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Biomedical subjects

R Mullner

Publications and source records attributed to R Mullner.

At least 19 recordsLinked to original sources
PubMed1990

The new old market: trends in hospital services for the aged.

Hospital health care services for the rapidly aging population should continue to expand. Several recent trends include the following: The overall number and proportion of admissions for the aged have increased since 1967 and will probably continue to increase in the future; The overall percentage of older patients in smaller hospitals has dropped steadily since 1967, but smaller hospitals continue to have a higher percentage of older admissions than do larger hospitals; The aged have a different seasonal pattern of admission compared to younger persons, reaching a nadir in August and an apex between January and April. The average inpatient length of stay for the aged has been dropping steadily over the last twenty years, long before the recent cost containment emphasis; Community hospitals are expanding their operations into long-term care services, including skilled nursing home care, intermediate care, and psychiatric long-term care; Emphasis on early patient discharge has led many hospitals to concentrate on continuity of care between institutions and the community, including increased emphasis on discharge planning and the coordination of services; and Hospitals plan to continue to expand care for the aging and aged population. As the population of the nation ages, hospitals will increasingly address the needs of older persons and continue to plan actively and aggressively and market their services to the aged, not only for humanitarian reasons but also for survival in an increasingly competitive environment. In the future, hospitals seem likely to continue to acquire new and more costly technology to enhance their acute care delivery. At the same time, however, they will continue to provide an increasing array of health care services to older persons. They will convert acute care beds to long-term care use, construct and or purchase nursing homes, and expand into other areas of care for the aged. Thus, the authors predict that hospitals will indeed evolve beyond acute care and play a central function in the provision of the nation's long-term care system.

Aged↗
PubMed1989

Cigarette smoking and attitudes toward quitting among black patients.

A sample of 1,388 black patients attending the medical clinic of a general public hospital were interviewed regarding smoking habits and attitudes toward quitting. Current smokers constituted 30% of respondents of both sexes, and approximately half of the sample were ex-smokers. Rates of current smoking were lower, and cessation rates higher, among older individuals and men. Two thirds of current smokers expressed a desire to quit, and of those an equal proportion wanted to participate in a formal cessation program. A majority of smokers reported attempting to quit on their own, and most had made more than one attempt. Given the large burden from cigarette-related disease in the black population, and the current absence of effective primary prevention efforts, smoking intervention in the clinical setting will remain an important obligation of health providers caring for black patients. This article demonstrates moderately high smoking prevalence rates of black individuals already under care for chronic illness, and a concomitant high level of desire to quit. The absence of effective programs appears to be the obstacle preventing significant progress in this important area of health promotion.

Adult↗
PubMed1986

Hospital characteristics and the use of computer processing and abstract services. A logistic analysis.

The use of computer processing and abstract services by hospitals is in a state of continuing change. Although many hospitals subscribe to abstract or turnkey systems, others are leaving shared services to set up their own in-house systems. To better understand the relationship between hospital characteristics and the use of computer processing and/or abstract services, data from the AHA 1982 Special Survey on Selected Hospital topic were analyzed using logistic regression analysis. Hospital size, ownership, and region were clearly related to the use of computer processing and/or abstract services for processing discharge data. Teaching status was also related to the use of abstract services, although teaching status hospitals also reported more reliance on in-house computer processing. Hospitals located in SMSAs and belonging to chains reported a higher use of discharge abstract services, and hospitals with higher operating margins were more likely to use abstract services on an "off-line" or batch-processing basis. The significance of these findings and their implications for abstract services are discussed.

Abstracting and Indexing↗
PubMed1984

Poor people and poor hospitals: implications for public policy.

In 1980, while most hospitals were in reasonably good financial health, hospitals heavily involved in serving the poor ran a considerable risk of financial trouble. Fewer than 9 percent of the nation's hospitals accounted for 40 percent of the nation's total care to the poor. These hospitals, almost half of which were in the 100 largest cities, not only devoted more of their care to the poor than other hospitals, they also served substantially smaller proportions of privately-insured patients. The result was that one-third of these hospitals--by themselves accounting for over 15 percent of all care to the poor--ran deficits in 1980. Using data from a 1980 survey of nonfederal, nonprofit hospitals, this paper examines the fiscal situation of hospitals heavily involved in serving the poor. The analysis shows that it is insufficient revenues, not inefficiency or underuse, that creates these hospitals' financial problems. The article concludes with an assessment of several policies that could be adopted to alleviate this financial pressure and sustain care to the poor.

Costs and Cost Analysis↗
PubMed1984

Toward a better understanding of hospital occupancy rates.

