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1

Variations in Nursing Care Quality across Hospitals  

PubMed Central

Aims The aim of the study was to describe Registered Nurses’ reports of unmet nursing care needs and examine the variation of nursing care quality across hospitals. Background Large proportions of Registered Nurses have reported leaving necessary care activities undone because they lacked the time to complete the activities. Nursing care left undone can be expected to adversely affect the quality of care. However, little is known about the degree of variation in the quality of nursing care across hospitals. Methods In 2008, a secondary analysis of a 1999 survey of Registered Nurses (N=10,184) was conducted using descriptive and comparative statistics. Data were derived from inpatient staff nurses working in acute care hospital settings (N=168). A hospital-level measure (i.e. unmet nursing care needs) of the quality of nursing care was developed from care needs left undone among all nurses. Results Across hospitals there was a wide range in the proportion of Registered Nurses who reported leaving each nursing care need undone. They reported leaving 2 out of 7 necessary nursing care activities undone during their last shift. After controlling for nurses’ demographic information, we found statistically significant variations in the quality of nursing care across hospitals. Conclusion Differences in nursing care quality across hospitals appear to be closely associated with variations in the quality of care environments. Understanding the determinants of unmet nursing care needs can support policy decisions on systems and human resources management to enhance nurses’ awareness of their care practices and the care environment. PMID:19737326

Lucero, Robert J.; Lake, Eileen T.; Aiken, Linda H.

2009-01-01

2

Does quality improvement implementation affect hospital quality of care?  

PubMed

The authors examined how the association between quality improvement (QI) implementation in hospitals and hospital clinical quality is moderated by hospital organizational and environmental context. The authors used Ordinary Least Squares regression analysis of 1,784 community hospitals to model seven quality indicators as a function of four measures of QI implementation and a variety of control variables. They found that forces that are external and internal to the hospital condition the impact of particular QI activities on quality indicators: specifically data use, statistical tool use, and organizational emphasis on Continuous Quality Improvement (CQI). Results supported the proposition that QI implementation is unlikely to improve quality of care in hospital settings without a commensurate fit with the financial, strategic, and market imperatives faced by the hospital. PMID:17650463

Alexander, Jeffrey A; Weiner, Bryan J; Shortell, Stephen M; Baker, Laurence C

2007-01-01

3

How has hospital consolidation affected the price and quality of hospital care?  

PubMed

During the 1990s, the hospital industry was transformed by mergers and acquisitions. This synthesis looks at why this rapid consolidation occurred and what impact it had on the price and quality for patients, and the cost of care for hospitals. Key findings include: Managed care was not a main driver of consolidation, but fear of managed care may have played a part. Other factors, including technological advances that reduced inpatient demand, and an antitrust environment that was receptive to consolidation contributed to consolidation. Research suggests hospital prices increased by 5 percent or more as a result of consolidation. When two hospitals merge, not only does the surviving hospital raise prices but so do its competitors. Evidence of the impact of consolidation on quality of care is limited and mixed, but the strongest studies show a reduction in quality. Hospital consolidation does modestly reduce the cost to hospitals of providing care. PMID:22051574

Vogt, William B; Town, Robert; Williams, Claudia H

2006-02-01

4

Acute care practices relevant to quality end-of-life care: a survey of Pennsylvania hospitals  

Microsoft Academic Search

BackgroundImproving end-of-life care in the hospital is a national priority.PurposeTo explore the prevalence and reasons for implementation of hospital-wide and intensive care unit (ICU) practices relevant to quality care in key end-of-life care domains and to discern major structural determinants of practice implementation.DesignCross-sectional mixed-mode survey of chief nursing officers of Pennsylvania acute care hospitals.ResultsThe response rate was 74% (129 of

C. Y. Lin; R. M. Arnold; J. R. Lave; D. C. Angus; A. E. Barnato

2010-01-01

5

What does quality care mean to nurses in rural hospitals?  

PubMed Central

Aim This paper is a report of a study conducted to answer the question: ‘How do rural nurses and their chief nursing officers define quality care?’ Background Established indicators of quality care were developed primarily in urban hospitals. Rural hospitals and their environments differ from urban settings, suggesting that there might be differences in how quality care is defined. This has measurement implications. Methods Focus groups with staff nurses and interviews with chief nursing officers were conducted in 2006 at four rural hospitals in the South-Eastern United States of America. Data were analysed using conventional content analysis. Findings The staff nurse and chief nursing officer data were analysed separately and then compared, exposing two major themes: ‘Patients are what matter most’ and ‘Community connectedness is both a help and a hindrance’. Along with conveying that patients were the utmost priority and all care was patient-focused, the first theme included established indicators of quality such as falls, pressure ulcers, infection rates, readmission rates, and lengths of stay. A new discovery in this theme was a need for an indicator relevant for rural settings: transfer time to larger hospitals. The second theme, Community Connectedness, is unique to rural settings, exemplifying the rural culture. The community and hospital converge into a family of sorts, creating expectations for quality care by both patients and staff that are not typically found in urban settings and larger hospitals. Conclusion Established quality indicators are appropriate for rural hospitals, but additional indicators need to be developed. These must include transfer times to larger facilities and the culture of the community. PMID:20546364

Baernholdt, Marianne; Jennings, Bonnie Mowinski; Merwin, Elizabeth; Thornlow, Deirdre

2013-01-01

6

Paying for efficiency: what price the quality of hospital care?  

PubMed

Economic recession prompts governments and health service ministers to seek increased efficiency in the production of hospital services in order to reconcile increasing demands with scarce resources. As one approach to the problem, the National Health Strategy is recommending pilot schemes, similar to those which have been introduced in both the United Kingdom and the Netherlands, which involve the separation of purchaser from the provider of hospital services. It is argued that such separation, with the introduction of competition between providers of hospital services for contracts placed by publicly funded Area Health Boards, will increase efficiency and accountability in the use of resources. However, this argument ignores the hospital management's ability to keep costs down by altering the quality of hospital care in ways which are difficult to monitor by purchasing agencies. The article considers the effects the introduction of managed competition is likely to have on the quality of hospital services. The outcome is uncertain and competition may improve some dimensions of quality while jeopardizing others. If managed competition is tried in Australia, the opportunity should also be taken to examine its impact on the quality and outcomes of hospital care. PMID:1482723

Shiell, A

1992-09-01

7

Supplemental Nurse Staffing in Hospitals and Quality of Care  

PubMed Central

Objective To promote evidence-based decision making regarding hospital staffing, the authors examined the characteristics of supplemental nurses, as well as the relationship of supplemental staff to nurse outcomes and adverse events. Background The use of supplemental nurses to bolster permanent nursing staff in hospitals is widespread but controversial. Quality concerns have been raised regarding the use of supplemental staff. Methods Data from the 2000 National Sample Survey of Registered Nurses were used to determine whether the qualifications of supplemental nurses working in hospitals differed from permanent staff nurses. Data from Pennsylvania nurse surveys were analyzed to examine whether nurse outcomes and adverse events differed in hospitals with varying proportions of nonpermanent nurses. Results Temporary nurses have qualifications similar to permanent staff nurses. Deficits in patient care environments in hospitals employing more temporary nurses explain the association between poorer quality and temporary nurses. Conclusion Negative perceptions of temporary nurses may be unfounded. PMID:17939464

Aiken, Linda H.; Xue, Ying; Clarke, Sean P.; Sloane, Douglas M.

2010-01-01

8

Spatial competition for quality in the market for hospital care.  

PubMed

This study analyses the market for secondary health care services when patient choice depends on the quality/distance mix that achieves utility maximization. First, the hospital's equilibrium in a Hotelling spatial competition model under simultaneous quality choices is analyzed to define hospitals' strategic behavior. A first equilibrium outcome is provided, the understanding of which is extremely useful for the policy maker wishing to improve social welfare. Second, patients are assumed to be unable, because of asymmetry of information, to observe the true quality provided. Their decisions reflect the perceived quality, which is affected by bias. Using the mean-variance method, the equilibrium previously found is investigated in a stochastic framework. PMID:15791476

Montefiori, Marcello

2005-06-01

9

Using Assessing Care of Vulnerable Elders Quality Indicators to Measure Quality of Hospital Care for Vulnerable Elders  

Microsoft Academic Search

OBJECTIVES: To assess the quality of care for hospital- ized vulnerable elders using measures based on Assessing Care of Vulnerable Elders (ACOVE) quality indicators (QIs). DESIGN: Prospective cohort study. SETTING: Single academic medical center. PARTICIPANTS: Subjects aged 65 and older hospitalized on the University of Chicago general medicine inpatient service who were defined as vulnerable using the Vulnerable Elder Survey-13

Vineet M. Arora; Martha Johnson; Jared Olson; Paula M. Podrazik; Stacie Levine; Catherine E. DuBeau; Greg A. Sachs; David O. Meltzer

2007-01-01

10

Quality of Care and Patient Outcomes in Critical Access Hospitals  

PubMed Central

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

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

2012-01-01

11

Nursing care quality and adverse events in US hospitals  

PubMed Central

Aim To examine the association between nurses' reports of unmet nursing care needs and their reports of patients' receipt of the wrong medication or dose, nosocomial infections and patient falls with injury in hospitals. Background Because nursing activities are often difficult to measure, and data are typically not collected by health care organisations, there are few studies that have addressed the association between nursing activities and patient outcomes. Design Secondary analysis of cross-sectional data collected in 1999 from 10,184 staff nurses and 168 acute care hospitals in the US. Methods Multivariate linear regression models estimated the effect of unmet nursing care needs on adverse events given the influence of patient factors and the care environment. Results The proportion of necessary nursing care left undone ranged from 26% for preparing patients and families for discharge to as high as 74% for developing or updating nursing care plans. A majority of nurses reported that patients received the wrong medication or dose, acquired nosocomial infections, or had a fall with injury infrequently. However, nurses who reported that these adverse events occurred frequently varied considerably [i.e. medication errors (15%), patient falls with injury (20%), nosocomial infection (31%)]. After adjusting for patient factors and the care environment, there remained a significant association between unmet nursing care needs and each adverse event. Conclusion The findings suggest that attention to optimising patient care delivery could result in a reduction in the occurrence of adverse events in hospitals. Relevance to clinical practice The occurrence of adverse events may be mitigated when nurses complete care activities that require them to spend time with their patients. Hospitals should engage staff nurses in the creation of policies that influence human resources management to enhance their awareness of the care environment and patient care delivery. PMID:20659198

Lucero, Robert J; Lake, Eileen T; Aiken, Linda H

2010-01-01

12

Blue Shield ensures uninterrupted access to quality medical care after Palm Drive Hospital ceases operations  

E-print Network

Blue Shield ensures uninterrupted access to quality medical care after Palm Drive Hospital ceases emergency care and in-patient care at Palm Drive. We are working with our members to ensure a smooth of California member in the Sonoma County area seeking emergency medical services or inpatient care, please

Ravikumar, B.

13

Intensive Care Unit Utilization and Interhospital Transfers As Potential Indicators of Rural Hospital Quality  

ERIC Educational Resources Information Center

Obtaining meaningful information from statistically valid and reliable measures of the quality of care for disease-specific care provided in small rural hospitals is limited by small numbers of cases and different definitive care capacities. An alternative approach may be to aggregate and analyze patient services that reflect more generalized care

Wakefield, Douglas S.; Ward, Marcia; Miller, Thomas; Ohsfeldt, Robert; Jaana, Mirou; Lei, Yang; Tracy, Roger; Schneider, John

2004-01-01

14

Quality and Innovations for Caring Hospitalized Older Persons in the Unites States  

PubMed Central

Older persons are occasionally acutely ill and their hospitalizations frequently end up with complications and adverse outcomes. Medicare from U.S. federal government’s payment resource for older persons is facing financial strain. Medicare highlights both cost-saving and high quality of care while older persons are hospitalized. Several health policy changes were initiated to achieve Medicare’s goals. In response to Medicare’s health policy changes, U.S. hospital environments have been changed and these resulted in hospital quality measurements’ improvement. American seniors are facing the challenges during and around their hospital care. Several innovative measures are suggested to overcome these challenges. PMID:24490116

Yoo, Ji Won; Kim, Sun Jung; Geng, Yan; Shin, Hyun Phil; Nakagawa, Shunichi

2014-01-01

15

Quality of Care for Acute Myocardial Infarction in Rural and Urban US Hospitals  

ERIC Educational Resources Information Center

Context: Acute myocardial infarction (AMI) is a common and important cause of admission to US rural hospitals, as transport of patients with AMI to urban settings can result in unacceptable delays in care. Purpose: To examine the quality of care for patients with AMI in rural hospitals with differing degrees of remoteness from urban centers.…

Baldwin, Laura-Mae; MacLehose, Richard F.; Hart, L. Gary; Beaver, Shelli K.; Every,Nathan; Chan,Leighton

2004-01-01

16

Quality of Care for Hospitalized Medicare Patients at Risk for Pressure Ulcers  

Microsoft Academic Search

Background: No state peer review organization has at- tempted to identify processes of care related to pressure ulcer prediction and prevention in US hospitals. Objective: To profile and evaluate the processes of care for Medicare patients hospitalized at risk for pressure ul- cer development by means of the Medicare Quality In- dicator System pressure ulcer prediction and preven- tion module.

Courtney H. Lyder; Jeanette Preston; Jacqueline N. Grady; Jeanne Scinto; Richard Allman; Nancy Bergstrom; George Rodeheaver

2001-01-01

17

Quality Nursing Care for Hospitalized Patients with Advanced Illness: Concept Development  

PubMed Central

The quality of nursing care as perceived by hospitalized patients with advanced illness has not been examined. A concept of quality nursing care for this population was developed by integrating the literature on constructs defining quality nursing care with empirical findings from interviews of 16 patients with advanced illness. Quality nursing care was characterized as competence and personal caring supported by professionalism and delivered with an appropriate demeanor. Although the attributes of competence, caring, professionalism, and demeanor were identified as common components of quality care across various patient populations, the caring domain increased in importance when patients with advanced illness perceived themselves as vulnerable. Assessment of quality nursing care for patients with advanced illness needs to include measures of patient perceptions of vulnerability. PMID:20572095

Izumi, Shigeko; Baggs, Judith G.; Knafl, Kathleen A.

2011-01-01

18

Using hospital surveys to enhance the quality of care.  

PubMed

Hospitals need the data that valid surveys can provide. However, no data are better than inaccurate or poorly interpreted data. Survey research appears to be deceptively simple. Many hospital managers are not sensitive to the pitfalls in writing a quality questionnaire and some who have their own personal computers believe that they can enter and tabulate the data. However, just as medical technology has advanced and become more complicated in recent years, survey research has also become more sophisticated during the past decade. The use of computers has assisted in the display of vast amounts of survey data, but interpretation is still the key to effective survey research. Many people can read the same table of data but come to different conclusions, depending on their point of view and their level of involvement with the issues being discussed. It is only human nature to interpret data to support what we believe to be the truth. Hospital managers should understand that interpretation of survey data is best done by neutral and skilled professionals who have worked closely with those who have authority to make costly decisions based on the results. A radiologist will tell you that reading a CT scan is an art as well as a science. So is quality survey research. PMID:10295772

Carey, R G

1989-11-01

19

Hospitalized patients' participation and its impact on quality of care and patient safety  

PubMed Central

Objective To understand the extent to which hospitalized patients participate in their care, and the association of patient participation with quality of care and patient safety. Design Random sample telephone survey and medical record review. Setting US acute care hospitals in 2003. Participants A total of 2025 recently hospitalized adults. Main Outcome Measures Hospitalized patients reported participation in their own care, assessments of overall quality of care and the presence of adverse events (AEs) in telephone interviews. Physician reviewers rated the severity and preventability of AEs identified by interview and chart review among 788 surveyed patients who also consented to medical record review. Results Of the 2025 patients surveyed, 99.9% of patients reported positive responses to at least one of seven measures of participation. High participation (use of >4 activities) was strongly associated with patients’ favorable ratings of the hospital quality of care (adjusted OR: 5.46, 95% CI: 4.15–7.19). Among the 788 patients with both patient survey and chart review data, there was an inverse relationship between participation and adverse events. In multivariable logistic regression analyses, patients with high participation were half as likely to have at least one adverse event during the admission (adjusted OR = 0.49, 0.31–0.78). Conclusions Most hospitalized patients participated in some aspects of their care. Participation was strongly associated with favorable judgments about hospital quality and reduced the risk of experiencing an adverse event. PMID:21307118

Weingart, Saul N.; Zhu, Junya; Chiappetta, Laurel; Stuver, Sherri O.; Schneider, Eric C.; Epstein, Arnold M.; David-Kasdan, Jo Ann; Annas, Catherine L.; Fowler, Floyd J.; Weissman, Joel S.

2011-01-01

20

Hospital staffing, organization, and quality of care: Cross-national findings  

Microsoft Academic Search

Objective: To examine the effects of nurse staffing and organizational support for nursing care on nurses' dissatisfaction with their jobs, nurse burnout, and nurse reports of quality of patient care in an international sample of hospitals. Design: Multisite cross-sectional survey Setting: Adult acute-care hospitals in the U.S. (Pennsylvania), Canada (Ontario and British Columbia), England and Scotland. Study Participants: 10319 nurses

Linda H. Aiken; Sean P. Clarke; Douglas M. Sloane

2002-01-01

21

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

PubMed

The debate concerning quality of care in hospitals, its "value" and affordability, is increasingly of concern to providers, consumers, and purchasers in the United States and elsewhere. We undertook an exploratory study to estimate the impact on hospital-wide costs if quality-of-care levels were varied. To do so, we obtained costs and service output data regarding 300 U.S. hospitals, representing approximately a 5% cross section of all hospitals operating in 1983; both inpatient and outpatient services were included. The quality-of-care measure used for the exploratory analysis was the ratio of actual deaths in the hospital for the year in question to the forecasted number of deaths for the hospital; the hospital mortality forecaster had earlier (and elsewhere) been built from analyses of 6 million discharge abstracts, and took into account each hospital's actual individual admissions, including key patient descriptors for each admission. Such adjusted death rates have increasingly been used as potential indicators of quality, with recent research lending support for the viability of that linkage. The authors then utilized the economic construct of allocative efficiency relying on "best practices" concepts and peer groupings, built using the "envelopment" philosophy of Data Envelopment Analysis and Pareto efficiency. These analytical techniques estimated the efficiently delivered costs required to meet prespecified levels of quality of care. The marginal additional cost per each death deferred in 1983 was estimated to be approximately $29,000 (in 1990 dollars) for the average efficient hospital. Also, over a feasible range, a 1% increase in the level of quality of care delivered was estimated to increase hospital cost by an average of 1.34%. This estimated elasticity of quality on cost also increased with the number of beds in the hospital. PMID:1640765

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

1992-08-01

22

Evaluation of maternal and neonatal hospital care: quality index of completeness.  

PubMed

OBJECTIVE Develop an index to evaluate the maternal and neonatal hospital care of the Brazilian Unified Health System. METHODS This descriptive cross-sectional study of national scope was based on the structure-process-outcome framework proposed by Donabedian and on comprehensive health care. Data from the Hospital Information System and the National Registry of Health Establishments were used. The maternal and neonatal network of Brazilian Unified Health System consisted of 3,400 hospitals that performed at least 12 deliveries in 2009 or whose number of deliveries represented 10.0% or more of the total admissions in 2009. Relevance and reliability were defined as criteria for the selection of variables. Simple and composite indicators and the index of completeness were constructed and evaluated, and the distribution of maternal and neonatal hospital care was assessed in different regions of the country. RESULTS A total of 40 variables were selected, from which 27 single indicators, five composite indicators, and the index of completeness of care were built. Composite indicators were constructed by grouping simple indicators and included the following variables: hospital size, level of complexity, delivery care practice, recommended hospital practice, and epidemiological practice. The index of completeness of care grouped the five variables and classified them in ascending order, thereby yielding five levels of completeness of maternal and neonatal hospital care: very low, low, intermediate, high, and very high. The hospital network was predominantly of small size and low complexity, with inadequate child delivery care and poor development of recommended and epidemiological practices. The index showed that more than 80.0% hospitals had a low index of completeness of care and that most qualified heath care services were concentrated in the more developed regions of the country. CONCLUSIONS The index of completeness proved to be of great value for monitoring the maternal and neonatal hospital care of Brazilian Unified Health System and indicated that the quality of health care was unsatisfactory. However, its application does not replace specific evaluations. PMID:25210827

Silva, Ana Lúcia Andrade da; Mendes, Antonio da Cruz Gouveia; Miranda, Gabriella Morais Duarte; Sá, Domicio Aurélio de; Souza, Wayner Vieira de; Lyra, Tereza Maciel

2014-08-01

23

Quantitative quality assurance in a community hospital pediatric intensive care unit.  

PubMed Central

Unbiased, objective evaluations of quality of care are preferred over subjective evaluations. We observed 681 admissions to a pediatric intensive care unit of a community hospital from 1989 through 1990 for outcomes and physiologic profiles of the patients on the admission day using the Pediatric Risk of Mortality score to assess severity of illness. Mortality adjusted for severity of illness was compared with that predicted from a pediatric intensive care unit of a tertiary medical center: 32.6 deaths were predicted based on the physiologic profiles, and 23 occurred. The number of outcomes and their distribution according to mortality risk indicated close agreement between observed and predicted results. Thus, a quality-assurance technique developed in tertiary care centers can be used to indicate a comparable level of care in a community hospital. PMID:1441464

Frank, B S; Pollack, M M

1992-01-01

24

The Quality of Care Provided to Hospitalized Patients at the End of Life  

PubMed Central

Background Patients in American hospitals receive intensive medical treatments. However, when lifesaving treatments are unsuccessful, patients often die in the hospital with distressing symptoms while receiving burdensome care. Systematic measurement of the quality of care planning and symptom palliation is needed. Methods Medical records were abstracted using sixteen Assessing Care of Vulnerable Elders quality indicators within the domains of end of life care and pain management designed to measure the quality of the dying experience for adult decedents hospitalized for at least 3 days between April 2005 and April 2006 (n=496) at a university medical center recognized for providing intensive care for the seriously ill. Results Over half of the patients (mean age 62, 47% female), were admitted to the hospital with end stage disease and 28% were age 75 or older. One third of the patients required extubation from mechanical ventilation prior to death and 15% died while receiving CPR. Overall, patients received recommended care for 70% of applicable indicators (range 25%–100%). Goals of care were addressed in a timely fashion for patients admitted to the ICU approximately half of the time, while pain assessments (94%) and treatments for pain (95%) and dyspnea (87%) were performed with fidelity. Follow-up for distressing symptoms was performed less well than initial assessment and 29% of patients extubated in anticipation of death had documented dyspnea assessments. Conclusions A practical, chart-based assessment identified discrete deficiencies in care planning and symptom palliation that can be targeted to improve care for patients dying in the hospital. PMID:20585072

Walling, Anne M.; Asch, Steven M.; Lorenz, Karl A.; Roth, Carol P.; Barry, Tod; Kahn, Katherine L.; Wenger, Neil S.

2010-01-01

25

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

ERIC Educational Resources Information Center

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…

Khan, Arshia A.

2012-01-01

26

Quality of Care for Patients With Traction in Shahid Beheshti Hospital in 2012  

PubMed Central

Background With increasing incidence of traumatic fractures, the use of orthopedic intervention such as traction has increased. Inappropriate traction care may cause substantial morbidity and delay the patient rehabilitation. Objectives This study was conducted to evaluate the quality of care for patients with traction in the orthopedic unit of Kashan's Shahid Beheshti Hospital, Kashan, Iran. Patients and Methods This observational study was conducted on 100 patients with traumatic fractures of hip and femur bones who were admitted to Kashan Shahid-Beheshti Hospital during the first 6 months of 2012, and for whom skeletal or skin traction was performed. Data were collected using a checklist including questions about the personal characteristics and 23 items related to care for patients with tractions. These items were in three domains including caring while establishing traction, recording care and patient’s education. Descriptive statistics were calculated and data were analyzed using the independent sample t-test and Pearson correlation coefficient. Results The mean age of patients was 51.16 ± 23.28 years and 66% of them were male. In total, 47% of the patients were treated by skin traction and 53% by skeletal traction. The overall mean score of quality of care was 10.20 ± 2.64. Quality of establishing traction was good in 55% of patients, but the quality of care was poor in the domains of recording care (88%) and patient education (96%). Total mean of quality of care was significantly different between male and female patients (P < 0.02). Conclusions The quality of care of patients with traction was not optimal. Therefore it is necessary to improve measures in this area. PMID:24396800

Adib Hajbaghery, Mohsen; Moradi, Tayebeh

2013-01-01

27

Nursing practice environment, quality of care, and morale of hospital nurses in Japan.  

PubMed

The purpose of this study was to describe Japanese hospital nurses' perceptions of the nursing practice environment and examine its association with nurse-reported ability to provide quality nursing care, quality of patient care, and ward morale. A cross-sectional survey design was used including 223 nurses working in 12 acute inpatient wards in a large Japanese teaching hospital. Nurses rated their work environment favorably overall using the Japanese version of the Practice Environment Scale of the Nursing Work Index. Subscale scores indicated high perceptions of physician relations and quality of nursing management, but lower scores for staffing and resources. Ward nurse managers generally rated the practice environment more positively than staff nurses except for staffing and resources. Regression analyses found the practice environment was a significant predictor of quality of patient care and ward morale, whereas perceived ability to provide quality nursing care was most strongly associated with years of clinical experience. These findings support interventions to improve the nursing practice environment, particularly staffing and resource adequacy, to enhance quality of care and ward morale in Japan. PMID:23855754

Anzai, Eriko; Douglas, Clint; Bonner, Ann

2014-06-01

28

Initial Steps for Quality Improvement of Obesity Care Across Divisions at a Tertiary Care Pediatric Hospital  

PubMed Central

Background: Pediatric subspecialists can participate in the care of obese children. Objective: To describe steps to help subspecialty providers initiate quality improvement efforts in obesity care. Methods: An anonymous patient data download, provider surveys and interviews assessed subspecialty providers’ identification and perspectives of childhood obesity and gathered information on perceived roles and care strategies. Participating divisions received summary analyses of quantitative and qualitative data and met with study leaders to develop visions for division/service-specific care improvement. Results: Among 13 divisions/services, subspecialists’ perceived role varied by specialty; many expressed the need for cross-collaboration. All survey informants agreed that identification was the first step, and expressed interest in obtaining additional resources to improve care. Conclusions: Subspecialists were interested in improving the quality and coordination of obesity care for patients across our tertiary care setting. Developing quality improvement projects to achieve greater pediatric obesity care goals starts with engagement of providers toward better identifying and managing childhood obesity. PMID:25233013

Chang, Sheila Z.; Beacher, Daniel R.; Kwon, Soyang; McCarville, Megan A.; Binns, Helen J.; Ariza, Adolfo J.

2014-01-01

29

A Perinatal Care Quality and Safety Initiative: Hospital Costs and Potential Savings  

PubMed Central

Background There is increasing national focus on hospital initiatives to improve obstetric and neonatal outcomes. While costs of providing care may decrease with improved quality, the accompanying reduced adverse outcomes may impact hospital revenues. The purpose of this study was to estimate, from a hospital perspective, the financial impacts of implementing a perinatal quality and safety initiative. Methods In 2008, a Minnesota-based health system (Fairview Health Services) launched the Zero Birth Injury (ZBI) initiative, which uses evidence-based care bundles to guide management of obstetric services. We conducted a pre-post analysis of financial impacts of ZBI, using hospital administrative records to measure costs and revenues associated with changes in maternal and neonatal birth injuries before (2008) and after (2009–11) the initiative. Results After adjusting for relevant covariates, implementation of ZBI was associated with an 11% decrease in the rate of maternal and neonatal adverse outcomes between 2008 and 2011 (AOR=0.89, p=0.076). As a result of the adverse events avoided, the hospital system saved $284,985 in costs but earned $324,333 less revenue, which produced a net financial decrease of $39,348 (or a $305 net financial loss per adverse event avoided) in 2011, compared with 2008. Conclusions Adoption of a perinatal quality and safety initiative that reduced birth injuries had little net financial impact on the hospital. ZBI produced better clinical results at a lower cost, which represents potential savings for payers, but the hospital system offering increased quality reaped no clear financial rewards. These results highlight the important role for shared-savings collaborations (among patients, providers, government and third-party payers, and employers) to incentivize quality improvement. Widespread adoption of perinatal safety initiatives combined with innovative payment models may contribute to better health at reduced cost. PMID:23991507

Kozhimannil, Katy B.; Sommerness, Samantha; Rauk, Phillip; Gams, Rebecca; Hirt, Charles; Davis, Stanley; Miller, Kristi K.; Landers, Daniel V.

2013-01-01

30

Variation in Surgical Readmissions and Relationship to Quality of Hospital Care  

PubMed Central

Background Reducing readmissions is a clinical and policy priority, but little is known about variations in readmission rates after major surgery and whether a hospital's surgical readmission rates are related to other markers of high-quality surgical care. Methods Using national Medicare data, we calculated 30-day readmission rates after hospitalization for coronary artery bypass graft (CABG), pulmonary lobectomy, endovascular abdominal aortic aneurysm repair (EVAR), open abdominal aortic aneurysm repair (AAA), colectomy, and hip replacement. We used bivariate and multivariable techniques to assess the relationship between readmission rates and other measures of surgical quality, including performance on surgical process measures, procedure volume, and mortality. Results There were 479,471 discharges following one of the six index procedures from 3,004 hospitals. The median risk-adjusted six-procedure composite 30-day readmission rate was 13.1% [interquartile range, IQR 9.9%-17.1%}. Adjusting for hospital characteristics, we found that hospitals in the highest quartile of surgical volume had lower readmission rates than the lowest-volume hospitals (12.7% vs. 16.8%, p<0.001), and hospitals with the lowest mortality rates had significantly lower readmission rates than hospitals with high mortality rates (13.3% vs. 14.2%, p<0.001). High performance on surgical process of care performance measures was only marginally associated with readmission rates (13.1% versus 13.6%, p=0.021). Patterns were similar when each of the six major surgeries was examined individually. Conclusion Nearly one in seven patients is readmitted within 30 days of discharge following a major surgical procedure. High volume and low mortality hospitals have lower surgical readmissions than other hospitals. PMID:24047062

Tsai, Thomas C.; Joynt, Karen E.; Orav, E. John; Gawande, Atul A.; Jha, Ashish K.

2014-01-01

31

Quality of intrapartum care at Mulago national referral hospital, Uganda: clients' perspective  

PubMed Central

Background Quality of intrapartum care is an important intervention towards increasing clients’ utilization of skilled attendance at birth and accelerating improvements in newborn’s and maternal survival and wellbeing. Ensuring quality of care is one of the key challenges facing maternal and neonatal services in Uganda. The study assessed quality of intrapartum care services in the general labor ward of the Mulago national referral and teaching hospital in Uganda from clients’ perspective. Methods A cross sectional study was conducted using face to face interviews at discharge with 384 systematically selected clients, who delivered in general labor ward at Mulago hospital during May, 2012. Data analysis was done using STATA Version (10) software. Means and median general index scores for quality of intrapartum care services were calculated. Linear regression models were used to determine factors associated with quality of care. Results Overall, quality of intrapartum care mean index score was 49.4 (standard deviation (sd) 15.46, and the median (interquartile range (IQR)) was 49.1 (37.5–58.9). Median index scores (IQR) per selected quality of care indicators were; dignity and respect 75 (50–87.5); relief of pain and suffering 71.4 (42.8-85.7); information 42.1 (31.6-55.3); privacy and confidentiality 33.3 (1–66.7); and involvement in decision making 16.7 (1–33.3). On average, higher educational level (college/university) (?: 6.81, 95% CI: 0.85-15.46) and rural residence of clients (?: 5.67, 95% CI: 0.95-10.3) were statistically associated with higher quality scores. Conclusion This study has revealed that quality of intrapartum care services from clients’ perspective was low. Improvements should be focused on involving clients in decision making, provision of information about their conditions and care, and provision of privacy and confidentiality. There is also need to improve the number and availability of health care providers in the labor ward. PMID:23941203

2013-01-01

32

Standard operating procedure changed pre-hospital critical care anaesthesiologists’ behaviour: a quality control study  

PubMed Central

Introduction The ability of standard operating procedures to improve pre-hospital critical care by changing pre-hospital physician behaviour is uncertain. We report data from a prospective quality control study of the effect on pre-hospital critical care anaesthesiologists’ behaviour of implementing a standard operating procedure for pre-hospital controlled ventilation. Materials and methods Anaesthesiologists from eight pre-hospital critical care teams in the Central Denmark Region prospectively registered pre-hospital advanced airway-management data according to the Utstein-style template. We collected pre-intervention data from February 1st 2011 to January 31st 2012, implemented the standard operating procedure on February 1st 2012 and collected post intervention data from February 1st 2012 until October 31st 2012. We included transported patients of all ages in need of controlled ventilation treated with pre-hospital endotracheal intubation or the insertion of a supraglottic airways device. The objective was to evaluate whether the development and implementation of a standard operating procedure for controlled ventilation during transport could change pre-hospital critical care anaesthesiologists’ behaviour and thereby increase the use of automated ventilators in these patients. Results The implementation of a standard operating procedure increased the overall prevalence of automated ventilator use in transported patients in need of controlled ventilation from 0.40 (0.34-0.47) to 0.74 (0.69-0.80) with a prevalence ratio of 1.85 (1.57-2.19) (p?=?0.00). The prevalence of automated ventilator use in transported traumatic brain injury patients in need of controlled ventilation increased from 0.44 (0.26-0.62) to 0.85 (0.62-0.97) with a prevalence ratio of 1.94 (1.26-3.0) (p?=?0.0039). The prevalence of automated ventilator use in patients transported after return of spontaneous circulation following pre-hospital cardiac arrest increased from 0.39 (0.26-0.48) to 0.69 (0.58-0.78) with a prevalence ratio of 1.79 (1.36-2.35) (p?=?0.00). Conclusion We have shown that the implementation of a standard operating procedure for pre-hospital controlled ventilation can significantly change pre-hospital critical care anaesthesiologists’ behaviour. PMID:24308781

2013-01-01

33

Health-related Quality of Life among hospitalized older people awaiting residential aged care  

Microsoft Academic Search

BACKGROUND: Health related quality of life (HRQoL) in very late life is not well understood. The aim of the present study was to assess HRQoL and health outcomes at four months follow-up in a group of older people awaiting transfer to residential aged care. METHODS: Secondary analysis of data from a randomized controlled trial conducted in three public hospitals in

Lynne C Giles; Graeme Hawthorne; Maria Crotty

2009-01-01

34

Dying in Palliative Care Units and in Hospital: A Comparison of the Quality of Life of Terminal Cancer Patients.  

ERIC Educational Resources Information Center

Compared quality of life of terminal cancer patients (n=182) in two palliative care units with that of those in general hospital. Patients in specialized palliative care units were found to differ from those dying in hospital, showing less indirectly expressed anger but more positive feelings. They also reported more anxiety about death but less…

Viney, Linda L.; And Others

1994-01-01

35

Profiling quality of care for patients with chronic headache in three different German hospitals – a case study  

Microsoft Academic Search

BACKGROUND: Legal requirements for quality assurance in German rehabilitation hospitals include comparisons of providers. Objective is to describe and to compare outcome quality of care offered by three hospitals providing in-patient rehabilitative treatment exemplified for patients with chronic headache. METHODS: We performed a prospective three center observational study on patients suffering from chronic headache. Patients underwent interventions commonly used according

Dieter Melchart; Anne Wessel; Ronald Brand; Stefan Hager; Wolfgang Weidenhammer

2008-01-01

36

Misdiagnosis and Quality of Management in Paediatric Surgical Patients Referred to a Tertiary Care Hospital  

PubMed Central

Background: The literature on diagnosis and management prior to transfer paediatric surgical patients to a tertiary care center is scarce. In referral centers, it is common to receive patients previously subjected to inadequate or inappropriate health care. Aim: Analyze the prevalence of misdiagnosis and quality of management in patients before being referred and factors related to misdiagnosis and inadequate management. Design: Prospective, longitudinal, comparative study between patients with appropriate and inappropriate submission diagnosis and between patients with adequate or inadequate treatment. Setting: Third level care hospital, Mexico City. Participants: Newborn to adolescents referred to Paediatric Surgery Department. Intervention(s): None. Main Outcome Measure(s): Misdiagnosis and quality of management prior to being referred. Result: Two hundred patients were evaluated. Correlation between submission diagnosis and final diagnosis showed that 70% were correct and 30% incorrect; 48.5% were properly managed and 51.5% inappropriately managed. Incorrect diagnosis was more frequent when referred from first-or second-level hospitals and in inflammatory conditions. Patients referred by paediatricians had a higher rate of adequate management. Conclusion: We present the frequency of incorrect diagnosis and inadequate patient management in a highly selected population. Sample size should be increased as well as performing these studies in other hospital settings in order to determine whether the results are reproducible. PMID:24959495

Cazares-Rangel, Joel; Zalles-Vidal, Cristian; Davila-Perez, Roberto

2014-01-01

37

Availability and quality of emergency obstetric care in Gambia's main referral hospital: women-users' testimonies  

PubMed Central

Background Reduction of maternal mortality ratio by two-thirds by 2015 is an international development goal with unrestricted access to high quality emergency obstetric care services promoted towards the attainment of that goal. The objective of this qualitative study was to assess the availability and quality of emergency obstetric care services in Gambia's main referral hospital. Methods From weekend admissions a group of 30 women treated for different acute obstetric conditions including five main diagnostic groups: hemorrhage, hypertensive disorders, dystocia, sepsis and anemia were purposively selected. In-depth interviews with the women were carried out at their homes within two weeks of discharge. Results Substantial difficulties in obtaining emergency obstetric care were uncovered. Health system inadequacies including lack of blood for transfusion, shortage of essential medicines especially antihypertensive drugs considerably hindered timely and adequate treatment for obstetric emergencies. Such inadequacies also inflated the treatment costs to between 5 and 18 times more than standard fees. Blood transfusion and hypertensive treatment were associated with the largest costs. Conclusion The deficiencies in the availability of life-saving interventions identified are manifestations of inadequate funding for maternal health services. Substantial increase in funding for maternal health services is therefore warranted towards effective implementation of emergency obstetric care package in The Gambia. PMID:19366451

Cham, Mamady; Sundby, Johanne; Vangen, Siri

2009-01-01

38

Financial incentives to promote health care quality: the hospital acquired conditions nonpayment policy.  

PubMed

Over a decade ago it was estimated that in the United States 98,000 patients die each year from hospital acquired conditions (HAC). Recently it has been reported that this many patients now die annually from hospital acquired infections (HAI) alone. Currently, HAI affects 1.7 million U.S. citizens each year. Although these conditions are often called "preventable errors," some are associated with particular hospital and physician cultures, and many of these conditions, such as pressure ulcer formation and infections, may be a sign of low facility staffing levels. Protocols have been developed that have been shown to lower the incidence of many HAC, but these have been slow to be adopted. Voluntary reporting mechanisms to ensure health care quality are reported as having reduced effectiveness by the Joint Commission and U.S. Department of Health and Human Services, Office of Inspector General reports. Transparency and public education have also met with resistance, but in the case of infections now have the support of major national medical organizations. As a further initiative to promote quality, financial incentives have been implemented by the Centers for Medicare and Medicaid Services. Surgeons have lived under stringent financial incentives since the mid-1980s when they were placed under global surgical fees. Medicare currently must make expenditure reductions because it is at risk of becoming insolvent within the decade. Implementation of financial incentives should depend upon a balance between the nonpayment of providers for nonpreventable HAC verses the promotion of health care quality and patient safety, the reduction in patient morbidity and mortality, the spurring of mechanisms to further reduce HAC, and the recouping of taxpayer dollars for HAC that could have been prevented. PMID:21902485

Kavanagh, Kevin T

2011-01-01

39

ADOPTION OF THE WHO ASSESSMENT TOOL ON THE QUALITY OF HOSPITAL CARE FOR MOTHERS AND NEWBORNS IN ALBANIA  

PubMed Central

Aim: The aim of the adoption process of the “Quality of hospital care for mothers and newborns babies, assessment tool” (WHO, 2009) was to provide the Albanian health professionals of maternity hospitals with a tool that may help them assess the quality of perinatal care and identify key areas of pregnancy, childbirth and newborn care that need to be improved. Methods: Four maternity hospitals (one university hospital and three regional hospitals) were selected for the assessment using this standard tool covering over 600 items grouped into 13 areas ranging from supportive services to case management. Sources of information consisted of site visits, hospital statistics, medical records, observation of cases and interviews with staff and patients. A score was assigned to each item (range 0-3) and area of care. The assessments were carried out in two rounds: in 2009 and in 2011. These assessments provided semi-quantitative data on the quality of hospital care for mothers and newborns. Results: Data collected on the first round established a baseline assessment, whereas the second round monitored the subsequent changes. The findings of the second round revealed improvements encountered in all maternities, notwithstanding differences in the levels of improvement between maternities, not necessarily linked with extra financial inputs. Conclusions: The Albanian experience indicates a successful process of the adoption of the WHO tool on the quality of hospital care for mothers and newborn babies. The adopted tool can be used country-wide as a component of a quality improvement strategy in perinatal health care in Albania. PMID:23378688

Mersini, Ehadu; Novi, Silvana; Tushe, Eduard; Gjoni, Maksim; Burazeri, Genc

2012-01-01

40

Investigating organizational quality improvement systems, patient empowerment, organizational culture, professional involvement and the quality of care in European hospitals: the 'Deepening our Understanding of Quality Improvement in Europe (DUQuE)' project  

Microsoft Academic Search

BACKGROUND: Hospitals in European countries apply a wide range of quality improvement strategies. Knowledge of the effectiveness of these strategies, implemented as part of an overall hospital quality improvement system, is limited. METHODS\\/DESIGN: We propose to study the relationships among organisational quality improvement systems, patient empowerment, organisational culture, professionals' involvement with the quality of hospital care, including clinical effectiveness, patient

Oliver Groene; Niek Klazinga; Cordula Wagner; Onyebuchi A Arah; Andrew Thompson; Charles Bruneau; Rosa Suñol

2010-01-01

41

[Hospital quality management in Germany].  

