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PURPOSE Few studies have determined whether clinician usage of a community health information exchange (HIE) directly improves patient care transitions. We hypothesized that lookup in the HIE by primary care physicians of patients recently released from the hospital would increase the time until hospital reuse. METHODS We identified a retrospective cohort of 8,216 hospital inpatients aged over 18 years that were discharged from January 1, 2021 through November 30, 2021 using the Paso del Norte Health Information Exchange, in El Paso County, Texas. All patients had a primary care physician visit within 30 days after hospital discharge, and we identified patients that were looked up in the HIE close to that visit. Of the cohort, 2,627 were rehospitalized and 3,809 visited an emergency department (ED) during the follow-up window. The remaining 1,780 patients were controls. We conducted survival analysis, censoring at the second ED or inpatient visit or end of the study window (January 31, 2022). The model was adjusted by ethnicity, gender, insurance, and age. RESULTS Lookup in the HIE was significantly associated with reducing the likelihood of visiting the ED by 53% and being rehospitalized by 61%. Lookup in the HIE was associated with an increased median time to use of the ED after inpatient discharge from 99 to 238 patient days. Ethnicity, insurance, gender, and age were also significant predictors of hospital reuse. CONCLUSIONS Increased utilization of community HIEs by primary care physicians on behalf of their recently discharged patients may dramatically increase the time until inpatient or ED reuse. Key words: care transitions; community health information exchange; family medicine; hospital readmission, INTRODUCTION The health care system in the United States is markedly fragmented, with patients moving through levels and types of care that benefit when seamless transfers of information from one [...]

Objectives Although a number of early childhood development (ECD) interventions in healthcare settings in low- and middle-income countries (LMICs) have been developed to improve parent-directed outcomes and support ECD, their impact have yet to be established. This review assesses the effectiveness of healthcare-based ECD interventions in LMICs on the following key evidence-informed parenting outcomes affecting ECD: (1) responsive caregiving (2) cognitive stimulation and (3) parental mental health. Impacts on parental knowledge regarding ECD and parenting stress were also assessed. Methods PubMed, PsycINFO, Scopus, CINAHL and Embase were searched. We included randomized controlled trials reporting effects of healthcare-based ECD interventions in LMICs on parent-directed outcomes in the first five years of life. Data extraction included study characteristics, design, sample size, participant characteristics, settings, intervention descriptions, and outcomes. Meta-analyses were conducted using random effects models. Results 8 articles were included. Summary standardized mean differences demonstrated significant benefits of healthcare-based interventions in LMICs for improving: (1) cognitive stimulation (n = 4; SMD = 0.32; 95% CI: 0.08 to 0.56) and (2) ECD knowledge (n = 4; SMD = 0.44; 95% CI: 0.27 to 0.60). No significant effects were seen on maternal depression and parenting stress; only one study assessed parent-child interactions in the context of responsiveness. Limitations included small number of studies for moderation analysis, high heterogeneity, variability in measures used for outcomes and timing of assessments. Conclusions for practice Our results demonstrate statistically significant effects of healthcare-based interventions in LMICs on improving key evidence-based parenting outcomes and offers one promising strategy to support children reach their full developmental potential., Author(s): Reshma Shah [sup.1] , Andrea Camarena [sup.2] , Christen Park [sup.3] , Aleah Martin [sup.1] , Maureen Clark [sup.4] [sup.5] , Marc Atkins [sup.6] , Alan Schwartz [sup.1] [sup.5] [...]

