Organization and Performance of US Health Systems.

Importance: Health systems play a central role in the delivery of health care, but relatively little is known about these organizations and their performance. Objective: To (1) identify and describe health systems in the United States; (2) assess differences between physicians and hospitals in and outside of health systems; and (3) compare quality and cost of care delivered by physicians and hospitals in and outside of health systems. Evidence Review: Health systems were defined as groups of commonly owned or managed entities that included at least 1 general acute care hospital, 10 primary care physicians, and 50 total physicians located within a single hospital referral region. They were identified using Centers for Medicare & Medicaid Services administrative data, Internal Revenue Service filings, Medicare and commercial claims, and other data. Health systems were categorized as academic, public, large for-profit, large nonprofit, or other private systems. Quality of preventive care, chronic disease management, patient experience, low-value care, mortality, hospital readmissions, and spending were assessed for Medicare beneficiaries attributed to system and nonsystem physicians. Prices for physician and hospital services and total spending were assessed in 2018 commercial claims data. Outcomes were adjusted for patient characteristics and geographic area. Findings: A total of 580 health systems were identified and varied greatly in size. Systems accounted for 40% of physicians and 84% of general acute care hospital beds and delivered primary care to 41% of traditional Medicare beneficiaries. Academic and large nonprofit systems accounted for a majority of system physicians (80%) and system hospital beds (64%). System hospitals were larger than nonsystem hospitals (67% vs 23% with >100 beds), as were system physician practices (74% vs 12% with >100 physicians). Performance on measures of preventive care, clinical quality, and patient experience was modestly higher for health system physicians and hospitals than for nonsystem physicians and hospitals. Prices paid to health system physicians and hospitals were significantly higher than prices paid to nonsystem physicians and hospitals (12%-26% higher for physician services, 31% for hospital services). Adjusting for practice size attenuated health systems differences on quality measures, but price differences for small and medium practices remained large. Conclusions and Relevance: In 2018, health system physicians and hospitals delivered a large portion of medical services. Performance on clinical quality and patient experience measures was marginally better in systems but spending and prices were substantially higher. This was especially true for small practices. Small quality differentials combined with large price differentials suggests that health systems have not, on average, realized their potential for better care at equal or lower cost.

Identification and assessment of a comprehensive set of structural factors associated with hospital costs in Switzerland.

Structural factors can influence hospital costs beyond case-mix differences. However, accepted measures on how to distinguish hospitals with regard to cost-related organizational and regional differences are lacking in Switzerland. Therefore, the objective of this study was to identify and assess a comprehensive set of hospital attributes in relation to average case-mix adjusted costs of hospitals. Using detailed hospital and patient-level data enriched with regional information, we derived a list of 23 cost predictors, examined how they are associated with costs, each other, and with different hospital types, and identified principal components within them. Our results showed that attributes describing size, complexity, and teaching-intensity of hospitals (number of beds, discharges, departments, and rate of residents) were positively related to costs and showed the largest values in university (i.e., academic teaching) and central general hospitals. Attributes related to rarity and financial risk of patient mix (ratio of rare DRGs, ratio of children, and expected loss potential based on DRG mix) were positively associated with costs and showed the largest values in children's and university hospitals. Attributes characterizing the provision of essential healthcare functions in the service area (ratio of emergency/ ambulance admissions, admissions during weekends/ nights, and admissions from nursing homes) were positively related to costs and showed the largest values in central and regional general hospitals. Regional attributes describing the location of hospitals in large agglomerations (in contrast to smaller agglomerations and rural areas) were positively associated with costs and showed the largest values in university hospitals. Furthermore, the four principal components identified within the hospital attributes fully explained the observed cost variations across different hospital types. These uncovered relationships may serve as a foundation for objectifying discussions about cost-related heterogeneity in Swiss hospitals and support policymakers to include structural characteristics into cost benchmarking and hospital reimbursement.

Resolving Pediatric Preventive Care Gaps Through Hospital Inreach.

