Hospital Topics最新文献

Background: Vaccination against SARS-CoV-2 is widely used and confers protection against morbidity and mortality in COVID-19. Little is known about disease severity and outcomes in fully vaccinated patients during hospitalization for COVID-19. Aim: To determine whether vaccination status and time from vaccination-to-hospitalization impacted disease severity in patients admitted with COVID-19. Methods: A multicenter retrospective cohort study was conducted on hospitalized adults with COVID-19 between January 1 and September 8, 2021, in Rhode Island, USA. Vaccination status and markers of disease severity, including C-reactive protein, D-Dimer values, and supplemental oxygen use during hospitalization, were obtained. Results: Two thousand three hundred forty-four patients were included. For every vaccinated patient, three unvaccinated patients were matched for a total of 424 patients in the analytic sample. Vaccinated patients had lower peak C-reactive protein (beta = -39.10, 95% CI [-79.10, -0. 65]) and supplemental oxygen requirements (beta = -38.14, 95% CI [-61.62, -9.91]) compared to unvaccinated patients. Patients who had a greater discrepancy between date of vaccination and admission had higher C-reactive protein (beta = 0.37, 95% CI [0.02, 0.71]) and supplemental oxygen requirements (beta = 0.44, 95% CI [0.15, 0.75]. Conclusion: Vaccination against SARS-CoV-2 was associated with a protective effect on disease severity during hospitalization for breakthrough COVID-19. Time elapsed since vaccination was associated with indicators of greater disease severity suggestive of waning protection over time.

Introduction: There is growing popularity of the Hospital Incident Command System (HICS) as an organizational tool for hospital management in the COVID-19 pandemic. We specifically describe implementation of HICS at the Isfahan province reference hospital (Isabn-e-Maryam) during the COVID-19 pandemic and try to explore performance of it. Methods: To document the actions taken during the COVID-19 pandemic, standard, open-ended interviews were conducted with individuals occupying activated HICS leadership positions during the event. A checklist based on the job action sheets of the HICS was used for performance assessment. Results: With the onset of the pandemic, hospital director revised ICS structure that adheres to span of better control of COVID-19. Methods of expanding hospital inpatient capacity to enable surge capacity were considered. The highest performance score was in the field of planning. Performance was intermediate in Financial/Administration section and good in other fields. Discussion: In the current COVID-19 pandemic, establishing HICS with some consideration about long-standing events can help improve communication, resource use, staff and patient protection, and maintenance of roles.

The space-time design of hospital care services is still an underdeveloped topic in sociological and medical literature. The article explores the social affordances inscribed in the space-time design of a hospital outpatient waiting room in relation to people care engagement and emotional comfort. The aim is to extend considerations to the broader context of relational and person-centered care. Observations employed of participants in the field study have a two-fold focus. One is 'waiting' for a service or a person, and the other is 'expecting' something or someone from a service. 'Multisensory-scape' and 'Self-less subject' are two metaphors I have adopted to describe the in field patient waiting experience. In the first case, people's perception of hospital staff seeing and hearing them is central to observation in the care path. The second case is instead the result of people feeling a loss of identity when there is a time-mismatch between daily life routines and hospital organization rules. It is fundamental to consider the impact on people's waiting experience because citizens and patients trace their feelings of 'being taken into charge' and 'continuity of care' back to the emotional comfort experienced the first moment they accessed the space-time design of hospital services.

Falls among older adults are a major public health concern: They result in $30 billion in direct US healthcare costs annually and take an immense psychological and physical toll on older adults. Particularly concerning are falls in nursing home settings, which account for three times as many falls in adults over 65 than in any other setting. Objectives: We hypothesized that tailoring falls prevention and response plans to nursing home profit model (for- or nonprofit) and ownership type (public, private, franchise) would greatly improve effectiveness of general plans. Methods: To this end, we extracted data from existing government databases, collected qualitative data through structured interviews with home employees, and collected novel quantitative data through web surveys from a representative sample of 40 Pennsylvania nursing homes about prevention and mitigation protocols, population, and facility characteristics, and falls outcome metrics. We analyzed fall-related risk factors that we scored and used to build multivariate logistic regression models to predict falls rates, and subsequently used to build multilevel logistic regression multivariate models to pinpoint the influence of facility type. Results: We found a significant correlation between facility ownership and profit type and falls rates and outcomes. Conclusions: Armed with these analytical insights, we formulated improved falls prevention plans targeted to home types to achieve better falls outcomes as predicted by the models. Finally, we quantify the predicted impact of implementing these targeted plans on fall rates and outcomes in the homes in our study.

