scholarly journals Clinical management: quality and safety of interdisciplinary obstetric gynaecological care in a health care institution

2018 ◽  
Vol 2 (1) ◽  
pp. 13
Author(s):  
María Guima Reinoso Huerta ◽  
Luis Alberto Núñez Lira
Keyword(s):  
Regression Model ◽  
Clinical Management ◽  
Statistical Significance ◽  
Continuous Process ◽  
Health Sector ◽  
Primary Objective ◽  
Public Hospitals ◽  
Quality And Safety ◽  
Process Of Care ◽  
Theoretical Significance

Safe surgery in public hospitals is a primary objective for the achievement of services-safety and -quality provided in the health sector. Within this framework, the research aimed to establish how clinical management affects the quality and safety of interdisciplinary obstetric gynecological care received by the user of a Lima public hospital. The population consisted of 150 health professionals: doctors, obstetricians, nurses and technicians. The instruments applied in the data collection were three questionnaires, the results of which indicate that clinical management is a tool of continuous process of quality improvement directly linked to the moral commitment of health institutions to safeguard the quality and safety of the care provided to the user from a right to health context. The statistical significance of the regression model proposed to express the analogy between clinical management and quality was 0.056, higher than the theoretical significance. However, the statistical significance of the regression model proposed to expose the analogy between Clinical Management and Safety was 0.019, lower than the theoretical significance. It is concluded that hospital management is a complex process, which requires the intervention of all actors involved in the process of care to assume the commitment to control, monitor and improve the risks that may affect the quality and safe environment of the services provided to the patient.

scholarly journals Heterogeneous effects of hospital competition on inpatient expenses: an empirical analysis of diseases grouping basing on conditions’ complexity and urgency

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Liyong Lu ◽  
Xiaojun Lin ◽  
Jay Pan
Keyword(s):  
Regression Model ◽  
Patient Flow ◽  
Statistical Significance ◽  
Healthcare Delivery ◽  
Hospital Competition ◽  
Process Of Care ◽  
Healthcare Delivery System ◽  
Discharge Data ◽  
Heterogeneous Effects ◽  
Hospital Administrative

Abstract Background Multiple pro-competition policies were implemented during the new round of healthcare reform in China. Differences in conditions’ complexity and urgency across diseases associating with various degrees of information asymmetry and choice autonomy in the process of care provision, would lead to heterogeneous effects of competition on healthcare expenses. However, there are limited studies to explore it. This study aims to examine the heterogeneous effects of hospital competition on inpatient expenses basing on disease grouping according to conditions’ complexity and urgency. Methods Collecting information from discharge data of inpatients and hospital administrative data of Sichuan province in China, we selected representative diseases. K-means clustering was used to group the selected diseases and Herfindahl-Hirschman Index (HHI) was calculated based on the predicted patient flow to measure the hospital competition. The log-linear multivariate regression model was used to examine the heterogeneous effects of hospital competition on inpatient expenses. Results We selected 19 representative diseases with significant burdens (more than 1.1 million hospitalizations). The selected diseases were divided into three groups, including diseases with highly complex conditions, diseases with urgent conditions, and diseases with less complex and less urgent conditions. For diseases with highly complex conditions and diseases with urgent conditions, the estimated coefficients of HHI are mixed in the direction and statistical significance in the identical regression model at the 5% level. For diseases with less complex and less urgent conditions, the coefficients of HHI are all positive, and almost all of them significant at the 5% level. Conclusions We found heterogeneous effects of hospital competition on inpatient expenses across disease groups: hospital competition does not play an ideal role in reducing inpatient expenses for diseases with highly complex conditions and diseases with urgent conditions, but it has a significant effect in reducing inpatient expenses of diseases with less complex and less urgent conditions. Our study offers implications that the differences in condition’s complexity and urgency among diseases would lead to different impacts of hospital competition, which would be given full consideration when designing the pro-competition policy in the healthcare delivery system to achieve the desired goal.

