Public Community Hospitals Research Articles

The use of a train-the-trainer model to educate non-dental healthcare professionals for oral care

Background: Associations between oral health and systemic conditions have been well established in recent literature. Improvements in oral hygiene have consistently shown to significantly reduce the incidence of respiratory infections, which has high morbidity and mortality rates in the frail elderly. However, the simple low-cost intervention of good oral care remains overlooked in healthcare institutions and nursing homes, due to limited awareness and knowledge. Previous efforts for oral care training of non-dental healthcare professionals have been largely sporadic, with little impact and reach to the medical fraternity. Purpose: To overcome these challenges, we utilized a train-the-trainer model, where seven senior nurses from the long-term stay wards of a public community hospital were educated on the importance of good oral health and trained to administer a comprehensive oral care protocol in patients requiring assistance. The Oral Health Education Programme (OHEP) consisted of a full-day workshop on Common Dental Conditions, Oral Health Assessment Technique (OHAT), and oral hygiene instruction for normal and assisted tooth brushing in independent and mechanically ventilated patients respectively. Results: Majority of the nurses felt that the training was effective and applicable to their work. The number of patients with chronic respiratory infections in the wards were reduced after commencement of OHEP. Conclusion: This interprofessional education collaboration using the train-the-trainer model provides a standardized curriculum, while allowing autonomy for the trainers to customize modules relevant to their respective institutions. This partnership model between medical nurses and oral health professionals allows for better sustainability of the programme.

First 1,000 Days Suncoast: Regional Initiative Transforming Care for Babies and Their Families

A child’s first 1,000 days are a period of rapid brain development; negative environments and stressful events can impact their lifelong health, well-being, resiliency, and prosperity. First 1,000 Days Suncoast is a tri-county initiative in southwest Florida comprising 90 partner organizations supporting families and babies by connecting them with resources and tools through a large and comprehensive network. Following the Collective Impact model, the region’s public community hospital was designated as the backbone organization, with a nurse-led team guiding the operations. A steering committee, with leaders of regional nonprofits and foundations, ensures tactical alignment with county priorities, and has been key in building a strong partner infrastructure. Three key components guide the activities of the initiative: care coordination; parent empowerment; and targeted interventions. Through collaboration with community professionals and parents, the initiative identifies the most pervasive barriers to care for families and develops innovative solutions. This method has led to system-wide transformations, organization-specific enhancements, and process improvements.

Iodine Status in Pregnant Women Having Urinary Fluoride in Contaminated Areas: A Case Study of Phayao Province.

Fluoride naturally occurs in the Earth's crust and is widely dispersed in groundwater. The high consumption of fluoride can inhibit iodine metabolism in the human body, especially in the thyroid gland. This study assessed iodine knowledge, iodine consumption behavior, urinary iodine (UI), thyroid stimulating hormone (serum TSH), and free triiodothyronine3 (serum FT3) and examined the connection between fluoride exposure and UI and thyroid function as serum concentrations of TSH and FT3 in pregnant women dwelling in an area of endemic fluorosis. This was a cross-sectional study. The population included 152 pregnant women within the 1st trimester of pregnancy, during which they were provided antenatal care (ANC) in seven public community hospitals in Phayao province, Thailand. The study consisted of two components. First, the study consisted of a questionnaire in which we evaluated the iodine knowledge and iodine consumptive behaviors in subjects. Second, biochemical data were investigated to evaluate thyroid function in the subjects. The gestational age of most subjects was 8-12 weeks. The study population has lived in fluoride-contaminated areas since birth (76.97%). The iodine and iodine consumption levels were moderate (50.00%). Their food iodine consumption was 3-4 days/week, and the top five consumption ranks were iodized salt, cooked pork, eggs, sticky rice, and iodine fish sauce. In terms of biochemical parameters, 63.16% of respondents had UI levels below 150.00 g/L, which is below the normal reference range of 150.00-249.00 g/L. 89.47% of the risk of hypothyroidism was associated with serum TSH levels below 2.50 g/L. In 38.16% of the samples, normal levels of serum FT3 (2.00-4.40 pg/L) were identified in the subjects. In addition, 61.84% of the samples had FT3 concentrations greater than 4.40 pg/L (high intake of iodine). The approved association between positive serum FT3 data and serum TSH was positive (r = 260 and p < 0.05). These studies imply that these elevated levels of TSH and FT3 place pregnant women in their first trimester at risk for hypothyroidism.

