Geographical disparities in access to hospital care in Ontario, Canada: a spatial coverage modelling approach

ObjectivesPrevious studies on geographical disparities in healthcare access have been limited by not accounting for the healthcare provider’s capacity, a key determinant of supply and demand relationships.DesignThis study proposed a spatial coverage modelling approach to evaluate disparities in hospital care access using Canadian Institute for Health Information data in 2007.SettingThis study focusses on accessibility of inpatient and emergency cares at both levels of individual hospital and the administrative regions of Local Health Integration Network (LHIN) levels.MeasuresWe integrated a set of traffic and geographical data to precisely estimate travel time as a measure of the level of accessibility to the nearest hospital by three scenarios: walking, driving and a combination of the both. We estimated population coverage rates, using hospital capacities and population in the catchments, as a measure of the level of the healthcare availability. Hospital capacities were calculated based on numbers of medical staff and beds, occupation rates and annual working hours of healthcare providers.ResultsWe observed significant disparities in hospital capacity, travel time and population coverage rate across the LHINs. This study included 25 teaching and 148 community hospitals. The teaching hospitals had stronger capacities with 489 209 inpatient and 130 773 emergency patients served in the year, while the population served in community hospitals were 2.64 times higher. Compared with north Ontario, more locations in the south could reach to hospitals within 30 min irrespective of the travel mode. Additionally, Northern Ontario has higher population coverage rates, for example, with 42.6~46.9% for inpatient and 15.7~44% for emergency cares, compared with 2.4~34.7% and 0.35~14.6% in Southern Ontario, within a 30 min catchment by driving.ConclusionCreating a comprehensive, flexible and integrated healthcare system should be considered as an effective approach to improve equity in access to care.

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From Cottage to Community Hospitals: Watlington Cottage Hospital and its Regional Context, 1874–2000

Local Population Studies ◽

10.35488/lps88.2012.33 ◽

2012 ◽

pp. 33-49 ◽

Cited By ~ 3

Author(s):

John Hall

Keyword(s):

General Practitioner ◽

Case Studies ◽

Hospital Care ◽

Teaching Hospitals ◽

Community Hospitals ◽

Regional Context ◽

Regional Setting ◽

Regional Basis ◽

The Impact

The appearance in England from the 1850s of 'cottage hospitals' in considerable numbers constituted a new and distinctive form of hospital provision. The historiography of hospital care has emphasised the role of the large teaching hospitals, to the neglect of the smaller and general practitioner hospitals. This article inverts that attention, by examining their history and shift in function to 'community hospitals' within their regional setting in the period up to 2000. As the planning of hospitals on a regional basis began from the 1920s, the impact of NHS organisational and planning mechanisms on smaller hospitals is explored through case studies at two levels. The strategy for community hospitals of the Oxford NHS Region—one of the first Regions to formulate such a strategy—and the impact of that strategy on one hospital, Watlington Cottage Hospital, is critically examined through its existence from 1874 to 2000.

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Antimicrobial Stewardship in Acute-Care Hospitals: A Report of the California Healthcare-Associated Infections Honor Roll

Antimicrobial Stewardship & Healthcare Epidemiology ◽

10.1017/ash.2021.59 ◽

2021 ◽

Vol 1 (S1) ◽

pp. s32-s32

Author(s):

Jane Kriengkauykiat ◽

Erin Epson ◽

Erin Garcia ◽

Kiya Komaiko

Keyword(s):

