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1

Hospital financial condition and the quality of patient care  

Microsoft Academic Search

Concerns about deficiencies in the quality of care delivered in US hospitals grew during a time period when an increasing number of hospitals were experiencing financial problems. Our study examines a six-year longitudinal database of general acute care hospitals in 11 states to assess the relationship between hospital financial condition and quality of care. We evaluate two measures of financial

Gloria J. Bazzoli; Mei Zhao; Richard C. Lindrooth

2008-01-01

2

Hospital Design's Influence on Productivity and Quality of Care.  

National Technical Information Service (NTIS)

The differences between two hospitals' level of productivity and quality of care were investigated to determine if efficiency in hospital design, and modern technology provide increases in either of these factors. The study consisted of a study of a singl...

B. A. Schwenk

1987-01-01

3

Helping You Choose Quality Hospital Care  

MedlinePLUS

... on Key Quality Measures SIRAS - Free Courses Topics Topics High Reliability Health Care-Associated Infections Portal Infection ... Details Monday 3:02 CST, October 28, 2013 Topic Details Topic Library Item < Return to Topic Library ...

4

Medicare Reimbursement and the Quality of Hospital Care.  

National Technical Information Service (NTIS)

This study examines the relationship between hospital reimbursement per discharge and the clinical quality of care received by Medicare patients before and after implementation of the Prospective Payment System (PPS) in 1983/84. The objectives are to eval...

M. McGinty

1991-01-01

5

Do Patients "Like" Good Care? Measuring Hospital Quality via Facebook.  

PubMed

With the growth of Facebook, public health researchers are exploring the platform's uses in health care. However, little research has examined the relationship between Facebook and traditional hospital quality measures. The authors conducted an exploratory quantitative analysis of hospitals' Facebook pages to assess whether Facebook "Likes" were associated with hospital quality and patient satisfaction. The 30-day mortality rates and patient recommendation rates were used to quantify hospital quality and patient satisfaction; these variables were correlated with Facebook data for 40 hospitals near New York, NY. The results showed that Facebook "Likes" have a strong negative association with 30-day mortality rates and are positively associated with patient recommendation. These exploratory findings suggest that the number of Facebook "Likes" for a hospital may serve as an indicator of hospital quality and patient satisfaction. These findings have implications for researchers and hospitals looking for a quick and widely available measure of these traditional indicators. PMID:23378059

Timian, Alex; Rupcic, Sonia; Kachnowski, Stan; Luisi, Paloma

2013-02-01

6

Quality of care delivered to hospitalized inflammatory bowel disease patients  

PubMed Central

Hospitalized patients with inflammatory bowel disease (IBD) are at high risk for morbidity, mortality, and health care utilization costs. While the literature on trends in hospitalization rates for this disease is conflicting, there does appear to be significant variation in the delivery of care to this complex group, which may be a marker of suboptimal quality of care. There is a need for improvement in identifying patients at risk for hospitalization in an effort to reduce admissions. Moreover, appropriate screening for a number of hospital acquired complications such as venous thromboembolism and Clostridium difficile infection is suboptimal. This review discusses areas of inpatient care for IBD patients that are in need of improvement and outlines a number of potential quality improvement initiatives such as pay-for-performance models, quality improvement frameworks, and healthcare information technology.

Weizman, Adam V; Nguyen, Geoffrey C

2013-01-01

7

Gauging food and nutritional care quality in hospitals  

PubMed Central

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

2012-01-01

8

Comparing public and private hospital care service quality.  

PubMed

The study applies the principles behind the SERVQUAL model and uses Donabedian's framework to compare and contrast Malta's public and private hospital care service quality. Through the identification of 16 service quality indicators and the use of a Likert-type scale, two questionnaires were developed. The first questionnaire measured patient pre-admission expectations for public and private hospital service quality (in respect of one another). It also determined the weighted importance given to the different service quality indicators. The second questionnaire measured patient perceptions of provided service quality. Results showed that private hospitals are expected to offer a higher quality service, particularly in the "hotel services", but it was the public sector that was exceeding its patients' expectations by the wider margin. A number of implications for public and private hospital management and policy makers were identified. PMID:10185325

Camilleri, D; O'Callaghan, M

1998-01-01

9

Culture and quality care perceptions in a Pakistani hospital  

Microsoft Academic Search

Purpose – Organizational culture is a determinant for quality improvement. This paper aims to assess organizational culture in a hospital setting, understand its relationship with perceptions about quality of care and identify areas for improvement. Design\\/methodology\\/approach – The paper is based on a cross-sectional survey in a large clinical department that used two validated questionnaires. The first contained 20 items

Fauziah Rabanni; S. M. Wasim Jafri; Farhat Abbas; Firdous Jahan; Nadir Ali Syed; Gregory Pappas; Syed Iqbal Azam; Mats Brommels; Göran Tomson

2009-01-01

10

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.

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

2010-01-01

11

Effects of Environmental Threats on the Quality of Care in Acute Care Hospitals  

Microsoft Academic Search

This study investigates how environmental threats may adversely affect internal resources (slacks) and how hospitals' slack level may mediate the adverse effect of environmental threats on quality. Two testable hypotheses are (1) The environmental threat and level of organizational slack in hospitals are inversely related; and (2) Hospitals' slack level and quality of care are positively related. Both hypotheses are

Kyung I. Youn; Thomas T. H. Wan

2001-01-01

12

Spatial competition for quality in the market for hospital care.  

PubMed

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

Montefiori, Marcello

2005-06-01

13

The Quality of Diabetes Care following Hospitalization for Ischemic Stroke  

PubMed Central

Background Follow-up is critically important for stroke survivors with diabetes, yet there is limited research about the quality of diabetes care that these patients receive. We investigated performance on diabetes quality of care indicators for stroke survivors overall and by race. Methods Claims data was extracted for 1,460 Medicare beneficiaries with preexisting diabetes who survived hospitalization for acute ischemic stroke in 2000. Adjusted probabilities of receiving HbA1c, LDL and dilated eye exams were estimated using logistic regression. Results 53% had a dilated eye exam, 60% received an LDL check, 73% percent had their HbA1c checked at least once and only 51% received two or more HbA1c checks. In the unadjusted results, blacks were significantly less likely than whites to receive these tests. Conclusions Care of stroke survivors, particularly blacks, shows gaps according to guidelines.

Pandhi, Nancy; Smith, Maureen A.; Kind, Amy J.H.; Frytak, Jennifer R.; Finch, Michael D.

2009-01-01

14

VA Health Care: The Quality of Care Provided by Some VA Psychiatric Hospitals is Inadequate.  

National Technical Information Service (NTIS)

In 1989, the Department of Veterans Affairs (VA) identified six primarily psychiatric hospitals in which 38 patient deaths may have occurred due to likely quality-of-care problems in the medical treatment these individuals received. Before this, in 1988, ...

1992-01-01

15

Your Guide to Choosing Quality Health Care: Health Plans, Doctors, Treatments, Hospitals, Long-Term Care.  

National Technical Information Service (NTIS)

So when it comes to making major health care decisions--about healthplans, doctors, treatments, hospitals, and long-term care--how can you tell which choices offer quality health care, and which do not. Fortunately, more and more public and private groups...

1999-01-01

16

Barriers to quality patient care in rural district hospitals.  

PubMed

Currently barriers exist in delivering quality health care. This study aimed to investigate such barriers in the eight rural district hospitals of the West Coast Winelands Region, three type A and five type B hospitals. A quantitative descriptive design was applied which included the total population of nursing staff (n = 340) working at the time of data collection. A self-administered questionnaire was distributed with a response rate of 82%.Reliability of the instrument was verified using the Cronbach alpha coefficient and a pilot study. The validity, specifically construct and content validity, were assured by means of an extensive literature review, pilot study and use of experts. Ethics approval was obtained from the relevant stakeholders.Results showed that 272 participants (97%) disagreed that provision of staff was adequate, with staff above 40 years of age more likely to disagree (p = <0.01). A statistically significant association was shown between availability of doctors and staff not being able to cope with emergencies (p = <0.01). Most participants (n =212; 76%) indicated that they were not receiving continuing education, with the registered nurses more likely to disagree (?² test, p = 0.02). Participants in both hospital types A (n = 131; 82%) and B (n = 108; 91%) also disagreed that provision of equipment and consumables was adequate.The research showed that inadequacies relating to human resources, professional development, consumables and equipment influenced the quality of patient care. Urgent attention should be given to the problems identified to ensure quality of patient care in rural hospitals. PMID:23327761

Eygelaar, Johanna E; Stellenberg, Ethelwynn L

2012-05-09

17

[Quality of care in psychiatric hospitals: literature review and perspectives].  

PubMed

Within hospitals, a plan for quality improvement consists of numerous steps to be taken by an inclusive management team, implicating all of the actors involved. The establishment of an instrument panel of indicators is the outcome of such a participatory process. The existence of best practice referentials allows for the construction of a coherent plan to improve the quality of care. A query of the francophone bibliographic databases reveals very few publications from internal audits on the relevance of care. Nevertheless, external audits demonstrate the significance of evaluation of the quality of care in psychiatric hospitals. The authors are therefore surprised to note the existing hiatus between the wealth of references and their lack of being used in the publications of the professionals concerned. The analysis of the relevance of the medical decision is not widely accepted. Clinical practice is still considered as an art form even though it has become a technique which now calls on the collective experience of peers. PMID:12891818

Da Silva, G Borgès

2003-06-01

18

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

Microsoft Academic Search

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

S. N. Weingart; J. Zhu; L. Chiappetta; S. O. Stuver; E. C. Schneider; A. M. Epstein; J. A. David-Kasdan; C. L. Annas; F. J. Fowler Jr; J. S. Weissman

2011-01-01

19

Hospital Ownership and Cost and Quality of Care: Is There a Dime's Worth of Difference?  

Microsoft Academic Search

This paper compares cost and quality of care for Medicare patients hospitalized in for-profit hospitals contrasted with those in nonprofit and government hospitals following admission for hip fracture, stroke, coronary heart disease, or congestive heart failure. Cost of care in for-profit hospitals was similar to that of nonprofits, but patients admitted to government hospitals incurred less Medicare payments on average.

Frank A. Sloan; Gabriel A. Picone; Donald H. Taylor Jr.; Shin-Yi Chou

1998-01-01

20

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

21

Delirium: a symptom of how hospital care is failing older persons and a window to improve quality of hospital care.  

PubMed

Delirium, or acute confusional state, which often results from hospital-related complications or inadequate hospital care for older patients, can serve as a marker of the quality of hospital care. By reviewing five pathways that can lead to a greater incidence of delirium--iatrogenesis, failure to recognize delirium in its early stages, attitudes toward the care of the elderly, the rapid pace and technological focus of health care, and the reduction in skilled nursing staff--we identify how future trends and cost-containment practices may exacerbate the problem. Examining delirium also provides an opportunity to improve the quality of hospital care for older persons. Interventions to reduce delirium would need to occur at the local and national levels. Local strategies would include routine cognitive assessment and the creation of systems to enhance geriatric care, such as incentives to change practice patterns, geriatric expertise, case management, and clinical pathways. National strategies might include providing education for physicians and nurses to improve the recognition of delirium and the awareness of its clinical implications, improving quality monitoring systems for delirium, and creating environments to facilitate the provision of high-quality geriatric care. PMID:10335730

Inouye, S K; Schlesinger, M J; Lydon, T J

1999-05-01

22

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

PubMed Central

Objectives To investigate predictors for specific dimensions of service quality perceived by hospital employees in long-term care hospitals. Methods Data collected from a survey of 298 hospital employees in 18 long-term care hospitals were analysed. Multivariate ordinary least squares regression analysis with hospital fixed effects was used to determine the predictors of service quality using respondents’ and organizational characteristics. Results The most significant predictors of employee-perceived service quality were job satisfaction and degree of consent on national evaluation criteria. National evaluation results on long-term care hospitals and work environment also had positive effects on service quality. Conclusion The findings of the study show that organizational characteristics are significant determinants of service quality in long-term care hospitals. Assessment of the extent to which hospitals address factors related to employeeperceived quality of services could be the first step in quality improvement activities. Results have implications for efforts to improve service quality in longterm care hospitals and designing more comprehensive national evaluation criteria.

Kim, Jinkyung; Han, Woosok

2012-01-01

23

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

24

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

25

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

26

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

27

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

28

Variations in the quality of care of patients with acute myocardial infarction among Swiss university hospitals  

Microsoft Academic Search

Objectives. The objective of our study was to assess hospital variations in the quality of care delivered to acute myocardial inf- arction (AMI) patients among three Swiss academic medical centres. Design. Cross-sectional study. Setting. Three Swiss university hospitals. Study participants. We selected 1129 eligible patients discharged from these hospitals from 1 January to 31 December 1999, with a primary or

JEAN-CHRISTOPHE LUTHI; WILLIAM M. MCCLELLAN; W. DANA FLANDERS; STEPHEN R. PITTS; BERNARD BURNAND

2005-01-01

29

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

Microsoft Academic Search

BACKGROUND: Reduction of maternal mortality ratio by two-thirds by 2015 is an international development goal with unrestricted access to high quality emergency obstetric care services promoted towards the attainment of that goal. The objective of this qualitative study was to assess the availability and quality of emergency obstetric care services in Gambia's main referral hospital. METHODS: From weekend admissions a

Mamady Cham; Johanne Sundby; Siri Vangen

2009-01-01

30

Explaining Variations in Hospital Death Rates: Randomness, Severity of Illness, Quality of Care.  

National Technical Information Service (NTIS)

The report attempts to sort out the relative importance of quality of care, severity of illness, and unmeasured factors or selection effects as determinants of hospital death rates. Medicare patients with congestive heart failure and acute myocardial infa...

R. E. Park R. H. Brook J. Kosecoff J. Keesey L. V. Rubenstein

1991-01-01

31

End-of-life care in acute care hospitals in Canada: a quality finish?  

PubMed

Understanding patients' and family members' perspectives on the relative importance of elements of end-of-life (EOL) care and their satisfaction with those elements will help prioritize quality improvement initiatives. We administered a face-to-face questionnaire containing a selection of 28 elements of care to eligible inpatients with advanced lung, heart, or liver disease, or metastatic cancer, and available family caregivers (FCGs) in five tertiary care hospitals across Canada. 440 of 569 (78%) eligible patients and 160 of 176 (91%) FCGs participated. No respondent reported complete satisfaction with all elements of care. The average satisfaction score was 4.6 on a 26 point scale. Medical patients reported lower levels of satisfaction than cancer patients. Elements rated as "extremely important" and anything other than "completely satisfied" most frequently by respondents related to discharge planning, availability of home health services, symptom relief, not being a burden, physician trust, and communication. In conclusion, most patients and their family members in our survey were not completely satisfied with EOL care. Improvement initiatives to target key elements identified by patients and FCGs have the potential to improve satisfaction with EOL care across care settings. PMID:16334968

Heyland, Daren K; Groll, Dianne; Rocker, Graeme; Dodek, Peter; Gafni, Amiram; Tranmer, Joan; Pichora, Deb; Lazar, Neil; Kutsogiannis, Jim; Shortt, Sam; Lam, Miu

2005-01-01

32

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

33

Early career RNs' perceptions of quality care in the hospital setting.  

PubMed

The purpose of this study was to explore early-career registered nurses' perceptions of high-quality nursing care in hospitals. The study findings contribute to ongoing work intended to explore and define what quality nursing care is and how it ultimately impacts patients. The final sample analyzed for this article consisted of 171 narrative responses from hospital-based registered nurses. We used Krippendorff's technique for qualitative content analysis to identify themes. Three themes emerged as integral to high quality nursing care: registered nurse presence, developing relationships, and facilitating the flow of knowledge and information. Development of nursing quality indicators should focus on nursing processes in addition to patient outcomes. Such a focus would better capture the complexity of hospital nursing care. PMID:21216983

Cline, Daniel D; Rosenberg, Marie-Claire; Kovner, Christine T; Brewer, Carol

2011-01-07

34

Study of the Ambulatory Care Quality Assurance Program at DeWitt Army Community Hospital, Fort Belvoir, Virginia.  

National Technical Information Service (NTIS)

In 1981 at DeWitt Army Community Hospital, an insufficient amount of usable ambulatory care information was being generated. This prohibited the hospital staff from identifying problems and making intelligent decisions regarding the quality of care provid...

J. R. O'Keiff

1982-01-01

35

Assessing quality of care from hospital case notes: comparison of reliability of two methods  

Microsoft Academic Search

ObjectivesTo determine which of the two methods of case note review provide the most useful and reliable information for reviewing quality of care.DesignRetrospective, multiple reviews of 692 case notes were undertaken using both holistic (implicit) and criterion-based (explicit) review methods. Quality measures were evidence-based review criteria and a quality of care rating scale.SettingNine randomly selected acute hospitals in England.ParticipantsSixteen doctors,

A. Hutchinson; J. E. Coster; K. L. Cooper; A. McIntosh; S. J. Walters; P. A. Bath; M. Pearson; K. Rantell; M. J. Campbell; J. Nicholl; P. Irwin

2010-01-01

36

Sex, quality of care, and outcomes of elderly patients hospitalized with heart failure: Findings from the National Heart Failure Project  

Microsoft Academic Search

BackgroundPrevious studies have demonstrated that women hospitalized for heart failure receive poorer quality of care and have worse outcomes than men. However, these studies were based upon selected patient populations and lacked quality of care measures.

Saif S. Rathore; JoAnne Micale Foody; Yongfei Wang; Jeph Herrin; Frederick A. Masoudi; Edward P. Havranek; Diana L. Ordin; Harlan M. Krumholz

2005-01-01

37

Study of the Ambulatory Care Quality Assurance Program at DeWitt Army Community Hospital, Fort Belvoir, Virginia.  

National Technical Information Service (NTIS)

This study was an endeavor to develop a system to collect and display useful information on the quality of ambulatory care by which hospital staff could make intelligent decisions in the management of the Ambulatory Care Quality Assurance Program.

J. R. O'Keiff

1982-01-01

38

Evaluating the implementation and effects of a multilevel quality collaborative in hospital care: a research strategy  

Microsoft Academic Search

Phase of the research when this was written: in the middle of the process. Before the data collection of the final part of the study, but after reviewing the literature and collection and anlysis first data. Main research question: How does the participation by hospitals in a multilivel quality collaborative (MQC) result in enhanced quality of care and the development

M. Dückers; C. Wagner; P. Groenewegen

2008-01-01

39

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

PubMed Central

Background Physician job satisfaction is reportedly associated with interpersonal quality of care, such as patient satisfaction, but its association with technical quality of care, as determined by whether patients are offered recommended services, is unknown. Objective We explored whether the job satisfaction of hospital-employed physicians in Japan is associated with the technical quality of care, with an emphasis on process qualities as measured by quality indicators. Design Cross-sectional study linking data from physician surveys with data abstracted from outpatient charts. Participants A total of 53 physicians working at 13 hospitals in Japan participated. Medical records covering 568 patients were reviewed. Measurements Disease-specific indicators related to the care of patients with hypertension, type 2 diabetes, and asthma, as well as disease-independent measures of the process of care were abstracted. We analyzed the association between the quality of care score for individual physicians, which is defined as the percentage of quality indicators satisfied among the total for which their patients were eligible, and physician job satisfaction, which was measured by a validated scale. Results No statistically significant association between physician job satisfaction and quality of care was observed. A 1-standard deviation (SD) increment in the physician job satisfaction scale was associated with an increase of only 0.3% for overall quality (P?=?0.85), ?3.0% for hypertension (P?=?0.22), 2.5% for type 2 diabetes (P?=?0.44), 8.0% for asthma (P?=?0.21), and ?0.4% for cross-cutting care (P?=?0.76). Conclusion Contrary to the positive association reported between physician job satisfaction and high quality of interpersonal care, no association was seen between physician job satisfaction and the technical quality of care.

Bito, Seiji; Matsumura, Shinji; Hayashino, Yasuaki; Fukuhara, Shunichi

2009-01-01

40

CORRELATION OF INPATIENT AND OUTPATIENT MEASURES OF STROKE CARE QUALITY WITHIN VETERANS HEALTH ADMINISTRATION HOSPITALS  

PubMed Central

Background Quality of care delivered in the inpatient and ambulatory settings may be correlated within an integrated health system such as the Veterans Health Administration (VHA). We examined the correlation between stroke care quality at hospital discharge and within 6 months post-discharge. Methods Cross-sectional hospital-level correlation analyses of chart-abstracted data for 3467 veterans discharged alive after an acute ischemic stroke from 108 VHA medical centers and 2380 veterans with post-discharge follow-up within 6 months, in fiscal year 2007. Four risk-standardized processes of care represented discharge care quality: prescription of anti-thrombotic and anti-lipidemic therapy, anti-coagulation for atrial fibrillation, and tobacco cessation counseling, along with a composite measure of defect-free care. Five risk-standardized intermediate outcomes represented post-discharge care quality: achievement of blood pressure, low-density lipoprotein (LDL), international normalized ratio (INR), and glycosylated hemoglobin target levels, and delivery of appropriate treatment for post-stroke depression, along with a composite measure of achieved outcomes. Results Median risk-standardized composite rate of defect-free care at discharge was 79%. Median risk-standardized post-discharge rates of achieving goal were 56% for blood pressure, 36% for LDL, 41% for INR, 40% for glycosylated hemoglobin, and 39% for depression management and the median risk-standardized composite six-month outcome rate was 44%. The hospital composite rate of defect-free care at discharge was correlated with meeting the LDL goal (r=0.31; p=0.007) and depression management (r=0.27; p=0.03) goal, but was not correlated with blood pressure, INR, or glycosylated hemoglobin goals, nor with the composite measure of achieved post-discharge outcomes (p-values >0.15). Conclusions Hospital discharge care quality was not consistently correlated with ambulatory care quality.

Ross, Joseph S.; Arling, Greg; Ofner, Susan; Roumie, Christianne L.; Keyhani, Salomeh; Williams, Linda S.; Ordin, Diana L.; Bravata, Dawn M.

2011-01-01

41

[Quality in hospital nursing care: the view of undergraduate nursing students].  

PubMed

Qualitative study developed in a public university of São Paulo State, Brazil, to identify the conception of quality of hospital nursing care under the perspective of last year undergraduate nursing students. Semi-structured interviews with 24 students were performed to collect the data and the speeches were analyzed according to Bardin's conceptual framework. The central ideas of the speeches were divided into six categories: holism, humanization, technically and scientifically trained team, promotion of self-care, appropriate management of the units and respecting the safety principles in care. It is concluded that students' view regarding the theme is wide; however it is necessary to incorporate important issues to the concept of quality of hospital care, such as the valorization of team work, the systematization of care and the satisfaction of all actors involved in nursing care. PMID:21574339

Gabriel, Carmen Silvia; Gabriel, Andrea Boldrini; Bernardes, Andréa; Rocha, Fernanda Ludmilla Rossi; Miasso, Adriana Inocenti

2010-09-01

42

Measuring Quality of Care in a Psychiatric Hospital Using Artificial Neural Networks  

Microsoft Academic Search

This study investigates a new method of measuring quality of care. Taking place at a tertiary psychiatric hos pital with 5,128 admissions from January 1989 through December 1995, this study uses artificial neural networks (ANNs) to predict hospital length-of-stay (LOS) and uses the standard deviation of LOS in a formula to measure quality of care, Q. ANNs are trained with

George E. Davis; Walter E. Lowell; Geoffrey L. Davis

1997-01-01

43

Comparison of maternity care quality in teaching and non-teaching hospitals in Khorram Abad, Islamic Republic of Iran.  

PubMed

The objective of this study was to compare the quality of maternity care in 2 types of government-run hospital in the town of Khorram Abad, Islamic Republic of Iran in 2009: a university-linked teaching and a social security organization non-teaching hospital. A sample of 264 women hospitalized in the delivery and postpartum wards was selected. Data collection was done using interviews with mothers and observation checklists based on Iranian government criteria. The quality of maternity care in the non-teaching hospital was higher than the teaching hospital in terms of facilities, processes of maternal and newborn care and outcomes (mother's satisfaction). In the teaching hospital, the quality of the physical space, the educational level and training of health care personnel and monitoring and evaluation of care quality needed improvement. In both hospitals, meeting women's expectations about the degree of privacy could lead to an increase in the quality of maternity services. PMID:21977565

Moosavisadat, S M; Lamyian, M; Parsap, S; Hajizadeh, E

2011-08-01

44

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

PubMed Central

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

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

2010-01-01

45

Evaluation of Quality of Trauma Care in a Local Hospital Using a Customization of ASCOT  

Microsoft Academic Search

\\u000a Abstract\\u000a \\u000a \\u000a Objective:\\u000a   Evaluating processes of care and outcomes of injured patients are important if improvements in the quality of care delivered\\u000a to injured patients are to be accomplished. We applied a customized ASCOT model developed from our database as a tool to criticize\\u000a the quality of care in a local hospital.\\u000a \\u000a \\u000a \\u000a \\u000a Patients and Methods:\\u000a   A total number of 4,096 trauma

Majid Moini; Hamed Rezaishiraz; Alireza Zarineh; Mohammad R. Rasouli

2009-01-01

46

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…

Khan, Arshia A.

2012-01-01

47

Connecting organisational culture and quality of care in the hospital: is job burnout the missing link?  

Microsoft Academic Search

Purpose – To date, relatively little evidence has been published as to what represents an effective and efficient way to improve quality of care and safety in hospitals. In addition, the initiatives that do exist are rarely designed or developed with regard to the individual and organisational factors that determine the success or failure of such initiatives. One of the

Anthony Montgomery; Efharis Panagopoulou; Ian Kehoe; Efthymios Valkanos

2011-01-01

48

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

Microsoft Academic Search

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

Elizabeth West

2001-01-01

49

Intergroup communication between hospital doctors: Implications for quality of patient care  

Microsoft Academic Search

Hospitals involve a complex socio-technical health system, where communication failures influence the quality of patient care. Research indicates the importance of social identity and intergroup relationships articulated through power, control, status and competition. This study focused on interspecialty communication among doctors for patients requiring the involvement of multiple specialist departments. The paper reports on an interview study in Australia, framed

David G. Hewett; Bernadette M. Watson; Cindy Gallois; Michael Ward; Barbara A. Leggett

2009-01-01

50

The Impact of Contact Isolation on the Quality of Inpatient Hospital Care  

PubMed Central

Background Contact Isolation is a common hospital infection prevention method that may improve infectious outcomes but may also hinder healthcare delivery. Methods To evaluate the impact of Contact Isolation on compliance with individual and composite process of care quality measures, we formed four retrospective diagnosis-based cohorts from a 662-bed tertiary-care medical center. Each cohort contained patients evaluated for one of four Centers for Medicare and Medicaid Services (CMS) Hospital Compare process measures including Acute Myocardial Infarction (AMI), Congestive Heart Failure (CHF), Pneumonia (PNA) and Surgical Care Improvement Project (SCIP) from January 1, 2007 through May 30, 2009. Results The 6716-admission cohort included 1259 with AMI, 834 with CHF, 1377 with PNA and 3246 in SCIP. Contact Isolation was associated with not meeting 4 of 23 individual hospital measures (4 of 10 measures were not met for care provided while patients are typically isolated). Contact Isolation was independently associated with lower compliance with the composite pneumonia process-of-care measure (OR 0.3, 95% CI 0.1–0.7). AMI, CHF and SCIP composite measures were not impacted by Contact Isolation. Conclusions Contact Isolation was associated with lower adherence to some pneumonia quality of care process measures of care on inpatient wards but did not impact CHF, AMI or SCIP measures.

Morgan, Daniel J.; Day, Hannah R.; Harris, Anthony D.; Furuno, Jon P.; Perencevich, Eli N.

2011-01-01

51

Relationship of hospital teaching status with quality of care and mortality for Medicare patients with acute MI  

Microsoft Academic Search

CONTEXT: Issues of cost and quality are gaining importance in the delivery of medical care, and whether quality of care is better in teaching vs nonteaching hospitals is an essential question in this current national debate.\\u000aOBJECTIVE: To examine the association of hospital teaching status with quality of care and mortality for fee-for-service Medicare patients with acute myocardial infarction (AMI).

Jeroan J. Allison; Catarina I. Kiefe; Norman W. Weissman; Sharina D. Person; Matthew Rousculp; John G. Canto; Sejong Bae; O. Dale Williams; Robert Farmer; Robert M. Centor

2000-01-01

52

Managing hospital quality performance in two related areas: patient care and customer service.  

PubMed

The Joint Commission on Accreditation of Healthcare Organization's new emphasis on continuous quality improvement provides hospitals with an opportunity to enhance both customer service as well as patient care. Both are expected by patients and delivered by providers. Patient care is the core product; customer service augments it by adding value and providing the opportunity for a competitive advantage. This article discusses issues for administrators to consider before including customer service as a component of continuous quality improvement and then presents methods for bringing about change. PMID:10127260

Dwore, R B

1993-01-01

53

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

PubMed Central

Background Health related quality of life (HRQoL) in very late life is not well understood. The aim of the present study was to assess HRQoL and health outcomes at four months follow-up in a group of older people awaiting transfer to residential aged care. Methods Secondary analysis of data from a randomized controlled trial conducted in three public hospitals in Adelaide. A total of 320 patients in hospital beds awaiting a residential aged care bed participated. Outcome measurements included HRQoL (Assessment of Quality of Life; AQoL), functional level (Modified Barthel Index), hospital readmission rates, survival, and place of residence at four months follow-up. Results In this frail group the median AQoL was poor at baseline (median 0.02; 95%CI -0.01 – 0.04) and at follow-up (0.05; 95%CI 0.03 – 0.06). On leaving hospital, more than one third of participants who were moving for the first time into nursing home care rated themselves in a state worse than death (AQoL ? 0.0). Poor HRQoL at discharge from hospital (AQoL ? 0.0) was a significant predictor of mortality (HR 1.7; 95%CI 1.2 – 2.7), but not hospital readmission nor place of residence at four months follow-up. Improved function was a predictor of improved HRQoL among the surviving cohort. Conclusion People making the transition to residential aged care from hospital have very poor HRQoL, but small gains in function seem to be related to improvement. While functional gains are unlikely to change discharge destination in this frail group, they can contribute to improvements in HRQoL. These gains may be of great significance for individuals nearing the end of life and should be taken into account in resource allocation.

Giles, Lynne C; Hawthorne, Graeme; Crotty, Maria

2009-01-01

54

[A clinical study for promoting quality nursing care in a university hospital].  

PubMed

The purpose of this study was to develop a new nursing unit which can meet changing health care needs, enhance patients' satisfaction and nurses' job satisfaction, and finally guarantee quality nursing care with present manpower. For this, one medical unit was selected as a unit for quality care. And one medical unit which is similar in staffing and patients' characteristics was selected as a control unit. To assess present problems and identify the remedies to the problems a hospital-wide survey and a workshop were performed. According to the survey results, educational programs and improvement of the facilities and equipment supply system, managerial support for interdepartmental cooperation and intensification of bed-side nursing care were adopted as main principles for operating model unit. This model unit was operated for 3 months from Sep. 1, 1992 to Nov. 30, 1992. To evaluate the effectiveness of the model unit, direct/indirect nursing care hours, patients' satisfaction to nursing care, nurses' job satisfaction, and quality care index were measured. Direct/indirect nursing care hours were compared with that of the control unit, and patients' and nurses' satisfaction and quality care index were measured before and after operating model unit and compared with each other. The results of the study were as follows; 1. In the model unit mean direct nursing care hours per each shift was 146.88 minutes and indirect nursing care hours was 354.72 minutes. The ratio of the direct nursing care hour to indirect nursing hour was 29.6:70.4 and that of the control unit was 26.9:73.1. Direct nursing care hour in model unit was longer than that of the control unit. But, the difference was not significant. In subcategories of direct nursing care, the time spent in mobility and exercise, conservation of body temperature, hygiene, and communication and health education were longer than that of the control unit. 2. Indirect nursing care hour in model unit was shorter than that of the control unit. But, the difference was not significant. In subcategories of indirect nursing care, the time spent in drug management and ward arrangement was shorter than that of the control unit. 3. Patients' satisfaction to nursing care was increased significantly after operating the model unit (T = -3.48, P = 0.002) and satisfaction to subcategories of physical comfort measure, psychological care, and unit management components were significantly higher than before.(ABSTRACT TRUNCATED AT 400 WORDS) PMID:8127047

Lee, A J; Kim, S H; Seong, Y H; Yoo, S A; Kwon, I G; Jeong, Y I; Nam, H K; Kwon, E J

55

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

Microsoft Academic Search

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

Lynne C Giles; Graeme Hawthorne; Maria Crotty

2009-01-01

56

Reimbursement systems and quality of hospital care: An empirical analysis for Italy.  

PubMed

There is an ongoing debate about the effect of different reimbursement systems on hospital performance and quality of care. The present paper aims at contributing to this literature by analysing the impact of different hospital payment schemes on patients' outcomes in Italy. The Italian National Health Service is, indeed, a particularly interesting case since it has been subject to a considerable decentralization process with wider responsibilities devolved to regional governments. Therefore, great variability exists in the way tariffs are used, as Regions have settled them in accordance with the characteristics of health care providers. An empirical analysis of the Italian hospital system is carried out using data from the National Program for Outcome Assessment on mortality and readmissions for Acute Myocardial Infarction (AMI), Congestive Heart Failure (CHF), stroke and Chronic Obstructive Pulmonary Diseases (COPD) in the years 2009-2010. The results show that hospitals operating in Regions where prospective payments are used more extensively are generally associated with better quality of care. PMID:23830561

Cavalieri, Marina; Gitto, Lara; Guccio, Calogero

2013-07-02

57

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

West, E.

