Hospital Supervision Research Articles

Comparison of Primary Care Experiences in Village Clinics with Different Ownership Models in Guangdong Province, China.

ObjectivesIn order to improve the quality of services at village clinics (VCs), which are important primary care service providers in rural China, the Chinese government has encouraged the township hospitals to own and manage VCs. There are currently three models of ownership and management of VCs: township hospital-owned and -managed (HVC), village committee-owned and -managed (VVC), and private-owned and -managed (PVC). This study aims to examine the association between these ownership models of VCs and patients' primary care experiences.MethodsVillagers were selected by multistage stratified sampling and their experiences with primary care were measured using the Primary Care Assessment Tool—Adult Edition (PCAT-AS). Data were collected through face-to-face interviews and the questionnaires administered by investigators in the cross-sectional study from February to April 2015. The PCAT scores were compared among the three models by covariance analysis, and multiple linear regression was used to analyze factors associated with the PCAT total scores.ResultsA total of 1491 questionnaires were collected. After controlling for covariates, HVCs reported the highest PCAT scores and satisfaction rate. In terms of the domains, HVC reported the highest scores in the coordination and comprehensiveness domains, while PVC had the highest scores in the first contact-accessibility domain. Multivariate linear regression showed that HVC, married participants, aged 60 and older, satisfied with the services, receiving six or more visits, and those with medical expenditures over 20% of their total family expenditures, were also positively associated with better primary care quality.ConclusionsThis study demonstrates that villagers receiving medical care at HVCs perceived better primary care than those at PVCs and VVCs. In order to improve the quality of primary care at VCs, it is necessary to increase government subsidies for public service packages, tighten the township hospital's supervision of PVCs and VVCs, and develop performance-based incentive plans to motivate improvements in the accessibility of HVCs.

The Influence of Quality Assurance and Supportive Supervision on the Quality of Medical Care in Children’s Hospitals of the Municipal Level of the Rostov Region

Background . Improving the quality of medical care is the absolute priority of the World Health Organization and all socially-oriented ministries and departments around the world. Objective . Our aim was to evaluate the effectiveness of quality assurance and supportive supervision in municipal hospitals to improve the quality of medical care for children (by the example of the Rostov region). Methods. The open observational study included 10 second-level hospitals in the Rostov Region. At the start of the project, the quality of inpatient care for children in the region was audited based on recommendations and tools of the World Health Organization, and training of medical personnel was organized. Monitoring visits to hospitals were carried out by experts every 3 months (supportive supervision). Reaudit of the quality of care was conducted a year later. Results. As a result of regular quality assurance and supportive supervision of hospitals during the first year of operation, such indicators of the quality of medical care as the availability of medical equipment for emergency care for children, the infrastructure of children’s departments, the triage and provision of emergency care in children’s departments, managing patients with various acute conditions (fever, diarrhea, respiratory diseases), supporting care, internal quality assurance, accessibility to standards of care and clinical guidelines for the diagnosis and treatment of various diseases, respect for children’s rights were significantly (p < 0.05) improved. Conclusion. Supportive supervision and regular external quality assurances of hospitals contribute to a rapid increase in the quality of medical care for children.

Investigating the Potential Contribution of Patient Rating Sites to Hospital Supervision: Exploratory Results From an Interview Study in the Netherlands.

BackgroundOver the last decades, the patient perspective on health care quality has been unconditionally integrated into quality management. For several years now, patient rating sites have been rapidly gaining attention. These offer a new approach toward hearing the patient’s perspective on the quality of health care.ObjectiveThe aim of our study was to explore whether and how patient reviews of hospitals, as reported on rating sites, have the potential to contribute to health care inspector’s daily supervision of hospital care.MethodsGiven the unexplored nature of the topic, an interview study among hospital inspectors was designed in the Netherlands. We performed 2 rounds of interviews with 10 senior inspectors, addressing their use and their judgment on the relevance of review data from a rating site.ResultsAll 10 Dutch senior hospital inspectors participated in this research. The inspectors initially showed some reluctance to use the major patient rating site in their daily supervision. This was mainly because of objections such as worries about how representative they are, subjectivity, and doubts about the relevance of patient reviews for supervision. However, confrontation with, and assessment of, negative reviews by the inspectors resulted in 23% of the reviews being deemed relevant for risk identification. Most inspectors were cautiously positive about the contribution of the reviews to their risk identification.ConclusionsPatient rating sites may be of value to the risk-based supervision of hospital care carried out by the Health Care Inspectorate. Health care inspectors do have several objections against the use of patient rating sites for daily supervision. However, when they are presented with texts of negative reviews from a hospital under their supervision, it appears that most inspectors consider it as an additional source of information to detect poor quality of care. Still, it should always be accompanied and verified by other quality and safety indicators. More research on the value and usability of patient rating sites in daily hospital supervision and other health settings is needed.