OBJECTIVES: Panel management processes have been used to help improve population-level care and outreach to patients outside the health care system. Opportunities to resolve gaps in preventive care are often missed when patients present outside of primary care settings but still within the larger health care system. We hypothesized that we could design a process of "inreach" capable of resolving care gaps traditionally addressed solely in primary care settings. Our aim was to identify and resolve gaps in vaccinations and screening for lead exposure for children within our primary care registry aged 2 to 66 months who were admitted to the hospital. We sought to increase care gaps closed from 12% to 50%. METHODS: We formed a multidisciplinary team composed of primary care and hospital medicine physicians, nursing leadership, and quality improvement experts within the Division of General and Community Pediatrics. The team identified a smart aim, mapped the process, predicted failure modes, and developed a key driver diagram. We identified, tested, and implemented multiple interventions related to role assignment, identification of admitted patients with care gaps, and communication with the inpatient teams. RESULTS: After increasing the reliability of our process to identify and contact the hospital medicine team caring for patients who needed action to 88%, we observed an increase in the preventive care gaps closed from 12% to 41%. CONCLUSIONS: A process to help improve preventive care for children can be successfully implemented by using quality improvement methodologies outside of the traditional domains of primary care.

Improving patient flow during infectious disease outbreaks using machine learning for real-time prediction of patient readiness for discharge.

BACKGROUND: Delays in patient flow and a shortage of hospital beds are commonplace in hospitals during periods of increased infection incidence, such as seasonal influenza and the COVID-19 pandemic. The objective of this study was to develop and evaluate the efficacy of machine learning methods at identifying and ranking the real-time readiness of individual patients for discharge, with the goal of improving patient flow within hospitals during periods of crisis. METHODS AND PERFORMANCE: Electronic Health Record data from Oxford University Hospitals was used to train independent models to classify and rank patients' real-time readiness for discharge within 24 hours, for patient subsets according to the nature of their admission (planned or emergency) and the number of days elapsed since their admission. A strategy for the use of the models' inference is proposed, by which the model makes predictions for all patients in hospital and ranks them in order of likelihood of discharge within the following 24 hours. The 20% of patients with the highest ranking are considered as candidates for discharge and would therefore expect to have a further screening by a clinician to confirm whether they are ready for discharge or not. Performance was evaluated in terms of positive predictive value (PPV), i.e., the proportion of these patients who would have been correctly deemed as 'ready for discharge' after having the second screening by a clinician. Performance was high for patients on their first day of admission (PPV = 0.96/0.94 for planned/emergency patients respectively) but dropped for patients further into a longer admission (PPV = 0.66/0.71 for planned/emergency patients still in hospital after 7 days). CONCLUSION: We demonstrate the efficacy of machine learning methods at making operationally focused, next-day discharge readiness predictions for all individual patients in hospital at any given moment and propose a strategy for their use within a decision-support tool during crisis periods.

Increased time from physiological derangement to critical care admission associates with mortality.

BACKGROUND: Rapid response systems aim to achieve a timely response to the deteriorating patient; however, the existing literature varies on whether timing of escalation directly affects patient outcomes. Prior studies have been limited to using 'decision to admit' to critical care, or arrival in the emergency department as 'time zero', rather than the onset of physiological deterioration. The aim of this study is to establish if duration of abnormal physiology prior to critical care admission ['Score to Door' (STD) time] impacts on patient outcomes. METHODS: A retrospective cross-sectional analysis of data from pooled electronic medical records from a multi-site academic hospital was performed. All unplanned adult admissions to critical care from the ward with persistent physiological derangement [defined as sustained high National Early Warning Score (NEWS) > / = 7 that did not decrease below 5] were eligible for inclusion. The primary outcome was critical care mortality. Secondary outcomes were length of critical care admission and hospital mortality. The impact of STD time was adjusted for patient factors (demographics, sickness severity, frailty, and co-morbidity) and logistic factors (timing of high NEWS, and out of hours status) utilising logistic and linear regression models. RESULTS: Six hundred and thirty-two patients were included over the 4-year study period, 16.3% died in critical care. STD time demonstrated a small but significant association with critical care mortality [adjusted odds ratio of 1.02 (95% CI 1.0-1.04, p = 0.01)]. It was also associated with hospital mortality (adjusted OR 1.02, 95% CI 1.0-1.04, p = 0.026), and critical care length of stay. Each hour from onset of physiological derangement increased critical care length of stay by 1.2%. STD time was influenced by the initial NEWS, but not by logistic factors such as out-of-hours status, or pre-existing patient factors such as co-morbidity or frailty. CONCLUSION: In a strictly defined population of high NEWS patients, the time from onset of sustained physiological derangement to critical care admission was associated with increased critical care and hospital mortality. If corroborated in further studies, this cohort definition could be utilised alongside the 'Score to Door' concept as a clinical indicator within rapid response systems.

