The Evolving Structure of Multi-Hospital Systems in the US: Focus on California

Objectives: Hospital consolidation and the growth of multi-hospital systems are generating media headlines in the US. While there is a growing literature on the role of multi-hospital systems in the US health care system, it is still quite limited. This study helps fill the gap by documenting and describing the structure and evolution of multi-hospital systems in California over a recent 18-year period. Methods: Descriptive analysis of a hospital level longitudinal database covering the period 2002-2019 in California. Results: The total number of hospitals declined by 40 hospitals, from 445 to 405, over the study period and the total number of multi-hospital systems increased substantially from 14 systems in 2002 to 30 systems in 2019. As a result, the number and proportion of all California hospitals that were part of a multi-hospital system grew—from 177 in 2002 to 238 in 2019. By 2019, 59% of all hospitals were part of systems (compared to 40% in 2002). The size distribution of multi-hospital systems in California changed substantially over time. In the early period, larger systems dominated the system landscape. Now, half of all systems have 5 or fewer hospitals compared to 29% in 2002, while the percentage of systems with 25 or more members has declined from 25% to just 7%. Interestingly, the clinical service mix of hospital systems has changed substantially. In 2002, all 14 systems were largely acute care focused. By 2019, less than half of systems had acute care as their only and primary focus. Conclusions: Combined, these findings provide insight into the development, evolution and growing role of hospitals systems in our health care system and identify new areas for further research.

Measuring the Success of Hospital Information System across Multispecialty Hospitals in Bahrain

Purpose： The aim of this paper is to measure the success of HISs （hospital information systems） in Bahrain from their end user’s perspectives. Methodology： a quantitative design using a questionnaire based on the DeLone and McLean Information System Success Model （2003） was employed to examine the key determinants comprise of SQ （system quality）, IQ （information quality）, SerQ （service quality） as the independent variables and their effect on the US （user satisfaction）, U （system use） and the perceived NB （net benefits） as the success measures. There are 324 respondents consisting of doctors, nurses, technicians, pharmacists and admin staff of hospitals. Data were analyzed using SPSS. Findings： SQ, IQ and SerQ are significantly positively related to US and U, and the two later are in turns significantly positively related to the perceived NB out of the system to both users and organizations. Research implications： the research reflects the experience of using innovative healthcare technologies in the Middle East and its results show the importance of improving the systems technical quality to ensure more satisfied users, more utilized technologies and to reach the optimal purpose of implementing these systems and reap out their prospected benefits. Moreover, sufficient training and full dependency on the systems are required to get more confident users and reduce the daily work load.

Hospitalizations and in-hospital mortality for inflammatory bowel disease in Brazil

BACKGROUND Inflammatory bowel disease(IBD)is associated with complications,frequent hospitalizations,surgery and death.The introduction of biologic drugs into the therapeutic arsenal in the last two decades,combined with an expansion of immunosuppressant therapy,has changed IBD management and may have altered the profile of hospitalizations and in-hospital mortality(IHM)due to IBD.AIM To describe hospitalizations from 2008 to 2018 and to analyze IHM from 1998 to 2017 for IBD in Brazil.METHODS This observational,retrospective,ecological study used secondary data on hospitalizations for IBD in Brazil for 2008-2018 to describe hospitalizations and for 1998-2017 to analyze IHM.Hospitalization data were obtained from the Hospital Information System of the Brazilian Unified Health System and population data from demographic censuses.The following variables were analyzed:Number of deaths and hospitalizations,length of hospital stay,financial costs of hospitalization,sex,age,ethnicity and type of hospital admission.RESULTS There was a reduction in the number of IBD hospitalizations,from 6975 admissions in 1998 to 4113 in 2017(trend:y=-0.1682x+342.8;R^(2)=0.8197;P<0.0001).The hospitalization rate also decreased,from 3.60/100000 in 2000 to 2.17 in 2010.IHM rates varied during the 20-year period,between 2.06 in 2017 and 3.64 in 2007,and did not follow a linear trend(y=-0.0005049x+2.617;R^(2)=0,00006;P=0.9741).IHM rates also varied between regions,increasing in all but the southeast,which showed a decreasing trend(y=-0.1122x+4.427;R^(2)=0,728;P<0.0001).The Southeast region accounted for 44.29%of all hospitalizations.The Northeast region had the highest IHM rate(2.86 deaths/100 admissions),with an increasing trend(y=0.1105x+1.110;R^(2)=0.6265;P<0.0001),but the lowest hospitalization rate(1.15).The Midwest and South regions had the highest hospitalization rates(3.27 and 3.17,respectively).A higher IHM rate was observed for nonelective admissions(2.88),which accounted for 81%of IBD hospitalizations.The total cost of IBD hospitalizations in 2017 exhibited an increase of 37.5%compared to 2008.CONCLUSION There has been a notable reduction in the number of hospitalizations for IBD in Brazil over 20 years.IHM rates varied and did not follow a linear trend.