Analysis of business operations of county-level public hospitals in Beijing

Objective To propose on reform and development policies of county-level public hospitals in Beijing by means of investigation and analysis of their business operations to identify existing problems. Methods Quantitative, descriptive analysis and in-depth interviews were used to study business operation data from 2012 to 2014 of the 30 county-level public hospitals in Beijing, in order to learn their development trends. Results Business operations of such hospitals were found to be desirable in general.The average growth rate per annum of the revenue of county-level hospitals, traditional Chinese medicine hospitals and women-children health hospitals was 15.7%, 18.7%, and 11.0% respectively; such growth rate of their expenditure was 16.4%, 21.1%, and 15.1% respectively.Roadblocks were also found, however, namely low income of medical personnels, operations in debt, lack of subsidy channels, and the marked gap of development among such hospitals. Conclusions In view of the above-mentioned problems, the authors put forward policy suggestions as follows: to optimize the government subsidy mechanism, to improve financial supervision and internal audit of such hospitals, to reasonably raise income of the medical personnels, and to build a mutually complementary system of medical service system that is mutually complementary between urban and rural areas in terms of their functionality. Key words: Beijing; County-level public hospital; Business operations; Subsidy mechanism

关于我国社会资本办医疗机构的分析与思考*

This paper mainly described the current situation of the medical institutions of social capital in our country, analyzed the existing problems, and put forward suggestions for improvement to further promote the medical institutions held by social capital. We should make reasonable set of private medical institutions, promote the flow of talent, create a fair market environment, strengthen supervision and management of private hospitals and other aspects of reform, make efforts to promote the process of social capital to do medicine and to provide better health services for people.

Exploring the value of vein center accreditation to the venous specialist

Whereas advancements in medicine offer potential alternatives for better treatment outcomes, these additional therapeutic options can make health care decision-making more difficult for patients, referring physicians, payers, and policy makers. In a complex and ever-changing medical world, quantifying quality care is a challenge, while the need to promote higher quality care is even more important. Many of the key developments in the field have come into common use without the opportunity for formal training for physicians already in practice, regardless of specialty background. These techniques are often learned through postgraduate educational experiences. As a result, it is likely that there is a wide range of knowledge, skill, and experience among physicians offering vein services. Given that many of these services are provided in the office, there is no hospital or institutional supervision or accreditation. In an effort to improve quality of venous care, the Intersocietal Accreditation Commission (IAC) established accreditation standards for superficial vein centers. This review discusses the process used to create the IAC Vein Center guidelines; summarizes important requirements for accreditation and their impact on quality of care; and examines the potential impact of IAC accreditation on patients, providers, and payers.

Reform attempts in Shenzhen to build a contemporary management system of public hospitals

Since its founding, the Management Center of Shenzhen Public Hospitals, on the basis of summarizing and inheriting reform outcomes in the past, has been working on to streamline the relationship between the government, public hospitals and the society in line with the general reform requirements of the state upholding public welfare nature, motivating and ensuring sustainability . The center carries out a general reform covering the hospital management system, operating mechanism, supervision mode, and service mode.This way the center has built a set of contemporary hospital management system fitting Shenzhen's conditions, encouraging hospital operations to better embody the interests of the government, medical workers and the society, and to better cover quality, equity and efficiency, thus effectively improving the management performance and services of the hospitals in question. Key words: Public hospitals; Management system; Funders

Mobile phones support adherence and retention of indigenous participants in a randomised controlled trial: strategies and lessons learnt.

BackgroundEnsuring adherence to treatment and retention is important in clinical trials, particularly in remote areas and minority groups. We describe a novel approach to improve adherence, retention and clinical review rates of Indigenous children.MethodsThis descriptive study was nested within a placebo-controlled, randomised trial (RCT) on weekly azithromycin (or placebo) for 3-weeks. Indigenous children aged ≤24-months hospitalised with acute bronchiolitis were recruited from two tertiary hospitals in northern Australia (Darwin and Townsville). Using mobile phones embedded within a culturally-sensitive approach and framework, we report our strategies used and results obtained. Our main outcome measure was rates of adherence to medications, retention in the RCT and self-presentation (with child) to clinic for a clinical review on day-21.ResultsOf 301 eligible children, 76 (21%) families declined participation and 39 (13%) did not have access to a mobile phone. 186 Indigenous children were randomised and received dose one under supervision in hospital. Subsequently, 182 (99%) children received dose two (day-7), 169 (93%) dose three (day-14) and 180 (97%) attended their clinical review (day-21). A median of 2 calls (IQR 1–3) were needed to verify adherence. Importantly, over 97% of children remained in the RCT until their clinical endpoint at day-21.ConclusionsIn our setting, the use of mobile phones within an Indigenous-appropriate framework has been an effective strategy to support a clinical trial involving Australian Indigenous children in urban and remote Australia. Further research is required to explore other applications of this approach, including the impact on clinical outcomes.Trial registrationACTRN12608000150347 (RCT component).

