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Lipitz-Snyderman, Allison, Coral L. Atoria, Stephen M. Schleicher, Peter B. Bach e Katherine S. Panageas. "Practice Patterns for Older Adult Patients With Advanced Cancer: Physician Office Versus Hospital Outpatient Setting". Journal of Oncology Practice 15, n.º 1 (janeiro de 2019): e30-e38. http://dx.doi.org/10.1200/jop.18.00315.
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PURPOSE: A shift in outpatient oncology care from the physician’s office to hospital outpatient settings has generated interest in the effect of practice setting on outcomes. Our objective was to examine whether medical oncologists’ prescribing of drugs and services for older adult patients with advanced cancer is used more in physicians’ offices compared with hospital outpatient departments. METHODS: This was a retrospective comparative study. SEER-Medicare data (2004 to 2011) were used to identify Medicare beneficiaries diagnosed with advanced breast, colon, esophagus, non–small-cell lung, pancreatic, or stomach cancer. Between physicians’ offices and hospital outpatient departments, we compared use of selected likely low-value supportive drugs, low-value therapeutic drugs, chemotherapy-related hospitalizations, and hospice. We used hierarchical modeling to assess differences between settings to account for correlation within physicians. RESULTS: Compared with patients treated in a hospital outpatient department, those treated in a physician’s office setting were more likely to receive erythropoiesis-stimulating agents (odds ratio, 1.72; 95% CI, 1.53 to 1.94) and granulocyte colony–stimulating factors (odds ratio, 1.28; 95% CI, 1.18 to 1.38). For combination chemotherapy and nanoparticle albumin-bound–paclitaxel in patients with breast cancer, there was a trend toward higher use in physicians’ offices, although this was not statistically significant. Chemotherapy-related hospitalizations and hospice did not vary by setting. CONCLUSION: We found somewhat higher use of several drugs for patients with advanced cancer in physicians’ office settings compared with hospital outpatient departments. Findings support research to dissect the mechanisms through which setting might influence physicians’ behavior.
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Schang, Laura, Daniela Koller, Sebastian Franke e L. Sundmacher. "Exploring the role of hospitals and office-based physicians in timely provision of statins following acute myocardial infarction: a secondary analysis of a nationwide cohort using cross-classified multilevel models". BMJ Open 9, n.º 10 (outubro de 2019): e030272. http://dx.doi.org/10.1136/bmjopen-2019-030272.
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ObjectivesTo examine the role of hospitals and office-based physicians in empirical networks that deliver care to the same population with regard to the timely provision of appropriate care after hospital discharge.DesignSecondary data analysis of a nationwide cohort using cross-classified multilevel models.SettingTransition from hospital to ambulatory care.ParticipantsAll patients discharged for acute myocardial infarction (AMI) from Germany’s largest statutory health insurance fund group in 2011.Main outcome measurePatients’ odds of receiving a statin prescription within 30 days after hospital discharge.ResultsWe found significant variation in 30-day statin prescribing between hospitals (median OR (MOR) 1.40; 95% credible interval (CrI) 1.36 to 1.45), hospital-physician pairs caring for the same patients (MOR 1.32; 95% CrI 1.26 to 1.38) and to a lesser extent between physicians (MOR 1.14; 95% CrI 1.11 to 1.19). About 67% of the variance between hospital-physician pairs and about 45% of the variance between hospitals was explained by hospital characteristics including a rural location, teaching status and the number of beds, the number of patients shared between a hospital and an office-based physician as well as 16 patient characteristics, including multimorbidity and dementia. We found no impact of physician characteristics.ConclusionsTimely prescription of appropriatesecondary prevention pharmacotherapy after AMI is subject to considerable practice variation which is not consistent with clinical guidelines. Hospitals contribute more to the observed variation than physicians, and most of the variation lies at the patient level. To ensure care continuity for patients, it is important to strengthen hospital capacity for discharge management and coordination between hospitals and office-based physicians.
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Rahman, Md Moshiur. "Cytokine Storm in Head Injury Patients and its Management in COVID-19 Era". Neuroscience and Neurological Surgery 8, n.º 2 (19 de março de 2021): 01–02. http://dx.doi.org/10.31579/2578-8868/153.
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Damiyana, Damdam, e Dina Meiliana Sari. "TUGAS DAN TANGGUNG JAWAB STAFF FRONT OFFICE PADA RUMAH SAKIT MEKARSARI". JURNAL LENTERA BISNIS 9, n.º 1 (31 de maio de 2020): 12. http://dx.doi.org/10.34127/jrlab.v9i1.334.
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<p>This research was conducted to find out how the responsibility of the Hospital front office staff in serving prospective patients. The study was conducted descriptively by direct observation and a brief interview with the front office supervisor. The writing of this report is presented descriptively to obtain an overview of various information relating to the provision of services to hospital customers. Methods of data collection using documentation studies, field studies and literature studies. The data obtained is then analyzed and presented descriptively. The conclusion can be drawn that the Mekarsari Hospital's Front Office has not been able to provide the best services for patients and their families, and in the Duties and Responsibilities of Front Office Staff must be able to create services that are Quick Response to problems, effective, efficient and prioritize patient safety.</p><p><strong>Keywords:</strong> Front Office, Hospital, Customers</p>
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Mukherjee, Dipankar, Brian Contos, Erica Emery, Devon T. Collins e James H. Black. "High Reintervention and Amputation Rates After Outpatient Atherectomy for Claudication". Vascular and Endovascular Surgery 52, n.º 6 (1 de maio de 2018): 427–33. http://dx.doi.org/10.1177/1538574418772459.
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Outpatient use of atherectomy for peripheral arterial disease has grown rapidly and outcomes are poorly understood. We analyzed outcomes of atherectomy done for claudication, comparing office and hospital outpatient settings. Analysis of Medicare Part B claims data was performed for incident femoral–popliteal or tibial–peroneal atherectomy from 2012 to 2014. Longitudinal analysis assessed services 18 months before, during, and up to 18 months after the incident peripheral vascular intervention (PVI). Differences between office-based and hospital outpatient-based settings were assessed using χ2 and Fisher exact tests. Comparing procedure settings, significant differences in race (femoral–popliteal: P = .04, tibial–peroneal: P = .001), chronic renal failure (femoral–popliteal: P = .002), and hypertension (femoral–popliteal: P = .01, tibial–peroneal: P = .006) were found. Nine hundred twenty-four patients undergoing femoral–popliteal atherectomy were analyzed (262 office based, 662 hospital outpatient based); 42.7% of office-based and 36.9% of hospital outpatient-based femoral–popliteal atherectomy patients had repeat PVI within 18 months ( P = .10). Major amputation was performed in 2.3% and 3.2% of patients in office and hospital outpatient settings, respectively ( P = .47). Four hundred twenty-three patients undergoing tibial–peroneal atherectomy were analyzed (202 office based, 221 hospital outpatient based); 46.5% of office-based and 38.9% of hospital outpatient-based tibial–peroneal atherectomy patients had repeat PVI within 1 year ( P = .11). Major amputation was performed in 5.0% and 8.1% of patients in office and hospital outpatient settings, respectively ( P = .19). Our study demonstrates higher than expected rates of major amputation for patients undergoing peripheral arterial atherectomy with regard to previously reported rates. Further studies may be required to prove the efficacy and safety of atherectomy for occlusive disease in the femoral–popliteal and tibial–peroneal segments to ensure outcomes are not worse than the natural history of medically managed claudicants.
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Leihitu, Izaak Samuel, Jajang Gunawijaya e Vitria Ariani. "Front Office Management Implementation at Mandaya Karawang Hospital Based on Hospitality Principles". TRJ Tourism Research Journal 3, n.º 1 (30 de abril de 2019): 1. http://dx.doi.org/10.30647/trj.v3i1.49.
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Hospitals are increasingly needed by the public. The increasing demand makes hospital growth increase. An increase of 154.7% occurred between 1997 and 2017. However, the increase in hospitals was not in line with improved services. Many complaints come from patients to the services provided by the hospital. This research is a study using a combination of qualitative methods and quantitative methods. Data collection techniques in qualitative methods were by observation and interviews with informants who worked at Mandaya Hospital Karawang and Resinda Hotel Karawang managed by Padma Hotels as a comparison. Data collection on quantitative methods is by distributing questionnaires to 100 respondents of patients at Mandaya Hospital Karawang. The results showed that the principle of hospitality services is very relevant to be implemented in the Mandaya Hospital Karawang. The implementation of these policies changed the old culture that had been used to become a new culture with the principle of hospitality. Various efforts have been made by management to anticipate changes and maximize service. Front office employees who accept changes in policies and facilities are expected to be able to provide quality services to their patients. By quantitative methods, researchers found a correlation test showed that service quality had a strong and positive effect on patient satisfaction.
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D’Souza, Steve M., Christopher L. Stout, Emilia Krol, David J. Dexter, Sadaf Sadie Ahanchi e Jean M. Panneton. "Outpatient Endovascular Tibial Artery Intervention in an Office-Based Setting Is as Safe and Effective as in a Hospital Setting". Journal of Endovascular Therapy 25, n.º 6 (15 de outubro de 2018): 666–72. http://dx.doi.org/10.1177/1526602818806691.
