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PubMed2000

[Influence of a day care hospital on the incidence of hospital admission of AIDS patients].

BACKGROUND: Day care units have become an usual way of medical care for AIDS patients. However, their influence on the incidence of hospital admissions has not been evaluated. METHODS: Observational and longitudinal study of a cohort of 308 patients with aids diagnosed between 1990 and 1994 and followed-up to June 1996. The incidence of hospital admissions according to the hospital of follow-up (with or without day care unit) was analyzed. A multivariate analysis of the number of hospital admissions was performed using regression model adjusted to a distribution of Poisson. RESULTS: After AIDS diagnosis, the incidence of hospital admissions was 108 per 100 patient-years of follow up (21 days as inpatient per patient-year). Those patients controlled in the hospital with day care unit have less hospital admissions (relative risk after adjusting by CD4+ cells count and type of diagnostic disease: 0.64; CI95% 0.55-0.76), and less days as inpatient through their follow-up (11 to 31 days less). There was no difference in survival among patients followed in both hospitals. CONCLUSIONS: A day care unit decrease the incidence of hospital admissions in aids patients. This positive impact is more evident in patients with lesser CD4+ cell counts.

Acquired Immunodeficiency Syndrome↗

PubMed1995

In-hospital mortality after out-of-hospital cardiac arrest.

In-hospital management of out-of-hospital cardiac arrest is complicated by uncertainty about prognosis and the need to identify markers of adverse outcome in individuals surviving initial resuscitation. We sought to identify factors that predict in-hospital death among patients who initially survive out-of-hospital cardiac arrest. We investigated 346 consecutive cases of out-of-hospital cardiac arrest received by a single centre in Edinburgh, UK (270 cases examined retrospectively, 76 prospectively). Of the retrospective cohort, 246 cases were thought to be of cardiac origin. There were associations between in-hospital mortality and pre-arrest variables, resuscitation variables, and factors measured during admission. Crew-witnessed arrests were associated with low mortality; arrest rhythm (p < 0.001), resuscitation by a health professional (p < 0.05), conscious level on admission (p < 0.001), and requirement for ventilation (p < 0.05) independently predicted in-hospital mortality. A weighted prognostic scoring system based on three of these variables accurately predicted the likelihood of in-hospital death in the prospective test group. Further assessment of conscious level during admission with the Glasgow coma score predicted mortality rates in the study population, but coma did not predict a hopeless prognosis in individual cases unless it persisted for 72 h or more. Accurate prognostic assessment of out-of-hospital cardiac arrest survivors can be made from information available on admission. Of factors that independently predicted outcome, the skill of the resuscitator is most readily modified. This suggests that public training in resuscitation may reduce mortality rates.

Adult↗

PubMed1991

[A survey on recovery rooms of French university hospitals and Ile de France hospitals].

This study reports the results of a survey of post-anaesthesia recovery rooms (PARR) in French public University Hospitals (UH), and in those of the "Ile de France" (IdFH) area. The study, carried out between the 2nd and 8th of April 1990, aimed to identify the place where patients recovered from anaesthesia, and the personnel and monitoring equipment available in these places. 90% of 55 departments of anaesthesia and intensive care in University Hospitals and 94% of 34 departments in "Ile de France" Hospitals responded. A total number of 20,567 patients was collected, with 10,027 from University Hospitals. Of the latter, 31.4% recovered in the operating room or in the anaesthetic room itself; 7.5% were directly transferred to an intensive care unit (ICU), and 61.1% (10,397) were admitted to a PARR. However, 2,460 of those admitted to such a PARR were in fact admitted to a PARR without any permanent nursing staff. Overall, 45.8% of the patients were not admitted to a PARR where adequate care by nurses was available. Of the 3,540 patients anaesthetized in "Ile de France" Hospitals, 3.1% were transferred to an ICU, 25% were not admitted to a PARR, and the remaining 71.7% were. However, 35% of those admitted to a PARR were admitted to a PARR without any permanent nursing staff. Therefore 50.1% of patients anaesthetized in the "Ile de France" Hospitals did not benefit from adequate post-anaesthetic supervision. In 82% of the patients anaesthetized in University Hospitals, the lowest rates of admission to a PARR were found in patients undergoing gastrointestinal endoscopy (GIE), and ENT, ophthalmological or stomatological surgical procedures. After anaesthesia for GIE, 69% of patients recovered at the anaesthetic post and 12% were admitted to a PARR without any permanent nursing staff. In ENT-Ophthalmology-Stomatology, Gynaecology and Obstetrics, and Radiology departments, 56%, 69% and 69% of patients, respectively, recovered in the anaesthetic room or in a PARR without any permanent staff, or, for the Radiology and Obstetrics departments, sent straight back to their room. Similar results were obtained with the patients in the "Ile de France" Hospitals. Nurses were not always present in 37% and 24% of PARR in University and "Ile de France" Hospitals respectively. In the PARR, there were three ECG monitors for 4 beds, and one pulse oximeter for seven beds. It seems therefore that, despite several ministerial recommendations, not all anaesthetized patients are admitted to a recovery room after their anaesthetic.

