Modelling demand and supply influences on utilization: A flow demand model to predict hospital utilization at the small area level

This study outlines a model to predict hospital utilization at the small area level within a National Health Service (NHS) institutional context. The proposed approach departs from alternative analyses based on utilization flows of hospital care between a local population and a hospital. A flow demand model is outlined that relates flow demand to utilization flows; models the interaction between hospital supply and utilization of alternative hospitals; captures the process of demand for hospital care, with special attention given to the role of other health care sectors, to the organizational and institutional context of the hospital system and to geographic variations. The flow approach partly overcomes the problem of dealing with simultaneity of determination between supply and demand. A two-part econometric model suitable to estimate the flow demand model for prediction purposes is tested and applied to the Portuguese health care system. The results show the model to be robust and to provide key information for defining future hospital policies at the central level.     

Internationally educated nurse hiring: geographic distribution, community, and hospital characteristics

As the largest importer of internationally educated nurses (IENs), the United States is considered to be the epicenter of global nurse migration. The purposes of this study were to examine the geographic distribution of IEN hiring and determine associations between community and hospital characteristics and IEN hiring. More community characteristics than hospital characteristics were strongly associated with IEN hiring which suggest perceived community needs and receptivity to lENs could be an important consideration in hospital administrators' decisions to hire IENs. These findings suggest that as the U.S. population ages and becomes increasingly diverse, the demand for IENs is likely to grow. Nurse leaders and faculty may face challenges with regard to the ethical recruitment of IENs from low-income countries, incorporation of IENs into U.S. health care organizations, and continued development of a diverse U.S.-educated nursing workforce. This study expands understanding of the demand side of IEN employment in U.S. hospitals by providing the first in-depth examination of the community and hospital factors related to hospitals' IEN hiring.     

中国城乡老年健康及照料状况研究

人口老龄化背景下我国城乡的老年健康及老年照料问题日益严重。利用中国城乡老年人状况调查数据、全国残疾人抽样调查数据以及国家卫生服务利用调查数据,从两周患病率、慢性病患病率、残疾水平、自评健康以及健康预期寿命等方面分析了我国城乡老年人的健康状况,探讨了目前我国城乡老年人的照料提供来源。提出了人口老龄化趋势下提高老年健康水平,应对老年人口照料危机的政策建议。     

美罗培南、亚胺培南西司他丁、厄他培南用药合理性分析

目的探讨三甲医院碳青霉烯类药物用药合理性情况。方法回顾性分析内蒙古科技大学包头医学院第一附属医院2018年9月至2019年2月使用美罗培南、亚胺培南西司他丁、厄他培南的全部出院患者469份病历,并按照国家卫健委于2018年9月18日印发的《碳青霉烯类抗菌药物临床应用评价细则》(国卫办医函〔2018〕822号附件2)及相关指南等,评价用药合理性。结果469例患者中,用药前微生物送检率81.88%,根据"评价细则"的评分标准扣分,用药合理性总体评价平均得分87.65分。结论某院碳青霉烯类抗菌药物的临床应用基本合理,仍需进一步提高临床应用水平。     