2001-01-01

58

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.

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

2012-01-01

59

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

2011-07-10

60

Are AMI Patients with Comorbid Mental Illness More Likely to be Admitted to Hospitals with Lower Quality of AMI Care?  

PubMed Central

Objective Older patients with comorbid mental illness are shown to receive less appropriate care for their medical conditions. This study analyzed Medicare patients hospitalized for acute myocardial infarction (AMI) and determined whether those with comorbid mental illness were more likely to present to hospitals with lower quality of AMI care. Methods Retrospective analyses of Medicare claims in 2008. Hospital quality was measured using the five “Hospital Compare” process indicators (aspirin at admission/discharge, beta-blocker at admission/discharge, and angiotension-converting enzyme inhibitor or angiotension receptor blocker for left ventricular dysfunction). Multinomial logit model determined the association of mental illness with admission to low-quality hospitals (rank of the composite process score <10th percentile) or high-quality hospitals (rank>90th percentile), compared to admissions to other hospitals with medium quality. Multivariate analyses further determined the effects of hospital type and mental diagnosis on outcomes. Results Among all AMI admissions to 2,845 hospitals, 41,044 out of 287,881 patients were diagnosed with mental illness. Mental illness predicted a higher likelihood of admission to low-quality hospitals (unadjusted rate 2.9% vs. 2.0%; adjusted odds ratio [OR]1.25, 95% confidence interval [CI] 1.17–1.34, p<0.01), and an equal likelihood to high-quality hospitals (unadjusted rate 9.8% vs. 10.3%; adjusted OR 0.97, 95% CI 0.93–1.01, p?=?0.11). Both lower hospital quality and mental diagnosis predicted higher rates of 30-day readmission, 30-day mortality, and 1-year mortality. Conclusions Among Medicare myocardial infarction patients, comorbid mental illness was associated with an increased risk for admission to lower-quality hospitals. Both lower hospital quality and mental illness predicted worse post-AMI outcomes.

Cai, Xueya; Li, Yue

2013-01-01

61

Improving quality and safety in the hospital: the link between organizational culture, burnout, and quality of care.  

PubMed

The need to improve quality of care represents a major goal of all health care systems. The objective of this series is to illuminate how the contextual factors of hospitals from eight European countries, and the well-being of their healthcare professionals, contribute to either construct or degrade quality of care. The studies reported here provide an important bottom-up perspective on quality of care, and the way that burnout and organizational culture are intertwined within it. Overall, the collected studies represent an in-depth examination through focus groups of the experiences of 153 physicians, 133 nurses, and 46 patients from Greece, Portugal, Bulgaria, Romania, Ireland, Turkey, Croatia, and the Republic of Macedonia. Each paper makes a unique contribution to the understanding of how institutional contexts, organizational management, and job characteristics impose constrains, both on the capacity of health workers for better treatment decisions and choices, but also on their day-to-day professional satisfaction and quality of life. Taken as a whole, the papers make an even greater contribution, by pointing out the underlying similarities and differences across these eight European countries. PMID:23607495

Montgomery, Anthony; Todorova, Irina; Baban, Adriana; Panagopoulou, Efharis

2013-04-23

62

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

63

[Quality indicators in the acute coronary syndrome for the analysis of the pre- and in-hospital care process].  

PubMed

We present a map of 27 indicators to measure the care quality given to patients with acute coronary syndrome attended in the pre- and hospital area. This includes technical process indicators (registration of care intervals, performance of electrocardiogram, monitoring and vein access, assessment of prognostic risk, hemorrhage and in-hospital mortality, use of reperfusion techniques and performance of echocardiograph), pharmacological process indicators (platelet receptors inhibition, anticoagulation, thrombolysis, beta-blockers, angiotensin converting inhibitors and lipid lowering drugs) and outcomes indicators (quality scales of the care given and mortality). PMID:20451303

Felices-Abad, F; Latour-Pérez, J; Fuset-Cabanes, M P; Ruano-Marco, M; Cuñat-de la Hoz, J; del Nogal-Sáez, F

2010-05-06

64

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

PubMed

Quality differentiation is especially important in the hospital industry, where the choices of Medicare patients are unaffected by prices. Unlike previous studies that use geographic market concentration to estimate hospital competitiveness, this article emphasizes the importance of quality differentiation in this spatially differentiated market. I estimate a random-coefficients discrete-choice model that predicts patient flow to different hospitals and find that demand responses to both distance and quality are substantial. The estimates suggest that patients do not substitute toward alternative hospitals in proportion to current market shares, implying that geographic market concentration is an inappropriate measure of hospital competitiveness. PMID:15025031

Tay, Abigail

2003-01-01

65

Accelerating Best Care in Pennsylvania: adapting a large academic system's quality improvement process to rural community hospitals.  

PubMed

Industrial quality improvement (QI) methods such as continuous quality improvement (CQI) may help bridge the gap between evidence-based "best care" and the quality of care provided. In 2006, Baylor Health Care System collaborated with Jefferson Medical College of Thomas Jefferson University to conduct a QI demonstration project in select Pennsylvania hospitals using CQI techniques developed by Baylor. The training was provided over a 6-month period and focused on methods for rapid-cycle improvement; data system design; data management; tools to improve patient outcomes, processes of care, and cost-effectiveness; use of clinical guidelines and protocols; leadership skills; and customer service skills. Participants successfully implemented a variety of QI projects. QI education programs developed and pioneered within large health care systems can be adapted and applied successfully to other settings, providing needed tools to smaller rural and community hospitals that lack the necessary resources to establish such programs independently. PMID:18658097

Haydar, Ziad; Gunderson, Julie; Ballard, David J; Skoufalos, Alexis; Berman, Bettina; Nash, David B

66

"Out of Sight, Out of Mind": Housestaff Perceptions of Quality-Limiting Factors in Discharge Care at Teaching Hospitals  

PubMed Central

BACKGROUND Improving hospital discharge has become a national priority for teaching hospitals, yet little is known about physician perspectives on factors limiting the quality of discharge care. OBJECTIVES To describe the discharge process from the perspective of housestaff physicians, and to generate hypotheses about quality-limiting factors and key strategies for improvement. METHODS Qualitative study with in-depth, in-person interviews with a diverse sample of 29 internal medicine housestaff, in 2010–2011, at 2 separate internal medicine training programs, including 7 different hospitals. We used the constant comparative method of qualitative analysis to explore the experiences and perceptions of factors affecting the quality of discharge care. RESULTS We identified 5 unifying themes describing factors perceived to limit the quality of discharge care: (1) competing priorities in the discharge process; (2) inadequate coordination within multidisciplinary discharge teams; (3) lack of standardization in discharge procedures; (4) poor patient and family communication; and (5) lack of postdischarge feedback and clinical responsibility. CONCLUSIONS Quality-limiting factors described by housestaff identified key processes for intervention. Establishment of clear standards for discharge procedures, including interdisciplinary teamwork, patient communication, and postdischarge continuity of care, may improve the quality of discharge care by housestaff at teaching hospitals.

Greysen, S. Ryan; Schiliro, Danise; Horwitz, Leora I.; Curry, Leslie; Bradley, Elizabeth H.

2012-01-01

67

Intergroup communication between hospital doctors: implications for quality of patient care.  

PubMed

Hospitals involve a complex socio-technical health system, where communication failures influence the quality of patient care. Research indicates the importance of social identity and intergroup relationships articulated through power, control, status and competition. This study focused on interspecialty communication among doctors for patients requiring the involvement of multiple specialist departments. The paper reports on an interview study in Australia, framed by social identity and communication accommodation theories of doctors' experiences of managing such patients, to explore the impact of communication. Interviews were undertaken with 45 doctors working in a large metropolitan hospital, and were analysed using Leximancer (text mining software) and interpretation of major themes. Findings indicated that intergroup conflict is a central influence on communication. Contested responsibilities emerged from a model of care driven by single-specialty ownership of the patient, with doctors allowed to evade responsibility for patients over whom they had no sense of ownership. Counter-accommodative communication, particularly involving interpersonal control, appeared as important for reinforcing social identity and winning conflicts. Strategies to resolve intergroup conflict must address structural issues generating an intergroup climate and evoke interpersonal salience to moderate their effect. PMID:19846246

Hewett, David G; Watson, Bernadette M; Gallois, Cindy; Ward, Michael; Leggett, Barbara A

2009-10-21

68

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

PubMed Central

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

2013-01-01

69

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…

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

2004-01-01

70

Determining the Number of State Psychiatric Hospital Beds by Measuring Quality of Care with Artificial Neural Networks  

Microsoft Academic Search

This study uses a new paradigm to calculate the min imum and the optimum number of involuntary psychi atric 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 predic tion of length-of-stay for the hospital, and of commu nity length-of-stay for the community,

George E. Davis; Walter E. Lowell; Geoffrey L. Davis

1998-01-01

71

Assessment of quality of care in postpartum wards of Shaheed Beheshti Medical Science University hospitals, 2004  

Microsoft Academic Search

Purpose – Despite 77 per cent antenatal care coverage and 90 per cent skilled attendant at delivery, adjusted maternal mortality in Iran is 76 per 100,000 births. Low quality of maternal health services is one cause of maternal morbidity and mortality. However, few and limited studies have been devoted to the quality of postpartum care in Iran. This study aims

M. Simbar; Z. Alizadeh Dibazari; J. Abed Saeidi; H. Alavi Majd

2005-01-01

72

Shoot, Ready, Aim: Pneumonia Care Quality and Costs in a Community Hospital  

Microsoft Academic Search

Mandatory community-acquired pneumonia (CAP) protocol usage was proposed in our community-based teaching hospital because of senior medical staff perceptions that excessive variation in CAP care was adversely affecting clinical outcomes and costs. The purpose of our study was to examine CAP process of care variation, outcomes, and costs to ascertain whether the mandatory CAP protocol could be justified. The study

Lori A. Milo; William Smucker; Everett Logue; James Orosz; Michael G. Grimes; Bonyo Bonyo; David Dulle; Marc McNaughton

2003-01-01

73

Measuring Patient Satisfaction of the Quality of Health Care: A Study of Hospitals in Turkey  

Microsoft Academic Search

Patient satisfaction is an important measure of service quality in health care systems. Patients' perceptions about health care systems seem to have been largely ignored by health care managers in developing countries. The aim of this study is to develop a reliable and valid instrument to measure patient satisfaction in Turkey. A questionnaire was developed and a total of 1100

Zeki Y?ld?z; ?enol Erdo?mu?

2004-01-01

74

Hospital Nurse Staffing and Quality of Care. Research in Action Issue 14.  

National Technical Information Service (NTIS)

Hospitals with low nurse staffing levels tend to have higher rates of poor patient outcomes such as pneumonia, shock, cardiac arrest, and urinary tract infections, according to research funded by the Agency for Healthcare Research and Quality (AHRQ) and o...

2004-01-01

75

Evaluation of HIV/AIDS clinical care quality: the case of a referral hospital in North West Ethiopia  

PubMed Central

Objective To assess the quality of clinical care provided to patients with HIV in Felege Hiwot Referral Hospital. Approach and design Normative evaluation based on Donabedian's structure–process–outcome model of health care quality. Cross-sectional study design was employed to gather data in September 2007. Setting Felege Hiwot Referral Hospital is a government hospital in North West Ethiopia. The hospital is providing clinical care for patients infected with HIV free of patient charge since 2005. Measures The evaluation used 10 process and 5 outcome indicators of quality measured by reviewing 351 randomly selected patient records and interview with 368 patients. Resource inventory was conducted to assess the availability of trained staff, laboratory facilities and drugs required for provision of HIV care. Results All resources recommended by the national antiretroviral therapy (ART) Implementation Guideline including trained staff, laboratory facilities and drugs were continuously available, except for a shortage of cotrimoxazole. Despite this, important components of care and treatment recommended by national treatment guidelines were not delivered for significant portion of patients. The study showed that only 45.9% of patients eligible for cotrimoxazole prophylactic therapy (CPT) and 76.8% of patients eligible for ART were actually taking CPT and ART, respectively. Compliance with national guidelines to monitor patients was also found to be a major problem. Conclusion Availability of resources alone does not ensure the quality of HIV care and treatment. The study results indicate a need for regular monitoring and improvement of processes and outcomes of care in the Ethiopian Health System.

Alemayehu, Yibeltal Kiflie; Bushen, Oluma Yoseph; Muluneh, Ayalew Tegegn

2009-01-01

76

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

PubMed Central

Background Legal requirements for quality assurance in German rehabilitation hospitals include comparisons of providers. Objective is to describe and to compare outcome quality of care offered by three hospitals providing in-patient rehabilitative treatment exemplified for patients with chronic headache. Methods We performed a prospective three center observational study on patients suffering from chronic headache. Patients underwent interventions commonly used according to internal guidelines of the hospitals. Measurements were taken at three points in time (at admission, at discharge and 6 months after discharge). Indicators of outcome quality included pain intensity and frequency of pain, functional ability, depression, quality of life and health related behavior. Analyses of differences amongst the hospitals were adjusted by covariates due to case-mix situation. Results 306 patients from 3 hospitals were included in statistical analysis. Amongst the hospitals, patients differed significantly in age, education, diagnostic subgroups, beliefs, and with respect to some pain-related baseline values (covariates). Patients in all three hospitals benefited from intervention to a clinically relevant degree. At discharge from hospital, outcome quality differed significantly after adjustment according to case-mix only in terms of patients' global assessment of treatment results. Six months after discharge, the only detectable significant differences were for secondary outcomes like improved coping with stress or increased use of self-help. The profiles for satisfaction with the hospital stay showed clear differences amongst patients. Conclusion The results of this case study do not suggest a definite overall ranking of the three hospitals that were compared, but outcome profiles offer a multilayer platform of reliable information which might facilitate decision making.

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

2008-01-01

77

An assessment of the quality of care for children in eighteen randomly selected district and sub-district hospitals in Bangladesh  

PubMed Central

Background Quality hospital care is important in ensuring that the needs of severely ill children are met to avert child mortality. However, the quality of hospital care for children in developing countries has often been found poor. As the first step of a country road map for improving hospital care for children, we assessed the baseline situation with respect to the quality of care provided to children under-five years age in district and sub-district level hospitals in Bangladesh. Methods Using adapted World Health Organization (WHO) hospital assessment tools and standards, an assessment of 18 randomly selected district (n=6) and sub-district (n=12) hospitals was undertaken. Teams of trained assessors used direct case observation, record review, interviews, and Management Information System (MIS) data to assess the quality of clinical case management and monitoring; infrastructure, processes and hospital administration; essential hospital and laboratory supports, drugs and equipment. Results Findings demonstrate that the overall quality of care provided in these hospitals was poor. No hospital had a functioning triage system to prioritise those children most in need of immediate care. Laboratory supports and essential equipment were deficient. Only one hospital had all of the essential drugs for paediatric care. Less than a third of hospitals had a back-up power supply, and just under half had functioning arrangements for safe-drinking water. Clinical case management was found to be sub-optimal for prevalent illnesses, as was the quality of neonatal care. Conclusion Action is needed to improve the quality of paediatric care in hospital settings in Bangladesh, with a particular need to invest in improving newborn care.

2012-01-01

78

Promotion of handwashing as a measure of quality of care and prevention of hospital- acquired infections in Eritrea: the Keren study  

Microsoft Academic Search

A complex interplay of cognitive, socio-economic and technical factors may determine hand-washing practice among hospital- based health workers, particularly doctors, regardless of the location of the country or hospital they work in. Objective: To assess quality of care with respect to handwashing practice as a routine measure of infection prevention in Keren hospital, a provincial referral hospital, second largest in

Rigbe Samuel; Astier M. Almedom; Giotom Hagos; Stephanie Albin; Alice Mutungi

2005-01-01

79

Preventable Hospitalizations: A Window Into Primary and Preventive Care, 2000.  

National Technical Information Service (NTIS)

This Fact Book examines one critical area of health care quality: potentially preventable hospitalizations, or hospitalizations that may be preventable with high quality primary and preventive care. These hospitalizations may be avoided if clinicians effe...

D. T. Kruzikas H. J. Jiang D. Remus M. L. Barrett R. M. Coffey R. Andrews

2004-01-01

80

Is health care a special challenge to quality management? Insights from the Danderyd Hospital case.  

PubMed

A 10-year quality journey of a Swedish university hospital is described in this case study based on a variety of data sources. A series of quality initiatives were implemented according to total quality management (TQM) "best practice." Many projects were successful, but still a majority of those did not meet the staff's requirement of practical relevance, and they provoked scepticism toward instruments introduced and resistance to service-related quality definitions. The hospital's incentive structures did not reward an engagement in improvement activities. The findings are interpreted as demonstrating that the programs were viewed upon as part of a "management" rather than "professional" agenda, despite the underlying philosophy of TQM. It is suggested that applying professional practice development approaches to improvement initiatives might help to overcome the barrier thus created. PMID:14603787

Striem, Jörgen; Øvretveit, John; Brommels, Mats

81

Quality of diabetes care at Armed Forces Hospital, Southern Region, Kingdom of Saudi Arabia, 2006  

PubMed Central

Objective: The aim of this study was to assess the current status of care provided by the Diabetes Center at Armed Forces Hospital, Southern Region. Materials and Methods: A total of 260 patients were randomly selected from the diabetic patients attending the Diabetes Center. Study tools comprised patients’ data sheets and patients’ interview questionnaire. Results: Two-thirds of the patients were aged 50 years or more. Half of patients had had the disease for less than 10 years. Diet therapy alone was followed by 2.3% of diabetic patients. More than half of patients (56.5%) were on insulin. Most of the diabetic patients were tested for HbA1c at least once per year (88.1%), and 71.5% had their lipid profile done at least once within two years. Low indicators included having a dilated eye examination (35.4%), assessment for nephropathy (28.8%), and having a well-documented foot examination (12.7%). Highest risk HbA1c level (>9.5%) was reached by 38.8% of patients, 48.8% had a low-density lipoprotein level of <130 mg/dl, and 36.5% of patients had controlled blood pressure (?130/80 mmHg). Most patients were satisfied with their interaction with the treating doctor, 41.5% were satisfied with access to treatment. Hypertension was found to be the most frequent comorbidity (38.5%). Conclusion: The quality of services as regard to process and outcome are low at the Diabetes Center. The overall diabetic patients’ satisfaction was high, whereas their satisfaction was low as regards to access to treatment or health professionals.

Al-Arfaj, Ibrahim S.

2010-01-01

82

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

2012-09-11

83

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

PubMed Central

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

2012-01-01

84

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

PubMed

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

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

2013-05-28

85

Determinants of patient satisfaction with care in a Spanish oncology Day Hospital and its relationship with quality of life.  

PubMed

OBJECTIVE: This study evaluates satisfaction with care (SC) in cancer patients treated at a Spanish day hospital to identify SC determinants and assess the relationship between SC and quality of life. METHODS: One hundred seventy-six patients with different tumour sites and disease stages completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30), the Cancer Outpatient Satisfaction with Care questionnaire for chemotherapy (OUT-PATSAT35 CT), the Oberst patients' perception of care quality and satisfaction scales, and an item on intention to recommend the hospital. Frequencies in the SC instruments, Spearman correlations between each scale of the OUT-PATSAT35 CT and overall satisfaction and between the subscales of OUT-PATSAT35 CT and of QLQ-C30 were calculated, and the determinants of patients' SC were calculated through multivariate regression models. RESULTS: Satisfaction with care was high: mean scores were >70 in all OUT-PATSAT35 CT areas except doctor availability and environment. These scores were in line with the other SC instruments. Correlation with overall satisfaction was high and statistically significant (p?care among cancer patients treated at the day hospital is high. Nurses play a key and successful role. Age and tumour location revealed stronger relationships with SC. Correlations between SC and quality of life indicate that these concepts are complementary. Copyright © 2013 John Wiley & Sons, Ltd. PMID:23733231

Arraras, Juan Ignacio; Illarramendi, Jose Juan; Viudez, Antonio; Ibáñez, Berta; Lecumberri, Maria Jose; de la Cruz, Susana; Hernandez, Berta; Zarandona, Uxue; Cambra, Koldo; Martinez, Maite; Salgado, Esteban; Lainez, Nuria; Vera, Ruth

2013-06-01

86

Do Beliefs About Hospital Technologies Predict Nurses' Perceptions of Their Ability to Provide Quality Care? A Study in Two Pediatric Hospitals  

Microsoft Academic Search

The purpose of this study was to test the hypothesis that nurse perceptions of technology they use in practice would affect\\u000a their perception that they were able to provide high quality patient care. A survey assessing the variables was administered\\u000a to 337 pediatric nurses from two academic freestanding pediatric hospitals in the US. Two separate equations were constructed,\\u000a one to

Ben-tzion Karsh; Kamisha Escoto; Samuel Alper; Richard Holden; Matthew Scanlon; Kathleen Murkowski; Neal Patel; Theresa Shalaby; Judi Arnold; Rainu Kaushal; Kathleen Skibinski; Roger Brown

2007-01-01

87

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

PubMed Central

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

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

1995-01-01

88

Use of Clinical Decision Support to Improve the Quality of Care Provided to Older Hospitalized Patients  

PubMed Central

Background Frail older inpatients are at risk of unintended adverse events while in hospital, particularly falls, functional decline, delirium and incontinence. Objective The aim of this pragmatic trial was to pilot and evaluate a multi-component knowledge translation intervention that incorporated a nurse-initiated computerized clinical decision support tool to reduce harms in the care of older medical inpatients. Methods A stepped wedge trial design was conducted on six medical units at two hospitals in Calgary, Alberta, Canada. The primary quantitative outcome was the rate of order set use. Secondary outcomes included the number of falls, the average number of days in hospital, and the total number of consults ordered for each of orthopedics, geriatrics, psychiatry and physiotherapy. Qualitative analysis included interviews with nurses to explore barriers and facilitators around the implementation of the electronic decision support tool. Results The estimated mean rate of order set use over a 2 week period was 3.1 (95% CI 1.9–5.3) sets higher after the intervention than before. The estimated odds of a fall happening on a unit over a 2-week period was 9.3 (p = 0.065) times higher before than after the intervention. There was no significant effect of the intervention on length of hospital stay (p = 0.67) or consults to related clinical services (all p <0.2). Interviews with front-line nurses and nurse managers/educators revealed that the order set is not being regularly ordered because its content is perceived as part of good nursing care and due to the high workload on these busy medical units. Conclusions Although not statistically significant, a reduction in the number of falls as a result of the intervention was noted. Frontline users’ engagement is crucial for the successful implementation of any decision support tool. New strategies of implementation will be evaluated before broad dissemination of this knowledge translation intervention.

Groshaus, H.; Boscan, A.; Khandwala, F.; Holroyd-Leduc, J.

2012-01-01

89

Using minimum nurse staffing regulations to measure the relationship between nursing and hospital quality of care.  

PubMed

This study tests whether changes in licensed nurse staffing led to changes in patient safety, using the natural experiment of 2004 California implementation of minimum staffing ratios. We calculated counts of six patient safety outcomes from California Patient Discharge Data from 2000 through 2006, using the Agency for Healthcare Research and Quality Patient Safety Indicators (PSI) software. For patients experiencing nonmortality-related PSIs, we measured mean lengths of stay. We estimated difference-in-difference equations of changes in PSIs using Poisson models and calculated the marginal impact of nurse staffing on outcomes from fixed-effect Poisson regressions. Licensed nurse staffing increased in the postregulation period, except for hospitals in the highest quartile of preregulation staffing. Growth in registered nurse staffing was associated with improvement for only one PSI and reduced length of stay for one PSI. Higher registered nurse staffing per patient day had a limited impact on adverse events in California hospitals. PMID:23401064

Spetz, Joanne; Harless, David W; Herrera, Carolina-Nicole; Mark, Barbara A

2013-02-11

90

[Quality assurance in German hospitals - federal quality of care monitoring vs. evaluation of routine clinical data. A head-to-head comparison on the example of pressure ulcers].  

PubMed

Quality assurance is a backbone for the provision of health care. This has lead to the introduction of systems to evaluate and improve patient care. Currently, a 29-category monitoring is mandatory for all German hospitals (EQS, Einrichtungsübergreifende Qualitätssicherung). Since 2007, the incidence rate of pressure ulcers as an indicator for quality of care has been incorporated. A concern associated with the EQS is the requirement for active data entry by doctors and nurses, whereas the US-based patient safety indicator "PSI 3 - pressure ulcer" relies on routine clinical data without the need for additional documentation. In this study, we perform a head-to-head comparison of the 2 methods and analyze the feasibility of implementing the PSI 3 system in German hospitals on the example of pressure ulcer incidence in a German academic hospital. Our analysis shows that the usage of the PSI 3 is feasible. In particular, all clinical data are readily available. Critical advantages of the PSI 3 include the low time consumption and the positive economic impact due to increased work-flow. A prerequisite for the accuracy of the PSI 3 is the careful distinction and documentation of whether a condition (in our case: pressure ulcers) is pre-existing or hospital-acquired. In this regard, the accurate documentation of admission diagnoses is a potential weakness because these are not essential for reimbursement from health insurances and thus tend to be less well documented. In the US and Australia this problem has been addressed by introducing "present on admission" tabs into patient records. In conclusion, our study demonstrates that the usage of a quality assurance system based on routinely acquired clinical data in German hospitals is feasible, and encourages further evaluation. PMID:20859847

Theisen, S; Drabik, A; Lüngen, M; Stock, S

2010-09-21

91

Quality care in pediatric trauma  

PubMed Central

Infrastructure, processes of care and outcome measurements are the cornerstone of quality care for pediatric trauma. This review aims to evaluate current evidence on system organization and concentration of pediatric expertise in the delivery of pediatric trauma care. It discusses key quality indicators for all phases of care, from pre-hospital to post-discharge recovery. In particular, it highlights the importance of measuring quality of life and psychosocial recovery for the injured child.

Simpson, Amelia J; Rivara, Frederick P; Pham, Tam N

2012-01-01

92

Do Malawian women critically assess the quality of care? A qualitative study on women's perceptions of perinatal care at a district hospital in Malawi  

PubMed Central

Background Malawi has a high perinatal mortality rate of 40 deaths per 1,000 births. To promote neonatal health, the Government of Malawi has identified essential health care packages for improving maternal and neonatal health in health care facilities. However, regardless of the availability of health services, women’s perceptions of the care is important as it influences whether the women will or will not use the services. In Malawi 95% of pregnant women receive antenatal care from skilled attendants, but the number is reduced to 71% deliveries being conducted by skilled attendants. The objective of this study was to describe women’s perceptions on perinatal care among the women delivered at a district hospital. Methods A descriptive study design with qualitative data collection and analysis methods. Data were collected through face-to-face in-depth interviews using semi-structured interview guides collecting information on women’s perceptions on perinatal care. A total of 14 in depth interviews were conducted with women delivering at Chiradzulu District Hospital from February to March 2011. The women were asked how they perceived the care they received from health workers during antepartum, intrapartum and postpartum. They were also asked about the information they received during provision of care. Data were manually analyzed using thematic analysis. Results Two themes from the study were good care and unsatisfactory care. Subthemes under good care were: respect, confidentiality, privacy and normal delivery. Providers’ attitude, delay in providing care, inadequate care, and unavailability of delivery attendants were subthemes under unsatisfactory care. Conclusions Although the results show that women wanted to be well received at health facilities, respected, treated with kindness, dignity and not shouted at, they were not critical of the care they received. The women did not know the quality of care to expect because they were not well informed. The women were not critical of the care they received because they were not aware of the standard of care. Instead they had low expectations. Health workers have a responsibility to inform women and their families about the care that women should expect. There is also a need for standardization of the antenatal information that is provided.

2012-01-01

93

Worldwide perspective of the quality of care provided to hospitalized patients with community-acquired pneumonia: results from the CAPO international cohort study.  

PubMed

National organizations from multiple countries have developed evidence-based recommendations for the management of hospitalized patients with community-acquired pneumonia (CAP). Good quality of care in CAP can be defined as patient care provided in compliance with evidence-based recommendations. To evaluate the quality of care provided to hospitalized patients with CAP, an international network of investigators is collecting local data on quality indicators from 36 hospitals in 14 countries. Participating countries in four regions are performing worldwide benchmarking: North America (region I), Europe (region II), Latin America (region III), and Asia and Africa (region IV). The quality of care provided to 2750 hospitalized patients with CAP was evaluated in the following areas: diagnosis, hospitalization, respiratory isolation, microbiological workup, empirical therapy, switch therapy, hospital discharge, and prevention. The greatest opportunities for improvement were identified in the areas of prevention of CAP, initial empirical therapy, and switch from intravenous to oral antibiotics. This study indicates that the care recommended by national guidelines is not being appropriately delivered to adults in all regions of the world. New interventions to advance quality of care are necessary to improve clinical and economic outcomes in CAP. PMID:16388426

Ramírez, Julio A

2005-12-01

94

Patient and Hospital Characteristics Associated With Recommended Processes of Care for Elderly Patients Hospitalized With Pneumonia: Results From the Medicare Quality Indicator System Pneumonia Module  

Microsoft Academic Search

Background: Unexplained wide variability exists in the performance of key initial processes of care associated with improved survival of elderly patients (those65 years) hos- pitalized with pneumonia. The objective of this study was to assess which patient and hospital characteristics are as- sociated with performance of these key initial processes of care for hospitalized elderly patients with pneumonia. Methods: A

Jonathan M. Fine; Michael J. Fine; Deron Galusha; Marcia Petrillo; Thomas P. Meehan

2002-01-01

95

Determinants of quality of life among people with epilepsy attending a secondary care rural hospital in south India  

PubMed Central

Context: Epilepsy is associated with profound physical, psychological, and social consequences. Aims: To assess the quality of life (QOL) among people with epilepsy attending the outpatient department of a secondary care hospital and to determine the various social and demographic factors affecting it. Materials and Methods: The QOL of 100 people with epilepsy attending the outpatient department of a community-based secondary care hospital was assessed using the WHOQOL-BREF (WHOQOL: World Health Organization QOL) questionnaire. Univariate analysis and logistic regression was done to determine the factors associated with poor QOL. Results: The QOL scores for all the domains ranged between 15.7 and 74.55 with a mean score of 51.49 [standard deviation (SD) 12.3]. The mean scores in the physical, psychological, social, and environmental domains were 55.7, 37.92, 57.75, and 50.56, respectively. Age more than 30 years [odds ratio (OR): 4.33, 95% confidence interval (CI): 1.73-10.82], female gender (OR: 2.90, 95% CI: 1.16-7.28), and currently married (OR: 3.82, 95% CI: 1.21-12.11) were the factors significantly associated with lower QOL scores. Conclusions: The QOL among people with epilepsy was lower in the psychological domain. Age more than 30 years, female gender, and being married were identified as the factors associated with poor QOL scores among people with seizure disorders.

Ashwin, M; Rakesh, PS; Pricilla, Ruby A; Manjunath, K; Jacob, KS; Prasad, Jasmin

2013-01-01

96

Essa y Addressing The Nurse Shortage To Improve The Quality Of Patient Care Efforts of the RWJF and selected funders around the nation to fix this problem affecting today's hospitals  

Microsoft Academic Search

Nurses are the largest group of health care professionals providing direct pa- tient care in hospitals, and the quality of care for hospital patients is strongly linked to the performance of nursing staff, according to an Institute of Medicine report. This paper de- scribes the Robert Wood Johnson Foundation's (RWJF's) work in nursing, which focuses on improving the hospital work

Susan B. Hassmiller; Maureen Cozine

97

Hospital Staff and Family Perspectives Regarding Quality of Pediatric Palliative Care  

Microsoft Academic Search

Background. Development of a pediatric palliative care program was preceded by a needs assess- ment that included a staff survey and family interviews regarding improving pediatric palliative care. Methods. Four hundred forty-six staff members and community physicians responded to a written survey regarding comfort and expertise in delivering end of life care. Sixty-eight family members of 44 deceased children were

Nancy A. Contro; Judith Larson; Sarah Scofield; Barbara Sourkes; Harvey J. Cohen

2010-01-01

98

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.

2010-01-01

99

Clinical pathways--an evaluation of its impact on the quality of care in an acute care general hospital in Singapore.  

