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Delirium is a state of acute confusion and is common in hospitalized older adults. Delirium is associated with significant increases in morbidity and mortality, as well as healthcare costs. Delirium also is associated with functional and cognitive decline, as well as need for institutionalization and rehabilitation. Delirium can cause psychosocial distress for patients and families. While much is understood about the epidemiology of delirium, the pathophysiological mechanisms that lead to the development of delirium are less clearly defined.The purpose of this study was to investigate the relationship of allostatic load (AL), a composite measure of primary (i.e. acute) stress mediators and secondary (i.e. chronic) stress outcomes and delirium in the hospitalized older adult. Development of the Allostatic Load & Delirium in Hospitalized Elderly model provided a theoretical framework for the study.Forty- four participants, ranging from 66 to 93 years of age (M = 76 years of age) were recruited from three intensive care units and enrolled once they were determined not to have a cognitive deficit or prevalent delirium, as assessed by the Standardized Mini-Mental State Examination and Confusion Assessment Method (CAM), respectively. Ten AL components reflective of acute and chronic stress were collected upon admission. Allostatic load was calculated as the sum of the number of components for which the participant was rated in the highest risk quartile. Allostatic load subsets based on acute and chronic components were also calculated. Incident delirium was assessed 48 -72 hours after admission with the CAM.Findings indicated that the incidence of delirium was 29.2%. The subset AL score based on components considered primary stress mediators was significantly related to delirium; however, no other variables were associated with delirium. Logistic regression modeling indicated that an AL subset of primary stress mediators did predict the incidence of delirium (OR 2.5, 95% CI = 1.12, 5.79; X2 (1) = 5.668, p < .05).The findings from this study exploring the relationship between AL and delirium in the hospitalized older adult suggest that an AL score based on primary mediators may be useful in predicting delirium in the hospitalized older adult.

Strategies to optimize birth outcomes are a top priority in the current health care delivery system, where the examination and elimination of health disparities in childbearing women remain an important public health objective. Several studies have examined the relationships between socioeconomic status (SES), occupational status, ethnicity, insurance status, health care utilization, and educational level on birth outcomes, all known to influence gestational age and newborn mortality. Lesser-known variables are the influence of provider practice and hospital characteristics on birth outcomes.The purpose of this study was to evaluate several dimensions of birth outcomes employing birth certificate records and information available from provider licensing surveys for a one year period to calculate how much variation was due to differences in; a) hospital organizational characteristics; b) provider characteristics; and c) patient socio-demographic characteristics.The Quality Health Outcomes Model by Mitchell et al. (1998) provided a valuable framework which allowed the analysis of the interplay between intervention, client, and system characteristics, and their impact on birth outcomes for Maricopa County in 2005.The study design was a retrospective descriptive study using secondary data analysis with a dataset (Arizona HealthQuery, housed at the Center for Health Information and Research at Arizona State University) that included birth certificate information and the physician licensing renewal surveys.Secondary data analysis of this large administrative dataset provided the advantage of having a large sample size (62,816) of demographically diverse cases, thus minimizing concerns related to sample size and generalizability. Multiple regression and non-linear estimation models were deployed to control for confounding and effect modifying variables that could influence the relationship of labor induction on birth outcomes, including prolonged labor, use of forceps or vacuum extractors, cesarean births, Apgar scores, and newborn intensive care unit (NICU) admission.

This research examined how the needs of elderly women are being met in the hospital setting. Qualitative data were gathered through in-depth interviews with eleven women between the ages of 70 and 93 who had had a hospital stay in the previous year. Data analysis revealed that the system failed to attend to participants' age specific needs. This failure created gaps in care which were particularly troubling for elderly female patients whose frailty made them susceptible to additional health problems. Participants received inadequate care in such areas as bathing, walking assistance and help with eating. Hearing impairments and denture issues were at times overlooked. These gaps in care caused participants to view a hospital stay as a matter of survival. Participants developed strategies to cope with gaps in care which included lowering their expectations, developing support networks and relying on family members to meet their basic needs and advocate on their behalf. Recommendations for change include identifying elderly women as a vulnerable patient population and defining the problems they face as structural issues as opposed to individual problems.

Emergency Department (ED) congestion can be better understood by examining overall system impacts, in particular inpatient admissions and discharges. This study first investigates trends of inpatient admissions, volume of patients in the ED who have been admitted (ED “boarders”), length of stay, and bed resources of three major admitting services at our teaching institution. It was found that patients admitted to the General Internal Medicine (GIM) service constituted the majority of ED boarders by default rather than design, as GIM served as a safety net for specialty services. This study investigates operational factors that impact discharge and found that day of the week and holidays followed by team organization and scheduling are significant predictors of daily variation in discharge rates. Based on these results, next, a system dynamics computer simulation was built to test the impact of various discharge smoothing strategies on the number of ED boarders. Next, this study uses the framework and tools of system dynamics methodology to design a conceptual model of the ED boarder problem that may be used as a generalizable roadmap to create sustainable improvements in ED congestion. Finally, this study introduces a novel real time metric of hospital operational discharge efficiency- daily discharge rate – to bring focus on the underlying causes of discharge variation and help indicate opportunities for improvement.

Emergency Department (ED) congestion can be better understood by examining overall system impacts, in particular inpatient admissions and discharges. This study first investigates trends of inpatient admissions, volume of patients in the ED who have been admitted (ED “boarders”), length of stay, and bed resources of three major admitting services at our teaching institution. It was found that patients admitted to the General Internal Medicine (GIM) service constituted the majority of ED boarders by default rather than design, as GIM served as a safety net for specialty services. This study investigates operational factors that impact discharge and found that day of the week and holidays followed by team organization and scheduling are significant predictors of daily variation in discharge rates. Based on these results, next, a system dynamics computer simulation was built to test the impact of various discharge smoothing strategies on the number of ED boarders. Next, this study uses the framework and tools of system dynamics methodology to design a conceptual model of the ED boarder problem that may be used as a generalizable roadmap to create sustainable improvements in ED congestion. Finally, this study introduces a novel real time metric of hospital operational discharge efficiency- daily discharge rate – to bring focus on the underlying causes of discharge variation and help indicate opportunities for improvement.

The aim of the paper is to analyse and evaluate the theoretical methods bases of evaluation of performance financial results and changes thereof, and based on this, to perform an extensive analysis of changes in “X” hospital financial results and present methods for the permanent evaluation of changes. Tasks: 1. To analyse and systemize the peculiarities and practical application possibilities of traditional and contemporary theories and methods, which study changes of institutional financial results. 2. To carry out extensive analysis of “X” hospital financial results and related changes through the identification of negative and positive facts and possibilities of using internal and external factors. 3. To identify problem fields of activities and search for ways of dealing with problems and present reasonable and optimum proposals for the increasing of “X” hospital activity efficiency. 4. To adopt decisions on the rationalization of current asset management. 5. To make the forecast of Hospital’s financial activities when the planned measures of problem solving are implemented. 6. To prepare the evaluation methodology of financial results and their changes for medical institutions. Research methods. Object of the paper– Hospital’s activity financial results and their changes. Research methods: logic analysis of scientific literature (comparison, grouping, detailing and systemization); analysis of legal documents; horizontal and vertical analysis of a balance-sheet and... [to full text]