Monitoring Changes in Hospital Utilization

This study focused on recent issues concerning health care utilization at the community level. The study focused on developments in hospital inpatient lengths of stay and discharges. The analysis in the study demonstrated that hospital lengths of stay in the metropolitan area of Syracuse, New York increased by 25.0 percent between 2019 and 2023. This has been a notable increase in the movement of patients with this indicator. The analysis also demonstrated that numbers of inpatient discharges for these hospital services declined substantially during the same periods. Review of the data suggested that this information has been related. The increase in hospital lengths of stay has been related to a rise in numbers of patients at high severity of illness. They have also been associated with a decline in numbers of patients at low severity.

Acute hospital-community hospital care bundle for elderly orthopedic surgery patients:A propensity score-matched economic analysis

BACKGROUND While Singapore attains good health outcomes,Singapore’s healthcare system is confronted with bed shortages and prolonged stays for elderly people recovering from surgery in acute hospitals.An Acute Hospital-Community Hospital(AHCH)care bundle has been developed to assist patients in postoperative rehabilitation.The core concept is to transfer patients out of AHs when clinically recommended and into CHs,where they can receive more beneficial dedicated care to aid in their recovery,while freeing up bed capacities in AHs.AIM To analyze the AH length of stay(LOS),costs,and savings associated with the AH-CH care bundle intervention initiated and implemented in elderly patients aged 75 years and above undergoing elective orthopedic surgery.METHODS A total of 8621:1 propensity score-matched patients aged 75 years and above who underwent elective orthopedic surgery in Singapore General Hospital(SGH)before(2017-2018)and after(2019-2021)the care bundle intervention period was analyzed.Outcome measures were AH LOS,CH LOS,hospitalization metrics,postoperative 30-d mortality,and modified Barthel Index(MBI)scores.The costs of AH inpatient hospital stay in the matched cohorts were compared using cost data in Singapore dollars.RESULTS Of the 862 matched elderly patients undergoing elective orthopedic surgery before and after the care bundle intervention,the age distribution,sex,American Society of Anesthesiologists classification,Charlson Comorbidity Index,and surgical approach were comparable between both groups.Patients transferred to CHs after the surgery had a shorter median AH LOS(7 d vs 9 d,P<0.001).The mean total AH inpatient cost per patient was 14.9%less for the elderly group transferred to CHs(S$24497.3 vs S$28772.8,P<0.001).The overall AH U-turn rates for elderly patients within the care bundle were low,with a 0%mortality rate following orthopedic surgery.When elderly patients were discharged from CHs,their MBI scores increased significantly(50.9 vs 71.9,P<0.001).CONCLUSION The AH-CH care bundle initiated and implemented in the Department of Orthopedic Surgery appears to be effective and cost-saving for SGH.Our results indicate that transitioning care between acute and community hospitals using this care bundle effectively reduces AH LOS in elderly patients receiving orthopedic surgery.Collaboration between acute and community care providers can assist in closing the care delivery gap and enhancing service quality.

Heart Failure: Organization of Care after Hospitalization at the Abidjan Cardiology Institute

Introduction: The care pathway for heart failure (HF) patients is poorly documented in sub-Saharan Africa. A multidisciplinary management reduces hospitalizations and mortality. In our context of frequent rehospitalization of heart failure patients, the objective of this study was to analyse the post-hospital follow-up health care. Methods: We conducted a prospective study in the medical department of a Heart Institute from January 1st to December 31, 2015. Patients over 18 years of age, hospitalized for heart failure, consenting and followed up on an outpatient basis for 2 years were included. Results: We collected 396 patients hospitalized for HF. The mean age was 57.4 ± 16 years with a male predominance (59.3%). Retired and unemployed people represented 27% and 16.2% respectively. During the post-hospitalization follow-up, patients who were regularly followed up represented 10.8% of the cases. 74.1% of the cases were regular patients. Patients were not followed up by the usual practitioner (58.2%). Only 94 patients had undergone a cardiovascular rehabilitation programme, of which 21.3% for exercise rehabilitation and 78.7% for therapeutic education. Patients who had attended titration sessions (n = 59) had reached optimal doses of ACE inhibitors, ARB II and beta blockers in 67.8%, 7.3% and 38.5% respectively. The rates of decompensation (73.3%) and rehospitalization (49.5%) were higher. The paraclinic check-up (ECG, X-ray, Cardiac Doppler ultrasonography, Biology) was rarely requested. The probability of survival was higher in patients regularly monitored than in those irregularly monitored. Conclusion: The organisation of care and coordination between professionals should be structured or planned. Therapeutic strategies need to be intensified in order to optimise their long-term benefits.

