This study analyzes the effect of episode-of-care payment and patient choice on waiting time and the comprehensive quality of hospital care. The study assumes that two hospitals are located in two cities with different population sizes and compete with each other. We find that the comprehensive quality of hospital care ...

Abstract Background: Breastfeeding initiation and duration increase because of physician encouragement. However, many physicians have not received education on breastfeeding, and some may not have a supportive attitude or commitment to breastfeeding. Patients identify dissatisfaction with their current provider as a motivating factor in seeking health information on the Internet. ...

In late 19th century Paris, people with epilepsy were treated alongside those with hysteria in the now famous Salpêtrière Hospital, where both conditions were deemed to have a neurological basis. When Jean Martin Charcot became chief physician at the Salpêtrière Hospital in 1862, he described himself 'in possession of a ...

Abstract Crimean-Congo hemorrhagic fever (CCHF) is a tick-borne infection which has been increasing in Turkey and European countries since the year 2000. The disease is particularly endemic in the Middle East and in some African countries. It is also seen in European countries as a travel infection. Patients with confirmed ...

IntroductionThere has been limited research on the perspectives and needs of national caregivers when confronted with large-scale societal violence. In Iraq, although the security situation has improved from its nadir in 2006-2007, intermittent bombings, and other hostilities continue. National workers remain the primary health resource for the affected populace.ProblemTo assess ...

Clinical audit has an important role as an indicator of the clinical practice in a given community. This European Respiratory Society COPD audit was designed as a pilot study to evaluate clinical practice variability as well as clinical and organisational factors related to outcomes for COPD hospital admissions across Europe.The ...

The journey toward Baby-Friendly status at Jersey Shore University Medical Center in Neptune, NJ began with a desire to improve overall breastfeeding rates at the hospital. Although evidence showed that hospitals that incorporated some or all of the Ten Steps to Successful Breastfeeding had improved breastfeeding rates, it was difficult ...

BACKGROUND:In this feasibility study, we tested whether prehospital diagnostic stroke workup enables rational decision-making regarding treatment and the target hospital in persons with suspected stroke. METHODS:A mobile stroke unit that delivers imaging (including multimodal brain imaging with CT angiography and CT perfusion), point-of-care-laboratory analysis, and neurologic expertise directly at the ...

OBJECTIVE: Hospitalization is a critical component of treatment for individuals with serious and persistent mental illness. Despite its resource intensity, the costs of inpatient psychiatric hospitalizations in the United States are not well understood. The objective of this research was to provide cost estimates for inpatient psychiatric care. METHODS: Using ...

INTRODUCTION: This study investigated acute treatment costs and related factors for traumatic brain injuries (TBI) in eastern China based on a prospective multicentre study. MATERIALS AND METHODS: Data were prospectively collected from 80 hospitals in eastern China by standardized structured questionnaires during 2004. Included patients were admitted to hospitals via ...

IntroductionThe Cochrane Library is the most important online evidence retrieval database of systematic reviews. Since 2007, the National Health Research Institutes has offered Taiwan's regional hospitals free access to the Cochrane Library. This study investigated how these hospitals disseminate its utilisation.MethodsThe usage rate of Cochrane reviews was measured in the ...

Since 2007, the Minnesota Hospital Association (MHA) has developed, managed, and promoted a statewide fall and injury reduction program to reduce inpatient falls and injuries, SAFE from FALLS. Because of statewide success in reducing falls from 2007-2010, the MHA set the goal in 2010 to eliminate serious fall-related injuries, especially ...

OBJECTIVE: To describe hospital-based physicians' responses to patients' verbal expressions of negative emotion and identify patterns of further communication associated with different responses. METHODS: Qualitative analysis of physician-patient admission encounters audio-recorded between August 2008 and March 2009 at two hospitals within a university system. A codebook was iteratively developed to ...

BACKGROUND: Enhanced oral (po) bioavailability of antimicrobial drugs allows conversion to po therapy once a patient meets defined clinical criteria. This can reduce length of hospital stay, healthcare costs and risk of complications related to intravenous (iv) access. We developed a quality indicator for assessing the appropriate iv-to-po switch of ...

INTRODUCTION: Prenatal decision making during extremely preterm labor is challenging for parents and physicians. Ethical and logistical concerns have limited empirical descriptions of physician counseling behaviors in this setting and constricted opportunities for communication training. This pilot study examines how simulation might be used to engage neonatologists in reflecting on ...

OBJECTIVE: Hepatitis B virus (HBV) infection is a highly endemic disease in China. The guidelines of the European Association for the Study of the Liver and the Asian Pacific Association for the Study of the Liver have improved in recent years. Here, we present a survey of physicians in terms ...

OBJECTIVE: Previous research in primary care has shown that physicians are more informative and/or patient-centered when they interact with high participation patients (e.g., those who ask questions, express preferences and concerns). This study contributes to this literature by examining parents' participation and physicians' discourse in a pediatric surgery context. METHODS: ...