Background: The knowledge gap regarding acute care resource use for patients with traumatic brain injury (TBI) impedes efforts to improve the efficiency and quality of the care of these patients. Our objective was to evaluate interhospital variation in resource use for patients with TBI, identify determinants of high resource use and assess the association between hospital resource use and clinical outcomes. Methods: We conducted a multicentre retrospective cohort study including patients aged 16 years and older admitted to the inclusive trauma system of Quebec following TBI, between 2013 and 2016. We estimated resource use using activity-based costs. Clinical outcomes included mortality, complications and unplanned hospital readmission. Interhospital variation was evaluated using intraclass correlation coefficients (ICCs) with 95% confidence intervals (CIs). Correlations between hospital resource use and clinical outcomes were evaluated using correlation coefficients on weighted, risk-adjusted estimates with 95% CIs. Results: We included 6319 patients. We observed significant interhospital variation in resource use for patients discharged alive, which was not explained by patient case mix (ICC 0.052, 95% CI 0.043 to 0.061). Adjusted mean resource use for patients discharged to long-term care was more than twice that of patients discharged home. Hospitals with higher resource use tended to have a lower incidence of mortality (r -0.347, 95% CI -0.559 to -0.087) and unplanned readmission (r -0.249, 95% CI -0.481 to 0.020) but a higher incidence of complications (r 0.491, 95% CI 0.255 to 0.666). Conclusion: Resource use for TBI varies significantly among hospitals and may be associated with differences in mortality and morbidity. Negative associations with mortality and positive associations with complications should be interpreted with caution but suggest there may be a trade-off between adverse events and survival that should be evaluated further. Contexte : Le manque de donnees sur l'utilisation des ressources en soins aigus chez les patients victimes d'un traumatisme cranien (TC) nuit aux efforts pour ameliorer l'efficience et la qualite de leurs soins. Notre objectif etait d'evaluer les variations quant a l'utilisation des ressources chez les patients victimes de traumatismes craniens entre les hdpitaux, d'identifier les determinants d'une grande utilisation des ressources et d'analyser le lien entre l'utilisation des ressources hospitalieres et les resultats cliniques. Methodes : Nous avons procede a une etude de cohorte retrospective multicentrique sur des patients ages de 16 ans et plus admis dans le systeme integre de traumatologie au Quebec apres un TC, entre 2013 et 2016. Nous avons estime l'utilisation des ressources a partir des couts bases sur les activites. Les resultats cliniques incluaient mortalite, complications et rehospitalisation non planifiee. La variation entre les hdpitaux a ete evaluee a l'aide de coefficients de correlation intra-classe (CCIC), avec des intervalles de confiance (IC) de 95 %. Les correlations entre l'utilisation des ressources hospitalieres et les resultats cliniques ont ete evaluees a l'aide de coefficients de correlation sur les estimations ponderees, ajustees en fonction du risque, avec des IC de 95 %. Resultats : Nous avons inclus 6319 patients. Nous avons observe des variations significatives entre les hdpitaux pour ce qui est de l'utilisation des ressources chez les patients ayant recu leur conge de l'hdpital et elle n'a pas pu etre expliquee par la clientele (CCIC 0,052, IC de 95 % 0,043 a 0,061). L'utilisation moyenne ajustee des ressources chez les patients transferes vers un etablissement de soins prolonges etait au-dela de 2 fois plus elevee que chez les patients ayant recu leur conge de l'hopital. Les hopitaux qui ont utilise davantage de ressources ont eu tendance a avoir une incidence moindre de mortalite (r -0,347, IC de 95 % -0,559 a -0,087) et de readmissions non planifiees (r -0,249, IC de 95 % -0,481 a 0,020), mais une incidence plus elevee de complications (r 0,491, IC de 95 % 0,255 a 0,666). Conclusion : L'utilisation des ressources pour les TC varie significativement d'un hopital a l'autre et pourrait etre associee a des differences de mortalite et de morbidite. Les associations negatives avec la mortalite et positives avec les complications devraient etre interpretees avec prudence, mais suggerent qu'il y aurait lieu d'analyser plus en profondeur le rapport entre evenements defavorables et survie., In North America, traumatic brain injury (TBI) is an important cause of mortality and disability for youth and older adults. (1,2) TBI is responsible for nearly half of all injury-related [...]

Objective To examine the effect of Medicaid managed care (MMC) versus Medicaid fee-for-service (FFS) on emergency department (ED) use and hospitalization during the first 6 and 12 months of life among low-birth-weight (LBW) infants. Methods We used the New York City Office of Vital Statistics-Statewide Planning and Research Cooperative System (OVS-SPARCS) dataset to identify 9135 LBW infants born to female Medicaid beneficiaries in New York City from January 2008-March 2012. We applied a robust regression discontinuity framework using a New York State Medicaid policy in effect at that time. This policy automatically enrolled infants born to female Medicaid beneficiaries to Medicaid managed care (MMC) or Medicaid fee-for-service (FFS) based on their birth weight (less than 1200 g vs. 1200-2500 g) during the first 6 months of their lives. Results LBW infants in MMC had an average 0.16% points higher probability of being hospitalized within the first year of their lives than those in Medicaid FFS (p-value = 0.04). Conclusions for Practice More research is necessary to understand possible differences in healthcare utilization between MMC and FFS participants with high health risks., Author(s): Sze Yan Liu [sup.1] [sup.2] , Sungwoo Lim [sup.2] Author Affiliations: (1) grid.260201.7, 0000 0001 0745 9736, Department of Public Health, Montclair State University, , Montclair, NJ, USA (2) [...]

