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Li H, Lin F, Wang R, Zhu C, Cao K, Chen Y, Fang G, Li J, Ding J, Li W. The impacts of national centralized drug procurement policy on drug utilization of medical institutions: an empirical study in a county-level hospital in China. BMC Health Serv Res 2024; 24:513. [PMID: 38658940 PMCID: PMC11040739 DOI: 10.1186/s12913-024-10964-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 04/08/2024] [Indexed: 04/26/2024] Open
Abstract
PURPOSE Under the background of the regular implementation of the National Centralized Drug Procurement (NCDP) policy, this study aimed to assess the impacts of the NCDP policy on drug utilization of county-level medical institutions, and probe into the influencing factors of the changes in drug utilization. METHOD A pre-post study was applied using inpatient data from a county-level medical institution in Nanjing. Drug utilization behavior of medical institutions of 88 most commonly used policy-related drugs (by generic name, including bid-winning and bid-non-winning brands) was analyzed, and the substitution of bid-winning brands for brand-name drugs after policy intervention was evaluated. RESULTS After policy intervention, 43.18% of policy-related drugs realized the substitution of bid-winning brands for bid-non-winning brands (6.82% of complete substitution, 36.36% of partial substitution). Meanwhile, 40.90% of policy-related drugs failed to realize brand substitution. Multiple factors affected brand substitution, including: (1) Policy effect: brand substitution was more obvious after the intervention of the first and third round of NCDP. (2) Drug market competition: the greater the price reduction of bid-non-winning brands, the more the drugs for the same indication, the more likely that medical institutions keep using the same brands as they did before policy intervention. (3) Previous drug utilization of medical institutions: brand substitution was more obvious in drugs with large number of prescriptions and weak preference for brand-name drugs. CONCLUSION The NCDP policy promoted the substitution of bid-winning brands for bid-non-winning brands. However, the NCDP policy remained to be further implemented in county-level medical institutions. Policy implememtation efforts, drug market competition and drug utilization of medical institutions would affect the implementation of the NCDP policy.
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Affiliation(s)
- Haoye Li
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Fanyu Lin
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Rui Wang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Chenxuan Zhu
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Keyao Cao
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Yu Chen
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Gang Fang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Jiaming Li
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China
| | - Jinxi Ding
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China.
- Pharmaceutical Market Access Policy Research Center, China Pharmaceutical University, Nanjing, China.
| | - Wei Li
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing, China.
- Pharmaceutical Market Access Policy Research Center, China Pharmaceutical University, Nanjing, China.
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Scheive M, Rowe LW, Tso HL, Wurster P, Kalafatis NE, Camp DA, Yung CWR. Assessment of patient follow-up from student-run free eye clinic to county ophthalmology clinic. Sci Rep 2022; 12:979. [PMID: 35046498 PMCID: PMC8770480 DOI: 10.1038/s41598-022-05033-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 12/17/2021] [Indexed: 11/20/2022] Open
Abstract
The Ophthalmology Student Interest Group at Indiana University School of Medicine provides a free student-run eye screening clinic for an underserved community in Indianapolis. Patients with abnormal findings are referred to the ophthalmology service of the local county hospital for further evaluation. This retrospective chart review studied 180 patients referred from our free eye clinic to follow up at the ophthalmology service of a local county hospital from October 2013 to February 2020. This study investigated factors impacting follow-up of patients by analyzing demographics, medical history, insurance coverage, and final diagnoses at follow-up. Thirty-five (19.4%) of 180 patients successfully followed up at the local county hospital with an average time to follow-up of 14.4 (± 15.9) months. Mean patient age was 51 (± 13.6) with nearly equal numbers of males and females. The most common diagnoses at follow-up included refractive error (51.4%), cataract (45.7%), and glaucoma (28.6%). Patients with diabetes diagnoses or Healthy Indiana Plan insurance coverage had increased probability of follow-up. This study reveals gaps in timely follow-up to the local county hospital, demonstrating the current limitations of our free clinic in connecting patients to more definitive care and the need for an improved referral process.
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Affiliation(s)
- Melanie Scheive
- Department of Ophthalmology, Indiana University School of Medicine, 1160 W Michigan St., Indianapolis, IN, 46202, USA.
| | - Lucas W Rowe
- Department of Ophthalmology, Indiana University School of Medicine, 1160 W Michigan St., Indianapolis, IN, 46202, USA
| | - Hanna L Tso
- Department of Ophthalmology, Baylor College of Medicine, 6565 Fannin St., Houston, TX, 77030, USA
| | - Patrick Wurster
- Department of Ophthalmology, Indiana University School of Medicine, 1160 W Michigan St., Indianapolis, IN, 46202, USA
| | - Nicholas E Kalafatis
- Department of Ophthalmology, Indiana University School of Medicine, 1160 W Michigan St., Indianapolis, IN, 46202, USA
| | - David A Camp
- Department of Ophthalmology, Indiana University School of Medicine, 1160 W Michigan St., Indianapolis, IN, 46202, USA
| | - Chi Wah Rudy Yung
- Department of Ophthalmology, Indiana University School of Medicine, 1160 W Michigan St., Indianapolis, IN, 46202, USA
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Rao S, Hughes A, Segar MW, Wilson B, Ayers C, Das S, Halm EA, Pandey A. Longitudinal Trajectories and Factors Associated With US County-Level Cardiovascular Mortality, 1980 to 2014. JAMA Netw Open 2021; 4:e2136022. [PMID: 34846526 PMCID: PMC8634057 DOI: 10.1001/jamanetworkopen.2021.36022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
IMPORTANCE Cardiovascular (CV) mortality has declined for more than 3 decades in the US. However, differences in declines among residents at a US county level are not well characterized. OBJECTIVE To identify unique county-level trajectories of CV mortality in the US during a 35-year study period and explore county-level factors that are associated with CV mortality trajectories. DESIGN, SETTING, AND PARTICIPANTS This longitudinal cross-sectional analysis of CV mortality trends used data from 3133 US counties from 1980 to 2014. County-level demographic, socioeconomic, environmental, and health-related risk factors were compiled. Data were analyzed from December 2019 to September 2021. EXPOSURES County-level characteristics, collected from 5 county-level data sets. MAIN OUTCOMES AND MEASURES Cardiovascular mortality data were obtained for 3133 US counties from 1980 to 2014 using age-standardized county-level mortality rates from the Global Burden of Disease study. The longitudinal K-means approach was used to identify 3 distinct clusters based on underlying mortality trajectory. Multinomial logistic regression models were constructed to evaluate associations between county characteristics and cluster membership. RESULTS Among 3133 US counties (median, 49.5% [IQR, 48.9%-50.5%] men; 30.7% [IQR, 27.1%-34.4%] older than 55 years; 9.9% [IQR, 4.5%-22.7%] racial minority group [individuals self-identifying as Black or African American, American Indian or Alaska Native, Asian, Native Hawaiian, Pacific Islander, other, or multiple races/ethnicities]), CV mortality declined by 45.5% overall and by 38.4% in high-mortality strata (694 counties), by 45.0% in intermediate-mortality strata (1382 counties), and by 48.3% in low-mortality strata (1057 counties). Counties with the highest mortality in 1980 continued to demonstrate the highest mortality in 2014. Trajectory groups were regionally distributed, with high-mortality trajectory counties focused in the South and in portions of Appalachia. Low- vs high-mortality groups varied significantly in demographic (racial minority group proportion, 7.6% [IQR, 4.1%-14.5%]) vs 23.9% [IQR, 6.5%-40.8%]) and socioeconomic characteristics such as high-school education (9.4% [IQR, 7.3%-12.6%] vs 20.1% [IQR, 16.1%-23.2%]), poverty rates (11.4% [IQR, 8.8%-14.6%] vs 20.6% [IQR, 17.1%-24.4%]), and violent crime rates (161.5 [IQR, 89.0-262.4] vs 272.8 [IQR, 155.3-431.3] per 100 000 population). In multinomial logistic regression, a model incorporating demographic, socioeconomic, environmental, and health characteristics accounted for 60% of the variance in the CV mortality trajectory (R2 = 0.60). Sociodemographic factors such as racial minority group proportion (odds ratio [OR], 1.70 [95% CI, 1.35-2.14]) and educational attainment (OR, 6.17 [95% CI, 4.55-8.36]) and health behaviors such as smoking (OR for high vs low, 2.04 [95% CI, 1.58-2.64]) and physical inactivity (OR, 3.74 [95% CI, 2.83-4.93]) were associated with the high-mortality trajectory. CONCLUSIONS AND RELEVANCE Cardiovascular mortality declined in all subgroups during the 35-year study period; however, disparities remained unchanged during that time. Disparate trajectories were associated with social and behavioral risks. Health policy efforts across multiple domains, including structural and public health targets, may be needed to reduce existing county-level cardiovascular mortality disparities.
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Affiliation(s)
- Shreya Rao
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Amy Hughes
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas
| | - Matthew W. Segar
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Brianna Wilson
- School of Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Colby Ayers
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Sandeep Das
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Ethan A. Halm
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas
- Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
| | - Ambarish Pandey
- Division of Cardiology, Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas
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Toor H, Savla P, Podkovik S, Patchana T, Ghanchi H, Kashyap S, Tashjian V, Miulli D. Timing of Chemoradiation in Newly Diagnosed Glioblastoma: Comparative Analysis Between County and Managed Care Health Care Models. World Neurosurg 2021; 149:e1038-e1042. [PMID: 33476782 DOI: 10.1016/j.wneu.2021.01.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Glioblastoma multiforme (GBM) is a primary brain malignancy with significant morbidity and mortality. The current standard of treatment for GBM is surgery followed by radiotherapy and temozolomide. Despite an established treatment protocol, there exists heterogeneity in outcomes due to patients not receiving all treatments. We analyzed patients in different health care models to investigate this heterogeneity. METHODS A retrospective analysis was performed at 2 hospitals in San Bernardino County, California, for patients with newly diagnosed GBM from 2004 to 2019. Patients younger than 18 years of age, with history of low-grade glioma, who had undergone prior treatment, and those lost to follow-up were excluded. RESULTS A total of 57 patients were included in our study. Chemotherapy was started at 41 ± 30 and 77 ± 68 days in the health maintenance organization (HMO) and county model, respectively (P = 0.050); radiation therapy was started at 46 ± 34 and 85 ± 76 days in the HMO and county models, respectively (P = 0.036). In individuals who underwent both chemotherapy and radiation therapy (XRT), the difference in time to XRT was no longer significant (P = 0.060). Recurrence time was 309 ± 263 and 212 ± 180 days in the HMO and county groups, respectively (P = 0.379). The time to death was 412 ± 285 and 343 ± 304 days for HMO and county models, respectively (P = 0.334). CONCLUSIONS Our study demonstrates a statistically significant difference in time to adjuvant therapies between patients within a county hospital and a managed health care organization. This information has the potential to inform future policies and care coordination for patients within the county model.
