Hospital Willingness Research Articles

Similarities and differences of lung cancer (LC) multidisciplinary teams (MDTs) in China compared to Europe and Canada.

e13562 Background: LC MDTs involve a collaborative approach where specialists work together to analyze individual cases, discuss treatment options, and tailor comprehensive care plans for patients. Implementing MDTs can be challenging, especially for developing countries with limited resources and high disease burden. China, with approximately 820,000 new patients with lung cancer in 2020 accounting for 37% of the total number in the world, bears the responsibility of treating the largest lung cancer patient population worldwide. The global MDT Aid Program (MAP) in LC has been including China to gather insights on the challenges, best practices, similarities, and differences of China LC MDT processes compared to other countries, so as to improve the outcome and cost-efficiency of global MDTs. Methods: In this study, we learned about the status, best practices, challenges of LC MDT development in China through virtual semi-structured healthcare professional (HCP) interviews, on-site masterclasses, and internal data sharing with 3 Chinese leading hospitals in LC - Guangdong Provincial People’s Hospital, West China Hospital and Xiangya Hospital. Similarities and differences were gathered based on previous MAP experience and insights from HCP discussions in LC across the Netherlands, Italy, Spain, Switzerland, Denmark, Norway, and Canada. To build a global collaboration on LC MDTs, three international knowledge exchange (IKE) sessions were organised to include China and all participating countries. Results: We identified seven main differences between China, Europe and Canada, including the enrolment criteria of patients in MDT that China MDTs focus on challenging cases such as resistance to multi-lines of therapy, multiple primary lung cancer and stage III lung cancer, while Europe and Canada MDTs mainly for routine patients. Other differences include setup and composition of MDT teams, digitalization of MDTs, incentives and reimbursement for MDT attendance, cross-institutional patient referral to the MDT, time spent per patient, patient follow-up after MDT discussion. Similarities identified include the MDT development model from both hospital and national level, experience sharing to educate junior physicians, hospital willingness to learn at global level, and challenges of high pressure with limited medical resources. Best practices of leveraging innovative digital capabilities to improve MDT efficiency and to support decision-making have been shared by China participants during the IKEs. Conclusions: Global collaboration to identify synergies within LC MDT communities can help China and other regions learn from each other and share China expertise in large-volume data-based practices globally. Alongside China’s rapid development of digital health, the digitalization of MDTs is likely to follow.

Tripartite evolutionary game study on coordination information security in prescription circulation.

To further reform the medical and health care system, regulating multi-level treatment and rationalizing the use of medicine, and securing prescription circulation information, this study explores the evolutionary behavior of three players in terms of information security collaboration under the prescription circulation policy, analyzes the evolutionary paths, and examines the influence of key parameters on evolutionary outcomes by constructing a tripartite evolutionary game model consisting of hospitals, retail pharmacies, and healthcare service platforms. The study shows the following: (1) When the information security costs of prescription circulation increase, the willingness of hospitals to promote information collaboration weakens, the probability of control and regulation by healthcare platforms will be enhanced, and the incentive for retail pharmacies to undertake prescription circulation increases and then decreases. (2) The increased profitability of prescription drug sales can cause a decrease in the likelihood of both parties working together to promote information security. Increasing the collaborative space between hospitals and retail pharmacies is conducive to improving information security in the circulation of prescriptions. (3) A bi-directional constraint relationship exists between the circulation and control subjects. The shorter the technology spillover time from the healthcare service platform is, the higher the probability that hospitals and retail pharmacies will maintain the security of prescription information. (4) In the early stages of prescription circulation, the external regulatory action of the healthcare service platform is essential to improve the coordination of information security. Finally, combined with the tripartite evolutionary game model and simulation analysis results, it offers countermeasures and suggestions for the government to realize the prescription circulation information security collaboration.

Hospital-based antimicrobial stewardship, India.