Acute Care ◽

Antimicrobial Stewardship ◽

Open Enrollment ◽

Acute Care Hospitals ◽

Teaching Hospitals ◽

Healthcare Associated Infection ◽

Community Hospitals ◽

Honor Roll ◽

Core Elements ◽

Healthcare Associated

Background: Antimicrobial stewardship has been demonstrated to improve patient outcomes and reduce unwanted consequences, such as antimicrobial resistance and Clostridioides difficile infection. The California Department of Public Health (CDPH) Healthcare-Associated Infection (HAI) Program developed an honor roll to recognize facilities with the goal of promoting antimicrobial stewardship programs and encouraging collaboration and research. Methods: The first open enrollment period in California was from August 1 to September 1, 2020, and was only open to acute-care hospitals (ACHs). Enrollment occurs every 6 months. Applicants completed an application and provided supporting documentation for bronze, silver, or gold designations. The criteria for the bronze designation were at least 1 item from each of CDC’s 7 core elements for ACHs. The criteria for silver were bronze criteria plus 9 HAI program prioritized items (based on published literature) from the CDC Core Elements and demonstration of outcomes from an intervention. The criteria for gold designation were silver criteria plus community engagement (ie, local work or collaboration with healthcare partners). Applications were evaluated in 3 phases: (1) CDPH reviewed core elements and documentation, (2) CDPH and external blinded antimicrobial stewardship experts reviewed outcomes as scientific abstracts, and (3) CDPH reviewed each program for overall effectiveness in antimicrobial stewardship and final designation determination. Designations expire after 2 years. Results: In total, 119 applications were submitted (30% of all ACHs in California), of which 100 were complete and thus were included for review. Moverover, 33 facilities were from northern California and 67 were from southern California. Also, 85 facilities were part of a health system or network, 14 were freestanding, and 1 was a district facility. Facility types included 68 community hospitals, 17 long-term acute-care (LTAC) facilities, 17 academic or teaching hospitals, 4 critical-access hospitals, and 4 pediatric hospitals. There was an even distribution of hospital bed size: 35 facilities had <250 beds. The final designations included 19 gold, 35 silver and 43 bronze designations. There was 44% incongruency in applicants not receiving the designation for which they applied. Community hospitals were 63%–74% of all designations, and no LTACs received a gold designation. Moreover, 63% of hospitals with gold designations had >250 beds, and 47% of hospitals with bronze designations had <1 25 beds. Conclusions: The number of applicants was higher than expected because the open enrollment period occurred during the COVID-19 pandemic. This finding demonstrates the high importance placed on antimicrobial stewardship among ACHs. It also provides insight into how facilities are performing and collaborating and how CDPH can support facilities to improve their ASP.Funding: NoDisclosures: None

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“Satanism is witchcraft’s younger sibling”: Changing perceptions of natural and supernatural anaemia causality in Malawian children

PLoS ONE ◽

10.1371/journal.pone.0250661 ◽

2021 ◽

Vol 16 (4) ◽

pp. e0250661

Author(s):

Sarah Svege ◽

Thandile Nkosi-Gondwe ◽

Siri Lange

Keyword(s):

Health Beliefs ◽

Hospital Care ◽

Hospital Admissions ◽

Treatment Options ◽

Age Groups ◽

Traditional Healers ◽

Sub Saharan Africa ◽

Local Health ◽

Traditional Treatment ◽

Poor Nutrition

In countries of sub-Saharan Africa, many children are admitted to hospital with severe forms of anaemia. The late hospital admissions of anaemic children contribute significantly to child morbidity and mortality in these countries. This qualitative study explores local health beliefs and traditional treatment practices that may hinder timely seeking of hospital care for anaemic children. In January of 2019, nine focus group discussions were conducted with 90 participants in rural communities of Malawi. The participants represented four groups of caregivers; mothers, fathers, grandmothers and grandfathers of children under the age of five. The Malawian medical landscape is comprised of formal and informal therapeutic alternatives–and this myriad of modalities is likely to complicate the healthcare choices of caregivers. When dealing with child illness, many participants reported how they would follow a step-by-step, ‘multi-try’ therapeutic pathway where a combination of biomedical and traditional treatment options were sought at varying time points depending on the perceived cause and severity of symptoms. The participants linked anaemia to naturalistic (malaria, poor nutrition and the local illnesses kakozi and kapamba), societal (the local illness msempho) and supernatural or personalistic (witchcraft and Satanism) causes. Most participants agreed that anaemia due to malaria and poor nutrition should be treated at hospital. As for local illnesses, many grandparents suggested herbal treatment offered by traditional healers, while the majority of parents would opt for hospital care. However, participants across all age groups claimed that anaemia caused by witchcraft and Satanism could only be dealt with by traditional healers or prayer, respectively. The multiple theories of anaemia causality combined with extensive use of and trust in traditional and complementary medicine may explain the frequent delay in admittance of anaemic children to hospital.

