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PubMed2004

Appropriate antibiotic utilization in seniors prior to hospitalization for community-acquired pneumonia is associated with decreased in-hospital mortality.

BACKGROUND: We analysed the association of mortality and prescription of antibiotics prior to hospitalization for community-acquired pneumonia. METHODS: We used administrative data (hospital abstracts, physician claims, prescriptions) for seniors (age 61 years and over) for Alberta, Canada from 1 April 1994 to 31 March 1999. RESULTS: Hospitalization of 21 191 seniors occurred during the study period. In about 43% of hospitalizations (n = 9034), a physician was consulted prior to hospital admission. Antibiotics were dispensed to 31% of those with a prior physician visit and in about 72%, the antibiotic choice was deemed appropriate. The odds for mortality were significantly decreased in those with prior physician visits (OR = 0.87, P < 0.01), with any antibiotic prescription (OR = 0.66, P < 0.0001), and with an appropriate antibiotic (OR = 0.68, P = 0.03). The choice of an appropriate antibiotic as opposed to an inappropriate antibiotic resulted in a 2.6% absolute and 38% relative mortality reduction. CONCLUSION: Choosing an appropriate outpatient antibiotic in accordance with published expert opinion guidelines compared with inappropriate antibiotic prescriptions decreased hospital mortality in patients subsequently hospitalized for community-acquired pneumonia.

Aged↗

PubMed1997

The composition of rural hospital medical staffs: the influence of hospital neighbors.

The local supply of physicians has a strong influence on the availability and the quality of services provided by rural hospitals. Nevertheless, there are no published studies that describe the composition of rural hospital medical staffs and, in particular, the availability of specialists on these staffs. This study uses 1991 and 1994 survey data from rural hospitals located in eight states to describe the specialty composition and factors that influence the presence of specialists on rural hospital medical staffs. The results show a strong, positive association between the level of medical staff specialization in rural hospitals and the level of medical specialization of their closet rural neighbors, which suggests there is competition among rural hospitals based on the composition of the hospital medical staff. Analysis by specialty type, however, indicates that the degree of competition may differ for different types of specialists.

Economic Competition↗

PubMed2000

Inter-hospital variations in caesarean sections. A risk adjusted comparison in the Valencia public hospitals.

BACKGROUND: The aim of this study was to describe the variability in caesarean rates in the public hospitals in the Valencia Region, Spain, and to analyse the association between caesarean sections and clinical and extra-clinical factors. METHODS: Analysis of data contained in the Minimum Basic Data Set (MBDS) compiled for all births in 11 public hospitals in Valencia during 1994-1995 (n=36 819). Bivariate and multivariate analyses were used to evaluate the association between caesarean section rates and specific risk factors. The multivariate model was used to construct predictions about caesarean rates for each hospital, for comparison with rates observed. RESULTS: Caesarean rates were 17.6% (inter-hospital range: 14.7% to 25.0%), with ample variability between hospitals in the diagnosis of maternal-fetal risk factors (particularly dystocia and fetal distress), and the indication for caesarean in the presence of these factors. Multivariate analysis showed that maternal-fetal risk factors correlated strongly with caesarean section, although extra-clinical factors, such as the day of the week, also correlated positively. After adjusting for the risk factors, the inter-hospital variation in caesarean rates persisted. CONCLUSIONS: Although certain limitations (imprecision of some diagnoses and information biases in the MBDS) make it impossible to establish unequivocal conclusions, results show a high degree of variability among hospitals when opting for caesarean section. This variability cannot be justified by differences in obstetric risks.

Cesarean Section↗

PubMed2005

[Alcoholism in the general hospital: 4 years mortality and hospitalization].

BACKGROUND AND OBJECTIVE: We aimed to analyze the mortality, and emergency room and hospital admissions in a sample of alcohol dependent patients during the four years following their identification in a general hospital. PATIENTS AND METHOD: 198 inpatients from a general hospital who where identified as alcohol dependent and referred during 1998 to the liaison-psychiatry service. RESULTS: 30.8% had died, at a mean age of 57.5 (11.3). Deaths had a direct relationship to the illness responsible for the initial admission to hospital. 42.6% of patients had previous admissions, and 74% had been previously attended at emergency room departments. During the 4 years of follow up, there were new hospital admissions (54.6%), emergency room visits (72.7%) and repeated liaison-psychiatry consultations (20%). Previous admissions to hospital predicted future admissions. Acceptance of alcohol treatment did not reduce the mortality rates. Mortality correlated with age, it was increased in patients with cognitive deficits and was reduced in those with psychiatric co-morbidity. CONCLUSIONS: Late detection of alcohol dependence leads to pour outcomes both in the treatment of alcohol dependence and the concomitant somatic diseases. Early detection strategies of hazardous and harmful alcohol consumption should be implemented in hospital settings.

