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Sample records for administration va hospitals

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

    ERIC Educational Resources Information Center

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

    2009-01-01

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

  2. FACILITIES FOR EDUCATION IN VA HOSPITALS. FINAL REPORT.

    ERIC Educational Resources Information Center

    GREEN, ALAN C.; AND OTHERS

    THIS STUDY WAS AUTHORIZED BY THE VA DEPARTMENT OF MEDICINE AND SURGERY FOR THE PURPOSE OF IDENTIFYING AND DETERMINING THE FACILITIES NEEDED TO PROPERLY HOUSE AND SUPPORT EDUCATION ACTIVITIES IN EXISTING AND FUTURE VA HOSPITALS AND TO PRODUCE ARCHITECTURAL GUIDANCE IN THE DESIGN OF THE FACILITIES. CURRENT PRACTICES AND SIGNIFICANT TRENDS IN MEDICAL…

  3. Hospital Library Administration.

    ERIC Educational Resources Information Center

    Cramer, Anne

    The objectives of a hospital are to improve patient care, while the objectives of a hospital library are to improve services to the staff which will support their efforts. This handbook dealing with hospital administration is designed to aid the librarian in either implementing a hospital library, or improving services in an existing medical…

  4. Classification of hospitals based on measured output: the VA system.

    PubMed

    Thomas, J W; Berki, S E; Wyszewianski, L; Ashcraft, M L

    1983-07-01

    Evaluation of hospital performance and improvement of resource allocation in hospital systems require a method for classifying hospitals on the basis of their output. Previous approaches to hospital classification relied largely on input characteristics. The authors propose and apply a procedure for classifying hospitals into groups where within-group hospitals are similar with respect to output. Direct measures of case-mix-adjusted discharges and outpatient visits are the principal measures of patient care output; other measures capture training and research functions. The component measures were weighted, and a composite output measure was calculated for each of the 162 hospitals in the Veterans Administration health care system. The output score then was used as the dependent variable in an Automatic Interaction Detector analysis, which partitioned the 162 hospitals into 10 groups, accounting for 85 per cent of the variance in the dependent variable. An extension of the output classification method is presented for illustration of how the difference between hospitals' actual operating costs and costs predicted on the basis of output can be used in defining isoefficiency groups. PMID:6350744

  5. The VA-Medical School Partnership: The Medical School Perspective.

    ERIC Educational Resources Information Center

    Petersdorf, Robert G.

    1987-01-01

    Issues in the relationship between the Veterans' Administration (VA) and medical schools are discussed, including VA faculty recruitment and retention, ambulatory care in VA teaching hospitals, governance and growth of research within VA medical centers, and effects of cost containment and competition on teaching and training in VA hospitals. (MSE)

  6. Identifying Homelessness among Veterans Using VA Administrative Data: Opportunities to Expand Detection Criteria.

    PubMed

    Peterson, Rachel; Gundlapalli, Adi V; Metraux, Stephen; Carter, Marjorie E; Palmer, Miland; Redd, Andrew; Samore, Matthew H; Fargo, Jamison D

    2015-01-01

    Researchers at the U.S. Department of Veterans Affairs (VA) have used administrative criteria to identify homelessness among U.S. Veterans. Our objective was to explore the use of these codes in VA health care facilities. We examined VA health records (2002-2012) of Veterans recently separated from the military and identified as homeless using VA conventional identification criteria (ICD-9-CM code V60.0, VA specific codes for homeless services), plus closely allied V60 codes indicating housing instability. Logistic regression analyses examined differences between Veterans who received these codes. Health care services and co-morbidities were analyzed in the 90 days post-identification of homelessness. VA conventional criteria identified 21,021 homeless Veterans from Operations Enduring Freedom, Iraqi Freedom, and New Dawn (rate 2.5%). Adding allied V60 codes increased that to 31,260 (rate 3.3%). While certain demographic differences were noted, Veterans identified as homeless using conventional or allied codes were similar with regards to utilization of homeless, mental health, and substance abuse services, as well as co-morbidities. Differences were noted in the pattern of usage of homelessness-related diagnostic codes in VA facilities nation-wide. Creating an official VA case definition for homelessness, which would include additional ICD-9-CM and other administrative codes for VA homeless services, would likely allow improved identification of homeless and at-risk Veterans. This also presents an opportunity for encouraging uniformity in applying these codes in VA facilities nationwide as well as in other large health care organizations.

  7. Relationship of hospital organizational culture to patient safety climate in the Veterans Health Administration.

    PubMed

    Hartmann, Christine W; Meterko, Mark; Rosen, Amy K; Shibei Zhao; Shokeen, Priti; Singer, Sara; Gaba, David M

    2009-06-01

    Improving safety climate could enhance patient safety, yet little evidence exists regarding the relationship between hospital characteristics and safety climate. This study assessed the relationship between hospitals' organizational culture and safety climate in Veterans Health Administration (VA) hospitals nationally. Data were collected from a sample of employees in a stratified random sample of 30 VA hospitals over a 6-month period (response rate = 50%; n = 4,625). The Patient Safety Climate in Healthcare Organizations (PSCHO) and the Zammuto and Krakower surveys were used to measure safety climate and organizational culture, respectively. Higher levels of safety climate were significantly associated with higher levels of group and entrepreneurial cultures, while lower levels of safety climate were associated with higher levels of hierarchical culture. Hospitals could use these results to design specific interventions aimed at improving safety climate.

  8. Exploring the link between ambulatory care and avoidable hospitalizations at the Veteran Health Administration.

    PubMed

    Pracht, Etienne E; Bass, Elizabeth

    2011-01-01

    This paper explores the link between utilization of ambulatory care and the likelihood of rehospitalization for an avoidable reason in veterans served by the Veteran Health Administration (VA). The analysis used administrative data containing healthcare utilization and patient characteristics stored at the national VA data warehouse, the Corporate Franchise Data Center. The study sample consisted of 284 veterans residing in Florida who had been hospitalized at least once for an avoidable reason. A bivariate probit model with instrumental variables was used to estimate the probability of rehospitalization. Veterans who had at least 1 ambulatory care visit per month experienced a significant reduction in the probability of rehospitalization for the same avoidable hospitalization condition. The findings suggest that ambulatory care can serve as an important substitute for more expensive hospitalization for the conditions characterized as avoidable.

  9. The Impact of VA and Navy Hospital Collaboration on Medical School Education

    ERIC Educational Resources Information Center

    Atre-Vaidya, Nutan; Ross, Arthur, III; Sandu, Ioana C.; Hassan, Tariq

    2009-01-01

    Objective: The U.S. Department of Veterans Affairs (VA) is the largest single provider of medical education in the United States and is often the preferred training site for medical students and residents. However, changing priorities of patients and the marketplace are forcing medical schools and the VA to consider new ways of practicing medicine…

  10. Maximising the value of hospital administrative datasets.

    PubMed

    Nadathur, Shyamala G

    2010-05-01

    Mandatory and standardised administrative data collections are prevalent in the largely public-funded acute sector. In these systems the data collections are used for financial, performance monitoring and reporting purposes. This paper comments on the infrastructure and standards that have been established to support data collection activities, audit and feedback. The routine, local and research uses of these datasets are described using examples from Australian and international literature. The advantages of hospital administrative datasets and opportunities for improvement are discussed under the following headings: accessibility, standardisation, coverage, completeness, cost of obtaining clinical data, recorded Diagnostic Related Groups and International Classification of Diseases codes, linkage and connectivity. In an era of diminishing resources better utilisation of these datasets should be encouraged. Increased study and scrutiny will enhance transparency and help identify issues in the collections. As electronic information systems are increasingly embraced, administrative data collections need to be managed as valuable assets and powerful operational and patient management tools.

  11. 38 CFR 3.1706 - Burial allowance for a veteran who died while hospitalized by VA.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... within a State, or to the border limits of the United States. (2) VA may pay the plot or interment allowance for burial in a veterans cemetery under § 3.1707, Plot or interment allowance. (Authority: 38...

  12. [Psychological wellbeing in the hospital administrative personnel].

    PubMed

    Tabolli, S; di Pietro, C; Luigi Aparo, U; Renzi, C

    2010-01-01

    Job satisfaction and psychological well being of health care workers significantly influence the quality of care. The aim of this study was to evaluate job satisfaction and psychological well-being in the administrative personnel of a large hospital in Rome-Italy. The personnel self-completed two anonymous questionnaires: the General Health Questionnaire (GHQ-12) for minor psychiatric non psychotic diseases and a validated job satisfaction questionnaire. Descriptive analysis and multiple logistic regression analysis were performed. Response rate was 65%. 74 were the questionnaires analyzed. 37.8% of respondents showed a high likelihood to develop symptoms of depression/anxiety (OR = 3.57; 95% CI 1.17-10.85). Major determinants of job dissatisfaction were the lower autonomy and poor communication in the working Unit. Factors associated with overall dissatisfaction were: insufficient training opportunities (p = 0.033), low autonomy (p = 0.023), poor communication between hospital Units (p = 0.009), unclear aims of their working Unit (p = 0.029), low agreement between personal expectations and required competence (p < 0.001). Among administrative staff job dissatisfaction was associated with high likelihood of depression/anxiety, low autonomy and poor communication, independently of sex, age, years of employment. Possible targets to improve satisfaction of administrative personnel were identified. PMID:20476655

  13. Validating physician-certified verbal autopsy and probabilistic modeling (InterVA) approaches to verbal autopsy interpretation using hospital causes of adult deaths

    PubMed Central

    2011-01-01

    Background The most common method for determining cause of death is certification by physicians based either on available medical records, or where such data are not available, through verbal autopsy (VA). The physician-certification approach is costly and inconvenient; however, recent work shows the potential of a computer-based probabilistic model (InterVA) to interpret verbal autopsy data in a more convenient, consistent, and rapid way. In this study we validate separately both physician-certified verbal autopsy (PCVA) and the InterVA probabilistic model against hospital cause of death (HCOD) in adults dying in a district hospital on the coast of Kenya. Methods Between March 2007 and June 2010, VA interviews were conducted for 145 adult deaths that occurred at Kilifi District Hospital. The VA data were reviewed by a physician and the cause of death established. A range of indicators (including age, gender, physical signs and symptoms, pregnancy status, medical history, and the circumstances of death) from the VA forms were included in the InterVA for interpretation. Cause-specific mortality fractions (CSMF), Cohen's kappa (κ) statistic, receiver operating characteristic (ROC) curves, sensitivity, specificity, and positive predictive values were applied to compare agreement between PCVA, InterVA, and HCOD. Results HCOD, InterVA, and PCVA yielded the same top five underlying causes of adult deaths. The InterVA overestimated tuberculosis as a cause of death compared to the HCOD. On the other hand, PCVA overestimated diabetes. Overall, CSMF for the five major cause groups by the InterVA, PCVA, and HCOD were 70%, 65%, and 60%, respectively. PCVA versus HCOD yielded a higher kappa value (κ = 0.52, 95% confidence interval [CI]: 0.48, 0.54) than the InterVA versus HCOD which yielded a kappa (κ) value of 0.32 (95% CI: 0.30, 0.38). Overall, (κ) agreement across the three methods was 0.41 (95% CI: 0.37, 0.48). The areas under the ROC curves were 0.82 for InterVA and 0

  14. 48 CFR 819.602-3 - Resolving differences between VA and the Small Business Administration.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... of Competency and Determinations of Responsibility 819.602-3 Resolving differences between VA and the... of correspondence sent to the SBA seeking a certificate of competency determination must be concurrently provided to the Director, OSDBU. Before appealing a certificate of competency, the HCA must...

  15. Marketing orientation: how do hospital administrators compare with marketing managers?

    PubMed

    Bartlett, P J; Schewe, C D; Allen, C T

    1984-01-01

    A recent study shows that the marketing orientation of hospital administrators is similar to that of marketing practitioners but that hospital administrators have an underdeveloped sense of market segmentation and market aggressiveness regarding their patients and physicians. Studies such as this one can be helpful in applying marketing techniques to today's hospitals.

  16. Graduate Education for Hospital Administration in the United States: Trends.

    ERIC Educational Resources Information Center

    Chester, Theodore E.

    In 1968, 75% of the 5,466 graduates of hospital administration were in management positions in hospitals and related institutions, and about 1,000 to 1,500 held key government jobs. The US needs approximately 40,000 trained hospital administrators, but the total graduate output is about one-eighth of that amount. Of the 23 existing programs, 8 are…

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

    PubMed

    West, T D

    1998-01-01

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

  18. A hospital as victim and responder: the Sepulveda VA Medical Center and the Northridge earthquake.

    PubMed

    Chavez, C W; Binder, B

    1996-01-01

    Many hospital emergency plans focus on the hospital as a disaster responder, with a fully operational medical facility, able to receive and treat mass casualties from a clearly defined accident scene. However, hospitals need to prepare a response for extreme casualty events such as earthquakes, tornadoes, or hurricanes. This article describes the planning, mitigation, response, and recovery of a major medical--surgical center thrust into a victim responder role following the devastating Northridge earthquake. The subsequent evacuation and care of patients, treatment of casualties, incident command, prior education and training, and recovery issues are addressed.

  19. 38 CFR 17.52 - Hospital care and medical services in non-VA facilities.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... World War I or who is in receipt of increased pension or additional compensation based on the need for... life or health of a veteran which developed during authorized travel to the hospital, or...

  20. 38 CFR 17.52 - Hospital care and medical services in non-VA facilities.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... World War I or who is in receipt of increased pension or additional compensation based on the need for...) Hospital care or medical services to a veteran for the treatment of— (i) A service-connected disability; or.... 19012, Pub. L. 99-272) (2) Medical services for the treatment of any disability of— (i) A veteran...

  1. Fitzsimons General Hospital, Women's Army Corps Recreation & Administration Building, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Fitzsimons General Hospital, Women's Army Corps Recreation & Administration Building, North Hickey Street, west side, 75 feet north of intersection of West Pennington Avenue & North Hickey Street, Aurora, Adams County, CO

  2. 78 FR 8329 - Federal Housing Administration (FHA): Hospital Mortgage Insurance Program-Refinancing Hospital Loans

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-05

    .... On January 29, 2010 (at 75 FR 4964), HUD published a proposed rule to commence the process to provide... Administration (FHA): Hospital Mortgage Insurance Program--Refinancing Hospital Loans; Final Rule #0;#0;Federal... HOUSING AND URBAN DEVELOPMENT 24 CFR Part 242 RIN 2502-AI74 Federal Housing Administration (FHA):...

  3. Hospital administrators in a market environment: the case of Utah.

    PubMed

    Dwore, R B; Murray, B P

    1987-11-01

    This study describes selected characteristics of hospital administrators in Utah, who are implementing a market strategy of cost containment. A mail survey was used to query hospital administrators concerning their personal backgrounds, professional practice patterns, and perceived role performance. The questionnaire elicited a 75.6 percent return from a limited universe sample. Analytical results disclose that Utah hospital administrators are relatively young, professionally dynamic, well educated, and subject to frequent career-motivated moves. Using Mintzberg's ten administrative roles, respondents identified two as key: "Leader" ranks as the role performed best, the role second most critical to survival, second best prepared for, second most time-consuming, and second most satisfying. "Entrepreneur" ranks as the role most critical to survival, most satisfying, most deserving of improvement, second least prepared for, and second best performed. Suggestions for innovative ways in which administrators can develop their skills to be better prepared to meet future challenges are listed.

  4. Introduction of Ambulatory Medical Training in a Veterans Administration Hospital.

    ERIC Educational Resources Information Center

    Casciato, Dennis A.

    1979-01-01

    The implementation of a continuity of a care clinic in a highly subspecialized Veterans Administration internal medicine training program for postgraduate medical students is described, with focus on resolving problems created by the idiosyncratic administrative features and resource limitations of the hospital. (Author/JMD)

  5. VA and HRS Local Coordination of Florida's Home-Based Services to the Elderly.

    ERIC Educational Resources Information Center

    Bradham, Douglas D.; Chico, Innette Mary

    Florida's District 12 Veterans Administration (VA) wanted to deliver medical case-management services to veterans not receiving home-based services due to the geographic restrictions of the VA's Hospital-Based Home Care Program. The Florida Department of Health and Rehabilitative Services (HRS) desired to demonstrate the effectiveness of nurse…

  6. Hospital administrator's perspectives regarding the health care industry.

    PubMed

    McDermott, D R; Little, M W

    1988-01-01

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

  7. Nurses' medication administration practices at two Singaporean acute care hospitals.

    PubMed

    Choo, Janet; Johnston, Linda; Manias, Elizabeth

    2013-03-01

    This study examined registered nurses' overall compliance with accepted medication administration procedures, and explored the distractions they faced during medication administration at two acute care hospitals in Singapore. A total of 140 registered nurses, 70 from each hospital, participated in the study. At both hospitals, nurses were distracted by personnel, such as physicians, radiographers, patients not under their care, and telephone calls, during medication rounds. Deviations from accepted medication procedures were observed. At one hospital, the use of a vest during medication administration alone was not effective in avoiding distractions during medication administration. Environmental factors and distractions can impact on the safe administration of medications, because they not only impair nurses' level of concentration, but also add to their work pressure. Attention should be placed on eliminating distractions through the use of appropriate strategies. Strategies that could be considered include the conduct of education sessions with health professionals and patients about the importance of not interrupting nurses while they are administering medications, and changes in work design.

  8. Demonstrating the value of antimicrobial stewardship programs to hospital administrators.

    PubMed

    Nagel, Jerod L; Stevenson, James G; Eiland, Edward H; Kaye, Keith S

    2014-10-15

    The movement away from fee-for-service models to those that emphasize quality of care and patient outcomes affords a unique opportunity for antimicrobial stewardship programs to expand their value for hospital administration. Antimicrobial stewardship participants must collaborate with administrators and key stakeholders to position themselves to improve economic, process, and outcomes measures. This will allow the establishment of antimicrobial stewardship programs as essential components of the present and future healthcare quality journey.

  9. Aquifer characterization at the Veterans Administration Hospital, Tuscaloosa, Alabama

    SciTech Connect

    Cronin, W.E.; Luttrell, S.P.; Hall, S.H.

    1989-10-01

    The Veterans Administration (VA) is studying the feasibility of aquifer thermal storage (ATES) at their Tuscaloosa, Alabama, facility. To determine the characteristics of the aquifer underlying the facility, the Pacific Northwest Laboratory gathered information about the environment of the aquifer and conducted tests to estimate the aquifer's transmissivity, ground-water flow direction, and velocity. Seven wells were drilled at the VA site. It was found that ground-water flow direction at the site is generally toward the southwest. The magnitude of the gradient is approximately 2.5 {times} 10{sup -3} to 3 {times} 10{sup -3} ft/ft. For six of the seven wells, clay lenses or thick clay layers appear to be acting locally as confining or semi-confining layers. Three types of test were conducted at the site: a step drawdown test, a constant discharge and recover test, and a single-well tracer test. The data yielded responses suggesting leaky confined or delayed yield models for the aquifer. Drawdown and recovery versus time were matched type curves for delayed yield to obtain estimates of transmissivity and storage. This recovery method gave the best fit to the drawdown-versus-time curves. Using this method it was found that transmissivity ranged from 500 to 9000 ft{sup 2}/day and storage ranged from 1.5 {times} 10{sup -4} to 4.5 {times} 10{sup -2} for the wells tested. Using the results of the pump and tracer tests simultaneously, ground-water velocity was estimated to be approximately 0.8 ft/day, with an effective porosity of approximately 12%. 4 refs., 7 figs., 3 tabs.

  10. OCLC for the hospital library: the justification plan for hospital administration.

    PubMed

    Allen, C W; Branson, J R

    1982-07-01

    This paper delineates the necessary steps to provide hospital administrators with the information needed to evaluate an automated system, OCLC, for addition to the medical library. Based on experience at the Norton-Children's Hospitals, included are: (1) cost analyses of present technical processing systems and cost comparisons with OCLC; (2) delineation of start-up costs for installing OCLC; (3) budgetary requirements for 1981; (4) the impact of automation on library systems, personnel, and services; (5) potential as a shared service; and (6) preparation of the proposal for administrative review. PMID:7116018

  11. Hospital administrative characteristics and volunteer resource management practices.

    PubMed

    Intindola, Melissa; Rogers, Sean; Flinchbaugh, Carol; Della Pietra, Doug

    2016-05-16

    Purpose - The purpose of this paper is to explore the links between various characteristics of hospital administration and the utilization of classes of volunteer resource management (VRM) practices. Design/methodology/approach - This paper uses original data collected via surveys of volunteer directors in 122 hospitals in five Northeastern and Southern US states. Findings - Structural equation modeling results suggest that number of paid volunteer management staff, scope of responsibility of the primary volunteer administrator, and hospital size are positively associated with increased usage of certain VRM practices. Research limitations/implications - First, the authors begin the exploration of VRM antecedents, and encourage others to continue this line of inquiry; and second, the authors assess dimensionality of practices, allowing future researchers to consider whether specific dimensions have a differential impact on key individual and organizational outcomes. Practical implications - Based on the findings of a relationship between administrative characteristics and the on-the-ground execution of VRM practice, a baseline audit comparing current practices to those VRM practices presented here might be useful in determining what next steps may be taken to focus investments in VRM that can ultimately drive practice utilization. Originality/value - The exploration of the dimensionality of volunteer management adds a novel perspective to both the academic study, and practice, of volunteer management. To the authors' knowledge, this is the first empirical categorization of VRM practices. PMID:27119392

  12. Hospital administrative characteristics and volunteer resource management practices.

    PubMed

    Intindola, Melissa; Rogers, Sean; Flinchbaugh, Carol; Della Pietra, Doug

    2016-05-16

    Purpose - The purpose of this paper is to explore the links between various characteristics of hospital administration and the utilization of classes of volunteer resource management (VRM) practices. Design/methodology/approach - This paper uses original data collected via surveys of volunteer directors in 122 hospitals in five Northeastern and Southern US states. Findings - Structural equation modeling results suggest that number of paid volunteer management staff, scope of responsibility of the primary volunteer administrator, and hospital size are positively associated with increased usage of certain VRM practices. Research limitations/implications - First, the authors begin the exploration of VRM antecedents, and encourage others to continue this line of inquiry; and second, the authors assess dimensionality of practices, allowing future researchers to consider whether specific dimensions have a differential impact on key individual and organizational outcomes. Practical implications - Based on the findings of a relationship between administrative characteristics and the on-the-ground execution of VRM practice, a baseline audit comparing current practices to those VRM practices presented here might be useful in determining what next steps may be taken to focus investments in VRM that can ultimately drive practice utilization. Originality/value - The exploration of the dimensionality of volunteer management adds a novel perspective to both the academic study, and practice, of volunteer management. To the authors' knowledge, this is the first empirical categorization of VRM practices.

  13. 77 FR 70967 - Authorization for Non-VA Medical Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-28

    ..., Alcoholism, Claims, Day care, Dental health, Drug abuse, Government contracts, Grant programs--health... its regulation governing payment by VA for non-VA outpatient care under VA's statutory authority to provide non-VA care. Under this authority, VA may contract for certain hospital care (inpatient care)...

  14. General surgery at rural Tennessee hospitals: a survey of rural Tennessee hospital administrators.

    PubMed

    Cofer, Joseph B; Petros, Tommy J; Burkholder, Hans C; Clarke, P Chris

    2011-07-01

    Rural communities face an impending surgical workforce crisis. The purpose of this study is to describe perceptions of rural Tennessee hospital administrators regarding the importance of surgical services to their hospitals. In collaboration with the Tennessee Hospital Association, we developed and administered a 13-item survey based on a recently published national survey to 80 rural Tennessee hospitals in August 2008. A total of 29 responses were received for an overall 36.3 per cent response rate. Over 44 per cent of rural surgeons were older than 50 years of age, and 27.6 per cent of hospitals reported they would lose at least one surgeon in the next 2 years. The responding hospitals reported losing 10.4 per cent of their surgical workforce in the preceding 2 years. Over 53 per cent were actively recruiting a general surgeon with an average time to recruit a surgeon of 11.8 months. Ninety-seven per cent stated that having a surgical program was very important to their financial viability with the mean and median reported revenue generated by a single general surgeon being $1.8 million and $1.4 million, respectively. Almost 11 per cent of the hospitals stated they would have to close if they lost surgical services. Although rural Tennessee hospitals face similar difficulties to national rural hospitals with regard to retaining and hiring surgeons, slightly more Tennessee hospitals (54 vs 36%) were actively attempting to recruit a general surgeon. The shortage of general surgeons is a threat to the accessibility of comprehensive hospital-based care for rural Tennesseans. PMID:21944341

  15. General surgery at rural Tennessee hospitals: a survey of rural Tennessee hospital administrators.

    PubMed

    Cofer, Joseph B; Petros, Tommy J; Burkholder, Hans C; Clarke, P Chris

    2011-07-01

    Rural communities face an impending surgical workforce crisis. The purpose of this study is to describe perceptions of rural Tennessee hospital administrators regarding the importance of surgical services to their hospitals. In collaboration with the Tennessee Hospital Association, we developed and administered a 13-item survey based on a recently published national survey to 80 rural Tennessee hospitals in August 2008. A total of 29 responses were received for an overall 36.3 per cent response rate. Over 44 per cent of rural surgeons were older than 50 years of age, and 27.6 per cent of hospitals reported they would lose at least one surgeon in the next 2 years. The responding hospitals reported losing 10.4 per cent of their surgical workforce in the preceding 2 years. Over 53 per cent were actively recruiting a general surgeon with an average time to recruit a surgeon of 11.8 months. Ninety-seven per cent stated that having a surgical program was very important to their financial viability with the mean and median reported revenue generated by a single general surgeon being $1.8 million and $1.4 million, respectively. Almost 11 per cent of the hospitals stated they would have to close if they lost surgical services. Although rural Tennessee hospitals face similar difficulties to national rural hospitals with regard to retaining and hiring surgeons, slightly more Tennessee hospitals (54 vs 36%) were actively attempting to recruit a general surgeon. The shortage of general surgeons is a threat to the accessibility of comprehensive hospital-based care for rural Tennesseans.

  16. 75 FR 4963 - Federal Housing Administration (FHA): Hospital Mortgage Insurance Program-Refinancing Hospital Loans

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-01-29

    ... rule published on January 10, 2005, at 70 FR 17250.) That rulemaking resulted in final regulations being promulgated on November 28, 2007. (See final rule published on November 28, 2007, at 72 FR 67524... Housing and Urban Development 24 CFR Part 242 Federal Housing Administration (FHA): Hospital...

  17. Qualifications for future hospital pharmacy directors as perceived by pharmacy directors and hospital administrators in Wisconsin.

    PubMed

    Vejraska, M T; Wiederholt, J B; Zilz, D A

    1987-07-01

    Hospital pharmacy directors and administrators in Wisconsin were surveyed to determine their perceptions of the responsibilities, skills, postgraduate education, training, and experience necessary for hospital pharmacy directors during the next 10 years. Packages containing two identical questionnaires were mailed in April 1985 to the pharmacy directors at all 159 hospitals in Wisconsin. The pharmacy director and his or her immediate supervisor were asked to use a 5-point Likert-type scale to rate the importance of various responsibilities and skills and also to rank the most important responsibilities, skills, and issues. In addition, respondents answered forced-choice questions about postgraduate education and training and an open-ended question about academic coursework. All responses were compared by respondent characteristics and hospital size. There was a response rate of 48.1% to the questionnaire, representing 60.7% of the pharmacy directors (n = 96) and 34.6% of the administrators (n = 55). Both groups agreed on which responsibilities and issues will be very important (mean importance rating of greater than 4) for future pharmacy directors. However, administrators rated clinical and technical skills as significantly more important than did pharmacy directors. Only 48% of pharmacy directors believed that a residency is essential and preferred either a general or administrative residency coupled with an advanced degree, whereas more than 50% of the responding administrators favored residencies not affiliated with a degree program. The majority of pharmacy directors and administrators believed that both general staff and administrative experience is necessary for future pharmacy directors.(ABSTRACT TRUNCATED AT 250 WORDS)

  18. Accountable care organizations: principles and implications for hospital administrators.

    PubMed

    Bennett, Andrew Russell

    2012-01-01

    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

  19. Hospital administrators as professionals: a study of occupational role identity.

    PubMed

    Storch, J L; Northcott, H C

    1989-01-01

    This study set out to examine how hospital administrators see themselves in relation to their occupational role, that is, do they see themselves primarily as professionals, as organizational men and women, or as some combination of both. The determinants of their perceptions of occupational role identity were also examined. Canadian hospital CEOs numbering 361 were surveyed with a 72 percent response rate showing wide variation in education and length of work experience. Findings indicate these CEOs manifest a combination of professional and organizational role identities with no apparent conflict between these identities and no systematic differences in role identity by type of education or by length of work experience. The structure of this integrated model of professionalism and its potential impact on the leadership role of the CEO is examined in this article.

  20. The concentration of hospital care for black veterans in Veterans Affairs hospitals: implications for clinical outcomes.

    PubMed

    Jha, Ashish K; Stone, Roslyn; Lave, Judith; Chen, Huanyu; Klusaritz, Heather; Volpp, Kevin

    2010-01-01

    Where minorities receive their care may contribute to disparities in care, yet, the racial concentration of care in the Veterans Health Administration is largely unknown. We sought to better understand which Veterans Affairs (VA) hospitals treat Black veterans and whether location of care impacted disparities. We assessed differences in mortality rates between Black and White veterans across 150 VA hospitals for any of six conditions (acute myocardial infarction, hip fracture, stroke, congestive heart failure, gastrointestinal hemorrhage, and pneumonia) between 1996 and 2002. Just 9 out of 150 VA hospitals (6% of all VA hospitals) cared for nearly 30% of Black veterans, and 42 hospitals (28% of all VA hospitals) cared for more than 75% of Black veterans. While our findings show that overall mortality rates were comparable between minority-serving and non-minority-serving hospitals for four conditions, mortality rates were higher in minority-serving hospitals for acute myocardial infarction (AMI) and pneumonia. The ratio of mortality rates for Blacks compared with Whites was comparable across all VA hospitals. In contrast to the private sector, there is little variation in the degree of racial disparities in 30-day mortality across VA hospitals, although higher mortality among patients with AMI and pneumonia requires further investigation.

  1. The concentration of hospital care for black veterans in Veterans Affairs hospitals: implications for clinical outcomes.

    PubMed

    Jha, Ashish K; Stone, Roslyn; Lave, Judith; Chen, Huanyu; Klusaritz, Heather; Volpp, Kevin

    2010-01-01

    Where minorities receive their care may contribute to disparities in care, yet, the racial concentration of care in the Veterans Health Administration is largely unknown. We sought to better understand which Veterans Affairs (VA) hospitals treat Black veterans and whether location of care impacted disparities. We assessed differences in mortality rates between Black and White veterans across 150 VA hospitals for any of six conditions (acute myocardial infarction, hip fracture, stroke, congestive heart failure, gastrointestinal hemorrhage, and pneumonia) between 1996 and 2002. Just 9 out of 150 VA hospitals (6% of all VA hospitals) cared for nearly 30% of Black veterans, and 42 hospitals (28% of all VA hospitals) cared for more than 75% of Black veterans. While our findings show that overall mortality rates were comparable between minority-serving and non-minority-serving hospitals for four conditions, mortality rates were higher in minority-serving hospitals for acute myocardial infarction (AMI) and pneumonia. The ratio of mortality rates for Blacks compared with Whites was comparable across all VA hospitals. In contrast to the private sector, there is little variation in the degree of racial disparities in 30-day mortality across VA hospitals, although higher mortality among patients with AMI and pneumonia requires further investigation. PMID:20946426

  2. Low-cost transitional care with nurse managers making mostly phone contact with patients cut rehospitalization at a VA hospital.

    PubMed

    Kind, Amy J H; Jensen, Laury; Barczi, Steve; Bridges, Alan; Kordahl, Rebecca; Smith, Maureen A; Asthana, Sanjay

    2012-12-01

    The Coordinated-Transitional Care (C-TraC) Program was designed to improve care coordination and outcomes among veterans with high-risk conditions discharged to community settings from the William S. Middleton Memorial Veterans Hospital, in Madison, Wisconsin. Under the program, patients work with nurse case managers on care and health issues, including medication reconciliation, before and after hospital discharge, with all contacts made by phone once the patient is at home. Patients who received the C-TraC protocol experienced one-third fewer rehospitalizations than those in a baseline comparison group, producing an estimated savings of $1,225 per patient net of programmatic costs. This model requires a relatively small amount of resources to operate and may represent a viable alternative for hospitals seeking to offer improved transitional care as encouraged by the Affordable Care Act. In particular, the model may be attractive for providers in rural areas or other care settings challenged by wide geographic dispersion of patients or by constrained resources. PMID:23213150

  3. Low-Cost Transitional Care With Nurse Managers Making Mostly Phone Contact With Patients Cut Rehospitalization At A VA Hospital

    PubMed Central

    Kind, Amy J.H.; Jensen, Laury; Barczi, Steve; Bridges, Alan; Kordahl, Becky; Smith, Maureen A.; Asthana, Sanjay

    2012-01-01

    The Coordinated-Transitional Care (C-TraC) Program was designed to improve care coordination and outcomes among veterans with high-risk conditions discharged to community settings from the William S. Middleton Memorial Veterans Hospital, in Madison, Wisconsin. Under the program, patients work with nurse case managers on care and health issues, including medication reconciliation, before and after hospital discharge, with all contacts made by phone once the patient is at home. Patients who received the C-TraC protocol experienced one-third fewer rehospitalizations than those in a baseline comparison group, producing an estimated savings of $1,225 per patient net of programmatic costs. This model requires a relatively low amount of resources to operate and may represent a viable alternative for hospitals seeking to offer improved transitional care as encouraged by the Affordable Care Act. In particular, the model may be attractive for providers in rural areas or other care settings challenged by wide geographic dispersion of patients or by constrained resources. PMID:23213150

  4. Expanded Access to Non-VA Care Through the Veterans Choice Program. Interim final rule.

    PubMed

    2015-12-01

    The Department of Veterans Affairs (VA) revises its medical regulations that implement section 101 of the Veterans Access, Choice, and Accountability Act of 2014 (hereafter referred to as "the Choice Act"), which requires VA to establish a program to furnish hospital care and medical services through eligible non-VA health care providers to eligible veterans who either cannot be seen within the wait-time goals of the Veterans Health Administration (VHA) or who qualify based on their place of residence (hereafter referred to as the "Veterans Choice Program" or the "Program"). These regulatory revisions are required by the most recent amendments to the Choice Act made by the Construction Authorization and Choice Improvement Act of 2014, and by the Surface Transportation and Veterans Health Care Choice Improvement Act of 2015. The Construction Authorization and Choice Improvement Act of 2014 amended the Choice Act to define additional criteria that VA may use to determine that a veteran's travel to a VA medical facility is an "unusual or excessive burden," and the Surface Transportation and Veterans Health Care Choice Improvement Act of 2015 amended the Choice Act to cover all veterans enrolled in the VA health care system, remove the 60-day limit on an episode of care, modify the wait-time and 40-mile distance eligibility criteria, and expand provider eligibility based on criteria as determined by VA. This interim final rule revises VA regulations consistent with the changes made to the Choice Act as described above.

  5. The art of improvisation: the working process of administrators at a Federal University Hospital.

    PubMed

    Littike, Denilda; Sodré, Francis

    2015-10-01

    The scope of this article is to analyze the working process of administrators at a Federal University Hospital (HUF). It includes research with a qualitative approach conducted through interviews with twelve administrators. The work process, the work tools and the human activity per se are understood to be under scrutiny. Work is acknowledged as a category that analyzes the management methods used by professional health workers. The HUFs are responsible for two social policies, namely education and health. The aim of the administrators' work is an organizational issue, and the administration tools used are bureaucratic and out-of-date for the current political context of hospital management. The most significant feature of this hospital administration is improvisation, which reduces the potential of the administrators in such a way that, instead of introducing innovative changes into their work process, they prefer to leave their jobs. Improvisation is caused by the production of sequential obstacles in management decision-making at this teaching hospital. In short, the transfer of administration at the HUF, from direct government administration by the University to the Brazilian Company of Hospital Services (EBSERH), was analyzed on the grounds that this would establish a "new" management model.

  6. Orthopedic Surgery in Rural American Hospitals: A Survey of Rural Hospital Administrators

    ERIC Educational Resources Information Center

    Weichel, Derek

    2012-01-01

    Rural American residents prefer to receive their medical care locally. Lack of specific medical services in the local community necessitates travel to a larger center which is less favorable. This study was done to identify how rural hospitals choose to provide orthopedic surgical services to their communities. Methods: All hospitals in 5 states…

  7. Organizational entrepreneurship and administrators of hospitals: case study of Iran.

    PubMed

    Raadabadi, Mehdi; Fayaz-Bakhsh, Ahmad; Nazari, Aslan; Mousavi, Seyed Masood; Fayaz-Bakhsh, Mohammadali

    2014-04-11

    Due to rapid changes of technology and scientific advances in health systems and need for fast planning in health care, entrepreneurial spirit among employers and employees is a crucial element. According to the field of entrepreneurship research has not been solved and where learning and innovation for healthcare organizations due to the nature of the work required. This study aims to examine the entrepreneurial activities within the hospitals affiliated to Tehran University of Medical Sciences, Iran. To achieve the aim of the study, a questionnaire containing 29 items regarding the areas of innovation, creative behavior, flexibility, empowerment, rewarding systems and the management support was distributed among the hospitals' managers. Establishment of a culture of entrepreneurship in healthcare organizations led to the development unit controlled, changing the culture of the hospital. The analysis of the data showed that the majority of the managers agreed with all five areas of entrepreneurship namely the existence of innovation and innovative behavior, flexibility, decision making, rewarding and encouraging system, as well as management supportive system of personnel's new ideas. In fact, the managers generally had positive attitude towards entrepreneurship in their organizations The Pearson correlation test also showed that there is a significant relationship between the areas of entrepreneurship and the managers' age as well as their working experience (P<0.05). Entrepreneurial activities in healthcare can be improved through providing a suitable environment, adjusting reward and encouragement systems, giving more authority to subordinates, promoting awareness and education, and mobilizing managers to attract appropriate opportunities for organization. Further active involvement of employees, more stable in front of changes and increased ability managers to capture opportunities in domestic and foreign situation.

  8. Organizational entrepreneurship and administrators of hospitals: case study of Iran.

    PubMed

    Raadabadi, Mehdi; Fayaz-Bakhsh, Ahmad; Nazari, Aslan; Mousavi, Seyed Masood; Fayaz-Bakhsh, Mohammadali

    2014-05-01

    Due to rapid changes of technology and scientific advances in health systems and need for fast planning in health care, entrepreneurial spirit among employers and employees is a crucial element. According to the field of entrepreneurship research has not been solved and where learning and innovation for healthcare organizations due to the nature of the work required. This study aims to examine the entrepreneurial activities within the hospitals affiliated to Tehran University of Medical Sciences, Iran. To achieve the aim of the study, a questionnaire containing 29 items regarding the areas of innovation, creative behavior, flexibility, empowerment, rewarding systems and the management support was distributed among the hospitals' managers. Establishment of a culture of entrepreneurship in healthcare organizations led to the development unit controlled, changing the culture of the hospital. The analysis of the data showed that the majority of the managers agreed with all five areas of entrepreneurship namely the existence of innovation and innovative behavior, flexibility, decision making, rewarding and encouraging system, as well as management supportive system of personnel's new ideas. In fact, the managers generally had positive attitude towards entrepreneurship in their organizations The Pearson correlation test also showed that there is a significant relationship between the areas of entrepreneurship and the managers' age as well as their working experience (P<0.05). Entrepreneurial activities in healthcare can be improved through providing a suitable environment, adjusting reward and encouragement systems, giving more authority to subordinates, promoting awareness and education, and mobilizing managers to attract appropriate opportunities for organization. Further active involvement of employees, more stable in front of changes and increased ability managers to capture opportunities in domestic and foreign situation. PMID:24762370

  9. A comparison of hospital administrative costs in eight nations: US costs exceed all others by far.

    PubMed

    Himmelstein, David U; Jun, Miraya; Busse, Reinhard; Chevreul, Karine; Geissler, Alexander; Jeurissen, Patrick; Thomson, Sarah; Vinet, Marie-Amelie; Woolhandler, Steffie

    2014-09-01

    A few studies have noted the outsize administrative costs of US hospitals, but no research has compared these costs across multiple nations with various types of health care systems. We assembled a team of international health policy experts to conduct just such a challenging analysis of hospital administrative costs across eight nations: Canada, England, Scotland, Wales, France, Germany, the Netherlands, and the United States. We found that administrative costs accounted for 25.3 percent of total US hospital expenditures--a percentage that is increasing. Next highest were the Netherlands (19.8 percent) and England (15.5 percent), both of which are transitioning to market-oriented payment systems. Scotland and Canada, whose single-payer systems pay hospitals global operating budgets, with separate grants for capital, had the lowest administrative costs. Costs were intermediate in France and Germany (which bill per patient but pay separately for capital projects) and in Wales. Reducing US per capita spending for hospital administration to Scottish or Canadian levels would have saved more than $150 billion in 2011. This study suggests that the reduction of US administrative costs would best be accomplished through the use of a simpler and less market-oriented payment scheme.

  10. Organizational Entrepreneurship and Administrators of Hospitals: Case Study of Iran

    PubMed Central

    Raadabadi, Mehdi; Fayaz-Bakhsh, Ahmad; Nazari, Aslan; Mousavi, Seyed Masood; Fayaz-Bakhsh, MohammadAli

    2014-01-01

    Due to rapid changes of technology and scientific advances in health systems and need for fast planning in health care, entrepreneurial spirit among employers and employees is a crucial element. According to the field of entrepreneurship research has not been solved and where learning and innovation for healthcare organizations due to the nature of the work required. This study aims to examine the entrepreneurial activities within the hospitals affiliated to Tehran University of Medical Sciences, Iran. To achieve the aim of the study, a questionnaire containing 29 items regarding the areas of innovation, creative behavior, flexibility, empowerment, rewarding systems and the management support was distributed among the hospitals’ managers. Establishment of a culture of entrepreneurship in healthcare organizations led to the development unit controlled, changing the culture of the hospital. The analysis of the data showed that the majority of the managers agreed with all five areas of entrepreneurship namely the existence of innovation and innovative behavior, flexibility, decision making, rewarding and encouraging system, as well as management supportive system of personnel’s new ideas. In fact, the managers generally had positive attitude towards entrepreneurship in their organizations The Pearson correlation test also showed that there is a significant relationship between the areas of entrepreneurship and the managers’ age as well as their working experience (P<0.05). Entrepreneurial activities in healthcare can be improved through providing a suitable environment, adjusting reward and encouragement systems, giving more authority to subordinates, promoting awareness and education, and mobilizing managers to attract appropriate opportunities for organization. Further active involvement of employees, more stable in front of changes and increased ability managers to capture opportunities in domestic and foreign situation. PMID:24762370

  11. Are diagnosis specific outcome indicators based on administrative data useful in assessing quality of hospital care?

    PubMed Central

    Scott, I; Youlden, D; Coory, M

    2004-01-01

    Background: Hospital performance reports based on administrative data should distinguish differences in quality of care between hospitals from case mix related variation and random error effects. A study was undertaken to determine which of 12 diagnosis-outcome indicators measured across all hospitals in one state had significant risk adjusted systematic (or special cause) variation (SV) suggesting differences in quality of care. For those that did, we determined whether SV persists within hospital peer groups, whether indicator results correlate at the individual hospital level, and how many adverse outcomes would be avoided if all hospitals achieved indicator values equal to the best performing 20% of hospitals. Methods: All patients admitted during a 12 month period to 180 acute care hospitals in Queensland, Australia with heart failure (n = 5745), acute myocardial infarction (AMI) (n = 3427), or stroke (n = 2955) were entered into the study. Outcomes comprised in-hospital deaths, long hospital stays, and 30 day readmissions. Regression models produced standardised, risk adjusted diagnosis specific outcome event ratios for each hospital. Systematic and random variation in ratio distributions for each indicator were then apportioned using hierarchical statistical models. Results: Only five of 12 (42%) diagnosis-outcome indicators showed significant SV across all hospitals (long stays and same diagnosis readmissions for heart failure; in-hospital deaths and same diagnosis readmissions for AMI; and in-hospital deaths for stroke). Significant SV was only seen for two indicators within hospital peer groups (same diagnosis readmissions for heart failure in tertiary hospitals and inhospital mortality for AMI in community hospitals). Only two pairs of indicators showed significant correlation. If all hospitals emulated the best performers, at least 20% of AMI and stroke deaths, heart failure long stays, and heart failure and AMI readmissions could be avoided

  12. Studying outcomes and hospital utilization in the elderly. The advantages of a merged data base for Medicare and Veterans Affairs hospitals.