Computer-based simulative training system--a new approach to teaching pre-hospital trauma care

Objective:A computer-based STS(simulative training system) in providing pre-hospital trauma care at a disaster site was applied to teaching nursing students in the Second Military Medical University,China.This article reports on the teaching effectiveness of this system.Methods:Among 92 participants,46 were in the study group and 46 were in the 'control' group. Each student completed a multiple-choice quiz after completing 18 hours(six three-hour sessions) of the study module,and a score was recorded.The simulative training module was completed only by the study group;the 'control' group was assigned in-class discussions for the same amount of time covering the same content as the study group.The final course scores,which included both comprehensive and group task-based tests were compared between these two groups.The study used a descriptive and comparative approach for quantitative data analysis.Tests of independency between the multiple choice scores and the simulation scores were also performed.Finally,anonymous surveys were conducted.Results:The study group performed better than the 'control' group with a significantly higher average score for the group scenario task-based test score,and consequently the study group's final course score was significantly higher than the 'control' group.As per chi-square tests,no significant associations were found between the multiple choice scores and the simulated training scores.The final surveys showed students overwhelmingly agreed that STS training improved their knowledge and skills,their ability to recognize a potential critical event, and their initial response for trauma care at pre-hospital settings.The survey responses of the study group were noteworthy as they indicated that students recognized the importance of simulative training,appreciated the realism of the simulation,and were able to fight/adjust to the stressful feelings in order to focus on the task.Conclusion:Computer-based STS may be an effective teaching model to help students improve their capability in providing pre-hospital trauma care,and in their effectiveness in disaster response.

Availability and Quality of Emergency Obstetric Care, an Alternative Strategy to Reduce Maternal Mortality: Experience of Tongji Hospital, Wuhan, China

The burden of maternal mortality (MM) and morbidity is especially high in Asia.However,China has made significant progress in reducing MM over the past two decades,and hence maternal death rate has declined considerably in last decade,To analyze availability and quality of emergency obstetric care (EmOC) received by women at Tongji Hospital,Wuhan,China,this study retrospectively analyzed various pregnancy-related complications at the hospital from 2000 to 2009.Two baseline periods of equal length were used for the comparison of variables.A total of 11 223 obstetric complications leading to MM were identified on a total of 15 730 hospitalizations,either 71.35％ of all activities.No maternal death was recorded.Mean age of women was 29.31 years with a wide range of 14-52 years.About 96.26％ of women had higher levels of schooling,university degrees and above and received the education of secondary school or college.About 3.74％ received primary education at period two (P2) from 2005 to 2009,which was significantly higher than that of period one (P1) from 2000 to 2004 (P＜0.05) (OR:0.586; 95％ CI:0.442 to 0.776).About 65.69％ were employed as skilled or professional workers at P2,which was significantly higher than that of P1 (P＜0.05).About 34.31％ were unskilled workers at P2,which was significantly higher than that of P1 (P＜0.05).Caesarean section was performed for 9,930 women (88.48％) and the percentage of the procedure increased significantly from 19.25％ at P1 to 69.23％ at P2 (P＜0.05).We were led to conclude that,despite the progress,significant gaps in the performance of maternal health services between rural and urban areas remain.However,MM reduction can be achieved in China.Priorities must include,but not limited to the following:secondary healthcare development,health policy and management,strengthening primary healthcare services.

Running a Volunteer Program for Palliative Care in a Chinese Hospital:Our Practice and Experience

The establishment and development of volunteer team are very important in the whole process of palliative care.The concept and practice of palliative care have been developed in Peking Union Medical College Hospital(PUMCH)since the end of2012.Great progress has been made in different aspects.Volunteers play an extremely important role in the development of palliative care in PUMCH.The whole work began with the establishment of volunteer teams.This article introduces the process of the establishment and development of palliative care volunteer team in PUMCH,aiming to provide practical references for hospitals in China's Mainland to develop their own palliative care volunteer team.

