Public Hospital Services Research Articles

Estimated height from knee height or ulna length and self-reported height are no substitute for actual height in inpatients

ObjectiveThe aim of this study was to evaluate the precision of estimated height from ulna length (UL) using the Malnutrition Universal Screening Tool (MUST) equation and compare it with predicted height from knee height (KH), and self-reported height in estimating actual body height in inpatients. MethodsThis cross-sectional study was carried out with patients admitted to an emergency service of a tertiary public hospital. Data were collected, at the patients' bedsides, from a specific questionnaire and anthropometric measurements. Height was estimated from UL and KH, and compared with self-reported and actual height. The Bland–Altman methods were used to evaluate agreement between measures. ResultsThis study included 427 inpatients (52.6% women, ages 54.30 ± 15.39 y). A significant difference was found when actual height (161.07 ± 8.77 cm) was compared with estimated height from KH (163.64 ± 8.61 cm) and self-reported height (164.54 ± 8.95 cm). A not significant difference of 1.07 cm was observed between actual height and estimated height from UL (160.74 ± 7.48 cm); however, the limits of agreement between measures were large (from 13.69 to 14.39 cm). The difference observed between actual and self-reported height was higher in men (−8.50 [−17.00; −2.00] cm) than in women (1.00 [−6.00; 8.00] cm), whereas the difference between actual height and estimated height from KH and UL did not differ statistically between men and women. ConclusionsEstimated height from UL (MUST equation), self-reported height and estimated height from KH led to errors in predicting actual height of inpatients.

Patient perceptions of the professional attitudes of radiographers

Introduction: In Nigeria radiographers practice in both public and private hospitals, yet there are lingering differences in perceptions among patients about the professional conduct of radiographers related to the type of hospital they work in. The purpose of this study was to investigate these differences and make policy recommendations. Methods: A cross-sectional study was undertaken in which 300 respondents (patients) who had received outpatient radiological services in a public and a private hospital answered a questionnaire. Results: The results showed that radiographers in the public facility excelled in five professional areas, including the principle of informed consent and the right of patients or their carers to refuse service or treatment, while radiographers in the private facility performed better in ten professional areas, including the observation of appropriate professional boundaries. Conclusion: Lack of enforcement of professional rules and regulations regarding the conduct of radiographers is a major problem. A monitoring body overseeing the professional conduct of radiographers is highly recommended to improve public trust and confidence in radiological services in public and private hospitals.

Care Appropriateness and Health Productivity Evolution: A Non-Parametric Analysis of the Italian Regional Health Systems.

There has been increasing interest in measuring the productive performance of healthcare services since the mid-1980s. By applying bootstrapped data envelopment analysis across the 20 Italian Regional Health Systems (RHSs) for the period 2008-2012, we employed a two-stage procedure to investigate the relationship between care appropriateness and productivity evolution in public hospital services. In the first stage, we estimated the Malmquist index and decomposed this overall measure of productivity into efficiency and technological change. In the second stage, the two components of the Malmquist index were regressed on a set of variables measuring per capita health expenditure, care appropriateness, and clinical appropriateness. Malmquist analysis shows that no gains in productivity in the health industry have been achieved in Italy despite the sequence of reforms that took place during the 1990s, which were devoted to increasing efficiency and reducing costs. Analysis of the efficiency change index clearly indicates that the source of productivity gain relies on a rationalization of the employed inputs in the Italian RHSs. At the same time, the trend of the technological change index reveals that the health systems in the three macro-areas (North, Central, and South) are characterized by technological regress. Overall, our results suggest that productivity increases could be achieved in the Italian health system by reducing the level of inputs, improving care and clinical appropriateness, and by counteracting the 'DRG (diagnosis-related group) creep' phenomenon.

Population policy regarding Mainland Chinese females’ contribution to Hong Kong fertility

Purpose – Hong Kong is considered to be an aging population because of the ultralow fertility rates and long life expectancy of its population. A promising solution to remedy this age imbalance is to recruit young people from outside Hong Kong. The inflow of Type II babies (i.e. babies born of Mainland Chinese women whose spouses are not Hong Kong citizens) has created an abundance of them within the young population. The paper aims to discuss this issue. Design/methodology/approach – These controversies have been evaluated being mindful of the operation of a free economy in Hong Kong and the relevance of upholding the rule of law (Wong, 2012). Findings – Wong’s (2012) recommendations to endow the Hong Kong Government with the authority to approve applications from a one-way permit system and to separate the right of residency of Type II babies from their entitlement to welfare services have also been summarized. Originality/value – The inflow of Type II babies, however, has also generated public controversy concerning the intensifying competition for both public and private hospital services between Hong Kong residents and Mainlanders. This controversy has given rise to some questioning of whether a reinterpretation of the law is warranted to deny residency to Type II babies whose parents are not Hong Kong residents (Wong, 2012).

