General Hospital Beds Research Articles

Cost Evaluation of Chronic Schizophrenic Patients During the First 3 Years After the First Contact

This study was performed in Italy, where mental health care is largely provided by the Government-financed Italian National Health Service (INHS). Since 1978, outpatient services and psychiatric beds in general hospitals have replaced psychiatric hospitals, which have not been permitted to admit new patients. The direct costs of three cohorts of 20 chronic schizophrenic patients were evaluated according to incidence data for a 3-year period. The analysis focused in particular on services provided by public institutions. The average cost per patient during this period following first contact-admission was $9,612 (1989 U.S. dollars), which is low compared to costs in other countries. The cost distribution between inpatient and outpatient services was different from other studies and showed that, in Italy, hospital expenses covered approximately 50 percent of total direct INHS costs. The length of time between onset and first contact-admission showed a significant association (p less than 0.01) with INHS costs during the 3 years. A significant association (p less than 0.05) also was found between the Scale for the Assessment of Positive Symptoms (SAPS) global symptom "delusions" evaluated after 5 to 7 years and the average INHS costs during the 3 years of the study.

Transfers of hospitalized psychiatric patients under Medicare's prospective payment system

Medicare's reimbursement policy provides payment incentives for hospitals to transfer psychiatric patients to another acute-care facility, especially when the destination facility is exempt from Medicare's prospective payment system. The authors found, however, that transfers were relatively infrequent in 1985, accounting for only approximately 3.4% of all psychiatric hospitalizations under Medicare. The most common type of transfer was from a nonspecialized general hospital bed to a Medicare-exempt psychiatric unit within the same hospital. Given that increasing financial pressures may result in a rise in the number of transfers, the authors discuss potential reforms of Medicare reimbursement for these cases.

Analytic Reviews : Acid-Base Abnormalities in Cardiopulmonary Arrest: Varying Patterns in Different Locations Within the Hospital

Arterial blood gas analysis performed in 67 episodes who suffered cardiopulmonary arrest revealed that the degree of acidemia correlated with the location of the patient within the hospital: emergency department (ED), general hospital bed (HB), or intensive care unit (ICU). Acidemia was most severe in patients who pre sented either in the ED (pH = 7.15) or in a HB (pH = 7.10) as a result of combined metabolic (bicarbonate ion [HCO 3-] = 20 ± 16 and 15 ± 10 mEq/L) and respiratory acidosis (arterial carbon dioxide tension [PaCO2] = 59 ± 30 and 50 ± 24 mm Hg). In contrast, patients in the ICU had only mild acidemia or even alkalemia (pH = 7.28); respiratory acidosis was un common in this setting (PaCO2 = 36 ± 18 mm Hg), and patients exhibited a degree of metabolic acidosis ([HCO3 - ] = 18 ± 8 mEq/L) similar to that seen in patients in EDS or HBS. This relative hypocarbia seen in patients in the ICU was attributed to the fact that most (14 of 22, 64% ) were already receiving mechanical ven tilation at the time of the cardiopulmonary arrest. Pa tients who were successfully resuscitated (20, 30% ) did not differ from those in whom resuscitation failed (47, 70% ) in degree of acidemia or location of arrest. Serum potassium levels obtained in 29 patients at the time of arrest revealed that serum potassium levels were greater than 5.2 mEq/L only 8 times; there was only one mea surement greater than 6.0 mEq/L, which did not corre late with the degree of acidemia.

Smoking policy in pediatric hospitals and wards.

The American Academy of Pediatrics has recommended that pediatricians take the lead in banning cigarette smoking in all pediatric health care facilities. This study investigated the use of "nonsmoking" policies and their planned revisions, problems in enforcement, and any history of challenges to restrictive or lenient policies. The surveys were mailed to 329 hospitals affiliated with pediatric training programs as the institutions most likely to attempt to comply with the American Academy of Pediatrics recommendations. Representatives from 199 (60%) of the programs responded. The programs had a range of 12 to 350 pediatric beds in children's hospitals (27%), pediatric wards (69%), or general hospitals (4%). Only nine hospitals were "smoke-free," ie, having no designated indoor area for smoking. Another 35 had "restrictive" policies allowing smoking in only a single site or two preselected sites. Pediatric hospitals or wards were no more likely to have smoke-free policies than general hospitals. Existence of smoke-free or restrictive policies was unrelated to any other factor examined. Smoke-free and restrictive policies were more likely to be rigorously enforced but not more likely to engender formal challenges. Although almost all policies had been recently or are being revised, pediatric hospitals and wards remain remiss in controlling childhood smoke exposure.

