Sample records for access hospitals cahs

  1. Critical Access Hospitals (CAH)

    MedlinePlus

    ... of CAH status? CAH status includes the following benefits: Cost-based reimbursement from Medicare. As of January 1, ... stabilize healthcare facilities’ census and may provide financial benefits. Swing bed services in CAHs are eligible for cost-based reimbursement, while swing bed services in non- ...

  2. Factors Associated with Iowa Rural Hospitals' Decision to Convert to Critical Access Hospital Status

    ERIC Educational Resources Information Center

    Li, Pengxiang; Ward, Marcia M.; Schneider, John E.

    2009-01-01

    Context: The Balanced Budget Act (BBA) of 1997 allowed some rural hospitals meeting certain requirements to convert to Critical Access Hospitals (CAHs) and changed their Medicare reimbursement from prospective to cost-based. Some subsequent CAH-related laws reduced restrictions and increased payments, and the number of CAHs grew rapidly. Purpose:…

  3. 42 CFR 409.12 - Nursing and related services, medical social services; use of hospital or CAH facilities.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 2 2013-10-01 2013-10-01 false Nursing and related services, medical social... Inpatient Hospital Services and Inpatient Critical Access Hospital Services § 409.12 Nursing and related... (b) of this section, Medicare pays for nursing and related services, use of hospital or CAH...

  4. 42 CFR 409.12 - Nursing and related services, medical social services; use of hospital or CAH facilities.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Nursing and related services, medical social... Inpatient Hospital Services and Inpatient Critical Access Hospital Services § 409.12 Nursing and related... (b) of this section, Medicare pays for nursing and related services, use of hospital or CAH...

  5. 42 CFR 409.12 - Nursing and related services, medical social services; use of hospital or CAH facilities.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 2 2012-10-01 2012-10-01 false Nursing and related services, medical social... Inpatient Hospital Services and Inpatient Critical Access Hospital Services § 409.12 Nursing and related... (b) of this section, Medicare pays for nursing and related services, use of hospital or CAH...

  6. 42 CFR 409.12 - Nursing and related services, medical social services; use of hospital or CAH facilities.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false Nursing and related services, medical social... Inpatient Hospital Services and Inpatient Critical Access Hospital Services § 409.12 Nursing and related... (b) of this section, Medicare pays for nursing and related services, use of hospital or CAH...

  7. 42 CFR 409.12 - Nursing and related services, medical social services; use of hospital or CAH facilities.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 2 2014-10-01 2014-10-01 false Nursing and related services, medical social... Inpatient Hospital Services and Inpatient Critical Access Hospital Services § 409.12 Nursing and related... (b) of this section, Medicare pays for nursing and related services, use of hospital or CAH...

  8. Intensive Care in Critical Access Hospitals

    ERIC Educational Resources Information Center

    Freeman, Victoria A.; Walsh, Joan; Rudolf, Matthew; Slifkin, Rebecca T.; Skinner, Asheley Cockrell

    2007-01-01

    Context: Although critical access hospitals (CAHs) have limitations on number of acute care beds and average length of stay, some of them provide intensive care unit (ICU) services. Purpose: To describe the facilities, equipment, and staffing used by CAHs for intensive care, the types of patients receiving ICU care, and the perceived impact of…

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

    PubMed

    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.

  10. Utilization and outcomes of inpatient surgical care at critical access hospitals in the United States.

    PubMed

    Gadzinski, Adam J; Dimick, Justin B; Ye, Zaojun; Miller, David C

    2013-07-01

    There is a growing interest in the quality and cost of care provided at Critical Access Hospitals (CAHs), a predominant source of care for many rural populations in the United States. To evaluate utilization, outcomes, and costs of inpatient surgery performed at CAHs. A retrospective cohort study of patients undergoing inpatient surgery from 2005 through 2009 at CAHs or non-CAHs was performed using data from the Nationwide Inpatient Sample and American Hospital Association. The CAH status of the admitting hospital. In-hospital mortality, prolonged length of stay, and total hospital costs. Among the 1283 CAHs and 3612 non-CAHs reporting to the American Hospital Association, 34.8% and 36.4%, respectively, had at least 1 year of data in the Nationwide Inpatient Sample. General surgical, gynecologic, and orthopedic procedures composed 95.8% of inpatient cases at CAHs vs 77.3% at non-CAHs (P < .001). For 8 common procedures examined (appendectomy, cholecystectomy, colorectal cancer resection, cesarean delivery, hysterectomy, knee replacement, hip replacement, and hip fracture repair), mortality was equivalent between CAHs and non-CAHs (P > .05 for all), with the exception that Medicare beneficiaries undergoing hip fracture repair in CAHs had a higher risk of in-hospital death (adjusted odds ratio = 1.37; 95% CI, 1.01-1.87). However, despite shorter hospital stays (P ≤ .001 for 4 procedures), costs at CAHs were 9.9% to 30.1% higher (P < .001 for all 8 procedures). In-hospital mortality for common low-risk procedures is indistinguishable between CAHs and non-CAHs. Although our findings suggest the potential for cost savings, changes in payment policy for CAHs could diminish access to essential surgical care for rural populations.

  11. Quality of Care and Patient Outcomes in Critical Access Hospitals

    PubMed Central

    Joynt, Karen E.; Harris, Yael; Orav, E. John; Jha, Ashish K.

    2012-01-01

    Context Critical Access Hospitals (CAHs) play a crucial role in the nation’s rural safety net. Current policy efforts have focused primarily on helping these small, isolated hospitals remain financially viable to ensure access for Americans living in rural areas. However, we know little about the quality of care they provide, or the outcomes their patients achieve. Objective To examine the quality of care and patient outcomes at CAHs, and to understand why patterns of care might differ for CAHs versus non-CAHs. Design Retrospective analysis of national data from Medicare and other sources. Setting U.S. hospitals. Patients Medicare fee-for-service beneficiaries with acute myocardial infarction (AMI), congestive heart failure (CHF), and pneumonia, discharged in 2008–2009. Main Outcome Measures Clinical capabilities, performance on processes of care, and 30-day mortality rates. Results Compared to other hospitals, CAHs were less likely to have intensive care units (30.0% versus 74.4%, p<0.001), cardiac catheterization capabilities (0.5% versus 47.7%, p<0.001), and at least basic electronic health records (4.6% versus 9.9%, p<0.001). CAHs had lower performance on process measures than non-CAHs for all three conditions examined (Hospital Quality Alliance summary score for AMI 91.0% versus 97.8%, for CHF, 80.6% versus 93.5%, and for pneumonia 89.3% versus 93.7%, p<0.001 for each). Patients admitted to a CAH had higher 30-day mortality rates for each condition than those admitted to non-CAHs (for AMI, 23.5% versus 16.2%, Odds Ratio (OR) 1.70 (95% confidence interval 1.61, 1.80), p<0.001; for CHF, 13.4% versus 10.9%, OR 1.28 (1.23, 1.32), p<0.001; and for pneumonia 14.1% versus 12.1%, OR 1.20 (1.16, 1.24) p<0.001). Conclusions Care in CAHs, compared with non-CAHs, is associated with worse processes of care and higher mortality rates. PMID:21730240

  12. Variations in Financial Performance among Peer Groups of Critical Access Hospitals

    ERIC Educational Resources Information Center

    Pink, George H.; Holmes, George M.; Thompson, Roger E.; Slifkin, Rebecca T.

    2007-01-01

    Context: Among the large number of hospitals with critical access hospital (CAH) designation, there is substantial variation in facility revenue as well as the number and types of services provided. If these variations have material effects on financial indicators, then performance comparisons among all CAHs are problematic. Purpose: To…

  13. Factors associated with Iowa rural hospitals' decision to convert to critical access hospital status.

    PubMed

    Li, Pengxiang; Ward, Marcia M; Schneider, John E

    2009-01-01

    The Balanced Budget Act (BBA) of 1997 allowed some rural hospitals meeting certain requirements to convert to Critical Access Hospitals (CAHs) and changed their Medicare reimbursement from prospective to cost-based. Some subsequent CAH-related laws reduced restrictions and increased payments, and the number of CAHs grew rapidly. To examine factors related to hospitals' decisions to convert and time to CAH conversion. Eighty-nine rural hospitals in Iowa were characterized and observed from 1998 to 2005. Cox proportional hazards models were used to identify the determinants of time to CAH conversion. T-test and one-covariate Cox regression indicated that, in 1998, Iowa rural hospitals with more staffed beds, discharges, and acute inpatient days, higher operating margin, lower skilled swing bed days relative to acute days, and located in relatively high density counties were more likely to convert later or not convert before 2006. Multiple Cox regression with baseline covariates indicated that lower number of discharges and average length of stay (ALOS) were significant after controlling all other covariates. Iowa rural hospitals' decisions regarding CAH conversion were influenced by hospital size, financial condition, skilled swing bed days relative to acute days, length of stay, proportion of Medicare acute days, and geographic factors. Although financial concerns are often cited in surveys as the main reason for conversion, lower number of discharges and ALOS are the most prominent factors affecting rural hospitals' decision on when to convert.

  14. Rural relevant quality measures for critical access hospitals.

    PubMed

    Casey, Michelle M; Moscovice, Ira; Klingner, Jill; Prasad, Shailendra

    2013-01-01

    To identify current and future relevant quality measures for Critical Access Hospitals (CAHs). Three criteria (patient volume, internal usefulness for quality improvement, and external usefulness for public reporting and payment reform) were used to analyze quality measures for their relevance for CAHs. A 6-member panel with expertise in rural hospital quality measurement and improvement provided input regarding the final measure selection. The relevant quality measures for CAHs include measures that are ready for reporting now and measures that need specifications to be finalized and/or a data reporting mechanism to be established. They include inpatient measures for specific medical conditions, global measures that address appropriate care across multiple medical conditions, and Emergency Department measures. All CAHs should publicly report on relevant quality measures. Acceptance of a single consolidated set of quality measures with common specifications for CAHs by all entities involved in regulation, accreditation, and payment; a phased process to implement the relevant measures; and the provision of technical assistance would help CAHs meet the challenge of reporting. © 2012 National Rural Health Association.

  15. Medication safety infrastructure in critical-access hospitals in Florida.

    PubMed

    Winterstein, Almut G; Hartzema, Abraham G; Johns, Thomas E; De Leon, Jessica M; McDonald, Kathie; Henshaw, Zak; Pannell, Robert

    2006-03-01

    The medication safety infrastructure of critical-access hospitals (CAHs) in Florida was evaluated. Qualitative assessments, including a self-administered survey and site visits, were conducted in seven of nine CAHs between January and June 2003. The survey consisted of the Institute for Safe Medication Practices Medication Safety Self-assessment, the 2003 Joint Commission on Accreditation of Healthcare Organizations patient safety goals, health information technology (HIT) questions, and medication-use-process flow charts. On-site visits included interviews of CAH personnel who had safety responsibility and inspections of pharmacy facilities. The findings were compiled into a matrix reflecting structural and procedural components of the CAH medication safety infrastructure. The nine characteristics that emerged as targets for quality improvement (QI) were medication accessibility and storage, sterile product compounding, access to drug information, access to and utilization of patient information in medication order review, advanced safety technology, drug formularies and standardized medication protocols, safety culture, and medication reconciliation. Based on weighted importance and feasibility, QI efforts in CAHs should focus on enhancing medication order review systems, standardizing procedures for handling high-risk medications, promoting an appropriate safety culture, involvement in seamless care, and investment in HIT.

  16. Economic Impact of the Critical Access Hospital Program on Kentucky's Communities

    ERIC Educational Resources Information Center

    Ona, Lucia; Davis, Alison

    2011-01-01

    Context: In 1997, the Medicare Rural Hospital Flexibility Grant Program created the Critical Access Hospital (CAH) Program as a response to the financial distress of rural hospitals. It was believed that this program would reduce the rate of rural hospital closures and improve access to health care services in rural communities. Objective: The…

  17. Impact of Critical Access Hospital Conversion on Beneficiary Liability

    ERIC Educational Resources Information Center

    Gilman, Boyd H.

    2008-01-01

    Context: While the Medicare Critical Access Hospital (CAH) program has improved the financial viability of small rural hospitals and enhanced access to care in rural communities, the program puts beneficiaries at risk for paying a larger share of the cost of services covered under the Medicare part B benefit. Purpose: This paper examines the…

  18. HIT implementation in critical access hospitals: extent of implementation and business strategies supporting IT use.

    PubMed

    Bahensky, James A; Ward, Marcia M; Nyarko, Kwame; Li, Pengxiang

    2011-08-01

    Small rural hospitals face considerable financial and personnel resource shortages which hinder their efforts to implement complex health information technology (HIT) systems. A survey on the use of HIT was completed by 85% of Iowa's 82 Critical Access Hospitals (CAH). Analyses indicate that low IT staffing in CAHs is a barrier to implementing HIT solutions. CAHs with fewer staff tend to employ alternative business strategies. There is a clear relationship between having IT staff at a CAH and the types of technologies used. Many CAHs report having difficulty expanding upon HIT functionalities due to the challenges of finding IT staff with healthcare expertise. Most CAHs are in the transition point of planning for or beginning implementation of complex clinical information systems. Strategies for addressing these challenges will need to evolve as the HIT investments by rural hospitals race to keep pace with the goals for the nation.

  19. Adoption and Perceived Effectiveness of Financial Improvement Strategies in Critical Access Hospitals

    ERIC Educational Resources Information Center

    Holmes, George M.; Pink, George H.

    2012-01-01

    Purpose: To ascertain the use and perceived success of strategies to improve the financial performance of Critical Access Hospitals (CAHs). Methods: Information about the use and perceived effectiveness of 44 specific strategies to improve financial performance was collected from an online survey of 291 CAH Chief Executive Officers and Chief…

  20. Patient Bypass Behavior and Critical Access Hospitals: Implications for Patient Retention

    ERIC Educational Resources Information Center

    Liu, Jiexin (Jason); Bellamy, Gail R.; McCormick, Melissa

    2007-01-01

    Purpose: To assess the extent of bypass for inpatient care among patients living in Critical Access Hospital (CAH) service areas, and to determine factors associated with bypass, the reasons for bypass, and what CAHs can do to retain patients locally. Methods: Six hundred and forty-seven subjects, aged 18 years and older, who had been admitted to…

  1. Creating a Shared Formulary in 7 Critical Access Hospitals

    ERIC Educational Resources Information Center

    Wakefield, Douglas S.; Ward, Marcia M.; Loes, Jean L.; O'Brien, John; Abbas, Nancy

    2010-01-01

    Purpose: This paper reports a case study of 7 Critical Access Hospitals' (CAH) and 1 rural referral hospital's successful collaboration to develop a shared formulary. Methods: Study methods included document reviews, interviews with key informants, and use of descriptive statistics. Findings: Through a systematic review and decision process, CAH…

  2. The Role of International Medical Graduates in America?s Small Rural Critical Access Hospitals

    ERIC Educational Resources Information Center

    Hagopian, Amy; Thompson, Matthew J.; Kaltenbach, Emily; Hart, L. Gary

    2004-01-01

    Critical access hospitals (CAHs) are a federal Medicare category for isolated rural facilities with 15 or fewer acute care beds that receive cost-based reimbursement from Medicare. Purpose: This study examines the role of foreign-born international medical graduates (IMGs) in the staffing of CAHs. Methods: Chief executive officers (CEOs) of CAH…

  3. Financial performance monitoring of the technical efficiency of critical access hospitals: a data envelopment analysis and logistic regression modeling approach.

    PubMed

    Wilson, Asa B; Kerr, Bernard J; Bastian, Nathaniel D; Fulton, Lawrence V

    2012-01-01

    From 1980 to 1999, rural designated hospitals closed at a disproportionally high rate. In response to this emergent threat to healthcare access in rural settings, the Balanced Budget Act of 1997 made provisions for the creation of a new rural hospital--the critical access hospital (CAH). The conversion to CAH and the associated cost-based reimbursement scheme significantly slowed the closure rate of rural hospitals. This work investigates which methods can ensure the long-term viability of small hospitals. This article uses a two-step design to focus on a hypothesized relationship between technical efficiency of CAHs and a recently developed set of financial monitors for these entities. The goal is to identify the financial performance measures associated with efficiency. The first step uses data envelopment analysis (DEA) to differentiate efficient from inefficient facilities within a data set of 183 CAHs. Determining DEA efficiency is an a priori categorization of hospitals in the data set as efficient or inefficient. In the second step, DEA efficiency is the categorical dependent variable (efficient = 0, inefficient = 1) in the subsequent binary logistic regression (LR) model. A set of six financial monitors selected from the array of 20 measures were the LR independent variables. We use a binary LR to test the null hypothesis that recently developed CAH financial indicators had no predictive value for categorizing a CAH as efficient or inefficient, (i.e., there is no relationship between DEA efficiency and fiscal performance).

  4. Critical Access Hospitals and Retail Activity: An Empirical Analysis in Oklahoma

    ERIC Educational Resources Information Center

    Brooks, Lara; Whitacre, Brian E.

    2011-01-01

    Purpose: This paper takes an empirical approach to determining the effect that a critical access hospital (CAH) has on local retail activity. Previous research on the relationship between hospitals and economic development has primarily focused on single-case, multiplier-oriented analysis. However, as the efficacy of federal and state-level rural…

  5. 42 CFR 409.68 - Guarantee of payment for inpatient hospital or inpatient CAH services furnished before...

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... HOSPITAL INSURANCE BENEFITS Scope of Hospital Insurance Benefits § 409.68 Guarantee of payment for... 42 Public Health 2 2010-10-01 2010-10-01 false Guarantee of payment for inpatient hospital or inpatient CAH services furnished before notification of exhaustion of benefits. 409.68 Section 409.68 Public...

  6. Electronic medical record systems in critical access hospitals: leadership perspectives on anticipated and realized benefits.

    PubMed

    Mills, Troy R; Vavroch, Jared; Bahensky, James A; Ward, Marcia M

    2010-04-01

    The growth of electronic medical records (EMRs) is driven by the belief that EMRs will significantly improve healthcare providers' performance and reduce healthcare costs. Evidence supporting these beliefs is limited, especially for small rural hospitals. A survey that focused on health information technology (HIT) capacity was administered to all hospitals in Iowa. Structured interviews were conducted with the leadership at 15 critical access hospitals (CAHs) that had implemented EMRs in order to assess the perceived benefits of operational EMRs. The results indicate that most of the hospitals implemented EMRs to improve efficiency, timely access, and quality. Many CAH leaders also viewed EMR implementation as a necessary business strategy to remain viable and improve financial performance. While some reasons reflect external influences, such as perceived future federal mandates, other reasons suggest that the decision was driven by internal forces, including the hospital's culture and the desires of key leaders to embrace HIT. Anticipated benefits were consistent with goals; however, realized benefits were rarely obvious in terms of quantifiable results. These findings expand the limited research on the rationale for implementing EMRs in critical access hospitals.

  7. Leading Change: A Case Study of the First Independent Critical-Access Hospital to Achieve Magnet® Designation.

    PubMed

    Nelson-Brantley, Heather V; Ford, Debra J; Miller, Karen L; Stegenga, Kristin A; Lee, Robert H; Bott, Marjorie J

    2018-03-01

    The aim of this study was to understand how nurses in a 25-bed critical-access hospital (CAH) led change to become the 1st to achieve Magnet®. Approximately 21% of the US population lives in rural areas served by CAHs. Rural nurse executives are particularly challenged with limited resources. Staff nurses, nurse managers, interprofessional care providers, the chief nursing officer, and board of directors (n = 27) were interviewed. Observations of hospital units and administrative meetings were done, and hospital reports were analyzed. Nine themes emerged to support a conceptual model of leading change. The CAH spent 3 years of its 6-year journey establishing organizational readiness. Nurses overcame complex challenges by balancing operational support and fostering relationships. The Magnet journey led to significantly improved nurse and patient outcomes. A new organizational culture centered on shared governance, evidence-based practice, and higher education emerged. The journey to Magnet leads to improved nurse, patient, and organization outcomes.

  8. Critical access hospital informatics: how two rural Iowa hospitals overcame challenges to achieve IT excellence.

    PubMed

    Bahensky, James A; Moreau, Brian; Frieden, Rob; Ward, Marcia M

    2008-01-01

    Critical access hospitals often have limited financial and personnel resources to implement today's healthcare IT solutions. Two CAHs in rural Iowa overcame these obstacles and found innovative ways to implement information technology. These hospitals earned recognition from Hospitals & Health Network's Most Wired Magazine for excellence in business processes, customer service, safety and quality, work force management, and public health and safety. Though the hospitals come from different environments-one is part of a system and the other is independent-both exemplify best practices on how to use healthcare IT solutions; engage clinicians from a community setting in informatics decisions; integrate technology into an organization's strategic directions; and support healthcare IT environments.

  9. Comparison of medication safety effectiveness among nine critical access hospitals.

    PubMed

    Cochran, Gary L; Haynatzki, Gleb

    2013-12-15

    The rates of medication errors across three different medication dispensing and administration systems frequently used in critical access hospitals (CAHs) were analyzed. Nine CAHs agreed to participate in this prospective study and were assigned to one of three groups based on similarities in their medication-use processes: (1) less than 10 hours per week of onsite pharmacy support and no bedside barcode system, (2) onsite pharmacy support for 40 hours per week and no bedside barcode system, and (3) onsite pharmacy support for 40 or more hours per week with a bedside barcode system. Errors were characterized by severity, phase of origination, type, and cause. Characteristics of the medication being administered and a number of best practices were collected for each medication pass. Logistic regression was used to identify significant predictors of errors. A total of 3103 medication passes were observed. More medication errors originated in hospitals that had onsite pharmacy support for less than 10 hours per week and no bedside barcode system than in other types of hospitals. A bedside barcode system had the greatest impact on lowering the odds of an error reaching the patient. Wrong dose and omission were common error types. Human factors and communication were the two most frequently identified causes of error for all three systems. Medication error rates were lower in CAHs with 40 or more hours per week of onsite pharmacy support with or without a bedside barcode system compared with hospitals with less than 10 hours per week of pharmacy support and no bedside barcode system.

  10. Improving Pediatric Preparedness in Critical Access Hospital Emergency Departments: Impact of a Longitudinal In Situ Simulation Program.

    PubMed

    Katznelson, Jessica H; Wang, Jiangxia; Stevens, Martha W; Mills, William A

    2018-01-01

    Critical access hospitals (CAH) see few pediatric patients. Many of these hospitals do not have access to physicians with pediatric training. We sought to evaluate the impact of an in situ pediatric simulation program in the CAH emergency department setting on care team performance during resuscitation scenarios. Five CAHs conducted 6 high-fidelity pediatric simulations over a 12-month period. Team performance was evaluated using a validated 35-item checklist representing commonly expected resuscitation team interventions. Checklists were scored by assigning zero point for "yes" and 1 point for "no". A lower final score meant more items on the list had been completed. The Kruskal-Wallis rank test was used to assess for differences in average scores among institutions. A linear mixed effects model with a random institution intercept was used to examine trends in average scores over time. P < 0.05 was considered significant. The Kruskal-Wallis rank test showed no difference in average scores among institutions. (P = 0.90). Checklist scores showed a significant downward trend over time, with a scenario-to-scenario decrease of 0.022 (P < 0.01). One hundred percent of providers surveyed in the last month stated they would benefit from ongoing scenarios. Regularly scheduled pediatric simulations in the CAH emergency department setting improved team performance over time on expected resuscitation tasks. The program was accepted by providers. Implementation of simulation-based training programs can help address concerns regarding pediatric preparedness in the CAH setting. A future project will look at the impact of the program on patient care and safety.

  11. Meaningful use of health information technology by rural hospitals.

    PubMed

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

    2011-01-01

    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. Data from the American Hospital Association (AHA) Annual Survey IT Supplement were analyzed, using t tests and probit regressions to assess whether implementation rates in CAHs and other rural hospitals are significantly different from rates in urban hospitals. Of the many measures we examined, only 4 have been met by a majority of rural hospitals: electronic recording of patient demographics and electronic access to lab reports, radiology reports, and radiology images. Meaningful use is even less prevalent among CAHs. We also find that rural hospitals lag behind urban institutions in nearly every measure of meaningful use. These differences are particularly large and significant for CAHs. The meaningful use incentive system creates many challenges for CAHs. First, investments are evaluated and subsidies determined after adoption. Thus, CAHs must accept financial risk when adopting health IT; this may be particularly important for large expenditures. Second, the subsidies may be low for relatively small expenditures. Third, since the subsidies are based on observable costs, CAHs will receive no support for their intangible costs (eg, workflow disruption). A variety of policies may be used to address these problems of financial risk, uncertain returns in a rural setting, and limited resources. © 2011 National Rural Health Association.

  12. Use of Critical Access Hospital Emergency Rooms by Patients with Mental Health Symptoms

    ERIC Educational Resources Information Center

    Hartley, David; Ziller, Erika C.; Loux, Stephenie L.; Gale, John A.; Lambert, David; Yousefian, Anush E.

    2007-01-01

    Context: National data demonstrate that mental health (MH) visits to the emergency room (ER) comprise a small, but not inconsequential, proportion of all visits; however, we lack a rural picture of this issue. Purpose: This study investigates the use of critical access hospital (CAH) ERs by patients with MH problems to understand the role these…

  13. 42 CFR 410.27 - Therapeutic outpatient hospital or CAH services and supplies incident to a physician's or...

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 2 2013-10-01 2013-10-01 false Therapeutic outpatient hospital or CAH services and supplies incident to a physician's or nonphysician practitioner's service: Conditions. 410.27 Section 410.27 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...

  14. 42 CFR 410.27 - Therapeutic outpatient hospital or CAH services and supplies incident to a physician's or...

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 2 2012-10-01 2012-10-01 false Therapeutic outpatient hospital or CAH services and supplies incident to a physician's or nonphysician practitioner's service: Conditions. 410.27 Section 410.27 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...

  15. 42 CFR 410.27 - Therapeutic outpatient hospital or CAH services and supplies incident to a physician's or...

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 2 2014-10-01 2014-10-01 false Therapeutic outpatient hospital or CAH services and supplies incident to a physician's or nonphysician practitioner's service: Conditions. 410.27 Section 410.27 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...

  16. Meaningful Use of Health Information Technology by Rural Hospitals

    ERIC Educational Resources Information Center

    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…

  17. Implementation of emergency department transfer communication measures in Minnesota critical access hospitals.

    PubMed

    Klingner, Jill; Moscovice, Ira; Casey, Michelle; McEllistrem Evenson, Alex

    2015-01-01

    Previously published findings based on field tests indicated that emergency department patient transfer communication measures are feasible and worthwhile to implement in rural hospitals. This study aims to expand those findings by focusing on the wide-scale implementation of these measures in the 79 Critical Access Hospitals (CAHs) in Minnesota from 2011 to 2013. Information was obtained from interviews with key informants involved in implementing the emergency department patient transfer communication measures in Minnesota as part of required statewide quality reporting. The first set of interviews targeted state-level organizations regarding their experiences working with providers. A second set of interviews targeted quality and administrative staff from CAHs regarding their experiences implementing measures. Implementing the measures in Minnesota CAHs proved to be successful in a number of respects, but informants also faced new challenges. Our recommendations, addressed to those seeking to successfully implement these measures in other states, take these challenges into account. Field-testing new quality measure implementations with volunteers may not be indicative of a full-scale implementation that requires facilities to participate. The implementation team's composition, communication efforts, prior relationships with facilities and providers, and experience with data collection and abstraction tools are critical factors in successfully implementing required reporting of quality measures on a wide scale. © 2014 National Rural Health Association.

  18. Conditional Function of Autoaggregative Protein Cah and Common cah Mutations in Shiga Toxin-Producing Escherichia coli

    PubMed Central

    Brandl, Maria T.; Kudva, Indira T.; Katani, Robab; Moreau, Matthew R.; Kapur, Vivek

    2017-01-01

    ABSTRACT Cah is a calcium-binding autotransporter protein involved in autoaggregation and biofilm formation. Although cah is widespread in Shiga toxin-producing Escherichia coli (STEC), we detected mutations in cah at a frequency of 31.3% in this pathogen. In STEC O157:H7 supershedder strain SS17, a large deletion results in a smaller coding sequence, encoding a protein lacking the C-terminal 71 amino acids compared with Cah in STEC O157:H7 strain EDL933. We examined the function of Cah in biofilm formation and host colonization to better understand the selective pressures for cah mutations. EDL933-Cah played a conditional role in biofilm formation in vitro: it enhanced E. coli DH5α biofilm formation on glass surfaces under agitated culture conditions that prevented autoaggregation but inhibited biofilm formation under hydrostatic conditions that facilitated autoaggregation. This function appeared to be strain dependent since Cah-mediated biofilm formation was diminished when an EDL933 cah gene was expressed in SS17. Deletion of cah in EDL933 enhanced bacterial attachment to spinach leaves and altered the adherence pattern of EDL933 to bovine recto-anal junction squamous epithelial (RSE) cells. In contrast, in trans expression of EDL933 cah in SS17 increased its attachment to leaf surfaces, and in DH5α, it enhanced its adherence to RSE cells. Hence, the ecological function of Cah appears to be modulated by environmental conditions and other bacterial strain-specific properties. Considering the prevalence of cah in STEC and its role in attachment and biofilm formation, cah mutations might be selected in ecological niches in which inactivation of Cah would result in an increased fitness in STEC during colonization of plants or animal hosts. IMPORTANCE Shiga toxin-producing Escherichia coli (STEC) harbors genes encoding diverse adhesins, and many of these are known to play an important role in bacterial attachment and host colonization. We demonstrated here that the

  19. Conditional Function of Autoaggregative Protein Cah and Common cah Mutations in Shiga Toxin-Producing Escherichia coli.

    PubMed

    Carter, Michelle Qiu; Brandl, Maria T; Kudva, Indira T; Katani, Robab; Moreau, Matthew R; Kapur, Vivek

    2018-01-01

    Cah is a calcium-binding autotransporter protein involved in autoaggregation and biofilm formation. Although cah is widespread in Shiga toxin-producing Escherichia coli (STEC), we detected mutations in cah at a frequency of 31.3% in this pathogen. In STEC O157:H7 supershedder strain SS17, a large deletion results in a smaller coding sequence, encoding a protein lacking the C-terminal 71 amino acids compared with Cah in STEC O157:H7 strain EDL933. We examined the function of Cah in biofilm formation and host colonization to better understand the selective pressures for cah mutations. EDL933-Cah played a conditional role in biofilm formation in vitro : it enhanced E. coli DH5α biofilm formation on glass surfaces under agitated culture conditions that prevented autoaggregation but inhibited biofilm formation under hydrostatic conditions that facilitated autoaggregation. This function appeared to be strain dependent since Cah-mediated biofilm formation was diminished when an EDL933 cah gene was expressed in SS17. Deletion of cah in EDL933 enhanced bacterial attachment to spinach leaves and altered the adherence pattern of EDL933 to bovine recto-anal junction squamous epithelial (RSE) cells. In contrast, in trans expression of EDL933 cah in SS17 increased its attachment to leaf surfaces, and in DH5α, it enhanced its adherence to RSE cells. Hence, the ecological function of Cah appears to be modulated by environmental conditions and other bacterial strain-specific properties. Considering the prevalence of cah in STEC and its role in attachment and biofilm formation, cah mutations might be selected in ecological niches in which inactivation of Cah would result in an increased fitness in STEC during colonization of plants or animal hosts. IMPORTANCE Shiga toxin-producing Escherichia coli (STEC) harbors genes encoding diverse adhesins, and many of these are known to play an important role in bacterial attachment and host colonization. We demonstrated here that the

  20. A modest proposal: nurse practitioners to improve clinical quality and financial viability in critical access hospitals.

    PubMed

    Marsh, Leslie; Diers, Donna; Jenkins, Allan

    2012-11-01

    Rural health care has achieved a new focus of attention with the passage of the Affordable Care Act (ACA). This article argues that nurse practitioners may be an important resource to help rural hospitals, especially critical access hospitals (CAH), achieve their mission of community service while protecting their always-delicate financial sustainability. Nurse practitioners' scope of practice is well suited to the needs of rural patients, and their ability to participate in expanding preventive services is especially essential in remote areas. Barriers to nurse practitioner practice include restrictive state laws and federal and state policies.

  1. Conditional function of autoaggregative protein cah and common cah mutations in Shiga toxin-producing Escherichia coli

    USDA-ARS?s Scientific Manuscript database

    Cah is a calcium-binding autotransporter protein involved in autoaggregation and biofilm formation. Although cah is widespread in Shiga toxin-producing Escherichia coli (STEC), we detected mutations in cah at a frequency of 31.3% in this pathogen. In STEC O157:H7 super-shedder strain SS17, a large d...

  2. 76 FR 25550 - Medicare and Medicaid Programs: Changes Affecting Hospital and Critical Access Hospital...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-05-05

    ... go through a burdensome credentialing and privileging process for each physician and practitioner who... issues. The most common comment expressed was that the proposed regulation did not go far enough in... CoPs did not go far enough in addressing the burdens borne by those small hospitals and CAHs that...

  3. 42 CFR 495.106 - Incentive payments to CAHs.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... PROGRAM Requirements Specific to the Medicare Program § 495.106 Incentive payments to CAHs. (a... computers and associated hardware and software, necessary to administer certified EHR technology as defined... determining if a CAH is a qualifying CAH under this section; (3) Specification of EHR reporting periods, cost...

  4. 42 CFR 495.106 - Incentive payments to CAHs.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... PROGRAM Requirements Specific to the Medicare Program § 495.106 Incentive payments to CAHs. (a... computers and associated hardware and software, necessary to administer certified EHR technology as defined... determining if a CAH is a qualifying CAH under this section; (3) Specification of EHR reporting periods, cost...

  5. Future financial viability of rural hospitals.

    PubMed

    Stensland, Jeffrey; Moscovice, Ira; Christianson, Jon

    2002-01-01

    Policymakers are concerned that some rural hospitals have suffered significant losses under the Balanced Budget Act (BBA) of 1997 and that access to inpatient and emergency care may be at risk. This article projects that the median total profit margin for rural hospitals will fall from 4 percent in 1997 to between 2.5 and 3.7 percent after the BBA, Balanced Budget Refinement Act (BBRA) of 1999, and Benefits Improvement and Protection Act (BIPA) of 2000 are fully implemented in 2004. The Critical Access Hospital (CAH) Program is expected to prevent reductions in inpatient and outpatient prospective payments from causing an increase in rural hospital closures.

  6. CAH1 and CAH2 as key enzymes required for high bicarbonate tolerance of a novel microalga Dunaliella salina HTBS.

    PubMed

    Hou, Yuyong; Liu, Zhiyong; Zhao, Yue; Chen, Shulin; Zheng, Yubin; Chen, Fangjian

    2016-06-01

    Outdoor microalgal cultivation with high concentration bicarbonate has been considered as a strategy for reducing contamination and improving carbon supply efficiency. The mechanism responsible for algae's strong tolerance to high bicarbonate however, remains not clear. In this study, we isolated and characterized a strain and revealed its high bicarbonate tolerant mechanism by analyzing carbonic anhydrase (CA). The strain was identified as Dunaliella salina HTBS with broad temperature adaptability (7-30°C). The strain grew well under 30% CO2 or 70gL(-1) NaHCO3. In comparison, two periplasm CAs (CAH1 and CAH2) were detected with immunoblotting analysis in HTBS but not in a non-HCO3(-)-tolerant strain. The finding was also verified by an enzyme inhibition assay in which only HTBS showed significant inhibition by extracellular CA inhibitor. Thus, we inferred that the extracellular CAH1 and CAH2 played a multifunctional role in the toleration of high bicarbonate by HTBS. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Development of a Medication Safety and Quality Survey for Small Rural Hospitals.

    PubMed

    Winterstein, Almut G; Johns, Thomas E; Campbell, Kyle N; Libby, Joel; Pannell, Bob

    2017-12-01

    We summarize the development and initial implementation of a survey tool to assess medication safety in small rural hospitals. As part of an ongoing rural hospital medication safety improvement program, we developed a survey tool in all 13 critical access hospitals (CAHs) in Florida. The survey was compiled from existing medication safety assessments and standards, clinical practice guidelines, and published literature. Survey items were selected based on considerations regarding practicality and relevance to the CAH setting.The final survey instrument included 134 items representing 17 medication safety domains. Overall hospital scores ranged from 41% to 95%, with a median of 59%. Most hospitals showed large variation in scores across domains, with 5 hospitals having at least 1 domain with scores less than 10%. Highest scores across all facilities were seen for safety procedures concerning high-alert or look-alike medications and the assembly of emergency carts. The lowest median scores included availability and consistent use of standardized order sets and the effective implementation of medication safety committees. Most hospitals used the survey results to identify and prioritize quality improvement activities. The survey can be used to conduct a short medication safety assessment specific to a limited number of areas and services in CAHs. It showed good ability to discriminate medication safety levels across participating sites and highlighted opportunities for improvement. It may need modification if case mix or services differ in other states or if the status quo of medication safety in CAHs or related standards advance. The described process of survey development might be helpful to support such modifications.

  8. What Are the Treatments for Congenital Adrenal Hyperplasia (CAH)?

    MedlinePlus

    ... Find a Study Resources and Publications Infertility and Fertility About NICHD Research Information Find a Study More ... treatment very soon after birth to reduce the effects of CAH. Classic CAH is treated with steroids ...

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

    PubMed

    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.

  10. Comparison of medication safety systems in critical access hospitals: Combined analysis of two studies.

    PubMed

    Cochran, Gary L; Barrett, Ryan S; Horn, Susan D

    2016-08-01

    The role of pharmacist transcription, onsite pharmacist dispensing, use of automated dispensing cabinets (ADCs), nurse-nurse double checks, or barcode-assisted medication administration (BCMA) in reducing medication error rates in critical access hospitals (CAHs) was evaluated. Investigators used the practice-based evidence methodology to identify predictors of medication errors in 12 Nebraska CAHs. Detailed information about each medication administered was recorded through direct observation. Errors were identified by comparing the observed medication administered with the physician's order. Chi-square analysis and Fisher's exact test were used to measure differences between groups of medication-dispensing procedures. Nurses observed 6497 medications being administered to 1374 patients. The overall error rate was 1.2%. The transcription error rates for orders transcribed by an onsite pharmacist were slightly lower than for orders transcribed by a telepharmacy service (0.10% and 0.33%, respectively). Fewer dispensing errors occurred when medications were dispensed by an onsite pharmacist versus any other method of medication acquisition (0.10% versus 0.44%, p = 0.0085). The rates of dispensing errors for medications that were retrieved from a single-cell ADC (0.19%), a multicell ADC (0.45%), or a drug closet or general supply (0.77%) did not differ significantly. BCMA was associated with a higher proportion of dispensing and administration errors intercepted before reaching the patient (66.7%) compared with either manual double checks (10%) or no BCMA or double check (30.4%) of the medication before administration (p = 0.0167). Onsite pharmacist dispensing and BCMA were associated with fewer medication errors and are important components of a medication safety strategy in CAHs. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  11. Developing a strategic marketing plan for physical and occupational therapy services: a collaborative project between a critical access hospital and a graduate program in health care management.

    PubMed

    Kash, Bita A; Deshmukh, A A

    2013-01-01

    The purpose of this study was to develop a marketing plan for the Physical and Occupational Therapy (PT/OT) department at a Critical Access Hospital (CAH). We took the approach of understanding and analyzing the rural community and health care environment, problems faced by the PT/OT department, and developing a strategic marketing plan to resolve those problems. We used hospital admissions data, public and physician surveys, a SWOT analysis, and tools to evaluate alternative strategies. Lack of awareness and negative perception were key issues. Recommended strategies included building relationships with physicians, partnering with the school district, and enhancing the wellness program.

  12. A comparative study of financial data sources for critical access hospitals: audited financial statements, the Medicare cost report, and the Internal Revenue Service form 990.

    PubMed

    Ozmeral, Alisha Bhadelia; Reiter, Kristin L; Holmes, George M; Pink, George H

    2012-01-01

    Medicare cost reports (MCR), Internal Revenue Service form 990s (IRS 990), and audited financial statements (AFS) vary in their content, detail, purpose, timeliness, and certification. The purpose of this study was to compare selected financial data elements and characterize the extent of differences in financial data and ratios across the MCR, IRS 990, and AFS for a sample of nonprofit critical access hospitals (CAHs). Line items from AFS of 47 CAHs were compared to data reported in the hospitals' MCR and IRS 990s. Line items were based on 9 financial indicators commonly used to assess hospital financial performance. Of the indicators examined, the equity financing ratio most frequently matched between the 3 reports, while salaries and benefits to total expenses and debt service coverage were often different. Variances were driven by differences in individual account balances used to construct the ratios. Relative to AFS, cash was frequently lower on the IRS 990 while marketable securities and unrestricted investments were often higher. Other revenue and net income were consistently lower on the MCR and IRS 990, and depreciation was often higher on the MCR. The majority of total assets and fund balance (equity) values matched across the 3 reports, suggesting differences in classification among detailed accounts were more common than variances between the component totals (total assets, total liabilities, and fund balance). Health policy researchers should consider the impact of these variances on study results and consider ways to improve the availability and quality of financial accounting information. © 2012 National Rural Health Association.

  13. Investigation on LiBH4-CaH2 composite and its potential for thermal energy storage.

    PubMed

    Li, Yang; Li, Ping; Qu, Xuanhui

    2017-01-31

    The LiBH 4 /CaH 2 composite are firstly studied as Concentrating Solar Power Thermal Storage Material. The LiBH 4 /CaH 2 composite according to the stoichiometric ratio are synthesized by high-energy ball milling method. The kinetics, thermodynamics and cycling stability of LiBH 4 /CaH 2 composite are investigated by XRD (X-ray diffraction), DSC (Differential scanning calorimeter) and TEM (Transmission electron microscope). The reaction enthalpy of LiBH 4 /CaH 2 composite is almost 60 kJ/mol H 2 and equilibrium pressure is 0.482 MPa at 450 °C. The thermal storage density of LiBH 4 /CaH 2 composite is 3504.6 kJ/kg. XRD results show that the main phase after dehydrogenation is LiH and CaB 6 . The existence of TiCl 3 and NbF 5 can effectively enhance the cycling perfomance of LiBH 4 /CaH 2 composite, with 6-7 wt% hydrogen capacity after 10 cycles. The high thermal storage density, high working temperature and low equilibrium pressure make LiBH 4 /CaH 2 composite a potential thermal storage material.

  14. The Rising Rate of Rural Hospital Closures.

    PubMed

    Kaufman, Brystana G; Thomas, Sharita R; Randolph, Randy K; Perry, Julie R; Thompson, Kristie W; Holmes, George M; Pink, George H

    2016-01-01

    Since 2010, the rate of rural hospital closures has increased significantly. This study is a preliminary look at recent closures and a formative step in research to understand the causes and the impact on rural communities. The 2009 financial performance and market characteristics of rural hospitals that closed from 2010 through 2014 were compared to rural hospitals that remained open during the same period, stratified by critical access hospitals (CAHs) and other rural hospitals (ORHs). Differences were tested using Pearson's chi-square (categorical variables) and Wilcoxon rank test of medians. The relationships between negative operating margin and (1) market factors and (2) utilization/staffing factors were explored using logistic regression. In 2009, CAHs that subsequently closed from 2010 through 2014 had, in general, lower levels of profitability, liquidity, equity, patient volume, and staffing. In addition, ORHs that closed had smaller market shares and operated in markets with smaller populations compared to ORHs that remained open. Odds of unprofitability were associated with both market and utilization factors. Although half of the closed hospitals ceased providing health services altogether, the remainder have since converted to an alternative health care delivery model. Financial and market characteristics appear to be associated with closure of rural hospitals from 2010 through 2014, suggesting that it is possible to identify hospitals at risk of closure. As closure rates show no sign of abating, it is important to study the drivers of distress in rural hospitals, as well as the potential for alternative health care delivery models. © 2015 National Rural Health Association.

  15. Reduced short term memory in congenital adrenal hyperplasia (CAH) and its relationship to spatial and quantitative performance.

    PubMed

    Collaer, Marcia L; Hindmarsh, Peter C; Pasterski, Vickie; Fane, Briony A; Hines, Melissa

    2016-02-01

    Girls and women with classical congenital adrenal hyperplasia (CAH) experience elevated androgens prenatally and show increased male-typical development for certain behaviors. Further, individuals with CAH receive glucocorticoid (GC) treatment postnatally, and this GC treatment could have negative cognitive consequences. We investigated two alternative hypotheses, that: (a) early androgen exposure in females with CAH masculinizes (improves) spatial perception and quantitative abilities at which males typically outperform females, or (b) CAH is associated with performance decrements in these domains, perhaps due to reduced short-term-memory (STM). Adolescent and adult individuals with CAH (40 female and 29 male) were compared with relative controls (29 female and 30 male) on spatial perception and quantitative abilities as well as on Digit Span (DS) to assess STM and on Vocabulary to assess general intelligence. Females with CAH did not perform better (more male-typical) on spatial perception or quantitative abilities than control females, failing to support the hypothesis of cognitive masculinization. Rather, in the sample as a whole individuals with CAH scored lower on spatial perception (p ≤ .009), a quantitative composite (p ≤ .036), and DS (p ≤ .001), despite no differences in general intelligence. Separate analyses of adolescent and adult participants suggested the spatial and quantitative effects might be present only in adult patients with CAH; however, reduced DS performance was found in patients with CAH regardless of age group. Separate regression analyses showed that DS predicted both spatial perception and quantitative performance (both p ≤ .001), when age, sex, and diagnosis status were controlled. Thus, reduced STM in CAH patients versus controls may have more general cognitive consequences, potentially reducing spatial perception and quantitative skills. Although hyponatremia or other aspects of salt-wasting crises or additional hormone

  16. Genetic screening of non-classic CAH females with hyperandrogenemia identifies a novel CYP11B1 gene mutation.

    PubMed

    Shammas, Christos; Byrou, Stefania; Phelan, Marie M; Toumba, Meropi; Stylianou, Charilaos; Skordis, Nicos; Neocleous, Vassos; Phylactou, Leonidas A

    2016-04-01

    Congenital adrenal hyperplasia (CAH) is an endocrine autosomal recessive disorder with various symptoms of diverse severity. Mild hyperandrogenemia is the most commonclinical feature in non-classic CAH patients and 95% of the cases are identified by mutations in the CYP21A2 gene. In the present study, the second most common cause for non-classic CAH (NC-CAH), 11β-hydroxylase deficiency due to mutations in the CYP11B1 gene, is investigated. Screening of the CYP21A2 and CYP11B1 genes by direct sequencing was carried out for the detection of possible genetic defects in patients with suspected CAH. It wasobserved that CYP11B1 variants co-exist only in rare cases along with mutations in CYP21A2 in patients clinically diagnosed with CAH. A total of 23 NC-CAH female patients out of 75 were identified with only one mutation in the CYP21A2 gene. The novel CYP11B1 gene mutation, p.Val484Asp, was identified in a patient with CAH in the heterozygous state. The structural characterization of the novel p.Val484Asp was found to likely cause distortion of the surrounding beta sheet and indirect destabilization of the cavity that occurs on the opposite face of the structural elements, leading to partial impairment of the enzymatic activity. CYP21A2 gene mutations are the most frequent genetic defects in cases of NC-CAH even when these patients are in the heterozygous state. These mutations have a diverse phenotype giving rise to a variable extent of cortisol synthesis impairment; it is also clear that CYP11B1 mutants are a rare type of defects causing CAH.

  17. 76 FR 39043 - TRICARE; Reimbursement of Sole Community Hospitals and Adjustment to Reimbursement of Critical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-05

    ... hospitals located within Military Treatment Facility (MTF) Prime Service Areas (PSAs) and deemed essential... costs. It has come to our attention that there may be some CAHs located in MTF PSAs that are deemed... proposing a CAH TMCPA for TRICARE network hospitals located within MTF PSAs and deemed essential for...

  18. Incentive Program Requirements for Eligible Hospitals, Critical Access Hospitals, and Eligible Professionals; Provider-Based Status of Indian Health Service and Tribal Facilities and Organizations; Costs Reporting and Provider Requirements; Agreement Termination Notices. Final rule.

    PubMed

    2017-08-14

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

  19. 42 CFR 486.322 - Condition: Relationships with hospitals, critical access hospitals, and tissue banks.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... access hospitals, and tissue banks. 486.322 Section 486.322 Public Health CENTERS FOR MEDICARE & MEDICAID... Measures § 486.322 Condition: Relationships with hospitals, critical access hospitals, and tissue banks. (a... hospital and critical access hospital staff. (c) Standard: Cooperation with tissue banks. (1) The OPO must...

  20. 42 CFR 486.322 - Condition: Relationships with hospitals, critical access hospitals, and tissue banks.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... access hospitals, and tissue banks. 486.322 Section 486.322 Public Health CENTERS FOR MEDICARE & MEDICAID... Measures § 486.322 Condition: Relationships with hospitals, critical access hospitals, and tissue banks. (a... hospital and critical access hospital staff. (c) Standard: Cooperation with tissue banks. (1) The OPO must...

  1. 42 CFR 486.322 - Condition: Relationships with hospitals, critical access hospitals, and tissue banks.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... access hospitals, and tissue banks. 486.322 Section 486.322 Public Health CENTERS FOR MEDICARE & MEDICAID... Measures § 486.322 Condition: Relationships with hospitals, critical access hospitals, and tissue banks. (a... hospital and critical access hospital staff. (c) Standard: Cooperation with tissue banks. (1) The OPO must...

  2. 42 CFR 486.322 - Condition: Relationships with hospitals, critical access hospitals, and tissue banks.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... access hospitals, and tissue banks. 486.322 Section 486.322 Public Health CENTERS FOR MEDICARE & MEDICAID... Measures § 486.322 Condition: Relationships with hospitals, critical access hospitals, and tissue banks. (a... hospital and critical access hospital staff. (c) Standard: Cooperation with tissue banks. (1) The OPO must...

  3. 42 CFR 486.322 - Condition: Relationships with hospitals, critical access hospitals, and tissue banks.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... access hospitals, and tissue banks. 486.322 Section 486.322 Public Health CENTERS FOR MEDICARE & MEDICAID... Measures § 486.322 Condition: Relationships with hospitals, critical access hospitals, and tissue banks. (a... hospital and critical access hospital staff. (c) Standard: Cooperation with tissue banks. (1) The OPO must...

  4. The carbonic anhydrase CAH1 is an essential component of the carbon-concentrating mechanism in Nannochloropsis oceanica.

    PubMed

    Gee, Christopher W; Niyogi, Krishna K

    2017-04-25

    Aquatic photosynthetic organisms cope with low environmental CO 2 concentrations through the action of carbon-concentrating mechanisms (CCMs). Known eukaryotic CCMs consist of inorganic carbon transporters and carbonic anhydrases (and other supporting components) that culminate in elevated [CO 2 ] inside a chloroplastic Rubisco-containing structure called a pyrenoid. We set out to determine the molecular mechanisms underlying the CCM in the emerging model photosynthetic stramenopile, Nannochloropsis oceanica , a unicellular picoplanktonic alga that lacks a pyrenoid. We characterized CARBONIC ANHYDRASE 1 ( CAH1 ) as an essential component of the CCM in N. oceanica CCMP1779. We generated insertions in this gene by directed homologous recombination and found that the cah1 mutant has severe defects in growth and photosynthesis at ambient CO 2 We identified CAH1 as an α-type carbonic anhydrase, providing a biochemical role in CCM function. CAH1 was found to localize to the lumen of the epiplastid endoplasmic reticulum, with its expression regulated by the external inorganic carbon concentration at both the transcript and protein levels. Taken together, these findings show that CAH1 is an indispensable component of what may be a simple but effective and dynamic CCM in N. oceanica .

  5. Androgen and psychosexual development: core gender identity, sexual orientation and recalled childhood gender role behavior in women and men with congenital adrenal hyperplasia (CAH).

    PubMed

    Hines, Melissa; Brook, Charles; Conway, Gerard S

    2004-02-01

    We assessed core gender identity, sexual orientation, and recalled childhood gender role behavior in 16 women and 9 men with CAH and in 15 unaffected female and 10 unaffected male relatives, all between the ages of 18 and 44 years. Women with congenital adrenal hyperplasia (CAH) recalled significantly more male-typical play behavior as children than did unaffected women, whereas men with and without CAH did not differ. Women with CAH also reported significantly less satisfaction with the female sex of assignment and less heterosexual interest than did unaffected women. Again, men with CAH did not differ significantly from unaffected men in these respects. Our results for women with CAH are consistent with numerous prior reports indicating that girls with CAH show increased male-typical play behavior. They also support the hypotheses that these women show reduced heterosexual interest and reduced satisfaction with the female sex of assignment. Our results for males are consistent with most prior reports that boys with CAH do not show a general alteration in childhood play behavior. In addition, they provide initial evidence that core gender identity and sexual orientation are unaffected in men with CAH. Finally, among women with CAH, we found that recalled male-typical play in childhood correlated with reduced satisfaction with the female gender and reduced heterosexual interest in adulthood. Although prospective studies are needed, these results suggest that those girls with CAH who show the greatest alterations in childhood play behavior may be the most likely to develop a bisexual or homosexual orientation as adults and to be dissatisfied with the female sex of assignment.

  6. UTILIZATION OF TREATABILITY AND PILOT TESTS TO PREDICT CAH BIOREMEDIATION

    EPA Science Inventory

    Multiple tools have been suggested to help in the design of enhanced anaerobic bioremediation systems for CAHs:
    - Extensive high quality microcosm testing followed by small-scale, thoroughly observed field pilot tests (i.e., RABITT Protocol, Morse 1998)
    - More limited ...

  7. Enhanced CAH dechlorination in a low permeability, variably-saturated medium

    USGS Publications Warehouse

    Martin, J.P.; Sorenson, K.S.; Peterson, L.N.; Brennan, R.A.; Werth, C.J.; Sanford, R.A.; Bures, G.H.; Taylor, C.J.; ,

    2002-01-01

    An innovative pilot-scale field test was performed to enhance the anaerobic reductive dechlorination (ARD) of chlorinated aliphatic hydrocarbons (CAHs) in a low permeability, variably-saturated formation. The selected technology combines the use of a hydraulic fracturing (fracking) technique with enhanced bioremediation through the creation of highly-permeable sand- and electron donor-filled fractures in the low permeability matrix. Chitin was selected as the electron donor because of its unique properties as a polymeric organic material and based on the results of lab studies that indicated its ability to support ARD. The distribution and impact of chitin- and sand-filled fractures to the system was evaluated using hydrologic, geophysical, and geochemical parameters. The results indicate that, where distributed, chitin favorably impacted redox conditions and supported enhanced ARD of CAHs. These results indicate that this technology may be a viable and cost-effective approach for remediation of low-permeability, variably saturated systems.

  8. Reassigning the CaH+ 11Σ → 21Σ vibronic transition with CaD+

    NASA Astrophysics Data System (ADS)

    Condoluci, J.; Janardan, S.; Calvin, A. T.; Rugango, R.; Shu, G.; Sherrill, C. D.; Brown, K. R.

    2017-12-01

    We observe vibronic transitions in CaD+ between the 11Σ and 21Σ electronic states by resonance enhanced multiphoton photodissociation spectroscopy in a Coulomb crystal. The vibronic transitions are compared with previous measurements on CaH+. The result is a revised assignment of the CaH+ vibronic levels and a disagreement with multi-state-complete-active-space second-order perturbation theory theoretical calculations by approximately 700 cm-1. Updated high-level coupled-cluster calculations that include core-valence correlations reduce the disagreement between theory and experiment to 300 cm-1.

  9. UTILIZATION OF TREATABILITY AND PILOT TESTS TO PREDICT CAH BIOREMEDIATION (Battelle)

    EPA Science Inventory

    Multiple tools have been suggested to help in the design of enhanced anaerobic bioremediation systems for CAHs:
    Extensive high quality microcosm testing followed by small-scale, thoroughly observed, induced flow field pilot tests (i.e. RABITT Protocol, Morse 1998)
    More...

  10. Access to inpatient dermatology care in Pennsylvania hospitals.

    PubMed

    Messenger, Elizabeth; Kovarik, Carrie L; Lipoff, Jules B

    2016-01-01

    Access to care is a known issue in dermatology, and many patients may experience long waiting periods to see a physician. In this study, an anonymous online survey was sent to all 274 Pennsylvania hospitals licensed by the US Department of Health in order to evaluate current levels of access to inpatient dermatology services. Although the response rate to this survey was limited, the data suggest that access to inpatient dermatology services is limited and may be problematic in hospitals across the United States. Innovation efforts and further studies are needed to address this gap in access to care.

  11. A Defined and Flexible Pocket Explains Aryl Substrate Promiscuity by the Cahuitamycin Starter Unit Activating Enzyme CahJ.

    PubMed

    Sherman, David H; Tripathi, Ashootosh; Park, Sung Ryeol; Sikkema, Andrew; Cho, Hyo Je; Wu, Jianfeng; Lee, Brian; Xi, Chuanwu; Smith, Janet L

    2018-05-09

    Cahuitamycins are biofilm inhibitors biosynthesized by a convergent NRPS pathway. Previous genetic analysis indicated that a discrete enzyme, CahJ, serves as a gatekeeper for cahuitamycin structural diversification. Herein, the CahJ protein was probed structurally, functionally and through mutasynthesis. This analysis enabled production of a new cahuitamycin congener through targeted precursor incorporation. © 2018 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  12. Hospital admissions and emergency department presentations for dental conditions indicate access to hospital, rather than poor access to dental health care in the community.

    PubMed

    Yap, Matthew; Kok, Mei-Ruu; Nanda, Soniya; Vickery, Alistair; Whyatt, David

    2018-03-01

    High rates of dental-related potentially preventable hospitalisations are thought to reflect poor access to non-hospital dental services. The association between accessibility (geographic and financial) to non-hospital dentists and potentially preventable hospitalisations was examined in Western Australia. Areas with persistently high rates of dental-related potentially preventable hospitalisations and emergency department (ED) presentations were mapped. Statistical models examined factors associated with these events. Persistently high rates of dental-related potentially preventable hospitalisations were clustered in metropolitan areas that were socioeconomically advantaged and had more dentists per capita (RR 1.06, 95% CI 1.04-1.08) after adjusting for age, sex, socioeconomics, and Aboriginality. Persistently high rates of ED presentations were clustered in socioeconomically disadvantaged areas near metropolitan EDs and with fewer dentists per capita (RR 0.91, 0.88-0.94). A positive association between dental-related potentially preventable hospitalisations and poor (financial or geographic) access to dentists was not found. Rather, rates of such events were positively associated with socioeconomic advantage, plus greater access to hospitals and non-hospital dental services. Furthermore, ED presentations for dental conditions are inappropriate indicators of poor access to non-hospital dental services because of their relationship with hospital proximity. Health service planners and policymakers should pursue alternative indicators of dental service accessibility.

  13. Positioning hospitals for improved access to capital.

    PubMed

    Ponton, Kevin T; Sandrick, Karen M

    2002-11-01

    Hospitals need to actively position themselves in the next 18 to 24 months to ensure continued access to financing. Hospitals need to shift their focus from investment income to operations. Hospitals should recognize the importance of balance-sheet liquidity to institutional investors. Not-for-profit hospitals should focus on both sides of the balance sheet. Healthcare executives need to develop effective leadership and investor-relations skills.

  14. 77 FR 53967 - Medicare and Medicaid Programs; Electronic Health Record Incentive Program-Stage 2

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-09-04

    ...This final rule specifies the Stage 2 criteria that eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) must meet in order to qualify for Medicare and/or Medicaid electronic health record (EHR) incentive payments. In addition, it specifies payment adjustments under Medicare for covered professional services and hospital services provided by EPs, eligible hospitals, and CAHs failing to demonstrate meaningful use of certified EHR technology (CEHRT) and other program participation requirements. This final rule revises certain Stage 1 criteria, as finalized in the July 28, 2010 final rule, as well as criteria that apply regardless of Stage.

  15. Raising the Level of Awareness of Nurse-to-Nurse Lateral Violence in a Critical Access Hospital.

    PubMed

    Embree, Jennifer L; Bruner, Deborah A; White, Ann

    2013-01-01

    Background/Significance of Problem. Nurse-to-nurse lateral violence (NNLV) has been internationally reported for greater than two decades and results in new nurse turnover and serious negative outcomes. Clinical Question/Project Objective. Will NNLV and cognitive rehearsal (CR) education result in a decrease in perceived nurse-to-nurse lateral violence in a critical access hospital (CAH)? The scope of this project was to determine perceived extent and increase awareness of NNLV through an educational project about NNLV and CR. Clinical Appraisal of Literature/Best Evidence. Trends of NNLV were assessed through an extensive literature review from Health Source, CINAHL, ProQuest Health, and Medical Complete. An educational forum about NNLV with CR was advocated for newly licensed nurses and current nurses (potential perpetrators of NNLV) with the goal of liberation of oppressed individuals. Integration into Practice/Discussion of Results. An interventional study with one group and pre-/postintervention was used to determine NNLV and CR education on perceived levels of lateral violence. Evidence-based measurement occurred through use of the Nurse Workplace Scale and the Silencing the Self-Work Scale. Outcomes were analyzed quantitatively through independent t-tests. Awareness of NNLV was increased. Evaluation of Evidence-Based Practice/Implications. Organizations must learn to eliminate NNLV. With increased levels of awareness of NNLV, nurses requested additional assistance in dealing with inappropriate behavior.

  16. Raising the Level of Awareness of Nurse-to-Nurse Lateral Violence in a Critical Access Hospital

    PubMed Central

    Embree, Jennifer L.; Bruner, Deborah A.; White, Ann

    2013-01-01

    Background/Significance of Problem. Nurse-to-nurse lateral violence (NNLV) has been internationally reported for greater than two decades and results in new nurse turnover and serious negative outcomes. Clinical Question/Project Objective. Will NNLV and cognitive rehearsal (CR) education result in a decrease in perceived nurse-to-nurse lateral violence in a critical access hospital (CAH)? The scope of this project was to determine perceived extent and increase awareness of NNLV through an educational project about NNLV and CR. Clinical Appraisal of Literature/Best Evidence. Trends of NNLV were assessed through an extensive literature review from Health Source, CINAHL, ProQuest Health, and Medical Complete. An educational forum about NNLV with CR was advocated for newly licensed nurses and current nurses (potential perpetrators of NNLV) with the goal of liberation of oppressed individuals. Integration into Practice/Discussion of Results. An interventional study with one group and pre-/postintervention was used to determine NNLV and CR education on perceived levels of lateral violence. Evidence-based measurement occurred through use of the Nurse Workplace Scale and the Silencing the Self-Work Scale. Outcomes were analyzed quantitatively through independent t-tests. Awareness of NNLV was increased. Evaluation of Evidence-Based Practice/Implications. Organizations must learn to eliminate NNLV. With increased levels of awareness of NNLV, nurses requested additional assistance in dealing with inappropriate behavior. PMID:23991337

  17. 42 CFR 495.4 - Definitions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... technology has the same definition as this term is defined at 45 CFR 170.102. Critical access hospital (CAH) means a facility that has been certified as a critical access hospital under section 1820(e) of the Act... AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM General...

  18. 42 CFR 495.4 - Definitions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... technology has the same definition as this term is defined at 45 CFR 170.102. Critical access hospital (CAH) means a facility that has been certified as a critical access hospital under section 1820(e) of the Act... AND CERTIFICATION STANDARDS FOR THE ELECTRONIC HEALTH RECORD TECHNOLOGY INCENTIVE PROGRAM General...

  19. Access block in NSW hospitals, 1999-2001: does the definition matter?

    PubMed

    Forero, Roberto; Mohsin, Mohammed; Bauman, Adrian E; Ieraci, Sue; Young, Lis; Phung, Hai N; Hillman, Kenneth M; McCarthy, Sally M; Hugelmeyer, C David

    2004-01-19

    To estimate the magnitude of access block and its trend over time in New South Wales hospitals, using different definitions of access block, and to explore its association with clinical and non-clinical factors. An epidemiological study using the Emergency Department Information System datasets (1 January 1999 to 31 December 2001) from a sample of 55 NSW hospitals. Prevalence of access block measured by four different definitions; strength of association between access block, type of hospital, year of presentation, mode and time of arrival, triage category (an indicator of urgency), age and sex. Rates of access block (for all four definitions) increased between 1999 and 2001 by 1%-2% per year. There were increases across all regions of NSW, but urban regions in particular. Patients presenting to Principal Referral hospitals and those who arrived at night were more likely to experience access block. After adjusting for triage category and year of presentation, the mode of arrival, time of arrival, type of hospital, age and sex were significantly associated with access block. Access block continues to increase across NSW, whatever the definition used. We recommend that hospitals in NSW and Australia move to the use of one standard definition of access block, as our study suggests there is no significant additional information emerging from the use of multiple definitions.

  20. Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2015 rates; quality reporting requirements for specific providers; reasonable compensation equivalents for physician services in excluded hospitals and certain teaching hospitals; provider administrative appeals and judicial review; enforcement provisions for organ transplant centers; and electronic health record (EHR) incentive program. Final rule.

    PubMed

    2014-08-22

    are participating in Medicare. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program. In addition, we are making technical corrections to the regulations governing provider administrative appeals and judicial review; updating the reasonable compensation equivalent (RCE) limits, and revising the methodology for determining such limits, for services furnished by physicians to certain teaching hospitals and hospitals excluded from the IPPS; making regulatory revisions to broaden the specified uses of Medicare Advantage (MA) risk adjustment data and to specify the conditions for release of such risk adjustment data to entities outside of CMS; and making changes to the enforcement procedures for organ transplant centers. We are aligning the reporting and submission timelines for clinical quality measures for the Medicare HER Incentive Program for eligible hospitals and critical access hospitals (CAHs) with the reporting and submission timelines for the Hospital IQR Program. In addition, we provide guidance and clarification of certain policies for eligible hospitals and CAHs such as our policy for reporting zero denominators on clinical quality measures and our policy for case threshold exemptions. In this document, we are finalizing two interim final rules with comment period relating to criteria for disproportionate share hospital uncompensated care payments and extensions of temporary changes to the payment adjustment for low-volume hospitals and of the Medicare-Dependent, Small Rural Hospital (MDH) Program.

  1. Association of Hospital Critical Access Status With Surgical Outcomes and Expenditures Among Medicare Beneficiaries.

    PubMed

    Ibrahim, Andrew M; Hughes, Tyler G; Thumma, Jyothi R; Dimick, Justin B

    2016-05-17

    Critical access hospitals are a predominant source of care for many rural populations. Previous reports suggest these centers provide lower quality of care for common medical admissions. Little is known about the outcomes and costs of patients admitted for surgical procedures. To compare the surgical outcomes and associated Medicare payments at critical access hospitals vs non-critical access hospitals. Cross-sectional retrospective review of 1,631,904 Medicare beneficiary admissions to critical access hospitals (n = 828) and non-critical access hospitals (n = 3676) for 1 of 4 common types of surgical procedures-appendectomy, 3467 for critical access and 151,867 for non-critical access; cholecystectomy, 10,556 for critical access and 573,435 for non-critical access; colectomy, 10,198 for critical access and 577,680 for non-critical access; hernia repair, 4291 for critical access and 300,410 for non-critical access-between 2009 and 2013. We compared risk-adjusted outcomes using a multivariable logistical regression that adjusted for patient factors (age, sex, race, Elixhauser comorbidities), admission type (elective, urgent, emergency), and type of operation. Undergoing surgical procedures at critical access vs non-critical access hospitals. Thirty-day mortality, postoperative serious complications (eg, myocardial infarction, pneumonia, or acute renal failure and a length of stay >75th percentile). Hospital costs were assessed using price-standardized Medicare payments during hospitalization. Patients (mean age, 76.5 years; 56.2% women) undergoing surgery at critical access hospitals were less likely to have chronic medical problems, and they had lower rates of heart failure (7.7% vs 10.7%, P < .0001), diabetes (20.2% vs 21.7%, P < .001), obesity (6.5% vs 10.6%, P < .001), or multiple comorbid diseases (% of patients with ≥2 comorbidities; 60.4% vs 70.2%, P < .001). After adjustment for patient factors, critical access and non

  2. 42 CFR 485.610 - Condition of participation: Status and location.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ...— (i) Is licensed by the State as a health clinic or a health center; (ii) Was a hospital that was... PROVIDERS Conditions of Participation: Critical Access Hospitals (CAHs) § 485.610 Condition of participation: Status and location. (a) Standard: Status. The facility is— (1) A currently participating hospital that...

  3. 42 CFR 485.610 - Condition of participation: Status and location.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ...— (i) Is licensed by the State as a health clinic or a health center; (ii) Was a hospital that was... PROVIDERS Conditions of Participation: Critical Access Hospitals (CAHs) § 485.610 Condition of participation: Status and location. (a) Standard: Status. The facility is— (1) A currently participating hospital that...

  4. 42 CFR 485.610 - Condition of participation: Status and location.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ...— (i) Is licensed by the State as a health clinic or a health center; (ii) Was a hospital that was... PROVIDERS Conditions of Participation: Critical Access Hospitals (CAHs) § 485.610 Condition of participation: Status and location. (a) Standard: Status. The facility is— (1) A currently participating hospital that...

  5. 42 CFR 485.610 - Condition of participation: Status and location.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ...— (i) Is licensed by the State as a health clinic or a health center; (ii) Was a hospital that was... PROVIDERS Conditions of Participation: Critical Access Hospitals (CAHs) § 485.610 Condition of participation: Status and location. (a) Standard: Status. The facility is— (1) A currently participating hospital that...

  6. Steroid profiling for congenital adrenal hyperplasia by tandem mass spectrometry as a second-tier test reduces follow-up burdens in a tertiary care hospital: a retrospective and prospective evaluation.

    PubMed

    Seo, Ja Young; Park, Hyung-Doo; Kim, Jong Won; Oh, Hyeon Ju; Yang, Jeong Soo; Chang, Yun Sil; Park, Won Soon; Lee, Soo-Youn

    2014-01-01

    Newborn screening for congenital adrenal hyperplasia (CAH) based on measuring 17-hydroxyprogesterone (17-OHP) by immunoassay generates a number of false-positive results, especially in preterm neonates. We applied steroid profiling by using liquid chromatography-tandem mass spectrometry (LC-MS/MS) as a second-tier test in newborns with positive CAH screening and evaluated its clinical utility in a tertiary care hospital setting. By performing a 4-year retrospective data review, we were able to test 121 dried blood spots from newborns with positive CAH screening for 17-OHP, androstenedione and cortisol levels by LC-MS/MS. We prospectively evaluated the clinical utility of steroid profiling after the implementation of steroid profiling as a second-tier test in our routine clinical practice. During the 2-year prospective study period, 104 cases with positive initial screening by FIA were tested by LC-MS/MS. Clinical and laboratory follow-up were performed for at least 6 months. The preterm neonates accounted for 50.7% (76/150) and 70.4% (88/125) of screening-positive cases in retrospective and prospective cohorts, respectively. By applying steroid profiling as a second-tier test for positive CAH screening, we eliminated all false-positive results and decreased the median follow-up time from 75 to 8 days. Our data showed that steroid profiling reduced the burden of follow-up exams by improving the positive predictive value of the CAH screening program. The use of steroid profiling as a second-tier test for positive CAH screening will improve clinical practice particularly in a tertiary care hospital setting where positive CAH screening from preterm neonates is frequently encountered.

