Long-term care hospitals under Medicare: facility-level characteristics

Though accounting for only a small percentage of total Medicare spending, long-term care hospitals (LTCHs) (defined as having an average length of stay [LOS] of 25 days or more) have been growing, in number and in Medicare expenditures, at a rapid rate in recent years. Because they have not been widely studied, we conducted research to describe the characteristics of this increasingly important Medicare provider type. We found that most LTCHs specialize in the provision of respiratory care or rehabilitation. Information from this study can help inform the development of a Medicare prospective payment system for LTCHs.     

Clinical pharmacology and general patient care in two teaching hospitals

The clinical responsibilities and activities over 12-month periods of the Departments of Clinical Pharmacology of two London teaching hospitals have been analysed. The results suggest that clinical pharmacology should not be regarded only as an academic specialty but that it has an important role in patient care.     

Variables correlated with elderly referral from nursing homes to general hospitals

Background

Referring patients from nursing homes to general hospitals exposes them to nosocomial diseases, and may result in the development of a broad spectrum of physical, mental and social damages. Therefore, minimizing the referring of nursing home patients to hospitals is an important factor for keeping the elderly healthy and minimizing health expenditures. In this study we examined the variables related to the referral rates from nursing homes to general hospitals and the relationship between the referral and the mortality rates among the elderly who live in nursing homes in the Haifa Sub-district.

Methods

Thirty-two nursing homes were included in a cross-sectional study. All medical directors and head nurses were interviewed using a structured questionnaire between November 2006 and October 2007. Statistical analysis, including the ANOVA and the nonparametric Spearman tests, were employed to determine the factors that influence referral rates and the correlation between referral rates and mortality rates.

Results

The referral rate ranged between 18 and 222 per 100 financed elderly in a single year. In the multivariate analysis, the absence of a physician from the nursing home at the time of the referral to general hospitals was the only significant variable related to referral rates. No significant relationships were found between referral rates and mortality rates.

Conclusions

Absence of a significant relationship between referral rates and mortality rates may indicate that high referral rates do not necessarily protect the elderly from death. Therefore, any recommendations issued by the Ministry of Health (MOH) should emphasize in-house treatment rather than hospitalization. Clear instructions on referral from nursing homes to general hospitals need to be constructed by the MOH. The MOH should increase the presence of physicians in the nursing homes, especially, when the need to refer a patient arises. Further quantitative and epidemiologic studies should be conducted in order to, more fully and reliably, create guidelines for policy recommendations.     

综合医院医疗质量评价的对比研究

目的 通过对比研究,加强医院医疗质量管理各个环节的控制与评价,找到医疗质量管理的关键环节,从而全面提高医院医疗质量管理水平.方法 应用综合性医院医疗质量关键评价指标对5所综合性医院2009年度医疗质量情况进行分析评价.结果 根据评价指标,5家医院在效率、效益和质量方面分别存在着不同的问题.结论 医院要根据自身的不足找出医疗质量管理的关键环节,加强医院医疗质量管理.     

Early intervention in alcohol abuse and addiction in general acute care hospitals

Early intervention has been shown to prevent alcohol-related diseases of the liver, the pancreas, and the gastrointestinal tract, as well as to reduce high blood pressure and the incidence of hospitalizations. At a general hospital, 27 patients were offered addiction counselling, six of whom were successfully referred to an outpatient addiction counsellor. However, prevalence rates of alcohol abuse and addiction were significantly lower than those reported in other studies. Similarly, referrals to addiction counselling were less frequent than in other programmes in which hospital staff had been specifically trained to identify problems of alcohol abuse and addiction and to initiate timely referrals. Intensive training of hospital staff as well as the provision of personal and logistical support at the hospital is crucial in the implementation of early intervention programmes for alcohol abuse and addiction in general hospitals.     

Psychiatric nurse reports on the quality of psychiatric care in general hospitals

Although acute inpatient psychiatric care has changed dramatically over the past 2 decades, little is known about how these changes have affected the quality of care, psychiatric nurse staffing, or patient outcomes. The purpose of this report is to explore the quality of care, quality of the practice environment, and adverse events as assessed by psychiatric nurses in the general hospital setting. The study sample consisted of 456 registered nurses permanently assigned to psychiatric units, compared with a larger sample of 11,071 registered nurses who work permanently on medical, surgical, or medical-surgical units. Compared with nonpsychiatric nurses, psychiatric nurse characteristics reveal an older, more experienced workforce, with a higher proportion of male nurses. Nurses rated quality of patient care lower in the psychiatric specialty than in the medical-surgical specialty. Furthermore, psychiatric nurses reported significant concern about the readiness of patients for discharge and higher incidence of adverse events. They also experienced more verbal abuse, physical injuries, and complaints from patients and families. Collectively, the results from this study underscore the organizational problems and quality-of-care issues that cause psychiatric nurses in general hospital settings to evaluate their work environments negatively.     

Role conflict and role ambiguity among middle managers in general acute care hospitals

One hundred ninety-three middle managers in general acute care hospitals participated in a study to measure role conflict and role ambiguity. Middle managers of both direct patient care and supporting services departments reported low levels of role conflict. Nonetheless, role overload and role conflict were significantly higher for managers of patient care departments than service departments. In addition, managers of both types of departments most often experienced intersender role conflict. Direct patient care and supporting services managers also reported low levels of role ambiguity, with no significant differences reported between the two types of departments. The relationship of role conflict and role ambiguity to demographic factors such as the manager's sex, educational level, years of managerial experience, and hospital size was also explored.