Prices,infrastructure, household characteristics and child height

A Brazilian household survey, ENDEF, in 1974-75 and the 1974 Informacoes Basicas Municipais (IBM) provided data for the analysis of the impact of community services and infrastructure and household characteristics on the logarithm of child height, standardized for age and gender. The sample was comprised of 36,974 children stratified by residential location, the child's age, and the educational level of the mother. Variance and covariance matrices were estimated with the jackknife developed by Efron (1982). Household characteristics included the logarithm of per capita expenditure as a measure of household resource availability, income, and parental education. Community characteristics were local market price indices for 6 food groups (dairy products, beans, cereals, meat, fish, and sugar), level of urbanization, buildings with sewage, water, and electricity connections per capita, per capita number of buildings, and population density. Health services were measured as per capita number of hospitals and clinics and doctors and nurses, and the number of beds are hospital. Educational services include a measure of student teacher ratios, elementary school class size, and per capita number of teachers living in the community. the results show that expenditure had a positive, significant effect on the height of children 2 years and older. Expenditure was a significant determinant for literate and illiterate mothers, and not well educated mothers. The impact of maternal education was largest on the length of babies and declined with the age of the child. Father's education had not impact of length of babies. The effect of parents' education was complementary. The effect of father's education was largest when mothers had some education. Better educated parents had healthier children. Maternal rather than paternal height had an impact of the length of a baby. In the community models, prices had a significant effect on child height, in both urban and rural areas, in all age groups, and for all levels of maternal education. Higher prices were associated with shorter children. Joint price and expenditure interactions were significant. Children at the top of the expenditure distribution were more affected by some prices than by others. Capital building improvements alone and with expenditures were all positively associated with child height. Only nurses per capita impacted on child height.     

Adolescent alcohol use,sociability and income as a young adult

We use data from the National Longitudinal Survey of Adolescent Health (Add Health) to study how sociability and adolescent alcohol use impact personal income as a young adult. We find that factors which enhance not only individual sociability but also social interaction at the community level are positively linked to future earnings of adolescents. Adolescents whose friends and friends of friends have greater sociability reap long-term labour market rewards into adulthood. After adjusting for individual and community sociability, the effect of teenage alcohol consumption on labour market earnings as young adults is reduced. Our results suggest that earnings premiums associated with adolescent alcohol consumption may be partially explained by social network dynamics.     

The importance of employment status in determining exit rates from nursing

To mitigate nurse shortages, health care decision makers tend to employ retention strategies that assume nurses employed in full-time, part-time, or casual positions and working in different sectors have similar preferences for work. However, this assumption has not been validated in the literature. The relationship between a nurse's propensity to exit the nurse profession in Ontario and employment status was explored by building an extended Cox Proportional Hazards Regression Model using a counting process technique. The differential exit patterns between part-time and casual nurses suggest that the common practice of treating part-time and casual nurses as equivalent is misleading. Health care decision makers should consider nurse retention strategies specifically targeting casual nurses because this segment of the profession is at the greatest risk of leaving. Nurse executives and nurse managers should investigate the different work preferences of part-time and casual nurses to devise tailored rather than "one-size fits all" nurse retention strategies to retain casual nurses.     

Workplace adjustment and intergenerational differences between matures, boomers, and xers

The authors explored the factors influencing occupational adjustment related to workplace stress among 413 nurses at a Midwestern pediatric hospital. Among critical factors found in responses to their questionnaire and follow-up focus groups were differences in work adjustment and intergenerational conflicts. Both real and perceived workplace stress can manifest itself both fiscal and human costs by increasing turnover, absenteeism and worker's compensation claims as well as "faulty products and negative behaviors." Baby boomers (those born between 1946 and 1964) and Generation Xers (those born between 1965 and 1981) reported quite different issues and perceptions of occupational stress.     

Firm Market Performance and Volatility in a National Real Estate Sector

We present empirical evidence using daily data for stock prices for 17 real estate companies traded in the Sao Paulo, Brazil stock exchange, from August 26, 2006 to March 31, 2010. We use the U.S. house price bubble, financial crisis and risk measures to instrument for momentums and reversals in the domestic real estate sector. We find evidence of conditional premium persistence and conditional volatility persistence in the market. We find that the conditional risk-return relationship in the sector is consistent with the prospect theory of risk attitudes in this period. Certain companies seem to be operating on a perceived potential industry return above the target, while most others are below the target, and the whole sector is below target on average.     

The 'Parent Shift' program: incentives for nurses, rewards for nursing teams

To create new opportunities for nurses to reenter the workforce, a RN p.r.n. program must meet the needs of nurses who wish to make dual commitments to home and work. The Parent Shift program provides an innovative model of attracting and retaining nurses in a hospital workforce. Many nurses who joined the program were away from the field of nursing for many years and were drawn to the program because of the promise of flexible shifts and minimal requirements for participation. In this study, flexible shifts not only encouraged program entry, they were also a powerful motivator for continued program participation over time. Parent Shift nurse presence was perceived by nurse managers to decrease stressors and improve time efficiency of full-shift staff.     

