scholarly journals The contribution of case mix, skill mix and care processes to the outcomes of community hospitals

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
J Lenzi ◽  
K Y C Adja ◽  
D Pianori ◽  
C Reno ◽  
M P Fantini
Keyword(s):  
Older People ◽  
Unmet Needs ◽  
Working Hours ◽  
Case Mix ◽  
Community Hospitals ◽  
Organizational Models ◽  
Skill Mix ◽  
Processes Of Care ◽  
Hospital Variation ◽  
Care Processes

Abstract Background The rapid increase in the proportion of older people underscores the need for new organizational models to face the unmet needs of frail patients with multiple conditions. Community hospitals (CHs) could be a solution to tackle these needs and foster integration between acute and primary care. The aim of this study was to investigate which patients' characteristics and which care processes affect clinical outcomes, in order to identify who could benefit the most from CH care and the best skill mix to deliver in this setting of care. Methods This study included all patients aged ≥65 and discharged in 2017 from the 16 CHs of Emilia-Romagna, northern Italy. Data sources were the regional CH informative system and hospital discharge records. CH skill mix and processes of care were collected with a survey; 3 non-respondent CHs were excluded. The study outcome was in-hospital variation of the Barthel index (BI) (≥10 vs. <10). We performed a 2-level random-intercept logistic regression analysis, and used the variance partition coefficient (VPC) to quantify the proportion of BI improvement that lay at CH level. Results Of the 13 CHs, 7 admitted ≥150 patients, 8 had a general practitioner medical support model, and 6 had >12 nurses' working hours/week/bed. Overall, 53% of the patients had a BI improvement ≥10 (4% to 71% across CHs). The patient case mix (i.e. baseline BI, female, older age, transfer from acute care) explained a portion of variability across CHs, as shown by the VPC that decreased from 0.32 to 0.26. Skill mix and processes of care were not associated with BI change, and the VPC resulting from controlling for these variables was virtually unchanged (0.28). Conclusions Patients' characteristics explained part of between-CH variation in BI improvement. Professional skill mix and processes of care, albeit fundamental to achieve appropriate care and respond to the unmet needs of the frail elderly, did not account for differences in CH-specific outcomes. Key messages A combination of quantitative and qualitative methods might better explain the outcome variability across intermediate care services. Multidisciplinary CH teams and services can be helpful to address the unmet needs of older people, but further studies are necessary.

scholarly journals The contribution of case mix, skill mix and care processes to the outcomes of community hospitals: a population-based observational study

2020 ◽  
Author(s):  
Davide Pianori ◽  
Kadjo Yves Cedric Adja ◽  
Jacopo Lenzi ◽  
Giulia Pieri ◽  
Andrea Rossi ◽  
...  
Keyword(s):  
Unmet Needs ◽  
Working Hours ◽  
Population Based ◽  
Case Mix ◽  
Community Hospitals ◽  
Organizational Models ◽  
Skill Mix ◽  
Processes Of Care ◽  
Random Intercept ◽  
Care Processes

AbstractBackgroundNew organizational models to face the unmet needs of frail patients are needed. Community hospitals (CHs) could foster integration between acute and primary care. The aim of this study was to investigate which patients’ characteristics and which care processes affect clinical outcomes, in order to identify who could benefit the most from CH care.MethodsThis study included all patients aged ≥65 and discharged in 2017 from the 16 CHs of Emilia-Romagna, Italy. Data sources were the regional CH informative system and hospital discharge records. CH skill mix and processes of care were collected with a survey. The study outcome was variation of the Barthel index (BI). We performed a 2-level random-intercept logistic regression analysis, and used the variance partition coefficient (VPC) to quantify the proportion of BI improvement that lay at CH level.ResultsOf the 13 CHs, 8 had a general practitioner medical support model, and 6 had >12 nurses’ working hours/week/bed. Overall, 53% of the patients had a BI improvement ≥10. The patient case mix explained a portion of variability across CHs. Skill mix and processes of care were not associated with BI change.ConclusionsPatients’ characteristics explained part of between-CH variation in BI improvement. Professional skill mix and processes of care, albeit fundamental to achieve appropriate care and respond to the unmet needs of the frail elderly, did not account for differences in CH-specific outcomes.

scholarly journals The Contribution of Case Mix, Skill Mix and Care Processes to the Outcomes of Community Hospitals: A Population-Based Observational Study

2021 ◽  
Vol 21 (2) ◽  
pp. 25
Author(s):  
Davide Pianori ◽  
Kadjo Yves Cedric Adja ◽  
Jacopo Lenzi ◽  
Giulia Pieri ◽  
Andrea Rossi ◽  
...  
Keyword(s):  
Observational Study ◽  
Population Based ◽  
Case Mix ◽  
Community Hospitals ◽  
Skill Mix ◽  
Care Processes

scholarly journals Skill mix change between general practitioners, nurse practitioners, physician assistants and nurses in primary healthcare for older people: a qualitative study