Recent years have seen considerable increases in both the demand for, and complexity of, ventral hernia repairs. This has led to calls for abdominal wall surgery to become a recognized subspecialty in the United States and Europe, with some centres responding by forming specialized, multidisciplinary teams for abdominal wall reconstruction. At present, however, no Canadian city has followed suit. In this article, we outline the major arguments underlying the drive toward the centralization of complex abdominal wall services., To justify the subspecialization of a branch of surgery, namely abdominal wall surgery, it is necessary to show an advantage to doing so for as many of the affected parties [...]

The rapid increase of extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae has challenged healthcare facilities worldwide regarding implementation of effective infection-control measures to limit further nosocomial spread (1). The benefits of routine enforcement [...]

The Ebola virus disease (EVD) epidemic during 20142015 led hospitals worldwide to prepare for the triage and admission of Ebola virus (EBOV)-infected patients (1). During the fall of 2014, the [...]

(1) Assess the accuracy of public health data sources used to investigate primary late preterm cesarean delivery (PLPCD) and (2) compare differences in data accuracy by hospital PLPCD rate classification. This analysis uses data from the Florida Investigation of Late Preterm and Cesarean Delivery (FILPCD), an investigation of singleton, PLPCD's that occurred from 2006 to 2007 in hospitals classified with either a low or high PLPCD rate (high rate 39.4-58.3%, low rate 11.9-25.1%). Three data sources were validated with maternal medical records: birth certificates, hospital discharge data, and combined birth certificate and hospital discharge data. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa values were calculated. A summary measure of kappa values was compared by hospital PLPCD rate classification using the paired sample Wilcoxon signed rank test. Large variations in accuracy of data elements were found by hospital PLPCD rate classification, with low PLPCD rate hospitals demonstrating higher overall data accuracy. The summary measure of agreement was significantly higher for low PLPCD rate hospitals compared to high PLPCD rate hospitals (0.60 vs. 0.50, p < 0.01). Accurate estimates of CD and late preterm birth are vital for public health practitioners and policy makers who seek to address the growing concern over recent increases in CD and late preterm birth. Understanding the potential for systematic differences in reporting accuracy by hospital PLPCD rate is important to data quality improvement efforts. Keywords Birth certificate * Hospital discharge data * Validity * Accuracy * Cesarean, Introduction The rate of cesarean delivery (CD) in the United States has increased for 11 consecutive years [1]. In 2009, the CD rate in Florida was higher than the national [...]

Abstract The acute hospital setting is increasingly regarded as an important area for the delivery of palliative care. A significant number of patients with advanced, life-limiting illness have a range [...]

This article reviews a study in which distal forearm fractures in children were treated with a below elbow semi-rigid cast, with instructions for removal at home. Patient satisfaction surveys established that children and parents were pleased they did not have to return to hospital to have the cast removed, and most patients returned to normal activity immediately or within one week after removing the plaster at home. Although semi-rigid casts are slightly more expensive to apply than standard plaster, the authors believe this is outweighed by the advantages of patients not having to return to the fracture clinic. Hospital clinics were significantly less busy, allowing them to create slots for new referrals. Keywords Children: accidents, fractures, semi-rigid casts, DISTAL FOREARM fractures in children make up a large proportion of fracture clinic workload, being the most common of type of fracture with a reported incidence of 30 per cent [...]

There are approximately 2.6 million people with diabetes in the UK, with the number expected to rise to over 4 million by 2025 (Diabetes UK, 2010a). As this number increases, [...]

The study attempts to estimate racial differences in survival for patients following in-hospital cardiac arrests and the factors associated with it. The results indicate that African-American patients were less likely to survive discharge as compared to white patients and also that most of the racial differences were associated with the hospital in which African-American patients received care.

People with learning disabilities have increased health problems compared with the general population but they often experience poor quality care in mainstream health services. Two north London boroughs worked in [...]

Summary Infection presents a significant risk for immunocompromised patients. To reduce this risk, various precautions can be implemented and these may affect patients' quality of life. Such precautions are controversial, [...]