Expectant Mother’s Preferences for Services in Public Hospitals of Tamil Nadu, India

Substantial programmatic efforts have been undertaken to improve the access to maternal care services in the public health system of India, yet the service users are often regarded as passive recipients. Limited research is available on the preferences of service users on what they regard the greatest issues in service delivery. A hospital-based discrete choice experiment (DCE) has been conducted in the public health facilities of Tamil Nadu, a southern state of India. This study uses a sample of 261 women who came for antenatal check-ups across six different public hospitals in Tamil Nadu. The DCE technique, which is rooted in random utility theory (RUT), and conditional logit model have been used to analyze the relative importance of health service attributes. The result showed that regular ward visits by specialist doctors like obstetricians and gynaecologists (O&G) and paediatricians were the most preferred attribute of the maternal care service. Expectant mothers are willing to wait the maximum and are prepared to tolerate health service characteristics in public hospitals, such as poor patient amenities, poor staff attitude and lack of privacy maintained during physical examination, provided specialist doctors are available in the hospitals.

Suivi immunologique en transplantation rénale : 13 ans d’expérience d’un laboratoire d’histocompatibilité marocain

Purpose of studyThe quality of the immunological monitoring is crucial because it determines the success of the kidney transplantation. The scope of this work is to describe the experience of the department of immunological unity of the Ibn Sina university hospital in Rabat regarding the immunological monitoring of patients transplanted between 2001 and 2014. Patients and methodsPatient samples were collected from nephrology services of different public and private hospitals of Morocco. The tests conducted in the context of immunological monitoring are ABO typing, HLA-A, B, DR, DQ typing, anti-HLA antibodies detection and identification and cross-match. ResultsOne hundred and fourteen benefited from a pre- and post-transplant immunological monitoring in our laboratory. The percentage of recipients having between 2 and 5 stored sera is 60.5 before transplantation and 56.1 after transplantation. Immunized patients account for 22.8% before the transplant and 17.6% after transplantation. Ninety-seven patients still have a functional graft, while 4 of them had DSA of low intensity before transplantation. Five immunological rejections were reported while the cross-match were negative and no DSA was identified before transplantation. Patient survival and graft at 1 year was 98.2% and 92.7% respectively. ConclusionConducting regular immunological monitoring is sometimes difficult in our context, however, the results are satisfactory in terms of graft and patients survival.

Presentación del Simposio Acceso al Aborto Terapéutico en el Perú

A pesar de que el aborto terapéutico (AT) está aprobado por ley en el Perú desde el año 1924 (1), solo recientemente desde el Ministerio de Salud (junio 2014) ha sido aprobada la Guía Nacional para Interrupción Voluntaria del Embarazo por Razones Terapéuticas (2). Sin embargo, las mujeres peruanas aún no disponen de un adecuado acceso a los servicios en los hospitales públicos. Esta deficiencia es en gran medida responsable de que las causas indirectas de muerte materna se presenten cada vez con mayor frecuencia (3). Los profesionales de la salud de los establecimientos públicos que prestan servicios de salud sexual y reproductiva carecen de información suficiente y mantienen aún estigmas contra las mujeres que se interrumpen la gestación y contra los profesionales que las atienden, debido a que falta aún estandarizar la atención, para seguridad de las mujeres y de los profesionales.

Evaluación del tratamiento de la espasticidad en España: estudio 5E

Although spasticity is a disabling complication of high incidence, there is a lack of either regional or national epidemiological studies in Spain evaluating its management. To evaluate the management of spasticity in Spain. An epidemiological, observational, multicenter, and retrospective study involving 49 rehabilitation services of public and private hospitals was designed. Two hundred and thirty-five patients from 49 centers, with evidence of upper (UL) or lower limb (LL) spasticity with one valid baseline visit and at least one follow-up visit, were included. Among the patients included in the study 148 (62.9%) have post stroke spasticity; 79 (33.6%) have LL spasticity, 38 (16.1%) UL, and 118 (50.3%) in both. At baseline, Modified Ashworth Scale, goniometry, Visual Analog Scale for pain and Tardieu Scale had been performed in 164 (69.8%), 99 (42.1%), 85 (36.2%), and 26 (11.1%) patients, respectively. A 93.8% (IC 95%: 81.4-97.6%) of the centers accurately defined the treatment goals and 52% of the objectives were agreed with the patient. Botulinum A toxin was administered in 186 (79.1%) of patients; 49 (20.9%) patients were treated with oral antispastic medications and 93 (39.6%) were under physiotherapy treatment. Most of the patients have post-stroke spasticity. Moreover, botulinum A toxin was the most commonly treatment applied to patients with spasticity. The results demonstrate that the management of spasticity varies significantly across the different centers participating in the study.

