Kinds Of Hospitals Research Articles

Narrative competence disparities between Children’s hospital and General hospital in China: A comparative survey

Background Narrative medicine was introduced in China in 2011 and has been applied as a tool for humane medical practice. The prominent problem in the narrative medicine is the lack of adequate attention and devotion. This study aimed to investigate Chinese medical staffs’ narrative competence and the influencing factors, confirming whether the level of narrative competence is different in different hospital settings. Methods A cross-sectional survey was conducted among 1003 medical staffs, including 201 from Children’s hospital and 802 from the General hospital. The participants were scored based on the Chinese narrative competence scale, a brief Chinese version of the resilience scale, and a Chinese version of the self-efficacy scale. Data were analyzed using IBM SPSS version 25.0. Results A total of 1003 medical staff from Children’s hospital and General hospital participated in the survey, with a response rate of 94.36%. Our results showed that the score of narrative competence of General hospital and Children’s hospital was 149.45±26.22 and 147.10±18.87, respectively, both of which were in intermediate level. Resilience, familiarity with narrative medicine were influencing factors of narrative competence in 2 kinds of hospitals, and whether having written parallel charts before were the influencing factors of narrative competence in General hospital. Besides, our study found that the level of narrative competence (χ2 = 13.672, p≤0.001), resilience score (personal ability dimension, t = 3.439, p≤0.001) and self-efficacy (t = 1.976, p<0.005) are different between General and Children’s hospital. Conclusions Narrative competence is different between General hospital and Children’s hospital. Medical staff in General hospital are more familiar with narrative medicine. The competence of medical staff in China needs to be improved.

Competition and coordination between traditional and internet hospitals

AbstractMotivated by the recent emergence and rapid growth of online healthcare platforms, this paper investigates its impacts on the healthcare ecosystem by taking into consideration of heterogeneous patients, homogeneous service providers and profit-driven hospitals. A game-theoretical model with a queueing framework is developed, and two healthcare systems are considered, including a monopolistic system with either an offline, traditional hospital, or an online, Internet hospital, and a duopolistic system with both kinds of hospitals. Our study finds that in both systems a large population of patients always increases the healthcare supply and demand and the hospital utilization, which leads to an improvement not only in the hospital profitability, but also in the welfare of both patients and service providers. When considering a monopolistic system only, our study suggests that the monopolistic Internet hospital outperforms its counterpart in hospital utilization only when the wait cost is not high (i.e., patients are less sensitive to wait time), especially when the wait cost is medium and the patient-provider ratio is small. When considering a duopolistic system, this study concludes that the decisions of patients, service providers, and hospital managers of both hospitals are interrelated, and that a large population of service providers increases its hospital’s supply, demand, and wage rate, while decreases its wait times. When comparing the two monopolistic with the duopolistic system, the latter outperforms and improves every entity’s utility (i.e., patients, hospital, and society) when there is abundance of service providers with more being allocated to the Internet hospital, whereas the monopolistic system dominates when the patient population is large, and more providers are allocated to the traditional hospital.

The Importance of Chowak in the Rituals of the Twiprasa in Tripura: An Ethnographic Study

This research paper attempts to investigate the use of chowak (rice beer) in several ceremonies as a social custom among the members of the Tripura tribe. In the Tripura tribe, chowak plays an important role in their socio-cultural life. It is also an essential part of their animistic belief system. Just as without animal sacrifice their deities cannot be worshipped, similarly without rice beer any propitiation remains inconclusive. According to popular belief, rice beer is the representative of the goddess Devi Laxmi. Hence, it is brewed with much religiosity. The preparation of rice beer involves a series of methods as well as taboos. Needless to say that chowak brings community harmony and it acts as a great way of bringing people together. It is assumed that sharing or drinking a bit of rice beer is like sharing the blessings of the goddess Devi Laxmi. They offer rice beer as a representation of Devi Laxmi while worshipping the deities. Rice beer is required in one’s life from the day of birth to the day of death for it is a must for every ritual. Rice beer is used in rituals as a kind of hospitality and respect towards the visitors. But with the passage of time, the significance of chowak is waning among the members of the tribe due to, commercialization, religious conversion, acculturation, and modernization.

