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1.
JAMA ; 324(3): 270-278, 2020 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-32692387

RESUMO

Importance: Philanthropy is an increasingly important source of support for health care institutions. There is little empirical evidence to inform ethical guidelines. Objective: To assess public attitudes regarding specific practices used by health care institutions to encourage philanthropic donations from grateful patients. Design, Setting, and Participants: Using the Ipsos KnowledgePanel, a probability-based sample representative of the US population, a survey solicited opinions from a primary cohort representing the general population and 3 supplemental cohorts (with high income, cancer, and with heart disease, respectively). Exposures: Web-based questionnaire. Main Outcomes and Measures: Descriptive analyses (with percentages weighted to make the sample demographically representative of the US population) evaluated respondents' attitudes regarding the acceptability of strategies hospitals may use to identify, solicit, and thank donors; perceptions of the effect of physicians discussing donations with their patients; and opinions regarding gift use and stewardship. Results: Of 831 individuals targeted for the general population sample, 513 (62%) completed surveys, of whom 246 (48.0%) were women and 345 (67.3%) non-Hispanic white. In the weighted sample, 47.0% (95% CI, 42.3%-51.7%) responded that physicians giving patient names to hospital fundraising staff after asking patients' permission was definitely or probably acceptable; 8.5% (95% CI, 5.7%-11.2%) endorsed referring without asking permission. Of the participants, 79.5% (95% CI, 75.6%-83.4%) reported it acceptable for physicians to talk to patients about donating if patients have brought it up; 14.2% (95% CI, 10.9%-17.6%) reported it acceptable when patients have not brought it up; 9.9% (95% CI, 7.1%-12.8%) accepted hospital development staff performing wealth screening using publicly available data to identify patients capable of large donations. Of the participants, 83.2% (95% CI, 79.5%-86.9%) agreed that physicians talking with their patients about donating may interfere with the patient-physician relationship. For a hypothetical patient who donated $1 million, 50.1% (95% CI, 45.4%-54.7%) indicated it would be acceptable for the hospital to show thanks by providing nicer hospital rooms, 26.0% (95% CI, 21.9%-30.1%) by providing expedited appointments, and 19.8% (95% CI, 16.1%-23.5%) by providing physicians' cell phone numbers. Conclusions and Relevance: In this survey study of participants drawn from the general US population, a substantial proportion did not endorse legally allowable approaches for identifying, engaging, and thanking patient-donors.


Assuntos
Atitude Frente a Saúde , Obtenção de Fundos/métodos , Doações , Hospitais , Pacientes/psicologia , Papel do Médico/psicologia , Adulto , Distribuição por Idade , Idoso , Estudos de Coortes , Economia Hospitalar , Feminino , Obtenção de Fundos/ética , Doações/ética , Cardiopatias , Hospitais/ética , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Neoplasias , Pacientes/estatística & dados numéricos , Probabilidade , Distribuição por Sexo , Fatores Socioeconômicos , Inquéritos e Questionários/estatística & dados numéricos , Estados Unidos , Adulto Jovem
2.
J Hosp Infect ; 106(1): 134-154, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32652215

RESUMO

Nosocomial or healthcare-associated infections (HCAIs) are associated with a financial burden that affects both patients and healthcare institutions worldwide. The clinical best care practices (CBPs) of hand hygiene, hygiene and sanitation, screening, and basic and additional precautions aim to reduce this burden. The COVID-19 pandemic has confirmed these four CBPs are critically important prevention practices that limit the spread of HCAIs. This paper conducted a systematic review of economic evaluations related to these four CBPs using a discounting approach. We searched for articles published between 2000 and 2019. We included economic evaluations of infection prevention and control of Clostridioides difficile-associated diarrhoea, meticillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and carbapenem-resistant Gram-negative bacilli. Results were analysed with cost-minimization, cost-effectiveness, cost-utility, cost-benefit and cost-consequence analyses. Articles were assessed for quality. A total of 11,898 articles were screened and seven were included. Most studies (4/7) were of overall moderate quality. All studies demonstrated cost effectiveness of CBPs. The average yearly net cost savings from the CBPs ranged from $252,847 (2019 Canadian dollars) to $1,691,823, depending on the rate of discount (3% and 8%). The average incremental benefit cost ratio of CBPs varied from 2.48 to 7.66. In order to make efficient use of resources and maximize health benefits, ongoing research in the economic evaluation of infection control should be carried out to support evidence-based healthcare policy decisions.


