Hospital Choice Research Articles

Lower Socioeconomic Status Predicts Greater Obstacles to Care: Using Outpatient Cholecystectomy as a Model Cohort.

Patients with low socioeconomic status (SES) are disadvantaged in terms of access to health care. A novel metric for SES is the Distressed Communities Index (DCI). This study evaluates the effect of DCI on hospital choice and distance traveled for surgery. A Florida database was queried for patients with symptomatic cholelithiasis or chronic cholecystitis who underwent an outpatient cholecystectomy between 2016 and 2019. Patients' DCI was compared with hospital ratings, comorbidities, Charlson Comorbidity Index, and distance traveled for surgery. Stepwise logistic regression was used to determine which factors most influenced distance traveled for surgery. There were 54,649 cases-81 open, 52,488 laparoscopic, and 2,080 robotic. There was no difference between surgical approach and patient's DCI group (p = 0.12). Rural patients traveled the farthest for surgery (avg 21.29 miles); urban patients traveled the least (avg 5.84 miles). Patients from distressed areas more often had surgery at one- or two-star hospitals than prosperous patients (61% vs 36.3%). Regression indicated distressed or at-risk areas predicted further travel for rural/small-town patients, while higher hospital ratings predicted further travel for suburban/urban patients. Compared to prosperous areas, patients from distressed areas have surgery at lower-rated hospitals, travel further if they live in rural/small-town areas, but travel less if they live in suburban areas. We postulate that farther travel in rural areas may be explained by a lack of health care resources in poor, rural areas, while traveling less in suburban areas may be explained by personal lack of resources for patients with low SES.

Travel Distances for Interhospital Transfers of Critically Ill Children: A Geospatial Analysis.

The U.S. pediatric acute care system has become more centralized, placing increasing importance on interhospital transfers. We conducted a geospatial analysis of critically ill children undergoing interfacility transfer with a specific focus on understanding travel distances between the patient's residence and the hospitals in which they receive care. Retrospective geospatial analysis using five U.S. state-level administrative databases; four states observed from 2016 to 2019 and one state from 2018 to 2019. Participants included 10,665 children who experienced 11,713 episodes of critical illness involving transfer between two hospitals. Travel distances and the incidence of "potentially suboptimal triage," in which patients were transferred to a second hospital less than five miles further from their residence than the first hospital. Patients typically present to hospitals near their residence (median distance from residence to first hospital, 4.2 miles; interquartile range [IQR], 1.8-9.6 miles). Transfer distances are relatively large (median distance between hospitals, 28.9 miles; IQR, 11.2-53.2 miles), taking patients relatively far away from their residences (median distance from residence to second hospital, 30.1 miles; IQR, 12.2-54.9 miles). Potentially suboptimal triage was frequent: 24.2 percent of patients were transferred to a hospital less than five miles further away from their residence than the first hospital. Potentially suboptimal triage was most common in children living in urban counties, and became less common with increasing medical complexity. The current pediatric critical care system is organized in a hub-and-spoke model, which requires large travel distances for some patients. Some transfers might be prevented by more efficient prehospital triage. Current transfer patterns suggest the choice of initial hospital is influenced by geography as well as by attempts to match hospital resources with perceived patient needs.

Determinants of Patient Preference for Private Hospitals Over Public Hospitals: An Empirical Study

