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Readmissions to hospital are increasingly being used as an indicator of quality of care. However, this approach is valid only when we know what proportion of readmissions are avoidable. We conducted a systematic review of studies that measured the proportion of readmissions deemed avoidable. We examined how such readmissions were measured and estimated their prevalence. We searched the MEDLINE and EMBASE databases to identify all studies published from 1966 to July 2010 that reviewed hospital readmissions and that specified how many were classified as avoidable. Our search strategy identified 34 studies. Three of the studies used combinations of administrative diagnostic codes to determine whether readmissions were avoidable. Criteria used in the remaining studies were subjective. Most of the studies were conducted at single teaching hospitals, did not consider information from the community or treating physicians, and used only one reviewer to decide whether readmissions were avoidable. The median proportion of readmissions deemed avoidable was 27.1% but varied from 5% to 79%. Three study-level factors (teaching status of hospital, whether all diagnoses or only some were considered, and length of follow-up) were significantly associated with the proportion of admissions deemed to be avoidable and explained some, but not all, of the heterogeneity between the studies. All but three of the studies used subjective criteria to determine whether readmissions were avoidable. Study methods had notable deficits and varied extensively, as did the proportion of readmissions deemed avoidable. The true proportion of hospital readmissions that are potentially avoidable remains unclear.

Background The aim of this study was to identify the range of ways that safety net hospitals (SNHs) have been empirically operationalized in the literature and determine the extent to which patterns could be identified in the use of empirical definitions of SNHs. Methods We conducted a PRISMA guided systematic review of studies published between 2009 and 2018 and analyzed 22 articles that met the inclusion criteria of hospital-level analyses with a clear SNH definition. Results Eleven unique SNH definitions were identified, and there were no obvious patterns in the use of a definition category (Medicaid caseload, DSH payment status, uncompensated care, facility characteristics, patient care mix) by the journal type where the article appeared, dataset used, or the year of publication. Conclusions Overall, there is broad variability in the conceptualization of, and variables used to define, SNHs. Our work advances the field toward the development of standards in measuring, operationalizing, and conceptualizing SNHs across research and policy questions.

By early May 2020, the number of new COVID-19 infections started to increase rapidly in Chile, threatening the ability of health services to accommodate all incoming cases. Suddenly, ICU capacity planning became a first-order concern, and the health authorities were in urgent need of tools to estimate the demand for urgent care associated with the pandemic. In this article, we describe the approach we followed to provide such demand forecasts, and we show how the use of analytics can provide relevant support for decision making, even with incomplete data and without enough time to fully explore the numerical properties of all available forecasting methods. The solution combines autoregressive, machine learning and epidemiological models to provide a short-term forecast of ICU utilization at the regional level. These forecasts were made publicly available and were actively used to support capacity planning. Our predictions achieved average forecasting errors of 4% and 9% for one- and two-week horizons, respectively, outperforming several other competing forecasting models.

Central to Safety-II is promoting resilience of healthcare practices. In the \"Room for Resilience\" research project we focus on the role of horizontal and vertical accountability in healthcare teams and aim to discover how the relation between the two impacts team reflections and discussions. In this article, we report on an explorative study at the start of the project which aimed to assess the structures and dynamics of horizontal and vertical accountability. A qualitative study in six teams in three hospitals in the Netherlands. For the project, each team selected a specific clinical process to work on (e.g. pain assessment). We interviewed healthcare professionals, managers, and quality advisors about these processes, how they are discussed in practice and how teams need to account for them. Additionally, we observed the processes and how teams discuss them in practice. In total, we conducted 35 interviews and 67.5 h of observation. Transcripts and field notes were analyzed using thematic analysis. Professionals at times varied in what they considered the right approach in the clinical process, with differing views on the importance of certain actions. When processes were discussed, this mostly was done during clinical work, and it often concerned reflections about the care for a specific patient instead of reflecting on the team's general approach of the clinical process. Organized reflections on the processes were sparse. How processes were conducted in practice deviated from guidelines, mainly due to staff shortages, a perceived lack of value of a guideline, equipment issues, and collaboration issues. For most processes, accountability to hierarchical layers consisted of quality indicator scores. Professionals were tasked with registering indicator data but did not find this meaningful for their work. The observed different perspectives within teams on what good quality care is show the importance of having team reflections about these processes. How vertical accountability was organized at times impacted the conditions for teams to discuss resilient performance. Following these findings, we recommend that reflection on resilient practice and the role of accountability processes is organized on all levels in (and outside) the organization.

