Challenging the holy grail of hospital accreditation: A cross sectional study of inpatient satisfaction in the field of cardiology

Extent: 7p.Background: Subjective parameters such as quality of life or patient satisfaction gain importance as outcome parameters and benchmarks in health care. In many countries hospitals are now undergoing accreditation as mandatory or voluntary measures. It is believed but unproven that accreditations positively influence quality of care and patient satisfaction. The present study aims to assess in a defined specialty (cardiology) the relationship between patient satisfaction (as measured by the recommendation rate) and accreditation status. Methods: Consecutive patients discharged from 25 cardiology units received a validated patient satisfaction questionnaire. Data from 3,037 patients (response rate > 55%) became available for analysis. Recommendation rate was used as primary endpoint. Different control variables such as staffing level were considered. Results: The 15 accredited units did not differ significantly from the 10 non-accredited units regarding main hospital (i.e. staffing levels, no. of beds) and patient (age, gender) characteristics. The primary endpoint "recommendation rate of a given hospital" for accredited hospitals (65.6%, 95% Confidence Interval (CI) 63.4 - 67.8%) and hospitals without accreditation (65.8%, 95% CI 63.1 - 68.5%) was not significantly different. Conclusion: Our results support the notion that - at least in the field of cardiology - successful accreditation is not linked with measurable better quality of care as perceived by the patient and reflected by the recommendation rate of a given institution. Hospital accreditation may represent a step towards quality management, but does not seem to improve overall patient satisfaction.Cornelia Sack, Peter Lütkes, Wolfram Günther, Raimund Erbel, Karl-Heinz Jöckel and Gerald J Holtman

Older Persons' Evaluations of Health Care: The Effects of Medical Skepticism and Worry about Health

OBJECTIVE: To describe how skepticism about medical care and other individual differences, including worry about health status, are associated with evaluations of health care among the noninstitutionalized elderly. DATA SOURCES/STUDY SETTING: Data were collected through a survey of approximately 5,000 community-dwelling elders (aged 65 and older) in a southwestern region of the United States. STUDY DESIGN: Global evaluations of health care were measured with two items from the Consumer Assessment of Health Plans Study (CAHPS) instrument, an overall care rating (OCR) and a personal doctor rating (PDR). Multivariate ordered logit regression models were tested to examine how medical skepticism and other factors were associated with ratings of 0–7, 8–9, and 10. PRINCIPAL FINDINGS: Consumers who were skeptical of prescription drugs relative to home remedies, who held attitudes that they understand their health better than most doctors, and who worried about their health had worse OCR and PDR. Those who held attitudes that individual behavior determines how soon one gets better when sick had better PDR and OCR. CONCLUSIONS: Health policymakers, managers, and providers may need to consider the degree to which they should attempt to satisfy skeptical consumers, many of whom may never rate their care highly. Alternatively, they may need to target skeptical consumers with educational efforts explaining the benefits of medical care

Urban stormwater quality and treatment

Stormwater runoff from urban and suburban areas generates numerous pollutants. The areas include residential areas, parks, commercial areas, industrial areas and road/highways. Land use and human activities largely determine the nature and level of pollutants. Among the various types of pollutants that can contribute to adverse water quality impact in receiving water bodies, of concern are suspended solids, heavy metals, polycyclic aromatic hydrocarbons and nutrients. This paper provides a critical review of the characteristics and sources of urban stormwater pollutants and the manner in which the pollution occurs. Treatment systems for urban stormwater runoff and for urban stormwater harvesting are discussed. © 2010 Korean Institute of Chemical Engineers, Seoul, Korea