Risk factors for hospitalization of children aged 1 to 4 years in Sao Luis, Maranhao, Brazil

Risk factors for pediatric hospitalization were studied using a cross-sectional multi-stage cluster sample survey. A standardized questionnaire was answered by children's mothers or other care providers. In the municipality of S?o Luís, Maranh?o, Brazil, 596 children aged 1 to 4 years were sampled in 50 census tracts. Design effect was calculated for each estimate. Hospitalization rate was 24. 4%. Main causes of hospitalization were pneumonia (7.3%) and diarrhea (7.1%). The Unified National Health System (SUS) and private insurance accounted for 78.1% and 18.2% of hospital admissions, respectively. After adjustment for confounding by Cox proportional hazards model modified for cross-sectional design, children whose families earned less than one minimum monthly wage and those with private insurance were at higher risk of hospitalization. Hospitalization due to outpatient-sensitive diseases accounted for most cases. The U-shaped hospitalization pattern suggests low quality of outpatient services among the poor and may be a proxy indicator for unnecessary and iatrogenic hospitalization among privately insured children.     

Hospital privileges for family physicians at university hospitals

Of the more than 350 family practice residency programs in the United States, 72 are affiliated with a medical school. Seventy-eight percent of these university programs hospitalize all or some of their patients at a university hospital. These hospitals grant various privileges to family physicians with the following frequencies: general medicine (94 percent), adult intensive care (50 percent), coronary care (65 percent), general pediatrics (81 percent), pediatric intensive care (29 percent), normal newborn nursery (79 percent), intensive care nursery (12 percent), routine obstetrics (77 percent), and high-risk obstetrics (31 percent). Sixteen (22 percent) of the university-based programs do not use a university hospital at all, either because the university hospital is too far away or because there is no university hospital. Only one program does not use the university hospital because of difficulty in obtaining privileges. Family physicians are unable to obtain various hospital privileges because of political reasons at the following percentages of university hospitals: general medicine (2 percent), adult intensive care (33 percent), coronary care (40 percent), general pediatrics (8 percent), pediatric intensive care (31 percent), newborn nursery (8 percent), intensive care nursery (29 percent), routine obstetrics (13 percent), and high-risk obstetrics (17 percent).     

Drug Utilization and Costs for Patients with Acute Myocardial Infarction

The study of drug experience of patients with acute myocardial infarction is part of a series studying factors that influence drug utilization in the hospital. The medical care field is more than ever aware of the associations between use of drugs, hospital costs, and quality of care. Aspects of utilization studied included variety, number, route, purpose, and cost of drugs; use of generic names in prescribing; and timing of drug orders during a patient's stay. In some of these aspects large teaching hospitals differ from small hospitals. It is especially striking that timing of drug orders differed between public and voluntary sectors; this was affected by the greater severity of disease and lower survival rate among city hospital patients. Direct costs of the drugs are low, in general, and so make up a small portion of hospital care costs. Each hospital showed a different pattern for principal purposes of medications used.

Future trends in utilization depend on interactions among social, technical, and administrative developments. Equalizing conditions of admission would smooth out contrasts in drug use between public and voluntary hospitals. Staff review of drugs in use could reduce needless variety. Cardiac monitoring devices can set up new patterns for use of intravenous drugs. Hospitals that must account for drugs under public reimbursement schemes could simplify their tasks by applying a group averaging system to most drugs.

     

Philanthropic hospitals and the operation of provider-owned health plans in Brazil

OBJECTIVE: To describe the management performance of philanthropic hospitals that operate their own health plans, in comparison with philanthropic hospitals as a whole in Brazil. METHODS: The managerial structures of philanthropic hospitals that operated their own health plans were compared with those seen in a representative group from the philanthropic hospital sector, in six dimensions: management and planning, economics and finance, human resources, technical services, logistics services and information technology. Data from a random sample of 69 hospitals within the philanthropic hospital sector and 94 philanthropic hospitals that operate their own health plans were evaluated. In both cases, only the hospitals with less than 599 beds were included. RESULTS: The results identified for the hospitals that operate their own health plans were more positive in all the managerial dimensions compared. In particular, the economics and finance and information technology dimensions were highlighted, for which more than 50% of the hospitals that operated their own health plans presented almost all the conditions considered. CONCLUSIONS: The philanthropic hospital sector is important in providing services to the Brazilian Health System (SUS). The challenges in maintaining and developing these hospitals impose the need to find alternatives. Stimulation of a public-private partnership in this segment, by means of operating provider-owned health plans or providing services to other health plans that work together with SUS, is a field that deserves more in-depth analysis.     