  7. The geographical accessibility of hospitals to the aged: a geographic information systems analysis within Illinois.

    PubMed Central

    Love, D; Lindquist, P

    1995-01-01

    OBJECTIVE. This article uses geographic information systems and their related tools to empirically measure and display the geographic accessibility of the aged population to hospital facilities within Illinois. DATA SOURCES AND STUDY SETTING. Geographic accessibility of Illinois' aged population is measured from each of the state's 10,796 census block groups to the state's 214 hospital facilities. Block group demographic compositions and centroids are obtained from 1990 census files. Hospital coordinates are obtained by the authors. STUDY DESIGN. Of five alternative measures of accessibility considered, empirical estimates are obtained for two: choice set and minimum distance. Access to both general hospitals and the subset having specialized geriatric facilities is measured with special attention to differences in accessibility between the aged within metropolitan statistical areas (MSAs) and those outside MSAs. Cumulative accessibility distributions and their summary statistics provide a basis of comparison among subgroups. DATA COLLECTION AND EXTRACTION. Geographic information systems (GIS) and their related tools are used as a means of efficiently capturing, organizing, storing, and retrieving the required data. Hospitals and census block groups are geocoded to specific locations in the database, and aspatial attributes are assigned to the hospitals and block groups. The GIS database is queried to produce shaded isarithm and point distribution maps that show the location of hospitals relative to surrounding aged populations. CONCLUSION. The vast majority of Illinois' aged population is within close proximity to hospital facilities. Eighty percent (1,147,504 persons) of the aged in Illinois are within 4.8 miles (7.7 km) of a hospital and 11.6 miles (18.7 km) of two hospitals. However, geographic accessibility differences between the aged living in MSAs and those living outside MSAs to hospitals offering geriatric services are substantial; but there is no

  8. Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2017 Rates; Quality Reporting Requirements for Specific Providers; Graduate Medical Education; Hospital Notification Procedures Applicable to Beneficiaries Receiving Observation Services; Technical Changes Relating to Costs to Organizations and Medicare Cost Reports; Finalization of Interim Final Rules With Comment Period on LTCH PPS Payments for Severe Wounds, Modifications of Limitations on Redesignation by the Medicare Geographic Classification Review Board, and Extensions of Payments to MDHs and Low-Volume Hospitals. Final rule.

    PubMed

    2016-08-22

    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 2017. Some of these changes will implement certain statutory provisions contained in the Pathway for Sustainable Growth Reform Act of 2013, the Improving Medicare Post-Acute Care Transformation Act of 2014, the Notice of Observation Treatment and Implications for Care Eligibility Act of 2015, and other legislation. We also are providing the estimated market basket update to apply to the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits for FY 2017. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) for FY 2017. In addition, we are making changes relating to direct graduate medical education (GME) and indirect medical education payments; establishing new requirements or revising existing requirements for quality reporting by specific Medicare providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities), including related provisions for eligible hospitals and critical access hospitals (CAHs) participating in the Electronic Health Record Incentive Program; updating policies relating to the Hospital Value-Based Purchasing Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition Reduction Program; implementing statutory provisions that require hospitals and CAHs to furnish notification to Medicare beneficiaries, including Medicare Advantage enrollees, when the beneficiaries receive outpatient observation services for more than 24 hours; announcing the implementation of the Frontier Community Health Integration Project Demonstration; and

  9. 75 FR 36610 - Medicare and Medicaid Programs: Changes to the Hospital and Critical Access Hospital Conditions...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-28

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Medicare & Medicaid Services 42 CFR Parts 482... Critical Access Hospital Conditions of Participation To Ensure Visitation Rights for All Patients AGENCY...) to ensure the visitation rights of all patients. Medicare- and Medicaid- participating hospitals and...

  10. Addressing geographic access barriers to emergency care services: a national ecologic study of hospitals in Brazil.

    PubMed

    Rocha, Thiago Augusto Hernandes; da Silva, Núbia Cristina; Amaral, Pedro Vasconcelos; Barbosa, Allan Claudius Queiroz; Rocha, João Victor Muniz; Alvares, Viviane; de Almeida, Dante Grapiuna; Thumé, Elaine; Thomaz, Erika Bárbara Abreu Fonseca; de Sousa Queiroz, Rejane Christine; de Souza, Marta Rovery; Lein, Adriana; Lopes, Daniel Paulino; Staton, Catherine A; Vissoci, João Ricardo Nickenig; Facchini, Luiz Augusto

    2017-08-22

    Unequal distribution of emergency care services is a critical barrier to be overcome to assure access to emergency and surgical care. Considering this context it was objective of the present work analyze geographic access barriers to emergency care services in Brazil. A secondary aim of the study is to define possible roles to be assumed by small hospitals in the Brazilian healthcare network to overcome geographic access challenges. The present work can be classified as a cross-sectional ecological study. To carry out the present study, data of all 5843 Brazilian hospitals were categorized among high complexity centers and small hospitals. The geographical access barriers were identified through the use of two-step floating catchment area method. Once concluded the previous step an evaluation using the Getis-Ord-Gi method was performed to identify spatial clusters of municipalities with limited access to high complexity centers but well covered by well-equipped small hospitals. The analysis of accessibility index of high complexity centers highlighted large portions of the country with nearly zero hospital beds by inhabitant. In contrast, it was possible observe a group of 1595 municipalities with high accessibility to small hospitals, simultaneously with a low coverage of high complexity centers. Among the 1595 municipalities with good accessibility to small hospitals, 74% (1183) were covered by small hospitals with at least 60% of minimum emergency service requirements. The spatial clusters analysis aggregated 589 municipalities with high values related to minimum emergency service requirements. Small hospitals in these 589 cities could promote the equity in access to emergency services benefiting more than eight million people. There is a spatial disequilibrium within the country with prominent gaps in the health care network for emergency services. Taking this challenge into consideration, small hospitals could be a possible solution and foster equity in access

  11. Field demonstration and evaluation of the Passive Flux Meter on a CAH groundwater plume.

    PubMed

    Verreydt, G; Annable, M D; Kaskassian, S; Van Keer, I; Bronders, J; Diels, L; Vanderauwera, P

    2013-07-01

    This study comprises the first application of the Passive Flux Meter (PFM) for the measurement of chlorinated aliphatic hydrocarbon (CAH) mass fluxes and Darcy water fluxes in groundwater at a European field site. The PFM was originally developed and applied to measurements near source zones. The focus of the PFM is extended from near source to plume zones. For this purpose, 48 PFMs of 1.4 m length were constructed and installed in eight different monitoring wells in the source and plume zone of a CAH-contaminated field site located in France. The PFMs were retrieved, sampled, and analyzed after 3 to 11 weeks of exposure time, depending on the expected contaminant flux. PFM evaluation criteria include analytical, technical, and practical aspects as well as conditions and applicability. PFM flux data were compared with so-called traditional soil and groundwater concentration data obtained using active sampling methods. The PFMs deliver reasonable results for source as well as plume zones. The limiting factor in the PFM applicability is the exposure time together with the groundwater flux. Measured groundwater velocities at the field site range from 2 to 41 cm/day. Measured contaminant flux data raise up to 13 g/m(2)/day for perchloroethylene in the plume zone. Calculated PFM flux averaged concentration data and traditional concentration data were of similar magnitude for most wells. However, both datasets need to be compared with reservation because of the different sampling nature and time. Two important issues are the PFM tracer loss during installation/extraction and the deviation of the groundwater flow field when passing the monitoring well and PFM. The demonstration of the PFM at a CAH-contaminated field site in Europe confirmed the efficiency of the flux measurement technique for source as well as plume zones. The PFM can be applied without concerns in monitoring wells with European standards. The acquired flux data are of great value for the purpose of site

  12. 42 CFR 412.113 - Other payments.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... provided in subpart E of this part. (c) Anesthesia services furnished by hospital or CAH employed... determined on a reasonable cost basis for anesthesia services provided in the hospital or CAH by qualified... anesthesia services provided in a hospital or CAH by qualified nonphysician anesthetists employed by the...

  13. 42 CFR 412.113 - Other payments.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... provided in subpart E of this part. (c) Anesthesia services furnished by hospital or CAH employed... determined on a reasonable cost basis for anesthesia services provided in the hospital or CAH by qualified... anesthesia services provided in a hospital or CAH by qualified nonphysician anesthetists employed by the...

  14. 42 CFR 412.113 - Other payments.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... provided in subpart E of this part. (c) Anesthesia services furnished by hospital or CAH employed... determined on a reasonable cost basis for anesthesia services provided in the hospital or CAH by qualified... anesthesia services provided in a hospital or CAH by qualified nonphysician anesthetists employed by the...

  15. 42 CFR 412.113 - Other payments.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... provided in subpart E of this part. (c) Anesthesia services furnished by hospital or CAH employed... determined on a reasonable cost basis for anesthesia services provided in the hospital or CAH by qualified... anesthesia services provided in a hospital or CAH by qualified nonphysician anesthetists employed by the...

  16. 42 CFR 412.113 - Other payments.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... provided in subpart E of this part. (c) Anesthesia services furnished by hospital or CAH employed... determined on a reasonable cost basis for anesthesia services provided in the hospital or CAH by qualified... anesthesia services provided in a hospital or CAH by qualified nonphysician anesthetists employed by the...

  17. Contract management in USA hospitals: service duplication and access within local markets.

    PubMed

    Carey, Kathleen; Dor, Avi

    2008-08-01

    This paper examines the extent to which hospitals that are under external contract management engage in service duplication, as well as the degree to which the various services they offer contribute to or detract from community access. The study incorporates all USA hospitals using data from the American Hospital Association Annual Survey Database, supplemented by county level measures obtained from the area resource file (ARF). Using data on the 3794 hospitals classified as acute care facilities in 2002, we performed a set of logistic regressions that analyzed whether a hospital offered each of 74 distinct services. For each service (regression), key independent variables measured the number of other hospitals in the local market area that also offered the service. Local area market definitions are the areas circumscribed by the hospital within distances of 10 and 20 miles. Results suggest that contract-managed (CM) hospitals display a more competitive pattern (service duplication) than hospitals in general, but CM hospitals that are the sole provider of services locally are less likely to offer services than traditionally managed sole hospital providers. Contract management does not appear to offer any particular advantages in improving access to hospital services.

  18. Telemental health evaluations enhance access and efficiency in a critical access hospital emergency department.

    PubMed

    Southard, Erik P; Neufeld, Jonathan D; Laws, Stephanie

    2014-07-01

    Mentally ill patients in crisis presenting to critical access hospital emergency rooms often face exorbitant wait times to be evaluated by a trained mental health provider. Patients may be discharged from the hospital before receiving an evaluation or boarded in a hospital bed for observation, reducing quality and increasing costs. This study examined the effectiveness of an emergency telemental health evaluation service implemented in a rural hospital emergency room. Retrospective data collection was implemented to consider patients presenting to the emergency room for 212 days prior to telemedicine interventions and for 184 days after. The study compared measures of time to treatment, length of stay (regardless of inpatient or outpatient status), and door-to-consult time. There were 24 patients seen before telemedicine was implemented and 38 seen using telemedicine. All patients had a mental health evaluation ordered by a physician and completed by a mental health specialist. Significant reductions in all three time measures were observed. Mean and median times to consult were reduced from 16.2 h (standard deviation=13.2 h) and 14.2 h, respectively, to 5.4 h (standard deviation =6.4 h) and 2.6 h. Similar reductions in length of stay and door-to-consult times were observed. By t tests, use of telemedicine was associated with a statistically significant reduction in all three outcome measures. Telemedicine appears to be an effective intervention for mentally ill patients by providing more timely access to mental health evaluations in rural hospital emergency departments.

  19. Progress and challenges: implementation and use of health information technology among critical-access hospitals.

    PubMed

    Gabriel, Meghan Hufstader; Jones, Emily B; Samy, Leila; King, Jennifer

    2014-07-01

    Despite major national investments to support the adoption of health information technology (IT), concerns persist that barriers are inhibiting that adoption and the use of advanced health IT capabilities in rural areas in particular. Using a survey of Medicare-certified critical-access hospitals, we examined electronic health record (EHR) adoption, key EHR functionalities, telehealth, and teleradiology, as well as challenges to EHR adoption. In 2013, 89 percent of critical-access hospitals had implemented a full or partial EHR. Adoption of key EHR capabilities varied. Critical-access hospitals that had certain types of technical assistance and resources available to support health IT were more likely to have adopted health IT capabilities and less likely to report significant challenges to EHR implementation and use, compared to other hospitals in the survey. It is important to ensure that the necessary resources and support are available to critical-access hospitals, especially those that operate independently, to assist them in adopting health IT and becoming able to electronically link to the broader health care system. Project HOPE—The People-to-People Health Foundation, Inc.

  20. Rapid steroid hormone quantification for congenital adrenal hyperplasia (CAH) in dried blood spots using UPLC liquid chromatography-tandem mass spectrometry.

    PubMed

    Janzen, Nils; Sander, Stefanie; Terhardt, Michael; Steuerwald, Ulrike; Peter, Michael; Das, Anibh M; Sander, Johannes

    2011-12-11

    Newborn screening for congenital adrenal hyperplasia (CAH) is usually done by quantifying 17α-hydroxyprogesterone using immunoassay. However, this test produces high rates of false positive results caused by cross reacting steroids. Therefore we have developed a selective and specific method with a short run time (1.25 min) for quantification of 17α-hydroxyprogesterone, 21-deoxycortisol, 11-deoxycortisol, 11-deoxycorticosterone and cortisol from dried blood spots. The extraction procedure is very simple and steroid separation is ensured on a BEH C18 column and an ultra-performance liquid chromatography-tandem mass spectrometry (UPLC-MS/MS). Analysis was done in positive ionization mode (ESI+) and recorded in multiple reaction monitoring mode (MRM). The method gave linear results for all steroids over a range of 5-200 (cortisol: 12.5-500)nmol/L with coefficients of regression >0.992. Absolute recovery was >64.1%. Across the analytical range the inter-assay coefficient of variation (CV) was <3%. Newborn blood samples of patients with confirmed 21-CAH and 11-CAH could clearly be distinguished from samples of unaffected newborns falsely positive on immunoassay. The method is not influenced by cross reactions as found on immunoassay. Analysis of dried blood spots shows that this method is sensitive and fast enough to allow rapid analysis and can therefore improve the newborn screening program. Copyright © 2011 Elsevier Inc. All rights reserved.

  1. Laser Cooling the Diatomic Molecule CaH

    NASA Astrophysics Data System (ADS)

    Velasquez, Joe, III; Di Rosa, Michael

    2014-06-01

    To laser-cool a species, a closed (or nearly closed) cycle is required to dissipate translational energy through many directed laser-photon absorption and subsequent randomly-directed spontaneous emission events. Many atoms lend themselves to such a closed-loop cooling cycle. Attaining laser-cooled molecular species is challenging because of their inherently complex internal structure, yet laser-cooling molecules could lead to studies in interesting chemical dynamics among other applications. Typically, laser-cooled atoms are assembled into molecules through photoassociation or Feschbach resonance. CaH is one of a few molecules whose internal structure is quite atom-like, allowing a nearly closed cycle without the need for many repumping lasers. We will also present our work-to-date on laser cooling this molecule. We employ traditional pulsed atomic/molecular beam techniques with a laser vaporization source to generate species with well-defined translational energies over a narrow range of velocity. In this way, we can apply laser-cooling to most species in the beam along a single dimension (the beam's axis). This project is funded by the LDRD program of the Los Alamos National Laboratory.

  2. Transformation rules and degradation of CAHs by Fentonlike oxidation in growth ring of water distribution network-A review

    NASA Astrophysics Data System (ADS)

    Zhong, D.; Ma, W. C.; Jiang, X. Q.; Yuan, Y. X.; Yuan, Y.; Wang, Z. Q.; Fang, T. T.; Huang, W. Y.

    2017-08-01

    Chlorinated hydrocarbons are widely used as organic solvent and chemical raw materials. After treatment, water polluted with trichloroethylene (TCE)/tetrachloroethylene (PCE) can reach the water quality requirements, while water with trace amounts of TCE/PCE is still harmful to humans, which will cause cancers. Water distribution network is an extremely complicated system, in which adsorption, desorption, flocculation, movement, transformation and reduction will occur, leading to changes of TCE/PCE concentrations and products. Therefore, it is important to investigate the transformation rules of TCE/PCE in water distribution network. What’s more, growth-ring, including drinking water pipes deposits, can act as catalysts in Fenton-like reagent (H2O2). This review summarizes the status of transformation rules of CAHs in water distribution network. It also evaluates the effectiveness and fruit of CAHs degradation by Fenton-like reagent based on growth-ring. This review is important in solving the potential safety problems caused by TCE/PCE in water distribution network.

  3. Convenient Access to Professional Interpreters in the Hospital Decreases Readmission Rates and Estimated Hospital Expenditures for Patients With Limited English Proficiency.

    PubMed

    Karliner, Leah S; Pérez-Stable, Eliseo J; Gregorich, Steven E

    2017-03-01

    Twenty-five million people in the United States have limited English proficiency (LEP); this growing and aging population experiences worse outcomes when hospitalized. Federal requirements that hospitals provide language access services are very challenging to implement in the fast-paced, 24-hour hospital environment. To determine if increasing access to professional interpreters improves hospital outcomes for older patients with LEP. Natural experiment on a medicine floor of an academic hospital. Patients age 50 years or above discharged between January 15, 2007 and January 15, 2010. Dual-handset interpreter telephone at every bedside July 15, 2008 to Mar 14, 2009. Thirty-day readmission, length of stay, estimated hospital expenditures. Of 8077 discharges, 1963 were for LEP, and 6114 for English proficient patients. There was a significant decrease in observed 30-day readmission rates for the LEP group during the 8-month intervention period compared with 18 months preintervention (17.8% vs. 13.4%); at the same time English proficient readmission rates increased (16.7% vs. 19.7%); results remained significant in adjusted analyses. This improved readmission outcome for the LEP group was not maintained during the subsequent postintervention period when the telephones became less accessible. There was no significant intervention impact on length of stay in either unadjusted or adjusted analyses. After accounting for interpreter services costs, the estimated 119 readmissions averted during the intervention period were associated with estimated monthly hospital expenditure savings of $161,404. Comprehensive language access represents an important, high value service that all medical centers should provide to achieve equitable, quality healthcare for vulnerable LEP populations.

  4. 42 CFR 485.603 - Rural health network.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Rural health network. 485.603 Section 485.603 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Participation: Critical Access Hospitals (CAHs) § 485.603 Rural health network. A rural health network is an...

  5. 42 CFR 485.603 - Rural health network.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 5 2011-10-01 2011-10-01 false Rural health network. 485.603 Section 485.603 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Participation: Critical Access Hospitals (CAHs) § 485.603 Rural health network. A rural health network is an...

  6. 42 CFR 485.603 - Rural health network.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 5 2013-10-01 2013-10-01 false Rural health network. 485.603 Section 485.603 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Participation: Critical Access Hospitals (CAHs) § 485.603 Rural health network. A rural health network is an...

  7. 42 CFR 485.603 - Rural health network.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 5 2012-10-01 2012-10-01 false Rural health network. 485.603 Section 485.603 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Participation: Critical Access Hospitals (CAHs) § 485.603 Rural health network. A rural health network is an...

  8. 42 CFR 485.603 - Rural health network.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 5 2014-10-01 2014-10-01 false Rural health network. 485.603 Section 485.603 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES... Participation: Critical Access Hospitals (CAHs) § 485.603 Rural health network. A rural health network is an...

  9. 42 CFR 489.2 - Scope of part.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ...) Hospices. (7) Critical access hospital (CAHs). (8) Community mental health centers (CMHCs). (9) Religious... 42 Public Health 5 2010-10-01 2010-10-01 false Scope of part. 489.2 Section 489.2 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) STANDARDS...

  10. Convenient Access to Professional Interpreters in the Hospital Decreases Readmission Rates and Estimated Hospital Expenditures for Patients with Limited English Proficiency

    PubMed Central

    Karliner, Leah S.; Pérez-Stable, Eliseo J.; Gregorich, Steven E.

    2016-01-01

    Background Twenty-five million people in the U.S. have limited English proficiency (LEP); this growing and aging population experiences worse outcomes when hospitalized. Federal requirements that hospitals provide language access services are very challenging to implement in the fast-paced, 24-hour hospital environment. Objective Determine if increasing access to professional interpreters improves hospital outcomes for older patients with LEP Design Natural experiment on a medicine floor of an academic hospital Participants Patients age ≥50 discharged between Jan 15, 2007–Jan 15, 2010. Exposure Dual-handset interpreter telephone at every bedside July 15, 2008–Mar 14, 2009 Outcome Measures 30-day readmission, length of stay (LOS), estimated hospital expenditures Results Of 8,077 discharges, 1,963 were for LEP, and 6,114 for English-proficient (EP) patients. There was a significant decrease in observed 30-day readmission rates for the LEP group during the 8-month intervention period compared to 18 months pre-intervention (17.8% vs. 13.4%); at the same time EP readmission rates increased (16.7% vs. 19.7%); results remained significant in adjusted analyses. This improved readmission outcome for the LEP group was not maintained during the subsequent post-intervention period when the telephones became less accessible. There was no significant intervention impact on LOS in either unadjusted or adjusted analyses. After accounting for interpreter services costs, the estimated 119 readmissions averted during the intervention period were associated with estimated monthly hospital expenditure savings of $161,404. Conclusions Comprehensive language access represents an important, high value service that all medical centers should provide in order to achieve equitable, quality healthcare for vulnerable LEP populations. PMID:27579909

  11. Laser Spectroscopic Study of CaH in the B^2σ^+ and D^2σ^+ States

    NASA Astrophysics Data System (ADS)

    Watanabe, Kyohei; Uchida, Kanako; Kobayashi, Kaori; Matsushima, Fusakazu; Moriwaki, Yoshiki

    2015-06-01

    Calcium hydride is one of the abundant molecules in the stellar environment, and is considered as a probe of stellar analysis. Ab initio calculations have shown that the electronic excited states of CaH have complex potential curves. It is suggested that the B^2σ^+ state has an interesting double minimum potential due to the avoided crossing. Such a potential leads to drastic change of the rotational constants when the vibrational energy level goes across the potential barrier. Spectroscopic studies on CaH began in the 1920's, and many studies have been carried out since then. Bell et al. extensively assigned the D^2σ^+-X^2σ^+ bands in the UV region. Bernath's group has observed transitions in the IR and visible regions and identified their upper states as the A^2σ^+, B^2σ^+ and E^2σ^+ states. We have carried out a laser induced fluorescence (LIF) study in the UV region between 360 and 430 nm. We have produced CaH by using laser ablation of a calcium target in a hydrogen gas environment, then molecules have been excited by a second harmonic pulse of dye laser and the fluorescence from molecules have been detected through a monochromator. Detection of the D^2σ^+-X^2σ^+ bands already identified by Bell et al. indicates the production of CaH. In addition, many other bands have been also found and a few bands have been assigned by using the combination differences, the lower state of these bands have been confirmed to the vibrational ground state of X^2σ^+ state. We have tentatively assigned these bands as the B^2σ^+ -X^2σ^+ transition. We will discuss the assignment of these bands, together with the rotational constants comparing with those calculated from the ab initio potential. B. Barbuy, R. P. Schiavon, J. Gregorio-Hetem, P. D. Singh C. Batalha , Astron. Astrophys. Sippl. Ser. 101, 409 (1993). P. F. Weck and P. C .Stabcil, J. Chem. Phys. {118}, 9997 (2003). R. S. Mulliken, Phys. Rev. {25}, 509 (1925). G. D. Bell, M, Herman, J. W. C. Johns, and E. R

  12. Equitable access to elective hospital services: the introduction of patient choice in a decentralised healthcare system.

    PubMed

    Ringard, Ånen

    2012-02-01

    During the 1980s and 1990s, increased waiting times for elective surgery was perceived to be a major accessibility problem in many countries. In an attempt to improve access, hospital choice reforms were introduced in a number of countries. In Norway, a nationwide reform to improve access came into effect in 2001. At the same time, renewed support was expressed for the long-standing political aim of ensuring equal access to healthcare services for all citizens regardless of their social position. The current aim is to analyse the relationship of the hospital choice reform and the goal of equitable access to hospital services. A survey conducted among Norwegian patients in 2004 provided information about whether a choice of hospital had been made. Information from the survey was merged with administrative data from the hospital that performed the treatment. The survey provided data on patients' socioeconomic position. Demographics, medical need, and prior use of healthcare services were controlled for to determine the effect of socioeconomic position on hospital choice. The patient's socioeconomic position, measured by education, was found to be significantly associated with hospital choice. The relationship resembled that of a social gradient. Patients with a primary education were less likely to have made a choice, followed by those with secondary education or a lower university degree. Patients with higher university education were most likely to have chosen. Hospital selection is a demanding task for many patients. Policymakers should therefore focus on crafting and implementing tools necessary for supporting uptake of choice in disadvantaged groups.

  13. Access thrombosis, hospitalization, and hematocrit level in hemodialysis patients.

    PubMed

    Heard, K A; Russell, T A

    2000-12-01

    Are occurrences of vascular access thrombosis and hospitalization higher in hemodialysis patients with hematocrits (Hcts) > 36% compared to those < 36%? This 12-month retrospective study included 30 male hemodialysis patients who received erythropoietin (rHuEPO) for at least 6 months. Sixty percent (n = 18) had arteriovenous fistulas and 40% (n = 12) had polytetrafluoroethylene grafts. The mean age was 59.6 years. Twenty patients during 216 patient months had a mean Hct < 36% with five thromboses (2.3%). Ten patients during 118 patient months had a mean Hct > 36% with four thromboses (3.4%). There was no statistically significant difference between the thrombosis rates in the two groups. There were four hospitalizations in 118 patient months in the > 36% group (3.4%). There were 33 hospitalizations in 216 patient months in the < 36% group (15.3%). This is 4.5 times higher than the > 36% group. Our data suggest that Hcts > 36% are not associated with increased thrombosis and are associated with lower hospitalization rates.

  14. Community health insurance in Gudalur, India, increases access to hospital care.

    PubMed

    Devadasan, Narayanan; Criel, Bart; Van Damme, Wim; Manoharan, S; Sarma, P Sankara; Van der Stuyft, Patrick

    2010-03-01

    To reduce the burden of out-of-pocket payments on households in India, the government has introduced community health insurance (CHI) as part of its National Rural Health Mission. Indian CHI schemes have been shown to provide financial protection and have the potential to improve quality of care, but do not seem to improve access. This study examines this dimension of CHI performance and explores conditions under which a CHI scheme can improve access to hospital care for the poor. We conducted a panel survey at the ACCORD-AMS-ASHWINI (AAA) CHI scheme in India. The AAA CHI scheme protects the poorest sections of society against hospitalization expenses. 297 insured and 248 matched uninsured households were observed by village volunteers on a weekly basis for 12 months. Any patient presenting with a 'major ailment' in these households was interviewed using a structured questionnaire. Outcomes measured were utilization of hospital services, cost of treatment and quality of treatment received. The two cohorts were similar regarding demographic, social and economic parameters. More insured than uninsured households expressed trust in the CHI scheme organizers. Both groups had similar levels of minor ailments, but the insured had higher incidence of chronic and major ailments. Insured patients had a hospital admission rate 2.2 times higher than uninsured patients, independent of confounding factors. This higher rate among the insured was also found in children and those with pre-existing conditions. Vulnerable sections of the insured population-children, pregnant women, the poorest-had the highest admission rates. Most admissions, in both cohorts, took place in the ASHWINI hospital. Credible and trustworthy organizers, effective providers, low co-payments, and low indirect costs contributed to this result. A well-designed CHI scheme has the potential to improve access to hospital care, even for vulnerable sections of the community-the poorest, individuals with pre

  15. Access to primary care and the route of emergency admission to hospital: retrospective analysis of national hospital administrative data.

    PubMed

    Cowling, Thomas E; Harris, Matthew; Watt, Hilary; Soljak, Michael; Richards, Emma; Gunning, Elinor; Bottle, Alex; Macinko, James; Majeed, Azeem

    2016-06-01

    The UK government is pursuing policies to improve primary care access, as many patients visit accident and emergency (A and E) departments after being unable to get suitable general practice appointments. Direct admission to hospital via a general practitioner (GP) averts A and E use, and may reduce total hospital costs. It could also enhance the continuity of information between GPs and hospital doctors, possibly improving healthcare outcomes. To determine whether primary care access is associated with the route of emergency admission-via a GP versus via an A and E department. Retrospective analysis of national administrative data from English hospitals for 2011-2012. Adults admitted in an emergency (unscheduled) for ≥1 night via a GP or an A and E department formed the study population. The measure of primary care access-the percentage of patients able to get a general practice appointment on their last attempt-was derived from a large, nationally representative patient survey. Multilevel logistic regression was used to estimate associations, adjusting for patient and admission characteristics. The analysis included 2 322 112 emergency admissions (81.9% via an A and E department). With a 5 unit increase in the percentage of patients able to get a general practice appointment on their last attempt, the adjusted odds of GP admission (vs A and E admission) was estimated to increase by 15% (OR 1.15, 95% CI 1.12 to 1.17). The probability of GP admission if ≥95% of appointment attempts were successful in each general practice was estimated to be 19.6%. This probability reduced to 13.6% when <80% of appointment attempts were successful. This equates to 139 673 fewer GP admissions (456 232 vs 316 559) assuming no change in the total number of admissions. Associations were consistent in direction across geographical regions of England. Among hospital inpatients admitted as an emergency, patients registered to more accessible general practices were more

  16. Einstein A coefficients for rovibronic lines of the A2Π → X2Σ+ and B2Σ+ → X2Σ+ transitions of CaH and CaD

    NASA Astrophysics Data System (ADS)

    Alavi, S. Fatemeh; Shayesteh, Alireza

    2018-02-01

    Calcium monohydride is an important diatomic molecule appearing in the spectra of sunspots and M dwarfs. We report complete line lists with Einstein A coefficients for the A2Π-X2Σ+ and B2Σ+-X2Σ+ electronic transitions of CaH and CaD radicals. The most recent ab initio transition dipole moments and potential energy curves were used for the calculation of vibronic band intensities, taking the Herman-Wallis effect into account, and the rotational line strengths were calculated using the PGOPHER program of Western. For the A2Π and B2Σ+ excited states of CaH and CaD, new off-diagonal electronic matrix elements were included in the Hamiltonian matrix, and new sets of spectroscopic constants were determined in order to accurately reproduce the line positions and relative intensities of the observed branches in laboratory spectra. For both CaH and CaD isotopologues, Einstein A coefficients were calculated for all possible rovibronic transitions from the v΄ = 0-3 vibrational levels of the A2Π state and the v΄ = 0-2 vibrational levels of the B2Σ+ state to the v″ = 0-4 vibrational levels of the X2Σ+ ground state. The line lists and intensities reported here can be used to accurately determine the amounts of CaH and CaD in stellar environments.

  17. Hospital-Based Outpatient Direct Access to Physical Therapist Services: Current Status in Wisconsin.

    PubMed

    Boissonnault, William G; Lovely, Karen

    2016-11-01

    Direct access to physical therapist services is available in all 50 states, with reported benefits including reduced health care costs, enhanced patient satisfaction, and no apparent compromised patient safety. Despite the benefits and legality of direct access, few data exist regarding the degree of model adoption, implementation, and utilization. The purposes of the study were: (1) to investigate the extent of implementation and utilization of direct access to outpatient physical therapist services in Wisconsin hospitals and medical centers, (2) to identify barriers to and facilitators for the provisioning of such services, and (3) to identify potential differences between facilities that do and do not provide direct access services. A descriptive survey was conducted. Eighty-nine survey questionnaires were distributed via email to the directors of rehabilitation services at Wisconsin hospitals and medical centers. The survey investigated facility adoption of the direct access model, challenges to and resources utilized during model implementation, and current barriers affecting model utilization. Forty-seven (52.8%) of the 89 survey questionnaires were completed and returned. Forty-two percent of the survey respondents (20 of 47) reported that their facility offered direct access to physical therapist services, but fewer than 10% of patients were seen via direct access at 95% of the facilities offering such services. The most frequently reported obstacles to model implementation and utilization were lack of health care provider, administrator, and patient knowledge of direct access; its legality in Wisconsin; and physical therapists' differential diagnosis and medical screening abilities. Potential respondent bias and limited generalizability of the results are limitations of the study. These findings apply to hospitals and medical centers located in Wisconsin, not to facilities located in other geographic regions. Respondents representing direct access

  18. Unravelling relationships: Hospital occupancy levels, discharge timing and emergency department access block.

    PubMed

    Khanna, Sankalp; Boyle, Justin; Good, Norm; Lind, James

    2012-10-01

    To investigate the effect of hospital occupancy levels on inpatient and ED patient flow parameters, and to simulate the impact of shifting discharge timing on occupancy levels. Retrospective analysis of hospital inpatient data and ED data from 23 reporting public hospitals in Queensland, Australia, across 30 months. Relationships between outcome measures were explored through the aggregation of the historic data into 21 912 hourly intervals. Main outcome measures included admission and discharge rates, occupancy levels, length of stay for admitted and emergency patients, and the occurrence of access block. The impact of shifting discharge timing on occupancy levels was quantified using observed and simulated data. The study identified three stages of system performance decline, or choke points, as hospital occupancy increased. These choke points were found to be dependent on hospital size, and reflect a system change from 'business-as-usual' to 'crisis'. Effecting early discharge of patients was also found to significantly (P < 0.001) impact overcrowding levels and improve patient flow. Modern hospital systems have the ability to operate efficiently above an often-prescribed 85% occupancy level, with optimal levels varying across hospitals of different size. Operating over these optimal levels leads to performance deterioration defined around occupancy choke points. Understanding these choke points and designing strategies around alleviating these flow bottlenecks would improve capacity management, reduce access block and improve patient outcomes. Effecting early discharge also helps alleviate overcrowding and related stress on the system. © 2012 CSIRO. EMA © 2012 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  19. Electricity and generator availability in LMIC hospitals: improving access to safe surgery.

    PubMed

    Chawla, Sagar; Kurani, Shaheen; Wren, Sherry M; Stewart, Barclay; Burnham, Gilbert; Kushner, Adam; McIntyre, Thomas

    2018-03-01

    Access to reliable energy has been identified as a global priority and codified within United Nations Sustainable Goal 7 and the Electrify Africa Act of 2015. Reliable hospital access to electricity is necessary to provide safe surgical care. The current state of electrical availability in hospitals in low- and middle-income countries (LMICs) throughout the world is not well known. This study aimed to review the surgical capacity literature and document the availability of electricity and generators. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search for surgical capacity assessments in LMICs in MEDLINE, PubMed, and World Health Organization Global Health Library was performed. Data regarding electricity and generator availability were extracted. Estimated percentages for individual countries were calculated. Of 76 articles identified, 21 reported electricity availability, totaling 528 hospitals. Continuous electricity availability at hospitals providing surgical care was 312/528 (59.1%). Generator availability was 309/427 (72.4%). Estimated continuous electricity availability ranged from 0% (Sierra Leone and Malawi) to 100% (Iran); estimated generator availability was 14% (Somalia) to 97.6% (Iran). Less than two-thirds of hospitals providing surgical care in 21 LMICs have a continuous electricity source or have an available generator. Efforts are needed to improve electricity infrastructure at hospitals to assure safe surgical care. Future research should look at the effect of energy availability on surgical care and patient outcomes and novel methods of powering surgical equipment. Copyright © 2017 Elsevier Inc. All rights reserved.

  20. Hospitalization among migrants in Italy: Access to health care as an opportunity for integration and inclusion.

    PubMed

    Barsanti, Sara

    2018-03-30

    This paper analyzes migrant access to health care by comparing hospitalizations of native and immigrant population with respect the Tuscany Region (Italy). In the analyses, a critical gap both for legal and undocumented migrant population is highlighted. Indeed, we found some key differences between the migrant and native populations related to the use of specific hospital services in Tuscany and, indirectly, of community and primary care services. Moreover, especially for undocumented migrants, hospitals seem to be the only point of access to the health-care system for migrant populations. The results suggest that the Italian health-care system is unable to ensure an equitable access to health services. In this context, maternity care could be a key point of access to the welfare system that allows participation in the health system not only for mothers but also for all migrant family members. Copyright © 2018 John Wiley & Sons, Ltd.

  1. Structure and stability of CaH 2 surfaces: on the possibility of electron-rich surfaces in metal hydrides for catalysis

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Ong, Phuong-Vu; Johnson, Lewis E.; Hosono, Hideo

    Structure, thermodynamic stability, and electronic properties of CaH 2 surfaces in (001),(110), and (111) crystallographic orientations are investigated using ab initio modeling. We show that stoichiometric surfaces terminated with a hydrogen atomic plane are the most energetically favorable and discuss properties of hydrogen vacancies (VH) at these surfaces. The average calculated work function of the most stable pristine surfaces (~5.2 eV) is in agree-ment with experimental data for powder samples. Neutral hydrogen vacancies host localized electrons and induce defect states in the band gap, thereby shifting the effective work function to much lower values of ~2.7 eV. Surface VH aremore » predicted to aggregate into dimers and form electron-rich centers (e -)Ca 2+(e -) stable to over 800 K. These results suggest that hydrogen-deficient surfaces of CaH 2 can host a large concentration of localized electrons and, thus, give rise to new catalytic functionalities involving electron transfer between the surface, catalysts supported on it, and reacting species.« less

  2. Access to primary care and the route of emergency admission to hospital: retrospective analysis of national hospital administrative data

    PubMed Central

    Cowling, Thomas E; Harris, Matthew; Watt, Hilary; Soljak, Michael; Richards, Emma; Gunning, Elinor; Bottle, Alex; Macinko, James; Majeed, Azeem

    2016-01-01

    Background The UK government is pursuing policies to improve primary care access, as many patients visit accident and emergency (A and E) departments after being unable to get suitable general practice appointments. Direct admission to hospital via a general practitioner (GP) averts A and E use, and may reduce total hospital costs. It could also enhance the continuity of information between GPs and hospital doctors, possibly improving healthcare outcomes. Objective To determine whether primary care access is associated with the route of emergency admission—via a GP versus via an A and E department. Methods Retrospective analysis of national administrative data from English hospitals for 2011–2012. Adults admitted in an emergency (unscheduled) for ≥1 night via a GP or an A and E department formed the study population. The measure of primary care access—the percentage of patients able to get a general practice appointment on their last attempt—was derived from a large, nationally representative patient survey. Multilevel logistic regression was used to estimate associations, adjusting for patient and admission characteristics. Results The analysis included 2 322 112 emergency admissions (81.9% via an A and E department). With a 5 unit increase in the percentage of patients able to get a general practice appointment on their last attempt, the adjusted odds of GP admission (vs A and E admission) was estimated to increase by 15% (OR 1.15, 95% CI 1.12 to 1.17). The probability of GP admission if ≥95% of appointment attempts were successful in each general practice was estimated to be 19.6%. This probability reduced to 13.6% when <80% of appointment attempts were successful. This equates to 139 673 fewer GP admissions (456 232 vs 316 559) assuming no change in the total number of admissions. Associations were consistent in direction across geographical regions of England. Conclusions Among hospital inpatients admitted as an emergency, patients

  3. Health-care providers' perspectives on health-insurance access, waiving procedures, and hospital detention practices in Kenya.

    PubMed

    Mostert, Saskia; Njuguna, Festus; van der Burgt, Renske H M; Musimbi, Joyce; Langat, Sandra; Skiles, Jodi; Seijffert, Anneloes; Sitaresmi, Mei N; Vik, Terry A; van de Ven, Peter M; Kaspers, Gertjan J L

    2018-05-09

    Patients at Kenyan public hospitals are detained if their families cannot pay their medical bills. Access to health insurance and waiving procedures to prevent detention may be limited. This study explores the perspectives of health-care providers (HCP) on health-insurance access, waiving procedures, and hospital detention practices. A self-administered structured questionnaire was completed by 104 HCP (response rate 78%) involved in childhood cancer care. The perspectives of respondents were as follows: all children with cancer should have health insurance according to 96% of HCP. After parents apply for health insurance, it takes too long before treatment costs are covered (67% agree). Patients with childhood cancer without health insurance have a higher chance of abandoning treatment (82% agree). Hospitals should waive bills of all children with cancer when parents have payment difficulties (69% agree). Waiving procedures take too long (75%). Parents are scared by waiving procedures and may decide never to return to the hospital again (68%). Poor families delay visiting the hospital because they fear hospital detention and first seek alternative treatment (92%). When poor families finally come to the hospital, the disease is in advanced stage already (94%). Parents sometimes have to abandon their detained child at the hospital if they cannot pay hospital bills (68%). Detention of children at the hospital if parents cannot pay their medical bills is not approved by 84% of HCP. HCP acknowledge that access to health insurance needs improvement and that waiving procedures contribute to treatment abandonment. By far, most HCP disapprove of hospital detention practices. These factors warrant urgent attention and adjustment. © 2018 Wiley Periodicals, Inc.

  4. Access to Accredited Cancer Hospitals Within Federal Exchange Plans Under the Affordable Care Act

    PubMed Central

    Liao, Kai-Ping; Krause, Trudy M.; Giordano, Sharon H.

    2017-01-01

    Purpose The Affordable Care Act expanded access to health insurance in the United States, but concerns have arisen about access to specialized cancer care within narrow provider networks. To characterize the scope and potential impact of this problem, we assessed rates of inclusion of Commission on Cancer (CoC) –accredited hospitals and National Cancer Institute (NCI) –designated cancer centers within federal exchange networks. Methods We downloaded publicly available machine-readable network data and public use files for individual federal exchange plans from the Centers for Medicare and Medicaid Services for the 2016 enrollment year. We linked this information to National Provider Identifier data, identified a set of distinct provider networks, and assessed the rates of inclusion of CoC-accredited hospitals and NCI-designated centers. We measured variation in these rates according to geography, plan type, and metal level. Results Of 4,058 unique individual plans, network data were available for 3,637 (90%); hospital information was available for 3,531 (87%). Provider lists for these plans reduced into 295 unique networks for analysis. Ninety-five percent of networks included at least one CoC-accredited hospital, but just 41% of networks included NCI-designated centers. States and counties each varied substantially in the proportion of networks listed that included NCI-designated centers (range, 0% to 100%). The proportion of networks that included NCI-designated centers also varied by plan type (range, 31% for health maintenance organizations to 49% for preferred provider organizations; P = .04) but not by metal level. Conclusion A large majority of federal exchange networks contain CoC-accredited hospitals, but most do not contain NCI-designated cancer centers. These results will inform policy regarding access to cancer care, and they reinforce the importance of promoting access to clinical trials and specialized care through community sites. PMID:28068172

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

    PubMed

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

    2007-07-01

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

  6. Community-acquired hypokalemia in elderly patients: related factors and clinical outcomes.

    PubMed

    Bardak, S; Turgutalp, K; Koyuncu, M B; Harı, H; Helvacı, I; Ovla, D; Horoz, M; Demir, S; Kıykım, A

    2017-03-01

    Electrolyte imbalance is a common problem affecting the elderly. Increased number of comorbidities and frequent use of drugs may contribute to increased risk of hypokalemia in the elderly. This study was performed to investigate the prevalence of community-acquired hypokalemia (CAH), risk factors for its development, related factors with hypokalemia, and morbidities and all-cause mortality rates (MR) of CAH in the elderly patients. Total of 36,361 patients aged above 65 years were screened retrospectively. Group 1 consisted of 269 elderly patients with potassium level ≤3.5 mmol/L, and group 2 (control group) consisted of 182 subjects with potassium level between 3.6 and 5.5 mmol/L. Etiologic factors of CAH, presence of comorbidities, duration of hospital stay, hospital cost, and clinical outcomes were recorded. Prevalence of hypokalemia was found 3.24% in patients aged above 65 years. Duration of hospital stay, presence of ≥2 comorbid diseases, hospital cost, and MR were significantly higher in group 1 compared to group 2 (p < 0.001 for all). Loop diuretics, hydrochlorothiazides, beta agonists, inadequate oral intake, and female gender were all independent risk factors for CAH in elderly patients. Patients with ≥2 comorbid diseases were found to have greater risk of hypokalemia than the patients with <2 comorbidities. Length of hospital stay, hospital cost, and MR were higher in elderly with CAH. Female gender, hydrochlorothiazides, loop diuretics, and ≥2 comorbid diseases are the leading risk factors associated with CAH in elderly.

  7. Is it morally permissible for hospital nurses to access prisoner-patients' criminal histories?

    PubMed

    Neiman, Paul

    2016-01-01

    In the United States, information about a person's criminal history is accessible with a name and date of birth. Ruth Crampton has studied nurses' care for prisoner-patients in hospital settings and found care to be perfunctory and reactive. This article examines whether it is morally permissible for nurses in hospital settings to access information about prisoner-patients' criminal histories. Nurses may argue for a right to such information based on the right to personal safety at work or the obligation to provide prisoner-patients with the care that they deserve. These two arguments are considered and rejected. It is further argued that accessing information about a prisoner-patient's criminal history violates nurses' duty to care. Care, understood through Sarah Ruddick's account as work and relationship, requires nurses to be open and unbiased in order to do their part in forming a caring relationship with patients. Knowledge of a prisoner-patient's criminal history inhibits the formation of this relationship and thus violates nurses' duty to care.

  8. DECHLORINATION OF PCBS, CAHS, HERBICIDES AND PESTICIDES NEAT AND IN SOILS AT 25&DEG;C USING NA/NH3. (R829421E01)

    EPA Science Inventory

    Na/NH3 reductions have been used to dehalogenate polychlorinated biphenyls (PCBs), chlorinated aliphatic hydrocarbons (CAHs) and pesticides at diffusion controlled rates at room temperature in model compound studies in both dry NH3 and when water was adde...

  9. Access to innovation: is there a difference in the use of expensive anticancer drugs between French hospitals?

    PubMed

    Bonastre, Julia; Chevalier, Julie; Van der Laan, Chantal; Delibes, Michel; De Pouvourville, Gerard

    2014-06-01

    In DRG-based hospital payment systems, expensive drugs are often funded separately. In France, specific expensive drugs (including a large proportion of anticancer drugs) are fully reimbursed up to national reimbursement tariffs to ensure equity of access. Our objective was to analyse the use of expensive anticancer drugs in public and private hospitals, and between regions. We had access to sales per anticancer drug and per hospital in the year 2008. We used a multilevel model to study the variation in the mean expenditure of expensive anticancer drugs per course of chemotherapy and per hospital. The mean expenditure per course of chemotherapy was €922 [95% CI: 890-954]. At the hospital level, specialisation in chemotherapies for breast cancers was associated with a higher expenditure of anticancer drugs per course for those hospitals with the highest proportion of cancers at this site. There were no differences in the use of expensive drugs between the private and the public hospital sector after controlling for case mix. There were no differences between the mean expenditures per region. The absence of disparities in the use of expensive anticancer drugs between hospitals and regions may indicate that exempting chemotherapies from DRG-based payments and providing additional reimbursement for these drugs has been successful at ensuring equal access to care. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  10. Assessment of access to primary health care among children and adolescents hospitalized due to avoidable conditions.

    PubMed

    Ferrer, Ana Paula Scoleze; Grisi, Sandra Josefina Ferraz Ellero

    2016-09-01

    Hospitalizations for ambulatory care-sensitive conditions (HACSC) are considered an indicator of the effectiveness of primary health care (PHC). High rates of HACSC represent problems in the access or the quality of health care. In Brazil, HACSC rates are high and there are few studies on the factors associated with it. To evaluate the access to PHC offered to children and adolescents hospitalized due to ACSC and analyze the conditioning factors. Cross-sectional study with a quantitative and qualitative approach. Five hundred and one (501) users (guardians/caregivers) and 42 professionals of PHC units were interviewed over one year. Quantitative data were obtained using Primary Care Assessment Tool validated in Brazil (PCATool-Brazil), while qualitative data were collected by semi-structured interview. The independent variables were: age, maternal education, family income, type of diagnosis, and model of care offered, and the dependent variables were access and its components (accessibility and use of services). Sixty-five percent (65.2%) of hospitalizations were ACSC. From the perspective of both users and professionals, access and its components presented low scores. Age, type of diagnosis, and model of care affected the results. The proportion of HACSC was high in this population. Access to services is inappropriate due to: barriers to access, appreciation of the emergency services, and attitude towards health needs. Professional attitudes and opinions reinforce inadequate ideas of users reflecting on the pattern of service use.

  11. Monitoring the impact of hospital downsizing on access to care and quality of care.

    PubMed

    Brownell, M D; Roos, N P; Burchill, C

    1999-06-01

    The most recent data used for monitoring the potential effects of bed closures in Winnipeg hospitals since 1992/93 found that despite downsizing, access to care was by no means compromised. Just as many patients were cared for in 1995/96 as in 1991/92. Changes in patterns of care included more outpatient and fewer inpatient surgeries, and a decrease in the number of hospital days. The number of high-profile surgical procedures, such as angioplasty, bypass, and cataract surgery, performed increased dramatically during downsizing. Quality of care delivered to patients, measured by mortality and readmission rates, was unaffected by bed closures. Of particular concern was the impact of downsizing on the two most vulnerable health groups--the elderly and Manitobans in the lowest income group. Access and quality of care for these groups also remained unchanged. However, those in the lowest income group spent almost 43% more days in hospital than those in the middle income group, and research demonstrates that these variations in hospital use across socioeconomic groups reflect real and important health differences and are not driven by social reasons for admissions. Finally, a large decrease in waiting time for nursing home placement underlines the relationship between downsizing and availability of alternatives to hospitalization.

  12. The effect of soft budget constraints on access and quality in hospital care.

    PubMed

    Shen, Yu-Chu; Eggleston, Karen

    2009-06-01

    Given an increasingly complex web of financial pressures on providers, studies have examined how hospitals' overall financial health affects different aspects of hospital operations. In our study, we develop an empirical proxy for the concept of soft budget constraint (SBC, Kornai, Kyklos 39:3-30, 1986) as an alternative financial measure of a hospital's overall financial health and offer an initial estimate of the effect of SBCs on hospital access and quality. An organization has a SBC if it can expect to be bailed out rather than shut down. Our conceptual model predicts that hospitals facing softer budget constraints will be associated with less aggressive cost control, and their quality may be better or worse, depending on the scope for damage to quality from noncontractible aspects of cost control. We find that hospitals with softer budget constraints are less likely to shut down safety net services. In addition, hospitals with softer budget constraints appear to have better mortality outcomes for elderly heart attack patients.

  13. Does improved access to diagnostic imaging results reduce hospital length of stay? A retrospective study

    PubMed Central

    2010-01-01

    Background One year after the introduction of Information and Communication Technology (ICT) to support diagnostic imaging at our hospital, clinicians had faster and better access to radiology reports and images; direct access to Computed Tomography (CT) reports in the Electronic Medical Record (EMR) was particularly popular. The objective of this study was to determine whether improvements in radiology reporting and clinical access to diagnostic imaging information one year after the ICT introduction were associated with a reduction in the length of patients' hospital stays (LOS). Methods Data describing hospital stays and diagnostic imaging were collected retrospectively from the EMR during periods of equal duration before and one year after the introduction of ICT. The post-ICT period was chosen because of the documented improvement in clinical access to radiology results during that period. The data set was randomly split into an exploratory part used to establish the hypotheses, and a confirmatory part. The data was used to compare the pre-ICT and post-ICT status, but also to compare differences between groups. Results There was no general reduction in LOS one year after ICT introduction. However, there was a 25% reduction for one group - patients with CT scans. This group was heterogeneous, covering 445 different primary discharge diagnoses. Analyses of subgroups were performed to reduce the impact of this divergence. Conclusion Our results did not indicate that improved access to radiology results reduced the patients' LOS. There was, however, a significant reduction in LOS for patients undergoing CT scans. Given the clinicians' interest in CT reports and the results of the subgroup analyses, it is likely that improved access to CT reports contributed to this reduction. PMID:20819224

  14. Potential impact of public access defibrillators on survival after out of hospital cardiopulmonary arrest: retrospective cohort study

    PubMed Central

    Pell, Jill P; Sirel, Jane M; Marsden, Andrew K; Ford, Ian; Walker, Nicola L; Cobbe, Stuart M

    2002-01-01

    Objective To estimate the potential impact of public access defibrillators on overall survival after out of hospital cardiac arrest. Design Retrospective cohort study using data from an electronic register. A statistical model was used to estimate the effect on survival of placing public access defibrillators at suitable or possibly suitable sites. Setting Scottish Ambulance Service. Subjects Records of all out of hospital cardiac arrests due to heart disease in Scotland in 1991-8. Main outcome measures Observed and predicted survival to discharge from hospital. Results Of 15 189 arrests, 12 004 (79.0%) occurred in sites not suitable for the location of public access defibrillators, 453 (3.0%) in sites where they may be suitable, and 2732 (18.0%) in suitable sites. Defibrillation was given in 67.9% of arrests that occurred in possibly suitable sites for locating defibrillators and in 72.9% of arrests that occurred in suitable sites. Compared with an actual overall survival of 744 (5.0%), the predicted survival with public access defibrillators ranged from 942 (6.3%) to 959 (6.5%), depending on the assumptions made regarding defibrillator coverage. Conclusions The predicted increase in survival from targeted provision of public access defibrillators is less than the increase achievable through expansion of first responder defibrillation to non-ambulance personnel, such as police or firefighters, or of bystander cardiopulmonary resuscitation. Additional resources for wide scale coverage of public access defibrillators are probably not justified by the marginal improvement in survival. What is already known on this topicThree quarters of all deaths from acute coronary events occur before the patient reaches a hospitalDefibrillation is an independent predictor of survival from out of hospital cardiac arrestThe probability of a rhythm being amenable to defibrillation declines with timeInterest in providing public access defibrillators to reduce the time to

  15. Development of the Nursing Community Apgar Questionnaire (NCAQ): a rural nurse recruitment and retention tool.

    PubMed

    Prengaman, M P; Bigbee, J L; Baker, E; Schmitz, D F

    2014-01-01

    Health professional shortages are a significant issue throughout the USA, particularly in rural communities. Filling nurse vacancies is a costly concern for many critical access hospitals (CAH), which serve as the primary source of health care for rural communities. CAHs and rural communities have strengths and weaknesses that affect their recruitment and retention of rural nurses. The purpose of this study was to develop a tool that rural communities and CAHs can utilize to assess their strengths and weaknesses related to nurse recruitment and retention. The Nursing Community Apgar Questionnaire (NCAQ) was developed based on an extensive literature review, visits to multiple rural sites, and consultations with rural nurses, rural nurse administrators and content experts. A quantitative interview tool consisting of 50 factors that affect rural nurse recruitment and retention was developed. The tool allows participants to rate each factor in terms of advantage and importance level. The tool also includes three open-ended questions for qualitative analysis. The NCAQ was designed to identify rural communities' and CAHs' strengths and challenges related to rural nurse recruitment and retention. The NCAQ will be piloted and a database developed for CAHs to compare their results with those in the database. Furthermore, the NCAQ results may be utilized to prioritize resource allocation and tailor rural nurse recruitment and retention efforts to highlight a community's strengths. The NCAQ will function as a useful real-time tool for CAHs looking to assess and improve their rural nurse recruitment and retention practices and compare their results with those of their peers. Longitudinal results will allow CAHs and their communities to evaluate their progress over time. As the database grows in size, state, regional, and national results can be compared, trends may be discovered and best practices identified.

  16. Specialty Care Access in the Safety Net-the Role of Public Hospitals and Health Systems.

    PubMed

    Makaroun, Lena K; Bowman, Chelsea; Duan, Kevin; Handley, Nathan; Wheeler, Daniel J; Pierluissi, Edgar; Chen, Alice Hm

    2017-01-01

    Access to specialty care in the United States safety net, already strained, is fac-ing increasing pressure with an influx of patients following the passage of the Affordable Care Act (ACA). We surveyed 18 public hospitals and health systems across the country to describe the current state of specialty care delivery in safety-net systems. We elicited information regarding challenges, provider models, metrics of access and productivity, and strategies for improving access. Based on our findings, we propose a framework for assessing and improving specialty care access with a focus on population health planning.

  17. Trends and Characteristics of United States Out-of-Hospital Births 2004-2014: New Information on Risk Status and Access to Care.

    PubMed

    MacDorman, Marian F; Declercq, Eugene

    2016-06-01

    Out-of-hospital births are increasing in the United States. Our purpose was to examine trends in out-of-hospital births from 2004 to 2014, and to analyze newly available data on risk status and access to care. Newly available data from the revised birth certificate for 47 states and Washington, DC, were used to examine out-of-hospital births by characteristics and to compare them with hospital births. Trends from 2004 to 2014 were also examined. Out-of-hospital births increased by 72 percent, from 0.87 percent of United States births in 2004 to 1.50 percent in 2014. Compared with mothers who had hospital births, those with out-of-hospital births had lower prepregnancy obesity (12.5% vs 25.0%) and smoking (2.8% vs 8.5%) rates, and higher college graduation (39.3% vs 30.0%) and breastfeeding initiation (94.3% vs 80.8%) rates. Among planned home births, 67.1 percent were self-paid, compared with 31.9 percent of birth center and 3.4 percent of hospital births. Vaginal births after cesarean (VBACs) comprised 4.6 percent of planned home births and 1.6 percent of hospital and birth center births. Sociodemographic and medical risk status of out-of-hospital births improved substantially from 2004 to 2014. Improvements in risk status of out-of-hospital births from 2004 to 2014 suggest that appropriate selection of low-risk women is improving. High rates of self-pay for the costs of out-of-hospital birth suggest serious gaps in insurance coverage, whereas higher-than-average rates of VBAC could reflect lack of access to hospital VBACs. Mandating private insurance and Medicaid coverage could substantially improve access to out-of-hospital births. Improving access to hospital VBACs might reduce the number of out-of-hospital VBACs. © 2016 Wiley Periodicals, Inc.

  18. California hospital networks are narrower in Marketplace than in commercial plans, but access and quality are similar.

    PubMed

    Haeder, Simon F; Weimer, David L; Mukamel, Dana B

    2015-05-01

    Do insurance plans offered through the Marketplace implemented by the State of California under the Affordable Care Act restrict consumers' access to hospitals relative to plans offered on the commercial market? And are the hospitals included in Marketplace networks of lower quality compared to those included in the commercial plans? To answer these questions, we analyzed differences in hospital networks across similar plan types offered both in the Marketplace and commercially, by region and insurer. We found that the common belief that Marketplace plans have narrower networks than their commercial counterparts appears empirically valid. However, there does not appear to be a substantive difference in geographic access as measured by the percentage of people residing in at least one hospital market area. More surprisingly, depending on the measure of hospital quality employed, the Marketplace plans have networks with comparable or even higher average quality than the networks of their commercial counterparts. Project HOPE—The People-to-People Health Foundation, Inc.

  19. We Are Lost: Measuring the Accessibility of Signage in Public General Hospitals

    ERIC Educational Resources Information Center

    Schuster, Michal; Elroy, Irit; Elmakais, Ido

    2017-01-01

    Hospital signage is a critical element in the patients' and visitors understanding of directions, instructions and warnings in the facility. In multilingual environments organizations need to make sure that the information is accessible in the languages of the people who consume their services. As part of a large-scale study that examined the…

  20. Assessing spatial access to public and private hospitals in Sichuan, China: The influence of the private sector on the healthcare geography in China.

    PubMed

    Pan, Jay; Zhao, Hanqing; Wang, Xiuli; Shi, Xun

    2016-12-01

    In 2009, the Chinese government launched a new round of healthcare reform, which encourages development of private hospitals. Meanwhile, many public hospitals in China also became increasingly profit-oriented. These trends have led to concerns about social justice and regional disparity. However, there is a lack of empirical scientific analysis to support the debate. We started to fill this gap by conducting a regional-level analysis of spatial variation in spatial access to hospitals in the Sichuan Province. Such variation is an important indication of (in) equity in healthcare resource allocation. Using data of 2012, we intended to provide a snapshot of the situation that was a few years later since the new policies had set out. We employed two methods to quantify the spatial access: the nearest-neighbor method and the enhanced two-step floating catchment area (E2SFCA) method. We recognized two sub-regions of Sichuan: the rural West Sichuan and the well-developed East Sichuan. We classified the hospitals using both ownership and level. We applied the analysis to the resulting groups of hospitals and their combinations in the two sub-regions. The two sub-regions have a high contrast in the spatial access to hospitals, in terms of both quantity and spatial pattern. Public hospitals still dominated the service in the province, especially in the West Sichuan, which had been solely relying on public hospitals. Private hospitals only occurred in the East Sichuan, and at the primary level, they had surpassed public hospitals in terms of spatial accessibility. However, the governmental health expenditures seemed to be disconnected with the actual situation of the spatial access to hospitals. The government should continue carrying on its responsibility in allocating healthcare resources, be cautious about marketizing public hospitals, and encourage private hospitals to expand into rural areas. Methodologically, the results from the two methods are concurring but not

  1. Unusual phenotype of congenital adrenal hyperplasia (CAH) with a novel mutation of the CYP21A2 gene.

    PubMed

    Raisingani, Manish; Contreras, Maria F; Prasad, Kris; Pappas, John G; Kluge, Michelle L; Shah, Bina; David, Raphael

    2016-07-01

    Gonadotropin independent sexual precocity (SP) may be due to congenital adrenal hyperplasia (CAH), and its timing usually depends on the type of mutation in the CYP21A2 gene. Compound heterozygotes are common and express phenotypes of varying severity. The objective of this case report was to investigate the hormonal pattern and unusual genetic profile in a 7-year-old boy who presented with pubic hair, acne, an enlarged phallus, slightly increased testicular volume and advanced bone age. Clinical, hormonal and genetic studies were undertaken in the patient as well as his parents. We found elevated serum 17-hydroxyprogesterone (17-OHP) and androstenedione that were suppressed with dexamethasone, and elevated testosterone that actually rose after giving dexamethasone, indicating activity of the hypothalamic-pituitary-gonadal (HPG) axis. An initial search for common mutations was negative, but a more detailed genetic analysis of the CYP21A2 gene revealed two mutations including R341W, a non-classical mutation inherited from his mother, and g.823G>A, a novel not previously reported consensus donor splice site mutation inherited from his father, which is predicted to be salt wasting. However, the child had a normal plasma renin activity. He was effectively treated with low-dose dexamethasone and a GnRH agonist. His father was an unaffected carrier, but his mother had evidence of mild non-classical CAH. In a male child presenting with gonadotropin independent SP it is important to investigate adrenal function with respect to the androgen profile, and to carry out appropriate genetic studies.

  2. Community-acquired hyperkalemia in elderly patients: risk factors and clinical outcomes.

    PubMed

    Turgutalp, Kenan; Bardak, Simge; Helvacı, Ilter; İşgüzar, Gizem; Payas, Ezgi; Demir, Serap; Kıykım, Ahmet

    2016-10-01

    Although the risk and related factors of hyperkalemia developed in the hospital are known in elderly, risk and related factors of community-acquired hyperkalemia (CAH) in this population are not well known. This study was performed to investigate the risk of CAH in elderly and evaluate the related factors and clinical outcomes. Study design, setting and participants, intervention: Patients (aged ≥65 years) with hyperkalemia were screened. Group 1 (young-old); 65-74 years/old, Group 2 (middle-old); 75-84 years/old, Group 3 (oldest-old); ≥85 years/old, and Group 4 (control group); ≥65 years/old (normal serum potassium levels). The relation between CAH and hospital expenses (HE), the number of comorbid diseases (NCD), and all-cause of mortality rates (MR) were evaluated. We also investigated whether drugs, sex, and NCD are risk factors for the development of CAH. There was a positive correlation between serum potassium levels and length of hospital stay, MR, HE, and NCD (p < 0.001). Risk factors for CAH were the use of non-steroidal-anti inflammatory drugs (NSAIDs) (Odds Ratio [OR]: 2.679), spironolactone (OR: 2.530), and angiotensin converting enzyme inhibitors (ACEI) (OR: 2.242), angiotensin receptor blockers (ARB) (OR: 2.679), ≥2 comorbid diseases (OR: 2.221), female gender (OR: 2.112), and renal injury (OR: 5.55). CAH risk was found to be increased 30.03 times when any of ACEI, ARB, NSAIDs, or spironolactone is given to a patient with a renal injury. Use of NSAIDs, ACEI, ARB, spironolactone and increased NCD are all independent risk factors for CAH in the elderly, especially in patients with kidney diseases.

  3. Neutron production at 0° from the 40Ca+H reaction at Elab=357A and 565A MeV

    NASA Astrophysics Data System (ADS)

    Tuvè, C.; Albergo, S.; Boemi, D.; Caccia, Z.; Chen, C.-X.; Costa, S.; Crawford, H. J.; Cronqvist, M.; Engelage, J.; Greiner, L.; Guzik, T. G.; Insolia, A.; Knott, C. N.; Lindstrom, P. J.; Mitchell, J. W.; Potenza, R.; Reito, S.; Romanski, J.; Russo, G. V.; Soutoul, A.; Testard, O.; Tull, C. E.; Waddington, C. J.; Webber, W. R.; Wefel, J. P.

    1997-08-01

    Neutrons produced in the 40Ca+H reaction at Elab=357A and 565A MeV have been detected using a three-module version of the multifunctional neutron spectrometer MUFFINS. The detector covered a narrow angular range around the beam in the forward direction (0°-3.2°). Semi-inclusive neutron production cross sections, at the two energies, are reported together with neutron energy spectra, angular, rapidity, and transverse momentum distributions. Comparison with a Boltzmann-Nordheim-Vlasov approach + phase space coalescence model is discussed.

  4. Ca(AlH4)2, CaAlH5, and CaH2+6LiBH4: Calculated dehydrogenation enthalpy, including zero point energy, and the structure of the phonon spectra.

    PubMed

    Marashdeh, Ali; Frankcombe, Terry J

    2008-06-21

    The dehydrogenation enthalpies of Ca(AlH(4))(2), CaAlH(5), and CaH(2)+6LiBH(4) have been calculated using density functional theory calculations at the generalized gradient approximation level. Harmonic phonon zero point energy (ZPE) corrections have been included using Parlinski's direct method. The dehydrogenation of Ca(AlH(4))(2) is exothermic, indicating a metastable hydride. Calculations for CaAlH(5) including ZPE effects indicate that it is not stable enough for a hydrogen storage system operating near ambient conditions. The destabilized combination of LiBH(4) with CaH(2) is a promising system after ZPE-corrected enthalpy calculations. The calculations confirm that including ZPE effects in the harmonic approximation for the dehydrogenation of Ca(AlH(4))(2), CaAlH(5), and CaH(2)+6LiBH(4) has a significant effect on the calculated reaction enthalpy. The contribution of ZPE to the dehydrogenation enthalpies of Ca(AlH(4))(2) and CaAlH(5) calculated by the direct method phonon analysis was compared to that calculated by the frozen-phonon method. The crystal structure of CaAlH(5) is presented in the more useful standard setting of P2(1)c symmetry and the phonon density of states of CaAlH(5), significantly different to other common complex metal hydrides, is rationalized.

  5. Ca(AlH4)2, CaAlH5, and CaH2+6LiBH4: Calculated dehydrogenation enthalpy, including zero point energy, and the structure of the phonon spectra

    NASA Astrophysics Data System (ADS)

    Marashdeh, Ali; Frankcombe, Terry J.

    2008-06-01

    The dehydrogenation enthalpies of Ca(AlH4)2, CaAlH5, and CaH2+6LiBH4 have been calculated using density functional theory calculations at the generalized gradient approximation level. Harmonic phonon zero point energy (ZPE) corrections have been included using Parlinski's direct method. The dehydrogenation of Ca(AlH4)2 is exothermic, indicating a metastable hydride. Calculations for CaAlH5 including ZPE effects indicate that it is not stable enough for a hydrogen storage system operating near ambient conditions. The destabilized combination of LiBH4 with CaH2 is a promising system after ZPE-corrected enthalpy calculations. The calculations confirm that including ZPE effects in the harmonic approximation for the dehydrogenation of Ca(AlH4)2, CaAlH5, and CaH2+6LiBH4 has a significant effect on the calculated reaction enthalpy. The contribution of ZPE to the dehydrogenation enthalpies of Ca(AlH4)2 and CaAlH5 calculated by the direct method phonon analysis was compared to that calculated by the frozen-phonon method. The crystal structure of CaAlH5 is presented in the more useful standard setting of P21/c symmetry and the phonon density of states of CaAlH5, significantly different to other common complex metal hydrides, is rationalized.