PubMed

Hospital quality management (QM) is a legal obligation in Germany. This article reviews the regulations of quality control, the basic principles of QM, specific quality techniques, the process of QM implementation in the hospital and the possibilities of external QM certifications. Due to the increasing and effective privatisation of hospitals in Germany, careful attention to specially designed QM systems for private hospitals seems to be reasonable. PMID:18759212

Framme, C; Kahla-Witzsch, H A

2008-09-01

42

Reducing unnecessary hospital days to improve quality of care through physician accountability: a cluster randomised trial  

PubMed Central

Background Over 20% of hospital bed use is inappropriate, implying a waste of resources and the increase of patient iatrogenic risk. Methods This is a cluster, pragmatic, randomised controlled trial, carried out in a large University Hospital of Northern Italy, aiming to evaluate the effect of a strategy to reduce unnecessary hospital days. The primary outcome was the percentage of patient-days compatible with discharge. Among secondary objectives, to describe the strategy’s effect in the long-term, as well as on hospital readmissions, considered to be a marker of the quality of hospital care. The 12 medical wards with the longest length of stay participated. Effectiveness was measured at the individual level on 3498 eligible patients during monthly index days. Patients admitted or discharged on index days, or with stay >90 days, were excluded. All ward staff was blinded to the index days, while staff in the control arm and data analysts were blinded to the trial’s objectives and interventions. The strategy comprised the distribution to physicians of the list of their patients whose hospital stay was compatible with discharge according to a validated Delay Tool, and of physician length of stay profiles, followed by audits managed autonomously by the physicians of the ward. Results During the 12 months of data collection, over 50% of patient-days were judged to be compatible with discharge. Delays were mainly due to problems with activities under medical staff control. Multivariate analysis considering clustering showed that the strategy reduced patient-days compatible with discharge by 16% in the intervention vs control group, (OR=0.841; 95% CI, 0.735 to 0.963; P=0.012). Follow-up at 1 year did not yield a statistically significant difference between the percentages of patient-days judged to be compatible with discharge between the two arms (OR=0.818; 95% CI, 0.476 to 1.405; P=0.47). There was no significant difference in 30-day readmission and mortality rates for all eligible patients (N=3498) between the two arms. Conclusions Results indicate that a strategy, involving physician direct accountability, can reduce unnecessary hospital days. Relatively simple interventions, like the one assessed in this study, should be implemented in all hospitals with excessive lengths of stay, since unnecessary prolongation may be harmful to patients. Trial registration ClinicalTrials.gov, identifier NCT01422811. PMID:23305251

2013-01-01

43

Quality of Nursing Care in Psychiatric Wards of University Hospitals in Northwest of Iran from the Perceptions of Nurses  

PubMed Central

Introduction: Nursing care is considered as an essential component of health services. Patients’ health improvement depends upon the quality of nursing care. As an important principle, perceptions of nurses as well as their active participation in decision-makings has an important role in the quality of services. This study aimed to determine the percep-tion of nurses toward the quality of nursing care in psychiatric wards. Methods: In this descriptive study, we used census sampling. Seventy-six nurses employed at psychiatric wards of university hospitals in Northwest of Iran participated in this study. Quality Patient Care Scale (QUALPAC) was used to collect data. The score of each aspect and total scores were categorized as desirable, partly desirable and undesirable. The collected data were analyzed using descriptive statistics. Results: Findings showed that 60.5% of nurses perceived the quality of nursing care as desirable, while 65.8% and 53.9% reported the quality of physical and communicational aspects of care as desirable. Moreover, 51.3% of nurses considered the quality of care in psychosocial aspect as partly desirable. Conclusion: Although research findings indicated the desirability of care quality from the perceptions of most nurses, designing and applying educational programs and continuous evaluation are necessary to improve nursing care quality especially in psychosocial aspects in these centers.

Ebrahimi, Hossein; Namdar, Hossein; Vahidi, Maryam

2012-01-01

44

Quality-quantity decomposition of income elasticity of u.s. Hospital care expenditure using state-level panel data.  

PubMed

Economic theory suggests that income growth could lead to changes in consumption quantity and quality as the spending on a commodity changes. Similarly, the volume and quality of healthcare consumption could rise with incomes because of demographic changes, usage of innovative medical technologies, and other factors. Hospital healthcare spending is the largest component of aggregate US healthcare expenditures. The novel contribution of our paper is estimating and decomposing the income elasticity of hospital care expenditures (HOCEXP) into its quantity and quality components. By using a 1999-2008 panel dataset of the 50 US states, results from the seemingly unrelated regressions model estimation reveal the income elasticity of HOCEXP to be 0.427 (std. error?=?0.044), with about 0.391 (calculated std. error?=?0.044) arising from care quality improvements and 0.035 (std. error?=?0.050) emanating from the rise in usage volume. Our novel research findings suggest the following: (i) the quantity part of hospital expenditure is inelastic to income change; (ii) almost the entire income-induced rise in hospital expenditure comes from care quality changes; and (iii) the 0.427 income elasticity of HOCEXP, the largest component of total US healthcare expenditure, makes hospital care a normal commodity and a much stronger technical necessity than aggregate healthcare. Policy implications are discussed. Copyright © 2013 John Wiley & Sons, Ltd. PMID:24038390

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

2014-11-01

45

Model for the cost-efficient delivery of continuous quality cancer care: a hospital and private-practice collaboration  

PubMed Central

Cancer care is expensive due to the high costs of treatment and preventable utilization of resources. Government, employer groups, and insurers are seeking cancer care delivery models that promote both cost-efficiency and quality care. Baylor University Medical Center at Dallas (BUMC), a large tertiary care hospital, in collaboration with Texas Oncology, a large private oncology practice, established two independent centers that function cooperatively within the Baylor Charles A. Sammons Cancer Center, the Oncology Evaluation and Treatment Center (OETC) and Infusion Center, to deliver urgent care and infusions after hours to oncology patients. Quality measures based on evidence-based care and cost-efficiency measures were implemented within these centers. Ability to meet predetermined goals for these measures will be a guide for implementing continuous quality and cost-efficiency interventions. During the first two quarters of operations, 2023 patients received care in the OETC (n = 423) and Infusion Center (n = 1600). The average time spent in the OETC was 48% less than the time spent in the BUMC emergency department (ED). Eighty-nine percent of the cancer center’ patients who received urgent care at BUMC were referred to the OETC for this care, instead of the BUMC ED. The hospital admission rate in the OETC was 59% lower than it was in the BUMC ED, a high-volume level I trauma center. The addition of the OETC and Infusion Center to the cancer center holds promise for providing continuous quality cancer care that is cost-efficient. PMID:23543960

Miller, Alan M.; Paulson, R. Steven

2013-01-01

46

Measuring Rural Hospital Quality  

ERIC Educational Resources Information Center

Increased interest in the measurement of hospital quality has been stimulated by accrediting bodies, purchaser coalitions, government agencies, and other entities. This paper examines quality measurement for hospitals in rural settings. We seek to identify rural hospital quality measures that reflect quality in all hospitals and that are sensitive…

Moscovice, Ira; Wholey, Douglas R.; Klingner, Jill; Knott, Astrid

2004-01-01

47

A Quality Control Program for Acute Pain Management in Out-of-Hospital Critical Care Medicine  

Microsoft Academic Search

Study objective: This study was conducted to evaluate a quality control program for improving pain treatment in the out-of-hospital setting. Methods: Pain was evaluated for all patients at the beginning (T0) and the end (Tend) of out-of-hospital management. During the first part of the study (part 1, n=108), the administration and choice of analgesics was left to the physician’s discretion.

Agnès Ricard-Hibon; Charlotte Chollet; Sylvie Saada; Bertrand Loridant; Jean Marty

1999-01-01

48

Reducing newborn mortality in the Asia-Pacific region: Quality hospital services and community-based care.  

PubMed

Improving newborn health and survival is an essential part of progression toward Millennium Development Goal 4 in the World Health Organization Western Pacific and South East Asian regions. Both community and facility-based services are required. Strategies to improve the quality of care provided for newborns in health clinics and district- and referral-level hospitals have been relatively neglected in most countries in the region and in the published literature. Indirect historical evidence suggests that improving facility-based care will be an increasing priority for improving newborn survival in Asia and the Pacific as newborn mortality rates decrease and health systems contexts change. There are deficiencies in many aspects of newborn care, including immediate care and care for seriously ill newborns, which contribute substantially to regional newborn morbidity and mortality. We propose a practical quality improvement approach, based on models and standards of newborn care for primary-, district- and referral-level heath facilities and incorporated within existing maternal, newborn and child health programmes. There are examples where such approaches are being used effectively. There is a need to produce more nurses, community health workers and doctors with skills in care of the well and the sick newborn, and there are World Health Organization models of training to support this, including guidelines on emergency obstetric and newborn care and the Pocket Book of Hospital Care for Children. There are also simple data collection and analysis programmes that can assist in auditing outcomes, problem identification and health services planning. Finally, with increased survival rates there are gaps in follow-up care for newborns at high risk of long-term health and developmental impairments, and addressing this will be necessary to ensure optimal developmental and health outcomes for these children. PMID:23713996

Milner, Kate M; Duke, Trevor; Bucens, Ingrid

2013-07-01

49

A 10 year (2000-2010) systematic review of interventions to improve quality of care in hospitals  

PubMed Central

Background Against a backdrop of rising healthcare costs, variability in care provision and an increased emphasis on patient satisfaction, the need for effective interventions to improve quality of care has come to the fore. This is the first ten year (2000–2010) systematic review of interventions which sought to improve quality of care in a hospital setting. This review moves beyond a broad assessment of outcome significance levels and makes recommendations for future effective and accessible interventions. Methods Two researchers independently screened a total of 13,195 English language articles from the databases PsychInfo, Medline, PubMed, EmBase and CinNahl. There were 120 potentially relevant full text articles examined and 20 of those articles met the inclusion criteria. Results Included studies were heterogeneous in terms of approach and scientific rigour and varied in scope from small scale improvements for specific patient groups to large scale quality improvement programmes across multiple settings. Interventions were broadly categorised as either technical (n?=?11) or interpersonal (n?=?9). Technical interventions were in the main implemented by physicians and concentrated on improving care for patients with heart disease or pneumonia. Interpersonal interventions focused on patient satisfaction and tended to be implemented by nursing staff. Technical interventions had a tendency to achieve more substantial improvements in quality of care. Conclusions The rigorous application of inclusion criteria to studies established that despite the very large volume of literature on quality of care improvements, there is a paucity of hospital interventions with a theoretically based design or implementation. The screening process established that intervention studies to date have largely failed to identify their position along the quality of care spectrum. It is suggested that this lack of theoretical grounding may partly explain the minimal transfer of health research to date into policy. It is recommended that future interventions are established within a theoretical framework and that selected quality of care outcomes are assessed using this framework. Future interventions to improve quality of care will be most effective when they use a collaborative approach, involve multidisciplinary teams, utilise available resources, involve physicians and recognise the unique requirements of each patient group. PMID:22925835

2012-01-01

50

HOSPITAL VARIATION IN MISSED NURSING CARE  

PubMed Central

Quality of nursing care across hospitals is variable, and this variation can result in poor patient outcomes. One aspect of quality nursing care is the amount of necessary care omitted. This paper reports on the extent and type of nursing care missed and the reasons for missed care. The MISSCARE Survey was administered to nursing staff (n = 4086) who provide direct patient care in ten acute care hospitals. Missed nursing care patterns, as well as reasons for missing care (labor resources, material resources, and communication) were common across all hospitals. Job title (i.e., RN vs. NA), shift worked, absenteeism, perceived staffing adequacy, and patient workloads were significantly associated with missed care. The data from this study can inform quality improvement efforts to reduced missed nursing care and promote favorable patient outcomes. PMID:21642601

Kalisch, Beatrice J.; Tschannen, Dana; Lee, Hyunhwa; Friese, Christopher R.

2010-01-01

51

HIV quality of care assessment at an academic hospital: outcomes and lessons learned.  

PubMed

Rapid changes in HIV treatment guidelines and antiretroviral therapy drug safety data add to the increasing complexity of caring for HIV-infected patients and amplify the need for continuous quality monitoring. The authors created an electronic HIV database of 642 patients who received care in the infectious disease (ID) and general medicine clinics in their academic center to monitor HIV clinical performance indicators. The main outcome measures of the study include process measures, including a description of how the database was constructed, and clinical outcomes, including HIV-specific quality improvement (QI) measures and primary care (PC) measures. Performance on HIV-specific QI measures was very high, but drug toxicity monitoring and PC-specific QI performance were deficient, particularly among ID specialists. Establishment of HIV QI data benchmarks as well as standards for how data will be measured and collected are needed and are the logical counterpart to treatment guidelines. PMID:22326983

Kerr, Christine A; Neeman, Naama; Davis, Roger B; Schulze, Joanne; Libman, Howard; Markson, Larry; Aronson, Mark; Bell, Sigall K

2012-01-01

52

Discharging patients earlier from Winnipeg hospitals: does it adversely affect quality of care?  

PubMed Central

OBJECTIVE: To determine whether decreasing lengths of stay over time for selected diagnostic categories were associated with increased hospital readmission rates and mean number of physician visits after discharge. DESIGN: Retrospective descriptive study. SETTING: The seven large (125 beds or more) acute care hospitals in Winnipeg. PATIENTS: Manitoba residents admitted to any one of the seven hospitals because acute myocardial infarction (AMI), bronchitis or asthma, transurethral prostatectomy (TURP) and uterine or adnexal procedures for nonmalignant disease during the fiscal years 1989-90 to 1992-93. Patients from out of province, those who died in hospital, those with excessively long stays (more than 60 days) and those who were transferred to or from another institution were excluded. OUTCOME MEASURES: Length of hospital stay, and rate of readmission within 30 days after discharge for all four categories and mean number of physician visits within 30 days after discharge for two categories (AMI and bronchitis or asthma. RESULTS: The length of stay decreased significantly over the 4 years for all of the four categories, the smallest change being observed for patients with AMI (11.1%) and the largest for those with bronchitis or asthma (22.0%). The readmission rates for AMI, bronchitis or asthma, and TURP showed no consistent change over the 4 years. The readmission rate for uterine or adnexal procedures increased significantly between the first and second year (chi 2 = 4.28, p = 0.04) but then remained constant over the next 3 years. The mean number of physician visits increased slightly for AMI in the first year (1.92 to 2.01) and then remained virtually the same. It decreased slightly for bronchitis or asthma over the 4 years. There was no significant correlation between length of stay and readmission rates for individual hospitals in 1992-93 in any of the four categories. Also, no correlation was observed between length of stay and mean number of physician visits for individual hospitals in 1992-93 in the categories AMI and bronchitis or asthma. CONCLUSIONS: Improving hospital efficiency by shortening length of stay does not appear to result in increased rates of readmission or numbers of physician visits within 30 days after discharge from hospital. Research is needed to identify optimal lengths of stay and expected readmission rates. PMID:7664228

Harrison, M L; Graff, L A; Roos, N P; Brownell, M D

1995-01-01

53

Making an impact on the hospital environment to improve quality care.  

PubMed

All hospitals and health systems in the country face the same problem: What do they do with the millions of tons of waste they generate each year? This issue of The Quality Letter for Healthcare Leaders reveals what a number of award-winning organizations and individuals are doing to make a difference in the healthcare environment through new and innovative ways while impacting the lives of patients, employees, community members, and future generations. Their methods include eliminating the use of products containing mercury, recycling to creating new consumer products, and reviewing the hazards of pharmaceutical disposal. PMID:14621639

2003-10-01

54

78 FR 61197 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...  

Federal Register 2010, 2011, 2012, 2013

...CMS-1599 & 1455-CN2] RINs 0938-AR53 and 0938-AR73 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2014 Rates; Quality...

2013-10-03

55

Quality of emergency medical care in Gondar University Referral Hospital, Northwest Ethiopia: a survey of patients' perspectives  

PubMed Central

Background Ethiopia has fairly good coverage but very low utilization of health care services. Emergency medical care services require fast, correct and curious services to clients as they present with acute problems. In Ethiopia and Gondar in particular, the quality of emergency medical care has not been studied. The main aim of this study was to assess the disease profile and patients’ satisfaction in Gondar University Referral Hospital (GURH). Methods A facility based cross-sectional study was conducted among patients visiting GURH for emergency care. Ethical clearance was obtained from the Institutional Review Board of University of Gondar. Patients were selected by systematic random sampling, using patient flow list in the day and night emergency services. Data were collected using a standard Press Ganey questionnaire by BSc health science graduates. Data were entered in to Epi Info 3.5.3 software and exported to SPSS version 20.0 for windows for analysis. Results A total of 963 patients (response rate?=?96.8%) were studied. The mean (+ s.d.) age of patients was 28.4 (+17.9) years. The overall satisfaction using the mean score indicates that 498 (51.7%) 95%CI: (48.4% - 54.9%) were satisfied with the service, the providers and the facility suitability whereas 465(48.3%) 95%CI: (45.1%- 51.6%) were not satisfied. Seven hundred and six (73.3%) 95%CI: 70.4%-76.1%, patients reported that they have been discriminated or treated badly during the service provision in the hospital. OPD site visited (p?hospital (AOR?=?1.9, 95%CI: 1.1, 3.1), reported discrimination/bad treatment of patients with service (AOR?=?0.4, 95%CI: 0.2, 0.7), were significantly associated determinants of patient satisfaction. Conclusions Non-communicable disease emergencies like injuries and cardiovascular diseases are common. There is a low level of patient satisfaction related to lack of confidence in the hospital for treatment, discrimination towards patient care, and under and delayed treatment of patients who were not in serious medical conditions. Hospitals shall prepare themselves to address the increasing challenge of non-communicable disease emergencies. It is important to revise the service delivery in the emergency department to improve staff courtesy and politeness, commitment, reduce discrimination and bad treatment and proper triage of emergencies at all points of care to increase patient satisfaction giving emphasis to earlier working days. PMID:24456203

2014-01-01

56

Quality Control in Linen and Laundry Service at A Tertiary Care Teaching Hospital in India  

PubMed Central

Introduction: The clean bedding and clean clothes installs psychological confidence in the patients and the public and enhances their faith in the services rendered by the hospital. Being an important Component in the management of the patients, a study was carried out to find out the current quality status and its conformity with the known standards and identify the areas of intervention in order to further increase the patient and staff satisfaction regarding the services provided by linen and laundry department Methods: Quality control practised in the Linen and Laundry Service was studied by conducting a prospective study on the concept of Donabedian model of structure, process and outcome. Study was done by pre-designed Proforma along with observation / Interviews / Questionnaire and study of records. The input studied included physical facilities, manpower, materials, equipments and environmental factors. The various elements of manpower studied consisted of number of staff working, their qualification, training, promotion avenues, motivation and job satisfaction. Process was studied by carrying out observations in linen and laundry service through a predesigned flow chart which was supplemented by interviews with different category of staff. Patient satisfaction, staff satisfaction and microbial count of laundered linen (quality dimensions) were studied in the outcome. Results: The current study found that in spite of certain deficiencies in the equipment, manpower and process, the linen and laundry service is providing a satisfactory service to its users. However the services can be further improved by removing the present deficiencies both at structure and process level. PMID:21475509

Singh, Dara; Qadri, GJ; Kotwal, Monica; Syed, AT; Jan, Farooq

2009-01-01

57

Effect of aromatherapy on the quality of sleep in ischemic heart disease patients hospitalized in intensive care units of heart hospitals of the Isfahan University of Medical Sciences  

PubMed Central

BACKGROUND: Sleep disorder is one of the common problems patients face in ICU and CCU and it is usually treated by sleeping pills. Nowadays, the complementary medicine is highly considered because of its effectiveness and safety. Aromatherapy is one of the holistic nursing cares which sees human beings as a biological, mental and social unit while the psychological dimension has the central role. Each of these dimensions is dependent on each other and is affected by each other. Therefore, it is fundamental for nurses to provide aromatherapy in their clinical performance. Aromatherapy helps treatment of diseases by using vegetable oils and it seems to be effective in reducing sleeplessness. METHODS: This was a clinical trial on 64 patients (male and female) hospitalized in CCU in Al-zahra and Chamran hospitals. The intervention included 3 nights, each time 9 hours aromatherapy with lavender oil for the experiment group, while the controls received no intervention. Both groups filled out the SMHSQ that includes 11 items to assess sleep quality before and after intervention. RESULTS: Data analysis showed that the mean scores of sleep quality in the two groups of experiment and control were significantly different after the aromatherapy with lavender oil (p < 0.001). CONCLUSIONS: Quality of sleep in ischemic heart disease patients was significantly improved after aromatherapy with lavender oil. Therefore, using aromatherapy can improve the quality of their sleep and health. PMID:22049287

Moeini, Mahin; Khadibi, Maryam; Bekhradi, Reza; Mahmoudian, Seyed Ahmad; Nazari, Fatemeh

2010-01-01

58

Quality of care for people with dementia in general hospitals: national cross-sectional audit of patient assessment.  

PubMed

There have been recent reports of poor quality care in the National Health Service in the UK, and older people with dementia are particularly vulnerable. This study aims to examine the quality of assessment of people with dementia admitted to hospital. Cross-sectional case-note audit of key physical and psychosocial assessments was carried out in 7,934 people with dementia who were discharged from 206 general hospitals. Most people had no record of a standardised assessment of their cognitive state (56.8%, 95% confidence interval [CI] = 55.8-58.0) or functioning (74.2%, 95% CI = 73.2-75.1). Information from carers was documented in 39.0% of cases (95% CI = 37.9-40.1). There was considerable variation across hospital sites. Key assessments were less likely when people were admitted to surgical wards. Assessments fall well below recommended standards especially with regard to social and cognitive functioning. Problems are particularly marked on surgical wards. PMID:25301908

Souza, Renata; Gandesha, Aarti; Hood, Chloe; Chaplin, Robert; Young, John; Crome, Peter; Crawford, Mike J

2014-10-01

59

Patient safety, satisfaction, and quality of hospital care: cross sectional surveys of nurses and patients in 12 countries in Europe and the United States  

PubMed Central

Objective To determine whether hospitals with a good organisation of care (such as improved nurse staffing and work environments) can affect patient care and nurse workforce stability in European countries. Design Cross sectional surveys of patients and nurses. Setting Nurses were surveyed in general acute care hospitals (488 in 12 European countries; 617 in the United States); patients were surveyed in 210 European hospitals and 430 US hospitals. Participants 33?659 nurses and 11?318 patients in Europe; 27?509 nurses and more than 120?000 patients in the US. Main outcome measures Nurse outcomes (hospital staffing, work environments, burnout, dissatisfaction, intention to leave job in the next year, patient safety, quality of care), patient outcomes (satisfaction overall and with nursing care, willingness to recommend hospitals). Results The percentage of nurses reporting poor or fair quality of patient care varied substantially by country (from 11% (Ireland) to 47% (Greece)), as did rates for nurses who gave their hospital a poor or failing safety grade (4% (Switzerland) to 18% (Poland)). We found high rates of nurse burnout (10% (Netherlands) to 78% (Greece)), job dissatisfaction (11% (Netherlands) to 56% (Greece)), and intention to leave (14% (US) to 49% (Finland, Greece)). Patients’ high ratings of their hospitals also varied considerably (35% (Spain) to 61% (Finland, Ireland)), as did rates of patients willing to recommend their hospital (53% (Greece) to 78% (Switzerland)). Improved work environments and reduced ratios of patients to nurses were associated with increased care quality and patient satisfaction. In European hospitals, after adjusting for hospital and nurse characteristics, nurses with better work environments were half as likely to report poor or fair care quality (adjusted odds ratio 0.56, 95% confidence interval 0.51 to 0.61) and give their hospitals poor or failing grades on patient safety (0.50, 0.44 to 0.56). Each additional patient per nurse increased the odds of nurses reporting poor or fair quality care (1.11, 1.07 to 1.15) and poor or failing safety grades (1.10, 1.05 to 1.16). Patients in hospitals with better work environments were more likely to rate their hospital highly (1.16, 1.03 to 1.32) and recommend their hospitals (1.20, 1.05 to 1.37), whereas those with higher ratios of patients to nurses were less likely to rate them highly (0.94, 0.91 to 0.97) or recommend them (0.95, 0.91 to 0.98). Results were similar in the US. Nurses and patients agreed on which hospitals provided good care and could be recommended. Conclusions Deficits in hospital care quality were common in all countries. Improvement of hospital work environments might be a relatively low cost strategy to improve safety and quality in hospital care and to increase patient satisfaction. PMID:22434089

2012-01-01

60

Health Care for Black and Poor Hospitalized Medicare Patients  

Microsoft Academic Search

OBJECTIVE: To analyze whether elderly patients who are black or from poor neighborhoods receive worse hospital care than other patients, taking account of hospital effects and using validated measures of quality of care. DESIGN: We compare quality of care provided to insured, hospitalized Medicare patients who are black or live in poor neighborhoods as compared with others, using simple and

Marjorie L. Pearson; Ellen R; Katherine A; William H; Robert H. Brook; Emmett B. Keeler

1994-01-01

61

Improving the quality of palliative and terminal care in the hospital by a network of palliative care nurse champions: the study protocol of the PalTeC-H project  

PubMed Central

Background The quality of care of patients dying in the hospital is often judged as insufficient. This article describes the protocol of a study to assess the quality of care of the dying patient and the contribution of an intervention targeted on staff nurses of inpatient wards of a large university hospital in the Netherlands. Methods/Design We designed a controlled before and after study. The intervention is the establishment of a network for palliative care nurse champions, aiming to improve the quality of hospital end-of-life care. Assessments are performed among bereaved relatives, nurses and physicians on seven wards before and after introduction of the intervention and on 11 control wards where the intervention is not applied. We focus on care provided during the last three days of life, covered in global ratings of the quality of life in the last three days of life and the quality of dying, and various secondary endpoints of treatment and care affecting quality of life and dying. Discussion With this study we aim to improve the understanding of and attention for patients’ needs, and the quality of care in the dying phase in the hospital and measure the impact of a quality improvement intervention targeted at nurses. PMID:23530686

2013-01-01

62

Quality of Care is Similar for Safety-Net and Non-Safety-Net Hospitals  

MedlinePLUS

... attack and pneumonia. In the case of heart failure, mortality rates did not differ between safety-net and non- ... attack and pneumonia. In the case of heart failure, readmission rates were modestly higher at safety-net hospitals. Importantly, ...

63

Examining Quality of Care -- How Poor Information Flow Can Impact on Hospital Workflow and Affect Patient Outcomes  

Microsoft Academic Search

This paper argues that effective management of patient image data can enhance patient care. It examines the workflow and information flows involved in the search for image based data in a hospital department and the possible consequences for both patients and hospitals where information is not available at the point in the workflow process when it is expected. In the

Reeva M. Lederman; Iain Morrison

2002-01-01

64

Effect of anxiety and depression on self-care agency and quality of life in hospitalized patients with chronic obstructive pulmonary disease: a questionnaire survey.  

PubMed

Chronic obstructive pulmonary disease (COPD) affects the lives of individuals in a number of ways; it causes an increase in the need for help and support and a decline in self-care agency and quality of life. This research has been conducted in patients with COPD hospitalized in the Pulmonary Department of Erzincan State Hospital in the eastern Turkey to examine the effect of anxiety and depression on self-care agency and quality of life (n = 135). The results showed that 69.6% and 85.6% of the patients were at risk for anxiety and depression, respectively, and that the mean scores of self-care agency and quality of life decreased as the mean scores of anxiety and depression increased. It was also established that the mean score of the quality of life increased as the mean score of self-care agency went up. It could be concluded that the majority of the patients are at risk for anxiety and depression and that presence of anxiety or depression has a negative effect on the self-care agency and the quality of life. The recognition and treatment of depression and anxiety in patients with COPD provide significant improvements in self-care agency and quality of life of patients. PMID:23432884

Yildirim, Arzu; A?ilar, Rabia Hacihasano?lu; Bakar, Nihal; Demir, Nilay

2013-02-01

65

Policies to improve end-of-life decisions in Flemish hospitals: communication, training of health care providers and use of quality assessments  

Microsoft Academic Search

BACKGROUND: The prevalence and implementation of institutional end-of-life policies has been comprehensively studied in Flanders, Belgium, a country where euthanasia was legalised in 2002. Developing end-of-life policies in hospitals is a first step towards improving the quality of medical decision-making at the end-of-life. Implementation of policies through quality assessments, communication and the training and education of health care providers is

Ina D'Haene; Robert H Vander Stichele; H Roeline W Pasman; Nele Van den Noortgate; Johan Bilsen; Freddy Mortier; L. H. J. Deliens

2009-01-01

66

End-of-Life Care in an Acute Care Hospital: Linking Policy and Practice  

Microsoft Academic Search

The care of people who die in hospitals is often suboptimal. Involving patients in decisions about their care is seen as one way to improve care outcomes. Federal and state government policymakers in Australia are promoting shared decision making in acute care hospitals as a means to improve the quality of end-of-life care. If policy is to be effective, health

Ros Sorensen; Rick Iedema

2011-01-01

67

Better Quality of Care or Healthier Patients? Hospital Utilization by Medicare Advantage and Fee-for-Service Enrollees  

PubMed Central

Do differences in rates of use among managed care and Fee-for-Service Medicare beneficiaries reflect selection bias or successful care management by insurers? I demonstrate a new method to estimate the treatment effect of insurance status on health care utilization. Using clinical information and risk-adjustment techniques on data on acute admission that are unrelated to recent medical care, I create a proxy measure of unobserved health status. I find that positive selection accounts for between one-quarter and one-third of the risk-adjusted differences in rates of hospitalization for ambulatory care sensitive conditions and elective procedures among Medicare managed care and Fee-for-Service enrollees in 7 years of Healthcare Cost and Utilization Project State Inpatient Databases from Arizona, Florida, New Jersey and New York matched to Medicare enrollment data. Beyond selection effects, I find that managed care plans reduce rates of potentially preventable hospitalizations by 12.5 per 1,000 enrollees (compared to mean of 46 per 1,000) and reduce annual rates of elective admissions by 4 per 1,000 enrollees (mean 18.6 per 1,000). PMID:24533012

Nicholas, Lauren Hersch

2013-01-01

68

The Effect of Communication Skills Training on Quality of Care, Self-Efficacy, Job Satisfaction and Communication Skills Rate of Nurses in Hospitals of Tabriz, Iran  

PubMed Central

Introduction: Having an effective relationship with the patient in the process of treatment is essential. Nurses must have communication skills in order to establish effective relationships with the patients. This study evaluated the impact of communication skills training on quality of care, self-efficacy, job satisfaction and communication skills of nurses. Methods: This is an experimental study with a control group that has been done in 2012. The study sample consisted of 73 nurses who work in hospitals of Tabriz; they were selected by proportional randomizing method. The intervention was only conducted on the experimental group. In order to measure the quality of care 160 patients, who had received care by nurses, participated in this study. The Data were analyzed by SPSS (ver.13). Results: Comparing the mean scores of communication skills showed a statistically significant difference between control and experimental groups after intervention. The paired t-test showed a statistically significant difference in the experimental group before and after the intervention. Independent t-test showed a statistically significant difference between the rate of quality of care in patients of control and experimental groups after the intervention. Conclusion: The results showed that the training of communication skills can increase the nurse's rate of communication skills and cause elevation in quality of nursing care. Therefore, in order to improve the quality of nursing care it is recommended that communication skills be established and taught as a separate course in nursing education.

Khodadadi, Esmail; Ebrahimi, Hossein; Moghaddasian, Sima; Babapour, Jalil

2013-01-01

69

[Quality of life of caregivers during the hospitalization of the patient under care in an Emergency Unit: some associated factors].  

PubMed

The purpose of this quantitative-descriptive study was to assess the quality of life of caregivers of patients hospitalized in emergency units of Hospital de Clínicas of the Federal University of Paraná. Tasks carried out by caregivers are significantly stressful and have a direct impact on their quality of life. From May to October 2011, 60 caregivers answered the WHOQOL-100 questionnaire developed by the World Health Organization. The majority of the interviewees were women (n = 47), with an average age of 43.2 years. Quality of life in general obtained an average score of 13.8. Results show that the quality of life of caregivers is vulnerable, which may affect their productivity. A sense of religiousness and spirituality, associated with a social-affective network are important resources to help them cope with the issues at hand. PMID:25351324

Dallalana, Tânia Madureira; Batista, Maria Geny Ribas

2014-11-01

70

An integrated care facilitation model improves quality of life and reduces use of hospital resources by patients with chronic obstructive pulmonary disease and chronic heart failure.  

PubMed

As part of the Department of Human Services Hospital Admissions Risk Program (HARP), a group of acute and community based health care providers located in the western suburbs of Melbourne formed a consortium to reduce the demand on hospital emergency services and improve health outcomes for patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). The model of care was designed by a team of multidisciplinary specialists and medical consultants. In addition to receiving normal care, patients recruited to the project were assessed by 'Care Facilitators', who identified unmet health care needs and provided information, advice and education for the patient concerning their condition and self-management. Patients declining recruitment received all normal care services. The patients' rates of emergency department (ED) presentations, inpatient admissions and hospital inpatient bed-days before and after their recruitment were calculated from the Western Health patient activity records, and pre- versus post-recruitment rates were compared using ANOVA. Changes relative to the ongoing use by those who declined recruitment were compared using the group-by-time interaction. Patient health outcomes were assessed using established disease-specific tools, and pre- versus post-recruitment values were compared using paired t-tests. Patients recruited to the COPD project reduced (P<0.05) their emergency presentations, admissions and hospital inpatient bed-days by 10, 25 and 18%, respectively, whereas those declining recruitment increased their usage by 45, 41 and 51% respectively. Recruited CHF patients also displayed reductions in emergency presentations (39%), admissions (36%) and hospital inpatient bed-days (33%), whereas those who declined recruitment displayed lesser reductions for ED presentations (26%) and admissions (20%), and increased their use of hospital inpatient bed-days (15%). The recruited COPD patients reported a significant reduction in their symptoms (P<0.005) and the CHF patients reported an improvement in their overall health and quality of life scores (P<0.001). The outcome measures used in this evaluation suggest that an integrated care facilitation model that is patient focussed, provides an education component to promote greater self-management compliance and delivers a continuum of care through the acute and community health sectors, may reduce the utilisation of acute health care facilities and benefit the patient. PMID:21138701

Bird, Stephen; Noronha, Michelle; Sinnott, Helen

2010-01-01

71

[Quality management in a Swiss hospital].  

PubMed

Although there are quite good examples of quality management in Swiss hospitals available (the guidelines of quality management in the Swiss hospital etc.), the distribution of measures of quality assurance in Swiss hospitals is insufficient and focuses more on Hotel services and technical equipment rather than on the care by physicians and nurses. Beginning with Jan. 1, 1998, contracts of quality assurance between health care providers and sponsors have to be presented according to the new health insurance act. These contracts are proofed periodically by a national office. This necessitates a country-wide introduction of statistics (ICD-codes) and computerization. This is currently only in the process of realization. Additionally, hospitals and medical practices already undertake a comprehensive quality control due to local and regional initiatives. The society of Swiss physicians FMH supports mainly three areas: compulsory continuing medical education (80 hours annually, including 50 hours in recognized meetings), the development of guidelines by medical societies, and data collection including the development of a network for measures of quality assurance. The ISO-standard 9000 was changed for health care as ordered by the NAQ (National workshop for quality assurance) and the FMH. It is supposed to be used mainly for the certification of facilities for continuing medical education, perhaps also for the certification of hospitals. PMID:9441034

Eicher, E

1997-09-01

72

[Quality of services in a small hospital].  

PubMed

The nursing services department of a 64 bed hospital in Caraquet, New Brunswick, (serving a widespread population of 25,000 people) decided to check the quality of care offered to their patients. A search was conducted among numerous quality of care management models to find the one that best suited their needs. They chose a structured quality appraisal and management program currently being used by the Royal Victoria Hospital in Montreal. The author outlines the way quality assurance directors in this Montreal hospital empower their health care providers. The author describes the concept of quality and summarizes the oriental and occidental ideologies that influence it. The nursing staff's perception of the essential elements of quality assurance are explained and the stages are identified. The author maintains that decentralization and delegation empowers individuals and instills confidence while maintaining the essential personal touch. She believes that the organization of the future is one that will promote teamwork. She also believes that motivation, participative management and workplace satisfaction promote quality care--"care that doesn't cost a dime." This program has numerous advantages. It allows employees to fully participate in the process. It also averts potential problems, and provides employees with the ability to discover and problem solve when necessary. It also allows for the strengths and weaknesses of each service to be outlined and identified deficiencies corrected. PMID:8472244

Clément, Y

1993-04-01

73

IBCD: Development and Testing of a Checklist to Improve Quality of Care for Hospitalized General Medical Patients  

PubMed Central

Background Several studies have demonstrated the usefulness of medical checklists to improve quality of care in surgery and the ICU. The feasibility, effectiveness, and sustainability of a checklist was explored. Methods Literature on checklists and adherence to quality indicators in general medicine was reviewed to develop evidence-based measures for the IBCD checklist: (I) pneumococcal immunization (I), (B) pressure ulcers (bedsores), (C) catheter-associated urinary tract infections (CAUTIs), and (D) deep venous thrombosis (DVT) were considered conditions highly relevant to the quality of care in general medicine inpatients. The checklist was used by attending physicians during rounds to remind residents to perform four actions related to these measures. Charts were audited to document actions prompted by the checklist. Results The IBCD checklist was associated with significantly increased documentation of and adherence to care processes associated with these four quality indicators. Seventy percent (46/66) of general medicine teams during the intervention period of July 2010–March 2011 voluntarily used the IBCD checklist, for 1,168 (54%) of 2,161 patients. During the intervention period, average adherence for all four checklist items increased from 68% on admission to 82% after checklist use (p < .001). Average adherence after checklist use was also higher when compared to a historical control group from one year before implementation (82% versus 50%, p < .0001). In the six weeks after the checklist was transitioned to the electronic medical record (EMR), IBCD was noted in documentation of 133 (59%) of 226 patients admitted to general medicine. Conclusion A checklist is a useful and sustainable tool to improve adherence to, and documentation of, care processes specific to quality indicators in general medicine. PMID:23641534

Aspesi, Anthony V.; Kauffmann, Greg E.; Davis, Andrew M.; Schulwolf, Elizabeth M.; Press, Valerie G.; Stupay, Kristen L.; Lee, Janey J.; Arora, Vineet M.

2014-01-01

74

Improving quality of life in hospitalized children.  

PubMed

There are many ways to add to children's quality of life within the hospital environment. Inpatient settings offer both opportunities and challenges with respect to providing care to children with life-threatening illnesses. The barriers to pediatric palliative care (PPC) on hospital wards, as with those in other settings, frequently stem from misconceptions. However, some barriers are intensified by characteristics of acute inpatient centers. Yet some characteristics of the inpatient setting, including the availability of human resources and unique interventions, offer creative ways to ease distress and improve quality of life for children and their families. PMID:25084722

Rapoport, Adam; Weingarten, Kevin

2014-08-01

75

Task-shifting an inpatient triage, assessment, and treatment program improves the quality of care for hospitalized Malawian children  

PubMed Central

Objective We aimed to improve pediatric inpatient surveillance at a busy referral hospital in Malawi with 2 new programs: (1) the provision of vital sign equipment and implementation of an inpatient triage program (ITAT) that includes a simplified pediatric severity-of-illness score; (2) task-shifting ITAT to a new cadre of health care workers called “Vital Sign Assistants” (VSAs). Methods This study, conducted on the pediatric inpatient ward of a large referral hospital in Malawi, was divided into 3 phases, each lasting 4 weeks. In Phase A, we collected baseline data. In Phase B, we provided 3 new automated vital sign poles and implemented ITAT with current hospital staff. In Phase C, VSAs were introduced and performed ITAT. Our primary outcome measures were the number of vital sign assessments performed and clinician notifications to reassess patients with high ITAT scores. Results We enrolled 3,994 patients who received 5,155 vital sign assessments. Assessment frequency was equal between Phases A (0.67 assessments/patient) and B (0.61 assessments/patient), but increased 3.6-fold in Phase C (2.44 assessments/patient, p<0.001). Clinician notifications increased from Phases A (84) and B (113) to Phase C (161, p=0.002). Inpatient mortality fell from Phase A (9.3%) to Phases B (5.7) and C (6.9%). Conclusions ITAT with VSAs improved vital sign assessments and nearly doubled clinician notifications of patients needing further assessment due to high ITAT scores, while equipment alone made no difference. Task-shifting ITAT to VSAs may improve outcomes in pediatric hospitals in the developing world. PMID:23600592

Olson, Dan; Preidis, Geoffrey A.; Milazi, Robert; Spinler, Jennifer K.; Lufesi, Norman; Mwansambo, Charles; Hosseinipour, Mina C.; McCollum, Eric D.

2013-01-01

76

Measuring the quality of medical care for women who experience sexual assault with data from the National Hospital Ambulatory Medical Care Survey  

Microsoft Academic Search

Study Objective: We provide new descriptive epidemiology on the demography and quality of care of women who experience sexual assault. Two limited aspects of emergency department treatment received by women who have experienced sexual assault are examined: (1) administration of emergency contraception to prevent pregnancy and (2) screening and treatment for sexually transmitted diseases (STDs). Methods: A nationally representative survey

Annette L. Amey; David Bishai

2002-01-01

77

[An existential health care approach in hospital psychiatric nursing].  

PubMed

The focus of Mental Health Care in Brazil has been on community psychiatric care services that replace the asylum model. However, individuals with mental disorders continue to shift between community services and psychiatric hospitals, besides becoming a target of the disciplinarization and violence that question the quality of the nursing care being delivered. The objective of this study is to understand the ontology of nursing care in psychiatric hospitalization. Participants were four individuals with mental disorders who attended a center for psychosocial care, who agreed to talk about their psychiatric hospitalization experience by means of a semi-directed interview. The subjects remembered about their psychiatric hospitalization and assigned meanings to it. Heidegger's Existential Analysis was used, and thus generated the Meaning Unit: Being-in-the-world cared with impersonality; which allowed to unveil the phenomenon through Dasein's structure, and thus made it possible to outline the ontological care in nursing in psychiatric hospitals. PMID:21655789

Furlan, Marcela Martins; Ribeiro, Cléa Regina de Oliveira

2011-04-01

78

Do variations in hospital mortality patterns after weekend admission reflect reduced quality of care or different patient cohorts? A population-based study  

PubMed Central

Background Proposed causes for increased mortality following weekend admission (the ‘weekend effect’) include poorer quality of care and sicker patients. The aim of this study was to analyse the 7?days post-admission time patterns of excess mortality following weekend admission to identify whether distinct patterns exist for patients depending upon the relative contribution of poorer quality of care (care effect) or a case selection bias for patients presenting on weekends (patient effect). Methods Emergency department admissions to all 501 hospitals in New South Wales, Australia, between 2000 and 2007 were linked to the Death Registry and analysed. There were a total of 3?381?962 admissions for 539?122 patients and 64?789 deaths at 1?week after admission. We computed excess mortality risk curves for weekend over weekday admissions, adjusting for age, sex, comorbidity (Charlson index) and diagnostic group. Results Weekends accounted for 27% of all admissions (917?257/3?381?962) and 28% of deaths (18?282/64?789). Sixteen of 430 diagnosis groups had a significantly increased risk of death following weekend admission. They accounted for 40% of all deaths, and demonstrated different temporal excess mortality risk patterns: early care effect (cardiac arrest); care effect washout (eg, pulmonary embolism); patient effect (eg, cancer admissions) and mixed (eg, stroke). Conclusions The excess mortality patterns of the weekend effect vary widely for different diagnostic groups. Recognising these different patterns should help identify at-risk diagnoses where quality of care can be improved in order to minimise the excess mortality associated with weekend admission. PMID:24163392

Concha, Oscar Perez; Gallego, Blanca; Hillman, Ken; Delaney, Geoff P; Coiera, Enrico

2014-01-01

79

Assessment of paediatric inpatient care during a multifaceted quality improvement intervention in Kenyan District Hospitals - use of prospectively collected case record data  

PubMed Central

Background In assessing quality of care in developing countries, retrospectively collected data are usually used given their availability. Retrospective data however suffer from such biases as recall bias and non-response bias. Comparing results obtained using prospectively and retrospectively collected data will help validate the use of the easily available retrospective data in assessing quality of care in past and future studies. Methods Prospective and retrospective datasets were obtained from a cluster randomized trial of a multifaceted intervention aimed at improving paediatric inpatient care conducted in eight rural Kenyan district hospitals by improving management of children admitted with pneumonia, malaria and diarrhea and/or dehydration. Four hospitals received a full intervention and four a partial intervention. Data were collected through 3 two weeks surveys conducted at baseline, after 6 and 18 months. Retrospective data was sampled from paediatric medical records of patients discharged in the preceding six months of the survey while prospective data was collected from patients discharged during the two week period of each survey. Risk Differences during post-intervention period of16 quality of care indicators were analyzed separately for prospective and retrospective datasets and later plotted side by side for comparison. Results For the prospective data there was strong evidence of an intervention effect for 8 of the indicators and weaker evidence of an effect for one indicator, with magnitude of effect sizes varying from 23% to 60% difference. For the retrospective data, 10 process (these include the 8 indicators found to be statistically significant in prospective data analysis) indicators had statistically significant differences with magnitude of effects varying from 10% to 42%. The bar-graph comparing results from the prospective and retrospective datasets showed similarity in terms of magnitude of effects and statistical significance for all except two indicators. Conclusion Multifaceted interventions can help improve adoption of clinical guidelines and hence improve the quality of care. The similar inference reached after analyses based on prospective assessment of case management is a useful finding as it supports the utility of work based on examination of retrospectively assembled case records allowing longer time periods to be studied while constraining costs. Trial registration Current Controlled Trials ISRCTN42996612. Trial registration date: 20/11/2008 PMID:25035114

2014-01-01

80

Supply chain automation and the effects on clinician satisfaction and patient care quality in the hospital setting  

E-print Network

The healthcare industry, more specifically hospitals, has in recent times been experiencing a steady rise in nursing shortages and cost pressures. To offset these problems hospitals have increasingly relied upon supply ...

