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2.
J Am Coll Surg ; 229(2): 158-163, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30880121

RESUMO

BACKGROUND: We sought to evaluate change in postoperative prescription practices in an independent community-based hospital after hospital interventions and a state legislation change. STUDY DESIGN: This is a retrospective review of opioid-naïve adult subjects who underwent 5 common general surgical procedures between 2015 and 2017, including cholecystectomy, appendectomy, minimally invasive inguinal hernia repair, open inguinal hernia repair, and breast lumpectomy. Educational interventions were introduced, new statewide legislation was passed, and 129 subsequent cases were reviewed. RESULTS: Mean ± SD oral morphine equivalent (OME) prescribed for all procedures on retrospective review was 218.8 ± 113.7 (n = 722), cholecystectomy 235.3 ± 133.8 (n = 248), appendectomy 220.2 ± 103.2 (n = 175), open inguinal hernia repair 214.4 ± 97.2 (n = 119), minimally invasive inguinal hernia repair 187.7 ± 87.8 (n = 117), and lumpectomy 212.5 ± 114.5 (n = 63). There was significant variation in OME prescribed by procedure and by surgeon (p = 0.006 and p = 0.008, respectively). Review of post-intervention cases showed a significant reduction in the OME prescribed each year (mean OME 197.6 in 2015 to 2017 vs 72.3 in 2018; p < 0.005), and a 60% to 70% reduction in mean OME per procedure. Post-intervention data also revealed resolution of previously seen variation in prescription practices, and a significant increase in the percentage of patients prescribed multimodal pain therapy (23.5% in 2015 to 2017 to 31.5% in 2018; p < 0.05). CONCLUSIONS: We achieved a 60% to 70% decrease in postoperative opioid prescription at our community hospital for 5 common surgical procedures, and resolution of variation in opioid prescription practices after a hospital-wide intervention and statewide legislation.


Assuntos
Analgésicos Opioides/uso terapêutico , Hospitais Comunitários/legislação & jurisprudência , Prescrição Inadequada/legislação & jurisprudência , Dor Pós-Operatória/tratamento farmacológico , Padrões de Prática Médica/legislação & jurisprudência , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais Comunitários/normas , Humanos , Prescrição Inadequada/prevenção & controle , Prescrição Inadequada/estatística & dados numéricos , Masculino , Michigan , Pessoa de Meia-Idade , Transtornos Relacionados ao Uso de Opioides/etiologia , Transtornos Relacionados ao Uso de Opioides/prevenção & controle , Padrões de Prática Médica/normas , Padrões de Prática Médica/estatística & dados numéricos , Estudos Retrospectivos , Adulto Jovem
3.
J Vasc Surg Venous Lymphat Disord ; 6(4): 541-544, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29909860

