Hospitals

The tertiary care medical facilities that account for about a third of national health expenditures.  Almost 80% of hospitals are non-profit. 

The Value of Teaching Hospitals

Jan. 14, 2020

One benefit of teaching hospitals is obvious: they train the next generation of clinicians. But that training comes at a cost: teaching hospitals tend to have higher-priced clinical care than other hospitals. In the era of value-based care, the question is whether the additional spending produces better patient outcomes, and if so, whether the clinical benefit is worth the cost.

Quality of End of Life Care in Magnet® and Non-Magnet Hospitals

Jan. 10, 2020

Karen B. Lasater, Amelia E. Schlak

Abstract [from journal]

Objective: To examine whether end-of-life care quality is superior in Magnet hospitals, a recognition designating nursing excellence.

Background: Considerable research shows better patient outcomes in hospitals with excellent nurse work environments, but end-of-life care quality has not been studied in Magnet hospitals.

Methods: An analysis of cross-sectional data was completed using surveys of nurses and hospitals. Multivariate logistic regression models were used to determine the

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Hospital Financial Incentives to Improve Care After Opioid Overdose

Jan. 6, 2020

Two patients are treated for opioid overdose at two different hospitals, just a few miles apart. The first hospital provides life-saving treatment to reverse the overdose and watches the patient for an hour, discharging them when deemed “medically stable.” The second hospital also provides life-saving treatment but then offers counseling, medication to prevent recurrent overdose and treat opioid withdrawal, and assistance navigating to outpatient treatment for the next day.

Live Discharge From Hospice Due to Acute Hospitalization: The Role of Neighborhood Socioeconomic Characteristics and Race/Ethnicity

Dec. 24, 2019

David Russell, Elizabeth Luth, Miriam Ryvicker, Kathryn Bowles, Holly Prigerson

Abstract [from journal]

Background: Acute hospitalization is a frequent reason for live discharge from hospice. Although risk factors for live discharge among hospice patients have been well documented, prior research has not examined the role of neighborhood socioeconomic characteristics, or how these characteristics relate to racial/ethnic disparities in hospice outcomes.

Objective: To examine associations between neighborhood socioeconomic characteristics and risk for live discharge from hospice because of acute hospitalization. The...

Association of a Targeted Population Health Management Intervention with Hospital Admissions and Bed-Days for Medicaid-Enrolled Children

David M. Rubin, MD, MSCE
Dec. 2, 2019

David M. Rubin, Chén C. Kenyon, Douglas Strane, Elizabeth Brooks, Genevieve P. Kanter,  Xianqun Luan, Tyra Bryant-Stephens, Roberto Rodriguez, Emily F. Gregory,  Leigh Wilson, Annique Hogan, Noelle Stack,...

Abstract [from journal]

Importance: As the proportion of children with Medicaid coverage increases, many pediatric health systems are searching for effective strategies to improve management of this high-risk population and reduce the need for inpatient resources.

Objective: To estimate the association of a targeted population health management intervention for children eligible for Medicaid with changes in monthly hospital admissions and bed-days.

Design, Setting, and Participants: This quality...

Failure to Rescue as an Outcome Metric for Pediatric and Congenital Cardiac Catheterization Laboratory Programs: Analysis of Data From the IMPACT Registry

Nov. 5, 2019

Michael L. O'Byrne, Kevin F. Kennedy, Natalie Jayaram, Lisa J. Bergersen, Matthew J. Gillespie, Yoav Dori, Jeffrey H. Silber, Steven M. Kawut, Jonathan J. Rome, Andrew C. Glatz
 

Abstract [form journal]

Background: Risk-adjusted adverse event (AE) rates have been used to measure the quality of pediatric and congenital cardiac catheterization laboratories. In other settings, failure to rescue (FTR) has demonstrated utility as a quality metric.

Methods and Results: A multicenter retrospective cohort study was performed using data from the IMPACT (Improving Adult and Congenital Treatment) Registry between January 2010 and December 2016. A modified FTR metric was developed for pediatric and congenital cardiac

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Patient Experiences With Miscarriage Management in the Emergency and Ambulatory Settings

Nov. 4, 2019

Carolyn Miller, Andrea Roe, Arden McAllister, Zachary Meisel, Nathanael Koelper, Courtney Schreiber

Abstract [from journal]

Objective: To quantitatively and qualitatively describe the patient experience for clinically stable patients presenting with miscarriage to the emergency department (ED) or ambulatory clinics.