Introduction: There are several choices when it comes to choosing the type of hospital. In Nepal, the general public is free to seek medical attention from any facility they feel is suitable for them. People have to make vital decisions while choosing a hospital because these decisions relate to health and relieve them from any burden regarding their health. There is a preference for private hospitals over public ones. Despite the relatively cheaper cost of care in public hospitals, such a setup was not preferred by the people; this observation motivated us and created a need to conduct a research study to validate the observation statistically. This study examines reasons why private hospitals are preferred by patients over public ones. Methods: The quantitative description research methodology has been adopted for this study. Developmental research approach is used in conducting this study through quantitative descriptive research. The researcher has followed a deductive research approach to examine the hypotheses we had set up with respect to their significance. Only 117 responses out of the 120 persons of the sample were found to be significant for the research study. A structured questionnaire was designed based on a five-point Likert scale. Random sampling was selected because of the probability sampling methodology used for the research study. Findings: In Tarkeshwor Municipality, the general public does not select a private hospital over a public hospital considering their income. There is no visible relation between the level of hospital services, treatment costs, and hospital selection criteria with income level of respondents. Three dependent variables—service quality, cost, and individual selection motive—have an influence on hospital choice decisions. The vast majority of the respondents appeared to make some kind of valuation about the value for money of the hospitals they visited, irrespective of their income. Since there exists a strong positive correlation between the cost and service mean, they attach higher costs to higher quality of service. Service quality: When asked about service quality, most of the respondents replied that what inclined their preference towards private hospitals and not government-run ones was the short waiting time and up to date medical equipments. Conclusion: Hence, based on this, it can be concluded that the choice of hospitals among the public is determined in view of the cost of treatment and hospital selection motives, such as access to up-to-date medical technology and lesser wait times and so on, rather than by income, which is not related to any of the dependent variables: service quality, treatment costs, and selection motives for hospitals.

Clinical Outcomes, Costs, and Value of Surgery Among Older Patients with Colon Cancer at US News and World Report Ranked Versus Unranked Hospitals

BackgroundUS News and World Report (USNWR) hospital rankings influence patient choice of hospital, but their association with surgical outcomes remains ill-defined. We sought to characterize clinical outcomes and costs of surgery for colon cancer among USNWR top ranked and unranked hospitals.MethodsUsing Medicare Standard Analytic Files, patients aged ≥65 years undergoing surgery for colon cancer were identified. Hospitals were categorized as ‘ranked’ or ‘unranked’ based on USNWR cancer hospital rankings. One-to-one matching was performed between patients treated at ranked and unranked hospitals, and clinical outcomes and costs of surgery were compared.ResultsAmong 50 ranked and 2522 unranked hospitals, 13,650 patient pairs were compared. Overall, 30-day mortality was 2.13% in ranked hospitals versus 3.68% in unranked hospitals (p < 0.0001), and the overall paired cost difference was $8159 (p < 0.0001). As patient risk increased, 30-day mortality differences became larger, with the ranked hospitals having 30-day mortality of 7.59% versus 11.84% for unranked hospitals among the highest-risk patients (p < 0.0001). Overall paired cost differences also increased with increasing patient risk, with cost of care being $72,229 for ranked hospitals versus $56,512 for unranked hospitals among the highest-risk patients (difference = $14,394; p = 0.02). The difference in cost per 1% reduction in 30-day mortality was $9009 (95% confidence interval [CI] $6422–$11,597) for lowest-risk patients, which dropped to $3387 (95% CI $2656–$4119) for highest-risk patients (p < 0.0001).ConclusionTreatment at USNWR-ranked hospitals, particularly for higher-risk patients, was associated with better outcomes but higher-cost care. The benefit of being treated at highly ranked USNWR hospitals was most pronounced among high-risk patients.

Steering them softly with a quality label? A case study analysis of a patient channelling strategy without financial incentives.

Steering patients to lower priced and/or higher quality providers can increase the value of a healthcare system. In a managed care setting, health insurers may use financial incentives for this purpose. However, introducing cost-sharing differences among providers may cause enrolee discontent, which may result in disenrollment. Simply informing and guiding enrolees to preferred providers without financial incentives may therefore be an attractive alternative for insurers. But the effectiveness of such a soft channelling strategy is unclear. This paper investigates whether a Dutch health insurer's strategy of designating preferred hospitals for breast cancer surgery and for inguinal hernia repair affected its enrolees' hospital choices. In October 2008, preferred hospitals received a quality label ('TopCare') because of their high-quality performances in previous years. The insurer recommended these hospitals to enrolees without a financial incentive. Individual patient-level claims data from the insurer over a 5-year period (2006-2010) and a conditional logit choice model was used. Our study samples for breast cancer surgery and inguinal hernia repair included 7985 and 17,292 patients, respectively. It is found that for both procedures, patients ex ante already had a certain preference for the hospitals designated by the insurer as top-quality providers, even when considering possible additional travel time. Also, for both procedures, patient choice did not differ significantly before and after the launch of the TopCare label. The quality label did not increase patient demand for preferred hospitals. Thus, the insurer's strategy to steer patients to preferred hospital alternatives without a financial incentive was not effective.