Mortality associated with gastrointestinal bleeding in children: A retrospective cohort study

To determine the clinical characteristics of children with gastrointestinal bleeding (GIB) who died during the course of their admission.METHODSWe interrogated the Pediatric Hospital Information System database, including International Classification of Diseases, Current Procedural Terminology and Clinical Transaction Classification coding from 47 pediatric tertiary centers extracting the population of patients (1-21 years of age) admitted (inpatient or observation) with acute, upper or indeterminate GIB (1/2007-9/2015). Descriptive statistics, unadjusted univariate and adjusted multivariate analysis of the associations between patient characteristics and treatment course with mortality was performed with mortality as primary and endoscopy a secondary outcome of interest. All analyses were performed using the R statistical package, v.3.2.3.RESULTSThe population with GIB was 19528; 54.6% were male, overall mortality was 2.07%; (0.37% in patients with the principal diagnosis of GIB). When considering only the mortalities in which GIB was the principal diagnosis, 48% (12 of 25 principal diagnosis GIB mortalities) died within the first 3 d of admission, whereas 19.8% of secondary diagnosis GIB patients died with 3 d of admission. Patients who died were more likely to have received octreotide (19.8% c.f. 4.04%) but tended to have not received proton pump inhibitor therapy in the first 48 h, and far less likely to have undergone endoscopy during their admission (OR = 0.489, P < 0.0001). Chronic liver disease associated with a greater likelihood of endoscopy. Mortalities were significantly more likely to have multiple complex chronic conditions.CONCLUSIONGIB associated mortality in children is highest within 7 d of admission. Multiple comorbidities are a risk factor whereas early endoscopy during the admission is protective.

Best Practices and Innovative Scenarios of Integrated Patient Data Management to Improve Continuity of Care and Scientific Research

Clinical data have strong features of complexity and multi-disciplinarity. Clinical data are generated both from the documentation of physicians＇ interactions with the patient and by diagnostic systems. During the care process, a number of different actors and roles （physicians, specialists, nurses, etc.） have the need to access patient data and document clinical activities in different moments and settings. Thus, data sharing and flexible aggregation based on different users＇ needs have become more and more important for supporting continuity of care at home, at hospitals, at outpatient clinics. In this paper, the authors identify and describe needs and challenges for patient data management at provider level and regional- （or inter-organizational-） level, because nowadays sharing patient data is needed to improve continuity and quality of care. For each level, the authors describe state-of-the-art Information and Communication Technology solutions to collect, manage, aggregate and share patient data. For each level some examples of best practices and solution scenarios being implemented in the Italian Healthcare setting are described as well.

Hospital management in China in a time of change

Chinese hospitals face complex challenges: allocating resources equitably and efficiently whilst moving to greater reliance on market mechanisms; maintaining quality despite declining government funding; exercising responsibility in some areas whilst tight government controls remain in others; and generating more revenue from user charges whilst ensuring access to care for the poor.