Methods: We present a subanalysis of a mixed-methods study from 2016 on factors that influence miscarriage treatment decision-making among clinically stable patients. Fifty-four patients were evaluated based on location of miscarriage care (ED or ambulatory-only), and novel parameters were assessed including timeline (

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Comparing Rates of Adverse Events and Medical Errors on Inpatient Psychiatric Units at Veterans Health Administration and Community-Based General Hospitals

Nov. 1, 2019

Sara W. Cullen, Ming Xie, Jentien M. Vermeulen, Steven C. Marcus

Abstract [from journal]

Objective: There is limited knowledge about how general hospitals and Veterans Health Administration (VHA) hospitals fare relative to each other on a broad range of inpatient psychiatry-specific patient safety outcomes. This research compares data from 2 large-scale epidemiological studies of adverse events (AEs) and medical errors (MEs) in inpatient psychiatric units, one in VHA hospitals and the other in community-based general hospitals.

Method: Retrospective medical record reviews assessed the prevalence of

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Centers of Excellence: Are There Standards?

Oct. 29, 2019

Joan Li, Randall C. Burson, Justin T. Clapp, Lee A. Fleisher

Abstract [from journal]

Introduction: Centers of Excellence (CoEs) are intended to label hospitals that have met certain quality, process, volume and infrastructure guidelines. However, there are largely no standardized metrics to designate what qualifies as a CoE, leading to entities across the healthcare spectrum creating their own designations. Empirical studies on the impact of CoEs on quality do not consistently show improved care. Given the variability in definitions and outcomes for CoEs, the study evaluated the current status of defining and using

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Perspectives of Clinicians, Staff, and Veterans in Transitioning Veterans from Non-VA Hospitals to Primary Care in a Single VA Healthcare System

Robert Burke, MD, University of Pennsylvania
Oct. 23, 2019

Roman Ayele, Emily Lawrence, Marina McCreight, Kelty Fehling, Russell Glasgow, Borsika Rabin, Robert Burke, Catherine Battaglia

Abstract [from journal]

Background: Veterans with healthcare needs utilize both Veterans Health Administration (VA) and non-VA hospitals. These dual-use veterans are at high risk of adverse outcomes due to the lack of coordination for safe transitions.

Objectives: The aim of this study was to understand the barriers and facilitators to providing high-quality continuum of care for veterans transitioning from non-VA hospitals to the VA primary care setting.

Design: Guided by the practical robust implementation

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Hospitalist Vs. Non-Hospitalist Care Outcomes and Costs for Medicare Beneficiaries Discharged to Skilled Nursing Facilities in 2012-2014

Rachel Werner
Oct. 21, 2019

Kira L. Ryskina, Yihao Yuan, Daniel Polsky, Rachel M. Werner

Abstract [from journal]

Background: Hospitals are increasingly at risk for post-acute care outcomes and spending, such as those in skilled nursing facilities (SNFs). While hospitalists are thought to improve patient outcomes of acute care, whether these effects extend to the post-acute setting in SNFs is unknown.

Objective: To compare longer term outcomes of patients discharged to SNFs who were treated by hospitalists vs. non-hospitalists during their hospitalization.

Design: This was a retrospective cohort

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The Association of Geographic Dispersion with Outcomes among Hospitalized Pulmonary Service Patients

Oct. 16, 2019

Rachel Kohn, Michael O. Harhay, Gary E. Weissman, George L. Anesi, Brian Bayes, Hummy Song, Scott D Halpern, S. Ryan Greysen, Meeta Prasad Kerlin

Abstract [from journal]

Hospitals geographically localize clinically similar patients into wards to provide specialized care that improves patient outcomes and care and lowers costs. When these wards exceed capacity, patients become “geographically dispersed” to alternate locations. For example, critically ill patients may “board” in emergency departments (EDs) or alternate intensive care units (ICUs) when the clinically appropriate ICUs are at capacity. Such geographic dispersion has been demonstrated to be associated with increased hospital length of stay (LOS), ICU and in-...

Comparing Outcomes and Costs of Surgical Patients Treated at Major Teaching and Nonteaching Hospitals: A National Matched Analysis

Oct. 15, 2019

Jeffrey Silber, Paul Rosenbaum, Bijan Niknam, Richard Ross, Joseph Reiter, Alexander Hill, Lauren Hochman, Sydney Brown, Alexander Arriaga, Rachel Kelz, Lee Fleisher

Abstract [from journal]

Objective: To compare outcomes and costs between major teaching and nonteaching hospitals on a national scale by closely matching on patient procedures and characteristics.

Background: Teaching hospitals have been shown to often have better quality than nonteaching hospitals, but cost and value associated with teaching hospitals remains unclear.

Methods: A study of Medicare patients at 340 teaching hospitals (resident-to-bed ratios ≥ 0.25) and matched patient controls from 2444

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