To establish a framework for implementing antimicrobial stewardship in Indian tertiary care hospitals, and identify challenges and enablers for implementation. Over 2018-2021 the Indian Council of Medical Research followed a systematic approach to establish a framework for implementation of antimicrobial stewardship in Indian hospitals. We selected 20 Indian tertiary care hospitals to study the feasibility of implementing a stewardship programme. Based on a questionnaire to lead physicians before and after the intervention, we assessed progress using a set of process and outcome indicators. In a qualitative survey we identified enablers and barriers to implementation of antimicrobial stewardship. We found an improvement in various antimicrobial stewardship implementation indicators in the hospitals after the intervention. All 20 hospitals conducted monthly point prevalence analysis of cultures compared with three hospitals before the intervention. The number of hospitals that initiated formulary restrictions increased from two to 12 hospitals and the number of hospitals that started practising prescription audit and feedback increased from six to 16 hospitals. Respondents in 15 hospitals expressed their willingness to expand the coverage of antimicrobial stewardship implementation to other wards and intensive care units. Six hospitals were willing to recruit the permanent staff needed for antimicrobial stewardship activities. Antimicrobial stewardship can be implemented in Indian tertiary hospitals with reasonable success, subject to institutional support, availability of trained manpower and willingness of hospitals to support antimicrobial stewardship-related educational and training activities.

Building and Sustaining the Health-care Workforce of the Future for COVID-19 and Beyond

The forces in play during the COVID-19 pandemic-driven slowdown and recession have affected the demand for health care, and consequently, the willingness of hospitals, health-care systems, and clinician group practices to continue employing health-care workers at prepandemic levels. The pandemic also has reduced the willingness of some health-care professionals to continue working in health care, independent of shifts in the demand of their services. To ensure that it continues to be responsive to community needs, and the workforce continues to be capable of delivering positive patient and community outcomes, the sector needs to develop early and proactive strategies to transition to effect positive cultural change. In this review of the literature, we have discussed the COVID-19 pandemic-related effects signal for the global health-care workforce in future is important to consider. Proactive planning and preparation today with an eye to tomorrow are critical; the health of the country's future generations depends on it.

Study on the Willingness of Hospital J to Participate in Station-based Assistance in Medical Alliance

Medical assistance is an important way to address the uneven distribution of medical resources and promote health equity. The medical alliance is the practice of medical administrative authorities and hospitals to explore the development of medical assistance, but at present there are difficulties in this cooperation. In this study, we analyze the practice of Hospital J in helping member hospitals in the construction of a medical alliance, and the key influencing factors of cooperation at three levels: hospital leaders, department heads and general practitioners. We propose a research design, focusing on how to enhance the level of willingness of core hospitals to participate in the cooperation of station-based support, which is useful for enhancing the leading role of core hospitals, promoting the steady development and achieving the policy objectives of the medical alliance.

Are Nonprofit Hospitals Addressing the Most Critical Community Health Needs That They Identify in Their Community Health Needs Assessments?

Virtually all nonprofit hospitals are in compliance with the Affordable Care Act's new Community Health Needs Assessments requirements. To assess what needs have emerged in the Community Health Needs Assessments hospitals complete nationally, the degree to which identified needs reflect the most pressing community health issues, and the extent to which hospitals address identified needs. Using both bivariate and logistic regressions, we analyzed the Community Health Needs Assessments and implementation strategies of nonprofit hospitals to determine whether identified needs overlapped with county health-ranking indicators of need and whether institutional or community-level factors predicted hospital willingness to address identified needs. We included a 20% random sample of US nonprofit hospitals (n = 496). Our main outcome measures were whether nonprofit hospitals addressed each of the most common needs. Mental health, access to care, obesity, substance abuse, diabetes, cancer, and the social determinants of health were the most commonly identified needs across the sample. The rate at which hospitals chose to address each of these needs in their implementation strategies, however, varied considerably, ranging from 56% (cancer) to 85% (obesity). We found that several institutional and community characteristics predicted hospital willingness to address each need; whether the community ranked a need as number 1 was a better predictor of hospital investment than the severity of the need, as measured by county health-rankings data. These findings may help inform local, state, and federal policy makers as they consider interventions aimed at encouraging hospitals to invest in improving the health of their communities.

