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At least 865 records · Page 48Linked to original sources
PubMed2004

Comparison of hospital costs and length of stay associated with general internists and hospitalist physicians at a community hospital.

OBJECTIVE: To compare initial and long-term hospital resource utilization of hospitalists and general internists at an urban community hospital. STUDY DESIGN: A retrospective cohort analysis. METHODS: Data were collected from 11 750 admissions associated with 28 diagnosis-related groups for 6 years (October 1, 1994, to September 30, 2000). Hospital cost, length of stay, mortality, and 30-day readmission rates of general and hospitalist internists were analyzed for comparison. RESULTS: Hospitalists had generally lower utilization compared with general internists. Overall, length of stay and hospital cost were 16.1% and 8.3% lower, respectively, for hospitalists. Hospital mortality and 30-day readmissions were similar for both physician groups. CONCLUSIONS: Hospital resource utilization is moderately lower for hospitalists compared with private practicing general internists.

Cohort Studies↗
PubMedDate not supplied

[Appropriateness evaluation of short hospital admissions using Appropriateness Evaluation Protocol (Italian version): experience of a teaching hospital].

Italian version of Appropriateness Evaluation Protocol (AEP) is a tool for evaluating the appropriateness of hospitalization for acute patients. In particular, it aims to verify and quantify the reasons of appropriateness associated to the day of admission and the single days of hospital stay. The aim of the present paper is to evaluate the appropriateness of ordinary, 2-3 days lasting, hospital admissions within an university hospital. We examined a sample of 518 hospital admissions: 370 admissions (71%) lasting 2 days, and 148 admissions (29%) lasting 3 days. Results analysis showed different levels of appropriateness between the 2-days and the 3-days admissions: the appropriate admissions were 18% in the sample of the 2-days admissions and 38% in the sample of 3-days admissions. Most inappropriate days of admission and stay in hospital are due to attended or to the execution of diagnostic procedures. In order to evaluate accuracy by means of AEP methodology, it is necessary to improve the quality of medical documentation using standardized medical records. AEP, in the framework of the continuous quality improvement, is a valid tool to reorganise health care processes.

Diagnosis-Related Groups↗
PubMed2005

[Hospital information system--project of implementation of SAP information system at Sveti Duh General Hospital].

Nowadays, as medical and hospital institutions have been facing a growing need of a more efficient provision of healthcare services to patients, with simultaneous complete monitoring of the successfulness of business activities, integrated information systems appear as the logical choice for the support to hospital business processes. The integrated business information system implemented at Sveti Duh General Hospital is a comprehensive system that supports all hospital, clinical and administrative processes, while providing the basis for decision making regarding the patients and hospital management. The system also enables transfer of all data with specific medical business segments such as laboratory device management. The project for the implementation of the information system was realized in accordance with the requests from the Ministry of Health, applying the proven methodology for the execution of such complex projects. The project team consisted of a number of consultants from b4b Co. from Zagreb, as well as Hospital employees. The new information system is completely ready for going live; however, the necessary decisions have to be made first. The application of the system gives the medical staff more time for their professional work with patients, and through longterm collection and analysis of data on symptoms, illnesses and medical treatments, the information system becomes an important tool for the improvement of health and quality of healthcare system in general.

Clinical Laboratory Information Systems↗
PubMed2005

[Population's satisfaction with hospitals before and after a hospital reform in Norway].

BACKGROUND: We investigated patients' satisfaction with availability and quality of hospital services in 2000 and 2003, that is before and after the Norwegian hospital reform. MATERIAL AND METHODS: The data were collected from two national surveys in 2000 and 2003. The participants were asked about their satisfaction with availability (choice and waiting time for an appointment) and quality (result of treatment, professional skills, service-mindedness, punctuality, information and available time). For each question, changes in mean satisfaction from 2000 to 2003, corrected for changes in the composition of the sample, were estimated. RESULTS: A clear and statistically significant improvement in patient satisfaction with the availability and quality of hospital services took place from 2000 to 2003. In general, patients were more satisfied with the quality than with the availability of hospital services. INTERPRETATION: The hospital reform may have contributed to improved satisfaction with hospitals, though other factors may also have played a part.

