Study objective: We assess the ability of the best demonstrated processes (BDP) methodology to decrease emergency department patient length of stay (LOS) in EDs in a large multihospital system. Methods: Two hundred ni...
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Study objective: We assess the ability of the best demonstrated processes (BDP) methodology to decrease emergency department patient length of stay (LOS) in EDs in a large multihospital system. Methods: Two hundred ninety-one EDs were ranked by LOS, and the fastest and slowest EDs were observed to identify the BDPs. The resulting "meaningful differences" were shared with all EDs throughout the hospital system. LOS studies were repeated after the BDP intervention. Five separate LOS measures were performed during a 19-month period, with 223 to 273 EDs participating in each measure. Three interval times were calculated: arrival to examination room, examination room to physician evaluation, and physician evaluation to discharge. Results: Two hundred ninety-one EDs participated, and 386,837 patient visits were evaluated. Before intervention, the average LOS was 147 minutes for all EDs and 186 minutes in the slowest third. At 19 months after intervention, the average LOS was 139 minutes for all EDs and 157 minutes In the slowest third. Between the initial and final measurement period, there was an 8-minute (5.4%) improvement in LOS on a system-wide basis, and the slowest third of EDs improved LOS by 29 minutes (15.6%). Before intervention, arrival to examination room time was 27 minutes, examination room to physician evaluation was 20 minutes, and evaluation to discharge was 100 minutes. After intervention, these times decreased to 22 (P < .001), IS (P < .001), and 99 (P=.33) minutes, respectively. The slowest one third of EDs went from 37 to 24 minutes for arrival to examination room time (P < .001), from 25 to 20 minutes for examination room to evaluation time (P < .001), and from 124 to 113 minutes for evaluation, to discharge time (P < .001). Conclusion: Implementing observed BDP meaningful differences resulted in decreased patient LOS in EDs, particularly in the slowest one third of EDs in the hospital system.
Consumer satisfaction with mental health services is a dimension of outcome. This report is on a university and state mental health department research project that involved development of the Kentucky Consumer Satisf...
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Consumer satisfaction with mental health services is a dimension of outcome. This report is on a university and state mental health department research project that involved development of the Kentucky Consumer Satisfaction Instrument (KY-CSI) and a retrospective, cross-sectional study designed to measure consumer satisfaction with services at a regional psychiatric hospital. Triangulation of methods guided the survey of participants (N = 189) near discharge from the hospital during a 6-month period. Research associates, who were former consumers of mental health services, collected data during face-to-face interviews, Most participants were unemployed White men. Factor analysis indicated the 19-item instrument was unidimensional;Cronbach's a was 0.90. Multiple regression indicated predictors of satisfaction were levels of education and diagnosis. As education increased, satisfaction decreased;participants with a diagnosis of bipolar disorder tended to be more satisfied than those with other diagnoses. Analysis of qualitative data combined with standardized summary of KY-CSI items indicated participants were most satisfied with opportunities to talk with other patients and least satisfied about lack of involvement of people with whom they lived in discharge planning. Study findings guided recommendations for quality of care and additional studies at other hospital sites. Copyright (C) 2001 by W.B. Saunders Company.
Study objective: We sought to validate a previously developed model of emergency department patient satisfaction in a general population using a standard mailed format. The study aims to export the findings of a compr...
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Study objective: We sought to validate a previously developed model of emergency department patient satisfaction in a general population using a standard mailed format. The study aims to export the findings of a comprehensive ED quality-of-care study to an easily measured patient population. Methods: A double-sided, single-page survey was mailed to all patients discharged home from 4 teaching hospital EDs during a 1-month period. Determinants of patient satisfaction were analyzed with a previously developed multivariate, ordinal logistic-regression model. Results: The mail survey response rate was 22.9% (2,373/10,381). The survey validates the importance of previously identified determinants of patient satisfaction, including age, help not received when needed, poor explanation of problem, not told about wait time, not told when to resume normal activity, poor explanation of test results, and not told when to return to the ED (P < .01). Greater age predicted higher patient satisfaction, whereas all other variables correlated with lower patient satisfaction. In contrast with prior findings, black race was not a significant predictor of satisfaction in the mail survey population. Low ratings of overall care are strongly correlated with reduced willingness to return (P < .0001). Conclusion: A patient satisfaction model was previously developed from a comprehensive research survey of ED care. We demonstrate the generalizability of this model to a mail survey population and replicate the finding that satisfaction strongly predicts willingness to return. The response rate of this study is typical of commercial patient-satisfaction surveys. The validated model suggests that ED patient satisfaction improvement efforts should focus on a limited number of modifiable and easily measured factors.
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 r...
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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.
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...
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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.
A rural health services development program of the University of Washington School of Medicine has worked for 15 years with communities throughout the five-state region of Alaska, Idaho, Montana, Washington and Wyomin...
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A rural health services development program of the University of Washington School of Medicine has worked for 15 years with communities throughout the five-state region of Alaska, Idaho, Montana, Washington and Wyoming to strengthen their health systems. Or the course of that work, 56 communities were surveyed about their utilization and opinions of local health systems. This database allows the following generalizations to be made about rural Northwest communities: (1) People think highly of their local hospitals, physicians and other key components of the acute medical care system and want their hospitals to remain open. Older respondents are more satisfied than younger respondents;(2) the typical hospital market share is 36 percent, the typical physician market share is 50 percent (3) satisfaction with discrete, well-funded services such as pharmacy ambulance and dentistry is quite high, whereas satisfaction with mental health and substance abuse treatment is significantly lower;(4) the most commonly cited serious problems in surveyed communities were "too few physicians or-services" and "care is too expensive" and (5) there is great variation between communities in both satisfaction and utilization.
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