    PubMed

    Fleming, C; Fisher, E S; Chang, C H; Bubolz, T A; Malenka, D J

    1992-05-01

    That veterans aged 65 years and older are eligible to receive care either in the Veteran Affairs (VA) health care system or in the private sector under Medicare confounds the analysis of veterans' health services utilization and outcomes in two ways. First, changes in eligibility or financial barriers to access with regard to either system influence veterans' decisions about where to seek needed care. Second, analyses of VA care for elderly veterans that rely solely on VA data sources underestimate both overall utilization and treatment complications. Similarly, failure to consider the contribution of health care delivery in the VA system may confound analyses of health care utilization by the Medicare-eligible population. To study the magnitude of such confounding influences, we linked the Medicare and VA health care administrative databases for residents of New England and New York. Results indicated that, for ten surgical procedures commonly performed in the elderly, as well as for hospitalizations resulting from acute myocardial infarction and hip fracture, VA patients receive from 17.6% to 37.4% of hospital care outside the VA system. Private hospitalizations account for 5.5% to 19.5% of the care received by veterans within 6 months after an initial episode of care in a VA hospital. It was also found that initial hospitalizations for study conditions in the VA accounted for 3.6% of all such hospitalizations among elderly Medicare-eligible men. Although overall hospital utilization appears to be underestimated in VA data sources, it was found that ascertaining mortality from sources available within the VA produced excellent results when compared with deaths recorded in the Medicare enrollment files. A national, merged VA-Medicare data base is feasible and would enhance the validity of analyses of health care delivery both for elderly veterans and for the Medicare population.

  13. Perspectives on Obesity Programs at Children's Hospitals: Insights From Senior Program Administrators

    PubMed Central

    Norwood, Victoria; Hampl, Sarah; Ferris, Michelle; Hibbeln, Trillium; Patterson, Kellee; Pomietto, Maureen; Hassink, Sandra

    2011-01-01

    OBJECTIVE: The obesity epidemic has resulted in an increasing number of children needing multidisciplinary obesity treatment. To meet this need, pediatric obesity programs have arisen, particularly in children's hospitals. In 2008, the National Association of Children's Hospitals and Related Institutions (NACHRI) convened FOCUS on a Fitter Future, a group drawn from NACHRI member institutions, to investigate the needs, barriers, and capacity-building in these programs. METHODS: Senior administrators of the 47 NACHRI member hospitals that completed an application to participate in the FOCUS group were invited to complete a Web-based survey. The survey targeted 4 key areas: (1) perceived value of the obesity program; (2) funding mechanisms; (3) administrative challenges; and (4) sustainability of the programs. RESULTS: Nearly three-quarters of the respondents reported that their obesity programs were integrated into their hospitals' strategic plans. Obesity programs added value to their institutions because the programs met the needs of patients and families (97%), met the needs of health care providers (91%), prevented future health problems in children (85%), and increased visibility in the community (79%). Lack of reimbursement (82%) and high operating costs (71%) were the most frequently cited challenges. Respondents most frequently identified demonstration of program effectiveness (79%) as a factor that is necessary for ensuring program sustainability. CONCLUSIONS: Hospital administrators view tackling childhood obesity as integral to their mission to care for children. Our results serve to inform hospital clinicians and administrators as they develop and implement sustainable pediatric obesity programs. PMID:21885650

  14. Strategic plan modelling by hospital senior administration to integrate diversity management.

    PubMed

    Newhouse, John J

    2010-11-01

    Limited research suggests that some hospital senior administrators and chief executive officers (CEOs) have employed a strategic planning function to achieve diversity management practices. As the hospital industry struggles with how to integrate diversity practices to improve patient satisfaction, increase the quality of care and enhance clinical outcomes for minority populations, understanding the planning process involved in this endeavour becomes significant for senior hospital administrators. What is not well understood is what this strategic planning process represents and how it is applied to integrate diversity management. Scant research exists about the type of strategic models that hospital CEOs employ when they wish to reposition their organizations through diversity management. This study examines the strategic planning models used by senior administrators to integrate diversity management for an institutional-wide agenda. A qualitative survey process was used for CEOs in the states of New York, Pennsylvania, New Jersey and Delaware. The key research questions dealt with what type of strategic plan approach senior administrators used for integrating diversity management and what rationale they used to pursue this. Significant differences were reported between three types of strategic plan modelling used by CEOs. Also, when comparing past and current practices over time, such differences existed. The need to integrate diversity management is underscored by this study. How senior hospital administrators apply strategic plan models and what impact these approaches have represent the major implications that this study offers.

  15. 78 FR 76061 - Authorization for Non-VA Medical Services

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-16

    ... Administrative practice and procedure, Alcohol abuse, Alcoholism, Claims, Day care, Dental health, Drug abuse...-VA medical care. In the Federal Register on November 28, 2012, VA proposed to remove an outdated regulatory limitation on veterans' eligibility to be referred for non- VA medical care. On the same date,...

  16. 75 FR 24757 - Virginia Disaster #VA-00029

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-05

    ... ADMINISTRATION Virginia Disaster VA-00029 AGENCY: U.S. Small Business Administration. ACTION: Notice. SUMMARY: This is a Notice of the Presidential declaration of a major disaster for Public Assistance Only for the... of Disaster Assistance, U.S. Small Business Administration, 409 3rd Street, SW., Suite...

  17. 76 FR 70804 - Virginia Disaster #VA-00037

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-15

    ... ADMINISTRATION Virginia Disaster VA-00037 AGENCY: U.S. Small Business Administration. ACTION: Notice. SUMMARY: This is a Notice of the Presidential declaration of a major disaster for the Commonwealth of Virginia... INFORMATION CONTACT: A. Escobar, Office of Disaster Assistance, U.S. Small Business Administration, 409...

  18. 76 FR 72994 - Virginia Disaster #VA-00041

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-28

    ... ADMINISTRATION Virginia Disaster VA-00041 AGENCY: U.S. Small Business Administration. ACTION: Notice. SUMMARY: This is a Notice of the Presidential declaration of a major disaster for Public Assistance Only for the... Disaster Assistance, U.S. Small Business Administration, 409 3rd Street SW., Suite 6050, Washington,...

  19. 76 FR 40766 - Virginia Disaster #VA-00032

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-11

    ... ADMINISTRATION Virginia Disaster VA-00032 AGENCY: U.S. Small Business Administration. ACTION: Notice. SUMMARY: This is a notice of an Administrative declaration of a disaster for the Commonwealth of Virginia dated... determined to be adversely affected by the disaster: Primary Counties: Pulaski. Contiguous Counties:...

  20. 76 FR 72020 - Virginia Disaster #VA-00039

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-21

    ... ADMINISTRATION Virginia Disaster VA-00039 AGENCY: U.S. Small Business Administration. ACTION: Notice. SUMMARY: This is a notice of an Administrative declaration of a disaster for the Commonwealth of Virginia dated... adversely affected by the disaster: Primary Counties: Fairfax, Prince William. Contiguous Counties:...

  1. 76 FR 59765 - Virginia Disaster # VA-00036

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-27

    ... ADMINISTRATION Virginia Disaster VA-00036 AGENCY: U.S. Small Business Administration. ACTION: Notice SUMMARY: This is a notice of an Administrative declaration of a disaster for the Commonwealth of Virginia dated...: Virginia: Charles City, Chesterfield, Colonial Heights City, Dinwiddie, Hanover, Henrico, James City,...

  2. 76 FR 40765 - Virginia Disaster #VA-00034

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-11

    ... ADMINISTRATION Virginia Disaster VA-00034 AGENCY: U.S. Small Business Administration. ACTION: Notice. SUMMARY: This is a notice of an Administrative declaration of a disaster for the Commonwealth of Virginia dated...: Virginia: Bristol City, Grayson, Russell, Scott, Smyth. Tennessee: Johnson, Sullivan. The Interest...

  3. 77 FR 74908 - Virginia Disaster #VA-00051

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-18

    ... ADMINISTRATION Virginia Disaster VA-00051 AGENCY: U.S. Small Business Administration. ACTION: Notice. SUMMARY: This is a notice of an Administrative declaration of a disaster for the Commonwealth of Virginia dated... adversely affected by the disaster: Primary Counties: Accomack. Contiguous Counties: Virginia:...

  4. 75 FR 35511 - Virginia Disaster Number VA-00028

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-22

    ... From the Federal Register Online via the Government Publishing Office SMALL BUSINESS ADMINISTRATION Virginia Disaster Number VA-00028 AGENCY: Small Business Administration. ACTION: Amendment 3... Federal Domestic Assistance Numbers 59002 and 59008) Roger B. Garland, Acting Associate Administrator...

  5. Incidence and Variation of Discrepancies in Recording Chronic Conditions in Australian Hospital Administrative Data

    PubMed Central

    Assareh, Hassan; Achat, Helen M.; Stubbs, Joanne M.; Guevarra, Veth M.; Hill, Kim

    2016-01-01

    Diagnostic data routinely collected for hospital admitted patients and used for case-mix adjustment in care provider comparisons and reimbursement are prone to biases. We aim to measure discrepancies, variations and associated factors in recorded chronic morbidities for hospital admitted patients in New South Wales (NSW), Australia. Of all admissions between July 2010 and June 2014 in all NSW public and private acute hospitals, admissions with over 24 hours stay and one or more of the chronic conditions of diabetes, smoking, hepatitis, HIV, and hypertension were included. The incidence of a non-recorded chronic condition in an admission occurring after the first admission with a recorded chronic condition (index admission) was considered as a discrepancy. Poisson models were employed to (i) derive adjusted discrepancy incidence rates (IR) and rate ratios (IRR) accounting for patient, admission, comorbidity and hospital characteristics and (ii) quantify variation in rates among hospitals. The discrepancy incidence rate was highest for hypertension (51% of 262,664 admissions), followed by hepatitis (37% of 12,107), smoking (33% of 548,965), HIV (27% of 1500) and diabetes (19% of 228,687). Adjusted rates for all conditions declined over the four-year period; with the sharpest drop of over 80% for diabetes (47.7% in 2010 vs. 7.3% in 2014), and 20% to 55% for the other conditions. Discrepancies were more common in private hospitals and smaller public hospitals. Inter-hospital differences were responsible for 1% (HIV) to 9.4% (smoking) of variation in adjusted discrepancy incidences, with an increasing trend for diabetes and HIV. Chronic conditions are recorded inconsistently in hospital administrative datasets, and hospitals contribute to the discrepancies. Adjustment for patterns and stratification in risk adjustments; and furthermore longitudinal accumulation of clinical data at patient level, refinement of clinical coding systems and standardisation of comorbidity

  6. Incidence and Variation of Discrepancies in Recording Chronic Conditions in Australian Hospital Administrative Data.

    PubMed

    Assareh, Hassan; Achat, Helen M; Stubbs, Joanne M; Guevarra, Veth M; Hill, Kim

    2016-01-01

    Diagnostic data routinely collected for hospital admitted patients and used for case-mix adjustment in care provider comparisons and reimbursement are prone to biases. We aim to measure discrepancies, variations and associated factors in recorded chronic morbidities for hospital admitted patients in New South Wales (NSW), Australia. Of all admissions between July 2010 and June 2014 in all NSW public and private acute hospitals, admissions with over 24 hours stay and one or more of the chronic conditions of diabetes, smoking, hepatitis, HIV, and hypertension were included. The incidence of a non-recorded chronic condition in an admission occurring after the first admission with a recorded chronic condition (index admission) was considered as a discrepancy. Poisson models were employed to (i) derive adjusted discrepancy incidence rates (IR) and rate ratios (IRR) accounting for patient, admission, comorbidity and hospital characteristics and (ii) quantify variation in rates among hospitals. The discrepancy incidence rate was highest for hypertension (51% of 262,664 admissions), followed by hepatitis (37% of 12,107), smoking (33% of 548,965), HIV (27% of 1500) and diabetes (19% of 228,687). Adjusted rates for all conditions declined over the four-year period; with the sharpest drop of over 80% for diabetes (47.7% in 2010 vs. 7.3% in 2014), and 20% to 55% for the other conditions. Discrepancies were more common in private hospitals and smaller public hospitals. Inter-hospital differences were responsible for 1% (HIV) to 9.4% (smoking) of variation in adjusted discrepancy incidences, with an increasing trend for diabetes and HIV. Chronic conditions are recorded inconsistently in hospital administrative datasets, and hospitals contribute to the discrepancies. Adjustment for patterns and stratification in risk adjustments; and furthermore longitudinal accumulation of clinical data at patient level, refinement of clinical coding systems and standardisation of comorbidity

  7. Incidence and Variation of Discrepancies in Recording Chronic Conditions in Australian Hospital Administrative Data.

    PubMed

    Assareh, Hassan; Achat, Helen M; Stubbs, Joanne M; Guevarra, Veth M; Hill, Kim

    2016-01-01

    Diagnostic data routinely collected for hospital admitted patients and used for case-mix adjustment in care provider comparisons and reimbursement are prone to biases. We aim to measure discrepancies, variations and associated factors in recorded chronic morbidities for hospital admitted patients in New South Wales (NSW), Australia. Of all admissions between July 2010 and June 2014 in all NSW public and private acute hospitals, admissions with over 24 hours stay and one or more of the chronic conditions of diabetes, smoking, hepatitis, HIV, and hypertension were included. The incidence of a non-recorded chronic condition in an admission occurring after the first admission with a recorded chronic condition (index admission) was considered as a discrepancy. Poisson models were employed to (i) derive adjusted discrepancy incidence rates (IR) and rate ratios (IRR) accounting for patient, admission, comorbidity and hospital characteristics and (ii) quantify variation in rates among hospitals. The discrepancy incidence rate was highest for hypertension (51% of 262,664 admissions), followed by hepatitis (37% of 12,107), smoking (33% of 548,965), HIV (27% of 1500) and diabetes (19% of 228,687). Adjusted rates for all conditions declined over the four-year period; with the sharpest drop of over 80% for diabetes (47.7% in 2010 vs. 7.3% in 2014), and 20% to 55% for the other conditions. Discrepancies were more common in private hospitals and smaller public hospitals. Inter-hospital differences were responsible for 1% (HIV) to 9.4% (smoking) of variation in adjusted discrepancy incidences, with an increasing trend for diabetes and HIV. Chronic conditions are recorded inconsistently in hospital administrative datasets, and hospitals contribute to the discrepancies. Adjustment for patterns and stratification in risk adjustments; and furthermore longitudinal accumulation of clinical data at patient level, refinement of clinical coding systems and standardisation of comorbidity

  8. Building capacity for the conduct of nursing research at a Veterans Administration hospital.

    PubMed

    Phelan, Cynthia H; Schumacher, Sandra; Roiland, Rachel; Royer, Heather; Roberts, Tonya

    2015-05-01

    Evidence is the bedrock of nursing practice, and nursing research is the key source for this evidence. In this article, we draw distinctions between the use and the conduct of nursing research and provide a perspective for how the conduct of nursing research in a Veterans Administration hospital can build an organization's capacity for nursing research.

  9. The Establishment and Administration of Operant Conditioning Programs in a State Hospital for the Retarded.

    ERIC Educational Resources Information Center

    Ball, Thomas S., Ed.

    Seven articles treat the establishment of operant conditioning programs for the mentally retarded at Pacific State Hospital in California. Emphasis is on the administrative rather than the demonstration of research aspects of operant conditioning programs. Following an introduction and overview, the medical director's point of view on operant…

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

    PubMed

    Lawrence, Justin; Delaney, Conor P

    2013-03-01

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

  11. Confirming delivery: understanding the role of the hospitalized patient in medication administration safety.

    PubMed

    Macdonald, Marilyn T; Heilemann, MarySue V; MacKinnon, Neil J; Lang, Ariella; Gregory, David; Gurnham, Mary Ellen; Fillatre, Theresa

    2014-04-01

    The purpose of our study was to gain an understanding of current patient involvement in medication administration safety from the perspectives of both patients and nursing staff members. Administering medication is taken for granted and therefore suited to the development of theory to enhance its understanding. We conducted a constructivist, grounded theory study involving 24 patients and 26 nursing staff members and found that patients had the role of confirming delivery in the administration of medication. Confirming delivery was characterized by three interdependent subprocesses: engaging in the medication administration process, being "half out of it" (patient mental status), and perceiving time. We believe that ours is one of the first qualitative studies on the role of hospitalized patients in administering medication. Medication administration and nursing care systems, as well as patient mental status, impose limitations on patient involvement in safe medication administration.

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

    PubMed Central

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

    2016-01-01

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

  13. 76 FR 56861 - Virginia Disaster #VA-00038

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-14

    ... ADMINISTRATION Virginia Disaster VA-00038 AGENCY: U.S. Small Business Administration. ACTION: Notice. SUMMARY... Commonwealth of Virginia (FEMA-4024-DR), dated 09/03/2011. Incident: Hurricane Irene. Incident Period: 08/26..., Southampton, Suffolk City, Sussex, Virginia Beach City, Westmoreland, Williamsburg City, York. The...

  14. 77 FR 73510 - Virginia Disaster #VA-00052

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-10

    ... From the Federal Register Online via the Government Publishing Office SMALL BUSINESS ADMINISTRATION Virginia Disaster VA-00052 AGENCY: U.S. Small Business Administration. ACTION: Notice. SUMMARY... State of Virginia (FEMA- 4092-DR), dated 11/26/2012. Incident: Hurricane Sandy Incident Period:...

  15. 75 FR 9006 - Virginia Disaster #VA-00028

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-02-26

    ... From the Federal Register Online via the Government Publishing Office SMALL BUSINESS ADMINISTRATION Virginia Disaster VA-00028 AGENCY: U.S. Small Business Administration. ACTION: Notice. SUMMARY... Commonwealth of Virginia (FEMA-1874-DR), dated 02/16/2010. Incident: Severe Winter Storm and...

  16. 76 FR 72022 - Virginia Disaster #VA-00040

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-21

    ... From the Federal Register Online via the Government Publishing Office SMALL BUSINESS ADMINISTRATION Virginia Disaster VA-00040 AGENCY: U.S. Small Business Administration. ACTION: Notice. SUMMARY... State of Virginia (FEMA- 4042-DR), dated 11/10/2011. Incident: Earthquake. Incident Period:...

  17. Improving Medication Administration Safety in a Community Hospital Setting Using Lean Methodology.

    PubMed

    Critchley, Sandy

    2015-01-01

    Virtually all health care organizations have goals of improving patient safety, but despite clear goals and considerable investments, gains have been limited. This article explores a community hospital's resounding success using Lean methodology to improve medication administration safety with process changes designed by engaged employees and leaders with the knowledge and skill to effect improvements. This article inspires an interdisciplinary approach to quality improvement using reproducible strategies. PMID:25599523

  18. Comparing Safety Climate between Two Populations of Hospitals in the United States

    PubMed Central

    Singer, Sara J; Hartmann, Christine W; Hanchate, Amresh; Zhao, Shibei; Meterko, Mark; Shokeen, Priti; Lin, Shoutzu; Gaba, David M; Rosen, Amy K

    2009-01-01

    Objective To compare safety climate between diverse U.S. hospitals and Veterans Health Administration (VA) hospitals, and to explore the factors influencing climate in each setting. Data Sources Primary data from surveys of hospital personnel; secondary data from the American Hospital Association's 2004 Annual Survey of Hospitals. Study Design Cross-sectional study of 69 U.S. and 30 VA hospitals. Data Collection For each sample, hierarchical linear models used safety-climate scores as the dependent variable and respondent and facility characteristics as independent variables. Regression-based Oaxaca–Blinder decomposition examined differences in effects of model characteristics on safety climate between the U.S. and VA samples. Principal Findings The range in safety climate among U.S. and VA hospitals overlapped substantially. Characteristics of individuals influenced safety climate consistently across settings. Working in southern and urban facilities corresponded with worse safety climate among VA employees and better safety climate in the U.S. sample. Decomposition results predicted 1.4 percentage points better safety climate in U.S. than in VA hospitals: −0.77 attributable to sample-characteristic differences and 2.2 due to differential effects of sample characteristics. Conclusions Results suggest that safety climate is linked more to efforts of individual hospitals than to participation in a nationally integrated system or measured characteristics of workers and facilities. PMID:19619250

  19. Work mistreatment and hospital administrative staff: policy implications for healthier workplaces.

    PubMed

    Harlos, Karen P; Axelrod, Lawrence J

    2008-08-01

    Research on work life quality in hospitals has focused on how nurses and physicians perceive or react to work conditions. We extend this focus to another major professional group - healthcare administrators - to learn more about how these employees experience the work environment. Administrators merit such attention given their key roles in sustaining the financial health of the hospital and in fulfilling management functions efficiently to support consistent, high-quality care. Specifically, we examined mistreatment in the workplace experienced by administrative staff from a hospital in a large Canadian city. Three dimensions of mistreatment - verbal abuse, work obstruction and emotional neglect - have been associated with diminished well-being, work satisfaction and organizational commitment, along with stronger intent to leave. In this paper, we provide additional support for interpreting these three dimensions as mistreatment and report on their frequencies in our sample. We then consider implications for policy development (e.g., communication and conflict resolution skills training, mentoring programs, respect-at-work policies) to make workplaces healthier for these neglected but important healthcare professionals. PMID:19377340

  20. Can cost sharing measures improve the function of outpatient departments of public hospitals: the opinions of administrative directors.

    PubMed

    Tsirona, Christina; Siskou, Olga; Galanis, Peter; Kaitelidou, Daphne; Tsavalias, Konstantinos; Ragkousi, Argyro; Semertziadi, Maria; Anagnostopoulou, Ioanna; Vafiadis, John; Liaropoulos, Lycourgos

    2013-01-01

    This paper describes a study aiming to investigate the opinions of administrative personnel concerning the effectiveness of a cost sharing mechanism (of euro 5/visit) at public hospitals' outpatient departments. Data was derived through a structured questionnaire (developed by the researchers) which appealed to 112 administrative directors of public hospitals. Results highlighted a positive attitude concerning the function of the cost - sharing mechanism at public hospitals, a rather fair measure for the users (vulnerable groups are excluded) which probably is enhancing the monetary flow in public hospitals.

  1. The corporate organization of hospital work: balancing professional and administrative responsibilities.

    PubMed

    Stoeckle, J D; Reiser, S J

    1992-03-01

    The development of the hospital into a corporation has influenced the care of patients and the work of the professional staff. As a corporate enterprise, the modern hospital has a private agenda aimed at increasing growth and efficiency with an emphasis on technical services, professionals as employees, and patients as customers. These changes have resulted in a decrease in trustee and professional authority and an increase in administrative control. This shift in the control structure has continued in response to the need for accounting and regulation of services and in response to demands for increased growth and efficiency made by an increasingly competitive market environment. Strategies for the reorganization of hospital staff aimed at improving both inpatient and outpatient care are reviewed. The reorganization of the institution and staff, using either a staff group-practice corporation or an administrative staff model, is proposed. Clinicians have new responsibilities for developing collective arrangements for institutional governance, for allocating institutional resources, for providing public accountability regarding the use of these resources, and for defining the missions of care.

  2. Prospective-pricing strategies for hospital and departmental effectiveness: the administrator's response.

    PubMed

    Van Etten, P

    1985-10-01

    The approach of the New England Medical Center toward case management and increased productivity, and the role of the pharmacy within this system, are described by a chief hospital administrator. External pressures that caused the hospital to alter its management style included changes in reimbursement, hospital overuse, increased competition, and a surplus of physicians. Variations in medical practice that affected admission rates, length of stay, and use of ancillary services existed because clinical and financial data had not been integrated, so clinicians had no information on the economic consequences of their decisions. The solution offered to this problem was to decentralize resource-use decisions to increase clinician accountability. The goal of the case-management system is to reduce the cost of intermediate product (e.g., laboratory tests) use through increased productivity. The system provides pharmacy with a new power base if pharmacists can reduce overall costs by influencing prescribers to use cost-effective therapies. Pharmacy can increase its influence within the institution by forming new relationships with administrators, physicians, and nurses that broaden its impact on cost. PMID:3933334

  3. The Dutch Hospital Standardised Mortality Ratio (HSMR) method and cardiac surgery: benchmarking in a national cohort using hospital administration data versus a clinical database

    PubMed Central

    Siregar, S; Pouw, M E; Moons, K G M; Versteegh, M I M; Bots, M L; van der Graaf, Y; Kalkman, C J; van Herwerden, L A; Groenwold, R H H

    2014-01-01

    Objective To compare the accuracy of data from hospital administration databases and a national clinical cardiac surgery database and to compare the performance of the Dutch hospital standardised mortality ratio (HSMR) method and the logistic European System for Cardiac Operative Risk Evaluation, for the purpose of benchmarking of mortality across hospitals. Methods Information on all patients undergoing cardiac surgery between 1 January 2007 and 31 December 2010 in 10 centres was extracted from The Netherlands Association for Cardio-Thoracic Surgery database and the Hospital Discharge Registry. The number of cardiac surgery interventions was compared between both databases. The European System for Cardiac Operative Risk Evaluation and hospital standardised mortality ratio models were updated in the study population and compared using the C-statistic, calibration plots and the Brier-score. Results The number of cardiac surgery interventions performed could not be assessed using the administrative database as the intervention code was incorrect in 1.4–26.3%, depending on the type of intervention. In 7.3% no intervention code was registered. The updated administrative model was inferior to the updated clinical model with respect to discrimination (c-statistic of 0.77 vs 0.85, p<0.001) and calibration (Brier Score of 2.8% vs 2.6%, p<0.001, maximum score 3.0%). Two average performing hospitals according to the clinical model became outliers when benchmarking was performed using the administrative model. Conclusions In cardiac surgery, administrative data are less suitable than clinical data for the purpose of benchmarking. The use of either administrative or clinical risk-adjustment models can affect the outlier status of hospitals. Risk-adjustment models including procedure-specific clinical risk factors are recommended. PMID:24334377

  4. In-hospital mortality following lung cancer resection: nationwide administrative database.

    PubMed

    Pagès, Pierre-Benoit; Cottenet, Jonathan; Mariet, Anne-Sophie; Bernard, Alain; Quantin, Catherine

    2016-06-01

    Our aim was to determine the effect of a national strategy for quality improvement in cancer management (the "Plan Cancer") according to time period and to assess the influence of type and volume of hospital activity on in-hospital mortality (IHM) within a large national cohort of patients operated on for lung cancer.From January 2005 to December 2013, 76 235 patients were included in the French Administrative Database. Patient characteristics, hospital volume of activity and hospital type were analysed over three periods: 2005-2007, 2008-2010 and 2011-2013.Global crude IHM was 3.9%: 4.3% during 2005-2007, 4% during 2008-2010 and 3.5% during 2011-2013 (p<0.01). 296, 259 and 209 centres performed pulmonary resections in 2005-2007, 2008-2010 and 2011-2013, respectively (p<0.01). The risk of death was higher in centres performing <13 resections per year than in centres performing >43 resections per year (adjusted (a)OR 1.48, 95% CI 1.197-1.834). The risk of death was lower in the period 2011-2013 than in the period 2008-2010 (aOR 0.841, 95% CI 0.764-0.926). Adjustment variables (age, sex, Charlson score and type of resection) were significantly linked to IHM, whereas the type of hospital was not.The French national strategy for quality improvement seems to have induced a significant decrease in IHM.

  5. Hospital administration team development and support in a children's cancer service.

    PubMed

    Slater, Penelope J

    2011-11-01

    The administration team in the Queensland Children's Cancer Centre at the Royal Children's Hospital, Brisbane, included a team of 16 administration staff supporting the service and the state-wide clinical network. Shortly after the creation of a new expanded service, issues became apparent in administration team morale, relationships, communication, processes, leadership, support and training. The analysis of these issues included team interviews and surveys, consultation with senior administration staff and monthly sick leave monitoring. Strategies implemented included providing information; the joint development of a team business plan and individual performance plans; a review of the team's structure, workload and business processes; engaging staff in quality improvements; and the development of relationships and leadership. As a result, the team reported being more comfortable and supported in their roles, had improved morale and worked better together with more consistent and improving business processes. They had clear purpose and expectations of their roles, displayed better customer service and had reduced sick leave. The study shows that in a high stress environment, such as a children's cancer centre, attention to the team's culture, vision and purpose, providing information and improving communication and relationships, when combined with a team's enthusiasm, will improve the team's growth, cooperation and work outcomes.

  6. Patient, hospital, and local health system characteristics associated with the use of observation stays in veterans health administration hospitals, 2005 to 2012.

    PubMed

    Wright, Brad; OʼShea, Amy M J; Glasgow, Justin M; Ayyagari, Padmaja; Vaughan-Sarrazin, Mary

    2016-09-01

    Recent studies have documented that a significant increase in the use of observation stays along with extensive variation in patterns of use across hospitals.The objective of this longitudinal observational study was to examine the extent to which patient, hospital, and local health system characteristics explain variation in observation stay rates across Veterans Health Administration (VHA) hospitals.Our data came from years 2005 to 2012 of the nationwide VHA Medical SAS inpatient and enrollment files, American Hospital Association Survey, and Area Health Resource File. We used these data to estimate linear regression models of hospitals' observation stay rates as a function of hospital, patient, and local health system characteristics, while controlling for time trends and Veterans Integrated Service Network level fixed effects.We found that observation stay rates are inversely related to hospital bed size and that hospitals with a greater proportion of younger or rural patients have higher observation stay rates. Observation stay rates were nearly 15 percentage points higher in 2012 than 2005.Although we identify several characteristics associated with variation in VHA hospital observation stay rates, many factors remain unmeasured. PMID:27603391

  7. 75 FR 78806 - Agency Information Collection (Create Payment Request for the VA Funding Fee Payment System (VA...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-16

    ... AFFAIRS Agency Information Collection (Create Payment Request for the VA Funding Fee Payment System (VA... Officer, OMB Human Resources and Housing Branch, New Executive Office Building, Room 10235, Washington, DC... Administration (VBA), Department of Veterans Affairs, will submit the collection of information abstracted...

  8. Pharmaceutical interventions in medications prescribed for administration via enteral tubes in a teaching hospital

    PubMed Central

    Ferreira, Carolina Justus Buhrer; Plodek, Caroline Koga; Soares, Franciny Kossemba; de Andrade, Rayza Assis; Teleginski, Fernanda; da Rocha, Maria Dagmar

    2016-01-01

    Abstract Objective: to analyze the impact of guidelines regarding errors in medications prescribed for administration through enteral tubes. Method: quantitative study, in three phases, undertaken in internal medicine, neurology and an intensive care unit in a general teaching hospital. In Phase 1, the following was undertaken: a protocol for dilution and unit-dose repackaging and administration for 294 medications via enteral tubes; a decision flowchart; operational-standard procedures for dilution and unit-dose repackaging of oral pharmaceutical forms and for administration of medications through enteral tubes. In phase 2, errors in 872 medications prescribed through enteral tubes, in 293 prescriptions for patients receiving inpatient treatment between March and June, were investigated. This was followed by training of the teams in relation to the guidelines established. In Phase 3, pharmaceutical errors and interventions in 945 medications prescribed through enteral tubes, in 292 prescriptions of patients receiving inpatient treatment between August and September, were investigated prospectively. The data collected, in a structured questionnaire, were compiled in the Microsoft Office Excel(r) program, and frequencies were calculated. Results: 786 errors were observed, 63.9% (502) in Phase 2, and 36.1% (284) in Phase 3. In Phase 3, a reduction was ascertained in the frequency of prescription of medications delivered via enteral tubes, medications which were contraindicated, and those for which information was not available. Conclusion: guidelines and pharmaceutical interventions were determined in the prevention of errors involving medications delivered through enteral tubes. PMID:27276019

  9. Analysis of the technology acceptance model in examining hospital nurses' behavioral intentions toward the use of bar code medication administration.

    PubMed

    Song, Lunar; Park, Byeonghwa; Oh, Kyeung Mi

    2015-04-01

    Serious medication errors continue to exist in hospitals, even though there is technology that could potentially eliminate them such as bar code medication administration. Little is known about the degree to which the culture of patient safety is associated with behavioral intention to use bar code medication administration. Based on the Technology Acceptance Model, this study evaluated the relationships among patient safety culture and perceived usefulness and perceived ease of use, and behavioral intention to use bar code medication administration technology among nurses in hospitals. Cross-sectional surveys with a convenience sample of 163 nurses using bar code medication administration were conducted. Feedback and communication about errors had a positive impact in predicting perceived usefulness (β=.26, P<.01) and perceived ease of use (β=.22, P<.05). In a multiple regression model predicting for behavioral intention, age had a negative impact (β=-.17, P<.05); however, teamwork within hospital units (β=.20, P<.05) and perceived usefulness (β=.35, P<.01) both had a positive impact on behavioral intention. The overall bar code medication administration behavioral intention model explained 24% (P<.001) of the variance. Identified factors influencing bar code medication administration behavioral intention can help inform hospitals to develop tailored interventions for RNs to reduce medication administration errors and increase patient safety by using this technology.

  10. 77 FR 51100 - Virginia Disaster No. VA-00048

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-23

    ... ADMINISTRATION Virginia Disaster No. VA-00048 AGENCY: U.S. Small Business Administration. ACTION: Amendment 1.... ADDRESSES: Submit completed loan applications to: U.S. Small Business Administration, Processing and..., Office of Disaster Assistance, U.S. Small Business Administration, 409 3rd Street, SW., Suite...

  11. Patient, hospital, and local health system characteristics associated with the use of observation stays in veterans health administration hospitals, 2005 to 2012

    PubMed Central

    Wright, Brad; O'Shea, Amy M.J.; Glasgow, Justin M.; Ayyagari, Padmaja; Vaughan-Sarrazin, Mary

    2016-01-01

    Abstract Recent studies have documented that a significant increase in the use of observation stays along with extensive variation in patterns of use across hospitals. The objective of this longitudinal observational study was to examine the extent to which patient, hospital, and local health system characteristics explain variation in observation stay rates across Veterans Health Administration (VHA) hospitals. Our data came from years 2005 to 2012 of the nationwide VHA Medical SAS inpatient and enrollment files, American Hospital Association Survey, and Area Health Resource File. We used these data to estimate linear regression models of hospitals’ observation stay rates as a function of hospital, patient, and local health system characteristics, while controlling for time trends and Veterans Integrated Service Network level fixed effects. We found that observation stay rates are inversely related to hospital bed size and that hospitals with a greater proportion of younger or rural patients have higher observation stay rates. Observation stay rates were nearly 15 percentage points higher in 2012 than 2005. Although we identify several characteristics associated with variation in VHA hospital observation stay rates, many factors remain unmeasured. PMID:27603391

  12. Development and evaluation of a nursing service management and administration information system at district hospital.

    PubMed

    Stamouli, M A; Mantas, J

    2001-01-01

    The rapid development of information technology and the multiple usage of Information Systems make indisputable their appliance in all the sectors including the Nursing Service area. Information Systems that have been developed for the Nursing Service Administration are extremely useful in the processing and the categorisation of a large number of information, providing significant advantages such as information storage, information availability, information precision and reliability. In addition, the appliance of Information Systems provides important advantages in the administration of the nursing personnel's data, contributing to the improvement of the operating effectiveness of the Nursing Service. This paper describes the development and the evaluation of an Information System for the Nursing Service Administration that classifies all the information related to the nursing personnel and helps the administration to handle the appropriate nursing data. The method of Life Cycle Model was decided as the most appropriate for the development of the System, because of the important advantages that it offers. For the evaluation of our own designed system we based on the standards, which are used for evaluating Information Systems in general. The evaluation of this Information System is carried out by a survey among the undergraduate and the postgraduate students of the Nursing Department of the University of Athens and the Nursing Personnel of a number of Hospitals. Useful conclusions have been derived concerning those characteristics, which should be fulfilled by the system. Important conclusions have been also drown out concerning the dependencies of the variables under study, the future readjustments of the system, and the general perception of the newcomers in health profession towards the application of the information technology.

  13. Understanding the causes of intravenous medication administration errors in hospitals: a qualitative critical incident study

    PubMed Central

    Keers, Richard N; Williams, Steven D; Cooke, Jonathan; Ashcroft, Darren M

    2015-01-01

    Objectives To investigate the underlying causes of intravenous medication administration errors (MAEs) in National Health Service (NHS) hospitals. Setting Two NHS teaching hospitals in the North West of England. Participants Twenty nurses working in a range of inpatient clinical environments were identified and recruited using purposive sampling at each study site. Primary outcome measures Semistructured interviews were conducted with nurse participants using the critical incident technique, where they were asked to discuss perceived causes of intravenous MAEs that they had been directly involved with. Transcribed interviews were analysed using the Framework approach and emerging themes were categorised according to Reason's model of accident causation. Results In total, 21 intravenous MAEs were discussed containing 23 individual active failures which included slips and lapses (n=11), mistakes (n=8) and deliberate violations of policy (n=4). Each active failure was associated with a range of error and violation provoking conditions. The working environment was implicated when nurses lacked healthcare team support and/or were exposed to a perceived increased workload during ward rounds, shift changes or emergencies. Nurses frequently reported that the quality of intravenous dose-checking activities was compromised due to high perceived workload and working relationships. Nurses described using approaches such as subconscious functioning and prioritising to manage their duties, which at times contributed to errors. Conclusions Complex interactions between active and latent failures can lead to intravenous MAEs in hospitals. Future interventions may need to be multimodal in design in order to mitigate these risks and reduce the burden of intravenous MAEs. PMID:25770226

  14. Outcomes of the Evidence-Based Pitocin Administration Checklist at a Tertiary-Level Hospital.

    PubMed

    Wojnar, Danuta M; Cowgill, Karen; Hoffman, Lindsay; Carlson, Hannah

    2014-09-01

    Pitocin, a synthetic form of the hormone oxytocin, is a high-alert medication that heightens patient harm when used incorrectly. This investigation examined the outcomes of an evidence-based Pitocin administration checklist used for labor augmentation at a tertiary-level hospital. Data came from patient records. Using the Perinatal Trigger Tool, N = 372 clinical records (n = 194 prior to and n = 178 following checklist implementation) were reviewed. Checklist implementation resulted in statistically significant reductions in the duration of hospitalization (1.72 vs. 2.02 days, p = .0005), presence of meconium (23.7% vs. 6.7%, p < .001), maternal fevers (7.2% vs. 2.3%, p = .030), and episiotomies (8.8% vs. 1.7%, p = .002), and clinically important reduction in APGAR scores < 7 at 5 min (3.6%-0.6%, p = .069) and instrumented deliveries (11.9%-8.4%, p = .307). A universal Pitocin checklist implementation can improve birth outcomes and costs of care.

  15. Prediction of hospital readmission for heart failure: development of a simple risk score based on administrative data

    PubMed

    Philbin; DiSalvo

    1999-09-01

    OBJECTIVES: The purpose of this study was to develop a convenient and inexpensive method for identifying and individual's risk for hospital readmission for congestive heart failure (CHF) using information derived exclusively from administrative data sources and available at the time of an index hospital discharge. BACKGROUND: Rates of readmission are higher after hospitalization for CHF. The significant determinants of rehospitalization are debated. METHODS: Administrative information on all 1995 hospital discharges in New York State which were assigned International Classification of Diseases--9--Clinical Modification codes indicative of CHF in the principal diagnosis position were obtained. The following were compared among hospital survivors who did and did not experience readmission: demographics, comorbid illness, hospital type and location, processes of care, length of stay and hospital charges. RESULTS: A total of 42,731 black or white patients were identified. The subgroup of 9,112 (21.3%) who were readmitted were distinguished by a greater proportion of blacks, a higher prevalence of Medicare and Medicaid insurance, more comorbid illnesses and the use of telemetry monitoring during their index hospitalization. Patients treated at rural hospitals, those discharged to skilled nursing facilities and those having echocardiograms or cardiac catheterization were less likely to be readmitted. Using multiple regression methods, a simple methodology was devised that segregated patients into low, intermediate and high risk for readmission. CONCLUSIONS: Patient characteristics, hospital features, processes of care and clinical outcomes may be used to estimate the risk of hospital readmission for CHF. However, some of the variation in rehospitalization risk remains unexplained and may be the result of discretionary behavior by physicians and patients.

  16. Best practices: The Administrative Review Committee at New Hampshire Hospital: a one-year follow-up.

    PubMed

    de Nesnera, Alexander; Folks, David G

    2012-06-01

    New Hampshire Hospital implemented an Administrative Review Committee (ARC), a best practice that provides a risk management process to mitigate potential liability for the hospital and clinicians treating high-profile, high-risk patients. This column reports on the first year of the ARC's operation, during which the committee reviewed 206 patients. The authors describe four patient groups and their distinguishing characteristics. The ARC is accepted by clinicians as an important venue to present high-risk clinical cases and to obtain risk management guidance and consultation. The committee has become an integral part of the hospital culture.

  17. Impact of implementing an Internal Bed Regulation Committee on administrative and care indicators at a teaching hospital

    PubMed Central

    Rodrigues, Luciane Cristine Ribeiro; Juliani, Carmen Maria Casquel Monti

    2015-01-01

    Objective To compare hospital indicators before and after implementing an Internal Bed Regulation Committee at a reference hospital. Methods It is an quantitative, evaluation, exploratory, descriptive and cross-sectional research. The data was gathered from the hospital administrative reports for the period 2008-2013, provided by the Information Technology Center of the Complexo FAMEMA. Results The indicators improved after implementation of the Internal Bed Regulation Committee. Conclusion The individuals involved in the process acknowledged the improvement. It is necessary to carry on the regulatory actions, especially in a comprehensive and complex healthcare system, such as the brazilian Sistema Único de Saúde. PMID:25993075

  18. 1. Oblique view of east portion of Portsmouth Naval Hospital ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    1. Oblique view of east portion of Portsmouth Naval Hospital Complex showing in middle ground, from left to right, Medical Ward A (HABS No. VA01287-G), Medical Ward B (HABS No. VA-1287-H), Medical Ward C (HABS No. VA-1287-I, Portsmouth Naval Hospital Building (HABS No. VA-1287-A), Hospital Point; and in foreground, from left to right, gardener's tool shed (HABS No. VA-1287-C), Service Building (HABS No. VA01287-D), garage (HABS No. VA-1287-F), Medical Officer's Quarters C (HABS No. VA-1287-B), and Medical Officer's Quarters B (HAQBS No. VA-1287-E), view to north from roof of 1960 high-rise hospital - Portsmouth Naval Hospital, Bounded by Elizabeth River, Crawford Street, Portsmouth General Hospital, Parkview Avenue, & Scotts Creek, Portsmouth, Portsmouth, VA

  19. Veterans Administration Databases

    Cancer.gov

    The Veterans Administration Information Resource Center provides database and informatics experts, customer service, expert advice, information products, and web technology to VA researchers and others.

  20. 78 FR 2708 - Virginia Disaster Number VA-00052

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-01-14

    ... From the Federal Register Online via the Government Publishing Office SMALL BUSINESS ADMINISTRATION Virginia Disaster Number VA-00052 AGENCY: U.S. Small Business Administration. ACTION: Amendment 1... completed loan applications to: U.S. Small Business Administration, Processing and Disbursement...

  1. Hospitalizations of Infants and Young Children with Down Syndrome: Evidence from Inpatient Person-Records from a Statewide Administrative Database

    ERIC Educational Resources Information Center

    So, S. A.; Urbano, R. C.; Hodapp, R. M.

    2007-01-01

    Background: Although individuals with Down syndrome are increasingly living into the adult years, infants and young children with the syndrome continue to be at increased risk for health problems. Using linked, statewide administrative hospital discharge records of all infants with Down syndrome born over a 3-year period, this study "follows…

  2. [Extent and use of administrative hospital data in the German DRG system].

