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1.
Pan Afr Med J ; 38: 289, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34122716

RESUMO

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.


Assuntos
Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Adulto , Comportamento de Escolha , Estudos Transversais , Parto Obstétrico/estatística & dados numéricos , Feminino , Hospitais Privados/normas , Hospitais Públicos/normas , Humanos , Recém-Nascido , Serviços de Saúde Materna/normas , Nigéria , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Qualidade da Assistência à Saúde , Fatores Socioeconômicos , Inquéritos e Questionários
2.
Gynecol Oncol ; 162(1): 12-17, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33941382

RESUMO

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.


Assuntos
Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Neoplasias dos Genitais Femininos/cirurgia , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/transmissão , Canadá/epidemiologia , Institutos de Câncer/organização & administração , Institutos de Câncer/normas , Institutos de Câncer/estatística & dados numéricos , Controle de Doenças Transmissíveis/normas , Feminino , Neoplasias dos Genitais Femininos/diagnóstico , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Ginecologia/economia , Ginecologia/organização & administração , Ginecologia/normas , Ginecologia/estatística & dados numéricos , Hospitais Privados/economia , Hospitais Privados/organização & administração , Hospitais Privados/normas , Hospitais Públicos/economia , Hospitais Públicos/organização & administração , Hospitais Públicos/normas , Humanos , Oncologia/economia , Oncologia/organização & administração , Oncologia/normas , Oncologia/estatística & dados numéricos , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Estudos Retrospectivos , Centros de Atenção Terciária/economia , Centros de Atenção Terciária/organização & administração , Centros de Atenção Terciária/normas , Centros de Atenção Terciária/estatística & dados numéricos , Fatores de Tempo , Triagem/estatística & dados numéricos , Estados Unidos/epidemiologia , Adulto Jovem
3.
Nurs Forum ; 56(1): 74-82, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33241867

RESUMO

BACKGROUND: Different work environments may create different nurses' job stressors, and in turn, may need different social support behaviors to help nurses overcome these stressors. AIMS: This study aimed at comparing nurses' job stressors and social support behaviors in three different work environments (i.e., public, teaching, and private hospitals) in Jordan and examining the predictors of these stressors and social support behaviors. MATERIALS & METHODS: This was a descriptive comparative study in which data were collected using the Nursing Stress Scale and the Inventory of Social Supportive Behaviors from 139, 190, and 135 nurses from the public, teaching, and private hospitals, respectively. Descriptive and inferential statistics including comparative and multiple linear regression statistics were used. RESULTS: The results indicated that there were no significant differences in the total scores of job stressors and social support behaviors among nurses at the three types of hospitals. However, significant differences were reported in the subscales of job stressors in teaching and public hospitals and in individual items of both scales across the three kinds of hospitals. Controlling for nurses' characteristics, the scores of both scales were not predicted by the type of hospitals. CONCLUSION: Similar to public hospitals, teaching, and private hospitals, administrators should initiate various social support behaviors in their clinical settings, and should consider the predictors of job stressors to help nurses overcome their job stressors.


Assuntos
Hospitais/classificação , Enfermeiras e Enfermeiros/psicologia , Estresse Ocupacional/psicologia , Apoio Social , Adulto , Estudos Transversais , Feminino , Hospitais/estatística & dados numéricos , Hospitais Privados/normas , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/normas , Hospitais Públicos/estatística & dados numéricos , Hospitais de Ensino/normas , Hospitais de Ensino/estatística & dados numéricos , Humanos , Satisfação no Emprego , Jordânia , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Estresse Ocupacional/terapia , Psicometria/instrumentação , Psicometria/métodos , Inquéritos e Questionários
4.
Afr Health Sci ; 20(2): 936-947, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33163062

RESUMO

Background: South Africa is moving towards National Health Insurance (NHI), which aims to provide access to universal health coverage for all South Africans. The NHI will only accredit and contract eligible health facilities that meet nationally approved quality standards in the public and private sector. Detailed tools for measuring compliance with the National Core Standards (NCS) and Batho Pele principles have been developed and implemented in the public sector. To date and since its implementation in the public sector, very little is known about the national audit tool and the method used to evaluate quality and patient safety standards in private hospitals in eThekwini district. Objective: The aim of the study was to develop an audit tool for relicensing inspection of private hospitals in eThekwini district based on the clinical domains of the NCS and Batho Pele principles. Methodology: An exploratory sequential mixed method research design was used with a qualitative first phase involving 24 nurse managers through purposive sampling. This was followed by a quantitative phase in which a structured questionnaire was administered to 270 nurses who were randomly sampled for the study from 4 hospitals. Results: The results revealed that the NCS and the Batho Pele principles are not fully implemented or evaluated in the selected hospitals in eThekwini district. Conclusion: These findings were significant and denoted the need for a standardised clinical audit tool for private hospitals in eThekwini district.


