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Objective: To compare general surgery outcomes at flagship systems, flagship hospitals, and flagship hospital affiliates versus matched controls. Summary Background Data: It is unknown whether flagship hospitals perform better than flagship hospital affiliates for surgical patients. Methods: Using Medicare claims for 2018 to 2019, we matched patients undergoing inpatient general surgery in flagship system hospitals to controls who underwent the same procedure at hospitals outside the system but within the same region. We defined a "flagship hospital" within each region as the major teaching hospital with the highest patient volume that is also part of a hospital system; its system was labeled a "flagship system." We performed 4 main comparisons: patients treated at any flagship system hospital versus hospitals outside the flagship system; flagship hospitals versus hospitals outside the flagship system; flagship hospital affiliates versus hospitals outside the flagship system; and flagship hospitals versus affiliate hospitals. Our primary outcome was 30-day mortality. Results: We formed 32,228 closely matched pairs across 35 regions. Patients at flagship system hospitals (32,228 pairs) had lower 30-day mortality than matched control patients [3.79% vs. 4.36%, difference=−0.57% (−0.86%, −0.28%), P <0.001]. Similarly, patients at flagship hospitals (15,571/32,228 pairs) had lower mortality than control patients. However, patients at flagship hospital affiliates (16,657/32,228 pairs) had similar mortality to matched controls. Flagship hospitals had lower mortality than affiliate hospitals [difference-in-differences=−1.05% (−1.62%, −0.47%), P <0.001]. Conclusions: Patients treated at flagship hospitals had significantly lower mortality rates than those treated at flagship hospital affiliates. Hence, flagship system affiliation does not alone imply better surgical outcomes. [ABSTRACT FROM AUTHOR]

Emergency department (ED) patients may be billed for critical care time (current procedural terminology codes 99291 and 99292) if they receive at least 30 min of critical care services. We sought to determine the median cash (self-pay) prices for critical care time performed in the ED in the United States and assess for associations between hospital characteristics and prices. We performed a cross-sectional analysis of hospital cash prices for critical care time performed in the ED using the first 25 alphabetical states. For each hospital, we recorded hospital characteristics including state, control (nonprofit, governmental, or for-profit), size, teaching status, and system. We then searched for each hospital's cash prices for 99291 and 99292 using Turquoise and hospital websites. We determined the median price for 99291 nationally, regionally, and for large hospital systems. We performed multivariable quantile regression to assess for associations between hospital characteristics and prices for 99291. Of the 2629 eligible hospitals, 2245 (85.4%) and 1893 (72.0%) reported cash prices for 99291 and 99292, respectively. For 99291, the cash price ranged from $45 to $84,775 with a median of $1816 (IQR: $1039-3237). For 99292, the median price was $567 (IQR: $298–1008). On multivariable analysis, hospitals had higher cash prices for 99291 if they were located in the West, for-profit, or part of a large system. In particular, hospitals owned by Tenet Healthcare charged the most for 99291 (median $28,244). The cash prices for critical care time vary substantially based on hospital characteristics. In particular, for-profit hospitals and those in the West tend to charge the most. Given that patients who require critical care are unlikely to be able to choose the hospital to which they present, standardization of critical care time fees should be considered. [ABSTRACT FROM AUTHOR]

Asynchronous medical care has increased in utilization, patient interest, and industry demand. While E-consults have been discussed extensively in the literature, there are rare examples of a multispecialty implementation within a large health system. Here, we describe our experience in implementing an internal E-consult program for asynchronous, nonurgent communication between ambulatory specialists and primary care providers in our large multispecialty regional health system. To ensure adoption of the program, patient, specialist, and primary care physician concerns were systematically addressed. The program commenced in February 2022 with three high referral rate specialties: cardiology, orthopedics, and dermatology. In the 12 months after implementation, 2243 total E-consults were ordered among 505 ordering providers. Dermatology received the most consultations, and we have expanded to 19 specialties and subspecialties available in the program in the first year. Our E-consult implementation experienced substantial growth in a short time period, demonstrating the viability of E-consult utilization for increasing asynchronous access to ambulatory specialists' expertise in a large healthcare system. [ABSTRACT FROM AUTHOR]