Background What is common to many healthcare systems is a discussion about the optimal balance between public and private provision. This paper provides a scoping review of research comparing the performance of public and private hospitals in Europe. The purpose is to summarize and compare research findings and to generate questions for further studies. Methods The review was based on a methodological approach inspired by the British EPPI-Centre’s methodology. This review was broader than review methodologies used by Cochrane and Campbell and included a wider range of methodological designs. The literature search was performed using PubMed, EconLit and Web of Science databases. The search was limited to papers published from 2006 to 2016. The initial searches resulted in 480 studies. The final sample was 24 papers. Of those, 17 discussed economic effects, and seven studies addressed quality. Results Our review of the 17 studies representing more than 5500 hospitals across Europe showed that public hospitals are most frequently reported as having the best economic performance compared to private not-for-profit (PNFP) and private for-profit (PFP) hospitals. PNFP hospitals are second, while PFP hospitals are least frequently reported as superior. However, a sizeable number of studies did not find significant differences. In terms of quality, the results are mixed, and it is not possible to draw clear conclusions about the superiority of an ownership type. A few studies analyzed patient selection. They indicated that public hospitals tend to treat patients who are slightly older and have lower socioeconomic status, riskier lifestyles and higher levels of co-morbidity and complications than patients treated in private hospitals. Conclusions The paper points to shortcomings in the available studies and argues that future studies are needed to investigate the relationship between contextual circumstances and performance. A big weakness in many studies addressing economic effects is the failure to control for quality and other operational dimensions, which may have influenced the results. This weakness should also be addressed in future comparative studies.

Hospital-based informal caregiving in Nigeria is shaped by care mobilities and contextual factors such as policy contradictions and normative care philosophies. This study explores how these factors influence caregiving practices in a Nigerian tertiary health facility. Using a qualitative approach, data were gathered through interviews and observations, involving 75 participants, including 36 in-depth interviews with caregivers and inpatients, and 39 key informant interviews with staff like nurses, doctors, security guards, and ad-hoc caregivers. Findings showed that many informal caregivers traveled long distances to assist hospitalized relatives, often “hanging around” the hospital and engaging in micro-mobilities, such as running errands. Geographical distance, policy contradictions, and the financial costs of hospitalization significantly affected caregiving dynamics. Care mobilities caregivers moving within the hospital environment emerged as a critical aspect of the caregiving process. Understanding these mobilities and how they intersect with contextual factors is essential to improving caregiving experiences. The study highlights the need for policies that support informal caregivers and enhance patient outcomes, especially in terms of reducing the burdens caregivers face due to long travel distances, hospital policies, and financial challenges.

Improving the efficiency of ophthalmology service is a global challenge to fight vision impairment, yet there is little concrete evidence of the current efficiency status. This study aimed to examine the efficiency of ophthalmology departments in the Hunan Province, China, and determine the associating factors of low-efficiency and high-efficiency ophthalmology departments. This cross-sectional study included a province-level survey of ophthalmology departments of public hospitals. All the ophthalmology departments of public hospitals in Hunan Province were invited to complete an online survey on ophthalmic competence resources. Bootstrap Data Envelopment Analysis was conducted to describe the service efficiency status of the ophthalmology departments using Maxdea (version 8.0) software. Then, we employed Fuzzy Set-Qualitative Comparative Analysis to explore the recipes of low-efficiency and high-efficiency ophthalmology departments using Fs-QCA (version 3.0) software. One hundred and ninety-five ophthalmology departments (87 in tertiary and 108 in secondary public hospitals) completed the survey. The mean efficiency score was 0.78 for ophthalmology departments in tertiary hospitals and 0.82 for secondary hospitals. The number of ophthalmologists and equipment positively contributed to the efficiency of ophthalmology departments in tertiary and secondary hospitals. While increasing the bed capacity was not always beneficial to improving the efficiency of ophthalmology departments in secondary hospitals. For ophthalmology departments in tertiary hospitals, simply increasing the number of nurses did not universally increase efficiency unless there were enough ophthalmologists and equipment to support the nurses' work. This study also revealed 2 configurations for ophthalmology departments in secondary hospitals and 5 configurations for those in tertiary hospitals that could guide their efficiency improvement efforts. Moderate efficiency levels in ophthalmology departments at both tertiary and secondary hospitals were found. Prioritizing the number of ophthalmologists and equipment was recommended to achieve high efficiency for ophthalmology departments in tertiary and secondary hospitals. We also proposed that blindly increasing the number of beds and nurses was meaningless, and ophthalmology departments should flex the bed capacity and number of nurses after premising having high numbers of ophthalmologists and equipment.