Adolescent↗
PubMed1991

[In-hospital injury reports and the injury evaluation work. Intentions and practice in somatic hospitals].

Doctors have no general obligation to report injuries to patients to the hospital administration, and hospitals have no obligation to establish committees to evaluate the cases reported. Most hospitals, however, have defined their own internal rules for reporting cases, and have established committees. The number of cases reported are few, but the reporting practice differs from hospital to hospital. Not all committees do evaluate the cases, and most patients do not receive the results of the evaluation. In order to realize important goals of health policy, such as better quality assurance and better information to patients, most hospitals have much left to do. One way to initiate a better practice may be to establish a uniform system throughout and a legal obligation to report and evaluate injuries.

Accidents↗
PubMedDate not supplied

[Hospital care and school attendance. Experimental school attendance outside the hospital for children in a psychiatric department (author's transl)].

If school is a natural part of the world of childhood, hospital and disease may impose themselves. In that case, maintaining the child's relationship with the school environment becomes a problem. Schools have therefore been set up inside hospitals. The acceptance, by schools, of patients with chronic illness or incapacitation has been facilitated. We chose an intermediate answer in which, for a given child, the hospital and the school coexist, although they remain separate. Hospitalized children attend ordinary schools located near the hospital. Through the observations of three children, we describe the progression of our considerations about the effects of this practice. When a hospital department opens up to the outside world, both external and internal difficulties arise. We believe that the process by which this adventure is made possible and is carried out is part of the team work which gives the child, it's parents, and the medical staff, more autonomy, thereby helping the child to return to it's family.

Adolescent↗
PubMed1995

Implementation of the totally integrated hospital information system (Humane) in Osaka University Hospital.

On September 1, 1993, in the new Osaka University Hospital, we implemented a new hospital information system named "HUMANE" (Human oriented Universal Medical Assessment system by Network Environment). We had planned to organize a more effective and efficient medical care system in the new hospital and improve the medical services to patients. To succeed in constructing a totally integrated hospital information system, the original data must be entered. Most of it would be entered by doctors who are not accustomed to the operation of a computer system, thus the production of a good man-machine interface is indispensable. For this reason, we adopted a micro-medium-main frame link system for the system configuration. The interface program and the copy of the master data about each subsystem are located on the microframe. Although, all patient data is stored on the mainframe, most of the active patients' data is delivered to the mediumframe before the data is requested. This system design makes it possible to shorten the response time and to use a comfortable user interface. On the basis of this system configuration, we made subsystems that support hospital management, for example, an ordering system, a reporting system, a reservation system, a supporting system for hospitalization, a nurse supporting system, and so on. These systems promote automation control in each central service division; pharmacy, radiology, laboratory for clinical investigation and accounting section, resulting in man-power being saved. At the same time, medical service to patients is improved, because waiting time is shortened and redundant examinations or prescription are avoided.

Computer Systems↗
PubMed1985

Home intravenous antimicrobial therapy provided by a community hospital and a university hospital.

A home intravenous antimicrobial program that was implemented at both a private community hospital and a university hospital with a wide rural referral base is described. Over an 18-month period, 63 patients were screened and selected for home i.v. antimicrobial management according to stringent criteria. The hospital pharmacies and two home health-care companies were used as the central points for coordinating the preparation and distribution of drug products and providing specialty nursing services. Predischarge inhospital education for each patient was conducted by a pharmacist and a nurse. On-call pharmacists and nurses were available to monitor and assist the patients, and the patients were seen regularly by physicians during the period of home therapy. The 63 patients received a total of 1108 days of home i.v. antimicrobial therapy; the mean duration of therapy was 17.6 days. Heparin-lock peripheral cannulae were used for 51 patients, while 12 patients received their treatment through central-subclavian or Hickman catheters. Home i.v. antimicrobial treatment seemed to be as effective as comparable inpatient management for each type of infection. Drug- and i.v. catheter-related adverse effects were uncommon and seemed similar in type and frequency to those of hospitalized patients. The estimated cost savings per treatment course was $3,514 for a total net savings of $221,406 over the 18-month study period. Home i.v. antimicrobial treatment programs can be successfully implemented in both community-based and tertiary-care settings. Home therapy is a safe, efficacious, and cost-effective alternative to prolonged hospitalization for a variety of infectious diseases.

