Ventilator-associated pneumonia in a multi-hospital system: differences in microbiology by location.

OBJECTIVE: To determine whether there were differences in the microbiologic etiologies of ventilator-associated pneumonia in different clinical settings. DESIGN: Observational retrospective cohort study of microbiologic etiologies of ventilator-associated pneumonia from 1998 to 2001 in a multi-hospital system. Microbiologic results were compared between hospitals and between different intensive care units (ICUs) within hospitals. SETTING: Three hospitals--one pediatric teaching hospital, one adult teaching hospital, and one community hospital--in one healthcare system in the midwestern United States. PATIENTS: Patients at the target hospitals who developed ventilator-associated pneumonia and for whom microbiologic data were available. RESULTS: Seven hundred fifty-three episodes of ventilator-associated pneumonia had culture data available for review. The most common organisms at all hospitals were Staphylococcus aureus (28.4%) and Pseudomonas aeruginosa (25.2%). The pediatric hospital had higher proportions of Escherichia coli (9.5% vs 2.3%; P < .001) and Klebsiella pneumoniae (13% vs 3.1%; P < .001) than did the adult hospitals. In the pediatric hospital, the pediatric ICU had higher P aeruginosa rates than did the neonatal ICU (33.3% vs 17%; P = .01). In the adult hospitals, the surgical ICU had higher Acinetobacter baumannii rates (10.2% vs. 1.7%; P < .001) than did the other ICUs. CONCLUSIONS: Microbiologic etiologies of ventilator-associated pneumonia vary between and within hospitals. Knowledge of these differences can improve selection of initial antimicrobial regimens, which may decrease mortality.     

Strategies for multi-hospital networks: a framework.

The last two decades have seen the significant emergence of multi-hospital networks (MHNs) in the health sectors of all industrialized countries. Such networks seem to represent an organizational choice, which provides interesting opportunities to cope with cost and quality issues stressing the health field. This work proposes and discusses a framework for strategies that can be implemented by MHNs to achieve projected benefits. The estimated advantages are then weighed against unexpected or underrated drawbacks and empirical evidence. The conclusions point out MHNs as viable future alternatives for freestanding hospitals looking to improve their efficiency and financial stability, on condition that a 'proper management' of their consolidation processes is carried out. This requires extensive pre-deal analysis to critically assess what benefits could be achieved through the network's formation, as well as post-deal perseverance in implementing consolidation strategies to their full. In this perspective, specific advices apt to minimize the risk of creating MHNs in the wake of a management fashion instead of through sound rational assessments are also discussed.     

Assessing performance of multi-hospital organizations: a measurement approach

PURPOSE: This paper aims to introduces a measure to assess the perceived effectiveness of multi-hospital organizations (MOs). DESIGN/METHODOLOGY/APPROACH: A sample of top managers of non-profit hospitals serves as the study setting. Data were collected via mail surveys. Usable responses were obtained from 189 hospitals. The measure was developed by considering the instrumentality and effect components of a set of relevant motives for joining an MO. During the course of the study, three alternative formulations were examined. FINDINGS: Results show that the measures based on effect alone and a multiplicative combination of effect and instrumentality demonstrate sound psychometric properties. The recommendation here is to adopt the latter measure. RESEARCH LIMITATIONS/IMPLICATIONS: The study was limited to a particular sample. Replications among other samples are needed to validate the current findings. Also, because the exact content of the objective function of a hospital for joining an MO is not necessarily constant over time, there is a need to conduct similar studies on a periodic basis. PRACTICAL IMPLICATIONS: The measure recommended here uses multiplicative/weighted instrumentality and effect scores as opposed to only the instrumentality or effect scores. This makes it possible to go beyond the mere "why" or "how" questions. Simultaneous consideration of instrumentality and effect dimensions affords a richer and more relevant understanding. ORIGINALITY/VALUE: Valid and reliable measures of performance are critical for both managerial and research purposes. The measure proposed in the current study could be used in structural equation models to investigate the effect of individual actions on performance and the impact of performance on other outcome measures (e.g. intentions to stay in an MO).     

Association of bond, market, operational, and financial factors with multi-hospital system bond issues.

Despite the growth of multi-hospital systems in the 1990s, their performance in the tax-exempt bond market has not been adequately evaluated. The purpose of this study is to compare bonds issued by multi-hospital systems to those issued by individual hospitals in terms of bond, market, operational, and financial characteristics. The study sample includes 2,078 newly issued, tax-exempt, revenue bonds between 1991 and 1997. The findings indicate that multi-hospital systems issued larger amounts of debt at a lower cost, were more likely to be insured, had higher debt service coverage and higher operating margins.     

Comparing HIPAA practices in two multi-hospital systems

The comparison of HIPAA compliance efforts at two multi-hospital networks (Children's Health System and Carilion Health System) suggests a framework for classifying practices and for facilitating the integration of further case studies into a national library of HIPAA practices.     