    PubMed

    Müller-Bergfort, S; Fritze, J

    2007-08-01

    In 2003 the mandatory introduction of diagnosis related groups as an overall payment system started for all hospitals in Germany, except for departments of psychiatry and psychotherapy as well as psychosomatics and psychotherapy. All hospitals are legally obliged to deliver extensive data on hospital treatment, including demographic data, diagnoses, comorbidities, complications, and procedures, to the "Institute for the Hospital Remuneration System" which uses the data for yearly adaptation of the German DRG system (G-DRG). This article describes legal issues of data collection, parameters and content of hospital data. In principle, the data might additionally be used for epidemiological, quality and public health issues which is, however, not supported by federal law, as of this time (January 2007). Completion of hospital data by unique patient identifiers, extended legal possibilities of scientific use of the data and the combination of hospital data from the DRG system with the data collected by the federal statistical office of Germany are proposed. PMID:17676420

  3. The Predictive Factors on Extended Hospital Length of Stay in Patients with AMI: Laboratory and Administrative Data.

    PubMed

    Magalhães, Teresa; Lopes, Sílvia; Gomes, João; Seixo, Filipe

    2016-01-01

    The length of hospital stay (LOS) is an important measure of efficiency in the use of hospital resources. Acute Myocardial Infarction (AMI), as one of the diseases with higher mortality and LOS variability in the OECD countries, has been studied with predominant use of administrative data, particularly on mortality risk adjustment, failing investigation in the resource planning and specifically in LOS. This paper presents results of a predictive model for extended LOS (LOSE - above 75th percentile of LOS) using both administrative and clinical data, namely laboratory data, in order to develop a decision support system. Laboratory and administrative data of a Portuguese hospital were included, using logistic regression to develop this predictive model. A model with three laboratory data and seven administrative data variables (six comorbidities and age ≥ 69 years), with excellent discriminative ability and a good calibration, was obtained. The model validation shows also good results. Comorbidities were relevant predictors, mainly diabetes with complications, showing the highest odds of LOSE (OR = 37,83; p = 0,001). AMI patients with comorbidities (diabetes with complications, cerebrovascular disease, shock, respiratory infections, pulmonary oedema), with pO2 above level, aged 69 years or older, with cardiac dysrhythmia, neutrophils above level, pO2 below level, and prothrombin time above level, showed increased risk of extended LOS. Our findings are consistent with studies that refer these variables as predictors of increased risk. PMID:26558393

  4. Validation of administrative hospital data for identifying incident pancreatic and periampullary cancer cases: a population-based study using linked cancer registry and administrative hospital data in New South Wales, Australia

    PubMed Central

    Creighton, Nicola; Walton, Richard; Roder, David; Aranda, Sanchia; Currow, David

    2016-01-01

    Objectives Informing cancer service delivery with timely and accurate data is essential to cancer control activities and health system monitoring. This study aimed to assess the validity of ascertaining incident cases and resection use for pancreatic and periampullary cancers from linked administrative hospital data, compared with data from a cancer registry (the ‘gold standard’). Design, setting and participants Analysis of linked statutory population-based cancer registry data and administrative hospital data for adults (aged ≥18 years) with a pancreatic or periampullary cancer case diagnosed during 2005–2009 or a hospital admission for these cancers between 2005 and 2013 in New South Wales, Australia. Methods The sensitivity and positive predictive value (PPV) of pancreatic and periampullary cancer case ascertainment from hospital admission data were calculated for the 2005–2009 period through comparison with registry data. We examined the effect of the look-back period to distinguish incident cancer cases from prevalent cancer cases from hospital admission data using 2009 and 2013 as index years. Results Sensitivity of case ascertainment from the hospital data was 87.5% (4322/4939), with higher sensitivity when the cancer was resected (97.9%, 715/730) and for pancreatic cancers (88.6%, 3733/4211). Sensitivity was lower in regional (83.3%) and remote (85.7%) areas, particularly in areas with interstate outflow of patients for treatment, and for cases notified to the registry by death certificate only (9.6%). The PPV for the identification of incident cases was 82.0% (4322/5272). A 2-year look-back period distinguished the majority (98%) of incident cases from prevalent cases in linked hospital data. Conclusions Pancreatic and periampullary cancer cases and resection use can be ascertained from linked hospital admission data with sufficient validity for informing aspects of health service delivery and system-level monitoring. Limited tumour clinical

  5. The applicability of Bass's model of transformational, transactional, and laissez-faire leadership in the hospital administrative environment.

    PubMed

    Spinelli, Robert J

    2006-01-01

    The purpose of this study is to evaluate empirically in the hospital administrative environment the relationship of leadership behaviors to subordinate manager's perceived outcomes, through examination of B. M. Bass's (1985) model of transformational, transactional, and laissez-faire leadership. The author measured leadership orientation and outcome factors through subordinate managers' ratings of hospital CEOs using a questionnaire, which asked: Is there a relationship between the leadership styles of hospital CEOs and subordinate managers' self-reported willingness to exert extra effort, perception of leader effectiveness and satisfaction with their leader? Findings revealed that the relationship between transformational leadership and the outcome factors were stronger and more positive than were the transactional and laissez-faire styles. These findings are consistent with the hierarchal patterns reported and support the universality of the model. PMID:16708688

  6. 75 FR 41247 - Virginia Disaster Number VA-00028

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-15

    ... ADMINISTRATION Virginia Disaster Number VA-00028 AGENCY: U.S. Small Business Administration. ACTION: Amendment 4... Only for the Commonwealth of Virginia (FEMA-1874-DR), dated 02/16/2010. Incident: Severe Winter Storm... disaster declaration for Private Non-Profit organizations in the Commonwealth of Virginia, dated...

  7. 77 FR 530 - Virginia Disaster Number VA-00037

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-05

    ... ADMINISTRATION Virginia Disaster Number VA-00037 AGENCY: U.S. Small Business Administration. ACTION: Amendment 1... Virginia (FEMA-4042-DR), dated 11/04/2011. Incident: Earthquake. Incident Period: 08/23/2011 through 10/25... major disaster declaration for the Commonwealth of Virginia, dated 11/04/2011 is hereby amended...

  8. 76 FR 62132 - Virginia Disaster Number VA-00038

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-06

    ... ADMINISTRATION Virginia Disaster Number VA-00038 AGENCY: U.S. Small Business Administration. ACTION: Amendment 2... only for the State of Virginia (FEMA-4024-DR), dated 09/03/2011. Incident: Hurricane Irene. Incident... Non-Profit organizations in the State of Virginia, dated 09/03/2011, is hereby amended to include...

  9. 75 FR 26813 - VIRGINIA Disaster Number VA-00028

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-12

    ... ADMINISTRATION VIRGINIA Disaster Number VA-00028 AGENCY: U.S. Small Business Administration. ACTION: Amendment 2... Only for the Commonwealth of VIRGINIA (FEMA-1874-DR), dated 02/16/2010. Incident: Severe Winter Storm... disaster declaration for Private Non-Profit organizations in the Commonwealth of VIRGINIA, dated...

  10. 76 FR 74837 - Virginia Disaster Number VA-00040

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-01

    ... ADMINISTRATION Virginia Disaster Number VA-00040 AGENCY: U.S. Small Business Administration. ACTION: Amendment 1... Only for the State of Virginia (FEMA-4042-DR), dated 11/10/2011. Incident: Earthquake. Incident Period... non-profit organizations in the State of Virginia, dated 11/10/2011, is hereby amended to include...

  11. 77 FR 1547 - Virginia Disaster Number VA-00040

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-10

    ... ADMINISTRATION Virginia Disaster Number VA-00040 AGENCY: U.S. Small Business Administration. ACTION: Amendment 3... Only for the Commonwealth of Virginia (FEMA--4042-DR), dated 11/10/2011. Incident: Earthquake. Incident... Non-Profit organizations in the Commonwealth of Virginia, dated 11/10/2011, is hereby amended...

  12. 77 FR 1547 - Virginia Disaster Number VA-00037

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-10

    ... ADMINISTRATION Virginia Disaster Number VA-00037 AGENCY: U.S. Small Business Administration. ACTION: Amendment 2... Virginia (FEMA-4042-DR), dated 11/04/ 2011. Incident: Earthquake. Incident Period: 08/23/2011 Through 10/25... disaster declaration for the State of Virginia, dated 11/04/2011 is hereby amended to include the...

  13. 75 FR 21370 - Virginia Disaster Number VA-00028

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-23

    ... ADMINISTRATION Virginia Disaster Number VA-00028 AGENCY: U.S. Small Business Administration. ACTION: Amendment 1... Only for the Commonwealth of Virginia (FEMA-1874-DR), dated 02/16/2010. Incident: Severe Winter Storm... disaster declaration for Private Non-Profit organizations in the Commonwealth of Virginia, dated...

  14. 76 FR 78957 - Virginia Disaster Number VA-00040

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-20

    ... ADMINISTRATION Virginia Disaster Number VA-00040 AGENCY: U.S. Small Business Administration. ACTION: Amendment 2... Only for the Commonwealth of Virginia (FEMA--4042--DR), dated 11/10/2011. Incident: Earthquake... Private Non-Profit organizations in the Commonwealth of Virginia, dated 11/10/2011, is hereby amended...

  15. Contracting with Medicare Advantage plans: a brief for critical access hospital administrators.

    PubMed

    Mason, Michelle; Fraser-Maginn, Roslyn; Mueller, Keith; King, Jennifer; Radford, Andrea; Slifkin, Rebecca; Lenardson, Jennifer; Silver, Lauren; Mueller, Curt

    2005-12-01

    This document summarizes the experience of CAH administrators with contracts offered by Medicare Advantage (MA) plans. Telephone surveys were conducted with CAH administrators across the country to learn about their experiences with MA plans. This brief includes information about the contract terms administrators have been offered, their experiences negotiating with MA plans, and their advice for others dealing with this issue. PMID:16397967

  16. 2. Oblique view of west portion of hospital complex showing ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    2. Oblique view of west portion of hospital complex showing in foreground, from left to right, Recreation Building (HABS No. VA-1287-N), shower room and swimming pool (HABS No. VA-1287-M); and in right middle ground, from front to rear, carpenter & paint shop (HABS No. VA-1287-L), medical storage building (HABS No. VA-1287-K), and central power house(HABS No. VA-1287-J), view to northwest from roof of 1960 high rise hospital - Portsmouth Naval Hospital, Bounded by Elizabeth River, Crawford Street, Portsmouth General Hospital, Parkview Avenue, & Scotts Creek, Portsmouth, Portsmouth, VA

  17. 78 FR 36642 - Proposed Information Collection (VA Loan Electronic Reporting Interface (VALERI) System) Activity...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-18

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS...: Comment Request AGENCY: Veterans Benefits Administration, Department of Veterans Affairs. ACTION: Notice. SUMMARY: The Veterans Benefits Administration (VBA), Department of Veterans Affairs (VA), is announcing...

  18. 78 FR 60379 - Proposed Information Collection (Credit Underwriting Standards and Procedures for Processing VA...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-01

    ... Guaranteed Loans) Activity: Comment Request AGENCY: Veterans Benefits Administration, Department of Veterans Affairs. ACTION: Notice. SUMMARY: The Veterans Benefits Administration (VBA), Department of Veterans... the notice. This notice solicits comments on information needed to underwrite VA-guaranteed...

  19. Characteristics and VA Health Care Utilization of U.S. Veterans Who Completed Suicide in Oregon between 2000 and 2005

    ERIC Educational Resources Information Center

    Basham, Chandra; Denneson, Lauren M.; Millet, Lisa; Shen, Xun; Duckart, Jonathan; Dobscha, Steven K.

    2011-01-01

    Oregon Violent Death Reporting System data were linked with Veterans Affairs (VA) administrative data to identify and describe veterans who completed suicide in Oregon from 2000 to 2005 (n = 968), and to describe their VA health care utilization in the year prior to death. Twenty-two percent had received health care in the VA system. Of these, 57%…

  20. Early administration of epinephrine (adrenaline) in patients with cardiac arrest with initial shockable rhythm in hospital: propensity score matched analysis

    PubMed Central

    Andersen, Lars W; Kurth, Tobias; Chase, Maureen; Berg, Katherine M; Cocchi, Michael N; Callaway, Clifton

    2016-01-01

    Objectives To evaluate whether patients who experience cardiac arrest in hospital receive epinephrine (adrenaline) within the two minutes after the first defibrillation (contrary to American Heart Association guidelines) and to evaluate the association between early administration of epinephrine and outcomes in this population. Design Prospective observational cohort study. Setting Analysis of data from the Get With The Guidelines-Resuscitation registry, which includes data from more than 300 hospitals in the United States. Participants Adults in hospital who experienced cardiac arrest with an initial shockable rhythm, including patients who had a first defibrillation within two minutes of the cardiac arrest and who remained in a shockable rhythm after defibrillation. Intervention Epinephrine given within two minutes after the first defibrillation. Main outcome measures Survival to hospital discharge. Secondary outcomes included return of spontaneous circulation and survival to hospital discharge with a good functional outcome. A propensity score was calculated for the receipt of epinephrine within two minutes after the first defibrillation, based on multiple characteristics of patients, events, and hospitals. Patients who received epinephrine at either zero, one, or two minutes after the first defibrillation were then matched on the propensity score with patients who were “at risk” of receiving epinephrine within the same minute but who did not receive it. Results 2978patients were matched on the propensity score, and the groups were well balanced. 1510 (51%) patients received epinephrine within two minutes after the first defibrillation, which is contrary to current American Heart Association guidelines. Epinephrine given within the first two minutes after the first defibrillation was associated with decreased odds of survival in the propensity score matched analysis (odds ratio 0.70, 95% confidence interval 0.59 to 0.82; P<0.001). Early epinephrine

  1. Facilitators and Barriers to Safe Medication Administration to Hospital Inpatients: A Mixed Methods Study of Nurses’ Medication Administration Processes and Systems (the MAPS Study)

    PubMed Central

    McLeod, Monsey; Barber, Nicholas; Franklin, Bryony Dean

    2015-01-01

    Context Research has documented the problem of medication administration errors and their causes. However, little is known about how nurses administer medications safely or how existing systems facilitate or hinder medication administration; this represents a missed opportunity for implementation of practical, effective, and low-cost strategies to increase safety. Aim To identify system factors that facilitate and/or hinder successful medication administration focused on three inter-related areas: nurse practices and workarounds, workflow, and interruptions and distractions. Methods We used a mixed-methods ethnographic approach involving observational fieldwork, field notes, participant narratives, photographs, and spaghetti diagrams to identify system factors that facilitate and/or hinder successful medication administration in three inpatient wards, each from a different English NHS trust. We supplemented this with quantitative data on interruptions and distractions among other established medication safety measures. Findings Overall, 43 nurses on 56 drug rounds were observed. We identified a median of 5.5 interruptions and 9.6 distractions per hour. We identified three interlinked themes that facilitated successful medication administration in some situations but which also acted as barriers in others: (1) system configurations and features, (2) behaviour types among nurses, and (3) patient interactions. Some system configurations and features acted as a physical constraint for parts of the drug round, however some system effects were partly dependent on nurses’ inherent behaviour; we grouped these behaviours into ‘task focused’, and ‘patient-interaction focused’. The former contributed to a more streamlined workflow with fewer interruptions while the latter seemed to empower patients to act as a defence barrier against medication errors by being: (1) an active resource of information, (2) a passive information resource, and/or (3) a

  2. Study of Educational Hospital Employees’ Satisfaction with the Administration of the Health Reform Plan in Ghazvin, 2015

    PubMed Central

    Gholami, Soheyla; Oveisi, Sonia; Ghamari, Fatemeh; Etedal, Mahboobeh Ghorban; Rajaee, Roya

    2015-01-01

    Introduction Employee satisfaction is considered to be an important component in the promotion of service quality and increased efficiency and effectiveness in the reform plan for a healthcare system. Neglecting this issue could result in a lack of success in achieving the healthcare system’s objectives. The healthcare reform plan is being implemented to achieve the objectives of the healthcare system. Thus, given the key role of hospital employees in implementing the reform plan, the aim of this study was to determine the levels of hospital employees’ satisfaction with their jobs. Methods This was a qualitative study in 2015 that included thematic analysis, and 138 employees of the Kosar, Rajaii, and Ghods Hospitals participated. Data were collected using semi-structured interviews, and the data were analyzed using content analysis. Results After analyzing the data collected by interviewing the employees, 132 codes were identified. The codes were classified into five general concepts including opinions about 1) the reform plan and its administrative barriers, 2) changes in visits, 3) changes in working conditions, 4) changes in salaries and 5) General satisfaction of personnel. Conclusion Increasing workloads, stagnant salaries, and the shortage of personnel were the main factors that reduced the satisfaction of the hospitals’ employees with the administration of the healthcare reform plan. PMID:26767104

  3. 'Baby talk' attracts neighbors to new Manassas, Va., birthing center.

    PubMed

    Botvin, Judith D

    2005-01-01

    An dollar 80 million expansion plan recently was launched by Prince William Hospital, Manassas, Va. The cornerstone of the plan is the new Hylton Family Birthing Center. The hospital employed a full range of tactics to promote the opening of the birthing center. These ranged from quarterly newsletters to billboards; from tours and radio spots to a newly revised web site. The campaign is characterized by infant testimonials, gentle humor and bright colors. PMID:15971721

  4. Indicators of breast cancer severity and appropriateness of surgery based on hospital administrative data in the Lazio Region, Italy

    PubMed Central

    Schifano, Patrizia; Papini, Paolo; Agabiti, Nera; Scarinci, Marina; Borgia, Piero; Perucci, Carlo A

    2006-01-01

    Background Administrative data can serve as an easily available source for epidemiological and evaluation studies. The aim of this study is to evaluate the use of hospital administrative data to determine breast cancer severity and the appropriateness of surgical treatment. Methods the study population consisted of 398 patients randomly selected from a cohort of women hospitalized for first-time breast cancer surgery in the Lazio Region, Italy. Tumor severity was defined in three different ways: 1) tumor size; 2) clinical stage (TNM); 3) severity indicator based on HIS data (SI). Sensitivity, specificity, and positive predictive value (PPV) of the severity indicator in evaluating appropriateness of surgery were calculated. The accuracy of HIS data was measured using Kappa statistic. Results Most of 387 cases were classified as T1 and T2 (tumor size), more than 70% were in stage I or II and the SI classified 60% of cases in medium-low category. Variation from guidelines indications identified under and over treatments. The accuracy of the SI to predict under-treatment was relatively good (58% of all procedures classified as under-treatment using pT where also classified as such using SI), and even greater predicting over-treatment (88.2% of all procedures classified as over treatment using pT where also classified as such using SI). Agreement between clinical chart and hospital discharge reports was K = 0.35. Conclusion Our findings suggest that administrative data need to be used with caution when evaluating surgical appropriateness, mainly because of the limited ability of SI to predict tumor size and the questionable quality of HIS data as observed in other studies. PMID:16464258

  5. Orthopedic Implant Value Drivers: A Qualitative Survey Study of Hospital Purchasing Administrators.

    PubMed

    Li, Chuan Silvia; Vannabouathong, Christopher; Sprague, Sheila; Bhandari, Mohit

    2015-01-01

    Osteoarthritis (OA) is a chronic, degenerative disease that is highly prevalent in the population, yet the factors that affect purchasing decisions related to this condition are poorly understood. A questionnaire was developed and administered to hospital executives across North America to determine the factors that affect purchasing decisions related to OA. Thirty-four individuals participated in the survey. Clinical evidence and cost effectiveness were deemed to be the most important factors in the process of making purchasing decisions. The most important considerations for adopting new technology were whether there was sufficient evidence in the literature, followed by thoughts of key opinion leaders, and cost of intervention/device. Ongoing research is still needed, but the current study allowed us to identify some trends in the data, providing new insight on how hospital purchasing decisions are made, which could have an immediate impact on those currently involved with making these decisions.

  6. The balancing act. Collaboration between frontline forensic staff and hospital administration.

    PubMed

    Encinares, Maxima; Pullan, Shirley

    2003-12-01

    1. Flexibility, creativity, and consistency are critical characteristics for both frontline staff and administrators in the delivery of treatment and care for complex forensic patients who may be difficult to manage. 2. Through collaborative efforts and ongoing communication, plans can be identified and implemented that enhance patient and staff safety and facilitate positive behavioral and rehabilitation outcomes for patients. 3. Effective partnerships among frontline staff, administration, patients, their families, labor unions, and communities contribute significantly to the effective resolution of conflicts and dilemmas in the provision of holistic care to forensic patients. PMID:14682030

  7. Non-administration of thrombolytic agents in acute myocardial infarction patients in Hajar hospital, Shahrekord, Iran: prevalence rate and causes

    PubMed Central

    Samieinasab, Mohammadreza; Shirani, Shahin; Hashemi, Sayyed Mohammad; Pourmoghaddas, Ali; Hekmat, Mostafa

    2013-01-01

    BACKGROUND Cardiovascular diseases are the major causes of mortality worldwide and acute myocardial infarction (AMI) is the leading cause of mortality among cardiovascular diseases. Thrombolytic therapies, especially during the first few hours after the disease onset, can significantly reduce AMI-related mortality. METHODS The current study aimed to determine the prevalence and causes of non-administration of thrombolytic therapy for AMI patients admitted to Hajar Hospital, Shahrekord, Iran, from May until November 2000. Non-probability convenient sampling method was used to select 106 subjects with Q-wave AMI. Data was collected by completing a questionnaire, reviewing medical records, and interviewing with patients. SPSS7.5 was for data analysis. RESULTS A total number of 106 AMI patients were studied among whom 62 (59%) individuals received thrombolytic therapy. Delayed referral to the hospital was the major cause of failure to provide thrombolytic therapy. The cause of non-treatment could not be identified in 15 (19.5%) subjects eligible to receive therapy. CONCLUSION Training general practitioners and individuals involved in this regard along with accelerating the process of patient referral to hospitals can reduce AMI-related mortality. PMID:23696767

  8. 30 CFR 57.22229 - Weekly testing (I-A, III, and V-A mines).

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Weekly testing (I-A, III, and V-A mines). 57.22229 Section 57.22229 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR...-A, III, and V-A mines). (a) The mine atmosphere shall be tested for methane and carbon monoxide...

  9. 30 CFR 57.22229 - Weekly testing (I-A, III, and V-A mines).

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Weekly testing (I-A, III, and V-A mines). 57.22229 Section 57.22229 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR...-A, III, and V-A mines). (a) The mine atmosphere shall be tested for methane and carbon monoxide...

  10. 30 CFR 57.22229 - Weekly testing (I-A, III, and V-A mines).

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Weekly testing (I-A, III, and V-A mines). 57.22229 Section 57.22229 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR...-A, III, and V-A mines). (a) The mine atmosphere shall be tested for methane and carbon monoxide...

  11. 77 FR 3841 - Proposed Information Collection (Survey of Veteran Enrollees (Quality and Efficiency of VA Health...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-01-25

    ... Care)) Activities Under OMB Review AGENCY: Veterans Health Administration, Department of Veterans... VA Health Care), VA Form 10-21088. OMB Control Number: 2900-0725. Type of Review: Extension of a... promote quality and efficient delivery of health care through the use of health information...

  12. 76 FR 70831 - Proposed Information Collection (Survey of Veteran Enrollees (Quality and Efficiency of VA Health...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-15

    ... Care)) Activity; Comment Request AGENCY: Veterans Health Administration, Department of Veterans Affairs... Efficiency of VA Health Care), VA Form 10-21088. OMB Control Number: 2900-0725. Type of Review: Extension of... necessary to promote quality and efficient delivery of health care through the use of health...

  13. 75 FR 20774 - Establishment of Class E Airspace; Fort A.P. Hill, VA

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-04-21

    ... final rule with a request for comments in the Federal Register on December 7, 2009 (74 FR 63974), Docket... Federal Aviation Administration 14 CFR Part 71 Establishment of Class E Airspace; Fort A.P. Hill, VA... Register December 7, 2009 that establishes Class E airspace at Fort A.P. Hill, VA. DATES: Effective...

  14. National Veterans Health Administration inpatient risk stratification models for hospital-acquired acute kidney injury

    PubMed Central

    Cronin, Robert M; VanHouten, Jacob P; Siew, Edward D; Eden, Svetlana K; Fihn, Stephan D; Nielson, Christopher D; Peterson, Josh F; Baker, Clifton R; Ikizler, T Alp; Speroff, Theodore

    2015-01-01

    Objective Hospital-acquired acute kidney injury (HA-AKI) is a potentially preventable cause of morbidity and mortality. Identifying high-risk patients prior to the onset of kidney injury is a key step towards AKI prevention. Materials and Methods A national retrospective cohort of 1,620,898 patient hospitalizations from 116 Veterans Affairs hospitals was assembled from electronic health record (EHR) data collected from 2003 to 2012. HA-AKI was defined at stage 1+, stage 2+, and dialysis. EHR-based predictors were identified through logistic regression, least absolute shrinkage and selection operator (lasso) regression, and random forests, and pair-wise comparisons between each were made. Calibration and discrimination metrics were calculated using 50 bootstrap iterations. In the final models, we report odds ratios, 95% confidence intervals, and importance rankings for predictor variables to evaluate their significance. Results The area under the receiver operating characteristic curve (AUC) for the different model outcomes ranged from 0.746 to 0.758 in stage 1+, 0.714 to 0.720 in stage 2+, and 0.823 to 0.825 in dialysis. Logistic regression had the best AUC in stage 1+ and dialysis. Random forests had the best AUC in stage 2+ but the least favorable calibration plots. Multiple risk factors were significant in our models, including some nonsteroidal anti-inflammatory drugs, blood pressure medications, antibiotics, and intravenous fluids given during the first 48 h of admission. Conclusions This study demonstrated that, although all the models tested had good discrimination, performance characteristics varied between methods, and the random forests models did not calibrate as well as the lasso or logistic regression models. In addition, novel modifiable risk factors were explored and found to be significant. PMID:26104740

  15. 1. Oblique view of Portsmouth Naval Hospital Building looking north ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    1. Oblique view of Portsmouth Naval Hospital Building looking north from roof of 1960 high-rise hospital - Portsmouth Naval Hospital, Hospital Building, Rixey Place, bounded by Williamson Drive, Holcomb Road, & The Circle, Portsmouth, Portsmouth, VA

  16. Military and VA General Dentistry Training: A National Resource.

    ERIC Educational Resources Information Center

    Atchison, Kathryn A.; Bachand, William; Buchanan, C. Richard; Lefever, Karen H.; Lin, Sylvia; Engelhardt, Rita

    2002-01-01

    Compared the program characteristics of the postgraduate general dentistry (PGD) training programs sponsored by the military and the Veterans Health Administration (VA). Gathered information on program infrastructure and emphasis, resident preparation prior to entering the program, and patients served and types of services provided. Programs…

  17. 76 FR 72838 - Amendment of Class E Airspace; Luray, VA

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-28

    ... Luray, VA, to accommodate the new Area Navigation (RNAV) Global Positioning System (GPS) Standard... Support Group, Eastern Service Center, Federal Aviation Administration, P.O. Box 20636, Atlanta, Georgia... FR 52292). Interested parties were invited to participate in this rulemaking effort by...

  18. VA Library Service--Today's look at Tomorrow's Library.

    ERIC Educational Resources Information Center

    Veterans Administration, Washington, DC.

    The Conference Poceedings are divided into three broad topics: systems planning, audiovisuals in biomedical communication, and automation and networking. Speakers from within the Veterans Administration (VA), from the National Medical Audiovisual Center, and the Lister Hill National Center for Biomedical Communications, National Library of…

  19. Haemoptysis in adults: a 5-year study using the French nationwide hospital administrative database.

    PubMed

    Abdulmalak, Caroline; Cottenet, Jonathan; Beltramo, Guillaume; Georges, Marjolaine; Camus, Philippe; Bonniaud, Philippe; Quantin, Catherine

    2015-08-01

    Haemoptysis is a serious symptom with various aetiologies. Our aim was to define the aetiologies, outcomes and associations with lung cancer in the entire population of a high-income country.This retrospective multicentre study was based on the French nationwide hospital medical information database collected over 5 years (2008-2012). We analysed haemoptysis incidence, aetiologies, geographical and seasonal distribution and mortality. We studied recurrence, association with lung cancer and mortality in a 3-year follow-up analysis.Each year, ~15 000 adult patients (mean age 62 years, male/female ratio 2/1) were admitted for haemoptysis or had haemoptysis as a complication of their hospital stay, representing 0.2% of all hospitalised patients. Haemoptysis was cryptogenic in 50% of cases. The main aetiologies were respiratory infections (22%), lung cancer (17.4%), bronchiectasis (6.8%), pulmonary oedema (4.2%), anticoagulants (3.5%), tuberculosis (2.7%), pulmonary embolism (2.6%) and aspergillosis (1.1%). Among incident cases, the 3-year recurrence rate was 16.3%. Of the initial cryptogenic haemoptysis patients, 4% were diagnosed with lung cancer within 3 years. Mortality rates during the first stay and at 1 and 3 years were 9.2%, 21.6% and 27%, respectively.This is the first epidemiological study analysing haemoptysis and its outcomes in an entire population. Haemoptysis is a life-threatening symptom unveiling potentially life-threatening underlying conditions.

  20. VA telemental health: suicide assessment.

    PubMed

    Godleski, Linda; Nieves, J Edwin; Darkins, Adam; Lehmann, Laurent

    2008-01-01

    The Department of Veterans Affairs (VA) encompasses one of the largest telemental health networks in the world, with over 45,000 videoconferencing and over 5,000 home telemental health encounters annually. Recently, the VA designated suicide prevention as a major priority, with telehealth modalities providing opportunities for remote interventions. Suicide risk assessments, using videoconferencing, are now documented in the literature, as are current studies that find telemental health to be equivalent to face-to-face treatment. Remote assessment of suicidality, however, involves complex legal issues: licensing requirements for remote delivery of care, legal procedures for involuntary detainment and commitment of potentially harmful patients, and liability questions related to the remote nature of the mental health service. VA best practices for remote suicide risk assessment include paradigms for establishing procedures in the context of legal challenges (licensing and involuntary detainment/commitment), for utilizing clinical assessment and triage decision protocols, and for contingency planning to optimize patient care and reduce liability.

  1. An empirical evaluation of devolving administrative control to Costa Rican hospital and clinic directors.

    PubMed

    Lee, Theodore; McKee, Douglas

    2015-01-01

    In the early 2000s, Costa Rica implemented comprehensive reforms of its health care system, including devolving administrative power from the central government to some providers that remain part of the national system. In this article, we evaluate how this aspect of the reform affected clinic efficiency and population health by analyzing administrative data on regional providers and mortality rates in local areas. We compare changes in outcomes across time between areas that signed performance contracts with the central government and received limited budgetary control to those that continued to be managed directly by the central government. We believe the reform created opportunities for providers to become more efficient and effective. Our results suggest that the reform significantly decreased costs without adversely affecting quality of care or population health.

  2. An empirical evaluation of devolving administrative control to Costa Rican hospital and clinic directors.

    PubMed

    Lee, Theodore; McKee, Douglas

    2015-01-01

    In the early 2000s, Costa Rica implemented comprehensive reforms of its health care system, including devolving administrative power from the central government to some providers that remain part of the national system. In this article, we evaluate how this aspect of the reform affected clinic efficiency and population health by analyzing administrative data on regional providers and mortality rates in local areas. We compare changes in outcomes across time between areas that signed performance contracts with the central government and received limited budgetary control to those that continued to be managed directly by the central government. We believe the reform created opportunities for providers to become more efficient and effective. Our results suggest that the reform significantly decreased costs without adversely affecting quality of care or population health. PMID:25813506

  3. Estimating the cost of diabetes mellitus-related events from inpatient admissions in Sweden using administrative hospitalization data.

    PubMed

    Gerdtham, Ulf-G; Clarke, Philip; Hayes, Alison; Gudbjornsdottir, Soffia

    2009-01-01

    To estimate short- and long-term costs of inpatient hospitalization in Sweden for major diabetes mellitus-related events. Costs were estimated using administrative hospital data from the Swedish National Board of Health and Welfare, which is linked to the Swedish National Diabetes Register. Data were available for 179 749 patients with diabetes in Sweden from 1998 to 2003 (mean and median duration of 6 years' follow-up). Costing of inpatient admissions was based on Nordic diagnosis-related groups (NordDRG). Multiple regression analysis (linear and generalizing estimating equation models) was used to estimate inpatient care costs controlling for age, sex and co-morbidities. The data on hospitalizations were converted to costs (euro) using 2003 exchange rates. The average annual costs (linear model) associated with inpatient admissions for a 60-year-old male in the year the first event first occurred were as follows: euro6488 (95% CI 5034, 8354) for diabetic coma; euro6850 (95% CI 6514, 7204) for heart failure; euro7853 (95% CI 7559, 8144) for non-fatal stroke; euro8121 (95% CI 7104, 9128) for peripheral circulatory complications; euro8736 (95% CI 8474, 9001) for non-fatal myocardial infarction (MI); euro10 360 (95% CI 10 085, 10 643) for ischaemic heart disease; euro11 411 (95% CI 10 298, 12 654) for renal failure; and euro14 949 (95% CI 13 849, 16 551) for amputation. On average, the costs were higher when co-morbidity was accounted for (e.g. MI with co-morbidity was twice as costly as MI alone). Average hospital inpatient costs associated with common diabetes-related events can be estimated using panel data regression methods. These could assist in modelling of long-term costs of diabetes and in evaluating the cost effectiveness of improving care.

  4. Administration of care to older patients in transition from hospital to home care services: home nursing leaders’ experiences

    PubMed Central

    Dale, Bjørg; Hvalvik, Sigrun

    2013-01-01

    Background Older persons in transition between hospital and home care services are in a particularly vulnerable situation and risk unfortunate consequences caused by organizational inefficiency. The purpose of the study reported here was to elucidate how home nursing leaders experience the administration of care to older people in transition from hospital to their own homes. Methods A qualitative study design was used. Ten home nursing leaders in two municipalities in southern Norway participated in individual interviews. The interview texts were audio taped, transcribed verbatim and analyzed by use of a phenomenological-hermeneutic approach. Results Three main themes and seven subthemes were deduced from the data. The first main theme was that the home nursing leaders felt challenged by the organization of home care services. Two subthemes were identified related to this. The first was that the leaders lacked involvement in the transitional process, and the second was that they were challenged by administration of care being decided at another level in the municipality. The second main theme found was that the leaders felt that they were acting in a shifting and unsettled context. Related to this, they had to adjust internal resources to external demands and expectations, and experienced lack of communication with significant others. The third main theme identified was that the leaders endeavored to deliver care in accordance with professional values. The two related subthemes were, first, that they provided for appropriate internal systems and routines, and, second, that they prioritized available professional competence, and made an effort to promote a professional culture. Conclusion To meet the complex needs of the patients in a professional way, the home nursing leaders needed to be flexible and pragmatic in their administration of care. This involved utilizing available professional competence appropriately. The coordination and communication between the

  5. Acquired Immune Deficiency Syndrome (AIDS) and the Veterans' Administration. Hearing before the Subcommittee on Hospitals and Health Care of the Committee on Veterans' Affairs. House of Representatives, One Hundredth Congress, First Session.

    ERIC Educational Resources Information Center

    Congress of the U.S., Washington, DC. House Committee on Veterans' Affairs.

    This document presents witness testimony and prepared statements from the Congressional hearing called to examine the issue of acquired immune deficiency syndrome (AIDS) and the role of the Veterans' Administration (VA) in combating AIDS. Opening statements are included from Representatives G. V. Montgomery, J. Roy Rowland, Joseph P. Kennedy, II,…

  6. Impact of Low Procalcitonin Results on Antibiotic Administration in Hospitalized Patients at a Tertiary Care Center.

    PubMed

    Brennan, Meghan B; Osterby, Kurt; Schulz, Lucas; Lepak, Alexander J

    2016-06-01

    Procalcitonin is a sensitive and specific marker of bacterial infection; low results allow clinicians to safely de-escalate antibiotics. This retrospective cohort study aimed to determine the effect of low procalcitonin results on withholding, discontinuing, or de-escalating antibiotics in hospitalized patients at a tertiary care center. Antibiotics were initiated or continued without de-escalation in 55% of patients with low procalcitonin results. Among patients with low procalcitonin results, the primary service, but not measures of patient complexity, disease severity, or underlying disease process (lower respiratory tract infection evaluation versus systemic inflammatory response syndrome/possible sepsis) was associated with initiation or continued broad-spectrum antibiotic use. Provider-level factors may be an important variable in the initiation or continued use of broad-spectrum antibiotics for patients with low procalcitonin levels. PMID:27251126

  7. Enhancing Clinical Content and Race/Ethnicity Data in Statewide Hospital Administrative Databases: Obstacles Encountered, Strategies Adopted, and Lessons Learned

    PubMed Central

    Pine, Michael; Kowlessar, Niranjana M; Salemi, Jason L; Miyamura, Jill; Zingmond, David S; Katz, Nicole E; Schindler, Joe

    2015-01-01

    Objectives Eight grant teams used Agency for Healthcare Research and Quality infrastructure development research grants to enhance the clinical content of and improve race/ethnicity identifiers in statewide all-payer hospital administrative databases. Principal Findings Grantees faced common challenges, including recruiting data partners and ensuring their continued effective participation, acquiring and validating the accuracy and utility of new data elements, and linking data from multiple sources to create internally consistent enhanced administrative databases. Successful strategies to overcome these challenges included aggressively engaging with providers of critical sources of data, emphasizing potential benefits to participants, revising requirements to lessen burdens associated with participation, maintaining continuous communication with participants, being flexible when responding to participants’ difficulties in meeting program requirements, and paying scrupulous attention to preparing data specifications and creating and implementing protocols for data auditing, validation, cleaning, editing, and linking. In addition to common challenges, grantees also had to contend with unique challenges from local environmental factors that shaped the strategies they adopted. Conclusions The creation of enhanced administrative databases to support comparative effectiveness research is difficult, particularly in the face of numerous challenges with recruiting data partners such as competing demands on information technology resources. Excellent communication, flexibility, and attention to detail are essential ingredients in accomplishing this task. Additional research is needed to develop strategies for maintaining these databases when initial funding is exhausted. PMID:26119470

  8. Use of VA and Medicare Services By Dually Eligible Veterans with Psychiatric Problems

    PubMed Central

    Carey, Kathleen; Montez-Rath, Maria E; Rosen, Amy K; Christiansen, Cindy L; Loveland, Susan; Ettner, Susan L

    2008-01-01

    Objective To examine how service accessibility measured by geographic distance affects service sector choices for veterans who are dually eligible for veterans affairs (VA) and Medicare services and who are diagnosed with mental health and/or substance abuse (MH/SA) disorders. Data Sources Primary VA data sources were the Patient Treatment (acute care), Extended Care (long-term care), and Outpatient Clinic files. VA cost data were obtained from (1) inpatient and outpatient cost files developed by the VA Health Economics and Resource Center and (2) outpatient VA Decision Support System files. Medicare data sources were the denominator, Medicare Provider Analysis Review (MEDPAR), Provider-of-Service, Outpatient Standard Analytic and Physician/Supplier Standard Analytic files. Additional sources included the Area Resource File and Census Bureau data. Study Design We identified dually eligible veterans who had either an inpatient or outpatient MH/SA diagnosis in the VA system during fiscal year (FY)'99. We then estimated one- and two-part regression models to explain the effects of geographic distance on both VA and Medicare total and MH/SA costs. Principal Findings Results provide evidence for substitution between the VA and Medicare, demonstrating that poorer geographic access to VA inpatient and outpatient clinics decreased VA expenditures but increased Medicare expenditures, while poorer access to Medicare-certified general and psychiatric hospitals decreased Medicare expenditures but increased VA expenditures. Conclusions As geographic distance to VA medical facility increases, Medicare plays an increasingly important role in providing mental health services to veterans. PMID:18355256

  9. A rapid infusion pump driven by micro electromagnetic linear actuation for pre-hospital intravenous fluid administration.

    PubMed

    Zhao, Peng; Chong, Yinbao; Zhao, An; Lang, Lang; Wang, Qing; Liu, Jiuling

    2015-02-01

    A rapid infusion pump with a maximum flow rate of 6 L/h was designed experimentally using a micro electromagnetic linear actuator, and its effectiveness was evaluated by comparing with that of a commercial Power Infuser under preset flow rates of 0.2, 2, and 6 L/h. The flow rate, air detection sensitivity, occlusion response time, quantitative determination of hemolysis, and power consumption of the infusion devices were extensively investigated using statistical analysis methods (p < 0.05). The experimental results revealed that the flow rate of the designed infusion pump was more stable and accurate, and the hemolysis was significantly less than that of the Power Infuser. The air detection sensitivity and the power consumption could be comparable to that of the Power Infuser except the occlusion response time. The favorable performance made the designed infusion pump a potential candidate for applications in pre-hospital fluid administration.

  10. 23. Photographic copy of historic photograph, view of the hospital ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    23. Photographic copy of historic photograph, view of the hospital complex grounds to the east, showing World War I emergency buildings behind the Portsmouth Naval Hospital Building, 29 November 1918. (Portsmouth Naval Shipyard Museum, Portsmouth, VA) - Portsmouth Naval Hospital, Bounded by Elizabeth River, Crawford Street, Portsmouth General Hospital, Parkview Avenue, & Scotts Creek, Portsmouth, Portsmouth, VA

  11. 22. Photographic copy of historic photograph, view of the hospital ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    22. Photographic copy of historic photograph, view of the hospital complex grounds to the west, showing World War I emergency buildings behind the Portsmouth Naval Hospital Building, 14 November 1918. (Portsmouth Naval Shipyard Museum, Portsmouth, VA) - Portsmouth Naval Hospital, Bounded by Elizabeth River, Crawford Street, Portsmouth General Hospital, Parkview Avenue, & Scotts Creek, Portsmouth, Portsmouth, VA

  12. Phenytoin blood concentrations in hospitalized geriatric patients: oral versus nasogastric feeding tube administration.

    PubMed

    Lubart, Emilia; Berkovitch, Matitiahu; Leibovitz, Arthur; Orly, Dafni; Segal, Refael

    2010-04-01

    Many medications administered to frail geriatric patients are not in a liquid form, but are crushed and dissolved in water before their administration through a nasogastric tube (NGT). Some medications are enteric coated and others are extended release. Only sparse information is available on their pharmacokinetics when administered through NGT. The aim of our study was to evaluate the pharmacokinetics of phenytoin administered through an NGT and to compare these with the pharmacokinetics of a group of patients receiving the drug orally. Twenty patients were studied in a stable clinical condition, from the long-term care ward of the Geriatric Medical Center Shmuel Harofeh. They were consistently treated with phenytoin for the prevention of seizure disorders. Patients in group 1 (n = 12) had oropharyngeal dysphagia and received feeding and medications by NGT. Group 2 (n = 8), included age-matched orally fed patients from the same department, who received phenytoin orally. Blood samples for phenytoin concentration were taken at baseline, time 0, and at 1, 3, 4, 6, and 8 hours postdrug administration; phenytoin was measured using the AxSYM assay. The mean daily dose was not statistically different between the 2 groups: 291 +/- 28 (200-300) mg/d and 300 +/- 53 (200-400) mg/d, in the NGT, and the orally fed group, respectively, in one dose. Pharmacokinetic parameters of phenytoin were not significantly different between the 2 groups; trough concentrations, 1.9 +/- 1.7 (0.5-4.9) versus 2.2 +/- 1.8 (1.0-6.5) microg/mL; Cmax, 6.6 +/- 3.4 (2.5-9.1) versus 7.3 +/- 6.7 (2.7-8.4) microg/mL; tmax, 5.1 +/- 3.1 (3.1-8.2) versus 4.6 +/- 2.7 (2.3-8.4) hours; area under the curve, 52.2 +/- 40.1 (41.1-61.2) versus 62.3 +/- 84.7 (30.2-77.2) microg/h/mL, in the NGT fed versus the oral fed, respectively. Phenytoin pharmacokinetic parameters are not significantly different between patients receiving the drug through NGT as compared with those who received it orally, but the implication

  13. Randomized trial of pragmatic education for low-risk COPD patients: impact on hospitalizations and emergency department visits

    PubMed Central

    Siddique, Haamid H; Olson, Raymond H; Parenti, Connie M; Rector, Thomas S; Caldwell, Michael; Dewan, Naresh A; Rice, Kathryn L

    2012-01-01

    Background: Most interventions aimed at reducing hospitalizations and emergency department (ED) visits in patients with chronic obstructive pulmonary disease (COPD) have employed resource-intense programs in high-risk individuals. Although COPD is a progressive disease, little is known about the effectiveness of proactive interventions aimed at preventing hospitalizations and ED visits in the much larger population of low-risk (no known COPD-related hospitalizations or ED visits in the prior year) patients, some of whom will eventually become high-risk. Methods: We tested the effect of a simple educational and self-efficacy intervention (n = 2243) versus usual care (n = 2182) on COPD/breathing-related ED visits and hospitalizations in a randomized study of low-risk patients at three Veterans Affairs (VA) medical centers in the upper Midwest. Administrative data was used to track VA admissions and ED visits. A patient survey was used to determine health-related events outside the VA. Results: Rates of COPD-related VA hospitalizations in the education and usual care group were not significantly different (3.4 versus 3.6 admissions per 100 person-years, respectively; 95% CI of difference −1.3 to 1.0, P = 0.77). The much higher patient-reported rates of non-VA hospitalizations for breathing-related problems were lower in the education group (14.0 versus 19.0 per 100 person-years; 95% CI −8.6 to −1.4, P = 0.006). Rates of COPD-related VA ED visits were not significantly different (6.8 versus 5.3; 95% CI −0.1 to 3.0, P = 0.07), nor were non-VA ED visits (32.4 versus 36.5; 95% CI −9.3 to 1.1, P = 0.12). All-cause VA admission and ED rates did not differ. Mortality rates (6.9 versus 8.3 per 100 person-years, respectively; 95% CI −3.0 to 0.4, P = 0.13) did not differ. Conclusion: An educational intervention that is practical for large numbers of low-risk patients with COPD may reduce the rate of breathing-related hospitalizations. Further research that more

  14. Incidence of Hospitalization for Respiratory Syncytial Virus Infection amongst Children in Ontario, Canada: A Population-Based Study Using Validated Health Administrative Data

    PubMed Central

    Pisesky, Andrea; Benchimol, Eric I.; Wong, Coralie A.; Hui, Charles; Crowe, Megan; Belair, Marc-Andre; Pojsupap, Supichaya; Karnauchow, Tim; O'Hearn, Katie; Yasseen, Abdool S.; McNally, James D.