  6. Access to and value of information to support good practice for staff in Kenyan hospitals

    PubMed Central

    Muinga, Naomi; Sen, Barbara; Ayieko, Philip; Todd, Jim; English, Mike

    2015-01-01

    Background Studies have sought to define information needs of health workers within very specific settings or projects. Lacking in the literature is how hospitals in low-income settings are able to meet the information needs of their staff and the use of information communication technologies (ICT) in day-to-day information searching. Objective The study aimed to explore where professionals in Kenyan hospitals turn to for work-related information in their day-to-day work. Additionally, it examined what existing solutions are provided by hospitals with regard to provision of best practice care. Lastly, the study explored the use of ICT in information searching. Design Data for this study were collected in July 2012. Self-administered questionnaires (SAQs) were distributed across 22 study hospitals with an aim to get a response from 34 health workers per hospital. Results SAQs were collected from 657 health workers. The most popular sources of information to guide work were fellow health workers and printed guidelines while the least popular were scientific journals. Of value to health workers were: national treatment policies, new research findings, regular reports from surveillance data, information on costs of services and information on their performance of routine clinical tasks; however, hospitals only partially met these needs. Barriers to accessing information sources included: ‘not available/difficult to get’ and ‘difficult to understand’. ICT use for information seeking was reported and with demographic specific differences noted from the multivariate logistic regression model; nurses compared to medical doctors and older workers were less likely to use ICT for health information searching. Barriers to accessing Internet were identified as: high costs and the lack of the service at home or at work. Conclusions Hospitals need to provide appropriate information by improving information dissemination efforts and providing an enabling environment that

  7. Access to and value of information to support good practice for staff in Kenyan hospitals.

    PubMed

    Muinga, Naomi; Sen, Barbara; Ayieko, Philip; Todd, Jim; English, Mike

    2015-01-01

    Studies have sought to define information needs of health workers within very specific settings or projects. Lacking in the literature is how hospitals in low-income settings are able to meet the information needs of their staff and the use of information communication technologies (ICT) in day-to-day information searching. The study aimed to explore where professionals in Kenyan hospitals turn to for work-related information in their day-to-day work. Additionally, it examined what existing solutions are provided by hospitals with regard to provision of best practice care. Lastly, the study explored the use of ICT in information searching. Data for this study were collected in July 2012. Self-administered questionnaires (SAQs) were distributed across 22 study hospitals with an aim to get a response from 34 health workers per hospital. SAQs were collected from 657 health workers. The most popular sources of information to guide work were fellow health workers and printed guidelines while the least popular were scientific journals. Of value to health workers were: national treatment policies, new research findings, regular reports from surveillance data, information on costs of services and information on their performance of routine clinical tasks; however, hospitals only partially met these needs. Barriers to accessing information sources included: 'not available/difficult to get' and 'difficult to understand'. ICT use for information seeking was reported and with demographic specific differences noted from the multivariate logistic regression model; nurses compared to medical doctors and older workers were less likely to use ICT for health information searching. Barriers to accessing Internet were identified as: high costs and the lack of the service at home or at work. Hospitals need to provide appropriate information by improving information dissemination efforts and providing an enabling environment that allows health workers find the information they need for

  8. Modeling hospital infrastructure by optimizing quality, accessibility and efficiency via a mixed integer programming model.

    PubMed

    Ikkersheim, David; Tanke, Marit; van Schooten, Gwendy; de Bresser, Niels; Fleuren, Hein

    2013-06-16

    The majority of curative health care is organized in hospitals. As in most other countries, the current 94 hospital locations in the Netherlands offer almost all treatments, ranging from rather basic to very complex care. Recent studies show that concentration of care can lead to substantial quality improvements for complex conditions and that dispersion of care for chronic conditions may increase quality of care. In previous studies on allocation of hospital infrastructure, the allocation is usually only based on accessibility and/or efficiency of hospital care. In this paper, we explore the possibilities to include a quality function in the objective function, to give global directions to how the 'optimal' hospital infrastructure would be in the Dutch context. To create optimal societal value we have used a mathematical mixed integer programming (MIP) model that balances quality, efficiency and accessibility of care for 30 ICD-9 diagnosis groups. Typical aspects that are taken into account are the volume-outcome relationship, the maximum accepted travel times for diagnosis groups that may need emergency treatment and the minimum use of facilities. The optimal number of hospital locations per diagnosis group varies from 12-14 locations for diagnosis groups which have a strong volume-outcome relationship, such as neoplasms, to 150 locations for chronic diagnosis groups such as diabetes and chronic obstructive pulmonary disease (COPD). In conclusion, our study shows a new approach for allocating hospital infrastructure over a country or certain region that includes quality of care in relation to volume per provider that can be used in various countries or regions. In addition, our model shows that within the Dutch context chronic care may be too concentrated and complex and/or acute care may be too dispersed. Our approach can relatively easily be adopted towards other countries or regions and is very suitable to perform a 'what-if' analysis.

  9. A Survey of Managers' Access to Key Performance Indicators via HIS: The Case of Iranian Teaching Hospitals.

    PubMed

    Ahmadi, Maryam; Khorrami, Farid; Dehnad, Afsaneh; Golchin, Mohammad H; Azad, Mohsen; Rahimi, Shafei

    2018-01-01

    The challenges of using health information systems in developing countries are different from developed countries for various reasons such as infrastructure and data culture of organizations. The aim of this study is to assess managers' access to key performance indicators (KPI) via Hospital Information System (HIS) in teaching hospitals of Iran. All managers (Census method) of the four teaching hospitals affiliated to Hormozgan University of Medical Sciences (HUMS) were included in this study. KPIs which are linked to the strategic objectives of organizations were adopted from the strategic plan of HUMS. The questionnaire used in this study included three categories: Financial, Human Resources and clinical. One-sample t-test was used and the significant difference score was calculated for the acceptable level. We found that HIS cannot facilitate access to KPIs for managers in the main categories, but it was effective in two subcategories of income (p = 0.314) and salary (P = 0.289)). A study of barriers to the use of managers of HIS in hospitals is suggested.

  10. [A computerized system for the management of letters of authorization for access to sensitive data in a research and teaching hospital].

    PubMed

    Bodina, Annalisa; Brizzolara, Antonella; Vadruccio, Gianluca; Castaldi, Silvana

    2012-01-01

    This paper describes the experience of a hospital which has introduced a system of computerized management of letters of authorization for healthcare workers to access sensitive health data, through the use of open source software. A new corporate intranet portal was created with access given only to the privacy contacts of each operational unit of the hospital. Once the privacy contact has entered the relevant user authorization, these must be approved first by the Directors of the respective operational units and finally by the privacy officer. The introduction of this system has allowed a systematic approach to the management of authorization for access to health data by hospital staff, regular updating and monitoring of the authorization and the start of a process of digitalization of documents.

  11. A casemix model for estimating the impact of hospital access block on the emergency department.

    PubMed

    Stuart, Peter

    2004-06-01

    To determine the ED activity and costs resulting from access block. A casemix model (AWOOS) was developed to measure activity due to access block. Using data from four hospitals between 1998 and 2002, ED activity was measured using the urgency and disposition group (UDG) casemix model and the AWOOS model with the purpose of determining the change in ED activity due to access block. Whilst the mean length of stay in ED (admitted patients) increased by 93% between 1998 and 2002, mean UDG activity increased by 0.63% compared to a mean increase in AWOOS activity of 24.5%. The 23.9% difference between UDG and AWOOS activity represents the (unmeasured) increase in ED activity and costs for the period 1998-2002 resulting from access block. The UDG system significantly underestimates the activity in EDs experiencing marked access block.

  12. Hypothetical Network Adequacy Schemes For Children Fail To Ensure Patients' Access To In-Network Children's Hospital.

    PubMed

    Colvin, Jeffrey D; Hall, Matt; Thurm, Cary; Bettenhausen, Jessica L; Gottlieb, Laura; Shah, Samir S; Fieldston, Evan S; Goldin, Adam B; Melzer, Sanford M; Conway, Patrick H; Chung, Paul J

    2018-06-01

    Insurers are increasingly adopting narrow network strategies. Little is known about how these strategies may affect children's access to needed specialty care. We examined the percentage of pediatric specialty hospitalizations that would be beyond existing Medicare Advantage network adequacy distance requirements for adult hospital care and, as a secondary analysis, a pediatric adaptation of the Medicare Advantage requirements. We examined 748,920 hospitalizations at eighty-one children's hospitals that submitted data for the period October 2014-September 2015. Nearly half of specialty hospitalizations were outside the Medicare Advantage distance requirements. Under the pediatric adaptation, there was great variability among the hospitals, with the percent of hospitalizations beyond the distance requirements ranging from less than 1 percent to 35 percent. Instead of, or in addition to, time and distance standards, policy makers may need to consider more nuanced network definitions, including functional capabilities of the pediatric care network or clear exception policies for essential specialty care services.

  13. Access to emergency hospital care provided by the public sector in sub-Saharan Africa in 2015: a geocoded inventory and spatial analysis.

    PubMed

    Ouma, Paul O; Maina, Joseph; Thuranira, Pamela N; Macharia, Peter M; Alegana, Victor A; English, Mike; Okiro, Emelda A; Snow, Robert W

    2018-03-01

    Timely access to emergency care can substantially reduce mortality. International benchmarks for access to emergency hospital care have been established to guide ambitions for universal health care by 2030. However, no Pan-African database of where hospitals are located exists; therefore, we aimed to complete a geocoded inventory of hospital services in Africa in relation to how populations might access these services in 2015, with focus on women of child bearing age. We assembled a geocoded inventory of public hospitals across 48 countries and islands of sub-Saharan Africa, including Zanzibar, using data from various sources. We only included public hospitals with emergency services that were managed by governments at national or local levels and faith-based or non-governmental organisations. For hospital listings without geographical coordinates, we geocoded each facility using Microsoft Encarta (version 2009), Google Earth (version 7.3), Geonames, Fallingrain, OpenStreetMap, and other national digital gazetteers. We obtained estimates for total population and women of child bearing age (15-49 years) at a 1 km 2 spatial resolution from the WorldPop database for 2015. Additionally, we assembled road network data from Google Map Maker Project and OpenStreetMap using ArcMap (version 10.5). We then combined the road network and the population locations to form a travel impedance surface. Subsequently, we formulated a cost distance algorithm based on the location of public hospitals and the travel impedance surface in AccessMod (version 5) to compute the proportion of populations living within a combined walking and motorised travel time of 2 h to emergency hospital services. We consulted 100 databases from 48 sub-Saharan countries and islands, including Zanzibar, and identified 4908 public hospitals. 2701 hospitals had either full or partial information about their geographical coordinates. We estimated that 287 282 013 (29·0%) people and 64 495 526 (28·2

  14. 2015 Edition Health Information Technology (Health IT) Certification Criteria, 2015 Edition Base Electronic Health Record (EHR) Definition, and ONC Health IT Certification Program Modifications. Final rule.

    PubMed

    2015-10-16

    This final rule finalizes a new edition of certification criteria (the 2015 Edition health IT certification criteria or "2015 Edition'') and a new 2015 Edition Base Electronic Health Record (EHR) definition, while also modifying the ONC Health IT Certification Program to make it open and accessible to more types of health IT and health IT that supports various care and practice settings. The 2015 Edition establishes the capabilities and specifies the related standards and implementation specifications that Certified Electronic Health Record Technology (CEHRT) would need to include to, at a minimum, support the achievement of meaningful use by eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) under the Medicare and Medicaid EHR Incentive Programs (EHR Incentive Programs) when such edition is required for use under these programs.

  15. A network collaboration implementing technology to improve medication dispensing and administration in critical access hospitals.

    PubMed

    Wakefield, Douglas S; Ward, Marcia M; Loes, Jean L; O'Brien, John

    2010-01-01

    We report how seven independent critical access hospitals collaborated with a rural referral hospital to standardize workflow policies and procedures while jointly implementing the same health information technologies (HITs) to enhance medication care processes. The study hospitals implemented the same electronic health record, computerized provider order entry, pharmacy information systems, automated dispensing cabinets (ADC), and barcode medication administration systems. We conducted interviews and examined project documents to explore factors underlying the successful implementation of ADC and barcode medication administration across the network hospitals. These included a shared culture of collaboration; strategic sequencing of HIT component implementation; interface among HIT components; strategic placement of ADCs; disciplined use and sharing of workflow analyses linked with HIT applications; planning for workflow efficiencies; acquisition of adequate supply of HIT-related devices; and establishing metrics to monitor HIT use and outcomes.

  16. Comparison of Accessibility, Cost, and Quality of Elective Coronary Revascularization Between Veterans Affairs and Community Care Hospitals.

    PubMed

    Barnett, Paul G; Hong, Juliette S; Carey, Evan; Grunwald, Gary K; Joynt Maddox, Karen; Maddox, Thomas M

    2018-02-01

    The Veterans Affairs (VA) Community Care (CC) Program supplements VA care with community-based medical services. However, access gains and value provided by CC have not been well described. To compare the access, cost, and quality of elective coronary revascularization procedures between VA and CC hospitals and to evaluate if procedural volume or publicly reported quality data can be used to identify high-value care. Observational cohort study of veterans younger than 65 years undergoing an elective coronary revascularization, controlling for differences in risk factors using propensity adjustment. The setting was VA and CC hospitals. Participants were veterans undergoing elective percutaneous coronary intervention (PCI) and veterans undergoing coronary artery bypass graft (CABG) procedures between October 1, 2008, and September 30, 2011. The analysis was conducted between July 2014 and July 2017. Receipt of an elective coronary revascularization at a VA vs CC facility. Access to care as measured by travel distance, 30-day mortality, and costs. In the 3 years ending on September 30, 2011, a total of 13 237 elective PCIs (79.1% at the VA) and 5818 elective CABG procedures (83.6% at the VA) were performed in VA or CC hospitals among veterans meeting study inclusion criteria. On average, use of CC was associated with reduced net travel by 53.6 miles for PCI and by 73.3 miles for CABG surgery compared with VA-only care. Adjusted 30-day mortality after PCI was higher in CC compared with VA (1.54% for CC vs 0.65% for VA, P < .001) but was similar after CABG surgery (1.33% for CC vs 1.51% for VA, P = .74). There were no differences in adjusted 30-day readmission rates for PCI (7.04% for CC vs 7.73% for VA, P = .66) or CABG surgery (8.13% for CC vs 7.00% for VA, P = .28). The mean adjusted PCI cost was higher in CC ($22 025 for CC vs $15 683 for VA, P < .001). The mean adjusted CABG cost was lower in CC ($55 526 for CC vs $63 144 for VA, P

  17. Medicare and Medicaid Programs; Fire Safety Requirements for Certain Health Care Facilities. Final rule.

    PubMed

    2016-05-04

    This final rule will amend the fire safety standards for Medicare and Medicaid participating hospitals, critical access hospitals (CAHs), long-term care facilities, intermediate care facilities for individuals with intellectual disabilities (ICF-IID), ambulatory surgery centers (ASCs), hospices which provide inpatient services, religious non-medical health care institutions (RNHCIs), and programs of all-inclusive care for the elderly (PACE) facilities. Further, this final rule will adopt the 2012 edition of the Life Safety Code (LSC) and eliminate references in our regulations to all earlier editions of the Life Safety Code. It will also adopt the 2012 edition of the Health Care Facilities Code, with some exceptions.

  18. A Correlational Analysis: Electronic Health Records (EHR) and Quality of Care in Critical Access Hospitals

    ERIC Educational Resources Information Center

    Khan, Arshia A.

    2012-01-01

    Driven by the compulsion to improve the evident paucity in quality of care, especially in critical access hospitals in the United States, policy makers, healthcare providers, and administrators have taken the advise of researchers suggesting the integration of technology in healthcare. The Electronic Health Record (EHR) System composed of multiple…

  19. Health care access, concentrated poverty, and pediatric asthma hospital care use in California's San Joaquin Valley: A multilevel approach.

    PubMed

    Alcala, Emanuel; Cisneros, Ricardo; Capitman, John A

    2017-12-20

    California's San Joaquin Valley is a region with a history of poverty, low health care access, and high rates of pediatric asthma. It is important to understand the potential barriers to care that challenge vulnerable populations. The objective was to describe pediatric asthma-related utilization patterns in the emergency department (ED) and hospital by insurance coverage as well as to identify contributing individual-level indicators (age, sex, race/ethnicity, and insurance coverage) and neighborhood-level indicators of health care access. This was a retrospective study based on secondary data from California hospital and ED records 2007-2012. Children who used services for asthma-related conditions, were aged 0-14 years, Hispanic or non-Hispanic white, and resided in the San Joaquin Valley were included in the analysis. Poisson multilevel modeling was used to control for individual- and neighborhood-level factors. The effect of insurance coverage on asthma ED visits and hospitalizations was modified by the neighborhood-level percentage of concentrated poverty (RR = 1.01, 95% CI = 1.01-1.02; RR = 1.03, 95% CI = 1.02-1.04, respectively). The effect of insurance coverage on asthma hospitalizations was completely explained by the neighborhood-level percentage of concentrated poverty. Observed effects of insurance coverage on hospital care use were significantly modified by neighborhood-level measures of health care access and concentrated poverty. This suggests not only an overall greater risk for poor children on Medi-Cal, but also a greater vulnerability or response to neighborhood social factors such as socioeconomic status, community cohesiveness, crime, and racial/ethnic segregation.

  20. Differing perspectives on parent access to their child's electronic medical record during neonatal intensive care hospitalization: a pilot study.

    PubMed

    Chung, Rebecca K; Kim, Una Olivia; Basir, Mir Abdul

    2018-04-01

    To improve informed medical decision-making, principles for family-centered neonatal care recommend that parents have access to their child's medical record on an ongoing basis during neonatal intensive unit care (NICU) hospitalization. Currently, many NICUs do not allow independent parent access to their child's electronic medical record (EMR) during hospitalization. We undertook a cross-sectional survey pilot study of medical professionals and parents to explore opinions regarding this practice. Inclusion criteria: 18-years old, English-literate, legal guardian of patients admitted to the NICU for 14 days. NICU medical professionals included physicians, nurse practitioners, nurses, and respiratory therapists. Medical professionals believed parent access would make their work more difficult, increase time documenting and updating families, making them more liable to litigation and hesitant to chart sensitive information. However, parents felt that they lacked control over their child's care and desired direct access to the EMR. Parents believed this would improve accuracy of their child's medical chart, and increase advocacy and understanding of their child's illness. NICU parents and medical professionals have differing perspectives on independent parental access to their child's EMR. More research is needed to explore the potential of independent parental EMR access to further improve family-centered neonatal care.

  1. Change in Vascular Access and Hospitalization Risk in Long-Term Hemodialysis Patients

    PubMed Central

    Wang, Weiling; Lazarus, J. Michael; Hakim, Raymond M.

    2010-01-01

    Background and objectives: Conversion from central venous catheters to a graft or a fistula is associated with lower mortality risk in long-term hemodialysis (HD) patients; however, a similar association with hospitalization risk remains to be elucidated. Design, setting, participants, & measurements: We conducted a prospective observational study all maintenance in-center HD patients who were treated in Fresenius Medical Care, North America legacy facilities; were alive on January 1, 2007; and had baseline laboratory data from December 2006. Access conversion (particularly from a catheter to a fistula or a graft) during the 4-month period from January 1 through April 30, 2007, was linked using Cox models to hospitalization risk during the succeeding 1-year follow-up period (until April 30, 2008). Results: The cohort (N = 79,545) on January 1, 2007 had 43% fistulas, 29% catheters, and 27% grafts. By April 30, 2007, 70,852 patients were still on HD, and among 19,792 catheters initially, only 10.3% (2045 patients) converted to either a graft or a fistula. With catheters as reference, patients who converted to grafts/fistulas had similar adjusted hazard ratios (0.69) as patients on fistulas (0.71), while patients with fistulas/grafts who converted to catheters did worse (1.22), all P < 0.0001. Conclusions: Catheters remain associated with the greatest hospitalization risk. Conversion from a catheter to either graft or fistula had significantly lower hospitalization risk relative to keeping the catheter. Prospective studies are needed to determine whether programs that reduce catheters will decrease hospitalization risk in HD patients. PMID:20884778

  2. Water availability at hospitals in low- and middle-income countries: implications for improving access to safe surgical care.

    PubMed

    Chawla, Sagar S; Gupta, Shailvi; Onchiri, Frankline M; Habermann, Elizabeth B; Kushner, Adam L; Stewart, Barclay T

    2016-09-01

    Although two billion people now have access to clean water, many hospitals in low- and middle-income countries (LMICs) do not. Lack of water availability at hospitals hinders safe surgical care. We aimed to review the surgical capacity literature and document the availability of water at health facilities and develop a predictive model of water availability at health facilities globally to inform targeted capacity improvements. Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search for surgical capacity assessments in LMICs in MEDLINE, PubMed, and World Health Organization Global Health Library was performed. Data regarding water availability were extracted. Data from these assessments and national indicator data from the World Bank (e.g., gross domestic product, total health expenditure, and percent of population with improved access to water) were used to create a predictive model for water availability in LMICs globally. Of the 72 records identified, 19 reported water availability representing 430 hospitals. A total of 66% of hospitals assessed had water availability (283 of 430 hospitals). Using these data, estimated percent of water availability in LMICs more broadly ranged from under 20% (Liberia) to over 90% (Bangladesh, Ghana). Less than two-thirds of hospitals providing surgical care in 19 LMICs had a reliable water source. Governments and nongovernmental organizations should increase efforts to improve water infrastructure at hospitals, which might aid in the provision of safe essential surgical care. Future research is needed to measure the effect of water availability on surgical care and patient outcomes. Copyright © 2016 Elsevier Inc. All rights reserved.

  3. Comparison of Accessibility, Cost, and Quality of Elective Coronary Revascularization Between Veterans Affairs and Community Care Hospitals

    PubMed Central

    Hong, Juliette S.; Carey, Evan; Grunwald, Gary K.; Joynt Maddox, Karen; Maddox, Thomas M.

    2018-01-01

    Importance The Veterans Affairs (VA) Community Care (CC) Program supplements VA care with community-based medical services. However, access gains and value provided by CC have not been well described. Objectives To compare the access, cost, and quality of elective coronary revascularization procedures between VA and CC hospitals and to evaluate if procedural volume or publicly reported quality data can be used to identify high-value care. Design, Setting, and Participants Observational cohort study of veterans younger than 65 years undergoing an elective coronary revascularization, controlling for differences in risk factors using propensity adjustment. The setting was VA and CC hospitals. Participants were veterans undergoing elective percutaneous coronary intervention (PCI) and veterans undergoing coronary artery bypass graft (CABG) procedures between October 1, 2008, and September 30, 2011. The analysis was conducted between July 2014 and July 2017. Exposures Receipt of an elective coronary revascularization at a VA vs CC facility. Main Outcomes and Measures Access to care as measured by travel distance, 30-day mortality, and costs. Results In the 3 years ending on September 30, 2011, a total of 13 237 elective PCIs (79.1% at the VA) and 5818 elective CABG procedures (83.6% at the VA) were performed in VA or CC hospitals among veterans meeting study inclusion criteria. On average, use of CC was associated with reduced net travel by 53.6 miles for PCI and by 73.3 miles for CABG surgery compared with VA-only care. Adjusted 30-day mortality after PCI was higher in CC compared with VA (1.54% for CC vs 0.65% for VA, P < .001) but was similar after CABG surgery (1.33% for CC vs 1.51% for VA, P = .74). There were no differences in adjusted 30-day readmission rates for PCI (7.04% for CC vs 7.73% for VA, P = .66) or CABG surgery (8.13% for CC vs 7.00% for VA, P = .28). The mean adjusted PCI cost was higher in CC ($22 025 for CC vs $15 683 for VA, P

  4. Access to new cardiovascular therapies in Canadian hospitals: a national survey of the formulary process.

    PubMed

    Shalansky, Stephen J; Virk, Roohina; Ackman, Margaret; Jackevicius, Cynthia; Kertland, Heather; Tsuyuki, Ross; Humphries, Karin

    2003-02-01

    Access to new therapies in hospitals depends upon both clinical trial evidence and local Pharmacy and Therapeutics (P&T) committee approval. The process of formulary evaluation by P&T committees is not well-understood. To describe the formulary decision-making process in Canadian hospitals for cardiovascular medications recently made available on the Canadian market. Postal survey of hospital pharmacy directors in all Canadian hospitals with more than 50 beds. Target drugs included abciximab, enoxaparin, dalteparin, clopidogrel, eptifibatide and tirofiban. Of 428 surveys mailed, responses were received from 164 P&T committees representing 350 hospitals for an effective response rate of 82%. While physicians make up the largest proportion of committee membership, pharmacists play an influential role. Information most commonly cited as influencing formulary decisions included published clinical trials (97%), regional guidelines (90%), pharmacoeconomic data (84%), decisions at peer hospitals (73%) and local opinion leaders (60%). However, this information was often not required on formulary applications. Approval timelines varied widely for target medications but there were no regional, hospital or P&T committee characteristics that were independent predictors of early formulary application or approval. There is wide variability in the time taken for Canadian institutions to adopt new cardiovascular therapies, which is not explained by regional, hospital or P&T committee characteristics. Standardization of the formulary application and evaluation processes, including sharing of information amongst institutions, would lead to broader understanding of the applicable issues, more objectivity and improved efficiency.

  5. [Access, use and preferences of Information and Communication Technologies by physicians in a general hospital in Peru].

    PubMed

    Vásquez-Silva, Luis; Ticse, Ray; Alfaro-Carballido, Luz; Guerra-Castañon, Felix

    2015-01-01

    We assessed the access, use and preferences of information and communication technology (ICT) by physicians who practice at Cayetano Heredia National Hospital. The questionnaire explored the availability and skills of ICT, time, educational activities, search engines and technological applications most used as well as ICT preferences in education.211 physicians were surveyed; laptop use was 93%, tablet and smartphone use was 66% and 88%.68% have mobile Internet. Differences were evident in the frequency of use of ICT in 25-34 year old age group as well as a higher level of skills (p<0.05). 86% use PubMed, Facebook and WhatsApp as a means of exchanging images and data related to health, 50% participated in medical blogs, online courses or videoconferences. The use and access of ICT is common among doctors in this hospital and there is positive interest in its use in education.

  6. Accessing packaged food and beverages in hospital. Exploring experiences of patients and staff.

    PubMed

    Bell, A F; Walton, K; Chevis, J S; Davies, K; Manson, C; Wypych, A; Yoxall, A; Kirkby, J; Alexander, N

    2013-01-01

    Food and beverage packaging has been identified as a contributing factor to malnutrition among elderly patients in hospitals. The focus of this research was to describe the types of food and beverage packaging used in NSW hospitals, determine the 'problematic' packaging from the users' perspective, investigate the effect of hand strength on the ability to open the packaging and to survey users' (patients and staff) views on the 'accessibility' of the packaging. The study was conducted in the Illawarra region of NSW, Australia. Participants (140 mostly elderly inpatients and 64 staff members) were recruited from four local public hospitals. Data were collected using interviews, questionnaires, observations and grip strength testing. Several food and beverage packages were found difficult to open by at least 40% of patients. These included milk and juices (52%), cereal (49%), condiments (46%), tetra packs (40%) and water bottles (40%). The difficulties were attributed to 'fiddly' packaging, hand strength and vision; however, only tetra packs demonstrated a relationship between time taken to open and hand strength, suggesting other aspects of hand function may be more important than strength when opening food and beverage packages. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

  7. Emergency Department Telemedicine Is Used for More Severely Injured Rural Trauma Patients, but Does Not Decrease Transfer: A Cohort Study.

    PubMed

    Mohr, Nicholas M; Harland, Karisa K; Chrischilles, Elizabeth A; Bell, Amanda; Shane, Dan M; Ward, Marcia M

    2017-02-01

    Traumatic injury is a leading cause of death in the United States, and rural populations are at increased risk of injury and death. Rural residents have limited access to trauma care, and telemedicine has been proposed as one strategy to improve the provision of trauma care locally. The objective of this study was to describe patient-level factors associated with telemedicine consultation in North Dakota critical-access hospital (CAH) emergency departments (EDs) and to measure the association between telemedicine consultation and interhospital transfer. Observational cohort study of all adult (age ≥ 18 years) trauma patients treated in North Dakota CAH EDs with an active telemedicine subscription between 2008 and 2014. Trauma cases were identified from the North Dakota Trauma Registry, and telemedicine-enabled care was determined using a probabilistic linking algorithm with the call records of the predominant telemedicine network in North Dakota. Multivariable generalized estimating equations were used to identify factors associated with telemedicine consultation and to measure the association between telemedicine consultation and interhospital transfer, adjusting for patient, injury, and hospital factors. Of the 9,281 North Dakota trauma patients seen in CAHs, 2,837 were treated in an ED with an active telemedicine subscription. Telemedicine was consulted for 11% of all trauma patients in telemedicine-capable EDs. Factors associated with telemedicine consultation included higher Injury Severity Score, penetrating injuries, burns, hypotension, tachycardia, and ambulance transport. Adjusting for severity of illness, injury mechanism, and type of injury, telemedicine use was not associated with interhospital transfer (adjusted odds ratio = 1.28, 95% confidence interval = 0.94 to 1.75). Emergency department-based telemedicine consultation is requested for the most severely injured rural trauma patients, especially with those with penetrating trauma, burns

  8. Accessing Inpatient Rehabilitation after Acute Severe Stroke: Age, Mobility, Prestroke Function and Hospital Unit Are Associated with Discharge to Inpatient Rehabilitation

    ERIC Educational Resources Information Center

    Hakkennes, Sharon; Hill, Keith D.; Brock, Kim; Bernhardt, Julie; Churilov, Leonid

    2012-01-01

    The objective of this study was to identify the variables associated with discharge to inpatient rehabilitation following acute severe stroke and to determine whether hospital unit contributed to access. Five acute hospitals in Victoria, Australia participated in this study. Patients were eligible for inclusion if they had suffered an acute severe…

  9. 42 CFR 495.106 - Incentive payments to CAHs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ..., and making estimates or using proxies of, inpatient-bed-days, hospital charges, charity charges, and... meaningful EHR user at § 495.4, if it were an eligible hospital. Reasonable costs incurred for the purchase...

  10. Access disparities to Magnet hospitals for patients undergoing neurosurgical operations

    PubMed Central

    Missios, Symeon; Bekelis, Kimon

    2017-01-01

    Background Centers of excellence focusing on quality improvement have demonstrated superior outcomes for a variety of surgical interventions. We investigated the presence of access disparities to hospitals recognized by the Magnet Recognition Program of the American Nurses Credentialing Center (ANCC) for patients undergoing neurosurgical operations. Methods We performed a cohort study of all neurosurgery patients who were registered in the New York Statewide Planning and Research Cooperative System (SPARCS) database from 2009–2013. We examined the association of African-American race and lack of insurance with Magnet status hospitalization for neurosurgical procedures. A mixed effects propensity adjusted multivariable regression analysis was used to control for confounding. Results During the study period, 190,535 neurosurgical patients met the inclusion criteria. Using a multivariable logistic regression, we demonstrate that African-Americans had lower admission rates to Magnet institutions (OR 0.62; 95% CI, 0.58–0.67). This persisted in a mixed effects logistic regression model (OR 0.77; 95% CI, 0.70–0.83) to adjust for clustering at the patient county level, and a propensity score adjusted logistic regression model (OR 0.75; 95% CI, 0.69–0.82). Additionally, lack of insurance was associated with lower admission rates to Magnet institutions (OR 0.71; 95% CI, 0.68–0.73), in a multivariable logistic regression model. This persisted in a mixed effects logistic regression model (OR 0.72; 95% CI, 0.69–0.74), and a propensity score adjusted logistic regression model (OR 0.72; 95% CI, 0.69–0.75). Conclusions Using a comprehensive all-payer cohort of neurosurgery patients in New York State we identified an association of African-American race and lack of insurance with lower rates of admission to Magnet hospitals. PMID:28684152

  11. Implementation of hospital-wide reform at improving access and flow: Impact on time to antibiotics in the emergency department.

    PubMed

    Roman, Cristina P; Poole, Susan G; Dooley, Michael J; Smit, De Villiers; Mitra, Biswadev

    2016-04-01

    ED overcrowding has been associated with increased mortality, morbidity and delays to essential treatment. It was hypothesised that hospital-wide reforms designed to improve patient access and flow, in addition to improving ED overcrowding, would impact on clinically important processes within the ED, such as timely delivery of antibiotics. A single pre-implementation and post-implementation prospective cohort study was conducted prior to and after a hospital-wide reform (Timely Quality Care (TQC)). Among patients who had intravenous antibiotics prescribed in the ED, data were prospectively collected on times of presentation, prescription and administration of antibiotics. Demographics and discharge diagnoses were retrospectively extracted. There were 380 cases included with 179 cases prior to introduction of the TQC model and 201 cases after its introduction. Time from presentation to administration of antibiotics improved significantly from 192 (99-320) min to 142 (81-209) min (P < 0.01). The time from presentation to prescription pre-TQC and post-TQC was 120 (51-230) min and 92 (49-153) min, respectively (P < 0.01). The times from prescription to administration pre-TQC and post-TQC were 43 (20-83) min and 34 (15-66) min, respectively (P = 0.03). Following implementation of hospital-wide reform directed at mitigating ED overcrowding through improved access and flow, times to administration of antibiotics were significantly reduced. These findings suggest that improved quality of care in this area may be achieved with processes aimed at improved hospital access and flow. Ongoing evaluation and vigilance is necessary to ensure sustainability and drive further improvements. © 2015 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  12. Comparison of access and costs of Medicaid dental services in a hospital clinic and community practices.

    PubMed

    Marcus, M; Coulter, I; Mann, J; Leibowitz, A; Buchanan, J

    1996-01-01

    This paper reports the results of a three-year evaluation of access to dental care and its associated costs for Aid to Families with Dependent Children (AFDC) beneficiaries enrolled in a hospital-based health maintenance organization (HMO) or a fee-for-service (FFS) option. Medicaid enrollees (n = 3, l655) having a year of eligibility were assigned to either the hospital HMO or FFS care, and their use of dental care and its costs compared. A higher percent of those beneficiaries enrolled in the FFS option used dental care than those in the HMO plan. FFS enrollees also had more annual visits per person than those in the randomly assigned HMO group. FFS dental patients treated in the hospital had the highest costs of any payment-provider combination studied. To understand the mix of utilization rates, visits, and costs, one must take into account the way in which the HMO hospital plan is reimbursed, the way in which the dental department is reimbursed, and the way in which the dental provider is reimbursed.

  13. Improving Patient Access by Determining Appropriate Staff Mix in the Family Practice Clinic of Bayne-Jones Army Community Hospital at Fort Polk, Louisiana Using an Animated Computer Simulation Model

    DTIC Science & Technology

    1997-07-01

    result of customer dissatisfaction due to problems associated with access into Bayne-Jones Army community Hospital (BJACH). On a recent Military Health ...Training Center (JRTC) by delivering quality, accessible, patient oriented health care, while maintaining our preparedness to support the Army mission...family practice clinic at Bayne-Jones Army Community hospital has as its mission: To provide accessible, quality and customer oriented health care to

  14. Charitable pharmacy services: Impact on patient-reported hospital use, medication access, and health status.

    PubMed

    Fahey Babeaux, Holly P; Hall, Laura E; Seifert, Jennifer L

    2015-01-01

    To evaluate the impact that Charitable Pharmacy of Central Ohio (CPCO), a pharmacy providing free pharmacy services and medications, had on an indigent patient population by determining the change in patient-reported hospital use, ability to access medications, and perception of health status after receiving CPCO services. Cross-sectional study with face-to-face interviews using a convenience sample. Columbus, OH, in January to March 2013. 206 English-speaking patients 18 years or older at CPCO. Free pharmacy services and medications provided by CPCO. Number of patient-reported hospital visits before and after CPCO use. In the year before using CPCO, patients reported using the hospital a mean of 2.36 (median, 2.00) times per year versus 1.33 (median, 0.67) times per year after, a decrease of 1.03 hospital visits per year per patient. Before coming to CPCO, 41% of patients were able to have all of their prescribed medications filled; this rose to 85% after using CPCO. A total of 89% of patients reported that not only was their overall health was better, but they also had a better understanding of their medications and believed they were in more control of their own health since receiving CPCO services. A charitable pharmacy model has the potential to decrease health care costs and empower patients to be more in control of their health.

  15. New Hampshire critical access hospitals: CEOs' report on ethical challenges.

    PubMed

    Nelson, William; Rosenberg, Marie-Claire; Weiss, Julie; Goodrich, Martha

    2009-01-01

    Research into the importance of organizational healthcare ethics has increasingly appeared in healthcare publications. However, to date, few published studies have examined ethical issues from the perspective of healthcare executives, and no empirical study has addressed organizational ethics with an explicit focus on rural hospitals. For our study, we sought to identify the frequency of ethical conflicts occurring within 12 general categories (domains) of administrative activities. Also, we wanted to determine what ethics resources are currently available and whether additional resources would be helpful. We conducted a structured telephone interview of all 13 chief executive officers (CEOs) of critical access hospitals in New Hampshire. All the CEOs in the study indicated that they encountered ethical conflicts. On average, the three most frequently noted domains were organizational-professional staff relations, reimbursement, and clinical care. All CEOs indicated they would like to have additional ethics resources to address these conflicts. This study verified that CEOs encounter a broad spectrum of ethical conflicts and need additional ethics resources to address them. Because this study used a small sample of CEOs and represented only one New England state, further ethics-related research in rural healthcare facilities is warranted. Follow-up study would allow for (1) a higher level of generalization of the findings, (2) clarity regarding specific ethical dilemmas that rural healthcare executives encounter, and (3) an assessment of ethics resources and training that healthcare executives need to address the ethical conflicts.

  16. Trends in hospital librarianship and hospital library services: 1989 to 2006.

    PubMed

    Thibodeau, Patricia L; Funk, Carla J

    2009-10-01

    The research studied the status of hospital librarians and library services to better inform the Medical Library Association's advocacy activities. The Vital Pathways Survey Subcommittee of the Task Force on Vital Pathways for Hospital Librarians distributed a web-based survey to hospital librarians and academic health sciences library directors. The survey results were compared to data collected in a 1989 survey of hospital libraries by the American Hospital Association in order to identify any trends in hospital libraries, roles of librarians, and library services. A web-based hospital library report form based on the survey questions was also developed to more quickly identify changes in the status of hospital libraries on an ongoing basis. The greatest change in library services between 1989 and 2005/06 was in the area of access to information, with 40% more of the respondents providing access to commercial online services, 100% more providing access to Internet resources, and 28% more providing training in database searching and use of information resources. Twenty-nine percent (n = 587) of the 2005/06 respondents reported a decrease in staff over the last 5 years. Survey data support reported trends of consolidation of hospitals and hospital libraries and additions of new services. These services have likely required librarians to acquire new skills. It is hoped that future surveys will be undertaken to continue to study these trends.

  17. Electromagnetic interference-aware transmission scheduling and power control for dynamic wireless access in hospital environments.

    PubMed

    Phunchongharn, Phond; Hossain, Ekram; Camorlinga, Sergio

    2011-11-01

    We study the multiple access problem for e-Health applications (referred to as secondary users) coexisting with medical devices (referred to as primary or protected users) in a hospital environment. In particular, we focus on transmission scheduling and power control of secondary users in multiple spatial reuse time-division multiple access (STDMA) networks. The objective is to maximize the spectrum utilization of secondary users and minimize their power consumption subject to the electromagnetic interference (EMI) constraints for active and passive medical devices and minimum throughput guarantee for secondary users. The multiple access problem is formulated as a dual objective optimization problem which is shown to be NP-complete. We propose a joint scheduling and power control algorithm based on a greedy approach to solve the problem with much lower computational complexity. To this end, an enhanced greedy algorithm is proposed to improve the performance of the greedy algorithm by finding the optimal sequence of secondary users for scheduling. Using extensive simulations, the tradeoff in performance in terms of spectrum utilization, energy consumption, and computational complexity is evaluated for both the algorithms.

  18. Trends in hospital librarianship and hospital library services: 1989 to 2006

    PubMed Central

    Thibodeau, Patricia L.; Funk, Carla J.

    2009-01-01

    Objective: The research studied the status of hospital librarians and library services to better inform the Medical Library Association's advocacy activities. Methods: The Vital Pathways Survey Subcommittee of the Task Force on Vital Pathways for Hospital Librarians distributed a web-based survey to hospital librarians and academic health sciences library directors. The survey results were compared to data collected in a 1989 survey of hospital libraries by the American Hospital Association in order to identify any trends in hospital libraries, roles of librarians, and library services. A web-based hospital library report form based on the survey questions was also developed to more quickly identify changes in the status of hospital libraries on an ongoing basis. Results: The greatest change in library services between 1989 and 2005/06 was in the area of access to information, with 40% more of the respondents providing access to commercial online services, 100% more providing access to Internet resources, and 28% more providing training in database searching and use of information resources. Twenty-nine percent (n = 587) of the 2005/06 respondents reported a decrease in staff over the last 5 years. Conclusions: Survey data support reported trends of consolidation of hospitals and hospital libraries and additions of new services. These services have likely required librarians to acquire new skills. It is hoped that future surveys will be undertaken to continue to study these trends. PMID:19851491

  19. Increasing access to legal termination of pregnancy and postabortion contraception at the University Teaching Hospital, Lusaka, Zambia.

    PubMed

    Macha, Swebby; Muyuni, Mutinta; Nkonde, Scholastica; Faúndes, Anibal

    2014-07-01

    The Zambian Association of Gynecology and Obstetrics is one of the International Federation of Gynecology and Obstetrics (FIGO) member societies participating in the FIGO Initiative for the Prevention of Unsafe Abortion and its Consequences from the East, Central, and Southern Africa region. The activities included in this country's plan of action were to provide access to safe abortion within the full extent of the law to women receiving care at the University Teaching Hospital in Lusaka, and to increase the proportion of women leaving the hospital with a contraceptive method. Zambian law regarding abortion is liberal, but in general it was not applied until very recently. The proportion of legal terminations of pregnancy among patients receiving abortion care at the hospital increased from 3.2% in 2009 to 7.7% in 2011, while the percentage of women leaving the hospital with a contraceptive method increased from 25.3% to 69.4% over the same period. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  20. Public-access AED pad application and outcomes for out-of-hospital cardiac arrests in Osaka, Japan.

    PubMed

    Kiyohara, Kosuke; Kitamura, Tetsuhisa; Sakai, Tomohiko; Nishiyama, Chika; Nishiuchi, Tatsuya; Hayashi, Yasuyuki; Sakamoto, Tetsuya; Marukawa, Seishiro; Iwami, Taku

    2016-09-01

    Actual application of public-access automated external defibrillator (AED) pads to patients with an out-of-hospital cardiac arrest (OHCA) by the public has been poorly investigated. AED applications, prehospital characteristics, and one-month outcomes of OHCAs occurring in Osaka Prefecture from 2011 to 2012 were obtained from the Utstein Osaka Project registry. Patients with a non-traumatic OHCA occurring before emergency medical service attendance were enrolled. The proportion of AED pads that were applied to the patients' chests by the public and one-month outcomes were analysed according to the location of OHCA. In total, public-access AED pads were applied to 3.5% of OHCA patients (351/9978) during the study period. In the multivariate analyses, OHCAs that occurred in public places and received bystander-initiated cardiopulmonary resuscitation were associated with significantly higher application of public-access AEDs. Among the patients for whom public-access AED pads were applied, 29.6% (104/351) received public-access defibrillation. One-month survival with a favourable neurological outcome was significantly higher among patients who had an AED applied compared to those who did not (19.4% vs. 3.0%; OR: 2.76 [95% CI: 1.92-3.97]). The application of public-access AEDs leads to favourable outcomes after an OHCA, but utilisation of available equipment remains insufficient, and varies considerably according to the location of the OHCA event. Alongside disseminating public-access AEDs, further strategic approaches for the deployment of AEDs at the scene, as well as basic life support training for the public are required to improve survival rates after OHCAs. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  1. Cost-effectiveness of Access to Critical Cerebral Emergency Support Services (ACCESS): a neuro-emergent telemedicine consultation program.

    PubMed

    Whetten, Justin; van der Goes, David N; Tran, Huy; Moffett, Maurice; Semper, Colin; Yonas, Howard

    2018-04-01

    Access to Critical Cerebral Emergency Support Services (ACCESS) was developed as a low-cost solution to providing neuro-emergent consultations to rural hospitals in New Mexico that do not offer comprehensive stroke care. ACCESS is a two-way audio-visual program linking remote emergency department physicians and their patients to stroke specialists. ACCESS also has an education component in which hospitals receive training from stroke specialists on the triage and treatment of patients. This study assessed the clinical and economic outcomes of the ACCESS program in providing services to rural New Mexico from a healthcare payer perspective. A decision tree model was constructed using findings from the ACCESS program and existing literature, the likelihood that a patient will receive a tissue plasminogen activator (tPA), cost of care, and resulting quality adjusted life years (QALYs). Data from the ACCESS program includes emergency room patients in rural New Mexico from May 2015 to August 2016. Outcomes and costs have been estimated for patients who were taken to a hospital providing neurological telecare and patients who were not. The use of ACCESS decreased neuro-emergent stroke patient transfers from rural hospitals to urban settings from 85% to 5% (no tPA) and 90% to 23% (tPA), while stroke specialist reading of patient CT/MRI imaging within 3 h of onset of stroke symptoms increased from 2% to 22%. Results indicate that use of ACCESS has the potential to save $4,241 ($3,952-$4,438) per patient and increase QALYs by 0.20 (0.14-0.22). This increase in QALYs equates to ∼73 more days of life at full health. The cost savings and QALYs are expected to increase when moving from a 90-day model to a lifetime model. The analysis demonstrates potential savings and improved quality-of-life associated with the use of ACCESS for patients presenting to rural hospitals with acute ischemic stroke (AIS).

  2. Gender role across development in adult women with congenital adrenal hyperplasia due to 21-hydroxylase deficiency.

    PubMed

    Long, Dominique N; Wisniewski, Amy B; Migeon, Claude J

    2004-10-01

    This study evaluated the degree of femininity and masculinity at different developmental stages in a group of adult women, some of whom were exposed to elevated prenatal adrenal androgens as a result of congenital adrenal hyperplasia (CAH) due to 21 hydroxylase (21-OH) deficiency. Women who had presented to the Johns Hopkins Hospital Pediatric Endocrine Clinic for treatment of CAH due to 21-OH deficiency were included. The control group consisted of sisters of CAH participants and women referred for evaluation of polycystic ovary syndrome. Study participants were given a questionnaire asking them to indicate their degree of masculinity and femininity during childhood, adolescence, and adulthood. In addition, participants were asked questions related to their play behavior during childhood, including playmate preferences, toy preferences, and admiration of male or female characters during fantasy play. Across participant groups, self-reported femininity decreased in a dose response manner, according to prenatal androgen exposure. For all groups, femininity increased through developmental stages. Women with salt-losing CAH remained less feminine than controls into adulthood. Conversely, self-reported masculinity increased in a dose-response manner, according to prenatal androgen exposure, across participant groups. Women with CAH showed a decrease in masculinity across developmental stages, such that by adulthood, there were no significant differences in masculinity between controls and the women with CAH. Women with salt-losing CAH were more likely to recall preferences for boy playmates, male-typical toys, and admiration for male characters during childhood than other study participants. Our data support the effect of both prenatal androgen exposure and socialization on gender role behavior in adult women with CAH due to 21-OH deficiency.

  3. Integrated evaluation of the performance of a more than seven year old permeable reactive barrier at a site contaminated with chlorinated aliphatic hydrocarbons (CAHs)

    NASA Astrophysics Data System (ADS)

    Muchitsch, Nanna; Van Nooten, Thomas; Bastiaens, Leen; Kjeldsen, Peter

    2011-11-01

    An important issue of concern for permeable reactive iron barriers is the long-term efficiency of the barriers due to the long operational periods required. Mineral precipitation resulting from the anaerobic corrosion of the iron filings and bacteria present in the barrier may play an important role in the long-term performance. An integrated study was performed on the Vapokon permeable reactive barrier (PRB) in Denmark by groundwater and iron core sample characterization. The detailed field groundwater sampling carried out from more than 75 well screens up and downstream the barrier showed a very efficient removal (> 99%) for the most important CAHs (PCE, TCE and 1,1,1-TCA). However, significant formation of cis-DCE within the PRB resulted in an overall insufficient efficiency for cis-DCE removal. The detailed analysis of the upstream groundwater revealed a very heterogeneous spatial distribution of contaminant loading into the PRB, which resulted in that only about a quarter of the barrier system is treating significant loads of CAHs. Laboratory batch experiments using contaminated groundwater from the site and iron material from the core samples revealed that the aged iron material performed equally well as virgin granular iron of the same type based on determined degradation rates despite that parts of the cored iron material were covered by mineral precipitates (especially iron sulfides, carbonate green rust and aragonite). The PCR analysis performed on the iron core samples indicated the presence of a microbial consortium in the barrier. A wide range of species were identified including sulfate and iron reducing bacteria, together with Dehalococcoides and Desulfuromonas species indicating microbial reductive dehalogenation potential. The microbes had a profound effect on the performance of the barrier, as indicated by significant degradation of dichloromethane (which is typically unaffected by zero valent iron) within the barrier.

  4. Neutron production in coincidence with fragments from the 4Ca+H reactions at Elab=357 and 565 A MeV

    NASA Astrophysics Data System (ADS)

    Tuvà, C.; Albergo, S.; Boemi, D.; Caccia, Z.; Chen, C.-X.; Costa, S.; Crawford, H. J.; Cronqvist, M.; Engelage, J.; Greiner, L.; Guzik, T. G.; Insolia, A.; Knott, C. N.; Lindstrom, P. J.; Mitchell, J. W.; Potenza, R.; Russo, G. V.; Soutoul, A.; Testard, O.; Tricomi, A.; Tull, C. E.; Waddington, C. J.; Webber, W. R.; Wefel, J. P.

    2000-04-01

    In the frame of the Transport Collaboration neutrons in coincidence with charged fragments produced in the 40Ca+H reaction at Elab=357 and 565 A MeV have been measured at the Heavy Ion Spectrometer System (HISS) facility of the Lawrence Berkeley National Laboratory, using the multifunctional neutron spectrometer MUFFINS. The detector covered a narrow angular range about the beam in the forward direction (0°-3.2°). In this contribution we report absolute neutron production cross sections in coincidence with charged fragments (10⩽Z⩽20). The neutron multiplicities have been estimated from the comparison between the neutron cross sections, in coincidence with the fragments, and the elemental cross sections. We have found evidence for a pre-equilibrium emission of prompt neutrons in superposition to a `slower' deexcitation of the equilibrated remnant by emission of nucleons and fragments, as already seen in the inclusive rapidity distributions.

  5. Medicare and Medicaid programs: hospital outpatient prospective payment; ambulatory surgical center payment; hospital value-based purchasing program; physician self-referral; and patient notification requirements in provider agreements. Final rule with comment period.

    PubMed

    2011-11-30

    This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) for CY 2012 to implement applicable statutory requirements and changes arising from our continuing experience with this system. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the OPPS. In addition, this final rule with comment period updates the revised Medicare ambulatory surgical center (ASC) payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system. In this final rule with comment period, we set forth the relative payment weights and payment amounts for services furnished in ASCs, specific HCPCS codes to which these changes apply, and other ratesetting information for the CY 2012 ASC payment system. We are revising the requirements for the Hospital Outpatient Quality Reporting (OQR) Program, adding new requirements for ASC Quality Reporting System, and making additional changes to provisions of the Hospital Inpatient Value-Based Purchasing (VBP) Program. We also are allowing eligible hospitals and CAHs participating in the Medicare Electronic Health Record (EHR) Incentive Program to meet the clinical quality measure reporting requirement of the EHR Incentive Program for payment year 2012 by participating in the 2012 Medicare EHR Incentive Program Electronic Reporting Pilot. Finally, we are making changes to the rules governing the whole hospital and rural provider exceptions to the physician self-referral prohibition for expansion of facility capacity and changes to provider agreement regulations on patient notification requirements.

  6. Barriers and facilitators to public access defibrillation in out-of-hospital cardiac arrest: a systematic review.

    PubMed

    Smith, Christopher M; Lim Choi Keung, Sarah N; Khan, Mohammed O; Arvanitis, Theodoros N; Fothergill, Rachael; Hartley-Sharpe, Christopher; Wilson, Mark H; Perkins, Gavin D

    2017-10-01

    Public access defibrillation initiatives make automated external defibrillators available to the public. This facilitates earlier defibrillation of out-of-hospital cardiac arrest victims and could save many lives. It is currently only used for a minority of cases. The aim of this systematic review was to identify barriers and facilitators to public access defibrillation. A comprehensive literature review was undertaken defining formal search terms for a systematic review of the literature in March 2017. Studies were included if they considered reasons affecting the likelihood of public access defibrillation and presented original data. An electronic search strategy was devised searching MEDLINE and EMBASE, supplemented by bibliography and related-article searches. Given the low-quality and observational nature of the majority of articles, a narrative review was performed. Sixty-four articles were identified in the initial literature search. An additional four unique articles were identified from the electronic search strategies. The following themes were identified related to public access defibrillation: knowledge and awareness; willingness to use; acquisition and maintenance; availability and accessibility; training issues; registration and regulation; medicolegal issues; emergency medical services dispatch-assisted use of automated external defibrillators; automated external defibrillator-locator systems; demographic factors; other behavioural factors. In conclusion, several barriers and facilitators to public access defibrillation deployment were identified. However, the evidence is of very low quality and there is not enough information to inform changes in practice. This is an area in urgent need of further high-quality research if public access defibrillation is to be increased and more lives saved. PROSPERO registration number CRD42016035543. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2017. For permissions

  7. 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

    PubMed Central

    van Dijk, Janneke H.; Moss, William J.; Hamangaba, Francis; Munsanje, Bornface; Sutcliffe, Catherine G.

    2014-01-01

    Background 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. Methods 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. Results 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. Conclusions 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. PMID:25122213

  8. Air filtration systems and restrictive access conditions improve indoor air quality in clinical units: Penicillium as a general indicator of hospital indoor fungal levels.

    PubMed

    Araujo, Ricardo; Cabral, João Paulo; Rodrigues, Acácio Gonçalves

    2008-03-01

    High-efficiency particulate air (HEPA) filters do not completely prevent nosocomial fungal infections. The first aim of this study was to evaluate the impact of different filters and access conditions upon airborne fungi in hospital facilities. Additionally, this study identified fungal indicators of indoor air concentrations. Eighteen rooms and wards equipped with different air filter systems, and access conditions were sampled weekly, during 16 weeks. Tap water samples were simultaneously collected. The overall mean concentration of atmospheric fungi for all wards was 100 colony forming units/m(3). We found a direct proportionality between the levels of the different fungi in the studied atmospheres. Wards with HEPA filters at positive air flow yielded lower fungal levels. Also, the existence of an anteroom and the use of protective clothes were associated to the lowest fungal levels. Principal component analysis showed that penicillia afforded the best separation between wards' air fungal levels. Fungal strains were rarely recovered from tap water samples. In addition to air filtration systems, some access conditions to hospital units, like presence of anteroom and use of protective clothes, may prevent high fungal air load. Penicillia can be used as a general indicator of indoor air fungal levels at Hospital S. João.

  9. 42 CFR 485.638 - Conditions of participation: Clinical records.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ..., readily accessible, and systematically organized. (3) A designated member of the professional staff is..., readily accessible, and systematically organized. (4) For each patient receiving health care services, the CAH maintains a record that includes, as applicable— (i) Identification and social data, evidence of...

  10. 42 CFR 485.638 - Conditions of participation: Clinical records.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., readily accessible, and systematically organized. (3) A designated member of the professional staff is..., readily accessible, and systematically organized. (4) For each patient receiving health care services, the CAH maintains a record that includes, as applicable— (i) Identification and social data, evidence of...

  11. 42 CFR 485.638 - Conditions of participation: Clinical records.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ..., readily accessible, and systematically organized. (3) A designated member of the professional staff is..., readily accessible, and systematically organized. (4) For each patient receiving health care services, the CAH maintains a record that includes, as applicable— (i) Identification and social data, evidence of...

  12. 42 CFR 485.638 - Conditions of participation: Clinical records.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ..., readily accessible, and systematically organized. (3) A designated member of the professional staff is..., readily accessible, and systematically organized. (4) For each patient receiving health care services, the CAH maintains a record that includes, as applicable— (i) Identification and social data, evidence of...

  13. A Study of the Access to the Scholarly Record from a Hospital Health Science Core Collection *

    PubMed Central

    Williams, James F.; Pings, Vern M.

    1973-01-01

    This study is an effort to determine possible service performance levels in hospital libraries based on access to the scholarly record of medicine through selected lists of clinical journals and indexing and abstracting journals. The study was designed to test a methodology as well as to provide data for planning and management decisions for health science libraries. Findings and conclusions cover the value of a core collection of journals, length of journal files, performance of certain bibliographic instruments in citation verification, and the implications of study data for library planning and management. PMID:4744345

  14. Vascular access for hemodialysis: creation, functioning, and complications (data of the Hospital of Kaunas University of Medicine).

    PubMed

    Kybartienė, Sondra; Skarupskienė, Inga; Ziginskienė, Edita; Kuzminskis, Vytautas

    2010-01-01

    There are no data about arteriovenous fistulas (AVF) formation, survival, and complications rate in patients with end-stage renal failure in Lithuania. We analyzed the data of patients (N=272) with end-stage renal failure, dialyzed at the Hospital of Kaunas University of Medicine from January 1, 2000, until March 30, 2010, and identified 368 cases of AVF creation. The patients were divided into two groups: group 1 included the patients with an AVF that functioned for <15 months (n=138) and group 2 included patients with an AVF that functioned for ≥15 months (n=171). Less than half (47%) of the patients started planned hemodialysis and 51% of the patients started hemodialysis urgently. The mean time of AVF functioning was 15.43±8.67 months. Age, gender, the kidney disease, and time of AVF maturation had no influence on AVF functioning time. AVFs of the patients who started planned hemodialysis functioned longer as compared to AVFs of the patients who started hemodialysis urgently (P<0.05). Hospitalization time of the patients who started hemodialysis urgently was longer as compared that of the patients who had a matured AVF (37.63±20.55 days vs. 16.54±9.43 days). The first vascular access had better survival than repeated access. AVF survival in patients with ischemic brain vascular disease was worse than in patients without this comorbidity.

  15. Outcomes of out-of-hospital cardiac arrest by public location in the public-access defibrillation era.

    PubMed

    Murakami, Yukiko; Iwami, Taku; Kitamura, Tetsuhisa; Nishiyama, Chika; Nishiuchi, Tatsuya; Hayashi, Yasuyuki; Kawamura, Takashi

    2014-04-22

    The strategy to place public-access automated external defibrillators (AEDs) has not yet been established in real settings. This, prospective, population-based observational study in Osaka, Japan, included consecutive out-of-hospital cardiac arrest (OHCA) patients with resuscitation attempts during 7 years, from January 2005 through December 2011. The trends in the proportion of public-access AED use and 1-month survival with neurologically favorable outcome were evaluated by location. Factors associated with neurologically favorable outcome (defined as cerebral performance category 1 or 2) after ventricular fibrillation were also assessed using multiple logistic regression analysis. A total of 9453 bystander-witnessed OHCAs of cardiac origin were documented and 894 (9.5%) of them occurred at public places. The proportion of public-access AED use significantly increased from 0.0% (0/20) in 2005 to 41.2% (7/17) in 2011 at railway stations and from 0.0% (0/7) to 56.5% (13/23) at sports facilities. Mean time from collapse to shock was 5.0 minutes among those who received shocks with public-access AEDs. The proportion of neurologically favorable outcome was 28.0% (33/118) at railway stations, 51.6% (48/93) at sports facilities, 23.3% (20/86) in public buildings, and 41.9% (13/31) in schools. In multivariate analysis, early defibrillation, irrespective of bystander or emergency medical service (EMS) personnel, was significantly associated with neurologically favorable outcome (adjusted odds ratio for 1-minute increment, 0.89; 95% confidence interval, 0.87 to 0.92). This large, population-based OHCA registry demonstrated that earlier shock, irrespective the shock provider (bystander or EMS personnel), contributed to improving outcome, and a public-access defibrillation program was successfully implemented so that shocks with public-access AEDs were delivered to over 40% of bystander-witnessed OHCAs and time to shock was shortened in some kinds of public places.

  16. Geographic access to high capability severe acute respiratory failure centers in the United States.

    PubMed

    Wallace, David J; Angus, Derek C; Seymour, Christopher W; Yealy, Donald M; Carr, Brendan G; Kurland, Kristen; Boujoukos, Arthur; Kahn, Jeremy M

    2014-01-01

    Optimal care of adults with severe acute respiratory failure requires specific resources and expertise. We sought to measure geographic access to these centers in the United States. Cross-sectional analysis of geographic access to high capability severe acute respiratory failure centers in the United States. We defined high capability centers using two criteria: (1) provision of adult extracorporeal membrane oxygenation (ECMO), based on either 2008-2013 Extracorporeal Life Support Organization reporting or provision of ECMO to 2010 Medicare beneficiaries; or (2) high annual hospital mechanical ventilation volume, based 2010 Medicare claims. Nonfederal acute care hospitals in the United States. We defined geographic access as the percentage of the state, region and national population with either direct or hospital-transferred access within one or two hours by air or ground transport. Of 4,822 acute care hospitals, 148 hospitals met our ECMO criteria and 447 hospitals met our mechanical ventilation criteria. Geographic access varied substantially across states and regions in the United States, depending on center criteria. Without interhospital transfer, an estimated 58.5% of the national adult population had geographic access to hospitals performing ECMO and 79.0% had geographic access to hospitals performing a high annual volume of mechanical ventilation. With interhospital transfer and under ideal circumstances, an estimated 96.4% of the national adult population had geographic access to hospitals performing ECMO and 98.6% had geographic access to hospitals performing a high annual volume of mechanical ventilation. However, this degree of geographic access required substantial interhospital transfer of patients, including up to two hours by air. Geographic access to high capability severe acute respiratory failure centers varies widely across states and regions in the United States. Adequate referral center access in the case of disasters and pandemics will

  17. Does access to general dental treatment affect the number and complexity of patients presenting to the acute hospital service with severe dentofacial infections?

    PubMed

    Bowe, Conor M; Gargan, Mary Louise; Kearns, Gerard J; Stassen, Leo F A

    2015-01-01

    This is a retrospective study to review the treatment and management of patients presenting with odontogenic infections in a large urban teaching hospital over a four-year period, comparing the number and complexity of odontogenic infections presenting to an acute general hospital in two periods, as follows: Group A (January 2008 to March 2010) versus Group B (April 2010 to December 2011). The background to the study is 'An alteration in patient access to primary dental care instituted by the Department of Health in April 2010'. a) to identify any alteration in the pattern and complexity of patients' presentation with odontogenic infections following recent changes in access to treatment via the Dental Treatment Services Scheme (DTSS) and the Dental Treatment Benefit Scheme (DTBS) in April 2010; and, b) to evaluate the management of severe odontogenic infections. Data was collated by a combination of a comprehensive chart review and electronic patient record analysis based on the primary discharge diagnosis as recorded in the Hospital In-Patient Enquiry (HIPE) system. Fifty patients were admitted to the National Maxillofacial Unit, St James's Hospital, under the oral and maxillofacial service over a four-year period, with an odontogenic infection as the primary diagnosis. There was an increased number of patients presenting with odontogenic infections during Group B of the study. These patients showed an increased complexity and severity of infection. Although there was an upward trend in the numbers and complexity of infections, this trending did not reach statistical significance. The primary cause of infection was dental caries in all patients. Dental caries is a preventable and treatable disease. Increased resources should be made available to support access to dental care, and thereby lessen the potential for the morbidity and mortality associated with serious odontogenic infections. The study at present continues as a prospective study.

  18. A Decomposition of Hospital Profitability

    PubMed Central

    Broom, Kevin; Elliott, Michael; Lee, Jen-Fu

    2015-01-01

    Objectives: This paper evaluates the drivers of profitability for a large sample of U.S. hospitals. Following a methodology frequently used by financial analysts, we use a DuPont analysis as a framework to evaluate the quality of earnings. By decomposing returns on equity (ROE) into profit margin, total asset turnover, and capital structure, the DuPont analysis reveals what drives overall profitability. Methods: Profit margin, the efficiency with which services are rendered (total asset turnover), and capital structure is calculated for 3,255 U.S. hospitals between 2007 and 2012 using data from the Centers for Medicare & Medicaid Services’ Healthcare Cost Report Information System (CMS Form 2552). The sample is then stratified by ownership, size, system affiliation, teaching status, critical access designation, and urban or non-urban location. Those hospital characteristics and interaction terms are then regressed (OLS) against the ROE and the respective DuPont components. Sensitivity to regression methodology is also investigated using a seemingly unrelated regression. Results: When the sample is stratified by hospital characteristics, the results indicate investor-owned hospitals have higher profit margins, higher efficiency, and are substantially more leveraged. Hospitals in systems are found to have higher ROE, margins, and efficiency but are associated with less leverage. In addition, a number of important and significant interactions between teaching status, ownership, location, critical access designation, and inclusion in a system are documented. Many of the significant relationships, most notably not-for-profit ownership, lose significance or are predominately associated with one interaction effect when interaction terms are introduced as explanatory variables. Results are not sensitive to the alternative methodology. Conclusion: The results of the DuPont analysis suggest that although there appears to be convergence in the behavior of NFP and IO

  19. Medicare program; hospital outpatient prospective payment system and CY 2007 payment rates; CY 2007 update to the ambulatory surgical center covered procedures list; Medicare administrative contractors; and reporting hospital quality data for FY 2008 inpatient prospective payment system annual payment update program--HCAHPS survey, SCIP, and mortality. Final rule with comment period and final rule.

    PubMed

    2006-11-24

    This final rule with comment period revises the Medicare hospital outpatient prospective payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system, and to implement certain related provisions of the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) of 2003 and the Deficit Reduction Act (DRA) of 2005. In this final rule with comment period, we describe changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes are applicable to services furnished on or after January 1, 2007. In addition, this final rule with comment period implements future CY 2009 required reporting on quality measures for hospital outpatient services paid under the prospective payment system. This final rule with comment period revises the current list of procedures that are covered when furnished in a Medicare-approved ambulatory surgical center (ASC), which are applicable to services furnished on or after January 1, 2007. This final rule with comment period revises the emergency medical screening requirements for critical access hospitals (CAHs). This final rule with comment period supports implementation of a restructuring of the contracting entities responsibilities and functions that support the adjudication of Medicare fee-for-service (FFS) claims. This restructuring is directed by section 1874A of the Act, as added by section 911 of the MMA. The prior separate Medicare intermediary and Medicare carrier contracting authorities under Title XVIII of the Act have been replaced with the Medicare Administrative Contractor (MAC) authority. This final rule continues to implement the requirements of the DRA that require that we expand the "starter set" of 10 quality measures that we used in FY 2005 and FY 2006 for the hospital inpatient prospective payment system (IPPS) Reporting Hospital Quality Data

  20. What Is the Impact of Health Reforms on Uncompensated Care in Critical Access Hospitals? A 5-Year Forecast in Washington State

    ERIC Educational Resources Information Center

    Coyne, Joseph; Fry, Benjamin; Murphy, Sean; Smith, Gary; Short, Robert

    2012-01-01

    Context: The 2008 financial crisis had a far-reaching impact on nearly every sector of the economy. As unemployment increased so did the uninsured. Already operating on a slim margin and poor payer mix, many critical access hospitals are facing a tough road ahead. Purpose: We seek to examine the increasing impact of uncompensated care on the…

  1. A spatial analysis of variations in health access: linking geography, socio-economic status and access perceptions

    PubMed Central

    2011-01-01

    Background This paper analyses the relationship between public perceptions of access to general practitioners (GPs) surgeries and hospitals against health status, car ownership and geographic distance. In so doing it explores the different dimensions associated with facility access and accessibility. Methods Data on difficulties experienced in accessing health services, respondent health status and car ownership were collected through an attitudes survey. Road distances to the nearest service were calculated for each respondent using a GIS. Difficulty was related to geographic distance, health status and car ownership using logistic generalized linear models. A Geographically Weighted Regression (GWR) was used to explore the spatial non-stationarity in the results. Results Respondent long term illness, reported bad health and non-car ownership were found to be significant predictors of difficulty in accessing GPs and hospitals. Geographic distance was not a significant predictor of difficulty in accessing hospitals but was for GPs. GWR identified the spatial (local) variation in these global relationships indicating locations where the predictive strength of the independent variables was higher or lower than the global trend. The impacts of bad health and non-car ownership on the difficulties experienced in accessing health services varied spatially across the study area, whilst the impacts of geographic distance did not. Conclusions Difficulty in accessing different health facilities was found to be significantly related to health status and car ownership, whilst the impact of geographic distance depends on the service in question. GWR showed how these relationships were varied across the study area. This study demonstrates that the notion of access is a multi-dimensional concept, whose composition varies with location, according to the facility being considered and the health and socio-economic status of the individual concerned. PMID:21787394

  2. 76 FR 42169 - Medicare and Medicaid Programs: Hospital Outpatient Prospective Payment; Ambulatory Surgical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-18

    ...This proposed rule would revise the Medicare hospital outpatient prospective payment system (OPPS) to implement applicable statutory requirements and changes arising from our continuing experience with this system. In this proposed rule, we describe the proposed changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the OPPS. These proposed changes would be applicable to services furnished on or after January 1, 2012. In addition, this proposed rule would update the revised Medicare ambulatory surgical center (ASC) payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system. In this proposed rule, we set forth the proposed relative payment weights and payment amounts for services furnished in ASCs, specific HCPCS codes to which these proposed changes would apply, and other proposed ratesetting information for the CY 2012 ASC payment system. These proposed changes would be applicable to services furnished on or after January 1, 2012. We are proposing to revise the requirements for the Hospital Outpatient Quality Reporting (IQR) Program, add new requirements for ASC Quality Reporting System, and make additional changes to provisions of the Hospital Inpatient Value-Based Purchasing (VBP) Program. We also are proposing to allow eligible hospitals and CAHs participating in the Medicare Electronic Health Record (EHR) Incentive Program to meet the clinical quality measure reporting requirement of the EHR Incentive Program for payment year 2012 by participating in the 2012 Medicare EHR Incentive Program Electronic Reporting Pilot. In addition, we are proposing to make changes to the rules governing the whole hospital and rural provider exceptions to the physician self-referral prohibition for expansion of facility capacity and changes to provider agreement regulations on patient notification requirements.

  3. 42 CFR 409.80 - Inpatient deductible and coinsurance: General provisions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... services that Medicare does not pay. (2) The hospital or CAH or SNF may charge these amounts to the... changes in the average cost of hospital care. In adjusting the deductible, the Secretary must use a... is increased each year by about the same percentage as the increase in the average Medicare daily...

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

    PubMed

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

    2016-01-01

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

  5. Vascular access for home haemodialysis.

    PubMed

    Al Shakarchi, Julien; Day, C; Inston, N

    2018-03-01

    Home haemodialysis has been advocated due to improved quality of life. However, there are very little data on the optimum vascular access for it. A retrospective cohort study was carried on all patients who initiated home haemodialysis between 2011 and 2016 at a large university hospital. Access-related hospital admissions and interventions were used as primary outcome measures. Our cohort consisted of 74 patients. On initiation of home haemodialysis, 62 individuals were using an arteriovenous fistula as vascular access, while the remaining were on a tunnelled dialysis catheter. Of the 12 patients who started on a tunnelled dialysis catheter, 5 were subsequently converted to either an arteriovenous fistula ( n = 4) or an arteriovenous graft ( n = 1). During the period of home haemodialysis use, four arteriovenous fistula failed or thrombosed with patients continuing on home haemodialysis using an arteriovenous graft ( n = 3) or a tunnelled dialysis catheter ( n = 1). To maintain uninterrupted home haemodialysis, interventional rates were 0.32 per arteriovenous fistula/arteriovenous graft access-year and 0.4 per tunnelled dialysis catheter access-year. Hospital admission rates for patients on home haemodialysis were 0.33 per patient-year. Our study has shown that home haemodialysis can be safely and independently performed at home within a closely managed home haemodialysis programme. The authors also advocate the use of arteriovenous fistulas for this cohort of patients due to both low complication and intervention rates.

