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1

Nurse Reported Quality of Care: A Measure of Hospital Quality  

PubMed Central

As the primary providers of round-the-clock bedside care, nurses are well positioned to report on hospital quality of care. Researchers have not examined how nurses’ reports of quality correspond with standard process or outcomes measures of quality. We assess the validity of evaluating hospital quality by aggregating hospital nurses’ responses to a single item that asks them to report on quality of care. We found that a 10% increment in the proportion of nurses reporting excellent quality of care was associated with lower odds of mortality and failure to rescue; greater patient satisfaction; and higher composite process of care scores for acute myocardial infarction, pneumonia, and surgical patients. Nurse reported quality of care is a useful indicator of hospital performance. PMID:22911102

McHugh, Matthew D.; Stimpfel, Amy Witkoski

2013-01-01

2

The quality of hospital-based antenatal care in Istanbul.  

PubMed

The aim of this study was to gather comprehensive data from three hospitals in Istanbul, Turkey, in order to gain in-depth understanding of the quality of antenatal care in this setting. The Bruce-Jain framework for quality of care was adapted for use in evaluating antenatal care. Methods included examination of hospital records, in-depth interviews, exit questionnaires, and structured observations. The study revealed deficiencies in the quality of antenatal care being delivered at the study hospitals in all six elements of the quality-of-care framework. The technical content of visits varied greatly among the hospitals, and an overuse of technology was accompanied by neglect of some essential components of antenatal care. Although at the private hospital some problems with the technical content of care were identified, client satisfaction was higher there, where the care included good interpersonal relations, information provision, and continuity. Providers at all three hospitals felt constrained by heavy patient loads and a lack of resources. Multifaceted approaches are needed to improve the quality of antenatal care in this setting. PMID:16570730

Turan, Janet Molzan; Bulut, Ay?pen; Nalbant, Hacer; Ortayli, Nuriye; Akalin, A Arzu Kolo?lu

2006-03-01

3

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

4

Competition, transparency and quality of hospital care: Analysis of the Dutch hospital sector  

Microsoft Academic Search

The paper focuses on the relationship between competition, quality, and voluntary disclosure of quality information by hospitals. So far, empirical evidence on this subject comes mostly from the US, which has a relatively long history of systematic data collection efforts creating harmonized datasets of quality indicators in health care. However, several European countries recently reforming their healthcare sectors have also

Ali Aouragh; Michiel Bijlsma; Pierre Koning; Victoria Shestalova

2010-01-01

5

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

6

Assessment of Quality of Care for Managed Care and Fee-For-Service Patients Based on Analysis of Avoidable Hospitalizations  

Microsoft Academic Search

As managed care has grown to dominate the US health care delivery system, questions have been raised about the impact on the quality of care provided to its enrollees. Two important aspects of health care quality are access to care and the appropriateness of care. This analysis evaluated the occurrence of preventable hospitalizations among managed care (MCO) versus fee for

L. Clark Paramore; Anne Elixhauser

1999-01-01

7

Quality improvement and paramedic care : What does the literature reveal for pre-hospital emergency care in Australia?  

Microsoft Academic Search

Purpose – The purpose of this article to review the literature relating to improving paramedic care in an Australian context. Design\\/methodology\\/approach – The paper presents changes and challenges that have occurred in the ambulance services in terms of improving care and measuring performance, exploring the literature on quality improvement initiatives and their application to pre-hospital care. Findings – While hospitals

Russell Linwood; Gary Day; Gerrard FitzGerald; Brian Oldenburg

2007-01-01

8

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.

9

Quality of Care for Myocardial Infarction in Rural and Urban Hospitals  

ERIC Educational Resources Information Center

Background: In the mid-1990s, significant gaps existed in the quality of acute myocardial infarction (AMI) care between rural and urban hospitals. Since then, overall AMI care quality has improved. This study uses more recent data to determine whether rural-urban AMI quality gaps have persisted. Methods: Using inpatient records data for 34,776…

Baldwin, Laura-Mae; Chan, Leighton; Andrilla, C. Holly A.; Huff, Edwin D.; Hart, L. Gary

2010-01-01

10

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

11

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

12

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

13

The effects of cardiac specialty hospitals on the cost and quality of medical care  

Microsoft Academic Search

The recent rise of specialty hospitals – typically for-profit firms that are at least partially owned by physicians – has led to substantial debate about their effects on the cost and quality of care. Advocates of specialty hospitals claim they improve quality and lower cost; critics contend they concentrate on providing profitable procedures and attracting relatively healthy patients, leaving (predominantly

Jason R. Barro; Robert S. Huckman; Daniel P. Kessler

2006-01-01

14

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

15

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

16

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

17

Hospital ownership and cost and quality of care: is there a dime’s worth of difference?  

Microsoft Academic Search

Nonprofit organizations may predominate when output quality is difficult to monitor. Hospital care has this characteristic. This study compared program cost and quality of care for Medicare patients hospitalized following onset of four common conditions by hospital ownership. Payments on behalf of Medicare patients admitted to for-profit hospitals during the first 6 months following a health shock were higher than

Frank A. Sloan; Gabriel A. Picone; Shin-Yi Chou

2001-01-01

18

Quality improvement in pre-hospital critical care: increased value through research and publication  

PubMed Central

Pre-hospital critical care is considered to be a complex intervention with a weak evidence base. In quality improvement literature, the value equation has been used to depict the inevitable relationship between resources expenditure and quality. Increased value of pre-hospital critical care involves moving a system from quality assurance to quality improvement. Agreed quality indicators can be integrated in existing quality improvement and complex intervention methodology. A QI system for pre-hospital critical care includes leadership involvement, multi-disciplinary buy-in, data collection infrastructure and long-term commitment. Further, integrating process control with governance systems allows evidence-based change of practice and publishing of results. PMID:24887186

2014-01-01

19

Quality improvement in pre-hospital critical care: increased value through research and publication.  

PubMed

Pre-hospital critical care is considered to be a complex intervention with a weak evidence base. In quality improvement literature, the value equation has been used to depict the inevitable relationship between resources expenditure and quality. Increased value of pre-hospital critical care involves moving a system from quality assurance to quality improvement. Agreed quality indicators can be integrated in existing quality improvement and complex intervention methodology. A QI system for pre-hospital critical care includes leadership involvement, multi-disciplinary buy-in, data collection infrastructure and long-term commitment. Further, integrating process control with governance systems allows evidence-based change of practice and publishing of results. PMID:24887186

Rehn, Marius; Krüger, Andreas J

2014-01-01

20

Improving quality and safety of hospital care: a reappraisal and an agenda for clinically relevant reform.  

PubMed

Improving quality and safety of hospital care is now firmly on the health-care agenda. Various agencies within different levels of government are pursuing initiatives targeting hospitals and health professionals that aim to identify, quantify and lessen medical error and suboptimal care. Although not denying the value of such 'top-down' initiatives, more attention may be needed towards 'bottom-up' reform led by practising physicians. This article discusses factors integral to delivery of safe, high-quality care grouped under six themes: clinical workforce, teamwork, patient participation in care decisions, indications for health-care interventions, clinical governance and information systems. Following this discussion, a 20-point action plan is proposed as an agenda for future reform capable of being led by physicians, together with some cautionary notes about relying too heavily on information technology, use of non-clinical quality personnel and quantitative evaluative approaches as primary strategies in improving quality. PMID:18190414

Scott, I A; Poole, P J; Jayathissa, S

2008-01-01

21

Changing hospital care: evaluation of a multi-layered organisational development and quality improvement programme  

Microsoft Academic Search

In the last decades many different policy changes have been initiated in the Dutch hospital sector to optimise health care delivery: national agenda-setting, increased competition and transparency, a new system of hospital reimbursement based on diagnosis-treatment-combinations, intensified monitoring of quality, and a multi-layered organisational development programme based on quality improvement collaboratives – the multi-level quality collaborative (MQC). The focus of

M. L. A Dückers

2009-01-01

22

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

PubMed Central

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

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

2014-01-01

23

Physician Job Satisfaction and Quality of Care Among Hospital Employed Physicians in Japan  

Microsoft Academic Search

Background  Physician job satisfaction is reportedly associated with interpersonal quality of care, such as patient satisfaction, but\\u000a its association with technical quality of care, as determined by whether patients are offered recommended services, is unknown.\\u000a \\u000a \\u000a \\u000a Objective  We explored whether the job satisfaction of hospital-employed physicians in Japan is associated with the technical quality\\u000a of care, with an emphasis on process qualities as

Makiko Utsugi-Ozaki; Seiji Bito; Shinji Matsumura; Yasuaki Hayashino; Shunichi Fukuhara

2009-01-01

24

Is quality of colorectal cancer care good enough? Core measures development and its application for comparing hospitals in Taiwan  

Microsoft Academic Search

BACKGROUND: Although performance measurement for assessing care quality is an emerging area, a system for measuring the quality of cancer care at the hospital level has not been well developed. The purpose of this study was to develop organization-based core measures for colorectal cancer patient care and apply these measures to compare hospital performance. METHODS: The development of core measures

Kuo-Piao Chung; Yun-Jau Chang; Mei-Shu Lai; Raymond Nien-Chen Kuo; Skye H Cheng; Li-Tzong Chen; Reiping Tang; Tsang-Wu Liu; Ming-Jium Shieh

2010-01-01

25

Closing the quality gap: promoting evidence-based breastfeeding care in the hospital.  

PubMed

Evidence shows that hospital-based practices affect breastfeeding duration and exclusivity throughout the first year of life. However, a 2007 CDC survey of US maternity facilities documented poor adherence with evidence-based practice. Of a possible score of 100 points, the average hospital scored only 63 with great regional disparities. Inappropriate provision and promotion of infant formula were common, despite evidence that such practices reduce breastfeeding success. Twenty-four percent of facilities reported regularly giving non-breast milk supplements to more than half of all healthy, full-term infants. Metrics available for measuring quality of breastfeeding care, range from comprehensive Baby-Friendly Hospital Certification to compliance with individual steps such as the rate of in-hospital exclusive breastfeeding. Other approaches to improving quality of breastfeeding care include (1) education of hospital decision-makers (eg, through publications, seminars, professional organization statements, benchmark reports to hospitals, and national grassroots campaigns), (2) recognition of excellence, such as through Baby-Friendly hospital designation, (3) oversight by accrediting organizations such as the Joint Commission or state hospital authorities, (4) public reporting of indicators of the quality of breastfeeding care, (5) pay-for-performance incentives, in which Medicaid or other third-party payers provide additional financial compensation to individual hospitals that meet certain quality standards, and (6) regional collaboratives, in which staff from different hospitals work together to learn from each other and meet quality improvement goals at their home institutions. Such efforts, as well as strong central leadership, could affect both initiation and duration of breastfeeding, with substantial, lasting benefits for maternal and child health. PMID:19752082

Bartick, Melissa; Stuebe, Alison; Shealy, Katherine R; Walker, Marsha; Grummer-Strawn, Laurence M

2009-10-01

26

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

27

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

28

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

Federal Register 2010, 2011, 2012, 2013

...410) 786-8705, Long-term care hospital quality...Care Hospitals and the Long-Term Care Hospital Prospective...quality reporting for long-term care hospitals (LTCHs...Continuity Assessment Record & Evaluation (CARE), we made...

2011-09-26

29

Instruments to measure patient experience of health care quality in hospitals: a systematic review protocol  

PubMed Central

Background Improving and sustaining the quality of care in hospitals is an intractable and persistent challenge. The patients’ experience of the quality of hospital care can provide insightful feedback to enable clinical teams to direct quality improvement efforts in areas where they are most needed. Yet, patient experience is often marginalised in favour of aspects of care that are easier to quantify (for example, waiting time). Attempts to measure patient experience have been hindered by a proliferation of instruments using various outcome measures with varying degrees of psychometric development and testing. Methods/Design We will conduct a systematic review and utility critique of instruments used to measure patient experience of health care quality in hospitals. The databases Medical Literature Analysis and Retrieval System Online (MEDLINE), Cumulative Index to Nursing and Allied Health Literature (CINAHL), Psychological Information (Psych Info) and Web of Knowledge will be searched from inception until end November 2013. Search strategies will include the key words; patient, adult, hospital, secondary care, questionnaires, instruments, health care surveys, experience, satisfaction and patient opinion in various combinations. We will contact experts in the field of measuring patient experience and scrutinise all secondary references. A reviewer will apply an inclusion criteria scale to all titles and abstracts. A second reviewer will apply the inclusion criteria scale to a random 10% selection. Two reviewers will independently evaluate the methodological rigour of the testing of the instruments using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist. Disagreements will be resolved through consensus. Instruments will be critiqued and grouped using van der Vleuten’s utility index. We will present a narrative synthesis on the utility of all instruments and make recommendations for instrument selection in practice. Discussion This systematic review of the utility of instruments to measure patient experience of hospital quality care will aid clinicians, managers and policy makers to select an instrument fit for purpose. Importantly, appropriate instrument selection will provide a mechanism for patients’ voices to be heard on the quality of care they receive in hospitals. PROSPERO registration CRD42013006754. PMID:24387141

2014-01-01

30

Psychiatric Nurse Reports on the Quality of Psychiatric Care in General Hospitals  

PubMed Central

Although acute inpatient psychiatric care has changed dramatically over the past 2 decades, little is known about how these changes have affected the quality of care, psychiatric nurse staffing, or patient outcomes. The purpose of this report is to explore the quality of care, quality of the practice environment, and adverse events as assessed by psychiatric nurses in the general hospital setting. The study sample consisted of 456 registered nurses permanently assigned to psychiatric units, compared with a larger sample of 11 071 registered nurses who work permanently on medical, surgical, or medical-surgical units. Compared with nonpsychiatric nurses, psychiatric nurse characteristics reveal an older, more experienced workforce, with a higher proportion of male nurses. Nurses rated quality of patient care lower in the psychiatric specialty than in the medical-surgical specialty. Furthermore, psychiatric nurses reported significant concern about the readiness of patients for discharge and higher incidence of adverse events. They also experienced more verbal abuse, physical injuries, and complaints from patients and families. Collectively, the results from this study underscore the organizational problems and quality-of-care issues that cause psychiatric nurses in general hospital settings to evaluate their work environments negatively. PMID:18641503

Aiken, Linda H.

2008-01-01

31

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

Microsoft Academic Search

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

Mary C Conry; Niamh Humphries; Karen Morgan; Yvonne McGowan; Anthony Montgomery; Kavita Vedhara; Efharis Panagopoulou; Hannah McGee

2012-01-01

32

The hospital standardised mortality ratio: a powerful tool for Dutch hospitals to assess their quality of care?  

PubMed Central

Aim of the study To use the hospital standardised mortality ratio (HSMR), as a tool for Dutch hospitals to analyse their death rates by comparing their risk-adjusted mortality with the national average. Method The method uses routine administrative databases that are available nationally in The Netherlands—the National Medical Registration dataset for the years 2005–2007. Diagnostic groups that led to 80% of hospital deaths were included in the analysis. The method adjusts for a number of case-mix factors per diagnostic group determined through a logistic regression modelling process. Results In The Netherlands, the case-mix factors are primary diagnosis, age, sex, urgency of admission, length of stay, comorbidity (Charlson Index), social deprivation, source of referral and month of admission. The Dutch HSMR model performs well at predicting a patient's risk of death as measured by a c statistic of the receiver operating characteristic curve of 0.91. The ratio of the HSMR of the Dutch hospital with the highest value in 2005–2007 is 2.3 times the HSMR of the hospital with the lowest value. Discussion Overall hospital HSMRs and mortality at individual diagnostic group level can be monitored using statistical process control charts to give an early warning of possible problems with quality of care. The use of routine data in a standardised and robust model can be of value as a starting point for improvement of Dutch hospital outcomes. HSMRs have been calculated for several other countries. PMID:20172876

Pieter, D; van der Veen, A A; Kool, R B; Aylin, P; Bottle, A; Westert, G P; Jones, S

2010-01-01

33

Quality of nursing care and satisfaction of patients attended at a teaching hospital1  

PubMed Central

Objectives assess the quality of nursing care, the patients' satisfaction and the correlation between both. Method cross-sectional study, involving 275 patients hospitalized at a teaching hospital in the Central-West of Brazil. The data were collected through the simultaneous application of three instruments. Next, they were included in an electronic database and analyzed in function of the positivity, median value and Spearman's correlation coefficients. Results among the nursing care assessed, only two were considered safe - hygiene and physical comfort; nutrition and hydration - while the remainder were classified as poor. Nevertheless, the patients were satisfied with the care received in the domains assessed: technical-professional, confidence and educational. This can be justified by the weak to moderate correlation that was observed among these variables. Conclusion Despite the quality deficit, the patients' satisfaction level with the nursing care received was high. These results indicate that the institution needs to center its objectives on a continuing evaluation system of the care quality, aiming to attend to the patients' expectations. PMID:25029057

de Freitas, Juliana Santana; Silva, Ana Elisa Bauer de Camargo; Minamisava, Ruth; Bezerra, Ana Lúcia Queiroz; de Sousa, Maiana Regina Gomes

2014-01-01

34

Management matters: the link between hospital organisation and quality of patient care  

PubMed Central

Some hospital trusts and health authorities consistently outperform others on different dimensions of performance. Why? There is some evidence that "management matters", as well as the combined efforts of individual clinicians and teams. However, studies that have been conducted on the link between the organisation and management of services and quality of patient care can be criticised both theoretically and methodologically. A larger, and arguably more rigorous, body of work exists on the performance of firms in the private sector, often conducted within the disciplines of organisational behaviour or human resource management. Studies in these traditions have focused on the effects of decentralisation, participation, innovative work practices, and "complementarities" on outcome variables such as job satisfaction and performance. The aim of this paper is to identify a number of reviews and research traditions that might bring new ideas into future work on the determinants of hospital performance. Ideally, future research should be more theoretically informed and should use longitudinal rather than cross sectional research designs. The use of statistical methods such as multilevel modelling, which allow for the inclusion of variables at different levels of analysis, would enable estimation of the separate contribution that structure and process make to hospital outcomes. Key Words: hospital organisation; hospital performance; management; quality of care PMID:11239143

West, E.

2001-01-01

35

Patterns of Care Quality and Prognosis Among Hospitalized Ischemic Stroke Patients With Chronic Kidney Disease  

PubMed Central

Background Relatively little is known about the quality of care and outcomes for hospitalized ischemic stroke patients with chronic kidney disease (CKD). We examined quality of care and in?hospital prognoses among patients with CKD in the Get With The Guidelines–Stroke (GWTG?Stroke) program Methods and Results We analyzed 679 827 patients hospitalized with ischemic stroke from 1564 US centers participating in the GWTG?Stroke program between January 2009 and December 2012. Use of 7 predefined ischemic stroke performance measures, composite “defect?free” care compliance, and in?hospital mortality were examined based on glomerular filtration rate (GFR) categorized as a dichotomous (+CKD as <60) or rank?ordered variable: normal (?90), mild (?60 to <90), moderate (?30 to <60), severe (?15 to <30), and kidney failure (<15 or dialysis). There were 236 662 (35%) ischemic stroke patients with CKD. Patients with severe renal dysfunction or failure were significantly less likely to receive guideline?based therapies. Compared with patients with normal kidney function (?90), those with CKD (adjusted OR 0.91 [95% CI: 0.89 to 0.92]), moderate dysfunction (adjusted OR 0.94 [95% CI: 0.92 to 0.97]), severe dysfunction (adjusted OR 0.80 [95% CI: 0.77 to 0.84]), or failure (adjusted OR 0.72 [95% CI: 0.68 to 0.0.76]), were less likely to receive 100% defect?free care measure compliance. Inpatient mortality was higher for patients with CKD (adjusted odds ratio 1.44 [95% CI: 1.40 to 1.47]), and progressively rose with more severe renal dysfunction. Conclusions Despite higher in?hospital mortality rates, ischemic stroke patients with CKD, especially those with greater severity of renal dysfunction, were less likely to receive important guideline?recommended therapies. PMID:24904017

Ovbiagele, Bruce; Schwamm, Lee H.; Smith, Eric E.; Grau?Sepulveda, Maria V.; Saver, Jeffrey L.; Bhatt, Deepak L.; Hernandez, Adrian F.; Peterson, Eric D.; Fonarow, Gregg C.

2014-01-01

36

Owning solutions: a collaborative model to improve quality in hospital care for Aboriginal Australians.  

PubMed

Well-documented health disparities between Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal) and non-Aboriginal Australians are underpinned by complex historical and social factors. The effects of colonisation including racism continue to impact negatively on Aboriginal health outcomes, despite being under-recognised and under-reported. Many Aboriginal people find hospitals unwelcoming and are reluctant to attend for diagnosis and treatment, particularly with few Aboriginal health professionals employed on these facilities. In this paper, scientific literature and reports on Aboriginal health-care, methodology and cross-cultural education are reviewed to inform a collaborative model of hospital-based organisational change. The paper proposes a collaborative model of care to improve health service delivery by building capacity in Aboriginal and non-Aboriginal personnel by recruiting more Aboriginal health professionals, increasing knowledge and skills to establish good relationships between non-Aboriginal care providers and Aboriginal patients and their families, delivering quality care that is respectful of culture and improving Aboriginal health outcomes. A key element of model design, implementation and evaluation is critical reflection on barriers and facilitators to providing respectful and culturally safe quality care at systemic, interpersonal and patient/family-centred levels. Nurses are central to addressing the current state of inequity and are pivotal change agents within the proposed model. PMID:22530862

Durey, Angela; Wynaden, Dianne; Thompson, Sandra C; Davidson, Patricia M; Bessarab, Dawn; Katzenellenbogen, Judith M

2012-06-01

37

Understanding the Role of the Professional Practice Environment on Quality of Care in Magnet® and Non-Magnet Hospitals  

PubMed Central

OBJECTIVE The aim of this study was to explore the relationship between Magnet Recognition® and nurse-reported quality of care. BACKGROUND Magnet® hospitals are recognized for nursing excellence and quality patient outcomes; however, few studies have explored contributing factors for these superior outcomes. METHODS This was a secondary analysis of linked nurse survey data, hospital administrative data, and a listing of American Nurses Credentialing Center Magnet hospitals. Multivariate regressions were modeled before and after propensity score matching to assess the relationship between Magnet status and quality of care. A mediation model assessed the indirect effect of the professional practice environment on quality of care. RESULTS Nurse-reported quality of care was significantly associated with Magnet Recognition after matching. The professional practice environment mediates the relationship between Magnet status and quality of care. CONCLUSION A prominent feature of Magnet hospitals, a professional practice environment that is supportive of nursing, plays a role in explaining why Magnet hospitals have better nurse-reported quality of care. PMID:24316613

Stimpfel, Amy Witkoski; Rosen, Jennifer E.; McHugh, Matthew D.

2014-01-01

38

Critical role of nutrition in improving quality of care: an interdisciplinary call to action to address adult hospital malnutrition.  

PubMed

The current era of health care delivery, with its focus on providing high-quality, affordable care, presents many challenges to hospital-based health professionals. The prevention and treatment of hospital malnutrition offers a tremendous opportunity to optimize the overall quality of patient care, improve clinical outcomes, and reduce costs. Unfortunately, malnutrition continues to go unrecognized and untreated in many hospitalized patients. This article represents a call to action from the interdisciplinary Alliance to Advance Patient Nutrition to highlight the critical role of nutrition intervention in clinical care and to suggest practical ways to promptly diagnose and treat malnourished patients and those at risk for malnutrition. We underscore the importance of an interdisciplinary approach to addressing malnutrition both in the hospital and in the acute post-hospital phase. It is well recognized that malnutrition is associated with adverse clinical outcomes. Although data vary across studies, available evidence shows that early nutrition intervention can reduce complication rates, length of hospital stay, readmission rates, mortality, and cost of care. The key is to systematically identify patients who are malnourished or at risk and to promptly intervene. We present a novel care model to drive improvement, emphasizing the following six principles: (1) create an institutional culture where all stakeholders value nutrition; (2) redefine clinicians' roles to include nutrition care; (3) recognize and diagnose all malnourished patients and those at risk; (4) rapidly implement comprehensive nutrition interventions and continued monitoring; (5) communicate nutrition care plans; and (6) develop a comprehensive discharge nutrition care and education plan. PMID:23871528

Tappenden, Kelly A; Quatrara, Beth; Parkhurst, Melissa L; Malone, Ainsley M; Fanjiang, Gary; Ziegler, Thomas R

2013-09-01

39

Meeting the ambition of measuring the quality of hospitals' stroke care using routinely collected administrative data: a feasibility study  

PubMed Central

Objective To examine the potential for using routinely collected administrative data to compare the quality and safety of stroke care at a hospital level, including evaluating any bias due to variations in coding practice. Design A retrospective cohort study of English hospitals' performance against six process and outcome indicators covering the acute care pathway. We used logistic regression to adjust the outcome measures for case mix. Setting Hospitals in England. Participants Stroke patients (ICD-10 I60–I64) admitted to English National Health Service public acute hospitals between April 2009 and March 2010, accounting for 91 936 admissions. Main Outcome Measure The quality and safety were measured using six indicators spanning the hospital care pathway, from timely access to brain scans to emergency readmissions following discharge after stroke. Results There were 182 occurrences of hospitals performing statistically differently from the national average at the 99.8% significance level across the six indicators. Differences in coding practice appeared to only partially explain the variation. Conclusions Hospital administrative data provide a practical and achievable method for evaluating aspects of stroke care across the acute pathway. However, without improvements in coding and further validation, it is unclear whether the cause of the variation is the quality of care or the result of different local care pathways and data coding accuracy. PMID:23584363

Palmer, William L.; Bottle, Alex; Davie, Charlie; Vincent, Charles A.; Aylin, Paul

2013-01-01

40

Assisted and Unassisted Falls: Different Events, Different Outcomes, Different Implications for Quality of Hospital Care  

PubMed Central

Background Many hospitals classify inpatient falls as assisted (if a staff member is present to ease the patient’s descent or break the fall) or unassisted for quality measurement purposes. Unassisted falls are more likely to result in injury, but there is limited research quantifying this effect or linking the assisted/unassisted classification to processes of care. A study was conducted to link the assisted/unassisted fall classification to both processes and outcomes of care, thereby demonstrating its suitability for use in quality measurement. This was only the second known published study to quantify the increased risk of injury associated with falling unassisted (versus assisted), and the first to estimate the effects of falling unassisted (versus assisted) on the likelihood of specific levels of injury. Methods A cross-sectional analysis of falls from all available 2011 data for 6,539 adult medical, surgical, and medical-surgical units in 1,464 general hospitals participating in the National Database of Nursing Quality Indicators® (NDNQI®) was performed. Results Participating units reported 166,883 falls (3.44 falls per 1,000 patient-days). Excluding repeat falls, 85.5% of falls were unassisted. Assisted and unassisted falls were associated with different processes and outcomes: Fallers in units without a fall prevention protocol in place were more likely to fall unassisted than those with a protocol in place (adjusted odds ratio [aOR], 1.39 [95% confidence interval (CI), 1.32, 1.46]), and unassisted falls were more likely to result in injury (aOR, 1.59 [95% CI, 1.52, 1.67]). Conclusions The assisted/unassisted fall classification is associated with care processes and patient outcomes, making it suitable for quality measurement. Unassisted falls are more likely than assisted falls to result in injury and should be considered as a target for future prevention efforts. PMID:25208441

Staggs, Vincent S.; Mion, Lorraine C.; Shorr, Ronald I.

2014-01-01

41

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

42

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

43

Determining the number of state psychiatric hospital beds by measuring quality of care with artificial neural networks.  

PubMed

This study uses a new paradigm to calculate the minimum and the optimum number of involuntary psychiatric beds at a state hospital in Maine with 5538 admissions over a 7-year period. The method measures quality of care (Q) based upon the accuracy of prediction of length-of-stay for the hospital, and of community length-of-stay for the community, each corrected for the severity of illness of the average patient. When Q in the hospital equals Q in the community, there is no net movement of patients from one phase of care to the other, analogous to a zero electromotive force, and the census at that point is the minimum number of beds (22 beds/100,000 population). When patients in the community were least ill, relative to the hospital then hospital bed census is at its optimum (31 beds/100,000) given current resources and technology. In studying specific diagnosis groups with the same methodology the authors found that patients with schizophrenia having the benefit of clozapine for most of the study period had a Q averaged over 7 years that was nearly equal in both hospital and community settings. This explains the perception that tertiary psychiatric hospitals comprised mostly of patients with schizophrenia can downsize significantly. However, affective disorders and "borderline" personality disorders clearly benefit from structured hospital care with specialized experienced staff. We make arguments for the role of the state hospital as a homeostat for the mental health care delivery system. PMID:9509590

Davis, G E; Lowell, W E; Davis, G L

1998-01-01

44

Quality of surgical care in hospitals providing internship training in Kenya: a cross sectional survey.  

PubMed Central

Objective To evaluate services in hospitals providing internship training to graduate doctors in Kenya. Methods A survey of 22 internship training hospitals was conducted. Availability of key resources spanning infrastructure, personnel, equipment and drugs was assessed by observation. Outcomes and process of care for pre-specified priority conditions (head injury, chest injury, fractures, burns and acute abdomen) were evaluated by auditing case records. Results Each hospital had at least one consultant surgeon. Scheduled surgical outpatient clinics, major ward rounds and elective (half day) theatre lists were provided once per week in 91%, 55% and 9%, respectively. In all other hospitals, these were conducted twice weekly. Basic drugs were not always available (e.g. gentamicin, morphine and pethidine in 50%, injectable antistaphylococcal penicillins in 5% hospitals). Fewer than half of hospitals had all resources needed to provide oxygen. One hundred and forty-five of 956 cases evaluated underwent operations under general or spinal anaesthesia. We found operation notes for 99% and anaesthetic records for 72%. Pre-operatively measured vital signs were recorded in 80% of cases, and evidence of consent to operation was found in 78%. Blood loss was documented in only one case and sponge and instrument counts in 7%. Conclusions Evaluation of surgical services would be improved by development and dissemination of clear standards of care. This survey suggests that internship hospitals may be poorly equipped and documented care suggests inadequacies in quality and training. Objectif Evaluer les services dans les hôpitaux offrant des stages de formation à des médecins diplômés au Kenya. Méthodes Enquête auprès de 22 hôpitaux offrant des stages de formation. La disponibilité des ressources clés incluant infrastructure, personnel, matériel et médicaments a été évaluée par observation. Les résultats et processus de soins pour des affections prioritaires prédéfinies (blessure à la tête, blessure à la poitrine, fractures, brûlures et maux d'estomac aigus) ont été évalués par l'audit des dossiers des cas. Résultats Chaque hôpital avait au moins un chirurgien consultant. Les cliniques chirurgicales ambulatoires planifiées, les principales tournées dans les chambres d'hospitalisation et des listes d'opérations choisies (demi-journée) ont été fournies une fois par semaine dans 91%, 55% et 9% des cas respectivement. Dans tous les autres hôpitaux, cela a été effectué deux fois par semaine. Les médicaments de base n’étaient pas toujours disponibles (par ex. la gentamicine, la morphine et la péthidine dans 50% des hôpitaux, les pénicillines anti-staphylococciques injectables dans 5%). Moins de la moitié des hôpitaux disposaient de toutes les ressources nécessaires pour fournir de l'oxygène. 145 sur 956 cas évalués ont subi des opérations sous anesthésie générale ou rachidienne. Nous avons retrouvé des notes d'opération pour 99% des cas et des dossiers d'anesthésie pour 72%. Les mesures préopératoires des signes vitaux ont été enregistrées dans 80% des cas et la preuve du consentement pour l'opération a été trouvée dans 78% des cas. La perte de sang a été documentée dans un seul cas et le comptage des éponges et instruments dans 7% des cas. Conclusions L’évaluation des services de chirurgie serait améliorée par le développement et la dissémination de normes de soins claires. Cette étude suggère que les hôpitaux offrant des stages peuvent être mal équipés et les soins enregistrés suggèrent des insuffisances dans la qualité et la formation. Objetivo Evaluar los servicios en hospitales que proveen entrenamiento a m

Mwinga, Stephen; Kulohoma, Colette; Mwaniki, Paul; Idowu, Rachel; Masasabi, John; English, Mike

2015-01-01

45

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

46

Immediate Outcome Indicators in Perioperative Care: A Controlled Intervention Study on Quality Improvement in Hospitals in Tanzania  

PubMed Central

Introduction Outcome assessment is the standard for evaluating the quality of health services worldwide. In this study, outcome has been divided into immediate and final outcome. Aim was to compare an intervention hospital with a Continuous Quality Improvement approach to a control group using benchmark assessments of immediate outcome indicators in surgical care. Results were compared to final outcome indicators. Method Surgical care quality in six hospitals in Tanzania was assessed from 2006–2011, using the Hospital Performance Assessment Tool. Independent observers assessed structural, process and outcome quality using checklists based on evidence-based guidelines. The number of surgical key procedures over the benchmark of 80% was compared between the intervention hospital and the control group. Results were compared to Case Fatality Rates. Results In the intervention hospital, in 2006, two of nine key procedures reached the benchmark, one in 2009, and four in 2011. In the control group, one of nine key procedures reached the benchmark in 2006, one in 2009, and none in 2011. Case Fatality Rate for all in-patients in the intervention hospital was 5.5% (n?=?12,530) in 2006, 3.5% (n?=?21,114) in 2009 and 4.6% (n?=?18,840) in 2011. In the control group it was 3.1% (n?=?17,827) in 2006, 4.2% (n?=?13,632) in 2009 and 3.8% (n?=?17,059) in 2011. Discussion Results demonstrated that quality assurance improved performance levels in both groups. After the introduction of Continuous Quality Improvement, performance levels improved further in the intervention hospital while quality in the district hospital did not. Immediate outcome indicators appeared to be a better steering tool for quality improvement compared to final outcome indicators. Immediate outcome indicators revealed a need for improvement in pre- and postoperative care. Conclusion Quality assurance programs based on immediate outcome indicators can be effective if embedded in Continuous Quality Improvement. Nevertheless, final outcome indicators cannot be neglected. PMID:23776482

Bosse, Goetz; Mtatifikolo, Ferdinand; Abels, Wiltrud; Strosing, Christian; Breuer, Jan-Philipp; Spies, Claudia

2013-01-01

47

Quality of care in patients with chronic kidney disease is determined by hospital specific factors  

Microsoft Academic Search

BACKGROUND: Guidelines have set goals for risk factor management in chronic kidney disease (CKD) patients. These goals are often not met. In this analysis, we set out to assess the quality of risk factor management in CKD and to identify factors that determine the quality of care (QoC). For that purpose, baseline data of the MASTERPLAN (Multifactorial Approach and Superior

A. D. van Zuilen; P. J. Blankestijn; M. van Buren; M. A. G. J. ten Dam; K. A. H. Kaasjager; G. Ligtenberg; Y. W. J. Sijpkens; H. E. Sluiter; P. J. G. van de Ven; G. M. M. Vervoort; L. J. Vleming; M. L. Bots; J. F. M. Wetzels

2010-01-01

48

Impact of a statewide intensive care unit quality improvement initiative on hospital mortality and length of stay: retrospective comparative analysis  

Microsoft Academic Search

Objective To evaluate whether implementation of the Michigan Keystone ICU project, a comprehensive statewide quality improvement initiative focused on reduction of infections, was associated with reductions in hospital mortality and length of stay for adults aged 65 or more admitted to intensive care units.Design Retrospective comparative study, using data from Medicare claims.Setting Michigan and Midwest region, United States.Population The study

Allison Lipitz-Snyderman; Donald Steinwachs; Dale M Needham; Elizabeth Colantuoni; Laura L Morlock; Peter J Pronovost

2011-01-01

49

Woman-centered post-abortion care in public hospitals in Tucumán, Argentina: assessing quality of care and its link to human rights.  

