RESUMO
Act CXXXII of the year 2006 - amended several times - on the development of the health care system requires that health insurance authorities should regularly review utilization of the contracted capacity of professional medical care providers, and the need for change of capacities. The first such analysis should be carried out in 2013, according to the current laws in Hungary. The law lists 16 items, which are the basis for evaluation of the performance of providers. Among them some items are difficult to analyse specifically even for health insurance specialists. This study aims to review aspects of the reevaluation process and their associated concepts. Author wants to provide help for setting up the analysis in practice by going through and analysing the requirements of the law in detail.
Assuntos
Alocação de Recursos para a Atenção à Saúde/legislação & jurisprudência , Alocação de Recursos para a Atenção à Saúde/normas , Necessidades e Demandas de Serviços de Saúde , Alocação de Recursos para a Atenção à Saúde/tendências , Planejamento em Saúde/legislação & jurisprudência , Planejamento em Saúde/normas , Acessibilidade aos Serviços de Saúde/legislação & jurisprudência , Acessibilidade aos Serviços de Saúde/normas , Número de Leitos em Hospital/normas , Humanos , Hungria , Legislação Hospitalar/normas , Transferência de Pacientes/normasRESUMO
Shifting boundaries in healthcare roles have led to anxiety among some nurses about their legal responsibilities and accountabilities. This is partly because of a lack of education about legal principles that underpin healthcare delivery. This article explains the law in terms of standards of care, duty of care, vicarious liability and indemnity insurance.
Assuntos
Atenção à Saúde/normas , Seguro de Responsabilidade Civil/legislação & jurisprudência , Gestão de Riscos/legislação & jurisprudência , Responsabilidade Social , Pessoal de Saúde/legislação & jurisprudência , Pessoal de Saúde/normas , Humanos , Legislação Hospitalar/normas , Medicina Estatal , Reino UnidoRESUMO
Since serious problematic cases regarding the technical safety of technically demanding operations were reported in Japan, the Ministry of Health, Labor and Welfare issued new regulations on June 10, 2016 requiring each hospital to check the status of informed consent, skill of surgery team and governance system of the surgical unit, when the highly difficult new medical technologies were introduced to a hospital. In order to firmly establish this new system for highly difficult new medical technologies, it is very important and informative to survey the current situation for guidelines and consensus regarding introduction of medical technology with special skills in Japan and overseas. Based on the survey of questionnaires, document retrieval, and expert interviews, we found that documentation related to the introduction process of highly difficult medical technologies is very rare, and the regulations were mainly issued by academic societies. Moreover, even if such documentation existed, the quality of the regulations is poor and not sufficient enough to perform surgical practice safely. Therefore, for medical practitioners, comprehensive and concrete regulations should be issued by the government or ministry to legally follow in regard to technically demanding operations. A new practice guideline was proposed by our special research group to regulate the introduction process of highly difficult new medical technologies in hospitals in Japan. This guideline, gained understanding from relevant academic societies, provided a comprehensive view on the interpretation of "high difficulty new medical technology" prescribed by the law and show the basic idea at a preliminary examination from the viewpoints of "Surgeon's requirement", "Guidance system", "Medical safety" , and "Informed consent". These efforts will contribute to the improvement of the quality of guidelines regarding "highly difficult new medical technology".