Academic Medical Centers↗

PubMed1998

Hospital profitability for a surgeon's common procedures predicts the surgeon's overall profitability for the hospital.

STUDY OBJECTIVE: To evaluate whether a hospital's profitability for a surgeon's common procedures predicts the surgeon's overall profitability for the hospital. DESIGN: Observational study. SETTING: Community and university-affiliated tertiary hospital with 21,903 surgical procedures performed per year. PATIENTS: 7,520 patients having surgery performed by one of 46 surgeons. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Financial data were obtained for all patients cared for by all the surgeons who performed at least ten cases of one of the hospital's six most common procedures. A surgeon's overall profitability for the hospital was measured using his or her contribution margin ratio (i.e., total revenue for all of the surgeon's patients divided by total variable cost for the patients). Contribution margin was calculated twice: once with all of a surgeon's patients, and second, limiting consideration to those patients who underwent one of the six common procedures. The common procedures accounted for 22 +/- 15% of the 46 surgeons' overall caseload, 29 +/- 10% of their patients' hospital costs, and 30 +/- 12% of the hospital revenue generated by the surgeons. Hospital contribution margin ratios ranged from 1.4 to 4.2. Contribution margin ratios for common procedures and contribution margin ratios for all patients were correlated (tau = 0.58, n = 46, p < 0.0001). CONCLUSIONS: Even though most surgical cases were for uncommon procedures, a surgeon's hospital profitability on common procedures predicted the surgeon's overall financial performance. Perioperative incentive programs based on common surgical procedures (clinical pathways) are likely to accurately reflect a surgeon's financial performance on their other surgeries.

Benchmarking↗

PubMed1999

Adherence to the ten steps of the Baby-Friendly Hospital Initiative in Minnesota hospitals.

BACKGROUND: A worldwide campaign has been initiated to improve the in-hospital care of mothers and babies through increased breastfeeding. The four objectives of the current investigation were to determine the in-hospital breastfeeding rate for Minnesota hospitals, to analyze the relationship between the in-hospital breastfeeding rates and selected hospital demographic characteristics, to determine the rate of adherence to each of the Baby-Friendly Hospital Initiative (BFHI) Ten Steps, and to analyze the relationship between the adherence rates for each of the Ten Steps and selected demographic characteristics. METHODS: A descriptive survey was conducted and analyzed for the year of 1994 from 79 (83%) Minnesota hospitals. Respondents were directors of nursing, nursing managers, or other staff familiar with their hospital's breastfeeding policies and practices. RESULTS: The average breastfeeding initiation rate was 59 percent. Four of the Ten Steps were implemented with a low adherence rate (0-49%), five were implemented with a moderate rate (50-89%), and none was implemented with a high rate (90-100%). Breastfeeding initiation rates and adherence to the Ten Steps varied with the size of the city and the number of births per year. CONCLUSIONS: Improvements in breastfeeding policies, practices, and staff education are needed if Minnesota hospitals are to provide care consistent with the Ten Steps of the BFHI. The results provide baseline information to guide institutional change that could promote successful breastfeeding experiences for postpartum families. This survey instrument could be used easily by researchers in other sites to assess nine of the Ten Steps.

Breast Feeding↗

PubMed2002

Asthma hospitalizations continue to decrease in schoolchildren but hospitalization rates for wheezing illnesses remain high in young children.