    2016-01-01

    Importance RSV is a common illness among young children that causes significant morbidity and health care costs. Objective Routinely collected health administrative data can be used to track disease incidence, explore risk factors and conduct health services research. Due to potential for misclassification bias, the accuracy of data-elements should be validated prior to use. The objectives of this study were to validate an algorithm to accurately identify pediatric cases of hospitalized respiratory syncytial virus (RSV) from within Ontario’s health administrative data, estimate annual incidence of hospitalization due to RSV and report the prevalence of major risk factors within hospitalized patients. Study Design and Setting A retrospective chart review was performed to establish a reference-standard cohort of children from the Ottawa region admitted to the Children’s Hospital of Eastern Ontario (CHEO) for RSV-related disease in 2010 and 2011. Chart review data was linked to Ontario’s administrative data and used to evaluate the diagnostic accuracy of algorithms of RSV-related ICD-10 codes within provincial hospitalization and emergency department databases. Age- and sex-standardized incidence was calculated over time, with trends in incidence assessed using Poisson regression. Results From a total of 1411 admissions, chart review identified 327 children hospitalized for laboratory confirmed RSV-related disease. Following linkage to administrative data and restriction to first admissions, there were 289 RSV patients in the reference-standard cohort. The best algorithm, based on hospitalization data, resulted in sensitivity 97.9% (95%CI: 95.5–99.2%), specificity 99.6% (95%CI: 98.2–99.8%), PPV 96.9% (95%CI: 94.2–98.6%), NPV 99.4% (95%CI: 99.4–99.9%). Incidence of hospitalized RSV in Ontario from 2005–2012 was 10.2 per 1000 children under 1 year and 4.8 per 1000 children aged 1 to 3 years. During the surveillance period, there was no identifiable

  15. 75 FR 24510 - Drug and Drug-Related Supply Promotion by Pharmaceutical Company Sales Representatives at VA...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-05

    ... limited to hospitals, CBOCs, nursing homes, and domiciliaries. We would define ``VA National Formulary... Veterans Nursing Home Care and 64.011 Veterans Dental Care. List of Subjects in 38 CFR Part 1... standard of permissible business practice at VA facilities. It would also facilitate mutually...

  16. 75 FR 26160 - Drug and Drug-Related Supply Promotion by Pharmaceutical Company Sales Representatives at VA...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-11

    ... VA medical facilities, including but not limited to hospitals, CBOCs, nursing homes, and... Veterans Nursing Home Care and 64.011 Veterans Dental Care. Signing Authority The Secretary of Veterans... VA facilities, and provide sales representatives with a consistent standard of permissible...

  17. 12. 1960 highrise hospital, front (south) facade, view to northwest ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    12. 1960 high-rise hospital, front (south) facade, view to northwest - Portsmouth Naval Hospital, Bounded by Elizabeth River, Crawford Street, Portsmouth General Hospital, Parkview Avenue, & Scotts Creek, Portsmouth, Portsmouth, VA

  18. Clinical and Administrative Approaches to Improving the Efficiency of Joint Arthroplasty and Reducing Hospital Length of Stay.

    PubMed

    Booth, Robert E

    2015-10-01

    In the current health care environment, it is more important than ever for orthopedic surgeons to strive for optimal efficiency and effectiveness. For maximum efficiency, patients can be preselected to limit patient types that commonly require a greater investment of the practice's time and resources. Structuring surgical practices for efficiency may involve rethinking the staffing model, anticipating problems that may occur with individual patients, and enhancing internal and external communications. Turnover time between patients must be measured and minimized, and activity in the operating room--including the surgeon's own technique--must be evaluated and refined where necessary. Clinical advances that can enhance efficiency should be considered. Among such advances are tranexamic acid, intravenous acetaminophen, and bupivacaine liposome injectable suspension (EXPAREL®, Pacira Pharmaceuticals, Inc). Intravenous acetaminophen and liposomal bupivacaine, in particular, can significantly improve efficiency by reducing the administration of opioid medication during the postoperative period, and thereby reducing opioid-related side effects. Liposomal bupivacaine has also been shown to shorten the hospital length of stay and, in many cases, eliminate the need for costly and inefficient nerve blocks. PMID:26447430

  19. Setting the stage for a new strategic plan for geriatrics and extended care in the Veterans Health Administration: summary of the 2008 VA State of the Art Conference, "The changing faces of geriatrics and extended care: meeting the needs of veterans in the next decade".

    PubMed

    Shay, Kenneth; Burris, James F

    2008-12-01

    The Department of Veterans Affairs (VA) assumed an early leadership role in focusing on care of elderly adults. In 1998, the Federal Advisory Committee on the Future of VA Long-Term Care, appointed by the VA Undersecretary for Health, recommended redirection of VA's extended care programs toward noninstitutional forms. A decade later, VA's Office of Geriatrics and Extended Care (GEC) initiated a strategic planning process by convening experts in geriatrics and health care, policy, and finance in Virginia on March 25 to 27, 2008, to present to VA clinicians and clinical managers the "State of the Art" of VA GEC. Recurring clinical themes included rising numbers and complexity of aging veterans, recent addition of younger veterans to VA's extended care mix, challenges that dementia and mental illness exert throughout GEC, and need for seamlessness in delivery of care across multiple venues. Ongoing research efforts quantifying demand and resources and validating models of care will remain indispensible for meeting clinical challenges. Serious undersupply of clinicians of all disciplines with general or specialty geriatrics knowledge persists. Much of VA's healthcare workforce and leadership are approaching retirement age, driving the need for new educational approaches, recruitment and retention strategies, and innovative delivery systems. Growing dependence on informal caregivers highlights the need for supporting these partners. VA's healthcare budget allocation illustrates how national policy dictates systemic, regional, and local clinical decisions. Rehabilitation of the newest veterans is resulting in systemwide efficiencies. Educating and empowering patients and families results in optimized utilization of health resources. PMID:19093933

  20. Using average cost methods to estimate encounter-level costs for medical-surgical stays in the VA.

    PubMed

    Wagner, Todd H; Chen, Shuo; Barnett, Paul G

    2003-09-01

    The U.S. Department of Veterans Affairs (VA) maintains discharge abstracts, but these do not include cost information. This article describes the methods the authors used to estimate the costs of VA medical-surgical hospitalizations in fiscal years 1998 to 2000. They estimated a cost regression with 1996 Medicare data restricted to veterans receiving VA care in an earlier year. The regression accounted for approximately 74 percent of the variance in cost-adjusted charges, and it proved to be robust to outliers and the year of input data. The beta coefficients from the cost regression were used to impute costs of VA medical-surgical hospital discharges. The estimated aggregate costs were reconciled with VA budget allocations. In addition to the direct medical costs, their cost estimates include indirect costs and physician services; both of these were allocated in proportion to direct costs. They discuss the method's limitations and application in other health care systems. PMID:15095543

  1. 24. Photographic copy of historic photograph, view of the hospital ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    24. Photographic copy of historic photograph, view of the hospital complex grounds to the southwest toward Parkview Avenue, showing the cemetery and the construction of World War I emergency buildings, 20 December 1918. (Portsmouth Naval Shipyard Museum, Portsmouth, VA) - Portsmouth Naval Hospital, Bounded by Elizabeth River, Crawford Street, Portsmouth General Hospital, Parkview Avenue, & Scotts Creek, Portsmouth, Portsmouth, VA

  2. 21. Photographic copy of historic photograph, view of the hospital ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    21. Photographic copy of historic photograph, view of the hospital complex grounds to the east from the roof of the Central Power House, showing the adjacent Medical Storage Building and World War I tent camp, 26 September, 1918. (Portsmouth Naval Shipyard Museum, Portsmouth, VA) - Portsmouth Naval Hospital, Bounded by Elizabeth River, Crawford Street, Portsmouth General Hospital, Parkview Avenue, & Scotts Creek, Portsmouth, Portsmouth, VA

  3. 75 FR 51331 - Draft Tier II Environmental Impact Statement: Southeast High Speed Rail Corridor-Richmond, VA...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-08-19

    ... Federal Railroad Administration Draft Tier II Environmental Impact Statement: Southeast High Speed Rail... the Tier II Draft Environmental Impact Statement for the Southeast High Speed Rail, Richmond, VA to... the Draft Tier II Environmental Impact Statement for the Southeast High Speed Rail, Richmond, VA...

  4. Statistical Match of the VA 1979-1980 Recipient File against the 1979-1980 Basic Grant Recipient File. Revised.

    ERIC Educational Resources Information Center

    Applied Management Sciences, Inc., Silver Spring, MD.

    The amount of misreporting of Veterans Administration (VA) benefits was assessed, along with the impact of misreporting on the Basic Educational Opportunity Grant (BEOG) program. Accurate financial information is need to determine appropriate awards. The analysis revealed: over 97% of VA beneficiaries misreported benefits; the total net loss to…

  5. Delivery of gender-sensitive comprehensive primary care to women veterans: implications for VA Patient Aligned Care Teams.

    PubMed

    Yano, Elizabeth M; Haskell, Sally; Hayes, Patricia

    2014-07-01

    The Veterans Health Administration (VA) has undertaken a major initiative to transform primary care delivery through implementation of Patient Aligned Care Teams (PACTs). Based on the patient-centered medical home concept, PACTs aim to improve access, continuity, coordination, and comprehensiveness using team-based care that is patient driven and patient centered. However, how PACT principles should be applied to meet the needs of special populations, including women veterans, is not entirely clear. While historical differences in military participation meant women veterans were rarely seen in VA healthcare settings, they now represent the fastest growing segment of new VA users. They also have complex healthcare needs, adding gender-specific services and other needs to the spectrum of services that the VA must deliver. These trends are changing the VA landscape, introducing challenges to how VA care is organized, how VA providers need to be trained, and how VA considers implementation of new initiatives, such as PACT. We briefly describe the evolution of VA primary care delivery for women veterans, review VA policy for delivering gender-sensitive comprehensive primary care for women, and discuss the challenges that women veterans' needs pose in the context of PACT implementation. We conclude with recommendations for addressing some of these challenges moving forward.

  6. Hospital financing by self administrated institutions. Proposals for a new form of organization and financing of hospital care in West-Germany.

    PubMed

    Baumgarten, J

    1988-01-01

    Acta Hospitalia publishes this summary as an illustration of the difficult process most Western countries experience in reorienting their hospital financing systems. The case of West-Germany is of particular interest. It is the leading economic power in the European Economic Community and its sickness funds (the Krankenkassen) play a very important role in hospital financing. The article reports on the conclusions of a five year study by the R. Bosch Stiftung. We draw attention to the following: The article illustrates that each hospital financing system implies a particul balance of power between the hospitals, on the one hand, and the sickness funds on the other hand, under the auspices of the government. The final balance of power is not so much determined by the general principles but by the detailed operational procedures on which the financing system will eventually be based. This may explain why the conclusions of the Commission are rather vague. The option of the price as the main control instrument immediately demands some 'state committee' to lay down the guidelines for the provision of hospital care including the regional conditions and minimum service quantity and quality standards.

  7. KaVA ESTEMA project

    NASA Astrophysics Data System (ADS)

    Oyadomari, Miyako; Imai, Hiroshi; Cho, Se-Hyung; Asaki, Yoshiharu; Choi, Yoon-Kyong; Kim, Jaeheon; Yun, Youngjoo; Matsumoto, Naoko; Min, Cheul-Hong; Oyama, Tomoaki; Yoon, Sung-Chul; Yoon, Dong-Hwan; Kim, Dong-Jin; Dodson, Richard; Rioja, Maria; Burns, Ross; Orosz, Gabor; Nakagawa, Akiharu; Chibueze O, James; Nakashima, Jun-ichi; Sobolev, Andrey

    2016-07-01

    The ESTEMA (Expanded Study on Stellar Masers) project is one of three Large Programs of the KaVA (the combined array of the Korean VLBI Network and Japanese VLBI Exploration of Radio Astrometry), and conducted in 2015-2016. It aims to publish a database of the largest sample of VLBI images of circumstellar water (H2O) and silicon-monoxide (SiO) maser sources towards circumstellar envelopes (CSEs) of 80 evolved stars in late AGB to early post-AGB phase. Here we present the specifications of the ESTEMA observations and the planned scientific goals in order to share the basic information of the ESTEMA with astronomical community and encourage future collaborations with the ESTEMA and future follow-up observations for the targeted stars.

  8. Medicare Program: Hospital Outpatient Prospective Payment and Ambulatory Surgical Center Payment Systems and Quality Reporting Programs; Short Inpatient Hospital Stays; Transition for Certain Medicare-Dependent, Small Rural Hospitals Under the Hospital Inpatient Prospective Payment System; Provider Administrative Appeals and Judicial Review. Final rule with comment period; final rule.

    PubMed

    2015-11-13

    This final rule with comment period revises the Medicare hospital outpatient prospective payment system (OPPS) and the Medicare ambulatory surgical center (ASC) payment system for CY 2016 to implement applicable statutory requirements and changes arising from our continuing experience with these systems. In this final rule with comment period, we describe the changes to the amounts and factors used to determine the payment rates for Medicare services paid under the OPPS and those paid under the ASC payment system. In addition, this final rule with comment period updates and refines the requirements for the Hospital Outpatient Quality Reporting (OQR) Program and the ASC Quality Reporting (ASCQR) Program. Further, this document includes certain finalized policies relating to the hospital inpatient prospective payment system: Changes to the 2-midnight rule under the short inpatient hospital stay policy; and a payment transition for hospitals that lost their status as a Medicare-dependent, small rural hospital (MDH) because they are no longer in a rural area due to the implementation of the new Office of Management and Budget delineations in FY 2015 and have not reclassified from urban to rural before January 1, 2016. In addition, this document contains a final rule that finalizes certain 2015 proposals, and addresses public comments received, relating to the changes in the Medicare regulations governing provider administrative appeals and judicial review relating to appropriate claims in provider cost reports.

  9. 48 CFR 801.690 - VA's COCP.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 5 2014-10-01 2014-10-01 false VA's COCP. 801.690 Section 801.690 Federal Acquisition Regulations System DEPARTMENT OF VETERANS AFFAIRS GENERAL DEPARTMENT OF... Responsibilities 801.690 VA's COCP....

  10. Homeless and nonhomeless VA service users likely eligible for Medicaid expansion.

    PubMed

    Tsai, Jack; Rosenheck, Robert A

    2014-01-01

    Administrative data on the population of Department of Veterans Affairs (VA) service users in 2010 under the age of 65 (n = 3,841,225) were analyzed to identify the number and characteristics of homeless and nonhomeless VA service users who are likely to be eligible for the Medicaid expansion (LEME) option under the Affordable Care Act. Results showed that, estimating conservatively, about 1.2 million (21%) current VA users are LEME if all states implement the expansion. Homeless service users were twice as likely to be eligible than nonhomeless users (64% vs 30%). VA service users who are LEME, regardless of housing status, were physically healthier than those not LEME but were more likely to have substance use disorders and posttraumatic stress disorder. These findings suggest that many VA service users are LEME, particularly those who are homeless and/or have mental health needs. Cross-system use of VA and Medicaid-funded services may be advantageous for veterans with extensive medical and psychiatric needs but also risks fragmented care. Information and education for VA clinicians and their patients about possible implications of the Affordable Care Act may be important. PMID:25358031

  11. Involving physicians in TQM. To gain physician support for quality management, hospital administrators must treat physicians as customers.

    PubMed

    McCarthy, G J

    1993-12-01

    The process of integrating physicians into a hospital's total quality management (TQM) program is not simple. Physicians will not view TQM as an acceptable strategy in the absence of a positive working relationship with hospital managers. Physicians must see hospital managers as colleagues who can help improve their medical practices both in efficiency and patient care. The first step in involving physicians in TQM is creating an environment that enhances physician relationships. The CEO should be actively involved with the medical staff, and senior hospital managers should work at cultivating physician relationships. Physician needs and the centrality of the physician-management relationship should enter into every management discussion. Also, managers must solicit physician feedback regularly. Managers can introduce physicians to TQM by accompanying them to off-site TQM programs for a few days. Managers should also coordinate a continuing education program at the hospital, inviting a physician to address medical staff about TQM. Physicians are more likely to respond positively to one of their peers than they would to a consultant or business manager. Managers should then invite hospital-based physicians to participate on TQM interdisciplinary teams to resolve a problem chosen by the senior medical staff. The problem should be one that promises to be a quick fix, thereby ensuring demonstrable success of TQM and allaying any doubts. After an initial demonstration of TQM's success, the cycle is repeated. A year or two later, managers should invite off-site clinicians to join interdisciplinary teams on issues important to them.

  12. Conducting research using the electronic health record across multi-hospital systems: semantic harmonization implications for administrators.

    PubMed

    Bowles, Kathryn H; Potashnik, Sheryl; Ratcliffe, Sarah J; Rosenberg, Melissa; Shih, Nai-Wei; Topaz, Maxim; Holmes, John H; Naylor, Mary D

    2013-06-01

    Administrators play a major role in choosing and managing the use of the electronic health record (EHR). The documentation policies and EHR changes enacted or approved by administrators affect the ability to use clinical data for research. This article illustrates the challenges that can be avoided through awareness of the consequences of customization, variations in documentation policies and quality, and user interface features. Solutions are posed that assist administrators in avoiding these challenges and promoting data harmonization for research and quality improvement.

  13. Development and use of an administrative claims measure for profiling hospital-wide performance on 30-day unplanned readmission

    PubMed Central

    Horwitz, Leora I.; Partovian, Chohreh; Lin, Zhenqiu; Grady, Jacqueline N.; Herrin, Jeph; Conover, Mitchell; Montague, Julia; Dillaway, Chloe; Bartczak, Kathleen; Suter, Lisa G.; Ross, Joseph S.; Bernheim, Susannah M.; Krumholz, Harlan M.; Drye, Elizabeth E.

    2014-01-01

    Background Existing publicly-reported readmission measures are condition-specific, representing < 20% of adult hospitalizations. An all-condition measure may better measure quality and promote innovation. Objective To develop an all-condition, hospital-wide readmission measure. Design Measure development Setting 4,821 US hospitals. Patients Medicare Fee for Service (FFS) beneficiaries ≥ 65 years. Measurements Hospital-level, risk-standardized unplanned readmissions within 30 days of discharge. The measure uses Medicare FFS claims and is a composite of five specialty-based risk-standardized rates for medicine, surgery/gynecology, cardiorespiratory, cardiovascular and neurology cohorts. We randomly split the 2007–2008 admissions for development and validation. Models were adjusted for age, principal diagnosis and comorbidity. We examined calibration in Medicare and all-payer data, and compared hospital rankings in the development and validation samples. Results The development dataset contained 8,018,949 admissions associated with 1,276,165 unplanned readmissions (15.9%). The median hospital risk-standardized unplanned readmission rate was 15.8 (range 11.6–21.9). The five specialty cohort models accurately predicted readmission risk in both Medicare and all-payer datasets for average risk patients but slightly overestimated readmission risk at the extremes. Overall hospital risk-standardized readmission rates did not differ statistically in the split samples (p=0.7 for difference in rank) and 76% of hospitals’ validation set rankings were within two deciles of the development rank (24% >2 deciles). Of hospitals ranking in the top or bottom deciles, 90% remained within two deciles (10% >2 deciles), and 82% remained within one decile (18% > 1 decile). Limitations Risk-adjustment was limited to that available in claims data. Conclusions We developed a claims-based hospital-wide unplanned readmission measure for profiling hospitals that produced reasonably

  14. 38 CFR 17.107 - VA response to disruptive behavior of patients.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2012-07-01 2012-07-01 false VA response to disruptive behavior of patients. 17.107 Section 17.107 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Disciplinary Control of Beneficiaries Receiving Hospital, Domiciliary Or Nursing Home...

  15. 38 CFR 17.107 - VA response to disruptive behavior of patients.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2013-07-01 2013-07-01 false VA response to disruptive behavior of patients. 17.107 Section 17.107 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Disciplinary Control of Beneficiaries Receiving Hospital, Domiciliary Or Nursing Home...

  16. 38 CFR 17.107 - VA response to disruptive behavior of patients.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2014-07-01 2014-07-01 false VA response to disruptive behavior of patients. 17.107 Section 17.107 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Disciplinary Control of Beneficiaries Receiving Hospital, Domiciliary Or Nursing Home...

  17. Self-controlled case series and misclassification bias induced by case selection from administrative hospital databases: application to febrile convulsions in pediatric vaccine pharmacoepidemiology.

    PubMed

    Quantin, Catherine; Benzenine, Eric; Velten, Michel; Huet, Frédéric; Farrington, C Paddy; Tubert-Bitter, Pascale

    2013-12-15

    Vaccine safety studies are increasingly conducted by using administrative health databases and self-controlled case series designs that are based on cases only. Often, several criteria are available to define the cases, which may yield different positive predictive values, as well as different sensitivities, and therefore different numbers of selected cases. The question then arises as to which is the best case definition. This article proposes new methodology to guide this choice based on the bias of the relative incidence and the power of the test. We apply this methodology in a validation study of 4 nested algorithms for identifying febrile convulsions from the administrative databases of 10 French hospitals. We used a sample of 695 children aged 1 month to 3 years who were hospitalized in 2008-2009 with at least 1 diagnosis code of febrile convulsions. The positive predictive values of the algorithms ranged from 81% to 98%, and their sensitivities were estimated to be 47%-99% in data from 1 large hospital. When applying our proposed methods, the algorithm we selected used a restricted diagnosis code and position on the discharge abstract. These criteria, which resulted in the selection of 502 cases with a positive predictive value of 95%, provided the best compromise between high power and low relative bias.

  18. Association of Opioids and Sedatives with Increased Risk of In-Hospital Cardiopulmonary Arrest from an Administrative Database

    PubMed Central

    Overdyk, Frank J.; Dowling, Oonagh; Marino, Joseph; Qiu, Jiejing; Chien, Hung-Lun; Erslon, Mary; Morrison, Neil; Harrison, Brooke; Dahan, Albert; Gan, Tong J.

    2016-01-01

    Background While opioid use confers a known risk for respiratory depression, the incremental risk of in-hospital cardiopulmonary arrest, respiratory arrest, or cardiopulmonary resuscitation (CPRA) has not been studied. Our aim was to investigate the prevalence, outcomes, and risk profile of in-hospital CPRA for patients receiving opioids and medications with central nervous system sedating side effects (sedatives). Methods A retrospective analysis of adult inpatient discharges from 2008–2012 reported in the Premier Database. Patients were grouped into four mutually exclusive categories: (1) opioids and sedatives, (2) opioids only, (3) sedatives only, and (4) neither opioids nor sedatives. Results Among 21,276,691 inpatient discharges, 53% received opioids with or without sedatives. A total of 96,554 patients suffered CPRA (0.92 per 1000 hospital bed-days). Patients who received opioids and sedatives had an adjusted odds ratio for CPRA of 3.47 (95% CI: 3.40–3.54; p<0.0001) compared with patients not receiving opioids or sedatives. Opioids alone and sedatives alone were associated with a 1.81-fold and a 1.82-fold (p<0.0001 for both) increase in the odds of CPRA, respectively. In opioid patients, locations of CPRA were intensive care (54%), general care floor (25%), and stepdown units (15%). Only 42% of patients survived CPRA and only 22% were discharged home. Opioid patients with CPRA had mean increased hospital lengths of stay of 7.57 days and mean increased total hospital costs of $27,569. Conclusions Opioids and sedatives are independent and additive risk factors for in-hospital CPRA. The impact of opioid sparing analgesia, reduced sedative use, and better monitoring on CPRA incidence deserves further study. PMID:26913753

  19. Security Station and Front Entrance to hospital property, looking northeast ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Security Station and Front Entrance to hospital property, looking northeast - U.S. Veterans Hospital, Jefferson Barracks, Security Station & Front Gate, VA Medical Center, Jefferson Barracks Division 1 Jefferson Barracks Drive, Saint Louis, Independent City, MO

  20. Conducting research using the electronic health record across multi-hospital systems: semantic harmonization implications for administrators.

    PubMed

    Bowles, Kathryn H; Potashnik, Sheryl; Ratcliffe, Sarah J; Rosenberg, Melissa; Shih, Nai-Wei; Topaz, Maxim; Holmes, John H; Naylor, Mary D

    2013-06-01

    Administrators play a major role in choosing and managing the use of the electronic health record (EHR). The documentation policies and EHR changes enacted or approved by administrators affect the ability to use clinical data for research. This article illustrates the challenges that can be avoided through awareness of the consequences of customization, variations in documentation policies and quality, and user interface features. Solutions are posed that assist administrators in avoiding these challenges and promoting data harmonization for research and quality improvement. PMID:23708504

  1. The Impact of Pre-Hospital Administration of Lactated Ringer's Solution versus Normal Saline in Patients with Traumatic Brain Injury.

    PubMed

    Rowell, Susan E; Fair, Kelly A; Barbosa, Ronald R; Watters, Jennifer M; Bulger, Eileen M; Holcomb, John B; Cohen, Mitchell J; Rahbar, Mohammad H; Fox, Erin E; Schreiber, Martin A

    2016-06-01

    Lactated Ringer's (LR) and normal saline (NS) are both used for resuscitation of injured patients. NS has been associated with increased resuscitation volume, blood loss, acidosis, and coagulopathy compared with LR. We sought to determine if pre-hospital LR is associated with improved outcome compared with NS in patients with and without traumatic brain injury (TBI). We included patients receiving pre-hospital LR or NS from the PRospective Observational Multicenter Major Trauma Transfusion (PROMMTT) study. Patients with TBI (Abbreviated Injury Scale [AIS] head ≥3) and without TBI (AIS head ≤2) were compared. Cox proportional hazards models including Injury Severity Score (ISS), AIS head, AIS extremity, age, fluids, intubation status, and hospital site were generated for prediction of mortality. Linear regression models were generated for prediction of red blood cell (RBC) and crystalloid requirement, and admission biochemical/physiological parameters. Seven hundred ninety-one patients received either LR (n = 117) or NS (n = 674). Median ISS, AIS head, AIS extremity, and pre-hospital fluid volume were higher in TBI and non-TBI patients receiving LR compared with NS (p < 0.01). In patients with TBI (n = 308), LR was associated with higher adjusted mortality compared with NS (hazard rate [HR] = 1.78, confidence interval [CI] 1.04-3.04, p = 0.035). In patients without TBI (n = 483), no difference in mortality was demonstrated (HR = 1.49, CI 0.757-2.95, p = 0.247). Fluid type had no effect on admission biochemical or physiological parameters, 6-hour RBC, or crystalloid requirement in either group. LR was associated with increased mortality compared with NS in patients with TBI. These results underscore the need for a prospective randomized trial comparing pre-hospital LR with NS in patients with TBI.

  2. Outbreak of a Cluster with Epidemic Behavior Due to Serratia marcescens after Colistin Administration in a Hospital Setting

    PubMed Central

    Merkier, Andrea Karina; Rodríguez, María Cecilia; Togneri, Ana; Brengi, Silvina; Osuna, Carolina; Pichel, Mariana; Cassini, Marcelo H.

    2013-01-01

    Serratia marcescens causes health care-associated infections with important morbidity and mortality. Particularly, outbreaks produced by multidrug-resistant isolates of this species, which is already naturally resistant to several antibiotics, including colistin, are usually described with high rates of fatal outcomes throughout the world. Thus, it is important to survey factors associated with increasing frequency and/or emergence of multidrug-resistant S. marcescens nosocomial infections. We report the investigation and control of an outbreak with 40% mortality due to multidrug-resistant S. marcescens infections that happened from November 2007 to April 2008 after treatment with colistin for Acinetobacter baumannii meningitis was started at hospital H1 in 2005. Since that year, the epidemiological pattern of frequently recovered species has changed, with an increase of S. marcescens and Proteus mirabilis infections in 2006 in concordance with a significant decrease of the numbers of P. aeruginosa and A. baumannii isolates. A single pulsed-field gel electrophoresis (PFGE) cluster of S. marcescens isolates was identified during the outbreak. When this cluster was compared with S. marcescens strains (n = 21) from 10 other hospitals (1997 to 2010), it was also identified in both sporadic and outbreak isolates circulating in 4 hospitals in Argentina. In132::ISCR1::blaCTX-M-2 was associated with the multidrug-resistant cluster with epidemic behavior when isolated from outbreaks. Standard infection control interventions interrupted transmission of this cluster even when treatment with colistin continued in several wards of hospital H1 until now. Optimizing use of colistin should be achieved simultaneously with improved infection control to prevent the emergence of species naturally resistant to colistin, such as S. marcescens and P. mirabilis. PMID:23698525

  3. Outbreak of a cluster with epidemic behavior due to Serratia marcescens after colistin administration in a hospital setting.

    PubMed

    Merkier, Andrea Karina; Rodríguez, María Cecilia; Togneri, Ana; Brengi, Silvina; Osuna, Carolina; Pichel, Mariana; Cassini, Marcelo H; Centrón, Daniela

    2013-07-01

    Serratia marcescens causes health care-associated infections with important morbidity and mortality. Particularly, outbreaks produced by multidrug-resistant isolates of this species, which is already naturally resistant to several antibiotics, including colistin, are usually described with high rates of fatal outcomes throughout the world. Thus, it is important to survey factors associated with increasing frequency and/or emergence of multidrug-resistant S. marcescens nosocomial infections. We report the investigation and control of an outbreak with 40% mortality due to multidrug-resistant S. marcescens infections that happened from November 2007 to April 2008 after treatment with colistin for Acinetobacter baumannii meningitis was started at hospital H1 in 2005. Since that year, the epidemiological pattern of frequently recovered species has changed, with an increase of S. marcescens and Proteus mirabilis infections in 2006 in concordance with a significant decrease of the numbers of P. aeruginosa and A. baumannii isolates. A single pulsed-field gel electrophoresis (PFGE) cluster of S. marcescens isolates was identified during the outbreak. When this cluster was compared with S. marcescens strains (n = 21) from 10 other hospitals (1997 to 2010), it was also identified in both sporadic and outbreak isolates circulating in 4 hospitals in Argentina. In132::ISCR1::blaCTX-M-2 was associated with the multidrug-resistant cluster with epidemic behavior when isolated from outbreaks. Standard infection control interventions interrupted transmission of this cluster even when treatment with colistin continued in several wards of hospital H1 until now. Optimizing use of colistin should be achieved simultaneously with improved infection control to prevent the emergence of species naturally resistant to colistin, such as S. marcescens and P. mirabilis.

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

    PubMed

    2014-08-22

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

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

    PubMed

    2014-08-22

    are participating in Medicare. We are updating policies relating to the Hospital Value-Based Purchasing (VBP) Program, the Hospital Readmissions Reduction Program, and the Hospital-Acquired Condition (HAC) Reduction Program. In addition, we are making technical corrections to the regulations governing provider administrative appeals and judicial review; updating the reasonable compensation equivalent (RCE) limits, and revising the methodology for determining such limits, for services furnished by physicians to certain teaching hospitals and hospitals excluded from the IPPS; making regulatory revisions to broaden the specified uses of Medicare Advantage (MA) risk adjustment data and to specify the conditions for release of such risk adjustment data to entities outside of CMS; and making changes to the enforcement procedures for organ transplant centers. We are aligning the reporting and submission timelines for clinical quality measures for the Medicare HER Incentive Program for eligible hospitals and critical access hospitals (CAHs) with the reporting and submission timelines for the Hospital IQR Program. In addition, we provide guidance and clarification of certain policies for eligible hospitals and CAHs such as our policy for reporting zero denominators on clinical quality measures and our policy for case threshold exemptions. In this document, we are finalizing two interim final rules with comment period relating to criteria for disproportionate share hospital uncompensated care payments and extensions of temporary changes to the payment adjustment for low-volume hospitals and of the Medicare-Dependent, Small Rural Hospital (MDH) Program. PMID:25167590

  6. 76 FR 11338 - Hospital and Outpatient Care for Veterans Released From Incarceration to Transitional Housing

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-03-02

    ... AFFAIRS 38 CFR Part 17 RIN 2900-AN41 Hospital and Outpatient Care for Veterans Released From Incarceration... regulations to authorize VA to provide hospital and outpatient care to a veteran in a program that provides... a duty exists, however, VA wants to be able to provide hospital and outpatient care to...

  7. 38 CFR 3.154 - Injury due to hospital treatment, etc.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Injury due to hospital... hospital treatment, etc. VA may accept as a claim for benefits under 38 U.S.C. 1151 and § 3.361 any... due to VA hospital care, medical or surgical treatment, examination, training and...

  8. 76 FR 56503 - Agency Information Collection (Report of Treatment in Hospital) Activity Under OMB Review

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-13

    ... AFFAIRS Agency Information Collection (Report of Treatment in Hospital) Activity Under OMB Review AGENCY... INFORMATION: Title: Report of Treatment in Hospital, VA FL 29-551. OMB Control Number: 2900-0119. Type of... information from hospitals where a claimant was treated. VA uses the data to determine the...

  9. 75 FR 26683 - Hospital and Outpatient Care for Veterans Released From Incarceration to Transitional Housing

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-05-12

    ... AFFAIRS 38 CFR Part 17 RIN 2900-AN41 Hospital and Outpatient Care for Veterans Released From Incarceration... Department of Veterans Affairs (VA) proposes to amend its regulations to authorize VA to provide hospital and... indicate that they are submitted in response to ``RIN 2900-AN41 Hospital and Outpatient Care for...

  10. A two-year retrospective review of the determinants of pre-hospital analgesia administration by alpine helicopter emergency medical physicians to patients with isolated limb injury.

    PubMed

    Eidenbenz, D; Taffé, P; Hugli, O; Albrecht, E; Pasquier, M

    2016-07-01

    Up to 75% of pre-hospital trauma patients experience moderate to severe pain but this is often poorly recognised and treated with insufficient analgesia. Using multi-level logistic regression analysis, we aimed to identify the determinants of pre-hospital analgesia administration and choice of analgesic agent in a single helicopter-based emergency medical service, where available analgesic drugs were fentanyl and ketamine. Of the 1156 patients rescued for isolated limb injury, 657 (57%) received analgesia. Mean (SD) initial pain scores (as measured by a numeric rating scale) were 2.8 (1.8), 3.3 (1.6) and 7.4 (2.0) for patients who did not receive, declined, and received analgesia, respectively (p < 0.001). Fentanyl as a single agent, ketamine in combination with fentanyl and ketamine as a single agent were used in 533 (84%), 94 (14%) and 10 (2%) patients, respectively. A high initial on-scene pain score and a presumptive diagnosis of fracture were the main determinants of analgesia administration. Fentanyl was preferred for paediatric patients and ketamine was preferentially administered for severe pain by physicians who had more medical experience or had trained in anaesthesia. PMID:27091515

  11. Safety and Traceability in Patient Healthcare through the Integration of RFID Technology for Intravenous Mixtures in the Prescription-Validation-Elaboration-Dispensation-Administration Circuit to Day Hospital Patients.

    PubMed

    Martínez Pérez, María; Vázquez González, Guillermo; Dafonte, Carlos

    2016-01-01

    This work presents the integration of the RFID technology with the aim of ensuring the traceability of patients and minimization of adverse events during the process of prescription-validation-elaboration-dispensation-administration of medication by means of the implementation of various passive and active WIFI RFID systems in the Pharmacy and Day Hospital services of the Complejo Hospitalario Universitario A Coruña. Obtaining patient traceability and using the patient/drug binomial during this process allows us to minimize the occurrence of adverse events. The key points in this work are the unmistakably unique identification and accurate real time location of the controlled items (patients and medication). RFID technology has proved to be invaluable in assisting with the everyday clinical practice of a hospital, and has been successfully implemented in this environment and others. In services such as the day hospital, the implementation of said technology is further justified by the high costs of the service and the high risk to the patient. PMID:27483269

  12. Safety and Traceability in Patient Healthcare through the Integration of RFID Technology for Intravenous Mixtures in the Prescription-Validation-Elaboration-Dispensation-Administration Circuit to Day Hospital Patients

    PubMed Central

    Martínez Pérez, María; Vázquez González, Guillermo; Dafonte, Carlos

    2016-01-01

    This work presents the integration of the RFID technology with the aim of ensuring the traceability of patients and minimization of adverse events during the process of prescription-validation-elaboration-dispensation-administration of medication by means of the implementation of various passive and active WIFI RFID systems in the Pharmacy and Day Hospital services of the Complejo Hospitalario Universitario A Coruña. Obtaining patient traceability and using the patient/drug binomial during this process allows us to minimize the occurrence of adverse events. The key points in this work are the unmistakably unique identification and accurate real time location of the controlled items (patients and medication). RFID technology has proved to be invaluable in assisting with the everyday clinical practice of a hospital, and has been successfully implemented in this environment and others. In services such as the day hospital, the implementation of said technology is further justified by the high costs of the service and the high risk to the patient. PMID:27483269

  13. Trends of hospitalized acute stroke care in Germany from clinical trials to bedside. Comparison of nation-wide administrative data 2008-2012.

    PubMed

    Krogias, Christos; Bartig, Dirk; Kitzrow, Martin; Weber, Ralph; Eyding, Jens

    2014-10-15

    Promising advances in stroke medicine have been reported recently regarding specialized stroke unit (SU) care, expansion of the time window of iv thrombolysis (IVT), mechanical thrombectomy (MT), and decompressive hemicraniectomy (DHC) for malignant brain infarction. It remains unclear to what extent new evidence of therapeutic procedures is transferred to the "real-world" of everyday hospital care. We analyzed epidemiologic and procedural therapeutic trends of hospitalized acute stroke patients in Germany by the comparison of administrative hospital data of the years 2008 (n=219,359) and 2012 (n=239,394). Proportion of specialized SU care rose from 43.4% to 56.9%. Even in age-matched analysis women were less likely to obtain this procedure. Rate of IVT increased from 5.6% to 10.2%. 32% of IVT therapies in 2012 were performed in patients over 80 years. Number of MT increased exponentially from 298 to 3906 procedures. Number of DHC did not increase significantly (2008=636; 2011=796). A strong momentum in transferring scientific insights to the "real-world" stroke care in Germany was documented. Increase of IVT therapy is largely due to the increase of off-label treatment. Almost every 46 th patient <80 years was treated by MT in 2012. Despite proven benefits in selected patients, utilization of DHC remained almost stable. PMID:25109534

  14. [Anti-tetanus immunity among university students and health staff in North Lebanon and administration of anti-tetanus serums in two hospitals].

    PubMed

    Hamze, M; Hlais, S; Dabboussi, F; Mallat, H

    2014-10-20

    Tetanus is a serious illness that kills about one million people a year globally. This study aimed to i) evaluate immunity against tetanus (by antibodies titres in blood) among health staff and students at the Public Health Faculty, Lebanese University, ii) explore the determinants of the anti-tetanus immunity by a questionnaire and iii) estimate anti-tetanic serum use in the emergency departments of two hospitals (1 private, 1 public) in Tripoli. Most of the participants (76.6%) had anti-tetanus antibody titres ≥ 0.1 UI/mL. There was no association between immune status and gender (P = 0.614) but more participants ≤ 25 years were immunized than those > 25 years (P < 0.001) and more students were immunized than employees (P = 0.032). There was an inverse association between anti-tetanus immunity and having visited a physician in the past year (P = 0.009). In 2011, 1037 people received anti-tetanus immunoglobulins at the hospitals, 73% at the private hospital. Vaccination campaigns targetting adults > 25 years may be warranted to assure good anti-tetanus protection and avoid administration of anti-tetanus immunoglobulins in emergency departments.

  15. Paleoepidemiologic investigation of Legionnaires disease at Wadsworth Veterans Administration Hospital by using three typing methods for comparison of legionellae from clinical and environmental sources.

    PubMed Central

    Edelstein, P H; Nakahama, C; Tobin, J O; Calarco, K; Beer, K B; Joly, J R; Selander, R K

    1986-01-01

    Multilocus enzyme electrophoresis, monoclonal antibody typing for Legionella pneumophila serogroup 1, and plasmid analysis were used to type 89 L. pneumophila strains isolated from nosocomial cases of Legionnaires disease at the Veterans Administration Wadsworth Medical Center (VAWMC) and from the hospital environment. Twelve L. pneumophila clinical isolates, obtained from patients at non-VAWMC hospitals, were also typed by the same methods to determine typing specificity. Seventy-nine percent of 33 VAWMC L. pneumophila serogroup 1 clinical isolates and 70% of 23 environmental isolates were found in only one of the five monoclonal subgroups. Similar clustering was found for the other two typing methods, with excellent correlation between all methods. Enzyme electrophoretic typing divided the isolates into the greatest number of distinct groups, resulting in the identification of 10 different L. pneumophila types and 5 types not belonging to L. pneumophila, which probably constitute an undescribed Legionella species; 7 clinical and 34 environmental VAWMC isolates and 2 non-VAWMC clinical isolates were found to be members of the new species. Twelve different plasmid patterns were found; 95% of VAWMC clinical isolates contained plasmids. Major VAWMC epidemic-bacterial types were common in the hospital potable-water distribution system and cooling towers. Strains of L. pneumophila which persisted after disinfection of contaminated environmental sites were of a different type from the prechlorination strains. All three typing methods were useful in the epidemiologic analysis of the VAWMC outbreak. PMID:3711303

  16. Safety and Traceability in Patient Healthcare through the Integration of RFID Technology for Intravenous Mixtures in the Prescription-Validation-Elaboration-Dispensation-Administration Circuit to Day Hospital Patients.

    PubMed

    Martínez Pérez, María; Vázquez González, Guillermo; Dafonte, Carlos

    2016-07-28

    This work presents the integration of the RFID technology with the aim of ensuring the traceability of patients and minimization of adverse events during the process of prescription-validation-elaboration-dispensation-administration of medication by means of the implementation of various passive and active WIFI RFID systems in the Pharmacy and Day Hospital services of the Complejo Hospitalario Universitario A Coruña. Obtaining patient traceability and using the patient/drug binomial during this process allows us to minimize the occurrence of adverse events. The key points in this work are the unmistakably unique identification and accurate real time location of the controlled items (patients and medication). RFID technology has proved to be invaluable in assisting with the everyday clinical practice of a hospital, and has been successfully implemented in this environment and others. In services such as the day hospital, the implementation of said technology is further justified by the high costs of the service and the high risk to the patient.

  17. 76 FR 44288 - Establishment of Class E Airspace; New Market, VA

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-25

    ...; (2) is not a ``significant rule'' under DOT Regulatory Policies and Procedures (44 FR 11034; February...: Authority: 49 U.S.C. 106(g); 40103, 40113, 40120; E.O. 10854, 24 FR 9565, 3 CFR, 1959-1963 Comp., p. 389... Federal Aviation Administration 14 CFR Part 71 Establishment of Class E Airspace; New Market, VA...

  18. 30 CFR 57.22229 - Weekly testing (I-A, III, and V-A mines).

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Weekly testing (I-A, III, and V-A mines). 57.22229 Section 57.22229 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-UNDERGROUND METAL AND NONMETAL MINES Safety Standards for Methane in Metal...

  19. 30 CFR 57.22229 - Weekly testing (I-A, III, and V-A mines).

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Weekly testing (I-A, III, and V-A mines). 57.22229 Section 57.22229 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-UNDERGROUND METAL AND NONMETAL MINES Safety Standards for Methane in Metal...

  20. 75 FR 55615 - Hanesbrands, Inc., Galax, VA; Notice of Negative Determination on Reconsideration

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-13

    ... Employment and Training Administration Hanesbrands, Inc., Galax, VA; Notice of Negative Determination on.... The Department's Notice was published in the Federal Register on May 20, 2010 (75 FR 28295). The initial investigation resulted in a negative determination based on the finding that Parkdale...

  1. 75 FR 70351 - Termination of Environmental Review Process Cities of Chesapeake and Virginia Beach, VA

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-11-17

    ... of intent was published in the Federal Register on Wednesday December 24, 2003, at 68 FR 74698. A... was published in the Federal Register on June 10, 2005, at 70 FR 33901. The identified preferred... Virginia Beach, VA AGENCY: Federal Highway Administration (FHWA), DOT. ACTION: Termination of...

  2. 78 FR 53506 - Agency Information Collection (HUD/VA Addendum to Uniform Residential Loan Application) Activity...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-29

    ... application for both VA and the Department of Housing and Urban Development (HUD). Lenders and Veterans use... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS... Under OMB Review AGENCY: Veterans Benefits Administration, Department of Veterans Affairs....

  3. Science Policy: Patent Power; No ERA? No AAAS; VA Budget Cuts Threaten Research

    ERIC Educational Resources Information Center

    Randal, Judith

    1978-01-01

    Brief updates are presented regarding institutional patent arrangements and whether an institution, individual, or government owns a patent; the decision of the American Association for the Advancement of Science not to hold its convention in non-ERA-ratified states; and the impact of the Carter Administration budget on VA biomedical research.…

  4. 78 FR 48079 - Proposed Amendment of Class E Airspace; Danville, VA

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-07

    ...; (2) is not a ``significant rule'' under DOT Regulatory Policies and Procedures (44 FR 11034; February...: Federal Aviation Administration (FAA), DOT. ACTION: Notice of proposed rulemaking (NPRM). SUMMARY: This action proposes to amend Class E Airspace at Danville Regional Airport, Danville, VA, to accommodate...

