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At least 1,711 records · Page 95Linked to original sources
PubMed1994

Quality of patient meal service in hospitals: delivery of meals by dietary employees vs delivery by nursing employees.

OBJECTIVE: To compare patient assessment of meal-service quality and employee-service orientation in hospitals where dietary employees deliver meals trays and in hospitals where nursing employees deliver meal trays. DESIGN: Survey. SETTING: General, medical-surgical (not Veterans Administration) hospitals of 300 to 500 beds with a self-operated foodservice department and a centralized, conventional food production system. SUBJECTS: 552 patients and 192 employees in nine hospitals geographically dispersed in the midwestern and eastern United States. Dietary employees delivered meal trays in five of the hospitals and nursing employees delivered trays in four. MAIN OUTCOME MEASURES: On a five-point scale, patients indicated level of agreement with 16 statements about hospital meal service. Employees who delivered meal trays rated their agreement with 20 service orientation statements on a five-point scale. STATISTICAL ANALYSIS: Factor analysis with varimax rotation, chi 2 analysis, and analysis of variance. RESULTS: Patient assessment of the quality of meal service was multidimensional. Patients gave more positive ratings to characteristics of the personnel delivering the tray than to the quality of the food. Patients in hospitals were dietary employees delivered meal trays rated the quality of food significantly higher (P < .01) than did patients in hospitals where nursing employees delivered trays. Service orientation of the personnel delivering the trays was also multidimensional. Dietary and nursing employees did not differ in their personal motivation toward providing service; however, dietary employees rated the organizational support for providing service significantly higher (P < .001) than did nursing employees. Nursing employees were significantly more positive (P < .05) than dietary employees about their interactions with patients. CONCLUSIONS: Patient perceptions of service quality differed in hospitals where dietary employees delivered meal trays and in those where nursing personnel delivered trays. Dietary and nursing employees differed in some aspects of their service orientation.

Adult↗
PubMed1988

Making difficult things easy: use of a relational data base for pharmacy management.

No one in the department was a proficient data base programmer. Yet we found that it was possible to learn Paradox in a very short time and apply it to many previously time consuming management problems. Some of the other applications we are working on are antimicrobial use data analysis, investigational drug use tracking, personnel records, publication indexing, drug information, clinical services tabulation, and work load statistics. Previously, we would not recommend the do-it-yourself approach when it was necessary to know a lot of technical details about programming. However, the ease and power of some of the new products leads us to change our minds. What was formerly a frustrating and boring aspect of management can be made into a creative challenge that can result in answers rather than in just more paper. Paradox is available from computer stores and it requires an IBM-compatible computer with at least 640K RAM. In addition, a 20+ megabyte hard disk is recommended.

Hospital Bed Capacity, 500 and over↗
PubMed1993

Candidature for hearing aids: justification for the concept and a two-part audiometric criterion.

A definition of hearing aid candidature is required for planning and other purposes. The number of candidates in the population actually receiving an adequate fitting would provide the major index of whether audiology services achieve their major public health goal. Many diverse factors determine the benefit that an individual receives from a hearing aid, and hence could in principle be included in some composite criterion for appropriate candidature reflecting the cost-effectiveness of patterns of provision. However, the complexity of universal capture, on those fitted with hearing aids, of data giving full auditory and demographic characteristics is beyond current routine NHS information systems. The most powerful known determinant established to date both of auditory disability and benefit is average hearing threshold level (HTL). Hearing threshold levels are hence both a necessary part of the fitting process and, given the data from the National Study of Hearing, a sufficient basis for computing population prevalences of hearing characteristics and service uptake in the major demographic strata. We report epidemiological data on consultation about problems with ears or hearing and uptake of hearing aids, which lead us to recommend a two-part candidature criterion on hearing threshold levels (0.5-4.0 kHz average): EITHER (a) better ear HTL > or = 35 dB OR (b) (15 dB < or = better ear HTL < 35 dB) WHEN worse ear HTL > or = 45 dB. The asymmetric component (b) may appear contentious, but is directly supported both by the epidemiological data and by further clinical data on benefit measured as performance on speech-in-noise tests. The proposed criterion is not over-liberal in clinical or related technological terms, but against the high prevalence of impairments in the population, the current provision and uptake of hearing aids in the UK still appear modest (about 3.3% in the population, and just under one-third of those qualifying by our criterion). Whatever the means of providing hearing aids, authorities charged with meeting the needs of their populations require such statistical indicators to know whether service delivery is appropriately geared. They should not use such an indicator as a basis of entitlement, as there are certainly individuals outside the criterion who receive benefit from their hearing aids. Equally, technological progress could expand the boundaries of candidature.

