Hospital Care (hospital + care)

Distribution by Scientific Domains
Distribution within Medical Sciences

Kinds of Hospital Care

  • acute hospital care


  • Selected Abstracts


    Measuring Hospital Care from the Patients' Perspective: An Overview of the CAHPS® Hospital Survey Development Process

    HEALTH SERVICES RESEARCH, Issue 6p2 2005
    Elizabeth Goldstein
    Objective. To describe the developmental process for the CAHPS® Hospital Survey. Study Design. A pilot was conducted in three states with 19,720 hospital discharges. Methods of Analysis. A rigorous, multi-step process was used to develop the CAHPS Hospital Survey. It included a public call for measures, multiple Federal Register notices soliciting public input, a review of the relevant literature, meetings with hospitals, consumers and survey vendors, cognitive interviews with consumer, a large-scale pilot test in three states and consumer testing and numerous small-scale field tests. Findings. The current version of the CAHPS Hospital Survey has survey items in seven domains, two overall ratings of the hospital and five items used for adjusting for the mix of patients across hospitals and for analytical purposes. Conclusions. The CAHPS Hospital Survey is a core set of questions that can be administered as a stand-alone questionnaire or combined with a broader set of hospital specific items. [source]


    Using Assessing Care of Vulnerable Elders Quality Indicators to Measure Quality of Hospital Care for Vulnerable Elders

    JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2007
    Vineet M. Arora MD
    OBJECTIVES: To assess the quality of care for hospitalized vulnerable elders using measures based on Assessing Care of Vulnerable Elders (ACOVE) quality indicators (QIs). DESIGN: Prospective cohort study. SETTING: Single academic medical center. PARTICIPANTS: Subjects aged 65 and older hospitalized on the University of Chicago general medicine inpatient service who were defined as vulnerable using the Vulnerable Elder Survey-13 (VES-13), a validated tool based on age, self-reported health, and functional status. MEASUREMENTS: Inpatient interview and chart review using ACOVE-based process-of-care measures referring to 16 QIs in general hospital care and geriatric-prevalent conditions (e.g., pressure ulcers, dementia, and delirium); adherence rates calculated for type of care process (screening, diagnosis, and treatment) and type of provider (doctor, nurse). RESULTS: Six hundred of 845 (71%) older patients participated. Of these, 349 (58%) were deemed vulnerable based on VES-13 score. Three hundred twenty-eight (94%) charts were available for review. QIs for general medical care were met at a significantly higher rate than for pressure ulcer care (81.5%, 95% confidence interval (CI)=79.3,83.7% vs 75.8%, 95% CI=70.5,81.1%, P=.04) and for delirium and dementia care (81.5%, 95% CI=79.3,83.7 vs 31.4% 95% CI=27.5,35.2%, P<.01). According to standard nursing assessment forms, nurses were responsible for high rates of adherence to certain screening indicators (pain, nutrition, functional status, pressure ulcer risk; P<.001 when compared with physicians), although in patients with functional limitations, nurse admission assessments of functional limitations often did not agree with reports of limitations by patients on admission. CONCLUSION: Adherence to geriatric-specific QIs is lower than adherence to general hospital care QIs. Hospital care QIs that focus on screening may overestimate performance by detecting standard nursing or protocol-driven care. [source]


    Hospital care of people living in residential care facilities: Profile, utilization patterns and factors impacting on quality and safety of care

    GERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 3 2007
    Sanjay Jayasinghe
    Background: Residents in residential care facilities (RCF) are frequent users of acute hospital services. However, the interface between the two sectors remains relatively unexplored. Our objective was to determine the patterns of utilization, characteristics and experiences of RCF residents accessing a tertiary referral center (TRC). Methods: An observational study of RCF residents presenting to the TRC emergency department (ED). The experiences of acute care services were explored for more than one-quarter of this group 2,3 days postdischarge. The carer within the RCF acted as the proxy respondent. Results: During the study period, RCF residents accounted for 2.3% of all ED presentations. These presentations involved 526 residents. The dimension "continuity of care" for the Picker Patient Experience questionnaire had the highest proportion (53.1%) reporting a problem. The likelihood of reporting a problem for "continuity of care" (odds ratio [OR], 3.58; confidence interval [CI], 1.72,7.45) and "information and education" (OR, 2.62; CI, 1.14,3.01) were higher if the resident was admitted to a ward compared to ED only. If the resident had a low level care status the likelihood of reporting a problem for "continuity of care" (OR, 2.8; CI, 1.02,7.72) also increased. The odds of RCF staff reporting a problem for "ambulance service" were significantly higher if the resident's presentation was related to a fall. (OR, 3.35; CI, 1.28,8.8). Conclusion: The utilization rates for acute hospital care in our study were similar to the two previous Australian studies. Factors at the patient and organizational level impacted significantly on problems relating to the quality and safety of care being reported. [source]