Neonatal Hearing Rescreening in a Second-Level Hospital: Problems and Solutions.

Second-level hospitals face peculiarities that make it difficult to implement hearing rescreening protocols, which is also common in other settings. This study analyzes the hearing rescreening process in these kinds of hospitals. A total of 1130 individuals were included; in this cohort, 61.07% were hospital newborns who failed their first otoacoustic emission test after birth (n = 679) or were unable to perform the test (n = 11), and who were then referred to an outpatient clinic. The remaining 38.93% were individuals born in another hospital with their first test conducted in the outpatient clinic (n = 440). A high number of rescreenings were made outside of the recommended time frame, mainly in children referred from another hospital. There was a high lost-to-follow-up rate, especially regarding otolaryngologist referrals. Neonatal hearing screening at second-level hospitals is difficult because of staffing and time constraints. This results in turnaround times that are longer than recommended, interfering with the timely detection of hearing loss. This is particularly serious in outpatient children with impaired screening. Referral to out-of-town centers leads to unacceptable follow-up loss. Legislative support for all these rescreening issues is necessary. In this article, these findings are discussed and some solutions are proposed.

Validation of a new cognitive screening tool, the Brain Health Test‐7, for identification of mild cognitive impairment and early dementia

AbstractBackgroundThe Brain Health Test‐7 (BHT‐7) was developed to identify patients with mild cognitive impairment (MCI) and early dementia. Here we report the validity of the BHT‐7 versus the Mini‐Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in subjects of different psychiatry or neurology clinics.MethodPatients with the chief complaint of memory decline were recruited in this study from the outpatient clinic of psychiatry or neurology in 3 different kinds of hospitals between November 2017 to December 2020. All patients underwent the evaluation of the BHT‐7, MMSE, MoCA, and CDR by trained research assistants or board‐certified psychologists. The final clinical diagnosis (normal, MCI, dementia) was made by consensus meeting, taking into account all available data, including clinical history and symptoms, brain image, cognitive tests, and CDR. Demographic data (age, gender, and education level) and the scores of the MMSE, MoCA, and BHT‐7 between groups were compared. Logistic regression was adopted for analysis of optimal cutoff values, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and the area under the ROC curve.ResultWe enrolled a total of 1090 subjects (normal 402, MCI 317, dementia 371); of them, 705 (64.7%) were female. There was a statistically significant difference in age, years of education, and 3 cognitive test scores among the 3 groups of subjects. Compared with the MMSE and MoCA, the BHT‐7 performed slightly better in differentiating MCI and dementia. In sub‐group analysis (divided based on 6 years of education), the BHT‐7 still performed slightly better than MMSE and MoCA. The testing time for the BHT‐7 was about 5‐7 minutes, shorter than that of the MMSE and MoCA. For BHT‐7, the cutoff point was 17 between normal and MCI, and 14 between normal and dementia. These cutoff points of BHT‐7 were consistent through 3 different settings (medical center’s psychiatry and neurology clinics, and outpatient clinic of a psychiatry center). In contrast, the cutoff points were inconsistent for MMSE and MoCA in different settings.ConclusionThe results support that BHT‐7 may be a useful cognitive screening tool for MCI or early dementia in various clinic settings.

Gender distribution and women leadership in German Otolaryngology, Head and Neck Surgery.

To determine the distribution of female physicians throughout the rank from resident to leadership positions in German Otolaryngology-Head and Neck Surgery (OHNS) departments. This cross-sectional study collected data about the physician workforce in the German OHNS.The primary outcome was the proportion of female physicians. Data were collected from 165 departments from January 2022 to February 2022. The physician workforce was stratified based on gender and leadership. We included 2089 physicians from 165 departments of OHNS in German hospitals. Female residents and specialists outnumbered male peers (484/872 [55.5%] vs. 388/872 [44.5%] and 224/363 [61.71%] vs. 139/363 [38.29%], respectively). However, the women proportion decreased gradually with elevated hierarchical rank starting at the attending physician level to reaching its lowest extreme (14/165 [7.23%]) at the head of the department level. Holding a leadership position was associated with being male (n = 282 [85.2%] vs. n = 49 [14.8%], p < .0001). This persisted even after controlling the academic rank in a multivariable regression model (OR: 5.027, 95% CI: 3.536-7.146). The gap between the two genders in favor of men regarding leadership persisted in all kinds of hospitals. However, this disparity was lowest in university hospitals, (male: n = 83 [78.3%] vs. female: n = 23, [21.7%], p < .0001). Even though women outnumbered men in resident and specialist positions, they are still underrepresented in leadership positions in OHNS. Continuous surveillance is needed to watch the dynamic changes in the gap between the two genders and address it with more sex equality-supporting policies. IV.

