Simple-minded questions and twirling stools.

This reply to Ullman includes the following points: (a) The 2 variables he implicates as spuriously producing the relationships found between the social atmosphere and effectiveness of hospitals, namely, percentage of personnel responding and percentage of psychiatric beds, yield relationships with the criteria which are either O or opposite in sign from what he supposes. When these are allowed for, the relationships we posit increase. (b) Hospital size and staff/patient ratio undoubtedly bear on effectiveness, but do so through their effects on staff attitude. (c) Ullman is mistaken in his belief that psychiatrists' means on Opinions about Mental Illness Scale (OMI) authoritarianism and social restrictiveness are unrelated to hospital effectiveness. In fact, psychiatrists' means are more highly correlated (-.38 to -.66) than are those of representative staff samples (-.35 to -.44). These additional analyses strengthen the conclusion Ullman questions: "Authoritarian-restrictive hospital atmospheres are bad for patients." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The relationship of hospital ownership and teaching status to 30- and 180-day adjusted mortality rates

Hospital characteristics have been shown previously to be associated with variations in the probability of death within 30 days of admission. In the current study, the authors extend the examination of the relationship between hospital type to both short-term and long-term adjusted mortality. Observed and predicted 1988 hospital mortality rates were obtained from the Health Care Financing Administration (HCFA). A total of 3,782 acute care hospitals were divided into six mutually exclusive groups on the basis of their status as osteopathic, private for-profit, public teaching, public nonteaching, private teaching, and private nonteaching hospitals. After adjusting for the HCFA predicted mortality, Medicaid admissions, and emergency visits, 30-day and 30-to-180-day patient mortality rates were compared for these hospital types. Separate comparisons also were performed after stratifying hospitals into three groups defined by community size. The risk-adjusted 30-day mortality per 1,000 patients was 91.5, ranging from 85.4 for private teaching hospitals to 95.3 for nonteaching public hospitals, and 97.4 for osteopathic hospitals. The adjusted 30-to-180-day mortality was 84.7, ranging from 82.6 for nonteaching public hospitals to 87.4 and 88.2, respectively for public teaching and osteopathic hospitals. Differences among hospital types were minimal for small communities and increased with community size. In the large communities, the types of hospitals with high 30-day mortality also had higher mortality after 30 days. There was a strong association of hospital type with adjusted 30-day mortality, which should depend on the quality of hospital care, and a much weaker association with post-30-day mortality, which may be more dependent on patient risk. There was no evidence that types of hospitals with low 30-day mortality were postponing rather than preventing mortality.     

Rural hospital health promotion: programs, methods, resource limitations

Most hospitals provide health promotion programs for community residents. There is little information concerning the specific types of services offered by rural hospitals. A questionnaire was sent to every acute care hospital in Iowa (N = 124), including 99 rural hospitals and 25 urban hospitals. Surveys were returned from 95 rural hospitals (96%) and 20 urban hospitals (80%). Results indicated that 98.9% of rural hospitals offered health promotion services to community residents. These services provided on average 7.5 programs on a regular basis, while using only 1.2 full-time equivalent (FTE) employees. Urban hospitals provided 9.5 regular programs with 2.4 FTE. The most common types of rural promotion programs were blood pressure screening, cholesterol screening, safety and protection programs, diet/nutrition programs, prenatal/maternal health, and breast cancer screening. Over 40% of rural respondents stated that other less common programs, including substance abuse prevention and mental health promotion, were needed but could not be offered because of resource limitations; these types of services were offered more commonly in urban hospitals. Rural hospital health promotion programs are attempting to meet a wide variety of programming needs with limited resources, and attention may be well directed towards finding how best to provide various programs with limited resources to maximize their impact on community health.     

The Influence of Prior Coping Resources and Constraints on Nurses' Coping Responses to Hospital Amalgamation in Canada.

Nurses (N=159) participated in a 5-year panel study of coping with hospital downsizing and amalgamation. Nurses in the acquiring hospitals increased their use of help-seeking coping, whereas nurses in the acquired hospitals reduced their use of help-seeking coping. Both groups of nurses increased their use of avoidance/resignation coping. Prior coping resources were positively associated with the use of control-oriented coping, whereas constraints inhibited the use of these coping strategies. Both groups of nurses reported a decrease in resources during the amalgamation, indicating a negative impact of amalgamation not only on nurses in the hospitals being acquired but also on nurses in the hospitals remaining open. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Prognostic indicators for children in a psychiatric hospital.

