Base de dados : MEDLINE
Pesquisa : N02.278.215 [Categoria DeCS]
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[PMID]:28400385
[Au] Autor:Sengupta A; Mukhopadhyay I; Weerasinghe MC; Karki A
[Ad] Endereço:People's Health Movement.
[Ti] Título:The rise of private medicine in South Asia.
[So] Source:BMJ;357:j1482, 2017 04 11.
[Is] ISSN:1756-1833
[Cp] País de publicação:England
[La] Idioma:eng
[Mh] Termos MeSH primário: Serviços de Saúde
Setor Privado
[Mh] Termos MeSH secundário: Ásia
Instituições Privadas de Saúde/economia
Instituições Privadas de Saúde/estatística & dados numéricos
Serviços de Saúde/economia
Hospitais Privados/economia
Hospitais Privados/estatística & dados numéricos
Seres Humanos
Programas Nacionais de Saúde/economia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:171108
[Lr] Data última revisão:
171108
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170413
[St] Status:MEDLINE
[do] DOI:10.1136/bmj.j1482


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[PMID]:28013447
[Au] Autor:Mehra T; Moos RM; Seifert B; Bopp M; Senn O; Simmen HP; Neuhaus V; Ciritsis B
[Ad] Endereço:Medical Directorate, University Hospital Zurich, Rämistr. 100, 8091, Zurich, Switzerland. tarun.mehra@usz.ch.
[Ti] Título:Impact of structural and economic factors on hospitalization costs, inpatient mortality, and treatment type of traumatic hip fractures in Switzerland.
[So] Source:Arch Osteoporos;12(1):7, 2017 Dec.
[Is] ISSN:1862-3514
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:The assessment of structural and potentially economic factors determining cost, treatment type, and inpatient mortality of traumatic hip fractures are important health policy issues. We showed that insurance status and treatment in university hospitals were significantly associated with treatment type (i.e., primary hip replacement), cost, and lower inpatient mortality respectively. INTRODUCTION: The purpose of this study was to determine the influence of the structural level of hospital care and patient insurance type on treatment, hospitalization cost, and inpatient mortality in cases with traumatic hip fractures in Switzerland. METHODS: The Swiss national medical statistic 2011-2012 was screened for adults with hip fracture as primary diagnosis. Gender, age, insurance type, year of discharge, hospital infrastructure level, length-of-stay, case weight, reason for discharge, and all coded diagnoses and procedures were extracted. Descriptive statistics and multivariate logistic regression with treatment by primary hip replacement as well as inpatient mortality as dependent variables were performed. RESULTS: We obtained 24,678 inpatient case records from the medical statistic. Hospitalization costs were calculated from a second dataset, the Swiss national cost statistic (7528 cases with hip fractures, discharged in 2012). Average inpatient costs per case were the highest for discharges from university hospitals (US$21,471, SD US$17,015) and the lowest in basic coverage hospitals (US$18,291, SD US$12,635). Controlling for other variables, higher costs for hip fracture treatment at university hospitals were significant in multivariate regression (p < 0.001). University hospitals had a lower inpatient mortality rate than full and basic care providers (2.8% vs. both 4.0%); results confirmed in our multivariate logistic regression analysis (odds ratio (OR) 1.434, 95% CI 1.127-1.824 and OR 1.459, 95% confidence interval (CI) 1.139-1.870 for full and basic coverage hospitals vs. university hospitals respectively). The proportion of privately insured varied between 16.0% in university hospitals and 38.9% in specialized hospitals. Private insurance had an OR of 1.419 (95% CI 1.306-1.542) in predicting treatment of a hip fracture with primary hip replacement. CONCLUSION: The seeming importance of insurance type on hip fracture treatment and the large inequity in the distribution of privately insured between provider types would be worth a closer look by the regulatory authorities. Better outcomes, i.e., lower mortality rates for hip fracture treatment in hospitals with a higher structural care level advocate centralization of care.
[Mh] Termos MeSH primário: Fraturas do Quadril
Hospitalização
[Mh] Termos MeSH secundário: Adulto
Idoso
Feminino
Custos de Cuidados de Saúde
Instituições Privadas de Saúde
Fraturas do Quadril/economia
Fraturas do Quadril/mortalidade
Fraturas do Quadril/terapia
Hospitalização/economia
Hospitalização/estatística & dados numéricos
Seres Humanos
Pacientes Internados/estatística & dados numéricos
Modelos Logísticos
Masculino
Meia-Idade
Melhoria de Qualidade
Suíça/epidemiologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171003
[Lr] Data última revisão:
171003
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161226
[St] Status:MEDLINE
[do] DOI:10.1007/s11657-016-0302-3


