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Antibiotic use and cost indicators at a rural hospital: A pilot project

AMERICAN JOURNAL OF INFECTION CONTROL 2000年第6期28卷 415-420页

作者： Mylotte, JM Weislo, P SUNY Buffalo Sch Med & Biomed Sci Dept Med Buffalo NY 14260 USA SUNY Buffalo Sch Med & Biomed Sci Dept Microbiol Buffalo NY 14260 USA Lake Shore Hlth Care Ctr Serv Pharm Irving TX USA

Background: Recently, simple antibiotic use and cost indicators were developed for use in long-term care facilities. It was hypothesized that these indicators also may be applicable to the acute hospital setting. Methods: For a 24-month period, data were collected quarterly on antibiotic use and cost indicators for 11 primary care physicians in a 40-bed rural hospital. Indicators included antimicrobial use ratio (AUR, ratio of the number of antibiotic days to the number of patient care days), cost per antibiotic day, and cost of antibiotics per patient care day. One-way analysis of variance and simple linear regression were used to analyze data. Results: Quinolones (oral plus parenteral) accounted for 26% of the total antibiotic days (N = 6020) followed by ceftriaxone (19%) and cefuroxime (11.8%;oral plus parenteral). Overall trends in antibiotic use and cost included a significant increase in quarterly AUR (R-2 = 0.78, P = .004) and cost per patient care day (R-2 = 0.82, P = .002) but no significant change in quarterly total antibiotic costs or cost per antibiotic day. Among physicians there was a significant difference in mean quarterly AUR (P < .001) and mean quarterly cost per patient care day (P < .001) but no significant difference in mean quarterly cost per antibiotic day. Variation in physician-specific cost per patient care day was best explained by variation in AUR (R-2 = 0.75, P < .001). Conclusions: Significant variation in simple antibiotic use and cost indicators was identified at a rural hospital from both the facility and physician perspective. Standardized methods for antibiotic use and cost monitoring, like the one described in this article, are required before the relationship between antibiotic use ana resistance can be fully understood.

关键词：方差分析抗菌药/经济学抗菌药/治疗应用药费支出/统计学和数值数据药物利用评审/经济学药物利用评审/统计学和数值数据家庭医学/经济学家庭医学/统计学和数值数据卫生服务研究医院病床数 100张以下医院费用/统计学和数值数据医院乡村/经济学医院乡村/统计学和数值数据内科学/经济学内科学/统计学和数值数据住院时间/经济学住院时间/统计学和数值数据线性模型纽约试点项目前瞻性研究人类

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Coronary interventions: Keeping score

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AMERICAN JOURNAL OF MEDICINE 2000年第9期108卷 748-750页

作者： Mathew, V Gersh, BJ Mayo Clin & Mayo Fdn Rochester MN 55905 USA

The relation between coronary interventional volume and procedural outcome remains controversial. Although some studies have demonstrated that procedural volume does not correlate with outcome (1,2), most of the available data suggest that there is a modest inverse relation between operator or hospital volume and the risk of periprocedural adverse events (3–5). The inconsistency of the findings in this area may be a result of variations in case mix (simpler versus more complex cases) and referral patterns, rather than procedural techniques or expertise. As a result, the benchmarking of outcomes based on raw data alone may be misleading. Current American College of Cardiology/American Heart Association (ACC/AHA) recommendations call for a minimum of 75 cases per operator per year and 200 cases per hospital per year to maintain proficiency. Such guidelines discourage the existence of low-volume operators at high-volume centers, as well as low-volume centers within reasonable proximity of high-volume centers in urban areas.

关键词：血管成形术经腔经皮冠状动脉/标准血管成形术经腔经皮冠状动脉/利用冠状动脉分流术/利用医院乡村/统计学和数值数据医院市区/统计学和数值数据心肌梗死/外科学心肌梗死/治疗结果评价(卫生保健) 危险因素治疗结果美国人类

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Outcomes of coronary angioplasty procedures performed in rural hospitals

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AMERICAN JOURNAL OF MEDICINE 2000年第9期108卷 710-713页

作者： Maynard, C Every, NR Chapko, MK Ritchie, JL Univ Washington Div Cardiol Dept Hlth Serv Seattle WA 98195 USA Dept Vet Affairs Hlth Serv Res & Dev Seattle WA USA Dept Vet Affairs Dept Med Seattle WA USA Univ Washington Dept Med Seattle WA USA