Alcoholism↗

PubMed2003

Risk stratification of in-hospital mortality in patients hospitalized for chronic congestive heart failure secondary to non-ischemic cardiomyopathy.

The study population consisted of 234 consecutive patients hospitalized for acute exacerbation of congestive heart failure secondary to non-ischemic cardiomyopathy. Of the 234 patients, there were 55 in-hospital deaths. Their medical records were deliberatively reviewed and the association of 38 clinical, hemodynamic and biochemical variables with in-hospital mortality was evaluated by multiple stepwise logistic regression analysis. The following variables were statistically associated with in-hospital mortality: profound cardiogenic shock, severe hyponatremia, the presence of ventricular arrhythmias, history of stroke, the presence of acute renal failure, and requirement of dobutamine therapy. In stratified analyses, the rates of in-hospital mortality rose rapidly as the number of risk factors increased: 0 risk factors, 2.5%; 1 risk factor, 5.1%; 2 risk factors, 36.4%; 3 risk factors, 75%, and no less than 4 risk factors, 100%. In conclusion, our study identified 6 variables that correlated with in-hospital death in patients with heart failure secondary to non-ischemic cardiomyopathy. The identification of these variables may allow more accurate risk stratification of individuals at risk of in-hospital mortality in this clinical setting.

Adult↗

PubMed1996

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

BACKGROUND AND PURPOSE: The purpose of this study was to estimate rates of hospitalization and in-hospital case-fatality for cerebral infarction and intracerebral hemorrhage in Canada and to describe variation in rates by age, sex, and calendar period. METHODS: Data were obtained from hospitalization databases for each of Canada's 10 provinces for the 10 fiscal years of 1982 through 1991. All hospitalizations of persons 15 years of age or older with a primary diagnosis at discharge coded 431, 434, or 436 according to the International Classification of Disease, 9th Revision, were included. Rates per 100,000 population were calculated for intracerebral hemorrhage and cerebral infarction, for men and women, and for five age groups. Annual age- and sex-specific, 30-day, in-hospital case-fatality rates were also calculated. RESULTS: A total of 335,283 discharges for stroke were enumerated over the 10-year period (309,631 cerebral infarctions and 25 652 intracerebral hemorrhages). A significant decline of approximately 1% per year was observed for the rate of cerebral infarctions. For hemorrhages, the reverse was seen. For men there was a 44% increase over the 10-year period, and for women there was a 34% increase. In-hospital case-fatality rates for cerebral infarctions increased with age but did not differ by sex when age was considered. For the five age groups of 15 to 54, 55 to 64, 65 to 74, 75 to 84 and > or = 85 years, rates were 6%, 8%, 12%, 18% and 27%, respectively. For intracerebral hemorrhage, the in-hospital case-fatality rates declined significantly over time from approximately 36% to 29%, 55% to 37%, 49% to 41%, 66% to 45%, and 72% to 59% for the five age groups, respectively. CONCLUSIONS: The possibility that these changes are artifactual could not be ruled out, but because there is no obvious risk in assuming that they are not, it would be prudent to investigate their causes further.

Adolescent↗

PubMed1988

Mental patients' attitudes toward hospitalization: a neglected aspect of hospital tenure.

Recent research on hospital tenure has neglected mental patients' attitudes toward hospitalization. The authors consider problems with past research on these attitudes and examine "living preference"--the patient's preference for living in the hospital or the community. Assessments of patients' living preferences were obtained from clinicians working with 187 chronically mentally ill patients in a state hospital aftercare program. These assessments strongly predicted both components of hospital tenure--rehospitalization and in-hospital days--during a 1-year follow-up. The authors point out the conceptual, heuristic, and practical clinical advantages of examining living preference rather than traditional correlates of hospital tenure.

Aftercare↗

PubMed2006

Directive and supportive behaviors used by families of hospitalized older adults to affect the process of hospitalization.