The interdependence between hospital choice and waiting time — with a case study in urban China

Hospital choice models often employ random utility theory and include waiting time as a choice determinant. When applied to evaluate health system improvement interventions, these models disregard that hospital choice in turn is a determinant of waiting time. We present a novel, general model capturing the endogeneous relationship between waiting time and hospital choice, including the choice to opt out, and characterize the unique equilibrium solution of the resulting convex problem. We apply the general model in a case study on the urban Chinese health system, specifying that patient choice follows a multinomial logit (MNL) model and waiting times are determined by M/M/1 queues. The results reveal that analyses which solely rely on MNL models overestimate the effectiveness of present policy interventions and that this effectiveness is limited. We explore alternative, more effective, improvement interventions.

Risk Factors for Biliary Duct Injuries: A Literature Review

Bile duct injuries (BDI) are serious consequences of surgical treatment of the bile duct, with the majority occurring after cholecystectomy. The prevalence ranges from 0.3 to 0.6%, with 400 BDI recorded annually in the US. Hepaticojejunostomy is the preferred choice for repairing BDI, but factors like biliary peritonitis, localized inflammation, sepsis, and early repair time can affect the outcome. BDIs are more common in women in their forties due to higher cholelithiasis diagnosis. Laparoscopic cholecystectomy is considered the most effective therapy for cholelithiasis, but open cholecystectomy remains a viable choice in hospitals without sufficient laparoscopic technology or training. Roux-en-Y hepaticojejunostomy remains the optimal choice for long-term management. This review focuses on evaluating stenosis and treatment efficacy in patients with bile duct injuries. The efficiency of treatment has decreased, with 2.5% of patients avoiding additional surgeries

Exploring the factors impacting choice and quality of overnight private hospital stays and consumer perspectives on patient reported experience measures (PREMs) in Australia: a qualitative interview study

ObjectivesPatient reported experience measures (PREMs) are tools often utilised in hospitals to support quality improvements and to provide objective feedback on care experiences. Less commonly PREMs can be used to support consumers choices in their hospital care. Little is known about the experience and views of the Australian consumer regarding PREMs nor the considerations these consumers have when they need to make decisions about attending hospital. This study aimed to explore consumer awareness of PREMs, consumer attitudes towards PREMs and the utility of PREMs as a decision-making tool in accessing hospital care.MethodsQualitative study involving semi-structured interviews conducted over the phone. Participants (n = 40) were recruited from across Australia and purposively sampled according to key characteristics: holding private health insurance, > 30-years of age, may have accessed private hospital care in the past year, variety of educational and cultural backgrounds, and if urban or rural residing. Interviews were audio-recorded, transcribed, and analysed thematically.ResultsFour overarching themes and six subthemes were identified from the data. Major findings were that prior awareness of PREMs was limited; however, many had filled in a PREM either for themselves or for someone they cared for following a hospital stay. Most respondents preferred to listen to experience of self or family/friends or the recommendation of their physician when choosing a hospital to attend. Participants appeared to be more interested in the treating clinician than the hospital with this clinician often dictating the hospital or hospital options. If provided choice in hospital, issues of additional costs, timeliness of treatment and location were important factors.ConclusionWhile PREMs were considered a possible tool to assist in hospital decision-making process, previous hospital experiences, the doctor and knowing up-front cost are an overriding consideration for consumers when choosing their hospital. Consideration to format and presentation of PREMs data is needed to facilitate understanding and allow meaningful comparisons. Future research could examine the considerations of those consumers who primarily access public healthcare facilities and how to improve the utility of PREMs.