Hospital-at-Home (HaH) is a care model providing acute, hospital-level care to patients in their own homes. It is gaining traction worldwide and could become an integral part of standard healthcare in the future. However, for countries like Singapore, implementation inefficiencies prevent the optimal uptake and establishment of HaH. Currently, there are no standardised guidelines guiding healthcare providers on effective implementation. Thus, our objective is to distil information from existing guidelines worldwide to collate the best practices for HaH implementation. The systematic review is according to the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 checklist. A literature review across three databases and an Advanced Internet Search was performed to collect guidelines that included recommendations on HaH implementation requirements. Two authors independently extracted recommendations. Two reviewers independently assessed guideline quality using the Appraisal of Guidelines for Research and Evaluation II Instrument (AGREE II), which consisted of twenty-three items across six domains. Overall guideline quality was calculated as the total points from all six domains as a percentage over maximum points, and guidelines with overall scores of 50% or more were deemed high quality. Fourteen guidelines and seven sections were identified, which covered the following topics: inclusion & exclusion criteria, admission process, clinical handover, discharge, team structure, partnerships with external stakeholders, and medication administration. Key observations underline deficiencies in addressing staff safety, appropriate medical supply storage, and admission after hours. The main discrepant recommendations included self-discharge, team structure, partnerships with primary care providers, and medication self-administration. Methodological quality of guidelines varied, with overall AGREE II scores ranging from 38.5% to 58.4%. Individual domain scores were consistently low for Rigour of Development and Editorial Independence. Despite low scores in these domains, all fourteen guidelines were deemed appropriate for information extraction. Despite inconsistencies among guidelines, a set of streamlined recommendations were consolidated. In Singapore, addressing home environment constraints, fostering stronger partnerships with community providers, and leveraging on multidisciplinary care can enhance the feasibility and sustainability of these HaH recommendations. Policy redesign should focus on further stratifying patients based on home suitability, leveraging on technology to support clinical handovers or collaborations, and investing in multidisciplinary training to strengthen workforce capabilities. In all, healthcare providers around the world should consider contextualising these recommendations within local socioeconomic and healthcare contexts for optimal HaH implementation.

Background This study aimed to examine the interactive effect of applying JCI accreditation standards and administrative control in improving the quality of health services in Yemeni hospitals. By examining the synergistic relationship between these two components, this study sought to shed light on how hospitals can improve their performance and achieve sustainable advancements in healthcare quality. Methods This study utilized a quantitative research design and collected data from Yemeni hospitals. The sample size was determined via the Krejcie and Morgan table, which provides a recommended sample size on the basis of the population. A total of 310 healthcare professionals were selected through a random sampling technique. Hypotheses were formulated to examine the impact of JCI accreditation standards and administrative control on healthcare quality. Statistical analyses were also conducted to test these hypotheses and determine the interaction effect between the two variables. Results The results confirmed that applying JCI accreditation standards has a statistically significant positive effect on improving the quality of health services in hospitals. Additionally, the practice of administrative control had a statistically significant effect on healthcare quality. Furthermore, there was an interactive effect between the application of JCI accreditation standards and administrative control, indicating that their combined implementation led to even greater improvements in healthcare quality. Conclusion The significance of this study lies in its potential to inform healthcare policymakers, administrators, and practitioners about the importance of integrating accreditation standards with robust administrative control measures. The findings emphasize the need for hospitals to prioritize both the implementation of accreditation standards and the establishment of effective administrative control systems to ensure the delivery of high-quality healthcare services. This study contributes to the literature by highlighting the interactive impact of these factors and providing insights into their synergistic relationship.