Modelling hospital and social care bed occupancy and use by elderly people in an English health district

The paper confirms that exponential equations can be used to model the total system and sub-systems of institutional health and social care for elderly people using bed occupancy census data for 6068 elderly aged 65 and over. Two streams of flow were present in NHS acute hospitals, Local Authority residential homes and independent sector nursing homes. Three streams of flow were present in the overall data set and in the NHS geriatric hospital beds, NHS psychiatry beds and independent sector residential care homes. In total 22% of patients/residents stayed an average of 24 days (short stay), 69% for 825 days (medium stay) and 9% for 3384 days (long stay). In both sexes, the older a patient/resident, the longer the time they occupied short stay beds and the shorter the time they occupied long stay beds.     

Impact of nutritional status on DRG length of stay

A prospective audit of 100 admissions to a general medical unit was performed to determine the relationship of the initial nutritional status of the patients to the actual length of stay and hospital charges. These data then were compared with the allowed length of stay and estimated reimbursement under the prospective payment system of diagnosis-related groups (DRGs). Forty-five percent of the malnourished patients were hospitalized longer than that allowed under DRGs, compared to 30% for normal patients and 37% in the borderline group. The average length of stay was 15.6 +/- 2.2 days in the malnourished group compared to approximately 10 days in the other two groups (p less than 0.01). Although the estimated base DRG reimbursement was similar in all three groups ($4352-$5124), the actual hospital charges were significantly greater in the malnourished ($16,691 +/- 4389) and borderline ($14,118 +/- 4962) groups compared to normals ($7692 +/- 687), (p less than 0.01). The DRG system will have an adverse financial impact in the care of malnourished patients. It is suggested that early recognition of malnutrition and aggressive treatment may lead to a decrease in the length of stay and cost deficit incurred by malnourished patients.     

Energy and nutrient intake of elderly hospitalized patients in a steady metabolic status versus catabolic status

Protein undernutrition enhances frailty and aggravates intercurrent diseases generally observed in elderly patients. Undernutrition results from insufficient food intake and catabolic status. Daily nutrient intakes were explored for hospitalized geriatric patients. Nutrient intake (carbohydrates, lipids, proteins, and calcium) was determined in randomly selected geriatric patients (n=49) over five consecutive days by weighting food in the plate before and after meals. For each geriatric patient, catabolic status and risk factors of undernutrition were considered. Results were compared between patients in a steady status or catabolic status. In steady status patients, protein, lipid and carbohydrate intake but not calcium intake, met recommended dietary allowances (total caloric intake:1535 +/- 370 Cal/day ; protein:1+/- 0.4 g/kg/day ; carbohydrates:55 +/- 7.7 % ; lipids: 30 +/- 6.3 % ; calcium:918 +/- 341 mg/day) . Patients in catabolic status (cardiopulmonary deficiency , neurologic disease , inflammatory process) had lower total caloric intake, lower protein intake and dramatically lower calcium intake (total caloric intake : 1375 +/- 500 Cal/day ; protein :0.9 +/- 0.4 g/kg/day ; carbohydrates : 54 +/- 8.3 % ; lipids : 31 +/-6.2 % ; calcium : 866 +/- 379 mg/day). Nutrient intake was lower in elderly patients hospitalized in short stay care units, perhaps due to failure to recognize suitable nutrient requirements. Protein-caloric undernutrition should be diagnosed early during hospitalization in order to allow appropriate dietary supplementation. However the incidence of protein undernutrition among elderly patients as a cause or a consequence of adverse pathophysiological processes remains a cause of debate.     

上海市医疗机构床位配置调整策略研究

目的 分析上海市医疗机构床位资源配置的现状和问题.方法 采用调查问卷对上海市所有设住院床位的医疗机构进行调查,并与美国加利福尼亚州医疗机构床位情况进行对比.结果 床位总量接近规划但配置结构不合理,综合急性病诊疗床位的平均住院时间过长,医疗服务压力主要集中在三级医疗机构,社会办医疗机构病床尚没有得到有效利用.结论 建立医疗机构床位分类管理制度,严格控制中心城区三级医疗机构床位数量,严格控制综合急性病诊疗床位,大幅增加护理床位数量,有效整合医疗床位资源.     

