scholarly journals Development of a Methodology for Hospital Beds Planning according to Population and Morbidity

2020 ◽  
Vol 25 (2) ◽  
pp. 6-10
Author(s):  
Heinz Vajasdi ◽  
Nona Delia Chiriac ◽  
Dana Galieta Minca
Keyword(s):  
Literature Review ◽  
Demographic Data ◽  
Family Doctor ◽  
County Level ◽  
Medical Migration ◽  
Demographic Indicators ◽  
Hospitalization Rates ◽  
Hospital Beds ◽  
Previous Hospitalization ◽  
Hospital Morbidity

AbstractIntroduction: Most of the forecast methods for hospital beds estimate a total number of beds per region, based on demographic and utilization indicators, without allocation on specialty wards.Objectives: Develop a forecast methodology per specialty in a county, according to the population needs.Materials and methods: Literature review, demographic data and indicators of hospital morbidity analysis; hospitalization rates adjustment for medical migration; model the allocation of new cases according to the previous hospitalization models.Results: the excess of hospitalization between similar counties varies between -34.71 to 96.50%; adjustment of the hospital beds for patient migration leads to increase in the number of beds in 5 of 6 counties; the allocation of new cases, based on the previous model of hospitalization, triggers the reallocation between specialties.Conclusions: demographic indicators, hospital activity, family doctor records can be used successfully to design the number of beds at county level, according to the needs of the population.

scholarly journals OP0257-PARE USING PATIENT HEALTH LITERACY PROFILES TO IDENTIFY SOLUTIONS TO CHALLENGES FACED IN RHEUMATOLOGY CARE

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 162.2-162
Author(s):  
M. Bakker ◽  
P. Putrik ◽  
J. Rademakers ◽  
M. Van de Laar ◽  
H. Vonkeman ◽  
...  
Keyword(s):  
Health Literacy ◽  
The Netherlands ◽  
Health System ◽  
Demographic Data ◽  
Family Doctor ◽  
List Type ◽  
Research Support ◽  
Score Distribution ◽  
Patient Health ◽  
Literacy Profiles