PURPOSE: To determine how many rural hospitals in the United States performed coronary angioplasty;to compare patient outcomes in rural and urban hospitals;and to assess whether outcomes were better in rural hospitals in which more procedures were performed. SUBJECTS AND METHODS: In 1996, among patients 65 years of age and older, 201,869 coronary angioplasties were performed in 996 hospitals that were included in the Medicare Provider Analysis and Review files. Geographic location was defined as rural or urban, according to U.S. Census Bureau criteria. Outcome variables were in-hospital death and coronary artery bypass surgery performed during the same admission. Hospital volumes were categorized as low (less than or equal to 100 cases or fewer per year), medium (101 to 200 cases per year), or high (> 200 cases per year). RESULTS: Fifty-one rural hospitals accounted for 4% of all angioplasties performed. After angioplasty, in-hospital mortality was greater in rural hospitals (8.1% versus 6.4%, P = 0.001) among patients with acute myocardial infarction, but was not different for patients without infarction (1.4% versus 1.3%, P = 0.41). Coronary artery bypass surgery rates during the same admission were similar in rural and urban hospitals. In general, in-hospital mortality and same-admission surgery rates wore lower in high-volume centers in both rural and urban areas. CONCLUSION: Although in-hospital mortality after angioplasty for acute myocardial infarction was worse in low- and medium-volume rural centers, overall outcomes in rural and urban hospitals were similar. Am J Med. 2000;108:710-713. (C)2000 by Excerpta Medica, Inc.

关键词：血管成形术经腔经皮冠状动脉/标准血管成形术经腔经皮冠状动脉/利用冠状动脉分流术/利用医院死亡率医院乡村/统计学和数值数据医院市区/统计学和数值数据 Medicare/统计学和数值数据心肌梗死/死亡率心肌梗死/治疗结果评价(卫生保健)/统计学和数值数据治疗结果美国/流行病学老年人老年人 80以上女(雌)性人类男(雄)性

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Trauma on rural roads: the role of a peripheral hospital

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INJURY-INTERNATIONAL JOURNAL OF THE CARE OF THE INJURED 1999年第5期30卷 337-340页

作者： Street, JT Winter, D Buckley, S Nicholson, P Twomey, A Cork Univ Hosp Dept Orthopaed Surg Cork Ireland

Road accident trauma is a leading cause of death and serious morbidity among healthy young adults in the developed world. The Irish Republic has the third worst road safety record in the EU. In studying the unique demographics of rural road accidents, our aim was to provide information essential to the future development of trauma care in Ireland. Our figures highlight the inadequacies of data received by the National Roads Authority, illustrate the resource impact of road trauma on a peripheral hospital, and demonstrate the need for similar studies in the rationalisation of trauma care as we approach the next millennium. (C) 1999 Elsevier Science Ltd. All rights reserved.

关键词：事故交通/统计学和数值数据年龄分布医院乡村/统计学和数值数据损伤严重度评分爱尔兰/流行病学转诊和会诊/统计学和数值数据回顾性研究农村卫生/统计学和数值数据季节创伤和损伤/流行病学创伤和损伤/病因学青少年成年人老年人老年人 80以上儿童儿童学龄前人类婴儿婴儿新生中年人

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Demographic analysis and needs assessment of rural emergency departments in New Mexico (DANARED-NM)

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ANNALS OF EMERGENCY MEDICINE 2002年第4期39卷 456-457页

作者： Sklar, D Spencer, D Alcock, J Cameron, S Saiz, M Univ New Mexico Hlth Sci Ctr Dept Emergency Med Albuquerque NM 87131 USA

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Bypassing of Local Hospitals by Rural Medicare Beneficiaries

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The Journal of Rural Health 1994年第4期10卷 237-246页

作者： Buczko, William Health Care Financing Administration in Baltimore Maryland United States

