking multiple measures including demographic and access to care metrics, data shows that TECS significantly improved access to care, with 33% of veterans receiving same-day access and >98% of veterans receiving an appointment within 30 days of request. TECS also provided care to a significant percentage of homeless veterans, 10.6% of the patients screened. Finally, TECS reduced healthcare costs, saving the VA up to US$148 per visit and approximately US$52 per patient in round trip travel reimbursements when compared to completing a face-to-face exam at the medical center. Overall savings to the VA system in this early phase of TECS totaled US$288,400, about US$41,200 per month. Other healthcare facilities may be able to use a similar protocol to extend care to at-risk patients.

Determining Disturbing Factors of Sleep Quality among Hospitalized Elderly Patients in Kashan Hospitals, Iran 2009

Directory of Open Access Journals (Sweden)

M Kafaei

2013-03-01

Full Text Available Introduction: Sleep is an effective factor in the recovery processes. Many variables affect on the sleep quality of hospitalized elderly people. This study was conducted to determine the factors disturbing sleep quality among hospitalized older adult patients in Kashan hospitals. Methods: A cross-sectional study was carried out on a sample of 390 elderly hospitalized patients in Kashan hospitals. The study data was gathered via Pittsburgh Sleep Quality Index (PSQI Questionnaire. A global total score of 5 or greater indicated a “poor" quality of sleep. The data were analyzed using Chi square, t- test and binary logistic regression at multivariate model. Results: The total quality of sleep was poor in hospitalized elderly patients (7/2±4/8. Sex, marital status, level of education, type of ward, previous hospitalization experience, use of hypnotics at home and hospital, and previous sleep disorders were statistically associated with quality of sleep; however, there was not significant relationship between quality of sleep and age, length of hospitalization, and daytime napping. In the final regression model, marital status (OR=4.6, level of education (OR=1.9, length of hospitalization (OR=1.1, Previous hospitalization experience (OR=0.4, use of hypnotics in hospital (OR=0.27 and previous sleep disorder (OR=0.01 were the most important determinants of sleep quality. Conclusion: Quality of sleep was poor in hospitalized elderly due to a wide range of sleep disturbing factors. The most important factors involved marital status, level of education, previous hospitalization experience, previous sleep disorder and use of hypnotics in hospital.

Health-Related Quality of Life of Rural Clients Seeking Telepsychology Services

Directory of Open Access Journals (Sweden)

Kevin R. Tarlow

2014-01-01

Full Text Available Sixty million US residents live in rural areas, but health policies and interventions developed from an urban mindset often fail to address the significant barriers to health experienced by these local communities. Telepsychology, or psychological services delivered by distance via technology, is an emerging treatment modality with special implications for underserved rural areas. This study found that a sample of rural residents seeking telepsychology services (n=94 had low health-related quality of life (HRQOL, often due to cooccurring physical and mental health diagnoses including high rates of depression. However, a brief telepsychology treatment delivered to rural clients (n=40 was associated with an improvement in mental health-related quality of life (d = 0.70,  P<.001. These results indicate that despite the complex health needs of these underserved communities, telepsychology interventions may help offset the disparities in health service access in rural areas.

An increase in the burden of neonatal admissions to a rural district hospital in Kenya over 19 years

Directory of Open Access Journals (Sweden)

Marsh Kevin

2010-10-01

Full Text Available Abstract Background Most of the global neonatal deaths occur in developing nations, mostly in rural homes. Many of the newborns who receive formal medical care are treated in rural district hospitals and other peripheral health centres. However there are no published studies demonstrating trends in neonatal admissions and outcome in rural health care facilities in resource poor regions. Such information is critical in planning public health interventions. In this study we therefore aimed at describing the pattern of neonatal admissions to a Kenyan rural district hospital and their outcome over a 19 year period, examining clinical indicators of inpatient neonatal mortality and also trends in utilization of a rural hospital for deliveries. Methods Prospectively collected data on neonates is compared to non-neonatal paediatric (≤ 5 years old admissions and deliveries' in the maternity unit at Kilifi District Hospital from January 1st 1990 up to December 31st 2008, to document the pattern of neonatal admissions, deliveries and changes in inpatient deaths. Trends were examined using time series models with likelihood ratios utilised to identify indicators of inpatient neonatal death. Results The proportion of neonatal admissions of the total paediatric ≤ 5 years admissions significantly increased from 11% in 1990 to 20% by 2008 (trend 0.83 (95% confidence interval 0.45 -1.21. Most of the increase in burden was from neonates born in hospital and very young neonates aged 7 mmol/l predicted inpatient neonatal death with a sensitivity of 81% and a specificity of 68%. Conclusions There is clear evidence of increasing burden in neonatal admissions at a rural district hospital in contrast to reducing numbers of non-neonatal paediatrics' admissions aged ≤ 5years. Though the inpatient case fatality for all admissions aged ≤ 5 years declined significantly, neonates now comprise close to 60% of all inpatient deaths. Simple indicators may identify

RURAL TOURISM AS AN IMPORTANT SOURCE OF INCOME FOR RURAL PLACES

Directory of Open Access Journals (Sweden)

Mariana IATAGAN

2009-06-01

Full Text Available Tourism is the most important economic branch, worldwide, owning 12% of all areas of activity and revenue of approximately 530 billion dollars per year. In the past 10 years we could see an increasing demand for rural tourism and ecotourism, many of the international travel agencies offering ecotourism packages. Our country is attractive from the perspective of international travel agencies, because of unpolluted nature, the authenticity of traditions, the Danube Delta, old forests and not least, because the Romanian hospitality.Rural tourism had been practiced for a long time in Romania but for the past 15-20 years, it was casual and without any form of organization. Tourism activities in rural areas are carried out when agricultural activities takeplace and contribute to the welfare of rural communities that practice it.The development of tourism activities requires attention to the quality of the environment by preserving and developing the quality in the areas that have entered the tourist circuit, controlling the activity quality for a rational use of tourism resources.Our country benefits from EU funding through several programs including SAPARD, taking one of the measures, Measure 3.4, which is called the development and diversification of economic activities that generate multiple activities and alternative incomes.A deciding role in the development of rural tourism is held by the general infrastructure, requiring subsidies from the budget for tourism attraction areas for sustaining, by public administrations, programs to support tourism in rural areas.Rural tourism contributes to the sustainable development of the Romanian rural environment by proper use of local resources, establishing youth in rural areas, reducing the number of unemployed, women's involvement in economic and social life of rural settlements, raising living standards, growth in household rural areas, increasing the industry's contribution to the formation of gross

Air pollution and decreased semen quality: A comparative study of Chongqing urban and rural areas

International Nuclear Information System (INIS)

Zhou, Niya; Cui, Zhihong; Yang, Sanming; Han, Xue; Chen, Gangcai; Zhou, Ziyuan; Zhai, Chongzhi; Ma, Mingfu; Li, Lianbing; Cai, Min; Li, Yafei; Ao, Lin; Shu, Weiqun; Liu, Jinyi; Cao, Jia

2014-01-01

To investigate the association and effects of air pollution level on male semen quality in urban and rural areas, this study examines the outdoor concentrations of particulate matter (PM 10 ), sulfur dioxide (SO 2 ), nitrous dioxide (NO 2 ) and semen quality outcomes for 1346 volunteers in both urban and rural areas in Chongqing, China. We found the urban area has a higher pollution level than the rural area, contrasted with better semen quality in the rural residents, especially for sperm morphology and computer assistant semen analysis (CASA) motility parameters. A multivariate linear regression analysis demonstrates that concentrations of PM 10 , SO 2 , and NO 2 significantly and negatively are associated with normal sperm morphology percentage (P  10 , SO 2 , and NO 2 in urban ambient air may account for worse semen quality in urban males. - Highlights: • We investigate the distributions of PM 10 , SO 2 and NO 2 in urban and rural areas in Chongqing, China. • We explore the associations of air pollution and male semen quality. • The concentrations of PM 10 , SO 2 , and NO 2 are significantly higher in urban areas. • Median values of some semen quality parameters in rural male were higher than urban male. • PM 10 , SO 2 , and NO 2 were negatively associated with semen quality parameters. - Air pollution is higher in the urban area while there is better semen quality in rural males. Polluted air may thus account for worse semen quality in urban males

Quality competition and hospital mergers-An experiment.

Science.gov (United States)

Han, Johann; Kairies-Schwarz, Nadja; Vomhof, Markus

2017-12-01

On the basis of a Salop model with regulated prices, we investigate quality provision behaviour of competing hospitals before and after a merger. For this, we use a controlled laboratory experiment where subjects decided on the level of treatment quality as head of a hospital. We find that the post-merger average quality is significantly lower than the average pre-merger quality. However, for merger insiders and outsiders, average quality choices are significantly higher than predicted for pure profit-maximising hospitals. This upward deviation is potentially driven by altruistic behaviour towards patients. Furthermore, we find that in the case where sufficient cost synergies are realised by the merged hospitals, there is a significant increase in average quality choices compared to the scenario without synergies. Finally, we find that our results do not change when comparing individual decisions to team decisions. Copyright © 2017 John Wiley & Sons, Ltd.

Job Satisfaction Analysis in Rural China: A Qualitative Study of Doctors in a Township Hospital

OpenAIRE

Chen, Qiwei; Yang, Lan; Feng, Qiming; Tighe, Scott S.

2017-01-01

Background. Township hospitals in China provide rural communities with basic but much needed critical health care services. The doctors working in these hospitals often feel unsatisfied when considering their work schedules and financial rewards. Method. To explore job satisfaction of health workers in a township hospital, a qualitative study was conducted of 39 doctors from five township hospitals in Guangxi Zhuang Autonomous Region. The goal was to understand the level of job satisfaction o...

Tobacco cessation Clinical Practice Guideline use by rural and urban hospital nurses: a pre-implementation needs assessment

Directory of Open Access Journals (Sweden)

Smith Patricia M

2012-04-01

Full Text Available Abstract Background This study was a pre-program evaluation of hospital-based nurses' tobacco intervention beliefs, confidence, training, practice, and perceived intervention barriers and facilitators. It was designed to identify relevant information prior to implementing tobacco cessation guidelines across a large northern rural region, home to 1 urban and 12 rural hospitals. Methods This cross-sectional survey was distributed by nurse managers to nurses in the 13 hospitals and returned by nurses (N = 269 via mail to the researchers. Results Nurses were somewhat confident providing cessation interventions, agreed they should educate patients about tobacco, and 94% perceived tobacco counselling as part of their role. Although only 11% had received cessation training, the majority reported intervening, even if seldom--91% asked about tobacco-use, 96% advised quitting, 89% assessed readiness to quit, 88% assisted with quitting, and 61% arranged post-discharge follow-up. Few performed any of these steps frequently, and among those who intervened, the majority spent Conclusions The findings showed nurses' willingness to engage in tobacco interventions. What the majority were doing maps onto the recommended minimum of 1-3 minutes but intervention frequency and follow-up were suboptimal. The rural-urban differences suggest a need for more research to explore the strengths of rural practice which could potentially inform approaches to smoking cessation in urban hospitals.

Inter-regional competition and quality in hospital care.

Science.gov (United States)

Aiura, Hiroshi

2013-06-01

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

Quality of medication information in discharge summaries from hospitals: an audit of electronic patient records.

Science.gov (United States)

Garcia, Beate Hennie; Djønne, Berit Svendsen; Skjold, Frode; Mellingen, Ellen Marie; Aag, Trine Iversen

2017-12-01

Background Low quality of medication information in discharge summaries from hospitals may jeopardize optimal therapy and put the patient at risk for medication errors and adverse drug events. Objective To audit the quality of medication information in discharge summaries and explore factors associated with the quality. Setting Helgelandssykehuset Mo i Rana, a rural hospital in central Norway. Method For each month in 2013, we randomly selected 60 discharge summaries from the Department of Medicine and Surgery (totally 720) and evaluated the medication information using eight Norwegian quality criteria. Main outcome measure Mean score per discharge summary ranging from 0 (lowest quality) to 16 (highest quality). Results Mean score per discharge summary was 7.4 (SD 2.8; range 0-14), significantly higher when evaluating medications used regularly compared to mediations used as needed (7.80 vs. 6.52; p < 0.001). Lowest score was achieved for quality criteria concerning generic names, indications for medication use, reasons why changes had been made and information about the source for information. Factors associated with increased quality scores are increasing numbers of medications and male patients. Increasing age seemed to be associated with a reduced score, while type of department was not associated with the quality. Conclusion In discharge summaries from 2013, we identified a low quality of medication information in accordance with the Norwegian quality criteria. Actions for improvement are necessary and follow-up studies to monitor quality are needed.

Surgical skills deficiencies and needs of rural general practitioners ...

African Journals Online (AJOL)

This open-access article is distributed under. Creative ... procedures performed in rural hospitals in Africa; and Framework for CPD ..... quality surgical care in rural areas is a challenge faced by the present .... Mullan F. The metrics of the physician brain drain. N Engl J Med ... Dare AJ, NgKamstra JS, Patra J, et al. Deaths ...

Service quality for facilities management in hospitals

CERN Document Server

Sui Pheng, Low

2016-01-01

This book examines the Facilities Management (FM) of hospitals and healthcare facilities, which are among the most complex, costly and challenging kind of buildings to manage. It presents and evaluates the FM service quality standards in Singapore’s hospitals from the patient’s perspective, and provides recommendations on how to successfully improve FM service quality and achieve higher patient satisfaction. The book also features valuable supplementary materials, including a checklist of 32 key factors for successful facilities management and another checklist of 24 service attributes for hospitals to achieve desirable service quality in connection with facilities management. The book adopts a unique approach of combining service quality and quality theory to provide a more holistic view of how FM service quality can be achieved in hospitals. It also integrates three instruments, namely the SERVQUAL model, the Kano model and the QFD model to yield empirical results from surveys for implementation in hosp...

Analysis of hospital interior air quality audits

Directory of Open Access Journals (Sweden)

Lin Lee-Kuo

2017-01-01

Full Text Available In general, people spent more than 80∼90% of living time in the indoor every day, human health and indoor environmental quality are closely related. The hospital has a complex and unique environmental characteristics, medical personnel and patients are prolonged exposed to risk factors in a variety of environments. Therefore, the merits of indoor air quality in the hospital, not only has a threat to the health of medical personnel and patients, but also will directly affect the quality and efficiency of health care work. A regular monitoring can, improve and maintain a well of indoor air quality, thus ensuring the safety maintenance of medical personnel and patients in hospital, it has become an important issue for hospital. This study has literatures review to collate and analyse that are related issues with indoor air quality. Then measures the indoor air quality test with direct-reading instruments. In selected hospital of this study were field-tested, then use the measured data in the field, discussion and analysis of the causes of air pollutants and the establishment of the sensing area of pollutants Concentration empirical mode.

Quality of life of the population as an indicator of sustainable development of rural territories

Directory of Open Access Journals (Sweden)

Larisa Alexandrovna Tretiakova

2012-09-01

Full Text Available The purpose of this study is theoretical justification of socio-economic foundations of sustainable livelihoods in rural areas and development of practical recommendations for evaluating and improving quality of life in rural areas. The subject of this study is a system of socio-economic relations that defines processes and patterns of sustainable livelihoods in rural areas. Methodological basis is a systematic approach and method of dialectical cognition, which examine processes of development of rural territories in relationship and complementarity. The results described in this paper are: the degree of differentiation of rural population under qualitative levels of well-being was studied; the authors’ system of indicators of regional socio-economic development on a basis of detailed hierarchical structure was presented; priority areas for improving standards and quality of life of the rural population were identified. A scope of results was developed and science-based recommendations and suggestions for sustainable development of rural territories based on authors’ methodology for evaluating quality life in rural areas may be subject to legislative and executive authorities in development socio-economic projects and programmes aimed at enhancing rural employment and income were made. The conclusions are: sustainable development of rural territories involves not only increase of efficiency of rural economy, but, above all, increasing and improving the quality of life of the rural population; on a system of complementarities, the evaluation of sustainability of livelihood strategies should take into account the economic, environmental, social and institutional factors

Achieving quality in a government hospital: departmental responsibility.

Science.gov (United States)

Haron, Yafa; Segal, Zvi; Barhoum, Masad

2009-01-01

Quality improvement in health care organizations requires structural reorganization and system reform and the development of an appropriate organizational "culture." In 2007, the Division of Quality and Excellence in Civil Service in Israel developed a concept to improve quality management in governmental institutions throughout the country. To put this strategy into practice, Western Galilee Hospital, a governmental hospital, in northern Israel, developed a plan to advance the quality management system where each department and unit is autonomously responsible for its own quality and excellence. Since the hospital has been certificated by ISO 9001 for more than 10 years (the only hospital in Israel to have this certificate), the main challenge now is to improve the quality and excellence system in every department. The aim of this article is to describe the implementation of a comprehensive program designed to raise the ability of managers and workers in Western Galilee Hospital in addressing all of the government's requirements for quality and excellence in service in Israel.

Disease patterns in the medical wards of a rural South African hospital

African Journals Online (AJOL)

Hypertension dominated the disease pattern followed by pulmonary tuberculosis, gastro-enteritis, pneumonia, diabetes, and asthma. The findings of this study suggest that diseases prominent in the affluent urban population affect patients seen at this rural hospital. The focus of primary care physicians should be to manage ...

RURAL-URBAN DIFFERENCES IN NURSING HOME ACCESS, QUALITY AND COST

OpenAIRE

Yu, Wei; Bradford, Garnett L.

1995-01-01

Rural-urban differences in the supply of nursing home services as hypothesized to be jointly affected by competitive and regulatory forces, government policies, and the cost structure. Study findings indicate that rural services are slightly less accessible and lower in quality. A translog cost share function reveals no difference in the operating cost structure of rural and urban homes. Cost shares for nursing care are directly related to the degree of skilled nursing provided by homes. Sign...

Racial Disparities in Diabetes Hospitalization of Rural Medicare Beneficiaries in 8 Southeastern States.

Science.gov (United States)

Wan, Thomas T H; Lin, Yi-Ling; Ortiz, Judith

2016-01-01

This study examined racial variability in diabetes hospitalizations attributable to contextual, organizational, and ecological factors controlling for patient variabilities treated at rural health clinics (RHCs). The pooled cross-sectional data for 2007 through 2013 for RHCs were aggregated from Medicare claim files of patients served by RHCs. Descriptive statistics were presented to illustrate the general characteristics of the RHCs in 8 southeastern states. Regression of the dependent variable on selected predictors was conducted using a generalized estimating equation method. The risk-adjusted diabetes mellitus (DM) hospitalization rates slightly declined in 7 years from 3.55% to 2.40%. The gap between the crude and adjusted rates became wider in the African American patient group but not in the non-Hispanic white patient group. The average DM disparity ratio increased 17.7% from the pre-Affordable Care Act (ACA; 1.47) to the post-ACA period (1.73) for the African American patient group. The results showed that DM disparity ratios did not vary significantly by contextual, organizational, and individual factors for African Americans. Non-Hispanic white patients residing in large and small rural areas had higher DM disparity ratios than other rural areas. The results of this study confirm racial disparities in DM hospitalizations. Future research is needed to identify the underlying reasons for such racial disparities to guide the formulation of effective and efficient changes in DM care management practices coupled with the emphasis of culturally competent, primary and preventive care.

Racial Disparities in Diabetes Hospitalization of Rural Medicare Beneficiaries in 8 Southeastern States

Directory of Open Access Journals (Sweden)

Thomas T. H. Wan

2016-10-01

Full Text Available This study examined racial variability in diabetes hospitalizations attributable to contextual, organizational, and ecological factors controlling for patient variabilities treated at rural health clinics (RHCs. The pooled cross-sectional data for 2007 through 2013 for RHCs were aggregated from Medicare claim files of patients served by RHCs. Descriptive statistics were presented to illustrate the general characteristics of the RHCs in 8 southeastern states. Regression of the dependent variable on selected predictors was conducted using a generalized estimating equation method. The risk-adjusted diabetes mellitus (DM hospitalization rates slightly declined in 7 years from 3.55% to 2.40%. The gap between the crude and adjusted rates became wider in the African American patient group but not in the non-Hispanic white patient group. The average DM disparity ratio increased 17.7% from the pre-Affordable Care Act (ACA; 1.47 to the post-ACA period (1.73 for the African American patient group. The results showed that DM disparity ratios did not vary significantly by contextual, organizational, and individual factors for African Americans. Non-Hispanic white patients residing in large and small rural areas had higher DM disparity ratios than other rural areas. The results of this study confirm racial disparities in DM hospitalizations. Future research is needed to identify the underlying reasons for such racial disparities to guide the formulation of effective and efficient changes in DM care management practices coupled with the emphasis of culturally competent, primary and preventive care.

Hospital Quality Initiative - Outcome Measures

Data.gov (United States)

U.S. Department of Health & Human Services — In the interest of promoting high-quality, patient-centered care and accountability, the Centers for Medicare and Medicaid Services (CMS) and Hospital Quality...

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

Science.gov (United States)

Rivers, P A; Fottler, M D

2004-11-01

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

Gauging food and nutritional care quality in hospitals

Directory of Open Access Journals (Sweden)

Diez-Garcia Rosa

2012-09-01

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

Organizational Attributes Associated With Medicare ACO Quality Performance.

Science.gov (United States)

Zhu, Xi; Mueller, Keith; Huang, Huang; Ullrich, Fred; Vaughn, Thomas; MacKinney, A Clinton

2018-05-08

To evaluate associations between geographic, structural, and service-provision attributes of Accountable Care Organizations (ACOs) participating in the Medicare Shared Savings Program (MSSP) and the ACOs' quality performance. We conducted cross-sectional and longitudinal analyses of ACO quality performance using data from the Centers for Medicare and Medicaid Services and additional sources. The sample included 322 and 385 MSSP ACOs that had successfully reported quality measures in 2014 and 2015, respectively. Results show that after adjusting for other organizational factors, rural ACOs' average quality score was comparable to that of ACOs serving other geographic categories. ACOs with hospital-system sponsorship, larger beneficiary panels, and higher posthospitalization follow-up rates achieved better quality performance. There is no significant difference in average quality performance between rural ACOs and other ACOs after adjusting for structural and service-provision factors. MSSP ACO quality performance is positively associated with hospital-system sponsorship, beneficiary panel size, and posthospitalization follow-up rate. © 2018 National Rural Health Association.

Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria

OpenAIRE

Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Winifred, Ekezie; Kelechi, Ohiri

2016-01-01

Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected...

Improving collected rainwater quality in rural communities.

Science.gov (United States)

Garrido, S; Aviles, M; Ramirez, A; Gonzalez, A; Montellano, L; Gonzalez, B; de la Paz, J; Ramirez, R M

2011-01-01

The country of Mexico is facing serious problems with water quality and supply for human use and consumption in rural communities, mainly due to topographic and isolation. In Mexico the average annual precipitation is 1,500 cubic kilometers of water, if 3% of that amount were used, 13 million Mexicans could be supplied with drinking water that they currently do not have access. Considering the limited infrastructure and management in rural communities, which do not receive services from the centralized systems of large cities, a modified pilot multi-stage filtration (MMSF) system was designed, developed, and evaluated for treating collected rainwater in three rural communities, Ajuchitlan and Villa Nicolas Zapata (Morelos State) and Xacxamayo (Puebla State). The efficiencies obtained in the treatment system were: colour and turbidity >93%. It is worth mentioning that the water obtained for human use and consumption complies with the Mexican Standard NOM-127-SSA1-1994.

Blood transfusion practice in a rural hospital in Northern Ghana, Damongo, West Gonja District.

Science.gov (United States)

Kubio, Chrysantus; Tierney, Geraldine; Quaye, Theophilus; Nabilisi, James Wewoli; Ziemah, Callistus; Zagbeeb, Sr Mary; Shaw, Sandra; Murphy, William G

2012-10-01

Blood transfusion in rural sub-Saharan Africa presents special challenges. Transfusions are primarily given for emergencies--life-threatening blood loss or anemia; blood is usually collected from family or replacement donors; and facilities to store an adequate reserve in a hospital bank are constrained. We report the everyday and organizational practices in a medium-sized district hospital in Northern Ghana. Information and data on blood transfusion practices at West Gonja Hospital, Damongo, were available from the laboratory reports, from day books and workbooks, and from direct observation in the following four areas: blood collection and blood donors; blood donation testing; blood storage and logistics; and clinical transfusion practice, adverse events, and follow-up. The hospital serves a rural community of 86,000. In 2009, a total of 719 units of whole blood were collected, a rate of 8.36 units per 1000 population. All donors were family or replacement donors. Positivity rates for infectious disease markers were 7.5% (64/853) for hepatitis B surface antigen, 6.1% (50/819) for hepatitis C virus, 3.9% (33/846) for human immunodeficiency virus, and 4.7% (22/468) for syphilis. Supply of laboratory materials was sometimes problematic, especially for temperature-critical materials. Difficulties in sample labeling, storage of blood and laboratory supplies, and disposal of waste were also incurred by operational, material, and financial constraints. Follow-up for outcomes of transfusion is not currently feasible. The operational, demographic, and financial environment pertaining in a rural hospital in Northern Ghana differs substantially from that in which much of current blood transfusion practice and technology evolved. Considerable effort and innovation will be needed to address successfully the challenges posed. © 2012 American Association of Blood Banks.

Making secondary care a primary concern: the rural hospital in Ecuador Hacer de la atención secundaria una preocupación primaria: los hospitales rurales en Ecuador

Directory of Open Access Journals (Sweden)

David Gaus

2008-03-01

Full Text Available En Ecuador, el acceso de la población rural a servicios adecuados de atención secundaria de salud se ha hecho cada vez más difícil. A pesar de que los sectores público y privado han acertado en dedicar esfuerzos a la atención primaria y a la salud pública, la mayoría de las poblaciones rurales no tienen acceso a una adecuada atención secundaria. Por lo general, los modelos tradicionales de atención médica secundaria en zonas rurales no se han adaptado a las nuevas situaciones, como la tendencia general a la descentralización, el énfasis en el desarrollo de capacidades locales, el antagonismo entre el acceso universal y la autonomía financiera, las alternativas financieras innovadoras y los recién llegados médicos de familia. En 2001, la organización no gubernamental con sede en los Estados Unidos de América Andean Health & Development (Saludesa en Ecuador inauguró un hospital rural de 17 camas, construido conjuntamente con el municipio local y el Ministerio de Salud de Ecuador. El hospital atiende a una comunidad rural de 50000 personas que antes no tenían acceso local a servicios secundarios de salud. Los esfuerzos de AHD/Saludesa para desarrollar una red autosostenible pública/privada de atención primaria/secundaria de salud y de alta calidad han generado una considerable experiencia en la administración de un hospital rural. El proyecto piloto de AHD se concentró en un hospital rural y logró su autosostenibilidad total en 2007. Esto se logró mediante una combinación de mecanismos financieros, entre ellos la venta de paquetes prepagados de atención sanitaria, un contrato con el Instituto Ecuatoriano de Seguridad Social, contribuciones municipales y el pago tradicional por los servicios.

Competition among Turkish hospitals and its effect on hospital efficiency and service quality.

Science.gov (United States)

Torun, Nazan; Celik, Yusuf; Younis, Mustafa Z

2013-01-01

The level of competition among hospitals in Turkey was analyzed for the years 1990 through 2006 using the Herfindahl-Hirschman Index (HHI). Multiple and simple regression analyses were run to observe the development of competition among hospitals over this period of time, to examine likely determinants of competition, and to calculate the effects of competition on efficiency and quality in individual hospitals. This study found that the level of competition among hospitals in Turkey has increased throughout the years. Also, competition has had a positive effect on the efficiency of hospitals; however, it did not have a significant positive effect on their quality. Moreover, there are important differences in the level of competition among hospitals that vary according to the geographical region, the type of ownership, and the type of hospital. This study is one of the first to evaluate the effects of health policies on competition as well as the effects of increasing competition on hospital quality and efficiency in Turkey.

Improving health related quality of life among rural hypertensive patients through the integrative strategy of health services delivery: a quasi-experimental trial from Chongqing, China.

Science.gov (United States)

Miao, Yudong; Zhang, Liang; Sparring, Vibeke; Sandeep, Sandeep; Tang, Wenxi; Sun, Xiaowei; Feng, Da; Ye, Ting

2016-08-23

Integrative strategy of health services delivery has been proven to be effective in economically developed countries, where the healthcare systems have enough qualified primary care providers. However rural China lacks such providers to act as gatekeeper, besides, Chinese rural hypertensive patients are usually of old age, more likely to be exposed to health risk factors and they experience a greater socio-economic burden. All these Chinese rural setting specific features make the effectiveness of integrative strategy of health services in improving health related quality of life among Chinese rural hypertensive patients uncertain. In order to assess the impact of integrative strategy of health services delivery on health related quality of life among Chinese rural hypertensive patients, a two-year quasi-experimental trial was conducted in Chongqing, China. At baseline the sample enrolled 1006 hypertensive patients into intervention group and 420 hypertensive patients into control group. Physicians from village clinics, town hospitals and county hospitals worked collaboratively to deliver multidisciplinary health services for the intervention group, while physicians in the control group provided services without cooperation. The quality of life was studied by SF-36 Scale. Blood pressures were reported by town hospitals. The Difference-in-Differences model was used to estimate the differences in SF-36 score and blood pressure of both groups to assess the impact. The study showed that at baseline there was no statistical difference in SF-36 scores between both groups. While at follow-up the intervention group scored higher in overall SF-36, Role Physical, Body Pain, Social Functioning and Role Emotional than the control group. The Difference-in-Differences result demonstrated that there were statistical differences in SF-36 total score (p = 0.011), Role Physical (p = 0.027), Social Functioning (p = 0.000), Role Emotional (p = 0.002) between both

Quality and rural-urban comparison of tuberculosis care in Rivers ...

African Journals Online (AJOL)

Quality and rural-urban comparison of tuberculosis care in Rivers State, Nigeria. ... out between May and June 2013, employing the Donabedian model of quality assessment. Data was analysed using the SPSS software package version 20.0.

[Subjective Workload, Job Satisfaction, and Work-Life-Balance of Physicians and Nurses in a Municipal Hospital in a Rural Area Compared to an Urban University Hospital].

Science.gov (United States)

Körber, Michael; Schmid, Klaus; Drexler, Hans; Kiesel, Johannes

2018-05-01

Medical and nursing shortages in rural areas represent a current serious public health problem. The healthcare of the rural population is at risk. This study compares perceived workload, job satisfaction and work-life balance of physicians and nurses at a clinic in a rural area with two clinics of a University hospital. Physicians and nurses were interviewed anonymously with a standardized questionnaire (paper and pencil), including questions on job satisfaction, subjective workload and work-life balance. The response rate was almost 50% in the University hospital as well as in the municipal hospital. 32 physicians and 54 nurses from the University hospital and 18 physicians and 137 nurses from the municipal hospital participated in the survey. Nurses at the University hospital assessed the organization of the daily routine with 94.1% as better than those at the municipal hospital (82.4%, p=0.03). Physicians at the University hospital were able to better implement acquired knowledge at a University clinic with 87.5% than their counterparts at the municipal hospital (55.5%, p=0.02). In contrast to their colleagues at the municipal hospital, only 50% of the physicians at the University hospital subjectively considered their workload as just right (83.3% municipal, p=0.02). 96.9% of the physicians at the University hospital were "daily" or "several times a week" under time pressure (municipal 50%, pwork and family life (62.9% University hospital, 72.8% Municipal hospital). In contrast, only 20% of the physicians at the University Hospital but 42.9% of the physicians of the municipal hospital had sufficient opportunities to balance workload and family (p=0.13). The return rate of almost 50% can be described as good. Due to the small number of physicians, especially from the municipal hospital, it can be assumed that some interesting differences could not be detected. There were only slight differences between the nurses from the two hospitals. In contrast, subjective

The impact of air quality conditioned by emission of pollutants to the development of rural tourism and potentials of rural areas

Directory of Open Access Journals (Sweden)

Cvijanović Drago

2017-01-01

Full Text Available Significant potentials for tourism development in Serbia are related to rural areas. Rural development, on its basis, includes the agrarian, but also the non-agrarian sector in rural areas, thus encompassing every vital component of the development of rural areas. This paper is, following the relevant theoretical positions, focused on key issues in the field of air quality impacts caused by the emission of pollutants to the development of rural tourism and the potentials of rural areas. These are primarily the following issues: which are the criteria for assessing air quality, or what are the limit values of the parameters for the protection of human health, and what is the trend of air quality by zones and agglomerations and what is the percentage of the population potentially exposed to concentrations of pollutants above the reference level. The mentioned topic is analyzed for the period 2012-2015. Analysis of the results of the degree of emission of suspended particles by zones and agglomerations in Serbia is presented correlatively in conclusion with concluding reviews on the existing ecological potential for the development of the basic rural areas in Serbia - Vojvodina, which makes up 28% of the total area of Serbia, Central Serbia, which consists of 29% of the total area of Serbia and South Serbia, which accounts for 44% of the total area of Serbia.