scholarly journals Detailed cost of robotic-assisted surgery in the Australian public health sector: from implementation to a multi-specialty caseload

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Kate McBride ◽  
Daniel Steffens ◽  
Christina Stanislaus ◽  
Michael Solomon ◽  
Teresa Anderson ◽  
...  
Keyword(s):  
Public Sector ◽  
Health Sector ◽  
Public Hospitals ◽  
Fixed Costs ◽  
Tertiary Referral Hospital ◽  
Robotic Assisted ◽  
The Public ◽  
Robotic Assisted Surgery ◽  
Specific Implementation ◽  
Theatre Utilisation

Abstract Background A barrier to the uptake of robotic-assisted surgery (RAS) continues to be the perceived high costs. A lack of detailed costing information has made it difficult for public hospitals in particular to determine whether use of the technology is justified. This study aims to provide a detailed description of the patient episode costs and the contribution of RAS specific costs for multiple specialties in the public sector. Methods A retrospective descriptive costing review of all RAS cases undertaken at a large public tertiary referral hospital in Sydney, Australia from August 2016 to December 2018 was completed. This included RAS cases within benign gynaecology, cardiothoracic, colorectal and urology, with the total costs described utilizing various inpatient costing data, and RAS specific implementation, maintenance and consumable costs. Results Of 211 RAS patients, substantial variation was found between specialties with the overall median cost per patient being $19,269 (Interquartile range (IQR): $15,445 to $32,199). The RAS specific costs were $8828 (46%) made up of fixed costs including $4691 (24%) implementation and $2290 (12%) maintenance, both of which are volume dependent; and $1848 (10%) RAS consumable costs. This was in the context of 37% robotic theatre utilisation. Conclusions There is considerable variation across surgical specialties for the cost of RAS. It is important to highlight the different cost components and drivers associated with a RAS program including its dependence on volume and how it fits within funding systems in the public sector.

scholarly journals Midwives’ perspectives on person-centred maternity care in public hospitals in South-east Nigeria: A mixed-method study

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261147
Author(s):  
Daniel Chukwuemeka Ogbuabor ◽  
Ijeoma Lewechi Okoronkwo
Keyword(s):  
Supportive Care ◽  
Maternity Care ◽  
Psychosocial Support ◽  
Statistical Significance ◽  
Demographic Characteristics ◽  
Public Hospitals ◽  
Sampled Data ◽  
Cross Sectional Survey ◽  
The Mean ◽  
Enugu State

Background Person-centred maternity care (PCMC) is acknowledged as essential for achieving improved quality of care during labour and childbirth. Yet, evidence of healthcare providers’ perspectives of person-centred maternity care is scarce in Nigeria. This study, therefore, examined the perceptions of midwives on person-centred maternity care (PCMC) in Enugu State, South-east Nigeria. Materials and methods This study was conducted in seven public hospitals in Enugu metropolis, Enugu State, South-east Nigeria. A mixed-methods design, involving a cross-sectional survey and focus group discussions (FGDs) was used. All midwives (n = 201) working in the maternity sections of the selected hospitals were sampled. Data were collected from February to May 2019 using a self-administered, validated PCMC questionnaire. A sub-set of midwives (n = 56), purposively selected using maximum variation sampling, participated in the FGDs (n = 7). Quantitative data were entered, cleaned, and analysed with SPSS version 20 using descriptive and bivariate statistics and multivariate regression. Statistical significance was set at alpha 0.05 level. Qualitative data were analysed thematically. Results The mean age of midwives was 41.8 years ±9.6 years. About 53% of midwives have worked for ≥10 years, while 60% are junior midwives. Overall, the prevalence of low, medium, and high PCMC among midwives were 26%, 49% and 25%. The mean PCMC score was 54.06 (10.99). High perception of PCMC subscales ranged from 6.5% (dignity and respect) to 19% (supportive care). Midwives’ perceived PCMC was not significantly related to any socio-demographic characteristics. Respectful care, empathetic caregiving, prompt initiation of care, paying attention to women, psychosocial support, trust, and altruism enhanced PCMC. In contrast, verbal and physical abuses were common but normalised. Midwives’ weakest components of autonomy and communication were low involvement of women in decision about their care and choice of birthing position. Supportive care was constrained by restrictive policy on birth companion, poor working conditions, and cost of childbirth care. Conclusion PCMC is inadequate in public hospitals as seen from midwives’ perspectives. Demographic characteristics of midwives do not seem to play a significant role in midwives’ delivery of PCMC. The study identified areas where midwives must build competencies to deliver PCMC.