Supporting the Quadruple Aim Using Simulation and Human Factors During COVID-19 Care.

The health care sector has made radical changes to hospital operations and care delivery in response to the coronavirus disease (COVID-19) pandemic. This article examines pragmatic applications of simulation and human factors to support the Quadruple Aim of health system performance during the COVID-19 era. First, patient safety is enhanced through development and testing of new technologies, equipment, and protocols using laboratory-based and in situ simulation. Second, population health is strengthened through virtual platforms that deliver telehealth and remote simulation that ensure readiness for personnel to deploy to new clinical units. Third, prevention of lost revenue occurs through usability testing of equipment and computer-based simulations to predict system performance and resilience. Finally, simulation supports health worker wellness and satisfaction by identifying optimal work conditions that maximize productivity while protecting staff through preparedness training. Leveraging simulation and human factors will support a resilient and sustainable response to the pandemic in a transformed health care landscape.

Delinquent Medical Records: Who Are the Stakeholders for Timely Medical Documentation?

The explosion of electronic documentation associated with Meaningful Use-certified electronic health record systems has led to a massive increase in provider workload for completion and finalization of patient encounters. Delinquency of required documentation affects multiple areas of hospital operations. We present the major stakeholders affected by delinquency of the electronic medical record and examine the differing perspectives to gain insight for successful engagement to reduce the burden of medical record delinquency.

Investigating Hospital Supervision: A Case Study of Regulatory Inspectors' Roles as Potential Co-creators of Resilience.

OBJECTIVES: The aim of this study was to explore if, and in what ways, there has been changes in the supervisory approach toward Norwegian hospitals due to the implementation of a new management and quality improvement regulation (Regulation on Management and Quality Improvement in the Healthcare Services, hereinafter referred to as "Quality Improvement Regulation"). Moreover, we aimed to understand how inspectors' work promotes or hampers resilience potentials of adaptive capacity and learning in hospitals. METHODS: The study design is a case study of implementation and impact of the Quality Improvement Regulation. We performed a document analysis, and conducted and analyzed 3 focus groups and 2 individual interviews with regulatory inspectors, recruited from 3 county governor offices who are responsible for implementation and supervision of the Quality Improvement Regulation in Norwegian regions. RESULTS: Data analysis resulted in 5 themes. Informants described no substantial change in their approach owing to the Quality Improvement Regulation. Regardless, data pointed to a development in their practices and expectations. Although the Norwegian Board of Health Supervision, at the national level, occasionally provides guidance, supervision is adapted to specific contexts and inspectors balance trade-offs. Informants expressed concern about the impact of supervision on hospital performance. Benefits and disadvantage with positive feedback from inspectors were debated. Inspectors could nurture learning by improving their follow-up and add more hospital self-assessment. CONCLUSIONS: A nondetailed regulatory framework such as the Quality Improvement Regulation provides hospitals with room to maneuver, and self-assessment might reduce resource demands. The impact of supervision is scarce with an unfulfilled potential to learn from supervision. The Government could contribute to a shift in focus by instructing the county governors to actively reflect on and communicate positive experiences from, and smart adaptations in, hospital practice.

Humanizing the Morbidity and Mortality Conference.

