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1	The Efficiency of Acute Care Hospitals in Canada Wang, Li January 2019 (has links) Improving hospital efficiency is a critical concern for health care managers and policy makers. Hospital technical efficiency is measured as the ratio of what quantity and quality of care is produced to what could be produced given the level of resources available to the hospital (its budget). What a hospital should produce given the resources at its disposal is called the “production frontier”. In order to improve hospital performance, health policy makers need knowledge and information about how well the hospitals they fund are utilizing the resources they receive. Data Envelopment Analysis, a non-parametric technique, is applied to administrative data on hospitals in Canada to produce the “technical frontier” and get insight into the variation of technical efficiency of acute hospitals at the Pan-Canadian level (except for the province of Quebec, which does not report its data on hospitals in a way that would make them comparable to the rest of Canada). DEA is preferred to the alternative method of stochastic frontier for the following reasons: DEA does not require to impose a specification on the production function of hospitals (for which theory is clearly lacking), and it allows the analyst to estimate a multi-output frontier (a stochastic frontier would have to weight arbitrarily the value of quantity versus that of quality of care in hospitals, whereas the DEA approach generates these weights from the data). Efficiency scores are serially de-correlated using a bootstrap technique and then entered as the dependent variable in regressions to identify the main factors of efficiency or inefficiency. Specifically, this thesis aims to: 1) estimate the level of technical efficiency of acute inpatient care in 35 teaching hospitals, 54 large hospitals and 90 medium-size hospitals respectively in Canada and identify the potential factors that have influence on technical efficiency; 2) uncover and measure the existence of possible spatial spillovers of hospital efficiency in Canada and examine its potential determinants while taking into account the interaction between hospitals by means of spatial regression; and 3) examine the technical and scale efficiency of the 229 small and rural hospitals across Canada (outside Quebec), as well as estimate the impact of institutional and contextual variables on hospital technical and scale efficiency respectively. The major findings are: 1) hospital output (combination of number and quality of stays; quality being measured as the inverse of in-hospital mortality) in Canada could be increased by 24 percent with the same resources by eliminating inefficiency. Highly efficient teaching hospitals benefit from producing care under favourable environments. Higher efficiency could be achieved by increasing cooperation within the health system and making more post- acute care beds available to both large and medium hospitals; 2) There is a substantial and significantly positive spatial spillover effect on the efficiency of acute inpatient care (elasticity of 0.3): Canadian hospitals are clearly complements to each other and work in networks much more than in competition. The hospital size (the number of beds), the percent of transfers between acute hospitals, and the percent of patient transfers to home care are the main drivers of efficiency among acute hospitals in Canada while controlling of the dependence between hospitals; and 3) Among small hospitals, the average output orientation technical efficiency on all types of services is 54% at the current input-output mix. To improve their technical efficiency, small hospitals should provide with more home care facilities to discharge their patients to (so-called Alternative Level of Care patients) and strengthen their cooperation with larger, urban hospitals. Small hospitals are scale inefficient, specifically, rural hospitals could reduce their size by 34% on average (around 6 acute beds) to achieve the optimal size. The study also found that the spending on diagnosis tests and the nursing as the percentages of total hospital spending (cost shares) are positively and significantly related to the scale efficiency. / Thesis / Doctor of Philosophy (PhD) / A hospital is technically efficient if it uses its resources (its budget) to get the most in terms of quantity (number of stays) and quality of care it can. A hospital can be more or less technically efficient for reasons independent of its control (typically, because of the environment in which the hospital operates) and efficiency is a value-neutral measure. This thesis aims to: 1) estimate the technical efficiency of acute inpatient care in Canada and identify the potential factors that influence the level of efficiency achieved by a given hospital; 2) uncover the existence of possible geographic clusters of efficiency (hospitals that are close geographically are also close in the efficiency