Implementing the Patient Health Questionnaire Modified for Adolescents to improve screening for depression among adolescents in a Federally Qualified Health Centre.

BACKGROUND: Depression, which is a serious medical illness, is prevalent worldwide and it negatively impacts the adolescent lifestyle. Adolescent depression is associated with adverse emotional and functional outcomes and suboptimal physical health. Over the last decade, it has been found that approximately 9% of teenagers meet the criteria for depression at any given time, and one in five teenagers have a history of depression during adolescence. Ninety per cent of paediatricians believe that recognition of child and adolescent depression is their responsibility; however, it has been reported that 46% lacked confidence that they could recognise depression. METHODS: In this study, adolescents between 12 and 17 years of age were screened during their well-child visits using the Patient Health Questionnaire Modified for Adolescents. A score of 10 or higher warrants a referral to a social worker and psychiatrist. The goals of this quality improvement project were to implement a standardised questionnaire and to improve the screening, diagnosis and treatment of depression in children from 12 to 17 years of age. RESULTS: It was found that the adolescent depression screening rate significantly improved within 6 months of implementing this quality improvement project. The screening rate improved to 50% by mid-cycle (Plan-Do-Study-Act (PDSA) cycle 3) and up to 70% at the end of the 6-month period (PDSA cycle 5). Improvement was noted among all providers, across all age groups, and in both male and female patients by the end of the study period. CONCLUSION: Standardised screening tests with a scoring system help providers to identify and monitor depression symptoms using a common language, especially in the outpatient clinical setting where the patient may be seen by different providers.

Geographic Expansion of Federally Qualified Health Centers 2007-2014.

PURPOSE: Federally Qualified Health Centers (FQHCs), which were expanded under the Affordable Care Act, are federally funded health centers that aim to improve access to primary care in underserved areas. With continued federal support, the number of FQHCs in the United States has increased >80% within a decade. However, the expansion patterns and their impact on the population served are unknown. METHODS: A pre (2007)-post (2014) study of FQHC locations. FQHC locations were identified from the Provider of Services Files then linked to primary care service areas (PCSAs), which represent the service markets that FQHCs served. Road-based travel time was estimated from each 2007 FQHC to the nearest new FQHC as an indicator of geographic expansion in access. PCSA-level characteristics were used to compare 2007 and 2014 FQHC service markets. FINDINGS: Between 2007 and 2014, there was greater expansion in the number of FQHCs (3,489 vs 6,376; 82.7%) than in the number of service markets (1,835 vs 2,695; 46.9%). Nearly half of 2007 FQHCs (47%) had at least one new FQHC within 30 minutes travel time. Most newly certified FQHCs (81%) were located in urban areas. Compared to 2007 service markets, the new 2014 markets (N = 174) were much less likely to be in areas with >20% of the population below poverty (31.4% vs 14.9%, P < .001). CONCLUSIONS: The latest expansion of FQHCs was less likely to be in rural or high poverty areas, suggesting the impact of expansion may have limitations in improving access to care among the most financially disadvantaged populations.

The process of defining the hospital care profile in federal hospitals in the city of Rio de Janeiro, Brazil. / O processo de conformação do perfil assistencial nos hospitais federais da cidade do Rio de Janeiro, Brasil.

This article analyzes the process of shaping the care profile of federal hospitals in the city of Rio de Janeiro. This is a qualitative, descriptive study that draws on semi-structured interviews with hospital administrators. Data analysis used the Collective Subject Discourse approach. Managers believe this process is the result of a set of emerging strategies, proposals and need for change, which result in adaptive reactions that hospitals develop with no coordination between them to resolve problems identified by professionals and managers. The process is analyzed much more from a political point of view than from a rational and systemic one. Some of the experience with the hospital mission, such as the focus on a strategic approach, already signals a more collegiate approach to defining the profile of care, where the hospital is one component of an integrated network of services, with a decision process that is less incremental and more integrating.

O processo de conformação do perfil assistencial nos hospitais federais da cidade do Rio de Janeiro, Brasil / The process of defining the hospital care profile in federal hospitals in the city of Rio de Janeiro, Brazil

Resumo Este artigo analisa o processo de conformação do perfil assistencial nos hospitais federais no município do Rio de Janeiro. Trata-se de um estudo descritivo, de abordagem qualitativa e que utilizou entrevistas semiestruturadas realizadas junto a gestores hospitalares. A análise dos dados foi realizada a partir da formação do Discurso do Sujeito Coletivo. Na percepção dos gestores esse processo é decorrente de um conjunto de estratégias emergentes, as propostas e as necessidades de mudança se constituem de reações adaptativas que as unidades desenvolvem de forma desarticulada visando à resolução de problemas identificados pelos profissionais e gestores. O processo é considerado muito mais a partir de uma perspectiva política do que racional e sistêmica. Algumas experiências de trabalho com a missão hospitalar, como o enfoque da démarche stratégique, já apontam para uma construção mais colegiada na definição do perfil assistencial, que considera o hospital como componente de uma rede integrada de serviços e que adota um processo de decisão menos incremental e mais integrador.

