A sample of motor vehicle accident victims hospitalized at Vancouver General Hospital, Vancouver, British Columbia, was chosen to analyze the relationship between hospital costs and the severity of the patient's injury or illness. Severity was measured using two scales, specifically, the Injury Severity Scale and the Abbreviated Injury Scale. Hospital costs were also measured, using two different methodologies. The first was the Per Diem costs that were derived by dividing all related annual costs by the number of patient separation days in 1975. A Per Diem episodic cost was determined by multiplying length of stay by the daily average cost. The second approach used a step-down technique that distributed all non-patient care related hospital services across direct patient care departments, cost centres or programs. Unit costs were then developed for each cost centre, depending upon their annual workload. The 1975 medical record for each patient in the sample was analyzed to determine the number of work units used in each cost centre during the patient's hospital stay. A Step-Down episodic cost was determined by totalling all costs from each cost centre that provided services to the patient. A paired t-Test did not show a significant difference between the Per Diem and Step-Down episodic costs. It was assumed that the range of severity of the patient in the sample weakened this t-Test, severity measured by I.S.S. was grouped in low, medium, and high categories, or when severity was measured by A.I.S., the paired t-Test did show that there was a significant difference in the two costing methodologies. The regression analysis identified a significant relationship between both episodic costs and severity. The strongest relationship occurred when severity was measured by I.S.S. and costs were determined, using the Step-Down methodology (R² = 0.26, F = 35.45). When other related independent variables (i.e., death as outcome and operation not performed) and all interaction terms were introduced, the regression co-efficient increased to R² = 0.45 and the F value increased to F = 24.9. Recommendations were made to include a severity rating on all hospitalized patients' records to assist in patient classification. A final outcome of this study was identifying the value of a Step-Down approach to determining hospital costs and identifying the limitations of the Per Diem methodology of hospital accounting. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Thesis (Ph.D.)--Virginia Commonwealth University, 2009. / Prepared for: Dept. of Health Administration. Title from title-page of electronic thesis. Bibliography: leaves 182-192.

Thesis equivalent (M.P.H.)--University of Michigan, 1947.

Thesis--University of Wisconsin. / Vita. Includes bibliographical references.

Thesis equivalent (M.P.H.)--University of Michigan, 1947.

Thesis--University of Wisconsin. / Vita. Includes bibliography.

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, in partial fulfilment of the requirements for the degree of Master of Public Health in the field of Hospital Management APRIL 2014 / Background: The South African Department of Health stipulated that district hospitals must provide comprehensive package of preventive, promotive, curative and rehabilitative reproductive health services for women that requires medical and special resources, not found in the health centres and clinics (Department of Health, 2002). The Evander District (ED) Hospital, a district hospital situated in the Govan Mbeki Subdistrict in the Mpumalanga Province provides both in-patient (36 beds in maternity unit and four nursery beds) and outpatient services. The Hospital Maternity Unit has recently been criticised by the Mpumalanga Department of Health for high rate of CS (30%), and perinatal mortality rate (40 per 1000). But, the Hospital never analysed the data collected routinely to develop an understanding of the challenges faced by the Unit. The Unit staff complained about inadequate resources as one of the reasons. The Hospital has introduced a Cost centre in the Maternity Unit for efficient management of resource allocation for the Unit. This study analysed the routinely collected data from the Hospital Information System and Maternity Unit Cost centre for assessing the maternity services currently rendered by the Evander District Hospital. Aim: To described the deliveries at the Evander Hospital over a period of 6 months from 01st January 2011 to 30th June 2011. Methodology: It was a cross sectional study that reviewed the records from Hospital Information System (all antenatal cards and Obstetric files of the women who delivered at the labour ward during the study period) and Maternity Unit cost center. The variables used for the study included number and type of deliveries, socio-demographic and clinical profiles of patients, maternal and perinatal complications and outcomes. In addition, costing information collected during the same period. Descriptive and inferential statistics were used for analysis. Permissions were obtained from the Mpumalanga Department of Health and University of the Witwatersrand ‘Human Research Ethics Committee (Medical) before commencement of the study. Results: A total of 1,081 deliveries were performed at the Evander Hospital over sixmonth period. The highest number of deliveries was NVD (67.44%), followed by caesarean sections (31.82%). The majority of the women who delivered came from poor socio-economic class and mostly single and black, which is a reflection of the characteristics of the catchment population of the Evander Hospital. Teenage pregnancy rate was quite high (20%). The majority of the subjects were primipara (41%). Although most of them (91.3%) of them were booked, only 14% had stipulated number of antenatal visits (4 or more visits) and 7.4% of booked mothers, did not have booking blood results, which was a missed opportunity. HIV was the most prevalent (33, 31.3%) medical conditions, which is similar to the HIV prevalence reported in antenatal sero-prevalence survey in South Africa. Only 17% had planned and scheduled CS. Very few patients had post-partum complications indicating well managed third stage of labour. There was no maternal death during this period. All patients were discharged home. More than 17% (n=185) subjects had low birth weight babies (less than 2500 g), which is just above national average of 16%. The median Apgar score among children delivered at Evander Hospital was 9. Interestingly, the Apgar scores of babies of subjects who had operative deliveries were significantly lower than those who had nonoperative deliveries. Most of the babies were born alive. Stillbirth rate (7 per 1000 live births) was significantly lower than South African national average 17.8 per 1000 live births. The total medical cost for the maternity ward for the six months studied amounted to R 4,584,466, the average monthly cost being R 76,407.67. The most expensive items were drugs and pharmaceuticals and least expensive being the medical consumables. Conclusion: This study was the first of its kind to be done in this Hospital and the Health District. The study identified gaps where management of pregnant women in the Evander Hospital could be further improved through improved booking, planned deliveries and thereby reducing low birth weight rates and still birth rate. This would assist the Hospital Management to develop appropriate measures to reduce unnecessary CS being done, NVD being delivered in the hospital rather than using CHC, and strengthening referral system and strategies to reduce HIV and AIDS incidence. In addition, further study is necessary at the PHC facilities in the Sub-district to identify determinants for high rate of teenage pregnancy.

Thesis (Ph.D.)--Virginia Commonwealth University, 2010. / Prepared for: Dept. of Health Administration. Title from title-page of electronic thesis. Bibliography: leaves 133-143.

Thesis (D.P.H.)--University of Michigan.

Source: Dissertation Abstracts International, Volume: 70-01, Section: B, page: 0197. Adviser: James R. Langabeer, II. Includes bibliographical references.