IntroductionWe have established one model for community care of glaucoma clinic patients. Community optometrists received training and accreditation in glaucoma care. Once qualified they alternated between running half day glaucoma clinics in their own High Street practices and assisting in a hospital-based glaucoma clinic session. This paper reports the cost ...

The Society for Vascular Surgery (SVS) Vascular Quality Initiative (VQI) is designed to improve the quality, safety, effectiveness, and cost of vascular health care. It uses the structure of a Patient Safety Organization to permit collection of patient-identified information but protect benchmarked comparisons from legal discovery. The SVS VQI is ...

There is an inherent tension between the training needs of inexperienced clinicians and the safety of the patients for whom they are responsible. Our society has accepted this tension as a necessary trade-off to maintain a competent workforce of physicians year after year. However, recent trends in medical education have ...

The Medicaid Recovery Audit Contractors (RAC) program is going to be a challenge for hospitals because each state has a different set of rules, different auditors, and different appeals processes. Since Medicaid agencies are always short of funds, the auditors are likely to be aggressive. Case managers must review all ...

Baylor Health Care System's Patient Transfer Centers gives community hospitals a central number to call when they want to transfer patients into the Baylor system. RNs staff the center and obtain clinical information from the sending hospital. They make sure beds, and an admitting or consulting physician, are available. Process ...

Hereditary angioedema (HAE) is an autosomal dominant disorder characterized by decreased expression or loss of function of C1 esterase inhibitor (C1-INH). In 2010, international guidelines were published regarding the management of both acute HAE attacks and prophylactic treatment. Additionally, several clinical trials for HAE therapies were published in 2010. The ...

A total of 17 cases of penetrating neck injury were managed by the otolaryngology team at King's College Hospital over a 3-year period in the 1980s. In April 2010 King's College Hospital became the major trauma centre for South East London. This prospective cohort study compares the incidence, changing demographic ...

Team-based performance sharing (TPS) is a tool that hospitals can use to achieve higher levels of performance by tapping into innovative thinking within a unit's staff regarding opportunities to improve performance. In a recent pilot implementation of TPS, employees were able to share in the financial gains from recommended and ...

Many elderly patients are hospitalized and discharged to skilled nursing facilities (SNF) for rehabilitation. OBJECTIVES: To examine potential risk factors for rehospitalization of SNF rehabilitation patients. DESIGN: Retrospective review of rehabilitation charts. SETTING: 114 SNF rehabilitation beds at a 514 bed urban, academic nursing home that receives patients from tertiary ...

BACKGROUND: Second medical opinions have become commonplace and even mandatory in some health-care systems, as variations in diagnosis, treatment or prognosis may emerge among physicians. OBJECTIVE: To evaluate whether physicians' judgment is affected by another medical opinion given to a patient. DESIGN: Orthopedic surgeons and neurologists filled out questionnaires presenting ...

ABSTRACT: BACKGROUND: Since 2005, Kenyan medical universities have been training general practitioners, providing them with clinical, management, teaching and research skills, in order to enhance access to and quality of health care services for the Kenyan population. This study assesses what expectations family physicians, colleagues of family physicians and policy ...

ABSTRACT: BACKGROUND: In Mexico 87% of births are attended by physicians. However, the decline in the national maternal mortality rate has been slower than expected. The Mexican Ministry of Health's 2009 strategy to reduce maternal mortality gives a role to two non-physician models that meet criteria for skilled attendants: obstetric ...

INTRODUCTION: Choosing the right burn patient that transfers to a rehabilitation facility following acute hospitalization is a difficult decision. In our study we characterize demographic, injury and hospitalization related variables that predict a burn patient's transfer to a rehabilitation facility. METHODS: We analyzed the data of 974 burn patients with ...

PURPOSE: To compare the performance of U.S. teaching and nonteaching hospitals using a portfolio of contemporary, publicly reported metrics. METHOD: The authors classified acute care general hospitals filing a Medicare Institutional Cost Report according to teaching intensity: nonteaching, teaching, or Council of Teaching Hospitals member. They compared aggregate results across ...

As more physicians adopt electronic health record systems in their practices, policy interest is focusing on whether physicians are ready to meet the federal "meaningful use" criteria-a vital threshold to qualify for financial incentives. In our analysis of a 2011 nationally representative survey of office-based physicians, we found that 91 percent ...

OBJECTIVE: To assess the structure and process of stroke rehabilitation in Nebraska hospitals. DESIGN: Cross-sectional mail survey using the Dillman tailored-design method of administration. SETTING: Hospitals in Nebraska. PARTICIPANTS: Approximately 77% of the 84 Nebraska hospitals that provide stroke rehabilitation are Critical Access Hospitals (CAHs) that are limited to 25 ...