AIM: To analyse changes in hospitalization rates for asthma in children during recent years. METHODS: In a population-based analysis, changes in asthma hospitalization rates were studied in children in Göteborg (Gothenburg), the second largest city in Sweden, during 1985-2000. The changes in different age groups have been correlated with the delivery of inhaled corticosteroids to the age groups. RESULTS: In the 5 to 18-y age group, there was a continuous, significant decrease in number of hospital days, admissions and individual patients admitted for asthma not only for the entire study period, 1985-2000, but also during the past 10-y period. The number of hospital days in the year 2000 was only 6% of the figure for 1985. An inverse correlation between delivery of inhaled corticosteroids and hospitalization for asthma was seen not only during 1985-1995, when use of inhaled corticosteroids became widespread (r(s) = -0.95, p = 0.007 for hospital days), but also when the entire period from 1985 to 2000 was analysed. Conversely, in the 0 to 1-y and 2 to 4-y age groups, there was no decrease in hospitalizations for wheezing illnesses or asthma-like symptoms during the past 10-y period, 1991-2000. CONCLUSION: During the period 1985-2000 the number of hospital days owing to asthma decreased by more than 90% in the 5 to 18-y age group. The marked decrease in asthma hospitalization rates among schoolchildren represents a great advance in paediatric respiratory medicine, which has been continuous during the past 10-y period. However, in young children admissions for wheezing have apparently not decreased.

Adolescent↗

PubMed1997

Cross-sectional survey of hospital paediatric HIV/AIDS care in Catalonia, 1992. Hospital Contributors.

A cross-sectional survey to assess the impact of the paediatric HIV/AIDS epidemic on the hospital-based health care system was performed in state-financed hospitals in Catalonia during 1992, raising issues of relevance today. Out of the 27 hospitals contacted, 20 responded. A considerable proportion of the health care to children with an HIV-related condition was provided by four hospitals. The average length of stay of the 176 HIV patients who were admitted was 10.8 days; these patients were admitted to the hospital twice a year on average. Nearly half of the out-patients who attended with an HIV-related condition were either seropositive without a confirmed diagnosis of an HIV infection (class P-0) or seronegative. Thirteen per cent of the overall admissions to paediatric day care hospitals were attributable to an HIV-related condition. By ownership status of the hospitals, HIV/AIDS paediatric in-patients of public hospitals generated the majority of admissions per patient per year, and had the shortest lengths of stay. Unlike the HIV/AIDS epidemic in adults, the magnitude and characteristics of the epidemic in children may not require the shift of hospital-based health care to primary health care.

Ambulatory Care↗

PubMed2002

Using seasonal variations in asthma hospitalizations in children to predict hospitalization frequency.

Asthma hospitalization rates have increased in the United States since 1980. The exposure risk of many environmental factors, which contribute to respiratory disease, vary throughout the year. The objective of this study was to investigate the seasonal variation of pediatric asthma hospitalizations and predict hospitalization frequency. This was a longitudinal analysis of all pediatric asthma hospitalizations in the state of Maryland by age, gender, race, and residence using non-confidential discharge data sets from 1986 to 1999. Of the 631,422 pediatric hospitalizations in the state of Maryland during the years 1986-1999, 45,924 (7%) had a primary admission diagnosis of asthma. Frequency of hospitalization for asthma was lowest in the summer in all age groups, and highest in the fall. Seasonal variation in severe asthma episodes was least striking in children aged 15-18. This was in contrast to non-asthma admissions, which were highest in winter in preschool children, but relatively flat in school- and teenaged children. Using neural network modeling, weekly asthma hospitalizations could be predicted with an R2 between 0.71 and 0.8. Temporal trends in asthma hospitalizations were seen in each age group, gender, race, and location. The seasonal variability in asthma hospitalizations suggests that acute asthma is influenced by variables beyond socioeconomic factors and adherence to medical regimens. Strategies to combat exacerbations of asthma should take into consideration seasonal effects on a population. In addition, temporal trends examined over many years can be used to predict frequency of severe asthma episodes in a population.

Adolescent↗

PubMed1999

Outcomes of patients hospitalized after out-of-hospital cardiac arrest in relation to sex.

