Acute Colonic Diverticulitis and Cirrhosis: Outcomes of Laparoscopic Colectomy Compared with an Open Approach

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Readmission treatment price and product quality in the hospital sector

In this paper, we study the effect of readmission treatment payment in a dynamic framework characterised by competition among hospitals and sluggish beliefs of patients concerning the service quality. We find that the effect of readmission treatment payment depends on the interplay between the effect of quality in lowering readmissions and its effect on future demand. When the readmission occurrence strongly depends on the service quality, the higher the readmission treatment payment for hospitals, the lower the incentive to provide quality. Instead, when readmission depends barely on quality, the readmission payment acts as the treatment price for first admissions, and thus it reinforces the incentive to provide quality. We also show that the detrimental effect of readmission payments on quality are fed by a high degree of demand sluggishness, that is, by situation where current quality has modest effect on future demand changes. Our findings are robust to different equilibrium concepts of the differential game (i.e., open‐loop and state‐feedback). The results suggest that a discounted regulated price for readmission can be an effective (and cost‐free) policy tool to improve health care quality, especially when the market is characterised by sluggish beliefs about quality.     

Factors Which Influence Hospital Doctors' Advance Care Plan Adherence

ContextAdvances in medicine have seen changes in mortality in Western countries. Simultaneously, countries such as Australia, Canada, U.S., New Zealand, U.K., and Germany have encouraged consumer-directed care and advance care plan (ACP) completion, giving patients a voice despite incapacity. Adhering to ACPs relies on the decision-making of treating doctors, making hospital doctors key partners, and their perspectives on ACP adherence critical.ObjectivesThe aim of this review was to explore and map existing research on factors associated with hospital doctors adhering to adult patients' ACPs.MethodsA scoping review of English language publications within CINAHL, Emcare, Medline, PsycInfo, and Scopus was conducted, following PRISMA Extension for Scoping Reviews (PRISMA-ScR) guidelines. ACPs were defined as adult patient-generated, written health care directions or values statements. Studies of any design, which reported original research associated with hospital doctors adhering to ACPs, were included.ResultsTwenty-seven publications were included in the final analysis. Results suggested ACPs were thought potentially useful; however, adherence has been associated with doctors' attributes (e.g., specialty, seniority), attitudes toward ACP (e.g., applicability), and legal knowledge.ConclusionCurrent literature suggests doctors hold largely positive attitudes toward ACPs that provide useful patient information that enables doctors to make appropriate treatment decisions. Doctors often perceive limitations to ACP applicability due to legal requirements or ambiguity of patient outcome goals.     

The influence of age and chronic medical conditions on neurological outcomes in out of hospital cardiac arrest

AimIt is unknown whether older patients with out of hospital cardiac arrest (OHCA) have worse outcomes because of aging itself, or because age can be a marker for overall health status. We aimed to study the prognostic utility of age and pre-arrest comorbidities.MethodsWe conducted a retrospective cohort study, reviewing electronic health records of all adults treated for non-traumatic OHCA in the University of Michigan Emergency Department (N = 588). Primary covariates included age, Charlson Comorbidity Index (CCI), and a combined Charlson-age index. The primary dichotomized outcome was favorable neurological outcome (cerebral performance category, 1–2), evaluated by logistic regressions.ResultsDementia (p = 0.01), witnessed arrest (p = 0.03), bystander CPR (p < 0.001), presenting rhythm (p < 0.001), and mild therapeutic hypothermia (p < 0.001) were associated with the primary outcome. Increasing age (unadjusted OR for each decade of life, 95% CI: 0.78, 0.70–0.88; adjusted 0.79, 0.67–0.94) was negatively associated with likelihood of a favorable neurological outcome. CCI and combined Charlson-age index significantly predicted outcome in the unadjusted, but not adjusted analysis. Composite variables were stronger predictors in patients with shockable than non-shockable presenting rhythms (interaction terms: age and rhythm [p = 0.004], CCI and rhythm [p = 0.01]).ConclusionAge, but not CCI, was significantly associated with less favorable neurological outcomes in patients with OHCA after adjusting important covariates. Age appears to be an independent predictor of prognosis rather than a marker for comorbidity.     

Incorporation of the health care system in the west

A reflection is made, from an interpretative perspective, on the historical evolution of health care in the West. It starts from the moment that this became a way to intervene the sick and an instrument for healing diseases, focusing on original documents and written sources which account for results of historical research, which range from XV century until today. To do this, it tries to understand the health care as an ideographic body of knowledge consisting of five pieces of a puzzle composed by: the state policy of hospitals accumulation implemented in Spain, the accumulation of medical practices in what is currently Germany, the hospital wards in England, the nosological rationality in France, and the US sanitizing machine; all these movements as producers of closely linked health care developments, that are nothing more than collective actions regulated by social norms around health.