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1.
BMJ Open ; 11(7): e042326, 2021 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-34215595

RESUMO

BACKGROUND: Cataract surgery is very important to prevent blindness, but its productivity and efficiency in China are unknown. Our study aimed to evaluate the geographical distribution of cataract surgeons and prospectively identify the factors associated with the increased productivity in cataract surgery and efficiency in outpatient ophthalmic services in rural Chinese hospitals. METHODS: Data were prospectively collated from various hospital datasets and the census registered by the geographical unit county. Prior to mapping, the geographical location data of counties were cross-linked with the equivalent ophthalmologist and service output data to create categories and map multiple data attributes. Descriptive statistical analyses were performed to characterise the data stratified by county. Linear regression analyses were used to explore the factors associated with the increased productivity/efficiency. RESULTS: The ophthalmologists, surgical productivity of ophthalmologists and outpatient efficacy of ophthalmologists significantly varied across counties. During the period between 2016 and 2018, the median (IQR) change in surgical productivity of and outpatient efficacy of ophthalmologists were 31.627 (-3.33 to 29.94) and 118.08 (-132.30 to 740.89). In the simple regression analysis for predictors of a high productivity change, only the increased number of phaco machine had statistical significance (p=0.003). In addition, only the gross domestic product per capita in 2016 was associated with an increased improvement in efficiency of outpatient services (p=0.008). CONCLUSIONS: This study demonstrated that the ophthalmologist productivity and the efficiency of outpatient services were unequally geographically distributed, and their predictors were identified. Further studies to elucidate the extent of the problem and improve the health service delivery models are required.


Assuntos
Extração de Catarata , Oftalmologistas , Oftalmologia , China , Hospitais de Condado , Humanos
4.
BMC Health Serv Res ; 21(1): 449, 2021 May 11.
Artigo em Inglês | MEDLINE | ID: mdl-33975605

RESUMO

BACKGROUND: County hospitals as the backbone of the China's healthcare system are providing services for over 70% of the total population. However, the hospital management practice (HMP) and its links with quality of care, efficiency and finance in these hospitals are unknown. METHODS: We did two cross-sectional surveys of HMP in 2013 and 2015 among 101 county hospitals across rural China. Three managing roles (hospital director, director of medical affairs office and director of cardiology) and a cardiologist were invited to the surveys. A novel HMP rating scale, with 100 as full score, was used to measure the HMP in 17 indicators under four dimensions (target, operation, performance, and talent management) for each hospital. We analyzed the association of HMP score with variables on quality of care, efficiency and finance using linear mixed models with and without adjustment for potential confounders. FINDINGS: A total of 95 hospitals participated in at least one survey and were included in the analysis. The overall mean HMP score varied dramatically across the hospitals and 84% of them scored less than 60. The dimension mean HMP score was 38.6 (target), 56.4 (operation), 53.2 (performance) and 55.7 (talent), respectively. The pattern of indicator mean HMP score, however, was almost identical between hospitals with high and low overall HMP score, showing the same 'strength' (staff satisfaction, staff performance appraisal, 'hard wares', patient-centered services, etc.) and 'weakness' (target balance, target setting, continuous quality improvement, penalties on staff with dissatisfied performance, etc.). The associations of overall mean HMP score with quality of care and efficiency variables and cost per hospitalization was not statistically significant. The statistical significance in the association with hospital annual total income disappeared after adjusting for region, teaching status, number of competitors, number of staff and number of beds in use. CONCLUSION: The HMP in Chinese county hospitals scores low in general and was not significantly associated with hospital care quality, efficiency and finance. The current healthcare reform in China should address the micro level issues in hospital management practices.