Assuntos
Infecções por Coronavirus/economia , Infecções por Coronavirus/prevenção & controle , Infecção Hospitalar/economia , Infecção Hospitalar/prevenção & controle , Economia Hospitalar/estatística & dados numéricos , Controle de Infecções/economia , Pandemias/economia , Pandemias/prevenção & controle , Pneumonia Viral/economia , Pneumonia Viral/prevenção & controle , Betacoronavirus , Canadá , Humanos , Controle de Infecções/estatística & dados numéricos
5.
N Z Med J ; 133(1514): 41-48, 2020 05 08.
Artigo em Inglês | MEDLINE | ID: mdl-32379738

RESUMO

AIMS: The purpose of this study is to audit the numbers of non-residents requiring orthopaedic admission to Dunedin and Southland Hospitals and determine the effects of increasing tourist numbers on healthcare resources. METHOD: All non-resident orthopaedic admissions to Dunedin Hospital from January 2005 to December 2017 and Invercargill Hospital from January 2011 to December 2017 were analysed with respect to country of residence, mechanism of injury, primary diagnosis and case weights consumed. The results were combined with figures from 1997-2004 to give a 21-year series for Dunedin Hospital. RESULTS: There has been a significant increase in the number of admissions and case weights (CW) over the past 21 years at Dunedin Hospital (p<0.001). The most common mechanisms of injury were snow sports at Dunedin Hospital and falls for Southland Hospital. Between 2011 and 2017 there were on average 50 non-resident admissions per year (92.9 CW/year) to Dunedin Hospital and 74 admissions (120.7 CW/year) in Southland. CONCLUSION: Increasing tourist numbers have resulted in an increase number of orthopaedic admissions to Dunedin Hospital over the last two decades although it remains a small proportion of the total workload. Southland Hospital is relatively more affected. These patients represent an annual cost in excess of $1,000,000 to Southern DHB.


Assuntos
Hospitais/estatística & dados numéricos , Ortopedia/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Admissão do Paciente/tendências , Ferimentos e Lesões/epidemiologia , Ásia/etnologia , Austrália/etnologia , Economia Hospitalar/estatística & dados numéricos , Fraturas Ósseas/epidemiologia , Humanos , Luxações Articulares/epidemiologia , Auditoria Médica , Nova Zelândia/epidemiologia , Ortopedia/organização & administração , Ortopedia/tendências , Traumatismos da Coluna Vertebral/epidemiologia , Viagem/estatística & dados numéricos , Reino Unido/etnologia , Ferimentos e Lesões/economia , Ferimentos e Lesões/etiologia
16.
Hist Cienc Saude Manguinhos ; 26(suppl 1): 79-108, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31994682

RESUMO

This article investigates how the santas casas de misericórdia charitable associations in the state of São Paulo were subsidized by the municipal, provincial, and state governments at the turn of the twentieth century. Budget appropriations from 1838 to 1915 were examined to evaluate these charitable grants as well as the growth in funding during this period. While a care network created with strong state backing, it was put into action by philanthropic assistance. This network of hospital care retained the same format until at least the first third of the twentieth century, and included misericórdia establishments created within the interior of the state of São Paulo.


Assuntos
Instituições de Caridade/história , Política de Saúde/história , Hospitais/história , Brasil , Orçamentos/história , Instituições de Caridade/economia , Instituições de Caridade/legislação & jurisprudência , Economia Hospitalar/história , Financiamento Governamental/história , Governo/história , História do Século XVIII , História do Século XIX , História do Século XX , Humanos
17.
Am J Public Health ; 110(3): 309-316, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31944837

RESUMO

"Anchor Institutions"-universities, hospitals, and other large, place-based organizations-invest in their communities as a way of doing business. Anchor "meds" (anchor institutions dedicated to health) that address social needs and social determinants of health have generated considerable community-based activity over the past several decades.Yet to date, virtually no research has analyzed their current status or effect on community health. To assess the current state and potential best practices of anchor meds, we conducted a search of the literature, a review of Web sites and related public documents of all declared anchor meds in the country, and interviews with 14 key informants.We identified potential best practices in adopting, operationalizing, and implementing an anchor mission and using specific social determinants of health strategies, noting early outcomes and lessons learned. Future dedicated research can bring heightened attention to this emerging force for community health.