PubMed

Unsafe abortion is a major public health and human rights problem in Argentina. Implementation of a woman-centered post-abortion care (PAC) model is one strategy to improve the situation. The quality of PAC services was measured in three public hospitals in Tucumán, a province with high levels of poverty and maternal mortality due to unsafe abortion. Overall, the quality of PAC services was found to be poor. Women do not receive services in a manner that respects their human rights, in particular their rights to health and health care, information, and to the benefits of scientific progress. Findings from the evaluation are being used to develop collaborative NGO/hospital/policy-maker efforts to improve PAC services through better training of health care providers. PMID:17061775

Gómez Ponce de León, Rodolfo; Billings, Deborah L; Barrionuevo, Karina

2006-01-01

50

Work engagement supports nurse workforce stability and quality of care: nursing team-level analysis in psychiatric hospitals.  

PubMed

Research in healthcare settings reveals important links between work environment factors, burnout and organizational outcomes. Recently, research focuses on work engagement, the opposite (positive) pole from burnout. The current study investigated the relationship of nurse practice environment aspects and work engagement (vigour, dedication and absorption) to job outcomes and nurse-reported quality of care variables within teams using a multilevel design in psychiatric inpatient settings. Validated survey instruments were used in a cross-sectional design. Team-level analyses were performed with staff members (n?=?357) from 32 clinical units in two psychiatric hospitals in Belgium. Favourable nurse practice environment aspects were associated with work engagement dimensions, and in turn work engagement was associated with job satisfaction, intention to stay in the profession and favourable nurse-reported quality of care variables. The strongest multivariate models suggested that dedication predicted positive job outcomes whereas nurse management predicted perceptions of quality of care. In addition, reports of quality of care by the interdisciplinary team were predicted by dedication, absorption, nurse-physician relations and nurse management. The study findings suggest that differences in vigour, dedication and absorption across teams associated with practice environment characteristics impact nurse job satisfaction, intention to stay and perceptions of quality of care. PMID:22962847

Van Bogaert, P; Wouters, K; Willems, R; Mondelaers, M; Clarke, S

2013-10-01

51

Hospital-Based Comparative Effectiveness Centers: Translating Research into Practice to Improve the Quality, Safety and Value of Patient Care  

PubMed Central

Hospital-based comparative effectiveness (CE) centers provide a model that clinical leaders can use to improve evidence-based practice locally. The model is used by integrated health systems outside the US, but is less recognized in the US. Such centers can identify and adapt national evidence-based policies for the local setting, create local evidence-based policies in the absence of national policies, and implement evidence into practice through health information technology (HIT) and quality initiatives. Given the increasing availability of CE evidence and incentives to meaningfully use HIT, the relevance of this model to US practitioners is increasing. This is especially true in the context of healthcare reform, which will likely reduce reimbursements for care deemed unnecessary by published evidence or guidelines. There are challenges to operating hospital-based CE centers, but many of these challenges can be overcome using solutions developed by those currently leading such centers. In conclusion, these centers have the potential to improve the quality, safety and value of care locally, ultimately translating into higher quality and more cost-effective care nationally. To better understand this potential, the current activity and impact of hospital-based CE centers in the US should be rigorously examined. PMID:20697961

Williams, Kendal; Brennan, Patrick J.

2010-01-01

52

[Perceived quality of care among health professionals at the University Hospital of Oran (EHUO)].  

PubMed

Created in 2003 as a profit organization, the University Hospital of Oran (Etablissement Hospitalier Universitaire d'Oran-EHUO) is currently in the process of developing a 'Quality' project aimed at assessing staff perception of quality. 20% of staff members representing the various professional categories working at EHUO (medical, nursing and administrative staff) were selected using quota sampling. Face-to-face interviews were conducted in March 2009 with 117 staff members from 25 medical and 5 non-medical units. The average length of service among medical and administrative staff was higher than the average length of service of nursing staff (8.3 vs 5.8 years; p = 0.9 Kruskal-Wallis H test). In discussing the question of quality, it was found that all categories of staff emphasized their specific professional experiences, standards and frames of reference. All staff members showed a greater preference for the various dimensions of the "are process" (mostly physicians and nurses rather than administrative staff (p=0.01)) than for the "structure" or "organization" components of the quality plan. In this sense, there appears to be a greater focus on technical rather than management aspects, as shown by the fact that two thirds of staff members were ill-informed about the hospital's quality assurance program (quality management, blood safety, complaints management...). While they appeared to be fully supportive of audit and certification procedures, 50% of health staff members were reluctant to support patient involvement in the management of the 'Quality' project. Finally, there appears to be a lack of awareness of quality concepts, standards and methodologies among hospital staff. This study suggests that there is a need for greater awareness, further training, and greater monitoring of practices based on concrete actions. PMID:22365045

Chougrani, Saada; Ali, Abdessamed Dali

2011-01-01

53

Costs and quality of hospitals in different health care systems: a multi-level approach with propensity score matching.  

PubMed

Cross-country comparisons of costs and quality between hospitals are often made at the macro level. The goal of this study was to explore methods to compare micro-level data from hospitals in different health care systems. To do so, we developed a multi-level framework in combination with a propensity score matching technique using similarly structured data for patients receiving treatment for acute myocardial infarction in German and US Veterans Health Administration hospitals. Our case study shows important differences in results between multi-level regressions based on matched and unmatched samples. We conclude that propensity score matching techniques are an appropriate way to deal with the usual baseline imbalances across the samples from different countries. Multi-level models are recommendable to consider the clustered structure of the data when patient-level data from different hospitals and health care systems are compared. The results provide an important justification for exploring new ways in performing health system comparisons. PMID:20084662

Schreyögg, Jonas; Stargardt, Tom; Tiemann, Oliver

2011-01-01

54

Medicare program; hospital inpatient prospective payment systems for acute care hospitals and the long-term care hospital prospective payment system and fiscal year 2013 rates; hospitals' resident caps for graduate medical education payment purposes; quality reporting requirements for specific providers and for ambulatory surgical centers. final rule.  

PubMed

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2012. We are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes made by the Affordable Care Act. Generally, these changes will be applicable to discharges occurring on or after October 1, 2012, unless otherwise specified in this final rule. In addition, we are implementing changes relating to determining a hospital's full-time equivalent (FTE) resident cap for the purpose of graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We also are establishing new administrative, data completeness, and extraordinary circumstance waivers or extension requests requirements, as well as a reconsideration process, for quality reporting by ambulatory surgical centers (ASCs) that are participating in Medicare. We are establishing requirements for the Hospital Value-Based Purchasing (VBP) Program and the Hospital Readmissions Reduction Program. PMID:22937544

2012-08-31

55

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

56

Acute care hospitals' accountability to provincial funders.  

PubMed

Ontario's acute care hospitals are subject to a number of tools, including legislation and performance measurement for fiscal accountability and accountability for quality. Examination of accountability documents used in Ontario at the government, regional and acute care hospital levels reveals three trends: (a) the number of performance measures being used in the acute care hospital sector has increased significantly; (b) the focus of the health system has expanded from accountability for funding and service volumes to include accountability for quality and patient safety; and (c) the accountability requirements are misaligned at the different levels. These trends may affect the success of the accountability approach currently being used. PMID:25305386

Kromm, Seija K; Ross Baker, G; Wodchis, Walter P; Deber, Raisa B

2014-09-01

57

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

58

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

59

77 FR 34326 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...  

Federal Register 2010, 2011, 2012, 2013

...Inpatient Prospective Payment Systems for Acute Care Hospitals...Care Hospital Prospective Payment System and Fiscal Year 2013 Rates...Graduate Medical Education Payment Purposes; Quality Reporting...2013 applications for new technology add-on...

2012-06-11

60

Criteria for clinical audit of the quality of hospital-based obstetric care in developing countries.  

PubMed Central

Improving the quality of obstetric care is an urgent priority in developing countries, where maternal mortality remains high. The feasibility of criterion-based clinical audit of the assessment and management of five major obstetric complications is being studied in Ghana and Jamaica. In order to establish case definitions and clinical audit criteria, a systematic review of the literature was followed by three expert panel meetings. A modified nominal group technique was used to develop consensus among experts on a final set of case definitions and criteria. Five main obstetric complications were selected and definitions were agreed. The literature review led to the identification of 67 criteria, and the panel meetings resulted in the modification and approval of 37 of these for the next stage of audit. Criterion-based audit, which has been devised and tested primarily in industrialized countries, can be adapted and applied where resources are poorer. The selection of audit criteria for such settings requires local expert opinion to be considered in addition to research evidence, so as to ensure that the criteria are realistic in relation to conditions in the field. Practical methods for achieving this are described in the present paper. PMID:10859855

Graham, W.; Wagaarachchi, P.; Penney, G.; McCaw-Binns, A.; Antwi, K. Y.; Hall, M. H.

2000-01-01

61

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  

PubMed Central

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 safety and patient involvement. We will employ a cross-sectional, multi-level study design in which patient-level measurements are nested in hospital departments, which are in turn nested in hospitals in different EU countries. Mixed methods will be used for data collection, measurement and analysis. Hospital/care pathway level constructs that will be assessed include external pressure, hospital governance, quality improvement system, patient empowerment in quality improvement, organisational culture and professional involvement. These constructs will be assessed using questionnaires. Patient-level constructs include clinical effectiveness, patient safety and patient involvement, and will be assessed using audit of patient records, routine data and patient surveys. For the assessment of hospital and pathway level constructs we will collect data from randomly selected hospitals in eight countries. For a sample of hospitals in each country we will carry out additional data collection at patient-level related to four conditions (stroke, acute myocardial infarction, hip fracture and delivery). In addition, structural components of quality improvement systems will be assessed using visits by experienced external assessors. Data analysis will include descriptive statistics and graphical representations and methods for data reduction, classification techniques and psychometric analysis, before moving to bi-variate and multivariate analysis. The latter will be conducted at hospital and multilevel. In addition, we will apply sophisticated methodological elements such as the use of causal diagrams, outcome modelling, double robust estimation and detailed sensitivity analysis or multiple bias analyses to assess the impact of the various sources of bias. Discussion Products of the project will include a catalogue of instruments and tools that can be used to build departmental or hospital quality and safety programme and an appraisal scheme to assess the maturity of the quality improvement system for use by hospitals and by purchasers to contract hospitals. PMID:20868470

2010-01-01

62

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

PubMed

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of the changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act) and other legislation. These changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits will be effective for cost reporting periods beginning on or after October 1, 2013. We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes that were applied to the LTCH PPS by the Affordable Care Act. Generally, these updates and statutory changes will be applicable to discharges occurring on or after October 1, 2013, unless otherwise specified in this final rule. In addition, we are making a number of changes relating to direct graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or have revised requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, LTCHs, and inpatient psychiatric facilities (IPFs)) that are participating in Medicare. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program and the Hospital Readmissions Reduction Program. In addition, we are revising the conditions of participation (CoPs) for hospitals relating to the administration of vaccines by nursing staff as well as the CoPs for critical access hospitals relating to the provision of acute care inpatient services. We are finalizing proposals issued in two separate proposed rules that included payment policies related to patient status: payment of Medicare Part B inpatient services; and admission and medical review criteria for payment of hospital inpatient services under Medicare Part A. PMID:23977713

2013-08-19

63

Quality of life assessment among patients living with HIV/AIDS at a tertiary care hospital in Thailand.  

PubMed

HIV/AIDS remains one of the most serious public health problems in Thailand. This study aimed to assess the health-related quality of life (HRQOL) and its related factors among people living with HIV/AIDS (PLWHA) in Thailand. A cross-sectional study was conducted with 259 patients at a tertiary care hospital. HRQOL was assessed using the Thai version of the Medical Outcomes Study HIV Health Survey (MOS-HIV) questionnaire. Socio-demographics and clinical status were measured using a self-administered questionnaire. Multiple linear regression models were used to explore associations between socio-demographic status, clinical status, and HRQL. Multiple linear regression analyses showed that employment status was strongly related to better overall physical and mental health summary scores (PHS, MHS). In addition, patients with disclosure of HIV status, aged over 50 years, and having at least a rating of good health in the nurses' opinion were the independent positive predictive factors for overall PHS. While being on antiretroviral therapy (ART) and good compliance with ART were positive predictive factors for overall MHS. Improving and strengthening quality of life among PLWHAs are important goals for HIV/AIDS services. Regular assessment of HRQL can provide potential information for intervention to improve quality of life. PMID:25427351

Bunjoungmanee, P; Chunloy, K; Tangsathapornpong, A; Khawcharoenporn, T; Apisarnthanarak, A

2014-07-01

64

Involvement of patients or their representatives in quality management functions in EU hospitals: implementation and impact on patient-centred care strategies  

PubMed Central

Objective The objective of this study was to describe the involvement of patients or their representatives in quality management (QM) functions and to assess associations between levels of involvement and the implementation of patient-centred care strategies. Design A cross-sectional, multilevel study design that surveyed quality managers and department heads and data from an organizational audit. Setting Randomly selected hospitals (n = 74) from seven European countries (The Czech Republic, France, Germany, Poland, Portugal, Spain and Turkey). Participants Hospital quality managers (n = 74) and heads of clinical departments (n = 262) in charge of four patient pathways (acute myocardial infarction, stroke, hip fracture and deliveries) participated in the data collection between May 2011 and February 2012. Main Outcome Measures Four items reflecting essential patient-centred care strategies based on an on-site hospital visit: (1) formal survey seeking views of patients and carers, (2) written policies on patients' rights, (3) patient information literature including guidelines and (4) fact sheets for post-discharge care. The main predictors were patient involvement in QM at the (i) hospital level and (ii) pathway level. Results Current levels of involving patients and their representatives in QM functions in European hospitals are low at hospital level (mean score 1.6 on a scale of 0 to 5, SD 0.7), but even lower at departmental level (mean 0.6, SD 0.7). We did not detect associations between levels of involving patients and their representatives in QM functions and the implementation of patient-centred care strategies; however, the smallest hospitals were more likely to have implemented patient-centred care strategies. Conclusions There is insufficient evidence that involving patients and their representatives in QM leads to establishing or implementing strategies and procedures that facilitate patient-centred care; however, lack of evidence should not be interpreted as evidence of no effect. PMID:24615596

Groene, Oliver; Sunol, Rosa; Klazinga, Niek S.; Wang, Aolin; Dersarkissian, Maral; Thompson, Caroline A.; Thompson, Andrew; Arah, Onyebuchi A.; Klazinga, N; Kringos, DS; Lombarts, MJMH; 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; Bottaro, S; Garel, P; 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; Lívio, A; Eiras, M; Franca, M; Leite, I; Almeman, F; Kus, H; Ozturk, K; Mannion, R; Arah, OA; DerSarkissian, M; Thompson, CA; Wang, A; Thompson, A

2014-01-01

65

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

MedlinePLUS

... residents Mental Health Survey finds rapid rise in antipsychotic use among young people Study finds few clinically ... affecting later dental outcomes Elderly/Long-Term Care Antipsychotic use among the elderly boosts risk of stroke ...

66

Quality Improvement Implementation and Hospital Performance on Quality Indicators  

PubMed Central

Objective To examine the association between the scope of quality improvement (QI) implementation in hospitals and hospital performance on selected indicators of clinical quality. Data Sources Secondary data from 1997 mailed survey of hospital QI practices, Medicare Inpatient Database, American Hospital Association's Annual Survey of Hospitals, the Bureau of Health Professions' Area Resource File, and two proprietary data sets compiled by Solucient Inc. containing data on managed care penetration and hospital financial performance. Study Design Cross-sectional study of 1,784 community hospitals to assess relationship between QI implementation approach and six hospital-level quality indicators. Data Collection/Abstraction Methods Two-stage instrumental variables estimation in which predicted values (instruments) of four QI scope variables and control (exogenous) variables used to estimate hospital-level quality indicators. Principal Findings Involvement by multiple hospital units in QI effort is associated with worse values on hospital-level quality indicators. Percentage of hospital staff and percentage of senior managers participating in formally organized QI teams are associated with better values on quality indicators. Percentage of physicians participating in QI teams is not associated with better values on the hospital-level quality indicators studied. Conclusions Results supported the proposition that the scope of QI implementation in hospitals is significantly associated with hospital-level quality indicators. However, the direction of the association varied across different measures of QI implementation scope. PMID:16584451

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

2006-01-01

67

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

ERIC Educational Resources Information Center

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…

Sorensen, Ros; Iedema, Rick

2011-01-01

68

The relationship of the hospital-acquired injurious fall rates with the quality profile of a hospital's care delivery and nursing staff patterns.  

PubMed

Fall occurrence during hospital stays is a well-recognized nursing-sensitive outcome indicator. This study was intended to determine the unique contributions of three inpatient satisfaction measures on the hospital-acquired injurious fall rates. Study results demonstrated the higher the inpatient satisfaction levels with the quietness of hospital environment, the lower the injurious fall rates. The physical environment (quietness) of the acute inpatient care settings was a significant and meaningful determinant of the prevalence of injurious falls. Additionally, more total nursing personnel FTEs per 1,000 discharges and a higher percentage of RN FTEs by total nursing personnel FTEs would not result in better patient outcomes. PMID:22360104

Tzeng, Huey-Ming; Hu, Hsou Mei; Yin, Chang-Yi

2011-01-01

69

[Quality of data or quality of care? Comparison of diverse standarization methods by clinical severity, based on the discharge form, in the analysis of hospital mortality].  

PubMed

Using discharge abstract data, we analysed hospital mortality comparing four different methods of risk adjustment. All patients discharged from the S. Giovanni Battista (Molinette) hospital in Turin (Italy) between January 1996 and June 1999 (n = 169,746) were classified with All Patient Refined--Diagnosis Related Groups (APR-DRG). A first analysis evaluated the time trend of hospital mortality by semester. A second analysis compared hospital mortality during the last 12 months among eight units of internal medicine (n = 5592). All comparisons were made through logistic regression models. As the quality of discharge abstracts increased during time and showed variation among units with similar patients, all comparisons were repeated using four models, characterised by increasing predictivity and sensitivity to quality of data. In addition to crude comparisons (A), the other models included as risk factors: B) age and emergency admission; C) same as 'B' plus expected mortality by APR-DRG; D) same as 'B' plus expected mortality by APR-DRG and risk of death subclass. If no risk factors were considered (A), hospital mortality showed an increasing trend, with an odds ratio (OR) of 1.02 by semester, with a 95% confidence interval (CI) between 1.01 and 1.03. The association was weakened when age and mode of admission were taken into account (B) and disappeared when the APR-DRG expected mortality was also considered (C) (OR = 1.00; CI = 0.98-1.01). Finally, if the comparisons were adjusted also for the expected mortality by APR-DRG and risk of death subclass (D) a reversed trend appeared (OR = 0.95; CI = 0.94-0.97). The comparison among the units of internal medicine gave discordant results according to the method used to adjust for confounders. The most striking variations were detected for those units with the best and the worst clinical data. The unit with the poorer clinical data (average number of diagnoses per patient = 2.9) showed a crude OR of 1.38 (CI = 0.99-1.93) and an adjusted OR (D) of 1.71 (CI = 1.10-2.66); the unit with the best quality of data (average number of diagnoses per patient = 4.4) changed the OR from 1.55 (CI = 1.06-2.26) (A) to 0.66 (CI = 0.37-1.17) (D). In conclusion, these results confirm the high sensitivity of the APR-DRG classification to the quality of data and, more in general, suggest to be prudent when using powerful instruments like this to assess quality of care, especially if the quality of data among the units compared is less than optimal or not homogeneous. PMID:10730469

Ciccone, G; Bertero, D; Bruno, A; Canavese, C; Ciccarelli, E; Ivaldi, C; Pacitti, A; Rosato, R; Arione, R

1999-01-01

70

Quality of Care  

Cancer.gov

The Institute of Medicine (IOM) defines quality of care as "the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge." In 1999, the IOM issued Ensuring Quality Cancer Care, a report that documented significant gaps in the quality of cancer care in the United States.

71

What Do the Hospital Pharmacists Think about the Quality of Pharmaceutical Care Services in a Pakistani Province? A Mixed Methodology Study  

PubMed Central

The objective of this study was to evaluate the perception of hospital pharmacists regarding quality of pharmaceutical care services in Khyber Pakhtunkhwa (KPK) Province, Pakistan, through qualitative as well as quantitative approach. For qualitative study, snow ball sampling technique was used. In quantitative part, a cross-sectional study was conducted in 112 hospital pharmacists (out of 128 accessed ones) from both private and public hospitals in six major divisions (divisions are the third tier of government in Pakistan, between the provinces and districts) of KPK. The qualitative study yielded five major themes during thematic analysis: (a) patients reporting, (b) lack of patient counseling, (c) lack of participation in health awareness programs, (d) pharmacists reducing the prescribing errors, and (e) insufficient number of pharmacists. A great proportion (67.9%) of the pharmacists was unsatisfied with their participation in health awareness programs. Findings of both phases revealed that hospital pharmacists in Pakistan are not actively participating in the provision of pharmaceutical care services. They are facing various hurdles for their active participation in patient care; major obstacles include the unavailability of sufficient number of pharmacists, lack of appropriate time for patient counseling, and poor relationship between pharmacists and other health care providers. PMID:25649021

Kousar, Rozina; Azhar, Saira; Khan, Shujaat Ali; Mahmood, Qaisar

2015-01-01

72

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

PubMed

We are revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs of acute care hospitals to implement changes arising from our continuing experience with these systems. Some of these changes implement certain statutory provisions contained in the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010 (collectively known as the Affordable Care Act), the Protecting Access to Medicare Act of 2014, and other legislation. These changes are applicable to discharges occurring on or after October 1, 2014, unless otherwise specified in this final rule. We also are updating the rate-of-increase limits for certain hospitals excluded from the IPPS that are paid on a reasonable cost basis subject to these limits. The updated rate-of-increase limits are effective for cost reporting periods beginning on or after October 1, 2014. We also are updating the payment policies and the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs) and implementing certain statutory changes to the LTCH PPS under the Affordable Care Act and the Pathway for Sustainable Growth Rate (SGR) Reform Act of 2013 and the Protecting Access to Medicare Act of 2014. In addition, we discuss our proposals on the interruption of stay policy for LTCHs and on retiring the "5 percent" payment adjustment for collocated LTCHs. While many of the statutory mandates of the Pathway for SGR Reform Act apply to discharges occurring on or after October 1, 2014, others will not begin to apply until 2016 and beyond. In addition, we are making a number of changes relating to direct graduate medical education (GME) and indirect medical education (IME) payments. We are establishing new requirements or revising requirements for quality reporting by specific providers (acute care hospitals, PPS-exempt cancer hospitals, and LTCHs) that are participating in Medicare. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program. In addition, we are making technical corrections to the regulations governing provider administrative appeals and judicial review; updating the reasonable compensation equivalent (RCE) limits, and revising the methodology for determining such limits, for services furnished by physicians to certain teaching hospitals and hospitals excluded from the IPPS; making regulatory revisions to broaden the specified uses of Medicare Advantage (MA) risk adjustment data and to specify the conditions for release of such risk adjustment data to entities outside of CMS; and making changes to the enforcement procedures for organ transplant centers. We are aligning the reporting and submission timelines for clinical quality measures for the Medicare HER Incentive Program for eligible hospitals and critical access hospitals (CAHs) with the reporting and submission timelines for the Hospital IQR Program. In addition, we provide guidance and clarification of certain policies for eligible hospitals and CAHs such as our policy for reporting zero denominators on clinical quality measures and our policy for case threshold exemptions. In this document, we are finalizing two interim final rules with comment period relating to criteria for disproportionate share hospital uncompensated care payments and extensions of temporary changes to the payment adjustment for low-volume hospitals and of the Medicare-Dependent, Small Rural Hospital (MDH) Program. PMID:25167590

2014-08-22

73

Nurses' Reports On Hospital Care In Five Countries  

Microsoft Academic Search

ABSTRACT: The current nursing shortage, high hospital nurse job dissatisfac- tion, and reports of uneven quality of hospital care are not uniquely American phenomena. This paper presents reports from 43,000 nurses from more than 700 hospitals in the United States, Canada, England, Scotland, and Germany in 1998–1999. Nurses in countries,with distinctly different health care systems report,similar shortcomings,in their work,environments,and,the quality

Linda H. Aiken; Sean P. Clarke; Douglas M. Sloane; J. A. Sochalski; Reinhard Busse; Heather Clarke; Phyllis Giovannetti; Jennifer Hunt; Anne Marie Rafferty; Judith Shamian

2001-01-01

74

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

75

Ambulatory and Hospital-based Quality Improvement Methods in Israel  

PubMed Central

This review article compares ambulatory and hospital-based quality improvement methods in Israel. Data were collected from: reports of the National Program for Quality Indicators in community, the National Program for Quality Indicators in Hospitals, and from the Organization for Economic Cooperation and Development (OECD) Reviews of Health Care Quality. PMID:25114571

Blum, Nava; Halperin, Dafna; Masharawi, Youssef

2014-01-01

76

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

77

[Quality management in the hospital].  

PubMed

Quality management in hospitals is a much discussed topic. However, mainly theorists take the floor, who have some good advice, but rarely have practical experience. All those theorists have been heard by the responsible person of the Fritz-König-hospital in Bad Harzburg, as well. At the end, however, an own system of quality management was developed with the aid of an external expert. This article describes the step-by-step introduction of quality management and the related experiences. PMID:9606890

Nagorny, H O; Faust, G; Plocek, M

1998-04-01

78

Screening for inter-hospital differences in cesarean section rates in low-risk deliveries using administrative data: An initiative to improve the quality of care  

Microsoft Academic Search

BACKGROUND: Rising national cesarean section rates (CSRs) and unexplained inter-hospital differences in CSRs, led national and international bodies to select CSR as a quality indicator. Using hospital discharge abstracts, we aimed to document in Belgium (1) inter-hospital differences in CSRs among low risk deliveries, (2) a national upward CSR trend, (3) lack of better neonatal outcomes in hospitals with high

Willem Aelvoet; Francis Windey; Geert Molenberghs; Hans Verstraelen; Patrick Van Reempts; Jean-Michel Foidart

2008-01-01

79

Diabetes ambulatory care-sensitive hospitalizations, care organization, and medication adherence  

Microsoft Academic Search

A retrospective cohort analysis using Indiana Medicaid claims, enrollment, and encounter data was conducted to determine the number and rate of ambulatory care sensitive conditions hospitalizations (ACSCH) that reflect quality of ambulatory diabetes care. ACSCH were identified based on the Agency for Healthcare Research and Quality Prevention Quality Indicators for diabetes short-term complications, uncontrolled diabetes, long-term complications and amputations. Association

Ankita Bharat Modi

2010-01-01

80

On measuring the hospital cost|quality trade-off  

Microsoft Academic Search

This paper explores the relationship between cost and quality of hospital care. A total operating cost function is estimated for 137 US Department of Veterans Affairs hospitals for 1988-1993 using three rate-based measures of quality as regressors. The high likelihood of the existence of measurement error in quality in the cross section leads to the application of novel instrumental variable

Kathleen Carey; James F. Burgess

1999-01-01

81

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

82

78 FR 50495 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...  

Federal Register 2010, 2011, 2012, 2013

...Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care; Hospital Prospective Payment System and Fiscal...Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital...

2013-08-19

83

76 FR 51475 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...  

Federal Register 2010, 2011, 2012, 2013

...Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and FY 2012...Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital...

2011-08-18

84

77 FR 53257 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...  

Federal Register 2010, 2011, 2012, 2013

...Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal...Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital...

2012-08-31

85

78 FR 27485 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...  

Federal Register 2010, 2011, 2012, 2013

...Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Proposed...Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital...

2013-05-10

86

77 FR 27869 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...  

Federal Register 2010, 2011, 2012, 2013

...Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal...Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital...

2012-05-11

87

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

88

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

89

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

Federal Register 2010, 2011, 2012, 2013

...for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System...for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System...for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment...

2012-10-17

90

QUALITY INDICATORS OF DIABETES CARE IN PRACTICE  

Microsoft Academic Search

The objective of this study was to explore the practicability of using process and outcome indicators to routinely assess the quality of diabetes care. Health care data of diabetic patients using antidiabetic drugs older than 40 years old in 2006-2008 were retrieved from an electronic information system of Phramongkutklao Hospital, Thailand. The process and outcome indicators were taken from the

Inthira Kanchanaphibool; Sanita Hirunrassami; Pensri Tongpugdee

2009-01-01

91

Spiritual care in hospitalized patients  

PubMed Central

BACKGROUND: Spiritual needs are among an individual's essential needs in all places and times. With his physical and spiritual dimensions and the mutual effect of these two dimensions, human has spiritual needs as well. These needs are an intrinsic need throughout the life; therefore, they will remain as a major element of holistic nursing care. One of the greatest challenges for nurses is to satisfy the patients’ spiritual needs. METHODS: This is a qualitative study with hermeneutic phenomenological approach. Data were collected from 16 patients hospitalized in internal medicine-surgery wards and 6 nurses in the respective wards. Data were generated by open-ended interview and analyzed using Diekelmann's seven-stage method. Rigorousness of findings was confirmed by use of this method as well as team interpretation, and referring to the text and participants. RESULTS: In final interpretation of the findings, totally 10 sub-themes, three themes including formation of mutual relation with patient, encouraging the patient, and providing the necessary conditions for patient's connection with God, and one constitutive pattern, namely spiritual need of hospitalized patients. CONCLUSIONS: Spiritual needs are those needs whose satisfaction causes the person's spiritual growth and make the person a social, hopeful individual who always thanks God. They include the need for communication with others, communication with God, and being hopeful. In this study, the three obtained themes are the spiritual needs whose satisfaction is possible in nursing system. Considering these spiritual aspects accelerates patient's treatment. PMID:22039390

Yousefi, Hojjatollah; Abedi, Heidar Ali

2011-01-01

92

The sentinel hospitalization and the role of palliative care.  

PubMed

With current healthcare reform and calls for improving care quality and safety, there is renewed emphasis on high-value care. Moreover, given the significant healthcare resource utilization for patients with chronically progressive illnesses or for patients at the end of life, innovative and efficient care delivery models are urgently needed. We propose here the concept of a sentinel hospitalization, defined as a transitional point in the patient's disease course that heralds a need to reassess prognosis, patient understanding, treatment options and intensities, and goals of care. Hospitalists are well positioned to recognize a patient's sentinel hospitalization and use it as an opportunity for active integration of palliative care that provides high-quality and cost-saving care through its patient- and family-oriented approach, its interdisciplinary nature, and its focus on symptom control and care coordination. PMID:24474682

Lin, Richard J; Adelman, Ronald D; Diamond, Randi R; Evans, Arthur T

2014-05-01

93

Hospital value-based purchasing (VBP) program: measurement of quality and enforcement of quality improvement.  

PubMed

VBP program is a novel medicare payment estimatin tool used to encourage clinical care quality improvement as well as improvement of patient experience as a customer of a health care system. The program utilizes well established tools of measuring clinical care quality and patient satisfaction such as the hospital IQR program and HCAHPS survey to estimate Medicare payments and encourage hospitals to continuosly improve the level of care they provide. PMID:24600783

Szablowski, Katarzyna M

2014-01-01

94

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.

95

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

96

Effectiveness in professional organizations: the impact of surgeons and surgical staff organizations on the quality of care in hospitals.  

PubMed Central

In this research, we examine the relative importance of different structural units in a professional organization, the hospital, as they affect organizational effectiveness. The difficulties of measuring effectiveness in a complex professional organization are discussed, and an adjusted measure of surgical outcome is developed. Data are drawn from a prospective study of over 8,000 surgical patients treated by more than 500 surgeons in 15 hospitals throughout the nation. Two different types of analyses are presented, both indicating that hospital features have more impact on surgical outcomes than do surgeon characteristics. The second analysis assesses the relative importance of specific attributes of the hospital, surgical staff organization, and surgeon characteristics on surgical outcomes. PMID:7152960

Flood, A B; Scott, W R; Ewy, W; Forrest, W H

1982-01-01

97

Hospitalization of older adults due to ambulatory care sensitive conditions  

PubMed Central

OBJECTIVE To analyze the temporal evolution of the hospitalization of older adults due to ambulatory care sensitive conditions according to their structure, magnitude and causes. METHODS Cross-sectional study based on data from the Hospital Information System of the Brazilian Unified Health System and from the Primary Care Information System, referring to people aged 60 to 74 years living in the state of Rio de Janeiro, Souhteastern Brazil. The proportion and rate of hospitalizations due to ambulatory care sensitive conditions were calculated, both the global rate and, according to diagnoses, the most prevalent ones. The coverage of the Family Health Strategy and the number of medical consultations attended by older adults in primary care were estimated. To analyze the indicators’ impact on hospitalizations, a linear correlation test was used. RESULTS We found an intense reduction in hospitalizations due to ambulatory care sensitive conditions for all causes and age groups. Heart failure, cerebrovascular diseases and chronic obstructive pulmonary diseases concentrated 50.0% of the hospitalizations. Adults older than 69 years had a higher risk of hospitalization due to one of these causes. We observed a higher risk of hospitalization among men. A negative correlation was found between the hospitalizations and the indicators of access to primary care. CONCLUSIONS Primary healthcare in the state of Rio de Janeiro has been significantly impacting the hospital morbidity of the older population. Studies of hospitalizations due to ambulatory care sensitive conditions can aid the identification of the main causes that are sensitive to the intervention of the health services, in order to indicate which actions are more effective to reduce hospitalizations and to increase the population’s quality of life. PMID:25372173

Marques, Aline Pinto; Montilla, Dalia Elena Romero; de Almeida, Wanessa da Silva; de Andrade, Carla Lourenço Tavares

2014-01-01

98

Transitional Care Strategies From Hospital to Home  

PubMed Central

Hospitals are challenged with reevaluating their hospital’s transitional care practices, to reduce 30-day readmission rates, prevent adverse events, and ensure a safe transition of patients from hospital to home. Despite the increasing attention to transitional care, there are few published studies that have shown significant reductions in readmission rates, particularly for patients with stroke and other neurologic diagnoses. Successful hospital-initiated transitional care programs include a “bridging” strategy with both predischarge and postdischarge interventions and dedicated transitions provider involved at multiple points in time. Although multicomponent strategies including patient engagement, use of a dedicated transition provider, and facilitation of communication with outpatient providers require time and resources, there is evidence that neurohospitalists can implement a transitional care program with the aim of improving patient safety across the continuum of care. PMID:25553228

Ranji, Sumant R.

