Changes in Hospital Adverse Events and Patient Outcomes Associated With Private Equity Acquisition.

Importance: The effects of private equity acquisitions of US hospitals on the clinical quality of inpatient care and patient outcomes remain largely unknown. Objective: To examine changes in hospital-acquired adverse events and hospitalization outcomes associated with private equity acquisitions of US hospitals. Design, Setting, and Participants: Data from 100% Medicare Part A claims for 662 095 hospitalizations at 51 private equity-acquired hospitals were compared with data for 4 160 720 hospitalizations at 259 matched control hospitals (not acquired by private equity) for hospital stays between 2009 and 2019. An event study, difference-in-differences design was used to assess hospitalizations from 3 years before to 3 years after private equity acquisition using a linear model that was adjusted for patient and hospital attributes. Main Outcomes and Measures: Hospital-acquired adverse events (synonymous with hospital-acquired conditions; the individual conditions were defined by the US Centers for Medicare & Medicaid Services as falls, infections, and other adverse events), patient mix, and hospitalization outcomes (including mortality, discharge disposition, length of stay, and readmissions). Results: Hospital-acquired adverse events (or conditions) were observed within 10 091 hospitalizations. After private equity acquisition, Medicare beneficiaries admitted to private equity hospitals experienced a 25.4% increase in hospital-acquired conditions compared with those treated at control hospitals (4.6 [95% CI, 2.0-7.2] additional hospital-acquired conditions per 10 000 hospitalizations, P = .004). This increase in hospital-acquired conditions was driven by a 27.3% increase in falls (P = .02) and a 37.7% increase in central line-associated bloodstream infections (P = .04) at private equity hospitals, despite placing 16.2% fewer central lines. Surgical site infections doubled from 10.8 to 21.6 per 10 000 hospitalizations at private equity hospitals despite an 8.1% reduction in surgical volume; meanwhile, such infections decreased at control hospitals, though statistical precision of the between-group comparison was limited by the smaller sample size of surgical hospitalizations. Compared with Medicare beneficiaries treated at control hospitals, those treated at private equity hospitals were modestly younger, less likely to be dually eligible for Medicare and Medicaid, and more often transferred to other acute care hospitals after shorter lengths of stay. In-hospital mortality (n = 162 652 in the population or 3.4% on average) decreased slightly at private equity hospitals compared with the control hospitals; there was no differential change in mortality by 30 days after hospital discharge. Conclusions and Relevance: Private equity acquisition was associated with increased hospital-acquired adverse events, including falls and central line-associated bloodstream infections, along with a larger but less statistically precise increase in surgical site infections. Shifts in patient mix toward younger and fewer dually eligible beneficiaries admitted and increased transfers to other hospitals may explain the small decrease in in-hospital mortality at private equity hospitals relative to the control hospitals, which was no longer evident 30 days after discharge. These findings heighten concerns about the implications of private equity on health care delivery.

Barreras y factores facilitadores para la accesibilidad a lainterrupción legal del embarazo (ILE) en el subsistema privado y de la seguridad social de Argentina: análisis dela situación institucional en el Hospital Italiano de Buenos Aires / Barriers and facilitating factors for accessibility to legal interruption of pregnancy in Argentina's public health and private subsystem: analysis of the institutional situation at Hospital Italiano de Buenos Aires

Hasta diciembre de 2020, en Argentina el aborto era legal ante determinadas causales. Sin embargo, era común que la implementación de esta legislación se viera entorpecida. El objetivo de esta investigación fue identificar las barreras y los factores facilitadores para la accesibilidad a la interrupción legal de embarazo en una institución del subsistema privado y de la seguridad social. Se realizó una investigación con enfoque cualitativo con entrevistas a profesionales del equipo de salud involucrados en el circuito de atención de interrupción legal de embarazo del Hospital Italiano de Buenos Aires. Los resultados se organizan en cinco ejes temáticos que surgieron luego de un proceso de lectura, interpretación y discusión:1) ausencia de una política institucional explícita, 2) los componentes de la práctica (falta de registro en la historia clínica electrónica, desarrollo de circuitos paralelos para acceder a la medicación: misoprostol), 3) el marco jurídico legal y las causales (falta de leyes claras, diversas interpretaciones en lo que respecta al causal salud), 4) la objeción de conciencia y 5) los aspectos contextuales (movimiento feminista, el proyecto de ley desaprobado en el senado en 2018). A pesar de que el equipo de salud contaba con un marco legal claro, implementar una política institucional interna resulta sumamente necesario. (AU)