A Follow‐Up Study of Patients with Alcohol‐Related Brain Damage in the Community

Abstract: An account is given of the outcome for 37 patients after their discharge into the community without receiving any rehabilitation geared specifically to their alcohol‐related brain damage. They were followed up for at least 12 months. There were 7 deaths, a figure greatly in excess of actuarial prediction. With one exception, neuropsychological test results at the time of intake did not predict outcome. Those admitted to the study from general hospital beds did better than those admitted through psychiatric or rehabilitation facilities, probably because those who had suffered Wernicke's encephalopathy (WE) at some time (usually at the time they entered the study) did better than others. They were less likely to be drinking at the end of the follow‐up period than those without a history of WE, who generally fared badly.

The severely mentally Ill in General Hospital psychiatric units

Analysis of data from the NIMH Survey of Discharges from Non-Federal General Hospitals found that severely mentally ill patients (those with schizophrenia, other psychoses, paranoia, and major affective disorders) became an increasingly larger proportion of general hospital discharges between 1970 and 1980, with more change observed between 1975 and 1980. This seems to confirm that general hospital care is replacing at least some of the care previously provided in State mental hospitals. There has been an increase in beds in nongovernment-owned general hospitals and a decrease in beds in state hospitals. In addition, while discharge referrals from government general hospitals for severe patients were made predominantly to state hospitals in 1970, in 1980 this was rarely the case.

Benefits of effective hospital services for elderly people.

An age related hospital service for elderly people was set up in Waltham Forest Health Authority to provide acute medical care when needed. Despite a reduction in the allocation of funds over the years 1982-4 the health authority increased the number of district general hospital beds available for elderly patients and improved home nursing services. The outcomes of the changes made were assessed against the aims of the service by using data from the Hospital Activity Analysis, SH3 returns, government population estimates, and yearly figures collected in our department. It is concluded that introducing an age related service in our health authority has benefited people aged over 65.

Assessing methods of predicting the need for psychiatric beds.

Actual psychiatric bed utilization in 16 metropolitan areas was compared with projected bed needs in those areas derived from seven common methods of assessing the need for inpatient psychiatric services. Six methods significantly underpredicted actual use, and one significantly overpredicted actual use. Methods that relied on multiple sources, including expert opinion, historical use, epidemiologic data, and social indicators, predicted need more accurately than those that relied exclusively on expert opinion or historical use. The author also found that utilization rates of acute beds in general and specialty hospitals kept pace with licensed bed rates at or below 45 to 50 beds per 100,000 population but remained steady if the number of licensed beds went higher. The author recommends reliance on local indicators to plan inpatient services.

Dynamic Model of Social Systems: An application to the delivery of health services

Abstract A simultaneous equation model is constructed in order to describe the health services delivery system serving the state of Indiana. The model consists of a set of stochastic equations that describe the joint dependency of physician manpower and short-term general hospital beds on social, demographic, and economic characteristics of the population served. The model is validated with county data from Indiana and the dynamic behavior of the health services delivery system that results from feedback in the model, and the inclusion of lagged physician manpower variables is analyzed.

INTEGRATION OF GERIATRIC WITH GENERAL MEDICAL SERVICES IN NEWCASTLE

In west Newcastle upon Tyne hospital geriatric and other acute medical specialty beds are managed as a functionally integrated service. This practice improves the efficiency of use of scarce district general hospital beds and carries other benefits in quality of patient care, experience of junior medical and nursing staff, and in working relationships. In an appropriate setting the integrated model offers an alternative to the more traditional separate development of geriatric services.

Abuse of Scientific Studies in Public Policy Determination

To the Editor.— As government becomes more involved in health care, it seeks reliable data on which to base its decisions. It is unfortunate that the data are not always used appropriately. All too often political pressures have led to abuse of data derived from scientific studies. Currently, there are congressional and agency proposals to study the efficacy of psychotherapy to determine reimbursement for professional care. Apart from the unwarranted assumption of nonefficacy 1 and numerous definitional and operational vagaries 2 and apart from their failure to grasp the essence of all medical treatment, the reimbursement proposals have caused great concern with respect to the application of scientific data. 3 The recent experience with bed-ceiling determination gives substance to that concern. The Department of Health, Education, and Welfare, wishing to limit the number of general hospital beds for short-term care, contracted with the Institute of Medicine to study the issue.