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Adverse Drug Reactions in Children Leading to Hospital Admission

PEDIATRICS ◽

10.1542/peds.82.1.24 ◽

1988 ◽

Vol 82 (1) ◽

pp. 24-29

Author(s):

Allen A. Mitchell ◽

Peter G. Lacouture ◽

Jane E. Sheehan ◽

Ralph E. Kauffman ◽

Samuel Shapiro

Keyword(s):

Adverse Drug Reactions ◽

Neonatal Intensive Care ◽

Hospital Admissions ◽

Teaching Hospitals ◽

Surveillance Program ◽

Pediatric Hospital ◽

Drug Reactions ◽

Drug Surveillance ◽

Community Hospitals ◽

Tetanus Vaccine

To provide information regarding pediatric hospital admissions prompted by adverse drug reactions, data were reviewed from an intensive drug surveillance program in which 10,297 patients admitted to diverse pediatric wards at four teaching and three community hospitals were systematically monitored. Among 3,026 neonatal intensive care unit admissions, 0.2% were prompted by adverse drug reactions; among 725 children with cancer, 22% of admissions were prompted by adverse drug reactions. Among 6,546 children with other conditions monitored on general medical and specialty wards at two teaching hospitals and on general pediatric wards at three community hospitals, 2% (131) of admissions were prompted by adverse drug reactions. Two patients (0.03%) died because of their reactions. The proportion of admissions prompted by drug reactions increased between infancy and 5 years of age and tended to be relatively stable thereafter. The drugs most commonly implicated in the admissions were phenobarbital, aspirin, phenytoin, ampicillin/amoxicillin, theophylline/aminophylline, trimethoprim-sulfamethoxazole, and diphtheria-pertussis-tetanus vaccine. Similar proportions of admissions were prompted by adverse drug reactions in teaching hospitals (2.1%) and in community hospitals (1.8%), and the drug groups implicated in these admissions were generally similar in the two settings. In contrast to adult populations, children with adverse drug reactions account for a small proportion of hospital admissions. Findings from this large, systematic study of pediatric admissions to teaching and community hospitals may serve as a baseline to which other pediatric facilities can compare their experience.

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Efficiency and shrinking in evolving networks

Journal of The Royal Society Interface ◽

10.1098/rsif.2019.0101 ◽

2019 ◽

Vol 16 (154) ◽

pp. 20190101 ◽

Cited By ~ 3

Author(s):

Arianna Bottinelli ◽

Marco Gherardi ◽

Marc Barthelemy

Keyword(s):

Travel Time ◽

Spatial Scales ◽

Population Coverage ◽

Railway Network ◽

Evolving Networks ◽

Total Length ◽

Good Population ◽

Total Travel Time ◽

Spatio Temporal ◽

Empirical Networks

Characterizing the spatio-temporal evolution of networks is a central topic in many disciplines. While network expansion has been studied thoroughly, less is known about how empirical networks behave when shrinking. For transportation networks, this is especially relevant on account of their connection with the socio-economical substrate, and we focus here on the evolution of the French railway network from its birth in 1840 to 2000, in relation to the country’s demographic dynamics. The network evolved in parallel with technology (e.g. faster trains) and under strong constraints, such as preserving a good population coverage and balancing cost and efficiency. We show that the shrinking phase that started in 1930 decreased the total length of the network while preserving efficiency and population coverage: efficiency and robustness remained remarkably constant while the total length of the network shrank by 50% between 1930 and 2000, and the total travel time and time-diameter decreased by more than 75% during the same period. Moreover, shrinking the network did not affect the overall accessibility with an average travel time that decreases steadily since its formation. This evolution leads naturally to an increase in transportation multimodality (such as a massive use of cars) and shows the importance of considering together transportation modes acting at different spatial scales. More generally, our results suggest that shrinking is not necessarily associated with a decay in performance and functions but can be beneficial in terms of design goals and can be part of the natural evolution of an adaptive network.

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Influenza vaccination campaigns targeted at healthcare workers:results of four hospitals in Rome

European Journal of Public Health ◽

10.1093/eurpub/ckz186.516 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

A Tognetto ◽

A Abbondanzieri ◽

G Cerone ◽

M Di Pumpo ◽

A Nardi ◽

...

