RESUMO
This paper presents preliminary quality and utilization data from a hospitalist system that is being implemented at Kaiser Permanente, a large health maintenance organization with 16 hospitals in northern California. Hospitalist programs, which are staffed by clinicians highly skilled in caring for inpatients, are being launched with the aim of delivering high-quality, efficient medical care in an increasingly competitive health care delivery environment. This paper also describes, in some detail, the process of implementation at one hospital. Challenges to implementation included 1) overcoming the reluctance of clinic physicians to relinquish inpatient care responsibilities, 2) developing sustainable work schedules, 3) creating effective channels of communication between staff in inpatient and outpatient settings, and 4) designing appropriate compensation scales for hospitalists. Mean length of stay, patient-day rates, admission rates, consultation request rates, costs, and readmission rates were examined for patients discharged from adult medicine services at all 16 hospitals between 1 January 1994 and 30 June 1997. These preliminary resource utilization data seem promising, but further analysis is needed to assess how hospitalist programs may affect clinical quality of care, costs, and patient and provider satisfaction.
Assuntos
Sistemas Pré-Pagos de Saúde/organização & administração , Médicos Hospitalares/estatística & dados numéricos , Adulto , California , Sistemas Pré-Pagos de Saúde/normas , Sistemas Pré-Pagos de Saúde/estatística & dados numéricos , Custos Hospitalares , Médicos Hospitalares/organização & administração , Humanos , Tempo de Internação/estatística & dados numéricos , Estudos de Casos Organizacionais , Avaliação de Resultados em Cuidados de Saúde , Admissão do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde/organização & administração , Qualidade da Assistência à Saúde/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricosRESUMO
We surveyed 1,000 randomly selected employers of handicapped individuals in the state of Washington. Overall, 64 of the 671 responding companies reported employing 166 handicapped people. The proportion of urban and rural employers hiring handicapped people did not differ significantly, but proportionally more large employers had handicapped employees. In terms of numbers of handicapped people employed, 66 worked for large companies, 39 worked for medium companies and 61 worked for small companies. Proportionally more public administration, transportation, and service industries hired handicapped people than other industries. Proportionally speaking, service and sales industries in urban settings were the most likely to have handicapped employees and hire the largest absolute number of handicapped individuals.