Up until December 2020, abortion was legal in Argentina on certain grounds. However, it was common for the implementation of this legislation to be hindered. The purpose of this research was to identify the barriers and facilitating factors for the accessibility to legal abortion in both private and public health care institutions. A qualitative research was carried out with interviews with health professionals involved in the health team at Hospital Italiano de Buenos Aires legal interruption of pregnancy care circuit. The results are organized into five thematic axes that emerged after a process of reading, interpreting and discussing: 1) the absence of an explicit institutional policy, 2) the components of the practice (lack of registration in the electronic health records, development of parallel circuits to access medication: misoprostol), 3) the legal framework and grounds (lack of clear laws, different interpretations regarding health grounds), 4) conscientious objection, and 5) contextual aspects (feminist movement, the bill disapproved in the Senate in 2018). Even though the health teamhad a clear legal framework in place, implementing an internal institutional policy is extremely necessary. (AU)

Determinants, reasons for choice and willingness to recommend birthing facility among mothers in public and private health facilities in Ebonyi, Nigeria.

INTRODUCTION: facility-based births remain low in Nigeria despite the enormous benefits on maternal and neonatal health. We compared the determinants, reasons for choice and willingness to recommend public and private birthing facilities among mothers in Ebonyi, Nigeria. METHODS: this was a cross-sectional survey among 620 women whose childbirth occurred in public (teaching) and private-for-profit mission hospitals in Ebonyi, Nigeria. Semi-structured, interviewer-administered questionnaires were used for data collection. RESULTS: the mean age of the respondents was 29.86±4.4. Most had post-secondary education (71.0%), more than 4 antenatal visits (83.4%) and vaginal births (77.7%). Respondents with high economic status [adjusted odds ratio (aOR) 2.88; Confidence Interval (CI) 1.98-4.18], post-secondary education (aOR 1.73; CI 1.13-2.64) and urban residence (aOR 3.51; CI 2.19-5.61) were more likely to utilize public birthing facilities. In the private hospital, religion (78.4%) was the commonest reason for utilization while poor quality of services (61.9%) was the major cause of dissatisfaction. In the public hospital, the main reason for patronage was insurance enrolment (73.2%) while negative provider attitude (66.7%) led to dissatisfaction. In both facilities, majority (92%) were willing to recommend their birth facility to others. CONCLUSION: regardless of facility type, respondents were willing to recommend or reuse the health facility for subsequent obstetric care. Religion and insurance enrolment were the major reasons for choosing the private and public hospital respectively. Residence, educational and income status influenced birthing facility type used. We recommend improved quality of services in private hospitals and provision of insurance with improved provider attitude in public health facilities.

Gynecologic oncology treatment modifications or delays in response to the COVID-19 pandemic in a publicly funded versus privately funded North American tertiary cancer center.

OBJECTIVE: To compare gynecologic oncology surgical treatment modifications and delays during the first wave of the COVID-19 pandemic between a publicly funded Canadian versus a privately funded American cancer center. METHODS: This is a retrospective cohort study of all planned gynecologic oncology surgeries at University Health Network (UHN) in Toronto, Canada and Brigham and Women's Hospital (BWH) in Boston, USA, between March 22,020 and July 302,020. Surgical treatment delays and modifications at both centers were compared to standard recommendations. Multivariable logistic regression was performed to adjust for confounders. RESULTS: A total of 450 surgical gynecologic oncology patients were included; 215 at UHN and 235 at BWH. There was a significant difference in median time from decision-to-treat to treatment (23 vs 15 days, p < 0.01) between UHN and BWH and a significant difference in treatment delays (32.56% vs 18.29%; p < 0.01) and modifications (8.37% vs 0.85%; p < 0.01), respectively. On multivariable analysis adjusting for age, race, treatment site and surgical priority status, treatment at UHN was an independent predictor of treatment modification (OR = 9.43,95% CI 1.81-49.05, p < 0.01). Treatment delays were higher at UHN (OR = 1.96,95% CI 1.14-3.36 p = 0.03) and for uterine disease (OR = 2.43, 95% CI 1.11-5.33, p = 0.03). CONCLUSION: During the first wave of COVID-19 pandemic, gynecologic oncology patients treated at a publicly funded Canadian center were 9.43 times more likely to have a surgical treatment modification and 1.96 times more likely to have a surgical delay compared to an equal volume privately funded center in the United States.

