Balance outcomes from two small rural hospitals

Objectives: To describe predicted and measured balance changes in patients receiving physiotherapy in two rural hospitals, and to explore the relationship among balance at discharge, carer availability and patients' discharge destination. Design: Prospective measurement study. Setting: Two rural Australian hospitals. Participants: Eighty‐nine inpatients with a median age of 84. Main outcome measures: Berg Balance Scale (BBS) on admission and the treating physiotherapist's estimate at admission of individual patient's discharge BBS. Follow‐up measures included discharge BBS, carer availability after discharge and patient discharge destination. Results: Although change in measured balance of study participants had wide variability, balance measured by the BBS displayed a statistically and clinically significant improvement. A strong relationship was found between balance scores and discharge destination. However, no relationship was found between carer availability and discharge destination. Physiotherapists' estimates of discharge BBS displayed an average error of 7/56. Conclusions: The strong relationship between measured balance and discharge destination in these elderly study participants suggests that maximising their balance might minimise admissions to nursing home. The high variability of measured balance change suggests outcomes are difficult to predict. The study results suggest that premature assessment of patient's suitability for nursing home placement should be avoided. The accuracy of physiotherapist's estimates of discharge BBS suggests that greater weight might be placed on their input to facilitate the discharge planning process.     

Improving quality in small hospitals

Often, the organizations profiled by THE QUALITY LETTER are the powerhouses of the healthcare industry, with the resources, researchers and technology to make quality improvements at the cutting edge of the field. This month, THE QUALITY LETTER looks at small and rural hospitals--often with 100 or fewer beds, isolated from competition or the pressures of managed care--that have made the most of their opportunities to improve the quality of care they deliver. Many of the issues they face and the answers they find are applicable to organizations of any size.     

Consolidation of community hospitals

The largest component of U.S. health care expenditures is the cost of hospital care. Evidence seems to indicate that community hospital costs can be reduced through the consolidation of some, or even all, hospital services. Although no discernible set of relevant minimal costs for the hospital industry has been established as yet, significant economies of scale can be attributed to the consolidation process. In addition to potential economic benefits, medical benefits can also accure to the community as well when inefficient, low-volume services are combined to provide more attractive resources to highly qualified specialists. Many independent community hospitals operate autonomously, often to the detriment of community health needs and economy. Those hospitals that fail to take advantage of the opportunities offered by consolidation may not be keeping faith with the population they claim to serve.     

Ethics committees in small hospitals.

Ethics committees at small hospitals confront most of the same ethical dilemmas present at large hospitals, but must usually deal with them with fewer resources and less access to recognized expertise. Nonetheless small hospital committees can function effectively in the areas of education, policy deliberation, and case consultation. The development of ethics committees at two small Vermont hospitals is described, noting some of the problems associated with smallness and making suggestions about how to surmount them.     

Dilemma of black community hospitals

This feature of Urban Health covers a wide range of topics related to metropolitan hospitals, both public and private. This month's column discusses a hospital setting with which relatively few practicing physicians are well acquainted--the Black community hospital. More than 500 such hospitals were established in years following the Civil War, but their numbers have dwindled steadily in recent decades to the point where today only a handful survive. A recasting of missions and a thrust into the middle class population are among strategies needed to halt the demise of these institutions, says the author.     

Classification of community hospitals.

This articles describes the methodology, results, and potential applications of a study conducted by the authors to classify the nation's community hospitals. The classification system is offered as a preferable alternative to the system presently used by the Social Security Administration to implement Section 223 of the Social Security Amendments of 1972 (P.L. 92-603).