Hospital Planning Research Articles

A Technique for Solving Special Type Quadratic Programming Problems

Because of its usefulness in production planning, financial and corporate planning, health care and hospital planning, quadratic programming (QP) problems have attracted considerable research and interest in recent years. In this paper, we first extend the simplex method for solving QP problems by replacing one basic variable at an iteration of simplex method. We then develop an algorithm and a computer technique for solving quadratic programming problem involving the product of two indefinite factorized linear functions. For developing the technique, we use programming language MATHEMATICA. We also illustrate numerical examples to demonstrate our technique.DOI: http://dx.doi.org/10.3329/dujs.v60i2.11520 Dhaka Univ. J. Sci. 60(2): 209-215, 2012 (July)

Il sistema ospedaliero e la resilienza urbana

The concept of resilience is critical when addressing the issue of natural hazards. The role of an urban planner is to analyze the territorial system, consisting of several functional sub-systems (housing, education, health, etc..) and its vulnerability. In order to have a specific knowledge of the territory in question, before the occurrence of a disaster it would be necessary, for each functional system, analyze various aspects and define risk simulations. In a city, in fact, there are strategic elements that should not lose functionality during or following a natural event; the definition of specific scenarios could put structures exposed to risk on safety in order not to compromise the system. In this paper I report a specific experience of research carried out within the hospital system that, in case of occurrence of a natural event, is often simultaneously exposed, and therefore need of rescue, and it is a dispenser of rescue. It’s considered strategic because it has to ensure the functionality of its service regardless of the occurrence of external events, such as natural ones; its functionality must be ensured in the continuum. In today is not very thorough the scientific literature about the analysis of the hospital system in respect of such events. Given the importance of the theme there are several initiatives, also promoted by The Italian Civil Protection, in particular the drafting of hospital emergency plans, which cover issues such as fire, road accidents, floods, ... Interesting was the collaboration between the Italian Civil Protection Department with Applied Technology Council for the planning of a background paper intended for the preparation of earthquake emergency plans, within which there are also aspects of prevention such as the evaluation of seismic vulnerability of hospitals themselves. The described methodology has allowed the definition of risk simulations for the hospital system, starting from the determination of qualitative and quantitative indices of hazard, vulnerability and exposure in support of plan emergency hospital. Specific focus was directed to the exposure, determined dynamically, going to know how the situation changes in the hospital complex, depending on the passing of hours a day. In these scenarios we introduced the parameter “time”, concept of the time policies (actions for the quality of the urban conditions of life of its citizens, acting on the aspects of urban functions and times of their coordination). Case study is the town of Cuneo and the considered event is the earthquake. The new “Planning and emergency hospital Plans” could well be a step forward for the safety of the territory. These could be an integral part of the town civil protection plans (not only dedicated to the emergency but also to forecast), in turn attached to urban plans in order to become operational tools of strategies and policies needed to increase urban resilience.

From Cottage to Community Hospitals: Watlington Cottage Hospital and its Regional Context, 1874–2000

The appearance in England from the 1850s of 'cottage hospitals' in considerable numbers constituted a new and distinctive form of hospital provision. The historiography of hospital care has emphasised the role of the large teaching hospitals, to the neglect of the smaller and general practitioner hospitals. This article inverts that attention, by examining their history and shift in function to 'community hospitals'within their regional setting in the period up to 2000. As the planning of hospitals on a regional basis began from the 1920s, the impact of NHS organisational and planning mechanisms on smaller hospitals is explored through case studies at two levels. The strategy for community hospitals of the Oxford NHS Region--one of the first Regions to formulate such a strategy--and the impact of that strategy on one hospital, Watlington Cottage Hospital, is critically examined through its existence from 1874 to 2000.

A guide for building hospital simulation models

Healthcare systems aspire to offer an effective and efficient provision of health service without compromising on quality. Hospitals are important links in the healthcare service chain, and Operational Research/Management Science methods have an essential role to play in helping to improve the planning and management of hospitals. In particular, simulation methods have been widely used by healthcare researchers and practitioners. This paper is written as a guide for building hospital simulation models and is based on the author's experience and the published literature. Two points of view emerge in this paper supporting each other: a conceptual view and a technical view. Initially, conceptual issues are discussed, including topics such as framing and specification, level of model detail, and data requirements. Second, a technical point of view buttresses the discussion from the methodological side and three simulation methods are evaluated, namely: Discrete Event Simulation, System Dynamics, and Agent-Based Simulation.