Abstract This article analyzes the process of shaping the care profile of federal hospitals in the city of Rio de Janeiro. This is a qualitative, descriptive study that draws on semi-structured interviews with hospital administrators. Data analysis used the Collective Subject Discourse approach. Managers believe this process is the result of a set of emerging strategies, proposals and need for change, which result in adaptive reactions that hospitals develop with no coordination between them to resolve problems identified by professionals and managers. The process is analyzed much more from a political point of view than from a rational and systemic one. Some of the experience with the hospital mission, such as the focus on a strategic approach, already signals a more collegiate approach to defining the profile of care, where the hospital is one component of an integrated network of services, with a decision process that is less incremental and more integrating.

Measuring efficiency among US federal hospitals.

This study evaluates the efficiency of federal hospitals, specifically those hospitals administered by the US Department of Veterans Affairs and the US Department of Defense. Hospital executives, health care policymakers, taxpayers, and federal hospital beneficiaries benefit from studies that improve hospital efficiency. This study uses data envelopment analysis to evaluate a panel of 165 federal hospitals in 2007 and 157 of the same hospitals again in 2011. Results indicate that overall efficiency in federal hospitals improved from 81% in 2007 to 86% in 2011. The number of federal hospitals operating on the efficiency frontier decreased slightly from 25 in 2007 to 21 in 2011. The higher efficiency score clearly documents that federal hospitals are becoming more efficient in the management of resources. From a policy perspective, this study highlights the economic importance of encouraging increased efficiency throughout the health care industry. This research examines benchmarking strategies to improve the efficiency of hospital services to federal beneficiaries. Through the use of strategies such as integrated information systems, consolidation of services, transaction-cost economics, and focusing on preventative health care, these organizations have been able to provide quality service while maintaining fiscal responsibility. In addition, the research documented the characteristics of those federal hospitals that were found to be on the Efficiency Frontier. These hospitals serve as benchmarks for less efficient federal hospitals as they develop strategies for improvement.

Hospital Cristo Redentor S/A: influências internas e externas na sua formação identitária (1956-2006), Porto Alegre/RS

Este trabalho tem por objetivo identificar as marcas identitárias do Hospital CristoRedentor no contexto de sua criação e quando do seu cinquentenário, analisando e colocandoem comparação as suas diferenças e/ou semelhanças, indicando quais as razões das mudançasou permanências diante do seu projeto original. Pois, esta entidade de saúde localizada nazona norte da cidade de Porto Alegre, no tempo de seu cinquentenário, tem característicasinstitucionais identitárias distintas das características de seu tempo de criação, determinadaspor postura e conduta no âmbito do estado no tocante à política de saúde no plano nacional.Ou seja, são questões internas e externas à instituição que fazem esta ter, atualmente,características de existência diferentes daquelas de sua fundação. E essas questões refletemdiretamente no atendimento à população e seus objetivos como instituição.Assim, para realizar a tarefa optamos por organizar o estudo em quatro partes: umacaracterizando a cidade e região no início do século XX; outra, estabelecendo o porquê dafundação do hospital e caracterizando o que identificamos como sua primeira fase; umaterceira esclarecendo a grande ruptura ideológica que o HCR sofreu na década de 70 e comoseguiu a partir daí até seu cinquentenário; e um último momento analítico, aonde destacamosas principais semelhanças e diferenças entre os períodos.

Estudo exploratório sobre satisfação do usuário de consultas externas do Hospital Josina Machel, Luanda, Angola / Exploratory study on user satisfaction outpatient Josina Machel Hospital - Luanda, Angola

Este estudo, de carácter descritivo e exploratório, analisou aspectos da satisfação do usuário de consultas externas do Hospital Josina Machel em Luanda, Angola. Foram entrevistados oito mulheres e seis homens, além de um supervisor de consultas externas. Os usuários, com idade a 18 anos, que aceitaram participar da pesquisa, assinaram o termo de consentimento livre e esclarecido ou, de alguma forma, validaram seu acordo com o termo Os critérios de seleção incluíram: ter frequentado pelo menos 2 vezes oHJM – serviço de consultas externas no último ano e achar-se em tratamento. A idade dos respondentes variou entre 19 e 60 anos. A escolaridade mínima foi a oitava classe, enquanto a máxima foi a decima segunda classe. Um dos entrevistados não possuia qualquer escolaridade formal. Doze são funcionários públicos e dois não têm vínculo laboral. O número de agregados familiares (residentes no mesmo domicílio, além do entrevistado) variou de 4 à 12 pessoas. (...) Foram entrevistados usuários das consultas de cardiologia, cirurgia geral, endocrinologia, medicina interna, oftalmologia, e ortopedia nos meses de Junho e Julho de 2011. A satisfação dos usuários foi analisada dentro das dimensões Agilidade, Dignidade, Instalações e Comparticipação (co-pagamento). Os usuários mostraram sua insatisfação por longos períodos de espera para a consulta, burocracia no processo de tramitação das fichas de atendimento, a falta (falha) de água corrente no hospital, a com participação nos custos com saúde bem como ineficientes mecanismos gerais de acolhimento. Por outro lado manifestaram sua satisfação com o atendimento médico.