Background:The prevalence of limited health literacy (i.e. cognitive and social resources of individuals to access, understand and apply health information to promote and maintain good health) in the Netherlands is estimated to be over 36% [1]. Access to and outcomes of rheumatological care may be compromised by limited patient health literacy, yet little is known about how to address this, thus action is required. As influencing individual patients’ health literacy in the rheumatology context is often unrealistic, it is paramount for the health system to be tailored to the health literacy needs of its patients. The OPtimising HEalth LIteracy and Access (Ophelia) process offers a method to inform system change [2].Objectives:Following the Ophelia approach:a. Identify health literacy profiles reflecting strengths and weaknesses of outpatients with RA, SpA and gout.b. Use the health literacy profiles to facilitate discussions on challenges for patients and professionals in rheumatological care and identify possible solutions the health system could offer to address these challenges.Methods:Patients with RA, SpA and gout attending outpatient clinics in three centres in the Netherlands completed the Health Literacy Questionnaire (HLQ) and questions on socio-demographic and health-related characteristics. Hierarchical cluster analysis using Ward’s method identified clusters based on the nine HLQ domains. Three researchers jointly examined 24 cluster solutions for meaningfulness by interpreting HLQ domain scores and patient characteristics. Meaningful clusters were translated into health literacy profiles using HLQ patterns and demographic data. A patient research partner confirmed the identified profiles. Patient vignettes were designed by combining cluster analyses results with qualitative patient interviews. The vignettes were used in two two-hour co-design workshops with rheumatologists and nurses to discuss their perspective on health literacy-related challenges for patients and professionals, and generate ideas on how to address these challenges.Results:In total, 895 patients participated: 49% female, mean age 61 years (±13.0), 25% lived alone, 18% had a migrant background, 6.6% did not speak Dutch at home and 51% had low levels of education. Figure 1 shows a heat map of identified health literacy profiles, displaying the score distribution per profile across nine health literacy domains. Figure 2 shows an excerpt of a patient vignette, describing challenges for a patient with profile number 9. The workshops were attended by 7 and 14 nurses and rheumatologists. Proposed solutions included health literacy communication training for professionals, developing and improving (visual) patient information materials, peer support for patients through patient associations or group consultations, a clear referral system for patients who need additional guidance by a nurse, social worker, lifestyle coach, pharmacist or family doctor, and more time with rheumatology nurses for target populations. Moreover, several system adaptations to the clinic, such as a central desk for all patient appointments, were proposed.Conclusion:This study identified several distinct health literacy profiles of patients with rheumatic conditions. Engaging with health professionals in co-design workshops led to numerous bottom-up ideas to improve care. Next steps include co-design workshops with patients, followed by prioritising and testing proposed interventions.References:[1]Heijmans M. et al. Health Literacy in the Netherlands. Utrecht: Nivel 2018[2]Batterham R. et al. BMC Public Health 2014, 14:694Disclosure of Interests:Mark Bakker: None declared, Polina Putrik: None declared, Jany Rademakers Speakers bureau: In March 2017, Prof. Dr. Rademakers was invited to speak about health literacy at the “Heuvellanddagen” Conference, hosted by Janssen-Cilag., Mart van de Laar Consultant of: Sanofi Genzyme, Speakers bureau: Sanofi Genzyme, Harald Vonkeman: None declared, Marc R Kok Grant/research support from: BMS and Novartis, Consultant of: Novartis and Galapagos, Hanneke Voorneveld: None declared, Sofia Ramiro Grant/research support from: MSD, Consultant of: Abbvie, Lilly, Novartis, Sanofi Genzyme, Speakers bureau: Lilly, MSD, Novartis, Maarten de Wit Grant/research support from: Dr. de Wit reports personal fees from Ely Lilly, 2019, personal fees from Celgene, 2019, personal fees from Pfizer, 2019, personal fees from Janssen-Cilag, 2017, outside the submitted work., Consultant of: Dr. de Wit reports personal fees from Ely Lilly, 2019, personal fees from Celgene, 2019, personal fees from Pfizer, 2019, personal fees from Janssen-Cilag, 2017, outside the submitted work., Speakers bureau: Dr. de Wit reports personal fees from Ely Lilly, 2019, personal fees from Celgene, 2019, personal fees from Pfizer, 2019, personal fees from Janssen-Cilag, 2017, outside the submitted work., Richard Osborne Consultant of: Prof. Osborne is a paid consultant for pharma in the field of influenza and related infectious diseases., Roy Batterham: None declared, Rachelle Buchbinder: None declared, Annelies Boonen Grant/research support from: AbbVie, Consultant of: Galapagos, Lilly (all paid to the department)

scholarly journals The Impact of ‘Stay At Home’ Orders on Emergency Room Admissions

2020 ◽  
Vol 18 (3) ◽  
pp. 165-169
Author(s):  
Abdullah Osman Kocak ◽  
◽  
Sinem Dogruyol ◽  
Ilker Akbas ◽  
Bugra Kerget ◽  
...  
Keyword(s):  
Emergency Room ◽  
Retrospective Cohort ◽  
Geriatric Patients ◽  
Demographic Data ◽  
Admission Diagnosis ◽  
The Public ◽  
Hospitalization Rates ◽  
First Case ◽  
Novel Coronavirus ◽  
The Impact

Introduction. The 2019-novel-coronavirus (2019-nCoV) outbreak has become a common problem for the whole world. Aim. To investigate the impact of the 2019-nCoV pandemic period in our country on emergency room admissions. Materials and methods. The study was designed as a retrospective cohort. The first case of pneumonia infected with nCoV in our country was diagnosed on March 11, 2020. Considering the date of March 11, 2020, emergency room admissions for two periods of 7 days were investigated, pre-COVID-19 and COVID19. Demographic data, admission diagnosis, vital findings, stay times in emergency room, terminations and emergency department mortality examined. A group of ‘geriatric’ patient populations were created to examine the admission characteristics of patients aged-65 and over. Results. The 3466 patients included in the study. The average number of daily admissions was significantly higher in the pre-COVID-19 period (350.4 ± 54.5), compared to the COVID-19 period (144.7 ± 20.2, p=0001). While the proportion of cardiac- caused admissions increased during the COVID period, the proportion of gastrointestinal-induced admissions decreased (p<0001). Hospitalization rates for both adult and geriatric patients increased during the COVID period (p<0001). Conclusion. Despite all the negativity caused by the outbreak, this period has been one in which the public is aware of unnecessary emergency room which has been subsequently lessened.