RESUMO

OBJECTIVE: Placement of inferior vena cava (IVC) filters is a controversial focus of medical malpractice. Clinicians currently have little information to guide them regarding key issues and outcomes in litigation. In this retrospective legal case review, we analyzed the factors associated with malpractice actions involving IVC filters. METHODS: The legal databases LexisNexis and Westlaw were searched from 1967 to 2016 for all published legal cases in the United States involving placement of IVC filters. Keywords included "IVC," "inferior vena cava," "filter," and "malpractice." Social Security Disability claims, product liability actions, and hospital employment contract disputes were excluded. RESULTS: There were 310 search results eligible for initial review. After application of exclusion criteria, 29 cases involving medical malpractice were included in final analysis. The majority of excluded cases were insurance disputes and tax revenue cases. Overall, private practitioners were most often sued (11/29 [37.9%]), whereas 24.1% of defendants were academic hospitals (7/29), 20.7% were prisons (6/29), and 17.2% were community hospitals (5/29). The most common specialty named was vascular surgery (8/29), whereas interventional radiologists were named only twice. The most common indications for IVC filter placement were hypercoagulable state (8/29 [29.6%]), recurrent pulmonary embolism (PE; 6/29 [22.2%]), and trauma (5/29 [18.5%]). The most common underlying allegations involved failure to insert IVC filter when indicated (14/29 [48.3%]), intraprocedural negligence (5/29 [17.2%]), and failure to timely remove device (5/29 [17.2%]). Common complications included failure to prevent occurrence of PE (14/29 [48.3%]), device migration (4/29 [13.8%]), and perforation of organs or vasculature (3/29 [10.3%]). Death of the patient occurred in 41.4% of total cases (12/29). In cases in which the patient died, the most common indications for filter placement were trauma (4/12 [33.3%]) and deep venous thrombosis (3/12 [25.0%]), and the most common complication in those patients who died was the failure to prevent a subsequent PE (9/12 [75.0%]). Available verdicts favored defendants (13/14 [92.9%]). In cases with defense verdicts, the most common indications for filter placement similarly were trauma (4/13 [30.8%]) and deep venous thrombosis (3/13 [23.1%)], and the most common complication was failure to prevent PE (9/14 [64.3%]). CONCLUSIONS: Analysis of malpractice cases involving IVC filters revealed key factors associated with litigation. Overall, verdicts favored defendants. Private practitioners were most commonly sued, and the most common reasons for bringing suit were failure to insert filter, intraprocedural complications, and failure to remove filter. Deeper awareness of issues related to malpractice litigation can inform clinical practice and improve patient care and safety.


Assuntos
Remoção de Dispositivo/legislação & jurisprudência , Seguro de Responsabilidade Civil/legislação & jurisprudência , Imperícia/legislação & jurisprudência , Erros Médicos/legislação & jurisprudência , Implantação de Prótese/legislação & jurisprudência , Procedimentos Cirúrgicos Vasculares/legislação & jurisprudência , Filtros de Veia Cava , Centros Médicos Acadêmicos/legislação & jurisprudência , Remoção de Dispositivo/efeitos adversos , Remoção de Dispositivo/instrumentação , Hospitais Comunitários/legislação & jurisprudência , Humanos , Erros Médicos/efeitos adversos , Prisões/legislação & jurisprudência , Prática Privada/legislação & jurisprudência , Implantação de Prótese/efeitos adversos , Implantação de Prótese/instrumentação , Implantação de Prótese/mortalidade , Radiologistas/legislação & jurisprudência , Radiologia Intervencionista/legislação & jurisprudência , Medição de Risco , Fatores de Risco , Cirurgiões/legislação & jurisprudência , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/instrumentação , Procedimentos Cirúrgicos Vasculares/mortalidade , Filtros de Veia Cava/efeitos adversos
4.
Unfallchirurg ; 119(11): 908-914, 2016 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-27752725

RESUMO

The requirements of the German statutory accident insurance (DGUV) for the new treatment procedure were presented on 1 January 2013 in a new catalogue. The implementation of the certification of hospitals for the very severe injury procedure (SAV) by the DGUV should have been completed by 2014. These requirements placed high demands on trauma-oriented hospitals because of the high structural and personnel prerequisites. The background to the new organization was the wish of the DGUV for quality improvement in patient treatment in hospitals for patients with very severe occupational and occupation-related trauma by placement in qualified centers with high case numbers. No increase in income was planned for the hospitals to cope with the necessary improvements in quality. After 2 years of experience with the SAV we can confirm for a community hospital that the structural requirements could be improved (e.g. establishment of departments of neurosurgery, plastic surgery and thoracic surgery) but the high requirements for qualification and attendance of physicians on duty are a continuous problem and are also costly. The numbers of severely injured trauma patients have greatly increased, particularly in 2015. The charges for the complex treatment are not adequately reflected in the German diagnosis-related groups system and no extra flat rate funding per case is explicitly planned in the DRG remuneration catalogue. The invoicing of a center surcharge in addition to the DRG charges has not been introduced.