Hospitalization due to fire-induced pollution in the Brazilian Amazon: A causal inference analysis with an assessment of policy trade-offs

Developing countries by relying on agricultural fires trade respiratory health for cheaper land preparation and greater food security of subsistence farmers. In the Brazilian Amazon, thousands of kilometres of vegetation are annually burned, releasing pollutants that impact the health of 24 million inhabitants. The paper seeks to fill two crucial informational gaps for policy planning, namely, the size of the impact on the most pollution-susceptible groups, i.e., children and the elderly, and the priority locations for health-oriented intervention on fires. A municipal-monthly panel covering ten years of the Amazonian territory was analysed by relying on exogenous and high-resolution wind direction variation to identify the effect of fires on pollution and hospitalizations. This is an unparalleled effort for applying to a large geographical area spanning five million km2 a highly refined identification strategy relying on hourly gridded wind and fire data. As the result, one extra standard deviation of “upwind” fires was estimated to increase asthma-related hospitalization of the elderly in 0.03 days/month, that is, 4 % of the bed-days commonly demanded by such kind of hospitalization, an effect whose size decayed with the distance between fires and hospitals. A policy assessment uncovered the trade-off between respiratory health of the elderly and nutritional health of fire-dependent subsistence farmers, presenting a priority map for tackling the issue with municipal-level interventions. The targeting of non-subsistence fires is advised, what could avoid 28 days of hospitalization per year. It is thus demonstrated that the trade-offs inherent to agricultural fires could be better balanced by evidence-based targeting of fire prevention policy.

Healthcare for Patients with Hepatitis B Virus: Analysis of 367 381 Inpatient Cases in China.

Hepatitis B virus (HBV) infection, which has been recognized as an international public health challenge, has caused significant morbidity for the entire world. This research focused on patients with HBV in China to examine health utilization and expenses. Patients hospitalized with HBV from 2017 to 2019 in tertiary hospitals in Hubei, a province located in central China, were selected as the study population. Healthcare information was collected from the provincial inpatient electronic system database. Univariate and regression analyses were performed to describe the basic situation of healthcare services and determine the influencing indicators of inpatient service expenditure. A total of 367 381 cases of HBV infection were identified in the study area. Most of these cases were patients who were married (90.2%) and males (63%). With the great efforts by the universal coverage of the basic medical insurance (BMI) in China, the increasing rate of inpatient hospitalization for HBV was 3.5 times higher than that of the total inpatient health service cases in the study area. The average age of this group was 52.84±14.10 years and 11.1% of patients paid for their own medical expenditures without insurance. The average length of stay (LOS) was 11.10 days, and the average cost per patient was 15 712.05 RMB. Both values were higher than the average level in study area. Gender, marital status, career, payment type, and kind of hospitals significantly influenced healthcare utilization. Males and the elderly might incur higher healthcare costs than their counterparts. The BMI operated by government has played a role in the utilization release of health services for HBV carriers. However, researchers must pay more attention to the continuing increase in the medical expenses of this group.

Accommodations Weave in Foz do Iguaçu-Brazil and Ecosystemic Responsibility

This article aims to present aspects related to the weaves of accommodation options in Foz do Iguaçu-Brazil city, regarding ecosystemic responsibility’s actions. The text is a partial report of a study being carried out, at the Master’s level, in Tourism and Hospitality, in association with other broader studies which have been held at a Research Group, from the University of the South of Brazil. The Cartography of Knowledge (Baptista, 2014) was used as a procedural, complex and systemic methodological strategy, in which four investigative tracks are activated: Personal Knowledge Trail, Theoretical Knowledge Trail, Production Plant Trail, and Intuitive Research Dimension Trail. It is consistent with the orientation of qualitative and multi-methodological research, having been carried out from multiple investigative procedures: bibliographic survey, interviews via Google Meet and phone calls, seminars and rounds of conversation, as well as data collection from websites, blogs and social networks. The study demonstrates the importance of raising awareness among hosting companies regarding ecosystemic responsibility, that is, the set of actions related to the care and preservation of resources, aiming at the well-being of the entire ecosystem. It is noticed that there is a lot of work to be done in this sense, since, in general, guests choose the means of accommodation considering cost and benefits according to their economic possibilities. While hosts’ main concern is about offering the kind of hospitality that guarantees the guest’s return to the lodging, based on the disclosure of the benefits offered at the time of booking.

