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PubMedDate not supplied

[Maternal mortality in Guatemala: differences between hospital and non-hospital deaths].

OBJECTIVE: To estimate the association between obstetric and socio-demographic characteristics and risk factors related to intra- and extra-hospital maternal mortality in Guatemala during the year 2000. MATERIALS AND METHODS: A cross-sectional epidemiologic study was carried out in 649 maternal mortality (MM) cases that occurred in Guatemala during 2000, comparing characteristics of intra- and extra-hospital maternal deaths. Multivariate statistical analysis was conducted using Stata 7.0 software. RESULTS: Out of 649 registered MM cases, 270 (41.6%) were classified as intra-hospital MM and 379 (58.4%) as extra-hospital MM.A larger proportion of deaths occurred in women over 35 years of age (29.28%), those of indigenous ethnicity (65.49%), married or cohabiting (87.83%),who had unpaid employment (94.78%), and without formal education (66.56%). Compared with intra-hospital MM cases,the risk of extra-hospital MM was greater among indigenous women (OR 3.4; CI 95% 2.8-5.3),those who had unpaid employment (OR 8.95; CI 95% 1.7-46.4), a low level of formal education (OR 1.96; CI 95% 1.0-3.8) and hemorrhaging as the immediate cause of death (OR 4.28; CI 95% 2.3-7.9). CONCLUSIONS: Although some characteristics of intra- and extra-hospital MM cases are similar, a greater proportion of deaths were extra-hospital. This could be related to the high percentage of the population that lives in rural or marginalized areas, which in addition to certain cultural aspects (related to the fact that most of the population is indigenous) may impede access to health services. The results of this study can be useful for determining intervention strategies to prevent maternal mortality in intra- and extra-hospital contexts in Guatemala.

Adolescent↗

PubMed1998

Medicare and Medicaid programs; hospital conditions of participation; identification of potential organ, tissue, and eye donors and transplant hospitals' provision of transplant-related data--HCFA. Final rule.

This final rule addresses only provisions relating to organ donation and transplantation. It imposes several requirements a hospital must meet that are designed to increase organ donation. One of these requirements is that a hospital must have an agreement with the Organ Procurement Organization (OPO) designated by the Secretary, under which the hospital will contact the OPO in a timely manner about individuals who die or whose death is imminent in the hospital. The OPO will then determine the individual's medical suitability for donation. As well, the hospital must have an agreement with at least one tissue bank and at least one eye bank to cooperative in the retrieval processing, preservation, storage, and distribution of tissue and eyes, as long as the agreement does not interfere with organ donation. The final rule requires a hospital to ensure, in collaboration with the OPO with which it has an agreement, that the family of every potential donor is informed of its opinion to donate organs or tissues or not to donate. Under the final rule, hospital must work with the OPO and at least one tissue bank and one eye bank in educating staff on donation issues, reviewing death records to improve identification of potential donors, and maintaining potential donors while necessary testing and placement of organs and tissues take place. In addition, transplant hospitals must provide organ-transplant-related data, as requested by the OPTN, the Scientific Registry, and the OPOs. The hospital must also provide, if requested, such data directly to the Department.

Centers for Medicare and Medicaid Services, U.S.↗

PubMed2002

[The emergence of Korean modern hospitals: hospitals in the late period of Chosun Dynasty].

Hospitals are confronting in the transforming or reforming period to cope with the rapid social and environmental changes worldwide. By the researches in the history of Korean health, we could understand the context of the introduction of Western medicine and institutions to Korea. However there have been few studies on the historical review of hospitals in relations to their roles in the modern medicine. This article is to review the issues around the rise of modern hospitals in Korean history of health affairs. The introduction of Western medicine in Korea was on the road with the establishment of Kwanghyewon, the Royal Hospital, which was possible due to favorable conditions under the Korean socio-political background for the emerging and accepting the entirely new medical system. And also the emergence of modern and transformed the Korean traditional health system from the fundamentals through the corruption of the old dynasty to nowadays. Most national health affairs including medical services, prevention of diseases, health promotion, and the training of health personnels have performed along with the development of modern hospitals, which have the roots in the period after the end of 19th century. Thus the Korean history of health care around the end of 19th century and beginning of 20th century could be defined as a period of emergence of modern hospitals. The hospitals also have played core roles in establishing the Korean modern health system and culture. Compared to the cases of Western countries, Korean modern hospitals were emerged with the exogenous factors in the turbulence of political and cultural changes in the world system. In sum, Korean modern hospitals in the period of late Chosun have the great meaning in that they are the beginning point to shape the current Korean health care system and the driving forces or carriers of this new system.

