The decision process for the acquisition of capital equipment in teaching hospitals

Technological innovations have been the foundation of modern medical advances which have provided cures for some formerly incurable diseases. Reflecting this new technology, state-of-the-art equipment must be acquired by hospitals. However, greatly increased costs of acquiring as well as operating and maintaining this equipment have caused both public and professional concern. Therefore, the decision process for the acquisition of capital equipment has become increasingly important. That process, as conducted by teaching hospitals, is the subject of this study. A questionnaire was administered to a sample of the 419 hospitals with membership in the Council of Teaching Hospitals (COTH) of the Association of American Medical Colleges in order to gather data for a descriptive study

Physician Opinion of the U.S. Health Care System: A Systematic Review

This systematic review of published research on physician attitudes toward health reform begins with a brief analytical illustration of organized medicine as an important political influence, before moving to a structured, critical appraisal of opinion literature. The systematic review identified 15 studies, culled from 1968-2009, which met quality standards. Physicians overall tended to be dissatisfied with the system and believed that everyone should have access to care, but they have yet to achieve consensus as to the best course for reform. Primary care, hospital-based, salaried, and urban physicians were more likely to support single payer plans. Meanwhile, surgeons, specialists, AMA members, office-based, and private practice physicians appear more likely to choose retention of the current system or a non-single-payer alternative, such as tax credits or health savings accounts. Several problems dog the literature throughout and limit our ability to draw conclusions, including: question wording problems, non-response bias, limited study populations, the absence of key variables, and a limited ability to track trends.Master of Public Healt

Program Factors Associated With Influencing Generalist Career Plans Among Primary Care Im Residents

The combination of a rapidly aging US population with the recent implementation of the Affordable Care Act has prompted a dramatic rise in health care demand for primary care services, most notably for general internal medicine physicians. This demand, however, coincides with a progressive decline in interest toward general internal medicine (GIM) careers with a notable disinterest among Primary Care Internal Medicine (PCIM) residents, whose selection of the PCIM residency is seemingly suggestive of a strong interest in GIM. The reasons for this discrepancy have been examined in prior surveys, citing perceptions of diminished lifestyle control, low prestige, and of frustrated general internists in practice. However, more in-depth study is warranted, particularly among PCIM residents who appear to be dissuaded from GIM careers, likely at some point during their residency. By gaining a more in-depth understanding of PCIM resident training experiences, the investigators aim to elucidate what program factors have the potential to encourage or discourage PCIM residents from GIM careers. The investigators in this study completed structured interviews with second and third year PCIM residents, analyzed the qualitative data obtained using grounded theory methods, and identified emergent themes from the interview transcripts. Among the seven study participants\u27 responses, the investigators identified six program factor themes with a potential to encourage or discourage residents from GIM. Three potentially encouraging themes were: a culture of like-mindedness among colleagues, including comfort with change; positive reflections on the outpatient curriculum; and an appreciation of exposure to various models of primary care. Three potentially discouraging themes were: a mismatch between trainee expectations and the actual experience with the practice of primary care; challenges with disjointed care, including interruption of continuity by inpatient rotations; and inadequate communication between practice teams and subspecialist physicians. Improving resident training experience by bolstering potentially encouraging program factors while addressing potentially discouraging program factors may influence a greater number of PCIM residents to enter GIM care

Perceptions About The New Pertussis Immunization Recommendation Among Health Care Workers

New guidelines from the Advisory Committee on Immunization Practices (ACIP) and the Healthcare Infection Control Practices Advisory Committee (HICP AC) recommend that health-care personnel should receive a single dose of tetanus toxoid, reduced diphtheria toxoid and acellular pertussis vaccine (Tdap) as soon as feasible, if they have not previously received T dap. This represents a change in previous bordetella Pertussis (Pertussis) immunization practices, which previously recommended completion of only a series of Pertussis vaccination during childhood. The ACIP's new policy is largely in response to an increasing in reported incidence of Pertussis within the United States over the past couple of decades and data suggesting that immunity to Pertussis wanes over time. This Master's Paper reviews the health care community's historical response to recommended vaccines and evaluates health care workers' perception of the new pertussis vaccination recommendation in one large University-based Hospital System. The literature review reveals that misperceptions about vaccines (such as vaccines cause infections or are not effective), individual barriers (such as high cost and inconvenience) and systematic obstacles (such as lack of vaccination policy and incomplete tracking of immunization) make it difficult to achieve high immunization rates across a wide variety of recommended vaccines. However, none of the studies included in the systematic review discussed the new T dap vaccine. Our study of health care worker peceptions of the T dap recommendation is the first published report on the topic. Results from our study indicate that health care workers feel the pertussis vaccine is very important to the health of the public and that health care workers strongly agree that vaccination will prevent them from getting pertussis or giving pertussis to patients. Health care workers agree that Tdap vaccination is a personal responsibility and they also feel that T dap vaccination should be required for persons who work at a hospital. Both free vaccines and workman's compensation, to cover complications of vaccination, are very important to HCWs. This willingness of health care workers to accept the new vaccine requirement is very different from the resistance healthcare workers have applied to other immunization recommendations as reported in the published literature. UNC Health Care System's Tdap vaccination requirement is an appropriate health care policy and other health care facilities should strongly consider similar Tdap vaccination mandates.Master of Public Healt