Morbidity and mortality conferences (MMCs) are a long-held legacy institution in academic medicine that enable medical providers and hospital administrators to learn from systemic and individual errors, thereby leading to improved medical care. Originally, this forum had 1 major role-education. The MMC evolved and a second key role was added: quality improvement. In the wake of the 2020 COVID-19 pandemic, a second evolution-one that will humanize the MMC-is required. The pandemic emphasizes the need to use MMCs not only as a place to discuss errors but also as a place for medical providers to reflect on lives lost. The authors' review of the literature regarding MMCs indicates that most studies focus on enabling MMCs to become a forum for quality improvement, while none have emphasized the need to humanize MMCs to decrease medical provider burnout and improve patient satisfaction. Permitting clinicians to be human on the job requires restructuring the MMC to provide a space for reflection and, ultimately, defining a new purpose and charge for the MMC. The authors have 3 main recommendations. First, principles of humanism such as compassion, empathy, and respect, in particular, should be incorporated into traditional MMCs. Second, shorter gatherings devoted to giving clinicians the opportunity to focus on their humanity should be arranged. Third, an MMC focused entirely on the human aspects of medical care should be periodically arranged to provide an outlet for storytelling, artistic expression, and reflection. Humanizing the MMC-a core symposium in clinical medicine worldwide-could be the first step in revitalizing the spirit at the heart of medicine, one dedicated to health and healing. This spirit, which has been eroding as the field of medicine becomes increasingly corporate in structure and mission, is as essential during peaceful times in health care as during a pandemic.

Analysis of factors and corresponding interactions influencing clinical management assistant ability using competency model in China.

ABSTRACT: The clinical management assistant (CMA) is an innovative and practical way to help manage a hospital, so the selection of CMA is important. This research is to find the influencing factors on the competency of CMA and help to select proper candidate of CMA.Based on the items of competency theory using the structural equation model, the data of 600 hospital managers from Shanghai, Guangzhou and Wuhan were identified by exploratory factor analysis and confirmatory factor analysis. In further analysis, the interactions among the factors were evaluated.A total of 20 items were identified as critical to CMA capability, which were further tested and divided into 3 factors: (1) personal characteristics; (2) competence; (3) thinking. The subsequent analysis showed that all factors had significant impact on CMA's ability, and competence contributed the most to the formation of CMA's ability, while the intermediary role of personal characteristics and thinking could not be ignored in practice. The results showed that the competency model contained these 3 factors and had the same structure as the classic competency model.This study presented a tentative approach for assessing CMA's competency, as well as provided the criteria to find and evaluate a CMA.

Challenges around COVID-19 at a tertiary-level healthcare facility in South Africa and strategies implemented for improvement.

SARS-CoV-2 has resulted in a global pandemic within months following its initial detection. South Africa (SA), like many other countries, was not prepared for the impact this novel infection would have on the healthcare system. In this paper, the authors discuss the challenges experienced while facing COVID-19 at a tertiary-level institution in Gauteng province, SA, and the dynamic strategies implemented to deal with the epidemic.

[Emergency overcrowding and hospital organization: Causes and solutions]. / La saturation de la structure des urgences et le rôle de l'organisation hospitalière : réflexions sur les causes et les solutions.

Emergency Department (ED) overcrowding is a silent killer. Thus, several studies in different countries have described an increase in mortality, a decrease in the quality of care and prolonged hospital stays associated with ED overcrowding. Causes are multiple: input and in particular lack of access to lab test and imaging for general practitioners, throughput and unnecessary or time-consuming tasks, and output, in particular the availability of hospital beds for unscheduled patients. The main cause of overcrowding is waiting time for available beds in hospital wards, also known as boarding. Solutions to resolve the boarding problem are mostly organisational and require the cooperation of all department and administrative levels through efficient bed management. Elderly and polypathological patients wait longer time in ED. Internal Medicine, is the ideal specialty for these complex patients who require time for observation and evaluation. A strong partnership between the ED and the internal medicine department could help to reduce ED overcrowding by improving care pathways.

Value of new performance information in healthcare: evidence from Japan.

