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Inquiry ; 58: 469580211028180, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34167375


Policymakers are using different ways to measure the community benefit provided by non-profit hospitals because different policy makers have different policy objectives. We compare 3 commonly used measures of community benefit; examine the correlation across the 3 measures; examine how the distribution of community benefits varies across non-profit hospitals; and compare the factors associated with the level of community benefit for each definition. The main dataset for this study is the Schedule H of IRS Form 990 data for 2017. We merged this data with the 2017 American Hospital Association (AHA), the 2017 CMS Hospital Cost Report, and the 2018 American Community Survey data. The final sample consists of 1904 non-profit hospitals. We define 3 measures of community benefit: (1) Total community benefits: combining all 17 possible measures in the 990 data; (2) Total community benefits less unreimbursed Medicaid care because it reflects a policy choice made by the state; and (3) only charity care. We also subdivided the community benefits into individual and service-based benefit. Gini Coefficients and descriptive analysis show the distribution of 3 types of community benefit measures. On average, hospitals spent 8.1% of their expenses on all community benefits; 4.3% on community benefits less unreimbursed Medicaid; and 1.7% on charity care. The provision of charity care showed more variation (Gini coefficient) than the other 2 measures. Different hospital and geographic characteristics were associated with each definition, suggesting that different types of hospitals place emphasis on different community benefits. When policy makers choose among different definitions of community benefit, they should consider what incentives they want to instill.

Instituições de Caridade , Hospitais Filantrópicos , Custos Hospitalares , Hospitais , Hospitais Comunitários , Humanos , Medicaid , Organizações sem Fins Lucrativos , Estados Unidos
Nurs Manag (Harrow) ; 28(5): 26-31, 2021 Oct 05.
Artigo em Inglês | MEDLINE | ID: mdl-34155872


India reported its index case of coronavirus disease 2019 (COVID-19) in January 2020 and since then there has been an alarming rise in cases. In response to the worsening pandemic and the challenge presented by COVID-19 for hospitals in the public sector, the Government of India asked the country's private hospitals to reserve a percentage of their beds for COVID-19 patients. This article describes how nursing services at the Christian Medical College, Vellore - an unaided, not-for-profit quaternary care teaching hospital in Tamil Nadu, India - addressed various challenges to ensure a sustained, high-quality nursing care response to increased patient load. The main challenges included changing COVID-19 policies, ensuring the hospital was prepared to care for COVID-19 patients, and ensuring the availability of nurses. The article demonstrates how proactive planning, empowered involvement of nursing leaders and collaborative efforts resulted in deployment and training of 1,400 nurses, and ensured coordinated care for more than 10,000 patients with COVID-19.

COVID-19/enfermagem , Hospitais de Ensino/organização & administração , Enfermeiras Administradoras , Recursos Humanos de Enfermagem no Hospital/organização & administração , COVID-19/epidemiologia , Hospitais Filantrópicos/organização & administração , Humanos , Índia/epidemiologia , Pesquisa em Administração de Enfermagem
JAMA Netw Open ; 4(4): e218075, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33904912