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Purpose: To compare outcomes of outpatient tibial artery procedures between an office endovascular center and a hospital angiography suite. Methods: A retrospective review was conducted of 204 outpatient tibial interventions performed on 161 patients (mean age 72±11.5 years; 81 men) in either an office (n=100) or hospital (n=104) angiography suite from April 2011 through September 2013. Patients who had an existing ipsilateral bypass that was completely proximal to the tibial trifurcation were eligible, as were patients with prior proximal endovascular interventions. Exclusion criteria included previous ipsilateral bypass involving the infrapopliteal vessels, in-patient status at the time of the procedure, planned admission after the procedure, and infrapopliteal stenting. Treatment included percutaneous transluminal angioplasty (PTA) or PTA with atherectomy. Primary outcomes were unplanned admission, emergency room visits, acute complications, and patency. Results: There were no significant differences in demographics or baseline Rutherford category between patients treated in an office endovascular suite vs a hospital angiography suite. Factors more prevalent in the hospital group included chronic obstructive pulmonary disease (16% vs 8%, p=0.045), renal insufficiency (37% vs 25%, p=0.017), and previous proximal bypass (12% vs 4%, p=0.045). Of the 100 office procedures, 25 involved PTA and 75 were PTA with atherectomy, while in the 104 hospital procedures, PTA was applied in 68 patients and PTA with atherectomy in 36. Thirty-day local complication rates (7% vs 11%, p=0.368), systemic complication rates (4% vs 8%, p=0.263), and mortality (1% vs 2%, p=0.596) in the office vs hospital setting were not statistically different. Unplanned postprocedure hospital admission rates for medical reasons were lower in the office group (2% vs 11%, p=0.01). Kaplan-Meier estimates of the 1-year follow-up data were better in the office group for primary patency (69% vs 53%, p=0.050), assisted primary patency (90% vs 89%, p=0.646), and amputation-free survival (89% vs 83%, p=0.476), but the differences were not statistically significant. Conclusion: Efficacy and safety of outpatient endovascular tibial artery interventions between office and hospital settings were similar, with lower unplanned admission rates and better patency. With appropriate patient selection, the office endovascular suite can be a safe alternative to the hospital angiography suite.
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Tziatzios, Georgios, Dimitrios N. Samonakis, Theocharis Tsionis, Spyridon Goulas, Dimitrios Christodoulou e Konstantinos Triantafyllou. "Sedation/Analgesia Administration Practice Varies according to Endoscopy Facility (Hospital- or Office-Based) Setting: Results from a Nationwide Survey in Greece". Gastroenterology Research and Practice 2020 (5 de outubro de 2020): 1–9. http://dx.doi.org/10.1155/2020/8701791.
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Objectives. To examine the impact of endoscopy setting (hospital-based vs. office-based) on sedation/analgesia administration and to provide nationwide data on monitoring practices among Greek gastroenterologists in real-world settings. Material and Methods. A web-based survey regarding sedation/analgesia rates and monitoring practices during endoscopy either in a hospital-based or in an office-based setting was disseminated to the members of the Hellenic Society of Gastroenterology and Professional Association of Gastroenterologists. Participants were asked to complete a questionnaire, which consisted of 35 items, stratified into 4 sections: demographics, preprocedure (informed consent, initial patient evaluation), intraprocedure (monitoring practices, sedative agents’ administration rate), and postprocedure practices (recovery). Results. 211 individuals responded (response rate: 40.3%). Propofol use was significantly higher in the private hospital compared to the public hospital and the office-based setting for esophagogastroduodenoscopy (EGD) (85.8% vs. 19.5% vs. 10.5%, p<0.0001) and colonoscopy (88.2% vs. 20.1% vs. 9.4%, p<0.0001). This effect was not detected for midazolam, pethidine, and fentanyl use. Endoscopists themselves administered the medications in most cases. However, a significant contribution of anesthesiology sedation/analgesia provision was detected in private hospitals (14.7% vs. 2.8% vs. 2.4%, p<0.001) compared to the other settings. Only 35.2% of the private offices have a separate recovery room, compared to 80.4% and 58.7% of the private hospital- and public hospital-based facilities, respectively, while the nursing personnel monitored patients’ recovery in most of the cases. Participants were familiar with airway management techniques (83.9% with bag valve mask and 23.2% with endotracheal intubation), while 49.7% and 21.8% had received Basic Life Support (BLS) and Advanced Life Support (ALS) training, respectively. Conclusion. The private hospital-based setting is associated with higher propofol sedation administration both for EGD and for colonoscopy. Greek endoscopists are adequately trained in airway management techniques.
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Robinson, William R., e Julie Beyer. "Impact of Shifting From Office- to Hospital-Based Treatment Facilities on the Administration of Intraperitoneal Chemotherapy for Ovarian Cancer". Journal of Oncology Practice 6, n.º 5 (setembro de 2010): 232–35. http://dx.doi.org/10.1200/jop.000058.
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Lately more ovarian cancer patients receive intraperitoneal (IP) chemotherapy treatment in hospitals due to reimbursement changes. This report examines changes in care of women treated with IP chemotherapy in an office versus a hospital setting.
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Tangri, Manoj Kumar, Prasad Lele, Krishan Kapur, Anupam Kapur, Neelam Chhabra, Binay Mitra e Monica Saraswat. "Role of office hysteroscopy in gynecology: retrospective observational study at a tertiary care hospital". International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, n.º 1 (20 de dezembro de 2016): 111. http://dx.doi.org/10.18203/2320-1770.ijrcog20164642.
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Background: Hysteroscopy being the gold standard for evaluation of uterine cavity can be utilized for varied gynaecological indications. Conventionally, hysteroscopy is performed under general anaesthesia but with technical advances over years, it is now possible to do the procedure in ambulatory office setting with same diagnostic accuracy. Aim of this study was to assess the role of hysteroscopy as a diagnostic tool in office setting, to evaluate various gynaecological conditions.Methods: Study performed retrospective analysis on 1920 patients who underwent office hysteroscopy between Jan 2011 to Apr 2015, at outpatient department of a tertiary care centre at Maharashtra, India. The procedure was done in office setting without any sedation or anaesthesia. Approach used was vaginoscopic free hand technique with minimal instrumentation and the findings were documented after evaluation of uterine cavity, ostea and endocervical canal.Results: Office hysteroscopy could be successfully performed in 1920 out of 1938 patients. Most common indications were primary infertility (38.0%), secondary infertility (11.2%), abnormal uterine bleeding (36.6%) and postmenopausal bleeding (8.3%). The procedure done in office setting was tolerated well. The procedure was also used for evaluation in patients with breast and endometrial carcinoma.Conclusions: Office hysteroscopy by vaginoscopic approach is a simple and convenient method for evaluation of uterine cavity and cervical canal. It has the potential to come out from formal operation theatre to more patient friendly outpatient department.
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Bair, Douglas, Joe Pham, M. Bianca Seaton, Naveen Arya, Michelle Pryce e Trevor L. Seaton. "The Quality of Screening Colonoscopies in an Office-Based Endoscopy Clinic". Canadian Journal of Gastroenterology 23, n.º 1 (2009): 41–47. http://dx.doi.org/10.1155/2009/831029.
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BACKGROUND: Wait times for hospital screening colonoscopy have increased dramatically in recent years, resulting in an increase in patient referrals to office-based endoscopy clinics. There is no formal regulation of office endoscopy, and it has been suggested that the quality of service in some office locations may be inferior to hospital procedures.OBJECTIVE: To compare the quality of office-based screening colonos-copies at a clinic in Oakville, Ontario, with published benchmarks for cecal intubation, withdrawal times, polyp detection, adenoma detection, cancer detection and patient complications.METHODS: Demographic information on consecutive patients and colonoscopy reports by all nine gastroenterologists at the Oakville Endoscopy Centre between August 2006 and December 2007 were prospectively obtained.RESULTS: A total of 3741 colonoscopies were analyzed. The mean age of patients was 57.1 years and 51.9% were women. The cecal intubation rate was 98.98% with an average withdrawal time of 9.75 min. A total of 3857 polyps were retrieved from 1725 patients (46.11%), and 1721 adenomas were detected in 953 patients (25.47%). A total of 126 patients (3.37%) had advanced polyps and 18 (0.48%) were diagnosed with colon cancer. One patient (0.027%) had a colonic perforation and two patients had postpolypectomy bleeding (0.053%). These results meet or exceed published benchmarks for quality colonoscopy.CONCLUSIONS: The Oakville Endoscopy Centre data demonstrate that office-based colonoscopies, performed by well-trained physicians using adequate sedation and hospital-grade equipment, result in outcomes at least equal to or better than those of published academic/community hospital practices and are therefore a viable option for the future of screening colonoscopy in Canada.
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Smith, Jeanette, Martin Donovan e Harvey Gordon. "Patients in Broadmoor Hospital from the South Western region: an audit of transfer procedures". Psychiatric Bulletin 15, n.º 2 (fevereiro de 1991): 81–84. http://dx.doi.org/10.1192/pb.15.2.81.
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Broadmoor Hospital is one of the three special hospitals covering England and Wales. It provides approximately 500 beds for mentally disordered patients who on account of their dangerous, violent or criminal propensities constitute a grave and immediate danger to the public, requiring treatment in conditions of special security (Section 4, National Health Service Act, 1977). It is generally recognised, however, that there are patients in special hospitals no longer requiring treatment in conditions of maximum security. These patients could probably be more appropriately cared for elsewhere if the facilities existed in general psychiatric hospitals or the community. However, special hospital consultants frequently encounter significant obstacles when attempting to transfer patients to local hospitals. Dell (1980) highlighted this problem, suggesting that 16% of special hospital patients were waiting to leave, following the agreement of the DHSS and the Home Office to their transfer. This delay appeared to be due to hospitals not wanting to accept patients who might prove to be difficult or dangerous. At the time of this current study (March 1990) these difficulties in transferring patients were particularly relevant as two of the special hospitals, Broadmoor and Ashworth (Park Lane and Moss Side) were full for male patients and therefore closed to male admissions, despite a continuing demand for beds.
