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PubMed1979

Hospital case mix and average charge per case: an initial study.

The use of case mix to explain hospital costs has been refined in previous research on the cost of hospital-based health care. This study demonstrates the significance of hospital case mix in explaining charges for health care treatment. By assuming that the variables which influence cost should also influence charges, an evaluative function is added to the basic investigative analysis potential of the hospital production process model. The relationship between case mix and charges is found to be weaker than the relationship between case mix and costs. This difference is qualified by methodological variation and possibly explained by cross-subsidization of patient services and lack of adequate controls on charge determination. Further, the relationship between case mix and charges is found to differ between Medicare and Blue Cross patients. This evidence suggests that hospital accounting may not be recovering costs evenly and equitably from clients.

Blue Cross Blue Shield Insurance Plans↗

PubMed1978

Pharmacist-managed patient assessment and medication refill clinic.

The effectiveness of a pharmacist in determining the appropriateness of prescription renewal for patients appearing at a hospital-based refill clinic was investigated. In part 1, data were collected on the clinic as it traditionally functioned with staff physicians evaluating the patients. In parts 2 and 3, data were collected with the pharmacist assuming the assessment function. In part 2, a physician reviewed the pharmacist's decisions before the patient left. In part 3, the pharmacist functioned without supervision and the physician reviewed patient records retrospectively. Physician agreement with the pharmacist's decisions was the primary criterion for determining effectiveness, and was found to be 99% in part 2, for a total of 105 patients. In part 3, physician agreement remained at the 99% level for a total of 106 patients. Patient waiting time was about the same in each part of the study because of clinic procedures beyond the pharmacist's control. A pharmacist can be cost-effective in this role if the task is combined with regular pharmaceutical functions.

Cost-Benefit Analysis↗

PubMed1979

Heart risks identified by program.

Hospital-based cardiac stress test has permitted the identification of persons with serious risk of heart problems without the need for excessive costs.

Community-Institutional Relations↗

PubMed1979

A ladder curriculum in clinical microbiology.

A continuum of four microbiology courses for medical technology majors has been developed by the Medical Laboratory Science Program at Northeastern University. Using a system approach to curriculum design, the academic and clinical faculty identified career-entry capabilities, delineated appropriate subject content, and developed an instructional system which placed individual topics into one of four courses in the ladder curriculum: a basic, second-year, university-based clinical microbiology course stressing microbial technique and common organism identification; third-year microbiology and cellular physiology courses developing theoretical aspects; a fourth-year, hospital-based clinical microbiology rotation emphasizing isolation and identification techniques for significant pathogens; and a fourth-year, university-based, didactic course covering host defense-organism virulence interactions, infectious disease principles, and new techniques and unusual isolates as reported in the recent journal literature. Based on four years of experience with this system and in light of the publication of the 1978 American Society for Medical Technology (ASMT) Competency Statements, the Northeastern Medical Laboratory Science Program faculty is currently reexamining the continuum to insure completeness and appropriateness of overall subject content, to provide reinforcement, and to remove unnecessary duplication among the courses in the curriculum.

Certification↗

PubMed1979

Measuring hospital medical staff organizational structure.

Based on organization theory and the work of Roemer and Friedman, seven dimensions of hospital medical staff organization structure are proposed and examined. The data are based on a 1973 nationwide survey of hospital medical staffs conducted by the American Hospital Association. Factor analysis yielded six relatively independent dimensions supporting a multidimensional view of medical staff organization structure. The six dimensions include 1) Resource Capability, 2) Generalist Physician Contractual Orientation, 3) Communication/Control, 4) Local Staff Orientation, 5) Participation in Decision Making, and 6) Hospital-Based Physician Contractual Orientation. It is suggested that these dimensions can be used to develop an empirical typology of hospital medical staff organization structure and to investigate the relationship between medical staff organization and public policy issues related to cost containment and quality assurance.

Analysis of Variance↗

PubMed1975

Slide- tape sequence: a teaching aid in instrumentation.