    Burden of stroke in Singapore

    INTERNATIONAL JOURNAL OF STROKE, Issue 1 2008
    N. Venketasubramanian
    Stroke is Singapore's fourth leading cause of death, with a crude death rate of 40·4/100 000 in 2006, a prevalence of 3·65% and an incidence of 1·8/1000, and is among the top 10 causes of hospitalization. Approximately one-quarter of strokes are hemorrhagic. Hospital care for acute stroke costs about US$5000. Subsidized healthcare is widely available for primary level and hospital care, as are rehabilitative services. A national stroke support group has been established. With our rapidly aging population, coupled with the high prevalence of stroke risk factors in the community, the burden of stroke is expected to increase dramatically in the years to come, posing challenges to the healthcare system and society. A national disease management plan incorporating high-quality clinical care coupled with research would be essential. [source]


    Using Assessing Care of Vulnerable Elders Quality Indicators to Measure Quality of Hospital Care for Vulnerable Elders

    JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2007
    Vineet M. Arora MD
    OBJECTIVES: To assess the quality of care for hospitalized vulnerable elders using measures based on Assessing Care of Vulnerable Elders (ACOVE) quality indicators (QIs). DESIGN: Prospective cohort study. SETTING: Single academic medical center. PARTICIPANTS: Subjects aged 65 and older hospitalized on the University of Chicago general medicine inpatient service who were defined as vulnerable using the Vulnerable Elder Survey-13 (VES-13), a validated tool based on age, self-reported health, and functional status. MEASUREMENTS: Inpatient interview and chart review using ACOVE-based process-of-care measures referring to 16 QIs in general hospital care and geriatric-prevalent conditions (e.g., pressure ulcers, dementia, and delirium); adherence rates calculated for type of care process (screening, diagnosis, and treatment) and type of provider (doctor, nurse). RESULTS: Six hundred of 845 (71%) older patients participated. Of these, 349 (58%) were deemed vulnerable based on VES-13 score. Three hundred twenty-eight (94%) charts were available for review. QIs for general medical care were met at a significantly higher rate than for pressure ulcer care (81.5%, 95% confidence interval (CI)=79.3,83.7% vs 75.8%, 95% CI=70.5,81.1%, P=.04) and for delirium and dementia care (81.5%, 95% CI=79.3,83.7 vs 31.4% 95% CI=27.5,35.2%, P<.01). According to standard nursing assessment forms, nurses were responsible for high rates of adherence to certain screening indicators (pain, nutrition, functional status, pressure ulcer risk; P<.001 when compared with physicians), although in patients with functional limitations, nurse admission assessments of functional limitations often did not agree with reports of limitations by patients on admission. CONCLUSION: Adherence to geriatric-specific QIs is lower than adherence to general hospital care QIs. Hospital care QIs that focus on screening may overestimate performance by detecting standard nursing or protocol-driven care. [source]


    Information Technology and Emergency Medical Care during Disasters

    ACADEMIC EMERGENCY MEDICINE, Issue 11 2004
    Theodore C. Chan MD
    Abstract Disaster response to mass-casualty incidents represents one of the greatest challenges to a community's emergency response system. Rescuers, field medical personnel, and regional emergency departments and hospitals must often provide care to large numbers of casualties in a setting of limited resources, inadequate communication, misinformation, damaged infrastructure, and great personal risk. Emergency care providers and incident managers attempt to procure and coordinate resources and personnel, often with inaccurate data regarding the true nature of the incident, needs, and ongoing response. In this chaotic environment, new technologies in communications, the Internet, computer miniaturization, and advanced "smart devices" have the potential to vastly improve the emergency medical response to such mass-casualty incident disasters. In particular, next-generation wireless Internet and geopositioning technologies may have the greatest impact on improving communications, information management, and overall disaster response and emergency medical care. These technologies have applications in terms of enhancing mass-casualty field care, provider safety, field incident command, resource management, informatics support, and regional emergency department and hospital care of disaster victims. [source]


    Positive health-care effects of an alcohol ignition interlock programme among driving while impaired (DWI) offenders

    ADDICTION, Issue 11 2007
    Bo Bjerre
    ABSTRACT Aims To compare the costs of hospital care and sick leave/disability pensions between two groups of driving while impaired (DWI) offenders: participants in an alcohol ignition interlock programme (AIIP) and controls with revoked licences, but with no comparable opportunity to participate in an AIIP. Setting As an alternative to licence revocation DWI offenders can participate in a voluntary 2-year AIIP permitting the offender to drive under strict regulations entailing regular medical check-ups. The participants are forced to alter their alcohol habits and those who cannot demonstrate sobriety are dismissed from the programme. Participants are liable for all costs themselves. Design Quasi-experimental, with a non-equivalent control group used for comparison; intent-to-treat design. Based on the number of occasions/days in hospital and on sick leave/disability pension, the health-care costs for public insurance have been calculated. Finding Average total health-care costs were 25% lower among AIIP participants (1156 individuals) than among controls (815 individuals) during the 2-year treatment period. This corresponds to over ,1000 (SEK9610) less annual costs per average participant. For those who complete the 2-year programme the cost reduction was more pronounced; 37% during the treatment and 20% during the post-treatment period. Conclusions The positive health-care effects were due apparently to reduced alcohol consumption. The social benefit of being allowed to drive while in the AIIP may also have contributed. The reduction in health-care costs was significant only during the 2-year treatment period, but among those who completed the entire AIIP sustained effects were also observed in the post-treatment period. The effects were comparable to those of regular alcoholism treatment programmes. [source]