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Affiliation(s)
- Harjyot Toor
- Department of Neurological Surgery, Riverside University Health System, Moreno Valley, California, USA; Department of Neurological Surgery, Arrowhead Regional Medical Center, Colton, California, USA
| | - Paras Savla
- Department of Neurological Surgery, Riverside University Health System, Moreno Valley, California, USA; Department of Neurological Surgery, Arrowhead Regional Medical Center, Colton, California, USA.
| | - Stacey Podkovik
- Department of Neurological Surgery, Riverside University Health System, Moreno Valley, California, USA; Department of Neurological Surgery, Arrowhead Regional Medical Center, Colton, California, USA
| | - Tye Patchana
- Department of Neurological Surgery, Riverside University Health System, Moreno Valley, California, USA; Department of Neurological Surgery, Arrowhead Regional Medical Center, Colton, California, USA
| | - Hammad Ghanchi
- Department of Neurological Surgery, Riverside University Health System, Moreno Valley, California, USA; Department of Neurological Surgery, Arrowhead Regional Medical Center, Colton, California, USA
| | - Samir Kashyap
- Department of Neurological Surgery, Riverside University Health System, Moreno Valley, California, USA; Department of Neurological Surgery, Arrowhead Regional Medical Center, Colton, California, USA
| | - Vartan Tashjian
- Department of Neurological Surgery, Kaiser Permanente Fontana Medical Center, Fontana, California, USA
| | - Dan Miulli
- Department of Neurological Surgery, Riverside University Health System, Moreno Valley, California, USA; Department of Neurological Surgery, Arrowhead Regional Medical Center, Colton, California, USA
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Shen C, Zhou Z, Lai S, Lu L, Dong W, Su M, Zhang J, Wang X, Deng Q, Chen Y, Chen X. Measuring spatial accessibility and within-province disparities in accessibility to county hospitals in Shaanxi Province of Western China based on web mapping navigation data. Int J Equity Health 2020; 19:99. [PMID: 32552715 PMCID: PMC7302366 DOI: 10.1186/s12939-020-01217-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 06/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Chinese government proposed the "XIAO BING BU CHU CUN, DA BING BU CHU XIAN" initiative in 2016, which states the rate of health care service provided by county hospitals should reach 90% of overall health care service provision. The prerequisite for achieving this goal is that citizens should be able to access county hospitals' services conveniently and impartially. However, little research has been done on the actual levels of the spatial accessibility of citizens to county hospitals in Western China. Therefore, we aimed to measure the spatial accessibility to county hospitals for county residents and to identify any regional disparities in Shaanxi Province in Western China. METHODS We implemented a novel method - involving utilizing navigation data from the AutoNavi web mapping system (knows as Gaode map in Chinese) - to assess the time and distance from villages and neighborhoods to the county hospitals. The navigation data were collected by request through an application-programming-interface using a web crawler (web data extraction tool) in Python. The shortest driving time and distance were extracted from the navigation data. The travel impedance to the nearest provider (TINP) indicator was used to measure spatial accessibility. RESULTS The results show that county residents in Western China's Shaanxi Province have poor spatial accessibility to county hospitals. Only 68.8% of villages and neighborhoods are within 60 min travel time (based on driving mode) to a county hospital, while 13.4% of such villages and neighborhoods are beyond 90 min travel time. Moreover, a significant within-province disparity exists, with residents in the central area enjoying the best accessibility to county hospitals, while the northern and southern areas still need improvements in accessibility. CONCLUSIONS Focused health resource planning is required to improve the spatial accessibility to county hospitals and to eliminate regional disparities. Further studies are called for to integrate the navigation data of web mapping systems with GIS methods to the measure spatial accessibility of health facilities in more complex contexts.
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Affiliation(s)
- Chi Shen
- School of Public Policy and Administration, Xi'an Jiaotong University, No.28 Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi'an Jiaotong University, No.28 Xianning West Road, Xi'an, 710049, Shaanxi, China.
| | - Sha Lai
- School of Public Policy and Administration, Xi'an Jiaotong University, No.28 Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Li Lu
- Team IETO, Bordeaux Population Health Research Center, University de Bordeaux, 33076, Bordeaux, France
| | - Wanyue Dong
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710063, China
| | - Min Su
- School of Public Administration, Inner Mongolia University, Hohhot, 010021, China
| | - Jian Zhang
- School of Public Policy and Administration, Xi'an Jiaotong University, No.28 Xianning West Road, Xi'an, 710049, Shaanxi, China
| | - Xinyu Wang
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710063, China
| | - Qiwei Deng
- School of Public Health, Health Science Center, Xi'an Jiaotong University, Xi'an, 710063, China
| | - Yaru Chen
- Centre for HealthCare Innovation Research, Cass Business School & School of Health Sciences, City, University of London, London, EC1V 0HB, UK
| | - Xi Chen
- Department of Health Policy and Management, Yale School of Public Health, New Haven, CT, 06520, USA
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Ye Q, Zhang Y, Gao HX, Chen YC, Li HM, Zhang H, Hu XM, Lei SH, Jiang D. Distribution of the Indicator of the Appropriate Admission of Patients with Circulatory System Diseases to County Hospitals in Rural China: A Cross-Sectional Study. Int J Environ Res Public Health 2019; 16:ijerph16091621. [PMID: 31075865 PMCID: PMC6539859 DOI: 10.3390/ijerph16091621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 05/07/2019] [Accepted: 05/08/2019] [Indexed: 11/16/2022]
Abstract
Background: The inappropriate admission of patients with circulatory system diseases (CSDs) have contributed to the rapid increase in hospitalisation rates in China. The purpose of this study is to identify the key indicators of appropriate admission and their distribution by analysing CSD cases. Methods: A total of 794 records of inpatient CSD cases were collected from county hospitals in five counties in midwestern rural China through stratified random sampling and evaluated by using the Rural Appropriateness Evaluation Protocol (RAEP). RAEP has two parts: Indicator A, which represents requirement for services, and Indicator B, which represents diseases severity. Indicator distribution was analysed through frequency analysis. A three-level logistic regression model was used to examine the sociodemographic determinants of the positive indicators of appropriate CDSs admissions. Result: The inappropriate admission rate of CSDs was 33.4% and varied between counties. A2 (Varying dosage/drug under supervision, 58.22%), A8 (Stopping/continuing oxygen inhalation, 38.19%), A7 (Electrocardiogram per 2 hours, 34.22%), A3 (Calculation of intake and output volume, 31.19%) and B14 (Abnormal blood condition, 27.98%) were the top five positive indicators of CSDs. Indicator A (requirements for services) was more active than Indicator B (disease severity). The limitation of the role of Indicator B over time may be attributed to the different policies and environments of rural China and stimulated the increase in inappropriate admission rates. The results of three-level logistic regression suggested that the influence of gender, year, region and disease type on positive indicators should receive increased attention in the evaluation of CSDs admissions. Conclusion: This study found that A2, A8, A7, A3 and B14 were the key indicators and were helpful to determine the appropriate admission of CSDs in rural China. Managers may focus on these indicators, particularly the use of indicator A.
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Affiliation(s)
- Qing Ye
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Hubei Provincial Department of Education, Key Research Institute of Humanities & Social Sciences, Research Centre for Rural Health Service, Wuhan 430030, China.
| | - Yan Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Hubei Provincial Department of Education, Key Research Institute of Humanities & Social Sciences, Research Centre for Rural Health Service, Wuhan 430030, China.
| | - Hong-Xia Gao
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Hubei Provincial Department of Education, Key Research Institute of Humanities & Social Sciences, Research Centre for Rural Health Service, Wuhan 430030, China.
| | - Ying-Chun Chen
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Hubei Provincial Department of Education, Key Research Institute of Humanities & Social Sciences, Research Centre for Rural Health Service, Wuhan 430030, China.
| | - Hao-Miao Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Hubei Provincial Department of Education, Key Research Institute of Humanities & Social Sciences, Research Centre for Rural Health Service, Wuhan 430030, China.
| | - Hui Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Hubei Provincial Department of Education, Key Research Institute of Humanities & Social Sciences, Research Centre for Rural Health Service, Wuhan 430030, China.
| | - Xiao-Mei Hu
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Hubei Provincial Department of Education, Key Research Institute of Humanities & Social Sciences, Research Centre for Rural Health Service, Wuhan 430030, China.
| | - Shi-Han Lei
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Hubei Provincial Department of Education, Key Research Institute of Humanities & Social Sciences, Research Centre for Rural Health Service, Wuhan 430030, China.
| | - Di Jiang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Hubei Provincial Department of Education, Key Research Institute of Humanities & Social Sciences, Research Centre for Rural Health Service, Wuhan 430030, China.
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Ayieko P, Irimu G, Ogero M, Mwaniki P, Malla L, Julius T, Chepkirui M, Mbevi G, Oliwa J, Agweyu A, Akech S, Were F, English M. Effect of enhancing audit and feedback on uptake of childhood pneumonia treatment policy in hospitals that are part of a clinical network: a cluster randomized trial. Implement Sci 2019; 14:20. [PMID: 30832678 PMCID: PMC6398235 DOI: 10.1186/s13012-019-0868-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Accepted: 02/04/2019] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND The World Health Organization (WHO) revised its clinical guidelines for management of childhood pneumonia in 2013. Significant delays have occurred during previous introductions of new guidelines into routine clinical practice in low- and middle-income countries (LMIC). We therefore examined whether providing enhanced audit and feedback as opposed to routine standard feedback might accelerate adoption of the new pneumonia guidelines by clinical teams within hospitals in a low-income setting. METHODS In this parallel group cluster randomized controlled trial, 12 hospitals were assigned to either enhanced feedback (n = 6 hospitals) or standard feedback (n = 6 hospitals) using restricted randomization. The standard (network) intervention delivered in both trial arms included support to improve collection and quality of patient data, provision of mentorship and team management training for pediatricians, peer-to-peer networking (meetings and social media), and multimodal (print, electronic) bimonthly hospital specific feedback reports on multiple indicators of evidence guideline adherence. In addition to this network intervention, the enhanced feedback group received a monthly hospital-specific feedback sheet targeting pneumonia indicators presented in multiple formats (graphical and text) linked to explicit performance goals and action plans and specific email follow up from a network coordinator. At the start of the trial, all hospitals received a standardized training on the new guidelines and printed booklets containing pneumonia treatment protocols. The primary outcome was the proportion of children admitted with indrawing and/or fast-breathing pneumonia who were correctly classified using new guidelines and received correct antibiotic treatment (oral amoxicillin) in the first 24 h. The secondary outcome was the proportion of correctly classified and treated children for whom clinicians changed treatment from oral amoxicillin to injectable antibiotics. RESULTS The trial included 2299 childhood pneumonia admissions, 1087 within the hospitals randomized to enhanced feedback intervention, and 1212 to standard feedback. The proportion of children who were correctly classified and treated in the first 24 h during the entire 9-month period was 38.2% (393 out of 1030) and 38.4% (410 out of 1068) in the enhanced feedback and standard feedback groups, respectively (odds ratio 1.11; 95% confidence interval [CI] 0.37-3.34; P = 0.855). However, in exploratory analyses, there was evidence of an interaction between type of feedback and duration (in months) since commencement of intervention, suggesting a difference in adoption of pneumonia policy over time in the enhanced compared to standard feedback arm (OR = 1.25, 95% CI 1.14 to 1.36, P < 0.001). CONCLUSIONS Enhanced feedback comprising increased frequency, clear messaging aligned with goal setting, and outreach from a coordinator did not lead to a significant overall effect on correct pneumonia classification and treatment during the 9-month trial. There appeared to be a significant effect of time (representing cumulative effect of feedback cycles) on adoption of the new policy in the enhanced feedback compared to standard feedback group. Future studies should plan for longer follow-up periods to confirm these findings. TRIAL REGISTRATION US National Institutes of Health-ClinicalTrials.gov identifier (NCT number) NCT02817971 . Registered September 28, 2016-retrospectively registered.