  6. Access to hospitals with high-technology cardiac services: how is race important?

    PubMed Central

    Blustein, J; Weitzman, B C

    1995-01-01

    OBJECTIVES. Relatively few hospitals in the United States offer high-technology cardiac services (cardiac catheterization, bypass surgery, or angioplasty). This study examined the association between race and admission to a hospital offering those services. METHODS. Records of 11,410 patients admitted with acute myocardial infarction to hospitals in New York State in 1986 were analyzed. RESULTS. Approximately one third of both White and Black patients presented to hospitals offering high-technology cardiac services. However, in a multivariate model adjusting for home-to-hospital distance, the White-to-Black odds ratio for likelihood of presentation to such a hospital was 1.68 (95% confidence interval = 1.42, 1.98). This discrepancy between the observed and "distance-adjusted" probabilities reflected three phenomena: (1) patients presented to nearby hospitals; (2) Blacks were more likely to live near high-technology hospitals; and (3) there were racial differences in travel patterns. For example, when the nearest hospitals did not include a high-technology hospital, Whites were more likely than Blacks to travel beyond those nearest hospitals to a high-technology hospital. CONCLUSIONS. Whites and Blacks present equally to hospitals offering high-technology cardiac services at the time of acute myocardial infarction. However, there are important underlying racial differences in geographic proximity and tendencies to travel to those hospitals. PMID:7892917

  7. Medicare and Medicaid programs; modifications to the Medicare and Medicaid Electronic Health Record (EHR) Incentive Program for 2014 and other changes to EHR Incentive Program; and health information technology: revision to the certified EHR technology definition and EHR certification changes related to standards. Final rule.

    PubMed

    2014-09-04

    This final rule changes the meaningful use stage timeline and the definition of certified electronic health record technology (CEHRT) to allow options in the use of CEHRT for the EHR reporting period in 2014. It also sets the requirements for reporting on meaningful use objectives and measures as well as clinical quality measure (CQM) reporting in 2014 for providers who use one of the CEHRT options finalized in this rule for their EHR reporting period in 2014. In addition, it finalizes revisions to the Medicare and Medicaid EHR Incentive Programs to adopt an alternate measure for the Stage 2 meaningful use objective for hospitals to provide structured electronic laboratory results to ambulatory providers; to correct the regulation text for the measures associated with the objective for hospitals to provide patients the ability to view online, download, and transmit information about a hospital admission; and to set a case number threshold exemption for CQM reporting applicable for eligible hospitals and critical access hospitals (CAHs) beginning with FY 2013. Finally, this rule finalizes the provisionally adopted replacement of the Data Element Catalog (DEC) and the Quality Reporting Document Architecture (QRDA) Category III standards with updated versions of these standards.

  8. Effect of high up front charges on access to surgery for poor patients at a public hospital in New Mexico.

    PubMed

    Kaufman, Will; Chavez, Augustine S; Skipper, Betty; Kaufman, Arthur

    2006-06-23

    A public hospital in New Mexico required collection of 50% of estimated costs prior to elective surgeries for self-pay patients. This study assesses the impact of this policy on access to elective surgical procedures. Chi-square tests determined if there was a statistically significant difference between the number of self-pay and insured patient cancellations for financial reasons. A multivariate binomial regression model was used to calculate risk ratios and confidence limits for effects of race/ethnicity, and insurance status, controlling for gender, on these cancellations. Of the 667 cancellations, there were 99 self-pay and 568 insured patients. Cancellations for financial reasons occurred in 55.6% of self-pay and 9.3% of insured patients (p < 0.0001). Inability to pay 50% up front accounted for 76.4% of self-pay patient cancellations for financial reasons. Self-pay, non-Hispanic whites and minority race/ethnicities were 8.76 and 8.61 times more likely to cancel for financial reasons, respectively, than insured non-Hispanic whites. Self-pay patients, regardless of race/ethnicity, have elective surgical procedures cancelled for financial reasons significantly more often than insured patients. The hospital's 50% up-front payment policy represents a significant financial barrier to accessing elective surgical procedures for self-pay patients.

  9. Comparative Performance Data for Critical Access Hospitals

    ERIC Educational Resources Information Center

    Pink, George H.; Slifkin, Rebecca T.; Coburn, Andrew F.; Gale, John A.

    2004-01-01

    Context: Among small rural hospitals, there is a growing recognition of the need to measure and report on the use of resources and the safety and quality of the services provided. Dashboards, clinical value compasses, and balanced scorecards are approaches to performance measurement that have been adopted by many health care organizations.…

  10. Reducing Hospital Toxicity: Impact on Patient Outcomes.

    PubMed

    Milani, Richard V; Bober, Robert M; Lavie, Carl J; Wilt, Jonathan K; Milani, Alexander R; White, Christopher J

    2018-05-02

    Circadian rhythms are endogenous 24-hour oscillations in biologic processes that drive nearly all physiologic and behavioral functions. Disruption in circadian rhythms can adversely impact short and long-term health outcomes. Routine hospital care often causes significant disruption in sleep-wake patterns that is further compounded by loss of personal control of health information and health decisions. We wished to evaluate measures directed at improving circadian rhythm and access to daily health information on hospital outcomes. We evaluated 3,425 consecutive patients admitted to a medical-surgical unit comprised of an intervention wing (n=1,185) or standard control wing (n=2,240) over a 2.5-year period. Intervention patients received measures to improve sleep that included reduction of nighttime noise, delay of routine morning phlebotomy, passive vital sign monitoring, and use of red-enriched lighting after sunset, as well as access to daily health information utilizing an inpatient portal. Intervention patients accessed the inpatient portal frequently during hospitalization seeking personal health and care team information. Measures impacting the quality and quantity of sleep were significantly improved. LOS was 8.6 hours less (p=0.04), 30 and 90-day readmission rates were 16% and 12% lower, respectively (both p≤ 0.02), and self-rated emotional/mental health was higher (69.2% vs. 52.4%; p=0.03) in the intervention group compared to controls. Modest changes in routine hospital care can improve the hospital environment impacting sleep and access to health knowledge, leading to improvements in hospital outcomes. Sleep-wake patterns of hospitalized patients represent a potential avenue for further enhancing hospital quality and safety. Copyright © 2018. Published by Elsevier Inc.

  11. Efficacy of the EZ-IO needle driver for out-of-hospital intraosseous access--a preliminary, observational, multicenter study.

    PubMed

    Schalk, Richard; Schweigkofler, Uwe; Lotz, Gösta; Zacharowski, Kai; Latasch, Leo; Byhahn, Christian

    2011-10-26

    Intraosseous (IO) access represents a reliable alternative to intravenous vascular access and is explicitly recommended in the current guidelines of the European Resuscitation Council when intravenous access is difficult or impossible. We therefore aimed to study the efficacy of the intraosseous needle driver EZ-IO in the prehospital setting. During a 24-month period, all cases of prehospital IO access using the EZ-IO needle driver within three operational areas of emergency medical services were prospectively recorded by a standardized questionnaire that needed to be filled out by the rescuer immediately after the mission and sent to the primary investigator. We determined the rate of successful insertion of the IO needle, the time required, immediate procedure-related complications, the level of previous experience with IO access, and operator's subjective satisfaction with the device. 77 IO needle insertions were performed in 69 adults and five infants and children by emergency physicians (n = 72 applications) and paramedics (n = 5 applications). Needle placement was successful at the first attempt in all but 2 adults (one patient with unrecognized total knee arthroplasty, one case of needle obstruction after placement). The majority of users (92%) were relative novices with less than five previous IO needle placements. Of 22 responsive patients, 18 reported pain upon fluid administration via the needle. The rescuers' subjective rating regarding handling of the device and ease of needle insertion, as described by means of an analogue scale (0 = entirely unsatisfied, 10 = most satisfied), provided a median score of 10 (range 1-10). The EZ-IO needle driver was an efficient alternative to establish immediate out-of-hospital vascular access. However, significant pain upon intramedullary infusion was observed in the majority of responsive patients.

  12. Disparities in access to emergency general surgery care in the United States.

    PubMed

    Khubchandani, Jasmine A; Shen, Connie; Ayturk, Didem; Kiefe, Catarina I; Santry, Heena P

    2018-02-01

    As fewer surgeons take emergency general surgery call and hospitals decrease emergency services, a crisis in access looms in the United States. We examined national emergency general surgery capacity and county-level determinants of access to emergency general surgery care with special attention to disparities. To identify potential emergency general surgery hospitals, we queried the database of the American Hospital Association for "acute care general hospital," with "surgical services," and "emergency department," and ≥1 "operating room." Internet search and direct contact confirmed emergency general surgery services that covered the emergency room 7 days a week, 24 hours a day. Geographic and population-level emergency general surgery access was derived from Geographic Information Systems and US Census. Of the 6,356 hospitals in the 2013 American Hospital Association database, only 2,811 were emergency general surgery hospitals. Counties with greater percentages of black, Hispanic, uninsured, and low-education individuals and rural counties disproportionately lacked access to emergency general surgery care. For example, counties above the 75th percentile of African American population (10.2%) had >80% odds of not having an emergency general surgery hospital compared with counties below the 25th percentile of African American population (0.6%). Gaps in access to emergency general surgery services exist across the United States, disproportionately affecting underserved, rural communities. Policy initiatives need to increase emergency general surgery capacity nationwide. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Impact of Chest Pain Protocol with Access to Telemedicine on Implementation of Pharmacoinvasive Strategy in a Private Hospital Network.

    PubMed

    Macedo, Thiago Andrade; de Barros E Silva, Pedro Gabriel Melo; Simões, Sheila Aparecida; Okada, Mariana Yumi; Garcia, José Carlos Teixeira; Sampaio, Marcio Campos; Dantas, Roberto Nery; Oliveira, Roger Pereira; Rocha, Liliane Gomes; da Cunha Lopes, Bernardo Baptista; Frigini, Tiago; Furlan, Valter

    2016-07-01

    Brazilian registries have shown a gap between evidence-based therapies and real treatments. We aim to compare the use of the pharmacoinvasive strategy and mortality in patients with ST elevation myocardial infarction (STEMI) transferred pre- and post-chest pain protocol with access to telemedicine (CPPT) in a private hospital network. A CPPT was implemented in 22 private emergency departments in 2012. Emergency physicians and nurses of all facilities were trained to disseminate the information to comply with a chest pain protocol focusing on reperfusion therapy (pharmacoinvasive strategy) for STEMI. To conduct clinical discussions using telemedicine, a cardiologist from a reference hospital in cardiology (RHC) was available 24 h/day, 7 days/week. Using the database of all consecutive admissions, we compared the data of patients with STEMI transferred to the RHC in 2011 (pre-CPPT) and 2013-2014 (post-CPPT). We included 376 patients (113 pre-CPPT and 263 post-CPPT) with STEMI. All patients admitted in the RHC were transferred from the 22 emergency departments. Comparing pre-CPPT and post-CPPT, we did not find differences regarding age, gender, hypertension, dyslipidemia, diabetes, smoking, previous myocardial infarction, or Killip classification. However, the use of CPPT was associated with a greater use of pharmacoinvasive strategy (55.8% versus 38%; p = 0.002) and a trend toward lower in-hospital mortality (3% versus 8%; p = 0.06). The implementation of a CPPT was associated with a significant increase in the use of pharmacoinvasive strategy in patients with STEMI and a trend toward reduced in-hospital mortality in a private hospital network.

  14. "Utstein style" spreadsheet and database programs based on Microsoft Excel and Microsoft Access software for CPR data management of in-hospital resuscitation.

    PubMed

    Adams, Bruce D; Whitlock, Warren L

    2004-04-01

    In 1997, The American Heart Association in association with representatives of the International Committee on Resuscitation (ILCOR) published recommended guidelines for reviewing, reporting and conducting in-hospital cardiopulmonary resuscitation (CPR) outcomes using the "Utstein style". Using these guidelines, we developed two Microsoft Office based database management programs that may be useful to the resuscitation community. We developed a user-friendly spreadsheet based on MS Office Excel. The user enters patient variables such as name, age, and diagnosis. Then, event resuscitation variables such as time of collapse and CPR team arrival are entered from a "code flow sheet". Finally, outcome variables such as patient condition at different time points are recorded. The program then makes automatic calculations of average response times, survival rates and other important outcome measurements. Also using the Utstein style, we developed a database program based on MS Office Access. To promote free public access to these programs, we established at a website. These programs will help hospitals track, analyze, and present their CPR outcomes data. Clinical CPR researchers might also find the programs useful because they are easily modified and have statistical functions.

  15. National Hospital Management Portal (NHMP): a framework for e-health implementation.

    PubMed

    Adetiba, E; Eleanya, M; Fatumo, S A; Matthews, V O

    2009-01-01

    Health information represents the main basis for health decision-making process and there have been some efforts to increase access to health information in developing countries. However, most of these efforts are based on the internet which has minimal penetration especially in the rural and sub-urban part of developing countries. In this work, a platform for medical record acquisition via the ubiquitous 2.5G/3G wireless communications technologies is presented. The National Hospital Management Portal (NHMP) platform has a central database at each specific country's national hospital which could be updated/accessed from hosts at health centres, clinics, medical laboratories, teaching hospitals, private hospitals and specialist hospitals across the country. With this, doctors can have access to patients' medical records more easily, get immediate access to test results from laboratories, deliver prescription directly to pharmacists. If a particular treatment can be provided to a patient more effectively in another country, NHMP makes it simpler to organise and carry out such treatment abroad.

  16. [Decrease in hospitalizations due to polyvalent medical day hospital].

    PubMed

    Escobar, M A; García-Egido, A A; Carmona, R; Lucas, A; Márquez, C; Gómez, F

    2012-02-01

    The day hospital is an alternative to hospitalization. This alternative improves accessibility and comfort of the patients, and avoids hospitalizations. Nevertheless, the efficacy of the polyvalent medical day hospital in avoiding hospitalizations has not been evaluated. To analyze hospital stays avoided by the polyvalent medical day hospital of a university hospital of the Andalusian Health Service. An observational prospective study of the patients studied and/or treated in the polyvalent medical day hospital of the Hospital Universitario Puerto Real over a one year period. A total of 9640 patients were attended to, with 1413 procedures and 4921 i.v. treatments. There were 3182 visits to the priority consultation of the polyvalent medical day hospital. The most frequent consultation complaints were constitutional symptoms (15.9%) and anemia (14.5%). After the first visit, 21.5% of the patients were discharged and fewer than 3% were hospitalized. Hospitalization was avoided in 16.8% of the patients, there being a 6.0% decrease in the need for hospital beds (5.0% reduction in the internal medicine unit). Inadequate hospitalizations and 30-day readmissions decreased 93.3% and 4.2%, respectively. The most frequent diagnosis was neoplasm (26.0%), and most of the beds freed up were generated by patients diagnosed of neoplasm (26.7%). With this type of polyvalent medical day hospital, we have observed improved efficiency of health care, freeing up hospital beds by reducing hospitalizations, inadequate hospitalizations and re-admissions in the medical units involved. Copyright © 2011 Elsevier España, S.L. All rights reserved.

  17. Access to capital: implications for hospital consolidation.

    PubMed

    Grauman, Daniel M; Harris, John M; Martin, Christine

    2010-04-01

    Recent economic challenges have left many independent hospitals and their boards concerned about long-term viability of their organizations as stand-alone facilities. The CFO's role should be to facilitate a candid, objective assessment of the organization's ability to continue to go it alone. Key indicators that should be considered in such an assessment include patient volume, degree of physician alignment, profitability, current debt burden, cash, available capital versus capital requirements, and credit rating changes.

  18. Racial/ethnic disparities in the utilization of high-technology hospitals.

    PubMed

    Kim, Tae Hyun; Samson, Linda F; Lu, Ning

    2010-09-01

    Hospitals with high-technology services may have better outcomes. However, access to high-technology hospitals might not be uniform across racial/ethnic groups. This study examined if racial/ethnic minorities, compared to whites, are less likely to utilize hospitals that have the availability of technology services and infrastructure items such as computed tomography, positron emission tomography, magnetic resonance imaging, diagnostics radiation facility, and a level 1 trauma unit. Data were obtained from the 2003 Healthcare Cost & Utilization Project's Nationwide Inpatient Sample and the 2003 American Hospital Association's annual survey data. The sample consisted of 3381 324 patients admitted to and discharged from 368 hospitals in 18 states in the United States. Logistic regression results suggest that Hispanic patients are less likely than whites to utilize high-technology hospitals when controlling for other factors (odds ratio[OR], 0.47; 95% confidence interval [CI], 0.28-0.79). Our study adds empirical evidence that significant gaps persist in access to care between minorities and whites. Particularly, access to high-technology hospitals for Hispanics appears to be a major problem.

  19. Smart cards: a specific application in the hospital.

    PubMed

    Güler, I; Zengin, R M; Sönmez, M

    1998-12-01

    Computers have the ability to process and access tremendous amounts of information in our daily lives. But, now, individuals have this ability by carrying a smart card in their own wallets. These cards provide us the versatility, power, and security of computers. This study begins with a short description of smart cards and their advantages. Then, an electronic circuit that is designed for healthcare application in hospitals is introduced. This circuit functions as a smart card holder identifier, access controller for hospital doors and also can be used as a smart card reader/writer. Design steps of this electronic circuit, operation principles, serial communication with P.C., and the software are examined. Finally a complete access control network for hospital doors that functions with smart cards is discussed.

  20. Two-tier charging in Maputo Central Hospital: costs, revenues and effects on equity of access to hospital services.

    PubMed

    McPake, Barbara; Hongoro, Charles; Russo, Giuliano

    2011-06-02

    Special services within public hospitals are becoming increasingly common in low and middle income countries with the stated objective of providing higher comfort services to affluent customers and generating resources for under funded hospitals. In the present study expenditures, outputs and costs are analysed for the Maputo Central Hospital and its Special Clinic with the objective of identifying net resource flows between a system operating two-tier charging, and, ultimately, understanding whether public hospitals can somehow benefit from running Special Clinic operations. A combination of step-down and bottom-up costing strategies were used to calculate recurrent as well as capital expenses, apportion them to identified cost centres and link costs to selected output measures. The results show that cost differences between main hospital and clinic are marked and significant, with the Special Clinic's cost per patient and cost per outpatient visit respectively over four times and over thirteen times their equivalent in the main hospital. While the main hospital cost structure appeared in line with those from similar studies, salary expenditures were found to drive costs in the Special Clinic (73% of total), where capital and drug costs were surprisingly low (2 and 4% respectively). We attributed low capital and drug costs to underestimation by our study owing to difficulties in attributing the use of shared resources and to the Special Clinic's outsourcing policy. The large staff expenditure would be explained by higher physician time commitment, economic rents and subsidies to hospital staff. On the whole it was observed that: (a) the flow of capital and human resources was not fully captured by the financial systems in place and stayed largely unaccounted for; (b) because of the little consideration given to capital costs, the main hospital is more likely to be subsidising its Special Clinic operations, rather than the other way around. We conclude that the

  1. 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.

    PubMed

    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

  2. HOSPITAL-BASED HEALTH TECHNOLOGY ASSESSMENT FOR THE ADOPTION OF INNOVATIVE MEDICAL DEVICES WITHIN FRENCH HOSPITALS: OPPORTUNITIES AND CHALLENGES FOR INDUSTRY.

    PubMed

    Dutot, Camille; Mercier, Grégoire; Borget, Isabelle; de Sauvebeuf, Côme; Martelli, Nicolas

    2017-01-01

    Within French university hospitals, some internal committees are in charge of conducting hospital-based health technology assessment (Hb-HTA) to support managerial decisions regarding the adoption of innovations. For manufacturers, hospitals are usually the entry point for new and innovative medical devices, which cannot be accessed without the Hb-HTA committees' approval. Thus, the main objective of this pilot survey was to explore manufacturers' insights into Hb-HTA processes. A two-step pilot survey was conducted in 2014. First, semi-structured phone interviews were carried out to capture manufacturers' feedback on the Hb-HTA procedure. Second, a prospective and iterative questionnaire designed to explore manufacturers' market access strategies was administered. Eight manufacturers from the medical device industry completed the retrospective phone interviews, and five of them participated in the prospective survey. According to the overall feedback, the Hb-HTA process timeline and transparency are major issues, and the expectations of internal committees, especially in terms of clinical evidence, remain difficult to understand. However, despite this and due to the complexity of reimbursement processes at the national level, manufacturers are increasingly considering hospital adoption through Hb-HTA submission as a viable market access and coverage opportunity. Our study reaffirms the primary role of hospitals in the diffusion of innovative medical devices. However, to ensure efficient and broad access to innovation, cooperation between local and national HTA bodies is critical and should be promoted.

  3. In-house access to PACS images and related data through World Wide Web

    NASA Astrophysics Data System (ADS)

    Mascarini, Christian; Ratib, Osman M.; Trayser, Gerhard; Ligier, Yves; Appel, R. D.

    1996-05-01

    The development of a hospital wide PACS is in progress at the University Hospital of Geneva and several archive modules are operational since 1992. This PACS is intended for wide distribution of images to clinical wards. As the PACS project and the number of archived images grow rapidly in the hospital, it was necessary to provide an easy, more widely accessible and convenient access to the PACS database for the clinicians in the different wards and clinical units of the hospital. An innovative solution has been developed using tools such as Netscape navigator and NCSA World Wide Web server as an alternative to conventional database query and retrieval software. These tools present the advantages of providing an user interface which is the same independently of the platform being used (Mac, Windows, UNIX, ...), and an easy integration of different types of documents (text, images, ...). A strict access control has been added to this interface. It allows user identification and access rights checking, as defined by the in-house hospital information system, before allowing the navigation through patient data records.

  4. Hospital bed occupancy: more than queuing for a bed.

    PubMed

    Keegan, Andrew D

    2010-09-06

    Timely access to safe hospital care remains a major concern. Target bed-occupancy rates have been proposed as a measure of the ability of a hospital to function safely and effectively. High bed-occupancy rates have been shown to be associated with greater risks of hospital-associated infection and access block and to have a negative impact on staff health. Clinical observational data have suggested that bed occupancies above 85% could adversely affect safe, effective hospital function. Using this figure, at least initially, would be of value in the planning and operational management of public hospital beds in Australia. There is an urgent need to develop meaningful outcome measures of patient care that could replace the process measures currently in use.

  5. Acquisition of electroencephalographic data in a large regional hospital - Bringing the brain waves to the computer.

    NASA Technical Reports Server (NTRS)

    Low, M. D.; Baker, M.; Ferguson, R.; Frost, J. D., Jr.

    1972-01-01

    This paper describes a complete electroencephalographic acquisition and transmission system, designed to meet the needs of a large hospital with multiple critical care patient monitoring units. The system provides rapid and prolonged access to a centralized recording and computing area from remote locations within the hospital complex, and from locations in other hospitals and other cities. The system includes quick-on electrode caps, amplifier units and cable transmission for access from within the hospital, and EEG digitization and telephone transmission for access from other hospitals or cities.

  6. Hospital-Owned Apps in Taiwan: Nationwide Survey

    PubMed Central

    Liu, Hao-Yen; Sun, Ying-Chou; Fen, Jun-Jeng; Chen, Tzeng-Ji; Chou, Li-Fang; Hwang, Shinn-Jang

    2018-01-01

    Background Over the last decade, the use of mobile phone apps in the health care industry has grown rapidly. Owing to the high penetration rate of Internet use in Taiwan, hospitals are eager to provide their own apps to improve the accessibility of medical care for patients. Objective The aims of this study were to provide an overview of the currently available hospital-owned apps in Taiwan and to conduct a cross-hospital comparison of app features. Methods In May 2017, the availability of apps from all 414 hospitals in Taiwan was surveyed from the hospital home pages and the Google Play app store. The features of the downloaded apps were then examined in detail and, for each app, the release date of the last update, download frequency, and rating score were obtained from Google Play. Results Among all the 414 hospitals in Taiwan, 150 (36.2%) owned Android apps that had been made available for public use, including 95% (18/19) of the academic medical centers, 77% (63/82) of the regional hospitals, and 22.0% (69/313) of the local community hospitals. Among the 13 different functionalities made available by the various hospital-owned apps, the most common were the doctor search (100%, 150/150), real-time queue monitoring (100%, 150/150), and online appointment scheduling (94.7%, 142/150) functionalities. The majority of apps (57.3%, 86/150) had a rating greater than 4 out of 5, 49.3% (74/150) had been updated at some point in 2017, and 36.0% (54/150) had been downloaded 10,000 to 50,000 times. Conclusions More than one-third of the hospitals owned apps intended to increase patient access to health care. The most common app features might reflect the health care situation in Taiwan, where the overcrowded outpatient departments of hospitals operate in an open-access mode without any strict referral system. Further research should focus on the effectiveness and safety of these apps. PMID:29339347

  7. 42 CFR 412.109 - Special treatment: Essential access community hospitals (EACHs).

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... standardized payment amount by CMS or the Medicare Geographic Classification Review Board; or (4) Is not... health network. (2) Request and documentation. In order for a hospital to qualify for an increase in its... resulting from the hospital's participation in a rural health network and show that the increased costs...

  8. 42 CFR 412.109 - Special treatment: Essential access community hospitals (EACHs).

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... standardized payment amount by CMS or the Medicare Geographic Classification Review Board; or (4) Is not... health network. (2) Request and documentation. In order for a hospital to qualify for an increase in its... resulting from the hospital's participation in a rural health network and show that the increased costs...

  9. 42 CFR 412.109 - Special treatment: Essential access community hospitals (EACHs).

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... standardized payment amount by CMS or the Medicare Geographic Classification Review Board; or (4) Is not... health network. (2) Request and documentation. In order for a hospital to qualify for an increase in its... resulting from the hospital's participation in a rural health network and show that the increased costs...

  10. 42 CFR 412.109 - Special treatment: Essential access community hospitals (EACHs).

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... standardized payment amount by CMS or the Medicare Geographic Classification Review Board; or (4) Is not... health network. (2) Request and documentation. In order for a hospital to qualify for an increase in its... resulting from the hospital's participation in a rural health network and show that the increased costs...

  11. 42 CFR 412.109 - Special treatment: Essential access community hospitals (EACHs).

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... standardized payment amount by CMS or the Medicare Geographic Classification Review Board; or (4) Is not... health network. (2) Request and documentation. In order for a hospital to qualify for an increase in its... resulting from the hospital's participation in a rural health network and show that the increased costs...

  12. US hospital-based direct access with radiology referral: an administrative case report.

    PubMed

    Keil, Aaron; Brown, Suzanne Robben

    2015-01-01

    Legislative gains in the US allow physical therapists to function in expanded scopes of practice including direct access and referral to specialists. The combination of direct access with privileges to order imaging studies directly offers a desirable practice status for many physical therapists, especially in musculoskeletal focused settings. Although direct access is legal in all US jurisdictions, institutional-based physical therapy settings have not embraced these practices. Barriers cited to implementing direct access with advanced practice are concerns over medical and administrative opposition, institutional policies, provider qualifications and reimbursement. This administrative case report describes the process taken to allow therapists to see patients without a referral and to order diagnostic imaging studies at an academic medical center. Nine-month implementation results show 66 patients seen via direct access with 15% referred for imaging studies. Claims submitted to 20 different insurance providers were reimbursed at 100%. While institutional regulations and reimbursement are reported as barriers to direct access, this report highlights the process one academic medical center used to implement direct access and advanced practice radiology referral by updating policies and procedures, identifying advanced competencies and communicating with necessary stakeholder groups. Favorable reimbursement for services is documented.

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

    PubMed

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

    2018-05-14

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

  14. Increased Access to Professional Interpreters in the Hospital Improves Informed Consent for Patients with Limited English Proficiency.

    PubMed

    Lee, Jonathan S; Pérez-Stable, Eliseo J; Gregorich, Steven E; Crawford, Michael H; Green, Adrienne; Livaudais-Toman, Jennifer; Karliner, Leah S

    2017-08-01

    Language barriers disrupt communication and impede informed consent for patients with limited English proficiency (LEP) undergoing healthcare procedures. Effective interventions for this disparity remain unclear. Assess the impact of a bedside interpreter phone system intervention on informed consent for patients with LEP and compare outcomes to those of English speakers. Prospective, pre-post intervention implementation study using propensity analysis. Hospitalized patients undergoing invasive procedures on the cardiovascular, general surgery or orthopedic surgery floors. Installation of dual-handset interpreter phones at every bedside enabling 24-h immediate access to professional interpreters. Primary predictor: pre- vs. post-implementation group; secondary predictor: post-implementation patients with LEP vs. English speakers. Primary outcomes: three central informed consent elements, patient-reported understanding of the (1) reasons for and (2) risks of the procedure and (3) having had all questions answered. We considered consent adequately informed when all three elements were met. We enrolled 152 Chinese- and Spanish-speaking patients with LEP (84 pre- and 68 post-implementation) and 86 English speakers. Post-implementation (vs. pre-implementation) patients with LEP were more likely to meet criteria for adequately informed consent (54% vs. 29%, p = 0.001) and, after propensity score adjustment, had significantly higher odds of adequately informed consent (AOR 2.56; 95% CI, 1.15-5.72) as well as of each consent element individually. However, compared to post-implementation English speakers, post-implementation patients with LEP had significantly lower adjusted odds of adequately informed consent (AOR, 0.38; 95% CI, 0.16-0.91). A bedside interpreter phone system intervention to increase rapid access to professional interpreters was associated with improvements in patient-reported informed consent and should be considered by hospitals seeking to improve

  15. Medicare program; additional extension of the payment adjustment for low-volume hospitals and the Medicare-dependent hospital (MDH) program under the hospital Inpatient Prospective Payment Systems (IPPS) for acute care hospitals for fiscal year 2014. Extension of a payment adjustment and a program.

    PubMed

    2014-06-17

    This document announces changes to the payment adjustment for low-volume hospitals and to the Medicare-dependent hospital (MDH) program under the hospital inpatient prospective payment systems (IPPS) for the second half of FY 2014 (April 1, 2014 through September 30, 2014) in accordance with sections 105 and 106, respectively, of the Protecting Access to Medicare Act of 2014 (PAMA).

  16. The interrelationship of organizational characteristics of magnet hospitals, nursing leadership, and nursing job satisfaction.

    PubMed

    Upenieks, Valda V

    2003-01-01

    This study examined whether magnet hospitals continue to provide higher levels of job satisfaction and empowerment among nurses when compared with non-magnet hospitals. Also studied at both types of hospitals was whether job satisfaction discrepancy was interlinked with leadership effectiveness and support of professional nursing practice. Nurses employed at magnet hospitals experienced higher levels of empowerment and job satisfaction due to greater access to work empowerment structures. The elements accounting for differences in empowerment and job satisfaction scores included: (1) greater accessibility of magnet nurse leaders, (2) better support of clinical nurse autonomous decision making by magnet nurse leaders, and (3) greater access to work empowerment structures such as opportunity, information, and resources at magnet hospitals.

  17. 78 FR 51061 - TRICARE; Reimbursement of Sole Community Hospitals and Adjustment to Reimbursement of Critical...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-20

    ... DEPARTMENT OF DEFENSE 32 CFR Part 199 [DoD-2010-HA-0072] RIN 0720-AB41 TRICARE; Reimbursement of Sole Community Hospitals and Adjustment to Reimbursement of Critical Access Hospitals; Correction... TRICARE; Reimbursement of Sole Community Hospitals and Adjustment to Reimbursement of Critical Access...

  18. An E-Hospital Security Architecture

    NASA Astrophysics Data System (ADS)

    Tian, Fang; Adams, Carlisle

    In this paper, we introduce how to use cryptography in network security and access control of an e-hospital. We first define the security goal of the e-hospital system, and then we analyze the current application system. Our idea is proposed on the system analysis and the related regulations of patients' privacy protection. The security of the whole application system is strengthened through layered security protection. Three security domains in the e-hospital system are defined according to their sensitivity level, and for each domain, we propose different security protections. We use identity based cryptography to establish secure communication channel in the backbone network and policy based cryptography to establish secure communication channel between end users and the backbone network. We also use policy based cryptography in the access control of the application system. We use a symmetric key cryptography to protect the real data in the database. The identity based and policy based cryptography are all based on elliptic curve cryptography—a public key cryptography.

  19. Aquatic access for the disabled.

    PubMed

    Walk, E E; Himel, H N; Batra, E K; Baruch, L; O'Connor, M B; Tanner, A E; Edlich, R F

    1992-01-01

    Innovations in rehabilitation engineering can now provide aquatic access for the disabled. In the regional burn center, the Bodi-Gard cart shower system (Hospital Therapy Products, Inc., Wood Dale, Ill.) uses three flexible hoses to provide precise hydrotherapy and debridement. Its main mixing valve controls temperature and pressure and is easily disinfected by an in-line chamber. This shower system is complemented by the foldable Bodi-Gard mobile seat shower system (Hospital Therapy Products, Inc.). This system, which is covered by a disposable liner, surrounds the patient with eight water jets that empty into any floor drain. The Bather 2001 (Silcraft Corp., Traverse City, Mich.) is a fiberglass hydrotherapy bathtub with a unique Aqua-Seal door (Silcraft Corp.) that can be raised to provide patient access. Its unique closed-loop disinfection system prevents contamination of its internal components. The Nolan Tublift (Aquatic Access, Louisville, Ky.) is a lightweight, removable lift that uses water power to gently raise and lower its seat. It can be manually swiveled to allow access from a wheelchair. Transfer benches span the tub wall to provide access to the shower and bathtub. Although they are a less expensive alternative to the Tublift, they allow water to spill outside the tub, which may create a slippery bathroom floor. The Nolan Poolift (Guardian Products, Arleta, Calif.) is a water-powered pool lift, which automatically rotates as it descends. It is capable of lifting up to 135 kg with a home water pressure of 55 psi. In contrast, the water-powered Aquatic Access Poolift is a less expensive pool lift, which rotates manually with assistance.(ABSTRACT TRUNCATED AT 250 WORDS)

  20. Incidence and outcome of out-of-hospital cardiac arrest with public-access defibrillation. A descriptive epidemiological study in a large urban community.

    PubMed

    Sasaki, Mie; Iwami, Taku; Kitamura, Tetsuhisa; Nomoto, Shinichi; Nishiyama, Chika; Sakai, Tomohiko; Tanigawa, Kayo; Kajino, Kentaro; Irisawa, Taro; Nishiuchi, Tatsuya; Hayashida, Sumito; Hiraide, Atsushi; Kawamura, Takashi

    2011-01-01

    Detailed characteristics of those who experience an out-of-hospital cardiac arrest (OHCA) with public-access defibrillation (PAD) are unknown. A prospective, population-based observational study involving consecutive OHCA patients with emergency responder resuscitation attempts was conducted from July 1, 2004 through December 31, 2008 in Osaka City. We extracted data for OHCA patients shocked by a public-access automated external defibrillator (AED) and evaluated the patients' and rescuers' characteristics. The main outcome measure was neurologically favorable 1-month survival. During the study period, 10,375 OHCA patients were registered and of 908 patients suffering ventricular fibrillation arrest, 53 (6%) received public-access AED shocks by lay-rescuers, with the proportion increasing from 0% in 2004 to 11% in 2008 (P for trend<0.001). Railway stations (34%) were the places where PAD shocks were most frequently delivered, followed by nursing homes (11%), medical facilities (9%), and fitness facilities (7%). In 57% of cases, the subject received public-access AED shocks delivered by non-medical persons, including employees of railway companies (13%), school teachers (6%), employees of fitness facilities (6%), and security guards (6%). The proportion of neurologically favorable 1-month survival tended to increase from 0% in 2005 to 58% in 2008 (P for trend=0.081). Railway stations are the most common places where shocks by public-access AEDs were delivered in large urban communities of Japan, and among lay-rescuers railway station workers use AEDs more frequently.

  1. Access to Orthopaedic Surgical Care in Northern Tanzania: A Modelling Study.

    PubMed

    Premkumar, Ajay; Ying, Xiaohan; Mack Hardaker, W; Massawe, Honest H; Mshahaba, David J; Mandari, Faiton; Pallangyo, Anthony; Temu, Rogers; Masenga, Gileard; Spiegel, David A; Sheth, Neil P

    2018-04-25

    The global burden of musculoskeletal disease and resulting disability is enormous and is expected to increase over the next few decades. In the world's poorest regions, the paucity of information defining and quantifying the current state of access to orthopaedic surgical care is a major problem in developing effective solutions. This study estimates the number of individuals in Northern Tanzania without adequate access to orthopaedic surgical services. A chance tree was created to model the probability of access to orthopaedic surgical services in the Northern Tanzanian regions of Arusha, Kilimanjaro, Tanga, Singida, and Manyara, with respect to four dimensions: timeliness, surgical capacity, safety, and affordability. Timeliness was estimated by the proportion of people living within a 4-h driving distance from a hospital with an orthopaedic surgeon, capacity by comparing number of surgeries performed to the number of surgeries indicated, safety by applying WHO Emergency and Essential Surgical Care infrastructure and equipment checklists, and affordability by approximating the proportion of the population protected from catastrophic out-of-pocket healthcare expenditure. We accounted for uncertainty in our model with one-way and probabilistic sensitivity analyses. Data sources included the Tanzanian National Bureau of Statistics and Ministry of Finance, World Bank, World Health Organization, New Zealand Ministry of Health, Google Corporation, NASA population estimator, and 2015 hospital records from Kilimanjaro Christian Medical Center, Machame Hospital, Nkoroanga Hospital, Mt. Meru Hospital, and Arusha Lutheran Medical Center. Under the most conservative assumptions, more than 90% of the Northern Tanzanian population does not have access to orthopaedic surgical services. There is a near absence of access to orthopaedic surgical care in Northern Tanzania. These findings utilize more precise country and region-specific data and are consistent with prior published

  2. The relationship between the Balanced Budget Act (BBA) and hospital profitability.

    PubMed

    Younis, Mustafa Z

    2006-01-01

    The Balanced Budget Act of 1997 (BBA) reduced the payment for fees for service providers and reduced the subsidy paid by the government for teaching hospitals. Since the passage of such cost containment measures, debates regarding their impact on hospitals, graduate medical education, and access to health care were raised. The need to examine the effect of such payment reduction on hospital profitability was widely ignored. We examined the relationship between the BBA and hospital profitability by using return on assets to measure profitability, by running an ordinary least squares regression for 1996 as pre-BBA and 1999 as post-BBA. We controlled for variables that were not included in previous literature, such as disproportionate share hospital status, critical access hospital status, and graduate medical education, measured by teaching hospitals to measure the effect of BBA cuts on teaching hospitals. Furthermore we incorporated several economic, financial, and utilization variables in the model. We used 1996 and 1999 data in our analysis to bridge potential effects of the BBA. To locate hospitals that changed ownership status we cross-matched the Medicare Cost Report data with the American Hospital Association Annual Survey. We found that overall hospital profitability declined as a result of the introduction of the BBA; however, small rural hospitals that converted to critical access status enjoyed improvement in financial status over the period of our study. Hospitals that converted to for-profit status did not improve in financial status, and showed a lower earning after the conversation. Our results show that the BBA had a negative effect on hospitals because of cuts in its reimbursement policy, except for critical access hospitals, which show improvement because of their exemption from the prospective payment system. Our study differs from others by using national comprehensive data for years that focus exclusively on the Balanced Budget Act period. We

  3. Rural versus urban academic hospital mortality following stroke in Canada.

    PubMed

    Fleet, Richard; Bussières, Sylvain; Tounkara, Fatoumata Korika; Turcotte, Stéphane; Légaré, France; Plant, Jeff; Poitras, Julien; Archambault, Patrick M; Dupuis, Gilles

    2018-01-01

    Stroke is one of the leading causes of death in Canada. While stroke care has improved dramatically over the last decade, outcomes following stroke among patients treated in rural hospitals have not yet been reported in Canada. To describe variation in 30-day post-stroke in-hospital mortality rates between rural and urban academic hospitals in Canada. We also examined 24/7 in-hospital access to CT scanners and selected services in rural hospitals. We included Canadian Institute for Health Information (CIHI) data on adjusted 30-day in-hospital mortality following stroke from 2007 to 2011 for all acute care hospitals in Canada excluding Quebec and the Territories. We categorized rural hospitals as those located in rural small towns providing 24/7 emergency physician coverage with inpatient beds. Urban hospitals were academic centres designated as Level 1 or 2 trauma centres. We computed descriptive data on local access to a CT scanner and other services and compared mean 30-day adjusted post-stroke mortality rates for rural and urban hospitals to the overall Canadian rate. A total of 286 rural hospitals (3.4 million emergency department (ED) visits/year) and 24 urban hospitals (1.5 million ED visits/year) met inclusion criteria. From 2007 to 2011, 30-day in-hospital mortality rates following stroke were significantly higher in rural than in urban hospitals and higher than the Canadian average for every year except 2008 (rural average range = 18.26 to 21.04 and urban average range = 14.11 to 16.78). Only 11% of rural hospitals had a CT-scanner, 1% had MRI, 21% had in-hospital ICU, 94% had laboratory and 92% had basic x-ray facilities. Rural hospitals in Canada had higher 30-day in-hospital mortality rates following stroke than urban academic hospitals and the Canadian average. Rural hospitals also have very limited local access to CT scanners and ICUs. These rural/urban discrepancies are cause for concern in the context of Canada's universal health care system.

  4. Rural versus urban academic hospital mortality following stroke in Canada

    PubMed Central

    Turcotte, Stéphane; Légaré, France; Plant, Jeff; Poitras, Julien; Archambault, Patrick M.; Dupuis, Gilles

    2018-01-01

    Introduction Stroke is one of the leading causes of death in Canada. While stroke care has improved dramatically over the last decade, outcomes following stroke among patients treated in rural hospitals have not yet been reported in Canada. Objectives To describe variation in 30-day post-stroke in-hospital mortality rates between rural and urban academic hospitals in Canada. We also examined 24/7 in-hospital access to CT scanners and selected services in rural hospitals. Materials and methods We included Canadian Institute for Health Information (CIHI) data on adjusted 30-day in-hospital mortality following stroke from 2007 to 2011 for all acute care hospitals in Canada excluding Quebec and the Territories. We categorized rural hospitals as those located in rural small towns providing 24/7 emergency physician coverage with inpatient beds. Urban hospitals were academic centres designated as Level 1 or 2 trauma centres. We computed descriptive data on local access to a CT scanner and other services and compared mean 30-day adjusted post-stroke mortality rates for rural and urban hospitals to the overall Canadian rate. Results A total of 286 rural hospitals (3.4 million emergency department (ED) visits/year) and 24 urban hospitals (1.5 million ED visits/year) met inclusion criteria. From 2007 to 2011, 30-day in-hospital mortality rates following stroke were significantly higher in rural than in urban hospitals and higher than the Canadian average for every year except 2008 (rural average range = 18.26 to 21.04 and urban average range = 14.11 to 16.78). Only 11% of rural hospitals had a CT-scanner, 1% had MRI, 21% had in-hospital ICU, 94% had laboratory and 92% had basic x-ray facilities. Conclusion Rural hospitals in Canada had higher 30-day in-hospital mortality rates following stroke than urban academic hospitals and the Canadian average. Rural hospitals also have very limited local access to CT scanners and ICUs. These rural/urban discrepancies are cause for

  5. Investigation of availability and accessibility of community automated external defibrillators in a territory in Hong Kong.

    PubMed

    Ho, C L; Lui, C T; Tsui, K L; Kam, C W

    2014-10-01

    To evaluate the availability and accessibility of community automated external defibrillators in a territory in Hong Kong. Cross-sectional study. Two public hospitals in New Territories West Cluster in Hong Kong. Information about the locations of community automated external defibrillators was obtained from automated external defibrillator suppliers and through community search. Data on locations of out-of-hospital cardiac arrests from August 2010 to September 2013 were obtained from the local cardiac arrest registry of the emergency departments of two hospitals. Sites of both automated external defibrillators and out-of-hospital cardiac arrests were geographically coded and mapped. The number of out-of-hospital cardiac arrests within 100 m of automated external defibrillators per year and the proportion of out-of-hospital cardiac arrests with accessible automated external defibrillators (100 m) were calculated. The number of community automated external defibrillators per 10,000 population and public access defibrillation rate were also calculated and compared with those in other countries. There were a total of 207 community automated external defibrillators in the territory. The number of automated external defibrillators per 10,000 population was 1.942. All facilities with automated external defibrillators in this territory had more than 0.2 out-of-hospital cardiac arrests per automated external defibrillator per year within 100 m. Among all out-of-hospital cardiac arrests, 25.2% could have an automated external defibrillator reachable within 100 m. The public access defibrillation rate was 0.168%. The number and accessibility of community automated external defibrillators in this territory are comparable to those in other developed countries. The placement site of community automated external defibrillators is cost-effective. However, the public access defibrillation rate is low.

  6. Hospital referral patterns: how emergency medical care is accessed in a disaster.

    PubMed

    Reilly, Michael J; Markenson, David

    2010-10-01

    A prevalent assumption in hospital emergency preparedness planning is that patient arrival from a disaster scene will occur through a coordinated system of patient distribution based on the number of victims, capabilities of the receiving hospitals, and the nature and severity of illness or injury. In spite of the strength of the emergency medical services system, case reports in the literature and major incident after-action reports have shown that most patients who present at a health care facility after a disaster or other major emergency do not necessarily arrive via ambulance. If these reports of arrival of patients outside an organized emergency medical services system are accurate, then hospitals should be planning differently for the impact of an unorganized influx of patients on the health care system. Hospitals need to consider alternative patterns of patient referral, including the mass convergence of self-referred patients, when performing major incident planning. We conducted a retrospective review of published studies from the past 25 years to identify reports of patient care during disasters or major emergency incidents that described the patients' method of arrival at the hospital. Using a structured mechanism, we aggregated and analyzed the data. Detailed data on 8303 patients from more than 25 years of literature were collected. Many reports suggest that only a fraction of the patients who are treated in emergency departments following disasters arrive via ambulance, particularly in the early postincident stages of an event. Our 25 years of aggregate data suggest that only 36% of disaster victims are transported to hospitals via ambulance, whereas 63% use alternate means to seek emergency medical care. Hospitals should evaluate their emergency plans to consider the implications of alternate referral patterns of patients during a disaster. Additional consideration should be given to mass triage, site security, and the potential need for

  7. Separate may not be equal: A preliminary investigation of clinical correlates of electronic psychiatric record accessibility in academic medical centers

    PubMed Central

    Kozubal, Dana E.; Samus, Quincy M.; Bakare, Aishat A.; Trecker, Carrilin C.; Wong, Hei-Wah; Guo, Huiying; Cheng, Jeffrey; Allen, Paul X.; Mayer, Lawrence S.; Jamison, Kay R.; Kaplin, Adam I.

    2014-01-01

    Objectives Electronic Medical Records (EMR) have the potential to improve the coordination of healthcare in this country, yet the field of psychiatry has lagged behind other medical disciplines in its adoption of EMR. Methods Psychiatrists at 18 of the top US hospitals completed an electronic survey detailing whether their psychiatric records were stored electronically and accessible to non-psychiatric physicians. Electronic hospital records and accessibility statuses were correlated with patient care outcomes obtained from the University Health System Consortium Clinical Database available for 13 of the 18 top US hospitals. Results 44% of hospitals surveyed maintained most or all of their psychiatric records electronically and 28% made psychiatric records accessible to non-psychiatric physicians; only 22% did both. Compared with hospitals where psychiatric records were not stored electronically, the average 7-day readmission rate of psychiatric patients was significantly lower at hospitals with psychiatric EMR (5.1% vs. 7.0%, p = .040). Similarly, the 14 and 30-day readmission rates at hospitals where psychiatric records were accessible to non-psychiatric physicians were lower than those of their counterparts with non-accessible records (5.8% vs. 9.5%, p = .019, 8.6% vs. 13.6%, p = .013, respectively). The 7, 14, and 30-day readmission rates were significantly lower in hospitals where psychiatric records were both stored electronically and made accessible than at hospitals where records were either not electronic or not accessible (4% vs 6.6%, 5.8% vs 9.1%, 8.9 vs 13%, respectively, all with p = 0.045). Conclusions Having psychiatric EMR that were accessible to non-psychiatric physicians correlated with improved clinical care as measured by lower readmission rates specific for psychiatric patients. PMID:23266060

  8. Gonadotropin-Releasing Hormone Agonist Combined With a Levonorgestrel-Releasing Intrauterine System or Letrozole for Fertility-Preserving Treatment of Endometrial Carcinoma and Complex Atypical Hyperplasia in Young Women.

    PubMed

    Zhou, Huimei; Cao, Dongyan; Yang, Jiaxin; Shen, Keng; Lang, Jinghe

    2017-07-01

    The aim of this study was to evaluate the efficacy and safety with gonadotropin-releasing hormone agonist (GnRHa) combined with a levonorgestrel-releasing intrauterine system or an aromatase inhibitor (letrozole) in young women with well-differentiated early endometrial carcinoma (EC) and complex atypical hyperplasia (CAH). We performed a retrospective analysis including the clinical characteristics of 29 patients younger than 45 years with early well-differentiated endometrioid adenocarcinoma of the uterus (EC) or CAH who were treated at the Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, from January 2012 to April 2016. Eighteen patients were treated with the combination of intramuscular injections of GnRHa every 4 weeks with the levonorgestrel intrauterine hormonal system (Mirena® Bayer Health Care Pharmaceutical Inc, Wayne, NY) was inserted. Eleven patients were treated with the combination of intramuscular injections of GnRHa every 4 weeks with oral letrozole 2.5 mg daily. The patients underwent follow-up with endometrial sampling by hysteroscopy and curettage for endometrial response every 3 months. After a median follow-up of 18.7 months (range, 5.6-54.9 months), 15 women (88.2%) in the EC group and 12 women (100%) in the CAH group had complete response (CR) after GnRHa combination treatment. Among the women who achieved CR, 1 woman (8.3%) with CAH and 1 woman (5.9%) with EC had recurrence after CR, and they finally underwent a hysterectomy. Time to CR was similar in the 2 groups (4.5 ± 1.9 months in the CAH group vs 5.0 ± 2.9 months in the EC group). Ten women (34.5%) had CR after the first 3 months, 8 women (27.6%) had CR after 6 months, and 9 women (31.0%) had CR after 9 months. Both GnRHa with the levonorgestrel-releasing intrauterine system and GnRHa with letrozole are alternative treatments for women with CAH and EC who desire fertility preservation. A larger multicenter trial of the fertility-preserving treatment is

  9. The Surge Capacity for People in Emergencies (SCOPE) study in Australasian hospitals.

    PubMed

    Traub, Matthias; Bradt, David A; Joseph, Anthony P

    2007-04-16

    To measure physical assets in Australasian hospitals required for the management of mass casualties as a result of terrorism or natural disasters. A cross-sectional survey of Australian and New Zealand hospitals. All emergency department directors of Australasian College for Emergency Medicine (ACEM)-accredited hospitals, as well as private and non-ACEM accredited emergency departments staffed by ACEM Fellows in metropolitan Sydney. Numbers of operating theatres, intensive care unit (ICU) beds and x-ray machines; state of preparedness using benchmarks defined by the Centers for Disease Control and Prevention in the United States. We found that 61%-82% of critically injured patients would not have immediate access to operative care, 34%-70% would have delayed access to an ICU bed, and 42% of the less critically injured would have delayed access to x-ray facilities. Our study demonstrates that physical assets in Australasian public hospitals do not meet US hospital preparedness benchmarks for mass casualty incidents. We recommend national agreement on disaster preparedness benchmarks and periodic publication of hospital performance indicators to enhance disaster preparedness.

  10. "Take the Volume Pledge" may result in disparity in access to care.

    PubMed

    Blanco, Barbara A; Kothari, Anai N; Blackwell, Robert H; Brownlee, Sarah A; Yau, Ryan M; Attisha, John P; Ezure, Yoshiki; Pappas, Sam; Kuo, Paul C; Abood, Gerard J

    2017-03-01

    "Take the Volume Pledge" proposes restricting pancreatectomies to hospitals that perform ≥20 per year. Our purpose was to identify those factors that characterize patients at risk for loss of access to pancreatic cancer care with enforcement of volume standards. Using the Healthcare Cost and Utilization Project State Inpatient Database from Florida, we identified patients who underwent pancreatectomy for pancreatic malignancy from 2007-2011. American Hospital Association and United States Census Bureau data were linked to patient-level data. High-volume hospitals were defined as performing ≥20 pancreatic resections per year. Univariable and multivariable statistics compared patient characteristics and utilization of high-volume hospitals. Classification and Regression Tree modeling was used to predict patients at risk for losing access to care. Our study included 1,663 patients. Five high-volume hospitals were identified, and they treated 1,056 (63.5%) patients. Patients residing far from high-volume hospitals, in areas with the highest population density, non-Caucasian ethnicity, and greater income had decreased odds of obtaining care at high-volume hospitals. Using these factors, we developed a Classification and Regression Tree-based predictive tool to identify these patients. Implementation of "Take the Volume Pledge" is an important step toward improving pancreatectomy outcomes; however, policymakers must consider the potential impact on limiting access and possible health disparities that may arise. Copyright © 2016 Elsevier Inc. All rights reserved.

  11. Open access gastroscopy: too much to swallow?

    PubMed Central

    Kerrigan, D D; Brown, S R; Hutchinson, G H

    1990-01-01

    OBJECTIVES--To ascertain the proportion of endoscopic examinations with normal findings in patients referred for gastroscopy through hospital medical staff or directly by their general practitioner and to assess the likely effect of targeting endoscopy in older patients. DESIGN--Retrospective audit of the gastroscopy practice of one consultant from 1986 to 1988 from information recorded on a standard form completed at the time of the examination, which contained details of patients, their endoscopic findings, and mode of referral (open access or clinic). SETTING--One district general hospital. PATIENTS--1545 Consecutive patients from primary catchment area attending for their first gastroscopy; 454 were referred through the outpatient clinic or by hospital colleagues (clinic group) and 1091 were accepted for endoscopy solely on their general practitioner's clinical diagnosis (open access group). RESULTS--Similar numbers (about 40%) of examinations with normal findings were performed in each group, although in patients aged over 40 the proportion with normal findings was significantly higher in the clinic group (p less than 0.03). Endoscopic evidence of gastro-oesophageal reflux disease, peptic ulceration, and gastroduodenal inflammation was equally common in each group; upper gastrointestinal malignancy, however, was significantly more common in patients referred through hospital doctors (5%, 23/454 v 2%, 22/1091 respectively; p less than 0.005) (although many of these patients had already been extensively investigated). IMPLICATIONS--Open access gastroscopy does not increase the number of unnecessary examinations and should become more widely available. Targeting this service to patients aged over 40 would reduce the number of requests but increase the diagnostic yield. PMID:2106992

  12. [Clinical research outside of teaching hospitals: Current situation in north-eastern France].

    PubMed

    Goetz, C; Dupoux, A; Déloy, L; Hertz, C; Jeanmaire, T; Parneix, N

    2015-04-01

    Most clinical research in France takes place in teaching hospitals. There are, however, many advantages to developing it in other hospitals: access to innovative treatments, improvement in healthcare quality, attractiveness of hospitals, increased trial inclusion rates and reduced selection bias. The objectives of our study were to report on the current situation of clinical research outside teaching hospitals. A three-stage survey was conducted between January 2012 and May 2013 in non-teaching hospitals of north-eastern France. First, questionnaires were sent to administrative and medical boards of all hospitals with more than 100 beds, then to head doctors of every department in hospitals with more than 300 beds and finally meetings were organized with members of 20 selected hospitals. The administrative and medical boards of 85 hospitals participated in the first stage of the survey; half of these hospitals were engaged in clinical research activities and for 10 the internal structuring was cross-disciplinary. Answers from 178 departments were obtained during the second stage; 47% reported a clinical research activity. Meetings with research teams in 20 hospitals allowed us to identify difficulties concerning research funding, transversal organization and sponsoring. Clinical research existed in more than half of the respondent non-teaching hospitals. Obstacles to its development can be grouped in three categories: 1) internal structuring of clinical research, 2) access to information and knowledge of how clinical research functions and to interlocutors outside the hospital and 3) access to skills necessary to sponsor clinical research. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  13. 75 FR 81885 - Medicare and Medicaid Programs; Electronic Health Record Incentive Program; Correcting Amendment

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-29

    ... ``Therefore, we revise this measure to require that at least one of the five rules be related to a clinical quality measure, assuming the EP, eligible hospital or CAH has at least one clinical quality measure... rule to a specific clinical quality measure.'' 4. On page 44359, a. First column, first partial...

  14. The Medicare Hospital Readmissions Reduction Program: potential unintended consequences for hospitals serving vulnerable populations.

    PubMed

    Gu, Qian; Koenig, Lane; Faerberg, Jennifer; Steinberg, Caroline Rossi; Vaz, Christopher; Wheatley, Mary P

    2014-06-01

    To explore the impact of the Hospital Readmissions Reduction Program (HRRP) on hospitals serving vulnerable populations. Medicare inpatient claims to calculate condition-specific readmission rates. Medicare cost reports and other sources to determine a hospital's share of duals, profit margin, and characteristics. Regression analyses and projections were used to estimate risk-adjusted readmission rates and financial penalties under the HRRP. Findings were compared across groups of hospitals, determined based on their share of duals, to assess differential impacts of the HRRP. Both patient dual-eligible status and a hospital's dual-eligible share of Medicare discharges have a positive impact on risk-adjusted hospital readmission rates. Under current Centers for Medicare and Medicaid Service methodology, which does not adjust for socioeconomic status, high-dual hospitals are more likely to have excess readmissions than low-dual hospitals. As a result, HRRP penalties will disproportionately fall on high-dual hospitals, which are more likely to have negative all-payer margins, raising concerns of unintended consequences of the program for vulnerable populations. Policies to reduce hospital readmissions must balance the need to ensure continued access to quality care for vulnerable populations. © Health Research and Educational Trust.

  15. The Medicare Hospital Readmissions Reduction Program: Potential Unintended Consequences for Hospitals Serving Vulnerable Populations

    PubMed Central

    Gu, Qian; Koenig, Lane; Faerberg, Jennifer; Steinberg, Caroline Rossi; Vaz, Christopher; Wheatley, Mary P

    2014-01-01

    Objective To explore the impact of the Hospital Readmissions Reduction Program (HRRP) on hospitals serving vulnerable populations. Data Sources/Study Setting Medicare inpatient claims to calculate condition-specific readmission rates. Medicare cost reports and other sources to determine a hospital's share of duals, profit margin, and characteristics. Study Design Regression analyses and projections were used to estimate risk-adjusted readmission rates and financial penalties under the HRRP. Findings were compared across groups of hospitals, determined based on their share of duals, to assess differential impacts of the HRRP. Principal Findings Both patient dual-eligible status and a hospital's dual-eligible share of Medicare discharges have a positive impact on risk-adjusted hospital readmission rates. Under current Centers for Medicare and Medicaid Service methodology, which does not adjust for socioeconomic status, high-dual hospitals are more likely to have excess readmissions than low-dual hospitals. As a result, HRRP penalties will disproportionately fall on high-dual hospitals, which are more likely to have negative all-payer margins, raising concerns of unintended consequences of the program for vulnerable populations. Conclusions Policies to reduce hospital readmissions must balance the need to ensure continued access to quality care for vulnerable populations. PMID:24417309

  16. Hospital economics of primary total knee arthroplasty at a teaching hospital.

    PubMed

    Healy, William L; Rana, Adam J; Iorio, Richard

    2011-01-01

    The hospital cost of total knee arthroplasty (TKA) in the United States is a major growing expense for the Centers for Medicare & Medicaid Services (CMS). Many hospitals are unable to deliver TKA with profitable or breakeven economics under the current Diagnosis-Related Group (DRG) hospital reimbursement system. The purposes of the current study were to (1) determine revenue, expenses, and profitability (loss) for TKA for all patients and for different payors; (2) define changes in utilization and unit costs associated with this operation; and (3) describe TKA cost control strategies to provide insight for hospitals to improve their economic results for TKA. From 1991 to 2009, Lahey Clinic converted a $2172 loss per case on primary TKA in 1991 to a $2986 profit per case in 2008. The improved economics was associated with decreasing revenue in inflation-adjusted dollars and implementation of hospital cost control programs that reduced hospital expenses for TKA. Reduction of hospital length of stay and reduction of knee implant costs were the major drivers of hospital expense reduction. During the last 25 years, our economic experience with TKA is concerning. Hospital revenues have lagged behind inflation, hospital expenses have been reduced, and our institution is earning a profit. However, the margin for TKA is decreasing and Managed Medicare patients do not generate a profit. The erosion of hospital revenue for TKA will become a critical issue if it leads to economic losses for hospitals or reduced access to TKA. Level III, Economic and Decision Analyses. See Guidelines for Authors for a complete description of levels of evidence.

  17. Markets for hospital services in Zambia.

    PubMed

    Nakamba, Pamela; Hanson, Kara; McPake, Barbara

    2002-01-01

    Hospital reforms involving the introduction of measures to increase competition in hospital markets are being implemented in a range of low and middle-income countries. However, little is understood about the operation of hospital markets outside the USA and the UK. This paper assesses the degree of competition for hospital services in two hospital markets in Zambia (Copperbelt and Midlands), and the implications for prices, quality and efficiency. We found substantial differences among different hospital types in prices, costs and quality, suggesting that the hospital service market is a segmented market. The two markets differ significantly in their degree of competition, with the high cost inpatient services market in Copperbelt relatively more competitive than that in the Midlands market. The implications of these differences are discussed in terms of the potential for competition to improve hospital performance, the impact of market structure on equity of access, and how the government should address the problem of the mine hospitals.

  18. Freestanding heart hospitals is the end near?

    PubMed

    Ronning, Philip L; Nugent, Michael

    2004-09-01

    Freestanding heart hospitals are not enjoying the same competitive advantages they have in recent years for several reasons: Regulatory policy seems to be turning against them. They no longer enjoy the same cost structure advantage. Technology shifts mean lower payment rates and higher costs for cardiac services. Their access to capital is diminished. Traditional hospitals are mounting more effective competitive responses, while entrepreneurial physician practice executives are pursuing alternative strategies that may lead to more competition for heart hospitals.

  19. 42 CFR 409.13 - Drugs and biologicals.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 42 Public Health 2 2012-10-01 2012-10-01 false Drugs and biologicals. 409.13 Section 409.13 Public... § 409.13 Drugs and biologicals. (a) Except as specified in paragraph (b) of this section, Medicare pays for drugs and biologicals as inpatient hospital or inpatient CAH services only if— (1) They represent...

  20. 42 CFR 409.13 - Drugs and biologicals.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false Drugs and biologicals. 409.13 Section 409.13 Public... § 409.13 Drugs and biologicals. (a) Except as specified in paragraph (b) of this section, Medicare pays for drugs and biologicals as inpatient hospital or inpatient CAH services only if— (1) They represent...

  1. 42 CFR 409.13 - Drugs and biologicals.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Drugs and biologicals. 409.13 Section 409.13 Public... § 409.13 Drugs and biologicals. (a) Except as specified in paragraph (b) of this section, Medicare pays for drugs and biologicals as inpatient hospital or inpatient CAH services only if— (1) They represent...

  2. 42 CFR 409.13 - Drugs and biologicals.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 42 Public Health 2 2013-10-01 2013-10-01 false Drugs and biologicals. 409.13 Section 409.13 Public... § 409.13 Drugs and biologicals. (a) Except as specified in paragraph (b) of this section, Medicare pays for drugs and biologicals as inpatient hospital or inpatient CAH services only if— (1) They represent...

  3. 42 CFR 409.13 - Drugs and biologicals.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 42 Public Health 2 2014-10-01 2014-10-01 false Drugs and biologicals. 409.13 Section 409.13 Public... § 409.13 Drugs and biologicals. (a) Except as specified in paragraph (b) of this section, Medicare pays for drugs and biologicals as inpatient hospital or inpatient CAH services only if— (1) They represent...

  4. 42 CFR 495.10 - Participation requirements for EPs, eligible hospitals, and CAHs.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... Certification Number (CCN) and its Taxpayer Identification Number (TIN). (c) Subject to paragraph (f) of this... in a manner specified by CMS, the Taxpayer Identification Number (TIN) which may be the EP's Social... EPs may also assign their incentive payments to a TIN for an entity promoting the adoption of EHR...

  5. 42 CFR 495.10 - Participation requirements for EPs, eligible hospitals, and CAHs.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... manner specified by CMS its CMS Certification Number (CCN) and its Taxpayer Identification Number (TIN... Number (TIN) which may be the EP's Social Security Number (SSN) to which the EP's incentive payment... CFR part 424 subpart F. (ii) Medicaid EPs may also assign their incentive payments to a TIN for an...

  6. 42 CFR 495.10 - Participation requirements for EPs, eligible hospitals, and CAHs.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... Certification Number (CCN) and its Taxpayer Identification Number (TIN). (c) Subject to paragraph (f) of this... in a manner specified by CMS, the Taxpayer Identification Number (TIN) which may be the EP's Social... EPs may also assign their incentive payments to a TIN for an entity promoting the adoption of EHR...

  7. 42 CFR 495.10 - Participation requirements for EPs, eligible hospitals, and CAHs.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... manner specified by CMS its CMS Certification Number (CCN) and its Taxpayer Identification Number (TIN... Number (TIN) which may be the EP's Social Security Number (SSN) to which the EP's incentive payment... CFR part 424 subpart F. (ii) Medicaid EPs may also assign their incentive payments to a TIN for an...

  8. 42 CFR 495.10 - Participation requirements for EPs, eligible hospitals, and CAHs.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... Certification Number (CCN) and its Taxpayer Identification Number (TIN). (c) Subject to paragraph (f) of this... in a manner specified by CMS, the Taxpayer Identification Number (TIN) which may be the EP's Social... EPs may also assign their incentive payments to a TIN for an entity promoting the adoption of EHR...

  9. Hospital Choice of Rural Medicare Beneficiaries: Patient, Hospital Attributes, and the Patient–Physician Relationship

    PubMed Central

    Tai, Wan-Tzu Connie; Porell, Frank W; Adams, E Kathleen

    2004-01-01

    Objective To examine how patient and hospital attributes and the patient–physician relationship influence hospital choice of rural Medicare beneficiaries. Data Sources Medicare Current Beneficiary Survey (MCBS), Health Care Financing Administration (HCFA) Provider of Services (POS) file, American Hospital Association (AHA) Annual Survey, and Medicare Hospital Service Area (HSA) files for 1994 and 1995. Study Design The study sample consisted of 1,702 hospitalizations of rural Medicare beneficiaries. McFadden's conditional logit model was used to analyze hospital choices of rural Medicare beneficiaries. The model included independent variables to control for patients' and hospitals' attributes and the distance to hospital alternatives. Principal Findings The empirical results show strong preferences of aged patients for closer hospitals and those of greater scale and service capacity. Patients with complex acute medical conditions and those with more resources were more likely to bypass their closest rural hospitals. Beneficiaries were more likely to bypass their closest rural hospital if they had no regular physician, had a shorter patient–physician tie, were dissatisfied with the availability of health care, and had a longer travel time to their physician's office. Conclusions The significant influences of patients' socioeconomic, health, and functional status, their satisfaction with and access to primary care, and their strong preferences for certain hospital attributes should inform federal program initiatives about the likely impacts of policy changes on hospital bypassing behavior. PMID:15533193

  10. The Economic Consequences of Hospital Admissions

    PubMed Central

    Dobkin, Carlos; Finkelstein, Amy; Kluender, Raymond; Notowidigdo, Matthew J.

    2017-01-01

    We use an event study approach to examine the economic consequences of hospital admissions for adults in two datasets: survey data from the Health and Retirement Study, and hospitalization data linked to credit reports. For non-elderly adults with health insurance, hospital admissions increase out-of-pocket medical spending, unpaid medical bills and bankruptcy, and reduce earnings, income, access to credit and consumer borrowing. The earnings decline is substantial compared to the out-of-pocket spending increase, and is minimally insured prior to age-eligibility for Social Security Retirement Income. Relative to the insured non-elderly, the uninsured non-elderly experience much larger increases in unpaid medical bills and bankruptcy rates following a hospital admission. Hospital admissions trigger less than 5 percent of all bankruptcies. PMID:29445246

  11. ADP Systems: Examination of Non-Federal Hospital Information Systems.

    DTIC Science & Technology

    1987-06-30

    administrative and business management, and other purposes, such as research . In 1980, we reported1 that integrated hospital information systems evolved...Defense’s (DOD) and Veterans Administration’s (VA) efforts to develop and implement systems for federal hospitals. We used two methods to derive the...integrated in that they supported a variety of hospital activities and a uniform set of data access methods . The hospitals in our survey indicated that

  12. Mapping Population-Level Spatial Access to Essential Surgical Care in Ghana Using Availability of Bellwether Procedures.