OP179 Nationwide Electroencephalographic Screening Using Telemedicine Apps

IntroductionDisruptive telemedicine tools can help overcome the lack of specialized care and electroencephalographic (EEG) support for diagnosing and treating nervous system disorders such as epilepsy in remote communities. However, evidence on how such cloud-based platforms could enhance data-driven health care is limited. The utility of telemedicine-based apps to achieve EEG screening of communities in rural areas of Paraguay was investigated.MethodsThis descriptive study was carried out by the Telemedicine Unit of the Ministry of Public Health in collaboration with the Department of Biomedical Engineering and Imaging of the Health Science Research Institute in Paraguay and the Basque Country University in Spain to evaluate the utility of telediagnostic apps for EEG screening. For this purpose, the results obtained by tele-EEG apps implemented in nineteen public community hospitals were analyzed to determine the utility of the apps as epidemiological surveillance tools.ResultsAmong the 10,791 remote EEG studies performed, the most common reasons for the test included epileptic seizure (44%), headache (22%), seizure disorder (8%), follow up (6%), attention deficits in children (5%), cognitive impairment (4%), cranioencephalic trauma (3%), brain death (1%), history of seizure (0.9%), abnormal movements (0.7%), and behavioral disorders (0.5%).ConclusionsThe results showed that telemedicine apps can significantly enhance nationwide EEG screening by freeing up professional time and increasing productivity, improving access and equity, and reducing costs. However, before their systematic implementation a contextualization of the apps using the regional epidemiological profile must be performed.

Presentation of self-detected breast mass in minority women with limited access to care: Can self-examination assist in early cancer detection?

ObjectiveThe United States Preventive Services Task Force recommends against breast self-examination. However, racial disparities exist in mammogram screening. We aimed to evaluate the presentation of women with newly diagnosed breast cancer in the underserved African-American and Hispanic community to provide insight regarding breast cancer screening in this population. MethodsThis retrospective cohort study included women newly diagnosed with breast cancer from 1/1/2016 to 1/1/2018 in an inner city public community hospital. Data was collected via chart review. Patients were divided based on whether they presented with self-detected breast mass. Logistic regression was used for analysis. Results59 women were newly diagnosed with breast cancer. 34 women (58%) were African-American, 20 (34%) were Hispanic, and 5 (8%) were other race. Of 59 women, 36 (61%) presented with self-detected breast mass, and only 21 (36%) reported prior mammography. For women who presented with breast mass, the odds of having prior mammography were 78% lower (OR = 0.22, 95% CI 0.07–0.69, p = 0.009), while the odds of having invasive ductal carcinoma were 4.33 times higher (OR = 4.33, 95% CI 1.09–17.25, p = 0.037), as compared to the odds for women not presenting with breast mass. ConclusionMany of our newly diagnosed breast cancer patients were African-American or Hispanic women presenting with self-detected breast mass without prior screening mammography. Further studies should evaluate whether supplemental screening methods, such as breast self-examination or clinical examination, can help with early breast cancer detection in minority women with limited access to care, and such disparities should be considered by organizations when creating screening guidelines.

Applying non-parametric methods measuring economic performance: a case of community hospitals in the State of New York

Background: Community hospitals in New York State hold a unique position in turbulent era, while community hospitals are the hub of healthcare delivery in State of New York .The primary purpose of this study is to measure the economic performance of community hospitals in the State of New York that provide general and acute healthcare services from 2001 to 2014 applying non-parametric approaches. Methods: To estimate the efficiency of community hospitals, this study uses data envelopment analysis (DEA) that corporate three input (total expenses, beds and FTEs) and three output ones (admissions, daily census and outpatients). Data is extracted from Annual Survey of Hospitals from 2001 to 2014. Results: The average efficiency score of the community hospital in the State of New York is 0.882 and the average of scale efficiency is 0.925, respectively, for the 14 years. This study reports that rural community hospitals are more efficient than urban community hospitals for the 14 years, and large-size community hospitals are more efficient than medium and small-size hospitals. This study also confirms that public community hospitals in the State of New York are more efficient than non-profit hospitals. Conclusions: To improve hospitals’ competitiveness and find an alternative business model, the healthcare stockholders who include hospital administrators, creditors, healthcare consultants, and policy makers, need to pay careful attention to the economic performance of community hospitals in relation to their capacity. This study is the first one to evaluate the economic efficiency of community hospitals applying non-parametric approaches and explore the factors that influence the performance of community hospitals in the State of New York.