PubMed

A critical or clinical pathway defines the optimal care process, sequencing and timing of interventions by healthcare professionals for a particular diagnosis or procedure. It is a relatively new clinical process improvement tool that has been gaining popularity across hospitals and various healthcare organisations in many parts of the world. It is now slowly gaining momentum and popularity in Asia and Singapore. Clinical pathways are developed through collaborative efforts of clinicians, case managers, nurses, and other allied healthcare professionals with the aim of improving the quality of patient care, while minimising cost to the patient. Clinical pathways have been shown to reduce unnecessary variation in patient care, reduce delays in discharge through more efficient discharge planning, and improve the cost-effectiveness of clinical services. The approach and objectives of clinical pathways are consistent with those of total quality management (TQM) and continuous clinical quality improvement (CQI), and is essentially the application of these principles at the patient's bedside. However, despite the growing popularity of pathways, their impact on clinical outcomes and their clinical effectiveness remains largely untested and unproven through rigorous clinical trials. This paper begins with an overview of the nature of clinical pathways and the analysis of variances from the pathway, their benefits to the healthcare organisation, their application as a tool for CQI activities in direct relation to patient care, and their effectiveness in a variety of healthcare settings. The paper describes an evaluation of the impact of a clinical pathway on the quality of care for patients admitted for uncomplicated acute myocardial infarction (AMI) through an analysis of variances. The author carried out a one year evaluation of a clinical pathway on uncomplicated AMI in Changi General Hospital (CGH) to determine its effectiveness and impact on a defined set of outcomes. A before and after nonrandomized study of two groups of patients admitted to the Hospital for uncomplicated AMI was done. A total of 169 patients were managed on the clinical pathway compared to 100 patients in the control (historical comparison) group. Outcomes were compared between the two groups of patients. Restriction and matching of study subjects in both groups ensured that the patients selected were comparable in terms of severity of illness. The results showed that the patients on the clinical pathway and the comparison group were similar with respect to demographic variables, prevalence of risk factors and comorbidities. There was a statistically significant reduction in the average length of stay after implementation of the clinical pathway. This was achieved without any adverse effect on short term clinical outcomes such as in-hospital mortality, complication rate and morbidity. There were no significant difference in readmission rates at 6 months after discharge. The paper concludes that clinical pathways, implemented in the context of an acute care general hospital, is able to significantly improve care processes through better collaboration among healthcare professionals and improvements in work systems. PMID:11026801

Cheah, J

2000-07-01

100

Financial Incentives to Promote Health Care Quality: The Hospital Acquired Conditions Nonpayment Policy  

Microsoft Academic Search

Over a decade ago it was estimated that in the United States 98,000 patients die each year from hospital acquired conditions (HAC). Recently it has been reported that this many patients now die annually from hospital acquired infections (HAI) alone. Currently, HAI affects 1.7 million U.S. citizens each year. Although these conditions are often called “preventable errors,” some are associated

Kevin T. Kavanagh

2011-01-01

101

Do Subspecialists Working Outside of Their Specialty Provide Less Efficient and Lower-Quality Care to Hospitalized Patients Than Do Primary Care Physicians?  

Microsoft Academic Search

Background: Studies show that subspecialists can pro- vide better quality care than primary care physicians when working within their subspecialty for patients with some medical conditions. However, many subspecialists care for patients outside of their chosen subspecialty. The present study compared the quality of care provided by subspe- cialists practicing outside of their specialty, general inter- nists, and subspecialists practicing

Scott R. Weingarten; Lynne Lloyd; Chiun-Fang Chiou; Glenn D. Braunstein

2002-01-01

102

Preventing Pressure Ulcers in Hospitals: A Toolkit for Improving Quality of Care.  

National Technical Information Service (NTIS)

Each year, more than 2.5 million people in the United States develop pressure ulcers. These skin lesions bring pain, associated risk for serious infection, and increased health care utilization. Moreover, the Centers for Medicare & Medicaid (CMS) no longe...

A. Niederhauser C. Logan C. V. Lukas D. Berlowitz J. Silver V. Parker

2011-01-01

103

Healthcare Inspection: Alleged Nursing Quality of Care Issues Edward Hines Jr. VA Hospital, Hines, Illinois.  

National Technical Information Service (NTIS)

The purpose of this inspection was to determine the merit of allegations made by an anonymous complainant alleging that the following incidents occurred on one nursing unit in a 34 week period prior to April 27, 2009, at the Edward Hines Jr. VA Hospital. ...

2009-01-01

104

Effects of the DRG-Based Prospective Payment System on Quality of Care for Hospitalized Medicare Patients. Executive Summary.  

National Technical Information Service (NTIS)

The study used a time series design to measure quality of care in 1981-1982, before the implementation of the prospective payment system (PPS), and in 1985-1986, after PPS implementation. Quality of care was judged using a clinically detailed review of th...

K. L. Kahn D. Draper E. B. Keeler W. H. Rogers L. V. Rubenstein

1991-01-01

105

Impact of Do-not-resuscitation Orders on Quality of Care Performance Measures in Patients Hospitalized with Acute Heart Failure  

PubMed Central

Background Heart failure (HF) is one of the leading causes of morbidity and mortality among Americans. Despite increased interest in end-of-life care, the implications of DNR orders in acutely ill patients with HF remain unclear. The goals of this observational study were to describe the use of do-not-resuscitate (DNR) orders and their impact on treatment approaches in residents of a large New England metropolitan area hospitalized with acute heart failure. Methods Use of HF performance measures, including assessment of left ventricular function, use of angiotensin receptor blocking agents, anticoagulation, smoking cessation counseling, and utilization of non-pharmacologic strategies, was examined through review of the medical records of 4,537 metropolitan Worcester (MA) residents admitted to 11 Central Massachusetts hospitals with acute HF in 1995 and 2000 according to the presence of DNR orders. Results Patients with DNR orders were less likely to have had their left ventricular function assessed (31 % vs. 43%) as well as receive renin-angiotensin system blockade (49% vs. 57%), anticoagulation (65% vs.78%), or nonpharmacologic interventions (87% vs. 92%) as compared to patients without DNR orders. Patients with DNR orders were significantly less likely to have received any quality assurance measure for acute HF (adjusted hazard ratio, 0.63; 95% CI, 0.40, 0.99) than patients without DNR orders. Conclusions The use of quality assurance measures in acute HF is markedly lower in patients with DNR orders. The implications of DNR orders need to be further clarified in the treatment of patients with acute HF.

Chen, Joline L.T.; Sosnov, Jonathan; Lessard, Darleen; Goldberg, Robert J.

2008-01-01

106

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

107

Purchaser/Provider Evaluation: Hospital Quality Data, TN.  

National Technical Information Service (NTIS)

The purpose of this study was to compare and contrast the perceptions of two key health care quality stakeholders, employers and hospital administrators, towards the Consumer Guide for Urban Hospital Care, 2001. This report was the first publicly released...

B. Braun J. Fowles D. Shaller J. Burgess E. Kind G. Fortner

2004-01-01

108

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

Microsoft Academic Search

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

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

2009-01-01

109

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

PubMed Central

Background The prevalence and implementation of institutional end-of-life policies has been comprehensively studied in Flanders, Belgium, a country where euthanasia was legalised in 2002. Developing end-of-life policies in hospitals is a first step towards improving the quality of medical decision-making at the end-of-life. Implementation of policies through quality assessments, communication and the training and education of health care providers is equally important in improving actual end-of-life practice. The aim of the present study is to report on the existence and nature of end-of-life policy implementation activities in Flemish acute hospitals. Methods A cross-sectional mail survey was sent to all acute hospitals (67 main campuses) in Flanders (Belgium). The questionnaire asked about hospital characteristics, the prevalence of policies on five types of end-of-life decisions: euthanasia, palliative sedation, alleviation of symptoms with possible life-shortening effect, do-not-resuscitate decision, and withdrawing or withholding of treatment, the internal and external communication of these policies, training and education on aspects of end-of-life care, and quality assessments of end-of-life care on patient and family level. Results The response rate was 55%. Results show that in 2007 written policies on most types of end-of-life decisions were widespread in acute hospitals (euthanasia: 97%, do-not-resuscitate decisions: 98%, palliative sedation: 79%). While standard communication of these policies to health care providers was between 71% and 91%, it was much lower to patients and/or family (between 17% and 50%). More than 60% of institutions trained and educated their caregivers in different aspects on end-of-life care. Assessment of the quality of these different aspects at patient and family level occurred in 25% to 61% of these hospitals. Conclusions Most Flemish acute hospitals have developed a policy on end-of-life practices. However, communication, training and the education of health care providers about these policies is not always provided, and quality assessment tools are used in less than half of the hospitals.

2009-01-01

110

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

Federal Register 2010, 2011, 2012, 2013

This document corrects technical errors in the correcting document that appeared in the October 3, 2012 Federal Register entitled ``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......

2013-03-13

111

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

Federal Register 2010, 2011, 2012, 2013

This document corrects technical and typographical errors in the proposed rule that appeared in the May 10, 2013 Federal Register titled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long Term Care Hospital Prospective Payment System and Proposed Fiscal Year 2014 Rates; Quality Reporting Requirements for Specific Providers; Hospital Conditions......

2013-06-27

112

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

Federal Register 2010, 2011, 2012, 2013

This document corrects technical and typographical errors in the proposed rule that appeared in the May 11, 2012 Federal Register entitled ``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......

2012-06-11

113

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

114

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

Microsoft Academic Search

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

Ros Sorensen; Rick Iedema

2011-01-01

115

Quality assurance in the health care industry.  

PubMed

The purpose of this article is to explore the quality assurance methods commonly used in the health care industry. Factors that influence the delivery of quality patient care is explored as well as factors that affect implementation of quality control measures. The importance of quality patient care to the economic success of the health care industry is described. Quality improvement efforts that are utilized by health care institutions are described including: independent performance audits, internal audits, outcomes analysis, consumer reports, industry guidelines, and consumer satisfaction surveys. Highly effective hospital managers exhibit management roles, behaviors, and a range of activities that correlate strongly to institutional commitment to quality and improved patient care outcomes. By reinforcing their involvement in quality improvement efforts, hospital managers were able to enhance their effectiveness in promoting and sustaining quality care. PMID:16080413

Guth, Kim Ann; Kleiner, Brian

2005-01-01

116

For-Profit Hospitals Loom Large on Health Care Scene.  

ERIC Educational Resources Information Center

Discusses the rising trend supporting for-profit hospitals. Compares for-profit and not-for-profit hospitals in regards to hospital costs, quality of care, care for the poor, education and research, and the role of the physician. (TW)

Culliton, Barbara J.

1986-01-01

117

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

PubMed Central

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 CSRs, and (4) possible under-use of CS. Methods We defined a population of low risk deliveries (singleton, vertex, full-term, live born, <4500 g, >2499 g). Using multivariable logistic regression techniques, we provided degrees of evidence regarding the observed departure ([relative risk-1]*100) of each hospital (N = 107) from the national CSR and its trend. To determine a benchmark, we defined three CSR groups (high, average and low) and compared them regarding 1 minute Apgar scores and other neonatal endpoints. An anonymous feedback is provided to the hospitals, the College of Physicians (with voluntary disclosure of the outlying hospitals for quality improvement purposes) and to the policy makers. Results Compared with available information, the completeness and accuracy of the data, regarding the variables selected to determine our study population, showed adequate. Important inter-hospital differences were found. Departures ranged from -65% up to +75%, and 9 "high CSR" and 13 "low CSR" outlying hospitals were identified. We observed a national increasing trend of 1.019 (95%CI [1.015; 1.022]) per semester, adjusted for age groups. In the "high CSR" group 1 minute Apgar scores < 4 were over-represented in the subgroup of vaginal deliveries, suggesting CSs not carried out for medical reasons. Under-use of CS was also observed. Given their questionable completeness, except Apgar scores, our neonatal results, showing a significant association of CS with adverse neonatal endpoints, are to be cautiously interpreted. Taking the available evidence into account, the "Average CSR" group seemed to be the best benchmark candidate. Conclusion Rather than firm statements about quality of care, our results are to be considered a useful screening. The inter-hospital differences in CSR, the national CS upward trend, the indications of over-use and under-use, the geographically different obstetric patterns and the admission day-related concentration of deliveries, whether or not by CS, may trigger initiatives aiming at improving quality of care.

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

2008-01-01

118

Perceptions of Quality of Nursing Care: Patients and Registered Nurses in a Hospital Using 12-Hour Shifts.  

National Technical Information Service (NTIS)

The purpose of the study was to investigate the quality of nursing care as perceived by patients and as perceived by registered nurses who worked a compressed workweek. There were 33 patients and 35 registered nurses in the sample. The study was conducted...

L. A. Van Vechten

1983-01-01

119

Health Care Planning and Quality Care.  

National Technical Information Service (NTIS)

Basic ingredients in health care planning and quality care are addressed. Proper planning can assure that adequate manpower facilities are available to insure proper patient care. Thus, one of the most basic ingredients in quality health care is continual...

M. K. Duval

1972-01-01

120

EMCRO - An Evaluation of Experimental Medical Care Review Organizations: Volume III. Hospital Review Projects; Final Report Summary.  

National Technical Information Service (NTIS)

The volume categorizes hospital review programs as hospital utilization review and quality of hospital care programs. Hospital utilization review was conducted differently among the EMCRO projects. New Mexico Foundation for Medical Care developed a hospit...

1976-01-01

121

Impact of quality strategies on hospital outputs  

PubMed Central

Context: This study was part of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) research project on patients crossing borders, a study to investigate quality improvement strategies in healthcare systems across the European Union (EU). Aim: To explore the association between the implementation of quality improvement strategies in hospitals and hospitals’ success in meeting defined quality requirements that are considered intermediate outputs of the care process. Methods: Data regarding the implementation of seven quality improvement strategies (accreditation, organisational quality management programmes, audit and internal assessment of clinical standards, patient safety systems, clinical practice guidelines, performance indicators and systems for obtaining patients’ views) and four dimensions of outputs (clinical, safety, patient-centredness and cross-border patient-centredness) were collected from 389 acute care hospitals in eight EU countries using a web-based questionnaire. In a second phase, 89 of these hospitals participated in an on-site audit by independent surveyors. Pearson correlation and linear regression models were used to explore associations and relations between quality improvement strategies and achievement of outputs. Results: Positive associations were found between six internal quality improvement strategies and hospital outputs. The quality improvement strategies could be reasonably subsumed under one latent index which explained about half of their variation. The analysis of outputs concluded that the outputs can also be considered part of a single construct. The findings indicate that the implementation of internal as well as external quality improvement strategies in hospitals has beneficial effects on the hospital outputs studied here. Conclusion: The implementation of internal quality improvement strategies as well as external assessment systems should be promoted.

Sunol, R; Vallejo, P; Thompson, A; Lombarts, M J M H; Shaw, C D; Klazinga, N

2009-01-01

122

Learning from MARQuIS: future direction of quality and safety in hospital care in the European Union  

PubMed Central

This article summarises the significant lessons to be drawn from, and the policy implications of, the findings of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) project—a part of the suite of research projects intended to support policy established by the European Commission through its Sixth Framework Programme. The article first reviews the findings of MARQuIS and their implications for healthcare providers (and particularly for hospitals), and then addresses the broader policy implications for member states of the European Union (EU) and for the commission itself. Against the background of the European Commission’s Seventh Framework Programme, it then outlines a number of future areas for research to inform policy and practice in quality and safety in Europe. The article concludes that at this stage, a unique EU-wide quality improvement system for hospitals does not seem to be feasible or effective. Because of possible future community action in this field, attention should focus on the use of existing research on quality and safety strategies in healthcare, with the aim of combining soft measures to accelerate mutual learning. Concrete measures should be considered only in areas for which there is substantial evidence and effective implementation can be ensured.

Groene, O; Klazinga, N; Walshe, K; Cucic, C; Shaw, C D; Sunol, R

2009-01-01

123

Hospital at Home: Feasibility and Outcomes of a Program To Provide Hospital-Level Care at Home for Acutely Ill Older Patients  

Microsoft Academic Search

Results: Hospital-at-home care was feasible and efficacious in delivering hospital-level care to patients at home. In 2 of 3 sites studied, 69% of patients who were offered hospital-at-home care chose it over acute hospital care; in the third site, 29% of patients chose hospital-at-home care. Although less procedurally oriented than acute hospital care, hospital-at-home care met quality stan- dards at

Bruce Leff; Lynda Burton; Scott L. Mader; Bruce Naughton; Jeffrey Burl; Sharon K. Inouye; William B. Greenough III; Susan Guido; Christopher Langston; Kevin D. Frick; Donald Steinwachs; John R. Burton

2005-01-01

124

Can we update the Summary Hospital Mortality Index (SHMI) to make a useful measure of the quality of hospital care? An observational study  

PubMed Central

Objective To advance methods for the estimation of hospital performance based upon mortality ratios. Design Observational study estimating trust performance in a year derived according to comparative standards from a 3-year period, accounting for patient-level case-mix and overdispersion (unexplained variability). Participants 23?363?630 admissions to the English National Health Service (NHS) by NHS Trust. Main outcome measures Number of SDs (QUality and Outcomes Research Unit Measure, QUORUM banding) and comparative odds of hospital mortality difference from mean performance by trust compared for 2010/2011, 2008/2009 and 2009/2010, accounting for patient-level case-mix. Results The model was highly predictive of mortality (C statistic=0.93), and well calibrated by risk stratum. There was substantial overdispersion. No trusts were more than 3 SDs above the mean, and only one trust was more than 2 SDs above the mean for 2010/2011. Conclusions QUORUM is highly predictive of patient mortality in hospital or up to 30?days after admission. However, like the Summary Hospital Mortality Indicator (SHMI), QUORUM is subjected to considerable remaining legitimate but unexplained variation. It is unlikely that measures like QUORUM and SHMI will be useful beyond identifying a very small number of trusts as potential outliers.

Freemantle, Nick; Richardson, Matthew; Wood, John; Ray, Daniel; Khosla, Sajan; Sun, Ping; Pagano, Domenico

2013-01-01

125

Using clinical audit to improve the quality of obstetric care at the Tibetan Delek Hospital in North India: a longitudinal study  

PubMed Central

Background The Tibetan Delek Hospital is a small general hospital providing primary and secondary care for the Tibetan refugee community and the local Indian population in Dharamsala, Himachal Pradesh, North India. In a baseline clinical audit of intrapartum care at the Tibetan Delek Hospital in 1996, high levels of postpartum haemorrhage associated with poor medical management of the third stage of labour, plus inappropriate transfer of women in labour were observed. These audit findings prompted the implementation of changes in the delivery of intrapartum care and follow-up audit cycles to monitor the ongoing effect of these changes. Methods The delivery of intrapartum care was modified in two ways. Firstly, nurses, midwives, and doctors were re-trained in the active management of the third stage of labour, which involved the administration of intramuscular syntocinon plus ergometrine with delivery of the anterior shoulder. Secondly partograms were introduced to help rationalise the management of labour, and in particular decisions about when to transfer women in labour. Follow up audits were conducted in 1997, 1998, and 2003 to quantify the effects of these changes. The key measures for improvement included the documented incidence of postpartum haemorrhage and the number of women transferred inappropriately for failure to progress in labour. Results A sustained reduction of approximately 50% in the incidence of postpartum haemorrhage was observed after the introduction of active management of the third stage of labour. The introduction of the routine use of partograms was associated with a more rational decision-making process regarding transfer during labour. Conclusion Introducing and maintaining a clinical audit cycle can lead to improvements in the quality of obstetric care in a refugee population.

Mercer, Stewart W; Sevar, Katherine; Sadutshan, Tsetan D

2006-01-01

126

A STUDY OF PSORIASIS AND QUALITY OF LIFE IN A TERTIARY CARE TEACHING HOSPITAL OF KOTTAYAM, KERALA  

PubMed Central

Background: Psoriasis is a chronic skin disease which has an impact on health-related quality of life (QoL). The psoriasis disability index (PDI) is a simple 15-item questionnaire which is used to assess overall psoriasis disability. Objectives: (1) To assess the health-related QoL among patients with psoriasis, attending dermatology OPD of Medical College Hospital, Kottayam. (2) To find out the association of QoL with age and gender. Materials and Methods: This was a descriptive case series study conducted in Dermatology OPD of Medical College Hospital, Kottayam, Kerala. Psoriasis patients attending the Dermatology OPD of Medical College Hospital for 2 months were assessed. Results: Out of the total 32 patients, 56.2% were males, whose mean age was 45; 72% were married, 47% had education above plus two and were employed. Also, 34% had income above Rs. 3000 per month. Among the PDI subsets, daily activities were affected the most (90.6%), followed by work (84.4%), leisure activities (71.9%), problems with treatment (68.7%) and the least affected was personal relations (62.5%). Overall PDI score (median 14.5, interquartile range 4.5–22) showed that the QoL was affected in 75% of which 9.4% were mild (score < 9), 31.2% were moderate (score 10–18) and 34.4% were severe (score > 18). There was no association between the total PDI score and age or gender. Conclusion: QoL was affected in 75% of psoriasis patients. There was no association between QoL and age or gender.

Manjula, V D; Sreekiran, S; Saril, P Surendran; Sreekanth, M P

2011-01-01

127

Continuous quality improvement, total quality management, and reengineering: one hospital's continuous quality improvement journey.  

PubMed

In recent years, there has been significantly increasing interest in the application of continuous quality improvement (CQI) and total quality management (TQM) in the health care arena. This case analysis is designed to identify and assess the strategies and processes that led to the successful implementation of CQI in the Emergency Care Center at St. Mary's Hospital in Grand Rapids, MI. PMID:9735478

Klein, D; Motwani, J; Cole, B

1998-01-01

128

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

129

[Long-term care elderly residents in general hospitals].  

PubMed

Long-term care facilities for the elderly have regularly to work together with general hospitals to provide care to acutely ill residents or when they require all together more complex diagnostic procedures and multi-specialty care. The decision to hospitalize a nursing home elderly resident is multifactorial and it is based on factors such as illness severity and care facility infrastructure. Hospitalizations have benefits and risks such developing iatrogenic diseases, delirium, and functional decline, which may deteriorate patients' general condition and their quality of life during and/or after hospitalization. This study aimed at addressing specific aspects of assessment, treatment and management of nursing home elderly who require to be hospitalized, especially focusing on their effective care. Common conditions such delirium, iatrogenic diseases, poor nutrition, functional decline, hospice care and special characteristics of nursing home elderly during their admission to general hospitals are discussed. PMID:17173173

Gorzoni, Milton Luiz; Pires, Sueli Luciano

2006-12-01

130

Can quality circles improve hospital-acquired infection control?  

Microsoft Academic Search

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

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

2000-01-01

131

Strategic service quality management for health care.  

PubMed

Quality management has become one of the most important and most debated topics within the service sector. This is especially true for health care, as the controversy rages on how the existing American system should be restructured. Health care reform aimed at reducing costs and ensuring access to all Americans cannot be allowed to jeopardize the quality of care. As such, total quality management (TQM) has become a vital ingredient to strategic planning within the health care domain. At the heart of any such quality improvement effort is the issue of measurement. TQM cannot be effectively utilized as a competitive weapon unless quality can be accurately defined, measured, evaluated, and monitored over time. Through such analysis a hospital can elect how to expend its limited resources toward those quality improvement projects which will impact customer perceptions of service quality the most. Thus, the purpose of this report is to establish a framework by which to approach the issue of quality measurement, delineate the various components of quality that exist in health care, and explore how these elements affect one another. We propose that the issue of quality measurement in health care be approached as an integration of service quality attributes common to other service organizations and technical quality attributes unique to health care. We hope that this research will serve as a first step toward the synthesis of the various quality attributes inherent in the health care domain and encourage other researchers to address the interactions of the various quality attributes. PMID:8763215

Anderson, E A; Zwelling, L A

1996-01-01

132

Quality of out-of-hospital palliative emergency care depends on the expertise of the emergency medical team—a prospective multi-centre analysis  

Microsoft Academic Search

Background  The number of palliative care patients who live at home and have non-curable life-threatening diseases is increasing. This\\u000a is largely a result of modern palliative care techniques (e.g. specialised out-of-hospital palliative medical care services),\\u000a changes in healthcare policy and the availability of home care services. Accordingly, pre-hospital emergency physicians today\\u000a are more likely to be involved in out-of-hospital emergency treatment

Christoph H. R. Wiese; Utz E. Bartels; Karolina Marczynska; David Ruppert; Bernhard M. Graf; Gerd G. Hanekop

2009-01-01

133

Monitoring Quality of Nursing Care  

PubMed Central

The first phase of a cooperative project to develop and pilot-test an improved system for monitoring the quality of nursing care is described. Evaluation criteria from existing methodologies were grouped in a comprehensive framework of nursing objectives and subobjectives, and both the framework and the criteria developed were tested statistically. The master criteria list was placed in a computer file, from which criteria subsets are systematically selected for actual quality monitoring. The methodology has been used in two pilot hospitals; in the second phase of the project, now under way, the system is being implemented in a wider sample of hospitals to further test the validity of the conceptual framework and the reliability of individual criteria.

Haussmann, R. K. Dieter; Hegyvary, Sue Thomas; Newman, John F.; Bishop, Annelle C.

1974-01-01

134

Identifying health care quality attributes.  

PubMed

Evaluating health care quality is important for consumers, health care providers, and society. Developing a measure of health care service quality is an important precursor to systems and organizations that value health care quality. SERVQUAL has been proposed as a broad-based measure of service quality that may be applicable to health care settings. Results from a study described in this paper verify SERVQUAL dimensions, but demonstrate additional dimensions that are specific to health care settings. PMID:16318013

Ramsaran-Fowdar, Roshnee R

2005-01-01

135

Evaluation of the built environment at a children's convalescent hospital: development of the Pediatric Quality of Life Inventory parent and staff satisfaction measures for pediatric health care facilities.  

PubMed

In preparation for the design, construction, and postoccupancy evaluation of a new Children's Convalescent Hospital, focus groups were conducted and measurement instruments were developed to quantify and characterize parent and staff satisfaction with the built environment of the existing pediatric health care facility, a 30-year-old, 59-bed, long-term, skilled nursing facility dedicated to the care of medically fragile children with complex chronic conditions. The measurement instruments were designed in close collaboration with parents, staff, and senior management involved with the existing and planned facility. The objectives of the study were to develop pediatric measurement instruments that measured the following: (1) parent and staff satisfaction with the built environment of the existing pediatric health care facility, (2) parent satisfaction with the health care services provided to their child, and (3) staff satisfaction with their coworker relationships. The newly developed Pediatric Quality of Life Inventory scales demonstrated internal consistency reliability (average alpha = 0.92 parent report, 0.93 staff report) and initial construct validity. As anticipated, parents and staff were not satisfied with the existing facility, providing detailed qualitative and quantitative data input to the design of the planned facility and a baseline for postoccupancy evaluation of the new facility. Consistent with the a priori hypotheses, higher parent satisfaction with the built environment structure and aesthetics was associated with higher parent satisfaction with health care services (r =.54, p <.01; r =.59, p <.01, respectively). Higher staff satisfaction with the built environment structure and aesthetics was associated with higher coworker relationship satisfaction (r =.53; p <.001; r =.51; p <.01, respectively). The implications of the findings for the architectural design and evaluation of pediatric health care facilities are discussed. PMID:14767351

Varni, James W; Burwinkle, Tasha M; Dickinson, Paige; Sherman, Sandra A; Dixon, Pamela; Ervice, Judy A; Leyden, Pat A; Sadler, Blair L

2004-02-01

136

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

137

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

138

Keys for successful implementation of total quality management in hospitals.  

PubMed

This article reports the findings of an analysis of the implementation of continuous quality improvement (CQI) or total quality management (TQM) programs in 10 hospitals. This analysis is the result of a 2-year study designed to identify and assess the ingredients that lead to the successful implementation of CQI programs in acute care hospitals. PMID:8647690

Carman, J M; Shortell, S M; Foster, R W; Hughes, E F; Boerstler, H; O'Brien, J L; O'Conner, E J

1996-01-01

139

Hospital quality and medicare payment: A theoretical and empirical investigation  

Microsoft Academic Search

Does Medicare's payment rate for a hospital stay influence the quality of care received by a patient? We examine this question, theoretically and empirically. First, a model is developed which generates the key hypothesis -- that Medicare's payment rate per admission should be positively related to care quality. We then test this hypothesis by estimating the relationship between Medicare's DRG

Jinghua Huang

2011-01-01

140

Hospital quality and Medicare payment: A theoretical and empirical investigation  

Microsoft Academic Search

Does Medicare's payment rate for a hospital stay influence the quality of care received by a patient? We examine this question, theoretically and empirically. First, a model is developed which generates the key hypothesis—that Medicare's payment rate per admission should be positively related to care quality. We then test this hypothesis by estimating the relationship between Medicare's DRG payment for

Jinghua Huang

2011-01-01

141

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.

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

1982-01-01

142

Quality of dying in a New Zealand teaching hospital  

Microsoft Academic Search

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

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

2008-01-01

143

Keys for successful implementation of total quality management in hospitals.  

PubMed

Editor's Note: This article reports the findings of an analysis of the implementation of continuous quality improvement (CQI) or total quality management (TQM) programs in 10 hospitals. This analysis is the result of a 2-year study designed to identify and assess the ingredients that lead to the successful implementation of CQI programs in acute care hospitals. This article first appeared in Health Care Management Review 21(1), 48-60. Copyright © 1996 Aspen Publishers, Inc. (Lippincott Williams & Wilkins). PMID:20844354

Carman, James M; Shortell, Stephen M; Foster, Richard W; Hughes, Edward F X; Boerstler, Heidi; O' Brien, James L; O'Connor, Edward J

144

Measuring the Quality of Care for High Risk Infants.  

National Technical Information Service (NTIS)

To improve the measurement of the quality of neonatal intensive care for infants with very low birth weights (VLBW)-under 1500 grams-and to study the hospital characteristics associated with high quality care. Measuring quality of care for VLBW infants tr...

J. A. Rogowski

2004-01-01

145

Hospital Inpatient Mortality: Is It a Predictor of Quality. (Reannouncement with New Availability Information).  

National Technical Information Service (NTIS)

Various potential measures of quality of care are being used to differentiate hospitals. Last year, on the basis of diagnostic and demographic data, the Health Care Financing Administration identified hospitals in which the actual death rate differed from...

R. W. Dubois W. H. Rogers J. H. Moxley D. Draper R. H. Brook

1980-01-01

146

Monitoring Quality of Nursing Care. Part II: Assessment and Study of Correlates.  

National Technical Information Service (NTIS)

A national trial of a methodology for monitoring quality of nursing care was conducted in 19 hospitals of differing sizes and characteristics. The relationship between the quality of nursing care provided in these hospitals and a number of organizational ...

R. D. Haussmann S. T. Hegyvary J. F. Newman

1976-01-01

147

The Price of Hospital Care.  

National Technical Information Service (NTIS)

A hospital price index constructed for the manpower studies was based as follows: The productivity of labor employed in hospitals has not been declining. Therefore, the assumption that hospital labor productivity has remained constant over time seems cons...

V. Taylor

1969-01-01

148

Intensive Care in Critical Access Hospitals  

ERIC Educational Resources Information Center

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

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

2007-01-01

149

Is the maturity of hospitals' quality improvement systems associated with measures of quality and patient safety?  

PubMed Central

Background Previous research addressed the development of a classification scheme for quality improvement systems in European hospitals. In this study we explore associations between the 'maturity' of the hospitals' quality improvement system and clinical outcomes. Methods The maturity classification scheme was developed based on survey results from 389 hospitals in eight European countries. We matched the hospitals from the Spanish sample (113 hospitals) with those hospitals participating in a nation-wide, voluntary hospital performance initiative. We then compared sample distributions and explored associations between the 'maturity' of the hospitals' quality improvement system and a range of composite outcomes measures, such as adjusted hospital-wide mortality, -readmission, -complication and -length of stay indices. Statistical analysis includes bivariate correlations for parametrically and non-parametrically distributed data, multiple robust regression models and bootstrapping techniques to obtain confidence-intervals for the correlation and regression estimates. Results Overall, 43 hospitals were included. Compared to the original sample of 113, this sample was characterized by a higher representation of university hospitals. Maturity of the quality improvement system was similar, although the matched sample showed less variability. Analysis of associations between the quality improvement system and hospital-wide outcomes suggests significant correlations for the indicator adjusted hospital complications, borderline significance for adjusted hospital readmissions and non-significance for the adjusted hospital mortality and length of stay indicators. These results are confirmed by the bootstrap estimates of the robust regression model after adjusting for hospital characteristics. Conclusions We assessed associations between hospitals' quality improvement systems and clinical outcomes. From this data it seems that having a more developed quality improvement system is associated with lower rates of adjusted hospital complications. A number of methodological and logistic hurdles remain to link hospital quality improvement systems to outcomes. Further research should aim at identifying the latent dimensions of quality improvement systems that predict quality and safety outcomes. Such research would add pertinent knowledge regarding the implementation of organizational strategies related with quality of care outcomes.

2011-01-01

150

Using care bundles to reduce in-hospital mortality: quantitative survey  

Microsoft Academic Search

Problem To reduce hospital inpatient mortality and thus increase public confidence in the quality of patient care in an urban acute hospital trust after adverse media coverage. Design Eight care bundles of treatments known to be effective in reducing in-hospital mortality were used in the intervention year; adjusted mortality (from hospital episode statistics) was compared to the preceding year for

Elizabeth Robb; Brian Jarman; Ganesh Suntharalingam; Clare Higgens; Rachel Tennant; Karen Elcock

2010-01-01

151

Quality Competition, Insurance, and Consumer Choice in Health Care Markets  

Microsoft Academic Search

In this model, insurance offering a choice of hospitals is valued because consumers are uncertain which hospital they will prefer ex post. A competitive insurance market facilitates tacit price collusion between hospitals; high margins induce hospitals to compete for customers through overinvestment in quality. Incentives may exist to lock in market share via managed-care plans with less choice and lower

Thomas P. Lyon

1999-01-01

152

Is Home Health Care a Substitute for Hospital Care?  