AN ANALYTICAL STUDY ON CONSUMER AWARENESS AND PERCEPTION OF HOSPITALS' DIGITAL MARKETING EFFORTS

This study explores consumer awareness and perceptions of digital marketing strategies employed by hospitals, focusing on social media presence, email newsletters, online advertisements, and their impact on understanding hospital services. As hospitals increasingly turn to digital platforms to reach patients, understanding consumer responses to these strategies is critical for effective engagement. The research utilizes a quantitative approach, with a sample of 65 respondents. Data were collected through a structured questionnaire, measuring awareness and perceptions of hospital digital marketing initiatives. The study tests three hypotheses related to consumer awareness of hospitals on social media, email communications, and online advertisements using one-sample t-tests. The results reveal a high level of consumer awareness regarding hospitals' social media presence and online advertisements, with mean scores significantly above the neutral value of 3. However, awareness through email newsletters and digital communication channels showed no significant difference from the neutral point, indicating a lower engagement level. These findings align with previous research indicating the increasing role of digital marketing in healthcare but suggest that certain channels, like email marketing, may require more attention. The study contributes to the literature on healthcare marketing by highlighting the importance of targeted digital strategies to improve patient engagement and awareness. Managerial implications suggest hospitals should strengthen their digital presence, particularly in underutilized channels, and develop personalized marketing approaches. Limitations of the study include the small sample size and geographical focus, with recommendations for future research to examine broader populations and the impact of digital marketing on patient decision-making and hospital choice.

Choosing a maternity hospital: a matter of travel distance or quality of care?

BackgroundThe choice of a hospital should be based on individual need and accessibility. For maternity hospitals, this includes known or expected risk factors, the geographic accessibility and level of care provided by the hospital. This study aims to identify factors influencing hospital choice with the aim to analyze if and how many deliveries are conducted in a risk-appropriate and accessible setting in Bavaria, Germany.MethodsThis is a cross-sectional secondary data analysis based on all first births in Bavaria (2015-18) provided by the Bavarian Quality Assurance Institute for Medical Care. Information on the mother and on the hospital were included. The Bavarian Index of Multiple Deprivation 2010 was used to account for area-level socioeconomic differences. Multiple logistic regression models were used to estimate the strength of association of the predicting factors and to adjust for confounding.ResultsWe included 195,087 births. Distances to perinatal centers were longer than to other hospitals (16 km vs. 12 km). 10% of women with documented risk pregnancies did not deliver in a perinatal center. Regressions showed that higher age (OR 1.03; 1.02–1.03 95%-CI) and risk pregnancy (OR 1.44; 1.41–1.47 95%-CI) were associated with choosing a perinatal center. The distances travelled show high regional variation with a strong urban-rural divide.ConclusionIn a health system with free choice of hospitals, many women chose a hospital close to home and/or according to their risks. However, this is not the case for 10% of mothers, a group that would benefit from more coordinated care.

Factors associated with patients' healthcare-seeking behavior and related clinical outcomes under China's hierarchical healthcare delivery system.