    Group motivational enhancement therapy as an adjunct to inpatient treatment for eating disorders: a preliminary study,

    EUROPEAN EATING DISORDERS REVIEW, Issue 4 2008
    Helen Y. Dean
    Abstract Difficulties in fostering eating disorder (ED) patients' motivations to overcome their illness are widely considered to be a major hurdle in the course of successful treatment. However, no previous study has assessed the use of interventions specifically designed to target poor motivation amongst patients with illnesses that are severe enough to warrant hospitalisation. Objective A brief Motivational Enhancement Therapy (MET) group programme for inpatient ED sufferers was developed and evaluated. Method Forty two consecutive inpatients were sequentially allocated to treatment groups. Twenty three inpatients completed a four session MET group programme in addition to routine hospital care. A control group of 19 participants completed treatment as usual (TAU). Results Despite an absence of significant differences between the MET and the TAU groups on the overall formal outcome measures, there were nevertheless differences between the groups. Specifically, the MET groups appeared to foster longer term motivation and engagement, and to promote treatment continuation. Conclusion The results tentatively suggest that MET could be valuable for the treatment of inpatient eating disorder patients and further research is warranted. Copyright © 2007 John Wiley & Sons, Ltd and Eating Disorders Association. [source]


    Expenditure Incidence in Africa: Microeconomic Evidence

    FISCAL STUDIES, Issue 3 2000
    David E. Sahn
    Abstract In this paper, we examine the progressivity of social sector expenditures in eight sub-Saharan African countries. We employ dominance tests, complemented by extended Gini/concentration coefficients, to determine whether health and education expenditures redistribute resources to the poor. We find that social services are poorly targeted. Among the services examined, primary education tends to be most progressive and university education is least progressive. The benefits associated with hospital care are also less progressive than other health facilities. Our results also show that, while concentration curves are a useful way to summarise information on the distributional benefits of government expenditures, statistical testing of differences in curves is important. [source]


    Hospital care of people living in residential care facilities: Profile, utilization patterns and factors impacting on quality and safety of care

    GERIATRICS & GERONTOLOGY INTERNATIONAL, Issue 3 2007
    Sanjay Jayasinghe
    Background: Residents in residential care facilities (RCF) are frequent users of acute hospital services. However, the interface between the two sectors remains relatively unexplored. Our objective was to determine the patterns of utilization, characteristics and experiences of RCF residents accessing a tertiary referral center (TRC). Methods: An observational study of RCF residents presenting to the TRC emergency department (ED). The experiences of acute care services were explored for more than one-quarter of this group 2,3 days postdischarge. The carer within the RCF acted as the proxy respondent. Results: During the study period, RCF residents accounted for 2.3% of all ED presentations. These presentations involved 526 residents. The dimension "continuity of care" for the Picker Patient Experience questionnaire had the highest proportion (53.1%) reporting a problem. The likelihood of reporting a problem for "continuity of care" (odds ratio [OR], 3.58; confidence interval [CI], 1.72,7.45) and "information and education" (OR, 2.62; CI, 1.14,3.01) were higher if the resident was admitted to a ward compared to ED only. If the resident had a low level care status the likelihood of reporting a problem for "continuity of care" (OR, 2.8; CI, 1.02,7.72) also increased. The odds of RCF staff reporting a problem for "ambulance service" were significantly higher if the resident's presentation was related to a fall. (OR, 3.35; CI, 1.28,8.8). Conclusion: The utilization rates for acute hospital care in our study were similar to the two previous Australian studies. Factors at the patient and organizational level impacted significantly on problems relating to the quality and safety of care being reported. [source]


    The geography of hospital admission in a national health service with patient choice

    HEALTH ECONOMICS, Issue 9 2010
    Daniele Fabbri
    Abstract Each year about 20% of the 10 million hospital inpatients in Italy get admitted to hospitals outside the Local Health Authority of residence. In this paper we carefully explore this phenomenon and estimate gravity equations for ,trade' in hospital care using a Poisson pseudo-maximum likelihood method. Consistency of the PPML estimator is guaranteed under the null of independence provided that the conditional mean is correctly specified. In our case we find that patients' flows are affected by network autocorrelation. We correct for it by relying upon spatial filtering. Our results suggest that the gravity model is a good framework for explaining patient mobility in most of the examined diagnostic groups. We find that the ability to restrain patients' outflows increases with the size of the pool of enrollees. Moreover, the ability to attract patients' inflows is reduced by the size of pool of enroless for all LHAs except for the very big LHAs. For LHAs in the top quintile of size of enrollees, the ability to attract inflows increases with the size of the pool. Copyright © 2010 John Wiley & Sons, Ltd. [source]