Mandatory measurement and disclosure of outcome measures are commonly used policy tools in healthcare. The effectiveness of such disclosures relies on the extent to which the new information produced by the mandatory system is internalized by the healthcare organization and influences its operations and decision-making processes. We use panel data from the Japanese National Hospital Organization to analyze performance improvements following regulation mandating standardized measurement and peer disclosure of patient satisfaction performance. Drawing on value of information theory, we document the absolute value and the benchmarking value of new information for future performance. Controlling for ceiling effects in the opportunities for improvement, we find that the new patient satisfaction measurement system introduced positive, significant, and persistent mean shifts in performance (absolute value of information) with larger improvements for poorly performing hospitals (benchmarking value of information). Our setting allows us to explore these effects in the absence of confounding factors such as incentive compensation or demand pressures. The largest positive effects occur in the initial period, and improvements diminish over time, especially for hospitals with poorer baseline performance. Our study provides empirical evidence that disclosure of patient satisfaction performance information has value to hospital decision makers.

Caracterização das guias de autorização de internação hospitalar (aih) para cirurgias eletivas / Characterization of hospital admission authorization guidelines (aih) for elective surgeries / Caracterización de las directrices de autorización hospitalaria (aih) para cirugías electivas

Introdução: A guia de Autorização de Internação Hospitalar (AIH) é um importante dispositivo de gestão, pois suas informações subsidiam o faturamento e pagamento de procedimentos médicos hospitalares e ou internações aos prestadores de serviços de saúde mediante avaliação e autorização prévia das secretarias de saúde a nível municipal, estadual e federal. Objetivo: Caracterizar as guias de Autorização de Internação Hospitalar para cirurgias eletivas do Complexo Regulador de Ribeirão Preto-SP. Método: Trata-se de um estudo descritivo, retrospectivo, observacional, de abordagem quantitativa, realizado na Secretaria Municipal de Saúde (SMS) do município de Ribeirão PretoSP, junto à Central de Regulação Médica, especificamente Central de Regulação de Cirurgias Eletivas. Resultados: Destacaram-se: liberação da maioria das guias n=212 (53,00%), cancelamento por não localização do usuário n=102 (30,18%), devolução por inadequação no código de procedimento n=91 (25,42%), grupo de doenças do aparelho digestivo n=598 (26,15%), especialidade ortopedia n=459 (20,07%), usuários de Ribeirão Preto n=2132 (93,22) e prestador de serviços Santa Casa de Misericórdia n=995(43,51%). Conclusão: Em virtude dos resultados apontados neste estudo conclui-se que estes oferecem subsídios para implementação de ações visando a redução de inadequações nas guias de AIH e consequente melhoria na qualidade das informações, bem como agilidade na realização das cirurgias eletivas, de modo a favorecer tratamento oportuno aos usuários do sistema de saúde.(AU)

Introduction: The Hospital Admission Authorization Guide (AIH) is an important management device, because their information subsidizes the billing and payment of hospital medical procedures and or hospitalizations to health service providers through evaluation and authorization provided by the municipal, state and federal health departments. Objective: To characterize the Hospital Admission Authorization Guidelines for elective surgeries of the Regulatory Complex of Ribeirão Preto-SP. Method: This is a descriptive, retrospective, observational, quantitative approach study, conducted at the Municipal Health Department (SMS) of the city of Ribeirão Preto-SP, next to the Central Medical Regulation, specifically Central Regulation of Elective Surgeries. Results: We highlight: release of most guides n=212 (53.00%), cancellation due to non-user location n=102 (30.18%), return due to inadequacy in procedure code n=91 (25.42%), group of digestive tract diseases n=598 (26.15%), specialty orthopedics n=459 (20.07%), users of Ribeirão Preto n=2132 (93.22) and service provider Santa Casa de Misericórdia n=995 (43.51%). Conclusion: Due to the results pointed out in this study, it is concluded that these offer subsidies for the implementation of actions aimed at reducing inadequacies in the AIH guidelines and consequent improvement in the quality of information, as well as agility in performing elective surgeries, in order to favor timely treatment to users of the health system.(AU)

