scholarly journals Multilevel Zero-One Inflated Beta Regression Model for the Analysis of the Relationship between Exogenous Health Variables and Technical Efficiency in the Spanish National Health System Hospitals

2021 ◽  
Vol 18 (19) ◽  
pp. 10166
Author(s):  
Ricardo Ocaña-Riola ◽  
Carmen Pérez-Romero ◽  
Mª Isabel Ortega-Díaz ◽  
José Jesús Martín-Martín
Keyword(s):  
Intensive Care ◽  
Technical Efficiency ◽  
Ownership Structure ◽  
Efficiency Index ◽  
Public Hospitals ◽  
Beta Regression ◽  
Efficiency Frontier ◽  
Private Hospitals ◽  
The Mean ◽  
The Relationship

Background: This article proposes a methodological innovation in health economics for the second stage analysis of technical efficiency in hospitals. It investigates the relationship between the installed capacity in regions and hospitals and their ownership structure. Methods: A multilevel zero-one inflated beta regression model is employed to model pure technical efficiency more adequately than other models frequently used in econometrics. Results: Compared to publicly managed hospitals, the mean efficiency index of hospitals with public-private partnership (PPP) formulas was 4.27-fold. This figure was 1.90-fold for private hospitals. Concerning the efficiency frontier, the odds ratio (OR) of PPP models vs. public hospitals was 42.06. The OR of private hospitals vs. public hospitals was 8.17. A one standard deviation increase in the percentage of beds in intensive care units increases the odds of being situated on the efficiency frontier by 50%. Conclusions: The proportion of hospital beds in intensive care units relates to a higher chance of being on the efficiency frontier. Hospital ownership structure is related to the mean efficiency index of Spanish National Health Service hospitals, as well as the odds of being situated on the efficiency frontier.

scholarly journals Multilevel Analysis of the Relationship between Ownership Structure and Technical Efficiency Frontier in the Spanish National Health System Hospitals

2020 ◽  
Vol 17 (16) ◽  
pp. 5905 ◽  
Author(s):  
Mª Isabel Ortega-Díaz ◽  
Ricardo Ocaña-Riola ◽  
Carmen Pérez-Romero ◽  
José Jesús Martín-Martín
Keyword(s):  
Health System ◽  
Technical Efficiency ◽  
National Health ◽  
Ownership Structure ◽  
National Health System ◽  
Public Hospitals ◽  
Efficiency Frontier ◽  
Spanish National Health System ◽  
Generalised Linear Mixed Model ◽  
The Relationship

Objective: To evaluate the relationship between the ownership structure of hospitals and the possibility of their being positioned on the frontier of technical efficiency in the economic crisis period 2010–2012, adjusting for hospital variables and regional characteristics in the areas where the Spanish National Health System (SNHS) hospitals are located. Methods: 230 National Health System hospitals were studied over the two-year period 2010–2012 according to their ownership structure—public hospitals, private hospitals and public–private partnership (PPP)—data envelopment analysis orientated to inputs was used to measure the overall technical efficiency, pure efficiency and efficiency of scale. A generalised linear mixed model (GLMM) with binomial distribution and logit link function was used to analyse the hospital and regional variables associated with positioning on the frontier. Results: There are substantial differences between the average pure technical efficiency of public, private and PPP hospitals, as well as a greater number of PPP models being positioned on the efficiency frontier (91.67% in 2012). The odds of being positioned on the frontier are 41.7 times higher in PPP models than in public hospitals. The average annual household income per region is related to the greater odds of hospitals being positioned on the frontier of efficiency. Conclusions: During the most acute period of recession in the Spanish economy, PPP formulas favoured hospital efficiency, by increasing the odds of being positioned on the frontier of efficiency when compared to private and public hospitals. The position on the frontier of efficiency of a hospital is related to the wealth of its region.

Matching Ethical Climate to Nurses’ Service Behaviors in Public and Private Hospitals: A Cross-Sectional Study

2020 ◽  
Author(s):  
Na Zhang ◽  
Jingjing Li ◽  
Xing Bu ◽  
Zhenxing Gong
Keyword(s):  
Ethical Climate ◽  
Cross Sectional Study ◽  
Public Hospitals ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Private Hospitals ◽  
Public And Private ◽  
Service Behavior ◽  
Public And Private Hospitals ◽  
The Relationship