This article shares some unusual insights into the natural and financial operations of the Croatian hospital system. It reveals a puzzling observation: the financial indicators of costs and hospital spending are on the rise, while at the same time, natural indicators, e.g., the number of hospital days and discharged patients, are declining. Physician numbers are increasing while hospital days of treatment are decreasing, and certain drugs consumption has been increasing without a corresponding increase in their patients. These are only some of the examples which are discussed in this publication. Stakeholders in healthcare insist that the hospital system is underfunded, while public finance, which sees financial sustainability through the prism of fiscal restraint, highlights uncontrolled growth of healthcare expenditures as key. Each has an element of truth, but neither is verifiably right or wrong. Due to the absence of a shared understanding of the dimensions of the problem, healthcare, and public finance have created a status quo of hidden deficits and government bailouts. A comprehensive response to this longstanding issue requires open and sincere communication of all public sector functions stakeholders on societal priorities. No matter how much it has been generally accepted so far, healthcare should no longer be a public function whose expenditures are regularly insufficiently planned in the budget, because under the pretext that the lives and health of citizens are at stake, it is irresistibly easy to subsequently cover the lack of financial resources.

The hospital system is one of the most critical systems in the city and plays an irreplaceable role in the whole process of earthquake disasters. This paper presents a method that considers the medical supply–demand relationship to quantify the functionality and functional loss of a hospital system under earthquake conditions, which is different from the current quantitative method that only considers internal factors of the hospital system. This method provides a "finest granularity" method for the division of quantitative evaluation units of hospital system functionality based on GIS overlay. Secondly, the functionality of the hospital system considering the medical supply–demand relationship and the quantitative metric, substitution capacity of medical resources (SCMR), is constructed. Then, we propose a quantification method of SCMR by combining the spatial and network analysis methods. Finally, a hospital system in eastern China is considered as an illustrative example. The impact of changes in the medical supply and demand at different times of the day on the hospital system functionality is analyzed. The results show that the medical supply and demand can impact hospital system functionality. The loss of medical supply causes a decline of hospital system functionality, while changes in the spatial aggregation of medical demand positively affect the loss of hospital system functionality. This paper can use the proposed method to quantify the hospital system functionality and reflect the balance of the medical supply–demand relationship before and after the earthquake. It can help decision-maker develop scientific post-earthquake emergency plans and enhance hospital system resilience. [ABSTRACT FROM AUTHOR]

Hospitals are places where you live a piece of your life, no matter you are healthcare professional, patient or caregiver. This editorial describes the humanistic approach to medicine adopted by the Montescano Institute, an Italian research and clinical hospital dedicated to the rehabilitation of neurological and cardiopulmonary diseases according to updated international guidelines. The aim of these “notes from the field” is to provide a sound example of humanistic clinical practice before, during and after the challenges posed by the COVID-19 pandemic. In this environmental each individual is indeed engaged in relationships, which trigger mutual empowerment and growth.

This article shares some unusual insights into the natural and financial operations of the Croatian hospital system. It reveals a puzzling observation: the financial indicators of costs and hospital spending are on the rise, while at the same time, natural indicators, e.g., the number of hospital days and discharged patients, are declining. Physician numbers are increasing while hospital days of treatment are decreasing, and certain drugs consumption has been increasing without a corresponding increase in their patients. These are only some of the examples which are discussed in this publication. Stakeholders in healthcare insist that the hospital system is underfunded, while public finance, which sees financial sustainability through the prism of fiscal restraint, highlights uncontrolled growth of healthcare expenditures as key. Each has an element of truth, but neither is verifiably right or wrong. Due to the absence of a shared understanding of the dimensions of the problem, healthcare, and public finance have created a status quo of hidden deficits and government bailouts. A comprehensive response to this longstanding issue requires open and sincere communication of all public sector functions stakeholders on societal priorities. No matter how much it has been generally accepted so far, healthcare should no longer be a public function whose expenditures are regularly insufficiently planned in the budget, because under the pretext that the lives and health of citizens are at stake, it is irresistibly easy to subsequently cover the lack of financial resources. [ABSTRACT FROM AUTHOR]

Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

A framework to quantitatively evaluate seismic resilience of hospital systems is proposed. A typical hospital system is categorized and importance factors for different functional units, subsystems, and components are quantified. Resilience demand is expressed as desirable recovery time of hospital system after earthquakes. Seismic resilience is quantified based on probabilistic seismic fragility analysis. Recovery time is calculated considering an idealized repair path. Loss of functionality of the hospital is evaluated as sum of weighted economic losses of all components. Case study of a hospital building was performed to demonstrate the feasibility and effectiveness of the proposed framework. [ABSTRACT FROM AUTHOR]

Hospitals are places where you live a piece of your life, no matter you are healthcare professional, patient or caregiver. This editorial describes the humanistic approach to medicine adopted by the Montescano Institute, an Italian research and clinical hospital dedicated to the rehabilitation of neurological and cardiopulmonary diseases according to updated international guidelines. The aim of these "notes from the field" is to provide a sound example of humanistic clinical practice before, during and after the challenges posed by the COVID-19 pandemic. In this environmental each individual is indeed engaged in relationships, which trigger mutual empowerment and growth. [ABSTRACT FROM AUTHOR]

Background: Increasing and substantial reliance on electronic health records (EHRs) and data types (ie, diagnosis, medication, and laboratory data) demands assessment of their data quality as a fundamental approach, especially since there is a need to identify appropriate denominator populations with chronic conditions, such as type 2 diabetes (T2D), using commonly available computable phenotype definitions (ie, phenotypes)., Objective: To bridge this gap, our study aims to assess how issues of EHR data quality and variations and robustness (or lack thereof) in phenotypes may have potential impacts in identifying denominator populations., Methods: Approximately 208,000 patients with T2D were included in our study, which used retrospective EHR data from the Johns Hopkins Medical Institution (JHMI) during 2017-2019. Our assessment included 4 published phenotypes and 1 definition from a panel of experts at Hopkins. We conducted descriptive analyses of demographics (ie, age, sex, race, and ethnicity), use of health care (inpatient and emergency room visits), and the average Charlson Comorbidity Index score of each phenotype. We then used different methods to induce or simulate data quality issues of completeness, accuracy, and timeliness separately across each phenotype. For induced data incompleteness, our model randomly dropped diagnosis, medication, and laboratory codes independently at increments of 10%; for induced data inaccuracy, our model randomly replaced a diagnosis or medication code with another code of the same data type and induced 2% incremental change from -100% to +10% in laboratory result values; and lastly, for timeliness, data were modeled for induced incremental shift of date records by 30 days to 365 days., Results: Less than a quarter (n=47,326, 23%) of the population overlapped across all phenotypes using EHRs. The population identified by each phenotype varied across all combinations of data types. Induced incompleteness identified fewer patients with each increment; for example, at 100% diagnostic incompleteness, the Chronic Conditions Data Warehouse phenotype identified zero patients, as its phenotypic characteristics included only diagnosis codes. Induced inaccuracy and timeliness similarly demonstrated variations in performance of each phenotype, therefore resulting in fewer patients being identified with each incremental change., Conclusions: We used EHR data with diagnosis, medication, and laboratory data types from a large tertiary hospital system to understand T2D phenotypic differences and performance. We used induced data quality methods to learn how data quality issues may impact identification of the denominator populations upon which clinical (eg, clinical research and trials, population health evaluations) and financial or operational decisions are made. The novel results from our study may inform future approaches to shaping a common T2D computable phenotype definition that can be applied to clinical informatics, managing chronic conditions, and additional industry-wide efforts in health care., (© Priyanka Dua Sood, Star Liu, Harold Lehmann, Hadi Kharrazi. Originally published in JMIR Medical Informatics (https://medinform.jmir.org).)