Factors Associated with Prolonged Hospital Stay in a Geriatric Ward of a University Hospital in Japan

We read with interest the article by Lakhan and colleagues,1 which showed the high prevalence and worsening of geriatric syndrome during acute care hospitalization. Because falls, incontinence, impairment in activities of daily living (ADLs), and other geriatric syndrome components increase the care burden and limit discharge planning in acute care hospitals, geriatric syndrome might cause prolonged hospital stays. A prolonged hospital stay is one of the major determinants of medical cost and is thus a serious problem in geriatric medicine. Previous studies have shown that clinical events during hospitalization,2, 3 basic ADLs,4 and nonmedical factors such as delayed transfer to a nursing facility or disagreement on the discharge plan among family members5 are risk factors for prolonged hospital stay. Furthermore, because older adults have multiple comorbid conditions and are susceptible to adverse drug reactions (ADRs), these factors might be related to length of hospital stay. To test this hypothesis, the association between geriatric conditions such as geriatric syndrome, ADLs, and ADRs and prolonged hospital stay were comprehensively investigated using the database of the geriatric ward of the University of Tokyo Hospital from 1995 to 2010. The ethics committee of the Graduate School of Medicine, University of Tokyo approved this study. All records of patients aged 65 and older from 1995 to 2010 were reviewed. Data on length of stay, acute hospitalization, ADRs, body mass index (BMI), number of diseases and drugs, geriatric syndrome, and Barthel Index were collected. Twenty-three components of geriatric syndrome such as falls, cognitive impairment, urinary incontinence, constipation, and insomnia were included in the analysis. Records lacking information on any of the variables were excluded. Cases of scheduled short-term hospitalization were excluded. Finally, the records of 1,616 patients were analyzed (mean age 78.3 ± 7.0, 52% male). All data were obtained soon after admission. Values are expressed as means ± standard deviations and were analyzed using JMP version 9.0.2 (SAS Institute, Inc., Cary, NC). P < .05 was considered statistically significant. Mean length of stay was 27.3 ± 22.6 days (range 1–322 days). The results of univariate and multivariate analyses for length of stay are shown in Table 1. Multiple stepwise regression analysis showed that ADRs, number of diseases, and number of geriatric syndrome components were positively associated with longer hospital stay, whereas age, BMI, and Barthel Index were negatively associated. The number of geriatric syndrome components was significantly associated with hospital stay independent of number of diseases. The present analysis demonstrated that geriatric factors such as ADRs, multiple diseases, low BMI, ADL dependence, and number of geriatric syndrome components were associated with longer hospital stay in a large group. The finding that ADRs are a risk for prolonged hospital stay is consistent with a previous report,6 and ADL dependence has been reported as a risk in a smaller group.4 Furthermore, the number of geriatric syndrome components and undernutrition were risk factors for prolonged hospital stay in a large-scale study. Frailty, which is also known to be a risk factor,7 was not examined independently in the present study, but ADL dependence and undernutrition, both of which are major components of frailty, were found to be risk factors, so it is reasonable to assume that frailty was associated with length of hospital stay in the current cohort as well. The present study revealed that the accumulation of geriatric syndrome components was a risk factor for prolonged hospital stay independent of multiple diseases and, presumably, frailty. Thus, geriatric syndrome should be comprehensively managed during hospitalization. The reason for the negative association between age and length of stay is unclear, but the presence of young-old patients with disability or complicated conditions on the geriatric ward might have influenced the results. In summary, the present study provides new insight into the significance of geriatric conditions in relation to prolonged hospital stay in older adults. ADL dependence, undernutrition, ADRs, and geriatric syndrome should be carefully assessed and interventions provided when caring for older inpatients. Conflict of Interest: The editor in chief has reviewed the conflict of interest checklist provided by the authors and has determined that the authors have no financial or any other kind of personal conflicts with this paper. Author Contributions: TK: acquisition of subjects and data analysis, interpretation of data, and drafting of manuscript. MA: coordinator of study concept and design, and study supervision. YK, KY, and HY: acquisition of subjects and data. ME: data analysis and interpretation of data. YO: study supervision. Sponsor's Role: The sponsors had no role in the design, methods, data collections, analysis, and preparation of this paper.