Xie, Yue, M. Eng. Massachusetts Institute of Technology

2006-01-01

81

Measuring Child Care Quality.  

ERIC Educational Resources Information Center

Child care quality is not a single dimension, but rather a multidimensional characteristic of programs that support the family in its child-rearing role and programs in which children thrive developmentally, socially, cognitively, physically, and emotionally. At the regulatory and accreditation level, approaches to quality focus on group size,…

Fiene, Richard

82

Can quality circles improve hospital-acquired infection control?  

Microsoft Academic Search

It is a fundamental principle of continuous quality improvement (CQI) that processes should be the objects of quality improvement. The objective of this study was to improve process quality concerning the prevention of hospital-acquired infections in surgical departments and intensive care units by a continuous quality improvement (CQI) approach based mainly on quality circles. This approach was evaluated in a

D. H Forster; G Krause; P Gastmeier; W Ebner; A Rath; N Wischnewski; M Lacour; H Rüden; F. D Daschner

2000-01-01

83

Controlling for quality in the hospital cost function  

Microsoft Academic Search

This paper explores the relationship between the cost and quality of hospital care from the perspective of applied microeconomics.\\u000a It addresses both theoretical and practical complexities entailed in incorporating hospital quality into the estimation of\\u000a hospital cost functions. That literature is extended with an empirical analysis that examines the use of 15 Patient Safety\\u000a Indicators (PSIs) as measures of hospital

Kathleen Carey; Theodore Stefos

2011-01-01

84

Inpatient Care Intensity And Patients' Ratings Of Their Hospital Experiences: What could explain the fact that Americans with chronic illnesses who receive less hospital care report better hospital experiences?  

PubMed Central

The intensity of hospital care provided to chronically ill Medicare patients varies greatly among regions, independent of illness. We examined the associations among hospital care intensity, the technical quality of hospital care, and patients’ ratings of their hospital experiences. Greater inpatient care intensity was associated with lower quality scores and lower patient ratings; lower quality scores were associated with lower patient ratings. The common thread linking greater care intensity with lower quality and less favorable patient experiences may be poorly coordinated care. PMID:19124860

Bronner, Kristen; Skinner, Jonathan S.; Fisher, Elliott S.; Goodman, David C.

2009-01-01

85

[Hospitalization and assessment of nursing care].  

PubMed

The purpose is to promote the reflection concerning the family role and the evidence of nursing practice, in hospital discharge of the elderly patient. In the settings where elderly patients prevail, the family must be valorised as a partner to guarantee the continuity of care when they return home. A communication strategy concerning what the meaning of being a nurse is and what she/he does, can contribute to unveil the role of nursing in the promotion of health and the quality of life of patients and their families. PMID:17824409

da Silva, João Fernandes

2007-01-01

86

Quality of Cancer Care  

Cancer.gov

Work is underway to make cancer a working model for quality of care research and the translation of this research into practice. This requires addressing how data collection about cancer care can be standardized and made most useful to a variety of audiences including providers, patients and their families, purchasers, payers, researchers, and policymakers. The Applied Research Program has spearheaded several key activities to carry out this initiative.

87

Quality Improvement Strategies and Best Practices in Critical Access Hospitals  

ERIC Educational Resources Information Center

Critical access hospitals (CAHs) face many challenges in implementing quality improvement (QI) initiatives, which include limited resources, low volume of patients, small staffs, and inadequate information technology. A primary goal of the Medicare Rural Hospital Flexibility Program is to improve the quality of care provided by CAHs. This article…

Casey, Michelle M.; Moscovice, Ira

2004-01-01

88

Pediatric palliative care: starting a hospital-based program.  

PubMed

The value of palliative care in pediatrics has received significant attention over the past 10 years. The American Academy of Pediatrics and the Institute of Medicine published recommendations involving children who have a life-limiting diagnosis in a palliative care program early in their disease process. Palliative care is intended to assure an emphasis on quality of life in addition to the current medical treatment, which may be focused on cure, symptom management, and/or end-of-life care. This article describes one hospital's experience in planning, implementing, and managing a pediatric palliative care program. Implementing a hospital-based palliative care program in a children's hospital can be accomplished through careful planning and analysis of need. Writing an official business plan formalized the request for organizational support for this program, including the mission and vision, plans for how services would be provided, expected financial implications, and initial plans for evaluation of success. PMID:22132573

Schmidt, Kaye

2011-01-01

89

Quality of dying in a New Zealand teaching hospital  

Microsoft Academic Search

Objective:Studies suggest that there is a need to improve the way we deliver care at the end of life. Based on recommendations from end-of-life experts, metrics were identified to measure the quality of dying in Dunedin Hospital.Design:A retrospective observational study was performed to assess the care provided to patients who died in the hospital in 2003.Setting:Dunedin Hospital is a 350-bed

J L Glasgow; S R McLennan; K J High; L A G Celi

2008-01-01

90

Child Care Cost and Quality  

Microsoft Academic Search

This article summarizes what is known about the cost and quality of full-time child care in centers and family child care homes, and about parents' attention to quality in mak- ing child care choices. It relies primarily upon two recent studies which are among the first to collect detailed information about child care operating costs: the Cost, Quality, and Child

Suzanne W. Helburn; Carollee Howes

91

Quality Assurance Through In-House Hospital Inspections  

PubMed Central

Hospitals, particularly those that are teaching institutions, must function at a high level of efficiency and effectiveness if they are to render excellent patient care, maintain accreditation, and provide a sound environment for learning and research. An urban 500-bed teaching hospital found that conducting its own internal monthly inspections produced several benefits in the areas of patient care, infection control, maintenance, safety, and administration. This hospital's in-house inspections also reduced anxiety in preparing for visits from various licensing agencies and review boards. Generally, this hospital has found that an in-house inspection program is a valid means of quality assurance in all areas of hospital work. PMID:4046058

Swamidoss, P.

1985-01-01

92

Quality improvement: perspectives on organizational learning from hospital-based quality control circles in Taiwan  

Microsoft Academic Search

The health care industry in Taiwan has faced many challenges in recent years. To tackle those challenges, many hospitals in Taiwan began using management techniques used in other industries. As a result, quality management has become important within Taiwan's health care industry. This study provides a perspective on how this health care industry, by developing both quality control circle (QCC)

I-Chi Chen; Min-Hsun Christine Kuo

2011-01-01

93

Frequency of poor quality of life and predictors of health related quality of life in cirrhosis at a tertiary care hospital Pakistan  

PubMed Central

Background Cirrhosis produces variety of symptoms which eventually lead to a negative impact on Health Related Quality of Life (HRQOL). The general aim of this study was to evaluate the magnitude of poor HRQOL and to assess factors related with HRQOL in patients with CLD in Pakistan. Findings This was a cross sectional study conducted in gastroenterology outpatient clinics of Aga Khan University Hospital, Karachi on adult patients with cirrhosis. In this study chronic liver disease questionnaire (CLDQ) was used to assess HRQOL of these patients and CLDQ score was used as an outcome measure to determine factors related with HRQOL. 273 participants were recruited in the study; 155 (57%) were males. Mean age of participants was 49?±?11?years. The most common cause for cirrhosis was viral infection 247(91.5%). Mean Model for End Stage Liver Disease (MELD) score was 12.6?±?6.8 and 2/3 of patients 209 (76.6%) had advanced cirrhosis in Child Turcot Pugh (CTP) B or C stage. Poor HRQOL was seen in 187(69%; 95% C.I.: 63%, 74%) of the participants. Mean CLDQ score was 4.36 ±1.1. Amongst all of the domains, fatigue domain had lower CLDQ score. Hemoglobin (??=?0.09 [SE?=?0.04]), Albumin (??=?0.32[SE?=?0.09]), Diastolic Blood Pressure (DBP) (??=?0.01[0.005) prior history of decompensation (??=?0.98[SE?=?0.39] were significant factors associated with HRQOL in patients with liver cirrhosis. Conclusion Frequency of poor health related quality of life determined by CLDQ score is high in patients with liver cirrhosis. Hemoglobin, serum albumen, prior history of decompensation (like encephalopathy and upper gastro intestinal bleed), are associated with health related quality of life. PMID:22905795

2012-01-01

94

38 CFR 17.45 - Hospital care for research purposes.  

Code of Federal Regulations, 2011 CFR

...2011-07-01 2011-07-01 false Hospital care for research purposes. 17.45...DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.45 Hospital care for research purposes....

2011-07-01

95

38 CFR 17.45 - Hospital care for research purposes.  

Code of Federal Regulations, 2010 CFR

...2010-07-01 2010-07-01 false Hospital care for research purposes. 17.45...DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.45 Hospital care for research purposes....

2010-07-01

96

38 CFR 17.45 - Hospital care for research purposes.  

...2014-07-01 2014-07-01 false Hospital care for research purposes. 17.45 Section 17...MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.45 Hospital care for research purposes. Subject to the...

2014-07-01

97

Outcome of per protocol best-evidence based routine breast cancer care in a large regional hospital in Belgium: the -importance of a prospective database in quality assurance  

PubMed Central

Aim: Criteria for future accreditation of breast cancer centres in Belgium will be mainly based on the case load per surgeon or per centre. We would like to argue that the prospective collection of relevant data and the analysis of treatment related outcome derived from these data is feasible and should be the ultimate criterion for quality assessment and thus for accreditation since outcome is a more direct measurement of quality. Methods: Data were prospectively collected on 715 invasive non metastatic breast cancers between 2002 and 2007 treated according to standard, best-evidence protocols in the setting of a large district hospital. Univariate and multivariate survival analysis were performed and compared to national and international databases. Results: 5 year disease-free survival (DFS) and overall survival (OS) in our series were respectively 77 and 84%. In the multivariate analysis of DFS, only her-2-neu status (her-2-neu positivity being associated with a poor prognosis) and age (older age being a worse prognostic factor) were statistically significant prognostic factors. For OS, her-2-neu, age, and positive nodes were statistically significant prognostic factors. The outcome is comparable to other data sets. Conclusion: Centres dedicated to the care of women with breast cancer have the moral duty to produce outcome based results of their treatment. This report shows that such a collection of data is feasible and can be imposed as a prerequisite for accreditation. We also argue that outcome based data of treatment are a more solid base for quality assurance than case load. PMID:25302106

G. Van de Putte, G.; Vlasselaer, J.; Teshome, B.; Gaddah, A.; Burzykowski, T.; Schobbens, J.C.; Benijts, G.; de Jonge, E.T.M.

2010-01-01

98

Do Gender and Race/Ethnicity Influence Acute Myocardial Infarction Quality of Care in a Hospital with a Large Hispanic Patient and Provider Representation?  

PubMed Central

Background. Disparities in acute myocardial infarction (AMI) care for women and minorities have been extensively reported in United States but with limited information on Hispanics. Methods. Medical records of 287 (62%) Hispanic and 176 (38%) non-Hispanic white (NHW) patients and 245 women (53%) admitted with suspected AMI to a southern California nonprofit community hospital with a large Hispanic patient and provider representation were reviewed. Baseline characteristics, outcomes (mortality, CATH, PCI, CABG, and use of pertinent drug therapy), and medical insurance were analyzed according to gender, Hispanic and NHW race/ethnicity when AMI was confirmed. For categorical variables, 2 × 2 chi-square analysis was conducted. Odds ratio and 95% confidence interval for outcomes adjusted for gender, race/ethnicity, cardiovascular risk factors, and insurance were obtained. Results. Women and Hispanics had similar drug therapy, CATH, PCI, and mortality as men and NHW when AMI was confirmed (n = 387). Hispanics had less private insurance than NHW (31.4% versus 56.3%, P < 0.001); no significant differences were found according to gender. Conclusions. No differences in quality measures and outcomes were found for women and between Hispanic and NHW in AMI patients admitted to a facility with a large Hispanic representation. Disparities in medical insurance showed no influence on these findings. PMID:24490100

Romero, Tomas; Glaser, Dale; Romero, Camila X.

2013-01-01

99

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

Federal Register 2010, 2011, 2012, 2013

...424, and 476 [CMS-1588-CN4] RIN 0938-AR12 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates; Hospitals'...

2013-03-13

100

Tweets about hospital quality: a mixed methods study  

PubMed Central

Background Twitter is increasingly being used by patients to comment on their experience of healthcare. This may provide information for understanding the quality of healthcare providers and improving services. Objective To examine whether tweets sent to hospitals in the English National Health Service contain information about quality of care. To compare sentiment on Twitter about hospitals with established survey measures of patient experience and standardised mortality rates. Design A mixed methods study including a quantitative analysis of all 198?499 tweets sent to English hospitals over a year and a qualitative directed content analysis of 1000 random tweets. Twitter sentiment and conventional quality metrics were compared using Spearman's rank correlation coefficient. Key results 11% of tweets to hospitals contained information about care quality, with the most frequent topic being patient experience (8%). Comments on effectiveness or safety of care were present, but less common (3%). 77% of tweets about care quality were positive in tone. Other topics mentioned in tweets included messages of support to patients, fundraising activity, self-promotion and dissemination of health information. No associations were observed between Twitter sentiment and conventional quality metrics. Conclusions Only a small proportion of tweets directed at hospitals discuss quality of care and there was no clear relationship between Twitter sentiment and other measures of quality, potentially limiting Twitter as a medium for quality monitoring. However, tweets did contain information useful to target quality improvement activity. Recent enthusiasm by policy makers to use social media as a quality monitoring and improvement tool needs to be carefully considered and subjected to formal evaluation. PMID:24748372

Greaves, Felix; Laverty, Antony A; Cano, Daniel Ramirez; Moilanen, Karo; Pulman, Stephen; Darzi, Ara; Millett, Christopher

2014-01-01

101

Future health care technology and the hospital.  

PubMed

The past decades have been a time of rapid technological change in health care, but technological change will probably accelerate during the next decade or so. This will bring problems, but it will also present certain opportunities. In particular, the health care system is faced with the need to spend its limited resources more effectively. The number of hospital beds is being reduced, and lengths of stay are falling. In the future, the health care system will have to care for an increasing number of elderly people, both with chronic disease and also with dependency because of frailty and functional problems. The hospital of the future will probably be smaller and more intensive in the nature of its care. In part, this is because many present and future clinical technologies can be delivered outside of the hospital setting. And communication technologies offer the possibility of tying the various parts of the health care system into one true system. This would mean that the future hospital would have a more active role in supervising technical care outside of the hospital, and in making specialized knowledge accessible in all parts of the health system. PMID:10104535

Banta, H D

1990-01-01

102

Organization of Care for Acute Myocardial Infarction in Rural and Urban Hospitals in Kansas  

ERIC Educational Resources Information Center

One in 4 Americans lives in a rural community and relies on rural hospitals and medical systems for emergent care of acute myocardial infarctions (AMI). The infrastructure and organization of AMI care in rural and urban Kansas hospitals was examined. Using a nominal group process, key elements within hospitals that might influence quality of AMI…

Ellerbeck, Edward F.; Bhimaraj, Arvind; Perpich, Denise

2004-01-01

103

Palliative Care in Acute Care Hospitals  

Microsoft Academic Search

Changes in the demographics and healthcare needs of the U.S. population have forced a shift in the types of healthcare services\\u000a that people want and need. Hospitals are faced with the challenge of meeting the needs of an increasingly older and frailer\\u000a population. An American born in 2000 can expect to live to nearly 77 years old; a 65 years

Randy Hebert; Nicole Fowler; Robert Arnold

104

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

Federal Register 2010, 2011, 2012, 2013

...Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective...Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective...No. 93.773, Medicare--Hospital Insurance; and Program No. 93.774,...

2012-10-29

105

Maternal satisfaction with organized perinatal care in Serbian public hospitals  

PubMed Central

Background Understanding the experiences and expectations of women across the continuum of antenatal, perinatal, and postnatal care is important to assess the quality of maternal care and to determine problematic areas which could be improved. The objective of this study was to identify the factors associated with maternal satisfaction with hospital-based perinatal care in Serbia. Methods Our survey was conducted from January 2009 to January 2010 using a 28-item, self-administered questionnaire. The sample consisted of 50% of women who expected childbirths during the study period from all 76 public institutions with obstetric departments in Serbia. The following three composite outcome variables were constructed: satisfaction with technical and professional aspects of care; communication and interpersonal aspects of care; and environmental factors. Results We analyzed 34,431 completed questionnaires (84.2% of the study sample). The highest and lowest average satisfaction scores (4.43 and 3.25, respectively) referred to the overall participation of midwives during delivery and the quality of food served in the hospital, respectively. Younger mothers and multiparas were less concerned with the environmental conditions (OR?=?0.55, p?=?0.006; OR?=?1.82, p?=?0.004). Final model indicated that mothers informed of patients’ rights, pregnancy and delivery through the Maternal Counseling Service were more likely to be satisfied with all three outcome variables. The highest value of the Pearson’s coefficient of correlation was between the overall satisfaction score and satisfaction with communication and interpersonal aspects of care. Conclusions Our study illuminated the importance of interpersonal aspects of care and education for maternal satisfaction. Improvement of the environmental conditions in hospitals, the WHO program, Baby-friendly Hospital, and above all providing all pregnant women with antenatal education, are recommendations which would more strongly affect the perceptions of quality and satisfaction with perinatal care in Serbian public hospitals by women. PMID:24410839

2014-01-01

106

Migrant-friendly hospitals: a paediatric perspective - improving hospital care for migrant children  

PubMed Central

Background The European Union (EU) Migrant-Friendly Hospital (MFH) Initiative, introduced in 2002, promotes the adoption of care approaches adapted to meet the service needs of migrants. However, for paediatric hospitals, no specific recommendations have been offered for MFH care for children. Using the Swiss MFH project as a case study, this paper aims to identify hospital-based care needs of paediatric migrants (PMs) and good service approaches. Methods Semi-structured interviews were conducted with principal project leaders of five paediatric hospitals participating in the Swiss MFH project. A review of the international literature on non-clinical hospital service needs and service responses of paediatric MFHs was conducted. Results Paediatric care can be complex, usually involving both the patient and the patient’s family. Key challenges include differing levels of acculturation between parents and children; language barriers; cultural differences between patient and provider; and time constraints. Current service and infrastructural responses include interpretation services for PMs and parents, translated information material, and special adaptations to ensure privacy, e.g., during breastfeeding. Clear standards for paediatric migrant-friendly hospitals (P-MFH) are lacking. Conclusions International research on hospital care for migrant children is scarce. The needs of paediatric migrants and their families may differ from guidance for adults. Paediatric migrant needs should be systematically identified and used to inform paediatric hospital care approaches. Hospital processes from admission to discharge should be revised to ensure implementation of migrant-sensitive approaches suitable for children. Staff should receive adequate support, such as training, easily available interpreters and sufficient consultation time, to be able to provide migrant-friendly paediatric services. The involvement of migrant groups may be helpful. Improving the quality of care for PMs at both policy and service levels is an investment in the future that will benefit native and migrant families. PMID:24093461

2013-01-01

107

Appendix: Health Care Systems The provision of high-quality health care in the United States and globally will challenge  

E-print Network

policy; and 3) Health care treatment. #12;Health Care Operations Clinics, hospitals, hospital networksAppendix: Health Care Systems The provision of high-quality health care in the United States., 2008). * * First two sentences of "Envisioning the Health Care Initiative at Lehigh" The financial

Napier, Terrence

108

Hospital mergers and reproductive health care.  

PubMed

In the US, when one of the two hospitals involved in a merger is a Catholic hospital, comprehensive reproductive health care tends to suffer. The Catholic Church forbids its hospitals from providing and making direct referrals for many reproductive health services (i.e., reversible contraception, infertility treatments, male and female sterilization, abortion, condoms for HIV prevention, and emergency contraception). These mergers are especially severe in small towns and rural areas. Several groups have formed to address this hidden crisis. In Troy, New York, a settlement was reached about 12 months after a law suit was filed against the conditions of a merger between a Catholic hospital and a nonsectarian hospital. After a long fight, the settlement essentially guaranteed that patients who are dependent on religious institutions obtain the contraceptive and sterilization services they need and want, but abortion services and referrals continued to be denied. The state of Montana considered the impact of a merger of a Catholic institution and a nonsectarian institution, yet continued availability of all reproductive health services was not guaranteed. The American Civil Liberties Union asked the Federal Trade Commission (FTC) to investigate the merger's impact on reproductive health care, since the merger created a monopoly on acute care in Great Falls. FTC took no action. Key factors to provision of reproductive health services other than abortion in cases of mergers between a Catholic hospital and a nonsectarian hospital include the type of association the two hospitals enter into, the local bishop's willingness to accept a creative solution, and the willingness of the state to consider the implications of such a merger and take steps to guarantee the continued availability of services. State reproductive health care advocacy groups (e.g., MergerWatch in New York) are increasing public awareness of the risks these mergers pose and helping residents ensure that reproductive health services remain available. Pressures to reduce costs will likely require Catholic hospitals to continue to merge with nonsectarian hospitals. PMID:8959420

Donovan, P

1996-01-01

109

[Care outside the hospital walls].  

PubMed

Physical activity can benefit people suffering from mental disorders, on the condition however that it is closely supervised by caregivers. It enables patients and caregivers to leave the hospital, physically, as well as figuratively speaking, by offering another space in which the nurse-patient relationship can bear fruit. PMID:23631081

Rosani, Mara; Bruno, Davide

2013-01-01

110

Limited Use of Price and Quality Advertising Among American Hospitals  

PubMed Central

Background Consumer-directed policies, including health savings accounts, have been proposed and implemented to involve individuals more directly with the cost of their health care. The hope is this will ultimately encourage providers to compete for patients based on price or quality, resulting in lower health care costs and better health outcomes. Objective To evaluate American hospital websites to learn whether hospitals advertise directly to consumers using price or quality data. Methods Structured review of websites of 10% of American hospitals (N=474) to evaluate whether price or quality information is available to consumers and identify what hospitals advertise about to attract consumers. Results On their websites, 1.3% (6/474) of hospitals advertised about price and 19.0% (90/474) had some price information available; 5.7% (27/474) of hospitals advertised about quality outcomes information and 40.9% (194/474) had some quality outcome data available. Price and quality information that was available was limited and of minimal use to compare hospitals. Hospitals were more likely to advertise about service lines (56.5%, 268/474), access (49.6%, 235/474), awards (34.0%, 161/474), and amenities (30.8%, 146/474). Conclusions Insufficient information currently exists for consumers to choose hospitals on the basis of price or quality, making current consumer-directed policies unlikely to realize improved quality or lower costs. Consumers may be more interested in information not related to cost or clinical factors when choosing a hospital, so consumer-directed strategies may be better served before choosing a provider, such as when choosing a health plan. PMID:23988296

Wilks, Chrisanne E A; Richter, Jason P

2013-01-01

111

Service quality in health care.  

PubMed

Although US health care is described as "the world's largest service industry," the quality of service--that is, the characteristics that shape the experience of care beyond technical competence--is rarely discussed in the medical literature. This article illustrates service quality principles by analyzing a routine encounter in health care from a service quality point of view. This illustration and a review of related literature from both inside and outside health care has led to the following 2 premises: First, if high-quality service had a greater presence in our practices and institutions, it would improve clinical outcomes and patient and physician satisfaction while reducing cost, and it would create competitive advantage for those who are expert in its application. Second, many other industries in the service sector have taken service quality to a high level, their techniques are readily transferable to health care, and physicians caring for patients can learn from them. PMID:10029131

Kenagy, J W; Berwick, D M; Shore, M F

1999-02-17

112

Patient Referral Patterns and the Spread of Hospital-Acquired Infections through National Health Care Networks  

Microsoft Academic Search

Rates of hospital-acquired infections, such as methicillin-resistant Staphylococcus aureus (MRSA), are increasingly used as quality indicators for hospital hygiene. Alternatively, these rates may vary between hospitals, because hospitals differ in admission and referral of potentially colonized patients. We assessed if different referral patterns between hospitals in health care networks can influence rates of hospital-acquired infections like MRSA. We used the

Tjibbe Donker; Jacco Wallinga; Hajo Grundmann

2010-01-01

113

Oral health care for hospitalized children.  

PubMed

Oral health care may be the greatest unmet health need of children in the U.S. Half of the children in the U.S. suffer from tooth decay by 8 years of age. The consequences of poor oral health are many, including mouth pain, inability to chew and eat, abscess and soft tissue infection, diminished self-esteem, and impaired school performance. Numerous medical conditions, such as asthma and diabetes, and developmental disabilities, such as cerebral palsy and autism, have associated oral health implications. Oral health care is often neglected by nondental health providers. Nurses are in a unique position to contribute to the improvement of this national health problem by promoting oral health care among hospitalized children and their families. A hospital program for oral health care is proposed, including assessment of teeth and gingiva, ensuring oral care for all, as well as oral health education as part of patient education. PMID:22132567

Blevins, Jo Young

2011-01-01

114

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

PubMed

Commercially insured and Medicare patients who are not in health maintenance organizations (HMOs) tend to use different hospitals than HMO patients use. This phenomenon, called market segmentation, raises important questions about how hospitals that treat many HMO patients differ from those that treat few HMO patients, especially with regard to quality of care. This study of patients undergoing coronary artery bypass graft surgery found no evidence that HMOs in southeast Florida systematically channel their patients to high-volume or low-mortality hospitals. These findings are consistent with other evidence that in many areas of the country, incentives for managed care plans to reduce costs may outweigh incentives to improve quality. PMID:9444826

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

1997-01-01

115

Rising hospital employment of physicians: better quality, higher costs?  

PubMed

In a quest to gain market share, hospital employment of physicians has accelerated in recent years to shore up referral bases and capture admissions, according to the Center for Studying Health System Change's (HSC) 2010 site visits to 12 nationally representative metropolitan communities. Stagnant reimbursement rates, coupled with the rising costs of private practice, and a desire for a better work-life balance have contributed to physician interest in hospital employment. While greater physician alignment with hospitals may improve quality through better clinical integration and care coordination, hospital employment of physicians does not guarantee clinical integration. The trend of hospital-employed physicians also may increase costs through higher hospital and physician commercial insurance payment rates and hospital pressure on employed physicians to order more expensive care. To date, hospitals' primary motivation for employing physicians has been to gain market share, typically through lucrative service-line strategies encouraged by a fee-for-service payment system that rewards volume. More recently, hospitals view physician employment as a way to prepare for payment reforms that shift from fee for service to methods that make providers more accountable for the cost and quality of patient care. PMID:21853632

O'Malley, Ann S; Bond, Amelia M; Berenson, Robert A

2011-08-01

116

Pharmaceutical care in Kuwait: hospital pharmacists' perspectives.  

PubMed

Background Pharmaceutical care practice has been championed as the primary mission of the pharmacy profession, but its implementation has been suboptimal in many developing countries including Kuwait. Pharmacists must have sufficient knowledge, skills, and positive attitudes to practise pharmaceutical care, and barriers in the pharmacy practice model must be overcome before pharmaceutical care can be broadly implemented in a given healthcare system. Objective To investigate hospital pharmacists' attitudes towards pharmaceutical care, perceptions of their preparedness to provide pharmaceutical care, and the barriers to its implementation in Kuwait. Setting Six general hospitals, eight specialized hospitals and seven specialized health centers in Kuwait. Method A descriptive, cross-sectional survey was distributed to all pharmacists working in the governmental hospitals in Kuwait (385 pharmacists). Data were collected via a pre-tested self-administered questionnaire. Descriptive statistics including percentages, medians and means Likert scale rating (standard deviations) were calculated and compared using statistical package for social sciences, version 20. Statistical significance was accepted at a p value of <0.05. Main outcome measure Pharmacists' attitudes towards pharmaceutical care, perceptions of their preparedness to provide pharmaceutical care competencies, and the barriers to its implementation in Kuwait. Results Completed surveys were received from 250 (64.9 %) of the 385 pharmacists. Pharmacists expressed overall positive attitudes towards pharmaceutical care. They felt well prepared to implement the various aspects of pharmaceutical care, with the least preparedness in the administrative/management aspects. Pharmacists with more practice experience expressed significantly more positive attitudes towards pharmaceutical care (p = 0.001) and they felt better prepared to provide pharmaceutical care competencies (p < 0.001) than those with less experience as practitioners. The respondents agreed/strongly agreed that the most significant barriers to the integration of pharmaceutical care into practice were lack of private counseling areas or inappropriate pharmacy layout (87.6 %), organizational obstacles (81.6 %), inadequate staff (79.6 %), and lack of pharmacist time and adequate technology (76.0 %). Conclusion Hospital pharmacists in Kuwait advocate implementation of pharmaceutical care while also appreciating the organizational, technical and professional barriers to its widespread adoption. Collaborative efforts between health authorities and educational institutions, and the integration of innovative approaches in pharmacy management and education could overcome these barriers and achieve the transition towards pharmaceutical care practice. PMID:25204259

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

2014-12-01

117

Documentation of care and prospective payment. One hospital's experience.  

PubMed Central

Hospitals are now being reimbursed by Diagnosis Related Group (DRG) for Medicare patients. The Johns Hopkins Hospital has worked successfully under this system for the past 5 years, with cost increases being maintained well below the national average. Allowable revenue varies considerably by diagnosis depending on such factors as secondary diagnoses, procedure, and patient age. Failure to document accurately may result in substantial loss of hospital income. More worrisome is the use of data by outside agencies to evaluate quality of care. Recent reports of mortality rates for surgery in Maryland hospitals and of permanent pacemaker use are illustrative. Conclusions were inaccurate because of inadequate documentation of diagnoses and procedures by physicians and inaccurate coding by quality assurance coordinators. Surgeons need to be aware that in the prospective payment era, accurate and complete documentation is essential and that their data are likely to be used for purposes other than monitoring fiscal performance. PMID:6426413

Zuidema, G D; Dans, P E; Dunlap, E D

1984-01-01

118

Seoul National University Bundang Hospital's Electronic System for Total Care  

PubMed Central

Objectives Seoul National University Bundang Hospital, which is the first Stage 7 hospital outside of North America, has adopted and utilized an innovative and emerging information technology system to improve the efficiency and quality of patient care. The objective of this paper is to briefly introduce the major components of the SNUBH information system and to describe our progress toward a next-generation hospital information system (HIS). Methods SNUBH opened in 2003 as a fully digital hospital by successfully launching a new HIS named BESTCare, "Bundang hospital Electronic System for Total Care". Subsequently, the system has been continuously improved with new applications, including close-loop medication administration (CLMA), clinical data warehouse (CDW), health information exchange (HIE), and disaster recovery (DR), which have resulted in the achievement of Stage 7 status. Results The BESTCare system is an integrated system for a university hospital setting. BESTCare is mainly composed of three application domains: the core applications, an information infrastructure, and channel domains. The most critical and unique applications of the system, such as the electronic medical record (EMR), computerized physician order entry (CPOE), clinical decision support system (CDSS), CLMA, CDW, HIE, and DR applications, are described in detail. Conclusions Beyond our achievement of Stage 7 hospital status, we are currently developing a next-generation HIS with new goals of implementing infrastructure that is flexible and innovative, implementing a patient-centered system, and strengthening the IT capability to maximize the hospital value. PMID:22844650

Yoo, Sooyoung; Lee, Kee Hyuck; Lee, Hak Jong; Ha, Kyooseob; Lim, Cheong; Chin, Ho Jun; Yun, Jonghoar; Cho, Eun-Young; Chung, Eunja; Baek, Rong-Min; Chung, Chin Youb; Wee, Won Ryang; Lee, Chul Hee; Lee, Hai-Seok; Byeon, Nam-Soo

2012-01-01

119

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

Federal Register 2010, 2011, 2012, 2013

...485, and 489 [CMS-1599-CN] RIN 0938-AR53 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Proposed Fiscal Year 2014 Rates;...

2013-06-27

120

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

Federal Register 2010, 2011, 2012, 2013

...CMS-1406-CN2] RIN 0938-AQ03 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and Fiscal Year 2010 Rates and to the Long- Term Care Hospital Prospective Payment System and Rate Year 2010...

2010-06-17

121

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

Federal Register 2010, 2011, 2012, 2013

...CMS-1406-F] RIN 0938-AP80; RIN 0938-AP33 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System Changes and FY 2011 Rates; Provider...

2010-10-01

122

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

Federal Register 2010, 2011, 2012, 2013

...413, and 476 [CMS-1518-CN4] RIN 0938-AQ24 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates;...

2012-02-01

123

77 FR 60315 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...  

Federal Register 2010, 2011, 2012, 2013

...424, and 476 [CMS-1588-CN2] RIN 0938-AR12 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates;...

2012-10-03

124

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

Federal Register 2010, 2011, 2012, 2013

...CFR Parts 412 [CMS-1588-F2] RIN 0938-AR12 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2013 Rates;...

2012-10-17

125

76 FR 59263 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...  

Federal Register 2010, 2011, 2012, 2013

...CMS-1518-CN3] RIN 0938-AQ24; 0938-AQ92 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates;...

2011-09-26

126

Achieving better in-hospital and after-hospital care of patients with acute cardiac disease  

Microsoft Academic Search

In patients hospitalised with acute coronary syndromes (ACS) and congestive heart failure (CHF), evidence suggests opportunities for improving in-hospital and after- hospital care, patient self-care, and hospital-community integration.

Ian A Scott; Charles P Denaro; Cameron J Bennett; Annabel C Hickey; Alison M Mudge; Judy L Flores; Daniela C J Sanders; Justine M Thiele; Beres Wenck; John W Bennett; Mark A Jones

2004-01-01

127

Integrated hospital emergency care improves efficiency  

Microsoft Academic Search

Background:There is uncertainty about the most efficient model of emergency care. An attempt has been made to improve the process of emergency care in one hospital by developing an integrated model.Methods:The medical admissions unit was relocated into the existing emergency department and came under the 4-hour target. Medical case records were redesigned to provide a common assessment document for all

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

2008-01-01

128

Factors and Models Associated with the amount of Hospital Care Services as Demanded by Hospitalized Patients: A Systematic Review  

PubMed Central

Background Hospitals are constantly being challenged to provide high-quality care despite ageing populations, diminishing resources, and budgetary restraints. While the costs of care depend on the patients' needs, it is not clear which patient characteristics are associated with the demand for care and inherent costs. The aim of this study was to ascertain which patient-related characteristics or models can predict the need for medical and nursing care in general hospital settings. Methods We systematically searched MEDLINE, Embase, Business Source Premier and CINAHL. Pre-defined eligibility criteria were used to detect studies that explored patient characteristics and health status parameters associated to the use of hospital care services for hospitalized patients. Two reviewers independently assessed study relevance, quality with the STROBE instrument, and performed data analysis. Results From 2,168 potentially relevant articles, 17 met our eligibility criteria. These showed a large variety of factors associated with the use of hospital care services; models were found in only three studies. Age, gender, medical and nursing diagnoses, severity of illness, patient acuity, comorbidity, and complications were the characteristics found the most. Patient acuity and medical and nursing diagnoses were the most influencing characteristics. Models including medical or nursing diagnoses and patient acuity explain the variance in the use of hospital care services for at least 56.2%, and up to 78.7% when organizational factors were added. Conclusions A larger variety of factors were found to be associated with the use of hospital care services. Models that explain the extent to which hospital care services are used should contain patient characteristics, including patient acuity, medical or nursing diagnoses, and organizational and staffing characteristics, e.g., hospital size, organization of care, and the size and skill mix of staff. This would enable healthcare managers at different levels to evaluate hospital care services and organize or reorganize patient care. PMID:24878506

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

2014-01-01

129

Perceptions of jordanian head nurses of variables that influence the quality of nursing care.  

PubMed

The purpose of this research was to study the perceptions of head nurses in Jordan about variables that influence the quality of nursing care in a teaching hospital. Head nurses perceived that nurses "usually" provided high quality nursing care. Time was the most important factor that influenced the quality of nursing care. High quality care required adequate staffing levels. PMID:15326998

Mrayyan, Majd T

2004-01-01

130

Proceed with care. Hospital board fiduciary responsibilities.  

PubMed

Historically, there has been a tendency to give deference to the business deliberations and decisions of non-profit hospital boards. Today there is growing evidence that these decisions are coming under closer scrutiny as the result of an increase in transactional activity in the health care corporate environment and corresponding regulatory initiatives. PMID:10165606

Burns, L P

1997-01-01

131

Satisfaction with Quality of Care Received by Patients without National Health Insurance Attending a Primary Care Clinic in a Resource-Poor Environment of a Tertiary Hospital in Eastern Nigeria in the Era of Scaling up the Nigerian Formal Sector Health Insurance Scheme  

PubMed Central

Background: The increasing importance of the concept of patients’ satisfaction as a valuable tool for assessing quality of care is a current global healthcare concerns as regards consumer-oriented health services. Aim: This study assessed satisfaction with quality of care received by patients without national health insurance (NHI) attending a primary care clinic in a resource-poor environment of a tertiary hospital in South-Eastern Nigeria. Subject and Methods: This was a cross-sectional study carried out on 400 non-NHI patients from April 2011 to October 2011 at the primary care clinic of Federal Medical Centre, Umuahia, Nigeria. Adult patients seen within the study period were selected by systematic sampling using every second non-NHI patient that registered to see the physicians and who met the selection criteria. Data were collected using pretested, structured interviewer administered questionnaire designed on a five points Likert scale items with 1 and 5 indicating the lowest and highest levels of satisfaction respectively. Satisfaction was measured from the following domains: patient waiting time, patient–staff communication, patient-staff relationship, and cost of care, hospital bureaucracy and hospital environment. Operationally, patients who scored 3 points and above in the assessed domain were considered satisfied while those who scored less than 3 points were dissatisfied. Results: The overall satisfaction score of the respondents was 3.1. Specifically, the respondents expressed satisfaction with patient–staff relationship (3.9), patient–staff communication (3.8), and hospital environment (3.6) and dissatisfaction with patient waiting time (2.4), hospital bureaucracy (2.5), and cost of care (2.6). Conclusion: The overall non-NHI patient's satisfaction with the services provided was good. The hospital should set targets for quality improvement in the current domains of satisfaction while the cost of care has implications for government intervention as it mirrors the need to make NHI universal for all Nigerians irrespective of the employment status. PMID:23634326

Iloh, GUP; Ofoedu, JN; Njoku, PU; Okafor, GOC; Amadi, AN; Godswill-Uko, EU

2013-01-01

132

The health care market: can hospitals survive?  

PubMed

Does it sound familiar? Resources are scarce, competition is tough, and government regulations and a balanced budget are increasingly hard to meet at the same time. This is not the automobile or oil industry but the health care industry, and hospital managers are facing the same problems. And, maintains the author of this article, they must borrow some proven marketing techniques from business to survive in the new health care market. He first describes the features of the new market (the increasing economic power of physicians, new forms of health care delivery, prepaid health plans, and the changing regulatory environment) and then the possible marketing strategies for dealing with them (competing hard for physicians who control the patient flow and diversifying and promoting the mix of services). He also describes various planning solutions that make the most of a community's hospital facilities and affiliations. PMID:10247957

Goldsmith, J C

1980-01-01

133

A methodology model for quality management in a general hospital.  

PubMed

A reappraisal is made of the relevance of industrial modes of quality management to the issues of medical care. Analysis of the nature of medical care, which differentiates it from the supplier-client relationships of industry, presents the main intrinsic characteristics, which create problems in application of the industrial quality management approaches to medical care. Several examples are the complexity of the relationship between the medical action and the result obtained, the client's nonacceptance of economic profitability as a value in his medical care, and customer satisfaction biased by variable standards of knowledge. The real problems unique to hospitals are addressed, and a methodology model for their quality management is offered. Included is a sample of indicator vectors, measurements of quality care, cost of medical care, quality of service, and human resources. These are based on the trilogy of planning quality, quality control, and improving quality. The conclusions confirm the inadequacy of industrial quality management approaches for medical institutions and recommend investment in formulation of appropriate concepts. PMID:10169184

Stern, Z; Naveh, E

1997-01-01

134

Perspectives on home care quality.  

PubMed

Home care quality assurance (QA) must consider features inherent in home care, including: multiple goals, limited provider control, and unique family roles. Successive panels of stakeholders were asked to rate the importance of selected home care outcomes. Most highly rated outcomes were freedom from exploitation, satisfaction with care, physical safety, affordability, and physical functioning. Panelists preferred outcome indicators to process and structure, and all groups emphasized "enabling" criteria. Themes highlighted included: interpersonal components of care; normalizing life for clientele; balancing quality of life with safety; developing flexible, negotiated care plans; mechanisms for accountability and case management. These themes were formulated differently according to the stakeholders' role. Providers preferred intermediate outcomes, akin to process. PMID:10140158

Kane, R A; Kane, R L; Illston, L H; Eustis, N N

1994-01-01

135

Randomised controlled trial comparing hospital at home care with inpatient hospital care. II: cost minimisation analysis  

Microsoft Academic Search

AbstractObjectives:To examine the cost of providing hospital at home in place of some forms of inpatient hospital care.Design: Cost minimisation study within a randomised controlled trial.Setting: District general hospital and catchment area of neighbouring community trust.Subjects: Patients recovering from hip replacement (n=86), knee replacement (n=86), and hysterectomy (n=238); elderly medical patients (n=96); and patients with chronic obstructive airways disease (n=32).Interventions:

Sasha Shepperd; Diana Harwood; Alastair Gray; Martin Vessey; Patrick Morgan

1998-01-01

136

Use of hospitals, physician visits, and hospice care during last six months of life among cohorts loyal to highly respected hospitals in the United States  

Microsoft Academic Search

Objective To evaluate the use of healthcare resources during the last six months of life among patients of US hospitals with strong reputations for high quality care in managing chronic illness. Design Retrospective cohort study based on claims data from the US Medicare programme. Participants Cohorts receiving most of their hospital care from 77 hospitals that appeared on the 2001

John E Wennberg; Elliott S Fisher; Thérèse A Stukel; Jonathan S Skinner; Sandra M Sharp; Kristen K Bronner; Peggy Y Thomson

2004-01-01

137

Contradictions in the commodification of hospital care.  

