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PubMed1983

Mental hospital and general hospital psychiatric units: a comparison of services within the same geographic area.

A comparison was made between the characteristics of patients admitted to the only psychiatric hospital in Newfoundland, Canada, and those admitted to general hospital psychiatric units within the same area. Patients were compared on demographic characteristics, diagnosis, incidence of violence and suicidal attempts, treatment, length of stay and previous admissions. The results suggest that patients admitted to the mental hospital are more likely to be single, male, of lower socio-economic status and to suffer from more chronic conditions. There is also a higher incidence of violence among patients admitted to the mental hospital. These findings have implications for the types of changes that will be required in general hospital units if the role of mental hospitals continues to decline.

Delivery of Health Care↗

PubMed2001

Hospitalization of patients with neurological disorders and estimation of the need of beds and of the related costs in Austria's non-profit hospitals.

In 1997, 273 722 hospitalizations as a result of neurological disorders, including the related operated cases, were reported in Austria's non-profit hospitals (80% of all hospitals). They represent 14.12% of all 1.9 million in-patient treatments. The individual disease groups, e.g. cerebrovascular disorders (59 269 admissions or 3.06%), multiple sclerosis (3920 admissions or 0.2%) and all other groups are detailed. We estimated the cost resulting from these diseases which amounted to 11.88% of all hospital costs. We were also able to estimate that 5549 beds are required for in-patient treatment in the area of neurology, assuming an average duration of treatment of 8 days (Austrian mean value for neurological disorders). This is equivalent to one bed per 1367 inhabitants or 11.31% of all beds for in-patient treatment in non-profit hospitals in Austria. Obviously at present the majority of neurological patients are treated in non-neurological departments. A major increase in resources to neurology is necessary if patients are to receive the benefit of specialized diagnosis and treatment. These further resources not only cover the increase of neurological beds in hospitals but also financial, personal resources and in consequence increased capacity for neurological education, training and research.

Austria↗

PubMed2002

Public hospitals: who's looking after you? The difficulties in encouraging patients to use their private health insurance in public hospitals.

Private health insurance (PHI) is an important part of the Australian health system. During the introduction of the recent PHI reforms it was argued that, without the reforms, the public hospital system would undoubtedly collapse under the increased demand for public health services. The increase in PHI coverage might also have been expected to result in an increase in the revenue earned by public hospitals as a result of treating privately insured patients. However, the decline in numbers of privately insured patients using their PHI in public hospitals has continued, with adverse impacts on public hospital budgets in some states. This article addresses the complex interactions between various policy instruments and their impact on public hospitals, and reports the results of a study conducted at the Austin & Repatriation Medical Centre (A&RMC) which examined the reasons for privately insured patients electing not to use their insurance in public hospitals, and methods by which they might be overcome.

Budgets↗

PubMed2001

Epidemiology, clinical course and impact on hospitalization costs of acute diarrhea among hospitalized children in Athens, Greece.

The aim of this study was to describe the etiology, morbidity and hospitalization costs associated with acute diarrhea among hospitalized children in Greece. During 1999, 294 hospitalized children (median age 1 y) with acute diarrhea were prospectively studied. Bacterial and viral enteropathogens were detected in 100 (34%) and 37 (12.5%) patients, respectively; 17 (6%) patients had mixed infections. Isolated agents included Salmonella spp. (43 patients; 15%), rotavirus (32; 11%), Campylobacter spp. (26; 9%), enteropathogenic Escherichia coli (16; 5.5%), Shigella spp. (11; 4%), Aeromonas spp. (7; 2.5%), adenovirus (6; 2%), Yersinia enterocolitica (6; 2%), enterohemorrhagic Escherichia coli (2; 0.5%) and Giardia lamblia (1; 0.5%). Of the patients with bacterial infection, 70% were admitted between April and September 1999. A rotavirus-associated peak was noted in March. Patients with a bacterial infection were hospitalized for longer periods than those with viral infections. It is concluded that bacterial enteropathogens account for one-third of admissions due to acute diarrhea among children in Greece and are associated with significant hospitalization costs. Rotavirus is also a frequent cause of acute diarrhea necessitating hospitalization.

Acute Disease↗

PubMed1998

The costs of hospital services: a case study of Evangelical Lutheran Church hospitals in Tanzania.