    The hospital costs of care for stroke in nine European countries

    HEALTH ECONOMICS, Issue S1 2008
    David Epstein
    Abstract Stroke is a major cause of mortality and morbidity, but the reasons for differences in costs of care within and between countries are not well understood. The HealthBASKET project used a vignette methodology to compare the mean costs and prices of hospital care across providers in nine European Union countries. Data on resource use, unit costs and prices of care for female stroke patients without co-morbidity were collected from a sample of 50 hospitals. Mean costs for each provider were analysed using multiple regression. Sensitivity analysis explored the effects on cost of using official exchange rates, purchasing power parity (PPP) and proportion of national income per capita. The mean cost of a hospital episode per patient for stroke at PPP was ,3813 (standard error 227) with an additional day in hospital typically associated with 6.9% (95% CI: 4,9%) higher costs and thrombolysis associated with 41% higher costs (10,73%). After adjusting for explanatory factors, about 76% of the variation in cost could be attributed to between-country differences, and the extent of this variation was sensitive to the method of currency conversion. There was considerable variation in the care pathways within and between countries, including differences in the availability of stroke units and access to rehabilitative services, but only the length of stay and use of thrombolytic therapy were significantly associated with higher cost. The vignette methodology appears feasible, but further research needs to consider access to healthcare over a longer follow up and to include both costs and outcomes. Copyright © 2008 John Wiley & Sons, Ltd. [source]


    A re-examination of distance as a proxy for severity of illness and the implications for differences in utilization by race/ethnicity ,,

    HEALTH ECONOMICS, Issue 7 2007
    Jayasree Basu
    Abstract The study analyzes the hospitalization patterns of elderly residents to examine whether the relation between distant travel and severity of illness is uniform across racial/ethnic subgroups. A hypothesis is made that severity thresholds could be higher for minorities than whites. Hospital discharge data from the Healthcare Cost and Utilization Project (HCUP-SID) of the Agency for Health Care Research and Quality for New York residents is used, with a link to the Area Resource File and American Hospital Association's survey files. Logistic models compare the association of distant admission with severity corresponding to each local threshold level, race, and type of hospital admission. The study uses four discrete distance thresholds in contrast to recent work. Also, an examination of severity thresholds for distant travel for different types of admission may clarify different sources of disparities in health care utilization. The findings indicate that minorities are likely to have higher severity thresholds than whites in seeking distant hospital care, although these conclusions depend on the type of condition. The study results imply that if costly elective services were regionalized to get the advantages of high volume for both cost and quality of care, some extra effort at outreach may be desirable to reduce disparities in appropriate care. Published in 2006 by John Wiley & Sons, Ltd. [source]


    Measuring horizontal inequity in Belgian health care using a Gaussian random effects two part count data model

    HEALTH ECONOMICS, Issue 7 2004
    Tom Van Ourti
    Abstract We estimate the determinants of utilisation of physician and hospital services in Belgium using a one- and two-part panel count data model, and a one- and two-part pooled count data model. We conclude that the two-part panel count data model is most appropriate as it controls for unobserved heterogeneity and allows for a two-part decision-making process. The estimates of the determinants of utilisation of health care are then used to calculate indices of horizontal inequity. We find that inequity for general practitioner and hospital services is stable across time and in favour of low-income individuals, in the sense that, overall, they consume more than one would expect on the basis of their need, albeit the indices for hospital care are not significant. Horizontal equity applies to specialist care in all years, but from 1999 onwards, some evidence (although not statistically significant) of pro-rich inequity is found. Copyright © 2004 John Wiley & Sons, Ltd. [source]


    The Relationship between Patients' Perception of Care and Measures of Hospital Quality and Safety

    HEALTH SERVICES RESEARCH, Issue 4 2010
    Thomas Isaac
    Background. The extent to which patient experiences with hospital care are related to other measures of hospital quality and safety is unknown. Methods. We examined the relationship between Hospital Consumer Assessment of Healthcare Providers and Systems scores and technical measures of quality and safety using service-line specific data in 927 hospitals. We used data from the Hospital Quality Alliance to assess technical performance in medical and surgical processes of care and calculated Patient Safety Indicators to measure medical and surgical complication rates. Results. The overall rating of the hospital and willingness to recommend the hospital had strong relationships with technical performance in all medical conditions and surgical care (correlation coefficients ranging from 0.15 to 0.63; p<.05 for all). Better patient experiences for each measure domain were associated with lower decubitus ulcer rates (correlations ,0.17 to ,0.35; p<.05 for all), and for at least some domains with each of the other assessed complications, such as infections due to medical care. Conclusions. Patient experiences of care were related to measures of technical quality of care, supporting their validity as summary measures of hospital quality. Further study may elucidate implications of these relationships for improving hospital care. [source]


    Validity of the indicator ,death in low-mortality diagnosis-related groups' for measuring patient safety and healthcare quality in hospitals