In an effort to find prognostic indicators of improvement for a group of 34 hospitalized children, the relationship between improvement and initial test score was computed. A combination of rated improvement and improvement in Full Scale Wechsler IQ was used as the criterion of improvement. Initially high scores on the Goodenough Draw-A-Man, Wechsler Performance IQ, Similarities, and Picture Completion subtests were significantly related to subsequent improvement in the hospital setting. Initially low deviation scores on Digit Span and Comprehension relative to the other subtests were found related to subsequent improvement. It is concluded that children with a normal intellectual potential but incapacitated by anxiety or other acute emotional disturbances show the most improvement in a hospital setting. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Admission to hospitals with on-site cardiac catheterization facilities :impact on long-term costs and outcomes

BACKGROUND: Admission to a hospital with a capability for cardiac procedures is associated with a higher likelihood of referral for a cardiac procedure but not with a better short-term clinical outcome. Whether there are differences in long-term mortality and resource consumption is not clear. We sought to determine whether elderly Medicare patients with acute myocardial infarction admitted to hospitals with on-site cardiac catheterization facilities have lower long-term hospital costs and better outcomes than patients admitted to hospitals without such facilities. METHODS AND RESULTS: As part of the Cooperative Cardiovascular Project pilot in Connecticut, we conducted a retrospective cohort study using data from medical charts and administrative files. The study sample included 2521 patients with acute myocardial infarction covered by Medicare from 1992 to 1993. The cardiac catheterization rate was higher in the hospitals with facilities (38.6% versus 26.9%; P<0.001), but the revascularization rate was similar (20.5% versus 19.5%) during the initial episode of care and at 3 years (29.7% versus 29.7%). Mortality rates were similar for patients admitted to the 2 types of hospitals at 30 days (OR, 1.08; 95% CI, 0.83 to 1.42) and at 3 years (OR, 1.02; 95% CI, 0.83 to 1.26). The adjusted readmission rates were significantly lower among patients admitted to hospitals with cardiac catheterization facilities (OR, 0.76; 95% CI, 0.61 to 0.94). However, the overall mean days in the hospital for the 3 years after admission was 25.9 for patients admitted to hospitals with facilities and 24.6 for the other patients (P=0.234). Adjusting for baseline patient characteristics, there was no significant difference in the 3-year costs between patients admitted to the 2 types of hospitals. CONCLUSIONS: With higher rates of cardiac catheterization and lower readmission rates, patients admitted to hospitals with on-site cardiac catheterization facilities did not have significantly different hospital costs compared with patients admitted to hospitals without these facilities. There was also no significant difference in short- or long-term mortality rates.     

The psychologist and the small mental hospital.

A brief questionnaire was sent to the directors of the 82 hospitals belonging to the National Association of Private Psychiatric Hospitals. Replies were received from 49 or 60% of the sample of which 47 could be used for tabulation. "Only two hospitals say they do not use psychological tests; four more use them occasionally; one does not say; and the other 40, or 85% of our sample, gives an unqualified 'yes.' All those hospitals giving tests even occasionally, indicate the Rorschach as routine. All but two also list the Wechsler in this way." "Only 14 of the hospitals employ full-time psychologists. 23 more employ part-time psychologists." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A discussion of hospital social atmosphere profiles and their relevance to effectiveness.

Recent data purporting to show that hospital social atmospheres lead to hospital effectiveness were questioned on the basis of sampling, design, and strong indications that an alternative explanation was as reasonable as the one put forward by the authors. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Patient knowledge and nurse role strain in three hospital settings

The relationship between patient medical and hospital knowledge and nurse role strain is examined within three contrasting types of general hospital. The nature of this relationship was found to differ greatly within each of the three hospitals. Interpretations of these findings focus upon differences in organizational structure and climate, staff orientation, and type of clientele group. These data suggest that cuation should accompany attempts to generalize across different types of hospitals when questions relevant to the patient role are posed.     

Residual psychopathology in released psychiatric patients and its relation to readmission.