Aging and quality of life of elderly people in rural areas

Directory of Open Access Journals (Sweden)

Juliana Ladeira Garbaccio

Full Text Available ABSTRACT Objective: To evaluate the quality of life and health of elderly in rural areas of Minas Gerais State’s center-west. Method: Cross-sectional study, in four municipalities of Minas Gerais State, by interviewing elderly people. Associations between socio-demographic and quality of life variables were tested, separated into “satisfactory”/“unsatisfactory” with values from the median of positive answers. It was used the chi-square test, Fisher’s test and regression. Results: 182 elderly answered the questions and showed a relation with the “satisfactory” quality of life - bivariate (p < 0.05: age by 69 years (61.6%, married (61.7%, living by 54 years in rural areas (68%, with no financial support (59.5%, living with someone else (61%, non-smoker (60%, presenting good health (76.7%, satisfied with life (69.6%; regression: not having financial support, living with someone else and not smoking. Conclusion: Elderly people in rural areas present good quality of life/health in the cognitive aspect, access to services, goods, habits, but awareness must be constant due to their weakness.

The effects of hospital competition on inpatient quality of care.

Science.gov (United States)

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

2008-01-01

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

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

OpenAIRE

Kim, Jinkyung; Han, Woosok

2012-01-01

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

[Quality of involuntary hospital administration in Switzerland].

Science.gov (United States)

Jäger, Matthias; Ospelt, Isabelle; Kawohl, Wolfram; Theodoridou, Anastasia; Rössler, Wulf; Hoff, Paul

2014-05-21

This study aims at investigating the formal and content-related quality of medical certificates directing compulsory hospital admissions before the scheduled alteration of the Swiss civil legislation in January 2013. A comparison between physicians with different professional backgrounds concerning certificates and patients was conducted. Retrospective investigation of medical records of involuntary inpatients at the University Hospital of Psychiatry in Zurich during a period of six months (N=489). Considerable deficits concerning formal and particularly content-related aspects of the certificates were found. Psychiatrists issued certificates of the highest quality followed by emergency physicians, hospital doctors and general practitioners. Patients differed with respect to several sociodemographic and clinical variables. The quality of certificates directing involuntary hospital admission has to be improved considering the impact on the individual concerned. The consequences of the new legislation on the quality of the admission practices should be inquired in order to improve professional training on the issue.

Job Satisfaction Analysis in Rural China: A Qualitative Study of Doctors in a Township Hospital.

Science.gov (United States)

Chen, Qiwei; Yang, Lan; Feng, Qiming; Tighe, Scott S

2017-01-01

Background . Township hospitals in China provide rural communities with basic but much needed critical health care services. The doctors working in these hospitals often feel unsatisfied when considering their work schedules and financial rewards. Method . To explore job satisfaction of health workers in a township hospital, a qualitative study was conducted of 39 doctors from five township hospitals in Guangxi Zhuang Autonomous Region. The goal was to understand the level of job satisfaction of doctors and to make recommendations for improvements. Results . About 75% (28/39) of the doctors expressed negative attitudes related to their work conditions. Slightly more than half (22/39) mentioned they should receive greater compensation for their work and more than one were seriously considering other options. Many participants (35/39) showed their satisfaction about the achievement of serving as a doctor. Conclusion . Their main concerns related to job satisfaction included working conditions, financial rewards, and the doctor's relationships with patients. Increasing the incomes and fringe benefits of healthcare workers, improving their work conditions, and providing training and continuing education opportunities would help rural clinics retain doctors and eliminate the current unsatisfactory conditions. The findings also highlight the need for the government to increase financial support of township hospitals.

Job Satisfaction Analysis in Rural China: A Qualitative Study of Doctors in a Township Hospital

Directory of Open Access Journals (Sweden)

Qiwei Chen

2017-01-01

Full Text Available Background. Township hospitals in China provide rural communities with basic but much needed critical health care services. The doctors working in these hospitals often feel unsatisfied when considering their work schedules and financial rewards. Method. To explore job satisfaction of health workers in a township hospital, a qualitative study was conducted of 39 doctors from five township hospitals in Guangxi Zhuang Autonomous Region. The goal was to understand the level of job satisfaction of doctors and to make recommendations for improvements. Results. About 75% (28/39 of the doctors expressed negative attitudes related to their work conditions. Slightly more than half (22/39 mentioned they should receive greater compensation for their work and more than one were seriously considering other options. Many participants (35/39 showed their satisfaction about the achievement of serving as a doctor. Conclusion. Their main concerns related to job satisfaction included working conditions, financial rewards, and the doctor’s relationships with patients. Increasing the incomes and fringe benefits of healthcare workers, improving their work conditions, and providing training and continuing education opportunities would help rural clinics retain doctors and eliminate the current unsatisfactory conditions. The findings also highlight the need for the government to increase financial support of township hospitals.

Outcomes of antiretroviral treatment programmes in rural Lesotho: health centres and hospitals compared.

Science.gov (United States)

Labhardt, Niklaus Daniel; Keiser, Olivia; Sello, Motlalepula; Lejone, Thabo Ishmael; Pfeiffer, Karolin; Davies, Mary-Ann; Egger, Matthias; Ehmer, Jochen; Wandeler, Gilles

2013-11-21

Lesotho was among the first countries to adopt decentralization of care from hospitals to nurse-led health centres (HCs) to scale up the provision of antiretroviral therapy (ART). We compared outcomes between patients who started ART at HCs and hospitals in two rural catchment areas in Lesotho. The two catchment areas comprise two hospitals and 12 HCs. Patients ≥16 years starting ART at a hospital or HC between 2008 and 2011 were included. Loss to follow-up (LTFU) was defined as not returning to the facility for ≥180 days after the last visit, no follow-up (no FUP) as not returning after starting ART, and retention in care as alive and on ART at the facility. The data were analysed using logistic regression, competing risk regression and Kaplan-Meier methods. Multivariable analyses were adjusted for sex, age, CD4 cell count, World Health Organization stage, catchment area and type of ART. All analyses were stratified by gender. Of 3747 patients, 2042 (54.5%) started ART at HCs. Both women and men at hospitals had more advanced clinical and immunological stages of disease than those at HCs. Over 5445 patient-years, 420 died and 475 were LTFU. Kaplan-Meier estimates for three-year retention were 68.7 and 69.7% at HCs and hospitals, respectively, among women (p=0.81) and 68.8% at HCs versus 54.7% at hospitals among men (phospitals among women (odds ratio (OR): 0.89, 95% confidence interval (CI): 0.73-1.09) and higher retention at HCs among men (OR: 1.53, 95% CI: 1.20-1.96). The latter result was mainly driven by a lower proportion of patients LTFU at HCs (OR: 0.68, 95% CI: 0.51-0.93). In rural Lesotho, overall retention in care did not differ significantly between nurse-led HCs and hospitals. However, men seemed to benefit most from starting ART at HCs, as they were more likely to remain in care in these facilities compared to hospitals.

Does Rurality Affect Quality of Life Following Treatment for Breast Cancer?

Science.gov (United States)

Reid-Arndt, Stephanie A.; Cox, Cathy R.

2010-01-01

Purpose: The present research examined the extent to which rural residence and social support seeking are associated with quality of life (QOL) among breast cancer patients following chemotherapy. Methods: Female breast cancer patients (n = 46) from communities of varying degrees of rurality in a Midwestern state completed psychological and QOL…

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

Directory of Open Access Journals (Sweden)

Badia BISBIS

2016-06-01

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

Effect of Outsourced Pharmacies of Rural Healthcare Centers on Service Quality in Abharand Soltanieh Counties

Directory of Open Access Journals (Sweden)

Ali Maher

2016-05-01

Full Text Available Recently, a part of healthcare services has been assigned to the private sector to increase the quality of medical services, increase patient satisfaction and reduce costs. In this regard, the outsourcing approach has been significantly considered for pharmaceutical services provided by healthcare centers. The purpose of this study is to evaluate the effect of outsourced pharmacies of rural healthcare centers on service quality using structural equations modelling. The methodology used was descriptive using correlation by structural equations modelling. The studied population included those patients who provided their medicines from pharmacies of rural healthcare centers in Abhar and Soltanieh counties. The samples included 384 of these patients. Data was collected by outsourcing and service quality questionnaires. A structural equation modelling was used to analyze data by LISREAL software. Results indicated a positive significant effect of outsourced pharmacies of rural healthcare centers on quality of tangibles, reliability, responsiveness, assurance and empathy. findings emphasize the role of outsourcing on quality of services. Outsourced pharmacies of rural healthcare centers of Abhar and Soltanieh counties lead to improved service quality.

The newest miracle drug: quality circles in hospitals.

Science.gov (United States)

McKinney, M M

1984-01-01

In recent years, a number of hospitals throughout the United States have been exploring the use of Japanese-style quality circles to reduce their operating expenses, improve productivity, and enhance the quality of work life for hospital employees. This article examines the organizational climate necessary for quality circles, methods used to implement quality circles, and management's role in guiding and responding to circle activities. Ideas for building and maintaining staff support are presented along with a cost/benefit analysis of quality circle programs. The author concludes that quality circles are most successful in hospitals where they are part of a larger organizational development effort. When administrators believe in their employees' ability to contribute to the institution and are willing to invest necessary time and resources in employee education and the measurement of quality circle achievements, quality circles can produce creative solutions to perplexing institutional problems.

Assessing water quality of rural water supply schemes as a measure ...

African Journals Online (AJOL)

Assessing water quality of rural water supply schemes as a measure of service ... drinking water quality parameters were within the World Health Organization ... Besides, disinfection of water at the household level can be an added advantage.

Telehealth-based model of care redesign to facilitate local fitting and management of patients with a spinal fracture requiring a thoracic lumbar sacral orthosis in rural hospitals in New South Wales.

Science.gov (United States)

Gallagher, Ryan; Giles, Michelle; Morison, Jane; Henderson, Judith

2018-03-23

To develop and implement a telehealth-based model of care for spinal fractures requiring management with thoracic lumbar sacral orthoses that eliminates the need for transfer to a metropolitan tertiary referral hospital. Pre-post design observational study evaluating model of care implementation. Rural referral hospitals in a large NSW region covering metropolitan, rural and remote hospitals. Patients presenting with a thoracic or lumbar spine fracture requiring thoracic lumbar sacral orthoses management and rural clinicians caring for them. Number of patients managed in rural hospitals without transfer to a metropolitan tertiary referral hospital; length of stay and related cost efficiencies; clinicians' perceived skills, knowledge and confidence levels. Model of care was implemented with clinical and system governance processes; and educational workshops across eight rural hospitals. A total of 81 patients managed in rural hospitals under this model between July 2013 and June 2016 without transfer were included in this study. Mean length of stay reduced from nine to four days. Hospital transfers were eliminated from the patient journey, totalling 24 324 km. Workshops were attended by 71 clinicians from nine rural hospitals and survey findings indicated a significant increase in staff knowledge, skill and confidence post education. Cost efficiencies were gained by eliminating 162 inter-hospital transfers and 405 patient bed days. This model has streamlined patient journeys and reduced transfers and travel, enabling rural clinicians to provide specialised services in local communities and facilitating timely evidence-based care in local communities without any adverse events. © 2018 National Rural Health Alliance Ltd.

Patients’ Perception on Hospital Quality in a Teaching Hospital of Tehran

Directory of Open Access Journals (Sweden)

Samad Azari

2016-01-01

Full Text Available ​Background and Objectives : Due to unique characteristics of the health sector, measuring the efficiency and quality of services provided are the top priorities of the Ministry of Health and Medical Education. In health systems, an appropriate response to the needs and demands of patients is a priority. This study was conducted to assess hospital’s services quality using logit model for prioritizing service attributes based on patients’ perception in 2012. Material and Methods : In this descriptive cross-sectional study, 330 patients in Imam Khomeini Hospital in Tehran were entered into the study based on Cochran method. Data were gathered using questionnaire in 5 dimensions and 10 scenarios. Reliability and validity of the questionnaire were approved. Data were input into STATA software 10th edition and utility function was estimated to calculate the marginal utility specifications. Results : According to the patients’ perception, type of examination and treatment was ranked as the first and cleaning services of the departments and toilets was ranked as the last priority. The results about waiting time between hospital arrival until admission was negative which means reverse influence on patient perception of quality. Except cleaning services of the departments and toilets and handling patients, other features had significant relationship with patient preferences. Conclusion : In order to increase the desirability of visiting patients in hospitals and delivering high quality services and considering patient preferences; hospital administrators need to be focused on improving the quality of the programs.

Expecting excellence is key to receivable success in small and rural hospitals.

Science.gov (United States)

Boucher, D

1990-06-01

Although small and rural hospitals may have trouble hiring experienced billing and collection personnel, they can succeed in keeping down receivable levels and receivable days by adopting two principles for the business office: expect excellence and inspect for excellence. These principles include setting goals for business office staff as well as listening to and implementing their ideas for more effective operations.

Locum tenens consultant doctors in a rural general hospital - an essential part of the medical workforce or an expensive stopgap?

Science.gov (United States)

Sim, Andrew Jw

2011-01-01

Maintaining hospital consultant staffing levels often requires the employment of locum tenens to meet service needs. This is particularly so in hospitals where core clinical services are run by a small number of permanently appointed consultants. The problems associated with locum employment are underestimated and little attention has been directed towards addressing the issue in the rural general hospitals of Scotland. This study looked at the permanent and short- and long-term locum consultant usage over an 8 year period in one Scottish rural general hospital, the Western Isles Hospital in Stornoway. Data were extracted from the Human Resources Department of NHS Western Isles' list of locum consultants for most weeks from the beginning of January 2002 to the end of December 2009. The Western Isles Hospital in Stornoway has an establishment of 17 permanent consultants. During the 8 year study period 239 different consultants were employed, 20 held substantive permanent positions, 31 were long-term locums (employed >3 months) and 188 were short-term locums. The short-term locums worked for 535 different locum episodes. The pattern of usage varied according to service configuration. Study data revealed the alarming scope of the locum tenens issue, which will increase unless action is taken. For sustainable medical services to continue in the rural general hospitals of Scotland, staffing models must minimise the need to employ locum consultants.

Evaluating quality management systems for HIV rapid testing services in primary healthcare clinics in rural KwaZulu-Natal, South Africa.

Directory of Open Access Journals (Sweden)

Ziningi Jaya

Full Text Available Rapid HIV tests have improved access to HIV diagnosis and treatment by providing quick and convenient testing in rural clinics and resource-limited settings. In this study, we evaluated the quality management system for voluntary and provider-initiated point-of-care HIV testing in primary healthcare (PHC clinics in rural KwaZulu-Natal (KZN, South Africa.We conducted a quality assessment audit in eleven PHC clinics that offer voluntary HIV testing and counselling in rural KZN, South Africa from August 2015 to October 2016. All the participating clinics were purposively selected from the province-wide survey of diagnostic services. We completed an on-site monitoring checklist, adopted from the WHO guidelines for assuring accuracy and reliability of HIV rapid tests, to assess the quality management system for HIV rapid testing at each clinic. To determine clinic's compliance to WHO quality standards for HIV rapid testing the following quality measure was used, a 3-point scale (high, moderate and poor. A high score was defined as a percentage rating of 90 to 100%, moderate was defined as a percentage rating of 70 to 90%, and poor was defined as a percentage rating of less than 70%. Clinic audit scores were summarized and compared. We employed Pearson pair wise correlation coefficient to determine correlations between clinics audit scores and clinic and clinics characteristics. Linear regression model was computed to estimate statistical significance of the correlates. Correlations were reported as significant at p ≤0.05.Nine out of 11 audited rural PHC clinics are located outside 20Km of the nearest town and hospital. Majority (18.2% of the audited rural PHC clinics reported that HIV rapid test was performed by HIV lay counsellors. Overall, ten clinics were rated moderate, in terms of their compliance to the stipulated WHO guidelines. Audit results showed that rural PHC clinics' average rating score for compliance to the WHO guidelines ranged

Evaluating quality management systems for HIV rapid testing services in primary healthcare clinics in rural KwaZulu-Natal, South Africa.

Science.gov (United States)

Jaya, Ziningi; Drain, Paul K; Mashamba-Thompson, Tivani P

2017-01-01

Rapid HIV tests have improved access to HIV diagnosis and treatment by providing quick and convenient testing in rural clinics and resource-limited settings. In this study, we evaluated the quality management system for voluntary and provider-initiated point-of-care HIV testing in primary healthcare (PHC) clinics in rural KwaZulu-Natal (KZN), South Africa. We conducted a quality assessment audit in eleven PHC clinics that offer voluntary HIV testing and counselling in rural KZN, South Africa from August 2015 to October 2016. All the participating clinics were purposively selected from the province-wide survey of diagnostic services. We completed an on-site monitoring checklist, adopted from the WHO guidelines for assuring accuracy and reliability of HIV rapid tests, to assess the quality management system for HIV rapid testing at each clinic. To determine clinic's compliance to WHO quality standards for HIV rapid testing the following quality measure was used, a 3-point scale (high, moderate and poor). A high score was defined as a percentage rating of 90 to 100%, moderate was defined as a percentage rating of 70 to 90%, and poor was defined as a percentage rating of less than 70%. Clinic audit scores were summarized and compared. We employed Pearson pair wise correlation coefficient to determine correlations between clinics audit scores and clinic and clinics characteristics. Linear regression model was computed to estimate statistical significance of the correlates. Correlations were reported as significant at p ≤0.05. Nine out of 11 audited rural PHC clinics are located outside 20Km of the nearest town and hospital. Majority (18.2%) of the audited rural PHC clinics reported that HIV rapid test was performed by HIV lay counsellors. Overall, ten clinics were rated moderate, in terms of their compliance to the stipulated WHO guidelines. Audit results showed that rural PHC clinics' average rating score for compliance to the WHO guidelines ranged between 64.4% (CI

Hospital Competition, Technical Efficiency, and Quality

OpenAIRE

C. L. Chua; Alfons Palangkaraya; Jongsay Yong

2009-01-01

This paper studies the link between competition and technical efficiency of public hospitals in the State of Victoria, Australia by accounting both quantity and quality of hospital output using a two-stage semi-parametric model of hospital production and Data Envelopment Analysis. On the one hand, it finds a positive relationship between efficiency and competition measured by the Hirschman-Herfindahl Index (HHI). On the other, it finds that efficiency and the number of competing hospitals, in...

Transfers to metropolitan hospitals and coronary angiography for rural Aboriginal and non-Aboriginal patients with acute ischaemic heart disease in Western Australia.

Science.gov (United States)

Lopez, Derrick; Katzenellenbogen, Judith M; Sanfilippo, Frank M; Woods, John A; Hobbs, Michael S T; Knuiman, Matthew W; Briffa, Tom G; Thompson, Peter L; Thompson, Sandra C

2014-05-01

Aboriginal people have a disproportionately higher incidence rate of ischaemic heart disease (IHD) than non-Aboriginal people. The findings on Aboriginal disparity in receiving coronary artery procedures are inconclusive. We describe the profile and transfers of IHD patients admitted to rural hospitals as emergency admissions and investigate determinants of transfers and coronary angiography. Person-linked hospital and mortality records were used to identify 28-day survivors of IHD events commencing at rural hospitals in Western Australia. Outcome measures were receipt of coronary angiography, transfer to a metropolitan hospital, and coronary angiography if transferred to a metropolitan hospital. Compared to non-Aboriginal patients, Aboriginal patients with IHD were more likely to be younger, have more co-morbidities, reside remotely, but less likely to have private insurance. After adjusting for demographic characteristics, Aboriginal people with MI were less likely to be transferred to a metropolitan hospital, and if transferred were less likely to receive coronary angiography. These disparities were not significant after adjusting for comorbidities and private insurance. In the full multivariate model age, comorbidities and private insurance were adversely associated with transfer to a metropolitan hospital and coronary angiography. Disparity in receiving coronary angiography following emergency admission for IHD to rural hospitals is mediated through the lower likelihood of being transferred to metropolitan hospitals where this procedure is performed. The likelihood of a transfer is increased if the patient has private insurance, however, rural Aboriginal people have a lower rate of private insurance than their non-Aboriginal counterparts. Health practitioners and policy makers can continue to claim that they treat Aboriginal and non-Aboriginal people alike based upon clinical indications, as private insurance is acting as a filter to reduce rural residents

Hospital Quality Systems - working mechanisms unraveled.

NARCIS (Netherlands)

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

2015-01-01

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

Successfully Reducing Hospitalizations of Nursing Home Residents: Results of the Missouri Quality Initiative.

Science.gov (United States)

Rantz, Marilyn J; Popejoy, Lori; Vogelsmeier, Amy; Galambos, Colleen; Alexander, Greg; Flesner, Marcia; Crecelius, Charles; Ge, Bin; Petroski, Gregory

2017-11-01

The goals of the Missouri Quality Initiative (MOQI) for long-stay nursing home residents were to reduce the frequency of avoidable hospital admissions and readmissions, improve resident health outcomes, improve the process of transitioning between inpatient hospitals and nursing facilities, and reduce overall healthcare spending without restricting access to care or choice of providers. The MOQI was one of 7 program sites in the United States, with specific interventions unique to each site tested for the Centers for Medicaid and Medicare Services (CMS) Innovations Center. A prospective, single group intervention design, the MOQI included an advanced practice registered nurse (APRN) embedded full-time within each nursing home (NH) to influence resident care outcomes. Data were collected continuously for more than 3 years from an average of 1750 long-stay Medicare, Medicaid, and private pay residents living each day in 16 participating nursing homes in urban, metro, and rural communities within 80 miles of a major Midwestern city in Missouri. Performance feedback reports were provided to each facility summarizing their all-cause hospitalizations and potentially avoidable hospitalizations as well as a support team of social work, health information technology, and INTERACT/Quality Improvement Coaches. The MOQI achieved a 30% reduction in all-cause hospitalizations and statistically significant reductions in 4 single quarters of the 2.75 years of full implementation of the intervention for long-stay nursing home residents. As the population of older people explodes in upcoming decades, it is critical to find good solutions to deal with increasing costs of health care. APRNs, working with multidisciplinary support teams, are a good solution to improving care and reducing costs if all nursing home residents have access to APRNs nationwide. Copyright © 2017 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Controlling for quality in the hospital cost function.

Science.gov (United States)

Carey, Kathleen; Stefos, Theodore

2011-06-01

This paper explores the relationship between the cost and quality of hospital care from the perspective of applied microeconomics. It addresses both theoretical and practical complexities entailed in incorporating hospital quality into the estimation of hospital cost functions. That literature is extended with an empirical analysis that examines the use of 15 Patient Safety Indicators (PSIs) as measures of hospital quality. A total operating cost function is estimated on 2,848 observations from five states drawn from the period 2001 to 2007. In general, findings indicate that the PSIs are successful in capturing variation in hospital cost due to adverse patient safety events. Measures that rely on the aggregate number of adverse events summed over PSIs are found to be superior to risk-adjusted rates for individual PSIs. The marginal cost of an adverse event is estimated to be $22,413. The results contribute to a growing business case for inpatient safety in hospital services.

Evaluation of service quality of hospital outpatient department services.

Science.gov (United States)

Chakravarty, Abhijit

2011-07-01

It has become essential for hospital managers to understand and measure consumer perspectives and service quality gaps, so that any perceived gap in delivery of service is identified and suitably addressed. A study was conducted at a peripheral service hospital to ascertain any service gap between consumer expectations and perceptions in respect of the hospital outpatient department (OPD) services. A cross-sectional study was conducted using SERVQUAL as the survey instrument, the instrument being validated for use in the hospital environment. Consumer ratings across 22 items of the survey instrument were collected in paired expectation and perception scores and then service quality gaps were identified and statistically analysed. Service quality gaps were identified to exist across all the five dimensions of the survey instrument, with statistically significant gaps across the dimensions of 'tangibles' and 'responsiveness.' The quality gaps were further validated by a total unweighted SERVQUAL score of (-) 1.63. The study concludes that significant service quality gaps existed in the delivery of the hospital OPD services, which need to be addressed by focused improvement efforts by the hospital management.

Funding issues and options for pharmacists providing sessional services to rural hospitals in Australia.

Science.gov (United States)

Tan, Amy Cw; Emmerton, Lynne M; Hattingh, H Laetitia; La Caze, Adam

2015-06-01

Many of Australia' s rural hospitals operate without an on-site pharmacist. In some, community pharmacists have sessional contracts to provide medication management services to inpatients. This paper discusses the funding arrangements of identified sessional employment models to raise awareness of options for other rural hospitals. Semistructured one-on-one interviews were conducted with rural pharmacists with experience in a sessional employment role (n =8) or who were seeking sessional arrangements (n = 4). Participants were identified via publicity and referrals. Interviews were conducted via telephone or Skype for ~40-55 min each, recorded and analysed descriptively. A shortage of state funding and reliance on federal funding was reported. Pharmacists accredited to provide medication reviews claimed remuneration via these federal schemes; however, restrictive criteria limited their scope of services. Funds pooling to subsidise remuneration for the pharmacists was evident and arrangements with local community pharmacies provided business frameworks to support sessional services. Participants were unaware of each other's models of practice, highlighting the need to share information and these findings. Several similarities existed, namely, pooling funds and use of federal medication review remuneration. Findings highlighted the need for a stable remuneration pathway and business model to enable wider implementation of sessional pharmacist models.

Limited use of price and quality advertising among American hospitals.

Science.gov (United States)

Muhlestein, David B; Wilks, Chrisanne E A; Richter, Jason P

2013-08-29

Consumer-directed policies, including health savings accounts, have been proposed and implemented to involve individuals more directly with the cost of their health care. The hope is this will ultimately encourage providers to compete for patients based on price or quality, resulting in lower health care costs and better health outcomes. To evaluate American hospital websites to learn whether hospitals advertise directly to consumers using price or quality data. Structured review of websites of 10% of American hospitals (N=474) to evaluate whether price or quality information is available to consumers and identify what hospitals advertise about to attract consumers. On their websites, 1.3% (6/474) of hospitals advertised about price and 19.0% (90/474) had some price information available; 5.7% (27/474) of hospitals advertised about quality outcomes information and 40.9% (194/474) had some quality outcome data available. Price and quality information that was available was limited and of minimal use to compare hospitals. Hospitals were more likely to advertise about service lines (56.5%, 268/474), access (49.6%, 235/474), awards (34.0%, 161/474), and amenities (30.8%, 146/474). Insufficient information currently exists for consumers to choose hospitals on the basis of price or quality, making current consumer-directed policies unlikely to realize improved quality or lower costs. Consumers may be more interested in information not related to cost or clinical factors when choosing a hospital, so consumer-directed strategies may be better served before choosing a provider, such as when choosing a health plan.

Rural and Urban Differences in Air Quality, 2008-2012, and Community Drinking Water Quality, 2010-2015 - United States.

Science.gov (United States)

Strosnider, Heather; Kennedy, Caitlin; Monti, Michele; Yip, Fuyuen

2017-06-23

The places in which persons live, work, and play can contribute to the development of adverse health outcomes. Understanding the differences in risk factors in various environments can help to explain differences in the occurrence of these outcomes and can be used to develop public health programs, interventions, and policies. Efforts to characterize urban and rural differences have largely focused on social and demographic characteristics. A paucity of national standardized environmental data has hindered efforts to characterize differences in the physical aspects of urban and rural areas, such as air and water quality. 2008-2012 for air quality and 2010-2015 for water quality. Since 2002, CDC's National Environmental Public Health Tracking Program has collaborated with federal, state, and local partners to gather standardized environmental data by creating national data standards, collecting available data, and disseminating data to be used in developing public health actions. The National Environmental Public Health Tracking Network (i.e., the tracking network) collects data provided by national, state, and local partners and includes 21 health outcomes, exposures, and environmental hazards. To assess environmental factors that affect health, CDC analyzed three air-quality measures from the tracking network for all counties in the contiguous United States during 2008-2012 and one water-quality measure for 26 states during 2010-2015. The three air-quality measures include 1) total number of days with fine particulate matter (PM 2.5 ) levels greater than the U.S. Environmental Protection Agency's (EPA's) National Ambient Air Quality Standards (NAAQS) for 24-hour average PM 2.5 (PM 2.5 days); 2) mean annual average ambient concentrations of PM 2.5 in micrograms per cubic meter (mean PM 2.5 ); and 3) total number of days with maximum 8-hour average ozone concentrations greater than the NAAQS (ozone days). The water-quality measure compared the annual mean

Recruiting and retaining high-quality teachers in rural areas.

Science.gov (United States)

Monk, David H

2007-01-01

In examining recruitment and retention of teachers in rural areas, David Monk begins by noting the numerous possible characteristics of rural communities--small size, sparse settlement, distance from population concentrations, and an economic reliance on agricultural industries that are increasingly using seasonal and immigrant workers to minimize labor costs. Many, though not all, rural areas, he says, are seriously impoverished. Classes in rural schools are relatively small, and teachers tend to report satisfaction with their work environments and relatively few problems with discipline. But teacher turnover is often high, and hiring can be difficult. Monk observes that rural schools have a below-average share of highly trained teachers. Compensation in rural schools tends to be low, perhaps because of a lower fiscal capacity in rural areas, thus complicating efforts to attract and retain teachers. Several student characteristics, including relatively large shares of students with special needs and with limited English skills and lower shares of students attending college, can also make it difficult to recruit and retain high-quality teachers. Other challenges include meeting the needs of highly mobile children of low-income migrant farm workers. With respect to public policy, Monk asserts a need to focus on a subcategory of what might be called hard-to-staff rural schools rather than to develop a blanket set of policies for all rural schools. In particular, he recommends a focus on such indicators as low teacher qualifications, teaching in fields far removed from the area of training, difficulty in hiring, high turnover, a lack of diversity among teachers in the school, and the presence of migrant farm workers' children. Successful efforts to stimulate economic growth in these areas would be highly beneficial. He also calls attention to the potential for modern telecommunication and computing technologies to offset some of the drawbacks associated with teaching

DUQuE quality management measures: associations between quality management at hospital and pathway levels.

Science.gov (United States)

Wagner, Cordula; Groene, Oliver; Thompson, Caroline A; Dersarkissian, Maral; Klazinga, Niek S; Arah, Onyebuchi A; Suñol, Rosa

2014-04-01

The assessment of integral quality management (QM) in a hospital requires measurement and monitoring from different perspectives and at various levels of care delivery. Within the DUQuE project (Deepening our Understanding of Quality improvement in Europe), seven measures for QM were developed. This study investigates the relationships between the various quality measures. It is a multi-level, cross-sectional, mixed-method study. As part of the DUQuE project, we invited a random sample of 74 hospitals in 7 countries. The quality managers of these hospitals were the main respondents. Furthermore, data of site visits of external surveyors assessing the participating hospitals were used. Three measures of QM at hospitals level focusing on integral systems (QMSI), compliance with the Plan-Do-Study-Act quality improvement cycle (QMCI) and implementation of clinical quality (CQII). Four measures of QM activities at care pathway level focusing on Specialized expertise and responsibility (SER), Evidence-based organization of pathways (EBOP), Patient safety strategies (PSS) and Clinical review (CR). Positive significant associations were found between the three hospitals level QM measures. Results of the relationships between levels were mixed and showed most associations between QMCI and department-level QM measures for all four types of departments. QMSI was associated with PSS in all types of departments. By using the seven measures of QM, it is possible to get a more comprehensive picture of the maturity of QM in hospitals, with regard to the different levels and across various types of hospital departments.