Abstract Background: Workplace climate is great significant element that has impact on nurses’ behavior and practice; moreover, nurses’ service behavior contributes to the patients’ satisfaction and subsequently to the long-term success of hospitals. Few studies explore how different types of organizational ethical climate encourage nurses to engage in both in-role and extra-role service behaviors, especially in comparing the influencing process between public and private hospitals. This study aimed to compare the relationship between the five types of ethical climate and nurses’ in-role and extra-role service behaviors in public and private hospitals.Methods: This study conducted a cross-sectional survey on 559 nurses from China. All participants were investigated using the Ethical Climate Scale and Service Behavior Questionnaire. SPSS 22.0 was used for correlation analysis, t-test and analysis of variance test, and Mplus 7.4 was used for group comparison.Results: The law and code climate has a much greater influence on nurses’ in-role service behavior in private hospitals than on that in public hospitals (β = -.277; CI 95% = [-.452, -.075]; p < .01), and the instrumental climate has a stronger influence on nurses’ extra-role service behavior private hospitals than on that in public hospitals (β = -.352; CI 95% = [-.651, -.056]; p < .05). Meanwhile, the rules climate has a greater effect on nurses’ extra-role service behavior in public hospitals than it does in private hospitals (β = .397; CI 95% = [.120, .651]; p < .01). Conclusions: As the relationship between the five types of ethical climate and nurses’ in-role and extra-role service behaviors in public and private hospitals were different, the strategies used to foster and enhance the types of ethical climate are various from public to private hospitals. The caring and instrumental climate are the key to promote extra-role service behavior for nurses in private hospitals. And independent climate has great effect on extra-role service behaviors for nurses in public hospitals.

Abstract 339: Relationship Between Post-arrest Care Hemodynamics and Cerebral Oxygen Saturation in Comatose Survivors of Out-of-hospital Cardiac Arrest: Insights From the CAPITAL-RETURN Trial

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Juan J Russo ◽  
Paul Boland ◽  
Simon Parlow ◽  
Jordan Bernick ◽  
Rebecca Mathew ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Arrest ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Oxygen Delivery ◽  
Cerebral Oxygen ◽  
Shockable Rhythm ◽  
The Mean ◽  
The Relationship ◽  
Capital Return

Introduction: Comatose survivors of OHCA develop a post cardiac arrest syndrome (PCAS) characterized by myocardial dysfunction and cerebrovascular dysregulation. Hemodynamic derangements related to PCAS can jeopardize cerebral oxygen delivery and therefore impair neurologic recovery. However, optimal hemodynamic targets to ensure adequate cerebral oxygen delivery following OHCA remain undefined. Accordingly, we examined the relationship between cardiac index (CI), mean arterial pressure (MAP), and regional cerebral oxygen saturation (rO 2 %) following OHCA. Methods: CAPITAL-RETURN was a prospective, single-center observational study examining hemodynamics in comatose survivors of OHCA undergoing targeted temperature management after an initial shockable rhythm. Between August 2016 and December 2017, comatose survivors of OHCA underwent continuous, blinded, non-invasive monitoring of CI and rO 2 % using bioimpedance (Cheetah Medical, Portland, OR, USA) and near-infrared spectroscopy (Covidien, Boulder, CO, USA), respectively, for 96 hours after intensive care unit admission. In the present study, we examined the relationship between CI, MAP, and rO 2 % using multivariable linear regression. Results: In 56 patients in this analysis, the mean CI and MAP during the first 96 hours of intensive care unit admission were 3.2±0.5 L/min/m 2 and 76±6 mmHg, respectively (Figure). The mean rO 2 % was 63±9% and increased over time (+0.1% per hour; p<0.001). Higher CI was associated with improved rO 2 % (+3.2% per L/min/m2 increase in CI; p<0.0001). There was no association between MAP and rO 2 % (p=0.42). After adjustment for MAP, the association between CI and rO 2 % remained significant (+3.1% per L/min/m2 increase in CI; p<0.0001). Conclusion: In comatose survivors of OHCA with an initial shockable rhythm, a higher CI is associated with improved rO 2 %. Further studies are needed to determine whether CI targets improve rO2% and neurologic outcomes following OHCA.

scholarly journals A Survey of Fellows of the Faculty of Anaesthetists of the Royal Australasian College of Surgeons Endorsed in Intensive Care by Examination in the First 10 Years of Final Examinations in Intensive Care

1992 ◽  
Vol 20 (2) ◽  
pp. 203-210 ◽  
Author(s):  
G. A. Harrison ◽  
P. L. Byth
Keyword(s):  
Internal Medicine ◽  
Intensive Care ◽  
Public Hospitals ◽  
Final Examination ◽  
Private Hospitals ◽  
Anaesthetic Practice ◽  
Vocational Qualification ◽  
Care Specialist ◽  
Royal Australasian College