Evaluation of rotavirus vaccine effectiveness in a pediatric group practice

Vaccines are traditionally tested under the optimal conditions of clinical trials (efficacy). However, their public health impact is better assessed under the real conditions of a clinical practice (effectiveness). The authors aimed to estimate the effectiveness of a rotavirus vaccine (rhesus rotavirus vaccine-tetravalent (RRV-TV)) to prevent rotavirus-related hospitalization among children 相似文献   

Proactive Geriatric Comanagement of Nursing Home Patients by a New Hospital-Based Liaison Geriatric Unit: A New Model for the Future

During the SARS-CoV-2 pandemic, hospital-based liaison geriatric units (LGUs) were created in Spanish hospitals with the aim to improve health care coordination between nursing homes (NHs) and hospitals. Our university hospital created a comprehensive, proactive LGU serving 31 public and private NHs of different sizes and characteristics to offer support to more than 2500 residents. In the first 3 months of 2021, this LGU performed 1252 assessments (81% as outpatients, 12% at the emergency department, and 7% during hospitalization), avoiding an estimated 49 hospital transfers and 29 hospitalizations. Other activities included giving NHs support and advice during COVID-19 outbreaks, comanagement of selected residents with other hospital-based specialists (implementing telemedicine), and implementation of a protocol that allowed using drugs only approved for hospital use in selected NHs. This model of LGU has been shown to be feasible, to improve residents' health care, and avoid hospital referrals. Long-term care needs to be re-imagined, and hospital geriatric departments need to prove that they are able to offer expertise to support NH health care professionals.     

The effects of corporate restructuring on hospital policymaking.

Hospital corporate restructuring is the segmentation of assets or functions of the hospital into separate corporations. While these functions are almost always legally separated from the hospital, their impact on hospital policymaking may be far more direct. This study examines the effects of corporate restructuring by community hospitals on the structure, composition, and activity of hospital governing boards. In general, we expect that the policymaking function of the hospital will change to adapt to the multicorporate structure implemented under corporate restructuring, as well as the overlapping boards and diversified business responsibilities of the new corporate entity. Specifically, we hypothesize that the hospital board under corporate restructuring will conform more to the "corporate" model found in the business/industrial sector and less to the "philanthropic" model common to most community hospitals to date. Analysis of survey data from 1,037 hospitals undergoing corporate restructuring from 1979-1985 and a comparison group of 1,883 noncorporately restructured hospitals suggests general support for this hypothesis. Implications for health care governance and research are discussed.     

Modeling the growth of long-stay populations in public mental hospitals

Long-stay, chronic patients have been a problematic subpopulation in public mental hospitals for over a century. Despite three decades of deinstitutionalization and a major shift toward shorter episodes of hospitalization, there continues to exist a group of patients who experience lengthy hospital stays. As the number of such patients increases in a facility, its ability to provide acute care may be compromised, and the size of this subpopulation must therefore be anticipated. This paper examines the length-of-stay patterns of a sample of public mental hospital admissions through the use of life table analysis, and develops a dynamic modeling algorithm using sample survival function values. Life table analysis revealed a declining hazard function, indicating a diminishing probability of discharge with increased hospital stay. The dynamic model showed that, after 2 years of operation of a hypothetical facility, current length-of-stay patterns would generate an inpatient population 40% of which had been hospitalized for over 6 months. Goodness-of-fit tests comparing the algorithm's forecast with actual hospital utilization data showed its predictions to be reliable. The authors discuss the use of this methodology to anticipate the effects of programmatic or other types of changes in mental hospitals, and also suggest other types of settings where such modeling techniques might profitably be applied.     