Assuntos
Administração Hospitalar , Hospitais de Condado , China , Estudos Transversais , Reforma dos Serviços de Saúde , Humanos
5.
BMC Health Serv Res ; 21(1): 385, 2021 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-33902578

RESUMO

BACKGROUND: China has initiated a medical pricing reform to combat the overuse of drugs and relieve the financial burden of patients. This paper aims to analyze the effect of medical pricing reform on revenue structure and healthcare expenditure of county public hospitals in Guangdong province. METHODS: Based on the monthly data from January 2013 to August 2019, we use interrupted time series design to evaluate the effects of medical pricing reform on healthcare expenditure in both outpatients and inpatients. A counterfactual is also established to examine the net effect of the policy. RESULTS: The proportion of drug revenue decreased from 35 % to 2015 to 29.7 % in 2019, and the revenue from medical services and inspection increased 3.2 and 3 % respectively. Meanwhile, the increasing trend of total expenditure and its main components is slowed down, especially the drug expense and medical consumable expense for inpatients after the Zero Mark-up Drug policy (coefficient = -18.76, p < 0.01; coefficient = -13.41, p < 0.01, respectively). However, the growth of inspection expense for outpatients continues to increase, while the healthcare expenditure for inpatients experiences an instant increase after the Zero Mark-up Medical Consumables policy. In terms of the net effect, most of healthcare expenditure in both outpatient and inpatient experienced a negative net growth from 2015 to 2019. CONCLUSIONS: The medical pricing reform is a valuable attempt in controlling the unreasonable increase of medical expenses. In the meantime, the unexpected increase in inspection expenditure and insufficient compensation from medical service adjustment should draw the attention of the policymakers.


Assuntos
Gastos em Saúde , Hospitais de Condado , China , Custos e Análise de Custo , Custos de Medicamentos , Reforma dos Serviços de Saúde , Humanos , Análise de Séries Temporais Interrompida
7.
Int J Health Plann Manage ; 36(4): 1308-1325, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33890341

RESUMO

BACKGROUND: The county-level traditional Chinese medicine hospitals have significantly expanded in recent decades. This study aims to assess the changes in the efficiency and productivity of the county-level traditional Chinese medicine hospitals and explore the possible causes of such changes. METHODS: Sixty one hospitals spanning from 2001 to 2017 were selected as samples in this study. And a slacks-based measure of super-efficiency in Data Envelopment Analysis and Malmquist index were used to respectively measure the changes in the efficiency and productivity. RESULTS: The scale of sample hospitals in Hubei continuously expanded from 2001 to 2017. The mean values of technical efficiency, pure technical efficiency and scale efficiency in 2017 were 0.686, 0.74 and 0.933, respectively. The technical efficiency changes in 2017 was 1.97 times that of 2001, and the technological changes in 2017 was 1.45 times that of 2001. CONCLUSIONS: The medical environment and resources have been greatly improved due to the expansion of the sample hospitals, but the technical efficiency value indicates that the operation efficiency of sample hospitals still needs to be significantly improved. Decision-makers are advised to attach importance to the efficiency of operation management and consider the impact of multiple factors on the change in productivity.


Assuntos
Eficiência Organizacional , Medicina Tradicional Chinesa , China , Hospitais de Condado , Estudos Retrospectivos
8.
World Neurosurg ; 149: e1038-e1042, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33476782

RESUMO

BACKGROUND: Glioblastoma multiforme (GBM) is a primary brain malignancy with significant morbidity and mortality. The current standard of treatment for GBM is surgery followed by radiotherapy and temozolomide. Despite an established treatment protocol, there exists heterogeneity in outcomes due to patients not receiving all treatments. We analyzed patients in different health care models to investigate this heterogeneity. METHODS: A retrospective analysis was performed at 2 hospitals in San Bernardino County, California, for patients with newly diagnosed GBM from 2004 to 2019. Patients younger than 18 years of age, with history of low-grade glioma, who had undergone prior treatment, and those lost to follow-up were excluded. RESULTS: A total of 57 patients were included in our study. Chemotherapy was started at 41 ± 30 and 77 ± 68 days in the health maintenance organization (HMO) and county model, respectively (P = 0.050); radiation therapy was started at 46 ± 34 and 85 ± 76 days in the HMO and county models, respectively (P = 0.036). In individuals who underwent both chemotherapy and radiation therapy (XRT), the difference in time to XRT was no longer significant (P = 0.060). Recurrence time was 309 ± 263 and 212 ± 180 days in the HMO and county groups, respectively (P = 0.379). The time to death was 412 ± 285 and 343 ± 304 days for HMO and county models, respectively (P = 0.334). CONCLUSIONS: Our study demonstrates a statistically significant difference in time to adjuvant therapies between patients within a county hospital and a managed health care organization. This information has the potential to inform future policies and care coordination for patients within the county model.