Assuntos
Tecnologia Biomédica/normas , Atenção à Saúde/normas , Difusão de Inovações , Hospitais/normas , Tecnologia Biomédica/legislação & jurisprudência , Competência Clínica , Atenção à Saúde/organização & administração , Administração Hospitalar/legislação & jurisprudência , Administração Hospitalar/normas , Hospitais/estatística & dados numéricos , Humanos , Consentimento Livre e Esclarecido/normas , Japão , Legislação Hospitalar/normas , Legislação Hospitalar/estatística & dados numéricos , Segurança do Paciente , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/prevenção & controle , Guias de Prática Clínica como Assunto , Cirurgiões/legislação & jurisprudência , Cirurgiões/normas , Procedimentos Cirúrgicos Operatórios/efeitos adversos , Procedimentos Cirúrgicos Operatórios/legislação & jurisprudência , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/normas , Inquéritos e Questionários/estatística & dados numéricosAssuntos
Atenção à Saúde/legislação & jurisprudência , Planejamento em Desastres/legislação & jurisprudência , Registros Eletrônicos de Saúde/legislação & jurisprudência , Legislação Hospitalar/economia , Medicare Part B/economia , Atenção à Saúde/economia , Atenção à Saúde/tendências , Planejamento em Desastres/economia , Revelação/legislação & jurisprudência , Registros Eletrônicos de Saúde/economia , Registros Eletrônicos de Saúde/normas , Fraude/legislação & jurisprudência , Fraude/prevenção & controle , Fidelidade a Diretrizes , Humanos , Legislação Hospitalar/normas , Legislação Hospitalar/tendências , Auditoria Médica/economia , Auditoria Médica/legislação & jurisprudência , Medicare Part B/legislação & jurisprudência , Mecanismo de Reembolso/legislação & jurisprudência , Mecanismo de Reembolso/tendências , Estados UnidosAssuntos
Atenção à Saúde/organização & administração , Reforma dos Serviços de Saúde/legislação & jurisprudência , Internato e Residência , Admissão e Escalonamento de Pessoal , Atenção à Saúde/legislação & jurisprudência , Humanos , Internato e Residência/legislação & jurisprudência , Internato e Residência/normas , Internato e Residência/tendências , Legislação Hospitalar/normas , Legislação Hospitalar/tendências , Admissão e Escalonamento de Pessoal/legislação & jurisprudência , Admissão e Escalonamento de Pessoal/normas , Admissão e Escalonamento de Pessoal/tendências , Estados UnidosRESUMO
BACKGROUND: The national pneumonia treatment guidelines in Kenya changed in February 2016 but such guideline changes are often characterized by prolonged delays in affecting practice. We designed an enhanced feedback intervention, delivered within an ongoing clinical network that provides a general form of feedback, aimed at improving and sustaining uptake of the revised pneumonia treatment policy. The objective was to determine whether an enhanced feedback intervention will improve correctness of classification and treatment of childhood pneumonia, compared to an existing approach to feedback, after nationwide treatment policy change and within an existing hospital network. METHODS/DESIGN: A pragmatic, cluster randomized trial conducted within a clinical network of 12 Kenyan county referral hospitals providing inpatient pediatric care to children (aged 2-59 months) with acute medical conditions between March and November 2016. The intervention comprised enhanced feedback (monthly written feedback incorporating goal setting, and action planning delivered by a senior clinical coordinator for selected pneumonia indicators) and this was compared to standard feedback (2-monthly written feedback on multiple quality of pediatric care indicators) both delivered within a clinical network promoting clinical leadership linked to mentorship and peer-to-peer support, and improved use of health information on service delivery. The 12 hospitals were randomized to receive either enhanced feedback (n = 6) or standard feedback (n = 6) delivered over a 9-month period following nationwide pneumonia treatment policy change. The primary outcome is the proportion of all admitted patients with pneumonia (fulfilling criteria for treatment with orally administered amoxicillin) who are correctly classified and treated in the first 24 h. The secondary outcome will be measured over the course of the admission as any change in treatment for pneumonia after the first 24 h. DISCUSSION: This trial protocol employs a pragmatic trial design during a period of nationwide change in treatment guidelines to address two high-priority areas within implementation research: promoting adoption of health policies and optimizing effectiveness of feedback. TRIAL REGISTRATION: ClinicalTrials.gov, ID: NCT02817971 . Registered retrospectively on 27 June 2016.
