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At least 127 records · Page 7Linked to original sources
PubMed1999

Health maintenance organizations and hospital quality for coronary artery bypass surgery.

This study uses hospital discharge data for 1992-1994 to assess differences between HMO and insured non-HMO patients in California and Florida with regard to the quality of the hospitals used for coronary artery bypass graft (CABG) surgery. The authors found that commercially insured HMO patients in California used higher quality hospitals than commercially insured non-HMO patients, controlling for patient distance to the hospital. In contrast, commercially insured HMO and non-HMO patients in Florida were similarly distributed across hospitals of different quality levels, whereas Medicare HMO patients in Florida used lower quality hospitals than patients in the standard Medicare program. The authors conclude that the association between HMO coverage and hospital quality may differ across geographic areas and patient populations, possibly related to the maturity and structure of managed care markets.

Aged↗
PubMed1980

Psycho-maintenance in asthma: hospitalization rates and financial impact.

Certain patient styles perpetuate chronic physical illness, defeat medical treatment, and increase the utilization of medical services. Two such extreme styles among asthmatic patients are indexed by the MMPI panic-fear scale, reflecting either (a) helpless dependency and anxiety, or (b) excessive inappropriate independence. The present findings indicate that both of these patient styles are related to excessively high hospitalization rates during the two 1-year periods after discharge from intensive treatment, even among patient groups having asthma of similar objective severity. The discussion centres upon the increased demand for medical services, and the need for early identification of patients whose personal styles contribute to the maintenance of illness.

Adolescent↗
PubMed1995

The political correctness of a physician hospital organization may precipitate its demise in a community hospital.

Health maintenance organizations are placing an increased pressure on physicians and hospitals to assume the risk of providing health care services under capitated agreements. They believe that if the providers' profits are based upon their cost-efficient provision of medical services, they will control their use of medical resources and reduce health care spending. Managing the risks of a capitated contract necessitates the integration of the hospital's and the physician's incentives. However, is the most appropriate legal structure that will enable physicians and hospitals to form risk-sharing contracts with managed care entities and manage these contracts profitably a physician-hospital organization? It is estimated that over 50 percent of the physician-hospital organizations that are created each year fail within the first two years of their operation because of political and financial reasons. A multispecialty group composed of select physicians, who are willing to integrate their practices and who have a low length of stay in the hospital, may be in a better position to manage the risks imposed by capitated contracts.

Attitude to Health↗
PubMedDate not supplied

Vascular access surgery for maintenance hemodialysis. Variables in hospital stay.

Access surgery in support of maintenance hemodialysis is a major factor contributing to prolonged hospitalization in the hemodialysis patient population. In surveying 140 consecutive patients admitted for access surgery, average length of stay was 14 days, independent of race or underlying cause of renal disease. Extended length of stay was most commonly encountered in older patients admitted for thrombosed fistulae or grafts. Postoperative fever, the need for repeated femoral catheterization, delay in access revision or placement due to infection, and the need for adequate social service support resulted in prolonged hospitalization. Understanding and preventing factors that prolong hospitalization may allow the minimization of length of stay in the future and improve quality of life for the end-stage renal disease patient, while also decreasing the cost of care.

Adult↗
PubMed1990

A personal computer-based maintenance management expert system for hospitals.

In this paper a Maintenance Management Expert System (MMES) is developed. This system is suitable for hospitals as well as for manufacturing organizations. This expert system consists of five sections. These are work order management, equipment management, craftsmen management, material and supply control, and monitoring of maintenance activities. In addition the MMES provides several reports that can be utilized for improving maintenance effectiveness.

Expert Systems↗
PubMed2005

Emotion work and boundary maintenance in hospital-based midwifery.

OBJECTIVE: To identify and explore the emotion work of hospital-based midwives. DESIGN: An ethnographic approach using focus groups, observations and interviews. SETTING: South Wales, UK. PARTICIPANTS: Phase one of the study: self-selected convenience sample of 27 student midwives in first and final years of 3-year (direct entry) and 18-month (post-nursing) programmes. Phase two: opportunistic sample of seven qualified hospital-based midwives. Phase three: Purposive sample of 10 hospital-based midwives working within one National Health Service Trust. Sample representative of a range of clinical locations, length of clinical experience and clinical grades. FINDINGS: The emotion work of midwives was strongly influenced by the context of practice. For hospital-based midwives, relationships with midwifery colleagues were of key importance, providing the main source of feedback on individual practice. Negotiating these relationships was a major source of emotion work. Although collegial relationships could provide support and affirmation, they were also a frequent source of conflict, particularly between junior and senior midwives. This discord was underpinned by conflicting ideologies of midwifery practice. KEY CONCLUSIONS: The theoretical framework of boundary maintenance was used to interpret the findings. Senior and junior midwives frequently held contradictory models of practice, resulting in competing claims for occupational jurisdiction. Midwives made use of a variety of devices in order to establish and maintain intra-occupational boundaries. Senior midwives attempted to maintain their position through unwritten rules and sanctions, supported by their claim to greater clinical expertise and experience. Junior midwives rarely challenged this authority; their responses were often subversive and designed to create an appearance of compliance. IMPLICATIONS FOR PRACTICE: These findings contribute to our understanding of inter-collegial conflict in UK midwifery, providing insights into workplace harassment and low staff morale, which are likely to exacerbate workforce attrition. The underpinning ideological dissonance experienced by midwives must be acknowledged and tackled for these issues to be effectively addressed.

Adult↗
PubMed1987

Extended state hospital treatment of severely impaired borderline patients.

Paradigms abstracted from the literature on hospital treatment of severely disturbed patients with borderline personality disorder are not adequate for extended treatment in state hospital settings. A new paradigm, based on Winnicott's concept of the holding environment, incorporates the development of a therapeutic environment in the hospital with the integrated use of mental health and other support services in the community. Treatment can succeed if three primary therapeutic tasks are accomplished, in three phases: the establishment of an adequate holding environment for the patient in the hospital, the maintenance of the hospital holding environment to foster limited structural change, and the transfer of the holding environment from the hospital to the community.

Adolescent↗
PubMed1991

The creation and maintenance of a hospital archives.

The libraries of the Capital Health System and York Hospital have been given the responsibility for collecting and maintaining the archival materials of their respective institutions. After an initial evaluation of donated items, each library researched methods of archival conservation, adapting them to their individual needs. Included in this article is an overview of these methods with many examples from the authors' experiences. Also included is an annotated bibliography of materials of value to anyone setting up a hospital archives.

Archives↗
PubMed1980

A study of hospitalized surgical patients on methadone maintenance.

It is possible that admission to hospital of methadone maintenance clients requiring treatment for pain with narcotics may result in an increase in methadone maintenance dose and affect subsequent rehabilitation of the client. The hospital admission itself may modify the subsequent outcome of the client. Fifty clients of a Methadone Maintenance Therapy Program were retrospectively evaluated. Twenty-five had been admitted to the Surgical Service of Bellevue Hospital, New York City, for a variety of conditions and for periods ranging from 2 to 43 days; twenty-five were not admitted to the Hospital. Irrespective of whether or not large amounts of narcotic analgesics had been added to the maintenance methadone, patients were discharged on the same amounts of maintenance methadone as on admission and had eventual courses and outcomes similar to the control group when followed for a mean period of 20 months.

Adult↗