Suchergebnisse

SUMMARYA mail survey of ambulatory dental programs at all 123 short‐stay hospitals in Massachusetts was conducted for the 1980 fiscal year. The major findings were as follows.Of the 122 responding hospitals, 105 (86%) reported having ambulatory dental visits, 2 1 (20%) of which had dental clinics. The remaining 84 (80%) hospitals provided dental care in surgical day care units, emergency rooms, or both, as did most hospitals with dental clinics. The 177,93 1 reported hospital ambulatory dental visits accounted for approximately 1.6% ambulatory dental visits in all settings, statewide. Approximately 69% of hospital ambulatory dental visits statewide took place in the 21 dental clinics, 21% in surgical day care units, and 10% in emergency rooms. Approxi‐ mately 66% of dental clinic visits were for gen‐ era1 dental care and represented less than 1% of ambulatory dental visits in all settings, statewide.Most hospitals with dental clinics were con‐ centrated in major urban centers. Hospitals in the Greater Boston area accounted for 75% of all ambulatory dental visits and 87% of dental clinic visits, statewide.To properly assess the hospital's role as a dental care resource to a community, general dental care services in community hospital dental clinics should be distinguished from other types of hospital dental care. Our study accomplished this by categorizing ambulatory dental visits according to the types of services provided, the types of hospitals at which they were provided, and the hospital settings in which they were provided.The data suggest that the significance of hospital ambulatory dental programs is not in the amount of dental care that they provide statewide but the types of services offered and their importance to dentally underserved inner city communities.

Ambulatory surgery centers (ASCs) recently have grown to become the dominant provider of specific surgical procedures in the United States. While the majority of ASCs focus primarily on a single specialty, many have diversified to offer a wide range of surgical specialties. We exploited a unique data set from Pennsylvania for the years 2004 to 2014 to conduct an empirical investigation of the relative cost of production in ASCs over varying degrees of specialization. We found that for the majority of ASCs, focus on a specialty was associated with lower facility costs. In addition, ASCs appeared to be capturing economies of scale over a broad range of service volume. In contrast to studies of cost efficiency in specialty hospitals, our results provide evidence that supports the focused factory model of production in the ASC sector.

Success in the provision of ambulatory personal health services, i.e. providing individuals with treatment for acute illness and preventive health care on an ambulatory basis, is the most significant contributor to the health care system's performance in most developing countries. Ambulatory personal health care has the potential to contribute the largest immediate gains in health status in populations, especially for the poor. At present, such health care accounts for the largest share of the total health expenditure in most lower income countries. It frequently comprises the largest share of the financial burden on households associated with health care consumption, which is typically regressively distributed. The "organization" of ambulatory personal health services is a critical determinant of the health system's performance which, at present, is poorly understood and insufficiently considered in policies and programmes for reforming health care systems. This article begins with a brief analysis of the importance of ambulatory care in the overall health system performance and this is followed by a summary of the inadequate global data on ambulatory care organization. It then defines the concept of "macro organization of health care" at a system level. Outlined also is a framework for analysing the organization of health care services and the major pathways through which the organization of ambulatory personal health care services can affect system performance. Examples of recent policy interventions to influence primary care organization--both government and nongovernmental providers and market structure--are reviewed. It is argued that the characteristics of health care markets in developing countries and of most primary care goods result in relatively diverse and competitive environments for ambulatory care services, compared with other types of health care. Therefore, governments will be required to use a variety of approaches beyond direct public provision of services to improve performance. To do this ...

ABSTRACTThis article describes patient access to the Hospital‐Sponsored Ambulatory Dental Services Program (HSADSP), a 4‐year effort initiated in 1979 by the Robert Wood Johnson Foundation. A major goal of the program was to provide comprehensive general dental care to underserved populations. Independent samples of 2,600 patients each, in 13 of the hospitals (200 patients per institution), were assessed at the beginning and end of the program to ascertain changes in dental care resulting from the expansion of the dental facilities and the support of general practice residents.According to data compiled by the evaluation team, patient volume increased by more than 15% from the first year of the program (baseline sample) to the period preceding the fourth year (final sample). Although the proportion of underserved patients accessing the program was high in both periods, the percentages of "special" patients, minority members, and the poor all decreased slightly during the study. At the same time, the proportion of episodic patients increased by 15% and the number of patients with private dental insurance increased at a lower rate than the national average. Counter to prior expectations, only about 20% to 35% of new patients accessing the dental clinics used the sponsoring hospital as a source of medical care, either inpatient or outpatient.The gains made in patient access to the HSADSP were lower than anticipated. There is little evidence that many of these hospital‐based general practices and residency programs would be able to sustain economic viability without innovative financing techniques or direct subsidy.