2015-01-01

99

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

100

Hospitalizations during pregnancy among managed care enrollees  

Microsoft Academic Search

Objective:To describe the prevalence of hospitalizations during pregnancy, the reason for hospitalization, the length of stay, and the associated costs.Methods:We analyzed data from a national managed care organization and determined the occurrence of hospitalizations for 46,179 women who had a live birth or a pregnancy loss in 1997.Results:Overall, 8.7% of women were hospitalized during their pregnancy. Of these, 5.7% were

Julie A Gazmararian; Ruth Petersen; Denise J Jamieson; Laura Schild; Melissa M Adams; Anjali D Deshpande; Adele L Franks

2002-01-01

101

Case-based reimbursement for psychiatric hospital care.  

PubMed

A fixed-prepayment system (case-based reimbursement) for patients initially requiring hospital-level care was evaluated for one year through an arrangement between a private nonprofit psychiatric hospital and a self-insured company desiring to provide psychiatric services to its employees. This clinical and financial experiment offered a means of containing costs while monitoring quality of care. A two-group, case-control study was undertaken of treatment outcomes at discharge, patient satisfaction with hospital care, and service use and costs during the program's first year. Compared with costs for patients in the control group, costs for those in the program were lower per patient and per admission; cumulative costs for patients requiring rehospitalization were also lower. However, costs for outpatient services for patients in the program were not calculated. Treatment outcomes and patients' satisfaction with hospital care were comparable for the two groups. PMID:1490713

Sederer, L I; Eisen, S V; Dill, D; Grob, M C; Gougeon, M L; Mirin, S M

1992-11-01

102

Quality of resuscitation in hospitals.  

PubMed

There is relatively less literature available on in-hospital cardiac arrest (IHCA) as opposed to that of out-of-hospital cardiac arrest (OHCA). Although IHCA and OHCA patients may differ at baseline, they share similar factors that are associated with survival. Important variables need to be standardised for reporting. Principles such as the 'chain of survival' remain applicable in the response. Early escalation protocols and medical emergency teams, together with streamlined activation pathways and staff training, are crucial. Post-resuscitation care bundles should be implemented. PMID:21879223

Leong, B S H; Chua, G S W

2011-08-01

103

Incorporating health care quality into health antitrust law  

PubMed Central

Background Antitrust authorities treat price as a proxy for hospital quality since health care quality is difficult to observe. As the ability to measure quality improved, more research became necessary to investigate the relationship between hospital market power and patient outcomes. This paper examines the impact of hospital competition on the quality of care as measured by the risk-adjusted mortality rates with the hospital as the unit of analysis. The study separately examines the effect of competition on non-profit hospitals. Methods We use California Office of Statewide Health Planning and Development (OSHPD) data from 1997 through 2002. Empirical model is a cross-sectional study of 373 hospitals. Regression analysis is used to estimate the relationship between Coronary Artery Bypass Graft (CABG) risk-adjusted mortality rates and hospital competition. Results Regression results show lower risk-adjusted mortality rates in the presence of a more competitive environment. This result holds for all alternative hospital market definitions. Non-profit hospitals do not have better patient outcomes than investor-owned hospitals. However, they tend to provide better quality in less competitive environments. CABG volume did not have a significant effect on patient outcomes. Conclusion Quality should be incorporated into the antitrust analysis. When mergers lead to higher prices and lower quality, thus lower social welfare, the antitrust challenge of hospital mergers is warranted. The impact of lower hospital competition on quality of care delivered by non-profit hospitals is ambiguous. PMID:18430219

2008-01-01

104

Observational study on patient's satisfactions and quality of life (QoL) among cancer patients receiving treatment with palliative care intent in a tertiary hospital in Malaysia.  

PubMed

The main objective of palliative treatment for cancer patients has been to maintain, if not improve, the quality of life (QoL). There is a lack of local data on satisfaction and QoL among cancer patients receiving palliative treatment in Malaysia. This study covers patients with incurable, progressive cancer disease receiving palliative treatment in a teaching hospital in Kuala Lumpur, comparing the different components of QoL and correlations with patient satisfaction. A cross-sectional survey using Malay validated SF36 QoL and PSQ-18 (Short Form) tools was carried out between July 2012 -January 2013 with 120 cancer patients receiving palliative treatment, recruited into the study after informed consent using convenient sampling. Results showed that highest satisfaction were observed in Communication Aspect (50.6±9.07) and the least in General Satisfaction (26.4±5.90). The Mental Component Summary (44.9±6.84) scored higher when compared with the Physical Component Summary (42.2±7.91). In this study, we found that patient satisfaction was strongly associated with good quality of life among cancer patients from a general satisfaction aspect (r=0.232). A poor significant negative correlation was found in Physical Component (technical quality, r=-0.312). The Mental Component showed there was a poor negative correlation between time spent with doctor (r=-0.192) and accessibility, (r=-0.279). We found that feeling at peace and having a sense of meaning in life were more important to patients than being active or achieving good physical comfort. More studyis needed to investigate patients who score poorly on physical and mental component aspects to understand their needs in order to achieve better cancer care. PMID:24568481

Sharifa Ezat, Wan Puteh; Fuad, Ismail; Hayati, Yaakub; Zafar, Ahmed; Wanda Kiyah, George Albert

2014-01-01

105

The nursing quality partnership: building a health system approach to improving care in community hospitals using principles of the magnet program of excellence.  

PubMed

Review of the Magnet Recognition Program journey related to the partnership between nursing and quality in building a comprehensive, results-driven quality and safety program in a 5 hospital community system in suburban Philadelphia over a 5-year period (2006-2011). PMID:22955223

Valentine, Nancy M; Murphy, Denise; DeRoberts, Annamarie; Lyman, Martha B

2012-01-01

106

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

107

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

108

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

109

Preventable hospitalization and access to primary health care in an area of Southern Italy  

Microsoft Academic Search

BACKGROUND: Ambulatory care-sensitive conditions (ACSC), such as hypertension, diabetes, chronic heart failure, chronic obstructive pulmonary disease and asthma, are conditions that can be managed with timely and effective outpatient care reducing the need of hospitalization. Avoidable hospitalizations for ACSC have been used to assess access, quality and performance of the primary care delivery system. The aims of this study were

Paolo Rizza; Aida Bianco; Maria Pavia; Italo F Angelillo

2007-01-01

110

38 CFR 17.45 - Hospital care for research purposes.  

Code of Federal Regulations, 2012 CFR

... false Hospital care for research purposes. 17.45 Section...DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and...17.45 Hospital care for research purposes. Subject to...Department of Veterans Affairs research project and there are...

2012-07-01

111

38 CFR 17.45 - Hospital care for research purposes.  

... false Hospital care for research purposes. 17.45 Section...DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and...17.45 Hospital care for research purposes. Subject to...Department of Veterans Affairs research project and there are...

2014-07-01

112

38 CFR 17.45 - Hospital care for research purposes.  

Code of Federal Regulations, 2013 CFR

... false Hospital care for research purposes. 17.45 Section...DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and...17.45 Hospital care for research purposes. Subject to...Department of Veterans Affairs research project and there are...

2013-07-01

113

38 CFR 17.45 - Hospital care for research purposes.  

Code of Federal Regulations, 2011 CFR

... false Hospital care for research purposes. 17.45 Section...DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and...17.45 Hospital care for research purposes. Subject to...Department of Veterans Affairs research project and there are...

2011-07-01

114

38 CFR 17.45 - Hospital care for research purposes.  

Code of Federal Regulations, 2010 CFR

... false Hospital care for research purposes. 17.45 Section...DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and...17.45 Hospital care for research purposes. Subject to...Department of Veterans Affairs research project and there are...

2010-07-01

115

Controlling for quality in the hospital cost function.  

PubMed

This paper explores the relationship between the cost and quality of hospital care from the perspective of applied microeconomics. It addresses both theoretical and practical complexities entailed in incorporating hospital quality into the estimation of hospital cost functions. That literature is extended with an empirical analysis that examines the use of 15 Patient Safety Indicators (PSIs) as measures of hospital quality. A total operating cost function is estimated on 2,848 observations from five states drawn from the period 2001 to 2007. In general, findings indicate that the PSIs are successful in capturing variation in hospital cost due to adverse patient safety events. Measures that rely on the aggregate number of adverse events summed over PSIs are found to be superior to risk-adjusted rates for individual PSIs. The marginal cost of an adverse event is estimated to be $22,413. The results contribute to a growing business case for inpatient safety in hospital services. PMID:21086051

Carey, Kathleen; Stefos, Theodore

2011-06-01

116

Efforts of hospital system wound care teams to reduce hospital acquired pressure ulcers  

Microsoft Academic Search

New reimbursement policies developed by the Centers for Medicare and Medicaid Services (CMS) are revolutionizing the health care landscape in America. The policies focus on clinical quality and patient outcomes. As part of the new policies, certain hospital acquired conditions have been identified by Medicare as \\

Jonathan F Rivera

2009-01-01

117

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

118

Comparison of presenting features, diagnostic tools, hospital outcomes, and quality of care indicators in older (>65 years) to younger, men to women, and diabetics to nondiabetics with acute chest pain triaged in the emergency department  

Microsoft Academic Search

In a total of 4,843 consecutive patients admitted to an emergency department (ED) with acute chest pain over a 1-year period, presenting features, diagnostic tools, hospital outcomes, and quality-of-care indicators were compared between older (n = 1,781) and younger (n = 3,062) patients, men (n = 3,095) and women (n = 1,748), and diabetics (n = 856) and nondiabetics (n

Francesco Pelliccia; Domenico Cartoni; Monica Verde; Paolo Salvini; Sandro Petrolati; Giuseppe Mercuro; Pietro Tanzi

2004-01-01

119

Evaluation of correlation of BODE index with health-related quality of life among patients with stable COPD attending a tertiary care hospital  

PubMed Central

Background: Chronic obstructive pulmonary disease (COPD) is characterized by progressive deterioration of respiratory function along with systemic effects which have a great impact on health-related quality of life (HRQoL). Classification of severity of airflow limitation in COPD does not represent the clinical consequences of COPD. Hence, combined COPD assessment should be preferred. BODE index (Body mass index, Airflow obstruction, Dyspnea and Exercise capacity) has recently been proposed to provide useful prognostic information. Objectives: To find out correlations between the BODE index and HRQoL, and between GOLD classification of COPD severity and HRQoL in stable COPD patients, and to compare between these two correlations. Materials and Methods: A longitudinal observational study was carried out with 114 stable COPD patients recruited over 10 months at the outpatient clinic of a tertiary care hospital in Kolkata, India. Patients were classified according to GOLD classification of severity of airflow limitation after performing spirometry. BODE index was calculated for each patient. Saint George's Respiratory Questionnaire (SGRQ) was used to assess the HRQoL. Results: BODE scores were categorized into four quartiles, quartile one to four with scores of 0-2, 3-4, 5-6 and 7-10, respectively. Higher BODE quartiles were associated with higher total SGRQ scores and SGRQ subscale scores (symptom, activity and impact). Very strong correlations were found between BODE quartiles and total SGRQ scores (P = 0.914; P < 0.01). In contrast, GOLD classes showed moderate correlation with total SGRQ scores (P = 0.590; P < 0.01). Conclusions: BODE index was strongly correlated with the HRQoL in stable COPD patients and it was better than GOLD classes of COPD severity to reflect the health status in patients with stable COPD.

Sarkar, Samir Kumar; Basuthakur, Sumitra; Das, Sibes K.; Das, Anirban; Das, Soumya; Choudhury, Sabyasachi; Datta, Samadarshi

2015-01-01

120

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

121

National Hospital Ambulatory Medical Care Survey (NHAMCS)  

NSDL National Science Digital Library

The National Center for Health Statistics (NCHS) released public-use data files for the 1997 National Hospital Ambulatory Medical Care Survey (NHAMCS). The NHAMCS "collect[s] data on the utilization and provision of ambulatory care services in hospital emergency and outpatient departments." The Website for the survey describes methodology and data, provides technical documentation for accessing and manipulating the data, and links users to related reports. The data and documentation for the survey may be downloaded from the Website or from the NCHS FTP server.

122

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

123

75 FR 31118 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and...  

Federal Register 2010, 2011, 2012, 2013

...Inpatient Prospective Payment Systems for Acute Care Hospitals and Fiscal Year 2010 Rates and to the Long- Term Care Hospital Prospective Payment System and...Payment Rates Implementing the Affordable Care Act AGENCY: Centers for Medicare &...

2010-06-02

124

75 FR 50041 - Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the...  

Federal Register 2010, 2011, 2012, 2013

...Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System Changes and...Participation for Rehabilitation and Respiratory Care Services; Medicaid Program: Accreditation...

2010-08-16

125

An approach to hospital quality improvement.  

PubMed

This study demonstrates many of the important features and challenges of improving hospital care. The unique confluence of software technology advances and increasingly complex clinical needs have made possible a redesign of the process by which discharge documentation is generated and disseminated. Using knowledge of the patients' experience of hospital care, a multidisciplinary team identified communication at the time of discharge as a key interaction point in the system of care. With this need in mind, the team identified an aim of improving the accuracy and timeliness of discharge data and their dissemination. The project leveraged existing information technology to help satisfy the general aims of recording only useful information only once and reducing wait times for information [14]. The ability to manage structured medication data and translate this information and specialized care instructions into patient-directed language facilitated the creation of a document that would ensure that patients knew what was expected of them after discharge. Implementation of a discharge form requires understanding all of the constituencies within a medical center. It was therefore necessary to put together a team that included representation from all the groups who interact with this discharge information. The authors proceeded with a small-scale test of change during which they identified training and education needs that would be useful as the new process expands to other areas of the hospital. The case illustrates how in one project a team needs to address all of the challenges to improving hospital quality. The discharge form clearly required understanding the patient's perspective. The approach taken by the team to change the discharge form also showed detailed understanding of the process of discharging a patient from the hospital. Many microsystems are involved in this process and the change that was implemented took into account the needs of each of those subsystems and drew on resources from the macroorganization (computer information system). Measurement was embedded into the system for monitoring. Organizational culture was addressed in that the organization itself was moving in the direction of greater use of electronic information for better patient care. Finally, multiple staff members needed to come together to accomplish this task, all working together as a team. They created an implementation plan that allowed them to do the work in staged, planned efforts, and to learn from each endeavor. Was the change an improvement? The team was able to implement successively a change in the discharge process as measured by utilization of the new form. Will the quality of care improve? Probably, although that remains to be seen. Improvements in care do not need to be sophisticated, they do not need to be elaborate, and they do not need to involve new devices or new technologies. Improvements start with thinking about the way work is done and reflecting on how the work might be done differently to meet and exceed patients' needs and expectations. PMID:12365342

Lurie, Jon D; Merrens, Edward J; Lee, Joshua; Splaine, Mark E

2002-07-01

126

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

127

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

128

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

...Special payment provisions for long-term care hospitals within hospitals and satellites of long-term care hospitals. 412.534 Section 412.534...Prospective Payment System for Long-Term Care Hospitals § 412.534 Special...

2014-10-01

129

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

Code of Federal Regulations, 2013 CFR

...false Special payment provisions for long-term care hospitals within hospitals and satellites of long-term care hospitals. 412.534 Section 412...SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.534 Special...

2013-10-01

130

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

Code of Federal Regulations, 2011 CFR

...false Special payment provisions for long-term care hospitals within hospitals and satellites of long-term care hospitals. 412.534 Section 412...SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.534 Special...

2011-10-01

131

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

Code of Federal Regulations, 2012 CFR

...false Special payment provisions for long-term care hospitals within hospitals and satellites of long-term care hospitals. 412.534 Section 412...SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.534 Special...

2012-10-01

132

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

Code of Federal Regulations, 2010 CFR

...false Special payment provisions for long-term care hospitals within hospitals and satellites of long-term care hospitals. 412.534 Section 412...SERVICES Prospective Payment System for Long-Term Care Hospitals § 412.534 Special...

2010-10-01

133

The role of stepdown beds in hospital care.  

PubMed

Stepdown beds provide an intermediate level of care for patients with requirements somewhere between that of the general ward and the intensive care unit. Models of care include incorporation of stepdown beds into intensive care units, stand-alone units, or incorporation of beds into standard wards. Stepdown beds may be used to provide a higher level of care for patients deteriorating on a ward ("step-up"), a lower level of care for patients transitioning out of intensive care ("stepdown") or a lateral transfer of care from a recovery room for postoperative patients. These units are one possible strategy to improve critical care cost-effectiveness and patient flow without compromising quality, but these potential benefits remain primarily theoretical as few patient-level studies provide concrete evidence. This narrative review provides a general overview of the theory of stepdown beds in the care of hospitalized patients and a summary of what is known about their impact on patient flow and outcomes and highlights areas for future research. PMID:25163008

Prin, Meghan; Wunsch, Hannah

2014-12-01

134

Financial and organizational determinants of hospital diversification into subacute care.  

PubMed Central

OBJECTIVE: To examine the financial, market, and organizational determinants of hospital diversification into subacute inpatient care by acute care hospitals in order to guide hospital managers in undertaking such diversification efforts. STUDY SETTING: All nongovernment, general, acute care, community hospitals that were operating during the years 1985 through 1991 (3,986 hospitals in total). DATA SOURCES: Cross-sectional, time-series data were drawn from the American Hospital Association's (AHA) Annual Survey of Hospitals, the Health Care Financing Administration's (HCFA) Medicare Cost Reports, a latitude and longitude listing for all community hospital addresses, and the Area Resource File (ARF) published in 1992, which provides county level environmental variables. STUDY DESIGN: The study is longitudinal, enabling the specification of temporal patterns in conversion, causal inferences, and the treatment of right-censoring problems. The unit of analysis is the individual hospital. KEY FINDINGS: Significant differences were found in the average level of subacute care offered by investor-owned versus tax-exempt hospitals. After controlling for selection bias, financial performance, risk, size, occupancy, and other variables, IO hospitals offered 31.3 percent less subacute care than did NFP hospitals. Financial performance and risk are predictors of IO hospitals' diversification into subacute care, but not of NFP hospitals' activities in this market. Resource availability appears to expedite expansion into subacute care for both types of hospitals. CONCLUSIONS: Investment criteria and strategy differ between investor-owned and tax-exempt hospitals. PMID:10201852

Wheeler, J R; Burkhardt, J; Alexander, J A; Magnus, S A

1999-01-01

135

Measuring quality of care nationwide.  

PubMed

This brief summarizes a study conducted by researchers at the RAND Corporation that measured the quality of health care for randomly selected adults from 12 communities across the United States. Because the researchers used 439 quality indicators to evaluate health care performance in 30 clinical areas, including diabetes mellitus, hypertension, heart disease, and related preventive care, the size and comprehensiveness of this study is particularly noteworthy. The findings reveal comparable deficits in adherence to standard care processes by both inpatient and outpatient providers within the 12 chosen communities. Overall, study participants received only half of the care consistent with evidence-based knowledge. Thus, study results provide systematic evidence detailing the gaps between the science and the practice of health care delivery throughout the country. PMID:15875428

Clark, Amy

2005-03-01

136

Perspectives on Home Care Quality  

PubMed Central

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, Rosalie A.; Kane, Robert L.; Illston, Laurel H.; Eustis, Nancy N.

1994-01-01

137

Outreach Education to Improve Quality of Rural ICU Care Results of a Randomized Trial  

Microsoft Academic Search

This study tests whether an outreach educational program tailored to institutional specific patient care practices would improve the quality of care delivered to mechanically ventilated intensive care unit (ICU) patients in rural hospitals. The study was conducted as a randomized control trial using 20 rural Iowa hospitals as the unit of analysis. Twelve randomly selected hospitals received an outreach educational

MICHAEL S. HENDRYX; JOHN F. FIESELMANN; M. JEANNE BOCK; DOUGLAS S. WAKEFIELD; CHARLES M. HELMS; SUZANNE E. BENTLER

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

Information vs advertising in the market for hospital care.  

PubMed

Recent health care reforms have introduced prospective payments and have allowed patients to choose their preferred providers. The expected outcome is efficiency in production and an increase in the quality level. The former objective should be obtained by the prospective payment scheme; the latter by the demand mechanism, through the competition between providers. Unfortunately, because of asymmetry of information, patients are unable to observe the true quality and the demand for health care services depends on a perceived quality as influenced by the hospital advertising. Inefficiency in the resource allocation and social welfare loss are the two likely effects. In this paper we show how the purchaser can implement effective policies to overcome these undesired effects. PMID:17659373

Montefiori, Marcello

2008-09-01

140

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

Microsoft Academic Search

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

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

2009-01-01

141

Hospitalizations for ambulatory care-sensitive conditions, Minas Gerais, Southeastern Brazil, 2000 and 2010  

PubMed Central

OBJECTIVE To analyze hospitalization rates and the proportion of deaths due to ambulatory care-sensitive hospitalizations and to characterize them according to coverage by the Family Health Strategy, a primary health care guidance program. METHODS An ecological study comprising 853 municipalities in the state of Minas Gerais, under the purview of 28 regional health care units, was conducted. We used data from the Hospital Information System of the Brazilian Unified Health System. Ambulatory care-sensitive hospitalizations in 2000 and 2010 were compared. Population data were obtained from the demographic censuses. RESULTS The number of ambulatory care-sensitive hospitalizations declined from 20.75/1,000 inhabitants [standard deviation (SD) = 10.42) in 2000 to 14.92/thousand inhabitants (SD = 10.04) in 2010 Heart failure was the most frequent cause in both years. Hospitalizations rates for hypertension, asthma, and diabetes mellitus, decreased, whereas those for angina pectoris, prenatal and birth disorders, kidney and urinary tract infections, and other acute infections increased. Hospitalization durations and the proportion of deaths due to ambulatory care-sensitive hospitalizations increased significantly. CONCLUSIONS Mean hospitalization rates for sensitive conditions were significantly lower in 2010 than in 2000, but no correlation was found with regard to the expansion of the population coverage of the Family Health Strategy. Hospitalization rates and proportion of deaths were different between the various health care regions in the years evaluated, indicating a need to prioritize the primary health care with high efficiency and quality.

Rodrigues-Bastos, Rita Maria; Campos, Estela Márcia Saraiva; Ribeiro, Luiz Cláudio; Bastos, Mauro Gomes; Bustamante-Teixeira, Maria Teresa

2014-01-01

142

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

143

Fall Prevention in Acute Care Hospitals  

PubMed Central

Context Falls cause injury and death for persons of all ages, but risk of falls increases markedly with age. Hospitalization further increases risk, yet no evidence exists to support short-stay hospital-based fall prevention strategies to reduce patient falls. Objective To investigate whether a fall prevention tool kit (FPTK) using health information technology (HIT) decreases patient falls in hospitals. Design, Setting, and Patients Cluster randomized study conducted January 1, 2009, through June 30, 2009, comparing patient fall rates in 4 urban US hospitals in units that received usual care (4 units and 5104 patients) or the intervention (4 units and 5160 patients). Intervention The FPTK integrated existing communication and workflow patterns into the HIT application. Based on a valid fall risk assessment scale completed by a nurse, the FPTK software tailored fall prevention interventions to address patients’ specific determinants of fall risk. The FPTK produced bed posters composed of brief text with an accompanying icon, patient education handouts, and plans of care, all communicating patient-specific alerts to key stakeholders. Main Outcome Measures The primary outcome was patient falls per 1000 patient-days adjusted for site and patient care unit. A secondary outcome was fall-related injuries. Results During the 6-month intervention period, the number of patients with falls differed between control (n=87) and intervention (n=67) units (P=.02). Site-adjusted fall rates were significantly higher in control units (4.18 [95% confidence interval {CI}, 3.45-5.06] per 1000 patient-days) than in intervention units (3.15 [95% CI, 2.54-3.90] per 1000 patient-days; P=.04). The FPTK was found to be particularly effective with patients aged 65 years or older (adjusted rate difference, 2.08 [95% CI, 0.61-3.56] per 1000 patient-days; P=.003). No significant effect was noted in fall-related injuries. Conclusion The use of a fall prevention tool kit in hospital units compared with usual care significantly reduced rate of falls. PMID:21045097

Dykes, Patricia C.; Carroll, Diane L.; Hurley, Ann; Lipsitz, Stuart; Benoit, Angela; Chang, Frank; Meltzer, Seth; Tsurikova, Ruslana; Zuyov, Lyubov; Middleton, Blackford

2011-01-01

144

The history of quality measurement in home health care.  

PubMed

Quality improvement is as central to home health care as to any other field of health care. With the mandated addition in 2000 of Outcome Assessment and Information Set (OASIS) and outcome-based quality improvement (OBQI), Medicare home health agencies entered a new era of documenting, tracking, and systematically improving quality. OBQI is augmented by the Medicare Quality Improvement Organization (QIO) program, which is now entering the ninth in a series of work assignments, with the tenth scope in the planning stages. Evidence has shown that applied quality improvement methods can drive better outcomes using important metrics, such as acute care hospitalization. This article reviews key findings from the past 2 decades of home care quality improvement research and public policy advances, describes specific examples of local and regional programmatic approaches to quality improvement, and forecasts near-future trends in this vital arena of home health care. PMID:19217497

Rosati, Robert J

2009-02-01

145

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

146

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

147

Quality competition and uncertainty in a horizontally differentiated hospital market.  

PubMed

The chapter studies hospital competition in a spatially differentiated market in which patient demand reflects the quality/distance mix that maximizes their utility. Treatment is free at the point of use and patients freely choose the provider which best fits their expectations. Hospitals might have asymmetric objectives and costs, however they are reimbursed using a uniform prospective payment. The chapter provides different equilibrium outcomes, under perfect and asymmetric information. The results show that asymmetric costs, in the case where hospitals are profit maximizers, allow for a social welfare and quality improvement. On the other hand, the presence of a publicly managed hospital which pursues the objective of quality maximization is able to ensure a higher level of quality, patient surplus and welfare. However, the extent of this outcome might be considerably reduced when high levels of public hospital inefficiency are detectable. Finally, the negative consequences caused by the presence of asymmetric information are highlighted in the different scenarios of ownership/objectives and costs. The setting adopted in the model aims at describing the up-coming European market for secondary health care, focusing on hospital behavior and it is intended to help the policy-maker in understanding real world dynamics. PMID:24864388

Montefiori, Marcello

2014-01-01

148

Geriatrics and the triple aim: defining preventable hospitalizations in the long-term care population.  

PubMed

Reducing preventable hospitalizations is fundamental to the "triple aim" of improving care, improving health, and reducing costs. New federal government initiatives that create strong pressure to reduce such hospitalizations are being or will soon be implemented. These initiatives use quality measures to define which hospitalizations are preventable. Reducing hospitalizations could greatly benefit frail and chronically ill adults and older people who receive long-term care (LTC) because they often experience negative effects of hospitalization, including hospital-acquired conditions, morbidity, and loss of functional abilities. Conversely, reducing hospitalizations could mean that some people will not receive hospital care they need, especially if the selected measures do not adequately define hospitalizations that can be prevented without jeopardizing the person's health and safety. An extensive literature search identified 250 measures of preventable hospitalizations, but the measures have not been validated in the LTC population and generally do not account for comorbidity or the capacity of various LTC settings to provide the required care without hospitalization. Additional efforts are needed to develop measures that accurately differentiate preventable from necessary hospitalizations for the LTC population, are transparent and fair to providers, and minimize the potential for gaming and unintended consequences. As the new initiatives take effect, it is critical to monitor their effect and to develop and disseminate training and resources to support the many community- and institution-based healthcare professionals and emergency department staff involved in decisions about hospitalization for this population. PMID:23194066

Ouslander, Joseph G; Maslow, Katie

2012-12-01

149

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

150

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

151

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

152

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

153

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

154

Hospital Quality Improvement Activities and the Effects of Interventions on Pneumonia: A Multistate Study of Medicare Beneficiaries  

Microsoft Academic Search

This article evaluates the relative effectiveness of quality improvement interventions on increasing the time to antibiotic administration after a diagnosis of pneumonia. Clinical data were abstracted from the medical records of 17,040 Medicare beneficiaries discharged from one of 215 acute-care hospitals across 15 states. Thirteen Quality Improvement Organizations collected data on hospital quality improvement interventions from each hospital in this

Joseph P. Weingarten; Weihong Fan; Holmes Peacher-Ryan; Susan Brittman; Dawn FitzGerald; Stacy Jowers; Chris Przybyszewski

2004-01-01

155

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

156

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.; Suñol, 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

157

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

158

Practice size, caseload, deprivation and quality of care of patients with coronary heart disease, hypertension and stroke in primary care: national cross-sectional study  

Microsoft Academic Search

BACKGROUND: Reports of higher quality care by higher-volume secondary care providers have fuelled a shift of services from smaller provider units to larger hospitals and units. In the United Kingdom, most patients are managed in primary care. Hence if larger practices provide better quality of care; this would have important implications for the future organization of primary care services. We

Sonia Saxena; Josip Car; Darren Eldred; Michael Soljak; Azeem Majeed

2007-01-01

159

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

160

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

161

Benchmarking and audit of breast units improves quality of care.  

PubMed

?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

162

Estimating Uncompensated Care Charges at Rural Hospital Emergency Departments  

ERIC Educational Resources Information Center

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

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

2007-01-01

163

Application of a robot for critical care rounding in small rural hospitals.  

PubMed

The purpose of this article is to present an option for a model of care that allows small rural hospitals to be able to provide specialty physicians for critical care patient needs in lieu of on-site critical care physician coverage. A real-time, 2-way audio and video remote presence robot is used to bring a specialist to the bedside to interact with patients. This article discusses improvements in quality and finance outcomes as well as care team and patient satisfaction associated with this model. Discussion also includes expansion of the care model to the emergency department for acute stroke care. PMID:25438890

Murray, Cindy; Ortiz, Elizabeth; Kubin, Cay

2014-12-01

164

Innovative and successful approaches to improving care transitions from hospital to home.  

PubMed

Effective transitions to home care have been identified as among the factors leading to reducing hospital readmissions within 30 days of discharge and improvements on various other quality measures. Innovative applications of published evidence-based models and best practices designed to improve care transitions have been implemented in various settings across the country in an effort to enhance quality performance. For this article, The Joint Commission collected a series of case examples to examine how evidence-based innovations in care transitions are reducing readmissions and improving other quality outcomes. The organizations providing the case examples were interviewed and asked to provide performance data demonstrating quality improvement, as well as information about their care processes and data-gathering techniques. Their innovative approaches are reducing hospital readmissions; improving patient safety, satisfaction, and engagement; and contributing to other positive outcomes. PMID:25654457

Labson, Margherita C

2015-02-01

165

The National Accreditation Board for Hospital and Health Care Providers accreditation programme in India.  

PubMed

Quality in health care is important as it is directly linked with patient safety. Quality as we know is driven either by regulation or by market demand. Regulation in most developing countries has not been effective, as there is shortage of health care providers and governments have to be flexible. In such circumstances, quality has taken a back seat. Accreditation symbolizes the framework for quality governance of a hospital and is based on optimum standards. Not only is India establishing numerous state of the art hospitals, but they are also experiencing an increase in demand for quality as well as medical tourism. India launched its own accreditation system in 2006, conforming to standards accredited by ISQua. This article shows the journey to accreditation in India and describes the problems encountered by hospitals as well as the benefits it has generated for the industry and patients. PMID:24938026

Gyani, Girdhar J; Krishnamurthy, B

2014-01-01

166

South Carolina hospitals unite to share charity care burden.  

PubMed

Four Columbia-area hospitals formed a partnership in 1984 to more equitably distribute responsibility for care of the medically indigent. This was primarily a response to the state's weak Medicaid program, which funded only 12 inpatient days per year per client. Resulting shortfalls especially crippled regional tertiary care facilities. The partnership included Richland Memorial, Baptist Medical Center, and Providence, all in Richland County; and Lexington County Hospital. These facilities provide service to about 1 million of South Carolina's 3 million people. Richland, although exclusively receiving county tax funds, questioned its provision of unlimited indigent care because of inadequate payment and unsponsored patients. Providence, expanding into a referral hospital with only 15 percent of the market share, wanted county funds available to any facility serving county residents. When Richland county opened its indigent fund to all the county's hospitals, recognizing the charity care private hospitals had been providing without county support, the hospitals formed the Midlands Hospitals Indigent Care Partnership. Each contributed to a fund to support charity care. The program's major fault was underestimating the hospitals' true cost of providing indigent care because it failed to account for the more intense use of services by the medically indigent population. The project accomplished its objectives of focusing public attention on the problem, resulting in passage of a state law to expand Medicaid benefits and other state initiatives to address the problem. PMID:10301135

Reibold, P G

1986-11-01

167

Care left undone’ during nursing shifts: associations with workload and perceived quality of care  

PubMed Central

Background There is strong evidence to show that lower nurse staffing levels in hospitals are associated with worse patient outcomes. One hypothesised mechanism is the omission of necessary nursing care caused by time pressure—‘missed care’. Aim To examine the nature and prevalence of care left undone by nurses in English National Health Service hospitals and to assess whether the number of missed care episodes is associated with nurse staffing levels and nurse ratings of the quality of nursing care and patient safety environment. Methods Cross-sectional survey of 2917 registered nurses working in 401 general medical/surgical wards in 46 general acute National Health Service hospitals in England. Results Most nurses (86%) reported that one or more care activity had been left undone due to lack of time on their last shift. Most frequently left undone were: comforting or talking with patients (66%), educating patients (52%) and developing/updating nursing care plans (47%). The number of patients per registered nurse was significantly associated with the incidence of ‘missed care’ (p<0.001). A mean of 7.8 activities per shift were left undone on wards that are rated as ‘failing’ on patient safety, compared with 2.4 where patient safety was rated as ‘excellent’ (p?<0.?001). Conclusions Nurses working in English hospitals report that care is frequently left undone. Care not being delivered may be the reason low nurse staffing levels adversely affects quality and safety. Hospitals could use a nurse-rated assessment of ‘missed care’ as an early warning measure to identify wards with inadequate nurse staffing. PMID:23898215

Ball, Jane E; Murrells, Trevor; Rafferty, Anne Marie; Morrow, Elizabeth; Griffiths, Peter

2014-01-01

168

A study of evaluation methods for hospital medical care systems.  

PubMed

When we seek to evaluate hospital medical care services, we first collect data regarding the existing system in order to gather information and to develop a method of analysis that we can use for evaluation. We took the OPD system as an example, taking into account systematic OPD services based on queuing theory and computer simulation. As a result of the computer simulation model based on experimental conditions, we were able to offer recommendations for modifications of the present system that could improve patient service. The hospital manager can use this information to aid him in the decision making processes concerning the hospital. A study of the methods for the evaluation of hospital medical care services is important. It is necessary to develop a regional medical care information system as well as a hospital medical care information system. PMID:10120546

Nobukawa, M; Eussen, M E

1992-07-01

169

The Impact of Medicaid Disproportionate Share Hospital Payment on Provision of Hospital Uncompensated Care  

PubMed Central

This study examines the association between hospital uncompensated care (UC) and reductions in Medicaid Disproportionate Share Hospital (DSH) payments resulting from the 1997 Balanced Budget Act. Data on California hospitals from 1996 to 2003 were examined using two-stage least squares with a first-differencing model to control for potential feedback effects. Our findings suggest that not-for-profit hospitals did reduce UC provision in response to reductions in Medicaid DSH, but the response was inelastic in value. Policy makers need to continue to monitor how UC changes as sources of support for indigent care change with the Patient Protection and Affordable Care Act (PPACA). PMID:23230705

Hsieh, Hui-Min; Bazzoli, Gloria J.