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Coniglio, Andrew J., Allison M. Deal, Oam Bhate e Trevor G. Hackman. "In-office versus Operating Room Sialendoscopy: Comparison of Outcomes, Patient Time Burden, and Charge Analysis". Otolaryngology–Head and Neck Surgery 160, n.º 2 (20 de novembro de 2018): 255–60. http://dx.doi.org/10.1177/0194599818813101.
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Objective To evaluate outcomes of in-office versus operating room (OR) sialendoscopy/sialolithotomy and to recognize the efficiency of outpatient salivary gland surgery with significant time and facility charge reductions. Study Design Case series with chart review. Setting State hospital OR and ambulatory clinic. Subjects and Methods Retrospective review was performed of adult patients treated for inflammatory salivary diseases by a single surgeon from 2011 to 2016. The patients were divided into 2 groups based on procedure setting (office vs OR) and compared by various baseline features, including demographics, symptom onset and duration, stone size, symptomatic improvement, and recurrence. Patient time burden was compared via office procedure records and OR time charting from the electronic health record. Retrospective clinic and hospital charge sheets were tallied and similarly compared. Results The 2 cohorts (office, n = 111; OR, n = 96) were comparable in all demographics, including sialolith number and size (7.36 vs 6.69 mm, P = .45). Additional subgrouping was statistically similar. Both cohorts had similar postprocedure symptom improvement (97% vs 95.8%, P = .65) and recurrence rates (8.9% vs 14.5%, P = .22) independent of subgroup. Overall time burden for patients was 39 minutes in the office versus 277 minutes in the OR ( P ≤ .0001). Procedure and hospital charge data were tallied and compared (office, $719.21; OR, $13,956.14; P ≤ .0001). Conclusion Bothcohorts were statistically similar in all features. There was significant reduction in patient time burden and health care charges with office-based procedures while maintaining similar symptom improvement and recurrence rates.
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Eagam, M., e R. W. Hostoffer. "Reimbursement Driven Medicare Patients Receiving IVIgG in the Hospital vs. the Physician's Office". Journal of Allergy and Clinical Immunology 119, n.º 1 (janeiro de 2007): S14. http://dx.doi.org/10.1016/j.jaci.2006.11.071.
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Zapattini, Diego Hernán, e Ignacio Ortiz. "Therapeutic adherence in hypertensive patients of the Internal Medicine office at the Hospital de Clínicas". Anales de la Facultad de Ciencias Médicas (Asunción) 54, n.º 2 (30 de agosto de 2021): 89–96. http://dx.doi.org/10.18004/anales/2021.054.02.89.
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Brammer, Melissa, Deepa Lalla, Geneviève Gauthier, Annie Guérin, Philippe Giguere-Duval, Eric Q. Wu e Eduardo Santos. "Comparison of discontinuation, health care resource utilization (HRU), and costs between metastatic breast cancer (mBC) patients (pts) who received trastuzumab (T) in an office clinic versus outpatient hospital setting." Journal of Clinical Oncology 31, n.º 15_suppl (20 de maio de 2013): 642. http://dx.doi.org/10.1200/jco.2013.31.15_suppl.642.
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642 Background: T treatment for mBC may be administered in an office clinic or outpatient hospital setting. This study assesses the impact of the site of care on T discontinuation risk, HRU, and costs. Methods: Adult women with mBC who received ≥2 T infusions in an outpatient hospital or office clinic setting were selected from the US-based Humana database (2007-2012). Pts were required to be continuous eligible in their healthcare plan for ≥6 months prior and ≥2 months following the first T infusion (index date). Pts were classified, based on their index site of care, into one of the following cohorts: 1) office clinic, or 2) outpatient hospital. Outcomes were measured from the index date up to the end of continuous eligibility/data availability, a change in the site of care, or 12 months after the index date, whichever occurred first. Treatment discontinuation (gap ≥45 consecutive days) was compared between cohorts using multivariate Cox-proportional hazards model. Monthly healthcare costs (2012 USD) and HRU were compared between cohorts using multivariate generalized linear/two-part models, and multivariate negative binomial regression models, respectively. Results: A total of 280 pts met the inclusion criteria; 64% and 36% in the office clinic and outpatient hospital cohort, respectively. Baseline characteristics were similar between cohorts. However, differences were found in terms of insurance plan type, year of index date and comorbid conditions (chronic pulmonary disease and peripheral vascular disorder). After adjusting for confounding factors, the outpatient hospital cohort had a 1.5 time higher risk of treatment discontinuation (p=.043) and incurred an incremental monthly cost of $1,954 (p=<.001), mainly driven by higher office clinic and outpatient hospital costs ($1,483 p=.016). No differences were observed in HRU. Conclusions: Pts in the office clinics cohort were less likely to discontinue T and were associated with lower monthly total healthcare costs. Future research should examine the impact early discontinuation may have on clinical outcomes.
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Dewi, Nurmala, e Dian Megasari Pattimahu. "ANALISIS KEBUTUHAN TENAGA DOKTER UMUM DI UNIT GAWAT DARURAT RS ISLAM PKU MUHAMMADIYAH PADA TAHUN 2018". TECHNO: JURNAL PENELITIAN 8, n.º 1 (8 de setembro de 2019): 271. http://dx.doi.org/10.33387/tk.v8i1.948.
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There is no special rules in Indonesia that organize about office hours of medical doctor that cause doctor often work more than they have to. In North Maluku as known as Ternate, especially in Islamic Hospital, the number of medical doctor is very low than other hospital, besides Islamic Hospital is one of the highest visiting patient in North Maluku. There are a lot of rumour in people nowadays that the service of these hospital especially in Emergency Room was took too long and sometimes the patients family had to complain first before they got treatment from doctor. It may cause by unbalanced between amount of medical patient who visited and total of onduty doctor and it maybe even worsening with massive office hours. The study methode was Descriptive. The sample of this study were the office hour and the shift. The result of this study show that General Practitoner in Emergency Room at Islamic Hospital Ternate hace office hour more than they had to. In fact, these condition can effect their quality of work and unfortunately, their health.
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Aeyels, Daan, Luk Bruyneel, Peter R. Sinnaeve, Marc J. Claeys, Sofie Gevaert, Danny Schoors, Massimiliano Panella, Walter Sermeus e Kris Vanhaecht. "Care Pathway Effect on In-Hospital Care for ST-Elevation Myocardial Infarction". Cardiology 140, n.º 3 (2018): 163–74. http://dx.doi.org/10.1159/000488932.
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Objectives: To study the care pathway effect on the percentage of patients with ST-elevation myocardial infarction (STEMI) receiving timely coronary reperfusion and the percentage of STEMI patients receiving optimal secondary prevention. Methods: A care pathway was implemented by the Collaborative Model for Achieving Breakthrough Improvement. One pre-intervention and 2 post-intervention audits included all adult STEMI patients admitted within 24 h after onset and eligible for reperfusion. Adjusted (hospital random intercepts and controls for transfer and out-of-office admission) differences in composite outcomes were analyzed by a multilevel logistic regression. Results: Significant improvements in intervals between the first medical contact (FMC) to percutaneous coronary intervention (PCI) and between the door to PCI were shown between post-intervention audit II and post-intervention audit I. Secondary prevention significantly deteriorated at post-intervention audit I but improved significantly between both post-intervention audits. Six out of nine outcomes were significantly poorer in the case of transfer. The interval from FMC to PCI was significantly poorer for patients admitted during out-of-office hours. Conclusions: After care pathway implementation, composite outcomes improved for in-hospital STEMI care. Collaborative efforts exploited heterogeneity in performance between hospitals. Iterative and incremental care pathway implementation maximized performance improvement.
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Stoeckle, John D. "Primary Care and Diagnostic Testing Outside the Hospital". International Journal of Technology Assessment in Health Care 5, n.º 1 (janeiro de 1989): 21–30. http://dx.doi.org/10.1017/s0266462300005912.
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This article enumerates and describes the wide range of sites at which primary care is now offered; analyzes the impact of diagnostic testing procedures used in locations outside the doctor's office, such as imaging centers, hospices, and nursing homes; and looks at the effect of this decentralization on patients and medicine.
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Krückl, Jana Sophia, Julian Moeller, Rainer Gaupp, Christoph E. Meier, Carl Bénédict Roth, Undine Emmi Lang e Christian G. Huber. "Implementing Home Office Work at a Large Psychiatric University Hospital in Switzerland During the COVID-19 Pandemic: Field Report". JMIR Mental Health 8, n.º 9 (1 de setembro de 2021): e28849. http://dx.doi.org/10.2196/28849.