Assuntos
Neoplasias Encefálicas/terapia , Quimiorradioterapia/estatística & dados numéricos , Glioblastoma/terapia , Sistemas Pré-Pagos de Saúde/estatística & dados numéricos , Hospitais de Condado/estatística & dados numéricos , Adulto , Idoso , Antineoplásicos Alquilantes/uso terapêutico , Neoplasias Encefálicas/tratamento farmacológico , Neoplasias Encefálicas/radioterapia , Terapia Combinada , Feminino , Glioblastoma/tratamento farmacológico , Glioblastoma/radioterapia , Política de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Intervalo Livre de Progressão , Estudos Retrospectivos , Análise de Sobrevida , Temozolomida/uso terapêutico
9.
BMJ Open Qual ; 10(1)2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33419735

RESUMO

Venous thromboembolism (VTE) is the fourth most commonly reported complication in trauma patients. For these patients, thromboprophylaxis is a standard of care. Patient compliance with sequential compression devices (SCDs), a form of mechanical VTE prophylaxis, has been a focus of efforts to improve patient safety. At our institution, a baseline audit in July 2020 revealed that patients admitted to the trauma floors have poor compliance with the use of SCDs. In this quality improvement project, we developed a patient education intervention to improve SCD compliance. We distributed an informational flyer to patients and led short educational sessions on VTE risk factors and proper SCD use. Our aim was to increase our SCD compliance rate by 30% in 4 weeks. We used three plan-do-study-act (PDSA) cycles to implement and refine our intervention. We measured SCD compliance during morning and afternoon patient observations and generated run charts to understand how our cycles were leading to change. After a 4-week period, we did not achieve our aim, but increased our overall compliance from 45% to 60% and sustained this improvement throughout our PDSA cycles. Morning compliance was lower than afternoon compliance both at baseline (45% vs 48.5%) and at the end the project (45% vs 53%). Our results suggest that patient education should be coupled with interventions that address other barriers to SCD compliance.


Assuntos
Melhoria de Qualidade , Tromboembolia Venosa , Anticoagulantes , Hospitais de Condado , Humanos , Cooperação do Paciente , Tromboembolia Venosa/prevenção & controle
10.
Dig Dis Sci ; 66(6): 1940-1948, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-32691385

RESUMO

BACKGROUND: Defining factors associated with severe reflux esophagitis allows for identification of subgroups most at risk for complications of strictures and esophageal malignancy. We hypothesized there might be unique clinical features in patients with reflux esophagitis in a predominantly Hispanic population of a large, safety-net hospital. AIM: Define clinical and endoscopic features of reflux esophagitis in a predominantly Hispanic population of a large, safety-net hospital. METHODS: This is retrospective comparative study of outpatients and hospitalized patients identified with mild (Los Angeles Grade A/B) and severe (Los Angeles Grade C/D) esophagitis through an endoscopy database review. The electronic medical record was reviewed for demographic and clinical data. RESULTS: Reflux esophagitis was identified in 382/5925 individuals: 56.5% males and 79.8% Hispanic. Multivariable logistic regression model adjusted for age, gender, race, body mass index (BMI), tobacco and alcohol use, and hospitalization status with severity as the outcome showed an interaction between gender and BMI (p ≤ 0.01). Stratification by gender showed that obese females had decreased odds of severe esophagitis compared to normal BMI females (OR = 0.18, 95% CI = 0.07-0.47; p < 0.01). In males, the odds of esophagitis were higher in inpatient status (OR = 2.84, 95% CI = 1.52 - 5.28; p < 0.01) and as age increased (OR = 1.37, 95% CI = 1.03 - 1.83; p = 0.03). CONCLUSIONS: We identify gender-specific associations with severe esophagitis in a predominantly Hispanic cohort. In females, obese BMI appears to be protective against severe esophagitis compared to normal BMI, while in men inpatient status and increasing age were associated with increased odds of severe esophagitis.