The Relationship between Place of Residence and Hospitalization Rate in the Biggest Referral Hospital of the Northwest according to Hospitalization Wards

Directory of Open Access Journals (Sweden)

Amin Talebpour

2016-06-01

Full Text Available ​ Background and objectives: In accordance with the global pattern, the urban population in Iran is higher than the rural population. But, are the statistics of using hospitalization services in public hospitals in these two categories similar to this pattern? This study seeks to determine the effect of place of residence on hospitalization rate by examining annual hospitalization statistics of the country’s biggest referral hospital in the northwest. Material and Methods: The method used in this study is cross-sectional and all cases of hospitalization in Imam Reza Hospital as the northwest’s biggest referral hospital were picked by available sampling method. The cases of 30260 hospitalized patients were examined through direct observation and items extracted from their files were recorded in the checklist. In order to determine the relations between the variables, K2 test was applied and the P-value was considered less than 0.05 The obtained data were analyzed by SPSS.16 software. Results: Results indicated that the frequency distribution of patients in terms of their urban or rural residence did not yield any significant difference (P>0/05. Results also showed that the highest hospitalization rate for urban patients was 16.1% (3305 individuals in surgery ward while it was 14.2% (1384 individuals for rural patients in orthopedic ward. The least significant statistical difference between urban and rural hospitalization rates was observed in renal ward with 72.9% (1162 individual urban patients and 27.1% (432 individuals rural patients of total patients hospitalized in this ward. The most significant statistical difference between urban and rural hospitalization rates was observed in ICU with 44.9% (297 individuals urban patients and 55.1% (365 individuals rural patients of the total patients hospitalized in this ward. Conclusion: A relative comparison among illnesses in urban and rural populations, aside from illnesses caused by trauma

Knowledge, attitude and practice about animal bite and rabies among victims attending a rural hospital in eastern India

Directory of Open Access Journals (Sweden)

Sirshendu Chaudhuri

2015-01-01

Full Text Available Rabies is highly prevalent in India. It is almost always fatal but preventable by timely administration of vaccine and proper wound care. Rural population have high disease burden. This may be partly due to lack of knowledge regarding the disease. Objectives- To identify the knowledge, attitude & practice of rural people attending in a rural hospital for animal bite management. Materials and Methods- Cross sectional observational study with 119 patients (period prevalence in February 2013. Results- Dogs were the main biting animal (87.4%. Children were the main victim(47.9%. 21% (25 of the respondent said that animal bite may lead to rabies. Neighbors were the main source of knowledge (38.7%. Mean duration of delay in presenting to hospital was 5.02 days. Roughly one third applied soap water to clean the wound. Attitude and practice was significantly associated with knowledge and attitude respectively (p<0.05. Conclusion- Rural population lack enough knowledge on rabies. Targeted group approach like educating mother and children may help improving health care utilization correctly.

What Impact Does Behavior of Doctors and Patients on Service Integration of Multi-institutional Readmission cross Township—county Hospitals in Rural China

OpenAIRE

Zhang, Yan; Tang, Wenxi; Zhang, Liang

2017-01-01

Background: With the change of rural residents’ disease spectrum and patients with chronic diseases boom, multi-institutional health service utilization of rural residents and the continuous service demands are growing sharply in rural China.Objective: Evaluate the service integration of multi-institutional readmission cross township—county hospitals (MRCTCH) in rural China, and figure out determines of service integration.Methods: This study featured 7 sample counties in rural China. Based o...

The application of a biometric identification technique for linking community and hospital data in rural Ghana.

Science.gov (United States)

Odei-Lartey, Eliezer Ofori; Boateng, Dennis; Danso, Samuel; Kwarteng, Anthony; Abokyi, Livesy; Amenga-Etego, Seeba; Gyaase, Stephaney; Asante, Kwaku Poku; Owusu-Agyei, Seth

2016-01-01

The reliability of counts for estimating population dynamics and disease burdens in communities depends on the availability of a common unique identifier for matching general population data with health facility data. Biometric data has been explored as a feasible common identifier between the health data and sociocultural data of resident members in rural communities within the Kintampo Health and Demographic Surveillance System located in the central part of Ghana. Our goal was to assess the feasibility of using fingerprint identification to link community data and hospital data in a rural African setting. A combination of biometrics and other personal identification techniques were used to identify individual's resident within a surveillance population seeking care in two district hospitals. Visits from resident individuals were successfully recorded and categorized by the success of the techniques applied during identification. The successes of visits that involved identification by fingerprint were further examined by age. A total of 27,662 hospital visits were linked to resident individuals. Over 85% of those visits were successfully identified using at least one identification method. Over 65% were successfully identified and linked using their fingerprints. Supervisory support from the hospital administration was critical in integrating this identification system into its routine activities. No concerns were expressed by community members about the fingerprint registration and identification processes. Fingerprint identification should be combined with other methods to be feasible in identifying community members in African rural settings. This can be enhanced in communities with some basic Demographic Surveillance System or census information.

The application of a biometric identification technique for linking community and hospital data in rural Ghana

Science.gov (United States)

Odei-Lartey, Eliezer Ofori; Boateng, Dennis; Danso, Samuel; Kwarteng, Anthony; Abokyi, Livesy; Amenga-Etego, Seeba; Gyaase, Stephaney; Asante, Kwaku Poku; Owusu-Agyei, Seth

2016-01-01

Background The reliability of counts for estimating population dynamics and disease burdens in communities depends on the availability of a common unique identifier for matching general population data with health facility data. Biometric data has been explored as a feasible common identifier between the health data and sociocultural data of resident members in rural communities within the Kintampo Health and Demographic Surveillance System located in the central part of Ghana. Objective Our goal was to assess the feasibility of using fingerprint identification to link community data and hospital data in a rural African setting. Design A combination of biometrics and other personal identification techniques were used to identify individual's resident within a surveillance population seeking care in two district hospitals. Visits from resident individuals were successfully recorded and categorized by the success of the techniques applied during identification. The successes of visits that involved identification by fingerprint were further examined by age. Results A total of 27,662 hospital visits were linked to resident individuals. Over 85% of those visits were successfully identified using at least one identification method. Over 65% were successfully identified and linked using their fingerprints. Supervisory support from the hospital administration was critical in integrating this identification system into its routine activities. No concerns were expressed by community members about the fingerprint registration and identification processes. Conclusions Fingerprint identification should be combined with other methods to be feasible in identifying community members in African rural settings. This can be enhanced in communities with some basic Demographic Surveillance System or census information. PMID:26993473

The application of a biometric identification technique for linking community and hospital data in rural Ghana

Directory of Open Access Journals (Sweden)

Eliezer Ofori Odei-Lartey

2016-03-01

Full Text Available Background: The reliability of counts for estimating population dynamics and disease burdens in communities depends on the availability of a common unique identifier for matching general population data with health facility data. Biometric data has been explored as a feasible common identifier between the health data and sociocultural data of resident members in rural communities within the Kintampo Health and Demographic Surveillance System located in the central part of Ghana. Objective: Our goal was to assess the feasibility of using fingerprint identification to link community data and hospital data in a rural African setting. Design: A combination of biometrics and other personal identification techniques were used to identify individual's resident within a surveillance population seeking care in two district hospitals. Visits from resident individuals were successfully recorded and categorized by the success of the techniques applied during identification. The successes of visits that involved identification by fingerprint were further examined by age. Results: A total of 27,662 hospital visits were linked to resident individuals. Over 85% of those visits were successfully identified using at least one identification method. Over 65% were successfully identified and linked using their fingerprints. Supervisory support from the hospital administration was critical in integrating this identification system into its routine activities. No concerns were expressed by community members about the fingerprint registration and identification processes. Conclusions: Fingerprint identification should be combined with other methods to be feasible in identifying community members in African rural settings. This can be enhanced in communities with some basic Demographic Surveillance System or census information.

Innovative financing for rural surgical patients: Experience in mission hospitals

Directory of Open Access Journals (Sweden)

Gnanaraj Jesudian

2016-01-01

Full Text Available In rural India most of the surgical patients become impoverished due to surgical treatment pushing several families below poverty line. We describe the various methods that we tried to help these patients pay for the surgical procedures without becoming impoverished. Some of them were successful and many of them were not so successful. The large turnover and innovative methods helped the mission hospitals to serve the poor and the marginalized. Some of these methods might not be relevant in areas other than Northeast India while many could be used in other areas.

Criteria-based audit of caesarean section in a referral hospital in rural Tanzania.

Science.gov (United States)

Heemelaar, S; Nelissen, E; Mdoe, P; Kidanto, H; van Roosmalen, J; Stekelenburg, J

2016-04-01

WHO uses the Caesarean section (CS) rate to monitor implementation of emergency obstetric care (EmOC). Although CS rates are rising in sub-Saharan Africa, maternal outcome has not improved. We audited indications for CS and related complications among women with severe maternal morbidity and mortality in a referral hospital in rural Tanzania. Cross-sectional study was from November 2009 to November 2011. Women with severe maternal morbidity and mortality were identified and those with CS were included in this audit. Audit criteria were developed based on the literature review and (inter)national guidelines. Tanzanian and Dutch doctors reviewed hospital notes. The main outcome measured was prevalence of substandard quality of care leading to unnecessary CS and delay in performing interventions to prevent CS. A total of 216 maternal near misses and 32 pregnancy-related deaths were identified, of which 82 (33.1%) had a CS. Indication for CS was in accordance with audit criteria for 36 of 82 (44.0%) cases without delay. In 20 of 82 (24.4%) cases, the indication was correct; however, there was significant delay in providing standard obstetric care. In 16 of 82 (19.5%) cases, the indication for CS was not in accordance with audit criteria. During office hours, CS was more often correctly indicated than outside office hours (60.0% vs. 36.0%, P audit. © 2016 John Wiley & Sons Ltd.

Immediate Symptom Relief After a First Session of Massage Therapy or Reiki in Hospitalized Patients: A 5-year Clinical Experience from a Rural Academic Medical Center.

Science.gov (United States)

Vergo, Maxwell T; Pinkson, Briane M; Broglio, Kathleen; Li, Zhongze; Tosteson, Tor D

2018-04-05

There is an increasing demand for and use of alternative and complementary therapies, such as reiki and massage therapy, in hospital-based settings. Most controlled studies and practice-based reports include oncology and surgical patient populations; thus the effect in a more heterogeneous hospitalized patient population is hard to estimate. We examined the immediate symptom relief from a single reiki or massage session in a hospitalized population at a rural academic medical center. Retrospective analysis of prospectively collected data on demographic, clinical, process, and quality of life for hospitalized patients receiving massage therapy or reiki. A 396-bed rural academic and tertiary medical center in the United States. Hospitalized patients requesting or referred to the healing arts team who received either a massage or reiki session and completed both a pre- and post-therapy symptom questionnaire. First session of routine reiki or massage therapy during a hospital stay. Differences between pre- and postsession patient-reported scores in pain, nausea, fatigue, anxiety, depression, and overall well-being using an 11-point Likert scale. Patients reported symptom relief with both reiki and massage therapy. Analysis of the reported data showed reiki improved fatigue (-2.06 vs. -1.55 p massage therapy and did not vary based on age, gender, length of session, and baseline symptoms. Reiki and massage clinically provide similar improvements in pain, nausea, fatigue, anxiety, depression, and overall well-being while reiki improved fatigue and anxiety more than massage therapy in a heterogeneous hospitalized patient population. Controlled trials should be considered to validate the data.

Costs and consequences of a cash transfer for hospital births in a rural district of Uttar Pradesh, India.

Science.gov (United States)

Coffey, Diane

2014-08-01

The Janani Suraksha Yojana, India's "safe motherhood program," is a conditional cash transfer to encourage women to give birth in health facilities. Despite the program's apparent success in increasing facility-based births, quantitative evaluations have not found corresponding improvements in health outcomes. This study analyses original qualitative data collected between January, 2012 and November, 2013 in a rural district in Uttar Pradesh to address the question of why the program has not improved health outcomes. It finds that health service providers are focused on capturing economic rents associated with the program, and provide an extremely poor quality care. Further, the program does not ultimately provide beneficiaries a large net monetary transfer at the time of birth. Based on a detailed accounting of the monetary costs of hospital and home deliveries, this study finds that the value of the transfer to beneficiaries is small due to costs associated with hospital births. Finally, this study also documents important emotional and psychological costs to women of delivering in the hospital. These findings suggest the need for a substantial rethinking of the program, paying careful attention to incentivizing health outcomes. Copyright © 2014 Elsevier Ltd. All rights reserved.

High prescription of antimicrobials in a rural district hospital in India

Directory of Open Access Journals (Sweden)

Alvarez-Uria G

2014-06-01

Full Text Available Background: The World Health Organization (WHO recommends surveillance of antibiotic use as part of the strategy to fight against antimicrobial resistance. However, there is little information about the antibiotic consumption in developing countries, especially in rural areas. Objective: The objective of this study was to describe the antimicrobial consumption in a rural hospital in India Methods: The study was performed in a district hospital situated in Anantapur, Andhra Pradesh. In accordance with WHO recommendations, we used the defined daily dose (DDD methodology to measure the antibiotic use during one year (from 1st August 2011 to 1st August 2012. The antibiotic use was measured using DDDs/100 admissions and DDDs/100 patient-days for inpatients, and DDDs/100 visits for outpatients. Results: During the study period, there were 15,735 admissions and 250,611 outpatient visits. Antibiotics were prescribed for 86% of inpatients and 12.5% of outpatients. Outpatient prescriptions accounted for 2/3 of the overall antibiotic consumption. For inpatients, the total antibiotic use was 222 DDDs/ 100 patient-days, 693 DDDs/ 100 admissions and the mean number of antibiotics prescribed was 1.8. For outpatients, the total antibiotic use was 86 DDDs/ 100 outpatient visits and the mean number of antibiotics prescribed was 1.2. The most common antibiotics prescribed were aminopenicillins and 3rd generation cephalosporins for inpatients, and tetracyclines and quinolones for outpatients. In a sample of patients with diarrhoea or upper respiratory tract infections (URTI, the proportion of patients who received antibiotics was 84% (95% confidence interval [CI], 67-93 and 52% (95% CI, 43-62, respectively. Conclusion: In this rural setting, the use of antimicrobials was extremely high, even in conditions with a predominantly viral aetiology such as diarrhoea or URTI.

Review of final-year medical students' rural attachment at district ...

African Journals Online (AJOL)

2013-11-15

Nov 15, 2013 ... This paper presents the first phase of an ongoing quality ... a rural district hospital can provide unique learning opportunities for students if the ..... Peabody C, Block A, Jain S. Multi-disciplinary service learning: a medico-legal.

Quality-of life of the elderly in urban and rural areas in Serbia.

Science.gov (United States)

Urosević, Jadranka; Odović, Gordana; Rapaić, Dragan; Davidović, Mladen; Trgovcević, Sanja; Milovanović, Verica

2015-11-01

The number of elderly people in the world is growing, in Serbia as well. Serbia is already among the top ten countries with the oldest population, it is the fact. Aging influences the quality of life in different ways. The aim of this study was to assess the health-related quality of life of the elderly in urban and rural areas in Serbia. The study included 100 elderly people aged 65 years and above in urban and rural areas in Serbia. The next questionnaires were used: a socio-demographic questionnaire and a Serbian version of standardized European Euro-QoL questionnaire (EQ-5D-3L), as a basic index for the assessment and description of the quality of life. In the structure of the respondents, according to the achieved social contacts (p = 0.012), the life of those with family members (p = 0.009), and health status (p = 0.000), in relation to the place of residence there was a statistically significant difference. There was a significant difference (p = 0.040), predominantly poor score for anxiety/depression within the rural population. The average value of quality of life in urban and rural areas was not statistically significant (p = 0.720). For those living in rural areas there was a statistically significant positive correlation between anxiety/depression and age, wealth status, marital status, living with family members and achieving social contacts, while a negative correlation was observed between anxiety/depression and education. On the basis of the data of our study, we can say that the presence of anxiety/depression among older people is greater in rural than in urban areas. The results of this study show that the perception of anxiety/depression among older in rural areas is bigger with the age and poverty increasing, the loss of a spouse, life without family members, lack of achievement of social contacts and lower education.

Quality of life of the elderly in urban and rural areas in Serbia

Directory of Open Access Journals (Sweden)

Urošević Jadranka

2015-01-01

Full Text Available Background/Aim. The number of elderly people in the world is growing, in Serbia as well. Serbia is already among the top ten countries with the oldest population, it is the fact. Aging influences the quality of life in different ways. The aim of this study was to assess the health-related quality of life of the elderly in urban and rural areas in Serbia. Methods. The study included 100 elderly people aged 65 years and above in urban and rural areas in Serbia. The next questionnaires were used: a sociodemographic questionnaire and a Serbian version of standardized European Euro-QoL questionnaire (EQ-5D-3L, as a basic index for the assessment and description of the quality of life. Results. In the structure of the respondents, according to the achieved social contacts (p = 0.012, the life of those with family members (p = 0.009, and health status (p = 0.000, in relation to the place of residence there was a statistically significant difference. There was a significant difference (p = 0.040, predominantly poor score for anxiety/depression within the rural population. The average value of quality of life in urban and rural areas was not statistically significant (p = 0.720. For those living in rural areas there was a statistically significant positive correlation between anxiety/depression and age, wealth status, marital status, living with family members and achieving social contacts, while a negative correlation was observed between anxiety/depression and education. Conclusion. On the basis of the data of our study, we can say that the presence of anxiety/depression among older people is greater in rural than in urban areas. The results of this study show that the perception of anxiety/depression among older in rural areas is bigger with the age and poverty increasing, the loss of a spouse, life without family members, lack of achievement of social contacts and lower education.

Quality Management Systems Implementation Compared With Organizational Maturity in Hospital.

Science.gov (United States)

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

2015-07-27

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

Quality of life in patients with sickle cell disease in Jamaica: rural-urban differences.

Science.gov (United States)

Asnani, Monika R; Reid, Marvin E; Ali, Susanna B; Lipps, Garth; Williams-Green, Pauline

2008-01-01

Quality of life (QOL) refers to people's ability to function in the ordinary tasks of living. It moves beyond direct manifestations of illness to the patient's personal morbidity. These assessments are an important aspect of chronic disease management. Sickle cell disease (SCD) is a chronic and potentially, quite a debilitating disease. The disease is severe and may result in significant morbidity, as well as a shortened life span. It is the most common genetic disorder seen in Jamaica and impacts on physical, psychological, social and occupational wellbeing. Jamaica is a developing country where support systems that exist for patients with SCD are sparse. Health related QOL has been shown to be poorer in people living in the rural areas as compared with urban populations. Utilization of comprehensive sickle cells disease services has also been shown to be lower for individuals with the disease living in rural areas than for those living in urban areas. As there are rural-urban differences in Jamaica's health services, it is hypothesized that there may be rural-urban differences in the experiences of the disease and the QOL of these patients in these subgroups. The SF 36 v2 (Short Form 36) questionnaire has been validated for use in the Jamaican SCD population. This validated questionnaire was interviewer-administered to 166 patients presenting to an urban clinic for routine health maintenance visits and to 90 patients presenting to the rural clinics for routine visits. Socio-demographic information was also collected on these two groups. Multiple linear regression analyses were performed to study predictors of QOL in these two sub-populations. The study received ethical approval from the University of the West Indies/University Hospital of the West Indies Ethics Committee. There were no significant differences in the measured socio-demographic characteristics of the rural and urban patients. Living in rural areas compared with urban areas (p <0.001), being

Service quality of private hospitals: the Iranian patients' perspective.

Science.gov (United States)

Zarei, Asghar; Arab, Mohammad; Froushani, Abbas Rahimi; Rashidian, Arash; Ghazi Tabatabaei, S Mahmoud

2012-02-02

Highly competitive market in the private hospital industry has caused increasing pressure on them to provide services with higher quality. The aim of this study was to determine the different dimensions of the service quality in the private hospitals of Iran and evaluating the service quality from the patients' perspective. A cross-sectional study was conducted between October and November 2010 in Tehran, Iran. The study sample was composed of 983 patients randomly selected from 8 private general hospitals. The study questionnaire was the SERVQUAL questionnaire, consisting of 21 items in service quality dimensions. The result of factor analysis revealed 3 factors, explaining 69% of the total variance. The total mean score of patients' expectation and perception was 4.91(SD = 0.2) and 4.02(SD = 0.6), respectively. The highest expectation and perception related to the tangibles dimension and the lowest expectation and perception related to the empathy dimension. The differences between perception and expectation were significant (p SERVQUAL is a valid, reliable, and flexible instrument to monitor and measure the quality of the services in private hospitals of Iran. Our findings clarified the importance of creating a strong relationship between patients and the hospital practitioners/personnel and the need for hospital staff to be responsive, credible, and empathetic when dealing with patients.

A 37-year-old man trying to choose a high-quality hospital: review of hospital quality indicators.

Science.gov (United States)

Howell, Michael D

2009-12-02

Mr A, a previously healthy 37-year-old man, was diagnosed as having Prinzmetal angina and a hypercoagulable state 3 years ago after an ST-elevation myocardial infarction. Now, his cardiologist is moving and Mr A must select a new physician and health system. Geographic relocation, insurance changes, and other events force millions in the United States to change physicians and hospitals every year. Mr A should begin by choosing a primary care physician, since continuity and coordination of care improves outcomes. Evidence for evaluating specific physicians is less robust, though a variety of sources are available. A broad range of detailed quality information, such as Medicare's Hospital Compare (http://www.hospitalcompare.hhs.gov/), is available for selecting a hospital. However, the relationship of these metrics to patient outcomes is variable, and different Web sites provide meaningfully different rankings and data interpretations. For Mr A in particular, a warfarin management team, the hospital's location, and a cardiologist with whom he feels comfortable and who can communicate with his primary care physician are important factors. Nevertheless, hospital quality information and metrics are an important component of the strategy Mr A should take to solve this challenging problem.

Antibiotics in Wastewater of a Rural and an Urban Hospital before and after Wastewater Treatment, and the Relationship with Antibiotic Use—A One Year Study from Vietnam

Directory of Open Access Journals (Sweden)

La Thi Quynh Lien

2016-06-01

Full Text Available Hospital effluents represent an important source for the release of antibiotics and antibiotic resistant bacteria into the environment. This study aims to determine concentrations of various antibiotics in wastewater before and after wastewater treatment in a rural hospital (60 km from the center of Hanoi and in an urban hospital (in the center of Hanoi in Vietnam, and it aims to explore the relationship between antibiotic concentrations in wastewater before wastewater treatment and quantities of antibiotics used in the rural hospital, over a period of one year in 2013. Water samples were collected using continuous sampling for 24 h in the last week of every month. The data on quantities of antibiotics delivered to all inpatient wards were collected from the Pharmacy department in the rural hospital. Solid-phase extraction and high performance liquid chromatography-tandem mass spectrometry were used for chemical analysis. Significant concentrations of antibiotics were present in the wastewater both before and after wastewater treatment of both the rural and the urban hospital. Ciprofloxacin was detected at the highest concentrations in the rural hospital’s wastewater (before treatment: mean = 42.8 µg/L; after treatment: mean = 21.5 µg/L. Metronidazole was detected at the highest concentrations in the urban hospital’s wastewater (before treatment: mean = 36.5 µg/L; after treatment: mean = 14.8 µg/L. A significant correlation between antibiotic concentrations in wastewater before treatment and quantities of antibiotics used in the rural hospital was found for ciprofloxacin (r = 0.78; p = 0.01 and metronidazole (r = 0.99; p < 0.001.

Antibiotics in Wastewater of a Rural and an Urban Hospital before and after Wastewater Treatment, and the Relationship with Antibiotic Use—A One Year Study from Vietnam

Science.gov (United States)

Lien, La Thi Quynh; Hoa, Nguyen Quynh; Chuc, Nguyen Thi Kim; Thoa, Nguyen Thi Minh; Phuc, Ho Dang; Diwan, Vishal; Dat, Nguyen Thanh; Tamhankar, Ashok J.; Lundborg, Cecilia Stålsby

2016-01-01

Hospital effluents represent an important source for the release of antibiotics and antibiotic resistant bacteria into the environment. This study aims to determine concentrations of various antibiotics in wastewater before and after wastewater treatment in a rural hospital (60 km from the center of Hanoi) and in an urban hospital (in the center of Hanoi) in Vietnam, and it aims to explore the relationship between antibiotic concentrations in wastewater before wastewater treatment and quantities of antibiotics used in the rural hospital, over a period of one year in 2013. Water samples were collected using continuous sampling for 24 h in the last week of every month. The data on quantities of antibiotics delivered to all inpatient wards were collected from the Pharmacy department in the rural hospital. Solid-phase extraction and high performance liquid chromatography-tandem mass spectrometry were used for chemical analysis. Significant concentrations of antibiotics were present in the wastewater both before and after wastewater treatment of both the rural and the urban hospital. Ciprofloxacin was detected at the highest concentrations in the rural hospital’s wastewater (before treatment: mean = 42.8 µg/L; after treatment: mean = 21.5 µg/L). Metronidazole was detected at the highest concentrations in the urban hospital’s wastewater (before treatment: mean = 36.5 µg/L; after treatment: mean = 14.8 µg/L). A significant correlation between antibiotic concentrations in wastewater before treatment and quantities of antibiotics used in the rural hospital was found for ciprofloxacin (r = 0.78; p = 0.01) and metronidazole (r = 0.99; p < 0.001). PMID:27314366

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

Science.gov (United States)

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

2015-07-06

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

Hospital heterogeneity: what drives the quality of health care.

Science.gov (United States)

Ali, Manhal; Salehnejad, Reza; Mansur, Mohaimen

2018-04-01

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

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

Science.gov (United States)

2015-08-17

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

Trauma on rural roads: the role of a peripheral hospital.

LENUS (Irish Health Repository)

Street, J T

2012-02-03

Road accident trauma is a leading cause of death and serious morbidity among healthy young adults in the developed world. The Irish Republic has the third worst road safety record in the EU. In studying the unique demographics of rural road accidents, our aim was to provide information essential to the future development of trauma care in Ireland. Our figures highlight the inadequacies of data received by the National Roads Authority, illustrate the resource impact of road trauma on a peripheral hospital, and demonstrate the need for similar studies in the rationalisation of trauma care as we approach the next millennium.

Caesarean section audit to improve quality of care in a rural referral hospital in Tanzania.

Science.gov (United States)

Dekker, Luuk; Houtzager, Tessa; Kilume, Omary; Horogo, John; van Roosmalen, Jos; Nyamtema, Angelo Sadock

2018-05-15

Caesarean section (CS) is often a life-saving procedure, but can also lead to serious complications, even more so in low-resource settings. Therefore unnecessary CS should be avoided and optimal circumstances for vaginal delivery should be created. In this study, we aim to audit indications for Caesarean sections and improve decision-making and obstetric management. Audit of all cases of CS performed from January to August 2013 was performed in a rural referral hospital in Tanzania. The study period was divided in three audit blocks; retrospective (before auditing), prospective 1 and prospective 2. A local audit panel (LP) and an external auditor (EA) judged if obstetric management was adequate and indications were appropriate or if CS could have been prevented and yet retain good pregnancy outcome. Furthermore, changes in modes of deliveries, overall pregnancy outcome and decision-to-delivery interval were monitored. During the study period there were 1868 deliveries. Of these, 403 (21.6%) were Caesarean sections. The proportions of unjustified CS prior to introduction of audit were as high as 34 and 75%, according to the respective judgments of LP and EA. Following introduction of audit, the proportions of unjustified CS decreased to 23% (p = 0.29) and 52% (p = 0.01) according to LP and EA respectively. However, CS rate did not change (20.2 to 21.7%), assisted vacuum delivery rate did not increase (3.9 to 1.8%) and median decision-to-delivery interval was 83 min (range 10 - 390 min). Although this is a single center study, these findings suggest that unnecessary Caesarean sections exist at an alarming rate even in referral hospitals and suggest that a vast number can be averted by introducing a focused CS audit system. Our findings indicate that CS audit is a useful tool and, if well implemented, can enhance rational use of resources, improve decision-making and harmonise practice among care providers.

AN INVESTIGATION OF VISION PROBLEMS AND THE VISION CARE SYSTEM IN RURAL CHINA.

Science.gov (United States)

Bai, Yunli; Yi, Hongmei; Zhang, Linxiu; Shi, Yaojiang; Ma, Xiaochen; Congdon, Nathan; Zhou, Zhongqiang; Boswell, Matthew; Rozelle, Scott

2014-11-01

This paper examines the prevalence of vision problems and the accessibility to and quality of vision care in rural China. We obtained data from 4 sources: 1) the National Rural Vision Care Survey; 2) the Private Optometrists Survey; 3) the County Hospital Eye Care Survey; and 4) the Rural School Vision Care Survey. The data from each of the surveys were collected by the authors during 2012. Thirty-three percent of the rural population surveyed self-reported vision problems. Twenty-two percent of subjects surveyed had ever had a vision exam. Among those who self-reported having vision problems, 34% did not wear eyeglasses. Fifty-four percent of those with vision problems who had eyeglasses did not have a vision exam prior to receiving glasses. However, having a vision exam did not always guarantee access to quality vision care. Four channels of vision care service were assessed. The school vision examination program did not increase the usage rate of eyeglasses. Each county-hospital was staffed with three eye-doctors having one year of education beyond high school, serving more than 400,000 residents. Private optometrists often had low levels of education and professional certification. In conclusion, our findings shows that the vision care system in rural China is inadequate and ineffective in meeting the needs of the rural population sampled.

The Effect of Infrastructure Access and Quality on Non-farm Employment and Income in Rural Indonesia

OpenAIRE

Olivia, Susan; Gibson, John

2008-01-01

There is growing interest in the rural non-farm sector in developing countries as a contributor to economic growth, employment generation, livelihood diversification and poverty reduction. Access to infrastructure is identified in some studies as a factor that affects non-farm rural employment and income but less attention has been paid to the constraints imposed by poor quality infrastructure. In this paper we use data from 4000 households in rural Indonesia to show that the quality of two k...

Children in the hospital: elements of quality in drawings.

Science.gov (United States)

Pelander, Tiina; Lehtonen, Kimmo; Leino-Kilpi, Helena

2007-08-01

Not much is known about how children perceive the quality of care that they receive in hospitals. This study set out to describe elements of quality in children's drawings of an ideal hospital. Thirty-five drawings were collected from children aged between 4 and 11 years during their stay in a university hospital in Finland. They were coded using the method of content analysis. The two main categories extracted from the analysis were the environment and the people of their ideal hospital. The emphasis was on the environment; patients, parents, and nurses appeared less frequently in the drawings. The findings showed that children are capable of offering valuable insights into the elements of quality through the medium of drawing.

Hospital competition, resource allocation and quality of care

Directory of Open Access Journals (Sweden)

Zwanziger Jack

2002-05-01

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

Willingness to pay for municipality hospital services in rural Japan: a contingent valuation study

Directory of Open Access Journals (Sweden)

Nakamura Toshihito

2011-06-01

Full Text Available Abstract Background The Japanese healthcare system has undergone reforms to address the struggles that municipality hospitals face. Reform guidelines clearly define criteria for administrative improvement. However, criteria to evaluate the demand for healthcare provisions in rural Japan, including the needs of rural residents for municipality hospitals in particular have not been specified. The purpose of this paper is to measure residents' willingness to pay (WTP for municipality hospital services using the contingent valuation method, and to evaluate municipality hospital valuation on the basis of WTP. K town, located in the Hokkaido prefecture of Japan, was selected as the location for this study. Participants were recruited by a town hall healthcare administrator, hospital and clinic staff, and a local dentist. Participants were asked what amount they would be willing to pay as taxes to continue accessing the services of the municipality hospital for one year by using open-ended questions in face-to-face interviews. Findings Forty-eight residents were initially recruited, and 40 participants were selected for the study (response rate 83%. As compared to K town's population, this data slanted toward the elderly, although there was no significant difference in frequency among the characteristics. The median WTP was estimated at 39,484 yen ($438.71, with a 95% confidence interval 27,806-55,437 yen ($308.95-615.96. Logistic regression revealed no significant factors affecting WTP. Conclusions If the total amount of residents' WTP for the municipality hospital were to be estimated by this result, it would calculate with 129,586,000 yen ($1,439,844. This is approximately equal to the amount of money to be transferred from the general account of the government of K town, more than one-half of the town tax of K town, and about two-fold in comparison to Japan as a whole. This showed that K town's residents placed a high valuation on the municipality

Achieving timely percutaneous reperfusion for rural ST-elevation myocardial infarction patients by direct transport to an urban PCI-hospital.