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Background During the COVID-19 pandemic in 2020, psychiatric hospitals all over the world had to adapt their services to the prevailing governmental regulations. As a consequence, home office use and telepsychiatry boomed. Objective The purpose of this study was to evaluate the potential of home office use, its adoption, and the association of home office use with employees’ mental health in a large psychiatric university hospital in Switzerland. Methods We obtained and analyzed home office implementation and use data from the psychiatric university hospital’s information technology services. We also conducted a cross-sectional web-based survey to assess the employees’ attitudes toward the clinic’s crisis management during the COVID-19 pandemic in early 2020. Part of this web-based survey consisted of questions about home office use between March and June 2020, attitudes toward home office implementation, and mental health. Three mental health measures assessed depressive symptoms (Patient Health Questionnaire [PHQ]–2), anxiety (General Anxiety Disorder [GAD]–2), and stress factors (stress module of the PHQ-D); a cut-off score ≥3 was used for the PHQ-2 and GAD-2. Results Of the 200 participating employees, 69 reported that they had worked from home at least partially (34.5%). Home office use differed significantly across professional groups (χ162=72.72, P≤.001, n=200). Employees experienced neither depressive symptoms (mean 0.76, SD 1.14) nor anxiety (mean 0.70, SD 1.03). The employees reported minor psychosocial stressors (mean 2.83, SD 2.92). The number of reported stress factors varied significantly across groups with different levels of home office use (χ42=9.72, P=.04). Conclusions In general, home office implementation appears to be feasible for large psychiatric hospitals, however, it is not equally feasible for all professional groups. Professional groups that require personal contact with patients and technical or manual tasks must work onsite. Further evaluation of home office use in psychiatric hospitals up to the development of clinics that function merely online will follow in future research. The situation created by the COVID-19 pandemic served as a stepping stone to promote home office use and should be used to improve employees’ work–life balance, to save employers costs and foster other benefits.
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Pelland, Kimberly D., Rosa R. Baier e Rebekah L. Gardner. "“It’s like texting at the dinner table”: A qualitative analysis of the impact of electronic health records on patient-physician interaction in hospitals". Journal of Innovation in Health Informatics 24, n.º 2 (4 de julho de 2017): 216. http://dx.doi.org/10.14236/jhi.v24i2.894.
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Background: Electronic health records (EHRs) may reduce medical errors and improve care, but can complicate clinical encounters.Objective: To describe hospital-based physicians’ perceptions of the impact of EHRs on patient-physician interactions and contrast these findings against office-based physicians’ perceptionsMethods: We performed a qualitative analysis of comments submitted in response to the 2014 Rhode Island Health Information Technology Survey. Office- and hospital-based physicians licensed in Rhode Island, in active practice, and located in Rhode Island or neighboring states completed the survey about their Electronic Health Record use.Results: The survey’s response rate was 68.3% and 2,236 (87.1%) respondents had EHRs. Among survey respondents, 27.3% of hospital-based and 37.8% of office-based physicians with EHRs responded to the question about patient interaction. Five main themes emerged for hospital-based physicians, with respondents generally perceiving EHRs as negatively altering patient interactions. We noted the same five themes among office-based physicians, but the rank-order of the top two responses differed by setting: hospital-based physicians commented most frequently that they spend less time with patients because they have to spend more time on computers; office-based physicians commented most frequently on EHRs worsening the quality of their interactions and relationships with patients.Conclusion: In our analysis of a large sample of physicians, hospital-based physicians generally perceived EHRs as negatively altering patient interactions, although they emphasized different reasons than their office-based counterparts. These findings add to the prior literature, which focuses on outpatient physicians, and can shape interventions to improve how EHRs are used in inpatient settings.
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Grubin, D. H. "Unfit to Plead in England and Wales, 1976–88". British Journal of Psychiatry 158, n.º 4 (abril de 1991): 540–48. http://dx.doi.org/10.1192/bjp.158.4.540.
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The Home Office files of all 295 cases of defendants being found unfit to plead between 1976 and 1988 were evaluated. The majority were male and either schizophrenic or mentally impaired. Median age was 32 years. Two-thirds had past criminal convictions, and nearly 90% had past contact with psychiatric or social services, but only 28% were receiving psychiatric care at the time of their alleged offence; 14% were hospital in-patients. Offences of theft and violence predominated, but in most cases they were not of a serious nature: 34% were rated as mild or nuisance, 40% moderate, and 26% severe. In more than 80% of cases, evidence linking the accused with the offence seemed good. Less than one-third were admitted to special hospitals. Forty-six per cent of the population (135 patients) eventually regained their capacity to plead (within a median of four months), with 76 (26%) returning for trial. Of the remainder, 68 (23%) are still in hospital, 39 of whom have been there for more than five years. Time to discharge without trial reflected the severity of the alleged offence.
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Ong, M. E., A. S. Wong, S. G. Teo, C. M. Seet, B. L. Lim, D. C. Foo, S. M. Lai et al. "(A80) Nationwide Study to Improve Door-to-Balloon Times in Patients with Acute St Elevation Myocardial Infarction Requiring Primary Percutaneous Coronary Intervention Using Prehospital ECG Transmission". Prehospital and Disaster Medicine 26, S1 (maio de 2011): s22. http://dx.doi.org/10.1017/s1049023x11000859.
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ObjectiveTo reduce nationwide door-to-balloon times (DTB) in patients presenting with acute ST-elevation myocardial infarction (STEMI) requiring primary percutaneous coronary intervention (PCI), by adoption of pre-hospital wireless 12-lead electrocardiogram (ECG) transmission by Singapore's national ambulance service.MethodsA phased, prospective, before-after, interventional study of all patients who presented to the national ambulance service with the diagnosis of STEMI. In the ‘Before’ phase, chest pain patients only received 12-lead ECGs on arrival at the Emergency Departments (ED), where diagnosis of STEMI could be made. In the ‘After’ phase, 12-lead ECGs were performed in the field by ambulance crews and transmitted while en-route to the hospitals. Diagnoses of STEMI was made by on-duty emergency physicians (EP) prior to patients' arrival and PCI activated. Data was collected from ambulance run sheets, ECG transmission logs, EDs and cardiology units.Results451 eligible patients from “Before” and 214 patients from “After” phase were included in the analysis. Median DTB time was 88 minutes in the “Before” and 52 minutes in the “After” phase (p = 0.0001). During office hours, median DTB times for ‘Before’ and ‘After’ phases were 84 minutes and 47 minutes, respectively (p = 0.0001). After office hours, median DTB times for ‘Before’ and ‘After’ phases were 95 minutes and 54 minutes, respectively (p = 0.0001). There were 11 false positive activations in “Before” phase and one in the “After” phase.ConclusionPre-hospital ECG transmission resulted in significant reduction of DTB time; this effect occurred regardless of whether patients presented to the ED before or after office hours. No increase in false activations was found in the “After” phase. Pre-hospital ECG transmission should be adopted as “standard of care” for all STEMI cases meeting the criteria for PCI.
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Voizard, Béatrice, Anastasios Maniakas e Issam Saliba. "Office-Based Stapes Surgery". Otolaryngology–Head and Neck Surgery 161, n.º 6 (1 de outubro de 2019): 1018–26. http://dx.doi.org/10.1177/0194599819877652.
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Objective The objective of this study was to provide a proof of concept and to assess the success and safety of stapes surgery for otosclerosis under local anesthesia in an office-based setting (OBS) as compared with a hospital operating room setting (ORS). Study Design Retrospective cohort study. Setting We reviewed all patients who underwent stapes surgery by the same surgeon from October 2014 to January 2017 at our tertiary care center (ORS, n = 36, 52%) and in an OBS (n = 33, 48%). Subjects and Methods The surgical technique was identical in both groups. All patients had a temporal bone computed tomography scan and audiogram within the 6 months prior to surgery. Air-bone gaps (ABGs), bone conduction, and air conduction pure tone average values were calculated. Preoperative results for pure tone average, bone conduction, ABG, and word recognition scores were compared with early (4 months) and late (12 months) follow-up audiograms. Intra- and postoperative complications were compared. Results Both groups were comparable in terms of demographic characteristics and severity of disease. The mean 1-year postoperative ABG was 5.66 dB (95% CI = 4.42-6.90) in the ORS group and 6.30 dB (95% CI = 4.50-8.10) in the OBS group ( P = .55). ABG improved by 24.27 dB (95% CI = 21.40-27.13) in the ORS group and 23.15 dB (95% CI = 18.45-27.85) in the OBS group ( P = .68). Complication rates did not differ, although this study remains underpowered. Conclusions In this small group of patients, the success of stapes surgery performed in an OBS and its complications were comparable to those of an ORS, thus providing an alternative to patients on long operating room waiting lists.
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Megwalu, Uchechukwu C., Yifei Ma, Tina Hernandez-Boussard, Vasu Divi e Scarlett Lin Gomez. "The Impact of Hospital Quality on Thyroid Cancer Survival". Otolaryngology–Head and Neck Surgery 162, n.º 3 (21 de janeiro de 2020): 269–76. http://dx.doi.org/10.1177/0194599819900760.
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Objective To develop a composite measure of thyroid cancer–specific hospital quality and to evaluate the association between hospital quality and survival in patients with well-differentiated thyroid cancer. Study Design Retrospective cohort study. Setting Population-based cancer database. Subjects and Methods Data were extracted from the California Cancer Registry data set linked with discharge records and hospital characteristics from the California Office of Statewide Health Planning and Development. The study cohort comprised adult patients with well-differentiated thyroid cancer diagnosed between January 1, 2004, and December 31, 2015. Principal component analysis, incorporating hospital volume, adherence to national guidelines, and accreditation/certification status, was used to generate a composite thyroid cancer–specific hospital quality score. Results Treatment in hospitals ranked in the highest quartile of quality was associated with improved overall survival (OS) (hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.67-0.98) and disease-specific survival (DSS) (HR, 0.72; 95% CI, 0.54-0.98). Treatment in hospitals meeting the combined metric of 10 or more thyroid cancer cases/year and 80% of patients with high-risk tumors treated with total/near-total thyroidectomy was associated with improved OS (HR, 0.80; 95% CI, 0.70-0.90) and DSS (HR, 0.77; 95% CI, 0.64-0.94). Conclusion Treatment in high-quality hospitals is associated with improved survival outcomes in patients with thyroid cancer. These findings are important because they help identify hospitals that are better suited to treat patients with thyroid cancer and provide actionable targets for quality improvement.