History, 19th Century↗

PubMed1992

Patient satisfaction with hospital services: determinants and level in a hospital in Kuwait.

The present study used a well-tested patient satisfaction measuring instrument to identify the determinants of the level of overall satisfaction with hospital services, and to examine the level of satisfaction with attributes of 7 specific dimensions of hospital services. Using multiple regression analysis, it was found that out of 12 patient characteristics, age was the most important determinant of overall satisfaction, followed by gender. Perceived health status, clinical department, and expectations about the quality of services before admission were also significant but less important determinants of overall satisfaction. Marital status, level of education, nationality, and previous hospitalization in the study hospital, in Kuwait, or in a western country hospital, all had no significant effect on overall satisfaction. Concerning the effect of satisfaction with specific dimensions of hospital services on overall satisfaction, it was found that satisfaction with physicians was the most important determinant of overall satisfaction, followed by satisfaction with housekeeping and with nurses. Satisfaction with hospital environment and facilities and with admission process were also significant but less important determinants of overall satisfaction, while satisfaction with food and radiology services did not affect overall satisfaction. The level of overall satisfaction as well as satisfaction with specific dimensions of hospital services were quite high. Physicians' care was the most favorably rated dimension, followed by admission process and housekeeping, while nursing care was the least favorably rated dimension. Among the attributes of physicians' and nurses' care, technical care and courtesy were the most favorably rated items; while communication, particularly imparting of information, was the least favorably rated aspect. Several attributes of the hospital environment and facilities and of the food services were found to be dissatisfying to patients.

Adult↗

PubMedDate not supplied

[Out-of- pocket expenditures during hospitalization of young leukemia patients with state medical insurance in two Mexican hospitals].

OBJECTIVE: To estimate out-of-pocket expenditures for health care during the first hospitalization of children treated for leukemia in two hospitals of the Mexican Institute of Social Security (Instituto Mexicano del Seguro Social-IMSS-). MATERIAL AND METHODS: A cross-sectional study was conducted in Mexico City and Leon, Guanajato, Mexico in 1997. The study population consisted of the parents of 51 children under 15 years of age diagnosed with leukemia, who were hospitalized for the first time in two IMSS hospitals. A questionnaire was applied to participants to obtain direct and indirect expenditures during that period. Consumer price indexes (1997-2002) were used to estimate expenditure prices for 2002. Average expenditures and catastrophic expenditures were estimated. Factors associated with expenditures were analyzed using a linear regression model in which the dependent variable was the total household expenditures during hospitalization. RESULTS: The average household cost per hospitalization was 7,318 pesos, 86% of which corresponded to medical care and 14% to indirect costs. Catastrophic expenditures occurred in 14% of households. In 47% of household expenditures exceeded 100% of the total household income during the hospitalization period. Expenditures during hospitalization were associated with place of residence, income level, and type of medical insurance. CONCLUSIONS: Being an IMSS policyholder decreased out-of-pocket expenditures, but not complementary expenditures, which may still be unaffordable for a large segment of the population. For more than a half of the households studied, continuity of care was compromised, as expenditures during the first hospitalization entailed using up savings, going into debt, and/or selling household property.

Child↗

PubMedDate not supplied

Accidental out-of-hospital deliveries: factors influencing delay in arrival to maternity hospital.