    INTERNAL MEDICINE JOURNAL, Issue 4 2010
    S. Mihrshahi
    Abstract The indicator ,death in low-mortality diagnosis-related groups (DRG)' is a patient safety indicator (PSI) that can be derived from routinely collected administrative data sources. It is included in a group of PSI that have been proposed to compare and monitor standards of hospital care in Australia. To summarize the attributes of this indicator as a measure of quality and safety in healthcare and examine issues regarding the development process, definitions and use of the indicator in practice. A structured literature search was conducted using the Ovid Medline database to identify peer-reviewed published literature which used ,death in low-mortality DRG' as a quality/safety indicator. Key quality websites were also searched. The studies were critically appraised using a standardized method. A total of 12 articles was identified which met our search criteria. Most were of low methodological quality because of their retrospective study designs. Only three studies provided evidence that the quality of care gap is higher in ,deaths in low-mortality DRG' than in other cases. Most of the studies reviewed show that there are several limitations of the indicator for assessing patient safety and quality of care. The few studies that have assessed associations with other measures of hospital quality have shown only weak and inconsistent associations. Higher quality, prospective, analytic studies are required before ,death in low-mortality DRG' is used as an indicator of quality and safety in healthcare. Based on current evidence, the most appropriate use is as a screening tool for institutions to quickly and easily identify a manageable number of medical records to investigate in more detail. [source]


    Measuring the quality of hospital care: an inventory of indicators

    INTERNAL MEDICINE JOURNAL, Issue 6 2009
    B. Copnell
    Abstract Background: Development of indicators to measure health-care quality has progressed rapidly. This development has, however, rarely occurred in a systematic fashion, and some aspects of care have received more attention than others. The aim of this study is to identify and classify indicators currently in use to measure the quality of care provided by hospitals, and to identify gaps in current measurement. Methods: A literature search was undertaken to identify indicator sets. Indicators were included if they related to hospital care and were clearly being collected and reported to an external body. A two-person independent review was undertaken to classify indicators according to aspects of care provision (structure, process or outcome), dimensions of quality (safety, effectiveness, efficiency, timeliness, patient-centredness and equity), and domain of application (hospital-wide, surgical and non-surgical clinical specialities). Results: 383 discrete indicators were identified from 22 source organizations or projects. Of these, 27.2% were relevant hospital-wide, 26.1% to surgical patients and 46.7% to non-surgical specialities, departments or diseases. Cardiothoracic surgery, cardiology and mental health were the specialities with greatest coverage, while nine clinical specialities had fewer than three specific indicators. Processes of care were measured by 54.0% of indicators and outcomes by 38.9%. Safety and effectiveness were the domains most frequently represented, with relatively few indicators measuring the other dimensions. Conclusion: Despite the large number of available indicators, significant gaps in measurement still exist. Development of indicators to address these gaps should be a priority. Work is also required to evaluate whether existing indicators measure what they purport to measure. [source]


    ,God's waiting room': how do older people with affective disorder view day hospital care?

    INTERNATIONAL JOURNAL OF GERIATRIC PSYCHIATRY, Issue 6 2004
    Elizabeth Davies
    No abstract is available for this article. [source]


    The care of older people with dementia in acute hospitals

    INTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 2 2010
    BA(Hons), DProf, Fiona Cowdell RN
    cowdell f. (2010) The care of older people with dementia in acute hospitals. International Journal of Older People Nursing 5, 83,92. Aim., To explore the experiences of patients and nursing staff of the care received by older people with dementia in acute hospitals. Background., The prevalence of dementia is steadily increasing as is the number of people with the condition requiring acute hospital care. Significant concerns about the quality of this care have been raised. There is a paucity of knowledge about the views of such care from the perspectives of people with dementia and nurses. Method., An ethnographic approach was used and data were collected thorough observation and interviews in one acute hospital in the United Kingdom. Findings., Findings suggest that care for older people with dementia in acute hospitals is not always optimum although there are clear exceptions. Generally, people with dementia found the delivery of care and the experience of being in hospital distressing as they did not know what was happening and they were often ignored. Nurses strive to give good care but do not always achieve this. Conclusion., Bourdieu's Model of Practice assists in explaining why care is as it is. There is a clear need to improve current practice. Relevance to clinical practice., It is imperative that innovative methods of developing practice are implemented and evaluated. Education alone will not lead to sustained changes in practice. Further research into this subject needs to be undertaken. [source]