Comparative preoperative characteristics and postoperative outcomes at a private versus a safety-net hospital following endoscopic endonasal transsphenoidal resection of pituitary adenomas.

OBJECTIVE: Sociodemographic disparities in health outcomes are well documented, but the effects of such disparities on preoperative presentation of pituitary adenomas (PA) and surgical outcomes following resection are not completely understood. In this study the authors sought to compare the preoperative clinical characteristics and postoperative outcomes in patients undergoing PA resection at a private hospital (PH) versus a safety-net hospital (SNH). METHODS: The authors conducted a retrospective review over a 36-month period of patients with PAs who underwent endoscopic endonasal transsphenoidal surgery performed by the same attending neurosurgeon at either a PH or an SNH at a single academic medical institution. RESULTS: A total of 92 PH patients and 69 SNH patients were included. SNH patients were more likely to be uninsured or have Medicaid (88.4% vs 10.9%, p < 0.0001). A larger percentage of SNH patients were Hispanic (98.7% vs 32.6% p < 0.0001), while PH patients were more likely to be non-Hispanic white (39.1% vs 4.3%, p < 0.0001). SNH patients had a larger mean PA diameter (26.2 vs 22.4 mm, p = 0.0347) and a higher rate of bilateral cavernous sinus invasion (13% vs 4.3%, p = 0.0451). SNH patients were more likely to present with headache (68.1% vs 45.7%, p = 0.0048), vision loss (63.8% vs 35.9%, p < 0.0005), panhypopituitarism (18.8% vs 4.3%, p = 0.0031), and pituitary apoplexy (18.8% vs 7.6%, p = 0.0334). Compared to PH patients, SNH patients were as likely to undergo gross-total resection (73.9% vs 76.1%, p = 0.7499) and had similar rates of postoperative improvement in headache (80% vs 89%, p = 0.14) and vision (82% vs 84%, p = 0.74), but had higher rates of postoperative panhypopituitarism (23% vs 10%, p = 0.04) driven by preoperative endocrinopathies. Although there were no differences in tumor recurrence or progression, loss to follow-up was seen in 7.6% of PH versus 18.6% (p = 0.04) of SNH patients. CONCLUSIONS: Patients presenting to the SNH were more often uninsured or on Medicaid and presented with larger, more advanced pituitary tumors. SNH patients were more likely to present with headaches, vision loss, and apoplexy, likely translating to greater improvements in headache and vision observed after surgery. These findings highlight the association between medically underserved populations and more advanced disease states at presentation, and underscore the likely role of academic tertiary multidisciplinary care teams and endoscopic PA resection in somewhat mitigating sociodemographic factors known to portend poorer outcomes, though longer-term follow-up is needed to confirm these findings.

Resuscitation of preterm infants in the Philippines: a national survey of resources and practice.

OBJECTIVE: There is a high incidence of preterm birth in low-income and middle-income countries where healthcare resources are often limited and may influence decision making. We aimed to explore the interplay between resource limitations and resuscitation practices for extremely preterm infants (EPIs) in neonatal intensive care units (NICUs) across the Philippines. METHODS: We conducted a national survey of NICUs in the Philippines. Institutions were classified according to sector (private/public), region and level. Respondents were asked about unit capacity, availability of ventilators and surfactant, resuscitation practices and estimated survival rates for EPIs of different gestational ages. RESULTS: Respondents from 103/228 hospitals completed the survey (response rate 45%). Public hospitals reported more commonly experiencing shortages of ventilators than private hospitals (85%vs23%, p<0.001). Surfactant was more likely to be available in city hospitals than regional/district hospitals (p<0.05) and in hospitals classified as Level III/IV than I/II (p<0.05). The financial capacity of parents was a major factor influencing treatment options. Survival rates for EPIs were estimated to be higher in private than public institutions. Resuscitation practice varied; active treatment was generally considered optional for EPIs from 25 weeks' gestation and usually provided after 27-28 weeks' gestation. CONCLUSION: Our survey revealed considerable disparities in NICU resource availability between different types of hospitals in the Philippines. Variation was observed between hospitals as to when resuscitation would be provided for EPIs. National guidelines may generate greater consistency of care yet would need to reflect the variable context for decisions in the Philippines.