Importance: Overuse of health care services exposes patients to unnecessary risk of harm and costs. Distinguishing patterns of overuse among hospitals requires hospital-level measures across multiple services. Objective: To describe characteristics of hospitals associated with overuse of health care services in the US. Design, Setting, and Participants: This retrospective cross-sectional analysis used Medicare fee-for-service claims data for beneficiaries older than 65 years from January 1, 2015, to December 31, 2017, with a lookback of 1 year. Inpatient and outpatient services were included, and services offered at specialty and federal hospitals were excluded. Patients were from hospitals with the capacity (based on a claims filter developed for this study) to perform at least 7 of 12 investigated services. Statistical analyses were performed from July 1, 2020, to December 20, 2020. Main Outcomes and Measures: Outcomes of interest were a composite overuse score ranging from 0 (no overuse of services) to 1 (relatively high overuse of services) and characteristics of hospitals clustered by overuse rates. Twelve published low-value service algorithms were applied to the data to find overuse rates for each hospital, normalized and aggregated to a composite score and then compared across 6 hospital characteristics using multivariable regression. A k-means cluster analysis was used on normalized overuse rates to identify hospital clusters. Results: The primary analysis was performed on 2415 cohort A hospitals (ie, hospitals with capacity for 7 or more services), which included 1 263 592 patients (mean [SD] age, 72.4 [14] years; 678 549 women [53.7%]; 101 017 191 White patients [80.5%]). Head imaging for syncope was the highest-volume low-value service (377 745 patients [29.9%]), followed by coronary artery stenting for stable coronary disease (199 579 [15.8%]). The mean (SD) composite overuse score was 0.40 (0.10) points. Southern hospitals had a higher mean score than midwestern (difference in means: 0.06 [95% CI, 0.05-0.07] points; P < .001), northeast (0.08 [95% CI, 0.06-0.09] points; P < .001), and western hospitals (0.08 [95% CI, 0.07-0.10] points; P < .001). Nonprofit hospitals had a lower adjusted mean score than for-profit hospitals (-0.03 [95% CI, -0.04 to -0.02] points; P < .001). Major teaching hospitals had significantly lower adjusted mean overuse scores vs minor teaching hospitals (difference in means, -0.07 [95% CI, -0.08 to -0.06] points; P < .001) and nonteaching hospitals (-0.10 [95% CI, -0.12 to -0.09] points; P < .001). Of the 4 clusters identified, 1 was characterized by its low counts of overuse in all services except for spinal fusion; the majority of major teaching hospitals were in this cluster (164 of 223 major teaching hospitals [73.5%]). Conclusions and Relevance: This cross-sectional study used a novel measurement of hospital-associated overuse; results showed that the highest scores in this Medicare population were associated with nonteaching and for-profit hospitals, particularly in the South.

Hospitais com Fins Lucrativos/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Sobremedicalização/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Planos de Pagamento por Serviço Prestado , Feminino , Número de Leitos em Hospital/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Hospitais Rurais/estatística & dados numéricos , Hospitais Urbanos/estatística & dados numéricos , Hospitais Filantrópicos/estatística & dados numéricos , Humanos , Masculino , Medicare , Meio-Oeste dos Estados Unidos , New England , Noroeste dos Estados Unidos , Estudos Retrospectivos , Provedores de Redes de Segurança/estatística & dados numéricos , Sudeste dos Estados Unidos , Sudoeste dos Estados Unidos , Estados Unidos
Health Aff (Millwood) ; 40(4): 629-636, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33819096


The different tax treatment of government, nonprofit, and for-profit hospitals implies different charity care obligations, with the greatest obligation for government hospitals and the least for for-profit hospitals. Prior research has not examined charity care provision among all three ownership types at the national level. Using 2018 Medicare Hospital Cost Reports, we compared charity care provision across 1,024 government, 2,709 nonprofit, and 930 for-profit hospitals. In aggregate, nonprofit hospitals spent $2.3 of every $100 in total expenses incurred on charity care, which was less than government ($4.1) or for-profit ($3.8) hospitals. No hospital ownership type outperformed the other two types with respect to charity care provision in a majority of hospital service areas containing all three types. Using different kinds of analyses, we also found wide variation in charity care provision within ownership types and a lack of a consistent pattern across ownership types. These results suggest that many government and nonprofit hospitals' charity care provision was not aligned with their charity care obligations arising from their favorable tax treatment. Policy makers may consider initiatives to enhance hospitals' charity care provision, particularly hospitals with government and nonprofit ownership.