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Kim, I. V., E. N. Penyugina, I. M. Barsukova e R. I. Minnullin. "MEDICAL SORTING IN THE HOSPITAL OF EMERGENCY MEDICAL SERVICE: THE ENTERING STREAM ON THE OBSTETRICS AND GYNECOLOGY PROFILE". EMERGENCY MEDICAL CARE 22, n.º 1 (6 de abril de 2021): 40–45. http://dx.doi.org/10.24884/2072-6716-2021-22-1-40-45.
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Relevance. Among the purposes and target indicators of the implemented National projects by the end of 2024 it should be noted increase in the expected duration of healthy life, increase in total coefficient of birth rate up to 1.7 on one woman which achievement is impossible without ensuring female health.The purpose: the analysis of a flow of the patients of an obstetric and gynecologic profile coming to a versatile hospital of emergency medical service (2015–2019).Methodology. Data of the versatile 800-bed hospital incorporating 60 beds for patients of an obstetric and gynecologic profile served as materials of a research. Statistical and analytical methods of a research are used.Results. The analysis of the entering stream (36.4 thousand in 5 years) with the diagnosis on the “obstetrics and gynecology” profile (the diagnosis of the direction) showed that most of them — 50.6% (р<0.01) were directed by the medical organizations of emergency medical service, 36.3% — the medical organizations of polyclinic link, 3.2% — the medical organizations of stationary type, and 9.8% — independently asked for medical care. 77.6% of patients arrived from 9:00 till 21:00, including 32.9% — from 9:00 till 12:00; the condition of 94.3% is regarded as satisfactory (р<0.01), only 71.5% of patients came to specialized offices according to a direction profile. The average time of stay of patients in office was about 2 hours (121.2±117.0 min.). Conclusion. Development of stationary offices of emergency medical service gives the chance of sorting of the arriving patients according to weight of a state and needs in specialized medical and diagnostic actions. The diagnosis only of 71.5% of the arriving patients corresponds to a direction profile. The share of patients (for 50.2%), capable to ask independently for medical care grows. Every fifth patient who is almost arriving in the emergency order receives adequate (necessary and sufficient) the volume of medical care in office of emergency medical service.
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Manchikanti, Laxmaiah. "Reframing Medicare Physician Payment Policy for 2019: A Look at Proposed Policy". January 2018 1, n.º 21;1 (15 de setembro de 2018): 415–32. http://dx.doi.org/10.36076/ppj.2018.5.415.
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On July 12, 2018, the Centers for Medicare and Medicaid Services (CMS) released the proposed 2019 Medicare physician fee schedule and quality payment program, combining these 2 rules for the first time. This occurred in a milieu of changing regulations that have been challenging for interventional pain management specialists. The Affordable Care Act (ACA) continuous to be amended by multiple administrative changes. This July 12th rule proposes substantial payment changes for evaluation and management (E&M) services, with documentation requirements, and blending of Level II to V CPT codes for E&M into a single payment. In addition, various changes in the quality payment program with liberalization of some metrics have been published. Recognizing that there are differing impacts based on specialty and practice type, as a whole interventional pain management specialists would likely see favorable reimbursement trends for E&M services as a result of this proposal. Moreover, in comparison with recent CMS final ruling, this proposed rule has relatively limited changes in procedural reimbursement performed in a facility or in-office setting. CMS, in the new rule, has proposed an overhaul of the E&M documentation and coding system ostensibly to reduce the amount of time physicians are required to spend inputting information into patients’ records. The new proposed rule blends Level II to V codes for E&M services into a single payment of $93 for office outpatient visits for established patients and $135 for new patient visits. This will also have an effect with blended payments for services provided in hospital outpatients. CMS also has provided additional codes to increase the reimbursement when prolonged services are provided with total reimbursement coming to Level V payments. Interventional pain managementcentered care has been identified as a specialty with complexity inherent to E&M associated with these services. Among the procedural payments, there exist significant discrepancies for the services performed in hospitals, ambulatory surgery centers (ASCs), and offices. A particularly egregious example is peripheral neurolytic blocks, which is reimbursed at 1,800% higher in hospital outpatient department (HOPD) settings as compared with procedures done in the office. The majority of hospital based procedures have faced relatively small cuts as compared with office based practice. The only significant change noted is for spinal cord stimulator implant leads when performed in office setting with 19.2% increase. However, epidural codes, which have been initiated with a lower payment, continue to face small reductions for physician portion. This review describes the effects of the proposed policy on interventional pain management reimbursement for E&M services, procedural services by physicians and procedures performed in office settings. Key words: Physician payment policy, physician fee schedule, Medicare, Merit-Based Incentive Payment System, interventional pain management, regulatory tsunami, Medicare Access and CHIP Reauthorization Act of 2015
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Ohsfeldt, Robert L., Pengxiang Li, John E. Schneider, Ivana Stojanovic e Cara M. Scheibling. "Outcomes of Surgeries Performed in Physician Offices Compared With Ambulatory Surgery Centers and Hospital Outpatient Departments in Florida". Health Services Insights 10 (1 de janeiro de 2017): 117863291770102. http://dx.doi.org/10.1177/1178632917701025.
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Background: The proportion of outpatient surgeries performed in physician offices has been increasing over time, raising concern about the impact on outcomes. Objective: To use a private insurance claims database to compare 7-day and 30-day hospitalization rates following relatively complex outpatient surgical procedures across physician offices, freestanding ambulatory surgery centers (ASCs), and hospital outpatient departments (HOPDs). Methods: A multivariable logistic regression model was used to compare the risk-adjusted probability of hospitalization among patients after any of the 88 study outpatient procedures at physician offices, ASCs, and HOPDs over 2008-2012 in Florida. Results: Risk-adjusted hospitalization rates were higher following procedures performed in physician offices compared with ASCs for all procedures grouped together, for most procedures grouped by type, and for many individual procedures. Conclusions: Hospitalizations following surgery were more likely for procedures performed in physician offices compared with ASCs, which highlights the need for ongoing research on the safety and efficacy of office-based surgery.
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Chino, Kristin, Steven Ganzberg e Kristopher Mendoza. "Office-Based Sedation/General Anesthesia for COPD Patients, Part I". Anesthesia Progress 65, n.º 4 (1 de dezembro de 2018): 261–68. http://dx.doi.org/10.2344/anpr-65-04-12.
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The safe treatment of patients with chronic obstructive pulmonary disease (COPD) in dental office–based settings can be quite complex without a current understanding of the etiology, course, severity, and treatment modalities of the disease. The additional concerns of providing sedation and/or general anesthesia to patients with COPD in settings outside of a hospital demand thorough investigation of individual patient presentation and realistic development of planned treatment that patients suffering from this respiratory condition can tolerate. Along with other comorbidities, such as advanced age and potential significant cardiovascular compromise, the dental practitioner providing sedation or general anesthesia must tailor any treatment plan to address multiple organ systems and mitigate risks of precipitating acute respiratory failure from inadequate pain and/or anxiety control. Part I of this article will cover the epidemiology, etiology, and pathophysiology of COPD. Patient evaluation in the preoperative period will also be reviewed. Part II will cover which patients are acceptable for sedation/general anesthesia in the dental office–based setting as well as sedation/general anesthesia techniques that may be considered.
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Chino, Kristin, Steven Ganzberg e Kristopher Mendoza. "Office-Based Sedation/General Anesthesia for COPD Patients, Part II". Anesthesia Progress 66, n.º 1 (1 de março de 2019): 44–51. http://dx.doi.org/10.2344/anpr-66-02-05.
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The safe treatment of patients with chronic obstructive pulmonary disease (COPD) in dental office office-based settings can be quite complex without a current understanding of the etiology, course, severity, and current treatment modalities of the disease. The additional concerns of providing sedation and/or general anesthesia to patients with COPD in settings outside of a hospital demand thorough investigation of individual patient presentation and realistic development of planned treatment that patients suffering from this respiratory condition can tolerate. Along with other co-morbidities, such as advanced age and potential significant cardiovascular compromise, the dental practitioner providing sedation or general anesthesia must tailor any treatment plan to address multiple organ systems and mitigate risks of precipitating acute respiratory failure from inadequate pain and/or anxiety control. Part I of this article covered the epidemiology, etiology, and pathophysiology of COPD. Patient considerations in the preoperative period were also reviewed. Part II will cover which patients are acceptable for sedation/general anesthesia in the dental office-based setting as well as sedation/general anesthesia techniques that may be considered. Postoperative care will also be reviewed.
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Langille, DB, L. Yates e TJ Marrie. "Serological Investigation of Pneumonia as It Presents to the Physician’s Office". Canadian Journal of Infectious Diseases 4, n.º 6 (1993): 328–32. http://dx.doi.org/10.1155/1993/435350.