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Affiliation(s)
- Philip Ayieko
- Health Services Unit, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Grace Irimu
- Health Services Unit, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Morris Ogero
- Health Services Unit, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Paul Mwaniki
- Health Services Unit, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Lucas Malla
- Health Services Unit, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Thomas Julius
- Health Services Unit, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Mercy Chepkirui
- Health Services Unit, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - George Mbevi
- Health Services Unit, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Jacquie Oliwa
- Health Services Unit, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Ambrose Agweyu
- Health Services Unit, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Samuel Akech
- Health Services Unit, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
| | - Fred Were
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, Kenya
| | - Mike English
- Health Services Unit, Kenya Medical Research Institute/Wellcome Trust Research Programme, Nairobi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
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Zhang Y, Zhang L, Li H, Chen Y. Determinants of Inappropriate Admissions in County Hospitals in Rural China: A Cross-Sectional Study. Int J Environ Res Public Health 2018; 15:ijerph15061050. [PMID: 29789496 PMCID: PMC6025444 DOI: 10.3390/ijerph15061050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/15/2018] [Accepted: 05/21/2018] [Indexed: 11/16/2022]
Abstract
Inappropriate admissions have contributed to the rapid increase in hospitalisations in rural China. This study characterised the degree and determinants of inappropriate admissions in county hospitals. We used expert consultation to develop an appropriateness evaluation protocol that included nine requirements for services and 21 indicators of disease severity. A total of 2230 medical records from 2014 were collected from five county hospitals by stratified cluster sampling and evaluated for appropriateness using the protocol in 2016. The determinants of inappropriate admissions were analysed by two-level logistic regression. The overall inappropriate admission rate was 15.2%. Patients aged.
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Affiliation(s)
- Yan Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Research Centre for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan 430030, China.
| | - Liang Zhang
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Research Centre for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan 430030, China.
| | - Haomiao Li
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Research Centre for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan 430030, China.
| | - Yingchun Chen
- School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.
- Research Centre for Rural Health Service, Key Research Institute of Humanities & Social Sciences of Hubei Provincial Department of Education, Wuhan 430030, China.
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Wang C, Li N, Wang H, Yin H, Zhao Y. Study on essential drug use status and its influencing factors among cerebral infarction inpatients in county level hospitals of Anhui Province, China. PLoS One 2018; 13:e0193513. [PMID: 29621245 PMCID: PMC5886397 DOI: 10.1371/journal.pone.0193513] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 02/06/2018] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND PURPOSE Drug costs is one of the main components of hospitalization expenditure for cerebral infarction inpatients. In China, the National Essential Medicine System (NEMS) was created to relieve the heavy drug-cost burden for patients. The objective of this study was to investigate essential drug-use status and its influencing factors among cerebral infarction inpatients in county-level hospitals of Anhui province, China. METHODS Three county-level hospitals were selected through a multi-stage cluster random sampling method. The hospitalization cost data of cerebral infarction inpatients in the three hospitals were extracted from the Anhui provincial information platform of the New Rural Cooperative Insurance System (NCMS), and whether the proportion of essential drug cost in the total drug cost reached the median value of 33.05% which was set as the evaluation index for essential drug-use status. Questionnaires for hospitals and physicians were designed and given to them to assess influencing factors. RESULTS We retrieved the cost data of 2,189 inpatients from the NCMS platform and investigated 51 corresponding physicians in total. The drug costs accounted for 52.6% of the total hospitalization cost, and essential drug costs alone accounted for 37.0% of the total drug costs. The essential drug-cost proportion was high among physicians with a higher recognition degree on NEMS, older age, lower final academic degree, longer work experience and lower professional title. Married physicians and those with tight organizational affiliation also prescribed more essential drugs. CONCLUSIONS Increasing the proportion of essential drugs was an effective way to reduce the disease burden for cerebral infarction patients. Perfecting the NEMS, increasing government investment, reinforcing education and propaganda, and formulating relevant incentive and restrictive mechanisms were all effective ways to promote and increase the number of essential drug prescriptions written by physicians.
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Affiliation(s)
- Cunhui Wang
- Social Science and Health Management School, Anhui Medical University, Hefei, China
| | - Niannian Li
- Department of Research Administration, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Heng Wang
- Social Science and Health Management School, Anhui Medical University, Hefei, China
- Department of Deam’s Office, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Hongyan Yin
- Social Science and Health Management School, Anhui Medical University, Hefei, China
| | - Yunwu Zhao
- Department of Human Resources, The First Affiliated Hospital of Anhui Medical University, Hefei, China
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Liu S, Wang J, Zhang L, Zhang X. Caesarean section rate and cost control effectiveness of case payment reform in the new cooperative medical scheme for delivery: evidence from Xi County, China. BMC Pregnancy Childbirth 2018; 18:66. [PMID: 29523121 PMCID: PMC5845290 DOI: 10.1186/s12884-018-1698-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 03/02/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In China, increases in both the caesarean section (CS) rates and delivery costs have raised questions regarding the reform of the medical insurance payment system. Case payment is useful for regulating the behaviour of health providers and for controlling the CS rates and excessive increases in medical expenses. New Cooperative Medical Scheme (NCMS) agencies in Xi County in Henan Province piloted a case payment reform (CPR) in delivery for inpatients. We aimed to observe the changes in the CS rates, compare the changes in delivery-related variables, and identify variables related to delivery costs before and after the CPR in Xi County. METHODS Overall, 28,314 cases were selected from the Xi County NCMS agency from 2009 to 2010 and from 2014 to 2015. One-way ANOVA and chi-square tests were used to compare the distributions of CS and vaginal delivery (VD) before and after the CPR under different indicators. We applied multivariate linear regressions for the total medical cost of the VD and CS groups and total samples to identify the relationships between medical expenses and variables. RESULTS The CS rates in Xi County increased from 26.1% to 32.5% after the CPR. The length of stay (LOS), total medical cost, and proportion of county hospitals increased in the CS and VD groups after the CPR, which had significant differences. The total medical cost in the CS and VD groups as well as the total samples was significantly influenced by inpatient age, LOS, and hospital type, and had a significant correlation with the CPR in the VD group and the total samples. CONCLUSION The CPR might fail to control the growth of unreasonable medical expenses and regulate the behaviour of providers, which possibly resulted from the unreasonable compensation standard of case payments, prolonged LOS, and the increasing proportion of county hospitals. The NCMS should modify the case payment standard of delivery to inhibit providers' motivation to render CS services. The LOS should be controlled by implementing clinical guidelines, and a reference system should be established to guide patients in choosing reasonable hospitals.
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Affiliation(s)
- Shuang Liu
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030 China
| | - Jing Wang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030 China
- The Key Research Institute of Humanities and Social Science of Hubei Province, Huazhong University of Science and Technology, Wuhan, Hubei 430030 China
| | - Liang Zhang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030 China
| | - Xiang Zhang
- Department of Health Management, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030 China
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Reinwalds M, Blixter A, Carlsson E. A Descriptive, Qualitative Study to Assess Patient Experiences Following Stoma Reversal After Rectal Cancer Surgery. Ostomy Wound Manage 2017; 63:29-37. [PMID: 29324431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Standard surgical treatment for patients operated for rectal cancer is abdominoperineal excision of the tumor result- ing in a permanent colostomy or an anterior resection, often with construction of a temporary loop ileostomy. Both options impact bowel function. Living with a permanent colostomy has been studied in depth, but knowledge is limited about patients' experiences living with a resected rectum after stoma reversal and how it affects daily life. A qualitative study was conducted to describe the rst 4 to 6 weeks after reversal of a temporary loop ileostomy due to rectal cancer. Patients from 1 university hospital and 1 county hospital in Sweden were recruited by telephone and were eligible to participate in the study if they: 1) had been operated for rectal cancer with an anterior resection and a temporary loop ileostomy that had been reversed; 2) were >18 years of age, fully oriented, and understood the Swedish language; and 3) had a postoperative course without complications. Interviews were conducted be- tween December 2013 and June 2015 either at the hospital or at the participants' homes. Participants were asked to narrate their experiences since stoma reversal. Probing open-ended questions were used to stimulate narration and clarify and enhance understanding. The interviews were recorded, transcribed verbatim, and analyzed us- ing thematic content analysis. The 16 participants included 9 women and 7 men (median age 67 years). Three (3) main themes emerged: Life being controlled by the altered bowel function, with the subthemes loss of control over bowel function, uncertainty regarding bowel function, and being limited in social life; Striving to regain control over the bowel, with the subthemes using ability and knowledge, social support, and being grateful and hopeful; and A desire to be normal, with subthemes getting rid of the stoma and restoration of body image. Patients experienced severe bowel function problems, including increased bowel movement frequency and inability to anticipate or trust bowel function after stoma reversal. Outwardly, patients experienced a signi cant improvement in body image but continued to struggle with suboptimal bowel function. Patients needed reassurance that their bowel symptoms were normal. Participants strove to regain control over bowel function using various strategies, including what they had learned about diet and medication before stoma reversal and by trying to defy the restrictions of their new normal. They felt they were ghting to regain bowel control without help from health care professionals. In order to cope with altered bowel function, they needed the support of family and friends. The results suggest that, following stoma reversal, patients need information about available treatments to address their symptoms and require regular follow- up visits to evaluate and address functional results.
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Affiliation(s)
| | | | - Eva Carlsson
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska University Hospital/ Östr; and Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Kimando MW, Otieno FCF, Ogola EN, Mutai K. Adequacy of control of cardiovascular risk factors in ambulatory patients with type 2 diabetes attending diabetes out-patients clinic at a county hospital, Kenya. BMC Endocr Disord 2017; 17:73. [PMID: 29191193 PMCID: PMC5709860 DOI: 10.1186/s12902-017-0223-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 11/20/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Type 2 diabetes is associated with substantial cardiovascular morbidity and mortality arising from the high prevalence of cardiovascular risk factors such as hypertension, dyslipidaemia, obesity, poor glycaemic control and albuminuria. Adequacy of control of these risk factors determines the frequency and outcome of cardiovascular events in the patients. Current clinical practice guidelines emphasize primary prevention of cardiovascular disease in type 2 diabetes. There is scarce data from the developing countries, Kenya included, on clinical care of patients with type 2 diabetes in the regions that are far away from tertiary health facilities. So we determined the adequacy of control of the modifiable risk factors: glycaemic control, hypertension, dyslipidemia, obesity and albuminuria in the study patients from rural and peri-urban dwelling. METHODS This was a cross-sectional study on 385 randomly selected ambulatory patients with type 2 diabetes without overt complications. They were on follow up for at least 6 months at the Out-patient diabetes clinic of Nyeri County Hospital, a public health facility located in the central region of Kenya. RESULTS Females were 65.5%. The study subjects had a mean duration of diabetes of 9.4 years, IQR of 3.0-14 years. Their mean age was 63.3 years, IQR of 56-71 years. Only 20.3% of our subjects had simultaneous optimal control of the three (3) main cardiovascular risk factors of hypertension, high LDL-C and hyperglycaemia at the time of the study. The prevalence of cardiovascular risk factors were as follows: HbA1c above 7% was 60.5% (95% CI, 55.6-65.5), hypertension, 49.6% of whom 76.6% (95% CI, 72.5-80.8) were poorly controlled. High LDL-Cholesterol above 2.0 mmol/L was found in 77.1% (95% CI 73.0-81.3) and Albuminuria occurred in 32.7% (95% CI 27.8-37.4). The prevalence of the other habits with cardiovascular disease risk were: excess alcohol intake at 26.5% (95% CI 27.8-37.4) and cigarette-smoking at 23.6%. A modest 23.4% of the treated patients with hypertension attained target blood pressure of <140/90 mmHg. Out of a paltry 12.5% of the statin-treated patients and others not actively treated, only 22.9% had LDL-Cholesterol of target <2.0 mmol/L. There were no obvious socio-demographic and clinical determinants of poor glycaemic control. However, old age above 50 yrs., longer duration with diabetes above 5 yrs. and advanced stages of CKD were significantly associated with hypertension. Female gender and age, statin non-use and socio-economic factor of employment were the significant determinants of high levels of serum LDL-cholesterol. CONCLUSION The majority of the study patients attending this government-funded health facility had high prevalence of cardiovascular risk factors that were inadequately controlled. Therefore patients with type 2 diabetes should be risk-stratified by their age, duration of diabetes and cardiovascular risk factor loading. Consequently, composite risk factor reduction strategies are needed in management of these patients to achieve the desired targets safely. This would be achieved through innovative care systems and modes of delivery which would translate into maximum benefit of primary cardiovascular disease prevention in those at high risk. It is a desirable quality objective to have a higher proportion of the patients who access care benefiting maximally more than the numbers we are achieving now.