Surgical density and its effect on esophageal cancer (EC) and gastric (GC) mortality.

2011 ◽  
Vol 29 (4_suppl) ◽  
pp. 16-16
Author(s):  
M. Y. Ho ◽  
J. S. Albarrak ◽  
W. Y. Cheung
Keyword(s):  
Household Income ◽  
Population Level ◽  
Multimodality Treatment ◽  
General Surgeon ◽  
County Level ◽  
Median Household Income ◽  
Hospital Beds ◽  
Beta Coefficient ◽  
General Surgeons ◽  
The Impact

16 Background: Surgical resection plays an integral role in the multimodality treatment of patients with EC or GC. The distribution of thoracic and general surgeons at the county level varies widely across the US. The impact of the allocation of these surgeons on cancer outcomes is unclear. Our aims were to 1) examine the effect of surgeon density on EC or GC mortality, 2) compare the relative roles of thoracic and general surgeons on EC and GC outcomes and 3) determine other county characteristics associated with cancer mortality. Methods: Using county-level data from the Area Resources File, U.S. Census and National Cancer Institute, we constructed regression models to explore the effect of thoracic and general surgeon density on EC and GC mortality, respectively. Multivariate analyses controlled for incidence rate, county demographics (population aged 65+, proportion eligible for Medicare, education attainment, metropolitan vs. rural), socioeconomic factors (median household income) and healthcare resources (number of general practitioners, number of hospital beds). Results: In total, 332 and 402 counties were identified for EC and GC, respectively: mean EC/GC incidence = 5.29/6.83; mean EC/GC mortality=4.70/3.92; 91% were metropolitan and 9% were rural; mean thoracic and general surgeon densities were 10 and 63 per 100,000 people, respectively. When compared to counties with no thoracic surgeons, those with at least 1 thoracic surgeon had reduced EC mortality (beta coefficient -0.031). For GC, counties with 1 or more general surgeons also had decreased number of deaths (beta coefficient -0.095) when compared with those without any surgeons. While increasing the density of surgeons beyond 10 only yielded minimal improvements in EC mortality, it resulted in significant further reductions in GC mortality. Other county characteristics, such as increased number of hospital beds and higher median household income, were correlated with improved outcomes. Conclusions: Mortality from GC appears to be more susceptible to the benefits of increased surgeon density. For EC, a strategic policy of allocating health resources and distributing the workforce across counties will be best able to optimize outcomes at the population-level. No significant financial relationships to disclose.

scholarly journals A comparative study of patient characteristics, opinions, and outcomes, for patients who leave the emergency department before medical assessment

CJEM ◽  
2016 ◽  
Vol 19 (5) ◽  
pp. 347-354 ◽  
Author(s):  
Jacqueline Fraser ◽  
Paul Atkinson ◽  
Audra Gedmintas ◽  
Michael Howlett ◽  
Rose McCloskey ◽  
...  
Keyword(s):  
Health Care ◽  
Emergency Department ◽  
Performance Indicator ◽  
Medical Condition ◽  
Demographic Data ◽  
Family Doctor ◽  
Wait Time ◽  
Wait Times ◽  
Control Group ◽  
Fisher Exact Test

AbstractObjectiveThe emergency department (ED) left-without-being-seen (LWBS) rate is a performance indicator, although there is limited knowledge about why people leave, or whether they seek alternate care. We studied characteristics of ED LWBS patients to determine factors associated with LWBS.MethodsWe collected demographic data on LWBS patients at two urban hospitals. Sequential LWBS patients were contacted and surveyed using a standardized telephone survey. A matched group of patients who did not leave were also surveyed. Data were analysed using the Fisher exact test, chi-square test, and student t-test.ResultsThe LWBS group (n=1508) and control group (n=1504) were matched for sex, triage category, recorded wait times, employment and education, and having a family physician. LWBS patients were younger, more likely to present in the evening or at night, and lived closer to the hospital. A long wait time was the most cited reason for leaving (79%); concern about medical condition was the most common reason for staying (96%). Top responses for improved likelihood of waiting were shorter wait times (LWBS, 66%; control, 31%) and more information on wait times (41%; 23%). A majority in both groups felt that their condition was a true emergency (63%; 72%). LWBS patients were more likely to seek further health care (63% v. 28%; p<0.001) and sooner (median time 1 day v. 2-4 days; p=0.002). Among patients who felt that their condition was not a true emergency, the top reason for ED attendance was the inability to see their family doctor (62% in both groups).ConclusionLWBS patients had similar opinions, experiences, and expectations as control patients. The main reason for LWBS was waiting longer than expected. LWBS patients were more likely to seek further health care, and did so sooner. Patients wait because of concern about their health problem. Shorter wait times and improved communication may reduce the LWBS rate.