Instituições de Caridade , Hospitais Filantrópicos , Idoso , Governo , Humanos , Medicare , Organizações sem Fins Lucrativos , Estados Unidos
Int J Health Plann Manage ; 36(4): 1069-1080, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33763915


BACKGROUND: Governance is a system that ensures and promotes accountability and responsibility toward stakeholders. The present study aims to compare the governance structures and practices in for-profit and non-for profit hospitals in Alexandria, Egypt. METHODS: The study is a descriptive cross sectional study in which Chief Executive officers (CEOs) in all hospitals in Alexandria Governorate were interviewed. A predesigned questionnaire was used in the interview that is composed of four section. The first section explored characteristics of study hospitals. The second section assessed the composition and the characteristics of boards. The third section assessed the functions of the board and the fourth section assessed boards' training and evaluation. RESULTS: A centralized board existed in the Health Insurance, Ministry of Health and Population and University hospitals. As for private hospitals, board existed in only 72 hospitals (82.75 %). Almost all boards have CEO duality. Board members were as few as two members in some boards and up to twenty members in others. Some hospital boards did not have an orientation manual or program. CONCLUSION: A proportion of study hospitals does not have a governing board. For the hospitals with governing boards, there were wide variation in governance structures and practices.

Hospitais Filantrópicos , Estudos Transversais , Egito , Conselho Diretor , Hospitais Privados , Humanos
BMC Health Serv Res ; 21(1): 230, 2021 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-33715624


BACKGROUND: Not-for-profit hospitals are facing an uncertain financial future, especially following the COVID-19 pandemic. Nevertheless, they are legally obligated to provide free and discounted health care services to communities. This study investigates the hospital, community, and state regulatory factors and whether these factors are associated with family income eligibility levels for free and discounted care. METHODS: Data were sourced from Internal Revenue Service Form 990, several data files from the Centers for Medicare and Medicaid, demographic and community factors from the Census Bureau, supplemental files from The Hilltop Institute, Community Benefit Insight, and Kaiser Family Foundation. The study employs multilevel mixed-effects linear and ordered logit regressions to estimate the association between the hospital, community, state policies, and the hospital's family income eligibility limit for free and discounted care. RESULTS: A plurality of hospitals (49.96%) offered a medium level of family income eligibility limit (160-200% of the federal poverty level (FPL)) for free care. In comparison, about 53% (52.94%) offered a low level (0-300 of FPL) eligibility limit for discounted care. Holding all else equal, hospitals designated as critical access, safety net, those in rural areas or located in disadvantaged areas were associated with an increased probability of offering low eligibility limits for free and discounted care. Hospitals in a joint venture, located in highly concentrated markets or states with minimum community benefits requirements, were associated with an increased probability of offering high eligibility limits. CONCLUSION: State and community factors appear to be associated with the eligibility level for free and discounted care. Hospitals serving low-income or rural communities seem to offer the least relief. The federal and state policymakers might need to consider relief to these hospitals with a requirement for them to provide a specific set of minimum community benefits.

COVID-19 , Acesso aos Serviços de Saúde/economia , Serviços de Saúde/economia , Hospitais Comunitários , Hospitais Filantrópicos , Renda , Humanos , Medicare , Pandemias , Análise de Regressão , SARS-CoV-2 , Estados Unidos
J Hosp Infect ; 108: 181-184, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33248977


Low-to-middle-income countries often have high incidence of surgical site infection (SSI). To assess spatial and sociodemographic predictors of SSI rates, this study analysed and georeferenced governmental surveillance data from 385 hospitals located in inner São Paulo State, Brazil. In multi-variate models, SSI rates were positively associated with distance from the state capital [incidence rate ratio (IRR) for each 100 km 1.19, 95% confidence interval (CI) 1.07-1.32], and were lower for non-profit (IRR 0.95, 95% CI 0.37-0.85) and private (IRR 0.47, 95% CI 0.31-0.71) facilities compared with public hospitals. Georeferencing results reinforced the need to direct SSI-prevention policies to hospitals located in areas distant from the state capital.