Zone of tolerance for healthcare services: a diagnostic model of public and private hospital service quality

Zone of tolerance for healthcare services: a diagnostic model of public and private hospital service quality

A study of the vitreoretinal interface in patients with age-related macular degeneration.

To assess whether hyaloid adhesion is more prevalent in patients with age-related macular degeneration (AMD) than in control patients and to evaluate whether it is more prevalent in exudative AMD than in non-exudative AMD. This was a cross-sectional, controlled analytical study. Patients from the Ophthalmology Department of the Public Service Hospital of the State of São Paulo were included if they were diagnosed with AMD that was confirmed by fundus biomicroscopy and fluorescein angiography. Patients were divided into three groups: patients without a vitreoretinal disease (controls), patients with exudative AMD, and patients with non-exudative AMD. For the optimal study of the vitreoretinal interface, all patients were subjected to spectral-domain optical coherence tomography (SD-OCT; Cirrus HD-OCT, version 4000; Carl Zeiss Meditec) and ultrasonography (UltraScan®, Alcon). Results with p values of ≤0.05 were considered statistically significant. We assessed 75 eyes of 23 patients with AMD (14 women and nine men) and 15 the control patients (11 women and four men). In total, 33 eyes had AMD that was consistent with the inclusion criteria, of which 11 had the non-exudative form (non-atrophic) and 22 had the exudative form (11 active and 11 disciform scars). Adherence was observed in eight eyes in the control group (26.67%), in seven eyes with exudative AMD (31.82%), and in five eyes with non-exudative AMD (45.45%). Patients with exudative and non-exudative forms of AMD did not present with higher vitreoretinal adhesion than control patients as assessed by SD-OCT and ultrasound. Moreover, patients with exudative AMD (neovascular membrane and disciform scar) did not reveal a higher adherence than those with non-exudative AMD when evaluated by the same methods.

A fuzzy framework to evaluate service quality in the healthcare industry: An empirical case of public hospital service evaluation in Sicily

A novel fuzzy evaluation framework is applied in this study to evaluate service quality in the public healthcare sector. In particular, the proposed framework is based on the ServQual disconfirmation paradigm and incorporates the Analytic Hierarchy Process (AHP) method to elicit reliable estimations of service quality expectations. Moreover, degrees of uncertainty, subjectivity and vagueness on the part of stakeholders are addressed via linguistic evaluation scales parameterized by triangular fuzzy numbers. With reference to nine relevant public hospitals in the Sicilian Region (Italy), a detailed case study evaluating four core service criteria and 15 fundamental service items is conducted so as to discern dissatisfying aspects regarding the public healthcare service in the Region. Dissatisfaction reasons with the provided service are identified in the analysis as well, further demonstrating the effectiveness of the proposed approach.

A survey analysis on the residents about the present situation of public medical institution service satisfaction in urban community

Objective To carry out the urban community residents satisfaction investigation and analyze the present situation of public service of medical institutions, to discuss under the new situation, the development of medical and health innovation mechanism, thus to meet the multi-level and diverse people health services demand. Methods Random stratified sampling of Qingdao city community residents, 1 430 people, adopted the method of the questionnaire about the present situation of public hospital and community health service center and the satisfaction was investigated. Results Of Qingdao city community residents, 1 430 people chose to large public hospital patients (65.8%), community health service centers (37.3%). In a large public hospital from visits to the end, took at least half a day to account for 69.5%, more than a day (18.7%); Unreasonable process part (45.2%), such as hospital formalities complex, paper take inconvenient, medical guide was too little, expert outpatient service limit number, to see the doctor for a long time, adjust time was shorter, the doctor for the patient and the lack of patience, etc.The process was reasonable and convenient accounted for 40.0%.Think of large public hospital service attitude, subject to further improvement accounted for 58.2%; Think good service attitude, the very satisfied accounted for 30.7%.Think that community health service center service attitude good, very satisfied accounted for 43.2%; Think the service attitude in general, efficiency was 37.9%.96.1% of the respondents believed that society should form a public-private joint diversified do medical pattern, provided residents with various preferential policies.98.4% of the respondents expected countries to optimize the medical service resources allocation, promoted resources with high quality and the countryside in poor areas. Conclusion At present, most of the patients choose to large public hospital, process and service attitude is the key of the need to improve.Large public hospitals and community health service center should strengthen the cooperation and formation mechanism of innovation and development, and make the patients more options, so as to get better medical service quality. Key words: Community residents; Medical institution; Service process, investigation and analysis

Factors affecting decision-making of patients choosing acupuncture in a public hospital.