Assuntos
Amoxicilina/administração & dosagem , Antibacterianos/administração & dosagem , Retroalimentação Psicológica , Fidelidade a Diretrizes/normas , Sistemas de Informação Hospitalar/normas , Hospitais/normas , Equipe de Assistência ao Paciente/normas , Pneumonia Bacteriana/tratamento farmacológico , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Administração Oral , Atitude do Pessoal de Saúde , Pré-Escolar , Fidelidade a Diretrizes/legislação & jurisprudência , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lactente , Quênia , Liderança , Legislação Hospitalar/normas , Mentores , Equipe de Assistência ao Paciente/legislação & jurisprudência , Grupo Associado , Pneumonia Bacteriana/classificação , Pneumonia Bacteriana/diagnóstico , Pneumonia Bacteriana/microbiologia , Formulação de Políticas , Padrões de Prática Médica/legislação & jurisprudência , Melhoria de Qualidade/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Projetos de PesquisaRESUMO
The authors compare the human right and medical aspects of the restraints which can be used in care of psychiatric patients. They outline the legislation in force and legislative objectives which were taken into consideration when codifying the ESzCsM (Ministry of Health, Welfare and Family) decree No. 60/2004. (VII. 6.) about the rules of admission of psychiatric patients to mental health facilities and the restraints applicable in care of them. The legal problems of the admission and its connection with the restraints and with the judicial review are summed up. Aspects for interpretation are given for the regulations of the decree which supposedly can prove to be most problematic in practice. Suggestions are made for the standpoints of legislative objectives which may seem necessary in the future.
Assuntos
Hospitais Psiquiátricos/legislação & jurisprudência , Legislação Hospitalar , Admissão do Paciente/legislação & jurisprudência , Direitos do Paciente/legislação & jurisprudência , Restrição Física/legislação & jurisprudência , Hospitais Psiquiátricos/normas , Humanos , Hungria , Legislação Hospitalar/ética , Legislação Hospitalar/normas , Direitos do Paciente/normasRESUMO
The threat posed by increased transmission of drug-resistant pathogens within healthcare settings and from healthcare settings to the community is very real and alarming. Although the developed world has taken strong steps to curb this menace, there has been little pressure on developing countries to take any corrective action. If the reporting of alarming rates of healthcare-associated infections (HCAIs) from hospitals in India and many other developing countries was made mandatory, it would help to force stakeholders (e.g. healthcare workers, legislators, administrators and policy makers in hospitals) to acknowledge and tackle the problem. This would introduce quality control in a long neglected area of health care, and enable patient empowerment which is practically non-existent in India. Healthcare institutions should commit towards enforcing 'zero tolerance' towards lapses in prevention of HCAIs. Public pressure would force the Indian Government to acknowledge the problem, and to allocate more funds to improve resources and infrastructure; this could substantially elevate the standard of health care given to the average Indian. Despite the numerous challenges, overall public benchmarking of HCAIs is a commendable goal that would go a long way towards tackling this menace in developing countries such as India.
Assuntos
Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Notificação de Abuso/ética , Benchmarking/normas , Complacência (Medida de Distensibilidade) , Países Desenvolvidos , Países em Desenvolvimento , Pessoal de Saúde , Hospitais/ética , Humanos , Índia , Controle de Infecções/legislação & jurisprudência , Legislação Hospitalar/normasRESUMO
We report a pilot study comparing antimicrobial usage and antimicrobial resistance trends for prominent nosocomial pathogens between 1994-1996. A convenience sample of ten hospitals participated in this retrospective review. We found a large variation in antimicrobial use and resistance trends and that many hospitals did not have data readily available to evaluate drug usage and resistance rates. A significant strong positive correlation was observed between the usage of ceftazidime and the prevalence of ceftazidime resistant Pseudomonas aeruginosa (r = 0.8, p = 0.005) and of ceftazidime resistant Enterobacter species (r = 0.8, p = 0.02). The presence of antibiotic control policies correlated with lower rates of some resistant strains and less antibiotic use. Our findings can be a useful starting point for hospitals that want to systematically measure antimicrobial use and resistance. Hospital laboratories, pharmacies, and infection control departments must work together to develop databases that will facilitate such measurements.