Assuntos
Esofagite Péptica/diagnóstico , Esofagite Péptica/fisiopatologia , Hospitais de Condado/tendências , Provedores de Redes de Segurança/tendências , Caracteres Sexuais , Adulto , Idoso , Esofagite Péptica/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco
11.
Trop Doct ; 51(2): 158-162, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33356919

RESUMO

Laparoscopy and antibiotic-first (NOM) strategies have been introduced in the management of acute appendicitis in industrialised countries. Data regarding the feasibility of these strategies in low-income nations are sparse. A retrospective analysis of adult patients undergoing appendicectomy at a county non-teaching hospital in San Benito, Guatemala (Hospital Nacional (HNSB)) was compared to an academic, teaching institution in Dallas, USA (Veterans Medical Centre). Most patients at the VA (92%) underwent computed tomography prior to being operated upon while none did so at HNSB. Whilst all patients at HNSB underwent an open approach, 95% of VA patients underwent a laparoscopic appendicectomy with a 4.7% conversion rate. General anaesthesia was universally used at Veterans Medical Centre, whilst spinal anaesthesia was utilised in 88% of cases at HNSB. NOM of acute appendicitis was undertaken only rarely at the Veterans Medical Centre and never at HNSB, where it was not thought expedient.


Assuntos
Apendicite/terapia , Hospitais de Condado , Hospitais de Ensino , Doença Aguda , Adulto , Feminino , Guatemala , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos
12.
J Interpers Violence ; 36(9-10): 4916-4926, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-30079797

RESUMO

Workplace violence (WPV) against health workers is a public concern worldwide. Yet little is known about WPV in Chinese county level hospitals and its risk factors. The current study aimed to examine the prevalence of and the risk factors of WPV in county hospitals. A total of 1,388 health workers were interviewed in eight county hospitals in four counties of Zhejiang Province. Results indicated that 7.8% of participants suffered physical attacks and 21.2% suffered physical threats, 51.6% experienced or witnessed Yi Nao (medical disturbance created by gangs using extreme means to obtain compensation from a hospital) at least once in the past year. Physical attacks were seen significantly more in physicians (10.9%) than in nurses (5.9%). Physicians were threatened at 27.1%, followed by nurses at 20.2%. Compared with general medicine, health workers working in emergency were significantly more likely to suffer physical attacks (odds ratio [OR] = 2.7, 95% confidence interval [CI] = [1.4, 5.2], p < .01) and WPV (physical attacks or threats; OR =2.5, 95% CI = [1.6, 4.1], p < .001). Being encouraged to tolerate WPV was correlated with physical attacks (OR = 6.1, 95% CI = [3.5, 10.4], p < .001) and WPV (OR = 6.7, 95% CI = [4.6, 9.8], p < .001). Health workers in county hospitals were vulnerable to encounter WPV. This highlights the need for a focused systematic prevention concerning health workers' safety and governmental regulations and the need for hospitals to encourage their employees to report the WPV.


