Conocimiento de los tratamientos en pacientes hospitalarios: herramienta necesaria para la seguridad asistencial / Knowledge of treatments in hospital patients: a necesary tool for safety in health care

Objetivo. Determinar la cantidad y calidad de información sobre medicamentos que reciben los pacientes atendidos en un hospital. Método. Estudio descriptivo transversal realizado durante febrero de 2011, mediante diseño de una encuesta y entrevista a 60 pacientes: 30 ingresados y 30 externos. Análisis descriptivo de los resultados: número y grado de conocimiento de los medicamentos respecto al tratamiento «real», analizado de forma global, por edad y por vía de administración. Resultados. En el grupo de pacientes ingresados se analizaron 234 medicamentos «reales». Según los resultados de la encuesta, 45/234 (19,2%; IC95%:14-25) fueron conocidos de forma adecuada por los pacientes. En los pacientes externos esta cifra ascendió a 29/42 (69,0%; IC95%:53-82). El 33,3% de los pacientes verificó su medicación antes de ser administrada o dispensada. Los pacientes ingresados conocían mejor los medicamentos administrados por vía oral: el 28,6% frente al 5,1% de los parenterales. El 45,3% de los ingresados y el 2,4% de los externos desconocían la medicación. La edad media de los pacientes con conocimiento nulo de su medicación fue de 68,5 años (DE=10,1) y tenían 8,7 medicamentos prescritos (DE=3,0). El 53,3% y el 93,3% de los pacientes ingresados y externos respectivamente, consideraban haber sido informado correctamente. El 96,7% dijeron estar satisfechos con la información recibida. Conclusiones. Los resultados obtenidos muestran un potencial de mejora importante respecto a la información que se da a los pacientes, especialmente ingresados, en el hospital. Informarles permitiría su participación como filtro ante posibles errores de medicación y como pieza necesaria para la mejora de la seguridad asistencial(AU)

Objective. To determine the quantity and quality of drug information that patients receive in hospital. Method. Cross-sectional study conducted in February 2011, by designing and conducting a structured questionnaire on 60 patients: 30 inpatients and 30 outpatients. Descriptive analysis of the results was performed including, number and level of knowledge of medication treatment versus the "real" one, globally analysed by age and route of administration. Results. A total of 234 drugs were analysed in the inpatient group. It was considered that 45/234 (19.2%;95% CI: 14-25) were known properly by patients. In outpatients, this rises to 29/42 (69.0%;95% CI: 53-82). One third (33.3%) of patients check the medication before it is administered or provided. Inpatients are more aware of orally administered drugs, they knew 28.6% vs 5.1% of parenteral treatments. Just under half (45.3%) of inpatients and 2.4% of outpatients completely unknown the medication. The average age of patients with no knowledge of their medication was 68.5 years (SD=10.1) and had 8.7 drugs prescribed (SD=3.0). A total of 53.3% of inpatients and 93.3% of outpatients, considered to have been properly informed. Most of patients (96.7%) were satisfied with the information received. Conclusions. The results show an opportunity for improvement in the information given to patients, particularly to inpatients. To inform them, would enable them to act as a filter to potential medication errors, and as a necessary part to improve the safety of care(AU)

Understanding diagnostic related groups (DRGs) and inpatient hospital reimbursement.

Knowing insurance plan regulations and complying precisely with requirements is critical for hospital reimbursement of care provided. Diagnostic related groups provide guidelines widely used in the United States to determine hospital reimbursement by Medicare, Medicaid, and many insurance providers. Because hospitals are the largest employers of nurses, nurses have a responsibility and interest in contributing to the stability of their hospital's financial status to protect incomes and job security. This article provides an overview of diagnostic related groups and demonstrates how nurses can contribute to more accurate documentation outcomes that determine hospital reimbursement.

What insurers know about your hospital ... and how they are using it.

Insurers are using their purchasing power and their enormous stores of claims data to push hospitals to improve quality. Health plans are able to parse the data according to such quality indicators as cost, length of stay and outcomes. Hospitals are wary of the trend, but some welcome it, especially if insurers use the so-called pay-for-performance model.