Assuntos
Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana , Hospitais/tendências , Legislação Hospitalar/normas , Ceftazidima/uso terapêutico , Resistência às Cefalosporinas , Cefalosporinas/uso terapêutico , Enterobacter/efeitos dos fármacos , Enterococcus/efeitos dos fármacos , Escherichia coli/efeitos dos fármacos , Humanos , Klebsiella pneumoniae/efeitos dos fármacos , Legislação Hospitalar/organização & administração , Legislação Hospitalar/tendências , Resistência a Meticilina , Penicilinas/uso terapêutico , Projetos Piloto , Pseudomonas aeruginosa/efeitos dos fármacos , Estudos Retrospectivos , Staphylococcus aureus/efeitos dos fármacos , Vancomicina/uso terapêutico , Resistência a VancomicinaRESUMO
The revision of the federal hospital act (Nov. 11, 1993; BGB1 Nr. 801/93) intends the introduction of an internal quality control as well as comparisons between different hospitals. For the application fo these constitutional requirements, the state governments had to develop laws being the basis for the hospital management to implement quality assurance. To support the introduction of a systematic quality control, the federal ministry of health published a guideline for quality assurance which was made available to all hospitals. Now, a questionnaire in all Austrian hospitals was designed to evaluate the progress and the specific ways of implementations as well as the possible need for action in the future.
Assuntos
Hospitais/normas , Avaliação de Programas e Projetos de Saúde/métodos , Áustria , Programas Governamentais , Hospitais/tendências , Legislação Hospitalar/normas , Legislação Hospitalar/tendências , Controle de QualidadeRESUMO
The Stichting Werkgroep Antibioticabeleid (SWAB, Foundation Antibiotic Policy Team) issued guidelines for empirical antimicrobial therapy in the hospital of sepsis in adults. A distinction is made between sepsis in patients with and patients without neutropenia. Patients without neutropenia are subdivided according to the setting where they contracted sepsis: at home, in the hospital or in the intensive-care unit. Because of the diversity in antibiotic spectrum of the different classes of cephalosporins, they can be used in all the categories of sepsis. The use of antibiotics with a very broad spectrum, like carbapenems and piperacillin-tazobactam, or antibiotics which can be applied in infections with microorganisms difficult to treat, like quinolones and glycopeptides, is limited in the empirical treatment of sepsis in order to combat development of resistance. It is crucial to streamline antibiotic therapy as soon as the causative agent of the sepsis is known; this includes choosing an antibiotic with the narrowest possible spectrum.
Assuntos
Antibacterianos/uso terapêutico , Infecção Hospitalar/prevenção & controle , Sepse/tratamento farmacológico , Adulto , Feminino , Humanos , Legislação Hospitalar/normas , Masculino , Países Baixos , Neutropenia/complicações , Farmacopeias como Assunto/normas , Sepse/complicaçõesRESUMO
The worldwide problem of antibiotic resistance of bacteria is a point of concern in the Netherlands as well. Responsible use of existing antibiotics was the incentive to establish a foundation, with the acronym SWAB, the primary goal of which is to optimize the use of antibiotics in the Netherlands in order to diminish the development of antibiotic resistance. One of the SWAB projects is the development of national guidelines for the use of antibiotics in hospitals. These guidelines are prepared by a committee of experts and reviewed by external consultants: infectious disease specialists, medical microbiologists and pharmacists. The revised version of the guidelines is submitted for publication in this journal. The SWAB hopes that these guidelines will make the prevention of antibiotic resistance a major factor in the choice of the antibiotic. Streamlining antibiotic therapy is an important tool in this respect.