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Affiliation(s)
- Mercy W. Kimando
- Department of Clinical Medicine and Therapeutics, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Frederick C. F. Otieno
- Department of Clinical Medicine and Therapeutics, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Elijah N. Ogola
- Department of Clinical Medicine and Therapeutics, College of Health Sciences, University of Nairobi, Nairobi, Kenya
| | - Kenn Mutai
- Kenyatta National Hospital, Nairobi, Kenya
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Yao D, Xi X, Huang Y, Hu H, Hu Y, Wang Y, Yao W. A national survey of clinical pharmacy services in county hospitals in China. PLoS One 2017; 12:e0188354. [PMID: 29190816 PMCID: PMC5708790 DOI: 10.1371/journal.pone.0188354] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 11/05/2017] [Indexed: 12/03/2022] Open
Abstract
Background Clinical pharmacy is not only a medical science but also an elaborate public health care system firmly related to its subsystems of education, training, qualification authentication, scientific research, management, and human resources. China is a developing country with a tremendous need for improvements in the public health system, including the clinical pharmacy service system. Objectives The aim of this research was to evaluate the infrastructure and personnel qualities of clinical pharmacy services in China. Setting Public county hospitals in China. Materials and method A national survey of clinical pharmacists in county hospitals was conducted. It was sampled through a stratified sampling strategy. Responses were analyzed using descriptive and inferential statistics. The main outcome measures include the coverage of clinical pharmacy services, the overall staffing of clinical pharmacists, the software and hardware of clinical pharmacy services, the charge mode of clinical pharmacy services, and the educational background, professional training acquisition, practical experience, and entry path of clinical pharmacists. Results The overall coverage of clinical pharmacy services on both the department scale (median = 18.25%) and the patient scale (median = 15.38%) does not meet the 100% coverage that is required by the government. In 57.73% of the sample hospitals, the staffing does not meet the requirement, and the size of the clinical pharmacist group is smaller in larger hospitals. In addition, 23.4% of the sample hospitals do not have management rules for the clinical pharmacists, and 43.1% do not have rational drug use software, both of which are required by the government. In terms of fees, 89.9% of the sample hospitals do not charge for the services. With regard to education, 8.5% of respondents are with unqualified degree, and among respondents with qualified degree, 37.31% are unqualified in the major; 43% of respondents lack the clinical pharmacist training required by the government. Most respondents (93.5%) have a primary or medium professional title. The median age and work seniority of respondents are 31 and four years, respectively. Only 18.5% of respondents chose this occupation by personal consideration or willingness. Conclusions The main findings in this research include the overall low coverage of clinical pharmacy services, the low rate of clinical pharmacy service software, hardware, and personnel as well as a wide variance in educational training of pharmacists at county hospitals.
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Affiliation(s)
- Dongning Yao
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Xiaoyu Xi
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing City, Jiangsu Province, China
| | - Yuankai Huang
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing City, Jiangsu Province, China
| | - Hao Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Yuanjia Hu
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
| | - Yitao Wang
- State Key Laboratory of Quality Research in Chinese Medicine, Institute of Chinese Medical Sciences, University of Macau, Macao, China
- * E-mail: (YW); (WY)
| | - Wenbing Yao
- School of International Pharmaceutical Business, China Pharmaceutical University, Nanjing City, Jiangsu Province, China
- * E-mail: (YW); (WY)
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Pillado E, Korn A, de Virgilio C, Bowens N. The Burden of Tunneled Central Venous Catheters for Hemodialysis in a County Hospital. Am Surg 2017; 83:1095-1098. [PMID: 29391102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Prolonged use of central venous catheters (CVCs) for hemodialysis (HD) is associated with greater morbidity and mortality when compared with autogenous arteriovenous fistulas (AVF). The objective was to assess compliance with CVC guidelines in adults referred for hemoaccess at a county teaching hospital. Out of 256 patients, 172 (67.2%) were male, with a mean age of 50.0 ± 12.4 years. Overall 62.5 per cent initiated dialysis via CVC. Patients were divided into two groups (those with CVC (62.5%) and those without (37.5%)). Male gender was associated with initiation of dialysis via CVC versus no CVC (72.5 vs 58.3%, P = 0.02), as was a history of prior vascular access (P < 0.01). There were no significant differences between the groups regarding age, diabetes, smoking, ambulatory status, or insurance status. There were no differences in gender, age, insurance status, or prior vascular access between prolonged CVC use (≥90 days) and short-term CVC use (<90 days). We conclude that most patients initiated HD with CVC and exceed the recommended CVC duration. Men are more likely to initiate HD via CVC. Insurance status was not associated with CVC use. Multidisciplinary action may address barriers to reducing CVC duration.
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Affiliation(s)
- Eric Pillado
- David Geffen School of Medicine at UCLA Dean's Leadership in Health and Science Scholarship, Torrance, California, USA
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Gathara D, Malla L, Ayieko P, Karuri S, Nyamai R, Irimu G, van Hensbroek MB, Allen E, English M. Variation in and risk factors for paediatric inpatient all-cause mortality in a low income setting: data from an emerging clinical information network. BMC Pediatr 2017; 17:99. [PMID: 28381208 PMCID: PMC5382487 DOI: 10.1186/s12887-017-0850-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2015] [Accepted: 03/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hospital mortality data can inform planning for health interventions and may help optimize resource allocation if they are reliable and appropriately interpreted. However such data are often not available in low income countries including Kenya. METHODS Data from the Clinical Information Network covering 12 county hospitals' paediatric admissions aged 2-59 months for the periods September 2013 to March 2015 were used to describe mortality across differing contexts and to explore whether simple clinical characteristics used to classify severity of illness in common treatment guidelines are consistently associated with inpatient mortality. Regression models accounting for hospital identity and malaria prevalence (low or high) were used. Multiple imputation for missing data was based on a missing at random assumption with sensitivity analyses based on pattern mixture missing not at random assumptions. RESULTS The overall cluster adjusted crude mortality rate across hospitals was 6 · 2% with an almost 5 fold variation across sites (95% CI 4 · 9 to 7 · 8; range 2 · 1% - 11 · 0%). Hospital identity was significantly associated with mortality. Clinical features included in guidelines for common diseases to assess severity of illness were consistently associated with mortality in multivariable analyses (AROC =0 · 86). CONCLUSION All-cause mortality is highly variable across hospitals and associated with clinical risk factors identified in disease specific guidelines. A panel of these clinical features may provide a basic common data framework as part of improved health information systems to support evaluations of quality and outcomes of care at scale and inform health system strengthening efforts.
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Affiliation(s)
- David Gathara
- Department of Public Health Research, KEMRI Wellcome Trust Research Programme, P.O. Box 43640 00100, Nairobi, Kenya
| | - Lucas Malla
- Department of Public Health Research, KEMRI Wellcome Trust Research Programme, P.O. Box 43640 00100, Nairobi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN UK
| | - Philip Ayieko
- Department of Public Health Research, KEMRI Wellcome Trust Research Programme, P.O. Box 43640 00100, Nairobi, Kenya
| | - Stella Karuri
- Department of Public Health Research, KEMRI Wellcome Trust Research Programme, P.O. Box 43640 00100, Nairobi, Kenya
| | - Rachel Nyamai
- Division of Maternal, Newborn, Child and Adolescent Health, Ministry of Health, Nairobi, Kenya
| | - Grace Irimu
- Department of Public Health Research, KEMRI Wellcome Trust Research Programme, P.O. Box 43640 00100, Nairobi, Kenya
- Department of Paediatrics and Child Health, University of Nairobi, Nairobi, 19676-00202 Kenya
| | - Michael Boele van Hensbroek
- Department of Global Health, Academic Medical Centre, University of Amsterdam, Amsterdam, 22700 1100 DE The Netherlands
| | - Elizabeth Allen
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, WC1E 7HT UK
| | - Mike English
- Department of Public Health Research, KEMRI Wellcome Trust Research Programme, P.O. Box 43640 00100, Nairobi, Kenya
- Nuffield Department of Medicine, University of Oxford, Oxford, OX3 7BN UK
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Masha SC, Wahome E, Vaneechoutte M, Cools P, Crucitti T, Sanders EJ. High prevalence of curable sexually transmitted infections among pregnant women in a rural county hospital in Kilifi, Kenya. PLoS One 2017; 12:e0175166. [PMID: 28362869 PMCID: PMC5375155 DOI: 10.1371/journal.pone.0175166] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Accepted: 03/21/2017] [Indexed: 11/21/2022] Open
Abstract
Background Women attending antenatal care (ANC) in resource-limited countries are frequently screened for syphilis and HIV, but rarely for other sexually transmitted infections (STIs). We assessed the prevalence of curable STIs, defined as infection with either Chlamydia trachomatis or Neisseria gonorrhoeae or Trichomonas vaginalis, from July to September 2015. Methods In a cross-sectional study, women attending ANC at the Kilifi County Hospital, Kenya, had a urine sample tested for C. trachomatis/N. gonorrhoeae by GeneXpert® and a vaginal swab for T. vaginalis by culture. Bacterial vaginosis (BV) was defined as a Nugent score of 7–10 of the Gram stain of a vaginal smear in combination with self-reported vaginal discharge. Genital ulcers were observed during collection of vaginal swabs. All women responded to questions on socio-demographics and sexual health and clinical symptoms of STIs. Predictors for curable STIs were assessed in multivariable logistic regression. Results A total of 42/202 (20.8%, 95% confidence interval (CI):15.4–27.0) women had a curable STI. The prevalence was 14.9% for C. trachomatis (95% CI:10.2–20.5), 1.0% for N. gonorrhoeae (95% CI: 0.1–3.5), 7.4% for T. vaginalis (95% CI:4.2–12.0), 19.3% for BV (95% CI: 14.1–25.4) and 2.5% for genital ulcers (95% CI: 0.8–5.7). Predictors for infection with curable STIs included women with a genital ulcer (adjusted odds ratio (AOR) = 35.0, 95% CI: 2.7–461.6) compared to women without a genital ulcer, women who used water for cleaning after visiting the toilet compared to those who used toilet paper or other solid means (AOR = 4.1, 95% CI:1.5–11.3), women who reported having sexual debut ≤ 17 years compared to women having sexual debut ≥18 years (AOR = 2.7, 95% CI:1.1–6.6), and BV-positive women (AOR = 2.7, 95% CI:1.1–6.6) compared to BV-negative women. Conclusion One in five women attending ANC had a curable STI. These infections were associated with genital ulcers, hygiene practices, early sexual debut and bacterial vaginosis.