Incentives and targets in hospital care: Evidence from a natural experiment

Performance targets are commonly used in the public sector, despite their well known problems when organisations have multiple objectives and performance is difficult to measure. It is possible that such targets may work where there is considerable consensus that performance needs to be improved. We investigate this possibility by examining the response of the English National Health Service to high profile waiting time targets. We exploit a natural policy experiment between two countries of the UK (England and Scotland) to establish the global effectiveness of the targets. We then use a within-England hospital analysis to confirm that responses vary by treatment intensity and to control for differences in resources which may accompany targets. We find that targets met their goals of reducing waiting times without diverting activity from other less well monitored aspects of health care and without decreasing patient health on exit from hospital.     

Changing the start of the hospital workweek

Essential to the success of a project of this magnitude were: (a) having the support and input of both management and staff; (b) clarifying federal wage and hour issues; (c) allowing adequate time for the change process; (d) determining impact of change on every hospital department; (e) providing hospital departments with necessary information, resources, and support to accommodate the change; and (f) communicating the change to each hospital employee in a timely manner. Can a hospital provide budget-neutral, flexible nurse schedules necessary to recruit and retain registered nurses? Yes, they can if they know how to do it. By redefining the workweek, Saint Marys realized an annual decrease of almost $750,000 in scheduled overtime expense for full-time nurses working 12-hour weekends, every third weekend. If health care institutions want the competitive edge in recruiting nurses, they will need to provide work schedules that are not only attractive, but also help ensure a positive "bottom line."     

A Socio-instutionalist Critique of the 1990s' Reforms of the United Kingdom's National Health Service

This paper argues that the on-going reforms to the UK's National Health Service initiated in the 1990s represent potentially profound institutional change to the values underpinning the process of care. The market-orientation of the reforms is highlighted, and it is asserted that the theoretical rationale for this is informed by the nascent neoclassical health economics and new institutionalist literatures, which exhibit utilitarian propensities in that both stress outcomes and at best relegate process. Drawing from the seminal contribution of Thorstein Veblen, the paper argues that market-oriented reform in the UK may induce a shift from a Hippocratic ethos to a more individualistic value system.     

珠三角转型社区物业依赖型经济的特征及其调控路径

在土地资源日益紧缺、全球金融危机和产业与劳动力双转型背景下,珠三角转型社区的物业依赖型经济面临前所未有的发展压力。这种本质上以土地租赁为核心的经济发展模式亟需在新的经营管理变革、政策制度转型和土地利用结构重组上寻求突破。珠三角转型社区物业依赖型经济具有以土地为基本生产资料、物业租赁为主要收入来源、福利性和事务性支出为主、物业产权薄弱和原村民对集体经济依赖强化的特点,存在着特定的历史背景、发展轨迹以及塑造这种经济发展形式的多种因素和根源。针对其存在的困境和问题,提出应对物业依赖型经济的社区管理、经济发展方向、土地管理政策和空间规划等事宜在新的发展形势和政策环境下进行优化,以推动转型社区物业依赖型经济向投资型实业经济的过渡。     

Efficiency of Payments for Environmental Services: Equity and additionality in a case study from a Biosphere Reserve in Chiapas, Mexico

Payments for Environmental Services (PES) have been claimed as a more efficient way of accomplishing conservation and development goals than other indirect strategies, reaching their optimum when the buyer pays the opportunity costs of the foregone benefits. Different inefficient situations have been described, like lack of additionality, where payments are given for practices that would have been adopted anyway. Trade-offs between efficiency and equity of PES have usually emerged as well. In this paper we assess the equity, additionality and stakeholders' perceptions of a PES scheme in a Mexican community inside a Biosphere Reserve. We applied structured interviews to all adults, a total of 66 people from 31 households. Our results show a dual response in equity and additionality, depending on land tenure. PES have an egalitarian effect within landowners and landless groups, but it broadens the gap between them. Additionality is low for landowners and high for the landless people in the community, even though the former are the ones with full decision over the land. Although the scheme does not seem efficient under the classical PES paradigm, it is perceived as a reward, reinforcing conservation attitudes even though most of the interviewees claim it to be insufficient.     

