Hospital Choice Research Articles

Интраоперационный гемостаз при преждевременном отделении нормально расположенной плаценты — право выбора

Aim. To evaluate the effectiveness of various variants of hemostatic sutures in the fight against obstetric bleeding caused by premature rupture of placenta and prevention of massive blood loss. Design. Analytical review and cohort retrospective study. Materials and methods. The analysis of the effectiveness of intraoperative hemostasis methods was carried out on the basis of data from 24 domestic and foreign scientific publications devoted to the problem of PPRP over the past 10 years (2014–2024). The information obtained was compared with the results of using a local algorithm for intraoperative hemostasis in 182 women with bleeding that occurred in the Clinical Maternity Hospital No. 2 in Volgograd in 2010–2023. The main group included 138 (75.8%) patients who underwent uterine devascularization on both sides at two levels. The comparison group consisted of 44 women who used B-Linch compression sutures: in 37 (20.3%) cases, only compression sutures were applied, in 7 (3.9%) a combination of these methods was used. Results. According to the literature, placenta abruption is the most common cause of bleeding that required surgical hemostasis. Uterine devascularization allowed the organ to be preserved in 135 out of 138 patients, while with the use of compression sutures and their combination with devascularization, the uterus was preserved in 37 out of 44 operated maternity hospitals (OR — 8.514; 95% CI: 2.098– 34.544), which confirms the statistically significant effectiveness of devascularization. Conclusion. It is advisable to start intraoperative stop of uterine bleeding caused by placenta abruption with uterine devascularization. This relatively easy-to-perform method of hemostasis in uterine bleeding may be the method of choice in maternity hospitals of the 1st and 2nd groups. Keywords: uterine bleeding, premature separation of a normally located placenta, devascularization of the uterus, compression sutures on the uterus.

Relationship between patient outcomes and patterns of fragmented cancer care in older adults with gastric cancer: A nationwide cohort study in South Korea

IntroductionFragmented cancer care, defined as receipt of care from multiple hospitals, has been shown to be associated with poor patient outcomes and high expense. However, evidence regarding the effects of hospital choice by patients with cancer on overall survival are lacking. Thus, we investigated the relationship between patterns of fragmented care and five-year mortality in patients with gastric cancer. Materials and MethodsUsing the Korean National Health Insurance senior cohort of adults aged ≥60 years, we identified patients with gastric cancer who underwent gastrectomy during 2007–2014. We examined the distribution of the study population by five-year mortality, and used Kaplan–Meier survival curves/log-rank test and Cox proportional hazard model to compare five-year mortality with fragmented cancer care. ResultsAmong the participants, 19.5% died within five years. There were more deaths among patients who received fragmented care, especially those who transferred to smaller hospitals (46.6%) than to larger ones (40.0%). The likelihood of five-year mortality was higher in patients who received fragmented cancer care upon moving from large to small hospitals than those who did not transfer hospitals (hazard ratio, 1.28; 95% confidence interval, 1.10–1.48, P = .001). Moreover, mortality was higher among patients treated in large hospitals or in the capital area for initial treatment, and this association was greater for patients from rural areas. DiscussionFragmentation of cancer care was associated with reduced survival, and the risk of mortality was higher among patients who moved from large to small hospitals.

Strategic management and risk control of emergency hospital construction: SWOT and STPA framework from a systems thinking perspective.

The construction of emergency hospitals is crucial for ensuring medical service provision during disasters. Assembled buildings have emerged as the preferred choice for large-scale emergency hospitals due to their rapid construction and high quality. However, the construction of emergency hospitals involves the collaboration of multiple departments, and there is a lack of research on the management of such construction projects. Given the urgent need for emergency hospitals, analyzing potential hazards in the construction process from a systemic perspective is essential to manage their construction effectively. In this study, the SWOT and STPA methods are employed to investigate the construction management of emergency buildings, with the Wuhan Vulcan Mountain Hospital in China serving as a case study for emergency management analysis. This study can provide ideas for emergency hospital management and a basis for controlling possible emergency construction accidents.

