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Among nonelderly adults with diabetes, we compared hospitalizations for ambulatory care--sensitive conditions from 2013 (pre-Medicaid expansion) and 2014 (post-Medicaid expansion) for 13 expansion and 4 nonexpansion states using State Inpatient Databases. Medicaid expansion was associated with decreases in proportions of hospitalizations for chronic conditions (difference between 2014 and 2013 -0.17 percentage points in expansion and 0.37 in nonexpansion states, P = .04), specifically diabetes short-term complications (difference between 2014 and 2013 -0.05 percentage points in expansion and 0.21 in nonexpansion states, P = .04). Increased access to care through Medicaid expansion may improve disease management in nonelderly adults with diabetes. [ABSTRACT FROM AUTHOR]

Study Objective: Many policymakers believe that expanding access to outpatient care will reduce emergency department (ED) use. However, outpatient health care providers often refer their patients to EDs for evaluation and management. We examine the factors underlying outpatient provider referral, its effect on ED visit volume, and whether referred ED visits are more likely to result in hospitalization than self-referred visits.Methods: We conducted a cross-sectional study of 19,342 adult (>18 years) respondents to the 2012 to 2014 National Health Interview Survey who reported they had visited an ED at least once in the past 12 months, representing an estimated 44,152,870 US adults. We categorized individuals as having been referred to the ED by an outside health care provider if they responded affirmatively to "your health care provider advised you to go" as a reason for their most recent ED visit. We performed descriptive analyses and logistic regressions to examine factors associated with outpatient health care provider referral to the ED. Respondents could choose multiple other reasons for their most recent ED visit, and we used existing Centers for Disease Control and Prevention guidelines to group these reasons into 2 categories: seriousness of the medical condition and lack of access to other providers. Our 2 main outcomes were whether an outpatient health care provider referred an individual to the ED and whether that ED visit resulted in hospitalization.Results: Of the 44,152,870 US adults (18.58%; 95% confidence interval [CI] 18.21% to 18.95%) with one or more ED visits in the previous 12 months, 10,913,271 (24.72%; 95% CI 23.80% to 25.64%) were referred to the ED by an outpatient provider. Respondents who reported their ED visit was due to the seriousness of their medical condition were more likely to be referred to the ED (odds ratio [OR] 2.18; 95% CI 1.91 to 2.49), whereas those reporting a lack of access to other providers were less likely to be referred (OR 0.58; 95% CI 0.52 to 0.64). Visits referred to the ED were more likely to result in hospitalization than self-referrals (OR 2.07; 95% CI 1.87 to 2.31).Conclusion: Almost one quarter of individuals' most recent ED visits were driven by referrals from outpatient health care providers. Being referred to the ED by an outpatient provider is strongly associated with the seriousness of one's medical condition, which also increases the odds of hospitalization compared with ED discharge. After controlling for seriousness of medical condition, ED referral by an outpatient provider continues to have an independent association with hospitalization. [ABSTRACT FROM AUTHOR]

Copyright of Revista Argentina de Clínica Psicológica is the property of Fundacion AIGLE and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Avoidable hospitalizations for ambulatory care sensitive conditions (AH-ACSCs) identify health problems that could be avoided by improving primary health care (PHC). On the basis of hospital discharges from Argentine public sector facilities, an expert panel convened to define a list of AH-ACSCs for children and adults. AH-ACSCs represented less than 30% of hospitalizations. Compared with country averages, poorer districts showed large differences in trends for adults but not for children. Despite that AH-ACSCs have demonstrated empirical validity to evaluate health system performance, its implementation to assess PHC in countries like Argentina, with pluralistic and fragmented health care systems, remains a big challenge. [ABSTRACT FROM AUTHOR]