The Centers for Medicare and Medicaid Innovation (CMMI) gave rise to the State Innovation Models (SIMs). Medicaid Integrated Purchasing for Physical and Behavioral Health, referred to as Payment Model 1 (PM1), was a core payment redesign area of the Washington State SIM project under which our research team was contracted to provide an evaluation. In doing so, we leveraged an open systems conceptual model to assess qualitatively Early Adopter stakeholders' perceived effects of implementation. Between 2017 and 2019, we conducted three rounds of interviews, examining themes of care coordination, common facilitators and barriers to integration, and potential concerns for sustaining the initiative into the future. Further, we noted the initiative's complexity may require the establishment of enduring partnerships, secure funding sources, and committed regional leadership to ensure longer-term success.

During the covid 19 pandemic, management of nursing resource which forms the crux of patient care emerged as one of the major challenges amongst many. The strategies for staff mobilization, redeployment and recruitment, along with laying down standard operating procedures evolved as the pandemic progressed. The safety of the staff has to be a major focus area. Guidelines for covid duty exemption, orientation and training of staff must be drafted, reviewed and revised as required. Issues related to accommodation, psychosocial support and wellbeing have to be addressed. It is very important to adapt to the ever changing needs for nursing resource and be vigilant for emerging issues for an effective response to the pandemic.

Utilizing resources to reduce costs and increase income while ensuring patient safety necessitates rigorous planning. The study aims to assess ergonomics, equipment utilization, outpatient satisfaction, and quality assurance in the Radiology Department. Four hundred outpatients, 39 radiographers, and 40 postgraduate students participated in a cross-sectional mixed-methods study that included surveys and interviews. The results were obtained using descriptive statistics, a utilization rate, and a Chi-square test with a 95% confidence interval. Three hundred eighty-two patients, or 95.5%, were satisfied with the overall service quality. Quality and explanation of the process by a radiographer 76.8%, patient knowledge of procedures 76.8%, privacy level 79%, and affordability of treatment 91.8% leading to 95.5% patient satisfaction and 87% were willing to recommend the facility to family and friends. Although there was a high percentage correlation with clinical diagnosis (81%), re-doing 43 (1%), reporting a mistake 30 (23.4%), or both might affect patient safety standards. Quality control, patient safety, and equipment utilization are all inextricably linked. Even minor changes in quality can influence utilization rates and patient safety.

Background: Hospitals make up the main cost factor of health systems and also face increasing pressure to improve efficiency. Improving the performance of hospitals, which are vital for public health, is very important for developing countries such as Turkey. Aims: We conducted this study to assess the performance of 544 secondary-level public hospitals in Turkey by geographical region. Methods: In the study, we used the entropy weighting method to obtain the objective weights of indicators with the evaluation criteria, and then we utilized the TOPSIS (Technique for Order Preference by Similarity to Ideal Solution) method to rank the performance of hospitals by geographical region. Results: The comparison of hospital performances by geographical region indicated that the highest and the lowest mean scores belonged to the Mediterranean Region and the Eastern Anatolia Region, respectively. Conclusions: The socio-economic differences between geographical regions in Turkey were in parallel with the findings of the study. Although there is a need for professional management in resource allocation and use to improve the performance of public hospitals, it is necessary to focus on the origin of the problems first.

A small percentage of patients consume most of the health services in the US. These cases of superutilization affect hospitals, but little is known about what it is, the impact on hospitals, or how hospitals can identify potential cases of superutilization. We conducted exploratory research using the Medical Expenditure Panel Survey (MEPS) datasets for 2019 to examine superutilization as it relates to hospitals. Using total charges for health services to identify superutilization, we found a surprising amount of superutilization was not related to hospital care. When superutilization did occur in hospitals, there was reduced reimbursement for care in superutilization as measured by the reimbursement relative to charges. Demographic variables had limited utility in predicting superutilization. Our demographic analysis suggested that there are potential cases of superutilization that are not accessing hospital care. Our analyses suggest that given the amount of care that cases of superutilization require, the decreased reimbursement for the high levels of care and the untapped potential of superutilization, hospitals should consider developing capabilities to manage these challenging cases.

The study deals with understanding of the factors associated with online ratings and reviews that help the healthcare consumers in better decision making. Data was collected from 303 participants using mixed methods. The results indicate the factors that help in decision making which includes use of ratings as a reference, impact of positive and negative ratings, whether these ratings depict the actual worth of healthcare service provider and the relevance of these websites in decision making. This study concludes that there is significant relevance of online rating and review websites on healthcare consumers in selecting a healthcare provider.