Technical Efficiency of Public and Private Hospitals in Beijing, China: A Comparative Study.

Objective: With the participation of private hospitals in the health system, improving hospital efficiency becomes more important. This study aimed to evaluate the technical efficiency of public and private hospitals in Beijing, China, and analyze the influencing factors of hospitals' technical efficiency, and thus provide policy implications to improve the efficiency of public and private hospitals. Method: This study used a data set of 154-232 hospitals from "Beijing's Health and Family Planning Statistical Yearbooks" in 2012-2017. The data envelopment analysis (DEA) model was employed to measure technical efficiency. The propensity score matching (PSM) method was used for matching "post-randomization" to directly compare the efficiency of public and private hospitals, and the Tobit regression was conducted to analyze the influencing factors of technical efficiency in public and private hospitals. Results: The technical efficiency, pure technical efficiency and scale efficiency of public hospitals were higher than those of private hospitals during 2012-2017. After matching propensity scores, although the scale efficiency of public hospitals remained higher than that of their private counterparts, the pure technical efficiency of public hospitals was lower than that of private hospitals. Panel Tobit regression indicated that many hospital characteristics such as service type, level, and governance body affected public hospitals' efficiency, while only the geographical location had an impact on private hospitals' efficiency. For public hospitals in Beijing, those with lower average outpatient and inpatient costs per capita had better performance in technical efficiency, and bed occupancy rate, annual visits per doctor, and the ratio of doctors to nurses also showed a positive sign with technical efficiency. For private hospitals, the average length of stay was negatively associated with technical efficiency, but the bed occupancy rate, annual visits per doctor, and average outpatient cost were positively associated with technical efficiency. Conclusions: To improve technical efficiency, public hospitals should focus on improving the management standards, including the rational structure of doctors and nurses as well as appropriate reduction of hospitalization expenses. Private hospitals should expand their scale with proper restructuring, mergers, and acquisitions, and pay special attention to shortening the average length of stay and increasing the bed occupancy rate.

Effect of data validation audit on hospital mortality ranking and pay for performance.

BACKGROUND: Quality improvement and epidemiology studies often rely on database codes to measure performance or impact of adjusted risk factors, but how validity issues can bias those estimates is seldom quantified. OBJECTIVES: To evaluate whether and how much interhospital administrative coding variations influence a typical performance measure (adjusted mortality) and potential incentives based on it. DESIGN: National cross-sectional study comparing hospital mortality ranking and simulated pay-for-performance incentives before/after recoding discharge abstracts using medical records. SETTING: Twenty-four public and private hospitals located in France PARTICIPANTS: All inpatient stays from the 78 deadliest diagnosis-related groups over 1 year. INTERVENTIONS: Elixhauser and Charlson comorbidities were derived, and mortality ratios were computed for each hospital. Thirty random stays per hospital were then recoded by two central reviewers and used in a Bayesian hierarchical model to estimate hospital-specific and comorbidity-specific predictive values. Simulations then estimated shifts in adjusted mortality and proportion of incentives that would be unfairly distributed by a typical pay-for-performance programme in this situation. MAIN OUTCOME MEASURES: Positive and negative predictive values of routine coding of comorbidities in hospital databases, variations in hospitals' mortality league table and proportion of unfair incentives. RESULTS: A total of 70 402 hospital discharge abstracts were analysed, of which 715 were recoded from full medical records. Hospital comorbidity-level positive predictive values ranged from 64.4% to 96.4% and negative ones from 88.0% to 99.9%. Using Elixhauser comorbidities for adjustment, 70.3% of hospitals changed position in the mortality league table after correction, which added up to a mean 6.5% (SD 3.6) of a total pay-for-performance budget being allocated to the wrong hospitals. Using Charlson, 61.5% of hospitals changed position, with 7.3% (SD 4.0) budget misallocation. CONCLUSIONS: Variations in administrative data coding can bias mortality comparisons and budget allocation across hospitals. Such heterogeneity in data validity may be corrected using a centralised coding strategy from a random sample of observations.