Keyword(s):

Public Health ◽

Influenza Vaccination ◽

Vaccination Coverage ◽

Seasonal Influenza ◽

Teaching Hospitals ◽

Easy Access ◽

Cross Sectional ◽

Seasonal Influenza Vaccination ◽

Coverage Rates ◽

Vaccination Campaigns

Abstract Background Seasonal influenza vaccination (SIV) of health care workers (HCWs) is well recognized as a public health measure that can protect both HCWs from infection and patients from the risk of influenza complications. Nevertheless, vaccination coverage rates among this specific population result generally lower than the recommended target. With our study, we aimed to describe the activities and the outcomes of four different SIV campaigns targeted at HCWs and organized during the season 2018/2019 in four hospitals in Rome. Methods A cross-sectional study involving four teaching hospitals was performed. The collected data were synthetized into a set of descriptors and indicators, validated through a previous study that had involved the same Centers. Results The Medical Directorates, in collaboration with the University Hygiene and Public Health Units of the four hospitals organized different strategies: Hospital 1, 3 and 4 realized educational courses for HCWs and actively promoted the campaigns through e-mail invitations to all HCWs. As for the access to vaccination, all the hospitals provided a dedicated unit for SIV; Hospital 1 and Hospital 4 organized also on-site vaccination sessions in the hospital wards, that required a large number of staff. The vaccination coverage rates resulted: 22.37% in Hospital 1, 18.10% in Hospital 4, 9.28% in Hospital 2 and 8,51% in Hospital 3. Conclusions Our results demonstrate that multi-activity campaigns, involving education, promotion and easy access to vaccination constitute an effective approach to reinforce the value of SIV. Our findings suggest that on-site vaccination may play a key role in determining a higher vaccination coverage. Key messages Multi-activity vaccination campaigns, involving education, promotion and easy access to vaccination constitute an effective approach to reinforce the value of seasonal influenza vaccination for HCWs. On-site vaccination may play a key role in determining a higher vaccination coverage.

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Hospital-Physician Integration: Case Studies of Community Hospitals

Health Services Management Research ◽

10.1177/095148489200500201 ◽

1992 ◽

Vol 5 (2) ◽

pp. 82-98 ◽

Cited By ~ 2

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.

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Healthcare digital services in Italy: good practices across Regions

European Journal of Public Health ◽

10.1093/eurpub/ckz186.087 ◽

2019 ◽

Vol 29 (Supplement_4) ◽

Author(s):

S Z Zuccarino ◽

E G Guidotti ◽

M C Cassano ◽

S D R De Rosis ◽

F F Ferrè

Keyword(s):

Healthcare Providers ◽

Digital Transformation ◽

Teaching Hospitals ◽

Public Healthcare ◽

Local Health ◽

Healthcare Organizations ◽

Grid Data ◽

Outpatient Visits ◽

Digital Services ◽

Health Authorities

Abstract Background In Europe, digital transformation of healthcare is one of the agenda priorities. Institutional websites and mobile applications (APPs) have been increasingly adopted by healthcare organizations for communication and service delivery. This study aims at describing the state of art and the variability of healthcare digitalization in Italy. Methods The study focuses on 144 active websites of public healthcare organizations (i.e. Local Health Authorities and Teaching Hospitals) of 11 out of the 21 Regional healthcare systems in Italy. The research investigates whether the healthcare organizations provide e-booking and e-paying for outpatient visits through their website/APP and whether citizens are informed of this opportunity. Researchers independently analyze the websites taking the user’s perspective, by adopting a common grid. Data refers to December 2018. Results The majority of items analyzed show a high variability within and among Regions. The provision of online services patients can benefit of change across the same territory. Almost 76% of the LHAs/hospitals allow for e-booking of outpatient visits and e-paying is available for 84% of them. The adoption of APPs for healthcare is not homogenous. Some Regions develop a specific regional tool (e.g. Apulia, Lombardy) providing uniform access to digital services to their resident population while in other Regions, public healthcare providers can implement their own APP (e.g. Liguria, Veneto). Conclusions Our findings suggest that centralizing digital services - at least at regional level - can enhance healthcare digitalization in Italy, avoiding jeopardized and unequal provision of digital services. Further research should investigate the actual use of these services by citizens and the reasons of variability. Key messages Italy is in delay in digital transformation of healthcare. Our study supports the identification of good regional practices, which could endorse the implementation of future actions.

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