Microsoft Academic Search

A previous study used aggregate (region-level) data to investigate whether home health care serves as a substitute for inpatient hospital care, and concluded that “there is no evidence that services provided at home replace hospital services.” However, that study was based on a cross-section of regions observed at a single point of time, and did not control for unobserved regional

Frank R. Lichtenberg

2011-01-01

153

Is Home Health Care a Substitute for Hospital Care?  

Microsoft Academic Search

A previous study used aggregate (region-level) data to investigate whether home health care serves as a substitute for inpatient hospital care and concluded that “there is no evidence that services provided at home replace hospital services.” However, that study was based on a cross-section of regions observed at a single point of time and did not control for unobserved regional

Frank R. Lichtenberg

2012-01-01

154

A call for board leadership on quality in hospitals.  

PubMed

A national agenda for health care quality is unfolding but there is concern about inadequate progress on improving quality in hospitals. The 2003 Institute of Medicine report calls for transformational leadership in health care organizations to change systems and processes underlying quality. The key question is: Who will provide leadership in hospitals? A natural choice is the board of trustees on account of its legal responsibility for quality and its authority over medical staff and administration. This article describes several barriers to board leadership on quality and suggests strategies by which boards can lead the campaign for quality. Barriers include trustee ignorance, trustee insecurity, board inattention, poor board-physician communication, fragmented information on quality, traditional medical staff structure, lack of professional management of quality, and lack of investment. Strategies for hospital board leadership should include preparing to lead, self-education, visible participation in quality activities, activism, role clarification, increased informal dialogue with physicians, medical staff reform, creation of a quality management department, instituting high-quality standards, and external quality audit. Boards face a historic opportunity to transform hospital quality backed by a strong legal mandate. PMID:15739579

Gautam, Kanak S

155

A new framework for quality partnerships in Children's Hospitals.  

PubMed

Children's hospitals and their affiliated departments of pediatrics often pursue separate programs in quality and safety; by integrating these programs, they can accelerate progress. Hospital executives and pediatric department chairs from 14 children's hospitals have been exploring practical approaches for integrating quality programs. Three components provide focus: (1) alignment of quality priorities and resources across the organizations; (2) education and training for physicians in the science of improvement; and (3) professional development and career progression for physicians in recognition of quality-improvement activities. Process and resource requirements are identified for each component, and specific, actionable steps are identified. The action steps are arrayed on a continuum from basic to advanced integration. The resulting matrix serves as an "integration framework," useful to a hospital and its pediatric academic department at any stage of integration for assessing its current state, plotting a path toward further integration, tracking its progress, and identifying potential collaborators and models of advanced integration. The framework contributes to health care's quality-improvement movement in multiple ways: it addresses a basic impediment to quality and safety improvement; it is an implementable model for integrating quality programs; it offers career-advancement potential for physicians interested in quality; it helps optimize investments in quality and safety; and it can be applied both within a single children's hospital and across multiple children's hospitals. Widespread adoption of the integration framework could have a transformative effect on the children's hospital sector, not the least of which is improved quality and safety on a large scale. PMID:21576310

Levy, Fiona Howard; Brilli, Richard J; First, Lewis R; Hyman, Daniel; Kohrt, Alan E; Ludwig, Stephen; Miles, Paul V; Saffer, Marian

2011-05-16

156

Quality in pediatric nursing care: children's expectations.  

PubMed

Children's perceptions of pediatric nursing care have not been systematically taken into account in the development of the quality of care. Usually, parents have evaluated children's care and its quality. The purpose of this study was to examine children's expectations concerning the quality of pediatric nursing care by interviewing 20 preschool and 20 school-aged children in Finland. Twenty of them had insulin-dependent diabetes mellitus (IDDM) and visited the hospital on a regular basis, and 20 were treated on a surgical ward for a short period. Using content analysis, the interviews were coded and categories and subcategories identified. The children's expectations concerning the quality of nursing care were related to the nurse, nursing activities, and environment. They expected the nurses to be humane and reliable, have a good sense of humor, and wear colorful clothes at work. Both the nurses and the parents were expected to take part in nursing activities. The children expected from nurses, in particular, entertainment, educational, caring, and safety activities, while parents were expected to relieve fears and longing and to provide company. The children also emphasized the role of other children as part of good care. The results demonstrate that children are capable of offering valuable insights into the quality of pediatric nursing care. The results open new avenues for strengthening children's perspectives on pediatric nursing. PMID:15371112

Pelander, Tiina; Leino-Kilpi, Helena

157

The trade-off between efficiency and quality in hospital departments  

Microsoft Academic Search

Purpose – Hospital managers are confronted with decisions that have to account for multiple objectives, which may be in conflict with regard to efficiency and quality of care. In empirical studies occupancy and staffing ratios as well as in-hospital mortality are frequently used measures for efficiency and quality-of-care, respectively. Efficiency and quality measures vary on a daily basis. However, most

Roman Mennicken; Ludwig Kuntz; Christoph Schwierz

2011-01-01

158

Limited Use of Price and Quality Advertising Among American Hospitals  

PubMed Central

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

Wilks, Chrisanne E A; Richter, Jason P

2013-01-01

159

The Link Between Hospital Quality and Profitability of Outpatient Services Offered  

Microsoft Academic Search

The analysis studies the relationship between hospital quality and hospital profits for a sample of 94 Alabama hospitals. Quality is measured by four groups of procedures performed on newly-admitted patients as suggested by the Center for Medicare and Medicaid Services. Profit is measured for five outpatient services. We find that the quality of inpatient care predicts profits in three of

Donald R. Self; Charles E. Hegji; Robin M. Self

2009-01-01

160

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

161

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

162

The association between quality of care and technical efficiency in long-term care  

Microsoft Academic Search

Objective. To analyse the association between quality of care and technical (productive) efficiency in institutional long-term care wards for the elderly. Setting. One hundred and fourteen public health centre hospitals and residential homes in Finland. Study design. Wards were divided into two categories according to their rank in the quality distribution, considering 41 quality variables separately. The technical efficiency scores

JUHA LAINE; U. HARRIET FINNE-SOVERI; MAGNUS BJÖRKGREN; MIIKA LINNA; ANJA NORO; UNTO HÄKKINEN

2005-01-01

163

[Quality management in palliative care].  

PubMed

The author, former chief of a medical department and experienced in quality management, describes the development of quality standards by palliative ch, the Swiss Society for Palliative Care. These standards are the basis for explicit quality-criteria. The performance of an institution for palliative care is evaluated against these criteria, during an audit and peer review. Further information is given concerning the label Quality in Palliative Care. The author describes the importance oft the PDCA-cycle as an instrument for permanent improvement. Institutions with little experience in quality management are adviced to start on a smaller scale and use internal audits. Finally the author gives some thoughts as to the limitations of quality management in palliative care. PMID:22334204

Cottier, Christoph

2012-02-01

164

Quality of Care in the US Territories  

PubMed Central

Background Health care quality in the US territories is poorly characterized. We used process measures to compare the performance of hospitals in the US territories and in the US states. Methods Our sample included nonfederal hospitals located in the United States and its territories discharging Medicare fee-for-service (FFS) patients with a principal discharge diagnosis of acute myocardial infarction (AMI), heart failure (HF), or pneumonia (PNE) (July 2005–June 2008). We compared risk-standardized 30-day mortality and readmission rates between territorial and stateside hospitals, adjusting for performance on core process measures and hospital characteristics. Results In 57 territorial hospitals and 4799 stateside hospitals, hospital mean 30-day risk-standardized mortality rates were significantly higher in the US territories (P < .001) for AMI (18.8% vs 16.0%), HF (12.3% vs 10.8%), and PNE (14.9% vs 11.4%). Hospital mean 30-day risk-standardized readmission rates (RSRRs) were also significantly higher in the US territories for AMI (20.6% vs 19.8%; P=.04), and PNE (19.4% vs 18.4%; P=.01) but was not significant for HF (25.5% vs 24.5%; P=.07). The higher risk-standardized mortality rates in the US territories remained statistically significant after adjusting for hospital characteristics and core process measure performance. Hospitals in the US territories had lower performance on all core process measures (P< .05). Conclusions Compared with hospitals in the US states, hospitals in the US territories have significantly higher 30-day mortality rates and lower performance on every core process measure for patients discharged after AMI, HF, and PNE. Eliminating the substantial quality gap in the US territories should be a national priority.

Nunez-Smith, Marcella; Bradley, Elizabeth H.; Herrin, Jeph; Santana, Calie; Curry, Leslie A.; Normand, Sharon-Lise T.; Krumholz, Harlan M.

2011-01-01

165

Hospital Costs for Stroke Care in Singapore  

Microsoft Academic Search

We performed this prospective study to determine the cost of care for acute stroke patients admitted to hospital. Stroke was subtyped into subarachnoid hemorrhage (SAH), intraparenchymal hemorrhage (IPH), nonlacunar infarct (NLC), lacunar infarct (LAC) and transient ischemic attack (TIA). Cost of care was computed for the various services the patient received. At the time of the study, US$ 1 =

N. Venketasubramanian; A. Yin

2000-01-01

166

A statewide review of postnatal care in private hospitals in Victoria, Australia  

Microsoft Academic Search

BACKGROUND: Concerns have been raised in Australia and internationally regarding the quality and effectiveness of hospital postnatal care, although Australian women receiving postnatal care in the private maternity sector rate their satisfaction with care more highly than women receiving public maternity care. In Victoria, Australia, two-thirds of women receive their maternity care in the public sector and the remainder in

Jo-Anne Rayner; Helen L McLachlan; Della A Forster; Louise Peters; Jane Yelland

2010-01-01

167

Impact of quality strategies on hospital outputs  

Microsoft Academic Search

Context:This study was part of the Methods of Assessing Response to Quality Improvement Strategies (MARQuIS) research project on patients crossing borders, a study to investigate quality improvement strategies in healthcare systems across the European Union (EU).Aim:To explore the association between the implementation of quality improvement strategies in hospitals and hospitals’ success in meeting defined quality requirements that are considered intermediate

R. Suñol; P. Vallejo; A. Thompson; M. J. M. H. Lombarts; C. D. Shaw; N. Klazinga

2009-01-01

168

Care pathways across the primary-hospital care continuum: using the multi-level framework in explaining care coordination  

PubMed Central

Background Care pathways are widely used in hospitals for a structured and detailed planning of the care process. There is a growing interest in extending care pathways into primary care to improve quality of care by increasing care coordination. Evidence is sparse about the relationship between care pathways and care coordination. The multi-level framework explores care coordination across organizations and states that (inter)organizational mechanisms have an effect on the relationships between healthcare professionals, resulting in quality and efficiency of care. The aim of this study was to assess the extent to which care pathways support or create elements of the multi-level framework necessary to improve care coordination across the primary - hospital care continuum. Methods This study is an in-depth analysis of five existing local community projects located in four different regions in Flanders (Belgium) to determine whether the available empirical evidence supported or refuted the theoretical expectations from the multi-level framework. Data were gathered using mixed methods, including structured face-to-face interviews, participant observations, documentation and a focus group. Multiple cases were analyzed performing a cross case synthesis to strengthen the results. Results The development of a care pathway across the primary-hospital care continuum, supported by a step-by-step scenario, led to the use of existing and newly constructed structures, data monitoring and the development of information tools. The construction and use of these inter-organizational mechanisms had a positive effect on exchanging information, formulating and sharing goals, defining and knowing each other’s roles, expectations and competences and building qualitative relationships. Conclusion Care pathways across the primary-hospital care continuum enhance the components of care coordination.

2013-01-01

169

Does Competition Kill? Hospital Quality and Competition  

Microsoft Academic Search

We seek to estimate the effects of competition for both Medicare and HMO patients on the quality decisions of hospitals in Southern California. We find that increases in the degree of competition for HMO patients decrease risk-adjusted hospital mortality rates. Conversely, increases in competition for Medicare enrollees are associated with increases in risk-adjusted mortality rates for hospitals. In conjunction with

Gautam Gowrisankaran; Robert J. Town

2000-01-01

170

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

171

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

PubMed

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

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

172

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

Microsoft Academic Search

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

Tjibbe Donker; Jacco Wallinga; Hajo Grundmann

2010-01-01

173

[Frequency of hospitalization in intensive care units of community hospitals].  

PubMed

One thousand eight hundred and eighty-eight patients were hospitalized and treated at the Intensive Care Unit, Department of Internal Medicine, Zabok General Hospital between January 1, 1990 and December 12, 1994. The majority of patients were admitted because of cardiovascular diseases (59.3%), gastrointestinal diseases (14.0%), metabolic diseases (5.1%), chronic obstructive lung disorders (4.6%), allergy and shock. The results show that the average treatment time of patients with cardiovascular diseases was 4.6 days, gastrointestinal diseases 3.2 days and metabolic diseases 4.2 days. The average age for males was 58 years and for females 64 years. We conclude that even hospitals with moderate equipment may provide a quick and proper medical care for critically ill patients. PMID:8649176

Mihaldinec, Z; Ulakovi?, L I; Avdi?, R; Bjelja, L; Drufovka, M; Glumpak, Z; Pesek, K; Rogan, S; Gasparovi?, H

1995-06-01

174

Global Variation in Quality of Care Among Patients Hospitalized With Acute Heart Failure in an International Trial: Findings From the Acute Study Clinical Effectiveness of Nesiritide in Decompensated Heart Failure Trial (ASCEND-HF).  

PubMed

Background- Translation of evidence-based heart failure (HF) therapies to clinical practice is incomplete and may vary internationally. We examined common measures of quality of care in patients enrolled in the international Acute Study of Clinical Effectiveness of Nesiritide in Decompensated Heart Failure trial. Methods and Results- Patients were admitted to 398 hospitals for acute HF in 5 regions (North America, n=3149; Latin America, n=658; Asia Pacific, n=1744; Central Europe, n=966; and Western Europe, n=490). Predefined quality indicators assessed at hospital discharge included the following: medications (angiotensin-converting enzyme inhibitors, angiotensin II receptor blockers, ?-blockers, aldosterone antagonists, hydralazine/nitrates, statin therapy, and warfarin), use (or planned use) of implantable intracardiac devices, and blood pressure control (<140/90 mm?Hg). We determined regional variations in quality indicators as well as the temporal variation of these indicators during the course of the trial. There was significant variation in conformity among different quality indicators, ranging from 0% to 89%. Of all potential performance opportunities, 19?076 of 32?268 (59%) were met, with Central Europe highest at 64%, followed by North America (63%), Western Europe (61%), Latin America (56%), and Asia Pacific (51%; P<0.0001). North America, Central Europe, and Asia Pacific regions demonstrated a modest increase in quality indicator conformity over time, although there was no significant change in other regions. Conclusions- Quality of care for patients hospitalized with acute HF varies and remains suboptimal even within a randomized clinical trial, which included quality improvement interventions. Specific measures designed to improve performance measures should be implemented even within multicenter clinical trials. Clinical Trial Registration- URL: http://www.clinicaltrials.gov. Unique identifier: NCT00475852. PMID:23899930

Howlett, Jonathan G; Ezekowitz, Justin A; Podder, Mohua; Hernandez, Adrian F; Diaz, Rafael; Dickstein, Kenneth; Dunlap, Mark E; Corbalán, Ramón; Armstrong, Paul W; Starling, Randall C; O'Connor, Christopher M; Califf, Robert M; Fonarow, Gregg C

2013-07-30

175

Business values and quality in psychiatric hospital treatment.  

PubMed

The last decade has seen an enormous increase in the use of business techniques in the ownership and operation of psychiatric hospitals. Many physicians have reacted negatively to these developments and have raised many concerns about their impact on patient care. However, commercialism in hospitals is not new. Certain key business values, including attention to a guiding mission statement, the needs of consumers, accountability, and marketing, have a positive impact on the quality of milieu treatment. PMID:10296947

Fleming, J L

1989-01-01

176

Total quality in health care.  

PubMed

Quality is at the top of American consumers' demand list, and consequently American manufacturing companies have been forced to assign priority to the development of high-quality products. To improve the quality of what they offer, many manufacturers use the management philosophy known as total quality management (TQM), and now the service sector is following in their footsteps. The health care industry is a good example of a service industry that can benefit greatly from TQM, and it is the purpose of this article to show how a health care provider can implement TQM and evaluate its effects. PMID:10178544

Brannan, K M

1998-05-01

177

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 ...

178

Personalizing Care: Integration of Hospital and Homecare  

Microsoft Academic Search

Hospital and homecare must be understood as a necessary conjunction to accomplish efficient personalized care. In this sense,\\u000a the integration of hospital and homecare protocols and technologies should be considered from the moment that they begin to\\u000a be designed. The proliferation of healthcare units and services complicates this task, as multiple administrative domains\\u000a can be found, usually spread out in

Isabel Román; Jorge Calvillo; Laura M. Roa

179

Children in the hospital: elements of quality in drawings.  

PubMed

Not much is known about how children perceive the quality of care that they receive in hospitals. This study set out to describe elements of quality in children's drawings of an ideal hospital. Thirty-five drawings were collected from children aged between 4 and 11 years during their stay in a university hospital in Finland. They were coded using the method of content analysis. The two main categories extracted from the analysis were the environment and the people of their ideal hospital. The emphasis was on the environment; patients, parents, and nurses appeared less frequently in the drawings. The findings showed that children are capable of offering valuable insights into the elements of quality through the medium of drawing. PMID:17645961

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

2007-08-01

180

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.

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

181

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.

1997-01-01

182

Establishing a Coalition of Hospital-Affiliated and Community-Based Child Care Services through a Family Home Day Care Network.  

ERIC Educational Resources Information Center

|The director of the child care and services program of a New England hospital designed and implemented this practicum for the purpose of expanding child care services for children of hospital employees and residents of communities around the hospital. The primary goal was to increase the number of quality child care slots in the area. A second…

Lombardo, Kathy A.

183

Hospital Competition, Managed Care, and Mortality after Hospitalization for Medical Conditions in California  

PubMed Central

Objective To assess the effect of hospital competition and health maintenance organization (HMO) penetration on mortality after hospitalization for six medical conditions in California. Data Source Linked hospital discharge and vital statistics data for short-term general hospitals in California in the period 1994–1999. The study sample included adult patients hospitalized for one of the following conditions: acute myocardial infarction (N = 227,446), hip fracture (N = 129,944), stroke (N = 237,248), gastrointestinal hemorrhage (GIH,N = 216,443), congestive heart failure (CHF,N = 355,613), and diabetes (N = 154,837). Study Design The outcome variable was 30-day mortality. We estimated multivariate logistic regression models for each study condition with hospital competition, HMO penetration, hospital characteristics, and patient severity measures as explanatory variables. Principal Findings Higher hospital competition was associated with lower 30-day mortality for three to five of the six study conditions, depending on the choice of competition measure, and this finding was robust to a variety of sensitivity analyses. Higher HMO penetration was associated with lower mortality for GIH and CHF. Conclusions Hospitals that faced more competition and hospitals in market areas with higher HMO penetration provided higher quality of care for adult patients with medical conditions in California. Studies using linked hospital discharge and vital statistics data from other states should be conducted to determine whether these findings are generalizable.

Rogowski, Jeannette; Jain, Arvind K; Escarce, Jose J

2007-01-01

184

Integrated hospital emergency care improves efficiency  

Microsoft Academic Search

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

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

2008-01-01

185

Privatization of local public hospitals: effect on budget, medical service quality, and social welfare.  

PubMed

We analyze a duopolistic health care market in which a rural public hospital competes against an urban public hospital on medical quality, by using a Hotelling-type spatial competition model extended into a two-region model. We show that the rural public hospital provides excess quality for each unit of medical service as compared to the first-best quality, and the profits of the rural public hospital are lower than those of the urban public hospital because the provision of excess quality requires larger expenditure. In addition, we investigate the impact of the partial (or full) privatization of local public hospitals. PMID:20552270

Aiura, Hiroshi; Sanjo, Yasuo

2010-06-16

186

Assessment of quality of care given to diabetic patients at Jimma University Specialized Hospital diabetes follow-up clinic, Jimma, Ethiopia  

PubMed Central

Background Sub-Saharan Africa is currently enduring the heaviest global burden of diabetes and diabetes care in such resource poor countries is far below standards. This study aims to describe the gaps in the care of Ethiopian diabetic patients at Jimma University Specialized Hospital. Methods 329 diabetic patients were selected as participants in the study, aged 15 years or greater, who have been active in follow-up for their diabetes for more than 1 year at the hospital. They were interviewed for their demographic characters and relevant clinical profiles. Their charts were simultaneously reviewed for characters related to diabetes and related morbidities. Descriptive statistics was used for most variables and Chi-square test, where necessary, was used to test the association among various variables. P-value of < 0.05 was used as statistical significance. Results Blood glucose determination was done for 98.5% of patients at each of the last three visits, but none ever had glycosylated haemoglobin results. The mean fasting blood sugar (FBS) level was 171.7 ± 63.6 mg/dl and 73.1% of patients had mean FBS levels above 130 mg/dl. Over 44% of patients have already been diagnosed to be hypertensive and 64.1% had mean systolic BP of > 130 and/or diastolic > 80 mmHg over the last three visits. Diabetes eye and neurologic evaluations were ever done for 42.9% and 9.4% of patients respectively. About 66% had urine test for albumin, but only 28.2% had renal function testing over the last 5 years. The rates for lipid test, electrocardiography, echocardiography, or ultrasound of the kidneys during the same time were < 5% for each. Diabetic neuropathy (25.0%) and retinopathy (23.1%) were the most common chronic complications documented among those evaluated for complications. Conclusions The overall aspects of diabetes care at the hospital were far below any recommended standards. Hence, urgent action to improve care for patients with diabetes is mandatory. Future studies examining patterns and prevalence of chronic complications using appropriate parameters is strongly recommended to see the true burden of diabetes.

2011-01-01

187

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

188

Prospective Payment and Medicare Hospital Outpatient Care  

Microsoft Academic Search

The Balanced Budget Act of 1997 established the Medicare Outpatient Prospective Payment System (OPPS) effective August 2000. Before 2000, Medicare reimbursed hospitals the actual costs incurred in outpatient care delivery. Under OPPS, Medicare classifies most outpatient services (including emergency room or ER services) into approximately 800 ambulatory payment classifications (APC) based on clinical and cost similarity. Regardless of the actual

Daifeng He; Jennifer Mellor

2010-01-01

189

A survey of medical quality assurance programs in Ontario hospitals.  

PubMed Central

OBJECTIVE: To determine the prevalence and types of medical quality assurance practices in Ontario hospitals. DESIGN: Survey. SETTING: All teaching, community, chronic care, rehabilitation and psychiatric hospitals that were members of the Ontario Hospital Association as of May 1990. PARTICIPANTS: The person deemed by the chief executive officer of each hospital to be most responsible for medical administration. INTERVENTION: A questionnaire to obtain information on each hospital's use of criteria audit, indicators inventory, occurrence screening and reporting, and utilization review and management (URM) activities. OUTCOME MEASURES: Prevalence of the use of the quality assurance activities, the people responsible for the activities and the relative success of the URM program in modifying physicians' performance. RESULTS: Of the 245 member hospitals participants from 179 (73%) responded. Criteria audits were performed in 136 (76%), indicators inventory in 43 (24%), occurrence screening in 44 (25%), occurrence reporting in 61 (34%) and URM in 123 (69%). In-hospital deaths were reviewed in 157 (88%) of the hospitals. In all, 87 (55%) of the respondents from hospitals that had a URM program or were developing one indicated that their program was successful in modifying physicians' practices, and 29 (18%) reported that it was not successful; 26 (16%) stated that the effect was still unknown, and 16 (10%) did not respond. Seventy (40%) stated that results of tissue reviews were reported at least 10 times per year and 94 (83%) that medical record reviews were reported at least as often. The differences in the prevalence of the quality assurance activities between the hospitals were not found to be significant. CONCLUSIONS: Many Ontario hospitals are conducting a wide variety of quality assurance activities. Further study is required to determine whether the differences in prevalence of these activities between hospitals would be significant in a larger, perhaps national, sample. Strategies are needed to ensure universal involvement and participation in the improvement of the quality of care and the assessment of the cost-effectiveness of health care treatments. Recommendations to achieve these objectives are suggested.

Barrable, B

1992-01-01

190

Accountable care organizations: principles and implications for hospital administrators.  

PubMed

With the passage of the Affordable Care Act (ACA) in 2010, broad agreement has been reached on the need for fundamental reform of healthcare delivery and payment systems. Accountable care organizations (ACOs) have become one of the most discussed provisions of the ACA, and Medicare's Shared Savings Program (SSP), the incentive program tied to ACOs, has the potential to change the delivery of healthcare. The SSP will attempt to improve the quality of care while reducing the growth in expenditures by encouraging the formation of ACOs. The SSP is voluntary, and organizations that wish to participate will encounter advantages and disadvantages in its adoption. This article provides hospital administrators with basic information about the ACO requirements set forth by the Centers for Medicare & Medicaid Services and helps frame decision making about hospital participation in ACOs. PMID:22905603

Bennett, Andrew Russell

191

Factors Affecting the Quality of Health Care.  

National Technical Information Service (NTIS)

Quality assurance is discussed as a health planning objective, and structural and process factors affecting the quality of care are examined. Quality assurance and health planning are explored in relation to the rising cost of health care and the evidence...

A. D. Spiegel B. Backhaut

1977-01-01

192

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

Microsoft Academic Search

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

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

1998-01-01

193

Moving Towards the Age-friendly Hospital: A Paradigm Shift for the Hospital-based Care of the Elderly  

PubMed Central

Introduction Care of the older adult in the acute care hospital is becoming more challenging. Patients 65 years and older account for 35% of hospital discharges and 45% of hospital days. Up to one-third of the hospitalized frail elderly loses independent functioning in one or more activities of daily living as a result of the ‘hostile environment’ that is present in the acute hospitals. A critical deficit of health care workers with expertise and experience in the care of the elderly also jeopardizes successful care delivery in the acute hospital setting. Methods We propose a paradigm shift in the culture and practice of event-driven acute hospital-based care of the elderly which we call the Age-friendly Hospital concept. Guiding principles include: a favourable physical environment; zero tolerance for ageism throughout the organization; an integrated process to develop comprehensive services using the geriatric approach; assistance with appropriateness decision-making and fostering links between the hospital and the community. Our current proposed strategy is to focus on delirium management as a hospital-wide condition that both requires and highlights the Geriatric Medicine specialist as an expert of content, for program development and of evaluation. Conclusion The Age-friendly Hospital concept we propose may lead the way to enable hospitals in the fast-moving health care system to deliver high-quality care without jeopardizing risk-benefit, function, and quality of life balances for the frail elderly. Recruitment and retention of skilled health care professionals would benefit from this positive ‘branding’ of an institution. Convincing hospital management and managing change are significant challenges, especially with competing priorities in a fiscal environment with limited funding. The implementation of a hospital-wide delirium management program is an example of an intervention that embodies many of the principles in the Age-friendly Hospital concept. It is important to change the way hospital care is delivered to older adults in time to meet our needs when we need hospital services ourselves.

Huang, Allen R.; Larente, Nadine; Morais, Jose A.

2011-01-01

194

Quality of mental health care for depressed adolescents.  

PubMed

Understanding the quality of routine care for adolescent depression constitutes the initial step in designing and implementing improvement strategies. This study assessed depression detection and type and duration of services for adolescents in mental health care settings. Medical record diagnosis and standardized research interview results were compared for youth seeking mental health treatment. The majority of depressed adolescents received care consistent with guidelines and evidence. However, only 51% received appropriate medication; fewer than half received at least 8 sessions of outpatient care or follow-up after hospitalization. Males received significantly fewer components of quality care compared with females. Depression diagnoses in routine care may be facilitated by using structured interviews or questionnaires. Quality monitoring and improvement initiatives may also increase rates of care components that are consistent with guidelines and evidence. Methods tested in this study may facilitate the evaluation of quality improvement initiatives for adolescent depression or other mental health disorders. PMID:18216276

Kramer, Teresa L; Miller, Terri L; Phillips, Susan D; Robbins, James M

2008-01-23

195

Building a mission for quality care.  

PubMed

Clearly, there is a benefit to the group process in helping to establish teamwork. Teamwork and cooperation can assist with promoting effective communication, improving work quality, and building a sense of well-being within the group. With this cooperation, setting goals and looking toward the future can become a reality. Once goals are set, then developing a professional image can begin. Developing a mission statement can be an effective means to help create that professional image. Having the opportunity to develop a mission for a patient care area and articulating it through a mission statement coalesces the values, beliefs, and philosophy of a group of neuroscience staff. The following is the mission statement developed by the neurosciences unit at the University of Wisconsin Hospital and Clinics: We, the staff of UWHC Neuroscience unit embrace a vision of excellence in health care for all. Our mission is to deliver consistent quality patient care, while fostering our own professional growth. As caring healers, teachers and patient advocates in an ever-changing health care environment, we are empowered by the code for nurses. Within our scope of practice, we strive to maintain a balance of basic human respect and dignity for patients and their families in their quest for wellness, adaptation, rehabilitation or comfort care. It is our hope that patients and families will work with the health care team to construct a plan of care that best meets the patient's needs and goals. We are committed to accommodate special communication, religious or cultural needs of patients and their families. Our final acknowledgment is to ourselves, as members of the health care team. We celebrate the dignity of the staff by recognizing each individual as a special person capable of making unique and significant contributions to the unit. PMID:10726245

Peterson, R

1999-12-01

196

National Hospital Ambulatory Medical Care Survey, 1993 (on Magnetic Tape).  

National Technical Information Service (NTIS)

The National Hospital Ambulatory Medical Care Survey (NHAMCS) provides data on ambulatory care rendered in hospital emergency and outpatient departments (EDs and OPDs). The NHAMCS is a national probability sample of visits to the emergency and outpatient ...

1996-01-01

197

National Hospital Ambulatory Medical Care Survey, 1995 (on Magnetic Tape).  

National Technical Information Service (NTIS)

The National Hospital Ambulatory Medical Care Survey (NHAMCS) provides data on ambulatory care rendered in hospital emergency and outpatient departments (EDs and OPDs). The NHAMCS is a national probability sample of visits to the emergency and outpatient ...

1997-01-01

198

National Hospital Ambulatory Medical Care Survey, 1996 (on Magnetic Tape).  

National Technical Information Service (NTIS)

The National Hospital Ambulatory Medical Care Survey (NHAMCS) provides data on ambulatory medical care rendered in hospital emergency and outpatient departments (EDs and OPDs). The NHAMCS is a nationally probability sample survey of visits to the emergenc...

1998-01-01

199

National Hospital Ambulatory Medical Care Survey, 1997 (Raw Data File).  

National Technical Information Service (NTIS)

The National Hospital Ambulatory Medical Care Survey (NHAMCS) provides data on ambulatory medical care rendered in hospital emergency and outpatient departments (EDs and OPDs). The NHAMCS is a nationally probability sample survey of visits to the emergenc...

1999-01-01

200

National Hospital Ambulatory Medical Care Survey, 1994 (on Magnetic Tape).  

National Technical Information Service (NTIS)

The National Hospital Ambulatory Medical Care Survey (NHAMCS) provides data on ambulatory care rendered in hospital emergency and outpatient departments (EDs and OPDs). The NHAMCS is a national probability sample of visits to the emergency and outpatient ...

1996-01-01

201

38 CFR 17.45 - Hospital care for research purposes.  

Code of Federal Regulations, 2013 CFR

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

2013-07-01

202

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

Code of Federal Regulations, 2010 CFR

...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...

2009-10-01

203

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

Code of Federal Regulations, 2010 CFR

...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...

2010-10-01

204

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 17.196...in State Homes § 17.196 Aid for hospital care. Aid may be paid to the designated State official for hospital care furnished in a recognized...

2013-07-01

205

Quality choice in a health care market: a mixed duopoly approach.  

PubMed

We investigate a health care market with uncertainty in a mixed duopoly, where a partially privatized public hospital competes against a private hospital in terms of quality choice. We use a simple Hotelling-type spatial competition model by incorporating mean-variance analysis and the framework of partial privatization. We show how the variance in the quality perceived by patients affects the true quality of medical care provided by hospitals. In addition, we show that a case exists in which the quality of the partially privatized hospital becomes higher than that of the private hospital when the patient's preference for quality is relatively high. PMID:18712422

Sanjo, Yasuo

2008-08-20

206

The contribution of hospital library information services to clinical care: a study in eight hospitals.  

PubMed Central

Hospital health sciences libraries represent, for the vast majority of health professionals, the most accessible source for library information and services. Most health professionals do not have available the specialized services of a clinical medical librarian, and rely instead upon general information services for their case-related information needs. The ability of the hospital library to meet these needs and the impact of the information on quality patient care have not been previously examined. A study was conducted in eight hospitals in the Chicago area as a quality assurance project. A total of 176 physicians, nurses, and other health professionals requested information from their hospital libraries related to a current case or clinical situation. They then assessed the quality of information received, its cognitive value, its contribution to patient care, and its impact on case management. Nearly two-thirds of the respondents asserted that they would definitely or probably handle their cases differently as a result of the information provided by the library. Almost all rated the libraries' performance and response highly. An overview of the context and purpose of the study, its methods, selected results, limitations, and conclusions are presented here, as is a review of selected earlier research.