Free choice of treatment withdrawn, free choice of hospital remains

Free choice of treatment withdrawn, free choice of hospital remains

Estimating access to surgical care: A community centered national household survey from Pakistan.

Pakistan is a lower middle-income country in South Asia with a population of 225 million. No estimate for surgical care access exists for the country. We postulate the estimated access to surgical care is less than the minimum 80% to be achieved by 2030. We conducted a randomized, stratified two-stage cluster household survey. A sample of 770 households was selected using 2017 census frames from the Pakistan Bureau of Statistics. Data was collected on choice of hospital and travel time to the chosen hospital for C-section, laparotomy, open fracture repair (OFR), and specialized surgery. Analysis was conducted using Stata 14. Access to all Bellwether surgeries (C-section, laparotomy, and open fracture repair) in Pakistan is estimated to be 74.8%. However, estimated access in rural areas and the provinces of Balochistan, Khyber Pakhtunkhwa (KP) and Sindh is far less than in urban areas and in Punjab and Islamabad. Estimated access to C-sections is more compared to OFR, laparotomy, and specialized surgery. Health system strengthening efforts should focus on improving surgical care access in rural areas and in Balochistan, KP, and Sindh. More focus is required on standardizing the availability and quality of surgical services in secondary-level hospitals.

Types of health service utilization in Mumbai slums: a community-based survey

ObjectiveSociodemographic factors play a crucial role in shaping the health-seeking behaviors of individuals residing in slum areas, particularly in their choice of healthcare facilities. Recognizing the importance of strengthening the existing healthcare systems, this research project was undertaken with the primary objective of comprehending the health-seeking behaviors among residents of Mumbai’s slum dwellings in India. To achieve this goal, a comprehensive cross-sectional community needs assessment was conducted spanning from October 2018 to January 2019.Results432 respondents reported utilizing at least one health facility in the past year. They reported using private hospitals (172), public hospitals (208), Community Health clinics [23], or other healthcare services (29). To gain further insights into the factors influencing these choices, logistic regression analysis was conducted. The analysis revealed that being female was found to be negatively associated with the selection of a general practitioner as a preferred healthcare provider. On the other hand, higher levels of education and income were found to have a positive association with the preference for private hospitals. Conversely, these factors were negatively associated with the choice of government hospitals.

Relevamiento de recursos disponibles para el manejo de status epiléptico en centros asistenciales en Argentina

IntroductionStatus epilepticus (SE) is a neurological emergency that requires prompt diagnosis and treatment due to its high morbidity and mortality. Knowing the availability of local diagnostic and treatment resources is important for improving therapeutic outcomes through effective strategies. ObjectiveTo assess the resources available for the diagnosis and treatment of SE in hospitals in the Argentine Republic. Materials and methodsThe Epilepsy Working Group of the Argentine Neurological Society distributed a voluntary semi-structured survey to 51 representative centers for the care of patients with SE in July 2021. Information was requested regarding the healthcare model, pharmacological protocols for different phases of SE, and available electroencephalographic resources. ResultsRegarding the early stage of SE, we found that there is adequate availability of antiseizure medications (ASMs) in both public and private centers, with lorazepam being the most commonly chosen drug. Regarding the treatment choice for established SE, we found that phenytoin is the most commonly used in public hospitals, while levetiracetam is the preferred choice in nonpublic hospitals, and this difference is statistically significant (p < 0.0001). There was a low availability of EEG monitoring in both settings, although there was a greater availability of prolonged monitoring in private centers (p = 0.0003). ConclusionThis study provides information about the available resources in our country for the management of SE and allows for the development of educational and management strategies to improve its diagnosis and treatment.

Mapping Choice of Healthcare Institutes for Cancer Care: A Study in Northeast India.