The health care systems of many developing countries are facing a severe crisis. Problems of financing services leads to high patient fees which make institutions of Western health care unaffordable for the majority of the rural poor. The conflict between sustainability and affordability of the official health care system challenges both local decision-makers and health management consultants. Decisions must be made soon so that the existing health care systems can survive. However, these decisions must be based on sound data, especially on the costs of health care services. The existing accounting systems of most hospitals in developing countries do not provide decision-makers with these data. Costs are generally underestimated. The leadership of the 16 hospitals of the Evangelical Lutheran Church in Tanzania is currently analyzing how the existing health care services should be restructured. Therefore, reliable estimates of the costs of hospitals services are required. A survey on 'Costing of health services of the Evang. Luth. Church in Tanzania' was prepared, which summarizes the results of seven months of field investigations in Lutheran hospitals. The major findings are that the costs of providing adequate services are much higher than expected. The most important factors determining these costs are the administrative efficiency of the hospital and the scope of services offered. The paper closes with some recommendations on how to improve the services in order to make them both affordable for the rural poor and financially sustainable for the Church. It is concluded that even the best improvement of technical efficiency will not safeguard the survival of the hospital-based health care services of the Lutheran Church in Tanzania. These findings call for a reallocation of health care resources to lower levels of the health care pyramid.

Christianity↗

PubMed1994

Are pediatric wards in developing countries only places to die? A study of prior to hospitalization risk factors of death among 0-2 year old hospitalized children in Niamey, capital of Niger.

The 461 0-2-year-old children admitted to the paediatric ward of the National Hospital in Niamey over a 2-month period were closely followed up from admission to discharge or death. The in-hospital mortality rate was 30 per cent, a great proportion of deaths occurring during the first 24 h of hospitalization. Malnutrition was highly prevalent (76 per cent). Children referred from other health facilities (72 per cent) did not experience a higher probability of survival. Using multivariate analysis, three variables remained significantly associated with death: nutritional status, consultation of a traditional practitioner, and a neonate disease. Neonate diseases are the third major cause of death because of a high case fatality rate. For the other causes, the main underlying factor is malnutrition. Most in-hospital deaths are due to events that occurred prior to hospitalization. The role of hospitals' pediatric wards of developing countries is discussed.

Cause of Death↗

PubMed1993

Hospital drug formularies and use of hospital services.

Many hospitals have introduced formularies to reduce hospital pharmacy expense, among other reasons. This study provides empirical evidence of the influence of hospital formulary restrictions on pharmacy charges, all other hospital charges, and on length of stay, using a survey of hospital drug policies and hospital discharge data from Washington State in 1989. Limiting the number of drugs in particular therapeutic categories reduced total charges incurred for gastrointestinal disease and asthma patients, increased total charges for cardiovascular disease patients, and had no effect on charges for infectious diseases patients. Restricting availability of drugs reduced pharmacy charges, but these savings tended to be offset by increases in other charges. Combining the categories, we found that restricting availability of drugs did not affect charges. We conclude that across-the-board restrictions do not result in cost savings, although savings may be realized for particular drug categories.

Aged↗

PubMed2004

Implementation of hospital restructuring and nursing staff perceptions of hospital functioning.

Hospital restructuring and downsizing has taken place in most developed countries during the past ten years. A small but growing body of research findings has identified aspects of these changes that serve as sources of stress for nursing staff, as well as features of the restructuring process that contribute to more effective transitions. This research reports results of a longitudinal study of hospital restructuring and downsizing on nursing staff perceptions of hospital effectiveness. Data were collected in November 1996 and again in November 1999 from nursing staff using questionnaires. Would the way hospital restructuring was implemented and managed in 1996 be related to nursing staff perceptions of hospital functioning in 1999? The findings showed positive but moderate relationships between more favorable restructuring processes and perceptions of hospital functioning.

Attitude of Health Personnel↗

PubMed2001

Emergency department overcrowding following systematic hospital restructuring: trends at twenty hospitals over ten years.