This longitudinal health services study (N = 733) (1) examines the impact of services received on 6-month outcomes, and (2) compares day-hospital to residential programs on services received. Services were measured at 2, 4, and 8 weeks postbaseline using a version of the Treatment Services Review. Higher odds of total sobriety at 6 months were associated with greater participation in (a) extracurricular (but not curricular) 12-step meetings, (b) sober recreational events, and (c) educational sessions. Program effects also emerged. Unexpectedly, extracurricular 12-step meeting attendance and the odds of having a sponsor were lower among residential (vs. day hospital) participants through 4 weeks, despite higher participation in curricular 12-step meetings among residential participants at 2 weeks. Still, residential participants reported higher involvement in sober recreation and informal peer socialization across most analyses. Findings suggest that residential and day-hospital programs might maximize outcomes by facilitating optional 12-step involvement and sober recreation, respectively. Keywords: Services received; Treatment components; 12-Step; AA; Sober recreation

In the first Irish study to examine a hospital-based bereavement care program, I year's cohort of bereavedpeople was surveyed. A response rate of over 40% provided 339 completed questionnaires flora bereaved next-of-kin. The findings suggest that a tiered pyramid model of bereavement care (the Beaumont model) may be functional in a number of ways. The outreach aspect of the service is successful in providing additional support and information through telephone and postal contact to people at a distance or with mobility difficulties. Those bereaved by sudden death are twice as likely to access the service as those for whom death was expected. These, and other findings, are discussed.

Byline: Erik Jan Lieshout (1,2), Rien Vos (3), Jan M. Binnekade (1), Rob Haan (3), Marcus J. Schultz (1,4), Margreeth B. Vroom (1) Keywords: Transportation ofpatients; Patient transfer; Interhospital transfer; Critical care; Questionnaire; Conjoint analysis Abstract: Objective This study assessed the relative importance of clinical and transport-related factors in physicians' decision-making regarding the interhospital transport of critically ill patients. Methods The medical heads of all 95 ICUs in The Netherlands were surveyed with a questionnaire using 16 case vignettes to evaluate preferences for transportability 78 physicians (82%) participated. The vignettes varied in eight factors with regard to severity of illness and transport conditions. Their relative weights were calculated for each level of the factors by conjoint analysis and expressed in [beta]. The reference value ([beta]a-=a-0) was defined as the optimal conditions for critical care transport a negative [beta] indicated preference against transportability. Results The type of escorting personnel (paramedic only: [beta]a-=a---3.1) and transport facilities (standard ambulance [beta]a-=a---1.21) had the greatest negative effect on preference for transportability. Determinants reflecting severity of illness were of relative minor importance (dose of noradrenaline [beta]a-=a---0.6, arterial oxygenation [beta]a-=a---0.8, level of peep [beta]a-=a---0.6). Age, cardiac arrhythmia, and the indication for transport had no significant effect. Conclusions Escorting personnel and transport facilities in interhospital transport were considered as most important by intensive care physicians in determining transportability. When these factors are optimal, even severely critically ill patients are considered able to undergo transport. Further clinical research should tailor transport conditions to optimize the use of expensive resources in those inevitable road trips. Author Affiliation: (1) Department of Intensive Care Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105a-AZ, Amsterdam, Netherlands (2) Mobile Intensive Care Unit, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105a-AZ, Amsterdam, Netherlands (3) Clinical Epidemiology, Biostatistics and Bioinformatics, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105a-AZ, Amsterdam, Netherlands (4) Laboratory of Experimental Intensive Care and Anesthesiology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105a-AZ, Amsterdam, Netherlands Article History: Registration Date: 22/01/2008 Received Date: 15/07/2007 Accepted Date: 17/01/2008 Online Date: 19/02/2008

75 Beliefs About Hospital Diabetes and Perceived Barriers to Glucose Management Among Inpatient Midlevel Practitioners SAGE Publications, Inc.200810.1177/0145721707311957 Curtiss B.Cook MD Division of Endocrinology, Mayo Chinlc, cook.curtiss@mayo.edu Kimberly A.Jameson Division [...]

Keywords: quality of care; rural hospitals; education; rapid-cycle quality improvement Article note: *The 'Critical Access Hospital' (CAH) designation was added to the classes of Medicare providers following recognition that, with [...]

Abstract Breastfeeding makes a vital contribution to the health and development of babies, as well as to long term health. Establishing breastfeeding may not be easy even for mothers with [...]

Abstract Increased pressure on paediatric facilities and increased demands on staff at a district general hospital led to the development of a paediatric high dependency facility. The objective of the [...]

The relationship between free-standing ambulatory surgery centers (ASCs) and hospital surgery volume is analyzed. ASCs are health care facilities that specialize in providing surgery services in an outpatient setting. Results show that the number of ASCs did not affect the number of hospital inpatient procedures.

The study was conducted to determine the relationship between prescription drug coverage for Medicare beneficiaries, and lower expenditure for hospital services. Results show that drug coverage does not necessarily affect Medicare spending for hospital or physician services, although drug coverage increases expenditures on medications.