OBJECTIVE: To find out various factors influencing delay in arrival to Shree Panch Ratna Rajya Laxmi Maternity Hospital leading to accidental - out - of hospital delivery. METHODOLOGY: This was a hospital based cross sectional descriptive study conducted at maternity hospital, Kathmandu. Women who delivered on the way to the maternity hospital during the time period- 060/9/1 to 060/12/ 31 (4 months) were interviewed using a structured questionnaire. RESULTS: The prevalence of such deliveries was 45 out of 5703 deliveries i.e. 0.78%. Majority of women (n= 37) who had accidental - out - of hospital delivery were of parity 1-2 group (82.22%), whereas 2 of them were primigravida (4.44%) and 6 of them were of group parity 3-4 (13.33%). Economic factor was not responsible for delay for majority of women as they could arrange money immediately in emergency situation (88.88%) and majority of women had personal money saved for use in emergency (71.11%). Accessibility to the hospital was difficult for few women (21.00%) only as many women lived within the ring road of Kathmandu valley (48.88%) or outside the ring road but within municipality area of Kathmandu valley (31.11%). Only 60% of women could get transport easily during daytime only. Eight of them were late due to delay in getting transport (17.77%), whereas five patients were late due to disturbed / diverted traffic (11.11%). In three cases, transport was not available due to Nepal Bundh and delay was due to time taken to arrange ambulance (6.66%). Majority of women came for antenatal visits (84.44%) and most of them came to maternity hospital for antenatal visits (73.33%). Lack of birth preparedness and inadequate counselling during antenatal visits probably contributed towards many A-O-H (65.78%). More than half of patients were not satisfied with health staff during ANC (63.15%). Many women did not have any discussion about place of birth during ANC (73.68%) and many of them had no discussion even in the family (36.84%). Seven patients had probably precipitate labour (15.55%). 4 patients were returned back home with diagnosis of false labour pain (8.88%) and later on they delivered on the way to the hospital. SUMMARY AND CONCLUSION: Lack of birth preparedness that involves adequate counselling during ANC about symptoms and signs of onset of labour pain and prior decision about place of birth together with delay in getting transport or delay due to diverted traffic were important factors leading to A-O-H. In addition, unusually short duration of labour or dismissing the diagnosis of true onset of labour may have accounted for few cases of A-O-H.

Adult↗

PubMed1989

Hospital costs, resource characteristics, and the dynamics of death for hospitalized patients in cardiology Diagnosis-Related Groups.

A number of complex health policy questions face the nation regarding the Diagnosis-Related Group (DRG) prospective hospital payment system. An ongoing debate ensues at the federal level of the utility of improving the DRG system, given the "budget neutrality" provision of the DRG law. We analyzed hospital resource consumption for 5809 cardiology inpatients by outcome (i.e., survival vs death). Hospital resource use was greater and financial risk under DRG pricing schemes was substantial for the 312 deaths compared with the 5497 survivors. Only cases in which the patient died within 1 week of admission to the hospital were profitable under DRGs. A long hospital length of stay for patients who eventually died was very unprofitable (those who died after more than a 60-day hospital length of stay generated a $24,688 loss per patient). Patients who died after emergency admission tended to have a similar hospital length of stay and to be similar financial risk under DRGs, compared with nonemergency patients who died. Those patients who had been referred from other clinical services and who died caused greater resource use and financial risk under DRGs, compared with patients who were not referred and who died. These data suggest significant inequities in the current DRG prospective payment system for patients in cardiology DRGs who die. Variables predictive of greater hospital resource use for cardiology patients who die include longer hospital lengths of stay and referral from another clinical service. Health policy leaders should attempt to improve the equity of cardiology DRGs regarding outcome in the future.

Aged↗

PubMed1989

[Trauma and poisoning in children and adolescents in Poland from 1980-1985 in the light of data on hospitalization. III. Hospital mortality of children and adolescents in Poland from trauma and poisoning].

The hospital mortality of children and adolescents hospitalized for traumas and intoxications in Poland in 1980-1985 is discussed. Only 20% of deaths due to these causes occurred in hospitals, the remaining deaths were on the scene of accident or in the home of the patient. The hospital mortality was similar in boys and girls although the frequency of hospitalization for trauma and intoxication was twice as high in boys as in girls. The main causes of death in hospital were cranial trauma, spinal fractures, internal organ injuries, burns and poisoning. With the exception of poisoning these causes produced a higher mortality in hospital of young individuals from rural areas than those from urban centres. Without respect to the place of residence nearly 40% of hospital deaths occurred on the first day in hospital.

Adolescent↗

PubMed1997

Comparison of two surveys of hospitalization: the National Hospital Discharge Survey and the NHANES I Epidemiologic Followup Study.