OBJECTIVE: Hospital restructuring often results in fewer inpatient beds, increased ambulatory services, and closures of hospitals or emergency departments (EDs). The authors sought to determine the impact of systematic hospital restructuring on ED overcrowding. METHODS: Time series analyses of average monthly overcrowding for EDs in Toronto, Ontario, Canada, from 1991 and 2000 (n = 20 hospitals, 120 months) were conducted. Autoregression models evaluated the rate of increase of overcrowding before and during systematic restructuring. A secondary analysis included total ED visits, patient age, and sex distribution as covariates. Seasonality was assessed by means of spectral analysis. RESULTS: Severe and moderate overcrowding averaged 3% and 14% of the time each month, respectively, over the whole period. Before restructuring (n = 74 months), severe and moderate overcrowding averaged 0.5% and 9% per month, respectively; during restructuring (n = 46 months), the monthly averages were 6% and 23%, respectively. Neither severe nor moderate overcrowding was increasing before restructuring. During restructuring, however, both increased significantly (severe 0.2% per month [p < 0.0001]; moderate 0.5% per month [p < 0.0001]). Similar results were found after controlling for ED utilization. Female gender independently predicted increased overcrowding; older age predicted reduced moderate overcrowding; number of total visits was not a predictor. Spectral analysis revealed significant seasonality in overcrowding. CONCLUSIONS: Hospital restructuring was associated with increased ED overcrowding, even after controlling for utilization and patient demographics. Restructuring should proceed slowly to allow time for monitoring of its effects and modification of the process, because the impact of incremental reductions in hospital resources may be magnified as maximum operating capacity is approached.

Adult↗

PubMed1992

Our Community Hospital: the evolution of a rural primary care hospital.

In the next few years, Our Community Hospital, located in the small town of Scotland Neck, NC, will undergo a conversion through which it may serve as an appropriate model for similar small hospitals in distressed rural communities. With technical and grant assistance from the Office of Rural Health and Resource Development of the North Carolina Department of Human Resources, the hospital has begun to phase out almost all acute care services and will expand and strengthen its focus on primary care, emergency medical services, and services for elderly persons. This paper addresses four issues of greatest concern to hospital administrators, rural health professionals, academics, and rural residents interested in hospital conversions: (1) community involvement during the planning process; (2) the evolution of the program's structure; (3) financing for the project; and (4) the development of cooperation between state and federal governments, foundations, and private groups. This case study describes one possible course in addressing an acute health care problem facing rural America--the viability of rural hospitals.

Aged↗

PubMed2003

Factors associated with survival to hospital discharge among patients hospitalised alive after out of hospital cardiac arrest: change in outcome over 20 years in the community of Göteborg, Sweden.

OBJECTIVE: To describe the change in survival and factors associated with survival during a 20 year period among patients suffering from out of hospital cardiac arrest and being hospitalised alive. PATIENTS: All patients hospitalised alive in the community of Göteborg after out of hospital cardiac arrest between 1 October 1980 and 1 October 2000 were included. METHODS: Patient data were prospectively computerised with regard to factors at resuscitation. Data on medical history and hospitalisation were retrospectively recorded. Patients were divided into two groups (the first and second 10 year periods). SETTING: Community of Göteborg, Sweden. RESULTS: 5505 patients suffered from cardiac arrest during the time of the survey. Among them 1310 patients (24%) were hospitalised alive. Survival (discharged alive) was 37.5% during the first part and 35.1% during the second part (NS). The following were independent predictors of an increased chance of survival: ventricular fibrillation/tachycardia as the first recorded rhythm (odds ratio (OR) 3.46, 95% confidence interval (CI) 2.36 to 5.07); witnessed arrest (OR 2.50, 95% CI 1.52 to 4.10); bystander initiated cardiopulmonary resuscitation (OR 2.00, 95% CI 1.42 to 2.80); the patient being conscious on admission to hospital (OR 6.43, 95% CI 3.61 to 11.45); sinus rhythm on admission to hospital (OR 1.53, 95% CI 1.12 to 2.10); and treatment with lidocaine in the emergency department (OR 1.64, 95% CI 1.16 to 2.31). The following were independent predictors of a low chance of survival: age > 70 years (median) (OR 0.65, 95% CI 0.47 to 0.88); atropine required in the emergency department (OR 0.35, 95% CI 0.16 to 0.75); and chronic treatment with diuretics before hospital admission (OR 0.59, 95% CI 0.43 to 0.81). CONCLUSION: There was no improvement in survival over time among initial survivors of out of hospital cardiac arrest during a 20 year period. Major indicators for an increased chance of survival were initial ventricular fibrillation/tachycardia, bystander cardiopulmonary resuscitation, arrest being witnessed, and the patient being conscious on admission. Major indicators for a lower chance were high age, requirement for atropine in the emergency department, and chronic treatment with diuretics before cardiac arrest.

Adolescent↗

PubMed1983

The limits of general hospital care: a continuing role for state hospitals.