John Godfrey Ball

After service in the Royal Army Medical Corps (RAMC), hospital posts in the Birmingham area and a traineeship in Stourport, John Godfrey Ball succeeded to a single handed practice in...

Präoperative Risikoevaluation erwachsener Patienten vor elektiven, nichtkardiochirurgischen Eingriffen

While assessing the medical history and physical examination are the cornerstones of preoperative risk evaluation, the importance of "routine" testing has been critically discussed in recent studies. The joint recommendations of the German Societies of Anaesthesiology and Intensive Care Medicine, Surgery and Internal Medicine for preoperative evaluation of adult patients prior to elective, non-cardiac surgery, which were published in November 2010, are the first comprehensive practice guidelines for preoperative evaluation in Germany. Aim of this study was to analyze former strategies for assessing perioperative risk at anaesthesia departments in Germany. A 29-item questionnaire concerning general hospital characteristics, strategies for preoperative evaluation and cognizance of the joint recommendations was developed as an online survey. In particular the reasons for technical assessment were surveyed (i.e. routine, patient age or pre-existing conditions, risk of operation being performed). In certain questions multiple answers were permitted. All hospitals with departments of anaesthesiology in Germany were included. Data are presented as percentages. A total of 396 hospitals (35.6%) completed the questionnaire. Physical examination is not performed regularly (37%) but only when indicated by the medical history. Criteria for performing preoperative electrocardiograms are comorbidities of the cardiovascular (80.1%) and pulmonary systems (42.2%) as well as patient age (52.8%) and as routine measures (10.1%). Laboratory testing was performed as a routine (43.2%) because of patient age (52.8%) or pre-existing conditions (37.3%). Preoperative chest x-ray was carried out when the medical history or physical examination suggest intrathoracic pathologies (81.3%) or was based on patient age (35.9%). The majority of hospitals (89.1%) plan to implement the joint recommendations for preoperative evaluation in the future. According to the joint recommendations preoperative testing is more and more directed to patients with an increased perioperative risk which is clinically indicated by medical history and physical examination. However, routine or age-related medical testing is still a frequently used strategy. German medical societies should focus on advanced implementation strategies to change current practices in order to avoid unnecessary diagnostic procedures and to increase patient safety and satisfaction.

Effects of modernisation and new population policies on reproductive health in Kars, Turkey

ABSTRACTBackground The 1983 Turkish Population Planning Act aimed at improving reproductive health outcomes. We examined the effects of the Act and of modernisation in a small, underdeveloped city and province, Kars.Methods Between June 2009 and January 2010, 576 parous women at a hospital in Kars participated in a study of reproductive histories and living standards. Results were compared by decade during which the birth took place of the first child who survived its first year, and urban/rural residence. Correlation and multi-way analyses of variance (ANOVA), χ2 and t tests were used as appropriate. We also examined women's education and living standards and use of hospital and family planning (FP) facilities.Result From 1970 through 2009 maternal age at first live birth increased by 4.9 years (p < 0.05) from a baseline of 18.9 years. The number of pregnancies fell from a mean of 8.1 per woman in the 1970s to 5.6 in the 1980s (p < 0.05), with strong indications of continued decreases through the 2000–2009 decade. FP sites in Kars province increased in number and services, as did antenatal hospital visits and the proportions of women giving birth in a hospital. Concomitantly, delivery by caesarean section augmented markedly over the decades. Education levels of both urban and rural women rose from two years of schooling in the 1970s to ten years in the last decade.Conclusion Modernisation, including increasing urbanisation, education, and new governmental policies that translated into maternal-child health and FP services were likely the backbone for improved reproductive health and lower fertility rates of women in Kars over the 40 year-period we studied.