    PubMed

    Stewart, Barclay T; Tansley, Gavin; Gyedu, Adam; Ofosu, Anthony; Donkor, Peter; Appiah-Denkyira, Ebenezer; Quansah, Robert; Clarke, Damian L; Volmink, Jimmy; Mock, Charles

    2016-08-17

    Conditions that can be treated by surgery comprise more than 16% of the global disease burden. However, 5 billion people do not have access to essential surgical care. An estimated 90% of the 87 million disability-adjusted life-years incurred by surgical conditions could be averted by providing access to timely and safe surgery in low-income and middle-income countries. Population-level spatial access to essential surgery in Ghana is not known. To assess the performance of bellwether procedures (ie, open fracture repair, emergency laparotomy, and cesarean section) as a proxy for performing essential surgery more broadly, to map population-level spatial access to essential surgery, and to identify first-level referral hospitals that would most improve access to essential surgery if strengthened in Ghana. Population-based study among all households and public and private not-for-profit hospitals in Ghana. Households were represented by georeferenced census data. First-level and second-level referral hospitals managed by the Ministry of Health and all tertiary hospitals were included. Surgical data were collected from January 1 to December 31, 2014. All procedures performed at first-level referral hospitals in Ghana in 2014 were used to sort each facility into 1 of the following 3 hospital groups: those without capability to perform all 3 bellwether procedures, those that performed 1 to 11 of each procedure, and those that performed at least 12 of each procedure. Candidates for targeted capability improvement were identified by cost-distance and network analysis. Of 155 first-level referral hospitals managed by the Ghana Health Service and the Christian Health Association of Ghana, 123 (79.4%) reported surgical data. Ninety-five (77.2%) did not have the capability in 2014 to perform all 3 bellwether procedures, 24 (19.5%) performed 1 to 11 of each bellwether procedure, and 4 (3.3%) performed at least 12. The essential surgical procedure rate was greater in bellwether

  13. Mapping Population-Level Spatial Access to Essential Surgical Care in Ghana Using Availability of Bellwether Procedures

    PubMed Central

    Stewart, Barclay T.; Tansley, Gavin; Gyedu, Adam; Ofosu, Anthony; Donkor, Peter; Appiah-Denkyira, Ebenezer; Quansah, Robert; Clarke, Damian L.; Volmink, Jimmy; Mock, Charles

    2017-01-01

    IMPORTANCE Conditions that can be treated by surgery comprise more than 16% of the global disease burden. However, 5 billion people do not have access to essential surgical care. An estimated 90% of the 87 million disability-adjusted life-years incurred by surgical conditions could be averted by providing access to timely and safe surgery in low-income and middle-income countries. Population-level spatial access to essential surgery in Ghana is not known. OBJECTIVES To assess the performance of bellwether procedures (ie, open fracture repair, emergency laparotomy, and cesarean section) as a proxy for performing essential surgery more broadly, to map population-level spatial access to essential surgery, and to identify first-level referral hospitals that would most improve access to essential surgery if strengthened in Ghana. DESIGN, SETTING, AND PARTICIPANTS Population-based study among all households and public and private not-for-profit hospitals in Ghana. Households were represented by georeferenced census data. First-level and second-level referral hospitals managed by the Ministry of Health and all tertiary hospitals were included. Surgical data were collected from January 1 to December 31, 2014. MAIN OUTCOMES AND MEASURES All procedures performed at first-level referral hospitals in Ghana in 2014 were used to sort each facility into 1 of the following 3 hospital groups: those without capability to perform all 3 bellwether procedures, those that performed 1 to 11 of each procedure, and those that performed at least 12 of each procedure. Candidates for targeted capability improvement were identified by cost-distance and network analysis. RESULTS Of 155 first-level referral hospitals managed by the Ghana Health Service and the Christian Health Association of Ghana, 123 (79.4%) reported surgical data. Ninety-five (77.2%) did not have the capability in 2014 to perform all 3 bellwether procedures, 24 (19.5%) performed 1 to 11 of each bellwether procedure, and 4 (3

  14. Internet Hospitals in China: Cross-Sectional Survey

    PubMed Central

    Lin, Lingyan; Fan, Si; Lin, Fen; Wang, Long; Guo, Tongjun; Ma, Chuyang; Zhang, Jingkun; Chen, Yixin

    2017-01-01

    Background The Internet hospital, an innovative approach to providing health care, is rapidly developing in China because it has the potential to provide widely accessible outpatient service delivery via Internet technologies. To date, China’s Internet hospitals have not been systematically investigated. Objective The aim of this study was to describe the characteristics of China’s Internet hospitals, and to assess their health service capacity. Methods We searched Baidu, the popular Chinese search engine, to identify Internet hospitals, using search terms such as “Internet hospital,” “web hospital,” or “cloud hospital.” All Internet hospitals in mainland China were eligible for inclusion if they were officially registered. Our search was carried out until March 31, 2017. Results We identified 68 Internet hospitals, of which 43 have been put into use and 25 were under construction. Of the 43 established Internet hospitals, 13 (30%) were in the hospital informatization stage, 24 (56%) were in the Web ward stage, and 6 (14%) were in full Internet hospital stage. Patients accessed outpatient service delivery via website (74%, 32/43), app (42%, 18/43), or offline medical consultation facility (37%, 16/43) from the Internet hospital. Furthermore, 25 (58%) of the Internet hospitals asked doctors to deliver health services at a specific Web clinic, whereas 18 (42%) did not. The consulting methods included video chat (60%, 26/43), telephone (19%, 8/43), and graphic message (28%, 12/43); 13 (30%) Internet hospitals cannot be consulted online any more. Only 6 Internet hospitals were included in the coverage of health insurance. The median number of doctors available online was zero (interquartile range [IQR] 0 to 5; max 16,492). The median consultation fee per time was ¥20 (approximately US $2.90, IQR ¥0 to ¥200). Conclusions Internet hospitals provide convenient outpatient service delivery. However, many of the Internet hospitals are not yet mature and

  15. Hospital safeguards capital program through private sector partnership.

    PubMed

    Thomas, J; Lungo, A; Bobrow, M

    1984-02-01

    As access to capital tightens, more hospitals are exploring the benefits of partnerships with private companies. A California hospital, burdened by the long-term debt it incurred for a medical office building, worked together with its medical staff and an outside real estate developer. By selling the building to the developer, not only was the hospital able to finance a much-needed expansion and reconstruction project, but the hospital's medical staff had an opportunity to become limited partners in the ownership of the building.

  16. Can I read my own hospital notes?

    PubMed

    Cornock, Marc

    2016-10-12

    Notes made about you while you are in any health setting are not yours. If it is an NHS hospital, they belong to the health secretary; if it is a private hospital, they belong to the consultant or the hospital itself. If something belongs to someone else, you do not have a right to it. The Data Protection Act 1998 allows you to access your health records, but this usually means you receive a copy rather than obtaining and holding the originals.

  17. A Continuous Flow Column Study of the Anaerobic Transformation of a CAH Mixture of Tetrachloroethene and Carbon Tetrachloride Using Formate as an Electron Donor

    NASA Astrophysics Data System (ADS)

    Semprini, L.; Azizian, M. F.; Kim, Y.

    2011-12-01

    Many groundwater sites are contaminated with mixtures of chlorinated aliphatic hydrocarbons (CAHs) that represent a challenge when biological remediation processes are being considered. This is especially challenging when high concentrations of CAHs are present.Trichloromethane (CF), for example, has been observed to inhibit and potentially exert toxicity on reductive dehalogenation of tetrachloroethene (PCE) and trichloroethene (TCE). Results will be presented from a continuous flow column study where the simultaneous transformation of PCE and carbon tetrachloride (CT) was achieved. The column was packed with a quartz sand and bioaugmented with the Evanite Culture (EV) that is capable of transforming PCE to ethene. The column was fed a synthetic groundwater that was amended with PCE to achieve an influent concentration near its solubility limit (0.10 mM) and formate (1.5 mM) that reacts to produce hydrogen as the ultimate electron donor. The column was operated for over 1600 days prior to the addition of CT. During this period PCE was transformed mainly to vinyl chloride (VC) and ethene (ETH) and minor amounts of cis-dichloroethene (cis-DCE) and TCE. The transformation extent achieved based on the column effluent concentrations ranged from about 50% ETH, 30% VC, and 20 cis-DCE up to 80% ETH and 20% VC. When the column was fed sulfate, it was completely transformed via sulfate reduction. Ferrous iron production from ferric iron reduction was observed early in the study. Acetate was also formed as a result of homoacetogenesis from hydrogen utilization. CT addition (0.015 mM) was started at 1600 days while PCE addition was continued. During the first 25 days of CT addition, CT concentrations gradually increased to 50% of the injection concentration and chloromethane (CM) and CF were observed as transformation products. CT concentrations then decreased with over 98% transformation achieved.CM was removed to below the detection limit and CF concentration decreases to

  18. [Public access defibrillation].

    PubMed

    Katz, Eugène; Metzger, Jacques-Thierry; Sierro, Christophe; Deac, Monica; Fishman, Daniel; Girod, Grégoire; Potin, Mathieu; Niquille, Marc; Stauffer, Jean-Christoffe; Kehtari, Réza; Sénéchaud, Christophe; Garcia, Wenceslao; Rodriguez, Maria; Fromer, Martin

    2008-08-27

    Placement of automated external defibrillators (AED) in public facilities and training of the lay persons in basic life support-defibrillation (BLS-D) was recommended by the American Heart Association for the treatment of out-of-hospital cardiac arrest (OHCA). Immediate use of AED result in increase of survival to hospital discharge. Many observation and much less randomized trials describe clinical efficacy of this approach. However, "negative" trials have also been published and some recent data suggest that public access defibrillation (PAD) will have a minimal impact on population survival. In this article various PAD strategies were briefly reviewed. In our opinion installation of AED in public places should be based on the long-term study of local OHCA demography and preceded by widespread BLS training of lay population.

  19. 42 CFR 409.87 - Blood deductible.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... after plasma is separated from whole blood. (2) A unit of packed red cells is treated as the equivalent... red cells—(1) Basic rule. Except as specified in paragraph (b)(2) of this section, the beneficiary is... hospital's or CAH's charges for the blood or packed red cells or arranging for it to be replaced. (2...

  20. [Public control and equity of access to hospitals under non-State public administration].

    PubMed

    Carneiro Junior, Nivaldo; Elias, Paulo Eduardo

    2006-10-01

    To analyze social health organizations in the light of public control and the guarantee of equity of access to health services. Utilizing the case study technique, two social health organizations in the metropolitan region of São Paulo were selected. The analytical categories were equity of access and public control, and these were based on interviews with key informants and technical-administrative reports. It was observed that the overall funding and administrative control of the social health organizations are functions of the state administrator. The presence of a local administrator is important for ensuring equity of access. Public control is expressed through supervisory actions, by means of accounting and financial procedures. Equity of access and public control are not taken into consideration in the administration of these organizations. The central question lies in the capacity of the public authorities to have a presence in implementing this model at the local level, thereby ensuring equity of access and taking public control into consideration.

  1. Primary Care Patients' Preference for Hospitals over Clinics in Korea.

    PubMed

    Kim, Agnus M; Cho, Seongcheol; Kim, Hyun Joo; Jung, Hyemin; Jo, Min-Woo; Lee, Jin Yong; Eun, Sang Jun

    2018-05-30

    Korea is in a unique condition to observe whether patients, when equal access to the levels of health care facilities is guaranteed by the support of the national health insurance, choose the appropriate levels of health care facilities. This study was performed to investigate the primary care patients' preference for hospitals over clinics under no restriction for their choice. We used the 2011 National Inpatient Sample database of the Health Insurance Review and Assessment Service in Korea. A primary care patient was defined as a patient who visited as an outpatient in health care facilities with one of the 52 minor conditions defined by the Korean government. We found that approximately 15% of outpatient visits of the patients who were eligible for primary care in Korea happened in hospitals. In terms of cost, the outpatient visits in hospitals accounted for about 29% of total cost of outpatient visits. This arbitrary access to hospitals can lead to an inefficient use of health care resources. In order to ensure that health care facilities are stratified in terms of access as well as size and function, interventions to distribute patients to the appropriate level of care are required.

  2. Access to electronic health knowledge in five countries in Africa: a descriptive study.

    PubMed

    Smith, Helen; Bukirwa, Hasifa; Mukasa, Oscar; Snell, Paul; Adeh-Nsoh, Sylvester; Mbuyita, Selemani; Honorati, Masanja; Orji, Bright; Garner, Paul

    2007-05-17

    Access to medical literature in developing countries is helped by open access publishing and initiatives to allow free access to subscription only journals. The effectiveness of these initiatives in Africa has not been assessed. This study describes awareness, reported use and factors influencing use of on-line medical literature via free access initiatives. Descriptive study in four teaching hospitals in Cameroon, Nigeria, Tanzania and Uganda plus one externally funded research institution in The Gambia. Survey with postgraduate doctors and research scientists to determine Internet access patterns, reported awareness of on-line medical information and free access initiatives; semi structured interviews with a sub-sample of survey participants to explore factors influencing use. In the four African teaching hospitals, 70% of the 305 postgraduate doctors reported textbooks as their main source of information; 66% had used the Internet for health information in the last week. In two hospitals, Internet cafés were the main Internet access point. For researchers at the externally-funded research institution, electronic resources were their main source, and almost all had used the Internet in the last week. Across all 333 respondents, 90% had heard of PubMed, 78% of BMJ on line, 49% the Cochrane Library, 47% HINARI, and 19% BioMedCentral. HINARI use correlates with accessing the Internet on computers located in institutions. Qualitative data suggested there are difficulties logging into HINARI and that sometimes it is librarians that limit access to passwords. Text books remain an important resource for postgraduate doctors in training. Internet use is common, but awareness of free-access initiatives is limited. HINARI and other initiatives could be more effective with strong institutional endorsement and management to promote and ensure access.

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

    PubMed

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

    2018-01-01

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

  4. 75 FR 70831 - Medicare and Medicaid Programs: Changes to the Hospital and Critical Access Hospital Conditions...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-19

    ..., sex, gender identity, sexual orientation, or disability. In addition, we proposed to require hospitals... race, color, national origin, religion, sex, gender identity, sexual orientation, or disability..., whether a spouse, a domestic partner (including a same-sex domestic partner), another family member, or a...

  5. Social efficiency of hospital care delivery: frontier analysis from the consumer's perspective.

    PubMed

    Bernet, Patrick M; Moises, James; Valdmanis, Vivian Grace

    2011-02-01

    The efficiency of hospital services and patients' access to hospitals are both important health care policy issues. In the past, research has relied on studying these topics separately. In this article, we measure both efficiency and access at the same time using data envelopment analysis (DEA). By including both the technically efficient use of resources, as well as the patients' travel distances, we found increases in social efficiency when patients' travel distances were taken into account. When compared with patients with nonurgent conditions, we found that patients suffering from conditions requiring urgent attention were treated at closer hospitals, increasing the social efficiency. Insurance coverage and hospital ownership were also examined. Our findings corroborated past literature in the hospital and travel distance literature and set out a framework for future research. Perhaps most important, we demonstrate the techniques needed to incorporate broader measures of social costs into studies of hospital efficiency.

  6. Using mPINC data to measure breastfeeding support for hospital employees.

    PubMed

    Allen, Jessica A; Belay, Brook; Perrine, Cria G

    2014-02-01

    Employer support is important for mothers, as returning to work is a common reason for discontinuing breastfeeding. This article explores support available to breastfeeding employees of hospitals that provide maternity care. This study aimed to describe the prevalence of 7 different types of worksite support and changes in these supports available to breastfeeding employees at hospitals that provide maternity care from 2007 to 2011. Hospital data from the 2007, 2009, and 2011 Centers for Disease Control and Prevention Survey on Maternity Practices in Infant Nutrition and Care (mPINC) were analyzed. Survey respondents were asked if the hospital provides any of the following supports to hospital staff: (1) a designated room to express milk, (2) on-site child care, (3) an electric breast pump, (4) permission to use existing work breaks to express milk, (5) a breastfeeding support group, (6) lactation consultant/specialist available for consult, and (7) paid maternity leave other than accrued vacation or sick leave. This study was exempt from ethical approval because it was a secondary analysis of a publicly available dataset. Of the 7 worksite supports in hospitals measured, 6 increased and 1 decreased from 2007 to 2011. Across all survey years, more than 70% of hospitals provided supports for expressing breast milk, whereas less than 15% provided direct access to the breastfeeding child through on-site child care, and less than 35% offered paid maternity leave. Results differed by region and hospital size and type. In 2011, only 2% of maternity hospitals provided all 7 worksite supports; 40% provided 5 or more. The majority of maternity care hospitals (> 70%) offer breastfeeding supports that allow employees to express breast milk. Supports that provide direct access to the breastfeeding child, which would allow employees to breastfeed at the breast, and access to breastfeeding support groups are much less frequent than other supports, suggesting opportunities for

  7. Changes in the Healthcare Safety Net 1992–2003: Disparities in Access for Uninsured Persons in Florida

    PubMed Central

    Kuo, Tzy-Mey; Mobley, Lee R.; Bazzoli, Gloria J.

    2011-01-01

    A patchwork of services is available to the US uninsured through the healthcare safety net (SN). During 1996–2003, some SN hospitals (SNHs) closed or converted ownership from public or non-profit to for-profit status. However, around this time the number of community health centers (CHCs) grew due to new federal funding. This paper examines the impact of these two countervailing SN events on access to care for the uninsured. Hospital admissions for ambulatory care sensitive conditions (ACSCs) relative to marker conditions were used as our access measure. We examined 35,730 discharges for uninsured adults treated in Florida hospitals in the years 1992 or 2003. A generalized estimating equation model was used to assess differential access effects for racial and ethnic groups. We found that in communities with CHC openings but no SNH contractions, uninsured black and white individuals experienced deteriorations in access over time but the Hispanic uninsured did not. However, in communities where SNHs closed or converted, access deteriorations occurred for all three racial and ethnic groups. Thus, the potentially beneficial effects of CHC expansions on access to primary care for the uninsured Hispanic population in Florida appeared to be offset if contractions in the hospital safety net were present. PMID:24066421

  8. Prenatal hormones and postnatal socialization by parents as determinants of male-typical toy play in girls with congenital adrenal hyperplasia.

    PubMed

    Pasterski, Vickie L; Geffner, Mitchell E; Brain, Caroline; Hindmarsh, Peter; Brook, Charles; Hines, Melissa

    2005-01-01

    Toy choices of 3- to 10-year-old children with congenital adrenal hyperplasia (CAH) and of their unaffected siblings were assessed. Also assessed was parental encouragement of sex-typed toy play. Girls with CAH displayed more male-typical toy choices than did their unaffected sisters, whereas boys with and without CAH did not differ. Mothers and fathers encouraged sex-typical toy play in children with and without CAH. However, girls with CAH received more positive feedback for play with girls' toys than did unaffected girls. Data show that increased male-typical toy play by girls with CAH cannot be explained by parental encouragement of male-typical toy play. Although parents encourage sex-appropriate behavior, their encouragement appears to be insufficient to override the interest of girls with CAH in cross-sexed toys.

  9. Medicare program: changes to the hospital outpatient prospective payment system and CY 2008 payment rates, the ambulatory surgical center payment system and CY 2008 payment rates, the hospital inpatient prospective payment system and FY 2008 payment rates; and payments for graduate medical education for affiliated teaching hospitals in certain emergency situations Medicare and Medicaid programs: hospital conditions of participation; necessary provider designations of critical access hospitals. Interim and final rule with comment period.

    PubMed

    2007-11-27

    This final rule with comment period revises the Medicare hospital outpatient prospective payment system to implement applicable statutory requirements and changes arising from our continuing experience with this system. We describe the changes to the amounts and factors used to determine the payment rates for Medicare hospital outpatient services paid under the prospective payment system. These changes are applicable to services furnished on or after January 1, 2008. In addition, the rule sets forth the applicable relative payment weights and amounts for services furnished in ASCs, specific HCPCS codes to which the final policies of the ASC payment system apply, and other pertinent rate setting information for the CY 2008 ASC payment system. Furthermore, this final rule with comment period will make changes to the policies relating to the necessary provider designations of critical access hospitals and changes to several of the current conditions of participation requirements. The attached document also incorporates the changes to the FY 2008 hospital inpatient prospective payment system (IPPS) payment rates made as a result of the enactment of the TMA, Abstinence Education, and QI Programs Extension Act of 2007, Public Law 110-90. In addition, we are changing the provisions in our previously issued FY 2008 IPPS final rule and are establishing a new policy, retroactive to October 1, 2007, of not applying the documentation and coding adjustment to the FY 2008 hospital-specific rates for Medicare-dependent, small rural hospitals (MDHs) and sole community hospitals (SCHs). In the interim final rule with comment period in this document, we are modifying our regulations relating to graduate medical education (GME) payments made to teaching hospitals that have Medicare affiliation agreements for certain emergency situations.

  10. 77 FR 29033 - Medicare and Medicaid Programs; Reform of Hospital and Critical Access Hospital Conditions of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-16

    ... organizational structure, whereby multi- hospital systems have integrated their governing body functions to... based on nationally recognized and evidence-based guidelines and recommendations. Verbal Orders: We have..., Outpatient services ($300 million). Our estimates were based on input from stakeholders as well as on our own...

  11. Hospital mergers: a panacea?

    PubMed

    Weil, Thomas

    2010-10-01

    Hospital mergers in Europe and North America have been launched to scale down expenditure, enhance the delivery of health care and elevate quality. However, the outcome of mergers suggest that they neither generated cost savings nor improved the quality of care. Almost all consolidations fall short, since those in leadership positions lack the necessary understanding and appreciation of the differences in culture, values and goals of the existing facilities. In spite of these shortcomings, hospital mergers will continue to be pursued in order to improve market share, eliminate excess capacity, gain access to capital and enhance the personal egos of the organizations' leaders.

  12. Ehlers-Danlos Syndrome Caused by Biallelic TNXB Variants in Patients with Congenital Adrenal Hyperplasia.

    PubMed

    Chen, Wuyan; Perritt, Ashley F; Morissette, Rachel; Dreiling, Jennifer L; Bohn, Markus-Frederik; Mallappa, Ashwini; Xu, Zhi; Quezado, Martha; Merke, Deborah P

    2016-09-01

    Some variants that cause autosomal-recessive congenital adrenal hyperplasia (CAH) also cause hypermobility type Ehlers-Danlos syndrome (EDS) due to the monoallelic presence of a chimera disrupting two flanking genes: CYP21A2, encoding 21-hydroxylase, necessary for cortisol and aldosterone biosynthesis, and TNXB, encoding tenascin-X, an extracellular matrix protein. Two types of CAH tenascin-X (CAH-X) chimeras have been described with a total deletion of CYP21A2 and characteristic TNXB variants. CAH-X CH-1 has a TNXB exon 35 120-bp deletion resulting in haploinsufficiency, and CAH-X CH-2 has a TNXB exon 40 c.12174C>G (p.Cys4058Trp) variant resulting in a dominant-negative effect. We present here three patients with biallelic CAH-X and identify a novel dominant-negative chimera termed CAH-X CH-3. Compared with monoallelic CAH-X, biallelic CAH-X results in a more severe phenotype with skin features characteristic of classical EDS. We present evidence for disrupted tenascin-X function and computational data linking the type of TNXB variant to disease severity. © 2016 WILEY PERIODICALS, INC.

  13. Enhancing healthcare accessibility measurements using GIS: A case study in Seoul, Korea.

    PubMed

    Kim, Yeeun; Byon, Young-Ji; Yeo, Hwasoo

    2018-01-01

    With recent aging demographic trends, the needs for enhancing geo-spatial analysis capabilities and monitoring the status of accessibilities of its citizens with healthcare services have increased. The accessibility to healthcare is determined not only by geographic distances to service locations, but also includes travel time, available modes of transportation, and departure time. Having access to the latest and accurate information regarding the healthcare accessibility allows the municipal government to plan for improvements, including expansion of healthcare infrastructure, effective labor distribution, alternative healthcare options for the regions with low accessibilities, and redesigning the public transportation routes and schedules. This paper proposes a new method named, Seoul Enhanced 2-Step Floating Catchment Area (SE2SFCA), which is customized for the city of Seoul, where population density is higher and the average distance between healthcare-service locations tends to be shorter than the typical North American or European cities. The proposed method of SE2SFCA is found to be realistic and effective in determining the weak accessibility regions. It resolves the over-estimation issues of the past, arising from the assignment of high healthcare accessibility for the regions with large hospitals and high density of population and hospitals.

  14. Internet Hospitals in China: Cross-Sectional Survey.

    PubMed

    Xie, Xiaoxu; Zhou, Weimin; Lin, Lingyan; Fan, Si; Lin, Fen; Wang, Long; Guo, Tongjun; Ma, Chuyang; Zhang, Jingkun; He, Yuan; Chen, Yixin

    2017-07-04

    The Internet hospital, an innovative approach to providing health care, is rapidly developing in China because it has the potential to provide widely accessible outpatient service delivery via Internet technologies. To date, China's Internet hospitals have not been systematically investigated. The aim of this study was to describe the characteristics of China's Internet hospitals, and to assess their health service capacity. We searched Baidu, the popular Chinese search engine, to identify Internet hospitals, using search terms such as "Internet hospital," "web hospital," or "cloud hospital." All Internet hospitals in mainland China were eligible for inclusion if they were officially registered. Our search was carried out until March 31, 2017. We identified 68 Internet hospitals, of which 43 have been put into use and 25 were under construction. Of the 43 established Internet hospitals, 13 (30%) were in the hospital informatization stage, 24 (56%) were in the Web ward stage, and 6 (14%) were in full Internet hospital stage. Patients accessed outpatient service delivery via website (74%, 32/43), app (42%, 18/43), or offline medical consultation facility (37%, 16/43) from the Internet hospital. Furthermore, 25 (58%) of the Internet hospitals asked doctors to deliver health services at a specific Web clinic, whereas 18 (42%) did not. The consulting methods included video chat (60%, 26/43), telephone (19%, 8/43), and graphic message (28%, 12/43); 13 (30%) Internet hospitals cannot be consulted online any more. Only 6 Internet hospitals were included in the coverage of health insurance. The median number of doctors available online was zero (interquartile range [IQR] 0 to 5; max 16,492). The median consultation fee per time was ¥20 (approximately US $2.90, IQR ¥0 to ¥200). Internet hospitals provide convenient outpatient service delivery. However, many of the Internet hospitals are not yet mature and are faced with various issues such as online doctor scarcity and

  15. Infection and hemodialysis access: an updated review.

    PubMed

    Gupta, Vineet; Yassin, Mohamed H

    2013-06-01

    The incidence of end-stage renal disease (ESRD) has almost doubled over past 2 decades. Despite decreasing overall hospital admission rates for ESRD population, the rate of infection-related hospitalizations has steadily increased. Infection remains the second most common cause of mortality in this patient population. Specifically, in the hemodialysis (HD) patients, the vascular access related infections are the most common identifiable source of infection. This concise review provides an update on the bacteremia related to vascular access primarily the catheters (Catheter Related Blood Stream Infection- CRBSI) in HD patients emphasizing on the determinants ranging from the epidemiology to pathogenesis, risk factors, cost implications and prevention. Staphylococcus aureus, coagulase negative Staphylococci, and Enterococci are the most common causative microorganisms implicated in CRBSI. The pathogenesis of CRBSI includes organism entry into the blood stream followed by adherence to catheter, colonization and biofilm formation. Vascular access type, catheter position, and prior bacteremic episodes are strongly associated with blood stream infection. Preventive measures should be multidisciplinary in nature and should include avoidance of central venous catheters, best practices for catheter care, surveillance, antimicrobial catheter lock solutions, and use of antibiotic impregnated catheters.

  16. Presence of nursing information on hospital websites in five countries: a review.

    PubMed

    Chen, L L; Liu, Y L

    2010-06-01

    The aims of this study were to (1) examine the presence of nursing information on 50 hospital websites across five countries; (2) describe the accessibility, range and depth of nursing information provided; and (3) compare the characteristics of nursing web information across the countries. Providing information on hospital website is an increasingly popular strategy for marketing hospital services, and it has been playing unique and important roles for nursing. So far, the nursing information offered via hospital websites is not uncommon worldwide, but the amount, content and form of such information presented by the institutions of different countries have not been examined systematically. Objective sampling was employed to select 50 top hospital websites from five countries, with ten for each geographical region, namely, Australia (Oceania), China (Asia), South Africa (Africa), UK (Europe) and the USA (North America). A self-developed checklist was used to examine the presence of nursing information on the above-mentioned hospital websites. The most frequently presented information on the hospital websites was nursing employment (job placement), nursing education, and news and events concerning the nursing profession, but information about other aspects of nursing was relatively lacking. The hospital websites in the USA and Australia provided more information as compared with those in China and the UK. Nursing information was almost unavailable on hospital websites in South Africa. Although the accessibility of nursing-related information has been improved, the presence of nursing information was not strong on the hospital websites across the five countries. The nursing information presented on hospital websites varied with different countries. Efforts have to be made to improve the presence and accessibility of nursing information. Information about the nursing services, professional image of nurses and nursing employment should be enhanced.

  17. Access to hospital interpreter services for limited English proficient patients in New Jersey: a statewide evaluation.

    PubMed

    Flores, Glenn; Torres, Sylvia; Holmes, Linda Janet; Salas-Lopez, Debbie; Youdelman, Mara K; Tomany-Korman, Sandra C

    2008-05-01

    We surveyed New Jersey (NJ) hospitals to assess current language services and identify policy recommendations on meeting limited English proficiency (LEP) patients' needs. Survey with 37 questions regarding hospital/patient features, interpreter services, and resources/policies needed to provide quality interpreter services. Sixty-seven hospitals responded (55% response rate). Most NJ hospitals have no interpreter services department, 80% provide no staff training on working with interpreters, 31% lack multilingual signs, and 19% offer no written translation services. Only 3% of hospitals have full-time interpreters, a ratio of 1 interpreter:240,748 LEP NJ residents. Most hospitals stated third-party reimbursement for interpreters would be beneficial, by reducing costs, adding interpreters, meeting population growth, and improving communication. Most NJ hospitals have no full-time interpreters, interpreter services department, or staff training on working with interpreters, and deficiencies exist in hospital signage and translation services. Most NJ hospitals stated third-party reimbursement for interpreter services would be beneficial.

  18. Hospital managers' attitude and commitment toward electronic medical records system in Isfahan hospitals 2014.

    PubMed

    Jahanbakhsh, Maryam; Karimi, Saeed; Hassanzadeh, Akbar; Beigi, Maliheh

    2017-01-01

    Electronic medical record system (EMRS) is a valuable system for safe access to the patient's data and increases health care quality. Manpower is one of the requirements for EMRS, among which manager is the most important person in any hospital. Taking into account manager's positive attitude and good commitments, EMRS will be implemented successfully. As such, we decided to assess manager's attitude and commitment toward EMRS in Isfahan hospitals in the year of 2014. This article aimed to determine the hospital managers' attitude and commitment toward the implementation of EMRS. The present article is an applied analytic study. Research society consisted of the managers of all the hospitals in Isfahan that include hospitals affiliated to Isfahan University of Medical Sciences, private, and social security hospitals. This study was done in 2014. Data collection tools included a questionnaire for which reliability and validity were determined. Data were analyzed by means of SPSS 20. Average score for the managers' attitude toward EMRS in the city of Isfahan was 77.5 out of 100 and their average score for commitment was 74.7. Manager's attitude in social security hospitals was more positive than the private and governmental ones (83.3%). In addition, the amount of commitment by the managers in social security hospitals was higher than the same in private and governmental hospitals (86.6%). At present, managers' attitude and commitment in Isfahan hospitals toward EMRS are very high and social security hospitals show more readiness in this respect.

  19. On-site availability of selected antidotes: results of a survey of Massachusetts hospitals.

    PubMed

    Woolf, A D; Chrisanthus, K

    1997-01-01

    Hospital pharmacies in Massachusetts were surveyed to determine their patterns of stocking antidotes. Mailed questionnaires were completed by hospital pharmacy directors at 82 of 93 acute care institutions (87% response rate). Results confirmed great variability in on-site accessibility of antidotes. Only 8 of the 82 hospitals (9.8%) stocked all of 14 common antidotes inventoried by the survey. Even fewer hospital pharmacies stocked specific antidotes (eg, Crotalid anti-venin, digoxin-specific Fab antibodies, pyridoxine) in an adequate quantity to treat one poisoned adult. Larger hospitals and those with a 24-hour pharmacy were more likely to have certain antidotes than smaller institutions. We conclude that Massachusetts hospitals do not carry complete inventories of 14 common antidotes. It is important that poisoned patients be referred to medical centers with adequate toxicological care. Improved guidelines for the accessibility of antidotes need to be developed and made available to hospital pharmacies and emergency departments.

  20. Associations between Extending Access to Primary Care and Emergency Department Visits: A Difference-In-Differences Analysis.

    PubMed

    Whittaker, William; Anselmi, Laura; Kristensen, Søren Rud; Lau, Yiu-Shing; Bailey, Simon; Bower, Peter; Checkland, Katherine; Elvey, Rebecca; Rothwell, Katy; Stokes, Jonathan; Hodgson, Damian

    2016-09-01

    Health services across the world increasingly face pressures on the use of expensive hospital services. Better organisation and delivery of primary care has the potential to manage demand and reduce costs for hospital services, but routine primary care services are not open during evenings and weekends. Extended access (evening and weekend opening) is hypothesized to reduce pressure on hospital services from emergency department visits. However, the existing evidence-base is weak, largely focused on emergency out-of-hours services, and analysed using a before-and after-methodology without effective comparators. Throughout 2014, 56 primary care practices (346,024 patients) in Greater Manchester, England, offered 7-day extended access, compared with 469 primary care practices (2,596,330 patients) providing routine access. Extended access included evening and weekend opening and served both urgent and routine appointments. To assess the effects of extended primary care access on hospital services, we apply a difference-in-differences analysis using hospital administrative data from 2011 to 2014. Propensity score matching techniques were used to match practices without extended access to practices with extended access. Differences in the change in "minor" patient-initiated emergency department visits per 1,000 population were compared between practices with and without extended access. Populations registered to primary care practices with extended access demonstrated a 26.4% relative reduction (compared to practices without extended access) in patient-initiated emergency department visits for "minor" problems (95% CI -38.6% to -14.2%, absolute difference: -10,933 per year, 95% CI -15,995 to -5,866), and a 26.6% (95% CI -39.2% to -14.1%) relative reduction in costs of patient-initiated visits to emergency departments for minor problems (absolute difference: -£767,976, -£1,130,767 to -£405,184). There was an insignificant relative reduction of 3.1% in total emergency

  1. Associations between Extending Access to Primary Care and Emergency Department Visits: A Difference-In-Differences Analysis

    PubMed Central

    Whittaker, William; Anselmi, Laura; Lau, Yiu-Shing; Bower, Peter; Checkland, Katherine; Elvey, Rebecca; Stokes, Jonathan

    2016-01-01

    Background Health services across the world increasingly face pressures on the use of expensive hospital services. Better organisation and delivery of primary care has the potential to manage demand and reduce costs for hospital services, but routine primary care services are not open during evenings and weekends. Extended access (evening and weekend opening) is hypothesized to reduce pressure on hospital services from emergency department visits. However, the existing evidence-base is weak, largely focused on emergency out-of-hours services, and analysed using a before-and after-methodology without effective comparators. Methods and Findings Throughout 2014, 56 primary care practices (346,024 patients) in Greater Manchester, England, offered 7-day extended access, compared with 469 primary care practices (2,596,330 patients) providing routine access. Extended access included evening and weekend opening and served both urgent and routine appointments. To assess the effects of extended primary care access on hospital services, we apply a difference-in-differences analysis using hospital administrative data from 2011 to 2014. Propensity score matching techniques were used to match practices without extended access to practices with extended access. Differences in the change in “minor” patient-initiated emergency department visits per 1,000 population were compared between practices with and without extended access. Populations registered to primary care practices with extended access demonstrated a 26.4% relative reduction (compared to practices without extended access) in patient-initiated emergency department visits for “minor” problems (95% CI -38.6% to -14.2%, absolute difference: -10,933 per year, 95% CI -15,995 to -5,866), and a 26.6% (95% CI -39.2% to -14.1%) relative reduction in costs of patient-initiated visits to emergency departments for minor problems (absolute difference: -£767,976, -£1,130,767 to -£405,184). There was an insignificant

  2. Mid-term NEAT review: analysing the improvements in hospital ED performance.

    PubMed

    Khanna, Sankalp; Boyle, Justin; Good, Norm; Lind, James

    2014-01-01

    Introduced with a promise to reduce overcrowding in the Emergency Department (ED) and the associated morbidity and mortality linked to bed access difficulties, the National Emergency Access Target (NEAT) is now over halfway through transitionary arrangements towards a target of 90% of patients that visit a hospital ED being admitted or discharged within 4 hours. Facilitation and reward funding has ensured hospitals around the country are remodelling workflows to ensure compliance. Recent reports however show that the majority of hospitals are still far from being able to meet this target. We investigate the NEAT journey of 30 Queensland hospitals over the past two years and compare this performance to a previous study that investigated the 4 hour ED discharge performance of these hospitals at various times of day and under varying occupancy conditions. Our findings reveal that, while most hospitals have made significant improvements to their 4 hour discharge performance in 2013, the underlying flow patterns and periods of poor NEAT compliance remain largely unchanged. The work identifies areas for targeted improvement to inform system redesign and workflow planning.

  3. Improving Health Care Accessibility: Strategies and Recommendations.

    PubMed

    Almorsy, Lamia; Khalifa, Mohamed

    2016-01-01

    Access time refers to the interval between requesting and actual outpatient appointment. It reflects healthcare accessibility and has a great influence on patient treatment and satisfaction. King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia studied the accessibility to outpatient services in order to develop useful strategies and recommendations for improvement. Utilized, unutilized and no-show appointments were analyzed. It is crucial to manage no-shows and short notice appointment cancellations by preparing a waiting list for those patients who can be called in to an appointment on the same day using an open access policy. An overlapping appointment scheduling model can be useful to minimize patient waiting time and doctor idle time in addition to the sensible use of appointment overbooking that can significantly improve productivity.

  4. Cost effective Internet access and video conferencing for a community cancer network.

    PubMed Central

    London, J. W.; Morton, D. E.; Marinucci, D.; Catalano, R.; Comis, R. L.

    1995-01-01

    Utilizing the ubiquitous personal computer as a platform, and Integrated Services Digital Network (ISDN) communications, cost effective medical information access and consultation can be provided for physicians at geographically remote sites. Two modes of access are provided: information retrieval via the Internet, and medical consultation video conferencing. Internet access provides general medical information such as current treatment options, literature citations, and active clinical trials. During video consultations, radiographic and pathology images, and medical text reports (e.g., history and physical, pathology, radiology, clinical laboratory reports), may be viewed and simultaneously annotated by either video conference participant. Both information access modes have been employed by physicians at community hospitals which are members of the Jefferson Cancer Network, and oncologists at Thomas Jefferson University Hospital. This project has demonstrated the potential cost effectiveness and benefits of this technology. Images Figure 1 Figure 2 Figure 3 PMID:8563397

  5. 42 CFR 410.161 - Part B blood deductible.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... remain after plasma is separated from whole blood. (2) A unit of packed red cells is treated as the... calendar year. (2) If the blood is furnished by a hospital or CAH, the rules set forth in § 409.87 (b), (c... 42 Public Health 2 2010-10-01 2010-10-01 false Part B blood deductible. 410.161 Section 410.161...

  6. Residential segregation and the survival of U.S. urban public hospitals.

    PubMed

    Ko, Michelle; Needleman, Jack; Derose, Kathryn Pitkin; Laugesen, Miriam J; Ponce, Ninez A

    2014-06-01

    Residential segregation is associated geographic disparities in access to care, but its impact on local health care policy, including public hospitals, is unknown. We examined the effects of racial residential segregation on U.S. urban public hospital closures from 1987 to 2007, controlling for hospital, market, and policy characteristics. We found that a high level of residential segregation moderated the protective effects of Black population composition, such that a high level of residential segregation, in combination with a high percentage of poor residents, conferred a higher likelihood of hospital closure. More segregated and poorer communities face disadvantages in access to care that may be compounded as a result of instability in the health care safety net. Policy makers should consider the influence of social factors such as residential segregation on the allocation of the safety net resources.

  7. Ensuring Access to Quality Health Care in Vulnerable Communities.

    PubMed

    Bhatt, Jay; Bathija, Priya

    2018-04-24

    For millions of Americans living in vulnerable rural and urban communities, their hospital is an important, and often their only, source of health care. As transformation in the hospital and health care field continues, some communities may be at risk of losing access to health care services and the opportunities and resources they need to improve and maintain their health. Integrated, comprehensive strategies to reform health care delivery and payment, within which vulnerable communities can make individual choices based on their needs, support structures, and preferences, are needed.In this Invited Commentary, the authors outline characteristics and parameters of vulnerable communities as well as the essential health care services that hospitals should strive to maintain locally identified by the American Hospital Association Task Force on Ensuring Access in Vulnerable Communities. They also describe four of nine emerging strategies-recommended by the task force-to reform health care delivery and payment and allow hospitals to provide the essential health care services, along with implementation barriers and how to address them. While this Invited Commentary focuses on vulnerable communities, the four highlighted strategies (addressing the social determinants of health, adopting new and innovative virtual care strategies, designing global budgets, and using inpatient/outpatient transformation strategy), as well as the other five strategies, may have broader applicability for all communities.

  8. Public hospital bed crisis: too few or too misused?

    PubMed

    Scott, Ian A

    2010-08-01

    * Increasing demand on public hospital beds has led to what many see as a hospital bed crisis requiring substantial increases in bed numbers. By 2050, if current bed use trends persist and as the numbers of frail older patients rise exponentially, a 62% increase in hospital beds will be required to meet expected demand, at a cost almost equal to the entire current Australian healthcare budget. * This article provides an overview of the effectiveness of different strategies for reducing hospital demand that may be viewed as primarily (although not exclusively) targeting the hospital sector - increasing capacity and throughput and reducing readmissions - or the non-hospital sector - facilitating early discharge or reducing presentations and admissions to hospital. Evidence of effectiveness was retrieved from a literature search of randomised trials and observational studies using broad search terms. * The principal findings were as follows: (1) within the hospital sector, throughput could be substantially improved by outsourcing public hospital clinical services to the private sector, undertaking whole-of-hospital reform of care processes and patient flow that address both access and exit block, separating acute from elective beds and services, increasing rates of day-only or short stay admissions, and curtailing ineffective or marginally effective clinical interventions; (2) in regards to the non-hospital sector, potentially the biggest gains in reducing hospital demand will come from improved access to residential care, rehabilitation services, and domiciliary support as patients awaiting such services currently account for 70% of acute hospital bed-days. More widespread use of acute care and advance care planning within residential care facilities and population-based chronic disease management programs can also assist. * This overview concludes that, in reducing hospital bed demand, clinical process redesign within hospitals and capacity enhancement of non-hospital

  9. Coordination between a district hospital and a reference hospital: evaluation of chest disease care models.

    PubMed

    Verea-Hernando, Héctor; Valdés-Cuadrado, Luis; López-Campos, José María; Fandiño-Orgeira, José; Blanco-Ramos, Manuel

    2011-06-01

    Specialised medical care at district hospitals has not been thoroughly defined. Respiratory care data from 2008 in Barbanza and Cee hospitals (Galicia, Spain), were analysed to evaluate different approaches, as they are both similar. Barbanza hospital has a chest diseases clinic run by specialist doctors from the reference hospital three days per week, while Cee hospital is operated by the staff on site. In both cases hospitalisation is the responsibility of the Internal Medicine department. Data was provided by the administrative departments of each hospital and the regional government. Average CDM4 stays were similar for both district hospitals; however, they were lower than in the reference hospital. Charlson scores and re-admissions a month after discharge were similar in both. Barbanza's hospital carried out more functional explorations, both at the centre (957 spirometries vs 21; P<.0001) and at the reference hospital (214 volume/diffusion tests vs 99; P<.001). CPAP treatments were more prevalent in the Barbanza area (3.9 vs 2/1,000 habitants; P<.0001). No differences were found in oxygen therapy and home mechanical ventilation. Mortality due to respiratory disease in 2007 was similar in both regions. Data suggests that in a district hospital scheme supported by chest disease consultants and outpatient clinics gives easier access to specialised, comprehensive and probably, higher quality care than district hospitals without them. Copyright © 2010 SEPAR. Published by Elsevier Espana. All rights reserved.

  10. Improved Maternal and Child Health Care Access in a Rural Community.

    ERIC Educational Resources Information Center

    Carcillo, Joseph A.; And Others

    1995-01-01

    Describes an underserved rural community in which health care initiatives increased access to comprehensive care. Over a 3-year period, increased accessibility to maternal and child health care also increased use of preventive services, thus decreasing emergency room visits and hospitalizations as well as low birth weight, risk of congenital…

  11. The Healthnet project: extending online information resources to end users in rural hospitals.

    PubMed

    Holtum, E; Zollo, S A

    1998-10-01

    The importance of easily available, high quality, and current biomedical literature within the clinical enterprise is now widely documented and accepted. Access to this information has been shown to have a direct bearing on diagnosis, choices of tests, choices of drugs, and length of hospital stay. However, many health professionals do not have adequate access to current health information, particularly those practicing in rural, isolated, or underserved hospitals. Thanks to a three-year telemedicine award from the National Library of Medicine, The University of Iowa (UI) has developed a high-speed, point-to-point telecommunications network to deliver clinical and educational applications to ten community-based Iowa hospitals. One of the services offered over the network allows health professionals from the site hospitals to access online health databases and order articles via an online document delivery service. Installation, training, and troubleshooting support are provided to the remote sites by UI project staff. To date, 1,339 health professionals from the ten networked hospitals have registered to use the Healthnet program. Despite the friendly interface on the computer workstations installed at the sites, training emerged as the key issue in maximizing health professional utilization of these programs.

  12. The Healthnet project: extending online information resources to end users in rural hospitals.

    PubMed Central

    Holtum, E; Zollo, S A

    1998-01-01

    The importance of easily available, high quality, and current biomedical literature within the clinical enterprise is now widely documented and accepted. Access to this information has been shown to have a direct bearing on diagnosis, choices of tests, choices of drugs, and length of hospital stay. However, many health professionals do not have adequate access to current health information, particularly those practicing in rural, isolated, or underserved hospitals. Thanks to a three-year telemedicine award from the National Library of Medicine, The University of Iowa (UI) has developed a high-speed, point-to-point telecommunications network to deliver clinical and educational applications to ten community-based Iowa hospitals. One of the services offered over the network allows health professionals from the site hospitals to access online health databases and order articles via an online document delivery service. Installation, training, and troubleshooting support are provided to the remote sites by UI project staff. To date, 1,339 health professionals from the ten networked hospitals have registered to use the Healthnet program. Despite the friendly interface on the computer workstations installed at the sites, training emerged as the key issue in maximizing health professional utilization of these programs. PMID:9803302

  13. Hospital Views of Factors Affecting Telemedicine Use.

    PubMed

    Merchant, Kimberly A S; Ward, Marcia M; Mueller, Keith J

    2015-04-01

    Telemedicine (also known as telehealth) is a means to increase access to care, one of the foundations of the Triple Aim. However, the expansion of telemedicine services in the United States has been relatively slow. We previously examined the extent of uptake of hospital based telemedicine using the 2013 HIMSS (Healthcare Information and Management Systems Society) Analytics national database of 4,727 non-specialty hospitals. Our analysis indicated that the largest percentage of operational telemedicine implementations (15.7 percent) was in radiology departments, with a substantial number in emergency/trauma care (7.5 percent) and cardiology/stroke/heart attack programs (6.8 percent). However, existing databases are limited because they do not identify whether a respondent hospital is a "hub" (providing telemedicine services) or a "spoke" (receiving telemedicine services). Therefore, we used data from interviews with hospital representatives to deepen the research and understanding of telemedicine use and the factors affecting that use. Interviews were conducted with key informants at 18 hub hospitals and 18 spoke hospitals to explore their perceptions of barriers and motivators to telemedicine adoption and expansion. Key Findings. (1) Respondents from both hub and spoke hospitals reported that telemedicine helps them meet their mission, enhances access, keeps lower-acuity patients closer to home, and helps head off competition. (2) Respondents from both hub and spoke hospitals reported licensing and credentialing to be significant barriers to telemedicine expansion. Thus, half of hubs provide services only within their state. (3) A variety of one-time funding sources have been used to initiate and grow telemedicine services among hubs and spokes. However, reimbursement issues have impeded the development of workable business models for sustainability. Hub hospitals shoulder the responsibility for identifying sustainable business models. (4) Although respondents

  14. Financing the future of independent community hospitals.

    PubMed

    Richman, Alan P

    2011-11-01

    Effingham Hospital, a critical access hospital, undertook a modernization initiative to expand the limited scope of its inpatient services to improve financial performance and ability to build liquidity reserves. FHA Section 242 mortgage insurance was the only means for Effingham to credit enhance its debt and obtain a low-interest rate loan. Effingham needed to convince residents and county commissioners to pledge 27 years of additional tax support to offset its annual uncompensated care. The hospital won support from the community and the commissioners, in part because of the educational outreach of the CEO, CFO, and board in articulating the imperative for maintaining local hospital care and the present and future economic benefits for Effingham County.

  15. Hospital mainframe computer documentation of pharmacist interventions.

    PubMed

    Schumock, G T; Guenette, A J; Clark, T; McBride, J M

    1993-07-01

    The hospital mainframe computer pharmacist intervention documentation system described has successfully facilitated the recording, communication, analysis, and reporting of interventions at our hospital. It has proven to be time efficient, accessible, and user-friendly from the standpoint of both the pharmacist and administrator. The advantages of this system greatly outweigh manual documentation and justify the initial time investment in its design and development. In the future, it is hoped that the system can have even broader impact. Intervention/recommendations documented can be made accessible to medical and nursing staff, and as such further increase interdepartmental communication. As pharmacists embrace the pharmaceutical care mandate, documenting interventions in patient care will continue to grow in importance. Complete documentation is essential if pharmacists are to assume responsibility for patient outcomes. With time being an ever-increasing premium, and with economic and human resources dwindling, an efficient and effective means of recording and tracking pharmacist interventions will become imperative for survival in the fiscally challenged health care arena. Documentation of pharmacist intervention using a hospital mainframe computer at UIH has proven both efficient and effective.

  16. Purchasing online journal access for a hospital medical library: how to identify value in commercially available products.

    PubMed

    Carter, Thomas P; Carter, Anne O; Broomes, Gwendolyn

    2006-07-12

    Medical practice today requires evaluating large amounts of information which should be available at all times. This information is found most easily in a digital form. Some information has already been evaluated for validity (evidence based medicine sources) and some is in unevaluated form (paper and online journals). In order to improve access to digital information, the School of Clinical Medicine and Research at the University of the West Indies and Queen Elizabeth Hospital decided to enhance the library by offering online full text medical articles and evidence based medicine sources. The aim of this paper is to evaluate the relative value of online journal commercial products available for a small hospital and medical school library. Three reference standards were chosen to represent the ideal list of core periodicals for a broad range of medical care: 2 Brandon/Hill selected lists of journals for the small medical library (BH and BH core) and the academic medical library core journal collection chosen for the Florida State University College of Medicine Medical Library. Six commercially available collections were compared to the reference standards and to the current paper journal subscription list as regards to number of journals matched and cost per journal matched. Ease of use and presence of secondary sources were also considered. The cost per journal matched ranged from US $3194 to $81. Because of their low subscription prices, the Biomedical Reference Collection and Proquest products were the most cost beneficial. However, they provided low coverage of the ideal lists (12-17% and 21-32% respectively) and contained significant embargoes on current editions, were not user friendly and contained no secondary sources. The Ovid Brandon/Hill Plus Collection overcame these difficulties but had a much higher cost-benefit range while providing higher coverage of the ideal lists (14-47%). After considering costs, benefits, ease of use, embargoes, presence of

  17. Estimating Uncompensated Care Charges at Rural Hospital Emergency Departments

    ERIC Educational Resources Information Center

    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…

  18. Hospital design for better infection control

    PubMed Central

    Lateef, Fatimah

    2009-01-01

    The physical design and infrastructure of a hospital or institution is an essential component of its infection control measure. Thus is must be a prerequisite to take these into consideration from the initial conception and planning stages of the building. The balance between designing a hospital to be an open, accessible and public place and the control to reduce the spread of infections diseases is a necessity. At Singapore General Hospital, many lessons were learnt during the SARS outbreak pertaining to this. During and subsequent to the SARS outbreak, many changes evolved in the hospital to enable us to handle and face any emerging infectious situation with calm, confidence and the knowledge that staff and patients will be in good stead. This paper will share some of our experiences as well as challenges PMID:20009307

  19. Development of the Kisiizi hospital health insurance scheme: lessons learned and implications for universal health coverage.

    PubMed

    Baine, Sebastian Olikira; Kakama, Alex; Mugume, Moses

    2018-06-15

    Kisiizi Hospital Health Insurance scheme started in 1996 to; improve access to health services, and provide a stable source of funding and reduce bad debts to Kisiizi hospital. Objectives of this study were; to describe Kisiizi Hospital Health Insurance scheme and to document lessons learned and implications for universal health coverage. This was a descriptive cross-sectional study. Data from different sources were triangulated and thematically analysed. Most households (96%) were organized in Engozi societies (e-Societies), met monthly, and made financial contributions. Cultural solidarity in e-Societies provided a platform for the Kisiizi hospital health insurance scheme establishment, operation and made it compulsory for members. e-Societies disciplinary measures and fear of high out-of-pocket payment for health care enforced enrolment, retention and increased membership. Community sensitisation and community participation in setting premiums and co-payments provided for better understanding of health insurance and rendered them acceptable, affordable and equitable. Membership increased from 330 in 1996 to 38,400 families in 2017. Kisiizi hospital health insurance scheme covered only health services obtained from Kisiizi hospital. Kisiizi hospital health insurance scheme offered no exemption, credit and referral facilities. e-Societies sometimes paid premiums for members from savings and offered them loans to. Kisiizi hospital provided good quality health services, which were easily accessed by insured members. Kisiizi hospital got a stable source of funding and reduced debt burden. Kisiizi hospital health insurance scheme improved access to health services, provided a stable source of funding and reduced bad debts to the hospital. Internal and external factors to e-Society enforced enrolment and retention of members in Kisiizi hospital health insurance scheme. Good quality health services at Kisiizi hospital demonstrated value for money and offered incentives

  20. [Hospital admissions and morbidity in people with intellectual developmental disorders].

    PubMed

    Bernal-Celestino, Rubén José; León-Hurtado, David; Martínez-Leal, Rafael

    2017-01-01

    People with intellectual developmental disorders (IDD) have worse health statuses in comparison with general population. The objective of this paper is to compare access and hospital morbimortality in people with IDD and general population. We conducted a retrospective cross-sectional analytical study and analyzed data on admissions and discharges between IDD patients and the rest of them, in Ciudad Real, España. Out of 51 325 hospital admissions, 441 (0.9%) belonged to the group of persons with IDD. The IDD group had fewer programmed hospitalization than the general population and fewer surgical interventions. They presented more admissions for mental disorders and respiratory system diseases. The data presented confirm TDI population have different patterns of disease. Furthermore, this study reveal potential difficulties in access to health care in this population.

  1. Enhancing healthcare accessibility measurements using GIS: A case study in Seoul, Korea

    PubMed Central

    Kim, Yeeun; Byon, Young-Ji

    2018-01-01

    With recent aging demographic trends, the needs for enhancing geo-spatial analysis capabilities and monitoring the status of accessibilities of its citizens with healthcare services have increased. The accessibility to healthcare is determined not only by geographic distances to service locations, but also includes travel time, available modes of transportation, and departure time. Having access to the latest and accurate information regarding the healthcare accessibility allows the municipal government to plan for improvements, including expansion of healthcare infrastructure, effective labor distribution, alternative healthcare options for the regions with low accessibilities, and redesigning the public transportation routes and schedules. This paper proposes a new method named, Seoul Enhanced 2-Step Floating Catchment Area (SE2SFCA), which is customized for the city of Seoul, where population density is higher and the average distance between healthcare-service locations tends to be shorter than the typical North American or European cities. The proposed method of SE2SFCA is found to be realistic and effective in determining the weak accessibility regions. It resolves the over-estimation issues of the past, arising from the assignment of high healthcare accessibility for the regions with large hospitals and high density of population and hospitals. PMID:29462194

  2. Economic analysis of an epilepsy outreach model of care in a university hospital setting.

    PubMed

    Maloney, Eimer; McGinty, Ronan N; Costello, Daniel J

    2017-07-01

    The prevalence of epilepsy in people with intellectual disability is higher than in the general population and prevalence rates increase with increasing levels of disability. Prevalence rates of epilepsy are highest among those living in residential care. The healthcare needs of people with intellectual disability and epilepsy are complex and deserve special consideration in terms of healthcare provision and access to specialist epilepsy clinics, which are usually held in acute hospital campuses. This patient population is at risk of suboptimal care because of significant difficulties accessing specialist epilepsy care which is typically delivered in the environs of acute hospitals. In 2014, the epilepsy service at Cork University Hospital established an Epilepsy Outreach Service providing regular, ambulatory outpatient follow up at residential care facilities in Cork city and county in an effort to improve access to care, reduce the burden and expense of patient and carer travel to hospital outpatient appointments, and to provide a dedicated specialist phone service for epilepsy related queries in order to reduce emergency room visits when possible. We present the findings of an economic analysis of the outreach service model of care compared to the traditional hospital outpatient service and demonstrate significant cost savings and improved access to care with this model. Ideally these cost savings should be used to develop novel ways to enhance epilepsy care for persons with disability. We propose that this model of care can be more suitable for persons with disability living in residential care who are at risk of losing access to specialist epilepsy care. Copyright © 2017 Elsevier Inc. All rights reserved.

  3. Hospital managers’ attitude and commitment toward electronic medical records system in Isfahan hospitals 2014

    PubMed Central

    Jahanbakhsh, Maryam; Karimi, Saeed; Hassanzadeh, Akbar; Beigi, Maliheh

    2017-01-01

    INTRODUCTION: Electronic medical record system (EMRS) is a valuable system for safe access to the patient's data and increases health care quality. Manpower is one of the requirements for EMRS, among which manager is the most important person in any hospital. Taking into account manager's positive attitude and good commitments, EMRS will be implemented successfully. As such, we decided to assess manager's attitude and commitment toward EMRS in Isfahan hospitals in the year of 2014. AIM: This article aimed to determine the hospital managers’ attitude and commitment toward the implementation of EMRS. MATERIALS AND METHODS: The present article is an applied analytic study. Research society consisted of the managers of all the hospitals in Isfahan that include hospitals affiliated to Isfahan University of Medical Sciences, private, and social security hospitals. This study was done in 2014. Data collection tools included a questionnaire for which reliability and validity were determined. Data were analyzed by means of SPSS 20. RESULTS: Average score for the managers’ attitude toward EMRS in the city of Isfahan was 77.5 out of 100 and their average score for commitment was 74.7. Manager's attitude in social security hospitals was more positive than the private and governmental ones (83.3%). In addition, the amount of commitment by the managers in social security hospitals was higher than the same in private and governmental hospitals (86.6%). CONCLUSION: At present, managers’ attitude and commitment in Isfahan hospitals toward EMRS are very high and social security hospitals show more readiness in this respect. PMID:28584837

  4. Dechlorination of PCBs, CAHs, herbicides and pesticides neat and in soils at 25 degrees C using Na/NH3.

    PubMed

    Pittman, Charles U; He, Jinbao

    2002-05-03

    Na/NH3 reductions have been used to dehalogenate polychlorinated biphenyls (PCBs), chlorinated aliphatic hydrocarbons (CAHs) and pesticides at diffusion controlled rates at room temperature in model compound studies in both dry NH3 and when water was added. The rate ratio of dechlorination (aliphatic and aromatic compounds) versus reaction of the solvated electron with water is very large, allowing wet soils or sludges to be remediated without an unreasonable consumption of sodium. Several soils, purposely contaminated with 1,1,1-trichloroethane, 1-chlorooctane and tetrachloroethylene, were remediated by slurring the soils in NH3 followed by addition of sodium. The consumption of sodium per mole of chlorine removed was examined as a function of both the hazardous substrate's concentration in the soil and the amount of water present. The Na consumption per Cl removed increases as the amount of water increases and as the substrate concentration in soil decreases. However, remediation was still readily accomplished from 5000 to 3000ppm to sub ppm levels of RCl in the presence of substantial amounts of water. PCB- and dioxin-contaminated oils were remediated with Na/NH3 as were PCB-contaminated soils and sludges from contaminated sites. Ca/NH3 treatments also successfully remediated PCB-contaminated clay, sandy and organic soils but laboratory studies demonstrated that Ca was less efficient than Na when substantial amounts of water were present. The advantages of solvated electron reductions using Na/NH3 include: (1) very rapid dehalogenation rates at ambient temperature, (2) soils (even clay soils) break down into particles and slurry nicely in NH3, (3) liquid ammonia handling technology is well known and (4) removal from soils, recovery and recycle of ammonia is easy due to its low boiling point. Finally, dechlorination is extremely fast even for the 'corner' chlorines in the substrate Mirex (structure in Eq. (5)).

  5. Hospital Distance and Readmissions Among VA-Medicare Dual-Enrolled Veterans.

    PubMed

    Wong, Edwin S; Rinne, Seppo T; Hebert, Paul L; Cook, Meredith A; Liu, Chuan-Fen

    2016-09-01

    Geographic access to inpatient care at the Veterans Affairs (VA) Health Care System is challenging for many veterans with chronic obstructive pulmonary disease (COPD) given relatively few VA hospitals nationwide. Veterans with lengthy travel distances may obtain non-VA care, particularly those dually enrolled in Medicare. Our primary objective was to assess whether distance from VA patients' residence to the nearest VA and non-VA hospitals was associated with 30-day all-cause readmission and the system where patients were readmitted (VA or Medicare). Using VA and Medicare administrative data, we identified 21,273 patients hospitalized for COPD between October 2008 and September 2011 and dually enrolled in VA and fee-for-service Medicare. Outcome variables were dichotomous measures denoting readmission for any cause within 30 days following discharge and whether the readmission occurred in a non-VA hospital through Medicare. Distance to the nearest hospital was defined as the number of miles between patients' residence ZIP code and the ZIP code of the nearest VA and non-VA hospital accepting Medicare, respectively. Probit models with sample selection were applied to examine the relationship between hospital distance and outcome measures. Respective distances to the nearest VA and non-VA hospital were not associated with 30-day all-cause readmission. Greater distance to the nearest VA hospital was associated with a greater conditional probability of choosing non-VA hospitals for readmission. COPD patients with poor geographic access to VA hospitals did not forgo subsequent inpatient care following their index hospitalization, but they were more likely to seek non-VA substitutes. © 2016 National Rural Health Association.

  6. Time trends in hospital stay after hip fracture in Canada, 2004-2012: database study.

    PubMed

    Sobolev, Boris; Guy, Pierre; Sheehan, Katie Jane; Kuramoto, Lisa; Bohm, Eric; Beaupre, Lauren; Sutherland, Jason M; Dunbar, Michael; Griesdale, Donald; Morin, Suzanne N; Harvey, Edward

    2016-01-01

    Changes in bed management and access policy aimed to shorten Canadian hip fracture hospital stay. Secular trends in hip fracture total, preoperative, and postoperative stay are unknown. Hip fracture stay shortened from 2004 to 2012, mostly from shortening postoperative stay. This may reflect changes in bed management rather than access policy. To compare the probability of discharge by time after patient admission to hospital with first-time hip fracture over a period of nine calendar years. We retrieved acute hospitalization records for 169,595 patients 65 years and older, who were admitted to an acute care hospital with hip fracture between 2004 and 2012 in Canada (outside of Quebec). The main outcome measure was cumulative incidence of discharge by inpatient day, accounting for competing events that end hospital stay. The probability of surgical discharge within 30 days of admission increased from 57.2 % in 2004 to 67.3 % in 2012. The probability of undergoing surgery on day of admission or day after fluctuated around 58.5 % over the study period. For postoperative stay, the discharge probability increased from 6.8 to 12.2 % at day 4 after surgery and from 57.2 to 66.6 % at day 21 after surgery, between 2004 and 2012. The differences across years persisted after adjustment for characteristics of patients, fracture, comorbidity, treatment, type and timing of surgery, and access to care. Hospital stay following hip fracture shortened substantially between 2004 and 2012 in Canada, mostly due to shortening of postoperative stays. Shorter hospital stays may reflect changes in bed management protocols rather than in access policy.

  7. Clinical staff perceptions of palliative care-related quality of care, service access, education and training needs and delivery confidence in an acute hospital setting.

    PubMed

    Frey, Rosemary; Gott, Merryn; Raphael, Deborah; O'Callaghan, Anne; Robinson, Jackie; Boyd, Michal; Laking, George; Manson, Leigh; Snow, Barry

    2014-12-01

    Central to appropriate palliative care management in hospital settings is ensuring an adequately trained workforce. In order to achieve optimum palliative care delivery, it is first necessary to create a baseline understanding of the level of palliative care education and support needs among all clinical staff (not just palliative care specialists) within the acute hospital setting. The objectives of the study were to explore clinical staff: perceptions concerning the quality of palliative care delivery and support service accessibility, previous experience and education in palliative care delivery, perceptions of their own need for formal palliative care education, confidence in palliative care delivery and the impact of formal palliative care training on perceived confidence. A purposive sample of clinical staff members (598) in a 710-bed hospital were surveyed regarding their experiences of palliative care delivery and their education needs. On average, the clinical staff rated the quality of care provided to people who die in the hospital as 'good' (x̄=4.17, SD=0.91). Respondents also reported that 19.3% of their time was spent caring for end-of-life patients. However, only 19% of the 598 respondents reported having received formal palliative care training. In contrast, 73.7% answered that they would like formal training. Perceived confidence in palliative care delivery was significantly greater for those clinical staff with formal palliative care training. Formal training in palliative care increases clinical staff perceptions of confidence, which evidence suggests impacts on the quality of palliative care provided to patients. The results of the study should be used to shape the design and delivery of palliative care education programmes within the acute hospital setting to successfully meet the needs of all clinical staff. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  8. Prevalence of and markers for the attenuated form of congenital adrenal hyperplasia and hyperprolactinemia masquerading as polycystic ovarian disease.

    PubMed

    Benjamin, F; Deutsch, S; Saperstein, H; Seltzer, V L

    1986-08-01

    To determine the prevalence of the attenuated form of congenital adrenal hyperplasia (CAH) and hyperprolactinemia (HPPN) relative to polycystic ovarian disease (PCOD), 100 consecutive women presenting with the classic clinical features of PCOD were evaluated by basal hormonal profiles and subsequent adrenocorticotropic hormone (ACTH) stimulation tests. The study also sought biochemical markers for CAH other than ACTH stimulation. The prevalences were found to be as follows: PCOD, 65%; PCOD with HPPN, 9%; HPPN, 3%, end-organ hypersensitivity (EOH), 4%; homozygotic CAH, 4%; and heterozygotic CAH, 15%. Other than the differential response to ACTH, the only other biochemical markers observed for homozygotic CAH were significantly higher basal levels of testosterone (T) and 17 alpha-hydroxyprogesterone (17-OHP). Luteinizing hormone/follicle-stimulating hormone ratio, androstenedione, and dehydroepiandrosterone sulfate all showed no significant differences between homozygotic CAH, heterozygotic CAH, HPPN, PCOD, and EOH. This study establishes the relative prevalences of the syndromes commonly mimicking PCOD. We also conclude that the observed low incidence of CAH does not justify routine ACTH testing on all patients presenting with features of PCOD--however, our data suggest that patients with basal serum levels of T and 17-OHP greater than 50% above the upper limit of normal should undergo this dynamic test, especially if there are also certain clinical features suggestive of CAH.

  9. How patients think about social responsibility of public hospitals in China?

    PubMed

    Liu, Wenbin; Shi, Lizheng; Pong, Raymond W; Chen, Yingyao

    2016-08-11

    Hospital social responsibility is receiving increasing attention, especially in China where major changes to the healthcare system have taken place. This study examines how patients viewed hospital social responsibility in China and explore the factors that influenced patients' perception of hospital social responsibility. A cross-sectional survey was conducted, using a structured questionnaire, on a sample of 5385 patients from 48 public hospitals in three regions of China: Shanghai, Hainan, and Shaanxi. A multilevel regression model was employed to examine factors influencing patients' assessments of hospital social responsibility. Intra-class correlation coefficients (ICCs) were calculated to estimate the proportion of variance in the dependent variables determined at the hospital level. The scores for service quality, appropriateness, accessibility and professional ethics were positively associated with patients' assessments of hospital social responsibility. Older outpatients tended to give lower assessments, while inpatients in larger hospitals scored higher. After adjusted for the independent variables, the ICC rose from 0.182 to 0.313 for inpatients and from 0.162 to 0.263 for outpatients. The variance at the patient level was reduced by 51.5 and 48.6 %, respectively, for inpatients and outpatients. And the variance at the hospital level was reduced by 16.7 % for both groups. Some hospital and patient characteristics and their perceptions of service quality, appropriateness, accessibility and professional ethics were associated with their assessments of public hospital social responsibility. The differences were mainly determined at the patient level. More attention to law-abiding behaviors, cost-effective health services, and charitable works could improve perceptions of hospitals' adherence to social responsibility.

  10. Hospitals' vertical integration into skilled nursing: a rational approach to controlling transaction costs.

    PubMed

    Lehrman, S; Shore, K K

    1998-01-01

    Using 1985 and 1988 American Hospital Association data, this study examines 1,523 hospitals nationwide and concludes that hospitals' ownership of skilled nursing facilities helps minimize the transaction costs associated with post-acute patient transfers while productively using empty hospital beds. Unfortunately, such ownership creates complex cost, quality, and accessibility trade-offs in terms of the skilled nursing care provided.

  11. Endoplasmic reticulum stress in complex atypical hyperplasia as a possible predictor of occult carcinoma and progestin response.

    PubMed

    Tierney, Katherine E; Ji, Lingyun; Dralla, Shannon S; Yoo, Eunjeong; Yessaian, Annie; Pham, Huyen Q; Roman, Lynda; Sposto, Richard; Mhawech-Fauceglia, Paulette; Lin, Yvonne G

    2016-12-01

    Glucose-regulated protein (GRP)-78, the key regulator of endoplasmic reticulum (ER) stress, is associated with endometrial cancer (EC) development and progression. However, its role in the continuum from complex atypical hyperplasia (CAH) to EC is unknown and the focus of this study. 252 formalin-fixed, paraffin-embedded endometrial biopsies from patients with CAH diagnosed between 2003 and 2011 were evaluated for GRP78 expression by immunohistochemistry. Expression was also evaluated in subsequent biopsies from those patients treated with progestins. Differences in GRP78 expression were assessed using standard statistical methods. GRP78 expression was undetectable in 45(18%) patients with CAH, while 120(48%) CAH cases showed moderate/strong expression. Among women who ultimately underwent hysterectomy for CAH (n=134), 54(40%) had occult EC while 57(43%) had persistent CAH. Those with occult EC upon hysterectomy had significantly stronger GRP78 expression than those who did not have occult EC (p=0.007). Greater GRP78 expression within CAH remained independently associated with the presence of an occult EC (p=0.017). Thirty-four of 54 (63%) patients with occult EC had moderate/strong GRP78 expression compared to 36 of 80 (45%) patients with persistent CAH, benign or non-atypical hyperplastic endometrium. In those treated with progestins, samples with persistent CAH and EC were more likely to have high levels of GRP78 expression in the initial biopsies than those who responded (p=0.014). Increased GRP78 expression in untreated CAH correlates with the presence of an occult EC. In addition, CAH specimens with greater GRP78 expression may identify patients who are less likely to respond to progestin therapy. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. The effect of information technology on hospital performance.