PubMed

The "moralized markets" school within economic sociology has convincingly demonstrated variation in the relationship between economic activity and moral values. Yet this scholarship has not sufficiently explored either the causes of this variation or the consequences of this variation for organizational practice. By examining different moral-market understandings and practices in the context of a single market-based organizational field, this article highlights the contradictory character of processes of commodification, as different historically institutionalized ideas conflict, in different ways, with the market logic that increasingly organizes the field as a whole. The article examines the contradictory commodification of hospital care in three hospitals within one Northern California community. PMID:25243271

Reich, Adam D

2014-05-01

138

Helping You Choose Quality Behavioral Health Care  

MedlinePLUS

Helping You Choose Quality Behavioral Health Care Selecting quality behavioral health care services for yourself, a relative or friend requires special thought and attention. The Joint Commission on ...

139

The Hospital Medicine Reengineering Network (HOMERuN): a learning organization focused on improving hospital care.  

PubMed

Converting the health care delivery system into a learning organization is a key strategy for improving health outcomes. Although the collaborative learning organization approach has been successful in neonatal intensive care units and disease-specific collaboratives, there are few examples in general medicine and none in adult medicine that have leveraged the role of hospitalists nationally across multiple institutions to implement improvements. The authors describe the rationale for and early work of the Hospital Medicine Reengineering Network (HOMERuN), a collaborative of hospitals, hospitalists, and multidisciplinary care teams founded in 2011 that seeks to measure, benchmark, and improve the efficiency, quality, and outcomes of care in the hospital and afterwards. Robust and timely evaluation, with learning and refinement of approaches across institutions, should accelerate improvement efforts. The authors review HOMERuN's collaborative model, which focuses on a community-based participatory approach modified to include hospital-based staff as well as the larger community. HOMERuN's initial project is described, focusing on care transition measurement using perspectives from the patient, caregiver, and providers. Next steps and sustainability of the organization are discussed, including benchmarking, collaboration, and effective dissemination of best practices to stakeholders. PMID:24448050

Auerbach, Andrew D; Patel, Mitesh S; Metlay, Joshua P; Schnipper, Jeffrey L; Williams, Mark V; Robinson, Edmondo J; Kripalani, Sunil; Lindenauer, Peter K

2014-03-01

140

38 CFR 17.45 - Hospital care for research purposes.  

Code of Federal Regulations, 2012 CFR

... Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.45 Hospital care for research purposes. Subject to the provisions of § 17.62(g),...

2012-07-01

141

38 CFR 17.45 - Hospital care for research purposes.  

Code of Federal Regulations, 2013 CFR

... Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.45 Hospital care for research purposes. Subject to the provisions of § 17.62(g),...

2013-07-01

142

Extending hospital to the primary care office.  

PubMed

Using a Centers for Medicare & Medicaid Services Innovation grant, Beth Israel Deaconess Medical Center in Boston launched a program to prevent readmissions. Care transition specialist nurses are assigned to six primary care practices and work with patients in the practice to which they are assigned. They meet patients in the hospital and follow them for 30 days after discharge. The program includes pharmacists who conduct medication reconciliation and work with patients on medication issues, and a social worker who is called in when patients have psychosocial needs. PMID:24923072

2014-06-01

143

Living with diabetes: quality of care and quality of life  

PubMed Central

Background: The aim of this research was to characterize the experience of living with diabetes mellitus (DM) and identify patients’ opinions of the quality of care received and the results of interventions. Methods: A descriptive, exploratory evaluation study using qualitative methodology was performed. Participants consisted of 40 adult patients diagnosed with DM and followed up in a public hospital in Barcelona, Spain. A semistructured interview and a focus group were used and a thematic content analysis was performed. Results: Patients described DM as a disease that is difficult to control and that provokes lifestyle changes requiring effort and sacrifice. Insulin treatment increased the perception of disease severity. The most frequent and dreaded complication was hypoglycemia. The main problems perceived by patients affecting the quality of care were related to a disease-centered medical approach, lack of information, limited participation in decision-making, and the administrative and bureaucratic problems of the health care system. Conclusion: The bureaucratic circuits of the health care system impair patients’ quality of life and perceived quality of care. Health professionals should foster patient participation in decision-making. However, this requires not only training and appropriate attitudes, but also adequate staffing and materials. PMID:21423590

Pera, Pilar Isla

2011-01-01

144

How Costly is Hospital Quality? A Revealed-Preference Approach*  

PubMed Central

We analyze the cost of quality improvement in hospitals, dealing with two challenges. Hospital quality is multidimensional and hard to measure, while unobserved productivity may influence quality supply. We infer the quality of hospitals in Los Angeles from patient choices. We then incorporate ‘revealed quality’ into a cost function, instrumenting with hospital demand. We find that revealed quality differentiates hospitals, but is not strongly correlated with clinical quality. Revealed quality is quite costly, and tends to increase with hospital productivity. Thus, non-clinical aspects of the hospital experience (perhaps including patient amenities) play important roles in hospital demand, competition, and costs. PMID:22299199

Romley, John A.; Goldman, Dana P.

2013-01-01

145

76 FR 19365 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and...  

Federal Register 2010, 2011, 2012, 2013

...RIN 0938-AQ97 Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and Fiscal Year 2011 Final Wage Indices...fiscal year (FY) 2011 wage indices and hospital reclassifications and other related...

2011-04-07

146

A taxonomy of nursing care organization models in hospitals  

PubMed Central

Background Over the last decades, converging forces in hospital care, including cost-containment policies, rising healthcare demands and nursing shortages, have driven the search for new operational models of nursing care delivery that maximize the use of available nursing resources while ensuring safe, high-quality care. Little is known, however, about the distinctive features of these emergent nursing care models. This article contributes to filling this gap by presenting a theoretically and empirically grounded taxonomy of nursing care organization models in the context of acute care units in Quebec and comparing their distinctive features. Methods This study was based on a survey of 22 medical units in 11 acute care facilities in Quebec. Data collection methods included questionnaire, interviews, focus groups and administrative data census. The analytical procedures consisted of first generating unit profiles based on qualitative and quantitative data collected at the unit level, then applying hierarchical cluster analysis to the units’ profile data. Results The study identified four models of nursing care organization: two professional models that draw mainly on registered nurses as professionals to deliver nursing services and reflect stronger support to nurses’ professional practice, and two functional models that draw more significantly on licensed practical nurses (LPNs) and assistive staff (orderlies) to deliver nursing services and are characterized by registered nurses’ perceptions that the practice environment is less supportive of their professional work. Conclusions This study showed that medical units in acute care hospitals exhibit diverse staff mixes, patterns of skill use, work environment design, and support for innovation. The four models reflect not only distinct approaches to dealing with the numerous constraints in the nursing care environment, but also different degrees of approximations to an “ideal” nursing professional practice model described by some leaders in the contemporary nursing literature. While the two professional models appear closer to this ideal, the two functional models are farther removed. PMID:22929127

2012-01-01

147

Quality indicators for cardiovascular primary care  

PubMed Central

BACKGROUND: The Canadian Cardiovascular Outcomes Research Team was established in 2001 to improve the quality of cardiovascular care for Canadians. Initially, quality indicators (QIs) for hospital-based care for those with acute myocardial infarctions and congestive heart failure were developed and measured. Qualitative research on the acceptability of those indicators concluded that indicators were needed for ambulatory primary care practice, where the bulk of cardiovascular disease care occurs. OBJECTIVES: To systematically develop QIs for primary care practice for the primary prevention and chronic disease management of ischemic heart disease, hypertension, hyperlipidemia and heart failure. METHODS: A four-stage modified Delphi approach was used and included a literature review of evidence-based practice guidelines and previously developed QIs; the development and circulation of a survey tool with proposed QIs, asking respondents to rate each indicator for validity, necessity to record and feasibility to collect; an in-person meeting of respondents to resolve rating and content discrepancies, and suggest additional QIs; and recirculation of the survey tool for rating of additional QIs. Participants from across Canada included family physicians, primary care nurses, an emergency room family physician and cardiologists. RESULTS: 31 QIs were agreed on, nine of which were for primary prevention and 22 of which were for chronic disease management. CONCLUSIONS: A core set of QIs for ambulatory primary care practice has been developed as a tool for practitioners to evaluate the quality of cardiovascular disease care. While the participants rated the indicators as feasible to collect, the next step will be to conduct field validation. PMID:17440644

Burge, Frederick I; Bower, Kelly; Putnam, Wayne; Cox, Jafna L

2007-01-01

148

Structural Predictors of Child Care Quality in Child Care Homes.  

ERIC Educational Resources Information Center

Used data from a family child care study and a licensing study to identify dimensions best predicting global day care quality in over 300 child care homes. Found that caregiver training most consistently predicted global quality. Found no reliable association between care quality and child-caregiver ratio or age-weighted group size recommendations…

Burchinal, Margaret; Howes, Carollee; Kontos, Susan

2002-01-01

149

Health Literacy and Communication Quality in Health Care Organizations  

Microsoft Academic Search

The relationship between limited health literacy and poor health may be due, in part, to poor communication quality within health care delivery organizations. We explored the relationship between health literacy status and receiving patient-centered communication in clinics and hospitals serving communication-vulnerable patient populations. Thirteen health care organizations nationwide distributed a survey to 5929 patients. All patients completed seven items assessing

Matthew K. Wynia; Chandra Y. Osborn

2010-01-01

150

Satisfaction of hospitalized psychiatry patients: why should clinicians care?  

PubMed Central

Background The aim of this study was to determine the relationship between inpatient satisfaction and health outcomes, quality of life, and adherence to treatment in a sample of patients with schizophrenia, while considering key sociodemographic and clinical confounding factors. Methods This cross-sectional study was conducted in the psychiatric departments of two public university hospitals in France. The data collected included sociodemographic information, clinical characteristics, quality of life (using the 36-Item Short Form Health Survey), nonadherence to treatment (Medication Adherence Report Scale), and satisfaction (a specific self-administered questionnaire based exclusively on patient point of view [Satispsy-22] and a generic questionnaire for hospitalized patients [QSH]). Multiple linear regressions were performed to assess the associations between satisfaction and quality of life and between satisfaction and nonadherence. Two sets of models were performed, ie, scores on the Satispsy-22 and scores on the QSH. Results Ninety-one patients with schizophrenia were enrolled. After adjustment for confounding factors, patients with better personal experience during hospitalization (Satispsy-22) had a better psychological quality of life (SF36-mental composite score, ?=0.37; P=0.004), and patients with higher levels of satisfaction with quality of care (Satispsy-22) showed better adherence to treatment (Medication Adherence Report Scale total score, ?=?0.32; P=0.021). Higher QSH scores for staff and structure index were linked to better adherence with treatment (respectively, ?=?0.33; P=0.019 and ?=?0.30; P=0.032), but not with quality of life. Conclusion Satisfaction was the only factor associated with quality of life and was one of the most important features associated with nonadherence. These findings confirm that satisfaction with hospitalization should not be neglected in clinical practice and that it may improve the management of patients with schizophrenia. PMID:24812494

Zendjidjian, Xavier-Yves; Baumstarck, Karine; Auquier, Pascal; Loundou, Anderson; Lancon, Christophe; Boyer, Laurent

2014-01-01

151

38 CFR 17.43 - Persons entitled to hospital or domiciliary care.  

...Persons entitled to hospital or domiciliary care. 17.43 Section 17.43 Pensions... Hospital, Domiciliary and Nursing Home Care § 17.43 Persons entitled to hospital or domiciliary care. Hospital or domiciliary care may...

2014-07-01

152

Epidemiology and costs of hospital care for COPD in Puglia  

PubMed Central

Background and aims Chronic obstructive pulmonary disease (COPD) is currently the 5th cause of morbidity and mortality in the developed world and represents a substantial economic and social burden. The aim of this study is to report on hospital admissions and related costs of hospital treatment for COPD in the Puglia Region of Italy in the years 2005-2007. Materials and methods Patients were selected who were hospitalized between 01/01/2005 and 31/12/2007 with ICD-9-CM code: 490.xx: bronchitis not specified as acute or chronic; 491.xx: chronic bronchitis; 492.xx: emphysema; 493.xx: asthma; 494.xx: bronchiectasis; 496.xx: chronic airway obstruction not elsewhere classified; 518.81: acute respiratory failure as principal or secondary diagnosis. Results In the period 2005-2007, there were 73,721 hospital admissions for COPD registered in Puglia (25,690 in 2005; 24,153 in 2006 and 23,878 in 2007) of which 34.3% were women, with no significant variation in the three years. There appears to be a negative trend in hospitalisations in Puglia for chronic bronchitis with ratios decreasing from 359.4 per 100,000 population in 2005 to 307.9 per 100,000 in 2007. The overall cost of COPD for Apulian hospital trusts was €272,293,182.85 over the 3-year period. Conclusions Analysis of the data for hospital care, its costs and performance may be an important indicator of the efficacy of community care. In particular, the lack of reduction in admissions for COPD should lead decision makers to question both the appropriateness and quality of the care given. PMID:22958809

2011-01-01

153

Telemedicine for the care of children in the hospital setting.  

PubMed

Telemedicine is by no means a new technology, given that audio-video telecommunication links have been utilized for the provision of medical services since the 1950s. Nonetheless, telemedicine is currently in a phase of rapid growth and evolution. The combination of increasingly affordable and powerful networking, computing, and communication technology, along with the continued nationwide crisis in health care access and costs, has created a "tipping point," whereby telemedicine has progressed from a novel means of practicing medicine to practical tool to help address our nation's health care needs. Telemedicine has also evolved beyond a means of providing care to remote communities to becoming a versatile tool in the delivery of health care in a variety of non-rural settings. Although no one can be everywhere at once, telemedicine allows us to be in more places at once than we've ever been before. The problems of disparities and access to care are even more evident in pediatrics, where subspecialists are fewer in number and more regionalized than adult providers. Numerous successful telemedicine programs across the country have demonstrated the impact that these technologies can have in pediatrics, with many more programs in development. As a versatile means of delivering care, telemedicine can be used at any point during the course of a health care encounter as not only a means of expanding our reach, but also as a means of increasing efficiency. Using telemedicine to provide consultations to community hospitals has been shown to improve quality of care, strengthen the referral base for the consulting facilities, facilitate cost savings, and improve the financial bottom line for both referring and consulting facilities. This review highlights some of the ways in which telemedicine is being used to facilitate timely and effective pediatric care in a variety of hospital settings. PMID:24512161

McSwain, S David; Marcin, James P

2014-02-01

154

Quality of care: past achievements and future challenges.  

PubMed

The heightened attention currently given to quality of care offers a unique opportunity for major advances. But to make the most of it, the greater energy and resources now available have to build on what is already known about quality of care, rather than largely ignore and therefore rediscover what has been learned in the past about, for example: how quality can be defined and measured, the relation between outcomes and the process of care, and the distinction between quality assessment and determinations of efficacy. If future efforts are rooted in what is known about these and other aspects of quality of care, they can yield substantial insights into how to improve quality, rather than simply how to measure it, and how to do it for more than inpatient hospital care. PMID:2966118

Wyszewianski, L

1988-01-01

155

Hospital Coding Practice, Data Quality, and DRG-Based Reimbursement under the Thai Universal Coverage Scheme  

ERIC Educational Resources Information Center

In the Thai Universal Coverage scheme, hospital providers are paid for their inpatient care using Diagnosis Related Group (DRG) reimbursement. Questionable quality of the submitted DRG codes has been of concern whereas knowledge about hospital coding practice has been lacking. The objectives of this thesis are (1) To explore hospital coding…

Pongpirul, Krit

2011-01-01

156

A framework of pediatric hospital discharge care informed by legislation, research, and practice.  

PubMed

To our knowledge, no widely used pediatric standards for hospital discharge care exist, despite nearly 10?000 pediatric discharges per day in the United States. This lack of standards undermines the quality of pediatric hospital discharge, hinders quality-improvement efforts, and adversely affects the health and well-being of children and their families after they leave the hospital. In this article, we first review guidance regarding the discharge process for adult patients, including federal law within the Social Security Act that outlines standards for hospital discharge; a variety of toolkits that aim to improve discharge care; and the research evidence that supports the discharge process. We then outline a framework within which to organize the diverse activities that constitute discharge care to be executed throughout the hospitalization of a child from admission to the actual discharge. In the framework, we describe processes to (1) initiate pediatric discharge care, (2) develop discharge care plans, (3) monitor discharge progress, and (4) finalize discharge. We contextualize these processes with a clinical case of a child undergoing hospital discharge. Use of this narrative review will help pediatric health care professionals (eg, nurses, social workers, and physicians) move forward to better understand what works and what does not during hospital discharge for children, while steadily improving their quality of care and health outcomes. PMID:25155156

Berry, Jay G; Blaine, Kevin; Rogers, Jayne; McBride, Sarah; Schor, Edward; Birmingham, Jackie; Schuster, Mark A; Feudtner, Chris

2014-10-01

157

WSU SPOKANE'S HEALTH CARE PARTNERS Pullman Memorial Hospital  

E-print Network

WSU SPOKANE'S HEALTH CARE PARTNERS · Pullman Memorial Hospital · Kootenai Medical Center · Sacred Heart Medical Center · Sacred Heart Children's Hospital · Empire Health Foundation · Providence Health Care · Community Health Systems · Shriners Hospital · St. Luke's Rehabilitation · Rockwood

Collins, Gary S.

158

Indigent Care As Quid Pro Quo In Hospital Regulation  

Microsoft Academic Search

Hospitals expend considerable resources each year to provide health care to the poor. Why do some hospitals voluntarily take on a disproportionate burden of this care? Our view is that the burdened hospitals are not simply altruistic. They are indirectly compensated for this expense with legal protections against competition under certificate-ofneed (CON) regulation. We test this hypothesis in a recursive

Gary M. Fournier; Ellen S. Campbell

1997-01-01

159

Ten Components of Quality Child Care  

E-print Network

Ten Components of Quality Child Care FACT SHEET The FSU Knight Foundation Quality Child Care Initiative What constitutes quality child care? Research defines ten essential components that produce meaningful outcomes for the young children they serve. Child care programs that endeavor to improve often

McQuade, D. Tyler

160

Competition, Payers, and Hospital Quality1  

PubMed Central

Objective To estimate the effects of competition for both Medicare and HMO patients on the quality decisions of hospitals in Southern California. Data Source Secondary discharge data from the Office of Statewide Health Planning and Development for the State of California for the period 1989–1993. Study Design Outcome variables are the risk-adjusted hospital mortality rates for pneumonia (estimated by the authors) and acute myocardial infarction (AMI) (reported by the state of California). Measures of competition are constructed for each hospital and payer type. The competition measures are formulated to mitigate the possibility of endogeneity bias. The relationships between risk-adjusted mortality and the different competition measures are estimated using ordinary least squares. Principal Findings The study finds that an increase in the degree of competition for health maintenance organization (HMO) patients is associated with a decrease in risk-adjusted hospital mortality rates. Conversely, an increase in competition for Medicare enrollees is associated with an increase in risk-adjusted mortality rates for hospitals. Conclusions In conjunction with previous research, the estimates indicate that increasing competition for HMO patients appears to reduce prices and save lives and hence appears to improve welfare. However, increases in competition for Medicare appear to reduce quality and may reduce welfare. Increasing competition has little net effect on hospital quality in our sample. PMID:14727780

Gowrisankaran, Gautam; Town, Robert J

2003-01-01

161

38 CFR 17.196 - Aid for hospital care.  

Code of Federal Regulations, 2010 CFR

...2010-07-01 2010-07-01 false Aid for hospital care. 17.196 Section...DEPARTMENT OF VETERANS AFFAIRS MEDICAL Aid to States for Care of Veterans in State Homes § 17.196 Aid for hospital care. Aid may be...

2010-07-01

162

38 CFR 17.196 - Aid for hospital care.  

Code of Federal Regulations, 2011 CFR

...2011-07-01 2011-07-01 false Aid for hospital care. 17.196 Section...DEPARTMENT OF VETERANS AFFAIRS MEDICAL Aid to States for Care of Veterans in State Homes § 17.196 Aid for hospital care. Aid may be...

2011-07-01

163

38 CFR 17.196 - Aid for hospital care.  

Code of Federal Regulations, 2012 CFR

...2012-07-01 2012-07-01 false Aid for hospital care. 17.196 Section...DEPARTMENT OF VETERANS AFFAIRS MEDICAL Aid to States for Care of Veterans in State Homes § 17.196 Aid for hospital care. Aid may be...

2012-07-01

164

38 CFR 17.196 - Aid for hospital care.  

Code of Federal Regulations, 2013 CFR

...2013-07-01 2013-07-01 false Aid for hospital care. 17.196 Section...DEPARTMENT OF VETERANS AFFAIRS MEDICAL Aid to States for Care of Veterans in State Homes § 17.196 Aid for hospital care. Aid may be...

2013-07-01

165

The Loneliest Babies: Foster Care in the Hospital  

ERIC Educational Resources Information Center

This article discusses an ignored problem--the plight of infants and toddlers in foster care who find themselves hospitalized. A majority of the children in foster care will be hospitalized for medical treatment while in foster care because they are more likely to have serious medical problems or developmental disabilities than their age peers.…

Dicker, Sheryl

2012-01-01

166

The Role of Specialized Geriatric Services in Acute Care Hospitals  

Microsoft Academic Search

In Canada, the sustainability of the health care system is a major issue that has led to two commissions which are currently addressing the future of health care.(1,2) Improving technology and changes in the delivery of health care have led to major restructuring of the system. Acute hospital beds and the length of hospital stays have decreased with the concomitant

Rory Fisher

167

38 CFR 17.196 - Aid for hospital care.  

...2014-07-01 false Aid for hospital care. 17.196 Section 17.196 Pensions...VETERANS AFFAIRS MEDICAL Aid to States for Care of Veterans in State Homes § 17.196 Aid for hospital care. Aid may be paid to the designated...

2014-07-01

168

Impact Of Asset Age\\/Fiscal Viability On Selected Measures Of Quality In Hospitals  

Microsoft Academic Search

Seventy-three New York hospitals were examined to determine if a relationship between age of assets, fiscal viability and quality of care existed. These factors were examined for 2002 for each of the hospitals selected. Several financial variables were used to construct a fiscal viability index; and a quality index was created from selected mortality outcomes and procedural measures that may

Jim Morey; Gary Scherzer

2005-01-01

169

Family Perspectives on the Quality of Pediatric Palliative Care  

Microsoft Academic Search

Background: As a prelude to establishing a Pediatric Palliative Care Program, we solicited information from families about their experiences and their suggestions for improving the quality of end-of-life care. Participants were English- and Spanish-speaking family members of de- ceased pediatric patients who received care at Lucile Salter Packard Children's Hospital, Stanford University Medi- cal Center, Palo Alto, Calif. Methods: Sixty-eight

Nancy Contro; Judith Larson; Sarah Scofield; Barbara Sourkes; Harvey Cohen

2002-01-01

170

Measuring Hospital Quality Using Pediatric Readmission and Revisit Rates  

PubMed Central

OBJECTIVE: To assess variation among hospitals on pediatric readmission and revisit rates and to determine the number of high- and low-performing hospitals. METHODS: In a retrospective analysis using the State Inpatient and Emergency Department Databases from the Healthcare Cost and Utilization Project with revisit linkages available, we identified pediatric (ages 1–20 years) visits with 1 of 7 common inpatient pediatric conditions (asthma, dehydration, pneumonia, appendicitis, skin infections, mood disorders, and epilepsy). For each condition, we calculated rates of all-cause readmissions and rates of revisits (readmission or presentation to the emergency department) within 30 and 60 days of discharge. We used mixed logistic models to estimate hospital-level risk-standardized 30-day revisit rates and to identify hospitals that had performance statistically different from the group mean. RESULTS: Thirty-day readmission rates were low (<10.0%) for all conditions. Thirty-day rates of revisit to the inpatient or emergency department setting ranged from 6.2% (appendicitis) to 11.0% (mood disorders). Study hospitals (n = 958) had low condition-specific visit volumes (37.0%–82.8% of hospitals had <25 visits). The only condition with >1% of hospitals labeled as different from the mean on 30-day risk-standardized revisit rates was mood disorders (4.2% of hospitals [n = 15], range of hospital performance 6.3%–15.9%). CONCLUSIONS: We found that when comparing hospitals’ performances to the average, few hospitals that care for children are identified as high- or low-performers for revisits, even for common pediatric diagnoses, likely due to low hospital volumes. This limits the usefulness of condition-specific readmission or revisit measures in pediatric quality measurement. PMID:23979094

Vittinghoff, Eric; Asteria-Penaloza, Renee; Edwards, Jeffrey D.; Yazdany, Jinoos; Lee, Henry C.; Boscardin, W. John; Cabana, Michael D.; Dudley, R. Adams

2013-01-01

171

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

PubMed Central

Objective The assessment of integral quality management (QM) in a hospital requires measurement and monitoring from different perspectives and at various levels of care delivery. Within the DUQuE project (Deepening our Understanding of Quality improvement in Europe), seven measures for QM were developed. This study investigates the relationships between the various quality measures. Design It is a multi-level, cross-sectional, mixed-method study. Setting and Participants As part of the DUQuE project, we invited a random sample of 74 hospitals in 7 countries. The quality managers of these hospitals were the main respondents. Furthermore, data of site visits of external surveyors assessing the participating hospitals were used. Main Outcome Measures Three measures of QM at hospitals level focusing on integral systems (QMSI), compliance with the Plan-Do-Study-Act quality improvement cycle (QMCI) and implementation of clinical quality (CQII). Four measures of QM activities at care pathway level focusing on Specialized expertise and responsibility (SER), Evidence-based organization of pathways (EBOP), Patient safety strategies (PSS) and Clinical review (CR). Results Positive significant associations were found between the three hospitals level QM measures. Results of the relationships between levels were mixed and showed most associations between QMCI and department-level QM measures for all four types of departments. QMSI was associated with PSS in all types of departments. Conclusion By using the seven measures of QM, it is possible to get a more comprehensive picture of the maturity of QM in hospitals, with regard to the different levels and across various types of hospital departments. PMID:24615597

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

2014-01-01

172

Skilled nursing facility quality and hospital readmissions  

PubMed Central

Importance Hospital readmissions are common, costly, and potentially preventable. Little is known about the association between available SNF performance measures and the risk of hospital readmission. Objective To measure the association between SNF performance measures and hospital readmissions among Medicare beneficiaries receiving post-acute care at U.S. SNFs. Design Using national Medicare data, we examined the association between SNF performance on publicly available metrics (SNF staffing intensity, performance on required facility site inspections, and the percentages of SNF patients with delirium, moderate-to-severe pain, and new or worsening pressure ulcers) and the risk of readmission or death 30 days after discharge to a SNF. Adjusted analyses controlled for patient case-mix, SNF facility factors, and the discharging hospital. Participants Fee-for-service Medicare beneficiaries discharged to a SNF following an acute-care hospitalization between September 1, 2009 and August 31, 2010. Main outcomes and measures Readmission to an acute-care hospital or death within 30 days of the index hospital discharge. Results Out of 1,530,824 discharges, 357,752 (23.4%;99% CI: 23.3%, 23.5%) were readmitted or died within 30 days; 4.7% (72,472 discharges) died within 30 days (99% CI: 4.7%, 4.8%), and 21.0%(N=321,709) were readmitted (99% CI: 20.9%, 21.1%). The unadjusted risk of readmission or death was lower at SNFs with better staffing ratings (lowest (19.2% of SNFs) vs. highest (6.7% of SNFs): 25.5%; 99% CI: 25.3%, 25.8% vs 19.8%; 99% CI: 19.5%, 20.1%, p<0.001) and better facility inspection ratings (lowest (20.1% of SNFs) vs. highest (9.8% of SNFs): 24.9%; 99% CI: 24.7%,25.1%; vs. 21.5%; 99% CI: 21.2%, 21.7%; p<0.001). Adjustment for patient factors, SNF facility factors, and the discharging hospital attenuated these associations; we observed small differences in the adjusted risk of readmission or death according to SNF facility inspection ratings (lowest vs. highest rating: 23.7%; 99% CI: 23.7%, 23.7%; vs 23.0%; 99% CI:23.0%, 23.1%; p<0.001). Other measures did not predict clinically meaningful differences in the adjusted risk of readmission or death. Conclusions and relevance Among fee-for-service Medicare beneficiaries discharged to a SNF following an acute care hospitalization, available performance measures were not consistently associated with differences in the adjusted risk of readmission or death. PMID:25321909

Neuman, Mark D.; Wirtalla, Christopher; Werner, Rachel M.

2014-01-01

173

Improving post-abortion care in a public hospital in Oaxaca, Mexico  

Microsoft Academic Search

This paper describes patients' and providers' perceptions of the quality of care in the treatment of 132 women who arrived at the emergency room of a public hospital in Oaxaca, Mexico, with complications of abortion, whether spontaneous or induced clandestinely. This hospital was interested in assessing and improving its services. Questionnaires, on-site observation and indepth interviews revealed insensitive personal treatment

Ana Langer; Cecilia Garcia-Barrios; Angela Heimburger; Karen Stein; Beverly Winikoff; Vilma Barahona; Beatriz Casas; Francisca Ramirez

1997-01-01

174

[Ethnography of health care after hospital discharge].  

PubMed

This paper presents an analysis of how Clifford Geertz' anthropological approach contributes to studies and investigations on health care. Geertz' approach relies basically on a semiotic conception of culture adopting thick description as the axis for interpretive elaborations and defending cultural interpretation as a science allowing to understand processes and to construct knowledge. We will present an overview of some constitutive elements of that author's thoughts we consider relevant for understanding the human experience of dealing with the disease/health process. The challenging question is how families deal with the need to provide care to a diseased relative after hospital discharge. We use this issue as an excuse for expounding this theoretical approach, interweaving the two areas. The micro-focus is the kind of healthcare that takes place outside the cultural environment where the technical forms of care based on scientific knowledge occur. We will briefly discuss how this question becomes evident in an object of study, and how it can be investigated according to the ethnography proposed by Geertz (op. cit.), allowing, in the end, for some considerations that further contribute to the construction of knowledge in public health. PMID:19039391

de Castro, Edna Aparecida Barbosa; de Camargo Junior, Kenneth Rochel

2008-12-01

175

How Far to the Hospital? The Effect of Hospital Closures on Access to Care  

Microsoft Academic Search

Do urban hospital closures affect health care access or health outcomes? We study closures in Los Angeles County between 1997 and 2003, through their effect on distance to the nearest hospital. We find that increased distance to the nearest hospital shifts regular care away from emergency rooms and outpatient clinics to doctor's offices. While most residents are otherwise unaffected by

Thomas C. Buchmueller; Mireille Jacobson; Cheryl Wold

2004-01-01

176

Hospital service quality: a managerial challenge.  

PubMed

While much is known generally about predictions of customer-perceived service quality, their application to health services is rarer. No attempt has been made to examine the impact of social support and patient education on overall service quality perception. Together with six quality dimensions identified from the literature, this study seeks to provide a more holistic comprehension of hospital service quality prediction. Although 79 percent of variation is explained, other than technical quality the impact of the remaining factors on quality perception is far from constant, and socio-economic variables further complicate unpredictability. Contrary to established beliefs, the cost factor was found to be insignificant. Hence, to manage service quality effectively, the test lies in how well healthcare providers know the customers they serve. It is not only crucial in a globalized environment, where trans-national patient mobility is increasingly the norm, but also within homogeneous societies that appear to converge culturally. PMID:15301271

Rose, Raduan Che; Uli, Jegak; Abdul, Mohani; Ng, Kim Looi

2004-01-01

177

Pattern of cancer deaths in a saudi tertiary care hospital.  

PubMed

The medical records of deceased patients were reviewed to describe the pattern of cancer deaths in a newly established Saudi tertiary care hospital. During eleven months, 87 patients died of cancer. The majority (80 patients, 92%) died of incurable cancer; among which 53% did not receive any systemic anti-cancer therapy (SAT) and 43% received SAT with palliative intent. Younger age (< 65 years), relatively chemosensitive tumours and initial presentation in a potentially curable stage were associated with higher prevalence of palliative SAT administration (p = 0.009, 0.019 and 0.001, respectively). The last palliative SAT was administered during the last two months of life in 66% and during the last two weeks in 14%. During the last admission, 54% of patients were admitted through emergency room, 50% stayed >14 days and 14% died in intensive care unit or emergency room. The results demonstrate that palliative care is a realistic treatment for the majority of patients in our setting and that a significant proportion of these patients receive aggressive care at the end-of-life. There is a need to establish an integrative palliative care program to improve the quality-of-life of dying cancer patients in our region and to minimize the aggressiveness of end-of-life care. PMID:22378940

Al-Zahrani, Abdullah S; El-Kashif, Amr T; Haggag, Rasha M; Alsirafy, Samy A

2013-02-01

178

Accountable Care Organizations: roles and opportunities for hospitals.  

PubMed

Federal health reform has established Medicare Accountable Care Organizations (ACOs) as a new program, and some states and private payers have been independently developing ACO pilot projects. The objective is to hold provider groups accountable for the quality and cost of care to a population. The financial models for providers generally build off of shared savings between the payers and providers or some type of global payment that includes the possibility of partial or full capitation. For ACOs to achieve the same outcomes with lower costs or, better yet, improved outcomes with the same or lower costs, the delivery system will need to become more oriented toward primary care and care coordination than is currently the case. Providers of clinical services, in order to be more effective, efficient, and coordinated, will need to be supported by a variety of shared services, such as off-hours care, easy access to specialties, and information exchanges. These services can be organized by an ACO as a medical neighborhood or community. Hospitals, because they have a management structure, history of developing programs and services, and accessibility 24/7/365, are logical leaders of this enhancement of health care delivery for populations and other providers. PMID:21881401

Schoenbaum, Stephen C

2011-08-01

179

Improving Health Care Quality Reporting: Lessons from the California HealthCare Foundation. Oakland, CA: California HealthCare Foundation  

Microsoft Academic Search

The California HealthCare Foundation has devoted substantial resources to promoting public reporting on the quality of California hospitals, physician groups, and nursing homes. Mathematica conducted an evaluation of the foundation's work from 1998 through 2005, identifying lessons from its experience in fostering quality information and exploring avenues for future foundation involvement in the field. This brief looks at the measurement

Beth Stevens; Tim Lake; Erin Fries Taylor

2007-01-01

180

Managing variability to improve quality, capacity and cost in the perioperative process at Massachusetts General Hospital  

E-print Network

The widely held assumption is that to improve access and quality of health care, we need to spend more. In fact, that is not necessarily true. The results of this project, performed at Massachusetts General Hospital (MGH), ...

Price, Devon J. (Devon Jameson)

2011-01-01

181

Does Investor Ownership of Nursing Homes Compromise the Quality of Care?  

Microsoft Academic Search

For the 1.6 million Americans who reside in nursing homes, the quality of care largely de- termines the quality of life. Most patients in acute-care hospitals will return to their homes and families, regaining command of their sleep schedules, food choices, hygiene, and mobility. They can generally change physicians and hospitals if dissatisfied. But most nursing home patients cannot go

Charlene Harrington; Steffie Woolhandler; Joseph Mullan; Helen Carrillo; David U. Himmelstein

2001-01-01

182

Organisational quality, nurse staffing and the quality of chronic disease management in primary care: Observational study using routinely collected data  

Microsoft Academic Search

Background An association between quality of care and staffing levels, particularly registered nurses, has been established in acute hospitals. Recently an association between nurse staffing and quality of care for several chronic conditions has also been demonstrated for primary care in English general practice. A smaller body of literature identifies organisational factors, in particular issues of human resource management, as

Peter Griffiths; Jill Maben; Trevor Murrells

2011-01-01

183

A Survey of Nursing Home Organizational Characteristics Associated with Potentially Avoidable Hospital Transfers and Care Quality in One Large British Columbia Health Region  

ERIC Educational Resources Information Center

Hospitalization of nursing home residents can be futile as well as costly, and now evidence indicates that treating nursing home residents in place produces better outcomes for some conditions. We examined facility organizational characteristics that previous research showed are associated with potentially avoidable hospital transfers and with…

McGregor, Margaret J.; Baumbusch, Jennifer; Abu-Laban, Riyad B.; McGrail, Kimberlyn M.; Andrusiek, Dug; Globerman, Judith; Berg, Shannon; Cox, Michelle B.; Salomons, Kia; Volker, Jan; Ronald, Lisa

2011-01-01

184

Organizing integrated care in a university hospital: application of a conceptual framework  

PubMed Central

Background and aim As a result of New Public Management, a number of industrial models of quality management have been implemented in health care, mainly in hospitals. At the same time, the concept of integrated care has been developed within other parts of the health sector. The aim of the article is to discuss the relevance of integrated care for hospitals. Theory and methods The discussion is based on application of a conceptual framework outlining a number of organizational models of integrated care. These models are illustrated in a case study of a Danish university hospital implementing a new organization for improving the patient flows of the hospital. The study of the reorganization is based mainly on qualitative data from individual and focus group interviews. Results The new organization of the university hospital can be regarded as a matrix structure combining a vertical integration of clinical departments with a horizontal integration of patient flows. This structure has elements of both interprofessional and interorganizational integration. A strong focus on teamwork, meetings and information exchange is combined with elements of case management and co-location. Conclusions It seems that integrated care can be a relevant concept for a hospital. Although the organizational models may challenge established professional boundaries and financial control systems, this concept can be a more promising way to improve the quality of care than the industrial models that have been imported into health care. This application of the concept may also contribute to widen the field of integrated care. PMID:24966806

Axelsson, Runo; Axelsson, Susanna Bihari; Gustafsson, Jeppe; Seemann, Janne

2014-01-01

185

Subjective Indoor Air Quality in Geriatric Hospitals  

Microsoft Academic Search

This investigation studied subjective indoor air quality (IAQ) in hospitals in relation to building dampness and the type of construction. Building dampness is known to be an important contributor to perception of the indoor environment. Dampness in floor construction is known to cause chemical degradation of polyvinyl chloride floor coatings, but few epidemiological studies on this topic have been published.

K. Nordström; D. Norbäck; G. Wieslander

1999-01-01

186

Patient readmission to critical care units during the same hospitalization at a community teaching hospital  

Microsoft Academic Search

The incidence and cause of patient readmission, during the same hospitalization, to a critical care unit was studied in an urban community teaching hospital. During a 12-month period, there were 1069 admissions to the critical care units with 640 patients being at risk for readmission. The readmission rate was 11.7%. Prematurity of transfer out of a critical care unit may

W. Baigelman; R. Katz; Geraldine Geary

1983-01-01

187

Hospital-based Palliative care: A Case for Integrating Care with Cure.  

PubMed

The reason that probably prompted Dame Cicely Saunders to launch the palliative care movement was the need to move away from the impersonal, technocratic approach to death that had become the norm in hospitals after the Second World War. Palliative care focuses on relieving the suffering of patients and families. Not limited to just management of pain, it includes comprehensive management of any symptom, which affects the quality of life. Care is optimized through early initiation and comprehensive implementation throughout the disease trajectory. Effective palliative care at the outset can help accelerate a positive clinical outcome. At the end of life, it can enhance the opportunity for the patient and family to achieve a sense of growth, resolve differences, and find a comfortable closure. It helps to reduce the suffering and fear associated with dying and prepares the family for bereavement. PMID:21811377

Kulkarni, Priya Darshini

2011-01-01

188

Hospital-based Palliative care: A Case for Integrating Care with Cure  

PubMed Central

The reason that probably prompted Dame Cicely Saunders to launch the palliative care movement was the need to move away from the impersonal, technocratic approach to death that had become the norm in hospitals after the Second World War. Palliative care focuses on relieving the suffering of patients and families. Not limited to just management of pain, it includes comprehensive management of any symptom, which affects the quality of life. Care is optimized through early initiation and comprehensive implementation throughout the disease trajectory. Effective palliative care at the outset can help accelerate a positive clinical outcome. At the end of life, it can enhance the opportunity for the patient and family to achieve a sense of growth, resolve differences, and find a comfortable closure. It helps to reduce the suffering and fear associated with dying and prepares the family for bereavement. PMID:21811377

Kulkarni, Priya Darshini

2011-01-01

189

Advocate Good Samaritan Hospital Advocate Good Samaritan Hospital, an acute-care medical facility  

E-print Network

Advocate Good Samaritan Hospital Advocate Good Samaritan Hospital, an acute-care medical facility in Downers Grove, Illinois, has evolved during the past 30 years from a midsized community hospital relationships as well as the organizational transformation of "moving from good to great," the hospital has

Magee, Joseph W.

190

Medicare Managed Care plan Performance: A Comparison across Hospitalization Types  

PubMed Central

Objective The study evaluates the performance of Medicare managed care (Medicare Advantage [MA]) Plans in comparison to Medicare fee-for-service (FFS) Plans in three states with historically high Medicare managed care penetration (New York, California, Florida), in terms of lowering the risks of preventable or ambulatory care sensitive conditions (ACSC) hospital admissions and providing increased referrals for admissions for specialty procedures. Study Design/Methods Using 2004 hospital discharge files from the Healthcare Cost and Utilization Project (HCUP-SID) of the Agency for Healthcare Research and Quality, ACSC admissions are compared with ‘marker’ admissions and ‘referral-sensitive’ admissions, using a multinomial logistic regression approach. The year 2004 represents a strategic time to test the impact of MA on preventable hospitalizations, because the HMOs dominated the market composition in that time period. Findings MA enrollees in California experienced 22% lower relative risk (RRR= 0.78, p<0.01), those in Florida experienced 16% lower relative risk (RRR= 0.84, p<0.01), while those in New York experienced 9% lower relative risk (RRR=0.91, p<0.01) of preventable (versus marker) admissions compared to their FFS counterparts. MA enrollees in New York experienced 37% higher relative risk (RRR=1.37, p<0.01) and those in Florida had 41% higher relative risk (RRR=1.41, p<0.01)—while MA enrollees in California had 13% lower relative risk (RRR=0.87, p<0.01)—of referral-sensitive (versus marker) admissions compared to their FFS counterparts. Conclusion While MA plans were associated with reductions in preventable hospitalizations in all three states, the effects on referral-sensitive admissions varied, with California experiencing lower relative risk of referral-sensitive admissions for MA plan enrollees. The lower relative risk of preventable admissions for MA plan enrollees in New York and Florida became more pronounced after accounting for selection bias. PMID:24800137

Basu, Jayasree; Mobley, Lee Rivers

2012-01-01

191

Defining Quality Child Care: Multiple Stakeholder Perspectives  

ERIC Educational Resources Information Center

Multiple perspectives regarding the definition of quality child care, and how child care quality can be improved, were examined using a focus group methodology. Participants were representatives from stakeholder groups in the child care profession, including child care center owners and directors (3 groups), parents (3 groups), child caregivers (3…

Harrist, Amanda W.; Thompson, Stacy D.; Norris, Deborah J.

2007-01-01

192

Healthcare professionals' views on factors influencing end-of-life care in hospitals  

Microsoft Academic Search

AbstractIntroduction and aimsThe majority of patients die in the acute setting, yet care delivered to the dying in hospitals is variable and the underlying reasons for this are not documented well. We aimed to explore healthcare professionals' views on the factors influencing good quality end-of-life care within an acute hospital Trust.MethodsWithin a feasibility study examining the impact of a simple

K Forbes; J Gibbins; M E Burcombe; S J Bloor; C M Reid; R C McCoubrie

2011-01-01

193

Quality-of-care challenges for rural health.  