OBJECTIVE: To describe characteristics and outcomes of patients hospitalized after out-of-hospital cardiac arrest in relation to sex. PATIENTS: All patients in the community of Göteborg who between 1980 and 1996 suffered out-of-hospital cardiac arrest and were hospitalized alive. METHODS: We calculated age-adjusted P values. RESULTS: In all 1038 patients were hospitalized alive of whom 29% were women. Women differed from men by being older and there being lower prevalences of previous acute myocardial infarction (AMI) and smoking and a higher prevalence of bronchial asthma among them. They had less commonly received cardio-pulmonary resuscitation (CPR) from bystanders (16 versus 25% of cases; P = 0.002) and were less commonly found to be in ventricular fibrillation when the ambulance crew arrived (55 versus 73% of cases; P < 0.0001). They were less commonly judged to have a cardiac etiology behind the arrest (87 versus 92% of cases; P = 0.016). Of women 31.3% could be discharged alive from hospital, compared with 41.8% of men (P = 0.001). While they were in hospital, women were less commonly subjected to exercise tests, coronary angiography, and coronary artery bypass grafting. CONCLUSION: Among patients who suffered out-of-hospital cardiac arrest and were hospitalized alive, women had less commonly received CPR from bystanders, were less commonly found in ventricular fibrillation, less commonly underwent coronary angiography and coronary artery bypass grafting and had a lower survival rate than did men.

Adolescent↗

PubMed2003

Effect of hospital volume and experience on in-hospital mortality for pancreaticoduodenectomy.

OBJECTIVE: To examine the relative impact of procedure volume versus years of hospital experience on inpatient death rates after pancreaticoduodenectomy. SUMMARY BACKGROUND DATA: Past studies have identified a significant volume-outcome relation for hospitals performing pancreaticoduodenectomy (the Whipple procedure). METHODS: Administrative discharge data were examined for 6,652 patients who underwent the procedure between 1988 and 1998 in California and Florida. Patients were divided into approximate quartiles according to each hospital's annual procedure volume: very low (1), low (2 or 3), medium (4-9), and high (10+). Logistic regression analysis was used to examine differences in inpatient mortality among hospitals with different procedure volume and years of experience, while adjusting for patient characteristics. RESULTS: Medium- and high-volume hospitals had lower rates of inpatient mortality after pancreaticoduodenectomy relative to very-low-volume facilities. Greater years of hospital experience also reduced the odds of inpatient death. Predictions based on the regression estimates indicate that within volume categories, increased hospital experience did not lead to significant reductions in inpatient mortality. However, high-volume hospitals had significantly lower inpatient mortality rates than very-low-volume facilities with the same amount of experience. CONCLUSIONS: Hospitals with more years of experience with pancreaticoduodenectomy had lower rates of inpatient mortality. However, higher procedure volume has played a larger role than increased experience in reducing inpatient death rates.

Aged↗

PubMed2005

Measuring hospital care from the patients' perspective: an overview of the CAHPS Hospital Survey development process.

OBJECTIVE: To describe the developmental process for the CAHPS Hospital Survey. STUDY DESIGN: A pilot was conducted in three states with 19,720 hospital discharges. METHODS OF ANALYSIS: A rigorous, multi-step process was used to develop the CAHPS Hospital Survey. It included a public call for measures, multiple Federal Register notices soliciting public input, a review of the relevant literature, meetings with hospitals, consumers and survey vendors, cognitive interviews with consumer, a large-scale pilot test in three states and consumer testing and numerous small-scale field tests. FINDINGS: The current version of the CAHPS Hospital Survey has survey items in seven domains, two overall ratings of the hospital and five items used for adjusting for the mix of patients across hospitals and for analytical purposes. CONCLUSIONS: The CAHPS Hospital Survey is a core set of questions that can be administered as a stand-alone questionnaire or combined with a broader set of hospital specific items.

Health Care Surveys↗

PubMed1991

Relationship of hospitalized stroke rate and in-hospital mortality to the decline in US stroke mortality.