OBJECTIVE: The Danish hospital sector faces a significant rebuilding program driven by recent regional reform and guidelines for acute admission hospitals. Within the next 5-10 years, the number of public hospitals offering acute admission will be reduced from 35 to approximately 20 larger hospitals. As the administrative data may be ...

Drug users are marginalized from typical primary care, often resulting in emergency department (ED) usage and hospitalization due to late-stage disease. Though data suggest methadone decreases such fragmented healthcare utilization (HCU), the impact of buprenorphine maintenance treatment (BMT) on HCU is unknown. Chart review was conducted on opioid dependent patients ...

In 2007, the use of a new therapeutic association that included two expensive drugs (bevacizumab and irinotecan), used in second line treatment for progressive glioblastoma, led to the increase of the monitoring and self-evaluation of the medical prescriptions. Methodological tools have been designed by neuro-oncologists together with pharmacists of the ...

Stroke is the leading cause of disability in adulthood, and the principal aim of care in cerebrovascular disease is the reduction of this negative outcome and mortality. Several studies demonstrated the efficacy of thrombolytic therapy in ischemic stroke, but up to 80% of cases could not be treated because the ...

Euthanasia and physician assisted-suicide are terms used to describe the process in which a doctor of a sick or disabled individual engages in an activity which directly or indirectly leads to their death. This behavior is engaged by the healthcare provider based on their humanistic desire to end suffering and ...

OBJECTIVE: 1) To evaluate the tuberculosis (TB) related financial burden of patients and health care providers over the course of diagnosis and treatment by choice of directly observed treatment (DOT); and 2) to examine treatment outcomes for different DOT programmes in Cambodia.SETTING AND DESIGN: Subjects were patients diagnosed with smear-positive ...

ACCESSIBLE SUMMARY: •  A key role of nursing staff in high secure hospitals is responding to patients' aggressive behaviour. •  Attitudes of staff in high secure hospitals may influence how they respond to patient aggression. •  Patients will have their own attitudes towards aggression and how it should be managed. ...

Hospital discharge planning for older adults is an essential component to successful transitional care and will become increasingly important as hospitals face financial penalties for avoidable readmissions. This study reports a cross-sectional descriptive web-based survey study about challenges to discharge planning experienced by hospitals in the Midwestern state of Missouri. ...

An increasing amount of evidence supports the use of cytoreductive surgery and heated intraperitoneal chemotherapy (HIPEC) for the treatment of select patients with carcinomatosis. The care of such patients is optimal at centers where physicians with expertise in the recognition, treatment, and follow-up of carcinomatosis collaborate to manage issues particular ...

Mandatory infectious disease consultation for parenteral antimicrobials at hospital discharge resulted in avoiding postdischarge parenteral antimicrobials in 28% of patients. No emergency department visit or rehospitalization within 30 days for these patients was a consequence of parenteral antimicrobial avoidance. Antimicrobial stewardship at transition of care is effective in reducing unnecessary ...

: Standardized discharge criteria are considered valuable to reduce the risk of premature discharge and avoid unnecessary hospital stays. The most appropriate criteria to indicate readiness for discharge after colorectal surgery are unknown. : The aim of this study is to achieve an international consensus on hospital discharge criteria for ...

Hypertonic saline (HS) was introduced in our physician-based mobile emergency care unit (MECU) in September 2006 for patients with severe traumatic brain injury and hypotension. HS has, however, rarely been used and we sought to identify barriers to its implementation. We conducted a survey based on a questionnaire administered to ...

Hospital transfusion committees can be instrumental in ensuring appropriate blood utilization and that best practice standards are followed. In Ontario, Canada, the provincial Ministry of Health and Long-Term Care Blood Programs Coordinating Office has implemented several initiatives to support these multi-disciplinary hospital committees to fulfill their mandate. The primary goal ...

The emphasis that hospitals place on cutting-edge technology and niche specialty services to attract physicians and patients has set the stage for health care's most recent competitive trend: an increased level of targeted, geographic service expansion to "capture" well-insured patients. We conducted interviews in twelve US communities in 2010 and ...

The needs of hospitalized male patients are often unrecognized and unmet. Men occupy greater than half of all inpatient hospital beds and incur a broad array of illnesses and injuries at higher rates than women-yet often receive health care that pays surprisingly little attention to the concept of patient masculinity, ...

Measuring and monitoring antibiotic use in hospitals is believed to be an important component of the strategies available to antimicrobial stewardship programs to address acquired antimicrobial resistance. Recent efforts to organize large numbers of hospitals into networks allow for interhospital comparisons of a variety of healthcare processes and outcomes, a ...

After a hospital acquires a physician practice, relations can become strained between the parties in any of four areas: Governance and decision making. Technology. Payment structures. Emotional factors related to the acquisition.