  5. 76 FR 67557 - Proposed Information Collection (Survey of Veteran Enrollees' Health and Reliance Upon VA...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-01

    ... ; or to Cynthia Harvey-Pryor, Veterans Health Administration (10P7B), Department of Veterans Affairs, 810 Vermont Avenue NW., Washington, DC 20420; or email: cynthia.harvey-pryor@va.gov . Please refer to... online through FDMS. FOR FURTHER INFORMATION CONTACT: Cynthia Harvey-Pryor at (202) 461-5870 or fax...

  6. 76 FR 2148 - Specialty Minerals, Inc., Franklin, VA; Notice of Revised Determination on Reconsideration

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-01-12

    ... on July 1, 2010 (75 FR 38142). On August 19, 2010, the Department issued a Notice of Negative... was published in the Federal Register on August 30, 2010 (75 FR 52989). The workers produced... Employment and Training Administration Specialty Minerals, Inc., Franklin, VA; Notice of...

  7. Elevations U.S. Veterans Hospital, Jefferson Barracks, Medical Officer in ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Elevations - U.S. Veterans Hospital, Jefferson Barracks, Medical Officer in Charge Residence, VA Medical Center, Jefferson Barracks Division 1 Jefferson Barracks Drive, Saint Louis, Independent City, MO

  8. First Floor Plan U.S. Veterans Hospital, Jefferson Barracks, Therapeutic ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    First Floor Plan - U.S. Veterans Hospital, Jefferson Barracks, Therapeutic Exercise Building, VA Medical Center, Jefferson Barracks Division 1 Jefferson Barracks Drive, Saint Louis, Independent City, MO

  9. Landscape Plan U.S. Veterans Hospital, Jefferson Barracks, Therapeutic Exercise ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Landscape Plan - U.S. Veterans Hospital, Jefferson Barracks, Therapeutic Exercise Building, VA Medical Center, Jefferson Barracks Division 1 Jefferson Barracks Drive, Saint Louis, Independent City, MO

  10. Window Details U.S. Veterans Hospital, Jefferson Barracks, Therapeutic Exercise ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Window Details - U.S. Veterans Hospital, Jefferson Barracks, Therapeutic Exercise Building, VA Medical Center, Jefferson Barracks Division 1 Jefferson Barracks Drive, Saint Louis, Independent City, MO

  11. 30 CFR 57.22101 - Smoking (I-A, II-A, III, and V-A mines).

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Smoking (I-A, II-A, III, and V-A mines). 57.22101 Section 57.22101 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR... Smoking (I-A, II-A, III, and V-A mines). Persons shall not smoke or carry smoking materials, matches,...

  12. 30 CFR 57.22101 - Smoking (I-A, II-A, III, and V-A mines).

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Smoking (I-A, II-A, III, and V-A mines). 57.22101 Section 57.22101 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR... Smoking (I-A, II-A, III, and V-A mines). Persons shall not smoke or carry smoking materials, matches,...

  13. 30 CFR 57.22101 - Smoking (I-A, II-A, III, and V-A mines).

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Smoking (I-A, II-A, III, and V-A mines). 57.22101 Section 57.22101 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR... Smoking (I-A, II-A, III, and V-A mines). Persons shall not smoke or carry smoking materials, matches,...

  14. 30 CFR 57.22101 - Smoking (I-A, II-A, III, and V-A mines).

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Smoking (I-A, II-A, III, and V-A mines). 57.22101 Section 57.22101 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR... Smoking (I-A, II-A, III, and V-A mines). Persons shall not smoke or carry smoking materials, matches,...

  15. 30 CFR 57.22101 - Smoking (I-A, II-A, III, and V-A mines).

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Smoking (I-A, II-A, III, and V-A mines). 57.22101 Section 57.22101 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR... Smoking (I-A, II-A, III, and V-A mines). Persons shall not smoke or carry smoking materials, matches,...

  16. The VA advantage: the gold standard in clinical informatics.

    PubMed

    Morgan, Matthew W

    2005-01-01

    How does a healthcare organization undergo such transformation as described in the lead paper in eight short years? Just imagine being part of an organization that achieved the following transformations: (1) reduction in hospital and long-term-care beds from 92,000 to 53,000 and an increase in outpatient clinics from 200 to 850 (2) a 75% increase in the number of patients treated on an annual basis (from 2.8 million to 4.9 million) with only a 32% cumulative increase in budget (from $19 billion to $25 billion) (3) clinicians who have access to complete medical records for almost all patient visits and all care settings (4) clinicians who willingly enter medication orders 94% of the time (5) patients who are increasingly satisfied with their care, ranking the service consistently higher than the competition (6) improved patient outcomes, achieved at costs 25% less than the competition. Such transformation is impossible to achieve without vision, leadership, talent, teamwork and tools. I will restrict my comments to a discussion of the tools, specifically the VA's clinical information system (VistA, HealtheVet, My HealtheVet. However, it is important to note that the results described in this paper would not be possible without the VA's transformational leadership and dedicated teams of professionals capable of executing the vision.

  17. 76 FR 75509 - Autopsies at VA Expense

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-02

    ... that amendment, VA promulgated 38 CFR 17.38, on October 6, 1999, 64 FR 54212. Section 17.38, inter alia... spouse or, in a proper case, the next of kin, unless the patient or domiciled person was abandoned by the... next preceding his death, he or she shall be deemed to have been abandoned. (b) If there is no...

  18. 78 FR 32126 - VA Dental Insurance Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-29

    ...) Resin-based composite restorations. (iv) Endodontic services. (A) Pulp capping. (B) Pulpotomy and... in the Federal Register (77 FR 12517) a proposed rule to amend VA regulations to establish VADIP, a... coverage capabilities as determined during the Federal contracting process. See 77 FR 12518. Although...

  19. 48 CFR 801.690 - VA's COCP.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 5 2011-10-01 2011-10-01 false VA's COCP. 801.690 Section 801.690 Federal Acquisition Regulations System DEPARTMENT OF VETERANS AFFAIRS GENERAL DEPARTMENT OF VETERANS AFFAIRS ACQUISITION REGULATION SYSTEM Career Development, Contracting Authority,...

  20. Uniform administrative requirements for grants and agreements with institutions of higher education, hospitals and other non-profit organizations--OMB. Final revision to OMB circular A-110.

    PubMed

    1993-11-29

    Office of Management and Budget (OMB) Circular A-110 provides standards for obtaining consistency and uniformity among Federal agencies in the administration of grants and agreements with institutions of higher education, hospitals, and other non-profit organizations. OMB issued Circular A-110 in 1976 and, except for a minor revision in February 1987, the Circular contains its original provisions. To update the Circular, OMB established an interagency task force to review the Circular. The task force solicited suggestions for changes to the Circular from university groups, non-profit organizations and other interested parties and compared, for consistency, the provisions of similar provisions applied to State and local governments. The revised Circular reflects the results of these efforts.

  1. 34. Photographic copy of historic drawing, "Naval Hospital and Battery ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    34. Photographic copy of historic drawing, "Naval Hospital and Battery at Portsmouth, VA.," ca. 1862. (From Paul F. Moteelay and T. Campbell-Copeland's The Soldier in Our Civil War: A Pictorial History of the Conflict, 1861-1865. New York: Stanley Bradley Publishing Company, 1890, vol. 1, p. 320.) - Portsmouth Naval Hospital, Bounded by Elizabeth River, Crawford Street, Portsmouth General Hospital, Parkview Avenue, & Scotts Creek, Portsmouth, Portsmouth, VA

  2. VA Health Care and Health Manpower Training Legislation. Hearing before the Subcommittee on Health and Hospitals of the Committee on Veterans' Affairs; United States Senate, Ninety-second Congress. First Session on S.2219, S.2354, S.2355, S.1924, S.2304, S.1635, S.2340, H. J. Res. 748, H. R. 481, and Related Bills.

    ERIC Educational Resources Information Center

    Congress of the U.S., Washington, DC. Senate Committee on Veteran's Affairs.

    Ten legislative bills related to VA health manpower training and education and to veterans' health care were considered at this hearing. The bills concerned the following: (1) establishment of new public nonprofit medical, health profession, and allied health schools and the expansion and improvement of health manpower training programs in VA…

  3. Medical procedures and outcomes of Japanese patients with trisomy 18 or trisomy 13: analysis of a nationwide administrative database of hospitalized patients.

    PubMed

    Ishitsuka, Kazue; Matsui, Hiroki; Michihata, Nobuaki; Fushimi, Kiyohide; Nakamura, Tomoo; Yasunaga, Hideo

    2015-08-01

    The choices of aggressive treatment for trisomy 18 (T18) and trisomy 13 (T13) remain controversial. Here, we describe the current medical procedures and outcomes of patients with T18 and T13 from a nationwide administrative database of hospitalized patients in Japan. We used the database to identify eligible patients with T18 (n = 438) and T13 (n = 133) who were first admitted to one of 200 hospitals between July 2010 and March 2013. Patients were divided into admission at day <7 (early neonatal) and admission at day ≥7 (late neonatal and post neonatal) groups, and we described the medical intervention and status at discharge for each group. In the day <7 groups, surgical interventions were performed for 56 (19.9%) T18 patients and 22 (34.4%) T13 patients, including pulmonary artery banding, and procedures for esophageal atresia and omphalocele. None received intracardiac surgery. The rate of patients discharged to home was higher in the day ≥7 groups than the day <7 groups (T18: 72.6 vs. 38.8%; T13: 73.9 vs. 21.9%, respectively). Our data show that a substantial number of patients with trisomy received surgery and were then discharged home, but, of these, a considerable number required home medical care. This included home oxygen therapy, home mechanical ventilation, and tube feeding. These findings will be useful to clinicians or families who care for patients with T18 and T13. PMID:25847518

  4. 11. Hospital Point, view to southwest from southeast bulkhead; background ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    11. Hospital Point, view to southwest from southeast bulkhead; background left to right: 1960 high-rise hospital, Medical Officer's Quarters B, and Medical Officer's Quarters C - Portsmouth Naval Hospital, Bounded by Elizabeth River, Crawford Street, Portsmouth General Hospital, Parkview Avenue, & Scotts Creek, Portsmouth, Portsmouth, VA

  5. Telephone Enrollment in the VA Healthcare System. Interim final rule.

    PubMed

    2016-03-16

    This rulemaking amends VA's medical regulations to allow veterans to complete applications for health care enrollment by telephone by providing application information to a VA employee, agreeing to VA's provisions regarding copayment liability and assignment of third-party insurance benefits, and attesting to the accuracy and authenticity of the information provided over the phone. This action will make it easier for veterans to apply to enroll and will speed VA processing of applications. PMID:26987128

  6. Injection device-related risk management toward safe administration of medications: experience in a university teaching hospital in The People's Republic of China.

    PubMed

    Zhu, Ling-Ling; Li, Wei; Song, Ping; Zhou, Quan

    2014-01-01

    The use of injection devices to administer intravenous or subcutaneous medications is common practice throughout a variety of health care settings. Studies suggest that one-half of all harmful medication errors originate during drug administration; of those errors, about two-thirds involve injectables. Therefore, injection device management is pivotal to safe administration of medications. In this article, the authors summarize the relevant experiences by retrospective analysis of injection device-related near misses and adverse events in the Second Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang University, People's Republic of China. Injection device-related near misses and adverse events comprised the following: 1) improper selection of needle diameter for subcutaneous injection, material of infusion sets, and pore size of in-line filter; 2) complications associated with vascular access; 3) incidents induced by absence of efficient electronic pump management and infusion tube management; and 4) liquid leakage of chemotherapeutic infusion around the syringe needle. Safe injection drug use was enhanced by multidisciplinary collaboration, especially among pharmacists and nurses; drafting of clinical pathways in selection of vascular access; application of approaches such as root cause analysis using a fishbone diagram; plan-do-check-act and quality control circle; and construction of a culture of spontaneous reporting of near misses and adverse events. Pharmacists must be professional in regards to medication management and use. The depth, breadth, and efficiency of cooperation between nurses and pharmacists are pivotal to injection safety. PMID:24669192

  7. Injection device-related risk management toward safe administration of medications: experience in a university teaching hospital in The People’s Republic of China

    PubMed Central

    Zhu, Ling-ling; Li, Wei; Song, Ping; Zhou, Quan

    2014-01-01

    The use of injection devices to administer intravenous or subcutaneous medications is common practice throughout a variety of health care settings. Studies suggest that one-half of all harmful medication errors originate during drug administration; of those errors, about two-thirds involve injectables. Therefore, injection device management is pivotal to safe administration of medications. In this article, the authors summarize the relevant experiences by retrospective analysis of injection device-related near misses and adverse events in the Second Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang University, People’s Republic of China. Injection device-related near misses and adverse events comprised the following: 1) improper selection of needle diameter for subcutaneous injection, material of infusion sets, and pore size of in-line filter; 2) complications associated with vascular access; 3) incidents induced by absence of efficient electronic pump management and infusion tube management; and 4) liquid leakage of chemotherapeutic infusion around the syringe needle. Safe injection drug use was enhanced by multidisciplinary collaboration, especially among pharmacists and nurses; drafting of clinical pathways in selection of vascular access; application of approaches such as root cause analysis using a fishbone diagram; plan–do–check–act and quality control circle; and construction of a culture of spontaneous reporting of near misses and adverse events. Pharmacists must be professional in regards to medication management and use. The depth, breadth, and efficiency of cooperation between nurses and pharmacists are pivotal to injection safety. PMID:24669192

  8. Injection device-related risk management toward safe administration of medications: experience in a university teaching hospital in The People's Republic of China.

    PubMed

    Zhu, Ling-Ling; Li, Wei; Song, Ping; Zhou, Quan

    2014-01-01

    The use of injection devices to administer intravenous or subcutaneous medications is common practice throughout a variety of health care settings. Studies suggest that one-half of all harmful medication errors originate during drug administration; of those errors, about two-thirds involve injectables. Therefore, injection device management is pivotal to safe administration of medications. In this article, the authors summarize the relevant experiences by retrospective analysis of injection device-related near misses and adverse events in the Second Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang University, People's Republic of China. Injection device-related near misses and adverse events comprised the following: 1) improper selection of needle diameter for subcutaneous injection, material of infusion sets, and pore size of in-line filter; 2) complications associated with vascular access; 3) incidents induced by absence of efficient electronic pump management and infusion tube management; and 4) liquid leakage of chemotherapeutic infusion around the syringe needle. Safe injection drug use was enhanced by multidisciplinary collaboration, especially among pharmacists and nurses; drafting of clinical pathways in selection of vascular access; application of approaches such as root cause analysis using a fishbone diagram; plan-do-check-act and quality control circle; and construction of a culture of spontaneous reporting of near misses and adverse events. Pharmacists must be professional in regards to medication management and use. The depth, breadth, and efficiency of cooperation between nurses and pharmacists are pivotal to injection safety.

  9. Payment for non-VA physician services associated with either outpatient or inpatient care provided at non-VA facilities--VA. Proposed rule.

    PubMed

    1997-07-22

    This document proposes to amend Department of Veterans Affairs (VA) medical regulations concerning payment for non-VA physician services that are associated with either outpatient or inpatient care provided to eligible VA beneficiaries at non-VA facilities. We propose that when a service specific reimbursement amount has been calculated under Medicare's Participating Physician Fee Schedule, VA would pay the lesser of the actual billed charge or the calculated amount. We also propose that when an amount has not been calculated, VA would pay the amount calculated under a 75th percentile formula or, in certain limited circumstances, VA would pay the usual and customary rate. In our view, adoption of this proposal would establish reimbursement consistency among federal health benefits programs, would ensure that amounts paid to physicians better represent the relative resource inputs used to furnish a service, and, would, as reflected by a recent VA Office of Inspector General (OIG) audit of the VA fee-basis program, achieve program cost reductions. Further, consistent with statutory requirements, the regulations would continue to specify that VA payment constitutes payment in full.

  10. 48 CFR 819.7109 - VA review of application.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false VA review of application... SOCIOECONOMIC PROGRAMS SMALL BUSINESS PROGRAMS VA Mentor-Protégé Program 819.7109 VA review of application. (a... that the information that is in VAAR 819.7108 is included. If the application relates to a...

  11. The Veterans Administration's Asbestos Abatement Program

    SciTech Connect

    Schepers, G.W. )

    1991-12-31

    The Veterans Administration has developed a program of asbestos abatement for its more than 1000 buildings, where health care personnel from 173 hospitals and 238 ambulatory care clinics are likely to encounter respirable asbestos. This is a costly program, which has averaged about $25 million annually for the past ten years. The VA has banned the use of new asbestos products containing more than 1% of asbestos in building construction or renovation projects. Industrial hygiene engineering programs have been ordered instituted at all VA medical centers to monitor dust levels in compliance with OSHA and EPA requirements. Health surveillance programs, managed by an environmental health physician at each medical center, have been instituted for all personnel who have been identified to have breathed asbestos fibers in excess of OSHA-EPA threshold limit values. The health care program focuses on the identification of asbestosis and asbestos-related cancer through periodic X-ray films, lung function tests, and electrocardiographic and physical examination screening. The program also stresses cessation of smoking.

  12. 38 CFR 1.9 - Description, use, and display of VA seal and flag.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... stationery. (B) Official VA identification cards and security credentials. (C) Business cards for VA employees. (D) Official VA signs. (E) Official publications or graphics issued by and attributed to VA,...

  13. 38 CFR 1.9 - Description, use, and display of VA seal and flag.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... stationery. (B) Official VA identification cards and security credentials. (C) Business cards for VA employees. (D) Official VA signs. (E) Official publications or graphics issued by and attributed to VA,...

  14. Variation between Hospitals with Regard to Diagnostic Practice, Coding Accuracy, and Case-Mix. A Retrospective Validation Study of Administrative Data versus Medical Records for Estimating 30-Day Mortality after Hip Fracture

    PubMed Central

    Kristoffersen, Doris Tove; Skyrud, Katrine Damgaard; Lindman, Anja Schou

    2016-01-01

    Background The purpose of this study was to assess the validity of patient administrative data (PAS) for calculating 30-day mortality after hip fracture as a quality indicator, by a retrospective study of medical records. Methods We used PAS data from all Norwegian hospitals (2005–2009), merged with vital status from the National Registry, to calculate 30-day case-mix adjusted mortality for each hospital (n = 51). We used stratified sampling to establish a representative sample of both hospitals and cases. The hospitals were stratified according to high, low and medium mortality of which 4, 3, and 5 hospitals were sampled, respectively. Within hospitals, cases were sampled stratified according to year of admission, age, length of stay, and vital 30-day status (alive/dead). The final study sample included 1043 cases from 11 hospitals. Clinical information was abstracted from the medical records. Diagnostic and clinical information from the medical records and PAS were used to define definite and probable hip fracture. We used logistic regression analysis in order to estimate systematic between-hospital variation in unmeasured confounding. Finally, to study the consequences of unmeasured confounding for identifying mortality outlier hospitals, a sensitivity analysis was performed. Results The estimated overall positive predictive value was 95.9% for definite and 99.7% for definite or probable hip fracture, with no statistically significant differences between hospitals. The standard deviation of the additional, systematic hospital bias in mortality estimates was 0.044 on the logistic scale. The effect of unmeasured confounding on outlier detection was small to moderate, noticeable only for large hospital volumes. Conclusions This study showed that PAS data are adequate for identifying cases of hip fracture, and the effect of unmeasured case mix variation was small. In conclusion, PAS data are adequate for calculating 30-day mortality after hip-fracture as a quality

  15. Uniform administrative requirements for grants and agreements with institutions of higher education, hospitals, other non-profit, and commercial organizations--Department of Commerce. Interim final rule.

    PubMed

    1998-09-01

    This interim final rule implements the revisions to the Office of Management and Budget (OMB) Circular A-110, "Uniform Administrative Requirements for Grants and Agreements With Institutions of Higher Education, Hospitals, and Other Non-Profit Organizations" which was published in the Federal Register on November 29, 1993. The revised Circular was developed by an interagency task force for governmentwide use in a model rule format to facilitate regulatory adoption by executive departments and agencies. In the published revised Circular, OMB specified as "required action" that Federal agencies responsible for awarding and administering grants and other agreements to recipients described therein, shall adopt the language of the Circular unless other provisions are required by Federal statute or exceptions or deviations are approved by OMB. This interim final rule adopts the provisions of the Circular and its language to the maximum extent feasible. However, minor changes were made to update the procedures, clarify the language, and make the language apply specifically to the DoC and its operating units. No changes are intended to deviate from the substance of Circular A-110. The Circular covers both grants and cooperative agreements made by Federal agencies and subawards, unless sections of the Circular specifically exclude subrecipients from coverage. Consistent with guidance provided in the Circular, DoC will apply its provisions to grants and agreements with institutions of higher education, hospitals, other nonprofit, and commercial organizations. The provisions of the interim final rule will also apply to foreign governments, organizations under the jurisdiction of foreign governments, and international organizations when appropriate.

  16. 76 FR 38743 - Proposed Information Collection (Report of Treatment in Hospital); Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-01

    ... AFFAIRS Proposed Information Collection (Report of Treatment in Hospital); Comment Request AGENCY... of Treatment in Hospital, VA FL 29-551. OMB Control Number: 2900-0119. Type of Review: Extension of a currently approved collection. Abstract: VA Form Letter 29-551 is used to collect information from...

  17. The association between work ethics and attitudes towards organizational changes among the administrative, financial and support employees of general teaching hospitals

    PubMed Central

    Ravangard, Ramin; Sajjadnia, Zahra; Jafari, Abdosaleh; Shahsavan, Najme; Bahmaie, Jamshid; Bahadori, Mohammadkarim

    2014-01-01

    In order to achieve success in today’s competitive world, organizations should adapt to environmental changes. On the other hand, managers should have a set of values and ethical guidelines for their administrative and organizational functions. This study aimed to investigate the association between work ethics and attitudes towards organizational changes among the administrative, financial and support employees of general teaching hospitals affiliated to Shiraz University of Medical Sciences. This was an applied, cross-sectional and descriptive-analytic study conducted in 2013. A sample of 124 employees was selected using stratified sampling proportional to size and simple random sampling methods. Data were collected using 2 questionnaires measuring the dimensions of employees' work ethics (four dimensions) and attitudes towards organizational changes (three dimensions). The collected data were analyzed using SPSS 18.0 and statistical tests, including ANOVA, independent samples t-test, and Pearson’s correlation coefficient. A P < 0.05 was considered statistically significant. The maximum and minimum score of work ethic dimensions were related to being cooperative (4.60 ± 0.38) and dependable (4.29 ± 0.39) respectively. On the other hand, the maximum and minimum score of attitudes towards the various dimensions of organizational changes were related to the behavioral (3.83 ± 0.70) and the affective (3.55 ± 0.88) dimensions respectively. Furthermore, there was a significant relationship between the work ethics and education levels of the employees in this study (P = 0.003). Also, among work s dimensions, only being considerate had a significant association with attitudes towards organizational changes (P = 0.014) and their cognitive dimension (P = 0.005). To improve employees' work ethics and attitudes towards organizational changes, the following suggestions can be offered: training hospitals managers in participative management style and its application

  18. Incidence and Risk Factors Associated With Hospitalization for Variant Angina in Korea

    PubMed Central

    Kim, Hack-Lyoung; Lee, Sang Hyung; Kim, Jayeun; Kim, Hyun Joo; Lim, Woo-Hyun; Seo, Jae-Bin; Chung, Woo-Young; Kim, Sang-Hyun; Zo, Joo-Hee; Kim, Myung-A; Lee, Jin Yong

    2016-01-01

    Abstract This study aimed to determine the incidence and the risk factors of hospitalization for variant angina (VA) in Korean patients. Using the National Inpatient Sample (NIS) database, manufactured and released by the Health Insurance Review and Assessment Service (HIRA) in Korea, the incidence of hospitalization and rehospitalization for VA were calculated. The numbers of patients hospitalized for VA were estimated to be 14,362 in 2009, 17,492 in 2010, and 20,592 in 2011. The standardized incidence rates of hospitalization for VA were 31.4% in 2009, 36.5% in 2010, and 41.7% in 2011 (relative increase rate from 2009 to 2011, 33.0%, P for trend < 0.0001). VA patients predominantly belonged to the middle-age group between 40 and 69 years (75.5%), and there were 54.3% male. Based on the hospitalization episodes, the number of rehospitalization was calculated to be 879, 1141, and 1446 patients out of 1867, 2274, and 2677 patients from 2009, 2010, and 2011, respectively. The rates of rehospitalization for VA were 47.1% in 2009, 50.2% in 2010, and 54.0% in 2011 (P for trend < 0.0001). Age was an independent factor associated with rehospitalization for VA. Hospitalization for VA occurred most frequently in fall from 2009 to 2011. In conclusion, hospitalization rates for VA steadily increased from 2009 to 2011 in Korea, and about a half of VA patients was hospitalized more than once a year in 2009 to 2011. Proper health policy and patient education are warranted to control the high rate of hospitalization for VA. PMID:27043695

  19. 48 CFR 853.215-70 - VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ..., Application for Furnishing Nursing Home Care to Beneficiaries of VA. 853.215-70 Section 853.215-70 Federal... 853.215-70 VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA. VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA, will be used...

  20. 48 CFR 853.215-70 - VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ..., Application for Furnishing Nursing Home Care to Beneficiaries of VA. 853.215-70 Section 853.215-70 Federal... 853.215-70 VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA. VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA, will be used...

  1. 48 CFR 853.215-70 - VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ..., Application for Furnishing Nursing Home Care to Beneficiaries of VA. 853.215-70 Section 853.215-70 Federal... 853.215-70 VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA. VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA, will be used...

  2. 48 CFR 853.215-70 - VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ..., Application for Furnishing Nursing Home Care to Beneficiaries of VA. 853.215-70 Section 853.215-70 Federal... 853.215-70 VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA. VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA, will be used...

  3. 48 CFR 853.215-70 - VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ..., Application for Furnishing Nursing Home Care to Beneficiaries of VA. 853.215-70 Section 853.215-70 Federal... 853.215-70 VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA. VA Form 10-1170, Application for Furnishing Nursing Home Care to Beneficiaries of VA, will be used...

  4. Network of fully integrated multispecialty hospital imaging systems

    NASA Astrophysics Data System (ADS)

    Dayhoff, Ruth E.; Kuzmak, Peter M.

    1994-05-01

    The Department of Veterans Affairs (VA) DHCP Imaging System records clinically significant diagnostic images selected by medical specialists in a variety of departments, including radiology, cardiology, gastroenterology, pathology, dermatology, hematology, surgery, podiatry, dental clinic, and emergency room. These images are displayed on workstations located throughout a medical center. All images are managed by the VA's hospital information system, allowing integrated displays of text and image data across medical specialties. Clinicians can view screens of `thumbnail' images for all studies or procedures performed on a selected patient. Two VA medical centers currently have DHCP Imaging Systems installed, and others are planned. All VA medical centers and other VA facilities are connected by a wide area packet-switched network. The VA's electronic mail software has been modified to allow inclusion of binary data such as images in addition to the traditional text data. Testing of this multimedia electronic mail system is underway for medical teleconsultation.

  5. Medical Student Psychiatry Examination Performance at VA and Non-VA Clerkship Sites

    ERIC Educational Resources Information Center

    Tucker, Phebe; von Schlageter, Margo Shultes; Park, EunMi; Rosenberg, Emily; Benjamin, Ashley B.; Nawar, Ola

    2009-01-01

    Objective: The authors examined the effects of medical student assignment to U.S. Department of Veterans Affairs (VA) Medical Center inpatient and outpatient psychiatry clerkship sites versus other university and community sites on the performance outcome measure of National Board of Medical Examiners (NBME) subject examination scores. Methods:…

  6. Improvements in VA health services for women veterans.

    PubMed

    Weiss, T W

    1995-01-01

    Since the early 1980s, health care for women veterans in the Department of Veterans Affairs (VA) has improved considerably, although problems still remain. The lack of privacy for women at many VA facilities and the provision of incomplete physical examinations for women continue to be problematic issues. A 1992 congressional appropriation of $7.5 million has substantially increased the awareness of women veterans health care in the VA. This appropriation, from Public Law 102-585, Veterans Health Care Act of 1992, Title I-Women Veterans Health Programs, has allowed VA to expand services for women veterans. Using these funds, VA has established eight comprehensive women veterans health centers, 23 full-time women veterans coordinators, and four regional stress disorder teams. This paper describes these and other important new initiatives and discusses how they will serve as the foundation on which VA expands care for women within the context of a changing health care system.

  7. VA Community Mental Health Service Providers' Utilization of and Attitudes toward Telemental Health Care: The Gatekeeper's Perspective

    ERIC Educational Resources Information Center

    Jameson, John Paul; Farmer, Mary Sue; Head, Katharine J.; Fortney, John; Teal, Cayla R.

    2011-01-01

    Context: Mental health (MH) providers in community-based outpatient clinics (CBOCs) are important stakeholders in the development of the Veterans Health Administration (VA) telemental health (TMH) system, but their perceptions of these technologies have not been systematically examined. Purpose: The purpose of this study was to investigate the…

  8. 30 CFR 57.22314 - Flow-control devices (V-A and V-B mines).

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Flow-control devices (V-A and V-B mines). 57.22314 Section 57.22314 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-UNDERGROUND METAL AND...

  9. 30 CFR 57.22314 - Flow-control devices (V-A and V-B mines).

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Flow-control devices (V-A and V-B mines). 57.22314 Section 57.22314 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-UNDERGROUND METAL AND...

  10. Telephone Enrollment in the VA Healthcare System. Final rule.

    PubMed

    2016-09-12

    The Department of Veterans Affairs (VA) adopts as final, without change, an interim final rule amending its medical regulations. Specifically, this rule allows veterans to complete applications for health care enrollment by providing application information, agreeing to VA's provisions regarding copayment liability and assignment of third-party insurance benefits, and attesting to the accuracy and authenticity of the information provided to a VA employee over the phone. This action makes it easier for veterans to apply to enroll and speeds VA processing of applications. PMID:27632804

  11. Telephone Enrollment in the VA Healthcare System. Final rule.

    PubMed

    2016-09-12

    The Department of Veterans Affairs (VA) adopts as final, without change, an interim final rule amending its medical regulations. Specifically, this rule allows veterans to complete applications for health care enrollment by providing application information, agreeing to VA's provisions regarding copayment liability and assignment of third-party insurance benefits, and attesting to the accuracy and authenticity of the information provided to a VA employee over the phone. This action makes it easier for veterans to apply to enroll and speeds VA processing of applications.

  12. HCA Richmond Hospitals' new marketing strategy a winning plan.

    PubMed

    Rees, Tom

    2003-01-01

    HCA Richmond Hospitals, a five-hospital system in Richmond, Va., is positioning itself as a winner in a highly competitive, healthcare-saturated market since overhauling is marketing strategy a little over a year ago. The marketing strategy enables individual hospital to target their own unique constituencies. "Understanding the intricate marketing dynamics of hospital systems is today of critical importance and equal complexity," said Tony Bejamin, principal of Oxygen Advertising Inc., New York, the agency that remodeled HCA Richmond Hospitals' marketing strategy.

  13. 30 CFR 57.22204 - Main fan operation and inspection (I-A, II-A, III, and V-A mines).

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 30 Mineral Resources 1 2012-07-01 2012-07-01 false Main fan operation and inspection (I-A, II-A, III, and V-A mines). 57.22204 Section 57.22204 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION... Main fan operation and inspection (I-A, II-A, III, and V-A mines). Main fans shall be— (a)...

  14. 30 CFR 57.22204 - Main fan operation and inspection (I-A, II-A, III, and V-A mines).

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Main fan operation and inspection (I-A, II-A, III, and V-A mines). 57.22204 Section 57.22204 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION... Main fan operation and inspection (I-A, II-A, III, and V-A mines). Main fans shall be— (a)...

  15. 30 CFR 57.22204 - Main fan operation and inspection (I-A, II-A, III, and V-A mines).

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Main fan operation and inspection (I-A, II-A, III, and V-A mines). 57.22204 Section 57.22204 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION... Main fan operation and inspection (I-A, II-A, III, and V-A mines). Main fans shall be— (a)...

  16. 30 CFR 57.22204 - Main fan operation and inspection (I-A, II-A, III, and V-A mines).

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Main fan operation and inspection (I-A, II-A, III, and V-A mines). 57.22204 Section 57.22204 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION... Main fan operation and inspection (I-A, II-A, III, and V-A mines). Main fans shall be— (a)...

  17. 30 CFR 57.22204 - Main fan operation and inspection (I-A, II-A, III, and V-A mines).

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Main fan operation and inspection (I-A, II-A, III, and V-A mines). 57.22204 Section 57.22204 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION... Main fan operation and inspection (I-A, II-A, III, and V-A mines). Main fans shall be— (a)...

  18. Racial/Ethnic Disparities in VA Services Utilization as a Partial Pathway to Mortality Differentials among Veterans Diagnosed with TBI

    PubMed Central

    Dismuke, Clara E.; Gebregziabher, Mulugeta; Egede, Leonard E.

    2016-01-01

    Objective: Primary: To examine Veterans Administration (VA) utilization and other potential mediators between racial/ethnic differentials and mortality in veterans diagnosed with traumatic brain injury (TBI). Design: A national cohort of veterans clinically diagnosed with TBI in 2006 was followed from January 1, 2006 through December 31, 2009 or until date of death. Utilization was tracked for 12 months. Differences in survival and potential mediators by race were examined via K-Wallis and chi-square tests. Potential mediation of utilization in the association between mortality and race/ethnicity was studied by fitting Cox models with and without adjustment for demographics and co-morbidities. Poisson regression was used to study the association of race/ethnicity with utilization of specialty services potentially important in the management of TBI. Setting: United States (US) Veterans Administration (VA) Hospitals and Clinics. Participants: 14, 690 US veterans clinically diagnosed with TBI in 2006. Interventions: Not Applicable. The study is a secondary data analysis. Main Outcome Measures: Mortality, Utilization. Results: Hispanic veterans were found to have significantly higher unadjusted mortality (6.69%) than Non-Hispanic White veterans (2.93%). Hispanic veterans relative to Non-Hispanic White were found to have significantly lower utilization of all services examined, except imaging. Neurology was found to be the utilization mediator with the highest percent of excess risk (3.40%) while age was the non utilization confounder with the highest percent of excess risk (31.49%). In fully adjusted models for demographics and co-morbidities, Hispanic veterans relative to Non-Hispanic Whites were found to have less total visits (IRR 0.89), TBI clinic (IRR 0.43), neurology (IRR 0.35), rehabilitation (IRR 0.37), and other visits (IRR 0.85) with only higher mental health visits (IRR 1.53). Conclusions: We found evidence that utilization is a partial mediator between race

  19. Contraceptive Provision in the VA Healthcare System to Women Who Report Military Sexual Trauma

    PubMed Central

    Mattocks, Kristin; Schwarz, Eleanor Bimla; Borrero, Sonya; Skanderson, Melissa; Zephyrin, Laurie; Brandt, Cynthia; Haskell, Sally

    2014-01-01

    Abstract Background: Women Veterans who suffered military sexual trauma (MST) may be at high risk for unintended pregnancy and benefit from contraceptive services. The objective of this study is to compare documented provision of contraceptives to women Veterans using the Department of Veterans Affairs (VA) health system who report or deny MST. Methods: This retrospective cohort study included women Veterans aged 18–45 years who served in Operation Enduring or Iraqi Freedom and had at least one visit to a VA medical center between 2002 and 2010. Data were obtained from VA administrative and clinical databases. Chi-squared tests and logistic regression were conducted to evaluate the association between MST, ascertained by routine clinical screening, and first documented receipt of hormonal or long-acting contraception. Results: Of 68,466 women Veterans, 13% reported, 59% denied and 28% had missing data for the MST screen. Among the entire study cohort, 30% of women had documented receipt of a contraceptive method. Women reporting MST were significantly more likely than those denying MST to receive a method of contraception (adjusted odds ratio [aOR] 1.12, 95% confidence interval [CI] 1.07–1.18) including an intrauterine device (odds ratio [OR] 1.29, 95% CI 1.17–1.41) or contraceptive injection (OR 1.17, 95% CI 1.05–1.29). Women who were younger, unmarried, seen at a women's health clinic, or who had more than one visit were more likely to receive contraception. Conclusions: A minority of women Veterans of reproductive age receive contraceptive services from the VA. Women Veterans who report MST, and particularly those who seek care at VA women's health clinics, are more likely to receive contraception. PMID:24787680

  20. 38 CFR 1.203 - Information to be reported to VA Police.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... reported to VA Police. 1.203 Section 1.203 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS... be reported to VA Police. Information about actual or possible violations of criminal laws related to... occurs on VA premises, will be reported by VA management officials to the VA police component...

  1. 38 CFR 1.203 - Information to be reported to VA Police.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... reported to VA Police. 1.203 Section 1.203 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS... be reported to VA Police. Information about actual or possible violations of criminal laws related to... occurs on VA premises, will be reported by VA management officials to the VA police component...

  2. 38 CFR 1.203 - Information to be reported to VA Police.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... reported to VA Police. 1.203 Section 1.203 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS... be reported to VA Police. Information about actual or possible violations of criminal laws related to... occurs on VA premises, will be reported by VA management officials to the VA police component...

  3. 38 CFR 1.203 - Information to be reported to VA Police.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... reported to VA Police. 1.203 Section 1.203 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS... be reported to VA Police. Information about actual or possible violations of criminal laws related to... occurs on VA premises, will be reported by VA management officials to the VA police component...

  4. 38 CFR 1.203 - Information to be reported to VA Police.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... reported to VA Police. 1.203 Section 1.203 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS... be reported to VA Police. Information about actual or possible violations of criminal laws related to... occurs on VA premises, will be reported by VA management officials to the VA police component...

  5. Home Health Care and Patterns of Subsequent VA and Medicare Health Care Utilization for Veterans

    ERIC Educational Resources Information Center

    Van Houtven, Courtney Harold; Jeffreys, Amy S.; Coffman, Cynthia J.

    2008-01-01

    Purpose: The Veterans Affairs or VA health care system is in the process of significantly expanding home health care (HOC) nationwide. We describe VA HHC use in 2003 for all VA HHC users from 2002; we examine whether VA utilization across a broad spectrum of services differed for a sample of VA HHC users and their propensity-score-matched…

  6. 77 FR 67063 - VA Directive 0005 on Scientific Integrity

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-08

    ... April 9, 2012 (77 FR 21158). FOR FURTHER INFORMATION CONTACT: Billy E. Jones, M.D., Senior Advisor to... http://www1.va.gov/vapubs/ . Directive 0005 establishes VA policies that: Foster a culture of... technological information from political or commercial influence; Prohibit suppression or alteration...

  7. 38 CFR 74.27 - How will VA store information?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false How will VA store information? 74.27 Section 74.27 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) VETERANS SMALL BUSINESS REGULATIONS Records Management § 74.27 How will VA store information?...

  8. 78 FR 63143 - VA Dental Insurance Program-Federalism

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-23

    ... AFFAIRS 38 CFR Part 17 RIN 2900-AO86 VA Dental Insurance Program--Federalism AGENCY: Department of... its regulations related to the VA Dental Insurance Program (VADIP), a pilot program to offer premium-based dental insurance to enrolled veterans and certain survivors and dependents of...

  9. 78 FR 62441 - VA Dental Insurance Program-Federalism

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-10-22

    ... AFFAIRS 38 CFR Part 17 RIN 2900-AO85 VA Dental Insurance Program--Federalism AGENCY: Department of... direct final action to amend its regulations related to the VA Dental Insurance Program (VADIP), a pilot program to offer premium-based dental insurance to enrolled veterans and certain survivors and...

  10. 33 CFR 80.510 - Chesapeake Bay Entrance, VA.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 33 Navigation and Navigable Waters 1 2014-07-01 2014-07-01 false Chesapeake Bay Entrance, VA. 80.510 Section 80.510 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY INTERNATIONAL NAVIGATION RULES COLREGS DEMARCATION LINES Fifth District § 80.510 Chesapeake Bay Entrance, VA....

  11. 33 CFR 80.510 - Chesapeake Bay Entrance, VA.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 33 Navigation and Navigable Waters 1 2011-07-01 2011-07-01 false Chesapeake Bay Entrance, VA. 80.510 Section 80.510 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY INTERNATIONAL NAVIGATION RULES COLREGS DEMARCATION LINES Fifth District § 80.510 Chesapeake Bay Entrance, VA....

  12. 33 CFR 80.510 - Chesapeake Bay Entrance, VA.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 33 Navigation and Navigable Waters 1 2012-07-01 2012-07-01 false Chesapeake Bay Entrance, VA. 80.510 Section 80.510 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY INTERNATIONAL NAVIGATION RULES COLREGS DEMARCATION LINES Fifth District § 80.510 Chesapeake Bay Entrance, VA....

  13. 33 CFR 80.510 - Chesapeake Bay Entrance, VA.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Chesapeake Bay Entrance, VA. 80.510 Section 80.510 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY INTERNATIONAL NAVIGATION RULES COLREGS DEMARCATION LINES Fifth District § 80.510 Chesapeake Bay Entrance, VA....

  14. 33 CFR 80.510 - Chesapeake Bay Entrance, VA.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 33 Navigation and Navigable Waters 1 2013-07-01 2013-07-01 false Chesapeake Bay Entrance, VA. 80.510 Section 80.510 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY INTERNATIONAL NAVIGATION RULES COLREGS DEMARCATION LINES Fifth District § 80.510 Chesapeake Bay Entrance, VA....

  15. Determining VA physician requirements through empirically based models.

    PubMed Central

    Lipscomb, J; Kilpatrick, K E; Lee, K L; Pieper, K S

    1995-01-01

    OBJECTIVE: As part of a project to estimate physician requirements for the Department of Veterans Affairs, the Institute of Medicine (IOM) developed and tested empirically based models of physician staffing, by specialty, that could be applied to each VA facility. DATA SOURCE/STUDY SETTING. These analyses used selected data on all patient encounters and all facilities in VA's management information systems for FY 1989. STUDY DESIGN. Production functions (PFs), with patient workload dependent on physicians, other providers, and nonpersonnel factors, were estimated for each of 14 patient care areas in a VA medical center. Inverse production functions (IPFs), with physician staffing levels dependent on workload and other factors, were estimated for each of 11 specialty groupings. These models provide complementary approaches to deriving VA physician requirements for patient care and medical education. DATA COLLECTION/EXTRACTION METHODS. All data were assembled by VA and put in analyzable SAS data sets containing FY 1989 workload and staffing variables used in the PFs and IPFs. All statistical analyses reported here were conducted by the IOM. PRINCIPAL FINDINGS. Existing VA data can be used to develop statistically strong, clinically plausible, empirically based models for calculating physician requirements, by specialty. These models can (1) compare current physician staffing in a given setting with systemwide norms and (2) yield estimates of future staffing requirements conditional on future workload. CONCLUSIONS. Empirically based models can play an important role in determining VA physician staffing requirements. VA should test, evaluate, and revise these models on an ongoing basis. PMID:7860320

  16. Veterans Administration support for medical research: opinions of the endangered species of physician-scientists.

    PubMed

    Zucker, Stanley; Crabbe, John C; Cooper, George; Finkelman, Fred; Largman, Corey; McCarley, Robert W; Rice, Louis; Rubin, Janet; Richardson, Bruce; Seil, Frederick; Snider, Gordon L; Vandenbark, Arthur A

    2004-10-01

    Over the past three decades the Veterans Affairs (VA) Research program has evolved into a powerful, peer-reviewed funding mechanism for basic and translational research that has resulted in numerous important contributions to medical science and improvements in patient care. Continuity in VA Merit Review funding has fostered and nurtured the scientific careers of a large number of physician-scientists who have remained devoted to the mission of performing creative and innovative research that affects the patient care mission of the VA. VA medical research policies have undergone a major overhaul in the past year. Although many of these changes (de-emphasizing bench research and revamping the peer review process) have recently been reversed, the future direction of VA research remains in flux. The goal of this manuscript is to demonstrate the importance of the Merit Review medical research funding mechanism not just to the VA, but to the entire nation's health care system. To achieve this goal, the opinions of 65 established VA medical investigators were obtained regarding the past success and future direction of VA research. The conclusions reached include the following. 1) Merit Review research funding has been essential to the training, recruitment, and retention of productive VA physician-scientists. 2) The VA research program has contributed both basic and clinical innovations that have led to improvements in medical care. Contributions of VA researchers to excellence in many aspects of patient care at VA hospitals have been extraordinary. 3) Development of initiatives that entice outstanding Ph.D.'s to develop their careers in the VA has been crucial to the success of the program. 4) The VA research program has fostered a mutually beneficial relationship with affiliated medical schools. 5) Better methods to quantify VA research contributions and outcomes are essential for future program development. PMID:15466355

  17. Impact of a pharmacist-prepared interim residential care medication administration chart on gaps in continuity of medication management after discharge from hospital to residential care: a prospective pre- and post-intervention study (MedGap Study)

    PubMed Central

    Tran, Tim; Taylor, Simone E; Harvey, Penelope A; Belfrage, Mary K; Jennings, Rhonda J; Marriott, Jennifer L

    2012-01-01

    Objectives To test the impact of a hospital pharmacist-prepared interim residential care medication administration chart (IRCMAC) on medication administration errors and use of locum medical services after discharge from hospital to residential care. Design Prospective pre-intervention and post-intervention study. Setting One major acute care hospital and one subacute aged-care hospital; 128 residential care facilities (RCF) in Victoria, Australia. Participants 428 patients (median age 84 years, IQR 79–88) discharged to a RCF from an inpatient ward over two 12-week periods. Intervention Seven-day IRCMAC auto-populated with patient and medication data from the hospitals' pharmacy dispensing software, completed and signed by a hospital pharmacist and sent with the patient to the RCF. Primary and secondary outcome measures Primary end points were the proportion of patients with one or more missed or significantly delayed (>50% of prescribed dose interval) medication doses, and the proportion of patients whose RCF medication chart was written by a locum doctor, in the 24 h after discharge. Secondary end points included RCF staff and general practitioners' opinions about the IRCMAC. Results The number of patients who experienced one or more missed or delayed doses fell from 37/202 (18.3%) to 6/226 (2.7%) (difference in percentages 15.6%, 95% CI 9.5% to 21.9%, p<0.001). The number of patients whose RCF medication chart was written by a locum doctor fell from 66/202 (32.7%) to 25/226 (11.1%) (difference in percentages 21.6%, 95% CI 13.5% to 29.7%, p<0.001). For 189/226 (83.6%) discharges, RCF staff reported that the IRCMAC improved continuity of care; 31/35 (88.6%) general practitioners said that the IRCMAC reduced the urgency for them to attend the RCF and 35/35 (100%) said that IRCMACs should be provided for all patients discharged to a RCF. Conclusions A hospital pharmacist-prepared IRCMAC significantly reduced medication errors and use of locum medical services

  18. 77 FR 38179 - Autopsies at VA Expense

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-06-27

    ... abuse; Alcoholism; Claims; Day care; Dental health; Drug abuse; Government contracts; Grant programs... statute that previously authorized certain outpatient and ambulatory care, which included post... performed on a veteran who dies outside of a facility while undergoing post-hospital care under...

