A national profile of patient safety in U.S. hospitals

Measures based on routinely collected data would be useful to examine the epidemiology of patient safety. Extending previous work, we established the face and consensual validity of twenty Patient Safety Indicators (PSIs). We generated a national profile of patient safety by applying these PSIs to the HCUP Nationwide Inpatient Sample. The incidence of most nonobstetric PSIs increased with age and was higher among African Americans than among whites. The adjusted incidence of most PSIs was highest at urban teaching hospitals. The PSIs may be used in AHRQ's National Quality Report, while providers may use them to screen for preventable complications, target opportunities for improvement, and benchmark performance.     

U.S. hospital chains retreat from Europe

With trade barriers expected to be lifted in Europe next year, many American companies have been beating a path overseas to position themselves for expansion. But not U.S. hospital chains. While pharmaceutical and hospital supply firms have made significant inroads overseas, hospital companies are choosing to divest their foreign facilities, citing obstacles to market penetration.     

U.S. hospital workforce-to-population ratios by service area

Traditionally, hospital productivity has been measured in terms of episodic patient services such as days or admissions. However, the delivery of health care is shifting toward a greater focus on the health of a covered population. Thus, population-based indicators of hospital productivity are needed. This work analyzes hospital FTEs per 10,000 served population across the United States as a function of regional demographic, socioeconomic, and geographic factors. For managers of integrated service networks, it provides benchmarks for hospital FTEs per service population for several personnel categories. Important findings for public policy include an 11 percent increase in FTEs per 1 percent increase in interns and residents and a 2 percent increase in FTEs per 1 percent increase in the elderly.     

The costs of hospital mergers

Most hospital mergers are sold to the community as a way to reduce service and staffing duplications, consolidate clinical programs, achieve economies of scale and increase profits to add services. But two new studies on hospitals that merge in small markets indicate such mergers don't always deliver on promised savings because of the costs of new construction and expansion into high-technology services.     

U.S. hospital efficiency and adoption of health information technology

This study empirically examines the association between hospital inefficiency and the decision to introduce electronic medical records (EMR) and computerized physician order entry (CPOE) in a national sample of U.S. general hospitals in urban areas in 2006. The main research question is whether the presence of hospital cost inefficiency or other factors driving inefficiency in the production process of a hospital explain low adoption rates of health information technology (HIT) in a hospital setting. We estimated a logistic regression of HIT adoption as a function of hospital cost inefficiency scores obtained using a stochastic frontier analysis. The results demonstrate that hospitals with a greater degree of cost inefficiency were more likely to introduce EMR, suggesting that the benefits of EMR implementation in terms of improved efficiency were likely to outweigh the costs of adoption compared to hospitals that are more efficient. The results showed no association between cost inefficiency and the CPOE adoption decision.     

Physician collective bargaining in a U.S. public hospital.

In a study to investigate the factors that would drive attending physicians employed in a public hospital to seek collective bargaining with their employer, the authors developed an instrument to determine which variables and which hypotheses were predictive of union proneness. The findings reveal that a desire for voice was the number one reason for physicians' wanting to join a union. Union-prone physicians had a lower salary on average, were more dissatisfied with their income, were more likely to feel the effects of work "speed up" (too many patients and too little time), were less likely to have administrative functions (thus a larger patient care role), had a strong sense of entitlement to collective bargaining, believed that unions improve participation in decisions affecting their jobs (reinforcing their desire for voice), and had a sense that a union would improve their treatment by supervisors (reinforcing their desire for due process and equity).     

美国医院的外部融资及其途径

二战以后，美国国会批准通过了西尔-波顿法案(HillBurton Act)，该法案的大体框架是美国公立医院可以通过争取联邦和州政府投入、内部集资或求助于慈善机构无息借款等方式来解决资金不足的问题，法案特别强调了政府对国民的健康状况负责。但到了20世纪70年代，由于世界经济危机的冲击，美国联邦和州财政已无能力支持卫生事业，借债便成为非营利性医院和公立医院的主要筹资方式，但是僧多粥少的局面使得医疗领域内的竞争火药味十足。     

U.S. hospital bond ratings in the managed care era

This study examines whether managed care organizations (MCOs) have made it more difficult for U.S. hospitals to finance capital improvements. Specifically, the study analyzes the link between MCO penetration and the ratings assigned to newly issued tax-exempt hospital bonds. Because of greater financial pressures, rating agencies may assign lower ratings to those hospitals most dependent on managed care revenues. Lower ratings in turn will require hospitals to offer higher yields to investors, thereby increasing the cost of capital improvements.