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Purpose: To define the etiology of pneumonia, using a battery of serological tests, among patients presenting to physicians’ offices in Cumberland County, Nova Scotia from July 2, 1989 to July 1, 1990.Methods: Patients presenting to their physician’s office with symptoms suggestive of pneumonia were invited to participate in the study by completing a questionnaire, having a chest radiograph and providing acute and convalescent phase serum samples. These serum samples were tested for antibodies toMycoplasma pneumoniae, Coxiella burnetii, Legionella pneumophila, adenovirus, and influenza viruses A and B. Some of the samples were tested for antibodies toChlamydia pneumoniae.Results: Seventy-five of the inception cohort of 203 patients had a chest radiograph compatible with pneumonia, a completed questionnaire and acute and convalescent phase serum samples. There were 39 females and 36 males with a mean age of 41.7 years. Twenty-six (35%) were admitted to hospital. The mortality rate was 3%. Forty-five per cent had a diagnosis made by serology:M pneumoniae, 22 (29%); influenza A virus, five (7%);C burnetii, L pneumophila, adenovirus, two (3%) each.Conclusions: While it is not possible to generalize about these findings because of ascertainment bias, the data suggest thatM pneumoniaeis a common cause of pneumonia presenting to a physician’s office and that mortality is low in this group of patients.
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White, T., e H. Rutherford. "An Audit of Urgent Referrals by the Procurator Fiscal to the Tayside Forensic Psychiatric Service". Medicine, Science and the Law 45, n.º 4 (outubro de 2005): 311–16. http://dx.doi.org/10.1258/rsmmsl.45.4.311.
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This study describes the demographic, offence and diagnostic characteristics of subjects referred by the Procurators Fiscal operating from three courts in Tayside, Scotland. A comparison is made of referrals made between 1988 to 1995 and 1997 to 1998. There was an increased rate of referral on an urgent basis over time, primarily involving patients already in contact with the psychiatric services, 37% of whom were detained and admitted to hospital. This urgent assessment ensured that mentally-disordered offenders were not remanded in custody simply for the preparation of a report, and it allowed an early assessment to be made regarding the suitability for diversion from prosecution. This outcome is compatible with guidelines issued by the Home Office in 1990 (Home Office, 1990).
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Manchikanti, Laxmaiah. "Recommendations of the Medicare Payment Advisory Commission (MEDPAC) on the Health Care Delivery System: The Impact on Interventional Pain Management in 2014 and Beyond". Pain Physician 5;16, n.º 5;9 (14 de setembro de 2013): 419–40. http://dx.doi.org/10.36076/ppj.2013/16/419.
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Continuing rise in health care costs in the United States, the Affordable Care Act (ACA), and a multitude of other regulations impact providers in 2013. Despite federal spending slowing in the past 2 years, the Board of Medicare Trustees believes that cost savings are only achievable if health care providers are able to realize productivity improvements at a quicker pace than experienced historically. Consequently, the re-engineering of U.S. health care and bridging of the divide between health and health care have been proposed beyond affordable care. Thus, the Medicare Payment Advisory Commission (MedPAC) envisions alignment of Medicare payment systems to eliminate variable rates for the same ambulatory services provided to similar patients in different settings, such as the physician’s office, hospital outpatient departments (HOPDs), and ambulatory surgery centers (ASCs). MedPAC believes that if the same service can be safely provided in different settings, a prudent purchaser should not pay more for that service in one setting than in another. MedPAC is also concerned that payment variations across settings encourage arrangements among providers that result in care being provided in high paid settings. MedPAC recommends that payment rates be based on the resources needed to treat patients in the most efficient setting, adjusting for differences in patient severity, to the extent the severity differences affect costs. MedPAC has analyzed the costs of evaluation and management (E&M) services and the differences between providing them in a HOPD setting compared to a physician office setting, echocardiography services, and multiple services provided in ASCs and HOPDs. MedPAC has shown that for an established patient office visit (CPT 99213) provided in a free-standing physician’s office, the program pays the physician 70% less than in HOPD setting with a payment for physician practice of $72.50 versus $123.38 for HOPD setting. Similarly, for a Level II echocardiogram, HOPD costs 141% more for the same service than a free-standing office ($188.31 versus $452.89). For interventional techniques, Medicare payments vary from physician office to HOPD setting, with $211.96 in an office setting, $407.28 in ASC setting, and $655.62 in HOPD for procedures such as epidural injections. The MedPAC proposal for changing HOPD payment rates for services would reduce program spending and result in beneficiary cost sharing by $900 million in one year. On average, hospitals’ overall Medicare revenue will decline by 0.6% and HOPD revenue would fall by 2.7%. Further, MedPAC provided a specific example that aligning payment rates between HOPDs and freestanding offices only for cardiac imaging services would reduce program spending and beneficiary cost sharing by $500 million in one year. In estimating the savings that would be realized by equalizing payment rates between HOPDs and ASCs for certain ambulatory surgical procedures, MedPAC have shown potential Medicare program spending and beneficiary cost savings to be about $590 million per year. The impact of the proposed policies that are discussed in this manuscript would result in savings of approximately $1.5 billion per year for Medicare. MedPAC also has recommended a stop-loss policy that would limit the loss of Medicare revenue for those hospitals. Key words: Medicare, health care delivery system, Medicare Payment Advisory Commission (MedPAC), hospital outpatient departments (HOPDs), ambulatory surgery centers (ASCs), physician office practices
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Miller, Anya J., e Glendon M. Gardner. "In-Office vs. Operating Room Procedures for Recurrent Respiratory Papillomatosis". Ear, Nose & Throat Journal 96, n.º 4-5 (abril de 2017): E24—E28. http://dx.doi.org/10.1177/0145561319889538.
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We conducted a study to analyze hospital and patient costs, outcomes, and patient satisfaction among adults undergoing in-office and operating room procedures for the treatment of recurrent respiratory papillomatosis. Our final study population was made up of 17 patients—1 man and 16 women, aged 30 to 86 years (mean: 62). The mean number of in-office laser procedures per patient was 4.2, and the mean interval between procedures was 5.4 months (although 10 patients underwent only 1 office procedure); the mean number of operating room procedures was 13.5, and the mean interval between procedures was 14.3 months. An equal number of patients reported complications or adverse events with the two types of procedures—5 each. The difference in cost between the office procedure (mean: $3,413.00) and the operating room procedure (mean: $12,382.59) was almost $9,000, but these savings were offset by the fact that the office procedures needed to be performed three times as often. Patients reported slightly more anxiety and discomfort during the office procedures and, overall, they appeared to prefer the operating room procedure. We conclude that office procedures are significantly more cost-effective than operating room procedures, but their use may be limited by patient tolerance and the increased frequency of the procedure.
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Dörner, Kinga, Melinda Kis, Emese Markovics, Orsolya Birta, Zsuzsa Koszta, Cristian Boeriu, Hajnal Vass e Melinda Székely. "Original Research. A Two-year Retrospective Study of Emergency Dental Treatments at Mureș County Emergency Hospital". Journal of Interdisciplinary Medicine 2, s1 (1 de março de 2017): 25–30. http://dx.doi.org/10.1515/jim-2017-0009.
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Abstract Background: Emergency dental care is provided at the Mureș County Emergency Hospital in Tîrgu Mureș since February 2012, however, there is little information available regarding its activity. Therefore, the aim of the study was to evaluate the prevalence and diagnosis of dental emergency cases treated in this dental office over the first two years. Material and methods: This two-year retrospective study was based on the analysis of patients’ dental records who were treated at the Dental Office of the Mureș County Emergency Hospital in Tîrgu Mureș. Results: In the first year 5567 patients were treated, whereas in the second year their number was significantly higher, 7213 patients. Pulp infections presented the highest prevalence in both years: 32.38% and 34.74%, respectively. Compared to the first year (n = 1,803) significantly more cases (p = 0.001) were treated with this diagnosis in the second year (n = 2,506). Periodontal infections were significantly more frequent (p <0.001) in the second year compared to the first - 951 cases (13.18%) vs. 681 (12.23%) cases. Conclusions: The main reasons of emergency dental treatments were dental and periodontal infections. The results suggest that dental care is unaffordable to socially disadvantaged persons, and this fosters radical treatment of pain in this free of charge 24 h dental emergency office.
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Knapp, Dee. "Nonemergency, Ambulatory Visits by Patients ≥ 75 Years to Hospital Outpatient Departments versus Office-Based Physicians:". Journal of Geriatric Drug Therapy 10, n.º 3 (11 de julho de 1996): 37–62. http://dx.doi.org/10.1300/j089v10n03_04.
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Potts, J. M. "The Home Office Mental Health Unit". Psychiatric Bulletin 20, n.º 12 (dezembro de 1996): 742–43. http://dx.doi.org/10.1192/pb.20.12.742.
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On 1 April the mental health section of the Home Office's C3 Division was renamed “Mental Health Unit”, as part of a wider initiative to streamline the Department and give more meaningful titles to the various different areas of work. The responsibilities of our Unit remain the same, however. First, we deal with the cases of restricted patients under mental health legislation. As well as advising Ministers or taking decisions on their behalf about leave, transfers and discharge, the Unit also authorises the transfer of mentally disordered prisoners to hospital. This prison transfer work is focused in a separate section of the Unit which is able to provide a very rapid response to urgent requests for transfer warrants. The number of transfers has gone up from 337 in 1990 to over 700 in each of the last three years.
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Lethem, Rosemary. "Aftercare: who attends section 117 meetings?" Psychiatric Bulletin 19, n.º 2 (fevereiro de 1995): 106–7. http://dx.doi.org/10.1192/pb.19.2.106.