Assuntos
Hospitais Comunitários/legislação & jurisprudência , Hospitais Comunitários/estatística & dados numéricos , Seguro de Acidentes/legislação & jurisprudência , Programas Nacionais de Saúde/legislação & jurisprudência , Medicina do Trabalho/legislação & jurisprudência , Ferimentos e Lesões/terapia , Alemanha , Regulamentação Governamental , Humanos , Seguro de Acidentes/economia , Seguro de Acidentes/normas , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/normas , Medicina do Trabalho/economia , Medicina do Trabalho/normas , Ferimentos e Lesões/economia
6.
Fed Regist ; 79(116): 3444-52, 2014 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-25011160

RESUMO

This document announces changes to the payment adjustment for low-volume hospitals and to the Medicare-dependent hospital (MDH) program under the hospital inpatient prospective payment systems (IPPS) for the second half of FY 2014 (April 1, 2014 through September 30, 2014) in accordance with sections 105 and 106, respectively, of the Protecting Access to Medicare Act of 2014 (PAMA).


Assuntos
Hospitais Comunitários/economia , Hospitais Rurais/economia , Medicare/economia , Sistema de Pagamento Prospectivo/economia , Tamanho das Instituições de Saúde , Hospitais Comunitários/legislação & jurisprudência , Hospitais Rurais/legislação & jurisprudência , Humanos , Medicare/legislação & jurisprudência , Sistema de Pagamento Prospectivo/legislação & jurisprudência , Estados Unidos
7.
Nurs Econ ; 32(2): 101-3, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-24834635

RESUMO

Electronic health records (EHRs) have numerous benefits, but are also besieged with risks. ealth care leaders must analyze potential risks throughout all EHR stages. Lessons learned from an EHR implementation may assist nurse leaders in avoiding disputes and risk. Strategies for reducing risk, liability, and ultimately litigation associated with EHR implementation are discussed.


Assuntos
Registros Eletrônicos de Saúde/organização & administração , Gestão de Riscos/organização & administração , Hospitais Comunitários/legislação & jurisprudência , Hospitais Comunitários/organização & administração , Responsabilidade Legal , Estados Unidos
9.
Fed Regist ; 78(153): 48303-11, 2013 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-23977716

RESUMO

This Final Rule implements for Sole Community Hospitals (SCHs) the statutory provision at title 10, United States Code (U.S.C.), section 1079(j)(2) that TRICARE payment methods for institutional care be determined, to the extent practicable, in accordance with the same reimbursement rules as those that apply to payments to providers of services of the same type under Medicare. This Final Rule implements a reimbursement methodology similar to that applicable to Medicare beneficiaries for inpatient services provided by SCHs. It will be phased in over a several-year period. This Final Rule also provides for special reimbursement for labor/delivery and nursery services in SCHs and creates a possible General Temporary Military Contingency Payment Adjustment (GTMCPA) for inpatient services in SCHs and for Critical Access Hospitals (CAHs).


Assuntos
Cuidados Críticos/economia , Hospitais Comunitários/economia , Reembolso de Seguro de Saúde/economia , Medicina Militar/economia , Cuidados Críticos/legislação & jurisprudência , Grupos Diagnósticos Relacionados , Reforma dos Serviços de Saúde/economia , Reforma dos Serviços de Saúde/legislação & jurisprudência , Hospitais Comunitários/legislação & jurisprudência , Humanos , Reembolso de Seguro de Saúde/legislação & jurisprudência , Medicare/economia , Medicare/legislação & jurisprudência , Medicina Militar/legislação & jurisprudência , Estados Unidos , United States Department of Defense/economia , United States Department of Defense/legislação & jurisprudência
12.
Hosp Top ; 90(4): 104-12, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23216264

RESUMO

Recent developments in healthcare reform legislation and in the private-payer marketplace have increased impetus toward clinical integration. Industry changes require that healthcare delivery institutions confront fundamental scope and scale structural issues that may lead to increased vertical integration. To accomplish integration, firms must decide the organizational form of integration (alliance or merger/acquisition). One form of integration, accountable care organizations (ACOs), has featured prominently in recent legislation. Clinical integration and ACOs present significant shared-governance challenges that must be understood by hospital boards. The author outlines these governance issues using a case study of Silver Cross Hospital's governance structure for its ACO.