Effects of payment incentives, hospital ownership and competition on hospitalization decisions for ambulatory surgical procedures

OBJECTIVE: To test the hypotheses that (1) for-profit (FP) and not-for-profit (NFP) hospitals are less likely than public hospitals to admit cases reimbursed by prospective payment favoring ambulatory over inpatient care; (2) admission odds of public, FP and NFP hospitals will converge under increasing hospital competition. METHODS: Retrospective, population-based, cross-sectional study covering 29,699 cases of unilateral, femoral/inguinal hernia operation (major surgical procedure) and 60,626 cases of cataract surgery (local surgical procedure), from Taiwan's National Health Insurance database was used. Diagnosis-wise logistic regression analysis were done to examine associations between admission propensities of FP versus public and NFP hospitals (large teaching hospitals with > or = 250 beds versus district hospitals with < 250 beds) under high and low competition, adjusted for clinical complications, and patient as well as physician demographics. RESULTS: Large public teaching hospitals are significantly more likely than FP district hospitals to admit hernia patients (ORs = 1.9 and 2.6, respectively, under high and low competition), and cataract surgery patients (ORs = 5.0 and 5.4, respectively, under high and low competition). The corresponding odds ratios for public district hospitals (relative to FP district hospitals) are 1.2 and 3.9 for hernia and 4.9 and 2.7 for cataract surgery. Odds ratios show convergence of admission odds across hospital ownership under high competition relative to low competition for hernia (OR range for different hospital types under high competition, 1.0-1.9; and under low competition, 1.0-3.9). Cataract cases show high divergence of admission odds between public and FP/NFP hospitals regardless of competition level (OR range for different hospital types under high competition, 0.3-5.0; and under low competition, 0.3-5.4). CONCLUSION: Overall, our data support the study hypotheses. Differences in the relevance of inpatient care for hernia and cataract surgery may account for the lack of admission convergence of public hospitals and FPs under high competition among cataract surgery group.     

Detection of rotavirus before and after monovalent rotavirus vaccine introduction and vaccine effectiveness among children in mainland Tanzania

BackgroundMonovalent rotavirus vaccine (RV1) was introduced in Tanzania in January 2013 under the Reach Every Child initiative, to be given at ages 6 and 10 weeks. We used the sentinel hospital rotavirus surveillance system to examine the rotavirus detection rate before and after vaccine introduction and estimate vaccine effectiveness.MethodsBefore vaccine introduction, rotavirus surveillance was established at two mainland hospitals; children admitted for acute diarrhea were eligible for enrollment and stools were tested for rotavirus antigen. We compared the rotavirus positivity rate in the pre-vaccine period (Tanga Hospital, 2009 and 2011; Bugando Medical Centre, 2012) to that from post-introduction years, 2014–2015. In 2013, surveillance was established at 9 additional hospitals. We examined rotavirus positivity among infants at these sites for 2014–2015. We obtained vaccine records and calculated vaccine effectiveness at 3 sites using case-test-negative control design.ResultsAt Tanga Hospital, the rotavirus positivity rate among infants was 41% (102/251) pre-vaccine and 14% (28/197) in post-vaccine years (rate ratio: 0.35 [95% CI 0.22–0.54]). At Bugando, the positivity rate was 58% (83/143) pre-vaccine, and 18% (49/277) post-introduction (rate ratio 0.30 [95% CI 0.210.44]). Results were similar among children <5 years. At the new sites, the median site rotavirus positivity rate among infants was 26% in 2014 (range 19–44%) and 18% in 2015 (range 16–33%). The effectiveness of ≥1 RV1 dose against rotavirus hospitalization among children 5–23 months was 53% (95% CI: −14, 81), and 66% (95% CI: 9–87) against hospitalization with intravenous rehydration. Following introduction, peak rotavirus activity occurred later in the year and appeared more concentrated in time.ConclusionRotavirus surveillance data from Tanzania indicate that the rotavirus positivity rate among children hospitalized with diarrhea that were enrolled was substantially reduced after vaccine introduction. Low positivity rates among infants were detected at hospitals across the country. Overall, the data support that rotavirus vaccine has been successfully introduced and is effective in Tanzanian children.     

Hospitals should replace emergency codes with plain language

The common and frequent use of emergency codes by hospitals to communicate during life‐threatening emergencies routinely segregates hospital staff from patients, visitors, and first‐responders during emergencies by providing each group with a different level of information regarding the threat. By relying on codes instead of plain language to communicate during an emergency, a hospital may introduce ambiguity into a potentially life‐threatening situation. Consequently, this means that coded alerts may endanger staff, patients, and visitors rather than protecting them from threats. This paper will maintain that (1) relying on codes, even standardized color codes for hospitals, interferes with the full integration of health care into the National Incident Management System (NIMS); (2) that planning to use plain language notifications improves coordination among response partners and ultimately increases safety for hospital patients, staff, and visitors; and (3) that the change to plain language is both practical and possible. This paper identifies both real world events and studies that demonstrate the benefits of using plain language alerts with directive messaging to elicit the desired response among members of the public during emergencies. This paper also presents guides that hospitals can use to transition from coded emergency messaging to plain language emergency alerts.     

