Does the perceived healthcare quality provided by full-time government employee doctors in the public system differ from the perceived care quality in their own privately managed facilities in Nigeria?

Objective: Although the differences in the quality levels between the public and private sectors have been identified in literature not much is known about the level of quality differences that exist when full time government employee doctors offer the same clinical services in their own privately managed facilities. The objective of this study was to compare service user perceived quality of care provided by full-time government employee doctors in the public system and in their own privately managed facilities in Nigeria.Methods: A cross-sectional multistage sampling design was used to elicit service user views on process, structure and outcome elements of quality identified in the Donabedian’s care quality model. The software for population surveys in EPI Info 7 was used to calculate the required sample. A total of 407 questionnaires were administered and completed after a pre-test.Results: Respondents reported better health outcomes in private practice than in the public system and a majority would recommend visiting a dual physician’s private practice than the public system where they work full-time. Process aspects of quality, including better rapport with doctors, greater perceived confidentiality, shorter wait times, and absence of bureaucratic impediments were said to be better in privately managed facilities of government doctors. However, respondents said that the public sector was superior in respect of the structure element of quality as reflected in better infrastructure, equipment, and availability of drugs.Conclusions: Despite the relatively lower cost of care in government hospitals the outcome and process elements are still crucial in determining which sector patients prefer. These two elements seem to have influenced patronage for private practices of dual practitioners.

Impact of COVID-19 on hospitalization, death rate, and other inpatient measures among Asian patients in hospitals in California

Objective: This study aims to analyze COVID-19 hospitalization and death rate in the Asian population of a predominantly Asian-serving multi-hospital system (ASMHS).Methods: The COVID-19 patient information was collected electronically from March 1 to November 12, 2020, including demographics, insurance, mortality, ICU admissions, and length of stay (LOS). Demographic characteristics were compared with the county-level and national data. A comparison of hospital LOS between Asians and non-Asians was conducted.Results: The prevalence ratio of deaths in Asians at ASMHS was 1.29, which was 53% higher than the county and 77% higher than the nation. The ICU admission for ASMHS Asian patients was 11.8% compared to 5.6% for non-Asian. Overall Asians and Asians aged > 65 had significantly longer LOS than non-Asians (p < .001).Conclusions: High prevalence ratio of deaths was noted in ASMHS’s Asian patients which may be related to older age, higher ICU rate, and longer LOS.

Operationalizing the emergent management of psychiatric patients during the COVID-19 pandemic at an academic public hospital

Background: While the volume of Emergency Department (ED) visits has declined during the 2019 novel coronavirus disease or COVID-19, the opposite has been observed with mental-health related visits. The need to screen and manage potential COVID-19 symptoms in parallel with psychiatric complaints have imposed new challenges in the ED at an academic public hospital.Objective: The objective is to share operational modifications in addressing the challenges related to the influx of ED mentalhealth related complaints at the departmental, hospital-wide, and city-wide level within an academic, public hospital.Methods: At the departmental level, a triage algorithm for screening patients with concerning symptoms was developed. A dedicated Respiratory Decision Unit with psychiatrically safe rooms that adhered to infection prevention protocol was also created. All staff were trained to utilize personal protective equipment through lectures, asynchronous learning, and multidisciplinary simulations. The ED team worked with hospital leadership to increase inpatient medical psychiatric bed capacity and to develop testing protocols for patients being admitted to allow for cohorting of symptomatic patients. At the city level, leadership within the three main organizations that provide mental health services to the city met regularly to address operational issues.Conclusions: The COVID-19 pandemic has imposed new challenges in terms of increased psychosocial needs while limiting transmission risks. Based on the experiences shared, a multitier approach is necessary. At all levels, the goals were to screen appropriately, decrease transmission risk, and maintain throughput. The purpose of this descriptive manuscript is to encourage dialogue and to raise awareness about the unique needs of the mental health system.

Creation of high-performing medical department

Background: Transforming dysfunctional medical groups into high-performing departments is a process that physician leaders are not typically trained to enact. Multiple issues challenge the ability to successfully create a financially sound department that offers high-quality care along with impactful academic deliverables.Methods: We present an example of a critical care group that was highly dysfunctional that was transformed into a highperforming medical department. It underwent a change that was achieved through three stages: (1) Defining Purpose; (2) Relationship Building and Problem Solving; and (3) Group Development. The later stage is approached in a three-phase cycle.Results: Success was achieved on all deliverables including clinical care, academics and finances as validated by external measures. The department was awarded best practice for delivery of clinical care by an international accreditation group. It was twice recognized as their hospital’s highest engaged medical group. Academic deliverables increased to become a high performer all while financial stability was achieved. The importance of health and wellness is highlighted.Conclusions: The process for transforming departments is suggested in a step-wise approach for other groups to achieving similar success.