OBJECTIVES: This report compares hospitalization data from the NHANES I Epidemiologic Followup Study (NHEFS) with data from the National Hospital Discharge Survey (NHDS), the benchmark for hospitalization in the United States, for men and women 35 years and older for the period 1971-87. The comparison is intended to help analysts evaluate the validity and generality of analyses based on the NHEFS. METHODS: Hospital stays per 1,000 population and average lengths of stay are compared year by year for each age-sex group and for the entire period. Regression analyses test for differences between the two surveys by age and sex, and for differences in trends over time and the effect of the Medicare program's prospective hospital payment system. RESULTS: Hospital stays per 1,000 population were lower in NHEFS than in NHDS in all age-sex groups at the beginning of the period, but the differences had almost disappeared by 1987. Lengths of stay, although somewhat longer in NHEFS, matched NHDS more closely. Differentials by age and sex were similar in the two surveys for both hospital stays per 1,000 population and length of hospital stay. With its extensive information on baseline risk factors, the NHEFS offers a unique opportunity to study determinants of hospitalization in a representative sample of U.S. adults. The evaluation presented here suggests two points for researchers who want to use the NHEFS. First, including age as a control should largely correct for differences in age distribution between NHEFS and NHDS. Second, a time trend should also be included to capture the effects of several factors that caused the count of stays to be low in the early years of NHEFS followup.

Adult↗

PubMed1998

Can hospital discharge diagnosis be used for surveillance of bacteremia? A data quality study of a Danish hospital discharge registry.

OBJECTIVE: To assess the data quality of septicemia and sepsis registration in a hospital discharge registry in the County of Northern Jutland, Denmark. DESIGN: Comparison of data from the discharge registry of an 880-bed, public, urban hospital in the County of Northern Jutland with data from a computerized bacteremia database at the regional department of clinical microbiology. SETTING: Urban hospital with approximately 45,000 admissions per year. PATIENTS: The study included 406 episodes of bacteremia in the bacteremia database and 83 discharges with the diagnosis of septicemia registered in the hospital discharge registry between January 1, 1994, and December 31, 1994. INTERVENTIONS: None. RESULTS: Eighteen episodes were registered in both the hospital discharge registry and the bacteremia database. Using the bacteremia database as reference standard, the sensitivity for the diagnosis of septicemia in the hospital discharge registry was 4.4% (18/406; 95% confidence intervals [CI95, 2.4%-6.4%]). By review of hospital records, we estimated the positive predictive value of septicemia registration in the hospital discharge registry as 21.7% (18/83; CI95, 12.8%-30.5%). No blood culture had been obtained in 44.4% (36/81; CI95, 33.6%-55.3%) of the cases with a discharge diagnosis of septicemia. In 33.3% (27/81; CI95, 23.1%-43.6%), the discharge diagnosis of septicemia was given, although blood cultures were negative. CONCLUSIONS: The hospital discharge registry revealed numerous misclassifications, and the system was found not suited for surveillance of, or research in, bacteremia at present.

Bacteremia↗

PubMed2001

Mortality and locomotion 6 months after hospitalization for hip fracture: risk factors and risk-adjusted hospital outcomes.

CONTEXT: Hip fracture is a common clinical problem that leads to considerable mortality and disability. A need exists for a practical means to monitor and improve outcomes, including function, for patients with hip fracture. OBJECTIVES: To identify and compare the importance of significant prefracture predictors of functional status and mortality at 6 months for patients hospitalized with hip fracture and to compare risk-adjusted outcomes for hospitals providing initial care. DESIGN: Prospective study with data obtained from medical records and through structured interviews with patients and proxies. SETTING AND PARTICIPANTS: A total of 571 adults aged 50 years or older with hip fracture who were admitted to 4 New York, NY, metropolitan hospitals between August 1997 and August 1998. MAIN OUTCOME MEASURES: In-hospital and 6-month mortality; locomotion at 6 months; and adverse outcomes at 6 months, defined as death or needing assistance to ambulate, compared by hospital, adjusting for patient risk factors. RESULTS: The in-hospital mortality rate was 1.6%. At 6 months, the mortality rate was 13.5%, and another 12.8% needed total assistance to ambulate. Laboratory values were strong predictors of mortality but were not significantly associated with locomotion. Age and prefracture residence at a nursing home were significant predictors of locomotion (P =.02 for both) but were not significantly associated with mortality. Adjustment for baseline characteristics either substantially augmented or diminished interhospital differences in outcomes. Two hospitals had 1 outcome (functional status or mortality) that was significantly worse than the overall mean while the other outcome was nonsignificantly better than average. CONCLUSIONS: Mortality and functional status ideally should be considered both together and individually to distinguish effects limited to one or the other outcome. Hospital performance for these 2 measures may differ substantially after adjustment, probably because different processes of care are important to each outcome.

