Information given to patients before appointments and its effect on non-attendance rate.
(9/50)
PROBLEM: Wasted outpatient appointments as a result of clinic non-attendance, exacerbating outpatient waiting times. DESIGN: Single centre, prospective, non-randomised, controlled study. BACKGROUND AND SETTING: Diabetes clinic in a district general hospital run by a consultant, one or two diabetes nurse specialists, a dietitian, and a podiatrist. Clinic receives 10-15 new referrals a week in a health district with a population of 340 000. KEY MEASURE FOR IMPROVEMENT: Non-attendance rate in 325 new patients who attended after the intervention compared with 1336 historical controls from the same clinic in the three years before the scheme. STRATEGY FOR CHANGE: Two weeks before their outpatient appointment new patients were sent an information pack telling them when and where to come, where to park, what to bring, who they will see, and what to expect. One week before the appointment they received a supplementary phone call. EFFECTS OF CHANGE: Telling patients what to expect reduced non-attendance rate overall from 15% (201/1336) to 4.6% (15/325), P<0.0001. Non-attendance rate was 7.3% (13/178) in those sent a pack but not phoned and 1.4% (2/147) in those sent a pack and phoned, P=0.01. LESSON LEARNT: Giving new patients detailed information reduces non-attendance to almost 1%. (+info)
Cost recovery beds in public hospitals in Indonesia.
(10/50)
A policy of allowing public hospitals to provide some better quality, higher priced hospital beds for those able to pay was introduced as government policy in Indonesia after 1993. A study was conducted in 1998 in three public hospitals in East Java to investigate if the policy objective of cost-recovery was being achieved. Hospital revenue from these commercial beds was less than both the recurrent and total costs of providing them in all three hospitals, but exceeded recurrent costs minus staff salaries in two hospitals. One reason for the low cost-recovery ratios was that between 55% and 66% of the revenue was used as staff incentives, mostly to doctors. This was more than the maximum of 40% stipulated in the policy. The high proportions of total revenue going to staff were a result of hospital management having set bed fees too low. The policy may be contributing to the retention of doctors within public sector employment; however, it is not achieving its stated objective, especially over the longer term where full recovery of salaries and investment costs needs to be considered. Public hospitals that wish to invest in commercial beds need effective management and accounting systems so as to be able to monitor and control costs and set fees at levels that recoup the costs incurred. Further research is required to determine if this form of public-private mix has negative effects on equity and access for poorer patients. (+info)
Trust in physicians and medical institutions: what is it, can it be measured, and does it matter?
(11/50)
Despite the profound and pervasive importance of trust in medical settings, there is no commonly shared understanding of what trust means, and little is known about what difference trust actually makes, what factors affect trust, and how trust relates to other similar attitudes and behaviors. To address this gap in understanding, the emerging theoretical, empirical, and public policy literature on trust in physicians and in medical institutions is reviewed and synthesized. Based on this review and additional research and analysis, a formal definition and conceptual model of trust is presented, with a review of the extent to which this model has been confirmed by empirical studies. This conceptual and empirical understanding has significance for ethics, law, and public policy. (+info)
Hospital competition, resource allocation and quality of care.
(12/50)
BACKGROUND: A variety of approaches have been used to contain escalating hospital costs. One approach is intensifying price competition. The increase in price based competition, which changes the incentives hospitals face, coupled with the fact that consumers can more easily evaluate the quality of hotel services compared with the quality of clinical care, may lead hospitals to allocate more resources into hotel rather than clinical services. METHODS: To test this hypothesis we studied hospitals in California in 1982 and 1989, comparing resource allocations prior to and following selective contracting, a period during which the focus of competition changed from quality to price. We estimated the relationship between clinical outcomes, measured as risk-adjusted-mortality rates, and resources. RESULTS: In 1989, higher competition was associated with lower clinical expenditures levels compared with 1982. The trend was stronger for non-profit hospitals. Lower clinical resource use was associated with worse risk adjusted mortality outcomes. CONCLUSIONS: This study raises concerns that cost reductions may be associated with increased mortality. (+info)
The Picker Patient Experience Questionnaire: development and validation using data from in-patient surveys in five countries.
(13/50)
OBJECTIVE: The purpose of this study was to develop and test a core set of questions to measure patients' experiences of in-patient care. Questions were selected from the bank of items developed for use in in-patient surveys undertaken by the Picker Institute for the purposes of assessing the quality of care. DESIGN: The data reported here come from surveys of patients who had attended acute care hospitals in five countries: the United Kingdom, Germany, Sweden, Switzerland, and the USA. Questionnaires were mailed to patients' homes within 1 month of discharge, either to all patients, or to a random sample, discharged during a specified period. SAMPLE: A total of 62 925 questionnaires were returned, with response rates of 65% (UK), 74% (Germany), 63% (Sweden), 52% (Switzerland), and 46% (USA). RESULTS: Fifteen items were selected from the bank of questions included in the Picker in-patient questionnaires. These items have a high degree of face validity and when summed to an index they show a high degree of construct validity and internal reliability consistency. DISCUSSION: Fifteen items derived from the longer form Picker in-patient survey have been found to provide a meaningful picture of patient experiences of health care, and constitute the 15-item Picker Patient Experience Questionnaire. These questions comprise a core set that should be measured in all in-patient facility surveys. The Picker Patient Experience Questionnaire represents a step forward in the measurement of patient experience as it provides a core set of questions around which further optional modules may be added. Scores are easy to interpret and actionable. CONCLUSION: This small set of questions could be incorporated into in-patient surveys in different settings, enabling the comparison of hospital performance and the establishment of national or international benchmarks. (+info)
Reliability and validity of the Satisfaction with Hospital Care Questionnaire.