Objective: To determine how often and for what reasons a hospital-based multidisciplinary child abuse team concluded that a report of alleged or suspected child abuse was unnecessary in young children with fractures. Methods: A retrospective review was completed of all children less than 12 months of age who, because of fractures, were referred to the hospital multidisciplinary child abuse team for consultation regarding the need to consider child abuse. Results: The team received 99 consultations, reported 92 (93%) children as alleged or possible victims of physical abuse, and did not report 7 (7%). Age at presentation of those who were reported was 4.2 months compared to 3.0 months in the non-reported group. The average number of fractures in the reported group was 2.9 (SD 3.53) compared to 3.4 (SD 4.6) in the non-reported group. Factors that led to cases not being reported included: (a) a trauma history consistent with the fracture (n = 4), (b) a diagnosis of bone fragility secondary to genetic, nutritional or medical therapy etiologies (n = 2), and (c) iatrogenic fracture (n = 1). Conclusions: Seven percent of the children less than 12 months of age and with at least one fracture referred to the multidisciplinary team for evaluation of possible child abuse were not reported as alleged or suspected physical abuse. The involvement of the hospital multidisciplinary child abuse team may have prevented unnecessary investigation by the county social services agency and/or police, and possible out-of-home temporary placement. Keywords: Multidisciplinary child abuse team; Fractures; Physical abuse; Reporting doi:10.1016/j.chiabu.2006.12.010

OBJECTIVE: To examine the extent to which US acute care hospitals have adopted recommended practices to prevent central venous catheter-related bloodstream infections (CR-BSIs). PARTICIPANTS AND METHODS: Between March 16, 2005, [...]

Aim: This study describes the impact of HIV/AIDS on the inpatient service of the main teaching hospital in Cameroon in 2001. Methods: The authors analyzed routinely collected hospital data and [...]

We examine how hospital treatment intensity is affected by an exogenous change in average reimbursement for an admission. Theory predicts that treatment intensity would be most affected for highly profitable services but unaffected for unprofitable services. We use Medicare inpatient data from 11 states for 16 disease categories that vary in the generosity of reimbursement to test this prediction. Using the coefficients from quantile regressions, we calculate a difference-in-difference estimate of the effect of the Balanced Budget Act (BBA) of 1998, comparing the pre- and post-BBA change in treatment intensity at high Medicare share hospitals to low Medicare share hospitals. We find that not-for-profit hospitals cut treatment intensity at the 50th, 75th, and 95th quantiles only for generously reimbursed services. Intensity at the 25th percentile was unaffected, regardless of generosity. We did not measure a statistically significant response at for-profit or public hospitals to the BBA. JEL Classification: I11, I18, L3, 1. Introduction We examine how an exogenous change in the average reimbursement of a hospital admission affects within-hospital treatment intensity. Treatment intensity has been shown to be correlated with the [...]

Purpose. To assess the impact of pandemic influenza on hospital services. Methods. Based on census data and estimates of hospital resources (non-ICU [intensive care unit] beds, ICU beds, and mechanical [...]

Through a series of interviews and a literature review this paper uncovers the key sources of motivation among employees in hospitals in Singapore. The study examines the use of several non-monetary rewards Singaporean managers can rely on to motivate their employees in service industries. One vital finding of this study is that there should be value congruence and person/environment-fit. Keywords Motivation * Singapore * Hospital employees * Monetary rewards Non-monetary rewards * Value congruence

Assessment of quality in health care delivery plays an increasingly prominent role in contemporary medical practice and selected care processes are increasingly being used to measure hospital quality, however, data regarding the association between hospital process performance and outcomes are limited. Government agencies, professional societies, accreditation organizations, and major insurers all have published sets of performance indicators.

Reports from the Food and Drug Administration (FDA) and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) have emphasized the potential for injury to patients caused by failures in [...]

ABSTRACT A web-based decision support system (DSS) can provide management with a strategic plan for business process reengineering (BPR) in a health-care system. An attempt is made to develop a [...]

The affiliations between hospitals and physicians and their positive effects on health care prices in California are discussed.

The benefits of integrating hospitals and physicians services for better transaction cost reduction are discussed.

Keywords * Outpatient's department * carers * communication These keywords are based on the subject headings from the British Nursing Index. This article has been subject to a double-blind review. [...]

A study of hospital services to measure the overall efficiencies of decision-making unit using data envelopment analysis method is presented.

Consumer spending on prescription drugs in United States has increased tremendously. This trend is due to the increased preference of newer drugs. Research done on antipsychotic drugs to know if this drug spending has reduced the demand for hospitalizations and other health care services indicates that this trend has not influenced the other kinds of medical care.