Quality of care activities in Danish hospitals

This article describes how hospitals in Denmark have tried to meet the quality challenge. How to improve health care has been a topic of debate in Denmark in the last decade, and various authorities and professional organizations have implemented quality improvement initiatives. A 1991 survey of Danish hospitals showed that methods of quality improvement and the responsibility for quality management were still issues in need of further clarification. This article illustrates the process of quality improvement using hospitals in the city of Copenhagen as examples.

Inequity in the distribution of urban health care infrastructure in Kenya: the Kisumu Municipality as an example

This paper discusses the phenomenon of the intra-urban inequities in the provision of health care. Using the example of Kisumu municipality in Kenya, the author demonstrates that the current gross differentials in the state of health and access to health care are neither inevitable nor unavoidable. The author however contends that the crisis is not insurmountable. What it requires is the willingness and readiness by the political superstructure to stimulate, institute and enforce appropriate changes in the legislative policies affecting the very basis upon which appropriate and innovative application of various policy alternatives to urban health planning and the overall domain of physical planning and urban renewal should take place.

Development of the city-county (public) hospital

Prior to 1966, the United States had a two-tiered system of health care. Those patients who could afford the cost of medical care were treated by private physicians in their offices and in private hospitals. For patients who could not afford care, ie, the indigent and retirees over 65 years of age who developed catastrophic illnesses, the city and county (public) hospitals provided the only health care available. All counties assumed responsibility for their indigent patients, and all but the smallest counties had their local hospital. In the larger cities, these hospitals developed teaching programs and affiliations with medical schools that provided a volunteer teaching faculty (Table) (John G. Raffensperger, unpublished data, 1991; John E. Salvaggio, unpublished data, 1989). The smaller county hospitals relied on a few full-time generalists, but primarily they depended on volunteer physicians from the community to provide patient care.

Wounded by violence. Can a KISS (Kids, Injuries, and Street Smarts) make it better?

Last year, Tyrone Sinkler, 16, and Ian Moore, his 17-year-old buddy, were gunned down in the hallway of their New York City school by a disgruntled classmate. For many EMTs and paramedics, this tragedy would have just added to the helplessness we feel when we go on calls in which children kill children. But for some New York City EMS (NYC*EMS) personnel, this incidence added fuel to their fire of determination to prevent such violence. Through a program called KISS (Kids, Injuries and Street Smarts), which coincidentally was poised to begin about the same time as the Sinkler and Moore tragedy, NYC*EMS personnel strive to reduce traumatic injuries to adolescents.

Custody of cocaine-exposed newborns: determinants of discharge decisions

OBJECTIVES

Maternal cocaine use is a leading grounds for newborn foster placement. This study was initiated to investigate the factors that predict custody status of infants born to substance-abusing women.

METHODS

A retrospective cohort design was used to study the correlates of discharge custody decisions for 99 consecutive infants testing positive for cocaine in a public hospital.

RESULTS

The population was 49% Black, 40% Hispanic, and 11% other or unknown. Custody at discharge was to mothers (38%), other family members (25%), or agency foster care (36%). Placement outside the family was greater when mothers had prior child welfare records, in Blacks vs others, with no prenatal care, and when mothers were younger at their first delivery or older at the index birth. Denial of custody to the mother was higher with prior child welfare involvement, in Blacks, and when the mother did not live in her own home. Both models also controlled for parity, child sex, and birthweight.

CONCLUSIONS

Earlier involvement with child welfare authorities, race, and other factors predict continued separation of mothers and children at newborn discharge, suggesting the need to reexamine current policies and practices.