Recommended practices for computerized clinical decision support and knowledge management in community settings: a qualitative study

BackgroundThe purpose of this study was to identify recommended practices for computerized clinical decision support (CDS) development and implementation and for knowledge management (KM) processes in ambulatory clinics and community hospitals using commercial or locally developed systems in the U.S.MethodsGuided by the Multiple Perspectives Framework, the authors conducted ethnographic field studies at two community hospitals and five ambulatory clinic organizations across the U.S. Using a Rapid Assessment Process, a multidisciplinary research team: gathered preliminary assessment data; conducted on-site interviews, observations, and field surveys; analyzed data using both template and grounded methods; and developed universal themes. A panel of experts produced recommended practices.ResultsThe team identified ten themes related to CDS and KM. These include: 1) workflow; 2) knowledge management; 3) data as a foundation for CDS; 4) user computer interaction; 5) measurement and metrics; 6) governance; 7) translation for collaboration; 8) the meaning of CDS; 9) roles of special, essential people; and 10) communication, training, and support. Experts developed recommendations about each theme. The original Multiple Perspectives framework was modified to make explicit a new theoretical construct, that of Translational Interaction.ConclusionsThese ten themes represent areas that need attention if a clinic or community hospital plans to implement and successfully utilize CDS. In addition, they have implications for workforce education, research, and national-level policy development. The Translational Interaction construct could guide future applied informatics research endeavors.

Hospital seguro frente aos desastres: uma reflexão sobre biossegurança e arquitetura

One of the biggest challenges in today's society is facing adversity caused by disasters. Health facilities, especially hospitals, are considered essential in these situations. This article discusses the principles of architectural design of hospitals safe from disasters, as proposed by the World Health Organization and the Pan American Health Organization. Designing a safe hospital requires multidisciplinary efforts, involving administrators, architects, engineers, physicians, and nurses. The planning of each hospital demands the analysis of specific risks and safety concerns. The concept of biosafety should also be addressed in planning safe hospitals. The balance between architectural aspects and biosafety provides an understanding of work-associated risks, facilitating the adequate planning of spaces to support response actions to emergencies. In short, the planning of a safe hospital requires the synthesis of various types of expertise, including those relating to biosafety and architecture. These principles should support the appraisal of safe hospitals and architectural planning with a focus on preparing facilities to function at full capacity even in the face of adverse situations.

Abstract 2197: Telestroke: Optimizing Access to Emergency Interventions in Acute Stroke Care

Background and Issues: The burden of stroke in North Carolina is one of the highest in the nation (approximately 28,000 stroke hospitalizations from 2003-2007). The number and high costs of stroke have made it incumbent to improve the numbers of patients receiving effective treatment. There are two major barriers for treatment of acute stroke: time and access. The utilization of telestroke in community hospitals aids in decreasing these barriers by providing immediate access to a stroke neurologist. In order for telestroke to be successful, awareness and education regarding acute stroke care must be provided for health care providers as well as the communities. Thus, the development of a telestroke system requires nursing and medical expertise. The Primary Stroke Center Team at Wake Forest Baptist Medical Center in Winston-Salem, N.C. implemented a telestroke network system (Intouch's Health's RP-7 Robotic system) in January of 2010 to provide 24/7 access to the medical center's acute stroke experts and the latest advancements in stroke interventions. There are eight hospitals in the network at the present time. Methods: Our team identified that many of the network hospital's staff are not experienced in taking care of a stroke patient and that a “roadmap” is useful to guide them in these steps.The stroke nurse specialist developed a quality improvement plan for the network hospitals which included: an evidence-based algorithm for patient care; stroke education, in particular, neurological assessment and tPA administration classes for the ED staff; quarterly meetings to provide outcome and feedback data with each network hospital; stroke awareness events for the community. Mock telestroke consults were also performed prior to “going live” with telestroke for each of the network hospitals. Of utmost importance is the early involvement and education of the EMS system in the respective county of the network hospital. The buy-in of EMS was found to be a key component in the success of the network. Finally, attention to customized quality improvement efforts for each of the facilities are required to accomplish integration into the telestroke network. Results: The data has been analyzed, and thus far, a 24% rate of tPA administration has been seen with our network hospitals (an increase from the 3.6% national average). Comparisons between each of the eight network hospitals' rates of administration of tPA prior to and after joining the network show a trend of increase (10%-40%). The effectiveness of the algorithm has also been explored by analysis of feedback and initial results have shown a positive impact. Conclusion: A combination of improving access to stroke neurologists in conjunction with a focus on improving the level of care via evidenced based stroke care teaching and implementation of algorithms at a network hospital is required for implementing and building a successful telestroke network.