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The purpose of aftercare is to enable patients to return to their home or accommodation other than a hospital or nursing home, and to minimse the need for future in-patient care. Under section 117 of the Mental Health Act 1983, local health and social services authorities have a legal duty to provide aftercare for certain categories of patients when they leave hospital (Department of Health and Welsh Office, 1993).
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Clarke, Christina A., Laurence C. Baker, Jennifer Malin, Joseph Parker, Merry Holliday-Hanson, Niya Fong, Stephanie Teleki, Lance Lang e Maryann O'Sullivan. "Creating an online resource providing hospital cancer surgery volumes in California." Journal of Clinical Oncology 34, n.º 7_suppl (1 de março de 2016): 172. http://dx.doi.org/10.1200/jco.2016.34.7_suppl.172.
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172 Background: Little evidence is available to help patients and providers, payers and policymakers find the highest-quality hospitals for cancer surgery. We initiated a groundbreaking effort in California ( www.calqualitycare.org ) to publicly report hospital cancer surgery volume data online. Methods: With financial support from the nonprofit California HealthCare Foundation, we assembled a multidisciplinary team to oversee the project and ensure sound methodology. We obtained existing hospital discharge summary data from the California Office of Statewide Health Planning and Development (OSHPD). We selected cancer surgeries eligible for display through comprehensive review of the literature addressing the association of hospital volume and mortality. We found eleven cancer sites with sufficient evidence of association including bladder, brain, breast, colon, esophagus, liver, lung, pancreas, prostate, rectum, and stomach. Experts advised volume calculation and display of results. Leaders of low volume hospitals were interviewed to understand the reasons for low volume. Results: In 2014, about 60% of cancer surgeries in California were performed at hospitals in the top 20% of volume, but many hospitals performed low numbers of complex procedures, with the per hospital median number of surgeries for esophageal, pancreatic, stomach, liver, or bladder cancer surgeries at 4 or less. Low-volume hospitals included rural and urban hospitals, with small and large bed sizes, and teaching and non-teaching status. At least 670 Californians received cancer surgery at hospitals that performed only one or two surgeries for a particular cancer site; 72% of those patients lived within 50 miles of a top-20% volume hospital. Conclusions: This project demonstrates the potential for public information about hospital volumes to point patients towards high-volume and away from low-volume hospitals. Data regarding 2014 volumes are now available online.
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John, Shibu, Rasika Sharma e Manoj Kumar Dhingra. "Role of Employee Satisfaction in Influencing Patient Satisfaction". International Journal of Research Foundation of Hospital and Healthcare Administration 1, n.º 1 (2013): 13–18. http://dx.doi.org/10.5005/jp-journals-10035-1003.
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ABSTRACT The proposed study is an attempt to understand the link between Outpatient Department (OPD) patient satisfaction and job satisfaction among front office executives of the OPD. The study was conducted in a 300 bedded multispecialty hospital in Delhi. The study is very important as the OPD is considered to be the mirror of any hospital, which reflects the functioning of the hospital being the first point of contact between the patient and the hospital staff. A structured questionnaire was used in conducting the study. Total 158 patients were interviewed during 2 months period. Stratified random sampling technique used in selecting the samples. Both type of patients, first timers and old patient participated in the study. As second part of the study, all 22 front office executives from the above-mentioned three concerned departments were participated. The age group of the employees ranged from 20 to 50 years. How to cite this article John S, Sharma R, Dhingra MK. Role of Employee Satisfaction in Influencing Patient Satisfaction. Int J Res Foundation Hosp Healthc Adm 2013;1(1):13-18.
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Lalwani, Kirk, Matthew Tomlinson, Jeffrey Koh e David Wheeler. "Office-Based Deep Sedation for Pediatric Ophthalmologic Procedures Using a Sedation Service Model". Anesthesiology Research and Practice 2012 (2012): 1–4. http://dx.doi.org/10.1155/2012/598593.
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Aims. (1) To assess the efficacy and safety of pediatric office-based sedation for ophthalmologic procedures using a pediatric sedation service model. (2) To assess the reduction in hospital charges of this model of care delivery compared to the operating room (OR) setting for similar procedures.Background. Sedation is used to facilitate pediatric procedures and to immobilize patients for imaging and examination. We believe that the pediatric sedation service model can be used to facilitate office-based deep sedation for brief ophthalmologic procedures and examinations.Methods. After IRB approval, all children who underwent office-based ophthalmologic procedures at our institution between January 1, 2000 and July 31, 2008 were identified using the sedation service database and the electronic health record. A comparison of hospital charges between similar procedures in the operating room was performed.Results. A total of 855 procedures were reviewed. Procedure completion rate was 100% (C.I. 99.62–100). There were no serious complications or unanticipated admissions. Our analysis showed a significant reduction in hospital charges (average of $1287 per patient) as a result of absent OR and recovery unit charges.Conclusions. Pediatric ophthalmologic minor procedures can be performed using a sedation service model with significant reductions in hospital charges.
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Flevari, Pagona, Irene Zorou, Athanassios Tsakris e George Saroglou. "Surveillance System and Prevalence of Healthcare-Associated Infections in a Maternity Hospital". ISRN Infectious Diseases 2013 (10 de setembro de 2013): 1–5. http://dx.doi.org/10.5402/2013/849493.
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Obstetrician-gynaecologist (Ob-Gyn) medical and nursing personnel usually have minimal in action training on infection control (IC). Limited information exists also about the epidemiology of healthcare-associated infections (HAIs) in maternity hospitals. The aim of this study was to determine in a 30-day survey prevalence of HAIs among hospitalised patients and neonates in a maternity hospital in Athens, Greece, and to offer to the IC office a practical IC manual. Patients hospitalized for more than 24 h in the clinics and the neonatal intensive care unit (NICU) were enrolled. An IC guide was created and distributed to the medical and nursing staff through educational seminars. Through the survey, among Ob-Gyn patients 16 HAIs were recognized during hospitalization and 14 HAIs after patients’ discharge; the overall prevalence of infected patients was 2.9% and the prevalence of HAIs was 3.2%. Among NICU patients, the prevalence of HAIs was 3.9%. The IC manual was found easily implemented in daily use improving staff’s compliance to IC practices. The results of the survey can be used as a baseline for future comparisons between maternity hospitals (benchmarking). The implementation of steady IC guideline protocols for a maternity hospital may update staff education and promote staff compliance on IC practices.
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Wang, Zhixiao, Xuan Li e Claudio Faria. "Characterization of health care resource utilization and costs in women with metastatic breast cancer in Medicaid." Journal of Clinical Oncology 30, n.º 15_suppl (20 de maio de 2012): e16521-e16521. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.e16521.
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e16521 Background: The costs of treating patients with metastatic breast cancer (mBC) have been examined in several studies, but there is very limited information regarding healthcare resource utilization (HCRU) and costs of mBC among Medicaid beneficiaries. The objective of this study was to characterize HCRU and costs in Medicaid among women with mBC. Methods: Women with mBC who were younger than 65 were identified using Thomson Reuters’ Medicaid claims data from 12-13 states (2005-2009). Overall HCRU and medical costs were estimated in those patients and compared to breast cancer (BC) patients without metastasis identified in the same population. Index date is the date of BC (or mBC) diagnosis and patients were followed to the date of disenrollment or the end of the study period, whichever occurred first. Mean (95% CI) cumulative healthcare costs were estimated using Kaplan-Meier Sample Average method. Results: 4,745 patients were included in the analysis. Among them, 3,767 were BC patients without metastasis and 978 with mBC. During an average of 14 months of follow up time, mBC patients on average incurred 1.56 hospital admissions, 9.01 inpatient days, and 1.97 emergency room (ER) visits, 25.54 physician office visits, 21.43 hospital outpatient visits, and 40.96 prescriptions. The total medical cost averaged at $63,068 (95% CI: $59,504, $66,624) per mBC patient, of which 33.0% were hospitalization costs, followed by hospital outpatient cost (27.4%) and physician office visit cost (14.8%). The average follow up time for BC patients was 18 months, during which BC patients on average incurred 0.69 hospital admissions, 3.79 inpatient days, 1.96 ER visits, 19.96 physician office visits, 12.27 hospital outpatient visits, and 40.89 prescriptions, and the total cost averaged at $29,776 (95% CI: $28,795, $30,762). Major cost drivers by type of service are similar to mBC. Conclusions: Overall HCRU and costs are substantially higher in mBC patients compared to BC patients of earlier stages in the Medicaid population, and the major cost drivers are similar in mBC and BC. Continuous Medicaid coverage is essential for BC/mBC patients in financial disadvantage to have access to quality medical care.
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Wessels, Lyndsey E., Richard Y. Calvo, Michael J. Sise, Jason M. Bowie, William J. Butler, Vishal Bansal e C. Beth Sise. "Association of Operative Repair Type and Trauma Center Designation With Outcomes in Ruptured Abdominal Aortic Aneurysm Repair". Vascular and Endovascular Surgery 54, n.º 4 (21 de fevereiro de 2020): 325–32. http://dx.doi.org/10.1177/1538574420907193.
