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Effects of hospitalists on cost, outcomes, and patient satisfaction in a rural health system

AMERICAN JOURNAL OF MEDICINE 2000年第8期108卷 621-626页

作者： Davis, KM Koch, KE Harvey, JK Wilson, R Englert, J Gerard, PD N Mississippi Hlth Serv Tupelo MS 38801 USA Mississippi State Univ Expt Stat Unit Starkville MS USA

PURPOSE: Previous studies have examined the effects of hospitalists in urban academic hospitals. We compared the outcomes of patients treated by hospitalists with those of patients treated by internists at a 647-bed rural community hospital. SUBJECTS AND METHODS: The 443 patients in the hospitalists' 10 most common diagnosis-related groups (DRGs) were compared with 1,681 patients in the same DRGs who were cared for by internists in fiscal year 1998. Length of stay, cost of care, patient illness severity, patient satisfaction, 30-day readmission rate, inpatient mortality, discharge status, and resource utilization were compared. RESULTS: The hospitalists' patients had a shorter mean (+/- SD) length of stay (4.1 +/- 3.0 days versus 5.5 +/- 4.9 days, P <0.001) and their cost of care was less than that of the internists' patients ($4,098 +/- $2,455 versus $4,658 +/- $4,084, P <0.001). Analyses that adjusted for patient age, race, sex, insurance status, severity of illness, and specific medical comorbidities confirmed these differences. The differences between hospitalists and internists were most apparent among very ill patients. Mortality rates were similar (4.5% for hospitalists versus 4.9% for internists, P = 0.80), as were the readmission rates (4.5% for hospitalists versus 5.6% for internists, P = 0.41). Patient satisfaction was similar for both groups. The internists used more resources in 8 of 11 categories. CONCLUSIONS:The hospitalists provided cost-effective care, particularly for the sickest patients, with good outcomes and patient satisfaction. (C) 2000 by Excerpta Medica, Inc.

关键词：卫生资源/利用医院费用/统计学和数值数据卫生设施管理人员/经济学卫生设施管理人员/统计学和数值数据医院社区/经济学医院社区/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密西西比结果评价(卫生保健) 病人满意度/统计学和数值数据乡村卫生服务/经济学乡村卫生服务/统计学和数值数据疾病严重程度指数人类

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Patterns and Predictors of Noninstitutional Health Care Utilization by Older Adults in Rural and Urban America

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The Journal of Rural Health 1995年第4期11.0卷 259-273页

作者： Rabiner, Donna J. Center for Health Services Research University of North Carolina at Chapel Hill Chapel Hill North Carolina 27599-7590 725 Airport Rd C.B. No. 7590 United States

Abstract: Noninstitutional long‐term care is not often included in policy studies or recommendations in the United States even though there have been recent efforts to include this type of care in health reform proposals. This study was designed to provide insight into the patterns and predictors of noninstitutional medical, home‐, and community‐based services utilization by older adults in rural and urban America. The National Long Term Care Survey (NLTCS) was used to explore the relationship between residential setting and subsequent noninstitutional services utilization. Weighted logistic regression procedures for complex survey designs were used to guide the analysis. Living in the Northeast and residence in moderately densely populated areas (towns, small cities, and suburbs) were significant positive predictors of subsequent medical, home‐, and community‐based services utilization. Because some differentials were found in access to and use of services by regional and geographic setting, policy‐makers need to develop alternative strategies to eliminate inequities in the distribution of noninstitutional long‐term care services in more remote areas. Copyright © 1995, Wiley Blackwell. All rights reserved

关键词：社区卫生服务/统计学和数值数据社区卫生服务/利用卫生保健公平提供老年人保健服务/统计学和数值数据老年人保健服务/利用家庭医疗保健服务/统计学和数值数据家庭医疗保健服务/利用长期医疗新英格兰乡村卫生服务/统计学和数值数据乡村卫生服务/利用市区卫生服务/统计学和数值数据市区卫生服务/利用老年人老年人 80以上女(雌)性人类男(雄)性