  19. Exploration Day at Busch Gardens, Williamsburg, Va. - Aug. 5, 2011

    NASA Video Gallery

    Friday, August 8, was NASA Days at Busch Gardens Williamsburg, Va. NASA exhibits and educational specialists worked to inspire young and old, and NASA astronaut Susan Kilrain -- a veteran of two Sp...

  20. 75 FR 35966 - Farm Credit Administration Board Meetings; Assessment and Apportionment of Administrative...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-06-24

    ..., Office of Regulatory Policy, Farm Credit Administration, McLean, VA 22102-5090, (703) 883-4498, TTY (703... extension of credit and the collection of loans would also necessarily include the administration of credit... From the Federal Register Online via the Government Publishing Office FARM CREDIT...

  1. Quality improvements in decreasing medication administration errors made by nursing staff in an academic medical center hospital: a trend analysis during the journey to Joint Commission International accreditation and in the post-accreditation era

    PubMed Central

    Wang, Hua-fen; Jin, Jing-fen; Feng, Xiu-qin; Huang, Xin; Zhu, Ling-ling; Zhao, Xiao-ying; Zhou, Quan

    2015-01-01

    Background Medication errors may occur during prescribing, transcribing, prescription auditing, preparing, dispensing, administration, and monitoring. Medication administration errors (MAEs) are those that actually reach patients and remain a threat to patient safety. The Joint Commission International (JCI) advocates medication error prevention, but experience in reducing MAEs during the period of before and after JCI accreditation has not been reported. Methods An intervention study, aimed at reducing MAEs in hospitalized patients, was performed in the Second Affiliated Hospital of Zhejiang University, Hangzhou, People’s Republic of China, during the journey to JCI accreditation and in the post-JCI accreditation era (first half-year of 2011 to first half-year of 2014). Comprehensive interventions included organizational, information technology, educational, and process optimization-based measures. Data mining was performed on MAEs derived from a compulsory electronic reporting system. Results The number of MAEs continuously decreased from 143 (first half-year of 2012) to 64 (first half-year of 2014), with a decrease in occurrence rate by 60.9% (0.338% versus 0.132%, P<0.05). The number of MAEs related to high-alert medications decreased from 32 (the second half-year of 2011) to 16 (the first half-year of 2014), with a decrease in occurrence rate by 57.9% (0.0787% versus 0.0331%, P<0.05). Omission was the top type of MAE during the first half-year of 2011 to the first half-year of 2014, with a decrease by 50% (40 cases versus 20 cases). Intravenous administration error was the top type of error regarding administration route, but it continuously decreased from 64 (first half-year of 2012) to 27 (first half-year of 2014). More experienced registered nurses made fewer medication errors. The number of MAEs in surgical wards was twice that in medicinal wards. Compared with non-intensive care units, the intensive care units exhibited higher occurrence rates of MAEs

  2. Performance of InterVA for assigning causes of death to verbal autopsies: multisite validation study using clinical diagnostic gold standards

    PubMed Central

    2011-01-01

    Background InterVA is a widely disseminated tool for cause of death attribution using information from verbal autopsies. Several studies have attempted to validate the concordance and accuracy of the tool, but the main limitation of these studies is that they compare cause of death as ascertained through hospital record review or hospital discharge diagnosis with the results of InterVA. This study provides a unique opportunity to assess the performance of InterVA compared to physician-certified verbal autopsies (PCVA) and alternative automated methods for analysis. Methods Using clinical diagnostic gold standards to select 12,542 verbal autopsy cases, we assessed the performance of InterVA on both an individual and population level and compared the results to PCVA, conducting analyses separately for adults, children, and neonates. Following the recommendation of Murray et al., we randomly varied the cause composition over 500 test datasets to understand the performance of the tool in different settings. We also contrasted InterVA with an alternative Bayesian method, Simplified Symptom Pattern (SSP), to understand the strengths and weaknesses of the tool. Results Across all age groups, InterVA performs worse than PCVA, both on an individual and population level. On an individual level, InterVA achieved a chance-corrected concordance of 24.2% for adults, 24.9% for children, and 6.3% for neonates (excluding free text, considering one cause selection). On a population level, InterVA achieved a cause-specific mortality fraction accuracy of 0.546 for adults, 0.504 for children, and 0.404 for neonates. The comparison to SSP revealed four specific characteristics that lead to superior performance of SSP. Increases in chance-corrected concordance are attained by developing cause-by-cause models (2%), using all items as opposed to only the ones that mapped to InterVA items (7%), assigning probabilities to clusters of symptoms (6%), and using empirical as opposed to expert

  3. Real-time seismic monitoring of instrumented hospital buildings

    USGS Publications Warehouse

    Kalkan, Erol; Fletcher, Jon Peter B.; Leith, William S.; McCarthy, William S.; Banga, Krishna

    2012-01-01

    In collaboration with the Department of Veterans Affairs (VA), the U.S. Geological Survey's National Strong Motion Project has recently installed sophisticated seismic monitoring systems to monitor the structural health of two hospital buildings at the Memphis VA Medical Center in Tennessee. The monitoring systems in the Bed Tower and Spinal Cord Injury buildings combine sensing technologies with an on-site computer to capture and analyze seismic performance of buildings in near-real time.

  4. 78 FR 18425 - Proposed Information Collection VA Police Officer Pre-Employment Screening Checklist); Comment...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-03-26

    ... AFFAIRS Proposed Information Collection VA Police Officer Pre-Employment Screening Checklist); Comment... applicant's qualification and suitability as a VA police officer. DATES: Written comments and... information technology. Title: VA Police Officer Pre-Employment Screening Checklist, VA Form 0120. OMB...

  5. 78 FR 38452 - Agency Information Collection (VA Police Officer Pre-Employment Screening Checklist) Activities...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-26

    ... AFFAIRS Agency Information Collection (VA Police Officer Pre-Employment Screening Checklist) Activities... ``OMB Control No. 2900-0524.'' SUPPLEMENTARY INFORMATION: Title: VA Police Officer Pre-Employment... checks on applicants seeking employment as VA police officers. VA will use the data collected...

  6. [Estimation for bugeting and evaluation of surgical procedures within the scope of comparative hospital administration. Value of LKA, PPR and DRG systems].

    PubMed

    Pinnau, R; Rostock, K; Gudath, R; Mansky, T; Meyer-Pannwitt, U

    1998-01-01

    Comparison of costing and performances of individual departments or hospitals are required by the statute book of social affairs (Sozialgesetzbuch V; SGB V), but have not been fully introduced in Germany. LBK Hamburg, a trust of 8 hospitals with 17 surgical departments, evaluated the significance of performance and cost-accounting systems such as performance and cost-accounting (LKA), nursing staff regulation (PPR), and the diagnosis-related group system in order to distribute a three-year budget (1996-1998) and to compare, e.g., performance of surgical departments. The DRG system seems to be the best choice, since it weights all cases by means in 640 groups according to the degree of difficulty. With a given closed budget, the DRG system may compare the actual cost with the target figures.

  7. The need to immobilise the cervical spine during cardiopulmonary resuscitation and electric shock administration in out-of-hospital cardiac arrest.

    PubMed

    Desroziers, Milene; Mole, Sophie; Jost, Daniel; Tourtier, Jean-Pierre

    2016-06-13

    In cases of out-of hospital cardiac arrest (OHCA), falling to the ground can cause brain and neck trauma to the patient. We present a case of a man in his mid-60s who suffered from an OHCA resulting in a violent collapse. The patient received immediate cardiopulmonary resuscitation, but his spine was immobilised only after a large frontal haematoma was found. The resuscitation efforts resulted in return of spontaneous circulation and discharge from hospital. After this, doctors performed angioplasty, followed by a cardiopulmonary bypass. Later, CT scan examination reported a displaced and unstable fracture of the 6th vertebra without bone marrow involvement. The patient underwent a second operation. 40 days later, he was able to return home without sequela. This case shows the importance of analysing the circumstances of a fall, considering the possibility of two concomitant diagnoses and prioritising investigations and treatment.

  8. Health Care Financing Administration--Federal health insurance for the aged and disabled; quality control and proficiency testing standards for laboratories in Medicare hospitals. Final rule.

    PubMed

    1980-03-31

    These amendments revise the Medicare regulations to provide that the quality control and proficiency testing requirements used by the American Osteopathic Association (AOA) in accrediting hospital laboratories are now equivalent to those established by the Department. This change reflects the results of a reevaluation made by the Department of upgraded standards adopted by AOA and the actions taken by AOA to implement these standards. The Department (Center for Disease Control) will monitor AOA's performance in applying the standards. The monitoring function shall include the review and transcription of laboratory survey data in AOA's offices which are necessary to the completion of this task. The finding of CDC/PHS monitoring will be used by HCFA to verify the equivalence of the AOA standards to the Federal standards. The amendments will eliminate the need for State health agency inspection of AOA accredited hospital laboratories.

  9. Ground Floor Plan (Section B) U.S. Veterans Hospital, Jefferson ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Ground Floor Plan (Section B) - U.S. Veterans Hospital, Jefferson Barracks, Spinal Cord Injury Unit and Tuberculosis Neuropsychiatric Building, VA Medical Center, Jefferson Barracks Division 1 Jefferson Barracks Drive, Saint Louis, Independent City, MO

  10. Second Floor Plan (Section B) U.S. Veterans Hospital, Jefferson ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Second Floor Plan (Section B) - U.S. Veterans Hospital, Jefferson Barracks, Spinal Cord Injury Unit and Tuberculosis Neuropsychiatric Building, VA Medical Center, Jefferson Barracks Division 1 Jefferson Barracks Drive, Saint Louis, Independent City, MO

  11. First Floor Plan (Section B) U.S. Veterans Hospital, Jefferson ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    First Floor Plan (Section B) - U.S. Veterans Hospital, Jefferson Barracks, Spinal Cord Injury Unit and Tuberculosis Neuropsychiatric Building, VA Medical Center, Jefferson Barracks Division 1 Jefferson Barracks Drive, Saint Louis, Independent City, MO

  12. U.S. Veterans Hospital, Jefferson Barracks, Spinal Cord Injury Unit and ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    U.S. Veterans Hospital, Jefferson Barracks, Spinal Cord Injury Unit and Tuberculosis Neuropsychiatric Building, VA Medical Center, Jefferson Barracks Division 1 Jefferson Barracks Drive, Saint Louis, Independent City, MO

  13. Second Floor Plan (Section A) U.S. Veterans Hospital, Jefferson ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Second Floor Plan (Section A) - U.S. Veterans Hospital, Jefferson Barracks, Spinal Cord Injury Unit and Tuberculosis Neuropsychiatric Building, VA Medical Center, Jefferson Barracks Division 1 Jefferson Barracks Drive, Saint Louis, Independent City, MO

  14. Ground Floor Plan (Section A) U.S. Veterans Hospital, Jefferson ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Ground Floor Plan (Section A) - U.S. Veterans Hospital, Jefferson Barracks, Spinal Cord Injury Unit and Tuberculosis Neuropsychiatric Building, VA Medical Center, Jefferson Barracks Division 1 Jefferson Barracks Drive, Saint Louis, Independent City, MO

  15. First Floor Plan (Section A) U.S. Veterans Hospital, Jefferson ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    First Floor Plan (Section A) - U.S. Veterans Hospital, Jefferson Barracks, Spinal Cord Injury Unit and Tuberculosis Neuropsychiatric Building, VA Medical Center, Jefferson Barracks Division 1 Jefferson Barracks Drive, Saint Louis, Independent City, MO

  16. West wall, looking northeast U.S. Veterans Hospital, Jefferson Barracks, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    West wall, looking northeast - U.S. Veterans Hospital, Jefferson Barracks, Spinal Cord Injury Unit and Tuberculosis Neuropsychiatric Building, VA Medical Center, Jefferson Barracks Division 1 Jefferson Barracks Drive, Saint Louis, Independent City, MO

  17. Southeast corner, looking northwest U.S. Veterans Hospital, Jefferson Barracks, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Southeast corner, looking northwest - U.S. Veterans Hospital, Jefferson Barracks, Spinal Cord Injury Unit and Tuberculosis Neuropsychiatric Building, VA Medical Center, Jefferson Barracks Division 1 Jefferson Barracks Drive, Saint Louis, Independent City, MO

  18. Interior, food processing room, looking northeast U.S. Veterans Hospital, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Interior, food processing room, looking northeast - U.S. Veterans Hospital, Jefferson Barracks, Kitchen, VA Medical Center, Jefferson Barracks Division 1 Jefferson Barracks Drive, Saint Louis, Independent City, MO

  19. Floor Plans and Stair Section U.S. Veterans Hospital, Jefferson ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Floor Plans and Stair Section - U.S. Veterans Hospital, Jefferson Barracks, Medical Officer in Charge Residence, VA Medical Center, Jefferson Barracks Division 1 Jefferson Barracks Drive, Saint Louis, Independent City, MO

  20. Interior, east bedroom, looking southeast U.S. Veterans Hospital, Jefferson ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Interior, east bedroom, looking southeast - U.S. Veterans Hospital, Jefferson Barracks, Medical Officer in Charge Residence, VA Medical Center, Jefferson Barracks Division 1 Jefferson Barracks Drive, Saint Louis, Independent City, MO

  1. Interior, rear sunporch, looking north U.S. Veterans Hospital, Jefferson ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Interior, rear sunporch, looking north - U.S. Veterans Hospital, Jefferson Barracks, Medical Officer in Charge Residence, VA Medical Center, Jefferson Barracks Division 1 Jefferson Barracks Drive, Saint Louis, Independent City, MO

  2. Southwest corner, looking north U.S. Veterans Hospital, Jefferson Barracks, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Southwest corner, looking north - U.S. Veterans Hospital, Jefferson Barracks, Medical Officer in Charge Residence, VA Medical Center, Jefferson Barracks Division 1 Jefferson Barracks Drive, Saint Louis, Independent City, MO

  3. Interior, living room, looking west U.S. Veterans Hospital, Jefferson ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Interior, living room, looking west - U.S. Veterans Hospital, Jefferson Barracks, Medical Officer in Charge Residence, VA Medical Center, Jefferson Barracks Division 1 Jefferson Barracks Drive, Saint Louis, Independent City, MO

  4. Basement, bathroom, looking south U.S. Veterans Hospital, Jefferson Barracks, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Basement, bathroom, looking south - U.S. Veterans Hospital, Jefferson Barracks, Medical Officer in Charge Residence, VA Medical Center, Jefferson Barracks Division 1 Jefferson Barracks Drive, Saint Louis, Independent City, MO

  5. Northeast corner, looking southwest U.S. Veterans Hospital, Jefferson Barracks, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Northeast corner, looking southwest - U.S. Veterans Hospital, Jefferson Barracks, Medical Officer in Charge Residence, VA Medical Center, Jefferson Barracks Division 1 Jefferson Barracks Drive, Saint Louis, Independent City, MO

  6. North wall, looking southeast U.S. Veterans Hospital, Jefferson Barracks, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    North wall, looking southeast - U.S. Veterans Hospital, Jefferson Barracks, Medical Officer in Charge Residence, VA Medical Center, Jefferson Barracks Division 1 Jefferson Barracks Drive, Saint Louis, Independent City, MO

  7. Interior, dining room, looking southeast U.S. Veterans Hospital, Jefferson ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Interior, dining room, looking southeast - U.S. Veterans Hospital, Jefferson Barracks, Medical Officer in Charge Residence, VA Medical Center, Jefferson Barracks Division 1 Jefferson Barracks Drive, Saint Louis, Independent City, MO

  8. South (front) wall, looking northwest U.S. Veterans Hospital, Jefferson ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    South (front) wall, looking northwest - U.S. Veterans Hospital, Jefferson Barracks, Medical Officer in Charge Residence, VA Medical Center, Jefferson Barracks Division 1 Jefferson Barracks Drive, Saint Louis, Independent City, MO

  9. Building Sections and Detailed Wall Sections U.S. Veterans Hospital, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    Building Sections and Detailed Wall Sections - U.S. Veterans Hospital, Jefferson Barracks, Therapeutic Exercise Building, VA Medical Center, Jefferson Barracks Division 1 Jefferson Barracks Drive, Saint Louis, Independent City, MO

  10. North and South Elevations U.S. Veterans Hospital, Jefferson Barracks, ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    North and South Elevations - U.S. Veterans Hospital, Jefferson Barracks, Therapeutic Exercise Building, VA Medical Center, Jefferson Barracks Division 1 Jefferson Barracks Drive, Saint Louis, Independent City, MO

  11. A clinical management system for patient participatory health care support. Assuring the patients' rights and confirming operation of clinical treatment and hospital administration.

    PubMed

    Ishikawa, Kiyomu; Konishi, Nakao; Tsukuma, Hidehiko; Tsuru, Satoko; Kawamura, Akie; Iwata, Norikazu; Tanaka, Takeshi

    2004-03-31

    We conducted a drastic change in our hospital information system to support patient participatory health care provided in the New Hiroshima University Hospital (HUH). The new information system in HUH (HU-MIND II-Hiroshima University Hospital Medical Intelligence and Notice Delivery system II) is designed as "clinical management system" (CMS). The core of this CMS is the electronic health record (EHR), which aims to assure both the patients' right to know, and the attendants' accountability. It is evident that the team practice including patients requires close communication. Data in the EHR are written not only by physicians, but also by all coworkers, which will enable them to realize the team communication and the ordering in a reliable way and to leave the evidence of conducted practices. Moreover, the bedside information systems were set-up at all 700 beds. Patients can access their anamnesis and future clinical care procedures themselves. Based on the demand outlined above, the new regulations of HUH are composed of 21 requirements, conditions of information collection, accumulation and use. Our focus was how to make patients' right compatible with attendants' accountability. As the data owners, patients have the facility to access their own data at their bedsides. They can view their own health condition and treatment program and can control the data flow.

  12. Smaller hospitals accept advertising.

    PubMed

    Mackesy, R

    1988-07-01

    Administrators at small- and medium-sized hospitals gradually have accepted the role of marketing in their organizations, albeit at a much slower rate than larger institutions. This update of a 1983 survey tracks the increasing competitiveness, complexity and specialization of providing health care and of advertising a small hospital's services. PMID:10288550

  13. 30 CFR 57.22314 - Flow-control devices (V-A and V-B mines).

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Flow-control devices (V-A and V-B mines). 57.22314 Section 57.22314 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-UNDERGROUND METAL AND NONMETAL MINES Safety Standards for Methane in Metal...

  14. Administration of Computer Resources.

    ERIC Educational Resources Information Center

    Franklin, Gene F.

    Computing at Stanford University has, until recently, been performed at one of five facilities. The Stanford hospital operates an IBM 370/135 mainly for administrative use. The university business office has an IBM 370/145 for its administrative needs and support of the medical clinic. Under the supervision of the Stanford Computation Center are…

  15. 48 CFR 831.7001-4 - Medical services and hospital care.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... hospital care. 831.7001-4 Section 831.7001-4 Federal Acquisition Regulations System DEPARTMENT OF VETERANS... and Procedures 831.7001-4 Medical services and hospital care. (a) VA may pay the customary student... Government. (b) When the customary student's health fee does not cover medical services or hospital care,...

  16. 78 FR 55671 - Hospital Care and Medical Services for Camp Lejeune Veterans

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-11

    ... hospital care and medical services. As discussed in a separate notice (78 FR 39832, July 2, 2013), we are... AFFAIRS 38 CFR Part 17 RIN 2900-AO78 Hospital Care and Medical Services for Camp Lejeune Veterans AGENCY... January 1, 1957, and ending on December 31, 1987. The law requires VA to furnish hospital care and...

  17. Administratively Necessary Days: More than an Administrative Problem.

    ERIC Educational Resources Information Center

    Markson, Elizabeth W.; And Others

    1983-01-01

    Surveyed discharge planners at 49 acute care hospitals to ascertain problems they perceived in placing elderly patients. Selected hospital characteristics and placement practices and the ways in which they are associated with hospital back-up (sometimes called administratively necessary days) and delays in placement were analyzed. (Author/JAC)

  18. Santa Barbara Cottage Hospital.

    PubMed

    1984-01-01

    The 465-bed Santa Barbara Cottage Hospital is the largest medical facility on the California coast between Los Angeles and the San Francisco bay area. The hospital dates back to 1888, when a group of local citizens began raising funds to build a "cottage-style" hospital for the growing community. Their original plans called for a complex in which each medical specialty would be housed in a separate bungalow. Even then, however, such a decentralized plan was too costly, so work began instead on a single cottage for all hospital departments. The first Cottage Hospital opened in 1891, with 25 beds housed in a two story Victorian building. Now a hugh medical complex employing some 1,500 people, the hospital continues to be called "Cottage" after the original home-like building. Rodney J. Lamb has been Hospital Administrator for the last 30 years.

  19. Examining the relationship between processes of care and selected AHRQ patient safety indicators postoperative wound dehiscence and accidental puncture or laceration using the VA electronic medical record.

    PubMed

    Chen, Qi; Borzecki, Ann M; Cevasco, Marisa; Shin, Marlena H; Shwartz, Michael; Itani, Kamal M F; Rosen, Amy K

    2013-01-01

    This study examines whether Agency for Healthcare Research and Quality Patient Safety Indicators (PSIs) Postoperative Wound Dehiscence (PWD) and Accidental Puncture or Laceration (APL) events reflect problems with hospital processes of care (POC). The authors randomly selected 112 PSI-flagged PWD/APL discharges from 2002-2007 VA administrative data, identified true cases using chart review, and matched cases with controls. This yielded a total of 95 case-control pairs per PSI. Patient information and clinical processes on each case-control pair were abstracted from the electronic medical record (EMR). Although PWD cases and controls differed on incision and closure types, APL cases and controls were comparable in examined processes. Further exploration of the process differences between PWD cases and controls indicated that they were primarily caused by patients' underlying surgical problems rather than quality of care shortfalls. Documentation of POC was frequently missing in EMRs. Future studies should combine EMR review with alternative approaches, such as direct observation, to better assess POC.

  20. Hospital Library Development. Hospital Library Handbooks No. 2.

    ERIC Educational Resources Information Center

    Cramer, Anne

    Addressed to the administrator of the hospital as well as the librarian, this handbook covers aspects of library service policy and long-range planning. While hospitals of all sizes are discussed, a special effort is made to cover problems of small hospitals (17 to 100 beds) in sparsely-settled regions. Contents: The library as a clinical service,…

  1. 38 CFR 51.210 - Administration.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.210 Administration. A facility must be... (annual at time of survey); (6) The number of nursing home patients who are veterans and non-veterans, the... Veterans. The percent of the facility residents eligible for VA nursing home care must be at least...

  2. 38 CFR 51.210 - Administration.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.210 Administration. A facility must be... (annual at time of survey); (6) The number of nursing home patients who are veterans and non-veterans, the... Veterans. The percent of the facility residents eligible for VA nursing home care must be at least...

  3. 38 CFR 51.210 - Administration.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.210 Administration. A facility must be... (annual at time of survey); (6) The number of nursing home patients who are veterans and non-veterans, the... residents eligible for VA nursing home care must be at least 75 percent veterans except that the...

  4. 38 CFR 51.210 - Administration.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... FOR NURSING HOME CARE OF VETERANS IN STATE HOMES Standards § 51.210 Administration. A facility must be... (annual at time of survey); (6) The number of nursing home patients who are veterans and non-veterans, the... Veterans. The percent of the facility residents eligible for VA nursing home care must be at least...

  5. Women in addictions treatment: comparing VA and community samples.

    PubMed

    Davis, Tania M; Carpenter, Kelly M; Malte, Carol A; Carney, Molly; Chambers, Sharon; Saxon, Andrew J

    2002-07-01

    Despite increasing awareness of gender issues in substance use treatment, women with substance use disorders (SUD) and gender-specific treatment remain understudied. This study examines differences, including identification of comorbid issues and patients' perceived treatment needs, between women in different SUD treatment settings: an intensive VA outpatient program (VA; N = 76) and a private residential/outpatient program (Residence XII; N = 308). In both settings the Addiction Severity Index (ASI) was administered at intake; ASI data were collected from retrospective chart review. Results support previous findings that women entering SUD treatment endorse high rates of psychiatric and medical comorbidity, and past abuse. Women in VA SUD treatment experienced more impairment on indices of medical, psychiatric, and employment issues whereas the private agency sample had higher alcohol and family/social composite scores. The differences between and similarities among the two treatment groups have implications for design of women-specific SUD treatment programs.

  6. Strategic market planning for hospitals.

    PubMed

    Zallocco, R L; Joseph, W B; Doremus, H

    1984-01-01

    The application of strategic market planning to hospital management is discussed, along with features of the strategic marketing management process. A portfolio analysis tool, the McKinsey/G.E. Business Screen, is presented and, using a large urban hospital as an example, discussed in detail relative to hospital administration. Finally, strategic implications of the portfolio analysis are examined.

  7. Blood oxygenation during hyperpressure intraperitoneal fluid administration in a rabbit model of severe liver injury: Evaluation of a novel concept for control of pre-hospital liver bleeding

    PubMed Central

    Ahmadi-Noorbakhsh, Siavash; Azizi, Saeed; Dalir-Naghadeh, Bahram; Maham, Masoud

    2012-01-01

    Oxygen is an essential part of the most important metabolic pathways in aerobic organisms. Oxygen delivery is merely dependent on blood, rendering blood loss a devastating event. Traumatic pre-hospital liver bleeding is a major cause of early trauma deaths in human and animals, with no established therapeutic method yet. Increasing intra-abdominal pressure (IAP) has been shown to reduce liver bleeding by half. Although reduction of blood loss could be in favor of blood oxygen delivery, however, the complex interaction between increased IAP and respiratory mechanics during severe hemorrhagic shock remained unclear. We used a novel model of liver trauma in 16 rabbits and randomly assigned them to either normotensive abdomen group or increased IAP by fluid infusion (HA) groups (n=8 each). Liver size and the amount of liver injury were evaluated. Various blood oxygenation parameters were recorded. Both groups were identical in terms of the liver size and injury. The HA group had significantly lower shock index. Arterial oxygen capacity and oxygen content were higher in the HA group. No significant statistical difference was seen between groups in terms of abdominal perfusion pressure; alveolar pressure of oxygen; dissolved oxygen in blood plasma; alveolar to arterial oxygen tension gradient; arterial to alveolar oxygen pressure ratio; the ratio between partial pressure of arterial oxygen and fraction of inspired oxygen; and respiratory index. In conclusion, the novel therapeutic method of increasing IAP by fluid infusion in a rabbit model of liver hemorrhage preserved blood oxygenation better than the classic therapeutic method. PMID:25653758

  8. 77 FR 25591 - Drawbridge Operation Regulation; Intracoastal Waterway, Chesapeake, VA

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-01

    ...The Commander Fifth Coast Guard District has issued a temporary deviation from the regulations governing the operation of the Norfolk Southern 7 Railroad Bridge, across the Intracoastal Waterway, mile 5.8, in Chesapeake, VA. The deviation is necessary to facilitate replacing the lift joints of the drawbridge. This deviation restricts operation of the draw span, allowing it to remain......

  9. 78 FR 72002 - Amendment of Class E Airspace; Danville, VA

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-02

    ... Class E surface area airspace at Danville Regional Airport, Danville, VA. (78 FR, 48079). Interested... rule'' under DOT Regulatory Policies and Procedures (44 FR 11034; February 26, 1979); and (3) does not..., 40113, 40120; E.O. 10854, 24 FR 9565, 3 CFR, 1959-1963 Comp., p. 389. Sec. 71.1 0 2. The...

  10. 76 FR 77270 - Board Meeting; January 9, 2012, Arlington, VA

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-12-12

    ... From the Federal Register Online via the Government Publishing Office NUCLEAR WASTE TECHNICAL REVIEW BOARD Board Meeting; January 9, 2012, Arlington, VA The U.S. Nuclear Waste Technical Review Board... under section 5051 of Public Law 100-203, Nuclear Waste Policy Amendments Act of 1987, the U.S....

  11. 76 FR 34576 - Amendment of Class E Airspace; Waynesboro, VA

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-06-14

    ...) to amend Class E airspace at Eagle's Nest Airport, Waynesboro, VA (75 FR 14820) Docket No. FAA-2010..., 40113, 40120; E.O. 10854, 24 FR 9565, 3 CFR, 1959-1963 Comp., p. 389. Sec. 71.1 0 2. The incorporation... Executive Order 12866; (2) is not a ``significant rule'' under DOT Regulatory Policies and Procedures (44...

  12. 48 CFR 801.695 - VA's Appointment of HCAs Program.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 5 2011-10-01 2011-10-01 false VA's Appointment of HCAs Program. 801.695 Section 801.695 Federal Acquisition Regulations System DEPARTMENT OF VETERANS AFFAIRS GENERAL DEPARTMENT OF VETERANS AFFAIRS ACQUISITION REGULATION SYSTEM Career Development,...

  13. Medical care collection or recovery--VA. Notice.

    PubMed

    1998-10-13

    In a companion document published in the "Proposed Rules" section of this issue of the Federal Register, we proposed to amend VA's medical regulations concerning collection or recovery by VA for medical care or services provided or furnished to a veteran: (i) For a non-service connected disability for which the veteran is entitled to care (or the payment of expenses of care) under a health-plan contract; (ii) For a non-service connected disability incurred incident to the veteran's employment and covered under a worker's compensation law or plan that provides reimbursement or indemnification for such care and services; or (iii) For a non-service connected disability incurred as a result of a motor vehicle accident in a State that requires automobile accident reparations insurance. The proposed rule includes methodology for establishing charges for VA medical care or services. Using this methodology, information for calculating proposed charge amounts at individual VA facilities for inpatient facility charges, skilled nursing facility/sub-acute inpatient facility charges, outpatient facility charges, and physician charges is set forth below. If this methodology were adopted subsequently as a final rule, the applicable data in this document, designed for the period August 1998 through September 1999, would be used for the period from the effective date of the final rule through September 1999. Accordingly, interested parties may wish to retain this document for future reference.

  14. 76 FR 43575 - Amendment of Class E Airspace; Staunton, VA

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-21

    ... Valley Regional Airport, Staunton, VA (76 FR 14822) Docket No. FAA- 2010-1285. Interested parties were... Executive Order 12866; (2) is not a ``significant rule'' under DOT Regulatory Policies and Procedures (44 FR... FR 9565, 3 CFR, 1959-1963 Comp., p. 389. Sec. 71.1 0 2. The incorporation by reference in 14 CFR...

  15. 76 FR 52230 - Establishment of Class E Airspace; Forest, VA

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-08-22

    ..., VA (76 FR 34196) Docket No. FAA-2011-0378. Interested parties were invited to participate in this... Procedures (44 FR 11034; February 26, 1979); and (3) does not warrant preparation of a Regulatory Evaluation.... 106(g); 40103, 40113, 40120; E.O. 10854, 24 FR 9565, 3 CFR, 1959-1963 Comp., p. 389. Sec. 71.1 0...

  16. 38 CFR 1.920 - Referral of VA debts.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... purpose of salary offset shall be done in accordance with 38 CFR 1.980 through 1.995 and regulations prescribed by the Director of the Office of Personnel Management (OPM) in 5 CFR part 550, subpart K... 38 Pensions, Bonuses, and Veterans' Relief 1 2011-07-01 2011-07-01 false Referral of VA debts....

  17. 38 CFR 1.920 - Referral of VA debts.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... purpose of salary offset shall be done in accordance with 38 CFR 1.980 through 1.995 and regulations prescribed by the Director of the Office of Personnel Management (OPM) in 5 CFR part 550, subpart K... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Referral of VA debts....

  18. 76 FR 60713 - Establishment of Class E Airspace; Bumpass, VA

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-30

    ... establish Class E airspace at Bumpass, VA (76 FR 45479) Docket No. FAA-2011-0377. Interested parties were...: Authority: 49 U.S.C. 106(g); 40103, 40113, 40120; E.O. 10854, 24 FR 9565, 3 CFR, 1959-1963 Comp., p. 389... Policies and Procedures (44 FR 11034; February 26, 1979); and (3) does not warrant preparation of...

  19. 32 CFR 105.10 - SARC and SAPR VA procedures.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... to accept reports of sexual assault along with the SAPR VA and healthcare personnel. (6) Report directly to the installation commander in accordance with 32 CFR part 103, to include providing regular... criminal investigative personnel on the SAPR policy and program and the roles and responsibilities of...

  20. 12 CFR 324.205 - VaR-based measure.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... risk-based capital requirements. The FDIC-supervised institution must update data sets at least monthly... observation period of at least one year. Data used to determine the VaR-based measure must be relevant to the... portfolio over a full business cycle. An FDIC-supervised institution using this option must update its...

  1. 12 CFR 3.205 - VaR-based measure.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... bank or Federal savings association must update data sets at least monthly or more frequently as... be based on a historical observation period of at least one year. Data used to determine the VaR... using this option must update its data more frequently than monthly and in a manner appropriate for...

  2. 12 CFR 217.205 - VaR-based measure.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... requirements. The Board-regulated institution must update data sets at least monthly or more frequently as... year. Data used to determine the VaR-based measure must be relevant to the Board-regulated institution.... A Board-regulated institution using this option must update its data more frequently than...

  3. 78 FR 71041 - VA Compensation and Pension Regulation Rewrite Project

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-27

    ... effect of the proposed revisions is to assist claimants, beneficiaries, veterans' representatives, and VA... quoted at length from NPRM AM 01, 72 FR 28770, May 22, 2007, to rebut the Secretary's assertion that his... noted that the NPRM stated that it explained any substantive changes between part 3 and part 5, 72...

  4. Geropsychology Training in a VA Nursing Home Setting

    ERIC Educational Resources Information Center

    Karel, Michele J.; Moye, Jennifer

    2005-01-01

    There is a growing need for professional psychology training in nursing home settings, and nursing homes provide a rich environment for teaching geropsychology competencies. We describe the nursing home training component of our Department of Veterans Affairs (VA) Predoctoral Internship and Geropsychology Postdoctoral Fellowship programs. Our…

  5. 75 FR 79295 - Establishment of Class E Airspace; Crewe, VA

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-20

    ... Federal Register a notice of proposed rulemaking to establish Class E airspace at Crewe, VA (75 FR 57215...: Authority: 49 U.S.C. 106(g); 40103, 40113, 40120; E.O. 10854, 24 FR 9565, 3 CFR, 1959-1963 Comp., p. 389... ``significant rule'' under DOT Regulatory Policies and Procedures (44 FR 11034; February 26, 1979); and (3)...

  6. 42 CFR 412.278 - Administrator's review.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 42 Public Health 2 2010-10-01 2010-10-01 false Administrator's review. 412.278 Section 412.278... Review Board Composition and Procedures § 412.278 Administrator's review. (a) Hospitals requests for review. A hospital or group of hospitals dissatisfied with the MGCRB's decision regarding its...

  7. 42 CFR 412.278 - Administrator's review.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 42 Public Health 2 2011-10-01 2011-10-01 false Administrator's review. 412.278 Section 412.278... Review Board Composition and Procedures § 412.278 Administrator's review. (a) Hospitals requests for review. A hospital or group of hospitals dissatisfied with the MGCRB's decision regarding its...

  8. Nurse Workforce Characteristics and Infection Risk in VA Community Living Centers: A Longitudinal Analysis

    PubMed Central

    Uchida-Nakakoji, Mayuko; Stone, Patricia W.; Schmitt, Susan K.; Phibbs, Ciaran S.

    2015-01-01

    Objective To examine effects of workforce characteristics on resident infections in Veterans Affairs (VA) Community Living Centers (CLCs). Data Sources A six-year panel of monthly, unit-specific data included workforce characteristics (from the VA Decision Support System and Payroll data) and characteristics of residents and outcome measures (from the Minimum Data Set). Study Design A resident infection composite was the dependent variable. Workforce characteristics of registered nurses (RN), licensed practical nurses (LPN), nurse aides (NA), and contract nurses included: staffing levels, skill mix and tenure. Descriptive statistics and unit-level fixed effects regressions were conducted. Robustness checks varying workforce and outcome parameters were examined. Principal Findings Average nursing hours per resident day was 4.59 hours (sd = 1.21). RN tenure averaged 4.7 years (sd = 1.64) and 4.2 years for both LPN (sd= 1.84) and NA (sd= 1.72). In multivariate analyses RN and LPN tenure were associated with decreased infections by 3.8% (IRR= 0.962 p<0.01) and 2% (IRR=0.98 p<0.01) respectively. Robustness checks consistently found RN and LPN tenure to be associated with decreased infections. Conclusions Increasing RN and LPN tenure are likely to reduce CLC resident infections. Administrators and policymakers need to focus on recruiting and retaining a skilled nursing workforce. PMID:25634087

  9. The process of implementing a rural VA wound care program for diabetic foot ulcer patients.

    PubMed

    Reiber, Gayle E; Raugi, Gregory J; Rowberg, Donald

    2007-10-01

    Delivering and documenting evidence-based treatment to all Department of Veterans Affairs (VA) foot ulcer patients has wide appeal. However, primary and secondary care medical centers where 52% of these patients receive care are at a disadvantage given the frequent absence of trained specialists to manage diabetic foot ulcers. A retrospective review of diabetic foot ulcer patient records and a provider survey were conducted to document the foot ulcer problem and to assess practitioner needs. Results showed of the 125 persons with foot ulcers identified through administrative data, only, 21% of diabetic foot patients were correctly coded. Chronic Care and Microsystem models were used to prepare a tailored intervention in a VA primary care medical center. The site Principal Investigators, a multidisciplinary site wound care team, and study investigators jointly implemented a diabetic foot ulcer program. Intervention components include wound care team education and training, standardized good wound care practices based on strong scientific evidence, and a wound care template embedded in the electronic medical record to facilitate data collection, clinical decision making, patient ordering, and coding. A strategy for delivering offloading pressure devices, regular case management support, and 24/7 emergency assistance also was developed. It took 9 months to implement the model. Patients were enrolled and followed for 1 year. Process and outcome evaluations are on-going.

  10. Variations in the Use of mHealth Tools: The VA Mobile Health Study

    PubMed Central

    2016-01-01

    Background Mobile health (mHealth) technologies exhibit promise for offering patients and their caregivers point-of-need tools for health self-management. This research study involved the dissemination of iPads containing a suite of mHealth apps to family caregivers of veterans who receive care from the Veterans Affairs (VA) Health Administration and have serious physical or mental injuries. Objective The goal of the study was to identify factors and characteristics of veterans and their family caregivers that predict the use of mHealth apps. Methods Veteran/family caregiver dyads (N=882) enrolled in VA’s Comprehensive Assistance for Family Caregivers program were recruited to participate in an mHealth pilot program. Veterans and caregivers who participated and received an iPad agreed to have their use of the apps monitored and were asked to complete a survey assessing Caregiver Preparedness, Caregiver Traits, and Caregiver Zarit Burden Inventory baseline surveys. Results Of the 882 dyads, 94.9% (837/882) of caregivers were women and 95.7% (844/882) of veteran recipients were men. Mean caregiver age was 40 (SD 10.2) years and mean veteran age was 39 (SD 9.15) years, and 39.8% (351/882) lived in rural locations. Most (89%, 788/882) of the caregivers were spouses. Overall, the most frequently used app was Summary of Care, followed by RX Refill, then Journal, Care4Caregivers, VA Pain Coach, and last, VA PTSD Coach. App use was significantly predicted by the caregiver being a spouse, increased caregiver computer skills, a rural living location, lower levels of caregiver preparedness, veteran mental health diagnosis (other than posttraumatic stress disorder), and veteran age. Conclusions This mHealth Family Caregiver pilot project effectively establishes the VA’s first patient-facing mHealth apps that are integrated within the VA data system. Use varied considerably, and apps that were most used were those that assisted them in their caregiving responsibilities

  11. 27. INTERIOR, ADMINISTRATION BUILDING, 2ND FLOOR, SOUTHEAST CORNER SPACE, LOOKING ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    27. INTERIOR, ADMINISTRATION BUILDING, 2ND FLOOR, SOUTHEAST CORNER SPACE, LOOKING UP AT CIRCULAR MOTIF AND BANDS IN THE CEILING ABOVE THE ACOUSTICAL TILES - Ford Motor Company Plant, 700 South Union Street, Alexandria, Independent City, VA

  12. 75 FR 41577 - VBA/VHA Musculoskeletal Forum: Improving VA's Disability Evaluation Criteria

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-07-16

    ... presentations made by subject matter experts. VA plans to use this information to update the sections of VA's... system. See 38 CFR 4.40-4.73. Specifically, diagnostic code descriptors and evaluation criteria will...

  13. 77 FR 24268 - Agency Information Collection (Dependents' Application for VA Educational Benefits) Activity...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-23

    ... AFFAIRS Agency Information Collection (Dependents' Application for VA Educational Benefits) Activity Under... INFORMATION: Title: Dependents' Application for VA Educational Benefits (Under Provisions of Chapters 33 and... spouses and children of veterans or servicemembers to apply for Survivors' and Dependents'...

  14. 31. FELGATES CREEK BRIDGE (HAER No. VA48I), VIEW FROM WEST ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    31. FELGATES CREEK BRIDGE (HAER No. VA-48-I), VIEW FROM WEST END. NOTE ALUMINUM RAILING ON EAST SIDE FOR CANTILEVERED BIKE PATH. - Colonial Parkway, Yorktown to Jamestown Island, Yorktown, York County, VA

  15. Evaluation of drug treatment in mild hypertension: VA-NHLBI feasibility trial. Plan and preliminary results of a two-year feasibility trial for a multicenter intervention study to evaluate the benefits versus the disadvantages of treating mild hypertension. Prepared for the Veterans Administration-National Heart, Lung, and Blood Institute Study Group for Evaluating Treatment in Mild Hypertension.