Anti-Infective Agents↗
PubMed1996

The effect of rural hospital closures on the financial performance of neighboring rural hospitals.

This study investigates how the closure of rural hospitals affected other rural hospitals. The empirical analysis examined whether being the neighbor of a closed rural hospital affected financial performance variables during the periods before and after closure. Before and after comparisons of surviving rural hospitals were made between 1985 and 1989 for closures in 1987 and between 1986 and 1990 for closures in 1988. The regression results showed that neighbors of closed rural hospitals typically did experience increased volume in comparison to non-neighbors, but the increased volume did not lead to reductions in average cost or to improved profitability, after controlling for other factors.

Cost Allocation↗
PubMed1980

Transfers from a general hospital psychiatric service to a state hospital.

The authors investigated the marked decline in the number of patients transferred from an inpatient service of a general hospital to a state hospital during a 30-month period. The major reasons for transfer were unmanageable behavior, high risk of suicide or homicide, administrative considerations, and unremitting or deteriorating course. They found that administrative concern about three factors--the many problems of patients likely to be transferred, staff anxiety, and the relationship between the general hospital and state hospital units--can facilitate the decline in the number of patients transferred to a state hospital.

Adolescent↗
PubMed1978

Hospital use of antimicrobial drugs. Survey at 19 hospitals and results of antimicrobial control program.

Costs and use of antimicrobial agents in 1976 at 19 hospitals were surveyed by review of pharmacy records. Total costs of antimicrobial drugs at individual hospitals ranged from $0.65 to $1.75 per patient day and accounted for 16% to 41% of total pharmacy drug costs. There was marked variation among hospitals in use of specific antimicrobial agents, especially cephalosporins and clindamycin. The cephalosporin and aminoglycoside antibiotics accounted for 66% of the total cost of antimicrobial agents. An 18-month antimicrobial drug control program at one hospital decreased antimicrobial drug costs by 31%. The major effect was in reducing cephalosporin use. The results of the control program document that a significant portion of hospital antimicrobial use is inappropriate and can be eliminated without apparent detriment to patient care.

Anti-Bacterial Agents↗
PubMed2003

[Working tools for hospital planning: application to the hospital of Lagny sur Marne].

The volume of use of beds and other goods and services provided by a hospital is evidently determined by the population of the hospital area, their morbidity, the competition from other hospitals inside and outside the area and so on. When building or renovating an hospital the decision maker needs to know the present situation and, more importantly, what will happen in the future. In general, relevant information on the present situation is lacking. However, the PMSI system, established in 1985 is now operational and provides sufficient basic information on the users and their needs. The article proposes several models for predicting future trends and assessing approximatively what will be seemingly required from the hospital in 20 or 30 years from now.

Adolescent↗
PubMed1988

Hospital-physician integration and hospital costs.

The integration of physicians into the management and policy-making structure of the hospital has been widely touted as necessary to achieve organizational efficiencies in a changing health care environment. This paper examines the implications of five such integrative strategies for hospital costs. Our findings indicate that greater administrative participation by physicians is consistently related to higher costs. We also found that other integrative strategies are associated with higher hospital costs in specific types of hospitals. We discuss the implications of our findings for hospital managers and policy makers.

Costs and Cost Analysis↗
PubMed1976

Hospital staffing and hospital costs.