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The effectiveness of a rural nursing center in improving health care access in a three-county area

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JOURNAL OF RURAL HEALTH 2000年第2期16卷 177-184页

作者： Anderko, L Robertson, JF Uscian, MM No Illinois Univ Sch Nursing De Kalb IL 60115 USA

The purpose of this article is to describe an innovative nurse-managed health center that has been effective in improving access to primary health care for residents of a Midwestern three-county rural area. Penchansky and Thomas's (1981) framework evaluating health care access was used to analyze client satisfaction and utilization data. Findings clearly indicate success in improving access. Client satisfaction surveys consistently show a high level of satisfaction across all framework dimensions, including overall satisfaction with the health cave received. Utilization data indicate a steady increase in the number of clients served, especially those who ave uninsured or underinsured. This article demonstrates that key dimensions of access can be effectively measured using the Penchansky and Thomas framework and concludes with recommendations for enhancing the model.

关键词：社区卫生中心/经济学社区卫生中心/统计学和数值数据卫生服务易得程度/统计学和数值数据伊利诺伊缺医地区未参加医疗保险者护士/利用病人满意度/统计学和数值数据乡村卫生服务/经济学乡村卫生服务/统计学和数值数据人类

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Rural Emergency Medical Services: Patients, Destinations, Times, and Services

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The Journal of Rural Health 1995年第4期11卷 286-294页

作者： Morrisey, Michael A. Johnson, Victoria Treat, Richard Lister Hill Center for Health Policy University of Alabama at Birmingham Birmingham Alabama 35294‐2010 1825 University Blvd. United States

Abstract: This study sought to describe the volume of use, mix of patients, origin and destination of runs, times and distances to care, and the volume of clinical services provided in a rural emergency medical services region. This study summarizes all 6,080 rural emergency ambulance trip reports filed from April through September 1991 from the 12 rural counties surrounding Augusta, GA. Rural ambulances are regularly used and are used extensively by elderly populations. The pattern of services provided suggests that while advanced care may or may not have been indicated, it was rarely provided and that rural emergency medical service programs should consider a greater reliance on basic life support teams. Copyright © 1995, Wiley Blackwell. All rights reserved

关键词：救护车/统计学和数值数据卫生服务范围地理学佐治亚卫生服务易得程度/组织和管理卫生服务易得程度/标准卫生服务易得程度/统计学和数值数据病人/分类病人/统计学和数值数据乡村卫生服务/组织和管理乡村卫生服务/标准乡村卫生服务/统计学和数值数据乡村卫生服务/利用时间因素病人转送/统计学和数值数据青少年成年人老年人儿童儿童学龄前女(雌)性人类婴儿婴儿新生男(雄)性中年人

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Agricultural work safety efforts by Wisconsin extension agricultural agents

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Journal of Rural Health 1995年第4期11.0卷 295-304页

作者： Chapman, L.I. Schuler, R.T. Skjolaas, C.A. Wilkinson, T.L. UW Agricultural Engg. Department 460 Henry Mall Madison WI 53706 United States

This study investigated the agricultural work-related safety and health programming of county-level cooperative extension agents who work through land grant universities to provide a range of educational programs to agricultural producers. A questionnaire was designed and administered to all 89 Wisconsin agriculture and agribusiness extension county faculty. The questionnaire obtained valid responses from 98.9 percent of the agents. Ninety percent of all agents conducted some occupational safety and health promotion programming in the last year. These activities occupied an average of 4.8 days per agent per year. Most of the reported activities were group programs for the agricultural labor force that involved other extension agents and included the use of videotapes. The greatest barrier to more programming was lack of time on the part of both the agricultural work force and the agents. Most extension agents placed greater emphasis on training in how to work safely around hazards than on how to recognize and permanently correct hazards. For future programs agents requested more short format materials to use in programming, such as fact sheets, videotapes, and farm hazard inspection checklists. Agents are important training delivery resources for controlling farm-related injury and disease. Agents could be more effective with more time, better materials, and with more emphasis on hazard correction in workplace safety programs.