Assuntos
Violência no Trabalho , Atitude , China/epidemiologia , Estudos Transversais , Hospitais , Hospitais de Condado , Humanos , Prevalência , Fatores de Risco , Inquéritos e Questionários , Local de Trabalho
13.
Dig Dis Sci ; 66(4): 1240-1248, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-32448921

RESUMO

BACKGROUND: Gastric signet ring cell carcinoma (GSRC) is a rare but increasingly prevalent tumor histotype whose clinical features and natural history are poorly understood, particularly in the USA and minorities. AIMS: To examine the occurrence, clinico-demographic characteristics, oncologic features, treatment, and outcomes of GSRC in a predominantly minority county hospital setting and benchmark them against data from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program. METHODS: We queried biopsy-proven GSRC cases at a Los Angeles County hospital, from 2004 to 2017. Clinical characteristics, treatment, and survival data were collected and compared to SEER data. RESULTS: We identified 63 patients with GSRC. Compared to SEER, our cohort was significantly younger (52.6 vs. 63.5 years, p < 0.01), Hispanic/Latino predominant (81% vs. 20%, p < 0.01), had higher overall stage (86% vs. 69% with stage III/IV, p < 0.01), and more frequent node involvement (89% vs. 49%, p < 0.01). Lower tumor stage, Helicobacter pylori positivity, and surgical intervention were associated with significantly longer median survival (all p < 0.05), which was similar in our study compared to SEER (median 12.6 vs. 9.0 months, p = 0.26). CONCLUSIONS: Patients with GSRC within the Los Angeles County population have different clinical characteristics compared to what has been reported in SEER. Our cohort was younger, and despite having more advanced disease, did not have shorter survival. Further study is needed to better identify protective and risk factors in this population and improve understanding of the etiopathogenesis and natural history of this malignancy.


Assuntos
Carcinoma de Células em Anel de Sinete/epidemiologia , Carcinoma de Células em Anel de Sinete/terapia , Hospitais de Condado/tendências , Neoplasias Gástricas/epidemiologia , Neoplasias Gástricas/terapia , Adulto , Idoso , Carcinoma de Células em Anel de Sinete/diagnóstico , Estudos de Coortes , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Programa de SEER/tendências , Neoplasias Gástricas/diagnóstico , Taxa de Sobrevida/tendências , Resultado do Tratamento
14.
Int J Equity Health ; 19(1): 219, 2020 12 10.
Artigo em Inglês | MEDLINE | ID: mdl-33302978

RESUMO

BACKGROUND: As a key part of the new round of health reform, the zero-markup drug policy (ZMDP) removed the profit margins of drug sales at public health care facilities, and had some effects to the operation of these institutions. This study aims to assess whether the ZMDP has different impacts between county general and traditional Chinese medicine (TCM) hospitals. METHODS: We obtained longitudinal data from all county general and TCM hospitals of Shandong province in 2007-2017. We used difference-in-difference (DID) method to identify the overall and dynamic effects of the ZMDP. RESULTS: On average, after the implementation of the ZMDP, the share of revenue from medicine sales reduced by 16.47 and 10.42%, the revenue from medicine sales reduced by 24.04 and 11.58%, in county general and TCM hospitals, respectively. The gross revenue reduced by 5.07% in county general hospitals. The number of annual outpatient visits reduced by 11.22% in county TCM hospitals. Government subsidies increased by 199.22 and 89.3% in county general and TCM hospitals, respectively. The ZMDP reform was not significantly associated with the revenue and expenditure surplus, the number of annual outpatient visits and the number of annual inpatient visits in county general hospitals, the gross revenue, the revenue and expenditure surplus and the number of annual inpatient visits in county TCM hospitals. In terms of dynamic effects, the share of revenue from medicine sales, revenue from medicine sales, and gross revenue decreased by 20.20, 32.58 and 6.08% respectively, and up to 28.53, 63.89 and 17.94% after adoption, while government subsidies increased by around 170 to 200% in county general hospitals. The number of annual outpatient visits decreased by 9.70% and up to 18.84% in county TCM hospitals. CONCLUSION: The ZMDP achieved its some initial goals of removing the profits from western medicines in county hospitals' revenue without disrupting the normal operation, and had different impacts between county general and TCM hospitals. Meanwhile, some unintended consequences were also recognized through the analysis, such as the decline of the utilization of the TCM.