As part of a grounded-theory study exploring the social processes of hospitalized older adults, family members were asked about their roles in relation to their hospitalized relative. Participants included five hospitalized older adults (aged > or = 75 years), a family member, and a nurse for each older adult. Data saturation determined the number of participants. Data were analyzed using the constant comparative method to develop the substantive theory of managing personal integrity during hospitalization. Personal integrity is a concept encompassing the properties of health, dignity, and autonomy. Siblings, spouses, children, and grandchildren used a combination of supportive and directive behaviors to affect personal integrity and the hospitalization for their older relatives. In prior research, the entire family was viewed as the patient. This research is unique in that the family is viewed as a modifier of hospitalization affecting the older adult's hospital experience and not as the focus of care.

Activities of Daily Living↗

PubMed2000

Understanding the effects of nurses, patients' hospital rooms, and patients' perception of control on the perceived quality of a hospital.

Service marketing researchers suggest that the physical environment, the people, and the process strongly affect consumers' judgements when they evaluate services. Previous research has rarely applied this general framework to help identify specific hospital variables that affect the perceived quality of a hospital. This article presents a proposed model and empirical evidence that is based upon this general framework. That is, this article reports the results of a study which found that the physical environment (i.e., patients' perception of their hospital rooms) and people (i.e., patients' perception of nurses) affected patients' perception of hospital quality. The process (i.e., patients' perception of control over the process) did not directly affect their perception of hospital quality. However, patients' perception of control over the process and their perception of their hospital rooms affected their perception of their nurses. Consequently, this research suggests that the general framework identified by service marketing researchers can be applied to help understand how patients develop their perception of hospital quality.

Health Services Research↗

PubMed2004

[Use of hospital mortality rates following myocardial revascularization surgery to monitor hospital care].

Brazilian hospitals performing coronary artery by-pass graft surgery (CABG) from 1996 to 1998 and covered by the Ministry of Health were ranked according to their risk-adjusted hospital mortality rates. Seventy-six hospitals that performed more than 150 CABGs (total of 38,962 surgical interventions) were classified as low or high outliers according to the ratio between observed and expected hospital mortality rates. Overall hospital mortality rate was 7.20%. The rate was 3.48% among patients treated in the low outliers and 13.96% among the high outliers. The methodology was useful for discriminating Brazilian hospitals according to their post-CABG mortality rates and may be a useful tool for identifying hospitals with possible quality-of-care problems.

Adult↗

PubMed1975

Unionization, strikes, threatened strikes, and hospitals--the view from hospital management.

The history of union organizing efforts in the hospital field is discussed in this article, along with the factors judged necessary for successful union organizing. The role played by labor legislation in the unionization of hospital workers is shown, and the influences of the National Labor Relations Act, the Taft-Hartley amendments, and labor legislation at the local level are described. Management has largely resisted unionization because of the social nature of hospitals. Competitive market forces do not confront the not-for-profit hospitals, which are dependent upon third-party reimbursement. While strikes are an integral and essential part of collective bargaining in industry, they are, in fact, detrimental to hospitals because of these institutions' concern with human life. Despite laws and assurances from labor leaders that strikes will not occur, strikes have been used as a method for resolving disputes, through they are basically inconsistent with the economic characteristics and objectives of the hospital. The authors conclude that arbitration awards should be made by arbitrators appointed from outside of the local region of the hospital involved, ant that, because of the catastrophic effect of strikes upon patients as well as employees, arbitration awards should be required, should be binding upon both parties, and should be federally enforced.

Attitude↗

PubMed1999

Was the decreasing trend in hospital mortality from heart failure attributable to improved hospital care? The Oregon experience, 1991-1995.

OBJECTIVE: To assess the trend in risk-adjusted hospital mortality from heart failure. STUDY DESIGN: Oregon hospital discharge data from 1991 through 1995 were analyzed. PATIENTS AND METHODS: A total of 29,530 hospitalizations because of heart failure in elderly patients (age > or = 65 years) were identified from International Classification of Diseases, 9th Revision, codes 428.0-428.9. The logistic regression and life table analyses were used to assess the risk-adjusted trend in hospital mortality from heart failure. RESULTS: From 1991 through 1995, 1757 (5.9%) patients with heart failure died in the hospital; 920 (52.4%) of them died within 3 days. The percentage of patients discharged to skilled nursing facilities increased from 6.1% in 1991 to 9.8% in 1995 (P value for trend < .001), whereas the percentage of patients discharged directly to home decreased from 69.2% in 1991 to 62.4% in 1995 (P value for trend < .001). The mean length of stay decreased from 5.15 days in 1991 to 3.97 days in 1995. The age- and sex-standardized mortality rate decreased by 33.8% from 7.4 in 1991 to 4.8 in 1995 (P value for trend < .01). Additional adjustment for comorbidity using multiple logistic regression revealed a greater reduction of 41.0% in the mortality rate (odds ratio = 0.59; 95% confidence interval = 0.50, 0.69) and a reduction of 46.0% in the 3-day mortality rate (odds ratio = 0.54; 95% confidence interval = 0.43, 0.67) across the 5-year period. Life table analysis showed consistently lower cumulative mortality rates during the first week after admission in 1995 compared with those in 1991 (P < .001). CONCLUSION: There was a decreasing trend over time in the risk-adjusted hospital mortality rates from heart failure, which was not an artifact of decreasing length of stay. Our findings raised the possibility of improved hospital care for heart failure in Oregon.