Objective: Our study investigated the level of implementation and utilization of Electronic Health Record (EHR) systems in all governmental and private hospitals that are registered in in the Kingdom of Bahrain under the Health Care Facilities section in the National Health Regulatory Authority (NHRA). Methods: This is a descriptive cross-sectional study conducted through a quantitative self-report survey. The data was collected from the IT division heads in the concerned hospitals from the 23rd June 2020 to the 27th July 2020. The first part consisted of demographic information of the hospitals and the second part requested the utilization level of items on the EHR comprehensive and basic functions (24 core functions). Only governmental and private hospitals licensed by NHRA in the Kingdom were included in the study. Results: Nearly 82% of all hospitals agreed to participate, where 89% of responding hospitals owned an EHR system and 55.6% had implemented comprehensive or basic electronic functionality features. Looking at the core functionality implementation in their EHR systems, the decision support had the lowest score with almost 42%. Conclusions: This is the first nationwide survey to be conducted on hospitals in Bahrain, showing that 89% of hospitals adopted an EHR system and 55.6% implemented a comprehensive or basic electronic system. Among the 24 electronic characteristics in EHR systems, hospitals must focus to improve the decision support functionality application status. The results may contribute to the improvement of the EHR system implementation in Bahrain and in the region. [ABSTRACT FROM AUTHOR]

Background: Complex surgical care is often centralized to one high volume (hub) hospital within a system. The benefit of this centralization in common operations is unknown., Methods: Using the Healthcare Cost and Utilization Project's State Inpatient Databases, adult general surgical patients within hospital systems in 13 states (2016-2018) were identified. Risk-adjusted logistic regression estimated the odds of death or serious morbidity (DSM) and prolonged length of stay (LOS) at hubs relative to other system hospitals (spokes)., Results: We identified 122,895 patients across 43 hub-and-spoke systems. Hubs completed 83.2 ​% of complex and 59.6 ​% of common operations. For complex operations, odds of DSM were significantly lower in hubs (OR: 0.80; 95 ​% CI [0.65, 0.98]). For common operations, odds of DSM were similar between hubs and spokes, while odds of prolonged LOS were greater at hubs (OR 1.19; 95 ​% CI [1.16,1.24])., Conclusions: While hub hospitals had lower odds of DSM for complex operation, they had higher odds of prolonged length of stay for common operations. This finding shows an opportunity for improved system efficiency., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Copyright of Revista de Historia (07169108) is the property of Universidad de Concepcion 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.)

The outbreak of coronavirus disease 2019 (COVID-19) in Wuhan has aroused widespread concern and attention from all over the world. Many articles have predicted the development of the epidemic. Most of them only use very basic SEIR model without considering the real situation. In this paper, we build a model called e-ISHR model based on SEIR model. Then we add hospital system and time delay system into the original model to simulate the spread of COVID-19 better. Besides, in order to take the government's control and people's awareness into consideration, we change our e-ISHR model into a 3-staged model which effectively shows the impact of these factors on the spread of the disease. By using this e-ISHR model, we fit and predict the number of confirmed cases in Wuhan and China except Hubei. We also change some of parameters in our model. The results indicate the importance of isolation and increasing the number of beds in hospital. [ABSTRACT FROM AUTHOR]

Copyright of Engineering Mechanics / Gongcheng Lixue is the property of Engineering Mechanics Editorial Department 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.)

