Using a public hospital funding model to strengthen a case for improved nutritional care in a cancer setting

2013 ◽  
Vol 37 (3) ◽  
pp. 286 ◽  
Author(s):  
Anna G. Boltong ◽  
Jenelle M. Loeliger ◽  
Belinda L. Steer
Keyword(s):  
At Risk ◽  
Public Hospital ◽  
Business Case ◽  
Public Hospitals ◽  
Nutritional Care ◽  
Hospital Funding ◽  
Hospitalised Patients ◽  
Casemix Funding ◽  
Icd 10 ◽  
Successful Business

Objective. This study aimed to measure the prevalence of malnutrition risk and assessed malnutrition in patients admitted to a cancer-specific public hospital, and to model the potential hospital funding opportunity associated with implementing routine malnutrition screening. Methods. A point-prevalence audit of malnutrition risk and diagnosable malnutrition was conducted. A retrospective audit of hospital funding associated with documented cases of malnutrition was conducted. Audit results were used to estimate annual malnutrition prevalence, associated casemix-based reimbursement potential and the clinical support resources required to adequately identify and treat malnutrition. Results. Sixty-four percent of inpatients were at risk of malnutrition. Of these, 90% were assessed as malnourished. Twelve percent of malnourished patients produced a positive change in the diagnosis-related group (DRG) and increased allocated financial reimbursement. Identifying and diagnosing all cases of malnutrition could contribute an additional AU$413644 reimbursement funding annually. Conclusions. Early identification of malnutrition may expedite appropriate nutritional management and improve patient outcomes in addition to contributing to casemix-based reimbursement funding for health services. A successful business case for additional clinical resources to improve nutritional care was aided by demonstrating the link between malnutrition screening, hospital reimbursements and improved nutritional care. What is known about the topic? It is known that between 20 and 50% of hospital patients are malnourished and oncology patients are 1.7 times more likely to be malnourished than are other hospitalised patients. Despite the existence of practice guidelines for malnutrition screening of at-risk oncology patients, these are not routinely implemented. Identification of malnutrition in hospitalised patients is linked to casemix funding via DRG. Casemix reimbursement for malnutrition can be enhanced if: (1) malnutrition risk is identified; (2) malnutrition is diagnosed; (3) the word ‘malnutrition’ and an associated action plan is documented in the medical record; and (4) malnutrition is recognised and recorded by the clinical coder. Amendments to the ICD-10-AM in 2008 allowing malnutrition to be recognised as a complication for coding when it is documented by a dietitian in the medical history has hospital reimbursement implications for dietetic practice. Reimbursement potential for malnutrition has been calculated in public hospitals in Australia with varying results. What does this paper add? This paper reports the components of a successful business case made to enhance resources for identification and treatment of malnutrition on the basis of improved treatment as well as enhanced reimbursement potential resulting from changes to the ICD-10-AM. The present study adds to the body of literature showing that malnutrition coding contributes to casemix funding in Australian public hospitals, as well as internationally, and highlights the previously unreported opportunity for a cancer-specific health service. This work demonstrated that reassignment of a DRG based on a diagnosis of malnutrition altered the overall casemix funding value for 12% of audited patients. This compares with the findings of other authors who demonstrated hypothetical DRG changes and financial reallocation. What are the implications for practitioners? This paper highlights that practitioner-centred strategies are needed to enhance malnutrition identification, diagnosis, documentation and coding to maximise casemix reimbursement and better treat malnutrition in hospitals. Strategies include education of the dietetics, medical and health-information workforce. This manuscript provides a description of the conduct of quality-improvement activities that may support successful business cases for increased dietetic resources in future.

scholarly journals Condom negotiation self-efficacy and preparatory behaviors among Mozambican women at sexual risk

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
A L Patrão ◽  
T McIntyre
Keyword(s):  
At Risk ◽  
Sexual Risk ◽  
Behavioral Change ◽  
Self Efficacy ◽  
Public Hospital ◽  
Demographic Variables ◽  
African Women ◽  
Final Model ◽  
Condom Negotiation ◽  
Additional Variance

