RESUMEN
In 1936, Fulgencio Batista, the head of the Cuban military (and the de facto ruler of Cuba), founded the National Tuberculosis Council (CNT) to lead a state-directed anti-tuberculosis campaign. While most national and colonial governments neglected tuberculosis until the postwar period, populist politics pushed Batista to prioritize a disease of poverty by the mid-1930s. However, national politics also undermined efforts to control the disease in Cuba. Authoritarianism facilitated Batista's considerable influence over tuberculosis policy, and he and his advisors pursued political objectives rather than following the technical advice offered by professional groups. As a result, the administration of the campaign was inefficient, nowhere more notably than in the CNT's premiere project, the Topes de Collantes National Sanatorium. Citizen and physician discontent with this project, the anti-tuberculosis campaign, and the state health sector fed into processes of political delegitimation and regime change in the 1950s.
Asunto(s)
Hospitales de Enfermedades Crónicas/historia , Política , Tuberculosis/historia , Cuba , Historia del Siglo XX , Hospitales de Enfermedades Crónicas/legislación & jurisprudencia , Hospitales de Enfermedades Crónicas/organización & administración , Humanos , Tuberculosis/terapiaRESUMEN
Objetivo. Conocer la prevalencia de pacientes crónicos complejos en el ámbito de Atención Primaria utilizando los criterios de pluripatología y los Clinical Risk Groups y el grado de concordancia entre estos 2 sistemas de identificación de los pacientes que precisan gestión de caso. Material y método. Estudio observacional transversal de 240 pacientes, seleccionados por muestreo aleatorio de 16 cupos asistenciales de 2 centros de salud de Atención Primaria de un área sanitaria. Solicitado consentimiento informado para acceder a su historia clínica electrónica con fines de investigación. Se registró la edad, el sexo, el estado de salud según los Clinical Risk Groups, nivel de gravedad, los criterios de pluripatológico e índice de Charlson por su médico durante la práctica clínica. Se excluyeron 3 pacientes por datos incompletos. Resultados. La prevalencia de pacientes pluripatológicos, siguiendo los criterios del Ministerio de Sanidad entre los demandantes, fue del 4,1% (IC 95% 2,1-7,3). La frecuencia de pacientes con Clinical Risk Groups de alto riesgo denominados G3 en la estrategia de cronicidad de la Comunidad Valenciana fue del 7,5% (IC 95% 4,7-11,7), que sumó los pacientes estado de salud 6 con nivel de complejidad 5 y 6 y los estados de salud 7, 8 y 9. La concordancia entre ambas clasificaciones fue baja con un índice kappa 0,17 (IC 95% 0-0,5). Conclusiones. Las prevalencias no difirieron significativamente de lo esperado y la concordancia entre ambas estratificaciones fue muy débil, no seleccionando a los mismos pacientes de alta complejidad para gestión de casos (AU)
Objective. To determine the prevalence of patients with multiple chronic diseases in Primary Care using the multiple morbidity criteria and Clinical Risk Groups, and the agreement in identifying high-risk patients that require case management with both methods. Material and method. A cross-sectional study was conducted on 240 patients, selected by random sampling of 16 care quotas from two Primary Health Care centres of a health area. Informed consent was obtained to access their electronic medical records for the study, and a record was made of age, sex, health status of Clinical Risk Groups, severity, multiple morbidity criteria, and Charlson index by physicians during clinical practice. Three patients were excluded due to incomplete data. Results. The prevalence of patients with multiple chronic diseases following the criteria of the Ministry of Health among users was 4.11 (95% CI; 2.13-7.30). The frequency of patients with high risk Clinical Risk Groups (G3) in the chronicity strategy of Valencian Community was 7.59 (95% CI; 4.70-11.70), which includes patients with health status 6 and complexity level 5-6, and health status 7, 8, and 9. Agreement between the two classifications was low, with a kappa index 0.17 (95% CI; 0-0.5). Conclusions. The prevalence did not differ significantly from that expected, and the agreement between the two stratifications was very weak, not selecting the same patients for highly complex case management (AU)
Asunto(s)
Humanos , Masculino , Femenino , Enfermedad Crónica/economía , Enfermedad Crónica/epidemiología , Atención Primaria de Salud/clasificación , Atención Primaria de Salud/legislación & jurisprudencia , Atención Primaria de Salud/métodos , Servicios de Salud/legislación & jurisprudencia , Servicios de Salud/normas , Comorbilidad , Estudios Transversales/métodos , Estudios Transversales , Hospitales de Enfermedades Crónicas/economía , Hospitales de Enfermedades Crónicas/legislación & jurisprudencia , Hospitales de Enfermedades Crónicas/organización & administración , Intervalos de ConfianzaRESUMEN
The history of creation and development of the Central Tuberculosis Hospital of the Ministry of Defense of the USSR--now branch No 1 FBU "3 TsVKG of the Russian Defense Ministry n. a. A.A. Vishnevsky". The contribution into the hospital, not only in organizing of effective treatment, but also into study the state of TB control in the armed forces, the development of methods for differential diagnosis of pulmonary tuberculosis and extrapulmonary forms are presented. The incidence of tuberculosis in the country remains high, so the problem faced by the institution, remain relevant and responsible.