2018 ◽  
Vol 19 (1) ◽  
Author(s):  
Marleen H. Lovink ◽  
Anneke J. A. H. van Vught ◽  
Anke Persoon ◽  
Lisette Schoonhoven ◽  
Raymond T. C. M. Koopmans ◽  
...  
Keyword(s):  
Qualitative Study ◽  
Older People ◽  
General Practitioners ◽  
Nurse Practitioners ◽  
Primary Healthcare ◽  
Physician Assistants ◽  
Skill Mix

Meeting unmet needs? The role of a rural mental health service for older people

2014 ◽  
Vol 12 (3) ◽  
pp. 182-191 ◽  
Author(s):  
Julie Henderson ◽  
Mikaila M Crotty ◽  
Jeffrey Fuller ◽  
Lee Martinez
Keyword(s):  
Mental Health ◽  
Mental Health Service ◽  
Health Service ◽  
Older People ◽  
Unmet Needs ◽  
Rural Mental Health

Hospital-Physician Integration: Case Studies of Community Hospitals

1992 ◽  
Vol 5 (2) ◽  
pp. 82-98 ◽  
Author(s):  
Louise Lemieux-Charles ◽  
Peggy Leatt
Keyword(s):  
Medical Staff ◽  
Teaching Hospitals ◽  
Future Research ◽  
Hospital Physician ◽  
Community Hospitals ◽  
Organizational Models ◽  
Study Results ◽  
Efficiency And Effectiveness ◽  
Physician Integration ◽  
The Relationship

Hospitals are attempting more meaningfully to involve physicians in management as one approach to increasing the efficiency and effectiveness of their operations. The purpose of this research was to explore the relationship between the structure of the medical staff organization, the extent to which physicians are integrated into hospital decision making and the hospital's financial performance. A measure of hospital-physician integration was developed based on Alexander et al's (1986) dimensions of hospital-physician integration which were based on Scott's (1982) organizational models, ie, autonomous, heteronomous and conjoint. A multiple case study design, which comprised eight community non-teaching hospitals over 200 beds located in the Province of Ontario, Canada, was used to examine the relationship between variables. Study results suggest that there is variation among community hospitals on both contextual and organization factors. Hospitals with high levels of hospital-physician integration were located in highly populated areas, had formulated and implemented a strategic plan, had highly structured medical staff organizations, and had no budgetary deficit. In contrast, hospitals with moderate or low levels of integration were more likely to be located in lowly populated areas, had little planning activity, had a moderately structured medical staff organization, and had deficit budgeting. Suggested areas for future research include examining the role of the Board of Trustees in determining physicians' organizational roles and identifying differences in commitments, characteristics, and motivations of physicians working in rural versus urban hospitals and their impact on integrative strategies.

scholarly journals Hospital Variation in Cholecystectomies in The Netherlands: A Nationwide Observational Study

2020 ◽  
Vol 37 (6) ◽  
pp. 488-494
Author(s):  
Carmen S.S. Latenstein ◽  
Sarah Z. Wennmacker ◽  
Stef Groenewoud ◽  
Mark W. Noordenbos ◽  
Femke Atsma ◽  
...  
Keyword(s):  
The Netherlands ◽  
Clinical Outcomes ◽  
Gallstone Disease ◽  
Practice Variation ◽  
Emergency Department Visits ◽  
Case Mix ◽  
Hospital Variation ◽  
Improved Outcomes ◽  
Related Group ◽  
Nationwide Observational Study

<b><i>Background:</i></b> Practice variation generally raises concerns about the quality of care. This study determined the longitudinal degree of hospital variation in proportion of patients with gallstone disease undergoing cholecystectomy, while adjusted for case-mix, and the effect on clinical outcomes. <b><i>Methods:</i></b> A nationwide, longitudinal, database study was performed in all hospitals in the Netherlands in 2013–2015. Patients with gallstone disease were collected from the diagnosis-related group database. Hospital variation in case-mix-adjusted cholecystectomy rates was calculated per year. Clinical outcomes after cholecystectomy were compared between hospitals in the lowest/highest 20th percentile of the distribution of adjusted cholecystectomy rates in all 3 subsequent years. <b><i>Results:</i></b> In total, 96,673 patients with gallstones were included. The cholecystectomy rate was 73.6%. In 2013–2015, the case-mix-adjusted performance of cholecystectomies was in hospitals with high rates 1.5–1.6 times higher than in hospitals with low rates. Hospitals with a high adjusted cholecystectomy rate had a higher laparoscopy rate, shorter time to surgery, and less emergency department visits after a cholecystectomy compared to hospitals with a low-adjusted cholecystectomy rate. <b><i>Conclusion:</i></b> Hospital variation in cholecystectomies in the Netherlands is modest, cholecystectomy rates varies by &#x3c;2-fold, and variation is stable over time. Cholecystectomies in hospitals with high adjusted cholecystectomy rates are associated with improved outcomes.