Aged↗

PubMed2000

Do practice-based preventive child health services affect the use of hospitals? A cross-sectional study of hospital use by children in east London.

BACKGROUND: Acute paediatric admissions have risen steadily over the past 20 years. During the same period, practice-based child health clinics have increased, although provision is less common in areas of deprivation where hospital use is greatest. AIM: To investigate the contribution of practice-based, preventive child health services to rates of hospital utilisation in children under five years of age. METHOD: A cross-sectional retrospective study examining practice variations in paediatric acute admissions, outpatient referrals, and accident and emergency (A&E) department attendances in the East London and the City Health authority, including all 164 practices in the inner-city boroughs of Hackney, Newham, Tower Hamlets, and the City of London. The main outcome measures were practice-based paediatric hospital attendance rates, for discrete age and sex bands, for the year to 31 March 1996. RESULTS: Hospital use varied with age and sex, with the rates being highest for the youngest children and for boys. The median A&E attendance rate (including reattendances) for boys up to one year of age was 897 per thousand children per practice. In east London, 62% of practices are registered for child health surveillance and 71% provide a child health clinic. Practice approval for child health surveillance, and the provision of child health clinics, did not account for differences between practices in hospital use, but proportionally greater health visiting hours were significantly related to lower rates of emergency hospital admission by young children. Multivariate analyses revealed that up to 23% of the variation between practice admission rates could be explained by health visiting hours. CONCLUSIONS: We found significant associations between the amount of health visiting time available to the practice population and rates of acute admission and outpatient referral among children up to five years of age. These findings suggest that increasing health visitor provision could contribute to lower paediatric emergency admission and outpatient referral rates. A small change would have a significant effect, particularly among the youngest children, given that during the study year 10,000 children under two years of age in east London were either admitted or referred to hospital.

Age Factors↗

PubMed2003

Medicare program; change in methodology for determining payment for extraordinarily high-cost cases (cost outliers) under the acute care hospital inpatient and long-term care hospital prospective payment systems. Final rule.

In this final rule, we are revising the methodology for determining payments for extraordinarily high-cost cases (cost outliers) made to Medicare-participating hospitals under the acute care hospital inpatient prospective payment system (IPPS). Under the existing outlier methodology, the cost-to-charge ratios from hospitals' latest settled cost reports are used in determining a fixed-loss amount cost outlier threshold. We have become aware that, in some cases, hospitals' recent rate-of-charge increases greatly exceed their rate-of-cost increases. Because there is a time lag between the cost-to-charge ratios from the latest settled cost report and current charges, this disparity in the rate-of-increases for charges and costs results in cost-to-charge ratios that are too high, which in turn results in an overestimation of hospitals' current costs per case. Therefore, we are revising our outlier payment methodology to ensure that outlier payments are made only for truly expensive cases. We also are revising the methodology used to determine payment for high-cost outlier and short-stay outlier cases that are made to Medicare-participating long-term care hospitals (LTCHs) under the long-term care hospital prospective payment system (LTCH PPS). The policies for determining outlier payment under the LTCH PPS are modeled after the outlier payment policies under the IPPS.

Economics, Hospital↗

PubMedDate not supplied

[Appropriateness of hospitalization in the teaching hospital of Chieti using the P.R.U.O. approach].