    Research use in the care of older people: a survey among healthcare staff

    INTERNATIONAL JOURNAL OF OLDER PEOPLE NURSING, Issue 3 2006
    Anne-Marie Boström MSc
    Background., Sweden has one of the largest proportions of older people in the world. To manage the healthcare needs of an aging population, there has been an alteration from hospital care to community-based care. In these settings, the majority of staff is enrolled nurses (EN) and nurse aides (NA) without university education. Aim and design., The overall aim of this cross-sectional survey was to explore staff perceptions of factors related to research utilization in the care of older people. Method., Questionnaires covering research utilization and demographics were sent to all staff (n = 132) working in seven units in older people care. The response rate was 67% (n = 89). The respondents consisted of ENs/NAs (n = 63), Registered Nurses (RN) and rehabilitation professionals (RP) as physiotherapists and occupational therapists (RN/RP n = 26). Results., Most of staff reported positive attitudes towards research. The RNs/RPs stated more often than the ENs/NAs that they wanted to base their practice on research (81% vs. 25%; P = 0.001). The RNs/RPs also reported a greater extent of research use in daily practice (54% vs. 17%; P = 0.001). Support from colleagues (77% vs. 22%; P < 0.001) and unit managers (73% vs. 10%; P < 0.001) for implementing research findings was also more frequently reported by the RNs/RPs compared with the ENs/NAs. The majority of the ENs/NAs stated Do not know on many items concerning attitudes towards research, support for research utilization and actual use of research. Conclusions., Despite overall positive attitudes towards research, the majority of staff did not use research findings in daily practice. This was particularly valid for the EN/NA group. Relevance to clinical practice., There is an urgent need for managers and others in the care of older people to develop strategies for implementing evidence-based practice that involves the EN/NA group. [source]


    Burden of stroke in Singapore

    INTERNATIONAL JOURNAL OF STROKE, Issue 1 2008
    N. Venketasubramanian
    Stroke is Singapore's fourth leading cause of death, with a crude death rate of 40·4/100 000 in 2006, a prevalence of 3·65% and an incidence of 1·8/1000, and is among the top 10 causes of hospitalization. Approximately one-quarter of strokes are hemorrhagic. Hospital care for acute stroke costs about US$5000. Subsidized healthcare is widely available for primary level and hospital care, as are rehabilitative services. A national stroke support group has been established. With our rapidly aging population, coupled with the high prevalence of stroke risk factors in the community, the burden of stroke is expected to increase dramatically in the years to come, posing challenges to the healthcare system and society. A national disease management plan incorporating high-quality clinical care coupled with research would be essential. [source]


    Use of perioperative dialogues with children undergoing day surgery

    JOURNAL OF ADVANCED NURSING, Issue 1 2008
    Berith Wennström
    Abstract Title.,Use of perioperative dialogues with children undergoing day surgery Aim., This paper is a report of a study to explore what it means for children to attend hospital for day surgery. Background., Hospitalization is a major stressor for children. Fear of separation, unfamiliar routines, anaesthetic/operation expectations/experiences and pain and needles are sources of children's negative reactions. Method., A grounded theory study was carried out during 2005,2006 with 15 boys and five girls (aged 6,9 years) scheduled for elective day surgery. Data were collected using tape-recorded interviews that included a perioperative dialogue, participant observations and pre- and postoperative drawings. Findings., A conceptual model was generated on the basis of the core category ,enduring inflicted hospital distress', showing that the main problem for children having day surgery is that they are forced into an unpredictable and distressful situation. Pre-operatively, the children do not know what to expect, as described in the category ,facing an unknown reality'. Additional categories show that they perceive a ,breaking away from daily routines' and that they are ,trying to gain control' over the situation. During the perioperative period, the categories ,losing control' and ,co-operating despite fear and pain' are present and intertwined. Post-operatively, the categories ,breathing a sigh of relief' and ,regaining normality in life' emerged. Conclusion., The perioperative dialogue used in our study, if translated into clinical practice, might therefore minimize distress and prepare children for the ,unknown' stressor that hospital care often presents. Further research is needed to compare anxiety and stress levels in children undergoing day surgery involving the perioperative dialogue and those having ,traditional' anaesthetic care. [source]


    South Asian patients' lived experience of acute care in an English hospital: a phenomenological study

    JOURNAL OF ADVANCED NURSING, Issue 1 2000
    Vasso Vydelingum PhD BSc(Hons) PG DipEd RN RHV DN
    South Asian patients' lived experience of acute care in an English hospital: a phenomenological study Studies on utilization of hospital services by South Asian patients in the United Kingdom have consistently demonstrated levels of dissatisfaction with care in relation to meeting religious and cultural needs, although there are few studies on minority ethnic patients' utilization of acute hospital services. This study aimed to describe and interpret from the consumer's view the ,lived experience' of acute hospital care from the perspectives of South Asian patients and their family carers. The purposive sample of 10 patients and six carers consisted of 13 females and three males (five Hindus, six Muslims and five Sikhs) who were interviewed at home 2 to 3 weeks after discharge from hospital. Data were gathered through semi-structured interviews that were tape recorded and transcribed. A phenomenological approach was used, and data were analysed using the principles of Heideggerian hermeneutics. Five themes were identified, ranging from feelings of satisfaction with care, unhappy about the service, fitting-in strategies and post-discharge coping mechanisms. Patients seemed to want to cause as little disruption as possible to the ward environment and tried to fit in to what they refer to as an ,English place'. The findings, although not generalizable, offer important insights into how South Asian patients survive their journey through their hospital stay and have implications for the provision of nursing care for minority ethnic patients. [source]