[User satisfaction in 2hospitals with different management models]. / Satisfacción de los usuarios en 2hospitales con diferente modelo de gestión.

BACKGROUND: Public, private, and mixed care management models coexist in the Spanish National Health System, in addition to those private models with state-funded financial support since the General Health Law was enacted. In order to function well, health systems must include quality management systems, and they must use patient satisfaction evaluations as an outcome indicator. OBJECTIVE: The objective of this article was to compare the level of satisfaction of users with conventional hospitalisation in 2hospitals in Elche (Spain) with different management models. METHOD: An observational, descriptive-analytical, and cross-sectional study was carried out in hospital units with the same type of patients in 2health centres with a different management model: Vinalopó Hospital (government franchise) and IMED in Elche (a private institution with service arrangement). Users discharged during June 2017 were included. User satisfaction was measured with a model used to evaluate the perceived quality of hospital care (SERVQHOS questionnaire). RESULTS: A total of 80% of Vinalopo users, and 75% of IMED users evaluated their care as better than expected. Almost all (97.1%) of users in Vinalopo, and 94.3% in IMED were satisfied or very satisfied with care received, and 97.1% of users in Vinalopo and 92.5% in IMED would not hesitate to recommend them. Global satisfaction and SERVQHOS questionnaire showed a narrow relationship with significance at a global level (R2=0.386; P=.055). However, the results of evaluations at each hospital were not significant (IMED: R2=0.639; P=.092; Vinalopó: R2=0.63; P=.282). CONCLUSIONS: High satisfaction levels were found, with little differences between the 2hospitals, and higher rates in some areas compared to other studies. As quality indicators, there are factors such as time, flexibility in systems and in information, probably due to changes in needs and user expectations. There are only a few studies that compare satisfaction between different management models.

Assessment of patient safety culture in private and public hospitals in Peru.

OBJECTIVE: To assess the patient safety culture in Peruvian hospitals from the perspective of healthcare professionals, and to test for differences between the private and public healthcare sectors. Patient safety is defined as the avoidance and prevention of patient injuries or adverse events resulting from the processes of healthcare delivery. DESIGN: A non-random cross-sectional study conducted online. SETTING: An online survey was administered from July to August 2016, in Peru. This study reports results from Lima and Callao, which are the capital and the port region of Peru. PARTICIPANTS: A total of 1679 healthcare professionals completed the survey. Participants were physicians, medical residents and nurses working in healthcare facilities from the private sector and public sector. MAIN OUTCOMES: Assessment of the degree of patient safety and 12 dimensions of patient safety culture in hospital units as perceived by healthcare professionals. RESULTS: Only 18% of healthcare professionals assess the degree of patient safety in their unit of work as excellent or very good. Significant differences are observed between the patient safety grades in the private sector (37%) compared to the public sub-sectors (13-15%). Moreover, in all patient safety culture dimensions, healthcare professionals from the private sector give more favorable responses for patient safety, than those from the public sub-systems. The most significant difference in support comes from patient safety administrators through communication and information about errors. CONCLUSIONS: Overall, the degree of patient safety in Peru is low, with significant gaps that exist between the private and the public sectors.

Service quality, patient satisfaction and loyalty in the Bangladesh healthcare sector.

Purpose The purpose of this paper is to investigate service quality, patient satisfaction and loyalty in Bangladesh's healthcare sector. It identifies healthcare quality conformance, patient satisfaction and loyalty based on demographics such as gender, age and marital status. It examines the differences between public and private healthcare sectors regarding service quality, patient satisfaction and loyalty. Design/methodology/approach The authors distributed 450 self-administered questionnaires to hospital patients resulting in 204 useful responses (45.3 per cent response rate). Data were analysed based on reliability analysis, exploratory factor analysis, independent samples t-tests, ANOVA and discriminant analysis using SPSS version 23. Findings Findings indicate that single patients perceive tangibles, reliability, empathy and loyalty higher compared to married patients. Young patients (⩽20 years) have a higher tangibles, empathy and loyalty scores compared to other age groups. The authors observed that private hospital patients perceive healthcare service quality performance higher compared to patients in public hospitals. Research limitations/implications The authors focussed solely on the Bangladesh health sector, so the results might not be applicable to other countries. Originality/value The findings provide guidelines for enhancing service quality, patient satisfaction and loyalty in the Bangladesh healthcare sector and other countries.