To map and identify the sequence of visitation to institutes by patients with common cancers. This paper used a mixed method to follow a descriptive multiple-embedded case study. Participants selected in phase one were 388 by stratified random sampling, and in phase two, by purposive sampling, a semi-structured interview was conducted for 21 participants (15 participants and six key informants-oncologists: radiation - 2, medical - 2, surgical - 1 and gynaecology - 1). Ethical clearances were received from the study institutes. Informed consent was obtained from the participants. Sparse research exists on mapping and choices of healthcare settings by cancer patients from northeast India. The main finding comprises a vivid overview of the decisions taken by cancer patients to get their necessary treatment based on all factors mitigating and inhibiting. Up to five hospitals for cancer treatment across the country. Private hospitals were preferred on the first visit by 74 percent (287), followed by the government by 26 percent (101); this, however, changes in subsequent hospital choices, with the latter preferred over the other, which could be due to the long duration of cancer treatment that is directly influenced by the paying capacity of the individual. Visitation was not limited to famous cancer hospitals, but few participants reported accessing herbal medicines, Ayurveda and Homoeopathy. Mapping patient choices of cancer institutes by patients from northeast India is essential as the challenges faced are unique to the region. By mapping patient choices of cancer institutes, insights into the preferred healthcare facilities can influence policies to improve the accessibility of cancer facilities. Findings from this study can support improving access to quality healthcare services, promoting cultural sensitivity, enhancing the quality of care, and informing policy planning and resource allocation.

Demand Analysis of a German Emergency Medical Service Feedback System.

The number of emergency medical service (EMS) calls in Germany is continuously increasing. The initial assessment, the pre-hospital care and the choice of hospital for further care by the EMS influences the patient's outcome and are the basis for further care in hospital. However, the EMS does not receive any official feedback on its decisions. This study evaluates the demand for a feedback system from the emergency department (ED) to the EMS, what it should contain, and how it could be integrated in the electronic clinical systems. A semi-structured interview guideline for expert interviews with members of EMS staff (n = 6) and ED staff (n = 17) was developed. A mockup to visualise a possible implementation was designed and included in the interview. There is a significant demand for feedback on pre-diagnosis, pre-hospital care and handover of patients from the EMS to the ED. The EDs are very interested in improving the collaboration with the paramedic services through feedback. A feedback system is strongly desired by various EMS stakeholders and, according to them, could improve both EMS and ED collaboration and overall patient care.

Health-seeking behavior and patient welfare: Evidence from China

The inefficient use of healthcare resources is a persisting challenge to almost all healthcare systems, making it imperative to understand the underlying factors of healthcare demand. This paper investigates patients' health-seeking behavior in rural China using a random coefficients logit model. We further perform a counterfactual simulation and welfare analyses to evaluate the inefficiencies in health services utilization. The counterfactual simulation reallocates patients to more efficient health providers following the principles of the hierarchical medical system. Our analysis suggests that out-of-pocket expenses and distance to providers discourage patients from utilizing healthcare, while quality of care has a positive effect on patients' hospital choices. However, significant heterogeneity exists in patient preferences over quality of care, out-of-pocket expenses, and distance to providers. The simulation results show that the overall welfare change may have masked variations related to the hypothetical change, with societal welfare loss from switching to higher-tier providers. Our analysis provides support for policies to improve hospitals and assist rural patients in financing healthcare in China.

An Industry Analysis of the Hospital Sector in Mangalore – A Study

Purpose: The purpose is to analyze the hospitals and their processes for knowing their functions and commonalities for the benefit of the best hospital choice for patients. In this study, five hospitals of Mangalore have been considered for the analysis. There are a few common things among these hospitals and certain competitive advantages that a few of them have. Hence, analysis is done based on various approaches like marketing, finance, HR, Strategy as well as the service in general. It is also to know the growth, uniqueness, competitive advantage, patient satisfaction, social contribution, and sustainability measures as well as to know the survival ability of hospitals. Design: This study is designed to collect information from various stakeholders of the respective hospitals and to analyze the same using various statistical tools. The data is then interpreted to ensure there is a perfect cross-sectional analysis of each organization from top to bottom as well as bottom-to-top approach. Findings: The findings are based on the data collected about the commonalities and differentiation of services that these five hospitals offer. KMC stands out to be number one among the five. Originality: This is a first of its kind approach to analyze five hospitals in one city in a paper and the entire study is done by the researcher as part of a bigger study. Type of Paper: Empirical Case study.