Science.gov (United States)

Bennin, Charles-Lwanga K; Ibrahim, Saif; Al-Saffar, Farah; Box, Lyndon C; Strom, Joel A

2016-10-01

ST-elevation myocardial infarction (STEMI) guidelines recommend reperfusion by primary percutaneous coronary intervention (PCI) ≤ 90 min from time of first medical contact (FMC). This strategy is challenging in rural areas lacking a nearby PCI-capable hospital. Recommended reperfusion times can be achieved for STEMI patients presenting in rural areas without a nearby PCI-capable hospital by ground transportation to a central PCI-capable hospital by use of protocol-driven emergency medical service (EMS) STEMI field triage protocol. Sixty STEMI patients directly transported by EMS from three rural counties (Nassau, Camden and Charlton Counties) within a 50-mile radius of University of Florida Health-Jacksonville (UFHJ) from 01/01/2009 to 12/31/2013 were identified from its PCI registry. The STEMI field triage protocol incorporated three elements: (1) a cooperative agreement between each of the rural emergency medical service (EMS) agency and UFHJ; (2) performance of a pre-hospital ECG to facilitate STEMI identification and laboratory activation; and (3) direct transfer by ground transportation to the UFHJ cardiac catheterization laboratory. FMC-to-device (FMC2D), door-to-device (D2D), and transit times, the day of week, time of day, and EMS shift times were recorded, and odds ratio (OR) of achieving FMC2D times was calculated. FMC2D times were shorter for in-state STEMIs (81 ± 17 vs . 87 ± 19 min), but D2D times were similar (37 ± 18 vs . 39 ± 21 min). FMC2D ≤ 90 min were achieved in 82.7% in-state STEMIs compared to 52.2% for out-of-state STEMIs (OR = 4.4, 95% CI: 1.24-15.57; P = 0.018). FMC2D times were homogenous after adjusting for weekday vs . weekend, EMS shift times. Nine patients did not meet FMC2D ≤ 90 min. Six were within 10 min of target; all patient achieved FMC2D ≤ 120 min. Guideline-compliant FMC2D ≤ 90 min is achievable for rural STEMI patients within a 50 mile radius of a PCI-capable hospital by use of protocol-driven EMS ground

An integrated approach to hospital strategic planning, quality assurance, and continuous quality improvement.

Science.gov (United States)

Day, G; Gardner, S; Herba, C

1995-01-01

Like many other healthcare organizations today, the authors' facility, a 306-bed acute care community hospital in Michigan, strives to visualize and make a transition from traditional quality assurance to continuous quality improvement. The Juran Trilogy provided the insight that strategic planning, measurement, and continuous improvement must exist side by side. At the authors' facility, this realization resulted in the hospital quality plan, which treats each of these components as part of the foundation for quality. The authors explain this model and the reporting and communication mechanisms that support it.

Identifying key hospital service quality factors in online health communities.

Science.gov (United States)

Jung, Yuchul; Hur, Cinyoung; Jung, Dain; Kim, Minki

2015-04-07

The volume of health-related user-created content, especially hospital-related questions and answers in online health communities, has rapidly increased. Patients and caregivers participate in online community activities to share their experiences, exchange information, and ask about recommended or discredited hospitals. However, there is little research on how to identify hospital service quality automatically from the online communities. In the past, in-depth analysis of hospitals has used random sampling surveys. However, such surveys are becoming impractical owing to the rapidly increasing volume of online data and the diverse analysis requirements of related stakeholders. As a solution for utilizing large-scale health-related information, we propose a novel approach to identify hospital service quality factors and overtime trends automatically from online health communities, especially hospital-related questions and answers. We defined social media-based key quality factors for hospitals. In addition, we developed text mining techniques to detect such factors that frequently occur in online health communities. After detecting these factors that represent qualitative aspects of hospitals, we applied a sentiment analysis to recognize the types of recommendations in messages posted within online health communities. Korea's two biggest online portals were used to test the effectiveness of detection of social media-based key quality factors for hospitals. To evaluate the proposed text mining techniques, we performed manual evaluations on the extraction and classification results, such as hospital name, service quality factors, and recommendation types using a random sample of messages (ie, 5.44% (9450/173,748) of the total messages). Service quality factor detection and hospital name extraction achieved average F1 scores of 91% and 78%, respectively. In terms of recommendation classification, performance (ie, precision) is 78% on average. Extraction and

Hospital Medicine and Fellowship Program in Rural North Dakota - A Multifaceted Success Story.

Science.gov (United States)

Hyder, S S; Amundson, Mary

2017-11-01

Recruitment of hospitalists and primary care physicians for Critical Access Hospitals and tertiary care hospitals in North Dakota is difficult. To address this challenge, 2 programs were implemented in Bismarck, North Dakota. St. Alexius Medical Center created a hospitalist fellowship training program in collaboration with the University of North Dakota School of Medicine and Health Sciences and physicians willing to work in Critical Access Hospitals were offered a joint appointment to teach hospitalist fellows and obtain a clinical academic appointment at the university. Since it was created in 2012, 84 physicians have applied for 13 fellowships. Of the 11 fellows who have completed the program, 64% (7/11) remained in North Dakota to practice. Physicians are more likely to work in a rural Critical Access Hospital if they spend time working at a tertiary care center and have clinical academic appointments. Where recruitment is challenging, hospitalist fellowship programs are helpful in meeting the health care workforce demand.

Rural-urban disparity in oral health-related quality of life.

Science.gov (United States)

Gaber, Amal; Galarneau, Chantal; Feine, Jocelyne S; Emami, Elham

2018-04-01

The objective of this population-based cross-sectional study was to estimate rural-urban disparity in the oral health-related quality of life (OHRQoL) of the Quebec adult population. A 2-stage sampling design was used to collect data from the 1788 parents/caregivers of schoolchildren living in the 8 regions of the province of Quebec in Canada. Andersen's behavioural model for health services utilization was used as a conceptual framework. Place of residency was defined according to the Statistics Canada Census Metropolitan Area and Census Agglomeration Influenced Zone classification. The outcome of interest was OHRQoL measured using the Oral Health Impact Profile (OHIP)-14 validated questionnaire. Data weighting was applied, and the prevalence, extent and severity of negative oral health impacts were calculated. Statistical analyses included descriptive statistics, bivariate analyses and binary logistic regression. The prevalence of poor oral health-related quality life (OHRQoL) was statistically higher in rural areas than in urban zones (P = .02). Rural residents reported a significantly higher prevalence of negative daily-life impacts in pain, psychological discomfort and social disability OHIP domains (P < .05). Additionally, the rural population showed a greater number of negative oral health impacts (P = .03). There was no significant rural-urban difference in the severity of poor oral health. Logistic regression indicated that the prevalence of poor OHRQoL was significantly related to place of residency (OR = 1.6; 95% CI = 1.1-2.5; P = .022), perceived oral health (OR = 9.4; 95% CI = 5.7-15.5; P < .001), dental treatment needs factors (perceived need for dental treatment, pain, dental care seeking) (OR = 8.7; 95% CI = 4.8-15.6; P < .001) and education (OR = 2.7; 95% CI = 1.8-3.9; P < .001). The results of this study suggest a potential difference in OHRQoL of Quebec rural and urban populations, and a need to develop strategies to promote oral health outcomes

QUALITY ASSURANCE IN THE HOSPITALITY INDUSTRY: QUALITATIVE ASSESMENT OF NIGERIA

Directory of Open Access Journals (Sweden)

OFOBRUKU SYLVESTER ABOMEH

2013-06-01

Full Text Available Hospitality is currently the fasted growing economic activity in Abuja-Nigeria. It has also been instrumental in creating jobs and has significant impact on other sectors of economic growth. Based on the above factors much attention need to be placed on the quality of the hospitality industry in Abuja-Nigeria in other to systematic compete with other destinations. Quality assurance is becoming an increasing integral component of the service industry. However, despite some indication that quality assurances are receiving attention in the hospitality industry, its adoption continues to be very slow. This paper examine the usefulness of quality assurance in hospitality operations and how to encourage it’s observances in the industry.

Measuring patient-perceived hospital service quality: a conceptual framework.

Science.gov (United States)

Pai, Yogesh P; Chary, Satyanarayana T

2016-04-18

Purpose - Although measuring healthcare service quality is not a new phenomenon, the instruments used to measure are timeworn. With the shift in focus to patient centric processes in hospitals and recognizing healthcare to be different compared to other services, service quality measurement needs to be tuned specifically to healthcare. The purpose of this paper is to design a conceptual framework for measuring patient perceived hospital service quality (HSQ), based on existing service quality literature. Design/methodology/approach - Using HSQ theories, expanding existing healthcare service models and literature, a conceptual framework is proposed to measure HSQ. The paper outlines patient perceived service quality dimensions. Findings - An instrument for measuring HSQ dimensions is developed and compared with other service quality measuring instruments. The latest dimensions are in line with previous studies, but a relationship dimension is added. Practical implications - The framework empowers managers to assess healthcare quality in corporate, public and teaching hospitals. Originality/value - The paper helps academics and practitioners to assess HSQ from a patient perspective.

Patient satisfaction and quality of surgical care in US hospitals.

Science.gov (United States)

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

2015-01-01

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

Duration and setting of rural immersion during the medical degree relates to rural work outcomes.

Science.gov (United States)

O'Sullivan, Belinda; McGrail, Matthew; Russell, Deborah; Walker, Judi; Chambers, Helen; Major, Laura; Langham, Robyn

2018-04-19

Providing year-long rural immersion as part of the medical degree is commonly used to increase the number of doctors with an interest in rural practice. However, the optimal duration and setting of immersion has not been fully established. This paper explores associations between various durations and settings of rural immersion during the medical degree and whether doctors work in rural areas after graduation. Eligible participants were medical graduates of Monash University between 2008 and 2016 in postgraduate years 1-9, whose characteristics, rural immersion information and work location had been prospectively collected. Separate multiple logistic regression and multinomial logit regression models tested associations between the duration and setting of any rural immersion they did during the medical degree and (i) working in a rural area and (ii) working in large or smaller rural towns, in 2017. The adjusted odds of working in a rural area were significantly increased if students were immersed for one full year (odds ratio [OR], 1.79; 95% confidence interval [CI], 1.15-2.79), for between 1 and 2 years (OR, 2.26; 95% CI, 1.54-3.32) and for 2 or more years (OR, 4.43; 95% CI, 3.03-6.47) relative to no rural immersion. The strongest association was for immersion in a mix of both regional hospitals and rural general practice (OR, 3.26; 95% CI, 2.31-4.61), followed by immersion in regional hospitals only (OR, 1.94; 95% CI, 1.39-2.70) and rural general practice only (OR, 1.91; 95% CI, 1.06-3.45). More than 1 year's immersion in a mix of regional hospitals and rural general practices was associated with working in smaller regional or rural towns (immersion programmes. Longer rural immersion and immersion in both regional hospitals and rural general practices are likely to increase rural work and rural distribution of early career doctors. © 2018 John Wiley & Sons Ltd and The Association for the Study of Medical Education.

The Effect of Hospital Service Quality on Patient's Trust.

Science.gov (United States)

Zarei, Ehsan; Daneshkohan, Abbas; Khabiri, Roghayeh; Arab, Mohammad

2015-01-01

The trust is meant the belief of the patient to the practitioner or the hospital based on the concept that the care provider seeks the best for the patient and will provide the suitable care and treatment for him/her. One of the main determinants of patient's trust is the service quality. This study aimed to examine the effect of quality of services provided in private hospitals on the patient's trust. In this descriptive cross-sectional study, 969 patients were selected using the consecutive method from eight private general hospitals of Tehran, Iran, in 2010. Data were collected through a questionnaire containing 20 items (14 items for quality, 6 items for trust) and its validity and reliability were confirmed. Data were analyzed using descriptive statistics and multivariate regression. The mean score of patients' perception of trust was 3.80 and 4.01 for service quality. Approximately 38% of the variance in patient trust was explained by service quality dimensions. Quality of interaction and process (P quality of the environment had no significant effect on the patients' degree of trust. The interaction quality and process quality were the key determinants of patient's trust in the private hospitals of Tehran. To enhance the patients' trust, quality improvement efforts should focus on service delivery aspects such as scheduling, timely and accurate doing of the service, and strengthening the interpersonal aspects of care and communication skills of doctors, nurses and staff.

Guidelines for radriopharmaceutical quality control in hospitals

International Nuclear Information System (INIS)

Welsh, W.J.

1982-01-01

This document has been prepared to assist hospital administrators in ensuring that adequate quality control is performed on radiopharmaceuticals administered to their patients. Three sets of guidelines are presented, the degree of sophistication being dependent on the amount of hospital involvement in the radiopharmaceutical preparation

Connecting College Learners with Rural Entrepreneurship Opportunities: The Rural Entrepreneurship Teaching Unit

Science.gov (United States)

Frazier, Barbara J.; Niehm, Linda S.; Stoel, Leslie

2012-01-01

The Rural Entrepreneurship Teaching Unit (RETU) is designed to acquaint university retailing and hospitality majors with rural entrepreneurship opportunities. The unit is an outcome of a federal grant focused on the contribution of the local retail sector to rural community resilience. The RETU integrates knowledge regarding rural development,…

Implementing hospital quality assurance policies in Iran: balancing licensing, annual evaluation, inspections and quality management systems.

Science.gov (United States)

Aghaei Hashjin, Asgar; Delgoshaei, Bahram; Kringos, Dionne S; Tabibi, Seyed Jamaladin; Manouchehri, Jila; Klazinga, Niek S

2015-01-01

The purpose of this paper is to provide an overview of applied hospital quality assurance (QA) policies in Iran. A mixed method (quantitative data and qualitative document analysis) study was carried out between 1996 and 2010. The QA policy cycle forms a tight monitoring system to assure hospital quality by combining mandatory and voluntary methods in Iran. The licensing, annual evaluation and grading, and regulatory inspections statutorily implemented by the government as a national package to assure and improve hospital care quality, while implementing quality management systems (QMS) was voluntary for hospitals. The government's strong QA policy legislation role and support has been an important factor for successful QA implementation in Iran, though it may affected QA assessment independency and validity. Increased hospital evaluation independency and repositioning, updating standards, professional involvement and effectiveness studies could increase QA policy impact and maturity. The study highlights the current QA policy implementation cycle in Iranian hospitals. It provides a basis for further quality strategy development in Iranian hospitals and elsewhere. It also raises attention about finding the optimal balance between different QA policies, which is topical for many countries. This paper describes experiences when implementing a unique approach, combining mandatory and voluntary QA policies simultaneously in a developing country, which has invested considerably over time to improve hospital quality. The experiences with a mixed obligatory/voluntary approach and comprehensive policies in Iran may contain lessons for policy makers in developing and developed countries.

Baldrige Award cites two hospitals. Baptist, Saint Luke's hospitals honored for quality, performance.

Science.gov (United States)

Rees, Tom

2004-01-01

Baptist Hospital Inc., Pensacola, Fla.; and Saint Luke's Hospital, Kansas City, Mo., have received the prestigious Malcolm Baldrige National Quality Award in the category of healthcare. Named for a former secretary of commerce, the award recognizes efficiency, effectiveness and excellence. The two hospitals are among only seven companies in the U.S. to be so recognized this year.

Information Architecture for Quality Management Support in Hospitals.

Science.gov (United States)

Rocha, Álvaro; Freixo, Jorge

2015-10-01

Quality Management occupies a strategic role in organizations, and the adoption of computer tools within an aligned information architecture facilitates the challenge of making more with less, promoting the development of a competitive edge and sustainability. A formal Information Architecture (IA) lends organizations an enhanced knowledge but, above all, favours management. This simplifies the reinvention of processes, the reformulation of procedures, bridging and the cooperation amongst the multiple actors of an organization. In the present investigation work we planned the IA for the Quality Management System (QMS) of a Hospital, which allowed us to develop and implement the QUALITUS (QUALITUS, name of the computer application developed to support Quality Management in a Hospital Unit) computer application. This solution translated itself in significant gains for the Hospital Unit under study, accelerating the quality management process and reducing the tasks, the number of documents, the information to be filled in and information errors, amongst others.

Haemodialysis in a rural area: a demanding form of treatment.

Science.gov (United States)

Brammah, A; Young, G; Allan, A; Robertson, S; Norrie, J; Isles, C

2001-09-01

To determine distances travelled and time spent waiting for transport among hospital haemodialysis patients living in a rural area. Cross sectional survey comparing the subregional dialysis unit in south west Scotland with 12 of the other 13 Scottish Adult Renal Units. Forty three Dumfries and Galloway patients and 935 other Scottish patients receiving hospital haemodialysis in November 1999. At the time of the survey 8/43 (19%) Dumfries patients travelled in excess of 100 miles per dialysis day (15,000 miles per year) solely for the purpose of dialysis, compared to 20/935 (2%) elsewhere in Scotland (p Scottish Units relied on hospital car, Patient Transport Service bus or ambulance for the journey home after treatment. Dumfries patients who travelled by Patient Transport Service or hospital ambulance had to wait twice as long before they left the renal unit as patients using a dedicated hospital car or private car. Haemodialysis in a rural area has every reason to be considered a demanding form of treatment. Greater promotion of home based treatment would improve the quality of life for many of these patients, while dedicated hospital cars would reduce 'car to needle time' for those who remain on hospital haemodialysis.

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

Science.gov (United States)

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

2014-10-11

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

Patient Satisfaction at America’s Lowest Performing Hospitals

Science.gov (United States)

Girotra, Saket; Cram, Peter; Popescu, Ioana

2012-01-01

BACKGROUND Previous studies have identified hospitals with poor performance on cardiac process measures. How these hospitals fare in other domains such as patient satisfaction remains unknown. METHODS We used Hospital Compare data to identify hospitals that reported acute myocardial infarction (AMI) and heart failure (HF) process measures for 2006–2008 and calculated respective composite performance scores. Using these scores, we classified hospitals as low-performing (bottom decile for all three years), top-performing (top decile for all three years), and intermediate (all others). We used Hospital Consumer Assessment of Healthcare Providers and Systems 2008 data to compare overall satisfaction between low, intermediate, and top-performing hospitals. RESULTS Low-performing hospitals had fewer beds, fewer nurses per-patient, and were more likely rural, safety-net hospitals located in the South, compared to intermediate and top-performing hospitals (Ppatient satisfaction (kappa statisticpatient satisfaction on average suggesting that these hospitals have overall poor quality of care. However, there is discordance between the two measures in profiling hospital quality. PMID:22496113

Service quality of hospital outpatient departments: patients' perspective.

Science.gov (United States)

Zarei, Ehsan

2015-01-01

Assessment of patient perceptions of health service quality as an important element in quality assessments has attracted much attention in recent years. The purpose of this paper is to assess the service quality of hospital outpatient departments affiliated to Shahid Beheshti University of Medical Sciences from the patients' perspective. This cross-sectional study was conducted in 2014 in Tehran, Iran. The study samples included 500 patients who were selected by multi-stage random sampling from four hospitals. The data collection instrument was a questionnaire consisting of 50 items, and the validity and reliability of the questionnaire were confirmed. For data analysis, exploratory and confirmatory factor analysis, Friedman test, and descriptive statistics were used through LISREL 8.54 and SPSS 18 applications. Eight significant factors were extracted for outpatient service quality, which explained about 67 per cent of the total variance. Physician consultation, information provided to the patient, and the physical environment of the clinic were the three determining factors of the quality of outpatient services. The highest and lowest perceptions were related to physician consultation and perceived waiting time dimension, respectively. The mean score of patients' perception of outpatient service quality was 3.89 (±0.60). About 59.5 per cent of patients assessed the quality of outpatient services as good, 38.2 per cent as moderate, and 2.3 per cent as poor. Practical implications - The instrument developed for this study is valid and reliable, and it can help hospital managers to identify the areas needing improvement and correction. According to the findings of this study, the majority of patients had a positive experience with outpatient departments of teaching hospitals, and the services provided in these centres were of adequate quality, based on patient assessments.

Return-on-Investment (ROI) Analyses of an Inpatient Lay Health Worker Model on 30-Day Readmission Rates in a Rural Community Hospital.

Science.gov (United States)

Cardarelli, Roberto; Bausch, Gregory; Murdock, Joan; Chyatte, Michelle Renee

2017-07-07

The purpose of the study was to assess the return-on-investment (ROI) of an inpatient lay health worker (LHW) model in a rural Appalachian community hospital impacting 30-day readmission rates. The Bridges to Home (BTH) study completed an evaluation in 2015 of an inpatient LHW model in a rural Kentucky hospital that demonstrated a reduction in 30-day readmission rates by 47.7% compared to a baseline period. Using the hospital's utilization and financial data, a validated ROI calculator specific to care transition programs was used to assess the ROI of the BTH model comparing 3 types of payment models including Diagnosis Related Group (DRG)-only payments, pay-for-performance (P4P) contracts, and accountable care organizations (ACOs). The BTH program had a -$0.67 ROI if the hospital had only a DRG-based payment model. If the hospital had P4P contracts with payers and 0.1% of its annual operating revenue was at risk, the ROI increased to $7.03 for every $1 spent on the BTH program. However, if the hospital was an ACO as was the case for this study's community hospital, the ROI significantly increased to $38.48 for every $1 spent on the BTH program. The BTH model showed a viable ROI to be considered by community hospitals that are part of an ACO or P4P program. A LHW care transition model may be a cost-effective alternative for impacting excess 30-day readmissions and avoiding associated penalties for hospital systems with a value-based payment model. © 2017 National Rural Health Association.

Study of Water Quality in Rural Regions of Northeastern Iran

OpenAIRE

Saeid Nazemi; Jaber Yeganeh; Shima Mohammad Khani

2016-01-01

Background: Providing Safe drinking water is a prime concerninany community. This analytical study was carried out to evaluate the microbial quality of drinking water in rural areas of northeastern Iran. Methods: The water microbial quality was determined in all villages (a population of 53047 people), in 3 rounds and based on 3 measurements, i.e. Total Coliform, Fecal Coliform, and Heterotrophic Plate Count. Census method was used for studying water distribution system too. Results: Re...

Rural older people had lower mortality after accidental falls than non-rural older people

Directory of Open Access Journals (Sweden)

Huang JW

2017-01-01

Full Text Available Jen-Wu Huang,1,2 Yi-Ying Lin,2,3 Nai-Yuan Wu,4 Yu-Chun Chen5–7 1Department of Surgery, National Yang-Ming University Hospital, National Yang-Ming University, Yilan, Taiwan; 2Institute of Emergency and Critical Care Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 3Department of Pediatrics, Heping Fuyou Branch, Taipei City Hospital, Taipei, Taiwan; 4Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan; 5Department of Medical Research and Education, National Yang-Ming University Hospital, Yilan, Taiwan; 6Faculty of Medicine and School of Medicine, National Yang-Ming University, Taipei, Taiwan; 7Institute of Hospital and Health Care Administration, School of Medicine, National Yang-Ming University, Taipei, Taiwan Objective: This study aimed to investigate the mortality rate after falls of rural and non-rural older people and to explore the risk factors of mortality after falls among older people. Patients and methods: This population-based case–control study identified two groups from a nationwide claim database (National Health Insurance Research Database in Taiwan: a rural group and a non-rural group, which included 3,897 and 5,541 older people, respectively, who were hospitalized for accidental falls (The International Classification of Diseases, Ninth Revision, Clinical Modification: E880–E888 during 2006–2009. Both groups were followed up for 4 years after falls. Four-year cumulative all-cause mortality rate after falls was calculated, and the demographic factor, comorbidity, and medications were considered as the potential risk factors of mortality after falls. Results: The rural group had a significantly higher frequency of fall-related hospitalizations (7.4% vs 4.3%, P<0.001, but a lower 4-year cumulative all-cause mortality rate after falls than the non-rural group (8.8% vs 23.4%, P<0.001. After adjusting for age, gender, comorbidity, and medication use, the rural group had

Correspondence: risk factors of acute respiratory infection in under-fives in a rural hospital of Central India – Authors’ reply

Directory of Open Access Journals (Sweden)

Amar Taksande

2016-07-01

Full Text Available Dear Editor,We thank the authors for their interest and comments on our paper. They have raised some very valid points. This corrispondence refers to the following article:Taksande AM, Yeole M. Risk factors of Acute Respiratory Infection (ARI in under-fives in a rural hospital of Central India. J Pediatr Neonat Individual Med. 2016;5(1:e050105. doi: 10.7363/050105 br />Comments can be found in the following article:Mandal A, Sahi PK. Correspondence: risk factors of acute respiratory infection in under-fives in a rural hospital of Central India. J Pediatr Neonat Individual Med. 2016;5(2:e050207. doi: 10.7363/050207

Nursing home quality: a comparative analysis using CMS Nursing Home Compare data to examine differences between rural and nonrural facilities.

Science.gov (United States)

Lutfiyya, May Nawal; Gessert, Charles E; Lipsky, Martin S

2013-08-01

Advances in medicine and an aging US population suggest that there will be an increasing demand for nursing home services. Although nursing homes are highly regulated and scrutinized, their quality remains a concern and may be a greater issue to those living in rural communities. Despite this, few studies have investigated differences in the quality of nursing home care across the rural-urban continuum. The purpose of this study was to compare the quality of rural and nonrural nursing homes by using aggregated rankings on multiple quality measures calculated by the Centers for Medicare and Medicaid Services and reported on their Nursing Home Compare Web site. Independent-sample t tests were performed to compare the mean ratings on the reported quality measures of rural and nonrural nursing homes. A linear mixed binary logistic regression model controlling for state was performed to determine if the covariates of ownership, number of beds, and geographic locale were associated with a higher overall quality rating. Of the 15,177 nursing homes included in the study sample, 69.2% were located in nonrural areas and 30.8% in rural areas. The t test analysis comparing the overall, health inspection, staffing, and quality measure ratings of rural and nonrural nursing homes yielded statistically significant results for 3 measures, 2 of which (overall ratings and health inspections) favored rural nursing homes. Although a higher percentage of nursing homes (44.8%-42.2%) received a 4-star or higher rating, regression analysis using an overall rating of 4 stars or higher as the dependent variable revealed that when controlling for state and adjusting for size and ownership, rural nursing homes were less likely to have a 4-star or higher rating when compared with nonrural nursing homes (OR = .901, 95% CI 0.824-0.986). Mixed model logistic regression analysis suggested that rural nursing home quality was not comparable to that of nonrural nursing homes. When controlling for

Can better infrastructure and quality reduce hospital infant mortality rates in Mexico?

Science.gov (United States)

Aguilera, Nelly; Marrufo, Grecia M

2007-02-01

Preliminary evidence from hospital discharges hints enormous disparities in infant hospital mortality rates. At the same time, public health agencies acknowledge severe deficiencies and variations in the quality of medical services across public hospitals. Despite these concerns, there is limited evidence of the contribution of hospital infrastructure and quality in explaining variations in outcomes among those who have access to medical services provided at public hospitals. This paper provides evidence to address this question. We use probabilistic econometric methods to estimate the impact of material and human resources and hospital quality on the probability that an infant dies controlling for socioeconomic, maternal and reproductive risk factors. As a measure of quality, we calculate for the first time for Mexico patient safety indicators developed by the AHRQ. We find that the probability to die is affected by hospital infrastructure and by quality. In this last regard, having been treated in a hospital with the worse quality incidence doubles the probability to die. This paper also presents evidence on the contribution of other risk factors on perinatal mortality rates. The conclusions of this paper suggest that lower infant mortality rates can be reached by implementing a set of coherent public policy actions including an increase and reorganization of hospital infrastructure, quality improvement, and increasing demand for health by poor families.

Quality indicators for the hospital transfusion chain : A national survey conducted in 100 dutch hospitals

NARCIS (Netherlands)

Zijlker-Jansen, Pauline Y.; Janssen, M. P.; van Tilborgh-de Jong, A. J W; Schipperus, M. R.; Wiersum-Osselton, J. C.

2015-01-01

Background: The 2011 Dutch Blood Transfusion Guideline for hospitals incorporates seven internal quality indicators for evaluation of the hospital transfusion chain. The indicators aim to measure guideline compliance as shown by the instatement of a hospital transfusion committee and transfusion

Computer Intervention: Illness Self-Management/Quality of Life of Rural Women.

Science.gov (United States)

Weinert, Clarann; Cudney, Shirley; Comstock, Bryan; Bansal, Aasthaa

2014-03-01

The Women To Women project, a computer-based support and educational research intervention, was designed to help rural women better understand and manage their chronic illnesses. Its impact on psychosocial adaptation has been reported elsewhere. This article reports on the effect of a computer intervention on chronic illness self-management skills and quality of life. Using a parallel 2-group study design, the researchers randomized 309 middle-aged rural women with chronic conditions to either a computer-based intervention or a control group. They collected data on self-management of chronic illness and quality of life indicators at baseline and at the end of the intervention. Women in the intervention group reported significantly more self-efficacy in managing their chronic disease than those in the control group and the observed effect was of moderate size. Women in the intervention group also reported statistically significant gains in quality of life; effect sizes were small but consistent. Select chronic illness self-management skills and quality of life can be positively influenced by a well-designed computer intervention. Copyright© by Ingram School of Nursing, McGill University.

Quality competition and uncertainty in a horizontally differentiated hospital market.

Science.gov (United States)

Montefiori, Marcello

2014-01-01

The chapter studies hospital competition in a spatially differentiated market in which patient demand reflects the quality/distance mix that maximizes their utility. Treatment is free at the point of use and patients freely choose the provider which best fits their expectations. Hospitals might have asymmetric objectives and costs, however they are reimbursed using a uniform prospective payment. The chapter provides different equilibrium outcomes, under perfect and asymmetric information. The results show that asymmetric costs, in the case where hospitals are profit maximizers, allow for a social welfare and quality improvement. On the other hand, the presence of a publicly managed hospital which pursues the objective of quality maximization is able to ensure a higher level of quality, patient surplus and welfare. However, the extent of this outcome might be considerably reduced when high levels of public hospital inefficiency are detectable. Finally, the negative consequences caused by the presence of asymmetric information are highlighted in the different scenarios of ownership/objectives and costs. The setting adopted in the model aims at describing the up-coming European market for secondary health care, focusing on hospital behavior and it is intended to help the policy-maker in understanding real world dynamics.

Hospital quality: a product of good management as much as good treatment.

Science.gov (United States)

Hyde, Andy; Frafjord, Anders

2013-01-01

In Norway, as in most countries, the demands placed on hospitals to reduce costs and improve the quality of services are intense. Although many say that improving quality reduces costs, few can prove it. Futhermore, how many people can show that improving quality improves patient satisfaction. Diakonhjemmet hospital in Norway has designed and implemented a hospital management system based on lean principles and the PDCA (Plan-Do-Check-Act) quality circle introduced by WE Deming (Deming 2000). The results are quite impressive with improvements in quality and patient satisfaction. The hospital also runs at a profit.

Rural-to-Urban Migrants' Experiences with Primary Care under Different Types of Medical Institutions in Guangzhou, China.

Directory of Open Access Journals (Sweden)

Jiazhi Zeng

Full Text Available China is facing the unprecedented challenge of rapidly increasing rural-to-urban migration. Migrants are in a vulnerable state when they attempt to access to primary care services. This study was designed to explore rural-to-urban migrants' experiences in primary care, comparing their quality of primary care experiences under different types of medical institutions in Guangzhou, China.The study employed a cross-sectional survey of 736 rural-to-urban migrants in Guangzhou, China in 2014. A validated Chinese version of Primary Care Assessment Tool--Adult Short Version (PCAT-AS, representing 10 primary care domains was used to collect information on migrants' quality of primary care experiences. These domains include first contact (utilization, first contact (accessibility, ongoing care, coordination (referrals, coordination (information systems, comprehensiveness (services available, comprehensiveness (services provided, family-centeredness, community orientation and culturally competent. These measures were used to assess the quality of primary care performance as reported from patients' perspective. Analysis of covariance was conducted for comparison on PCAT scores among migrants accessing primary care in tertiary hospitals, municipal hospitals, community health centers/community health stations, and township health centers/rural health stations. Multiple linear regression models were used to explore factors associated with PCAT total scores.After adjustments were made, migrants accessing primary care in tertiary hospitals (25.49 reported the highest PCAT total scores, followed by municipal hospitals (25.02, community health centers/community health stations (24.24, and township health centers/rural health stations (24.18. Tertiary hospital users reported significantly better performance in first contact (utilization, first contact (accessibility, coordination (information system, comprehensiveness (service available, and cultural competence

Clinical indications and determinants of the rise of cesarean section in three hospitals in rural China.