Frequency of hospital readmission and care fragmentation in gastroparesis:A nationwide analysis

AIM To evaluate rates and predictors of hospital readmission and care fragmentation in patients hospitalized with gastroparesis.METHODS We identified all adult hospitalizations with a primary diagnosis of gastroparesis in the 2010-2014 National Readmissions Database,which captures statewide readmissions.We excluded patients who died during the hospitalization,and calculated 30 and 90-d unplanned readmission and care fragmentation rates.Readmission to a non-index hospital(i.e.,different from the hospital of the index admission) was considered as care fragmentation.A multivariate Cox regression model was used to analyze predictors of 30-d readmissions.Logistic regression was used to determine hospital and patient factors independently associated with 30-d care fragmentation.Patients readmitted within 30 d were followed for 60 d post discharge from the first readmission.Mortality during the first readmission,hospitalization cost,length of stay,and rates of 60-d readmission were compared between those with and without care fragmentation.RESULTS There were 30064 admissions with a primary diagnosis of gastroparesis.The rates of 30 and 90-d readmissions were 26.8% and 45.6%,respectively.Younger age,male patient,diabetes,parenteral nutrition,≥ 4 Elixhauser comorbidities,longer hospital stay(> 5 d),large and metropolitan hospital,and Medicaid insurance were associated with increased hazards of 30-d readmissions.Gastric surgery,routine discharge and private insurance were associated with lower 30-d readmissions.The rates of 30 and 90-d care fragmentation were 28.1% and 33.8%,respectively.Younger age,longer hospital stay(> 5 d),self-pay or Medicaid insurance were associated with increased risk of 30-d care fragmentation.Diabetes,enteral tube placement,parenteral nutrition,large metropolitan hospital,and routine discharge were associated with decreased risk of 30-d fragmentation.Patients who were readmitted to a non-index hospital had longer length of stay(6.5 vs 5.8 d,P = 0.03),and higher mean hospitalization cost($15645 vs $12311,P < 0.0001),compared to those readmitted to the index hospital.There were no differences in mortality(1.0% vs 1.3%,P = 0.84),and 60-d readmission rate(55.3% vs 54.6%,P = 0.99) between the two groups.CONCLUSION Several factors are associated with the high 30-d readmission and care fragmentation in gastroparesis.Knowledge of these predictors can play a role in implementing effective preventive interventions to highrisk patients.

Impact of Antimicrobial Stewardship Programs on Antibiotic Use and Drug Resistance:Analysis of Data from Maternal and Child Health Care Hospitals in Hubei Province,China

ObjectiveTo evaluate the impact of Antimicrobial Stewardship Programs(ASPs)on antibiotic use and drug resistance.MethodsThis was a retrospective,multicenter,management intervention study.The data from 85 maternity hospitals(maternal and child health care hospitals)in Hubei province from 2012 to 2019 were collected.The indicators related to antimicrobial drug use included the utilization rate of different grades of antimicrobial drugs,the intensity of antimicrobial agent use,the rational use of prophylactic antimicrobial agents before class I surgical incision,and pathogenic detection and consultation rates before antimicrobial drug use.ResultsSince the implementation,the purchase of antimicrobial agents in hospitals has been maintained within the prescribed range,and the defined daily dose system(DDDs)of antimicrobial agents has been reduced,prophylactic use and accurate treatment of antimicrobial agents related to class I surgical incision have been more reasonable.With the implementation of ASPs,the detection rate of imipenem-resistant Acinetobacter baumannii,cefotaxime-resistant Escherichia coli,and methicillin-resistant Staphylococcus aureus has been decreased in China from national bacterial resistance surveillance data.ConclusionASPs have positive effects on antibiotic use and drug resistance in 85 maternity hospitals(maternal and child health care hospitals).

Hand Hygiene by Ward Staff at Dapaong Regional Hospital in Togo

Introduction: Hand hygiene (HH) is an effective way to fight infections in healthcare settings. The general purpose of our study was to explore the knowledge, attitudes and practices of health care providers on HH at Dapaong regional hospital (DRH). Methodology: This was a prospective, descriptive cross-sectional study conducted from March to June 2022 in the DRH wards. Data were collected using a questionnaire and observation grid. Results: 90 care providers were surveyed. Males and non-physician personnel predominated with 57.8%, and 94.4% respectively. The survey on staff’s knowledge reported: 31.1% of practitioners did not wash their hands on arrival and departure in services. 24% did not know the difference between simple hand washing (SHW) and hygienic hand washing (HHW). 23.3% did not know the type of soap to use for HHW. The caregivers did not know the type of hand washing (HW) required after a septic and non-septic procedure in respectively 41.6%, and 37.8%. They did not know that there are two types of hand antiseptics (45.4%), nor the amount of antiseptic for HW (78.9%). The survey on staff’s attitude regarding HW found that: 70% did not remove all jewels prior HW, and 51.1% did not know that wearing gloves cannot replace the HW. For HW Staff Practice: 62.2% did not wash their hands before treatment. 91.1% did not spread the soap on their hands and forearms after wetting them. 65.55% did not rinse hands from nails to elbows. Conclusion: The HH was poorly known, the attitude of the staff was dangerous in relation to the HH and the practice of HH was very inadequate at the RHC-Dapaong. As a result, there is a need to retrain staff to increase their capacity to prevent care-related infections and enhance patient safety in the hospital.