Perinatal mortality distributed by type of hospital in the Central Hospital District of Helsinki, Finland

In Finland as in many other countries, perinatal mortality is higher in those institutions having a higher level of care. To explain this phenomenon, mortality by weight groups was studied in different hospitals in the Central Hospital District of Helsinki in Finland in 1977-81. Among infants weighing less than 2 500 g, perinatal mortality was higher in the local hospital than in the university hospital, the higher mortality being due to the higher rate of stillborn infants. Among babies weighing over 2 500 g, the mortality was lower in local hospitals than in the university hospital. Further studies to explain the higher mortality of infants weighing over 2 500 g in the university hospital are needed.     

Corporate and philanthropic models of hospital governance: a taxonomic evaluation.

OBJECTIVE. We assess the theoretical integrity and practical utility of the corporate-philanthropic governance typology frequently invoked in debates about the appropriate form of governance for nonprofit hospitals operating in increasingly competitive health care environments. DATA SOURCES. Data were obtained from a 1985 national mailed survey of nonprofit hospitals conducted by the American Hospital Association (AHA) and the Hospital Research and Educational Trust (HRET). STUDY DESIGN. A sample 1,577 nonprofit community hospitals were selected for study. Representativeness was assessed by comparing the sample with the population of non-profit community hospitals on the dimensions of bed size, ownership type, urban-rural location, multihospital system membership, and census region. DATA COLLECTION. Measurement of governance types was based on hospital governance attributes conforming to those cited in the literature as distinguishing corporate from philanthropic models and classified into six central dimensions of governance: (1) size, (2) committee structure and activity, (3) board member selection, (4) board composition, (5) CEO power and influence, and (6) bylaws and activities. PRINCIPAL FINDINGS. Cluster analysis and ANCOVA indicated that hospital board forms adhered only partially to corporate and philanthropic governance models. Further, board forms varied systematically by specific organizational and environmental conditions. Boards exhibiting more corporate governance forms were more likely to be large, privately owned, urban, and operating in competitive markets than were hospitals showing more philanthropic governance forms. CONCLUSIONS. Findings suggest that the corporate-philanthropic governance distinction must be seen as an ideal rather than an actual depiction of hospital governance forms. Implications for health care governance are discussed.     

Ambulatory Care Sensitive Hospitalization Rates in the Aged Medicare Population in Utah, 1990 to 1994: A Rural-Urban Comparison

The objective of this study is to compare the likelihood of hospitalization for conditions that are related to the adequacy and use of ambulatory health care services for Medicare beneficiaries residing in rural and urban regions in Utah. The Health Care Financing Administration's (HCFA) hospital discharge database (Utah hospitals: 1990 to 1994) was used to estimate hospitalization rates (with adjustment for out-of-state admissions) for ambulatory care sensitive conditions. Population estimates were obtained from HCFA beneficiary files. Regional hospitalization rates were obtained through ZIP code matching of the hospital discharge and beneficiary files. Medicare beneficiaries aged 65 and older residing in Utah during 1990 to 1994 are the subjects for the study. The main outcome measures include age and sex-adjusted hospitalization rates by region for the entire state and rate ratio estimates for nonurban regions. The results of the study show that Medicare beneficiaries residing in two rural-frontier regions were more likely than urban beneficiaries to be hospitalized for ambulatory care sensitive conditions. Rate ratio estimates were greater than 1.4 for both regions during the study period. These findings suggest a pattern of an increased burden of avoidable secondary complications and disease progression among Utah Medicare beneficiaries residing in some rural regions. This increased burden may be the result of limitations in the ambulatory care system, medical care provider supply, and/or beneficiary propensity to seek care. Variation in disease prevalence or hospital use patterns for these conditions also may be responsible for all or part of the observed variation in ambulatory care sensitive admission rates.     