Assuntos
Disparidades nos Níveis de Saúde , Administração Hospitalar , Determinantes Sociais da Saúde , Relações Comunidade-Instituição , Economia Hospitalar , Política de Saúde , Hospitais , Humanos , Saúde Pública , Isenção Fiscal
18.
Ann Emerg Med ; 75(3): 370-381, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31455571

RESUMO

STUDY OBJECTIVE: In 2014, Maryland launched a population-based payment model that replaced fee-for-service payments with global budgets for all hospital-based services. This global budget revenue program gives hospitals strong incentives to tightly control patient volume and meet budget targets. We examine the effects of the global budget revenue model on rates of admission to the hospital from emergency departments (EDs). METHODS: We used medical record and billing data to examine adult ED encounters from January 1, 2012, to December 31, 2015, in 25 hospital-based EDs, including 10 Maryland global budget revenue hospitals, 10 matched non-Maryland hospitals (primary control), and 5 Maryland Total Patient Revenue hospitals (secondary control). Total Patient Revenue hospitals adopted global budgeting in 2010 under a pilot Maryland program targeting rural hospitals. We conducted difference-in-differences analyses for overall ED admission rates, ED admission rates for ambulatory-care-sensitive conditions and non-ambulatory-care-sensitive conditions, and for clinical conditions that commonly lead to admission. RESULTS: In 3,175,210 ED encounters, the ED admission rate for Maryland global budget revenue hospitals decreased by 0.6% (95% confidence interval -0.8% to -0.4%) compared with that for non-Maryland controls after global budget revenue implementation, a 3.0% relative decline, and decreased by 1.9% (95% confidence interval -2.2% to -1.7%) compared with that for Total Patient Revenue hospitals, a 9.5% relative decline. Relative declines in ED admission rates were similar for ambulatory-care-sensitive-condition and non-ambulatory-care-sensitive-condition encounters. Admission rate declines varied across clinical conditions. CONCLUSION: Implementation of the global budget revenue model led to statistically significant although modest declines in ED admission rates within its first 2 years, with declines in ED admissions most pronounced among certain clinical conditions.


Assuntos
Orçamentos/métodos , Economia Hospitalar/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Economia Hospitalar/organização & administração , Serviço Hospitalar de Emergência/economia , Feminino , Humanos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Masculino , Maryland/epidemiologia , Pessoa de Meia-Idade , Admissão do Paciente/economia
20.
Ann Surg ; 271(3): 412-421, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31639108

RESUMO

OBJECTIVE: To compare outcomes and costs between major teaching and nonteaching hospitals on a national scale by closely matching on patient procedures and characteristics. BACKGROUND: Teaching hospitals have been shown to often have better quality than nonteaching hospitals, but cost and value associated with teaching hospitals remains unclear. METHODS: A study of Medicare patients at 340 teaching hospitals (resident-to-bed ratios ≥ 0.25) and matched patient controls from 2444 nonteaching hospitals (resident-to-bed ratios < 0.05).We studied 86,751 pairs admitted for general surgery (GS), 214,302 pairs of patients admitted for orthopedic surgery, and 52,025 pairs of patients admitted for vascular surgery. RESULTS: In GS, mortality was 4.62% in teaching hospitals versus 5.57%, (a difference of -0.95%, <0.0001), and overall paired cost difference = $915 (P < 0.0001). For the GS quintile of pairs with highest risk on admission, mortality differences were larger (15.94% versus 18.18%, difference = -2.24%, P < 0.0001), and paired cost difference = $3773 (P < 0.0001), yielding $1682 per 1% mortality improvement at 30 days. Patterns for vascular surgery outcomes resembled general surgery; however, orthopedics outcomes did not show significant differences in mortality across teaching and nonteaching environments, though costs were higher at teaching hospitals. CONCLUSIONS: Among Medicare patients, as admission risk of mortality increased, the absolute mortality benefit of treatment at teaching hospitals also increased, though accompanied by marginally higher cost. Major teaching hospitals appear to return good value for the extra resources used in general surgery, and to some extent vascular surgery, but this was not apparent in orthopedic surgery.


Assuntos
Economia Hospitalar , Custos Hospitalares , Hospitais de Ensino/economia , Procedimentos Cirúrgicos Operatórios/economia , Idoso , Custos e Análise de Custo , Feminino , Mortalidade Hospitalar , Humanos , Masculino , Medicare/economia , Procedimentos Cirúrgicos Operatórios/mortalidade , Estados Unidos
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