An examination of the characteristics of patients transferred to a state hospital after their treatment in a rural community general hospital had failed provides some data for defining the state hospital's role in relation to such patients. Of 2,128 discharges from the general hospital in a three-year period, 33, or 1.6 percent, were referred to the state hospital. The patients could be divided into four subgroups: violent patients, unresponsive patients with severely disorganized mental states, dependent patients treated successfully but referred because of a lack of community residential facilities, and deteriorating alcoholic recidivists who had proved to be unresponsive to treatment. At follow-up, the most improvements had occurred among the unresponsive subgroup. The author believes that, among those subgroups, state hospitals are most useful for violent patients, for deteriorating recidivist alcoholics, and, depending on further research, possibly for unresponsive patients.

Adult↗

PubMed1998

Comparing the value of service between a state hospital and a private, for-profit psychiatric hospital: a clarified role for tertiary care.

We apply pattern-recognizing artificial neural networks (ANNs) to the patients of two psychiatric hospitals, a private, for-profit hospital (PH) and a state hospital (SH), both serving the southern tier of Maine (approximately two-thirds of the state's population, i.e., 800,000 persons) over a 19-month period. In our data from the PH, N = 837 admissions, and at the SH, N = 834. Unique patient identifiers were assigned to patients so that their individual patterns of care could be incorporated into our ANNs. We used a previously reported methodology to measure quality of care (Q), and developed a measure of value of service (V) from the patients' perspective for both facilities. A random portion of the demographic and outcome data of patients from each hospital was sequestered as a test set, whereas the remainder was used to train ANNs with length-of-stay (LOS) as an outcome measure. Q, and V normalized for risk (RR), i.e., V/RR, were calculated for each test set, which included multiple admissions of individual patients to each hospital. The methodology for V accounts for the severity of illness with the calculation of a metric called U/G, for the differences in case-mix by exchanging "virtual patients" between ANNs, and for entropy in the health care system by using a metric called the risk ratio (RR). Results showed that V/RR was 2.4 times greater at the SH than at the PH. This advantage is likely due to prior knowledge of individual patient patterns of treatment by the SH's staff. Data sets from each hospital using only single admissions for each patient in the study period (thereby eliminating unique patient patterns of LOS), yielded a V/RR that was only 21% greater at the SH. We hypothesize that this difference is due to the SH's ability to use treatment and discharge based upon patient strengths and level of clinical improvement, unfettered by insurance deadlines. Approximately 5% of the admissions to our studied PH went on to our SH, namely, the most severely impaired and indigent patients. The SH not only had twice the value, but also had half the cost of the PH, despite the greater number of treatment non-responders and non-compliants at the SH. The reasons for this are skilled staff and specialized ancillary services, staff knowledge of patients' responses to previous therapy, and individualized LOSs. These are features that create a caring environment and better compliance with treatment. This study emphasizes the value of tertiary care psychiatric facilities in a comprehensive mental health care delivery system. There are few studies of the effects of excessive downsizing of SHs on the community, but reports from Massachusetts (in 1995) suggest a 79% increase in suicides when the closing of SH beds exceeded 98% of maximum historical census. Routine use of pattern-recognizing tools such as ANNs would serve to inform the public about the value of mental health services so that the most vulnerable in our society are not neglected.

Adolescent↗

PubMed2001

Measuring shortages of hospital nurses: how do you know a hospital with a nursing shortage when you see one?

Lack of clarity in definitions of shortages of hospital registered nurses may cause problems for effective policy making, particularly if different measures for identifying a nurse shortage lead to different conclusions about which hospitals and regions are experiencing a shortage. The authors compared different methods of identifying hospitals and regions with a shortage of registered nurses, including both relatively subjective measures (e.g., a hospital administrator's report of a nurse shortage) and more objective measures (e.g., number of registered nurses per inpatient year). Associations were strongest between self-reported shortage status and nursing vacancy rates and weaker for self-reported shortage status and registered nurses per inpatient year and overall regional supply of nurses. Different definitions of nursing shortage are not equally reliable in discriminating between hospitals and regions with and without nursing shortages. When faced with reports sounding an alarm about a hospital nursing shortage, policy makers should carefully consider the definition of shortage being used.

Catchment Area, Health↗

PubMed1991

Measuring hospital input price increases: the rebased hospital market basket.