The hierarchical healthcare delivery system is an important measure to improve the allocation of medical resources and promote equitable distribution of basic medical and health services. It is one of the key factors in the success or failure of China's medical reform. This study aims to analyze the factors influencing patients' healthcare-seeking behaviors, including socioeconomic and clinical outcomes, under China's hierarchical healthcare delivery system, and to provide potential solutions. Patients receiving outpatient treatment in the past 14 days and inpatient care in the past 1 year were investigated. The multivariate logistic regression was used to analyze the influencing factors of patient's medical treatment behavior selection, and to compare whether the clinical outcomes of primary medical institutions and grade A hospitals are the same. Nine thousand and ninety-eight person-times were included in the study. Of these, 4,538 patients were outpatients, 68.27% of patients were treated in primary medical institutions; 4,560 patients were hospitalized, 58.53% chose to be hospitalized in grade A hospitals. Provinces and cities, urban and rural areas, occupation, education level, medical insurance type, income, whether there are comorbid diseases, and doctors' medical behavior are the factors affecting the choice of medical treatment behavior. Patients who choose primary medical institutions and grade A hospitals have different control levels and control rate for the blood pressure, blood lipids, blood glucose. Under the hierarchical diagnosis and treatment system, the patients' choice of hospital is mainly affected by their level of education, medical insurance types, and the inpatients are also affected by whether there are comorbid conditions. Clinical outcomes of choosing different levels of hospitals were different.

Punished for Success? A Natural Experiment of Displaying Clinical Hospital Quality on Review Platforms

The healthcare market struggles with information asymmetry, limiting patients’ ability to make informed hospital choices. Aiming to bridge this gap, review platforms like Yelp have begun displaying hospitals’ clinical quality data alongside consumer reviews. However, our research uncovers that Yelp’s introduction of maternity care clinical quality measures unexpectedly resulted in lower subsequent Yelp ratings for high-quality hospitals with insufficient staffing. Employing precise foot traffic data and transfer deep learning, we discovered that high-quality, yet understaffed, hospitals experienced a surge in patient volume, which strained their resources and diminished patient satisfaction, leading to negative reviews. This finding has significant implications, signaling the unintended consequences of revealing clinical quality measures, including potential financial losses for hospitals because of reduced federal funding. This research not only contributes to our understanding the dynamics of patient satisfaction but also, offers actionable insights for high-quality hospitals to mitigate the negative impacts of unexpected visibility on review platforms. Our research underscores the importance for patients to discern between objective clinical quality measures and self-reported subjective ratings in their decision-making process. This research applies machine learning and transfer deep learning techniques to healthcare analytics, offering a deeper understanding of the interplay between information disclosure, online reviews, patient satisfaction, and hospital management.

Measuring Local-Area Racial Segregation for Medicare Hospital Admissions

Considerable racial segregation exists in US hospitals that cannot be explained by where patients live. Approaches to measuring such segregation are limited. To measure how and where sorting of older Black patients to different hospitals occurs within the same health care market. This retrospective cross-sectional study used 2019 Medicare claims data linked to geographic data. Hospital zip code markets were based on driving time. The local hospital segregation (LHS) index was defined as the difference between the racial composition of a hospital's admissions and the racial composition of the hospital's market. Assessed admissions were among US Medicare fee-for-service enrollees aged 65 or older living in the 48 contiguous states with at least 1 hospitalization in 2019 at a hospital with at least 200 hospitalizations. Data were analyzed from November 2022 to January 2024. Degree of residential segregation, ownership status, region, teaching hospital designation, and disproportionate share hospital status. The LHS index by hospital and a regional LHS index by hospital referral region. In the sample of 1991 acute care hospitals, 4 870 252 patients (mean [SD] age, 77.7 [8.3] years; 2 822 006 [56.0%] female) were treated, including 11 435 American Indian or Alaska Native patients (0.2%), 129 376 Asian patients (2.6%), 597 564 Black patients (11.9%), 395 397 Hispanic patients (7.8), and 3 818 371 White patients (75.8%). In the sample, half of hospitalizations among Black patients occurred at 235 hospitals (11.8% of all hospitals); 878 hospitals (34.4%) exhibited a negative LHS score (ie, admitted fewer Black patients relative to their market area) while 1113 hospitals (45.0%) exhibited a positive LHS (ie, admitted more Black patients relative to their market area); of all hospitals, 79.4% exhibited racial admission patterns significantly different from their market. Hospital-level LHS was positively associated with government hospital status (coefficient, 0.24; 95% CI, 0.10 to 0.38), while New York, New York; Chicago, Illinois; and Detroit, Michigan, hospital referral regions exhibited the highest regional LHS measures, with hospital referral region LHS scores of 0.12, 0.16, and 0.21, respectively. In this cross-sectional study, a novel measure of LHS was developed to quantify the extent to which hospitals were admitting a representative proportion of Black patients relative to their market areas. A better understanding of hospital choice within neighborhoods would help to reduce racial inequities in health outcomes.