PubMed

The purpose of this article is to examine the issue of quality of care in rural America and to help others examine this issue in a way that is consistent with the very real challenges faced by rural communities in ensuring the availability of adequate health services. Rural citizens have a right to expect that their local health care meets certain basic standards. Unless rural providers can document that the quality of local health care meets objective external standards, third-party payers might refuse to contract with rural providers, and increasingly sophisticated consumers might leave their communities for basic medical care services. To improve the measurement of health care quality in a rural setting, a number of issues specific to the rural environment must be addressed, including small sample sizes (volume and outcome issues), limited data availability, the ability to define rural health service areas, rural population preferences and the lower priority of formal quality-of-care assessment in shortage areas. Several current health policy initiatives have substantial implications for monitoring and measuring the quality of rural health services. For example, to receive community acceptance and achieve fiscal stability, critical access hospitals (CAHs) must be able to document that the care they provide is at least comparable to that of their predecessor institutions. The expectations for quality assurance activities in CAHs should consider their limited institutional resources and community preferences. As managed care extends from urban areas, there will be an inevitable collision between the ability to provide care and the ability to measure quality. As desirable as it might be to have a national standard for health care quality, this is not an attainable goal. The spectrum and content of rural health care are different from the spectrum and content of care provided in large cities. Accrediting agencies, third-party carriers and health insurance purchasers need to develop rural health care quality standards that are practical, useful and affordable. PMID:10981369

Moscovice, I; Rosenblatt, R

2000-01-01

194

Benchmarking and audit of breast units improves quality of care  

PubMed Central

?Quality Indicators (QIs) are measures of health care quality that make use of readily available hospital inpatient administrative data. Assessment quality of care can be performed on different levels: national, regional, on a hospital basis or on an individual basis. It can be a mandatory or voluntary system. In all cases development of an adequate database for data extraction, and feedback of the findings is of paramount importance. In the present paper we performed a Medline search on “QIs and breast cancer” and “benchmarking and breast cancer care”, and we have added some data from personal experience. The current data clearly show that the use of QIs for breast cancer care, regular internal and external audit of performance of breast units, and benchmarking are effective to improve quality of care. Adherence to guidelines improves markedly (particularly regarding adjuvant treatment) and there are data emerging showing that this results in a better outcome. As quality assurance benefits patients, it will be a challenge for the medical and hospital community to develop affordable quality control systems, which are not leading to excessive workload. PMID:24753926

van Dam, P. A.; Verkinderen, L.; Hauspy, J.; Vermeulen, P.; Dirix, L.; Huizing, M.; Altintas, S.; Papadimitriou, K.; Peeters, M.; Tjalma?, W.

2013-01-01

195

Managed care and the scale efficiency of US hospitals.  

PubMed

Managed care penetration has been partly responsible for slowing down increases in health care costs in recent years. This study uses a 1992-1996 Health Care Utilization Project sample of hospitals to analyze the relationship between managed care penetration in local insurance markets and hospital scale efficiency. After controlling for hospital and market area variables, we find that managed care insurance, particularly the preferred provider type, is associated with increases in hospital scale efficiency in tertiary cases. The results presented here are consistent with the view that managed care can lead to reductions in health cost inflation by controlling the diffusion of technology via improvements in the scale efficiency of hospitals. PMID:17111213

Brown, H Shelton; Pagán, José A

2006-12-01

196

Can we tell whether hospital care is safe?  

PubMed

One of the most troubling implications of Sir Robert Francis's reports on Mid Staffordshire ( Mid Staffordshire NHS Foundation Trust Inquiry, 2010 ; Mid Staffordshire NHS Foundation Trust Public Inquiry, 2013b) is that similar failings might be occurring elsewhere, undetected and uncorrected. That the deficits in the quality of care at Stafford should have gone unnoticed and unaddressed for so long has caused widespread soul-searching. It prompted the government to commission a review of 14 other hospitals 'to take a fresh look at these organisations, many of which have been inspected many times before and granted a clean bill of health, despite the continuing high mortality rates' ( Keogh, 2013 ), which 'uncovered previously undisclosed problems in care' ( Keogh, 2013 ). If, as the Keogh review suggests, existing methods cannot always give us an accurate picture of risk and harm, then how can we tell whether patients are safe? PMID:25216161

2014-09-01

197

Quality assurance and organizational effectiveness in hospitals.  

PubMed Central

The purpose of this paper is to explore some aspects of a general theoretical model within which research on the organizational impacts of quality assurance programs in hospitals may be examined. Quality assurance is conceptualized as an organizational control mechanism, operating primarily through increased formalization of structures and specification of procedures. Organizational effectiveness is discussed from the perspective of the problem-solving theory of organizations, wherein effective organizations are those which maintain at least average performance in all four system problem areas simultaneously (goal-attainment, integration, adaptation and pattern-maintenance). It is proposed that through the realization of mutual benefits for both professionals and the bureaucracy, quality assurance programs can maximize such effective performance in hospitals. PMID:7096096

Hetherington, R W

1982-01-01

198

Situational awareness, relational coordination and integrated care delivery to hospitalized elderly in The Netherlands: a comparison between hospitals  

PubMed Central

Background It is known that interprofessional collaboration is crucial for integrated care delivery, yet we are still unclear about the underlying mechanisms explaining effectiveness of integrated care delivery to older patients. In addition, we lack research comparing integrated care delivery between hospitals. Therefore, this study aims to (i) provide insight into the underlying components ‘relational coordination’ and ‘situational awareness’ of integrated care delivery and the role of team and organizational context in integrated care delivery; and (ii) compare situational awareness, relational coordination, and integrated care delivery of different hospitals in the Netherlands. Methods This cross-sectional study took place in 2012 among professionals from three different hospitals involved in the delivery of care to older patients. A total of 215 professionals filled in the questionnaire (42% response rate).Descriptive statistics and paired-sample t-tests were used to investigate the level of situational awareness, relational coordination, and integrated care delivery in the three different hospitals. Correlation and multilevel analyses were used to investigate the relationship between background characteristics, team context, organizational context, situational awareness, relational coordination and integrated care delivery. Results No differences in background characteristics, team context, organizational context, situational awareness, relational coordination and integrated care delivery were found among the three hospitals. Correlational analysis revealed that situational awareness (r?=?0.30; p?care delivery. Stepwise multilevel analyses showed that formal internal communication (p?care delivery. Team climate was not significantly associated with integrated care delivery when situational awareness and relational coordination were included in the equation. Thus situational awareness acted as mediator between team climate and integrated care delivery among professionals delivering care to older hospitalized patients. Conclusions The results of this study show the importance of formal internal communication and situational awareness for quality of care delivery to hospitalized older patients. PMID:24410889

2014-01-01

199

Service quality in health care setting  

Microsoft Academic Search

Purpose – This paper attempts to explore the concept of service quality in a health care setting. Design\\/methodology\\/approach – This paper probes the definition of service quality from technical and functional aspects for a better understanding on how consumers evaluate the quality of health care. It adopts the conceptual model of service quality frequently used by the most researchers in

Wan Edura Wan Rashid; Hj. Kamaruzaman Jusoff

2009-01-01

200

The effect of care planning on quality of patient care.  

PubMed

Nursing care plans can be seen as a means of ensuring holistic care. This study investigated the view of nurses and support workers on the care plan as a tool to enhance quality care and how their views were reflected in practice. PMID:9873343

Webster, J

1998-11-01

201

HOSPITAL-LEVEL VARIATION IN THE QUALITY OF UROLOGIC CANCER SURGERY  

PubMed Central

Background Unexplained variation in outcomes after common surgeries raises concerns about the quality and appropriateness of surgical care. Understanding variation in surgical outcomes may identify processes that could affect the quality of surgical and postoperative care. We sought to examine hospital-level variation in outcomes following inpatient urologic oncology procedures. Methods We identified subjects that underwent radical cystectomy, radical nephrectomy, and radical prostatectomy from the Washington State Comprehensive Hospital Abstract Reporting System (CHARS) for the years 2003–2007. We measured postoperative length of stay (LOS) and classified LOS exceeding the 75th percentile as prolonged, the occurrence of Agency for Healthcare Quality Patient Safety Indicators (PSIs), readmissions, and death. We adjusted for patient age and comorbidity in random effects multilevel multivariable models that assessed hospital-level outcomes. Results We identified 853 cystectomy subjects from 37 hospitals, 3,018 nephrectomy subjects from 51 hospitals, and 8,228 prostatectomy subjects from 51 hospitals. Complications captured by PSIs were rare. Hospital-level variation was most profound for LOS outcomes after nephrectomy and prostatectomy (8.1% and 26.7% of variance in prolonged LOS, respectively), thromboembolic events after nephrectomy (8.0% of variance), and mortality after cystectomy (7.1% of variance). Conclusions Hospital-level variation confounds the care of urologic cancer patients in the state of Washington. Transparent reporting of surgical outcomes and local quality improvement initiatives should be considered to ameliorate the observed variation and improve the quality of cystectomy, nephrectomy, and prostatectomy care. PMID:21792864

Gore, John L.; Wright, Jonathan L.; Daratha, Kenn B.; Roberts, Kenneth P.; Lin, Daniel W.; Wessells, Hunter; Porter, Michael

2011-01-01

202

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

Code of Federal Regulations, 2010 CFR

...2010-10-01 2010-10-01 false Special payment provisions for long-term care hospitals within hospitals and satellites of long-term care hospitals. 412.534 Section 412.534 Public Health CENTERS FOR MEDICARE &...

2010-10-01

203

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

Code of Federal Regulations, 2011 CFR

...2011-10-01 2011-10-01 false Special payment provisions for long-term care hospitals within hospitals and satellites of long-term care hospitals. 412.534 Section 412.534 Public Health CENTERS FOR MEDICARE &...

2011-10-01

204

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

Code of Federal Regulations, 2013 CFR

...2013-10-01 2013-10-01 false Special payment provisions for long-term care hospitals within hospitals and satellites of long-term care hospitals. 412.534 Section 412.534 Public Health CENTERS FOR MEDICARE &...

2013-10-01

205

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

Code of Federal Regulations, 2012 CFR

...2012-10-01 2012-10-01 false Special payment provisions for long-term care hospitals within hospitals and satellites of long-term care hospitals. 412.534 Section 412.534 Public Health CENTERS FOR MEDICARE &...

2012-10-01

206

Variations in the quality of care at radical prostatectomy  

PubMed Central

Postoperative morbidity and mortality is low following radical prostatectomy (RP), though not inconsequential. Due to the natural history of the disease process, the implications of treatment on long-term oncologic control and functional outcomes are of increased significance. Structures, processes and outcomes are the three main determinants of quality of RP care and provide the framework for this review. Structures affecting quality of care include hospital and surgeon volume, hospital teaching status and patient insurance type. Process determinants of RP care have been poorly studied, by and large, but there is a developing trend toward the performance of randomized trials to assess the merits of evolving RP techniques. Finally, the direct study of RP outcomes has been particularly controversial and includes the development of quality of life measurement tools, combined outcomes measures, and the use of utilities to measure operative success based on individual patient priority. PMID:22496709

Sammon, Jesse; Jhaveri, Jay; Sun, Maxine; Ghani, Khurshid R.; Schmitges, Jan; Jeong, Wooju; Peabody, James O.; Karakiewicz, Pierre I.; Menon, Mani

2012-01-01

207

[Criteria used in the health care quality assurance systems].  

PubMed

The author presents the criteria used in the health care quality assurance systems with special attention paid to the following issues: Quality management system ISO 9000:2000. European Foundation Quality Management. Hospital accreditation. Quality assurance system in occupational health services in Norway "Good OHS". Quality management criteria are regarded as guidelines for functioning of organizations. All presented evaluation systems are based on a common set of criteria, which include: client-patient orientation; advancement of stuff skills; information management; services and management improvement. PMID:14978899

Wdówik, Pawe?

2003-01-01

208

Assessing the quality of patient handoffs at care transitions  

Microsoft Academic Search

BackgroundEffective handoff practices (ie, mechanisms for transferring information, responsibility and authority) are critical to ensure continuity of care and patient safety.ObjectiveThis study aimed to develop a rating tool (self-rating and external rating) for handoff quality that goes beyond mere information transfer.MethodsThe rating tool was piloted during 126 patient handoffs performed in three different clinical settings in a tertiary care hospital:

Tanja Manser; Simon Foster; Stefan Gisin; Dalit Jaeckel; Wolfgang Ummenhofer

2010-01-01

209

Who's Judging the Quality of Care? Indigenous Maya and the Problem of “Not Being Attended”  

Microsoft Academic Search

In developing countries, lack of trust in the quality of care provided is often cited as a major factor promoting reluctance to seek biomedical help for obstetric emergencies. This article draws on fieldwork among Mayan informants in Sololá, Guatemala, to explore poor perceptions of the quality of care received when seeking obstetric care in the hospital. Using data collected over

Nicole S. Berry

2008-01-01

210

Hospitals, managed care, and the charity caseload in California.  

PubMed

We ask whether increasing HMO penetration causes hospitals to cut back on charity care using California hospital discharge data for 1988-1996. There is little evidence at the hospital level that private hospitals respond to HMOs by turning away uninsured and/or Medicaid patients. In the for-profit sector hospitals actually reduce the share of privately insured patients and increase the shares of Medicare patients and Medicaid births. Apparently, HMO penetration reduces the price paid by privately insured patients, making them relatively less attractive to for-profit hospitals. PMID:15120464

Currie, Janet; Fahr, John

2004-05-01

211

Nurse staffing and patient falls on acute care hospital units  

Microsoft Academic Search

Changes in health care financing, beginning in the 1980's, resulted in reduced nurse staffing and skill levels in acute care hospitals. Research has shown that reduced nurse staffing has endangered some aspects of patient safety. This study estimated the relationship between three aspects of nurse staffing and the patient fall rate for four types of acute care units. The association

Nancy Dunton; Byron Gajewski; Roma Lee Taunton; Jan Moore

2004-01-01

212

[Quality management in intensive care medicine].  

PubMed

Treatment of critical ill patients in the intensive care unit is tantamount to well-designed risk or quality management. Several tools of quality management and quality assurance have been developed in intensive care medicine. In addition to external quality assurance by benchmarking with regard to the intensive care medicine, peer review procedures have been established for external quality assurance in recent years. In the process of peer review of an intensive care unit (ICU), external physicians and nurses visit the ICU, evaluate on-site proceedings, and discuss with the managing team of the ICU possibilities for optimization. Furthermore, internal quality management in the ICU is possible based on the 10 quality indicators of the German Interdisciplinary Society for Intensive Care Medicine (DIVI, "Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin"). Thereby every ICU has numerous possibilities to improve their quality management system. PMID:24493011

Martin, J; Braun, J-P

2014-02-01

213

Quality of Care and Quality of Life: Convergence or Divergence?  

PubMed Central

The aim of this study was to explore the impact of quality of care (QoC) on patients’ quality of life (QoL). In a cross-sectional study, two domains of QoC and the World Health Organization Quality of Life-Bref questionnaire were combined to collect data from 1,059 pre-discharge patients in four accredited hospitals (ACCHs) and four non-accredited hospitals (NACCHs) in Saudi Arabia. Health and well-being are often restricted to the characterization of sensory qualities in certain settings such as unrestricted access to healthcare, effective treatment, and social welfare. The patients admitted to tertiary health care facilities are generally able to present themselves with a holistic approach as to how they experience the impact of health policy. The statistical results indicated that patients reported a very limited correlation between QoC and QoL in both settings. The model established a positive, but ultimately weak and insignificant, association between QoC (access and effective treatment) and QoL (r = 0.349, P = 0.000; r = 0.161, P = 0.000, respectively). Even though the two settings are theoretically different in terms of being able to conceptualize, adopt, and implement QoC, the outcomes from both settings demonstrated insignificant relationships with QoL as the results were quite similar. Though modern medicine has substantially improved QoL around the world, this paper proposes that health accreditation has a very limited impact on improving QoL. This paper raises awareness of this topic with multiple healthcare professionals who are interested in correlating QoC and QoL. Hopefully, it will stimulate further research from other professional groups that have new and different perspectives. Addressing a transitional health care system that is in the process of endorsing accreditation, investigating the experience of tertiary cases, and analyzing deviated data may limit the generalization of this study. Global interest in applying public health policy underlines the impact of such process on patients’ outcomes. As QoC accreditation does not automatically produce improved QoL outcomes, the proposed study encourages further investigation of the value of health accreditation on personal and social well-being. PMID:25114568

Alonazi, Wadi B; Thomas, Shane A

2014-01-01

214

Quality of everyday life in long stay institutions for the elderly. An observational study of long stay hospital and nursing home care  

Microsoft Academic Search

The observational study reported here was part of a wider evaluation of long stay care for elderly people. The observational study showed that it was essential not to rely on interview material alone. Qualitative techniques provided insights into behaviours, moods and interactions which would have been difficult to measure using traditional survey techniques. The data collected was analyzed in relation

Patricia Clark; Ann Bowling

1990-01-01

215

Hospital-sponsored primary care: I. Organizational and financial effects.  

PubMed Central

Findings are presented from a seven-year (1976-83) evaluation of the Community Hospital Program (CHP), a national demonstration program sponsored by the Robert Wood Johnson Foundation to assist 54 community hospitals in improving the organization of access to primary care. Upon grant expiration, 66 per cent of hospital-sponsored group practices continued under some form of hospital sponsorship; over 90 per cent developed or were planning to develop spin-off programs; and new physicians were recruited and retained in the community. About 9 per cent of hospital admissions were accounted for by group physicians and grantee hospitals experienced a greater annual increase in their market share of admissions than competing hospitals in the area. While only three of the groups generated sufficient revenue to cover expenses during the grant period, 21 additional groups broke even during the first post-grant year. Productivity and cost per visit compared favorably with most other forms of care. Hospitalization rates from the hospital-sponsored practices were somewhat lower than those for other forms of care. Medical director leadership and involvement and the organization design of the practice were among several key factors associated with higher performing practices. The ability of such joint hospital-physician ventures to meet the needs of the poor and elderly in a time of Medicare and Medicaid cutbacks is discussed along with suggestions for targeting future initiatives in primary care. PMID:6742268

Shortell, S M; Wickizer, T M; Wheeler, J R

1984-01-01

216

Defining and advocating for spiritual care in the hospital.  

PubMed

A definition of spiritual care and attention to the scientific literature can strengthen the advocacy efforts of hospital funded chaplaincy programs. Adapting Pargament's work, spiritual care is defined here as giving professional attention to the subjective spiritual and religious worlds of patients, worlds comprised of perceptions, assumptions, feelings, and beliefs concerning the relationship of the sacred to their illness, hospitalization, and recovery or possible death. Results from the scientific literature are then presented in response to four advocacy related questions: 1) How do hospital decision makers and chaplains perceive the experience of hospitalization, 2) Does a need for spiritual care exists; is it relevant, 3) Who can best provide spiritual care, and 4) Are chaplain visits helpful? This definition and advocacy material can be useful when decision makers review the funding of spiritual care. PMID:20828074

VandeCreek, Larry

2010-01-01

217

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

PubMed Central

Background Strategic leadership is an important organizational capability and is essential for quality improvement in hospital settings. Furthermore, the quality of leadership depends crucially on a common set of shared values and mutual trust between hospital management board members. According to the concept of social capital, these are essential requirements for successful cooperation and coordination within groups. Objectives We assume that social capital within hospital management boards is an important factor in the development of effective organizational systems for overseeing health care quality. We hypothesized that the degree of social capital within the hospital management board is associated with the effectiveness and maturity of the quality management system in European hospitals. Methods We used a mixed-method approach to data collection and measurement in 188 hospitals in 7 European countries. For this analysis, we used responses from hospital managers. To test our hypothesis, we conducted a multilevel linear regression analysis of the association between social capital and the quality management system score at the hospital level, controlling for hospital ownership, teaching status, number of beds, number of board members, organizational culture, and country clustering. Results The average social capital score within a hospital management board was 3.3 (standard deviation: 0.5; range: 1-4) and the average hospital score for the quality management index was 19.2 (standard deviation: 4.5; range: 0-27). Higher social capital was associated with higher quality management system scores (regression coefficient: 1.41; standard error: 0.64, p=0.029). Conclusion The results suggest that a higher degree of social capital exists in hospitals that exhibit higher maturity in their quality management systems. Although uncontrolled confounding and reverse causation cannot be completely ruled out, our new findings, along with the results of previous research, could have important implications for the work of hospital managers and the design and evaluation of hospital quality management systems. PMID:24392027

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

2013-01-01

218

38 CFR 17.49 - Priorities for outpatient medical services and inpatient hospital care.  

Code of Federal Regulations, 2011 CFR

...outpatient medical services and inpatient hospital care. 17.49 Section 17.49 ...DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care...outpatient medical services and inpatient hospital care. In scheduling...

2011-07-01

219

38 CFR 17.43 - Persons entitled to hospital or domiciliary care.  

Code of Federal Regulations, 2011 CFR

...2011-07-01 false Persons entitled to hospital or domiciliary care. 17.43 ...DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.43 Persons entitled to hospital or domiciliary care....

2011-07-01

220

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

Code of Federal Regulations, 2011 CFR

...2011-07-01 2011-07-01 false Hospital care and medical services in foreign...OF VETERANS AFFAIRS MEDICAL Hospital Or Nursing Home Care and Medical...Foreign Countries § 17.35 Hospital care and medical services in...

2011-07-01

221

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

Code of Federal Regulations, 2010 CFR

...2010-07-01 2010-07-01 false Hospital care and medical services in foreign...OF VETERANS AFFAIRS MEDICAL Hospital Or Nursing Home Care and Medical...Foreign Countries § 17.35 Hospital care and medical services in...

2010-07-01

222

38 CFR 17.43 - Persons entitled to hospital or domiciliary care.  

Code of Federal Regulations, 2010 CFR

...2010-07-01 false Persons entitled to hospital or domiciliary care. 17.43 ...DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.43 Persons entitled to hospital or domiciliary care....

2010-07-01

223

38 CFR 17.43 - Persons entitled to hospital or domiciliary care.  

Code of Federal Regulations, 2013 CFR

...2013-07-01 false Persons entitled to hospital or domiciliary care. 17.43 ...DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.43 Persons entitled to hospital or domiciliary care....

2013-07-01

224

38 CFR 17.49 - Priorities for outpatient medical services and inpatient hospital care.  

Code of Federal Regulations, 2010 CFR

...outpatient medical services and inpatient hospital care. 17.49 Section 17.49 ...DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care...outpatient medical services and inpatient hospital care. In scheduling...

2010-07-01

225

38 CFR 17.43 - Persons entitled to hospital or domiciliary care.  

Code of Federal Regulations, 2012 CFR

...2012-07-01 false Persons entitled to hospital or domiciliary care. 17.43 ...DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.43 Persons entitled to hospital or domiciliary care....

2012-07-01

226

38 CFR 17.49 - Priorities for outpatient medical services and inpatient hospital care.  

...medical services and inpatient hospital care. 17.49 Section 17.49 Pensions...Hospital, Domiciliary and Nursing Home Care § 17.49 Priorities for outpatient medical services and inpatient hospital care. In scheduling appointments for...

2014-07-01

227

38 CFR 17.49 - Priorities for outpatient medical services and inpatient hospital care.  

Code of Federal Regulations, 2013 CFR

...outpatient medical services and inpatient hospital care. 17.49 Section...VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17...outpatient medical services and inpatient hospital care. In scheduling...

2013-07-01

228

38 CFR 17.49 - Priorities for outpatient medical services and inpatient hospital care.  

Code of Federal Regulations, 2012 CFR

...outpatient medical services and inpatient hospital care. 17.49 Section...VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17...outpatient medical services and inpatient hospital care. In scheduling...

2012-07-01

229

Patterns of Care/Quality of Care  

Cancer.gov

POC studies began in 1987 with SEER cases serving as controls for a study that examined the provision of state-of-the-art therapy in Community Clinical Oncology Program hospitals. In 1990, the number of cases included in the POC initiative was increased substantially to obtain more stable estimates of community practice in a population-based sample of cases.

230

Parents' participation in taking care of hospitalized children: A concept analysis with hybrid model  

PubMed Central

Background: Although today parents’ participation in taking care of hospitalized children is considered as an indispensable principle, it is still among the concepts with no consensus about. The main objective of this study is to define parents’ participation in taking care of hospitalized children. Materials and Methods: The concept of “parents’ participation in taking care of hospitalized children” was analyzed using a hybrid model in three phases: Literature review (theoretical phase), fieldwork, and combination of literature review and fieldwork (analytical phase). Results: Based on the results of theoretical (literature review), fieldwork, and analytical phases, the best definitions for the concept of “parents’ participation in taking care of hospitalized children” are mutual relationship and gaining parents’ trust toward nurses, giving the required information and education to the parents about care and treatment process, assigning the needed home care to the parents, involving the parents in caregiving process, and finally, defining their participation in decision making (clarifying the parents’ role) in order to improve the quality of care given to the children. Conclusions: The findings of this study showed that the dimensions of parents’ participation can be applied in pediatric wards, and nurses can improve the quality of care through application of the obtained findings. PMID:24834082

Vasli, Parvaneh; Salsali, Mahvash

2014-01-01

231

Hospital episode statistics: improving the quality and value of hospital data: a national internet e-survey of hospital consultants  

PubMed Central

Hypothesis Senior hospital clinicians are poorly engaged with clinical coding and hospital episode statistics (HES). Aims ???To understand the current level of clinical engagement with collection of national data and clinical coding. ??To gain the views of frontline staff on proposed improvements to hospital statistics. ??To gain an indication of likely clinical engagement in change. ??To understand the clinical priority for improvement. Design Internet e-survey accessible from Academy of Royal Medical College Website. Setting National Health Service (NHS) Trusts. Participants 1081 NHS hospital consultants and two general practitioners who volunteered to take part. Results 3.4% of the sample regularly access HES data; 21% are regularly involved in clinical coding and 6.2% meet coding staff at least monthly. 95% would like to access HES data and there was a strong support for using this data for appraisal, revalidation and improving the quality of patient care. In terms of improvements, 91.9% would be prepared to code diagnosis in outpatients given the right tools. The highest priority for improvement is clinical validation of diagnostic data. Conclusions Clinical engagement with coding and access to HES data is poor. However, there is professional support for improvement. Clinical requirements should be considered in all future developments of national data collection to provide the quality and scope of data that is required to deliver the information revolution. PMID:23166129

Spencer, Stephen Andrew; Davies, Mark Price

2012-01-01

232

Implementing a Pediatric Obesity Care Guideline in a Freestanding Children's Hospital to Improve Child Safety and Hospital Preparedness1  

PubMed Central

Medical and surgical care of children with severe obesity is complicated and requires recognition of the problem, appropriate equipment, and safe management. There is little literature describing patient, provider, and institutional needs for the severely obese pediatric patient. Nonetheless, the limited data suggest 3 broad categories of needs unique to this population: (a) airway management, (b) drug dosing and pharmacology, and (c) equipment and infrastructure. We describe an opportunity at the Children’s Hospital Colorado to better prepare and optimize care for this patient population by creation of a Pediatric Obesity Care Guideline that focused on key areas of quality and safety. PMID:22178030

Porter, Renee M.; Thrasher, Jodi; Krebs, Nancy F.

2013-01-01

233

The association between hospital volume and processes, outcomes, and costs of care for congestive heart failure  

PubMed Central

Background Congestive Heart Failure (CHF) is common and costly, and despite pharmacologic and technical advances, outcomes remain suboptimal. Objective To examine whether hospitals that have more experience caring for patients with CHF provide better, more efficient care. Design We used national Medicare claims data from 2006–2007 to examine the relationship between hospitals’ case volume and quality, outcomes, and costs for patients with CHF. Setting 4,095 U.S. hospitals Patients Medicare fee-for-service patients with a primary discharge diagnosis of CHF Measurements Hospital Quality Alliance (HQA) CHF process measures, 30-day risk-adjusted mortality rates, 30-day risk-adjusted readmission rates, and costs per discharge. Results Hospitals in the lowest volume group had lower performance on HQA measures than medium- or high-volume hospitals (80.2% versus 87.0% versus 89.1%, p<0.001). Within the low volume group, being admitted to a hospital with a higher case volume was associated with lower mortality, lower readmission, and higher costs. For example, in the lowest volume group of hospitals, an increase of 10 cases of CHF was associated with 1% lower odds of mortality, 1% lower odds of readmissions and $22 higher costs per case. We found similar though smaller relationships between case volume and both mortality and costs in the medium and high-volume hospital cohorts. Limitations Our analysis was limited to Medicare patients 65 years of age or older; risk adjustment was performed using administrative data. Conclusions Experience with managing CHF, as measured by an institution’s volume, is associated with higher quality of care and better outcomes for patients, but at a higher cost. Understanding which practices employed by high-volume institutions account for these advantages can help improve quality of care and clinical outcomes for all CHF patients. PMID:21242366

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

2012-01-01

234

Patient satisfaction surveys and quality of care: an information paper.  

PubMed

With passage of the Patient Protection and Affordable Care Act of 2010, payment incentives were created to improve the "value" of health care delivery. Because physicians and physician practices aim to deliver care that is both clinically effective and patient centered, it is important to understand the association between the patient experience and quality health outcomes. Surveys have become a tool with which to quantify the consumer experience. In addition, results of these surveys are playing an increasingly important role in determining hospital payment. Given that the patient experience is being used as a surrogate marker for quality and value of health care delivery, we will review the patient experience-related pay-for-performance programs and effect on emergency medicine, discuss the literature describing the association between quality and the patient-reported experience, and discuss future opportunities for emergency medicine. PMID:24656761

Farley, Heather; Enguidanos, Enrique R; Coletti, Christian M; Honigman, Leah; Mazzeo, Anthony; Pinson, Thomas B; Reed, Kevin; Wiler, Jennifer L

2014-10-01

235

Child Care: Use of Standards To Ensure High Quality Care.  

ERIC Educational Resources Information Center

Prepared to assist Congress in its deliberations of various child care proposals, this report identifies key child care center standards that are critical in helping to ensure high quality child care. The article also examines the extent to which states incorporate these standards into their own standards, and discusses other important issues that…

General Accounting Office, Washington, DC. Health, Education, and Human Services Div.

236

Current status of quality evaluation of nursing care through director review and reflection from the Nursing Quality Control Centers  

PubMed Central

Background: The quality evaluation of nursing care is a key link in medical quality management. It is important and worth studying for the nursing supervisors to know the disadvantages during the process of quality evaluation of nursing care and then to improve the whole nursing quality. This study was to provide director insight on the current status of quality evaluation of nursing care from Nursing Quality Control Centers (NQCCs). Material and Methods: This qualitative study used a sample of 12 directors from NQCCs who were recruited from 12 provinces in China to evaluate the current status of quality evaluation of nursing care. Data were collected by in-depth interviews. Content analysis method was used to analyze the data. Results: Four themes emerged from the data: 1) lag of evaluation index; 2) limitations of evaluation content; 3) simplicity of evaluation method; 4) excessive emphasis on terminal quality. Conclusion: It is of great realistic significance to ameliorate nursing quality evaluation criteria, modify the evaluation content based on patient needs-oriented idea, adopt scientific evaluation method to evaluate nursing quality, and scientifically and reasonably draw horizontal comparisons of nursing quality between hospitals, as well as longitudinal comparisons of a hospital’s nursing quality. These methods mentioned above can all enhance a hospital’s core competitiveness and benefit more patients.

Duan, Xia; Shi, Yan

2014-01-01

237

Acute Care For Elders Units Produced Shorter Hospital Stays At Lower Cost While Maintaining Patients' Functional Status  

PubMed Central

Acute Care for Elders Units offer enhanced care for older adults in specially designed hospital units. The care is delivered by interdisciplinary teams, which can include geriatricians, advanced practice nurses, social workers, pharmacists, and physical therapists. In a randomized controlled trial of 1,632 elderly patients, length-of-stay was significantly shorter—6.7 days per patient versus 7.3 days per patient—among those receiving care in the Acute Care for Elders Unit compared to usual care. This difference produced lower total inpatient costs—$9,477 per patient versus $10,451 per patient—while maintaining patients’ functional abilities and not increasing hospital readmission rates. The practices of Acute Care for Elders Units, and the principles they embody, can provide hospitals with effective strategies for lowering costs while preserving quality of care for hospitalized elders. PMID:22665834

Barnes, Deborah E.; Palmer, Robert M.; Kresevic, Denise M.; Fortinsky, Richard H.; Kowal, Jerome; Chren, Mary-Margaret; Landefeld, C. Seth

2013-01-01

238

42 CFR 440.140 - Inpatient hospital services, nursing facility services, and intermediate care facility services...  

Code of Federal Regulations, 2011 CFR

...false Inpatient hospital services, nursing facility services, and intermediate care facility services for individuals...140 Inpatient hospital services, nursing facility services, and intermediate care facility services for...

2011-10-01

239

42 CFR 440.140 - Inpatient hospital services, nursing facility services, and intermediate care facility services...  

Code of Federal Regulations, 2013 CFR

...false Inpatient hospital services, nursing facility services, and intermediate care facility services for individuals...140 Inpatient hospital services, nursing facility services, and intermediate care facility services for...

2013-10-01

240

42 CFR 440.140 - Inpatient hospital services, nursing facility services, and intermediate care facility services...  

Code of Federal Regulations, 2010 CFR

...false Inpatient hospital services, nursing facility services, and intermediate care facility services for individuals...140 Inpatient hospital services, nursing facility services, and intermediate care facility services for...

2010-10-01

241

42 CFR 440.140 - Inpatient hospital services, nursing facility services, and intermediate care facility services...  

Code of Federal Regulations, 2012 CFR

...false Inpatient hospital services, nursing facility services, and intermediate care facility services for individuals...140 Inpatient hospital services, nursing facility services, and intermediate care facility services for...

2012-10-01

242

Satisfaction of women from cesarean section care services in public and private hospitals of Tabriz  

PubMed Central

Background: Consumer satisfaction is recognized as an important parameter for assessing the quality of patient care services. Materials and Methods: By using quota sampling method and questionnaire device, 392 mothers were selected who had been hospitalized for cesarean section in the public and private hospitals of Tabriz. statistical package for social sciences (SPSS) version 13, descriptive statistics, independent t-test, analysis of variance (ANOVA), and correlation tests were used for data analysis. Results: Findings indicated that the highest rate for mothers’ satisfaction was in the physical and comfort categories and the least satisfaction was in the informational aspect. The analysis of data showed significant difference between mothers’ satisfaction with all aspects of care in the public and private hospitals (P < 0.001). Conclusion: The results showed that mothers were more satisfied of physical and comfortable aspects, but informational aspect of care in both kinds of hospitals was low and there is a need for promote aspect. PMID:24554939

Azari, Sahar; Sehaty, Fahimmeh; Ebrahimi, Hosseyn

2013-01-01

243

Have procompetitive changes altered hospital provision of indigent care?  

PubMed

In the past decade alone there have been numerous changes in the financial and competitive environment of hospitals in the United States. Some examples include the advent of Medicare's Prospective Payment System, growth in managed care options, relaxation of states' Certificate of Need (CON) regulations, and court cases questioning the tax-exempt status of nonprofit hospitals. In this paper we attempt to reveal how hospitals alter their provision of care to the poor in a more cost conscious and competitive environment. Using hospital data from the State of California for the fiscal years ending in 1983 and 1987, estimates explaining uncompensated care commitments are presented. In particular, this study illustrates how hospitals under different ownership control varied their provision of uncompensated care over the period studied on average and by profitability level. Other factors, such as hospital location, teaching status, medicare patient load, and contractual adjustments, are also included in the analysis. A number of interesting trends are detected. Moreover, the results are found to be compatible with a quid pro quo hypothesis which states that hospital regulators reward large uncompensated care providers with profitable CON licenses. PMID:8275173

Campbell, E S; Ahern, M W

1993-10-01

244

Iowa Child Care Quality Rating System: QRS Profile. The Child Care Quality Rating System (QRS) Assessment  

ERIC Educational Resources Information Center

This paper presents a profile of Iowa's Child Care Quality Rating System prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile is divided into the following categories: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4) Indicators for Family Child Care Programs;…

Child Trends, 2010

2010-01-01

245

Reductions in Inpatient Mortality following Interventions to Improve Emergency Hospital Care in Freetown, Sierra Leone  

PubMed Central

Background The demand for high quality hospital care for children in low resource countries is not being met. This paper describes a number of strategies to improve emergency care at a children's hospital and evaluates the impact of these on inpatient mortality. In addition, the cost-effectiveness of improving emergency care is estimated. Methods and Findings A team of local and international staff developed a plan to improve emergency care for children arriving at The Ola During Children's Hospital, Freetown, Sierra Leone. Following focus group discussions, five priority areas were identified to improve emergency care; staff training, hospital layout, staff allocation, medical equipment, and medical record keeping. A team of international volunteers worked with local staff for six months to design and implement improvements in these five priority areas. The improvements were evaluated collectively rather than individually. Before the intervention, the inpatient mortality rate was 12.4%. After the intervention this improved to 5.9%. The relative risk of dying was 47% (95% CI 0.369–0.607) lower after the intervention. The estimated number of lives saved in the first two months after the intervention was 103. The total cost of the intervention was USD 29 714, the estimated cost per death averted was USD 148. There are two main limitation of the study. Firstly, the brevity of the study and secondly, the assumed homogeneity of the clinical cases that presented to the hospital before and after the intervention. Conclusions This study demonstarted a signficant reductuion in inpatient mortality rate after an intervention to improve emergency hospital care If the findings of this paper could be reproduced in a larger more rigorous study, improving the quality of care in hospitals would be a very cost effective strategy to save children's lives in low resource settings. PMID:23028427

Clark, Matthew; Spry, Emily; Daoh, Kisito; Baion, David; Skordis-Worrall, Jolene

2012-01-01

246

Nurse entrepreneurship: opportunities in acute care hospitals.  

PubMed

"Heartcheck," a new hospital-based program initiated by a nurse clinician, focuses on patient needs. Factors related to the program's success are evaluated from an entrepreneurial perspective. PMID:1996153

Wolfson, B; Neidlinger, S H

1991-01-01

247

Clinical career ladders: St. Vincent Hospital and Health Care Center.  

PubMed

The career ladder program developed for pharmacists at St. Vincent Hospital and Health Care Center (SVH), a 625-bed community hospital, is described. Before 1986 the only advancement program for pharmacists at SVH was a traditional managerial one. The need for a system that would reward outstanding pharmacists both professionally and financially and prevent increases in turnover led to the development of a three-tiered ladder system in which clinical expertise and participation in elective professional activities are important keys to advancement. All baccalaureate-level pharmacists are hired at level I. Level II represents the standard of pharmacy practice at SVH. Pharmacists promoted to level III have made a major contribution. Advancement is contingent upon the accumulation of points awarded for performance evaluations, elective activities, and tenure. In addition to distributive and clinical duties, level II and III pharmacists must participate in special projects or on committees. Promoted pharmacists must accumulate additional points annually to remain at the higher level. The program was objected to by some staff members who believed that it would cut into personal time and give certain pharmacists preferred work schedules. Nevertheless, several promotions have quickened interest in the program, and participation in advancement-related activities has increased. The career ladder program has stimulated employees' professional and financial growth, enhanced the quality and quantity of pharmaceutical services, and averted potential increases in staff turnover. PMID:2589343

Wills, T M; Garing, T L

1989-11-01

248

Integrating hospital administrative data to improve health care efficiency and outcomes: "the socrates story".  

PubMed

Evaluation of health care outcomes has become increasingly important as we strive to improve quality and efficiency while controlling cost. Many groups feel that analysis of large datasets will be useful in optimizing resource utilization; however, the ideal blend of clinical and administrative data points has not been developed. Hospitals and health care systems have several tools to measure cost and resource utilization, but the data are often housed in disparate systems that are not integrated and do not permit multisystem analysis. Systems Outcomes and Clinical Resources AdministraTive Efficiency Software (SOCRATES) is a novel data merging, warehousing, analysis, and reporting technology, which brings together disparate hospital administrative systems generating automated or customizable risk-adjusted reports. Used in combination with standardized enhanced care pathways, SOCRATES offers a mechanism to improve the quality and efficiency of care, with the ability to measure real-time changes in outcomes. PMID:24436649

Lawrence, Justin; Delaney, Conor P

2013-03-01

249

Quality of Cancer Care - Applied Research  

Cancer.gov

The purpose of these efforts, substantially supported by the Applied Research Program, is to enhance the state of the science on the quality of cancer care and inform federal and private-sector decision making on care delivery, coverage, regulation, and standard setting. Work is underway to make cancer a working model for quality of care research and the translation of this research into practice.

250

Revisiting the Relationship between Managed Care and Hospital Consolidation  

PubMed Central

Objective This paper analyzes whether the rise in managed care during the 1990s caused the increase in hospital concentration. Data Sources We assemble data from the American Hospital Association, InterStudy and government censuses from 1990 to 2000. Study Design We employ linear regression analyses on long differenced data to estimate the impact of managed care penetration on hospital consolidation. Instrumental variable analogs of these regressions are also analyzed to control for potential endogeneity. Data Collection All data are from secondary sources merged at the level of the Health Care Services Area. Principle Findings In 1990, the mean population-weighted hospital Herfindahl–Hirschman index (HHI) in a Health Services Area was .19. By 2000, the HHI had risen to .26. Most of this increase in hospital concentration is due to hospital consolidation. Over the same time frame HMO penetration increased three fold. However, our regression analysis strongly implies that the rise of managed care did not cause the hospital consolidation wave. This finding is robust to a number of different specifications. PMID:17355590

Town, Robert J; Wholey, Douglas; Feldman, Roger; Burns, Lawton R

2007-01-01

251

Dying in two acute hospitals: would usual care meet Australian national clinical standards?  

PubMed

The Australian Commission for Quality and Safety in Health Care (ACQSHC) has articulated 10 clinical standards with the aim of improving the consistency of quality healthcare delivery. Currently, the majority of Australians die in acute hospitals. But despite this, no agreed standard of care exists to define the minimum standard of care that people should accept in the final hours to days of life. As a result, there is limited capacity to conduct audits that focus on the gap between current care and recommended care. There is, however, accumulating evidence in the end of life literature to define which aspects of care are likely to be considered most important to those people facing imminent death. These themes offer standards against which to conduct audits. This is very apt given the national recommendation that healthcare should be delivered in the context of considering people's wishes while always treating people with dignity and respect. PMID:24589365

Clark, Katherine; Byfieldt, Naomi; Green, Malcolm; Saul, Peter; Lack, Jill; Philips, Jane L

2014-05-01

252

Mindfulness meditation to improve care quality and quality of life in long-term care settings.  

PubMed

Quality of long-term care has been the focus of 2 recent Institute of Medicine reports: "Improving the Quality of Long-Term Care"(1) and "Improving the Quality of Care in Nursing Homes."(2) Although there has been some improvement in care quality since regulatory reforms were enacted in 1987,(3) poor care persists.(4) Certified nursing assistants (CNAs) are challenged in the provision of optimal care by chronic stress in the workplace, leading to absenteeism, reduced job satisfaction, and increased turnover.(5-7) Mindfulness training, which cultivates a practice of being present in the moment, recognizing stressful situations when they arise, and responding to stress in an adaptive manner,(8) holds promise as a simple, inexpensive approach to reduce CNA stress and improve quality of care and quality of life for residents in long-term care settings. Formal and informal mindfulness practices can readily be incorporated into CNA educational programs. PMID:21239085

Zeller, Janice M; Lamb, Karen

2011-01-01

253

Impact of hospital-wide surveillance on hospital-acquired infections in an acute-care hospital in The Netherlands  

Microsoft Academic Search

The goal of surveillance is to identify hospital-acquired infections (HAI) and risk factors, to apply targeted interventions and to evaluate their effect in an ongoing system. Continuing active surveillance in a 270-bed acute-care hospital is being performed on clinical patients, excluding day-care. The period 1984–1997 is described here. Specific surveillance-based interventions included the introduction of antimicrobial prophylaxis in gynaecology patients

A. J Mintjes-de Groot; C. A. N van Hassel; J. A Kaan; R. P Verkooyen; H. A Verbrugh

2000-01-01

254

Choosing quality of care measures based on the expected impact of improved care on health.  

