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"If you do not have health insurance or you are unable to pay your hospital bill, you may qualify for assistance." What if you received life-saving treatment but didn't have [...]

Background: For patients admitted to hospital both pastoral care and privacy or confidentiality are important. Rules related to each have come into conflict recently in the US. Federal laws and other rules protect confidentiality in ways that countermand hospitals' methods for facilitating access to pastoral care. This leads to conflicts and poses an unusual type of dilemma--one of conflicting values and rights. As interests are elements necessary for establishing rights, it is important to explore patients' interests in privacy compared with their desire for attention from a cleric. Aim: To assess the willingness of patients to have their names and rooms included on a list by religion, having that information given to clergy without their consent, their sense of privacy violation if that were done and their views about patients' privacy rights. Methods and participants: 179 patients, aged 18-92 years, admitted to hospital in an acute care setting, were interviewed and asked about their preferences for confidentiality and pastoral support. Results: Most (57%) patients did not want to be listed by religion; 58% did not think hospitals should give lists to clergy without their consent and 84% welcomed a visit by their own clergy even if triggered from a hospital list. Conclusions: Values related to confidentiality or privacy and pastoral care were found to be inconsistent and more complicated than expected. Balancing the right to privacy and the value of religious support continue to present a challenge for hospitals. Patients' preferences support the importance of providing balance in a way that protects rights while offering comprehensive services.

Specialty hospitals are not a new phenomenon. Hospitals that focus specifically on care for women, children, cancer, rehabilitation, and long-term healthcare needs, among other types of specialty hospitals, have been [...]

"Financial measures are lag indicators that report on the outcomes from past actions. Exclusive reliance on financial indicators could promote behavior that sacrifices long-term value creation for short-term performance." --Robert [...]

Abstract. In recent years, the media has portrayed long-term care in a negative light, with expose news stories on skilled nursing facilities, personal care homes, and hospitals that provide long-term [...]

THE NUMBERS DO NOT PAINT A PRETTY PICTURE: Together, blacks, American Indians and Alaska Natives receive worse health care than whites for 40 percent of 44 quality measures studied by [...]

Payers often seem to be looking for ways to give new meanings to their provider contracts-meanings that were never addressed during the contract's negotiation and are not included in its [...]

Objective. To describe translation and cultural adaptation procedures, and examine the degree of equivalence between the Spanish and English versions of the Agency for Healthcare Research and Quality's (AHRQ) Consumer Assessments of Healthcare Providers and Systems (CAHPS[R]) Hospital Survey (H-CAHPS[R]) of patient experiences with care. Data Sources. Cognitive interviews on survey comprehension with 12 Spanish-speaking and 31 English-speaking subjects. Psychometric analyses of 586 responses to the Spanish version and 19,134 responses to the English version of the H-CAHPS survey tested in Arizona, Maryland, and New York in 2003. Study Design. A forward/backward translation procedure followed by committee review and cognitive testing was used to ensure a translation that was both culturally and linguistically appropriate. Responses to the two language versions were compared to evaluate equivalence and assess the reliability and validity of both versions. Data Collection/Extraction Methods. Comparative analyses were carried out on the 32 items of the shortened survey version, focusing on 16 items that comprise seven composites representing different aspects of hospital care quality (communication with nurses, communication with doctors, communication about medicines, nursing services, discharge information, pain control, and physical environment); three items that rate the quality of the nursing staff, physician staff, and the hospital overall; one item on intention to recommend the hospital. The other 12 items used in the analyses addressed mainly respondent characteristics. Analyses included item descriptives, correlations, internal consistency reliability of composites, factor analysis, and regression analysis to examine construct validity. Principal Findings. Responses to both language versions exhibit similar patterns with respect to item-scale correlations, factor structure, content validity, and the association between each of the seven qualifies of care composites with both the hospital rating and intention to recommend the hospital. Internal consistency reliability was slightly, yet significantly lower for the Spanish-language respondents for five of the seven composites, but overall the composites were generally equivalent across language versions. Conclusions. The results provide preliminary evidence of the equivalence between the Spanish and English versions of H-CAHPS. The translated Spanish version can be used to assess hospital quality of care for Spanish speakers, and compare results across these two language groups. Key Words. Survey translation and adaptation, patient survey, language equivalence, hospital care quality, Spanish-language survey, The United States is an increasingly diverse country where 45 million people, representing 18 percent of the population, speak a language other than English at home. Among the more than [...]