Assuntos
Atitude do Pessoal de Saúde , Hospitais Privados/normas , Assistência ao Paciente/normas , Direitos do Paciente/normas , Guias de Prática Clínica como Assunto/normas , Qualidade da Assistência à Saúde/normas , Humanos , Entrevistas como Assunto , Enfermeiras Administradoras , Setor Privado , Pesquisa Qualitativa , África do Sul , Inquéritos e Questionários
5.
Hosp Top ; 98(4): 172-183, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32819212

RESUMO

This paper examines the role of service climate (SC) in the link connecting human resource management practices (HRMP) to commitment to service quality (CSQ). Data were collected from 1236 hospital staff working in different private hospitals in India. The model linking HRMP to CSQ with the moderation of SC was tested using Hayes PROCESS. Results revealed that human resource management practices found to be influencing CSQ and with the interaction of SC the effect is further augmented. The interacting role service climate has been found to be significant at mean and high levels.


Assuntos
Cultura Organizacional , Qualidade da Assistência à Saúde/normas , Recursos Humanos/normas , Hospitais Privados/organização & administração , Hospitais Privados/normas , Hospitais Privados/tendências , Humanos , Índia , Relações Interprofissionais , Administração de Recursos Humanos/métodos , Administração de Recursos Humanos/normas , Qualidade da Assistência à Saúde/tendências , Recursos Humanos/tendências
6.
Curationis ; 43(1): e1-e9, 2020 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-32129642

RESUMO

BACKGROUND: Nurse leadership is about aligning employees to a vision. This happens with buy-in, motivation and communication. When conducive environments are created by organisations, the motivation of nurse leaders will be enhanced, which will have a positive outcome on the organisation. Highly motivated nurse leaders accomplish more and are more productive. Nurse leadership is an essential source of support, mentorship and role modelling. These attributes tend to be more evident when nurse leaders are motivated. OBJECTIVES: The objective of this study was to determine the factors that influence the motivation of nurse leaders. METHOD: A quantitative, descriptive design and stratified sampling was used. Participants comprised unit managers (n = 49) from five hospitals in a private hospital group in South Africa. A self-administered questionnaire, namely, the Multidimensional Work Motivation Scale, was used to collect the data. Data were analysed using the IBM SPSS 22.0 program. RESULTS: The results indicated that the nurse leaders in this study were intrinsically motivated. Their motivation was influenced by support, relatedness, autonomy and competence. No relationships were found between motivation and age, years in a management position, gender, qualifications and staff-reporting structure. CONCLUSION: By implication, to understand what motivates nurse leaders and to keep them motivated, recommendations were proposed to nursing and human resources management. It is expected that the implementation of the recommendations will have a positive influence on patient outcomes, organisational success and the motivation and satisfaction of nurse leaders.


Assuntos
Motivação , Enfermeiras Administradoras/psicologia , Adulto , Atitude do Pessoal de Saúde , Esgotamento Profissional/psicologia , Feminino , Hospitais Privados/organização & administração , Hospitais Privados/normas , Hospitais Privados/estatística & dados numéricos , Humanos , Satisfação no Emprego , Liderança , Enfermeiras Administradoras/estatística & dados numéricos , Psicometria/instrumentação , Psicometria/métodos , África do Sul , Inquéritos e Questionários
8.
J Neurosurg ; 134(3): 742-749, 2020 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-32109866

RESUMO

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.


