Journal of hospital management and health policy最新文献

{"title":"Innovations and Practices that Influence Patient-Centered Health Care Delivery Special Series","authors":"Naleef Fareed, S. Moffatt-Bruce, A. McAlearney","doi":"10.21037/jhmhp-21-32","DOIUrl":"https://doi.org/10.21037/jhmhp-21-32","url":null,"abstract":"The publication of this special series on Innovations and Practices that Influence Patient-Centered Health Care Delivery was intended to report on research that focused on innovative practices and interventions that influence what matters most in health care: the patient. It was proposed to the Editor in March 2020, only a few weeks before many jurisdictions in the U.S. went under pandemic control measures in response to the emergence of the novel coronavirus 2019 (COVID-19) including curfews, stay-at-home orders, and other widespread restrictions. For most, the pandemic has been extremely difficult with isolation and loss impacting individuals and groups across communities and countries. Amidst this chaos, grave racial and social injustices surfaced and served to heighten awareness about inequities that permeate health care systems and delivery. The 15 papers in this special series all focus on practices in patient-centered care, with some directly addressing issues related to the pandemic and racial and social inequities. In this editorial, we highlight four papers that reflect the breadth of practices that influence patient-centered health care delivery, and also focus on the important issues of responses to the pandemic and health equity considerations. Lai and colleagues highlight the challenges associated with the deployment of primary care physicians (PCPs) to inpatient settings during the pandemic. They provide recommendations for developing a clinician-friendly and sustainable transitional workflow to overcome existing problems such as PCPs lack of up-to-date training to deliver inpatient care, workflow and technology challenges, and fatigue due to the need to work extended hours. Reportedly, nearly 31% of PCPs noted experiencing burnout, and those serving in organizations that provide pandemic-related care had a higher risk of burnout. The authors propose three practices to address these problems. First, hospitals should have a transition plan in place for PCPs to adopt new practices (e.g., functioning in a team) to effectively deliver care in a dynamically changing environment. Second, a comprehensive orientation plan should be implemented for PCPs that includes","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47022324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Improving health system efficiency for better health outcomes","authors":"Wu Zeng","doi":"10.21037/jhmhp-21-77","DOIUrl":"https://doi.org/10.21037/jhmhp-21-77","url":null,"abstract":"","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47327629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and facilitators to hospital implementation of obstetric emergency safety bundles: a qualitative study","authors":"D. Walker, Matthew J. Depuccio, A. McAlearney","doi":"10.21037/JHMHP-20-74","DOIUrl":"https://doi.org/10.21037/JHMHP-20-74","url":null,"abstract":"Department of Family and Community Medicine, College of Medicine, The Ohio State University, Columbus, OH, USA; The Center for the Advancement of Team Science, Analytics, and Systems Thinking (CATALYST), College of Medicine, The Ohio State University, Columbus, OH, USA Contributions: (I) Conception and design: DM Walker, AS McAlearney; (II) Administrative support: DM Walker, AS McAlearney; (III) Provision of study materials or patients: DM Walker, AS McAlearney; (IV) Collection and assembly of data: DM Walker, AS McAlearney; (V) Data analysis and interpretation: DM Walker, AS McAlearney; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Daniel M. Walker, PhD, MPH. Assistant Professor, Department of Family and Community Medicine, College of Medicine, The Ohio State University, 460 Medical Center Drive, Suite 520, Columbus, OH 43210, USA. Email: Daniel.Walker@osumc.edu.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46435018","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aiming for health equity: the bullseye of the quadruple aim","authors":"J. N. Olayiwola, Mark Rastetter","doi":"10.21037/JHMHP-20-101","DOIUrl":"https://doi.org/10.21037/JHMHP-20-101","url":null,"abstract":"In 2014, Drs. Bodenheimer and Sinsky introduced the Quadruple Aim into our health system improvement lexicon (1). Building off of the Triple Aim articulated by Dr. Berwick (2), an early pioneer of quality improvement in health systems and healthcare, the Quadruple Aim expanded the goals of enhancing patient experience, reducing cost and optimizing population health to include improvements to the work-life and experience of clinicians and care teams that provide care to patients. Immediately after and further catalyzed by emerging literature on the enormous financial, clinical and workforce impact of clinician burnout (3), evolving clinical settings focused on population health and national alternative payment models for advancing primary care delivery in new ways, and the true north for optimal health system performance was codified—it was now reflected in the Quadruple Aim. In fact, the addition of this 4 aim effectively eclipsed the other aims, because optimization of the initial Triple Aim was now considered impossible without the additional focus on clinician and workforce wellness, resilience and satisfaction. However, what became apparent was that a stringent focus on checking the boxes to the Quadruple Aim was insufficient, in and of itself, to reduce health disparities. The notion that global improvements in quality and delivery of care would improve health disparities and achieve health equity is explicitly false (4). In fact, the opposite is true. The health system in the United States is one of the most inequitable when compared to peer developed nations. Despite enormous spending on health care per capita, in fact spending more per capita than all other nations in the Organization for Economic Cooperation and Development combined, the United States has staggering and disappointing outcomesranking 28 out of 34 countries in life expectancy, 33 in infant mortality and 1 in poverty (5,6). In the landmark Mirror, Mirror International Comparison report done by the Commonwealth Fund, the United States ranked last on performance overall, and ranked last or near last on the Access, Administrative Efficiency, Equity, and Health Care Outcomes domains (7). While this performance certainly challenges the health system to rethink its focus, perhaps more confronting is the growing body of evidence about significant health and health care disparities based on race, ethnicity, income, zip code, education and other social determinants (8). For example, in the state of Ohio, known for its alarmingly high rates of infant mortality, numerous initiatives led to an overall decrease in infant mortality from 2009 to 2018, an average decrease of 1.1% per year. However, regardless of these global improvements spurred by advocacy and education initiatives as well as clinical and population health efforts, the Black infant mortality rate has not changed significantly since 2009 and Black infants still die at rates 2.5–3 times higher than White infants (9). Additi","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49046769","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COVID-19 and primary care physicians: adapting to rapid change in clinical roles and settings","authors":"A. Lai, S. Thomas, E. Sullivan, Bram P. I. Fleuren, Minakshi Raj, Matthew J. Depuccio, Amber L. Stephenson, A. McAlearney","doi":"10.21037/jhmhp-20-130","DOIUrl":"https://doi.org/10.21037/jhmhp-20-130","url":null,"abstract":"© Journal of Hospital Management and Health Policy. All rights reserved. J Hosp Manag Health Policy 2020;4:31 | http://dx.doi.org/10.21037/jhmhp-20-130 With the emergence of COVID-19, drastic measures have been taken to create, deploy, and sustain a pandemic workforce as well as to continuously adapt this workforce in preparation for future needs (1). One major shift in primary care has been to deliver care via telemedicine. Another shift that has been more disruptive to primary care practice patterns, however, is the deployment of primary care physicians (PCPs) to hospitals in order to meet emergent care delivery needs. In many hospital and health systems, PCPs have been expected to join the hospital-based workforce and take on roles in emergency, hospitalist, and respiratory medicine as the pandemic has overwhelmed and depleted many hospitals’ existing workforce capacities. This article highlights challenges in such deployment efforts and proposes recommendations to help PCPs and health care organizations adapt so that they are able to effectively respond to potential upcoming pandemic waves. Challenges with deploying PCPs to inpatient care settings","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43096091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The first wave: lessons learned from the initial surge of general medicine inpatients during the SARS-CoV-2 pandemic","authors":"Amber B. Moore, Melissa L. P. Mattison","doi":"10.21037/JHMHP-20-117","DOIUrl":"https://doi.org/10.21037/JHMHP-20-117","url":null,"abstract":"","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43672141","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Attrition in emergency department point-of-care ultrasound workflow adherence for the evaluation of cutaneous abscesses","authors":"S. Alerhand, Carl T. Mickman, K. Hu, Donald U. Apakama, J. Mishoe, B. Nelson","doi":"10.21037/jhmhp-20-85","DOIUrl":"https://doi.org/10.21037/jhmhp-20-85","url":null,"abstract":"Background: Many emergency departments (ED) have implemented software solutions for ordering, documenting, and interpreting point-of-care ultrasound (POCUS) scans before healthcare bill generation. However, there are human and design barriers that prevent workflow completion. We sought to evaluate attrition in adherence to this step-wise workflow for evaluating cutaneous abscesses in a large urban ED, while quantifying missed potential revenue. Methods: Patient charts in 2017 with discharge diagnoses containing “abscess”, “boil”, or “cyst” were retrospectively extracted. Exclusion criteria included: POCUS not reasonably performed, abscess already draining, advanced imaging ordered, or consultant involvement. Each workflow step was assessed for completion. Revenue estimation was performed by multiplying number of scans by the appropriate relative value unit and medicare conversion factor. Results: Of 2,240 total charts, 710 abscesses (31.7%) met inclusion. Of those, 283 (39.8%) POCUS were performed, of which 213 (30.0%) were ordered, 198 (27.8%) interpreted, and 180 (25.3%) had images saved. Professional fees were billed for 120 POCUS examinations (16.9%). There were 66 payments collected (9.3%), amounting to $1,400.69 revenue. Estimated billing for the 120 POCUS was $2,546.71. If proper workflow had been implemented for all 283 POCUS performed, estimated revenue would have been $6,006.00. If POCUS had been performed with proper workflow for all 710 abscesses, estimated revenue would have been $15,068.05. Conclusions: POCUS workflow was interrupted at several points and completed sub-optimally. This attrition directly affected optimal patient care, documentation, and departmental revenue. Since cutaneous abscesses represent one of many ED POCUS applications, the extrapolated missed potential revenue would be much greater overall.