scholarly journals Convergence processes of selected demographic indicators in regions of the Czech Republic

2010 ◽  
Vol 58 (3) ◽  
pp. 137-144
Author(s):  
Bohumil Minařík ◽  
Jaroslav Dufek ◽  
Zlata Sojková
Keyword(s):  
Czech Republic ◽  
Demographic Data ◽  
Point Of View ◽  
Capital City ◽  
Demographic Development ◽  
Original Result ◽  
The Czech Republic ◽  
Demographic Indicators ◽  
Sigma Convergence ◽  
Opposite Situation

A number of authors deal with problems of convergence, divergence and disparities, particularly with reference to economic growth and its comparison in groups of countries. This paper is aimed at problems of using basic methods of measuring the convergence at the evaluation of the development of selected demographic characteristics of particular regions of the Czech Republic for the period 1992 to 2007. From demographic data provided by the Czech Statistical Office some indicators were selected associated with aging the CR population. In particular, following indicators were used: the proportion of productive population, coefficient of loading the productive population by young persons, coefficient of loading the productive population by old persons, coefficient of the total loading and index of age. A precondition served as a working hypothesis that in addition to the negative demographic development affecting the CR as a whole, the convergence of its particular regions also occurred, viz. regions at the level of NUTS 3. At the quantification of convergence processes in particular regions of the CR, the method of beta convergence was used (in a simplified linearized form) as well as the method of sigma convergence. Both methods predicate unambiguously on the convergence of the CR regions from the point of view of all examined demographic indicators. From the aspect of both methods, the fastest convergence occurred in the studied period in the indicator of loading the productive population by old persons. In this indicator (as the only from monitored ones), no disparity showed as well, ie a region showing an isolated development was not noted. Opposite situation manifested itself at the indicator of loading the productive population by young persons. Only elimination of the capital city of Prague reversed an original result showing evidence of the divergence of regions from the aspect of this indicator. Disparities of the capital city of Prague occurred even at other two indicators. Only from the aspect of age, the Central Bohemian region became a region being beside the general trend of convergence.

scholarly journals Inter‑Municipal Cooperation in Education as a Possible Remedy for Current Difficulties of Local Government in Poland

2020 ◽  
Vol 5 (350) ◽  
pp. 101-125
Author(s):  
Aneta Kaczyńska
Keyword(s):  
Public Education ◽  
Literature Review ◽  
Local Governments ◽  
Economies Of Scale ◽  
County Level ◽  
Emergence Of Cooperation ◽  
Net Benefits ◽  
Joint Provision ◽  
Potential Remedy

The purpose of this article is to fill the existing gap and contribute to the literature in two ways: firstly, by investigating problems that caused the emergence of cooperation between two municipalities despite the administrative border at the county level, and secondly, by analysing the effects of joint provision of public education based on a case study from Poland. The case study is preceded by the use of the literature review method. The problem of possible enhancement of inter‑municipal cooperation (IMC) in Poland is proposed as a potential remedy for current difficulties that Polish local governments face after the reform of the education system and the COVID–19 pandemic, as well as due to demographic decline and budgetary challenges. Studies suggest that net benefits of cooperating are higher if IMC partners are smaller and more homogenous with respect to the quality and level of public services. The theory of exploiting economies of scale and scope was studied based on the case study of a Polish inter‑municipal union created only to provide education in two municipalities. The cooperation resulted in little positive financial effects reflected in the lower spending per pupil only in the case of primary school. However, the union caused nonfinancial benefits not only for pupils but also for parents and teachers, who are voters as well. The article concludes that inter‑municipal unions could be used especially by small and rural municipalities that struggle with the previously mentioned problems.

scholarly journals The Role of SARS-CoV-2 Testing on Hospitalizations in California