Several previous studies of hospital utilization by nonelderly rural residents suggest that local rural hospitals have been increasingly bypassed, often for care in urban hospitals. This resulted in lost volume for rural hospitals, detracting from their financial viability. It is not clear to what extent elderly rural residents also bypass local hospitals and whether this reflects regionalization of treatment for some conditions or avoidance of local hospitals assumed to provide inadequate care. This study examines hospital use by aged rural Delaware Medicare beneficiaries living in a ZIP code area that has a local hospital during Fiscal Year (FY) 1987 (N=670). Most of these Medicare beneficiaries were hospitalized locally. Those beneficiaries who bypassed local rural hospitals usually did so because cardiovascular surgical procedures were required and were often only performed in large urban teaching hospitals. Beneficiaries using nonlocal hospitals were similar to users of local hospitals with respect to age and sex and traveled an average of nearly 42 miles for treatment. “Bypassing” here appears to be due primarily to regional specialization of care rather than abandonment of local rural hospitals by rural residents. Copyright © 1994, Wiley Blackwell. All rights reserved

关键词：卫生服务范围数据收集特拉华卫生服务易得程度卫生服务滥用卫生服务研究医院乡村/统计学和数值数据医院乡村/利用医院教学医院市区 Logistic模型 Medicare/利用比值比病人接受卫生保健的程度/统计学和数值数据卫生保健质量农村人口美国老年人人类

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Risk-adjusted in-hospital death rates for peer hospitals in rural and urban regions

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JOURNAL OF RURAL HEALTH 1999年第1期15卷 94-107页

作者： Glenn, LL Jijon, CR E Tennessee State Univ Off Rural & Community Hlth Johnson City TN 37614 USA

The purpose of this research project Ic,as to compare impatient mortality rates for rural hospitals with mortality rates of urban hospitals of given sizes and ranges of service. Statistical adjustments for risk were made in the probability of death during hospitalization for 43,000 patients across 166 hospitals by age, gender, principal diagnosis, principal surgical procedure, characteristics of the secondary diagnoses, and whether or not cancer was a secondary diagnosis. Eighty-three small hospitals that had a relatively unspecialized range of services constituted the stimy group. Patients characteristics of this study group were moderately representative, of the national population. A standardized score was calculated for each hospital using a formula based oil the actual hospital death rate and the death rate expected for a given hospital with patients of the same demographic and medicinal characteristics. Patients admitted to hospitals ill nonmetropolitan areas had a mortality rate of 0.41 percent compared with a mortality rate of 0.66 percent in peer hospitals in metropolitan areas. After mortality rates were risk-adjusted and converted to z scores, nonmetropolitan areas had an nz,average z of +0.16, and metropolitan areas had an average z of -0.25, where positive z scores reflect a lower-than-average adjusted mortality rate. The metropolitan-nonmetropolitan (urban-rural) difference ic,ns not statistically significant, but if is meaningful in that rural hospitals tended to have a lower adjusted mortality rate than urban hospitals of the same size and type, indicating that rural hospitals had the same or lower adjusted mortality rates. The possibility of urban hospitals having riskier patients was minimized but could not be definitely ruled out. Taken together with other studies, the data are consistent ,with the view ro that small rural hospitals generally make appropriate transfer decisions for severely ill patients and quality cars for retained patients.

关键词：年龄分布诊断相关患者组卫生服务研究医院病床数医院死亡率医院乡村/标准医院乡村/统计学和数值数据医院市区/标准医院市区/统计学和数值数据前瞻性研究卫生保健质量可重复性结果风险调节/组织和管理性别分布田纳西青少年成年人老年人老年人 80以上儿童儿童学龄前女(雌)性人类婴儿婴儿新生男(雄)性中年人

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Is There a Role for the Small Rural Hospital?

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The Journal of Rural Health 1990年第2期6卷 101-118页

作者： Hart, L. Gary Amundson, Bruce A. Rosenblaff, Roger A. Hart, L. Gary Rosenblatt, Roger A. Department of Family Medicine University of Washington Seattle 98195.