With increasing evidence to support its practice, acupuncture has been integrated within many hospitals around the world. The purpose of this study is to understand the factors affecting decision making of patients as they select acupuncture treatment for their medical conditions and symptoms within a public hospital. A qualitative study consisting of in depth interviews with 14 patients was conducted. All patients attended an acupuncture clinic within a public hospital. Data collected was analysed via thematic analysis. Four main factor groups affecting decision making of patients were identified- factors affecting the level and value of patient-centric care, the confidence and trust patients place within the acupuncture service, the presence of collaborative efforts between acupuncturists and Western medicine practitioners, and the knowledge, culture and belief society has regarding the role of acupuncture and Western medicine. All participants interviewed had more than one factor group present as enablers toward their eventual selection of acupuncture for ailment management. It was also noted that although the majority of participants had sufficient knowledge regarding acupuncture, there were a select few who had misperceptions or no knowledge regarding certain aspects of acupuncture. There may be certain patterns in the way patients choose to utilise acupuncture services in public hospitals. Further studies should also be carried out in other public hospitals to analyse the factor groups identified further.

Adequacy of nutritionist (dietician) resources in Chilean public hospitals

Human resource deficit is an important management problem in Chilean public hospitals. To analyze the adequacy of Nutritionist (Dietician) resources in public hospitals. A questionnaire about Nutritionist resources was sent to head Nutritionists of all public Chilean hospitals, asking about the number of Nutritionists per service, number of hospital beds and number of daily rations served. Results were analyzed based on the Technical Guideline about Nutritional and Feeding Services of public hospitals issued by the Chilean Ministry of Health in 2005. According to the guideline, there should be 1,396 nutritionists working in public hospitals and the results of the survey showed that there were only 603 professionals with a 57% deficit. There is a huge gap between the amount of Nutritionists (Dieticians) required and those effectively working in public hospitals.

Measured and self-reported body weight and stature in Emergency Service of a South Brazilian public hospital

Measured and self-reported body weight and stature in Emergency Service of a South Brazilian public hospital

Dynamic Pricing Model of Medical Services in Public Hospitals in China

For improving the current pricing mode of medical services, the present study seeks to explore the pricing elements and processes, and establish the dynamic pricing model of involving both the government and hospitals. The pricing process and mathematical model shows the logical relationships between medical prices and pricing elements. The causal relationship model reveals how to accomplish dynamic equilibrium between elements. The simulation model has been built based on system dynamics theory. Results of the simulation and sensitivity tests, show that different grades of hospitals while applying the pricing model may better perform their respective responsibilities and continuously improve core strengths.

Needs Assessment on the Use of Health Services Among Men Who Have Sex with Men in Ho Chi Minh City, Vietnam

Men who have sex with men (MSM) in Vietnam are at high risk for HIV and sexually transmitted infections (STI). However, few MSM in Vietnam routinely utilize HIV/STI testing and treatment services. We conducted a survey among MSM in Ho Chi Minh City to assess practices and preferences for accessing health services. In this qualitative study, 19 individual interviews and 3 focus group discussions were conducted with a total of 50 MSM. All participants self-identified as gay or bisexual and were stratified by age group. Recruitment was by convenience sampling through social networks. Semi-structured interview guides included experience accessing health services, stigma and discrimination in the health care setting, and preferences for HIV and STI counseling and services. Fifty MSM aged 17 to 40 participated in the assessment. The majority had post-secondary education (92%) and above-average incomes. Almost all participants appreciated the cleanliness and quicker service in the private sector, while services in public hospitals were described as lower in quality but acceptable and uniform. The majority of the participants expressed a preference for MSM-specific services focusing on HIV/STI counseling, testing, and treatment. There was a strong preference for accessing HIV and STI services at a stand-alone clinic independent from other health facilities, where confidentiality could be assured. The majority were willing to pay a higher cost for private sector services, provided the service was of high quality, confidential, and non-stigmatizing. This study confirms the need for high quality, nonjudgmental, and confidential HIV/STI health services for MSM in Vietnam. There is generally a willingness to pay for health services provided that the services are seen to be tolerant and friendly to MSM.