King, D N

1987-01-01

207

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

208

Quality measurement in diabetes care.  

PubMed

This study aimed to evaluate diabetes quality measurement efforts, assess their strengths and areas for improvement, and identify gaps not adequately addressed by these measures. We conducted an environmental scan of diabetes quality measures, focusing on metrics included in the National Quality Measures Clearinghouse or promulgated by leading measurement organizations. Key informant interviews were also completed with thought leaders who develop, promote, and use quality measures. The environmental scan identified 146 distinct measures spanning 31 clinical processes or outcomes. This suggests a measurement system that is both redundant and inconsistent, with many different measures assessing the same clinical indicators. Interviewees believe that current diabetes measurement efforts are excessively broad and complex and expressed a need for better harmonization of these measures. Several gaps were also found, including a lack of measures focusing on population health, structural elements of health care, and prevention of diabetes. PMID:19848568

Leas, Brian F; Berman, Bettina; Kash, Kathryn M; Crawford, Albert G; Toner, Richard W; Goldfarb, Neil I; Nash, David B

2009-10-01

209

Architectural Quality Criteria for Hospital Information Systems  

PubMed Central

An important part of hospital information systems (HIS) evaluation is the quality assessment of its architecture, i.e. the structure of its IT infrastructure. Therefore, quantitative architectural quality criteria are needed. On the basis of relevant architectural components of a HIS, as defined by 3LGM2, the following quality criteria were defined: functional redundancy, functional under-saturation, functional correspondence, informational redundancy, degree of heterogeneity and degree of computer-support. These quality criteria were implemented as part of the 3LGM2 tool: a modelling tool to create 3LGM2 conformant HIS models. For every 3LGM2 model and its corresponding components, the relevant quality criteria are automatically calculated and presented. The defined quality criteria can be used for several information management purposes. Nevertheless they are not intended to make absolute statements about the HIS quality. To ensure their expressiveness, complete and consistent underlying 3LGM2 models are needed.

Brigl, Birgit; Hubner-Bloder, Gudrun; Wendt, Thomas; Haux, Reinhold; Winter, Alfred

2005-01-01

210

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.

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

211

Family Perspectives on the Quality of Pediatric Palliative Care  

Microsoft Academic Search

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

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

2002-01-01

212

Cost of Acute Stroke Care at a tertiary care hospital in Karachi, Pakistan  

Microsoft Academic Search

Objective: To evaluate cost of acute stroke care and its determinants at a tertiary care hospital in Karachi and to find out predictors of high cost care. Acute stroke is a leading cause of morbidity and mortality. Cost of care is the single most important determinant in availability of acute stroke care at a tertiary care hospital in Pakistan. It

B. A. Khealani; Z. F. Javed; N. A. Syed; S. Shafqat; M. Wasay

2003-01-01

213

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

Federal Register 2010, 2011, 2012, 2013

This document corrects technical errors and typographical errors in the final rule entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and FY 2012 Rates; Hospitals' FTE Resident Caps for Graduate Medical Education Payment; Corrections'' which appeared in the August 18, 2011 Federal...

2011-09-26

214

Epidemiology and costs of hospital care for COPD in Puglia  

PubMed Central

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

2011-01-01

215

Choosing The Best Hospital: The Limitations Of Public Quality Reporting Despite multiple and often conflicting ratings, public reporting on hospital quality seems to have gained a permanent foothold  

Microsoft Academic Search

The call for accountability in health care quality has fueled the development of consumer-oriented Web sites that provide hospital ratings. Taking the consumer perspec- tive, we compared five Web sites to assess the level of agreement in their rankings of local hospitals for four diagnoses. The sites assessed different measures of structure, process, and outcomes and did not use consistent

Michael B. Rothberg; Elizabeth Morsi; Evan M. Benjamin; Penelope S. Pekow; Peter K. Lindenauer

216

Hospital Collaboration with Emergency Medical Services in the Care of Patients with Acute Myocardial Infarction: Perspectives from Key Hospital Staff  

PubMed Central

Objective Evidence suggests that active collaboration between hospitals and emergency medical services (EMS) is significantly associated with lower acute myocardial infarction (AMI) mortality rates; however, the nature of such collaborations is not well understood. We sought to characterize views of key hospital staff regarding collaboration with EMS in the care of patients hospitalized with AMI. Methods We performed an exploratory analysis of qualitative data previously collected from site visits and in-depth interviews with 11 US hospitals that ranked in the top or bottom 5% of performance on 30-day risk-standardized AMI mortality rates (RSMRs) using Centers for Medicare and Medicaid Services data from 2005–2007. We selected all codes from the first analysis in which EMS was most likely to have been discussed. A multidisciplinary team analyzed the data using the constant comparative method to generate recurrent themes. Results Both higher and lower performing hospitals reported that EMS is critical to the provision of timely care for patients with AMI. However, close, collaborative relationships with EMS were more apparent in the higher performing hospitals. Higher performing hospitals demonstrated specific investment in and attention to EMS through: 1) respect for EMS as valued professionals and colleagues; 2) strong communication and coordination with EMS; and 3) active engagement of EMS in hospital AMI quality improvement efforts. Conclusion Hospital staff from higher performing hospitals described broad, multifaceted strategies to support collaboration with EMS in providing AMI care. The association of these strategies with hospital performance should be tested quantitatively in a larger, representative study.

Landman, Adam B.; Spatz, Erica S.; Cherlin, Emily J.; Krumholz, Harlan M.; Bradley, Elizabeth H.; Curry, Leslie A.

2013-01-01

217

Quality of Hypertension Care for Asian Refugees.  

National Technical Information Service (NTIS)

The three aims of the Hmong Quality Hypertension Care Project (QoHC) were to: (1) define quality of care for hypertension from the perspective of Hmong patients; (2) develop a hypertension quality of care instrument for use with Hmong patients; and (3) pi...

C. C. Wong

2003-01-01

218

Defining Quality Child Care: Multiple Stakeholder Perspectives  

ERIC Educational Resources Information Center

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

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

2007-01-01

219

Quality management and quality of care in nursing homes  

Microsoft Academic Search

Purpose – The purpose of this paper is to study the appropriateness of applying “manufacturing sector” quality management strategies to residential care homes sector and to analyze its influence on the quality of care. Design\\/methodology\\/approach – Observation and in-depth interviews were conducted with 41 Spanish care home top and middle managers, consultants and employees. Findings – The quality management paradigm

Iñaki Heras; Ernesto Cilleruelo; Jon Iradi

2008-01-01

220

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

Microsoft Academic Search

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

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

2001-01-01

221

Managing the quality of health care.  

PubMed

This article reviews quality of health care initiatives beginning with the quality assessment/quality assurance movement of the 1970s. Conceptually, modern quality of care management is rooted in the intellectual work of Avedis Donabedian who defined quality of care as a combination of structure, process, and outcome. Donabedian's model is presented and some limitations are pointed out. In the late 1980s and 1990s. the health care industry adopted total quality management (TQM). More recently, the pursuit of health care quality has led to substantial performance measurement initiatives such as ORYX by the Joint Commission on Accreditation of Healthcare Organizations and MEDIS by the National Commission of Quality Assurance. The importance of CONQUEST, a freely available performance measurement database developed at the Harvard School of Public Health, is noted and discussed. The article concludes with a list of challenges facing public and private parties interests in health care quality improvement. PMID:15188996

Larson, James S; Muller, Andreas

2002-01-01

222

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

2012-11-29

223

Quality activities associated with hospital tissue services.  

PubMed

Quality assurance is a vital component of a tissue service that aims to meet regulatory requirements and provide safe and functional tissue for surgical procedures in the institution. Many hospital transfusion services have or are in the process of assuming tissue service functions for their institutions, and the concepts of tissue quality assurance requirements should be familiar to the transfusion service. This review discusses the key aspects of tissue service quality assurance, including requirements for FDA registration, selection and qualification of tissue suppliers, recordkeeping, management of occurrences and tissue recalls, adverse event reporting, audits, and quality control. Comparing the similarities and differences between tissue and blood component regulatory requirements suggests transfusion service processes can be readily adapted to incorporate quality assurance for tissue service activities. PMID:20406015

Hillberry, C M; Schlueter, A J

2009-01-01

224

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

225

The Role of Specialized Geriatric Services in Acute Care Hospitals  

Microsoft Academic Search

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

Rory Fisher

226

The Loneliest Babies: Foster Care in the Hospital  

ERIC Educational Resources Information Center

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

Dicker, Sheryl

2012-01-01

227

Sleep Quality among Female Hospital Staff Nurses.  

PubMed

Purpose. To investigate sleep quality of hospital staff nurses, both by subjective questionnaire and objective measures. Methods. Female staff nurses at a regional teaching hospital in Northern Taiwan were recruited. The Chinese version of the pittsburgh sleep quality index (C-PSQI) was used to assess subjective sleep quality, and an electrocardiogram-based cardiopulmonary coupling (CPC) technique was used to analyze objective sleep stability. Work stress was assessed using questionnaire on medical worker's stress. Results. A total of 156 staff nurses completed the study. Among the staff nurses, 75.8% (117) had a PSQI score of ?5 and 39.8% had an inadequate stable sleep ratio on subjective measures. Nurses with a high school or lower educational degree had a much higher risk of sleep disturbance when compared to nurses with a college or higher level degree. Conclusions. Both subjective and objective measures demonstrated that poor sleep quality is a common health problem among hospital staff nurses. More studies are warranted on this important issue to discover possible factors and therefore to develop a systemic strategy to cope with the problem. PMID:23766916

Chien, Pei-Li; Su, Hui-Fang; Hsieh, Pi-Ching; Siao, Ruo-Yan; Ling, Pei-Ying; Jou, Hei-Jen

2013-05-13

228

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

229

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

Microsoft Academic Search

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

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

1997-01-01

230

Device-associated nosocomial infection rates in intensive care units in four Mexican public hospitals  

Microsoft Academic Search

Background: Routine surveillance of nosocomial infections has become an integral part of infection control and quality assurance in US hospitals. Methods: As part of the International Nosocomial Infection Control Consortium, we performed a prospective nosocomial infection surveillance cohort study in 5 adult intensive care units of 4 Mexican public hospitals using the Centers for Disease Control and Prevention National Nosocomial

Ector Jaime; Ramirez Barba; Victor Daniel Rosenthal; Francisco Higuera; Martha Sobreyra Oropeza; Hector Torres Hernandez; Martha Sanchez Lopez; Elia Lara Lona; Pablo Duarte; Javier Ruiz; Raul Rojas Hernandez; Amalia Chavez; Irma Perez Cerrato; Gloria Elena; Ramirez Ramirez

231

[Ethnography of health care after hospital discharge].  

PubMed

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

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

2008-12-01

232

[Quality assurance of inpatient care--exemplified by surgery].  

PubMed

Internal quality assurance is natural for hospital physicians. External quality control is undertaken in cooperation with medical societies and sponsors-partly on voluntary basis. Despite considerable efforts in optimizing treatment procedures by classification of injuries and tumor stages, algorithms and tightly scheduled practical medical training, further control mechanisms are demanded; the economic drive is evident. In parallel to the introduction of quality control for services with a case-based flat rate, an interstructural result quality is desired. Hospital certification procedures are no longer utopian. The physician's duty for continuing medical education, which is set down in the professional code, has to be proven. The development of guidelines by scientific societies may help but is in need of a corrective. The medical chambers may play a particular role in this connection. Even if mechanisms of quality assurance differ, it is in the patient's interest that there must be no difference between ambulant and hospital care. PMID:9221208

Ekkernkamp, A

1997-02-01

233

An economic analysis of two models of hospital care for AIDS patients: implications for hospital discharge planning.  

PubMed

The development of cost effective models of hospital care and discharge planning for people with HIV is a vital policy issue. However, almost no data exist evaluating cost and quality differences in alternate hospital models of care. This empirical study retrospectively evaluates social work discharge planning for patients with HIV disease in two hospital care models: a cluster AIDS unit and general inpatient site beds. The independent effect of each hospital model of care on length of stay is assessed in a multivariate analysis, controlling for level of care needs and other social and clinical factors. Results reveal that the cluster AIDS unit, where a specialized AIDS social work staff works in collaboration with the interdisciplinary AIDS team, is associated with a significant reduction in hospital length of stay for persons with HIV disease and complex discharge planning needs. These results support the hypothesis that discharge planning services, performed by specialized social workers, are a cost effective investment for hospitals treating patients with complex chronic conditions, such as AIDS. Further research should be developed to systematically evaluate the cost effectiveness of hospital-based social workers, using prospective experimental designs, in order to establish the net impact of social work discharge planning services on patient and family outcomes and institutional and social costs. PMID:8807736

Fahs, M C; Wade, K

1996-01-01

234

Development of a Multiple-item Scale for Measuring Hospital Service Quality  

Microsoft Academic Search

Many hospitals apply modern marketing ideas to serve customer markets in a more efficient and effective way. An important strategic variable in this respect is service quality. Gives a theoretical conceptualization of the service-quality construct and discusses its major underlying assumptions and concepts. Also describes some specific characteristics of the quality construct in the health-care sector. Explores the dimensionality of

R. Vandamme; J. Leunis

1993-01-01

235

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

Microsoft Academic Search

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

Thomas C. Buchmueller; Mireille Jacobson; Cheryl Wold

2004-01-01

236

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

Federal Register 2010, 2011, 2012, 2013

This document corrects technical errors that occurred in the Addendum of the final rule entitled ``Medicare Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates'' which appeared in the August 18, 2011 Federal...

2012-02-01

237

Analysis of blood tests in the emergency department of a tertiary care hospital  

Microsoft Academic Search

There is ample evidence that many investigations sent from the accident and emergency department are inappropriate, thus affecting the quality of patient care. A study was designed to address this issue in the emergency department of a tertiary care hospital of a large city. A prospective cross-sectional study was carried out during the 3-month period 1 December 1996 to 28

Rifat Rehmani; Siraj Amanullah

1999-01-01

238

Tailoring an Enteral and Parenteral Nutrition Handbook to the Standards of Care at an University Hospital  

Microsoft Academic Search

Clinical nutritionists from both the medical and surgical nutrition support teams have developed a nutrition support handbook tailored to the standards of care at an university teaching hospital. The objectives for developing the handbook included: a) to promote consistent quality of care among nutrition support clinicians, b) provide a teaching tool for dietetic interns, c) orient new clinical staff, and

C. Dadlani; P. Dharamsi; C. Cumming; S. McCray

1998-01-01

239

Auditing the Quality of Care of a Crisis Center  

ERIC Educational Resources Information Center

Defines and describes different types of audits and areas of patient care which lend themselves to a quality of performance review. Describes an audit application at a hospital-based crisis intervention center and the corrective action taken on the basis of the findings. (Author)

Stelmachers, Zigfrids T.; And Others

1978-01-01

240

[Quality management in intensive care medicine].  

PubMed

Treatment of critical ill patients in the intensive care unit is tantamount to well-designed risk or quality management. Several tools of quality management and quality assurance have been developed in intensive care medicine. In addition to extern quality assurance by benchmarking with regard to the intensive care medicine, peer review procedures have been established for external quality assurance in recent years. In the process of peer review of an intensive care unit (ICU), external physicians and nurses visit the ICU, evaluate on-site proceedings, and discuss with the managing team of the ICU possibilities for optimization. Furthermore, internal quality management in the ICU is possible based on the 10 quality indicators of the German Interdisciplinary Society for Intensive Care Medicine (DIVI, "Deutschen Interdisziplinären Vereinigung für Intensiv- und Notfallmedizin"). Thereby every ICU has numerous possibilities to improve their quality management system. PMID:23846174

Martin, J; Braun, J-P

2013-09-01

241

Assessing the quality of patient handoffs at care transitions  

Microsoft Academic Search

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

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

2010-01-01

242

Effective Marketing of Quality Child Care.  

ERIC Educational Resources Information Center

|Identifies negative public and professional attitudes that lie beneath the contemporary negative image of quality child care. Argues that concepts and principles of marketing are appropriate for influencing parents to choose high quality services and helping ensure that supplementary care is of sufficient quality to enhance, not inhibit, the…

Caldwell, Bettye M.; Boyd, Harper W., Jr.

1984-01-01

243

Effective Marketing of Quality Child Care.  

ERIC Educational Resources Information Center

Identifies negative public and professional attitudes that lie beneath the contemporary negative image of quality child care. Argues that concepts and principles of marketing are appropriate for influencing parents to choose high quality services and helping ensure that supplementary care is of sufficient quality to enhance, not inhibit, the…

Caldwell, Bettye M.; Boyd, Harper W., Jr.

1984-01-01

244

78 FR 64953 - Medicare Program; Inpatient Hospital Deductible and Hospital and Extended Care Services...  

Federal Register 2010, 2011, 2012, 2013

This notice announces the inpatient hospital deductible and the hospital and extended care services coinsurance amounts for services furnished in calendar year (CY) 2014 under Medicare's Hospital Insurance Program (Medicare Part A). The Medicare statute specifies the formulae used to determine these amounts. For CY 2014, the inpatient hospital deductible will be $1,216. The daily coinsurance......

2013-10-30

245

Quality improvement in nursing care facilities: extent, impetus, and impact.  

PubMed

This study examines the extent, motivation, and performance implications of normal quality improvement (QI) programs in Pennsylvania nursing care facilities. Responses to a 20-item survey sent to facility administrators indicate that continuous quality improvement/total quality management (CQI/TQM) adopters are more motivated by quality of care and human resource concerns in implementing QI, more satisfied with the results of QI efforts, and more aware of a competitive environment than are non-adopters. There are few differences between adopters and non-adopters with respect to organizational characteristics or performance on quality of care measures. Comparison with the results of a study of QI implementation in hospitals reveals some differences in motivation, but similarities in satisfaction with results. PMID:9116533

Zinn, J S; Brannon, D; Weech, R

1997-01-01

246

Women's perceptions of quality and benefits of postpartum care.  

PubMed

Increased competition in the United States has led to increased interest in women's perceptions of their obstetric experience. Family-centered postpartum care (FCPPC) was originated to improve women's perceptions of care quality. This study examined differences in and the hypothesized relationship between quality and beneficence in a group receiving traditional postpartum care (TPPC) and a group receiving FCPPC in a safety-net hospital in West Tennessee. Both groups had high mean quality and beneficence scores; however, the FCPPC group's scores were significantly higher than those of the TPPC group. There was a relationship between quality and beneficence for the combined sample. The findings suggest that nurses should incorporate FCPPC approaches as a means of improving perceived quality and benefits. PMID:9842172

Hunter, M A; Larrabee, J H

1998-12-01

247

Quality in health care. Medical or managerial?  

PubMed

Explores the notion that the introduction of total quality management (TQM) in the public health-care sector indicates a conceptual break with a tradition in which the authority to define and interpret the meaning of medical practice has been located solely within the medical profession. It also serves to shift the focus of medical practice away from its contextual and interactional character towards numerical representations and codification in monetary terms. Further, it is argued that the realization of management ideals in everyday practice is dependent more on the availability of pre-existing technologies and standard procedures than on the ingenuity of particular organizational and institutional actors. These arguments are illustrated with the reutilization for TQM purposes of "local incident reports" in a Swedish hospital organization. PMID:11200301

Hansson, J

2000-01-01

248

Stroke care: how do we measure quality?  

PubMed Central

The purpose of this paper is to review the methods used to measure quality of stroke care. Relevant articles were searched for on Medline using the following key words: stroke, quality, outcome of care, process of care, structure of care. Articles that examined how to measure the quality of stroke care and that examined difficulties in the measurement of care outcomes, processes, and structures were selected. Selected articles were reviewed to summarise methods used to measure quality of stroke care and the primary outcome measures of the studies were extracted. Conclusions were drawn about the best ways to measure the quality of stroke care. Practical problems in using outcome measures to monitor quality of care include the consequences of case mix and difficulties in risk adjustment. Clinicians may use process measures to understand differences in outcome. Once a process of care has been linked to an outcome measure, this care process should be measured. The national sentinel audit for stroke is an audit tool used to examine the quality of the processes of stroke care.

Walsh, K; Gompertz, P; Rudd, A

2002-01-01

249

Disciplined care for disciplined patients: experience of hospitalized blind patients.  

PubMed

Blindness is a permanent condition that alters daily life of blind people. Interpretive phenomenology was used to understand lived experiences of the hospitalized blind people. "Disciplined care for disciplined patients" was one of the themes that emerged from the data. Provision of disciplined care can help health care professionals provide a holistic and comprehensive competent care for blind patients. PMID:24121699

Shamshiri, Mahmood; Mohammadi, Nooredin; Cheraghi, Mohammad Ali; Vehviläinen-Julkunen, Katri; Sadeghi, Tahereh

250

[Application of subjective quality indicators in intensive care].  

PubMed

Our aim is to describe the clients'perception related to to the admission in the Intensive Care. We have developed a descriptive study based on a qualitative approach in the intensive care in a university hospital in RJ, from May, 2003 to May, 2004. Thirty-two clients participated in this study just after hospital discharge. Data collection was possible through a questionaire. We consider that the clients showed some kind of satisfaction related to nursing intensive care, and the problem that really annoys them is the physical and ambiental stressors. The study shows questions that need a continuous discussion considering the stress, once it is a part of the activities and the atmosphere of intensive care and it also detaches the relavence of a work using indicatives of subjective quality in the intensive care. PMID:17051891

de Souza, Sônia Regina Oliveira e Silva; da Silva, Cláudia Aparecida; de Mello, Ursula Magliano; Ferreira, Carolina Neris

251

National and international quality initiatives to improve stroke care.  

PubMed

Stroke, the second leading cause of death throughout the world, has a major impact on society. This article provides a summary of quality improvement initiatives, including those relating to hospitals, the system of care delivery infrastructure, and legislative efforts in the United States and in various countries outside of the United States. Through quality improvement initiatives, it is projected that stroke outcomes may improve and the economic burden of stroke may be reduced. PMID:19026908

Fedder, Wende

2008-11-01

252

Quality in health care and ethical principles.  

PubMed

Quality in health care and ethical principles The last three decades have seen rapid changes in the way United States of America (USA) health care has been delivered, financed and regulated. Four major stakeholders have emerged in the health care debate: patients, providers, payers and public regulatory agencies. These groups do not agree on a definition of quality health care. This paper suggests five ethical principles - autonomy, justice, beneficence, non-maleficence, and prudence - be included in the framework of quality health care. A framework that outlines possible relationships among these ethical attributes and four major stakeholders is presented. PMID:11012797

Huycke, L; All, A C

2000-09-01

253

Channel leadership in health care marketing: a natural role for hospitals.  

PubMed

Health care has entered an era of rapid change. Most observers agree that important long-term changes will fundamentally reshape health care as we know it. To that end, health care providers should consider the benefits of operating vertically integrated marketing system with hospitals as the channel leader. Whether an administered VMS (hospitals have the power to gain compliance) or a corporate VMS (hospitals own successive levels of care providers), integrated channel management holds the promise of cost containment and quality patient care for the future. However, a great deal of integrating work must be done before VMSs will become a practical solution. Research studies are needed on each of the issues just discussed. As marketers, it is time we make a transition from treating health care marketing as a disjointed entity and instead treat it as an industry where all marketing principles are considered including channel management. PMID:10106898

Fugate, D L; Decker, P J

1990-01-01

254

Global initiatives for improving hospital care for children: state of the art and future prospects  

PubMed Central

Deficiencies in the quality of health care are major limiting factors to the achievement of the Millennium Development Goals for child and maternal health. Quality of patient care in hospitals is firmly on the agendas of Western countries, but has been slower to gain traction in developing countries, despite evidence that there is substantial scope for improvement, that hospitals have a major role in child survival and that inequities in quality may be as important as inequities in access. There is now substantial global experience of strategies and interventions that improve the quality of care for children in hospitals with limited resources. WHO has developed a toolkit containing adaptable instruments, including a framework for quality improvement, evidence-based clinical guidelines in the form of the Pocketbook of Hospital Care for Children, teaching material, assessment and mortality audit tools. These tools have been field-tested by doctors, nurses and other child health workers in many developing countries. This collective experience was brought together in a global WHO meeting in Bali in 2007. This article describes how many countries are achieving improvements in quality of paediatric care, despite limited resources and other major obstacles, and how the evidence has progressed in recent years from documenting the nature and scope of the problems to describing the effectiveness of innovative interventions. The challenges remain to bring these and other strategies to scale, and to support research into their use, impact and sustainability in different environments.

Campbell, Harry; Duke, Trevor; Weber, Martin; English, Mike; Carai, Susanne; Tamburlini, Giorgio

2009-01-01

255

COMPETITION AND QUALITY IN HOME HEALTH CARE MARKETS.  

PubMed

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. Copyright © 2013 John Wiley & Sons, Ltd. PMID:23670849

Jung, Kyoungrae; Polsky, Daniel

2013-05-14

256

Quick Checks for Quality: Choosing Quality Health Care  

MedlinePLUS

... Based Decisionmaking Improving Primary Care Practice Resources Quality & Patient Safety Comprehensive Unit-based Safety Program (CUSP) Patient Safety Measure Tools & Resources Pharmacy Health Literacy Center Surveys ...

257

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

258

An approach to maximize hospital service quality under budget constraints  

Microsoft Academic Search

This study proposes a mathematical method for evaluating the quality of hospital services, and it intends to provide the top management with a systematic means and scientific tool to quantify and improve the service quality from the customers' satisfaction perspective. In order to manage effectively the quality, the authors identify and assess the key elements of the hospital service quality,

Wei-Kuo Chang; Chiu-Chi Wei; Nen-Ting Huang

2006-01-01

259

The Valuation of Pastoral Care by Hospital Administrators  

Microsoft Academic Search

This paper reports on a study of 600 hospital administrators, half of which were in non-profit institutions and half of which were in hospitals owned or managed by the Hospital Corporation of America. The project was designed to identify what differences, if any, existed between surveyed administrators in both bypes of institutions in their valuation of pastoral care. No significant

Maureen Young Manns

1990-01-01

260

Candida tropicalis Fungemia in a Tertiary Care Hospital  

Microsoft Academic Search

Candida tropicalis is a frequent cause of fungemia in hospitals in Latin America. Candida albicans (33%) was the most frequently isolated species, followed by Candida parapsilosis (27%), andCandida tropicalis (24%) in tertiary care hospital in Brazil. We identified and retrospectively reviewed 27 cases of C. tropicalis fungemia that occurred at Hospital de Cl??nicas de Porto Alegre from 1996 to 1999.

L. Z. Goldani; P. S. S. Mário

2003-01-01

261

National Hospital Ambulatory Medical Care Survey: 2006 Outpatient Department Summary  

Microsoft Academic Search

Objectives—This report describes ambulatory care visits to hospital outpatient departments (OPDs) in the United States. Statistics are presented on selected hospital, patient, and visit characteristics. Selected trends in OPD utilization from 1996 through 2006, as well as items new to the 2006 survey, are also presented. Methods—The data presented in this report were collected in the 2006 National Hospital Ambulatory

Esther Hing; Margaret J. Hall; Jianmin Xu

2006-01-01

262

Barriers to out-of-hospital care for AIDS patients  

Microsoft Academic Search

Inappropriate delays in hospital discharge for AIDS patients add to the expense of health care, as well as to the stress felt by the patient. It has been postulated that delays are due to a lack of suitable out-of-hospital services and weak patient support networks. The charts of AIDS patients discharged from hospitals in northern New Jersey and southern New

M. Widman; D. W. Light; J. J. Platt

1994-01-01

263

'Assessment and care management'--a hospital perspective.  

PubMed Central

Patients placed from hospital to nursing or residential homes or to home under the intensive domiciliary care scheme were compared before and after the introduction of 'assessment and care management' on the 1st April 1993. In geriatric medical wards there was a 69% increase in the average length of stay for patients assessed and care managed and a 52% increase in the length of stay for self-funding patients compared with patients placed before the introduction of assessment and care management. Care managed patients discharged on the intensive domiciliary care scheme had a 66% increase in their length of hospital stay compared with care managed patients placed in private nursing homes. In contrast, the length of stay for care managed patients in other hospital wards was half that for geriatric medical wards.

Taylor, I. C.; McConnell, J. G.

1994-01-01

264

Mortality in the elderly during respite hospital care.  

PubMed Central

This study examined the mortality in the elderly during 243 respite hospital admissions. Sixty-four dependent elderly patients entered a regular respite care scheme and were admitted to hospital for a period of 4 weeks out of every 12 weeks. The mortality rate in hospital was one death per 976 days, in comparison to one death per 1296 days at home. This small increase in mortality should not deprive patients and their carers from access to respite care.

McCaffrey, P. M.; Gilmore, D. H.; Beringer, T. R.

1989-01-01

265

Patients' falls and injuries during hospitalization as quality indicators of work in hospitals.  

PubMed

The number of patients' falls and injuries happening during their hospital treatment is a good quality indicator of safety of in-patients. A fall is of multifactorial etiology, and its causes are usually classified into intrinsic and extrinsic factors. According to Jenise Morse there are three categories of falls among inpatients: accidental, non-anticipated physiologic and anticipated physiologic fall. Fall induced injuries in clinical and hospital settings are mostly categorized into five groups: no injury, minor injury, moderate injury, severe injury and lethal injury. The number of in-patient falls can be reduced by implementing a prevention programme in order to improve the quality of the specific health care and health care in general. The key preventive strategies aimed at safe and efficient health care include: a regular assessment of the risk for falls using predictive scales, visual identification of patients at high risk for falls, communication with patients and education of patients, their family members and staff about fall prevention interventions. PMID:19650562

Milutinovi?, Dragana; Martinov-Cvejin, Mirjana; Simi?, Svetlana

266

Factors Associated with Ambulatory Care—Sensitive Hospitalizations among Nursing Home Residents  

Microsoft Academic Search

Objectives: This study examined patient-level, facility-level, and area market-level factors affecting ambulatory care-sensitive hospitalization (ACSH) rates among nursing home residents. Although ACSH has long been used to monitor accessibility to health care services among community-dwelling populations, the use of ACSH rates as an indicator of potential quality-of-care problems affecting nursing home residents has not been employed. Methods: Three years of

Mary W. Carter

2003-01-01

267

Health information technology in urologic care: current status and implications for quality of care.  

PubMed

Health information technology (HIT) is expected to transform the delivery of health care in the United States, but implementation and adoption vary widely across settings, specialties, and geographies. Significant barriers to high-level adoption persist despite federal incentives to hospitals and health-care providers. This article will review the current status and future impact of HIT in the specialty of urology, with emphasis on the intersection of HIT and quality measurement. PMID:23881730

Dowling, Robert A

2013-12-01

268

Confronting competing demands to improve quality: a five-country hospital survey.  

PubMed

This paper reports on a 2003 comparative survey of hospital executives in Australia, Canada, New Zealand, the United Kingdom, and the United States. Reflecting higher spending levels, U.S. hospitals as a group stand out for generally more positive ratings of facilities and finances and short or no waiting times. Yet U.S. hospital executives are also the most negative about their country's health care system. Hospital executives in all five countries expressed concerns about staffing shortages and emergency department waiting times and quality. Asked about future strategies to improve quality, executives in all five countries expressed support for making information technology an investment priority. PMID:15160810

Blendon, Robert J; Schoen, Cathy; DesRoches, Catherine M; Osborn, Robin; Zapert, Kinga; Raleigh, Elizabeth

269

Looking at lessons on quality from the Medicare pay-for-performance hospital demonstration.  

PubMed

In 2003, the new CMS/Premier Hospital Quality Incentive Demonstration Project--a new type of pay-for-performance pilot project--was set up to financially reward hospitals that improved their care in five clinical areas. The top government players announcing the demo may have left for other endeavors, but 268 hospitals affiliated with Premier are participating in the initiative. With preliminary results in from the first year and the first payments due to be sent out this fall, The Quality Letter for Healthcare Leaders looks at what participating hospitals have accomplished in this pilot program with that financial carrot. PMID:16358933

2005-10-01

270

Changes in treatment and mortality of acute myocardial infarction in Estonian tertiary and secondary care hospitals in 2001 and 2007  

PubMed Central

Background High quality care for acute myocardial infarction (AMI) improves patient outcomes. Still, AMI patients are treated in hospitals with unequal access to percutaneous coronary intervention. The study compares changes in treatment and 30-day and 3-year mortality of AMI patients hospitalized into tertiary and secondary care hospitals in Estonia in 2001 and 2007. Results Final analysis included 423 cases in 2001 (210 from tertiary and 213 from secondary care hospitals) and 687 cases in 2007 (327 from tertiary and 360 from secondary care hospitals). The study sample in 2007 was older and had twice more often diabetes mellitus. The patients in the tertiary care hospitals underwent reperfusion for ST-elevation myocardial infarction, cardiac catheterization and revascularisation up to twice as often in 2007 as in 2001. In the secondary care, patient transfer for further invasive treatment into tertiary care hospitals increased (P < 0.001). Prescription rates of evidence-based medications for in-hospital and for outpatient use were higher in 2007 in both types of hospitals. However, better treatment did not improve significantly the short- and long-term mortality within a hospital type in crude and baseline-adjusted analysis. Still, in 2007 a mortality gap between the two hospital types was observed (P < 0.010). Conclusions AMI treatment improved in both types of hospitals, while the improvement was more pronounced in tertiary care. Still, better treatment did not result in a significantly lower mortality. Higher age and cardiovascular risk are posing a challenge for AMI treatment.