Fifty-nine of the 70 Fellows of the Faculty of Anaesthetists who had passed the Final Examination in Intensive Care including that of October 1989, responded to a questionnaire on the pattern of their intensive care and anaesthetic practice and their perception of the training and examination. Responses came predominantly from Fellows who had passed the examination more than two years previously. Forty-eight (81%) were practising intensive care at least 50% of the time and 51% had become Director or Deputy Director of an Intensive Care Unit. However, 51% maintained some anaesthetic practice. Although individuals had changed the intensive care/anaesthetic distribution of their practice, the group overall had not. With one exception all Fellows were practising in public hospitals but 26% in private hospitals also. Only eight had sought intensive care as their first vocational qualification. Training and examination were generally regarded favourably except for training in research methods and experience in internal medicine. The results suggest that the intensive care specialist is not likely to leave such practice in the long term, but there has been a reluctance to abandon altogether training and some subsequent practice in anaesthetics.

The effects of healthcare governance and ownership structure on the performance of hospitals in Ghana

2015 ◽  
Vol 57 (2) ◽  
pp. 107-140 ◽  
Author(s):  
Patience Aseweh Abor
Keyword(s):  
Ownership Structure ◽  
Public Hospitals ◽  
Governing Board ◽  
Board Governance ◽  
Private Hospitals ◽  
Content Type ◽  
Effective Governance ◽  
Multiple Regression Models ◽  
Health Care Governance ◽  
Better Than

Purpose – The purpose of this study is to examine the effects of health-care governance and ownership structure on the performance of hospitals in Ghana. Design/methodology/approach – The study uses multiple regression models based on a sample of 132 hospitals in Ghana. Findings – The results of the study indicate that hospitals with a governing board perform better than those without a governing board. The results of this study also suggest that board characteristics and ownership structure are important in explaining the performance of hospitals in Ghana. The results further indicate that mission-based and private hospitals with effective board governance structures exhibit better performance than public hospitals. Originality/value – This study makes a number of new and meaningful contributions to the extant literature and the findings support managerialism, stakeholder and resource dependency theories. The findings also have important implications for the effective governance of hospitals.

scholarly journals Measuring the Efficiency of Public Hospitals in Kuwait: A Two-Stage Data Envelopment Analysis and a Qualitative Survey Study

2020 ◽  
Vol 12 (3) ◽  
pp. 121
Author(s):  
Abdullah M. Alsabah ◽  
Hassan Haghparast-Bidgoli ◽  
Jolene Skordis
Keyword(s):  
Technical Efficiency ◽  
Efficiency Score ◽  
Hospital Efficiency ◽  
Public Hospitals ◽  
Scale Efficiency ◽  
Data Envelopment ◽  
Tobit Regression ◽  
Factors Affecting ◽  
The Mean ◽  
Technical Efficiency Score

The recent drop in oil prices has challenged public sector financing in Kuwait. Technical and scale efficiency scores for fifteen public hospitals in Kuwait from 2010 to 2014 were estimated using a two-stage data envelopment analysis (DEA). Technical efficiency scores were regressed against institutional characteristics using Tobit regression to investigate the determinants of efficiency differences in hospitals. Semi-structured interviews were also carried out with fourteen public and private hospital managers to qualitatively explore their perceptions and experience about about factors affecting hospital efficiency. The mean technical efficiency score for all hospitals was 85.8%, an improvement of 2% since 2010. The mean pure technical efficiency score was 79.6%, improving from 75% in 2010 to 81.2% in 2014. The mean scale efficiency score was 91.8%, improving from 87.6% in 2010 to 94.2% in 2014. Only three hospitals were constantly technically and scale efficient. Tobit regression showed that hospital efficiency was significantly associated with the average length of patient stay. Hospitals with more than 400 beds were potentially more technically and scale efficient. The qualitative study revealed that external factors affecting efficiency commonly included implemention of legislative changes and decreasing bureaucracy, while internal factors included increasing bed capacity and improving qualifications and training of human resources. Most public hospitals in Kuwait were not technically and scale efficient, but improvements were observed. Potential factors that affected the efficiency of hospitals in Kuwait were identified. These findings are useful to decision-makers in Kuwait for developing strategies to improve public hospital efficiency.

scholarly journals The relationship between ethical climate and nursing service behavior in public and private hospitals: a cross-sectional study in China