Assuntos
Custos de Medicamentos/tendências , Política de Saúde , Hospitais de Condado/economia , Medicina Tradicional Chinesa/economia , China , Controle de Custos , Financiamento Governamental/tendências , Hospitais de Condado/estatística & dados numéricos , Humanos , Estudos Longitudinais , Medicina Tradicional Chinesa/estatística & dados numéricos
16.
J Grad Med Educ ; 12(5): 578-582, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33149827

RESUMO

Background: The I-PASS framework is increasingly being adopted for patient handoffs after a recent study reported a decrease in medical errors and preventable adverse events. A key component of the I-PASS handoff included assignment of illness severity. Objective: We evaluated whether illness severity categories can identify patients at higher risk of overnight clinical deterioration as defined by activation of the rapid response team (RRT). Methods: The I-PASS handoff documentation created by internal medicine residents and patient charts with overnight RRT activations from April 2016 through March 2017 were reviewed retrospectively. The RRT activations, illness severity categories, vital signs prior to resident handoff, and patient outcomes were evaluated. Results: Of the 28 235 written patient handoffs reviewed, 1.3% were categorized as star (sickest patients at risk for higher level of care), 18.8% as watcher (unsure of illness trajectory), and 79.9% as stable (improving clinical status). Of the 98 RRT activations meeting the inclusion criteria, 5.1% were labeled as star, 35.7% as watcher, and 59.2% as stable. Patients listed as watcher had an odds ratio of 2.6 (95% confidence interval 1.7-3.9), and patients listed as star had an odds ratio of 5.2 (95% confidence interval 2.1-13.1) of an overnight RRT activation compared with patients listed as stable. The overall in-hospital mortality of patients with an overnight RRT was 29.6%. Conclusions: The illness severity component of the I-PASS handoff can identify patients at higher risk of overnight clinical deterioration and has the potential to help the overnight residents prioritize patient care.


Assuntos
Deterioração Clínica , Transferência da Responsabilidade pelo Paciente/organização & administração , Índice de Gravidade de Doença , Estudos de Coortes , Mortalidade Hospitalar , Equipe de Respostas Rápidas de Hospitais , Hospitais de Condado , Humanos , Medicina Interna , Internato e Residência , Estudos Retrospectivos , Texas
18.
Int J Equity Health ; 19(1): 142, 2020 08 20.
Artigo em Inglês | MEDLINE | ID: mdl-32819362

RESUMO

BACKGROUND: China has launched the medical alliances (MAs) reform to drive the development of primary medical institutions and decrease health inequality in rural areas. Three different types of MAs were built to promote township hospitals in Y County. This study aims to evaluate the actual effect of China's MAs reform in rural areas on inpatient distribution especially amongst different types of MAs. METHODS: We obtain 2008-2015 claims data from the New Cooperative Medical Scheme (NCMS) in Y County, Hubei Province of China. We consider January 2008-December 2010 as the pre-reform period and January 2011-December 2015 as the post-reform period. We use independent sample t-test and single-group interrupted time series analysis (ITSA) to compare the number of inpatients per month in the three MAs, including three county and 10 township hospitals before and after the reform. We use paired t-test and multiple-group ITSA between seven township hospitals within MAs and seven township hospitals outside MAs. RESULTS: The MAs reform in Y County increased the number of inpatients in county and township hospitals within MAs. After the reform, the number of inpatients per month in county hospitals had an upward trend, with a slope of 31.01 person/month (P < 0.000). Approximately 19.99 new inpatients were admitted to township hospitals monthly after the reform (P < 0.000). Furthermore, township hospitals within MAs had a substantial increase in the number of inpatients (10.45 new inpatients monthly) compared with those outside MAs. CONCLUSION: The MAs reform in Y County significantly improved the capability of medical institutions within MAs. After the reform, township hospitals within MAs had greater development advantages than those outside MAs. However, it also caused further imbalance in the county region, which contained the new health inequality risk.