scholarly journals Infertility and associated factors in three hospitals in Douala, Cameroon: a cross-sectional study

2020 ◽  
Vol 20 (4) ◽  
pp. 1985-95
Author(s):  
Thomas Obinchemti Egbe ◽  
Charmaine Ngo Mbaki ◽  
Nicholas Tendongfor ◽  
Elvis Temfack ◽  
Eugene Belley-Priso
Keyword(s):  
Associated Factors ◽  
Statistical Significance ◽  
Cross Sectional Study ◽  
Public Hospitals ◽  
Multivariate Logistic Regression Model ◽  
Toxic Substances ◽  
Sectional Study ◽  
Cross Sectional ◽  
Reproductive Tract Infection ◽  
History Of

Aim: We determined the prevalence and factors associated with couple infertility in three hospitals in Douala, Cameroon. Methods: We conducted a cross-sectional study from December 18th 2015 to March 18th 2016 in three public hospitals in Douala. Three hundred and sixty participants were studied prospectively for associated fac- tors using a multivariate logistic regression model and 4732 files were studied retrospectively for the prevalence of infertility. Statistical significance was set at p < 0.05. Results: The prevalence of couple infertility was 19.2%. In logistic models, the factors which independently increased the risk of couple infertility were a history of reproductive tract infection/STI, a history of uterine fibroids, a history of dys- menorrhea and abortion for the females while for males it was a history of mumps, erectile dysfunction and exposure to chemicals/toxic substances/pesticides. Conclusion: One in every five couples in this study was infertile. Several factors affect the risks associated with couple in- fertility. The identification of these factors could help detect subgroups of couples at high risk of infertility. Reproductive health education, screening programmes for STI’s that may lead to infertility should be offered to couples. Keywords: Couple infertility; prevalence; associated factors; Douala; Cameroon.

scholarly journals The efficiency of public expenditure on Higher Education: a study with Brazilian Federal Universities

2020 ◽  
Vol 28 (109) ◽  
pp. 1076-1097
Author(s):  
David Daniel Hammes Junior ◽  
Leonardo Flach ◽  
Luísa Karam de Mattos
Keyword(s):  
Higher Education ◽  
Regression Model ◽  
Statistical Significance ◽  
Significance Test ◽  
Survey Method ◽  
Public Expenditures ◽  
Data Envelopment ◽  
Truncated Regression ◽  
Second Stage ◽  
Determining Factors

Abstract This study aims to describe the determining factors in efficiency of public expenditures in Brazilian Federal Universities. A two-stage survey method was applied for a sample of fifty-nine Brazilian Federal Universities, from 2013 to 2017. The Data Envelopment Analysis (DEA) was applied for the first stage in order to measure the efficiency of public expenditures. For the second stage, a truncated regression model was applied, with a double bootstrap procedure for bias correction and statistical significance test of the variables. Results show that some Brazilian Federal Universities were inefficient during this period. Considering the truncated regression model of Simar and Wilson (2007), significant variables that influence the efficiency of public expenditures in federal universities were: public expenditures in Higher Education, number of professors, amount of enrolments, amount of graduates, total expenditures with employees and total amount of employees. Therefore, this study has contributed to scientific literature showing that these variables play a key role to public efficiency in federal universities.

scholarly journals Why it is time to review the role of private health insurance in Australia

