Outcomes Of Hospital Care Research Articles

Issues of recruitment and maintaining high response rates in a longitudinal study of older hospital patients in England--pathways through care study.

STUDY OBJECTIVES: To describe and discuss the methods used to recruit and maintain an unbiased sample of older discharged hospital patients in a study of the process and outcomes of...

Commentary

When I was a doctoral student in health care administration at the University of Chicago, I worked with Odin Anderson, who introduced me to Osier Peterson and Bjprn Smedby. Odin first took me to Sweden in 1966. In early 1970, I met Lee Lusted and heard about clinical decision analysis. My interests, then as now, were the costs and outcomes of hospital care, although the methods I have used to address these problems have varied over time.

HIP Fracture: Use of Admission Assessment Data to Predict the Outcome of Hospital Care

HIP Fracture: Use of Admission Assessment Data to Predict the Outcome of Hospital Care

Outcome of Hospital Care for Stroke in 12 Centres

Outcome of Hospital Care for Stroke in 12 Centres

Paying for efficiency: what price the quality of hospital care?

Economic recession prompts governments and health service ministers to seek increased efficiency in the production of hospital services in order to reconcile increasing demands with scarce resources. As one approach to the problem, the National Health Strategy is recommending pilot schemes, similar to those which have been introduced in both the United Kingdom and the Netherlands, which involve the separation of purchaser from the provider of hospital services. It is argued that such separation, with the introduction of competition between providers of hospital services for contracts placed by publicly funded Area Health Boards, will increase efficiency and accountability in the use of resources. However, this argument ignores the hospital management's ability to keep costs down by altering the quality of hospital care in ways which are difficult to monitor by purchasing agencies. The article considers the effects the introduction of managed competition is likely to have on the quality of hospital services. The outcome is uncertain and competition may improve some dimensions of quality while jeopardizing others. If managed competition is tried in Australia, the opportunity should also be taken to examine its impact on the quality and outcomes of hospital care.

Volume and outcome in hospital care: evidence, explanations and implications.

The relationship between the volume of work undertaken in a hospital and the outcome of care has assumed increasing importance in recent years. A review of the literature reveals that most studies have been carried out in the USA and have largely been confined to six specific areas of health care. There is evidence that better outcomes are obtained at higher volumes for several surgical operations, cardiac catheterisation and care of the severely injured. As yet there is no clear association for coronary, neo-natal and burn care. There are two competing hypotheses to explain any association -- 'practice-makes-perfect' and 'selective referral'. These are discussed and implications for the future provision of hospital services considered.

A severity classification system for AIDS hospitalizations.

The authors describe a new model for classifying hospitalized patients with acquired immunodeficiency syndrome (AIDS) according to their severity of illness. In the first phase of the project, a clinical model indicating the relative severity of AIDS complications was formulated, based on the clinical literature and expert opinion. In the second phase, the model was tested empirically using data on in-patient mortality of over 6,000 adult AIDS hospitalizations in New York State during 1985. The ordering of AIDS-related complications in the clinical model was revised to reflect a continuum of increasing likelihood of death in the hospital. The final classification system for AIDS hospitalizations has 20 substages, grouped into three stages, with in-patient mortality rates increasing from 6% to 60%. The system is automated and can be applied to different AIDS populations to analyze resource use and outcomes of hospital care.

Reviewing the process and outcome of hospital care in Europe: The tracer method

A method is described for reviewing and comparing the process and outcome of hospital care, which involves collecting data on a consecutive series of patients with the same medical condition. Criteria for choice of tracer condition are given, and illuminated with reference to fractured neck of femur. The method has been developed in the context of the European Collaborative Health Services Studies, and participants from five countries have been involved. It is concluded that the method is practicable and succeeds in its objectives. The role of health care managers is one of stimulus and support to doctors and nurses who might be interested in carrying out such studies, and a set of stages from the initial idea for a study, through study design and data collection to conclusions for practical change, is described.

Private Initiative in PSRO.

Private initiative in PSRO (Pl) is a privately funded joint effort by five major professional organizations to influence the implementation of PSRO on behalf of the public interest. Working with five PSRO's, PI is testing a form of concurrent quality assurance and its effect on the immediate outcomes of hospital care. The project also promotes and evaluates participation in local PSRO's by representatives of the general public. The operating costs of PSRO's and their impact on hospital utilization and reimbursements by Medicare and Medicaid are being prospectively determined. A central issue addressed by PI is growing encroachment by the central administration of PSRO on private medicine's traditional responsibility for assuring the quality of care. PI seeks improved means of rendering a satisfactory public accounting in quality assurance as an alternative to federal regulation of this elemental professional function.

Outcome of hospital care--the patient's view.

How do patients feel about their hospital care? Unlike physicians and others who work there, most patients come to the hospital with problems they did not want and seek to be rid of. Most are naive about the hospital environment, and often fearful or insecure. Examined, talked over, tested and tended by a strange and changing throng of students, doctors, nurses and technicians, does the object of hospital attention feel himself to be an inanimate problem rather than the raison d'etre of the whole complex? A recent study1 concludes that at least the medical service of one Vermont hospital is . . .