基于Microsim Hospital的情景模拟结合课程思政的应用探索——以急危重症护理学为例

探讨以Microsim Hospital为基础的情景模拟与课程思政融合在急危重症护理学中的教学效果。选择我院2017级护生为研究对象,共110名,按照综合测评成绩将排名为奇数的护生分对照组,排名为偶数的护生分为试验组,两组均进行以Microsim Hospital模拟培训系统为基础的实践教学,且试验组需在情景模拟的过程中融入思政元素。结果发现,护生自我导向学习能力有所提高(P<0.001)。虽然试验组的人文关怀能力高于对照组[理解维度:(81.08±4.86)分vs.(72.44±4.32)分;耐心维度:(70.87±4.47)分vs.(64.16±2.94)分;鼓励维度:(62.83±3.22)分vs.(59.51±4.11)分],但除理解维度外,耐心维度和鼓励维度均低于常模,还需要更多的教育实践来提高。以Microsim Hospital医学模拟培训系统为基础的情景模拟与课程思政的有机融合不失为践行素质教育、提高护生综合分析以及临床思维能力的有效策略。

Predictors of Clostridium difficile infection severity in patients hospitalised in medical intensive care

AIM:To describe and analyse factors associated with Clostridium difficile infection(CDI)severity in hospitalised medical intensive care unit patients.METHODS:We performed a retrospective cohort study of 40 patients with CDI in a medical intensive care unit(MICU)at a French university hospital.We include patients hospitalised between January 1,2007and December 31,2011.Data on demographics characteristics,past medical history,CDI description was collected.Exposure to risk factors associated with CDI within 8 wk before CDI was recorded,including previous hospitalisation,nursing home residency,antibiotics,antisecretory drugs,and surgical procedures.RESULTS:All included cases had their first episode of CDI.The mean incidence rate was 12.94 cases/1000admitted patients,and 14.93,8.52,13.24,19.70,and8.31 respectively per 1000 admitted patients annually from 2007 to 2011.Median age was 62.9[interquartile range(IQR)55.4-72.40]years,and 13(32.5%)were women.Median length of MICU stay was 14.0d(IQR 5.0-22.8).In addition to diarrhoea,the clinical symptoms of CDI were fever(>38℃)in 23 patients,abdominal pain in 15 patients,and ileus in 1 patient.The duration of diarrhoea was 13.0(8.0-19.5)d.In addition to diarrhoea,the clinical symptoms of CDI were fever(>38℃)in 23 patients,abdominal pain in 15 patients,and ileus in 1 patient.Prior to CDI,38patients(95.0%)were exposed to antibiotics,and 12(30%)received at least 4 antibiotics.Fluoroquinolones,3rdgeneration cephalosporins,coamoxiclav and tazocillin were prescribed most frequently(65%,55%,40%and 37.5%,respectively).The majority of cases were hospital-acquired(n=36,90%),with 5 cases(13.9%)being MICU-acquired.Fifteen patients had severe CDI.The crude mortality rate within 30 d after diagnosis was 40%(n=16),with 9 deaths(9 over 16;56.3%)related to CDI.Of our 40 patients,15(37.5%)had severe CDI.Multivariate logistic regression showed that male gender[odds ratio(OR):8.45;95%CI:1.06-67.16,P=0.044],rising serum C-reactive protein levels(OR=1.11;95%CI:1.02-1.21,P=0.021),and previous exposure to fluoroquinolones(OR=9.29;95%CI:1.16-74.284,P=0.036)were independently associated with severe CDI.CONCLUSION:We report predictors of severe CDI not dependent on time of assessment.Such factors could help in the development of a quantitative score in ICU’s patients.