Alimentação hospitalar: proposições para a qualificação do Serviço de Alimentação e Nutrição, avaliadas pela comunidade científica

The scope of this paper is to validate proposals used to qualify hospital food by the Brazilian scientific community. An electronic questionnaire was applied to clinical nutrition professionals registered on the Lattes Platform (Brazilian database of institutions and researchers' curricula in the areas of Science and Technology). The questionnaire incorporated a Likert scale and had spaces for comments. The themes dealt with patient participation, the nutritional and sensory quality of hospital diets, and planning and goals of the Hospital Food and Nutrition Service (HFNS). The questionnaire also asked for the top five priorities for a HFNS. Proposals with total or partial adherence equal to or greater than 70% were considered to be approved. All proposals had total adherence equal to or greater than 70%. The proposal that had minimal adherence (70%) was the one that proposed that nutritional intervention must be arranged by mutual agreement with the patient. The proposal that had maximal adherence (93%) was the one advocating that there must be statistical control on diets prescribed by the HFNS. The most cited priorities referred to infrastructure and training of human resources (40%), the quality of hospital food (27%) and the nutritional status of the patient.

THE VALUE OF CONSUMER CHOICE AND THE DECLINE IN HMO ENROLLMENTS

I. INTRODUCTION AND OVERVIEW Health insurance contracts may restrict consumers' choice of medical provider in order to minimize moral hazard. For example, consumers who are insured for their marginal healthcare expenses have no incentive to enforce price discipline on their own. In this case, insurers may impose this discipline by restricting consumers' choice of medical provider to those who offer competitive prices. (1) This practice, known as selective contracting (SC), may have other benefits as well, including channeling consumers to efficient providers and achieving other efficiencies associated with (partial) vertical integration. SC has been utilized by insurers both in the United States and abroad. (2) However, it is not a universal feature of health insurance contracts. In part, this is because reducing the choice set of medical providers imposes costs on consumers to the extent that consumers assign option to choice (Capps, Dranove, and Satterthwaite 2003). For example, SC was widely employed in the United States by health maintenance organizations (HMOs) and other insurers in the 1990s and appears to have been an important cost control mechanism (Cutler, McClellan, and Newhouse 2000; Robinson and Phibbs 1989). However, most private U.S. health insurers moderated their use of SC during the past decade, at the same time that healthcare costs accelerated. Anecdotally, a consumer and regulatory backlash against provider choice restrictions forced insurers to expand choice and largely abandon the practice (Blendon et al., 1998; Vita 2001). Simultaneously, HMO enrollments declined. The purpose of this article is to explore the economic tradeoffs of SC with a particular focus on directly measuring the value that consumers assign to choice in medical markets. I am interested in assessing whether the magnitude of any utility loss from choice restrictions can be offset by volume-based price discounts that insurers may receive from hospitals. My results bear on the larger question of whether an economic linkage can be drawn between consumers' demand for choice and their apparent rejection of what is called tightly managed care. They also have implications for many healthcare reform proposals that necessarily imply restrictions on the consumers' choice sets. I analyze health plan's SC of hospitals in the state of Florida between 1999 and 2003. Hospital SC restricts consumer choice in multiple ways including their choice of hospital. In addition, hospital choice restrictions imply restrictions over the use of specific physicians. (3) I start by constructing hospital networks for each of a set of plan choices and then estimate a discrete choice model of health insurance demand, conditional on each plan's restricted network. For these purposes I use the Capps, Dranove, and Satterthwaite (2003) measure of SC disutility that focuses on the option of choice. I employ several different discrete choice estimators to estimate the model, including models with plan-metropolitan statistical area (MSA) fixed effects designed to control for unobserved plan attributes. This provides me with estimates of disutility resulting from choice restrictions. Subsequently, I project the estimated plan effects onto an instrumented value of plan price in order to estimate the price elasticity and also convert my disutility estimates into dollars. My results show that consumers associated restrictive hospital networks with plan disutility during each of the years of the study period with choice elasticities that range from -0.10 to -0.32 in pooled estimates (greater effects are obtained in 2003 using models where I allow the estimates to vary by year). Using my instrumental variables methodology to recover unbiased price coefficients, I show that consumers associated a one standard deviation reduction in the size of a plan's hospital network with a reduction in plan value of between $62 and $118. …