[Health care standards for surgical patients in clinical hospital]. / O standartakh meditsinskoi pomoshchi khirurgicheskim bol'nym v klinicheskom statsionare.

In Russian Federation the Obligatory Health Insurance Standards are based on the a priori expert assessments but not on statistical analysis of really recorded cases. This leads to the essential standard incompleteness, indistinctness and heterogeneity. In Vishnevsky Institute of surgery the "Automatized system for care registration in hospital" was designed, and data base on more than 10,000 patients treated in 1995 to 1999 was created giving now the starting-point for further efforts for overcoming the above standards insufficiency.

Health maintenance organizations and hospital quality for coronary artery bypass surgery.

This study uses hospital discharge data for 1992-1994 to assess differences between HMO and insured non-HMO patients in California and Florida with regard to the quality of the hospitals used for coronary artery bypass graft (CABG) surgery. The authors found that commercially insured HMO patients in California used higher quality hospitals than commercially insured non-HMO patients, controlling for patient distance to the hospital. In contrast, commercially insured HMO and non-HMO patients in Florida were similarly distributed across hospitals of different quality levels, whereas Medicare HMO patients in Florida used lower quality hospitals than patients in the standard Medicare program. The authors conclude that the association between HMO coverage and hospital quality may differ across geographic areas and patient populations, possibly related to the maturity and structure of managed care markets.

Death by managed care--denial of hospitalization for headache.

A 47-year-old man with a severe headache disorder, taking meperidine injections 8 to 12 times a day and approximately 6 butalbital-containing tablets per day, was denied hospitalization for the management of headache and died while awaiting evaluation for detoxification by a psychiatric facility. The criteria for hospitalization and the implications of the denial of care by insurance companies are explored. The biases against the publication of such cases are reviewed.

Options for purchasing provider excess insurance.

Provider organizations accepting capitated payments often purchase provider excess insurance to protect themselves from catastrophic loss. These organizations have the option of purchasing such insurance coverage from the HMOs with which they contract or from commercial insurance companies. To determine which purchase strategy will be cost-effective, provider organizations must carefully analyze their risk, determine how much coverage they need, and exercise due diligence.

Use of diagnosis-related groups by non-Medicare payers.

Medicare's prospective payment system (PPS) for hospital cases is based on diagnosis-related groups (DRGs). A wide variety of other third-party payers for hospital care have adapted elements of this system for their own use. The extent of DRG use varies considerably both by type of payer and by geographical area. Users include: 21 State Medicaid programs, 3 workers' compensation systems, the Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), more than one-half of the Blue Cross and Blue Shield Association (BCBSA) member plans, several self-insured employers, and a few employer coalitions. We describe how each of these payers use DRGs. No single approach is dominant. Some payers negotiate specific prices for so many combinations of DRG and hospital that the paradigm that payment equals rate times weight does not apply. What has emerged appears to be a very flexible payment system in which the only constant is the use of DRGs as a measure of output.

Should insurers pay the same fees under an all-payer system?

Medicare's use of diagnosis-related groups (DRGs) and the resource-based relative value scale (RBRVS) has led to interest in developing a national all-payer system in which insurers use the same payment methods and payment rates. Using data for 81 high-volume DRGs from 457 California hospitals, we conclude that a single set of rates for hospital care would not be appropriate. On average, Medicare patients were 11.7 percent more expensive than commercially insured patients, but less expensive in many DRGs. Further research is needed to determine if Medicare patients require more physician resources compared with non-Medicare patients, particularly for surgical procedures.

The process and outcome of hospital care for Medicaid versus privately insured hospital patients.

Some have argued that low Medicaid payment rates compromise the accessibility and quality of medical care for Medicaid beneficiaries. In this study we compare the process and outcome of hospital care for Medicaid versus privately insured hospital patients. We studied 4,033 emergency patients admitted with a principal diagnosis of acute myocardial infarction, to Massachusetts hospitals in 1987. After we statistically adjusted for differences among patients relating to clinical and demographic characteristics and the type of hospital where treatment occurred, we found that the Medicaid patients had longer hospital stays but were less likely to receive three selected coronary procedures. Moreover, after controlling for confounding variables, we found the risk of death for Medicaid patients to be almost twice as high as for privately insured patients.