A comparison of two hospitalist models with traditional care in a community teaching hospital

PURPOSE: Many studies have documented significant length of stay reduction and cost savings when hospitalist care is compared with traditional care. However, less is known about the concurrent performance of more than one hospitalist model in a single site. SUBJECTS AND METHODS: This retrospective cohort study of 10595 patients was conducted between July 2001 and June 2002 in a tertiary care community-based teaching hospital. Risk-adjusted length of stay, variable costs, 30-day readmission rates, and in-hospital and 30-day mortality were measured for patients treated by Community Physicians, Private Hospitalists and Academic Hospitalists. RESULTS: There was a 20% reduction in length of stay on the Academic Hospitalist service (p <.0001) and 8% on the Private Hospitalist service (P = .049) compared with Community Physicians. Similarly, total costs were 10% less on the Academic (P <.0001) and 6% less on the Private Hospitalist (P = .02) services compared with Community Physicians. The length of stay of Academic Hospitalists was 13% shorter than that of Private Hospitalists (P = .002); differences in costs between hospitalist groups were not statistically significant. Differences in in-hospital and 30-day mortality and 30-day readmission rates among the 3 physician groups were also not statistically significant. CONCLUSIONS: The impact on patient outcomes and resource utilization may vary with the hospitalist model used. Future studies should examine the specific organizational characteristics of hospitalists that contribute to improved patient care and resource utilization.     

Resource utilization and its management in splenic trauma

Background

This study compared resource utilization and its management for splenic injury at 2 level-I trauma centers and a pediatric referral center with other facilities in a state currently developing a trauma system.

Methods

Management strategy, length of stay, and total charges for children were compared among the pediatric referral center, trauma centers, and other facilities. Adult management, length of stay, and total charges were compared between trauma centers and other facilities.

Results

Nonoperative management was more frequent in children at the pediatric referral center than trauma centers or other facilities and was more common in adults at trauma centers than at other facilities. Mean length of stay and total charges for children were significantly greater at the pediatric referral center and trauma centers than at other facilities and for adults at trauma centers than at other facilities. Facility type was associated with length of stay and total charges when injury type and severity were controlled.

Conclusions

Nonoperative management of splenic injury is more common at trauma centers, and splenic trauma management may be more costly at trauma centers.     

Direct medical costs unequivocally related to diabetes in Italian specialized centers

This study estimated the resource utilization and direct medical costs in Italian diabetes centers (DCs). Hospital admissions for major chronic complications were not considered since DCs deliver primary care and follow up only complications unequivocally related to diabetes-acute complications and diabetic foot. The multicenter, prospective, observational study involving 31 Italian DCs included a total of 1,910 patients classified into eight prognostic groups by type of diabetes (types 1 and 2), metabolic control (HbA1c >7.5%, HbA1c 7.5%) and age (60, >60). The average total cost of type 1 diabetes per patient per year ranged from € 762 in group 2 (age 60, HbA1c >7.5%) to € 1,060 in group 4 (age >60, HbA1c >7.5%), and that the cost of type 2 diabetes from € 423 in group 5 (age 60, HbA1c 7.5%) to € 613 in group 8 (age >60, HbA1c >7.5%). The study brought to light the wide variability in the single cost components across clinically defined groups of patients. The cost of diabetes management in the strict sense was significantly affected by the type of diabetes and metabolic control.Data monitoring: E. Negri.E. Ansaldi, Alessandria; C. Baggiore, Florence; M. Balsanelli, Ostia; C. Bertoni, La Spezia; V. Borzì, Catania; A. Boscolo Bariga, Chioggia; A. Bruno, Turin; S. Caronna, Parma; F. Chiaromonte, Rome; S. Ciaccio, Pisa; G. Cicioni, Terni; M. Di Mauro, Catania; S. Gamba, Turin; L. Gentile, Asti; S. Giannini, Florence; D. Giorgi Pierfranceschi, Piacenza; T. Lavagnini, Padua; M. Lunetta, Catania; M. Marchesi, Bolzano; I. Meloncelli, San Benedetto del Tronto (Ascoli Piceno); G. Micali, Messina; M. Orrasch, Treviso; C. Pacchioni, Modena; M. Parillo, Caserta; G. Perriello, Perugia; S. Pistone, Potenza; G. Rinaldi, Naples; G. Sessa, Naples; M. Tagliaferri, Larino; P. Tatti, Marino (Rome); P. Ubaldi, Genua; M. Velussi, Monfalcone (Triest); E. Vitacolonna, Pescara; G. Zoppini, Verona; P. Zucchi, Asola (Mantua).     

Hospital resources used for ectopic pregnancy treatment by laparoscopy and methotrexate.