Stateside care of marines and sailors injured in Iraq at the National Naval Medical Center in Bethesda, Maryland.

This article has been written by four staff members from the Critical Care Department at the National Naval Medical Center in Bethesda, Maryland. They are part of a large and extremely sophisticated medical response team who cares for the injured when they return to the United States. This article covers the interdisciplinary teamwork that is vital to the care of catastrophic war injuries and shows how detailed treatment plans are formulated for each casualty. It describes the unique and profound emotional responses of the staff members who are instrumental in the recuperation of the service member. It also tells of the joy of recovery from horrific injuries, and the intense dedication of staff members to the military wounded.

Efficiency of federal hospitals in the United States.

This study evaluates the technical efficiency of federal hospitals in the United States using a variable returns to scale, input-oriented, data envelopment analysis (DEA) methodology. Hospital executives, health care policy-makers, taxpayers, and other stakeholders, benefit from studies that improve the efficiency of federal hospitals. Data for 280 federal hospitals in 1998 and 245 in 2001 were analyzed using DEA to measure hospital efficiency. Results indicate overall efficiency in federal hospitals improved from 68% in 1998 to 79% in 2001. However, based upon 2001 spending of $42.5 billion for federal hospitals potential savings of $2.0 billion annually are possible through more efficient management of resources. From a policy perspective, this study highlights the importance of establishing more specific policies to address inefficiency in the federal health care industry.

Hospitais universitários: indicadores de utilizaçäo e análise de eficiência / Universitary hospitals: indicators of utilization and the analysis of efficiency

Estuda o desempenho de 45 hospitais universitários federais brasileiros (HUs) durante cinco semestres a partir de 1998, realizando análises específicas e conexöes entre indicadores de eficiência técnica e de utilizaçäo da capacidade de atendimento dos HUs. Relata que os indicadores de eficiência técnica säo extraídos de modelos de programaçäo matemática referidos na literatura como análise de envoltória de dados [data envelopment analysis (DEA)]. Os indicadores de utilizaçäo säo a taxa de ocupaçäo, a taxa de rotatividade e o prazo médio de internaçäo. Além de resultados individuais para os hospitais, faz recortes metodológicos que permitem estudar o desempenho dos HUs em níveis regional e temporal, por porte (números de leitos) e por tipos de clínica (médica e cirúrgica). Realiza a conexäo entre os indicadores de eficiência e os indicadores de utilizaçäo com o recurso de um modelo de regressäo em painel (panel data model) para os cinco semestres disponíveis, permitindo a constataçäo de relaçöes interessantes entre os distintos indicadores.

Hospitais universitários: avaliaçäo comparativa de eficiência técnica / Universitary hospitals: comparative analysis of technic efficiency

Faz um exercício de avaliaçäo comparativa de eficiência de 43 hospitais universitários federais brasileiros (HUs). Utiliza a metodologia de análise de envoltória de dados [Data Envelopment Analysis (DEA)] em combinaçäo com testes e procedimentos estatísticos näo-paramétricos específicos. Explora as extensöes, como as orientaçöes que a DEA fornece para ajustes nas (in)eficiências observadas, relativas ao problema de retornos de escala, e associaçöes das eficiências observadas com formas de interaçäo entre os HUs. Procura oferecer elementos para se apreciar a DEA como mecanismo de avaliaçäo comparativa de organizaçöes complexas (assim como de identificaçäo de "best practices" no conjunto de casos observados) e como possível e útil mecanismo de acompanhamento e de coordenaçäo do comportamento de agentes de políticas públicas, como é o caso dos HUs.

Managing clinical research information: a case study in information access, presentation, and analysis.

Medical information systems at the NIH must meet the twin challenges of excellent patient care and innovative clinical research. This article describes the approach taken by the clinical center at the NIH to enhance its information systems to meet these challenges. The four key components of this strategy are the standard clinical desktop, the clinical data repository, the repository access package, and protocol mapping. Together, these tools provide significant new capabilities for patient care staff and clinical investigators.