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[PMID]:27434542
[Au] Autor:Ozawa S; Singh S; Singh K; Chhabra V; Bennett S
[Ad] Endereço:Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America.
[Ti] Título:The Avahan Transition: Effects of Transition Readiness on Program Institutionalization and Sustained Outcomes.
[So] Source:PLoS One;11(7):e0158659, 2016.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: With declines in development assistance for health and growing interest in country ownership, donors are increasingly faced with the task of transitioning health programs to local actors towards a path to sustainability. Yet there is little available guidance on how to measure and evaluate the success of a transition and its subsequent effects. This study assesses the transition of the Avahan HIV/AIDS prevention program in India to investigate how preparations for transition affected continuation of program activities post-transition. METHODS: Two rounds of two surveys were conducted and supplemented by data from government and Avahan Computerized Management Information Systems (CMIS). Exploratory factor analysis was used to develop two measures: 1) transition readiness pre-transition, and 2) institutionalization (i.e. integration of initial program systems into organizational procedures and behaviors) post-transition. A fixed effects model was built to examine changes in key program delivery outcomes over time. An ordinary least square regression was used to assess the relationship between transition readiness and sustainability of service outcomes both directly, and indirectly through institutionalization. RESULTS: Transition readiness data revealed 3 factors (capacity, alignment and communication), on a 15-item scale with adequate internal consistency (alpha 0.73). Institutionalization was modeled as a unidimensional construct, and a 12-item scale demonstrated moderate internal consistency (alpha 0.60). Coverage of key populations and condom distribution were sustained compared to pre-transition levels (p<0.01). Transition readiness, but not institutionalization, predicted sustained outcomes post-transition. Transition readiness did not necessarily lead to institutionalization of key program elements one year after transition. CONCLUSION: Greater preparedness prior to transition is important to achieve better service delivery outcomes post-transition. This paper illustrates a methodology to measure transition readiness pre-transition to identify less ready organizations or program components in advance, improving the likelihood of service sustainability. Further research is needed around the conceptualization and development of measures of institutionalization and its effects on long-term program sustainability.
[Mh] Termos MeSH primário: Infecções por HIV/prevenção & controle
Institucionalização/organização & administração
Programas de Assistência Gerenciada/organização & administração
Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Feminino
Instituições Privadas de Saúde/economia
Seres Humanos
Índia
Masculino
Meia-Idade
Propriedade
Avaliação de Programas e Projetos de Saúde/economia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1707
[Cu] Atualização por classe:170718
[Lr] Data última revisão:
170718
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160720
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0158659


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[PMID]:27223577
[Au] Autor:Hsu AT; Berta W; Coyte PC; Laporte A
[Ad] Endereço:Institute of Health Policy,Management and Evaluation (IHPME),University of Toronto.
[Ti] Título:Staffing in Ontario's Long-Term Care Homes: Differences by Profit Status and Chain Ownership.
[So] Source:Can J Aging;35(2):175-89, 2016 06.
[Is] ISSN:1710-1107
[Cp] País de publicação:Canada
[La] Idioma:eng
[Ab] Resumo:Ontario has the highest proportion of for-profit nursing homes in Canada. These facilities, which are known in Ontario as long-term care (LTC) homes, offer 24-hour custodial as well as nursing care to individuals who cannot live independently. Increasingly, they are also operating as members of multi-facility chains. Using longitudinal data (1996-2011) from the Residential Care Facilities Survey (n = 627), our analysis revealed discernible differences in staffing levels by profit status and chain affiliation. We found for-profit LTC homes - especially those owned by a chain organization - provided significantly fewer hours of care, after adjusting for variation in the residents' care needs. Findings from this study offer new information on the impact of organizational structure on staffing levels in Ontario's LTC homes and have implications for other jurisdictions where a growing presence of private, chain-affiliated operators has been observed.
[Mh] Termos MeSH primário: Instituições Privadas de Saúde/estatística & dados numéricos
Assistência de Longa Duração/recursos humanos
Assistência de Longa Duração/estatística & dados numéricos
Casas de Saúde/recursos humanos
Casas de Saúde/estatística & dados numéricos
Admissão e Escalonamento de Pessoal/estatística & dados numéricos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Seres Humanos
Estudos Longitudinais
Ontário
Propriedade
Qualidade da Assistência à Saúde
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1703
[Cu] Atualização por classe:170314
[Lr] Data última revisão:
170314
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160526
[St] Status:MEDLINE
[do] DOI:10.1017/S0714980816000192