    PubMed

    Williams, Cynthia; Asi, Yara; Raffenaud, Amanda; Bagwell, Matt; Zeini, Ibrahim

    2016-12-01

    While healthcare entities have integrated various forms of health information technology (HIT) into their systems due to claims of increased quality and decreased costs, as well as various incentives, there is little available information about which applications of HIT are actually the most beneficial and efficient. In this study, we aim to assist administrators in understanding the characteristics of top performing hospitals. We utilized data from the Health Information and Management Systems Society and the Center for Medicare and Medicaid to assess 1039 hospitals. Inputs considered were full time equivalents, hospital size, and technology inputs. Technology inputs included personal health records (PHR), electronic medical records (EMRs), computerized physician order entry systems (CPOEs), and electronic access to diagnostic results. Output variables were measures of quality, hospital readmission and mortality rate. The analysis was conducted in a two-stage methodology: Data Envelopment Analysis (DEA) and Automatic Interaction Detector Analysis (AID), decision tree regression (DTreg). Overall, we found that electronic access to diagnostic results systems was the most influential technological characteristics; however organizational characteristics were more important than technological inputs. Hospitals that had the highest levels of quality indicated no excess in the use of technology input, averaging one use of a technology component. This study indicates that prudent consideration of organizational characteristics and technology is needed before investing in innovative programs.

  13. Adverse Events in Affiliated Hospitals of Mazandaran University of Medical Sciences

    PubMed Central

    Saravi, Benyamin Mohseni; Siamian, Hasan; Nezhad, Ayyob Barzegar; Asghari, Zoleleykha; Kabirzadeh, Azar

    2014-01-01

    Due to the complexity of the hospital environment, its structure faces with multiple hazards. The risks whether by providing the care and whether by hospital environment endanger patients, relatives and care providers. Therefore, a more accurate reporting and analysis of the report by focusing on access to preventative methods is essential. In this study, hospitals' adverse event that has sent by affiliated hospitals of Mazandaran University of Medical Sciences to deputy for treatment has studied. PMID:24944536

  14. Public hospitals in financial distress: Is privatization a strategic choice?

    PubMed

    Ramamonjiarivelo, Zo; Weech-Maldonado, Robert; Hearld, Larry; Menachemi, Nir; Epané, Josué Patien; O'Connor, Stephen

    2015-01-01

    As safety net providers, public hospitals operate in more challenging environments than private hospitals. Such environments put public hospitals at greater risk of financial distress, which may result in privatization and deterioration of the safety net. The purpose of this study was to investigate whether financial distress is associated with privatization among public hospitals. We used panel data merged from the American Hospital Association Annual Survey, Medicare Cost Reports, Area Resource File, and Local Area Unemployment Statistics. Our study population consisted of all U.S. nonfederal acute care public hospitals in 1997 tracked through 2009, resulting in 6,426 hospital-year observations. The dependent variable "privatization" was defined as conversion from public status to either private not-for-profit or private for-profit status. The main independent variable, "financial distress," was based on the Altman Z-score methodology. Control variables included market and organizational factors. Two random-effects logistic regression models with state and year fixed-effects were constructed. The independent and control variables were lagged by 1 year and 2 years for Models 1 and 2, respectively. Public hospitals in financial distress had greater odds of being privatized than public hospitals not in financial distress: (OR = 4.53, p < .001) for Model 1 and (OR = 3.05, p = .001) for Model 2. Privatization eases access to resources and may provide financial relief to government entities from the burden of continuously funding a hospital operating at a loss, which in turn may help keep the hospital open and preserve access to care for the community. Privatizing a financially distressed public hospital may be a better strategic alternative than closure. The Altman Z-score could be used as a managerial tool to monitor hospitals' financial condition and take corrective actions.

  15. A regional assessment of medicaid access to outpatient orthopaedic care: the influence of population density and proximity to academic medical centers on patient access.

    PubMed

    Patterson, Brendan M; Draeger, Reid W; Olsson, Erik C; Spang, Jeffrey T; Lin, Feng-Chang; Kamath, Ganesh V

    2014-09-17

    Access to care is limited for patients with Medicaid with many conditions, but data investigating this relationship in the orthopaedic literature are limited. The purpose of this study was to investigate the relationship between health insurance status and access to care for a diverse group of adult orthopaedic patients, specifically if access to orthopaedic care is influenced by population density or distance from academic teaching hospitals. Two hundred and three orthopaedic practices within the state of North Carolina were randomly selected and were contacted on two different occasions separated by three weeks. An appointment was requested for a fictitious adult orthopaedic patient with a potential surgical problem. Injury scenarios included patients with acute rotator cuff tears, zone-II flexor tendon lacerations, and acute lumbar disc herniations. Insurance status was reported as Medicaid at the time of the first request and private insurance at the time of the second request. County population density and the distance from each practice to the nearest academic hospital were recorded. Of the 203 practices, 119 (59%) offered the patient with Medicaid an appointment within two weeks, and 160 (79%) offered the patient with private insurance an appointment within this time period (p < 0.001). Practices in rural counties were more likely to offer patients with Medicaid an appointment as compared with practices in urban counties (odds ratio, 2.25 [95% confidence interval, 1.16 to 4.34]; p = 0.016). Practices more than sixty miles from academic hospitals were more likely to accept patients with Medicaid than practices closer to academic hospitals (odds ratio, 3.35 [95% confidence interval, 1.44 to 7.83]; p = 0.005). Access to orthopaedic care was significantly decreased for patients with Medicaid. Practices in less populous areas were more likely to offer an appointment to patients with Medicaid than practices in more populous areas. Practices that were farther from

  16. 42 CFR 410.28 - Hospital or CAH diagnostic services furnished to outpatients: Conditions.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ..., including drugs and biologicals required in the performance of the services (even if those drugs or biologicals are self-administered), if those services meet the following conditions: (1) They are furnished by... biologicals are also subject to the limitations specified in § 410.29(b) and (c). (c) Diagnostic services...

  17. 42 CFR 410.28 - Hospital or CAH diagnostic services furnished to outpatients: Conditions.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ..., including drugs and biologicals required in the performance of the services (even if those drugs or biologicals are self-administered), if those services meet the following conditions: (1) They are furnished by... biologicals are also subject to the limitations specified in § 410.29(b) and (c). (c) Diagnostic services...

  18. The private management of public hospitals.

    PubMed Central

    Rundall, T G; Lambert, W K

    1984-01-01

    Since the public sector traditionally has provided the public goods viewed as unprofitable by the private sector, the growing trend to manage public hospitals under outside private contract raises some fundamental issues of concern. It is hypothesized here that the system maintenance and output goals of privately managed public hospitals become increasingly similar to those of investor-owned hospitals. The thesis is empirically tested using documented effects of private contract management on the operative goals of short-term, general hospitals owned by local governmental bodies. Traditionally managed public hospitals matched with the study hospitals on important characteristics serve as the control group. Costs do appear to be reduced under private contract management, but the service structure becomes somewhat altered. It is the task of public health policymakers to reconcile the cost-control and efficiency mechanisms brought about by private management with the community's right of access to comprehensive medical care. Carefully structured regionalization plans--a possible means of providing both--will require the stimulation of more government involvement during an era of cutbacks. PMID:6490379

  19. Do more hospital beds lead to higher hospitalization rates? a spatial examination of Roemer's Law.

    PubMed

    Delamater, Paul L; Messina, Joseph P; Grady, Sue C; WinklerPrins, Vince; Shortridge, Ashton M

    2013-01-01

    Roemer's Law, a widely cited principle in health care policy, states that hospital beds that are built tend to be used. This simple but powerful expression has been invoked to justify Certificate of Need regulation of hospital beds in an effort to contain health care costs. Despite its influence, a surprisingly small body of empirical evidence supports its content. Furthermore, known geographic factors influencing health services use and the spatial structure of the relationship between hospital bed availability and hospitalization rates have not been sufficiently explored in past examinations of Roemer's Law. We pose the question, "Accounting for space in health care access and use, is there an observable association between the availability of hospital beds and hospital utilization?" We employ an ecological research design based upon the Anderson behavioral model of health care utilization. This conceptual model is implemented in an explicitly spatial context. The effect of hospital bed availability on the utilization of hospital services is evaluated, accounting for spatial structure and controlling for other known determinants of hospital utilization. The stability of this relationship is explored by testing across numerous geographic scales of analysis. The case study comprises an entire state system of hospitals and population, evaluating over one million inpatient admissions. We find compelling evidence that a positive, statistically significant relationship exists between hospital bed availability and inpatient hospitalization rates. Additionally, the observed relationship is invariant with changes in the geographic scale of analysis. This study provides evidence for the effects of Roemer's Law, thus suggesting that variations in hospitalization rates have origins in the availability of hospital beds. This relationship is found to be robust across geographic scales of analysis. These findings suggest continued regulation of hospital bed supply to assist in

  20. Ergonomics and accessibility for people with visual impairment in hotels.

    PubMed

    Dos Santos, Larissa Nascimento; de Carvalho, Ricardo José Matos

    2012-01-01

    This article presents a diagnosis of luxury or superior hotels in the city of Natal, located in the state of Rio Grande do Norte, in northeastern Brazil, in what concerns accessibility to the visually impaired. The main objective is to present the guiding principles to design actions and interventions that must be considered in the preparation or revision of technical standards and manuals of good practice in accessibility related to people with visual impairments who are hotel users. The survey showed that the hotels do not meet the normative indications of accessibility, their facilities are in-accessible (have prevented access) or of reduced accessibility and its employees are not prepared to provide adequate hospital services for people with visual impairment. It was concluded that some of the accessibility problems faced by people with visual impairments are also faced by people in general.

  1. Estimating the intensity of ward admission and its effect on emergency department access block.

    PubMed

    Luo, Wei; Cao, Jiguo; Gallagher, Marcus; Wiles, Janet

    2013-07-10

    Emergency department access block is an urgent problem faced by many public hospitals today. When access block occurs, patients in need of acute care cannot access inpatient wards within an optimal time frame. A widely held belief is that access block is the end product of a long causal chain, which involves poor discharge planning, insufficient bed capacity, and inadequate admission intensity to the wards. This paper studies the last link of the causal chain-the effect of admission intensity on access block, using data from a metropolitan hospital in Australia. We applied several modern statistical methods to analyze the data. First, we modeled the admission events as a nonhomogeneous Poisson process and estimated time-varying admission intensity with penalized regression splines. Next, we established a functional linear model to investigate the effect of the time-varying admission intensity on emergency department access block. Finally, we used functional principal component analysis to explore the variation in the daily time-varying admission intensities. The analyses suggest that improving admission practice during off-peak hours may have most impact on reducing the number of ED access blocks. Copyright © 2012 John Wiley & Sons, Ltd.

  2. Barriers to health service access among female migrant Ugandan sex workers in Guangzhou, China.

    PubMed

    Davis, Alissa; Meyerson, Beth E; Aghaulor, Blessing; Brown, Katherine; Watson, Adisyn; Muessig, Kathryn E; Yang, Ligang; Tucker, Joseph D

    2016-10-14

    Increased trade between China and Uganda has fueled trafficking of female Ugandans into China. These women may face challenges accessing health services. This study focused on examining barriers to health care access among female Ugandan sex workers in China. In 2014, we undertook in-depth interviews with 19 female Ugandan sex workers in Guangzhou, China. Interviews focused on barriers to health service access and were analyzed using an a priori coding framework followed by open-coding to capture emergent themes. Out of 19 women, 12 women reported a history of being trafficked into China. None of the women had a valid Chinese visa. Fear of being arrested for lack of documentation discouraged women in this sample from accessing hospital services. Low pay, housing exploitation, and remittances contributed to participants' lack of financial resources, which further inhibited their ability to access health services. Participants expressed feeling social isolation from the local community and reported mistrust of local individuals and organizations, including hospitals. Ugandan sex workers in China faced substantial structural barriers that limited health service access. Policy changes and the development of new programs are urgently needed to ensure these women have improved access to health services.

  3. The relationship between violence in Northern Mexico and potentially avoidable hospitalizations in the USA-Mexico border region.

    PubMed

    Geissler, Kimberley; Stearns, Sally C; Becker, Charles; Thirumurthy, Harsha; Holmes, George M

    2016-03-01

    Substantial proportions of US residents in the USA-Mexico border region cross into Mexico for health care; increases in violence in northern Mexico may have affected this access. We quantified associations between violence in Mexico and decreases in access to care for border county residents. We also examined associations between border county residence and access. We used hospital inpatient data for Arizona, California and Texas (2005-10) to estimate associations between homicide rates and the probability of hospitalization for ambulatory care sensitive (ACS) conditions. Hospitalizations for ACS conditions were compared with homicide rates in Mexican municipalities matched by patient residence. A 1 SD increase in the homicide rate of the nearest Mexican municipality was associated with a 2.2 percentage point increase in the probability of being hospitalized for an ACS condition for border county patients. Residence in a border county was associated with a 1.3 percentage point decrease in the probability of being hospitalized for an ACS condition. Increased homicide rates in Mexico were associated with increased hospitalizations for ACS conditions in the USA, although residence in a border county was associated with decreased probability of being hospitalized for an ACS condition. Expanding access in the border region may mitigate these effects by providing alternative sources of care. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  4. A rapid appraisal of access to and utilisation of psychotropic medicines in Bihar, India

    PubMed Central

    2014-01-01

    Background A major aspect of providing mental healthcare is access to and use of psychotropic medications. Bihar is a state in northeast India with limited mental healthcare provision; consequently access to and utilisation of psychotropic medications are likely to be limited. However, to date there has been no research assessing the situation. This study therefore aims to analyse the psychotropic medications management cycle (selection, procurement, distribution and use), and identify the barriers to access and utilisation, and their underlying causes. Method A rapid appraisal method was used in which primary and secondary data sources were collected and analysed. Semi-structured interviews were conducted with twenty-two stakeholders and twenty-one service users from the government, non-governmental organisation (NGO) and private sectors. The qualitative data collected was analysed using a comparative thematic approach. The research was supported by the NGOs BasicNeeds and Nav Bharat Jagriti Kendra. Results Availability, distance and cost were the main barriers to access and utilisation. At the medical college hospital level a lack of supply appears to be due to a discrepancy between orders made by the hospital and medications supplied by the manufacturers. At the primary health centre and district hospital level the main barrier is a cycle between lack of demand for treatments for mental illness by doctors and patients. Conclusion Further investigation and monitoring is necessary to ensure the availability of psychotropic medications at the medical college hospital level. In addition, implementation of the District Mental Health Programme is likely to address the access and utilisation barriers due to its potential to break the current cycle of lack of demand. PMID:25053976

  5. Gendered Peer Involvement in Girls with Congenital Adrenal Hyperplasia: Effects of Prenatal Androgens, Gendered Activities, and Gender Cognitions.

    PubMed

    Berenbaum, Sheri A; Beltz, Adriene M; Bryk, Kristina; McHale, Susan

    2018-05-01

    A key question in understanding gender development concerns the origins of sex segregation. Children's tendencies to interact with same-sex others have been hypothesized to result from gender identity and cognitions, behavioral compatibility, and personal characteristics. We examined whether prenatal androgen exposure was related to time spent with boys and girls, and how that gendered peer involvement was related to sex-typed activities and gender identity and cognitions. We studied 54 girls with congenital adrenal hyperplasia (CAH) aged 10-13 years varying in degree of prenatal androgen exposure: 40 girls with classical CAH (C-CAH) exposed to high prenatal androgens and 14 girls with non-classical CAH (NC-CAH) exposed to low, female-typical, prenatal androgens. Home interviews and questionnaires provided assessments of gendered activity interests and participation, gender identity, and gender cognitions. Daily phone calls over 7 days assessed time spent in gendered activities and with peers. Girls with both C-CAH and NC-CAH interacted more with girls than with boys, with no significant group differences. The groups did not differ significantly in gender identity or gender cognitions, but girls with C-CAH spent more time in male-typed activities and less time in female-typed activities than did girls with NC-CAH. Time spent with girls reflected direct effects of gender identity/cognitions and gender-typed activities, and an indirect effect of prenatal androgens (CAH type) through gender-typed activities. Our results extend findings that prenatal androgens differentially affect gendered characteristics and that gendered peer interactions reflect combined effects of behavioral compatibility and feelings and cognitions about gender. The study also shows the value of natural experiments for testing hypotheses about gender development.

  6. Increasing malaria hospital admissions in Uganda between 1999 and 2009

    PubMed Central

    2011-01-01

    Background Some areas of Africa are witnessing a malaria transition, in part due to escalated international donor support and intervention coverage. Areas where declining malaria rates have been observed are largely characterized by relatively low baseline transmission intensity and rapid scaling of interventions. Less well described are changing patterns of malaria burden in areas of high parasite transmission and slower increases in control and treatment access. Methods Uganda is a country predominantly characterized by intense, perennial malaria transmission. Monthly pediatric admission data from five Ugandan hospitals and their catchments have been assembled retrospectively across 11 years from January 1999 to December 2009. Malaria admission rates adjusted for changes in population density within defined catchment areas were computed across three time periods that correspond to periods where intervention coverage data exist and different treatment and prevention policies were operational. Time series models were developed adjusting for variations in rainfall and hospital use to examine changes in malaria hospitalization over 132 months. The temporal changes in factors that might explain changes in disease incidence were qualitatively examined sequentially for each hospital setting and compared between hospital settings Results In four out of five sites there was a significant increase in malaria admission rates. Results from time series models indicate a significant month-to-month increase in the mean malaria admission rates at four hospitals (trend P < 0.001). At all hospitals malaria admissions had increased from 1999 by 47% to 350%. Observed changes in intervention coverage within the catchments of each hospital showed a change in insecticide-treated net coverage from <1% in 2000 to 33% by 2009 but accompanied by increases in access to nationally recommended drugs at only two of the five hospital areas studied. Conclusions The declining malaria disease

  7. A Decomposition of Hospital Profitability: An Application of DuPont Analysis to the US Market.

    PubMed

    Turner, Jason; Broom, Kevin; Elliott, Michael; Lee, Jen-Fu

    2015-01-01

    This paper evaluates the drivers of profitability for a large sample of U.S. hospitals. Following a methodology frequently used by financial analysts, we use a DuPont analysis as a framework to evaluate the quality of earnings. By decomposing returns on equity (ROE) into profit margin, total asset turnover, and capital structure, the DuPont analysis reveals what drives overall profitability. Profit margin, the efficiency with which services are rendered (total asset turnover), and capital structure is calculated for 3,255 U.S. hospitals between 2007 and 2012 using data from the Centers for Medicare & Medicaid Services' Healthcare Cost Report Information System (CMS Form 2552). The sample is then stratified by ownership, size, system affiliation, teaching status, critical access designation, and urban or non-urban location. Those hospital characteristics and interaction terms are then regressed (OLS) against the ROE and the respective DuPont components. Sensitivity to regression methodology is also investigated using a seemingly unrelated regression. When the sample is stratified by hospital characteristics, the results indicate investor-owned hospitals have higher profit margins, higher efficiency, and are substantially more leveraged. Hospitals in systems are found to have higher ROE, margins, and efficiency but are associated with less leverage. In addition, a number of important and significant interactions between teaching status, ownership, location, critical access designation, and inclusion in a system are documented. Many of the significant relationships, most notably not-for-profit ownership, lose significance or are predominately associated with one interaction effect when interaction terms are introduced as explanatory variables. Results are not sensitive to the alternative methodology. The results of the DuPont analysis suggest that although there appears to be convergence in the behavior of NFP and IO hospitals, significant financial differences remain

  8. Growth and development in children with classic congenital adrenal hyperplasia.

    PubMed

    Bonfig, Walter

    2017-02-01

    Final height outcome in classic congenital adrenal hyperplasia (CAH) has been of interest for many years. With analysis of growth patterns and used glucocorticoid regimens, enhanced treatment strategies have been developed and are still under development. Most of the current reports on final height outcome are confirmative of previous results. Final height data is still reported in cohorts that were diagnosed clinically and not by newborn screening. Clinical diagnosis of CAH leads to delayed diagnosis especially of simple virilizing CAH with significantly advanced bone age resulting in early pubertal development and reduced final height. In contrast salt-wasting CAH is diagnosed at an earlier stage in most cases resulting in better final height outcome in some cohorts. Nevertheless, final height outcome in patients with CAH treated with glucocorticoids is lower than the population norm and also at the lower end of genetic potential. Achievement of regular adult height is still a challenge with conventional glucocorticoid treatment in patients with CAH, which is why new hydrocortisone formulations and new treatment options for CAH are underway.

  9. Using QR codes to enable quick access to information in acute cancer care.

    PubMed

    Upton, Joanne; Olsson-Brown, Anna; Marshall, Ernie; Sacco, Joseph

    2017-05-25

    Quick access to toxicity management information ensures timely access to steroids/immunosuppressive treatment for cancer patients experiencing immune-related adverse events, thus reducing length of hospital stays or avoiding hospital admission entirely. This article discusses a project to add a QR (quick response) code to a patient-held immunotherapy alert card. As QR code generation is free and the immunotherapy clinical management algorithms were already publicly available through the trust's clinical network website, the costs of integrating a QR code into the alert card, after printing, were low, while the potential benefits are numerous. Patient-held alert cards are widely used for patients receiving anti-cancer treatment, and this established standard of care has been modified to enable rapid access of information through the incorporation of a QR code.

  10. Preventable hospitalizations, barriers to care, and disability.

    PubMed

    Pezzin, Liliana E; Bogner, Hillary R; Kurichi, Jibby E; Kwong, Pui L; Streim, Joel E; Xie, Dawei; Na, Ling; Hennessy, Sean

    2018-05-01

    The AHRQ's Prevention Quality Indicators assume inpatient hospitalizations for certain conditions, referred as ambulatory-care sensitive (ACS) conditions, are potentially preventable and may indicate reduced access to and a lower quality of ambulatory care. Using a cohort drawn from the Medicare Current Beneficiary Survey (MCBS) linked to Medicare claims, we examined the extent to which barriers to healthcare are associated with ACS hospitalizations and related costs, and whether these associations differ by beneficiaries' disability status. Our results indicate that the regression-adjusted cost of ACS hospitalizations for elderly Medicare beneficiaries with no disabilities was $799. This cost increased six-fold, by $5148, among beneficiaries with mild disability, by $9045 for beneficiaries with moderate disability, by $5513 for those with severe disability, and by $8557 for persons with complete disability (P < 0.001). Persons reporting having foregone or delayed needed medical care because of financial difficulties (+$2082, P = .05), those experiencing low satisfaction with care coordination (+$1714, P = .01), and those reporting low satisfaction with access to care (+$1237, P = .02) also incurred significant excess ACS hospitalization costs relative to persons reporting no such barriers. This pattern held true for those with and without a disability, but were especially marked among persons with no functional limitations. These findings suggest that a better understanding of how public policy might effectively improve care coordination and reduce financial barriers to care is essential to formulating programs that reduce excess hospitalizations among the large and growing number of elderly Medicare beneficiaries.

  11. A clinical data repository enhances hospital infection control.

    PubMed Central

    Samore, M.; Lichtenberg, D.; Saubermann, L.; Kawachi, C.; Carmeli, Y.

    1997-01-01

    We describe the benefits of a relational database of hospital clinical data (Clinical Data Repository; CDR) for an infection control program. The CDR consists of > 40 Sybase tables, and is directly accessible for ad hoc queries by members of the infection control unit who have been granted privileges for access by the Information Systems Department. The data elements and functional requirements most useful for surveillance of nosocomial infections, antibiotic use, and resistant organisms are characterized. Specific applications of the CDR are presented, including the use of automated definitions of nosocomial infection, graphical monitoring of resistant organisms with quality control limits, and prospective detection of inappropriate antibiotic use. Hospital surveillance and quality improvement activities are significantly benefited by the availability of a querable set of tables containing diverse clinical data. PMID:9357588

  12. [Trends in hospital care].

    PubMed

    Vecina Neto, Gonzalo; Malik, Ana Maria

    2007-01-01

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

  13. Hospital choice factors: a case study in Turkey.

    PubMed

    Akinci, Fevzi; Esatoğlu, A Ezel; Tengilimoglu, Dilaver; Parsons, Amy

    2004-01-01

    In an attempt to test the robustness of the numerous American findings related to hospital choice in the context of another country, this study examines the factors affecting hospital choice decisions of 869 patients in three public and one private hospital policlinics in Ankara, Turkey and attempts to determine their importance levels. Identification of these factors and determining their effect levels is important in concentrating management efforts on these key areas and in formulating effective marketing strategies to retain and expand hospital patient bases in the future. Our findings highlight the importance of accessibility of hospital services to consumers in hospital choice as well as the role of hospital's image, its physical appearance, and technological capabilities in informing such choices. American health care managers can use these findings to further understand how patients make choices related to health care facilities and to develop marketing strategies that may more effectively market their facilities.

  14. Access of primary and secondary literature by health personnel in an academic health center: implications for open access*

    PubMed Central

    Steinberg, Ryan M.; Moorhead, Laura; O'Brien, Bridget; Willinsky, John

    2013-01-01

    Purpose: The research sought to ascertain the types and quantity of research evidence accessed by health personnel through PubMed and UpToDate in a university medical center over the course of a year in order to better estimate the impact that increasing levels of open access to biomedical research can be expected to have on clinical practice in the years ahead. Methods: Web log data were gathered from the 5,042 health personnel working in the Stanford University Hospitals (SUH) during 2011. Data were analyzed for access to the primary literature (abstracts and full-text) through PubMed and UpToDate and to the secondary literature, represented by UpToDate (research summaries), to establish the frequency and nature of literature consulted. Results: In 2011, SUH health personnel accessed 81,851 primary literature articles and visited UpToDate 110,336 times. Almost a third of the articles (24,529) accessed were reviews. Twenty percent (16,187) of the articles viewed were published in 2011. Conclusion: When it is available, health personnel in a clinical care setting frequently access the primary literature. While further studies are needed, this preliminary finding speaks to the value of the National Institutes of Health public access policy and the need for medical librarians and educators to prepare health personnel for increasing public access to medical research. PMID:23930091

  15. Visualizing collaborative electronic health record usage for hospitalized patients with heart failure.

    PubMed

    Soulakis, Nicholas D; Carson, Matthew B; Lee, Young Ji; Schneider, Daniel H; Skeehan, Connor T; Scholtens, Denise M

    2015-03-01

    To visualize and describe collaborative electronic health record (EHR) usage for hospitalized patients with heart failure. We identified records of patients with heart failure and all associated healthcare provider record usage through queries of the Northwestern Medicine Enterprise Data Warehouse. We constructed a network by equating access and updates of a patient's EHR to a provider-patient interaction. We then considered shared patient record access as the basis for a second network that we termed the provider collaboration network. We calculated network statistics, the modularity of provider interactions, and provider cliques. We identified 548 patient records accessed by 5113 healthcare providers in 2012. The provider collaboration network had 1504 nodes and 83 998 edges. We identified 7 major provider collaboration modules. Average clique size was 87.9 providers. We used a graph database to demonstrate an ad hoc query of our provider-patient network. Our analysis suggests a large number of healthcare providers across a wide variety of professions access records of patients with heart failure during their hospital stay. This shared record access tends to take place not only in a pairwise manner but also among large groups of providers. EHRs encode valuable interactions, implicitly or explicitly, between patients and providers. Network analysis provided strong evidence of multidisciplinary record access of patients with heart failure across teams of 100+ providers. Further investigation may lead to clearer understanding of how record access information can be used to strategically guide care coordination for patients hospitalized for heart failure. © The Author 2015. Published by Oxford University Press on behalf of the American Medical Informatics Association.

  16. Identifying hospitals that may be at most financial risk from Medicaid disproportionate-share hospital payment cuts.

    PubMed

    Cole, Evan S; Walker, Daniel; Mora, Arthur; Diana, Mark L

    2014-11-01

    Medicaid disproportionate-share hospital (DSH) payments are expected to decline by $35.1 billion between fiscal years 2017 and 2024, a reduction brought about by the Affordable Care Act (ACA) and recent congressional action. DSH payments have long been a feature of the Medicaid program, intended to partially offset uncompensated care costs incurred by hospitals that treat uninsured and Medicaid populations. The DSH payment cuts were predicated on the expectation that the ACA's expansion of health insurance to millions of Americans would bring about a decline in many hospitals' uncompensated care costs. However, the decision of twenty-five states not to expand their Medicaid programs, combined with residual coverage gaps, may leave as many as thirty million people uninsured, and hospitals will bear the burden of their uncompensated care costs. We sought to identify the hospitals that may be the most financially vulnerable to reductions in Medicaid DSH payments. We found that of the 529 acute care hospitals that will be particularly affected by the cuts, 225 (42.5 percent) are in weak financial condition. Policy makers should recognize that decreases in revenue may affect these hospitals' ability to give vulnerable populations access to care. Project HOPE—The People-to-People Health Foundation, Inc.

  17. Technical Efficiency of Hospitals in Tehran, Iran.

    PubMed

    Kakeman, Edris; Rahimi Forushani, Abbas; Dargahi, Hossein

    2016-04-01

    Nowadays, restriction on access and optimum use of resources is the main challenge of development in all organizations. Therefore, the aim of this study was to determine the technical efficiency and its factors, influencing hospitals of Tehran. This research was a descriptive-analytical and retrospective study conducted in 2014-2015. Fifty two hospitals with public, private, and social security ownership type were selected for this study. The required data was collected by a researcher-made check list in 3 sections of background data, inputs and outputs. The data was analyzed by DEAP 1.0.2, and STATA-13 technique. Seventeen (31/48) of hospitals had the efficiency score of 1 as the highest technical efficiency. The highest average score of efficiency was related to social security hospitals as 84.32, and then the public and private hospitals with the average of 84.29 and 79.64 respectively. Tobit regression results showed that the size, type of practice, and ownership of hospitals were effective on the degree of their technical efficiency. However, there was no significant correlation between teaching / non-teaching hospitals with technical efficiency. Establishment of competition system among hospitals, constitution of medium size hospitals and allocation of budget to hospitals based on national accreditation system are recommended.

  18. Do More Hospital Beds Lead to Higher Hospitalization Rates? A Spatial Examination of Roemer’s Law

    PubMed Central

    Delamater, Paul L.; Messina, Joseph P.; Grady, Sue C.; WinklerPrins, Vince; Shortridge, Ashton M.

    2013-01-01

    Background Roemer’s Law, a widely cited principle in health care policy, states that hospital beds that are built tend to be used. This simple but powerful expression has been invoked to justify Certificate of Need regulation of hospital beds in an effort to contain health care costs. Despite its influence, a surprisingly small body of empirical evidence supports its content. Furthermore, known geographic factors influencing health services use and the spatial structure of the relationship between hospital bed availability and hospitalization rates have not been sufficiently explored in past examinations of Roemer’s Law. We pose the question, “Accounting for space in health care access and use, is there an observable association between the availability of hospital beds and hospital utilization?” Methods We employ an ecological research design based upon the Anderson behavioral model of health care utilization. This conceptual model is implemented in an explicitly spatial context. The effect of hospital bed availability on the utilization of hospital services is evaluated, accounting for spatial structure and controlling for other known determinants of hospital utilization. The stability of this relationship is explored by testing across numerous geographic scales of analysis. The case study comprises an entire state system of hospitals and population, evaluating over one million inpatient admissions. Results We find compelling evidence that a positive, statistically significant relationship exists between hospital bed availability and inpatient hospitalization rates. Additionally, the observed relationship is invariant with changes in the geographic scale of analysis. Conclusions This study provides evidence for the effects of Roemer’s Law, thus suggesting that variations in hospitalization rates have origins in the availability of hospital beds. This relationship is found to be robust across geographic scales of analysis. These findings suggest

  19. 42 CFR 422.620 - Notifying enrollees of hospital discharge appeal rights.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... facility providing care at the inpatient hospital level, whether that care is short term or long term... specialty care or providing a broader spectrum of services. This definition also includes critical access... enrollee refuses to sign the notice. The hospital may annotate its notice to indicate the refusal, and the...

  20. 42 CFR 422.620 - Notifying enrollees of hospital discharge appeal rights.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... facility providing care at the inpatient hospital level, whether that care is short term or long term... specialty care or providing a broader spectrum of services. This definition also includes critical access... enrollee refuses to sign the notice. The hospital may annotate its notice to indicate the refusal, and the...

  1. Molecular Characteristics of Multicorn, a New Large Proteolytic Assembly and Potential Anti-Cancer Drug Target, in Human Breast Cancer Cells

    DTIC Science & Technology

    2005-05-01

    modifications: peptide N-terminal glutamine to pyroglutamic transformation, oxidation of methionine, acetylation of protein N-terminus, and...or identical with human tripeptidyl peptidase II (TPPII) with a sequence of 1249 amino acids , accession number CAH72179, GI:55661755, derived from the...34In- Gel" Digestion Procedure for the Micropreparation of Internal Protein Fragments for Amino Acid Sequencing. Anal. Biochem., 224, 451-455. Osmulski

  2. Association between use of a health information exchange system and hospital admissions.

    PubMed

    Vest, J R; Kern, L M; Campion, T R; Silver, M D; Kaushal, R

    2014-01-01

    Relevant patient information is frequently difficult to obtain in emergency department (ED) visits. Improved provider access to previously inaccessible patient information may improve the quality of care and reduce hospital admissions. Health information exchange (HIE) systems enable access to longitudinal, community-wide patient information at the point of care. However, the ability of HIE to avert admissions is not well demonstrated. We sought to determine if HIE system usage is correlated with a reduction in admissions via the ED. We identified 15,645 adults from New York State with an ED visit during a 6-month period, all of whom consented to have their information accessible in the HIE system, and were continuously enrolled in two area health plans. Using claims we determined if the ED encounter resulted in an admission. We used the HIE's system log files to determine usage during the encounter. We determined the association between HIE system use and the likelihood of admission to the hospital from the ED and potential cost savings. The HIE system was accessed during 2.4% of encounters. The odds of an admission were 30% lower when the system was accessed after controlling for confounding (odds ratio = 0.70; 95%C I= 0.52, 0.95). The annual savings in the sample was $357,000. These findings suggest that the use of an HIE system may reduce hospitalizations from the ED with resultant cost savings. This is an important outcome given the substantial financial investment in interventions designed to improve provider access to patient information in the US.

  3. Towards Age-Friendly Hospitals in Developing Countries: A Case Study in Iran

    PubMed Central

    Ahmadi, Ahmad; Seyedin, Hesam; Fadaye-Vatan, Reza

    2015-01-01

    Background: Developing countries such as Iran are experiencing a growth in the elderly population. This is a challenge for healthcare providers and their families. This study investigated the extent in which hospitals at Tehran meet the criteria of age-friendly hospitals. Methods: In this descriptive study, using convenience sampling, 26 hospitals were selected in Tehran, the capital city of Iran. The instrument was a checklist included 50 items in the three dimensions of information and training of service providers, management systems in health care centers, physical environment and accessibility of hospitals. Results: Most hospitals were in a good condition regarding physical environment and access to public transportation, but in a poor condition for special healthcare programs for the elderly, teaching principles of geriatrics and gerontology, interaction of medical staff, physicians and nurses with senior patients and systems of priority for them. Conclusion: Due to the growing elderly population, it is necessary for health policymakers, especially in developing countries, to consider seriously the issue of elderly healthcare and their need for special outpatient and inpatient services. PMID:26000245

  4. Hospital level analysis to improve patient flow.

    PubMed

    Khanna, Sankalp; Boyle, Justin; Good, Norm; Bugden, Simon; Scott, Mark

    2013-01-01

    The complexity of hospital operations ensures that one-size-fits-all solutions seldom work. As hospitals turn to evidence based strategies to redesign flow, it is critical that they tailor the strategies to suit their individual service. This paper analyses the effect of hospital occupancy on inpatient and emergency department patient flow parameters at the Caboolture hospital in Queensland, Australia, and identifies critical levels, or choke points, that result in performance decline. The effect of weekdays and weekends on patient flow is also investigated. We compare these findings to a previous study that has analysed patient flow across Queensland hospitals grouped by size, and discover several differences in the interaction between rising occupancy and patient flow parameters including rates of patient flow, length of stay, and access block. We also identify significantly higher choke points for Caboolture hospital as compared to other similarly sized Queensland hospitals, which suggest that patient flow here can be redesigned to operate at higher levels of occupancy without degrading flow performance. The findings support arguments for hospitals to analyse patient flow at a service level to deliver optimum service improvement.

  5. Disaster easily averted? Data confidentiality and the hospital desktop computer.

    PubMed

    Sethi, Neeraj; Lane, Gethin; Newton, Sophie; Egan, Philip; Ghosh, Samit

    2014-05-01

    We specifically identified the hospital desktop computer as a potential source of breaches in confidentiality. We aimed to evaluate if there was accessible, unprotected, confidential information stored on the desktop screen on computers in a district general hospital and if so, how a teaching intervention could improve this situation. An unannounced spot check of 59 ward computers was performed. Data were collected regarding how many had confidential information stored on the desktop screen without any password protection. An online learning module was mandated for healthcare staff and a second cycle of inspection performed. A district general hospital. Two doctors conducted the audit. Computers in clinical areas were assessed. All clinical staff with computer access underwent the online learning module. An online learning module regarding data protection and confidentiality. In the first cycle, 55% of ward computers had easily accessible patient or staff confidential information stored on their desktop screen. This included handovers, referral letters, staff sick leave lists, audits and nursing reports. The majority (85%) of computers accessed were logged in under a generic username and password. The intervention produced an improvement in the second cycle findings with only 26% of computers being found to have unprotected confidential information stored on them. The failure to comply with appropriate confidential data protection regulations is a persistent problem. Education produces some improvement but we also propose a systemic approach to solving this problem. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

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

    PubMed

    Sutton, Janet P; Stensland, Jeffrey

    2004-05-01

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

  7. Medi-Cal Hospital Contracting—Did It Achieve Its Legislative Objectives?

    PubMed Central

    Brown, E. Richard; Price, Walter T.; Cousineau, Michael R.

    1985-01-01

    The 1982 Medi-Cal reforms and reductions established selective contracting with hospitals for inpatient care of Medi-Cal beneficiaries. The legislation established a special negotiator and criteria to be used in selecting contract hospitals. We report the findings of a study that analyzed the characteristics of contract and noncontract hospitals in Los Angeles County to assess how well these criteria were reflected in the outcome of the contracting process. We examine issues of beneficiary access to general inpatient care and to specialized services, the efficiency of contract hospitals compared with noncontract ones and quality-related issues. PMID:3898595

  8. Development of postgraduate research supervisors within a teaching hospital setting.

    PubMed

    Scott, K M; Caldwell, P H Y; Oldmeadow, W; Dale, R C; Jones, C A

    2015-08-01

    The recent trend to embed medical research at point of care has created a need for postgraduate research supervisors in hospitals who are practising clinicians and lab-based researchers. We explored the training needs of supervisors to inform the design and evaluation of a hospital-based development programme. We found that if hospital-based supervisors are to improve their practice, the programme needs to be on-site to ensure access and relevance to local issues. © 2015 Royal Australasian College of Physicians.

  9. "I go I die, I stay I die, better to stay and die in my house": understanding the barriers to accessing health care in Timor-Leste.

    PubMed

    Price, Jennifer A; Soares, Ana I F Sousa; Asante, Augustine D; Martins, Joao S; Williams, Kate; Wiseman, Virginia L

    2016-09-30

    Despite public health care being free at the point of delivery in Timor-Leste, wealthier patients access hospital care at nearly twice the rate of poorer patients. This study seeks to understand the barriers driving inequitable utilisation of hospital services in Timor-Leste from the perspective of community members and health care managers. This multisite qualitative study in Timor-Leste conducted gender segregated focus groups (n = 8) in eight districts, with 59 adults in urban and rural settings, and in-depth interviews (n = 8) with the Director of community health centres. Communication was in the local language, Tetum, using a pre-tested interview schedule. Approval was obtained from community and national stakeholders, with written consent from participants. Lack of patient transport is the critical cross-cutting issue preventing access to hospital care. Without it, many communities resort to carrying patients by porters or on horseback, walking or paying for (unaffordable) private arrangements to reach hospital, or opt for home-based care. Other significant out-of-pocket expenses for hospital visits were blood supplies from private suppliers; accommodation and food for the patient and family members; and repatriation of the deceased. Entrenched nepotism and hospital staff denigrating patients' hygiene and personal circumstances were also widely reported. Consequently, some respondents asserted they would never return to hospital, others delayed seeking treatment or interrupted their treatment to return home. Most considered traditional medicine provided an affordable, accessible and acceptable substitute to hospital care. Obtaining a referral for higher level care was not a significant barrier to gaining access to hospital care. Onerous physical, financial and socio-cultural barriers are preventing or discouraging people from accessing hospital care in Timor-Leste. Improving access to quality primary health care at the frontline is a key strategy for

  10. Histochemical localisation of carbonic anhydrase in the inner ear of developing cichlid fish, Oreochromis mossambicus

    NASA Astrophysics Data System (ADS)

    Beier, M.; Hilbig, R.; Anken, R.

    2008-12-01

    Inner ear otolith growth in terms of mineralisation mainly depends on the enzyme carbonic anhydrase (CAH). CAH is located in specialised, mitochondria-rich macular cells (ionocytes), which are involved in the endolymphatic ion exchange, and the enzyme is responsible for the provision of the pH-value necessary for otolithic calcium carbonate deposition. In the present study, for the first time the localisation of histochemically demonstrated CAH was analysed during the early larval development of a teleost, the cichlid fish Oreochromis mossambicus. CAH-reactivity was observed already in stage 7 animals (onset of otocyst development; staging follows Anken et al. [Anken, R., Kappel, T., Slenzka, K., Rahmann, H. The early morphogenetic development of the cichlid fish, Oreochromis mossambicus (Perciformes, Teleostei). Zool. Anz. 231, 1-10, 1993]). Neuroblasts (from which sensory and supporting cells are derived) proved to be CAH-positive. Already at stage 12 (hatch), CAH-positive regions could be attributed to ionocyte containing regions both in the so-called meshwork and patches area of the macula (i.e., clearly before ionocytes can be identified on ultrastructural level or by employing immunocytochemistry). In contrast to the circumstances observed in mammalian species, sensory hair cells stained negative for CAH in the cichlid. With the onset of stage 16 (finray primordia in dorsal fin, yolk-sac being increasingly absorbed), CAH-reactivity was observed in the vestibular nerve. This indicates the onset of myelinisation and thus commencement of operation. The localisation of CAH in the inner ear of fish (especially the differences in comparison to mammals) is discussed on the basis of its role in otolith calcification. Since the vestibular system is a detector of acceleration and thus gravity, also aspects regarding effects of altered gravity on CAH and hence on the mineralisation of otoliths in an adaptive process are addressed.

  11. The effect of the global financial crisis on preventable hospitalizations among the homeless in New York State.

    PubMed

    White, Brandi; Ellis, Charles; Jones, Walter; Moran, William; Simpson, Kit

    2018-04-01

    Objective Periods of economic instability may increase preventable hospitalizations because of increased barriers to accessing primary care. For underserved populations such as the homeless, these barriers may be more pronounced due to limited resources in the health care safety net. This study examined the impact of the global financial crisis of 2007-2008 on access to care for the homeless in New York State. Methods Hospitalizations for ambulatory care sensitive conditions (ACSCs) were used as a proxy measure for primary care access. Admissions for ACSCs were identified in the New York State Inpatient Database from 2006 to 2012. Hospitalization rates for ACSCs were calculated for the homeless and nonhomeless. Multivariable linear regression was used to investigate the impact of the financial crisis on hospitalization rates for ACSCs. Results The findings indicate that during the financial crisis, homeless adults had significantly higher preventable hospitalizations than nonhomeless adults, and the uninsured homeless had significantly higher preventable hospitalizations when compared to other homeless subgroups. After the financial crisis, preventable hospitalizations for the homeless stabilized but remained at higher rates than those for the nonhomeless. Conclusions These findings are important to developing health policies designed to provide effective care for underserved population such as the homeless.

  12. Screen Media Use in Hospitalized Children.

    PubMed

    Arora, Gitanjli; Soares, Neelkamal; Li, Ning; Zimmerman, Frederick J

    2016-05-01

    Screen media overuse is associated with negative physical and mental health effects in children. The American Academy of Pediatrics recommends limiting screen media use at home; however, there are no similar guidelines for children's hospitals. This study was conducted to explore caregiver (parent or other guardian) perceptions about screen media use, compare at-home with in-hospital screen media use, and measure screen use among hospitalized children. We obtained data from a convenience cohort of hospitalized children at a single, comprehensive tertiary care children's hospital over 3 periods of 2 weeks each from 2013 to 2014. Home and hospital screen media use was measured through survey and study personnel directly observed hospital screen use. Descriptive statistics are reported and generalized estimating equation was used to identify characteristics associated with screen media use. Observation (n = 1490 observations) revealed screen media on 80.3% of the time the hospitalized child was in the room and awake, and 47.8% of observations with direct attention to a screen. Surveyed caregivers reported their child engaging in significantly more screen media use in the hospital setting as compared with home, and 42% of caregivers reported the amount of screen time used by their child in the hospital was more than they would have liked. Hospitalized children have access to a variety of screen media, and this media is used at rates far higher than recommended by the American Academy of Pediatrics. Children's hospitals should consider developing guidelines for screen media use. Copyright © 2016 by the American Academy of Pediatrics

  13. Post-abortion and induced abortion services in two public hospitals in Colombia.

    PubMed

    Darney, Blair G; Simancas-Mendoza, Willis; Edelman, Alison B; Guerra-Palacio, Camilo; Tolosa, Jorge E; Rodriguez, Maria I

    2014-07-01

    Until 2006, legal induced abortion was completely banned in Colombia. Few facilities are equipped or willing to offer abortion services; often adolescents experience even greater barriers of access in this context. We examined post abortion care (PAC) and legal induced abortion in two large public hospitals. We tested the association of hospital site, procedure type (manual vacuum aspiration vs. sharp curettage), and age (adolescents vs. women 20 years and over) with service type (PAC or legal induced abortion). Retrospective cohort study using 2010 billing data routinely collected for reimbursement (N=1353 procedures). We utilized descriptive statistics, multivariable logistic regression and predicted probabilities. Adolescents made up 22% of the overall sample (300/1353). Manual vacuum aspiration was used in one-third of cases (vs. sharp curettage). Adolescents had lower odds of documented PAC (vs. induced abortion) compared with women over age 20 (OR=0.42; 95% CI=0.21-0.86). The absolute difference of service type by age, however, is very small, controlling for hospital site and procedure type (.97 probability of PAC for adolescents compared with .99 for women 20 and over). Regardless of age, PAC via sharp curettage is the current standard in these two public hospitals. Both adolescents and women over 20 are in need of access to legal abortion services utilizing modern technologies in the public sector in Colombia. Documentation of abortion care is an essential first step to determining barriers to access and opportunities for quality improvement and better health outcomes for women. Following partial decriminalization of abortion in Colombia, in public hospitals nearly all abortion services are post-abortion care, not induced abortion. Sharp curettage is the dominant treatment for both adolescents and women over 20. Women seek care in the public sector for abortion, and must have access to safe, quality services. Copyright © 2014. Published by Elsevier Inc.

  14. A descriptive study of access to services in a random sample of Canadian rural emergency departments.

    PubMed

    Fleet, Richard; Poitras, Julien; Maltais-Giguère, Julie; Villa, Julie; Archambault, Patrick

    2013-11-27

    To examine 24/7 access to services and consultants in a sample of Canadian rural emergency departments (EDs). Cross-sectional study-mixed methods (structured interview, survey and government data bases) with random sampling of hospitals. Canadian rural EDs (rural small town (RST) definition-Statistics Canada). 28% (95/336) of Canadian rural EDs providing 24/7 physician coverage located in hospitals with acute care hospitalisation beds. General characteristics of the rural EDs, information about 24/7 access to consultants, equipment and services, and the proportion of rural hospitals more than 300 km from levels 1 and 2 trauma centres. Of the 336 rural EDs identified, 122 (36%) were randomly selected and contacted. Overall, 95 EDs participated in the study (participation rate, 78%). Hospitals had, on an average, 23 acute care beds, 7 ED stretchers and 13 500 annual ED visits. The proportion of rural hospitals with local access to the following 24/7 services was paediatrician, 5%; obstetrician, 10%; psychiatrist, 11%; internist, 12%; intensive care unit, 17%; CT scanner, 20%; surgeon, 26%; ultrasound, 28%; basic X-ray, 97% and laboratory services, 99%. Forty-four per cent and 54% of the RST EDs were more than 300 km from a level 1 and level 2 trauma centre, respectively. This is the first study describing the services available in Canadian rural EDs. Apart from basic laboratory and X-ray services, most rural EDs have limited access to consultants, advanced imaging and critical care services. A detailed study is needed to evaluate the impact of these limited services on patient outcomes, costs and interfacility transport demands.

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

    PubMed

    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.

  16. The legal duty of physicians and hospitals to provide emergency care

    PubMed Central

    Walker, Anne F.

    2002-01-01

    ACCESSIBILITY OF HOSPITAL EMERGENCY SERVICES HAS BEEN an issue of increasing concern and was recently brought into public focus in Ontario by the tragic death of Joshua Fleuelling, whose ambulance was redirected from the nearest hospital. As will be reviewed, the limited case law has identified a legal duty for physicians and hospitals to provide treatment to people in need of emergency care, a duty that should be considered when formulating hospital policies. The impact of this duty of care on the existing standard of medical practice will be considered. PMID:11873926

  17. Comparison of hospitalization rates among for-profit and nonprofit dialysis facilities.

    PubMed

    Dalrymple, Lorien S; Johansen, Kirsten L; Romano, Patrick S; Chertow, Glenn M; Mu, Yi; Ishida, Julie H; Grimes, Barbara; Kaysen, George A; Nguyen, Danh V

    2014-01-01

    The vast majority of US dialysis facilities are for-profit and profit status has been associated with processes of care and outcomes in patients on dialysis. This study examined whether dialysis facility profit status was associated with the rate of hospitalization in patients starting dialysis. This was a retrospective cohort study of Medicare beneficiaries starting dialysis between 2005 and 2008 using data from the US Renal Data System. All-cause hospitalization was examined and compared between for-profit and nonprofit dialysis facilities through 2009 using Poisson regression. Companion analyses of cause-specific hospitalization that are likely to be influenced by dialysis facility practices including hospitalizations for heart failure and volume overload, access complications, or hyperkalemia were conducted. The cohort included 150,642 patients. Of these, 12,985 (9%) were receiving care in nonprofit dialysis facilities. In adjusted models, patients receiving hemodialysis in for-profit facilities had a 15% (95% confidence interval [95% CI], 13% to 18%) higher relative rate of hospitalization compared with those in nonprofit facilities. Among patients receiving peritoneal dialysis, the rate of hospitalization in for-profit versus nonprofit facilities was not significantly different (relative rate, 1.07; 95% CI, 0.97 to 1.17). Patients on hemodialysis receiving care in for-profit dialysis facilities had a 37% (95% CI, 31% to 44%) higher rate of hospitalization for heart failure or volume overload and a 15% (95% CI, 11% to 20%) higher rate of hospitalization for vascular access complications. Hospitalization rates were significantly higher for patients receiving hemodialysis in for-profit compared with nonprofit dialysis facilities.

  18. Characterization of Chlorinated Aliphatic Hydrocarbons and Environmental Variables in a Shallow Groundwater in Shanghai Using Kriging Interpolation and Multifactorial Analysis.

    PubMed

    Lu, Qiang; Luo, Qi Shi; Li, Hui; Liu, Yong Di; Gu, Ji Dong; Lin, Kuang Fei; Fei Lin, Kuang

    2015-01-01

    CAHs, as a cleaning solvent, widely contaminated shallow groundwater with the development of manufacturing in China's Yangtze River Delta. This study focused on the distribution of CAHs, and correlations between CAHs and environmental variables in a shallow groundwater in Shanghai, using kriging interpolation and multifactorial analysis. The results showed that the overall CAHs plume area (above DIV) was approximately 9,000 m(2) and located in the 2-4 m underground, DNAPL was accumulated at an area of approximately 1,400 m(2) and located in the 6-8m sandy silt layer on the top of the muddy silty clay. Heatmap of PPC for CAHs and environmental variables showed that the correlation between "Fe(2+)" and most CAHs such as "1,1,1-TCA", "1,1-DCA", "1,1-DCE" and "%TCA" were significantly positive (p<0.001), but "%CA" and/or "%VC" was not, and "Cl-" was significantly positive correlated with "1,1-DCA" and "1,1-DCE" (p<0.001). The PCA demonstrated that the relative proportions of CAHs in groundwater were mostly controlled by the sources and the natural attenuation. In conclusion, the combination of geographical and chemometrics was helpful to establishing an aerial perspective of CAHs and identifying reasons for the accumulation of toxic dechlorination intermediates, and could become a useful tool for characterizing contaminated sites in general.

  19. Determinants of the microbial community structure of eutrophic, hyporheic river sediments polluted with chlorinated aliphatic hydrocarbons.

    PubMed

    Hamonts, Kelly; Ryngaert, Annemie; Smidt, Hauke; Springael, Dirk; Dejonghe, Winnie

    2014-03-01

    Chlorinated aliphatic hydrocarbons (CAHs) often discharge into rivers as contaminated groundwater baseflow. As biotransformation of CAHs in the impacted river sediments might be an effective remediation strategy, we investigated the determinants of the microbial community structure of eutrophic, CAH-polluted sediments of the Zenne River. Based on PCR-DGGE analysis, a high diversity of Bacteria, sulfate-reducing bacteria, Geobacteraceae, methanogenic archaea, and CAH-respiring Dehalococcoides was found. Depth in the riverbed, organic carbon content, CAH content and texture of the sediment, pore water temperature and conductivity, and concentrations of toluene and methane significantly contributed to the variance in the microbial community structure. On a meter scale, CAH concentrations alone explained only 6% of the variance in the Dehalococcoides and sulfate-reducing communities. On a cm-scale, however, CAHs explained 14.5-35% of the variation in DGGE profiles of Geobacteraceae, methanogens, sulfate-reducing bacteria, and Bacteria, while organic carbon content explained 2-14%. Neither the presence of the CAH reductive dehalogenase genes tceA, bvcA, and vcrA, nor the community structure of the targeted groups significantly differed between riverbed locations showing either no attenuation or reductive dechlorination, indicating that the microbial community composition was not a limiting factor for biotransformation in the Zenne sediments. © 2013 Federation of European Microbiological Societies. Published by John Wiley & Sons Ltd. All rights reserved.

  20. AMSARA: Accession Medical Standards Analysis and Research Activity. Report of 2006 Attrition and Morbidity Data for 2005 Accessions

    DTIC Science & Technology

    2007-12-17

    and Research Activity (AMSARA) NUMBER Department of Epidemiology Division of Preventive Medicine Walter Reed Army Institute of Research 503 Robert...Hospitalizations, Recruits, Epidemiology, Attrition, Disability, Statistics, Preventive Medicine , Physical Fitness, Motivation, Accession, Waiver, Existing Prior to...an active duty Army enlistee. These findings are presented in abstract form in this report and as a full manuscript submitted to Military Medicine in

  1. Explaining Racial/Ethnic Disparities in Use of High-Volume Hospitals

    PubMed Central

    Gray, Bradford H.; Schlesinger, Mark

    2014-01-01

    Racial/ethnic minorities are less likely to use higher-quality hospitals than whites. We propose that a higher level of information-related complexity in their local hospital environments compounds the effects of discrimination and more limited access to services, contributing to racial/ethnic disparities in hospital use. While minorities live closer than whites to high-volume hospitals, minorities also face greater choice complexity and live in neighborhoods with lower levels of medical experience. Our empirical results reveal that it is generally the overall context associated with proximity, choice complexity, and local experience, rather than differential sensitivity to these factors, that provides a partial explanation of the disparity gap in high-volume hospital use. PMID:25316717

  2. Management changes resulting from hospital accreditation 1

    PubMed Central

    de Oliveira, João Lucas Campos; Gabriel, Carmen Silvia; Fertonani, Hosanna Pattrig; Matsuda, Laura Misue

    2017-01-01

    ABSTRACT Objective: to analyze managers and professionals' perceptions on the changes in hospital management deriving from accreditation. Method: descriptive study with qualitative approach. The participants were five hospital quality managers and 91 other professionals from a wide range of professional categories, hierarchical levels and activity areas at four hospitals in the South of Brazil certified at different levels in the Brazilian accreditation system. They answered the question "Tell me about the management of this hospital before and after the Accreditation". The data were recorded, fully transcribed and transported to the software ATLAS.ti, version 7.1 for access and management. Then, thematic content analysis was applied within the reference framework of Avedis Donabedian's Evaluation in Health. Results: one large family was apprehended, called "Management Changes Resulting from the Accreditation: perspectives of managers and professionals" and five codes, related to the management changes in the operational, structural, financial and cost; top hospital management and quality management domains. Conclusion: the management changes in the hospital organizations resulting from the Accreditation were broad, multifaceted and in line with the improvements of the service quality. PMID:28301031

  3. Point prevalence of access block and overcrowding in New Zealand emergency departments in 2010 and their relationship to the 'Shorter Stays in ED' target.

    PubMed

    Jones, Peter G; Olsen, Sarah

    2011-10-01

    To document the extent of access block and ED overcrowding in New Zealand in 2010 and to determine whether these were linked to the hospital's ability to meet the Shorter Stays in ED target. Surveys of all New Zealand EDs were undertaken at two points in time in 2010 to determine ED occupancy. Data on target achievement during corresponding time periods were obtained from the Ministry of Health. In tertiary and secondary hospitals, respectively, access block was seen in 64% versus 23% (P= 0.05) and overcrowding was seen in 57.1% versus 39% (P= 0.45). No hospital with access block met the 'Shorter Stays' target, compared with 60% without access block (P= 0.001). Twenty-three per cent of hospitals with ED overcrowding met the target compared with 43% without ED overcrowding (P= 0.42). The number of patients experiencing ≥8 h delay to admission were 25 in May and 59 in August (P= 0.04). This represented 45.5% and 79.7% of patients waiting for admission, respectively (P= 0.08). Hospital access block was seen more often in larger hospitals and significantly associated with failure to meet the 'Shorter Stays in ED' health target, whereas ED overcrowding was seen in both small and large hospitals, but not associated with failure to meet the target. © 2011 The Authors. EMA © 2011 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  4. A network of web multimedia medical information servers for a medical school and university hospital.

    PubMed

    Denier, P; Le Beux, P; Delamarre, D; Fresnel, A; Cleret, M; Courtin, C; Seka, L P; Pouliquen, B; Cleran, L; Riou, C; Burgun, A; Jarno, P; Leduff, F; Lesaux, H; Duvauferrier, R

    1997-08-01

    Modern medicine requires a rapid access to information including clinical data from medical records, bibliographic databases, knowledge bases and nomenclature databases. This is especially true for University Hospitals and Medical Schools for training as well as for fundamental and clinical research for diagnosis and therapeutic purposes. This implies the development of local, national and international cooperation which can be enhanced via the use and access to computer networks such as Internet. The development of professional cooperative networks goes with the development of the telecommunication and computer networks and our project is to make these new tools and technologies accessible to the medical students both during the teaching time in Medical School and during the training periods at the University Hospital. We have developed a local area network which communicates between the School of Medicine and the Hospital which takes advantage of the new Web client-server technology both internally (Intranet) and externally by access to the National Research Network (RENATER in France) connected to the Internet network. The address of our public web server is http:(/)/www.med.univ-rennesl.fr.

  5. Utility of a precursor-to-product ratio in the evaluation of presumptive positives in newborn screening of congenital adrenal hyperplasia.

    PubMed

    Tieh, P Y; Yee, J K; Hicks, R A; Mao, C S; Lee, W-Np

    2017-03-01

    Screening for congenital adrenal hyperplasia (CAH) caused by 21-α-hydroxylase deficiency is challenging because factors such as prematurity and stress increase intermediate steroid metabolite levels in newborn infants. The objective of this study was to explore the use of the 17-α-hydroxyprogesterone (17-OHP)/11-deoxycortisol ratio as an adjunct measure in the follow-up evaluation of infants with presumptive positive newborn screens for CAH to distinguish between infants with no disorder and those with CAH. This was a retrospective cohort study of infants with presumptive positive newborn screens for CAH. The precursor-to-product ratio of 17-OHP/11-deoxycortisol was compared between infants with no disorder (n=47) and infants with CAH (n=5). The CAH infants had higher 17-OHP/11-deoxycortisol ratios than infants with no disorder: 26 (18 to 58) and 1.05 (0.69 to 1.46), respectively (P<0.05). Among infants with no disorder, higher levels of serum 17-OHP did not reflect higher ratios, indicating sufficient enzyme activity. The results suggest that a low 17-OHP/11-deoxycortisol ratio represents 21-α-hydroxylase sufficiency among presumptive positives in newborn screening of CAH.

  6. Vital pathways for hospital librarians: present and future roles

    PubMed Central

    Holst, Ruth; Funk, Carla J.; Adams, Heidi Sue; Bandy, Margaret; Boss, Catherine Mary; Hill, Beth; Joseph, Claire B.; Lett, Rosalind K.

    2009-01-01

    Objectives: The research objectives were to (1) describe the current and future roles of hospital librarians and the challenges they face and (2) find evidence supporting the hypothesis that librarians are essential to hospitals in achieving the organizations' mission-critical goals. Method: The authors used results from a previous research study that identified the five organizational mission-critical goals important to hospital administrators and then searched the literature and solicited examples from hospital librarians to describe the librarian's role in helping hospitals achieve these goals. Results: The literature supports the hypothesis that hospital librarians play important roles in the success of the hospital. Librarians support quality clinical care, efficient and effective hospital operations, continuing education for staff, research and innovation, and patient, family, and community health information needs. Conclusion: Hospital librarians fulfill many mission-critical roles in today's hospital, providing the right information at the right time in a variety of ways to enhance hospital and medical staff effectiveness, optimize patient care, improve patient outcomes, and increase patient and family satisfaction with the hospital and its services. Because hospital librarians and their services provide an excellent return on investment for the hospital and help the hospital keep its competitive edge, hospital staff should have access to the services of a professional librarian. PMID:19851493

  7. Vital pathways for hospital librarians: present and future roles.

    PubMed

    Holst, Ruth; Funk, Carla J; Adams, Heidi Sue; Bandy, Margaret; Boss, Catherine Mary; Hill, Beth; Joseph, Claire B; Lett, Rosalind K

    2009-10-01

    The research objectives were to (1) describe the current and future roles of hospital librarians and the challenges they face and (2) find evidence supporting the hypothesis that librarians are essential to hospitals in achieving the organizations' mission-critical goals. The authors used results from a previous research study that identified the five organizational mission-critical goals important to hospital administrators and then searched the literature and solicited examples from hospital librarians to describe the librarian's role in helping hospitals achieve these goals. The literature supports the hypothesis that hospital librarians play important roles in the success of the hospital. Librarians support quality clinical care, efficient and effective hospital operations, continuing education for staff, research and innovation, and patient, family, and community health information needs. Hospital librarians fulfill many mission-critical roles in today's hospital, providing the right information at the right time in a variety of ways to enhance hospital and medical staff effectiveness, optimize patient care, improve patient outcomes, and increase patient and family satisfaction with the hospital and its services. Because hospital librarians and their services provide an excellent return on investment for the hospital and help the hospital keep its competitive edge, hospital staff should have access to the services of a professional librarian.

  8. Accessibility and distribution of the Norwegian National Air Emergency Service: 1988-1998.

    PubMed

    Heggestad, Torhild; Børsheim, Knut Yngve

    2002-01-01

    To evaluate the accessibility and distribution of the Norwegian National Air Emergency Service in the 10-year period from 1988 to 1998. The primary material was annual standardized activity data that included all helicopter missions. A multivariate model of determinants for use of the helicopter service was computed by linear regression. Accessibility was measured as the percentage of the population reached in different flying times, and we evaluated the service using a simulation of alternative locations for the helicopter bases. The helicopter service (HEMS) has short access times, with a mean reaction time of 8 minutes and a mean response time of 26 minutes for acute missions. Nearly all patients (98%) are reached within 1 hour. A simulation that tested alternative locations of the helicopter bases compared with current locations showed no increase in accessibility. The use of the service shows large regional differences. Multivariate analyses showed that the distances of the patients from the nearest helicopter base and the nearest hospital are significant determinants for the use of HEMS. Establishment of a national service has given the Norwegian population better access to highly qualified prehospital emergency services. Furthermore, the HEMS has a compensating effect in adjusting for differences in traveling distances to a hospital. Safety, cost-containment, and gatekeeper functions remain challenges.

  9. Infornut® Process; improves accessibility to diagnosis and nutritional support for the malnourished hospitalized patient; impact on management indicators; two-year assessment.

    PubMed

    Villalobos Gámez, Juan Luis; González Pérez, Cristina; García-Almeida, José Manuel; Martínez Reina, Alfonso; Del Río Mata, José; Márquez Fernández, Efrén; Rioja Vázquez, Rosalía; Barranco Pérez, Joaquín; Enguix Armada, Alfredo; Rodríguez García, Luis Miguel; Bernal Losada, Olga; Osorio Fernández, Diego; Mínguez Mañanes, Alfredo; Lara Ramos, Carlos; Dani, Laila; Vallejo Báez, Antonio; Martínez Martín, Jesús; Fernández Ovies, José Manuel; Tinahones Madueño, Francisco Javier; Fernández-Crehuet Navajas, Joaquín

    2014-06-01

    . With respect to process performance, more than 3,600 patients per year (30% of admissions with a stay > 3 days) underwent analytical screening. Half of these patients were at medium or high risk and a nutritional assessment using INFORNUT® was completed for 55% of them, generating approximately 1,000 reports/year. Our coding rates exceeded the mean rates in Andalusia, being 3.5 times higher for diagnoses (35‰); 2.5 times higher for procedures (50‰) and five times the rate of procedurerelated diagnoses in the same patient (25‰). The Mean Stay of patients coded with malnutrition at discharge was 31.7 days, compared to 9.5 for the overall hospital stay. The Mortality Rate for the same patients (21.8%) was almost five times higher than the mean and Urgent Readmissions (5.5%) were 1.9 times higher. The impact of this coding on the hospital Complexity Index was four hundredths (from 2.08 to 2.12 in 2009 and 2.15 to 2.19 in 2010). This translates into a hospitalization cost justification of 2,000,000; five to six times the cost of artificial nutrition. The process facilitated access to the diagnosis of malnutrition and to understanding the risk of developing it, as well as to the prescription of procedures and/or supplements to correct it. The interdisciplinary team coordination, the participatory process and the tools used improved coding rates to give results far above the Andalusian mean. These results help to upwardly adjust the hospital Complexity Index or Case Mix-, as well as to explain hospitalization costs. Copyright AULA MEDICA EDICIONES 2014. Published by AULA MEDICA. All rights reserved.

  10. 42 CFR 485.641 - Condition of participation: Periodic evaluation and quality assurance review.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... physicians and practitioners providing telemedicine services to the CAH's patients under a written agreement... physicians and practitioners providing telemedicine services to the CAH's patients under a written agreement between the CAH and a distant-site telemedicine entity, one of the entities listed in paragraphs (b)(4)(i...

  11. 42 CFR 485.641 - Condition of participation: Periodic evaluation and quality assurance review.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... physicians and practitioners providing telemedicine services to the CAH's patients under a written agreement... physicians and practitioners providing telemedicine services to the CAH's patients under a written agreement between the CAH and a distant-site telemedicine entity, one of the entities listed in paragraphs (b)(4)(i...

  12. 42 CFR 485.641 - Condition of participation: Periodic evaluation and quality assurance review.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... physicians and practitioners providing telemedicine services to the CAH's patients under a written agreement... physicians and practitioners providing telemedicine services to the CAH's patients under a written agreement between the CAH and a distant-site telemedicine entity, one of the entities listed in paragraphs (b)(4)(i...

  13. 42 CFR 485.641 - Condition of participation: Periodic evaluation and quality assurance review.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... physicians and practitioners providing telemedicine services to the CAH's patients under a written agreement... physicians and practitioners providing telemedicine services to the CAH's patients under a written agreement between the CAH and a distant-site telemedicine entity, one of the entities listed in paragraphs (b)(4)(i...

  14. Strength in unity: the power of redesign to align the hospital team.

    PubMed

    Bell, Anthony; Cochrane, Alastair; Courtice, Sally; Flanigan, Kathy; Mathur, Mandeep; Wilckens, Daniel

    2014-06-01

    The aim of Queen Elizabeth II Jubilee Hospital (QEII) redesign project (QEII United) was to enhance timely access to an inpatient bed and maximise opportunities to value add during the inpatient episode of care. A tripartite relationship between the hospital team, system manager and external consultants. The team, QEII United, was formed to 'diagnose, solve and implement' change under the unifying metaphorical banner of a football team. A marketing strategy and communication plan targeted the key 'players' and outlined the 'game plan'. Baseline data were collected, analysed and reported in keeping with key aims. Strategies for systems improvement implementation were attached to key performance indicators (KPIs). Thematic KPIs were developed to embed internal process change to reflect the contributions made towards the National Emergency Access Target (NEAT) at each stage of the patient journey. As such, access block of under 20%, morning discharge rates of 50% before midday, reduced length of stay for selected elective orthopaedic and general medical diagnostic related groupings (DRGs; i.e. relative stay index ≤1) and hospital in the home (HITH) utilisation rates 1.5% of all admissions were all met. Key to sustainability was the transfer of clinical redesign skills to hospital staff and the fostering of emergent ground up leadership. QEII United's success has been underpinned by the development of themed solution areas developed by the hospital staff themselves. Robust baseline data analysis used in combination with nationally available benchmarking data provided a quantitative starting point for the work. The collaborative elements of the program re-energised the hospital team, who were kept informed by targeted communications, to establish quick wins and build trust and momentum for the more challenging areas.

  15. Problems facing Korean hospitals and possible countermeasures.

    PubMed

    Kim, Kwang-Tae

    2004-07-01

    Korea has a unique health care system, of which the private sector comprises most of the country's health resources: 88% of the beds and 91% of specialists in Korea, but are funded by public financing, such as national health insurance and the national aid program. However, the public financing pays only 50% of actual costs and the patient's co-payment is still high. Healthcare organizations in Korea are categorized into four types; tertiary care hospitals, general hospitals, hospitals and clinics by scale of operator: number of beds. General hospitals must have 100 beds and over, and compulsorily specialties in internal medicine, surgery, obstetrics-gynecology, pediatrics, dental service, other ancillary service units and an emergency care unit. General hospitals with 300 beds and more must operate an intensive care unit. There are many challenges facing the Korean healthcare system, such as reformation of primary healthcare system, enhancing hospitals' competitiveness, and permission of for-profit hospital, introduction of private health insurance, enhancement of geriatric care. These challenges can be resolved with long-term vision, willingness and strategies of the Korean government to ensure equitable financing and access to healthcare, combined with the active participation and utilization of the private sector.