PP132 Telemedicine Enhances Community Hospital Response Capacity

IntroductionTelediagnostic apps based on information and communication technology tools can be used to enhance community hospital response capacity. Evidence on how this innovative technology can improve health services is limited, but will likely expand in the new decade. The ability of different telediagnostic methods to enhance the response capacity of community hospitals in rural areas of Paraguay was investigated.MethodsThis descriptive study was carried out by the Telemedicine Unit of the Ministry of Public Health and Social Welfare, in collaboration with the Department of Biomedical Engineering and Imaging of the Health Science Research Institute and the University of the Basque Country, to evaluate the utility of telediagnostic apps for different disciplines in public health. The results from implementing telediagnosis apps in 60 public community hospitals across the country were analyzed and evaluated.ResultsA total of 410,840 diagnoses were performed remotely between January 2014 and August 2018 across 60 rural community hospitals. The diagnoses involved computed tomography (147,627 or 36%), electrocardiography (256,422 or 62%), electroencephalography (6,772 or 2%), and ultrasound (19 or 0.01%). There were no significant differences between the remote and face-to-face diagnoses; remote diagnoses were correct in 93 percent of cases. Utilizing telediagnostic apps reduced costs, which is an important benefit for the 60 communities.ConclusionsThe results showed that telemedicine can significantly enhance the community hospital response capacity of diagnostic services and health programs, making optimal use of professional time and productivity, increasing access and equity, and reducing costs. However, before carrying out the systematic implementation of this technology, contextualization with the regional epidemiological profile must be performed.

Defining the activities of publicness for Korea's public community hospitals using the Delphi method.

This study aims to identify which activities of a public community hospital (PHC) should be included in their definition of publicness and tries to achieve a consensus among experts using the Delphi method. We conduct 2 rounds of the Delphi process with 17 panel members using a developed draft of tentative activities for publicness including 5 main categories covering 27 items. The questions remain the same in both rounds and the applicability of each of the 27 items to publicness is measured on a 9-point scale. If the participants believe government funding is needed, we ask how much they think the government should support each item on a 0% to 100% scale. After conducting 2 rounds of the Delphi process, 22 out of the 27 items reached a consensus as activities defining the publicness of the PHCs. Among the 5 major categories, in category C, activities preventing market failure, all 10 items were considered activities of publicness. Nine of these were evaluated as items that should be compensated at 100% of total financial loss by the Korean government. Throughout results, we were able to define the activities of the PCH that encompassed its publicness and confirm that there are “good deficits” in the context of the PCHs. Thus, some PCH deficits are unavoidable and not wasted as these monies support a necessary role and function in providing public health. The Korean government should therefore consider taking actions such as exempting such “good deficits” or providing additional financial aid to reimburse the PHCs for “good deficits.”

Technical and scale efficiency of public community hospitals in Eritrea: an exploratory study.

BackgroundEritrean gross national income of Int$610 per capita is lower than the average for Africa (Int$1620) and considerably lower than the global average (Int$6977). It is therefore imperative that the country’s resources, including those specifically allocated to the health sector, are put to optimal use. The objectives of this study were (a) to estimate the relative technical and scale efficiency of public secondary level community hospitals in Eritrea, based on data generated in 2007, (b) to estimate the magnitudes of output increases and/or input reductions that would have been required to make relatively inefficient hospitals more efficient, and (c) to estimate using Tobit regression analysis the impact of institutional and contextual/environmental variables on hospital inefficiencies.MethodsA two-stage Data Envelopment Analysis (DEA) method is used to estimate efficiency of hospitals and to explain the inefficiencies. In the first stage, the efficient frontier and the hospital-level efficiency scores are first estimated using DEA. In the second stage, the estimated DEA efficiency scores are regressed on some institutional and contextual/environmental variables using a Tobit model. In 2007 there were a total of 20 secondary public community hospitals in Eritrea, nineteen of which generated data that could be included in the study. The input and output data were obtained from the Ministry of Health (MOH) annual health service activity report of 2007. Since our study employs data that are five years old, the results are not meant to uncritically inform current decision-making processes, but rather to illustrate the potential value of such efficiency analyses.ResultsThe key findings were as follows: (i) the average constant returns to scale technical efficiency score was 90.3%; (ii) the average variable returns to scale technical efficiency score was 96.9%; and (iii) the average scale efficiency score was 93.3%. In 2007, the inefficient hospitals could have become more efficient by either increasing their outputs by 20,611 outpatient visits and 1,806 hospital discharges, or by transferring the excess 2.478 doctors (2.85%), 9.914 nurses and midwives (0.98%), 9.774 laboratory technicians (9.68%), and 195 beds (10.42%) to primary care facilities such as health centres, health stations, and maternal and child health clinics. In the Tobit regression analysis, the coefficient for OPDIPD (outpatient visits as a proportion of inpatient days) had a negative sign, and was statistically significant; and the coefficient for ALOS (average length of stay) had a positive sign, and was statistically significant at 5% level of significance.ConclusionsThe findings from the first-stage analysis imply that 68% hospitals were variable returns to scale technically efficient; and only 42% hospitals achieved scale efficiency. On average, inefficient hospitals could have increased their outpatient visits by 5.05% and hospital discharges by 3.42% using the same resources. Our second-stage analysis shows that the ratio of outpatient visits to inpatient days and average length of inpatient stay are significantly correlated with hospital inefficiencies. This study shows that routinely collected hospital data in Eritrea can be used to identify relatively inefficient hospitals as well as the sources of their inefficiencies.