2004 ◽  
Vol 28 (1) ◽  
pp. 106
Author(s):  
Michael Roff ◽  
Leonie Segal
Keyword(s):  
Diagnosis Related Groups ◽  
Health Sector ◽  
Public Hospitals ◽  
Private Hospitals ◽  
Australian Health ◽  
Private Health Sector ◽  
Recent Addition ◽  
The Subject ◽  
Health Review

TO THE EDITOR: Since its introduction on 1 January 1999, the 30% rebate has been the subject of much misleading comment by the opponents of the private health sector. A recent addition to these ranks was published in the first edition for 2004 of Australian Health Review (Segal 2004). There is no real attempt at balance in the article. While Segal argues that the rebate has failed to take the pressure off public hospitals, we are not told, for example, that almost one-in-five extra patients admitted by public hospitals in the three years to 2002-03 were actually private patients! Similarly, the article is littered with generalisations and, in some cases, misleading or completely incorrect statements, such as ?Private hospitals do not offer a complete hospital service . . .? Even a cursory examination of the available national data indicates that private hospitals provide services in all but 7 of the 654 diagnosis-related groups (DRGs) recorded. Private hospitals perform all the remaining 647 DRGs.

Rebuilding India’s Public Health

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Imrana Qadeer
Keyword(s):  
Public Health ◽  
Health Service ◽  
Structural Adjustment ◽  
Public Health Service ◽  
Developmental Process ◽  
Health Sector ◽  
Public Hospitals ◽  
International Standards ◽  
Local Context ◽  
Inequality In Health

Assuming impervious boundaries of public health service systems when searching for answers to its problems can be misleading as historically, economic and welfare planning to improve the quality of life of all was considered critical. Despite years of planning, the health sector in India has acquired a tumultuous trajectory with chaos prevailing at different levels – conceptualization, policy, financing, organization and community participation. Using the concept of order in Chaos, this paper attempts to trace four basic underlying elementary patterns in the developmental process rooted in the larger socio-political structures that led to this chaos. Its second section explores the roots from where these patterns explaining the links between health, poverty and inequality in health emanate - the zone of conflict of interests among those who hold power and those whom they represent. It explores how they altered the public health service system and settled in favour of a small but powerful elite (the corporates, the upper-middle class and the professionals) seeking international standards irrespective of the local context. Structural Adjustment and the Health Sector Reforms benefited them by shifting subsidies to the private/corporate sector, transforming services into a costly commodity, fragmented and marginalized primary health care and public hospitals while ushering in hi-tech medicine.

The Role of Management Accounting Systems in Public Hospitals and the Construction of Budgets

2016 ◽  
pp. 366-389
Author(s):  
Carla Marina Pereira de Campos ◽  
Lúcia Lima Rodrigues ◽  
Susana Margarida Faustino Jorge
Keyword(s):  
Management Accounting ◽  
Health Sector ◽  
Public Hospitals ◽  
Public Funds ◽  
Accounting Systems ◽  
The Public ◽  
Management Accounting Systems ◽  
Alternative Approaches ◽  
Traditional Approaches

The role of management accounting systems (MAS) in the construction of budgets in the public health sector has been one of the least studied topics in the international literature. Furthermore, several studies have confirmed the loss of relevance of traditional approaches to budgeting due to the need to implement techniques that are more performance-oriented. Since public hospitals are organisations that depend significantly on public funds, with substantial impacts on governments' budgets, the pressure for reducing expenditures is strong, causing increased difficulties in hospital management. In order to analyse the role of MAS in the preparation of hospital budgets, this chapter presents a literature review on this topic. This review allows to understand the loss of relevance of traditional budgeting techniques and to present alternative approaches. In this process, the implementation of different kinds of budgeting is heavily influenced by governments and professionals. Nevertheless, the research on this topic is still very scarce, evidencing the need to continue studying it.