Intro -- COMMON PROBLEMS IN AMBULATORY PEDIATRICS: SPECIFIC CLINICAL PROBLEMS, VOLUME 1 -- Library of Congress Cataloging-in-Publication Data -- Contents -- Chapter 1: Chronic Non-specific Diarrhea of Childhood -- Abstract -- Introduction -- Etiology -- Clinical Manifestations -- Laboratory Investigations -- Diagnosis -- Management -- Prognosis -- References -- Chapter 2: Gastroesophageal Reflux -- Abstract -- Introduction -- Epidemiology -- Pathophysiology -- Clinical Manifestations -- Complications -- Diagnostic Studies -- Esophagography -- Radionuclide Gastroesophagography -- 24-Hour Intra-esophageal pH Monitoring -- Intraluminal Esophageal Electrical Impedance -- Esophageal Manometry -- Esophagoscopy and Biopsy -- Management -- Medical Management -- Surgical Treatment -- Prognosis -- References -- Chapter 3: Infantile Perianal Protrusions -- Abstract -- Introduction -- Etiology and Pathogenesis -- Clinical Manifestations -- Differential Diagnosis -- Management -- References -- Chapter 4: Anal Fissure -- Abstract -- Introduction -- Incidence -- Etiology and Pathogenesis -- Clinical Manifestations -- Management -- References -- Chapter 5: Umbilical Hernia -- Abstract -- Introduction -- Epidemiology -- Etiology and Embryology -- Clinical Manifestations -- Diagnostic Studies -- Differential Diagnosis -- Complications -- Management -- References -- Chapter 6: Indirect Inguinal Hernia -- Abstract -- Introduction -- Incidence -- Pathogenesis -- Clinical Manifestations -- Complications -- Clinical Evaluation -- Diagnostic Studies -- Differential Diagnosis -- Management -- References -- Chapter 7: Hydrocele -- Abstract -- Introduction -- Incidence -- Pathogenesis -- Clinical Manifestations -- Complications -- Diagnosis -- Diagnostic Studies -- Differential Diagnosis -- Management -- References -- Chapter 7: Cryptorchidism -- Abstract -- Introduction.

Medication errors generally refer to mistakes made in the processes of ordering, transcribing, dispensing, administering or monitoring of pharmaceutical agents used in clinical practice. The Institute of Medicine report, To Err Is Human: Building a Safer Health System, has helped raise public awareness surrounding the issue of patient safety within our hospitals. A number of legislative and regulatory steps have resulted in hospital authorities putting in place various systems to allow for error reporting and prevention. Medication errors are being closely scrutinized as part of these hospital-based efforts. Most Americans, however, receive their healthcare in the ambulatory primary care setting. Primary care physicians are involved in the writing of several million prescriptions annually. The steps underway in our hospitals to reduce medication errors should occur concurrently with steps to increase awareness of this problem in the out-patient setting. This article provides an overview of strategies that can be adopted by primary care physicians to decrease medication errors in ambulatory practice.

With an increasing volume of Medicaid recipient enrollees in managed care, many states are developing tools for monitoring service quality and access of Medicaid recipients. This article explores the use of ambulatory care-sensitive (ACS) hospital discharge rates as a simple, practical indicator tool for monitoring the access of Medicaid health maintenance organization (HMO) enrollees through an empirical application in Massachusetts in 1995. Although unadjusted hospital discharge rates were lower, Medicaid HMO enrollees had higher age-gender-race adjusted total and ACS hospital discharge rates than Medicaid recipients enrolled in a primary care case management program under fee-for-service reimbursement. Higher HMO discharge rates for the specific ACS conditions of asthma and dehydration were suggestive of potential HMO access problems.

