Financial and market characteristics appear to be associated with closure of rural hospitals from 2010 through 2014, suggesting that it is possible to identify hospitals at risk of closure. As closure rates show no sign of abating, it is important to study the drivers of distress in rural hospitals, as well as the potential for alternative health care delivery models.
CANADA DOES NOT HAVE INTEGRATED HEALTHCARE. Canada has a series of disconnected parts, a hodge-podge patchwork, healthcare industry comprising hospitals, doctors' offices, group practices, community agencies, private sector organizations, public health departments and so on. Each Canadian province is experimenting with different types of organizational structures and processes with the intent of improving the coordination of services, facilitating better collaboration among providers and providing better healthcare to the population. However, regional health authorities and their variants in Canada do not possess most of the basic characteristics of integrated healthcare such as physician integration and a rostered population (Hospital Management Research Unit 1996,1997). In contrast, most developed countries are currently emphasizing integration of the components of healthcare as a 13
The results of this study suggest that a higher proportion of professional nurses in the staff mix (RNs/RPNs) on medical and surgical units in Ontario teaching hospitals are associated with lower rates of medication errors and wound infections. Higher patient complexity was associated with greater patient use of nursing care resources.
This study aims to establish a sociodemographic and personality profile of Canadians who donate internationally, fills the gap in the literature with regard to individual-level determinants of international giving, and compares these determinants with those of domestic donors. Women, volunteers, and individuals of non-Canadian origin, with higher income, higher education, higher level of religiosity, higher political awareness and participation, and higher frequency of extended family participation were more likely to contribute internationally. Higher education and a higher level of religiosity seem to influence international giving more than they did domestic giving. In terms of the variations in amount of international donations the important determinants are income, education, level of religiosity, and feeling of financial security. These results suggest that international charities should probably target their efforts at more-educated, higher-income and more-religious individuals. The other target donors are volunteers, women, individuals of non-Canadian origin, and politically aware and socially involved individuals.
Continuity of care is a concern for individuals with persistent mental illness who need diverse services over time in response to multiple and changing needs. Efforts to study continuity have been hampered by lack of appropriate instruments. The Alberta Continuity of Services Scale--Mental Health is a newly developed, self-report scale that assesses continuity of care across settings and providers. This study examined the structure, reliability, and validity of the measure among users of community mental health programs. Findings were positive. Scores captured both positive and negative perceptions of care. Factor analyses elucidated 3 components of continuity--system access, interpersonal aspects, and care team function. Associations between the continuity scores and selected client and service use measures supported its validity. The tool holds promise for system monitoring, but would need refinements to create a shorter, conceptually clearer version. Also, performance among individuals with mild and very severe levels of mental illness needs to be evaluated.
Objective. To determine whether, following implementation of California's minimum nurse staffing legislation, changes in acuity-adjusted nurse staffing and quality of care in California hospitals outpaced similar changes in hospitals in comparison states without such regulations. Data Sources/Study Setting. Study Design. We grouped hospitals into quartiles based on their preregulation staffing levels and used a difference-in-difference approach to compare changes in staffing and in quality of care in California hospitals to changes over the same time period in hospitals in 12 comparison states without minimum staffing legislation. Data Collection/Extraction Methods. We merged data from the above data sources to obtain measures of nurse staffing and quality of care. We used Agency for Healthcare Research and Quality's Patient Safety Indicators to measure quality. Principal Findings. With few exceptions, California hospitals increased nurse staffing levels over time significantly more than did comparison state hospitals. Failure to rescue decreased significantly more in some California hospitals, and infections due to medical care increased significantly more in some California hospitals than in comparison state hospitals. There were no statistically significant changes in either respiratory failure or postoperative sepsis. Conclusions. Following implementation of California's minimum nurse staffing legislation, nurse staffing in California increased significantly more than it did in comparison states' hospitals, but the extent of the increases depended upon preregulation staffing levels; there were mixed effects on quality.
This methodology offers improved specificity and predictive power relative to existing measures of financial distress applied to rural hospitals. This risk assessment tool may inform programs at the federal, state, and local levels that provide funding or support to rural hospitals.
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