고객세분화를 통한 지방의료원의 의료서비스 전문화 전략

본 연구는 지방의료원의 고객세분화를 통하여 향후 전문화된 의료기관으로 진료전문성을 강화하여 경쟁력을 확보할 수 있는 진료전문화 전략을 제시하는데 목적이 있다. 조사기간은 2013년 1월부터 12월까지 입원한 환자 26,658명을 연구대상을 선정하였다. 분석방법은 군집분석과 의사결정나무분석을 이용하였다. 결론을 보면, 성별은 여자, 연령은 60세 이상, 질환별로는 근 골격계 및 결합조직의 질환이 충성고객으로 선정되었다. 이들은 지방의료원의 고객관리측면에서 향후 구전의 효과가 높은 고객 군으로 금전적인 소비규모가 높은 점을 고려하여 이들에게 제공된 의료서비스에 대한 모니터링과 커뮤니케이션을 통해 지속적인 관계를 유지하는 것이 중요하다. 앞으로 전문 분야의 전문의와 전문적 시설 확보 등의 적합한 조직구조와 환경을 갖추는 것이 중요하며, 지역 내 개원의, 유관기관간의 전략적 제휴 통한 진료협력 및 의뢰, 의료서비스 범위의 집중화가 필요하다. 【This study aims to further strengthen the medical expertise to offer specialized medical care specialization strategies to gain a competitive edge through the customer segmentation of the Regional Public Hospital. Investigation period was selected to study the inpatients 26,658 people January to December 2013. The method of analysis are Cluster analysis and Decision Tree Analysis. In conclusion, female, age over 60, and diseases in musculoskeletal system and connective tissue were commonly selected as identifiers of the target market of Regional Public Hospital. Customers in this target market are loyal to specialized medical service and keeping continuous relationship with these customers through communication and monitoring of results of provided medical service would be important because the effect of word of mouth propagated to other group of customers having equivalent scale of consumption is expected. And the concentration of the scope of medical service of Regional Public Hospital and the collaboration and mutual reliance of medical service under the strategic alliance with other institutions and private hospitals are also needed.】

Validation of the Spanish version of the HIV Related Fatigue Scale and application in people with hepatitis C

To validate the American fatigue scale HIV-Related Fatigue Scale (HRFS) and present the Spanish version called Integrated Fatigue Assessment Scale to assess fatigue in HCV and co-infected patients. Psychometric study with cross-sectional design was used. The HRFS was translated into Spanish using the back-translation method-later to be validated. Participants completed the questionnaire adapted to a self-report form, as well as a sociodemographic questionnaire. The reliability and validity of the Spanish version was evaluated. A total of 7 public service hospitals and two prisons in Catalonia participated in the evaluation. The sample consisted of 122 subjects selected by consecutive sampling in the fourth week of treatment of hepatitis C with combination therapy or triple therapy. The Cronbach alpha for the total scale was 0.958. Content Validity Index (I-CVI) varied from 0.5 to 1. Validity Scale Content-level (S-CVI) was 0.85. Pearson correlations between the three dimensions were between 0.49 and 0.68. The process followed for the cultural adaptation and validation shows that the Spanish version of the HRFS) is a valid and reliable instrument that can be used in clinical practice and in the investigation of fatigue in patients with hepatitis C.

Possible options for introducing quality aspects in Activity-Based Funding pricing

Background In 2011, all of the Australian governments committed to health care reform in which they agreed to use a nationally consistent “Activity-Based Funding” approach for public hospital services in Australia. This reform sought to increase the transparency of public hospital funding and improve the efficiency of public hospital services. As part of this reform, the Independent Hospital Pricing Authority (NIHA) was created, to determine the National Efficient Price (NEP) for public hospitals services, as well as the classification, costing, and counting standards used in setting the NEP. One criticism of Activity-Based Funding is that it fosters increases in hospital activity without measuring quality, safety, or outcomes. To address this criticism, in the last two years, the IHPA has begun to develop several options for introducing quality components into the NEP. The work has been carried out in partnership with the Australian Commission on Safety and Quality in Healthcare, and is overseen by a Joint Working Party (JWP) comprised of senior clinicians from across the country. This paper gives an overview of the timeconsuming and complex, but ultimately productive, work that has been carried out to date.