Abstract Background Preparatory behaviors (intention to use and buy/get condoms) are extremely important for sexual protection among African women, because the intentions to use and get condoms are the best predictors of effective condom use in some African contexts. However, these preventive behaviors are not as successful as desired, because they are often associated with negative meanings in the context of the sexual relationship. This study aims to identify whether condom negotiation self-efficacy is associated with sexual preparatory behaviors among Mozambican women at risk for HIV/AIDS infection. Methods Women (173), patients at a public Hospital and at risk for HIV infection, completed measures of sociodemographic and marital characteristics, condom negotiation self-efficacy, and sexual preparatory behaviors. Results Socio-demographic variables (age and education) explained 16.1% of variance (ΔF(2, 170)=16.30, p <.001), and marital variables, “marital status” and “talking about AIDS with partner” explained 22.3% of additional variance (ΔF(2, 168)=30.36, p <.001) in preparatory behaviors. The final model with condom negotiation self-efficacy explained 11.7% of additional variance (ΔF(1, 167)= 39.14, p <.001), this being the most important correlate in the model (β = .48). We observed that higher condom negotiation self-efficacy is associated with higher levels of preparatory behaviors. The overall model explained 48.6% of variance in sexual preparatory behaviors. Conclusions These results seem to support an exploratory predictive model of sexual preparatory behaviors that can inform interventions directed at behavioral change among Mozambican women at sexual risk. Key messages Women who were younger, had a higher level of education, were single, and talked about AIDS, had higher levels of preparatory behaviors. Women who had a higher level of condom negotiation self-efficacy, had higher levels of preparatory behaviors.

scholarly journals Longitudinal Evaluation on the Operation Index Applied to Public Hospitals in Pudong New District of Shanghai, China

2018 ◽  
Vol 55 ◽  
pp. 004695801879059
Author(s):  
Shanshan Liu ◽  
Jiaoling Huang ◽  
Yanting Li ◽  
Jincheng Fan ◽  
Hong Liang ◽  
...  
Keyword(s):  
Financial Risk ◽  
Public Hospital ◽  
Risk Index ◽  
Condition Index ◽  
Public Hospitals ◽  
Operating Index ◽  
The Public ◽  
Management Condition ◽  
Service Operation ◽  
Public Hospital Reform

The public hospital reform has lasted 5 years in China; however, the operation development status and trends of public hospitals have not been systematically evaluated in Pudong New District. We first applied the technology of longitudinal index to assess the development of public hospitals there. The quantitative data were mainly gathered by taking health statistics database from 2009 to 2014. The results showed that overall operating index presented a down-up trend, with the highest point in 2014 and the lowest point in 2012. Overall operating index, development foundation index, and management condition index were found to be statistically different ( P = .010, P = .016, P = .031) in different years, whereas the service operation index and financial risk index were not so ( P = .543, P = .228). Moreover, the results demonstrated that no obvious difference was observed in the overall operating index between the general and specialized hospitals ( P = .327), which was the same in the 4 first-class indexes. However, there were statistical differences in the overall operating index and development foundation index among these 5 years ( P = .018, P = .036), but none in the service operation index, management condition index, and financial risk index ( P = .503, P = .062, P = .177). No interaction effects were discovered between year and hospital categories in the current study ( P = .673, P = .375, P = .885, P = .152, P = .288).

scholarly journals DIFFERENCES IN LEUKOCYTE RATE BETWEEN ACUTE NONPERFORATED AND PERFORATED APPENDICITIS IN HOSPITALISED PATIENTS BANDAR LAMPUNG-INDONESIA

2019 ◽  
Vol 2 (1) ◽  
pp. 25-31
Author(s):  
Festy Ladyani ◽  
Nur Fitria Dewi
Keyword(s):  
Acute Appendicitis ◽  
Public Hospital ◽  
Leucocyte Count ◽  
Univariate Analysis ◽  
Perforated Appendicitis ◽  
Sampling Technique ◽  
Bivariate Analysis ◽  
P Value ◽  
Cross Sectional ◽  
Hospitalised Patients