Access to neonatal intensive care for low-birthweight infants: the role of maternal characteristics.

OBJECTIVES. This study assessed the impact of mother's race, insurance status, and use of prenatal care on very low birthweight infant delivery in or transfer to hospitals with neonatal intensive care units (ICUs). METHODS. Multivariate analysis of Alabama vital statistics records between 1988 and 1990 for infants weighing 500 to 1499 g was conducted, comparing hospital of birth and maternal and infant transfer status, and controlling for infant birthweight and for maternal pregnancy history and demographic characteristics. RESULTS. With other factors adjusted for, non-White mothers with early prenatal care were more likely than White mothers to deliver their very low birthweight infants in hospitals with neonatal ICUs without transfer. Among the mothers who presented first at hospitals without such facilities, those who had late prenatal care were less likely than those with early care to be transferred to hospitals with neonatal ICUs before delivery. Medicaid coverage increased the likelihood of antenatal transfer for White women. Likelihood of infant transfer was not associated with these maternal characteristics. CONCLUSIONS. Maternal race, prenatal care use, and insurance status may influence the likelihood that very low birthweight infants will have access to neonatal intensive care. Interventions to improve perinatal regionalization should address individual and system barriers to the timely referral of high-risk mothers.     

Variation in cesarean section rates among hospitals in Washington State.

OBJECTIVES. This study examined hospital characteristics and hospital population risk factors and their associations with hospital-specific cesarean section rates in Washington State. METHODS. Data were obtained from 1987 birth certificates. The study population included all hospitals that had 12 or more singleton live births. RESULTS. Hospital-specific cesarean section rates varied from 0% to 43% and were positively associated with proprietary ownership, size of delivery service, and the proportions of women who had complications or high-birthweight infants. The proportion of women who had late prenatal care was inversely associated with cesarean section rates. Although proprietary hospitals had higher cesarean section rates, their patient populations were lower risk than patients of public or teaching hospitals. CONCLUSIONS. Variation in cesarean section rates among hospitals cannot be fully explained by either hospital or patient population characteristics. A combined strategy may be necessary to lower unjustifiably high cesarean section rates.     

北京地区79例婴幼儿诺如病毒腹泻的临床特点分析

目的分析婴幼儿诺如病毒腹泻的发病特点，为临床诊断提供依据。方法对2002年1月至2006年12月在首都儿科研究所附属儿童医院就诊的318例急性腹泻患儿采集粪便标本，用酶联免疫吸附试验（ELISA）检测粪便诺如病毒抗原，同时用聚丙烯酰胺凝胶电泳（PAGE）检测轮状病毒。结果经检测的318份粪便标本中，诺如病毒阳性标本共79份，阳性检出率为24．8％（79/318）。其中有48例在10-12月份检出，占阳性标本的60．8％（48/79）。2岁以内患儿占91．2％。有16例同时合并轮状病毒感染。经统计学分析，轮状病毒混合感染组与单纯诺如病毒感染组在发热的严重程度上有差异，但是在腹泻严重程度上的差异无统计学意义。诺如病毒阳性患儿中有14例是以其他疾病住院，分别于住院1-11d出现腹泻。结论诺如病毒是引起婴幼儿急性腹泻的病原之一，也是医院内感染性腹泻的病因之一。     

Health care reform and changes in nursing practice in philanthropic hospitals in Ribeir?o Preto (SP), Brazil]

This paper describes part of a multicenter study sponsored by the Pan American Health Organization to assess health care reforms and their implications for nursing in several countries. The objective of this research was to learn the views of nurses working in philanthropic hospitals in Ribeir?o Preto, in the state of S?o Paulo, Brazil, regarding the changes in nursing practice coming from Brazil's health care reform and implementation of the Unified Health System (UHS). Data were obtained through structured interviews with seven nurses who met the selection criteria, from the three philanthropic hospitals in Ribeir?o Preto. The nurses reported a decline in the quality of care and in the number of beds for UHS patients. The nurses reported that UHS implementation initially led to infrastructure improvements in the philanthropic hospitals. However, the reforms eventually shifted toward improving the care of private and privately insured patients. In addition, the nurses emphasized their heavy work loads and low pay. The nurses' reports indicated that Brazil's UHS is going through a crisis. In general, the nurses linked this crisis to problems in funding and allocation of resources.