The healthcare environment—The importance of aesthetic surroundings: Health professionals’ experiences from a surgical ward in Finland

There is a growing acceptance of the vital role patient centered design plays in shaping the environment. Art can be of use in every area of health care. It is within the power of each person to share and interpret experience by means of the arts, by viewing the work of others, and by using feelings and imagination. Health professionals [n = 24 of a total of n = 35], answered the Wheel Questionnaire test instrument. It measures structure, motivation/engagement, and degree of emotional investment in a situation. Participants were requested to describe, in their own words, their perception of the enrichment of the ward interiordesign and the double-sided photos with a short poetic text, and the photo-book placed at each patient room. The results demonstrate that participants are motivated, structured and emotionally engaged when describing the new enrichment. The domains and themes are: Social interaction domain; rising thoughts and conversations. Comfort domain; atmosphere. Aesthetic do main; enrichment of the working environment. It could be concluded that the surgical ward environmental enrichment stimulated conversations between health professionals and between health professionals and patients and should be regarded as an important aspect in hospital planning.

A decision support system for technological planning and management of field hospitals

A well-planned medical response should consider the use of field hospitals ‘FHs’ specialised for the disasters and planned to guarantee high technical and medical standards. The purpose of this work is to support in locating technical requirements for FHs planning through an analysis of the most important and useful variables for the installation. A review of disaster medicine literature and technical norms has been carried out in order to offer support in individualising functional and technical requirements for FH planning through an analysis of the most important and useful variables for the installation. Three FH types were designed to be used in emergency and disaster medicine according to the kind of event, to the disaster area and to the local health care system capacity. Organisational, technical and technological requirements for each FH area were provided in order to improve hygiene and quality criteria for a safe and efficient system.

In-Process Agent Simulation for Early Stages of Hospital Planning

AbstractIn the early stages of hospital planning, work processes are typically modelled in a static manner, using flow-charts or business process modelling notation as means. Diagrams of this kind are easily simulated, however, employed process engines lack possibilities for dealing with dynamic aspects of the process which depend on the building layout (e.g. elevators, behaviour of automatic delivery carts). If one could give planners the opportunity to employ dynamic entities without having to change their usual workflow, one of the benefits would be that they are not being forced to resort to naive assumptions (e.g. 15 seconds per floor) that are still commonplace in today's planning practice.

Biomedical Waste Management: A Review

ABSTRACT Various national and international agencies have shown their concern towards proper handling, treatment and disposal of biomedical waste, as they may cause serious infectious diseases like hepatitis, tuberculosis and HIV/AIDS. Most of the hospitals do not have effective disposal system leading to complex problem of hygiene and sanitation in hospitals. The use of disposable items has reduced the rate of infection but at the same time has increased the volume of the waste which needs to be disposed properly. Effective waste disposal can be achieved only by considering the various components of the waste management system and this should be made an integral part of hospital planning and designing.

Economic Liberal or Arch Planner? Enoch Powell and the Political Economy of the Hospital Plan

The article critically analyses the view that Enoch Powell's promotion of the 1962 Hospital Plan was strategically incoherent. It has been argued that there was a contradiction between Powell's economic liberal position on public expenditure and his support for the Plan as a major long-term public sector capital expenditure programme. The article argues that Powell's promotion of the Plan was designed to be part of a consistent economic liberal strategy. However, the approach was problematic because of his mistaken belief that the Plan could be reconciled with modest growth in hospital running costs. This weakness is analysed with reference to the failure by Powell, and by leading officials in the Ministry of Health and the Treasury, to understand the dynamics of acute hospital costs.