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Affiliation(s)
- Simon Chengo Masha
- Centre for Geographic Medicine Research–Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- Laboratory Bacteriology Research, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
- Pwani University, Faculty of Pure and Applied Sciences, Department of Biological Sciences, Kilifi, Kenya
- * E-mail:
| | - Elizabeth Wahome
- Centre for Geographic Medicine Research–Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
| | - Mario Vaneechoutte
- Laboratory Bacteriology Research, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Piet Cools
- Laboratory Bacteriology Research, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Tania Crucitti
- HIV/STI Reference Laboratory, Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium
| | - Eduard J. Sanders
- Centre for Geographic Medicine Research–Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya
- Nuffield Department of Medicine, University of Oxford, Headington, United Kingdom
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Bruckner J, Barr B. Data-driven population health: collaboration between Macon county public health and community hospitals. N C Med J 2014; 75:200-201. [PMID: 24830496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
| | - Becky Barr
- Population Health Section, Macon County Public Health, Franklin, NC, USA
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Leşe M, Szasz A, Leşe I. Emergency surgery in colorectal cancer: experience of a county hospital at a 10-year interval. Comparison of immediate postoperative results. Chirurgia (Bucur) 2014; 109:335-341. [PMID: 24956338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2014] [Indexed: 06/03/2023]
Abstract
UNLABELLED A great majority of procedures for colorectal cancer are performed as emergencies, implying a high morbidity and mortality. The aim of this study is to compare the immediate postoperative results of emergency procedures for colorectal cancer between a 10 year interval in a single centre. We performed a retrospective research of the patients files, totalizing 24 emergency operations in 2001 and 22 emergency operations in 2011. We followed demographic data, the complication which lead to emergency surgery, the time interval between the onset of the complication and the time of surgery, the type of procedure performed, postoperative morbidity and mortality. In 2001 we noticed morbidity in 66.66% of the cases (16 patients)and a mortality of 41.66% (10 patients), while in 2011 the postoperative morbidity was 54.54% (12 patients) and a mortality of 36.36% (8 patients). CONCLUSION although both morbidity and mortality rates decreased in a 10 year interval, they still present high values, and the difference is not statistically significant(p = 0.21 and 0.40).
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Ung C, Murakami Y, Zhang E, Alfaro T, Zhang M, Seider MI, Singh K, Lin SC. The association between compliance with recommended follow-up and glaucomatous disease severity in a county hospital population. Am J Ophthalmol 2013; 156:362-9. [PMID: 23601654 DOI: 10.1016/j.ajo.2013.03.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 03/06/2013] [Accepted: 03/07/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To assess the association between insufficient follow-up and clinical parameters such as disease severity and medication use among glaucoma patients at a metropolitan county hospital. DESIGN Cross-sectional study. METHODS Two-hundred and six patients with established glaucoma were recruited from San Francisco General Hospital. Subjects were classified based on compliance with recommended follow-up examination intervals over the year preceding commencement of the study, as determined by patient medical records. Glaucoma severity was determined based on the American Academy of Ophthalmology Preferred Practice Patterns guidelines. Multivariate logistic regression analysis was used to assess the relationship between adherence with follow-up visits and disease severity. RESULTS After adjustment for the impact of potential confounding variables, subjects with severe glaucomatous disease were found to have been less adherent to their recommended follow-up than those patients with mild or moderate glaucomatous disease (adjusted OR 1.89, 95% CI 1.21-2.94; P = .01). Subjects who were on glaucoma medications were found to be less adherent to follow-up recommendations (adjusted OR 3.29, 95% CI 1.41-7.65, P = .01). CONCLUSION Subjects with poor follow-up adherence were significantly more likely to have severe glaucomatous disease, suggesting that poor follow-up may contribute to disease worsening or, alternatively, those with more severe disease are less inclined to follow up at appropriate intervals.
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Affiliation(s)
- Cindy Ung
- Department of Ophthalmology, Stanford University School of Medicine, Stanford, CA, USA
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Bennett KJ, Probst JC, Vyavaharkar M, Glover S. Missing the handoff: post-hospitalization follow-up care among rural Medicare beneficiaries with diabetes. Rural Remote Health 2012; 12:2097. [PMID: 22816373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
INTRODUCTION Diabetes is a condition that requires adequate care to ensure ideal outcomes. One need is for proper post-discharge follow-up care to reduce unnecessary hospital re-admissions. This care is more difficult in US rural areas due to lower physician and resource availability. The purpose of this analysis was to examine US urban-rural differences in 30 day post-discharge physician follow-up care. METHODS This analysis utilized data from 2005 Medicare claims files, merged with county-level information from the area resource file. Beneficiaries with diabetes and with a hospitalization served as the study population. Differences in hospitalization rates and 30 day physician follow-up care were estimated across levels of rurality. Multi-level multivariate models estimated the factors that significantly contributed to obtaining such care. RESULTS Approximately 90% of the study population had a follow-up physician visit within 30 days; this rate was lower among rural beneficiaries. Adjusted estimates indicated that beneficiaries in rural areas were not less likely to obtain a follow-up visit. Factors associated with obtaining a follow up included having addition comorbidities, being female or White, and living in the US Northeast. CONCLUSIONS This analysis found evidence that rural Medicare beneficiaries were less likely to obtain post-discharge physician follow-up visits within 30 days. The adjusted result indicate that other factors such as personal demographic and illness characteristics are more predictive of this behavior than the rural location itself. More research is needed to identify why these specific factors are associated with visit behavior, and how to design interventions to improve these rates.
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Affiliation(s)
- Kevin J Bennett
- Department of Family and Preventive Medicine, School of Medicine, Columbia, University of South Carolina, South Carolina, USA.
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Velciov S, Gluhovschi G, Trandafirescu V, Petrica L, Bozdog G, Gluhovschi C, Bob F, Gădălean F, Bobu M. Specifics of the renal abscess in nephrology: observations of a clinic from a county hospital in Western Romania. Rom J Intern Med 2011; 49:59-66. [PMID: 22026254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
During the last years renal abscesses are being diagnosed with increasing frequency in Nephrology departments. Progresses achieved in imaging procedures permit a timely diagnosis of renal abscesses. At the same time modern antibiotic therapies permit the treatment of this disease in Nephrology departments. In the current paper we present some specifics of renal abscess management encountered in a Nephrology department in western Romania. We performed a retrospective analysis of 2793 patients with upper urinary tract infection hospitalised during 2002-2009 in our Nephrology Department, of whom 44 showed renal abscesses. Uropathic factors were identified less frequently, in 28% of the renal abscess cases, compared to cases in the literature where these have been reported in over 50% of the patients. General predisposing conditions were pregnancy in 7%, postviral cirrhosis in 4%, diabetes mellitus in 4%, surgically single kidney in 2%, polycystic kidney disease in 4% of the patients. We diagnosed renal abscesses in relatively young patients (mean age 38.73 +/- 19.64), fact that could be due to a decreased immune resistance of these patients. Renal function impairment was present in 17% of the patients. Urine cultures were positive in 25% with a predominance of E. coli and rarely of other germs (e.g. Citrobacter and Candida albicans). Therapy consisted of broad spectrum antibiotics applied to all patients. Two patients required the insertion of double J catheter. Five patients (11%) were referred to the Urology Department, where one patient underwent nephrectomy. Renal abscess was diagnosed and treated in the majority of cases in the Nephrology Department, and only in special cases is a referral to the Urology clinic required.
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Affiliation(s)
- Silvia Velciov
- Nephrology Department, University of Medicine and Pharmacy, Timişoara, Romania.
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Márkus B. [Birth centennary of Dr. Zoltán Szabolcs]. Magy Seb 2009; 62:386-389. [PMID: 19945945 DOI: 10.1556/maseb.62.2009.6.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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Abstract
This study presents evidence from a major hospital that the uninsured received less care than privately insured patients when they came for emergency treatment, even when the insured and uninsured had similar diagnoses. Uninsured emergency patients were also less likely to be admitted to the hospital than insured emergency patients. Among those treated and released, the uninsured have lower discharge costs than privately insured patients. Among those patients admitted to the hospital, however, the costs of treatment were quite similar for insured and uninsured patients alike.
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Affiliation(s)
- P Jackson
- School of Arts and Sciences, Benedict College, USA
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Karsten B, Kim J, King J, Kumar RR. Characteristics of colorectal cancer in young patients at an urban county hospital. Am Surg 2008; 74:973-976. [PMID: 18942625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Colorectal cancer (CRC) is a disease primarily affecting an older population. The incidence of CRC in young patients has been rising. The purpose of this study was to evaluate the characteristics of CRC in an ethnically diverse, young population. Two groups of patients with CRC (40 years old or younger and 60 years old or older) treated from 1998 to 2005 were retrospectively evaluated. Forty-one young patients with CRC were identified. Hispanics constituted 51 per cent of the young population. Forty-four per cent of the lesions were right-sided in the young group compared with 21 per cent in the older group (P = 0.004). Advanced tumor stage (T3 and T4) was noted in 87.8 per cent of the young and 63 per cent of the older patients (P = 0.002; OR, 4.08). Poorly differentiated tumor grade was more common in young patients (P = 0.003) as well as mucinous/ signet ring characteristics (P = 0.005). Young patients had an increased likelihood of a family history (P = 0.0001). Operative intervention and survival were similar for the two groups. Our study confirms, in an ethnically diverse young population, that CRC tends to be advanced stage, aggressive, and frequently nonoperable at the time of diagnosis. It is important for physicians to recognize the poor outcome of CRC in a younger population and consider an aggressive approach to diagnosis and early treatment.
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Affiliation(s)
- Benjamin Karsten
- Division of Colon and Rectal Surgery, Harbor-UCLA Medical Center, Torrance, California, USA
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Garland AM, Riskin DJ, Brundage SI, Moritz F, Spain DA, Purtill MA, Sherck JP. A county hospital surgical practice: a model for acute care surgery. Am J Surg 2007; 194:758-63; discussion 763-4. [PMID: 18005767 DOI: 10.1016/j.amjsurg.2007.08.019] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2007] [Revised: 08/13/2007] [Accepted: 08/13/2007] [Indexed: 11/19/2022]
Abstract
BACKGROUND Trauma surgery has changed significantly over the past decade. Nonoperative evidence-based algorithms have become common and surgical trauma volume has become increasingly difficult to maintain. The acute care surgery (ACS) model, which integrates trauma, critical care, and emergency surgery, has been proposed as a future model of trauma practice. METHODS Database information from an academic, county-based, trauma center was reviewed. A performance improvement surgical procedure database and level I trauma registry from 2005 were used to evaluate one center's ACS practice. RESULTS There were 2,276 cases performed by 7 full-time and 5 part-time surgeons. Elective cases accounted for 64% (1,480) of caseload, emergency/urgent general surgery accounted for 32% (719) of cases, and emergency trauma surgeries accounted for 4% (96 procedures in 77 patients). In all, 23% were performed after hours. The ACS model supported controllable hours, adequate surgical volume, excellent patient care, and an appealing clinical practice. CONCLUSION Surgical practice in a county-run trauma hospital can be similar to the ACS model, with positive results in terms of clinical volume and physician satisfaction. As clinical practices shift to the ACS model, there are lessons to be learned from currently existing, thriving, long-standing similar prototypes.