  5 / 1191 MEDLINE  
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[PMID]:27207164
[Au] Autor:Govil D; Purohit N; Gupta SD; Mohanty SK
[Ad] Endereço:Department of Population Policies and Programs, International Institute for Population Sciences, Govandi Station Road, Deonar, Mumbai, 400088, Maharashtra, India. diptigovil@gmail.com.
[Ti] Título:Out-of-pocket expenditure on prenatal and natal care post Janani Suraksha Yojana: a case from Rajasthan, India.
[So] Source:J Health Popul Nutr;35:15, 2016 May 20.
[Is] ISSN:2072-1315
[Cp] País de publicação:Bangladesh
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Though Janani Suraksha Yojana (JSY) under National Rural Health Mission (NRHM) is successful in increasing antenatal and natal care services, little is known on the cost coverage of out-of-pocket expenditure (OOPE) on maternal care services post-NRHM period. METHODS: Using data from a community-based study of 424 recently delivered women in Rajasthan, this paper examined the variation in OOPE in accessing maternal health services and the extent to which JSY incentives covered the burden of cost incurred. Descriptive statistics and logistic regression analyses are used to understand the differential and determinants of OOPE. RESULTS: The mean OOPE for antenatal care was US$26 at public health centres and US$64 at private health centres. The OOPE (antenatal and natal) per delivery was US$32 if delivery was conducted at home, US$78 at public facility and US$154 at private facility. The OOPE varied by the type of delivery, delivery with complications and place of ANC. The OOPE in public health centre was US$44 and US$145 for normal and complicated delivery, respectively. The share of JSY was 44 % of the total cost per delivery, 77 % in case of normal delivery and 23 % for complicated delivery. Results from the log linear model suggest that economic status, educational level and pregnancy complications are significant predictors of OOPE. CONCLUSIONS: Our results suggest that JSY has increased the coverage of institutional delivery and reduced financial stress to household and families but not sufficient for complicated delivery. Provisioning of providing sonography/other test and treating complicated cases in public health centres need to be strengthened.
[Mh] Termos MeSH primário: Parto Obstétrico/efeitos adversos
Gastos em Saúde
Complicações do Trabalho de Parto/prevenção & controle
Assistência Perinatal
Cuidado Pré-Natal
Saúde da População Rural
Medicina Estatal
[Mh] Termos MeSH secundário: Adulto
Estudos Transversais
Parto Obstétrico/economia
Escolaridade
Feminino
Pesquisas sobre Serviços de Saúde
Instituições Privadas de Saúde
Disparidades em Assistência à Saúde
Parto Domiciliar/efeitos adversos
Parto Domiciliar/economia
Hospitais Públicos
Seres Humanos
Índia
Complicações do Trabalho de Parto/economia
Complicações do Trabalho de Parto/terapia
Aceitação pelo Paciente de Cuidados de Saúde
Assistência Perinatal/economia
Gravidez
Cuidado Pré-Natal/economia
Saúde da População Rural/economia
Classe Social
Adulto Jovem
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1701
[Cu] Atualização por classe:170220
[Lr] Data última revisão:
170220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160522
[St] Status:MEDLINE
[do] DOI:10.1186/s41043-016-0051-3