Background: Acute appendicitis is one of the most common acute abdominal pain. A late check up and diagnosis could bring harms which is turning into perforated appendicitis. Leukocyte count is a laboratory collation that is generous and quick to diagnose the acute apendicitis and perforated appendicitis, however there’s no certain limit of the leukocytes count to recognize whether it is acute apendicitis or perforated appendicitis.Purpose: This research was to find out the comparison of leucocyte count average between acute appendicitis and perforation appendicitis in Dr. H. Abdul Moeleok public hospital of Lampung province in 2014-2016.Methods: An analytic research with cross sectional approach. Population was 382 patients with appendicitis in Dr. Hi. Abdul Moeloek public hospital. Samples were taken using total sampling technique with 196 respondent samples for acute appendicitis and 196 respondent samples for perforation appendicitis. Data were analyzed by using univariate analysis with percentage and bivariate analysis with t-test.Results: the average of leucocyte count of acute appendicitis patients was 10,907 with minimum and maximum leucocyte count of 5,000 and 18,500 respectively. The average of leucocyte count of perforation appendicitis patients was 22,789 with minimum and maximum leucocyte count of 16,500 and 31,000 respectively. There were differences of leucocyte counts between acute appendicitis patients and perforation appendicitis patients with p-value < 0.05.Conclusion: there were significant differences of leucocyte count averages between acute appendicitis and perforation appendicitis.

scholarly journals Measuring multimorbidity in hospitalised patients using linked hospital episode data: comparison of two measures

2019 ◽  
Vol 4 (1) ◽  
Author(s):  
Lynn Robertson ◽  
Dolapo Ayansina ◽  
Marjorie Johnston ◽  
Angharad Marks ◽  
Corri Black
Keyword(s):  
At Risk ◽  
Length Of Stay ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Resource Planning ◽  
Kappa Statistics ◽  
Data Systems ◽  
Hospital Episode ◽  
Hospitalised Patients ◽  
Poor Outcomes

IntroductionMultimorbidity is a complex and growing health challenge. There is no accepted “gold standard” multimorbidity measure for hospital resource planning, and few studies have compared measures in hospitalised patients. AimTo evaluate operationalisation of two multimorbidity measures in routine hospital episode data in NHS Grampian, Scotland. MethodsLinked hospital episode data (Scottish Morbidity Record (SMR)) for the years 2009-2016 were used. Adults admitted to hospital as a general/acute inpatient during 2014 were included. Conditions (ICD-10) were identified from general/acute (SMR01) and psychiatric (SMR04) admissions during the five years prior to first admission in 2014. Two count-based multimorbidity measures were used (Charlson Comorbidity Index and Tonelli et al.), and multimorbidity was defined as ≥2 conditions. Kappa statistics assessed agreement. The association between multimorbidity and length of stay, readmission and mortality was assessed using logistic and negative binomial regression as appropriate. ResultsIn 41,545 adults (median age 62 years, 52.6% female), multimorbidity prevalence was 15.1% (95% CI 14.8%, 15.5%) using Charlson and 27.4% (27.0%, 27.8%) using Tonelli – agreement 85.1% (Kappa 0.57). Multimorbidity prevalence, using both measures, increased with age. Multimorbidity was higher in males (16.5%) than females (13.9%) using the Charlson measure, but similar across genders when measured with Tonelli. After adjusting for covariates, multimorbidity remained associated with longer length of stay (Charlson IRR 1.1 (1.0, 1.2); Tonelli IRR 1.1 (1.0, 1.2)) and readmission (Charlson OR 2.1 (1.9, 2.2); Tonelli OR 2.1 (2.0, 2.2)). Multimorbidity had a stronger association with mortality when measured using Charlson (OR 2.7 (2.5, 2.9)), than using Tonelli (OR (1.8 (1.7, 2.0)). ConclusionsMultimorbidity measures operationalised in hospital episode data identified those at risk of poor outcomes and such operationalised tools will be useful for future multimorbidity research and use in secondary care data systems. Multimorbidity measures are not interchangeable, and the choice of measure should depend on the purpose. Hightlights Operationalisation of two count-based multimorbidity measures using linked electronic hospitalepisode data was evaluated (Charlson and Tonelli). First study to compare the Tonelli measure with another measure for investigating multimor-bidity in hospitalised patients. Multimorbidity prevalence differed depending on measure used, but both multimorbidity mea-sures identified those at risk of poor outcomes. Operationalised multimorbidity tools have uses for future multimorbidity research and use insecondary care data systems. Multimorbidity measures are not interchangeable, and choice of measure should depend onpurpose.

