On the minimum requirements for otolaryngology clinics in National Health Service hospitals.

OBJECTIVE: This paper, a report by the Clinical Governance and Audit Committee of the Scottish Otolaryngological Society, presents a consensus view of the minimal requirements for ENT clinics in National Health Service hospitals. RESULTS AND CONCLUSION: The provision of adequate equipment and staff has gained increasing importance as the vast majority of ENT procedures can be safely performed in the out-patient or office setting.

[Alcohol-related mortality in the assessments of hospital unit physicians and pathologists: analysis of accounting medical documents].

AIM: To make a comparative analysis of the data available in the accounting medical documents drawn up at a multidisciplinary hospital on the level and structure of alcohol-related mortality (ARM) and to evaluate the efficiency of its accounting. MATERIALS AND METHODS: Accounting medical documents, such as 453 inpatient cards (Form 003/y), 453 postmortem protocols (cards) (Form 013/H-80), and 453 death certificates (Form 106/y-08), were chosen as the basis for the study. The data of the final clinical and postmortem diagnoses in the patients who had died at hospital and their primary cause of death were comparatively analyzed. RESULTS: According to Form 003/y, ARM was 5.5%; the detection rate of alcohol-related disease (ARD) was 11% (95% confidence interval (CI), 8.3 to 14.3%); according to Form 013/H-80, ARM was 7.1% (95% CI, 4.9 to 9.8%) and the detection rate of ARD was 12.6% (95% CI, 9.7 to 16%). The consistency of the diagnoses of ARD as a main cause of death, made by hospital unit physicians and pathologists, is estimated as the mean--the Cohen's kappa coefficient (kappa) is 0.570) (p < 0.001). CONCLUSION: The results of the investigation suggest that there are 3 types of ARM, which differ in its level and structure: ARM in the assessments of hospital unit physicians; that in the assessments of pathologists, and that according to the death certificates drawn up. The consistency index for the diagnosis of ARD as a main cause of death indicates that the hospital unit physicians only determine the etiology of alcohol-related cause of death, without identifying it specifically.

The objective and subjective outcome of orthodontic care in one municipal health center.

OBJECTIVE: The aim of this study was to assess the outcome of orthodontic care in one municipal health center. MATERIALS AND METHODS: The material consisted of one age-cohort of 15-16 year-old adolescents (n = 67). Of them, 97% participated in a clinical examination. The final group included in the study consisted of 61 adolescents (91% of the whole age cohort). The occlusions were evaluated applying the Occlusal Morphology and Function Index (OMFI), the Dental Health Component (DHC) and the Aesthetic Component (AC) of the Index of Orthodontic Treatment Need (IOTN). Moreover, all adolescents filled in a semi-structured questionnaire enquiring about their satisfaction with the function and appearance of their own dentition and self-perceived orthodontic treatment need. They also scored their own dental appearance on a Visual Analog Scale (VAS). RESULTS: Of the adolescents, 42% had received orthodontic treatment, while 58% were untreated. All morphological criteria of the OMFI were met by 58% of orthodontically treated and 49% of untreated adolescents and all functional criteria by 67% and 57%, respectively. Treatment need was registered in two of the treated adolescents (7%) and five of the untreated adolescents (14%). Treated adolescents were more often satisfied with their dental appearance than untreated adolescents (p = 0.034). In both groups, satisfaction with the function was high (93%). CONCLUSIONS: Orthodontic treatment seems to improve both occlusal morphology and function. The high satisfaction with one's own dental appearance among the treated adolescents is worth noting.

Women's experiences with legal abortion in Mexico City: a qualitative study.

In April 2007, elective first-trimester abortion was legalized in Mexico City. As of June 2011, more than 60,000 women from Mexico City and other Mexican states have obtained legal abortions in the city's public hospitals and health centers, with private facilities providing additional abortion services. This study examines women's experiences of abortion services in one public and two private clinic settings in 2008. Twenty-five in-depth interviews were conducted: 15 with women who obtained abortions in a public health center and 10 who obtained the procedure at either of two private clinics. Participants were highly satisfied with services at both public and private sites, although some had to go to more than one site before receiving services. None expressed doubts about their decision to have an abortion, and they felt unanimously that they were treated with respect. Furthermore, participants were pleased with the counseling they received and most accepted a contraceptive method after the procedure.

[An assessment of hospital services from the perspective of health professionals]. / Avaliação de serviços hospitalares na perspectiva dos profissionais de saúde.