544 - Validation of a new cognitive screening tool, the Brain Health Test-7, for identification of mild cognitive impairment and early dementia in 3 differentkinds of hospital settings

BackgroundThe Brain Health Test-7 (BHT-7) is a revised tool from the original BHT, containing more tests about frontal lobe function. It was developed with theaim of identifying patients with mild cognitive impairment (MCI) and early dementia.Research objectiveHere we report the validity of the BHT-7 versus the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) in differentpsychiatry or neurology clinics.MethodsPatients with memory complaints were recruited in this study from the outpatient clinic of psychiatry or neurology in 3 different kinds of hospitals. Allpatients underwent the evaluation of the BHT-7, MMSE, MoCA, and clinical dementia rating (CDR). The clinical diagnosis (normal, MCI, dementia) was made by consensus meeting, taking into account all available data.Demographic data and the scores of the MMSE, MoCA, and BHT-7 between groups were compared. Logistic regression was adopted for analysis of optimal cutoff values, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), receiver operating characteristic (ROC) curve,and the area under the ROC curve (AUC).ResultsWe enrolled a total of 1090 subjects (normal 402, MCI 317, dementia 371); of them, 705 (64.7%) were female. There was a statistically significant differencein age, years of education, and 3 cognitive test scores among the 3 groups.Compared with the MMSE and MoCA, the BHT-7 performed slightly betterthan MMSE and MoCA in differentiating MCI or dementia from the normalcontrols (Table 1). For BHT- 7, the cutoff point was 17 between normal andMCI, and 14 between normal and dementia. These cutoff points for BHT-7were consistent through 3 different clinical settings, but inconsistent for MMSE and MoCA. The testing time for the BHT-7 was about 5-7 minutes, shorter than that of the MMSE and MoCA.ConclusionCompared with MMSE and MoCA, the BHT-7 showed slightly better performance in differentiating normal from MCI or dementia subjects. The testing time for the BHT-7 was shorter, and its cutoff points were consistent through different outpatient clinic settings. The results support that BHT-7 is auseful cognitive screening tool for MCI or early dementia in various hospital settings.Table 1Comparisons of the performance of BHT-7, MMSE, MoCAAUCcutoffSENSPEPPVNPVNormal vs. MCIBHT-70.8532≦170.81700.74130.71350.8371MMSE0.8061≦270.79500.68830.66840.8091MoCA0.8316≦250.82020.67910.66840.8273Normal vs. DementiaBHT-70.9848≦140.94340.96020.95630.9484MMSE0.9693≦240.88950.96260.95650.9040MoCA0.9768≦210.92450.94280.93720.9312Normal vs. MCI + DementiaBHT-70.9241≦160.83720.84580.90280.7522MMSE0.8941≦250.72820.91520.93650.6625MoCA0.9099≦230.80810.85320.90410.7221

Clinical characteristics of patients with undergoing unplanned excisions of malignant soft tissue tumors.