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[PMID]:27166496
[Ti] Título:[Study: poorer nursing care in cheap and profit-oriented homes. When quality is a matter of price].
[Ti] Título:Studie: Schlechtere Pflege in billigen und profitorientierten Heimen. Wann Qualität eine Frage des Preises ist..
[So] Source:Pflege Z;69(1):5, 2016 Jan.
[Is] ISSN:0945-1129
[Cp] País de publicação:Germany
[La] Idioma:ger
[Mh] Termos MeSH primário: Tabela de Remuneração de Serviços/economia
Tabela de Remuneração de Serviços/legislação & jurisprudência
Instituições Privadas de Saúde/economia
Instituição de Longa Permanência para Idosos/economia
Instituição de Longa Permanência para Idosos/legislação & jurisprudência
Casas de Saúde/economia
Casas de Saúde/legislação & jurisprudência
Qualidade da Assistência à Saúde/economia
[Mh] Termos MeSH secundário: Alemanha
Instituições Privadas de Saúde/legislação & jurisprudência
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1607
[Cu] Atualização por classe:160511
[Lr] Data última revisão:
160511
[Sb] Subgrupo de revista:N
[Da] Data de entrada para processamento:160512
[St] Status:MEDLINE


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[PMID]:27111924
[Au] Autor:Kash BA
[Ti] Título:EDITORIAL.
[So] Source:J Healthc Manag;61(2):79-80, 2016 Mar-Apr.
[Is] ISSN:1096-9012
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Instituições Privadas de Saúde
Recursos Humanos em Saúde
Hospitais Filantrópicos
[Pt] Tipo de publicação:EDITORIAL; INTRODUCTORY JOURNAL ARTICLE
[Em] Mês de entrada:1606
[Cu] Atualização por classe:160426
[Lr] Data última revisão:
160426
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:160427
[St] Status:MEDLINE


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[PMID]:27079019
[Au] Autor:Evans M
[Ti] Título:Rough financial market slows CHS' plans to spin off Quorum.
[So] Source:Mod Healthc;46(9):10, 2016 Feb 29.
[Is] ISSN:0160-7480
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Instituições Privadas de Saúde/economia
Sistemas Multi-Institucionais/economia
[Mh] Termos MeSH secundário: Instituições Privadas de Saúde/organização & administração
Seres Humanos
Sistemas Multi-Institucionais/organização & administração
Estados Unidos
[Pt] Tipo de publicação:NEWS
[Em] Mês de entrada:1606
[Cu] Atualização por classe:160415
[Lr] Data última revisão:
160415
[Sb] Subgrupo de revista:H
[Da] Data de entrada para processamento:160416
[St] Status:MEDLINE


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[PMID]:27010965
[Au] Autor:Devaiah A; Murchison C
[Ad] Endereço:Department of Otolaryngology-Head and Neck Surgery, Neurologic Surgery, and Ophthalmology, Boston Medical Center, Boston, Massachusetts, U.S.A.
[Ti] Título:Characteristics of NIH- and industry-sponsored head and neck cancer clinical trials.
[So] Source:Laryngoscope;126(9):E300-3, 2016 09.
[Is] ISSN:1531-4995
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVES/HYPOTHESIS: Compare U.S. clinical trials sponsored by the National Institutes of Health (NIH) and industry, especially with regard to trial design, interventions studied, and results reporting rates. STUDY DESIGN: U.S. head and neck cancer clinical trials. METHODS: We used information from ClinicalTrials.gov to compare NIH- and industry-sponsored head and neck cancer clinical trials, specifically analyzing differences in trial design and interventions studied. We examined publication rates and positive results rates using PubMed.gov. RESULTS: About 50% of NIH- and industry-sponsored clinical trials have their results reported in peer-reviewed literature. Industry-sponsored trials had higher rates of positive results than NIH-sponsored trials. NIH- and industry-sponsored clinical trials had similar trial designs, although industry-sponsored trials had significantly lower rates of randomization. Industry trials utilized radiation in 19% of trials and surgery in 2% of trials. NIH trials also had low utilization of both radiation and surgery (27% and 12% of trials, respectively). NIH- and industry-sponsored trials published their results in journals with comparable impact factors. CONCLUSION: There is significant underreporting of results in U.S. head and neck cancer clinical trials, whether sponsored by NIH or industry. Industry trials have significantly higher rates of positive results, although it is unclear what contributes to this. Both NIH- and industry-sponsored trials underutilize surgery and radiation as treatment modalities, despite the fact that these are standard-of-care therapies for head and neck cancer. We recommend that the NIH and industry report all results from clinical trials and use surgery and radiation as treatment arms in order to arrive at more balanced therapeutic recommendations. LEVEL OF EVIDENCE: N/A. Laryngoscope, 126:E300-E303, 2016.
[Mh] Termos MeSH primário: Ensaios Clínicos como Assunto
Neoplasias de Cabeça e Pescoço/terapia
Setor de Assistência à Saúde
National Institutes of Health (U.S.)
Apoio à Pesquisa como Assunto
[Mh] Termos MeSH secundário: Programas Governamentais
Instituições Privadas de Saúde
Seres Humanos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:171124
[Lr] Data última revisão:
171124
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160325
[St] Status:MEDLINE
[do] DOI:10.1002/lary.25942