How Is The Implementation of Social Media Marketing In The Hospital Industry?

The hospital industry with a variety of increasingly strict government rules and increasing hospital choices creates tough competition. The purpose of this study is to find out how is the implementation of social media marketing in the hospital industry?. In private hospitals, a good marketing strategy is needed to continue to increase public trust. In the era of marketing 5.0 (technology with humanity) requires hospitals to continue to innovate in terms of services and technology. Social media marketing is one way to image the hospital in the eyes of the public. Marketing using social media has low capital and is easy to do. Delta Surya Hospital is one of the type C private hospitals in Sidoarjo that has applied the principles of social media marketing. The data was taken in November 2022 by analyzing the hospital's social media, namely Instagram, YouTube, and TikTok. The results of the data were compared with similar journals that already existed.

Results of ultrasonic examination of patients with internal bleeding and multiple injury at the prehospital stage: a literature review

Purpose: review and systematisation of publications in scientific medical literature devoted to ultrasound examination of trauma patients at the prehospital stage. Materials and methods: a search in scientific databases SCOPUS, Cochrane, PubMed, Russian Science Citation Index (RSCI) by key words: polytrauma, haemorrhage, evacuation of victims, ultrasound examination (US) was carried out. We analysed 46 literature sources — 2 domestic and 44 foreign, including data of meta ‑ analyses and systematic reviews; 23 studied articles were published in the last 5 years. Results: according to a number of scientific studies, ultrasound examination can be successfully used in patients with polytrauma at the prehospital stage, including during air ambulance evacuation on board a helicopter. Ultrasound examination according to the FAST protocol reduces the time to surgical intervention by 64–76%, reduces the need for radiation exposure, the incidence of complications after injury and the duration of the patient’s hospital stay. According to some authors, the sensitivity, specificity, positive and negative predictive value of the method in detecting intra–abdominal injuries and haemorrhage are 28–76%, 83–97%, 87–96% and 37–94%, respectively, which makes it an important tool for examination of an urgent patient, especially with unstable haemodynamics, influencing the treatment tactics. For the paediatric population in the diagnosis of haemoperitoneum, according to a meta‑analysis, the specificity of US leaves 95%, sensitivity — 66%. The method can be successfully applied in the work of aeromedical teams on board an air ambulance helicopter: according to a systematic review and meta‑analysis, the overall sensitivity of ultrasound in the diagnosis of pneumothorax during air ambulance evacuation is 61%, specificity — 99%. Conclusion: considering the analysed data from large randomised trials, meta‑analyses and systematic reviews, the use of ultrasound allows to make the right decisions regarding the tactics of treatment of the urgent patient, its transportation and choice of hospital, reduces the number of examinations, shortens the time to get the patient to the operating room and the duration of hospital stay, positively affects the outcome of the disease.

Factors Influencing Medical Interns' Choice of Hospital for Training, Saudi Arabia: A Cross-Sectional Study.