This study had the objective of determining the way in which health professionals assess hospital services offered by their institutions, as well as identifying the core of social representations elaborated by those professionals regarding such institutions. A hundred and fifty-three questionnaires, applied in two hospitals (a state hospital and a charity hospital) in the metropolitan area of Natal, Rio Grande do Norte, Brazil, were analyzed. In the service assessment the Charity Hospital got the highest average score as for Service Quality. The state hospital presented the lowest average in the item "Respect for patient's privacy". The central categories were "Overpopulation" and "Humanized care" in both State and Charity hospitals, respectively. The peripheral categories were "Low wages" and "Overpopulation". Conducting an assessment is a very complex and important task. The assessment should become part of the organizational culture and guide improvements hospital care quality.

Mass General makes its survey findings public.

Hospital takes two-pronged approach, dealing with transparency while pursuing performance improvement. In addition to a copy of The Joint Commission survey, facility answers key questions and provides regular updates on web site. Policy of openness helps generate staff buy-in for PI initiatives.

Frecuencia de recién nacidos con bajo peso al nacer en pacientes con síndrome hipertensivo del embarazo en el hospital municipal Boliviano Holandés: experiencia institucional / General medical service support obstetrics and gynecology Netherlands Bolivian municipal hospital

PREGUNTA DE INVESTIGACIÓN¿Cuál es la frecuencia de recién nacidos (RN) con bajo peso al nacer(BPN) en pacientes con síndrome hipertensivo del embarazo (SHE),en el Servicio de Ginecología y Obstetricia del Hospital Municipal Boliviano Holandés entre septiembre de 2005 y septiembre de 2006? OBJETIVO GENERALConocer la frecuencia de RN con BPN en pacientes con SHE enel Servicio de Ginecología y Obstetricia del Hospital Municipal Boliviano Holandés en 13 meses de estudio. OBJETIVOS ESPECIFICOS Conocer el peso de RN de pacientes con síndrome hipertensivodel embarazo. Identifi car la edad gestacional de RN de pacientes con síndromehipertensivo del embarazo. Determinar la relación entre los tipos de síndrome hipertensivo delembarazo y RN con BPN. Identifi car la presencia de óbito en pacientes con síndrome hipertensivo del embarazo. MATERIAL Y METODOS El presente trabajo es un estudio descriptivo donde se revisó 210 historias clínicas de pacientes con síndrome hipertensivo del embarazo, internadas en el Servicio de Ginecología y Obstetricia del Hospital Municipal Boliviano Holandés de la ciudad de El Alto, entre septiembre de 2005 y septiembre de 2006.RESULTADOS En las 210 historias clínicas revisadas en el Servicio de Ginecología y Obstetricia del Hospital Municipal Boliviano Holandés en el período mencionado, hallamos 57 casos de RN con BPN, que correspondea 27,1...

Disparities in obstructive sleep apnea and its management between a minority-serving institution and a voluntary hospital.

We assessed disparities in severity of obstructive sleep apnea (OSA) and associated comorbidities, as well as in provision of sleep medicine health care, between patients evaluated for OSA in a voluntary hospital (VH) primarily serving a middle-class population with health-care insurance and a city hospital-based minority-serving institution (MSI) largely treating lower income, uninsured, and indigent patients. A retrospective chart review of patients evaluated for OSA at the VH (n=200) and at the MSI (n=103) was performed. Despite similar age and apnea hypopnea index, MSI patients had a greater body mass index, higher daytime systemic blood pressure, more comorbid medical conditions, and a lower minimum sleep SaO2 than VH patients. Systemic hypertension, diabetes mellitus, asthma, and congestive heart failure were more prevalent in the MSI group. Forty-two percent of the MSI patients diagnosed with OSA failed to follow up for treatment compared with 7% in the VH group, p<0.001. Disparities in OSA-associated comorbid conditions, as well as in delivery of sleep medicine-related health care, were evident between the VH and MSI groups. These findings suggest that OSA may be an important factor contributing to socioeconomic-based differences in morbidity and mortality.

[National health policies and local decisions in Mexico: the case of an intercultural hospital in Cuetzalan, Puebla]. / Políticas nacionales de salud y decisiones locales en México: el caso del Hospital Mixto de Cuetzalan, Puebla.

