Local Pharmacy Partnership to Prevent Pediatric Asthma Reutilization in a Satellite Hospital.

OBJECTIVES: In our previous work, providing medications in-hand at discharge was a key strategy to reduce asthma reutilization (readmissions and emergency revisits) among children in a large, urban county. We sought to spread this work to our satellite hospital in an adjacent county. A key initial barrier was the lack of an outpatient pharmacy on site, so we sought to determine if a partnership with community pharmacies could improve the percentage of patients with medications in-hand at discharge, thus decreasing reutilization. METHODS: A multidisciplinary team partnered with community pharmacies. Using rapid-cycle improvement methods, the team aimed to reduce asthma reutilization by providing medications in-hand at discharge. Run charts were used to display the proportion of patients with asthma discharged with medications in-hand and to track 90-day reutilization rates. RESULTS: During the intervention period, the median percentage of patients with asthma who received medications in-hand increased from 0% to 82%. A key intervention was the expansion of the medication in-hand program to all patients. Additional changes included expanding team to evening stakeholders, narrowing the number of community partners, and building electronic tools to support key processes. The mean percentage of patients with asthma discharged from the satellite who had a readmission or emergency department revisit within 90 days of their index admission decreased from 18% to 11%. CONCLUSIONS: Impacting population-level asthma outcomes requires partnerships between community resources and health providers. When hospital resources are limited, community pharmacies are a potential partner, and providing access to medications in-hand at hospital discharge can reduce asthma reutilization.

Ten trends transforming cancer care and their effects on space planning for academic medical centers.

OBJECTIVE: This article aims to define the major trends currently affecting space needs for academic medical center (AMC) cancer centers. It will distinguish between the trends that promote the concentration of services with those that promote decentralization as well as identify opportunities for achieving greater effectiveness in cancer care space planning. BACKGROUND: Changes in cancer care-higher survival rates, increased clinical trials, new technology, and changing practice models-increasingly fill hospitals' and clinicians' schedules and strain clinical space resources. Conflicts among these trends are concentrating some services and dispersing others. As a result, AMCs must expand and renovate intelligently to continue providing state-of-the-art, compassionate care. CONCLUSIONS: Although the typical AMC cancer center can expect to utilize more space than it would have 10 years ago, a deeper understanding of the cancer center enterprise can lead to opportunities for more effectively using available facility resources. Each AMC must determine for itself the appropriate balance of patient volume, clinical activity, and services between its main hospital campus and satellite branches. As well, space allocation should be flexible, as care trends, medical technology, and the provider's own priorities shift over time. The goal isn't necessarily more space-it's better space.

Análisis retrospectivo de operaciones de cataratas efectuadas en el Hospital Regional de Temuco en comparación con operaciones efectuadas en hospitales periféricos de la novena región / Retrospective analysis of cataract surgeries carried out in Hospital Regional de Temuco and the satellite hospitals of the ninth region

Se realizó un análisis retrospectivo de 518 cirugías de catara. 431 (83 por ciento) de ellas fueron hechas en el hospital Regional y 87 (17 por ciento) en hospitales periféricos: En las cirugías participaron 12 cirujanos del staff entre el año 1996 y 2001. El 90 por ciento de los pacientes fue operado en los años 1999 y 2000. Cuatro cirujanos operaron el 70 por ciento de los pacientes estudiados. El 52.5 por ciento fue operado con técnica extracapsular y el 47.5 por ciento con facoemulsificación. El 37.1 por ciento fueron hombres y el 62.9 mujeres. El promedio de edad fue de 70.5 años con una mínima de 6 años y una máxima de 96. El 53.1 por ciento ojos derechos y el 46.9 por ciento ojos izquierdos. El 27.6 por ciento tuvo complicaciones. 1 por ciento desprendimiento de retina (DR), 1.7 por ciento hipertensión, 6.2 por ciento opacidad de la cápsula posterior (OCP), 4.6 por ciento rotura cápsula posterior (RCP), 5.8 por ciento RCP más vitrectomía anterior, 2.3 por ciento iritis, 0.13 por ciento endoftalmitis. Las visiones pre operatorias eran en un 77.4 por ciento menos de 0.2 y el 22.6 por ciento entre 0.25 y 0.40 y las post operatorias 9.3 por ciento quedaron bajo 0.2 un 12.7 por ciento entre 0.25 y 0.4 y un 78 por ciento entre 0.5 y 1.0. El promedio de las visiones para los pre operados es de 0.14 con un rango de 0.04 al 0.40. El promedio para los post operados es de 0.56 con un rango de 0.04 al 1.0. Para evaluar el resultado de la operación se construye un incremento de la visión (vpost-vpre). Este incremento tiene un promedio de 0.421 y es significativo. Existe una diferencia significativa entre el incremento de la visión después de la operación de los pacientes operados dentro del hospital mayor que los operados fuera del hospital. Las complicaciones de las cirugías en los hospitales periféricos (17.2 por ciento) son menores estadísticamente que las efectuadas en el hospital Regional (29.7 por ciento). Objetivo: Analizar la posibilidad de efectuar operaciones de cataratas en la IX Región en un hospital distinto del Hospital Regional de Temuco, sin que eso significara riesgo para el paciente o malos resultados visuales.

Health care delivery: strength in numbers.

The number and types of multi-institutional arrangements among health care facilities are on the increase, and the days of the completely autonomous, independent hospital are coming to a close. Although by themselves hospital systems are no panacea in dealing with the challenges facing hospitals today, many such arrangements offer more opportunities than problems in coping with the rapid changes currently facing the health care industry. The pros and cons of seven arrangements are discussed in detail.