Government stewardship of the for-profit private health sector in Afghanistan.

BACKGROUND: Since 2003, Afghanistan's largely unregulated for-profit private health sector has grown at a rapid pace. In 2008, the Ministry of Public Health (MoPH) launched a long-term stewardship initiative to oversee and regulate private providers and align the sector with national health goals. AIM: We examine the progress the MoPH has made towards more effective stewardship, consider the challenges and assess the early impacts on for-profit performance. METHODS: We reviewed publicly available documents, publications and the grey literature to analyse the development, adoption and implementation of strategies, policies and regulations. We carried out a series of key informant/participant interviews, organizational capacity assessments and analyses of hospital standards checklists. Using a literature review of health systems strengthening, we proposed an Afghan-specific definition of six key stewardship functions to assess progress towards MoPH stewardship objectives. RESULTS: The MoPH and its partners have achieved positive results in strengthening its private sector stewardship functions especially in generating actionable intelligence and establishing strategic policy directions, administrative structures and a legal and regulatory framework. Progress has also been made on improving accountability and transparency, building partnerships and applying minimum required standards to private hospitals. Procedural and operational issues still need resolution and the MoPH is establishing mechanisms for resolving them. CONCLUSIONS: The MoPH stewardship initiative is notable for its achievements to date under challenging circumstances. Its success is due to the focus on developing a solid policy framework and building institutions and systems aimed at ensuring higher quality private services, and a rational long-term and sustainable role for the private sector. Although the MoPH stewardship initiative is still at an early stage, the evidence suggests that enhanced stewardship functions in the MoPH are leading to a more efficient and effective for-profit private sector. These successful early efforts offer high-leverage potential to rapidly scale up going forward.

Assessing the disparity in spatial access to hospital care in ethnic minority region in Sichuan Province, China.

BACKGROUND: There is a great disparity in spatial accessibility to hospital care between ethnic minority and non-minority regions in China. Being one of the basic social demands, spatial access to hospital care in minority regions draws increasing attention in China in recent years. We performed this study to have a better understanding of spatial access to hospital care in ethnic minority region in China, and to guide the allocation of government investment in the future. METHODS: Sichuan Province, southwest of China was selected as a sample to examine the difference in hospital access between ethnic minority and non-minority region in China. We applied the shortest path analysis and the enhanced two-step floating catchment area (E2SFCA) method under ArcGIS 9.3 environment. RESULTS: In Sichuan, healthcare access in ethnic minority region is worse than in non-minority region in terms of time to hospital and the value of spatial accessibility. There is relatively greater inequality in access to doctors and health professionals than in access to hospital beds. In ethnic minority region, the balance between primary, secondary, and tertiary hospitals, as well as between public and private hospitals, is less even, compared with the non-minority region. The disparity within ethnic minority region is larger than in non-minority region. CONCLUSIONS: The combination of shortest path analysis and E2SFCA method is superior to the traditional county ratio method in assessing spatial access to healthcare. Compared to the non-minority region, ethnic minority region rely more heavily on government investment to provide healthcare. In ethnic minority region, the current distribution of primary, secondary and tertiary hospitals is inappropriate, and there is an urgent shortage of healthcare personnel. We therefore recommend that the government use preferential policies to encourage more social capital investment in ethnic minority region, use government investment as a supplement to build a more equitable healthcare market, encourage doctors to work in such regions, and push forward road construction in rural area.

Hospitals Known for Nursing Excellence Perform Better on Value Based Purchasing Measures.