OBJECTIVE: To compare resources used in the medical and laparoscopic treatment of unruptured ectopic pregnancy. METHODS: We prospectively recorded all the medical resources required in the treatment of unruptured ectopic pregnancy. The study period ranged from January 1, 1995 to June 30, 1998. Single-dose intramuscular methotrexate injections were administered in 55 women (group I). This therapeutic option was provided on an outpatient basis in small EP (beta-HCG level < 5000 IU/L and hematosalpinx diameter < 3 cm). Serial clinical controls and biologic tests were performed until bHCG became negative. Forty women underwent a laparoscopic salpingostomy because they refused the methotrexate regimen or had "social" contra-indications (ie, predictable difficulties in the follow-up) (group II). Twenty-one patients underwent conservative laparoscopic treatment because of "medical" contraindications to methotrexate (group III). We recorded the resources used with the outpatient and inpatient treatment in each group (methotrexate consumption, operating room acts, length of hospital stay, clinical examinations, biological tests, and sonograms during the follow-up). RESULTS: We observed similar cure rates in each group, but it took significantly longer for beta-HCG to become negative in group 1. However, hospitalization was significantly less often required, and the length of hospital stay was shorter in this group. But length of follow-up, number of office visits, biological tests, sonograms, and subsequent readmissions were significantly more frequent after methotrexate. Despite more severe clinical presentations for patients in group III, we didn't find any significant differences in the hospital resources used in this group in comparison with those used in group II. CONCLUSIONS: The outpatient methotrexate option may result in low consumption of resources for a hospital because most of the follow-up can be performed by city practitioners and laboratories. For the laparoscopic option, efforts should be made to reduce the postoperative hospital stay.     

关于实现卫生资源优化配置的思考

分析了当前卫生资源配置存在的主要问题进行，提出了实现卫生资源优化配置应遵循可及性、可得性、有效性和有序性的原则，以指导建立符合我国国情的卫生资源优化配置模式。     

胜任力模型在卫生机构人力资源管理中的应用初探

胜任力模型是一种新型的人力资源分析评价方法,已逐渐成为人力资源管理体系的核心和基础。目前胜任力研究在卫生机构人力资源管理中仍较为少见。文章介绍了胜任力模型的概念,指出胜任力模型在卫生人力资源管理中实施的必要性以及构建的步骤,并分析存在的问题。     

分布式异构数字资源整合概述

 

对分布式异构数字资源的整合检索模式、整合协议、资源连接方式、编码等几个方面

进行了概括介绍。

     

What determines health? To where should we shift resources? : Attitudes towards the determinants of health among multiple stakeholder groups in Prince Edward Island, Canada

The population health perspective has become significant in academic and policy discourse. The purpose of this paper is to assess its significance among health care practitioners and administrators as well as the general public. Respondents in Prince Edward Island, Canada were asked to rank the broad determinants of health and comment on to where resources should be shifted to improve the health of the population. Important variations are noted between the groups with family physicians and front-line staff being similar in perceptions to the general public on most determinants than other groups. The paper concludes with discussion on the relevance of the findings for population health research and health policy.     

分类收集是实现垃圾处置“三化”的重要措施

按照垃圾处置的需要对垃圾分类收集，是一种较为科学的收集方式，对于实现垃圾的减量化，资源化，无割化有显著的作用，北京，广义两城市的社会调查说明，中虽有半数以上的群众理解，支持这种收集方式，但传统习惯是一个阻力，实际操作也有一定困难，需要通过宣传教育，经济支持及政府的优惠政策等，取得群众的合作，才能顺利实施这种新的收集方式。     

A cross-sectional analysis of reported corporate environmental sustainability practices

The concept of sustainability evolved throughout the 1970s and 1980s, but was formally described by the 27 principles of the Rio Declaration on Environment and Development in 1992. Despite the passage of nearly 20 years, to date there are no uniform set of federal rules, regulations, or guidelines specifically governing the environmental aspects of sustainability practices or related requirements in the United States. In this benchmark analysis, we have collected information on the sustainability programs of the five largest US companies in each of the 26 industrial sectors [based on the Forbes Global 2000 through 2009 (n = 130)]. For each company, we reviewed the most recent corporate sustainability, citizenship, or responsibility report, limiting our scope to environmental components, if available. Ten criteria were identified and analyzed, including leadership, reporting, external review, certification, and individual components of environmental sustainability programs. With respect to the prevalence of sustainability components between various business sectors, we found that the Drugs and Biotechnology (87%), Household and Personal Products (87%) and Oil and Gas Operations (87%) industries had the most comprehensive environmental sustainability programs. Using the nine components of environmental sustainability as a benchmark, we identified four key components as the characteristics of the most comprehensive environmental sustainability programs. These were (1) empowering leadership with a commitment to sustainability (80%), (2) standardized reporting (87%), (3) third-party evaluation of the sustainability programs (73%), and (4) obtaining ISO 14001 certification (73%). We found that many firms shaped their own definition of sustainability and developed their associated sustainability programs based on their sector, stakeholder interests, products or services, and business model. We noted an emerging area that we have called product sustainability – one in which toxicologists and environmental scientists can play a vital role helping to ensure that a manufactured item will indeed be considered acceptable for distribution now, as well as in the coming years. Numerous examples or case studies are presented.