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Affiliation(s)
- Adella M Garland
- Department of Surgery, Santa Clara Valley Medical Center, 751 S. Bascom Ave, San Jose, CA 95125, USA
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Lund L, Larsen UL, Anderson E, Mikkelsen NT, Holt G. The outcome of computed tomography in patients with acute renal colic from a low-volume hospital. Int Urol Nephrol 2007; 40:255-8. [PMID: 17899437 DOI: 10.1007/s11255-007-9264-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Accepted: 07/18/2007] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To assess the interobserver variability of unenhanced helical computed tomography (UHCT) in patients with acute renal colic admitted into a low-volume hospital. MATERIALS AND METHODS All admissions with acute renal colic between August 2002 and February 2004 (18 months) were registered. A total of 133 CT scans were performed on patients suspected of having a stone in the urinary tract (< 24 h after admission). All records were subsequently evaluated, the acute CT scans were re-evaluated by a radiological specialist. Interobserver agreements were assessed by means of Kappa analysis. RESULTS A total of 133 consecutive patients met the criteria for inclusion, of whom 62 were women and 71 were men. A total of 67 stones in 53 patients were identified. The variability of the radiological diagnosis (doctors under training and one consultant) was calculated, and the Kappa values were +0.66 and +0.69 for stones on the right and left side, respectively. The Kappa values for stones in ureter and the kidney were +0.79 and +0.52, respectively. In addition to stone disease, there were additional diagnoses in 30 patients (23%), out of whom seven had a malignant tumor. CONCLUSION In a low-volume hospital with fewer than 100 procedures a year, we found the UHCT method to be safe and reliable with a good interobserver agreement and Kappa value.
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Affiliation(s)
- L Lund
- Department of Urology, Regionshospitalet Viborg, Viborg Hospital, 8800 Viborg, Denmark.
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Hickson GB, Federspiel CF, Blackford J, Pichert JW, Gaska W, Merrigan MW, Miller CS. Patient Complaints and Malpractice Risk in a Regional Healthcare Center. South Med J 2007; 100:791-6. [PMID: 17713305 DOI: 10.1097/smj.0b013e318063bd75] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To study the association between physicians' complaint records and their risk management experiences in a regional healthcare center. DATA SOURCES Patient complaints about physicians in a large border state medical center's hospital and outpatient clinics were recorded and coded. The study period was from January 2001 through December 2003. These records were linked to the counterpart physicians' data covered by the institutions' risk management plan through June 2004. STUDY DESIGN AND DATA COLLECTION All physicians at the institution who had contact with patients during the study period were identified as surgeons or non-surgeons. Complaints for these physicians were recorded by the institution's Office of Patient Relations (OPR) and independently coded using a standardized protocol to characterize the nature of the problem and to uniquely identify the person complained about. The complaint records were then linked to the risk management files (RMFs) for the defined physician cohort. In addition, these data were supplemented with clinical service values (RVUs) which were available for 338 members (76%) of the 445 member cohort. PRINCIPAL FINDINGS Both patient complaints and risk management events were higher for surgeons than for non-surgeons. This was true for the number of RMFs, those involving expenditures, and for lawsuits. Logistic regression was used to assess the effects of complaint counts, practice type and volume of clinical activity. All were statistically significant in predicting the number of RMF openings, RMF openings with expenditures and lawsuits. Predictive concordance was 75% or greater for each of the three risk management outcomes. CONCLUSIONS Expressions of patient dissatisfaction and practice type are significantly related to risk management experiences in a regional medical center. Associations of risk management experiences with volume of clinical activity (RVUs) for surgeons in the regional medical center environment were not as strong as those found in a similar study reported from an academic medical center.
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Affiliation(s)
- Gerald B Hickson
- Center for Patient and Professional Advocacy, Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN 37232, USA.
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Nilsen P, Holmqvist M, Nordqvist C, Bendtsen P. Frequency of heavy episodic drinking among nonfatal injury patients attending an emergency room. Accid Anal Prev 2007; 39:757-66. [PMID: 17217905 DOI: 10.1016/j.aap.2006.11.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2005] [Revised: 11/13/2006] [Accepted: 11/19/2006] [Indexed: 05/13/2023]
Abstract
This study investigated the relationship between frequency of heavy episodic drinking and nonfatal injury in four categories: environment, external cause, diagnosis, and activity at the time of injury. Data were collected over 18 months at the emergency room facility of a Swedish hospital. Injury patients aged 18-70 years answered an alcohol screening questionnaire. Heavy episodic drinking was measured as drinking six glasses (72 g alcohol) or more per occasion, for both males and females. A total of 2211 patients were enrolled in the study (79.5% completion rate). Demographic and drinking characteristics for the patients were compared to those of the general population, data for which were derived from a population-based survey. The proportion of people who reported heavy episodic drinking once a month or more was nearly twice as large among the injury patients as in the general population. However, age and sex outweighed heavy episodic drinking as risk factors for most injury types. There were 11 significant associations between frequency of heavy episodic drinking and injury types in the four injury categories, yet no linear trends of increased likelihood of injury with increased frequency of heavy episodic drinking could be discerned.
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Affiliation(s)
- Per Nilsen
- Department of Health and Society, Division of Social Medicine and Public Health Science, Linköping University, SE-58183 Linköping, Sweden.
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Nardi R, Scanelli G, Tragnone A, Lolli A, Kalfus P, Baldini A, Ghedini T, Bombarda S, Fiadino L, Di Ciommo S. Difficult hospital discharges in internal medicine wards. Intern Emerg Med 2007; 2:95-9. [PMID: 17622495 DOI: 10.1007/s11739-007-0029-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2006] [Accepted: 11/22/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Investigate the prevalence of difficult hospital discharges (DHD), describe clinical and social patients' characteristics as potential reasons for discharge delays in an internal medicine ward and implement tailored post-discharge care. METHODS During the year 2005 we analysed, in a middle-sized country hospital, all the patients for which some delay for discharge, owing to their whole complexity, was presumable. Comprehensive multidimensional assessment, clinical-social risk score, specific needs of care, mean of stay and outcomes were evaluated. RESULTS 68.5% of DHD patients were >/=80 years old, with 3.8 the mean number of diseases per patient; 57.5% presented a loss of autonomy (ADL) just before acute deterioration; 80% were functionally and/or cognitively impaired. Only 5% had suitable family support; 5.1% were living at a nursing home; 2% were living alone. The most frequent causes of admission were stroke, cognitive impairment-dementia, cardiovascular diseases, fractures and cancer. Mean length of stay was 12 days. Fifty-two percent of patients were discharged home, 30% were admitted to a long-term care facility, 1% to hospice and 17% died during their hospital stay. CONCLUSIONS The aim of "coordinated care" (i.e., targeting "at-risk" patients with assessment of medical, functional, social and emotional needs; provision of optimal medical treatment, self-care education, integrated services, monitoring of progress and early signs of problems) is to improve health outcomes and reduce costs. More than 80% of DHDs patients, with specific tailored programmes, may be discharged from hospital, with satisfactory solutions for them and their families.
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Affiliation(s)
- R Nardi
- Internal Medicine Department, Bazzano Hospital, Azienda USL di Bologna, Bologna, Italy.
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Croon AC, Wahlberg J, Andréasson C, Bergström C, Björklund E, Jynge O, Wilczek H, Tibell A. Changing Donation Pattern in Central Sweden. Transplant Proc 2006; 38:2627-8. [PMID: 17098019 DOI: 10.1016/j.transproceed.2006.07.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Since 1990, the Organisation for Organ donation in Central Sweden has registered the numbers of donations at the various hospitals in the area. During this period, a significant decrease in donation rate was observed in the large hospitals, while there was an increase in donation rate in the smaller hospitals. Taken together, the small hospitals are now at least as important as the large hospitals. Possible reasons for the observed change in donation pattern are discussed.
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Nordqvist C, Holmqvist M, Nilsen P, Bendtsen P, Lindqvist K. Usual drinking patterns and non-fatal injury among patients seeking emergency care. Public Health 2006; 120:1064-73. [PMID: 17007896 DOI: 10.1016/j.puhe.2006.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2005] [Revised: 04/21/2006] [Accepted: 06/16/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To explore the association between drinking patterns, irrespective of whether alcohol was consumed in the event of the injury or not, and different injury variables; and to identify settings and situations in which risky drinkers have an increased likelihood of injury. STUDY DESIGN The study population consisted of all patients aged 18-70 years registered for an injury according to ICD-10 at a Swedish emergency department during an 18-month period. After informed consent, the injury patients were screened for drinking habits by the AUDIT-C questionnaire. The gender, age and drinking pattern of injury patients were compared with the general population. METHODS A total of 2782 patients aged 18-70 years were registered for an injury during the study period. The number of drop-outs was 631. Drop-outs include those who did not consent to participate, were severely injured, too intoxicated or did not fill out the questionnaire satisfactory. Thus, 77.3% of the target group were included for further analysis (1944 drinkers and 207 abstainers). The patients were categorized into three drinking categories: abstainers, non-risky and risky drinkers. Risky drinkers were defined according to usual weekly consumption of 80g or more of alcohol for women and 110g or more for men and/or heavy episodic drinking (i.e. having six glasses or more one glass=12g alcohol), or both, on one occasion at least once a month, valid for both women and men. To estimate the relationship between drinking patterns and the injury variables (environment, cause of injury, activity and diagnosis), odds ratios (OR) were calculated by logistic regression. Multiple logistic regression was used in order to control for age and sex differences between the various drinking and injury categories. RESULTS The proportion of risky drinkers was higher in the study population compared with the general population in the same area. When controlling for age and sex, risky drinkers (OR 6.4(adj) Confidence interval CI 1.9-21.2) and non-risky drinkers (OR .4.5(adj) CI 1.4-14.5) displayed an increased risk for injury compared with abstainers, in amusement locations, parks, by or on lakes or seas, especially while engaged in play, hobby or other leisure activities (risky drinkers: OR 2.8(adj) CI 1.3-5.6; non-risky drinkers: OR 2.4(adj) CI 1.2-4.6). All differences between drinking patterns in external cause of injury disappeared when age and sex were considered. During rest, meals and attending to personal hygiene, the non-risky drinkers had a lower probability of injury compared with abstainers (OR 0.3(adj) CI 0.1-0.8). Non-risky drinkers had a higher probability than abstainers of suffering luxation (dislocation) or distortion (OR 1.6(adj) CI 1.1-2.5). Nine per cent of the study population reported that they believed that their injury was related to intake of alcohol. Half of this group were non-risky drinkers (CI for the 13.7% difference was 9.7-17.6). CONCLUSIONS Few significant associations between drinking pattern and injury remained when age and sex were controlled for.
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Affiliation(s)
- C Nordqvist
- Department of Health and Society, Social Medicine and Public Health Science, Linköping University, S-581 83 Linköping, Sweden.
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Spearman CWN, McCulloch M, Millar AJW, Burger H, Numanoglu A, Goddard E, Gajjar P, Davies C, Muller E, McCurdie F, Kemm D, Cywes S, Rode H, Khan D. Liver transplantation at Red Cross War Memorial Children's Hospital. S Afr Med J 2006; 96:960-3. [PMID: 17077925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
UNLABELLED The liver transplant programme for infants and children at Red Cross War Memorial Children's Hospital is the only established paediatric service in sub-Saharan Africa. Referrals for liver transplant assessment come from most provinces within South Africa as well as neighbouring countries. PATIENTS AND METHODS Since 1987, 81 children (range 6 months-14 years) have had 84 liver transplants with biliary atresia being the most frequent diagnosis. The indications for transplantation include biliary atresia (48), metabolic (7), fulminant hepatic failure (10), redo transplants (3) and other (16). Four combined liver/kidney transplants have been performed. Fifty-three were reduced-size transplants with donor/recipient weight ratios ranging from 2:1 to 11:1 and 32 children weighed less than 10 kg. RESULTS Sixty patients (74%) survived 3 months-14 years post-transplant. Overall cumulative 1- and 5-year patient survival figures are 79% and 70% respectively. However, with the introduction of prophylactic intravenous ganciclovir and the exclusion of hepatitis B virus (HBV) IgG core Ab-positive donors, the 1-year patient survival is 90% and the projected 5-year paediatric survival is > 80%. Early (< 1 month) post-liver-transplant mortality was low. Causes include primary malfunction (1), inferior vena cava thrombosis (1), bleeding oesophageal ulcer (1), sepsis (1) and cerebral oedema (1). Late morbidity and mortality was mainly due to infections: de novo hepatitis B (5 patients, 2 deaths), Epstein-Barr virus (EBV)- related post-transplantation lymphoproliferative disease (12 patients, 7 deaths) and cytomegalovirus (CMV) disease (10 patients, 5 deaths). Tuberculosis (TB) treatment in 3 patients was complicated by chronic rejection (1) and TB-drug-induced subfulminant liver failure (1). CONCLUSION Despite limited resources, a successful paediatric programme has been established with good patient and graft survival figures and excellent quality of life. Shortage of donors because of infection with HBV and human immunodeficiency virus (HIV) leads to significant waiting-list mortality and infrequent transplantation.