Assuntos
Adenoma/cirurgia , Endoscopia/métodos , Endoscopia/normas , Hospitais Privados/normas , Procedimentos Neurocirúrgicos/métodos , Procedimentos Neurocirúrgicos/normas , Neoplasias Hipofisárias/cirurgia , Cuidados Pré-Operatórios/normas , Provedores de Redes de Segurança , Osso Esfenoide/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , California , Estudos de Coortes , Feminino , Disparidades em Assistência à Saúde , Humanos , Imageamento por Ressonância Magnética , Masculino , Medicare , Pessoa de Meia-Idade , Fatores Socioeconômicos , Estados Unidos , Adulto Jovem
9.
Reprod Health ; 17(1): 9, 2020 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-31959206

RESUMO

BACKGROUND: Disrespect and abuse (D&A) can violate human rights, affect women's decisions on the type of delivery method, and exacerbate their mental health conditions; therefore, this study aims to: a) assess the status of D&A and respectful maternity care (RMC) during childbirth and their relationships with childbirth experience, socio-demographic and obstetrics characteristics; b) explain women's perceptions of various RMC aspects and determinants during childbirth; and c) present a guideline for promoting of RMC. METHODS/DESIGN: A mixed methods sequential explanatory design will be used to conduct this study in 3 phases. The first phase is a quantitative study with a longitudinal descriptive-analytical design to identify any D&A and RMC and their relationships with childbirth experience among 334 women who have given birth in public and private hospitals in Tabriz, Iran. The sample will be selected proportional to each population. The second phase is a qualitative study to explore women's perceptions of various RMC aspects and their determinants during childbirth. The conventional content analysis approach will be used to analyze the data. The third phase is focused on developing a guideline to improve the quality of maternity care. The literature review, findings of phase one and two, and focus group discussion (FGDs) with staff in the labour ward and using a Delphi technique will be used to complete the final phase. DISCUSSION: Considering the vulnerability of women during labor and delivery and the effect of D&A on cesarean section rates, a supportive guideline can improve the quality of maternity care and reduce D&A during childbirth, and improve women's childbirth experiences. ETHICAL CODE: IR.TBZMED.REC.1398.202.


Assuntos
Parto Obstétrico/normas , Pessoal de Saúde/normas , Hospitais Privados/normas , Hospitais Públicos/normas , Serviços de Saúde Materna/normas , Parto/psicologia , Qualidade da Assistência à Saúde/normas , Atitude do Pessoal de Saúde , Parto Obstétrico/estatística & dados numéricos , Feminino , Pessoal de Saúde/psicologia , Humanos , Irã (Geográfico) , Serviços de Saúde Materna/estatística & dados numéricos , Gravidez , Relações Profissional-Paciente , Pesquisa Qualitativa , Melhoria de Qualidade , Qualidade da Assistência à Saúde/estatística & dados numéricos , Respeito
10.
Arch Dis Child Fetal Neonatal Ed ; 105(2): 209-214, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31201255

RESUMO

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.


Assuntos
Países em Desenvolvimento , Lactente Extremamente Prematuro , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Unidades de Terapia Intensiva Neonatal/normas , Ressuscitação/estatística & dados numéricos , Idade Gestacional , Alocação de Recursos para a Atenção à Saúde/normas , Alocação de Recursos para a Atenção à Saúde/estatística & dados numéricos , Gastos em Saúde , Hospitais Privados/normas , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/normas , Hospitais Públicos/estatística & dados numéricos , Humanos , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Filipinas , Padrões de Prática Médica , Surfactantes Pulmonares/administração & dosagem , Respiração Artificial/normas , Respiração Artificial/estatística & dados numéricos , Ressuscitação/normas , Fatores Socioeconômicos , Análise de Sobrevida
11.
Int J Health Plann Manage ; 35(1): e196-e209, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31713280

RESUMO

Since the new round of health care reform in 2009, the vertical integration of hospitals and primary health institutions has become widely implemented in China as an efficient method for improving quality of primary care. This study aimed to answer the following questions: (a) What is the perceived quality of township health centres (THCs) under integration? (B) What differences could be observed among the three typical integration models, namely, private hospital-THC integration, public hospital-THC integration, and loose collaboration? Two rounds of cross-sectional surveys were conducted from November 2016 to June 2018. The Chinese version of the Primary Care Assessment Tool was used to evaluate perceived quality of sample THCs, and 1118 adult patients were interviewed in total. Multiple linear regressions were employed to compare the quality scores between two survey rounds and among different integration models after controlling for potential confounders. The results revealed that the quality of care significantly improved under private hospital-THC integration as observed by comparing two survey rounds, while no change or slight changes were observed in the other two models. The difference observed among the three models was that the perceived quality of THCs integrated with private hospitals was worse than that of THCs integrated with public hospitals and THCs under loose collaboration, while no significant difference was observed between public hospital-THC integration and loose collaboration. Increased attention should be given to highlighting the tight integration between hospitals and THCs and the different roles played by private and public hospitals in the current reform.