Science.gov (United States)

Qin, Cheng; Zhou, Min; Callaghan, William M; Posner, Samuel F; Zhang, Jun; Berg, Cynthia J; Zhao, Gengli

2012-10-01

This study investigated changes in cesarean delivery rate and cesarean indications in 3 county-level hospitals in rural China. Hospital delivery records in 1997 and 2003 were used to examine the reasons behind the changes. In Chengde County Hospital, the cesarean delivery rate increased from 28% in 1997 to 54% in 2003. The rate increased from 43% in 1997 to 65% in 2003 in Anxian County Hospital and Anxian Maternal and Child Health Hospital. The dramatic increase in cesarean delivery in the study hospitals was associated with a shift from more severe to mild or no clinical indications. The ratio of mild to moderate to severe hypertension increased substantially. More than half of the cephalopelvic disproportion cases were diagnosed prior to labor. The majority of nuchal cord cases were diagnosed without fetal distress. Maternal/family request was the number one cesarean indication in Anxian County Hospital and Anxian MCH Hospital in 2003. Ultrasound evidence of nuchal cord moved from the ninth ranked indication in 1997 to the second in 2003 in Chengde County Hospital.

Promoting self-management through adherence among heart failure patients discharged from rural hospitals: a study protocol [v2; ref status: indexed, http://f1000r.es/5c7

Directory of Open Access Journals (Sweden)

Lufei Young

2015-05-01

Full Text Available Background Heart failure is one of the most prevalent chronic conditions in adults, leading to prolonged morbidity, repeated hospitalizations, and placing tremendous economic burden on the healthcare system. Heart failure patients discharged from rural hospitals, or primarily critical access hospitals, have higher 30-day readmission and mortality rates compared to patients discharged from urban hospitals. Self-management improves heart failure patients’ health outcomes and reduces re-hospitalizations, but adherence to self-management guidelines is low. We propose a home based post-acute care service managed by advanced practice nurses to enhance patient activation and lead to the improvement of self-management adherence in heart failure patients discharged from rural hospitals. Objective This article describes the study design and research methods used to implement and evaluate the intervention. Method Our intervention is a 12-week patient activation (Patient AcTivated Care at Home [PATCH] to improve self-management adherence. Patients were randomized into two parallel groups (12-week PATCH intervention + usual care vs. usual care only to evaluate the effectiveness of this intervention. Outcomes were measured at baseline, 3 and 6 months. Discussion This study aimed to examine the effectiveness of a rural theory based, advance practice nurse led, activation enhancing intervention on the self-management adherence in heart failure patients residing in rural areas. Our expectation is to facilitate adherence to self-management behaviors in heart failure patients following discharge from rural hospitals and decrease complications and hospital readmissions, leading to the reduction of economic burden.  Clinical Trial Registration Information: ClinicalTrials.gov; https://register.clinicaltrials.gov/ NCT01964053

Promoting self-management through adherence among heart failure patients discharged from rural hospitals: a study protocol [v1; ref status: indexed, http://f1000r.es/4y8

Directory of Open Access Journals (Sweden)

Lufei Young

2014-12-01

Full Text Available Background Heart failure is one of the most prevalent chronic conditions in adults, leading to prolonged morbidity, repeated hospitalizations, and placing tremendous economic burden on the healthcare system. Heart failure patients discharged from rural hospitals, or primarily critical access hospitals, have higher 30-day readmission and mortality rates compared to patients discharged from urban hospitals. Self-management improves heart failure patients’ health outcomes and reduces re-hospitalizations, but adherence to self-management guidelines is low. We propose a home based post-acute care service managed by advanced practice nurses to enhance patient activation and lead to the improvement of self-management adherence in heart failure patients discharged from rural hospitals. Objective This article describes the study design and research methods used to implement and evaluate the intervention. Method Our intervention is a 12-week patient activation (Patient AcTivated Care at Home [PATCH] to improve self-management adherence. Patients were randomized into two parallel groups (12-week PATCH intervention + usual care vs. usual care only to evaluate the effectiveness of this intervention. Outcomes were measured at baseline, 3 and 6 months. Discussion This study aimed to examine the effectiveness of a rural theory based, advance practice nurse led, activation enhancing intervention on the self-management adherence in heart failure patients residing in rural areas. Our expectation is to facilitate adherence to self-management behaviors in heart failure patients following discharge from rural hospitals and decrease complications and hospital readmissions, leading to the reduction of economic burden.  Clinical Trial Registration Information: ClinicalTrials.gov; https://register.clinicaltrials.gov/ NCT01964053

[Comprehensive quality management in hospitals--experience and recommendations].

Science.gov (United States)

Schubert, H J

1999-03-01

Total quality management concepts, increasingly being introduced into hospitals, offer opportunities for integrative leadership concepts because of their multidimensional character viewed from the aspects of results and from the standpoint of organisational design. Customized for leadership and organisation of hospitals in Germany, questions of introduction strategies as well as recommendations for the integration of total quality understanding into the daily practice of management and employees are discussed. The active support of top and middle management and a combination of radical change in selected problem areas and continual incremental improvements on a broad base have been proven as significant factors for the success in the introductory phase. For a lasting integration of the principles of a comprehensive quality management concept in a hospital, it will be necessary to carry out regularly relevant measurements of success. The results become an important part of agreements with management.

Enhancing board oversight on quality of hospital care: an agency theory perspective.

Science.gov (United States)

Jiang, H Joanna; Lockee, Carlin; Fraser, Irene

2012-01-01

Community hospitals in the United States are almost all governed by a governing board that is legally accountable for the quality of care provided. Increasing pressures for better quality and safety are prompting boards to strengthen their oversight function on quality. In this study, we aimed to provide an update to prior research by exploring the role and practices of governing boards in quality oversight through the lens of agency theory and comparing hospital quality performance in relation to the adoption of those practices. Data on board practices from a survey conducted by The Governance Institute in 2007 were merged with data on hospital quality drawn from two federal sources that measured processes of care and mortality. The study sample includes 445 public and private not-for-profit hospitals. We used factor analysis to explore the underlying dimensions of board practices. We further compared hospital quality performance by the adoption of each individual board practice. Consistent with the agency theory, the 13 board practices included in the survey appear to center around enhancing accountability of the board, management, and the medical staff. Reviewing the hospital's quality performance on a regular basis was the most common practice. A number of board practices, not examined in prior research, showed significant association with better performance on process of care and/or risk-adjusted mortality: requiring major new clinical programs to meet quality-related criteria, setting some quality goals at the "theoretical ideal" level, requiring both the board and the medical staff to be as involved as management in setting the agenda for discussion on quality, and requiring the hospital to report its quality/safety performance to the general public. Hospital governing boards should examine their current practices and consider adopting those that would enhance the accountability of the board itself, management, and the medical staff.

Patient-perceived hospital service quality: an empirical assessment.

Science.gov (United States)

Pai, Yogesh P; Chary, Satyanarayana T; Pai, Rashmi Yogesh

2018-02-12

Purpose The purpose of this paper is to appraise Pai and Chary's (2016) conceptual framework for measuring patient-perceived hospital service quality (HSQ). Design/methodology/approach A structured questionnaire was used to obtain data from teaching, public and corporate hospital patients. Several tests were conducted to assess the instrument's reliability and validity. Pai and Chary's (2016) nine dimensions for measuring HSQ were examined in this paper. Findings The tests confirm that Pai and Chary's (2016) conceptual framework is reliable and valid. The study also establishes that the nine dimensions measure HSQ. Practical implications The framework empowers managers to assess service quality in any hospital settings, corporate, public and teaching, using an approach that is superior to the existing HSQ scales. Originality/value This paper helps researchers and practitioners to assess HSQ from patient perspectives in any hospital setting.

The Journey to Meet Emerging Community Benefit Requirements in a Rural Hospital: A Case Study

Science.gov (United States)

Sabin, Allison V; Levin, Pamela F

2015-10-22

The Affordable Care Act requires nonprofit hospitals to collaborate with public health agencies and community stakeholders to identify and address community health needs. As a rural organization, Wabash County (Indiana) Hospital pursued new approaches to achieve these revised requirements of the community benefit mandate. Using a case study approach, the authors provide a historical review of governmental relationships with nonprofit community hospitals, offer a case study application for implementing legislative mandates and community benefit requirements, share the insights they garnered on their journey to meet the mandates, and conclude that drawing upon the existing resources in the community and using current community assets in novel ways can help conserve time, and also financial, material, and human resources in meeting legislative mandates.

Methicillin-resistant Staphylococcus aureus prevention practices in hospitals throughout a rural state.

Science.gov (United States)

McDanel, Jennifer S; Ward, Melissa A; Leder, Laurie; Schweizer, Marin L; Dawson, Jeffrey D; Diekema, Daniel J; Smith, Tara C; Chrischilles, Elizabeth A; Perencevich, Eli N; Herwaldt, Loreen A

2014-08-01

The Institute for Healthcare Improvement (IHI) created an evidence-based bundle to help reduce methicillin-resistant Staphylococcus aureus (MRSA) health care-associated infections. The study aim was to identify which components of the IHI's MRSA bundle that rural hospitals have implemented and to identify barriers that hindered implementation of bundle components. Four surveys about the IHI's MRSA bundle were administered at the Iowa Statewide Infection Prevention Seminar between 2007 and 2011. Surveys were mailed to infection preventionists (IPs) who did not attend the meetings. The percentage of IPs reporting that their hospital implemented a hand hygiene program (range by year, 87%-94%) and used contact precautions for patients infected (range by year, 97%-100%) or colonized (range by year, 77%-92%) with MRSA did not change significantly. The number of hospitals that monitored the effectiveness of environmental cleaning significantly increased from 23%-71% (P hospitals assessed daily if central lines were necessary (range by year, 22%-26%). IPs perceived lack of support to be a major barrier to implementing bundle components. Most IPs reported that their hospitals had implemented most components of the MRSA bundle. Support within the health care system is essential for implementing each component of an evidence-based bundle. Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.

Quality of sleep for hospitalized patients in Rasoul-Akram hospital.

Science.gov (United States)

Ghanbari Jolfaei, Atefeh; Makvandi, Alena; Pazouki, Abdolreza

2014-01-01

Sleep disturbances have negative effects on medical conditions, mental health and cognitive performance. It was shown that about 60% of inpatients suffer from sleep problems. The aim of this study was to assess the correlation between sleep quality and other factors in the inpatients of Rasoul-e-Akram hospital. In this cross-sectional study, all the hospitalized patients in twelve wards of Rasoul-e-Akram hospital during September 2012, were examined. Sleeping habits of 209 inpatients of different wards were assessed through the Persian version of Pittsburgh Sleep Questionnaire (PSQI). A self-designed 18- question questionnaire was conducted for all patients in order to assess their attitude to interior and atmosphere of wards. Content validity and test retest reliability were evaluated. The pain level was also measured by the visual analog scale (VAS) and scores analyzed by the statistical methods of frequency, percentage, chi-square and logistic regression. The mean of the total scores in PSQI was 8.8±4.8 and 70.8% of the patients were 'poor sleepers' (global PSQI> 5). Age and gender had no effect on the PSQI total score, but the number of roommates, type of the ward, hospitalization period, presence and severity of pain, taking sleep medication and attitude toward the overall atmosphere and interior of wards have caused deviation in scores. Sleep problems are quite frequent in medical inpatients. Pain management and modification of the ward interior and atmosphere can impact inpatients sleep quality.

Rural-Urban Differences in End-of-Life Nursing Home Care: Facility and Environmental Factors

Science.gov (United States)

Temkin-Greener, Helena; Zheng, Nan Tracy; Mukamel, Dana B.

2012-01-01

Purpose of the study: This study examines urban-rural differences in end-of-life (EOL) quality of care provided to nursing home (NH) residents. Data and Methods: We constructed 3 risk-adjusted EOL quality measures (QMs) for long-term decedent residents: in-hospital death, hospice referral before death, and presence of severe pain. We used…

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

Science.gov (United States)

Mobley, Lee R; Magnussen, Jon

2002-01-01

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

Depression in chronic respiratory disorders in a tertiary rural hospital of Central India

Institute of Scientific and Technical Information of China (English)

Sameer singhal; Pankaj Banode; Nitish Baisakhiya

2009-01-01

Objective: To determine prevalence of depression in chronic respiratory disorders in a tertiary rural hospital of Central India. Various studies done in past have shown that prevalence of depression in diabetes and hypertension is around 40%-57%. Few studies have been done to screen depression in chronic respiratory disorders. This study was conducted in a tertiary rural hospital of Central India to find out prevalence of depression in indoor patients suffering from chronic respiratory disorders. Methods: Total 68 patients were evaluated for depression. Patients suffering from chronic respiratory disorders (total duration of illness >3 months) were evaluated using Prime MD Questionnaire. Patients suffering from diabetes, heart diseases, stroke, having past history of psychiatric illness, drug abusers, having lack of social support and suffering from chronic upper respiratory tract infections were excluded from this study. Questionnaire was asked when treatment for acute phase of illness is over. Results: Out of 68 patients evaluated, 36 (53%) were found out to be suffering from depression. Female gender (80%) was more prone to depression, inspite of the fact that all alcoholics were male. 39% of all chronic obstructive pulmonary disease (COPD) patients were suffering from depression in comparison to 65% for pulmonary tuberculosis and 44% for other chronic respiratory illness. 54% of patients suffering from depression are 60 yrs of age, suggesting that age has no relation with depression. No association was seen between alcoholism and depression. Conclusion: Prevalence of depression in patients of chronic respiratory illness is very high, like in cases of diabetes and hypertension. Further community and hospital based studies are needed to find out exact prevalence of depression in chronic respiratory illnesses.

Analysis of birth weights of a rural hospital

Directory of Open Access Journals (Sweden)

Ashtekar Shyam

2010-01-01

Full Text Available Background: Low birth weight remains a major reason behind childhood malnutrition. The NFHS findings show no dent in this problem. Objective: This study was undertaken to explore change in birth weights in a period from 1989 to 2007 and any associations thereof. Materials and Methods: All birth records of a private rural hospital spanning two decades (1989-2007 were analyzed for birth weight, age of mother, gender, birth order of the baby, proportion of pre-term babies and low birth weight babies. Results: No change was observed in the average birth weights (average 2.71 kg over the period. Although the birth weight shows some expected variance with the age of mother, it was found to have no relation with the baby′s birth order and gender. The low birth weight proportion is about 24% and shows little difference before and after the series midpoint of year 1998. Conclusion: The birth weights have hardly changed in this population in the two decades.

Analysis of Birth Weights of a Rural Hospital

Science.gov (United States)

Ashtekar, Shyam V; Kulkarni, Madhav B; Sadavarte, Vaishali S; Ashtekar, Ratna S

2010-01-01

Background: Low birth weight remains a major reason behind childhood malnutrition. The NFHS findings show no dent in this problem. Objective: This study was undertaken to explore change in birth weights in a period from 1989 to 2007 and any associations thereof. Materials and Methods: All birth records of a private rural hospital spanning two decades (1989-2007) were analyzed for birth weight, age of mother, gender, birth order of the baby, proportion of pre-term babies and low birth weight babies. Results: No change was observed in the average birth weights (average 2.71 kg) over the period. Although the birth weight shows some expected variance with the age of mother, it was found to have no relation with the baby’s birth order and gender. The low birth weight proportion is about 24% and shows little difference before and after the series midpoint of year 1998. Conclusion: The birth weights have hardly changed in this population in the two decades. PMID:20922101

The incidence, aetiology and outcome of acute seizures in children admitted to a rural Kenyan district hospital

NARCIS (Netherlands)

Idro, Richard; Gwer, Samson; Kahindi, Michael; Gatakaa, Hellen; Kazungu, Tony; Ndiritu, Moses; Maitland, Kathryn; Neville, Brian G. R.; Kager, Piet A.; Newton, Charles R. J. C.

2008-01-01

BACKGROUND: Acute seizures are a common cause of paediatric admissions to hospitals in resource poor countries and a risk factor for neurological and cognitive impairment and epilepsy. We determined the incidence, aetiological factors and the immediate outcome of seizures in a rural malaria endemic

Tobacco smoke exposure and impact of smoking legislation on rural and non-rural hospitality venues in North Dakota.

Science.gov (United States)

Buettner-Schmidt, Kelly; Lobo, Marie L; Travers, Mark J; Boursaw, Blake

2015-08-01

The purpose of this cross-sectional study in a stratified random sample of 135 bars and restaurants in North Dakota was to describe factors that influenced tobacco smoke pollution levels in the venues; to compare the quantity of tobacco smoke pollution by rurality and by presence of local ordinances; and to assess compliance with state and local laws. In data collection in 2012, we measured the indoor air quality indicator of particulate matter (2.5 microns aerodynamic diameter or smaller), calculated average smoking density and occupant density, and determined compliance with state and local smoking ordinances using observational methods. As rurality increased, tobacco smoke pollution in bars increased. A significant association was found between stringency of local laws and level of tobacco smoke pollution, but the strength of the association varied by venue type. Compliance was significantly lower in venues in communities without local ordinances. Controlling for venue type, 69.2% of smoke-free policy's impact on tobacco smoke pollution levels was mediated by observed smoking. This study advances scientific knowledge on the factors influencing tobacco smoke pollution and informs public health advocates and decision makers on policy needs, especially in rural areas. © 2015 Wiley Periodicals, Inc.

Risk aversion and willingness to pay for water quality: The case of non-farm rural residents.

Science.gov (United States)

Larue, Bruno; West, Gale E; Singbo, Alphonse; Tamini, Lota Dabio

2017-07-15

Stated choice experiments are used to investigate the economic valuation of rural residents living in the province of Quebec for water quality improvements. In Quebec, rural residents played an important role in the setting of stricter environmental regulations. Unlike most stated choice experiments about the valuation of improvements in water quality, this study explicitly accounts for risk in the design and analysis of choice experiments. Risk in phosphorus and coliform reductions is introduced through a three-point uniform distribution in the choice sets. The results show greater support for constant absolute risk aversion preferences than for constant relative risk aversion. Rural residents value coliform and phosphorus reductions and the more educated ones are particularly willing to see the government tax farmers and taxpayers to secure such reductions. As the science improves and risk in water quality outcomes decrease and as the political weight of non-farm rural residents increase, it should be easier for governments to replace voluntary cost-share programs by polluter-payer programs. Copyright © 2017 Elsevier Ltd. All rights reserved.

Degree of value alignment - a grounded theory of rural nurse resignations.

Science.gov (United States)

Bragg, S M; Bonner, A

2014-01-01

they could perform nursing that aligned with their internalised professional values and integrity. Resignation occurred when nurses were unable to realign their personal values to changed organisational values - the organisational values changed due to rural area health service restructures, centralisation of budgets and resources, cumbersome hierarchies and management structures that inhibited communication and decision making, out-dated and ineffective operating systems, insufficient and inexperienced staff, bullying, and a lack of connectedness and shared vision. To fully comprehend rural nurse resignations, this study identified three stages that nurses move through prior to resignation. Effective retention strategies for the nursing workforce should address contributors to a decrease in value alignment and work towards encouraging the coalescence of nurses' and hospitals' values. It is imperative that strategies enable nurses to provide high quality patient care and promote a sense of connectedness and a shared vision between nurse and hospital. Senior managers need to have clear ways to articulate and imbue organisational values and be explicit in how these values accommodate nurses' values. Ward-level nurse managers have a significant responsibility to ensure that a hospital's values (both explicit and implicit) are incorporated into ward culture.

Drinking Water Quality in Hospitals and Other Buildings ...

Science.gov (United States)

Drinking water quality entering large buildings is generally adequately controlled by the water utility, but localized problems may occur within building or “premise” plumbing. Particular concerns are loss of disinfectant residual and temperature variability, which may enhance pathogen activity and metallic corrosion. Disinfection systems are available to building managers and are being installed in a variety of commercial buildings (hospitals, hotels, office buildings.) Yet our understanding of such additional treatment and of how to monitor end water quality at these buildings is limited. This class lecture will discuss challenges in maintaining acceptable water quality in hospitals, schools and other buildings. To give a lecture to a class of graduate students (ENVE 6054: Physical/Chemical Processes for Water Quality Control) at the University of Cincinnati, by presenting past research projects.

Quality Management in Tourism and Hospitality: an Exploratory Study among Tourism Stakeholders

OpenAIRE

Soultana Kapiki

2012-01-01

Quality in the tourism and hospitality industry involves consistent delivery of products and guest services according to expected standards. Delivering quality service is one of the major challenges the hospitality managers will be facing in the following years as it is an essential condition for success in the emerging, keenly competitive, global hospitality markets. There are various tools that measure and improve quality service, as well as mechanisms for quality recognition in the tourism...

Total quality management in a 300-bed community hospital: the quality improvement process translated to health care.

Science.gov (United States)

Hughes, J M

1992-09-01

Winter Park Memorial Hospital (Winter Park, Florida) began implementation of a well-strategized plan for total quality management (TQM) in 1987. Having no guidelines for applying TQM to health care but using the industrial quality management techniques of Philip Crosby Associates, Inc, the hospital made the transition and saved thousands of dollars in the process. This article describes the transition, especially the integral part played by the Medical Staff Quality Council in changing the hospital's culture.

Patients' satisfaction of service quality in Saudi hospitals: a SERVQUAL analysis.

Science.gov (United States)

Al-Borie, Hussein M; Damanhouri, Amal M Sheikh

2013-01-01

Saudi Arabian hospital performance, vis-á-vis patient satisfaction with service provision, has emerged as a key policy and planning concern. Keeping in view public and private hospital service quality, this article seeks to provide guidelines to the on-going Saudi Arabian health service reorganization, which emphasizes decentralization, bed-capacity expansion, research-based policymaking and initiatives in the health insurance sector. The article outlines an empirical study that compares patient satisfaction with service quality in Saudi Arabian public and private sector hospitals. The authors employ a stratified random sample (1,000 inpatients) from five Saudi Arabian public and five private hospitals. Data were collected through questionnaire using the SERVQUAL scale. For reducing the language bias the questionnaire was translated into Arabic. The response rate was 74.9 percent. Data were analyzed using SPSS and appropriate descriptive and inferential statistical techniques. Cronbach's alpha for five service-quality dimensions (tangibles, reliability, responsiveness, safety and empathy) were high and the SERVQUAL instrument proved to be reliable, valid and appropriate. The results showed that sex, education, income and occupation were statistically significant in influencing inpatients' satisfaction, and all the null hypotheses were rejected. Only inpatient age was not significant. The study highlights service quality influence in the design of broader healthcare strategies for Saudi Arabian public and private hospitals. It demands that management researchers and analysts must identify regional service quality consistencies and related inpatient demographic indicators. The study offers some insights into, and guidance for, hospital quality assurance in Saudi Arabia in general and the urban hospital setting in the Middle-East in particular.

Social Support Networks and Quality of Life of Rural Men in a Context of Marriage Squeeze in China.

Science.gov (United States)

Wang, Sasa; Yang, Xueyan; Attané, Isabelle

2018-07-01

A significant number of rural Chinese men are facing difficulties in finding a spouse and may fail to ever marry due to a relative scarcity of women in the adult population. Research has indicated that marriage squeeze is a stressful event which is harmful to men's quality of life, and also weakens their social support networks. Using data collected in rural Chaohu city, Anhui, China, this study explores the effects of social support networks on quality of life of rural men who experience a marriage squeeze. The results indicate that the size of social contact networks is directly and positively associated with the quality of life of marriage-squeezed men, and moderate the negative effect of age on quality of life. Having no or limited instrumental support network and social contact network are double-edged swords, which have direct negative associations with the quality of life of marriage-squeezed men, and have moderate effects on the relationship between marriage squeeze and quality of life.

Do hospitals respond to rivals' quality and efficiency? A spatial panel econometric analysis.

Science.gov (United States)

Longo, Francesco; Siciliani, Luigi; Gravelle, Hugh; Santos, Rita

2017-09-01

We investigate whether hospitals in the English National Health Service change their quality or efficiency in response to changes in quality or efficiency of neighbouring hospitals. We first provide a theoretical model that predicts that a hospital will not respond to changes in the efficiency of its rivals but may change its quality or efficiency in response to changes in the quality of rivals, though the direction of the response is ambiguous. We use data on eight quality measures (including mortality, emergency readmissions, patient reported outcome, and patient satisfaction) and six efficiency measures (including bed occupancy, cancelled operations, and costs) for public hospitals between 2010/11 and 2013/14 to estimate both spatial cross-sectional and spatial fixed- and random-effects panel data models. We find that although quality and efficiency measures are unconditionally spatially correlated, the spatial regression models suggest that a hospital's quality or efficiency does not respond to its rivals' quality or efficiency, except for a hospital's overall mortality that is positively associated with that of its rivals. The results are robust to allowing for spatially correlated covariates and errors and to instrumenting rivals' quality and efficiency. Copyright © 2017 John Wiley & Sons, Ltd.

Does adding clinical data to administrative data improve agreement among hospital quality measures?

Science.gov (United States)

Hanchate, Amresh D; Stolzmann, Kelly L; Rosen, Amy K; Fink, Aaron S; Shwartz, Michael; Ash, Arlene S; Abdulkerim, Hassen; Pugh, Mary Jo V; Shokeen, Priti; Borzecki, Ann

2017-09-01

Hospital performance measures based on patient mortality and readmission have indicated modest rates of agreement. We examined if combining clinical data on laboratory tests and vital signs with administrative data leads to improved agreement with each other, and with other measures of hospital performance in the nation's largest integrated health care system. We used patient-level administrative and clinical data, and hospital-level data on quality indicators, for 2007-2010 from the Veterans Health Administration (VA). For patients admitted for acute myocardial infarction (AMI), heart failure (HF) and pneumonia we examined changes in hospital performance on 30-d mortality and 30-d readmission rates as a result of adding clinical data to administrative data. We evaluated whether this enhancement yielded improved measures of hospital quality, based on concordance with other hospital quality indicators. For 30-d mortality, data enhancement improved model performance, and significantly changed hospital performance profiles; for 30-d readmission, the impact was modest. Concordance between enhanced measures of both outcomes, and with other hospital quality measures - including Joint Commission process measures, VA Surgical Quality Improvement Program (VASQIP) mortality and morbidity, and case volume - remained poor. Adding laboratory tests and vital signs to measure hospital performance on mortality and readmission did not improve the poor rates of agreement across hospital quality indicators in the VA. Efforts to improve risk adjustment models should continue; however, evidence of validation should precede their use as reliable measures of quality. Published by Elsevier Inc.

Development of Service Quality Scale for Surgical Hospitalization

Directory of Open Access Journals (Sweden)

Ching-I Teng

2007-01-01

Conclusion: The SQSH has sufficient usefulness, reliability and validity. Future research on service quality can apply the SQSH scale to link with utilization intention and patient loyalty and attempt to develop a hospitalization quality scale for other departments.

Cost-effectiveness of the "helping babies breathe" program in a missionary hospital in rural Tanzania.

Science.gov (United States)

Vossius, Corinna; Lotto, Editha; Lyanga, Sara; Mduma, Estomih; Msemo, Georgina; Perlman, Jeffrey; Ersdal, Hege L

2014-01-01

The Helping Babies Breathe" (HBB) program is an evidence-based curriculum in basic neonatal care and resuscitation, utilizing simulation-based training to educate large numbers of birth attendants in low-resource countries. We analyzed its cost-effectiveness at a faith-based Haydom Lutheran Hospital (HLH) in rural Tanzania. Data about early neonatal mortality and fresh stillbirth rates were drawn from a linked observational study during one year before and one year after full implementation of the HBB program. Cost data were provided by the Tanzanian Ministry of Health and Social Welfare (MOHSW), the research department at HLH, and the manufacturer of the training material Lærdal Global Health. Costs per life saved were USD 233, while they were USD 4.21 per life year gained. Costs for maintaining the program were USD 80 per life saved and USD 1.44 per life year gained. Costs per disease adjusted life year (DALY) averted ranged from International Dollars (ID; a virtual valuta corrected for purchasing power world-wide) 12 to 23, according to how DALYs were calculated. The HBB program is a low-cost intervention. Implementation in a very rural faith-based hospital like HLH has been highly cost-effective. To facilitate further global implementation of HBB a cost-effectiveness analysis including government owned institutions, urban hospitals and district facilities is desirable for a more diverse analysis to explore cost-driving factors and predictors of enhanced cost-effectiveness.

Cost-effectiveness of the "helping babies breathe" program in a missionary hospital in rural Tanzania.

Directory of Open Access Journals (Sweden)

Corinna Vossius

Full Text Available The Helping Babies Breathe" (HBB program is an evidence-based curriculum in basic neonatal care and resuscitation, utilizing simulation-based training to educate large numbers of birth attendants in low-resource countries. We analyzed its cost-effectiveness at a faith-based Haydom Lutheran Hospital (HLH in rural Tanzania.Data about early neonatal mortality and fresh stillbirth rates were drawn from a linked observational study during one year before and one year after full implementation of the HBB program. Cost data were provided by the Tanzanian Ministry of Health and Social Welfare (MOHSW, the research department at HLH, and the manufacturer of the training material Lærdal Global Health.Costs per life saved were USD 233, while they were USD 4.21 per life year gained. Costs for maintaining the program were USD 80 per life saved and USD 1.44 per life year gained. Costs per disease adjusted life year (DALY averted ranged from International Dollars (ID; a virtual valuta corrected for purchasing power world-wide 12 to 23, according to how DALYs were calculated.The HBB program is a low-cost intervention. Implementation in a very rural faith-based hospital like HLH has been highly cost-effective. To facilitate further global implementation of HBB a cost-effectiveness analysis including government owned institutions, urban hospitals and district facilities is desirable for a more diverse analysis to explore cost-driving factors and predictors of enhanced cost-effectiveness.

Diabetes mellitus, hypertension and albuminuria in rural Zambia: a hospital-based survey.

Science.gov (United States)

Rasmussen, Jon B; Thomsen, Jakúp A; Rossing, Peter; Parkinson, Shelagh; Christensen, Dirk L; Bygbjerg, Ib C

2013-09-01

To assess albuminuria in rural Zambia among patients with diabetes mellitus only (DM group), hypertension only (HTN group) and patients with combined DM and HTN (DM/HTN group). A cross-sectional survey was conducted at St. Francis Hospital in the Eastern province of Zambia. Albumin-creatinine ratio in one urine sample was used to assess albuminuria. Other information obtained included age, sex, body mass index (BMI), waist circumference (WC), blood pressure (BP), glycosylated haemoglobin (HbA1c ), random capillary glucose, time since diagnosis, medication and family history of DM or HTN. A total of 193 participants were included (DM group: n = 33; HTN group: n = 92; DM/HTN group: n = 68). The participants in the DM group used insulin more frequently as diabetes medication than the DM/HTN group (P < 0.05). Furthermore, the DM group was younger and had lower BMI, WC and BP than the two other groups. In the DM group, HTN group and DM/HTN group, microalbuminuria was found in 12.1%, 19.6% and 29.4% (P = 0.11), and macroalbuminuria was found in 0.0%, 3.3% and 13.2% (P = 0.014), respectively. The urine albumin (P = 0.014) and albumin-creatinine ratio (P = 0.0006) differed between the three groups. This hospital-based survey in rural Zambia found a lower frequency of albuminuria among the participants than in previous studies of patients with DM or HTN in urban sub-Saharan Africa. © 2013 John Wiley & Sons Ltd.

Irrigation water quality as indicator of sustainable rural development

Directory of Open Access Journals (Sweden)

Trajković Slaviša

2004-01-01

Full Text Available The sustainable rural development more and more depends on the efficient usage of water resources. Most often, at least in one part of the year, the rain is not sufficient for plant growth and rain plant production significantly depends on the yearly precipitation variation. The increase and stability of the agricultural production is possible in the irrigation conditions. The most part (around 70% of the global water resources is used for food production. Irrigation water quality indicator is used to show if the available water resources have the required quality for application in agriculture. Irrigation is characterised by the complex water-plant-soil relationship, and in that eco-system the man as the end user of the irrigated fields occupies a very important place. That explains the difficulties in producing one universal classification of irrigation water quality. The paper analyses numerous water quality classifications from the aspect of the applicability on the quantifying of this indicator. The adopted classification should possess understandable, qualified and internationally comparable indicator. Thus, local classifications (Neigebauer, Miljkovic cannot be used for this indicator. United Nation Food and Agricultural Organization (FAO and US Salinity Laboratory (USSL classifications are used for the evaluation of the irrigation water quality throughout the world. FAO classification gives the complex picture of the usability of the irrigation water from the point of its influence on the soil and the plants. However, the scope of the analyses is not often suited to the needs of that classification, which makes it difficult to apply. The conclusion is that the USSL (US Salinity Laboratory classification is best suited to this range of chemical water analyses. The evaluation of the irrigation water quality indicator in the Juzna Morava river basin, upstream from the Toplica river estuary is given in this paper. Based on the obtained

Private drinking water quality in rural Wisconsin.