关键词：农业工人疾病/流行病学农业工人疾病/预防和控制农业/人力健康教育/经济学健康教育/统计学和数值数据健康促进/经济学健康促进/统计学和数值数据职业卫生问卷调查危险处理乡村卫生服务/统计学和数值数据威斯康星人类

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Measuring time utilization in rural health centres

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HEALTH POLICY AND PLANNING 1995年第4期10卷 415-422页

作者： Bryant, M Essomba, RO MINIST HLTH YAOUNDECAMEROON

Objectives. During the recent re-design of the primary health care system in Cameroon a time-motion study was undertaken to determine how health workers at rural health centres use their time before redefining their roles. Methods. The study developed a simple, effective and inexpensive tool which uses the activity sampling technique, and was applied to 20 health centres with a total of 19 080 observations being made of 64 health workers who represented all grades of worker in the government health services. Results. The study developed a clear picture of how health centre staff apportion their time, and how the division of labour and tasks Is carried out in a rural health centre. It found that only 27% of health workers' time is currently being spent on productive, health-related activities, and of this time, the largest proportion is spent on curative, clinical work. Less than 1% of health workers' time is spent on preventive and outreach activities. Discussion. This study has developed a simple and inexpensive tool which can be used in any health facility to determine how health-related activities are carried out. This is an important step if changes in the delivery structure are to be made, because it establishes the discrepancy between expected and actual behaviour, and provides an important baseline for the evaluation of the effectiveness of any changes that are introduced within the system.

关键词：喀麦隆社区卫生中心/人力社区卫生中心/统计学和数值数据数据收集发展中国家卫生服务研究/方法护理人员/统计学和数值数据护理人员/利用乡村卫生服务/人力乡村卫生服务/统计学和数值数据时间和运动研究

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Inequities in Health Care and Survival After Injury Among Pedestrians: Explaining the Urban/Rural Differential

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The Journal of Rural Health 1995年第3期11.0卷 177-184页

作者： Miles‐Doan, Rebecca Center for the Study of Population Florida State University Tallahassee Florida 32306‐4065 United States

Abstract: This study investigated whether rural/urban differences in injury mortality and morbidity are primarily due to medical care maldistribution or to other factors such as sociodemographic or environmental characteristics that are highly correlated with location. To separate incidence from case‐fatality rates, the study analyzed the determinants of survival rather than cause‐specific mortality rates. Using information from Florida traffic crash reports for 1988 through 1990, the study focused on Florida pedestrians hit by motor vehicles. It explores the effect of individual‐level demographic characteristics, crash‐level indicators of impact severity, and county‐level measures of socioeconomic and medical care resources, on the odds a pedestrian survived an injury. Logistic regression analyses reveal the importance of both road environment and percent of the county that is rural. However, these analyses are not able to isolate the influence of medical care from the level of urbanization. Although the percent rural was statistically significant, indicators of the mechanical energy involved in producing the injury, posted speed, and a dark road environment were substantively more important determinants of survival. Copyright © 1995, Wiley Blackwell. All rights reserved

关键词：事故交通/统计学和数值数据佛罗里达/流行病学卫生服务易得程度/统计学和数值数据回归分析农村卫生/统计学和数值数据乡村卫生服务/统计学和数值数据乡村卫生服务/供应和分配社会经济因素存活率分析创伤严重度指数城市卫生/统计学和数值数据市区卫生服务/统计学和数值数据市区卫生服务/供应和分配创伤和损伤/流行病学创伤和损伤/死亡率女(雌)性人类男(雄)性

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Childhood mortality in sub-Saharan Africa

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LANCET 1999年第9153期353卷 673-673页

作者： Müller, O Garenne, M Univ Heidelberg Dept Trop Hyg & Publ Hlth D-69120 Heidelberg Germany CEPED Paris France

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