Data from the National Hospital Discharge Survey was used to estimate the admission rate and in-hospital mortality for US stroke patients from 1970 to 1987. Over this period the hospital admission rate increased from 5.0 per 1,000 population to 5.5 per 1,000, while the in-hospital mortality fell from 18.6 to 10.0% of discharges. When patients experiencing general or late effects or transient ischemic attacks were excluded, the hospital admission rate increased from 2.8 to 4.8 per 1,000 and in-hospital mortality fell from 26 to 12% of discharges. Admission rates increased from 1970 to 1987 for both hemorrhagic strokes and cerebral infarctions, but fell for ill-defined cerebrovascular events, presumably reflecting increased use of computed tomography and magnetic resonance imaging during this period. Mortality for hemorrhagic strokes decreased from 45 to 30% of discharges, mortality for infarctions decreased from 24 to 13% and mortality for ill-defined events fell from 24 to 17%. There are several limitations with the use of the National Hospital Discharge Survey data to estimate changes in hospital admission rates and in-hospital mortality. However, these data suggest a greater role for decreasing case fatality in explaining nationwide declines in stroke mortality rates than has generally been acknowledged.

Acute Disease↗

PubMed1977

Characteristics of hospitalizations and death cases of diabetic patients in a general hospital.

Hospital admissions of diabetic patients were analyzed in relation to total hospital admissions, during a period of 7 years in a general hospital. The prevalence of hospitalization of diabetic patients was 2.5%. The female to male ratio was 1.4:1.0. Admissions of diabetic patients to hospital are mainly in the older age groups. By the age of 40 years, 73.4% of the total hospitalizations occur but only 13.0% of these hospital admissions are diabetics. The age at time of death of admissions ending fatally is similar in both the total and the diabetic admission groups to hospital. When the percentages of hospital admissions which terminated in death are calculated for age groups, an increase is specifically demonstrated in the diabetic group compared to the total admission group. Thus, diabetes is a complicating factor which increases mortality in people over 50 years of age.

Adolescent↗

PubMed1997

Hospitalization and case-fatality rates for subarachnoid hemorrhage in Canada from 1982 through 1991. The Canadian Collaborative Study Group of Stroke Hospitalizations.

BACKGROUND AND PURPOSE: Subarachnoid hemorrhage (SAH) has a different epidemiological profile from other types of stroke and a different etiology. Although there has been a general decline in overall stroke incidence since the 1950s, secular trends for SAH have been modest. In contrast to other stroke types, changes in incidence over the last few decades have been less clear. The purpose of this study was to estimate hospitalization and case-fatality rates of SAH according to age, sex, calendar year, and season. METHODS: Data were obtained for each of Canada's 10 provinces for the 10 fiscal years 1982 through 1991. All hospitalizations of persons 15 years of age or older with a primary diagnosis at discharge coded 430 according to the International Classification of Diseases, 9th Revision, were included. Rates of SAH per 100,000 population were calculated for men and women for 5-year age groups, by calendar year, and by season. Annual age- and sex-specific (hospital) case-fatality rates up to 30 days were also calculated. Additionally, hospital deaths from this study were related to national SAH mortality statistics. RESULTS: A total of 14145 women and 8995 men were discharged with a primary diagnosis of SAH during the 10-year period. In contrast to other types of stroke, the rates of SAH were higher for women than for men at all ages. The age-standardized rates of SAH in 1991-1992 were 11.2 per 100000 women and 8.0 per 100000 men. For women, there was a 6% (95% confidence interval [CI], -12% to 0%) decline in hospitalization rates over that period; for men, the decline was 15% (95% CI, -21% to -8%). The peak season for SAH among women was winter; for men the peaks were in the fall and spring. For both sexes, the lowest occurrence was in the summer. Over this period, 30-day case-fatality rates declined somewhat (statistically significant only in the age group of 35 to 44 years). The number of deaths enumerated from hospital discharges was 20% to 50% lower than the number recorded on national mortality statistics, indicating that a proportion of SAH deaths occurred before (or after) the hospital stay. CONCLUSIONS: Although rates of hospitalization for SAH declined over this period, SAH remains an important neurological event affecting individuals at relatively young ages. The rates were higher for women than for men at all ages. Total (in-hospital) case-fatality rate remains high.

Adolescent↗

PubMed1996

Patterns of hospital care and physician perspectives from an Italian, Japanese, and USA hospital.