Understanding the barriers to setting up a healthcare quality improvement process in resource-limited settings: a situational analysis at the Medical Department of Kamuzu Central Hospital in Lilongwe, Malawi

BackgroundKnowledge regarding the best approaches to improving the quality of healthcare and their implementation is lacking in many resource-limited settings. The Medical Department of Kamuzu Central Hospital in Malawi set out to improve the quality of care provided to its patients and establish itself as a recognized centre in teaching, operations research and supervision of district hospitals. Efforts in the past to achieve these objectives were short-lived, and largely unsuccessful. Against this background, a situational analysis was performed to aid the Medical Department to define and prioritize its quality improvement activities.MethodsA mix of quantitative and qualitative methods was applied using checklists for observed practice, review of registers, key informant interviews and structured patient interviews. The mixed methods comprised triangulation by including the perspectives of the clients, healthcare providers from within and outside the department, and the field researcher’s perspectives by means of document review and participatory observation.ResultsHuman resource shortages, staff attitudes and shortage of equipment were identified as major constraints to patient care, and the running of the Medical Department. Processes, including documentation in registers and files and communication within and across cadres of staff were also found to be insufficient and thus undermining the effort of staff and management in establishing a sustained high quality culture. Depending on their past experience and knowledge, the stakeholder interviewees revealed different perspectives and expectations of quality healthcare and the intended quality improvement process.ConclusionsEstablishing a quality improvement process in resource-limited settings is an enormous task, considering the host of challenges that these facilities face. The steps towards changing the status quo for improved quality care require critical self-assessment, the willingness to change as well as determined commitment and contributions from clients, staff and management.

Comparaison de l’hospitalisation à domicile et de l’hospitalisation conventionnelle dans la prise en charge des ruptures prématurées des membranes

ObjectivePremature prelabour rupture of membrane (PPROM) is associated with an increased risk for both mother and fetus. Expectant management is usually advised under hospital supervision. Home care is associated with reduced cost. However, its safety in PPROM management has not been well established. Our objective was to assess neonatal and maternal outcome in pregnancies complicated by PPROM comparing home care to in-hospital management.Study designRetrospective study in two tertiary centers over a two-year period between January 2009 and December 2010. We included all singleton pregnancies with a history of PPROM which occured between 24 and 35 weeks of gestation. We compared women with PPROM and in-hospital management in Center 1 (Group 1; N = 42) to women with PPROM and a home care after a short period of observation in Center 2 (Group 2; N = 32), and. We studied gestational age at delivery, pregnancy complications, mode of delivery and neonatal outcome.ResultsDemographic characteristics were similar at onset of PPROM between the two groups.Women in group 2 delivered later than in group 1 (234.8 ± 19.54 days vs 224.6 ± 22.02 days; P = 0.04). There was no difference between the groups in pregnancy complications including chorioamnionitis, delivery issue and neonatal outcome. The length of stay in neonatal intensive care unit was higher in group 1 compared to group 2 (N = 43.51 ± 2.67 days for group 1 vs. N = 24.21 ± 2.72 days for group 2; P = 0.0003).ConclusionHome care appears to be a safe option for women with PPROM between 24 and 35 weeks with stable condition. These preliminary findings suggest performing a randomized control trial with a higher number of women, including further data such as assessment of maternal satisfaction and cost analysis.

Influence of In-house Pediatric Intensivist Supervision on Complications of Emergent Intubations

PURPOSE: In adult populations, implementation of in-house, full-time (24 hour/day, 7 day/week) supervision by intensivists is thought to reduce mortality and decrease complication rates. Little is known about the impact of in-house intensivist supervision in children's hospitals. We recently began providing such coverage in our children's hospital, and have evaluated its relationship to patient outcomes. Specifically, we sought to determine the influence of in-house intensivist supervision on the incidence of complications in children requiring emergent intubations.

