Adverse medical events: do they influence discharge decisions?

The author examined relationships between adverse medical events (AMEs) on discharge decisions. Using secondary data capturing inpatient utilization from Oklahoma hospitals, the author employed logistic regression to estimate the probability of extended hospital stay and the need for postacute care as a function of AMEs, and multiple regression analysis to assess the effect of AMEs on the number of days of care. Findings showed that an AME increased the likelihood of extended hospital stay, number of extended days of care, and needed postacute care. Findings indicated that reducing AME incidence would likely improve quality while reducing healthcare utilization and spending.

Making the Patient Safety and Quality Improvement Act of 2005 work

Potential reasons for failure to report medical errors include concerns about adverse publicity, fear of litigation and professional sanctions, the burden of reporting, uncertainty about what information is required to be reported, and lack of feedback. The Patient Safety Quality and Improvement Act of 2005 (PSQIA) was passed by the U.S. Congress as a response to these issues. Successful implementation of PSQIA requires changes such as moving toward an incentive-based system or providing continuing education programs for healthcare providers. In addition, the reform of residency programs will help in the implementation of PSQIA by future healthcare providers.

Factors influencing inappropriate hospitalization in Riyadh, Saudi Arabia: physicians' perspectives

This study investigated factors causing inappropriate hospitalization from the physicians' perspectives at government, primary and military hospitals in Riyadh, Saudi Arabia. A self-administered questionnaire to 250 physicians showed that the majority were aware of inappropriate admissions. Problems with inappropriate admissions occurred more frequently at public hospitals (both government and military) than private hospitals. The reasons believed to contribute most to inappropriate admission and hospitalization were the inability of the patient's family to take care of the patient, to satisfy the patient's request, and the absence of someone to get the patient out of the hospital.

Healthcare in Japan: its professionals, institutions, and financing

Like the United States, Japan's healthcare system is a conglomerate of government, employer, and individual financing--but that's about as far as the similarity goes. Universal access to basic healthcare has been achieved in Japan through comprehensive employer/employee plans and government subsidies. However, the United States should not be too hasty in emulating Japan, for culture plays a definite role in healthcare on both sides of the Pacific.

Quality assurance and iron deficiency in Egypt

OBJECTIVE

To develop an intervention in rural Egypt to address the problem of iron deficiency anemia and to demonstrate the effectiveness of applying quality assurance (QA) methods in combating this.

DESIGN

Assessment of an intervention study utilizing QA methods.

SETTING

Rural primary care clinics in Egypt.

STUDY PARTICIPANTS

One hundred and eighty pregnant mothers (and their 180 children) were randomly selected at two clinic sites from all those who were diagnosed as having an iron deficiency disorder.

INTERVENTION

Multi-disciplinary teams were formed to develop and deliver health promotional approaches related to iron deficiency to the study participants. By using QA techniques the teams were able to strengthen local capacity and participant compliance to the educational messages.

MAIN OUTCOME MEASURES

Pre- and post-measurements of client satisfaction, results of hemoglobin lab tests, and the extent of retention of nutritional messages by the participants.

RESULTS

Eighty percent of the study population demonstrated satisfactory knowledge of the nutritional messages. There was a 75% improvement of client satisfaction with the clinic and an effective follow-up system of care was designed and implemented successfully for each clinic. On average, the number of children aged less than 5 years diagnosed with an iron deficiency disorder decreased from 37% to 5%. Similar success was achieved with the pregnant mothers: the prevalence of iron deficiency anemia was reduced from 100% to only 14%.

CONCLUSIONS

The use of QA process improvement techniques was extremely effective in reducing iron deficiency anemia among the target population. There is an increasing need to include quality methods in micronutrient intervention techniques.

Managerial burnout

It is well to understand that the consequences of burnout due to work-related stress are usually quite serious. Yet, this kind of burnout can and should be prevented; if detected early, it is manageable. Organizations should take steps to identify their executives who are most susceptible to burnout and offer them a broad range of assistance. There are, after all, no more important resources than human resources, and this, of course, includes an organization's executive-level employees.

Management preparedness criteria: a study of nursing home administrators

The observations from this study seem to suggest that there are some correlations between education, experience, age, and sex on the level of preparedness in the practice domains identified. Specifically, this study finds that years of experience have a significant negative correlation with the practice domains of physical plant/building management, fiscal reimbursement, financial management, and overall preparedness in both Oklahoma and Connecticut respondents. Experience level further correlates negatively with all other practice domains (except licensing standards) in Oklahoma respondents. Education level, on the other hand, did not correlate with any practice domain (except licensing standards among Oklahoma respondents). Age correlated positively with financial management activities but only with Oklahoma respondents, while sex correlated positively with physical plant/building management (Oklahoma and Connecticut) and with financial management in Connecticut only. Sex, however, had a negative correlation with basic nursing activities among Connecticut respondents. This study suggests that the nursing home administrators from Connecticut in our study felt that they were more prepared in the practice domains identified as compared to those responding from Oklahoma. This can be attributed to the fact that Connecticut respondents had almost a 13 percent higher average of experience years. This was also demonstrated in the correlation table. Other factors such as sex, age at onset of administrator career, and educational level had no or very limited effect on the practice domains identified in the study (p greater than 0.05). This holds true for both Oklahoma and Connecticut respondents. Therefore, the hypothesis stating that education has a direct effect on job performance and preparedness of nursing home administrators does not hold true with this study. It is the years of experience that has a direct effect on performance and preparedness of nursing home administrators.