2012-01-01

170

Quality indicators and performance measures in diabetes care.  

PubMed

The operations of any portion of the healthcare delivery system, eg, ambulatory care, the consultation and referral process, or hospital care, are critically dependent upon their control systems. The quality of health care produced by the system and its components is also subject to "control." One of the regulatory mechanisms involves performance measures. The development of good measures of quality is a complex and dynamic process. Within endocrinology, most measures have addressed diabetes care and most quality measurement in diabetes has focused on the ambulatory setting and mainly includes measures of process and intermediate outcomes. This review addresses quality and performance measures for diabetes, their development, characteristics, use, misuse, and future prospects. PMID:24496919

Aron, David C

2014-03-01

171

[Program for operating teams for quality improvement of hospital services].  

PubMed

In mid-1992, improvement of quality of service was set as a major goal in the framework of a 5-year plan at this hospital. This subject was selected in preparation for a new era in health care emerging in the world in general, and in Israel in particular. 6 problematic departments with high potential for improvement were chosen for the first stage of implementing a total quality management program (TQM). The goal was to gain experience through the implementation of TQM in a few medical and nonmedical departments in preparation for implementing TQM in the entire hospital. This process is ongoing and the first conclusions and perspectives are now being studied by all involved. PMID:7721177

Stern, Z; Wolfenson, M; Gedalia, N; Rotem, O; Adato-Levi, R; Mor-Yosef, S

1995-01-15

172

Assessing trauma care at the district and provincial hospital levels: a case study of hospitals in Kenya.  

PubMed

Trauma is a major cause of death and disability worldwide, of which more than 90% occur in low- and middle-income countries. Given the magnitude of this inequality, there is a need to devise and use tools to assess the capacity of facility-based trauma care. This study used two tools, hospital flowcharts and the World Health Organization's Trauma Care Checklist, to describe trauma care capacity at two hospitals in Kenya and ways in which this capacity can be strengthened. We found these hospitals had a large volume of trauma, but due to the lack of intensive care units, specialized trauma units, and axillary services, such as orthopedics and neurosurgery, the hospitals had a limited ability to provide definitive care for injured patients in critical condition. Additionally, organizational capabilities, such as trauma registries, trauma-specific training, and quality improvement programmes were lacking. The state of trauma care at district and provincial levels in Kenya demonstrates a strong case for national and global investment in clinical and systemic interventions. PMID:24377784

Wesson, Hadley K H; Bachani, Abdulgafoor M; Wekesa, John Masasabi; Mburu, Joseph; Hyder, Adnan A; Stevens, Kent A

2013-12-01

173

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

Code of Federal Regulations, 2010 CFR

... 2010-07-01 false Hospital care and medical services...and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital Or Nursing Home Care and...Foreign Countries § 17.35 Hospital care and medical...

2010-07-01

174

[Indicators of quality for hospital antisepsis].  

PubMed

In any health care institution, the most important quality indicator for antisepsis is the existence of systems of reference of use, secondly the knowledge of those systems and then the compliance by the different classes of professionals. These refrentials must be regularly evaluated and updated according to general consensus. PMID:11246481

Tissot Guerraz, F; Haond, C; Reverdy, M E; Freney, J; Nicolle, M C; Goullet, D

2000-10-01

175

Quality of Child Care and Children's Quality of Life.  

ERIC Educational Resources Information Center

This paper examines child care quality and the effects of in-home and out-of-home child care on children's quality of life, focusing on the results of a 1992 study of child care in northern and central Italy. The study surveyed the parents of 2,158 toddlers cared for exclusively in the home and 2,346 toddlers attending public day care centers. It…

Musatti, Tullia

176

Can Hospital Cultural Competency Reduce Disparities in Patient Experiences with Care?  

PubMed Central

Background Cultural competency has been espoused as an organizational strategy to reduce health disparities in care. Objective To examine the relationship between hospital cultural competency and inpatient experiences with care. Research Design The first model predicted Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores from hospital random effects, plus fixed effects for hospital cultural competency, individual race/ethnicity/language, and case-mix variables. The second model tested if the association between a hospital’s cultural competency and HCAHPS scores differed for minority and non-Hispanic white patients. Subjects The National CAHPS® Benchmarking Database’s (NCBD) HCAHPS Surveys and the Cultural Competency Assessment Tool of Hospitals (CCATH) Surveys for California hospitals were merged, resulting in 66 hospitals and 19,583 HCAHPS respondents in 2006. Measures Dependent variables include ten HCAHPS measures: six composites (communication with doctors, communication with nurses, staff responsiveness, pain control, communication about medications, and discharge information), two individual items (cleanliness, and quietness of patient rooms), and two global items (overall hospital rating, and whether patient would recommend hospital). Results Hospitals with greater cultural competency have better HCAHPS scores for doctor communication, hospital rating, and hospital recommendation. Furthermore, HCAHPS scores for minorities were higher at hospitals with greater cultural competency on four other dimensions: nurse communication, staff responsiveness, quiet room, and pain control. Conclusions Greater hospital cultural competency may improve overall patient experiences, but may particularly benefit minorities in their interactions with nurses and hospital staff. Such effort may not only serve longstanding goals of reducing racial/ethnic disparities in inpatient experience, but may also contribute to general quality improvement. PMID:23064277

Weech-Maldonado, Robert; Elliott, Marc N.; Pradhan, Rohit; Schiller, Cameron; Hall, Allyson; Hays, Ron D.

2013-01-01

177

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

178

Hospital's transition program coordinates care throughout the continuum.  

PubMed

UnityPoint-St. Luke's Hospital's Transitions Home program has slashed all-cause readmissions to an average of 10% by focusing on making sure patients' needs are met while they are in the hospital and after discharge. An Advanced Medical Team of RN care navigators and social workers works in the outpatient clinic and coordinates care for patients with multiple comorbidities who take multiple medications and are being treated by multiple physicians. The Consistent Care program, overseen by a social worker, links patients who use the emergency department for primary care with a primary care physician. Dedicated care coordinators on each unit have cubicles in the nurses' stations and meet daily with the charge nurse, social worker, and bedside nurse caring for the patient to discuss the goals of care and goals for discharge of each patient on the unit. PMID:25632707

2015-02-01

179

Severe Sepsis in Pre-Hospital Emergency Care  

PubMed Central

Rationale: Severe sepsis is common and highly morbid, yet the epidemiology of severe sepsis at the frontier of the health care system—pre-hospital emergency care—is unknown. Objectives: We examined the epidemiology of pre-hospital severe sepsis among emergency medical services (EMS) encounters, relative to acute myocardial infarction and stroke. Methods: Retrospective study using a community-based cohort of all nonarrest, nontrauma King County EMS encounters from 2000 to 2009 who were transported to a hospital. Measurements and Main Results: Overall incidence rate of hospitalization with severe sepsis among EMS encounters, as well as pre-hospital characteristics, admission diagnosis, and outcomes. Among 407,176 EMS encounters, we identified 13,249 hospitalizations for severe sepsis, of whom 2,596 died in the hospital (19.6%). The crude incidence rate of severe sepsis was 3.3 per 100 EMS encounters, greater than for acute myocardial infarction or stroke (2.3 per 100 and 2.2 per 100 EMS encounters, respectively). More than 40% of all severe sepsis hospitalizations arrived at the emergency department after EMS transport, and 80% of cases were diagnosed on admission. Pre-hospital care intervals, on average, exceeded 45 minutes for those hospitalized with severe sepsis. One-half or fewer of patients with severe sepsis were transported by paramedics (n = 7,114; 54%) or received pre-hospital intravenous access (n = 4,842; 37%). Conclusions: EMS personnel care for a substantial and increasing number of patients with severe sepsis, and spend considerable time on scene and during transport. Given the emphasis on rapid diagnosis and intervention for sepsis, the pre-hospital interval may represent an important opportunity for recognition and care of sepsis. PMID:23087028

Rea, Thomas D.; Kahn, Jeremy M.; Walkey, Allan J.; Yealy, Donald M.; Angus, Derek C.

2012-01-01

180

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

181

COMPETITION AND QUALITY IN HOME HEALTH CARE MARKETS†  

PubMed Central

SUMMARY Market-based solutions are often proposed to improve health care quality; yet evidence on the role of competition in quality in non-hospital settings is sparse. We examine the relationship between competition and quality in home health care. This market is different from other markets in that service delivery takes place in patients’ homes, which implies low costs of market entry and exit for agencies. We use 6 years of panel data for Medicare beneficiaries during the early 2000s. We identify the competition effect from within-market variation in competition over time. We analyze three quality measures: functional improvements, the number of home health visits, and discharges without hospitalization. We find that the relationship between competition and home health quality is nonlinear and its pattern differs by quality measure. Competition has positive effects on functional improvements and the number of visits in most ranges, but in the most competitive markets, functional outcomes and the number of visits slightly drop. Competition has a negative effect on discharges without hospitalization that is strongest in the most competitive markets. This finding is different from prior research on hospital markets and suggests that market-specific environments should be considered in developing polices to promote competition. PMID:23670849

JUNG, KYOUNGRAE; POLSKY, DANIEL

2013-01-01

182

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

183

Quality of care and quality of life: convergence or divergence?  

PubMed

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

184

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.

185

Care for hospitalized patients with unhealthy alcohol use: a narrative review  

PubMed Central

There is increasing emphasis on screening, brief intervention, and referral to treatment (SBIRT) for unhealthy alcohol use in the general hospital, as highlighted by new Joint Commission recommendations on SBIRT. However, the evidence supporting this approach is not as robust relative to primary care settings. This review is targeted to hospital-based clinicians and administrators who are responsible for generally ensuring the provision of high quality care to patients presenting with a myriad of conditions, one of which is unhealthy alcohol use. The review summarizes the major issues involved in caring for patients with unhealthy alcohol use in the general hospital setting, including prevalence, detection, assessment of severity, reduction in drinking with brief intervention, common acute management scenarios for heavy drinkers, and discharge planning. The review concludes with consideration of Joint Commission recommendations on SBIRT for unhealthy alcohol use, integration of these recommendations into hospital work flows, and directions for future research. PMID:23738519

2013-01-01

186

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

187

Factors Contributing to Readmission of Seniors into Acute Care Hospitals  

ERIC Educational Resources Information Center

Medicare spending is expected to increase by 79% between the years 2010 and 2020, caused, in-part, by hospital readmissions within 30 days of discharge. This study identified factors contributing to hospital readmissions in a midwest heath service area (HSA), using Coleman's Transition Care Model as the theoretical framework. The researchers…

DeCoster, Vaughn; Ehlman, Katie; Conners, Carolyn

2013-01-01

188

Some impacts of nursing on acute care hospital outcomes.  

PubMed

Measuring nursing-sensitive patient outcomes using publicly available data provides exciting opportunities for the nursing profession to quantify the patient care impact of staffing changes at individual hospitals and to make comparisons among hospitals with differing staffing patterns. Using data from California and New York, this study tested the feasibility of measuring such outcomes in acute care hospitals and examining relationships between these outcomes and nurse staffing. Nursing intensity weights were used to acuity-adjust the patient data. Both higher nurse staffing and higher proportion of RNs were significantly related to shorter lengths of stay. Lower adverse outcome rates were more consistently related to a higher proportion of RNs. PMID:10029799

Lichtig, L K; Knauf, R A; Milholland, D K

1999-02-01

189

Evaluating Hospital Compliance with the JCAH Quality Assurance Standards  

PubMed Central

This paper reviews the history of the quality assurance standards of the Joint Commission on Accreditation of Hospitals, reviews some of the technical problems associated with creation of a very large automated file of standards' compliance data from surveyed hospitals, and summarizes quality assurance findings from among 1,156 hospitals surveyed in 1982.

Downey, James E.; Walczak, Regina M.; Hohri, William M.

1983-01-01

190

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

191

NCI Community Cancer Centers Program - Pilot Subcommittees - Quality of Care  

Cancer.gov

The issue of quality of care involves many different components, including what cancer care quality looks like, which patients are more likely to receive poor quality care, and ways to measure healthcare quality.

192

Hospital discharge of elderly patients to primary health care, with and without an intermediate care hospital – a qualitative study of health professionals' experiences  

PubMed Central

Introduction Intermediate care is an organisational approach to improve the coordination of health care services between health care levels. In Central Norway an intermediate care hospital was established in a municipality to improve discharge from a general hospital to primary health care. The aim of this study was to investigate how health professionals experienced hospital discharge of elderly patients to primary health care with and without an intermediate care hospital. Methods A qualitative study with data collected through semi-structured focus groups and individual interviews. Results Discharge via the intermediate care hospital was contrasted favourably compared to discharge directly from hospital to primary health care. Although increased capacity to receive patients from hospital and prepare them for discharge to primary health care was viewed as a benefit, professionals still requested better communication with the preceding care level concerning further treatment and care for the elderly patients. Conclusions The intermediate care hospital reduced the coordination challenges during discharge of elderly patients from hospital to primary health care. Nevertheless, the intermediate care was experienced more like an extension of hospital than an included part of primary health care and did not meet the need for communication across care levels. PMID:24868194

Dahl, Unni; Steinsbekk, Aslak; Jenssen, Svanhild; Johnsen, Roar

2014-01-01

193

Engaging consumers in safety and quality at Royal Adelaide hospital.  

PubMed

Objective? The objective of this study was to elicit barriers and enablers of safe, high-quality care as identified by consumers, and to position consumers as 'possessors' of valuable knowledge related to systems and practices (as they had experienced these directly) rather than the receivers of knowledge and information. The central aim was to develop recommendations for consumer input into quality improvement, generated from the analysis of narrative accounts of their experiences. Methods? The four-phase methodology adopted for this project involved the development of quality improvement strategies as identified (phase one) and validated (phase two) by consumers through the conduct of discovery interviews with 30 consumers over the age of 18?years who had experienced an adverse event. Clinicians and quality managers were then provided with an opportunity to validate the strategies identified through participation in a focus group (phase three). All data collected through discovery interviews and focus groups were transcribed and entered into the Joanna Briggs Institute Qualitative Assessment and Review Manager for analysis. The final phase of the study involved integrating this process of consumer involvement and of identified improvement strategies into the quality improvement program of Royal Adelaide Hospital. Results? A total of 28 findings were entered into the Joanna Briggs Institute Qualitative Assessment and Review Manager for analysis. The process of meta-synthesis embodied in these programs involves the aggregation or synthesis of findings or conclusions. Six categories and four syntheses were derived through this process with key themes relating to assessment and prevention strategies, a necessity for improved education and communication, the hospital environment and the potential life impact that the experience of an adverse event may have. Conclusion? Consumers identified a number of strategies that could contribute to improved safety and clinical outcomes in hospital and a reduction in adverse events. This current study provides a solid foundation upon which future research may be conducted. PMID:21631817

Long, Leslye; Pearson, Alan; Page, Tamara; Jordan, Zoe

2008-03-01

194

Prevalence and incidence of pressure ulcers in Japanese long-term-care hospitals.  

PubMed

In Japan, long-term-care hospitals and facilities face the problem of quality of care, and providing adequate pressure ulcer care is one of the most urgent quality issues. Purpose of the present study was to explore the prevalence and incidence of pressure ulcers in long-term-care hospitals in Japan, and to identify factors associated with them. An anonymous questionnaire was sent to 720 randomly sampled, long-term-care hospitals all over Japan. The prevalence and incidence of pressure ulcers and their factors, including organizational strategies for pressure ulcer prevention and management, were examined. The mean prevalence and incidence of pressure ulcers was 9.6 and 1.9% per month, respectively. Almost all hospitals had established an interdisciplinary team for pressure ulcer prevention, developed a clinical protocol for pressure ulcers, and implemented education for staff. However, 35% of the interdisciplinary teams were not useful, more than half of the clinical protocols were not used frequently, and about half of the wards did not have sufficient pressure-relieving mattresses. In multiple regression analyses, a low prevalence of pressure ulcers was associated with a lower ratio of clients with a high medical severity level (p=0.034), the use of a clinical protocol including the management of preventive devices (p=0.023), the standardized pressure ulcer assessment tool (DESIGN-R; p=0.017), and staff education (p=0.003). This study demonstrated a higher prevalence and incidence of pressure ulcers in long-term-care hospitals in Japan as compared to regular acute-care hospitals, as well as poor organizational strategies for managing pressure ulcers. PMID:22974661

Igarashi, Ayumi; Yamamoto-Mitani, Noriko; Gushiken, Yukino; Takai, Yukari; Tanaka, Makoto; Okamoto, Yuko

2013-01-01

195

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

Code of Federal Regulations, 2010 CFR

...authorized public or private hospital care. 17.55 Section...Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS...of Public Or Private Hospitals § 17.55 Payment...authorized public or private hospital care. Except...

2010-07-01

196

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

Code of Federal Regulations, 2012 CFR

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

2012-07-01

197

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

...2014-07-01 false Hospital care and medical services in non-VA facilities... DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Public Or Private Hospitals § 17.52 Hospital care and medical services in non-VA...

2014-07-01

198

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

Code of Federal Regulations, 2011 CFR

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

2011-07-01

199

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

Code of Federal Regulations, 2013 CFR

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

2013-07-01

200

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.

201

Pre-hospital care in burn injury  

PubMed Central

The care provided to the victims of burn injury immediately after sustaining burns can largely affect the extent and depth of the wound. Although standard guidelines have been formulated by various burn associations, they are still not well known to public at large in our country. In burn injuries, most often, the bystanders are the first care providers. The swift implementation of the measures described in this article for first aid in thermal, chemical, electrical and inhalational injuries in the practical setting, within minutes of sustaining the burn, plays a vital role and can effectively reduce the morbidity and mortality to a great extent. In case of burn disasters, triage needs to be carried out promptly as per the defined protocols. Proper communication and transport from the scene of the accident to the primary care centre and onto the burn care facility greatly influences the execution of the management plans PMID:21321651

Shrivastava, Prabhat; Goel, Arun

2010-01-01

202

Quality of haemophilia care in the Netherlands: new standards for optimal care  

PubMed Central

Background In the Netherlands, the first formal haemophilia comprehensive care centre was established in 1964, and Dutch haemophilia doctors have been organised since 1972. Although several steps were taken to centralise haemophilia care and maintain quality of care, treatment was still delivered in many hospitals, and formal criteria for haemophilia treatment centres as well as a national haemophilia registry were lacking. Material and methods In collaboration with patients and other stakeholders, Dutch haemophilia doctors have undertaken a formal process to draft new quality standards for the haemophilia treatment centres. First a project group including doctors, nurses, patients and the institute for harmonisation of quality standards undertook a literature study on quality standards and performed explorative visits to several haemophilia treatment centres in the Netherlands. Afterwards concept standards were defined and validated in two treatment centres. Next, the concept standards were evaluated by haemophilia doctors, patients, health insurance representatives and regulators. Finally, the final version of the standards of care was approved by Central body of Experts on quality standards in clinical care and the Dutch Ministry of Health. Results A team of expert auditors have been trained and, together with an independent auditor, will perform audits in haemophilia centres applying for formal certification. Concomitantly, a national registry for haemophilia and allied disorders is being set up. Discussion It is expected that these processes will lead to further concentration and improved quality of haemophilia care in the Netherlands. PMID:24922288

Leebeek, Frank W.G.; Fischer, Kathelijn

2014-01-01

203

Health care technology and quality of care.  

PubMed

The increasing costs and complexity of technologic advances in diagnosis and treatment have been accompanied by other important issues. They are often moral or ethical in nature; they include the public's desire and determination to have access to these "high-tech" advances; and the quality and equity with which those advances are apportioned and applied must be addressed. Seven criteria that can be applied to technology assessment are identified as is a process for that assessment. Together, these procedures can provide valuable information and assistance to those who make decisions about health benefits coverage--both in the public and the private sectors. PMID:2980910

Schaffarzick, R W

1987-08-01

204

Surgical Volume, Hospital Quality, and Hospitalization Cost in Congenital Heart Surgery in the United States.  

PubMed

Hospital volume has been associated with improved outcomes in congenital cardiac surgery. However, the relationship between hospital volume and hospitalization cost remains unclear. This study examines the relationship between hospital surgical volume and hospitalization costs, while accounting for measures of quality, in children undergoing congenital heart surgery. A retrospective, repeated cross-sectional analysis was performed, using discharges from the 2006 and 2009 Kids' Inpatient Database. All pediatric admissions (<18 years) with a Risk Adjustment for Congenital Heart Surgery procedure and hospitalization cost/charge data were included. Multivariate, linear mixed regression models were run on hospitalization costs, with and without adjustment for indicators of quality (hospital mortality rate and complication rate). Both medium and high-volume hospitals (200-400 cases/year and >400 cases/year, respectively) were associated with lower odds of mortality but not occurrence of a complication. Hospital mortality was associated with the largest increase in hospitalization costs. High-volume hospitals (>400 cases/year) were associated with the lowest hospitalization costs per discharge ($37,775, p < 0.01) when compared to low-($43,270) and medium($41,085)-volume hospitals, prior to adjusting for quality indicators. However, when adjusting for hospital mortality rate, high-volume hospitals no longer demonstrated significant cost savings. When adjusting for hospital complication rate, high-volume hospitals continued to have the lowest hospitalization costs. High-volume hospitals are associated with a reduction in hospitalization costs that appear to be mediated through improvements in quality. PMID:25099030

Chan, Titus; Kim, Jaewhan; Minich, L LuAnn; Pinto, Nelangi M; Waitzman, Norman J

2014-08-01

205

Hospital Epidemiology and Infection Control in Acute-Care Settings  

PubMed Central

Summary: Health care-associated infections (HAIs) have become more common as medical care has grown more complex and patients have become more complicated. HAIs are associated with significant morbidity, mortality, and cost. Growing rates of HAIs alongside evidence suggesting that active surveillance and infection control practices can prevent HAIs led to the development of hospital epidemiology and infection control programs. The role for infection control programs has grown and continues to grow as rates of antimicrobial resistance rise and HAIs lead to increasing risks to patients and expanding health care costs. In this review, we summarize the history of the development of hospital epidemiology and infection control, common HAIs and the pathogens causing them, and the structure and role of a hospital epidemiology and infection control program. PMID:21233510

Sydnor, Emily R. M.; Perl, Trish M.

2011-01-01

206

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

207

The quality imperative for palliative care.  

PubMed

Palliative medicine must prioritize the routine assessment of the quality of clinical care we provide. This includes regular assessment, analysis, and reporting of data on quality. Assessment of quality informs opportunities for improvement and demonstrates to our peers and ourselves the value of our efforts. In fact, continuous messaging of the value of palliative care services is needed to sustain our discipline; this requires regularly evaluating the quality of our care. As the reimbursement mechanisms for health care in the U.S. shift from fee-for-service to fee-for-value models, palliative care will be expected to report robust data on quality of care. We must move beyond demonstrating to our constituents (including patients and referrers), "here is what we do," and increase the focus on "this is how well we do it" and "let us see how we can do it better." It is incumbent on palliative care professionals to lead these efforts. This involves developing standardized methods to collect data without adding additional burden, comparing and sharing our experiences to promote discipline-wide quality assessment and improvement initiatives, and demonstrating our intentions for quality improvement on the clinical frontline. PMID:25057987

Kamal, Arif H; Hanson, Laura C; Casarett, David J; Dy, Sydney M; Pantilat, Steven Z; Lupu, Dale; Abernethy, Amy P

2015-02-01

208

Piloting nursing-sensitive hospital care measures in Massachusetts.  

PubMed

Under the umbrella of the Massachusetts Hospital Association and Massachusetts Organization of Nurse Executives Patients First Initiative, Massachusetts hospitals tested a subset of NQF-endorsed nursing-sensitive care measures in 2006. In this report, we describe the pilot test, report on pilot test measure data, summarize participant feedback on the tested measures, and offer observations on lessons learned from the pilot test. PMID:18281873

Smith, David P; Jordan, Harmon S

2008-01-01

209

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, Éveline; Haggerty, Jeannie L.; Bonin, Lucie; Duplain, Réjean; Goudreau, Johanne; Hogg, William

2014-01-01

210

A study on poisoning cases in a tertiary care hospital  

PubMed Central

Acute poisoning with various substance is common everywhere. The earlier the initial resuscitations, gastric decontamination and use of specific antidotes, the better the outcome. The aim of this study was to characterize the poisoning cases admitted to the tertiary care hospital, Warangal district, Andhra Pradesh, Southern India. All cases admitted to the emergency department of the hospital between the months of January and December, 2007, were evaluated retrospectively. We reviewed data obtained from the hospital medical records and included the following factors: socio-demographic characteristics, agents and route of intake and time of admission of the poisoned patients. During the outbreak in 2007, 2,226 patients were admitted to the hospital with different poisonings; the overall case fatality rate was 8.3% (n = 186). More detailed data from 2007 reveals that two-third of the patients were 21–30 years old, 5.12% (n = 114) were male and 3.23% (n = 72) were female, who had intentionally poisoned themselves. In summary, the tertiary care hospitals of the Telangana region, Warangal, indicate that significant opportunities for reducing mortality are achieved by better medical management and further sales restrictions on the most toxic pesticides. This study highlighted the lacunae in the services of tertiary care hospitals and the need to establish a poison information center for the better management and prevention of poisoning cases. PMID:22096334

Kumar, Subash Vijaya; Venkateswarlu, B.; Sasikala, M.; Kumar, G. Vijay

2010-01-01

211

Facilitating the provision of quality spiritual care in palliative care.  

PubMed

In 1948, Dame Cicely Saunders, the founder of the modem hospice movement, established a core principle of palliative care, Total Pain, which is defined as physical, spiritual, psychological, and social suffering. In 2009, a consensus panel (Puchalski, Ferrell, Virani, Otis-Green, Baird, Bull, et al., 2009) was convened to address the important issue of integrating spirituality in palliative care, which led to renewed efforts to focus on spiritual care as a critical component of quality palliative care. This project is a combination of advocacy for the importance of spiritual care, training chaplains, seminarians, community clergy, and healthcare professionals in palliative care, and creating a spiritual care curriculum which can be self-taught or taught to members of transdisciplinary teams. PMID:23977777

Bodek, Hillel

2013-01-01

212

Medicare's prospective payment system for hospitals: the impact on nursing home quality.  

PubMed

How are changes in Medicare affecting the quality of long term care? Finding an answer to this question is made difficult by the many variables that must be considered and the lack of concrete data on the subject. The variables include the care requirements of Medicare patients being discharged from hospitals to nursing homes, the availability and accessibility of skilled-care beds, the trends in utilization of skilled-care beds, and the capability of nursing homes to provide the care required by these patients. Anecdotal data suggest that Medicare patients are being discharged from hospitals earlier, sicker, and with more complex skilled nursing requirements than before the implementation of prospective payment, that there has been limited collaboration among hospitals and nursing homes during this period of transition in the Medicare system, and that nursing home administrators and staffs are increasingly concerned about the actual cost of providing care to a sicker group of patients and about the qualifications of staff to meet more complex care needs. One positive outgrowth of this situation is an increase in collaboration among hospitals and nursing homes. Nursing home staff are now more apt to visit a patient in the hospital to perform a preadmission assessment. Such collaboration can help avoid inappropriate nursing home admissions and improve continuity of care for patients who are admitted.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3090503

Goodwin, M E

1986-06-01

213

Health care communication networks: disseminating employee information for hospital security.  

PubMed

Health care in the United States is a system that, organizationally speaking, is fragmented. Each hospital facility is independently operated and is responsible for the hiring of its own employees. Corrupt individuals can take advantage of this fragmentation and move from hospital to hospital, gaining employment while hiding previous employment history. However, the need to exchange pertinent information regarding employees will become necessary as hospitals seek to fill positions throughout their organizations. One way to promote this information exchange is to develop trusted information sharing networks among hospital units. This study examined the problems surrounding organizational information sharing and the cultural factors necessary to enhance the exchange of employee information. Surveys were disseminated to 2,603 hospital chief executive officers and chief information officers throughout the nation. A sample of 154 respondents provided data into their current hiring practices and on their willingness to engage in the sharing of employee information. Findings indicated that, although fear of defamation and privacy violations do hinder the exchange of information between hospitals during the hiring process, by increasing external trust, linking the sharing process with the organizational goals of the hospital, and developing a "sharing culture" among hospitals, the exchange of employee information could be enhanced. PMID:19910705

Sumner, Jennifer; Liberman, Aaron; Rotarius, Timothy; Wan, Thomas T H; Eaglin, Ronald

2009-01-01

214

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

215

The optimal outcomes of post-hospital care under medicare.  

PubMed Central

OBJECTIVE: To estimate the differences in functional outcomes attributable to discharge to one of four different venues for post-hospital care for each of five different types of illness associated with post-hospital care: stroke, chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), hip procedures, and hip fracture, and to estimate the costs and benefits associated with discharge to the type of care that was estimated to produce the greatest improvement. STUDY SETTING/DATA SOURCES: Consecutive patients with any of the target diagnoses were enrolled from 52 hospitals in three cities. Data sources included interviews with patients or their proxies, medical record reviews, and the Medicare Automated Data Retrieval System. ANALYSIS: A two-stage regression model looked first at the factors associated with discharge to each type of post-hospital care and then at the outcomes associated with each location. An instrumental variables technique was used to adjust for selection bias. A predictive model was created for each patient to estimate how that person would have fared had she or he been discharged to each type of care. The optimal discharge location was determined as that which produced the greatest improvement in function after adjusting for patients' baseline characteristics. The costs of discharge to the optimal type of care was based on the differences in mean costs for each location. DATA COLLECTION/EXTRACTION METHODS: Data were collected from patients or their proxies at discharge from hospital and at three post-discharge follow-up times: six weeks, six months, and one year. In addition, the medical records for each participant were abstracted by trained abstractors, using a modification of the Medisgroups method, and Medicare data were summarized for the years before and after the hospitalization. PRINCIPAL FINDINGS: In general, patients discharged to nursing homes fared worst and those sent home with home health care or to rehabilitation did best. Because the cost of rehabilitation is high, greater use of home care could result in improved outcomes at modest or no additional cost. CONCLUSIONS: Better decisions about where to discharge patients could improve the course of many patients. It is possible to save money by making wiser discharge planning decisions. Nursing homes are generally associated with poorer outcomes and higher costs than the other post-hospital care modalities. PMID:10966088

Kane, R L; Chen, Q; Finch, M; Blewett, L; Burns, R; Moskowitz, M

2000-01-01

216

A Conceptual Framework for Quality of Care  

PubMed Central

Despite extensive research on defining and measuring health care quality, little attention has been given to different stakeholders’ perspectives of high-quality health care services. The main purpose of this study was to explore the attributes of quality healthcare in the Iranian context. Exploratory in-depth individual and focus group interviews were conducted with key healthcare stakeholders including clients, providers, managers, policy makers, payers, suppliers and accreditation panel members to identify the healthcare service quality attributes and dimensions. Data analysis was carried out by content analysis, with the constant comparative method. Over 100 attributes of quality healthcare service were elicited and grouped into five categories. The dimensions were: efficacy, effectiveness, efficiency, empathy, and environment. Consequently, a comprehensive model of service quality was developed for health care context. The findings of the current study led to a conceptual framework of healthcare quality. This model leads to a better understanding of the different aspects of quality in health care and provides a better basis for defining, measuring and controlling quality of health care services. PMID:23922534

Mosadeghrad, Ali Mohammad

2012-01-01

217

Cost sharing and hospitalizations for ambulatory care sensitive conditions.  

PubMed

During the last decade, Chile's private health sector has experienced a dramatic increase in hospitalization rates, growing at four times the rate of ambulatory visits. Such evolution has raised concern among policy-makers. We studied the effect of ambulatory and hospital co-insurance rates on hospitalizations for ambulatory care sensitive conditions (ACSC) among individuals with private insurance in Chile. We used a large administrative dataset of private insurance claims for the period 2007-8 and a final sample of 2,792,662 individuals to estimate a structural model of two equations. The first equation was for ambulatory visits and the second for future hospitalizations for ACSC. We estimated the system by Two Stage Least Squares (2SLS) corrected by heteroskedasticity via Generalized Method of Moments (GMM) estimation. Results show that increased ambulatory visits reduced the probability of future hospitalizations, and increased ambulatory co-insurance decreased ambulatory visits for the adult population (19-65 years-old). Both findings indicate the need to reduce ambulatory co-insurance as a way to reduce hospitalizations for ACSC. Results also showed that increasing hospital co-insurance does have a statistically significant reduction on hospitalizations for the adult group, while it does not seem to have a significant effect on hospitalizations for the children (1-18 years-old) group. This paper's contribution is twofold: first, it shows how the level of co-insurance can be a determinant in avoiding unnecessary hospitalizations for certain conditions; second, it highlights the relevance for policy-making of using data on ACSC to improve the efficiency of health systems by promoting ambulatory care as well as population health. PMID:25461868

Arrieta, Alejandro; García-Prado, Ariadna

2015-01-01

218

Helping You Choose Quality Hospital Care  

MedlinePLUS

... Spots What Is Accreditation? Become Accredited Download the Gold Seal Find Accredited Organizations Newsletters Publicity Kits State ... Spots What Is Certification? Become Certified Download the Gold Seal Find Certified Organizations Newsletters Publicity Kit State ...

219

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

220

Total quality management (TQM) in a hospital library: identifying service benchmarks.  

PubMed Central

Hospitals are turning to total quality management (TQM) to lower costs of providing care. A hospital library in a TQM environment needs to embrace corporate goals while maintaining its accountability as a contributor to quality patient care. Alliant Health System (AHS) Library at Norton Hospital and Kosair Children's Hospital in Louisville, Kentucky, conducted a study to establish TQM benchmarks and to examine the significance of its role in clinical care. Using a methodology designed to allow both library user and nonuser to respond, 2,091 surveys were distributed to physicians and nursing and allied health personnel. Areas surveyed included frequency of library use, impact of information received on clinical judgments, cognitive value of the information, and satisfaction with library products and services. Results confirm that the library has a substantial clinical role. Eighty-eight percent of reporting physicians agreed that information from the library contributed to higher quality care. Nursing and allied health were less convinced of the importance of the library's clinical role. Sixty-nine percent of nursing personnel and 58% of allied health personnel agreed that the library contributed to higher quality care. Nursing and allied health personnel also used the library less frequently than physicians. With these results as benchmarks, improving the clinical role of the library will take commitment to the TQM process and a willingness to change. PMID:1422505

Fischer, W W; Reel, L B

1992-01-01

221

Total quality management (TQM) in a hospital library: identifying service benchmarks.  