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Objective: Open repair of ruptured abdominal aortic aneurysm (rAAA) has shown improved outcomes at trauma centers. Whether the benefit of trauma center designation extends to endovascular repair of rAAA is unknown. Methods: Retrospective cohort study using the California Office of Statewide Health Planning and Development 2007 to 2014 discharge database to identify patients with rAAA. Data included demographic and admission factors, discharge disposition, International Classification of Diseases, Ninth Revision, Clinical Modification codes, and hospital characteristics. Hospitals were categorized by trauma center designation and teaching hospital status. The effect of repair type and trauma center designation (level I, level II, or other—other trauma centers and nondesignated hospitals) was evaluated to determine rates and risks of 9 postoperative complications, in-hospital mortality, and 30-day postdischarge mortality. Results: Of 1941 rAAA repair patients, 61.2% had open and 37.8% had endovascular; 1.0% had both. Endovascular repair increased over the study interval. Hospitals were 12.0% level I, 25.0% level II, and 63.0% other. A total of 48.7% of hospitals were teaching hospitals (level I, 100%; level II, 42.2%; and other, 41.8%). Endovascular repair was significantly more common at teaching hospitals (41.5% vs 34.3%, P < .001) and was the primary repair method at level I trauma centers ( P < .001). Compared with open repair, endovascular repair was protective for most complications and in-hospital mortality. The risk for in-hospital mortality was highest among endovascular patients at level II trauma centers (hazard ratio 1.67, 95% confidence interval [CI]: 0.95-2.92) and other hospitals (hazard ratio 1.66, 95% CI: 1.01-2.72). Conclusions: Endovascular repair overall was associated with a lower risk of adverse outcomes. Endovascular repair at level I trauma centers had a lower risk of in-hospital mortality which may be a result of their teaching hospital status, organizational structure, and other factors. The weight of the contributions of such factors warrants further study.
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Browne, Kevin P., Steve D. Shafran e John M. Conly. "The Cost of Health Care for AIDS Patients in Saskatchewan". Canadian Journal of Infectious Diseases 1, n.º 4 (1990): 127–32. http://dx.doi.org/10.1155/1990/487591.
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The medical records of 19 patients with acquired immune deficiency syndrome (aids) were reviewed in an attempt to estimate their health care costs. The patients were all male, members of high risk groups and diagnosed between April 1985 and February 1988. Twelve of the patients died; they lived a mean of 240 days (range 0 to 580) after diagnosis, were admitted three times (range one to six) to hospital for 65 total days (range one to 148) for a cost per patient of $33,721 (range $2,768 to $64,981) for inpatient care. They made five (range zero to 25) office visits per patient costing $196 per patient (range $0 to $4,999) for outpatient care. The seven survivors (one was lost to follow-up) have lived 375 days (range 186 to 551) since diagnosis, have been admitted to hospital two times (range zero to seven) for 30 total days (range zero to 86) for a total cost per patient of $14,223 (range $0 to $39,410) for inpatient care. They have made 11 office/emergency room visits (range zero to 46) costing in total $4322 (range $0 to $13,605) for outpatient care. The total expenditure was $546,332 ($28,754 per patient), of which total fees to physicians were $37,210 (6.8%), and estimated costs of laboratory tests $117,917 (21.6%), drugs $36,930 (6.7%), and medical imaging $20,794 (3.8%). Patients now deceased cost $416,445 (mean $34,704 per patient), accounting for 76.2% of overall expenditures. The average medical/surgical and drug costs per patient day in hospital were greater foraidspatients than for the average medical/surgical patient in the authors’ institution.
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Siahaan, Yusak M. T., e Vinson Hartoyo. "Sacroiliac Joint Pain: A Study of Predisposing Factors in an Indonesian Hospital". Open Pain Journal 12, n.º 1 (19 de fevereiro de 2019): 1–5. http://dx.doi.org/10.2174/1876386301912010001.
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Background: Sacroiliac joint pain has been one of the most common causes of lower back pain, regardless of gender. Diminished pain after an anaesthetic block has been the only gold standard diagnostic procedure, making the diagnosis become challenging due to the needs of fluoroscopic procedure. Thus, a study to find predisposing factors of sacroiliac joint pain is pivotal for primary prevention and prognosis predictor. Objective: Our study aims to find predisposing factors of sacroiliac joint pain in Indonesian patients. Methods: We conducted a prospective study on patients with a chief complaint of lower back pain whose pain diminished after anaesthetic block. Results: We found 99 subjects, with a male to female ratio of 1:2.19, aged from 21 to 75 years old (mean: 42.88). In addition to multiparous pregnancy and obesity, office-based occupation and prolonged sitting duration are also becoming major predisposing factors of sacroiliac joint pain (50.5% and 51.51% respectively). We also found majority of the patients with a history of vertical trauma with the onset of pain 1 year post trauma. Conclusion: We found some factors that can be considered to trigger sacroiliac joint pain that are: female gender, advancing age, pregnancy history, long sitting duration and office worker occupation.
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Odisho, Anobel Y., John L. Gore e Ruth Douglas Etzioni. "Beyond classical risk adjustment: Socioeconomic status and hospital performance in urologic oncology." Journal of Clinical Oncology 35, n.º 6_suppl (20 de fevereiro de 2017): 526. http://dx.doi.org/10.1200/jco.2017.35.6_suppl.526.
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526 Background: Safety-net hospitals care for more patients of lower socioeconomic status (SES) than non-safety-net hospitals and may be disproportionately punished under readmission risk adjustment models that do not incorporate (SES). We developed a readmission risk adjustment framework incorporating SES to assess impact of SES on safety-net hospital rankings for patients undergoing major surgery for urologic malignancies. Methods: Quasi-experimental design using California Office of Statewide Health Planning and Development data from 2007-2011. Subjects included all patients undergoing radical cystectomy for bladder cancer (n = 3,771), partial nephrectomy (n = 5,556), and radical nephrectomy (n = 13,136) for kidney cancer. Unadjusted hospital rankings and predicted rankings under a base model, which simulated the Medicare Hospital Readmissions Reduction Program model, were compared with predicted rankings under models incorporating socioeconomic status. Socioeconomic status was derived from a multifactorial neighborhood score at the ZIP code level calculated from US Census data. The main outcome measures were hospital rankings based on 30-day all-cause readmission rate and differences between model predicted rankings. Results: For all procedures, the addition of socioeconomic status, geographic, and hospital factors changed the overall hospital rankings significantly compared with the base model (p < 0.01), with the exception of socioeconomic status in radical cystectomy (p = 0.07) and socioeconomic status and rural factors in partial nephrectomy (p = 0.12). For radical nephrectomy and partial nephrectomy, the addition of socioeconomic status and hospital factors significantly improved the mean ranking of safety-net hospitals and improved the ratio of observed relative to expected rankings (p < 0.01). For radical cystectomy there was no significant change in rankings with the addition of socioeconomic status, rural status, or hospital factors. Conclusions: Adding socioeconomic status to existing Medicare readmission risk adjustment models leads to significant changes in hospital rankings, with a differential impact on safety-net hospitals.
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Tri Nurwahyuni, Niki, Laila Fitria, Olce Umboh e Dismo Katiandagho. "Pengolahan Limbah Medis COVID-19 Pada Rumah Sakit". Jurnal Kesehatan Lingkungan 10, n.º 2 (31 de outubro de 2020): 52–59. http://dx.doi.org/10.47718/jkl.v10i2.1162.
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COVID-19 medical waste is residual material from unused reuse which is contaminated by substances that protect infectious or in contact with patients and/or hospital staff who need COVID-19 patients from service activities in the emergency room, isolation room, ICU room, treatment rooms, and other service rooms. The purpose of this study was to discover waste treatment in referral hospitals in North Sulawesi Province arising from the implementation of COVID-19 in 2020. The research was conducted on 18 of COVID-19 Referral Hospitals in North Sulawesi Province in period May - June 2020, by using cross-sectional as a research design. The results showed that 11 hospitals (61.1%) treated COVID-19 medical waste using their own incinerator, while 7 other hospitals (38.9%) treated COVID-19 medical waste using third-party services. All of the hospitals that treat medical waste using an incinerator do not fully have an operational permit from the Ministry of Environment and Forestry. The results obtained, in an emergency (COVID-19 pandemic), are excluded from having permission to use incinerators. All health facilities are expected to carry out the process of arranging incinerator operational permit documents coordinating with the Provincial / Regency / City Health Office and Provincial / Regency / City Environment Offices, even in the COVID-19 pandemic.
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Siglock, Timothy J., James Benecke e Eliot R. Clauss. "Minimizing The Risk of Malpractice Suits". Otolaryngology–Head and Neck Surgery 112, n.º 5 (maio de 1995): P66—P67. http://dx.doi.org/10.1016/s0194-5998(05)80144-5.
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Educational objectives: To improve all aspects of patient care and communication in ways that reduce the risk of malpractice suits and to eliminate from office and hospital practice conduct and behavior that invites patients to sue.
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Smith, Alan D., e Pamela J. Taylor. "Serious sex offending against women by men with schizophrenia". British Journal of Psychiatry 174, n.º 3 (março de 1999): 233–37. http://dx.doi.org/10.1192/bjp.174.3.233.
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BackgroundLittle is known about men who commit sex offences in the context of psychosis.AimsTo examine the relationship of illness and psychotic symptoms to sex offending in men with schizophrenia.MethodA search of Home Office records was completed for all 84 male restricted hospital order in-patients with schizophrenia, resident in any hospital in England and Wales during May 1997, with an index conviction for a contact sex offence against a woman.ResultsAt the time of their index offences 80 men were psychotic and half of them had delusions or hallucinations related to the offences. Specific delusional or hallucinatory drive was pertinent in only 18 men but the majority of men committed their first sex offence after onset of schizophrenia. Exclusive sex offending was uncommon.ConclusionsWhen a man with schizophrenia commits a serious sex offence the illness is, more commonly than not, relevant to that offence even though a direct symptom relationship may be relatively unusual.