Every healthcare organisation (HCO) enacts a multitude of policies, but there has been no discussion as to what procedural and substantive requirements a policy writing process should meet in order to achieve good outcomes and to possess sufficient authority for those who are asked to follow it. Using, as an example, the controversy about patient's refusal of blood transfusions, I argue that a hospital wide policy is preferable to individual decision making, because it ensures autonomy, quality, fairness, and efficiency. Policy writing for morally controversial medical practices needs additional justification compared to policies on standard medical practices and secures legitimate authority for HCO members by meeting five requirements: all parties directed by the policy are represented; the deliberative process encompasses all of the HCO's obligations; the rationales for the policy are made available; there is a mechanism for criticising, and for evaluating the policy.

Key words: communication; critical care; effect size; evaluation; family satisfaction Abbreviation: CCFAP = Critical Care Family Assistance Program ********** The ICU of a hospital provides sophisticated medical mad nursing care [...]

Traumatic injury is the fifth leading cause of death in the United States and creates a substantial burden on society in terms of lost productivity, increased disability, as well as [...]

General guidelines must be set to understand innovation in hospitals. The quality of the services that are provided by the hospital and the principles that cause innovation in hospitals is studied.

AT A GLANCE * Physicians may refer patients to specialty facilities in which they have an ownership interest, and they have no qualms about doing so. * Specialty hospitals typically [...]

Hospital diversification and its impact on the operating ratio are studied for 168 hospitals during the period from 1999 to 2004. Diversification and the operating ratio are modeled in a [...]

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.amjmed.2005.02.012 Byline: LeRoi S. Hicks (a)(c)(d), John Z. Ayanian (a)(d), E. John Orav (a), Jane Soukup (a), J. Michael McWilliams (a), Sharon S. Choi (b), Paula A. Johnson (a)(b) Abstract: Little is known about the influence of processes of hospital care on racial and ethnic differences in experiences with hospital care. Author Affiliation: (a) Department of Medicine, Division of General Internal Medicine (b) Division of Women's Health (c) Brigham and Women's-Faulkner Hospitalist Program, Brigham and Women's Hospital (d) Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts

Nearly 30 years ago. Milton Friedman wrote There's No Such Thing as a Free Lunch. To which hospitals might respond, "Have you heard about health care, Milton?" Hospitals traditionally have [...]

A patient shows up at your hospital for a scheduled procedure. He tells the admitting clerk that he just lost his job and has no health insurance. A patient calls [...]

Hospitals are faced with a dilemma. An estimated 45 million Americans have no health insurance, and millions more have inadequate coverage that leads to difficulties in paying for health services. [...]

AT A GLANCE Hospitals shouldn't dismiss a primary care practice ownership strategy from the outset. Instead, it's important to learn from past missteps and conduct a thorough analysis of the [...]

Jeanne Musgrove is wrestling with how to prepare for a wave of cancer patients that may never arrive. As Piedmont Medical Center's oncology services director, Musgrove has heard local physicians [...]

There's a theory making the rounds in the emergency department at Children's Medical Center Dallas: "I'm not sure why it is," Dr. Thomas Abramo told me one morning last April […]

A hospital struggles when a joint venture with two long-term care (LTC) providers generates substantially less revenue than was projected. A second hospital is stung when several discharged patients complain [...]

This study examines factors determining hospital length of stay (LOS) for Medicare patients in the post-prospective-payment-system (PPS) era according to type of ownership, geographical region, bed size, and financial performance. [...]

This study examines the effectiveness of hospital-based wellness programs in lowering both the acuity of illness of patients and the total expenses of acute care hospitals from a strategic management [...]

In a recent report that summarizes the reasons that hospitals undertake construction projects, "operational efficiency and patient flow" are cited as the most common objectives (Carpenter 2004). Intuitively, improvements in [...]