Duplicated hospital facilities: How much can we save by consolidating them?

One strategy for controlling the costs of health care is to eliminate duplicative hospital facilities so that the current volume of services can be delivered more efficiently. We evaluated the potential saving from consolidating hospital facilities according to the guidelines recently established by the Department of Health and Human Services (HHS) Eliminating duplication in four categories (computerized axial-tomographic scanners, open-heart surgery and cardiac-catheterization units, megavoltage-radiation units, and general hospital beds) would yield a potential theoretical saving of about $1 billion a year. However, the resulting indirect costs, such as those incurred by certificate-of-need programs and by moving patients from one facility to another, would reduce or possibly eradicate this gain. Overall, the expected saving falls far short of HHS goals. We conclude that only by reducing the demand for services will substantial savings be realized.

The impact of Hill-Burton: an analysis of hospital bed and physician distribution in the United States, 1950-1970.

The Hospital Survey and Construction Act of 1946, commonly known as the Hill-Burton Act, was intended to improve the supply, distribution and quality of general hospital beds across the United States. Some also saw the program as a means of affecting the supply and distribution of physicians. The strategy used here for evaluating the Hill-Burton program derives in part from the assumptions about health resources supplies on which Hill-Burton policy was found and in part from a model of socioeconomic convergence developed in public policy research on the American states. Major conclusions include 1) Hill-Burton had a major redistributive impact on state bed supplies; 2) physician redistribution lagged far behind progress in bed redistribution; and 3) interstate distribution of physicians appears to have been unaffected by Hill-Burton-associated bed redistribution, a finding contrary to other work in this area.

Berkson Fallacy and Studies on Reserpine and Breast Cancer-Reply

In Reply.—The survey that Dr Jick is defending1could have yielded a spurious association between reserpine use and breast cancer in women, if some uneven selection rates were taking place. The articles1.2give no assurance that precautions were taken to prevent the Berkson fallacy. Let me illustrate how a spurious association could have occurred, and could have yielded the precise data reported by Dr Jick and his associates. In describing the Boston Collaborative Drug Surveillance studies, the investigators stated2that the survey patients were served in 24 hospitals that provided 45% of all general hospital beds in the greater metropolitan Boston area. They estimated that approximately 1,300,000 people are served by these hospitals. The total population served might be estimated to be about 2.9 million. Half of these would be women: 1,450,000. The incidence of breast cancer in women in the United States is about

An Elaboration of the Relationship Between General Hospital Bed Supply and General Hospital Utilization

An elaboration of the relationship between changes in an area's general hospital bed supply and changes in its hospital utilization rate is performed using path analysis in order to test two opposing interpretations of this relation. One interpretation sees this relationship as spurious due to the antecedent effect of high demand and consequent unmet need that leads both to increased bed supply and to increased utilization. The opposing interpretation accepts the relationship as causal and sees it operating through the intervening mechanism of changes in the way medicine is practiced in that area. The analysis, using data for New York State counties collectedfrom American Hospital Association statistics, supports the causal rather than the spurious interpretation. The implications of this result for health care delivery are discussed.

Certification-of-need: The Massachusetts experience.

Massachusetts, like 22 other states, regulates its health-care industry in part through a certification and changes in service. As a basis for assessing the program's impact, data from the first 19 months are aggregated. A total of 209 determinations were made during the period, 21 involving beds in general hospitals, and 107 beds in long-term-care facilities. They apparently forestalled the addition of 478 beds in the general-hospital sector and of 1885 long term-care beds. Most of the 40 "facility-improvement" and 35 of 37 clinic proposals were approved. Fifteen determinations were appealed. Hindrances to assessment certification-of-need are formidable. As a consumer-oriented regulatory tool, it is valuable though limited since it can only react to proposals and can neither initiate nor provide positive incentives for new programs.

Geriatric medicine in a community hospital.

A study is reported of the care that was being received by the patients over the age of 60 years in general practitioner community hospital beds at Abingdon Hospital in Berkshire. The appropriateness of this care is discussed and measures are suggested for improving it. The practical working relationship between general practitioners attending the community hospital and the local consultant physicians in geriatric medicine is also discussed and again measures for improving their combined services to the community hospital are suggested.