Assuntos
Prestação Integrada de Cuidados de Saúde/normas , Atenção Primária à Saúde/normas , Qualidade da Assistência à Saúde/normas , Adolescente , Adulto , China , Estudos Transversais , Feminino , Hospitais Privados/organização & administração , Hospitais Privados/normas , Hospitais Públicos/organização & administração , Hospitais Públicos/normas , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Organizacionais , Atenção Primária à Saúde/organização & administração , Garantia da Qualidade dos Cuidados de Saúde , Melhoria de Qualidade/organização & administração , Adulto Jovem
12.
Artigo em Inglês | MEDLINE | ID: mdl-31861922

RESUMO

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.


Assuntos
Eficiência Organizacional/normas , Hospitais Privados/organização & administração , Hospitais Públicos/organização & administração , China , Eficiência , Hospitais Privados/economia , Hospitais Privados/normas , Hospitais Públicos/economia , Hospitais Públicos/normas , Humanos
13.
BMC Health Serv Res ; 19(1): 639, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488141

RESUMO

BACKGROUND: The Australian Commission on Safety and Quality in Health Care released a set of national standards which became a mandatory part of accreditation in 2013. Standard 9 focuses on the identification and treatment of deteriorating patients. The objective of the study was to identify changes in the characteristics and perceptions of rapid response systems (RRS) since the implementation of Standard 9. METHODS: Cross-sectional study of Australian hospitals. Baseline data was obtained from a pre-implementation survey in 2010 (220 hospitals). A follow-up survey was distributed in 2015 to staff involved in implementing Standard 9 in public and private hospitals (276 responses) across Australia. RESULTS: Since 2010, the proportion of hospitals with formal RRS had increased from 66 to 85. Only 7% of sites had dedicated funding to operate the RRS. 83% of respondents reported that Standard 9 had improved the recognition of, and response to, deteriorating patients in their health service, with 51% believing it had improved awareness at the executive level and 50% believing it had changed hospital culture. CONCLUSIONS: Implementing a national safety and quality standard for deteriorating patients can change processes to deliver safer care, while raising the profile of safety issues. Despite limited dedicated funding and staffing, respondents reported that Standard 9 had a positive impact on the care for deteriorating patients in their hospitals.


Assuntos
Deterioração Clínica , Equipe de Respostas Rápidas de Hospitais/normas , Acreditação/normas , Austrália , Estudos Transversais , Hospitais Privados/normas , Hospitais Públicos/normas , Humanos , Cultura Organizacional , Padrões de Referência , Inquéritos e Questionários
14.
J Int Assoc Provid AIDS Care ; 18: 2325958219869309, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31538531

RESUMO

We compared quality improvement (QI) interventions for prevention of mother-to-child transmission in a private hospital and a government hospital (GH). From November 2013 to October 2016, data were extracted retrospectively for HIV-positive mothers and HIV-exposed infants. The overall number of mother-baby pairs (MBPs) was significantly (P < .001) higher at the GH (mean = 294, standard deviation [SD] = 180) than the private hospital (mean = 72, SD = 27). There was a significantly higher number of MBPs receiving care (P < .001) and routine services (P < .001) at the GH. The proportion of MBPs retained in care (P < .001) and receiving the routine service package (P < .001) was significantly higher at the private hospital. Overtime, indicators at the private hospital peaked significantly in year 2 and reduced moderately in the final year. The trend for the GH showed gradual but nonsignificant improvement in 2 indicators. QI showed positive results in the private hospital. If systematically applied in GHs, QI can support improved services for larger patient volumes.