PubMed

Hospitals are turning to total quality management (TQM) to lower costs of providing care. A hospital library in a TQM environment needs to embrace corporate goals while maintaining its accountability as a contributor to quality patient care. Alliant Health System (AHS) Library at Norton Hospital and Kosair Children's Hospital in Louisville, Kentucky, conducted a study to establish TQM benchmarks and to examine the significance of its role in clinical care. Using a methodology designed to allow both library user and nonuser to respond, 2,091 surveys were distributed to physicians and nursing and allied health personnel. Areas surveyed included frequency of library use, impact of information received on clinical judgments, cognitive value of the information, and satisfaction with library products and services. Results confirm that the library has a substantial clinical role. Eighty-eight percent of reporting physicians agreed that information from the library contributed to higher quality care. Nursing and allied health were less convinced of the importance of the library's clinical role. Sixty-nine percent of nursing personnel and 58% of allied health personnel agreed that the library contributed to higher quality care. Nursing and allied health personnel also used the library less frequently than physicians. With these results as benchmarks, improving the clinical role of the library will take commitment to the TQM process and a willingness to change. PMID:1422505

Fischer, W W; Reel, L B

1992-10-01

222

Oregon Child Care Quality Indicators Program: QRS Profile. The Child Care Quality Rating System (QRS) Assessment  

ERIC Educational Resources Information Center

This paper presents a profile of Oregon's Child Care Quality Indicators Program prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4)…

Child Trends, 2010

2010-01-01

223

Children in Foster Care: Before, during, and after Psychiatric Hospitalization  

ERIC Educational Resources Information Center

Although it is generally accepted that foster children are at greater risk for mental health problems than are children in the general population, very little is known about the smaller group of foster children admitted to psychiatric hospitals. The present study sought to determine whether foster children admitted to inpatient care are a distinct…

Persi, Joe; Sisson, Megan

2008-01-01

224

[Evaluation of primary health care activities at the Albert Schweitzer hospital in Lambarene, Gabon].  

PubMed

In 1999 the Albert Schweitzer Hospital in Lambrene, Gabon set up a community health care service that provides immunization campaigns and mother/child health care and manages 9 village health care centers in a district with a population of approximately 64000 inhabitants. An evaluation conducted in April 2006 showed that collection of a consultation charge (15 euros) could cover the basic costs of operating these centers and purchasing necessary medicines. Three of the four centers evaluated demonstrated good quality indicators including properly kept records, posting of information bulletins for patients, appropriate referrals, and good relations with village authorities. At the center that performed poorly, the nurse apparently received no pay or lodging. Analysis of data about pediatric activity showed that diagnosis of diarrhea, malnutrition and anemia has fallen while hospitalization for tuberculosis and urinary schistomiasis is now being recorded. At the same time, village health centers are increasingly concerned with problems related to management and prevention of AIDS, malaria and urinary schistomiasis. This service shows that with good supervision it is possible to improve the quality of primary health care with partial but adequate recovery of costs and that basic health care workers are able to provide overall management for complicated patients, facilitate the work of reference hospital, and report new health problems. PMID:17784673

Diallo, M; Ninteretse, B

2007-06-01

225

Analysis of early accountable care organizations defines patient, structural, cost, and quality-of-care characteristics.  

PubMed

Accountable care organizations (ACOs) have attracted interest from many policy makers and clinical leaders because of their potential to improve the quality of care and reduce costs. Federal ACO programs for Medicare beneficiaries are now up and running, but little information is available about the baseline characteristics of early entrants. In this descriptive study we present data on the structural and market characteristics of these early ACOs and compare ACOs' patient populations, costs, and quality with those of their non-ACO counterparts at baseline. We found that ACO patients were more likely than non-ACO patients to be older than age eighty and had higher incomes. ACO patients were less likely than non-ACO patients to be black, covered by Medicaid, or disabled. The cost of care for ACO patients was slightly lower than that for non-ACO patients. Slightly fewer than half of the ACOs had a participating hospital. Hospitals that were in ACOs were more likely than non-ACO hospitals to be large, teaching, and not-for-profit, although there was little difference in their performance on quality metrics. Our findings can be useful in interpreting the early results from the federal ACO programs and in establishing a baseline to assess the programs' development. PMID:24395940

Epstein, Arnold M; Jha, Ashish K; Orav, E John; Liebman, Daniel L; Audet, Anne-Marie J; Zezza, Mark A; Guterman, Stuart

2014-01-01

226

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

227

Hospital Medicine (Part 1): what is wrong with acute hospital care?  

PubMed

Modern hospitals are facing several challenges and, over the last decade in particular, many of these institutions have become dysfunctional. Paradoxically as medicine has become more successful the demand for acute hospital care has increased, yet there is no consensus on what conditions or complaints require hospital admission and there is wide variation in the mortality rates, length of stay and possibly standards of care between different units. Most acutely ill patients are elderly and instead of one straightforward diagnosis are more likely to have a complex combination of multiple co-morbid conditions. Any elderly patient admitted to hospital is at considerable risk which must be balanced against the possible benefits. Although most of the patients in hospital die from only approximately ten diagnoses, obvious life saving treatment is often delayed by a junior doctor in-training first performing an exhaustive complete history and physical, and then ordering a number of investigations before consulting a senior colleague. Following this traditional hierarchy delays care with several "futile cycles" of clinical activity thoughtlessly directed at the patient without any benefit being delivered. If acute hospital medicine is to be improved changes in traditional assumptions, attitudes, beliefs and practices are needed. PMID:19712844

Kellett, John

2009-09-01

228

The effect of health information technology on quality in U.S. hospitals.  

PubMed

Health information technology (IT), such as computerized physician order entry and electronic health records, has potential to improve the quality of health care. But the returns from widespread adoption of such technologies remain uncertain. We measured changes in the quality of care following adoption of electronic health records among a national sample of U.S. hospitals from 2004 to 2007. The use of computerized physician order entry and electronic health records resulted in significant improvements in two quality measures, with larger effects in academic than nonacademic hospitals. We conclude that achieving substantive benefits from national implementation of health IT may be a lengthy process. Policies to improve health IT's efficacy in nonacademic hospitals might be more beneficial than adoption subsidies. PMID:20368594

McCullough, Jeffrey S; Casey, Michelle; Moscovice, Ira; Prasad, Shailendra

2010-04-01

229

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

230

Building the Quality Control System for Medical Equipments in Hospital  

Microsoft Academic Search

Using safety of medical equipments is essential for patient safety and medical quality in hospital, up to now strategy of systematically quality control of medical equipments on the using safety has not been established. In this paper, we proposed six-dimension risk model for risk level evaluation quantitatively and established the quality control system to assure the using quality of medical

Hao Wu; Guangrong Liu

2010-01-01

231

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

232

Air quality in Ain Shams University Surgery Hospital.  

PubMed

Through air sampling, it was possible to evaluate microbial contamination in environments at high risk of infection, and to check the efficiency of ventilation system and the medical team's hygiene procedures. This study measured the concentration of particulate matter (PM) 2.5 or less microns and microbiological organisms in operating rooms (OR), intensive care units (ICU) and emergency rooms (ER) in Ain Shams University Surgery Hospital, and to assess ventilation characteristics in operating rooms in the hospital. The passive air sampling was done from ICUs, ORs, and ERs in Ain Shams University Surgery Hospital. Also for each operating room, an observational checklist was done to record other factors that may affect air quality in the room. The evaluated air quality indices were: suspended (PM) 2.5 micrometer or less, culture media and microbial identification of bacteria and fungi, and temperature and relative humidity. The results showed that the highest mean found for bacterial (105.70±30.49) and fungi concentration (7.50±5.30) was in ER. The three settings did not differ statistically as regard levels of PM 2.5, temperature, and relative humidity. A positive correlation exits between bacteria and fungi concentration on one hand and relative humidity on the other. Diphteroid, CONS, MRSA, S. aureus, and Anthracoid were the most frequent isolated bacterial types, while Penicillium and Asperigillus fumigatus were the most frequent isolated fungi. In operating rooms, the percent of unmasked persons present and the temperature positively influence the bacterial count, while ventilation condition is negatively influencing fungi count, and the number of persons present in the operating room positively affects the PM level. PMID:25643516

El Awady, M Y; El Rahman, A T Abd; Al Bagoury, L S; Mossad, I M

2014-12-01

233

[Quality of care: from theory to practice].  

PubMed

Quality of care is growing concern among health care professionals and managers. As a multidimensional concept, it cannot be reduced to simple customer satisfaction. Taking into account the views of the three major players in the health care system-patients, providers and payers-quality can be defined as the capacity to satisfy patients' needs according to professional knowledge and within available resources. Efficacy, efficiency, appropriateness, acceptability, legitimacy and equity are dimensions of health care quality. Contrary to popular belief, quality is neither maximum performance, nor satisfaction at all costs, nor punishment or elimination of "bad apples". In ambulatory medicine, quality implies first of all the ability to master the processes occurring during an office visit. However, although history taking and physical examination are the cornerstones of medical practice, they have not been well studied. Improving quality of care in the ambulatory sector will require better knowledge about medical decision-making processes, in particular identification of the most relevant information required for a decision and the optimal way of obtaining it in any specific clinical situation. PMID:9190666

Guillain, H; Raetzo, M A

1997-03-29

234

Reflections on Quality Infant Care.  

ERIC Educational Resources Information Center

Examines some of the basic issues involved in creating a warm and safe day-care environment for infants and toddlers, one that supports and promotes development and learning. Describing policies that were generated from everyday classroom experience, discusses the issues of security and trust, separation anxiety, group size, exploration and…

Reinsberg, Judy

1995-01-01

235

Telemedicine in pre-hospital care: a review of telemedicine applications in the pre-hospital environment  

PubMed Central

The right person in the right place and at the right time is not always possible; telemedicine offers the potential to give audio and visual access to the appropriate clinician for patients. Advances in information and communication technology (ICT) in the area of video-to-video communication have led to growth in telemedicine applications in recent years. For these advances to be properly integrated into healthcare delivery, a regulatory framework, supported by definitive high-quality research, should be developed. Telemedicine is well suited to extending the reach of specialist services particularly in the pre-hospital care of acute emergencies where treatment delays may affect clinical outcome. The exponential growth in research and development in telemedicine has led to improvements in clinical outcomes in emergency medical care. This review is part of the LiveCity project to examine the history and existing applications of telemedicine in the pre-hospital environment. A search of electronic databases including Medline, Excerpta Medica Database (EMBASE), Cochrane, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for relevant papers was performed. All studies addressing the use of telemedicine in emergency medical or pre-hospital care setting were included. Out of a total of 1,279 articles reviewed, 39 met the inclusion criteria and were critically analysed. A majority of the studies were on stroke management. The studies suggested that overall, telemedicine had a positive impact on emergency medical care. It improved the pre-hospital diagnosis of stroke and myocardial infarction and enhanced the supervision of delivery of tissue thromboplasminogen activator in acute ischaemic stroke. Telemedicine presents an opportunity to enhance patient management. There are as yet few definitive studies that have demonstrated whether it had an effect on clinical outcome. PMID:25635190

2014-01-01

236

42 CFR 412.536 - Special payment provisions for long-term care hospitals and satellites of long-term care...  

Code of Federal Regulations, 2012 CFR

...false Special payment provisions for long-term care hospitals and satellites of long-term care hospitals that discharged Medicare patients...building or on the same campus as the long-term care hospital or satellite of the...

2012-10-01

237

42 CFR 412.536 - Special payment provisions for long-term care hospitals and satellites of long-term care...  

Code of Federal Regulations, 2010 CFR

...false Special payment provisions for long-term care hospitals and satellites of long-term care hospitals that discharged Medicare patients...building or on the same campus as the long-term care hospital or satellite of the...

2010-10-01

238

42 CFR 412.536 - Special payment provisions for long-term care hospitals and satellites of long-term care...  

Code of Federal Regulations, 2011 CFR

...false Special payment provisions for long-term care hospitals and satellites of long-term care hospitals that discharged Medicare patients...building or on the same campus as the long-term care hospital or satellite of the...

2011-10-01

239

42 CFR 412.536 - Special payment provisions for long-term care hospitals and satellites of long-term care...  

Code of Federal Regulations, 2013 CFR

...false Special payment provisions for long-term care hospitals and satellites of long-term care hospitals that discharged Medicare patients...building or on the same campus as the long-term care hospital or satellite of the...

2013-10-01

240

Linking RN workgroup job satisfaction to pressure ulcers among older adults on acute care hospital units.  

PubMed

We examined the relationship between registered nurse (RN) workgroup job satisfaction and hospital-acquired pressure ulcers (HAPUs) among older adults on six types of acute care units. Random-intercept logistic regression analyses were performed using 2009 unit-level data from the National Database of Nursing Quality Indicators® (NDNQI®) and the NDNQI RN Survey. Overall, RN workgroup job satisfaction was negatively associated with HAPU rates, although the relationship varied by unit type. RN workgroup satisfaction was significantly associated with HAPU rates on critical care, medical, and rehabilitation units. No significant association was found on step-down, surgical, and medical-surgical units. Findings provide evidence that higher RN workgroup job satisfaction is related to lower HAPU rates among older adult patients in acute care hospitals. PMID:23408439

Choi, Jisun; Bergquist-Beringer, Sandra; Staggs, Vincent S

2013-04-01

241

Innovative and Successful Approaches to Improving Care Transitions From Hospital to Home.  

PubMed

Effective transitions to home care have been identified as among the factors leading to reducing hospital readmissions within 30 days of discharge and improvements on various other quality measures. Innovative applications of published evidence-based models and best practices designed to improve care transitions have been implemented in various settings across the country in an effort to enhance quality performance. For this article, The Joint Commission collected a series of case examples to examine how evidence-based innovations in care transitions are reducing readmissions and improving other quality outcomes. The organizations providing the case examples were interviewed and asked to provide performance data demonstrating quality improvement, as well as information about their care processes and data-gathering techniques. Their innovative approaches are reducing hospital readmissions; improving patient safety, satisfaction, and engagement; and contributing to other positive outcomes.This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivitives 3.0 License, where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially. http://creativecommons.org/licenses/by-nc-nd/3.0. PMID:25494403

Labson, Margherita C

2014-12-01

242

Public perceptions of quality care and provider profiling in New York: implications for improving quality care and public health.  

PubMed

Despite a growing emphasis on providing health care consumers with more information about quality care, useful and valid provider-specific information often has not been available to the public or has been underutilized. To assess this issue in New York State, random telephone surveys were conducted in September 2002 and March 2003, respectively, of 1,001 and 500 English- or Spanish-speaking persons, 18 years or older. Results indicated that 33% of New Yorkers were very concerned about the quality of care, with African Americans being particularly concerned. Less than half of the respondents recalled hearing or seeing information about health care quality in the past year and less than 20% actually used this information in medical decision making. African Americans were the least likely to recall receiving or being exposed to quality-related information, whereas women and more educated adults were the most likely to report being exposed. Furthermore, New Yorkers received quality information from multiple sources, with about 20% saying that they obtained information about physician and hospital quality from media (eg, newspaper) and nonmedia (eg, recommendation by family member) sources. Evaluations of different kinds of information suggested that some types (eg, whether or not a doctor is board certified) carried more weight in health care decision making than other types (eg, government ratings). Unexpectedly, those who used information to make health care decisions were more likely to have reported experiencing a medical error in the household. Finally, in the 6-month follow-up survey, concerns about the quality of care in the state remained about the same, while fears of terrorism decreased and preparations for future terrorist attacks increased. In the survey, few major differences were found in results based on payer status (eg, private insurance versus Medicaid/no insurance). These findings have implications for both the private and public health care sectors. Specifically, they suggest that greater access to and use of provider-specific health care information by the public is a viable way to improve quality, particularly if health care professionals support the public use of these data. PMID:15253520

Boscarino, Joseph A; Adams, Richard E

2004-01-01

243

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

244

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

245

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

246

Improving the quality of health care: what's taking so long?  

PubMed

Nearly fourteen years ago the Institute of Medicine's report, To Err Is Human: Building a Safer Health System, triggered a national movement to improve patient safety. Despite the substantial and concentrated efforts that followed, quality and safety problems in health care continue to routinely result in harm to patients. Desired progress will not be achieved unless substantial changes are made to the way in which quality improvement is conducted. Alongside important efforts to eliminate preventable complications of care, there must also be an effort to seriously address the widespread overuse of health services. That overuse, which places patients at risk of harm and wastes resources at the same time, has been almost entirely left out of recent quality improvement endeavors. Newer and much more effective strategies and tools are needed to address the complex quality challenges confronting health care. Tools such as Lean, Six Sigma, and change management are proving highly effective in tackling problems as difficult as hand-off communication failures and patient falls. Finally, the organizational culture of most American hospitals and other health care organizations must change. To create a culture of safety, leaders must eliminate intimidating behaviors that suppress the reporting of errors and unsafe conditions. Leaders must also hold everyone accountable for adherence to safe practices. PMID:24101066

Chassin, Mark R

2013-10-01

247

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. PMID:25400990

Makharia, Govind K

2014-01-01

248

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

Code of Federal Regulations, 2011 CFR

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

2011-07-01

249

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

Code of Federal Regulations, 2012 CFR

...Compensation Programs, and other Federal agencies. (3) Pensioners of nations allied with the United States in World War I and World War II may be supplied hospital care when duly authorized. (b) Emergency hospital care may be provided...

2012-07-01

250

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

Code of Federal Regulations, 2011 CFR

...Compensation Programs, and other Federal agencies. (3) Pensioners of nations allied with the United States in World War I and World War II may be supplied hospital care when duly authorized. (b) Emergency hospital care may be provided...

2011-07-01

251

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

Code of Federal Regulations, 2013 CFR

...Compensation Programs, and other Federal agencies. (3) Pensioners of nations allied with the United States in World War I and World War II may be supplied hospital care when duly authorized. (b) Emergency hospital care may be provided...

2013-07-01

252

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

253

Disparities in Health Care Quality among Minority Women  

MedlinePLUS

Disparities in Health Care Quality Among Minority Women Selected Findings From the 2011 National Healthcare Quality and Dispar Findings From the 2011 ... race and ethnicity are combined. Return to Contents Health Care Delivery and Systems Information about health care delivery ...

254

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

255

Publicly disclosed information about the quality of health care: response of the US public  

PubMed Central

Public disclosure of information about the quality of health plans, hospitals, and doctors continues to be controversial. The US experience of the past decade suggests that sophisticated quality measures and reporting systems that disclose information on quality have improved the process and outcomes of care in limited ways in some settings, but these efforts have not led to the "consumer choice" market envisaged. Important reasons for this failure include limited salience of objective measures to consumers, the complexity of the task of interpretation, and insufficient use of quality results by organised purchasers and insurers to inform contracting and pricing decisions. Nevertheless, public disclosure may motivate quality managers and providers to undertake changes that improve the delivery of care. Efforts to measure and report information about quality should remain public, but may be most effective if they are targeted to the needs of institutional and individual providers of care. Key Words: public disclosure; quality of health care; quality improvement PMID:11389318

Schneider, E; Lieberman, T

2001-01-01

256

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

...Method of payment under the long-term care hospital prospective payment system...Prospective Payment System for Long-Term Care Hospitals § 412.541 Method of payment under the long-term care hospital prospective payment system....

2014-10-01

257

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

...preadmission services under the long-term care hospital prospective payment system...Prospective Payment System for Long-Term Care Hospitals § 412.540 Method of payment...preadmission services under the long-term care hospital prospective payment...

2014-10-01

258

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

Code of Federal Regulations, 2012 CFR

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

2012-07-01

259

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

Code of Federal Regulations, 2013 CFR

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

2013-07-01

260

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

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

2014-07-01

261

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

Code of Federal Regulations, 2010 CFR

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

2010-07-01

262

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

Code of Federal Regulations, 2011 CFR

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

2011-07-01

263

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

Code of Federal Regulations, 2010 CFR

...for preadmission services under the long-term care hospital prospective payment system... Prospective Payment System for Long-Term Care Hospitals § 412.540 Method...for preadmission services under the long-term care hospital prospective payment...

2010-10-01

264

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

Code of Federal Regulations, 2010 CFR

...false Method of payment under the long-term care hospital prospective payment system... Prospective Payment System for Long-Term Care Hospitals § 412.541 Method of payment under the long-term care hospital prospective payment...

2010-10-01

265

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

Code of Federal Regulations, 2013 CFR

...false Method of payment under the long-term care hospital prospective payment system... Prospective Payment System for Long-Term Care Hospitals § 412.541 Method of payment under the long-term care hospital prospective payment...

2013-10-01

266

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

Code of Federal Regulations, 2013 CFR

...for preadmission services under the long-term care hospital prospective payment system... Prospective Payment System for Long-Term Care Hospitals § 412.540 Method...for preadmission services under the long-term care hospital prospective payment...

2013-10-01

267

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

Code of Federal Regulations, 2011 CFR

...for preadmission services under the long-term care hospital prospective payment system... Prospective Payment System for Long-Term Care Hospitals § 412.540 Method...for preadmission services under the long-term care hospital prospective payment...

2011-10-01

268

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

Code of Federal Regulations, 2011 CFR

...false Method of payment under the long-term care hospital prospective payment system... Prospective Payment System for Long-Term Care Hospitals § 412.541 Method of payment under the long-term care hospital prospective payment...

2011-10-01

269

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

Code of Federal Regulations, 2012 CFR

...for preadmission services under the long-term care hospital prospective payment system... Prospective Payment System for Long-Term Care Hospitals § 412.540 Method...for preadmission services under the long-term care hospital prospective payment...

2012-10-01

270

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

Code of Federal Regulations, 2012 CFR

...false Method of payment under the long-term care hospital prospective payment system... Prospective Payment System for Long-Term Care Hospitals § 412.541 Method of payment under the long-term care hospital prospective payment...

2012-10-01

271

Redesigning Care For Patients At Increased Hospitalization Risk: The Comprehensive Care Physician Model  

PubMed Central

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.

2015-01-01

272

Patients’ satisfaction with emergency care and priorities for change in a university teaching hospital in Nigeria  

Microsoft Academic Search

Little work has been done on patients’ satisfaction with hospital care in Nigeria. This prospective study was done to identify factors affecting patients’ satisfaction with emergency care in a teaching hospital in Nigeria. This study was carried out among adult patients who had received care at the Accident and Emergency unit of the hospital. We used the priority index (calculated

Kehinde Oluwadiya; Samuel A. Olatoke; Adekunle J. Ariba; Omotola A. Omotosho; Olakunle A. Olakulehin

2010-01-01

273

Palliative Care Integration Project (PCIP) quality improvement strategy evaluation.  

PubMed

This study evaluated the effectiveness of implementation of common assessment tools, collaborative care plans, and symptom management guidelines for cancer patients as a strategy to improve the quality, coordination, and integration of palliative care service across organizations and health care sectors. A pre-post design to measure the impact on symptom management, caregiver burden and satisfaction with care delivery, and service utilization was used. Two cohorts of eligible patients and caregivers completed Edmonton Symptom Assessment Scales, Caregiver Reaction Assessment and FAMCARE Scales and chart audits were conducted. Administrative data from each participating site were examined for utilization trends. Audits of 53 charts preimplementation and 63 postimplementation showed an increase in documentation of pain from 24.5% to 74.6% (P<0.001) of charts. Administrative data showed a decrease in the percentage of patients with at least one emergency room visit from 94.3% to 84.8% (P<0.001), in the percentage of patients with at least one admission to the acute care hospital (P<0.001), and deaths in acute care 43.1%-35.7% (P=0.133). There was minimal change in the intensity of symptoms (P=0.591), and no change in the burden on the caregiver (P=0.086) or caregiver satisfaction with care (P=0.942). This study showed that implementation of common assessment tools, collaborative care plans, and symptom management guidelines across health sectors can result in some increased documentation of symptoms and efficiencies in care. Future projects should consider imbedding a continuous quality improvement methodology and longer timelines into their projects to improve outcomes. PMID:18358693

Dudgeon, Deborah J; Knott, Christine; Eichholz, Mary; Gerlach, Jacqueline Lochhaas; Chapman, Cheryl; Viola, Raymond; Van Dijk, Janice; Preston, Sharon; Batchelor, Diane; Bartfay, Emma

2008-06-01

274

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

275

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

276

Patient satisfaction scores and their relationship to hospital website quality measures.  

PubMed

Hospitals and health systems are using web-based and social media tools to market themselves to consumers with increasingly sophisticated strategies. These efforts are designed to shape the consumers' expectations, influence their purchase decisions, and build a positive reputation in the marketplace. Little is known about how these web-based marketing efforts are taking form and if they have any relationship to consumers' satisfaction with the services they receive. The purpose of this study is to assess if a relationship exists between the quality of hospitals' public websites and their aggregated patient satisfaction ratings. Based on analyses of 1,952 U.S. hospitals, our results show that website quality is significantly and positively related to patients' overall rating of the hospital and their intention to recommend the facility to others. The potential for web-based information sources to influence consumer behavior has important implications for policymakers, third-party payers, health care providers, and consumers. PMID:24308412

Ford, Eric W; Huerta, Timothy R; Diana, Mark L; Kazley, Abby Swanson; Menachemi, Nir

2013-01-01

277

Nurse qualifications and perceptions of patient safety and quality of care in South Africa.  

PubMed

A plethora of research links professional nurses' qualifications to patient outcomes. Also, research has shown that reports by nurses on the quality of care correspond with process or outcome measures of quality in a hospital. New to the debate is whether professional nurses' qualifications impact on their perceptions of patient safety and quality of care. This research aims to investigate professional nurses' perceptions of patient safety and quality of care in South Africa, and the relationship between these perceptions and professional nurses' qualifications. A cross-sectional survey of 1117 professional nurses from medical and surgical units of 55 private and 7 public hospitals was conducted. Significant problems with regard to nurse-perceived patient safety and quality of care were identified, while adverse incidents in patients and professional nurses were underreported. Qualifications had no correlation with perceptions of patient safety and quality of care, although perceptions may serve as a valid indicator of patient outcomes. Creating an organizational culture that is committed to patient safety and encourages the sharing of adverse incidents will contribute to patient safety and quality of care in hospitals. PMID:24102916

Blignaut, Alwiena J; Coetzee, Siedine K; Klopper, Hester C

2014-06-01

278

Patient participation in hospital care: Nursing staffs' point of view.  

PubMed

The aim was to investigate nursing staff's perceptions related to patient participation and the parameters affecting it during nursing care. A cross-sectional study with both a quantitative and qualitative orientation was conducted. The sample consisted of all nursing staff working in medical and surgical wards in three Greek hospitals. A questionnaire was developed and the data were analysed with exploratory factor analysis, whereas content analysis was used for qualitative data. Nursing staff perceived participation as the process of information giving to patients, communication of symptoms by patients and compliance with the staff's orders. 'Information providing' and 'ability to influence and responsibility' were significant aspects of the content of participation, whereas the parameters affecting participation were related to patients, nursing staff and the care context. These results support patient engagement in dialogue and shared decision-making, while highlighting the need to implement participation systematically and stimulate changes in nursing care organization. PMID:24666538

Kolovos, Petros; Kaitelidou, Daphne; Lemonidou, Chrysoula; Sachlas, Athanasios; Zyga, Sofia; Sourtzi, Panayota

2014-03-26

279

The CareWell in Hospital questionnaire: a measure of frail elderly inpatient experiences with individualized and integrated hospital care.  

PubMed

Given our aging society with an increasing number of frail elderly patients, we must provide integrated care tailored to their complex needs regarding health and well-being. The aim of this study was to develop and validate a questionnaire designed to assess how frail hospitalized elderly patients experience several important aspects of individualized and integrated care. An 8-item questionnaire was developed using input from a panel representing the target group and administered to patients age ?70 years from surgical, medical, and geriatric departments to measure data characteristics, internal consistency, test-retest reliability, construct validity, and responsiveness. A total of 470 questionnaires were returned, including 78 for test-retest reliability. Data were missing from 1.7% to 7.0% within the individual questions. The percentage of questions answered with "don't know" ranged 3.8% to 21.9%. Cronbach's ? for internal consistency was 0.70. Test-retest intraclass correlation was 0.75. Achievement of goals during the hospital stay was significantly correlated with the questionnaire score. Scores did not differ significantly between departments or between the before and after measurements related to an innovative intervention study in healthcare delivery. The CareWell in Hospital questionnaire has good content validity, internal consistency, and test-retest reliability and warrants further research to explore responsiveness. PMID:24474635

Bakker, Franka C; Persoon, Anke; Schoon, Yvonne; Olde Rikkert, Marcel G M

2014-05-01

280

Evaluating the impact of ICT-tools on health care delivery in sub-Saharan hospitals.  

PubMed

This research explores to what extent Information and Communication Technology (ICT)-based information management methods can help to improve efficiency and effectiveness of health services in sub-Saharan hospitals and how clinical information can be made available for secondary use enabling non-redundant reporting of health- and care performance indicators. In the course of a 6 years research effort between 2006 and 2012, it was demonstrated that patient identification, financial management and structured reporting improved dramatically after implementation of well adapted ICT-tools in a set of 19 African health facilities. Real-time financial management metrics helped hospitals to quickly identify fraudulent practices and defective invoicing procedures. Out-patient case load significantly increased compared to the national average, average length of stay has been shortened in 15 of 19 health facilities and global hospital mortality decreased. Hospital workforce-evaluated impact of hospital information system implementation on local working conditions and quality of care was very positive. It was demonstrated that local sub-Saharan health professionals strongly believe in the importance of health information systems. PMID:23920609

Verbeke, Frank; Karara, Gustave; Nyssen, Marc

2013-01-01

281

Improving transitions of care at hospital discharge--implications for pediatric hospitalists and primary care providers.  

PubMed

Delays, omissions, and inaccuracy of discharge information are common at hospital discharge and put patients at risk for adverse outcomes. We assembled an interdisciplinary team of stakeholders to evaluate our current discharge process between hospitalists and primary care providers (PCPs). We used a fishbone diagram to identify potential causes of suboptimal discharge communication to PCPs. Opportunities for improvement (leverage points) to achieve optimal transfer of discharge information were identified using tally sheets and Pareto charts. Quality improvement strategies consisted of training and implementation of a new discharge process including: (1) enhanced PCP identification at discharge, (2) use of an electronic discharge order and instruction system, and (3) autofaxing discharge information to PCPs. The new discharge process's impact was evaluated on 2,530 hospitalist patient discharges over a 34-week period by measuring: (1) successful transfer of discharge information (proportion of discharge information sheets successfully faxed to PCPs), (2) timeliness (proportion of sheets faxed within 2 days of discharge), and (3) content (presence of key clinical elements in discharge sheets). Postintervention, success, and timeliness of discharge information transfer between pediatric hospitalists and PCPs significantly improved while content remained high. PMID:20854359

Harlan, Gregory A; Nkoy, Flory L; Srivastava, Rajendu; Lattin, Gena; Wolfe, Doug; Mundorff, Michael B; Colling, Dayvalena; Valdez, Angelika; Lange, Shay; Atkinson, Sterling D; Cook, Lawrence J; Maloney, Christopher G

2010-01-01

282

Quality of life after intensive care - evaluation with EQ-5D questionnaire  

Microsoft Academic Search

Objective. To evaluate health-related quality of life (HR-QOL) and study its determinants in adult patients discharged from an intensive care unit (ICU). Design. Cohort study. Setting. Intensive care unit (ICU), tertiary care hospital, Oporto, Portugal. Patients. Of all the patients discharged over a 2year period, 355 were considered eligible and 275 completed the study. Measurements and results. Patients were interviewed

Cristina Granja; Armando Teixeira-Pinto; Altamiro Costa-Pereira

2002-01-01

283

Comparison of health care professionals' and surveyors' opinions on problems and obstacles in implementing quality management system in Thailand: a national survey  

Microsoft Academic Search

Objectives. To explore problems and obstacles of hospitals in Thailand implementing quality management systems according to the hospital accreditation (HA) standards. Design. Questionnaire survey. Setting. Thirty-nine hospitals in all 13 regions of Thailand. Participants. A total of 728 health care professionals and 41 surveyors of the national accreditation program. Main outcome measures. Health care professionals' and surveyors' opinions on problems

KRIT PONGPIRUL; JIRUTH SRIRATANABAN; SANTAWAT ASAVAROENGCHAI; JADEJ THAMMATACH-AREE; PORANEE LAOITTHI

2006-01-01

284

Managerial attitude to the implementation of quality management systems in Lithuanian support treatment and nursing hospitals  

PubMed Central

Background The regulations of the Quality Management System (QMS) implementation in health care organizations were approved by the Lithuanian Ministry of Health in 1998. Following the above regulations, general managers of health care organizations had to initiate the QMS implementation in hospitals. As no research on the QMS implementation has been carried out in Lithuanian support treatment and nursing hospitals since, the objective of this study is to assess its current stage from a managerial perspective. Methods A questionnaire survey of general managers of Lithuanian support treatment and nursing hospitals was carried out in the period of January through March 2005. Majority of the items included in the questionnaire were measured on a seven-point Likert scale. During the survey, a total of 72 questionnaires was distributed, out of which 58 filled-in ones were returned (response rate 80.6 per cent; standard sampling error 0.029 at 95 per cent level of confidence). Results Quality Management Systems were found operating in 39.7 per cent of support treatment and nursing hospitals and currently under implementation in 46.6 per cent of hospitals (13.7% still do not have it). The mean of the respondents' perceived QMS significance is 5.8 (on a seven-point scale). The most critical issues related to the QMS implementation include procedure development (5.5), lack of financial resources (5.4) and information (5.1), and development of work guidelines (4.6), while improved responsibility and power sharing (5.2), better service quality (5.1) and higher patient satisfaction (5.1) were perceived by the respondents as the key QMS benefits. The level of satisfaction with the QMS among the management of the surveyed hospitals is mediocre (3.6). However it was found to be higher among respondents who were more competent in quality management, were familiar with ISO 9000 standards, and had higher numbers of employees trained in quality management. Conclusion QMSs are perceived to be successfully running in one third of the Lithuanian support treatment and nursing hospitals. Its current implementation stage is dependent on the hospital size – the bigger the hospital the more success it meets in the QMS implementation. As to critical Quality Management (QM) issues, hospitals tend to encounter such major problems as lack of financial resources, information and training, as well as difficulties in procedure development. On the other hand, the key factors that assist to the success of the QMS implementation comprise managerial awareness of the QMS significance and the existence of employee training systems and audit groups in hospitals. PMID:16987416

Buciuniene, Ilona; Malciankina, Sonata; Lydeka, Zigmas; Kazlauskaite, Ruta

2006-01-01

285

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

286

Measuring geographic inequities in the Portuguese health care system: an estimation of hospital care needs.  