    PubMed

    1978-03-30

    A feasibility trial to investigate the practicality of determining the advantages and disadvantages of prompt pharmacologic treatment for mild hypertension was jointly funded by the Veterans Administration and the National Heart, Lung and Blood Institute. Its clinical phase has been completed, and it demonstrated 1. that the required relatively young asymptomatic population could be enrolled in the study and 2. that it could be persuaded to adhere to the protocol for 2 years; however, it was evident that intensive efforts would be required in both areas. The feasibility trial screened almost 120,000 potential subjects over a period of 16 months to randomize about 1,000 subjects at four clinical centers. These men and women were 21 to 50 years old, had diastolic pressures from 85 to 105 mm Hg as outpatients, and had no evidence of cardiovascular renal abnormalities. They were randomized in double-blind fashion into active drug therapy and placebo groups. Stepped care therapy involved 50 mg chlorthalidone (Step 1), 100 mg chlorthalidone (Step 2) and 100 chlorthalidone plus 0.25 mg reserpine (Step 3). Death, myocardial infarction, stroke, angina pectoris, and congestive heart failure were the "major" morbid events that were looked for; also recorded were "minor" morbid events consisting primarily of electrocardiographic arrhythmias. The development of significant hypertension was considered a treatment failure. Side effects were carefully tabulated in both active drug and placebo groups. The study revealed an average drop in diastolic pressure of almost 12 mm Hg for active drug group and less than half of that for the placebo group; once established 6 months after randomization, the new pressure levels persisted almost without change throughout the study. Although the feasibility trial was not designed to answer the primary question regarding the benefits of treatment, the events were tabulated for each group. A total of 12 placebo-treated subjects developed

  16. The Impact of VA's Geriatric Research, Education and Clinical Centers on Academic Affiliates

    ERIC Educational Resources Information Center

    Bragg, Elizabeth J.; Meganathan, Karthikeyan; Shay, Kenneth; Gilman, Stuart C.; Zeiss, Robert A.; Hettler, Debbie L.

    2011-01-01

    The education mission of the Department of Veterans Affairs (VA) is to train health professionals to benefit VA and the United States. One approach for achieving that mission, along with VA's research and clinical missions, was the establishment of Geriatric Research, Education and Clinical Centers (GRECCs) in 1975. These were developed at VA…

  17. 78 FR 76412 - Agency Information Collection (VA National Rehabilitation Special Events, Event Registration...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-17

    ...-0759''. SUPPLEMENTARY INFORMATION: Titles: a. National Disabled Veterans Winter Sports Clinic... sports Clinic Event Application, VA Form 0928a, c. l. Volunteer Application, VA Form 0928h. m. Surfing... already approved collection. Abstract: Veterans who are enrolled for VA health care may apply...

  18. 78 FR 26250 - Payment for Home Health Services and Hospice Care to Non-VA Providers

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-06

    ... November 21, 2011 (76 FR 71920), VA proposed to amend its regulations concerning the billing methodology... AFFAIRS 38 CFR Part 17 RIN 2900-AN98 Payment for Home Health Services and Hospice Care to Non-VA Providers... services and hospice care. Because the newly applicable methodology cannot supersede rates for which VA...

  19. 78 FR 11094 - Drawbridge Operation Regulation; James River, Between Isle of Wight and Newport News, VA

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-02-15

    ... and Newport News, VA AGENCY: Coast Guard, DHS. ACTION: Notice of deviation from drawbridge regulation... News, VA. This deviation is necessary to facilitate generator replacement on the James River Draw... operating schedule, the James River Bridge, mile 5.0, between Isle of Isle and Newport News, VA opens...

  20. 48 CFR 853.236-70 - VA Form 10-6298, Architect-Engineer Fee Proposal.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 48 Federal Acquisition Regulations System 5 2011-10-01 2011-10-01 false VA Form 10-6298, Architect... VETERANS AFFAIRS CLAUSES AND FORMS FORMS Prescription of Forms 853.236-70 VA Form 10-6298, Architect-Engineer Fee Proposal. VA Form 10-6298, Architect-Engineer Fee Proposal, shall be used as prescribed in...

  1. 75 FR 78808 - Agency Information Collection (VA Request for Determination of Reasonable Value) Activity Under...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-12-16

    ... AFFAIRS Agency Information Collection (VA Request for Determination of Reasonable Value) Activity Under... comment. The PRA submission describes the nature of the information collection and its expected cost and... INFORMATION: Title: VA Request for Determination of Reasonable Value VA Form 26- 1805 and 26-1805-1....

  2. 78 FR 59773 - Proposed Information Collection (VA Request for Determination of Reasonable Value) Activity...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-27

    ... AFFAIRS Proposed Information Collection (VA Request for Determination of Reasonable Value) Activity... solicits comments for information needed to determine the reasonable value of properties for guaranteed or... information technology. Title: VA Request for Determination of Reasonable Value, VA Form 26-1805 and...

  3. 38 CFR 26.9 - Information on and public participation in VA environmental process.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... participation in VA environmental process. 26.9 Section 26.9 Pensions, Bonuses, and Veterans' Relief DEPARTMENT...) ACTIONS § 26.9 Information on and public participation in VA environmental process. (a) During the..., the Office of Environmental Affairs, or a VA element, information is available by writing to...

  4. 76 FR 63357 - VA National Academic Affiliations Council; Notice of Establishment

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-12

    ... AFFAIRS VA National Academic Affiliations Council; Notice of Establishment As required by Section 9(a)(2... establishment of the Department of Veterans Affairs (VA) National Academic Affiliations Council. The Secretary... partnerships between VA and its academic affiliates. The Council will provide a forum for discussion and...

  5. Managing diversity in hospitals.

    PubMed

    Schwartz, R H; Sullivan, D B

    1993-01-01

    Hospital work force diversity, although potentially a source of creativity and improved problem solving, is often a source of political strife and the mistreatment of people based on their identification with one or another of the diverse groups that are employed in hospitals. Factors linked to these phenomena are discussed and are the basis for suggestions about how administrators can deal with the organizational pathologies that are often associated with unmanaged work force diversity.

  6. Infrastructure for quality transformation: measurement and reporting in veterans administration intensive care units.

    PubMed

    Render, Marta L; Freyberg, Ron W; Hasselbeck, Rachael; Hofer, Timothy P; Sales, Anne E; Deddens, James; Levesque, Odette; Almenoff, Peter L

    2011-06-01

    BACKGROUND Veterans Health Administration (VA) intensive care units (ICUs) develop an infrastructure for quality improvement using information technology and recruiting leadership. METHODS Setting Participation by the 183 ICUs in the quality improvement program is required. Infrastructure includes measurement (electronic data extraction, analysis), quarterly web-based reporting and implementation support of evidence-based practices. Leaders prioritise measures based on quality improvement objectives. The electronic extraction is validated manually against the medical record, selecting hospitals whose data elements and measures fall at the extremes (10th, 90th percentile). results are depicted in graphic, narrative and tabular reports benchmarked by type and complexity of ICU. RESULTS The VA admits 103 689±1156 ICU patients/year. Variation in electronic business practices, data location and normal range of some laboratory tests affects data quality. A data management website captures data elements important to ICU performance and not available electronically. A dashboard manages the data overload (quarterly reports ranged 106-299 pages). More than 85% of ICU directors and nurse managers review their reports. Leadership interest is sustained by including ICU targets in executive performance contracts, identification of local improvement opportunities with analytic software, and focused reviews. CONCLUSION Lessons relevant to non-VA institutions include the: (1) need for ongoing data validation, (2) essential involvement of leadership at multiple levels, (3) supplementation of electronic data when key elements are absent, (4) utility of a good but not perfect electronic indicator to move practice while improving data elements and (5) value of a dashboard. PMID:21345859

  7. Water Surface Turbulance and Internal Waves, Norfolk, VA, USA

    NASA Technical Reports Server (NTRS)

    1991-01-01

    Norfolk and the mouth of the Chesapeake Bay, VA, (37.5N, 75.5W) was exposed in sunglint conditions to emphasizes water surface patterns. Outgoing tides from the bay generate considerable turbulence as they encounter coastal ocean currents and can be observed as differences in the reflective properties of the water surface. Smooth flowing water has high reflectivity. Turbulent water has a rough surface and low reflectance. Ship wakes can also be seen.

  8. Validation of KENO V.a Comparison with Critical Experiments

    SciTech Connect

    Jordan, W.C.

    1999-01-01

    Section 1 of this report documents the validation of KENO V.a against 258 critical experiments. Experiments considered were primarily high or low enriched uranium systems. The results indicate that the KENO V.a Monte Carlo Criticality Program accurately calculates a broad range of critical experiments. A substantial number of the calculations showed a positive or negative bias in excess of 1 1/2% in k-effective (k{sub eff}). Classes of criticals which show a bias include 3% enriched green blocks, highly enriched uranyl fluoride slab arrays, and highly enriched uranyl nitrate arrays. If these biases are properly taken into account, the KENO V.a code can be used with confidence for the design and criticality safety analysis of uranium-containing systems. Section 2 of this report documents the results of investigation into the cause of the bias observed in Sect. 1. The results of this study indicate that the bias seen in Sect. 1 is caused by code bias, cross-section bias, reporting bias, and modeling bias. There is evidence that many of the experiments used in this validation and in previous validations are not adequately documented. The uncertainty in the experimental parameters overshadows bias caused by the code and cross sections and prohibits code validation to better than about 1% in k{sub eff}.

  9. Hospital-acquired infections - when are hospitals legally liable?

    PubMed

    McQuoid-Mason, David

    2012-04-12

    Hospital-acquired infections (nosocomial infections) are acquired in healthcare settings by patients admitted for reasons unrelated to the infection or not previously infected when admitted to the facility. Liability for hospital-acquired infections depends on whether the hospital: (i) has introduced best practice infection control measures; (ii) has implemented best practice infection control measures; or (iii) will be vicariously liable for negligent or intentional failures by staff to comply with the infection control measures implemented. A hospital and hospital administrators may be held directly liable for not introducing or implementing best practice infection control measures, resulting in harm to patients. The hospital may also be held vicariously liable where patients have been harmed because hospital staff negligently or intentionally failed to comply with the infection control measures that have been implemented by the hospital, during the course and scope of their employment.

  10. 43 CFR 12.947 - Contract administration.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... REQUIREMENTS AND COST PRINCIPLES FOR ASSISTANCE PROGRAMS Uniform Administrative Requirements for Grants and Agreements With Institutions of Higher Education, Hospitals, and Other Non-Profit Organizations...

  11. Overutilization of acute-care beds in Veterans Affairs hospitals.

    PubMed

    Smith, C B; Goldman, R L; Martin, D C; Williamson, J; Weir, C; Beauchamp, C; Ashcraft, M

    1996-01-01

    The authors tested the hypothesis that the Department of Veterans Affairs (VA) hospitals would have substantial overutilization of acute care beds and services because of policies that emphasize inpatient care over ambulatory care. Reviewers from 24 randomly selected VA hospitals applied the InterQual ISD* (Intensity, Severity, Discharge) criteria for appropriateness concurrently to a random sample of 2,432 admissions to acute medical, surgical, and psychiatry services. Reliability of hospital reviewers in applying the ISD* criteria was tested by comparing their reviews with those of a small group of expert reviewers. Validity of the ISD* criteria was tested by comparing the assessments of master reviewers with the implicit judgments of panels of nine physicians. The physician panels validated the ISD* admission criteria for medicine and surgery (74% agreement with master reviewers, kappa > 0.4), whereas the psychiatry criteria were not validated (66% agreement, kappa 0.29). Hospital reviewers reliably used all three criteria sets (> 83% agreement with master reviewers, kappa > 0.6). Rates of nonacute admissions to acute medical and surgical services were > 38% as determined by the hospital and master reviewers and by the physician panels. Nonacute rates of continued stay were > 32% for both medicine and surgery services. Similar rates of nonacute admissions and continued stay were found for all 24 hospitals. Reasons for nonacute admissions and continued stay included lack of an ambulatory care alternative, conservative physician practices, delays in discharge planning, and social factors such as homelessness and long travel distances to the hospital. Using criteria that the authors showed to be reliable and valid, substantial overutilization of acute medicine and surgical beds was found in a representative sample of VA hospitals. Correcting this situation will require changes in physician practice patterns, development of ambulatory care alternatives to inpatient

  12. 78 FR 48543 - Veterans Health Administration Fund Availability Under the VA's Homeless Providers Grant and Per...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-08-08

    ..., and plans for social engagement within the program and in the community; (3) Provide opportunities for... participants to engage in ``tasks of dying,'' or activities of ``getting things in order'' or other...

  13. Reducing nurse medicine administration errors.

    PubMed

    Ofosu, Rose; Jarrett, Patricia

    Errors in administering medicines are common and can compromise the safety of patients. This review discusses the causes of drug administration error in hospitals by student and registered nurses, and the practical measures educators and hospitals can take to improve nurses' knowledge and skills in medicines management, and reduce drug errors.

  14. [Treatment of communication disorders in the schizophrenic. Experience at the Brentwood VA Hospital in California].

    PubMed

    Langeard, J

    1985-01-01

    The author relates a one-year research experience on "social skills training" behavior therapies applied to DSM-III schizophrenic patients. Besides role playing, positive reinforcement and generalization, a cognitive approach to attention and information processing deficits is described using modelling and videotape material. The objective is an intensive teaching of necessary skills for independent living.

  15. 38 CFR 17.52 - Hospital care and medical services in non-VA facilities.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... disabilities being treated, and (iii) A veteran of the Mexican border period or World War I or who is in... emergencies which pose a serious threat to the life or health of a veteran which developed during...

  16. 38 CFR 17.52 - Hospital care and medical services in non-VA facilities.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...), and (iii) A veteran of the Mexican border period or World War I or who is in receipt of increased... emergencies which pose a serious threat to the life or health of a veteran which developed during...

  17. 38 CFR 17.52 - Hospital care and medical services in non-VA facilities.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...), and (iii) A veteran of the Mexican border period or World War I or who is in receipt of increased... emergencies which pose a serious threat to the life or health of a veteran which developed during...

  18. Hospital Library Development.

    ERIC Educational Resources Information Center

    Cramer, Anne

    Although this handbook is addressed primarily to the hopital administrator, it contains material of interest to the librarian as well. Basic requirements for providing good library services to hospital staff are identified as: (1) well chosen and well trained manpower; (2) a current collection of information materials; and (3) appropriate space in…

  19. [Quality of involuntary hospital administration in Switzerland].

    PubMed

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

    2014-05-21

    Fragestellung: Diese Studie hat zum Ziel, die vor Einführung des neuen Kindes- und Erwachsenenschutzrechts per Januar 2013 bestehende Praxis der Fürsorgerischen Freiheitsentziehung (FFE) anhand formaler und inhaltlicher Kriterien der Zuweisungsschreiben zu untersuchen. Hinweise auf Unterschiede zwischen Zuweisern mit verschiedenen professionellen Hintergründen sollen überprüft und die eingewiesenen Personen charakterisiert werden. Methode: Retrospektive Auswertung der Zuweisungsformulare und der Krankenakten sämtlicher per FFE in die Psychiatrische Universitätsklinik Zürich eingetretenen Patienten in einem Zeitraum von sechs Monaten (n=489). Resultate: Es bestehen erhebliche Mängel bezüglich formaler und insbesondere inhaltlicher Qualitätskriterien. Psychiatrische Fachärzte erstellen die Zeugnisse mit der höchsten Qualität, gefolgt von Notärzten sowie Spitälern und Hausärzten. Die Patienten dieser Zuweisergruppen unterscheiden sich bezüglich soziodemographischer und klinischer Variablen. Schlussfolgerungen: Die formale und insbesondere inhaltliche Qualität der Zwangseinweisungen ist angesichts der schwerwiegenden ethischen und juristischen Konsequenzen für die betroffene Person verbesserungsbedürftig. Die Auswirkungen der neuen Gesetzgebung auf die Qualität der Zuweisungen sollten überprüft werden, sodass etwaige Defizite in der Anwendung freiheitsbeschränkender Massnahmen in der Aus- und Weiterbildungspraxis adressiert werden können.

  20. Norovirus - hospital

    MedlinePlus

    Gastroenteritis - norovirus; Colitis - norovirus; Hospital acquired infection - norovirus ... Symptoms start within 24 to 48 hours of infection, and can last for 1 ... norovirus. Hospital patients who are very old, very young, or ...

  1. 30 CFR 57.22234 - Actions at 1.0 percent methane (I-A, I-B, III, V-A, and V-B mines).

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Actions at 1.0 percent methane (I-A, I-B, III, V-A, and V-B mines). 57.22234 Section 57.22234 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE SAFETY AND HEALTH SAFETY AND HEALTH STANDARDS-UNDERGROUND METAL AND NONMETAL MINES Safety...

  2. The VA Maryland Health Care System's telemental health program.

    PubMed

    Koch, Edward F

    2012-05-01

    The VA Maryland Health Care System introduced videoconferencing technology to provide psychiatry, evidenced-based psychotherapy, case management, and patient education at rural clinics where it was difficult to recruit providers. Telemental health services enable rural clinics to offer additional services, such as case management and patient education. Services have been expanded to urban outpatient clinics where a limited number of mental health clinic hours are available. This technology expands the availability of mental health providers and services, allowing patients to receive services from providers located at distant medical centers.

  3. Helping safeguard Veterans Affairs' hospital buildings by advanced earthquake monitoring

    USGS Publications Warehouse

    Kalkan, Erol; Banga, Krishna; Ulusoy, Hasan S.; Fletcher, Jon Peter B.; Leith, William S.; Blair, James L.

    2012-01-01

    In collaboration with the U.S. Department of Veterans Affairs (VA), the National Strong Motion Project of the U.S. Geological Survey has recently installed sophisticated seismic systems that will monitor the structural integrity of hospital buildings during earthquake shaking. The new systems have been installed at more than 20 VA medical campuses across the country. These monitoring systems, which combine sensitive accelerometers and real-time computer calculations, are capable of determining the structural health of each structure rapidly after an event, helping to ensure the safety of patients and staff.

  4. A model for improving the quality and timeliness of compensation and pension examinations in VA facilities.

    PubMed

    Weeks, William Brinson; Mills, Peter Donald; Waldron, Julia; Brown, Steven Holloway; Speroff, Theodore; Coulson, Lewis R

    2003-01-01

    In response to external and internal customer dissatisfaction and in anticipation of markedly higher volumes of examination requests, the Department of Veterans Affairs (VA) produced an eight-month facilitated quality-improvement project designed to improve the quality and timeliness of compensation examination processing. To determine whether participation in the project was associated with better outcomes and to identify team characteristics that were associated with high performance, we obtained centrally collected facility-level performance measures on quality and timeliness of the examinations. To determine factors associated with team success, we compared measures of leadership support reported by teams with high and low performance outcomes. Thirty teams representing 34 VA medical centers and 22 Veterans Benefits Administration's regional offices participated in the project. Monthly volumes were significantly higher for participating teams, and volumes increased significantly over time for both groups. At the beginning of the project, examination timeliness was substantially worse for participating teams (34.1 versus 29.9 days, p = .03); by the end, participants had better performance (28.5 versus 30.3 days, p = .00). Quality measures were maintained. By the end of the project, high performers reported improved leadership, frontline support, resource availability, alignment with strategic goals, and leadership mandate when compared to performance at the beginning of the project; low performers reported the opposite. These results suggest that the principles of clinical improvement can be applied successfully to teach teams how to achieve process improvements within a large healthcare organization. Visible, ongoing support by leadership and alignment of project objectives with strategic goals are associated with improved project outcomes.

  5. 38 CFR 3.361 - Benefits under 38 U.S.C. 1151(a) for additional disability or death due to hospital care, medical...

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ..., error in judgment, or similar instance of fault on VA's part in furnishing hospital care, medical or.... 1151(a) for additional disability or death due to hospital care, medical or surgical treatment.... 1151(a) for additional disability or death due to hospital care, medical or surgical...

  6. 38 CFR 3.361 - Benefits under 38 U.S.C. 1151(a) for additional disability or death due to hospital care, medical...

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ..., error in judgment, or similar instance of fault on VA's part in furnishing hospital care, medical or.... 1151(a) for additional disability or death due to hospital care, medical or surgical treatment.... 1151(a) for additional disability or death due to hospital care, medical or surgical...

  7. 38 CFR 3.361 - Benefits under 38 U.S.C. 1151(a) for additional disability or death due to hospital care, medical...

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    .... 1151(a) for additional disability or death due to hospital care, medical or surgical treatment.... 1151(a) for additional disability or death due to hospital care, medical or surgical treatment..., VA compares the veteran's condition immediately before the beginning of the hospital care, medical...

  8. 38 CFR 3.361 - Benefits under 38 U.S.C. 1151(a) for additional disability or death due to hospital care, medical...

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    .... 1151(a) for additional disability or death due to hospital care, medical or surgical treatment.... 1151(a) for additional disability or death due to hospital care, medical or surgical treatment..., VA compares the veteran's condition immediately before the beginning of the hospital care, medical...

  9. Trends affecting hospitals' human resources.

    PubMed

    Neudeck, M M

    1985-01-01

    Hospital workers at every level--from administrators to housekeepers--will be affected by the interaction of changes already underway in the healthcare industry. Societal forces that will affect the hospital workforce include demographic change, the rise of the participatory ethic and decentralization, a growing philosophy of job entitlement, and new pressures for unionization. At the same time, the industry is faced with changing manpower requirements, cost containment, and the oversupply of physicians. This article identifies some of the likely effects of these changes on hospital human resources and suggests ways that administrators can prepare for them.

  10. Practical and Policy Implications of Using Different Rural-Urban Classification Systems: A Case Study of Inpatient Service Utilization among Veterans Administration Users

    ERIC Educational Resources Information Center

    Berke, Ethan M.; West, Alan N.; Wallace, Amy E.; Weeks, William B.

    2009-01-01

    Context: Several classification systems exist for defining rural areas, which may lead to different interpretations of rural health services data. Purpose: To compare rural classification systems on their implications for estimating Veterans Administration (VA) utilization. Methods: Using 7 classification systems, we counted VA health care…

  11. KENO V.a Primer: A Primer for Criticality Calculations with SCALE/KENO V.a Using CSPAN for Input

    SciTech Connect

    Busch, R.D.

    2003-01-17

    The SCALE (Standardized Computer Analyses for Licensing Evaluation) computer software system developed at Oak Ridge National Laboratory (ORNL) is widely used and accepted around the world for criticality safety analyses. The well-known KENO V.a three-dimensional Monte Carlo criticality computer code is the primary criticality safety analysis tool in SCALE. The KENO V.a primer is designed to help a new user understand and use the SCALE/KENO V.a Monte Carlo code for nuclear criticality safety analyses. It assumes that the user has a college education in a technical field. There is no assumption of familiarity with Monte Carlo codes in general or with SCALE/KENO V.a in particular. The primer is designed to teach by example, with each example illustrating two or three features of SCALE/KENO V.a that are useful in criticality analyses. The primer is based on SCALE 4.4a, which includes the Criticality Safety Processor for Analysis (CSPAN) input processor for Windows personal computers (PCs). A second edition of the primer, which uses the new KENO Visual Editor, is currently under development at ORNL and is planned for publication in late 2003. Each example in this first edition of the primer uses CSPAN to provide the framework for data input. Starting with a Quickstart section, the primer gives an overview of the basic requirements for SCALE/KENO V.a input and allows the user to quickly run a simple criticality problem with SCALE/KENO V.a. The sections that follow Quickstart include a list of basic objectives at the beginning that identifies the goal of the section and the individual SCALE/KENO V.a features which are covered in detail in the example problems in that section. Upon completion of the primer, a new user should be comfortable using CSPAN to set up criticality problems in SCALE/KENO V.a.

  12. 30 CFR 57.22227 - Approved testing devices (I-A, I-B, I-C, II-A, II-B, III, IV, V-A, and V-B mines).

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... methane, other gases, and contaminants in mine air shall be approved by MSHA under the applicable..., II-B, III, IV, V-A, and V-B mines). 57.22227 Section 57.22227 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE SAFETY AND HEALTH SAFETY AND...

  13. 30 CFR 57.22227 - Approved testing devices (I-A, I-B, I-C, II-A, II-B, III, IV, V-A, and V-B mines).

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... methane, other gases, and contaminants in mine air shall be approved by MSHA under the applicable..., II-B, III, IV, V-A, and V-B mines). 57.22227 Section 57.22227 Mineral Resources MINE SAFETY AND HEALTH ADMINISTRATION, DEPARTMENT OF LABOR METAL AND NONMETAL MINE SAFETY AND HEALTH SAFETY AND...

  14. 38 CFR 62.70 - Financial management and administrative costs.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ...-Profit Organizations,” codified by VA at 38 CFR Part 41. (b) Grantees must use a financial management... forth in OMB Circular A-122, Cost Principles for Non-Profit Organizations, codified at 2 CFR Part 235... management of the program. These costs will include the administrative costs, both direct and indirect,...

  15. 38 CFR 62.70 - Financial management and administrative costs.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ...-Profit Organizations,” codified by VA at 38 CFR part 41. (b) Grantees must use a financial management... forth in OMB Circular A-122, Cost Principles for Non-Profit Organizations, codified at 2 CFR part 235... management of the program. These costs will include the administrative costs, both direct and indirect,...

  16. 38 CFR 62.70 - Financial management and administrative costs.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ...-Profit Organizations,” codified by VA at 38 CFR Part 41. (b) Grantees must use a financial management... forth in OMB Circular A-122, Cost Principles for Non-Profit Organizations, codified at 2 CFR Part 235... management of the program. These costs will include the administrative costs, both direct and indirect,...

  17. 38 CFR 62.70 - Financial management and administrative costs.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ...-Profit Organizations,” codified by VA at 38 CFR Part 41. (b) Grantees must use a financial management... forth in OMB Circular A-122, Cost Principles for Non-Profit Organizations, codified at 2 CFR Part 235... management of the program. These costs will include the administrative costs, both direct and indirect,...

  18. Decreasing Congestive Heart Failure Readmission Rates Within 30 Days at the Tampa VA.

    PubMed

    Messina, William

    2016-01-01

    High hospital readmission rates contribute to the problem of escalating costs and fragmented quality in the US health care system. This article describes the implementation of a home telehealth (HT) performance improvement project with subsequent cost-avoidance savings. The HT project was designed to potentiate communication between and among patients, clinicians, and administrative staff, in addition to reducing readmissions for patients with congestive heart failure at the James A. Haley Veterans Hospital in Tampa, Florida. Pre- and post-HT implementation comparisons were made of readmission rates, costs, and veteran satisfaction from the same 4-month periods in 2012 and 2013. The application of telehealth and phone care initiatives reduced the congestive heart failure hospital readmission rate by 5%, decreased costs, and improved veteran satisfaction with overall care experience.

  19. Parallelization of KENO-Va Monte Carlo code

    NASA Astrophysics Data System (ADS)

    Ramón, Javier; Peña, Jorge

    1995-07-01

    KENO-Va is a code integrated within the SCALE system developed by Oak Ridge that solves the transport equation through the Monte Carlo Method. It is being used at the Consejo de Seguridad Nuclear (CSN) to perform criticality calculations for fuel storage pools and shipping casks. Two parallel versions of the code: one for shared memory machines and other for distributed memory systems using the message-passing interface PVM have been generated. In both versions the neutrons of each generation are tracked in parallel. In order to preserve the reproducibility of the results in both versions, advanced seeds for random numbers were used. The CONVEX C3440 with four processors and shared memory at CSN was used to implement the shared memory version. A FDDI network of 6 HP9000/735 was employed to implement the message-passing version using proprietary PVM. The speedup obtained was 3.6 in both cases.

  20. Development of 30 kVA class fully superconducting generator

    SciTech Connect

    Tsukamoto, O.; Amemiya, N.; Takao, T. . Faculty of Engineering); Akita, S. ); Ohishi, K.; Shimuzu, H.; Tanaka, Y. ); Uchikawa, Y. )

    1992-01-01

    This paper reports that the authors are developing a 4 poles 30 kVA class fully superconducting generator to investigate the characteristics of superconducting armature winding subject to the rotating magnetic field produced by the superconducting rotor and behavior of a superconducting generator connected to an electric power utility grid. A static test of the armature winding have been performed by applying 50 Hz AC current. AC quench currents of the armature windings have reached to 200 Arms after several quenches which was well over the rated current. A static test of the field windings have been also performed to verify its rated performance. In the paper, detailed configurations and electrical test results of the generator are shown.

  1. Administrative Synergy

    ERIC Educational Resources Information Center

    Hewitt, Kimberly Kappler; Weckstein, Daniel K.

    2012-01-01

    One of the biggest obstacles to overcome in creating and sustaining an administrative professional learning community (PLC) is time. Administrators are constantly deluged by the tyranny of the urgent. It is a Herculean task to carve out time for PLCs, but it is imperative to do so. In this article, the authors describe how an administrative PLC…

  2. ICD discrimination of SVT versus VT with 1:1 V-A conduction: A review of the literature

    PubMed Central

    Cardoso, Rhanderson N.; Healy, Chris; Viles-Gonzalez, Juan; Coffey, James O.

    2016-01-01

    Inappropriate ICD shocks are associated with increased mortality. They also impair patients' quality of life, increase hospitalizations, and raise health-care costs. Nearly 80% of inappropriate ICD shocks are caused by supraventricular tachycardia. Here we report the case of a patient who received a single-lead dual-chamber sensing ICD for primary prevention of sudden cardiac death and experienced inappropriate ICD shocks. V-A time, electrogram morphology, and response to antitachycardia pacing suggested atrioventricular nodal reentry tachycardia, which was confirmed in an electrophysiology study. Inspired by this case, we performed a literature review to discuss mechanisms for discrimination of supraventricular tachycardia with 1:1 A:V relationship from ventricular tachycardia with 1:1 retrograde conduction. PMID:27134440

  3. Union Density and Hospital Outcomes.

    PubMed

    Koys, Daniel J; Martin, Wm Marty; LaVan, Helen; Katz, Marsha

    2015-01-01

    The authors address the hospital outcomes of patient satisfaction, healthcare quality, and net income per bed. They define union density as the percentage of a hospital's employees who are in unions, healthcare quality as its 30-day acute myocardial infraction (AMI; heart attack) mortality rate, and patient satisfaction as its overall Hospital Consumer Assessment of Healthcare Providers and Systems score. Using a random sample of 84 union and 84 nonunion hospitals from across the United States, multiple regression analyses show that union density is negatively related to patient satisfaction. Union density is not related to healthcare quality as measured by the AMI mortality rate or to net income per bed. This implies that unions per se are not good or bad for hospitals. The authors suggest that it is better for hospital administrators to take a Balanced Scorecard approach and be concerned about employee satisfaction, patient satisfaction, healthcare quality, and net income. PMID:26652043

  4. Making Bullying Prevention a Priority in Finnish Schools: The KiVa Antibullying Program

    ERIC Educational Resources Information Center

    Salmivalli, Christina; Poskiparta, Elisa

    2012-01-01

    The KiVa antibullying program has been widely implemented in Finnish comprehensive schools since 2009. The program is predicated on the idea that a positive change in the behaviors of classmates can reduce the rewards gained by the perpetrators of bullying and consequently their motivation to bully in the first place. KiVa involves both universal…

  5. 48 CFR 852.219-9 - VA Small business subcontracting plan minimum requirements.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... review of personnel in the Office of Small and Disadvantaged Business Utilization. (e) The contractor may... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false VA Small business... Provisions and Clauses 852.219-9 VA Small business subcontracting plan minimum requirements. As prescribed...

  6. 77 FR 21158 - VA Directive 0005 on Scientific Integrity: Availability for Review and Comment

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-09

    ... AFFAIRS VA Directive 0005 on Scientific Integrity: Availability for Review and Comment AGENCY: Office of... (VA) Directive 0005 on Scientific Integrity. The Draft Directive incorporates the principles of scientific integrity contained in the Presidential Memorandum of March 9, 2009, and the Director, Office...

  7. 33 CFR 334.350 - Chesapeake Bay off Fort Monroe, Va.; firing range danger zone.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ..., Va.; firing range danger zone. 334.350 Section 334.350 Navigation and Navigable Waters CORPS OF ENGINEERS, DEPARTMENT OF THE ARMY, DEPARTMENT OF DEFENSE DANGER ZONE AND RESTRICTED AREA REGULATIONS § 334.350 Chesapeake Bay off Fort Monroe, Va.; firing range danger zone. (a) The danger zone. All of...

  8. 33 CFR 80.515 - Cape Henry, VA to Cape Hatteras, NC.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 33 Navigation and Navigable Waters 1 2012-07-01 2012-07-01 false Cape Henry, VA to Cape Hatteras, NC. 80.515 Section 80.515 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY INTERNATIONAL NAVIGATION RULES COLREGS DEMARCATION LINES Fifth District § 80.515 Cape Henry, VA...

  9. 33 CFR 80.515 - Cape Henry, VA to Cape Hatteras, NC.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 33 Navigation and Navigable Waters 1 2014-07-01 2014-07-01 false Cape Henry, VA to Cape Hatteras, NC. 80.515 Section 80.515 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY INTERNATIONAL NAVIGATION RULES COLREGS DEMARCATION LINES Fifth District § 80.515 Cape Henry, VA...

  10. 33 CFR 80.515 - Cape Henry, VA to Cape Hatteras, NC.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 33 Navigation and Navigable Waters 1 2013-07-01 2013-07-01 false Cape Henry, VA to Cape Hatteras, NC. 80.515 Section 80.515 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY INTERNATIONAL NAVIGATION RULES COLREGS DEMARCATION LINES Fifth District § 80.515 Cape Henry, VA...

  11. 33 CFR 80.515 - Cape Henry, VA to Cape Hatteras, NC.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 33 Navigation and Navigable Waters 1 2011-07-01 2011-07-01 false Cape Henry, VA to Cape Hatteras, NC. 80.515 Section 80.515 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY INTERNATIONAL NAVIGATION RULES COLREGS DEMARCATION LINES Fifth District § 80.515 Cape Henry, VA...

  12. 33 CFR 80.515 - Cape Henry, VA to Cape Hatteras, NC.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 33 Navigation and Navigable Waters 1 2010-07-01 2010-07-01 false Cape Henry, VA to Cape Hatteras, NC. 80.515 Section 80.515 Navigation and Navigable Waters COAST GUARD, DEPARTMENT OF HOMELAND SECURITY INTERNATIONAL NAVIGATION RULES COLREGS DEMARCATION LINES Fifth District § 80.515 Cape Henry, VA...

  13. 78 FR 28949 - Fund Availability Under VA's Homeless Providers Grant and Per Diem Program (Rehabilitation)

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-16

    ... AFFAIRS Fund Availability Under VA's Homeless Providers Grant and Per Diem Program (Rehabilitation) AGENCY... announces the availability of rehabilitation funds under VA's Homeless Providers Grant and Per Diem Program... local or state codes. Each rehabilitation funded program will submit quarterly reports to the Grant...

  14. Myosin Va Transports Dense Core Secretory Vesicles in Pancreatic MIN6 β-CellsV⃞

    PubMed Central

    Varadi, Aniko; Tsuboi, Takashi; Rutter, Guy A.

    2005-01-01

    The role of unconventional myosins in neuroendocrine cells is not fully understood, with involvement suggested in the movement of both secretory vesicles and mitochondria. Here, we demonstrate colocalization of myosin Va (MyoVa) with insulin in pancreatic β-cells and show that MyoVa copurifies with insulin in density gradients and with the vesicle marker phogrin-enhanced green fluorescent protein upon fluorescence-activated sorting of vesicles. By contrast, MyoVa immunoreactivity was poorly colocalized with mitochondrial or other markers. Demonstrating an important role for MyoVa in the recruitment of secretory vesicles to the cell surface, a reduction of MyoVa protein levels achieved by RNA interference caused a significant decrease in glucose- or depolarization-stimulated insulin secretion. Similarly, expression of the dominant-negative–acting globular tail domain of MyoVa decreased by ∼50% the number of vesicles docked at the plasma membrane and by 87% the number of depolarization-stimulated exocytotic events detected by total internal reflection fluorescence microscopy. We conclude that MyoVa-driven movements of vesicles along the cortical actin network are essential for the terminal stages of regulated exocytosis in β-cells. PMID:15788565

  15. 77 FR 23204 - VA Acquisition Regulation: Electronic Submission of Payment Requests

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-04-18

    ... waste in other agency programs and operations. Executive Order 13520 of November 20, 2009 (``Reducing... Electronic Invoicing Could Further Reduce Late Payments'' (GAO-06-358). The report confirmed the... using under VA's current interim electronic invoicing clause. See 74 FR 32223. VA's Electronic...

  16. 33 CFR 334.130 - Atlantic Ocean off Wallops Island and Chincoteague Inlet, Va.; danger zone.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 33 Navigation and Navigable Waters 3 2014-07-01 2014-07-01 false Atlantic Ocean off Wallops Island and Chincoteague Inlet, Va.; danger zone. 334.130 Section 334.130 Navigation and Navigable Waters... REGULATIONS § 334.130 Atlantic Ocean off Wallops Island and Chincoteague Inlet, Va.; danger zone. (a) The...

  17. 78 FR 56151 - Safety Zone, North Atlantic Ocean; Virginia Beach, VA

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-12

    ... SECURITY Coast Guard 33 CFR Part 165 RIN 1625-AA00 Safety Zone, North Atlantic Ocean; Virginia Beach, VA... zone on the navigable waters of the North Atlantic Ocean in Virginia Beach, VA to support the Virginia... over the navigable waters of the Atlantic Ocean. Due to the need to protect mariners and...

  18. 48 CFR 853.236-70 - VA Form 10-6298, Architect-Engineer Fee Proposal.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 48 Federal Acquisition Regulations System 5 2010-10-01 2010-10-01 false VA Form 10-6298, Architect-Engineer Fee Proposal. 853.236-70 Section 853.236-70 Federal Acquisition Regulations System DEPARTMENT OF...-Engineer Fee Proposal. VA Form 10-6298, Architect-Engineer Fee Proposal, shall be used as prescribed in...

  19. 48 CFR 853.236-70 - VA Form 10-6298, Architect-Engineer Fee Proposal.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 48 Federal Acquisition Regulations System 5 2014-10-01 2014-10-01 false VA Form 10-6298, Architect-Engineer Fee Proposal. 853.236-70 Section 853.236-70 Federal Acquisition Regulations System DEPARTMENT OF...-Engineer Fee Proposal. VA Form 10-6298, Architect-Engineer Fee Proposal, shall be used as prescribed in...

  20. 48 CFR 853.236-70 - VA Form 10-6298, Architect-Engineer Fee Proposal.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 48 Federal Acquisition Regulations System 5 2012-10-01 2012-10-01 false VA Form 10-6298, Architect-Engineer Fee Proposal. 853.236-70 Section 853.236-70 Federal Acquisition Regulations System DEPARTMENT OF...-Engineer Fee Proposal. VA Form 10-6298, Architect-Engineer Fee Proposal, shall be used as prescribed in...

  1. 75 FR 54771 - Safety Zone; Thunder on the Bay, Chesapeake Bay, Buckroe Beach Park, Hampton, VA

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-09

    ... Beach Park, Hampton, VA AGENCY: Coast Guard, DHS. ACTION: Temporary final rule. SUMMARY: The Coast Guard... a fireworks display on the Buckroe Beach Park Fishing Pier over the navigable waters of the...). This safety zone will be established in the vicinity of Buckroe Beach Park in Hampton, VA from 9:15...

  2. 77 FR 12697 - VA Homeless Providers Grant and Per Diem Program

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-03-01

    ...We propose to revise and reorganize regulations which contain the Department of Veterans Affairs' (VA) Homeless Providers Grant and Per Diem Program. This rulemaking would update our current regulations, implement and authorize new VA policies, and generally improve the clarity of part...

  3. 77 FR 39404 - Safety Zone; Wicomico Community Fireworks Rain Date, Great Wicomico River, Mila, VA

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-07-03

    ... SECURITY Coast Guard 33 CFR Part 165 RIN 1625-AA00 Safety Zone; Wicomico Community Fireworks Rain Date..., VA in support of the Wicomico Community Rain Date Fireworks event. This action is necessary to.... 165.T05-0425 Safety Zone; Wicomico Community Fireworks Rain Date, Great Wicomico River, Mila, VA....

  4. 33 CFR 334.290 - Elizabeth River, Southern Branch, Va., naval restricted areas.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ..., Va., naval restricted areas. 334.290 Section 334.290 Navigation and Navigable Waters CORPS OF....290 Elizabeth River, Southern Branch, Va., naval restricted areas. (a) The areas—(1) St. Helena Annex Area. Beginning at a point at St. Helena Annex of the Norfolk Naval Shipyard, on the eastern shore...

  5. 78 FR 77204 - Proposed Information Collection (VA National Veterans Sports Programs and Special Event Surveys...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-12-20

    ... AFFAIRS Proposed Information Collection (VA National Veterans Sports Programs and Special Event Surveys... solicits comments on the information needed to evaluate the National Veterans Sports Programs and Special... ``OMB Control No. 2900-NEW (VA National Veterans Sports Programs and Special Event Surveys)'' in...

  6. 77 FR 48127 - Foreign-Trade Zone 20-Suffolk, VA; Notification of Proposed Production Activity, Usui...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-08-13

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF COMMERCE Foreign-Trade Zones Board Foreign-Trade Zone 20--Suffolk, VA; Notification of Proposed Production Activity, Usui International Corporation, (Diesel Engine Fuel Lines), Chesapeake, VA The Virginia Port Authority, grantee of FTZ 20, submitted a...

  7. 30 CFR 57.22309 - Methane monitors (V-A mines).

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 30 CFR part 18, and prevent starting of such equipment when methane levels reach 1.5 percent; and (3... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Methane monitors (V-A mines). 57.22309 Section... Standards for Methane in Metal and Nonmetal Mines Equipment § 57.22309 Methane monitors (V-A mines)....

  8. 30 CFR 57.22309 - Methane monitors (V-A mines).

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 30 CFR part 18, and prevent starting of such equipment when methane levels reach 1.5 percent; and (3... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Methane monitors (V-A mines). 57.22309 Section... Standards for Methane in Metal and Nonmetal Mines Equipment § 57.22309 Methane monitors (V-A mines)....

  9. 30 CFR 57.22309 - Methane monitors (V-A mines).

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 CFR part 18, and prevent starting of such equipment when methane levels reach 1.5 percent; and (3... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Methane monitors (V-A mines). 57.22309 Section... Standards for Methane in Metal and Nonmetal Mines Equipment § 57.22309 Methane monitors (V-A mines)....

  10. 38 CFR 74.26 - What types of business information will VA collect?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... VETERANS AFFAIRS (CONTINUED) VETERANS SMALL BUSINESS REGULATIONS Records Management § 74.26 What types of business information will VA collect? VA will examine a variety of business records. See § 74.12, “What is... 38 Pensions, Bonuses, and Veterans' Relief 2 2010-07-01 2010-07-01 false What types of...

  11. 78 FR 55777 - Proposed Information Collection (VA, National Veterans Sports Programs and Special Events, Event...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-11

    ... AFFAIRS Proposed Information Collection (VA, National Veterans Sports Programs and Special Events, Event... Events, Department of Veterans Affairs. ACTION: Notice. SUMMARY: The Office of National Veterans Sports Programs and Special Events (NVSP), Department of Veterans Affairs (VA), is announcing an opportunity...

  12. 38 CFR 17.96 - Medication prescribed by non-VA physicians.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 38 Pensions, Bonuses, and Veterans' Relief 1 2010-07-01 2010-07-01 false Medication prescribed by non-VA physicians. 17.96 Section 17.96 Pensions, Bonuses, and Veterans' Relief DEPARTMENT OF VETERANS AFFAIRS MEDICAL Outpatient Treatment § 17.96 Medication prescribed by non-VA physicians. Any prescription, which is not part of...

  13. 78 FR 56271 - FY 2014-2020 Draft VA Strategic Plan

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-12

    ... AFFAIRS FY 2014-2020 Draft VA Strategic Plan AGENCY: Department of Veterans Affairs. ACTION: Notice of... availability of the FY 2014-2020 Draft VA Strategic Plan (Strategic Plan) for public review and comment, as...). The Strategic Plan provides the Department's long-term direction and places a stronger emphasis...

  14. 75 FR 61858 - Proposed Information Collection (VA Request for Determination of Reasonable Value) Activity...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-06

    ... AFFAIRS Proposed Information Collection (VA Request for Determination of Reasonable Value) Activity... solicits comments for information needed to determine the reasonable value of properties for guaranteed or... Request for Determination of Reasonable Value, VA Form 26-1805 and 26-1805-1. OMB Control Number:...

  15. 33 CFR 334.350 - Chesapeake Bay off Fort Monroe, Va.; firing range danger zone.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 33 Navigation and Navigable Waters 3 2011-07-01 2011-07-01 false Chesapeake Bay off Fort Monroe, Va.; firing range danger zone. 334.350 Section 334.350 Navigation and Navigable Waters CORPS OF....350 Chesapeake Bay off Fort Monroe, Va.; firing range danger zone. (a) The danger zone. All of...

  16. 33 CFR 334.220 - Chesapeake Bay, south of Tangier Island, Va.; naval firing range.

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 33 Navigation and Navigable Waters 3 2011-07-01 2011-07-01 false Chesapeake Bay, south of Tangier Island, Va.; naval firing range. 334.220 Section 334.220 Navigation and Navigable Waters CORPS OF....220 Chesapeake Bay, south of Tangier Island, Va.; naval firing range. (a) The danger zone....

  17. 33 CFR 334.350 - Chesapeake Bay off Fort Monroe, Va.; firing range danger zone.

