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At least 361 records · Page 20Linked to original sources
PubMed1980

Social deprivation amongst short stay psychiatric patients.

Two samples of newly admitted psychiatric patients were examined. Of 558 patients admitted during one year, 76 (13.7 per cent) came in from transitory accommodation or no fixed abode; of 456 patients discharged 131 (28.7 per cent) either changed address during their stay in hospital or left without known accommodation. Of 102 patients in the wards and day hospital on one day, 29 (28.4 per cent) came in from transitory accommodation or no fixed abode, 66 (64.7 per cent) were unemployed, 51 (50 per cent) were living alone. Of the 74 inpatients 30 (40.5 per cent) were homeless and 27 (36.5 per cent) had no visitors. These results indicate that many patients have lost their community supports by the time they reach hospital.

Community Mental Health Services↗
PubMed2005

Hospital utilization, efficiency and access to care during and shortly after restructuring acute care in Newfoundland and Labrador.

OBJECTIVES: Since the 1990s restructuring, including regionalization and downsizing, has largely been driven by a desire for cost containment. Regionalization, hospital closure and changes in management processes occurred in Newfoundland and Labrador (NL), Canada between 1995 and 2000. The objectives of the current study were: to describe trends in the utilization of acute care hospital services by residents of NL during and shortly after restructuring; to examine trends in the efficiency of utilization of acute care beds in the province during the same time frame; and to compare the trends in St John's with the rest of the province, taking account of confounding events, in an attempt to understand the impact of aggregation of hospitals in this region. METHODS: Hospital discharge and day surgical data were analysed for all facilities in NL from 1995/96 to 2000/01. Analyses were by facility of service and also by region of residence directly standardized to the provincial population for 1996. Efficiency of bed utilization was examined on three occasions by concurrent utilization review using a modified version of the Appropriateness Evaluation Protocol. Trends in the St John's region (where most tertiary services are located and greater aggregation of hospitals occurred) were compared with the rest of the province. RESULTS: Admissions declined by 14% in St John's facilities and by 17% elsewhere. Inpatient days fell by 9% in St John's and by 12% elsewhere. Average length of stay and Resource Intensity Weight changed little, apart from a rise in the final study year, with the largest change in St John's. Standardized hospital admission rates declined by 10% and inpatient days by 5.6% for residents of St John's region, and by 16% and 14% respectively for residents of other regions. There was no change over time in the use of day surgery. Efficiency of acute care bed use improved in 2002 in St John's, but was unchanged in other regions. Use of acute care beds by elderly patients for extended stay, or when an alternate level of care would have been appropriate, was greater in St John's with the disparity persisting over time. Waiting time for continuing care in the St John's region was unchanged comparing 1995/96 and 1999/00. CONCLUSIONS: The degree to which acute care restructuring or financial pressures and constraints imposed at the provincial level contributed to observed utilization trends is unclear. Aggregation of hospitals in the St John's region may have contributed to more efficient use of acute care beds. Restructuring as carried out did not integrate health care sectors, and problems at the acute care/continuing care boundary were not resolved in St John's, where access to continuing care remained difficult.

Adult↗
PubMed1981

The impact of early and comprehensive social work services on length of stay.

The efficient use of health care resources requires that patients remain in in-patient facilities only as long as is necessary. High-quality patient care requires that patients are physically, socially and psychologically prepared for leaving the hospital and that plans for their post-hospital care are adequate. The authors discuss a study of Orthopaedic patients which demonstrates that early and comprehensive social work intervention can reduce the length of time patients stay in the hospital. They also describe the effect of the study on expanding the role of social work within the acute care, general hospital.

Concurrent Review↗
PubMedDate not supplied

Back to the drawing board: new directions in health plans' care management strategies.

The backlash against managed care has pressured health plans to reexamine their approaches to controlling utilization and managing their members' health care needs, but how much has really changed? Interviews with health plans and others in twelve nationally representative markets suggest that the changes are significant. New and refined disease management programs are improving the care experience of participants with certain prevalent chronic illnesses, while utilization management changes are reducing the administrative burden for providers. Still, disease management programs will need to greatly expand in scope and scale if plans are to succeed in addressing the complex health care needs of aging populations and those with chronic diseases.

Chronic Disease↗
PubMed2002

Prenatal HIV counseling and testing in California: women's experiences and providers' practices.

Two concurrent surveys were conducted in four California counties to compare the prenatal HIV counseling and voluntary testing (C&VT) experiences of women with the self-reported practices of prenatal care providers. Participants were 850 women currently or recently receiving prenatal care and 254 providers. Although 79.9% of women reported being offered an HIV test during a prenatal visit, only 56.2% said they were told about the risks and benefits of taking an HIV test. Almost all providers (98.4%) indicated they offer an HIV test, and 76.8% reported offering counseling, to every patient. One third of the women (65.9%) knew that treatment exists for reducing the chance of prenatal transmission of HIV, and 78.7% of women said they were more likely to be tested given knowledge of such therapy. Women may have underreported prenatal C&VT because providers spend insufficient time discussing related issues or because C&VT information is not presented in a way that is relevant to all patients.

