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PubMed1979

Introduction of ambulatory medical training in a Veterans Administration hospital.

Planners of postgraduate medical education in the United States have mandated that training programs include experience in continuing patient care in the ambulatory setting. Idiosyncratic administrative features and limitation of resources present relatively unique problems for the development of such programs in Veterans Administration teaching hospitals. The authors describe the implementation of a continuity of care clinic in a highly subspecialized large VA internal medicine training program. Crucially, all residents attend the clinic on the same day. The internal medicine educational program was altered to prevent conflict of the new clinic with other teaching activities. The program has been well received by the involved house staff members and has achieved some of the intended goals.

Ambulatory Care↗
PubMed2004

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

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.

Hospital Information Systems↗
PubMed1982

Why veterans choose Veterans Administration hospitalization: A multivariate model.

Data from a national survey of veterans are analyzed to determine how age, income, health insurance and service-connected disability influence the veteran's choice of Veterans Administration (VA) hospitalization. Log-linear analysis is used to provide a model that expresses in numerically quantifiable terms (odds and odds ratios) the effects of these factors on the choice of VA hospitalization. Moreover, the multivariate nature of the analysis provides the opportunity for assessing the magnitude of these effect simultaneously in the presence of all other effects. The final model shows that age and health insurance act independently of each other and of all other factors. The effect of income is modified by service-connected disability status and vice versa; this interaction of two factors is probably due to VA hospital care eligibility criteria. Overall, the single most important factor affecting a veteran's choice of hospitalization is health insurance; veterans without health insurance have nearly five times greater odds of going to VA hospitals than do those with health insurance-regardless of age, income or service-connected disability status.

Age Factors↗