A study at Wayne State University involving 34 medical technology students was conducted in an effort to provide supportive evidence for the use of selected audiovisual material in the teaching of instrumentation. The study did not conclusively demonstrate the effectiveness of a slide-tape sequence in this university instrumentation course. However, the methodology and evaluative procedures may prove helpful to universities and hospital-based programs in determining the usefulness of their audiovisual material.

Audiovisual Aids↗

PubMed1977

Rape: an organized approach to evaluation and treatment.

Rape is a rapidly spreading form of violence. The physician must examine and treat the victim and establish an adequate record for legal purposes. Treatment of the victim includes follow-up for late-emerging ego disruption and is greatly aided by employing the assistance of organized agencies such as a hospital-based Social Service or a Rape Crisis Center. It is also important that the victim receive adequate protection against venereal disease and pregnancy.

Female↗

PubMed1977

Cancer registries in Australia.

Cancer registries are at an early stage of development in Australia. Population-based registries are located in New South Wales Registry and Western Australia, and of these, only the New South Wales Registry is fully functioning. A hospital-based registry is maintained in Victoria. We have a national cancer registry in principle but it will not be functional for many years. Preliminary statistics for New South Wales indicate a cancer pattern similar to Caucasian populations. Some epidemiologic surveys have been undertaken.

Australia↗

PubMed1978

Health information for patients: The hospital library's role.

Libraries today, including most hospital-based patients' libraries, are involved only peripherally in providing patient health science information. Hospital libraries should collaborate with health professionals in getting health information to patients--along with the library's more traditional roles of providing recreational reading for patients and serving the informational needs of the physician and medical staff. The library should act as the center for educational materials and programs within the hospital. Many health agencies, health educators, physicians, and librarians have been discussing the need for patient health education, but there are few effectively organized or established education centers. This paper discusses an overview of patient health education and intellectural freedom, proposes a new role for the existing hospital library in patient health education, and suggests guidelines for establishing a patient education center.

Health Education↗

PubMed1978

AMTEC: a cooperative effort in medical technology education.

A committee in the St. Louis Metropolitan area has been established to promote communication and cooperation among the area's existing hospital-based programs in medical technology. Area Medical Technology Education Coordinators (AMTEC) was established three years ago primarily to facilitate the administrative functions of medical technology education and to serve as an instrument for the exchange of ideas. Its primary undertaking has been the central processing of applications to the area programs, as an aid in the admission process. In addition, a continuing education program sponsored by the committee has been established, and various "curriculum sharing" activities have been sponsored for the students enrolled in the schools. Future plans for the committee include sponsoring an on-going evaluation process of graduates by employers, and establishing a criterion-referenced question pool. The authors describe the experiences of the committee to date and plans for the implementation of future goals.

Medical Laboratory Science↗

PubMed1978

Improving physician performance by continuing medical education.

In 1973 the division of continuing medical education of the University of Saskatchewan initiated a 3-year study to determine the effect of hospital-based education on the prescribing accuracy of physicians. This study was undertaken in response to an urgent need to develop more effective methods of continuing medical education and improved techniques of measuring their effectiveness. The educational program focused on common prescribing problems that had previously been defined by experts in the field. Problem frequency was determined by the monitoring of hospital records prior to institution of the educational program and at 3, 6 and 12 months after the program had concluded; this was found to be a satisfactory method of identifying educational needs and is considered to provide a measure of the quality of medical care. Fifteen physicians at three rural hospitals participated in the study. Seventeen physicians at two similar hospitals served as controls. The average problem frequency for topics selected at the study hospitals was reduced by 63% (the percentage of possible improvement), whereas at the control hospitals the frequency of the same problems declined by 32% over the same period. The results of this study provide evidence that an intensive, problem-based program on therapeutics can improve physician performance.

Drug Prescriptions↗

PubMed1978

Cooperation between an academic subspecialty department and a community-based family medicine department: a developmental model.