2012-01-01

271

The impact of TennCare on hospital efficiency  

Microsoft Academic Search

This study measures the effect of TennCare, a Medicaid managed care reform initiated in 1994, on the efficiency of hospitals\\u000a in Tennessee. We apply a multiple-output stochastic frontier approach to a panel dataset that represents all short-term acute\\u000a care hospitals operating in Tennessee for 1990–2001 and find a modest gain in operating efficiency overall. Our results also\\u000a reveal that the

Cyril F. Chang; Jennifer L. Troyer

2009-01-01

272

Validation Protocol: First Step of a Lean-Total Quality Management Principle in a New Laboratory Set-up in a Tertiary Care Hospital in India  

Microsoft Academic Search

Method validation is pursued as the first step in establishing Lean-Total Quality Management in a new clinical laboratory,\\u000a in order to eliminate error in test results. Validation of all the new tests were done (with particular reference to alkaline\\u000a phosphatase) by verifying reference intervals, analytical accuracy and precision, inter-assay and intra-assay variations,\\u000a analytical sensitivity, limit of detection, linearity and reportable

Barnali Das

273

Can Primary Care Visits Reduce Hospital Utilization Among Medicare Beneficiaries at the End of Life?  

PubMed Central

Background Medical care at the end of life is often expensive and ineffective. Objective To explore associations between primary care and hospital utilization at the end of life. Design Retrospective analysis of Medicare data. We measured hospital utilization during the final 6 months of life and the number of primary care physician visits in the 12 preceding months. Multivariate cluster analysis adjusted for the effects of demographics, comorbidities, and geography in end-of-life healthcare utilization. Subjects National random sample of 78,356 Medicare beneficiaries aged 66+ who died in 2001. Non-whites were over-sampled. All subjects with complete Medicare data for 18 months prior to death were retained, except for those in the End Stage Renal Disease program. Measurements Hospital days, costs, in-hospital death, and presence of two types of preventable hospital admissions (Ambulatory Care Sensitive Conditions) during the final 6 months of life. Results Sample characteristics: 38% had 0 primary care visits; 22%, 1–2; 19%, 3–5; 10%, 6–8; and 11%, 9+ visits. More primary care visits in the preceding year were associated with fewer hospital days at end of life (15.3 days for those with no primary care visits vs. 13.4 for those with ?9 visits, P?hospital death (44% vs. 40%, P?hospitalizations for those with congestive heart failure (adjusted odds ratio, aOR?=?0.82, P?care visits in the preceding year are associated with less, and less costly, end-of-life hospital utilization. Increased primary care access for Medicare beneficiaries may decrease costs and improve quality at the end of life.

Ash, Arlene S.; Freund, Karen M.; Hanchate, Amresh; Emanuel, Ezekiel J.

2008-01-01

274

Cost of hospital care for elderly at risk of falling.  

PubMed

The variables that relate to cost of hospital care for a large sample of elderly patients at risk for falling are examined. The chief predictors of cost of hospitalization were medical, pharmacy, and nursing interventions. Use of nursing interventions, on average, raised the median hospital cost less than use of medical or pharmacy interventions. Using a standardized nursing language with the hospital's information system can provide nurses with information that demonstrates the cost effectiveness of their interventions. PMID:16459901

Titler, Marita; Dochterman, Joanne; Picone, Debra M; Everett, Linda; Xie, Xian-Jin; Kanak, Mary; Fei, Qiang

275

Population-Based Planning for Hospital Care.  

National Technical Information Service (NTIS)

Market or service areas of hospitals are noted as important considerations in the functioning of health systems agencies (HSA's) and State health planning and development agencies (SHPDA's) and in the process of hospital planning. It is essential that hos...

R. Kropf

1978-01-01

276

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).

Hsieh, Hui-Min; Bazzoli, Gloria J.

2012-01-01

277

[Waste management as part of self-care: an in-hospital training?].  

PubMed

As a health care professional, I feel concerned by the gap existing between urban and hospital practice concerning the management of waste, even when it is the same objects which are disposed. In the daily practice of the hospital care givers, the patients' education is mainly focused on the prevention measures or the care techniques to be adopted. The waste dumping modes are very seldom taken in consideration, despite the fact that everybody is afraid at the discovery of care material abandoned in a public place. That is why the following hypothesis was formulated: "The better the patient is educated, the better he will manage his self-care waste." The methods used for this diploma work are the documentary research and the investigation interviews with all the actors in and out of the hospital concerned by the patients' education and/or the management of care waste. The pilot study was conducted by means of enquiry questionnaires. It was focused on the hospital care givers and on the insulin-dependent diabetic patients who practice their self-care, through the enquiry technique "before-after" The aims of this research were to assess the quality of the education given by the hospital care giving staff on the management of self-care waste and the impact of this training on the patients. The drawing up of a system of reference (at the end of this research investigation work) should enable the improvement of the present situation. The small size of the sample used for the pilot study did not enable us to invalidate or confirm our working hypotheses. But the results obtained during out pilot study showed the bad quality of the training given by the hospital care givers and the inadequacy of the patients' procedure. That is why our professional project is based on an updating of the knowledge of the hospital care givers for the management of the self-care material in order to improve the quality of the care given by a hospital team and its adequation to the needs of the population at which it is aimed. PMID:10897743

Delpech, A

2000-03-01

278

Quality of care in historical perspective  

Microsoft Academic Search

The study of quality of care in two mid-nineteenth-century day nurseries in North America indicates that quality was associated with saving children's lives within a context of charity-based social welfare. The concern for the health and safety of children led to the entrenchment of a custodial mode of child care. Child care staff developed “coping strategies” that served to modify

Larry Prochner

1996-01-01

279

Palliative care: community nurses' perceptions of quality  

Microsoft Academic Search

Objectives—To identify community nurses' perceptions of quality care provision for patients requiring palliative care.Design—Semi-structured interviews were conducted with community nurses working within the district nursing service. An adaptation of Flanagan's critical incident technique was employed to elicit factors associated with high or poor quality palliative care. Interviews were tape recorded and transcribed. Data were analysed using thematic content analysis, recurrent

Lynn Austin; Karen Luker; Ann Caress; Chris Hallett

2000-01-01

280

Quality of Care Indicators for Radical Cystectomy  

Microsoft Academic Search

\\u000a Radical cystectomy is the gold standard treatment for invasive bladder cancer, and requires high standards for both surgical\\u000a skill and ancillary support to achieve consistently good outcomes. As is the case elsewhere in the health care system, increasing\\u000a attention has been paid in recent years to the quality of care delivered before, during, and after surgery. Defining high-quality\\u000a care in

Matthew R. Cooperberg; Badrinath R. Konety

281

[Day hospital end therapeutic community: an effective care for the elderly psychiatric out patients].  

PubMed

The effectiveness of psychiatric day hospital care in elderly patients remains disputed. Based on a therapeutic community approach, psychotherapeutic day hospital treatment was evaluated in 122 elderly depressed patients and 76 demented patients suffering from behavioural and psychological symptoms. Neuropsychiatric symptoms, quality of life and therapeutic community progress were assessed at day hospital admission and discharge. In absence of any change in pharmacological treatment, results show a significant reduction of depressive and neuropsychiatric symptoms as well as improved adhesion to therapeutic community treatment, even in the demented patients. Results further reveal improved mental quality of life and subjective perception of clinical progress in depressed patients. PMID:18549082

Canuto, A; Meiler, C; Weber, K

2008-04-16

282

[Day care hospital in psychiatry: diversity or specificity?].  

PubMed

Day Care Hospitals represent efficient structures for the treatment of various psychatric disorders through a large variety of medical care. In the litterature, multiple terms are used to define the various models of Day Care Hospitals, according to their use, their orientation and their therapeutic programmes. Our aim in this study is to compare, through a search on "Medline", the various existing models of Day Care Hospitals in France and in Belgium. Thereafter, the "specific" model which exists at the Centre Hospitalier du Luxembourg will be described. Two main types of Day Care Hospitals are described in the litterature: the "classical" type, with mainly a support fuction, resides on the downstream side of hospitalisation and the "specific" type, with a care function for a short duration, resides on its upstream side. The model developed at the Centre Hospitalier du Luxembourg is upstream the hospital. From our study, it is concluded that, rather of being an inconvenience, the large number of existing Day Care Hospitals, which differ by various specificities, represent excellent complementary opportunities for the current care of mental diseases. PMID:18561596

d'Albis, Marc-Antoine; Pull, Charles

2008-01-01

283

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.

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

2012-01-01

284

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

Code of Federal Regulations, 2013 CFR

...17.43 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Hospital, Domiciliary and Nursing Home Care § 17.43 Persons entitled to hospital or domiciliary care. Hospital or domiciliary care may be...

2013-07-01

285

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

Code of Federal Regulations, 2010 CFR

...determination procedures for inpatient hospital care. 405.1206 Section 405...determination procedures for inpatient hospital care. (a) Beneficiary's right...beneficiary requires inpatient hospital care, the beneficiary is not...

2010-10-01

286

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

Code of Federal Regulations, 2013 CFR

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

2013-07-01

287

A comparative study of total quality management of health care system in India and Iran  

PubMed Central

Background Total quality management (TQM) has a great potential to address quality problems in a wide range of industries and improve the organizational performance. The growing need to take initiatives by hospitals in countries like India and Iran to improve the service quality and reduce wastage of resources has inspired the authors to develop a survey instrument to measure health care quality and performance in the two countries. Methods Based on the Baldrige health care criteria for performance excellence 2009-2010 and the guidelines proposed by the American Hospitals Association for hospitals in pursuit of excellence, compared health care services in three countries. The data are collected from the capital cities and their nearby places in India and Iran. Using ANOVAs, three groups in quality planning and performance have been compared. Result Results showed there is significantly difference between groups and in no case the hospitals from India and Iran are found scoring close to the benchmarks. The average scores of Indian and Iranian hospitals on different constructs of the IHCQPM model are compared with the major results achieved by the recipients of the MBNQ award. Conclusion In no case the hospitals from India and Iran are found scoring close to the benchmarks (Baldrige health care criteria for performance excellence 2009-2010 and the guidelines proposed by the American Hospitals Association for hospitals). These results suggested to health care services more attempt to achieve high quality in management and performance.

2011-01-01

288

Hospital Performance Trends on National Quality Measures and the Association With Joint Commission Accreditation  

PubMed Central

BACKGROUND Evaluations of the impact of hospital accreditation have been previously hampered by the lack of nationally standardized data. One way to assess this impact is to compare accreditation status with other evidence-based measures of quality, such as the process measures now publicly reported by The Joint Commission and the Centers for Medicare and Medicaid Services (CMS). OBJECTIVES To examine the association between Joint Commission accreditation status and both absolute measures of, and trends in, hospital performance on publicly reported quality measures for common diseases. DESIGN, SETTING, AND PATIENTS Performance data for 2004 and 2008 from U.S. acute care and critical access hospitals were obtained using publicly available CMS Hospital Compare data augmented with Joint Commission performance data. MEASUREMENTS Changes in hospital performance between 2004 and 2008, and percent of hospitals with 2008 performance exceeding 90% for 16 measures of quality-of-care and 4 summary scores. RESULTS Hospitals accredited by The Joint Commission tended to have better baseline performance in 2004 than non-accredited hospitals. Accredited hospitals had larger gains over time, and were significantly more likely to have high performance in 2008 on 13 out of 16 standardized clinical performance measures and all summary scores. CONCLUSIONS While Joint Commission-accredited hospitals already outperformed non-accredited hospitals on publicly reported quality measures in the early days of public reporting, these differences became significantly more pronounced over 5 years of observation. Future research should examine whether accreditation actually promotes improved performance or is a marker for other hospital characteristics associated with such performance. Journal of Hospital Medicine 2011;6:458–465. © 2011 Society of Hospital Medicine

Schmaltz, Stephen P; Williams, Scott C; Chassin, Mark R; Loeb, Jerod M; Wachter, Robert M

2011-01-01

289

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.

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

2013-01-01

290

Leadership and the quality of care  

PubMed Central

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

Firth-Cozens, J; Mowbray, D

2001-01-01

291

Patient satisfaction with nursing care at a university hospital in Turkey.  

PubMed

Patient satisfaction is an important measure of service quality (SQ) in health care organizations. Patients' satisfaction and their expectations of care are valid indicators of quality nursing care. This article reports the results of a survey patient satisfaction with nursing care, administered by interview to 422 adults discharged from a university hospital in Turkey. The direct measurement of patient satisfaction with nursing care is a new phenomenon for this university hospital, and this was the first time that such an evaluation had been done in this particular hospital. In this study, SERVQUAL scale was used for determining patient satisfaction with nursing care. Weighted scores in dimensions of SERVQUAL were generally low, and there were statistically significant differences in means paired t-tests (p < .01). Sociodemographic characteristics of the patients (age, gender, education level) with regard to patient satisfaction were determined. Several statistically significant differences were found between the sociodemographic characteristics and weighted scores for dimensions of SERVQUAL (p < 0.5). According to results, the SQ gap scores for five dimensions were negative to meet expectations. The negative scores for tangibles, reliability, responsiveness, assurance, and empathy indicate areas needing improvement. In this hospital, results of this study support the need for nurses to take steps to improve patient satisfaction with nursing care. PMID:11668854

Uzun, O

2001-10-01

292

Partial hospitalization. An alternative to inpatient care.  

PubMed

Despite problems with research designs, sample sizes, differing areas of focus, and various research instruments, psychiatry can be encouraged by studies pointing to the following: Partial hospitalization can offer a viable alternative to inpatient hospitalization with less stigma and less family burden for patients. Such patients fare as well or better than their inpatient counterparts. When families or stable living situations are not available, the most acute patients can be treated and housed in a supervised living situation. Social and familial roles can be maintained. Partial hospitalization is helpful in reducing length and expense of full-time hospitalization when used as an transition to more traditional outpatient treatment and community life. This does not lead to increased rates of readmission or to exacerbating other symptoms or pathology. Partial hospitalization has grown steadily in the past 20 years. The question is no longer whether partial hospitalization works, but "what kind of patient can be best treated by partial hospitalization?" Innovative programs are sprouting. The 1980s bring fiscal, educational, and clinical challenges to partial hospitalization programs everywhere. PMID:4059096

Pang, J

1985-09-01

293

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

PubMed Central

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

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

2009-01-01

294

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

295

Health Literacy and Communication Quality in Health Care Organizations  

PubMed Central

The relationship between limited health literacy and poor health may be due to poor communication quality within health care delivery organizations. We explored the relationship between health literacy status and receiving patient-centered communication in clinics and hospitals serving communication-vulnerable patient populations. Thirteen health care organizations nationwide distributed a survey to 5,929 patients. All patients completed seven items assessing patient-centered communication. One third also completed three items assessing health literacy. The majority of patients had self-reported health literacy challenges, reporting problems learning about their medical condition because of difficulty understanding written information (53%), a lack of confidence in completing medical forms by themselves (61%), and needing someone to help them read hospital/clinic materials (57%). Logistic regression models showed that, after adjustment for patient demographic characteristics and health care organization type, patients with limited health literacy were 28–79% less likely than those with adequate health literacy to report their health care organization “always” provides patient-centered communication across seven communication items. Using a scaled composite of these items, limited health literacy remained associated with lower reported communication quality. These results suggest that improving communication quality in health care organizations might help to address the challenges facing patients with limited health literacy. They also highlight that efforts to address the needs of patients with limited health literacy should be sensitive to the range of communication challenges confronting these patients and their caregivers.

Wynia, Matthew K.; Osborn, Chandra Y.

2011-01-01

296

Caregiver Burden and Institutionalization, Hospital Use, and Stability of Care.  

National Technical Information Service (NTIS)

The study assessed a variety of longitudinal models to examine the effect of different types of caregiver burden on outcomes important to policymakers--nursing home admissions, hospital use, and stability of the family and formal care networks. Analyses w...

B. Miller S. McFall

1989-01-01

297

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.

Mosadeghrad, Ali Mohammad

2012-01-01

298

Health care costs, long-term survival, and quality of life following intensive care unit admission after cardiac arrest  

Microsoft Academic Search

Introduction  The purpose of this study was to investigate the costs and health status outcomes of intensive care unit (ICU) admission in\\u000a patients who present after sudden cardiac arrest with in-hospital or out-of-hospital cardiopulmonary resuscitation.\\u000a \\u000a \\u000a \\u000a \\u000a Methods  Five-year survival, health-related quality of life (Medical Outcome Survey Short Form-36 questionnaire, SF-36), ICU costs,\\u000a hospital costs and post-hospital health care costs per survivor, costs per

Jürgen Graf; Cecile Mühlhoff; Gordon S Doig; Sebastian Reinartz; Kirsten Bode; Robert Dujardin; Karl-Christian Koch; Elke Roeb; Uwe Janssens

2008-01-01

299

Improved tuberculosis infection control practices in Maryland acute care hospitals  

Microsoft Academic Search

Background: In 1992 and 1993, the Maryland Hospital Association and the Maryland Department of Health and Mental Hygiene conducted 2 surveys of tuberculosis prevention practices in Maryland hospitals that showed poor compliance with the 1990 Centers for Disease Control and Prevention's guidelines for preventing transmission of tuberculosis in health care facilities.Objective: The objective of this study was to assess compliance

Elizabeth P. Fuss; Ebenezer Israel; Nancy Baruch; Mary-Claire Roghmann

2000-01-01

300

Changes in General Hospital Psychiatric Care, 1980–1985  

Microsoft Academic Search

More than 60% of all inpatient psychiatric episodes occur in general hospitals. The need for psychologists' involvement in this important area is discussed. Changes in general hospital inpatient care from 1980 to 1985 are described. These include important and controversial changes in public policy, most notably Medicare's prospective payment system. Substantial changes in the de facto system occurred in patterns

Charles A. Kiesler

1991-01-01

301

Incidence of congenital heart disease in tertiary care hospital  

Microsoft Academic Search

Aims and Objectives: The present study was under taken to determine the spectrum, clinical profile and outcome of patients with congenital heart disease (CHD) admitted to a tertiary care hospital. Materials and methods: This is a retrospective, observational hospital based study conducted during January 2006 to December 2006. Out of 14461 admissions, 84 were cases of CHD. Only patients with

Shah GS; Singh MK; Pandey TR; Kalakheti BK; Bhandari GP

302

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

PubMed Central

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

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

2012-01-01

303

Extended hospital care as treatment of choice.  

PubMed

A review of the histories of six patients who failed to adapt to community living after hospital discharge identified six factors that are predictive of serious maladjustment in the community. The are the absence of a family or soical network, repeated threats of violent behavior, previous hospitalization, poor previous functioning, inability to take responsibility for medical and mental health treatment, and suffering. Patients identified by two or more factors are likely to be unable to cope with life outside the hospital. The authors question whether attempting to maintain such patients in the community is desirable in terms of economic cost and patient suffering. PMID:437713

Zaleski, J; Gale, M S; Winget, C

1979-06-01

304

Helping You Choose Quality Ambulatory Care  

MedlinePLUS

... on Key Quality Measures SIRAS - Free Courses Topics Topics High Reliability Health Care-Associated Infections Portal Infection ... Details Monday 3:02 CST, October 28, 2013 Topic Details Topic Library Item < Return to Topic Library ...

305

Helping You Choose Quality Hospice Care  

MedlinePLUS

... on Key Quality Measures SIRAS - Free Courses Topics Topics High Reliability Health Care-Associated Infections Portal Infection ... Details Monday 3:02 CST, October 28, 2013 Topic Details Topic Library Item < Return to Topic Library ...

306

Survey of infection control training program graduates: Long-term care facility and small hospital practitioners  

Microsoft Academic Search

Graduates of a 2-day basic training course in infection control were surveyed. Respondents were generally from Midwestern long-term care facilities and small hospitals. These infection control practitioners had multiple roles in addition to infection control, most notably employee health and quality assurance. Infection control practitioners demonstrated significant job stability. The vast majority of institutions where survey respondents were employed followed

Philip W. Smith; Virginia Helget; Dorothy Sonksen

2002-01-01

307

Quality of diabetes care in Arab Americans  

Microsoft Academic Search

The quality of care received by Arab American patients with type 2 diabetes residing in a city with a large migrant Arab population has not been examined. Arab American adults with a self-reported diagnosis of diabetes were identified in a rigorous cross-sectional, population-based epidemiologic study conducted in Dearborn, MI. Quality of diabetes care was determined by assessing adherence to the

Helen D. Berlie; William H. Herman; Morton B. Brown; Adnan Hammad; Linda A. Jaber

2008-01-01

308

Evaluating beauty care provided by the hospital to women suffering from breast cancer: qualitative aspects  

Microsoft Academic Search

Goals of work  Cancer patients are offered more and more access to beauty care during their stay in the hospital. This kind of intervention\\u000a has not been evaluated yet. Primary objective of our research was to determine what type of evaluation strategy to be implemented\\u000a (as a supportive care with quality of life and\\/or medical benefits; as a service providing immediate

Philippe Amiel; Sarah Dauchy; Julie Bodin; Céline Cerf; Franck Zenasni; Elisabeth Pezant; Anne-Marie Teller; Fabrice André; Mario DiPalma

2009-01-01

309

The hospital-supplier partnership: take care of the relationship first, and individual rewards will follow.  

PubMed

Partnerships and consolidation will continue to occur with increasing frequency within the supplier and health care provider communities as the health care industry strives to lower costs without diminishing quality and service. This article examines what constitutes the ideal hospital-supplier relationship. It asks the question: What does each partner need to do to make the relationship work effectively? It outlines the keys to a win-win proposition and ways to prevent the relationship from breaking down. PMID:10139713

Sjoerdsma, M

1995-02-01

310

Quality of diabetes care in general practice  

Microsoft Academic Search

In the Netherlands, a quality incentive is expected to ensue from improved collaboration between healthcare professionals. Whether this view is supported by sufficient evidence is, however, questionable. Therefore, the first study included in this thesis is a systematic review of studies on the effects of sharing and delegating diabetes care tasks. It became apparent that sharing and delegating care tasks

J. A. R. van Bruggen

2009-01-01

311

Predictors of quality in family child care  

Microsoft Academic Search

This study of 231 regulated family child care providers proposed a theoretical model to explore the effects on quality of: (1) provider level of general education; (2) provider degree of intentionality; (3) provider training and experience in family child care; (4) provider use of support services; and (5) provider work environment. Hierarchical linear regressions confirmed the predictive power of the

Gillian Doherty; Barry Forer; Donna S. Lero; Hillel Goelman; Annette LaGrange

2006-01-01

312

Internet Point of Care Learning at a Community Hospital  

ERIC Educational Resources Information Center

Introduction: Internet point of care (PoC) learning is a relatively new method for obtaining continuing medical education credits. Few data are available to describe physician utilization of this CME activity. Methods: We describe the Internet point of care system we developed at a medium-sized community hospital and report on its first year of…

Sinusas, Keith

2009-01-01

313

Nonpharmacologic Care of Heart Failure: Patient, Family, and Hospital Organization  

Microsoft Academic Search

Patients with severe heart failure require large quantities of health care resources, and more intensive interven- tions are not always related to a decrease in need for medical care, including hospitalization. A thoughtful ap- proach to the efficient and expeditious allocation of these resources is required. In fact, the nonpharmaco- logic therapy of patients with chronic congestive heart failure (CHF)

Michele D'Alto; Giuseppe Pacileo

314

Nonpharmacologic care of heart failure: patient, family, and hospital organization  

Microsoft Academic Search

Patients with severe heart failure require large quantities of health care resources, and more intensive interventions are not always related to a decrease in need for medical care, including hospitalization. A thoughtful approach to the efficient and expeditious allocation of these resources is required. In fact, the nonpharmacologic therapy of patients with chronic congestive heart failure (CHF) has to include

Michele D’Alto; Giuseppe Pacileo; Raffaele Calabrò

2003-01-01

315

Internet Point of Care Learning at a Community Hospital  

ERIC Educational Resources Information Center

|Introduction: Internet point of care (PoC) learning is a relatively new method for obtaining continuing medical education credits. Few data are available to describe physician utilization of this CME activity. Methods: We describe the Internet point of care system we developed at a medium-sized community hospital and report on its first year of…

Sinusas, Keith

2009-01-01

316

Hospital Emergency Rooms and Children's Health Care Attitudes  

Microsoft Academic Search

Objective: To assess attitudes of children requiring hospital emergency room (ER) treatment for trauma in- juries 5 years afterward to evaluate the long-term effect of treatment distress. For comparison, health care attitudes of a large random sample of children were assessed. Method: Children (N 139, 7-19 years old) recruited from the ER completed a health care attitude ques- tionnaire. Comparable

Carole Peterson; Abraham Ross; V. Charlene Tucker

2002-01-01

317

Nursing Home Ownership and Quality of Care  

Microsoft Academic Search

This article examines the relationship between nursing home ownership and the quality of care. It was hypothesized that not-for-profit homes provide less inappropriate care than for-profit homes, and that not-for-profit residents make more functional improvement than for-profit residents. A multiple regression analysis of 3,149 Virginia nursing home residents in 174 homes found that not-for-profit homes provided less inappropriate care than

Charles B. Moseley

1994-01-01

318

Revisiting the Relationship between Managed Care and Hospital Consolidation  

PubMed Central

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

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

2007-01-01

319

When medicare cuts hospital prices, seniors use less inpatient care.  

PubMed

The Affordable Care Act permanently slows the growth in Medicare hospital prices. To better understand the effects of those price cuts, we used data from ten states for the period 1995-2009 to examine the market-level relationship between Medicare prices and hospital utilization among the elderly. Regression analyses indicate that a 10 percent reduction in the Medicare price was associated with a 4.6 percent reduction in discharges among the elderly. This volume response to price cuts appears to be accomplished through hospitals' reduction in their numbers of staffed beds. They did not leave beds empty; instead, they reduced their scale of operations. Based on our results, we conclude that the Affordable Care Act will help reduce inpatient hospital utilization in the future. From a federal budgetary standpoint, lower utilization is good news, but the implications for patient care and health outcomes are not yet clear. PMID:24101070

White, Chapin; Yee, Tracy

2013-10-01

320

Waiting times and hospitalizations for ambulatory care sensitive conditions  

Microsoft Academic Search

Long waits for health care are hypothesized to cause negative health outcomes due to delays in diagnosis and treatment. This\\u000a study uses administrative data to examine the relationship between time spent waiting for outpatient care and the risk of\\u000a hospitalization for an ambulatory care sensitive condition (ACSC). Data on the number of days until the next available appointment\\u000a were extracted

Julia C. Prentice; Steven D. Pizer

2008-01-01

321

The ethical leadership challenge: creating a culture of patient- and family-centered care in the hospital setting.  

PubMed

The growing number of medical errors and resulting preventable deaths in hospitals presents an ethical dilemma that must be addressed by health care leaders and managers. These medical errors and deaths raise questions about safety and quality issues resulting in rising public mistrust and patient dissatisfaction. Many of these medical errors and deaths could have been avoided by including the patient and family in the care. The ethical challenge for leadership is creating a culture of patient- and family-centered care as a means to improve quality, safety, patient satisfaction, and public trust. This article addresses ways to improve safety, quality, patient satisfaction, and cost and thereby reduce medical errors and deaths by implementing a patient- and family-centered care culture. The first critical step for improvement is for hospital leaders and managers to answer the ethical call to create a culture centered on patient- and family-centered care in the hospital setting. PMID:21537133

Piper, Llewellyn E

322

Hospitalized Patients' Understanding of Their Plan of Care  

PubMed Central

OBJECTIVE: To evaluate hospitalized patients' understanding of their plan of care. PATIENTS AND METHODS: Interviews of a cross-sectional sample of hospitalized patients and their physicians were conducted from June 6 through June 26, 2008. Patients were asked whether they knew the name of the physician and nurse responsible for their care and specific questions about 6 aspects of the plan of care for the day (primary diagnosis, planned tests, planned procedures, medication changes, physician services consulted, and the expected length of stay). Physicians were interviewed and asked about the plan of care in the same fashion as for the patients. Two board-certified internists reviewed responses and rated patient-physician agreement on each aspect of the plan of care as none, partial, or complete agreement. RESULTS: Of 250 eligible patients, 241 (96%) agreed to be interviewed. A total of 233 (97%) of 241 physicians completed the interview, although sample sizes vary because of missing data elements. Of 239 patients, 77 (32%) correctly named at least 1 of their hospital physicians, and 143 patients (60%) correctly named their nurses. For each aspect of care, patients and physicians lacked agreement on the plan of care in a large number of instances. Specifically, there was no agreement between patients and physicians on planned tests or procedures for the day in 87 (38%) of 229 instances and in 22 (10%) of 220 instances. Complete agreement on the anticipated length of stay occurred in only 85 (39%) of 218 instances. CONCLUSION: A substantial portion of hospitalized patients do not understand their plan of care. Patients' limited understanding of their plan of care may adversely affect their ability to provide informed consent for hospital treatments and to assume their own care after discharge.

O'Leary, Kevin J.; Kulkarni, Nita; Landler, Matthew P.; Jeon, Jiyeon; Hahn, Katherine J.; Englert, Katherine M.; Williams, Mark V.

2010-01-01

323

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

Microsoft Academic Search

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

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

2000-01-01

324

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

2012-09-11

325

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

Shrivastava, Prabhat; Goel, Arun

2010-01-01

326

Association between hospital volume and network membership and an analgesia, sedation and delirium order set quality score: a cohort study  

PubMed Central

Introduction Protocols for the delivery of analgesia, sedation and delirium care of the critically ill, mechanically ventilated patient have been shown to improve outcomes but are not uniformly used. The extent to which elements of analgesia, sedation and delirium guidelines are incorporated into order sets at hospitals across a geographic area is not known. We hypothesized that both greater hospital volume and membership in a hospital network are associated with greater adherence of order sets to sedation guidelines. Methods Sedation order sets from all nonfederal hospitals without pediatric designation in Washington State that provided ongoing care to mechanically ventilated patients were collected and their content systematically abstracted. Hospital data were collected from Washington State sources and interviews with ICU leadership in each hospital. An expert-validated score of order set quality was created based on the 2002 four-society guidelines. Clustered multivariable linear regression was used to assess the relationship between hospital characteristics and the order set quality score. Results Fifty-one Washington State hospitals met the inclusion criteria and all provided order sets. Based on expert consensus, 21 elements were included in the analgesia, sedation and delirium order set quality score. Each element was equally weighted and contributed one point to the score. Hospital order set quality scores ranged from 0 to 19 (median = 8, interquartile range 6 to 14). In multivariable analysis, a greater number of acute care days (P = 0.01) and membership in a larger hospital network (P = 0.01) were independently associated with a greater quality score. Conclusions Hospital volume and membership in a larger hospital network were independently associated with a higher quality score for ICU analgesia, sedation and delirium order sets. Further research is needed to determine whether greater order-set quality is associated with improved outcomes in the critically ill. The development of critical care networks might be one strategy to improve order set quality scores.

2012-01-01

327

The continuity and quality of primary care.  

PubMed

Patients who have access to different health care systems, such as Medicare-eligible veterans, may obtain services in either or both health systems. We examined whether quality of diabetes care was associated with care continuity or veterans' usual source of primary care in a retrospective cohort study of 1,867 Medicare-eligible veterans with diabetes in 2001 to 2004. Underprovision of quality of diabetes care was more common than overprovision. In adjusted analyses, veterans who relied only on Medicare fee-for-service (FFS) for primary care were more likely to be underprovided HbA1c testing than veterans who relied only on Veteran Affairs (VA) for primary care. Dual users of VA and Medicare FFS primary care were significantly more likely to be overprovided HbA1c and microalbumin testing than VA-only users. VA and Medicare providers may need to coordinate more effectively to ensure appropriate diabetes care to Medicare-eligible veterans, because VA reliance was a stronger predictor than care continuity. PMID:23868082

Maciejewski, Matthew L; Wang, Virginia; Burgess, James F; Bryson, Chris L; Perkins, Mark; Liu, Chuan-Fen

2013-07-17

328

The nephro-geriatric unit in a lean-oriented in-hospital model of care.  

PubMed

Nephrologists worldwide are gradually coping with elderly patients. This is because of the burden of chronic disease in the aging population and specifically chronic kidney disease (CKD). CKD in the elderly rarely occurs in isolation from other chronic conditions and can often be a marker of these conditions themselves. Geriatricians usually take care of chronic conditions and are trained to perform comprehensive geriatric assessment, a tool to estimate frailty, that is the risk of adverse outcome, disability, and death in the clinical setting of elderly inpatients. Unfortunately, they are not used to a CHD invasive and non-invasive approach and so there is no doubt about the need for a co-managed care model for these patients. However, where and how this model must be realized is still questionable. New hospital care models are patient-centered and encompass the concepts of departments to embrace the differentiated levels of care approach. According to this model the hospital is subdivided into three different standards of care: 1-high; 2 -intermediate; 3- low and this organization avoids inpatients being transferred frequently to different units, receiving specific care easily obtained by moving and changing the medical staff in charge of the patient. The lean care approach integrates the principles of the Toyota Producing System (TPS), a leading system of the industrial world, into intensity-based hospital care, thereby maximizing quality processes and promoting co-managed care as in the nephro-geriatric clinical setting. PMID:22641567

Greco, Antonio; Cascavilla, Leandro; Paris, Francesco; Addante, Filomena; Miscio, Leonardo; De Vincentis, Gabriella; Di Bisceglie, Domenico; Crupi, Domenico

2012-01-01

329

Hypodermoclysis therapy. In a chronic care hospital setting.  

