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This is a follow-up study to the 1974 report, 'Strengthening Hospital Management', in which several management problems facing VA and non-VA hospitals were identified. In this document, the action plans for accelerating the pace o...
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This is a follow-up study to the 1974 report, 'Strengthening Hospital Management', in which several management problems facing VA and non-VA hospitals were identified. In this document, the action plans for accelerating the pace of patient care at Ann Arbor and Cincinnati VA hospitals are described. At Ann Arbor it was decided that patient care could be accelerated by improving physician management of patients, diagnosing or treating more patients on an outpatient basis, improving response times for special x-ray procedures, and strengthening responsiveness of other key support activities. The Cincinnati study concluded that care could be speeded up by eliminating causes of outplacement delays, emphasizing timeliness of physician management of patients, and reducing structural problems contributing to prolonged pre-operative stays.
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The average length of stay in VA hospitals remains unnecessarily long in comparison to other U.S. hospitals, in spite of recent progress in this area. Avoidable inpatient days have been found to be caused primarily by delays in ph...
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The average length of stay in VA hospitals remains unnecessarily long in comparison to other U.S. hospitals, in spite of recent progress in this area. Avoidable inpatient days have been found to be caused primarily by delays in physicians' management of patient care, treatment on an inpatient basis where outpatient treatment would have been appropriate, and delays in outplacement. This report describes methods developed in five test hospitals for gauging the appropriateness of lengths of stay, identifying the causes of unnecessarily prolonged hospitalization, and developing programs to achieve reductions. The methods involve analysis of random samples of patient records, formal staff and resident performance evaluations concerning length of stay, and corrective programs targeted specifically to the causes of avoidable inpatient delays as identified in the review of the patient records sample. Suggestions are made for incorporating this approach into the management systems of individual hospitals and the VA Department of Medicine and Surgery overall.
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This study examined how Utah children used emergency medical services (EMS) and211 related hospital care in 1991-1992. The EMS and hospital records were linked 211 using special software (probabilistic linkage). The principal find...
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This study examined how Utah children used emergency medical services (EMS) and211 related hospital care in 1991-1992. The EMS and hospital records were linked 211 using special software (probabilistic linkage). The principal findings of the 211 study concerned the care of young children less than 5 years of age. They 211 received fewer procedures prior to being transported to a hospital and required 211 more time at the scene for assessment. Some interventions such as splinting of 211 fractured arms prior to transport to a hospital were related to reduced hospital 211 charges. Ambulance and hospital charges for children were estimated to be 211 $35,000,000 not counting physician charges, prescriptions, and rehabilitation 211 care. A training program in intravenous (IV) line placement for ambulance 211 personnel resulted in a reduction in the amount of time EMS personnel spent at 211 the scene. This study raised several hypotheses which could be the subject of 211 future research.
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This study uses 1995 - 1999 Contingent Workers Supplement and hospital ownership data from the American Hospital Association's Annual Surveys to how the employer sponsored insurance market responds to changes in hospital ownership...
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This study uses 1995 - 1999 Contingent Workers Supplement and hospital ownership data from the American Hospital Association's Annual Surveys to how the employer sponsored insurance market responds to changes in hospital ownership. A Nested Multinomial Logit model estimates a two dimensional choice set of availability of an employer based plan and participation in that plan. The model indicates that access to a public hospital system produces a negligible effect on insurance availability and participation for all but the lowest income workers, and the data showed no appreciable difference for not-for-profit and for-profit hospitals.
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The elderly population in the U.S. is projected to more than double from approximately 35 million in 2000 (12 percent of the U.S. population) to an estimated 71 million in 2030 (20 percent of the U.S. population). As the American ...
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The elderly population in the U.S. is projected to more than double from approximately 35 million in 2000 (12 percent of the U.S. population) to an estimated 71 million in 2030 (20 percent of the U.S. population). As the American population continues to age, the demand for hospital care will increase rapidly since elderly individuals are at high risk for costly, age-associated chronic diseases and other health conditions. This Statistical Brief presents data from the Healthcare Cost and Utilization Project (HCUP) summarizing information about hospital stays for elderly individuals, age 65 and older, from 1997 to 2004. Specifically, this brief notes the most frequent reasons for hospitalizations among older patients, with a focused look at the characteristics of six select health conditions: congestive heart failure, pneumonia, acute myocardial infarction (heart attack), chronic obstructive pulmonary disease, acute cerebrovascular disease (stroke), and osteoarthritis. These conditions were selected based on volume as well as relevance to the priority conditions identified by the Department of Health and Human Services for research under the Medicare Modernization Act. All differences between estimates provided in the text are statistically significant at the 0.05 level or better.