Activities of Daily Living↗

PubMedDate not supplied

Hospital autonomy: the experience of Kenyatta National Hospital.

An increasing number of countries are exploring the introduction or expansion of autonomous hospitals as one of the numerous health reforms they are introducing to their health system. Hospital autonomy is one of the forms of decentralization that is focused on a specific institution rather than on a political unit. It has gained much interest because it is an attempt to amalgamate the best elements of the public and private sectors in how a hospital is governed, managed and financed. This paper reviews the key elements of the concept of hospital autonomy, the reasons for its expanded use in many countries and a specific example of making a major teaching hospital autonomous in Kenya. A review of the successful experience of Kenyatta National Hospital and its process of introducing autonomy, with regard to governance, operations and management, and finances, lead to several conclusions on replicability. The legal framework is a critical element for successfully structuring the autonomous hospital. Additionally, success is highly dependent on the extent to which there is adequate funding during the process of attaining autonomy due to the length of the transition period needed. Autonomy must be granted within the context of the national health system and national health objectives and be consistent with those aims and their underlying societal values. Finally, as with decentralization, success is dependent upon the preparation done with the systems and management necessary for the proper governance and operation of autonomous hospitals.

Decision Making, Organizational↗

PubMed1992

Community hospital ethics consultation: evaluation and comparison with a university hospital service.

BACKGROUND: Ethics consultants may improve patient care by responding to physician requests for assistance with problems they identify as ethical issues. OBJECTIVE: To examine three aspects of ethics consultation: the clinical questions asked; the helpfulness of the consultation to requesting physicians; and the differences between consultations performed at a community teaching hospital and those performed at a university hospital. SETTINGS: A community teaching hospital and a university teaching hospital. SUBJECTS: Physicians who formally requested ethics consultations in both hospitals and the patients for whom they requested them. METHODS: Over 2 years (January 1, 1988, to December 31, 1989), we prospectively evaluated a newly established clinical ethics consultation service in a community teaching hospital using confidentially completed, pretested, structured questionnaires, and compared our data with previously reported university hospital data. RESULTS: During the 2-year study, 104 consultation requests were received from 68 physicians in eight departments. Requesters most often requested consultation about deciding to forego life-sustaining treatment (74%), resolving disagreements (46%), and assessing patient competence (30%). Requesters found the consultation "very helpful" or "helpful" in one or more aspects of patient care in 86% of cases, or in one or more aspects of physician education in 86% of cases. These data are similar to university hospital data.

Adolescent↗

PubMed1985

Former state hospital patients in private general hospital psychiatric emergency settings.

Increasing numbers of patients formerly hospitalized in state facilities are using private general hospital psychiatric emergency services. To define their clinical needs, the authors compared the characteristics of patients hospitalized in state institutions to those hospitalized privately and to those never hospitalized. They found that two discrete clinical groups exist: those from state and those from private systems. Clinicians reacted most negatively to former state patients. This was also reflected by differences in the dispositions of voluntary patients from the emergency room. Those not hospitalized or privately hospitalized were more likely than former state hospitalized patients to be sent to private facilities.

Adult↗

PubMed2006

Closure of a home hospital program: impact on hospitalization rates.

Home hospitalization (HH), as a substitute to in-patient care, is an area of growing interest, particularly amongst the elderly. Debate nonetheless exists concerning its economic justification. This study describes a natural experiment that arose following spending cuts and closure of the 400 patient Jerusalem HH program. It examines the hypothesis that HH closure would cause increasing geriatric and general medical hospital utilization amongst the 45,000 beneficiaries of the Jerusalem Clalit Health Fund (HMO) aged 65 years and over. Hospitalization rates were measured prior to and following HH closure, and analysis of variance confirmed the significance of the differences in both geriatric (p<0.0001) and general medical hospitalization rates (p=0.02) over the study period. Linear regression analyses of the hospitalization rates prior to HH closure were performed to determine the expected trajectory of hospitalization rates following HH closure. The observed hospital utilization in the year following HH closure cost 6.2 million US dollars in excess of predicted expenditure; closure of the HH resulted in the saving of 1.3 million USdollars. The ratio of direct increased costs to savings was 5:1 thus confirming the hypothesis that HH closure would result in increased hospital utilization rates among the local elderly population.