PubMed

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

Worobec, G; Brown, M K

1997-06-01

330

Improving Quality of Care and Life in Nursing Homes  

Microsoft Academic Search

For nursing home residents, quality of life is largely determined by the quality of the care they receive. Unfortunately, that quality is all too often inadequate. Current regulatory systems have failed in their efforts to assure high-quality care. Policy could vitally improve institutional quality of care in three ways: (1) increase efforts to derive a valid and reliable quality of

Anne P. Glass

1988-01-01

331

To handle the unexpected - the meaning of caring in pre-hospital emergency care.  

PubMed

The patient's voice has not been present to the same degree as the professional perspective in caring research in a pre-hospital context. In order to further develop and improve pre-hospital care, it is therefore important to explore patients' situations not only in life threatening but also in non-traumatic situations. This is especially important as these patients might be defined as inappropriate attendees of ambulance services. The aim of this study was to interpret and explain experiences of caring in pre-hospital care situations that are not defined as traumatic or life threatening. Twenty informants aged between 34 and 82 years were interviewed. The design of the study was exploratory, and it used an interpretative approach in order to understand the meaning of pre-hospital caring. The findings show that pre-hospital caring can be understood and explained as a matter of interplay between carer(s) and patient with potentials for positive as well as negative outcomes. Our conclusion is that the initial meeting is of vital importance in how patients experience pre-hospital care. It is suggested that general public information on the development of Swedish pre-hospital care received in turn may facilitate the first encounter between patient and carer(s). PMID:22243716

Ahl, Caroline; Nyström, Maria

2011-06-12

332

Quality determinants and hospital satisfaction. Perceptions of the facility and staff might be key influencing factors.  

PubMed

Perceptions of service quality ultimately affect consumer satisfaction, but objective measures of quality can be hard to come by when evaluating the quality of clinical care in a hospital. To determine if dimensions other than those found in models such as SERVQUAL were at play, the authors undertook a survey of 472 consumers, who were divided into two groups: those who had been hospital patients within the last three years (users) and those who were visitors (observers). The results suggest that facilities-related and human-factor related considerations helped shape the quality assessments of both groups, with observers generally giving higher marks to the hospitals with which they were familiar on the dimension of facilities-related quality and users expressing a less critical view of the human-factor dimension. PMID:10179390

Oswald, S L; Turner, D E; Snipes, R L; Butler, D

1998-01-01

333

General medical care external hospitalizations for patients in Texas state mental health hospitals.  

PubMed

We explored the characteristics of general medical hospital admissions for patients in state mental health hospitals. Data were extracted from a statewide database of all hospital discharges for 5 years identified as general medical hospital admissions that occurred during the stay of patients at state mental health hospitals. Across the 9 mental health hospitals in the state system, rates of admission to general medical hospitals varied significantly from 0.7% to 3.7%. On average, of the 1.9% of all state mental health inpatients who had a general hospital admission, 25% occurred within 4 days of admission to the mental hospital. The average general hospitalization lasted 5.7 days. The reported total charge for all stays was $34 million. Dehydration (15%), hypertension (10%), and diabetes (10%) were the most frequent diagnoses. Thirteen percent of diagnoses met preventable hospitalization criteria. Given the variability among hospitals in admission rates and the number of preventable conditions, improvements in patient care and health as well as reduced admissions to general medical hospitals may be possible. PMID:23479290

Shafer, Alan B; Ray, Ryan Kumar; Becker, Emilie A

2013-03-01

334

Computers and Quality of Care Review  

PubMed Central

This paper reports on the use of computer systems in psychiatric care settings in conjunction with the performance of four quality assurance functions (utilization review, patient care audit, individual case review, and medical records review for completeness). Thirty-two centers that treat psychiatric patients and 22 standards setting agencies were surveyed concerning: 1) the general use of computer systems by the facilities surveyed; 2) the computer applications used in conjunction with quality assurance activities by both facilities and agencies, and 3) the computer applications that facility personnel perceived as most useful in the performance of quality assurance activities. Relatively limited use of computer applications was reported in the facilities surveyed, with moderate use reported by the agency personnel who were interviewed. These findings are discussed and recommendations made with regard to the use of computers in conjunction with quality of care review.

Murtaugh, Chris; Siegel, Carole; Fischer, Susan; Alexander, Mary Jane; Craig, Thomas J.

1982-01-01

335

[Dementia--a secondary diagnosis in acute hospital care or more? Measures for improving care of hospitalized dementia patients].  

PubMed

More and more people with dementia need acute care. However, a stay in the hospital involves severe risks for these patients: insufficient treatment, complications and a considerable emotional strain. A model project in Northrhine-Westfalia provides acute care hospitals with measures to improve the care of patients with dementia. This article presents the conceptual results of the project referring to three fields: discharge and networking, medical treatment and general ward setting. Finally, the article points out some implications of the rising number of old age patients on health politics and research. PMID:19190869

Angerhausen, Susanne

2008-10-30

336

Hospital in the home is cost saving for appropriately selected patients: a comparison with in-hospital care  

Microsoft Academic Search

Background. As the cost of acute care in hospitals increases, there is an increasing need to find alternative means of providing acute care. Hospital in the home (HITH) has developed in response to this challenge. Current evidence is conflicting as to whether HITH provides cost savings compared with in-hospital care (IHC). The heterogeneous nature of HITH and the clinical complexity

C. RAINA MACINTYRE; DENISE RUTH; ZAHID ANSARI

2002-01-01

337

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

338

A decision support database for nurse care planning as part of a hospital information system.  

PubMed

This paper, based on a doctoral thesis, describes the development and evaluation of a computerized care planning database at the Royal Hampshire County Hospital. It is part of an integrated Hospital Information System, the first to be installed in an United Kingdom. The research examines nurses' attitudes to the Nursing Process to the new care planning system before, three months after, and one year after its implementation. The quality of manual vs. computer care planning is compared in the same time periods using an existing quality assurance instrument and an audit tool, developed during the research. All data was analyzed in each time period in a framework of personal and organizational change theories. The proactive nature of the research allowed findings to be used as a basis for modifications during the process, which culminated in a further project to provide a database of standard based care plans. Results showed that an understanding of the Nursing Process was inadequate and that most nurses were ambivalent about paper care planning and the proposed computer care plans. Three months after implementation, attitudes became more unfavorable; however, after a year, attitudes showed a significant shift towards the positive pole. Conversely, the overall quality-of-care planning improved significantly. PMID:8591458

Newton, C

1995-01-01

339

Enhancing cultural competence for improved access to quality care.  

PubMed

The Hospital for Sick Children (SickKids) is situated in one of the most diverse cities in the world. This is reflected in the patient population it serves. In 2009, the hospital embarked on a quality improvement initiative to address the existing evidence base on health disparities and to enhance health equity through cultural competence programming. The goal was to achieve optimal health outcomes for all patients and families, with a particular focus on new immigrant and other vulnerable populations. Evaluation results indicate changes in clinical practice as a result of this initiative and increased patient satisfaction with regard to staff members' level of cultural sensitivity. This article provides an overview of this hospital-wide initiative, as well as the evaluation methods and outcomes. Based on a needs assessment, we developed an institutionally meaningful curriculum with SickKids' values of family-centred care, patient safety and service excellence embedded in the program. Educational sessions were delivered to clinical and non-clinical hospital staff, focusing on health disparities, the case for culturally competent care and practical tools for healthcare practitioners. Organizational change strategies, including the use of champions as change agents and role models, were used to embed cultural competence as integral to family-centred care at SickKids. PMID:22008574

Karmali, Karima; Grobovsky, Linda; Levy, Jennifer; Keatings, Margaret

2011-10-01

340

Hospital quality scorecards, patient severity, and the emerging value shopper.  

PubMed

Results of an anticipated second attempt at Medicare fatality ratings in 1987 may prove as misleading as did the first, much-criticized HCFA report, unless the analysts focus more attention on well-defined methodology and accurate analysis, especially in terms of sample size and patient severity issues. Unless all of the information is based on systematic inquiry and statistically defensible results concerning low- or high-quality care, the outcome will fail short of the rhetorical promises made on behalf of comparison shopping and consumer choice. Employers and consumer groups are currently making modest attempts to disseminate information--before any well-defined, accurate methodology to back that information has evolved. Aggressive consumer groups, interested in "price wars" and "quality wars," are raising the battle cry: "Select your hospital and doctor on the facts, not just hopes!" If providers become subject to competition based on high-quality, low-cost criteria, they had better have accurate analysis--"the facts"--behind their claims. Future critics may well argue that circulating incorrect information scorecards has done more harm than providing no information at all. More basic research needs to be undertaken if we are to avoid such mistakes. PMID:10279765

Eastaugh, S R

341

Hospital Quality and Selective Contracting: Evidence from Kidney Transplantation*  

PubMed Central

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

Howard, David H.

2008-01-01

342

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

343

Pediatric hospitalizations at two different setting community hospitals in north India: Implications for regionalization of care  

Microsoft Academic Search

Objective  To evaluate pediatric hospitalizations at two different setting community hospitals in north India, and to understand the\\u000a implications for regionalization of pediatric care in heterogeneous environment of India.\\u000a \\u000a \\u000a \\u000a Methods  Retrospective review of medical records of children hospitalized at a large and a small community hospital catering to population\\u000a from different social classes but in close proximity to each other was carried

Pankaj Garg; Sitaram Bhartia

2009-01-01

344

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

345

Effects of care pathways on the in-hospital treatment of heart failure: a systematic review  

PubMed Central

Background Care pathways have become a popular tool to enhance the quality of care by improving patient outcomes, promoting patient safety, increasing patient satisfaction, and optimizing the use of resources. We performed a disease specific systematic review to determine how care pathways in the hospital treatment of heart failure affect in-hospital mortality, length of in-hospital stay, readmission rate and hospitalisation cost when compared with standard care. Methods Medline, Cinahl, Embase and the Cochrane Central Register of Controlled Trials were searched from 1985 to 2010. Each study was assessed independently by two reviewers. Methodological quality of the included studies was assed using the Jadad methodological approach for randomised controlled trials, controlled clinical trials and the New Castle Ottawa Scale for case–control studies, cohort studies and time interrupted series. Results Seven studies met the study inclusion criteria and were included in the systematic review with a total sample of 3,690 patients. The combined overall results showed that care pathways have a significant positive effect on mortality and readmission rate. A shorter length of hospital stay was also observed compared with the standard care group. No significant difference was found in the hospitalisation costs. More positive results were observed in controlled trials compared to randomized controlled trials. Conclusion By combining all possible results, it can be concluded that care pathways for treatment of heart failure decrease mortality rates and length of hospital stay, but no statistically significant difference was observed in the readmission rates and hospitalisation costs. However, one should be cautious with overall conclusions: what works for one organization may not work for another because of the subtle differences in processes and bottlenecks.

2012-01-01

346

Essential features of designating out-of-hospital cardiac arrest as a reportable event: a scientific statement from the American Heart Association Emergency Cardiovascular Care Committee; Council on Cardiopulmonary, Perioperative, and Critical Care; Council on Cardiovascular Nursing; Council on Clinical Cardiology; and Quality of Care and Outcomes Research Interdisciplinary Working Group.  

PubMed

The 2010 impact goal of the American Heart Association is to reduce death rates from heart disease and stroke by 25% and to lower the prevalence of the leading risk factors by the same proportion. Much of the burden of acute heart disease is initially experienced out of hospital and can be reduced by timely delivery of effective prehospital emergency care. Many patients with an acute myocardial infarction die from cardiac arrest before they reach the hospital. A small proportion of those with cardiac arrest who reach the hospital survive to discharge. Current health surveillance systems cannot determine the burden of acute cardiovascular illness in the prehospital setting nor make progress toward reducing that burden without improved surveillance mechanisms. Accordingly, the goals of this article provide a brief overview of strategies for managing out-of-hospital cardiac arrest. We review existing surveillance systems for monitoring progress in reducing the burden of out-of-hospital cardiac arrest in the United States and make recommendations for filling significant gaps in these systems, including the following: 1. Out-of-hospital cardiac arrests and their outcomes through hospital discharge should be classified as reportable events as part of a heart disease and stroke surveillance system. 2. Data collected on patients' encounters with emergency medical services systems should include descriptions of the performance of cardiopulmonary resuscitation by bystanders and defibrillation by lay responders. 3. National annual reports on key indicators of progress in managing acute cardiovascular events in the out-of-hospital setting should be developed and made publicly available. Potential barriers to action on cardiac arrest include concerns about privacy, methodological challenges, and costs associated with designating cardiac arrest as a reportable event. PMID:18413503

Nichol, Graham; Rumsfeld, John; Eigel, Brian; Abella, Benjamin S; Labarthe, Darwin; Hong, Yuling; O'Connor, Robert E; Mosesso, Vincent N; Berg, Robert A; Leeper, Barbara Bobbi; Weisfeldt, Myron L

2008-04-14

347

End-of-life care in hospitalized adults with complex congenital heart disease: care delayed, care denied.  

PubMed

Adults with congenital heart disease represent a growing patient population. Notwithstanding dramatic improvements in survival and life expectancy over recent decades, many of these patients remain at risk of premature death from progressive heart disease and would benefit from the principles of palliative and end-of-life care. Data on end-of-life care in this patient group are, however, lacking. We report a retrospective study of 48 patients with congenital heart disease who died while admitted to our hospital (mean age at death 37 ± 14 years). We describe circumstances of death, end-of-life discussions, and the provision of end-of-life care. The majority of patients had complex congenital heart disease and were considered to be in the end stage of their disease. Despite this, only a minority of patients had documented end-of-life discussions prior to their terminal admission and most received continuing aggressive medical treatment up to their demise. Advanced palliative and end-of-life care strategies should be developed for and provided to this group of patients, with the dual aims of reduction of unwarranted therapies and enhancement of the quality of death and dying. PMID:21697263

Tobler, Daniel; Greutmann, Matthias; Colman, Jack M; Greutmann-Yantiri, Mehtap; Librach, Lawrence S; Kovacs, Adrienne H

2011-06-22

348

Hospital discharge planning and continuity of care for aged people in an Italian local health unit: does the care-home model reduce hospital readmission and mortality rates?  

Microsoft Academic Search

BACKGROUND: Hospital discharge planning is aimed to decrease length of stay in hospitals as well as to ensure continuity of health care after being discharged. Hospitalized patients in Turin, Italy, who are in need of medical, social and rehabilitative care are proposed as candidates to either discharge planning relying on a care-home model (DPCH) for a period of about 30

Gianfranco Damiani; Bruno Federico; Antonella Venditti; Lorella Sicuro; Silvia Rinaldi; Franco Cirio; Cristiana Pregno; Walter Ricciardi

2009-01-01

349

Quality measurement combined with peer review improved german in-hospital mortality rates for four diseases.  

PubMed

Mortality rates during hospital stays for common diseases show considerable variation at the hospital level, which suggests that there is potential for outcome improvement. We studied changes in mortality after an intervention that aimed to improve medical outcomes through quality measurement combined with peer review. We examined eighteen acute care hospitals purchased by the Helios Hospital Group in Germany from one year before to three years after the start of the intervention. In-hospital mortality for myocardial infarction, heart failure, ischemic stroke, and pneumonia was stratified by initial hospital performance and compared to the German average. Following the intervention, hospitals whose performance was initially subpar significantly reduced in-hospital mortality for all four diseases. In hospitals that initially performed well, no significant changes in mortality were observed. The observational nonrandomized data suggest that the quality management approach was associated with improved outcomes in initially subpar hospitals. Disease-specific measures of mortality, combined with peer reviews, can be used to direct actions to areas of potential improvement. PMID:24019367

Nimptsch, Ulrike; Mansky, Thomas

2013-09-01

350

Uncompensated hospital care for pregnancy and childbirth cases.  

PubMed Central

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

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

1991-01-01

351

[Quality control of surgical care (author's transl)].  

PubMed

Based on studies carried on for more than ten years, various methods for voluntary quality control of surgical care are proposed. Besides short-term measures (e.g., "strategy of therapy"), a long-term pilot study would permit detection of defects and errors in surgical care through the recording of comparable data. An organization (similar to the Dutch "Concilium chirurgicum") should sponser visitations to various surgical centers. These two, strictly voluntary measures should form the basis for quality control that boots self-esteem of surgeons and does away with the need for state-sponsored measures. PMID:593000

Müller-Osten, W

1977-11-01

352

Quality care and qualifications: examining the link between professional learning and care-based practices  

Microsoft Academic Search

The importance of quality care for young children participating in formal care arrangements such as family day care, long day care and occasional care is an important topic for a range of stakeholders including those involved in policy development, care provision, parents, and perhaps most importantly, the children. Quality care for young children comprises four main dimensions including Consistency, Appropriateness,

Suzy Edwards

353

Dramatic changes in care: the experience of one psychiatric hospital.  

PubMed

Recent and dramatic changes in this country's mental healthcare service are widely documented. To assess the extent and timing of those changes at one private psychiatric hospital, the authors examined length of stay, number of admissions, and patient age for general trends between 1980 and 1990 and more closely examined trends between July 1990 and December 1991. We related our findings to data for other private psychiatric hospitals and compared them with data from psychiatric units in general hospitals. The results are discussed in terms of changes in insurance coverage, changing utilization by different age groups, and a national shift from inpatient to outpatient care. PMID:10123737

Frank, L; Sharfstein, S S

354

Quality of care: how good is good enough?  

PubMed Central

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/

2012-01-01

355

Can sustainable hospitals help bend the health care cost curve?  

PubMed

As policymakers seek to rein in the nation's escalating health care costs, one area deserving attention is the health system's costly environmental footprint. This study examines data from selected hospitals that have implemented programs to reduce energy use and waste and achieve operating room supply efficiencies. After standardizing metrics across the hospitals studied and generalizing results to hospitals nationwide, the analysis finds that savings achievable through these interventions could exceed $5.4 billion over five years and $15 billion over 10 years. Given the return on investment, the authors rec­ommend that all hospitals adopt such programs and, in cases where capital investments could be financially burdensome, that public funds be used to provide loans or grants, particularly to safety-net hospitals. PMID:23214181

Kaplan, Susan; Sadler, Blair; Little, Kevin; Franz, Calvin; Orris, Peter

2012-11-01

356

Making nursing-sensitive quality indicators real in ambulatory care.  

PubMed

Pay-for-performance initiatives are changing the quality landscape. Gaps exist in quantifying and linking ambulatory care quality indicators to care provided by nurses in ambulatory care. Ambulatory care quality indicators that are sensitive to nursing care, standardized, and tested need to be identified and adopted by ambulatory care nurses, ambulatory care provider organizations, professional organizations, and endorsed by a consensus organization. PMID:18616060

Swan, Beth Ann

357

Quality outcomes of hospital supplemental nurse staffing.  

PubMed

Use of supplemental RNs (SRNs) is common practice among US hospitals to fill gaps in nurse staffing. The objective of this study was to examine the relationship between use of SRNs and patient outcomes. Multilevel modeling was performed to analyze hospital administrative data from 19 hospital units in a large tertiary medical center for the years 2003 to 2006. Patient outcomes included in-hospital mortality, medication errors, falls, pressure ulcers, and patient satisfaction with nurses. Use of SRNs ranged from 0% to 30.4% of total RN hours per unit quarter. Among 188 of the 304 unit quarters in which SRNs were used, the average SRN use was 9.8% in non-ICUs and 6.4% in ICUs. All observed effects of SRN use on patient outcomes were nonsignificant. Use of SRNs was substantial and varied widely by unit. No evidence was found that links SRN use to either adverse or positive patient outcomes. PMID:23151931

Xue, Ying; Aiken, Linda H; Freund, Deborah A; Noyes, Katia

2012-12-01

358

Determinants of acute hospital care use by elderly patients in Italy from 1996 to 2006.  

PubMed

To determine the trend of elderly hospitalization rates in Italy, following the economic rationalization of health systems in Western countries, and to evaluate which alternatives to acute hospitalization have been developed during the period 1996-2006 an ecological observational study has been carried out. Data from the Italian Hospital-Discharge Registries (HDRs) of the years 1996, 2001, and 2006 have been analyzed in order to assess the variations among the elderly in terms of hospitalization rates, hospital stay, and bed rates. The results were compared with nursing home admission rates and home care offer. Relations among these variables were explored by univariate and multivariate analyses. Elderly hospital admission rates decreased in Italy from 324.2/1000 in 1996, to 258.7 in 2006. Mean hospital stay of elderly patients was 9.4 days in 2006, 9.5 in 2001 and 10.1 in 1996. A multivariate linear regression model was statistically significant in explaining the variations in hospitalization rates (F: 5.68; p=0.004; R(2)=0.77). The main determinants linked to such variations were the bed rate (?=0.67; p=0.004) and the hospital length of stay (?=-0.77; p=0.03). The analysis showed a reduction in hospitalization rates among the elderly, which was not counterbalanced by an increased offer of home care and/or nursing home services, but was mainly linked to a decrease in the supply of acute beds, with possible consequences on the quality of health care. PMID:21899898

Liotta, Giuseppe; Mancinelli, Sandro; Scarcella, Paola; Emberti Gialloreti, Leonardo

359

[The quality of chronic care in Germany].  

PubMed

Over the last ten years changes in the legal framework of the German health care system have promoted the development of new health service models to improve chronic care. Recent innovations include the nation-wide introduction of disease management programmes (DMPs), integrated care contracts, community nurse programmes, the introduction of General Practitioner (GP)-centred care contracts, and new opportunities to offer interdisciplinary outpatient care in polyclinics. The aim of this article is to describe the recent developments regarding both the implementation of new health care models by statutory health insurance companies and their evaluation. As part of a European project on the development and validation of disease management evaluation methods (DISMEVAL), we carried out a selective literature search to identify relevant models and evaluation studies. However, on the basis of the currently available evaluation and study results it is difficult to judge whether these developments have actually led to an improvement in the quality of chronic care in Germany. Only for DMPs, evaluation is legally mandatory; its methods are inappropriate, though, for studying the effectiveness of DMPs. Further study results on the effectiveness of DMPs mostly focus on the DMP Diabetes mellitus type II and show consistent improvements regarding process parameters such as regular routine examinations, adherence to treatment guidelines, and quality of life. More research will be needed to determine whether DMPs can also help reduce the incidence of secondary disease and mortality in the long term. PMID:22142877

Fullerton, Birgit; Nolte, Ellen; Erler, Antje

2011-01-22

360

Quality Assurance Program in a University Teaching Hospital.  

National Technical Information Service (NTIS)

The establishment of a quality assurance program at University Hospital, the primary teaching facility at the University of Arkansas Medical Center, Little Rock, is described. During a 5-month planning effort funded by the Arkansas Regional Medical Progra...

1974-01-01

361

Management Tools and Organization as Key Factors Towards Quality Care: Reflections from Experience  

Microsoft Academic Search

Health care organization in French hospitals has become an increasingly important issue, as efforts to ensure better cost control have Increased financial constraints, as patients hare demanded ever better results and quality, and as nurses' expectations for better working conditions have grown. Organiz- ing a health care unit requires an articulation between individual efforts — necessary both for gathering accurate

DOMINIQUE TONNEAU

1997-01-01

362

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

2008-03-20

363

[Implementations of hospital medical equipments quality control system].  

PubMed

Medical equipment quality control is the core content of hospital management. It runs through the whole process of medical equipment management, including the purchase, the installation and acceptance, the use and maintenance, the abandonment. It is the absolute duty for a hospital to assure and control the quality of the equipment. This paper presents the establishment of medical equipment quality control system, as well as a detailed description and analysis in the implementation of this system. Finally, discuss a few experiences in the quality control work. PMID:20812654

Yu, Lu; Liu, Xiaowen; Deng, Houbin; Ge, Yi; Wang, Min

2010-05-01

364

An assessment of quality of sleep and the use of drugs with sedating properties in hospitalized adult patients  

Microsoft Academic Search

BACKGROUND: Hospitalization can significantly disrupt sleeping patterns. In consideration of the previous reports of insomnia and apparent widespread use of benzodiazepines and other hypnotics in hospitalized patients, we conducted a study to assess quality of sleep and hypnotic drug use in our acute care adult patient population. The primary objectives of this study were to assess sleep disturbance and its

Luciana Frighetto; Carlo Marra; Shakeel Bandali; Kerry Wilbur; Terryn Naumann; Peter Jewesson

2004-01-01

365

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

PubMed Central

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

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

2010-01-01

366

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

Code of Federal Regulations, 2010 CFR

...2009-07-01 2009-07-01 false Hospital care and medical services in non-VA...Private Hospitals § 17.52 Hospital care and medical services in non-VA...capable of furnishing economical hospital care or medical services because...

2009-07-01

367

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...Private Hospitals § 17.52 Hospital care and medical services in non-VA...capable of furnishing economical hospital care or medical services because...

2010-07-01

368

Implications of Medicare reimbursement changes related to inpatient nursing care quality.  

PubMed

Recent changes to the inpatient prospective payment system by the Centers for Medicare and Medicaid Services will negatively affect reimbursement to hospitals for patients who develop certain types of nursing-sensitive, hospital-acquired conditions such as pressure ulcers, falls with injuries, or nosocomial infections. The author examines the effects of the new payment policy on inpatient nursing care and addresses ways to improve quality and minimize financial impacts to hospitals. PMID:18690122

Welton, John M

369

Community health orientation, community-based quality improvement, and health promotion services in hospitals.  

PubMed

The objective of the study presented in this article was to examine the relationship between hospital community orientation and the provision of health promotion services. The study used data from the 2000 American Hospital Association survey and the 2000 Area Resource File to examine acute care hospitals throughout the United States. The study was a cross-sectional multiple regression analysis. Hospital community orientation was measured by two independent variables: (1) community health orientation and (2) community-based quality orientation. Health promotion services were represented by two dependent variables: (1) hospital-based health promotion services and (2) collaborative health promotion services. Organizational control variables included bed-size code, not-for-profit ownership, network participation, and joint venture/alliance membership. Environmental control variables included the proportion of population over age 65, the percentage of population below the poverty level, the square root of the proportion of Medicaid inpatient revenue, the presence of state community benefit laws/guidelines, a Herfindahl-Hirschman Index of level of competition, and an index of managed care influence. Results of regression analyses showed that community health and community-based quality orientations were positively and significantly related to both the direct provision of health promotion services by hospitals and the collaborative provision of health promotion services through systems, joint ventures, and networks. The study concludes that a community health orientation and a community-based quality orientation lead to greater provision of health promotion services. PMID:15499804

Ginn, Gregory O; Moseley, Charles B

370

A Teaching Hospital Medical Clinic: Secondary Rather than Primary Care.  

ERIC Educational Resources Information Center

A review of 287 patient visits to a teaching hospital polyclinic shows that most patients had multiple problems that required the help of subspecialists. However, the patients' needs for accessibility, comprehensiveness, coordination, and continuity are as great as those of patients receiving primary care. Implications for academic internal…

Fletcher, Suzanne; And Others

1979-01-01

371

The Tremendous Cost of Seeking Hospital Obstetric Care in Bangladesh  

Microsoft Academic Search

In Bangladesh, maternal mortality is estimated to be 320 per 100,000 live births, among the highest in the world, and most deliveries in rural areas occur at home. Women with obstetric complications fear to seek hospital care for various reasons; one of which is the tremendous cost. This paper shows how cost impedes rural, poor women's access to emergency obstetric

Kaosar Afsana

2004-01-01

372

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

Microsoft Academic Search

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

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

2009-01-01

373

Total quality management issues in managed care.  

PubMed

The implementation of total quality management (TQM) in health care has gone on in parallel with the growth of managed care. What is the interaction between the two? Key issues are the ascendance of cost control over quality in many areas, erosion of employee commitment and loyalty, and a short-run orientation. Associated with this is an emphasis on organizational learning rather than learning by autonomous professionals. Both TQM and managed care acknowledge the dynamic nature of clinical processes and the ability and responsibility of both institutions and clinicians to improve their processes. Both are consistent with efforts to identify and implement best practices. However, these similarities should not mask fundamental differences. Continuous improvement must shift its focus from avoiding unnecessary variation to facilitating rapid organizational learning and institutionalizing mass customization into the delivery of health services. PMID:9327355

McLaughlin, C P; Kaluzny, A D

1997-01-01

374

Transitional care facility for elderly people in hospital awaiting a long term care bed: randomised controlled trial  

Microsoft Academic Search

Objective To assess the effectiveness of moving patients who are waiting in hospital for a long term care bed to an off-site transitional care facility. Design Randomised controlled trial. Setting Three public hospitals in Southern Adelaide. Participants 320 elderly patients (mean age 83 years) in acute hospital beds (212 randomised to intervention, 108 to control). Interventions A transitional care facility

Maria Crotty; Craig H Whitehead; Rachel Wundke; Lynne C Giles; David Ben-Tovim; Paddy A Phillips

2005-01-01

375

Health care reform and Connecticut's non-profit hospitals.  

PubMed

The recent federal Health Care Reform Act signed into law by President Obama is expected to lead to greater patient volumes at non-profit hospitals in Connecticut (and throughout the country). The financial implications for these hospitals depend on how the costs per patient are expected to change in response to the anticipated higher patient volumes. Using a regression analysis of costs with annual data on 30 Connecticut hospitals over the period 2006 to 2008, we find that there are considerable differences between outpatient and inpatient unit cost structures at these hospitals. Based on the results of our analysis, and assuming health care reform leads to an overall increase in the number of outpatients, we would expect Connecticut hospitals to experience lower costs per outpatient treated (economies of scale). On the other hand, an influx of additional inpatients would be expected to raise unit costs (diseconomies of scale). After controlling for other cost determinants, we find that the marginal cost of an inpatient is about $8,000 while the marginal cost of an outpatient is about $44. This disparity may provide an explanation for our finding that the effect of additional patient volumes overall (combining inpatient and outpatient) is an increase in hospitals' unit costs. PMID:21294435

Cohen, Jeffrey R; Gerrish, William; Galvin, J Robert

2010-01-01

376

30-day hospital readmission of older adults using care transitions after hospitalization: a pilot prospective cohort study  

PubMed Central

Purpose Patients leaving the hospital are at increased risk of functional decline and hospital readmission. The Employee and Community Health service at Mayo Clinic in Rochester developed a care transition program (CTP) to provide home-based care services for medically complex patients. The study objective was to determine the relationship between CTP use, 30-day hospital readmission, and Emergency Room (ER) visits for adults over 60 years with high Elder Risk Assessment scores. Patients and methods This was a pilot prospective cohort study that included 20 patients that used the CTP and 20 patients discharged from the hospital without using the CTP. The medically complex study patients were drawn from the department of Employee and Community Health population between October 14, 2011 and September 27, 2012. The primary outcomes were 30-day hospital readmission or ER visit after discharge from the hospital. The secondary outcomes were within-group changes in grip strength, gait speed, and quality of life (QOL). Patients underwent two study visits, one at baseline and one at 30 days postbaseline. The primary analysis included time-to-event from baseline to rehospitalization or ER visit. Paired t-tests were used for secondary outcomes, with continuous scores. Results Of the 40 patients enrolled, 36 completed all study visits. The 30-day hospital readmission rates for usual care patients were 10.5% compared with no readmissions for CTP patients. There were 31.6% ER visits in the UC group and 11.8% in the CTP group (P = 0.37). The secondary analysis showed some improvement in physical QOL scores (pre: 32.7; post: 39.4) for the CTP participants (P < 0.01) and no differences in gait speed or grip strength. Conclusion Based on this pilot study of care transition, we found nonsignificant lower hospital and ER utilization rates and improved physical QOL scores for patients in the CTP group. However, the data leads us to recommend future studies with larger sample sizes (N = 250).

Takahashi, Paul Y; Haas, Lindsey R; Quigg, Stephanie M; Croghan, Ivana T; Naessens, James M; Shah, Nilay D; Hanson, Gregory J

2013-01-01

377

Nursing home closures and quality of care.  

