RESUMO
BACKGROUND: Hospital workers are at high risk of work-related musculoskeletal disorders (WRMSDs), but outcomes following such injuries have not been well studied longitudinally. AIMS: To ascertain functional recovery in hospital workers following incident WRMSDs and identify predictors of functional status. METHODS: Cases (incident WRMSD) and matched referents from two hospitals were studied at baseline and at 2 year follow-up for health status [SF-12 physical component summary (PCS)], lost workdays, self-rated work effectiveness and work status change (job change or work cessation). Predictors included WRMSD and baseline demographics, socio-economic status (SES), job-related strain and effort-reward imbalance. Logistic regression analysis tested longitudinal predictors of adverse functional status. RESULTS: The WRMSD-associated risk of poor (lowest quartile) PCS was attenuated from a baseline odds ratio (OR) of 5.2 [95% confidence interval (CI) 3.5-7.5] to a follow-up OR of 1.5 (95% CI 1.0-2.3) and was reduced further in multivariate modelling (OR = 1.4; 95% CI 0.9-2.2). At follow-up, WRMSD status did not predict significantly increased likelihood of lost workdays, decreased effectiveness or work status change. In multivariate modelling, lowest quintile SES predicted poor PCS (OR = 2.0; 95% CI 1.0-4.0) and work status change (OR = 2.5; 95% CI 1.1-5.8). High combined baseline job strain/effort-reward imbalance predicted poor PCS (OR = 1.7; 95% CI 1.1-2.7) and reduced work effectiveness (OR = 2.6; 95% CI 1.6-4.2) at follow-up. CONCLUSIONS: Baseline functional deficits associated with incident WRMSDs were largely resolved by 2 year follow-up. Nonetheless, lower SES and higher combined job strain/effort-reward imbalance predicted adverse outcomes, controlling for WRMSDs.
Assuntos
Acidentes de Trabalho/estatística & dados numéricos , Nível de Saúde , Doenças Musculoesqueléticas/epidemiologia , Saúde Ocupacional/estatística & dados numéricos , Recursos Humanos em Hospital/estatística & dados numéricos , Recuperação de Função Fisiológica/fisiologia , Métodos Epidemiológicos , Humanos , Satisfação no Emprego , Doenças Musculoesqueléticas/fisiopatologia , Recompensa , Fatores Socioeconômicos , Carga de Trabalho/psicologia , Local de Trabalho/psicologiaRESUMO
OBJECTIVE: To determine whether physicians followed a hospital policy permitting them to not offer cardiopulmonary resuscitation (CPR) to patients considered unlikely to benefit from this therapy. DESIGN: Prospective series. SETTING: San Francisco General Hospital, a university-affiliated public hospital. PATIENTS: Attending physicians were interviewed about patients admitted over a period of 5 consecutive months for whom do-not resuscitate (DNR) orders were written. Only the first patient for whom each physician wrote a DNR order was included. MAIN OUTCOME MEASURES: Responses of physicians to questions regarding their initiation of DNR orders for these patients. RESULTS: Sixty-nine physicians responded to questions about DNR orders written for 69 patients. Fifty-seven of these physicians said that they were aware of the hospital policy, and 49 of the 57 physicians said that they generally agreed with it. Thirty-three physicians felt that CPR should be offered only to patients likely to benefit from it. In contrast, 36 physicians said that CPR should be offered to all patients, regardless of benefit. CPR was offered to 41 patients and 15 surrogates; 27 of these patients were considered to be unlikely to benefit from CPR. CONCLUSION: Despite a policy that allows them to do otherwise, physicians usually offered CPR to patients, regardless of benefit. Most physicians believed that CPR should be offered to all patients. These findings suggest that policies such as that of San Francisco General Hospital may not be compelling because physicians hold attitudes that are inconsistent with the policies.
Assuntos
Atitude do Pessoal de Saúde , Hospitais Gerais , Política Organizacional , Médicos/psicologia , Ordens quanto à Conduta (Ética Médica) , Mortalidade Hospitalar , Humanos , Avaliação de Resultados em Cuidados de Saúde , Defesa do Paciente , Medição de Risco , São Francisco , Suspensão de TratamentoRESUMO
In 1993 the California Office of Statewide Health Planning and Development (OSHPD) began public release of risk-adjusted monitoring of outcomes (RAMO) under the California Hospital Outcomes Project. We studied how 17 acute are public hospitals in California used these RAMO data for quality improvement purposes following their initial distribution, first by analyzing the outcome data for San Francisco General Hospital Medical Center as recommended by OSHPD and, second, by querying the departments at the other 16 public hospitals to determine how their own analyses compared. We found that the hospitals generally did minimal analyses of the OSHPD RAMO data and considered the data of little value to them. Only 3 hospitals initiated quality improvement activities based on their data review. The major reasons given by the hospitals for not using the RAMO data were that their outcomes were adequate, as verified by a comparison of their observed outcomes and those expected after risk-adjustment; that the hospitals had too few patients in the diagnostic categories; that they had too few resources; and that they were not concerned with the data's public release. Other possible explanations were that awareness of the California Hospital Outcomes Project was not widespread at the time of the study, that the RAMO data were not distributed in a way that encouraged their use, and that public hospitals were not inclined to use the outcome data because the project was imposed on them. Whatever the explanation, our study suggests that the California Hospital Outcomes Project has had little effect on quality improvement in public hospitals.