Many studies have compared different countries' health care systems at the macro level. Less has been done to analyze care provided for patients with specific diseases and to compare physician attitudes concerning factors that influence patient care. This study compares severity of illness and length of hospital stay for patients admitted for diabetes mellitus, cholecystitis, or appendicitis at three teaching hospitals in Italy, Japan, and the United States. Physicians caring for patients with these diseases were surveyed to assess their opinions of the adequacy of resources available at their hospital, perceived administrative pressures concerning resource use, and interactions with patients and their families that relate to admission and discharge decisions. The severity of the patient mix was consistently higher in the U.S. hospital than in the Italian or Japanese hospitals. Controlling for diagnosis, severity of illness, surgery, age, and presence of co-morbid conditions, the U.S. hospital consistently had the shortest stays and the Japanese hospital the longest. Japanese physicians were more likely than U.S. or Italian physicians to report insufficient resources, such as nurses, to provide quality care, but less likely to report administrative pressures interfering with patient care. Differences in hospital utilization may reflect variation in clinical practices, availability of resources, barriers to access to care, organizational differences at the national and hospital level, and patient and family preferences.

Adult↗

PubMed1992

Regulatory intensity, hospital size and the formalization of medical staff organization in hospitals.

Using a theory of organizational response to regulation, this study examined the effects of regulatory intensity and hospital size on the formalization of medical staff organization in Canadian hospitals. The general hypothesis was that, in provinces with greater regulatory intensity, hospitals would exhibit greater formalization of medical staff, and greater involvement of physicians in hospital governance and management; larger hospitals would have greater formalization of medical staff than smaller hospitals. Data from 574 hospitals indicated that both hospital size and provincial regulatory intensity were important factors predictive of the overall formalization of medical staff organization. Depending upon the provincial location, hospitals have developed different patterns of formalizing their medical staff structures.

Canada↗

PubMed2006

Hospital competition, managed care, and mortality after hospitalization for medical conditions: evidence from three states.

This study assessed the effect of hospital competition and HMO penetration on mortality after hospitalization for six medical conditions in California, New York, and Wisconsin. We used linked hospital-discharge and vital-statistics data to study adults hospitalized for myocardial infarction, hip fracture, stroke, gastrointestinal hemorrhage, congestive heart failure, or diabetes. We estimated logistic regression models with death within 30 days of admission as the dependent variable and hospital competition, HMO penetration, and hospital and patient characteristics as explanatory variables. Higher hospital competition was associated with lower mortality in California and New York but not Wisconsin. Higher HMO penetration was associated with lower mortality in California but higher mortality in New York. These findings suggest that hospitals in highly competitive markets compete on quality even in the absence of mature managed-care markets. The findings also underscore the need to consider geographic effects in studies of market structure and hospital quality.

Economic Competition↗

PubMed1997

[Evaluation by users of hospitals which participate in the hospital quality program of the State of São Paulo, Brazil].

INTRODUCTION: The Hospital Quality Program (HQP) in S. Paulo State, Southeastern Brazil, has been conducted by Medical Association of the S. Paulo State--"Associação Paulista de Medicina (APM)", since 1991. General and specialised, public and private hospitals have taken part in the HQP/APM. Such hospitals are evaluated by their users by means of the HQP-06 ("users' evaluation") questionnaire, with closed and open-ended questions for observations and suggestions. The results of the HQP-06 questionnaire of the HQP/APM are evaluated. MATERIAL AND METHODOLOGY: The 23,751 questionnaires (i.e., from 5.27% of all discharged patients), received by 66 hospitals during 1994, were analysed. The questionnaire flow, the quantity and quality of answers, the data from the closed of and open-ended answers and the comparison of closed and open-ended answers, were all taken into consideration in the analysed. RESULTS AND CONCLUSIONS: The following aspects were observed:-the importance of the direct flow of questionnaires from users to HQP/APM:-the need for HQP-06 to contain general items that permit a comparison between the hospitals concerned; the importance of the hospital staff being motivated to offer explanations when giving the questionnaires to users and the latters' being motivated to answer them with a view to the greater quantity and better quality of the answers:-in the hospitals of the HQP the user's evaluation presents a median of 4.32% (25%ile = 1.83% and 75%ile = 7.92%), and the number of questionnaires containing observations about the service as compared with the total presents a median of 42.11% (25%ile = 27.28% and 75%ile = 57.82%). Finally, hospital managements are recommended to take their users opinions into consideration with a view to obtaining feed-back and the continuous quality improvement of the hospitals of the HQP/APM.

Brazil↗