Discussions of the hospital evaluation pattern in the "Peri-evaluation" theory

The Peri-evaluation hospital evaluation theory comes into being based on a review of the traditional hospital evaluation patterns in China, and the reference of advanced international experiences of hospital evaluation. This theory is already applied to the evaluation and care quality supervision of hospitals in Hainan, On such basis, a third-party hospital evaluation management mechanism and Peri-evaluation hospital evaluation pattern have been worked out Such mechanism and pattern will prove inspirational for the pending hospital evaluation in China. Key words: Hospital evaluation; Peri-evaluation; Care quality; Third-party

Models and Methods in Hospital Social Work Supervision

This is the first qualitative study of the perceptions of hospital-based social work supervisees regarding their hospital supervision. Seventeen social workers were recruited using a national listserv and snowball sampling techniques. According to the perception of the clinical social workers participating in the study, hospital social work supervision is organizationally driven rather than worker-focused. Implications for social work education and research are discussed.

The effect of exercise on hip muscle strength, gait speed and cadence in patients with total hip arthroplasty: a randomized controlled study

Objective: To evaluate the effect of home versus in-hospital exercise (under supervision) programmes on hip strength, gait speed and cadence in patients with total hip arthroplasty at least one year after operation. Setting: Physical therapy and rehabilitation department. Subjects: Twenty-six patients who had had a total hip arthroplasty operation 12—24 months prior to the study were enrolled. Interventions: The patients were randomized into three groups: group 1 patients were assigned a home exercise programme, group 2 patients exercised under physiotherapist supervision in hospital, and group 3 served as the control group, with no specific intervention. The study duration was six weeks. Main measures: Maximum isometric abduction torque of operated hip muscle, gait speed and cadence were measured before and after the study. Results: Maximum isometric abduction torques of the hip abductor muscles improved in groups 1 and 2, but not in group 3 (30 ± 12 to 38 ± 11 ft.lb in group 1, 18 ± 10 to 30 ± 9.8 ft.lb in group 2). Gait speed improved from 67.8 ± 23 to 74.35 ± 24 m/min in group 1, from 48.53 ± 4 to 56.7 ± 5 m/min in group 2 and from 58.01 ± 12 to 59.8 ± 14 m/min in group 3. Cadence also improved, from 97.7 ± 18 to 111 ± 17 steps/min in group 1, from 90.75 ± 6 to 104.75 ± 7 steps/min in group 2, and from 87 ± 16 to 88.22 ± 16 steps/min in group 3. When the three groups were compared, group 2 showed the best improvement (P = 0.006) only in maximum isometric abduction torque. Conclusion: Our findings suggest that both home and supervised exercise programmes are effective one year after total hip arthroplasty. Home exercise programmes with close follow-up could be recommended.

Respiratory tract infections: at-risk patients, who are they?: Implications for their management with levofloxacin

Two of the most serious respiratory tract infections are community-acquired pneumonia (CAP) and acute exacerbations of chronic bronchitis (AECB). The most common pathogens found in patients with these infections are Haemophilus influenzae and Streptococcus pneumoniae. Pseudomonas aeruginosa is also relatively common, particularly in elderly patients with AECB. S. pneumoniae and P. aeruginosa are also of concern in relation to the development of resistance to antimicrobial drugs. The administration of antibiotics at doses that result in concentrations exceeding the mutant prevention concentration at the site of infection is one strategy to prevent the development of drug-resistant pathogens. AECB is associated with a high risk of in-hospital mortality, particularly in patients treated in the intensive care unit. CAP is also associated with significant risks and often requires treatment under hospital supervision. Several patient-related factors help identify those patients who are most at risk of mortality and morbidity. Treatment should be tailored towards the severity of the disease. The fluoroquinolones, such as levofloxacin, are an effective treatment option for AECB and CAP. Compared with many other antibiotics, resistance to levofloxacin remains low for most infecting pathogens. The oral bioavailability of levofloxacin is over 99%, enabling simple switching from intravenous to oral therapy during treatment. It is also preferentially distributed to compartments in the lung, thus achieving high concentrations at the site of respiratory tract infections. Combined with cover of the major infecting pathogens found in patients with AECB and CAP, and a cost-effective treatment compared with many alternative therapies, levofloxacin is an attractive option for the treatment of at-risk patients with these respiratory tract infections.

Effective and safe control of incontinence by the intra-anal plug electrode.

Abstract A régime is described for treatment of urinary and faecal incontinence by the intra-anal plug electrode, giving results in 30 patients. Therapy is safe, inexpensive, and involves the minimum of hospital or general practitioner supervision. Positioning and control are easy with the modified electrode. Stimulation causes no appreciable discomfort in most patients. Possible modes of action are discussed and it is suggested that stimulation works by strengthening levator tone rather than local sphincters. Perineal awareness is enhanced, making conscious muscle contraction easier in exercises. Greater use should be made of this device.