The input prices indexes used in part to set payment rates for Medicare inpatient hospital services in both prospective payment system (PPS) and PPS-excluded hospitals were rebased from 1982 to 1987 beginning with payments for fiscal year 1991. In this article, the issues and evidence used to determine the composition of the revised hospital input price indexes are discussed. One issue is the need for a separate market basket for PPS-excluded hospitals. Also, the payment implications of using hospital-industry versus economywide measures of wage rates as price proxies for the growth in hospital wage rates are addressed.

Abstracting and Indexing↗

PubMed1993

A study of disposal of hospital wastes in a rural teaching hospital.

The present study was carried out in order to observe and analyse the waste disposal patterns in a 500 bedded, multidisciplinary hospital located in a rural area. The hospital under study is a teaching hospital attached to a Medical college and has been functioning for over ten years. Data were collected by means of pre-structured interviews and on-the-spot observations of the various stages in the waste disposal chain. It was observed that the hospital does not have a documented wastes management and disposal policy. The disposal of wastes is not properly supervised and is exclusively entrusted to the junior most staff from the house keeping department. The disposal of all categories of hospital wastes, in general, leaves much to be desired and even pathological wastes were observed to be disposed off, on the open ground with scant regard to aesthetic considerations. Both the internal as well as external transportation of hospital wastes were found to be far from satisfactory.

Data Collection↗

PubMed1987

A unique urban state hospital: partial-hospital programs reduce full-time bed occupancy.

This paper describes a complex treatment system which serves a large urban population with a very small number of inpatient beds. From its very outset, the South Beach Psychiatric Center, a state facility in New York City, was determined to treat its patients with minimal use of inpatient bed occupancy. As a result, it started with a large outpatient program, in which day hospitals played a critical role. The aim was to treat patients on their home turf and, thus, to limit inpatient bed use to the period when the patient was out of control and a danger to self or others. Partial-hospitalization (PH) literature is replete with articles about utilization and underutilization [see Kennedy, L. L., A Bibliography on Partial Hospitalization, American Association for Partial Hospitalization (AAPH), Washington, D.C., 1986, pp. 1-70; Proceedings of the Annual Conference on Partial Hospitalization, Washington, D.C., 1976-1986; Wilner, M. (ed.), AAPH Newsletter, AAPH, Washington, D.C.] There are many discussions about the appropriate use of the PH program, how to get the program reimbursed, and how to get referrals to the program. Often, a pragmatic, although inefficient and sometimes very wrong, decision is made that, in the absence of a proper choice of treatment modalities, one judges the best referral to be the one that is available. South Beach therefore presents a useful study because it has a very wide range of treatment modalities: inpatient acute, intermediate, and chronic beds, admitting services, clinics, day hospitals (adolescent, adult, geriatric, acute, chronic), varieties of residences including quarter-way housing and supervised and unsupervised apartments, etc.(ABSTRACT TRUNCATED AT 250 WORDS)

Bed Occupancy↗

PubMed1999

Improving communication between hospital and community physicians. Feasibility study of a handwritten, faxed hospital discharge summary. Discharge Summary Study Group.

OBJECTIVE: To assess the timing, legibility, and completeness of handwritten, faxed hospital discharge summaries as judged by family physicians and to obtain their opinion on the information categories on a standardized discharge summary form. DESIGN: Fax survey of physicians for consecutive patients discharged from hospital over 8 weeks. SETTING: Three wards in a tertiary care teaching hospital. PARTICIPANTS: One hundred two family physicians and general practitioners practising in Hamilton, Ont. MAIN OUTCOME MEASURES: Proportions of summaries that were received, received within 48 hours of discharge, legible, and complete; types of information missing from incomplete summaries; proportion of physicians satisfied with the information categories. RESULTS: Of 271 consecutive patient discharges, 195 (72%) were eligible for study. Among those ineligible, 22 patients (8%) did not have a family doctor identified on their hospital records. Among records that did have a family physician identified, fax numbers were unavailable or unknown for 54 physicians (20%). One hundred two physicians completed 166 discharge summary assessments for a response rate of 85% (166/195). By 3 weeks after discharge, 138 discharge summaries (83%) had been received by patients' family doctors. Among those received, 86% were received within 48 hours of discharge; 92% were legible; and 88% were complete. Hospital doctors' signatures, patients' diagnoses, and follow-up plans were most frequently missing. Ninety-five percent of physicians were satisfied with the information categories included on the standardized form. CONCLUSIONS: Handwritten, faxed hospital discharge summaries were acceptable to family physicians for most patients. Criteria are needed for determining which patients require both handwritten and dictated discharge summaries.

Attitude of Health Personnel↗