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US Hospitals (us + hospital)
Selected AbstractsQuality of Care for Acute Myocardial Infarction in Rural and Urban US HospitalsTHE JOURNAL OF RURAL HEALTH, Issue 2 2004Laura-Mae Baldwin MD ABSTRACT: Context: Acute myocardial infarction (AMI) is a common and important cause of admission to US rural hospitals, as transport of patients with AMI to urban settings can result in unacceptable delays in care. Purpose: To examine the quality of care for patients with AMI in rural hospitals with differing degrees of remoteness from urban centers. Methods: This cohort study used data from the Cooperative Cardiovascular Project (CCP), including 4,085 acute care hospitals (408 remote small rural, 893 small rural, 619 large rural, and 2,165 urban) with 135,759 direct admissions of Medicare beneficiaries ages 65 and older for a confirmed AMI between February 1994 and July 1995. Outcomes included use of aspirin, reperfusion, heparin, and intravenous nitroglycerin during hospitalization; use of beta-blockers, aspirin, and angiotensin-converting enzyme (ACE) inhibitors at discharge; avoidance of calcium channel blockers at discharge; and 30-day mortality. Findings: Substantial proportions of Medicare beneficiaries in both urban and rural hospitals did not receive the recommended treatments for AMI. Medicare patients in rural hospitals were less likely than urban hospitals' patients to receive aspirin, intravenous nitroglycerin, heparin, and either thrombolytics or percutaneous transluminal coronary angioplasty. Only ACE inhibitors at discharge was used more for patients in rural hospitals than urban hospitals. Medicare patients in rural hospitals had higher adjusted 30-day post-AMI death rates from all causes than those in urban hospitals (odds ratio for large rural 1.14 [1.10 to 1.18], small rural 1.24 [1.20 to 1.29], remote small rural 1.32 [1.23 to 1.41]). Conclusions: Efforts are needed to help hospital medical staffs in both rural and urban areas develop systems to ensure that patients receive recommended treatments for AMI. [source] Hospital ownership and quality of care: what explains the different results in the literature?HEALTH ECONOMICS, Issue 12 2008Karen Eggleston Abstract This systematic review examines what factors explain the diversity of findings regarding hospital ownership and quality. We identified 31 observational studies written in English since 1990 that used multivariate analysis to examine quality of care at nonfederal general acute, short-stay US hospitals. We find that pooled estimates of ownership effects are sensitive to the subset of studies included and the extent of overlap among hospitals analyzed in the underlying studies. Ownership does appear to be systematically related to differences in quality among hospitals in several contexts. Whether studies find for-profit and government-controlled hospitals to have higher mortality rates or rates of adverse events than their nonprofit counterparts depends on data sources, time period, and region covered. Policymakers should be aware of the underlying reasons for conflicting evidence in this literature, and the strengths and weaknesses of meta-analytic synthesis. The ,true' effect of ownership appears to depend on institutional context, including differences across regions, markets, and over time. Copyright © 2008 John Wiley & Sons, Ltd. [source] Does the profit motive make Jack nimble?HEALTH ECONOMICS, Issue 4 2006Ownership form, the evolution of the US hospital industry Abstract We examine the evolving structure of the US hospital industry since 1970, focusing on how ownership form influences entry and exit behavior. We develop theoretical predictions based on the model of Lakdawalla and Philipson, in which for-profit and not-for-profit hospitals differ regarding their objectives and costs of capital. The model predicts for-profits would be quicker to enter and exit than not-for-profits in response to changing market conditions. We test this hypothesis using data for all US hospitals from 1984 to 2000. Examining annual and regional entry and exit rates, for-profit hospitals consistently have higher entry and exit rates than not-for-profits. Econometric modeling of entry and exit rates yields similar patterns. Estimates of an ordered probit model of entry indicate that entry is more responsive to demand changes for for-profit than not-for-profit hospitals. Estimates of a discrete hazard model for exit similarly indicate that negative demand shifts increase the probability of exit more for for-profits than not-for-profits. Finally, membership in a hospital chain significantly decreases the probability of exit for for-profits, but not not-for-profits. Copyright © 2006 John Wiley & Sons, Ltd. [source] Nursing care quality and adverse events in US hospitalsJOURNAL OF CLINICAL NURSING, Issue 15-16 2010Robert J Lucero Aim., To examine the association between nurses' reports of unmet nursing care needs and their reports of patients' receipt of the wrong medication or dose, nosocomial infections and patient falls with injury in hospitals. Background., Because nursing activities are often difficult to measure, and data are typically not collected by health care organisations, there are few studies that have addressed the association between nursing activities and patient outcomes. Design., Secondary analysis of cross-sectional data collected in 1999 from 10,184 staff nurses and 168 acute care hospitals in the US. Methods., Multivariate linear regression models estimated the effect of unmet nursing care needs on adverse events given the influence of patient factors and the care environment. Results., The proportion of necessary nursing care left undone ranged from 26% for preparing patients and families for discharge to as high as 74% for developing or updating nursing care plans. A majority of nurses reported that patients received the wrong medication or dose, acquired nosocomial infections, or had a fall with injury infrequently. However, nurses who reported that these adverse events occurred frequently varied considerably [i.e. medication errors (15%), patient falls with injury (20%), nosocomial infection (31%)]. After adjusting for patient factors and the care environment, there