Reflection article: Gender, sexuality and the Argentinian radical Jewish left

2021 ◽  
Vol 20 (20) ◽  
pp. 146-160
Author(s):  
Nerina Visacovsky
Keyword(s):  
At Risk ◽  
Catholic Church ◽  
Women's Movement ◽  
Termination Of Pregnancy ◽  
Public Hospitals ◽  
The Law ◽  
The Catholic Church ◽  
Voluntary Termination

On 30 December 2020, amid the turmoil caused by the COVID pandemic, Argentina approved the Voluntary Termination of Pregnancy Law, which legalises abortion until the fourteenth week of pregnancy. In public hospitals, the procedure is now free of charge. Prior to this milestone, which was enacted on 14 January 2021, abortion was only permitted in cases of rape or when a pregnant woman's health was at risk. The law is the result of years of activism and protests against prevailing conservatism in a country heavily influenced by the Catholic Church, led by a grassroots women's movement, known as the 'green wave', which unites many different organisations that have been working towards the same goals.

scholarly journals Systematic review and meta-analysis of public hospital efficiency studies in Gulf region and selected countries in similar settings

2019 ◽  
Vol 17 (1) ◽  
Author(s):  
Ahmed Alatawi ◽  
Sayem Ahmed ◽  
Louis Niessen ◽  
Jahangir Khan
Keyword(s):  
Public Hospital ◽  
Meta Analysis ◽  
Hospital Efficiency ◽  
Public Hospitals ◽  
Quality Data ◽  
Risk Level ◽  
Gulf Region ◽  
Substantial Impact ◽  
Gcc Countries ◽  
Strategic Plans

Abstract Background The assessment of hospital efficiency is attracting interest worldwide, particularly in Gulf Cooperation Council (GCC) countries. The objective of this study was to review the literature on public hospital efficiency and synthesise the findings in GCC countries and comparable settings. Methods We systematically searched six scientific databases, references and grey literature for studies that measured the efficiency of public hospitals in appropriate countries, and followed PRISMA guidelines to present the results. We summarised the included studies in terms of samples, methods/technologies and findings, then assessed their quality. We meta-analysed the efficiency estimates using Spearman’s rank correlations and logistic regression, to examine the internal validity of the findings. Results We identified and meta-analysed 22 of 1128 studies. Four studies were conducted in GCC nations, 18 came from Iran and Turkey. The pooled technical-efficiency (TE) was 0.792 (SE ± 0.03). There were considerable variations in model specification, analysis orientation and variables used in the studies, which influenced efficiency estimates. The studies lacked some elements required in quality appraisal, achieving an average of 73%. Meta-analysis showed negative correlations between sample size and efficiency scores; the odd ratio was 0.081 (CI 0.005: 1.300; P value = 0.07) at 10% risk level. The choice of model orientation was significantly influenced (82%) by the studied countries’ income categories, which was compatible with the strategic plans of these countries. Conclusions The studies showed methodological and qualitative deficiencies that limited their credibility. Our review suggested that methodology and assumption choices have a substantial impact on efficiency measurements. Given the GCC countries’ strategic plans and resource allocations, these nations need further efficiency research using high-quality data, different orientations and developed models. This will establish an evidence-based knowledge base appropriate for use in public hospital assessments, policy- and decision-making and the assurance of value for money.

scholarly journals Nursing documentation practice and associated factors among nurses in public hospitals, Tigray, Ethiopia

2019 ◽  
Vol 12 (1) ◽  
Author(s):  
Hagos Tasew ◽  
Teklewoini Mariye ◽  
Girmay Teklay
Keyword(s):  
Nursing Care ◽  
Associated Factors ◽  
Public Hospital ◽  
Response Rate ◽  
Chief Executive ◽  
Public Hospitals ◽  
Nursing Documentation ◽  
Factors Affecting ◽  
Tigray Region ◽  
Nursing Directors