Establishing an ambulance dispatch system for intrahospital transfers in a large teaching hospital in India

During the Covid Pandemic, a lot of structural and process changes had to be made in a quick time in almost all the hospitals to accommodate the patients and admit them with the least exposure to the Hospital Staff and the bystanders of the patients. AIIMS Hospital in New Delhi India is a premier tertiary care teaching hospital, which is spread out in different areas. Two Hospital centers of AIIMS were designated as COVID Hospitals. Since there was no previous experience of intrahospital transfers of this magnitude, the hospital had to face lots of difficulties in such transfers and this translated into increased turnaround time. This paper concentrates on the mechanisms in which the Department of Hospital Administration found out the various issues plaguing this process. Later by Change Management, an Intervention was brought in, which helped in the framing of a standard operating procedure that helped in the easy transfer of the patients which was hassle-free and which continued to the second wave of the COVID pandemic.

Efficiency of coronavirus inactivation on environmental surfaces: A comparison study of two available disinfectants

Background: There are many coronaviruses of significant medical and veterinary concern, all of which are the result of spillover from another species. Disinfection of healthcare and veterinary environments is an important factor in limiting the transmission of coronaviruses. Disinfection agents for coronaviruses use bleach, quaternary compounds, hydrogen peroxide, and sodium hydroxide. Product labels list contact times that range from 10-30 minutes for total inactivation. Decon7 is a combination disinfectant that is currently used in the food and agriculture, medical facilities, and other industries. While Decon7 has been shown to inactivate a variety of pathogens and disrupt biofilms, its effectiveness and rate of coronavirus inactivation has not been evaluated.Objective: This project sought to evaluate Decon7’s effectiveness and rate of coronavirus inactivation.Methods: This study evaluated the disinfection efficacy of Decon7 (diluted at 1:4) and bleach (diluted at 1:10) after 3 coronaviruses (SARS-CoV-2, HCoV OC43, and HCoV NL63) were inoculated onto up to sixteen environmental surface materials.Results: A 1:4 dilution of Decon7 inactivated all coronaviruses on all surfaces with 1 minute contact time. A 1:10 dilution of bleach was not effective in inactivating coronaviruses with a contact time of 1 minute on all surfaces.Conclusions: New technologies and chemistries may offer more efficient inactivation of pathogens on environmental surfaces. These disinfection methods and materials, which require less than 10 minutes contact time, may improve the efficacy of cleaning and disinfecting surfaces in the built environment.

Telemedicine use in 2020 during the COVID-19 pandemic among community dwelling U.S. Medicare beneficiaries

Objective: CMS reimbursement regulations for telemedicine changed after the onset of the COVID-19 pandemic. This study aimed to assess telemedicine utilization patterns offered by health care providers and used by Medicare beneficiaries during the COVID-19 pandemic during 2020.Methods: This study used the Fall 2020 Medicare Current Beneficiary Survey (MCBS) supplemental COVID-19 survey to identify Medicare beneficiaries (≥ 65 years) with a regular place for medical care that offered telemedicine during 2020. Major outcomes: prevalence for whether telemedicine was offered before and during the pandemic, telemedicine use, and digital access to telemedicine. Logistic regression identified the demographic factors associated with telemedicine use.Results: The study sample included 4,380 eligible individual Medicare beneficiaries ≥ 65 years. Of those, 42.9% made telemedicine visits during the pandemic. Approximately 60% of the telemedicine visits were conducted via telephone. Telemedicine was offered to 18% of the respondents before the pandemic vs. 64% during year 2020 of the pandemic. Among telemedicine users, 57.2%, 28.3%, and 14.5% used voice calls, video calls, and both voice and video calls for health care appointments, respectively. Overall telemedicine use varied by sex, race, and region. Individuals 65-74 years, female, living in a metropolitan area, with higher incomes were more likely to make video visits. Experience using telecommunications via the internet influenced telemedicine use significantly.Conclusions: Telemedicine offered to older Medicare beneficiaries increased dramatically after the onset of the COVID-19 pandemic. Yet, less than half used telemedicine and differences in utilization existed by demographic characteristics.