Assuntos
Reforma dos Serviços de Saúde , Equidade em Saúde , Hospitalização , Hospitais de Condado , Alocação de Recursos , População Rural , China , Atenção à Saúde/organização & administração , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Hospitalização/estatística & dados numéricos , Hospitais , Hospitais de Condado/estatística & dados numéricos , Humanos , Pacientes Internados , Análise de Séries Temporais Interrompida , Estudos Longitudinais
19.
Emerg Radiol ; 27(6): 785-790, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-32632551

RESUMO

The coronavirus disease 2019 (COVID-19) has rapidly spread across the world since first being identified in Wuhan, China, in late 2019. In order to prepare for the surge of patients and the corresponding increase in radiology exams, clear and detailed policies need to be implemented by hospitals and radiology departments. In this article, we highlight the experiences and policies at LAC+USC Medical Center, the largest single provider of healthcare in LA County. Our policies aim to reduce the risk of transmission, guide patient management and workflow, preserve and effectively allocate resources, and be responsive to changing dynamics. We hope this communication may help other institutions in dealing with this pandemic as well as future outbreaks.


Assuntos
Infecções por Coronavirus/epidemiologia , Hospitais de Condado/organização & administração , Pneumonia Viral/epidemiologia , Serviço Hospitalar de Radiologia/organização & administração , Betacoronavirus , COVID-19 , Humanos , Controle de Infecções/organização & administração , Los Angeles/epidemiologia , Política Organizacional , Pandemias , Alocação de Recursos , SARS-CoV-2 , Fluxo de Trabalho
20.
J Am Med Inform Assoc ; 27(7): 1102-1109, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32495830

RESUMO

OBJECTIVE: To reduce pathogen exposure, conserve personal protective equipment, and facilitate health care personnel work participation in the setting of the COVID-19 pandemic, three affiliated institutions rapidly and independently deployed inpatient telemedicine programs during March 2020. We describe key features and early learnings of these programs in the hospital setting. METHODS: Relevant clinical and operational leadership from an academic medical center, pediatric teaching hospital, and safety net county health system met to share learnings shortly after deploying inpatient telemedicine. A summative analysis of their learnings was re-circulated for approval. RESULTS: All three institutions faced pressure to urgently standup new telemedicine systems while still maintaining secure information exchange. Differences across patient demographics and technological capabilities led to variation in solution design, though key technical considerations were similar. Rapid deployment in each system relied on readily available consumer-grade technology, given the existing familiarity to patients and clinicians and minimal infrastructure investment. Preliminary data from the academic medical center over one month suggested positive adoption with 631 inpatient video calls lasting an average (standard deviation) of 16.5 minutes (19.6) based on inclusion criteria. DISCUSSION: The threat of an imminent surge of COVID-19 patients drove three institutions to rapidly develop inpatient telemedicine solutions. Concurrently, federal and state regulators temporarily relaxed restrictions that would have previously limited these efforts. Strategic direction from executive leadership, leveraging off-the-shelf hardware, vendor engagement, and clinical workflow integration facilitated rapid deployment. CONCLUSION: The rapid deployment of inpatient telemedicine is feasible across diverse settings as a response to the COVID-19 pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Pacientes Internados , Pneumonia Viral/terapia , Telemedicina , Centros Médicos Acadêmicos , COVID-19 , California , Computadores de Mão , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Hospitais de Condado , Hospitais Pediátricos , Humanos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Pandemias , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , SARS-CoV-2 , Provedores de Redes de Segurança , Visitas com Preceptor
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