Assuntos
Antibacterianos/uso terapêutico , Uso de Medicamentos/normas , Fundações/organização & administração , Guias de Prática Clínica como Assunto , Antibacterianos/economia , Resistência Microbiana a Medicamentos , Política de Saúde , Humanos , Legislação Hospitalar/normas , Países Baixos , Formulação de Políticas , Administração em Saúde Pública/legislação & jurisprudênciaRESUMO
The Netherlands Antibiotic Policy Foundation issued guidelines for empirical antimicrobial therapy of adult pneumonia patients in hospitals. A distinction is made between pneumonia contracted at home or in hospital because of the differences in micro-organisms and resistance patterns. These two categories are subdivided further with an empirical antibiotic treatment being chosen on the basis of the causative agents to be expected. For instance, pneumonia contracted at home is mostly caused by Streptococcus pneumoniae, to be treated with benzylpenicillin or amoxicillin. With regard to nosocomial pneumonia, treatment varies according to whether a pneumonia has or has not been contracted in the intensive care unit. Combating development of resistance is alloted an important place. Emphasis is laid on 'streamlining' the therapy, i.e. its adjustment (including choosing an antibiotic with the narrowest possible spectrum) once the causative agent is known.
Assuntos
Antibacterianos/uso terapêutico , Infecção Hospitalar/tratamento farmacológico , Política de Saúde , Pneumonia/tratamento farmacológico , Adulto , Idoso , Antibacterianos/classificação , Cuidados Críticos/normas , Resistência Microbiana a Medicamentos , Assistência Domiciliar/normas , Hospitais/normas , Humanos , Legislação Hospitalar/organização & administração , Legislação Hospitalar/normas , Pessoa de Meia-Idade , Países Baixos , Pneumonia/epidemiologiaAssuntos
Direitos Humanos , Legislação Hospitalar/normas , Legislação Médica/normas , Transplante de Órgãos/economia , Prisioneiros/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , China , Humanos , Legislação Hospitalar/economia , Legislação Médica/economia , Transplante de Órgãos/estatística & dados numéricos , Obtenção de Tecidos e Órgãos/economia , Obtenção de Tecidos e Órgãos/éticaRESUMO
Most US states have enacted or are considering legislation mandating hospitals to publicly report hospital-acquired infection (HAI) rates. We conducted a survey of infection control professionals and found that state-legislated public reporting of HAIs is not associated with perceived improvements in infection prevention program process measures or HAI rates.
Assuntos
Infecção Hospitalar/prevenção & controle , Profissionais Controladores de Infecções , Controle de Infecções/métodos , Legislação Hospitalar/normas , Notificação de Abuso , Vigilância da População , Estudos Transversais , Coleta de Dados , Higiene das Mãos , Humanos , Controle de Infecções/economia , Avaliação de Processos e Resultados em Cuidados de Saúde , Isolamento de Pacientes , Percepção , Estados UnidosRESUMO
The US government has dedicated substantial resources to help certain providers, such as short-term acute care hospitals and physicians, adopt and meaningfully use electronic health record (EHR) systems. We used national data to determine adoption rates of EHR systems among all types of inpatient providers that were ineligible for these same federal meaningful-use incentives: long-term acute care hospitals, rehabilitation hospitals, and psychiatric hospitals. Adoption rates for these institutions were dismally low: less than half of the rate among short-term acute care hospitals. Specifically, 12 percent of short-term acute care hospitals have at least a basic EHR system, compared with 6 percent of long-term acute care hospitals, 4 percent of rehabilitation hospitals, and 2 percent of psychiatric hospitals. To advance the creation of a nationwide health information technology infrastructure, federal and state policy makers should consider additional measures, such as adopting health information technology standards and EHR system certification criteria appropriate for these ineligible hospitals; including such hospitals in state health information exchange programs; and establishing low-interest loan programs for the acquisition and use of certified EHR systems by ineligible providers.