Determinants of the Eurosystem's Central Banks Provisions

Central bank provisions may be used as a measure of the perceived risk of the balance sheet composition by a central bank. We identify three possible sources that may change the size of the provisions. These are: The length of the balance sheet, the central bank revenues, and measures of fiscal stress. Using data of the 11 founding members of the Eurosystem for the years 1999–2015, we are able to test each of the three determinants. We find that provisions are increased with the size of the balance sheet especially in the recent financial crisis. Moreover, provisions are increased at the cost of lower central bank revenues. While this holds for the pre‐crisis period this relationship seems to be less pronounced in the crisis period probably because of the more active collateral policy. Finally, central banks do not tend to lower provisions because of fiscal tensions. This is even more true in the crisis period.     

基于政策导向的医用耗材管理

《关于深化医药卫生体制改革的意见》和《全国医疗服务价格项目规范（试行）》两政策对医院来说,都是更大的挑战。基于这些政策导向,就必须加强医用耗材管理,规范医用耗材的使用。为此,应控制高端产品的适用范围;引进ERP系统,同时对高值耗材实行条码化管理,确保医用耗材的实耗实销。将政策导向贯彻到医用耗材管理中,实现账物相符,收支平衡,杜绝内耗,在保证医护质量的情况下,合理使用医用耗材,保证患者费用合理,控制医疗费用的不合理增长,确保医院成本效益合理。     

Hospital RNs' and CNOs' perceptions of the impact of the nursing shortage on the quality of care

The results of analyses of the 2002 and 2004 National Sample Surveys of RNs and the 2004 National Sample of CNOs document the widespread perception that the shortage of nurses is a major problem for the overall quality of patient care in hospitals. In the eyes of the majority of hospital RNs and CNOs surveyed, care processes involving communication, timely response to pages and telephone calls, delays in patient discharges, and the time patients had to wait for tests and procedures were all affected negatively by the nursing shortage. These results are not encouraging.     

When nursing takes ownership of financial outcomes: achieving exceptional financial performance through leadership, strategy, and execution

With nurses and unlicensed supportive personnel composing the greatest percentage of the workforce at any hospital, it is not surprising nursing leadership plays an increasing role in the attainment of financial goals. The nursing leadership team at one academic medical center reduced costs by more than $10 million over 4 years while outperforming national benchmarks on nurse-sensitive quality indicators. The most critical success factor in attaining exceptional financial performance is a personal and collective accountability to achieving outcomes. Whether it is financial improvement, advancing patient safety, or ensuring a highly engaged workforce, success will not be attained without thoughtful, focused leadership. The accountability model ensures there is a culture built around financial performance where nurses and leaders think and act, on a daily basis, in a manner necessary to understand opportunities, find answers, and overcome obstacles. While structures, processes, and tools may serve as the means to achieve a target, it is leadership's responsibility to set the right goal and motivate others.     

Nursing is the room rate

Shrinking dollars increase the need for health care stakeholders to clearly understand nursing's worth. For nursing to assure an adequate investment in nurses, it needs to articulate its value drivers. Nursing revenue offers a data source that reflects stakeholder choices and patient needs. The daily nursing billing supports hospital payment and provides cost data, important for hospital financial decision making. This revenue is a tangible asset reflecting nursing value and can be used to justify an investment in the profession. Nursing leadership can use this daily nursing charge data to monitor and measure the impact of efficiencies related to patient care.