  16. [Evaluation of the Andalusia Public Health System hospital websites in the period 2010-2012].

    PubMed

    de la Torre Barbero, M J; Estepa Luna, M J; López-Pardo Martínez, M; León Márquez, M; Sánchez Laguna, F; Toledano Redondo, S

    2014-01-01

    Evaluate the quality, accessibility and presence of Web 2.0 tools in the Andalusia Public Health System hospitals websites Observational, descriptive study carried out between 2010 and 2012. The variables analyzed were: quality, accessibility and innovation. The quality was evaluated using a Bermudez-Tamayo questionnaire. Accessibility was measured using the Web Accessibility Test (TAW) tool. Web 2.0 tools were identified by direct observation. A total of 31 of the 45 hospitals (68.9%) had a website in the year 2010, increasing to 34 (75.5%) in 2012. The average score+standard deviation (SD) of the Bermudez-Tamayo quality questionnaire was 11.1+3.8 points in 2010, and 12.3+3.9 points in 2012, observing a statistically significant difference of 0.25 being observed between the means (P=.007), 95% CI; 0.00 to 0.50) In the accessibility evaluation only 7 websites (n=31) in 2010, and 10 (n=34) in 2012, fulfilled the legal criteria for accessibility. The use of Web 2.0 tools has increased throughout the study. In 2010, 19.4% (n=6) of the hospital websites had this type of tool, in comparison to 58.8% (n=20) in 2012. In general, the quality of the websites studied is good. However, current legislation regarding accessibility is not fulfilled and must be revised and adapted to the current legal rules. There is an incipient use of Web 2.0 resources as education and communication strategies with regard to health. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

  17. The Impact of Hospital Closures and Hospital and Population Characteristics on Increasing Emergency Department Volume: A Geographic Analysis.

    PubMed

    Lee, David C; Carr, Brendan G; Smith, Tony E; Tran, Van C; Polsky, Daniel; Branas, Charles C

    2015-12-01

    Emergency visits are rising nationally, whereas the number of emergency departments is shrinking. However, volume has not increased uniformly at all emergency departments. It is unclear what factors account for this variability in emergency volume growth rates. The objective of this study was to test the association of hospital and population characteristics and the effect of hospital closures with increases in emergency department volume. The study team analyzed emergency department volume at New York State hospitals from 2004 to 2010 using data from cost reports and administrative databases. Multivariate regression was used to evaluate characteristics associated with emergency volume growth. Spatial analytics and distances between hospitals were used in calculating the predicted impact of hospital closures on emergency department use. Among the 192 New York hospitals open from 2004 to 2010, the mean annual increase in emergency department visits was 2.7%, but the range was wide (-5.5% to 11.3%). Emergency volume increased nearly twice as fast at tertiary referral centers (4.8%) and nonurban hospitals (3.7% versus urban at 2.1%) after adjusting for other characteristics. The effect of hospital closures also strongly predicted variation in growth. Emergency volume is increasing faster at specific hospitals: tertiary referral centers, nonurban hospitals, and those near hospital closures. This study provides an understanding of how emergency volume varies among hospitals and predicts the effect of hospital closures in a statewide region. Understanding the impact of these factors on emergency department use is essential to ensure that these populations have access to critical emergency services.

  18. A population-based analysis of injury-related deaths and access to trauma care in rural-remote Northwest British Columbia.

    PubMed

    Simons, Richard; Brasher, Penelope; Taulu, Tracey; Lakha, Nasira; Molnar, Nadine; Caron, Nadine; Schuurman, Nadine; Evans, David; Hameed, Morad

    2010-07-01

    Injury rates and injury mortality rates are generally higher in rural and remote communities compared with urban jurisdictions as has been shown to be the case in the rural-remote area of Northwest (NW) British Columbia (BC). The purpose of study was to identify: (1) the place and timing of death following injury in NW BC, (2) access to and quality of local trauma services, and (3) opportunities to improve trauma outcomes. Quantitative data from demographic and geographic databases, the BC Trauma Registry, Hospital discharge abstract database, and the BC Coroner's Office, along with qualitative data from chart reviews of selected major trauma cases, and interviews with front-line trauma care providers were collated and analyzed for patients sustaining injury in NW BC from April 2001 to March 2006. The majority of trauma deaths (82%) in NW BC occur prehospital. Patients arriving alive to NW hospitals have low hospital mortality (1.0%), and patients transferring from NW BC to tertiary centers have better outcomes than matched patients achieving direct entry into the tertiary center by way of geographic proximity. Access to local trauma services was compromised by: incident discovery, limited phone service (land lines/cell), incomplete 911 emergency medical services system access, geographical and climate challenges compounded by limited transportation options, airport capabilities and paramedic training level, dysfunctional hospital no-refusal policies, lack of a hospital destination policies, and lack of system leadership and coordination. Improving trauma outcomes in this rural-remote jurisdiction requires a systems approach to address root causes of delays in access to care, focusing on improved access to emergency medical services, hospital bypass and destination protocols, improved transportation options, advanced life support transfer capability, and designated, coordinated local trauma services.

  19. Duration to Establish an Emergency Vascular Access and How to Accelerate It: A Simulation-Based Study Performed in Real-Life Neonatal Resuscitation Rooms.

    PubMed

    Schwindt, Eva M; Hoffmann, Florian; Deindl, Philipp; Waldhoer, Thomas J; Schwindt, Jens C

    2018-05-01

    To compare the duration to establish an umbilical venous catheter and an intraosseous access in real hospital delivery rooms and as a secondary aim to assess delaying factors during establishment and to provide recommendations to accelerate vascular access in neonatal resuscitation. Retrospective analysis of audio-video recorded neonatal simulation training. Simulation training events in exact replications of actual delivery/resuscitation rooms of 16 hospitals with different levels of care (Austria and Germany). Equipment was prepared the same way as for real clinical events. Medical teams of four to five persons with birth-related background (midwives, nurses, neonatologists, and anesthesiologists) in a realistic team composition. Audio-video recorded mannequin-based simulated resuscitation of an asphyxiated newborn including the establishment of either umbilical venous catheter or intraosseous access. The duration of access establishment (time from decision to first flush/aspiration), preparation (decision to start of procedure), and the procedure itself (start to first flush/aspiration) was significantly longer for umbilical venous catheter than for intraosseous access (overall duration 199 vs 86 s). Delaying factors for umbilical venous catheter establishment were mainly due to the complex approach itself, the multitude of equipment required, and uncertainties about necessary hygiene standards. Challenges in intraosseous access establishment were handling of the unfamiliar material and absence of an intraosseous access kit in the resuscitation room. There was no significant difference between the required duration for access establishment between large centers and small hospitals, but a trend was observed that duration for umbilical venous catheter was longer in small hospitals than in centers. Duration for intraosseous access was similar in both hospital types. Vascular access establishment in neonatal resuscitation could be accelerated by infrastructural

  20. Design, Planning and Management of the Hospital Custody Unit at Hospital Universitario Fundación Alcorcón.

    PubMed

    Fuente-Martín, C de la; Fuente Martín, B de la; Grifol-Clar, E

    2017-12-01

    The design and management of a Hospital Custody Unit at Hospital Universitario Fundación Alcorcón, to focus the aim of this study on specialized medical care for extra-penitentiary patients who have suffered from a disease. We are building a new space to facilitate their daily lives at hospital and we want to offer a double function to the patients that consists of a custody space and a health rehabilitation space. We carried out a scientific literature search on the international and national databases, about Hospital Custody Units or Restricted Access Units. The language of the reviews that we checked was English and Spanish. We wrote the Action Guide of the Hospital Custody Unit for the design, planning and management of the Hospital Custody Unit at Hospital Universitario Fundación Alcorcón. (We included complementary bibliographic material and the Quick Guide in the Unit). The Hospital Custody Unit will be compatible with medical activity, occupational safety and the custody of patients that are in prison. We thus require consensus with police departments about custody protocols along with assistance from the clinicians' teams at penitentiary centers and referral hospitals. Furthermore, it is important to step up special care for mental health and to promote telemedicine and new technologies to streamline medical care along with coordination with healthcare professionals.

  1. Association Between Use of a Health Information Exchange System and Hospital Admissions

    PubMed Central

    Vest, J.R.; Kern, L.M.; Campion, T.R.; Silver, M.D.; Kaushal, R.

    2014-01-01

    Summary Objective Relevant patient information is frequently difficult to obtain in emergency department (ED) visits. Improved provider access to previously inaccessible patient information may improve the quality of care and reduce hospital admissions. Health information exchange (HIE) systems enable access to longitudinal, community-wide patient information at the point of care. However, the ability of HIE to avert admissions is not well demonstrated. We sought to determine if HIE system usage is correlated with a reduction in admissions via the ED. Methods We identified 15,645 adults from New York State with an ED visit during a 6-month period, all of whom consented to have their information accessible in the HIE system, and were continuously enrolled in two area health plans. Using claims we determined if the ED encounter resulted in an admission. We used the HIE’s system log files to determine usage during the encounter. We determined the association between HIE system use and the likelihood of admission to the hospital from the ED and potential cost savings. Results The HIE system was accessed during 2.4% of encounters. The odds of an admission were 30% lower when the system was accessed after controlling for confounding (odds ratio = 0.70; 95%C I= 0.52, 0.95). The annual savings in the sample was $357,000. Conclusion These findings suggest that the use of an HIE system may reduce hospitalizations from the ED with resultant cost savings. This is an important outcome given the substantial financial investment in interventions designed to improve provider access to patient information in the US. PMID:24734135

  2. Utilisation of prehospital intravenous access.

    PubMed

    Bester, B H; Sobuwa, Simpiwe

    2014-07-22

    To describe the use of intravenous (IV) therapy in the South African (SA) prehopsital setting, and to determine the proportion of prehopsital cannulations considered unnecessary when graded against the South African Triage Score (SATS) chart. The study was conducted in the prehospital emergency medical care setting in the Western Cape Province, SA. Using a descriptive research design, we looked at the report forms of patients treated and transported by personnel currently employed in the public sector, serving the urban and rural areas stipulated by the municipal boundaries. All medical and trauma cases in which establishment of IV access was documented for the month of April 2013 were included. Interhospital transfers, unsuccessful attempts at IV access and intraosseous cannulation were excluded. When graded against the SATS, prophylactic IV access was not justified in 42.3% of the total number of cases (N=149) in which it was established, and therefore added no direct benefit to the continuum of patient care. It is worth noting that 18.8% (n=39) of the IV lines were utilised for fluid administration, as opposed to 9.2% (n=19) for the administration of IV medications. In view of the paucity of studies indicating a direct benefit of out-of-hospital IV intervention, the practice of precautionary, protocol-driven prophylactic establishment of IV access should be evaluated. Current data suggest that in the absence of scientific evidence, IV access should only be initiated when it will benefit the patient immediately, and precautionary IV access, especially in non-injured patients, should be re-evaluated.

  3. HYDROCORTISONE THERAPY AND GROWTH TRAJECTORY IN CHILDREN WITH CLASSICAL CONGENITAL ADRENAL HYPERPLASIA.

    PubMed

    Bizzarri, Carla; Improda, Nicola; Maggioli, Chiara; Capalbo, Donatella; Roma, Silvia; Porzio, Ottavia; Salerno, Mariacarolina; Cappa, Marco

    2017-05-01

    Poor linear growth is one of the main concerns in children with congenital adrenal hyperplasia (CAH). We aimed to analyze factors affecting growth trajectory in children with classical CAH. Clinical records of children followed from infancy up to the end of growth at two Italian tertiary referral hospitals were reviewed. Fifty-seven patients (31 males), treated with hydrocortisone and fludrocortisone only, were included. Clinical observations were divided into three groups: 0 to 2 years, 172 observations; from 2 years to puberty onset, 813 observations; after puberty onset, 527 observations. Height velocity, pubertal growth spurt, and final height were evaluated as outcomes. Final height standard deviation score (SDS) was lower than target height SDS (-0.74 ± 1.1 versus -0.31 ± 1.01; P<.001). Target-adjusted final height SDS was -0.44 ± 1.8 in males and -0.13 ± 1.1 in females (P = .001). Total pubertal growth was 21.9 ± 7.3 cm in males and 19.2 ± 8.2 cm in females (P = .19). Hydrocortisone dose increased and height-velocity SDS decreased during puberty. At multivariable analysis, height-velocity SDS was adversely affected by hydrocortisone dose (P = .038) and directly related to adrenocorticotropic hormone (ACTH) levels (P = .023). Target-adjusted final-height SDS was adversely affected by hydrocortisone dose (P<.001) and positively related to mineralocorticoid therapy (P = .001) and ACTH levels (P = .02). Total pubertal growth (cm) was positively related to ACTH levels (P = .01). Height outcome of CAH patients is now better than previously reported. During puberty, the lowest effective dose of hydrocortisone should be used to optimize pubertal growth spurt and final height. 17-OHP = 17-alpha-hydroxyprogesterone ACTH = adrenocorticotropic hormone BMI = body mass index CAH = congenital adrenal hyperplasia GH = growth hormone HPA = hypothalamus-pituitary-adrenal PRA = plasma renin activity SDS = standard deviation score SV = simple virilizing SW = salt-wasting.

  4. The challenges and possibilities of public access defibrillation.

    PubMed

    Ringh, M; Hollenberg, J; Palsgaard-Moeller, T; Svensson, L; Rosenqvist, M; Lippert, F K; Wissenberg, M; Malta Hansen, C; Claesson, A; Viereck, S; Zijlstra, J A; Koster, R W; Herlitz, J; Blom, M T; Kramer-Johansen, J; Tan, H L; Beesems, S G; Hulleman, M; Olasveengen, T M; Folke, F

    2018-03-01

    Out-of-hospital cardiac arrest (OHCA) is a major health problem that affects approximately four hundred and thousand patients annually in the United States alone. It is a major challenge for the emergency medical system as decreased survival rates are directly proportional to the time delay from collapse to defibrillation. Historically, defibrillation has only been performed by physicians and in-hospital. With the development of automated external defibrillators (AEDs), rapid defibrillation by nonmedical professionals and subsequently by trained or untrained lay bystanders has become possible. Much hope has been put to the concept of Public Access Defibrillation with a massive dissemination of public available AEDs throughout most Western countries. Accordingly, current guidelines recommend that AEDs should be deployed in places with a high likelihood of OHCA. Despite these efforts, AED use is in most settings anecdotal with little effect on overall OHCA survival. The major reasons for low use of public AEDs are that most OHCAs take place outside high incidence sites of cardiac arrest and that most OHCAs take place in residential settings, currently defined as not suitable for Public Access Defibrillation. However, the use of new technology for identification and recruitment of lay bystanders and nearby AEDs to the scene of the cardiac arrest as well as new methods for strategic AED placement redefines and challenges the current concept and definitions of Public Access Defibrillation. Existing evidence of Public Access Defibrillation and knowledge gaps and future directions to improve outcomes for OHCA are discussed. In addition, a new definition of the different levels of Public Access Defibrillation is offered as well as new strategies for increasing AED use in the society. © 2018 The Association for the Publication of the Journal of Internal Medicine.

  5. Diagnosis and management of classical congenital adrenal hyperplasia.

    PubMed

    Marumudi, Eunice; Khadgawat, Rajesh; Surana, Vineet; Shabir, Iram; Joseph, Angela; Ammini, Ariachery C

    2013-08-01

    Congenital adrenal hyperplasia (CAH) is among the most common genetic disorders. Deficiency of adrenal steroid 21-hydroxylase deficiency due to mutations in the CYP21A2 gene accounts for about 95% cases of CAH. This disorder manifests with androgen excess with or without salt wasting. It also is a potentially life threatening disorder; neonatal screening with 17-hydroxyprogesterone measurement can diagnose the condition in asymptomatic children. Carefully monitored therapy with glucocorticoid and mineralocorticoid supplementation will ensure optimal growth and development for children with CAH. Genital surgery may be required for girls with CAH. Continued care is required for individuals with CAH as adults to prevent long-term adverse consequences of the disease, including infertility, metabolic syndrome and osteoporosis. Copyright © 2013 Elsevier Inc. All rights reserved.

  6. [Effects of hospital mergers on health economy].

    PubMed

    Ingebrigtsen, Tor

    2010-05-06

    Norwegian hospitals have been characterised by increasing activity, expansion of services and increasing costs for a long time. Differences in quality and accessibility have been documented between hospitals in various geographic locations. Transferral of hospital ownership to the state (from 2002) aimed at increasing capacities and improving quality of services, but also at restricting the increase of costs. These goals have only been partly met. The structure of hospital trusts and organisation of services are therefore continuously debated. This literature review aims at examining whether hospital mergers can reduce costs and at the same time increase the quality of services offered. Literature was identified through a Medline search using the terms "hospital", "merger" and "cost saving". The results are summarized and discussed. Seven original studies of totally 476 hospital mergers (in the USA, Great Britain and Norway) were identified in the period 1982 - 2000. The literature indicates that hospital mergers have a potential to reduce costs by about 10 % if the process achieves complete fusion of previously independent organisations, with a more optimal dimensioning of services and development of a common organizational culture. Collaboration between top management and the professional bureaucracy are prerequisites for success. Mergers are associated with a significant risk of unexpected problems and temporary reduced quality of the services.

  7. Reproductive and oncologic outcomes after progestin therapy for endometrial complex atypical hyperplasia or carcinoma.

    PubMed

    Kudesia, Rashmi; Singer, Tomer; Caputo, Thomas A; Holcomb, Kevin Michael; Kligman, Isaac; Rosenwaks, Zev; Gupta, Divya

    2014-03-01

    This study evaluated fertility and oncological outcomes in women with complex atypical hyperplasia (CAH) or nonmyoinvasive grade 1 endometrioid endometrial carcinoma (EM) who desired fertility-sparing therapy. The retrospective cohort study included women younger than 45 years with CAH or EM who desired fertility-sparing treatment at our institution. Only patients for whom both oncological treatment and pregnancy outcomes were available were included. Statistical analyses were performed using a Fisher exact test, Pearson χ(2) test, and Spearman rank correlation test, as appropriate. Seventy-five patients were identified, and 23 (13 CAH, 10 EM) met the inclusion criteria. All 23 patients had at least 1 prior pregnancy. Treatment was split between oral progesterone only (38.5% CAH, 40% EM), levonorgestrel intrauterine device only (30.8% CAH, 20% EM), and both (30.8% CAH, 40% EM). After a median follow-up of 13 months (range, 3-74 months), 9 patients (46.2% CAH, 30% EM, P = .39) had persistent/progressive disease. Eight patients (30.8% CAH, 40% EM, P = .69) ultimately had a hysterectomy, and 3 of these (13.0%) were found to have persistent/progressive disease. Median time from diagnosis to hysterectomy was 13 months (range, 4-56 months). Fourteen of the 23 patients utilized assisted reproductive techniques (60.9%); 12 underwent IVF and 2 chose a gestation carrier. Seven clinical intrauterine pregnancies (30.4%) resulting in 6 live births (26.1%) were found in the entire cohort. Fertility-sparing treatment for CAH and grade 1 endometrial cancer is feasible with progestin therapy and leads to clinically meaningful rates of pregnancy in young women who desire fertility. Copyright © 2014 Mosby, Inc. All rights reserved.

  8. Tablet computers for hospitalized patients: a pilot study to improve inpatient engagement.

    PubMed

    Greysen, S Ryan; Khanna, Raman R; Jacolbia, Ronald; Lee, Herman M; Auerbach, Andrew D

    2014-06-01

    Inadequate patient engagement in hospital care inhibits high-quality care and successful transitions to home. Tablet computers may provide opportunities to engage patients, particularly during inactive times between provider visits, tests, and treatments, by providing interactive health education modules as well as access to their personal health record (PHR). We conducted a pilot project to explore inpatient satisfaction with bedside tablets and barriers to usability. Additionally, we evaluated use of these devices to deliver 2 specific Web-based programs: (1) an interactive video to improve inpatient education about hospital safety, and (2) PHR access to promote inpatient engagement in discharge planning. We enrolled 30 patients; 17 (60%) were aged 40 years or older, 17 (60%) were women, 17 (60%) owned smartphones, and 6 (22%) owned tablet computers. Twenty-seven (90%) reported high overall satisfaction with the device, and 26 (87%) required ≤ 30 minutes for basic orientation (70% required ≤ 15 minutes). Twenty-five (83%) independently completed an interactive educational module on hospital patient safety. Twenty-one (70%) accessed their personal health record (PHR) to view their medication list, verify scheduled appointments, or send a message to their primary care physician. Next steps include education on high-risk medications, assessment of discharge barriers, and training clinical staff (such as respiratory therapists, registered nurses, or nurse practitioners) to deliver tablet interventions. © 2014 Society of Hospital Medicine.

  9. The impact of primary health care on malaria morbidity - defining access by disease burden

    PubMed Central

    O’Meara, W.P.; Noor, A.; Gatakaa, H.; Tsofa, B.; McKenzie, F. E.; Marsh, K.

    2009-01-01

    Objectives The convergence of malaria endemicity and poor health care infrastructure has resulted in persistently high rates of malaria morbidity and mortality in many parts of sub-Saharan Africa. Primary care facilities are increasingly becoming the focal point for distribution of intervention strategies, but physical access to these facilities may limit the extent to which communities can be reached. Here we investigate the impact of travel time to primary care on the incidence of hospitalized malaria episodes in a rural district in Kenya. Methods The incidence of hospitalized malaria in a population under continuous demographic surveillance was recorded over three years. The time to travel to the nearest primary health care facility was calculated for every child between birth and five years of age and trends in incidence of hospitalized malaria as a function of travel time were evaluated. Results and conclusions We show that the incidence of hospitalized malaria more than doubled as travel time to the nearest primary care facility increased from ten minutes up to two hours. Good access to primary health facilities may reduce the burden of disease by as much as 66%. Our results highlight both the potential of the primary health care system in reaching those most at risk and reducing the disease burden, and that insufficient access is an important risk factor, one that may be inequitably distributed to the poorest households. PMID:19121148

  10. [Diffuse hypertrichosis revealing non-classical congenital adrenal hyperplasia].

    PubMed

    Berthin, C; Sibilia, P; Martins-Hericher, J; Donzeau, A; Martin, L

    2018-04-01

    polycystic ovary syndrome. 21-OH deficiency results in defective cortisol and aldosterone synthesis, and thus in raised ACTH, leading to increased adrenal androgen secretion. The early appearance of secondary sexual characteristics is associated with a gradual accumulation of 17-OHP. Depending on severity, hydrocortisone or anti-androgens may be given, or where treatment fails, aesthetic measures such as epilation or hair discolouration may be performed. In children presenting NC-CAH, the appearance of pubic hair and hirsutism often constitute the initial reasons for consultation, including with dermatologists. However, hypertrichosis may occur in isolation. It is important that these abnormalities be clearly known to enable early diagnosis and rapid initiation of simple and readily accessible treatment. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

  11. A descriptive study of access to services in a random sample of Canadian rural emergency departments

    PubMed Central

    Fleet, Richard; Poitras, Julien; Maltais-Giguère, Julie; Villa, Julie; Archambault, Patrick

    2013-01-01

    Objective To examine 24/7 access to services and consultants in a sample of Canadian rural emergency departments (EDs). Design Cross-sectional study—mixed methods (structured interview, survey and government data bases) with random sampling of hospitals. Setting Canadian rural EDs (rural small town (RST) definition—Statistics Canada). Participants 28% (95/336) of Canadian rural EDs providing 24/7 physician coverage located in hospitals with acute care hospitalisation beds. Main outcome measures General characteristics of the rural EDs, information about 24/7 access to consultants, equipment and services, and the proportion of rural hospitals more than 300 km from levels 1 and 2 trauma centres. Results Of the 336 rural EDs identified, 122 (36%) were randomly selected and contacted. Overall, 95 EDs participated in the study (participation rate, 78%). Hospitals had, on an average, 23 acute care beds, 7 ED stretchers and 13 500 annual ED visits. The proportion of rural hospitals with local access to the following 24/7 services was paediatrician, 5%; obstetrician, 10%; psychiatrist, 11%; internist, 12%; intensive care unit, 17%; CT scanner, 20%; surgeon, 26%; ultrasound, 28%; basic X-ray, 97% and laboratory services, 99%. Forty-four per cent and 54% of the RST EDs were more than 300 km from a level 1 and level 2 trauma centre, respectively. Conclusions This is the first study describing the services available in Canadian rural EDs. Apart from basic laboratory and X-ray services, most rural EDs have limited access to consultants, advanced imaging and critical care services. A detailed study is needed to evaluate the impact of these limited services on patient outcomes, costs and interfacility transport demands. PMID:24285633

  12. Access to Expert Stroke Care with Telemedicine: REACH MUSC

    PubMed Central

    Kazley, Abby Swanson; Wilkerson, Rebecca C.; Jauch, Edward; Adams, Robert J.

    2012-01-01

    Stroke is a leading cause of death and disability, and recombinant tissue plasminogen activator (rtPA) can significantly reduce the long-term impact of acute ischemic stroke (AIS) if given within 3 h of symptom onset. South Carolina is located in the “stroke belt” and has a high rate of stroke and stroke mortality. Many small rural SC hospitals do not maintain the expertise needed to treat AIS patients with rtPA. MUSC is an academic medical center using REACH MUSC telemedicine to deliver stroke care to 15 hospitals in the state, increasing the likelihood of timely treatment with rtPA. The purpose of this study is to determine the increase in access to rtPA through the use of telemedicine for AIS in the general population and in specific segments of the population based on age, gender, race, ethnicity, education, urban/rural residence, poverty, and stroke mortality. We used a retrospective cross-sectional design examining Census data from 2000 and geographic information systems analysis to identify South Carolina residents that live within 30 or 60 min of a primary stroke center (PSC) or a REACH MUSC site. We include all South Carolina citizens in our analysis and specifically examine the population’s age, gender, race, ethnicity, education, urban/rural residence, poverty, and stroke mortality. Our sample includes 4,012,012 South Carolinians. The main measure is access to expert stroke care at a PSC or a REACH MUSC hospital within 30 or 60 min. We find that without REACH MUSC, only 38% of the population has potential access to expert stroke care in SC within 60 min given that most PSCs will maintain expert stroke coverage. REACH MUSC allows 76% of the population to be within 60 min of expert stroke care, and 43% of the population to be within 30 min drive time of expert stroke care. These increases in access are especially significant for groups that have faced disparities in care and high rates of AIS. The use of telemedicine can greatly increase

  13. Comparison of Hospitalization Rates among For-Profit and Nonprofit Dialysis Facilities

    PubMed Central

    Johansen, Kirsten L.; Romano, Patrick S.; Chertow, Glenn M.; Mu, Yi; Ishida, Julie H.; Grimes, Barbara; Kaysen, George A.; Nguyen, Danh V.

    2014-01-01

    Summary Background and objectives The vast majority of US dialysis facilities are for-profit and profit status has been associated with processes of care and outcomes in patients on dialysis. This study examined whether dialysis facility profit status was associated with the rate of hospitalization in patients starting dialysis. Design, setting, participants, & methods This was a retrospective cohort study of Medicare beneficiaries starting dialysis between 2005 and 2008 using data from the US Renal Data System. All-cause hospitalization was examined and compared between for-profit and nonprofit dialysis facilities through 2009 using Poisson regression. Companion analyses of cause-specific hospitalization that are likely to be influenced by dialysis facility practices including hospitalizations for heart failure and volume overload, access complications, or hyperkalemia were conducted. Results The cohort included 150,642 patients. Of these, 12,985 (9%) were receiving care in nonprofit dialysis facilities. In adjusted models, patients receiving hemodialysis in for-profit facilities had a 15% (95% confidence interval [95% CI], 13% to 18%) higher relative rate of hospitalization compared with those in nonprofit facilities. Among patients receiving peritoneal dialysis, the rate of hospitalization in for-profit versus nonprofit facilities was not significantly different (relative rate, 1.07; 95% CI, 0.97 to 1.17). Patients on hemodialysis receiving care in for-profit dialysis facilities had a 37% (95% CI, 31% to 44%) higher rate of hospitalization for heart failure or volume overload and a 15% (95% CI, 11% to 20%) higher rate of hospitalization for vascular access complications. Conclusions Hospitalization rates were significantly higher for patients receiving hemodialysis in for-profit compared with nonprofit dialysis facilities. PMID:24370770

  14. Organizing uninsured safety-net access to specialist physician services.

    PubMed

    Hall, Mark A

    2013-05-01

    Arranging referrals for specialist services is often the greatest difficulty that safety-net access programs face in attempting to provide fairly comprehensive services for the uninsured. When office-based community specialists are asked to care for uninsured patients, they cite the following barriers: difficulty determining which patients merit charity care, having to arrange for services patients need from other providers, and concerns about liability for providing inadequate care. Solutions to these barriers to specialist access can be found in the same institutional arrangements that support primary care and hospital services for the uninsured. These safety-net organization structures can be extended to include specialist physician care by funding community health centers to contract for specialist referrals, using free-standing referral programs to subsidize community specialists who accept uninsured patients at discounted rates, and encouraging hospitals through tax exemption or disproportionate share funding to require specialists on their medical staffs to accept an allocation of uninsured office-based referrals.

  15. Access to care for patients with time-sensitive conditions in Pennsylvania.

    PubMed

    Salhi, Rama A; Edwards, J Matthew; Gaieski, David F; Band, Roger A; Abella, Benjamin S; Carr, Brendan G

    2014-05-01

    Collective knowledge and coordination of vital interventions for time-sensitive conditions (ST-segment elevation myocardial infarction [STEMI], stroke, cardiac arrest, and septic shock) could contribute to a comprehensive statewide emergency care system, but little is known about population access to the resources required. We seek to describe existing clinical management strategies for time-sensitive conditions in Pennsylvania hospitals. All Pennsylvania emergency departments (EDs) open in 2009 were surveyed about resource availability and practice patterns for time-sensitive conditions. The frequency with which EDs provided essential clinical bundles for each condition was assessed. Penalized maximum likelihood regressions were used to evaluate associations between ED characteristics and the presence of the 4 clinical bundles of care. We used geographic information science to calculate 60-minute ambulance access to the nearest facility with these clinical bundles. The percentage of EDs providing each of the 4 clinical bundles in 2009 ranged from 20% to 57% (stroke 20%, STEMI 32%, cardiac arrest 34%, sepsis 57%). For STEMI and stroke, presence of a board-certified/board-eligible emergency physician was significantly associated with presence of a clinical bundle. Only 8% of hospitals provided all 4 care bundles. However, 53% of the population was able to reach this minority of hospitals within 60 minutes. Reliably matching patient needs to ED resources in time-dependent illness is a critical component of a coordinated emergency care system. Population access to critical interventions for the time-dependent diseases discussed here is limited. A population-based planning approach and improved coordination of care could improve access to interventions for patients with time-sensitive conditions. Copyright © 2013 American College of Emergency Physicians. Published by Mosby, Inc. All rights reserved.

  16. Characterization of Chlorinated Aliphatic Hydrocarbons and Environmental Variables in a Shallow Groundwater in Shanghai Using Kriging Interpolation and Multifactorial Analysis

    PubMed Central

    Lu, Qiang; Luo, Qi Shi; Li, Hui; Liu, Yong Di; Gu, Ji Dong; Fei Lin, Kuang

    2015-01-01

    CAHs, as a cleaning solvent, widely contaminated shallow groundwater with the development of manufacturing in China's Yangtze River Delta. This study focused on the distribution of CAHs, and correlations between CAHs and environmental variables in a shallow groundwater in Shanghai, using kriging interpolation and multifactorial analysis. The results showed that the overall CAHs plume area (above DIV) was approximately 9,000 m2 and located in the 2–4 m underground, DNAPL was accumulated at an area of approximately 1,400 m2 and located in the 6-8m sandy silt layer on the top of the muddy silty clay. Heatmap of PPC for CAHs and environmental variables showed that the correlation between “Fe2+” and most CAHs such as “1,1,1-TCA”, “1,1-DCA”, “1,1-DCE” and “%TCA” were significantly positive (p<0.001), but “%CA” and/or “%VC” was not, and “Cl-” was significantly positive correlated with “1,1-DCA” and “1,1-DCE” (p<0.001). The PCA demonstrated that the relative proportions of CAHs in groundwater were mostly controlled by the sources and the natural attenuation. In conclusion, the combination of geographical and chemometrics was helpful to establishing an aerial perspective of CAHs and identifying reasons for the accumulation of toxic dechlorination intermediates, and could become a useful tool for characterizing contaminated sites in general. PMID:26565796

  17. Hospitalization and aesthetic health in older adults.

    PubMed

    Moss, Hilary; Donnellan, Claire; O'Neill, Desmond

    2015-02-01

    To assess the impact of hospitalization on arts engagement among older people; and to assess perceptions of whether hospitals are aesthetically deprived environments. A Survey of Aesthetic and Cultural Health was developed to explore the role of aesthetics before, during and after hospital. Study participants were n = 150 hospital in-patients aged >65. Descriptive and inferential statistics were used to analyze the data. Attendance at arts events was an important part of life for this sample and a large drop off was noted in continuation of these activities in the year post-hospital stay. Physical health issues were the main causes but also loss of confidence and transport issues. Film, dance, and music were the most popular arts for this sample prior to hospital stay. Noise pollution caused by other patients, lack of control over TV/radio, and access to receptive arts in hospital (reading and listening to music) were important issues for patients in hospital. This study identifies a trend for decreasing exposure to arts beginning with a hospital stay and concludes that older people may need encouragement to resume engagement in arts following a hospital stay. There is relatively limited evidence regarding the nature of, and potential benefit from, aesthetics in healthcare and limited studies with rigorous methodology, and further research is needed to understand the aesthetic preferences of older people in hospital. Copyright © 2015 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

  18. The utility of outpatient commitment: acute medical care access and protecting health.

    PubMed

    Segal, Steven P; Hayes, Stephania L; Rimes, Lachlan

    2018-06-01

    This study considers whether, in an easy access single-payer health care system, patients placed on outpatient commitment-community treatment orders (CTOs) in Victoria Australia-are more likely to access acute medical care addressing physical illness than voluntary patients with and without severe mental illness. For years 2000 to 2010, the study compared acute medical care access of 27,585  severely mentally ill psychiatrically hospitalized patients (11,424 with and 16,161 without CTO exposure) and 12,229 never psychiatrically hospitalized outpatients (individuals with less morbidity risk as they were not considered to have severe mental illness). Logistic regression was used to determine the influence of the CTO on the likelihood of receiving a diagnosis of physical illness requiring acute care. Validating their shared and elevated morbidity risk, 53% of each hospitalized cohort accessed acute care compared to 32% of outpatients during the decade. While not under mental health system supervision, however, the likelihood that a CTO patient would receive a physical illness diagnosis was 31% lower than for non-CTO patients, and no different from lower morbidity-risk outpatients without severe mental illness. While, under mental health system supervision, the likelihood that CTO patients would receive a physical illness diagnosis was 40% greater than non-CTO patients and 5.02 times more likely than outpatients were. Each CTO episode was associated with a 4.6% increase in the likelihood of a member of the CTO group receiving a diagnosis. Mental health system involvement and CTO supervision appeared to facilitate access to physical health care in acute care settings for patients with severe mental illness, a group that has, in the past, been subject to excess morbidity and mortality.

  19. Beware: hospital control or ownership of medical groups.

    PubMed

    Hepps, S A

    1995-01-01

    The rapidly changing, unsettled economic and political health care environment is cause for great anxieties for physicians and hospitals alike. Most physicians have joined IPAs or medical groups in order to obtain continued access to patients who are rapidly shifting from indemnity to cost saving HMOs and PPOs. Many hospitals are seeking to increase their primary care provider base by obtaining control of physicians which may increase their opportunity for institutional success. In many cases, hospitals are providing substantial subsidies or buying physician practices, sometimes in apparent violation of anti-trust law. Physicians ostensibly receive good management advice and infrastructure support from hospital business officers or hospital controlled MSOs. However, when the hospital controls individual physicians or medical groups, there is an inherent conflict of interest because of very different strategic needs. It is not in the physicians' best interests to succumb to the siren songs which hospitals are playing. Providing the highest level of care possible for patients requires that physicians maintain professional independence and autonomy now and in the foreseeable future. Equitable negotiation and collaboration between medical groups and hospitals can only be obtained when there is a lawful and level playing field.

  20. Creating a mobile subject guide to improve access to point-of-care resources for medical students: a case study.

    PubMed

    Boruff, Jill T; Bilodeau, Edward

    2012-01-01

    Can a mobile optimized subject guide facilitate medical student access to mobile point-of-care tools? The guide was created at a library at a research-intensive university with six teaching hospital sites. The team created a guide facilitating medical student access to point-of-care tools directly on mobile devices to provide information allowing them to access and set up resources with little assistance. Two librarians designed a mobile optimized subject guide for medicine and conducted a survey to test its usefulness. Web analytics and survey results demonstrate that the guide is used and the students are satisfied. The library will continue to use the subject guide as its primary means of supporting mobile devices. It remains to be seen if the mobile guide facilitates access for those who do not need assistance and want direct access to the resources. Internet access in the hospitals remains an issue.

  1. Modeling the Impact of Cracking in Low Permeability Layers in a Groundwater Contamination Source Zone on Dissolved Contaminant Fate and Transport

    NASA Astrophysics Data System (ADS)

    Sievers, K. W.; Goltz, M. N.; Huang, J.; Demond, A. H.

    2011-12-01

    Dense Non-Aqueous Phase Liquids (DNAPLs), which are chemicals and chemical mixtures that are heavier than and only slightly soluble in water, are a significant source of groundwater contamination. Even with the removal or destruction of most DNAPL mass, small amounts of remaining DNAPL can dissolve into flowing groundwater and continue as a contamination source for decades. One category of DNAPLs is the chlorinated aliphatic hydrocarbons (CAHs). CAHs, such as trichloroethylene and carbon tetrachloride, are found to contaminate groundwater at numerous DoD and industrial sites. DNAPLs move through soils and groundwater leaving behind residual separate phase contamination as well as pools sitting atop low permeability layers. Recently developed models are based on the assumption that dissolved CAHs diffuse slowly from pooled DNAPL into the low permeability layers. Subsequently, when the DNAPL pools and residual DNAPL are depleted, perhaps as a result of a remediation effort, the dissolved CAHs in these low permeability layers still remain to serve as long-term sources of contamination, due to so-called "back diffusion." These recently developed models assume that transport in the low permeability zones is strictly diffusive; however field observations suggest that more DNAPL and/or dissolved CAH is stored in the low permeability zones than can be explained on the basis of diffusion alone. One explanation for these field observations is that there is enhanced transport of dissolved CAHs and/or DNAPL into the low permeability layers due to cracking. Cracks may allow for advective flow of water contaminated with dissolved CAHs into the layer as well as possible movement of pure phase DNAPL into the layer. In this study, a multiphase numerical flow and transport model is employed in a dual domain (high and low permeability layers) to investigate the impact of cracking on DNAPL and CAH movement. Using literature values, the crack geometry and spacing was varied to model

  2. Eye health seeking habits and barriers to accessing curative services among blind beggars in an urban community in Northern Nigeria.

    PubMed

    Balarabe, Aliyu Hamza; Hassan, Ramatu; Fatai, Olatunji O

    2014-01-01

    The aim of the following study was to determine the types of intervention sought by the blind street beggars and assess the barriers to accessing available eye care services. This cross-sectional study was conducted among consenting blind street beggars in Sokoto, Nigeria between May and June, 2009. A semi-structured interview was conducted to probe issues on historical antecedents of the blindness and the eye heath seeking behavior including the use of traditional eye medications. Assessment of barriers to accessing curative services among the blind persons was explored. Questions were asked and the individual responses were recorded in the questionnaire under the appropriate sections. Two hundred and two of 216 (94.7%) of the examined subjects were found to be blind and included in the analysis. The principal cause of blindness was corneal opacity. Overall 82% of the blindness was due to avoidable causes with majority irreversibly blind. Only 38 subjects (18.8%) sought for intervention in hospitals, others resorted to self-medication (42.1%), medicine store (31.2%) and traditional facility (7.9%). Those that accessed treatment at a hospital did so mainly at a primary health center (50.0%) and General Hospitals (34.2%). The barriers to accessing treatment at the hospital were mainly due to "not taken to any hospital" by the parents/relatives (50.3%) and "services not available" (25.2%). Most respondents resorted to ocular self-medication particularly traditional eye medicines. We advocate for a provision of affordable, accessible and qualitative eye care services with a strong health education component on avoidable causes of blindness.

  3. Arterial Access in Patients With De Novo Acute Coronary Syndrome Undergoing Coronary Angiography.

    PubMed

    Abdul Jabbar, Ali; Mufti, Omar; Sabol, Angeline; Markert, Ronald; White, Bryan; Broderick, George

    2017-04-01

    Bleeding is a major limitation of antithrombotic therapy among invasively managed patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACSs). Randomized clinical trials have generally failed to favor either the femoral or the radial arterial approach for coronary angiography or intervention in NSTE-ACS. In 561 hospitalized patients with a new diagnosis of NSTE-ACS referred for coronary angiography, 364 and 197 patients underwent the femoral and the radial approach, respectively. Femoral and radial access did not differ in bleeding complications in the first 72 hours (8 of 364 or 2.2% vs 8 of 197 or 4.1%, P = .21), duration of hospitalization (4.67 ± 5.02 vs 4.51 ± 4.81, P = .28) nor in-hospital mortality (0.8% vs 0.5%, P = .67). Contrast volume was higher for femoral versus radial cases (204 ± 119 vs 168 ± 104, P < .001). In patients with de novo NSTE-ACS without prior cardiac bypass, radial and femoral arterial access did not differ in instances of bleeding within the first 72 hours postoperatively, length of hospital stay, or in-hospital mortality. Less contrast was used in radial cases, which may represent an advantage for patients with renal insufficiency.

  4. Influences on hospital admission for asthma in south Asian and white adults: qualitative interview study.

    PubMed

    Griffiths, C; Kaur, G; Gantley, M; Feder, G; Hillier, S; Goddard, J; Packe, G

    2001-10-27

    To explore reasons for increased risk of hospital admission among south Asian patients with asthma. Qualitative interview study using modified critical incident technique and framework analysis. Newham, east London, a deprived area with a large mixed south Asian population. 58 south Asian and white adults with asthma (49 admitted to hospital with asthma, 9 not admitted); 17 general practitioners; 5 accident and emergency doctors; 2 out of hours general practitioners; 1 asthma specialist nurse. Patients' and health professionals' views on influences on admission, events leading to admission, general practices' organisation and asthma strategies, doctor-patient relationship, and cultural attitudes to asthma. South Asian and white patients admitted to hospital coped differently with asthma. South Asians described less confidence in controlling their asthma, were unfamiliar with the concept of preventive medication, and often expressed less confidence in their general practitioner. South Asians managed asthma exacerbations with family advocacy, without systematic changes in prophylaxis, and without systemic corticosteroids. Patients describing difficulty accessing primary care during asthma exacerbations were registered with practices with weak strategies for asthma care and were often south Asian. Patients with easy access described care suggesting partnerships with their general practitioner, had better confidence to control asthma, and were registered with practices with well developed asthma strategies that included policies for avoiding hospital admission. The different ways of coping with asthma exacerbations and accessing care may partly explain the increased risk of hospital admission in south Asian patients. Interventions that increase confidence to control asthma, confidence in the general practitioner, understanding of preventive treatment, and use of systemic corticosteroids in exacerbations may reduce hospital admissions. Development of more sophisticated

  5. A Global Assessment of Access to and Use of Medical Information: The State of Evidence-Based Surgery.

    PubMed

    LaGrone, Lacey N; Fuhs, Amy K; Egoavil, Eduardo Huaman; Langdale, Lorrie A; Fuangworawong, Phupit; Hamasaki, Jose Luis; Gyedu, Adam; Mock, Charles N

    2018-02-01

    We aimed to assess surgeons' access to and use of medical information, as well as their training and perceptions about evidence-based medicine (EBM), in order to identify priority areas for improvement. An anonymous survey conducted among surgeons from the USA, Ghana, Peru, and Thailand examined access to, and use and perception of, medical literature. Of 307 participants, 98% reported access to "OK" or "good" internet. Fifty-one percent reported that language was a barrier to accessing needed medical information; most frequently in Peru (73%) and Thailand (64%). Access to priced full-text journals was poorest in Peru, where 54% lacked access, followed by Ghana (42%) and Thailand (32%). US respondents scored highest on the EBM knowledge test (1.4, SD 0.8), followed by Thailand (1.3, SD 0.9), Ghana (1.1, SD 0.8), and Peru (0.9, SD 0.8) (p < 0.001). Adjusted analysis revealed Ghanaians and Peruvians spent 5% and 1% more on medical information, respectively, relative to country income, than persons from other countries (p < 0.01). After adjustment, employment in a large and/or urban hospital and history of EBM training were associated with better EBM test scores, while middle-income origin and public hospital employment were associated with worse scores (p < 0.05). Language, access to priced full-text journals, and training are significant barriers to surgeons' practice of EBM globally. The way forward involves collaboration among surgical societies, publishers, hospital employers, and international policymakers in providing surgeons from all country income levels with the access and training necessary to interpret and apply medical information.

  6. Early Hormonal Influences on Childhood Sex-Typed Activity and Playmate Preferences: Implications for the Development of Sexual Orientation.

    ERIC Educational Resources Information Center

    Berenbaum, Sheri A.; Snyder, Elizabeth

    1995-01-01

    Examined hormonal influences on activity and playmate preferences in children with congenital adrenal hyperplasia (CAH) age 2.5 to 12 years and their relatives. Found that girls with CAH preferred boys' toys and activities, whereas boys with CAH did not differ significantly from controls. Activity and playmate preferences were not related. (MDM)

  7. Strategic hospital partnerships: improved access to care and increased epilepsy surgical volume.

    PubMed

    Vadera, Sumeet; Chan, Alvin Y; Mnatsankanyan, Lilit; Sazgar, Mona; Sen-Gupta, Indranil; Lin, Jack; Hsu, Frank P K

    2018-05-01

    OBJECTIVE Surgical treatment of patients with medically refractory focal epilepsy is underutilized. Patients may lack access to surgically proficient centers. The University of California, Irvine (UCI) entered strategic partnerships with 2 epilepsy centers with limited surgical capabilities. A formal memorandum of understanding (MOU) was created to provide epilepsy surgery to patients from these centers. METHODS The authors analyzed UCI surgical and financial data associated with patients undergoing epilepsy surgery between September 2012 and June 2016, before and after institution of the MOU. Variables collected included the length of stay, patient age, seizure semiology, use of invasive monitoring, and site of surgery as well as the monthly number of single-surgery cases, complex cases (i.e., staged surgeries), and overall number of surgery cases. RESULTS Over the 46 months of the study, a total of 104 patients underwent a total of 200 operations; 71 operations were performed in 39 patients during the pre-MOU period (28 months) and 129 operations were performed in 200 patients during the post-MOU period (18 months). There was a significant difference in the use of invasive monitoring, the site of surgery, the final therapy, and the type of insurance. The number of single-surgery cases, complex-surgery cases, and the overall number of cases increased significantly. CONCLUSIONS Partnerships with outside epilepsy centers are a means to increase access to surgical care. These partnerships are likely reproducible, can be mutually beneficial to all centers involved, and ultimately improve patient access to care.

  8. Acute hospital dementia care: results from a national audit.

    PubMed

    Timmons, Suzanne; O'Shea, Emma; O'Neill, Desmond; Gallagher, Paul; de Siún, Anna; McArdle, Denise; Gibbons, Patricia; Kennelly, Sean

    2016-05-31

    Admission to an acute hospital can be distressing and disorientating for a person with dementia, and is associated with decline in cognitive and functional ability. The objective of this audit was to assess the quality of dementia care in acute hospitals in the Republic of Ireland. Across all 35 acute public hospitals, data was collected on care from admission through discharge using a retrospective chart review (n = 660), hospital organisation interview with senior management (n = 35), and ward level organisation interview with ward managers (n = 76). Inclusion criteria included a diagnosis of dementia, and a length of stay greater than 5 days. Most patients received physical assessments, including mobility (89 %), continence (84 %) and pressure sore risk (87 %); however assessment of pain (75 %), and particularly functioning (36 %) was poor. Assessment for cognition (43 %) and delirium (30 %) was inadequate. Most wards have access at least 5 days per week to Liaison Psychiatry (93 %), Geriatric Medicine (84 %), Occupational Therapy (79 %), Speech & Language (81 %), Physiotherapy (99 %), and Palliative Care (89 %) Access to Psychology (9 %), Social Work (53 %), and Continence services (34 %) is limited. Dementia awareness training is provided on induction in only 2 hospitals, and almost half of hospitals did not offer dementia training to doctors (45 %) or nurses (48 %) in the previous 12 months. Staff cover could not be provided on 62 % of wards for attending dementia training. Most wards (84 %) had no dementia champion to guide best practice in care. Discharge planning was not initiated within 24 h of admission in 72 % of cases, less than 40 % had a single plan for discharge recorded, and 33 % of carers received no needs assessment prior to discharge. Length of stay was significantly greater for new discharges to residential care (p < .001). Dementia care relating to assessment, access to certain specialist services

  9. 20 CFR 435.53 - Retention and access requirements for records.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 20 Employees' Benefits 2 2010-04-01 2010-04-01 false Retention and access requirements for records. 435.53 Section 435.53 Employees' Benefits SOCIAL SECURITY ADMINISTRATION UNIFORM ADMINISTRATIVE REQUIREMENTS FOR GRANTS AND AGREEMENTS WITH INSTITUTIONS OF HIGHER EDUCATION, HOSPITALS, OTHER NON-PROFIT...

  10. A risk-based prospective payment system that integrates patient, hospital and national costs.

    PubMed

    Siegel, C; Jones, K; Laska, E; Meisner, M; Lin, S

    1992-05-01

    We suggest that a desirable form for prospective payment for inpatient care is hospital average cost plus a linear combination of individual patient and national average cost. When the coefficients are chosen to minimize mean squared error loss between payment and costs, the payment has efficiency and access incentives. The coefficient multiplying patient costs is a hospital specific measure of financial risk of the patient. Access is promoted since providers receive higher reimbursements for risky, high cost patients. Historical cost data can be used to obtain estimates of payment parameters. The method is applied to Medicare data on psychiatric inpatients.

  11. Patient access and clinical efficiency improvement in a resident hospital-based women's medicine center clinic.

    PubMed

    Bush, Stephen H; Lao, Michael R; Simmons, Kathy L; Goode, Jeff H; Cunningham, Steve A; Calhoun, Byron C

    2007-12-01

    To apply the Six Sigma tools of Change Acceleration Process and Work-Out and to improve patient access in an outpatient clinic in a hospital-based residency training program. Observational study. Comparison of productivity in an obstetrics and gynecology clinic after implementation of the Six Sigma principles, with a comparable internal medicine clinic as a control group. Productivity from January 1 through December 31, 2005, was assessed in both clinics. After applying the Six Sigma tools to obstetrics and gynecology, outputs from both clinics from January 1 through December 31, 2006, were analyzed. Wait times for new obstetrical visits decreased from 38 to 8 days. The patient time spent in the clinic dropped from 3.2 to 1.5 hours. Initial gynecologic visits increased by 87% (from 453 to 850 per year), return gynecologic visits increased by 66% (from 1392 to 2311 per year), initial obstetrical visits increased by 55% (from 520 to 808 per year), repeat obstetrical visits increased by 45% (from 2239 to 3243 per year), and the mean patient satisfaction scores increased from 5.75 to 8.54 (on a 10-point scale). The gross clinic revenue increased by 73% in the first 6 months of 2006 over that of the previous year. By contrast, internal medicine patient wait times for new patients and for revisits, patient satisfaction scores, total number of clinic visits, and revenues remained unchanged. Application of the Six Sigma principles resulted in a team approach to solving the clinic's productivity issues.

  12. Improving access to important recovery information for heart patients with low health literacy: reflections on practice-based initiatives.

    PubMed

    Naccarella, Lucio; Biuso, Catuscia; Jennings, Amanda; Patsamanis, Harry

    2018-05-29

    Evidence exists for the association between health literacy and heart health outcomes. Cardiac rehabilitation is critical for recovery from heart attack and reducing hospital readmissions. Despite this, <30% of people participate in a program. Significant patient, hospital and health system challenges exist to improve recovery through increased heart health literacy. This brief case study reflects and documents practice-based initiatives by Heart Foundation Victoria to improve access to recovery information for patients with low literacy levels. Three key initiatives, namely the Six Steps To Cardiac Recovery resource, the Love Your Heart book and the nurse ambassador program, were implemented informed by mixed methods that assessed need and capacity at the individual, organisational and systems levels. Key outcomes included increased access to recovery information for patients with low health literacy, nurse knowledge and confidence to engage with patients on recovery information, improved education of patients and improved availability and accessibility of information for patients in diverse formats. Given the challenges involved in addressing heart health literacy, multifaceted practice-based approaches are essential to improve access to recovery information for patients with low literacy levels. What is known about the topic? Significant challenges exist for patients with lower health literacy receiving recovery information after a heart attack in hospitals. What does this paper add? This case study provides insights into a practice-based initiative by Heart Foundation Victoria to improve access to recovery information for patients with low literacy levels. What are the implications for practitioners? Strategies to improve recovery through increased heart health literacy must address the needs of patients, nursing staff and the health system within hospitals. Such strategies need to be multifaceted and designed to build the capacity of nurses, heart patients and

  13. Obtaining i.v. fosfomycin through an expanded-access protocol.

    PubMed

    Frederick, Corey M; Burnette, Jennifer; Aragon, Laura; Gauthier, Timothy P

    2016-08-15

    One hospital's experience with procuring i.v. fosfomycin via an expanded-access protocol to treat a panresistant infection is described. In mid-2014, a patient at a tertiary care institution had an infection caused by a gram-negative pathogen expressing notable drug resistance. Once it was determined by the infectious diseases (ID) attending physician that i.v. fosfomycin was a possible treatment for this patient, the ID pharmacist began the process of drug procurement. The research and ID pharmacists completed an investigational new drug (IND) application, which required patient-specific details and contributions from the ID physician. After obtaining approval of the IND, an Internet search identified a product vendor in the United Kingdom, who was then contacted to begin the drug purchasing and acquisition processes. Authorization of the transaction required signatures from key senior hospital administrators, including the chief financial officer and the chief operating officer. Approximately 6 days after beginning the acquisition process, the research pharmacist arranged for the wholesaler to expedite product delivery. The ID pharmacist contacted the wholesaler's shipping company at the U.S. Customs Office, providing relevant contact information to ensure that any unexpected circumstances could be quickly addressed. The product arrived at the U.S. Customs Office 8 days after beginning the acquisition process and was held in the U.S. Customs Office for 2 days. The patient received the first dose of i.v. fosfomycin 13 days after starting the expanded-access protocol process. I.V. fosfomycin was successfully procured through an FDA expanded-access protocol by coordinating efforts among ID physicians, pharmacists, and hospital executives. Copyright © 2016 by the American Society of Health-System Pharmacists, Inc. All rights reserved.

  14. Accession Medical Standards Analysis and Research Activity (AMSARA)

    DTIC Science & Technology

    2004-01-01

    young adults with psychiatric disorders 15. SUBJECT TERMS Accession, medical, standards, attrition, waiver, discharge, hospitalization, disability...86 Research to Develop a Screening Test for Detection of Psychiatric Disorders in Young Adults ...secondary to organic or functional mental disorders that interfere with work or school after age 12 or current use of medication to improve or maintain

  15. Regional consolidation of orthopedic surgery: impacts on hip fracture surgery access and outcomes.

    PubMed

    Kreindler, Sara A; Siragusa, Lanette; Bohm, Eric; Rudnick, Wendy; Metge, Colleen J

    2017-09-01

    Timely access to orthopedic trauma surgery is essential for optimal outcomes. Regionalization of some types of surgery has shown positive effects on access, timeliness and outcomes. We investigated how the consolidation of orthopedic surgery in 1 Canadian health region affected patients requiring hip fracture surgery. We retrieved administrative data on all regional emergency department visits for lower-extremity injury and all linked inpatient stays from January 2010 through March 2013, identifying 1885 hip-fracture surgeries. Statistical process control and interrupted time series analysis controlling for demographics and comorbidities were used to assess impacts on access (receipt of surgery within 48-h benchmark) and surgical outcomes (complications, in-hospital/30-d mortality, length of stay). There was a significant increase in the proportion of patients receiving surgery within the benchmark. Complication rates did not change, but there appeared to be some decrease in mortality (significant at 6 mo). Length of stay increased at a hospital that experienced a major increase in patient volume, perhaps reflecting challenges associated with patient flow. Regionalization appeared to improve the timeliness of surgery and may have reduced mortality. The specific features of the present consolidation (including pre-existing interhospital performance variation and the introduction of daytime slates at the referral hospital) should be considered when interpreting the findings.

  16. Safe Sleep Practices of Kansas Birthing Hospitals

    PubMed Central

    Ahlers-Schmidt, Carolyn R.; Schunn, Christy; Sage, Cherie; Engel, Matthew; Benton, Mary

    2018-01-01

    Background Sleep-related death is tied with congenital anomalies as the leading cause of infant mortality in Kansas, and external risk factors are present in 83% of these deaths. Hospitals can impact caregiver intentions to follow risk-reduction strategies. This project assessed the current practices and policies of Kansas hospitals with regard to safe sleep. Methods A cross-sectional survey of existing safe sleep practices and policies in Kansas hospitals was performed. Hospitals were categorized based on reported delivery volume and data were compared across hospital sizes. Results Thirty-one of 73 (42%) contacted hospitals responded. Individual survey respondents represented various hospital departments including newborn/well-baby (68%), neonatal intensive care unit (3%) and other non-nursery departments or administration (29%). Fifty-eight percent of respondents reported staff were trained on infant safe sleep; 44% of these held trainings annually. High volume hospitals tended to have more annual training than low or mid volume birth hospitals. Thirty-nine percent reported a safe sleep policy, though most of these (67%) reported never auditing compliance. The top barrier to safe sleep education, regardless of delivery volume, was conflicting patient and family member beliefs. Conclusions Hospital promotion of infant safe sleep is being conducted in Kansas to varying degrees. High and mid volume birth hospitals may need to work more on formal auditing of safe sleep practices, while low volume hospitals may need more staff training. Low volume hospitals also may benefit from access to additional caregiver education materials. Finally, it is important to note hospitals should not be solely responsible for safe sleep education. PMID:29844848

  17. Private hospital emergency departments in Australia: challenges and opportunities.

    PubMed

    FitzGerald, Gerry; Toloo, Ghasem; He, Jun; Doig, Gavin; Rosengren, David; Rothwell, Sean; Sultana, Ron; Costello, Steve; Hou, Xiang-Yu

    2013-06-01

    Public hospital EDs in Australia have become increasingly congested because of increasing demand and access block. Six per cent of ED patients attend private hospital EDs whereas 45% of the population hold private health insurance. This study describes the patients attending a small selection of four private hospital EDs in Queensland and Victoria, and tests the feasibility of a private ED database. De-identified routinely collected patient data were provided by the four participating private hospital and amalgamated into a single data set. The mean age of private ED patients was 52 years. Males outnumbered females in all age groups except > 80 years. Attendance was higher on weekends and Mondays, and between 08.00 and 20.00 h. There were 6.6% of the patients triaged as categories 1 and 2, and 60% were categories 4 or 5. There were 36.4% that required hospital admission. Also, 96% of the patients had some kind of insurance. Furthermore, 72% were self-referred and 12% were referred by private medical practitioners. Approximately 25% arrived by ambulance. There were 69% that completed their ED treatment within 4 h. This study is the first public description of patients attending private EDs in Australia. Private EDs have a significant role to play in acute medical care and in providing access to private hospitals which could alleviate pressure on public EDs. This study demonstrates the need for consolidated data based on a consistent data set and data dictionary to enable system-wide analysis, benchmarking and evaluation. © 2013 Australasian College for Emergency Medicine and Australasian Society for Emergency Medicine.

  18. Access, quality, and costs of care at physician owned hospitals in the United States: observational study.

    PubMed

    Blumenthal, Daniel M; Orav, E John; Jena, Anupam B; Dudzinski, David M; Le, Sidney T; Jha, Ashish K

    2015-09-02

    To compare physician owned hospitals (POHs) with non-POHs on metrics around patient populations, quality of care, costs, and payments. Observational study. Acute care hospitals in 95 hospital referral regions in the United States, 2010. 2186 US acute care hospitals (219 POHs and 1967 non-POHs). Proportions of patients using Medicaid and those from ethnic and racial minority groups; hospital performance on patient experience metrics, care processes, risk adjusted 30 day mortality, and readmission rates; costs of care; care payments; and Medicare market share. The 219 POHs were more often small (<100 beds), for profit, and in urban areas. 120 of these POHs were general (non-specialty) hospitals. Compared with patients from non-POHs, those from POHs were younger (77.4 v 78.4 years, P<0.001), less likely to be admitted through an emergency department (23.2% v. 29.0%, P<0.001), equally likely to be black (5.1% v 5.5%, P=0.85) or to use Medicaid (14.9% v 15.4%, P=0.75), and had similar numbers of chronic diseases and predicted mortality scores. POHs and non-POHs performed similarly on patient experience scores, processes of care, risk adjusted 30 day mortality, 30 day readmission rates, costs, and payments for acute myocardial infarction, congestive heart failure, and pneumonia. Although POHs may treat slightly healthier patients, they do not seem to systematically select more profitable or less disadvantaged patients or to provide lower value care. © Blumenthal et al 2015.

  19. Social variations in access to hospital care for patients with colorectal, breast, and lung cancer between 1999 and 2006: retrospective analysis of hospital episode statistics.

    PubMed

    Raine, Rosalind; Wong, Wun; Scholes, Shaun; Ashton, Charlotte; Obichere, Austin; Ambler, Gareth

    2010-01-14

    To determine the extent to which type of hospital admission (emergency compared with elective) and surgical procedure varied by socioeconomic circumstances, age, sex, and year of admission for colorectal, breast, and lung cancer. Repeated cross sectional study with data from individual patients, 1 April 1999 to 31 March 2006. Hospital episode statistics (HES) dataset. 564 821 patients aged 50 and over admitted with a diagnosis of colorectal, breast, or lung cancer. Proportion of patients admitted as emergencies, and the proportion receiving the recommended surgical treatment. Patients from deprived areas, older people, and women were more likely to be admitted as emergencies. For example, the adjusted odds ratio for patients with breast cancer in the least compared with most deprived fifth of deprivation was 0.63 (95% confidence interval 0.60 to 0.66) and the adjusted odds ratio for patients with lung cancer aged 80-89 compared with those aged 50-59 was 3.13 (2.93 to 3.34). There were some improvements in disparities between age groups but not for patients living in deprived areas over time. Patients from deprived areas were less likely to receive preferred procedures for rectal, breast, and lung cancer. These findings did not improve with time. For example, 67.4% (3529/5237) of patients in the most deprived fifth of deprivation had anterior resection for rectal cancer compared with 75.5% (4497/5959) of patients in the least deprived fifth (1.34, 1.22 to 1.47). Over half (54.0%, 11 256/20 849) of patients in the most deprived fifth of deprivation had breast conserving surgery compared with 63.7% (18 445/28 960) of patients in the least deprived fifth (1.21, 1.16 to 1.26). Men were less likely than women to undergo anterior resection and lung cancer resection and older people were less likely to receive breast conserving surgery and lung cancer resection. For example, the adjusted odds ratio for lung cancer patients aged 80-89 compared with those aged 50-59 was 0

  20. Creating a web-based digital photographic archive: one hospital library's experience.

    PubMed

    Marshall, Caroline; Hobbs, Janet

    2017-04-01

    Cedars-Sinai Medical Center is a nonprofit community hospital based in Los Angeles. Its history spans over 100 years, and its growth and development from the merging of 2 Jewish hospitals, Mount Sinai and Cedars of Lebanon, is also part of the history of Los Angeles. The medical library collects and maintains the hospital's photographic archive, to which retiring physicians, nurses, and an active Community Relations Department have donated photographs over the years. The collection was growing rapidly, it was impossible to display all the materials, and much of the collection was inaccessible to patrons. The authors decided to make the photographic collection more accessible to medical staff and researchers by purchasing a web-based digital archival package, Omeka. We decided what material should be digitized by analyzing archival reference requests and considering the institution's plan to create a Timeline Wall documenting and celebrating the history of Cedars-Sinai. Within 8 months, we digitized and indexed over 500 photographs. The digital archive now allows patrons and researchers to access the history of the hospital and enables the library to process archival references more efficiently.

  1. Creating a mobile subject guide to improve access to point-of-care resources for medical students: a case study

    PubMed Central

    Boruff, Jill T; Bilodeau, Edward

    2012-01-01

    Question: Can a mobile optimized subject guide facilitate medical student access to mobile point-of-care tools? Setting: The guide was created at a library at a research-intensive university with six teaching hospital sites. Objectives: The team created a guide facilitating medical student access to point-of-care tools directly on mobile devices to provide information allowing them to access and set up resources with little assistance. Methods: Two librarians designed a mobile optimized subject guide for medicine and conducted a survey to test its usefulness. Results: Web analytics and survey results demonstrate that the guide is used and the students are satisfied. Conclusion: The library will continue to use the subject guide as its primary means of supporting mobile devices. It remains to be seen if the mobile guide facilitates access for those who do not need assistance and want direct access to the resources. Internet access in the hospitals remains an issue. PMID:22272160

  2. Implementation of Enterprise Imaging Strategy at a Chinese Tertiary Hospital.

    PubMed

    Li, Shanshan; Liu, Yao; Yuan, Yifang; Li, Jia; Wei, Lan; Wang, Yuelong; Fei, Xiaolu

    2018-01-04

    Medical images have become increasingly important in clinical practice and medical research, and the need to manage images at the hospital level has become urgent in China. To unify patient identification in examinations from different medical specialties, increase convenient access to medical images under authentication, and make medical images suitable for further artificial intelligence investigations, we implemented an enterprise imaging strategy by adopting an image integration platform as the main tool at Xuanwu Hospital. Workflow re-engineering and business system transformation was also performed to ensure the quality and content of the imaging data. More than 54 million medical images and approximately 1 million medical reports were integrated, and uniform patient identification, images, and report integration were made available to the medical staff and were accessible via a mobile application, which were achieved by implementing the enterprise imaging strategy. However, to integrate all medical images of different specialties at a hospital and ensure that the images and reports are qualified for data mining, some further policy and management measures are still needed.

  3. Prenatal Hormones and Postnatal Socialization by Parents as Determinants of Male-Typical Toy Play in Girls With Congenital Adrenal Hyperplasia

    ERIC Educational Resources Information Center

    Pasterski, Vickie L.; Geffner, Mitchell E.; Brain, Caroline; Hindmarsh, Peter; Brook, Charles; Hines, Melissa

    2005-01-01

    Toy choices of 3- to 10-year-old children with congenital adrenal hyperplasia (CAH) and of their unaffected siblings were assessed. Also assessed was parental encouragement of sex-typed toy play. Girls with CAH displayed more male-typical toy choices than did their unaffected sisters, whereas boys with and without CAH did not differ. Mothers and…

  4. Are there parental socialization effects on the sex-typed behavior of individuals with congenital adrenal hyperplasia?

    PubMed

    Wong, Wang I; Pasterski, Vickie; Hindmarsh, Peter C; Geffner, Mitchell E; Hines, Melissa

    2013-04-01

    Influences of prenatal androgen exposure on human sex-typical behavior have been established largely through studies of individuals with congenital adrenal hyperplasia (CAH). However, evidence that addresses the potential confounding influence of parental socialization is limited. Parental socialization and its relationship to sex-typical toy play and spatial ability were investigated in two samples involving 137 individuals with CAH and 107 healthy controls. Females with CAH showed more boy-typical toy play and better targeting performance than control females, but did not differ in mental rotations performance. Males with CAH showed worse mental rotations performance than control males, but did not differ in sex-typical toy play or targeting. Reported parental encouragement of girl-typical toy play correlated with girl-typical toy play in all four groups. Moreover, parents reported encouraging less girl-typical, and more boy-typical, toy play in females with CAH than in control females and this reported encouragement partially mediated the relationship between CAH status and sex-typical toy play. Other evidence suggests that the reported parental encouragement of sex-atypical toy play in girls with CAH may be a response to the girls' preferences for boys' toys. Nevertheless, this encouragement could further increase boy-typical behavior in girls with CAH. In contrast to the results for toy play, we found no differential parental socialization for spatial activities and little evidence linking parental socialization to spatial ability. Overall, evidence suggests that prenatal androgen exposure and parental socialization both contribute to sex-typical toy play.

  5. Animal Models of Cancer-Associated Hypercalcemia

    PubMed Central

    Kohart, Nicole A.; Elshafae, Said M.; Breitbach, Justin T.; Rosol, Thomas J.

    2017-01-01

    Cancer-associated hypercalcemia (CAH) is a frequently-occurring paraneoplastic syndrome that contributes to substantial patient morbidity and occurs in both humans and animals. Patients with CAH are often characterized by markedly elevated serum calcium concentrations that result in a range of clinical symptoms involving the nervous, gastrointestinal and urinary systems. CAH is caused by two principle mechanisms; humorally-mediated and/or through local osteolytic bone metastasis resulting in excessive calcium release from resorbed bone. Humoral hypercalcemia of malignancy (HHM) is the most common mechanism and is due to the production and release of tumor-associated cytokines and humoral factors, such as parathyroid hormone-related protein (PTHrP), that act at distant sites to increase serum calcium concentrations. Local osteolytic hypercalcemia (LOH) occurs when primary or metastatic bone tumors act locally by releasing factors that stimulate osteoclast activity and bone resorption. LOH is a less frequent cause of CAH and in some cases can induce hypercalcemia in concert with HHM. Rarely, ectopic production of parathyroid hormone has been described. PTHrP-mediated hypercalcemia is the most common mechanism of CAH in human and canine malignancies and is recognized in other domestic species. Spontaneous and experimentally-induced animal models have been developed to study the mechanisms of CAH. These models have been essential for the evaluation of novel approaches and adjuvant therapies to manage CAH. This review will highlight the comparative aspects of CAH in humans and animals with a discussion of the available animal models used to study the pathogenesis of this important clinical syndrome. PMID:29056680

  6. Implementation of Hospital Computerized Physician Order Entry Systems in a Rural State: Feasibility and Financial Impact

    PubMed Central

    Ohsfeldt, Robert L.; Ward, Marcia M.; Schneider, John E.; Jaana, Mirou; Miller, Thomas R.; Lei, Yang; Wakefield, Douglas S.