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47021981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outpatient forecasting model in spine hospital using ARIMA and SARIMA methods","authors":"Kyeong-Rae Kim, Jae-Eun Park, I. Jang","doi":"10.21037/jhmhp-20-29","DOIUrl":"https://doi.org/10.21037/jhmhp-20-29","url":null,"abstract":"Background: Examining the matter of how to appropriately allocate the limited supply of medical resources is a crucial issue in terms of the management of a medical institution. Based on the time-series data on all outpatients visiting N hospitals in Gangnam-gu, Seoul from January 2, 2017 to December 31, 2017. Methods: This study utilized Auto Regressive Integrated Moving-Average (ARIMA) and Seasonal Auto Regressive Integrated Moving Average (SARIMA) models to build an outpatient prediction model. And we determined to be ARIMA (3,0,2) and SARIMA (2,0,1) (1,0,0) 6 . Further, the accuracy of the SARIMA model was confirmed by comparing and analyzing the ARIMA model, which was built using the SARIMA model, and its predictability, which is mainly used in the existing forecasting field. Currently, the use of the SARIMA model is extremely rare in areas that predict the number of outpatients in hospitals. Results: Comparing the predicted accuracy of outpatient visits, the SARIMA model was found to be relatively more accurate than the ARIMA model. Conclusions: The study was conducted by applying the time unit at the “daily” level to predict the suspension rather than the quarterly and monthly data used to predict the existing time series. It is thought that this study will serve as basis for hospital-to-house management and policymaking by using the SARIMA model to predict the number of patients visiting hospitals.","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-07-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41994778","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nurses as essential members of an effective in-hospital cardiac resuscitation team","authors":"Tabitha L. Cumpian, B. Yasmeh, A. Jahangir","doi":"10.21037/JHMHP-20-18","DOIUrl":"https://doi.org/10.21037/JHMHP-20-18","url":null,"abstract":"© Journal of Hospital Management and Health Policy. All rights reserved. J Hosp Manag Health Policy 2020;4:17 | http://dx.doi.org/10.21037/jhmhp-20-18 In-hospital cardiac arrest (IHCA), defined as loss of circulation prompting resuscitation with chest compressions, defibrillation, or both, is an increasingly common event affecting healthcare systems worldwide (1). The Get With The Guidelines-Resuscitation (GWTG-R) registry, a large, prospective, hospital-based clinical registry, documented an average of 209,000 cases of IHCA each year in the United States between 2003 and 2007, with an increase to 292,000 per year between 2008 and 2017 (1,2). Survival rates for IHCA remain poor (3,4) with average survival rates of about 26% among 311 hospitals in the United States in 2017 (2). The rate of survival to hospital discharge after cardiac arrest varies among medical centers and is higher in hospitals with higher cardiac arrest volume, higher surgical volume, greater availability of invasive cardiac services, and more affluent catchment areas (2). Among those surviving to hospital discharge, 81.7% were considered to possess good functional status as evidenced by a cerebral performance category of 1 or 2 (2), representing mild or no neurologic disability to moderate neurologic disability (5). A significant difference in survival rates exists across hospitals in the United States, with survival rates ranging from 5.3–49.6% (3,6). This wide variation is present despite published guidelines by the American Heart Association (AHA) for the management of cardiac arrest. Even with guidelines in place, implementation of recommended procedures during IHCA has proved difficult as these events take place in varied environments with complex and diverse medical issues and require the collaboration of a multidisciplinary team to achieve successful outcomes. There are several factors involved and multiple steps are needed to ensure effective management of an IHCA patient. The initial step in the evaluation and treatment of IHCA requires timely identification of the cardiac arrest event and the underlying cause. When a cardiac arrest occurs, early appropriate initiation of cardiopulmonary resuscitation (CPR) with quality chest compressions and thorough postresuscitation care are crucial to a positive outcome (1,5,7). In approximately 50–60% of cases, the underlying cause is cardiac in nature, whereas 15–40% are due to respiratory insufficiency (1) and appropriate care is needed for each of the underlying conditions and modifying factors to prevent deterioration that might lead to cardiac arrest. Development of a dedicated cardiac arrest or code team is essential. Top-performing hospitals are found to have dedicated or designated resuscitation teams with additional support staff (i.e., nursing, pharmacy, clerical, spiritual staff), clear patterns of communication between team members, and specific training and education around resuscitation (7). Although ample research h","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47707526","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Social media and the workplace: “could loose lips cost you a pink slip?”","authors":"P. Kalina","doi":"10.21037/jhmhp.2020.03.05","DOIUrl":"https://doi.org/10.21037/jhmhp.2020.03.05","url":null,"abstract":"","PeriodicalId":92075,"journal":{"name":"Journal of hospital management and health policy","volume":"4 11","pages":""},"PeriodicalIF":0.0,"publicationDate":"2020-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.21037/jhmhp.2020.03.05","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41243250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}