The degree and type of mental pathology reflected in MMPI scores was surveyed in 147 hospitalized psychiatric patients upon admission and release. Both statistical and clinical assessments of the profiles were made with analyses related to changes during hospitalization and to comparison with normal groups. Results vary depending on method of assessment. A substantial group of profile-pairs are judged as showing improvement at release (75%), while the remainder (25%) show more illness. Statistical analysis shows significant group improvement but exit profiles do not resemble those of normals. Psychotic profile types do not change to resemble neurotic ones with hospital treatment. MMPI change scores seem to anticipate rehospitalization better than evaluation of the patients' exit profile alone. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

In-group bias in response to an organizational merger.

The present research examined the extent of in-group bias in response to a planned organizational merger. Data were collected from 1,104 employees of 2 hospitals intending to merge—a high-status metropolitan teaching hospital and a relatively low-status local area hospital. As predicted from social identity theory, there was clear evidence of in-group bias, particularly among the employees of the lower status hospital on the dimensions irrelevant to the status differentiation between hospitals. On the status-relevant dimensions, in-group bias was significantly more marked among the employees of the high-status hospital. Also, as predicted, perceived threat was related to in-group bias on the status-irrelevant dimensions among the low-status employees. The present results indicate that managers need to be cognizant of the intergroup rivalry that is likely to be engendered in the context of an organizational merger, particularly among the employees of the lower status organization. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hygienic practices and acute respiratory illness in family and group day care homes

BACKGROUND: The Dutch guideline on hospital policy for the prevention of nosocomial spread of methicillin-resistant Staphylococcus aureus (MRSA) states that patients transferred from hospitals abroad must be placed in strict isolation immediately on admission to a hospital in the Netherlands. Three patients colonized with both MRSA and a multiresistant Acinetobacter were transferred from hospitals in Mediterranean countries to 3 different hospitals in the Netherlands. Despite isolation precautions, Acinetobacter spread in 2 of the 3 hospitals, whereas nosocomial spread of MRSA did not occur. METHODS: For outbreak analysis, the Acinetobacter isolates, identified as Acinetobacter baumannii by the use of amplified ribosomal DNA restriction analysis, were comparatively typed by 4 methods. Comparison of isolation measures in the hospitals was performed retrospectively. RESULTS: In the 2 hospitals in which nosocomial spread of Acinetobacter occurred, most of the epidemiologically related isolates were indistinguishable from the index strains. In these 2 hospitals, isolation measures were in concordance with those recommended for the prevention of contact transmission. The precautions of the hospital in which no outbreak occurred included the prevention of airborne transmission. CONCLUSIONS: Precautions recommended for multiresistant gram-negative organisms are insufficient for the prevention of nosocomial spread of multiresistant Acinetobacter. The airborne mode of spread of acinetobacters should be taken into account, and guidelines should be revised accordingly.     

Aortic pseudoaneurysm in the L3-L4 disc space after lumbar disc surgery. A case report

OBJECTIVES: This paper explores the relationship of state hospital and general hospital psychiatric caseloads in a statewide system of care. METHODS: Probabilistic population estimation was applied to general hospital and state hospital data sets. RESULTS: General hospitals provide inpatient psychiatric services to more people than do state hospitals, and a significant number are served in both sectors. There were notable differences in use patterns related to patient gender and age. CONCLUSIONS: These results demonstrate that probabilistic methodologies can significantly enhance the value of existing databases for epidemiological research.     

Pure versus hybrid: performance implications of Porter's generic strategies

This article identifies the strategic types in the hospital industry based on the hospital's use of Porter's generic strategies in their pure and hybrid forms. The article also examines differences in performance of hospitals across strategic types. Results indicate that hospitals that follow a focussed cost leadership strategy, in general, have superior performance on a variety of performance measures, while hospitals that use a combination of cost leadership and differentiation perform the poorest. Implications of findings for hospital administrators are also discussed.     