Aged↗

PubMed2004

From corporate governance to hospital governance. Authority, transparency and accountability of Belgian non-profit hospitals' board and management.

As a result of multiple developments in health care and health care policy, hospital administrators, policy makers and researchers are increasingly challenged to reflect on the meaning of good hospital governance and how they can implement it in the hospital organisations. The question arises whether and to what extent governance models that have been developed within the corporate world can be valuable for these reflections. Due to the unique societal position of hospitals--which involves a large diversity of stakeholders--the claim for autonomy of various highly professional groups and the lack of clear business objectives, principles of corporate governance cannot be translated into the hospital sector without specific adjustments. However, irrespective of these contextual differences, corporate governance can provide for a comprehensive 'frame of reference', to which the hospital sector will have to give its own interpretation. A multidisciplinary research unit of the university of Leuven has taken the initiative to develop a governance model for Belgian hospitals. As part of the preliminary research work a survey has been performed among 82 hospitals of the Flemish Community on their governance structure, the composition of the governance entities, the partition of competencies and the relationship between management and medical staff.

Belgium↗

PubMed2006

Outcomes of variation in hospital nurse staffing in English hospitals: cross-sectional analysis of survey data and discharge records.

CONTEXT: Despite growing evidence in the US, little evidence has been available to evaluate whether internationally, hospitals in which nurses care for fewer patients have better outcomes in terms of patient survival and nurse retention. OBJECTIVES: To examine the effects of hospital-wide nurse staffing levels (patient-to-nurse ratios) on patient mortality, failure to rescue (mortality risk for patients with complicated stays) and nurse job dissatisfaction, burnout and nurse-rated quality of care. DESIGN AND SETTING: Cross-sectional analysis combining nurse survey data with discharge abstracts. PARTICIPANTS: Nurses (N=3984) and general, orthopaedic, and vascular surgery patients (N=118752) in 30 English acute trusts. RESULTS: Patients and nurses in the quartile of hospitals with the most favourable staffing levels (the lowest patient-to-nurse ratios) had consistently better outcomes than those in hospitals with less favourable staffing. Patients in the hospitals with the highest patient to nurse ratios had 26% higher mortality (95% CI: 12-49%); the nurses in those hospitals were approximately twice as likely to be dissatisfied with their jobs, to show high burnout levels, and to report low or deteriorating quality of care on their wards and hospitals. CONCLUSIONS: Nurse staffing levels in NHS hospitals appear to have the same impact on patient outcomes and factors influencing nurse retention as have been found in the USA.

Adult↗

PubMed1999

Pediatric surgical workload during the past decade: impact on clinical activity and hospital finance at a children's hospital.

PURPOSE: The authors hypothesized that there are significant differences in clinical effort among the faculty of the various departments at an academic Children's Hospital, and that the clinical workload of surgeons has increased over the past decade. METHODS: A retrospective analysis of clinical practice and financial performance of the five departments (anesthesiology/critical care medicine, pathology, pediatrics, radiology, and surgery) at the Children's Hospital of Philadelphia from 1987 to 1997 was performed including clinical activity parameters (admissions, discharges, clinic visits), departmental faculty rosters, number of operations for the department of surgery as a whole and for individual surgeons in each pediatric surgical specialty, and professional and hospital financial data. RESULTS: Pediatric surgical specialists represented 15% of the total full-time physicians throughout the decade. In 1997, surgeons were responsible for 29% of hospital admissions, 28% of total outpatient visits at all clinical care sites, 37% of total professional fee revenue, 39% of hospital-based revenue, and a substantial portion of the hospital margin. Compared with 1987, the department of surgery in 1997 had a 60% increase in outpatient visits and a 58% increase in total operative case load (10,265 to 16,266). In terms of individual surgeon's workload during the decade, the outpatient visits per surgeon increased 45% and the operations per surgeon increased 27%, yet total reimbursement per surgeon slipped 16%. CONCLUSIONS: For the Children's Hospital that was studied, pediatric surgical specialists are doing more clinical work compared with 10 years ago, which may impact teaching, research, and administrative responsibilities. Surgeons have a greater responsibility than nonsurgeons for the hospital's clinical activity and financial health.

Academic Medical Centers↗