Long-stay patients in a psychiatric hospital in Southern Brazil

OBJECTIVE: To describe the demographic profile, social functioning, and quality of life of a population of long-stay care patients in a psychiatric hospital. METHODS: A study was carried out in Porto Alegre, Southern Brazil, in 2002. A total of 584 (96%) long-stay patients were assessed by means of the following instruments: the World Health Organization Quality of Life, the Social Behavior Schedule, the Independent Living Skills Survey, the Brief Psychiatric Rating Scale and another instrument for assessing disability (Questionnaire for Assessing Physical Disability). RESULTS: The average hospital stay was 26 years (SD: 15.8) and 46.6% of inpatients had no physical disability. Patients had their social functioning skills and autonomy largely impaired. Few of them (27.7%) answered the instrument for assessing quality of life, and showed significant impairments in all domains. The Brief Psychiatric Rating Scale evidenced a low prevalence of positive symptoms in this population. CONCLUSIONS: The institutionalized population studied presented significantly impaired social functioning, autonomy, and quality of life. These aspects need to be taken into consideration while planning for their deinstitutionalization.     

Measuring hospital medical staff organizational structure.

Based on organization theory and the work of Roemer and Friedman, seven dimensions of hospital medical staff organization structure are proposed and examined. The data are based on a 1973 nationwide survey of hospital medical staffs conducted by the American Hospital Association. Factor analysis yielded six relatively independent dimensions supporting a multidimensional view of medical staff organization structure. The six dimensions include 1) Resource Capability, 2) Generalist Physician Contractual Orientation, 3) Communication/Control, 4) Local Staff Orientation, 5) Participation in Decision Making, and 6) Hospital-Based Physician Contractual Orientation. It is suggested that these dimensions can be used to develop an empirical typology of hospital medical staff organization structure and to investigate the relationship between medical staff organization and public policy issues related to cost containment and quality assurance.     

Managing hospital infections

Major infections in hospitals may cause, or contribute to, patient deaths and, at best, disrupt hospital routines. Elaine Leaver describes the management response to a major infection in the hospital environment.     

Hospital closure: maintaining staff morale

Closing a large psychiatric hospital is a complex exercise, and one of the main tasks for management is to maintain staff numbers and staff morale during the run-down period, and to help staff find new and rewarding roles in the community based service. Alistair Bailey and Martin Barkley explain how this was tackled at Netherne Hospital.     

Medical staff specialty mix and hospital production.

This paper analyzes the role of medical staff characteristics in determining different dimensions of hospital output. Using a set of flexible functional form production functions, and adjusting for hospital case mix, we examine the output contribution of physicians and other inputs, and the influence that physicians in different specialties have on the productivity of other physicians, as well as on other labor and capital. We also examine the input substitution possibilities available to hospitals, and where possible, we compare our estimates to those obtained by other researchers. We find that physicians have numerous significant effects of production and conclude that physicians are an important input that should not be ignored in empirical cost and production function studies for hospitals.     

Rural community hospital closure and health policy.

Closure of rural community hospitals in the U.S.A. is a growing and important trend with serious implications for rural communities and the overall health care system. This study analyzes characteristics of all U.S. rural hospitals that closed between 1980 and 1986. Variables correlated with risk of closure--for-profit ownership status, non-government not-for-profit ownership status, number of other hospitals in the county, presence of a nursing or other long-term care unit, few facilities and services offered, lack of accreditation by the Joint Commission of Accreditation of Hospitals, lack of membership in a multihospital system--indicate that a rural hospital's survival depends upon its ability to compete and adapt in a volatile, competitive health care marketplace. five policy options are discussed: changes in Medicare payments, expansion of the number of hospitals designated as sole Community Hospitals, the use of swing beds, establishment of state offices of rural health, and short-term federal and state grants. Allowing hospitals the flexibility to adapt and compete, while ensuring adequate quality health care to rural residents, is suggested as the priority in rural health policy.     

Health planning and the closure of a community hospital.

The overall purpose of the research reported in this article is two-fold: firstly, to describe the efforts of a regional health planning agency in the United States to reduce the size of acute care facilities in its planning area; and, secondly, to frame these events into a general theory of structural problems of state interventions in the American health care sector. Specifically, a case study is presented that documents--over time--the process of decision making, in seeking to close a community hospital against strong, and vocal, local interests. This analysis supports the view that, in the real world of health planning, power is exercised through a process of bargaining between health care providers and government, and between health care providers. Overall, the study illustrates the constraints upon the American health planning agencies to steer a relatively autonomous health care sector.