Hospital-based care for people living with HIV/AIDS in Ibadan,South Western Nigeria

Objective:To describe the pattern of admission-defining ailments and outcomes of care among people living with human immunodeficiency virus(HIV) /acquired immune deficiency syndrome(AIDS)(PLWHA) who presented for treatment at a tertiary health care institution in Nigeria.Methods:We reviewed the hospital records of all patients admitted for AIDS and AIDS-related illnesses at the University College Hospital,Ibadan, Nigeria,from January 2005 to January 2006.Results:Seventy-two PLWHA were admitted during the study period.There were 39 females(54.2%) and 33(45.8%) males.Sixty-seven(95%) PLWHA presented with AIDS.Only 12(17%) were already receiving highly active antiretroviral therapy before admission.Forty -three patients(60%) commenced antiretroviral(ARV) therapy on admission.Thirty-three patients(46%) had pulmonary tuberculosis,10(14%) had extrapulmonary tuberculosis,21(29.1%) had diarrhoea-related illnesses,20(28%) had anaemia,and nine(12.5%) presented with coma.Twenty-nine patients(40.3%) were discharged home,and 43(59.7%) died before discharge.Sixty-nine patients(95.6%) were judged to be indigent,and required financial support.The contributory causes of death included pulmonary tuberculosis in 21(48.8%),diarrhoeal diseases in five(11.6%),anaemia in five(11.6%),coma in nine(20.9%), and pneumonia in three(7.1%).Conclusion:Tuberculosis was the major admission-defining ailment among PLWHA.

Evaluating the average access to care and continuity of care patients in Tehran teaching hospitals

Background: Standards of Joint Commission International emphasize on the organizational performance level in basic functional domains including patient right, patient care, medical safety and infection control. These standards are focused on two principles: expectations of the actual organizational performance and assessment of organizational capabilities to provide high quality and safe health care services. The aim of this study is to evaluate the possibility of improvement in Access to Care and Continuity of Care for patients (ACC) in teaching hospitals of Tehran University of Medical Sciences. Methods: This cross-sectional study was conducted in hospitals affiliated to Tehran University of Medical Sciences during 2012. Data collection was performed using author-designed questionnaire of “Access to Care and Continuity of Care patients” based on JCI standards (2013). A total of 171 questionnaires were sent to 26 hospitals and 154 (90%) questionnaires were successfully completed and used for data analysis. The questionnaire was reviewed by experts and the Cronbach’s alpha was calculated to be 0.967. The effects of the two variables of hospital type (general, specialty) and the number of beds on mean scores of ACC standards and each of its domains were analyzed using T-test or Mann-Whitney test depending on the distribution due to Kolmogorov-Smirnov test result. Results: In general, the mean of ACC standards was found comprehendible and applicable by 82.3 (SD = 11) of the respondents. The highest and lowest mean scores of ACC questions belonged to hospitals H21 (90 ± 6) and H14 (67 ± 12), respectively. There were not any significant effects of hospital type and the number of beds on the ACC scores. Conclusion: There was not any important effect of hospital type and bed numbers on ACC, although there was a 9%-15% possibility of improvement in accreditation scores of ACC standards in hospitals of Tehran University of Medical Sciences. A complete accreditation score in this domain didn’t seem achievable in these hospitals. However, it is proposed that future managerial planning of the studied hospitals lead to a complete accreditation score.

Reducing Hospital Stays through Subacute and Complex Care Programs

The needs of patients who can stay for extended periods in hospitals generate large amounts of health care expenses. They usually experience multiple diagnoses and their needs are not easily understood or served. This study described the efforts of the acute hospitals in Syracuse, New York to address the needs of these Complex Care patients. The hospitals developed a series of Subacute Programs, each of which addressed a single care need, which might have helped restrain the growth of adult medicine stays during a five-month period. The study demonstrated that reductions in adult medicine stays were associated with the introduction of Complex Care Programs that addressed multiple care needs, in 2015. The association between the implementation of the Complex Care Programs and length of stay reduction for adult medicine was present at the combined and individual hospital levels. The study suggested that the amount of Program Development Funds invested in these programs saved 2000 adult medicine days or $1,600,000 compared with total expenses of $292,000 during a five-month period. The experiences of the Syracuse hospitals suggested that small programs with simple structures could have a positive impact on health care efficiency at the community level.