Clostridium difficile among hospitalized patients receiving antibiotics: a case-control study.

OBJECTIVES: Clostridium difficile is the most common cause of infectious nosocomial diarrhea and can be found in up to 30% of asymptomatic hospitalized patients. Our primary aim was to compare the clinical characteristics of hospitalized patients who received antibiotics and developed C. difficile-associated diarrhea (CDAD) with those of hospitalized patients who received antibiotics and did not develop the disease. DESIGN: Case-control study comprising inpatients at a single institution. PATIENTS: Case-patients were defined as patients who had diarrhea and tested positive for C. difficile. Control-patients (matched 4:1 to case-patients) were defined as patients who received antibiotics for at least 5 days and did not develop CDAD. RESULTS: On univariate analysis, nine variables were associated with CDAD. Only three of the variables, need for intensive care, length of stay, and macrolide antibiotic use, were found to be significant (P < .05) on logistic regression analysis. The odds ratios for status as a CDAD case were 3.68 (CI95, 1.44 to 9.40) for stay in the intensive care unit and 1.03 (CI95, 1.02 to 1.05) for each day of hospital stay. Receipt of macrolide antibiotics reduced risk significantly; the odds ratio was 0.23 (CI95, 0.19 to 0.87). CONCLUSIONS: We identified need for intensive care and length of stay as important risk factors for the development of CDAD. We also identified macrolide antibiotic use as protective against its development. Patients receiving intensive care may represent a population to study for targeted prophylaxis.     

Home living conditions in Alsace of the disabled elderly aged 75 years and more

OBJECTIVE: Our aim was to describe the living conditions of disabled elderly subjects aged 75 years and more living at home. DESIGN: This study was conducted in 1996-97 in the Alsace region in France and included two parts. First, a sample survey was mailed to 15,600 subjects randomly selected from a pension funds list. This survey provided with a reliable representation of the study population in terms of disabilities using the Colvez classification. In the second part, the most disabled individuals were selected and, among them, 1,259 subjects were visited at home. Their disabilities and living conditions were noted using a predefined set of questions. RESULTS: An estimated 71,000 subjects aged 75 years and more lived at home in the study region. The vast majority were free of significant disability. Help to wash and dress was needed by 6,000 until 1,500 were bedridden or confined to an armchair. Between 4,350 and 5,400 met the criteria for iso-resource grades (IRG) 1 to 3. Disability was associated with age, female gender, cognitive impairment and some social and professional characteristics. Family support was routine in almost every aspect of everyday life including personal hygiene. Professional support was mostly limited to technical interventions. Professional nursing care concerned only the most dependent persons. Nevertheless, needs for help in home and social activities remained high even in the least dependent individuals and were strongly age-dependent. Only 10% of individuals with IRG 1 to 3 complained of inadequate help. More than 80% of the elderly felt comfortable with their living conditions at home and were not thinking of moving from home to an institution for old people. CONCLUSION: The present study confirms the important commitment of family members and their close relationships toward their elderly.     

Factors affecting the increase in hospitalized medical care expenditure in Japan: analysis of national data in all 47 prefectures]

