Oxygen therapy for children with acute respiratory infections in small hospitals.

Oxygen administration is one of the most important modalities of therapy for a patient with hypoxaemia to prevent death and disability from common conditions such as acute lower respiratory tract infections. Oxygen needs to be available at all times in hospitals, however, it is too expensive for many developing countries. There is little information for health professionals regarding indications for initiating oxygen therapy, selecting appropriate method of oxygen administration and deciding on the source for oxygen. A review of the literature using medline citations and cross references from published articles and other manuscripts was made. The review described the two main sources of oxygen for small hospital-cylinders and oxygen concentrators and their advantages and disadvantages. It also looked at the evidences for clinical indications to initiate and discontinue oxygen therapy. Studies on efficient and safe methods of administration of oxygen were reviewed as well. The review concluded that oxygen may be administered in children with cyanosis, chest indrawing, inability to drink or breastfeed, tachypnea with respiratory rate above 70/minute or in a child who develops restlessness and improves on oxygen. The initial capital cost of concentrators is high but the running cost is low and it does not require transport while oxygen cylinders are expensive to transport and need continuous refilling. The safest method of oxygen administration are the prongs followed by the nasal catheters.

Cost allocation patterns between hospital inpatient and outpatient departments.

OBJECTIVE: This study examines changes in hospitals' cost allocation patterns between inpatient and outpatient departments in response to the implementation of the prospective payment system. DATA SOURCES AND STUDY SETTINGS: The analysis was carried out using data for 3,961 hospitals obtained from the Medicare Cost Reports and from the American Hospital Association for the years 1984 through 1988. STUDY DESIGN: A total operating cost function was estimated on the two outputs of discharges and outpatient visits. The estimation results were instrumental in disaggregating costs into inpatient and outpatient components. This was done cross-sectionally for each of the five years. PRINCIPAL FINDINGS: Comparison of this cost breakdown with that of hospital revenue provides evidence of distinct patterns in which nonteaching, rural, and small hospitals increasingly allocated greater costs to outpatient departments than did large, urban, and teaching hospitals. CONCLUSIONS: The results suggest that small rural hospitals turned to the outpatient side in the face of tough economic challenges over the period of study. Because differences in cost allocation patterns occur by particular hospital category, analyses that rely on accounting cost or revenue data in order to identify cost differences among those same categories may come to erroneous conclusions. In particular, because teaching hospitals apportion costs more heavily on the inpatient side, cost allocation differences cause upward bias in the PPS medical education adjustment.