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 33 Navigation and Navigable Waters 3 2013-07-01 2013-07-01 false Chesapeake Bay off Fort Monroe, Va.; firing range danger zone. 334.350 Section 334.350 Navigation and Navigable Waters CORPS OF....350 Chesapeake Bay off Fort Monroe, Va.; firing range danger zone. (a) The danger zone. All of...

  18. 33 CFR 334.350 - Chesapeake Bay off Fort Monroe, Va.; firing range danger zone.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 33 Navigation and Navigable Waters 3 2012-07-01 2012-07-01 false Chesapeake Bay off Fort Monroe, Va.; firing range danger zone. 334.350 Section 334.350 Navigation and Navigable Waters CORPS OF....350 Chesapeake Bay off Fort Monroe, Va.; firing range danger zone. (a) The danger zone. All of...

  19. 33 CFR 334.220 - Chesapeake Bay, south of Tangier Island, Va.; naval firing range.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 33 Navigation and Navigable Waters 3 2014-07-01 2014-07-01 false Chesapeake Bay, south of Tangier Island, Va.; naval firing range. 334.220 Section 334.220 Navigation and Navigable Waters CORPS OF....220 Chesapeake Bay, south of Tangier Island, Va.; naval firing range. (a) The danger zone....

  20. 33 CFR 334.350 - Chesapeake Bay off Fort Monroe, Va.; firing range danger zone.

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 33 Navigation and Navigable Waters 3 2014-07-01 2014-07-01 false Chesapeake Bay off Fort Monroe, Va.; firing range danger zone. 334.350 Section 334.350 Navigation and Navigable Waters CORPS OF....350 Chesapeake Bay off Fort Monroe, Va.; firing range danger zone. (a) The danger zone. All of...

  1. 33 CFR 334.220 - Chesapeake Bay, south of Tangier Island, Va.; naval firing range.

    Code of Federal Regulations, 2012 CFR

    2012-07-01

    ... 33 Navigation and Navigable Waters 3 2012-07-01 2012-07-01 false Chesapeake Bay, south of Tangier Island, Va.; naval firing range. 334.220 Section 334.220 Navigation and Navigable Waters CORPS OF....220 Chesapeake Bay, south of Tangier Island, Va.; naval firing range. (a) The danger zone....

  2. 76 FR 67561 - Proposed Information Collection (VA Enrollment Certification) Activity: Comment Request

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-11-01

    ... information needed to determine the amount of educational benefits payable to claimants pursuing approved... use of other forms of information technology. Title: VA Enrollment Certification, VA Form 22-1999. OMB... educational program. The data is used to determine the amount of benefits payable and whether the...

  3. 77 FR 27118 - Safety Zone; Rocketts Red Glare Fireworks, Ancarrows Landing Park, James River, Richmond, VA

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-05-09

    ..., VA in the Federal Register (76 FR 13525). We ] received no comments on the proposed rule. No public... SECURITY Coast Guard 33 CFR Part 165 RIN 1625-AA00 Safety Zone; Rocketts Red Glare Fireworks, Ancarrows... in Richmond, VA in support of the Rocketts Red Glare Fireworks event. This action is necessary...

  4. 78 FR 27882 - VA Veteran-Owned Small Business (VOSB) Verification Guidelines

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-05-13

    ... AFFAIRS 38 CFR Part 74 RIN 2900-AO63 VA Veteran-Owned Small Business (VOSB) Verification Guidelines AGENCY... and Disadvantaged Business Utilization (OSDBU) is currently reviewing its regulations governing the Department of Veterans Affairs (VA) Veteran-Owned Small Business (VOSB) Verification Program. OSDBU...

  5. 30 CFR 57.22309 - Methane monitors (V-A mines).

    Code of Federal Regulations, 2011 CFR

    2011-07-01

    ... 30 CFR part 18, and prevent starting of such equipment when methane levels reach 1.5 percent; and (3... 30 Mineral Resources 1 2011-07-01 2011-07-01 false Methane monitors (V-A mines). 57.22309 Section... Standards for Methane in Metal and Nonmetal Mines Equipment § 57.22309 Methane monitors (V-A mines)....

  6. VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Programs. Final rule.

    PubMed

    2013-08-20

    The Department of Veterans Affairs (VA) is amending its VA Health Professional Scholarship Program (HPSP) regulations. VA is also establishing regulations for a new program, the Visual Impairment and Orientation and Mobility Professional Scholarship Program (VIOMPSP). These regulations comply with and implement sections 302 and 603 of the Caregivers and Veterans Omnibus Health Services Act of 2010 (the 2010 Act). Section 302 of the 2010 Act established the VIOMPSP, which authorizes VA to provide financial assistance to certain students seeking a degree in visual impairment or orientation or mobility, in order to increase the supply of qualified blind rehabilitation specialists for VA and the United States. Section 603 of the 2010 Act reauthorized and modified HPSP, a program that provides scholarships for education or training in certain health care occupations.

  7. Empirical analysis on future-cash arbitrage risk with portfolio VaR

    NASA Astrophysics Data System (ADS)

    Chen, Rongda; Li, Cong; Wang, Weijin; Wang, Ze

    2014-03-01

    This paper constructs the positive arbitrage position by alternating the spot index with Chinese Exchange Traded Fund (ETF) portfolio and estimating the arbitrage-free interval of futures with the latest trade data. Then, an improved Delta-normal method was used, which replaces the simple linear correlation coefficient with tail dependence correlation coefficient, to measure VaR (Value-at-risk) of the arbitrage position. Analysis of VaR implies that the risk of future-cash arbitrage is less than that of investing completely in either futures or spot market. Then according to the compositional VaR and the marginal VaR, we should increase the futures position and decrease the spot position appropriately to minimize the VaR, which can minimize risk subject to certain revenues.

  8. VA Health Professional Scholarship and Visual Impairment and Orientation and Mobility Professional Scholarship Programs. Final rule.

    PubMed

    2013-08-20

    The Department of Veterans Affairs (VA) is amending its VA Health Professional Scholarship Program (HPSP) regulations. VA is also establishing regulations for a new program, the Visual Impairment and Orientation and Mobility Professional Scholarship Program (VIOMPSP). These regulations comply with and implement sections 302 and 603 of the Caregivers and Veterans Omnibus Health Services Act of 2010 (the 2010 Act). Section 302 of the 2010 Act established the VIOMPSP, which authorizes VA to provide financial assistance to certain students seeking a degree in visual impairment or orientation or mobility, in order to increase the supply of qualified blind rehabilitation specialists for VA and the United States. Section 603 of the 2010 Act reauthorized and modified HPSP, a program that provides scholarships for education or training in certain health care occupations. PMID:23977714

  9. Structural determinants of hospital closure.

    PubMed

    Longo, D R; Chase, G A

    1984-05-01

    In a retrospective case-control study, structural characteristics of hospitals that closed during the years 1976-1980 were contrasted with three comparison groups: hospitals that were acquired in a merger; hospitals that joined a multihospital system; and hospitals that remained autonomously opened, to investigate these characteristics as predictors of closure. Characteristics investigated included environmental, structural, and process variables. The independent variables were measured 5 years prior to outcome. Findings indicate that closed hospitals resemble hospitals acquired in a merger ("failure"), and likewise autonomous hospitals resemble hospitals that join a multihospital system ("success"). The most important predictors of hospital failure were the physician-to-population ratio, the East North Central and West North Central census regions, the level of diversification, low occupancy rate, location in a standard metropolitan statistical area, the chief executive officer's lack of affiliation in the American College of Hospital Administrators, profit status, bed size of less than 50, and presence in a state with a rate-setting agency. Surprisingly, this study shows the bed-to-population ratio to be unrelated to closure. In addition, the findings strongly support the open-system perspective, which, unlike the closed-system perspective, is concerned with the vulnerability of the organization to the uncontrollable and often unpredictable influences of the environment.

  10. Growth of the teaching nursing home. The Veterans Administration experience.

    PubMed

    Rubenstein, L Z; Wieland, D; Pearlman, R A; Grover, P; Mabry, J

    1990-01-01

    Nursing homes are becoming increasingly involved with medical education, and the Veterans Administration (VA) has been particularly active in this movement. We conducted a system-wide survey of VA nursing home facilities to determine the degree to which they participate in medical and other professional training and the features associated with such training. Of the 116 VA nursing homes in 1987, 113 (97.4%) returned completed questionnaires. Compared to "standard" VA facilities (n = 85), "teaching" nursing homes (n = 28)--those in which physicians received at least 20 hours of training per capita annually--were significantly larger, admitted and discharged significantly more patients per occupied bed, and placed a significantly larger proportion of discharged patients in noninstitutional community settings. Care costs in the teaching nursing homes were slightly but not significantly higher, despite significant increases in levels of professional staffing and amounts of training activities in all disciplines. During the survey year, teaching nursing homes provided training experiences for 440 students, residents, and fellows in internal and rehabilitation medicine, as well as for 2,700 other health professionals. The growth of teaching nursing homes in the VA system appears to be associated with positive changes in the pattern of health-care delivery, and it is increasing the number of health-care professionals trained in long-term care.

  11. Building strong research partnerships between public health and researchers: a VA case study.

    PubMed

    Midboe, Amanda M; Elwy, A Rani; Durfee, Janet M; Gifford, Allen L; Yakovchenko, Vera; Martinello, Richard A; Ross, David; Czarnogorski, Maggie; Goetz, Matthew B; Asch, Steven M

    2014-12-01

    We are in a new era of partner-based implementation research, and we need clear strategies for how to navigate this new era. Drawing on principles from community-based participatory research, the Clinical Public Health group of the Department of Veterans Affairs and the HIV/Hepatitis Quality Enhancement Research Initiative (HHQUERI) forged a longstanding partnership that has improved the care of Veterans with Human Immunodeficiency Virus (HIV) and Hepatitis C Virus. An exemplar HIV testing project epitomizes this partnership and is discussed in terms of the lessons learned as a result of our high level of collaboration around design, analysis, implementation, and dissemination across projects over the past several years. Lessons learned through this partnered testing program involve respecting different time horizons among the partners, identifying relevant research questions for both parties, designing flexible studies, engaging all partners throughout the research, and placing an emphasis on relationship building at all times. These lessons and strategies can benefit others conducting partner-based research both within the Veterans Health Administration (VA) and in other integrated healthcare systems.

  12. Building strong research partnerships between public health and researchers: a VA case study.

    PubMed

    Midboe, Amanda M; Elwy, A Rani; Durfee, Janet M; Gifford, Allen L; Yakovchenko, Vera; Martinello, Richard A; Ross, David; Czarnogorski, Maggie; Goetz, Matthew B; Asch, Steven M

    2014-12-01

    We are in a new era of partner-based implementation research, and we need clear strategies for how to navigate this new era. Drawing on principles from community-based participatory research, the Clinical Public Health group of the Department of Veterans Affairs and the HIV/Hepatitis Quality Enhancement Research Initiative (HHQUERI) forged a longstanding partnership that has improved the care of Veterans with Human Immunodeficiency Virus (HIV) and Hepatitis C Virus. An exemplar HIV testing project epitomizes this partnership and is discussed in terms of the lessons learned as a result of our high level of collaboration around design, analysis, implementation, and dissemination across projects over the past several years. Lessons learned through this partnered testing program involve respecting different time horizons among the partners, identifying relevant research questions for both parties, designing flexible studies, engaging all partners throughout the research, and placing an emphasis on relationship building at all times. These lessons and strategies can benefit others conducting partner-based research both within the Veterans Health Administration (VA) and in other integrated healthcare systems. PMID:25355082

  13. Hospital fundamentals.

    PubMed

    Althausen, Peter L; Hill, Austin D; Mead, Lisa

    2014-07-01

    Under the current system, orthopaedic trauma surgeons must work in some form of hospital setting as our primary service involves treatment of the trauma patient. We must not forget that just as a trauma center cannot exist without our services, we cannot function without their support. As a result, a clear understanding of the balance between physicians and hospitals is paramount. Historical perspective enables physicians and hospital personnel alike to understand the evolution of hospital-physician relationship. This process should be understood upon completion of this chapter. The relationship between physicians and hospitals is becoming increasingly complex and multiple forms of integration exist such as joint ventures, gain sharing, and co-management agreements. For the surgeon to negotiate well, an understanding of hospital governance and the role of the orthopaedic traumatologist is vital to success. An understanding of the value provided by the traumatologist includes all aspects of care including efficiency, availability, cost effectiveness, and research activities. To create effective and sustainable healthcare institutions, physicians and hospitals must be aligned over a sustained period of time. Unfortunately, external forces have eroded the historical basis for the working relationship between physicians and hospitals. Increased competition and reimbursement cuts, coupled with the increasing demands for quality, efficiency, and coordination and the payment changes outlined in healthcare reform, have left many organizations wondering how to best rebuild the relationship. The principal goal for the physician when partnering with a hospital or healthcare entity is to establish a sustainable model of service line management that protects or advances the physician's ability to make impactful improvements in quality of patient care, decreases in healthcare costs, and improvements in process efficiency through evidence-based practices and protocols. PMID

  14. Hospital fundamentals.

    PubMed

    Althausen, Peter L; Hill, Austin D; Mead, Lisa

    2014-07-01

    Under the current system, orthopaedic trauma surgeons must work in some form of hospital setting as our primary service involves treatment of the trauma patient. We must not forget that just as a trauma center cannot exist without our services, we cannot function without their support. As a result, a clear understanding of the balance between physicians and hospitals is paramount. Historical perspective enables physicians and hospital personnel alike to understand the evolution of hospital-physician relationship. This process should be understood upon completion of this chapter. The relationship between physicians and hospitals is becoming increasingly complex and multiple forms of integration exist such as joint ventures, gain sharing, and co-management agreements. For the surgeon to negotiate well, an understanding of hospital governance and the role of the orthopaedic traumatologist is vital to success. An understanding of the value provided by the traumatologist includes all aspects of care including efficiency, availability, cost effectiveness, and research activities. To create effective and sustainable healthcare institutions, physicians and hospitals must be aligned over a sustained period of time. Unfortunately, external forces have eroded the historical basis for the working relationship between physicians and hospitals. Increased competition and reimbursement cuts, coupled with the increasing demands for quality, efficiency, and coordination and the payment changes outlined in healthcare reform, have left many organizations wondering how to best rebuild the relationship. The principal goal for the physician when partnering with a hospital or healthcare entity is to establish a sustainable model of service line management that protects or advances the physician's ability to make impactful improvements in quality of patient care, decreases in healthcare costs, and improvements in process efficiency through evidence-based practices and protocols.

  15. 76 FR 58557 - Virginia Disaster Number VA-00038

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-09-21

    ..., Charles City, Chesterfield, Dinwiddie, Henrico, King George, King and Queen, King William, Mathews... Numbers 59002 and 59008) James E. Rivera, Associate Administrator for Disaster Assistance. BILLING...

  16. Utilization of hospital resources.

    PubMed

    Black, C D; Roos, N P; Burchill, C A

    1995-12-01

    A population-based approach was used to analyze the utilization patterns of hospital care by Manitoba residents during the fiscal year 1991/1992. Patterns were analyzed for eight administrative regions, with use assigned to the patient's region of residence, regardless of the location of the hospitalization. Regional boundaries consistent with those used for presentation of data on health status and socioeconomic risk permitted integration of findings across the Population Health Information System. Marked differences in acute hospital use were found. Residents of the urban Winnipeg ("good health") region had the lowest rates of use of acute care overall, and northern rural ("poor health") regions had significantly higher rates of use. However, almost one half of hospital days by Winnipeg residents were used in long-stay care (60+ days), while rural residents were more likely to use short-stay hospital care. Despite a concentration of surgical specialists in Winnipeg, there were only small regional differences in overall rates of surgery. PMID:7500670

  17. Hospital marketing.

    PubMed

    Carter, Tony

    2003-01-01

    This article looks at a prescribed academic framework for various criteria that serve as a checklist for marketing performance that can be applied to hospital marketing organizations. These guidelines are drawn from some of Dr. Noel Capon of Columbia University's book Marketing Management in the 21st Century and applied to actual practices of hospital marketing organizations. In many ways this checklist can act as a "marketing" balanced scorecard to verify performance effectiveness and develop opportunities for innovation.

  18. Hospital philanthropy.

    PubMed

    Smith, Dean G; Clement, Jan P

    2013-01-01

    It remains an open question whether hospital spending on fundraising efforts to garner philanthropy is a good use of funds. Research and industry reports provide conflicting results. We describe the accounting and data challenges in analysis of hospital philanthropy, which include measurement of donations, measurement of fundraising expenses, and finding the relationships among organizations where these cash flows occur. With these challenges, finding conflicting results is not a surprise. PMID:23614267

  19. Hospital marketing.

    PubMed

    Carter, Tony

    2003-01-01

    This article looks at a prescribed academic framework for various criteria that serve as a checklist for marketing performance that can be applied to hospital marketing organizations. These guidelines are drawn from some of Dr. Noel Capon of Columbia University's book Marketing Management in the 21st Century and applied to actual practices of hospital marketing organizations. In many ways this checklist can act as a "marketing" balanced scorecard to verify performance effectiveness and develop opportunities for innovation. PMID:14753323

  20. 76 FR 67257 - Computer Matching Program Between the Department of Veterans Affairs (VA) and the Department of...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-10-31

    ... education benefit payments under the Post-9/11 GI Bill. These benefit records are contained in a VA system of records identified as 58VA21/ 22/28 entitled: Compensation, Pension, Education and Vocational Rehabilitation and Employment Records--VA, first published in the Federal Register at 74 FR 9294 (March 3,...

  1. Prevalence and costs of chronic conditions in the VA health care system.

    PubMed

    Yu, Wei; Ravelo, Arliene; Wagner, Todd H; Phibbs, Ciaran S; Bhandari, Aman; Chen, Shuo; Barnett, Paul G

    2003-09-01

    Chronic conditions are among the most common causes of death and disability in the United States. Patients with such conditions receive disproportionate amounts of health care services and therefore cost more per capita than the average patient. This study assesses the prevalence among the Department of Veterans Affairs (VA) health care users and VA expenditures (costs) of 29 common chronic conditions. The authors used regression to identify the marginal impact of these conditions on total, inpatient, outpatient, and pharmacy costs. Excluding costs of contracted medical services at non-VA facilities, total VA health care expenditures in fiscal year 1999 (FY1999) were $14.3 billion. Among the 3.4 million VA patients in FY1999, 72 percent had 1 or more of the 29 chronic conditions, and these patients accounted for 96 percent of the total costs ($13.7 billion). In addition, 35 percent (1.2 million) of VA health care users had 3 or more of the 29 chronic conditions. These individuals accounted for 73 percent of the total cost. Overall, VA health care users have more chronic diseases than the general population. PMID:15095551

  2. Administrative Ecology

    ERIC Educational Resources Information Center

    McGarity, Augustus C., III; Maulding, Wanda

    2007-01-01

    This article discusses how all four facets of administrative ecology help dispel the claims about the "impossibility" of the superintendency. These are personal ecology, professional ecology, organizational ecology, and community ecology. Using today's superintendency as an administrative platform, current literature describes a preponderance of…

  3. Administrative Support.

    ERIC Educational Resources Information Center

    Doran, Dorothy; And Others

    This guide is intended to assist business education teachers in administrative support courses. The materials presented are based on the Arizona validated occupational competencies and tasks for the occupations of receptionist, secretary, and administrative assistant. Word processing skills have been infused into each of the three sections. The…

  4. Electrical Resistivity Study of a Pleistocene Riverbed in Saltville, VA

    NASA Astrophysics Data System (ADS)

    Herman, R. B.; Whisonant, R. C.

    2008-05-01

    A shallow capacitively coupled resistivity survey was performed in Saltville, VA, in an area of suspected buried Pleistocene river deposits. Previous excavations in the sediments beneath the Saltville valley floor had been performed to recover late Pleistocene megafaunal remains and possible Clovis-age human artifacts. These digs encountered a zone, one to two meters deep, of gravel-sized rock fragments, including some boulders up to 75 cm. in diameter. These large clasts are rounded, show some imbrication (shingle-like overlapping indicative of current flow), and have been interpreted as river channel deposits. Carbon 14 dates from the megafaunal bones within and just above the gravel bed yielded dates of 14,500 years BP. Resistivity signals in a number of locations were consistent with cobbles and boulders deposited in a river channel. These signals are generally bowl- shaped areas with large circular (2-d scans) anomalies near the center, and smaller circular anomalies tapering out towards both sides. The bowl-shaped anomalies are within 3 meters of the surface. With several lines imaged in this survey a rough path of the riverbed, along with a number of branchings is traceable in the survey area. An exploratory hole confirmed the presence of a layer of rounded cobbles and boulders 1.3 meters deep beneath one of the survey lines.

  5. Effects of inspired CO2, hyperventilation, and time on VA/Q inequality in the dog

    NASA Technical Reports Server (NTRS)

    Tsukimoto, K.; Arcos, J. P.; Schaffartzik, W.; Wagner, P. D.; West, J. B.

    1992-01-01

    In a recent study by Tsukimoto et al. (J. Appl. Physiol. 68: 2488-2493, 1990), CO2 inhalation appeared to reduce the size of the high ventilation-perfusion ratio (VA/Q) mode commonly observed in anesthetized mechanically air-ventilated dogs. In that study, large tidal volumes (VT) were used during CO2 inhalation to preserve normocapnia. To separate the influences of CO2 and high VT on the VA/Q distribution in the present study, we examined the effect of inspired CO2 on the high VA/Q mode using eight mechanically ventilated dogs (4 given CO2, 4 controls). The VA/Q distribution was measured first with normal VT and then with increased VT. In the CO2 group at high VT, data were collected before, during, and after CO2 inhalation. With normal VT, there was no difference in the size of the high VA/Q mode between groups [10.5 +/- 3.5% (SE) of ventilation in the CO2 group, 11.8 +/- 5.2% in the control group]. Unexpectedly, the size of the high VA/Q mode decreased similarly in both groups over time, independently of the inspired PCO2, at a rate similar to the fall in cardiac output over time. The reduction in the high VA/Q mode together with a simultaneous increase in alveolar dead space (estimated by the difference between inert gas dead space and Fowler dead space) suggests that poorly perfused high VA/Q areas became unperfused over time. A possible mechanism is that elevated alveolar pressure and decreased cardiac output eliminate blood flow from corner vessels in nondependent high VA/Q regions.

  6. Using the Veterans Health Administration inpatient care database: trends in the use of antireflux surgery.

    PubMed

    Finalyson, Samuel R G; Stroupe, Kevin T; Joseph, George J; Fisher, Elliott S

    2002-01-01

    Context. In the private sector, the use of surgery to treat gastroesophageal reflux disease has increased substantially since the development of minimally invasive laparoscopic techniques. However, trends in the use of antireflux surgery in the Veterans Affairs (VA) health care system have not been explored. Objective. To compare secular trends in the use of antireflux surgery in VA hospitals and the private sector. Data Sources. VA data are from the 1991-1999 medical SAS datasets for inpatient care (commonly known as patient treatment files); private sector data are from the 1991-1997 Nationwide Inpatient Sample and the U.S. census. Calculations. We compared secular trends in the use of antireflux surgery in the VA and private sector with each group's baseline rate in 1991. For the VA, we calculated annual rates of antireflux surgery among active users of the VA health care system by dividing the number of procedures (based on the appropriate procedure codes from the International Classification of Diseases, ninth revision, clinical modification) by the number of veterans who had at least two hospital or clinic visits in a given year. For the private sector, we calculated true population rates by dividing procedure counts by the total U.S. population. Results. From 1991 to 1995, the annual rate of antireflux surgery among active users of VA hospitals increased by 64%, then decreased over the next 4 years to almost baseline rates. In contrast, rates of antireflux surgery in the private sector increased 185% from 1991 to 1995, then appeared to reach a plateau thereafter. Among patients undergoing antireflux surgery, those in the VA were less likely than those in the private sector to undergo laparoscopic surgery (29% vs. 65%, respectively, in 1997). Conclusions. With the development of laparoscopic surgery, rates of antireflux surgery in VA hospitals increased only modestly compared with the private sector and have decreased in recent years. Both patient and

  7. US Department of Veterans Affairs disability policies for posttraumatic stress disorder: administrative trends and implications for treatment, rehabilitation, and research.

    PubMed

    Frueh, B Christopher; Grubaugh, Anouk L; Elhai, Jon D; Buckley, Todd C

    2007-12-01

    An accumulating body of empirical data suggests that current Department of Veterans Affairs (VA) psychiatric disability and rehabilitation policies for combat-related posttraumatic stress disorder (PTSD) are problematic. In combination, recent administrative trends and data from epidemiological and clinical studies suggest theses policies are countertherapeutic and hinder research efforts to advance our knowledge regarding PTSD. Current VA disability policies require fundamental reform to bring them into line with modern science and medicine, including current empirically supported concepts of resilience and psychiatric rehabilitation.

  8. Reducing Maladaptive Family Interaction by Involving Significant Others of Hospitalized Psychiatric Patients.

    ERIC Educational Resources Information Center

    Mabel, Sanford

    The program was set up to involve, on a continuing basis, the significant other of frequently-readmitted hospitalized psychiatric VA patients. The couples identified their characteristic strengths, and their maladaptive ways of functioning, and were expected to make use of alternative ways of behaving which were recommended by the staff. A…

  9. The changing power equation in hospitals.

    PubMed

    Rayburn, J M; Rayburn, L G

    1997-01-01

    This research traces the origins, development, and reasons for change in the power equation in the U.S. hospitals between physicians, administrators and accountants. The paper contains three major sections: a review of the literature concerning authority, power, influence, and institutional theory; a review of the development of the power of professions, especially physicians, accounting and healthcare administrators, and the power equilibrium of a hospital; and, a discussion of the social policy implications of the power struggle. The basis for physicians' power derives from their legal ability to act on which others are dependent, such as choosing which hospital to admit patients, order tests and procedures for their patients. The Federal Government's prospective payment system and the hospitals' related case-mix accounting systems appear to influence the power structure in hospitals by redistributing that power. The basis of the accountants' power base is control of financial information. Accountants have a definite potential for influencing which departments receive financial resources and for what purpose. This moves hospital accountants into the power equation. The basis of the hospital administrators' power is their formal authority in the organization. Regardless of what actions federal government agencies, hospital accountants, or hospital administrators take, physicians are expected to remain the dominant factor in the power equation. Without major environmental changes to gain control of physician services, only insignificant results in cost containment will occur. PMID:10163913

  10. 77 FR 70212 - Agency Information Collection Activities Under OMB Review: VA MATIC Enrollment/Change

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-11-23

    ... MATIC or change their financial institution from which VA currently deducts his/her Government Life Insurance premium. An agency may not conduct or sponsor, and a person is not required to respond to...

  11. 38 CFR 74.29 - When will VA dispose of records?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... (CONTINUED) VETERANS SMALL BUSINESS REGULATIONS Records Management § 74.29 When will VA dispose of records? The records, including those pertaining to businesses not determined to be eligible for the...

  12. 78 FR 66266 - Drawbridge Operation Regulation; Atlantic Intracoastal Waterway (AIWW), Chesapeake, VA

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-11-05

    ... Chesapeake, VA. This deviation is necessary to facilitate maintenance work on the rotary span limit switches... 33 CFR 117.997(e), to facilitate maintenance of the moveable spans on the structure. The...

  13. 75 FR 9277 - Proposed Information Collection (VA National Rehabilitation Special Events, Event Registration...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-03-01

    ... AFFAIRS Proposed Information Collection (VA National Rehabilitation Special Events, Event Registration Applications); Comment Request AGENCY: Office of National Programs and Special Events, Department of Veterans Affairs. ACTION: Notice. SUMMARY: The Office of National Programs and Special Events (NPSE), Department...

  14. 77 FR 60746 - Proposed Information Collection (VA/DOD Joint Disability Evaluation Board Claim) Activity...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-10-04

    ... Interagency Task Force on Returning Global War on Terror Heroes, VA and the Department of Defense (DOD) have agreed to develop a joint process in which Global War on Terror (GWOT) service members are evaluated...

  15. 77 FR 74279 - Agency Information Collection (VA/DOD Joint Disability Evaluation Board Claim): Activity under...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2012-12-13

    ... President Bush's Interagency Task Force on Returning Global War on Terror Heroes, VA and the Department of Defense (DOD) have agreed to develop a joint process in which Global War on Terror (GWOT) service...

  16. 38 CFR 74.25 - What types of personally identifiable information will VA collect?

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... DEPARTMENT OF VETERANS AFFAIRS (CONTINUED) VETERANS SMALL BUSINESS REGULATIONS Records Management § 74.25 What types of personally identifiable information will VA collect? In order to establish owner... in a specific business seeking to obtain verified status....

  17. 76 FR 40453 - Agency Information Collection (Application for VA Education Benefits) Activity Under OMB Review

    Federal Register 2010, 2011, 2012, 2013, 2014

    2011-07-08

    .... The PRA submission describes the nature of the information collection and its expected cost and burden....Regulations.gov or to VA's OMB Desk Officer, OMB Human Resources and Housing Branch, New Executive...

  18. 75 FR 54003 - Imperial Savings and Loan Association, Martinsville, VA; Notice of Appointment of Receiver

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-09-02

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF THE TREASURY Office of Thrift Supervision Imperial Savings and Loan Association, Martinsville, VA; Notice of... Insurance Corporation as sole Receiver for Imperial Savings and Loan Association, Martinsville,...

  19. 78 FR 34892 - Drawbridge Operation Regulation; Elizabeth River, Eastern Branch, Norfolk, VA

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-06-11

    ..., VA. This deviation is necessary to facilitate thermite welding on rail joints on the Norfolk Southern... 33 CFR 117.5 to facilitate thermite welding on the rails. Under the regular operating schedule,...

  20. 79. Credit JTL. Detail of 2000 kVA generator (unit 2) ...

    Library of Congress Historic Buildings Survey, Historic Engineering Record, Historic Landscapes Survey

    79. Credit JTL. Detail of 2000 kVA generator (unit 2) looking southwest. Note the elevated neutral on upper part of generator (added later). - Battle Creek Hydroelectric System, Battle Creek & Tributaries, Red Bluff, Tehama County, CA

  1. Profit efficiency and ownership of German hospitals.

    PubMed

    Herr, Annika; Schmitz, Hendrik; Augurzky, Boris

    2011-06-01

    This paper investigates the cost and profit efficiency of German hospitals and their variation with ownership type. It is motivated by the empirical finding that private (for-profit) hospitals - having been shown to be less cost efficient in the past - on average earn higher profits than public hospitals. We conduct a Stochastic Frontier Analysis on a multifaceted administrative German data set combined with the balance sheets of 541 hospitals of the years 2002-2006. The results show no significant differences in cost efficiency but higher profit efficiency of private than of publicly owned hospitals.

  2. 12 CFR 3.206 - Stressed VaR-based measure.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 1 2014-01-01 2014-01-01 false Stressed VaR-based measure. 3.206 Section 3.206 Banks and Banking COMPTROLLER OF THE CURRENCY, DEPARTMENT OF THE TREASURY CAPITAL ADEQUACY STANDARDS Risk-Weighted Assets-Market Risk § 3.206 Stressed VaR-based measure. (a) General requirement. At least weekly, a national bank or Federal...

  3. 12 CFR 324.206 - Stressed VaR-based measure.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 5 2014-01-01 2014-01-01 false Stressed VaR-based measure. 324.206 Section 324.206 Banks and Banking FEDERAL DEPOSIT INSURANCE CORPORATION REGULATIONS AND STATEMENTS OF GENERAL POLICY CAPITAL ADEQUACY OF FDIC-SUPERVISED INSTITUTIONS Risk-Weighted Assets-Market Risk § 324.206 Stressed VaR-based measure. (a) General...

  4. 12 CFR 217.206 - Stressed VaR-based measure.

    Code of Federal Regulations, 2014 CFR

    2014-01-01

    ... 12 Banks and Banking 2 2014-01-01 2014-01-01 false Stressed VaR-based measure. 217.206 Section 217.206 Banks and Banking FEDERAL RESERVE SYSTEM BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM CAPITAL ADEQUACY OF BOARD-REGULATED INSTITUTIONS Risk-Weighted Assets-Market Risk § 217.206 Stressed VaR-based measure. (a) General requirement. At...

  5. 30 CFR 57.22240 - Actions at 2.0 percent methane (V-A mines).

    Code of Federal Regulations, 2013 CFR

    2013-07-01

    ... 30 Mineral Resources 1 2013-07-01 2013-07-01 false Actions at 2.0 percent methane (V-A mines). 57... MINES Safety Standards for Methane in Metal and Nonmetal Mines Ventilation § 57.22240 Actions at 2.0 percent methane (V-A mines). If methane reaches 2.0 percent in the mine atmosphere, all persons other...

  6. 30 CFR 57.22240 - Actions at 2.0 percent methane (V-A mines).

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 30 Mineral Resources 1 2010-07-01 2010-07-01 false Actions at 2.0 percent methane (V-A mines). 57... MINES Safety Standards for Methane in Metal and Nonmetal Mines Ventilation § 57.22240 Actions at 2.0 percent methane (V-A mines). If methane reaches 2.0 percent in the mine atmosphere, all persons other...

  7. 30 CFR 57.22240 - Actions at 2.0 percent methane (V-A mines).

    Code of Federal Regulations, 2014 CFR

    2014-07-01

    ... 30 Mineral Resources 1 2014-07-01 2014-07-01 false Actions at 2.0 percent methane (V-A mines). 57... MINES Safety Standards for Methane in Metal and Nonmetal Mines Ventilation § 57.22240 Actions at 2.0 percent methane (V-A mines). If methane reaches 2.0 percent in the mine atmosphere, all persons other...

  8. 46 CFR 7.55 - Cape Henry, VA to Cape Fear, NC.

    Code of Federal Regulations, 2013 CFR

    2013-10-01

    ... 46 Shipping 1 2013-10-01 2013-10-01 false Cape Henry, VA to Cape Fear, NC. 7.55 Section 7.55 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC BOUNDARY LINES Atlantic Coast § 7.55 Cape Henry, VA to Cape Fear, NC. (a) A line drawn from Rudee Inlet Jetty Light “2”...

  9. 46 CFR 7.55 - Cape Henry, VA to Cape Fear, NC.

    Code of Federal Regulations, 2014 CFR

    2014-10-01

    ... 46 Shipping 1 2014-10-01 2014-10-01 false Cape Henry, VA to Cape Fear, NC. 7.55 Section 7.55 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC BOUNDARY LINES Atlantic Coast § 7.55 Cape Henry, VA to Cape Fear, NC. (a) A line drawn from Rudee Inlet Jetty Light “2”...

  10. 46 CFR 7.55 - Cape Henry, VA to Cape Fear, NC.

    Code of Federal Regulations, 2011 CFR

    2011-10-01

    ... 46 Shipping 1 2011-10-01 2011-10-01 false Cape Henry, VA to Cape Fear, NC. 7.55 Section 7.55 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC BOUNDARY LINES Atlantic Coast § 7.55 Cape Henry, VA to Cape Fear, NC. (a) A line drawn from Rudee Inlet Jetty Light “2”...

  11. 46 CFR 7.55 - Cape Henry, VA to Cape Fear, NC.

    Code of Federal Regulations, 2010 CFR

    2010-10-01

    ... 46 Shipping 1 2010-10-01 2010-10-01 false Cape Henry, VA to Cape Fear, NC. 7.55 Section 7.55 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC BOUNDARY LINES Atlantic Coast § 7.55 Cape Henry, VA to Cape Fear, NC. (a) A line drawn from Rudee Inlet Jetty Light “2”...

  12. 46 CFR 7.55 - Cape Henry, VA to Cape Fear, NC.

    Code of Federal Regulations, 2012 CFR

    2012-10-01

    ... 46 Shipping 1 2012-10-01 2012-10-01 false Cape Henry, VA to Cape Fear, NC. 7.55 Section 7.55 Shipping COAST GUARD, DEPARTMENT OF HOMELAND SECURITY PROCEDURES APPLICABLE TO THE PUBLIC BOUNDARY LINES Atlantic Coast § 7.55 Cape Henry, VA to Cape Fear, NC. (a) A line drawn from Rudee Inlet Jetty Light “2”...

  13. Report on the evaluation of the VA/Seattle below-knee prosthesis.

    PubMed

    Ellepola, W; Sheredos, S J

    1993-01-01

    The Department of Veterans Affairs (VA), Rehabilitation Research and Development (Rehab R&D) Service, Technology Transfer Section (TTS) with collaboration from the Prosthetic and Sensory Aids Service (PSAS) managed clinical trials to evaluate the VA/Seattle Below-Knee (BK) Prosthetic System. The clinical trials were held at the Prosthetic Treatment Center (PTC), VA Medical Center, Hines, Illinois. Five other VA medical centers participated in the outreach program of the trials as satellite stations, with PTC Hines as the central fabrication facility. The VA/Seattle BK system is the first complete prosthetic system designed and developed by the Department of Veterans Affairs. It consists of a socket designed and fabricated using computer-aided, automated technology, and off-the-shelf modular components: a lightweight pylon and an ankle unit, and a lightweight, energy-storing foot. The computer-based socket design software, the modular components, and the prosthetic foot were developed with funds from the VA Rehab R&D Service. The evaluation trials were conducted to determine the efficacy of the VA/Seattle prosthesis, its reliability, and acceptance by veterans. The clinical trials began in April 1991 and were completed in August 1992. Forty-six BK amputee veterans were fitted with the VA/Seattle prosthesis. Their progress with the prosthesis was followed for a period of 6 months and data were gathered at intervals of 2 weeks, 3 months, and 6 months. Forty sets of subject data instruments were collected. In order to maintain the accuracy of the results, TTS used the 22 sets that were complete for data analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

  14. 75 FR 61859 - Proposed Information Collection (Create Payment Request for the VA Funding Fee Payment System (VA...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2010-10-06

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS... FFPS); A Computer Generated Funding Fee Receipt) Activity: Comment Request AGENCY: Veterans Benefits Administration, Department of Veterans Affairs. ACTION: Notice. SUMMARY: The Veterans Benefits...

  15. 78 FR 59771 - Proposed Information Collection (Create Payment Request for the VA Funding Fee Payment System (VA...

    Federal Register 2010, 2011, 2012, 2013, 2014

    2013-09-27

    ... From the Federal Register Online via the Government Publishing Office DEPARTMENT OF VETERANS... FFPS); a Computer Generated Funding Fee Receipt) Activity: Comment Request AGENCY: Veterans Benefits Administration, Department of Veterans Affairs. ACTION: Notice. SUMMARY: The Veterans Benefits...

  16. VaRank: a simple and powerful tool for ranking genetic variants.

    PubMed

    Geoffroy, Véronique; Pizot, Cécile; Redin, Claire; Piton, Amélie; Vasli, Nasim; Stoetzel, Corinne; Blavier, André; Laporte, Jocelyn; Muller, Jean

    2015-01-01

    Background. Most genetic disorders are caused by single nucleotide variations (SNVs) or small insertion/deletions (indels). High throughput sequencing has broadened the catalogue of human variation, including common polymorphisms, rare variations or disease causing mutations. However, identifying one variation among hundreds or thousands of others is still a complex task for biologists, geneticists and clinicians. Results. We have developed VaRank, a command-line tool for the ranking of genetic variants detected by high-throughput sequencing. VaRank scores and prioritizes variants annotated either by Alamut Batch or SnpEff. A barcode allows users to quickly view the presence/absence of variants (with homozygote/heterozygote status) in analyzed samples. VaRank supports the commonly used VCF input format for variants analysis thus allowing it to be easily integrated into NGS bioinformatics analysis pipelines. VaRank has been successfully applied to disease-gene identification as well as to molecular diagnostics setup for several hundred patients. Conclusions. VaRank is implemented in Tcl/Tk, a scripting language which is platform-independent but has been tested only on Unix environment. The source code is available under the GNU GPL, and together with sample data and detailed documentation can be downloaded from http://www.lbgi.fr/VaRank/.

  17. VaRank: a simple and powerful tool for ranking genetic variants

    PubMed Central

    Geoffroy, Véronique; Pizot, Cécile; Redin, Claire; Piton, Amélie; Vasli, Nasim; Stoetzel, Corinne; Blavier, André; Laporte, Jocelyn

    2015-01-01

    Background. Most genetic disorders are caused by single nucleotide variations (SNVs) or small insertion/deletions (indels). High throughput sequencing has broadened the catalogue of human variation, including common polymorphisms, rare variations or disease causing mutations. However, identifying one variation among hundreds or thousands of others is still a complex task for biologists, geneticists and clinicians. Results. We have developed VaRank, a command-line tool for the ranking of genetic variants detected by high-throughput sequencing. VaRank scores and prioritizes variants annotated either by Alamut Batch or SnpEff. A barcode allows users to quickly view the presence/absence of variants (with homozygote/heterozygote status) in analyzed samples. VaRank supports the commonly used VCF input format for variants analysis thus allowing it to be easily integrated into NGS bioinformatics analysis pipelines. VaRank has been successfully applied to disease-gene identification as well as to molecular diagnostics setup for several hundred patients. Conclusions. VaRank is implemented in Tcl/Tk, a scripting language which is platform-independent but has been tested only on Unix environment. The source code is available under the GNU GPL, and together with sample data and detailed documentation can be downloaded from http://www.lbgi.fr/VaRank/. PMID:25780760

  18. Myosin Va bound to phagosomes binds to F-actin and delays microtubule-dependent motility.

    PubMed

    Al-Haddad, A; Shonn, M A; Redlich, B; Blocker, A; Burkhardt, J K; Yu, H; Hammer, J A; Weiss, D G; Steffen, W; Griffiths, G; Kuznetsov, S A

    2001-09-01

    We established a light microscopy-based assay that reconstitutes the binding of phagosomes purified from mouse macrophages to preassembled F-actin in vitro. Both endogenous myosin Va from mouse macrophages and exogenous myosin Va from chicken brain stimulated the phagosome-F-actin interaction. Myosin Va association with phagosomes correlated with their ability to bind F-actin in an ATP-regulated manner and antibodies to myosin Va specifically blocked the ATP-sensitive phagosome binding to F-actin. The uptake and retrograde transport of phagosomes from the periphery to the center of cells in bone marrow macrophages was observed in both normal mice and mice homozygous for the dilute-lethal spontaneous mutation (myosin Va null). However, in dilute-lethal macrophages the accumulation of phagosomes in the perinuclear region occurred twofold faster than in normal macrophages. Motion analysis revealed saltatory phagosome movement with temporarily reversed direction in normal macrophages, whereas almost no reversals in direction were observed in dilute-lethal macrophages. These observations demonstrate that myosin Va mediates phagosome binding to F-actin, resulting in a delay in microtubule-dependent retrograde phagosome movement toward the cell center. We propose an "antagonistic/cooperative mechanism" to explain the saltatory phagosome movement toward the cell center in normal macrophages. PMID:11553713

  19. Semi-nonparametric VaR forecasts for hedge funds during the recent crisis

    NASA Astrophysics Data System (ADS)

    Del Brio, Esther B.; Mora-Valencia, Andrés; Perote, Javier

    2014-05-01

    The need to provide accurate value-at-risk (VaR) forecasting measures has triggered an important literature in econophysics. Although these accurate VaR models and methodologies are particularly demanded for hedge fund managers, there exist few articles specifically devoted to implement new techniques in hedge fund returns VaR forecasting. This article advances in these issues by comparing the performance of risk measures based on parametric distributions (the normal, Student’s t and skewed-t), semi-nonparametric (SNP) methodologies based on Gram-Charlier (GC) series and the extreme value theory (EVT) approach. Our results show that normal-, Student’s t- and Skewed t- based methodologies fail to forecast hedge fund VaR, whilst SNP and EVT approaches accurately success on it. We extend these results to the multivariate framework by providing an explicit formula for the GC copula and its density that encompasses the Gaussian copula and accounts for non-linear dependences. We show that the VaR obtained by the meta GC accurately captures portfolio risk and outperforms regulatory VaR estimates obtained through the meta Gaussian and Student’s t distributions.

  20. Myosin-Va Mediates RNA Distribution in Primary Fibroblasts From Multiple Organs

    PubMed Central

    Salerno, Verônica P.; Calliari, Aldo; William Provance, D.; Sotelo-Silveira, José R.; Sotelo, José R.; Mercer, John A.

    2008-01-01

    Myosin-Va has been shown to have multiple functions in a variety of cell types, including a role in RNA transport in neurons. Using primary cultures of cells from organs of young dilute-lethal (Myo5ad-l/Myo5ad-l) null mutant mice and wild-type controls, we show that in some, but not all, tissues, RNA distribution is dramatically different in the homozygous null mutant cells. The dependence of RNA localization on myosin-Va correlates with the relative abundance of the brain-specific splicing pattern of the myosin-Va tail. We also show that myosin-Va is involved in RNA localization soon after synthesis, because the effects of its absence are diminished for RNAs that are more than 30 min old. Finally, we show that localization of β-actin mRNA is significantly changed by the absence of myosin-Va. These results suggest that myosin-Va is involved in a transient transport or tethering function in the perinuclear region. Cell Motil. PMID:18357619