To clarify factors affecting the increase in annual expenditure for hospitalized medical care in Japan, the effects of the following four variables in all 47 prefectures were analyzed: (1) the hospitalized medical care expenditure per day per inpatient, (2) the number of admissions per population base, (3) average length of stay of patients in hospital per year and (4) the number of hospital beds per population base. The annual expenditure for hospitalized medical care per population base was correlated most significantly with the number of hospital beds per population base. The annual expenditure was also significantly correlated positively with the number of admissions per population base and average length of stay of patients in hospital per year, and inversely with the hospitalized medical care expenditure per day per inpatient. Hospitalized medical care expenditure per day per inpatient was inversely correlated with average length of stay of patients in hospital and the number of hospital bed per population base. Results from stepwise multiple regression analysis indicated that the number of hospital bed per population base and the hospitalized medical care expenditure per day per inpatient are the only two variables which have significant effects on the annual expenditure for hospitalized medical care per population base. The annual rate of increase for annual expenditure for hospitalized medical care per population base from 1980 to 1986 was 6.1%. Similarly, the rate of increase in the hospitalized medical care expenditure per day per inpatient was 3.5%; that of the number of admissions per population base was 3.1%.(ABSTRACT TRUNCATED AT 250 WORDS)     

Risk of in-hospital mortality following emergency department admission: Results from the geriatric EDEN cohort study

Objective

To determine whether being admitted to emergency department (ED) for social disorders may predict a higher risk of in-hospital mortality among older inpatients.

Design

Prospective cohort study (mean follow-up: 9.1±10.0 days).

Setting

Angers University Hospital, France.

Participants

Four hundred twenty-two inpatients (mean age 84.9±5.6years, 64.2% women).

Methods

At their admission to ED, inpatients aged 75 years and over received an assessment composed of 6 items: age, gender, number of drugs daily taken, history of falls during the past 6 months, usual place of life, and use of formal and/or informal home and social services. The reasons for admission to ED as well the diagnosis at the time of hospital discharge were separated into social and health disorders. The length of hospital stay was calculated in number of days using the hospital registry. Inpatients were separated into 2 groups based on the occurrence or not of death during the hospital stay.

Results

Older inpatients who died at hospital were more frequently institutionalized (P=0.034) and admitted to ED for social disorders (P=0.002) than those who did not. Multiple Cox regression model revealed that living in institution and social disorders as a reason for admission to ED were significantly associated with the occurrence of death at hospital (P=0.008 and P=0.036). Kaplan-Meier distributions of in-hospital mortality showed that home-living inpatients admitted to ED for social disorders died more and faster during hospitalization than those admitted for health disorders (P=0.016).

Conclusion

Being admitted to ED for social disorders and living in institution predicted a higher risk of in-hospital mortality.     

Effect of nutritional support on clinical outcome in patients at nutritional risk

BACKGROUND & AIMS: Undernourished patients have an increased risk of complications and a prolonged hospital stay, compared to those who are not undernourished. The aim of this study was to evaluate the effect of nutritional intervention in a random sample of hospitalized patients at nutritional risk. METHODS: A randomized, controlled trial of nutritional intervention in 212 patients. Intervention consisted of a specialized nutritional team (nurse and dietician) who attended patients and staff for motivation, detailed a nutritional plan, assured delivery of prescribed food and gave advice on enteral or parenteral nutrition when appropriate. The control group received the standard regime used in the department. The primary endpoint was the part of the length of stay (LOS) that was considered to be sensitive to nutritional support, designated LOSNDI. The nutritional discharge index (NDI) consists of three objective criteria: (1) the patient is able to manage toilet visits without assistance, reflecting mobilization; (2) the patient is without fever (tp < 38 degrees C), reflecting absence of infection; and (3) the patient has no intravenous access, reflecting absence of complications in general. On the day when all three criteria were fulfilled, hospital stay was no longer considered to be sensitive to nutritional support. Actual LOS is also reported. Incidence and severity of complications were recorded to explain LOSNDI findings. As a secondary endpoint, quality of life was evaluated by the Short Form 36 (SF-36) questionnaire. RESULTS: Intervention led to an intake of > or = 75% of requirements in 62% of the intervention patients, as compared to 36% of the control patients. Rates of complications, mean LOSNDI and LOS were not significantly different between the two study groups. However, among patients with complications a difference in LOSNDI between intervention patients (14 +/- 2 days, mean +/- SE) and control patients (20 +/- 2 days) was statistically significant (P = 0.015). In the same patients, LOS was 17 +/- 2 days in the intervention group and 22 +/- 2 days in the control group (P = 0.028). The SF-36 questionnaire did not show a significant effect of treatment. CONCLUSIONS: Protein and energy intake of nutritionally at-risk patients was increased which resulted in shortening of the part of the length of stay that was considered to be sensitive to nutritional support (LOSNDI) and shorter length of stay (LOS) among patients with complications.     