PubMed Central

Consumers, payers, and policymakers are demanding to know more about the quality of the services they are purchasing or might purchase. The information provided, however, is often driven by data availability rather than by epidemiologic and clinical considerations. In this article, we present an approach for selecting topics for measuring technical quality of care, based on the expected impact on health of improved quality. This approach employs data or estimates on disease burden, efficacy of available treatments, and the current quality of care being provided. We use this model to select measures that could be used to measure the quality of care in health plans, but the proposed framework could also be used to select quality of care measures for other purposes or in other contexts (for example, to select measures for hospitals). Given the limited resources available for quality assessment and the policy consequences of better information on provider quality, priorities for assessment efforts should focus on those areas where better quality translates into improved health. PMID:1464537

Siu, A L; McGlynn, E A; Morgenstern, H; Beers, M H; Carlisle, D M; Keeler, E B; Beloff, J; Curtin, K; Leaning, J; Perry, B C

1992-01-01

255

Hypodermoclysis therapy. In a chronic care hospital setting.  

PubMed

Occasionally, elderly patients experience acute, episodic incidents of illness that result in dehydration or a high potential for dehydration (e.g., flu, diarrhea). At times, patients may be unable, or refuse, to take fluids orally. Enteral routes via a nasogastric tube or enteral stomach tube may also not be available. In the past, these patients often had to be transferred from home or long-term care facilities to an acute care hospital for intravenous therapy. A transfer of the acutely ill elderly patient to an acute care hospital is often very stressful to the patient and his/her family and is costly to the health care delivery system. Hypodermoclysis, the process of rehydrating a patient by providing isotonic fluids into the subcutaneous tissues over a short time period, provides an alternative method to deal with acute, short-term fluid deficit problems in the elderly. Hypodermoclysis therapy can be administered in a chronic care setting thus potentially decreasing the need to transfer the elderly client to an acute care hospital. The purpose of this study was to investigate the use of hypodermoclysis therapy in solving acute, or potentially acute fluid deficit problems, that were anticipated to be both reversible and short term in nature. This was carried out in an elderly population that resided in a 284-bed chronic care hospital in southern Ontario. PMID:9197621

Worobec, G; Brown, M K

1997-06-01

256

How five leading safety-net hospitals are preparing for the challenges and opportunities of health care reform.  

PubMed

Safety-net hospitals will continue to play a critical role in the US health care system, as they will need to care for the more than twenty-three million people who are estimated to remain uninsured after the Affordable Care Act is implemented. Yet such hospitals will probably have less federal and state support for uncompensated care. At the same time, safety-net hospitals will need to reposition themselves in the marketplace to compete effectively for newly insured people who will have a choice of providers. We examine how five leading safety-net hospitals have begun preparing for reform. Building upon strong organizational attributes such as health information technology and system integration, the study hospitals' preparations include improving the efficiency and quality of care delivery, retaining current and attracting new patients, and expanding the medical home model. PMID:22869646

Coughlin, Teresa A; Long, Sharon K; Sheen, Edward; Tolbert, Jennifer

2012-08-01

257

Leadership and the quality of care  

PubMed Central

The importance of good leadership is becoming increasingly apparent within health care. This paper reviews evidence which shows that it has effects, not only on financial management, but on the quality of care provided. Some theories of leadership are discussed, primarily in terms of how different types of leaders might affect quality in different ways, including the effects that they might have on the stress or wellbeing of their staff which, in turn, is related to the quality of care produced. Finally, the conflicts shown in terms of leadership within the context of health care are discussed, leading to the conclusion that development programmes must be specially tailored to address the complexities of this arena. Key Words: leadership; quality of care; stress; personality PMID:11700372

Firth-Cozens, J; Mowbray, D

2001-01-01

258

Application of quality improvement strategies in 389 European hospitals: results of the MARQuIS project  

PubMed Central

Context: This study was part of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) research project investigating the impact of quality improvement strategies on hospital care in various countries of the European Union (EU), in relation to specific needs of cross-border patients. Aim: This paper describes how EU hospitals have applied seven quality improvement strategies previously defined by the MARQuIS study: organisational quality management programmes; systems for obtaining patients’ views; patient safety systems; audit and internal assessment of clinical standards; clinical and practice guidelines; performance indicators; and external assessment. Methods: A web-based questionnaire was used to survey acute care hospitals in eight EU countries. The reported findings were later validated via on-site survey and site visits in a sample of the participating hospitals. Data collection took place from April to August 2006. Results: 389 hospitals participated in the survey; response rates varied per country. All seven quality improvement strategies were widely used in European countries. Activities related to external assessment were the most broadly applied across Europe, and activities related to patient involvement were the least widely implemented. No one country implemented all quality strategies at all hospitals. There were no differences between participating hospitals in western and eastern European countries regarding the application of quality improvement strategies. Conclusions: Implementation varied per country and per quality improvement strategy, leaving considerable scope for progress in quality improvements. The results may contribute to benchmarking activities in European countries, and point to further areas of research to explore the relationship between the application of quality improvement strategies and actual hospital performance. PMID:19188458

Lombarts, M J M H; Rupp, I; Vallejo, P; Suñol, R; Klazinga, N S

2009-01-01

259

Are the CMS Hospital Outpatient Quality Measures Relevant for Rural Hospitals?  

ERIC Educational Resources Information Center

Context: Quality measures focused on outpatient settings are of increasing interest to policy makers, but little research has been conducted on hospital outpatient quality measures, especially in rural settings. Purpose: To evaluate the relevance of Centers for Medicare and Medicaid Services' (CMS) outpatient quality measures for rural hospitals,…

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

2012-01-01

260

Hospital administrator's perspectives regarding the health care industry.  

PubMed

Based on responses from 52 hospital administrators, four areas of managerial concern have been addressed, including: (1) decision-making factors; (2) hospital service offerings: current and future; (3) marketing strategy and service priorities; and (4) health care industry challenges. Of the total respondents, 35 percent indicate a Director of Marketing has primary responsibility for making marketing-related decisions in their hospital, and 19 percent, a Vice-President of Marketing, thus demonstrating the increased priority of the marketing function. The continued importance of the physician being the primary market target is highlighted by 70 percent of the administrators feeling physician referrals will be more important regarding future admissions than in the past, compared to only two percent feeling the physicians' role will be less important. Of primary importance to patients selecting a hospital, as perceived by the administrators, are the physician's referral, the patient's previous experience, the hospital's reputation, and the courtesy of the staff. The clear majority of the conventional-care hospitals surveyed offer out-patient surgery, a hospital pharmacy, obstetrics/maternity care, and diabetic services. The future emphasis on expanding services is evidenced by some 50 percent of the hospital administrators indicating they either possibly or definitely plan to offer long-term nursing care, out-patient substance abuse programs, and cancer clinics by 1990. In addition, some one-third of the respondents are likely to expand their offerings to include wellness/fitness centers, in-patient substance abuse programs, remote or satellite primary care clinics, and diabetic services. Other areas having priority for future offerings include services geared specifically toward women and the elderly. Perceived as highest in priority by the administrators regarding how their hospital can achieve its goals in the next three years are market development strategies, followed by product/service development and finally, market penetration strategies. Clearly, the role of marketing will increase as new targets and new offerings dominate future, strategic decision-making. Specific hospital services having the highest future priority include out-patient services, in-patient care, cardiology, cancer/oncology, obstetrics, and services geared specifically to women and the elderly. Finally, when asked to identify the three most significant challenges facing the health care/hospital industry over the next five years, 12 challenges emerged, with five being mentioned by the majority of the administrators and seven by the minority.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:10292530

McDermott, D R; Little, M W

1988-01-01

261

38 CFR 17.55 - Payment for authorized public or private hospital care.  

Code of Federal Regulations, 2011 CFR

...Payment for authorized public or private hospital care. 17.55 Section 17.55 ...MEDICAL Use of Public Or Private Hospitals § 17.55 Payment for authorized public or private hospital care. Except as otherwise...

2011-07-01

262

38 CFR 17.55 - Payment for authorized public or private hospital care.  

Code of Federal Regulations, 2013 CFR

...Payment for authorized public or private hospital care. 17.55 Section 17.55 ...MEDICAL Use of Public Or Private Hospitals § 17.55 Payment for authorized public or private hospital care. Except as otherwise...

2013-07-01

263

42 CFR 405.1206 - Expedited determination procedures for inpatient hospital care.  

Code of Federal Regulations, 2012 CFR

...determination procedures for inpatient hospital care. 405.1206 Section 405...Terminations, and Procedures for Inpatient Hospital Discharges § 405.1206 Expedited...determination procedures for inpatient hospital care. (a)...

2012-10-01

264

38 CFR 17.55 - Payment for authorized public or private hospital care.  

Code of Federal Regulations, 2012 CFR

...Payment for authorized public or private hospital care. 17.55 Section 17.55 ...MEDICAL Use of Public Or Private Hospitals § 17.55 Payment for authorized public or private hospital care. Except as otherwise...

2012-07-01

265

42 CFR 405.1206 - Expedited determination procedures for inpatient hospital care.  

Code of Federal Regulations, 2013 CFR

...determination procedures for inpatient hospital care. 405.1206 Section 405...Terminations, and Procedures for Inpatient Hospital Discharges § 405.1206 Expedited...determination procedures for inpatient hospital care. (a)...

2013-10-01

266

38 CFR 17.55 - Payment for authorized public or private hospital care.  

Code of Federal Regulations, 2010 CFR

...Payment for authorized public or private hospital care. 17.55 Section 17.55 ...MEDICAL Use of Public Or Private Hospitals § 17.55 Payment for authorized public or private hospital care. Except as otherwise...

2010-07-01

267

42 CFR 405.1206 - Expedited determination procedures for inpatient hospital care.  

Code of Federal Regulations, 2010 CFR

...determination procedures for inpatient hospital care. 405.1206 Section 405...Terminations, and Procedures for Inpatient Hospital Discharges § 405.1206 Expedited...determination procedures for inpatient hospital care. (a)...

2010-10-01

268

42 CFR 405.1206 - Expedited determination procedures for inpatient hospital care.  

Code of Federal Regulations, 2011 CFR

...determination procedures for inpatient hospital care. 405.1206 Section 405...Terminations, and Procedures for Inpatient Hospital Discharges § 405.1206 Expedited...determination procedures for inpatient hospital care. (a)...

2011-10-01

269

38 CFR 17.52 - Hospital care and medical services in non-VA facilities.  

...2014-07-01 2014-07-01 false Hospital care and medical services in non-VA...52 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Public Or Private Hospitals § 17.52 Hospital care...

2014-07-01

270

Venous thromboembolism prophylaxis after hospital discharge: transition to preventive care.  

PubMed

Deep vein thrombosis and pulmonary embolism, the common clinical manifestations of venous thromboembolism (VTE), are among the most preventable complications of hospitalized patients. However, survey data repeatedly show poor rates of compliance with guideline-based preventive strategies. This has led the Centers for Medicare and Medicaid Services to deny reimbursement for hospital readmission for thromboembolic complications in patients undergoing total hip or knee arthroplasty. Multiple strategies and national initiatives have been developed to improve rates of VTE prophylaxis during hospitalization; however, most VTE occurs in the outpatient setting. Epidemiologic data suggest that recent surgery or hospitalization is a strong risk factor for the development of VTE and that this risk may persist for up to 6 months. These observations call into question whether VTE prophylaxis should be administered only during hospitalization or if this preventive strategy should be continued after hospital discharge. Many of the randomized trials showing efficacy of VTE prophylaxis have used longer durations of prophylaxis than are typical for current length of hospital stay, highlighting the issue of how long the duration of prophylaxis should be. Several patient groups have undergone formal testing to evaluate the risks and benefits of extended-duration VTE prophylaxis, but this issue is less clear for other categories of patients. Although there is clear consensus that most hospitalized patients should receive VTE prophylaxis, there is uncertainty about whether to continue VTE prophylaxis in the immediate post-hospital period or for an extended duration. The transition from inpatient to outpatient care is a key event in the coordination of continuity of care, but VTE-specific care transition guidance is limited. In this article, we review the evidence for both standard- and extended-duration VTE prophylaxis and discuss the difficulties in effectively maintaining VTE prophylaxis during the transition from inpatient to outpatient care. PMID:21881387

Kaatz, Scott; Spyropoulos, Alex C

2011-08-01

271

Providing high-quality care in primary care settings  

PubMed Central

Abstract Objective To gain a deeper understanding of how primary care (PC) practices belonging to different models manage resources to provide high-quality care. Design Multiple-case study embedded in a cross-sectional study of a random sample of 37 practices. Setting Three regions of Quebec. Participants Health care professionals and staff of 5 PC practices. Methods Five cases showing above-average results on quality-of-care indicators were purposefully selected to contrast on region, practice size, and PC model. Data were collected using an organizational questionnaire; the Team Climate Inventory, which was completed by health care professionals and staff; and 33 individual interviews. Detailed case histories were written and thematic analysis was performed. Main findings The core common feature of these practices was their ongoing effort to make trade-offs to deliver services that met their vision of high-quality care. These compromises involved the same 3 areas, but to varying degrees depending on clinic characteristics: developing a shared vision of high-quality care; aligning resource use with that vision; and balancing professional aspirations and population needs. The leadership of the physician lead was crucial. The external environment was perceived as a source of pressure and dilemmas rather than as a source of support in these matters. Conclusion Irrespective of their models, PC practices’ pursuit of high-quality care is based on a vision in which accessibility is a key component, balanced by appropriate management of available resources and of external environment expectations. Current PC reforms often create tensions rather than support PC practices in their pursuit of high-quality care. PMID:24829023

Beaulieu, Marie-Dominique; Geneau, Robert; Grande, Claudio Del; Denis, Jean-Louis; Hudon, Eveline; Haggerty, Jeannie L.; Bonin, Lucie; Duplain, Rejean; Goudreau, Johanne; Hogg, William

2014-01-01

272

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

PubMed Central

Background Chronic heart failure (CHF) is a major public health problem characterised by progressive deterioration with disabling symptoms and frequent hospital admissions. To influence hospitalisation rates it is crucial to identify precipitating factors. To characterise patients with CHF who seek an emergency department (ED) because of worsening symptoms and signs and to explore the reasons why they are admitted to hospital. Method Patients (n = 2,648) seeking care for dyspnoea were identified at the ED, Sahlgrenska University Hospital/Östra. Out of 2,648 patients, 1,127 had a previous diagnosis of CHF, and of these, 786 were included in the present study with at least one sign and one symptom of worsening CHF. Results Although several of the patients wanted to go home after acute treatment in the ED, only 2% could be sent home. These patients were enrolled in an interventional study, which evaluated the acute care at home compared to the conventional, in hospital care. The remaining patients were admitted to hospital because of serious condition, including pneumonia/respiratory disease, myocardial infarction, pulmonary oedema, anaemia, the need to monitor cardiac rhythm, pathological blood chemistry and difficulties to communicate. Conclusion The vast majority of patients with worsening CHF seeking the ED required hospital care, predominantly because of co-morbidities. Patients with CHF with symptomatic deterioration may be admitted to hospital without additional emergency room investigations. PMID:22401538

2012-01-01

273

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

PubMed

Healthcare financing and insurance is changing everywhere. We want to understand the impact that financial pressures can have for the uninsured in advanced economies. To do so we focus on analyzing the effect of the introduction in the US of managed care and the big rise in financial pressures that it implied. Traditionally, in the US safety net hospitals have financed their provision of unfunded care through a complex system of cross-subsidies. Our hypothesis is that financial pressures undermine the ability of a hospital to cross-subsidize and challenges their survival. We focus on the impact of price pressures and cost-controlling mechanisms imposed by managed care. We find that financial pressures imposed by managed care disproportionately affect the closure of safety net hospitals. Moreover, amongst those hospitals that remain open, in areas where managed care penetration increases the most, they react by closing the health services most commonly used by the uninsured. PMID:23389814

Mas, Núria

2013-06-01

274

The effect of managed care on hospital marketing orientation.  

PubMed

Marketing is a central activity of modern organizations. To survive and succeed, organizations must know their markets, attract sufficient resources, convert these resources into appropriate services, and communicate them to various consuming publics. In the hospital industry, a marketing orientation is currently recognized as a necessary management function in a highly competitive and resource-constrained environment. Further, the literature supports a marketing orientation as superior to other orientation types, namely production, product and sales. In this article, the results of the first national cross-sectional study of the marketing orientation of U.S. hospitals in a managed care environment are reported. Several key lessons for hospital executives have emerged. First, to varying degrees, U.S. hospitals have adopted a marketing orientation. Second, hospitals that are larger, or that have developed strong affiliations with other providers that involve some level of financial interdependence, have the greatest marketing orientation. Third, as managed care organizations have increased their presence in a state, hospitals have become less marketing oriented. Finally, contrary to prior findings, for-profit institutions are not intrinsically more marketing oriented than their not-for-profit counterparts. This finding is surprising because of the traditional role of marketing in non-health for-profit enterprises and management's greater emphasis on profitability. An area of concern for hospital executives arises from the finding that as managed care pressure increases, hospital marketing orientation decreases. Although a marketing orientation is posited to lead to greater customer satisfaction and improved business results, a managed care environment seems to force hospitals to focus more on cost control than on customer satisfaction. Hospital executives are cautioned that cost-cutting, the primary focus in intense managed care environments, may lead to short-term gains by capturing managed care business, but may not be sufficient for long-term success and survival. Understanding consumer needs and perceptions, and using appropriate marketing strategies to ensure greater customer satisfaction and repeat business, will be among the key tasks for hospital executives in the future. PMID:10181799

Loubeau, P R; Jantzen, R

1998-01-01

275

Candida glabrata: an emerging pathogen in Brazilian tertiary care hospitals.  

PubMed

Candida glabrata is an infrequent cause of candidemia in Brazilian public hospitals. We investigated putative differences in the epidemiology of candidemia in institutions with different sources of funding. Prospective laboratory-based surveillance of candidemia was conducted in seven private and two public Brazilian tertiary care hospitals. Among 4,363 episodes of bloodstream infection, 300 were caused by Candida spp. (6.9%). Incidence rates were significantly higher in public hospitals, i.e., 2.42 vs. 0.91 episodes per 1,000 admissions (Phospitals were older, more likely to be in an intensive care unit and to have been exposed to fluconazole before candidemia. Candida parapsilosis was more frequently recovered as the etiologic agent in public (33% vs. 16%, Phospitals, whereas C. glabrata was more frequently isolated in private hospitals (13% vs. 3%, P hospitals (76.5% vs. 20%, P =?0.02). The 30-day mortality was slightly higher among patients in public hospitals (53% vs. 43%, P =?0.10). Candida glabrata is an emerging pathogen in private institutions and in this setting, fluconazole should not be considered as a safe option for primary therapy of candidemia. PMID:22762208

Colombo, Arnaldo L; Garnica, Marcia; Aranha Camargo, Luis Fernando; Da Cunha, Clovis Arns; Bandeira, Antonio Carlos; Borghi, Danielle; Campos, Tatiana; Senna, Ana Lucia; Valias Didier, Maria Eugenia; Dias, Viviane Carvalho; Nucci, Marcio

2013-01-01

276

Changing personnel behavior to promote quality care practices in an intensive care unit  

PubMed Central

The delivery of safe high quality patient care is a major issue in clinical settings. However, the implementation of evidence-based practice and educational interventions are not always effective at improving performance. A staff-led behavioral management process was implemented in a large single-site acute (secondary and tertiary) hospital in the North of England for 26 weeks. A quasi-experimental, repeated-measures, within-groups design was used. Measurement focused on quality care behaviors (ie, documentation, charting, hand washing). The results demonstrate the efficacy of a staff-led behavioral management approach for improving quality-care practices. Significant behavioral change (F [6, 19] = 5.37, p < 0.01) was observed. Correspondingly, statistically significant (t-test [t] = 3.49, df = 25, p < 0.01) reductions in methicillin-resistant Staphylococcus aureus (MRSA) were obtained. Discussion focuses on implementation issues. PMID:18360574

Cooper, Dominic; Farmery, Keith; Johnson, Martin; Harper, Christine; Clarke, Fiona L; Holton, Phillip; Wilson, Susan; Rayson, Paul; Bence, Hugh

2005-01-01

277

Visitor Expectations of Service Quality Ideals Among Hospitality Industry Employees  

Microsoft Academic Search

Visitor expectations regarding service quality ideals as perceived by hospitality industry staff have received relatively little research attention. This study sought to explore perceived visitor expectations among a sample of hospitality industry employees, together with a set of personality, motivation, employment interest and career anchor variables. Major predictors of visitor expectations among hospitality industry employees wwere higher levels of the

Glenn F. Ross

1995-01-01

278

Factors Affecting Patient Safety Culture In A Tertiary Care Hospital In Sri Lanka  

E-print Network

Abstract:- Purpose Patient safety is an important component of the quality of health care. As health care organizations improve their quality of care, importance of establishing patient safety culture arises. According to WHO, rate of adverse incidents of healthcare system is very high in developing countries. Sri Lanka, being a developing country, may encounter adverse events in healthcare system due to lack of infrastructure and equipment, quality and supply of drugs, poor performance of health care staff and severe shortage of essential financial investments. This will be helpful in patient safety improvements and developmental studies. Methodology This cross-sectional descriptive study was carried out to assess the current patient safety culture in a tertiary care hospital in Sri Lanka. This study was carried out using a self administered questionnaire with eleven dimensions of patient safety culture, on with 389 respondents including Administrators, Consultants, and Postgraduate trainees, Medical Officers, H ouse officers and Nursing Officers. Pearson‘s correlation was used to assess the patient safety culture in the hospital by measuring correlation between overall patient safety and other independent variables. Findings This survey showed there is a positive response towards patient safety culture within the organization. Correlation between the overall patient safety and other variables are found to be significant. Prevailing patient safety culture seems to be in a reactive stage but, with strong ?blame Culture‘. Originality/value This is a patient safety culture assessment, which was done in Sri Lanka, for the first time in government sector hospitals under developing country setting.

M Amarapathy; S Sridharan; R Perera

279

A proclamation for change: transforming the hospital patient care environment.  

PubMed

Mounting evidence describes inefficiencies in the hospital work environment that threaten the safety and sustainability of care. In response to these concerns, diverse experts convened to create a set of evidence-based recommendations for the transformation of the hospital work environment. The resulting Proclamation for Change, now endorsed by multiple health systems and professional and consumer organizations, cites patient-centered design, systemwide integrated technology, seamless workplace environments, and vendor partnerships as the cornerstones of transformational change. PMID:19509601

Hendrich, Ann; Chow, Marilyn P; Goshert, Wendy S

2009-06-01

280

EULAR efforts to define quality of care.  

PubMed

EULAR is deeply involved in the field of quality of care of musculoskeletal disorders via numerous initiatives. EULAR has promoted initiatives in the different steps involved in improving/facilitating quality of care (e.g. original studies (basic, translational, clinical research studies), meta-analysis/systematic liter-ature research, elaboration and dissemination of recommendations, ...).Moreover, EULAR is promoting educational programs and is lobbying at the European Community level in order to improve the recognition of musculo-skeletal disorders. PMID:18021501

Dougados, M

2007-01-01

281

Uncompensated hospital care for pregnancy and childbirth cases.  

PubMed Central

BACKGROUND: The large number of medically indigent patients in the United States is a major concern to policymakers and may be due to recent increases in the number of uninsured people. The purpose of this study was to identify the factors that affect the amount of unpaid hospital charges for services provided to pregnant women. METHODS: Individual and hospital data were collected on a representative set of 235 pregnancy and childbirth patients with unpaid hospital charges from 28 hospitals in the state of Indiana. RESULTS: Most of these patients did not have insurance coverage (63.8%), yet the majority were employed in the public or private sector (72.3%). Over half (55.5%) of the total uncompensated care amount for this group was from the $1000 to 2499 debt category. The median charge for these patients was $1468, of which the typical hospital was able to collect only 25.5%. CONCLUSIONS: The findings support the belief that any national effort to expand the availability of health insurance coverage to women through increased employment will not totally eliminate the uncompensated care problem. The findings also indicate that rural hospitals face the uncompensated care problem mainly because a significant portion of rural patients are without adequate health insurance coverage. PMID:1853993

Zollinger, T W; Saywell, R M; Chu, D K

1991-01-01

282

Home or hospital? Terminal care as seen by surviving spouses  

PubMed Central

Among 276 married patients with cancer under the age of 65 who died in two South London boroughs during the period 1967 to 1971, 41 were still under active treatment at the time of death. I studied the remaining 85 per cent who experienced some form of terminal care, and in particular compared reports by the surviving spouses of 65 patients whose care was home-centred and 100 hospital-centred patients. Although home-centred care was most often chosen for patients who were said to have had little severe pain before the period of terminal care, during that period there was a sharp increase in reports of pain, much of it severe and unrelieved. Hospital-centred patients were said to have had much less pain and more confusion during the final phase of care and were more likely to have been confined to bed than those at home. The amount of anxiety reported by the patient's spouse was not markedly different under the two patterns of care, nor did the pattern of care influence subsequent adjustment to bereavement. Qualitative differences between the two groups are considered and it is concluded that although home-centred care can be successful it is often associated with unnecessary suffering. Implications for the home care of the terminally ill are discussed. PMID:553166

Parkes, C. Murray

1978-01-01

283

[Quality improvement of health care services in Croatian emergency medicine].  

PubMed

Emergency medical services (EMS) in the Republic of Croatia are currently organized as part of the existing health care system and delivered in the form of pre-hospital and hospital EMS. The pre-hospital EMS are delivered by standalone EMS Centers, EMS units set up in community health centers, and by general practitioners working in shifts and on call in remote and scarcely populated areas. In hospitals, each ward usually has its own emergency reception area, and only in a couple of cases there is an integrated emergency admission unit for the entire hospital. The current EMS structure does not meet the basic requirements that would make an EMS system optimal, i.e. equal quality, equal access, effectiveness and appropriate equipment. The EMS Restructuring Project is part of the Croatian health care system reform and is addressed by the National Health Development Strategy 2006-2011. As part of restructuring efforts, the Croatian National Institute of Emergency Medicine, 21 County Institutes of Emergency Medicine and county-level call centers are going to be set up. In addition, the project will introduce the following: integrated emergency admission areas at hospitals; telemedicine as part of emergency medicine; emergency medicine specialty for physicians and additional specialized training for nurses/technicians; separation of emergency and non-emergency transport; standards for vehicles and equipment and guidelines/protocols/algorithms for care. The Croatian National Institute of Emergency Medicine is an umbrella EMS organization. It shapes the EMS in Croatia and proposes, plans, monitors and analyzes EMS actions in Croatia. In addition, it submits a proposal of the Emergency Medicine Network to the minister, sets standards for EMS transport, and coordinates, guides and supervises the work of County Institutes of Emergency Medicine. County Institutes organize and deliver pre-hospital EMS in their counties. Integrated hospital emergency admission units represent a single point of entry for all emergencies at a particular hospital. Upon triage, depending on the level of emergency, patients are provided with appropriate care and treatment. The introduction of EMS specialty for physicians and additional specialized training for nurses/ technicians is going to increase competencies of all EMS team members. The main objectives of the EMS Restructuring Project to be achieved in the 5-year period are the following: to reduce the response time of pre-hospital EMS teams to 10 minutes in urban areas and 20 minutes in rural areas in 20% of team interventions; to bring patients to hospital within the "golden hour" in 80% of cases; to have 200 physicians specialized in emergency medicine; and to have 220 nurses/technicians that have successfully completed their specialized training in emergency medicine. The objectives are going to be monitored through indicators as part of the World Bank Project for which data have already been collected throughout Croatia: number of interventions; number of emergency interventions; time between call receipt and arrival to scene; time between call receipt and arrival to hospital emergency reception area; percentage of arrivals to hospital by EMS vehicles within 12 hours of symptom onset; polytrauma and cardiac arrest survival rate before admission to hospital; time spent in hospital emergency reception areas and integrated hospital emergency admission units; polytrauma and cardiac arrest survival rate within 24 hours of hospital admission; number of integrated hospital emergency admission units per county; and number of pre-hospital EMS teams per capita. PMID:21692265

Predavec, Sanja; Sogori?, Selma; Jurkovi?, Drazen

2010-12-01

284

Hospital Variation and Temporal Trends in Palliative and End-of-Life Care in the ICU  

PubMed Central

Objectives Although studies have shown regional and interhospital variability in the intensity of end-of-life care, few data are available assessing variability in specific aspects of palliative care in the ICU across hospitals or interhospital variability in family and nurse ratings of this care. Recently, relatively high family satisfaction with ICU end-of-life care has prompted speculation that ICU palliative care has improved over time, but temporal trends have not been documented. Design/Setting Retrospective cohort study of consecutive patients dying in the ICU in 13 Seattle-Tacoma-area hospitals between 2003 and 2008. Measurements We examined variability over time and among hospitals in satisfaction and quality of dying assessed by family, quality of dying assessed by nurses, and chart-based indicators of palliative care. We used regression analyses adjusting for patient, family, and nurse characteristics. Main Results Medical charts were abstracted for 3,065 of 3,246 eligible patients over a 55-month period. There were significant differences between hospitals for all chart-based indicators (p < 0.001), family satisfaction (p < 0.001), family-rated quality of dying (p = 0.03), and nurse-rated quality of dying (p = 0.003). There were few significant changes in these measures over time, although we found a significant increase in pain assessments in the last 24 hours of life (p < 0.001) as well as decreased documentation of family conferences (p < 0.001) and discussion of prognosis (p = 0.020) in the first 72 hours in the ICU. Conclusions We found significant interhospital variation in ratings and delivery of palliative care, consistent with prior studies showing variation in intensity of care at the end of life. We did not find evidence of temporal changes in most aspects of palliative care, family satisfaction, or nurse/family ratings of the quality of dying. With the possible exception of pain assessment, there is little evidence that the quality of palliative care has improved over the time period studied. PMID:23518869

DeCato, Thomas W.; Engelberg, Ruth A.; Downey, Lois; Nielsen, Elizabeth L.; Treece, Patsy D.; Back, Anthony L.; Shannon, Sarah E.; Kross, Erin K.; Curtis, J. Randall

2013-01-01

285

Use of a risk analysis method to improve care management for outlying inpatients in a university hospital  

Microsoft Academic Search

Objective:To improve the quality of care provided for inpatients outlying in inappropriate wards of a teaching hospital because of lack of vacant beds in appropriate specialty wards.Methods:A multidisciplinary team consisting of hospital doctors, nurses and managers performed a prospective risk analysis of the process of care provided for outlying patients during their hospitalisation. The design of the study was Failure

B Lepage; R Robert; M Lebeau; C Aubeneau; C Silvain; V Migeot

2009-01-01

286

Nurse Burnout and Quality of Care: Cross-National Investigation in Six Countries  

PubMed Central

We explored the relationship between nurse burnout and ratings of quality of care in 53,846 nurses from six countries. In this secondary analysis, we used data from the International Hospital Outcomes Study; data were collected from1998 to 2005. The Maslach Burnout Inventory and a single-item reflecting nurse-rated quality of care were used inmultiple logistic regression modeling to investigate the association between nurse burnout and nurse-rated quality of care. Across countries, higher levels of burnout were associated with lower ratings of the quality of care independent of nurses’ ratings of practice environments. These findings suggest that reducing nurse burnout may be an effective strategy for improving nurse-rated quality of care in hospitals. PMID:20645421

Clarke, Sean P.; Finlayson, Mary; Aiken, Linda H.

2010-01-01

287

The role of hospital managers in quality and patient safety: a systematic review  

PubMed Central

Objectives To review the empirical literature to identify the activities, time spent and engagement of hospital managers in quality of care. Design A systematic review of the literature. Methods A search was carried out on the databases MEDLINE, PSYCHINFO, EMBASE, HMIC. The search strategy covered three facets: management, quality of care and the hospital setting comprising medical subject headings and key terms. Reviewers screened 15?447 titles/abstracts and 423 full texts were checked against inclusion criteria. Data extraction and quality assessment were performed on 19 included articles. Results The majority of studies were set in the USA and investigated Board/senior level management. The most common research designs were interviews and surveys on the perceptions of managerial quality and safety practices. Managerial activities comprised strategy, culture and data-centred activities, such as driving improvement culture and promotion of quality, strategy/goal setting and providing feedback. Significant positive associations with quality included compensation attached to quality, using quality improvement measures and having a Board quality committee. However, there is an inconsistency and inadequate employment of these conditions and actions across the sample hospitals. Conclusions There is some evidence that managers’ time spent and work can influence quality and safety clinical outcomes, processes and performance. However, there is a dearth of empirical studies, further weakened by a lack of objective outcome measures and little examination of actual actions undertaken. We present a model to summarise the conditions and activities that affect quality performance. PMID:25192876

Parand, Anam; Dopson, Sue; Renz, Anna; Vincent, Charles

2014-01-01

288

A system-wide analysis using a senior-friendly hospital framework identifies current practices and opportunities for improvement in the care of hospitalized older adults.  

PubMed

Older adults are vulnerable to hospital-associated complications such as falls, pressure ulcers, functional decline, and delirium, which can contribute to prolonged hospital stay, readmission, and nursing home placement. These vulnerabilities are exacerbated when the hospital's practices, services, and physical environment are not sufficiently mindful of the complex, multidimensional needs of frail individuals. Several frameworks have emerged to help hospitals examine how organization-wide processes can be customized to avoid these complications. This article describes the application of one such framework-the Senior-Friendly Hospital (SFH) framework adopted in Ontario, Canada-which comprises five interrelated domains: organizational support, processes of care, emotional and behavioral environment, ethics in clinical care and research, and physical environment. This framework provided the blueprint for a self-assessment of all 155 adult hospitals across the province of Ontario. The system-wide analysis identified practice gaps and promising practices within each domain of the SFH framework. Taken together, these results informed 12 recommendations to support hospitals at all stages of development in becoming friendly to older adults. Priorities for system-wide action were identified, encouraging hospitals to implement or further develop their processes to better address hospital-acquired delirium and functional decline. These recommendations led to collaborative action across the province, including the development of an online toolkit and the identification of accountability indicators to support hospitals in quality improvement focusing on senior-friendly care. PMID:25355067

Wong, Ken S; Ryan, David P; Liu, Barbara A

2014-11-01

289

Healthcare technologies, quality improvement programs and hospital organizational culture in Canadian hospitals  

PubMed Central

Background Healthcare technology and quality improvement programs have been identified as a means to influence healthcare costs and healthcare quality in Canada. This study seeks to identify whether the ability to implement healthcare technology by a hospital was related to usage of quality improvement programs within the hospital and whether the culture within a hospital plays a role in the adoption of quality improvement programs. Methods A cross-sectional study of Canadian hospitals was conducted in 2010. The sample consisted of hospital administrators that were selected by provincial review boards. The questionnaire consisted of 3 sections: 20 healthcare technology items, 16 quality improvement program items and 63 culture items. Results Rasch model analysis revealed that a hierarchy existed among the healthcare technologies based upon the difficulty of implementation. The results also showed a significant relationship existed between the ability to implement healthcare technologies and the number of quality improvement programs adopted. In addition, culture within a hospital served a mediating role in quality improvement programs adoption. Conclusions Healthcare technologies each have different levels of difficulty. As a consequence, hospitals need to understand their current level of capability before selecting a particular technology in order to assess the level of resources needed. Further the usage of quality improvement programs is related to the ability to implement technology and the culture within a hospital. PMID:24119419

2013-01-01

290

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

Microsoft Academic Search

Medical respite programs offer medical, nursing, and other care as well as accommodation for homeless persons discharged from acute hospital stays. They represent a community-based adaptation of urban health systems to the specific needs of homeless persons. This article examines whether post-hospital discharge to a homeless medical respite program was associated with a reduced chance of 90-day readmission compared to

Stefan G. Kertesz; Michael A. Posner; James J. OConnell; Stacy Swain; Ashley N. Mullins; Michael Shwartz; Arlene S. Ash

2009-01-01

291

Small primary care physician practices have low rates of preventable hospital admissions.  

PubMed

Nearly two-thirds of US office-based physicians work in practices of fewer than seven physicians. It is often assumed that larger practices provide better care, although there is little evidence for or against this assumption. What is the relationship between practice size--and other practice characteristics, such as ownership or use of medical home processes--and the quality of care? We conducted a national survey of 1,045 primary care-based practices with nineteen or fewer physicians to determine practice characteristics. We used Medicare data to calculate practices' rate of potentially preventable hospital admissions (ambulatory care-sensitive admissions). Compared to practices with 10-19 physicians, practices with 1-2 physicians had 33 percent fewer preventable admissions, and practices with 3-9 physicians had 27 percent fewer. Physician-owned practices had fewer preventable admissions than hospital-owned practices. In an era when health care reform appears to be driving physicians into larger organizations, it is important to measure the comparative performance of practices of all sizes, to learn more about how small practices provide patient care, and to learn more about the types of organizational structures--such as independent practice associations--that may make it possible for small practices to share resources that are useful for improving the quality of care. PMID:25122562

Casalino, Lawrence P; Pesko, Michael F; Ryan, Andrew M; Mendelsohn, Jayme L; Copeland, Kennon R; Ramsay, Patricia Pamela; Sun, Xuming; Rittenhouse, Diane R; Shortell, Stephen M

2014-09-01

292

Empathy and quality of care.  

PubMed Central

Empathy is a complex multi-dimensional concept that has moral cognitive emotive and behavioural components Clinical empathy involves an ability to: (a) understand the patient's situation, perspective, and feelings (and their attached meanings); (b) to communicate that understanding and check its accuracy; and (c) to act on that understanding with the patient in a helpful (therapeutic) way. Research on the effect of empathy on health outcomes in primary care is lacking, but studies in mental health and in nursing suggest it plays a key role. Empathy can be improved and successfully taught at medical school especially if it is embedded in the students actual experiences with patients. A variety of assessment and feedback techniques have also been used in general medicine psychiatry and nursing. Further work is required to determine if clinical empathy needs to be, and can be, improved in the primary care setting. PMID:12389763

Mercer, Stewart W; Reynolds, William J

2002-01-01

293

In their own words: Patients and families define high-quality palliative care in the intensive care unit*  

PubMed Central

Objective Although the majority of hospital deaths occur in the intensive care unit and virtually all critically ill patients and their families have palliative needs, we know little about how patients and families, the most important “stakeholders,” define high-quality intensive care unit palliative care. We conducted this study to obtain their views on important domains of this care. Design Qualitative study using focus groups facilitated by a single physician. Setting A 20-bed general intensive care unit in a 382-bed community hospital in Oklahoma; 24-bed medical–surgical intensive care unit in a 377-bed tertiary, university hospital in urban California; and eight-bed medical intensive care unit in a 311-bed Veterans’ Affairs hospital in a northeastern city. Patients Randomly-selected patients with intensive care unit length of stay ?5 days in 2007 to 2008 who survived the intensive care unit, families of survivors, and families of patients who died in the intensive care unit. Interventions None. Measurements and Main Results Focus group facilitator used open-ended questions and scripted probes from a written guide. Three investigators independently coded meeting transcripts, achieving consensus on themes. From 48 subjects (15 patients, 33 family members) in nine focus groups across three sites, a shared definition of high-quality intensive care unit palliative care emerged: timely, clear, and compassionate communication by clinicians; clinical decision-making focused on patients’ preferences, goals, and values; patient care maintaining comfort, dignity, and personhood; and family care with open access and proximity to patients, interdisciplinary support in the intensive care unit, and bereavement care for families of patients who died. Participants also endorsed specific processes to operationalize the care they considered important. Conclusions Efforts to improve intensive care unit palliative care quality should focus on domains and processes that are most valued by critically ill patients and their families, among whom we found broad agreement in a diverse sample. Measures of quality and effective interventions exist to improve care in domains that are important to intensive care unit patients and families. PMID:20198726

Nelson, Judith E.; Puntillo, Kathleen A.; Pronovost, Peter J.; Walker, Amy S.; McAdam, Jennifer L.; Ilaoa, Debra; Penrod, Joan

2011-01-01

294

Effect of reactive pharmacy intervention on quality of hospital prescribing  

Microsoft Academic Search

OBJECTIVE--To evaluate the medical impact of reactive pharmacy intervention. DESIGN--Analysis of all interventions during 28 days by all 35 pharmacists in hospitals in Nottingham. SETTING--All (six) hospitals in the Nottingham health authority (a teaching district), representing 2530 mainly acute beds, 781 mental illness beds, and 633 mainly health care of the elderly beds. PATIENTS--Hospital inpatients and outpatients. INTERVENTIONS--Recording of every

C J Hawkey; S Hodgson; A Norman; T K Daneshmend; S T Garner

1990-01-01

295

Adverse Events Associated With Organizational Factors of General Hospital Inpatient Psychiatric Care Environments  

PubMed Central

Objective Although general hospitals receive nearly 60% of all inpatient psychiatric admissions, little is known about the care environment and related adverse events. The purpose of this study was to determine the occurrence of adverse events and examine the extent to which organizing factors of inpatient psychiatric care environments were associated with the occurrence of these events. The events examined were wrong medication, patient falls with injuries, complaints from patients and families, work-related staff injuries, and verbal abuse directed toward nurses. Methods This cross-sectional study used data from a 1999 nurse survey linked with hospital data. Nurse surveys from 353 psychiatric registered nurses working in 67 Pennsylvania general hospitals provided information on nurse characteristics, organizational factors, and the occurrence of adverse events. Linear regression models and robust clustering methods at the hospital level were used to study the relationship of organizational factors of psychiatric care environments and adverse event outcomes. Results Verbal abuse toward registered nurses (79%), complaints (61%), patient falls with injuries (44%), and work-related injuries (39%) were frequent occurrences. Better management skill was associated with fewer patient falls and fewer work-related injuries to staff. In addition, fewer occurrences of staff injuries were associated with better nurse-physician relationship and lower patient-to-nurse staffing ratios. Conclusions Adverse events are frequent for inpatient psychiatric care in general hospitals, and organizational factors of care environments are associated with adverse event outcomes. Further development of evidence-based quality and safety monitoring of inpatient psychiatric care in general hospitals is imperative. PMID:20513679

Kumar, Aparna; Aiken, Linda H.

2010-01-01

296

Comparing change readiness, quality improvement, and cost management among Veterans Administration, for-profit, and nonprofit hospitals.  