Introducción: La Guía de Autorización de Hospitalización (AIH) es un dispositivo de gestión importante, ya que su información subsidia la facturación y pago de procedimientos médicos hospitalarios y/o hospitalizaciones a proveedores de servicios de salud mediante evaluación previa y autorización de los departamentos de salud para nivel municipal, estatal y federal. Objetivo: Caracterizar las guías de Autorización de Hospitalización para cirugías electivas en el Complejo Regulador de Ribeirão Preto-SP. Método: Se trata de un estudio observacional, descriptivo, retrospectivo, con abordaje cuantitativo, realizado en la Secretaría Municipal de Salud (SMS) de la ciudad de Ribeirão Preto-SP, contigua al Centro de Regulación Médica, específicamente el Centro de Regulación de Cirugía Electiva. Resultados: Se destacan: liberación de la mayoría de guías n = 212 (53,00%), cancelación por falta de ubicación del usuario n = 102 (30,18%), devolución por inadecuación en el código de procedimiento n = 91 (25, 42%), grupo de enfermedades digestivas n = 598 (26,15%), especialidad de ortopedia n = 459 (20,07%), usuarios de Ribeirão Preto n = 2132 (93,22) y prestador de servicios Santa Casa de Misericordia n = 995 (43,51%). Conclusión: A la vista de los resultados señalados en este estudio, se concluye que estos ofrecen subsidios para la implementación de acciones encaminadas a reducir las deficiencias en los lineamientos de AIH y la consecuente mejora en la calidad de la información, así como agilidad en la realización de cirugías electivas, con el fin de tratamiento oportuno de los usuarios del sistema de salud.(AU)

Prevention of health care associated venous thromboembolism through implementing VTE prevention clinical practice guidelines in hospitalized medical patients: a systematic review and meta-analysis.

BACKGROUND: Venous thromboembolism (VTE) is a leading cause of morbidity and mortality in hospitalized patients. Numerous VTE prevention clinical practice guidelines are available but not consistently implemented. This systematic review explored effectiveness of implementing VTE prevention clinical practice guidelines on VTE risk assessment and appropriateness of prophylaxis in hospitalized adult medical patients and identified the interventions followed to improve the adherence to these guidelines. METHODS: Six electronic databases were searched for randomized controlled trials, clinical controlled trials, or pre/post evaluation studies up to January 2019. Studies identified were screened for eligibility by two reviewers independently. Data were extracted by two reviewers using a standardized form. Risk of bias was assessed using MINORS and the certainty of evidence for each outcome using the GRADE approach. RESULTS: Of the 3537 records identified, 36 were eligible; eight studies were included for qualitative synthesis and four for meta-analysis. The meta-analysis of the studies assessing the impact of implementing VTE clinical practice guidelines favored appropriate prophylaxis (RR 1.67, 95% CI 1.41 to 1.97, 552 patients). Potential risk of bias was assessed to be low for 28% of the studies. However, using GRADE, the certainty of the evidence of all outcomes was rated very low quality. CONCLUSIONS: The lack of randomized controlled trials in this area reduces the quality of the evidence available. The evidence from before-after studies suggests that the implementation of VTE clinical practice guidelines may increase the practice of VTE risk assessment and appropriate prophylaxis in hospitalized medical patients. TRIAL REGISTRATION: PROSPERO CRD42018085506.

Evaluating health promotion standards at the Farshchian heart center of Hamadan, Iran.