Purpose: Interhospital critical care transfers are common, yet few studies address the underlying reasons for transfers. We examined clinician and patient/surrogate perceptions about interhospital transfers and assessed their agreement on these transfers. Materials and methods: This is a mixed-mode survey of 3 major stakeholders in interhospital transfers to an academic medical intensive care unit from August 2007 to April 2008. Results: Sixty-two hospitals transferred 138 patients during the study period. Response rates varied among stakeholders (accepting physician, 90%; referring physicians, 20%; patients/surrogates, 33%). All 3 groups frequently endorsed quality of care and need for a specific test/procedure as important. Referring hospital reputation and quality were rarely endorsed. Accepting physicians and patients/ surrogates substantially agreed on the need for a specific test (κ = 0.70) and increased survival (κ = 0.78) but, otherwise, had fair to poor agreement. Referring physicians and patients/surrogates rarely agreed and sometimes disagreed greater than expected by chance (κ < 0). Physician pairs strongly agreed on the importance of accepting hospital experience (κ = 0.96) but agreed less on patient satisfaction at the referring hospital (κ = 0.37) and referring hospital reputation (κ = 0.35). Conclusions: Stakeholders do not always agree on the reasons for critical care transfers. Efforts to improve communication are warranted to ensure informed patient choices. [ABSTRACT FROM AUTHOR]

Copyright of Cuadernos de Relaciones Laborales is the property of Universidad Complutense de Madrid and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective: Hospitalization of a child can cause severe anxiety and stress in the parents, especially for the mother. This stress consequently affects the treatment course of the child. Hereby, we investigate the impact of different stressors in mothers of hospitalized children. Materials & Methods: In this cross-sectional study, 225 mothers of hospitalized children in the pediatric ward of Besat hospital were randomly selected and studied. Data collection tool was a two-part questionnaire gathered by interviewing the mother. The first part included demographic information of the patients. The second part included questions regarding stressors in four different categories; child-related factors, environmental factors, socioeconomic factors and health professional factors. SPSS 16.5 was used for statistical analysis and data were analyzed by one way ANOVA and T test. Results: In the child-related factor category, fear of child death (84%); in the socioeconomic factor category, fear of disease in the other siblings (84%); in the environmental factor category, unpleasant odors in the ward (56%); and in the health professional category, not enough explanation about inserting IV lines, (54.2%) constituted the most important factors. There was a meaningful correlation between the stressors and the mothers’ age and occupation, child age, days of hospitalization, types of admission and health insurance coverage, but there was no meaningful correlation between stressors and other factors. Conclusion:Professional and in depth training programs should be provided for health care providers and nursing staff regarding dealing with mothers of hospitalized children. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Our aim was to evaluate Korea’s Pandemic Influenza Preparedness Plan. Methods: We conducted a sensitivity analysis on the expected number of outpatients and hospital bed occupancy, with 1,000,000 parameter combinations, in a situation of pandemic influenza, using the mathematical simulation program InfluSim. Results: Given the available resources in Korea, antiviral treatment and social distancing must be combined to reduce the number of outpatients and hospitalizations sufficiently; any single intervention is not enough. The antiviral stockpile of 4–6% is sufficient for the expected eligible number of cases to be treated. However, the eligible number assumed (30% for severe cases and 26% for extremely severe cases) is very low compared to the corresponding number in European countries, where up to 90% of the population are assumed to be eligible for antiviral treatment. Conclusions: A combination of antiviral treatment and social distancing can mitigate a pandemic, but will only bring it under control for the most optimistic parameter combinations. [Copyright &y& Elsevier]

This article discusses the history of hospitals in France. It examines the historical differences in the names and constructions of medical care facilities that were available to the population. There were differences in the types of places established both inside and outside of the metropolitan areas. For example, the places set up for medical care either in the center of cities were known as "xenodochia," while those that were situated at the entrance to the city or on the side of roads were known as "hospitalia" and were open to travelers and religious pilgrims. The history and differences of these establishments is examined in the Ardenne and Mosane regions of Belgium.

Copyright of Interface - Comunicação, Saúde, Educação is the property of Fundacao UNI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Assessing patients' views indicates to patients that we are concerned about continuous assessment and improving services in general. It also indicates that we are a conscientious professional within a genuine humanistic line of work. The paper discusses the many theoretical and methodological problems that have arisen from attempts to measure and quantify patient satisfaction. Numerical data are thought to be 'sterile' without any insight into personal meanings. On the other hand purely qualitative methods have not been widely used. This discussion paper ends with the formulation of two simple questions which can help us to explore and negotiate patients' needs and satisfaction. Two non-offensive straightforward questions are proposed as examples which could be used on a regular basis by nurses caring for older patients. [ABSTRACT FROM AUTHOR]

Copyright of Revista Eletrônica de Enfermagem is the property of Revista Eletronica de Enfermagem and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)