It is well-established that hospitals recognized for good nursing care - Magnet hospitals - are associated with better patient outcomes. Less is known about how Magnet hospitals compare to non-Magnets on quality measures linked to Medicare reimbursement. The purpose of this study was to determine how Magnet hospitals perform compared to matched non-Magnet hospitals on Hospital Value Based Purchasing (VBP) measures. A cross-sectional analysis of three linked data sources was performed. The sample included 3,021 non-federal acute care hospitals participating in the VBP program (323 Magnets; 2,698 non-Magnets). Propensity score matching was used to match Magnet and non-Magnet hospitals with similar hospital characteristics. After matching, linear and logistic regression models were used to examine the relationship between Magnet status and VBP performance. After matching and adjusting for hospital characteristics, Magnet recognition predicted higher scores on Total Performance (Regression Coefficient [RC] = 1.66, p < 0.05), Clinical Processes (RC = 3.85; p < 0.01), and Patient Experience (RC = 6.33; p < 0.001). The relationships between Magnet recognition and the Outcome and Efficiency domains were not statistically significant. Magnet hospitals known for nursing excellence perform better on Hospital VBP measures. As healthcare systems adapt to evolving incentives that reward value, attention to nurses at the front lines may be central to ensuring high-value care for patients.

Rethinking health care commercialization: evidence from Malaysia.

BACKGROUND: Against the backdrop of systemic inefficiency in the public health care system and the theoretical claims that markets result in performance and efficiency improvement, developing countries' governments have been rapidly commercializing health care delivery. This paper seeks to determine whether commercialization through an expansion in private hospitals has led to performance improvements in public hospitals. METHODS: Inpatient utilization records of all public hospitals in Peninsular Malaysia over the period 2006-2010 were used in this study. These records were obtained from the Ministry of Health. The study relied on utilization ratios, bed occupancy rates (BOR), bed turnover rates (BTR) and average length of stay (ALOS). The data were analyzed using SPSS 22 Statistical Software and the Pabon Lasso technique. RESULTS: Over 60 % of public hospitals in Malaysia are inefficient and perform sub-optimally. Average BOR among the public hospitals was 56 % in 2006 and 61 % in 2010. There was excessive BTR of 65 and 73 times within the period. Overall, the ALOS was low, falling from 3.4 days in 2006 to 3.1 days in 2010. CONCLUSIONS: This study demonstrates that commercialization has not led to performance improvements in the public health care sector in Malaysia. The evidence suggests that efforts to improve performance will require a focus directly on public hospitals.

Accurate falls risk assessment and interventions for preventing falls in patients in the acute care setting within a private hospital in a large capital city: a best practice implementation project.

BACKGROUND: Patient falls are a leading cause of adverse events in Australian hospitals. Most Australian hospitals have fall prevention policies, procedures and programs for preventing inpatient falls; however despite these resources many preventable falls continue to occur in Australian hospitals.It is imperative that clinicians understand the potential impact of inpatient falls, and what triggers can be identified and managed by a multifactorial team approach. Patients admitted to hospital often experience changes in physical and/or cognitive function which is then exacerbated by an unfamiliar environment and medical interventions. Adverse outcomes post falling can range from minor injuries such as skin tears to significant injuries such as intracranial hemorrhages and fractures which can ultimately result in permanent disability or death.In 2007, Calvary Wakefield Hospital implemented a Falls Minimization Program requiring routine assessment of all patients admitted using an Admission Risk Screening Tool in conjunction with completion of a detailed Falls Risk Assessment Tool when indicated. OBJECTIVES: The aim of this implementation was to review current nursing practice against compliance with the Falls Minimization Program and also identify areas for improvement with a focus on preventative strategies. It was essential that the project and its outcomes also complement the National Safety and Quality Health Service Standards (standard 10 - Preventing Falls and Harm from Falls) that provide a benchmark for Calvary Wakefield Hospital. This was achieved by completing a baseline audit, implementing a corrective action plan post audit and then re-auditing in three months once strategies had been implemented METHODS: This project used the pre- and post-implementation audit strategy made up of eight criteria using the Joanna Briggs Institute Practical Application of Clinical Evidence System and Getting Research into Practice. The audit, review, implementation and re-audit sequence was the strategy used to improve clinical practice, and the project was conducted over a five-month period, with the addition of a third audit cycle six months post completion of the implementation phase.Results were generated using the JBI-PACES module and were scrutinized by the project lead in conjunction with members of the project team. Results were discussed with key clinicians throughout the duration of the project. Baseline audit results provided the foundation for generating change and this data was then compared with the first follow-up audit to identify improvements in compliance with criteria. Again this data was compared with audits from six months post implementation to identify sustainability of the project. RESULTS: The results from the baseline audit highlighted that there was significant opportunity for improvement in all criteria audited. It was pleasing to report that in the first follow-up audit cycle, nearly all criteria showed an improvement in both medical and surgical fields. The greatest areas of improvement pertained to healthcare professionals receiving formal education (improvement of 46%), and patient and family education improved by 43%. To measure sustainability, a second follow-up audit was conducted using the same criteria and identified that strategies implemented had in fact been maintained, and the results were consistent with those from the first follow-up audit. CONCLUSIONS: The project used the pre- and post-audit strategy to translate evidence into practice, and not only demonstrated that implementation of evidence-based practice is possible in the acute setting but also showed improvement in the prevention of falls and harm from falls in that setting.