PubMed

Portugal created a NHS to achieve greater equity of access to health care. Successive governments continued to assert the importance of equity in the face of evidence of inequities in supply of hospital resources, but lacked methods to provide sound information on the degree of inequities in Portugal and hence how to achieve greater equity. Capitation formulae have been increasingly used in other countries with a NHS to measure geographical inequities and allocate resources to reduce them. The main objective of this paper was to develop a capitation formula to measure need for hospital care for the Portuguese system by transferring this technology from methods used in other countries, and, in particular, in England. We find, however, problems with the common use of standardised mortality ratios (SMRs) as a measure of need and found age-specific mortality ratios to offer more soundly-based estimates. We also raise questions on the use of empirical estimates of utilisation of health care by age and sex as they appear to reflect inadequacies of health care in Portugal. We also believe it is important to improve knowledge of health insurance and care outside the NHS. Our results show that there are considerable inequities on the distribution of hospital resources in Portugal. PMID:14637012

Oliveira, Monica Duarte; Bevan, Gwyn

2003-12-01

287

An audit of the quality of care indicators for the management of diabetes in family practice clinics in Karachi, Pakistan  

Microsoft Academic Search

BACKGROUND: Management of diabetes is a painstaking and careful approach. This study was aimed to evaluate the quality of care for the management of diabetes provided by family practitioners to their patients having diabetes. This is a retrospective audit of medical records conducted in a tertiary care teaching hospital of private sector in Karachi for one month.METHODS: For this study,

Raheem H Dhanani; Mohammad Mustafa Qureshi; Ali Khan Khuwaja; Badar Sabir Ali; Riaz Qureshi

2008-01-01

288

Markers of Access to and Quality of Primary Care for Aboriginal People in Ontario, Canada  

PubMed Central

Objectives. We evaluated primary care accessibility and quality for Ontario’s aboriginal population. Methods. We compared a defined aboriginal cohort with nonaboriginal populations with analogous geographic isolation and low socioeconomic status. We determined rates of hospitalization for the following indicators of adequacy of primary care: ambulatory care–sensitive (ACS) conditions and utilization of referral care–sensitive (RCS) procedures from administrative databases. Results. ACS hospitalization rates, relative to the general population, were 2.54, 1.50, and 1.14 for the aboriginal population, the geographic control populations, and the socioeconomic control populations, respectively. The relative RCS procedure utilization rates were 0.64, 0.91, and 1.00, respectively. Conclusions. The increased ACS hospitalization rate and reduced RCS procedure utilization rate suggest that northern Ontario’s aboriginal residents have insufficient or ineffective primary care. PMID:12721147

Shah, Baiju R.; Gunraj, Nadia; Hux, Janet E.

2003-01-01

289

Care to terminal patients. Perception of nurses from the intensive care unit of a hospital.  

PubMed

Objective. To identify the perception of nurses with regard to the process of providing care to patients in the context of hospice care. Method. Qualitative study using the methodological framework Collective Subject Discourse. A total of 18 nursing professionals of the adult intensive care unit of a public hospital in São Paulo, Brazil were interviewed between June and August 2012. Results. The process of providing care to terminal patients is permeated by negative, conflictive and mixed feelings. As regards communication, while the participants acknowledge its importance as a therapeutic resource, they also admit a lack of professional qualification. Conclusion. The interviewees have difficulties to deal with care provided to terminal patients. The qualification of these professionals needs to be improved, starting in the undergraduate program. PMID:25504407

Mussolin Tamaki, Camila; Meneguin, Silmara; Aguiar Alencar, Rubia; Bronzatto Luppi, Claudia Helena

2014-12-01

290

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

291

Quality of health care in the US managed care system : Comparing and highlighting successful states  

Microsoft Academic Search

Purpose – This paper aims to examine the issue of quality of care in the US managed care system and to compare state-level policies and programs. Specifically, it aims to describe five states which are making the most quality of care improvements. Design\\/methodology\\/approach – This study examines the literature to identify states' care quality rankings. Additionally, five state case studies

Kristina L. Guo

2008-01-01

292

Home based care and standard hospital care for patients with severe mental illness: a randomised controlled trial.  

PubMed Central

OBJECTIVE--To compare the efficacy of home based care with standard hospital care in treating serious mental illness. DESIGN--Randomised controlled trial. SETTING--South Southwark, London. PATIENTS--189 patients aged 18-64 living in catchment area. 92 were randomised to home based care (daily living programme) and 97 to standard hospital care. At three months' follow up 68 home care and 60 hospital patients were evaluated. MAIN OUTCOME MEASURES--Use of hospital beds, psychiatric diagnosis, social functioning, patients' and relatives' satisfaction, and activity of daily living programme staff. RESULTS--Home care reduced hospital stay by 80% (median stay six days in home care group, 53 days in hospital group) and did not increase the number of admissions compared with hospital care. On clinical and social outcome there was a non-significant trend in favour of home care, but both groups showed big improvements. On the global adjustment scale home care patients improved by 26.8 points and the hospital group by 21.6 points (difference 5.2; 95% confidence interval -1.5 to 12). Other rating scales showed similar trends. Home care patients required a wide range of support in areas such as housing, finance, and work. Only three patients dropped out from the programme. CONCLUSIONS--Home based care may offer some slight advantages over hospital based care for patients with serious mental illness and their relatives. The care is intensive, but the low drop out rate suggests appreciation. Changes to traditional training for mental health workers are required. PMID:1571681

Muijen, M.; Marks, I.; Connolly, J.; Audini, B.

1992-01-01

293

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

Code of Federal Regulations, 2010 CFR

...2010-07-01 2010-07-01 false Hospital care and medical services in non-VA...Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Use of Public Or Private Hospitals § 17.52 Hospital care and medical services in...

2010-07-01

294

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

295

Improving the quality of care for Medicare patients with acute myocardial infarction: results from the Cooperative Cardiovascular Project  

Microsoft Academic Search

CONTEXT: Medicare has a legislative mandate for quality assurance, but the effectiveness of its population-based quality improvement programs has been difficult to establish.\\u000aOBJECTIVE: To improve the quality of care for Medicare patients with acute myocardial infarction.\\u000aDESIGN: Quality improvement project with baseline measurement, feedback, remeasurement, and comparison samples.\\u000aSETTING: All acute care hospitals in the United States.\\u000aPATIENTS: Preintervention

Thomas A. Marciniak; Edward F. Ellerbeck; Martha J. Radford; Timothy F. Kresowik; Jay A. Gold; Harlan M. Krumholz; Catarina I. Kiefe; Richard M. Allman; Robert A. Vogel; Stephen F. Jencks

1998-01-01

296

Differentiating innovation priorities among stakeholder in hospital care  

PubMed Central

Background Decisions to adopt a particular innovation may vary between stakeholders because individual stakeholders may disagree on the costs and benefits involved. This may translate to disagreement between stakeholders on priorities in the implementation process, possibly explaining the slow diffusion of innovations in health care. In this study, we explore the differences in stakeholder preferences for innovations, and quantify the difference in stakeholder priorities regarding costs and benefits. Methods The decision support technique called the analytic hierarchy process was used to quantify the preferences of stakeholders for nine information technology (IT) innovations in hospital care. The selection of the innovations was based on a literature review and expert judgments. Decision criteria related to the costs and benefits of the innovations were defined. These criteria were improvement in efficiency, health gains, satisfaction with care process, and investments required. Stakeholders judged the importance of the decision criteria and subsequently prioritized the selected IT innovations according to their expectations of how well the innovations would perform for these decision criteria. Results The stakeholder groups (patients, nurses, physicians, managers, health care insurers, and policy makers) had different preference structures for the innovations selected. For instance, self-tests were one of the innovations most preferred by health care insurers and managers, owing to their expected positive impacts on efficiency and health gains. However, physicians, nurses and patients strongly doubted the health gains of self-tests, and accordingly ranked self-tests as the least-preferred innovation. Conclusions The various stakeholder groups had different expectations of the value of the nine IT innovations. The differences are likely due to perceived stakeholder benefits of each innovation, and less to the costs to individual stakeholder groups. This study provides a first exploratory quantitative insight into stakeholder positions concerning innovation in health care, and presents a novel way to study differences in stakeholder preferences. The results may be taken into account by decision makers involved in the implementation of innovations. PMID:23947398

2013-01-01

297

Quality in transitional care of the elderly: Key challenges and relevant improvement measures  

PubMed Central

Introduction Elderly people aged over 75 years with multifaceted care needs are often in need of hospital treatment. Transfer across care levels for this patient group increases the risk of adverse events. The aim of this paper is to establish knowledge of quality in transitional care of the elderly in two Norwegian hospital regions by identifying issues affecting the quality of transitional care and based on these issues suggest improvement measures. Methodology Included in the study were elderly patients (75+) receiving health care in the municipality admitted to hospital emergency department or discharged to community health care with hip fracture or with a general medical diagnosis. Participant observations of admission and discharge transitions (n = 41) were carried out by two researchers. Results Six main challenges with belonging descriptions have been identified: (1) next of kin (bridging providers, advocacy, support, information brokering), (2) patient characteristics (level of satisfaction, level of insecurity, complex clinical conditions), (3) health care personnel's competence (professional, system, awareness of others’ roles), (4) information exchange (oral, written, electronic), (5) context (stability, variability, change incentives, number of patient handovers) and (6) patient assessment (complex clinical picture, patient description, clinical assessment). Conclusion Related to the six main challenges, several measures have been suggested to improve quality in transitional care, e.g. information to and involvement of patients and next of kin, staff training, standardisation of routines and inter-organisational staff meetings. PMID:24868196

Storm, Marianne; Siemsen, Inger Margrete D.; Laugaland, Kristin; Dyrstad, Dagrunn Nåden; Aase, Karina

2014-01-01

298

Does a palliative care consult decrease the cost of caring for hospitalized patients with dementia?  

PubMed

Objective: Advanced dementia (AD) is a terminal disease. Palliative care is increasingly becoming of critical importance for patients afflicted with AD. The primary objective of this study was to compare pharmacy cost before and after a palliative care consultation (PCC) in patients with end-stage dementia. A secondary objective was to investigate the cost of particular types of medication before and after a PCC. Method: This was a retrospective study of 60 hospitalized patients with end-stage dementia at a large academic tertiary care hospital from January 1, 2010 to October 1, 2011, in order to investigate pharmacy costs before and after a PCC. In addition to demographics, we carried out a comparison of the average daily pharmacy cost and comparison of the proportion of subjects taking each medication type (cardiac, analgesics, antibiotics, antipsychotics and antiemetics) before and after a PCC. Results: There was a significant decrease in overall average daily pharmacy cost from before to after a PCC ($31.16 ± 24.71 vs. $20.83 ± 19.56; p < 0.003). There was also a significant difference in the proportion of subjects taking analgesics before and after PCC (55 vs. 73.3%; p < 0.009), with a significant average daily analgesic cost rise from pre- to post-PCC: $1.36 ± 5.07 (median = $0.05) versus. $2.35 ± 5.35 (median = $0.71), respectively, p < 0.011; average daily antiemetics cost showed a moderate increase from pre- to post-PCC: $0.08 ± 0.37 (median = $0) versus $0.23 ± 0.75 (median = $0), respectively, p < 0.047. Significance of results: Our findings indicate that PCC is associated with overall decreased medication cost in hospitalized AD patients. Additionally, receiving a PCC was related to greater use of pain medications in hospitalized dementia patients. Our study corroborates the benefits of palliative care team intervention in managing elderly hospitalized dementia patients. PMID:24139019

Araw, Marissa; Kozikowski, Andrzej; Sison, Cristina; Mir, Tanveer; Saad, Maha; Corrado, Lauren; Pekmezaris, Renee; Wolf-Klein, Gisele

2013-10-21

299

Quality of care indicators for gout management  

Microsoft Academic Search

OBJECTIVE: Despite the significant health impact of gout, there is no consensus on management standards. To guide physician practice, we sought to develop quality of care indicators for gout management.\\u000aMETHODS: A systematic literature review of gout therapy was performed using the Medline database. Two abstractors independently reviewed each of the articles for relevance and satisfaction of minimal inclusion criteria.

Ted R. Mikuls; Catherine H. MacLean; Jason Olivieri; Fausto G. Patino; Jeroan J. Allison; John T. Farrar; Warren B. Bilker; Kenneth G. Saag

2004-01-01

300

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

Code of Federal Regulations, 2010 CFR

...Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and...retirement pay who require hospital care for chronic diseases...no eligibility for hospital care under laws governing the Department of Veterans...

2010-07-01

301

38 CFR 17.120 - Payment or reimbursement of the expenses of hospital care and other medical services not...  

Code of Federal Regulations, 2010 CFR

...of the expenses of hospital care and other medical...Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS...of the expenses of hospital care and other medical...public (or Federal) hospital not operated by the Department of Veterans...

2010-07-01

302

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

Code of Federal Regulations, 2011 CFR

...determining eligibility for hospital, nursing home or domiciliary care. 17.47... MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.47 Considerations...determining eligibility for hospital, nursing home or domiciliary...

2011-07-01

303

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

Code of Federal Regulations, 2012 CFR

...determining eligibility for hospital, nursing home or domiciliary care. 17.47... MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.47 Considerations...determining eligibility for hospital, nursing home or domiciliary...

2012-07-01

304

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

Code of Federal Regulations, 2010 CFR

...determining eligibility for hospital, nursing home or domiciliary care. 17.47... MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.47 Considerations...determining eligibility for hospital, nursing home or domiciliary...

2010-07-01

305

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

...determining eligibility for hospital, nursing home or domiciliary care. 17.47... MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.47 Considerations...determining eligibility for hospital, nursing home or domiciliary...

2014-07-01

306

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

Code of Federal Regulations, 2013 CFR

...determining eligibility for hospital, nursing home or domiciliary care. 17.47... MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.47 Considerations...determining eligibility for hospital, nursing home or domiciliary...

2013-07-01

307

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

308

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.; Suñol, 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.; Lívio, A.; Eiras, M.; Franca, M.; Leite, I.; Almeman, F.; Kus, H.; Ozturk, K.; Mannion, R.; Wang, A.; Thompson, A.

2014-01-01

309

78 FR 55671 - Hospital Care and Medical Services for Camp Lejeune Veterans  

Federal Register 2010, 2011, 2012, 2013

...38 CFR Part 17 RIN 2900-AO78 Hospital Care and Medical Services for Camp Lejeune Veterans...statutory mandate that VA provide health care to certain veterans who served at Camp...The law requires VA to furnish hospital care and medical services for these...

2013-09-11

310

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 ...

311

[Support to spiritual needs in hospital care. Integration perspective in modern hospitals].  

PubMed

Within the course of medical care in the most advanced health care settings, an increasing attention is being paid to the so-called care humanization. According to this perspective, we try to integrate the usual care pathways with aspects related to the spiritual and religious dimension of all people and their families, as well as the employees themselves. It is clearly important to establish this kind of practices on the basis of scientific evidences. That is the reason why it's a necessity to improve the knowledge about the importance that spiritual assistance can offer within the current health service. The aim of this work is to show the relevance of the integration of spiritual perspectives in the hospital setting according to a multidisciplinary point of view. In this work many data that emerge from the international scientific literature, as well as the definition that is given to the concept of "spirituality" are analyzed; about this definition in fact there is not unanimous consent even today. It is also analyzed the legal situation in force within the European territory according to the different laws and social realities. Finally, the possible organizational practices related to spiritual support are described and the opportunity to specific accreditation pathways and careful training of chaplains able to integrate traditional religious practices with modern spiritual perspectives is discussed. PMID:25072543

Proserpio, Tullio; Piccinelli, Claudia; Arice, Carmine; Petrini, Massimo; Mozzanica, Mario; Veneroni, Laura; Clerici, Carlo Alfredo

2014-01-01

312

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

313

[Hospitalization of elderly in an acute-care geriatric department].  

PubMed

Hospital admissions following emergency visits of elderly people are frequent. This admission modality is often problematic both for the patients and the emergency healthcare professionals. Direct admission from home (or nursing home) in acute geriatric units (AGU) has been developed but has never been prospectively assessed. We conducted a 6-month prospective observational study to compare the 97 patients admitted through the emergency room (ER) in the AGU of Bichat's hospital to the 76 patients admitted directly. Collected data included socio-demographic and medical baseline data, clinical severity score at admission, cause of hospitalization, final diagnosis, in-hospital occurrence of urinary retention and of pressure ulcer, length of stay, discharge disposition and mortality. No significant differences between the groups were found for most baseline characteristics, clinical severity score, occurrence of pressure ulcers, length of stay and mortality. However ER patients were significantly older (88±6 vs 86±7 years, p=0.04) and had more often history of arrhythmia (29% vs 15%, p=0.02) and protein-energy malnutrition preceding admission (63% vs 46%, p=0.03). Falls as admission cause was more common in ER patients while unexplained health status or functional decline were most common in those admitted directly. Clinical outcomes were less favourable in ER patients with significantly more urinary retentions (25% vs 4%, p=0.0002) and transfers to rehabilitation units (48% vs 31%, p=0.04). The patients admitted directly returned more often at home without additional social support (53% vs 30%, p=0.001). Direct admission in AGU is feasible, medically effective and provides an alternative to attending an emergency room. This admission modality could be specially suitable for elder people suffering from an unexplained functional or health status declines. Further studies are necessary to support the hypothesis that quality gains and cost-effective measures may be achieved by dissemination of such an admission modality at the hospital. PMID:22713842

Neouze, Angèle; Dechartres, Agnès; Legrain, Sylvie; Raynaud-Simon, Agathe; Gaubert-Dahan, Marie-Line; Bonnet-Zamponi, Dominique

2012-06-01

314

Quality of Care for Gastrointestinal Conditions: A Primer for Gastroenterologists  

Microsoft Academic Search

The Institute of Medicine’s publications To Err Is Human and Crossing the Quality Chasm publicized the widespread deficits in health-care quality. The quality of care for digestive diseases has not been evaluated comprehensively, although emerging literature suggests that the gap between recommended care and actual practice may be quite substantial. This paper reviews the history of, the rationale behind, and

Michael D Kappelman; Spencer D Dorn; Erica Peterson; Thomas Runge; John I Allen

2011-01-01

315

Rural and Urban Hospitals' Role in Providing Inpatient Care, 2010  

MedlinePLUS

... CDC/NCHS, National Hospital Discharge Survey, 2010. How did rural hospital inpatients differ from urban hospital inpatients ... CDC/NCHS, National Hospital Discharge Survey, 2010. How did patients' first-listed diagnoses differ in rural and ...

316

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

Code of Federal Regulations, 2010 CFR

...services and inpatient hospital care. 17.49...Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and...2002] Use of Department of Defense, Public...Service or Other Federal...

2010-07-01

317

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

Code of Federal Regulations, 2010 CFR

...Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and...facilities of the Department of Veterans Affairs...facilities. (c) Hospital care when incidental...of a specialized Department of Veterans...

2010-07-01

318

Epidemiology of trauma in an acute care hospital in Singapore  

PubMed Central

Background: Trauma injury is the leading cause of mortality and hospitalization worldwide and the leading cause of potential years of productive life lost. Patients with multiple injuries are prevalent, increasing the complexity of trauma care and treatment. Better understanding of the nature of trauma risk and outcome could lead to more effective prevention and treatment strategies. Materials and Methods: A retrospective review of 1178 trauma patients with Injury Severity Score (ISS) ? 9, who were admitted to the Acute and Emergency Care of an acute care hospital between January 2011 and December 2012. The statistical analysis included calculation of percentages and proportions and application of test of significance using Pearson's chi-square test or Fisher's exact test where appropriate. Results: Over the study period, 1178 patients were evaluated, 815 (69.2%) males and 363 (30.8%) females. The mean age of patients was 52.08 ± 21.83 (range 5-100) years. Falls (604; 51.3%) and road traffic accidents (465; 39.5%) were the two most common mechanisms of injury. Based on the three most common mechanisms of injury, i.e. fall on the same level, fall from height, and road traffic accident, the head region (484; 45.40%) was the most commonly injured in the body, followed by lower limbs (377; 35.37%) and thorax (299; 28.05%). Conclusion: Fall was the leading cause of injury among the elderly population with road traffic injuries being the leading cause among the younger group. There is a need to address the issues of injury control and prevention in these areas. PMID:25114427

Wui, Lim Woan; Shaun, Goh E; Ramalingam, Ganesh; Wai, Kenneth Mak Seek

2014-01-01

319

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

320

Hospital admissions from the Surgical Day Care Centre of Vancouver General Hospital 1977–1987  

Microsoft Academic Search

The admissions to Vancouver General Hospital from its Surgical Day Care Centre were reviewed for the period I977 to 1987.\\u000a The overall mean rate of admission for the period was 0.28 per cent, for surgically-related admissions 0.22 per cent and for\\u000a anaesthesia-related admissions 0.07 per cent. The principal reasons for surgery-related admissions were postoperative bleeding,\\u000a complications, the need for further

Peter F. Fancourt-Smith; Jeffrey Hornstein; Leonard C. Jenkins

1990-01-01

321

38 CFR 17.86 - Provision of hospital care and medical services during certain disasters and emergencies under 38...  

Code of Federal Regulations, 2011 CFR

...false Provision of hospital care and medical services during certain disasters and...Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Care During Certain Disasters and Emergencies...86 Provision of hospital care and medical services during certain disasters...

2011-07-01

322

38 CFR 17.86 - Provision of hospital care and medical services during certain disasters and emergencies under 38...  

Code of Federal Regulations, 2012 CFR

...false Provision of hospital care and medical services during certain disasters and...Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Care During Certain Disasters and Emergencies...86 Provision of hospital care and medical services during certain disasters...

2012-07-01

323

38 CFR 17.86 - Provision of hospital care and medical services during certain disasters and emergencies under 38...  

Code of Federal Regulations, 2013 CFR

...false Provision of hospital care and medical services during certain disasters and...Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Care During Certain Disasters and Emergencies...86 Provision of hospital care and medical services during certain disasters...

2013-07-01

324

Comparison of childbirth care models in public hospitals, Brazil  

PubMed Central

OBJECTIVE To compare collaborative and traditional childbirth care models. METHODS Cross-sectional study with 655 primiparous women in four public health system hospitals in Belo Horizonte, MG, Southeastern Brazil, in 2011 (333 women for the collaborative model and 322 for the traditional model, including those with induced or premature labor). Data were collected using interviews and medical records. The Chi-square test was used to compare the outcomes and multivariate logistic regression to determine the association between the model and the interventions used. RESULTS Paid work and schooling showed significant differences in distribution between the models. Oxytocin (50.2% collaborative model and 65.5% traditional model; p < 0.001), amniotomy (54.3% collaborative model and 65.9% traditional model; p = 0.012) and episiotomy (collaborative model 16.1% and traditional model 85.2%; p < 0.001) were less used in the collaborative model with increased application of non-pharmacological pain relief (85.0% collaborative model and 78.9% traditional model; p = 0.042). The association between the collaborative model and the reduction in the use of oxytocin, artificial rupture of membranes and episiotomy remained after adjustment for confounding. The care model was not associated with complications in newborns or mothers neither with the use of spinal or epidural analgesia. CONCLUSIONS The results suggest that collaborative model may reduce interventions performed in labor care with similar perinatal outcomes. PMID:24897052

Vogt, Sibylle Emilie; da Silva, Kátia Silveira; Dias, Marcos Augusto Bastos

2014-01-01

325

The potential impact of accountable care organizations with respect to cost and quality with special attention to imaging.  

PubMed

An accountable care organization is a form of a managed care organization in which a group of networked health care providers, which may include hospitals, group practices, networks of practices, hospital-provider partnerships, or joint ventures, are accountable for the health care of a defined group of patients. Initial results of the institutions participating in CMS's Physician Group Demonstration Project did not demonstrate a substantial reduction in imaging that could be directly attributed to the accountable care organization model. However, the initial results suggest that incentive-based methodology appears to be successful for increasing compliance for measuring quality metrics. PMID:24332427

Mukherji, Suresh K

2014-04-01

326

The hospital mortality project: a tool for using administrative data for continuous clinical quality assurance.  

PubMed

The increasing demand for greater clinical accountability requires development of convenient tools to measure healthcare safety and quality, which are able to provide information contemporaneously. The purpose of this paper is to describe the development of the Hospital Mortality Project, a quality assurance initiative designed to encourage and facilitate clinical accountability for hospital mortality by all clinical departments and clinicians. The project was carried out in two stages. Part 1: After registration of in-hospital patient deaths ( May 1, 2004 to December 31, 2007), the consultant in charge of patient care was notified and requested to assign the death to a predefined category. This categorisation leads to further investigation as appropriate. Part 2: Hospital administrative data from April 1, 1997 to December 31, 2007 were used to assess a defined index, the Hospital Mortality Index (HMI), which was the expressed in the form of an Attribute Control Chart (p-CHART ) and then used as a performance indicator for hospital departments and clinicians. Summary data are reported to the clinical departments and to the hospital executive via the Quality Improvement Committee on quarterly basis. The clinical review was complete for 2,990 of 3,132 (95%) inpatient deaths till December 31, 2007, while a further 142 (5%) deaths are still in the process of being reviewed as of April 7, 2008. The median age of all the cases was 78 years (IQR 67-86) of which 1,657 (53%) were male. The Poisson regression analysis showed that since 1997 departments with a minimum of 100 deaths in total showed no clinically significant change in HMI over time. The Hospital Mortality Project provides a simple and efficient tool to analyse data for clinical managers to facilitate accountability. PMID:18583717

Mukhtar, S Aqif; Hoffman, Neville E; MacQuillan, Gerry; Semmens, James B

2008-01-01

327

Bowel care: implementing changes toward quality improvement.  

PubMed

This article describes the challenges accepted by two healthcare teams at the Hampton Veterans Affairs Medical Center, which impacted significantly upon the practice of nursing. The first healthcare team developed a medium size glycerine suppository ("glycerine bomb"), which was determined to be more effective than the bisacodyl in oil base suppository. The second team evaluated the effectiveness of a suppository of choice ("Magic Bullet") which was approved for use and replaced the "glycerine bomb." The need for a formalized protocol for a bowel care program was identified, developed and implemented. A bowel care program quality improvement monitor was developed to evaluate the effectiveness of the protocol. With continuous monitoring, we are challenged to evaluate our findings and restructure our interventions. PMID:7792580

Walker-Dalton, L M

1995-03-01

328

CDC Vital Signs: Making Health Care Safer Antibiotic Rx in Hospitals  

MedlinePLUS

... About CDC.gov . Vital Signs Share Compartir Making Health Care Safer Antibiotic Rx in Hospitals: Proceed with Caution ... resistance and improving prescribing practices. Work with other health care facilities to prevent infections, transmission, and resistance. Issue ...

329

ChildCare Quality and Children's Social Development  

Microsoft Academic Search

This study examined the influence on children's social development of variation in the quality of their child-care environments. The sample consisted of 166 children attending representative child-care centers that varied widely in quality. Possible relations associated with age, child-care experience, and family background were controlled using hierarchical multiple regression. Both global estimates of child-care quality and specific program features, such

Deborah Phillips; Kathleen McCartney; Sandra Scarr

1987-01-01

330

Quality of cancer follow-up care: a focus on Latina breast cancer survivors  

PubMed Central

Introduction Receiving quality cancer follow-up care influences survivorship outcomes. Among Latinas, breast cancer is the number one cause of cancer death; yet Latinas do not receive adequate follow-up care. This study examined quality of cancer follow-up care among Latina breast cancer survivors (BCS) and whether it differs by participant language and healthcare system variables (provider specialty, and medical setting). Methods Two hundred thirty-two (95 English-speaking Latina and 137 Spanish-speaking) Latina BCS were recruited from the California Cancer Registry, hospital cancer registries, and community agencies. Results English-speaking Latina BCS were more likely to report receiving cancer follow-up care at a doctor’s office (p<0.001). BCS without a regular place for cancer follow-up care were more likely to report not seeing a primary care provider (p<0.05) or cancer specialist (p<0.001) in the past 12 months. English-speaking Latina BCS (p<0.001), BCS who saw a cancer specialist in the past 12 months (p<0.001), and received follow-up care at a doctor’s office (p<0.05) reported higher quality of care. Speaking English, having seen a cancer specialist, and receiving follow-up care at a doctor’s office were independently associated with higher quality of care, explaining 44 % of the variance. Conclusions Our study findings suggest that examining the influence of ethnic and linguistic factors on quality of cancer follow-up care is necessary to address health disparities. Improved access to cancer follow-up care for Spanish-speaking Latina BCS is of particular concern. Implication of Cancer Survivors Identifying follow-up care needs of Latina BCS may contribute to providing high-quality care and improved survivorship outcomes. PMID:24563169

Ashing, Kimlin; Napoles, Anna

2014-01-01

331

Analysis of the quality of hospital information systems audit trails  

PubMed Central

Background Audit Trails (AT) are fundamental to information security in order to guarantee access traceability but can also be used to improve Health information System’s (HIS) quality namely to assess how they are used or misused. This paper aims at analysing the existence and quality of AT, describing scenarios in hospitals and making some recommendations to improve the quality of information. Methods The responsibles of HIS for eight Portuguese hospitals were contacted in order to arrange an interview about the importance of AT and to collect audit trail data from their HIS. Five institutions agreed to participate in this study; four of them accepted to be interviewed, and four sent AT data. The interviews were performed in 2011 and audit trail data sent in 2011 and 2012. Each AT was evaluated and compared in relation to data quality standards, namely for completeness, comprehensibility, traceability among others. Only one of the AT had enough information for us to apply a consistency evaluation by modelling user behaviour. Results The interviewees in these hospitals only knew a few AT (average of 1 AT per hospital in an estimate of 21 existing HIS), although they all recognize some advantages of analysing AT. Four hospitals sent a total of 7 AT – 2 from Radiology Information System (RIS), 2 from Picture Archiving and Communication System (PACS), 3 from Patient Records. Three of the AT were understandable and three of the AT were complete. The AT from the patient records are better structured and more complete than the RIS/PACS. Conclusions Existing AT do not have enough quality to guarantee traceability or be used in HIS improvement. Its quality reflects the importance given to them by the CIO of healthcare institutions. Existing standards (e.g. ASTM:E2147, ISO/TS 18308:2004, ISO/IEC 27001:2006) are still not broadly used in Portugal. PMID:23919501

2013-01-01

332

Availability and Quality of Prehospital Care on Pakistani Interurban Roads  

PubMed Central

Interurban road crashes often result in severe Road Traffic Injuries (RTIs). Prehospital emergency care on interurban roads was rarely evaluated in the low- and middle-income countries. The study highlighted the availability and quality of prehospital care facilities on interurban roads in Pakistan, a low-income country. The study setting was a 592-km-long National highway in the province of Sindh, Pakistan. Using the questionnaires adapted from the World Health Organization prehospital care guidelines [Sasser et al., 2005], managers and ambulance staff at the stations along highways were interviewed regarding the process of care, supplies in ambulances, and their experience of trauma care. Ambulance stations were either managed by the police or the Edhi Foundation (EF), a philanthropic organization. All highway stations were managed by the EF; the median distance between highway stations was 38 km (Interquartile Range [IQR]=27–46). We visited 14 stations, ten on the highway section, and four in cities, including two managed by the police. Most highway stations (n=13) received one RTI call per day. Half of stations (n=5) were inside highway towns, usually near primary or secondary-level healthcare facilities. Travel time to the nearest tertiary healthcare facility ranged from 31 to 70 minutes (median=48 minutes; IQR=30–60). Other shortcomings noted for stations were not triaging RTI cases (86%), informing hospitals (64%), or recording response times (57%). All ambulances (n=12) had stretchers, but only 58% had oxygen cylinders. The median schooling of ambulance staff (n=13) was 8 years (IQR=3–10), and the median paramedic training was 3 days (IQR=2–3). Observed shortcomings in prehospital care could be improved by public-private partnerships focusing on paramedic training, making available essential medical supplies, and linking ambulance stations with designated healthcare facilities for appropriate RTI triage. PMID:24406963

Bhatti, Junaid A.; Waseem, Hunniya; Razzak, Junaid A.; Shiekh, Naeem-ul-lah; Khoso, Ajmal Khan; Salmi, L.-Rachid

2013-01-01

333

Availability and quality of prehospital care on pakistani interurban roads.  