remained a significant association between unmet nursing care needs and each adverse event. Conclusion., The findings suggest that attention to optimising patient care delivery could result in a reduction in the occurrence of adverse events in hospitals. Relevance to clinical practice., The occurrence of adverse events may be mitigated when nurses complete care activities that require them to spend time with their patients. Hospitals should engage staff nurses in the creation of policies that influence human resources management to enhance their awareness of the care environment and patient care delivery. [source] The performance of US hospitals as reflected in risk-standardized 30-day mortality and readmission rates for medicare beneficiaries with pneumonia,,JOURNAL OF HOSPITAL MEDICINE, Issue 6 2010Peter K. Lindenauer MD MSc Abstract BACKGROUND: Pneumonia is a leading cause of hospitalization and death in the elderly, and remains the subject of both local and national quality improvement efforts. OBJECTIVE: To describe patterns of hospital and regional performance in the outcomes of elderly patients with pneumonia. DESIGN: Cross-sectional study using hospital and outpatient Medicare claims between 2006 and 2009. SETTING: A total of 4,813 nonfederal acute care hospitals in the United States and its organized territories. PATIENTS: Hospitalized fee-for-service Medicare beneficiaries age 65 years and older who received a principal diagnosis of pneumonia. INTERVENTION: None. MEASUREMENTS: Hospital and regional level risk-standardized 30-day mortality and readmission rates. RESULTS: Of the 1,118,583 patients included in the mortality analysis 129,444 (11.6%) died within 30 days of hospital admission. The median (Q1, Q3) hospital 30-day risk-standardized mortality rate for patients with pneumonia was 11.1% (10.0%, 12.3%), and despite controlling for differences in case mix, ranged from 6.7% to 20.9%. Among the 1,161,817 patients included in the readmission analysis 212,638 (18.3%) were readmitted within 30 days of hospital discharge. The median (Q1, Q3) 30-day risk-standardized readmission rate was 18.2% (17.2%, 19.2%) and ranged from 13.6% to 26.7%. Risk-standardized mortality rates varied across hospital referral regions from a high of 14.9% to a low of 8.7%. Risk-standardized readmission rates varied across hospital referral regions from a high of 22.2% to a low of 15%. CONCLUSIONS: Risk-standardized 30-day mortality and, to a lesser extent, readmission rates for patients with pneumonia vary substantially across hospitals and regions and may present opportunities for quality improvement, especially at low performing institutions and areas. Journal of Hospital Medicine 2010. © 2010 Society of Hospital Medicine. [source] Rising trends of gastric cancer and peptic ulcer in the 19th centuryALIMENTARY PHARMACOLOGY & THERAPEUTICS, Issue 7 2010A. Sonnenberg Aliment Pharmacol Ther 2010; 32: 901,907 Summary Background, The risk of dying from gastric cancer appears to have increased among consecutive generations born during the 19th century. Aim, To follow the time trends of hospitalization for gastric cancer and test whether they confirm such increase. Methods, Inpatient records of the last two centuries from four hospitals in Scotland and three US hospitals were analysed. Proportional rates of hospitalization for gastric cancer, gastric ulcer and duodenal ulcer were calculated during consecutive 5-year periods. Results, The data from all seven cities revealed strikingly similar patterns. No hospital admissions for gastric cancer or peptic ulcer were recorded prior to 1800. Hospital admissions for gastric cancer increased in an exponential fashion throughout the 19th and the beginning of the 20th century. In a majority of cities, the rise in hospitalization for gastric cancer preceded a similar rise in hospitalization for gastric ulcer. Hospitalization for these two latter diagnoses clearly preceded hospitalization for duodenal ulcer by 20,40 years. Conclusions, The occurrence of gastric cancer, gastric ulcer and duodenal ulcer markedly increased during the 19th century. Improvements in hygiene may have resulted in the decline of infections by other gastrointestinal organisms that had previously kept concomitant infection by Helicobacter pylori suppressed. [source] Nonfatal tool- or equipment-related injuries treated in US emergency departments among workers in the construction industry, 1998,2005AMERICAN JOURNAL OF INDUSTRIAL MEDICINE, Issue 6 2010Hester J. Lipscomb PhD Abstract Background Individuals in the construction industry are exposed to a variety of tools and pieces of equipment as they work. Methods Data from the National Institute for Occupational Safety and Health (NIOSH) occupational supplement to the National Electronic Injury Surveillance System (NEISS-Work) were used to characterize tool- and equipment,related injuries among workers in the construction industry that were treated in US emergency departments between 1998 and 2005. Based on a national stratified probability sample of US hospitals with 24,hr emergency services, NEISS-Work allows calculation of national injury estimates. Results Over the 8-year period between 1998 and 2005, we estimated 786,900 (95% CI 546,600,1,027,200) ED-treated tool- or equipment-related injuries identified by the primary or secondary source of injury code. These injuries accounted for a quarter of all ED-treated construction industry injuries. Although over 100 different tools or pieces of equipment were responsible for these injuries, seven were responsible for over 65% of the injury burden: ladders, nail guns, power saws, hammers, knives, power drills, and welding tools in decreasing order. Conclusions Current injury estimates and their severity, marked by the proportion of cases that were not released after ED treatment, indicate interventions are particularly needed to prevent injuries associated with use of ladders as well as nail guns and power saws. Attention should focus on design and guarding to more efficiently prevent these injuries rather than simply calling for the training of workers in how to safely use a dangerous tool or piece of equipment. Am. J. Ind. Med. 53: 581,587, 2010. © 2010 Wiley-Liss, Inc. [source] | ||||||||||