Understanding patients heterogeneity in healthcare travel and hospital choice - A latent class analysis with covariates

Access to health care is key to well-being, and it is increasingly clear that aggregated accessibility analysis is hard to reflect people's actual healthcare behaviour. This paper employs a patient-based healthcare travel survey to obtain a nuanced picture of how healthcare travel varies across patients. The existing literature shows transportation is an essential factor in accessing health care; however, most studies focus on separate healthcare travel mode choices or hospital choices for certain segments of patients, making it difficult to derive clear profiles of patients. Also, the attitudinal factors in healthcare travel have long been neglected. This research explores the joint hospital choice and travel behaviour of patients. We conducted an online survey with patients in Shanghai to identify the heterogeneity in healthcare travel behaviour and hospital choice. A latent class model with covariates is adopted to identify different patient types that exhibited distinct hospital choices and healthcare travel behaviour. Attitudinal factors are included in our model to form clear-separated clusters. Four categories of patients are identified: public transit patients, car-oriented patients, near-hospital patients, and non-downtown hospital patients, which differ in sociodemographic characteristics, healthcare-seeking behaviour, and public transit accessibility. Our research shows that a substantial share of non-downtown hospital patients should not be underestimated in healthcare travel demand analysis. The behaviour of public transit and non-downtown patients requires improvement of quality and public transit accessibility in non-downtown tertiary hospitals. Our study contributes to a better understanding of the market segments of patients and tailored healthcare and transport policies to meet patient healthcare travel demand.

Robotic-assisted surgery for prostatectomy – does the diffusion of robotic systems contribute to treatment centralization and influence patients’ hospital choice?

BackgroundBetween 2008 and 2018, the share of robotic-assisted surgeries (RAS) for radical prostatectomies (RPEs) has increased from 3 to 46% in Germany. Firstly, we investigate if this diffusion of RAS has contributed to RPE treatment centralization. Secondly, we analyze if a hospital’s use of an RAS system influenced patients’ hospital choice.MethodsTo analyze RPE treatment centralization, we use (bi-) annual hospital data from 2006 to 2018 for all German hospitals in a panel-data fixed effect model. For investigating RAS systems’ influence on patients’ hospital choice, we use patient level data of 4614 RPE patients treated in 2015. Employing a random utility choice model, we estimate the influence of RAS as well as specialization and quality on patients’ marginal utilities and their according willingness to travel.ResultsDespite a slight decrease in RPEs between 2006 and 2018, hospitals that invested in an RAS system could increase their case volumes significantly (+ 82% compared to hospitals that did not invest) contributing to treatment centralization. Moreover, patients are willing to travel longer for hospitals offering RAS (+ 22% than average travel time) and for specialization (+ 13% for certified prostate cancer treatment centers, + 9% for higher procedure volume). The influence of outcome quality and service quality on patients’ hospital choice is insignificant or negligible.ConclusionsIn conclusion, centralization is partly driven by (very) high-volume hospitals’ investment in RAS systems and patient preferences. While outcome quality might improve due to centralization and according specialization, evidence for a direct positive influence of RAS on RPE outcomes still is ambiguous. Patients have been voting with their feet, but research yet has to catch up.

Current Trends in Volume and Surgical Outcomes in Gastric Cancer

Gastric cancer is ranked as the fifth most frequently diagnosed type of cancer. Complete resection with adequate lymphadenectomy represents the goal of treatment with curative intent. Quality assurance is a crucial factor in the evaluation of oncological surgical care, and centralization of healthcare in referral hospitals has been proposed in several countries. However, an international agreement about the setting of "high-volume hospitals" as well as "minimum volume standards" has not yet been clearly established. Despite the clear postoperative mortality benefits that have been described for gastric cancer surgery conducted by high-volume surgeons in high-volume hospitals, many authors have highlighted the limitations of a non-composite variable to define the ideal postoperative period. The textbook outcome represents a multidimensional measure assessing the quality of care for cancer patients. Transparent and easily available hospital data will increase patients' awareness, providing suitable elements for a more informed hospital choice.