Science.gov (United States)

Knobeloch, Lynda; Gorski, Patrick; Christenson, Megan; Anderson, Henry

2013-03-01

Between July 1, 2007, and December 31, 2010, Wisconsin health departments tested nearly 4,000 rural drinking water supplies for coliform bacteria, nitrate, fluoride, and 13 metals as part of a state-funded program that provides assistance to low-income families. The authors' review of laboratory findings found that 47% of these wells had an exceedance of one or more health-based water quality standards. Test results for iron and coliform bacteria exceeded safe limits in 21% and 18% of these wells, respectively. In addition, 10% of the water samples from these wells were high in nitrate and 11% had an elevated result for aluminum, arsenic, lead, manganese, or strontium. The high percentage of unsafe test results emphasizes the importance of water quality monitoring to the health of nearly one million families including 300,000 Wisconsin children whose drinking water comes from a privately owned well.

HOSPITAL IMAGE AS A MODERATING VARIABLE ON THE EFFECT OF HOSPITAL SERVICE QUALITY ON THE CUSTOMER PERCEIVED VALUE, CUSTOMER TRUST AND CUSTOMER LOYALTY IN HOSPITAL SERVICES

Directory of Open Access Journals (Sweden)

Indrianawati Usman

2017-12-01

Full Text Available This is an explanatory research, analyzing the hospital image as a moderating variable on the effect of hospital service quality on customer perceived value and trust. Research was conducted at several hospitals in Surabaya Indonesia, especially to outpatients. Data was collected by survey to the outpatients of the hospitals. The purpose of this research was empirically examining the effects of hospital service quality on customer perceived value and customer trust, examine effects of customer perceived value and customer trust on customer loyalty. Moreover This research also examined the variable of hospital image as a moderating variable in the effects of hospital service quality on customer perceived value and customer trust. The result of this research gave a perspective to hospital management about the importance of building patient trust, since trust is very important, even more important than satisfaction level. Further studies with more emphasis on identifying the factors building patient trust to the hospital in order to raise customer loyalty should be conducted.

HOSPITAL IMAGE AS A MODERATING VARIABLE ON THE EFFECT OF HOSPITAL SERVICE QUALITY ON THE CUSTOMER PERCEIVED VALUE, CUSTOMER TRUST AND CUSTOMER LOYALTY IN HOSPITAL SERVICES

OpenAIRE

Indrianawati Usman

2017-01-01

This is an explanatory research, analyzing the hospital image as a moderating variable on the effect of hospital service quality on customer perceived value and trust. Research was conducted at several hospitals in Surabaya Indonesia, especially to outpatients. Data was collected by survey to the outpatients of the hospitals. The purpose of this research was empirically examining the effects of hospital service quality on customer perceived value and customer trust, examine eff...

RN work engagement in generational cohorts: the view from rural US hospitals.

Science.gov (United States)

Sullivan Havens, Donna; Warshawsky, Nora E; Vasey, Joseph

2013-10-01

To describe staff nurse work engagement, identify predictors by generational cohort, present implications for nurse managers and suggest future research. A global nurse shortage looms. While an adequate supply of nurses is needed to ensure access to care, access to quality care may be enhanced by an adequate supply of highly engaged nurses-those who are dedicated, energized, and absorbed. Nurses have long reported the presence of energy depleting practice environments. Nurses practicing in professional practice environments may be more engaged. A non-experimental survey design was executed. Direct care Registered Nurses (n = 747) working in five rural acute care hospitals completed questionnaires to assess work engagement (Utrecht Work Engagement Scale-9), decisional involvement (Decisional Involvement Scale), relational coordination (Relational Coordination Survey) and the nursing practice environment (Practice Environment Scale of the Nursing Work Index). Descriptive, correlational and regression analyses examined work engagement and predictors by generational cohort. With the exception of the absorption component, no statistically significant differences in engagement emerged across generational cohorts. Predictors of engagement differed by cohort, however across all cohorts, professional nursing practice environments predicted nurse work engagement. Professional nursing practice environments are significantly associated with nurse work engagement. Enhancing nurse work engagement is a complex challenge. Generational cohorts may respond to different strategies to enhance engagement. © 2013 John Wiley & Sons Ltd.

Indoor environmental quality in Hellenic hospital operating rooms

Energy Technology Data Exchange (ETDEWEB)

Dascalaki, Elena G.; Gaglia, Athina G.; Balaras, Constantinos A. [Group Energy Conservation, Institute for Environmental Research and Sustainable Development, National Observatory of Athens, I. Metaxa and Vas. Pavlou, GR 152 36 P. Penteli (Greece); Lagoudi, Argyro [Terra Nova Ltd., Environmental Engineering Consultancy, Athens, Kaisareias 39, GR 115 27 Athens (Greece)

2009-05-15

Indoor environmental quality (IEQ) in hospital operating rooms (ORs) constitutes a major challenge for the proper design and operation of an energy efficient hospital. A subjective assessment of the indoor environment along with a short monitoring campaign was performed during the audits of 18 ORs at nine major Hellenic hospitals. A total of 557 medical personnel participated in an occupational survey, providing data for a subjective assessment of IEQ in the audited ORs. The OR personnel reported work related health symptoms and an assessment of indoor conditions (thermal, visual and acoustical comfort, and air quality). Overall, personnel reported an average of 2.24 work-related symptoms each, and 67.2% of respondents reported at least one. Women suffer more health symptoms than men. Special dispositions, such as smoking and allergies, increase the number of reported symptoms for male and female personnel. Personnel that perceive satisfactory indoor comfort conditions (temperature, humidity, ventilation, light, and noise) average 1.18 symptoms per person, while for satisfactory indoor air quality the average complaints are 0.99. The perception of satisfactory IEQ (satisfactory comfort conditions and air quality) reduces the average number of health complaints to 0.64 symptoms per person and improves working conditions, even in a demanding OR environment. (author)

easuring the quality of health services provided at a Greek Public Hospital through patient satisfaction. Case Study: The General Hospital of Kavala

Directory of Open Access Journals (Sweden)

Vasiliki A. Georgiadou

2017-06-01

Full Text Available Purpose: The aim of this study is to examine the quality of hospital services as perceived by patients in terms of patient satisfaction with services. Design/Methodology/Approach: A conceptual framework of quality of hospital services, developed by Padma et al. (2009, composed by eight quality dimensions, applied the performance measurement model (SERVPERF, was used for the approach. The Quality Score Tool was a two-part questionnaire that quantified patient satisfaction with benchmarks of the quality dimensions. In order to investigate the above model, the case study method was utilized. The survey was conducted in a public regional hospital. Findings: Five (5 quality dimensions (5Qs have found having a significant impact on overall quality of service, measure of patient satisfaction in the hospital. These dimensions are on a hierarchical scale: "clinical care", "social responsibility", "staff quality", "infrastructure" and "Hospital reliability". Originality/Value: The results of this study can be used as a source of feedback to hospital management, meaning that they can essentially lead to improved adjustments or serve as a basis of process reengineering.

Measuring, evaluating and improving hospital quality parameters/dimensions--an integrated healthcare quality approach.

Science.gov (United States)

Zineldin, Mosad; Camgöz-Akdağ, Hatice; Vasicheva, Valiantsina

2011-01-01

This paper aims to examine the major factors affecting cumulative summation, to empirically examine the major factors affecting satisfaction and to address the question whether patients in Kazakhstan evaluate healthcare similarly or differently from patients in Egypt and Jordan. A questionnaire, adapted from previous research, was distributed to Kazakhstan inpatients. The questionnaire contained 39 attributes about five newly-developed quality dimensions (5Qs), which were identified to be the most relevant attributes for hospitals. The questionnaire was translated into Russian to increase the response rate and improve data quality. Almost 200 usable questionnaires were returned. Frequency distribution, factor analysis and reliability checks were used to analyze the data. The three biggest concerns for Kazakhstan patients are: infrastructure; atmosphere; and interaction. Hospital staffs concern for patients' needs, parking facilities for visitors, waiting time and food temperature were all common specific attributes, which were perceived as concerns. These were shortcomings in all three countries. Improving health service quality by applying total relationship management and the 5Qs model together with a customer-orientation strategy is recommended. Results can be used by hospital staff to reengineer and redesign creatively their quality management processes and help move towards more effective healthcare quality strategies. Patients in three countries have similar concerns and quality perceptions. The paper describes a new instrument and method. The study assures relevance, validity and reliability, while being explicitly change-oriented. The authors argue that patient satisfaction is a cumulative construct, summing satisfaction as five different qualities (5Qs): object; processes; infrastructure; interaction and atmosphere.

Subjective sleep quality and sleep duration of patients in a psychiatric hospital

Directory of Open Access Journals (Sweden)

Matthias J. Müller

2016-07-01

Full Text Available Sleep complaints and sleep disturbances are highly prevalent in patients with psychiatric disorders. During hospitalization the patients’ condition may be even worse but little is known about the subjective sleep quality in psychiatric hospitals. Thus, we have investigated subjective sleep quality and mean sleep duration in patients with different psychiatric disorders at the end of hospitalization. For a period of one year, inpatients of a psychiatric hospital with diagnosis of substance use disorder (SUD, schizophrenia (SCZ, or anxiety/depressive disorders (AND were routinely asked to fill in an easily comprehensible sleep quality questionnaire at the end of their hospitalization. Age, gender, subjective sleep quality, and sleep duration were analyzed; sleep duration was classified according to age-specific recommendations. Data of n=309 patients (age 52.1±17.9y, 56.1% women were analyzed (n=63 SUD, n=50 SCZ, n=196 AND. Mean sleep duration was 7.0±2.0 h; 20.7% of patients had sleep durations below and 4.5% above age-specific recommendations. Non-restorative sleep during hospitalization was reported “almost always” in 38.2% (n=118, and “occasionally” in 30.1% (n=93. Subjective sleep quality was significantly associated with sleep duration (rs=−0.31, P<0.0005, but not with age, gender or diagnostic subgroup. The study showed that a great proportion of patients reported poor subjective sleep quality during hospitalization, regardless of age, gender and psychiatric diagnosis. As sleep quality was significantly associated with short sleep duration, a first step could be to take care to achieve recommended age-specific sleep durations in psychiatric hospitals.

The role of interpersonal sensitivity, social support, and quality of life in rural older adults.

Science.gov (United States)

Wedgeworth, Monika; LaRocca, Michael A; Chaplin, William F; Scogin, Forrest

The mental health of elderly individuals in rural areas is increasingly relevant as populations age and social structures change. While social support satisfaction is a well-established predictor of quality of life, interpersonal sensitivity symptoms may diminish this relation. The current study extends the findings of Scogin et al by investigating the relationship among interpersonal sensitivity, social support satisfaction, and quality of life among rural older adults and exploring the mediating role of social support in the relation between interpersonal sensitivity and quality of life (N = 128). Hierarchical regression revealed that interpersonal sensitivity and social support satisfaction predicted quality of life. In addition, bootstrapping resampling supported the role of social support satisfaction as a mediator between interpersonal sensitivity symptoms and quality of life. These results underscore the importance of nurses and allied health providers in assessing and attending to negative self-perceptions of clients, as well as the perceived quality of their social networks. Copyright © 2016 Elsevier Inc. All rights reserved.

Quality of Public Hospitals Websites: A Cross-Sectional Analytical Study in Iran.

Science.gov (United States)

Salarvand, Shahin; Samadbeik, Mahnaz; Tarrahi, Mohammad Javad; Salarvand, Hamed

2016-04-01

Nowadays, hospitals have turned increasingly towards the Internet and develop their own web presence. Hospital Websites could be operating as effective web resources of information and interactive communication mediums to enhance hospital services to the public. Therefore, the aim of this study was to assess the quality of websites in Tehran's public hospitals. This cross-sectional analysis involved all public hospitals in Iran's capital city, Tehran, with a working website or subsites between April and June, 2014 (N=59). The websites were evaluated using three validated instruments: a localized checklist, Google page rank, and the Alexa traffic ranking. The mentioned checklist consisted of 112 items divided into five sections: technical characteristics, hospital information and facilities, medical services, interactive on-line services and external activities. Data were analyzed using descriptive and analytical statistics. The mean website evaluation score was 45.7 out of 224 for selected public hospitals. All the studied websites were in the weak category based on the earned quality scores. There was no statistically significant association between the website evaluation score with Google page rank (P=0.092), Alexa global traffic rank and Alexa traffic rank in Iran (P>0.05). The hospital websites had a lower quality score in the interactive online services and external activities criteria in comparing to other criteria. Due to the low quality level of the studied websites and the importance of hospital portals in providing information and services on the Internet, the authorities should do precise planning for the appreciable improvement in the quality of hospital websites.

Improving Quality of Care in Primary Health-Care Facilities in Rural Nigeria

Science.gov (United States)

Ugo, Okoli; Ezinne, Eze-Ajoku; Modupe, Oludipe; Nicole, Spieker; Kelechi, Ohiri

2016-01-01

Background: Nigeria has a high population density but a weak health-care system. To improve the quality of care, 3 organizations carried out a quality improvement pilot intervention at the primary health-care level in selected rural areas. Objective: To assess the change in quality of care in primary health-care facilities in rural Nigeria following the provision of technical governance support and to document the successes and challenges encountered. Method: A total of 6 states were selected across the 6 geopolitical zones of the country. However, assessments were carried out in 40 facilities in only 5 states. Selection was based on location, coverage, and minimum services offered. The facilities were divided randomly into 2 groups. The treatment group received quality-of-care assessment, continuous feedback, and improvement support, whereas the control group received quality assessment and no other support. Data were collected using the SafeCare Healthcare Standards and managed on the SafeCare Data Management System—AfriDB. Eight core areas were assessed at baseline and end line, and compliance to quality health-care standards was compared. Result: Outcomes from 40 facilities were accepted and analyzed. Overall scores increased in the treatment facilities compared to the control facilities, with strong evidence of improvement (t = 5.28, P = .0004) and 11% average improvement, but no clear pattern of improvement emerged in the control group. Conclusion: The study demonstrated governance support and active community involvement offered potential for quality improvement in primary health-care facilities. PMID:28462280

A review of water quality policies in relation to public good benefits and community engagement in rural Ireland

Directory of Open Access Journals (Sweden)

Daly Karen

2017-03-01

Full Text Available This paper examines current recreational water use in the rural landscape in Ireland and reviews current EU policies and national regulations aimed at protecting water quality and the wider environment under agri-environmental schemes. Specifically, we review policy instruments that protect water for recreational use, their impacts and the challenges they pose for rural development against current requirements to increase public awareness and participation. In Ireland, there is limited experience in public participation in water quality protection and restoration and we highlight how this can be addressed by focussing on the specific contribution of water quality in rural areas in relation to the provision of recreational ecosystem services. These services provide the infrastructure for much of Ireland’s rural tourism sector. In this context, emerging participatory approaches to policy implementation are also assessed as national and local government prioritise community engagement for the second cycle under the EU Water Framework Directive.

Hospital employment of physicians does not improve quality

OpenAIRE

Robbins RA

2016-01-01

No abstract available. Article truncated at 150 words. The Annals of Internal Medicine posted a manuscript online today reporting that the growing trend of physician employment by hospitals does not improve quality (1). In 2003, approximately 29% of hospitals employed members of their physician workforce, a number that rose to 42% by 2012. The authors conducted a retrospective cohort study of U.S. acute care hospitals between 2003 and 2012 and examined mortality rates, 30-day readmission rate...

Aging and quality of life of elderly people in rural areas.

Science.gov (United States)

Garbaccio, Juliana Ladeira; Tonaco, Luís Antônio Batista; Estêvão, Wilson Goulart; Barcelos, Bárbara Jacome

2018-01-01

To evaluate the quality of life and health of elderly in rural areas of Minas Gerais State's center-west. Cross-sectional study, in four municipalities of Minas Gerais State, by interviewing elderly people. Associations between socio-demographic and quality of life variables were tested, separated into "satisfactory"/"unsatisfactory" with values from the median of positive answers. It was used the chi-square test, Fisher's test and regression. 182 elderly answered the questions and showed a relation with the "satisfactory" quality of life - bivariate (p cognitive aspect, access to services, goods, habits, but awareness must be constant due to their weakness.

Relationship Between Hospital Performance on a Patient Satisfaction Survey and Surgical Quality.

Science.gov (United States)

Sacks, Greg D; Lawson, Elise H; Dawes, Aaron J; Russell, Marcia M; Maggard-Gibbons, Melinda; Zingmond, David S; Ko, Clifford Y

2015-09-01

The Centers for Medicare and Medicaid Services include patient experience as a core component of its Value-Based Purchasing program, which ties financial incentives to hospital performance on a range of quality measures. However, it remains unclear whether patient satisfaction is an accurate marker of high-quality surgical care. To determine whether hospital performance on a patient satisfaction survey is associated with objective measures of surgical quality. Retrospective observational study of participating American College of Surgeons National Surgical Quality Improvement Project (ACS NSQIP) hospitals. We used data from a linked database of Medicare inpatient claims, ACS NSQIP, the American Hospital Association annual survey, and Hospital Compare from December 2, 2004, through December 31, 2008. A total of 103 866 patients older than 65 years undergoing inpatient surgery were included. Hospitals were grouped by quartile based on their performance on the Hospital Consumer Assessment of Healthcare Providers and Systems survey. Controlling for preoperative risk factors, we created hierarchical logistic regression models to predict the occurrence of adverse postoperative outcomes based on a hospital's patient satisfaction scores. Thirty-day postoperative mortality, major and minor complications, failure to rescue, and hospital readmission. Of the 180 hospitals, the overall mean patient satisfaction score was 68.0% (first quartile mean, 58.7%; fourth quartile mean, 76.7%). Compared with patients treated at hospitals in the lowest quartile, those at the highest quartile had significantly lower risk-adjusted odds of death (odds ratio = 0.85; 95% CI, 0.73-0.99), failure to rescue (odds ratio = 0.82; 95% CI, 0.70-0.96), and minor complication (odds ratio = 0.87; 95% CI, 0.75-0.99). This translated to relative risk reductions of 11.1% (P = .04), 12.6% (P = .02), and 11.5% (P = .04), respectively. No significant relationship was noted between patient satisfaction

The combination of environmental quality with increasingly rural residence and associations with adverse birth outcomes

Science.gov (United States)

Environmental quality differs across levels of urbanicity, and both urban and rural residence having been previously associated with better health. To explore these relationships, we constructed an environmental quality index (EQI) with data representing five domains (air, water,...

Perceived quality of healthcare delivery in a rural District of Ghana ...

African Journals Online (AJOL)

Objective: The study aimed at finding out clients' perceptions of the quality of healthcare delivery at the district level in rural Ghana, using the Komenda-Edina- Eguafo-Abrem District as a case study. Design: 803 patients were purposively selected and interviewed after visits to health facilities using a pretested questionnaire, ...

Educational Quality Differences in a Middle-Income Country: The Urban-Rural Gap in Malaysian Primary Schools

Science.gov (United States)

Othman, Mariam; Muijs, Daniel

2013-01-01

Shortcomings of educational quality in rural schools remain a key focus in the literature related to developing countries. This paper studies whether rural primary schools in Malaysia, an upper middle-income developing country, are still experiencing lower levels of educational resources, school climate, school leadership, and parental involvement…

[Quality management according to DIN EN ISO 9001 at a university eye hospital].

Science.gov (United States)

Schönherr, U; Händel, A; Naumann, G O

2001-02-01

Quality assurance is an integral part of modern microsurgical ophthalmology. Health care laws also mandate overall quality management. In recent years we have standardized the preexisting features of quality management according DIN EN ISO 9001 and have integrated previously missing features. Establishing quality management according to ISO 9001 is possible even at a university eye hospital and department of ophthalmology. Certification according to ISO 9001 specifications was granted in April 1999. The major difficulty was in translating industrial norms to the context of an eye hospital. It was also difficult to overcome skepticism towards quality-assurance measures that lie beyond ophthalmological quality control. It is useful and feasible to establish a quality management system at German university eye hospitals and departments of ophthalmology. Certification according to ISO 9001 is one possibility to make a quality management system transparent and evaluable both inside and outside the hospital.

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

Science.gov (United States)

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

2017-06-01

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

Determinants of quality management systems implementation in hospitals.

Science.gov (United States)

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

2009-03-01

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

Problems with provision: barriers to drinking water quality and public health in rural Tasmania, Australia.

Science.gov (United States)

Whelan, Jessica J; Willis, Karen

2007-01-01

Access to safe drinking water is essential to human life and wellbeing, and is a key public health issue. However, many communities in rural and regional parts of Australia are unable to access drinking water that meets national standards for protecting human health. The aim of this research was to identify the key issues in and barriers to the provision and management of safe drinking water in rural Tasmania, Australia. Semi-structured interviews were conducted with key local government employees and public health officials responsible for management of drinking water in rural Tasmania. Participants were asked about their core public health duties, regulatory responsibilities, perceptions and management of risk, as well as the key barriers that may be affecting the provision of safe drinking water. This research highlights the effect of rural locality on management and safety of fresh water in protecting public health. The key issues contributing to problems with drinking water provision and quality identified by participants included: poor and inadequate water supply infrastructure; lack of resources and staffing; inadequate catchment monitoring; and the effect of competing land uses, such as forestry, on water supply quality. This research raises issues of inequity in the provision of safe drinking water in rural communities. It highlights not only the increasing need for greater funding by state and commonwealth government for basic services such as drinking water, but also the importance of an holistic and integrated approach to managing drinking water resources in rural Tasmania.

Quality management and patient safety: survey results from 102 Hungarian hospitals.

NARCIS (Netherlands)

Makai, P.; Klazinga, N.; Wagner, C.; Boncz, I.; Gulácsi, L.

2009-01-01

OBJECTIVES: The aim of this study is to describe the development of quality management systems in Hungarian hospitals. It also aims to answer the policy question, whether a separate patient safety policy should be created additional to quality policies, on national as well as hospital level. METHOD:

Variations in fresh fruit and vegetable quality by store type, urban-rural setting and neighbourhood deprivation in Scotland.

Science.gov (United States)

Cummins, Steven; Smith, Dianna M; Taylor, Mathew; Dawson, John; Marshall, David; Sparks, Leigh; Anderson, Annie S

2009-11-01

Neighbourhood differences in access to fresh fruit and vegetables may explain social inequalities in diet. Investigations have focused on variations in cost and availability as barriers to the purchase and consumption of fresh produce; investigations of quality have been neglected. Here we investigate whether produce quality systematically varies by food store type, rural-urban location and neighbourhood deprivation in a selection of communities across Scotland. Cross-sectional survey of twelve fresh fruit and vegetable items in 288 food stores in ten communities across Scotland. Communities were selected to reflect a range of urban-rural settings and a food retail census was conducted in each location. The quality of twelve fruit and vegetable items within each food store was evaluated. Data from the Scottish Executive were used to characterise each small area by deprivation and urban-rural classification. Scotland. Quality of fruit and vegetables within the surveyed stores was high. Medium-sized stores, stores in small town and rural areas, and stores in more affluent areas tended to have the highest-quality fresh fruit and vegetables. Stores where food is secondary, stores in urban settings and stores in more deprived areas tended have the lowest-quality fresh produce. Although differences in quality were not always statistically significant, patterns were consistent for the majority of fruit and vegetable items. The study provides evidence that variations in food quality may plausibly be a micro-environmental mediating variable in food purchase and consumption and help partially explain neighbourhood differences in food consumption patterns.

Effects of Biosolids and Manure Application on Microbial Water Quality in Rural Areas in the US

Directory of Open Access Journals (Sweden)

Amira Oun

2014-11-01

Full Text Available Most of the waterborne disease outbreaks observed in North America are associated with rural drinking water systems. The majority of the reported waterborne outbreaks are related to microbial agents (parasites, bacteria and viruses. Rural areas are characterized by high livestock density and lack of advanced treatment systems for animal and human waste, and wastewater. Animal waste from livestock production facilities is often applied to land without prior treatment. Biosolids (treated municipal wastewater sludge from large wastewater facilities in urban areas are often transported and applied to land in rural areas. This situation introduces a potential for risk of human exposure to waterborne contaminants such as human and zoonotic pathogens originating from manure, biosolids, and leaking septic systems. This paper focuses on waterborne outbreaks and sources of microbial pollution in rural areas in the US, characterization of the microbial load of biosolids and manure, association of biosolid and manure application with microbial contamination of surface and groundwater, risk assessment and best management practice for biosolids and manure application to protect water quality. Gaps in knowledge are identified, and recommendations to improve the water quality in the rural areas are discussed.

Variation in Surgical Quality Measure Adherence within Hospital Referral Regions: Do Publicly Reported Surgical Quality Measures Distinguish among Hospitals That Patients Are Likely to Compare?

Science.gov (United States)

Safavi, Kyan C; Dai, Feng; Gilbertsen, Todd A; Schonberger, Robert B

2014-01-01

Objective To determine whether surgical quality measures that Medicare publicly reports provide a basis for patients to choose a hospital from within their geographic region. Data Source The Department of Health and Human Services' public reporting website, Medicare Claims Processing Manual Baltimore, MD CMS http://www.medicare.gov/hospitalcompare. Study Design We identified hospitals (n = 2,953) reporting adherence rates to the quality measures intended to reduce surgical site infections (Surgical Care Improvement Project, 1–3) in 2012. We defined regions within which patients were likely to compare hospitals using the hospital referral regions (HRRs) from the Dartmouth Atlas of Health Care Project. We described distributions of reported SCIP adherence within each HRR, including medians, interquartile ranges (IQRs), skewness, and outliers. Principal Findings Ninety-seven percent of HRRs had median SCIP-1 scores ≥95 percent. In 93 percent of HRRs, half of the hospitals in the HRR were within 5 percent of the median hospital's score. In 62 percent of HRRs, hospitals were skewed toward the higher rates (negative skewness). Seven percent of HRRs demonstrated positive skewness. Only 1 percent had a positive outlier. SCIP-2 and SCIP-3 demonstrated similar distributions. Conclusions Publicly reported quality measures for surgical site infection prevention do not distinguish the majority of hospitals that patients are likely to choose from when selecting a surgical provider. More studies are needed to improve public reporting's ability to positively impact patient decision making. PMID:24611578

A survey of medical quality assurance programs in Ontario hospitals.

OpenAIRE

Barrable, B

1992-01-01

OBJECTIVE: To determine the prevalence and types of medical quality assurance practices in Ontario hospitals. DESIGN: Survey. SETTING: All teaching, community, chronic care, rehabilitation and psychiatric hospitals that were members of the Ontario Hospital Association as of May 1990. PARTICIPANTS: The person deemed by the chief executive officer of each hospital to be most responsible for medical administration. INTERVENTION: A questionnaire to obtain information on each hospital's use of cri...

Quality assurance and organizational effectiveness in hospitals.

OpenAIRE

Hetherington, R W

1982-01-01

The purpose of this paper is to explore some aspects of a general theoretical model within which research on the organizational impacts of quality assurance programs in hospitals may be examined. Quality assurance is conceptualized as an organizational control mechanism, operating primarily through increased formalization of structures and specification of procedures. Organizational effectiveness is discussed from the perspective of the problem-solving theory of organizations, wherein effecti...

Assessing competition in hospital care markets: the importance of accounting for quality differentiation.

Science.gov (United States)

Tay, Abigail

2003-01-01

Quality differentiation is especially important in the hospital industry, where the choices of Medicare patients are unaffected by prices. Unlike previous studies that use geographic market concentration to estimate hospital competitiveness, this article emphasizes the importance of quality differentiation in this spatially differentiated market. I estimate a random-coefficients discrete-choice model that predicts patient flow to different hospitals and find that demand responses to both distance and quality are substantial. The estimates suggest that patients do not substitute toward alternative hospitals in proportion to current market shares, implying that geographic market concentration is an inappropriate measure of hospital competitiveness.

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

Directory of Open Access Journals (Sweden)

Alibhai Arif

2011-11-01

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

Factor selection for service quality evaluation: a hospital case study.

Science.gov (United States)

Ameryoun, Ahmad; Najafi, Seyedvahid; Nejati-Zarnaqi, Bayram; Khalilifar, Seyed Omid; Ajam, Mahdi; Ansarimoghadam, Ahmad

2017-02-13

Purpose The purpose of this paper is to develop a systematic approach to predict service quality dimension's influence on service quality using a novel analysis based on data envelopment and SERVQUAL. Design/methodology/approach To assess hospital service quality in Tehran, expectation and perception of those who received the services were evaluated using SERVQUAL. The hospital service quality dimensions were found by exploratory factor analysis (EFA). To compare customer expectation and perception, perceived service quality index (PSQI) was measured using a new method based on common weights. A novel sensitivity approach was used to test the service quality factor's impact on the PSQI. Findings A new service quality dimension named "trust in services" was found using EFA, which is not an original SERVQUAL factor. The approach was applied to assess the hospital's service quality. Since the PSQI value was 0.76 it showed that improvements are needed to meet customer expectations. The results showed the factor order that affect PSQI. "Trust in services" has the strongest influence on PSQI followed by "tangibles," "assurance," "empathy," and "responsiveness," respectively. Practical implications This work gives managers insight into service quality by following a systematic method; i.e., measuring perceived service quality from the customer viewpoint and service factors' impact on customer perception. Originality/value The procedure helps managers to select the required service quality dimensions which need improvement and predict their effects on customer perception.

CT scanning in stroke patients: meeting the challenge in the remote and rural district general hospital.

Science.gov (United States)

Todd, A W; Anderson, E M

2009-05-01

National audit data allow crude comparison between centres and indicate that most Scottish hospitals fail to meet current guidelines for CT scanning of the brain in stroke patients. This study identifies some of the reasons for delay in performing CT scans in a largely rural population. This audit study assesses the delays from onset of symptoms, time of admission and request received to CT scan in stroke patients for three different in-patient groups as well as those managed in the community. The reasons for delay in CT scanning varied between different patient groups but for one group of in-patients, changes in booking procedure and introduction of a second CT scanner increased the proportion scanned within 48 hours of request from 65% to 96%. Further developments including the introduction of Saturday and Sunday routine CT scanning, radiologist reporting from home and additional CT scanners placed in remote hospitals may be expected to improve these figures further. Target times of three hours from onset of symptoms to scan to allow thrombolysis may however be impossible to meet for all stroke patients in rural areas.

Using creative problem solving (TRIZ) in improving the quality of hospital services.

Science.gov (United States)

LariSemnani, Behrouz; Mohebbi Far, Rafat; Shalipoor, Elham; Mohseni, Mohammad

2014-08-14

TRIZ is an initiative and SERVQUAL is a structured methodology for quality improvement. Using these tools, inventive problem solving can be applied for quality improvement, and the highest quality can be reached using creative quality improvement methodology. The present study seeks to determine the priority of quality aspects of services provided for patients in the hospital as well as how TRIZ can help in improving the quality of those services. This Study is an applied research which used a dynamic qualitative descriptive survey method during year 2011. Statistical population includes every patient who visited in one of the University Hospitals from March 2011. There existed a big gap between patients' expectations from what seemingly is seen (the design of the hospital) and timely provision of services with their perceptions. Also, quality aspects of services were prioritized as follows: keeping the appearance of hospital (the design), accountability, assurance, credibility and having empathy. Thus, the only thing which mattered most for all staff and managers of studied hospital was the appearance of hospital as well as its staff look. This can grasp a high percentage of patients' satisfaction. By referring to contradiction matrix, the most important principles of TRIZ model were related to tangible factors including principles No. 13 (discarding and recovering), 25 (self-service), 35 (parameter changes), and 2 (taking out). Furthermore, in addition to these four principles, principle No. 24 (intermediary) was repeated most among the others. By utilizing TRIZ, hospital problems can be examined with a more open view, Go beyond The conceptual framework of the organization and responded more quickly to patients ' needs.