Considerable research has focused on hospitalizations for ambulatory care–sensitive conditions (ACSHs), but little of that research has focused on the role played by chronic disease in ACSHs involving children or youth (C/Y). This research investigates, for C/Y, the effects of chronic disease on the likelihood of an ACSH. The database included 699 473 hospital discharges for individuals under 18 in Texas between 2011 and 2015. Effects of chronic disease, individual, and contextual factors on the likelihood of a discharge involving an ACSH were estimated using logistic regression. Contrary to the results for adults, the presence of chronic diseases or a complex chronic disease among children or youth was protective, reducing the likelihood of an ACSH for a nonchronic condition. Results indicate that heightened ambulatory care received by C/Y with chronic diseases is largely protective. Two of more chronic conditions or at least one complex chronic condition significantly reduced the likelihood of an ACSH.

The purpose of this study was to examine potential associations among ambulatory surgery centers' (ASCs) organizational strategy, structure, and quality performance. The authors obtained several large-scale, all-payer claims data sets for the 1997 to 2004 period. The authors operationalized quality performance as unplanned hospitalizations at 30 days after outpatient arthroscopy and colonoscopy procedures . The authors draw on related organizational theory, behavior, and health services research literatures to develop their conceptual framework and hypotheses and fitted fixed and random effects Poisson regression models with the count of unplanned hospitalizations. Consistent with the key hypotheses formulated, the findings suggest that higher levels of specialization and the volume of procedures may be associated with a decrease in unplanned hospitalizations at ASCs.

Les acteurs privés (à but lucratif) sont devenus d'importants prestataires de services dans le domaine du care en Irlande, en particulier depuis 2006, lorsque l'État a introduit des changements axés sur le marché dans le financement des soins à domicile. Dans le même temps, une pénurie aiguë de travailleuses, une demande croissante de care et une infrastructure publique de care médiocre signifient que l'Irlande connaît une crise profonde du care , y compris à domicile. Cet article utilise une méthodologie d'analyse critique du discours pour examiner les déclarations publiques et les documents politiques générés par les prestataires privés de soins à domicile entre 2018 et 2023 sur la réforme du soin à domicile. Cette approche a révélé les stratégies discursives utilisées par les prestataires privés de soins à domicile en Irlande pour revendiquer un rôle dans la résolution de la crise et façonner le futur développement du système de soins à domicile. Cette analyse des commentaires des prestataires privés dans les débats politiques et publics révèle les formulations sous-jacentes du problème et les solutions politiques qui visent à résoudre la crise du care à domicile par la consolidation et l'approfondissement de cette marchandisation du care . S'appuyant sur l'analyse du pouvoir commercial des prestataires de soins privés, cette contribution s'inspire des approches féministes et éthiques de la marchandisation du care pour illustrer les éléments idéationnels déployés dans les stratégies discursives visant à positionner les prestataires privés en tant qu'experts et producteurs de connaissances sur les soins. Le Covid-19 a favorisé ces stratégies en fournissant des ressources idéationnelles qui permettent aux prestataires privés d'assumer un rôle dans la résolution des crises, en plaidant pour une augmentation du financement public du care privé. Cela mérite d'être examiné alors que l'État irlandais prépare une réforme des soins à domicile, attendue depuis longtemps, et que les prestataires privés font face aux critiques concernant leurs pratiques en matière d'emploi.

The ambulatory landscape -- Strategy and leadership / with contributing author Jalana McCasland -- Organizational structure / by Carol K. Lucas -- Quality, safety, and patient experience / with contributing author Kristin Baird -- Operations -- Case study : LemonAid health : pursuing a new strategy in mental health -- Financial management -- Human resources.

The report describes the method and instruments used to collect and process drug information for the 1980 National Ambulatory Medical Care Survey. It explains in detail the development of the system by which the drug information was classified and coded, and offers a complete set of coding instructions along with an alphabetized list of 7,227 drugs that office-based physicians might prescribe. Finally, it presents the plan for analyzing the drug data and reporting it to potential users. ; [by Hugo Koch and William H. Campbell]. ; Includes bibliographical references.

Wayfinding services help ambulatory clients develop skills to travel independently to health care facilities. The authors review social work's contribution to ambulatory clients through wayfinding training. They assert that wayfinding services promote client compliance with ambulatory services and discuss wayfinding guidelines for travel between health facility and home.