This study describes the results of a research carried out to evaluate inappropriate admissions and totally inappropriate hospitalizations (RTI) in the teaching hospital "SS. Annunziata" of Chieti using the 1999 version of the PRUO manual. A random sample of 1218 medical charts, drawn from all the medical charts of patients admitted from June to December 2000 in the units of Medicine, Surgery and Orthopaedics, was selected. The percentage of inappropriate admissions was 38.2%, while totally inappropriate hospitalizations were 18.1%. The highest percentage of inappropriate admissions was in the class of age 55-64 years. Moreover, inappropriate admissions were more frequent in the morning hours (7:00-12:59) and, within the week, on Monday. The first reason of inappropriateness of the admission, was the execution of diagnostic examinations (62.2%), followed by the execution of medical therapy (19.3%) and waiting of surgical intervention (13.4%). Short hospitalizations (2-3 days) are more frequently totally inappropriate as compared to longer hospitalizations. These findings suggest that a system for the assessment of appropriateness of hospitalizations should be established in the Abruzzo region including all accredited public and private hospitals.

Aged↗

PubMed2006

[Patients' satisfaction with their hospital stay at the Department of Psychiatry, Amager Hospital, in 2000 and 2003].

INTRODUCTION: Our goal was to compare patients' satisfaction with their hospital stay at the Department of Psychiatry, Copenhagen University Hospital, Amager, before and after the department was moved to newly built facilities. MATERIALS AND METHODS: In 2000 and again in 2003, patients who were about to be discharged from the department were asked to anonymously fill in a 24-item questionnaire related to their satisfaction with their recent hospital stay. RESULTS: The percentage of participants was 39% of discharged patients in 2000 and 33% in 2003. A high percentage rated their general satisfaction with the hospital stay as either "good" or "very good" (94% in 2000 and 88% in 2003). From 2000 to 2003, we noted a significant (23%) increase in the percentage who rated their satisfaction with the buildings as either "good" or "very good". In other areas, there was reduced patient satisfaction. We noted a reduction with respect to the respondents' satisfaction with the hospital staff on specific matters; for instance, a significant (23%) reduction in the respondents' perception of the hospital staff having spent sufficient time with them. CONCLUSION: After the department was moved to newly built facilities, patients' satisfaction with the buildings appears to have increased. In other areas, such as satisfaction with the hospital staff on specific matters, patient satisfaction appears to have decreased. The results should be interpreted with caution due to the low participation rate.

Denmark↗

PubMedDate not supplied

[Evaluation of the appropriateness of hospital admissions with the Italian version of the AEP in a university hospital].

It has been carried out a survey to evaluate the appropriateness of hospital stay in a university hospital. The aims of the study were: to determine the amount of inappropriate hospital admissions and inappropriate days of stay in relation to either wards and characteristics of admission; to analyse the reasons for inappropriate patient stay. A randomised sample stratified by ward of discharge of 224 medical records were analysed using the Italian version of the Appropriateness Evaluation Protocol. 37.9% of the hospital admissions and 18.9% of hospitalisation days were judged to be inappropriate. The main reasons for categorising an admission or a day of stay as inappropriate were a) delay in performing elective surgery procedures; b) that the patient's problem could be treated on an outpatient basis; c) delay in performing diagnostic examinations. The univariate statistical analysis showed an association between appropriateness of hospital stay and gender age, ward of discharge, length of hospital stay and DRG type (medical/surgical). The study highlights a lower level of inappropriateness compared to the results of other investigations. Hints were also identified for achieving an improved efficiency at hospital level.

Adolescent↗

PubMed2007

Hospital DOTS linkage in Indonesia: a model for DOTS expansion into government and private hospitals.

BACKGROUND: To accelerate DOTS expansion, the hospital sector and specialized chest clinics must be engaged. OBJECTIVE: To develop a model for public-private partnership through DOTS expansion into public and private hospitals in Indonesia. DESIGN: Model development included gaining commitment from stakeholders, stepwise training of hospital staff, and developing unified networks for case management, patient referral, laboratory quality assurance, supervision and evaluation. RESULTS: The number of notified tuberculosis (TB) cases (all forms and new smear-positive) increased dramatically from baseline. Together, hospitals and chest clinics accounted for a significant proportion of the total cases notified by the province (51% of total TB cases and 56% of new smear-positive cases in 2004). Compared to health centers and chest clinics, hospitals reported lower cure and success rates. Despite the option for referral to health centers, the majority of patients diagnosed in hospitals and chest clinics in 2002-2004 opted to be fully managed by the diagnosing facility. CONCLUSION: The roles and strengths of hospitals differ with regard to health centers, providing a rational basis for linkage of these health service components. In Yogyakarta, linkage became effective only after establishing a stakeholder-based provincial coordinating (DOTS) committee as the recognized interface between the National Tuberculosis Programme and various providers.

Antitubercular Agents↗