A computer-based approach for data analyzing in hospital’s health-care waste management sector by developing an index using consensus-based fuzzy multi-criteria group decision-making models

BackgroundProper Health-Care Waste Management (HCWM) and integrated documentation in this sector of hospitals require analyzing massive data collected by hospital’s health experts. This study presented a quantitative software-based index to assess the HCWM process performance by integrating ontology-based Multi-Criteria Group Decision-Making techniques and fuzzy modeling that were coupled with data mining. This framework represented the Complex Event Processing (CEP) and Corporate Performance Management (CPM) types of Process Mining in which a user-friendly software namely Group Fuzzy Decision-Making (GFDM) was employed for index calculation. FindingsAssessing the governmental hospitals of Shiraz, Iran in 2016 showed that the proposed index was able to determine the waste management condition and clarify the blind spots of HCWM in the hospitals. The index values under 50 were found in some of the hospitals showing poor process performance that should be at the priority of optimization and improvement. ConclusionThe proposed framework has distinctive features such as modeling the uncertainties (risks) in hospitals’ process assessment and flexibility enabling users to define the intended criteria, stakeholders, and number of hospitals. Having computer-aided approach for decision process also accelerates the index calculation as well as its accuracy which would contribute to more willingness of hospitals’ experts and other end-users to use the index in practice. The methodology could efficiently be employed as a tool for managing hospitals’ event logs and digital documentation in big data environment not only for the health-care waste management, but also in other administrative wards of hospitals.

Financial Incentives to Reduce Hospital-Acquired Infections Under Alternative Payment Arrangements.

OBJECTIVEThe financial incentives for hospitals to improve care may be weaker if higher insurer payments for adverse conditions offset a portion of hospital costs. The purpose of this study was to simulate incentives for reducing hospital-acquired infections under various payment configurations by Medicare, Medicaid, and private payers.DESIGNMatched case-control study.SETTINGA large, urban hospital system with 1 community hospital and 2 tertiary-care hospitals.PATIENTSAll patients discharged in 2013 and 2014.METHODSUsing electronic hospital records, we identified hospital-acquired bloodstream infections (BSIs) and urinary tract infections (UTIs) with a validated algorithm. We assessed excess hospital costs, length of stay, and payments due to infection, and we compared them to those of uninfected patients matched by propensity for infection.RESULTSIn most scenarios, hospitals recovered only a portion of excess HAI costs through increased payments. Patients with UTIs incurred incremental costs of $6,238 (P<.01), while payments increased $1,901 (P<.05) at public diagnosis-related group (DRG) rates. For BSIs, incremental costs were $15,367 (P<.01), while payments increased $7,895 (P<.01). If private payers reimbursed a 200% markup over Medicare DRG rates, hospitals recovered 55% of costs from BSI and UTI among private-pay patients and 54% for BSI and 33% for UTI, respectively, across all patients. Under per-diem payment for private patients with no markup, hospitals recovered 71% of excess costs of BSI and 88% for UTI. At 150% markup and per-diem payments, hospitals profited.CONCLUSIONSHospital incentives for investing in patient safety vary by payer and payment configuration. Higher payments provide resources to improve patient safety, but current payment structures may also reduce the willingness of hospitals to invest in patient safety.Infect Control Hosp Epidemiol 2018;39:509-515.