Information for integration. A senior services program spurs development of a multi-hospital integrated network

In 1985 St. Charles Hospital, Oregon, OH, and Mercy Hospital of Toledo, OH, launched a plan to jointly offer a continuum of services to area seniors. A multidisciplinary team of professionals from both hospitals decided that a membership program (titled the Senior Advantage Program) would be the most effective way to market the services and make them available. As part of the program's development, professionals from the two facilities created a personal computer-based software package that enabled them to capture and update information about Senior Advantage participants. The software program includes a detailed application form and a section for recording enrollees' service utilization. The program enables care givers to enter data when they interact with clients in any healthcare or community-based setting. To complement the personal computer software, a program to construct a central data base was written for the two hospitals' main computer systems. In 1991 St. Charles and Mercy hospitals joined two other facilities to form First InterHealth Network, a for-profit integrated delivery network. The Senior Advantage Program became the basis for the first package of services offered by First InterHealth. In 1992 the program became the catalyst for yet another collaborative venture, linking two rural Ohio Mercy hospitals to St. Charles and Mercy hospitals. The expanded network encouraged rural patients to remain within the Mercy network, utilizing inner-city and suburban Mercy-sponsored hospitals when appropriate.     

Effect of implementing safety-engineered devices on percutaneous injury epidemiology.

OBJECTIVE: To assess the effect of implementing safety-engineered devices on percutaneous injury epidemiology, specifically on percutaneous injuries associated with a higher risk of blood-borne pathogen exposure. DESIGN: Before-and-after intervention trial comparing 3-year preintervention (1998--2000) and 1-year postintervention (2001--2002) periods. Percutaneous injury data have been entered prospectively into CDC NaSH software since 1998. SETTING: A 427-bed, tertiary-care hospital in Manhattan. PARTICIPANTS: All employees who reported percutaneous injuries during the study period. INTERVENTION: A "safer-needle system," composed of a variety of safety-engineered devices to allow for needle-safe IV delivery, blood collection, IV insertion, and intramuscular and subcutaneous injection, was implemented in February 2001. RESULTS: The mean annual incidence of percutaneous injuries decreased from 34.08 per 1,000 full-time-equivalent employees preintervention to 14.25 postintervention (P < .001). Reductions in the average monthly number of percutaneous injuries resulting from both low-risk (P < .01) and high-risk (P was not significant) activities were observed. Nurses experienced the greatest decrease (74.5%, P < .001), followed by ancillary staff (61.5%, P = .03). Significant rate reductions were observed for the following activities: manipulating patients or sharps (83.5%, P < .001), collisions or contact with sharps (73.0%, P = .01), disposal-related injuries (21.41%, P = .001), and catheter insertions (88.2%, P < .001). Injury rates involving hollow-bore needles also decreased (70.6%, P < .001). CONCLUSIONS: The implementation of safety-engineered devices reduced percutaneous injury rates across occupations, activities, times of injury, and devices. Moreover, intervention impact was observed when stratified by risk for blood-borne pathogen transmission.     

Differences in dietary patterns of nonsmoking adults married to smokers vs. nonsmokers

PURPOSE: To compare dietary intakes of nonsmoking adults married to smokers or nonsmokers. DESIGN: Respondents to the U.S. Department of Agriculture's Continuing Survey of Food Intakes by Individuals (CSFII), 1994 to 1996 (response rate = 76.1% for 2 days of dietary intake). Nonsmoking adults aged 18 and older were grouped according to the smoking status of their spouse. SETTING: In-home interviews in all 50 states and Washington, D.C. SUBJECTS: The selected sample included 757 men and 754 women who were married to nonsmokers, and 197 men and 262 women who were married to smokers. MEASURES: Selected demographic variables, food group servings, food energy, and densities of selected nutrients were compared using chi 2 and analysis of covariance. RESULTS: Men and women married to smokers had greater (p < or = .025) energy-adjusted intakes of total and saturated fat but significantly lower (p < or = .05) energy-adjusted intakes of fiber and vitamin A. Men married to smokers consumed significantly more (p < .025) energy-adjusted cholesterol and ethanol but significantly less calcium (p = .026); women married to smokers consumed significantly less (p = .014) energy-adjusted folate. Men married to smokers consumed significantly more (p < or = .05) alcoholic beverages, coffee, and soft drinks; women married to smokers consumed significantly less water (p = .014) but more cheese and table sweeteners (p < or = .05). CONCLUSIONS: Nonsmoking men and women who were married to smokers had compromised dietary intakes. Nonsmoking men whose wives smoked, in particular, had unhealthy diets due to elevated intakes of fat and cholesterol and low intakes of vitamin A, calcium, and fiber. Health professionals should continue to provide tobacco cessation instruction and dietary guidance, but also be aware of at-risk patients' immediate family members who likely share an increased risk of disease because of poor diet quality and exposure to environmental tobacco smoke.