Patient-Provider-Relationship in the Hospital Care of the Elderly—A Qualitative, Multi-Perspective Study

For many years, there has been a growing demand for patient-centered care in inpatient settings, but a lack of clear consensus on how to exactly implement such programs. The main aim of this study was to analyze patient-centered care in the acute-care setting in a multidimensional manner from the perspectives of elderly patients, their relatives, and an independent observer. A multi-method design was used to capture the three perspectives. Passive observations and post-situational interviews with patients were integrated with semi-structured interviews with patients and their relatives. 18 elderly patients and their relatives (n = 8) were recruited on wards for internal medicine of six hospitals. The data show significant deficits in patient-centered care in the acute-care setting. Although individual patients have different needs, certain categories of deficits emerge as universally relevant, one being the patient-provider-relationship. Patients express a desire for more frequent contact with the hospital staff. Access to doctors and nurses is particularly limited at night and on weekends. The patients are aware of these limitations and often do not draw attention to their own needs to reduce the workload on the staff. The wishes and needs of patients are not always adequately addressed. However, patients, relatives and the independent observer take positive notice of some employees because of their patient-centered attitude. The results show that there is still a need for improvement of patient-centered care. Participants from all three perspectives described differences between employees within the same institutional setting. This finding suggests that patient-centered care strongly depends on the personality of the individual caregiver.

Service Delivery Factors That Influence Utilization of HIV Integrated Primary Health Care Programme in Embu Referral Hospital, Kenya

Globally, there are approximately 36.7 million people living with HIV. Integration of HIV treatment with primary care services improves effectiveness, efficiency and equity in service delivery. The study sought to establish service delivery factors that influenced utilization of integrated HIV and primary health care services in Embu Teaching and Referral hospital. A descriptive cross-sectional survey design was used to collect data at a specific period and point of time from a sample of 302 seropositive clients who were selected using simple random method. Data collection tool was structured and semi-structured questionnaire. The tool was reliable at Cronbach’s alpha of 0.817. SPSS version 23 was used to analyze the data. A binary logistic regression model was used to predict the relationship between service delivery and utilization of integrated services. Results: Majority of the respondents (59.6%) were aged over 35 years with majority being female (58.9%) and the married were 57.6% of the total sample. On service delivery factors, majority (94.7%) felt that their health status had improved. Action taken when clients developed side effects, 78.8% reported that the drugs were changed. Action taken following drug side effects significantly affected utilization, χ2 = 1.305, p = 0.001, df = 1. The findings showed that waiting time significantly influenced utilization, χ2 = 9.284, df = 1, p = 0.002. Source of information on self care also significantly influenced utilization, χ2 = 10.689, df = 1, p = 0.001. Kind of treatment at the facility also significantly influenced utilization, χ2 = 5.713, p = 0.048. Conclusion: significant factors that influenced utilization of integrated services were source of health care information, secondly waiting time was another factor which influenced utilization. Majority of the respondents were satisfied with duration of time they take before they were served;they reported to take utmost 1 hour to be attended to and action taken by health care provider following side effects was another factor that influenced the utilization.

Association between Geographic Accessibility of Home Care Clinics and Hospitalization in Japan Using Geographic Information Systems and Insurance Claim Data

Measuring and improving home care clinic resource volume and geographic allocation are an important public health issue regarding prolonging home care system usage among disabled elderly people. This study examined clinic volume and accessibility’s association with hospitalization duration among disabled elderly people in 13 municipalities in Japan;additionally, this study compared clinic volume and accessibility’s ability to explain hospitalization duration in this population. Home care clinics’ service volume and geographic accessibility were calculated for 17 municipalities using public data and geographic information systems. We analyzed medical claim data from October 2012;the sample included 22,662 persons who were aged ≥75 years, certified as disabled in daily living, and lived in 13 municipalities regarding which data could be obtained for all examined municipality characteristics. Multilevel logistic models with random intercepts were constructed for municipalities and individual- and municipality-level independent variables in order to examine home care clinic volume and accessibility’s correlation with hospitalization duration. Clinic volume ranged from 0 to 9.53 per 10,000 elderly people;clinic accessibility ranged from 0% to 83%. Clinic volume and accessibility were both significantly negatively correlated with hospitalization duration of ≥10 days (odds ratios, 0.944 and 0.713;confidence intervals, 0.914 - 0.974 and 0.553 - 0.921, respectively). Clinics were not homogeneously geographically distributed;clinic accessibility explained hospitalization duration better than clinic volume. Clinic accessibility may more accurately indicate care clinic allocation appropriateness than clinic volume.