PubMed

Interurban road crashes often result in severe Road Traffic Injuries (RTIs). Prehospital emergency care on interurban roads was rarely evaluated in the low- and middle-income countries. The study highlighted the availability and quality of prehospital care facilities on interurban roads in Pakistan, a low-income country. The study setting was a 592-km-long National highway in the province of Sindh, Pakistan. Using the questionnaires adapted from the World Health Organization prehospital care guidelines [Sasser et al., 2005], managers and ambulance staff at the stations along highways were interviewed regarding the process of care, supplies in ambulances, and their experience of trauma care. Ambulance stations were either managed by the police or the Edhi Foundation (EF), a philanthropic organization. All highway stations were managed by the EF; the median distance between highway stations was 38 km (Interquartile Range [IQR]=27-46). We visited 14 stations, ten on the highway section, and four in cities, including two managed by the police. Most highway stations (n=13) received one RTI call per day. Half of stations (n=5) were inside highway towns, usually near primary or secondary-level healthcare facilities. Travel time to the nearest tertiary healthcare facility ranged from 31 to 70 minutes (median=48 minutes; IQR=30-60). Other shortcomings noted for stations were not triaging RTI cases (86%), informing hospitals (64%), or recording response times (57%). All ambulances (n=12) had stretchers, but only 58% had oxygen cylinders. The median schooling of ambulance staff (n=13) was 8 years (IQR=3-10), and the median paramedic training was 3 days (IQR=2-3). Observed shortcomings in prehospital care could be improved by public-private partnerships focusing on paramedic training, making available essential medical supplies, and linking ambulance stations with designated healthcare facilities for appropriate RTI triage. PMID:24406963

Bhatti, Junaid A; Waseem, Hunniya; Razzak, Junaid A; Shiekh, Naeem-Ul-Lah; Khoso, Ajmal Khan; Salmi, L-Rachid

2013-01-01

334

Comparison between two mobile pre-hospital care services for trauma patients  

PubMed Central

Objectives Pre-hospital care (PH) in Brazil is currently in the phase of implementation and expansion, and there are few studies on the impacts of this public health service. The purpose of this study is to assess the quality of care and severity of trauma among the population served, using trauma scores, attendance response times, and mortality rates. This work compares two pre-hospital systems: the Mobile Emergency Care Service, or SAMU 192, and the Fire Brigade Group, or CB. Method Descriptive study evaluating all patients transported by both systems in Catanduva, SP, admitted to a single hospital. Results 850 patients were included, most of whom were men (67.5%); the mean age was 38.5 ± 18.5 years. Regarding the use of PH systems, most patients were transported by SAMU (62.1%). The trauma mechanisms involved motorcycle accidents in 32.7% of cases, transferred predominantly by SAMU, followed by falls (25.8%). Regarding the response time, CB showed the lowest rates. In relation to patient outcome, only 15.5% required hospitalization. The average score on the Glasgow Coma Scale was 14.7 ± 1.3; average RTS was 7.7 ± 0.7; ISS 3.8 ± 5.9; and average TRISS 97.6 ± 9.3. The data analysis showed no statistical differences in mortality between the groups studied (SAMU - 1.5%; CB - 2.5%). The trauma scores showed a higher severity of trauma among the fatal victims. Conclusion Trauma victims are predominantly young and male; the trauma mechanism that accounted for the majority of PH cases was motorcycle accidents; CB responded more quickly than SAMU; and there was no statistical difference between the services of SAMU and CB in terms of severity of the trauma and mortality rates. PMID:23531089

2012-01-01

335

interRAI home care quality indicators  

PubMed Central

Background This paper describe the development of interRAI’s second-generation home care quality indicators (HC-QIs). They are derived from two of interRAI’s widely used community assessments: the Community Health Assessment and the Home Care Assessment. In this work the form in which the quality problem is specified has been refined, the covariate structure updated, and two summary scales introduced. Methods Two data sets were used: at the client and home-care site levels. Client-level data were employed to identify HC-QI covariates. This sample consisted of 335,544 clients from Europe, Canada, and the United States. Program level analyses, where client level data were aggregated at the site level, were also based on the clients from the samples from Europe, Canada, and the United States. There were 1,654 program-based observations – 22% from Europe, 23% from the US, and 55% from Canada. The first task was to identify potential HC-QIs, including both change and prevalence measures. Next, they were reviewed by industry representatives and members of the interRAI network. A two-step process adjustment was followed to identify the most appropriate covariance structure for each HC-QI. Finally, a factor analytic strategy was used to identify HC-QIs that cluster together and thus are candidates for summary scales. Results The set of risk adjusted HC-QIs are multi-dimensional in scope, including measures of function, clinical complexity, social life, distress, and service use. Two factors were identified. The first includes a set of eleven measures that revolve around the absence of decline. This scale talks about functional independence and engagement. The second factor, anchored on nine functional improvement HC-QIs, referenced positively, this scale indicates a return to clinical balance. Conclusions Twenty-three risk-adjusted, HC-QIs are described. Two new summary HC-QI scales, the “Independence Quality Scale” and the “Clinical Balance Quality Scale” are derived. In use at a site, these two scales can provide a macro view of local performance, offering a way for a home care agency to understand its performance. When scales perform less positively, the site then is able to review the HC-QI items that make up the scale, providing a roadmap for areas of greatest concern and in need of targeted interventions. PMID:24245920

2013-01-01

336

In-hospital mortality following hip fracture care in southern Ontario  

PubMed Central

Background The incidence of hip fractures is increasing within the aging population. We investigated the overall rate of in-hospital mortality following hip fracture and how this mortality rate compares across academic and community hospitals. Methods We reviewed prospectively collected data from 17 hospitals in southern Ontario as part of a project to evaluate a new streamlined clinical care pathway developed for acute care of elderly patients with hip fractures. We collected demographic data, prefracture living status, acute care mortality and time to surgery, and we compared these data between community and academic hospitals. Results Between March 2007 and February 2008, 2178 consecutive patients were admitted with a hip fracture to 13 community and 4 academic hospitals. The mean age was 79 years and 72% were women. The overall in-hospital mortality rate was 5.0%, with no difference between patients treated in academic versus community hospitals (p = 0.56). We found a greater rate of acute care in-hospital mortality for patients admitted from dependent-living facilities compared with those who were living independently (risk ratio 0.63, 95% confidence interval 0.42–0.96). Conclusion Acute care in-hospital mortality following hip fractures remains high and is consistent across academic and community hospitals. With the rising incidence of hip fractures, we need to improve the models of care for these patients to reduce mortality and to maximize functional outcomes while maintaining efficient use of limited health care resources. PMID:20858372

Alzahrani, Khalid; Gandhi, Rajiv; Davis, Aileen; Mahomed, Nizar

2010-01-01

337

Mandatory quality reports in Germany from the hospitals’ point of view: a cross-sectional observational study  

PubMed Central

Background Public reporting of hospital quality is to enable providers, patients and the public to make comparisons regarding the quality of care and thus contribute to informed decisions. It stimulates quality improvement activities in hospitals and thus positively impacts treatment results. Hospitals often use publicly reported data for further internal or external purposes. As of 2005, German hospitals are obliged to publish structured quality reports (QR) every two years. This gives them the opportunity to demonstrate their performance by number, type and quality in a transparent way. However, it constitutes a major burden to hospitals to generate and publish data required, and it is yet unknown if hospitals feel adequately represented and at the same time consider the effort appropriate. This study assesses hospital leaders’ judgement about the capability of QR to put legally defined aims effectively and efficiently into practice. It also explores the additional purposes hospitals use their QR for. Methods In a cross-sectional observational study, a representative random sample out of 2,064 German hospitals (N=748) was invited to assess QR via questionnaire; 333 hospitals participated. We recorded the suitability of QR for representing number, type and quality of services, the adequacy of cost and benefits (6-level Likert scales) and additional purposes QR are used for (free text question). For representation purposes, the net sample was weighted for hospital size and hospital ownership (direct standardization). Data was analyzed descriptively and using inferential statistics (chi-2 test) or for the purpose of generating hypotheses. Results German hospitals rated the QR as suitable to represent the number of services but less so for the type and quality of services. The cost-benefit ratio was seen as inadequate. There were no significant differences between hospitals of different size or ownership. Public hospitals additionally used their reports for mostly internal purposes (e.g. comparison with competitors, quality management) whereas private ones used them externally (e.g. communication, marketing) (p=0.024, chi-2 test, hypotheses-generating level). Conclusions German hospitals consider the mandatory QR as only partially capable to put the legally defined aims effectively and efficiently into practice. In order for public reporting to achieve its potentially positive effects, the QR must be more closely aligned to the needs of hospitals. PMID:23114403

2012-01-01

338

Psychometric properties of the hospital survey on patient safety culture, HSOPSC, applied on a large Swedish health care sample  

PubMed Central

Background A Swedish version of the USA Agency for Healthcare Research and QualityHospital Survey on Patient Safety Culture” (S-HSOPSC) was developed to be used in both hospitals and primary care. Two new dimensions with two and four questions each were added as well as one outcome measure. This paper describes this Swedish version and an assessment of its psychometric properties which were tested on a large sample of responses from personnel in both hospital and primary care. Methods The questionnaire was mainly administered in web form and 84215 forms were returned (response rate 60%) between 2009 and 2011. Eleven per cent of the responses came from primary care workers and 46% from hospital care workers. The psychometric properties were analyzed using both the total sample and the hospital and primary care subsamples by assessment of construct validity and internal consistency. Construct validity was assessed by confirmatory (CFA) and exploratory factor (EFA) analyses and internal consistency was established by Cronbachs’s ?. Results CFA of the total, hospital and primary care samples generally showed a good fit while the EFA pointed towards a 9-factor model in all samples instead of the 14-dimension S-HSOPSC instrument. Internal consistency was acceptable with Cronbach’s ? values above 0.7 in a major part of the dimensions. Conclusions The S-HSOPSC, consisting of 14 dimensions, 48 items and 3 single-item outcome measures, is used both in hospitals and in primary care settings in Sweden for different purposes. This version of the original American instrument has acceptable construct validity and internal consistency when tested on large datasets of first-time responders from both hospitals and primary care centres. One common instrument for measurements of patient safety culture in both hospitals and primary care settings is an advantage since it enables comparisons between sectors and assessments of national patient safety improvement programs. Future research into this version of the instrument includes comparing results from patient safety culture measurements with other outcomes in relation to safety improvement strategies. PMID:23964867

2013-01-01

339

Improving service quality in primary care.  

PubMed

A framework for improving health care service quality was implemented at a 12-provider family medicine practice in 2010. A national patient satisfaction research vendor conducted weekly telephone surveys of 840 patients served by that practice: 280 patients served in 2009, and 560 served during 2010 and 2011. After the framework was implemented, the proportion of "excellent" ratings of provider service (the highest rating on a 5-point scale) increased by 5% to 9%, most notably thoroughness (P = .04), listening (P = .04), and explaining (P = .04). Other improvements included prompt test result notification and telephone staff courtesy (each by 10%, P = .02), as well as teamwork (by 8%, P = .04). Overall quality increased by 10% (P = .01), moving the practice from the 68th to the 91st percentile of medical practices in the research vendor's database. Improvements in patient satisfaction suggest that this framework may be useful in value-based payment models. PMID:24418754

Kennedy, Denise M; Nordrum, Jon T; Edwards, Frederick D; Caselli, Richard J; Berry, Leonard L

2015-01-01

340

Emergency Care and the National Quality Strategy: Highlights From the Centers for Medicare & Medicaid Services.  

PubMed

The Centers for Medicare & Medicaid Services (CMS) of the US Department of Health and Human Services seeks to optimize health outcomes by leading clinical quality improvement and health system transformation through a variety of activities, including quality measure alignment, prioritization, and implementation. CMS manages more than 20 federal quality measurement and public reporting programs that cover the gamut of health care providers and facilities, including both hospital-based emergency departments (EDs) and individual emergency physicians. With more than 130 million annual visits, and as the primary portal of hospital admission, US hospital-based EDs deliver a substantial portion of acute care to Medicare beneficiaries. Given the position of emergency care across clinical conditions and between multiple settings of care, the ED plays a critical role in fulfilling all 6 priorities of the National Quality Strategy. We outline current CMS initiatives and future opportunities for emergency physicians and EDs to effect each of these priorities and help CMS achieve the triple aim of better health, better health care, and lower costs. PMID:25128008

Venkatesh, Arjun K; Goodrich, Kate

2014-08-13

341

The central role of comorbidity in predicting ambulatory care sensitive hospitalizations*  

PubMed Central

Background: Ambulatory care sensitive hospitalizations (ACSHs) are commonly used as measures of access to and quality of care. They are defined as hospitalizations for certain acute and chronic conditions; yet, they are most commonly used in analyses comparing different groups without adjustment for individual-level comorbidity. We present an exploration of their roles in predicting ACSHs for acute and chronic conditions. Methods: Using 1998–99 US Medicare claims for 1 06 930 SEER-Medicare control subjects and 1999 Area Resource File data, we modelled occurrence of acute and chronic ACSHs with logistic regression, examining effects of different predictors on model discriminatory power. Results: Flags for the presence of a few comorbid conditions—congestive heart failure, chronic obstructive pulmonary disease, diabetes, hypertension and, for acute ACSHs, dementia—contributed virtually all of the discriminative ability for predicting ACSHs. C-statistics were up to 0.96 for models predicting chronic ACSHs and up to 0.87 for predicting acute ACSHs. C-statistics for models lacking comorbidity flags were lower, at best 0.73, for both acute and chronic ACSHs. Conclusion: Comorbidity is far more important in predicting ACSH risk than any other factor, both for acute and chronic ACSHs. Imputations about quality and access should not be made from analyses that do not control for presence of important comorbid conditions. Acute and chronic ACSHs differ enough that they should be modelled separately. Unaggregated models restricted to persons with the relevant diagnoses are most appropriate for chronic ACSHs. PMID:23543676

Wang, Ching-Yun; Dobie, Sharon A.; Green, Pamela K.; Baldwin, Laura-Mae

2014-01-01

342

Evaluation of the Impact of the Kuwait Diabetes Care Program on the Quality of Diabetes Care  

Microsoft Academic Search

Objectives: To evaluate the impact of the Kuwait Diabetes Care Program on the quality of care provided for diabetic patients in the Primary Health Care setting. Materials and Methods: The Kuwait Diabetes Care Program developed, published and disseminated clinical practice guidelines, conducted training courses, standards for diabetes care, and introduced a monitoring and evaluation system. Four audits (September 1999, October

Afaf Al-Adsani; Jamila Al-Faraj; Fatma Al-Sultan; Mohamed El-Feky; Nouria Al-Mezel; Wafik Saba; Sharifa Aljassar

2008-01-01

343

Clinical audit of multidisciplinary care at a medium-sized hospital in Spain  

PubMed Central

Background Multidisciplinary care is a key enabler in the provision of high quality care for cancer patients. Despite compelling evidence supporting their benefit to patients and for providers, multidisciplinary cancer conferences (MCC) are not universally occurring. Team composition of MCC reflects the multidisciplinary nature of the body. Lack of nursing input can have a negative impact on team decision making. The objective of this study was to evaluate multidisciplinary care and adherence to national recommendations at a medium-sized hospital through a clinical audit of cancer conferences and clinical records. Methods A total of 77 multidisciplinary cancer conferences were visited and 496 electronic health records were reviewed. The regularity of meetings and multidisciplinary attendance were evaluated. Each electronic health record was checked to verify documented prospective discussion before any treatment was started. Results Nine multidisciplinary teams meet on a weekly or biweekly basis at the hospital with an average number of ten people and six different specialties represented. Average duration of meetings was 46.8 min. Though most patients (64.5%) were discussed at some point at the relevant cancer conference, only 40% had a documented multidisciplinary team discussion prior to the first treatment. Pathological stage (pTNM) was documented in 53.6% of clinical records. Conclusions Nursing representatives should be included as usual attendees at cancer conferences. Prospective discussion of all cancer cases should be encouraged. Use of checklists and systematic collection of key information, specifically cancer staging, could improve clinical documentation in the electronic clinical record. PMID:24597686

2014-01-01

344

Service Quality of Delivered Care from the Perception of Women with Caesarean Section and Normal Delivery  

PubMed Central

Background: Our aim was to determine the service quality of delivered care for people with Caesarean Section and Normal Delivery. Methods: A cross-sectional study was conducted among 200 people who had caesarean section and normal delivery in Al-Zahra Teaching Hospital in Tabriz, north western Iran. Service quality was calculated using: Service Quality = 10 – (Importance × Performance) based on importance and performance of service quality aspects from the postpartum women’s perspective.A hierarchical regression analysis was applied in two steps using the enter method to examine the associations between demographics and SQ scores. Data were analysed using the SPSS-17 software. Results: “Confidentiality”, “autonomy”, “choice of care provider” and “communication” achieved scores at the highest level of quality; and “support group”, “prompt attention”, “prevention and early detection”, “continuity of care”, “dignity”, “safety”, “accessibility and “basic amenities” got service quality score less than eight. Statistically significant relationship was found between service quality score and continuity of care (P=0.008). Conclusion: A notable gap between the participants? expectations and what they have actually received in most aspects of provided care. So, there is an opportunityto improve the quality of delivered care. PMID:25650105

Tabrizi, Jafar S.; Askari, Samira; Fardiazar, Zahra; Koshavar, Hossein; Gholipour, Kamal

2014-01-01

345

Differential Susceptibility to Parenting and Quality Child Care  

ERIC Educational Resources Information Center

Research on differential susceptibility to rearing suggests that infants with difficult temperaments are disproportionately affected by parenting and child care quality, but a major U.S. child care study raises questions as to whether quality of care influences social adjustment. One thousand three hundred sixty-four American children from…

Pluess, Michael; Belsky, Jay

2010-01-01

346

Greek Day Care Centres' Quality, Caregivers' Behaviour and Children's Development.  

ERIC Educational Resources Information Center

Examined the relationship between preschool children's development and the quality of child care, group size, adult-child ratio, caregiving style, and caregiver child interactions in child care centers in Athens, Greece. Found that development could be predicted by the overall quality of the child care center, with smaller effect from group size.…

Petrogiannis, Konstantinos

2002-01-01

347

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

...prospective payment system for long-term care hospitals. 412.505 Section 412...Prospective Payment System for Long-Term Care Hospitals § 412.505 Conditions for...prospective payment system for long-term care hospitals. (a) Long-term care...

2014-10-01

348

Performance management excellence among the Malcolm Baldrige National Quality Award Winners in Health Care.  

PubMed

When carefully constructed, performance management systems can help health care organizations direct their efforts toward strategic goals, high performance, and continuous improvement needed to ensure high-quality patient care and cost control. The effective management of performance is an integral component in hospital and health care systems that are recognized for excellence by the Malcolm Baldrige National Quality Award in Health Care. Using the framework in the 2011-2012 Health Care Criteria for Performance Excellence, this article identifies the best practices in performance management demonstrated by 15 Baldrige recipients. The results show that all of the recipients base their performance management systems on strategic goals, outcomes, or competencies that cascade from the organizational to the individual level. At the individual level, each hospital or health system reinforces the strategic direction with performance evaluations of leaders and employees, including the governing board, based on key outcomes and competencies. Leader evaluations consistently include feedback from internal and external stakeholders, creating a culture of information sharing and performance improvement. The hospitals or health care systems also align their reward systems to promote high performance by emphasizing merit and recognition for contributions. Best practices can provide a guide for leaders in other health systems in developing high-performance work systems. PMID:24168871

Duarte, Neville T; Goodson, Jane R; Arnold, Edwin W

2013-01-01

349

Physician Patient-Sharing Networks and the Cost and Intensity of Care in US Hospitals  

PubMed Central

Background There is substantial variation in the cost and intensity of care delivered by US hospitals. We assessed how the structure of patient-sharing networks of physicians affiliated with hospitals might contribute to this variation. Methods We constructed hospital-based professional networks based on patient-sharing ties among 61,461 physicians affiliated with 528 hospitals in 51 hospital referral regions in the US using Medicare data on clinical encounters during 2006. We estimated linear regression models to assess the relationship between measures of hospital network structure and hospital measures of spending and care intensity in the last 2 years of life. Results The typical physician in an average-sized urban hospital was connected to 187 other doctors for every 100 Medicare patients shared with other doctors. For the average-sized urban hospital an increase of one standard deviation (SD) in the median number of connections per physician was associated with a 17.8% increase in total spending, in addition to 17.4% more hospital days, and 23.8% more physician visits (all p<0.001). In addition, higher “centrality” of primary care providers within these hospital networks was associated with 14.7% fewer medical specialist visits (p<0.001) as well as lower spending on imaging and tests (?9.2% and ?12.9% for 1 SD increase in centrality, p<0.001). Conclusions Hospital-based physician network structure has a significant relationship with an institution’s care patterns for their patients. Hospitals with doctors who have higher numbers of connections have higher costs and more intensive care, and hospitals with primary care-centered networks have lower costs and care intensity. PMID:22249922

Barnett, Michael L.; Christakis, Nicholas A.; O’Malley, A. James; Onnela, Jukka-Pekka; Keating, Nancy L.; Landon, Bruce E.

2011-01-01

350

Effects of the Program of All-Inclusive Care for the Elderly on Hospital Use  

ERIC Educational Resources Information Center

Purpose of the Study: This study evaluates the effects of the Program of All-Inclusive Care for the Elderly (PACE) on hospital use. PACE's capitated financing creates incentives to reduce the use of costly services. Furthermore, its emphasis on preventative care and regular monitoring by provides a mechanism for reducing unnecessary hospital use…

Meret-Hanke, Louise A.

2011-01-01

351

Care requirements of people with ARC\\/AIDS in Rome: Non-hospital services  

Microsoft Academic Search

In Italy, care for people with AIDS (PWA) is centred on hospital services. However, other services are beginning to develop, both in the form of residential facilities and of home care. It seems, therefore, important to define the type of non-hospital services that should be supplied on the basis of AIDS patients' real needs. The aim of this paper is

M. C. Marazzi; L. Palombi; S. Mancinelli; G. Liotta; A. Pana

1994-01-01

352

Prospects for comparing European hospitals in terms of quality and safety: lessons from a comparative study in five countries  

PubMed Central

Purpose Being able to compare hospitals in terms of quality and safety between countries is important for a number of reasons. For example, the 2011 European Union directive on patients' rights to cross-border health care places a requirement on all member states to provide patients with comparable information on health-care quality, so that they can make an informed choice. Here, we report on the feasibility of using common process and outcome indicators to compare hospitals for quality and safety in five countries (England, Portugal, The Netherlands, Sweden and Norway). Main Challenges Identified The cross-country comparison identified the following seven challenges with respect to comparing the quality of hospitals across Europe: different indicators are collected in each country; different definitions of the same indicators are used; different mandatory versus voluntary data collection requirements are in place; different types of organizations oversee data collection; different levels of aggregation of data exist (country, region and hospital); different levels of public access to data exist; and finally, hospital accreditation and licensing systems differ in each country. Conclusion Our findings indicate that if patients and policymakers are to compare the quality and safety of hospitals across Europe, then further work is urgently needed to agree the way forward. Until then, patients will not be able to make informed choices about where they receive their health care in different countries, and some governments will remain in the dark about the quality and safety of care available to their citizens as compared to that available in neighbouring countries. PMID:23292003

Burnett, Susan; Renz, Anna; Wiig, Siri; Fernandes, Alexandra; Weggelaar, Anne Marie; Calltorp, Johan; Anderson, Janet E.; Robert, Glenn; Vincent, Charles; Fulop, Naomi

2013-01-01

353

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

PubMed

Tele-emergency services provide immediate and synchronous audio/video connections, most commonly between rural low-volume hospitals and an urban "hub" emergency department. We performed a systematic literature review to identify tele-emergency models and outcomes. We then studied a large tele-emergency service in the upper Midwest. We sent a user survey to all seventy-one hospitals that used the service and received 292 replies. We also conducted telephone interviews and site visits with ninety clinicians and administrators at twenty-nine of these hospitals. Participants reported that tele-emergency improves clinical quality, expands the care team, increases resources during critical events, shortens time to care, improves care coordination, promotes patient-centered care, improves the recruitment of family physicians, and stabilizes the rural hospital patient base. However, inconsistent reimbursement policy, cross-state licensing barriers, and other regulations hinder tele-emergency implementation. New value-based payment systems have the potential to reduce these barriers and accelerate tele-emergency expansion. PMID:24493765

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

2014-02-01

354

Determinants of patient satisfaction with hospital health care in psychiatry: results based on the SATISPSY-22 questionnaire  

PubMed Central

Background The aim of our study was to identify patient- and care-related factors that are associated with patients’ satisfaction with psychiatric hospital care, using a specific, self-administered questionnaire based exclusively on the patient’s point of view: the Satisfaction with Psychiatry Care Questionnaire-22 (SATISPSY-22). Methods This cross-sectional study was conducted in the psychiatric departments of two French public university teaching hospitals. The data collected included sociodemographic information, clinical characteristics, care characteristics, and the SATISPSY-22. A multivariate analysis using multiple linear regressions was performed to determine the variables potentially associated with satisfaction levels. Results Two hundred seventy patients were enrolled in our study. Only one moderate association was found between satisfaction and sociodemographic characteristics: the personal experience dimension with age (?=0.15). Clinical improvement was moderately associated with higher global satisfaction (?=?0.15), higher satisfaction with quality of care (?=?0.19), and higher satisfaction with food (?=?0.18). Stronger associations with satisfaction were found for care characteristics, particularly the therapeutic alliance with all of the satisfaction dimensions (?, 0.20–0.43) except food, and for seclusion with global satisfaction (?=?0.33) and personal experience (?=?0.32). Patients with previous hospitalization also had a higher level of satisfaction with quality of care compared with patients who were admitted for the first time (?=?0.15). Conclusion This study has identified a number of potential determinants of satisfaction. The therapeutic relationship and seclusion were the most important features associated with a patient’s satisfaction. These factors might be amenable through intervention, which, in turn, might be expected to improve satisfaction, patients’ management, and health outcomes in psychiatric hospitals. PMID:25368515

Zendjidjian, Xavier Y; Auquier, Pascal; Lançon, Christophe; Loundou, Anderson; Parola, Nathalie; Faugère, Melanie; Boyer, Laurent

2014-01-01

355

Assessing the service quality of Iran military hospitals: Joint Commission International standards and Analytic Hierarchy Process (AHP) technique  

PubMed Central

Background: Military hospitals are responsible for preserving, restoring and improving the health of not only armed forces, but also other people. According to the military organizations strategy, which is being a leader and pioneer in all areas, providing quality health services is one of the main goals of the military health care organizations. This study was aimed to evaluate the service quality of selected military hospitals in Iran based on the Joint Commission International (JCI) standards and comparing these hospitals with each other and ranking them using the analytic hierarchy process (AHP) technique in 2013. Materials and Methods: This was a cross-sectional and descriptive study conducted on five military hospitals, selected using the purposive sampling method, in 2013. Required data collected using checklists of accreditation standards and nominal group technique. AHP technique was used for prioritizing. Furthermore, Expert Choice 11.0 was used to analyze the collected data. Results: Among JCI standards, the standards of access to care and continuity of care (weight = 0.122), quality improvement and patient safety (weight = 0.121) and leadership and management (weight = 0.117) had the greatest importance, respectively. Furthermore, in the overall ranking, BGT (weight = 0.369), IHM (0.238), SAU (0.202), IHK (weight = 0.125) and SAB (weight = 0.066) ranked first to fifth, respectively. Conclusion: AHP is an appropriate technique for measuring the overall performance of hospitals and their quality of services. It is a holistic approach that takes all hospital processes into consideration. The results of the present study can be used to improve hospitals performance through identifying areas, which are in need of focus for quality improvement and selecting strategies to improve service quality. PMID:25250364

Bahadori, Mohammadkarim; Ravangard, Ramin; Yaghoubi, Maryam; Alimohammadzadeh, Khalil

2014-01-01

356

Taking the Time to Care: Empowering Low Health Literacy Hospital Patients with Virtual Nurse Agents  

E-print Network

1 Taking the Time to Care: Empowering Low Health Literacy Hospital Patients with Virtual Nurse.jack@bmc.org} ABSTRACT Ninety million Americans have inadequate health literacy, resulting in a reduced ability to read interface for educating and counseling hospital patients with inadequate health literacy in their hospital

Bickmore, Timothy

357

An Epidemiologic Study on Aging and Dysphagia in the Acute Care Hospitalized Population: 2000–2007  

Microsoft Academic Search

Objectives: To describe total and yearly demographic trends relative to aging, dysphagia referral rates and oral feeding status in hospitalized patients from 2000 through 2007. Methods: We evaluated a prospective, consecutive, referred sample of 4,038 hospitalized patients in an urban, tertiary, acute care teaching hospital. Dysphagia referral rates are described according to year, age (decade), sex, admitting diagnostic category, results

Steven B. Leder; Debra M. Suiter

2009-01-01

358

Consumer Perspectives on Quality in Adult Day Care  

Microsoft Academic Search

Purpose: The purpose of this project was to gain insight into the quality of care and services provided through adult day care from the user’s perspective. Design and Methods: The project utilized 13 focus groups to explore aspects associated with user needs, preferences, and satisfaction with adult day care centers. Results: Focus group participants described aspects of adult day care

Amy Leventhal Stern; Francis G. Caro

2004-01-01

359

Exploring Reasons for Bed Pressures in Winnipeg Acute Care Hospitals  

ERIC Educational Resources Information Center

Hospital overcrowding has plagued Winnipeg and other Canadian cities for years. This study explored factors related to overcrowding. Hospital files were used to examine patterns of hospital use from fiscal years 1996/1997 to 1999/2000. Chart reviews were conducted to examine appropriateness of admissions and hospital stays during one pressure…

Menec, Verena H.; Bruce, Sharon; MacWilliam, Leonard R.

2005-01-01

360

Influenza vaccination performance measurement among acute care hospital-based health care personnel--United States, 2013-14 influenza season.  

PubMed

Annual influenza vaccination is recommended for all health care personnel (HCP). In August 2011, the Centers for Medicare and Medicaid Services (CMS) published a final rule requiring acute care hospitals that participate in its Hospital Inpatient Quality Reporting Program to report HCP influenza vaccination data through the National Healthcare Safety Network (NHSN) beginning January 1, 2013. Data reported by 4,254 acute care hospitals, covering the period October 1, 2013, through March 31, 2014, were analyzed to collect estimates of the proportion of HCP vaccinated nationally and by state for three groups: (1) employees, (2) licensed independent practitioners (LIPs), and (3) adult students/trainees and volunteers. Overall in the United States, 81.8% of hospital-based HCP were reported vaccinated, with the highest proportion (86.1%) among employees and the lowest (61.9%) among LIPs. The proportion reported vaccinated varied widely by state, with ranges of 69.0%-97.6% for employees, 33.8%-93.6% for LIPs, and 50.3%-96.3% for adult students/trainees and volunteers. Public reporting of vaccination data has been shown to increase HCP influenza vaccination coverage. These new NHSN data provide a baseline for measuring changes in future hospital-based reporting of HCP influenza vaccination. PMID:25233282

Lindley, Megan C; Bridges, Carolyn B; Strikas, Raymond A; Kalayil, Elizabeth J; Woods, LaDora O; Pollock, Daniel; Sievert, Dawn

2014-09-19

361

QUALITY IMPROVEMENT ACTIVITIES IN HEALTH CARE VERSUS RESEARCH  

E-print Network

1 QUALITY IMPROVEMENT ACTIVITIES IN HEALTH CARE VERSUS RESEARCH 04/30/2013 Policy Scope."1 Quality improvement (QI) in health care, unlike research, focuses on translating existing In general, a quality improvement (QI) project does not need to be submitted to the IRB. An IRB submission

362

Strained Mercy: The Quality of Medical Care in Delhi  

Microsoft Academic Search

The quality of medical care is a potentially important determinant of health outcomes. Nevertheless, it remains an understudied area. The limited research that exists defines quality either on the basis of drug availability or facility characteristics, but little is known about how provider quality affects the provision of health care. Das and Hammer address this gap through a survey in

Jishnu Das; Jeffrey Hammer

2004-01-01

363

Child Care in the American South: Poverty, Costs, and Quality  

ERIC Educational Resources Information Center

High-quality child care has been shown to improve the academic success and life adjustments of children living in poverty. During the past decade, many American states have adopted voluntary Quality Rating and Improvement (QRI) systems in an attempt to increase the level of quality in child care. Using data compiled by the National Association of…

Collins, Vikki K.

2012-01-01

364

Effect of empowerment on quality of life and social ability of road traffic accident disables in Khon Kaen Hospital  

Microsoft Academic Search

This Action Research aimed to develop quality of life of the traffic accident disables who mostly were less opportunity socioeconomic status youth, admitted in Khon Kaen Hospital due to severe injury from traffic accident and holistic care Multidisciplinary team provided. Sample were 25 traffic accident 23 men and 2 women average ages was 41 (min-max= 6–87 years, Mode = 25)

P Shawong; J Chantarasiri; S Kulleub; T Kaesri; T Srilamai; T Maneerat

2010-01-01

365

Evaluating the Quality of the Child Care in Finland  

ERIC Educational Resources Information Center

In this study we examine parents' and teachers' perceptions of the early childhood education and care (ECEC) quality in Finland. The study is based on the paradigm of inclusionary quality and the assessment is based on the quality evaluation model. The parents and teachers assess the quality to be good. The strength of the quality was the effect…

Hujala, Eeva; Fonsen, Elina; Elo, Janniina

2012-01-01

366

Reasons for Delayed Orchiopexies in a Korean Tertiary Care Hospital  

PubMed Central

Purpose Since the 1990s, it has been well known that orchiopexies should be performed by no later than 2 years of age. Nevertheless, studies from other countries report a substantial number of delayed orchiopexies. On the basis of an analysis of a tertiary care hospital database, we aimed to investigate the incidence of delayed orchiopexies performed in patients after 5 years of age and to understand the causes of such delays and the possible consequences. Materials and Methods We retrospectively analyzed the surgical database of Seoul National University Hospital between 2004 and 2012 and detected patients who underwent orchiopexy later than 5 years of age. Reasons for delayed orchiopexies were studied and the possible consequences of delayed orchiopexies were assessed with respect to surgical difficulty and testicular volume. Results We found 160 cases of delayed orchiopexies, which accounted for about 15% of all orchiopexies performed. Two major reasons for delay were related to the parents of the child: parental delay and parental request for the treatment of persistent retractile testis. Acquired cryptorchidism was found in 21 cases (13.1%), mainly associated with hypospadias. Surgical difficulty, especially owing to a short testicular cord, was encountered in 48 cases (30.2%), and a comparison with age-matched normative values showed substantially smaller testicular volume. Conclusions Despite well-established guidelines for the optimal age of surgery, 15% of orchiopexies were not performed at a proper time. Improved propagation of an optimal age limit is necessary to reduce the rate of delayed orchiopexies considering increases in surgical difficulty and potential testicular growth retardation. PMID:24466401

Ahn, Hyunsoo; Lee, Hahn Ey; Choi, Hwang

2014-01-01

367

Pattern of Blood Stream Infections within Neonatal Intensive Care Unit, Suez Canal University Hospital, Ismailia, Egypt  

PubMed Central

Introduction. Blood stream infection (BSI) is a common problem of newborn in neonatal intensive care units (NICUs). Monitoring neonatal infections is increasingly regarded as an important contributor to safe and high-quality healthcare. It results in high mortality rate and serious complications. So, our aim was to determine the incidence and the pattern of BSIs in the NICU of Suez Canal University Hospital, Egypt, and to determine its impact on hospitalization, mortality, and morbidity. Methods. This study was a prospective one in which all neonates admitted to the NICUs in Suez Canal University hospital between January, 2013 and June 2013 were enrolled. Blood stream infections were monitored prospectively. The health care associated infection rate, mortality rate, causative organism, and risk factors were studied. Results. A total of 317 neonates were admitted to the NICU with a mortality rate of 36.0%. During this study period, 115/317 (36.3%) developed clinical signs of sepsis and were confirmed as BSIs by blood culture in only 90 neonates with 97 isolates. The total mean length of stay was significantly longer among infected than noninfected neonates (34.5 ± 18.3 and 10.8 ± 9.9 days, resp., P value < 0.001). The overall mortality rates among infected and noninfected neonates were 38.9% and 34.8%, respectively, with a significant difference. Klebsiella spp. were the most common pathogen (27.8%) followed by Pseudomonas (21.6%) and Staphylococcus aureus (15.4%). Conclusion. The rate of BSIs in NICU at Suez Canal University Hospital was relatively high with high mortality rate (36.0%). PMID:25389439

Kishk, Rania Mohammed; Mandour, Mohamed Fouad; Farghaly, Rasha Mohamed; Ibrahim, Ahmed; Nemr, Nader Attia

2014-01-01

368

Alternate Level of Care Patients in Hospitals: What Does Dementia Have To Do With This?  