Regional Analysis of Excess Beds in General Hospitals

This study examines projected surgical and medical bed needs for 1974 in Connecticut’s general hospitals. The federal method for determining needs, based on fixed occupancy rates, is compared with an alternative based on probabilities of overcrowding. Bed needs were equal when the two methods were applied on an individual hospital basis. For groups of hospitals in health service areas, the alternative indicated potential reductions in planned beds. Under the Federal plan the 1969 base of 8,976 beds should be increased to 9,578. This is 765 more beds than estimated as adequate by the alternative approach. When allowances are made for excess beds already constructed, the federal plan indicates a need for 469 more beds than does the alternative. Daily additions to per patient charges attributable to federally planned excess beds is estimated to lie between $4 and $10. These findings are significant for people concerned with methods for reducing hospital costs.

General Hospital Facilities in Michigan, 1965

T IS commonly assumed that rural areas have fewer beds per 1,000 population than urban areas. With rapid net outmigration from rural areas, this supposition may be no longer true. The purpose of this study was to determine the availability of general hospital beds and the variation in availability by degree of rurality. Licensed capacity, an approximation of facility quantity, of hospitals by type of bed, was obtained for each county.' Licensed capacity does not measure underutilization, overcrowding, or quality of facilities. Non-public hospitals, such as military base hospitals, federal and state veterans' facilities, U. S. Public Health Service hospitals, and student health facilities, were excluded from the analysis. Mental, long term or rehabilitation, and tuberculosis (TB) beds for public hospitals were also excluded because of the specificity of location for such services. Hospitals with mental or TB facilities were located in counties with a town of 5,000 or more and within 25 miles of a Standard Metropolitan Statistical Area, with the exception of Marquette County. Marquette could be considered the central place of the Upper Peninsula. The long-term facilities were all located in areas with a town of at least 5,000 population or were within 25 miles of a SMSA.

Medical care for patients with neurological and sensory diseases—I: Utilization of institutional facilities

1. 1. A study was made of the utilization of short-term general hospital beds in Kansas by patients with neurological and sensory disorders. A stratified sub-sample of all such hospitals, grouped according to bed size, was studied. Eighty-seven per cent of all the institutions cooperated in the survey. An average of 7 per cent of all patients dismissed from these hospitals had been discharged with a primary diagnosis of a neurological or sensory disorder. This estimate is based upon approximately 30 per cent of all hospital beds of this type in the state. The most common dismissal diagnoses were cerebrovascular disease and polyneuropathies secondary to diabetes or alcoholism. In the pediatric age group strabismus and meningitis were the most common causes for hospitalization. 2. 2. All of the records of patients discharged in one month at the University Medical Center (the large referral center in the area) were reviewed. A total of 79 per cent of the records of 1592 patients discharged were complete and available for this survey, and of these patients 158 (10 per cent) were discharged with a primary diagnosis of a neurological or sensory disorder. Of the 158 such patients, 13 per cent had at least one other chronic disease. Of the total number of charts reviewed 12 (1 per cent) had a secondary diagnosis of a neurological or sensory disease. The most common disorders recorded were cataract, epilepsy and/or convulsive disorder. A total of 56 different diagnoses were recorded. The average duration of hospitalization for patients with primary diagnoses of neurological or sensory diseases was six days. 3. 3. Statistics were provided by the State Department of Health on the broad categories of admission diagnoses of adult care home residents in 1962. Nineteen per cent of all residents of these homes had a diagnosis of a neurological or sensory disease as their primary reason for hospitalization. During 1962 a total of 2050 residents of these homes were admitted to various hospitals in the state. Of this total, 201 were transferred to general hospitals because of neurological or sensory disorders. Approximately 1 per cent of all individuals in the geriatric group in the state are patients in adult care homes because of these diseases. Only senility and disease of the circulatory system produce more transfers from adult care homes to acute short-term hospitals. 4. 4. Data were obtained from the Director of Institutions regarding patients with neurological and sensory diseases in these facilities. A total of 2000 or 28 per cent of the residents of state institutions have one of the diseases under consideration. The annual cost to the state is estimated to be between two and three million dollars for the custodial care of these persons. The most common diagnoses observed among these patients were cerebrovascular disease, mongolism, syphilis and heredodegenerative diseases.