Rural hospitals represent almost half of all short‐stay nonfederal general hospitals in the United States, but have been more severely affected than their urban counterparts by changes in reimbursement, regulation, and technology. Two hundred and six rural community hospitals closed during thefirst nineyears of the 1980s, and the rate of closure is accelerating. Using secondary data sources to examine the structure, role, and content of rural hospitals, small rural hospitals are described and compared to larger and nonrural hospitals. Rural hospitals differ systematically from other hospitals in the United States, with smaller daily censuses, lower occupation rates, shorter lengths of stay, and disproportionately high shares of Medicare patients. They are dominated by very small institutions, with more than 1,000 rural hospitals having fewer than 50 beds. Small rural hospitals offer a core of basic services to the populations they serve. Emergency, obstetric, and newborn services are virtually ubiquitous in rural hospitals of all sizes, and they are also more likely to offer long‐term nursing and home care services than urban hospitals of similar size. The inpatient diagnostic and procedural mix of these institutions demonstrates that they provide care for common medical and surgical conditions of low complexity. Rural hospitals are also relatively inexpensive, representing only 6 percent of total expenditures for hospital care. Given their central role in supporting the provision of health services to rural areas, the apparent appropriateness of the conditions they treat, and their relatively modest cost, it would seem reasonable to use federal policy to stabilize our previous investment in these institutions. Copyright © 1990, Wiley Blackwell. All rights reserved

关键词：数据收集人口统计学评价研究医院病床数 100张以下医院/统计学和数值数据医院乡村/统计学和数值数据医院市区/统计学和数值数据角色外科手术美国人类

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Effects of Payment Changes on Urgent/Emergent Admissions in Rural and Urban Communities

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The Journal of Rural Health 1993年第2期9卷 120-128页

作者： Ahern, Melissa Department of Health Services Administration Florida International University North Miami Florida 33181 AC I Room 222 North Miami Campus United States

Abstract: Reimbursement changes during the 1980s, particularly Medicare diagnosis‐related group (DRG) reform and the growth of managed care, have squeezed hospital revenues available for cross‐subsidizing care for uninsured patients and patients for whom marginal costs exceed marginal revenues. This study uses logistic regression with time and residence interactions to explore the impact of payment changes on rural versus urban patients' admission status (urgent versus nonurgent). Findings show that uninsured rural patients had a significantly higher probability in 1987 than they did in 1983 of being admitted to hospitals in an urgent/emergent condition. Findings also show incrementally higher probabilities for Medicare and Medicaid rural patients in 1987. Results are consistent with the view that cross‐subsidization is no longer effective for covering uninsured rural care and that more direct subsidies may be necessary. Copyright © 1993, Wiley Blackwell. All rights reserved

关键词：加利福尼亚数据收集急症女(雌)性卫生服务易得程度/经济学卫生服务易得程度/统计学和数值数据卫生服务研究医院乡村/经济学医院乡村/统计学和数值数据医院乡村/发展趋势医院乡村/利用医院市区/经济学医院市区/统计学和数值数据医院市区/发展趋势医院市区/利用人类住院病人/分类保险健康补偿/统计学和数值数据保险健康补偿/发展趋势 Logistic模型男(雄)性未参加医疗保险者/统计学和数值数据病人入院/经济学病人入院/统计学和数值数据病人入院/发展趋势

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Small Rural Hospitals with Long‐Term Care: 1983 to 1987

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The Journal of Rural Health 1992年第2期8卷 121-127页

作者： Beaulieu, Joyce E. Health Administration and of Public Administration Sanders-Brown Center on Aging University of Kentucky Lexington Kentucky United States

Rural hospitals were under tremendous stress in the 1980s, as evidenced by decreasing use and closures. Rural populations increased in the two proportions of people older than 65 years relative to urban areas. Rural communities had more chronically ill residents than urban areas. Population aging and hospital stress have opened an option for small rural hospitals to develop long‐term care units. Analysis of a national cohort of 750 small rural hospitals was undertaken in 1983,1985, and 1987 to identify the characteristics of these hospitals, their communities, and the relative contribution of the small rural hospital to long‐term care bed supply. Hospitals more likely to have long‐term care during this period of time had lower occupancy rates and higher expenses per admission both prior to and after developing long‐term care. While only 14 percent of the 750 hospitals studied had long‐term care, they contributed nearly 30 percent of the total long‐term care bed supply in their counties. Population‐based need and bed supply measures were not significantly different in counties having a small rural hospital with long‐term care. Areas of further analysis of the small rural hospital as a resource for long‐term care are suggested. The implications for the health care system of small rural hospitals with long‐term care are discussed. Copyright © 1992, Wiley Blackwell. All rights reserved

关键词：病床调整/统计学和数值数据病床利用率/统计学和数值数据队列研究数据收集卫生服务需求/统计学和数值数据医院病床数 100张以下医院乡村/统计学和数值数据医院乡村/利用长期医疗/组织和管理美国人类

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