Accurate determination of energy needs in hospitalized patients

OBJECTIVE: To evaluate the accuracy of seven predictive equations, including the Harris-Benedict and the Mifflin equations, against measured resting energy expenditure (REE) in hospitalized patients, including patients with obesity and critical illness. DESIGN: A retrospective evaluation using the nutrition support service database of a patient cohort from a similar timeframe as those used to develop the Mifflin equations. SUBJECTS/SETTING: All patients with an ordered nutrition assessment who underwent indirect calorimetry at our institution over a 1-year period were included. INTERVENTION: Available data was applied to REE predictive equations, and results were compared to REE measurements. MAIN OUTCOME MEASURES: Accuracy was defined as predictions within 90% to 110% of the measured REE. Differences >10% or 250 kcal from REE were considered clinically unacceptable. STATISTICAL ANALYSES PERFORMED: Regression analysis was performed to identify variables that may predict accuracy. Limits-of-agreement analysis was carried out to describe the level of bias for each equation. RESULTS: A total of 395 patients, mostly white (61%) and African American (36%), were included in this analysis. Mean age+/-standard deviation was 56+/-18 years (range 16 to 92 years) in this group, and mean body mass index was 24+/-5.6 (range 13 to 53). Measured REE was 1,617+/-355 kcal/day for the entire group, 1,790+/-397 kcal/day in the obese group (n=51), and 1,730+/-402 kcal/day in the critically ill group (n=141). The most accurate prediction was the Harris-Benedict equation when a factor of 1.1 was multiplied to the equation (Harris-Benedict 1.1), but only in 61% of all the patients, with significant under- and over-predictions. In the patients with obesity, the Harris-Benedict equation using actual weight was most accurate, but only in 62% of patients; and in the critically ill patients the Harris-Benedict 1.1 was most accurate, but only in 55% of patients. The bias was also lowest with Harris-Benedict 1.1 (mean error -9 kcal/day, range +403 to -421 kcal/day); but errors across all equations were clinically unacceptable. CONCLUSIONS: No equation accurately predicted REE in most hospitalized patients. Without a reliable predictive equation, only indirect calorimetry will provide accurate assessment of energy needs. Although indirect calorimetry is considered the standard for assessing REE in hospitalized patients, several predictive equations are commonly used in practice. Their accuracy in hospitalized patients has been questioned. This study evaluated several of these equations, and found that even the most accurate equation (the Harris-Benedict 1.1) was inaccurate in 39% of patients and had an unacceptably high error. Without knowing which patient's REE is being accurately predicted, indirect calorimetry may still be necessary in difficult to manage hospitalized patients.     

Institutional risk factors for outbreaks of nosocomial gastroenteritis: survival analysis of a cohort of hospital units in South-west England, 2002-2003

Nosocomial outbreaks of gastroenteritis are a major burden on hospital inpatient services, costing an estimated pound115 million annually to the English National Health Service. We actively followed-up 171 inpatient units from four major acute hospitals and 11 community hospitals in South-west England for one year. Outbreaks of gastroenteritis were ascertained through an active surveillance network using standard clinical definitions. Survival analysis Cox regression models using an outbreak of gastroenteritis as the endpoint were fitted to identify institutional and operational attributes related to increased outbreak rates at the level of the care unit. Greater number of beds in unit [hazard ratio (HR) 1.22 (per 10 additional beds), 95% confidence intervals (CI) 0.96-1.55] was associated with increased hazard, as were geriatric (HR 2.6, 95%CI 1.6-4.3) and general medical (HR 1.7, 95%CI 1.1-2.6) care units. The average length of stay on a unit was inversely associated with outbreak incidence [HR=0.89 (per additional week of stay), 95%CI 0.80-0.99]. Larger care units and those with higher throughput have increased rates of gastroenteritis outbreaks. These results should guide infection control policy and support the design of hospitals with smaller care units.     