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Affiliation(s)
- C W N Spearman
- School of Child and Adolescent Health, University of Cape Town and Red Cross War Memorial Children's Hospital, Rondebosch, Cape Town, South Africa.
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Grandin W, Westwood T, Lagerdien K, King MS. Deaths at Red Cross Children's Hospital, Cape Town 1999-2003--a study of death notification forms. S Afr Med J 2006; 96:964-8. [PMID: 17077926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
OBJECTIVES The availability of cause-specific mortality data for children in South Africa is limited. Hospital-based data have the potential to contribute to understanding of the causation of childhood death in South Africa. The objectives of the study were to gain insights into the causes of death in a South African children's hospital. DESIGN Prospective, descriptive study of death notification forms. SETTING Red Cross War Memorial Children's Hospital, Cape Town. METHODS Data from 1999 to 2003 were analysed by direct and underlying causes of death (using a modified Global Burden of Diseases (GBD) classification) and demographic variables. Death rates per 1 000 hospital admissions were calculated for certain common causes of death. Seasonal correlates of mortality were examined. RESULTS There were 1 978 deaths. The number of deaths per year increased by 11.4% over the period. The death rate rose from 15.9 to 18.4 per 1 000 admissions from 1999 to 2002, declining to 17.4/1 000 in 2003. The death rate was higher for females than for males (18.4/1 000 versus 17.6/1 000, p = 0.007). Sixty per cent of deaths occurred in children less than 1 year old. GBD group I diseases (infectious, nutritional, perinatal) accounted for the greatest proportion of deaths (58.6%), followed by noncommunicable diseases (29.1%), and injuries (7.9%). HIV/AIDS accounted for 60% of infectious deaths (31.6% of all deaths). Diarrhoea-related mortality was 3 times higher in summer than in winter. Congenital conditions dominated GBD group II (57.5%). CONCLUSION The analysis shows the value of routinely recording data on childhood hospital deaths. The results mirror those of the South African Medical Research Council's Burden of Disease studies but also reflect the hospital's tertiary functions. Female children were at higher risk of death. Childhood HIV-related deaths are a major challenge to the health system.
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Affiliation(s)
- Wilson Grandin
- Children's Institute, University of Cape Town, South Africa
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Marino LV, Goddard E, Workman L. Determining the prevalence of malnutrition in hospitalized paediatric patients. S Afr Med J 2006; 96:993-5. [PMID: 17077931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
AIM To determine the prevalence of malnutrition in hospitalised paediatric patients at Red Cross War Memorial Children's Hospital. METHOD A 1-day cross-sectional survey was completed in all medical and surgical wards and some specialist outpatient clinics. RESULTS A total of 227 children participated in the study. Thirty-five per cent of patients were moderately malnourished (< or = -2 z-score), of whom 70% had no road to health card with them. Thirty-four per cent of children under 60 months of age received supplements in addition to a normal ward diet, 7.8% were enterally fed and less than 1% were parenterally fed. Almost 14% of children were found to be overweight/obese, which is higher than the national average of 6%. The prevalence of HIV infection on the day of the audit was 18% across all age groups compared with the Western Cape antenatal prevalence of 15.7% (2005). CONCLUSION The overall prevalence of undernutrition was 34%, which is comparable with similar studies. However, the proportion of overweight children (14%) was greater than the national average. In view of the level of malnutrition seen, a nutrition risk-screening tool, identifying risk factors for malnutrition such as food access and vulnerability, should be developed. The tool should be used to assess nutrition status and risk during the course of hospitalisation, in addition to planning appropriate nutrition care plan interventions for discharge.
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Affiliation(s)
- L V Marino
- Department of Dietetics, Red Cross War Memorial Children's Hospital, Rondebosch, Cape Town, South Africa.
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Rode H, Fieggen AG, Brown RA, Cywes S, Davies MRQ, Hewitson JP, Hoffman EB, Jee LD, Lawrenson J, Mann MD, Matthews LS, Millar AJW, Numanoglu A, Peter JC, Thomas J, Wainwright H. Four decades of conjoined twins at Red Cross Children's Hospital--lessons learned. S Afr Med J 2006; 96:931-40. [PMID: 17077920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
Conjoined twins represent a rare but fascinating congenital condition, the aetiology of which remains obscure. Over the past four decades, the paediatric surgeons at Red Cross Children's Hospital have been involved in the management of 46 pairs of conjoined twins, of which 33 have been symmetrical and 12 asymmetrical. Seventeen symmetrical twins have undergone separation with 22 children (65%) surviving; all of the live asymmetrical twins survived separation. We describe the important features of this unique cohort, outline our approach to management and present the results of this approach. We consider some of the ethical and moral dilemmas we have confronted, and discuss the prenatal diagnosis, obstetric implications and postnatal care of these children, including the relevant investigations and anaesthetic and surgical management. Specific aspects related to the cardiovascular system, hepatobiliary and gastrointestinal tracts, urogenital tract, central nervous system and musculoskeletal system are highlighted.
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Affiliation(s)
- H Rode
- Division of Paediatric Surgery, Red Cross War Memorial Children's Hospital, Rondebosch, Cape Town, South Africa.
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Lindsjö U, Nilsson F, Thorén L. [Utopian visions of the future threaten county health services]. Lakartidningen 2006; 103:1865-6; author reply 1866-7. [PMID: 16838602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
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Weiner SJ, Vangeest JB, Abrams RI, Moswin A, Warnecke R. Avoiding free care at all costs: a survey of uninsured patients choosing not to seek emergency services at an urban county hospital. J Urban Health 2006; 83:244-52. [PMID: 16736373 PMCID: PMC2527167 DOI: 10.1007/s11524-005-9018-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
The purpose of this case study was to understand why many uninsured patients opt not to make use of a free public hospital when it is available, instead seeking emergency department care at sites where they will be billed for the services they receive. One hundred fifty seven uninsured patients were interviewed over an 8-week period at three emergency departments that bill for services near a county hospital that provides free care. Data was gathered on income, health status, and credit history. Subjects were also asked if they had previously sought care at the county hospital and, if they had, how satisfied they were with the quality of care and with the wait time. Seventy two percent of the subjects reported household incomes of <$20,000, 48% reported they were in fair or poor health, and 33% said they were unable to pay at least one medical bill at the site where they were seeking care. 65% reported they had previously received care at the county hospital, and of these 61% said they were not-too-likely or not-at-all likely to return. In a regression analysis, experience with wait time correlated with subjects willingness to return, whereas their satisfaction with quality, their income, problems with debt, and reported health status did not. Access involves more than geographic proximity and affordability. Excessive wait times can deter even patients who are poor, in ill health and in debt from making use of services that are intended for their benefit.
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Affiliation(s)
- Saul J Weiner
- Department of Medicine, University of Illinois at Chicago, 840 South Wood Street, M/C 718, Chicago, IL, 60612, USA.
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Sun BC, Mohanty SA, Weiss R, Tadeo R, Hasbrouck M, Koenig W, Meyer C, Asch S. Effects of hospital closures and hospital characteristics on emergency department ambulance diversion, Los Angeles County, 1998 to 2004. Ann Emerg Med 2006; 47:309-16. [PMID: 16546614 DOI: 10.1016/j.annemergmed.2005.12.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2005] [Revised: 11/17/2005] [Accepted: 12/01/2005] [Indexed: 10/25/2022]
Abstract
STUDY OBJECTIVE We assess the effects of nearby hospital closures and other hospital characteristics on emergency department (ED) ambulance diversion. METHODS The study design was a retrospective, multiple interrupted time series with control group. We studied all ambulance-receiving hospitals with EDs in Los Angeles County from 1998 to 2004. The main outcome measure was monthly ambulance diversion hours because of ED saturation. RESULTS Our sample included 80 hospitals, of which 9 closed during the study period. There were increasing monthly diversion hours over time, from an average of 57 hours (95% confidence interval [CI] 51 to 63 hours) in 1998 to 190 hours (95% CI 180 to 200 hours) in 2004. In multivariate modeling, hospital closure increased ambulance monthly diversion hours by an average of 56 hours (95% CI 28 to 84 hours) for 4 months at the nearest ED. County-operated hospitals had 150 hours (95% CI 90 to 200 hours) and trauma centers had 48 hours (95% CI 9 to 87 hours) more diversion than other hospitals. Diversion hours for a given facility were positively correlated with diversion hours of the nearest ED (0.3; 95% CI 0.28 to 0.32). There was a significant and positive interaction between diversion hours of the nearest ED and time, suggesting that the effects of an adjacent facility's diversion hours increased during the study period. CONCLUSION Hospital closure was associated with a significant but transient increase in ambulance diversion for the nearest ED. The temporal trend toward more diversion hours, as well as increasing effects of the nearest facility's diversion hours over time, implies that the capacity to absorb future hospital closures is declining.
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Affiliation(s)
- Benjamin C Sun
- Robert Wood Johnson Clinical Scholars Program, University of California, Los Angeles, CA, USA.
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Blomquist PH. Methicillin-resistant Staphylococcus aureus infections of the eye and orbit (an American Ophthalmological Society thesis). Trans Am Ophthalmol Soc 2006; 104:322-45. [PMID: 17471350 PMCID: PMC1809917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
PURPOSE To ascertain if methicillin-resistant Staphylococcus aureus (MRSA) ophthalmic infections are increasing. METHODS A retrospective review of all patients with a culture positive for MRSA in the Parkland Health and Hospital System, the urban public healthcare system for Dallas County, Texas, for the years 2000 through 2004 was performed. Patients with ocular, orbital, and ocular adnexal infection were identified, and isolates were categorized as nosocomial or community-acquired (CA). RESULTS A total of 3,640 patients with a culture positive for MRSA were identified, with 1,088 patients (30%) considered to have acquired the isolate via nosocomial transmission and 2,552 patients (70%) considered to have CA-MRSA. Forty-nine patients (1.3%) had ophthalmic MRSA involvement. For both ophthalmic and nonophthalmic cases, the number of CA-MRSA patients increased each year, whereas the numbers of nosocomial patients remained fairly constant. Patients with ophthalmic MRSA tended to be younger than other MRSA patients (P = .023). The most common manifestation of ophthalmic MRSA infection was preseptal cellulitis and/or lid abscess followed by conjunctivitis, but sight-threatening infections, including corneal ulcers, endophthalmitis, orbital cellulitis, and blebitis, also occurred. Empirical antibiotic coverage was initially prescribed in 48 (98%) of ophthalmic cases and did not adequately cover for the MRSA isolate in 24 (50%). CONCLUSIONS CA-MRSA is becoming increasingly prevalent, and ophthalmologists will see more ophthalmic MRSA infections. Although ophthalmic CA-MRSA commonly presents as preseptal lid infection and conjunctivitis, sight-threatening infections also occur. Ophthalmologists must identify MRSA patients, adjust empirical treatment regimens where MRSA is endemic, and take steps to control emergence of resistant organisms in both inpatient and outpatient practices.