scale, something called spatial spillovers in the literature) in Canada.; and 3) examine the role that size plays in the variation of technical efficiency among small and rural hospitals across Canada. The major findings are: 1) hospital output could be increased by 24 percent with the same resources by eliminating technical inefficiency; 2) There is a substantial and significantly positive spatial spillover effect on the efficiency of acute inpatient care: being close to an efficient hospital increases the efficiency score of a hospital, everything else being the same; and 3) The level of technical efficiency of small and rural hospitals across Canada is low overall and, perhaps surprisingly, larger rural hospitals are among the least efficient: among small hospitals, scale does not yield economies of resources. Efficiency, Acute care, Hospital
2	The Feasibility of a Randomized Controlled Trial Investigating the Effects of Fish Oil - Eicosapentaenoic Acid (EPA) and Docosahexanoic Acid (DHA) - on Chronic Ventilator Patients in a Long-Term Acute Care Hospital (LTACH) Setting Rosing, Keith Andrew 14 July 2009 (has links) No description available. Nutrition Fish Oil Long-term Acute Care Hospital Setting Mechanical Ventilation
3	Factors preventing the successful implementation of a Fall Prevention Programme (FPP) in an acute care hospital setting in Abu Dhabi, United Arab Emirates Haripersad, Vasanthee 03 1900 (has links) Thesis (MCur)--University of Stellenbosch, 2011. / ENGLISH ABSTRACT: The Joint Commission International Accreditation (JCIA) has included a patient safety goal as part of the standards for the accreditation of hospitals. Goal number six states the need to “reduce the risk of patient harm resulting from falls”. An acute care hospital setting in Abu Dhabi, United Arab Emirates had implemented a multifaceted, multidisciplinary fall prevention programme (FPP) in preparation for accreditation by the JCIA. The achievement of the above goal is dependent on compliance with JCIA standard requirements and the hospital’s FPP. This study was undertaken to identify the factors preventing the successful implementation of the existing FPP in an acute care setting. The FPP is recognised to be in its development stages and therefore has opportunities for improvement for better patient safety outcomes, more so by reducing the incidence of falls and the severity of injuries from falls. Literature studies by Gowdy and Godfrey (2003:365) and Hathaway, Walsh, Lacey and Saenger (2001:172) suggests that the most successful approach to reducing falls and the severity of injuries from falls among patients in an acute care setting is that of a multifaceted, multidisciplinary approach. The nurses, who were primarily responsible for completing the initial fall risk assessment, expressed feelings of being overwhelmed by more safety standards being required for the JCIA. Patients with a high risk for falls were not referred to the physicians and physical therapists, nor were they referred to the clinical pharmacists for the review of high-risk medications. In addition, fall risk assessments were sometimes not done in the afternoon and during the night shift. The existing programme also did not consider bedbound, long-term patients, who require less frequent assessment. There furthermore was observer evidence to suggest that the existing FPP was not being implemented correctly. The aim of this study was to describe factors preventing the successful implementation of the existing FPP. The objectives were to identify areas being implemented successfully, to identify any barriers to successful implementation and to identify aspects of the existing FPP that may need revision. A quantitative descriptive approach was applied. The population was healthcare providers (HCPs), including both registered and practical nurses, physicians, physical therapists and pharmacists, working in an acute care setting in the United Arab Emirates. The respondents were 118 (86%) from a stratified sample of n = 137 (20%) from 684 HCPs. A specifically developed structured questionnaire was used for data collection. Reliability and validity were assured through the use of experts in questionnaire design and statistical consulting, in addition to pre-testing of the questionnaire. Ethical approval was obtained from the University of Stellenbosch Committee for Human Research and the Ethics Committee of the hospital where the study was undertaken. The respondents’ completion of the questionnaire served as voluntary consent to participate. The data were analysed and are presented in frequency tables. The mean and standard deviation were used for the statistical analysis. Correlational analyses were not done because of the descriptive approach to the study. It was considered most practical to focus on the professional groups and not on the variables, as the initial analysis indicated weak correlations. The results show those aspects of the FPP that were successfully implemented and those areas that need