Background High-quality, adequately resourced, and strategically oriented medical internship training plays a pivotal role in the continual growth of junior doctors. Evaluating the perspectives of final-year medical students regarding their internship year and their preferred placement is of paramount importance. This study aims to furnish internship programs with valuable insights into interns' perceptions and attitudes toward an optimal internship experience. By doing so, we aim to empower internship programs with the necessary knowledge to enhance their offerings, ensuring they are better tailored to the needs and preparation of future doctors. Objective The objective of this study was to elucidate the primary factors that influence the preferences of medical interns in selecting a hospital for their internship training. Methods In the academic year spanning September 2023 to 2024, a comprehensive cross-sectional study was conducted at three esteemed medical universities in Riyadh, Saudi Arabia. A meticulously crafted questionnaire, consisting of twenty questions was disseminated via various social media platforms, targeting all final-year medical students of the selected medical schools. Overall 241 students actively participated in the survey, their valuable contributions enriching the overall quality and depth of the research findings. Results Among the 241 respondents, 67.22% were male, 83.40% identified as Saudi, and 43.57% hailed from King Saud bin Abdulaziz University for Health Sciences (KSAU-HS). A predominant 94.61% of participants fell within the age group of 22-25 years. Notably, the top four influential factors influencing participants' choice of internship training programs were encouraging consultants (93.80%), the hospital working environment (91.29%), an internship program with effective teamwork (88.38%), and a subspecialty residency program (85.48%). Furthermore, our findings underscored that access to electronic health record (EHR) systems, orientation prior to clinical rotations, and seniors' experiences significantly impact students' decisions when selecting a hospital for rotations. It was also observed that considerations such as the number of on-calls and working hours, salary, location, and extracurricular activities wield a substantial influence over their choices, as indicated by the majority of the surveyed students. Conclusion Given that internship training is one of the most critical stages of medical education, it is recommended to take into account the elements that students believe can influence their hospital choice for conducting their internship. We hope that by acknowledging these aspects, potential approaches to improve and advance hospital training can be formulated in order to provide interns with effective training, a reasonable workload, and a conducive and supportive environment to work in.

ANALYSIS OF THE IMPLEMENTATION OF THE SOCIAL SECURITY ADMINISTERING AGENCY'S (BPJS) PATIENT REFERRAL SYSTEM AT PIDIE DISTRICT HEALTH CENTER.

Background: The referral system is still a problem in the health sector and its implementation is still not in accordance with existing regulations. This can be seen from the still high number of referrals at community health centres. There are several things that cause the referral rate to remain high, such as a lack of understanding by health workers regarding the vertical referral system and horizontal referral system. Many patients also lack information about referrals, which results in these patients tending to prefer to receive secondary services. Objective: To find out how to implement the Health Insurance Administering Agency (BPJS) patient referral system at the Pidie Regency health centre. Research Method: This research is qualitative research. As for There were 12 informants related to the implementation of the referral system determined in this research. Results: The referral implementation that has been carried out at 3 community health centres in the Aceh Pidie area is a tiered referral from the community health centre to the hospital with a choice of hospitals according to the needs of the patient's medical condition and the hospital contained in the P Care application. Obstacles faced by community health centres in implementing the referral system include requests for referrals by patients and the referral process not yet running optimally from specialist doctors on duty at the hospital. Suggestion: Researchers suggest that the head of the community health centre should carry out monitoring and evaluation every month to be able to take intervention measures in an effort to provide training for the P Care application staff at the health centre and supporting community health centres so that the P Care application data input will be controlled every month in inputting patient visit data so that the ratio can be achieved. referrals as expected, namely 15% every month.

Predictors of Intern Pharmacists Job Satisfaction in Federal Teaching Hospitals in Southeast Nigeria

Background: Job satisfaction is a quality assessment standard measure used in evaluation of employers output and outcomes. Increase in job satisfaction correlates positively with employees output. This study assessed the predictors of intern pharmacists job satisfaction ina tertiary hospital in southeast Nigeria. Methods: The study was a questionnaire web and paper-based prospective cross-sectional survey among eligible intern pharmacists who gave their informed consent to participate in the study. Data was summarized with descriptive statistics. Linear regression analysis were used to predict factors affecting intern pharmacist’s job satisfaction while correlation coefficient was used to determine the strength of association. Reliability estimation was done using the Cronbach alpha. All tests for differences between subgroup distributions were regarded as significant if p-values equal to or less than (0.05) (two-tailed test) was reported. Results: Overall, (168) intern pharmacists participated in the study out of which (87) (51.8%) were females. Majority of the respondents were resident outside the hospital premises (136) (86%) while (21) (12.5%) were also locum practitioners. Most of the interns have spent (5-9) months out of the mandatory (12) months (139) (82.7%). Accomodation within the hospital and choice of hospital educational funding had a p-value of (0.864) in the linear regression analysis while the choice of hospital was 0.003. Conclusion: Interns accommodation within the hospital and choice of hospital for inernship training were the major predictors of job satisfaction among the respondents. Job satisfaction is an essential determinant of work output and outcomes.