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This report outlines the steps taken towards revising the nurse's orientation program of the Minneapolis Veterans Administration Hospital. The introduction gives a preliminary account of the project along with the goal which was t...
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This report outlines the steps taken towards revising the nurse's orientation program of the Minneapolis Veterans Administration Hospital. The introduction gives a preliminary account of the project along with the goal which was the strengthening of administrative skills not from the standpoint of education per se, but of improved nursing care and development. The paper further outlines the revision through steps in planning and implementing the program and the administrative uses of the program. The appendix contains the previous nurse orientation program as well as the revised program.
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There has been much debate about specialty hospitals--short-term acute care hospitals with physician owners or investors that primarily treat patients who have specific medical conditions or need surgical procedures--and the compe...
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There has been much debate about specialty hospitals--short-term acute care hospitals with physician owners or investors that primarily treat patients who have specific medical conditions or need surgical procedures--and the competitive effects they may have on general hospitals. Advocates of specialty hospitals contend that competition from these physician-owned facilities can prompt general hospitals to implement efficiency, quality, and amenity improvements, thus favorably affecting the overall health care delivery system. Critics of specialty hospitals are concerned that general hospitals may respond to such competition by making changes that do not necessarily increase efficiency or benefit patients or communities, for example, by adding services already available in the community. The appropriateness of physicians' financial interests in specialty hospitals has also been questioned. GAO was asked to provide information on the competitive response of general hospitals to specialty hospitals. GAO surveyed approximately 600 general hospitals in markets with and without specialty hospitals to provide information on the extent to which these two groups of general hospitals reported implementing operational and clinical service changes to remain competitive. GAO received responses from 401 general hospitals.
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Circulatory diseasesconditions including heart disease, stroke, and peripheral vascular diseases such as deep vein thrombosis and varicose veinsare the most common reason for admission to the hospital for both men and women, exclu...
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Circulatory diseasesconditions including heart disease, stroke, and peripheral vascular diseases such as deep vein thrombosis and varicose veinsare the most common reason for admission to the hospital for both men and women, excluding pregnancy and childbirth. Circulatory diseases often result in acute episodes that require care in emergency rooms and hospitals. As a result, medical care for circulatory diseases is a significant contributor to the number of hospital admissions and total hospital costs in the United States. This Statistical Brief presents data from the Healthcare Cost and Utilization Project (HCUP) on the hospital treatment of circulatory diseases in 2004. The usage and expense of hospital stays for circulatory diseases are compared with hospital stays for all conditions. Additionally, the most common circulatory diseases resulting in hospital admission are described, and variations in hospital utilization are illustrated by payer. All differences between estimates noted in the text are statistically significant at the 0.05 level or better.
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Pressure sores typically result from prolonged periods of un-interrupted pressure on the skin, soft tissue, muscle, and bone. Vulnerable patients include the elderly, stroke victims, patients with diabetes, those with dementia, an...
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Pressure sores typically result from prolonged periods of un-interrupted pressure on the skin, soft tissue, muscle, and bone. Vulnerable patients include the elderly, stroke victims, patients with diabetes, those with dementia, and people who use wheelchairs or who are bedriddenany patient with impaired mobility or sensation. These individuals are particularly susceptible to pressure sores unless they regularly change position or use other preventive measures, such as pressure-reducing mattresses. This Statistical Brief presents data from the Healthcare Cost and Utilization Project (HCUP) on patterns of utilization and expense for hospital stays involving the treatment of pressure sores in 2003. Variations in utilization and hospital billing for these stays are illustrated according to patient age, expected source of payment, and related conditions. Unless otherwise noted, estimates are based on all listed diagnoses.All differences between estimates noted in the text are statistically significant at the 0.05 level or better.
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;Contents: Demonstrations of alternative delivery systems under medicare and medicaid; General revenue financing of medicare--Who will bear the burden; The rise in the incidence of hospitalizations for the aged, 1967 to 1979; Tren...
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;Contents: Demonstrations of alternative delivery systems under medicare and medicaid; General revenue financing of medicare--Who will bear the burden; The rise in the incidence of hospitalizations for the aged, 1967 to 1979; Trends and regional variations in hospital use under Medicare; Nursing home pre-admission screening--A review of state programs; Bioactuarial models of National Mortality Time Series Data.
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