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Different Hospitals (different + hospital)
Selected AbstractsManaged Care Incentives and Inpatient ComplicationsJOURNAL OF ECONOMICS & MANAGEMENT STRATEGY, Issue 1 2002Philip A. Haile Managed care organizations control costs through restrictions on patient access to specialized services, oversight of treatment protocols, and financial incentives for providers. We investigate possible effects of such practices on the care patients receive by studying frequencies of in-hospital complications. We find significant differences in complication rates between managed care and fee-for-service patients. We investigate the sources of this variation by comparing probabilities of complications among patients with different types of managed care coverage and patients treated in different hospitals. For several patient categories, the differences in outcomes we find appear to arise not from differential treatment of patients within hospitals or from heterogeneity in patients, but from variations in care across hospitals that tend to treat patients with different insurance types. [source] A comparison of SAPS II and SAPS 3 in a Norwegian intensive care unit populationACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 5 2009K. STRAND Background: Simplified Acute Physiology Score (SAPS II) is the most widely used general severity scoring system in European intensive care medicine. Because its performance has been questioned in several external validation studies, SAPS 3 was recently released. To our knowledge, there are no published validation studies of SAPS II or SAPS 3 in the Scandinavian countries. We aimed to evaluate and compare the performance of SAPS II and SAPS 3 in a Norwegian intensive care unit (ICU) population. Method: Prospectively collected data from adult patients admitted to two general ICUs at two different hospitals in Norway were used. Probability of mortality was calculated using the SAPS 3 global equation (SAPS 3 G), the SAPS 3 Northern European equation (SAPS 3 NE), and the original SAPS II equation. Performance was assessed by the standardized mortality ratio (SMR), area under receiving operating characteristic, and the Hosmer and Lemeshow goodness-of-fit , test. Results: One thousand eight hundred and sixty-two patients were included after excluding readmissions, and patients who were admitted after coronary surgery or burns. The SMRs were SAPS 3 G 0.71 (0.65, 0.78), SAPS 3 NE 0.74 (0.68, 0.81), and SAPS II 0.82 (0.75, 0.91). Discrimination was good in all systems. Only the SAPS 3 equations displayed satisfactory calibration, as measured by the Hosmer,Lemeshow test. Conclusion: The performance of SAPS 3 was satisfactory, but not markedly better than SAPS II. Both systems considerably overestimated mortality and exhibited good discrimination, but only the SAPS 3 equations showed satisfactory calibration. Customization of these equations based on a larger cohort is recommended. [source] Benchmarking in nursing care by the RAFAELA patient classification system , a possibility for nurse managersJOURNAL OF NURSING MANAGEMENT, Issue 7 2007Dean, LISBETH FAGERSTRÖM PhD Aim, The aim of the study was to explore the possibilities of benchmarking with the RAFAELA system. In this study, comparisons are made between: (1) costs for one nursing care intensity point; (2) the nursing care intensity per nurse; (3) the relationship between nursing care intensity per nurse and (4) the optimal nursing care intensity. Background, During the period from 1994 to 2000 a new system for patient classification, the RAFAELA system, was developed in Finland. Methods, 86 wards from 14 different hospitals in Finland took part in the study. Results, The costs for one nursing care intensity point on the adults' wards were on average 7.80,. The average workload was 25.2 nursing care intensity points per nurse. The optimal nursing care intensity was exceeded during 49.5% of the days and under during 20% of the days. Conclusions, The study shows that benchmarking with the RAFAELA system provides many opportunities for the nurse managers' resource allocation and their personnel administration. [source] Students' perceptions of relationships between some educational variables in the out-patient settingMEDICAL EDUCATION, Issue 8 2002D H J M Dolmans Background Medical education uses the cognitive apprenticeship model of student learning extensively. Students rotate among different hospitals and out- patient clinics where they are exposed to a range of professionally relevant contexts. Here they learn to think and act in different domains under the supervision of experts. Previous research has shown that these learning situations involve little teaching. Students see a narrow range of patient problems and feedback is limited. The aim of this study is to investigate relationships among some educational variables in the out-patient clinic. Method This paper provides a theoretical model that specifies the factors influencing the effectiveness of student rotations at out-patient clinics. The model makes distinctions between input variables, such as organizational quality, number of students contemporaneously involved and available space, and process variables, such as patient mix and supervision, and the output variable of the effectiveness of rotations in out-patient clinics. Results The model was tested against empirical data from evaluative surveys and showed a reasonable fit. The model offers suggestions for improving the learning environment of clinical rotations. Discussion The strength of this study lies in its process evaluation perspective which investigates interactions between intervening variables rather than the influence of particular variables in isolation from other variables. [source] Breast-Conserving Therapy in Low-Literacy Patients in a Developing CountryTHE BREAST JOURNAL, Issue 2 2003Ashraf Nour MD Abstract: The purpose of this study was to determine the frequency with which low-literacy patients in a developing country chose their treatment plan. In this study, data for 312 patients admitted to different hospitals in Egypt were reviewed regarding their disease stage, optimal management plan, and treatment. It was found that the majority of patients were primarily concerned with keeping their breasts, regardless of the disease stage., [source] Tetraplegia following parathyroidectomy in two long-term haemodialysis patientsANAESTHESIA, Issue 9 2009M. Mercieri Summary We report two cases of postoperative iatrogenic tetraparesis, which occurred in different hospitals after surgery for parathyroidectomy. Both patients were on long-term haemodialysis. The prolonged neck extension usually required by this procedure was probably the main factor involved in the genesis of the spinal cord injury. Spinal abnormalities associated with chronic renal failure may have made these patients more vulnerable. In our opinion, it is advisable to investigate thoroughly any sign of spinal stenosis in patients who undergo any procedure requiring significant neck extension, particularly if on long-term haemodialysis. [source] Effects of gynaecological education on interpersonal communication skillsBJOG : AN INTERNATIONAL JOURNAL OF OBSTETRICS & GYNAECOLOGY, Issue 5 2001A.M. van Dulmen Objective To investigate the effects of an experimental communication course on how gynaecologists handle psychosocial issues in gynaecological consultation. Design Pre-post testing. Multilevel analysis was used to take into account the similarity among encounters with the same gynaecologist. Sample Eighteen gynaecologists (13 consultants and 5 junior doctors) from five different hospitals participated. All gynaecologists videotaped consecutive outpatient encounters before and after attending an intensive training course. Main outcome measures The communicative performance of the gynaecologists at pre-and post measurement. Results The gynaecologists recorded a total of 526 outpatient encounters, 272 before and 254 after the training. As a result of the training, gynaecologists' sensitivity to psychosocial aspects of their patients increased. At post measurement, the gynaecologists gave more signs of agreement, became less directive, asked fewer medical questions and more psychosocial questions. No difference was found in the duration of the outpatient visits. With the trained gynaecologists, patients asked more questions and provided more psychosocial information. Conclusions Junior doctors and clinically experienced gynaecologists can be taught to handle psychosocial issues without lengthening the visit. [source] | ||||||||||