China
Africa
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Sources of data/modeling
Published in Edward M. Rafalski, Ross M. Mullner, Healthcare Analytics, 2022
Edward M. Rafalski, Robert Marksthaler
Market data, including share of COVID-19 patients, was central to understanding impact on financial performance. In the United States there are 6,090 hospitals of which 5,141 are community hospitals. Community hospitals are defined as all nonfederal, short-term general, and other special hospitals. Other special hospitals include obstetrics and gynecology; eye, ear, nose, and throat; long-term acute-care; rehabilitation; orthopedic; and other individually described specialty services. Community hospitals include academic medical centers or other teaching hospitals if they are nonfederal short-term hospitals. Excluded are hospitals not accessible by the general public, such as prison hospitals or college infirmaries. We have a mixture of nongovernmental private not-for-profit community hospitals (2,946), investor-owned private (for-profit) hospitals (1,233) and state and local government community hospitals (962), federal government hospitals, such as the Veterans Administration (VA) hospitals (208), non-federal psychiatric hospitals (625), and other hospitals (116). Other hospitals include non-federal long-term care hospitals and hospital units within an institution such as a prison hospital or school infirmary. Long-term care hospitals may be defined by different methods; here they include other hospitals with an average length of stay (LOS) of 30 or more days. 1,805 hospitals are in rural communities, 3,336 are located in urban communities, and 3,453 hospitals are part of a larger system.2
What Promotes Joy
Published in Eve Shapiro, Joy in Medicine?, 2020
I was in the ER at the county hospital in one town, and a town north of us had a community hospital with an emergency department of three rooms and a couple of beds. The ophthalmologists were staffing it. When I finished my internship and was working as a staff doctor in the county hospital ER, the community hospital administrator contacted me and asked if I could staff their hospital emergency department too. Remember, there was no residency and I had just finished my internship. So, with one of my intern friends, and two of his medical school friends from across the country, we formed a group to staff the emergency department. Even without any residency training, we were better than the limited specialists we replaced.
Nurse-led minor injury units
Published in Chris Salisbury, Jeremy Dale, Lesley Hallam, 24-Hour Primary Care, 2018
Emma Jefferys, Alistair Stinson
Geographical location has a major impact on the type and scope of minor injury services. For example, in rural areas primary care-based services are more likely, while district general hospital-based services are more likely to serve suburban and inner-city populations; community hospital-based services mainly serve market towns and mixed suburban areas. Services in more rural locations are less likely to have nearby A&E departments to whom patients can be referred. This can result either in more restrictive protocols, ensuring patients do not attend the unit if there is any possibility that they will need to be transferred to an A&E, or more inclusive protocols because of the lack of alternative service provision.
One and Done Epinephrine in Out-of-Hospital Cardiac Arrest? Outcomes in a Multiagency United States Study
Published in Prehospital Emergency Care, 2023
Nicklaus P. Ashburn, Bryan P. Beaver, Anna C. Snavely, Niaman Nazir, James T. Winslow, R. Darrell Nelson, Simon A. Mahler, Jason P. Stopyra
This study has limitations. Patients were not randomized to a single-dose vs. multidose epinephrine protocol, thereby opening the study to unknown confounders and maturation effects. Although this study occurred in a diverse area with rural, urban, and suburban communities with a variety of ALS EMS systems in central NC, generalizability to other regions and non-ALS EMS systems may be limited. Furthermore, the survival to hospital discharge rates was higher in the single-dose and multidose epinephrine cohorts than the national average (10, 11). This is likely reflective of each participating EMS agency being a regional leader in OHCA resuscitation, with each focusing on team-focused CPR, early defibrillation, and minimizing peri-shock pause times. Therefore, the high survival to hospital discharge rates seen with these EMS agencies may not be reflective of national care patterns. Additionally, the receiving hospitals varied, with some being tertiary-care centers and others being community hospitals. The outcomes provided by CARES were not adjudicated, thus risking misclassification bias. Due to the nature of the study and data collection procedures, a per protocol analysis was not possible. The study was not powered to detect a difference in neurologic outcomes among survivors given that only 244 patients survived. Baseline neurologic status was also unknown, further limiting inferences regarding epinephrine dosing and neurologic outcomes.
Impact of Medicaid expansion on mental health and substance use related emergency department visits
Published in Substance Abuse, 2022
The study utilizes state-level ED visit data from Healthcare Cost and Utilization Project (HCUP) Fast Stats database available from the Agency for Healthcare Research and Quality (AHRQ).26 The HCUP Fast Stats database provides quarterly rates of ED visits related to MHSU disorders for calendar years 2006–2019 from 34 states of which 20 were Medicaid expansion states and 14 were non-expansion states. State-level data on MHSU related ED visits are drawn from HCUP State Emergency Department Databases (SEDD) and State Inpatient Databases (SID).27,28 The SID and the SEDD have data on patients treated in hospital-owned EDs of community hospitals. The HCUP defines community hospitals as short-term, nonfederal, general, and other hospitals, excluding hospital units of other institutions (e.g., prisons). MHSU ED visits utilized in the analysis include only non-Medicare adult population (age 19–64) data with expected primary payer listed as Medicaid, privately insured, or self-pay/no charge. The HCUP database indicates that patients identified as self-pay/no charge can have an expected primary payer of self-pay, no charge, charity, or no expected payment.26 To be consistent with the literature, we will refer to the expected payer listed as self-pay/no charge as uninsured hereafter.8 The Fast Stats database excludes anyone in this population (age 19–64) that has Medicare as their primary expected payer.26 Medicare specific MHSU ED visits for age 65+ were excluded from the analyses since Medicaid expansion may not affect Medicare-covered ED visits.
Clinical outcomes and operational impact of a medical photography based teledermatology service with over 8,000 patients in the UK
Published in Journal of Visual Communication in Medicine, 2022
Ioulios Palamaras, Helen Wark, Billy Short, Omair Akhtar Hameed, Adil Ahmed Sheraz, Penelope Thomson, Kam Kalirai, Lisa Rose
To summarise this TD service:Is using medical photographers for clinical images results in very few inappropriate images thereby reducing the number of redundant TD consultations and is likely to have been able to increase diagnostic accuracy.TD software system was designed and developed with the full participation of its future users and clinicians throughout and is fully integrated with the EPR of the Trust. The system is paperless and outcomes are emailed straight to GPs together with the clinical images.Can also be used as an educational tool to GPs as they receive the images of the referred lesion with the diagnosis and management plan.Is community-based for patients with ‘care closer-to-home’ inconveniently located surgeries/community hospitals.Offers a solution to the workforce crisis experienced in Dermatology by making the most effective use of expert clinicians