Assuntos
Organizações de Assistência Responsáveis/organização & administração , Hospitais Comunitários/organização & administração , Governança Clínica , Reforma dos Serviços de Saúde , Convênios Hospital-Médico , Hospitais Comunitários/legislação & jurisprudência , Illinois , Estudos de Casos Organizacionais , Inovação Organizacional , Estados Unidos
13.
Hosp Top ; 90(4): 91-7, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-23216262

RESUMO

Abstract In recent years, community hospitals have experienced heightened regulation with many unfunded mandates. The authors assessed the market, organizational, operational, and financial characteristics of general acute care hospitals in California that have a main acute care hospital building that is noncompliant with state requirements and at risk of major structural collapse from earthquakes. Using California hospital data from 2007 to 2009, and employing logistic regression analysis, the authors found that hospitals having buildings that are at the highest risk of collapse are located in larger population markets, possess smaller market share, have a higher percentage of Medicaid patients, and have less liquidity.


Assuntos
Códigos de Obras/legislação & jurisprudência , Terremotos , Fidelidade a Diretrizes , Hospitais Comunitários/legislação & jurisprudência , Programas Obrigatórios , Gestão da Segurança/legislação & jurisprudência , Análise de Variância , California , Hospitais Comunitários/normas , Colapso Estrutural
14.
WMJ ; 111(5): 215-9, 2012 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23189454

RESUMO

CONTEXT: The Affordable Care Act is drawing increased attention to the Internal Revenue Service (IRS) Community Benefit policy. To qualify for tax exemption, the IRS requires nonprofit hospitals to allocate a portion of their operating expenses to certain "charitable" activities, such as providing free or reduced care to the indigent. OBJECTIVE: To determine the total amount of community benefit reported by Wisconsin hospitals using official IRS tax return forms (Form 990), and examine the level of allocation across allowable activities. DESIGN: Primary data collection from IRS 990 forms submitted by Wisconsin hospitals for 2009. MAIN OUTCOME MEASURE: Community benefit reported in absolute dollars and as percent of overall hospital expenditures, both overall and by activity category. RESULTS: For 2009, Wisconsin hospitals reported $1.064 billion in community benefits, or 7.52% of total hospital expenditures. Of this amount, 9.1% was for charity care, 50% for Medicaid subsidies, 11.4% for other subsidized services, and 4.4% for Community Health Improvement Services. CONCLUSION: Charity care is not the primary reported activity by Wisconsin hospitals under the IRS Community Benefit requirement. Opportunities may exist for devoting increasing amounts to broader community health improvement activities.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Hospitais Comunitários/organização & administração , Organizações sem Fins Lucrativos/organização & administração , Isenção Fiscal/legislação & jurisprudência , Serviços de Saúde Comunitária/legislação & jurisprudência , Órgãos Governamentais , Reforma dos Serviços de Saúde/legislação & jurisprudência , Hospitais Comunitários/legislação & jurisprudência , Humanos , Organizações sem Fins Lucrativos/legislação & jurisprudência , Patient Protection and Affordable Care Act , Cuidados de Saúde não Remunerados/legislação & jurisprudência , Estados Unidos , Wisconsin
15.
Clin Obstet Gynecol ; 55(4): 997-1004, 2012 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-23090469

RESUMO

Is vaginal birth after cesarean in the community a disappearing practice? Since 1996 the rate of trial of labor after cesarean for low-risk women has dropped precipitously. This paper reviews the current literature and summarizes opinions of community obstetricians and midwives. Descriptive data are presented to document the scope of the problem and identify barriers: liability concerns, provider biases, and institutional restrictions. Our perspective draws on experience in our community hospital with a previously high vaginal birth after cesarean rate and a subsequent ban. Strategies to reduce the skyrocketing cesarean rate and encourage trial of labor after cesarean for low-risk women are outlined.