Hospitais Públicos , Infecção da Ferida Cirúrgica/epidemiologia , Brasil/epidemiologia , Hospitais Privados , Hospitais Filantrópicos , Humanos , Incidência , Fatores Socioeconômicos , Análise Espacial
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1145833


Objetivo: compreender o processo de construção do enfermeiro líder na perspectiva da etnoenfermagem. Método: Pesquisa qualitativa baseada nos pressupostos da etnoenfermagem, sendo desenvolvida em um hospital filantrópico no extremo sul do país, em um setor clínico assistencial com 22 profissionais da equipe de enfermagem. A coleta de dados foi realizada de julho a novembro de 2015 em nove fases da etnoenfermagem. Análise dos dados foi feita de forma simultânea e concomitante as fases de observação, conforme preconizado pela metodologia da etnoenfermagem. Resultados: emergiram três categorias que caracterizam a construção do enfermeiro líder, sendo elas a advocacia em saúde, relações interpessoais e exercício da autonomia. Conclusão: a compreensão do processo de construção do enfermeiro líder constitui-se um elemento importante no exercício da profissão, pois garante a valorização profissional e reconhecimento do enfermeiro como gestor do cuidado, ampliado a qualidade dos serviços através das ações promovidas pela liderança da equipe

Objective: the nurses construction process in the perspective of the ethnonursing. Methods: qualitative research for our services, and developed in a philanthropic hospital in the extreme south of the country, in a clinical care sector with 22 professionals of the nursing team. A data collection was carried out from July to November of 2015 in nine phases of ethnonursing. Analysis of the data to measure simultaneously and concomitantly as phases of observation, as recommended by the methodology of ethnonursing. Results: three categories emerged that characterize a construction of the leading nurse, being they an advocacy in health, interpersonal relationships and exercise of autonomy. Conclusion: an understanding of the nurses' construction process is an important element in the exercise of the profession, since it guarantees a professional appreciation and recognition of nurses as care manager, increasing the quality of services through the actions promoted by the team leadership

Objectivo: comprender el proceso de construcción del enfermero líder en la perspectiva de la etnoenfermería. Método: investigación cualitativa basada en los presupuestos de la etnoenfermería, siendo desarrollada en un hospital filantrópico en el extremo sur del país, en un sector clínico asistencial con 22 profesionales del equipo de enfermería. La recolección de datos se realizó de julio a noviembre de 2015 en nueve fases de la etnoenfermería. El análisis de los datos fue realizado de forma simultánea y concomitante con las fases de observación, según lo preconizado por la metodología de la etnoenfermería. Resultados: surgieron tres categorías que caracterizan la construcción del enfermero líder, siendo ellas la abogacía en salud, relaciones interpersonales y ejercicio de la autonomía. Conclusión: la comprensión del proceso de construcción del enfermero líder constituye un elemento importante en el ejercicio de la profesión, pues garantiza la valorización profesional y reconocimiento del enfermero como gestor del cuidado, ampliando la calidad de los servicios a través de las acciones promovidas por el liderazgo del equipo

Liderança , Antropologia Cultural/métodos , Equipe de Enfermagem , Hospitais Filantrópicos , Gestão da Qualidade , Autonomia Pessoal , Advocacia em Saúde , Pesquisa Qualitativa , Relações Interpessoais
Rev. Pesqui. (Univ. Fed. Estado Rio J., Online) ; 13: 164-169, jan.-dez. 2021. tab
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1337817


Objetivo: caracterizar o perfil epidemiológico e clínico dos pacientes com classificação de risco vermelha (prioridade zero) em um hospital filantrópico. Método: estudo documental, quantitativo, realizado em um hospital filantrópico com 109 prontuários de pacientes com classificação de risco vermelha que adentraram a emergência ao longo de oito meses. Realizou-se a análise estatística descritiva. Resultados: verificou-se que 33,9% da amostra tinha idade entre 61 e 80 anos; 67,7% eram mulheres; 61,4% não fumavam; 62,4% não eram etilistas; 42,2% eram hipertensos; 16,5% apresentou rebaixamento do sensório. Percebeu-se que 37,6% dos prontuários não tinham a hipótese diagnóstica registrada e que 56,9% tiveram alta hospitalar. Conclusão: constatou-se que a maioria dos pacientes com classificação de risco vermelha era idosa, hipertensa, tinha 2º grau completo, não fumava ou era etilista. A principal queixa referida foi rebaixamento do sensório. A principal hipótese diagnóstica foi acidente vascular encefálico. A maioria dos pacientes evoluiu para alta hospitalar

