Patient satisfaction in Bangkok: the impact of hospital ownership and patient payment status.
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INTRODUCTION: Patient satisfaction with care received is an important dimension of evaluation that is examined only rarely in developing countries. Evidence about how satisfaction differs according to type of provider or patient payment status is extremely limited. OBJECTIVE: To (i) compare patient perceptions of quality of inpatient and outpatient care in hospitals of different ownership and (ii) explore how patient payment status affected patient perception of quality. METHODS: Inpatient and outpatient satisfaction surveys were implemented in nine purposively selected hospitals: three public, three private for-profit and three private non-profit. RESULTS: Clear and significant differences emerged in patient satisfaction between groups of hospitals with different ownership. Non-profit hospitals were most highly rated for both inpatient and outpatient care. For inpatient care public hospitals had higher levels of satisfaction amongst clientele than private for-profit hospitals. For example 76% of inpatients at public hospitals said they would recommend the facility to others compared with 59% of inpatients at private for-profit hospitals. This pattern was reversed for outpatient care, where public hospitals received lower ratings than private for-profit ones. Patients under the Social Security Scheme, who are paid for on a capitation basis, consistently gave lower ratings to certain aspects of outpatient care than other patients. For inpatient care, patterns by payment status were inconsistent and insignificant. CONCLUSIONS: The survey confirms, to some extent, the stereotypes about quality of care in hospitals of different ownership. The results on payment status are intriguing but warrant further research. (+info)
Significant reductions in length of stay after carotid endarterectomy can be safely accomplished without modifying either anesthetic technique or postoperative ICU monitoring.
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BACKGROUND AND PURPOSE: We sought to determine whether postoperative length of stay (LOS) and resource utilization could be safely reduced without changing our uniform protocol of performing carotid endarterectomy (CEA) under general anesthesia with postoperative intensive care unit monitoring. METHODS: We retrospectively reviewed the hospital records of 421 consecutive CEA operations performed during a 3-year period of transition in discharge policy to determine LOS, complications, and resource utilization. We divided operated patients into 3 cohorts: cohort I patients were operated on before a stay reduction policy was instituted (1995, n=171); cohort II patients were operated on after the institution of a single-day-stay policy for selected patients (January to August 1996, n=95); and cohort III patients were operated on after the institution of a universal single-day-stay policy (September 1996 to December 1997, n=155). RESULTS: While significant in-hospital complications leading to increased LOS remained essentially unchanged over time (cohort I: 4.0%; II: 6.3%; III: 3.9%; P=NS), the mean postoperative LOS decreased from 2.6+/-0.3 days in cohort I to 1.6+/-0.1 days in cohort III (P<0.0001). The median postoperative LOS also decreased from 2 days to 1 day from cohort I to III, with 70% of patients discharged after 1 day in cohort III compared with only 32% for cohort I (P<0.0001). In addition, the total number of laboratory studies ordered decreased from 8.0+/-0.8 per patient in cohort I to 6.4+/-0.5 in cohort III (P<0.01). CONCLUSIONS: A uniform policy of discharge home from the intensive care unit on postoperative day 1 following CEA under general anesthesia can reduce LOS and decrease resource utilization without compromising care. (+info)
Organizational and technological insight as important factors for successful implementation of IT.
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Politicians and hospital management in Sweden and Denmark focus on IT and especially Electronic Patient Record, EPR as a tool for changes that will lead to better economy as well as better quality and service to the patients. These changes are not direct effects of the new medium for patient records but indirect effects due to the possibilities embedded in the new technology. To ensure that the implementation is successful, i.e. leads to changes in organization structure and workflow, we need tools to prepare clinicians and management. The focus of this paper is the individual insight in technology and organization and it proposes a model to assess and categorize the possibilities of individuals and groups to participate in and make an implementation process powerful. (+info)
IAIMS: an interview with Dick West. Integrated Advanced Information Management Systems. Interview by Joan S Ash and Frances E Johnson.
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Richard T. West, IAIMS (Integrated Advanced Information Management Systems) Program Officer at the National Library of Medicine for 13 years, reflects on the origin, development, effectiveness, and future of IAIMS efforts. He dwells on the changes that have taken place as the concept of IAIMS has evolved from a technology-based to an organization-based level of integration. The role of IAIMS in patient care, education, and research is discussed, along with the role of the librarian in the implementation of IAIMS programs. He sees a need for training for librarians, informaticians, and others in preparation for these efforts and for the development of academic reward systems that encourage them. He expresses a desire for those working in information technology in hospitals to gain a clearer understanding of IAIMS, because the concept fits hospitals as well as academic health science centers. He exhorts informaticians to bring to reality the futuristic fantasies of a new information world. (+info)
Measuring hospital efficiency: a comparison of two approaches.