Malignant soft tissue tumors are rare tumors representing <1% of all malignancies. As these tumors are rare, it is not uncommon that malignant soft tissue tumor excision is performed without the required preoperative imaging, staging, or wide resection margins for sarcomas. The purpose of this study was to investigate the characteristics of patients with undergoing unplanned excisions. Risk factors for tumor recurrence and mortality in patients treated with unplanned excisions were also analyzed. Forty-nine patients who underwent unplanned excision at other hospitals and additional wide excision at our hospital between January 2002 and December 2018 were identified. Among them, 42 patients with follow-up for more than 1year were included in this retrospective study. The relationships between sex, age, tumor depth, histological grade, location, size, surgical margin at additional wide excision, residual tumor, reconstruction, kind of hospital where the primary excision was done (sarcoma vs non-sarcoma center), preoperative examination, chemotherapy, radiation therapy, and oncological outcomes were statistically analyzed. Mean patient age was 57.3years (15-85years) and the mean observation period was 72.5 months (14-181months). This analysis showed 53.8% tumors that underwent unplanned excisions were small (<5cm) and 70.7% tumors were superficial. Multivariate analysis revealed that a positive margin during additional wide excision was significantly associated with a lower 5-year LRFS (p < 0.01). Most of the tumors underwent unplanned excisions were small (<5cm) and superficial. Surgeons should be aware that a positive margin during additional wide excision is an independent risk factor for local recurrence.

Drug-related problems and risk factors related to unplanned hospital readmission among cancer patients in Belgium.

There are about 60,000 diagnoses of cancer per year in Belgium. After hospital care, about 12-13% of cancer patients are readmitted within 30days after discharge. These readmissions are partly related to drug-related problems (DRP), such as interactions or adverse drug effects (ADE). The aim of this study is to quantify and to classify DRP readmissions within 30days for cancer patients and to highlight risk factors potentially correlated to readmissions. This study is a 6-month observational retrospective study in two care facilities in Brussels: an academic general hospital and an academic oncology center. Patients readmitted within 30days after their last hospital care for a potential DRP were included. Patient files were evaluated with an intermediate medication review that included interactions analysis (Lexicomp®). The probability of DRP readmission was assessed using the World Health Organization's Uppsala Monitoring Centre (WHO-UMC) system. The final population included 299 patients; among them, 123 (41.1%) were readmitted due to DRP (certain DRP (4.9%), probable DRP (49.6%), and possible DRP (45.5%)). Risks factors linked to these DRP were a low Charlson Comorbidity Index, polypharmacy, the kind of hospital, and some chemotherapies (platinum preparations). Among all readmitted patients, the D-type interactions were the most common (44.8%), which suggest a possible therapy modification. However, around 10% of interactions were X-type (drug combination to avoid). Almost 10% of patient readmitted within 30days were potentially related to a DRP, most of them from adverse drug effects. Four risk factors (low Charlson Comorbidity Index, polypharmacy, the hospital, and some chemotherapies) were highlighted to prevent these readmissions.

Land-they're not making it any more: logistical challenges of hospital development and redevelopment

Before the 2019 general election, the Conservatives pledged to build 40 new hospitals (Campbell, 2019). Ostensibly this is good news, but what kind of hospitals were envisaged? The media and politicians often talk about hospitals as if they are all the same, when in reality there is much variation between the size, mix and balance of specialties in different district general hospitals. A new building does not necessarily mean a new hospital; for example, it may instead be built to replace a 19th century hospital that was struggling to accommodate modern medicine. The sign above the front door might say ‘Accident and Emergency’, but this does not necessarily mean that all the required supportive services are behind it. Any such department needs access to beds in a variety of specialties, including trauma and orthopaedics, general surgery, general medicine, paediatrics and intensive care. Many other key specialities are also needed, such as obstetrics and mental health services.

Nurses' job stressors and social support behaviors: Comparing public, teaching, and private hospitals.

Different work environments may create different nurses' job stressors, and in turn, may need different social support behaviors to help nurses overcome these stressors. This study aimed at comparing nurses' job stressors and social support behaviors in three different work environments (i.e., public, teaching, and private hospitals) in Jordan and examining the predictors of these stressors and social support behaviors. This was a descriptive comparative study in which data were collected using the Nursing Stress Scale and the Inventory of Social Supportive Behaviors from 139, 190, and 135 nurses from the public, teaching, and private hospitals, respectively. Descriptive and inferential statistics including comparative and multiple linear regression statistics were used. The results indicated that there were no significant differences in the total scores of job stressors and social support behaviors among nurses at the three types of hospitals. However, significant differences were reported in the subscales of job stressors in teaching and public hospitals and in individual items of both scales across the three kinds of hospitals. Controlling for nurses' characteristics, the scores of both scales were not predicted by the type of hospitals. Similar to public hospitals, teaching, and private hospitals, administrators should initiate various social support behaviors in their clinical settings, and should consider the predictors of job stressors to help nurses overcome their job stressors.