The Perinatal Palliative Care Perceptions and Barriers Scale Instrument©

To devise and test an instrument measuring clinician perceptions of perinatal palliative care (PPC) and barriers to care delivery. PPC was theorized to involve the care of pregnant women and their families after prenatal testing resulted in a life-limiting fetal diagnosis. Both giving birth to a child with a life-limiting condition or termination of pregnancy for fetal anomaly can be emotionally traumatic life events. Clinicians were thought to face ethical dilemmas that involved approaches to care for this population. The ethical dilemmas were measured on a perceptions scale using items about informed consent, justice, beneficence, and autonomy. Barriers were theorized as obstacles to delivering quality PPC and included insufficient education, personal discomfort, and difficulty garnering team or administrative support for care. Licensed clinicians practicing in the perinatal field. Stage 1 entailed instrument development and validation, which was achieved through a Delphi study involving 11 expert panelists. The devised instrument included 64 six-point Likert items. In stage 2, a computer survey gathered data from a multidisciplinary, clinician group. A total of 264 clinicians completed the survey. Exploratory factor analysis with varimax rotation was used to validate the instrument, evaluate the factors, and summarize the explained variance achieved by sum scores of the perceptions and barriers scales. The perceptions scale was reduced to 23 items with a 6-factor solution explaining 67% of the variance with a good internal consistency reliability of 0.77 (Cronbach α). The 22-item barriers scale had a 6-factor solution explaining 71% of the variance with an alpha reliability of 0.83. The Perinatal Palliative Care Perceptions and Practice Barriers Scale instrument is a valid and reliable measure of PPC perceptions and barriers for measuring the attitudes of physicians and nurses. Use of this instrument can foster educational programs and hospital planning for PPC teams that provide grieving families with the varied support they need. It is also a useful instrument for examining trends in the clinician perspectives and practice barriers as more genetic testing and subsequent terminal diagnoses occur.

Abstract 9251: Increasing Prevalence and Decreasing Mortality in Pulmonary Hypertension Related Hospitalizations in the United States: An Analysis of Over 20,000 Hospital Admissions

Introduction: Pulmonary hypertension (PH) is a serious but uncommon disorder. However, few large scale data exist on the prevalence or mortality associated with PH hospitalizations in children. Risk factors for hospital mortality are also unknown. Hypothesis: The prevalence of pediatric PH admissions has increased, but the mortality has decreased, over the 7-year period from 2000 - 2006. Methods: A retrospective analysis of the Healthcare Cost and Utilization Project Kids' Inpatient Database was performed for pediatric (age ≤ 20 years) PH related admissions for the years 2000, 2003, and 2006. The database is a nationwide sampling of pediatric hospital discharges and is weighted to provide national estimates. Results: In 2000 there were 7,348 (95%CI 6,176 to 8,521) pediatric PH related admissions and in 2006 there were 9,378 (95%CI 8,068 to 10,687) admissions (p&lt;0.001). Congenital heart disease was the most common associated diagnosis in all years (range 46.5% to 50.4%). Bronchopulmonary dysplasia (BPD) with PH increased over time from 4.2% in 2000 to 10.2% in 2006 (p&lt;0.001). Several comorbidities increased over time including sepsis, acute renal failure, and respiratory failure (p&lt;0.05 for all). Overall hospital mortality was greater for patients with PH (6.2%) compared to patients without PH (0.4%) (OR 17.7, 95%CI 16.1 to 19.4). Mortality for PH patients decreased over time from 7.7% in 2000 to 4.8% in 2006 (p&lt;0.001). Mortality was greatest among infants (8.2%), those with BPD (9.5%), respiratory failure (19.9%), renal failure (38.2%), and with extracorporeal membrane oxygenation (ECMO) (34.1%). On multivariable analysis, factors associated with increased mortality included earlier year (OR 2.0, 95% CI 1.6 to 2.5), respiratory failure (OR 4.5, 95% CI 3.6 to 5.7), ECMO (OR 4.8, 95% CI 3.1 to 7.4), and acute renal failure (OR 6.3, 95% CI 4.2 to 9.4). Conclusions: There were 2,000 more PH related hospitalizations in children in 2006 than in 2000. Comorbidities increased over this time period; however, hospital mortality decreased over 60%. These findings have critical implications for pediatric hospital utilization and planning. Increased off-label application of PH pharmacotherapeutic agents may have contributed to the improved survival.