Influenza vaccination is safe and immunogenic when administered to hospitalized patients

CONTEXT: Very few high-risk persons receive influenza vaccine while hospitalized. Health care providers may be reluctant to administer the influenza vaccine to hospitalized patients because of insufficient data related to the safety and immunogenicity of vaccinating this population. OBJECTIVE: To evaluate the safety and immunogenicity of the influenza vaccine administered to hospitalized patients compared to ambulatory clinic patients. DESIGN: Prospective cohort study. SETTING: A 711-bed, acute-care, private tertiary hospital and two private internal medicine clinics from October 1 to December 25, 1999. Participants: 51 inpatients; 177 outpatients. INTERVENTION: All study participants received influenza vaccine. Serum samples for antibody assays were collected at baseline and at 3 weeks after vaccination. Study participants were mailed a questionnaire to elicit information about adverse effects of vaccination. MAIN OUTCOME MEASURE: Seroconversion rates (4-fold increase in hemagglutination-inhibiting antibodies) and seroprotection rates (titers > or = 1:40) to the influenza vaccine in hospitalized and ambulatory patients. RESULTS: The seroconversion and post-vaccination seroprotection rates in the inpatient group were 65% (33/51) and 88% (45/51) compared to 55% (98/177) and 94% (167/177) in the ambulatory clinic patients. Soreness at the site of injection was the most common adverse effect, reported by 12% of both the inpatients (5/42) and ambulatory clinic patients (20/171). Seventy-four percent of patients (31/41 inpatients and 127/174 outpatients) reported no significant side effect to vaccination. CONCLUSIONS: Influenza vaccine is at least as safe and immunogenic in hospitalized patients as it is in ambulatory patients. These data can be used to help convince health care providers to order the influenza vaccine for their hospitalized patients.     

Dynamics of institutionalization of older adults in Belo Horizonte, Brazil

INTRODUCTION: Epidemiological and social changes related to population aging in Brazil will probably increase the need for nursing homes (NH). The study analyses the dynamics of institutionalization in Belo Horizonte, a 3 million inhabitant city of whom 8.0% are aged 60 or more. METHODS: Age and length of stay of 1,128 NH residents (92.5% of the estimated population) was registered and occupancy and institutionalization rates were determined. RESULTS: Among women aged 65+ in Belo Horizonte, 0.88% were living in NH; among men, 0.26%. Occupancy rates were 92%. Women (81%) were older than men (76.4 x 70.4 years; two-tailed t test = 6. 4; p=0.00) and lived there for a longer period (5.6 x 4.5 years; two-tailed t test = 2.6; p=0.01). Almost 1/3 of the men were aged < 65. CONCLUSIONS: High occupancy rates, long waiting lists and hard criteria for admission (half reject demented or dependent individuals) insinuates that these low institutionalization rates are related to scarcity of beds. The preponderance of women reflects the proportion of those widowed or separated in the community (66% of those aged 65-+, versus 76% of married man). The high frequency of institutionalized men aged <65 suggests lower capacity of maintaining themselves after widowhood. High death rates (24% during a 20 month follow-up of a 263 random sample) determines the small median length of stay (3 years). These data unveil the anachronism of a system which is not directed towards the maintenance of the Brazilian older people among their families and homes.     