Obstetric education and neonatal resuscitation at birth: an Italian survey

Introduction Approximately 10% of infants at birth require some assistance to breathe and 1% require vigorous resuscitation. As such, midwives need appropriate education and training on newborn life support (NLS) techniques. Methods We conducted a survey on Italian territory about the correlation between obstetric education and the management of the neonatal resuscitation in the delivery room. The study was led through a web survey based on 23 questions, given anonymously online through the Google Drive platform. Results 272 women aged from 19 to 59 years answered the questions (83% midwives and 17% midwifery students). 93% of them attended an NLS course before graduation, while only 57% have repeated it afterwards once or more times. The midwives working in hospitals with neonatal intensive care units (NICUs) experienced more involvement within the emergency neonatal resuscitation team than the others working in other kind of hospitals (hospital with NICU 79%, hospital without NICU 57%, private hospital 48%; p < .001). Moreover, the midwives’ years of experience at work are much more related to the prompt execution of primary resuscitation maneuvers (more than 10 years of experience 74%, 5–10 years 48%, less than 5 years 30%; p < .001). Power analysis showed an adequate sample size of the study population. Conclusions In spite of NLS techniques are taught to near all midwives, only working in hospitals within a NICU and longer work experience are directly related with greater involvement of a midwife in the neonatal resuscitation team.

The Evolution and Devolution of Hospital Care

The Evolution and Devolution of Hospital Care

Map of ethics conflicts in chronic patient's hospitalization

The identification, priorization and anticipation of the ethics conflicts, allow the Healthcare Ethics Committees (HEC) a better approach to them, as well as the adoption of measures to prevent its appearance and/or its mitigation. For this purpose, we set ourselves the objective of knowing what they are in the present, how important they are, and what would be the future scenario to face. An qualitative structure research was made whit two focal groups whit the participation of nurses, nurse auxiliary and doctors from the hospitalization area, they also answer a future ethics conflicts Decalogue. The results were tested after by their importance level (Relevance-Frequency-Consistency). The medium age of the participants was 34,7 +- 15,4, whit a medium experience at work of 11,7 +- 15,4 years. A total of 40 ethics conflicts was identify grouped in 5 risk areas: professional, assistance, social, organizational and legal. From there 21 results the more important, between them we find patient abandonment, inexistence of internal performance protocols, patient and relatives false expectations waiting for non-assistance care, unnecessary care at the end of the life, lack of rules for family / caregivers, and ignorance of legality. The more important ethical dilemmas for the future identified by the personal will be patients in abandonment, the lack of sociohealth resources, conflicts with family / caregivers situation and lack of information for decision making at the end of the life. The ethical conflicts between the personal from a chronic patients hospital and the relatives/caregivers was identifying, the most important were prioritized, and futures were anticipated. In these scenarios, we highlight abandonment as the most important. A map of ethics conflicts is a good tool to identify risk areas for ethics conflicts, we see the difference between the ethics conflicts found in other kind of hospitals. The map of ethics conflicts need to be update periodically to keep the validity.

Influence of Leadership, Remuneration and Organizational Culture on Health Madani Trough Performance of Public Hospital as Mediator

Health of Madani or Civil Society is "Healthy, Self-reliant and Equitable People”. The hospital as the spearhead of the leading health care services, whereas there are two kind of hospital in Batam, Public and Private Hospital. Orientation performance of hospitals is certainly influenced by the spirit and variable determiner of the hospital's performance, so this study aims to: "analyse of Leadership, Remuneration and Organizational Culture on Health Madani through Performance of Public Hospital”. The study population was all over the State Civil Administration, with a random sampling technique as the sample population, totally 220 respondents. The data were analyzed using SEM. The software used for the structural analysis is AMOS, and for a descriptive study using SPSS version 24.0. The research proves that: Leadership, Remuneration and Organizational Culture on Health Madani through Performance of Public Hospital as Mediator has significant effect. Pursuant to the result of this study is suggested that management of hospital in order to have a spirit of service as health care does not only embed oriented profit, the government also suggested to provide subsidized financing to hospital, so that health Madani which is "Healthy, Self-reliant and Equitable People” can be reached.

