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Schaefer MK, Perkins KM, Link-Gelles R, Kallen AJ, Patel PR, Perz JF. Outbreaks and infection control breaches in health care settings: Considerations for patient notification. Am J Infect Control 2020; 48:718-724. [PMID: 32284161 DOI: 10.1016/j.ajic.2020.02.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 02/26/2020] [Accepted: 02/26/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Melissa K Schaefer
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA.
| | - Kiran M Perkins
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - Ruth Link-Gelles
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - Alexander J Kallen
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - Priti R Patel
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA
| | - Joseph F Perz
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention (CDC), Atlanta, GA
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Direct-to-Consumer Hospital Advertising and Domestic Medical Travel in the United States. J Healthc Manag 2020; 65:30-43. [PMID: 31913237 DOI: 10.1097/jhm-d-18-00232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
EXECUTIVE SUMMARY Expanding hospitals' geographic market area has been proposed as a means to increase competition and reduce healthcare costs. However, most patients in the United States receive care locally and are unlikely to seek out distant hospitals, effectively limiting competition to local markets. We hypothesize that mass media advertising can help overcome patients' reluctance to travel for elective medical care. We examined hospitals' advertising in distant markets to determine whether their expenditures predict the number of patients who travel to those hospitals.We obtained data on 2015 advertising expenditures by 273 U.S. academic medical centers from a market research firm. Regression models examined associations between hospitals' advertising expenditures and patient volume metrics: inpatients, encounters, and charges originating from distant markets where the medical centers advertised. Results showed that hospitals' advertising expenditures in distant markets were associated with higher numbers of inpatient admissions, patient visits, and charges from those markets. Compared to the distant markets where they advertised, the hometown markets of these hospitals are smaller with lower per capita income, suggesting hospitals are seeking incremental patient volume from more lucrative markets.Findings suggest that advertising may familiarize patients with distant facilities, encouraging domestic medical travel and enabling broader geographic competition among hospitals.
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Aggarwal A, Lewis D, Mason M, Sullivan R, van der Meulen J. Patient Mobility for Elective Secondary Health Care Services in Response to Patient Choice Policies: A Systematic Review. Med Care Res Rev 2016; 74:379-403. [PMID: 27357394 PMCID: PMC5502904 DOI: 10.1177/1077558716654631] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Our review establishes the empirical evidence for patient mobility for elective secondary care services in countries that allow patients to choose their health care provider. PubMed and Embase were searched for relevant articles between 1990 and 2015. Of 5,994 titles/abstracts reviewed, 26 studies were included. The studies used three main methodological models to establish mobility. Variation in the extent of patient mobility was observed across the studies. Mobility was positively associated with lower waiting times, indicators of better service quality, and access to advanced technology. It was negatively associated with advanced age or lower socioeconomic backgrounds. From a policy perspective we demonstrate that a significant proportion of patients are prepared to travel beyond their nearest provider for elective services. As a consequence, some providers are likely to be “winners” and others “losers,” which could result in overall decreased provider capacity or inefficient utilization of existing services. Equity also remains a key concern.
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Affiliation(s)
- Ajay Aggarwal
- 1 London School of Hygiene and Tropical Medicine, London, UK
| | - Daniel Lewis
- 1 London School of Hygiene and Tropical Medicine, London, UK
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Beaussier AL, Demeritt D, Griffiths A, Rothstein H. Accounting for failure: risk-based regulation and the problems of ensuring healthcare quality in the NHS. HEALTH, RISK & SOCIETY 2016; 18:205-224. [PMID: 27499677 PMCID: PMC4950452 DOI: 10.1080/13698575.2016.1192585] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 05/18/2016] [Indexed: 11/09/2022]
Abstract
In this paper, we examine why risk-based policy instruments have failed to improve the proportionality, effectiveness, and legitimacy of healthcare quality regulation in the National Health Service (NHS) in England. Rather than trying to prevent all possible harms, risk-based approaches promise to rationalise and manage the inevitable limits of what regulation can hope to achieve by focusing regulatory standard-setting and enforcement activity on the highest priority risks, as determined through formal assessments of their probability and consequences. As such, risk-based approaches have been enthusiastically adopted by healthcare quality regulators over the last decade. However, by drawing on historical policy analysis and in-depth interviews with 15 high-level UK informants in 2013-2015, we identify a series of practical problems in using risk-based policy instruments for defining, assessing, and ensuring compliance with healthcare quality standards. Based on our analysis, we go on to consider why, despite a succession of failures, healthcare regulators remain committed to developing and using risk-based approaches. We conclude by identifying several preconditions for successful risk-based regulation: goals must be clear and trade-offs between them amenable to agreement; regulators must be able to reliably assess the probability and consequences of adverse outcomes; regulators must have a range of enforcement tools that can be deployed in proportion to risk; and there must be political tolerance for adverse outcomes.