Hospitalized patients co-diagnosed with infective endocarditis and opioid drug dependence in Florida, 2015-2018

Objective: As the opioid addiction epidemic continues to grow, other serious health issues regarding drug use has also increased. This study examines the trends in admissions and population characteristics of those who experience infective endocarditis with opioid drug dependence.Methods: We used ICD-9-CM and ICD-10-CM codes to identify patients admitted to a hospital with infective endocarditis and with a secondary diagnosis of opioid use related disorders using data released by the Florida Agency for Health Care Administration (AHCA). Data included age, gender, ethnicity, race, discharge disposition, admission type, payer status, total charges, and zip code of patients’ residence.Results: During the four-year period, the percent of patients diagnosed with infective endocarditis and a diagnosis code associated with opioid abuse or dependence doubled (4.48% to 8.52%). Of the patients dually diagnosed, the mean age was 37.47 and the majority were white (90.78%), non-Hispanic (91.96%), and female (58.55%). Nearly 47% of the patients did not have health insurance. The percentage of patients with both diagnosis codes living in urban counties was 91.37%. Median length of stay was 10 days and median total charges for patients was $101,604.Conclusions: With the increasing incidence of opioid dependence and addiction within the United States, there is a rise in infective endocarditis, a costly and debilitating disease. Our analysis provides the framework for hospital systems to identify patients who may benefit from addiction services, which through downstream effects will cause less of a health and financial burden.

The role of comprehensive international electronic medical file in improving the quality of medical services and achieving the satisfaction of stakeholders: An exploratory study in Jeddah, Saudi Arabia

Objective: The current study investigates the possible impact of creating a comprehensive international electronic medical file that is part of a database which can be used in various areas to achieve the highest levels of satisfaction for patients and official bodies and enhance the quality of medical services at hospitals as well. One of the key purposes of this e-file is achieving the readiness and confidentiality of data so that it can be shared among hospitals whether inside the Kingdom of Saudi Arabia or even abroad. In addition, the medical e-file may contribute to reducing the costs of treatment, monitoring the performance of doctors and minimising medical errors. Moreover, the e-file may be used for even other purposes such as security or financial reasons.Methods: The study employed the quantitative research design where 171 questionnaires were distributed to patients, managers and staff in 19 small private hospitals in Jeddah city. The questionnaire 44 questions were designed after conducting a small pilot study on 15 participants. The response rate was about 82.5% in terms of the study questionnaire as only 141 questionnaires were collected. 84 male and 57 female participants took part in the study.Results: The study shows that there is a statistically significant correlation between the use of the international electronic medical file and the enhancement of the quality level of services provided at hospitals, the electronic rehabilitation, training, integrity and awareness of medical staff, and the productivity of hospital workers in line with the Kingdom’s 2030 vision. Moreover, there is a statistically significant correlation between the use of the comprehensive international electronic medical file and raising the level of patient satisfaction by working to protect their medical and financial information and speeding up the process of providing it whenever needed, whether inside the KSA or abroad, as well as reducing the costs of treatment locally and internationally and raising the rates of patient awareness of their medical rights. The results also reveal that using the comprehensive international electronic medical file helps to link patients’ data to all concerned authorities, which leads to enabling them to monitor the performance of hospitals and their staff, monitor the performance of doctors, reduce medical errors, and follow up on patients’ cases and rights to the fullest extent.Conclusions: The study recommends the necessity of selecting and training medical personnel in a professional manner, including those working in the field of the database, and the necessity of maintaining the confidentiality of personal information.

Economic impact of the Swiss Diagnosis-Related Group system on acute neurorehabilitation

Objective: To assess the economic impact of introducing the Swiss Diagnosis-Related Group (DRG)-financing system on the Acute Neurorehabilitation Unit (ANRU) of a University hospital in 2012 and to discuss the implications in 2020.Methods: A retrospective study using monocentric patient cohort and collecting anonymized data of consecutive patients admitted to the ANRU in 2012 and 2013. The characteristics, DRG A43Z, costs and revenues were retrieved from the hospital accounting system and allowed a comparison between the 2012 and 2013 groups of patients.Results: Forty-seven patients were included over the assessment period. In 2012, of the 23 patients admitted, 20 were coded A43Z, while in 2013, out of the 24 admissions, only eight had that specific code (p < .01). The average length of stay (LOS) increased from 45.5 days in 2012 to 49.5 days in 2013. Similarly, the average cost per patient increased by Swiss Franc (CHF) 19,994 over the two years, from CHF 183,634 in 2012 to CHF 194,629 in 2013. Finally, the average reimbursement per patient diminished by CHF 11,392, from CHF 193,153 in 2012 to CHF 181,760 in 2013.Conclusions: The negative impact on the cost–revenue balance is linked to both the increased cost of a longer stay and the decreased revenue due to less patients being coded A43Z. This study highlights the difficulties to justify funding of the complex care needed and to properly reflect patient burden in medico-administrative documents. Certainly, there is a need for a concerted effort to identify the services and resources needed within the DRG-system to guarantee the optimal management of acute neurorehabilitation.