Validating a model &amp; self-assessment tool to measure organizational health literacy in hospitals

Abstract Background The European Health Literacy Survey (HLS-EU) demonstrated that in many European countries a considerable proportion of the population has limited health literacy (HL), that there is a social gradient for HL and that HL is associated with use of health services. Furthermore research mostly from the US also showed that HL of patients has detrimental effects not only on use but also on outcomes of health care. Therefore in the US the concept of the Health Literate Health Care Organization (HLHCO) has been developed by IOM to make health services more sensitive to the needs of patients with limited HL. Methods Based on the IOM concept, a more comprehensive model of a Health Literate Health Care Organization fulfilling criteria of WH&amp;Oacute;s health promoting setting approach has been developed. A set of standards and indicators according to quality management criteria (ISQUA) to measure the organizational HL of a hospital has been constructed, tested and validated in 9 different kinds of hospitals by a team in Vienna. This model and measurement tool has been translated to English and other languages and been used and validated also in other countries (Belgium, Italy, Taiwan). By an international working group of the international Health Promoting Hospitals and Health Services network an international version of the model and tool has been developed and will be tested in different countries. Results The model and self-assessment tool has been demonstrated to be acceptable, feasibly, valid and useful to start self-assessment and improvement of organizational HL in different types of hospitals and health care systems. Conclusions Organizational HL of health services matters for use and quality of health care of patients. Measuring organizational HL of hospitals by a validated instrument can support development of a more health literate health care organization and by that improve quality of care and tackle the health gap. Key messages Health literacy matter for health care and can be measured and improved on a personal and on an organizations or systems level to improve quality of care and tackle the health gap. A model and self-assessment instrument to measure organizational health literacy of hospitals has been developed and validated to support hospitals to improve their organizational health literacy.

Impact analysis of the payment reform of “same disease with the same price in the same level of hospital” diagnosis-related group based on L City, Guizhou Province: an empirical study

BackgroundDiagnosis-related group (DRG)-based payment system has been widely implemented in China to improve hospital efficiency, standardise the behaviours of health-care providers, and control the increase of medical costs. In order to study the impact of the DRG reform strategy “same disease with the same price in the same level of hospital” on the costs control of medical institutions, we analysed changes in the level and trend of hospitalisation expenses before and after the implementation of the new rural cooperative medical insurance DRG-based payment reform. MethodsWe collected medical insurance claims data of four pilot hospitals implementing DRG-based payment reform in L City, Guizhou Province, from Jan 1, 2016, to July 31, 2018, including 141 987 cases. Hospitals A and B were tertiary hospitals, and hospitals C and D were secondary hospitals. Taking October 2017 as the intervention point, we used interrupted time series (ITS) and qualitative interview methods to evaluate the policy effect. FindingsBefore the reform, the costs per case of hospital A and hospital B were higher than that of tertiary hospitals, and hospital A also had the highest increase in the costs per case. After the reform, the growth rate of costs per case declined by ¥43·98 per month in hospital A, while that increased by ¥5·91 per month in hospital B. The growth rate of costs per case in hospital A decreased much more obviously than that in hospital B. Before the reform, the costs per case of hospital C were slightly higher than the average costs level of secondary hospital, while the costs per case of hospital D were lower than the average level. After the reform, the increase of costs per case in hospital C has changed from ¥41·40 per month to ¥ 109·73 per month, and the long-term growth trend has not been controlled. The increase of costs per case in hospital D was ¥32·03 per month, which was smaller than that of hospital C. In terms of total costs, the growth rate of hospital A and hospital D increased by ¥66 000 per month and ¥154 000 per month, respectively, which was smaller than that of hospital B (¥788 900 per month) and hospital C (¥158 300 per month). InterpretationThis DRG-based payment reform strategy has set up the overall costs benchmark of the hospitals at the same level, which has prompted providers to take the initiative to pay attention to costs. And the reform was also beneficial to curb the hospitals that pushed up the costs in the first place. After the reform, the overall costs control of pilot hospitals has not changed significantly, it is still necessary to continue to track the impact of the reform on all kinds of hospitals at all levels in the city. FundingNew rural cooperative medical system (NCMS) payments reform contact point project of Grass-roots Department of the National Health Commission (2209121).