Objective: To characterize the epidemiological and clinical profile of patients with red risk classification (priority zero) in a philanthropic hospital. Method: A quantitative documentary study carried out in a philanthropic hospital with 109 charts of patients with red risk classification who entered the emergency room during eight months. The descriptive statistical analysis was performed. Results: It was verified that 33.9% of the sample was aged between 61 and 80 years; 67.7% were women; 61.4% did not smoke; 62.4% were non-alcoholic; 42.2% were hypertensive; 16.5% presented lowering of the sensorium. It was noticed that 37.6% of the medical records did not have the diagnostic hypothesis registered and that 56.9% were discharged from hospital. Conclusion: It was found that the majority of the DOI: 10.9789/2175-5361.rpcfo.v13.8072Caracterização de pacientes com classificação de risco vermelha...ISSN 2175-5361Pontes TO, Oliveira BSB, Joventino ES165R. pesq.: cuid. fundam. online 2021 jan/dez 13: 164-169patients with red risk classification were elderly, hypertensive, had a full second degree, did not smoke or were an alcoholic. The main complaint reported was lowering of the sensorium. The main diagnostic hypothesis was stroke. Most of the patients evolved to hospital discharge

Objetivo: Caracterizar el perfil epidemiológico y clínico de los pacientes con clasificación de riesgo rojo (prioridad cero) en un hospital filantrópico. Método: Estudio documental, cuantitativo, realizado en un hospital filantrópico con 109 prontuarios de pacientes con clasificación de riesgo roja que adentraron la emergencia a lo largo de ocho meses. Se realizó el análisis estadístico descriptivo. Resultados: Se verificó que el 33,9% de la muestra tenía edad entre 61 y 80 años; El 67,7% eran mujeres; 61,4% no fumaban; El 62,4% no eran etilistas; El 42,2% eran hipertensos; El 16,5% presentó descenso del sensorio. Se percibió que el 37,6% de los prontuarios no tenían la hipótesis diagnóstica registrada y que el 56,9% tuvo alta hospitalaria. Conclusión: Se constató que la mayoría de los pacientes con clasificación de riesgo rojo era anciana, hipertensa, tenía 2º grado completo, no fumaba o era etilista. La principal queja referida fue descenso del sensorio. La principal hipótesis diagnóstica fue accidente vascular encefálico. La mayoría de los pacientes evolucionaron a alta hospitalaria

Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Hospitais Filantrópicos , Acidente Vascular Cerebral/enfermagem , Serviço Hospitalar de Emergência , Enfermagem em Emergência/estatística & dados numéricos , Medição de Risco , Terminologia Padronizada em Enfermagem
J Am Med Inform Assoc ; 27(11): 1688-1694, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32984901


OBJECTIVE: To improve patient safety and clinical outcomes by reducing the risk of prescribing errors, we tested the accuracy of a hybrid clinical decision support system in prioritizing prescription checks. MATERIALS AND METHODS: Data from electronic health records were collated over a period of 18 months. Inferred scores at a patient level (probability of a patient's set of active orders to require a pharmacist review) were calculated using a hybrid approach (machine learning and a rule-based expert system). A clinical pharmacist analyzed randomly selected prescription orders over a 2-week period to corroborate our findings. Predicted scores were compared with the pharmacist's review using the area under the receiving-operating characteristic curve and area under the precision-recall curve. These metrics were compared with existing tools: computerized alerts generated by a clinical decision support (CDS) system and a literature-based multicriteria query prioritization technique. Data from 10 716 individual patients (133 179 prescription orders) were used to train the algorithm on the basis of 25 features in a development dataset. RESULTS: While the pharmacist analyzed 412 individual patients (3364 prescription orders) in an independent validation dataset, the areas under the receiving-operating characteristic and precision-recall curves of our digital system were 0.81 and 0.75, respectively, thus demonstrating greater accuracy than the CDS system (0.65 and 0.56, respectively) and multicriteria query techniques (0.68 and 0.56, respectively). DISCUSSION: Our innovative digital tool was notably more accurate than existing techniques (CDS system and multicriteria query) at intercepting potential prescription errors. CONCLUSIONS: By primarily targeting high-risk patients, this novel hybrid decision support system improved the accuracy and reliability of prescription checks in a hospital setting.