Separating the wheat from the chaff: How to measure hospital quality in routine data?

To measure hospital quality based on routine data available in many health care systems including the United States, Germany, the United Kingdom, Scandinavia, and Switzerland. We use the Swiss Medical Statistics of Hospitals, an administrative hospital dataset of all inpatient stays in acute care hospitals in Switzerland for the years 2017-2019. We study hospital quality based on quality indicators used by leading agencies in five countries (the United States, the United Kingdom, Germany, Austria, and Switzerland) for two high-volume elective procedures: inguinal hernia repair and hip replacement surgery. We assess how least absolute shrinkage and selection operator (LASSO), a supervised machine learning technique for variable selection, and Mundlak corrections that account for unobserved heterogeneity between hospitals can be used to improve risk adjustment and correct for imbalances in patient risks across hospitals. The Swiss Federal Statistical Office collects annual data on all acute care inpatient stays including basic socio-demographic patient attributes and case-level diagnosis and procedure codes. We find that LASSO-selected and Mundlak-corrected hospital random effects logit models outperform common practice logistic regression models used for risk adjustment. Besides the more favorable statistical properties, they have superior in- and out-of-sample explanatory power. Moreover, we find that Mundlak-corrected logits and the more complex LASSO-selected models identify the same hospitals as high or low-quality offering public health authorities a valuable alternative to standard logistic regression models. Our analysis shows that hospitals vary considerably in the quality they provide to patients. We find that routine hospital data can be used to measure clinically relevant quality indicators that help patients make informed hospital choices.

Influence of the coronavirus disease 2019 pandemic on the post-graduate career paths of medical students: a cross-sectional study

BackgroundThe World Health Organization first declared the coronavirus disease 2019 (COVID-19) pandemic in March 2020 and announced the end of the emergency in May 2023. Additionally, the COVID-19 pandemic significantly impacted individuals globally, including medical students. Although the COVID-19 pandemic increased online education, it restricted clinical training, extracurricular activities, and interprovincial travel. Therefore, this study aimed to examine whether the COVID-19 pandemic influenced the choice of training hospitals and career paths among 3rd- to 6th-year medical students in Japan.MethodsWe developed a questionnaire comprising 21 multiple-choice and 1 open-ended questions, which was administered anonymously via online platforms. The survey targeted Japanese medical students to obtain insights into their preferences for training hospitals and career paths during the COVID-19 pandemic. Participants included 4th- to 6th-year medical students from 51 medical schools in Japan. The survey was conducted through student networks from 8 February 2022 to 20 March 2022.ResultsOverall, 507 medical students participated in the survey, with representation from various academic years as follows: 102 (20.1%), 134 (26.4%), 121 (23.9%), and 150 (29.6%) students from the 3rd, 4th, 5th, and 6th year, respectively. Of these, 338 (66.6%) students reported that the COVID-19 pandemic had influenced their choice of training hospitals. The degree of the influence varied based on the university region and the student year. However, most of the students (473, 93.3%) did not change their course for clinical, basic research, or administrative pathways due to the COVID-19 pandemic. Among the clinically oriented students, 391 (77.2%) did not change their preferred speciality.ConclusionsThe COVID-19 pandemic influenced medical students’ choice of training hospitals. Although many students believed that the pandemic would not change their career choices, our results indicate a potential subconscious trend to avoid internal medicine, which is the speciality most directly involved in treating patients with COVID-19.