Asunto(s)
Hospitales de Enfermedades Crónicas/historia , Hospitales de Enfermedades Crónicas/organización & administración , Hospitales Militares/historia , Hospitales Militares/organización & administración , Regulación Gubernamental , Historia del Siglo XX , Historia del Siglo XXI , Hospitales con 300 a 499 Camas , Hospitales de Enfermedades Crónicas/legislación & jurisprudencia , Hospitales Militares/legislación & jurisprudencia , Humanos , Personal Militar , Federación de Rusia , Tuberculosis/diagnóstico , Tuberculosis/prevención & control , Tuberculosis/terapia , Recursos HumanosRESUMEN
This final rule updates the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs). The final payment amounts and factors used to determine the updated Federal rates that are described in this final rule were determined based on the LTCH PPS rate year July 1, 2007 through June 30, 2008. The annual update of the long-term care diagnosis-related group (LTC-DRG) classifications and relative weights remains linked to the annual adjustments of the acute care hospital inpatient diagnosis-related group system, and continue to be effective each October 1. The final outlier threshold for July 1, 2007, through June 30, 2008, is derived from the LTCH PPS rate year calculations. We are also finalizing policy changes which include revisions to the GME and IME policies. In addition, we are adding a technical amendment correcting the regulations text at Sec. 412.22.
Asunto(s)
Educación de Postgrado en Medicina/economía , Hospitales de Enfermedades Crónicas/economía , Medicare/economía , Sistema de Pago Prospectivo/economía , Economía Hospitalaria , Educación de Postgrado en Medicina/legislación & jurisprudencia , Hospitales de Enfermedades Crónicas/legislación & jurisprudencia , Humanos , Legislación Hospitalaria , Medicare/legislación & jurisprudencia , Sistema de Pago Prospectivo/legislación & jurisprudencia , Estados UnidosAsunto(s)
Hospitales de Enfermedades Crónicas/economía , Reembolso de Seguro de Salud/legislación & jurisprudencia , Medicare Part A/legislación & jurisprudencia , Acampadores DRG/economía , Centros de Rehabilitación/economía , Anciano , Centers for Medicare and Medicaid Services, U.S. , Hospitales de Enfermedades Crónicas/legislación & jurisprudencia , Humanos , Centros de Rehabilitación/legislación & jurisprudencia , Estados UnidosRESUMEN
This final rule updates the annual payment rates for the Medicare prospective payment system (PPS) for inpatient hospital services provided by long-term care hospitals (LTCHs). The payment amounts and factors used to determine the updated Federal rates that are described in this final rule have been determined based on the LTCH PPS rate year. The annual update of the long-term care diagnosis-related group (LTC-DRG) classifications and relative weights remains linked to the annual adjustments of the acute care hospital inpatient diagnosis-related group system, and will continue to be effective each October 1. The outlier threshold for July 1, 2004 through June 30, 2005 is also derived from the LTCH PPS rate year calculations. In this final rule, we also are making clarifications to the existing policy regarding the designation of a satellite of a LTCH as an independent LTCH. In addition, we are expanding the existing interrupted stay policy and changing the procedure for counting days in the average length of stay calculation for Medicare patients for hospitals qualifying as LTCHs.
Asunto(s)
Economía Hospitalaria/legislación & jurisprudencia , Hospitales de Enfermedades Crónicas/economía , Legislación Hospitalaria/economía , Medicare/economía , Sistema de Pago Prospectivo/economía , Hospitales de Enfermedades Crónicas/legislación & jurisprudencia , Humanos , Cuidados a Largo Plazo/economía , Cuidados a Largo Plazo/legislación & jurisprudencia , Medicare/legislación & jurisprudencia , Sistema de Pago Prospectivo/legislación & jurisprudencia , Estados UnidosRESUMEN
This article describes actual UI prevalence and quality of care at Israeli LTC institutions for the elderly. The analysis is based on current regulatory data on 14,406 residents at 196 residential homes, and 8,278 patients at 159 hospitals for the chronically ill. It includes a calculation of summary indices of quality, the percentage of institutions with deficient items and of those showing change, and a description of functional status profiles. Multiple regression explains the deficiency rate variance through independent institutional variables. There is a higher prevalence of severe functional impairment and full incontinence at hospitals for the chronically ill than at residential homes. There were higher rates of deficiencies and lower rates of corrections for structural items than for process items at both. A major improvement occurred for process items (50-100 per cent). Regarding outcomes, 34 percent of the residents with UI during the first assessment were continent two years later.