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Affiliation(s)
| | - David Demeritt
- Department of Geography, King’s College London, London, UK
| | - Alex Griffiths
- School of Management and Business, King’s College London, London, UK
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Laverty AA, Laudicella M, Smith PC, Millett C. Impact of ‘high-profile’ public reporting on utilization and quality of maternity care in England: a difference-in-difference analysis. J Health Serv Res Policy 2015; 20:100-8. [DOI: 10.1177/1355819615571444] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives To evaluate the impact of ‘high-profile’ (with extensive media coverage) public reporting versus public reporting without ‘high profile’ coverage on utilization and perceived quality of maternity services in England’s National Health Service. Methods Analysis of national hospital administrative data using difference-in-difference models with propensity score matching, and of two maternity surveys from 2007 and 2010. Outcomes were counts of women admitted for delivery of a baby and the percentage of women rating their care positively in 2007 and 2010. Results Hospitals highly publicized as providing the best maternity care in England had fewer admissions annually and lower occupancy rates than the national comparison group (63.0% vs. 77.3%; p = 0.09). There was no statistically significant change in overall maternity admissions in the best hospitals (+2.2%, p = 0.40 at six months), or the worst hospitals (−2.8%, p = 0.49 at six months) during any period in the 36 months after public reporting relative to their matched comparison groups. Survey analyses found that compared to the national comparison group of hospitals without ‘high profile’ media coverage, the worst rated hospitals experienced greater improvements in perceived quality after public reporting but these findings were not maintained in the analysis of matched hospitals. Conclusions ‘High-profile’ public reporting of maternity care in England was not associated with changes in the use of maternity services or improvements in patient-reported quality. These findings provide further evidence that public reporting is unlikely to drive major improvements in health system performance through the mechanism of patient choice.
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Affiliation(s)
- Anthony A Laverty
- Research Fellow, Department of Primary Care & Public Health, Imperial College London, London, UK
| | - Mauro Laudicella
- Senior Lecturer, Health Service Research & Management Division, School of Health Sciences, City University London, London, UK
| | - Peter C Smith
- Professor of Health Policy, Centre for Health Policy, Imperial College Business School, London, UK
| | - Christopher Millett
- NIHR Professor of Public Health, Department of Primary Care and Public Health, Imperial College London, London, UK
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Ketelaar NABM, Faber MJ, Braspenning JC, Westert GP. Patients' expectations of variation in quality of care relates to their search for comparative performance information. BMC Health Serv Res 2014; 14:617. [PMID: 25464982 PMCID: PMC4265457 DOI: 10.1186/s12913-014-0617-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2013] [Accepted: 11/19/2014] [Indexed: 11/10/2022] Open
Abstract
Background Choice of hospital based on comparative performance information (CPI) was introduced for Dutch healthcare consumers at least 5 years ago, but CPI use has not yet become commonplace. Our aim was to assess the role of patients’ expectations regarding variation in the quality of hospital care in determining whether they search for CPI. Methods A questionnaire (for a cross-sectional survey) was distributed to 475 orthopaedic patients in a consecutive sample, who underwent primary hip or knee replacement in a university, teaching, or community hospital between September 2009 and July 2010. Results Of the 302 patients (63%) who responded, 13% reported searching for CPI to help them choose a hospital. People who expected quality differences between hospitals (67%) were more likely to search for CPI (OR =3.18 [95% CI: 1.02–9.89]; p <0.04) than those who did not. Quality differences were most often expected in hospital reputation, distance, and accessibility. Patients who did not search for CPI stated that they felt no need for this type of information. Conclusion Patients’ expectations regarding variation in quality of care are positively related to their reported search for CPI. To increase the relevance of CPI for patients, future studies should explore the underlying reasoning of patients about meaningful quality-of-care variation between hospitals.