Molecular analysis of glycopeptide-resistant Enterococcus faecium isolates collected from Michigan hospitals over a 6-year period

The purpose of this study was to evaluate the molecular relatedness of clinical isolates of glycopeptide-resistant Enterococcus faecium isolates collected from hospitals in Michigan. A total of 379 isolates used in this study were all vancomycin-resistant E. faecium isolates collected from 28 hospitals and three extended-care facilities over a 6-year period from 1991 to 1996. For the 379 isolates, there were 73 pulsed-field gel electrophoresis (PFGE) strain types. Within strain types, there were as many as six restriction fragment differences. Most isolates (70%) belonged to six strain types, which were designated M1 (36%), M2 (3%), M3 (18%), M4 (6%), M10 (4%), and M11 (3%). PFGE strain M1 was cultured from 135 patients in 13 hospitals during the period 1993 to 1996. Strain type M2 was cultured from 11 patients in two hospitals during the period 1991 to 1992 and was not observed after 1992. Strain type M3 was cultured from 70 patients in 10 hospitals during the period of 1994 to 1996. Both M4 and M10 were cultured from 23 patients in three hospitals and from 15 patients in two hospitals, respectively, during 1995 to 1996. M11 was cultured from 13 patients in four hospitals during 1996. A total of 23 of 28 hospitals had evidence of clonal dissemination of some isolates. Plasmid content and hybridization analysis done on 103 isolates from one hospital and two affiliated extended-care facilities indicated that the strains contained from one to eight plasmids. Mating experiments indicated transfer of vancomycin resistance from 94 of these isolates into plasmid-free E. faecium GE-1 at transfer frequencies of <10(-9) to 10(-4). Gentamicin resistance and erythromycin resistance were cotransferred at various frequencies. A probe for the vanA gene hybridized to the plasmids of 23 isolates and to the chromosomes of 72 isolates. A probe for the vanB gene hybridized to the chromosomes of 8 isolates. The results of this study suggest inter- and intrahospital dissemination of vancomycin-resistant E. faecium strains over a 6-year period in southeastern Michigan. The majority of isolates studied belonged to the same few PFGE strains, indicating that clonal dissemination was responsible for most of the spread of resistance that occurred.     

Self-presentation and the schizophrenic "deficit".

103 schizophrenics were selected from 2 treatment and 2 custodial buildings in 3 hospitals and were classified according to their motivation for presenting a sick, incompetent or a healthy, competent impression on others. 10 hospital employees provided base-line comparison data. 1/2 of each group of schizophrenics was tested on reaction time without evaluation, and 1/2 were tested in an evaluation condition where they were told at a break that they had been performing like most mental patients. By taking patients' self-presentations and hospital atmospheres into account, it was possible both to increase the amount of "deficit" for each group and to reduce it to the point of elimination. The implications of these results for the understanding of schizophrenia are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Hospital facilities available to patients with Kawasaki disease: results of a national survey of Kawasaki disease in Japan

Since 1970, thirteen nationwide epidemiologic surveys of Kawasaki disease have been conducted, and questions on the current situation of hospitals and their facilities have been included in the survey form to assess the care available to patients with Kawasaki disease. To clarify the characteristics of medical care for Kawasaki disease, this paper summarizes the present condition of hospital facilities available to patients with Kawasaki disease. A questionnaire form including questions about the situation of hospital facilities was sent to all pediatric departments of hospitals with 100 or more beds throughout Japan. The proportion of hospitals in which successive observations with echocardiography (UCG) is available (UCG available hospital) was significantly increased compared with the ninth survey (1985-86), whereas that of the hospitals in which coronary angiography (CAG) is available (CAG available hospital) was significantly decreased. Almost all (96.2%) of the patients were reported from the UCG available hospitals. The proportion of patients reported from hospitals with a set policy for intravenous gamma globulin (IVGG) therapy was 74.5%. The proportion of UCG available and CAG available hospitals and that of hospitals with a set policy for IVGG therapy correlated with the increase in the number of patients. In conclusion, hospital facilities available to patients with Kawasaki disease in Japan have satisfactory capability for diagnosis and management of Kawasaki disease.     

Dimensions of psychiatric symptom ratings determined at thirteen timepoints from hospital admission.

Principal factor-varimax factor analyses of the Symptom Rating Scale (SRS) were performed at 13 timepoints over a 4-yr period, both in and out of the hospital, on pooled samples of predominantly chronic schizophrenic patients from 12 VA hospitals (N = 329-1274). 5 symptom factors were found: Uncooperative, Depression-Anxiety, Paranoid Hostility, Deteriorated Thinking, and Unmotivated. The high degree of factor similarity found over time, place (hospital or community), and rater (psychologist or social worker) makes longitudinal comparisons meaningful and makes it possible to use the Admission SRS analysis (N = 1274) as a basis for factor scoring throughout. The findings argue for the robustness of rated psychiatric symptom dimensions over changes in time and setting of the rating and in profession of the rater. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Teaching hospital costs: implications for academic missions in a competitive market