Life ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 1336
Author(s):  
José Cricelio Montesinos-López ◽  
Maria L. Daza-Torres ◽  
Yury E. García ◽  
Luis A. Barboza ◽  
Fabio Sanchez ◽  
...  
Keyword(s):  
Mixed Linear Model ◽  
Health Conditions ◽  
County Level ◽  
Health Crisis ◽  
Socioeconomic Characteristics ◽  
Hospitalization Rates ◽  
Rapid Spread ◽  
Public Health Officials ◽  
Virus Strains

The rapid spread of the new SARS-CoV-2 virus triggered a global health crisis, disproportionately impacting people with pre-existing health conditions and particular demographic and socioeconomic characteristics. One of the main concerns of governments has been to avoid health systems becoming overwhelmed. For this reason, they have implemented a series of non-pharmaceutical measures to control the spread of the virus, with mass tests being one of the most effective controls. To date, public health officials continue to promote some of these measures, mainly due to delays in mass vaccination and the emergence of new virus strains. In this research, we studied the association between COVID-19 positivity rate and hospitalization rates at the county level in California using a mixed linear model. The analysis was performed in the three waves of confirmed COVID-19 cases registered in the state to September 2021. Our findings suggest that test positivity rate is consistently associated with hospitalization rates at the county level for all study waves. Demographic factors that seem to be related to higher hospitalization rates changed over time, as the profile of the pandemic impacted different fractions of the population in counties across California.

Minmaxing of Bayesian Improved Surname Geocoding and Geography Level Ups in Predicting Race

2021 ◽  
pp. 1-7
Author(s):  
Jesse T. Clark ◽  
John A. Curiel ◽  
Tyler S. Steelman
Keyword(s):  
Demographic Data ◽  
Critical Factor ◽  
County Level ◽  
Racial Identification ◽  
Substantial Portion ◽  
Ecological Data ◽  
Trade Offs ◽  
Hispanic Voters ◽  
Black Voters ◽  
Zip Code

Abstract Racial identification is a critical factor in understanding a multitude of important outcomes in many fields. However, inferring an individual’s race from ecological data is prone to bias and error. This process was only recently improved via Bayesian improved surname geocoding (BISG). With surname and geographic-based demographic data, it is possible to more accurately estimate individual racial identification than ever before. However, the level of geography used in this process varies widely. Whereas some existing work makes use of geocoding to place individuals in precise census blocks, a substantial portion either skips geocoding altogether or relies on estimation using surname or county-level analyses. Presently, the trade-offs of such variation are unknown. In this letter, we quantify those trade-offs through a validation of BISG on Georgia’s voter file using both geocoded and nongeocoded processes and introduce a new level of geography—ZIP codes—to this method. We find that when estimating the racial identification of White and Black voters, nongeocoded ZIP code-based estimates are acceptable alternatives. However, census blocks provide the most accurate estimations when imputing racial identification for Asian and Hispanic voters. Our results document the most efficient means to sequentially conduct BISG analysis to maximize racial identification estimation while simultaneously minimizing data missingness and bias.

scholarly journals Certificate-Of-Need Regulation and Healthcare Service Quality: Evidence from the Nursing Home Industry

Healthcare ◽  
2020 ◽  
Vol 8 (4) ◽  
pp. 423
Author(s):  
Bichaka Fayissa ◽  
Saleh Alsaif ◽  
Fady Mansour ◽  
Tesa E. Leonce ◽  
Franklin G. Mixon
Keyword(s):  
Nursing Home ◽  
Service Quality ◽  
Demographic Data ◽  
County Level ◽  
Nursing Assistant ◽  
Certificate Of Need ◽  
Licensed Practical Nurse ◽  
Certified Nursing Assistant ◽  
Level Data ◽  
Nursing Home Industry

This quantitative study investigates the effect of certificate-of-need (CON) regulation on the quality of care in the nursing home industry. It uses county-level demographic data from the 48 contiguous US states that are extracted from the American Community Survey (ACS) and cover the years 2012, 2013, and 2014. In doing so, it employs a new set of service quality variables captured from a variety of county-level data sources. Instrumental variables results indicate that health survey scores for nursing homes that are computed by healthcare professionals are about 18–24% lower, depending on the type of nursing home under consideration, in states with CON regulation. We also find that the presence of CON regulation leads to a substitution of lower-quality certified nursing assistant care for higher-quality licensed practical nurse care, regardless of the type of nursing home under consideration.

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