Assuntos
Infecções por HIV/prevenção & controle , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Melhoria de Qualidade , Fármacos Anti-HIV/uso terapêutico , Feminino , Infecções por HIV/tratamento farmacológico , Hospitais Privados/normas , Hospitais Públicos/normas , Humanos , Lactente , Transmissão Vertical de Doenças Infecciosas/estatística & dados numéricos , Lesoto , Mães , Gravidez , Complicações Infecciosas na Gravidez , Estudos Retrospectivos
15.
Int J Health Plann Manage ; 34(4): 1364-1376, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31025447

RESUMO

Performance measurement is a necessity for private hospitals as they need to be efficient, attract customers, increase profitability, and survive in the competitive environment of the health care industry. Hospitals typically struggle to identify appropriate performance measures because of lack of reliable source of performance measures for private hospitals. Despite numerous studies on performance measurement, few studies have focused on performance measures in private hospitals. This paper aims to fill that gap by identifying and ranking a specific set of performance measures that are feasible and relevant for private hospitals. Forty-four health care performance measures in four balanced scorecard (BSC) performance perspectives (financial, customer, internal business processes, and learning and growth) were compiled and filtered based on "feasibility" and "relevance" criteria using a questionnaire survey in private hospitals in the Klang Valley area, Malaysia. Since all collected data were in numeric format, data analysis was performed quantitatively. Consequently, 31 BSC performance measures were identified for private hospitals. Next, the 31 performance measures went through a ranking survey in Klang Valley private hospitals. Therefore, a weight between 0 and 1 with a range of 0.095 to 0.207 was obtained for each performance measure to help hospitals quantify their overall performance more accurately.


Assuntos
Hospitais Privados/organização & administração , Garantia da Qualidade dos Cuidados de Saúde/métodos , Indicadores de Qualidade em Assistência à Saúde , Hospitais Privados/normas , Humanos , Malásia
16.
Sex Reprod Healthc ; 19: 78-83, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30928139

RESUMO

OBJECTIVE: To investigate the quality of intrapartum care provided at Rwandan healthcare facilities to women undergoing normal pregnancy and spontaneous full-term labour. METHODS: A cross-sectional study was conducted over eight weeks during 2014-2015 in 18 healthcare facilities in Kigali City and the Northern Province: eight health centres, seven district hospitals, one provincial hospital, one private hospital, and one referral hospital. Data were collected from medical records and a questionnaire including the Bologna score with its five variables: presence of a companion, use of partograph, no augmentation of labour, birth in a non-supine position, and skin-to skin contact. RESULTS: Among the 435 women who fulfilled the inclusion criteria during the study period, mean age was 27.4 years and 41.8% were primiparous. The assisting healthcare professionals were midwives (49.4%), nurses (28.8%), and physicians (22%), and birth occurred at health centres (29%), district hospitals (40%), and the referral hospital (31%). Mean Bologna score was 2.03 of the maximum 5 (range: 0-4). Only one woman (0.2%) had a companion present (her husband). A partograph was used for the majority (84.8%), and 88.0% had no augmentation of labour with oxytocin. Few (6.2%) gave birth in a non-supine position, and few (12.4%) had early skin-to-skin contact with their newborn. CONCLUSION: There are several areas for improving childbirth care according to the Bologna score. Healthy newborns should be placed skin-to-skin with their mothers shortly after birth, non-supine birthing positions should be encouraged, and the importance of a companion during labour and birth should be considered.


Assuntos
Parto Obstétrico/normas , Instalações de Saúde/normas , Assistência Perinatal/normas , Nascimento a Termo , Adulto , Entorno do Parto , Centros Comunitários de Saúde/normas , Estudos Transversais , Parto Obstétrico/métodos , Feminino , Hospitais de Distrito/normas , Hospitais Privados/normas , Humanos , Início do Trabalho de Parto , Relações Mãe-Filho , Posicionamento do Paciente , Gravidez , Ruanda , Adulto Jovem
17.
Rev. salud pública ; 21(2): 168-174, ene.-abr. 2019. tab, graf
Artigo em Espanhol | LILACS | ID: biblio-1094386