PubMed

Health care organizations throughout the country are facing increasing pressure to improve their quality of care while reducing cost. This article describes a model of organizational change and develops a change readiness matrix that managers can use to benchmark their organization's performance on three dimensions: (1) change readiness, (2) quality improvement, and (3) cost management. The model and the matrix combine to offer managers a framework for pursuing organizational change and operational innovation within their organization. A survey methodology is used to compare VA hospitals (n = 44), for-profit hospitals (n = 108), and nonprofit hospitals (n = 449) on the three performance dimensions. The results indicate that Veterans Administration hospitals react differently than either for-profit or nonprofit hospitals on these dimensions. However, responses from for-profit and nonprofit hospitals were not significantly different from each other. Additional insights are presented into how hospitals in general can facilitate the organizational change process. PMID:9718511

West, T D

1998-01-01

297

Predictors of patient satisfaction with hospital health care  

PubMed Central

Background We used a validated inpatient satisfaction questionnaire to evaluate the health care received by patients admitted to several hospitals. This questionnaire was factored into distinct domains, creating a score for each to assist in the analysis. We evaluated possible predictors of patient satisfaction in relation to socio-demographic variables, history of admission, and survey logistics. Methods Cross-sectional study of patients discharged from four acute care general hospitals. Random sample of 650 discharged patients from the medical and surgical wards of each hospital during February and March 2002. A total of 1,910 patients responded to the questionnaire (73.5%). Patient satisfaction was measured by a validated questionnaire with six domains: information, human care, comfort, visiting, intimacy, and cleanliness. Each domain was scored from 0 to 100, with higher scores indicating higher levels of patient satisfaction. Results In the univariate analysis, age was related to all domains except visiting; gender to comfort, visiting, and intimacy; level of education to comfort and cleanliness; marital status to information, human care, intimacy, and cleanliness; length of hospital stay to visiting and cleanliness, and previous admissions to human care, comfort, and cleanliness. The timing of the response to the mailing and who completed the questionnaire were related to all variables except visiting and cleanliness. Multivariate analysis confirmed in most cases the previous findings and added additional correlations for level of education (visiting and intimacy) and marital status (comfort and visiting). Conclusion These results confirm the varying importance of some socio-demographic variables and length of stay, previous admission, the timing of response to the questionnaire, and who completed the questionnaire on some aspects of patient satisfaction after hospitalization. All these variables should be considered when evaluating patient satisfaction. PMID:16914046

Quintana, Jose M; Gonzalez, Nerea; Bilbao, Amaia; Aizpuru, Felipe; Escobar, Antonio; Esteban, Cristobal; San-Sebastian, Jose Antonio; de-la-Sierra, Emilio; Thompson, Andrew

2006-01-01

298

Quality of care in Crohn's disease.  

PubMed

Crohn's disease (CD) is a chronic and progressive inflammatory disease of the intestine. Overall, healthcare delivery for patients with CD is not optimal at the present time and therefore needs improvement. There are evidences which suggest that there is a variation in the care provided to patients with CD by the inflammatory bowel disease (IBD) experts and community care providers. The delivery of healthcare for patients with CD is often complex and requires coordination between gastroenterologists/IBD specialist, gastrointestinal surgeon, radiologists and IBD nurses. In order to improve the quality of health care for patients with CD, there is need that we focus on large-scale, system-wide changes including creation of IBD comprehensive care units, provision to provide continuous care, efforts to standardize care, and education of the community practitioners. PMID:25400990

Makharia, Govind K

2014-11-15

299

Quality of care in Crohn's disease  

PubMed Central

Crohn’s disease (CD) is a chronic and progressive inflammatory disease of the intestine. Overall, healthcare delivery for patients with CD is not optimal at the present time and therefore needs improvement. There are evidences which suggest that there is a variation in the care provided to patients with CD by the inflammatory bowel disease (IBD) experts and community care providers. The delivery of healthcare for patients with CD is often complex and requires coordination between gastroenterologists/IBD specialist, gastrointestinal surgeon, radiologists and IBD nurses. In order to improve the quality of health care for patients with CD, there is need that we focus on large-scale, system-wide changes including creation of IBD comprehensive care units, provision to provide continuous care, efforts to standardize care, and education of the community practitioners.

Makharia, Govind K

2014-01-01

300

Hospital Quality and Selective Contracting: Evidence from Kidney Transplantation*  

PubMed Central

Most private health insurers offer a limited network of providers to enrollees. Critics have questioned whether selective contracting benefits patients. Plans counter that they take quality into account when choosing providers. Using data on five plans’ networks for kidney transplant hospitals, this study shows that in-network hospitals have better outcomes than out-of-network facilities. Conditional logit estimates using patient level data confirm this result: compared to Medicare patients, privately-insured patients are more likely to register at hospitals with higher survival rates. Restricting choice has the potential to improve patient welfare if plans steer uninformed patients to high quality hospitals and physicians. PMID:19079762

Howard, David H.

2008-01-01

301

Evolving a Successful Acute Care Surgical\\/Surgical Critical Care Group at a Nontrauma Hospital  

Microsoft Academic Search

A large acute care but nontrauma teaching hospital in Manhattan, New York performing 24 000 operations\\/year has evolved a Surgical Intensive Care Unit (SICU) Service with 3 attendings and 5 physician assistants over 9 years. The division follows nationally recognized, published best practices in shock, sepsis, ventilator management, nutrition, and antibiotic use and has maintained a total mortality of 1.9%

Marvin A. McMillen

2011-01-01

302

The economics of health care quality and medical errors.  

PubMed

Hospitals have been looking for ways to improve quality and operational efficiency and cut costs for nearly three decades, using a variety of quality improvement strategies. However, based on recent reports, approximately 200,000 Americans die from preventable medical errors including facility-acquired conditions and millions may experience errors. In 2008, medical errors cost the United States $19.5 billion. About 87 percent or $17 billion were directly associated with additional medical cost, including: ancillary services, prescription drug services, and inpatient and outpatient care, according to a study sponsored by the Society for Actuaries and conducted by Milliman in 2010. Additional costs of $1.4 billion were attributed to increased mortality rates with $1.1 billion or 10 million days of lost productivity from missed work based on short-term disability claims. The authors estimate that the economic impact is much higher, perhaps nearly $1 trillion annually when quality-adjusted life years (QALYs) are applied to those that die. Using the Institute of Medicine's (IOM) estimate of 98,000 deaths due to preventable medical errors annually in its 1998 report, To Err Is Human, and an average of ten lost years of life at $75,000 to $100,000 per year, there is a loss of $73.5 billion to $98 billion in QALYs for those deaths--conservatively. These numbers are much greater than those we cite from studies that explore the direct costs of medical errors. And if the estimate of a recent Health Affairs article is correct-preventable death being ten times the IOM estimate-the cost is $735 billion to $980 billion. Quality care is less expensive care. It is better, more efficient, and by definition, less wasteful. It is the right care, at the right time, every time. It should mean that far fewer patients are harmed or injured. Obviously, quality care is not being delivered consistently throughout U.S. hospitals. Whatever the measure, poor quality is costing payers and society a great deal. However, health care leaders and professionals are focusing on quality and patient safety in ways they never have before because the economics of quality have changed substantially. PMID:23155743

Andel, Charles; Davidow, Stephen L; Hollander, Mark; Moreno, David A

2012-01-01

303

Altruism or moral hazard: the impact of hospital uncompensated care pools.  

PubMed

Empirical evidence from New Jersey supports theories of hospitals altruism. From 1987 to 1992, New Jersey reimbursed hospitals for uncompensated care through the Uncompensated Care Trust Fund. The Trust Fund reduced the shadow price of charity care, inducing hospitals to increase their provision of uncompensated care. Hospitals increased inpatient uncompensated care by an average of 14.8% and statewide uncompensated care increased by $360 million during 1987-1990. Empirical evidence suggests that the state effectively addressed the moral hazard problem created by the Trust Fund by auditing uncompensated care and regulating hospital collection procedures. PMID:10169098

Gaskin, D J

1997-08-01

304

Current Quality Management Practices In U.S. Hospitals  

Microsoft Academic Search

For decades the U.S. health care industry has been operating on its own ignoring emerging factors such as competition, patient safety, skyrocketing health care cost, liability, malpractice insurance cost and DRG for Medicare payment. However, as these factors became more prevalent and competition within the industry intensified, many U.S. hospitals have been becoming increasingly aware of the critical needs of

Jayanta K. Bandyopadhyay

305

Strategies to Prevent Falls and Fractures in Hospitals and Care Homes and Effect of Cognitive Impairment: Systematic Review and Meta-Analyses  

Microsoft Academic Search

Objectives: To evaluate the evidence for strategies to prevent falls or fractures in residents in care homes and hospital inpatients and to investigate the effect of dementia and cognitive impairment. Design: Systematic review and meta-analyses of studies grouped by intervention and setting (hospital or care home). Meta-regression to investigate the effects of dementia and of study quality and design. Data

David Oliver; James B. Connelly; Christina R. Victor; Fiona E. Shaw; Anne Whitehead; Yasemin Genc; Alessandra Vanoli; Finbarr C. Martin; Margot A. Gosney; Kurrle

2007-01-01

306

Strategies to prevent falls and fractures in hospitals and care homes and effect of cognitive impairment: systematic review and meta-analyses  

Microsoft Academic Search

Objectives To evaluate the evidence for strategies to prevent falls or fractures in residents in care homes and hospital inpatients and to investigate the effect of dementia and cognitive impairment. Design Systematic review and meta-analyses of studies grouped by intervention and setting (hospital or care home). Meta-regression to investigate the effects of dementia and of study quality and design. Data

David Oliver; James B Connelly; Christina R Victor; Fiona E Shaw; Anne Whitehead; Yasemin Genc; Alessandra Vanoli; Finbarr C Martin; Margot A Gosney

2006-01-01

307

The small area predictors of ambulatory care sensitive hospitalizations: a comparison of changes over time.  

PubMed

The hospital admission for ambulatory care sensitive conditions (ACSCs) is a validated indicator of impeded access to good primary and preventive care services. The authors examine the predictors of ACSC admissions in small geographic areas in two cross-sections spanning an 11-year time interval (1995-2005). Using hospital discharge data from the Healthcare Cost and Utilization Project of the Agency for Healthcare Research and Quality for Arizona, California, Massachusetts, Maryland, New Jersey, and New York for the years 1995 and 2005, the study includes a multivariate cross-sectional design, using compositional factors describing the hospitalized populations and the contextual factors, all aggregated at the primary care service area level. The study uses ordinary least squares regressions with and without state fixed effects, adjusting for heteroscedasticity. Data is pooled over 2 years to assess the statistically significant changes in associations over time. ACSC admission rates were inversely related to the availability of local primary care physicians, and managed care was associated with declines in ACSC admissions for the elderly. Minorities, aged elderly, and percent under federal poverty level were found to be associated with higher ACSC rates. The comparative analysis for 2 years highlights significant declines in the association with ACSC rates of several factors including percent minorities and rurality. The two policy-driven factors, primary care physician capacity and Medicare-managed care penetration, were not found significantly more effective over time. Using small area analysis, the study indicates that improvements in socioeconomic conditions and geographic access may have helped improve the quality of primary care received by the elderly over the last decade, particularly among some minority groups. PMID:24405202

Basu, Jayasree; Mobley, Lee R; Thumula, Vennela

2014-01-01

308

The impact of horizontal mergers and acquisitions on cost and quality in health care.  

PubMed

Mergers and acquisitions among HMOs, hospitals and other health care providers can be disconcerting to benefits staff and employees, but they can be successfully managed. They may offer an employer the opportunity to improve the quality of care provided and to do so at reduced costs. PMID:10153603

Taylor, M J; Porper, R W; Manji, S

1995-12-01

309

42 CFR 412.140 - Participation, data submission, and validation requirements under the Hospital Inpatient Quality...  

Code of Federal Regulations, 2013 CFR

...submission, and validation requirements under the Hospital Inpatient Quality Reporting (IQR) Program... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Payments to Hospitals Under the Prospective Payment Systems §...

2013-10-01

310

42 CFR 412.140 - Participation, data submission, and validation requirements under the Hospital Inpatient Quality...  

Code of Federal Regulations, 2012 CFR

...submission, and validation requirements under the Hospital Inpatient Quality Review (IQR) Program... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Payments to Hospitals Under the Prospective Payment Systems §...

2012-10-01

311

42 CFR 412.140 - Participation, data submission, and validation requirements under the Hospital Inpatient Quality...  

Code of Federal Regulations, 2011 CFR

...submission, and validation requirements under the Hospital Inpatient Quality Review (IQR) Program... PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Payments to Hospitals Under the Prospective Payment Systems §...

2011-10-01

312

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

PubMed Central

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

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

2009-01-01

313

Post-hospital medical respite care and hospital readmission of homeless persons.  

PubMed

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

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

2009-01-01

314

Medical groups can reduce costs by investing in improved quality of care for patients with diabetes.  

PubMed

A major feature of many new contracts between providers and payers is shared savings programs, in which providers can earn a percentage of the savings if the cost of the care they provide is lower than the projected cost. Unless providers are also held accountable for meeting quality benchmarks, some observers fear that these programs could erode quality of care by rewarding only cost savings. We estimated the effects on Medicare expenditures of improving the quality of care for patients with diabetes. Analyzing 234 practices that provided care for 133,703 diabetic patients, we found a net savings of $51 per patient with diabetes per year for every one-percentage-point increase in a score of the quality of care. Cholesterol testing for all versus none of a practice's patients with diabetes, for example, was associated with a dramatic drop in avoidable hospitalizations. These results show that improving the quality of care for patients with diabetes does save money. PMID:22869662

Kralewski, John E; Dowd, Bryan E; Xu, Yi Wendy

2012-08-01

315

Implementing a working together model for Aboriginal patients with acute coronary syndrome: an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse working together to improve hospital care.  

PubMed

Acute coronary syndrome (ACS) contributes to the disparity in life expectancy between Aboriginal and non-Aboriginal Australians. Improving hospital care for Aboriginal patients has been identified as a means of addressing this disparity. This project developed and implemented a working together model of care, comprising an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse, providing care coordination specifically directed at improving attendance at cardiac rehabilitation services for Aboriginal Australians in a large metropolitan hospital in Melbourne. A quality improvement framework using a retrospective case notes audit evaluated Aboriginal patients' admissions to hospital and identified low attendance rates at cardiac rehabilitation services. A working together model of care coordination by an Aboriginal Hospital Liaison Officer and a specialist cardiac nurse was implemented to improve cardiac rehabilitation attendance in Aboriginal patients admitted with ACS to the cardiac wards of the hospital. A retrospective medical records audit showed that there were 68 Aboriginal patients admitted to the cardiac wards with ACS from 1 July 2008 to 30 June 2011. A referral to cardiac rehabilitation was recorded for 42% of these. During the implementation of the model of care, 13 of 15 patients (86%) received a referral to cardiac rehabilitation and eight of the 13 (62%) attended. Implementation of the working together model demonstrated improved referral to and attendance at cardiac rehabilitation services, thereby, has potential to prevent complications and mortality. PMID:25200319

Daws, Karen; Punch, Amanda; Winters, Michelle; Posenelli, Sonia; Willis, John; MacIsaac, Andrew; Rahman, Muhammad Aziz; Worrall-Carter, Linda

2014-11-01

316

Attracting and retaining quality human resources for Niagara's hospitality industry  

Microsoft Academic Search

Purpose – The purpose of this paper is to identify the best approaches management should embrace to successfully attract and retain high quality human resource talent within the Niagara region's hospitality industry. Design\\/methodology\\/approach – A selected cross-section of relevant and recent publications are reviewed. The key findings from a mini survey involving 14 senior hospitality managers in the Niagara region

Paul A. Willie; Chandana Jayawardena; Barrie Laver

2008-01-01

317

Family Participation in the Nursing Care of the Hospitalized Patients  

PubMed Central

Background: Few studies, especially in Iran, have assessed the status of family participation in the care of the hospitalized patients. Objectives: This study was conducted to assess why family members partake in caregiving of their patients in hospitals, the type of care that family provide, and the outcomes of the participation in the opinions of nurses and family members. Patients and Methods: In this comparative-descriptive study, data was collected by a two- version researcher-developed questionnaire, from 253 family members of patients by quota sampling method and 83 nurses by census sampling method from wards which had licensed for entering the families. Each questionnaire has three sections: the care needs of the patients which family participated to provide, the reasons to take part, and the outcomes of this collaborative care. The data was analyzed using descriptive statistics and also chi-squared test through SPSS software version 11.5. Results: The patients received more unskilled and non- professional nursing care from their family members. Most of the nurses and families believed that family participation is both voluntary and compulsory. The shortage of personnel in different categories of nursing and speeding up the patient-related affairs were the most important outcome of the participation, from the nurses’ viewpoint was speeding up the patient-related affairs and from the side of the family members, it was the patients’ feeling of satisfaction from the presence of one of their relatives beside them. Conclusions: Co understanding, skillfulness and competence of families and nurses in collaboration with each other were not good enough.Few studies, especially in Iran, have assessed the status of family participation in the care of the hospitalized patients. PMID:24719705

Khosravan, Shahla; Mazlom, Behnam; Abdollahzade, Naiemeh; Jamali, Zeinab; Mansoorian, Mohammad Reza

2014-01-01

318

American Hospital Association  

MedlinePLUS

... Health Information Technology Health Reform Moving Forward Teaching Hospitals - Medical Education Quality and Patient Safety Tools & Resources ... Amicus Briefs Legal Resources: Litigation State Issues Forum (Hospital Association Executives Only) Key Initiatives America’s Hospitals: Caring ...

319

Quality of Mental Health Care for Nursing Home Residents: A Literature Review  

PubMed Central

Because of the high proportion of nursing home residents with a mental illness other than dementia, the quality of mental health care in nursing homes is a major clinical and policy issue. The authors apply Donabedian's framework for assessing quality of care based on the triad of structure, process, and outcome-based measures in reviewing the literature on the quality of mental health care in nursing homes. Quality measures used within the literature include mental health consultations and hospitalizations, inappropriate use of medications, and mental health survey deficiencies. Factors related to the resident's welfare (nurse staffing), provider norms (locality), and financial factors (payer mix) were associated with the quality of mental health care. Although future research is necessary, the extant literature suggests that persons with mental illness are frequently admitted to nursing homes and their care is often of poor quality and related to a series of resident and facility factors. PMID:20223943

Grabowski, David C.; Aschbrenner, Kelly A.; Rome, Vincent F.; Bartels, Stephen J.

2010-01-01

320

Analyzing staffing trade-offs on acute care hospital units.  

PubMed

Given today's resource-limited environment, nurse leaders must make judicious staffing decisions to deliver safe, cost-effective care. Investing in 1 element of staffing often requires scaling back in another. A national cross section of acute care hospital unit leaders was surveyed regarding staffing resources, including nurse workload, education, specialty certification, experience, and level of support staff. The authors report findings from the survey and discuss the trade-offs observed among units regarding nurse-to-patient ratios and the proportion of baccalaureate-prepared nurses. PMID:25208268

Berkow, Steven; Vonderhaar, Kate; Stewart, Jennifer; Virkstis, Katherine; Terry, Anne

2014-10-01

321

Care adjustments for people with learning disabilities in hospitals.  

PubMed

Health inequalities start early in life for people with learning disabilities. In the UK, they can arise from various barriers that people experience when trying to access care that should be appropriate, timely and effective. Inequalities in health care are likely to result in many NHS organisations breaching their legal responsibilities, as outlined in the Disability Discrimination Acts 1995 and 2005, the Equality Act 2010 and the Mental Capacity Act 2005 (Emerson and Baines 2010). This article seeks to help nurses, healthcare professionals and hospital managers ensure that better services are delivered by encouraging them to explore how reasonable adjustments can improve outcomes for people with learning disabilities. PMID:22256461

Blair, Jim

2011-12-01

322

Comparing Clinician Ratings of the Quality of Palliative Care in the Intensive Care Unit  

PubMed Central

Objective There are numerous challenges to successfully integrating palliative care in the ICU. Our primary goal was to describe and compare the quality of palliative care delivered in an ICU as rated by physicians and nurses working in that ICU. Design Multi-site study using self-report questionnaires. Setting Thirteen hospitals throughout the United States. Participants Convenience sample of 188 physicians working in critical care (attending physicians, critical care fellows, resident physicians) and 289 critical care nurses. Measurements Clinicians provided overall ratings of the care delivered by either nurses or physicians in their ICU for each of seven domains of ICU palliative care using a 0–10 scale (0 indicating the worst possible and 10 indicating the best possible care). Analyses included descriptive statistics to characterize measurement characteristics of the 10 items, paired Wilcoxon tests comparing item ratings for the domain of symptom management with all other item ratings, and regression analyses assessing differences in ratings within and between clinical disciplines. We used p<0.001 to denote statistical significance to address multiple comparisons. Main Results The ten items demonstrated good content validity with few missing responses, ceiling or floor effects. Items receiving the lowest ratings assessed spiritual support for families, emotional support for ICU clinicians, and palliative-care education for ICU clinicians. All but two items were rated significantly lower than the item assessing symptom management (p<0.001). Nurses rated nursing care significantly higher (p<0.001) than physicians rated physician care in five domains. In addition, while nurses and physicians gave comparable ratings to palliative care delivered by nurses, nurses’ and physicians’ ratings of physician care were significantly different, with nurse ratings of this care lower than physician ratings on all but one domain. Conclusion Our study supports the content validity of the 10 overall rating items and supports the need for improvement in several aspects of palliative care including spiritual support for families, emotional support for clinicians, and clinician education about palliative care in the ICU. Further, our findings provide some preliminary support for surveying ICU clinicians as one way to assess the quality of palliative care in the ICU. PMID:21283006

Ho, Lawrence A.; Engelberg, Ruth A.; Curtis, J. Randall; Nelson, Judith; Luce, John; Ray, Daniel E.; Levy, Mitchell M.

2011-01-01

323

Caring and Learning Environments: Quality in Child Care Centres across Canada. You Bet I Care!  

ERIC Educational Resources Information Center

Canadian experts in diverse fields as well as people concerned about social justice and cohesion have identified quality child care as a crucial component in addressing a variety of broad societal goals. This study explored the relationships between child care center quality and: center characteristics; teaching staff wages and working conditions;…

Goelman, Hillel; Doherty, Gillian; Lero, Donna S.; LaGrange, Annette; Tougas, Jocelyne

324

Caring and Learning Environments: Quality in Regulated Family Child Care across Canada. You Bet I Care!  

ERIC Educational Resources Information Center

Canadian experts in diverse fields as well as people concerned about social justice and cohesion have identified quality child care as a crucial component in addressing a variety of broad societal goals. This study explored the relationships between quality in Canadian family child care homes and: provider characteristics and attitudes about…

Doherty, Gillian; Lero, Donna S.; Goelman, Hillel; Tougas, Jocelyne; LaGrange, Annette

325

Accountable care organizations: financial advantages of larger hospital organizations.  

PubMed

Accountable care organizations (ACOs) are groups of providers who agree to accept the responsibility for elevating the health status of a defined group of patients, with the goal of enabling people to take charge of their health and enroll in shared decision making with providers. The large initial investment required (estimated at $1.8 million) to develop an ACO implies that the participation of large health care organizations, especially hospitals and health systems, is required for success. Findings of this study suggest that ACOs based in a larger hospital organization are more likely to meet Centers for Medicare and Medicaid Services criteria for formation because of financial and structural assets of those entities. PMID:24776829

Camargo, Rodrigo; Camargo, Thaisa; Deslich, Stacie; Paul, David P; Coustasse, Alberto

2014-01-01

326

The Effects of Quality of Care on Costs: A Conceptual Framework  

PubMed Central

Context The quality of health care and the financial costs affected by receiving care represent two fundamental dimensions for judging health care performance. No existing conceptual framework appears to have described how quality influences costs. Methods We developed the Quality-Cost Framework, drawing from the work of Donabedian, the RAND/UCLA Appropriateness Method, reports by the Institute of Medicine, and other sources. Findings The Quality-Cost Framework describes how health-related quality of care (aspects of quality that influence health status) affects health care and other costs. Structure influences process, which, in turn, affects proximate and ultimate outcomes. Within structure, subdomains include general structural characteristics, circumstance-specific (e.g., disease-specific) structural characteristics, and quality-improvement systems. Process subdomains include appropriateness of care and medical errors. Proximate outcomes consist of disease progression, disease complications, and care complications. Each of the preceding subdomains influences health care costs. For example, quality improvement systems often create costs associated with monitoring and feedback. Providing appropriate care frequently requires additional physician visits and medications. Care complications may result in costly hospitalizations or procedures. Ultimate outcomes include functional status as well as length and quality of life; the economic value of these outcomes can be measured in terms of health utility or health-status-related costs. We illustrate our framework using examples related to glycemic control for type 2 diabetes mellitus or the appropriateness of care for low back pain. Conclusions The Quality-Cost Framework describes the mechanisms by which health-related quality of care affects health care and health status–related costs. Additional work will need to validate the framework by applying it to multiple clinical conditions. Applicability could be assessed by using the framework to classify the measures of quality and cost reported in published studies. Usefulness could be demonstrated by employing the framework to identify design flaws in published cost analyses, such as omitting the costs attributable to a relevant subdomain of quality. PMID:23758513

Nuckols, Teryl K; Escarce, Jose J; Asch, Steven M

2013-01-01

327

Redesigning care for patients at increased hospitalization risk: the Comprehensive Care Physician model.  

PubMed

Patients who have been hospitalized often experience care coordination problems that worsen outcomes and increase costs. One reason is that hospital care and ambulatory care are often provided by different physicians. However, interventions to improve care coordination for hospitalized patients have not consistently improved outcomes and generally have not reduced costs. We describe the rationale for the Comprehensive Care Physician model, in which physicians focus their practice on patients at increased risk of hospitalization so that they can provide both inpatient and outpatient care to their patients. We also describe the design and implementation of a study supported by the Center for Medicare and Medicaid Innovation to assess the model's effects on costs and outcomes. Evidence concerning the effectiveness of the program is expected by 2016. If the program is found to be effective, the next steps will be to assess the durability of its benefits and the model's potential for dissemination; evidence to the contrary will provide insights into how to alter the program to address sources of failure. PMID:24799573

Meltzer, David O; Ruhnke, Gregory W

2014-05-01

328

38 CFR 17.46 - Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from...  

...hospital, domiciliary or nursing home care of persons discharged or released from...Hospital, Domiciliary and Nursing Home Care § 17.46 Eligibility for hospital, domiciliary or nursing home care of persons discharged or released...

2014-07-01

329

38 CFR 17.47 - Considerations applicable in determining eligibility for hospital, nursing home or domiciliary care.  

...for hospital, nursing home or domiciliary care. 17.47 Section 17.47 Pensions...Hospital, Domiciliary and Nursing Home Care § 17.47 Considerations applicable...for hospital, nursing home or domiciliary care. (a)(1) For...

2014-07-01

330

38 CFR 17.44 - Hospital care for certain retirees with chronic disability (Executive Orders 10122, 10400 and...  

...2014-07-01 2014-07-01 false Hospital care for certain retirees with chronic disability (Executive...MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.44 Hospital care for certain retirees with chronic disability...

2014-07-01

331

NURSES' PERCEPTIONS OF QUALITY NURSING CARE PROVIDED TO POST PROCEDURE ELECTIVE PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY PATIENTS  

Microsoft Academic Search

This paper will present some of the findings of a qualitative study that utilised grounded theory to discover nurses perceptions of quality and factors that affect quality nursing care provided to Percutaneous Transluminal Coronary Angioplasty (PTCA) patients in a large Queensland Metropolitan Hospital. The study used focus group interviews, participant observation, in-depth interviews and published literature to gather data. Fifteen

Sonja Cleary; Sansnee Jirojwong; Sandra Walker

332

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

...2014-07-01 2014-07-01 false Hospital care and medical services in foreign countries...AFFAIRS MEDICAL Hospital Or Nursing Home Care and Medical Services in Foreign Countries § 17.35 Hospital care and medical services in foreign...

2014-07-01

333

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

Code of Federal Regulations, 2012 CFR

...2012-07-01 2012-07-01 false Hospital care and medical services in foreign countries...Foreign Countries § 17.35 Hospital care and medical services in foreign countries... The Secretary may furnish hospital care and medical services to any...

2012-07-01

334

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

Code of Federal Regulations, 2013 CFR

...2013-07-01 2013-07-01 false Hospital care and medical services in foreign countries...Foreign Countries § 17.35 Hospital care and medical services in foreign countries... The Secretary may furnish hospital care and medical services to any...

2013-07-01

335

Sudden Death in Hospital after Discharge from Coronary Care Unit  

PubMed Central

In a group of 339 patients with acute myocardial infarction treated in a coronary care unit, 273 left the unit while improving and were expected to leave hospital alive; 23 had a cardiac arrest or died suddenly while still in hospital—17 died immediately or after temporary resuscitation and six were resuscitated to leave hospital alive. Ventricular fibrillation was found in 13 of the 20 patients attended by the cardiac arrest team. The incidents were scattered from the 4th to the 24th day after the onset of infarction. Risk factors in these “late sudden death” patients were compared with the 250 patients who left the unit while improving and did not die or suffer cardiac arrest. The patients susceptible to late sudden death were characterized early in their hospital course by the findings of severe, predominantly anterior infarction, left ventricular failure, persistent sinus tachycardia, and frequent ventricular arrhythmias. It is suggested that such patients be chosen for prolonged observation in a second-stage coronary care unit. PMID:5113015

Thompson, Peter; Sloman, Graeme

1971-01-01

336

AHRQ prevention quality indicators to assess the quality of primary care of local providers: a pilot study from Italy  

PubMed Central

Background: Outside the USA, Agency for Healthcare Research and Quality (AHRQ) prevention quality indicators (PQIs) have been used to compare the quality of primary care services only at a national or regional level. However, in several national health systems, primary care is not directly managed by the regions but is in charge of smaller territorial entities. We evaluated whether PQIs might be used to compare the performance of local providers such as Italian local health authorities (LHAs) and health districts. Methods: We analysed the hospital discharge abstracts of 44 LHAs (and 11 health districts) of five Italian regions (including ?18 million residents) in 2008–10. Age-standardized PQI rates were computed following AHRQ specifications. Potential predictors were investigated using multilevel modelling. Results: We analysed 11 470 722 hospitalizations. The overall rates of preventable hospitalizations (composite PQI 90) were 1012, 889 and 988 (×100 000 inhabitants) in 2008, 2009 and 2010, respectively. Composite PQIs were able to differentiate LHAs and health districts and showed small variation in the performance ranking over years. Conclusion: Although further research is required, our findings support the use of composite PQIs to evaluate the performance of relatively small primary health care providers (50 000–60 000 enrollees) in countries with universal health care coverage. Achieving high precision may be crucial for a structured quality assessment system to align hospitalization rate indicators with measures of other contexts of care (cost, clinical management, satisfaction/experience) that are typically computed at a local level. PMID:24367065

Flacco, Maria Elena; De Vito, Corrado; Arca, Silvia; Carle, Flavia; Capasso, Lorenzo; Marzuillo, Carolina; Muraglia, Angelo; Samani, Fabio; Villari, Paolo

2014-01-01

337

Supporting hospital staff to provide compassionate care: Do Schwartz Center Rounds work in English hospitals?  

PubMed Central

Objective To assess (1) whether the Schwartz Center Rounds (“Rounds”), a multidisciplinary forum which brings together hospital staff to discuss the nonclinical, social and emotional aspects of caring for patients, could transfer from the US to a UK setting; and (2) whether UK Rounds would achieve a similar positive impact on individuals and teams, and hospital culture. Design The results reported are based on 41 qualitative interviews with context provided by additional quantitative research. Setting We introduced Rounds at two pilot sites, both NHS hospitals providing acute care. Participants Over the one-year, ten-Rounds pilot period, Rounds were attended by 1250 staff across the two sites. We conducted qualitative research into the experiences of staff involved in implementing Rounds at the outset and the end of the pilot. Main outcome measures Interviewees' assessment of the effects of Rounds on participants, their relationships with colleagues, and the wider hospital. Results The findings show that in the two pilot trusts, Rounds are perceived by participants as a source of support and that their benefit may translate into benefits for patients and team working; and that Rounds have the potential to effect change in the hospital culture. Conclusion Rounds appear to transfer successfully from the US to the UK, and there is some evidence that they are having a similarly positive impact, but more research is needed. PMID:22434811

Goodrich, Joanna

2012-01-01

338

An Assessment of the Appropriateness of Respiratory Care Delivered at a 450Bed Acute Care Veterans Affairs Hospital  

Microsoft Academic Search

INTRODUCTION: Respiratory care is expensive and time-intensive, inappropriate care wastes resources, and failure to provide necessary and appropriate respiratory care may adversely affect patient outcomes. OBJECTIVE: To determine the appropriateness of basic respiratory care delivered at a 450-bed Veterans Affairs hospital during a 3-month interval. METHODS: We determined (1) the percentage of delivered respiratory care that was not indicated (based

David C Shelledy; Terry S LeGrand; Jay I Peters

339

The Children's Hospitals Neonatal Database: an overview of patient complexity, outcomes and variation in care.  

PubMed

The Children's Hospitals Neonatal Consortium is a multicenter collaboration of leaders from 27 regional neonatal intensive care units (NICUs) who partnered with the Children's Hospital Association to develop the Children's Hospitals Neonatal Database (CHND), launched in 2010. The purpose of this report is to provide a first summary of the population of infants cared for in these NICUs, including representative diagnoses and short-term outcomes, as well as to characterize the participating NICUs and institutions. During the first 2 1/2 years of data collection, 40910 infants were eligible. Few were born inside these hospitals (2.8%) and the median gestational age at birth was 36 weeks. Surgical intervention (32%) was common; however, mortality (5.6%) was infrequent. Initial queries into diagnosis-specific inter-center variation in care practices and short-term outcomes, including length of stay, showed striking differences. The CHND provides a contemporary, national benchmark of short-term outcomes for infants with uncommon neonatal illnesses. These data will be valuable in counseling families and for conducting observational studies, clinical trials and collaborative quality improvement initiatives. PMID:24603454

Murthy, K; Dykes, F D; Padula, M A; Pallotto, E K; Reber, K M; Durand, D J; Short, B L; Asselin, J M; Zaniletti, I; Evans, J R

2014-08-01

340

Improving hospital care for young children in the context of HIV/AIDS and poverty.  

PubMed

Paediatric wards in South African government hospitals are occupied predominantly by children with HIV and AIDS-related illnesses. Although access to anti-retroviral treatment for adults is being scaled up, it is likely to be many years before South Africa achieves anywhere near universal access for children. Currently, most children living with HIV or AIDS are identified only when they become acutely or chronically ill and/or hospitalized, if at all. In the absence of treatment, the stress of caring for ill and hospitalized HIV-positive children often results in emotional withdrawal among both health professionals and caregivers. The demoralizing cycle of repeated admissions, treatment failure and death also affect the quality of the care given to HIV-negative children in over-burdened wards. This article describes the development of simple, low-cost and context-relevant interventions to improve the care environment for young hospitalized children within the context of the HIV/AIDS epidemic and poverty. PMID:19713404

Richter, Linda; Chandan, Upjeet; Rochat, Tamsen

2009-09-01

341

Intermediate care: for better or worse? Process evaluation of an intermediate care model between a university hospital and a residential home  

PubMed Central

Background Intermediate care was developed in order to bridge acute, primary and social care, primarily for elderly persons with complex care needs. Such bridging initiatives are intended to reduce hospital stays and improve continuity of care. Although many models assume positive effects, it is often ambiguous what the benefits are and whether they can be transferred to other settings. This is due to the heterogeneity of intermediate care models and the variety of collaborating partners that set up such models. Quantitative evaluation captures only a limited series of generic structure, process and outcome parameters. More detailed information is needed to assess the dynamics of intermediate care delivery, and to find ways to improve the quality of care. Against this background, the functioning of a low intensity early discharge model of intermediate care set up in a residential home for patients released from an Amsterdam university hospital has been evaluated. The aim of this study was to produce knowledge for management to improve quality of care, and to provide more generalisable insights into the accumulated impact of such a model. Methods A process evaluation was carried out using quantitative and qualitative methods. Registration forms and patient questionnaires were used to quantify the patient population in the model. Statistical analysis encompassed T-tests and chi-squared test to assess significance. Semi-structured interviews were conducted with 21 staff members representing all disciplines working with the model. Interviews were transcribed and analysed using both 'open' and 'framework' approaches. Results Despite high expectations, there were significant problems. A heterogeneous patient population, a relatively unqualified staff and cultural differences between both collaborating partners impeded implementation and had an impact on the functioning of the model. Conclusion We concluded that setting up a low intensity early discharge model of intermediate care between a university hospital and a residential home is less straightforward than was originally perceived by management, and that quality of care needs careful monitoring to ensure the change is for the better. PMID:15910689

Plochg, Thomas; Delnoij, Diana MJ; van der Kruk, Tineke F; Janmaat, Tonnie ACM; Klazinga, Niek S

2005-01-01

342

Recognition of depression and anxiety and their association with quality of life, hospitalization and mortality in primary care patients with heart failure - study protocol of a longitudinal observation study  

PubMed Central

Background International disease management guidelines recommend the regular assessment of depression and anxiety in heart failure patients. Currently there is little data on the effect of screening for depression and anxiety on the quality of life and the prognosis of heart failure (HF). We will investigate the association between the recognition of current depression/anxiety by the general practitioner (GP) and the quality of life and the patients’ prognosis. Methods/Design In this multicenter, prospective, observational study 3,950 patients with HF are recruited by general practices in Germany. The patients fill out questionnaires at baseline and 12-month follow-up. At baseline the GPs are interviewed regarding the somatic and psychological comorbidities of their patients. During the follow-up assessment, data on hospitalization and mortality are provided by the general practice. Based on baseline data, the patients are allocated into three observation groups: HF patients with depression and/or anxiety recognized by their GP (P+/+), those with depression and/or anxiety not recognized (P+/?) and patients without depression and/or anxiety (P?/?). We will perform multivariate regression models to investigate the influence of the recognition of depression and/or anxiety on quality of life at 12 month follow-up, as well as its influences on the prognosis (hospital admission, mortality). Discussion We will display the frequency of GP-acknowledged depression and anxiety and the frequency of installed therapeutic strategies. We will also describe the frequency of depression and anxiety missed by the GP and the resulting treatment gap. Effects of correctly acknowledged and missed depression/anxiety on outcome, also in comparison to the outcome of subjects without depression/anxiety will be addressed. In case results suggest a treatment gap of depression/anxiety in patients with HF, the results of this study will provide methodological advice for the efficient planning of further interventional research. PMID:24279590

2013-01-01

343

The Hospitality Industry: Defining Quality for a Quality Assurance Programme - A Study of Perceptions  

Microsoft Academic Search

Fundamental to hospitality organisations are services which will satisfy the expectations of customers; however, management perceptions of quality of service often differ from customer perceptions. This paper examines the concepts of service and quality within the framework of the hospitality industry. These are then used to contrast the expectations of customers with the perception of those expectations by the providers

Michael Nightingale

1985-01-01

344

Service quality of private hospitals: The Iranian Patients' perspective  

PubMed Central

Background Highly competitive market in the private hospital industry has caused increasing pressure on them to provide services with higher quality. The aim of this study was to determine the different dimensions of the service quality in the private hospitals of Iran and evaluating the service quality from the patients' perspective. Methods A cross-sectional study was conducted between October and November 2010 in Tehran, Iran. The study sample was composed of 983 patients randomly selected from 8 private general hospitals. The study questionnaire was the SERVQUAL questionnaire, consisting of 21 items in service quality dimensions. Results The result of factor analysis revealed 3 factors, explaining 69% of the total variance. The total mean score of patients' expectation and perception was 4.91(SD = 0.2) and 4.02(SD = 0.6), respectively. The highest expectation and perception related to the tangibles dimension and the lowest expectation and perception related to the empathy dimension. The differences between perception and expectation were significant (p < 0.001). There was a significant difference between the expectations scores based on gender, education level, and previous hospitalization in that same hospital. Also, there was a significant difference between the perception scores based on insurance coverage, average length of stay, and patients' health conditions on discharge. Conclusion The results showed that SERVQUAL is a valid, reliable, and flexible instrument to monitor and measure the quality of the services in private hospitals of Iran. Our findings clarified the importance of creating a strong relationship between patients and the hospital practitioners/personnel and the need for hospital staff to be responsive, credible, and empathetic when dealing with patients. PMID:22299830

2012-01-01

345

Respiratory care of the hospitalized patient with cystic fibrosis.  

PubMed

Hospitalization can occur at any age for patients with cystic fibrosis (CF). The leading cause for admission is an acute worsening of signs and symptoms that can be called a pulmonary exacerbation. The reasons for admission are usually the need for intravenous antibiotics and aggressive airway clearance with good nutritional support. Respiratory therapists (RTs) play a key role in the care of CF patients in the out-patient clinics and taking care of the patients while hospitalized. Following the CF pulmonary guidelines, they administer aerosol delivery and airway clearance while also providing education to patients and families. The RT should have the skills to perform and teach all manners of airway clearance and understand the medications and delivery devices that make up a CF treatment. As CF lung disease progresses, so does the chance that these patients may develop complications such as pneumothorax and hemoptysis, which may require different strategies, especially when airway clearance is performed. The RT needs to have the skills that can take the patient from simple oxygen therapy as lung function deteriorates to the point where chronic oxygen or noninvasive ventilation is needed, or to the point where the end-stage patient waits for a lung transplant. An important aspect of the hospitalization is the interaction between the RT and the patient. To give good therapy is to be a great coach. From infection control to following proper nebulizer protocol, to consistency with airway clearance, to education, the CF RT is there for the life of the patient. PMID:19467163

Newton, Thomas J

2009-06-01

346

Impact of hospital nursing care on 30-day mortality for acute medical patients  

Microsoft Academic Search

Title. Impact of hospital nursing care on 30-day mortality for acute medical patients Aim. This paper reports on structures and processes of hospital care influencing 30-day mortality for acute medical patients. Background. Wide variation in risk-adjusted 30-day hospital mortality rates for acute medical patients indicates that hospital structures and processes of care affect patient death. Because nurses provide the majority

Ann E. Tourangeau; Diane M. Doran; Linda McGillis Hall; Linda O'Brien Pallas; Dorothy Pringle; Jack V. Tu; Lisa A. Cranley

2007-01-01

347

Improving the Quality of Maternal and Neonatal Care: the Role of Standard Based Participatory Assessments  

PubMed Central

Background Gaps in quality of care are seriously affecting maternal and neonatal health globally but reports of successful quality improvement cycles implemented at large scale are scanty. We report the results of a nation-wide program to improve quality of maternal and neonatal hospital care in a lower-middle income country focusing on the role played by standard-based participatory assessments. Methods Improvements in the quality of maternal and neonatal care following an action-oriented participatory assessment of 19 areas covering the whole continuum from admission to discharge were measured after an average period of 10 months in four busy referral maternity hospitals in Uzbekistan. Information was collected by a multidisciplinary national team with international supervision through visit to hospital services, examination of medical records, direct observation of cases and interviews with staff and mothers. Scores (range 0 to 3) attributed to over 400 items and combined in average scores for each area were compared with the baseline assessment. Results Between the first and the second assessment, all four hospitals improved their overall score by an average 0.7 points out of 3 (range 0.4 to 1), i.e. by 22%. The improvements occurred in all main areas of care and were greater in the care of normal labor and delivery (+0.9), monitoring, infection control and mother and baby friendly care (+0.8) the role of the participatory action-oriented approach in determining the observed changes was estimated crucial in 6 out of 19 areas and contributory in other 8. Ongoing implementation of referral system and new classification of neonatal deaths impede the improved process of care to be reflected in current statistics. Conclusions Important improvements in the quality of hospital care provided to mothers and newborn babies can be achieved through a standard-based action-oriented and participatory assessment and reassessment process. PMID:24167616

Tamburlini, Giorgio; Yadgarova, Klara; Kamilov, Asamidin; Bacci, Alberta

2013-01-01

348

Organisational factors affecting the quality of hospital clinical coding.  