A comparative study of costs per bed per day in teaching hospitals affiliated with Monash University compared with large non-teaching metropolitan hospitals (1964 to 1974) shows they are much higher in teaching hospitals. There is no evidence that this is due to the additional costs arising from the clinical schools. Research in the teaching hospitals and the accompanying high professional standards and demands on services are major factors accounting for the difference. Over the decade studied, the resident staff have increased by 77% and other salaried staff by 24%. The index of expenditure for the three teaching hospitals in the decade has increased by 386%.

Australia↗
PubMed1989

Diagnosis related group 'all payor' hospital payment and medical diseases. Financial risk and hospital cost in medical noncomplicating condition-stratified diagnosis related groups.

There are many health policy issues related to diagnosis-related group (DRG) hospital payment. Previous work by our group had suggested that some DRGs did not adequately comorbidities. Despite recommendations by federal advisory committees, the secretary of Health and Human Services has proposed no major changes to DRGs along these lines. We analyze resource consumption in any of the 88 non-complicating condition (CC)-stratified medical DRGs using the DRG prospective "all payor system" in effect at our hospital. Analysis of 12,340 medical patients by payor (Medicare, Medicaid, Blue Cross, and commercial insurance) in these non-CC-stratified medical DRGs for a three-year period demonstrated that patients with more CCs per DRG for each payor generated higher total hospital costs, a longer hospital length of stay, a greater percentage of procedures per patient, higher financial risk under DRG payment, and a higher mortality, compared with patients in these same DRGs with fewer CCs. These findings suggest that new prospective DRG all payor systems may be inequitable to certain groups of patients or types of hospitals vis-à-vis the non-CC-stratified medical DRGs. Health policy leaders should be encouraged to stratify many medical DRGs by the numbers and types of CCs to more equitably reimburse hospitals under DRG all payor systems.

Costs and Cost Analysis↗
PubMed1992

Information flow in the hospital: a comparative study of the Hungarian and the Dutch situation using a two axes model of hospital information flow.

This study compares the organization and structure of information flow in a Dutch and in a Hungarian hospital. The study was carried out as a field orientation part of a Health Care Management project of the Hogeschool van Amsterdam. The host of the field orientation was the BAZIS Foundation, the Central Development and Support Group Hospital Information System, Leiden. The visited hospitals were equipped with the BAZIS Hospital Information System. The method of study consisted of series of formalized interviews with all-level actors of a hospital; the interpretation of data was enhanced by a two axes (patient and management) model of information flow defined by the authors. In summary, Dutch hospitals show a more elaborate information flow system, with more information flow channels sideways among equal levels, less bureaucracy in organization of information flow, and significantly more benefits of automation, compared to the Hungarian situation.

Computer Systems↗
PubMed2006

[Patient- and hospital-related determinants of satisfaction with hospital stay of severely injured patients].

BACKGROUND: General political and legal changes in the German health care system will increase the importance of patient surveys. Patient satisfaction with medical and organizational care during their stay in a hospital is a relevant outcome of quality assurance. Satisfied patients also show a higher compliance with treatment and therefore increase the probability of a successful outcome. The objective of this analysis was to identify determinants of satisfaction with hospital stay of severely injured patients. METHODS: A written questionnaire was sent to 121 severely injured patients, who were predominantly hurt by traffic or work-related accidents and were treated between 1996 and 2001 in two hospitals in Cologne (response rate=74.4%, n=90). The questionnaire used in this study contained questions about psychosocial care of physicians and nurses in and organizational and structural characteristics of the hospital. RESULTS: Logistic regressions identified two significant predictors for satisfaction with hospital stay: (1) subjective evaluation of psychosocial quality of care by physicians and (2) patients' perception of active integration in treatment decisions. CONCLUSION: The results of this analysis confirm the importance of soft science in medical education also for surgeons. Medical education should integrate knowledge about psychosocial aspects of medicine. The quality of psychosocial care of physicians seems to be a predictor of patient satisfaction. The probability of dissatisfaction increases with deficits in communication, information, and time as well as no active integration in treatment. The results of this analysis confirm the vital importance of psychosocial aspects in physician-patient interactions with severely injured patients for satisfaction with stay in hospital.

Accidents, Occupational↗