AIDS Serodiagnosis↗
PubMed1997

[Causes of unjustified hospital stay following cerebral infarction].

The frequency and causes of prolonged length of stay (LOS) in patients with acute ischemic stroke were studied in 20 patients admitted to a university hospital participating in the International Stroke Trial (IST). The protocol for prolonged LOS study designed by R. S. Goldman et al. (1996) was reproduced. Mean (+/- SD) LOS was 13.1 +/- 11.5 days (median = 10 days). Prolonged LOS occurred in 12 (60%) patients. In these 12 patients, a total of 83 (62%) of 134 days were found to be unnecessary (6.9 +/- 4.6). Most of these patients remained hospitalized while awaiting for routinely performed tests, such as 2D echocardiogram or carotid Doppler. LOS was not influenced by patient characteristics (age or gender) or specific location in the hospital (emergency room or other). In conclusion, LOS and hospitalization costs can be markedly reduced in this hospital by rational use of already available diagnostic tests.

Cerebral Infarction↗
PubMed2006

Interaction between warfarin and cranberry juice.

Warfarin is extensively used for anticoagulation to a target international normalized ratio of 2.0-3.0 for most indications or 2.5-3.5 for high-risk indications; however, many drugs and dietary supplements induce fluctuations in the international normalized ratio. Such fluctuations may lead to therapeutic failure or bleeding complications. Cranberry juice is increasingly used for the prevention and adjunctive treatment of urinary tract infections. The United Kingdom's Committee on Safety of Medicines has alerted clinicians to a potential interaction between warfarin and cranberry juice and has advised that patients avoid their concurrent use. Review and analysis of the literature revealed that ingestion of large volumes of cranberry juice destabilize warfarin therapy. Small amounts of juice are not expected to cause such an interaction. Clinicians should be aware of this potential interaction and monitor and counsel patients accordingly.

Anticoagulants↗
PubMed1980

The role of the cranial CT scan in municipal hospitals.

House officer predictions of lesions and CT scan diagnosis were compared for accuracy in a municipal and community hospital setting. The input of the CT scan into initial patient care was also evaluated. In the municipal hospital, house officers made fewer most-correct diagnoses, and the CT scan more often established the correct diagnosis (P less than .03) and altered therapy (P less than .02). Results suggest that municipal hospital patients could benefit from accessible CT scanners.

Brain Diseases↗
PubMed1991

Occurrence screening in critical care.

Occurrence screening is a system of quality assurance in which patient care is reviewed, both concurrently and retrospectively, against a set of general outcome screening criteria. It is a method for monitoring the quality of clinical practice more comprehensively that has been possible in the past. If implemented appropriately, occurrence screening eliminates the random efforts and audits of past quality assurance efforts with a systematic and comprehensive monitoring process aimed at identifying questionable quality of care practices. This article discusses the concept of occurrence screening as a useful tool in assessing quality of care in a special care unit.

Humans↗
PubMed1994

Practice guidelines and reminders to reduce duration of hospital stay for patients with chest pain. An interventional trial.

OBJECTIVE: The acceptability, safety, and efficacy of practice guidelines have rarely been evaluated. Moreover, despite the recent development of guidelines and decision aids for patients admitted to coronary care and intermediate care units, few have been tested in clinical practice. DESIGN: A prospective, controlled clinical trial with an alternate-month design. SETTING: A large teaching community hospital. PATIENTS: Patients admitted to coronary care and intermediate care units with chest pain who were considered at low risk for complications according to a practice guideline (n = 375). INTERVENTION: Physicians caring for patients with chest pain who were at low risk for complications received concurrent, personalized written and verbal reminders regarding a guideline that recommended a 2-day hospital stay. RESULTS: Use of the practice guideline recommendation with concurrent reminders was associated with a 50% to 69% increase in guideline compliance (P < 0.001) and a decrease in length of stay from 3.54 +/- 4.1 to 2.63 +/- 3.0 days (0.91-day reduction, 95% CI, 0.18 to 1.63; P = 0.02) for all patients with chest pain considered at low risk for complications. The intervention was associated with a total (direct and indirect) cost reduction of $1397 per patient (CI, $176 to $2618; P = 0.03). No significant difference was found in the hospital complication rate between patients admitted to the hospital during control and intervention periods, and no significant difference was noted in complications, patient health status, or patient satisfaction when measured 1 month after hospital discharge. CONCLUSION: These results suggest that implementation of this practice guideline through concurrent reminders reduced hospital costs for patients with chest pain considered at low risk for complications. Further study of the guideline is warranted.