The influence of institutional characteristics on length of stay for psychiatric patients: A national database study in South Korea

The institutionalization of psychiatric patients has put a tremendous burden on many societies, but few studies have examined the effects of institutional characteristics on patient length of stay (LOS). This paper investigated the association between institutional characteristics and LOS for 160,517 psychiatric patients in South Korea by applying a two-level modeling technique to administrative claims databases covering the entire patient population. Patient LOS, expressed in terms of days, was analyzed by taking account of institutional type, ownership, location, inpatient capacity, staffing, and patient demographics. The characteristics of inpatients were used as control variables and consisted of gender, age, sub-diagnosis, and the type of national health security program. The main findings of this study are: (1) patient LOS was 69% longer at psychiatric hospitals than at tertiary-care hospitals; (2) neither location nor inpatient capacity was associated with LOS; (3) larger staffs reduced LOS; and (4), LOS increased with a higher proportion of male inpatients, inpatients ≥65 years old, or inpatients diagnosed with organic or schizophrenic disorders, possibly through contextual effects. The results of this study suggest that researchers and policy makers could improve their assessment of psychiatric patient LOS and its association with health outcome by taking into account institutional characteristics and using multi-level analyses.     

Using routine data to monitor inequalities in an acute trust: a retrospective study

ABSTRACT: BACKGROUND: Reducing inequalities is one of the priorities of the National Health Service. However, there is no standard system for monitoring inequalities in the care provided by acute trusts. We explore the feasibility of monitoring inequalities within an acute trust using routine data. METHODS: A retrospective study of hospital episode statistics from one acute trust in London over three years (2007 to 2010). Waiting times, length of stay and readmission rates were described for seven common surgical procedures. Inequalities by age, sex, ethnicity and social deprivation were examined using multiple logistic regression, adjusting for the other socio-demographic variables and comorbidities. Sample size calculations were computed to estimate how many years of data would be ideal for this analysis. RESULTS: This study found that even in a large acute trust, there was not enough power to detect differences between subgroups. There was little evidence of inequalities for the access, process and outcome measures examined, statistically significant differences by age, sex, ethnicity or deprivation were only found in 11 out of 80 analyses. Bariatric surgery patients who were black African or Caribbean were more likely than white patients to experience a prolonged wait (longer than 64 days, aOR = 2.47, 95% CI: 1.36-4.49). Following a coronary angioplasty, patients from more deprived areas were more likely to have had a prolonged length of stay (aOR = 1.66, 95% CI: 1.25-2.20). CONCLUSIONS: This study found difficulties in using routine data to identify inequalities on a trust level. There was little evidence of inequalities in waiting time, length of stay or readmission rates by sex, ethnicity or social deprivation, although some differences were identified which warrant further investigation. Even with three years of data from a large trust there was insufficient power to detect inequalities by procedure. Data will therefore need to be pooled from multiple trusts to detect inequalities.     

High mortality despite good care-seeking behaviour: a community study of childhood deaths in Guinea-Bissau.

The care-seeking behaviour of mothers of 125 children deceased aged 1-30 months was investigated by verbal autopsy in an urban area of Guinea-Bissau. A total of 93% of the children were seen at a health centre or hospital during the 2 weeks before death. In a previous survey covering the period 1987-90 we found that 78% of the children who died had presented for consultation (8); despite this increase in care seeking, infant mortality had not decreased. Comparison of elapsed time from disease onset to first consultation between children who died and matched surviving controls indicated that the interval was shorter for children who died than for those who survived (odds ratio (OR) = 0.7; 95% confidence interval (CI): 0.5-0.99). Of the 125 terminally ill children, 56 were hospitalized. A total of 20 children died on the way to hospital or while waiting in the outpatient clinic. Lack of hospital beds resulted in 15 mothers being refused hospitalization for their child. Of hospitalized children, 42% were discharged as improved or recovered during the 30 days preceding death. These results reveal a need for improved hospital admission criteria, improved recognition of the symptoms of serious illness, better discharge criteria, and the implementation of quality assurance systems for health services.     