Users' Satisfaction with the Electronic Health Record (EHR) in the Kingdom of Bahrain

2016 ◽  
Vol 7 (3) ◽  
pp. 29-51
Author(s):  
Aysha Ebrahim Abdulla ◽  
Shurooq Yousif Ahmed ◽  
Maryam Abdulrahman Alnoaimi ◽  
Hayat Ali
Keyword(s):  
Service Quality ◽  
Electronic Health Record ◽  
Online Survey ◽  
Healthcare Providers ◽  
Health Sector ◽  
Public Hospitals ◽  
Health Record ◽  
Record System ◽  
Substantial Impact ◽  
Electronic Health

Today, many hospitals seek to adopt the latest and most sophisticated technologies in order to raise the service quality and users' satisfaction. The Electronic Health Record (EHR) had a substantial impact on the health sector and has enhanced the efficiency and effectiveness of healthcare providers. The purpose of this research is to examine the factors that affect users' satisfaction with the current Health Record System in the Kingdom of Bahrain. A research model was built based on three popular models of users' satisfaction toward information systems. Toward achieving the research objective, a quantitative approach was followed to collect data from an online survey. Accordingly, 152 responses were collected from the users of EHR in public hospitals and health centres in Bahrain. The results of the survey were analyzed using SPSS and SmartPLS 3.0. It was concluded that the most effective factors in the users' satisfaction with EHR were directly service quality and technical support, with system and information quality indirectly through trust.

scholarly journals Evaluation of common variants in the CNR2 gene and its interaction with abdominal obesity for osteoporosis susceptibility in Chinese post-menopausal females

2019 ◽  
Vol 8 (11) ◽  
pp. 544-549
Author(s):  
W. Zheng ◽  
C. Liu ◽  
M. Lei ◽  
Y. Han ◽  
X. Zhou ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Regression Model ◽  
Abdominal Obesity ◽  
Logistic Regression Model ◽  
Haplotype Analysis ◽  
Statistical Significance ◽  
Chinese Patients ◽  
Sign Test ◽  
Environment Interaction ◽  
Post Menopausal

Objectives The objective of this study was to investigate the association of four single-nucleotide polymorphisms (SNPs) of the cannabinoid receptor 2 (CNR2) gene, gene-obesity interaction, and haplotype combination with osteoporosis (OP) susceptibility. Methods Chinese patients with OP were recruited between March 2011 and December 2015 from our hospital. In this study, a total of 1267 post-menopausal female patients (631 OP patients and 636 control patients) were selected. The mean age of all subjects was 69.2 years (sd 15.8). A generalized multifactor dimensionality reduction (GMDR) model and logistic regression model were used to examine the interaction between SNP and obesity on OP. For OP patient-control haplotype analyses, the SHEsis online haplotype analysis software ( http://analysis.bio-x.cn/ ) was employed. Results The logistic regression model revealed that the C allele of rs2501431 and the G allele of rs3003336 were associated with increased OP risk, compared with those with wild genotype. However, no significant correlations were found when analyzing the association of rs4237 and rs2229579 with OP risk. The GMDR analysis suggested that the interaction model composed of two factors, rs3003336 and abdominal obesity (AO), was the best model with statistical significance (p-value from sign test (Psign) = 0.012), indicating a potential gene-environment interaction between rs3003336 and AO. Overall, the two-locus models had a cross-validation consistency of 10/10 and had a testing accuracy of 0.641. Abdominally obese subjects with the AG or GG genotype have the highest OP risk, compared with subjects with the AA genotype and normal waist circumference (WC) (odds ratio (OR) 2.23, 95% confidence interval (CI) 1.54 to 3.51). Haplotype analysis also indicated that the haplotype containing the rs3003336-G and rs2501431-C alleles was associated with a statistically increased OP risk. Conclusion Our results suggested that the C allele of rs2501431 and the G allele of rs3003336 of the CNR2 gene, interaction between rs3003336 and AO, and the haplotype containing the rs3003336-G and rs2501431-C alleles were all associated with increased OP risk. Cite this article: Bone Joint Res 2019;8:544–549.

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