Long‐Range Studies of Mental Hospital Patients: An Important Area for Research in Chronic Disease

Long‐Range Studies of Mental Hospital Patients: An Important Area for Research in Chronic Disease

Swedish guidelines for the management of community-acquired pneumonia in immunocompetent adults

This document presents the evidence-based guidelines of the Swedish Society of Infectious Diseases for the management of adult immunocompetent patients with community-acquired pneumonia (CAP), who are assessed at hospital. The prognostic score 'CURB-65' is recommended for all CAP patients in the emergency room. The score provides an assessment tool for the decision regarding outpatient treatment or level of hospital supervision, the choice of microbiological investigations, and empirical antibiotic treatment. In patients with non-severe CAP (CURB-65 score 0-2) we recommend initial narrow-spectrum antibiotic treatment, orally or intravenously, primarily directed at Streptococcus pneumoniae. In those with CURB-65 score 3, penicillin G or a cephalosporin intravenously is recommended. For CURB-65 score 0-3 atypical pathogens should be covered only when they are suspected on clinical or epidemiological grounds. In patients with CURB-65 score 4-5 intravenous combination therapy with either cephalosporin/macrolide or penicillin G/fluoroquinolone is recommended. Efforts should be made to identify the CAP aetiology in order to support the ongoing antibiotic treatment or to suggest treatment alterations. Recommended measures for prevention of CAP include influenza -- and pneumococcal -- vaccination to risk groups and efforts for smoking cessation.

Low-toxicity Ingestions

Accidental exposure to substances found in the environment is common, particularly in children aged 1-4 years and in boys. Many such ingestions carry little or no risk to health; if there are no symptoms, reassurance is all that is required. Some common household and garden substances are significantly toxic, however, and it is important to educate the public to ensure that these are always inaccessible to young children. This contribution discusses plants and substances that are unlikely to cause more than mild gastrointestinal irritation, nausea or vomiting. Only ingestion of very large amounts or development of worrying features should necessitate referral to hospital or medical supervision.

Proctocolectomy and ileostomy to pouch surgery for ulcerative colitis.

The development of continence-preserving and sphincter-preserving procedures for operation of ulcerative colitis has a long and interesting history. Reported clinical results on the continent ileostomy (Kock pouch) and the pelvic pouch procedure have often been enthusiastic; and when confronted with the options patients have mostly been in no doubt in selecting "the best operation." However, even if the continent ileostomy and subsequently restorative proctocolectomy were great innovations, it is by no means obvious that they should be recommended as the first choice for all patients. For patients old enough to join in a responsible discussion the pros and cons of the various operations available today must first be carefully described and a decision reached that reasonably meets the patient's wishes and that seems to the surgeon to be soundly based. When comparing the postoperative morbidity, long-term outcome, and quality of life assessment of the options, such a decision is in fact far from easy. Thus panproctocolectomy and ileostomy for ulcerative colitis can be considered a comparatively safe, predictable operation that can cure the patient and allow a short hospital stay, a quick recovery, and rehabilitation. It should also enable the patient to be free of hospital supervision after a year or so. Although there is a major change in body image and sexual disturbances may occur, the operation is in fact still the yardstick by which the other options should be compared. Despite the great attraction of rectum- and sphincter-preserving operations, there will always be patients for whom panproctocolectomy and a conventional end-ileostomy is the superior alternative. The ileal pouch operations are technically demanding and should probably best be restricted to specialist centers even in the future. Complications, if they arise, are often serious, and the hospital stay is often counted in weeks. The functional result may be good, but defects in continence are common and sexual dysfunction is a problem for many of these patients. The pouchitis syndrome is a great disappointment, and recent reports on subsequent epithelial dysplasia and even development of cancer are alarming. The long-term results are in this respect still uncertain. Careful patient selection, with full discussion with the patient and his or her family are essential before a decision on a continent ileostomy or a pelvic pouch is reached. Strong motivation toward avoidance of a conventional ileostomy is important. When compared with the imperfect functional results and the high morbidity associated with the pelvic pouch procedure, there is at present a great revival of interest for total colectomy with ileorectal anastomosis. It is still a useful operation and should be seriously considered particularly in the young. The functional results are comparatively good. Sexual function is well preserved. The use of the operation may enable the teenager to regain good health and finish education and family planning. Due to the cancer risk the need for subsequent supervision must be made clear, however. The operation may also be valuable in elderly patients who would be much bothered by an ileostomy and who are unlikely to live long enough for carcinoma to become a problem. The great advantage is that should a failure occur the other options remain.