Women's choices of hospital for breast cancer surgery in Italy: Quality and equity implications

This paper employs mixed logit regression to investigate the effects of providers characteristics on women's choice of hospital for breast surgery. Patient level data are used to model choices in Tuscany region, Italy. In particular, we focus on the effects of travel time and hospital quality indicators including quality standard (volumes of breast surgery), measurement of process (waiting times) and quality of surgical procedures. Variation in preferences related to individual characteristics such as age, education and travel distance from the hospital are also considered. Findings show that, on average, women prefer closer hospital with longer waiting times and higher quality (high volumes of interventions). We found preference heterogeneity associated to education: travel distance affects choice especially among less educated women (regardless of age), while among younger women (<65 years), less educated ones prefer shorter waiting times. These results could be used to optimize the allocation of resources toward breast cancer units that meet quality and efficacy standards to increase the efficiency and responsiveness of breast cancer care.

Selective referral or learning by doing? An analysis of hospital volume-outcome relationship of vascular procedures.

This paper analyzes the effects of hospital volume on outcomes of patients undergoing percutaneous transluminal angioplasty (PTA) with stent implant in Slovakia between 2014 and 2019. The volume-outcome relationship is estimated jointly using a discrete factor approach, where choice of hospital is correlated with durations until readmission or death, accounting for observed and unobserved characteristics. The results reveal the importance of controlling for between-hospital differences and selectivity in patient referral. Estimates without hospital fixed effects overstate the positive effect of volume on outcomes, but the results remain statistically significant. Once selectivity is accounted for in the joint correlated model, the positive volume-outcome relationship is not different from zero. Overall, the main driver of the volume-outcome relationship for PTA procedures appears to be related to selective referral and differences in quality of health care providers.

Factors associated with hospital choice of Chinese patients: A meta-analysis.

While China continues to optimize the tiered medical care system, the status quo of patients preferring higher-tier hospitals has not improved. Herein, we aimed to analyze the factors influencing patients' healthcare choices in China and to provide an evidentiary basis for optimizing the tiered healthcare system. Most patients are concerned that primary care services will not provide appropriate treatment or health advice. Also, patients consider medical technology, cost, experience, quality of service and convenience before seeking care. A total of 18 cross-sectional studies involving 10,348 samples were included. After combining the effect size, the factors affecting the choice of Chinese patients for medical treatment were medical technology and quality (49%), the convenience of medical treatment (37%), medical expenses (23%), hospital service quality (20%) medical insurance policy (16%), and acquaintance relationship (11%). The selection of medical treatment for Chinese residents is primarily influenced by medical technology and convenience. The medical insurance policy does not provide sufficient guidance. Furthermore, the tiered medical care system should be optimized to improve the usability of primary care services.

Hospital rating websites play a minor role for uro-oncologic patients when choosing a hospital for major surgery: results of the German multicenter NAVIGATOR-study

PurposeHospital rating websites (HRW) offer decision support in hospital choice for patients. To investigate the impact of HRWs of uro-oncological patients undergoing elective surgery in Germany.MethodsFrom 01/2020 to 04/2021, patients admitted for radical prostatectomy, radical cystectomy, or renal tumor surgery received a questionnaire on decision-making in hospital choice and the use of HRWs at 10 German urologic clinics.ResultsOur study includes n = 812 completed questionnaires (response rate 81.2%). The mean age was 65.2 ± 10.2 years; 16.5% were women. Patients were scheduled for prostatectomy in 49.1%, renal tumor surgery in 20.3%, and cystectomy in 13.5% (other 17.1%). Following sources of information influenced the decision process of hospital choice: urologists’ recommendation (52.6%), previous experience in the hospital (20.3%), recommendations from social environment (17.6%), the hospital's website (10.8%) and 8.2% used other sources. Only 4.3% (n = 35) used a HRW for decision making. However, 29% changed their hospital choice due to the information provided HRW. The most frequently used platforms were Weisse-Liste.de (32%), the AOK-Krankenhausnavigator (13%) and Qualitaetskliniken.de (8%). On average, patients rated positively concerning satisfaction with the respective HRW on the Acceptability E-Scale (mean values of the individual items: 1.8–2.1).ConclusionIn Germany, HRWs play a minor role for uro-oncologic patients undergoing elective surgery. Instead, personal consultation of the treating urologist seems to be far more important. Although patients predominantly rated the provided information of the HRW as positive, only a quarter of users changed the initial choice of hospital.