Retrospective study of antibiotic resistance among uropathogens from rural teaching hospital, Tamilnadu, India

Directory of Open Access Journals (Sweden)

Kasi Murugan

2012-10-01

Full Text Available Objective: To determine the community associated urinary tract infection (UTI causing uropathogen's prevalence, antibiotic resistance pattern and the risk factors predisposing infection in Indian rural settings. Methods: A pilot study was conducted between January and December 201 0 among out patients attending rural teaching medical college hospital at Tamilnadu, India. The demographic details, culture, common antibiotic Kirby-Bauer disc diffusion assay susceptibility profiles of the isolates and the resistance analysis by WHONET 5.6 software were performed. Results: During this surveillance study, a total number of 1 359 urinary samples were collected, among which 309 (22.78% gave positive culture. The common uropathogens encountered were Escherichia coli (66.02%, Staphylococcus sp. (12.62%, Klebsiella sp. (5.83%, Streptococcus sp. (5.1 8%, Enterococcus sp. (2.59% and Proteus sp., (2.26%. Antibiotic resistance analysis revealed the multiple drug resistance nature of the isolates to the commonly used antibiotics. It is also found that both genders at the specific age group of 40-50 were more prone to infection and seasonal variations also play an important role in their establishment. Conclusions: The obtained results suggest that antibiotic selection for empirical treatment should be based on individual drug-sensitive test results. There is also an urgent need to develop a new combination of chemotherapeutic agents and awareness on antibiotic use for the effective UTI management in rural settings.

MEMBANGUN SERVICE QUALITY UNTUK MENCAPAI KEPUASAN KONSUMEN DI INDUSTRI HOSPITALITY

Directory of Open Access Journals (Sweden)

Sienny Thio

2001-01-01

Full Text Available Service quality is necessary especially in the hospitality industry, remembering that consumers have expectations that must be fulfilled and satisfied. Consumers often expect to get maximal service from the service providers and wish to be treated professionally and as a unique individual. This paper seeks to give a further idea about service quality which can be developed and done by service providers with the hope of fulfilling consumer expectations and finally to satisfy all consumers, both internal and external to the company. Abstract in Bahasa Indonesia : Service Quality sangat dibutuhkan terutama di industri hospitality mengingat konsumen yang mempunyai ekspektasi yang selalu ingin dipenuhi dan dipuaskan. Konsumen selalu mengharapkan untuk mendapatkan service yang maksimal dari para penyedia jasa dalam hal ingin diperlakukan secara professional, dan diperlakukan sebagai individu yang unik. Tulisan ini dimaksudkan untuk memberikan gambaran yang lebih jauh mengenai service quality yang dapat dibangun dan dilakukan oleh para penyedia jasa yang diharapkan dapat memenuhi ekspektasi dari konsumen yang pada akhirnya dapat memuaskan eksternal konsumen maupun internal konsumen. Kata kunci: hospitality, service quality, ekspektasi, kepuasan, penyedia jasa.

National Quality Forum Colon Cancer Quality Metric Performance: How Are Hospitals Measuring Up?

Science.gov (United States)

Mason, Meredith C; Chang, George J; Petersen, Laura A; Sada, Yvonne H; Tran Cao, Hop S; Chai, Christy; Berger, David H; Massarweh, Nader N

2017-12-01

To evaluate the impact of care at high-performing hospitals on the National Quality Forum (NQF) colon cancer metrics. The NQF endorses evaluating ≥12 lymph nodes (LNs), adjuvant chemotherapy (AC) for stage III patients, and AC within 4 months of diagnosis as colon cancer quality indicators. Data on hospital-level metric performance and the association with survival are unclear. Retrospective cohort study of 218,186 patients with resected stage I to III colon cancer in the National Cancer Data Base (2004-2012). High-performing hospitals (>75% achievement) were identified by the proportion of patients achieving each measure. The association between hospital performance and survival was evaluated using Cox shared frailty modeling. Only hospital LN performance improved (15.8% in 2004 vs 80.7% in 2012; trend test, P fashion [0 metrics, reference; 1, hazard ratio (HR) 0.96 (0.89-1.03); 2, HR 0.92 (0.87-0.98); 3, HR 0.85 (0.80-0.90); 2 vs 1, HR 0.96 (0.91-1.01); 3 vs 1, HR 0.89 (0.84-0.93); 3 vs 2, HR 0.95 (0.89-0.95)]. Performance on metrics in combination was associated with lower risk of death [LN + AC, HR 0.86 (0.78-0.95); AC + timely AC, HR 0.92 (0.87-0.98); LN + AC + timely AC, HR 0.85 (0.80-0.90)], whereas individual measures were not [LN, HR 0.95 (0.88-1.04); AC, HR 0.95 (0.87-1.05)]. Less than half of hospitals perform well on these NQF colon cancer metrics concurrently, and high performance on individual measures is not associated with improved survival. Quality improvement efforts should shift focus from individual measures to defining composite measures encompassing the overall multimodal care pathway and capturing successful transitions from one care modality to another.

Unpredictability dictates quality of maternal and newborn care provision in rural Tanzania-A qualitative study of health workers' perspectives.

Science.gov (United States)

Baker, Ulrika; Hassan, Farida; Hanson, Claudia; Manzi, Fatuma; Marchant, Tanya; Swartling Peterson, Stefan; Hylander, Ingrid

2017-02-06

Health workers are the key to realising the potential of improved quality of care for mothers and newborns in the weak health systems of Sub Saharan Africa. Their perspectives are fundamental to understand the effectiveness of existing improvement programs and to identify ways to strengthen future initiatives. The objective of this study was therefore to examine health worker perspectives of the conditions for maternal and newborn care provision and their perceptions of what constitutes good quality of care in rural Tanzanian health facilities. In February 2014, we conducted 17 in-depth interviews with different cadres of health workers providing maternal and newborn care in 14 rural health facilities in Tandahimba district, south-eastern Tanzania. These facilities included one district hospital, three health centres and ten dispensaries. Interviews were conducted in Swahili, transcribed verbatim and translated into English. A grounded theory approach was used to guide the analysis, the output of which was one core category, four main categories and several sub-categories. 'It is like rain' was identified as the core category, delineating unpredictability as the common denominator for all aspects of maternal and newborn care provision. It implies that conditions such as mothers' access to and utilisation of health care are unreliable; that availability of resources is uncertain and that health workers have to help and try to balance the situation. Quality of care was perceived to vary as a consequence of these conditions. Health workers stressed the importance of predictability, of 'things going as intended', as a sign of good quality care. Unpredictability emerged as a fundamental condition for maternal and newborn care provision, an important determinant and characteristic of quality in this study. We believe that this finding is also relevant for other areas of care in the same setting and may be an important defining factor of a weak health system. Increasing

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

Science.gov (United States)

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

2013-01-01

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

Analysis of the quality of hospital information systems Audit Trails.

Science.gov (United States)

Cruz-Correia, Ricardo; Boldt, Isabel; Lapão, Luís; Santos-Pereira, Cátia; Rodrigues, Pedro Pereira; Ferreira, Ana Margarida; Freitas, Alberto

2013-08-06

Audit Trails (AT) are fundamental to information security in order to guarantee access traceability but can also be used to improve Health information System's (HIS) quality namely to assess how they are used or misused. This paper aims at analysing the existence and quality of AT, describing scenarios in hospitals and making some recommendations to improve the quality of information. The responsibles of HIS for eight Portuguese hospitals were contacted in order to arrange an interview about the importance of AT and to collect audit trail data from their HIS. Five institutions agreed to participate in this study; four of them accepted to be interviewed, and four sent AT data. The interviews were performed in 2011 and audit trail data sent in 2011 and 2012. Each AT was evaluated and compared in relation to data quality standards, namely for completeness, comprehensibility, traceability among others. Only one of the AT had enough information for us to apply a consistency evaluation by modelling user behaviour. The interviewees in these hospitals only knew a few AT (average of 1 AT per hospital in an estimate of 21 existing HIS), although they all recognize some advantages of analysing AT. Four hospitals sent a total of 7 AT - 2 from Radiology Information System (RIS), 2 from Picture Archiving and Communication System (PACS), 3 from Patient Records. Three of the AT were understandable and three of the AT were complete. The AT from the patient records are better structured and more complete than the RIS/PACS. Existing AT do not have enough quality to guarantee traceability or be used in HIS improvement. Its quality reflects the importance given to them by the CIO of healthcare institutions. Existing standards (e.g. ASTM:E2147, ISO/TS 18308:2004, ISO/IEC 27001:2006) are still not broadly used in Portugal.

Quality Indicators for Quality of Care During Hospitalization for Vulnerable Elder Persons

National Research Council Canada - National Science Library

Kleerup, Eric

2004-01-01

.... While many of the above conditions, such as congestive heart failure, pressure ulcers, and ischemic heart disease, contain indicators for the quality of hospital care associated with that condition...

Gender differences in job quality and job satisfaction among doctors in rural western China.

Science.gov (United States)

Miao, Yang; Li, Lingui; Bian, Ying

2017-12-28

Few studies about gender differences in job quality and job satisfaction among medical professionals have been carried out in China. So the objectives of this study were to examine whether and to what extent gender differences existed in job quality and job satisfaction of doctors in rural western China. From 2009 to 2011, a total of 1472 doctors from 103 selected county-level health care facilities in rural western China were recruited into the study. Information about the doctors' demographic characteristics, job quality, and job satisfaction was collected through a designed questionnaire. Besides examining gender differences in single dimensions of job quality and job satisfaction, principal component analysis was used to construct a composite job quality index to measure the differences in the comprehensive job quality, and exploratory factor analysis was applied to evaluate the differences in the overall job satisfaction. Chi-square test was used to calculate differences between proportions, and t-test was used to compare differences between means. Among the doctors, there were 705 males and 767 females (ratio 1:1.09). Male doctors had significantly higher monthly salaries, longer working hours, more times of night shifts per month, longer continuous working hours, and longer years of service at current facilities, and marginally significantly higher hourly wage and longer years of service in current professions. However, female doctors showed greater overall job qualities. Significant and marginally significant gender differences were only found in satisfaction with remuneration compared to workload, the chance of promotion and working environment. But female showed greater satisfaction in the overall job satisfaction and the factor including sub-aspects of working environment, remuneration compared to workload, the chance of promotion, utilization of subjective initiative, and sense of achievement. Gender differences in job quality and job satisfaction did

Temporal variations of surface water quality in urban, suburban and rural areas during rapid urbanization in Shanghai, China

International Nuclear Information System (INIS)

Wang Junying; Da Liangjun; Song Kun; Li Bailian

2008-01-01

As the economic and financial center of China, Shanghai has experienced an extensive urban expansion since the early 1980s, with an attendant cost in environmental degradation. We use an integrated pollution index to study the temporal variations of surface water quality in urban, suburban and rural areas between 1982 and 2005. Data on monitored cross-sections were collected from the Shanghai Environmental Monitoring Center. The results indicated that the spatial pattern of surface water quality was determined by the level of urbanization. Surface water qualities in urban and suburban areas were improved by strengthening the environmental policies and management, but were worsening in rural areas. The relationship between economic growth and surface water quality in Shanghai showed an inversed-U-shaped curve, which reflected a similar pattern in most developed countries. This research suggests that decision makers and city officials should be more aware of the recent pollution increases in Shanghai. - An integrated pollution index documents the deterioration of water quality in greater Shanghai, recently most serious in rural sections

Assessing the Organizational Characteristics Influencing Quality Improvement Implementation in Saudi Hospitals.

Science.gov (United States)

Shamsuddin Alaraki, Mohammad

The health care system in Saudi Arabia has serious problems with quality and safety that can be reduced through systematic quality improvement (QI) activities. Despite the use of different QI models to improve health care in Saudi hospitals during the last 2 decades, consistent improvements have not yet been achieved and the results are still far below expectations. This may reflect a problem in introducing and implementing the QI models in the local contexts. The objective of this study is to assess the extent of QI implementation in Saudi hospitals and to identify the organizational characteristics that make Saudi hospitals particularly challenging for QI. Understanding these characteristics can inform efforts to improve them and may lead to more successful implementation. A mixed-methods approach was conducted using 2 data collection tools: questionnaires and interviews. The quantitative phase (questionnaires) aimed to uncover the current level of QI implementation in Saudi hospital as measured by 7 critical dimensions adapted from the literature. The qualitative phase (interviews) aimed to understand the organizational characteristics that impede or underpin QI in Saudi hospitals. The QI implementation was found to be significantly poor across the 7 dimensions with average score ranging between 22.80 ± 0.57 and 2.11 ± 0.69 on a 5-point Likert scale and with P value of less than .05. We also found that the current level of QI implementation helped Saudi hospitals neither to improve "customer satisfaction" nor to achieve measurable improvements in "quality results" scoring significantly low at 2.11 ± 0.69 with P value of .000 and 2.47 ± 0.57 with P value of .000, respectively. Our study confirms the presence of a multitude of organizational barriers that impede QI in Saudi hospitals. These are related to organizational culture, human resources management, processes and systems, and structure. These 4 were found to have the strongest impact on QI in Saudi

The associations between organizational culture, organizational structure and quality management in European hospitals.

Science.gov (United States)

Wagner, C; Mannion, R; Hammer, A; Groene, O; Arah, O A; Dersarkissian, M; Suñol, R

2014-04-01

To better understand associations between organizational culture (OC), organizational management structure (OS) and quality management in hospitals. A multi-method, multi-level, cross-sectional observational study. As part of the DUQuE project (Deepening our Understanding of Quality improvement in Europe), a random sample of 188 hospitals in 7 countries (France, Poland, Turkey, Portugal, Spain, Germany and Czech Republic) participated in a comprehensive questionnaire survey and a one-day on-site surveyor audit. Respondents for this study (n = 158) included professional quality managers and hospital trustees. Extent of implementation of quality management systems, extent of compliance with existing management procedures and implementation of clinical quality activities. Among participating hospitals, 33% had a clan culture as their dominant culture type, 26% an open and developmental culture type, 16% a hierarchical culture type and 25% a rational culture type. The culture type had no statistically significant association with the outcome measures. Some structural characteristics were associated with the development of quality management systems. The type of OC was not associated with the development of quality management in hospitals. Other factors (not culture type) are associated with the development of quality management. An OS that uses fewer protocols is associated with a less developed quality management system, whereas an OS which supports innovation in care is associated with a more developed quality management system.

Increasing the availability and quality of caesarean section in Tanzania.

Science.gov (United States)

Nyamtema, A; Mwakatundu, N; Dominico, S; Mohamed, H; Shayo, A; Rumanyika, R; Kairuki, C; Nzabuhakwa, C; Issa, O; Lyimo, C; Kasiga, I; van Roosmalen, J

2016-09-01

To describe the results of increasing availability and quality of caesarean deliveries and anaesthesia in rural Tanzania. Before-after intervention study design. Rural Tanzania. Ten health centres located in rural areas were upgraded to provide comprehensive emergency obstetric care (CEmOC) and the four related district hospitals were supported. Upgrading entailed constructing and equipping maternity blocks, operation rooms and laboratories; installing solar systems, backup generators and water supply systems. Associate clinicians were trained in anaesthesia and in CEmOC. Mentoring and audit of reasons for caesarean section (CS) and maternal deaths were carried out. Measures of interest were compared using analysis of variance (ANOVA) statistical tests. Trends in CS rates, proportion of unjustified CS, use of spinal anaesthesia, and the risk of death from complications related to CS and anaesthesia. During the audit period (2012-2014), 5868 of 58 751 deliveries were by CS (10%). The proportion of CS considered to be unjustified decreased from 30 to 17% in health centres (P = 0.02) and from 37 to 20% in hospitals (P availability and quality of CS by improving infrastructure, training and audit of reasons for CS is feasible, acceptable and required in low resource settings. Increasing availability and quality of CS in rural Africa is feasible. © 2016 Royal College of Obstetricians and Gynaecologists.

Assessment of Groundwater Quality in a Typical Rural Settlement in Southwest Nigeria

Directory of Open Access Journals (Sweden)

O. B. Banjoko

2007-12-01

Full Text Available In most rural settlements in Nigeria, access to clean and potable water is a great challenge, resulting in water borne diseases. The aim of this study was to assess the levels of some physical, chemical, biochemical and microbial water quality parameters in twelve hand – dug wells in a typical rural area (Igbora of southwest region of the country. Seasonal variations and proximity to pollution sources (municipal waste dumps and defecation sites were also examined. Parameters were determined using standard procedures. All parameters were detected up to 200 m from pollution source and most of them increased in concentration during the rainy season over the dry periods, pointing to infiltrations from storm water. Coliform population, Pb, NO3- and Cd in most cases, exceeded the World Health Organization recommended thresholds for potable water. Effect of distance from pollution sources was more pronounced on fecal and total coliform counts, which decreased with increasing distance from waste dumps. The qualities of the well water samples were therefore not suitable for human consumption without adequate treatment. Regular monitoring of groundwater quality, abolishment of unhealthy waste disposal practices and introduction of modern techniques are recommended.

Quality of care and investment in property, plant, and equipment in hospitals.

Science.gov (United States)

Levitt, S W

1994-02-01

This study explores the relationship between quality of care and investment in property, plant, and equipment (PPE) in hospitals. Hospitals' investment in PPE was derived from audited financial statements for the fiscal years 1984-1989. Peer Review Organization (PRO) Generic Quality Screen (GQS) reviews and confirmed failures between April 1989 and September 1990 were obtained from the Massachusetts PRO. Weighted least squares regression models used PRO GQS confirmed failure rates as the dependent variable, and investment in PPE as the key explanatory variable. Investment in PPE was standardized, summed by the hospital over the six years, and divided by the hospital's average number of beds in that period. The number of PRO reviewed cases with one or more GQS confirmed failures was divided by the total number of cases reviewed to create confirmed failure rates. Investment in PPE in Massachusetts hospitals is correlated with GQS confirmed failure rates. A financial variable, investment in PPE, predicts certain dimensions of quality of care in hospitals.

Are performance indicators used for hospital quality management: a qualitative interview study amongst health professionals and quality managers in The Netherlands.

Science.gov (United States)

Botje, Daan; Ten Asbroek, Guus; Plochg, Thomas; Anema, Helen; Kringos, Dionne S; Fischer, Claudia; Wagner, Cordula; Klazinga, Niek S

2016-10-13

Hospitals are under increasing pressure to share indicator-based performance information. These indicators can also serve as a means to promote quality improvement and boost hospital performance. Our aim was to explore hospitals' use of performance indicators for internal quality management activities. We conducted a qualitative interview study among 72 health professionals and quality managers in 14 acute care hospitals in The Netherlands. Concentrating on orthopaedic and oncology departments, our goal was to gain insight into data collection and use of performance indicators for two conditions: knee and hip replacement surgery and breast cancer surgery. The semi-structured interviews were recorded and summarised. Based on the data, themes were synthesised and the analyses were executed systematically by two analysts independently. The findings were validated through comparison. The hospitals we investigated collect data for performance indicators in different ways. Similarly, these hospitals have different ways of using such data to support their quality management, while some do not seem to use the data for this purpose at all. Factors like 'linking pin champions', pro-active quality managers and engaged medical specialists seem to make a difference. In addition, a comprehensive hospital data infrastructure with electronic patient records and robust data collection software appears to be a prerequisite to produce reliable external performance indicators for internal quality improvement. Hospitals often fail to use performance indicators as a means to support internal quality management. Such data, then, are not used to its full potential. Hospitals are recommended to focus their human resource policy on 'linking pin champions', the engagement of professionals and a pro-active quality manager, and to invest in a comprehensive data infrastructure. Furthermore, the differences in data collection processes between Dutch hospitals make it difficult to draw

Three-level quality assessment of a dental hospital using EFQM.

Science.gov (United States)

Vakani, Farhan; Fatmi, Zafar; Naqvi, Kashif

2011-01-01

This article aims to measure quality by applying the European Foundation for Quality Management (EFQM) excellence model at three different participation levels, in a Karachi teaching university dental hospital. The case study assessed the eight EFQM model excellence concepts as benchmarks for providing quality services: results orientation; customer focus; leadership and constancy of purpose; management by processes and facts; people development and involvement; continuous learning, innovation and improvement; partnership development; and corporate social responsibility. This study was conducted at Hamdard University Dental Hospital (HUDH), located in Karachi - part of the largest privately-owned university in Pakistan. Data were collected through in-depth interviews with internal stakeholders at three levels (management, faculty and student). Continuous learning, innovation and improvement; partnership development; and corporate social responsibility were satisfactorily represented. The EFQM assessment was limited to a single university dental hospital, hence findings cannot be generalized. The article highlights that it is envisaged that this exercise will bring about a positive change in attitude and will stimulate institute staff to kick start the self assessment process and implement measures leading to better quality practices, thus establishing a continuous quality improvement cycle.

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

Science.gov (United States)

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

2013-01-01

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

Hospital employment of physicians does not improve quality

Directory of Open Access Journals (Sweden)

Robbins RA

2016-09-01

Full Text Available No abstract available. Article truncated at 150 words. The Annals of Internal Medicine posted a manuscript online today reporting that the growing trend of physician employment by hospitals does not improve quality (1. In 2003, approximately 29% of hospitals employed members of their physician workforce, a number that rose to 42% by 2012. The authors conducted a retrospective cohort study of U.S. acute care hospitals between 2003 and 2012 and examined mortality rates, 30-day readmission rates, length of stay, and patient satisfaction scores for common medical conditions for 803 hospitals that switched to the employment model compared with 2085 control hospitals that did not switch. 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 <0.001. The authors used Medicare Provider Analysis and Review File (MedPAR from 2002 to 2013 to calculate hospital-level risk-adjusted performance on mortality ...

The trade-off between hospital cost and quality of care. An exploratory empirical analysis.

Science.gov (United States)

Morey, R C; Fine, D J; Loree, S W; Retzlaff-Roberts, D L; Tsubakitani, S

1992-08-01

The debate concerning quality of care in hospitals, its "value" and affordability, is increasingly of concern to providers, consumers, and purchasers in the United States and elsewhere. We undertook an exploratory study to estimate the impact on hospital-wide costs if quality-of-care levels were varied. To do so, we obtained costs and service output data regarding 300 U.S. hospitals, representing approximately a 5% cross section of all hospitals operating in 1983; both inpatient and outpatient services were included. The quality-of-care measure used for the exploratory analysis was the ratio of actual deaths in the hospital for the year in question to the forecasted number of deaths for the hospital; the hospital mortality forecaster had earlier (and elsewhere) been built from analyses of 6 million discharge abstracts, and took into account each hospital's actual individual admissions, including key patient descriptors for each admission. Such adjusted death rates have increasingly been used as potential indicators of quality, with recent research lending support for the viability of that linkage. The authors then utilized the economic construct of allocative efficiency relying on "best practices" concepts and peer groupings, built using the "envelopment" philosophy of Data Envelopment Analysis and Pareto efficiency. These analytical techniques estimated the efficiently delivered costs required to meet prespecified levels of quality of care. The marginal additional cost per each death deferred in 1983 was estimated to be approximately $29,000 (in 1990 dollars) for the average efficient hospital. Also, over a feasible range, a 1% increase in the level of quality of care delivered was estimated to increase hospital cost by an average of 1.34%. This estimated elasticity of quality on cost also increased with the number of beds in the hospital.

Adoption of new HIV treatment guidelines and drug substitutions within first-line as a measure of quality of care in rural Lesotho: health centers and hospitals compared.

Science.gov (United States)

Labhardt, Niklaus D; Sello, Motlalepula; Lejone, Thabo; Ehmer, Jochen; Mokhantso, Mohlaba; Lynen, Lutgarde; Pfeiffer, Karolin

2012-10-01

In 2007, Lesotho launched new national antiretroviral treatment (ART) guidelines, prioritising tenofovir and zidovudine over stavudine as a backbone together with lamivudine. We compared the rate of adoption of these new guidelines and substitution of first-line drugs by health centers (HC) and hospitals in two catchment areas in rural Lesotho. Retrospective cohort analysis. Patients aged ≥16 years were stratified into a HC- and a hospital-group. Type of backbone at ART-initiation (i), substitutions within first line (ii) and type of backbone among patients retained by December 2010 (iii). A multiple logistic regression model including HC vs. hospital, patient characteristics (sex, age, WHO-stage, baseline CD4-count, concurrent pregnancy, concurrent tuberculosis treatment) and year of ART-start, was used. Of 3936 adult patients initiated on ART between 2007 and 2010, 1971 started at hospitals and 1965 at HCs. Hospitals were more likely to follow the new guidelines as measured by prescription of backbones without stavudine (Odds-ratio 1.55; 95%CI: 1.32-1.81) and had a higher rate of drug substitutions while on first-line ART (2.39; 1.83-3.13). By December 2010, patients followed at health centres were more likely to still receive stavudine (2.28; 1.83-2.84). Health centers took longer to adopt the new guidelines and substituted drugs less frequently. Decentralised ART-programmes need close support, supervision and mentoring to absorb new guidelines and to adhere to them. © 2012 Blackwell Publishing Ltd.

Networking the rural community.

Science.gov (United States)

Tiongson, K H; Arneson, S I

1993-04-01

A branch network of affiliate hospitals has been providing home care services to rural North Dakota residents successfully for a decade. Here's how this effective system meets the special challenges that a rural environment poses for hiring, training, scheduling, and supporting home care aides.

DUQuE quality management measures: associations between quality management at hospital and pathway levels

NARCIS (Netherlands)

Wagner, C.; Groene, O.; Thompson, C.A.; DerSarkissian, M.; Klazinga, N.S.; Arah, O.A.; Sunol, R.

2014-01-01

Objective. The assessment of integral quality management (QM) in a hospital requires measurement and monitoring from different perspectives and at various levels of care delivery. Within the DUQuE project (Deepening our Understanding of Quality improvement in Europe), seven measures for QM were

DUQuE quality management measures: associations between quality management at hospital and pathway levels.

NARCIS (Netherlands)

Wagner, C.; Groene, O.; Thompson, C.A.; DerSarkissian, M.; Klazinga, N.S.; Arah, O.A.; Suñol, R.

2014-01-01

Objective: The assessment of integral quality management (QM) in a hospital requires measurement and monitoring from different perspectives and at various levels of care delivery. Within the DUQuE project (Deepening our Understanding of Quality improvement in Europe), seven measures for QM were

The impact of quality management on patient satisfaction in a hospital: brief report

Directory of Open Access Journals (Sweden)

Ali Mohammad Mosadeghrad

2017-06-01

Full Text Available Background: Patient satisfaction is an important indicator of healthcare quality and effectiveness. Quality management as an organizational strategy enhances the quality of hospital services through continuously improving hospital structures and processes. This study aimed to examine the impact of quality management on patient satisfaction. Methods: A participatory action research was conducted in respiratory intensive care unit, at Labafinejad hospital, Tehran, Iran, in 2013. A quality improvement team was established. Operational processes were improved using a quality management model. The quality improvement team standardized processes, identified quality goals for the processes and improved them until achieved quality goals. Patients’ satisfaction data was collected before and after the intervention using a valid and reliable questionnaire. Results: Patients’ satisfaction was 75 percent at the beginning of the study. Patients were mostly dissatisfied with the nutrition services, amenities, lack of attention to their personal needs and lack of involving them in their treatment processes. An action plan was developed for improving patient satisfaction. After the quality management intervention, patient satisfaction reached to 81 percent at the end of this study. The quality management model improved the quality of services by 54.5 percent and consequently increased patient satisfaction by 7.2 percent. Almost half of the patients at the beginning of this study were definitely willing to recommend the hospital to their friends and relatives. This figure increased to 76 percent. The rest of patients stated that they may recommend the hospital to others. Conclusion: Implementing an appropriate quality management model appropriately in a supportive environment helps improve the quality of services and enhance patient satisfaction and loyalty.

Out-of-hospital cardiac arrest (OHCA) survival in rural Northwest Ireland: 17 years' experience.

LENUS (Irish Health Repository)

Masterson, Siobhán

2011-05-01

SAVES, the name used to describe a register of survivors of out-of-hospital cardiac arrest (OHCA), was established in rural Northwest Ireland in 1992. From 1992 to 2008, 80 survivors were identified (population 239,000 (2006)). Most incidents were witnessed (69\\/70) and all were in shockable rhythm at the time of first rhythm analysis (66\\/66). Of 66 patients who could be traced, 46 were alive in December 2008. Average survival rates appeared to increase over the lifetime of the database. SAVES has also contributed to the development of a national OHCA register.

Hospital services quality assessment: hospitals of Kerman University of Medical Sciences, as a tangible example of a developing country.

Science.gov (United States)

Nekoei-Moghadam, Mahmood; Amiresmaili, Mohammadreza

2011-01-01

Although quality orientation is one of the main priorities of any progressive organization, quality evaluation in organizations providing services such as hospitals is one of the key challenges, because in this sector quality is determined by many intangible factors. Applying the service quality gap model is one of the common tools for quality evaluation in the service sector. This paper seeks to evaluate this issue. The present descriptive study was carried out through a cross-sectional method in 2008. The participants of this study were patients who had been referred to Kerman University of Medical Sciences hospitals. The sample comprised 385 patients, the data were collected by SERVQUAL as a standard questionnaire, and data analysis was carried out on 385 completed questionnaires. In all five dimensions of quality, a gap was observed between patients' perceptions and expectations as follows: Assurance: -1.28, Empathy: -1.36, Responsiveness: -1.80, Tangibles: -1.86 and Reliability: -1.69. A paired T-test showed that the differences between quality perceptions and expectations are significant (p value SERVQUAL approach to hospital services of a developing country.

Nurse managers' experiences in continuous quality improvement in resource-poor healthcare settings.

Science.gov (United States)

Kakyo, Tracy Alexis; Xiao, Lily Dongxia

2017-06-01

Ensuring safe and quality care for patients in hospitals is an important part of a nurse manager's role. Continuous quality improvement has been identified as one approach that leads to the delivery of quality care services to patients and is widely used by nurse managers to improve patient care. Nurse managers' experiences in initiating continuous quality improvement activities in resource-poor healthcare settings remain largely unknown. Research evidence is highly demanded in these settings to address disease burden and evidence-based practice. This interpretive qualitative study was conducted to gain an understanding of nurse managers' Continuous Quality Improvement experiences in rural hospitals in Uganda. Nurse managers in rural healthcare settings used their role to prioritize quality improvement activities, monitor the Continuous Quality Improvement process, and utilize in-service education to support continuous quality improvement. The nurse managers in our sample encountered a number of barriers during the implementation of Continuous Quality Improvement, including: limited patient participation, lack of materials, and limited human resources. Efforts to address the challenges faced through good governance and leadership development require more attention. © 2017 John Wiley & Sons Australia, Ltd.

QUALITY ASSURANCE IN THE HOSPITALITY INDUSTRY: QUALITATIVE ASSESMENT OF NIGERIA

OpenAIRE

OFOBRUKU SYLVESTER ABOMEH; Amagbakhan Omoghan Roland

2013-01-01

Hospitality is currently the fasted growing economic activity in Abuja-Nigeria. It has also been instrumental in creating jobs and has significant impact on other sectors of economic growth. Based on the above factors much attention need to be placed on the quality of the hospitality industry in Abuja-Nigeria in other to systematic compete with other destinations. Quality assurance is becoming an increasing integral component of the service industry. However, despite some indication that qual...

Risk factors for type 2 diabetes mellitus among patients attending a rural Kenyan hospital

Directory of Open Access Journals (Sweden)

Masemiano P. Chege

2010-05-01

Objectives: To describe the risk factors for type 2 diabetes mellitus among patients attending the outpatient clinics in a rural mission hospital in Kenya. Method: Forty-five diabetics and forty-five non-diabetics, resident in this rural hospital’s catchment area for at least 10 years, were randomly selected from patients attending outpatient clinics. Diabetics in a stable condition (not requiring hospitalisation, whose fasting blood sugars were below 6.1 mmol/L, were matched for age and gender with the non-diabetics who came to the hospital for outpatient services. A pilot-tested questionnaire on demography, current and past dietary habits, social habits, and family history was used to collect data. Waist circumference, height and weight were measured and BMI calculated. Data was analysed using SPSS for Windows. The Kruskal–Wallis test was used to compare the medians for the continuous variables, while the chi-squared test was used for the categorical variables. The z-test was used to calculate the relative risk. Results: Ninety participants (26 males, 64 females. The mean age was 61.8 for diabetics and 61.4 for non-diabetics. Childhood starvation (relative risk 2.08, p = 0.0090 and use of cassava for sustenance during childhood starvation (relative risk 3.12, p = 0.0090 were identified as risk factors. Diabetes in close relatives, another risk factor for this population (relative risk 2.2, p = 0.0131. Abdominal obesity was a risk factor for this population (in females relative risk 2.0, p = 0.0010. Conclusion: The risk factors for type 2 diabetes mellitus described in this rural population include advancing age, diabetes in a first-degree relative and abdominal obesity. This is similar to what has been cited in other studies. At variance, we found that more than 50% of the diabetics reported having suffered malnutrition/starvation in childhood, with more than half of them reporting their dependence on cassava as the only food source during starvation.