improvement if the JCIA requirements are to be met. Policy revision to include a clearly defined referral process for the high-risk patients, in addition to consistency of the environmental safety rounds and greater involvement and support of the unit managers/supervisors, will contribute to the greater success of the FPP. The hallmark of a successful FPP is staff education, which should be the key step in addressing the identified barriers. The human need for safety and the patient’s right to safe care and a safe environment must be integrated into staff orientation, and education and safety training programmes for all HCPs. Increased compliance may occur when HCPs are more aware of the hospital’s commitment to the patient’s right to safety. Compliance with JCIA standards and the FPP will contribute in the achievement of the accreditation. / AFRIKAANSE OPSOMMING: Die Joint Commission International Accreditation (JCIA) het ’n pasiëntveiligheidsdoelwit as deel van die standaarde vir die akkreditasie van hospitale ingesluit. Doelwit nommer ses lui: “verminder die risiko vir leed aan die pasiënt as gevolg van val”. ’n Akute sorg hospitaal in die Verenigde Arabiese Emirate het ’n veelvuldig gefasetteerde, multidissiplinêre program vir die voorkoming van val (fall prevention programme (FPP)) geïmplementeer ter voorbereiding vir akkreditasie deur die JCIA. Die bereiking van bogenoemde doelwit is afhanklik van nakoming van die standaardvereistes van die JCIA en die hospitaal se FPP. Hierdie studie is onderneem om die faktore wat die suksesvolle implementering van die bestaande FPP in die akute sorg omgewing verhinder, te identifiseer. Daar word erken dat die FPP nog in die ontwikkelingstadium is en dat daar dus geleenthede vir beter pasiëntveiligheidsuitkomstes is, veral deur die aantal valvoorvalle en die erns van beserings as gevolg van val te verminder. Literatuurstudies deur Gowdy en Godfrey (2003:365) en Hathaway, Walsh, Lacey en Saenger (2001:172) stel voor dat die suksesvolste benadering tot die vermindering van val en die erns van die gevolglike beserings onder pasiënte in ’n akute sorg omgewing ’n veelvuldig gefasetteerde, multidissiplinêre benadering behels. Verpleërs, wat die primêre verantwoordelikheid vir die voltooiing van die aanvanklike assessering van die risiko vir val het, het daarop gewys dat hulle oorweldig voel deur bykomende veiligheidstandaarde wat vir die JCIA vereis word. Pasiënte met ’n hoë risiko vir val is nie na die geneeshere en fisiese terapeute verwys nie, en ook nie na die kliniese aptekers vir die beoordeling van hoë-risiko medikasie nie. Assessering van die risiko vir val is soms ook nie in die middag en tydens die nagskof gedoen nie. Die bestaande program het ook nie bedlêende, langtermyn pasiënte wat minder gereelde assessering benodig, oorweeg nie. Daar is verder ook waargeneem dat die bestaande FPP nie korrek geïmplementeer word nie. Die doel van hierdie studie was om die faktore te beskryf wat die suksesvolle implementering van die bestaande FPP verhoed. Die doelwitte was om areas wat suksesvol geïmplementeer word, te identifiseer, sowel as hindernisse tot suksesvolle implementering en aspekte van die bestaande FPP wat hersiening benodig. ’n Kwantitatiewe beskrywende benadering is gebruik. Die populasie was gesondheidsorgverskaffers, insluitend beide geregistreerde en praktiese verpleërs, geneeshere, fisiese terapeute en aptekers wat in ’n akute sorg omgewing in die Verenigde Arabiese Emirate werk. Daar war 118 (86%) respondente uit ’n gestratifiseerde steekproef van n = 137 (20%) uit 684 gesondheidsorgverskaffers. ’n Spesiaal ontwikkelde, gestruktureerde vraelys is vir dataversameling gebruik. Betroubaarheid en geldigheid is verseker deur die gebruik van kundiges in vraelysontwerp en statistiese raadgewing, sowel as die vooraftoetsing van die vraelys. Etiese goedkeuring is van die Universiteit Stellenbosch se Komitee vir Menslike Navorsing, en die Etiekkomitee van die hospitaal waar die studie onderneem is, verkry. Die voltooiing van die vraelys deur die respondente het gedien as vrywillige toestemming om deel te neem. Die data is geanaliseer en in frekwensietabelle voorgesit. Die gemiddelde en standaardafwyking is vir die statistiese analises gebruik. Korrelasie-analises is as gevolg van die beskrywende benadering nie onderneem nie. Daar is besluit dat die mees praktiese benadering sou wees om op die professionele groeperinge te fokus en nie op die veranderlikes nie, aangesien die aanvanklike analise swak korrelasies aangedui het. Die resultate identifiseer daardie aspekte van die FPP wat die suksesvolste geïmplementeer is, sowel as dié gebiede wat verbetering benodig om aan die JCIA-vereistes te voldoen. Faktore wat sal bydra tot die groter sukses van die FPP is beleidshersiening wat ’n duidelik bepaalde verwysingsproses vir hoë-risiko pasiënte insluit, sowel as konsekwentheid in die omgewingsveiligheidsrondtes, en meer betrokkenheid en ondersteuning deur die eenheidsbestuurders/toesighouers Die waarmerk van ’n suksesvolle FPP is personeelopvoeding, wat die belangrikste stap in die aanspreek van die geïdentifiseerde hindernisse moet wees. Die menslike behoefte aan veiligheid en die pasiënt se reg op veilige sorg en ’n veilige omgewing moet in personeeloriëntering, personeelopvoeding- en veiligheidsopleidingsprogramme vir alle gesondheidsorgverskaffers ingesluit word. Verhoogde nakoming sou moontlik plaasvind indien gesondheidsorgverskaffers meer bewus was van die hospitaal se verbintenis tot die pasiënt se reg op veiligheid. Nakoming van JCIA-standaarde en die FPP sal bydra tot die verkryging van die akkreditasie. Acute care hospital -- Abu Dhabi Fall prevention programme (FPP) Dissertations -- Nursing Theses -- Nursing