OBJECTIVE: To identify the changes brought about by various national and international factors in an intercultural hospital of the municipality of Cuetzalán, Puebla. MATERIAL AND METHODS: A case study was conducted during 2000 and 2001 in two Intercultural Hospitals of Mexico; the Cuetzalán Hospital in Puebla and the Jesús María Hospital in Nayarit State. Data were collected by means of 72 semi-structured interviews with allopathic therapists, indigenous therapists, and authorities of the different health care levels. Moreover, documental research was carried out on national policies for indigenous peoples as well as on indigenist policies. These policies were related with the five organizational stages of the hospital. State authorities gave their permission and interviewees signed informed consent. RESULTS: The hospital was created in 1958 by the Ministry of Health as a biomedical institution, in agreement with the integrationist indigenist policies going on at the time. It remained so during the beginning of the administration by the National Indigenist Institute. In 1990, the new participative indigenist policy trends and the creativity and sensitivity of some authorities, under the influence of international strategies, helped to transform the hospital into an Intercultural Hospital (offering both types of medicine, indigenous and allopathic) with regional coverage. In 2000, the devolution of the hospital to the State Ministry of Health, based on financial rather than socio-cultural considerations, caused the temporary loss of its intercultural character. The last stage as an Integral Hospital with Traditional Medicine (from 2003 onwards) was due to a combination of state official initiatives and the new political stance acquired by the Mexican indigenous movement. The hospital is now part of a regional project of five such hospitals officially denominated Integral Hospitals with Traditional Medicine, to be financed by the Puebla-Panama Plan of regional development. CONCLUSIONS: Our results confirmed that health organizations follow a historical process in which selected national and international forces open opportunities to promote intercultural health models that respond to the needs of indigenous populations. Despite the formerly held belief that traditional and scientific medicines were incompatible, this study demonstrates the viability of intercultural health care models that may become a real possibility in the country, based on new conventions to establish alternative and intercultural health services, thereby setting an example for other regions and countries. The English version of this paper is available at: http://www.insp.mx/salud/index.html.

Políticas nacionales de salud y decisiones locales en México: el caso del Hospital Mixto de Cuetzalan, Puebla / National health policies and local decisions in Mexico: the case of an intercultural hospital in Cuetzalan, Puebla

OBJETIVO: Identificar la evolución del hospital del municipio de Cuetzalan a partir de la influencia que diversos elementos del contexto nacional e internacional han tenido sobre ella. MATERIAL Y MÉTODOS: Estudio de caso, realizado en 2000 y 2001 sobre los Hospitales Mixtos en México -el de Cuetzalan, en el estado de Puebla, y el de Jesús María, en el estado de Nayarit-. Durante el trabajo de campo se obtuvo información a través de 72 entrevistas semiestructuradas con terapeutas alópatas e indígenas del hospital y con directivos de los diferentes niveles del sistema de salud. Además, se hizo una revisión documental, tanto de las políticas nacionales de salud para pueblos indígenas, como de las indigenistas, para relacionarlas con las cinco etapas organizacionales del hospital. Además de la autorización de los directivos estatales para el estudio, se pidió el consentimiento informado de los entrevistados. RESULTADOS: El hospital fue creado en 1958 por la Secretaría de Salud con carácter biomédico, acorde con el indigenismo integracionista de la época, y continuó con ese carácter durante la administración inicial del Instituto Nacional Indigenista. Pero las nuevas tendencias del indigenismo participativo y la sensibilidad y creatividad de algunos funcionarios del Instituto, sumadas a estrategias internacionales para lograr una mayor integración de las culturas indígenas, impulsaron su transformación, en 1990, en Hospital Mixto (que ofrecía las dos medicinas, la indígena y la alopática) con proyección regional. En la devolución del hospital a la Secretaría Estatal de Salud en 2000, que causó retrocesos temporales en el carácter mixto del hospital, primaron los criterios financieros sobre los socioculturales, mientras que en la actual versión del hospital como Hospital Integral con Medicina Tradicional influyeron, además de la iniciativa de funcionarios estatales, el reposicionamiento político de los indígenas en el país y la disponibilidad de recursos internacionales del Plan Puebla Panamá. CONCLUSIONES: El análisis ratifica el carácter histórico del desarrollo de las organizaciones de salud, y las oportunidades que las coyunturas y políticas nacionales e internacionales constituyen para impulsar modelos alternativos e interculturales de atención para la salud de los pueblos indígenas que respondan a sus necesidades. A pesar de que...

Impact of a cardiac risk reduction program in vulnerable patients hospitalized with coronary artery disease.

STUDY OBJECTIVE: To increase the use of guideline-based pharmacotherapy in vulnerable patients (ethnic minorities and the poor) with coronary artery disease (CAD) through a nurse-based quality-improvement program. DESIGN: Retrospective program evaluation. SETTING: Inner-city hospital in Denver, Colorado. PATIENTS: One hundred fifty-one consecutive patients hospitalized with a CAD-related diagnosis. INTERVENTION: A nurse-management program was initiated for patients with angiographically documented CAD, and rates of guideline-based care were compared with rates for historic controls. The intervention consisted of two key elements: patient counseling with language-appropriate education materials and direct physician education regarding the importance of cardioprotective drugs. The 151 patients in the intervention group were compared with 125 historic control patients hospitalized before the program was begun. Multivariable logistic regression analysis was used to assess differences in care with regard to ethnicity, education level, and insurance status, and to adjust for different baseline characteristics. MEASUREMENTS AND MAIN RESULTS: At hospital discharge, patients in the intervention group were more likely to receive statins (71% vs 52%, p=0.001) and angiotensin-converting enzyme inhibitors (79% vs 51%, p<0.001) compared with controls. These differences remained after adjusting for ethnicity, education level, insurance status, and baseline clinical characteristics. Also, a trend was noted toward greater use of aspirin (92% vs 86%, p=0.13) and beta-blockers (79% vs 73%, p=0.24) in the intervention group compared with controls. Patients in the intervention group were more likely to receive counseling for smoking cessation. CONCLUSION: An inpatient nurse-management program improved the quality of care for patients with CAD regardless of sociodemographic status. Properly designed disease-management initiatives can be effective for disadvantaged patients, who often obtain health care through emergency and inpatient services.