Sistemas de Apoio a Decisões Clínicas , Aprendizado de Máquina , Sistemas de Registro de Ordens Médicas , Erros de Medicação/prevenção & controle , Sistemas Especialistas , Hospitais Filantrópicos , Humanos , Paris , Segurança do Paciente , Farmacêuticos , Prescrições , Curva ROC
Clin Psychol Psychother ; 27(5): 770-778, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32307805


Psychological intervention outcomes depend in part on the therapist who provides the intervention (a therapist effect). However, recent reviews suggest that therapist effects may vary as a function of the context in which care is provided and therefore should not be generalized beyond that context. This study statistically analysed therapist effect differences between care sectors delivering psychological interventions. The sample comprised routine clinical data from 26,814 patients (69% female; mean age 38) and 466 therapists in five care sectors: primary care, secondary care, university, voluntary, and workplace. Therapist effects were analysed using multilevel models and Markov chain Monte Carlo credible intervals. The therapist effect was significantly larger in primary care (8.4%) than in any other sector (1.1%-2.3%) except secondary care (4.1%), after controlling for explanatory baseline and process variables as well as accounting for differences between clinics. There were no other significant differences detected between care sectors. These findings support the hypothesis that differences in effectiveness between therapists vary depending on the context in which psychological treatment is provided. Differences in relative therapist impact can vary by a factor of 4-8 across treatment sectors. This should be considered in the application of research evidence, treatment planning, and the design and delivery of psychological care provision.

Transtornos Mentais/terapia , Psicoterapeutas/psicologia , Psicoterapeutas/estatística & dados numéricos , Psicoterapia/métodos , Adulto , Feminino , Hospitais Filantrópicos , Humanos , Masculino , Cadeias de Markov , Método de Monte Carlo , Atenção Primária à Saúde , Atenção Secundária à Saúde , Serviços de Saúde para Estudantes , Local de Trabalho
Am J Public Health ; 110(4): 492-498, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32078357


Objectives. To examine content of financial assistance polices (FAPs) among US tax-exempt hospitals and determine whether restrictive policies were associated with reduced charity care spending.Methods. Using hospital tax filings with the Internal Revenue Service in 2016 and FAPs obtained from hospital Web sites, we examined characteristics of FAPs and associated expenditures for charity care in a representative sample of 170 tax-exempt hospitals. We identified common eligibility requirements and used them to define restrictiveness of FAPs.Results. FAPs were characterized by various ways to exclude patients, a patchwork of coverage for typical health care services, and wide-ranging discounts. FAP expenditures were lowest among restrictive hospitals in states that expanded Medicaid as part of the Affordable Care Act and highest among nonrestrictive hospitals in nonexpansion states. FAP expenses did not differ by hospital restrictiveness alone.Conclusions. Standardizing common eligibility requirements among FAPs carries potential benefits with regard to optimizing charity care for community benefit and achieving at least some level of equity; however, further policy efforts must account for additional restrictions, charges, and exclusions to be effective.

Hospitais Públicos/economia , Hospitais Filantrópicos/economia , Cuidados de Saúde não Remunerados/economia , Hospitais Públicos/estatística & dados numéricos , Hospitais Filantrópicos/estatística & dados numéricos , Humanos , Medicaid , Patient Protection and Affordable Care Act , Políticas , Pobreza/economia , Isenção Fiscal , Cuidados de Saúde não Remunerados/estatística & dados numéricos , Estados Unidos