4	När vården blir sjuksköterskans ansvar. : sjuksköterskors upplevelser av att ge palliativ vård i livets slut på en strokeenhet / When caring becomes the nurse´s responsibility : nurses´experiences of giving palliative care at the end-of-life within a stroke unit Listermar, Karin January 2013 (has links) No description available. Nurses´experience Palliative care End-of-life care Acute care hospital Stroke unit Qualitative interview study Sjuksköterskans upplevelse Palliativ vård Vård i livets slut Akutsjukhus Strokeenhet Kvalitativ intervjustudie
5	The impact of healthcare-associated infectious disease outbreaks on the nature of the healthcare professionals daily work Musau, Joan 10 1900 (has links) <p><strong>ABSTRACT</strong><strong></strong></p> <p><strong>Background</strong>: Healthcare-associated infections (HAIs) and HAI disease outbreaks present challenges for healthcare facilities. In 2008, a <em>Clostridium difficile</em> outbreak in Ontario resulted in the deaths of 91 patients and raised awareness of HAIs. Over the last 5 years, the outbreak rate has risen dramatically. Traditionally, HAI research has focused on epidemiology, healthcare systems, and the economic burden. Little is known about the impact HAI disease outbreaks have on the work of healthcare professionals.</p> <p><strong>Purpose</strong>: The purpose of this study was to examine the effects of HAI outbreaks on healthcare professionals in a large acute care hospital in Ontario.</p> <p><strong>Methods</strong>:<strong> </strong>A retrospective exploratory case study approach was used, including individual interviews, document analysis, and incidence analysis of HAIs hospital data. The sample was frontline nurses, clinical managers, infection control professionals, and environmental service staff. Document analysis included hospital policies and protocols related to infectious diseases and HAI disease outbreaks.</p> <p><strong>Findings</strong>: The incidence rates of Methicillin-resistant s<em>taphylococcus aureus</em>, <em>Clostridium difficile</em>, and Vancomycin-resistant<em> </em>enterococci<em> </em>have decreased but remained above the provincial benchmarks. The daily work of healthcare professionals was impacted by HAI outbreaks. Nurses experienced workload challenges, time pressures, and increased documentation. Infection control professionals' responsibilities have expanded. The environmental services staffs' cleaning processes have become more intensive. In response, several unique innovations were developed by hospital staff.</p> <p><strong>Conclusion</strong>: The daily work of healthcare professionals at the study site has been affected by HAI outbreaks. Implications for future research include the need to review healthcare professionals’ workloads and evaluate contributing factors to HAI outbreaks.</p> / Master of Science in Nursing (MSN) healthcare professionals daily work healthcare associated infections Acute care hospital Health Services Research Health Services Research
6	Disruptive Transformations in Health Care: Technological Innovation and the Acute Care General Hospital Lucas, D. Pulane 24 April 2013 (has links) Advances in medical technology have altered the need for certain types of surgery to be performed in traditional inpatient hospital settings. Less invasive surgical procedures allow a growing number of medical treatments to take place on an outpatient basis. Hospitals face growing competition from ambulatory surgery centers (ASCs). The competitive threats posed by ASCs are important, given that inpatient surgery has been the cornerstone of hospital services for over a century. Additional research is needed to understand how surgical volume shifts between and within acute care general hospitals (ACGHs) and ASCs. This study investigates how medical technology within the hospital industry is changing medical services delivery. The main purposes of this study are to (1) test Clayton M. Christensen’s theory of disruptive innovation in health care, and (2) examine the effects of disruptive innovation on appendectomy, cholecystectomy, and bariatric surgery (ACBS) utilization. Disruptive innovation theory contends that advanced technology combined with innovative business models—located outside of traditional product markets or delivery systems—will produce