Adolescent↗
PubMed1976

VD education in developing countries. A comparison with developed countries.

No new method of control of the sexually transmitted diseases is imminent. Reliance has to be placed on existing methods including health education. Health education has a double role, being a primary method in its own right, and--of equal or greater importance--being involved in the enforcement of all of the other tried methods. A comparison is made of the situation in countries with a developed or an underdeveloped venereal disease control service, in respect of organization, statistical reporting, the various agencies treating venereal disease, clinic and diagnostic facilities, personnel concerned in venereal disease management, and other aspects. The vicious circle inherent in developing countries is outlined. A lack of awareness of the extent of the problem and the presence of other serious competing diseases lead to a low budget, thence to poor diagnostic and treatment facilities, and to few cases being seen in the official clinics and hospitals. Thus relatively small numbers of cases are reported and there is consequently a continuing lack of awareness of the problem. A method of cutting through such a circle is suggested, and the importance of health education activities during this period is emphasized.

Developing Countries↗
PubMed1979

Regression models of emergency medical service demand for different types of emergencies.

Second-order statistical regression models are developed for the rates of demand for different types of emergency medical services (EMS) as they relate to various socioeconomic, demographic, and other characteristics of a service area. The model parameters are estimated by the recent technique of ridge regression, which is shown to provide superior estimates to those of the ordinary least squares regression method, because of the presence of substantial multicollinearity (nonorthogonality) in the exogenous data set. The ridge results are also compared with those derived from a related Bayesian approach. The resulting models provide substantial fits to the empirical data for the EMS system of the city of Atlanta, GA.

Catchment Area, Health↗
PubMed2005

Surgeons' economic profiles: can we get the "right" answers?

Hospitals and payers use economic profiling to evaluate physician and surgeon performance. However, there is significant variation in the data sources and analytic methods that are used. We used information from a hospital's cardiac surgery and cost accounting information systems to create surgeon economic profiles. Three scenarios were examined: (1) surgeon modeled as fixed effect with no patient-mix adjustment; (2) surgeon modeled as fixed effect with patient-mix adjustment; (3) and surgeon modeled as random effect with patient-mix adjustment. We included 574 patients undergoing coronary artery bypass surgery at Baptist Medical Center, Oklahoma City, OK between July 1, 1995 and April 30, 1996. We found that profiles reporting unadjusted average surgeon costs may incorrectly identify high- and low-cost outliers. Adjusting for patient-mix differences and treating surgeons as random effects was the preferred approach. These results demonstrate the need for hospitals to reexamine their economic profiling methods.

Aged↗
PubMed1996

Medical and dental staffing in the National Health Service in Scotland in 1994.

The Scottish Office Home and Health Department (SOHHD) has, since 1980, published a regular series of articles on medical staffing in Scotland. The articles have taken the form of a series of tables provided by the Information and Statistics Division (ISD) of the Common Services Agency from the annual 'Medman' Census of Medical and Dental Staff in Scotland. Although the information given this year is similar to previous years, the format of some of the tables has been changed, and in particular primary care medical and dental manpower information is now included. Comparable medical and dental manpower statistics are regularly published for England and Wales. The background to the present manpower planning strategies have been summarized. In the publications 'Achieving a Balance: Plan for Action', the 'Shaw' Report, 'Hospital Medical Staffing in Scotland' and the Report of the Working Party on the UK Specialist Medical Training (the 'Calman' Report). In essence the strategy has sought to improve and reshape the pyramidal staffing structure of NHS hospitals by matching the number of doctors in the training grades more closely with career opportunities, and by expanding the consultant grade. As the reforms in Specialist Medical Training are introduced, the length of training is likely to be shorter, but more structured. Additionally the 'New Deal' to reduce junior doctors' hours of work is also having a significant impact not only on the hours worked by training grade doctors, but also on local patterns of staffing. There are, too, increased opportunities for flexible and part-time working. SOHHD and the Department of Health have both published recent reports on flexible and part-time working for doctors.

Adult↗
PubMed2004

Measuring community preferences for public mental health services: pilot test of a mail survey method.

This study tested the feasibility of a simple mail survey approach to measuring community preferences for mental health services. A 38 item survey detected statistically significant differences in preferences for four central goals, finding that community members most value Focus on the Severely Mentally Ill, followed by Community Safety and Environment, Service Quality and Original Community Mental Health Goals. Some procedural problems were encountered that reduced the response rates, however, the study yielded information that suggests improved procedures for future surveys. Simple mail surveys appear to offer a potentially affordable, efficient way to assess community service priorities.

Adult↗