RESUMO

RESUMEN Objetivos Determinar y comparar entre hospitales públicos y privados, los elementos y factores del contexto que pueden favorecer el logro de la acreditación en salud. Métodos y Materiales De un estudio fuente de casos y controles, realizado en hospitales de mediana y alta complejidad en Colombia, 16 acreditados y 38 no-acreditados, se realiza estudio auxiliar en los 38 hospitales no-acreditados según su naturaleza público o privado. Para la recolección de información se utilizó como referencia instrumento MUSIQ ("Model for Understanding Sucess in Quality") y se realizó análisis comparativo entre elementos y factores del contexto en sus dimensiones "Ambiente-Macrosistema-Microsistema-Equipos de Calidad", mediante prueba Chi cuadrado y t de Student ó U de Mann-Whitney, previa comprobación de normalidad en su distribución con la prueba de Shapiro Wilk. En todos los casos se consideró significativo valor de p menor o igual a 0,05. Resultados Evaluados los 23 elementos y factores que conforman las cuatro dimensiones del contexto en hospitales públicos y privados para el logro de la acreditación en salud, tres presentan diferencias significativas con mayor avance en hospitales privados: en el Macrosistema los sistemas de Información de apoyo para el mejoramiento de la calidad y la estabilidad laboral y en el microsistema el factor motivación. Los demás 20 elementos y factores del contexto evaluados en este estudio, no presentaron diferencias significativas. Conclusiones Existen diferencias en elementos y factores del contexto entre hospitales públicos y privados que pueden favorecer en estos últimos el logro de la acreditación en salud.(AU)


ABSTRACT Objective To determine and compare the contextual elements and factors that may favor the achievement of accreditation of public and private healthcare hospitals. Materials and Methods Based on a source study of cases and controls conducted in medium and high complexity hospitals of Colombia, 16 accredited and 38 non-accredited, this auxiliary study investigated the 38 non-accredited hospitals according to their public or private nature. The MUSIQ instrument ("Model for Understanding Success in Quality") was used to collect data used as reference, while the dimensions "Environment-Macrosystem-Microsystems-Quality Equipment" of the elements and context factors underwent a comparative analysis by means of Chi square test and Student's t or Mann-Whitney's U test after distribution normality verification using the Shapiro-Wilk test. In all cases, a p-value equal to or less than 0.05 was considered significant. Results The 23 elements and factors that make up the 4 context dimensions for the achievement of accreditation in health in public and private hospitals were evaluated. It was found that tree had significant differences associated with greater progress in private hospitals, namely, the information systems to support the Quality Improvement (QI) and job stability in the macrosystem, and the motivation factor in the microsystem. The remaining 20 elements and factors evaluated in this study did not have significant differences. Conclusion There are differences in elements and factors of the context between public and private hospitals that can favor privates in the achievement of accreditation in health.(AU)


Assuntos
Hospitais Privados/normas , Gestão da Qualidade , Acreditação Hospitalar , Melhoria de Qualidade/normas , Hospitais Públicos/normas , Colômbia
18.
JAMA Netw Open ; 2(1): e187096, 2019 01 04.
Artigo em Inglês | MEDLINE | ID: mdl-30657532

RESUMO

Importance: Concerns have been raised about the adequacy of health care access among patients cared for within the United States Department of Veterans Affairs (VA) health care system. Objectives: To determine wait times for new patients receiving care at VA medical centers and compare wait times in the VA medical centers with wait times in the private sector (PS). Design, Setting, and Participants: A retrospective, repeated cross-sectional study was conducted of new appointment wait times for primary care, dermatology, cardiology, or orthopedics at VA medical centers in 15 major metropolitan areas in 2014 and 2017. Comparison data from the PS came from a published survey that used a secret shopper survey approach. Secondary analyses evaluated the change in overall and unique patients seen in the entire VA system and patient satisfaction survey measures of care access between 2014 and 2017. Main Outcomes and Measures: The outcome of interest was patient wait time. Wait times in the VA were determined directly from patient scheduling. Wait times in the PS were as reported in Merritt Hawkins surveys using the secret shopper method. Results: Compared with the PS, overall mean VA wait times for new appointments in 2014 were similar (mean [SD] wait time, 18.7 [7.9] days PS vs 22.5 [7.3] days VA; P = .20). Department of Veterans Affairs wait times in 2014 were similar to those in the PS across specialties and regions. In 2017, overall wait times for new appointments in the VA were shorter than in the PS (mean [SD], 17.7 [5.9] vs 29.8 [16.6] days; P < .001). This was true in primary care (mean [SD], 20.0 [10.4] vs 40.7 [35.0] days; P = .005), dermatology (mean [SD], 15.6 [12.2] vs 32.6 [16.5] days; P < .001), and cardiology (mean [SD], 15.3 [12.6] vs 22.8 [10.1] days; P = .04). Wait times for orthopedics remained longer in the VA than the PS (mean [SD], 20.9 [13.3] vs 12.4 [5.5] days; P = .01), although wait time improved significantly between 2014 and 2017 in the VA for orthopedics while wait times in the PS did not change (change in mean wait times, increased 1.5 days vs decreased 5.4 days; P = .02). Secondary analysis demonstrated an increase in the number of unique patients seen and appointment encounters in the VA between 2014 and 2017 (4 996 564 to 5 118 446, and 16 476 461 to 17 331 538, respectively), and patient satisfaction measures of access also improved (satisfaction scores increased by 1.4%, 3.0%, and 4.0% for specialty care, routine primary care, and urgent primary care, P < .05). Conclusions and Relevance: Although wait times in the VA and PS appeared to be similar in 2014, there have been interval improvements in VA wait times since then, while wait times in the PS appear to be static. These findings suggest that access to care within the VA has improved over time.