While new, community-based family practice residency programs desperately need support from sister departments in academic centers, a variety of problems frequently prevents such cooperation. At the University of Wisconsin, Madison, the Department of Human Oncology, which is University Hospital-based, has worked to develop an appropriate educational program in oncology, together with and for the Department of Family Medicine and Practice, which is community-based. This paper, relating how and why these two departments have cooperated in this project, is presented to assist other departments in similar situations.

Family Practice↗

PubMed1978

There's more to patient care than medicine.

There is a side to patient care that goes beyond caring for physical complaints. Here the patient's psychological and spiritual needs are dealt with. At holistic health center, the attitude of caring for the whole patient is an essential ingredient of the care system. Because of the success of these centers, hospitals have become interested in establishing similar hospital-based models.

Adolescent↗

PubMed1978

Hospital child care center yields high dividends.

In an effort to reduce staff turnover and to improve employee morale, a medical center established an around-the-clock, hospital-based child care center. A developmental atmosphere is maintained in the center by establishing goals for each child enrolled in the program and monitoring each child's progress on a regular basis.

Child↗

PubMed1978

Auditing the quality of care of a crisis center.

The purpose of this paper is twofold: First, it defines and describes different types of audits and areas of patient care which lend themselves to a quality of performance review. Second, it describes an audit application at a hospital-based crisis intervention center and the corrective action taken on the basis of the findings. The major emphasis of the audit was to determine the quality of medical-psychiatric consultation and to develop criteria for its initiation.

Crisis Intervention↗

PubMed1978

Survey shows increase in hospital training programs.

A 1976 AHA survey has determined that the extent of hospital-based training programs for the allied professions has increased since 1973, when the previous survey was conducted. Both surveys depict the wide range of types of such programs offered by hospitals.

Allied Health Personnel↗

PubMed1978

Patient education in the community hospital.

Recent events have led to a favorable climate for the development of hospital-based patient education. A pilot model program in a community hospital is utilized to illustrate the variety of settings in which patient education is conducted, and includes: group classes, patient clubs, volunteer visits, individual instruction, community outreach, screening and detection programs, and behavior modification workshops. The use of television for inpatient education is highlighted in a discussion of media approaches and needs.

Audiovisual Aids↗

PubMed2026

Short-term aerobic exercise as an adjunct treatment for depression in acute geriatric psychiatry: Results of a randomized controlled trial.

BACKGROUND: This randomized controlled trial examined whether short-term aerobic exercise provided additional clinical benefit over an active control in older inpatients with depression in geriatric psychiatry. METHODS: 100 patients (mean age 76 years) were randomized to 2-week supervised aerobic ergometer training (intervention group, IG) or a flexibility program (control group, CG), both delivered in addition to treatment as usual (TAU). Adherence, training exposure and adverse events were recorded to assess feasibility. The primary outcome was clinical improvement measured with the Clinical Global Impression of Change (CGI). Secondary outcomes included depressive symptom severity assessed by the Beck Depression Inventory-II (BDI-II) and clinician-rated Hamilton Rating Scale for Depression (HAMD), physical activity, 6-min walk test (6MWT) performance, and fluoxetine-equivalent antidepressant dose (FLX). RESULTS: Thirty-nine participants attended at least 80% of sessions, with lower adherence in the IG. Weekly training duration differed between groups (74.0 ± 31.9 vs. 95.0 ± 25.3 min/week, p = .003). CGI did not differ between groups (IG: MD -0.31, 95% CI -0.67 to 0.05; p = .069). Depressive symptom severity decreased over time in both groups (p < .001), without significant between-group differences for HAMD (MD -0.22, 95% CI -2.55 to 2.12) or BDI-II (MD -0.62, 95% CI -3.68 to 2.45). 6MWT and FLX increased over time (both p < .001), without group differences (6MWT: MD -1.08 m, 95% CI -20.04 to 17.89; FLX: MD 5.69 mg/day, 95% CI -2.40 to 13.77). CONCLUSION: Short-term aerobic exercise was deliverable, but showed no additional clinical benefit over low-intensity flexibility during TAU. Further research should determine dose, duration and adherence for clinically relevant effects.

Humans↗