Assuntos
Atitude do Pessoal de Saúde , Hospitais Comunitários/organização & administração , Prova de Trabalho de Parto , Nascimento Vaginal Após Cesárea/ética , Nascimento Vaginal Após Cesárea/tendências , Recesariana/tendências , Feminino , Hospitais Comunitários/legislação & jurisprudência , Humanos , Consentimento Livre e Esclarecido , Responsabilidade Legal , Tocologia , Política Organizacional , Preferência do Paciente , Médicos , Padrões de Prática Médica/legislação & jurisprudência , Padrões de Prática Médica/tendências , Gravidez , Fatores de Risco , Estados Unidos , Nascimento Vaginal Após Cesárea/legislação & jurisprudência
16.
J Healthc Manag ; 57(1): 66-76; discussion 77-8, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22397105

RESUMO

US policymakers continue to call into question the tax-exempt status of hospitals. As nonprofit tax-exempt entities, hospitals are required by the Internal Revenue Service (IRS) to report the type and cost of community benefits they provide. Institutional theory indicates that organizations derive organizational legitimacy from conforming to the expectations of their environment. Expectations from the state and federal regulators (the IRS, state and local taxing authorities in particular) and the community require hospitals to provide community benefits to achieve legitimacy. This article examines community benefit through an institutional theory framework, which includes regulative (laws and regulation), normative (certification and accreditation), and cultural-cognitive (relationship with the community including the provision of community benefits) pillars. Considering a review of the results of a 2006 IRS study of tax-exempt hospitals, the authors propose a model of hospital community benefit behaviors that distinguishes community benefits between cost-quantifiable activities appropriate for justifying tax exemption and unquantifiable activities that only contribute to hospitals' legitimacy.


Assuntos
Hospitais Comunitários/economia , Hospitais Filantrópicos/economia , Isenção Fiscal/normas , Relações Comunidade-Instituição/normas , Política de Saúde/legislação & jurisprudência , Hospitais Comunitários/legislação & jurisprudência , Hospitais Filantrópicos/legislação & jurisprudência , Humanos , Medicaid , Medicare , Isenção Fiscal/legislação & jurisprudência , Cuidados de Saúde não Remunerados , Estados Unidos
17.
Am J Public Health ; 102(2): 229-37, 2012 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-22390437

RESUMO

In response to a growing concern that nonprofit hospitals are not providing sufficient benefit to their communities in return for their tax-exempt status, the Internal Revenue Service (IRS) now requires nonprofit hospitals to formally document the extent of their community contributions. While the IRS is increasing financial scrutiny of nonprofit hospitals, many provisions in the recently passed historical health reform legislation will also have a significant impact on the provision of uncompensated care and other community benefits. We argue that health reform does not render the nonprofit organizational form obsolete. Rather, health reform should strengthen the nonprofit hospitals' ability to fulfill their missions by better targeting subsidies for uncompensated care and potentially increasing subsidized health services provision, many of which affect the public's health.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Órgãos Governamentais , Hospitais Comunitários/organização & administração , Organizações sem Fins Lucrativos/organização & administração , Isenção Fiscal/legislação & jurisprudência , Serviços de Saúde Comunitária/legislação & jurisprudência , Reforma dos Serviços de Saúde/legislação & jurisprudência , Hospitais Comunitários/legislação & jurisprudência , Humanos , Organizações sem Fins Lucrativos/legislação & jurisprudência , Cuidados de Saúde não Remunerados/legislação & jurisprudência , Estados Unidos
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