[Factors associated with precarious prenatal care in a sample of post-partum adolescent mothers in maternity hospitals in Rio de Janeiro, Brazil, 1999-2000]. / Fatores associados à assistência pré-natal precária em uma amostra de puérperas adolescentes em maternidades do Município do Rio de Janeiro, 1999-2000.

This study characterizes the women receiving precarious prenatal care according to socio-demographic variables, mother's reproductive history, family support, satisfaction with pregnancy, and risk behavior during pregnancy. A total of 1,967 adolescents were interviewed in the immediate post-partum in public and outsourced maternity hospitals in the City of Rio de Janeiro. The dependent variable was the number of prenatal appointments (0-3; 4-6; 7 or more). The statistical analysis aimed to test the hypothesis of homogeneity of proportions, including bi- and multivariate analysis, using multinomial logistic regression, in which the reference category for the response variable was 7 or more prenatal visits. Higher (and statistically significant) proportions of insufficient number of prenatal visits (0-3) were associated with: precarious sanitation conditions; not living with the child's father; attempted abortion; and smoking, drinking, and/or drug use during pregnancy. The results strongly indicate that mothers with worse living conditions and risk behavior during pregnancy were the same who lacked access to prenatal care.

[Model project on coding accuracy]. / Modellprojekt Kodierqualität.

First experiences with the external evaluation of coding accuracy in view of the German DRG-System are reported. 387 randomised inpatient cases of three departments of a municipal hospital were evaluated. 1.648 diagnosis codes and 946 procedure codes were evaluated with complete clinical data. Before and after correction by the reviewers the cases were grouped (AR-DRG 4.1) and the casemix index of the sample was calculated. 45.9% to 56.7% of primary diagnosis in the department samples were rated as correct. 25.2% to 37.5% of secondary diagnosis were rated as correct, 8.3% to 14.2% were corrected and 49.2% to 60.5% were rated as not relevant with regard to the German coding standards. 7.2% to 22.7% of secondary diagnosis had to be completed in the data. Evaluation of procedure codes resulted in 54.2% to 65.7% accepted codes, 5.9% to 12.1% corrected codes and 23.1% to 39.9% not accepted with regard to the German coding standards. 30.8% to 37.0% of procedure codes had to be completed in the data. After review, remarkable shift in DRGs was seen and casemix index increased 6.9% in average (0.25-12.1%). General and department-specific implications for improvement of coding accuracy could be evaluated. Consequences of potential coding errors in a prospective payment system on DRG basis were seen under conditions of daily hospital practice. External evaluation of coding accuracy used in this study could be the methodological basis for further investigations on this topic.

[Quality of health care of the urban population]. / Kachestvo meditsinskoi pomoshchi gorodskomu naseleniiu.

A study was carried out in 3 outpatient clinics in the city of Makhachkala (Daghestan Republic), aimed at working out recommendations to enhance the quality of medical aid. The latter was studied through expert inspection of clinical records of 568 outpatients. The expert inspection showed an inadequate level of therapeutic aid in municipal outpatient clinics. There was an irregular and insufficient examination, on the average, in 2/3 of patients, deficient treatment in every fourth patient, discrepant diagnoses in 8.3% of cases, groundless sick leaves in every 8th case. There was a succession in examinations and patients' treatment between outpatient clinics and hospitals. The results of the study provided the basis for working out a system of measures to assure and manage the quality of therapeutic aid in municipal clinics.

Case management: an evaluation at Childrens Hospital Los Angeles.

This prospective, quantitative, and qualitative evaluation of the case management program at CHLA clearly demonstrated the value of professional service coordination of care for children with complex, special health needs. Most specifically, the program documented improvement in three discrete areas of evaluation: 1. Financial, with decreased unnecessary expenditures and increased revenue. 2. Patient satisfaction, documented with validated questionnaires. 3. Clinical process improvement, using quantifiable clinical outcomes. At the very least, case management is an extremely valuable service in the present managed health care environment, and may in fact be indispensable.