Abstract Objective The objective of this study was to investigate documentation practice and factors affecting documentation practice among nurses working in public hospital of Tigray region, Ethiopia. Results In this study, there were 317 participants with 99.7% response rate. The result of this study shows that practice nursing care documentation was inadequate (47.8%). Inadequacy of documenting sheets AOR = 3.271, 95% CI (1.125, 23.704), inadequacy of time AOR = 2.205, 95% CI (1.101, 3.413) and with operational standard of nursing documentation AOR = 2.015, 95% CI (1.205, 3.70) were significantly associated with practice of nursing care documentation. To conclude, more than half of nurses were not documented their nursing care. Employing institutions should provide training on documentation of nursing care to enhance knowledge and create awareness on nurses’ documentation to nursing directors and chief executive officer to access adequate documenting supplies besides employing more nurses.

scholarly journals Brokers on the Ward

2020 ◽  
Vol 48 (1-2) ◽  
pp. 92-114 ◽  
Author(s):  
Shahaduz Zaman ◽  
Sjaak van der Geest
Keyword(s):  
Social Inequality ◽  
Public Hospital ◽  
Social Dynamics ◽  
Hospital Staff ◽  
Ethnographic Study ◽  
Public Hospitals ◽  
Considerable Influence ◽  
Local Character ◽  
The Social ◽  
Level Hospital

Abstract This paper is based on an ethnographic study conducted in a public hospital in Bangladesh. The study shows how the social dynamics necessary to deal with the structural realities of the hospital give this cosmopolitan institution a local character. In this paper, we describe this local character by focusing on the lower-level hospital staff, such as ward boys, cleaners, and gatemen. Social inequality and exclusion are rampant in Bangladeshi public hospitals. Doctors and nurses are unwilling to communicate with patients and their relatives, while the latter are unable to approach the former for specific help or information. Our research, shows how low-level support workers fill the void between the two “factions” and act as brokers transporting information and activities between these factions. By doing so they do not only make a crucial contribution to the functioning of the ward, but also gain considerable influence in spite of their low position.

scholarly journals Culturally safe and sustainable solution for Closing the Gap-registered patients discharging from a tertiary public hospital

2020 ◽  
Vol 44 (2) ◽  
pp. 200
Author(s):  
Scott Mitchell ◽  
Hayley Michael ◽  
Stephanie Highden-Smith ◽  
Vivian Bryce ◽  
Sean Grugan ◽  
...  
Keyword(s):  
Continuity Of Care ◽  
Public Hospital ◽  
Torres Strait Islander ◽  
Culturally Sensitive ◽  
Public Hospitals ◽  
Smooth Transition ◽  
Cardiac Care ◽  
Funding Model ◽  
Closing The Gap ◽  
Torres Strait

This case study describes the development, implementation and review of a sustainable and culturally sensitive procedure for a hospital-funded discharge medicine subsidy for Aboriginal and Torres Strait Islander patients registered with the Closing the Gap (CTG) program discharging from a public hospital. A 7-day fully subsidised medication supply was approved to be offered to Aboriginal and Torres Strait Islander patients admitted under cardiac care teams, including cardiology and cardiothoracic surgery patients. Patients were offered the option of a 7-day supply free of cost to them or a full Pharmaceutical Benefits Scheme (PBS) supply if preferred. A general practitioner (GP) appointment was organised within 7 days of discharge to ensure patients received ongoing supply of their medications as well as timely clinical review after discharge. Over a 34-month period from September 2015 to June 2018, 535 Aboriginal and Torres Strait Islander patients were admitted to the hospital under cardiac care teams. Of these patients, 296 received a subsidised discharge medication supply with a total cost of A$6314.56 to the hospital over the trial period, with a mean cost of A$21.26 per discharge. The provision of subsidised medications through the CTG program has improved the continuity of care for Aboriginal and Torres Strait Islander patients. The culturally sensitive approach is well received and has allowed smooth transition back to the community. This site-specific and state-based funding model was found to be financially sustainable at a public hospital. What is known about the topic?The CTG PBS program is not applicable to discharge prescriptions from public hospitals. As such, patients are required to either leave the hospital with no medicines or leave the hospital with medicines for which they have to pay full PBS price. This creates a huge financial barrier to the care for CTG-registered patients in the acute care setting. What does this paper add?A sustainable solution to the problem was found via a state-funded model while providing a supportive team to ensure GP follow-up and continuity of care after discharge. What are the implications for practitioners?If similar approvals are granted and supported at other public hospital sites, practitioners will be afforded one less barrier to provide patient-centred care for Aboriginal and Torres Strait Islander patients.

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