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Affiliation(s)
- Preston Howard Blomquist
- Department of Ophthalmology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
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Abstract
This study investigated predictors of length of stay (LOS) for two inpatient psychiatric units (a crisis stabilization unit and a longer-stay milieu unit) in a large, urban, university-affiliated, county hospital. It was hypothesized that three variables would be independently associated with shorter LOS: (1) higher Global Assessment of Functioning (GAF) scale scores, (2) not requiring the use of seclusion or restraints, and (3) the presence of a comorbid substance use disorder. Data were collected on consecutive discharges (n=234) from the two inpatient units. Bivariate tests were conducted, and multiple linear regression models assessed the independent effects of potential determinants of LOS. The presence of a comorbid personality disorder or substance use disorder was predictive of shorter LOS on the crisis stabilization unit (n=88). Several variables were found to be predictive of shorter LOS on the longer-stay milieu unit (n=146), including: involuntary legal status on discharge, not requiring seclusion or restraints, higher admission GAF scale score, female gender, and the presence of a comorbid substance use disorder. Findings indicate that a substantial portion of the variance in LOS in this setting can be predicted from basic sociodemographic and clinical factors available in hospital medical charts.
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Affiliation(s)
- Michael T Compton
- Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences, Atlanta, GA, USA.
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Abstract
OBJECTIVES To review the indications, complications, and outcomes of patients undergoing urgent surgical airway intervention. METHODS The inpatient and outpatient charts of patients who underwent awake tracheostomy or were converted from cricothyrostomy to tracheostomy at our institutional-affiliated County Hospital over a 3 year period were reviewed. RESULTS Ninety patients underwent awake tracheotomy, and seven were converted from cricothyrostomy to tracheostomy. Indications for awake tracheotomy included impending airway obstruction from malignancy of the aerodigestive tract or that causing extrinsic compression of the airway in 72 (80%) patients, neck abscess in 4 (4.4%), subglottic stenosis in 3 (3.3%), and a variety of other etiologies in 11 (12.2%). Thirty-eight (42%) patients were noted to have stridor. On fiberoptic laryngoscopy, 66 (80%) patients had moderate or severe airway obstruction, whereas 17 (20%) had mild or no obstruction. Of the 72 patients with squamous cell carcinoma, only 6 (8%) have been subsequently decannulated. Among the remainder, 13 of 18 (72%) have been decannulated. Complications occurred in seven (7.8%) patients after awake tracheotomy, none with untoward sequelae. Three severe complications occurred among the seven patients converted from cricothyrostomy to tracheostomy: anoxic brain injury in each, leading to death in two. CONCLUSIONS Awake tracheostomy should be considered in any patient with impending or ongoing airway obstruction or with potential for difficult intubation. This should be performed in a timely manner before an emergent situation arises because the complications of emergency surgical airway can be devastating.
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Affiliation(s)
- Kenneth W Altman
- Department of Surgery, John H. Stroger Hospital of Cook County, Chicago, Illinois, USA
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Abstract
OBJECTIVE This study examined relationships between homelessness, mental disorder, violence, and the use of psychiatric emergency services. To the authors' knowledge, this study is the first to examine these issues for all episodes of care in a psychiatric emergency service that serves an entire mental health system in a major city. METHODS Archival databases were examined to gather data on all individuals (N=2,294) who were served between January 1, 1997, and June 30, 1997, in the county hospital's psychiatric emergency service in San Francisco, California. RESULTS Homeless individuals accounted for approximately 30 percent of the episodes of service in the psychiatric emergency service and were more likely than other emergency service patients to have multiple episodes of service and to be hospitalized after the emergency department visit. Homelessness was associated with increased rates of co-occurring substance-related disorders and severe mental disorders. Eight percent of persons who were homeless had exhibited violent behavior in the two weeks before visiting the emergency service. CONCLUSIONS Homeless individuals with mental disorders accounted for a large proportion of persons who received psychiatric emergency services in the community mental health system in the urban setting of this study. The co-occurrence of homelessness, mental disorder, substance abuse, and violence represents a complicated issue that will likely require coordination of multiple service delivery systems for successful intervention. These findings warrant consideration in public policy initiatives. Simply diverting individuals with these problems from the criminal justice system to the community mental health system may have limited impact unless a broader array of services can be brought to bear.
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Affiliation(s)
- Dale E McNiel
- Clinical Psychology, University of California, San Francisco, 401 Parnassus Avenue, San Francisco, California 94143-0984, USA.
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Abstract
Performance measurement is considered to be an important part in improving and controlling contemporary organizations. Despite the increased interest in using and improving performance measurement systems, the number of researchers investigating the design and implementation process in more detail is still very small. The purpose of this article is to increase the understanding of how a performance measurement system, called the flow model, is designed and implemented by development teams in Swedish health care. The purpose of the flow model is to follow up the requirements in the National Care Guarantee through 8 measures. From a multiple case study of 6 local development teams, we conclude that the performance measurement system of the flow model is designed and implemented in Swedish County Councils through 3 development tracks, which are reflected in close interaction between the local development team and people in clinical departments. Enabling factors in the design and implementation are (1) the recognition of a need to change the current situation, (2) the teams' interaction with people in the clinical departments, (3) the national network meetings arranged by the financier, (4) the struggle to motivate and inform the top management, and (5) the establishment of contact with other development teams and ongoing projects.
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Affiliation(s)
- Beata Kollberg
- Division of Quality Technology and Management, Linköping Institute of Technology, Linköping University, Linköping, Sweden.
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Hoehne FM, Taylor E. Trends in breast cancer at a county hospital. Am Surg 2005; 71:159-63. [PMID: 16022017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Breast cancer mortality has changed dramatically with improvements in screening techniques. Mammography is essential for early detection; however, its contribution to the survival benefit in young women is questionable. We report our experience in breast biopsies at a county teaching hospital with a traditionally younger patient population. Institutional review board approval was obtained prior to data collection. A total of 550 breast biopsies were conducted between 1995 and 2000. Data regarding age, method of breast biopsy, and pathology was reviewed. One hundred twenty of 550 patients (21.8%) had breast carcinoma detected on breast biopsies with the predominant histologic subtype being invasive ductal carcinoma. The mean age of patients with carcinoma was 52.8 years, whereas that of patients with benign breast disease was 43.6 years (P < 0.05). Forty-three per cent of all breast cancers occurred in women under the age of 50 years. During the study period, there was neither an increase in the number of breast biopsies performed per year nor a decrease in the average age of women with breast cancer. However, observing a significant percentage of breast cancer patients under 50 years old, our data suggest the importance of strict adherence to current screening recommendations including self-breast examination and yearly mammography.
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Affiliation(s)
- Francesca M Hoehne
- Surgery Department, Kern Medical Center, 1830 Flower Street, Bakersfield, CA 93305, USA
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Abstract
The aim of this study was to report serum immunoglobulin (Ig) and IgG subclass levels in a large pediatric population with cystic fibrosis, and relate these to measures of disease severity. Total immunoglobulin levels were measured in 154 patients, and IgG subclass levels were measured in 136 patients and compared to age-related normal population data and to levels reported in previously published studies of children with cystic fibrosis. Clinical data were also collected: genotype; height, weight, and BMI standard deviation scores; FEV(1) (as percent predicted); Shwachmann-Kulczycki (S-K) and Northern chest X-ray scores; and Pseudomonas aeruginosa infection status. The clinical well-being of patients with hypo- or hyper-gammaglobulinemia was compared with age- and sex-matched control patients who had normal levels of gammaglobulin. IgG subclass levels were measured, and the results were compared with previous studies. Eleven patients had hypergammaglobulinemia (7.8% compared with 0-69% in the published literature). Patients with hypergammaglobulinemia had lower FEV(1) percent-predicted values, and worse S-K and Northern chest X-ray scores than controls. Three patients had hypogammaglobulinemia (1.9% compared with 0-10.8% in the published literature). There was no difference in any clinical parameter between controls and those with hypogammaglobulinemia. Nineteen patients (14%) had low levels of IgG1, and 40 patients (29%) had low levels of IgG2. The low percentage of patients with abnormally high immunoglobulin levels probably reflects the improved respiratory status of today's children with CF. The low percentage of those with low IgG probably reflects better nutritional status. The finding of worse lung function and clinical scores in patients with hypergammaglobulinemia agrees with the published literature. The high percentage of patients with low IgG2 was unexpected and was not previously reported. The clinical significance of this in patients with CF is unknown.
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Affiliation(s)
- J P Garside
- Department of Paediatrics and Child Health, Leeds General Infirmary, Leeds, UK
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Aparici Bolufer JV, Taboada Montero C. [A study of antibiotic use at a county hospital. Years 1998-2002]. Farm Hosp 2004; 28:410-8. [PMID: 15628943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Abstract
INTRODUCTION Adequate antibiotic use clearly influences the development of bacterial resistance, adverse events and healthcare costs. Studies of drug usage allow us to detect deviations in antibiotic use. MATERIAL AND METHODS Antibiotic use during the period 1998-2002 was analyzed using data provided by management software applications. The prescription of restricted-use antibiotics during years 2001 and 2002 was analyzed by selecting patients according to the information available in the unit-dose drug distribution area database at the pharmacy department. RESULTS Antibiotic use increased from 78 to 100 DDD during the period of time studied. The use of new quinolones has displaced macrolides. Two thirds of piperacillin --tazobactam prescriptions are for surgical patients. CONCLUSIONS 1. Changes in the pattern of antibiotic use have been detected. 2. The relative weight of restricted-use antibiotics has increased. 3. This study allows a prioritization of intervention areas.
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Zöllei I, Györi A, Wener G, Csapo J. [Improvement in surgical treatment of rectal cancer in the surgical department of County Hospital, Szekszard]. Zentralbl Chir 2004; 129:136-8. [PMID: 15106047 DOI: 10.1055/s-2004-818742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
247 elective rectal operations were performed between 1st of Jan., 1996 till 31st of Dec., 2001 in our surgical department. The observation period was divided into one 4-year and one 2-year period. 148 operations were performed in the first and 99 in the second period. In the second period some personal, methodical and technical changes occurred. Age and sex distributions were similar, and the groups were comparable. The early postoperative mortality rate decreased from 9% to 4%. Due to the double stapling technique the rate of anterior rectal resections increased from 40% to 69% and the rate of abdomino-perineal rectal extirpation decreased from 43% to 23% in the same time. Large differences were found in the rate of palliative stoma performing operations, the rate decreased from 16% to 8% in the second period, so the quality of life of the patients improved. The operative time, the length of hospital stay and the rate of blood transfusions decreased as did the rate of postoperative infections. The new quality program improved the results significantly.
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Affiliation(s)
- I Zöllei
- Surgical Department of County Hospital, Szekszard, Hungary.
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Benko LB. It takes a county. Tax increase proposed to save public system in Calif. Mod Healthc 2004; 34:17-8. [PMID: 15029682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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Abstract
OBJECTIVE To examine predicted relationships among transtheoretical model of change measures in a sample of 211 low-income, African American hospitalized smokers. METHODS We used discriminant analysis to examine differences in decisional balance and self-efficacy across stages of change for quitting. RESULTS Differences in decisional balance and self-efficacy were concurrent with stage differences. The function discriminated among all 3 stages with the clearest differences between precontemplation and preparation. CONCLUSION Although results with this specialized sample are not generalizable, they add to the evidence that transtheoretical model of change variables are robust across populations.
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Affiliation(s)
- Connie L Kohler
- University of Alabama at Birmingham, 227 Ryals Public Health Budding, 1665 University Boulevard, Birmingham, AL 35294-0022, USA.
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