Medical Device-Associated Candida Infections in a Rural Tertiary Care Teaching Hospital of India

Directory of Open Access Journals (Sweden)

Sachin C. Deorukhkar

2016-01-01

Full Text Available Health care associated infections (HCAIs add incrementally to the morbidity, mortality, and cost expected of the patient’s underlying diseases alone. Approximately, about half all cases of HCAIs are associated with medical devices. As Candida medical device-associated infection is highly drug resistant and can lead to serious life-threatening complications, there is a need of continuous surveillance of these infections to initiate preventive and corrective measures. The present study was conducted at a rural tertiary care hospital of India with an aim to evaluate the rate of medical device-associated Candida infections. Three commonly encountered medical device-associated infections (MDAI, catheter-associated urinary tract infection (CA-UTI, intravascular catheter-related blood stream infections (CR-BSI, and ventilator-associated pneumonia (VAP, were targeted. The overall rate of MDAI in our hospital was 2.1 per 1000 device days. The rate of Candida related CA-UTI and CR-BSI was noted as 1.0 and 0.3, respectively. Untiring efforts taken by team members of Hospital Acquired Infection Control Committee along with maintenance of meticulous hygiene of the hospital and wards may explain the low MDAI rates in our institute. The present surveillance helped us for systematic generation of institutional data regarding MDAI with special reference to role of Candida spp.

Are performance indicators used for hospital quality management: a qualitative interview study amongst health professionals and quality managers in The Netherlands

NARCIS (Netherlands)

Botje, Daan; ten Asbroek, Guus; Plochg, Thomas; Anema, Helen; Kringos, Dionne S.; Fischer, Claudia; Wagner, Cordula; Klazinga, Niek S.

2016-01-01

Hospitals are under increasing pressure to share indicator-based performance information. These indicators can also serve as a means to promote quality improvement and boost hospital performance. Our aim was to explore hospitals' use of performance indicators for internal quality management

Occupational Therapy and Physiotherapy in Acute Stroke: Do Rural Patients Receive Less Therapy?

Directory of Open Access Journals (Sweden)

Josie Merchant

2016-01-01

Full Text Available Objective. To assess whether acute stroke patients in rural hospitals receive less occupational therapy and physiotherapy than those in metropolitan hospitals. Design. Retrospective case-control study of health data in patients ≤10 days after stroke. Setting. Occupational therapy and physiotherapy services in four rural hospitals and one metropolitan hospital. Participants. Acute stroke patients admitted in one health district. Main Outcome Measures. Frequency and duration of face-to-face and indirect therapy sessions. Results. Rural hospitals admitted 363 patients and metropolitan hospital admitted 378 patients. Mean age was 73 years. Those in rural hospitals received more face-to-face (p>0.0014 and indirect (p=0.001 occupational therapy when compared to those in the metropolitan hospital. Face-to-face sessions lasted longer (p=0.001. Patients admitted to the metropolitan hospital received more face-to-face (p>0.000 and indirect (p>0.000 physiotherapy when compared to those admitted to rural hospitals. Face-to-face sessions were shorter (p>0.000. Almost all were seen within 24 hours of referral. Conclusions. Acute stroke patients in Australian rural hospital may receive more occupational therapy and less physiotherapy than those in metropolitan hospitals. The dose of therapy was lower than recommended, and the referral process may unnecessarily delay the time from admission to a patient’s first therapy session.

Use of a "secure room" and a security guard in the management of the violent, aggressive or suicidal patient in a rural hospital: a 3-year audit.

Science.gov (United States)

Brock, Gordon; Gurekas, Vydas; Gelinas, Anne-Fredrique; Rollin, Karina

2009-01-01

Little has been published on the management of psychiatric crises in rural areas, and little is known of the security needs or use of "secure rooms" in rural hospitals. We conducted a 3-year retrospective chart audit on the use of our secure room/security guard system at a rural hospital in a town of 3500, located 220 km from our psychiatric referral centre. Use of our secure room/security guard system occurred at the rate of 1.1 uses/1000 emergency department visits, with the most common indication being physician perception of risk of patient suicide or self-harm. Concern for staff safety was a factor in 10% of uses. Eighty percent of patients were treated locally, with most being released from the secure room after 2 days or less. Fourteen percent of patients required ultimate transfer to our psychiatric referral centre and 6% to a detoxification centre. The average annual cost of security was $16 259.61. A secure room can provide the opportunity for close observation of a potentially self-harming patient, additional security for staff and early warning if a patient flees the hospital. Most admissions were handled locally, obviating the need for transfer to distant psychiatric referral centres. Most patients who were admitted were already known as having a psychiatric illness and 80% of the patients required the use of the secure room/security guard system for less than a 2-night stay, suggesting that most rural mental health crises pass quickly. Most patients admitted to a rural hospital with a mental health crisis can be managed locally if an adequate secure room/security guard system is available.

DUQuE quality management measures: associations between quality management at hospital and pathway levels

NARCIS (Netherlands)

Wagner, Cordula; Groene, Oliver; Thompson, Caroline A.; Dersarkissian, Maral; Klazinga, Niek S.; Arah, Onyebuchi A.; Suñol, Rosa; Kringos, D. S.; Lombarts, K.; Plochg, T.; Lopez, M. A.; Secanell, M.; Sunol, R.; Vallejo, P.; Bartels, P.; Kristensen, S.; Michel, P.; Saillour-Glenisson, F.; Vlcek, F.; Car, M.; Jones, S.; Klaus, E.; Garel, P.; Hanslik, K.; Saluvan, M.; Bruneau, C.; Depaigne-Loth, A.; Shaw, C.; Hammer, A.; Ommen, O.; Pfaff, H.; Groene, O.; Botje, D.; Wagner, C.; Kutaj-Wasikowska, H.; Kutryba, B.; Escoval, A.; Franca, M.; Almeman, F.; Kus, H.; Ozturk, K.; Mannion, R.; Chow, A.; Dersarkissian, M.; Thompson, C.; Wang, A.; Thompson, A.

2014-01-01

The assessment of integral quality management (QM) in a hospital requires measurement and monitoring from different perspectives and at various levels of care delivery. Within the DUQuE project (Deepening our Understanding of Quality improvement in Europe), seven measures for QM were developed. This

[Influence of malnutrition on childhood mortality in a rural hospital in Rwanda].

Science.gov (United States)

Ngirabega, J-d-D; Munyanshongore, C; Donnen, P; Dramaix, M

2011-10-01

Recent estimates of the role of malnutrition on childhood mortality have led to a call for action by decision makers in the fight against child malnutrition. Further evaluation is needed to assess the burden of malnutrition in terms of morbidity and mortality, as well as to assess the impact of various interventions. The objective of this study is to determine the effect of malnutrition on mortality in a pediatric service of a rural hospital in Rwanda. A prospective cohort study included children aged 6-59 months coming from the catchment area of the hospital and admitted to the pediatric ward between January 2008 and June 2009. Anthropometric, clinical and biological data were gathered at the time of admission. The effect of malnutrition at the time of admission on mortality during hospitalization was analyzed by using logistic regression. At the time of admission, the prevalences of wasting, underweight and stunting among children was 14.2%, 37.5% and 57.3% respectively. Fifty-six children died during hospitalization. The period mortality rate was 6.9%. After adjustment for age, sex, malaria thick smear and breathing with chest retractions, death was associated with underweight and stunting with adjusted odds rations of 4.6 (IC95% 2.5-8.4) and 4.0 (IC95% 2.0-8.2) respectively. The study confirmed the influence of malnutrition on child mortality in pediatrics wards. These results can be of great help for improving the awareness of the community decision-makers in the fight to prevent malnutrition. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Patient experience shows little relationship with hospital quality management strategies.

NARCIS (Netherlands)

Groene, O.; Arah, O.A.; Klazinga, N.S.; Wagner, C.; Bartels, P.D.; Kristensen, S.; Saillour, F.; Thompson, C.A.; Pfaff, H.; DerSarkissian, M.; Suñol, R.

2015-01-01

Objectives: Patient-reported experience measures are increasingly being used to routinely monitor the quality of care. With the increasing attention on such measures, hospital managers seek ways to systematically improve patient experience across hospital departments, in particular where outcomes

Effect of medicare payment on rural health care systems.

Science.gov (United States)

McBride, Timothy D; Mueller, Keith J

2002-01-01

Medicare payments constitute a significant share of patient-generated revenues for rural providers, more so than for urban providers. Therefore, Medicare payment policies influence the behavior of rural providers and determine their financial viability. Health services researchers need to contribute to the understanding of the implications of changes in fee-for-service payment policy, prospects for change because of the payment to Medicare+Choice risk plans, and implications for rural providers inherent in any restructuring of the Medicare program. This article outlines the basic policy choices, implications for rural providers and Medicare beneficiaries, impacts of existing research, and suggestions for further research. Topics for further research include implications of the Critical Access Hospital program, understanding how changes in payment to rural hospitals affect patient care, developing improved formulas for paying rural hospitals, determining the payment-to-cost ratio for physicians, measuring the impact of changes in the payment methodology used to pay for services delivered by rural health clinics and federally qualified health centers, accounting for the reasons for differences in historical Medicare expenditures across rural counties and between rural and urban counties, explicating all reasons for Medicare+Choice plans withdrawing from some rural areas and entering others, measuring the rural impact of proposals to add a prescription drug benefit to the Medicare program, and measuring the impact of Medicare payment policies on rural economies.

A cross-sectional study of quality of life in incident stroke survivors in rural northern Tanzania.

Science.gov (United States)

Howitt, Suzanne C; Jones, Matthew P; Jusabani, Ahmed; Gray, William K; Aris, Eric; Mugusi, Ferdinand; Swai, Mark; Walker, Richard W

2011-08-01

The aim of this study was to evaluate changes to, and predictors of, quality of life (QOL) in a community-based cohort of stroke survivors from an earlier stroke incidence study in rural northern Tanzania. Patients were assessed 1-5 years after their incident stroke. The study cohort was compared with an age- and sex-matched control group from the same rural district within a cross-sectional design. Patients and controls were asked a series of questions relating to their QOL [World Health Organization quality of life, abbreviated version (WHOQOL-BREF)], levels of anxiety and depression [hospital anxiety and depression (HAD) scale], cognitive function [community screening instrument for dementia (CSI-D) screening tool], socioeconomic status and demographic characteristics (e.g. age, sex, education and abode). Patients were further assessed for functional outcome and disability (Barthel index, modified Rankin scale), post-stroke care and psychosocial functioning. Patients (n = 58) were found to have significantly lower QOL than controls (n = 58) in all six domains of the WHOQOL-BREF. Gender, socioeconomic status, cognitive function and time elapsed since stroke were not associated with QOL. Older patients and those with more impaired motor function and disability (Barthel index, modified Rankin score) had significantly poorer physical health-related QOL. Greater anxiety and depression, reduced muscle power and less involvement in social events were significantly correlated with lower physical and psychological health-related QOL. To our knowledge, this is the first long-term study of QOL in survivors of incident stroke in Sub-Saharan Africa (SSA). Poorer QOL was associated with greater levels of physical disability, anxiety and depression and reduced social interaction. Demographic factors appear to be much less significant. Modifying these QOL predictors could be important in planning effective post-stroke care within a stretched healthcare system.

Patient Experience Shows Little Relationship with Hospital Quality Management Strategies

NARCIS (Netherlands)

Groene, Oliver; Arah, Onyebuchi A.; Klazinga, Niek S.; Wagner, Cordula; Bartels, Paul D.; Kristensen, Solvejg; Saillour, Florence; Thompson, Andrew; Thompson, Caroline A.; Pfaff, Holger; Dersarkissian, Maral; Sunol, Rosa

2015-01-01

Patient-reported experience measures are increasingly being used to routinely monitor the quality of care. With the increasing attention on such measures, hospital managers seek ways to systematically improve patient experience across hospital departments, in particular where outcomes are used for

Quality of care and investment in property, plant, and equipment in hospitals.

Science.gov (United States)

Levitt, S W

1994-01-01

OBJECTIVE. This study explores the relationship between quality of care and investment in property, plant, and equipment (PPE) in hospitals. DATA SOURCES. Hospitals' investment in PPE was derived from audited financial statements for the fiscal years 1984-1989. Peer Review Organization (PRO) Generic Quality Screen (GQS) reviews and confirmed failures between April 1989 and September 1990 were obtained from the Massachusetts PRO. STUDY DESIGN. Weighted least squares regression models used PRO GQS confirmed failure rates as the dependent variable, and investment in PPE as the key explanatory variable. DATA EXTRACTION. Investment in PPE was standardized, summed by the hospital over the six years, and divided by the hospital's average number of beds in that period. The number of PRO reviewed cases with one or more GQS confirmed failures was divided by the total number of cases reviewed to create confirmed failure rates. PRINCIPAL FINDINGS. Investment in PPE in Massachusetts hospitals is correlated with GQS confirmed failure rates. CONCLUSIONS. A financial variable, investment in PPE, predicts certain dimensions of quality of care in hospitals. PMID:8113054

Rural maternity care.

Science.gov (United States)

Miller, Katherine J; Couchie, Carol; Ehman, William; Graves, Lisa; Grzybowski, Stefan; Medves, Jennifer

2012-10-01

To provide an overview of current information on issues in maternity care relevant to rural populations. Medline was searched for articles published in English from 1995 to 2012 about rural maternity care. Relevant publications and position papers from appropriate organizations were also reviewed. This information will help obstetrical care providers in rural areas to continue providing quality care for women in their communities. Recommendations 1. Women who reside in rural and remote communities in Canada should receive high-quality maternity care as close to home as possible. 2. The provision of rural maternity care must be collaborative, woman- and family-centred, culturally sensitive, and respectful. 3. Rural maternity care services should be supported through active policies aligned with these recommendations. 4. While local access to surgical and anaesthetic services is desirable, there is evidence that good outcomes can be sustained within an integrated perinatal care system without local access to operative delivery. There is evidence that the outcomes are better when women do not have to travel far from their communities. Access to an integrated perinatal care system should be provided for all women. 5. The social and emotional needs of rural women must be considered in service planning. Women who are required to leave their communities to give birth should be supported both financially and emotionally. 6. Innovative interprofessional models should be implemented as part of the solution for high-quality, collaborative, and integrated care for rural and remote women. 7. Registered nurses are essential to the provision of high-quality rural maternity care throughout pregnancy, birth, and the postpartum period. Maternity nursing skills should be recognized as a fundamental part of generalist rural nursing skills. 8. Remuneration for maternity care providers should reflect the unique challenges and increased professional responsibility faced by providers in

Perceptions by medical students of their educational environment for obstetrics and gynaecology in metropolitan and rural teaching sites.

Science.gov (United States)

Carmody, Dianne F; Jacques, Angela; Denz-Penhey, Harriet; Puddey, Ian; Newnham, John P

2009-12-01

Medical student education in Western Australia is expanding to secondary level metropolitan hospitals and rural sites to accommodate workforce demands and increasing medical student numbers. To determine if students' perceptions of the teaching environment for obstetrics and gynaecology differ between tertiary, secondary level metropolitan hospitals and rural sites, and to determine if students' perceptions of their learning environment are associated with improved academic performance. An evaluation was conducted of medical students' perceptions of their learning environment during an obstetrics and gynaecology program at a variety of sites across metropolitan and rural Western Australia. The evaluation was based on the Dundee Ready Education Environmental Measure (DREEM) questionnaire. There were no significant differences in students' perceptions of their learning environment between the tertiary hospital, combined programs involving a tertiary and secondary metropolitan hospital, rural sites with a population of more than 25,000 and rural sites with a population less than 25,000 people. Perceptions were similar in male and female students. The overall mean score for all perceptions of the learning environment in obstetrics and gynaecology were in the range considered to be favorable. Higher scores of perceptions of the learning environment were associated positively with the measures of academic achievement in the clinical, but not written, examination. Medical students' perceptions of their learning environment in obstetrics and gynaecology were not influenced by the geographical site of delivery or their gender but were positively related to higher academic achievement. Providing appropriate academic and clinical support systems have been put in place the education of medical students can be extended outside major hospitals and into outer metropolitan and rural communities without any apparent reduction in perceptions of the quality of their learning

Indications for Caesarean sections in a rural hospital in the Highlands of Papua New Guinea.

Science.gov (United States)

Mark, Terence B; Radcliffe, Jim; Laman, Moses

2014-07-01

We retrospectively documented indications for Caesarean sections in a rural district level hospital in the highlands of Papua New Guinea. Over a 53-month study period, 745 Caesarean sections were performed. Prolonged labour, previous history of Caesarean section, cephalopelvic disproportion, malpresentation and fetal distress accounted for over 88% of Caesarean sections performed. In older mothers (aged >30 years), antepartum haemorrhage (Fisher exact test, P = 0.05) and multiple indications (P = 0.001) were leading reasons for Caesarean sections while cephalopelvic disproportion (P = 0.005) was the leading indication in younger mothers. Further prospective studies incorporating perinatal and maternal mortality rates are required to optimise the value of Caesarean sections at district level hospitals in Papua New Guinea. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Experts speak: advice from key informants to small, rural hospitals on implementing the electronic health record system.

Science.gov (United States)

Craven, Catherine K; Sievert, MaryEllen C; Hicks, Lanis L; Alexander, Gregory L; Hearne, Leonard B; Holmes, John H

2013-01-01

The US government has allocated $30 billion dollars to implement Electronic Health Records (EHRs) in hospitals and provider practices through a policy called Meaningful Use. Small, rural hospitals, particularly those designated as Critical Access Hospitals (CAHs), comprising nearly a quarter of US hospitals, had not implemented EHRs before. Little is known on implementation in this setting. We interviewed a spectrum of 31 experts in the domain. The interviews were then analyzed qualitatively to ascertain the expert recommendations. Nineteen themes emerged. The pool of experts included staff from CAHs that had recently implemented EHRs. We were able to compare their answers with those of other experts and make recommendations for stakeholders. CAH peer experts focused less on issues such as physician buy-in, communication, and the EHR team. None of them indicated concern or focus on clinical decision support systems, leadership, or governance. They were especially concerned with system selection, technology, preparatory work and a need to know more about workflow and optimization. These differences were explained by the size and nature of these small hospitals.

Marketing of rural and remote pharmacy practice via the digital medium.

Science.gov (United States)

Peterson, G M; Fitzmaurice, K D; Rasiah, R L; Kruup, H

2010-08-01

The shortage of community and hospital pharmacists is particularly acute in rural and remote areas of Australia. Pharmacy students, in particular, as those who may be able to alleviate this shortage, need to be made more aware of the challenges and rewards of rural pharmacy practice. A marketing tool was developed to promote rural and remote pharmacy practice as a career option. A DVD was produced from interviews with health professionals working in rural and remote areas of Australia. This DVD will complement current rural practical placements, which have been incorporated into the curriculum of Australian schools of pharmacy. Interviews were conducted with healthcare professionals from areas in Tasmania, Northern Queensland and the Northern Territory. Interviewees included pharmacists, graduate pharmacists, pharmacy students, aboriginal health workers and a general practitioner. Each of the interviewees was able to provide personal accounts of experiences in rural and remote healthcare, and roles and opportunities for pharmacists. A final draft of the DVD was shown to University of Tasmania students to assess the impact and quality of the production. A number of common themes arose from interviewing and these were subsequently converted into five key chapters of the DVD - Lifestyle, Belonging, Diversity, Indigenous Health and 'Give it a go'. The final DVD, produced from over 15 h of footage, runs for 35 min. Students reported positive feedback on both the technical quality and the information contained within the DVD; 37% of students who viewed the DVD felt that it increased their awareness of what rural pharmacy has to offer. The rural pharmacy, 'Enjoy the Lifestyle' DVD can be used to increase awareness of rural and remote pharmacy practice to students and other pharmacists, and complements other pharmacy workforce strategies for rural and remote areas of Australia. It could also be a useful approach for adaptation in other countries.

Customer Contribution to improving Service Quality in the Hospitality Industry

OpenAIRE

Dragos Constantin Vasile

2009-01-01

The actors on the today business stage have no more well-defined roles with clear and rigid borders between them. Hospitality industry in particular is a good example how it has been blurred the roles that customers play in dealing with service providers. The study reveals that customers can influence the quality of hospitality service through performing a qualitycontrol function. This involves a series of activities to be achieved by them: (1) on-the-spot quality control, (2) service failure...

Quality of Care and Services of a Public Hospital: Awareness and Assessment

Directory of Open Access Journals (Sweden)

Abdel-ilah Aziane

2015-04-01

Full Text Available In order to give everyone access to quality care, this study attempts to make quality awareness, highlighting the importance of the implementation of the quality management system in health care facilities. The objective of our work is to make a quality awareness, to analyze the current situation and to provide recommendations. The analysis of the existing situation consists of identifying, describing, and analyzing the key processes implemented, listing the dysfunctions, classifying them, deciding on the corresponding actions and putting in place indicators and dashboards, which will help track improvements. The overall situation of the hospital regarding the requirements of ISO 9001 indicated a respect of about 28% of the requirements of the standard. The state of the premises of the establishment does not indicate a clear organization at the hospital. The hospital environment is a prerequisite to the establishment of a system of quality management that enables you to deploy a clear and shared policy to improve the quality of care and services.

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

Science.gov (United States)

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

2011-09-01

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

Can there be mutual support between hospital marketing and continuous quality improvement?

Science.gov (United States)

Weiland, D E

1992-01-01

Marketing the results of continuous quality improvement in hospitals builds a growing bank of loyal customers in an increasingly competitive and quality-oriented environment: If healthcare institutions want to survive and flourish, they must develop a lasting relationship with their customers. The long-term goal of CQI is to provide quality products and services. If marketing managers can sell these improved services, hospitals will build a solid client foundation.

The role of amenities and quality of life in rural economic growth

Science.gov (United States)

Steven C. Deller; Tsung-Hsiu (Sue) Tsai; David W. Marcouiller; Donald B.K. English

2001-01-01

A structural model of regional economic growth is estimated using data for 2243 rural US. counties. Five indices designed to capture specific amenity and quality of life characteristics are constructed using 54 separate indicators. Results suggest that amenity characteristics can be organized into consistent and meaningful empirical measures that move beyond ad hoc...

Evolution of hospital industrial engineering: from scientific management to total quality management.

Science.gov (United States)

Sahney, V K

1993-01-01

Industrial engineering applications in the hospital industry first began in 1910. This paper traces the evolution of hospital industrial engineering in five distinct phases. For each of the major phases, this paper presents the contributions made by industrial engineers. Many of the techniques advocated by industrial engineers are now being taught to hospital employees as hospitals introduce total quality management (TQM) within the health-care industry. TQM introduction has meant a new role for industrial engineers, as that of a teacher, coach, and a facilitator. This new role holds much promise for the improvement of quality and productivity in health care.

Quality of life at work among nurses of a university hospital

Directory of Open Access Journals (Sweden)

Eliane de Fátima Almeida Lima

2013-12-01

Full Text Available The objective of this cross-sectional study was to evaluate the quality of life at work of nurses from a university hospital, between January and April of 2011. A sample of 90 nurses answered the WHOQOL-Bref and a questionnaire addressing their sociodemographic profile and working conditions. Most subjects were female, aged between 23 and 40 years, married, and holding a specialization degree. The Physical domain had the highest mean (73.05 and the Environment domain the lowest (63.12. Subjects with the best scores in the quality of life domains were male, married, public servants, holding a master’s/doctorate degree, and working three jobs or more. The chosen instrument allowed for outlining the nurses’ profile and learning the domains and variables that affect their quality of life. It is suggested that university hospitals encourage nurses to pursue a stricto sensu graduate course. Descriptors: Quality of Life; Nurses, Male; Working Conditions; Hospitals, University.

The association between socioeconomic status and health-related quality of life among Polish postmenopausal women from urban and rural communities.

Science.gov (United States)

Kaczmarek, M; Pacholska-Bogalska, J; Kwaśniewski, W; Kotarski, J; Halerz-Nowakowska, B; Goździcka-Józefiak, A

2017-01-01

In recent years, more scholarly attention has been paid to a growing range of geographic characteristics as antecedents of inequalities in women's health and well-being. The purpose of this study was to evaluate differences in health-related quality of life between rural and urban Polish postmenopausal women. Using a data set from a reproductive health preventive screening of 660 postmenopausal women aged 48-60 years, inhabitants of Wielkopolska and Lublin provinces, the association of place of residence, socioeconomic status and lifestyle factors with health-related quality of life (the SF-36 instrument) was evaluated using ANCOVA models and multiple logistic regression analysis with backward elimination steps. A consistent rural-to-urban gradient was found in all indices of physical health functioning and well-being but not in vitality, social functioning, emotional role and mental health scales with women in large cities being likely to enjoy the highest and those in villages the lowest quality of life. The rural-urban disparities in health-related quality of life were mediated by women's socioeconomic status. The likelihood of worse physical and mental functioning and well-being was 2-3 times greater for the low socioeconomic status rural women than their counterparts from more affluent urban areas. The educational attainment and employment status were the most powerful independent risk factors for health-related quality of life in both rural and urban women. Better understanding of the role of socioeconomic status that acts as a mediator in the association between area of residence and health-related quality of life may be useful in developing public health policies on health inequalities among women at midlife. Copyright © 2016. Published by Elsevier GmbH.

Relationships between the implementation of quality management strategies and clinical outcomes in European hospitals.

NARCIS (Netherlands)

Suñol, R.; Arah, O.A.; Wagner, C.; Groene, O.

2013-01-01

Objectives: Considerable resources are spent on implementing hospital and departmental quality management strategies. Yet, the evidence on the factors associated with the uptake of hospitals of quality management and the impact of quality management systems on clinical outcomes is limited. We

Leading quality through the development of a multi-year corporate quality plan: sharing The Ottawa Hospital experience.

Science.gov (United States)

Hunter, Linda; Myles, Joanne; Worthington, James R; Lebrun, Monique

2011-01-01

This article discusses the background and process for developing a multi-year corporate quality plan. The Ottawa Hospital's goal is to be a top 10% performer in quality and patient safety in North America. In order to create long-term measurable and sustainable changes in the quality of patient care, The Ottawa Hospital embarked on the development of a three-year strategic corporate quality plan. This was accomplished by engaging the organization at all levels and defining quality frameworks, aligning with internal and external expectations, prioritizing strategic goals, articulating performance measurements and reporting to stakeholders while maintaining a transparent communication process. The plan was developed through an iterative process that engaged a broad base of health professionals, physicians, support staff, administration and senior management. A literature review of quality frameworks was undertaken, a Quality Plan Working Group was established, 25 key stakeholder interviews were conducted and 48 clinical and support staff consultations were held. The intent was to gather information on current quality initiatives and challenges encountered and to prioritize corporate goals and then create the quality plan. Goals were created and then prioritized through an affinity exercise. Action plans were developed for each goal and included objectives, tasks and activities, performance measures (structure, process and outcome), accountabilities and timelines. This collaborative methodology resulted in the development of a three-year quality plan. Six corporate goals were outlined by the tenets of the quality framework for The Ottawa Hospital: access to care, appropriate care (effective and efficient), safe care and satisfaction with care. Each of the six corporate goals identified objectives and supporting action plans with accountabilities outlining what would be accomplished in years one, two and three. The three-year quality plan was approved by senior

Examination of the relative importance of hospital employment in non-metropolitan counties using location quotients.

Science.gov (United States)

Smith, Jon L

2013-01-01

The US Health Care and Social Services sector (North American Industrial Classification System 'sector 62') has become an extremely important component of the nation's economy, employing approximately 18 million workers and generating almost $753 billion in annual payrolls. At the county level, the health care and social services sector is typically the largest or second largest employer. Hospital employment is often the largest component of the sector's total employment. Hospital employment is particularly important to non-metropolitan or rural communities. A high quality healthcare sector serves to promote economic development and attract new businesses and to provide stability in economic downturns. The purpose of this study was to examine the intensity of hospital employment in rural counties relative to the nation as a whole using location quotients and to draw conclusions regarding how potential changes in Medicare and Medicaid might affect rural populations. Estimates for county-level hospital employment are not commonly available. Estimates of county-level hospital employment were therefore generated for all counties in the USA the Census Bureau's County Business Pattern Data for 2010. These estimates were used to generate location quotients for each county which were combined with demographic data to generate a profile of factors that are related to the magnitude of location quotients. The results were then used to draw inferences regarding the possible impact of the Patient Protection and Affordable Care Act 2010 (ACA) and the possible imposition of aspects of the Budget Control Act 2011 (BCA). Although a very high percentage of rural counties contain medically underserved areas, an examination of location quotients indicates that the percentage of the county workforce employed by hospitals in the most rural counties tends to be higher than for the nation as a whole, a counterintuitive finding. Further, when location quotients are regressed upon data

Is There a Correlation Between Infection Control Performance and Other Hospital Quality Measures?

Science.gov (United States)

O'Hara, Lyndsay M; Morgan, Daniel J; Pineles, Lisa; Li, Shanshan; Sulis, Carol; Bowling, Jason; Drees, Marci; Jacob, Jesse T; Anderson, Deverick J; Warren, David K; Harris, Anthony D

2017-06-01

Quality measures are increasingly reported by hospitals to the Centers for Medicare and Medicaid Services (CMS), yet there may be tradeoffs in performance between infection control (IC) and other quality measures. Hospitals that performed best on IC measures did not perform well on most CMS non-IC quality measures. Infect Control Hosp Epidemiol 2017;38:736-739.

Learning maternity: the experiences of rural nurses.

Science.gov (United States)

MacKinnon, Karen

2010-03-01

Two research studies explored rural nurses' experience with the provision of maternity care in rural British Columbia, Canada. Frontline nurses, managers, and health-care providers were interviewed and their practices observed. One of the main challenges identified by rural nurses was ensuring that a knowledgeable/skilled maternity or perinatal nurse was always available at the local hospital. Learning how to provide safe and supportive maternity care is difficult for nurses working in small rural hospitals today due to declining birth rates, increased workloads, and a decrease in opportunities for mentoring. Decisions about the allocation of time off and resources for rural nurses' continuing professional education (CPE) were structured by discourses of personal responsibility for "continuing competence." These institutional work processes increase the burden on rural nurses, negatively affecting their opportunities for CPE and their experiences of providing maternity care, with implications for both patient safety and nurse retention.

Barriers facing junior doctors in rural practice.

Science.gov (United States)

Smith, Deborah M

2005-01-01

Early postgraduate, or junior doctors, are still required to practise in rural and remote communities, and they continue to face numerous issues and difficulties. Within the hospital setting, exposure to rural practice appears to be very limited during internship, and also to some extent, during the second postgraduate year and beyond. This is a major issue for those required to undertake country relieving, rural terms or who will be bonded to rural and remote practice for several years after internship. This research investigated the current issues and difficulties faced by junior doctors, required to undertake rural and remote practice in Queensland, Australia. An exploratory study was undertaken. Primary data were collected through semi-structured interviews held with key stakeholders. Stakeholders included: directors of clinical training; medical educators; junior doctors; rural practitioners; academic rural practitioners; and medical administrators. Of the 23 people approached, a total of 19 agreed to be interviewed. The response rate was 82.6%. Similar to the issues identified in the literature, there are currently a number of barriers influencing the ability of junior doctors to practise competently and confidently when undertaking practice in rural and remote communities. Minimal clinical experience, lack of supervision and on-site support, inadequate orientation and uninformed expectations, limited access to relevant education, and the influence of isolation, results in an overall lack of preparation both professionally and personally. When asked, respondents supported the identification of core skills and knowledge, and integration of these and other issues affecting rural practice, into their hospital-based programs. Current hospital-based education and training programs were not adequately preparing junior doctors for rural and remote practice. It was commented that orientation and education, with a rural emphasis, could assist junior doctors in their

Service Quality Assessment of Hospitals in Asian Context: An Empirical Evidence From Pakistan.