BMC Nursing ◽  
2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Na Zhang ◽  
Jingjing Li ◽  
Xing Bu ◽  
Zhen-Xing Gong
Keyword(s):  
Ethical Climate ◽  
Public Hospitals ◽  
Snowball Sampling ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Private Hospitals ◽  
Public And Private ◽  
Service Behavior ◽  
Public And Private Hospitals ◽  
The Relationship

Abstract Background Workplace climate is a great significant element that has an impact on nurses’ behavior and practice; moreover, nurses’ service behavior contributes to the patients’ satisfaction and subsequently to the long-term success of hospitals. Few studies explore how different types of organizational ethical climate encourage nurses to engage in both in-role and extra-role service behaviors, especially in comparing the influencing process between public and private hospitals. This study aimed to compare the relationship between the five types of ethical climate and nurses’ in-role and extra-role service behaviors in public and private hospitals. Methods This study conducted a cross-sectional survey on 559 nurses from China in May 2019. The questionnaire was distributed to nurses by sending a web link via the mobile phone application WeChat through snowball sampling methods. All participants were investigated using the Ethical Climate Scale and Service Behavior Questionnaire. SPSS 22.0 was used for correlation analysis, t-test, and analysis of variance test, and Mplus 7.4 was used for group comparison (p < .05). Results The law and code climate has a much greater influence on nurses’ in-role service behavior in private hospitals than on that in public hospitals (β = − 0.277; CI 95 % = [-0.452, − 0.075]; p < .01), and the instrumental climate has a stronger influence on nurses’ extra-role service behavior private hospitals than on that in public hospitals (β = − 0.352; CI 95 % = [-0.651, − 0.056]; p < .05). Meanwhile, the rules climate has a greater effect on nurses’ extra-role service behavior in public hospitals than it does in private hospitals (β = 0.397; CI 95 % = [0.120, 0.651]; p < .01). Conclusions As the relationship between the five types of ethical climate and nurses’ in-role and extra-role service behaviors in public and private hospitals were different, the strategies used to foster and enhance the types of ethical climate are various from public to private hospitals. The caring and instrumental climate are the key to promote extra-role service behavior for nurses in private hospitals. And the independent climate has a great effect on extra-role service behaviors for nurses in public hospitals.

scholarly journals Relationship Between Ethical Leadership Behavior and Work Motivation in Intensive Care Nurses: A Cross-sectional Study

2020 ◽  
Vol 27 (1) ◽  
pp. E202011
Author(s):  
Derya Uzelli Yilmaz ◽  
Fatma Düzgün ◽  
Dilek Yilmaz
Keyword(s):  
Intensive Care ◽  
Ethical Leadership ◽  
Work Motivation ◽  
Leadership Behavior ◽  
Cross Sectional ◽  
Intensive Care Nurses ◽  
The Mean ◽  
Motivation Scale ◽  
The Relationship ◽  
Ethical Leadership Scale

Aim: Affecting the attitudes and the behaviors of the employees, leaders’ ethical focused behavior is one of the most important factors affecting employee work motivation. The study was conducted with the aim of examining the relationship between ethical leadership behavior and the work motivation of Intensive Care Nurses (ICNs). Material and Methods: The study adopted a cross-sectional and descriptive design and was performed between August and October 2018 with 98 ICNs at a university hospital in Turkey. A Nurses’ Description Form, the Ethical Leadership Scale, and the Nurses’ Work Motivation Scale were used to collect data. Since the data were found to be normally distributed, to compare the total scores of ethical leadership scale and nurses’ work motivation scale for demographic information of the nurses independent t-test and analysis of variance (ANOVA) test were used. Pearson correlation analysis was used to determine the relationship between ethical leadership and work satisfaction. Results: A statistically significant positive correlation was found between the mean total score of the Ethical Leadership Scale and the mean total score of the Nurses’ Work Motivation Scale (p < 0.001). A statistically significant difference was found between the mean total score of the ELS and the number of patients for whom daily nursing care was provided (p < 0.05). Conclusions: It was concluded from this study that the perceptions of ICNs concerning ethical leadership behavior and their work motivation were at a medium level. In addition, it was found that the nurses’ ethical leadership behavior had a positive effect on their work motivation. Nursing leaders should therefore endeavor to maintain their ethical behavioral integrity in order to promote nurses’ work motivation.