    2005-01-01

    Objective The aim of this study was to estimate the costs of implementing computerized physician order entry (CPOE) systems in hospitals in a rural state and to evaluate the financial implications of statewide CPOE implementation. Methods A simulation model was constructed using estimates of initial and ongoing CPOE costs mapped onto all general hospitals in Iowa by bed quantity and current clinical information system (CIS) status. CPOE cost estimates were obtained from a leading CPOE vendor. Current CIS status was determined through mail survey of Iowa hospitals. Patient care revenue and operating cost data published by the Iowa Hospital Association were used to simulate the financial impact of CPOE adoption on hospitals. Results CPOE implementation would dramatically increase operating costs for rural and critical access hospitals in the absence of substantial costs savings associated with improved efficiency or improved patient safety. For urban and rural referral hospitals, the cost impact is less dramatic but still substantial. However, relatively modest benefits in the form of patient care cost savings or revenue enhancement would be sufficient to offset CPOE costs for these larger hospitals. Conclusion Implementation of CPOE in rural or critical access hospitals may depend on net increase in operating costs. Adoption of CPOE may be financially infeasible for these small hospitals in the absence of increases in hospital payments or ongoing subsidies from third parties. PMID:15492033

  7. The Effects of Safety Net Hospital Closures and Conversions on Patient Travel Distance to Hospital Services

    PubMed Central

    Bazzoli, Gloria J; Lee, Woolton; Hsieh, Hui-Min; Mobley, Lee Rivers

    2012-01-01

    Objective To examine the effects of safety net hospital (SNH) closure and for-profit conversion on uninsured, Medicaid, and racial/ethnic minorities. Data Sources/Extraction Methods Hospital discharge data for selected states merged with other sources. Study Design We examined travel distance for patients treated in urban hospitals for five diagnosis categories: ambulatory care sensitive conditions, referral sensitive conditions, marker conditions, births, and mental health and substance abuse. We assess how travel was affected for patients after SNH events. Our multivariate models controlled for patient, hospital, health system, and neighborhood characteristics. Principal Findings Our results suggested that certain groups of uninsured and Medicaid patients experienced greater disruption in patterns of care, especially Hispanic uninsured and Medicaid women hospitalized for births. In addition, relative to privately insured individuals in SNH event communities, greater travel for mental health and substance abuse care was present for the uninsured. Conclusions Closure or for-profit conversions of SNHs appear to have detrimental access effects on particular subgroups of disadvantaged populations, although our results are somewhat inconclusive due to potential power issues. Policy makers may need to pay special attention to these patient subgroups and also to easing transportation barriers when dealing with disruptions resulting from reductions in SNH resources. PMID:22091871

  8. A dose-response relationship between long working hours and unmet need for access to hospital facilities.

    PubMed

    Soek, Hongdeok; Won, Jong-Uk; Lee, Tae Il; Kim, Yeong-Kwang; Lee, Wanhyung; Lee, June-Hee; Roh, Jaehoon; Yoon, Jin-Ha

    2016-03-01

    Lack of access to hospital facilities, indicating unmet healthcare need, plays an important role in health inequity in the workplace. We aimed to investigate the association between long working hours and unmet healthcare need. We used data from the Korea National Health and Nutrition Examination Surveys collected during 2007-2012, which included 8369 participants (4765 males, 3604 females) aged 20-54 years, who were paid workers. We used a logistic regression model with gender stratification to investigate the association between working hours and unmet healthcare need. Of the 8369 participants, 855 males (17.94%) and 981 females (27.22%) experienced unmet healthcare need. After adjusting for covariates, and compared to 30-39 working hours per week, the odds ratios (OR) of unmet healthcare need were 1.07 [(95% confidence interval (95% CI) 0.76-1.51], 1.46 (95% CI 1.03-2.07), and 1.57 (95% CI 1.11-2.23) in males, and 1.13 (95% CI 0.92-1.40), 1.30 (95% CI 0.99-1.69), and 1.60 (95% CI 1.21-2.10) in females, for 40-49, 50-59, and ≥ 60 work hours per week, respectively. There was a dose-response relationship between working hours per week and unmet healthcare need in both genders. Those who work long hours are more likely to have unmet healthcare needs, the cause of which seems to be lack of time.

  9. Income Related Inequality of Health Care Access in Japan: A Retrospective Cohort Study

    PubMed Central

    Fujita, Misuzu; Hata, Akira

    2016-01-01

    The purpose of this retrospective cohort study was to analyze the association between income level and health care access in Japan. Data from a total of 222,259 subjects (age range, 0–74 years) who submitted National Health Insurance claims in Chiba City from April 2012 to March 2014 and who declared income for the tax period from January 1 to December 31, 2012 were integrated and analyzed. The generalized estimating equation, in which household was defined as a cluster, was used to evaluate the association between equivalent income and utilization and duration of hospitalization and outpatient care services. A significant positive linear association was observed between income level and outpatient visit rates among all age groups of both sexes; however, a significantly higher rate and longer period of hospitalization, and longer outpatient care, were observed among certain lower income subgroups. To control for decreased income due to hospitalization, subjects hospitalized during the previous year were excluded, and the data was then reanalyzed. Significant inverse associations remained in the hospitalization rate among 40–59-year-old men and 60–69-year-old women, and in duration of hospitalization among 40–59 and 60–69-year-olds of both sexes and 70–74-year-old women. These results suggest that low-income individuals in Japan have poorer access to outpatient care and more serious health conditions than their higher income counterparts. PMID:26978270

  10. Rationing of hospital services in the Australian health system.

    PubMed

    Kovac, M

    1998-09-01

    This article reports on the rationing in the Australian hospital sector and explains why it has been undertaken. It also briefly overviews the Australian health system in order to provide a necessary background for the issue of rationing itself. Rationing of hospital services has occurred because governments in Australia have limited hospital sector resources trying to ensure the containment of their health budgets. The resources available to hospitals have been insufficient to ensure that the supply of services meets the demand for such services. Therefore, in order to contain hospital budgets rationing has been required. Medicare, the universal health insurance system, assures that access to public hospital services is on the basis of clinical needs. However, due to the federal nature of government in Australia, the available services are determined by health system structural interrelationships and direct government regulation. For example, services provided in the community sector, and funded by the Commonwealth government, are prime candidates for being removed from the hospital sector by State/Territory governments. Similarly, expensive services with a wide range of usage are candidates for regulation to contain costs.

  11. Hospital Versus Home Death: Results from the Mexican Health and Aging Study

    PubMed Central

    Cárdenas-Turanzas, Marylou; Torres-Vigil, Isabel; Tovalín-Ahumada, Horacio; Nates, Joseph L.

    2013-01-01

    Context Characterizing where people die is needed to inform palliative care programs in Mexico. Objectives To determine whether access to health care influences the place of death of older Mexicans and examine the modifying effects of demographic and clinical characteristics. Methods We analyzed 2001 baseline and 2003 follow-up data from the Mexican Health and Aging Study. Cases included adults who completed the baseline interview and died before the follow-up interview and for whom a proxy interview was obtained in 2003. The main outcome variable was the place of death (hospital vs. home). The predictors of the place of death were identified using logistic regression analysis. Results The study group included 473 deceased patients; 52.9% died at home. Factors associated with hospital death were having spent at least one night in a hospital during the last year of life (odds ratio [OR]: 6.73; 95% confidence interval [CI]: 3.29, 13.78) and dying in a city other than the city of usual residence (OR: 4.68, 95% CI: 2.56, 8.57). Factors associated with home death were not having health care coverage (OR: 2.78, 95% CI: 1.34, 5.88), living in a city of less than 100,000 residents (OR: 2.44, 95% CI: 1.43, 4.17), and older age (OR: 1.03, 95% CI: 1.01, 1.05). Conclusion Older Mexicans with access to health care services were more likely to die in the hospital even after controlling for important clinical and demographic characteristics. Findings from the study may be used to plan the provision of accessible end-of-life hospital and home-based services. PMID:21146354

  12. Medicine procurement in hospital pharmacies of Nepal: A qualitative study based on the Basel Statements.

    PubMed

    Shrestha, Mina; Moles, Rebekah; Ranjit, Eurek; Chaar, Betty

    2018-01-01

    Accessibility and affordability of evidence-based medicines are issues of global concern. For low-income countries like Nepal, it is crucial to have easy and reliable access to affordable, good-quality, evidence-based medicines, especially in the aftermath of natural or manmade disasters. Availability of affordable and evidence-based high quality medicines depends on the medicine procurement procedure, which makes it an important aspect of healthcare delivery. In this study, we aimed to investigate medicine procurement practices in hospital pharmacies of Nepal within the framework of International Pharmaceutical Federation [FIP] hospital pharmacy guidelines "the Basel Statements". We conducted semi-structured interviews with hospital pharmacists or procurement officers in hospital pharmacies of four major regions in Nepal to explore procurement practices. Data were collected until saturation of themes, analysed using the framework approach, and organised around the statements within the procurement theme of the Basel Statements. Interviews conducted with 53 participants revealed that the procurement guidelines of the Basel Statements were adopted to a certain extent in hospital pharmacies of Nepal. It was found that the majority of hospital pharmacies in Nepal reported using an expensive direct-procurement model for purchasing medicines. Most had no formulary and procured medicines solely based on doctors' prescriptions, which were heavily influenced by pharmaceutical companies' marketing strategies. Whilst most procured only registered medicines, a minority reported purchasing unregistered medicines through unauthorised supply-chains. And although the majority of hospital pharmacies had some contingency plans for managing medicine shortages, a few had none. Procurement guidelines of the Basel Statements were thus found to be partially adopted; however, there is room for improvement in current procurement practices in hospital pharmacies of Nepal. Adoption and

  13. Medicine procurement in hospital pharmacies of Nepal: A qualitative study based on the Basel Statements

    PubMed Central

    Ranjit, Eurek

    2018-01-01

    Background Accessibility and affordability of evidence-based medicines are issues of global concern. For low-income countries like Nepal, it is crucial to have easy and reliable access to affordable, good-quality, evidence-based medicines, especially in the aftermath of natural or manmade disasters. Availability of affordable and evidence-based high quality medicines depends on the medicine procurement procedure, which makes it an important aspect of healthcare delivery. In this study, we aimed to investigate medicine procurement practices in hospital pharmacies of Nepal within the framework of International Pharmaceutical Federation [FIP] hospital pharmacy guidelines “the Basel Statements”. Method We conducted semi-structured interviews with hospital pharmacists or procurement officers in hospital pharmacies of four major regions in Nepal to explore procurement practices. Data were collected until saturation of themes, analysed using the framework approach, and organised around the statements within the procurement theme of the Basel Statements. Results Interviews conducted with 53 participants revealed that the procurement guidelines of the Basel Statements were adopted to a certain extent in hospital pharmacies of Nepal. It was found that the majority of hospital pharmacies in Nepal reported using an expensive direct-procurement model for purchasing medicines. Most had no formulary and procured medicines solely based on doctors’ prescriptions, which were heavily influenced by pharmaceutical companies’ marketing strategies. Whilst most procured only registered medicines, a minority reported purchasing unregistered medicines through unauthorised supply-chains. And although the majority of hospital pharmacies had some contingency plans for managing medicine shortages, a few had none. Conclusions Procurement guidelines of the Basel Statements were thus found to be partially adopted; however, there is room for improvement in current procurement practices in

  14. Sustaining change: the imperative for patient access strategies.

    PubMed

    Glynn, Peter A R

    2006-01-01

    The paper by Trypuc, MacLeod and Hudson provides a timely and important overview of methods to sustain provincial wait time strategies. The emphasis on accountability for patient access to timely care throughout the healthcare system comes through strongly--as it should. These accountabilities are made "real" through purchase service agreements. Physician-hospital relationships are a fundamental aspect of this accountability. This commentary suggests the inclusion of two additional supporting tools in addition to those cited by the authors of the lead paper--quality monitoring and the use of industrial engineering techniques for queue management and patient flow analysis. Strong and persistent leadership of patient access strategies will ensure sustainable change.

  15. Port-Access cardiac surgery: from a learning process to the standard.

    PubMed

    Greco, Ernesto; Barriuso, Clemente; Castro, Miguel Angel; Fita, Guillermina; Pomar, José L

    2002-01-01

    Port-Access surgery has been one of the most innovative and controversial methods in the spectrum of minimally invasive techniques for cardiac operations and has been widely used for the treatment of several cardiac diseases. The technique was introduced in our center to evaluate its efficacy in reproducing standardized results without an additional risk. Endovascular cardiopulmonary bypass (CPB) through femoral access and endoluminal aortic occlusion were used in 129 patients for a variety of surgical procedures, all of which were video-assisted. A minimal (4-6 cm) anterior thoracotomy through the fourth intercostal space was used in all cases as the surgical approach. More than 96% of the planned cases concluded as true Port-Access procedures. Mean CBP and crossclamp times were 87.2 min. +/- 51.2 (range of 10-457) and 54.9 min. +/- 30.6 (range of 10-190), respectively. Hospital mortality for the overall group was 1.5%, and mitral valve surgery had a 2.2% hospital death rate. The incidence of early neurological events was 0.7%. Mean extubation time, ICU stay, and total length of hospital stay were 5 hours +/- 6 hrs. (range of 2-32), 12 hours +/- 11.8 hrs. (range of 5-78), and 7 days +/- 7.03 days (range of 1-72), respectively. Our experience indicates that the Port- Access technique is safe and permits reproduction of standardized results with the use of a very limited surgical approach. We are convinced that this is a superior procedure for certain types of surgery, including isolated primary or redo mitral surgery, repair of a variety of atrial septal defects (ASDs), and atrial tumors. It is especially useful in high-risk patients, such as elderly patients or those requiring reoperation. Simplification of the procedure is nevertheless desirable in order to further reduce the time of operation and to address other drawbacks.

  16. Do Hospitals Support Second Victims? Collective Insights From Patient Safety Leaders in Maryland.

    PubMed

    Edrees, Hanan H; Morlock, Laura; Wu, Albert W

    2017-09-01

    Second victims-defined as health care providers who are emotionally traumatized after a patient adverse event-may not receive needed emotional support. Although most health care organizations have an employee assistance program (EAP), second victims may be reluctant to access this service because of worries about confidentiality. A study was conducted to describe the extent to which organizational support for second victims is perceived as desirable by patient safety officers in acute care hospitals in Maryland and to identify existing support programs. Semistructured interviews (using existing and newly developed questions) were conducted with 43 patient safety representatives from 38 of the 46 acute care hospitals in Maryland (83% response rate). All but one of the responding hospitals offered EAP services to their employees, but there were gaps in the services provided related to timeliness, EAP staff's ability to relate to clinical providers, and physical accessibility. There were no valid measures in place to assess the effectiveness of EAP services. Participants identified a need for peer support, both for the second victim and potentially for individuals who provide that support. Six (16%) of the 38 hospitals had second victim support programs, which varied in structure, accessibility, and outcomes, while an additional 5 hospitals (13%) were developing such a program. Patient safety officers thought their organizations should reevaluate the support currently provided by their EAPs, and consider additional peer support mechanisms. Future research is needed to evaluate the effectiveness of these programs. Copyright © 2017 The Joint Commission. Published by Elsevier Inc. All rights reserved.

  17. Does Selection and Management of Patients with Chronic Kidney Disease In Government Run and Private Hospitals Differ?

    PubMed

    Gowda, Anoop; Dutt, Aswini Raghavendra; Bangera, Shobith

    2017-08-01

    Globally, incidence of Chronic Kidney Disease (CKD) is rapidly rising with huge burden on the life expectancy of the patients. Regular haemodialysis improves the quality of life in these patients. They get treatment at either government run or private sector hospitals. A difference in disease pattern, comorbidity, patient management and number of access failures can be observed in these set ups. The present study was carried out to find out selection, management and disease pattern of CKD patients admitted for dialysis in government run and private hospital. A cross-sectional study on patients (18-90 years) admitted and undergoing dialysis at government run (N=129) and private hospital (N=182) was undertaken in Karnataka, India. Parameters like comorbidity (diabetes), number of dialysis per week, number of access failures, and follow up visits were compared between these patients. Chi- squared test was used to compare the data. All tests were two-tailed and p< 0.05 was considered as significant. More number of younger patients and associated comorbidity, were seen in patients admitted in government run hospital (p<0.001), with no gender bias in selection of patients for dialysis between the two hospitals. Similarly, follow-ups with nephrologist, number of dialysis done per week and erythropoietin supplements administered were significantly more among private hospital patients (p<0.001). Number of dialysis sessions and mean haemoglobin level was less in government run hospital patients, as compared to those in private hospital. No statistical difference was seen with access failure in both these setups. No bias in management of CKD patient was seen among the two sets of hospitals though available facilities seemed to vary.

  18. Understanding levels of morbidity and hospitalization in Kerala, India.

    PubMed Central

    Dilip, T. R.

    2002-01-01

    The prevalence of ailments and hospitalization in Kerala was examined using data from the 52 nd National Sample Survey Data on Health Care in Kerala in 1995-6. The survey included 24401 people from 4928 households. Age and seasonality had considerable effects on the morbidity of individuals. The burden of ill health was higher in rural areas than in urban areas. People who were more likely to have a better lifestyle had a higher level of morbidity and hospitalization. Regional differences were seen, with levels of morbidity and hospitalization higher in the comparatively developed regions of Southern Kerala than in Northern Kerala. Factors like physical accessibility of health care services and capacity to seek health care services could create artificial differences in morbidity and hospitalization among different subgroups of the population in Kerala. PMID:12378294

  19. Lack of access and continuity of adult health care: a national population-based survey

    PubMed Central

    Dilélio, Alitéia Santiago; Tomasi, Elaine; Thumé, Elaine; da Silveira, Denise Silva; Siqueira, Fernando Carlos Vinholes; Piccini, Roberto Xavier; Silva, Suele Manjourany; Nunes, Bruno Pereira; Facchini, Luiz Augusto

    2015-01-01

    OBJECTIVE To describe the lack of access and continuity of health care in adults. METHODS A cross-sectional population-based study was performed on a sample of 12,402 adults aged 20 to 59 years in urban areas of 100 municipalities of 23 states in the five Brazilian geopolitical regions. Barriers to the access and continuity of health care and were investigated based on receiving, needing and seeking health care (hospitalization and accident/emergency care in the last 12 months; care provided by a doctor, by other health professional or home care in the last three months). Based on the results obtained by the description of the sample, a projection is provided for adults living in Brazilian urban areas. RESULTS The highest prevalence of lack of access to health services and to provision of care by health professionals was for hospitalization (3.0%), whilst the lowest prevalence was for care provided by a doctor (1.1%). The lack of access to care provided by other health professionals was 2.0%; to accident and emergency services, 2.1%; and to home care, 2.9%. As for prevalences, the greatest absolute lack of access occurred in emergency care (more than 360,000 adults). The main reasons were structural and organizational problems, such as unavailability of hospital beds, of health professionals, of appointments for the type of care needed and charges made for care. CONCLUSIONS The universal right to health care in Brazil has not yet been achieved. These projections can help health care management in scaling the efforts needed to overcome this problem, such as expanding the infrastructure of health services and the workforce. PMID:26061454

  20. RURAL/URBAN RESIDENCE, ACCESS, AND PERCEIVED NEED FOR TREATMENT AMONG AFRICAN AMERICAN COCAINE USERS

    PubMed Central

    BORDERS, TYRONE F.; BOOTH, BRENDA M.; STEWART, KATHARINE E.; CHENEY, ANN M.; CURRAN, GEOFFREY M.

    2014-01-01

    Objective To examine how rural/urban residence, perceived access, and other factors impede or facilitate perceived need for drug use treatment, a concept closely linked to treatment utilization. Study Design Two hundred rural and 200 urban African American cocaine users who were not receiving treatment were recruited via Respondent-Driven Sampling and completed a structured in-person interview. Bivariate and multivariate analyses were conducted to test the associations between perceived need and rural/urban residence, perceived access, and other predisposing (eg, demographics), enabling (eg, insurance), and health factors (eg, psychiatric distress). Principal Findings In bivariate analyses, rural relative to urban cocaine users reported lower perceived treatment need (37% vs 48%), availability, affordability, overall ease of access, and effectiveness, as well as lower perceived acceptability of residential, outpatient, self-help, and hospital-based services. In multivariate analyses, there was a significant interaction between rural/urban residence and the acceptability of religious counseling. At the highest level of acceptability, rural users had lower odds of perceived need (OR=.23); at the lowest level, rural users had higher odds of perceived need (OR=2.74) than urban users. Among rural users, the acceptability of religious counseling was negatively associated with perceived need (OR=.64). Ease of access was negatively associated (OR=.71) whereas local treatment effectiveness (OR=1.47) and the acceptability of hospital-based treatment (OR=1.29) were positively associated with perceived need among all users. Conclusions Our findings suggest rural/urban disparities in perceived need and access to drug use treatment. Among rural and urban cocaine users, improving perceptions of treatment effectiveness and expanding hospital-based services could promote treatment seeking. PMID:25213603

  1. The key to health services in Turkey: new perspectives on leadership and hospital management.

    PubMed

    Sahin, Alper A

    2014-01-01

    Health services are one of the most important criteria for making a country function. Turkey has mobilized all of its resources to provide high-quality, easily accessible and patient-friendly services for its population. To achieve this aim, the Turkish health care system has been undergoing a significant transformation through its Health Transformation Programme begun in 2005. The reforms focus on the introduction of a general health insurance system, changing hospital health services, improvements in hospital management and transformational leadership skills. Firstly, all state-run hospitals in the country were merged under the same umbrella, giving millions of people covered by the national security agency access to all of these hospitals. Secondly, all drugs and medical equipment used by patients were made free of charge. Thanks to these developments, hospitals were modernized, and this modernization process in the health sector is still continuing swiftly. On the other hand, for Turkish hospitals to survive, they need to modernize further and become closer to European models, and produce new leaders with new paradigms. In this new and changing health system, hospital leaders and executive officers should be visionaries and strategists advising when to change direction. Following this doctrine, most Turkish hospitals are now run by two top executives: the hospital manager and the chief executive officer who is in charge of business functions. These executives should clearly be the leaders of high-quality, health care organizations.

  2. Global survey of hospital pharmacy practice.

    PubMed

    Doloresco, Fred; Vermeulen, Lee C

    2009-03-01

    The current state of hospital pharmacy practice around the globe and key issues facing international hospital pharmacy practice were studied. This survey assessed multiple aspects of hospital pharmacy practice within each of the Member States recognized by the United Nations. An official respondent from each nation was identified by a structured nomination process. The survey instrument was developed; pilot tested; translated into English, French, and Spanish; and distributed in July 2007. The nature, scope, and breadth of hospital pharmacy practices in medication procurement, prescribing, preparation and distribution, administration, outcomes monitoring, and human resources and training were evaluated. Descriptive statistics were used to characterize the responses. Eighty-five countries (44% of the 192 Member States) responded to the survey. The respondent sample of countries was representative of all nations in terms of population, geographic region, World Health Organization region, and level of economic development. In addition to qualifying the nature of hospital pharmacy practice, the survey highlighted numerous challenges facing the profession of pharmacy in the hospital setting around the globe, including access to medicines and adequately trained pharmacists. While the practice of hospital pharmacy differs from country to country, many nations face similar challenges, regardless of their population, location, or wealth. These survey results provide a basis for identifying opportunities for growth and development, as well as for international collaboration, to advance the profession of pharmacy and ensure that patients worldwide receive the care that they deserve.

  3. Factors that influence minority use of high-volume hospitals for colorectal cancer care.

    PubMed

    Huang, Lyen C; Tran, Thuy B; Ma, Yifei; Ngo, Justine V; Rhoads, Kim F

    2015-05-01

    Previous studies suggest that minorities cluster in low-quality hospitals despite living close to better performing hospitals. This may contribute to persistent disparities in cancer outcomes. The purpose of this work was to examine how travel distance, insurance status, and neighborhood socioeconomic factors influenced minority underuse of high-volume hospitals for colorectal cancer. The study was a retrospective, cross-sectional, population-based study. All hospitals in California from 1996 to 2006 were included. Patients with colorectal cancer diagnosed and treated in California between 1996 and 2006 were identified using California Cancer Registry data. Multivariable logistic regression models predicting high-volume hospital use were adjusted for age, sex, race, stage, comorbidities, insurance status, and neighborhood socioeconomic factors. A total of 79,231 patients treated in 417 hospitals were included in the study. High-volume hospitals were independently associated with an 8% decrease in the hazard of death compared with other settings. A lower proportion of minorities used high-volume hospitals despite a higher proportion living nearby. Although insurance status and socioeconomic factors were independently associated with high-volume hospital use, only socioeconomic factors attenuated differences in high-volume hospital use of black and Hispanic patients compared with white patients. The use of cross-sectional data and racial and ethnic misclassifications were limitations in this study. Minority patients do not use high-volume hospitals despite improved outcomes and geographic access. Low socioeconomic status predicts low use of high-volume settings in select minority groups. Our results provide a roadmap for developing interventions to increase the use of and access to higher quality care and outcomes. Increasing minority use of high-volume hospitals may require community outreach programs and changes in physician referral practices.

  4. Sodium Chloride Supplementation Is Not Routinely Performed in the Majority of German and Austrian Infants with Classic Salt-Wasting Congenital Adrenal Hyperplasia and Has No Effect on Linear Growth and Hydrocortisone or Fludrocortisone Dose.

    PubMed

    Bonfig, Walter; Roehl, Friedhelm; Riedl, Stefan; Brämswig, Jürgen; Richter-Unruh, Annette; Fricke-Otto, Susanne; Hübner, Angela; Bettendorf, Markus; Schönau, Eckhard; Dörr, Helmut; Holl, Reinhard W; Mohnike, Klaus

    2018-01-01

    Sodium chloride supplementation in salt-wasting congenital adrenal hyperplasia (CAH) is generally recommended in infants, but its implementation in routine care is very heterogeneous. To evaluate oral sodium chloride supplementation, growth, and hydrocortisone and fludrocortisone dose in infants with salt-wasting CAH due to 21-hydroxylase in 311 infants from the AQUAPE CAH database. Of 358 patients with classic CAH born between 1999 and 2015, 311 patients had salt-wasting CAH (133 females, 178 males). Of these, 86 patients (27.7%) received oral sodium chloride supplementation in a mean dose of 0.9 ± 1.4 mmol/kg/day (excluding nutritional sodium content) during the first year of life. 225 patients (72.3%) were not treated with sodium chloride. The percentage of sodium chloride-supplemented patients rose from 15.2% in children born 1999-2004 to 37.5% in children born 2011-2015. Sodium chloride-supplemented and -unsupplemented infants did not significantly differ in hydrocortisone and fludrocortisone dose, target height-corrected height-SDS, and BMI-SDS during the first 2 years of life. In the AQUAPE CAH database, approximately one-third of infants with salt-wasting CAH receive sodium chloride supplementation. Sodium chloride supplementation is performed more frequently in recent years. However, salt supplementation had no influence on growth, daily fludrocortisone and hydrocortisone dose, and frequency of adrenal crisis. © 2017 S. Karger AG, Basel.

  5. Access to health care and community social capital.

    PubMed

    Hendryx, Michael S; Ahern, Melissa M; Lovrich, Nicholas P; McCurdy, Arthur H

    2002-02-01

    To test the hypothesis that variation in reported access to health care is positively related to the level of social capital present in a community. The 1996 Household Survey of the Community Tracking Study, drawn from 22 metropolitan statistical areas across the United States (n = 19,672). Additional data for the 22 communities are from a 1996 multicity broadcast media marketing database, including key social capital indicators, the 1997 National Profile of Local Health Departments survey, and Interstudy, American Hospital Association, and American Medical Association sources. The design is cross-sectional. Self-reported access to care problems is the dependent variable. Independent variables include individual sociodemographic variables, community-level health sector variables, and social capital variables. Data are merged from the various sources and weighted to be population representative and are analyzed using hierarchical categorical modeling. Persons who live in metropolitan statistical areas featuring higher levels of social capital report fewer problems accessing health care. A higher HMO penetration rate in a metropolitan statistical area was also associated with fewer access problems. Other health sector variables were not related to health care access. The results observed for 22 major U.S. cities are consistent with the hypothesis that community social capital enables better access to care, perhaps through improving community accountability mechanisms.

  6. Can lay responder defibrillation programmes improve survival to hospital discharge following an out-of-hospital cardiac arrest?

    PubMed

    Smith, Leigh M; Davidson, Patricia M; Halcomb, Elizabeth J; Andrew, Sharon

    2007-11-01

    The importance of early defibrillation in improving outcomes and reducing morbidity following out-of-hospital cardiac arrest underscores the importance of examining novel approaches to treatment access. The increasing evidence to support the importance of early defibrillation has increased attention on the potential for lay responders to deliver this therapy. This paper seeks to critically review the literature that evaluates the impact of lay responder defibrillator programs on survival to hospital discharge following an out-of-hospital cardiac arrest in the adult population. The electronic databases, Medline and CINAHL, were searched using keywords including; "first responder", "lay responder", "defibrillation" and "cardiac arrest". The reference lists of retrieved articles and the Internet were also searched. Articles were included in the review if they reported primary data, in the English language, which described the effect of a lay responder defibrillation program on survival to hospital discharge from out-of-hospital cardiac arrest in adults. Eleven studies met the inclusion criteria. The small number of published studies, heterogeneity of study populations and study outcome methods prohibited formal meta-analysis. Therefore, narrative analysis was undertaken. Studies included in this report provided inconsistent findings in relation to survival to hospital discharge following out-of-hospital cardiac arrest. Although there are limited data, the role of the lay responder appears promising in improving the outcome from out-of-hospital cardiac arrest following early defibrillation. Despite the inherent methodological difficulties in studying this population, future research should address outcomes related to morbidity, mortality and cost-effectiveness.

  7. Influences on hospital admission for asthma in south Asian and white adults: qualitative interview study

    PubMed Central

    Griffiths, Chris; Kaur, Gurmit; Gantley, Madeleine; Feder, Gene; Hillier, Sheila; Goddard, Jill; Packe, Geoff

    2001-01-01

    Objective To explore reasons for increased risk of hospital admission among south Asian patients with asthma. Design Qualitative interview study using modified critical incident technique and framework analysis. Setting Newham, east London, a deprived area with a large mixed south Asian population. Participants 58 south Asian and white adults with asthma (49 admitted to hospital with asthma, 9 not admitted); 17 general practitioners; 5 accident and emergency doctors; 2 out of hours general practitioners; 1 asthma specialist nurse. Main outcome measures Patients' and health professionals' views on influences on admission, events leading to admission, general practices' organisation and asthma strategies, doctor-patient relationship, and cultural attitudes to asthma. Results South Asian and white patients admitted to hospital coped differently with asthma. South Asians described less confidence in controlling their asthma, were unfamiliar with the concept of preventive medication, and often expressed less confidence in their general practitioner. South Asians managed asthma exacerbations with family advocacy, without systematic changes in prophylaxis, and without systemic corticosteroids. Patients describing difficulty accessing primary care during asthma exacerbations were registered with practices with weak strategies for asthma care and were often south Asian. Patients with easy access described care suggesting partnerships with their general practitioner, had better confidence to control asthma, and were registered with practices with well developed asthma strategies that included policies for avoiding hospital admission. Conclusions The different ways of coping with asthma exacerbations and accessing care may partly explain the increased risk of hospital admission in south Asian patients. Interventions that increase confidence to control asthma, confidence in the general practitioner, understanding of preventive treatment, and use of systemic corticosteroids in

  8. Hydrogen Storage Properties of New Hydrogen-Rich BH3NH3-Metal Hydride (TiH2, ZrH2, MgH2, and/or CaH2) Composite Systems

    DOE Office of Scientific and Technical Information (OSTI.GOV)

    Choi, Young Joon; Xu, Yimin; Shaw, Wendy J.

    2012-04-19

    Ammonia borane (AB = NH3BH3) is one of the most attractive materials for chemical hydrogen storage due to its high hydrogen contents of 19.6 wt.%, however, impurity levels of borazine, ammonia and diborane in conjunction with foaming and exothermic hydrogen release calls for finding ways to mitigate the decomposition reactions. In this paper we present a solution by mixing AB with metal hydrides (TiH2, ZrH2, MgH2 and CaH2) which have endothermic hydrogen release in order to control the heat release and impurity levels from AB upon decomposition. The composite materials were prepared by mechanical ball milling, and their H2 releasemore » properties were characterized by thermogravimetric analysis (TGA) and differential scanning calorimetry (DSC). The formation of volatile products from decomposition side reactions, such as borazine (N3B3H6) was determined by mass spectrometry (MS). Sieverts type pressure-composition-temperature (PCT) gas-solid reaction instrument was adopted to observe the kinetics of the H2 release reactions of the combined systems and neat AB. In situ 11B MAS-NMR revealed a destabilized decomposition pathway. We found that by adding specific metal hydrides to AB we can eliminate the impurities and mitigate the heat release.« less

  9. Creative payment strategy helps ensure a future for teaching hospitals.

    PubMed

    Vancil, D R; Shroyer, A L

    1998-11-01

    The Colorado Medicaid Program in years past relied on disproportionate share hospital (DSH) payment programs to increase access to hospital care for Colorado citizens, ensure the future financial viability of key safety-net hospitals, and partially offset the state's cost of funding the Medicaid program. The options to finance Medicaid care using DSH payments, however, recently have been severely limited by legislative and regulatory changes. Between 1991 and 1997, a creative Medicaid refinancing strategy called the major teaching hospital (MTH) payment program enabled $131 million in net payments to be distributed to the two major teaching hospitals in Colorado to provide enhanced funding related to their teaching programs and to address the ever-expanding healthcare needs of their low-income patients. This new Medicaid payment mechanism brought the state $69.5 million in Federal funding that otherwise would not have been received.

  10. How are hospitals financing the future? Core competencies in capital planning.

    PubMed

    2004-07-01

    Financing the Future is a yearlong project to help hospitals take advantage of growth opportunities. Led by HFMA in partnership with GE Healthcare Financial Services, the project provides information, insights, strategies, and tools designed to help hospitals finance their future. The findings of Financing the Future are based on research conducted by HFMA and PricewaterhouseCoopers. To access the first four Financing the Future reports, visit www.financingthefuture.org.

  11. Access to hyperacute stroke services across Canadian provinces: a geospatial analysis

    PubMed Central

    Eswaradass, Prasanna Venkatesan; Swartz, Richard H.; Rosen, Jamey; Hill, Michael D.; Lindsay, M. Patrice

    2017-01-01

    Background: Canada's vast geography creates challenges for ensuring prompt transport to hospital of patients who have had a stroke. We sought to determine the proportion of people across various Canadian provinces for whom hyperacute stroke services are accessible within evidence-based time targets. Methods: We calculated, for the 8 provinces with available data, drive-time polygons on a map of Canada that delineated the area around stroke centres and emergency medical services (EMS) base centres to which one can drive in 3.5-6 hours. We calculated the proportional area of each forward sortation area (first 3 digits of the postal code) contained within a drive-time polygon. We applied this ratio to the 2011 Canadian census population of the forward sortation area to estimate the population that can reach a stroke centre in a designated time. Results: A total of 47.1%-96.4% of Canadians live within a 4.5-hour drive to a stroke centre via road EMS, and 53.3%-96.8% live within a 6-hour drive. Assuming a total travel time of 5 hours by EMS from base centre to patient and patient to hospital, 84.7%-99.8% of the population has access to a current or proposed endovascular thrombectomy site. Interpretation: Most Canadians live within 6 hours' road access to a stroke centre. Geospatial mapping could be used to inform decisions for additional sites and identify gaps in service accessibility. Coordinated systems of care and ambulance bypass agreements must continue to evolve to ensure maximal access to time-sensitive emergency stroke services. PMID:28615192

  12. 32 CFR 32.53 - Retention and access requirements for records.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 1 2010-07-01 2010-07-01 false Retention and access requirements for records. 32.53 Section 32.53 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE DoD... OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Reports...

  13. 32 CFR 32.53 - Retention and access requirements for records.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 32 National Defense 1 2011-07-01 2011-07-01 false Retention and access requirements for records. 32.53 Section 32.53 National Defense Department of Defense OFFICE OF THE SECRETARY OF DEFENSE DoD... OF HIGHER EDUCATION, HOSPITALS, AND OTHER NON-PROFIT ORGANIZATIONS Post-Award Requirements Reports...

  14. Medical residencies and increased admissions in rural hospitals with fewer than 200 beds.

    PubMed

    Connor, R A

    2000-01-01

    Medical education programs in general, and rural residency programs in particular, can be beneficial for rural hospitals. This study of 1,792 non-metropolitan statistical area, acute general hospitals with fewer than 200 beds from 1993 to 1996 was designed to help rural hospitals and communities to quantify the likely effects of rural residency programs on hospital admissions. Data came from the hospital Prospective Payment System minimum data set. The results show that additional residents at rural hospitals with fewer than 200 beds generally result in an increase of approximately 100 to 200 admissions per resident--more for smaller hospitals and fewer for larger hospitals. Because increased admissions generally improve the financial health and continued operation of rural hospitals, this study confirms the importance of education-based strategies in ensuring access to care in rural communities.

  15. Toll motorway accessibility for wheelchair users: a survey.

    PubMed

    Prigent, Hélène; Roche, Nicolas; Guillon, Bruno; Hurand, Anne; Moreau, Bernadette; Dufresne, Jean Pierre; Ravaud, Jean-François; Lofaso, Frédéric

    2008-09-01

    To identify difficulties encountered by wheelchair users who travel on toll motorways, with the goal of defining areas for improvement. Survey. After observing a wheelchair user travelling on a toll motorway and using the associated services, we designed a self-questionnaire on perceptions by wheelchair users of toll motorway accessibility. Toll motorway and rehabilitation hospital in France. We recruited 167 wheelchair users by advertisement and, to assess selection bias, 19 consecutive outpatients who visited our hospital's wheelchair showroom. None. Of the 186 included subjects, 91 (49%) were used to driving independently on toll motorways. Among them, only 16% used automatic toll booths and 32% reported difficulties at toll booths. Furthermore, 53% routinely asked for help at filling stations, and only 27% were aware of the availability of a free-of-charge assistance service for disabled people at some filling stations. Among the 186 toll motorway users, only 84 (45%) reported never encountering difficulties in lay-bys; 162 (87%) felt that toilet accessibility was the most important feature of lay-bys and 143 (77%) preferred the locked toilets reserved for disabled people. Wheelchair users reported difficulties on toll motorways that could be corrected fairly easily.

  16. Health Status of Adults with Congenital Adrenal Hyperplasia: A Cohort Study of 203 Patients

    PubMed Central

    Arlt, Wiebke; Willis, Debbie S.; Wild, Sarah H.; Krone, Nils; Doherty, Emma J.; Hahner, Stefanie; Han, Thang S.; Carroll, Paul V.; Conway, Gerry S.; Rees, D. Aled; Stimson, Roland H.; Walker, Brian R.; Connell, John M. C.; Ross, Richard J.

    2010-01-01

    Context: No consensus exists for management of adults with congenital adrenal hyperplasia (CAH) due to a paucity of data from cohorts of meaningful size. Objective: Our objective was to establish the health status of adults with CAH. Design and Setting: We conducted a prospective cross-sectional study of adults with CAH attending specialized endocrine centers across the United Kingdom. Patients: Participants included 203 CAH patients (199 with 21-hydroxylase deficiency): 138 women, 65 men, median age 34 (range 18–69) years. Main Outcome Measures: Anthropometric, metabolic, and subjective health status was evaluated. Anthropometric measurements were compared with Health Survey for England data, and psychometric data were compared with appropriate reference cohorts. Results: Glucocorticoid treatment consisted of hydrocortisone (26%), prednisolone (43%), dexamethasone (19%), or a combination (10%), with reverse circadian administration in 41% of patients. Control of androgens was highly variable with a normal serum androstenedione found in only 36% of patients, whereas 38% had suppressed levels suggesting glucocorticoid overtreatment. In comparison with Health Survey for England participants, CAH patients were significantly shorter and had a higher body mass index, and women with classic CAH had increased diastolic blood pressure. Metabolic abnormalities were common, including obesity (41%), hypercholesterolemia (46%), insulin resistance (29%), osteopenia (40%), and osteoporosis (7%). Subjective health status was significantly impaired and fertility compromised. Conclusions: Currently, a minority of adult United Kingdom CAH patients appear to be under endocrine specialist care. In the patients studied, glucocorticoid replacement was generally nonphysiological, and androgen levels were poorly controlled. This was associated with an adverse metabolic profile and impaired fertility and quality of life. Improvements in the clinical management of adults with CAH are

  17. Regional consolidation of orthopedic surgery: impacts on hip fracture surgery access and outcomes

    PubMed Central

    Kreindler, Sara A.; Siragusa, Lanette; Bohm, Eric; Rudnick, Wendy; Metge, Colleen J.

    2017-01-01

    Background Timely access to orthopedic trauma surgery is essential for optimal outcomes. Regionalization of some types of surgery has shown positive effects on access, timeliness and outcomes. We investigated how the consolidation of orthopedic surgery in 1 Canadian health region affected patients requiring hip fracture surgery. Methods We retrieved administrative data on all regional emergency department visits for lower-extremity injury and all linked inpatient stays from January 2010 through March 2013, identifying 1885 hip-fracture surgeries. Statistical process control and interrupted time series analysis controlling for demographics and comorbidities were used to assess impacts on access (receipt of surgery within 48-h benchmark) and surgical outcomes (complications, in-hospital/30-d mortality, length of stay). Results There was a significant increase in the proportion of patients receiving surgery within the benchmark. Complication rates did not change, but there appeared to be some decrease in mortality (significant at 6 mo). Length of stay increased at a hospital that experienced a major increase in patient volume, perhaps reflecting challenges associated with patient flow. Conclusion Regionalization appeared to improve the timeliness of surgery and may have reduced mortality. The specific features of the present consolidation (including pre-existing interhospital performance variation and the introduction of daytime slates at the referral hospital) should be considered when interpreting the findings. PMID:28930037

  18. Paying more for faster care? Individuals' attitude toward price-based priority access in health care.

    PubMed

    Benning, Tim M; Dellaert, Benedict G C

    2013-05-01

    Increased competition in the health care sector has led hospitals and other health care institutions to experiment with new access allocation policies that move away from traditional expert based allocation of care to price-based priority access (i.e., the option to pay more for faster care). To date, little is known about individuals' attitude toward price-based priority access and the evaluation process underlying this attitude. This paper addresses the role of individuals' evaluations of collective health outcomes as an important driver of their attitude toward (price-based) allocation policies in health care. The authors investigate how individuals evaluate price-based priority access by means of scenario-based survey data collected in a representative sample from the Dutch population (N = 1464). They find that (a) offering individuals the opportunity to pay for faster care negatively affects their evaluations of both the total and distributional collective health outcome achieved, (b) however, when health care supply is not restricted (i.e., when treatment can be offered outside versus within the regular working hours of the hospital) offering price-based priority access affects total collective health outcome evaluations positively instead of negatively, but it does not change distributional collective health outcome evaluations. Furthermore, (c) the type of health care treatment (i.e., life saving liver transplantation treatment vs. life improving cosmetic ear correction treatment - priced at the same level to the individual) moderates the effect of collective health outcome evaluations on individuals' attitude toward allocation policies. For policy makers and hospital managers the results presented in this article are helpful because they provide a better understanding of what drives individuals' preferences for health care allocation policies. In particular, the results show that policies based on the "paying more for faster care" principle are more

  19. Comparing Recruitment and Retention Strategies for Rehabilitation Professionals among Hospital and Home Care Employers

    PubMed Central

    Tran, Diem; Davis, Aileen; McGillis Hall, Linda

    2012-01-01

    ABSTRACT Purpose: The objective of this study was to compare hospital and home care employers' rankings of both the importance and the feasibility of workforce strategies for recruiting and retaining rehabilitation professionals. Methods: An online self-administered questionnaire was distributed to all employers of rehabilitation professionals in Ontario hospitals (n=144) and Community Care Access Centre home care providers (n=34). Importance and feasibility rankings were based on the percentage of high ratings; 95% CIs were used to determine significant differences between hospital and home care rankings of recruitment and retention strategies. Results: The response rate was 50% (72/144) from hospitals and 73.5% (25/34) from home-care settings. The recruitment and retention strategies considered most important and feasible for rehabilitation therapists, regardless of setting, were communication between employer and worker, compensation packages, access to research, and professional development in budget planning. Tangible resources, support personnel, work safety, and marketing rehabilitation careers to high school students were ranked significantly higher by hospitals than by home care providers. Conclusions: Similarities exist between hospital and home care employers in terms of the importance and feasibility of recruitment and retention strategies for rehabilitation professionals. However, when developing a rehabilitation health human resources plan, the strategies identified as different between hospital and home care settings should be taken into account. PMID:23277683

  20. Tolerance of anaerobic bacteria to chlorinated solvents.

    PubMed

    Koenig, Joanna C; Groissmeier, Kathrin D; Manefield, Mike J

    2014-01-01

    The aim of this research was to evaluate the effects of four chlorinated aliphatic hydrocarbons (CAHs), perchloroethene (PCE), carbon tetrachloride (CT), chloroform (CF) and 1,2-dichloroethane (1,2-DCA), on the growth of eight anaerobic bacteria: four fermentative species (Escherichia coli, Klebsiella sp., Clostridium sp. and Paenibacillus sp.) and four respiring species (Pseudomonas aeruginosa, Geobacter sulfurreducens, Shewanella oneidensis and Desulfovibrio vulgaris). Effective concentrations of solvents which inhibited growth rates by 50% (EC50) were determined. The octanol-water partition coefficient or log Po/w of a CAH proved a generally satisfactory measure of its toxicity. Most species tolerated approximately 3-fold and 10-fold higher concentrations of the two relatively more polar CAHs CF and 1,2-DCA, respectively, than the two relatively less polar compounds PCE and CT. EC50 values correlated well with growth rates observed in solvent-free cultures, with fast-growing organisms displaying higher tolerance levels. Overall, fermentative bacteria were more tolerant to CAHs than respiring species, with iron- and sulfate-reducing bacteria in particular appearing highly sensitive to CAHs. These data extend the current understanding of the impact of CAHs on a range of anaerobic bacteria, which will benefit the field of bioremediation.

  1. A Complete Image Management and Communications Network for the Neuroradiology Service at Georgetown University Hospital

    NASA Astrophysics Data System (ADS)

    Horii, Steven C.; Muraki, Alan; Mallon-Ingeholm, Mary L.; Mun, Seong K.; Clark, Letitia; Schellinger, Dieter

    1989-05-01

    A complete image management and communications system has been installed at Georgetown University Hospital (GUH). The network is based on the A T & T CommView System. In the Neuroradiology Division, this comprehensive network supports a multiscreen workstation with access to multiple imaging modalities such as CT and MRI from both the hospital and a remote imaging center. In addition, the radiologist can access these images from various workstations located throughout the hospital as well as from remote sites such as the home. Among the radiology services supported by the network, neuroradiology has the greatest need for such a system with extensive daily requirements involving the remote imaging center and on-line consultation around the clock. By providing neuroradiology with all available communication links, the radiologist can monitor, diagnose, and consult. The remote site has a subsystem capable of acquiring images and transmitting them over a high speed T1 data circuit. The GUH neuroradiologist can view these images on the neuro workstation or any of the workstations available in the Hospital. Fast and easy access to the images allows a radiologist to monitor multiple examinations as well as to utilize the workstation for diagnosis. To provide the neuroradiologist quick access to images at all times, a PC-based Results Viewing Station (RVS) has been placed in a doctor's home. Images may be sent to the RVS, or the user may request images from the central database at the hospital. Images can be viewed at home either as they are transmitted, or following transfer of a whole study. The efficiency and effectiveness of the system's capabilities with special regard to remote and teleradiology (RVS) operations have been studied for the neuroradiology service. This paper will discuss the current clinical acceptance and use, problems in implementation, and ways these difficulties are being surmounted.

  2. The Politics of Racial Disparities: Desegregating the Hospitals in Jackson, Mississippi

    PubMed Central

    Smith, David Barton

    2005-01-01

    As health care policymakers and providers focus on eliminating the persistent racial disparities in treatment, it is useful to explore how resistance to hospital desegregation was overcome. Jackson, Mississippi, provides an instructive case study of how largely concealed deliberations achieved the necessary concessions in a still rigidly segregated community. The Veterans Administration hospital, the medical school hospital, and the private nonprofit facilities were successively desegregated, owing mainly to the threatened loss of federal dollars. Many of the changes, however, were cosmetic. In contrast to the powerful financial incentives offered to hospitals to desegregate and ensure equal access in the early years of the Medicare program, current trends in federal reimbursement encourage segregation and disparities in treatment. PMID:15960771

  3. Pay More Attention: a national mixed methods study to identify the barriers and facilitators to ensuring equal access to high-quality hospital care and services for children and young people with and without learning disabilities and their families

    PubMed Central

    Oulton, Kate; Wray, Jo; Carr, Lucinda; Hassiotis, Angela; Jewitt, Carey; Kerry, Sam; Gibson, Faith

    2016-01-01

    Introduction Despite evidence of health inequalities for adults with intellectual disability (ID) there has yet to be a comprehensive review of how well hospital services are meeting the needs of children and young people (CYP) with ID and their families. We do not know how relevant existing recommendations and guidelines are to CYP, whether these are being applied in the paediatric setting or what difference they are making. Evidence of parental dissatisfaction with the quality, safety and accessibility of hospital care for CYP with ID exists. However, the extent to which their experience differs from parents of CYP without ID is not known and the views and experiences of CYP with ID have not been investigated. We will compare how services are delivered to, and experienced by CYP aged 5–15 years with and without ID and their families to see what inequalities exist, for whom, why and under what circumstances. Methods and analysis We will use a transformative, mixed methods case study design to collect data over four consecutive phases. We will involve CYP, parents and hospital staff using a range of methods; interviews, parental electronic diary, hospital and community staff questionnaire, patient and parent satisfaction questionnaire, content analysis of hospital documents and a retrospective mapping of patient hospital activity. Qualitative data will be managed and analysed using NVivo and quantitative data will be analysed using parametric and non-parametric descriptive statistics. Ethics and dissemination The study will run from December 2015 to November 2018. We have Health Authority Approval (IRAS project ID: 193932) for phase 1 involving staff only and ethical and Health Authority Approval for phases 2–4 (IRAS project ID: 178525). We will disseminate widely to relevant stakeholders, using a range of accessible formats, including social media. We will publish in international peer-reviewed journals and present to professional, academic and lay audiences

  4. Pay More Attention: a national mixed methods study to identify the barriers and facilitators to ensuring equal access to high-quality hospital care and services for children and young people with and without learning disabilities and their families.

    PubMed

    Oulton, Kate; Wray, Jo; Carr, Lucinda; Hassiotis, Angela; Jewitt, Carey; Kerry, Sam; Tuffrey-Wijne, Irene; Gibson, Faith

    2016-12-09

    Despite evidence of health inequalities for adults with intellectual disability (ID) there has yet to be a comprehensive review of how well hospital services are meeting the needs of children and young people (CYP) with ID and their families. We do not know how relevant existing recommendations and guidelines are to CYP, whether these are being applied in the paediatric setting or what difference they are making. Evidence of parental dissatisfaction with the quality, safety and accessibility of hospital care for CYP with ID exists. However, the extent to which their experience differs from parents of CYP without ID is not known and the views and experiences of CYP with ID have not been investigated. We will compare how services are delivered to, and experienced by CYP aged 5-15 years with and without ID and their families to see what inequalities exist, for whom, why and under what circumstances. We will use a transformative, mixed methods case study design to collect data over four consecutive phases. We will involve CYP, parents and hospital staff using a range of methods; interviews, parental electronic diary, hospital and community staff questionnaire, patient and parent satisfaction questionnaire, content analysis of hospital documents and a retrospective mapping of patient hospital activity. Qualitative data will be managed and analysed using NVivo and quantitative data will be analysed using parametric and non-parametric descriptive statistics. The study will run from December 2015 to November 2018. We have Health Authority Approval (IRAS project ID: 193932) for phase 1 involving staff only and ethical and Health Authority Approval for phases 2-4 (IRAS project ID: 178525). We will disseminate widely to relevant stakeholders, using a range of accessible formats, including social media. We will publish in international peer-reviewed journals and present to professional, academic and lay audiences through national and international conferences. Published by

  5. Patient satisfaction in Turkey: differences between public and private hospitals.

    PubMed

    Tengilimoglu, D; Kisa, A; Dziegielewski, S F

    1999-02-01

    This article reports the results of a patient-satisfaction survey administered by interview to 2045 adults discharged from several major public and private hospitals in Turkey. The direct measurement of patient-satisfaction is a new phenomenon for this country. An instrument was designed similar to those available in the United States and administered during exit interviews. Two primary areas of analyses were determined in comparing services provided by these public and private hospitals: demographic factors with regard to accessibility and consumer perceptions of the quality of service provided. Relationships and percentages within and among the five public and two private hospitals are reported. Several statistically significant differences were found between the hospitals, with the private hospitals achieving the greatest satisfaction on most of the quality of services issues examined. Future recommendations outline the need to take into account the public's perception of these hospitals and enhancing customer satisfaction as a means of increasing service utilization.

  6. Does Selection and Management of Patients with Chronic Kidney Disease In Government Run and Private Hospitals Differ?

    PubMed Central

    Gowda, Anoop; Bangera, Shobith

    2017-01-01

    Introduction Globally, incidence of Chronic Kidney Disease (CKD) is rapidly rising with huge burden on the life expectancy of the patients. Regular haemodialysis improves the quality of life in these patients. They get treatment at either government run or private sector hospitals. A difference in disease pattern, comorbidity, patient management and number of access failures can be observed in these set ups. Aim The present study was carried out to find out selection, management and disease pattern of CKD patients admitted for dialysis in government run and private hospital. Materials and Methods A cross-sectional study on patients (18–90 years) admitted and undergoing dialysis at government run (N=129) and private hospital (N=182) was undertaken in Karnataka, India. Parameters like comorbidity (diabetes), number of dialysis per week, number of access failures, and follow up visits were compared between these patients. Chi- squared test was used to compare the data. All tests were two-tailed and p< 0.05 was considered as significant. Results More number of younger patients and associated comorbidity, were seen in patients admitted in government run hospital (p<0.001), with no gender bias in selection of patients for dialysis between the two hospitals. Similarly, follow-ups with nephrologist, number of dialysis done per week and erythropoietin supplements administered were significantly more among private hospital patients (p<0.001). Number of dialysis sessions and mean haemoglobin level was less in government run hospital patients, as compared to those in private hospital. No statistical difference was seen with access failure in both these setups. Conclusion No bias in management of CKD patient was seen among the two sets of hospitals though available facilities seemed to vary. PMID:28969180

  7. New roles: professional staff sharing between a hospital and an academic library.

    PubMed

    Just, Melissa L

    2003-01-01

    Childrens Hospital Los Angeles is a pediatric hospital and research institute affiliated with the Keck School of Medicine of the University of Southern California (USC). Historically, the library at Childrens Hospital was staffed by a hospital-employed librarian. In 1999, the library position was outsourced to USC's Norris Medical Library. The new position is staffed by a librarian who divides her time equally between two locations: the Childrens Hospital Library and the Norris Medical Library. This staff sharing arrangement has three primary goals: increase the collaboration between the libraries; improve access to resources and library staff expertise; and provide faster document delivery service to the Childrens Hospital library. This paper presents the details of the position, and addresses the pros and cons for both libraries and the librarian.

  8. A reliable user authentication and key agreement scheme for Web-based Hospital-acquired Infection Surveillance Information System.

    PubMed

    Wu, Zhen-Yu; Tseng, Yi-Ju; Chung, Yufang; Chen, Yee-Chun; Lai, Feipei

    2012-08-01

    With the rapid development of the Internet, both digitization and electronic orientation are required on various applications in the daily life. For hospital-acquired infection control, a Web-based Hospital-acquired Infection Surveillance System was implemented. Clinical data from different hospitals and systems were collected and analyzed. The hospital-acquired infection screening rules in this system utilized this information to detect different patterns of defined hospital-acquired infection. Moreover, these data were integrated into the user interface of a signal entry point to assist physicians and healthcare providers in making decisions. Based on Service-Oriented Architecture, web-service techniques which were suitable for integrating heterogeneous platforms, protocols, and applications, were used. In summary, this system simplifies the workflow of hospital infection control and improves the healthcare quality. However, it is probable for attackers to intercept the process of data transmission or access to the user interface. To tackle the illegal access and to prevent the information from being stolen during transmission over the insecure Internet, a password-based user authentication scheme is proposed for information integrity.

  9. Organizational Characteristics Associated With Fundraising Performance of Nonprofit Hospitals.

    PubMed

    Erwin, Cathleen Owens; Landry, Amy Yarbrough

    2015-01-01

    Fundraising has become increasingly important to nonprofit hospitals as access to capital has grown more difficult and reimbursement for services more complex. This study analyzes the variation in organizational characteristics and fundraising performance among nonprofit acute care hospitals in the United States to identify and measure critical factors related to one key fundraising performance indicator: public support. Results indicate that the presence of an endowment, along with its value, investments in fundraising, and the geographic location of the organization, account for approximately 46% of variance in public support among nonprofit hospitals. The use of a separate foundation for the fundraising operation is not necessarily associated with measures of fundraising success; however, a majority of hospitals do use a foundation, signaling a strategic choice that may be made for numerous reasons. The study results and limitations are discussed and recommendations are made for maximizing the effectiveness of the fundraising enterprise within nonprofit hospitals. Increasing awareness of challenges associated with fundraising success will enhance the strategic management of fundraising operations by hospital executives and board members.

  10. The contribution of hospital library information services to clinical care: a study in eight hospitals.

    PubMed Central

    King, D N

    1987-01-01

    Hospital health sciences libraries represent, for the vast majority of health professionals, the most accessible source for library information and services. Most health professionals do not have available the specialized services of a clinical medical librarian, and rely instead upon general information services for their case-related information needs. The ability of the hospital library to meet these needs and the impact of the information on quality patient care have not been previously examined. A study was conducted in eight hospitals in the Chicago area as a quality assurance project. A total of 176 physicians, nurses, and other health professionals requested information from their hospital libraries related to a current case or clinical situation. They then assessed the quality of information received, its cognitive value, its contribution to patient care, and its impact on case management. Nearly two-thirds of the respondents asserted that they would definitely or probably handle their cases differently as a result of the information provided by the library. Almost all rated the libraries' performance and response highly. An overview of the context and purpose of the study, its methods, selected results, limitations, and conclusions are presented here, as is a review of selected earlier research. PMID:3450340

  11. Do as I say, not as I do: a survey of public impressions of queue-jumping and preferential access.

    PubMed

    Friedman, Steven Marc; Schofield, Lee; Tirkos, Sam

    2007-10-01

    The Canada Health Act legislates that Canadian citizens have access to healthcare that is publicly administered, universal, comprehensive, portable, and accessible (i.e. unimpeded by financial, clinical, or social factors). We surveyed public impressions and practices regarding preferential access to healthcare and queue jumping. Households were randomly selected from the Toronto telephone directory. English speakers aged 18 years or older were solicited for a standardized telephone survey. Statistical analysis was performed using SPSS and SAS. Fifteen percent (n=101) of 668 solicited were surveyed. Ninety-five percent advocated equal access based on need. Support for queue jumping in the emergency department (ED) was strong for cases of emergency, severe pain, and pediatrics, equivocal for police, and minimal for the homeless, doctors, hospital administrators, and government officials. To improve a position on a waiting list, approximately half surveyed would call a friend who is a doctor, works for a doctor, or is a hospital administrator. Sixteen percent reported having done this. The likelihoods of offering material inducement for preferential access were 30 and 51% for low and high-impact medical scenarios, respectively. The likelihoods of offering nonmaterial inducement were 56 and 71%, respectively. Responses were not associated with sex, occupation, or education. Respondents expressed support for equal access based on need. Policy and scenario-type questions elicited different responses. Expressed beliefs may vary from personal practice. Clearly defined and enforced policies at the hospital and provincial level might enhance principles of fairness in the ED queue.

  12. Effects of improved access to transportation on emergency obstetric care outcomes in Uganda.

    PubMed

    Mucunguzi, Stephen; Wamani, Henry; Lochoro, Peter; Tylleskar, Thorkild

    2014-09-01

    Reduction in maternal mortality has not been appreciable in most low-income countries. Improved access to transport for mothers is one way to improve maternal health. This study evaluated a free-of-charge 24-hour ambulance and communication services intervention in Oyam district using 'Caesarean section rate' (CSR) and compared with the neighbouring non-intervention district. Ecological data were collected retrospectively from maternity/theatre registers in October 2010 for 3 years pre and 3 years intervention period. The average CSR in the intervention district increased from 0.57% before the intervention to 1.21% (p = 0.022) during the intervention, while there was no change in the neighbouring district (0.51% to 0.58%, p = 0.512). Hospital deliveries increased by over 50% per year with a slight reduction in the average hospital stillbirths per 1000 hospital births in the intervention district (46.6 to 37.5, p = 0.253). Reliable communication and transport services increased access to and utilization of maternal health services, particularly caesarean delivery services.

  13. Retroperitoneal versus direct femoral artery approach for thoracic endovascular aortic repair access: a case-control study.

    PubMed

    Etezadi, Vahid; Katzen, Barry T; Benenati, James F; Alehashemi, Sara; Tsoukas, Athanassios I; Puente, Orlando A

    2011-04-01

    Many individuals who are candidates for thoracic endovascular aortic repair (TEVAR) are found to have iliac artery anatomy and/or disease that preclude transfemoral endovascular access and require retroperitoneal surgical approach through more proximal arteries. This relatively more invasive technique could potentially affect the procedural outcomes. This study compares the retroperitoneal with transfemoral access used for TEVAR in a single center. In this study, 133 consecutive patients (96 men; mean age ± SD: 69.5 ± 14.7 years) who underwent TEVAR between 1994 and 2009 in a single center were retrospectively evaluated. The type of endovascular access was identified in all the patients. The basic demographics, access method, endograft type, 30-day morbidity and mortality rates, as well as procedure recordings including fluoroscopic and procedure duration, estimated blood loss, and duration of hospitalization were compared between the TEVAR procedures performed using a surgical retroperitoneal approach and those using the standard femoral access. Retroperitoneal access was used in 19 (14.3%; 13 women; mean age ± SD: 71 ± 12.2 years) and direct femoral access in 114 (85.7%; 24 women; mean age ± SD: 69 ± 15.4 years) patients. Two of the retroperitoneal accesses were obtained after failure of femoral approach. Techniques that were used included iliac artery conduit (seven patients), aortic artery conduit (eight patients), aortobifemoral artery graft conduit (one patient), and direct sheath introduction through the distal aorta (two patients) or common iliac artery (one patient). Retroperitoneal approach was used more frequently in women (35%) as compared with men (6%) (p = 0.0001). In all, 79% of the retroperitoneal approaches were associated with use of delivery sheath sizes larger than 24F (p = 0.049). TEVAR technical success was 100% with retroperitoneal and 97.3% with femoral access (p > 0.05). Thirty-day mortality rates were 0% and 8.8% and the rates of

  14. Accessibility and Use of Web-Based Electronic Resources by Physicians in a Psychiatric Institution in Nigeria

    ERIC Educational Resources Information Center

    Oduwole, Adebambo Adewale; Oyewumi, Olatundun

    2010-01-01

    Purpose: This study aims to examine the accessibility and use of web-based electronic databases on the Health InterNetwork Access to Research Initiative (HINARI) portal by physicians in the Neuropsychiatric Hospital, Aro--a psychiatry health institution in Nigeria. Design/methodology/approach: Collection of data was through the use of a three-part…

  15. Decrease Hospital Spending: There's an App for That! A Retrospective Analysis of Implementation of a Mobile Resident Handbook on Hospital Costs and Disposition.

    PubMed

    Holtkamp, Matthew D

    2017-10-01

    Patient care involves time sensitive decisions. Matching a patient's presenting condition with possible diagnoses requires proper assessment and diagnostic tests. Timely access to necessary information leads to improved patient care, better outcomes, and decreased costs. This study evaluated objective outcomes of the implementation of a novel Resident Handbook Application (RHAP) for smart phones. The RHAP included tools necessary to make proper assessments and to order appropriate tests. The RHAPs effectiveness was accessed using the Military Health System Military Mart database. This database includes patient specific aggregate data, including diagnosis, patient demographics, itemized cost, hospital days, and disposition status. Multivariable analysis was used to compare before and after RHAP implementation, controlling for patient demographics and diagnosis. Internal medicine admission data were used as a control group. There was a statistically significant decrease in laboratory costs and a strong trend toward statistically significant decreases in the cost of radiology performed after implementation of RHAP (p value of <0.02 and <0.07, respectively). There was also a decrease in hospital days (3.66-3.30 days), in total cost per admission ($18,866-$16,305), and in cost per hospital day per patient ($5,140-$4,936). During the same time period a Control group had no change or increases in these areas. The use of the RHAP resulted in decreases in costs in a variety of areas and a decrease in hospital bed days without any apparent negative effect upon patient outcomes or disposition status.

  16. Parathyroid hormone (PTH)-related protein, PTH, and 1,25-dihydroxyvitamin D in dogs with cancer-associated hypercalcemia.

    PubMed

    Rosol, T J; Nagode, L A; Couto, C G; Hammer, A S; Chew, D J; Peterson, J L; Ayl, R D; Steinmeyer, C L; Capen, C C

    1992-09-01

    Circulating N-terminal PTH-related protein (PTHrP), N-terminal PTH, and 1,25-dihydroxyvitamin D [1,25-(OH)2D] concentrations were measured in normal dogs and dogs with cancer-associated hypercalcemia (CAH), parathyroid adenomas, and miscellaneous tumors. PTHrP was undetectable (less than 1.8 pM) in normal dogs and increased in dogs with CAH due to adenocarcinomas derived from apocrine glands of the anal sac (44.9 +/- 27 pM), lymphoma (8.3 +/- 4.4 pM), and miscellaneous carcinomas (13.3 +/- 11.4 pM). The PTHrP concentration decreased in dogs with lymphoma and anal sac adenocarcinomas after successful treatment of CAH. The PTHrP concentration had a significant linear correlation with total serum calcium in dogs with anal sac adenocarcinomas and hypercalcemia, but not in dogs with lymphoma and hypercalcemia. Serum N-terminal PTH concentrations were usually in the normal range (12-34 pg/ml) for all groups of dogs except dogs with parathyroid adenomas (83 +/- 38 pg/ml). The serum PTH concentration increased after successful treatment of CAH. Serum 1,25-(OH)2D concentrations were decreased, normal, or increased in dogs with CAH, and 1,25-(OH)2D levels decreased after treatment of CAH. In summary, circulating concentrations of PTHrP are consistently increased in dogs with CAH, and PTHrP appears to play an important role in the induction of hypercalcemia.

  17. Improving access to health care for undocumented immigrants in the United States.

    PubMed

    Wallace, Steven P; Rodriguez, Michael; Padilla-Frausto, Imelda; Arredondo, Armando; Orozco, Emanuel

    2013-01-01

    To identify policies that increase access to health care for undocumented Mexican immigrants. Four focus groups (n=34 participants) were conducted with uninsured Mexican immigrants in Los Angeles, California. The feasibility and desirability of different policy proposals for increasing access were discussed by each group. Respondents raised significant problems with policies including binational health insurance, expanded employer-provided health insurance, and telemedicine. The only solution with a consensus that the change would be feasible, result in improved access, and they had confidence in was expanded access to community health centers (CHC's). Given the limited access to most specialists at CHC's and the continued barriers to hospital care for those without health insurance, the most effective way of improving the complete range of health services to undocumented immigrants is through immigration reform that will bring these workers under the other health care reform provisions.

  18. Borrowed buildings: Canada's temporary hospitals during World War I.

    PubMed

    Adams, A

    1999-01-01

    This article explores the alterations and additions made to houses, colleges, and larger public buildings in their temporary use as convalescent homes for wounded Canadian soldiers during World War I. These ''borrowed buildings'' anticipated and emphasized three important characteristics of subsequent hospital architecture by suggesting that domestic environments enhanced healing, that hospitals should be accessible, and that patients should be segregated according to social status and disease. The broader implications of the study are that temporarily appropriated spaces contribute to the definition of many institutions and often act as arenas of resistance to established practices.

  19. Health Information Security in Hospitals: the Application of Security Safeguards.

    PubMed

    Mehraeen, Esmaeil; Ayatollahi, Haleh; Ahmadi, Maryam

    2016-02-01

    A hospital information system has potentials to improve the accessibility of clinical information and the quality of health care. However, the use of this system has resulted in new challenges, such as concerns over health information security. This paper aims to assess the status of information security in terms of administrative, technical and physical safeguards in the university hospitals. This was a survey study in which the participants were information technology (IT) managers (n=36) who worked in the hospitals affiliated to the top ranked medical universities (university A and university B). Data were collected using a questionnaire. The content validity of the questionnaire was examined by the experts and the reliability of the questionnaire was determined using Cronbach's coefficient alpha (α=0.75). The results showed that the administrative safeguards were arranged at a medium level. In terms of the technical safeguards and the physical safeguards, the IT managers rated them at a strong level. According to the results, among three types of security safeguards, the administrative safeguards were assessed at the medium level. To improve it, developing security policies, implementing access control models and training users are recommended.

  20. [Drug information management through the intranet of a hospital center].

    PubMed

    Juárez Giménez, J C; Mendarte Barrenechea, L; Gil Luján, G; Sala Piñol, F; Lalueza Broto, P; Girona Brumós, L; Monterde Junyent, J

    2006-01-01

    This paper describes the methodology used for the implementation and validation of a network resource incorporated to the intranet of the Hospital, in order to retain and disseminate information from the Drug Information Center (DIC) of a pharmacy service in a hospital center. A working group designed the structure, contents, memory needs, priority of access for users and a quality assessment questionnaire. The resource developed by the working group had a capacity of 70 Gb and its structure was based on HTML documents, including files with different format and 12 theme areas. Two levels of priority of access were established depending on the user and two persons were in charge of the resource. The questionnaire was delivered after three months of use. Sixty nine per cent of the users regarded the resource as very useful and 31%, as useful. The final structure, according to the results of the survey, had 11 theme areas. The use of the hospital Intranet in order to include and organize DIC information can be very simple and economic. Furthermore, the involvement of all the users in its design and structure can facilitate the practical use of this tool and improve its quality.