simplified, quality products and services at lower costs with broader accessibility. Consequently, new markets will emerge, and conventional industry leaders will experience a loss of market share to “non-traditional” new entrants into the marketplace. The underlying assumption of this work is that ASCs (innovative business models) have adopted laparoscopy (innovative technology) and their unification has initiated disruptive innovation within the hospital industry. The disruptive effects have spawned shifts in surgical volumes from open to laparoscopic procedures, from inpatient to ambulatory settings, and from hospitals to ASCs. The research hypothesizes that: (1) there will be larger increases in the percentage of laparoscopic ACBS performed than open ACBS procedures; (2) ambulatory ACBS will experience larger percent increases than inpatient ACBS procedures; and (3) ASCs will experience larger percent increases than ACGHs. The study tracks the utilization of open, laparoscopic, inpatient and ambulatory ACBS. The research questions that guide the inquiry are: 1. How has ACBS utilization changed over this time? 2. Do ACGHs and ASCs differ in the utilization of ACBS? 3. How do states differ in the utilization of ACBS? 4. Do study findings support disruptive innovation theory in the hospital industry? The quantitative study employs a panel design using hospital discharge data from 2004 and 2009. The unit of analysis is the facility. The sampling frame is comprised of ACGHs and ASCs in Florida and Wisconsin. The study employs exploratory and confirmatory data analysis. This work finds that disruptive innovation theory is an effective model for assessing the hospital industry. The model provides a useful framework for analyzing the interplay between ACGHs and ASCs. While study findings did not support the stated hypotheses, the impact of government interventions into the competitive marketplace supports the claims of disruptive innovation theory. Regulations that intervened in the hospital industry facilitated interactions between ASCs and ACGHs, reducing the number of ASCs performing ACBS and altering the trajectory of ACBS volume by shifting surgeries from ASCs to ACGHs. Disruptive Disruptive Innovation Theory Disruptive Transformations Disruptive Innovation Innovation Technology Technological Innovation Medical Innovation Medical Technology Medical Advancement Laparoscopy Laparoscopic Surgery open surgery appendectomy cholecystectomy bariatric surgery weight loss surgery appendectomies cholecystectomies inpatient outpatient ambulatory ambulatory surgery ambulatory surgery center acute care general hospital hospital acute care hospital general hospital health care healthcare hospital industry health care industry Clayton Christensen Clayton M Christensen Michael Porter Harvard Business School Virginia Commonwealth University CMS Health policy public policy public administration organizational theory organization theory Population Ecology Theory Competitive Strategy policy analysis John Kimberly Organization Size Structural Inertia liability of smallness health spending health care cost specialty medical facility open system niche width dynamic outpatient department technology shift surgical setting surgical setting shift medical facility shift substitution threat health system system level analysis Ecological Approach hospital trends ambulatory surgery trends reimbursement rate Medicare CMS coverage decision P J DiMaggio DiMaggio and Powell w w Powell Hannan and Freeman M T Hannan Organizational change minimally invasive surgery less invasive surgery Prospective Payment System Outpatient Prospective Payment System entreprenuerial physician health care organization health care management Roice Luke Carl Ameringer new technology surgical utilization elective surgery Medicare Payment Advisory Commission MedPAC coverage decision trends in surgery abdominal surgery surgical variation physician-owned physician ownership physician autonomy outpatient clinic utilization trends unnecessary surgery Pfeffer Salancik technology diffusion redefining health care interdisciplinary research health care delivery panel design diffusion of hospital technology state variation regional variation local health care market government intervention medical facility health care capacity focused factory advances in health care physician organization relationship hospital competition medical specialization hospital expansion medical arms race integrated care integrated health system J E Wennberg health care transformation reimbursement scheme surgical volume Florida Wisconsin policy making health policy analysis competitive dynamics center of excellence intervening factor service line competition service-line competition surgical reimbursement innovative business model innovative technology environmental influence established firm new market entrant patient safety sophisticated technology Harvard Divinity School Social and Behavioral Sciences

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