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Affiliation(s)
- Nicole A B M Ketelaar
- Scientific Institute for Quality of Healthcare (114), Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands.
| | - Marjan J Faber
- Scientific Institute for Quality of Healthcare (114), Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands.
| | - Jozé C Braspenning
- Scientific Institute for Quality of Healthcare (114), Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands.
| | - Gert P Westert
- Scientific Institute for Quality of Healthcare (114), Radboud University Medical Center, PO Box 9101, 6500, HB, Nijmegen, The Netherlands.
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Abstract
Traditional 'hierarchical' regulation involves checks and balances and external accountability and review bodies. There have been high profile failures of this approach in England (Mid Staffs) and Australia (Bundaberg, Queensland). The regulatory framework needs to be transformed to recognise the increasing use of market and market-like mechanisms in health care. Improvement in the ability to measure quality and safety of care using routine (already collected) data facilitates this. New regulation needs to ensure quality and financial incentives are aligned. New instruments such as incorporating safety/quality measures into service descriptions, use of patient reported outcome measures, and making information about expected outcomes of care to patients available, ought to be used more widely. Improved data capture, including whether a diagnosis was present on admission, will help in improving quality and safety of care and its measurement.
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Mammen C, Matsell DG, Lemley KV. The importance of clinical pathways and protocols in pediatric nephrology. Pediatr Nephrol 2014; 29:1903-14. [PMID: 23955786 DOI: 10.1007/s00467-013-2577-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2013] [Revised: 06/28/2013] [Accepted: 07/10/2013] [Indexed: 11/25/2022]
Abstract
Modern clinical practice is increasingly delivered by teams of individuals working within an environment of rising complexity and daunting patient care loads. Clinical pathways, protocols and checklists offer a way to assure coordination, efficiency, quality and safety in this chaotic environment. In this review, we discuss some of the principal characteristics of these clinical tools, some of the challenges involved with introducing them into clinical practice and the evidence that they can positively affect patient and system outcomes. We believe pediatric nephrology, as a discipline, is ready for the widespread introduction of these important quality tools.
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Affiliation(s)
- Cherry Mammen
- Division of Nephrology, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada,
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Impact of the Iranian hospital grading system on hospitals' adherence to audited standards: an examination of possible mechanisms. Health Policy 2013; 115:206-14. [PMID: 24300103 DOI: 10.1016/j.healthpol.2013.11.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2013] [Revised: 10/29/2013] [Accepted: 11/07/2013] [Indexed: 11/22/2022]
Abstract
INTRODUCTION All Iranian hospitals have been subject to a grading system which determines the payments they can charge. We examined all possible pathways through which the grading system could influence hospitals' adherence to audited standards. METHODS Using a mixed methods study we examined five stakeholder groups: hospital staff, patients, general practitioners, health insurance organisations and surveyor organisations. Data were collected via semi-structured interviews, a questionnaire survey, observation and documentary analysis. FINDINGS Patients and general practitioners were generally unaware of the hospital grading. Hospital staff and insurance organisations were informed, but this was not found to influence the hospital staff's choice of where to work nor the insurance organisations contracting behaviour. The grading system was criticised for the performance standards' validity and the validity of hospitals' awarded results. Hospitals responded to financial and reputational incentives for achieving better grades, although gaming and misrepresentation was also reported. CONCLUSION Pay-for-performance was the main influential factor in shaping hospitals' adherence to audit standards. Other potential mechanisms for influencing hospital behaviour, the selection mechanism and intrinsic motives, were not found to be sufficient to affect hospital behaviour.
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Prouty CD, Foglia MB, Gallagher TH. Patients’ Experiences with Disclosure of a Large-Scale Adverse Event. THE JOURNAL OF CLINICAL ETHICS 2013. [DOI: 10.1086/jce201324406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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