Assuntos
Agendamento de Consultas , Hospitais Privados/estatística & dados numéricos , Hospitais de Veteranos/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais Privados/normas , Hospitais de Veteranos/normas , Humanos , Masculino , Medicina , Pessoa de Meia-Idade , Satisfação do Paciente , Fatores de Tempo , Estados Unidos , United States Department of Veterans Affairs , Adulto Jovem
19.
J Stroke Cerebrovasc Dis ; 28(2): 430-434, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30415916

RESUMO

BACKGROUND: Developing quality metrics to assess hospital-level care and outcomes is increasingly popular in the United States. The U.S. News & World Report ranking of "America's Best Hospitals" is an existing, popular hospital-profiling system, but it is unknown whether top-ranked hospitals in their report have better outcomes according to other hospital quality metrics such as the Centers for Medicare and Medicaid Services (CMS) publicly reported 30-day stroke measures. METHODS: The analysis was based on the 2015-2016 U.S. News & World Report ranking of the 50 top-rated hospitals for neurology and neurosurgery and 2012-2014 CMS Hospital Compare Data. We used mixed models adjusted for hospital characteristics and weighted by hospital volume to compare 30-day risk-standardized mortality and readmission between top-ranked and other hospitals. Among the 50 top-ranked hospitals, we determined whether ranking order was associated with the CMS outcomes. RESULTS: Compared with 2737 other hospitals, the 50 top-ranked hospitals had lower 30-day mortality (14.8% versus 15.3%) but higher readmission (14.5% versus 13.3%). These patterns persisted in adjusted analyses with top-ranked hospitals having .72% (95% confidence interval [CI] -1.09%, -.34%) lower mortality and .41% (95% CI .16%, .67%) higher readmission. Among top-ranked hospitals, rank order was not associated with mortality (.05% decrease in mortality with each rank, 95% CI -.10%, .01%) or readmission (.02% increase; 95% CI -.03%, .06%). CONCLUSION: Admission to a top-ranked hospital for neurology or neurosurgery was associated with lower 30-day risk-standardized mortality but higher readmission after ischemic stroke. There was heterogeneity in outcomes among the 50 top-ranked hospitals.


Assuntos
Isquemia Encefálica/terapia , Hospitais/normas , Avaliação de Processos em Cuidados de Saúde/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Acidente Vascular Cerebral/terapia , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/mortalidade , Número de Leitos em Hospital/normas , Mortalidade Hospitalar , Hospitais com Alto Volume de Atendimentos/normas , Hospitais com Baixo Volume de Atendimentos/normas , Hospitais Privados/normas , Hospitais Rurais/normas , Hospitais de Ensino/normas , Humanos , Joint Commission on Accreditation of Healthcare Organizations , Readmissão do Paciente/normas , Complicações Pós-Operatórias/mortalidade , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/mortalidade , Fatores de Tempo , Resultado do Tratamento , Estados Unidos
20.
BMJ Qual Saf ; 28(6): 459-467, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30366969

RESUMO

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.


Assuntos
Codificação Clínica/normas , Hospitais Privados/normas , Hospitais Públicos/normas , Qualidade da Assistência à Saúde/normas , Reembolso de Incentivo , Estudos Transversais , França/epidemiologia , Mortalidade Hospitalar , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Auditoria Médica , Múltiplas Afecções Crônicas/epidemiologia , Múltiplas Afecções Crônicas/terapia , Avaliação de Programas e Projetos de Saúde
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