PubMed

The purpose of this research is to examine the relationship between quality of care in nursing homes and their likelihood of closure. We hypothesize that lower-quality facilities will be more likely to close than higher-quality facilities. Using the rates of physical restraint use, urethral catheterization, contractures, pressure ulcers, and psychotropic medication use as quality measures from approximately 12,000 facilities from 1992 to 1998, the author examine cross-sectional and change score relationships between these measures and a nursing home's likelihood of closure. The descriptive analysis shows that 621 nursing homes closed in this time period, and the results for physical restraint use were robust in their positive association with closures in most analyses lending some support for this study's hypothesis. However, overall, the author concludes that nursing facility closures are relatively rare events. And the likelihood of closure, even for poor-quality facilities, is low. PMID:15643031

Castle, Nicholas G

2005-02-01

378

The need for acute, subacute and nonacute care at 105 general hospital sites in Ontario  

Microsoft Academic Search

Background: Previous studies of hospital utilization have not taken into account the use of acute care beds for subacute care. The authors determined the proportion of patients who required acute, subacute and nonacute care on admission and during their hospital stay in general hospitals in Ontario. From this analysis, they identified areas where the efficiency of care delivery might be

Virginia F. Flintoft; J. Ivan Williams; Robert C. Williams; Antoni S. H. Basinski; Paula Blackstien-Hirsch; C. David Naylor

1998-01-01

379

The Relationship Between Nursing Home Residents' Perceptions of Nursing Staff and Quality of Nursing Home Care  

Microsoft Academic Search

The purpose of the study was to determine if nursing home patients' perception of nursing staff members were associated with quality of nursing home care. Three hospital professional staff members who were familiar with the homes in the study rated the LO homes on a 1 = excellent to 4 = poor quality. Patients (N = 239) admitted to the

Shayna Stein; Margaret W. Linn; Elliott M. Stein

1986-01-01

380

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

381

Managed Care Features Affecting Quality for Coronary Artery Disease (CAD).  

National Technical Information Service (NTIS)

Managed care profoundly changed medical care in the US, yet the impact of these changes on the quality of care remains unclear. The primary aim of this study was to determine the aspects of managed care that impact evidence-based quality of care markers a...

E. R. DeLong

2003-01-01

382

Pre-hospital care of pediatric patients with trauma  

PubMed Central

Prehospital pediatric care is an important component in the treatment of the injured child, as the prehospital responders are the first medical providers performing life saving and directed medical care. Traumatic injuries are the leading cause of morbidity and mortality in the pediatric patient population. Nevertheless, for most prehospital provider it is a rare event to treat pediatric trauma patients and there is a still existing gap between the quality of care for pediatric patients compared to adults. To improve pediatric prehospital trauma care more provider need to be trained in identifying the specific differences between adult and pediatric patients.

Seid, Terrence; Ramaiah, Ramesh; Grabinsky, Andreas

2012-01-01

383

Relationship between Number of Medical Conditions and Quality of Care  

Microsoft Academic Search

We assessed measurements of the quality of medical care received in three cohorts of community-dwelling adult patients in the Community Quality Index study, the Assessing Care of Vulnerable Elders study, and the Veterans Health Administration project (7680 patients in total). We analyzed the relationship between the quality of care that patients received, defined as the percentage of quality indicators satisfied

Takahiro Higashi; Neil S. Wenger; John L. Adams; Constance Fung; Martin Roland; Elizabeth A. McGlynn; David Reeves; Steven M. Asch; Eve A. Kerr; Paul G. Shekelle

2010-01-01

384

Approaches to Quality of Control in Diabetes Care  

Microsoft Academic Search

Management methods for quality of diabetes care need new approaches because of the poor metabolic control of most of these patients. Poor quality of care generally results from poor instruction and training rather than from misbehaviour of both patients and their families. Structure quality of care (who and where?), process quality (how?, which are the goals, what resolution is taken

F. Chiarelli; A. Verrotti; L. di Ricco; M. de Martino; G. Morgese

1998-01-01

385

Health care-associated infection and hospital readmission in a home care service for children.  

PubMed

The number of children in home health care services is increasing, and there is a need for infection control regulation in this environment. We describe the main causes of infection and hospitalization in children assisted by a pediatric home health care service in Rio de Janeiro, Brazil. PMID:21570739

Araujo da Silva, André Ricardo; de Souza, Cristina Vieira; Viana, Mario Eduardo; Sargentelli, Guilherme; de Andrada Serpa, Maria José; Gomes, Marisa Zenaide Ribeiro

2011-05-14

386

Facilitating transition from hospital stay to nursing home admission: a Hospital-Based Long-Term Care Ombudsman Program.  

PubMed

The Older Americans Act requires all states to establish Long-Term Care Ombudsman Programs in nursing homes as well as in personal care homes. However, the law does not specify that hospitals that have special beds to provide skilled nursing care need to have long-term care ombudsmen. Many of these hospital patients subsequently enter a nursing or personal care home. Therefore, it seems that there is a need for patient advocacy for transition from hospital stays to long-term care facility admission. The Hospital-Based Long-Term Care Ombudsman Program is described, and specific actions social workers can take to facilitate the establishment of the program in a hospital-based, long-term care unit are described. PMID:19830611

Cox, Carolyn; Bylina, Maureen; Krogmann, Emily; Krambeck, Hank

2009-11-01

387

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

2013-02-13

388

Length of hospital stay and contributing variables in supratentorial craniotomy patients with brain tumour: a pre-care map study.  

PubMed

The study included 70 patients admitted to Neurosurgical ICU (NICU) with the diagnosis of Supratentorial Craniotomy for Brain Tumour. These patients were followed throughout their hospitalization in NICU, to the ward and until discharge from hospital. The purposes of the study were (a) to indicated the NICU and floor length of stay (LOS) in this group of patients, prior to the use of care map and compare it to a developed care map, and (b) to identify the variables that contribute toe overall prolonged hospital LOS. The findings indicated that, prior to the use of care map, 68.8% of Supratentorial Craniotomy Patients with Brain Tumour had an ICU LOS of one day. However, only 38.6% of these patients were discharged from hospital within the care map indicated 5 day post ICU, floor LOS. The findings also showed that the overall hospital LOS, in 71.4% of the patients, was over 7 days, as indicated on the developed care cap. Several variables such as patient complications, consults, rehab/placement, patient falls and additional diagnostic tests contributed to the overall pronged hospital LOS. Thus, by monitoring these variables with the use of a care map, may produce measurements to evaluate cost effectiveness, and allow health care professionals to provide more effective and quality patient care. PMID:7857865

Sarkissian, S

1994-06-01

389

Hospital and community-based care for patients with chronic schizophrenia in Hong Kong  

Microsoft Academic Search

.   Background: There have been few studies on the impact of de-institutionalization on psychiatric patients' lives in Chinese culture. The\\u000a objectives of the present study were: (1) to compare quality of life (QOL) of Chinese patients with schizophrenia living in\\u000a three different treatment settings (hospital, long-stay care home and half-way house) in Hong Kong, and (2) to identify factors\\u000a associated

Grace W. L. Chan; Gabor S. Ungvari; Daniel T. L. Shek

2003-01-01

390

Patient satisfaction with nursing care in a regional university hospital in southern Spain.  

PubMed

Patient satisfaction is a valid indicator for measurement of service quality. Patients' opinions are important because dissatisfaction suggests opportunities for improvement. We evaluated the satisfaction of patients with nursing care in a regional university hospital in southern Spain and determined the relevant sociodemographic and attendance characteristics. A cross-sectional descriptive study was undertaken using the SERVQUAL questionnaire. Reliability and validity of the SERVQUAL instrument were established. The only interaction considered was gender and education level. Analysis of covariance showed that the only factors significantly associated with lower patient satisfaction were female gender, higher educational level, lower overall satisfaction with the hospital, and not knowing the name of the nurse. PMID:15686078

González-Valentín, Araceli; Padín-López, Susana; de Ramón-Garrido, Enrique

391

[Acute hospital care for the elderly in Italy: comparison between 2001 and 2006].  

PubMed

The continous health expenditure increase in developed countries is often related with the acute hospital care of the elderly. To monitor the characteristics of elderly acute hospital care included the expenditure trend is crucial in order to identify the appropriateness of this care. The aim of this study is to describe quality and quantity of in-hospital care use of elderly population in Italy in 2006 and to compare the results with the same information gathered for 1996 and 2001. All the 2006 acute hospital admission longer than one day of the patients older than 64 years sourced from the Register of Discharge Form of the Italian Ministry of Health have been analyzed. A list of the 30 more frequent diagnoses has been compiled and compared with the same list compiled for 2001. On the basis of the National Fee for each Disease Related Group an analysis of the hospital expenditure has been carried out. The correlation between DRGs National Fees and frequency of the diagnosis in the discharge form has been based on the 80 diagnosis that has been recorded for more than 10.000 discharge forms in 2006. A relevant increase of acute hospital admission for respiratory, cardiovascular and urinary pathologies among the elderly has been observed. Moreover the number of hospital admissions for major joints and implant of lower limbs is doubled from 1996. The total health expenditure for the elderly acute care longer than one day is increased of 6.3% and a positive correlation between higher DRGs fees and higher frequency of diagnosis has been observed (Pearson correlation value = 0.478; p<0.001 - cubic regression R-square value = 0.301; p<0.001). The hospital acute care use of the elderly patients seems to be more related to emergency care than in the past, while a decrease of DRGs related to chronic diseases and generic diagnosis has been observed. The more frequent cause of in-hospital admission seems to be related also to a higher DRGs fee. As already observed in the past years, a trend towards the use of more expensive DRGs could be detected. PMID:22403992

Liotta, G; Gilardi, F; Marazzi, M C; Mancinelli, S; Scarcella, P

392

Health care quality management by means of an incident report system and an electronic patient record system  

Microsoft Academic Search

Background: Quality management in health care services has not been as successful as in other industries. Objective: To assess the potential contribution of an on-line incident reporting system (OIRS) and of an electronic patient record (EPR) system to quality management in hospitals. Methods: The two approaches are being implemented in Osaka University Hospital. Results: Analysis of the early use of

Hiroshi Takeda; Yasushi Matsumura; Kazue Nakajima; Shigenori Kuwata; Yang Zhenjun; Ji Shanmai; Qiyan Zhang; Chen Yufen; Hideo Kusuoka; Michitoshi Inoue

2003-01-01

393

The quality of care for medicare patients with peptic ulcer disease  

Microsoft Academic Search

OBJECTIVE:The aim of this study was to examine quality of care for hospitalized Medicare beneficiaries with peptic ulcer disease.METHODS:Collaborating with five Peer Review Organizations, we used 1995 Medicare claim files to select samples of inpatients with a principal diagnosis of peptic ulcer disease. Quality of care indicators developed by content experts included percentages for ulcer patients tested for Helicobacter pylori

Joshua J Ofman; Jeff Etchason; William Alexander; Beth R Stevens; Jeph Herrin; Charles Cangialose; David J Ballard; Dale Bratzler; Kurtis S Elward; Dawn FitzGerald; Joan Culpepper-Morgan; Barry Marshall

2000-01-01

394

Poor Work Environments and Nurse Inexperience Are Associated with Burnout, Job Dissatisfaction, and Quality Deficits in Japanese Hospitals  

PubMed Central

Aims To describe nurse burnout, job dissatisfaction, and quality of care in Japanese hospitals, and to determine how these outcomes are associated with work environment factors. Background Nurse burnout and job dissatisfaction are associated with poor nurse retention and uneven quality of care in other countries but comprehensive data have been lacking on Japan. Design Cross-sectional survey of 5,956 staff nurses on 302 units in 19 acute hospitals in Japan. Methods Nurses provided information about years of experience, completed the Maslach Burnout Inventory, and reported on resource adequacy and working relations with doctors using the Nursing Work Index-Revised. Results 56% of nurses scored high on burnout, 60% were dissatisfied with their jobs, and 59% ranked quality of care as only fair or poor. About one-third had fewer than 4 years of experience, and more than two-thirds had less than 10. Only one in five nurses reported there were enough RNs to provide quality care and more than half reported that teamwork between nurses and physicians was lacking. The odds on high burnout, job dissatisfaction and poor-fair quality of care were twice as high in hospitals with 50% inexperienced nurses than with 20% inexperienced nurses, and 40% higher in hospitals where nurses had less satisfactory relations with physicians. Nurses in poorly staffed hospitals were 50% more likely to exhibit burnout, twice as likely to be dissatisfied, and 75% more likely to report poor or fair quality care than nurses in better staffed hospitals. Conclusions Improved nurse staffing and working relationships with physicians may reduce nurse burnout, job dissatisfaction, and low nurse-assessed quality of care. Relevance to clinical practice Staff nurses should engage supervisors and medical staff in discussions about retaining more experienced nurses at the bedside, implementing strategies to enhance clinical staffing, and identifying ways to improve nurse-physician working relations.

2008-01-01

395

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.

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

2006-01-01

396

Marketing the mental health care hospital: identification of communication factors.  

PubMed

The current study provides guidance to hospital administrators in their effort to develop more effective marketing communication strategies. Two types of communication factors are revealed: primary and secondary. Marketers of psychiatric hospitals may use the primary factors as basic issues for their communication campaign, while secondary factors may be used for segmentation or positioning purposes. The primary factors are open wards, special treatment for adolescents, temporary absence, while patient, in-patient care, and visitation management. The secondary factors are temporary absence while a patient, voluntary consent to admit oneself, visitation management, health insurance, open staff, accreditation, physical plant, and credentials of psychiatrists. PMID:10137171

Patzer, G L; Rawwas, M Y

1994-01-01

397

Syncope: experience at a tertiary care hospital in Karachi, Pakistan  

Microsoft Academic Search

Introduction  Our aim was to determine the characteristics of patients presenting with syncope at a tertiary care hospital in Karachi, Pakistan.\\u000a \\u000a \\u000a \\u000a Methods  A review of medical records was conducted retrospectively at the Department of Medicine, Aga Khan University Hospital, Karachi.\\u000a Patients aged 16 and above, admitted from January 2000 to December 2005 with the diagnosis of syncope made by the attending\\u000a physician

Muhammad Junaid Patel; Nadeem Ullah Khan; Abdul Jawwad Samdani; Muhammad Furqan; Aamir Hameed; Muhammad Shoaib Khan; Syed Imran Ayaz; Muhammad Omer Jamil

2008-01-01

398

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

399

Quality of care in humanitarian surgery.  

PubMed

Humanitarian surgical programs are set up de novo, within days or hours in emergency or disaster settings. In such circumstances, insuring quality of care is extremely challenging. Basic structural inputs such as a safe structure, electricity, clean water, a blood bank, sterilization equipment, a post-anesthesia recovery unit, appropriate medications should be established. Currently, no specific credentials are needed for surgeons to operate in a humanitarian setting; the training of more humanitarian surgeons is desperately needed. Standard perioperative protocols for the humanitarian setting after common procedures such as Cesarean section, burn care, open fractures, and amputations and antibiotic prophylaxis, and post-operative pain management must be developed. Outcome data, especially long-term outcomes, are difficult to collect as patients often do not return for follow-up and may be difficult to trace; standard databases for post-operative infections and mortality rates should be established. Checklists have recently received significant attention as an instrument to support the improvement of surgical quality; knowing which items are most applicable to humanitarian settings remains unknown. In conclusion, the quality of surgical services in humanitarian settings must be regulated. Many other core medical activities of humanitarian organizations such as therapeutic feeding, mass vaccination, and the treatment of infectious diseases, such as tuberculosis and human immunodeficiency virus, are subject to rigorous reporting of quality indicators. There is no reason why surgery should be exempted from quality oversight. The surgical humanitarian community should pull together before the next disaster strikes. PMID:21487849

Chu, Kathryn M; Trelles, Miguel; Ford, Nathan P

2011-06-01

400

Composite measures for rating hospital quality with major surgery  

PubMed Central

Objective To assess the value of a novel composite measure for identifying the best hospitals for major procedures. Data Source We used national Medicare data for patients undergoing 5 high risk surgical procedures between 2005 and 2008. Study Design For each procedure, we used empirical Bayes techniques to create a composite measure combining hospital volume, risk-adjusted mortality with the procedure of interest, risk-adjusted mortality with other related procedures, and other variables. Hospitals were ranked based on 2005–06 data and placed in one of 3 groups: 1-star (bottom 20%), 2-star (middle 60%), and 3-star (top 20%). We assessed how well these ratings forecasted risk-adjusted mortality rates in the next two years (2007–08), compared to other measures. Principal Findings For all 5 procedures, the composite measures based on 2005–06 data performed well in predicting future hospital performance. Compared to 1-star hospitals, risk-adjusted mortality was much lower at 3-star hospitals for esophagectomy (6.7% vs. 14.4%), pancreatectomy (4.7% vs. 9.2%), coronary artery bypass surgery (2.6% vs. 5.0%), aortic valve replacement (4.5% vs. 8.5%), and percutaneous coronary interventions (2.4% vs. 4.1%). Compared to individual surgical quality measures, the composite measures were better at forecasting future risk-adjusted mortality. These measures also outperformed the Center for Medicare and Medicaid Services (CMS) Hospital Compare ratings. Conclusion Composite measures of surgical quality are very effective at predicting hospital mortality rates with major procedures. Such measures would be more informative than existing quality indicators in helping patients and payers identify high quality hospitals with specific procedures.

Dimick, Justin B.; Staiger, Douglas O.; Osborne, Nicholas H.; Nicholas, Lauren H.; Birkmeyer, John D.

2012-01-01

401

Hospital swing-bed care in the United States.  

PubMed Central

As a result of federal legislation implemented in 1982, hospital beds that are used to provide both long-term care and acute care are now proliferating rapidly throughout the country. Termed swing beds, such beds are currently restricted to rural areas. However, due largely to the impacts of Medicare DRG reimbursement, pressure is mounting to expand the swing-bed approach to urban settings. Swing beds appear to fill a significant gap between the relatively intense medical needs of post-acute care patients (now discharged earlier) and the capacity of our current nursing home delivery system to meet such needs. The evolution of swing beds is marked by an unusual blend of experimentation, scientific investigation, and public policy response to community and personal health care needs. This article summarizes that evolution, highlighting research findings and key policy developments. It concludes with the current status of the national swing-bed program and issues pertinent to future directions.

Shaughnessy, P W; Schlenker, R E

1986-01-01

402

Examining Quality Improvement Programs: The Case of Minnesota Hospitals  

PubMed Central

Objective To determine if there is a hierarchy of improvement program adoption by hospitals and outline that hierarchy. Data Sources Primary data were collected in the spring of 2007 via e-survey from 210 individuals representing 109 Minnesota hospitals. Secondary data from 2006 were assembled from the Leapfrog database. Study Design As part of a larger survey, respondents were given a list of improvement programs and asked to identify those programs that are used in their hospital. Data Collection/Data Extraction Rasch Model Analysis was used to assess whether a unidimensional construct exists that defines a hospital's ability to implement performance improvement programs. Linear regression analysis was used to assess the relationship of the Rasch ability scores with Leapfrog Safe Practices Scores to validate the research findings. Principal Findings The results of the study show that hospitals have widely varying abilities in implementing improvement programs. In addition, improvement programs present differing levels of difficulty for hospitals trying to implement them. Our findings also indicate that the ability to adopt improvement programs is important to the overall performance of hospitals. Conclusions There is a hierarchy of improvement programs in the health care context. A hospital's ability to successfully adopt improvement programs is a function of its existing capabilities. As a hospital's capability increases, the ability to successfully implement higher level programs also increases.

Olson, John R; Belohlav, James A; Cook, Lori S; Hays, Julie M

2008-01-01

403

The long term importance of English primary care groups for integration in primary health care and deinstitutionalisation of hospital care  

PubMed Central

Abstract Purpose This article reviews the impact of successive experiments in the development of primary care organisations in England and assesses the long-term importance of English primary care groups for the integration of health and community and health and social care and the deinstitutionalisation of hospital care. Theory Governments in a number of Western countries are attempting to improve the efficiency, appropriateness and equity of their health systems. One of the main ways of doing this is to devolve provision and commissioning responsibility from national and regional organisations to more local agencies based in primary care. Such primary care organisations are allocated budgets that span both primary and secondary (hospital) services and also, potentially, social care. Method This article is based on a systematic review of the literature forthcoming from the UK Government's Department of Health-funded evaluations of successive primary care organisational developments. These include total purchasing pilots, GP commissioning group pilots, personal medical services pilots and primary care groups and trusts. Results Primary care organisations in England have proved to be a catalyst in facilitating the development of integrated care working between primary and community health services. Conversely, primary care organisations have proved less effective in promoting integration between health and social care agencies where most progress has been made at the strategic commissioning level. The development of primary care trusts in England is heralding an end to traditional community hospitals. Conclusions The development of primary care groups in England are but an intermediate step of a policy progression towards future primary care-based organisations that will functionally integrate primary and community health services with local authority services under a single management umbrella.

Goodwin, Nick

2001-01-01

404

Assessment of foodservice quality and identification of improvement strategies using hospital foodservice quality model  

PubMed Central

The purposes of this study were to assess hospital foodservice quality and to identify causes of quality problems and improvement strategies. Based on the review of literature, hospital foodservice quality was defined and the Hospital Foodservice Quality model was presented. The study was conducted in two steps. In Step 1, nutritional standards specified on diet manuals and nutrients of planned menus, served meals, and consumed meals for regular, diabetic, and low-sodium diets were assessed in three general hospitals. Quality problems were found in all three hospitals since patients consumed less than their nutritional requirements. Considering the effects of four gaps in the Hospital Foodservice Quality model, Gaps 3 and 4 were selected as critical control points (CCPs) for hospital foodservice quality management. In Step 2, the causes of the gaps and improvement strategies at CCPs were labeled as "quality hazards" and "corrective actions", respectively and were identified using a case study. At Gap 3, inaccurate forecasting and a lack of control during production were identified as quality hazards and corrective actions proposed were establishing an accurate forecasting system, improving standardized recipes, emphasizing the use of standardized recipes, and conducting employee training. At Gap 4, quality hazards were menus of low preferences, inconsistency of menu quality, a lack of menu variety, improper food temperatures, and patients' lack of understanding of their nutritional requirements. To reduce Gap 4, the dietary departments should conduct patient surveys on menu preferences on a regular basis, develop new menus, especially for therapeutic diets, maintain food temperatures during distribution, provide more choices, conduct meal rounds, and provide nutrition education and counseling. The Hospital Foodservice Quality Model was a useful tool for identifying causes of the foodservice quality problems and improvement strategies from a holistic point of view.

Kim, Kyungjoo; Kim, Minyoung

2010-01-01

405

National Hospital Ambulatory Medical Care Survey, 1996 (on CD-ROM with Search and Retrieval Software).  

National Technical Information Service (NTIS)

The National Hospital Ambulatory Medical Care Survey (NHAMCS) provides data on ambulatory medical care rendered in hospital emergency and outpatient departments (EDs and OPDs). The NHAMCS is a nationally probability sample survey of visits to the emergenc...

1998-01-01

406

Effective Managerial Control of Acute Care Hospitals Under the Phase IV Regulations.  

National Technical Information Service (NTIS)

An approach to management planning and control functions of acute care hospitals is outlined that can enchance effective operations under the Phase IV health care regulations of the Economic Stabilization Program. Two major components of normal hospital o...

J. D. Twiname

1974-01-01

407

[Chlamydial infection: quality of medical care].  

PubMed

The analysis of case histories of patients with chlamydial infection has detected some typical errors in management of patients: the absence of topical diagnosis, choice of antibacterial drugs and treatment duration do not satisfy standard recommendations both in uncomplicated and complicated disease. A standard approach to management of patients with Chlamydia infection will help to avoid situations when experts conclude on inadequate quality of medical care delivered by medical professionals. PMID:21815460

Ignatovski?, A V; Sokolovski?, E V

408

Quality of Care in Humanitarian Surgery  

Microsoft Academic Search

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

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

2011-01-01

409

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

410

Automated Quality of Care Evaluation Support System (AQCESS) Distribution Kit.  

National Technical Information Service (NTIS)

The Automated Quality of Care Evaluation Support System (AQCESS) is a microcomputer based, integrated, terminal oriented, interactive, on-line computer system designed to support Patient Administration, Clinical Records and Quality of Care Evaluation func...

M. D. Rodman

1987-01-01

411

Assessment of Quality of Emergency Care: Final Report.  

National Technical Information Service (NTIS)

The Emergency Care Project, in response to increasing public pressure for development and institution of systems for assessments and assurance of quality of health care, was designed to try to develop an operational system for evaluating the quality of me...

B. S. Linn

1978-01-01

412

Small Numbers Limit the Use of the Inpatient Pediatric Quality Indicators for Hospital Comparison  

PubMed Central

Objective To determine the percentage of hospitals with adequate sample size to meaningfully compare performance using the Agency for Healthcare Research and Quality (AHRQ) pediatric inpatient quality indicators (PDIs), which measure pediatric inpatient adverse events such as decubitus ulcer rate and infections due to medical care, have been nationally endorsed, and are currently publicly reported in at least two states. Methods We performed a cross-sectional analysis of California hospital discharges from 2005–2007 for patients <18 years old. For nine hospital-level PDIs, after excluding discharges with PDIs indicated as present on admission, we determined for each PDI: the volume of eligible pediatric patients for each measure at each hospital, the statewide mean rate, and the percent of hospitals with adequate volume to identify an adverse event rate twice the statewide mean. Results Unadjusted California-wide event rates for PDIs during the study period (N=2,333,556 discharges) were 0.2-38/1000 discharges. Event rates for specific measures were, for example, 0.2/1000 (iatrogenic pneumothorax in non-neonates), 19/1000 (post-operative sepsis) and 38/1000 (pediatric heart surgery mortality), requiring patient volumes of 49,869, 419, and 201 to detect an event rate twice the statewide average; 0%, 6.6%, and 25% of California hospitals had this pediatric volume, respectively. Conclusion Using these AHRQ-developed, nationally-endorsed measures of the quality of inpatient pediatric care, one would not be able to identify many hospitals with performance two times worse than the statewide average due to extremely low event rates and inadequate pediatric hospital volume.

Bardach, Naomi S.; Chien, Alyna T.; Dudley, R. Adams

2010-01-01

413

Experiences with Hospital Care: Perspectives of Black and Hispanic Patients  

Microsoft Academic Search

BACKGROUND  Significant racial and ethnic differences along several dimensions of patients’experiences with hospital care have been previously\\u000a documented. However, the relationship between these differences and possible differences in processes of care has not been\\u000a well described.\\u000a \\u000a \\u000a \\u000a METHODS  We conducted focus groups with 37 black and Hispanic men and women who had recently been discharged from either medical or\\u000a obstetrical services at an

LeRoi S. Hicks; Dora A. Tovar; E. John Orav; Paula A. Johnson

2008-01-01

414

Are pediatric quality care measures too stringent?  

PubMed Central

Introduction We aimed (1) to demonstrate the application of national pediatric quality measures derived from claims-based data, for use with Electronic Medical Record (EMR) data, and (2) to determine the extent to which rates differ if specifications were modified to allow for flexibility in measuring receipt of care. Methods We reviewed EMR data for all patients up to 15 years with?1 office visit to a safety net family medicine clinic in 2010 (n=1,544). We assessed rates of appropriate well-child visits (WCVs), immunizations, and body mass index (BMI) documentation, defined strictly by national guidelines versus by guidelines with clinically relevant modifications. Results Among children <3 years, 52.4% attended ?6 WCVs by 15 months; 60.8% had ?6 visits by 2 years. Less than 10% completed 10 vaccination series before their 2nd birthday; with modifications, 36% were up-to-date. Among children aged 3-15 years, 63% had a BMI percentile recorded; 91% had BMI recorded within 36 months of the measurement year. Discussion Applying relevant modifications to national quality measure definitions captured a substantial number of additional services. Strict adherence to measure definitions might miss the true quality of care provided, especially in populations who may have sporadic patterns of care utilization.

Casciato, Allison; Angier, Heather; Milano, Christina; Gideonse, Nicholas; Gold, Rachel; DeVoe, Jennifer

2012-01-01

415

[The characteristics of medical technologies in emergency medical care hospital].  

PubMed

The article analyzes the implementation of major 12 diagnostic and 17 treatment technologies applied during medical care of patients with 12 key nosology forms of diseases in departments of the emergency medical care hospital No 2 of Omsk. It is established that key groups of technologies in the implementation of diagnostic process are the laboratory clinical diagnostic analyses and common diagnostic activities at reception into hospital and corresponding departments. The percentage of this kind of activities is about 78.3% of all diagnostic technologies. During the realization of treatment process the priority technologies are common curative and rehabilitation activities, intensive therapy activities and clinical diagnostic monitoring activities. All of them consist 80.1% of all curative technologies. PMID:23808039

Murakhovski?, A G; Babenko, A I; Bravve, Iu I; Tataurova, E A

416

The implementation of quality management systems in hospitals: a comparison between three countries  

PubMed Central

Background Is the implementation of Quality Management (QM) in health care proceeding satisfactorily and can national health care policies influence the implementation process? Policymakers and researchers in a country need to know the answer to this question. Cross country comparisons can reveal whether sufficient progress is being made and how this can be stimulated. The objective of the study was to investigate agreement and disparities in the implementation of QMS between The Netherlands, Hungary and Finland with respect to the evaluation model used and the national policy strategy of the three countries. Methods The study has a cross sectional design, based on measurements in 2000. Empirical data about QM-activities in hospitals were gathered by a self-administered questionnaire. The questionnaires were answered by the directors of the hospitals or the quality coordinators. The analyses are based on data from 101 hospitals in the Netherlands, 116 hospitals in Hungary and 59 hospitals in Finland. Outcome measures are the developmental stage of the Quality Management System (QMS), the development within five focal areas, and distinct QM-activities which were listed in the questionnaire. Results A mean of 22 QM-activities per hospital was found in the Netherlands and Finland versus 20 QM-activities in Hungarian hospitals. Only a small number of hospitals has already implemented a QMS (4% in The Netherlands,0% in Hungary and 3% in Finland). More hospitals in the Netherlands are concentrating on quality documents, whereas Finnish hospitals are concentrating on training in QM and guidelines. Cyclic quality improvement activities have been developed in the three countries, but in most hospitals the results were not used for improvements. All three countries pay hardly any attention to patient participation. Conclusion The study demonstrates that the implementation of QM-activities can be measured at national level and that differences between countries can be assessed. The hypothesis that governmental legislation or financial reimbursement can stimulate the implementation of QM-activities, more than voluntary recommendations, could not be confirmed. However, the results show that specific obligations can stimulate the implementation of QM-activities more than general, framework legislation.

Wagner, C; Gulacsi, L; Takacs, E; Outinen, M

2006-01-01

417

Disparities in Health Care Quality among Minority Women  

MedlinePLUS

... 3-EF Go to Online Store Disparities in Health Care Quality Among Minority Women Selected Findings From the ... race and ethnicity are combined. Return to Contents Health Care Delivery and Systems Information about health care delivery ...

418

The spiritual needs and resources of hospitalized primary care patients.  

PubMed

Previous studies have recognized the importance of hospitalized primary care patients' spiritual issues and needs. The sources patients consult to address these spiritual issues, including the role of their attending physician, have been largely unstudied. We sought to study patients' internal and external resources for addressing spiritual questions, while also exploring the physician's role in providing spiritual care. Our multicenter observational study evaluated 326 inpatients admitted to primary care physicians in four midwestern hospitals. We assessed how frequently these patients identified spiritual concerns during their hospitalization, the manner in which spiritual questions were addressed, patients' desires for spiritual interaction, and patient outcome measures associated with spiritual care. Nearly 30% of respondents (referred to as "R/S respondents") reported religious struggle or spiritual issues associated specifically with their hospitalization. Eight-three percent utilized internal religious coping for dealing with spiritual issues. Chaplains, clergy, or church members visited 54% of R/S respondents; 94% found those visits helpful. Family provided spiritual support to 45% of R/S respondents. Eight percent of R/S respondents desired, but only one patient actually received, spiritual interaction with their physician, even though 64% of these patients' physicians agreed that doctors should address spiritual issues with their patients. We conclude that inpatients quite commonly utilize internal resources and quite rarely utilize physicians for addressing their spiritual issues. Spiritual caregiving is well received and is primarily accomplished by professionals, dedicated laypersons, or family members. A significantly higher percentage of R/S patients desire spiritual interaction with their physician than those who actually receive it. PMID:22311475

Ellis, Mark R; Thomlinson, Paul; Gemmill, Clay; Harris, William

2013-12-01

419

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

PubMed Central

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

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

2013-01-01

420

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

421

Health care expenditure for hospital-based delivery care in Lao PDR  

PubMed Central

Background Delivery by a skilled birth attendant (SBA) in a hospital is advocated to improve maternal health; however, hospital expenses for delivery care services are a concern for women and their families, particularly for women who pay out-of-pocket. Although health insurance is now implemented in Lao PDR, it is not universal throughout the country. The objectives of this study are to estimate the total health care expenses for vaginal delivery and caesarean section, to determine the association between health insurance and family income with health care expenditure and assess the effect of health insurance from the perspectives of the women and the skilled birth attendants (SBAs) in Lao PDR. Methods A cross-sectional study was carried out in two provincial hospitals in Lao PDR, from June to October 2010. Face to face interviews of 581 women who gave birth in hospital and 27 SBAs was carried out. Both medical and non-medical expenses were considered. A linear regression model was used to assess influencing factors on health care expenditure and trends of medical and non-medical expenditure by monthly family income stratified by mode of delivery were assessed. Results Of 581 women, 25% had health care insurance. Health care expenses for delivery care services were significantly higher for caesarean section (270 USD) than for vaginal delivery (59 USD). After adjusting for the effect of hospital, family income was significantly associated with all types of expenditure in caesarean section, while it was associated with non-medical and total expenditures in vaginal delivery. Both delivering women and health providers thought that health insurance increased the utilisation of delivery care. Conclusions Substantially higher delivery care expenses wer