Data Collection Instrument for Full Accreditation Surveys

The Liaison Committee on Medical Education’s (LCME) Data Collection Instrument for the UNM Health and Science Center. This third party accreditation gives exhaustive information on the HSC and its consistency with established standards

Health Care Institutions and the Taft-Hartley Act: An Assessment of the Impact of the 1974 Amendments

The problem with which this research is concerned is that of determining the impact of the 1974 Amendments (Public Law No. 93-3 60) to the Taft Hartley Act. These amendments provided new coverage to over two million health care workers. The purpose of this study is to determine the impact of this law on labor relations in the health care industry. In retrospect, the first years following the amendments have been eventful; National Labor Relations Board cases, court decisions, increased organizing activities. Boards of Inquiry recommendations, and professional associations union functions are the most significant developments. Future research will be able to present a longitudinal analyses of these activities and investigate other important areas of health care labor relations such as nursing homes and clinics

The Illusion of Autonomy at the End of Life: Unconsented Life Support and the Wrongful Life Analogy

Overwhelming evidence indicates that physicians routinely ignore patient preferences about life-sustaining care. Yet, the ability of wrongfully treated patients to recover compensatory damages has recently been placed in doubt. Both courts and commentators have suggested that actions for unconsented life support are analogous to actions for wrongful life and should, for that reason, be rejected. In this article, Professor Philip Peters argues that the obvious similarity between the two kinds of claims is overshadowed by many factors that distinguish the two settings. As a result, Professor Peters concludes that a physician who wrongfully administers life-sustaining care over the objections of the patient or her proxy should be liable for compensatory damages

Health information acquisition in British and Brazilian hospitals

The information transfer in the context of hospitals in two countries, the UK and Brazil has been observed and analysed. This entailed identifying patterns of information use and need by medical professionals and ancillaries in both countries, and especially in determining deficiencies in satisfying such needs. [Continues.

Minutes of a Regular Meeting, The University of Oklahoma Board of Regents, December 20, 1989

21490-2156

Adoption of Electronic Health Records by Admitting Physicians: A Heuristic Model

Background: Although hospital electronic health records (EHRs) are generally perceived to improve care, physician resistance may hinder EHR adoption. Purpose: This study uses constructs from diffusion of innovations and resource dependence theories to predict adoption and rate of adoption of an EHR by admitting physicians from three of ten hospitals in a highly integrated health system in Virginia. Functions evaluated: computerized physician order entry (CPOE), electronic history and physical (EH&P) and electronic discharge summary (EDS). The study tested hypotheses that adoption would be associated with: working at larger, academic hospitals; financial alignment; larger physician groups; office EHR; youth; males; medical specialty; high volume; hospital-based; high inpatient ratio; and high loyalty. Methods: Administrative data collected for 326 physicians admitting at least ten patients during the six months following EHR activation represented over 80% of the total admissions. Logistic Regression and Cox Regression were used to evaluate how well variables predicted adoption (80% utilization) and adoption rate. Results: The Logistic Regression model predicted significant proportions of variation in adoption of CPOE (66%), EH&P (34%) and EDS (40%). CPOE adoption was more likely (p \u3c .05) for physicians who were male, had a high inpatient ratio, lower patient volume and community hospital setting. EH&P and EDS adoption was more likely for physicians with financial alignment and large, academic hospital setting. The Cox Regression model predicted significant proportions of variation in rate of adoption of CPOE (10%), EH&P (14%) and EDS (19%). The overall model for CPOE was significant (p=.006); no individual predictors were significant. Physicians who were financially aligned or worked at the large, academic hospital adopted EH&P and EDS faster. Conclusion: Personal factors: loyalty, age and gender were generally not predictive. Organizational factors: hospital setting and financial alignment were most predictive of adoption. Study results may help administrators improve EHR installations