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OBJECTIVE: To compare the results of scoring hospital efficiency by means of two new types of frontier models, Data Envelopment Analysis (DEA) and stochastic frontier regression (SFR). STUDY SETTING: Financial records of Florida acute care hospitals in continuous operation over the period 1982-1993. STUDY DESIGN: Comparable DEA and SFR models are specified, and these models are then estimated to obtain the efficiency indexes yielded by each. The empirical results are subsequently examined to ascertain the extent to which they serve the needs of hospital policymakers. DATA COLLECTION: A longitudinal or panel data set is assembled, and a common set of output, input, and cost indicators is constructed to support the estimation of comparable DEA and SFR models. PRINCIPAL FINDINGS: DEA and SFR models yield convergent evidence about hospital efficiency at the industry level, but divergent portraits of the individual characteristics of the most and least efficient facilities. CONCLUSIONS: Hospital policymakers should not be indifferent to the choice of the frontier model used to score efficiency relationships. They may be well advised to wait until additional research clarifies reasons why DEA and SFR models yield divergent results before they introduce these methods into the policy process. (+info)
Hospital ownership and preventable adverse events.
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OBJECTIVE: To determine if type of hospital ownership is associated with preventable adverse events. DESIGN: Medical record review of a random sample of 15,000 nonpsychiatric, non-Veterans Administration hospital discharges in Utah and Colorado in 1992. MEASUREMENTS AND MAIN RESULTS: A two-stage record review process using nurse and physician reviewers was used to detect adverse events. Preventability was then judged by 2 study investigators who were blinded to hospital characteristics. The association among preventable adverse events and hospital ownership was evaluated using logistic regression with nonprofit hospitals as the reference group while controlling for other patient and hospital characteristics. We analyzed 4 hospital ownership categories: nonprofit, for-profit, major teaching government (e.g., county or state ownership), and minor or nonteaching government. RESULTS: When compared with patients in nonprofit hospitals, multivariate analyses adjusting for other patient and hospital characteristics found that patients in minor or nonteaching government hospitals were more likely to suffer a preventable adverse event of any type (odds ratio [OR] 2.46; 95% confidence interval [CI], 1.45 to 4.20); preventable operative adverse events (OR, 4.85; 95% CI, 2.44 to 9.62); and preventable adverse events due to delayed diagnoses and therapies (OR, 4.27; 95% CI, 1.48 to 12.31). Patients in for-profit hospitals were also more likely to suffer preventable adverse events of any type (OR, 1.57; 95% CI, 1.03 to 2.38); preventable operative adverse events (OR, 2.63; 95% CI, 1.42 to 4.87); and preventable adverse events due to delayed diagnoses and therapies (OR, 4.15; 95% CI, 1. 84 to 9.34). Patients in major teaching government hospitals were less likely to suffer preventable adverse drug events (OR, 0.38; 95% CI, 0.16 to 0.89). CONCLUSIONS: Patients in for-profit and minor teaching or nonteaching government-owned hospitals were more likely to suffer several types of preventable adverse events. Further research is needed to determine how these events could be prevented. (+info)
The role of the hospital in a changing environment.
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Hospitals pose many challenges to those undertaking reform of health care systems. This paper examines the evolving role of the hospital within the health care system in industrialized countries and explores the evidence on which policy-makers might base their decisions. It begins by tracing the evolving concept of the hospital, concluding that hospitals must continue to evolve in response to factors such as changing health care needs and emerging technologies. The size and distribution of hospitals are matters for ongoing debate. This paper concludes that evidence in favour of concentrating hospital facilities, whether as a means of enhancing effectiveness or efficiency, is less robust than is often assumed. Noting that care provided in hospitals is often less than satisfactory, this paper summarizes the evidence underlying three reform strategies: (i) behavioural interventions such as quality assurance programmes; (ii) changing organizational culture; and (iii) the use of financial incentives. Isolated behavioural interventions have a limited impact, but are more effective when combined. Financial incentives are blunt instruments that must be monitored. Organizational culture, which has previously received relatively little attention, appears to be an important determinant of quality of care and is threatened by ill-considered policies intended to 're-engineer' hospital services. Overall, evidence on the effectiveness of policies relating to hospitals is limited and this paper indicates where such evidence can be found. (+info)
An analysis of hospital productivity and product change.
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We developed a model to measure the contribution of changes in length-of-stay, service intensity, and productivity to the unusually low rate of growth in hospital costs per discharge in recent years. From 1992 through 1996 declining length-of-stay explained 97 percent of the decrease in real costs per discharge. Much of the drop was probably caused by care shifted from inpatient to postacute settings. Although complete data for our model are unavailable beyond that point, we cite several "leading indicators" that suggest that length-of-stay declines have played a smaller role in the continued low cost growth of 1997 and 1998 and that productivity may have risen sharply. (+info)