Factors Associated With the Increasing Rates of Discharges Directly Home From Intensive Care Units—A Direct From ICU Sent Home Study

2016 ◽  
Vol 33 (2) ◽  
pp. 121-127 ◽  
Author(s):  
Vincent I. Lau ◽  
Fran A. Priestap ◽  
Joyce N. H. Lam ◽  
Ian M. Ball
Keyword(s):  
Intensive Care ◽  
Disease Burden ◽  
Inverse Correlation ◽  
Patient Characteristics ◽  
Median Number ◽  
Surgical Trauma ◽  
Home Study ◽  
Transfer Delay ◽  
The Mean ◽  
The Relationship

Objectives: To evaluate the relationship between rates of discharge directly to home (DDH) from the intensive care unit (ICU) and bed availability (ward and ICU). Also to identify patient characteristics that make them candidates for safe DDH and describe transfer delay impact on length of stay (LOS). Methods: Retrospective cohort study of all adult patients who survived their stay in our medical–surgical–trauma ICU between April 2003 and March 2015. Results: Median age was 49 years (interquartile range [IQR]: 33.5-60.4), and the majority of the patients were males (54.8%). Median number of preexisting comorbidities was 5 (IQR: 2-7) diagnoses. Discharge directly to home increased from 28 (3.1% of all survivors) patients in 2003 to 120 (12.5%) patients in 2014. The mean annual rate of DDH was between 11% and 12% over the last 6 years. Approximately 62% (n = 397) of patients waited longer than 4 hours for a ward bed, with a median delay of 2.0 days (IQR: 0.5-4.7) before being DDH. There was an inverse correlation between ICU occupancy and DDH rates ( rP = −.55, P < .0001, 95% confidence interval [CI] = −0.36 to −0.69, R2 = .29). There was no correlation with ward occupancy and DDH rates ( rs = −.055, P = .64, 95% CI = −0.25 to 0.21). Conclusions: The DDH rates have been increasing over time at our institution and were inversely correlated with ICU bed occupancy but were not associated with ward occupancy. The DDH patients are young, have few comorbidities on admission, and few discharge diagnoses, which are usually reversible single system problems with low disease burden. Transfers to the ward are delayed in a majority of cases, leading to increased ICU LOS and likely increased overall hospital LOS as well.

scholarly journals Injury profile and healthcare expenditure of cyclists admitted in intensive care units

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
M Papadakaki ◽  
C h Gnardellis ◽  
A Tsalkanis ◽  
M A Stamouli ◽  
E Petelos ◽  
...  
Keyword(s):  
Intensive Care ◽  
Intensive Care Units ◽  
Injury Severity ◽  
Road Traffic ◽  
Diagnosis Related Groups ◽  
Health Care Expenditure ◽  
Public Hospitals ◽  
High Dependency ◽  
Hospitalization Costs ◽  
The Mean

Abstract Background The current paper is part of the EU-funded REHABILAID Project and aims to describe the profile of cyclists sustaining severe injuries in a road traffic incident as well as the healthcare costs associated with their injury, including hospitalization costs and out-of-pocket expenditure. Methods Seven public hospitals were involved; Greece=5, Italy=1 and Germany=1. Both the intensive care units (ICU) and sub-intensive care units (as high-dependency areas) were involved. Participants enrolled during a 12-month period starting from April 2013 and were followed for one year from admission date. The study used widely recommended classifications for injury severity (AIS-Update 2008, MAIS). Information on the injury was retrieved upon patients’ consent, from medical records while interviews were carried out at months 1,6,12 for personal and cost-related information. Health Care Expenditure was assessed through the MUARC’s framework. Diagnosis-related groups (DRGs) were used to estimate hospitalization costs. Results 120 subjects enrolled in the study in total and 14 were cyclists(Greece=1, Germany=3, Italy=10). Most of them were men(n = 9, 64.3%), with a mean age of 55.5 years (SD16.3;min 32-max 84). As for the current incidents, the majority occurred at city roads (n = 10;71.4%), straight roads (n = 9;64.3%) and intersections (n = 3;21.4%). Many were single-vehicle (n = 4;28.6%), lateral (n = 4;28.6%) and front-lateral (n = 3;21.4%). Half of the cyclists sustained an injury of MAIS3+ severity (n = 7;50.0%). A major injury was primarily sustained at the lower extremities (n = 10;71.4%), head (n = 7;50.0%), face (5=35.7%) and upper extremities (n = 5;35.7%). The mean total hospitalization cost was 5815,6(min 209,00-max 20.647,00) and the mean direct costs arising from injury was 4.047,5(min 0,0-max 24.670,00). Conclusions Individual differences need to be taken into account in future injury prevention efforts as well as in attempts to improve healthcare system’s response to road victims. Key messages Systematic collection of data relevant to health condition and economics of the victims is necessary at European level. Personalized rehabilitation plans are necessary to facilitate the recovery process of victims.

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