    Using Assessing Care of Vulnerable Elders Quality Indicators to Measure Quality of Hospital Care for Vulnerable Elders

    JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 11 2007
    Vineet M. Arora MD
    OBJECTIVES: To assess the quality of care for hospitalized vulnerable elders using measures based on Assessing Care of Vulnerable Elders (ACOVE) quality indicators (QIs). DESIGN: Prospective cohort study. SETTING: Single academic medical center. PARTICIPANTS: Subjects aged 65 and older hospitalized on the University of Chicago general medicine inpatient service who were defined as vulnerable using the Vulnerable Elder Survey-13 (VES-13), a validated tool based on age, self-reported health, and functional status. MEASUREMENTS: Inpatient interview and chart review using ACOVE-based process-of-care measures referring to 16 QIs in general hospital care and geriatric-prevalent conditions (e.g., pressure ulcers, dementia, and delirium); adherence rates calculated for type of care process (screening, diagnosis, and treatment) and type of provider (doctor, nurse). RESULTS: Six hundred of 845 (71%) older patients participated. Of these, 349 (58%) were deemed vulnerable based on VES-13 score. Three hundred twenty-eight (94%) charts were available for review. QIs for general medical care were met at a significantly higher rate than for pressure ulcer care (81.5%, 95% confidence interval (CI)=79.3,83.7% vs 75.8%, 95% CI=70.5,81.1%, P=.04) and for delirium and dementia care (81.5%, 95% CI=79.3,83.7 vs 31.4% 95% CI=27.5,35.2%, P<.01). According to standard nursing assessment forms, nurses were responsible for high rates of adherence to certain screening indicators (pain, nutrition, functional status, pressure ulcer risk; P<.001 when compared with physicians), although in patients with functional limitations, nurse admission assessments of functional limitations often did not agree with reports of limitations by patients on admission. CONCLUSION: Adherence to geriatric-specific QIs is lower than adherence to general hospital care QIs. Hospital care QIs that focus on screening may overestimate performance by detecting standard nursing or protocol-driven care. [source]


    Do We Need to Create Geriatric Hospitals?

    JOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 1 2002
    Muriel R. Gillick MD
    During a single illness episode, the sickest, frailest older patients are often treated in multiple distinct sites, including the emergency room, the intensive care unit, a general medical floor, and a skilled nursing facility. Such frequent transfers involve changes in physician, changes in nursing care, the rewriting of orders, and physical dislocation, all of which can adversely affect outcomes. This system, although efficient, increases the chance of medical errors, promotes delirium, and undermines the doctor-patient relationship. Partial solutions include a team approach to care, an electronic medical record, and substitution of home for hospital care. A more comprehensive solution is to create a geriatric hospital for treatment of the most common medical and surgical problems and for provision of rehabilitative or skilled nursing care. Designing new institutions for geriatric care will require new legislation and a new set of regulations but should be considered for the oldest and frailest patients. [source]


    Access to Secondary Healthcare for People with Intellectual Disabilities: A Review of the Literature

    JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 6 2009
    Clare Backer
    Background, There is growing evidence that people with intellectual disabilities have greater healthcare needs than the general population and that these needs are often unmet. Recently, increasing attention has been drawn to poor care received by people with intellectual disabilities when admitted to hospital. Method, A literature search was conducted to identify studies on experiences of secondary healthcare for people with intellectual disabilities. Studies were published between January 1990 and March 2008. Results, Thirteen studies were identified. Important influences on the experience of hospital care were: individual factors; the carer's role; the attitudes, knowledge and communicative style of health staff; and the physical environment. A range of recommendations and initiatives have been developed to improve hospital care. Conclusion, More research is needed, given that so few studies are published in this area. Initiatives to improve access to secondary healthcare need to be evaluated to inform the development of services. [source]


    Service Use and Costs of Support 12 Years after Leaving Hospital

    JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES, Issue 4 2006
    Angela Hallam
    Background, There have been major changes in the provision and organization of services for people with intellectual disabilities in England over the last 30 years, particularly deinstitutionalization and the development of the mixed economy of care. The experiences of the people who participated in the Care in the Community Demonstration Programme in the mid-1980s provide evidence of the immediate and longer-term effects of the reprovision policy. Methods, Cross-sectional and longitudinal evidence was gathered on service use and costs for over 250 people 12 years after they left long-stay hospitals for community living arrangements. Comparisons were made with the situation in hospital, and 1 and 5 years after leaving. Relationships between costs after 12 years and individual characteristics assessed before people left hospital were explored. Results, Community care at the 12-year follow-up remained more expensive than hospital-based support, although the average cost was lower than at either of the 1- or 5-year community follow-up points. Service users were living in a wide variety of accommodation settings. Management responsibility fell on National Health Service (NHS) trusts, local authorities, voluntary agencies, or to private organizations or individuals. After standardizing for users' skills and abilities, costs in minimum support accommodation were significantly lower than those in residential and nursing homes, costs in staffed group homes significantly higher, and costs in hostels slightly lower. When looking at differences between individuals, no relationship was found between costs and outcomes although, overall, people were better off in the community than they had been when in hospital. Conclusions, Reprovision planning for hospital and other institutional modes of care requires major and long-term commitment of resources. Quality of life improvements can be achieved at a cost little different in the long-run from that for hospital care. The link between needs and costs (reflecting the services intended to meet those needs) would be made stronger through the individualization of care. [source]