Community hospitals – issues for older people

1998 ◽  
Vol 10 (5) ◽  
pp. 42-43
Author(s):  
Brendan McCormack
Keyword(s):  
Older People ◽  
Community Hospitals

Multi-institutional assessment of sphincter preservation for rectal cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 566-566
Author(s):  
Zaid M. Abdelsattar ◽  
Sandra L. Wong ◽  
Nancy J. Birkmeyer ◽  
Robert K. Cleary ◽  
Melissa L. Times ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Selection Criteria ◽  
Clinical Characteristics ◽  
Anal Verge ◽  
Multivariable Analysis ◽  
Hospital Performance ◽  
Sphincter Preservation ◽  
Case Mix ◽  
General Hypothesis ◽  
Hospital Variation

566 Background: Rates of sphincter preserving surgery (SPS) have been proposed as a quality measure for rectal cancer (RC) surgery. However, administrative and registry-based SPS rates often lack critical patient and tumor characteristics, rendering it unclear if variations in SPS rates are due to unmeasured case-mix differences or selection criteria. The aim of this study was to determine whether hospitals’ SPS rates differ after accounting for clinical characteristics. Methods: As part of a RC quality project, 10 hospitals in the Michigan Surgical Quality Collaborative retrospectively collected RC-specific data from 2007-2012. We assessed for SPS predictors using multivariable regression. Patients were categorized as “definitely SPS eligible” a priori if they did not have any of the following: poor sphincter control, stoma preference, sphincter involvement, tumor <6 cm from the anal verge (an intentionally conservative cutoff) or metastatic disease. We compared hospital performance with and without these clinical data using Spearman’s correlations. Results: In total, 349 patients underwent surgery for RC in 10 hospitals (5/10 high volume and 6/10 major teaching). Of those, 74% had SPS (range by hospital 50%-91%). On multivariable analysis, only pre-op radiation, tumor location, hospital teaching status and hospital ID were independent predictors of SPS, but not age, sex, BMI, AJCC stage, ASA class, or hospital CRC surgery volume. Analyses of the “definitely eligible” patients revealed an overall SPS rate of 88% (65-100%). Hospital SPS rankings using crude versus clinically-adjusted SPS rates proved to be highly correlated (Spearman’s ρ= 0.9). Tumor locations suggest differing selection criteria for SPS in different hospitals (Table). Conclusions: Rates of SPS vary by hospital, even after correcting for clinical characteristics using detailed chart review. These data suggest missed opportunities for SPS, and refute the general hypothesis that hospital variation in SPS rates in previous studies is due to unmeasured case-mix differences. [Table: see text]

scholarly journals Community mental health teams for older people: variations in case mix and service receipt (I)

2014 ◽  
Vol 30 (6) ◽  
pp. 595-604 ◽  
Author(s):  
Sue Tucker ◽  
Mark Wilberforce ◽  
Christian Brand ◽  
Michele Abendstern ◽  
Anthony Crook ◽  
...  
Keyword(s):  
Mental Health ◽  
Community Mental Health ◽  
Older People ◽  
Case Mix

scholarly journals The Needs of Older People with Mental Health Problems: A Particular Focus on Dementia Patients and Their Carers

2012 ◽  
Vol 2012 ◽  
pp. 1-7 ◽  
Author(s):  
Joaquim Passos ◽  
Carlos Sequeira ◽  
Lia Fernandes
Keyword(s):  
Mental Health ◽  
Mental Illness ◽  
Psychological Distress ◽  
Older People ◽  
Unmet Needs ◽  
Mental Health Problems ◽  
Clinical Manifestations ◽  
Health Problems ◽  
Association Analyses ◽  
Dementia Patients

The problems and needs of older people are often associated with mental illness, characterized by a set of clinical manifestations, which constitute important domains for investigation and clinical practice. This paper presents the results of a pilot study whose main purpose was to identify met and unmet needs and to analyze the relationship between those needs, psychopathology and functionality in older people with mental health problems. A sample of 75 patients aged 65 or over, of both sexes, diagnosed with mental illness using ICD-9. The main diagnoses were depression (36%) and dementia (29.3%). Most patients had cognitive impairment (MMSE, 52%; CDT, 66.7%), depression (GDS, 61.3%), anxiety (ZAS, 81.3%), and moderate dependence (BI, 49.3% and LI, 77.3%). The main unmet needs found were daytime activities (40%), social benefits (13.3%), company (10.7%), psychological distress (9.3%), and continence (8%). The majority of these unmet needs occur with dementia patients. The majority of the carers of these patients had global needs (met and unmet) in terms of psychological distress. Findings also reveal that a low level of functionality is associated with dementia diagnoses. The association analyses suggest that dementia is an important determinant of the functional status and needs.

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