This article starts out with the premise that a "uniform occupancy rate" for hospitals is not a meaningful concept because the ability of individual hospitals to maintain a certain occupancy rate consistent with a specified "protection level" depends upon several factors. These factors include hospital size, the number of nonsubstitutable patient facilities, the percent of nonurgent (elective) beds, the number of hospitals serving an area, and the relative variation (fluctuation) in the demand for services faced by the hospital. A regression analysis with observed, overall occupancy rate as the dependent variable, and measures that attempt to represent the factors just mentioned as independent variables, tends to substantiate this line of reasoning. However, inasmuch as the status of the independent variables (that is, whether or not they can be regarded as justifiable or uncontrollable) depends largely on the circumstances of each case, the regression model cannot be used as a standard-setting tool. Nonetheless, it offers valuable guidelines for hospital management, planners, and regulators in such areas of decisionmaking as the location and size of hospitals, and acceptable occupancy standards.

Bed Occupancy↗
PubMed1984

Interstate variations in the growth of chain-owned proprietary hospitals, 1973-1982.

Proprietary hospital chains are now the predominant, and the fastest growing, segment of the for-profit sector of the hospital industry. This paper examines the relationships between the growth patterns of proprietary hospital chains and state-level variations in a number of demographic and economic factors related to health care. Results indicate that increases in the market share of proprietary chains are greatest in states that have the greatest increases in population, per capita income, and insurance coverage and that already have large proprietary market shares of beds. The growth behavior of proprietary chains thus appears to be highly consistent with standard market behavior.

Data Collection↗
PubMed1984

Falling through the cracks: poverty, insurance coverage, and hospital care for the poor, 1980 and 1982.

About one-third of the nation's poor lack insurance--public or private--against the costs of illness. Data from 1980 and 1982 show that a patchwork of state and local government charitable grants, and the disparate efforts of hospitals to provide free care, cannot mend the national "safety net." A prudent short-run approach to modifying charity care is advanced, although the long-run necessity for insuring the uninsured is inevitable.

Charities↗
PubMed1983

National health care surveys and health care management. Examples from the National Center for Health Statistics.

The bulk of medical care in the United States is provided in hospitals, physicians' offices, and nursing homes. The National Center for Health Statistics conducts three health record surveys that collect information on patient and provider characteristics and the services provided in these three settings. This paper describes each of these three surveys in terms of background (scope and data set), design, collection, processing procedures, and data dissemination. In addition, specific examples of how the survey data have been or can be used for management purposes in terms of monitoring, evaluating, and planning the utilization of health care in the United States are given.

Ambulatory Care↗
PubMed1983

Community hospital characteristics associated with RN and LPN vacancy rates.

Vacancy rates for RNs and for LPNs reported in a universe survey of U.S. community hospitals were examined for relationships to a number of characteristics of the institutional makeup, environment and setting, staff organization and composition of these hospitals. RN vacancy rates were found to have a statistically significant positive relationship to the number of beds in the hospitals, the number of hospital beds in the states in which the hospitals were located, and government control. Significant negative relationships were found with the number of RN graduates from nursing programs in the state, occupancy rate, and the ratio of RNs to total inpatient days. LPN vacancy rates showed a significant positive relationship to government control, southern locations, restriction of admissions to children and the ratio of RNs to LPNs. LPN vacancy rates showed a significant negative relationship to the number of hospital beds, occupancy rate, the ratio of LPNs to total inpatient days and the ratio of other nursing service personnel to LPNs.

Bed Occupancy↗
PubMed1983

Toward an inventory of U.S. health care data bases.

Because researchers have lacked convenient and comprehensive sources of information about data available to them from the health care data bases maintained by others in their field, many health care data collection activities are unnecessarily duplicative and many data bases have not been fully exploited. This paper presents the preliminary results of work by the Hospital Data Center of the American Hospital Association on an inventory of current (1976 to the present), nonbibliographic, computer-readable data bases containing national health care information that have been collected by organizations and agencies throughout the United States and that are, or can be, made available to outside researchers. The 30 public and private sector organizations identified as having such data bases are listed, together with the titles and main subject areas of their 112 data bases.

American Hospital Association↗
PubMed1983

Hospital closure in the United States, 1976-1980: a descriptive overview.

This paper is an overview of hospital closure in the United States for the five-year period 1976-1980. We describe the distributional patterns of closings among noncommunity and community hospitals classified according to institutional characteristics such as bed size, control, and location. We also examine the ten percent of community hospitals operating at the beginning of the period which were shown to have combined institutional characteristics strongly associated with closure via a method of regression analysis.

Health Facilities↗