OBJECTIVE: Farshchian Heart Center is the fifth health-promoting hospital and the first center of its type in Western Iran that officially joined the International Network of Health Promoting Hospitals and Health Services (HPH) in 2016. The purpose of the present study is to evaluate the health promotion standards at this center in 2018. METHODS: We conducted this cross-sectional study at Farshchian Heart Center of Hamadan. The main data collection instruments included questionnaires obtained from indicators of five different main standards of health-promoting hospitals developed by the World Health Organization (WHO) which were evaluated from three different perspectives: Management staff, hospital employees, and patients. The data were analyzed by SPSS version 21 software. RESULTS: We evaluated 111 hospital employees, 109 patients, and 6 management staff. Nurses (46.8%) comprised the majority of the hospital staff respondents. Less than half (42.3%) of the hospital staff expressed awareness of hospital health promotion policies; however, only 13.5% had attended various health promotion programs. Only 51.4% of patients knew about the hospital health promotion policies and 17.4% of them participated in relevant programs. The mean score for patient satisfaction with the hospital health promotion programs according to the visual analogue scale (VAS, range: 0-10) was 7.16 ± 2.45, which was significantly higher in outpatients (8.16 ± 1.85) compared to inpatients (6.44 ± 2.59, p = 0.001). Two thirds (66.7%) of the management staff expressed awareness of implementation of these programs. CONCLUSION: The results of this study demonstrated that health promotion policies based on WHO standards were not well-recognized among patients, hospital employees, and management staff in Farshchian Heart Center of Hamadan, Iran.

A tool to assess the quality perception of healthcare employees.

PURPOSE: The purpose of this project was to determine the validity and reliability of the Healthcare Quality Perception (HQP) questionnaire tool designed to capture employees' perceptions of healthcare quality in Indian hospitals. DESIGN/METHODOLOGY/APPROACH: Two hundred employees in private and public sector hospitals in India were randomly selected and given the HQP tool. It consisted of 38 Likert-scale items and six different subscales: (1) Planning and Documentation (n = 7); (2) Employee Participation in Quality Management Activities (n = 5); (3) Existence of Policies/Procedures/Guidelines (n = 5); (4) Quality and Patient Safety Management (n = 9); (5) Perceived Effect of Quality Improvement (n = 7) and (6) Training and Development Opportunities (n = 5). 156 completed questionnaires were received, demonstrating a 78% response rate. HQP tool subjected to statistical analysis to measure its reliability and validity. A p-value of less than 0.05 was considered as "significant." FINDINGS: Factor analysis pulled out six factors that conjointly demonstrated 66.4 % of the variance in healthcare professionals' (HCPs') perception of healthcare service quality in selected Indian hospitals. The overall Cronbach's alpha coefficient was measured at 0.959 for internal consistency reliability. This study demonstrates that the identified six critical factors are important determinants influencing HCPs' perception of the quality of healthcare services in private and public sector hospitals in India. ORIGINALITY/VALUE: This study provides evidence for the reliability and validity of the newly developed HCP Scale for the assessment of employee perception of the quality of services offered in selected hospitals in India, with potential applications in other contexts.

Using ICD-10 codes to identify elective epilepsy monitoring unit admissions from administrative billing data: A validation study.

Video-electroencephalogram (EEG) monitoring in the epilepsy monitoring unit (EMU) is essential for managing epilepsy and seizure mimics. Evaluation of care in the EMU would benefit from a validated code set capable of identifying EMU admissions from administrative databases comprised of large, diverse cohorts. We assessed the ability of code-based queries to parse EMU admissions from administrative billing records in a large academic medical center over a four-year period, 2016-2019. We applied prespecified queries for admissions coded as follows: 1) elective, 2) receiving video-EEG monitoring, and 3) including diagnoses typically required by major US healthcare payers for EMU admission. Sensitivity (Sn), specificity (Sp), and predictive value positive/negative (PVP, PVN) were determined. Two approaches were highly effective. Incorporating epilepsy, seizure, or seizure mimic codes as the admitting diagnosis (assigned at admission; Sn 96.3%, Sp 100.0%, PVP 98.3%, and PVN 100.0%) or the principal diagnosis (assigned after discharge; Sn 94.9%, Sp 100.0%, PVP 98.8%, and PVN 100.0%) identified elective adult EMU admissions with comparable reliability (p = 0.096). The addition of surgical procedure codes further separated EMU admissions for intracranial EEG monitoring. When applied to larger, more comprehensive datasets, these code-based queries should enhance our understanding of EMU utilization and access to care on a scalable basis.