Explaining turnover intention in Korean public community hospitals: occupational differences

Personnel in public hospitals had relatively low job satisfaction despite of tenure employment. High turnover rates degrade hospital image and incur additional costs related to recruitment and training. The purposes of this study were to describe the occupational differences and to identify factors affecting turnover intention among public hospital personnel. A questionnaire survey was conducted as part of Administrative Services Quality Evaluation Program by Seoul metropolitan municipality from 1 November to 1 December in 2003. The subjects were 1251 entire hospital personnel in four hospitals. The questionnaire was designed to measure job satisfaction, organizational commitment, turnover intention, and demographic characteristics. Logistic regression analysis was performed to determine factors influencing turnover intention. There were significant differences in job satisfaction, organizational commitment, and turnover intention according to the occupations. The turnover intention rates were highest among physicians, followed by paramedicals and nursing staffs and then administrators. The significant factors affecting turnover intention were involvement and loyalty among physicians, hospital type, satisfaction with systems and loyalty among nursing staffs, satisfaction with relationship and loyalty among administrators, and loyalty among paramedicals. There were different moderators that influence turnover intentions of hospital personnel. Loyalty had the most important effect upon turnover intention in all occupations.

Collecting Direct Non-Health Care and Time Cost Data: Application to Screening and Diagnosis of Cervical Cancer

Data on direct non-health care and time costs are rarely collected, though the incorporation of such data is essential for performing cost-effectiveness analyses according to established guidelines. To explore the challenges involved in collecting and analyzing these data from patients enrolled in a clinical trial. Through the use of a pilot study, the authors designed a questionnaire to collect these costs. They used this questionnaire in a clinical trial conducted at a comprehensive cancer center and a public community hospital. Patients in the trial were undergoing screening or diagnostic procedures through a clinical protocol designed to measure the effectiveness of fluorescence and reflectance spectroscopy for detecting cervical precancers. Direct non-health care costs were adjusted to 2003 constant dollars. The authors successfully collected direct non-health care and time cost data, thus demonstrating the feasibility of acquiring such data. Compared to patients receiving diagnostic services for cervical cancer, those receiving screening services for the same condition in both settings incurred lower direct non-health care costs and time costs, as defined in the questionnaire. Compared to patients receiving either service at the comprehensive cancer center, those seeking either service at the public community hospital incurred lower direct non-health care costs and time costs. When outliers were removed, total direct non-health care costs and time costs substantially decreased for diagnostic patients in the comprehensive cancer center; total direct non-health care costs and time costs for other subgroups remained essentially unchanged. Direct non-health care and time cost data can be collected within a large-scale clinical trial. The setting (community v. specialty hospital) and population (patients receiving screening v. diagnostic examination) makes a difference regarding the cost totals. The order of magnitude of the final result depends on the context in which the non-health care and time cost data will be used.

Phase 1 safety trial of Filgrastim (r-metHuG-CSF) in non-neutropenic patients with severe community-acquired pneumonia

The objectives of the present study were to: (1) evaluate the safety of Filgrastim therapy in non-neutropenic patients with severe community-acquired pneumonia; (2) determine the absolute neutrophil count (ANC) response to various dosages of Filgrastim in non-neutropenic patients with active infection; and (3) describe the impact of therapy with Filgrastim in combination with antibiotics on selected pneumonia-related clinical parameters. The study design was an open-label, dose-ranging, clinical trial, set in the General Clinical Research Unit of a large, public community hospital. The study population consisted of 30 patients who had presented to the Emergency Department with severe, community-acquired pneumonia. One of five dosages (75, 150, 300, 450 or 600 μg day −1) of Filgrastim (r-metHuG-CSF) was given subcutaneously daily for 10 days, until discharge or until the absolute neutrophil count >75 × 10 9 1 −1, whichever was earlier. Vital signs, pulse oximetry, arterial blood gases, daily complete blood counts with differential, serum chemistries, coagulation profiles, electrocardiograms, chest radiographs, plasma G-CSF concentrations and duration of hospitalization were measured. There was no evidence of Filgrastim-related lung injury or evidence of extra-pulmonary toxicity. There was no apparent dose-response effect of Filgrastim on pneumonia-related clinical variables. Dosages of Filgrastim between 150 and 600 μg day −1 had similar effects on increasing the ANC. Filgrastim appeared to be safe in non-neutropenic patients with severe, community-acquired pneumonia when given in dosages of 75–600 μg day −1 in combination with appropriate antibiotic therapy. Further study is needed to determine the effect of Filgrastim on morbidity, mortality and duration of symptoms in this patient population.