Rising cost of antidotes in the U.S.: cost comparison from 2010 to 2015

Context: Our poison control center observed a large increase in the cost of many antidotes over the past several years. The high cost of antidotes has previously been cited as a factor leading to inadequate antidote supply at some hospitals. Continued increases in the cost of antidotes may lead to further reductions in antidote supply and represent serious concerns. This research aims to quantify recent trends in the costs of antidotes in the U.S.Methods: Antidotes and minimum stocking recommendations were retrieved from published guidelines. RED BOOK Online® was used to identify the U.S. average wholesale price (AWP) of each antidote in 2010 and 2015. The AWP in 2010 was adjusted using the U.S. Consumer Price Index to adjust for inflation. The cost of minimum stocking levels for each antidote was calculated and compared between the year 2010 and 2015.Results: The cost of stocking many antidotes demonstrated a large increase in AWP from 2010 to 2015. Of the antidotes evaluated, 15 out of 33 had greater than 50% increase in AWP and 8 out of 33 had greater than $1000 increase in AWP. Only four antidotes demonstrated decreases in AWP greater than 10% and only one antidote had its cost of stocking decrease in AWP by more than $1000.Discussion: The price increase over the last 5 years may further hinder the willingness of hospitals to stock recommended antidotes at adequate quantities. This may impede timely treatment of patients, and negatively impact poisoning outcomes.Conclusions: The price of many antidotes substantially increased in the United States from 2010 to 2015. Strategies should be investigated to help decrease the cost associated with stocking and use of antidotes, including dose rounding, consignment, and regional sharing.

Triple Rule Out: Why It Is Not Ready to Roll Out

Triple Rule Out: Why It Is Not Ready to Roll Out

Uncompensated hospital care. Will it be there if we need it?

The debates over health care system reform continue, but they rarely mention the enduring need for free or reduced-cost hospital care as a safety net for uninsured and underinsured individuals. Policy changes on numerous fronts threaten the ability or willingness of hospitals to provide uncompensated care. These changes include the decline of Hill-Burton funds, the closings or mergers of not-for-profit and public hospitals, the dominance of competitive forces, and the redirection of funds intended for disproportionate share hospitals or uncompensated pools. Federal and state governments lack coordinated approaches toward uncompensated care, and health system reforms may not have the expected effects on reducing hospitals' burden of paying for services to indigents. Furthermore, measurement of uncompensated care is inconsistent. In light of the persistent growth in the number of persons with inadequate health insurance coverage and the central role that uncompensated care will continue to play in ensuring access to care for the poor and uninsured, these policies need to be reexamined. Guidelines for policy based on past experience are presented herein.

Regional Perinatal Care in Crisis: A Case Study of an Urban Public Hospital

Regionalized perinatal care is intended to guarantee pregnant women and neonates access to appropriate care regardless of ability to pay. Its effectiveness depends on the willingness of hospitals to transfer high-risk patients according to established protocols and affiliations. This study examines maternal transfers (n = 896) to Cook County Hospital (CCH), a public facility and a designated perinatal center in Chicago. In 1987 and 1988, the majority (68%) of maternal transfers to CCH came from out-of-network hospitals, and 52% of these came directly from another perinatal center. The data indicate that 62% of the out-of-network transfers who delivered were medically high-risk. The study also documents the transfer of women in active labor, a violation of federal law. The term "perinatal dumping" is introduced to mean the transfer of high-risk pregnant women between hospitals for economic rather than medical reasons. Strategies for safeguarding the integrity of regionalized perinatal care are discussed.

Pricing by non-profit institutions: The case of hospital cost-shifting

This paper shows that a hospital whose objective function includes output as well as profits may raise price to private paying patients in response to cuts in the price it receives for Madicaid or Medicaid patients. Evidence is presented to show that hospitals in Illinois ‘cost-shifted’ in this manner in response to substantial reductions in Medicaid payments in the early 1980s. As private sector pricing becomes more competitive, however, the ability and willingness of hospitals to cost-shift will wane.

The Massachusetts Psychiatric Society's Position Paper on Involuntary Psychiatric Admissions to General Hospitals

Believing that if general hospitals are pressured into admitting involuntary patients without adequate safeguards, care may deteriorate, the Massachusetts Psychiatric Society drafted a detailed position statement enumerating what resources and services would be required to provide the same high-quality care for involuntary as for voluntary patients. Among other points, treatment of involuntary patients should be considered "psychiatric intensive care," with attention given to the needs for special staffing, training, ancillary services, and funding. To provide high-quality care in the least restrictive environment, separate locked and unlocked units should be provided. Not all involuntary patients can be cared for within a general hospital, the statement says; some require specialized units more appropriately located elsewhere. The general hospital's willingness to accept involuntary patients should be contingent on its being able to control its admissions, and on the hospital's not being the provider of last resort.