Hospital sector choice and support for public hospital care in New Zealand: Results from a labeled discrete choice survey.

This study uses a discrete choice experiment (DCE) to measure patients' preferences for public and private hospital care in New Zealand. A labeled DCE was administered to 583 members of the general public, with the choice between a public and private hospital for a non-urgent surgery. The results suggest that cost of surgery, waiting times for surgery, option to select a surgeon, convenience, and conditions of the hospital ward are important considerations for patients. The most important determinant of hospital choice was whether it was a public or private hospital, with respondents far more likely to choose a public hospital than a private hospital. The results have implications for government policy toward using private hospitals to clear waiting lists in public hospitals, with these results suggesting the public might not be indifferent to policies that treat private hospitals as substitutes for public hospitals.

An empirical study on hospital selection in India.

PURPOSE: The purpose of this paper is to understand the different factors patients consider in choosing a hospital in a major city in India, prior to admission. DESIGN/METHODOLOGY/APPROACH: A 20-item scale to identify various factors a patient considers in choosing a hospital was developed. A field survey was conducted on patients who were discharged in the recent past from a public or a private hospital. The data collected were analysed using multivariate techniques. FINDINGS: The data analysis highlighted several factors in the hospital choice selection process, namely quality of treatment, referral, transport convenience, cost, and safety and services. RESEARCH LIMITATIONS/IMPLICATIONS: This research study was carried out in one of the four major metropolitan cities of India. Nonetheless, the study provides valuable insights into the hospital selection process in a developing country like India. PRACTICAL IMPLICATIONS: Hospital managers, in general, can use the study findings to improve the operating performance of their hospitals so that they are able to attract more patients in the future. Additionally, the information can be useful to the marketing managers for developing appropriate marketing strategies for their hospitals. ORIGINALITY/VALUE: Majority of the empirical research on hospital choice process has been conducted in Europe and North America. Limited knowledge exists on the same in a developing nation like India. This research illustrates a comprehensive study to address that concern.

Revisit rates and associated costs after an emergency department encounter: a multistate analysis.

BACKGROUND: Return visits to the emergency department (ED) or hospital after an index ED visit strain the health system, but information about rates and determinants of revisits is limited. OBJECTIVE: To describe revisit rates, variation in revisit rates by diagnosis and state, and associated costs. DESIGN: Observational study using the Healthcare Cost and Utilization Project databases. SETTING: 6 U.S. states. PATIENTS: Adults with ED visits between 2006 and 2010. MEASUREMENTS: Revisit rates and costs. RESULTS: Within 3 days of an index ED visit, 8.2% of patients had a revisit; 32% of those revisits occurred at a different institution. Revisit rates varied by diagnosis, with skin infections having the highest rate (23.1% [95% CI, 22.3% to 23.9%]). Revisit rates also varied by state. For skin infections, Florida had higher risk-adjusted revisit rates (24.8% [CI, 23.5% to 26.2%]) than Nebraska (10.6% [CI, 9.2% to 12.1%]). In Florida, the only state with complete cost data, total revisit costs for the 19.8% of patients with a revisit within 30 days were 118% of total index ED visit costs for all patients (including those with and without a revisit). LIMITATION: Whether a revisit reflects inadequate access to primary care, a planned revisit, the patient's nonadherence to ED recommendations, or poor-quality care at the initial ED visit remains unknown. CONCLUSION: Revisits after an index ED encounter are more frequent than previously reported, in part because many occur outside the index institution. Among ED patients in Florida, more resources are spent on revisits than on index ED visits. PRIMARY FUNDING SOURCE: Agency for Healthcare Research and Quality.