CONTEXT: As the managed care environment demands lower prices and a greater focus on primary care, the high cost of teaching hospitals may adversely affect their ability to carry out academic missions. OBJECTIVE: To develop a national estimate of total inpatient hospital costs related to graduate medical education (GME). DESIGN: Using Medicare cost report data for fiscal year 1993, we developed a series of regression models to analyze the relationship between inpatient hospital costs per case and explanatory variables, such as case mix, wage levels, local market characteristics, and teaching intensity (the ratio of interns and residents to beds). SETTING AND PARTICIPANTS: A total of 4764 nonfederal, general acute care hospitals, including 1014 teaching hospitals. MAJOR OUTCOME MEASURES: Actual direct GME hospital costs and estimated indirect GME-related hospital costs based on the statistical relationship between teaching intensity and inpatient costs per case. RESULTS: In 1993, academic medical center (AMC) costs per case were 82.9% higher than those for urban nonteaching hospitals (actual cost per case, $9901 vs $5412, respectively). Non-AMC teaching hospital costs per case were 22.5% higher than those for nonteaching hospitals (actual cost per differences in case, $6630 vs $5412, respectively). After adjustment for case mix, wage levels, and direct GME costs, AMCs were 44% more expensive and other teaching hospitals were 14% more costly than nonteaching hospitals. The majority of this difference is explained by teaching intensity. Total estimated US direct and indirect GME-related costs were between $18.1 billion and $22.8 billion in 1997. These estimates include some indirect costs, not directly educational in nature, related to clinical research activities and specialized service capacity. CONCLUSIONS: The cost of teaching hospitals relative to their nonteaching counterparts justifies concern about the potential financial impact of competitive markets on academic missions. The 1997 GME-related cost estimates provide a starting point as public funding mechanisms for academic missions are debated. The efficiency of residency programs, their consistency with national health workforce needs, financial benefits provided to teaching hospitals, and ability of AMCs to maintain higher payment rates are also important considerations in determining future levels of public financial support.     

Hospital vascular surgery volume and procedure mortality rates in California, 1982-1994

PURPOSE: Little is known about the long-term growth and outcomes of vascular surgery procedures over time. Trends in the use of three major vascular surgery procedures by a general population-lower extremity arterial bypass (LEAB), carotid endarterectomy (CEA), and abdominal aortic aneurysm repair (AAA)-are described. The extent to which these procedures are being performed in low-, moderate-, and high-volume hospitals is examined. METHODS: California hospital discharge records for LEAB, CEA, AAA, lower extremity angioplasty, coronary angioplasty, and coronary bypass surgery (CABG) were studied in all non-federal hospitals between 1982 and 1994. The data were age- and sex-adjusted to describe procedure growth. In-hospital mortality rates for LEAB, CEA, and AAA are related to overall hospital procedure volume, using logistic regression to control for risk factors and time trends. RESULTS: Growth in the number of vascular procedures performed in California was modest between 1982 and 1994, with no age-adjusted growth. Lower extremity angioplasty grew considerably in the 1980s and has since plateaued. Annual in-hospital death rates declined for all procedures except ruptured AAA. Comparing the two 5-year periods of 1982-1986 and 1990-1994, in-hospital death rates decreased from 4.2% to 3.3% for LEAB, from 9.2% to 6.2% for unruptured AAA, and from 1.6% to 1.0% for CEA (p < 0.0001). The odds of dying for patients treated in high-volume hospitals for LEAB and CEA procedures compared with patients treated in hospitals performing fewer than 20 procedures in a year were 66.7% (p = < 0.0001) and 66.1% (p < 0.0001), respectively. For patients with ruptured and unruptured AAA procedures, the odds of dying in hospitals with at least 50 AAA procedures in a year were 49.1% (p < 0.0001) and 83.8% (p = 0.016), respectively, compared with the odds of dying in low-volume hospitals. CONCLUSIONS: In-hospital mortality rates for CEA, LEAB, and unruptured AAA have been significantly decreasing over time. Mortality is inversely related to hospital volume and directly related to patient age and emergency status. Mortality trends over time for ruptured AAA remains unchanged; however, mortality is less in high-volume hospitals. Coronary angioplasty (PTCA) has not had an impact on rates for LEAB.