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[PMID]:26920700
[Au] Autor:Clark EG; Akbari A; Hiebert B; Hiremath S; Komenda P; Lok CE; Moist LM; Schachter ME; Tangri N; Sood MM
[Ad] Endereço:Division of Nephrology, Department of Medicine, The Ottawa Hospital and Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, ON, Canada. edclark@toh.on.ca.
[Ti] Título:Geographic and facility variation in initial use of non-tunneled catheters for incident maintenance hemodialysis patients.
[So] Source:BMC Nephrol;17:20, 2016 Feb 27.
[Is] ISSN:1471-2369
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Non-tunneled (temporary) hemodialysis catheters (NTHCs) are the least-optimal initial vascular access for incident maintenance hemodialysis patients yet little is known about factors associated with NTHC use in this context. We sought to determine factors associated with NTHC use and examine regional and facility-level variation in NTHC use for incident maintenance hemodialysis patients. METHODS: We analyzed registry data collected between January 2001 and December 2010 from 61 dialysis facilities within 12 geographic regions in Canada. Multi-level models and intra-class correlation coefficients were used to evaluate variation in NTHC use as initial hemodialysis access across facilities and geographic regions. Facility and patient characteristics associated with the lowest and highest quartiles of NTHC use were compared. RESULTS: During the study period, 21,052 patients initiated maintenance hemodialysis using a central venous catheter (CVC). This included 10,183 patients (48.3 %) in whom the initial CVC was a NTHC, as opposed to a tunneled CVC. Crude variation in NTHC use across facilities ranged from 3.7 to 99.4 % and across geographic regions from 32.4 to 85.1 %. In an adjusted multi-level logistic regression model, the proportion of total variation in NTHC use explained by facility-level and regional variation was 40.0 % and 34.1 %, respectively. Similar results were observed for the subgroup of patients who received greater than 12 months of pre-dialysis nephrology care. Patient-level factors associated with increased NTHC use were male gender, history of angina, pulmonary edema, COPD, hypertension, increasing distance from dialysis facility, higher serum phosphate, lower serum albumin and later calendar year. CONCLUSIONS: There is wide variation in NTHC use as initial vascular access for incident maintenance hemodialysis patients across facilities and geographic regions in Canada. Identifying modifiable factors that explain this variation could facilitate a reduction of NTHC use in favor of more optimal initial vascular access.
[Mh] Termos MeSH primário: Instituições de Assistência Ambulatorial/provisão & distribuição
Cateterismo Venoso Central/métodos
Cateterismo Venoso Central/utilização
Cateteres de Demora
Diálise Renal/estatística & dados numéricos
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Canadá
Feminino
Geografia
Instituições Privadas de Saúde
Seres Humanos
Masculino
Meia-Idade
Diálise Renal/métodos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1610
[Cu] Atualização por classe:170220
[Lr] Data última revisão:
170220
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:160228
[St] Status:MEDLINE
[do] DOI:10.1186/s12882-016-0236-4



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