Summary: Background: Reports of fatal anaphylaxis remain scarce because of the rarity of the condition and the fact that information is limited to a few countries. Objective: Our objective was to investigate clinical and demographic characteristics and the causes of fatal anaphylaxis in Spain using two databases of cases of fatal anaphylaxis. Methods: We analysed fatal anaphylaxis in a series from the Spanish hospital system and a series from the National Institute of Toxicology and Forensic Sciences (Instituto Nacional de Toxicología y Ciencias Forenses [INTCF]), which predominantly comprise extrahospital deaths. Deaths from the Spanish hospital system were retrieved from among all deaths occurring during 1998‐2011 using codes related to anaphylaxis. Deaths due to anaphylaxis in the INTCF database during the same period were retrieved by 2 allergists, who identified cases in which anaphylaxis was a possible cause of death. A logistic regression model was constructed to predict the characteristics of fatal anaphylaxis in each database. Results: The incidence of death by anaphylaxis in Spain using both databases was 0.25 (95% CI, 0.24‐0.26) deaths per million person‐years. The most frequent causes of death in the hospital system were drugs (46.1%), unknown causes (40.0%), and foods (10.4%); in the INTCF, the most common causes of death were drugs (47.2%), insect stings (30.6%), and foods (11.1%). The logistic regression model showed that fatal anaphylaxis due to unknown causes (OR 15.2, 95% CI 1.8‐129.8) was more likely in the hospital database, whereas insect stings (OR 100, 95% CI 10‐833.3) and previous atopic comorbidity (OR 15.2, 95% CI 6.3‐33.3) were more likely in the INTCF database. Conclusions & Clinical Relevance: The estimated frequency of fatal anaphylaxis in Spain was among the lowest reported. Future studies of fatal anaphylaxis should use databases from different origins in order to show the considerable heterogeneity in this type of death. [ABSTRACT FROM AUTHOR]

Topicality. Starting with the middle of the ‘90s of the previous century, the Republic of Moldova started to implement a series of important reforms, aimed at improving the access and quality of the services for increasing the efficiency and the performances of the health system. The aim of the research is the analysis of the Regionalization Plan of the Hospital Services and the assessment of medical workers opinion from district and republican hospitals regarding the envisaged transformations, in order to elaborate conclusions and recommendations that will be considered at the stage of reform’s implementation. The object of the research is the physicians of different profile (therapeutic, surgical, diagnostic), which work in republican and district hospitals. Methods: questioners, statistic data analyze, comparative method. Results. The logic of the regionalization suggests a reality, and namely, the need to transfer the physicians from the republican institutions to regional hospitals will be little. As a result, it will be applied only for the provision of the highly specialized services, for the solution of the associated cases or for the use of certain sophisticated methods of diagnosis and treatment (cardiac catheterization with subsequent plasty, etc). Therefore, it can be appreciated positively the fact that only 1/5 of physicians that work in the republican hospitals accept to commute or the transfer. It is more regrettable another reality, which shows that almost ½ of the specialists from the republican medical institutions generally do not want the regionalization and boycott the reform, just when they should promote the change. It results that mainly these physicians plead for the continuous maintenance of poor quality of hospital medical assistance, for the access limitation of the rural population at quality health service and, as consequence, and the financial burden to be left on patients shoulders – a fact mentioned in all the reports of foreign experts. Therefore we made the conclusion that as our society cannot get rid of the principles of health Semasko system for 25 years, so our physicians, especially the elderly and the most qualified – continue to guide themselves of stereotypes deeply rooted in the past.

Many studies have addressed resource allocation issues by using centralized data envelopment analysis models. However, few of them provided a local resource reallocation plan which may be carried out more easily. This article proposes two models to get such plans. The first one considers an acceptable percentage of changes in resources to ensure practical feasibility. The second one further considers a situation where resources can only be allowed to shift within specific units. The proposed models are applied to an empirical study based on a hospital system in Taiwan. To demonstrate the practical feasibility of the suggested plans, we compare our reallocation suggestions to a plan that can make the whole system be perfectly efficient. The main conclusion is that the plans derived from our models are more practically feasible than that with perfect efficiency. [ABSTRACT FROM AUTHOR]