PubMed

The influence of organisational factors on the quality of hospital coding using the International Statistical Classification of Diseases and Health Related Problems, 10th Revision, Australian Modification (ICD-10-AM) was investigated using a mixed quantitative-qualitative approach. The organisational variables studied were: hospital specialty; geographical locality; structural characteristics of the coding unit; education, training and resource supports for Clinical Coders; and quality control mechanisms. Baseline data on the hospitals' coding quality, measured by the Performance Indicators for Coding Quality tool, were used as an independent index measure. No differences were found in error rates between rural and metropolitan hospitals, or general and specialist hospitals. Clinical Coder allocation to "general" rather than "specialist" unit coding resulted in fewer errors. Coding Managers reported that coding quality can be improved by: Coders engaging in a variety of role behaviours; improved Coder career opportunities; higher staffing levels; reduced throughput; fewer time constraints on coding outputs and associated work; and increased Coder interactions with medical staff. PMID:18245862

Santos, Suong; Murphy, Gregory; Baxter, Kathryn; Robinson, Kerin M

2008-01-01

349

Musculoskeletal Pain and Psychological Distress in Hospital Patient Care Workers  

PubMed Central

Purpose The aim of the study was to assess the association of psychological distress and musculoskeletal pain, how it is related to pain interference with work and multiple pain areas, and potential differences between the different pain areas in hospital patient care workers. Methods Data were collected from a cross-sectional survey of patient care workers (n=1572) from two large hospitals. Results Patient care workers with musculoskeletal pain reported significantly more psychological distress than those without pain. Psychological distress was significantly related to pain interference with work, even after adjusting for pain and demographics (OR = 1.05; CI = 1.01–1.09). The association was strongest for those with both upper- and lower body pain (OR = 1.12; CI = 1.06–1.18). Psychological distress was also independently associated with multiple pain areas. Conclusions Psychological distress was found to be higher in workers with musculoskeletal pain, and highest among workers with both upper and lower body pain. Distress was further significantly associated with pain interference with work as well as number of pain areas. The findings may be followed up with a longitudinal design to better determine the direction of the associations, and to investigate if psychological distress increases the risk of work disability and injuries. PMID:22466375

Reme, Silje Endresen; Dennerlein, Jack T.; Hashimoto, Dean; Sorensen, Glorian

2013-01-01

350

[Quality improvement initiatives in hospitals: which one to choose].  

PubMed

The number of quality improvement initiatives in hospitals has been steadily increasing in the last decades. Most of these initiatives are inspired by three quality control and improvement models developed in the manufacturing industry: the final inspection, the quality assurance and the total quality management. The purpose of this review is to describe how these methods have been implemented in healthcare organizations and to assess their effectiveness and acceptability by healthcare professionals. This review should help quality managers and healthcare professionals to choose a model that is best adapted to their needs and expected goals. PMID:24941688

Haller, G; Quenon, J L

2014-05-21

351

Recent advances in palliative cancer care at a regional hospital in Japan.  

PubMed

More than 30 years have passed since the introduction of the concept of palliative care in cancer care in Japan. However, the majority of the estimated three million cancer patients in Japan do not receive palliative care. Higashi Sapporo Hospital was established in 1983 as a hospital specialized in cancer care. The palliative care unit of our hospital currently consists of 58 beds. Our hospital is one of the largest hospitals in Japan in terms of the number of palliative care beds. On admission to our hospital, all patients are evaluated for palliative care by a multi-disciplinary team and some patients who undergo anticancer therapy receive palliative care when necessary. There are about 65 patients on average (28.3%) who are receiving only palliative care. In 2011, 793 patients died of cancer while admitted at our hospital. This number of cancer deaths accounted for 15% of the 5,324 cancer deaths in Sapporo City in the same year. Our hospital has played an active role according to the philosophy that "palliative cancer care is part of cancer medical care". We here report the current status of the contribution of our hospital to overcoming problems in palliative care and cancer care in Japan. PMID:24023262

Terui, Takeshi; Koike, Kazuhiko; Hirayama, Yasuo; Kusakabe, Toshiro; Ono, Kaoru; Mihara, Hiroyoshi; Kobayashi, Kenji; Takahashi, Yuji; Nakajima, Nobuhisa; Kato, Junji; Ishitani, Kunihiko

2014-11-01

352

Quality of Care in Humanitarian Surgery  

Microsoft Academic Search

Humanitarian surgical programs are set up de novo, within days or hours in emergency or disaster settings. In such circumstances,\\u000a insuring quality of care is extremely challenging. Basic structural inputs such as a safe structure, electricity, clean water,\\u000a a blood bank, sterilization equipment, a post-anesthesia recovery unit, appropriate medications should be established. Currently,\\u000a no specific credentials are needed for surgeons

Kathryn M. ChuMiguel; Miguel Trelles; Nathan P. Ford

2011-01-01

353

Do hospitalist physicians improve the quality of inpatient care delivery? A systematic review of process, efficiency and outcome measures  

Microsoft Academic Search

Background  Despite more than a decade of research on hospitalists and their performance, disagreement still exists regarding whether\\u000a and how hospital-based physicians improve the quality of inpatient care delivery. This systematic review summarizes the findings\\u000a from 65 comparative evaluations to determine whether hospitalists provide a higher quality of inpatient care relative to traditional\\u000a inpatient physicians who maintain hospital privileges with concurrent

Heather L White; Richard H Glazier

2011-01-01

354

Delivery System Integration and Health Care Spending and Quality for Medicare Beneficiaries  

PubMed Central

Background The Medicare accountable care organization (ACO) programs rely on delivery system integration and provider risk sharing to lower spending while improving quality of care. Methods Using 2009 Medicare claims and linked American Medical Association Group Practice data, we assigned 4.29 million beneficiaries to provider groups based on primary care use. We categorized group size according to eligibility thresholds for the Shared Savings (?5,000 assigned beneficiaries) and Pioneer (?15,000) ACO programs and distinguished hospital-based from independent groups. We compared spending and quality of care between larger and smaller provider groups and examined how size-related differences varied by 2 factors considered central to ACO performance: group primary care orientation (measured by the primary care share of large groups’ specialty mix) and provider risk sharing (measured by county health maintenance organization penetration and its relationship to financial risk accepted by different group types for managed care patients). Spending and quality of care measures included total medical spending, spending by type of service, 5 process measures of quality, and 30-day readmissions, all adjusted for sociodemographic and clinical characteristics. Results Compared with smaller groups, larger hospital-based groups had higher total per-beneficiary spending in 2009 (mean difference: +$849), higher 30-day readmission rates (+1.3% percentage points), and similar performance on 4 of 5 process measures of quality. In contrast, larger independent physician groups performed better than smaller groups on all process measures and exhibited significantly lower per-beneficiary spending in counties where risk sharing by these groups was more common (?$426). Among all groups sufficiently large to participate in ACO programs, a strong primary care orientation was associated with lower spending, fewer readmissions, and better quality of diabetes care. Conclusions Spending was lower and quality of care better for Medicare beneficiaries served by larger independent physician groups with strong primary care orientations in environments where providers accepted greater risk. PMID:23780467

McWilliams, J. Michael; Chernew, Michael E.; Zaslavsky, Alan M.; Hamed, Pasha; Landon, Bruce E.

2013-01-01

355

Health care quality improvement publication trends.  

PubMed

To analyze the extent of academic interest in quality improvement (QI) initiatives in medical practice, annual publication trends for the most well-known QI methodologies being used in health care settings were analyzed. A total of 10 key medical- and business-oriented library databases were examined: PubMed, Ovid MEDLINE, EMBASE, CINAHL, PsycINFO, ISI Web of Science, Scopus, the Cochrane Central Register of Controlled Trials, ABI/INFORM, and Business Source Complete. A total of 13 057 articles were identified that discuss at least 1 of 10 well-known QI concepts used in health care contexts, 8645 (66.2%) of which were classified as original research. "Total quality management" was the only methodology to demonstrate a significant decline in publication over time. "Continuous quality improvement" was the most common topic of study across all publication years, whereas articles discussing Lean methodology demonstrated the largest growth in publication volume over the past 2 decades. Health care QI publication volume increased substantially beginning in 1991. PMID:24101680

Sun, Gordon H; MacEachern, Mark P; Perla, Rocco J; Gaines, Jean M; Davis, Matthew M; Shrank, William H

2014-01-01

356

Clinical Audit of Diabetes Care in the Bahrain Defence Forces Hospital  

PubMed Central

Objectives: Primary care audits in Bahrain have consistently revealed a failure to meet recognised standards of delivery of process and outcome measures to patients with diabetes. This study aimed to establish for the first time the quality of diabetes care in a Bahraini hospital setting. Methods: A retrospective clinical audit was conducted of a random sample of patients attending the Diabetes and Endocrine Center at the Bahrain Defence Forces Hospital over a 15-month period which ended in June 2010. The medical records of 287 patients with diabetes were reviewed electronically and manually for process and outcome measures, and a statistical analysis was performed. Results: Of the patients, 47% were male, with a median age of 54 years, and 5% had type 1 diabetes. Measured processes, including haemoglobin A1c, blood pressure, lipids, creatinine and weight, were recorded in over 90% of the patients. Smoking (8%) and the patient’s body mass index (19%) were less frequently recorded. Screening for complications was low, with retinal screening in 42%, foot inspection in 22% and microalbuminuria in 23% of patients. Conclusion: This study shows that the implementation of recognised evidence-based practice continues to pose challenges in routine clinical care. Screening levels for the complications of diabetes were low in this hospital diabetes clinic. It is important to implement a systematic approach to diabetes care to improve the quality of care of patients with diabetes which could lead to a lowering of cardiovascular risk and a reduction in healthcare costs in the long term. PMID:24273661

Al-Baharna, Marwa M.; Whitford, David L.

2013-01-01

357

Is having quality as an item on the executive board agenda associated with the implementation of quality management systems in European hospitals: a quantitative analysis  

PubMed Central

Objective To assess whether there is a relationship between having quality as an item on the board's agenda, perceived external pressure (PEP) and the implementation of quality management in European hospitals. Design A quantitative, mixed method, cross-sectional study in seven European countries in 2011 surveying CEOs and quality managers and data from onsite audits. Participants One hundred and fifty-five CEOs and 155 quality managers. Setting One hundred and fifty-five randomly selected acute care hospitals in seven European countries (Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey). Main outcome measure(s) Three constructs reflecting quality management based on questionnaire and audit data: (i) Quality Management System Index, (ii) Quality Management Compliance Index and (iii) Clinical Quality Implementation Index. The main predictor was whether quality performance was on the executive board's agenda. Results Discussing quality performance at executive board meetings more often was associated with a higher quality management system score (regression coefficient b = 2.53; SE = 1.16; P = 0.030). We found a trend in the associations of discussing quality performance with quality compliance and clinical quality implementation. PEP did not modify these relationships. Conclusions Having quality as an item on the executive board's agenda allows them to review and discuss quality performance more often in order to improve their hospital's quality management. Generally, and as this study found, having quality on the executive board's agenda matters. PMID:24550260

Botje, Daan; Klazinga, N.S.; Sunol, R.; Groene, O.; Pfaff, H.; Mannion, R.; Depaigne-Loth, A.; Arah, O.A.; Dersarkissian, M.; Wagner, C.; Klazinga, N.; Kringos, D.S.; Lombarts, M.J.M.H.; Plochg, T.; Lopez, M.A.; Vallejo, P.; Saillour-Glenisson, F.; Car, M.; Jones, S.; Klaus, E.; Bottaro, S.; Garel, P.; Saluvan, M.; Bruneau, C.; Depaigne-Loth, A.; Hammer, A.; Ommen, O.; Pfaff, H.; Botje, D.; Escoval, A.; Livio, A.; Eiras, M.; Franca, M.; Leite, I.; Almeman, F.; Kus, H.; Ozturk, K.; Mannion, R.; Wang, A.; Thompson, A.

2014-01-01

358

Examining financial performance indicators for acute care hospitals.  

PubMed

Measuring financial performance in acute care hospitals is a challenge for those who work daily with financial information. Because of the many ways to measure financial performance, financial managers and researchers must decide which measures are most appropriate. The difficulty is compounded for the non-finance person. The purpose of this article is to clarify key financial concepts and describe the most common measures of financial performance so that researchers and managers alike may understand what is being measured by various financial ratios. PMID:23614262

Burkhardt, Jeffrey H; Wheeler, John R C

2013-01-01

359

A Canadian Experience of Integrating Complementary Therapy in a Hospital Palliative Care Unit  

PubMed Central

Abstract Background The provision of complementary therapy in palliative care is rare in Canadian hospitals. An Ontario hospital's palliative care unit developed a complementary therapy pilot project within the interdisciplinary team to explore potential benefits. Massage, aromatherapy, Reiki, and Therapeutic Touch™ were provided in an integrated approach. This paper reports on the pilot project, the results of which may encourage its replication in other palliative care programs. Objectives The intentions were (1) to increase patients'/families' experience of quality and satisfaction with end-of-life care and (2) to determine whether the therapies could enhance symptom management. Results Data analysis (n=31) showed a significant decrease in severity of pain, anxiety, low mood, restlessness, and discomfort (p<0.01, 95% confidence interval); significant increase in inner stillness/peace (p<0.01, 95% confidence interval); and convincing narratives on an increase in comfort. The evaluation by staff was positive and encouraged continuation of the program. Conclusions An integrated complementary therapy program enhances regular symptom management, increases comfort, and is a valuable addition to interdisciplinary care. PMID:24020920

Tavares, Marianne; Berger, Brian

2013-01-01

360

Influence of Structural Features on Portuguese Toddler Child Care Quality  

ERIC Educational Resources Information Center

Whereas child care quality has been extensively studied in the U.S., there is much less information about the quality of child care in other countries. With one of the highest maternal employment rates in Europe, it is important to examine child care in Portugal. Thirty toddler classrooms in child care centers were observed. The purpose of this…

Pessanha, Manuela; Aguiar, Cecilia; Bairrao, Joaquim

2007-01-01

361

Hospital readiness for health information exchange: development of metrics associated with successful collaboration for quality improvement  

PubMed Central

Objective The development of readiness metrics for organizational participation in health information exchange is critical for monitoring progress toward, and achievement of, successful inter-organizational collaboration. In preparation for the development of a tool to measure readiness for data-sharing, we tested whether organizational capacities known to be related to readiness were associated with successful participation in an American data-sharing collaborative for quality improvement. Design Cross-sectional design, using an on-line survey of hospitals in a large, mature data-sharing collaborative organized for benchmarking and improvement in nursing care quality. Measurements Factor analysis was used to identify salient constructs, and identified factors were analyzed with respect to “successful” participation. “Success” was defined as the incorporation of comparative performance data into the hospital dashboard. Results The most important factor in predicting success included survey items measuring the strength of organizational leadership in fostering a culture of quality improvement (QI Leadership): 1) presence of a supportive hospital executive; 2) the extent to which a hospital values data; 3) the presence of leaders’ vision for how the collaborative advances the hospital’s strategic goals; 4) hospital use of the collaborative data to track quality outcomes; and 5) staff recognition of a strong mandate for collaborative participation (? = 0.84, correlation with Success 0.68 [P < 0.0001]). Conclusion The data emphasize the importance of hospital QI Leadership in collaboratives that aim to share data for QI or safety purposes. Such metrics should prove useful in the planning and development of this complex form of inter-organizational collaboration. PMID:21330191

Korst, Lisa M.; Aydin, Carolyn E.; Signer, Jordana M. K.; Fink, Arlene

2011-01-01

362

Processes of Care, Illness Severity, and Outcomes in the Management of Community-Acquired Pneumonia at Academic Hospitals  

Microsoft Academic Search

Background: Prompt antibiotic administration, oxy- genation measurement, and blood cultures are generally considered markers of high-quality care in the inpatient management of community-acquired pneumonia (CAP). However, few studies have examined the rela- tionship between prompt achievement of process-of- care markers and outcomes for patients with CAP. We examined whether antibiotic administration within 8 hours of hospital arrival, a blood culture

Julien Dedier; Daniel E. Singer; Yuchiao Chang; Maria Moore; Steven J. Atlas

2001-01-01

363

Creating Champions for Health Care Quality and Safety  

Microsoft Academic Search

Patient safety and quality of care are public concerns that demand personal responsibility at all levels of the health care organization. Senior residents in our graduate medical education program took responsibility for a capstone quality improvement project designed to transform them into champions for health care quality. Residents (n = 26) participated alone or in pairs in a 1-month faculty-mentored

Robert Holland; David Meyers; Christopher Hildebrand; Alan J. Bridges; Mary A. Roach; Bennett Vogelman

2010-01-01

364

38 CFR 17.52 - Hospital care and medical services in non-VA facilities.  

Code of Federal Regulations, 2011 CFR

... 1 2011-07-01 2011-07-01 false Hospital care and medical services in non-VA facilities...VETERANS AFFAIRS MEDICAL Use of Public Or Private Hospitals § 17.52 Hospital care and medical services in non-VA...

2011-07-01

365

38 CFR 17.52 - Hospital care and medical services in non-VA facilities.  

Code of Federal Regulations, 2012 CFR

... 1 2012-07-01 2012-07-01 false Hospital care and medical services in non-VA facilities...VETERANS AFFAIRS MEDICAL Use of Public Or Private Hospitals § 17.52 Hospital care and medical services in non-VA...

2012-07-01

366

Therapist-centred design of NUI based therapies in a neurological care hospital  

E-print Network

Therapist-centred design of NUI based therapies in a neurological care hospital Junia Anacleto chronic care hospital that has no ICT based workflow processes we identified three main components where social intranet. Hospital staff liked the game-activity and logging, but expressed concerns about

British Columbia, University of

367

38 CFR 17.52 - Hospital care and medical services in non-VA facilities.  

Code of Federal Regulations, 2013 CFR

... 1 2013-07-01 2013-07-01 false Hospital care and medical services in non-VA facilities...VETERANS AFFAIRS MEDICAL Use of Public Or Private Hospitals § 17.52 Hospital care and medical services in non-VA...

2013-07-01

368

38 CFR 17.52 - Hospital care and medical services in non-VA facilities.  

Code of Federal Regulations, 2010 CFR

... 1 2010-07-01 2010-07-01 false Hospital care and medical services in non-VA facilities...VETERANS AFFAIRS MEDICAL Use of Public Or Private Hospitals § 17.52 Hospital care and medical services in non-VA...

2010-07-01

369

The effectiveness of substitution of hospital ward care from medical doctors to physician assistants: a study protocol  

PubMed Central

Background Because of an expected shrinking supply of medical doctors for hospitalist posts, an increased emphasis on efficiency and continuity of care, and the standardization of many medical procedures, the role of hospitalist is increasingly allocated to physician assistants (PAs). PAs are nonphysician clinicians with medical tasks. This study aims to evaluate the effects of substitution of hospital ward care to PAs. Methods/Design In a multicenter matched controlled study, the traditional model in which the role of hospitalist is taken solely by medical doctors (MD model) is compared with a mixed model in which a PA functions as a hospitalist, contingent with MDs (PA/MD model). Twenty intervention and twenty control wards are included across The Netherlands, from a range of medical specialisms. Primary outcome measure is patients’ length of hospital stay. Secondary outcomes include indicators for quality of hospital ward care, patients experiences with medical ward care, patients health-related quality of life, and healthcare providers’ experiences. An economic evaluation is conducted to assess the cost implications and potential efficiency of the PA/MD model. For most measures, data is collected from medical records or questionnaires in samples of 115 patients per hospital ward. Semi-structured interviews with healthcare professionals are conducted to identify determinants of efficiency, quality and continuity of care and barriers and facilitators for the implementation of PAs in the role of hospitalist. Discussion Findings from this study will help to further define the role of nonphysician clinicians and provides possible key components for the implementation of PAs in hospital ward care. Like in many studies of organizational change, random allocation to study arms is not feasible, which implies an increased risk for confounding. A major challenge is to deal with the heterogeneity of patients and hospital departments. Trial registration ClinicalTrials.gov ID NCT01835444 PMID:24472112

2014-01-01

370

The impact of ageing on hospital care and long-term care—the example of Germany  

Microsoft Academic Search

Background: In the next few decades the population in all EU-countries will age rapidly. This could have a major impact on the health care sector. This study analyses the effect of population ageing on utilisation in two key sectors of the health care system, namely hospital care and long-term care in Germany, up to 2020 with an outlook to 2050.

Erika Schulz; Reiner Leidl; Hans-Helmut König

2004-01-01

371

An Empirical Analysis of the Current Need for Teleneuromedical Care in German Hospitals without Neurology Departments  

PubMed Central

Indroduction. At present, modern telemedicine methods are being introduced, that may contribute to reducing lack of qualified stroke patient care, particularly in less populated regions. With the help of video conferencing systems, a so-called neuromedical teleconsultation is carried out. Methods. The study included a multicentered, completely standardized survey of physicians in hospitals by means of a computerized on-line questionnaire. Descriptive statistical methods were used for data analysis. Results. 119 acute hospitals without neurology departments were included in the study. The most important reasons for participating in a teleneuromedical network is seen as the improvement in the quality of treatment (82%), the ability to avoid unnecessary patient transport (76%), easier and faster access to stroke expertise (72%) as well as better competitiveness among medical services (67%). The most significant problem areas are the financing system of teleneuromedicine with regard to the acquisition costs of the technical equipment (43%) and the compensation for the stroke-unit center with the specialists' consultation service (31%) as well as legal aspects of teleneuromedicine (27%). Conclusions. This investigation showed that there is a high acceptance for teleneuromedicine among co-operating hospitals. However these facilities have goals in addition to improved quality in stroke treatment. Therefore the use of teleneuromedicine must be also associated with long term incentives for the overall health care system, particularly since the implementation of a teleneuromedicine network system is time consuming and associated with high implementation costs. PMID:20671991

Ickenstein, G. W.; Gross, S.; Tenckhoff, D.; Hausn, P.; Becker, U.; Klisch, J.; Isenmann, S.

2010-01-01

372

Acute care in neurosurgery: quantity, quality, and challenges  

PubMed Central

OBJECTIVE—Part of the daily routine in neurosurgery is the treatment of emergency room admissions, and acute cases from other departments or from outside hospitals. This acute care is not normally included in performance figures or budget management, nor analysed scientifically in respect of quantity and quality of care provided by neurosurgeons.?METHOD—Over a 1 year period, all acute care cases managed by two neurosurgical on call teams in a large northern German city, were recorded prospectively on a day by day basis. A large database of 1819 entries was created and analysed using descriptive statistics.?RESULTS—The minimum incidence of patients requiring neurosurgical acute care was estimated to be 75-115/100 000 inhabitants/year. This corresponds to a mean of about 6/day. Only 30% of patients came directly via the emergency room. The fate of 70% of patients depended initially on the "neurosurgical qualification" of primary care doctors and here deficits existed. Although most intracerebral and subarachnoid haemorrhages were managed with the participation of neurosurgeons, they were not involved in the management of most mild and moderate traumatic brain injuries. Within 1 year the additional workload from acute care amounted to 1000 unplanned admissions, 900 acute imaging procedures, and almost 400 emergency operations.?CONCLUSION—The current policy in public health, which includes cuts in resources, transport facilities, and manpower, is not compatible with the demonstrated extent of acute neurosurgical care. In addition to routine elective work, many extra admissions, evening or night time surgery, and imaging procedures have to be accomplished. An education programme for generalists is required to improve overall patient outcome. These conclusions hold special importance if health authorities wish to not only maintain present standards but aim to improve existing deficits.?? PMID:11459889

Schuhmann, M; Rickels, E; Rosahl, S; Schneekloth, C; Samii, M

2001-01-01

373

Nurses' Emotional Intelligence Impact on the Quality of Hospital Services  

PubMed Central

Background Emotional intelligence is the potential to feel, use, communicate, recognize, remember, describe, identify, learn from, manage, understand and explain emotions. Service quality also can be defined as the post-consumption assessment of the services by consumers that are determined by many variables. Objectives This study was aimed to determine the nurses’ emotional intelligence impact on the delivered services quality. Materials and Methods This descriptive - applied study was carried out through a cross-sectional method in 2010. The research had 2 populations comprising of patients admitted to three academic hospitals of Yazd and the hospital nurses. Sample size was calculated by sample size formula for unlimited (patients) and limited (nursing staff) populations and obtained with stratified- random method. The data was collected by 4 valid questionnaires. Results The results of study indicated that nurses' emotional intelligence has a direct effect on the hospital services quality. The study also revealed that nurse's job satisfaction and communication skills have an intermediate role in the emotional intelligence and service quality relation. Conclusions This paper reports a new determinant of hospital services quality. PMID:23482866

Ranjbar Ezzatabadi, Mohammad; Bahrami, Mohammad Amin; Hadizadeh, Farzaneh; Arab, Masoomeh; Nasiri, Soheyla; Amiresmaili, Mohammadreza; Ahmadi Tehrani, Gholamreza

2012-01-01

374

Quality of care: how good is good enough?  

PubMed

Israel has made impressive progress in improving performance on key measures of the quality of health care in the community in recent years. These achievements are all the more notable given Israel's modest overall spending on health care and because they have accrued to virtually the entire population of the country.Health care systems in most developed nations around the world find themselves in a similar position today with respect to health care quality. Despite significantly increased improvement efforts over the past decade, routine safety processes, such as hand hygiene and medication administration, fail routinely at rates of 30% to 50%. People with chronic diseases experience preventable episodes of acute illness that require hospitalization due to medication mix-ups and other failures of outpatient management. Patients continue to be harmed by preventable adverse events, such as surgery on the wrong part of the body and fires in operating theaters. Health care around the world is not nearly as safe as other industries, such as commercial aviation, that have mastered highly effective ways to manage serious hazards.Health care organizations will have to undertake three interrelated changes to get substantially closer to the superlative safety records of other industries: leadership commitment to zero major quality failures, widespread implementation of highly effective process improvement methods, and the adoption of all facets of a culture of safety. Each of these changes represents a major challenge to the way today's health care organizations plan and carry out their daily work. The Israeli health system is in an enviable position to implement these changes. Universal health insurance coverage, the enrolment of the entire population in a small number of health plans, and the widespread use of electronic health records provide advantages available to few other countries.Achieving and sustaining levels of safety comparable to, say, commercial aviation will be a long journey for health care--one we should begin promptly.This is a commentary on http://www.ijhpr.org/content/1/1/3/ PMID:22913581

Chassin, Mark R

2012-01-01

375

Who should care about the cost and quality of medical care? The American Board of Internal  

E-print Network

Who should care about the cost and quality of medical care? The American Board of Internal Medicine of care and reducing health care costs, and how health care professionals can participate in this important work. Choosing Wisely: RATIONING OR COST-CONSCIOUS HEALTH CARE? USF McClaren Conference Room 250

Galles, David

376

Hospitals Pharmacy Quality Assurance System Assessment in Tehran University of Medical Sciences, Iran  

PubMed Central

Background: Health system pharmacies, like other health care professional, practice under a number of mandated standards. Basic concepts of quality assurance (QA) standards should be applied to hospital pharmacy practice. The survey reported here is to assess QA system implementation and its standard indicators observation in Tehran University of Medical Sciences (TUMS) hospitals’ pharmacies in 2007 – 2008. Methods: A cross – sectional, descriptive analytical survey was accomplished. First, a checklist within the framework of QA standard indicators was made to assess TUMS hospitals pharmacies practice. Collected data was saved by Excel software for recording and analyzed by SPSS version-15. Observation rate of QA standard indicators was classified by inappropriate, relatively appropriate, and appropriate. Results: Characteristics of TUMS hospitals pharmacists organizational structure, size, equipment, safety facility and drug requirement were studied by QA standard indicators. Conclusion: Many of QA standard indicators are observed and implemented in TUMS hospitals pharmacies, but several of these standards are not observed too. It is appropriate that all TUMS hospitals pharmacies are required to advance the profession, often with the same goal of increasing involvement in direct patient care. PMID:23113043

Dargahi, H; Khosravi, SH

2010-01-01

377

[Medical care at the Royal Hospital of Natives].  

PubMed

After the Conquest, the indigenous populations of New Spain were left unprotected by the new government. Thus the Royal Hospital of Naturals (RHN) was created, offering care to the indigenous population for health and with hospitality, as well as religious aid. However, later solely care was provided. The RHN had great support from the Spanish Crown and became a suitable place for clinical investigation that on the peninsula and in all of Europe was forbidden: the autopsies, that in indigenous population are carried out without sanction, only needing authorization of local authorities for their accomplishment, considering the indigenous as inferior to Spaniards. In addition, the RHN was the best place for foundation of the Royal Surgery School of Mexico in the XVIII century. The contribution of the RHN was the fusion of indigenous medicine with European medicine, increasing the therapeutic resource array, as well as the opportunity of carrying clinic investigation through autopsy's for better clinic correlation, and matchless learning for the era in the art of out surgery, this being an important point in the development of the medicine and surgery of Mexico. PMID:14984677

Romero-Huesca, Andrés; Ramírez-Bollas, Julio

2003-01-01

378

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

PubMed

Staff at 11 rural hospitals in an under-resourced region of Eastern Cape Province, South Africa, participated in an intervention to improve the quality of care of severely malnourished children through training and support aimed at implementing the WHO case-management guidelines. Despite similar intervention inputs, some hospitals reduced their case-fatality rates by at least half, whereas others did not. The aim of this study was to investigate reasons for this disparity. Two successful and two poorly performing hospitals were purposively selected based on their case-fatality rates, which were <10% in the successful hospitals and >30% in those performing poorly. Comparative data were collected during June to October 2004 through structured observations of ward procedures, compilation of hospital data on case-loads and resources, and staff interviews and discussions related to attitudes, teamwork, training, supervision, managerial support and leadership. The four study hospitals had broadly similar resources, infrastructure and child:nurse ratios, and all had made changes to their clinical and dietary management following training. Case-management was broadly in line with WHO guidelines but the study revealed clear differences in institutional culture which influenced quality of care. Staff in the successful hospitals were more attentive and assiduous than staff in the poorly performing hospitals, especially in relation to rehydration procedures, feeding and the recording of vital signs. There was a strong emphasis on in-service training and induction of incoming staff in the successful hospitals and better supervision of junior staff and carers. Nurses had more positive attitudes towards malnourished children and their carers, and were less judgmental. Underlying factors were differences in leadership, teamwork, and managerial supervision and support. We conclude that unless there are supportive structures at managerial level, the potential benefits of efficacious interventions and related training programmes to improve health worker performance can be thwarted. PMID:18796499

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

2008-11-01

379

Child Care Quality in Different State Policy Contexts  

ERIC Educational Resources Information Center

Using data from the Child Care Supplement to the Fragile Families and Child Wellbeing Study, we test associations between the quality of child care and state child care policies. These data, which include observations of child care and interviews with care providers and mothers for 777 children across 14 states, allow for comparisons across a…

Rigby, Elizabeth; Ryan, Rebecca M.; Brooks-Gunn, Jeanne

2007-01-01

380

42 CFR 412.505 - Conditions for payment under the prospective payment system for long-term care hospitals.  

Code of Federal Regulations, 2011 CFR

...prospective payment system for long-term care hospitals. 412.505 Section 412.505 ...PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.505 Conditions for...

2011-10-01

381

38 CFR 17.46 - Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from...  

Code of Federal Regulations, 2013 CFR

...2013-07-01 false Eligibility for hospital, domiciliary or nursing home care...DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.46 Eligibility for hospital, domiciliary or nursing home...

2013-07-01

382

42 CFR 412.541 - Method of payment under the long-term care hospital prospective payment system.  

Code of Federal Regulations, 2012 CFR

...of payment under the long-term care hospital prospective payment system. 412...PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.541 Method of payment...

2012-10-01

383

42 CFR 412.541 - Method of payment under the long-term care hospital prospective payment system.  

Code of Federal Regulations, 2010 CFR

...of payment under the long-term care hospital prospective payment system. 412...PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.541 Method of payment...

2010-10-01

384

38 CFR 17.46 - Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from...  

Code of Federal Regulations, 2011 CFR

...2011-07-01 false Eligibility for hospital, domiciliary or nursing home care...DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.46 Eligibility for hospital, domiciliary or nursing home...

2011-07-01

385

42 CFR 412.541 - Method of payment under the long-term care hospital prospective payment system.  

Code of Federal Regulations, 2011 CFR

...of payment under the long-term care hospital prospective payment system. 412...PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.541 Method of payment...

2011-10-01

386

42 CFR 412.540 - Method of payment for preadmission services under the long-term care hospital prospective payment...  

Code of Federal Regulations, 2013 CFR

...preadmission services under the long-term care hospital prospective payment system. 412...PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.540 Method of payment...

2013-10-01

387

42 CFR 412.540 - Method of payment for preadmission services under the long-term care hospital prospective payment...  

Code of Federal Regulations, 2012 CFR

...preadmission services under the long-term care hospital prospective payment system. 412...PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.540 Method of payment...

2012-10-01

388

42 CFR 412.540 - Method of payment for preadmission services under the long-term care hospital prospective payment...  

Code of Federal Regulations, 2010 CFR

...preadmission services under the long-term care hospital prospective payment system. 412...PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.540 Method of payment...

2010-10-01

389

42 CFR 412.541 - Method of payment under the long-term care hospital prospective payment system.  

Code of Federal Regulations, 2013 CFR

...of payment under the long-term care hospital prospective payment system. 412...PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.541 Method of payment...

2013-10-01

390

42 CFR 412.505 - Conditions for payment under the prospective payment system for long-term care hospitals.  

Code of Federal Regulations, 2010 CFR

...prospective payment system for long-term care hospitals. 412.505 Section 412.505 ...PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.505 Conditions for...

2010-10-01

391

42 CFR 412.505 - Conditions for payment under the prospective payment system for long-term care hospitals.  

Code of Federal Regulations, 2012 CFR

...prospective payment system for long-term care hospitals. 412.505 Section 412.505 ...PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.505 Conditions for...

2012-10-01

392

42 CFR 412.540 - Method of payment for preadmission services under the long-term care hospital prospective payment...  

Code of Federal Regulations, 2011 CFR

...preadmission services under the long-term care hospital prospective payment system. 412...PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.540 Method of payment...

2011-10-01

393

42 CFR 412.505 - Conditions for payment under the prospective payment system for long-term care hospitals.  

Code of Federal Regulations, 2013 CFR

...prospective payment system for long-term care hospitals. 412.505 Section 412.505 ...PROSPECTIVE PAYMENT SYSTEMS FOR INPATIENT HOSPITAL SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.505 Conditions for...

2013-10-01

394

38 CFR 17.46 - Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from...  

Code of Federal Regulations, 2012 CFR

...2012-07-01 false Eligibility for hospital, domiciliary or nursing home care...DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.46 Eligibility for hospital, domiciliary or nursing home...

2012-07-01

395

38 CFR 17.46 - Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from...  

Code of Federal Regulations, 2010 CFR

...2010-07-01 false Eligibility for hospital, domiciliary or nursing home care...DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.46 Eligibility for hospital, domiciliary or nursing home...

2010-07-01

396

Who's Who in Your Health Care, Part 1: In the Hospital  

MedlinePLUS

Who's Who in Your Health Care, Part 1: In the Hospital Who's Who in Your Health Care, Part 1: In the Hospital htmNEWSICN20040614152812 For people in ... understanding who all your caregivers were. Even when health care professionals introduce themselves and tell patients why they ...

397

76 FR 11338 - Hospital and Outpatient Care for Veterans Released From Incarceration to Transitional Housing  

Federal Register 2010, 2011, 2012, 2013

...RIN 2900-AN41 Hospital and Outpatient Care for Veterans Released From Incarceration...authorize VA to provide hospital and outpatient care to a veteran in a program that provides...h), VA is not required ``to furnish care to a veteran to whom another agency...

2011-03-02

398

The outcome of extubation failure in a community hospital intensive care unit: a cohort study  

Microsoft Academic Search

INTRODUCTION: Extubation failure has been associated with poor intensive care unit (ICU) and hospital outcomes in tertiary care medical centers. Given the large proportion of critical care delivered in the community setting, our purpose was to determine the impact of extubation failure on patient outcomes in a community hospital ICU. METHODS: A retrospective cohort study was performed using data gathered

Christopher W Seymour; Anthony Martinez; Jason D Christie; Barry D Fuchs

2004-01-01

399

Changes in hospital mortality for United States intensive care unit admissions from 1988 to 2012  

PubMed Central

Introduction A decrease in disease-specific mortality over the last twenty years has been reported for patients admitted to United States (US) hospitals, but data for intensive care patients are lacking. The aim of this study was to describe changes in hospital mortality and case-mix using clinical data for patients admitted to multiple US ICUs over the last 24 years. Methods We carried out a retrospective time series analysis of hospital mortality using clinical data collected from 1988 to 2012. We also examined the impact of ICU admission diagnosis and other clinical characteristics on mortality over time. The potential impact of hospital discharge destination on mortality was also assessed using data from 2001 to 2012. Results For 482,601 ICU admissions there was a 35% relative decrease in mortality from 1988 to 2012 despite an increase in age and severity of illness. This decrease varied greatly by diagnosis. Mortality fell by >60% for patients with chronic obstructive pulmonary disease, seizures and surgery for aortic dissection and subarachnoid hemorrhage. Mortality fell by 51% to 59% for six diagnoses, 41% to 50% for seven diagnoses, and 10% to 40% for seven diagnoses. The decrease in mortality from 2001 to 2012 was accompanied by an increase in discharge to post-acute care facilities and a decrease in discharge to home. Conclusions Hospital mortality for patients admitted to US ICUs has decreased significantly over the past two decades despite an increase in the severity of illness. Decreases in mortality were diagnosis specific and appear attributable to improvements in the quality of care, but changes in discharge destination and other confounders may also be responsible. PMID:23622086

2013-01-01

400

Taking the Time to Care: Empowering Low Health Literacy Hospital Patients with Virtual Nurse Agents  

E-print Network

interface for educating and counseling hospital patients with inadequate health literacy in their hospital Conversational Agent, Health Literacy, Patient Education, Patient Safety, Hospital Discharge ACM Classification1 Taking the Time to Care: Empowering Low Health Literacy Hospital Patients with Virtual Nurse

Bickmore, Timothy

401

Improving cancer patient care: development of a generic cancer consumer quality index questionnaire for cancer patients  

PubMed Central

Background To develop a Consumer Quality Index (CQI) Cancer Care questionnaire for measuring experiences with hospital care of patients with different types of cancer. Methods We derived quality aspects from focus group discussions, existing questionnaires and literature. We developed an experience questionnaire and sent it to 1,498 Dutch cancer patients. Another questionnaire measuring the importance of the quality aspects was sent to 600 cancer patients. Data were psychometrically analysed. Results The response to the experience questionnaire was 50 percent. Psychometric analysis revealed 12 reliable scales. Patients rated rapid and adequate referral, rapid start of the treatment after diagnosis, enough information and confidence in the healthcare professionals as most important themes. Hospitals received high scores for skills and cooperation of healthcare professionals and a patient-centered approach by doctors; and low scores for psychosocial guidance and information at completion of the treatment. Conclusions The CQI Cancer Care questionnaire is a valuable tool for the evaluation of the quality of cancer care from the patient’s perspective. Large scale implementation is necessary to determine the discriminatory powers of the questionnaire and may enable healthcare providers to improve the quality of cancer care. Preliminary results indicate that hospitals could improve their psychosocial guidance and information provision. PMID:23617741

2013-01-01

402

The need for acute, subacute, and nonacute care at 105 general hospital sites on Ontario  

PubMed Central

BACKGROUND: Previous studies of hospital utilization have not taken into account the use of acute care beds for subacute care. The authors determined the proportion of patients who required acute, subacute and nonacute care on admission and during their hospital stay in general hospitals in Ontario. From this analysis, they identified areas where the efficiency of care delivery might be improved. METHODS: Ninety-eight of 189 acute care hospitals in Ontario, at 105 sites, participated in a review that used explicit criteria for rating acuity developed by Inter-Qual Inc., Marlborough, Mass. The records of 13,242 patients who were discharged over a 9-month period in 1995 after hospital care for 1 of 8 high-volume, high-variability diagnoses or procedures were randomly selected for review. Patients were categorized on the basis of the level of care (acute, subacute or nonacute) they required on admission and during subsequent days of hospital care. RESULTS: Of all admissions, 62.2% were acute, 19.7% subacute and 18.1% nonacute. The patients most likely to require acute care on admission were those with acute myocardial infarction (96.2% of 1826 patients) or cerebrovascular accident (84.0% of 1596 patients) and those admitted for elective surgery on the day of their procedure (73.4% of 3993 patients). However, 41.1% of patients awaiting hip or knee replacement were admitted the day before surgery so did not require acute care on admission. The proportion of patients who required acute care on admission and during the subsequent hospital stay declined with age; the proportion of patients needing nonacute care did not vary with age. After admission, acute care was needed on 27.5% of subsequent days, subacute care on 40.2% and nonacute care on 32.3%. The need for acute care on admission was a predictor of need for acute care during subsequent hospital stay among patients with medical conditions. The proportion of patients requiring subacute care during the subsequent hospital stay increased with age, decreased with the number of inpatient beds in each hospital and was highest among patients with congestive heart failure, chronic obstructive pulmonary disease and pneumonia. INTERPRETATION: In 1995, inpatients requiring subacute care accounted for a substantial proportion of nonacute care days in Ontario's general hospitals. These findings suggest a need to evaluate the efficiencies that might be achieved by introducing a subacute category of care into the Canadian health care system. Generally, efforts are needed to reduce the proportion of admissions for nonacute care and of in-hospital days for other than acute care. PMID:9614821

Flintoft, V F; Williams, J I; Williams, R C; Basinski, A S; Blackstien-Hirsch, P; Naylor, C D

1998-01-01

403

The quality caring nursing model: a journey to selection and implementation.  

PubMed

A nursing model selection team was created to evaluate the theoretical framework of the professional practice model for the department of nursing. The team's mission was to assess whether the present nursing model was congruent with the culture of contemporary practice of nursing within the organization. After a year of in-depth readings, meetings, and communications with other hospitals, the committee adopted the Quality Caring Model(©) (QCM) developed by Joanne Duffy, RN, PhD. The implementation team used focus groups, Web-based tutorials, and interactive media as educational tools. Quality caring advocates (unit-based direct care nurses) were selected to assist with the sustainability of the QCM(©). PMID:22024041

Edmundson, Elizabeth

2012-08-01

404

Advance Data Number 320. National Hospital Ambulatory Medical Care Survey: 1999 Emergency Department Summary.  

National Technical Information Service (NTIS)

This report describes ambulatory care visits to hospital emergency departments (ED's) in the United States. Statistics are presented on selected hospital, patient, and visit characteristics. Highlights of trends in ED utilization from 1992 through 1999 ar...

L. F. McCaig, M. P. H. Burt, C. W. Burt

2001-01-01

405

38 CFR 17.55 - Payment for authorized public or private hospital care.  

...for authorized public or private hospital care. 17.55 Section 17.55 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Public Or Private Hospitals § 17.55 Payment for...

2014-07-01

406

Interventions to reduce hospitalizations from nursing homes: evaluation of the INTERACT II collaborative quality improvement project.  

PubMed

A substantial proportion of hospitalizations of nursing home (NH) residents may be avoidable. Medicare payment reforms, such