(14/50)
OBJECTIVE: To establish the psychometric properties of the Satisfaction with Hospital Care Questionnaire (SHCQ) for measuring patient satisfaction and evaluations of hospital care quality. DESIGN AND PARTICIPANTS: Patients (n = 275) and staff members (n = 83) of four hospital wards completed the 57-item SHCQ addressing 13 aspects of care. Staff members completed the SHCQ from the patient's perspective. The data were analyzed within the framework of generalizability theory. MAIN OUTCOME MEASURES: Generalizability coefficients (GCs) and standard errors of measurement (SEs). RESULTS: GCs indicating differentiation among patients with different overall levels of satisfaction (SHCQ mean scores) were high (> 0.90). GCs indicating differentiation among patients as to satisfaction with aspects of care (SHCQ scale scores) were generally satisfactory (> 0.75) to high. Patients agreed well on overall level of hospital care quality (GCs > 0.90) and differentiated reliably (GCs > 0.80) among aspects of care. No differentiation among wards was found with respect to quality of care. Patients and staff agreed to a considerable extent (0.78) on ranking the SHCQ items on care quality, but staff ratings were lower. Reliability and validity of patients' evaluations of quality of hospital care varied according to aspect of care. CONCLUSIONS: The SHCQ reliably establishes both patient satisfaction and overall quality of hospital care. Whereas patients' ratings may be too lenient, their ranking of the items on care quality appears to be valid, and is therefore suitable for monitoring and improving hospital care. Within scales, however, results should be interpreted more cautiously: for some items, patients cannot really tell the difference in quality of care. (+info)
Influence of length of stay on patient satisfaction with hospital care in Japan.
(15/50)
OBJECTIVE: The objective of this study was to identify specific patient satisfaction items related to overall satisfaction by different length of stay (LOS) for patients in Japanese hospital settings. METHODS: This cross-sectional study involved a participant sample, drawn from 77 voluntarily participating hospitals throughout Japan, of in-patients discharged to the community. Older patients and psychiatric, pediatric, obstetric and gynecologic patients were excluded. The 1050 respondents analyzed (response rate > or = 5l.1%) were divided into three groups based on their LOS: group 1, LOS < or = 1 week; group 2, LOS < or = 1 month; and group 3, LOS > 1 month. Using stepwise multiple regression analysis, we explored for each LOS group the relationship between overall patient satisfaction and satisfaction with 33 individual items, including three regarding perceived reputation of the hospital in question. RESULTS: Some unique satisfaction items for each group (e.g. 'skill of nursing care' in group 1, 'Recovery of physical health', 'skill of nursing care', and 'respect for patients opinions and feelings' in group 2, and 'relief from pain' and 'respect for patients' opinions and feelings' in group 3) were significantly associated with overall satisfaction. In all three groups, common items (e.g. 'recovery from distress and anxiety' and 'doctor's clinical competence') also related significantly to overall satisfaction. Two items pertaining to the hospital reputation dimension (e.g. 'family member's evaluation of the hospital' and 'hospital reputation among other patients') were also significant predictors of overall satisfaction in all three groups. CONCLUSION: The findings show that according to LOS, unique items could determine significantly the achievement of overall satisfaction, while some common predictors across all three LOS groupings also seemed to be indispensable for inpatient's assessment of hospital care. It was also confirmed in this study that a positive perception of hospital reputation might have an important role in patient satisfaction in Japan. (+info)
What happens to patients who leave hospital against medical advice?
(16/50)
BACKGROUND: Patients who leave hospital against medical advice (AMA) may be at risk of adverse health outcomes and readmission. In this study we examined rates of readmission and predictors of readmission among patients leaving hospital AMA. METHODS: We prospectively studied 97 consecutive patients who left the general medicine service of an urban teaching hospital AMA. Each patient was matched according to age, sex and primary diagnosis with a control patient who was discharged routinely. Readmission rates were examined using Kaplan-Meier analysis. Regression models were used to test the hypothesis that readmissions among patients discharged AMA followed a biphasic curve. RESULTS: Patients who left AMA were much more likely than the control patients to be readmitted within 15 days (21% v. 3%, p < 0.001). Readmissions occurred at an accelerated pace during the first 15 days, followed by a 75-day period during which readmissions occurred at a rate comparable to that among the control patients. Among the patients who left AMA, being male and having a history of alcohol abuse were significant predictors of readmission within 15 days; however, these characteristics were common among the patients who left AMA. In the Cox proportional hazard models, leaving AMA was the only significant predictor of readmission (adjusted hazard ratio 2.5, 95% confidence interval 1.4-4.4). INTERPRETATION: The significantly increased risk of readmission among general medicine patients who leave hospital AMA is concentrated in the first 2 weeks after discharge. However, it is difficult to identify which patients will likely be readmitted. (+info)