Aged↗
PubMed2004

Cost-effectiveness of cardiac resynchronization therapy in patients with symptomatic heart failure.

BACKGROUND: Heart failure is a common, costly, and debilitating illness. Resynchronization of ventricular contraction in patients with heart failure improves ejection fraction. The long-term morbidity and costs associated with such cardiac resynchronization therapy remain unclear. OBJECTIVE: To assess the incremental cost-effectiveness of cardiac resynchronization therapy. DESIGN: Markov model with Monte Carlo simulation. Future costs and effects were discounted at 3%. DATA SOURCES: Effects data were obtained from a concurrent systematic review. Health-related quality-of-life and cost data were obtained from publicly available data or from surveys. TARGET POPULATION: Patients with reduced ventricular function and prolonged QRS. TIME HORIZON: Lifetime. PERSPECTIVE: U.S. health care system. INTERVENTIONS: Cardiac resynchronization therapy versus medical therapy. OUTCOME MEASURES: Quality-adjusted life-years (QALYs), costs, and incremental cost-effectiveness. RESULTS OF BASE-CASE ANALYSIS: Medical therapy yielded a median of 2.64 (interquartile range, 2.47 to 2.82) discounted QALYs and a median discounted lifetime cost of 34,400 dollars (interquartile range, 31,100 dollars to 37,700 dollars). Cardiac resynchronization therapy was associated with a median incremental cost of 107,800 dollars(interquartile range, 79,800 dollars to 156,500 dollars) per additional QALY. RESULTS OF SENSITIVITY ANALYSIS: Results were sensitive to changes in several variables, including the relative risk for death or hospitalization. LIMITATIONS: These results apply to patients who meet the inclusion criteria of the currently completed trials. CONCLUSIONS: The incremental cost per QALY for cardiac resynchronization is similar to that of other commonly used interventions but is sensitive to changes in several key variables. Resynchronization therapy should not be considered in patients with comorbid illness that shortens life expectancy.

Cardiac Pacing, Artificial↗
PubMed1990

Documenting concurrent clinical pharmacy interventions.

The documentation of clinical pharmacy activities is an important issue and the authors describe a relatively simple and easily implemented method of documenting concurrent clinical pharmacy interventions. This quality assurance measure was added to the quality assurance calendar of a tertiary care medical center/teaching hospital to: (1) document to the Joint Commission on Accreditation of Healthcare Organizations that the pharmacy department is involved in direct patient care, and (2) demonstrate to hospital administrators that pharmacists are an integral and necessary component of the health care team. At least 115 of 428 (27%) documented interventions during 1988 prevented patients from suffering potentially serious side effects and adverse drug reactions. Physicians and nurses initiated consultations by contacting pharmacists, either by phone or in person, and asking them to: (1) recommend dosages for renally impaired patients; (2) monitor patients receiving medications such as aminoglycosides, digoxin, and phenytoin; (3) suggest appropriate doses for specific indications; (4) recommend a formulary drug for a specific condition; and (5) provide drug information. Pharmacists initiated consultations by contacting physicians and nurses, either by phone or in person, to clarify an order or make recommendations regarding drug therapy. Nurses, pharmacists, and physicians initiated 37%, 33%, and 30% of the clinical interventions, respectively. Most of the physician (89%) and nurse (82%) initiated interventions were requests for drug information, whereas most of the pharmacist initiated interventions were order clarifications (51%). The daily documentation of clinical pharmacy interventions demonstrated that the quality of patient care and patient outcome was improved and served as an effective method of cost-justifying pharmacist positions in this era of fiscal constraints.

Concurrent Review↗
PubMed1990

A simplistic approach to establishing drug usage/quality assurance programs.

Eighty-eight percent of the hospitals accredited by the Joint Commission on Accreditation of Health Care Organizations don't fully comply with JCAHO standards in the area of drug usage evaluation, reports JCAHO in Hospitals, August 5, 1989. Why are so many hospital pharmacies receiving contingencies from JCAHO for QA/DUE? Do we lack a clear understanding of the required features and terms, and/or are we confused on how to best implement a comprehensive program? JCAHO has a number of publications which describe not only newer QA/DUE terminology and requirements but also a nine step process to establish a comprehensive program. This article will describe and summarize both terminology and the nine step process. Integration of the nine step process into the drug distribution system allows the pharmacists to identify drug related problems on an ongoing basis. This process is not only efficient but also cost effective. The article will provide simple examples of QA/DUE programs which dovetail with existing drug distribution processes. Lastly, current JCAHO published QA/DUE scoring guidelines will be discussed. The establishment of structured ongoing QA/DUE programs can begin to collect data vital to documenting the impact of the pharmacist on patient care.

Accreditation↗