    Musculoskeletal Rehabilitation in Osteoporosis: A Review,

    JOURNAL OF BONE AND MINERAL RESEARCH, Issue 8 2004
    Michael Pfeifer
    Abstract Measures of musculoskeletal rehabilitation play an integral part in the management of patients with increased fracture risk because of osteoporosis or extraskeletal risk factors. This article delineates current scientific evidence concerning nonpharmacologic approaches that are used in conjunction with pharmacotherapy for prevention and management of osteoporosis. Fractures caused by osteoporotic fragility may be prevented with multidisciplinary intervention programs, including education, environmental modifications, aids, and implementation of individually tailored exercise programs, which are proved to reduce falls and fall-related injuries. In addition, strengthening of the paraspinal muscles may not only maintain BMD but also reduce the risk of vertebral fractures. Given the strong interaction between osteoporosis and falls, selection of patients for prevention of fracture should be based on bone-related factors and on risk factors for falls. Rehabilitation after vertebral fracture includes proprioceptive dynamic posture training, which decreases kyphotic posturing through recruitment of back extensors and thus reduces pain, improves mobility, and leads to a better quality of life. A newly developed orthosis increases back extensor strength and decreases body sway as a risk factor for falls and fall-related fractures. Hip fractures may be prevented by hip protectors, and exercise programs can improve strength and mobility in patients with hip fracture. So far, there is no conclusive evidence that coordinated multidisciplinary inpatient rehabilitation is more effective than conventional hospital care with no rehabilitation professionals involved for older patients with hip fracture. Further studies are needed to evaluate the effect of combined bone- and fall-directed strategies in patients with osteoporosis and an increased propensity to falls. [source]


    Home care with regard to definition, care recipients, content and outcome: systematic literature review

    JOURNAL OF CLINICAL NURSING, Issue 6 2003
    Bibbi Thomé MSc
    Summary ,,In spite of the fact that home care has grown considerably during the last few years and will continue to grow even more in the future, home care as a phenomenon and a concept is not clearly defined. ,,The aim of this study was to review the empirical literature for the description of home care as a phenomenon and as a concept, especially with regard to who the care recipients are, what actions and assessments are performed and what effects are achieved for the care recipient in terms of functional health status and quality of life (QoL). ,,Twenty-six relevant studies meeting the inclusion criteria and requirements for methodological quality were identified. ,,The phenomenon of home care is described through content, outcome and objectives. The content of home care involved a range of activities from actions preventing decreased functional abilities in old people to palliative care in advanced diseases. ,,The outcome had two different underlying foci: (1) for the benefit of the patient based on the assumption that being cared at home increases their QoL, (2) in the interests of the society, to minimize hospital care by moving activities to the home of the patient. ,,The objectives were found to be aiming at improving the QoL and/or maintaining independence, by means of actions and assessments, based on the patient's needs, undertaken to preserve and increase functional ability and make it possible for the person to remain at home. ,,In conclusion, home care as a phenomenon was the care provided by professionals to people in their own homes with the ultimate goal of not only contributing to their life quality and functional health status, but also to replace hospital care with care in the home for societal reasons; home care covered a wide range of activities, from preventive visits to end-of-life care. [source]


    The subjective incremental cost of informed consent and documentation in hospital care: a multicentre questionnaire survey in Japan

    JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 2 2009
    Haruhisa Fukuda MPH
    Abstract Objective, To reveal the amount of time and financial cost required to obtain informed consent and to preserve documentation. Methods, The questionnaire was delivered to all staff in six acute care public hospitals in Japan. We examined health care staff perceptions of the time they spent obtaining informed consent and documenting information. All data were collected in 2006 and estimates in the past week in 2006 were compared to estimates of time spent in a week in 1999. We also calculated the economic costs of incremental amounts of time spent in these procedures. Results, In 2006, health care staff took about 3.89 hours [95% Confidence Interval (CI) 3.71,4.07] per week to obtain informed consent and 6.64 hours (95% CI 6.40,6.88) per week to write documentation on average. Between 1999 and 2006, the average amount of time for conducting informed consent was increased to 0.67 (P < 0.001) hours per person-week, and the average amount of time for documentation was increased to 0.70 (P < 0.001) hours per person-week. The annual economic cost of activities for informed consent and documentation in a 100-bed hospital increased from 117 755 to 449 402 US dollars. Conclusions, We found a considerable increase in time spent on informed consent and documentation, and associated cost over a 7-year time period. Although greater attention to the informed consent process should be paid to ensure the notions of patient autonomy and self-determination, the increased resources devoted to these practices must be considered in light of current cost containment policies. [source]