Driving time drives the hospital choice: choice models for pelvic organ prolapse surgery in Italy

ObjectiveThe Italian healthcare jurisdiction promotes patient mobility, which is a major determinant of practice variation, thus being related to the equity of access to health services. We aimed to explore how travel times, waiting times, and other efficiency- and quality-related hospital attributes influenced the hospital choice of women needing pelvic organ prolapse (POP) surgery in Tuscany, Italy.MethodsWe obtained the study population from Hospital Discharge Records. We duplicated individual observations (n = 2533) for the number of Tuscan hospitals that provided more than 30 POP interventions from 2017 to 2019 (n = 22) and merged them with the hospitals’ list. We generated the dichotomous variable “hospital choice” assuming the value one when hospitals where patients underwent surgery coincided with one of the 22 hospitals. We performed mixed logit models to explore between-hospital patient choice, gradually adding the women’s features as interactions.ResultsPatient choice was influenced by travel more than waiting times. A general preference for hospitals delivering higher volumes of interventions emerged. Interaction analyses showed that poorly educated women were less likely to choose distant hospitals and hospitals providing greater volumes of interventions compared to their counterpart. Women with multiple comorbidities more frequently chose hospitals with shorter average length of stay.ConclusionTravel times were the main determinants of hospital choice. Other quality- and efficiency-related hospital attributes influenced hospital choice as well. However, the effect depended on the socioeconomic and clinical background of women. Managers and policymakers should consider these findings to understand how women behave in choosing providers and thus mitigate equity gaps.

Predictors of surgery choices in women with early-stage breast cancer in China: a retrospective study

BackgroundThe breast-conserving surgery and reconstruction rate in China is relatively low when compared with those in Western countries. Moreover, predictors of surgical choices for women with breast cancer in China have not yet been explored. This study aims to explore differences in the surgical choices of women with different demographic and clinical characteristics and the predictors that influence surgical choices of women with early-stage breast cancer.MethodsThis retrospective study included women with early-stage (0-II) breast cancer who underwent surgeries at one of two Xiamen University-affiliated hospitals between 2009 and 2017. Using medical records, eleven variables were collected: the woman's age, year of diagnosis, hospital, marital status, payment method, cancer stage, presence of positive axillary lymph node, histology, neoadjuvant chemotherapy, radiotherapy, and the type(s) of surgery they chose. Binary logistic regression was used to analyse predictors of surgical choice.ResultsA total of 1,787 cases were included in this study. Of the total number of women with breast cancer, 61.3% underwent mastectomy without breast reconstruction, 26.4% underwent mastectomy with breast reconstruction, and the remaining 12.2% chose breast-conserving surgery. Women with different demographic and clinical characteristics underwent different types of surgery. Cancer stage, neoadjuvant chemotherapy, radiotherapy, and the choice of hospital were found to be predictors of breast-conserving surgery. Meanwhile, age, year of diagnosis, payment method, neoadjuvant chemotherapy, and the choice of hospital were found to be predictors of reconstruction after mastectomy in women with early-stage breast cancer.ConclusionsIn China, surgical choices for women with breast cancer have diversified. Healthcare workers should understand the surgical preferences of women of different ages. For early detection of breast cancer, knowledge of breast self-examination and breast cancer screening should be provided. Adequate information about the safety of reconstruction and advocacy for medical insurance coverage of reconstruction should be offer. Breast surgeons need specialised training and standardising protocols towards different types of breast surgery. These actions will help women make better, well-informed decisions about their breast surgeries.