PubMed Central

Background Patients in acute care hospitals no longer in need of acute care are called Alternate Level of Care (ALC) patients. This is growing and common all across Canada. A better understanding of this patient population would help to address this problem. Methods A chart review was conducted in two hospitals in New Brunswick. All patients designated as ALC on July 1, 2009 had their charts reviewed. Results Thirty-three per cent of the hospital beds were occupied with ALC patients; 63% had a diagnosis of dementia. The mean length of stay was 379.6 days. Eighty-six per cent were awaiting a long-term care bed in the community. Most patients experienced functional decline during their hospitalization. One year prior to admission, 61% had not been admitted to hospital and 59.2% had had at least one visit to the emergency room. Conclusions The majority of the ALC patients in hospital have a diagnosis of dementia and have been waiting in hospital for over one year for a long-term care bed in the community. Many participants were recipients of maximum home care in the community, suggesting home maker services alone may not be adequate for some community-dwelling older adults. Early diagnosis of dementia, coupled with appropriate care in the community, may help to curtail the number of patients with dementia who end up in hospital as ALC patients. PMID:25232367

McCloskey, Rose; Jarrett, Pamela; Stewart, Connie; Nicholson, Patricia

2014-01-01

369

Measurement of Quality of Care and Quality of Life at the End of Life  

Microsoft Academic Search

Purpose: Consumers and providers demand better indi- cators for quality of care and quality of life at the end of life. This article presents recommendations for advancing the science of measurement at end of life. Design and Methods: The authors reviewed the extant literature and applied the Institute of Medicine's conceptual framework for national health care quality to end-of-life care

Virginia P. Tilden; Susan Tolle; Linda Drach; Susan Hickman

2002-01-01

370

Dual diagnosis patients in community or hospital care: One-year outcomes and health care utilization and costs  

Microsoft Academic Search

Background: Services for dual diagnosis patients are strained by reductions in hospital-based inpatient treatment facilities and the lengths of inpatient stays in order to reduce health care costs. Aims: This study evaluated the effectiveness and cost-effectiveness of community- and hospital-based acute residential treatment for dually disordered patients, and whether moderately-ill patients benefitted more from community care, and severely-ill patients from

Christine Timko; Shuo Chen; Jill Sempel; Paul Barnett

2006-01-01

371

Effect of a national primary care pay for performance scheme on emergency hospital admissions for ambulatory care sensitive conditions: controlled longitudinal study  

PubMed Central

Objective To estimate the impact of a national primary care pay for performance scheme, the Quality and Outcomes Framework in England, on emergency hospital admissions for ambulatory care sensitive conditions (ACSCs). Design Controlled longitudinal study. Setting English National Health Service between 1998/99 and 2010/11. Participants Populations registered with each of 6975 family practices in England. Main outcome measures Year specific differences between trend adjusted emergency hospital admission rates for incentivised ACSCs before and after the introduction of the Quality and Outcomes Framework scheme and two comparators: non-incentivised ACSCs and non-ACSCs. Results Incentivised ACSC admissions showed a relative reduction of 2.7% (95% confidence interval 1.6% to 3.8%) in the first year of the Quality and Outcomes Framework compared with ACSCs that were not incentivised. This increased to a relative reduction of 8.0% (6.9% to 9.1%) in 2010/11. Compared with conditions that are not regarded as being influenced by the quality of ambulatory care (non-ACSCs), incentivised ACSCs also showed a relative reduction in rates of emergency admissions of 2.8% (2.0% to 3.6%) in the first year increasing to 10.9% (10.1% to 11.7%) by 2010/11. Conclusions The introduction of a major national pay for performance scheme for primary care in England was associated with a decrease in emergency admissions for incentivised conditions compared with conditions that were not incentivised. Contemporaneous health service changes seem unlikely to have caused the sharp change in the trajectory of incentivised ACSC admissions immediately after the introduction of the Quality and Outcomes Framework. The decrease seems larger than would be expected from the changes in the process measures that were incentivised, suggesting that the pay for performance scheme may have had impacts on quality of care beyond the directly incentivised activities. PMID:25389120

Harrison, Mark J; Dusheiko, Mark; Sutton, Matt; Gravelle, Hugh; Doran, Tim

2014-01-01

372

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

Federal Register 2010, 2011, 2012, 2013

...to figures and data for the Hospital Readmissions Reduction program. Since that time...the errors related to the Hospital Readmissions Reduction Program included in October...corrections to figures regarding the Hospital Readmissions Reduction Program, we made an...

2013-03-13

373

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

ERIC Educational Resources Information Center

This paper presents a profile of Louisiana's Quality Start Child Care Rating System prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs;…

Child Trends, 2010

2010-01-01

374

Tennessee Star-Quality Child Care Program: QRS Profile. The Child Care Quality Rating System (QRS) Assessment  

ERIC Educational Resources Information Center

This paper presents a profile of Tennessee's Star-Quality Child Care Program prepared as part of the Child Care Quality Rating System (QRS) Assessment Study. The profile consists of several sections and their corresponding descriptions including: (1) Program Information; (2) Rating Details; (3) Quality Indicators for Center-Based Programs; (4)…

Child Trends, 2010

2010-01-01

375

The Quality of Primary Care in a Country with Universal Health Care Coverage  

Microsoft Academic Search

BACKGROUND  Standard indicators of quality of care have been developed in the United States. Limited information exists about quality\\u000a of care in countries with universal health care coverage.\\u000a \\u000a \\u000a \\u000a \\u000a OBJECTIVE  To assess the quality of preventive care and care for cardiovascular risk factors in a country with universal health care\\u000a coverage.\\u000a \\u000a \\u000a \\u000a \\u000a DESIGN AND PARTICIPANTS  Retrospective cohort of a random sample of 1,002 patients aged

Tinh-Hai Collet; Sophie Salamin; Lukas Zimmerli; Eve A. Kerr; Carole Clair; Michel Picard-Kossovsky; Eric Vittinghoff; Edouard Battegay; Jean-Michel Gaspoz; Jacques Cornuz; Nicolas Rodondi

2011-01-01

376

42 CFR 412.536 - Special payment provisions for long-term care hospitals and satellites of long-term care...  

... Special payment provisions for long-term care hospitals and satellites of long-term care hospitals that discharged Medicare patients...building or on the same campus as the long-term care hospital or satellite of the long-term...

2014-10-01

377

Beyond ‘unloving care’: linking human resource management and patient care quality in nursing homes  

Microsoft Academic Search

This study examines the link between human resource management, (HRM), work organization and patient care quality in US long-term care settings, proposing a key role for both management philosophy and improved front-line staffing arrangements in delivering consistently higher quality care, defined to include both physical and psychological outcomes. Using the ‘high performance’ model from industrial relations as a lens, the

Susan C. Eaton

2000-01-01

378

Child Care and Mothers' Mental Health: Is High-Quality Care Associated with Fewer Depressive Symptoms?  

ERIC Educational Resources Information Center

Finding high-quality child care may pose financial and logistical challenges and create ongoing emotional strains for some mothers. We use the Study of Early Child Care and Youth Development to ask (a) are child-care settings that mothers select on the basis of their own perceptions of quality rated more highly by independent observers (and more…

Gordon, Rachel A.; Usdansky, Margaret L.; Wang, Xue; Gluzman, Anna

2011-01-01

379

House Staff Quality Council: One Institution's Experience to Integrate Resident Involvement in Patient Care Improvement Initiatives  

PubMed Central

Background Residents and fellows perform a large portion of the hands-on patient care in tertiary referral centers. As frontline providers, they are well suited to identify quality and patient safety issues. As payment reform shifts hospitals to a fee-for-value–type system with reimbursement contingent on quality outcomes, preventive health, and patient satisfaction, house staff must be intimately involved in identifying and solving care delivery problems related to quality, outcomes, and patient safety. Many challenges exist in integrating house staff into the quality improvement infrastructure; these challenges may ideally be managed by the development of a house staff quality council (HSQC). Methods Residents and fellows at Scott & White Memorial Hospital interested in participating in a quality council submitted an application, curriculum vitae, and letter of support from their program director. Twelve residents and fellows were selected based on their prior quality improvement experience and/or their interest in quality and safety initiatives. Results In only 1 year, our HSQC, an Alliance of Independent Academic Medical Centers National Initiative III project, initiated 3 quality projects and began development of a fourth project. Conclusion Academic medical centers should consider establishing HSQCs to align institutional quality goals with residency training and medical education. PMID:24052771

Dixon, Jennifer L.; Papaconstantinou, Harry T.; Erwin, John P.; McAllister, Russell Keith; Berry, Tiffany; Wehbe-Janek, Hania

2013-01-01

380

Organizational Determinants of Work Outcomes and Quality Care Ratings Among Army Medical Department Registered Nurses  

PubMed Central

The Practice Environment Scale of the Nursing Work Index, the Maslach Burnout Inventory, and several single-item measures were administered to registered nurses (RNs) working within 23 U.S.-based Army Medical Department (AMEDD) hospitals. Data were analyzed with logistic regression for nested data. Unfavorable nursing practice environments had a substantial association with job dissatisfaction (OR 13.75, p < .01), emotional exhaustion (OR 12.70, p < .01), intent to leave (OR 3.03, p < .01), and fair to poor quality of care (OR 10.66, p < .01). This study provides the first system-wide analyses of nursing practice environments in AMEDD hospitals in the U.S. Similar to findings in civilian samples, poor quality work environments are associated with less favorable RN work outcomes and quality of care ratings. PMID:20151409

Patrician, Patricia A.; Shang, Jingjing; Lake, Eileen T.

2010-01-01

381

Decreasing antibiotic overuse in neonatal intensive care units: quality improvement research  

PubMed Central

Overutilization of antibiotics and emergence of resistant bacteria are important problems, particularly in intensive care units. To date, reproducible interventions to improve antibiotic utilization in hospitals have not been proven to be effective or safe. Evidence-based medicine, clinical practice guidelines, and health information technology are frequently promoted as means to cross the “quality chasm” described by the Institute of Medicine. This article outlines how these approaches intersect in a strategy for quality improvement research evaluating the safety and effectiveness of clinical practice guidelines designed to improve antibiotic use in neonatal intensive care units. PMID:16200185

2005-01-01

382

Managing Quality in Health Care: Involving Patient Care Information Systems and Healthcare Professionals in Quality Monitoring and Improvement  

Microsoft Academic Search

It is no longer possible to ignore the issue of quality in health care. Care institutions strive to\\u000aprovide all patients with effective, efficient, safe, timely, patient-centered care. Increased\\u000aattention for quality is also found in discussions regarding use of information and\\u000acommunication technologies (ICTs) in health care processes. In these discussions, ICT is almost\\u000aalways brought into a direct

Mul de M

2009-01-01

383

Quality of sleep for hospitalized patients in Rasoul-Akram hospital  

PubMed Central

Background: Sleep disturbances have negative effects on medical conditions, mental health and cognitive performance. It was shown that about 60% of inpatients suffer from sleep problems. The aim of this study was to assess the correlation between sleep quality and other factors in the inpatients of Rasoul-e-Akram hospital. Methods: In this cross-sectional study, all the hospitalized patients in twelve wards of Rasoul-e-Akram hospital during September 2012, were examined. Sleeping habits of 209 inpatients of different wards were assessed through the Persian version of Pittsburgh Sleep Questionnaire (PSQI). A self-designed 18- question questionnaire was conducted for all patients in order to assess their attitude to interior and atmosphere of wards. Content validity and test retest reliability were evaluated. The pain level was also measured by the visual analog scale (VAS) and scores analyzed by the statistical methods of frequency, percentage, chi-square and logistic regression. Results: The mean of the total scores in PSQI was 8.8±4.8 and 70.8% of the patients were 'poor sleepers' (global PSQI> 5). Age and gender had no effect on the PSQI total score, but the number of roommates, type of the ward, hospitalization period, presence and severity of pain, taking sleep medication and attitude toward the overall atmosphere and interior of wards have caused deviation in scores. Conclusion: Sleep problems are quite frequent in medical inpatients. Pain management and modification of the ward interior and atmosphere can impact inpatients sleep quality. PMID:25405138

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

2014-01-01

384

Methodological challenges in using the Finnish Hospital Discharge Register for studying fire-related injuries leading to inpatient care  

PubMed Central

Background The objective was to examine feasibility of using hospital discharge register data for studying fire-related injuries. Methods The Finnish National Hospital Discharge Register (FHDR) was the database used to select relevant hospital discharge data to study usability and data quality issues. Patterns of E-coding were assessed, as well as prominent challenges in defining the incidence of injuries. Additionally, the issue of defining the relevant amount of hospital days accounted for in injury care was considered. Results Directly after the introduction of the ICD-10 classification system, in 1996, the completeness of E-coding was found to be poor, but to have improved dramatically around 2000 and thereafter. The scale of the challenges to defining the incidence of injuries was found to be manageable. In counting the relevant hospital days, psychiatric and long-term care were found to be the obvious and possible sources of overestimation. Conclusions The FHDR was found to be a feasible data source for studying fire-related injuries so long as potential challenges are acknowledged and taken into account. Hospital discharge data can be a unique and powerful means for injury research as issues of representativeness and coverage of traditional probability samples can frequently be completely avoided. PMID:23496937

2013-01-01

385

42 CFR 482.66 - Special requirements for hospital providers of long-term care services (“swing-beds”).  

Code of Federal Regulations, 2010 CFR

... Special requirements for hospital providers of long-term care...MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES...CONDITIONS OF PARTICIPATION FOR HOSPITALS Requirements for Specialty Hospitals § 482.66 Special...

2010-10-01

386

Parallels and distinctions between health care quality improvement and health care disparities reduction  

Microsoft Academic Search

Purpose – This paper aims to compare and contrast quality improvement in the domain of health care disparities with quality improvement in other domains. Design\\/methodology\\/approach – The author provides a descriptive essay and review to put forward the findings of their research. Findings – In the USA, health care quality improvement systems have largely been accepted and institutionalized. Most if

Wally R. Smith

2007-01-01

387

OECD Health Care Quality Indicator Project. The expert panel on primary care prevention and health promotion  

Microsoft Academic Search

Purpose. This article describes a project undertaken as part of the Organization for Economic Co-operation and Development (OECD)'s Healthcare Quality Indicator (HCQI) Project, which aimed to develop a set of quality indicators representing the domains of primary care, prevention and health promotion, and which could be used to assess the performance of primary care systems. Methods. Existing quality indicators from

MARTIN MARSHALL; NIEK KLAZINGA; SHEILA LEATHERMAN; CHARLIE HARDY; ECKHARD BERGMANN; LUIS PISCO; SOEREN MATTKE; JAN MAINZ

2006-01-01

388

Priority Queuing Models for Hospital Intensive Care Units and Impacts to Severe Case Patients  

PubMed Central

This paper examines several different queuing models for intensive care units (ICU) and the effects on wait times, utilization, return rates, mortalities, and number of patients served. Five separate intensive care units at an urban hospital are analyzed and distributions are fitted for arrivals and service durations. A system-based simulation model is built to capture all possible cases of patient flow after ICU admission. These include mortalities and returns before and after hospital exits. Patients are grouped into 9 different classes that are categorized by severity and length of stay (LOS). Each queuing model varies by the policies that are permitted and by the order the patients are admitted. The first set of models does not prioritize patients, but examines the advantages of smoothing the operating schedule for elective surgeries. The second set analyzes the differences between prioritizing admissions by expected LOS or patient severity. The last set permits early ICU discharges and conservative and aggressive bumping policies are contrasted. It was found that prioritizing patients by severity considerably reduced delays for critical cases, but also increased the average waiting time for all patients. Aggressive bumping significantly raised the return and mortality rates, but more conservative methods balance quality and efficiency with lowered wait times without serious consequences. PMID:24551379

Hagen, Matthew S.; Jopling, Jeffrey K; Buchman, Timothy G; Lee, Eva K.

2013-01-01

389

Priority queuing models for hospital intensive care units and impacts to severe case patients.  

PubMed

This paper examines several different queuing models for intensive care units (ICU) and the effects on wait times, utilization, return rates, mortalities, and number of patients served. Five separate intensive care units at an urban hospital are analyzed and distributions are fitted for arrivals and service durations. A system-based simulation model is built to capture all possible cases of patient flow after ICU admission. These include mortalities and returns before and after hospital exits. Patients are grouped into 9 different classes that are categorized by severity and length of stay (LOS). Each queuing model varies by the policies that are permitted and by the order the patients are admitted. The first set of models does not prioritize patients, but examines the advantages of smoothing the operating schedule for elective surgeries. The second set analyzes the differences between prioritizing admissions by expected LOS or patient severity. The last set permits early ICU discharges and conservative and aggressive bumping policies are contrasted. It was found that prioritizing patients by severity considerably reduced delays for critical cases, but also increased the average waiting time for all patients. Aggressive bumping significantly raised the return and mortality rates, but more conservative methods balance quality and efficiency with lowered wait times without serious consequences. PMID:24551379

Hagen, Matthew S; Jopling, Jeffrey K; Buchman, Timothy G; Lee, Eva K

2013-01-01

390

Appraising Hospital Performance by Using the JCHAO/CMS Quality Measures in Southern Italy  

PubMed Central

Objectives The main objective of the present study was to estimate the uptake to quality indicators that reflect the current evidence-based recommendations and guidelines. Methods A retrospective review of medical records of patients admitted to two hospitals in the South of Italy was conducted. For the purposes of the analysis, a sets of quality indicators has been used from the Joint Commission on Accreditation of Hospital Organizations and Centers for Medicare & Medicaid Services. Four areas of care were selected: acute myocardial infarction (AMI), heart failure (HF), pneumonia (PN), and surgical care improvement project (SCIP). Frequency or median was calculated, as appropriate, for each indicator. A composite score was calculated to estimate the overall performance for each area of care. Results A total of 1772 medical records were reviewed. The adherence rates showed a wide-ranging variability among the selected indicators. The use of aspirin and angiotensin-converting enzyme inhibitor (ACEI) or angiotensin receptor blocker (ARB) for AMI, the use of ACEI or ARB for HF, the use of appropriate thromboembolism prophylaxis and appropriate hair removal for surgical patients almost approached optimal adherence. At the other extreme, rates regarding adherence to smoking-cessation counseling in AMI and HF patients, discharge instructions in HF patients, and influenza and pneumococcal vaccination in pneumonia patients were noticeably intangible. Overall, the recommended processes of care among eligible patients were provided in 70% for AMI, in 32.4% for HF, in 46.4% for PN, and in 46% for SCIP. Conclusions The results show that there is still substantial work that lies ahead on the way to improve the uptake to evidence-based processes of care. Improvement initiatives should be focused more on domains of healthcare than on specific conditions, especially on the area of preventive care. PMID:23145023

Flotta, Domenico; Rizza, Paolo; Coscarelli, Pierluigi; Pileggi, Claudia; Nobile, Carmelo G. A.; Pavia, Maria

2012-01-01

391

Medicare spending, mortality rates, and quality of care.  

PubMed

We applied instrumental variable analysis to a sample of 388,690 Medicare beneficiaries predicted to be high-cost cases to estimate the effects of medical care use on the relative odds of death or experiencing an avoidable hospitalization in 2006. Contrary to conclusions from the observational geographic variations literature, the results suggest that greater medical care use is associated with statistically significant and quantitatively meaningful health improvements: a 10% increase in medical care use is associated with a 8.4% decrease in the mortality rate and a 3.8% decrease in the rate of avoidable hospitalizations. PMID:22399369

Hadley, Jack; Reschovsky, James D

2012-03-01

392

Effect of a Restorative Model of Posthospital Home Care on Hospital Readmissions  

PubMed Central

OBJECTIVES To compare readmissions of Medicare recipients of usual home care and a matched group of recipients of a restorative model of home care. DESIGN Quasiexperimental; matched and unmatched. SETTING Community, home care. PARTICIPANTS Seven hundred seventy individuals receiving care from a large home care agency after hospitalization. INTERVENTION A restorative care model based on principles adapted from geriatric medicine, nursing, rehabilitation, goal attainment, chronic care management, and behavioral change theory. MEASUREMENTS Hospital readmission, length of home care episode. RESULTS Among the matched pairs, 13.2% of participants who received restorative care were readmitted to an acute hospital during the episode of home care, versus 17.6% of those who received usual care. Individuals receiving the restorative model of home care were 32% less likely to be readmitted than those receiving usual care (conditional odds ratio = 0.68, 95% confidence interval = 0.43–1.08). The mean length of home care episodes was 20.3 ± 14.8 days in the restorative care group and 29.1 ± 31.7 days in the usual care group (P < .001). Results were similar in unmatched analyses. CONCLUSION Although statistical significance was marginal, results suggest that the restorative care model offers an effective approach to reducing the occurrence of avoidable readmissions. It was previously shown that the restorative model of home care was associated with better functional recovery, fewer emergency department visits, and shorter episodes of home care. This model could be incorporated into usual home care practices and care delivery redesign. PMID:22860756

Tinetti, Mary E.; Charpentier, Peter; Gottschalk, Margaret; Baker, Dorothy I.

2014-01-01

393

Transitional care strategies from hospital to home: a review for the neurohospitalist.  

PubMed

Hospitals are challenged with reevaluating their hospital's transitional care practices, to reduce 30-day readmission rates, prevent adverse events, and ensure a safe transition of patients from hospital to home. Despite the increasing attention to transitional care, there are few published studies that have shown significant reductions in readmission rates, particularly for patients with stroke and other neurologic diagnoses. Successful hospital-initiated transitional care programs include a "bridging" strategy with both predischarge and postdischarge interventions and dedicated transitions provider involved at multiple points in time. Although multicomponent strategies including patient engagement, use of a dedicated transition provider, and facilitation of communication with outpatient providers require time and resources, there is evidence that neurohospitalists can implement a transitional care program with the aim of improving patient safety across the continuum of care. PMID:25553228

Rennke, Stephanie; Ranji, Sumant R

2015-01-01

394

Quality of hospital service: a study comparing 'Asian' and 'non-Asian' patients in Middlesbrough.  

PubMed

To compare 'Asian' and 'non-Asian' patients' experience of and satisfaction with non-clinical aspects of their hospital care, and to evaluate the effect of subsequent provision of 'Asian' food, we undertook interview surveys of recently discharged adult patients in Middlesbrough. Fifty-two 'Asians' and 52 'non-Asians' matched for sex, age, specialty of admission and hospital reported similar experiences in regard to the amount of information received, the presence of medical students during examination, and satisfaction with privacy and visiting arrangements. The main differences between the groups related to the receipt of written information in the patients' first language, 'Asian' patients' inability to communicate because of lack of English and their dissatisfaction with existing interpreting arrangements, 'Asian' women's attitudes to examination by male doctors, and provision of and satisfaction with hospital food. For example, 47 (90 per cent) 'Asians' and 14 (27 per cent) 'non-Asians' required a special diet but 19 per cent and 86 per cent, respectively, received it; and 'Asians' were less satisfied with the food overall. Despite being disadvantaged 'Asian' patients seldom complained. Following the provision of 'Asian' food, 'Asian' patients reported satisfaction levels comparable with those of 'non-Asians'. Equitable health care provision for ethnic minorities requires a level of service comparable with that enjoyed by the majority community. Written information in minority languages, professional interpreters, examination of female patients by women doctors and culturally suitable food were confirmed as priority needs. Staff training and community education may ensure successful implementation of policy on health care of ethnic minorities. Finally, the quality of non-clinical care in hospital needs to be raised for all groups of patients. PMID:1419205

Madhok, R; Bhopal, R S; Ramaiah, R S

1992-09-01

395

42 CFR 413.114 - Payment for posthospital SNF care furnished by a swing-bed hospital.  

...2014-10-01 false Payment for posthospital SNF care furnished by a swing-bed hospital... § 413.114 Payment for posthospital SNF care furnished by a swing-bed hospital...which provides for payment for posthospital SNF care furnished by rural hospitals and...

2014-10-01

396

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

Code of Federal Regulations, 2010 CFR

...the prospective payment system for long-term care hospitals. 412.505 Section... Prospective Payment System for Long-Term Care Hospitals § 412.505 Conditions...the prospective payment system for long-term care hospitals. (a) Long-term...

2010-10-01

397

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

Code of Federal Regulations, 2013 CFR

...the prospective payment system for long-term care hospitals. 412.505 Section... Prospective Payment System for Long-Term Care Hospitals § 412.505 Conditions...the prospective payment system for long-term care hospitals. (a) Long-term...

2013-10-01

398

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

Code of Federal Regulations, 2012 CFR

...the prospective payment system for long-term care hospitals. 412.505 Section... Prospective Payment System for Long-Term Care Hospitals § 412.505 Conditions...the prospective payment system for long-term care hospitals. (a) Long-term...

2012-10-01

399

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

Code of Federal Regulations, 2011 CFR

...the prospective payment system for long-term care hospitals. 412.505 Section... Prospective Payment System for Long-Term Care Hospitals § 412.505 Conditions...the prospective payment system for long-term care hospitals. (a) Long-term...

2011-10-01

400

42 CFR 413.114 - Payment for posthospital SNF care furnished by a swing-bed hospital.  

Code of Federal Regulations, 2012 CFR

...2012-10-01 false Payment for posthospital SNF care furnished by a swing-bed hospital... § 413.114 Payment for posthospital SNF care furnished by a swing-bed hospital...which provides for payment for posthospital SNF care furnished by rural hospitals and...

2012-10-01

401

42 CFR 413.114 - Payment for posthospital SNF care furnished by a swing-bed hospital.  

Code of Federal Regulations, 2010 CFR

...2010-10-01 false Payment for posthospital SNF care furnished by a swing-bed hospital... § 413.114 Payment for posthospital SNF care furnished by a swing-bed hospital...which provides for payment for posthospital SNF care furnished by rural hospitals and...

2010-10-01

402

42 CFR 413.114 - Payment for posthospital SNF care furnished by a swing-bed hospital.  

Code of Federal Regulations, 2011 CFR

...2011-10-01 false Payment for posthospital SNF care furnished by a swing-bed hospital... § 413.114 Payment for posthospital SNF care furnished by a swing-bed hospital...which provides for payment for posthospital SNF care furnished by rural hospitals and...

2011-10-01

403

42 CFR 413.114 - Payment for posthospital SNF care furnished by a swing-bed hospital.  

Code of Federal Regulations, 2013 CFR

...2013-10-01 false Payment for posthospital SNF care furnished by a swing-bed hospital... § 413.114 Payment for posthospital SNF care furnished by a swing-bed hospital...which provides for payment for posthospital SNF care furnished by rural hospitals and...

2013-10-01

404

Assessing Safety Attitudes among Healthcare Providers after a Hospital-Wide High-Risk Patient Care Program  

PubMed Central

Purpose Cardiopulmonary resuscitation (CPR) is commonly performed in high-risk, high intensity situations and is therefore a good procedure around which to develop and implement safety culture strategies in the hospital. The purpose of this study was to evaluate the impact of a hospital-wide quality improvement program on the management of sudden cardiac arrests by assessing healthcare providers' attitudes towards patient safety. Materials and Methods This study was designed as a prospective cohort study at a single academic medical center. The comprehensive hospital-based safety program included steps to identify areas of hazard, partner units with the Resuscitation Committee, and to conduct a Safety Attitudes Questionnaire (SAQ). The SAQ evaluated 35 questions in seven domains to assess changes in patient safety culture by comparing the results before and after the hospital-wide high risk patient care improvement program. Results The response rates of the pre- and post-SAQ survey were 489 out of 1121 (43.6%) and 575 out of 1270 (45.3%), respectively. SAQ survey responses revealed significant improvement in all seven domains of the questionnaire (p-values of 0.006 and lower). In a subgroup analysis, doctors and nurses showed improvement in five domains. Both doctors and nurses did not show improvement in the "sharing information" domain. Conclusion A hospital-wide quality improvement program for high-risk, high reliability patient care involving CPR care was shown to be associated with a change in healthcare providers' attitudes towards patient safety. Through an immersive and active program on CPR care, change in healthcare providers' attitudes towards patient safety was initiated. PMID:24532527

Je, Sang Mo; Kim, Hyun Jong; You, Je Sung; Chung, Sung Phil; Cho, Junho; Lee, Jin Hee; Lee, Hahn Shick

2014-01-01

405

77 FR 70786 - Request for Information Regarding Health Care Quality for Exchanges  

Federal Register 2010, 2011, 2012, 2013

...Request for Information Regarding Health Care Quality for Exchanges AGENCY...Strategy for Quality Improvement in Health Care (National Quality Strategy) to...efforts to improve the quality of health care in the United States. The...

2012-11-27

406

Exploring the provision of hospital trauma care for road traffic injury victims in Iran: a qualitative approach  

PubMed Central

Abstract: Background: Identifying factors affecting the provision of trauma care is essential for improving the quality of care for road traffic injury (RTI) victims. The study aimed to explore the perceptions and experiences of trauma care among injured patients and health professionals to identify factors influencing an effective trauma care delivery at emergency departments (EDs) in Iran. Methods: The study was conducted with a grounded theory approach. The study participants consisted of 15 health professionals and 20 injured patients. The data were collected via semi-structured interviews and were analyzed using constant comparative analysis method. Results: Lack of a systematic approach to providing trauma care at EDs emerged as the core category. The leading factors in the development of the core category were unclear national policies and poor organization of care at the ED. Other major factors were contextual factors in the environment of the hospitals such as inappropriate structure and unsupportive environment and also factors specific to the context of Iran such as a rapid increase in the number of traumas. Professionals reacted to the prevailing conditions in ways that contributed to an ineffective trauma care, even though strategies employed by Emergency Medicine Physicians (EMPs) improved the quality of trauma care locally. Conclusions: Building a national trauma system, using available professional resources especially EMPs, and implementing low cost and evidence-based improvements such as establishing trauma teams and trauma training for staff working at the EDs on a regular basis is necessary in order to improve delivery of trauma care at the hospitals. PMID:22095003

Haghparast-Bidgoli, Hassan; Khankeh, Hamidreza; Johansson, Eva; Yarmohammadian, Mohammad Hossein; Hasselberg, Marie

2013-01-01

407

Effect of the Transformation of the Veterans Affairs Health Care System on the Quality of Care  

Microsoft Academic Search

methods Using data from an ongoing performance-evaluation program in the VA, we evaluated the quality of preventive, acute, and chronic care. We assessed the change in quality-of- care indicators from 1994 (before reengineering) through 2000 and compared the qual- ity of care with that afforded by the Medicare fee-for-service system, using the same in- dicators of quality. results In fiscal

Ashish K. Jha; Jonathan B. Perlin; Kenneth W. Kizer; R. Adams Dudley

2010-01-01

408

Assessing Quality of Care of Elderly Patients Using the ACOVE Quality Indicator Set: A Systematic Review  

Microsoft Academic Search

BackgroundCare of the elderly is recognized as an increasingly important segment of health care. The Assessing Care Of Vulnerable Elderly (ACOVE) quality indicators (QIs) were developed to assess and improve the care of elderly patients.ObjectivesThe purpose of this review is to summarize studies that assess the quality of care using QIs from or based on ACOVE, in order to evaluate

Marjan Askari; Peter C. Wierenga; Saied Eslami; Stephanie Medlock; Sophia E. de Rooij; Ameen Abu-Hanna

2011-01-01

409

Supply chain management with cost-containment & financial-sustainability in a tertiary care hospital.  

PubMed

Financial crunch in the present recession results in the non-availability of the right materials at the right time in large hospitals. However due to insufficient impetus towards systems development, situation remains dismal even when funds are galore. Cost incurred on materials account for approximately one-third of the total recurring expenditures in hospitals. Systems development for effective and efficient materials management is thus tantamount to cost-containment and sustainability. This scientific paper describes an innovative model, Hospital Revolving Fund (HRF), developed at a tertiary care research institute in Asia. The main idea behind inception of HRF was to ensure availability of all supplies in the hospital so that the quality of healthcare delivery was not affected. The model was conceptualized in the background of non-availability of consumables in the hospital leading to patient as well as staff dissatisfaction. Hospital supplies have been divided into two parts, approximately 3250 unit items and 1750 miscellaneous items. This division is based on cost, relative-utility and case-specific utilization. 0.1 Million USD, separated from non-planned budget, was initially used as seed money in 1998. HRF procures supplies from reputed firms on concessional rates (8-25%) and make them available to patients at much lesser rates vis-à-vis market rates, levying minimal maintenance charges. In 2009-10, total annual purchases of 14 Million USD were made. The balance sheet reflected 1.4 Million USD as fixed deposit investment. The minimal maintenance charges levied on the patients along with the interest income were sufficient to pay for all recurring expenses related to HRF. Even after these expenses, HRF boosted of 0.2 Million USD as cash-in-hand in financial year 2009-10. In-depth analysis of 'balance sheet' and 'Income and Expenditure' statement of the fund for last five financial years affirms that HRF is a self-sustainable and viable supply chain mechanism to ensure availability of the right materials at the right time at a reasonable cost. Thus innovations like HRF will prove robust in rendering quality healthcare at an affordable cost. PMID:24010261

Chandra, Hem; Rinkoo, Arvind Vashishta; Verma, Jitendra Kumar; Verma, Shuchita; Kapoor, Rakesh; Sharma, R K

2013-01-01

410

Effects of Quality Improvement System for Child Care Centers  

ERIC Educational Resources Information Center

Using multiple years of data collected from about 100 child care centers in Palm Beach County, Florida, the authors studied whether the Quality Improvement System (QIS) made a significant impact on quality of child care centers. Based on a pre- and postresearch design spanning a period of 13 months, QIS appeared to be effective in improving…

Ma, Xin; Shen, Jianping; Kavanaugh, Amy; Lu, Xuejin; Brandi, Karen; Goodman, Jeff; Till, Lance; Watson, Grace

2011-01-01

411

Child Outcome Measures in the Study of Child Care Quality  

ERIC Educational Resources Information Center

This article assesses whether there are methodological problems with child outcome measures that may contribute to the small associations between child care quality and child outcomes found in the literature. Outcome measures used in 65 studies of child care quality published between 1979 and December 2005 were examined, taking the previous review…

Zaslow, Martha; Halle, Tamara; Martin, Laurie; Cabrera, Natasha; Calkins, Julia; Pitzer, Lindsay; Margie, Nancy Geyelin

2006-01-01

412

Children's Emotional Expression in Child Care Centers Varying in Quality.  

ERIC Educational Resources Information Center

Examined the relationships between day-care quality, children's emotional expression, and temperament among 60 3- to 5-year-olds in 26 day-care centers. Found that the appropriateness of the caregiving, but not the appropriateness of activities in the child-care center, significantly predicted the proportion of positive emotional affect in…

Hestenes, Linda L.; And Others

1993-01-01

413

Experiences of the quality of care of women with near-miss maternal morbidities in the UK  

PubMed Central

We undertook a qualitative interview study of women's and their partners’ experiences of severe pregnancy complications. Across the care pathway, women identified a number of examples of good practice that made an important difference to their recovery. There were some areas where women felt the quality of care could be improved, for example during points of transition between higher level and routine care or from hospital to the community. Longer-term support and counselling were felt to be particularly valuable, and yet not always universally available. These results emphasise the importance of integrated quality care across the whole patient pathway. PMID:25236629

Hinton, L; Locock, L; Knight, M

2014-01-01

414

High-quality chronic care delivery improves experiences of chronically ill patients receiving care  

PubMed Central

Objective Investigate whether high-quality chronic care delivery improved the experiences of patients. Design This study had a longitudinal design. Setting and Participants We surveyed professionals and patients in 17 disease management programs targeting patients with cardiovascular diseases, chronic obstructive pulmonary disease, heart failure, stroke, comorbidity and eating disorders. Main Outcome Measures Patients completed questionnaires including the Patient Assessment of Chronic Illness Care (PACIC) [T1 (2010), 2637/4576 (58%); T2 (2011), 2314/4330 (53%)]. Professionals' Assessment of Chronic Illness Care (ACIC) scores [T1, 150/274 (55%); T2, 225/325 (68%)] were used as a context variable for care delivery. We used two-tailed, paired t-tests to investigate improvements in chronic illness care quality and patients' experiences with chronic care delivery. We employed multilevel analyses to investigate the predictive role of chronic care delivery quality in improving patients' experiences with care delivery. Results Overall, care quality and patients' experiences with chronic illness care deli