Health Literacy: Prevalence among Elderly Care Givers and Its Impact on the Frequency of Elderly Hospitalization and Elderly Health Related Quality of Life

Caring for the elderly is an extremely lonely and frustrating vigil. The care giver has the responsibility of caring for an elderly one to the myriad decisions on different topics such as diabetes care or cancer treatment. Care givers with low levels of health literacy have less health knowledge, worse management of chronic disease and lower use of preventive services. This study was conducted to determine the prevalence of health literacy among elderly care givers and its impact on the frequency of elderly hospitalization and elderly health related quality of life (QOL). The study was carried out on 200 elderly patients and their corresponding care givers. Rapid Estimate of Adult Literacy in Medicine (REALM) and Newest Vital Sign (NVS) were used to assess caregivers’ health literacy. Assessment of the elderly health related QOL was done by the use of short form-12 health survey (SF-12). The results were as followed, in elderly patients;92 were males and 108 were females. The mean elderly age was 69.4 ± 8.8. The mean age of caregivers was 42.1 ± 12.9 years. The prevalence of inadequate health literacy among elderly caregivers was 75.0%. There were significant associations between care givers, health literacy and the frequency of elderly hospitalization (p = 0.001), duration of hospital stay (p = 0.009), and the elderly health related QOL (p = 0.001). The study concluded that inadequate health literacy is a problem among elderly care givers in Egypt. Healthcare professionals must be made aware of this problem, which is to provide simplified educational materials to elderly care givers to maximize elderly care.

Relationship between information technology functionalities and hospital-acquired injurious fall rates in US acute care hospitals

The purpose of this exploratory study was to determine health information technology functionalities in inpatient care units that were associated with reduced fall risk among adult patients aged 65 years or older in acute care hospitals in the United States. This study compared the differences in the hospital-acquired injurious fall rates for hospitals in California, Florida, and New York with and without fully implemented IT functionalities in their general medical and surgical inpatient units. It used publicly available 2007 datasets, the hospital was the unit of analysis, and teaching and non-teaching hospitals were analyzed separately. Hospital-acquired injurious falls were identified based on fall-related primary and secondary diagnoses and were flagged by the hospitals as not “present on admission” in the 2007 California, Florida, and New York State Inpatient Database data. The 4 health IT functionalities in general medical and surgical inpatient units were 1) electronic clinical documentation, 2) results viewing, 3) computerized provider order entry, and 4) decision support. The research question was What are the effective health IT functionalities in the general medical and surgical units for reducing fall risk among adult patients aged 65 years or older at their hospitals? Independent t tests were used. The results showed that no significant difference was found in the hospital-acquired injurious fall rates between hospitals with and without each of the 4 functionalities and between the teaching hospitals with and without each of the 4 functionalities. Significant differences were found in the injurious fall rates between non-teaching hospitals with and without electronic clinical documentation and result viewing. Future research may focus on assessing the clinicians’ use of the IT functionalities of electronic clinical documentation and results viewing, as well as the effect of the clinicians’ use patterns on patient outcomes.

The Practice of Palliative Care amongst Nurses in Selected Hospitals in Eastern Nigeria

In recent times, palliative care nursing has caught the attention of nurse researchers in Africa as more individuals are being diagnosed with chronic diseases of the aged like cancer, cardiac and cerebrovascular conditions. This study examined the influence of knowledge and attitude on the practice of palliative care among practicing nurses in eastern part of Nigeria. A descriptive cross-sectional research design was used for the study. The population of the study is all registered, licensed and practicing nurses working in the named public and private hospitals where palliative care is supposedly well established. Proportionate sampling technique was used to select 289 respondents. Three commercial instruments that were modified were used for data collection. Level of significance was set at 5%. The study was conducted from October 2018 to June 2019. Results revealed that 52.7% of the respondents had satisfactory practice of palliative care, 73.7% of the respondents had adequate knowledge of palliative care (mean 2.64 (1.06) and 77.5% of the respondents had positive attitude towards palliative care (Mean 2.81 (1.14)). There was also a significant weak positive association between nurses’ educational level and their knowledge of palliative care with an effect size of 21.9% (P = 0.003). There was also a significant association between nurses’ years of experience and their attitude to palliative care with an effect size of 35.6% (P < 0.001). There was no significant association between type of hospital facility nurses work in and their practice of palliative care (P = 0.343). Recommendations were made on how to improve the practice of palliative care among professional nurses.