Impact of a computerized information system on quality of nutritional support in the ICU

OBJECTIVE: In intensive care units (ICUs), patient outcome depends on quality of nutritional support. We investigated the effect of computerized information systems (CISs) on quality of nutritional support by comparing two ICUs with or without CIS and burned patients before and after CIS implementation. METHODS: Part 1 was a 2-wk prospective survey in two units of a surgical ICU: unit A (11 beds) without CIS and unit B (four beds) with CIS. Part 2 consisted of two 18-mo periods in burn patients before and after CIS implementation. Nurses and doctors belonged to the same team; procedures were identical. A computer page was configured to retrieve data related to nutritional support. RESULTS: A total of 1313 ICU days were analyzed in 109 patients. Patients' characteristics were similar in parts 1 and 2. In part 1, nutritional support was required 38% of days. Nutritional route was similar but data were more frequently missing in unit A. Energy delivery was higher with CIS but below target values in both units (31+/-11% of target in unit A, 77+/-4% in unit B). Computations were incomplete and time consuming for unit A versus B (11+/-2 versus 2+/-1 min/patient, P<0.0001). In part 2, in the 54 burn patients, use of postpyloric feeding tubes and energy delivery increased with CIS, resulting in less weight loss. CONCLUSION: Computerized information systems favored standardization of nutritional care and monitoring, thus decreasing time required for writing and computations. Follow-up was improved and nutrient delivery was closer to target values, thus increasing quality of care. In burn patients, the better data visibility was associated with a significant improvement in nutrient delivery.     

Staffing patterns in hospital clinical dietetics and nutrition support: a survey conducted by the Dietitians in Nutrition Support dietetic practice group.

The Dietitians in Nutrition Support dietetic practice group of The American Dietetic Association administered a questionnaire to evaluate changes in nutrition support services provided to hospitalized patients and home patients in 1989 and compared the results with results of a survey administered in 1986. The 1986 survey documented an increase in tube feeding to inpatients during 1984 to 1986 and greater dietitian staffing in tertiary care hospitals than in primary care hospitals and in larger hospitals in 1986. The 1989 questionnaire was mailed to clinical nutrition managers from a nationwide random sample of 1,000 hospitals from American Hospital Association members; 271 responses were received. Full-time equivalent (FTE) registered dietitians (RDs)--including clinical RDs, nutrition support service RDs, and clinical nutrition managers--decreased 11% from 1986 to 1989. FTE dietetic technicians decreased 22%. The number of FTE nutrition support service RDs and clinical nutrition managers decreased significantly (P less than .05). The mean number of FTE clinical dietitians per 100 beds decreased from 1.4 to 1.0 from 1986 to 1989. These decreases in dietetics staffing occurred despite an overall increase in total hospital FTE staff of 2.9%. Reported daily provision of nutrition support modalities to inpatients was 3.5% for parenteral nutrition, 4.9% for enteral tube feeding, and 9.6% for oral supplements. Decreased dietetics staffing was accompanied by other factors that negatively affect productivity (and therefore ability to provide adequate patient care), including inadequate delegation of technical tasks to dietetic technicians, limited availability of secretarial and computer support, and minimal provision of pocket pagers. These trends may be evidence of inadequacy of dietetics staffing to meet the needs of the US population for nutrition care.     

城镇女性医保患者住院医疗费用的影响因素分析

目的:探讨城镇女性医保患者住院医疗费用的影响因素,为建立合理的费用控制机制提供理论基础。方法:选择某县2004年度在县、镇级12个医院所有住院治疗的城镇参保女职工499例,从社会因素与非社会因素9个因素方面对其住院医疗费用进行分析,组间比较采用t检验及单因素方差分析,用多元逐步回归方法进行多因素分析。结果:女性医保患者住院医疗费用的主要影响因素依次为住院日、医院级别、收入水平,二甲医院住院总费高于一甲医院,随收入水平的提高和住院日的延长,住院费用增加。结论:缩短平均住院日,是有效控制医疗费用重要措施。