Accessibility of pediatric inpatient services in Japan.
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ABSTRACT:
SUBMITTER: Ehara A
PROVIDER: S-EPMC6075767 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Background: Although many children with diseases of the kidneys and the urinary tract may not tolerate long journeys, the number of facilities that provide specialized care for these patients is limited. Therefore, the geographical accessibility of the required health services is critical especially in this patient group. We have analyzed the geographical accessibility of pediatric inpatient and nephro-urology services in Germany, Ireland, and the United Kingdom (UK). Methods: This study introduces a model to compare countries or regions regarding the geographical accessibility of their health services. We calculated the geodesic distances, travel distances, and travel time by car from evenly distributed random points to the nearest facilities that provide pediatric inpatient or nephro-urology outpatient services (pediatric inpatient ward, urology clinic, nephrology clinic, hemodialysis unit). The results were weighted by population density. We compared the three countries with regard to the accessibility of the named services. Results: Weighted median travel times from the random points to the nearest pediatric inpatient ward are < 30 min in all countries. Weighted travel times to the nearest point of pediatric service are shortest in the UK (median <50 min) and longest in Ireland (median <90 min), regardless of the type of service (p < 0.0001). Non-weighted travel times to the nearest pediatric inpatient ward and hemodialysis unit, however, are shorter in Germany than in the UK (p < 0.0001). Conclusions: There is a surprising disparity between the travel times to the nearest facility with pediatric nephro-urology service in these three industrialized European countries. Reasons may be differences in the geographical distribution of the population, the focus of the health care system, and a different degree of clinical networking.
| S-EPMC7396594 | biostudies-literature
Project description:ObjectivesWe sought to evaluate trends in pediatric inpatient unit capacity and access and to measure pediatric inpatient unit closures across the United States.MethodsWe performed a retrospective study of 4720 US hospitals using the 2008-2018 American Hospital Association survey. We used linear regression to describe trends in pediatric inpatient unit and PICU capacity. We compared trends in pediatric inpatient days and bed counts by state. We examined changes in access to care by calculating distance to the nearest pediatric inpatient services by census block group. We analyzed hospital characteristics associated with pediatric inpatient unit closure in a survival model.ResultsPediatric inpatient units decreased by 19.1% (34 units per year; 95% confidence interval [CI] 31 to 37), and pediatric inpatient unit beds decreased by 11.8% (407 beds per year; 95% CI 347 to 468). PICU beds increased by 16.0% (66.9 beds per year; 95% CI 53 to 81), primarily at children's hospitals. Rural areas experienced steeper proportional declines in pediatric inpatient unit beds (-26.1% vs -10.0%). Most states experienced decreases in both pediatric inpatient unit beds (median state -18.5%) and pediatric inpatient days (median state -10.0%). Nearly one-quarter of US children experienced an increase in distance to their nearest pediatric inpatient unit. Low-volume pediatric units and those without an associated PICU were at highest risk of closing.ConclusionsPediatric inpatient unit capacity is decreasing in the United States. Access to inpatient care is declining for many children, particularly those in rural areas. PICU beds are increasing, primarily at large children's hospitals. Policy and surge planning improvements may be needed to mitigate the effects of these changes.
| S-EPMC8642812 | biostudies-literature
Project description:PurposeTo determine whether higher rates of medical errors were associated with positive screenings for depression or burnout among resident physicians.MethodThe authors conducted a prospective cohort study from 2011 to 2013 in seven pediatric academic medical centers in the United States and Canada. Resident physicians were screened for burnout and depression using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS) and Harvard Department of Psychiatry/National Depression Screening Day Scale (HANDS). A two-step surveillance methodology, involving a research nurse and two physician reviewers, was used to measure and categorize errors. Bivariate and mixed-effects regression models were used to evaluate the relationship between burnout, depression, and rates of harmful, nonharmful, and total errors.ResultsA total of 388/537 (72%) resident physicians completed the MBI-HSS and HANDS surveys. Seventy-six (20%) and 178 (46%) resident physicians screened positive for depression and burnout, respectively. Screening positive for depression was associated with a 3.0-fold higher rate of harmful errors (incidence rate ratio = 2.99 [95% CI 1.40-6.36], P = .005). However, there was no statistically significant association between depression and total or nonharmful errors or between burnout and harmful, nonharmful, or total errors.ConclusionsResident physicians with a positive depression screen were three times more likely than those who screened negative to make harmful errors. This association suggests resident physician mental health could be an important component of patient safety. If further research confirms resident physician depression increases the risk of harmful errors, it will become imperative to determine what interventions might mitigate this risk.
| S-EPMC6667283 | biostudies-literature
Project description:Although it is currently popular to reflect consumers' perspectives to medical service management, insufficient attempts have been made to understand detailed perception of the consumer side of medical services to promote medical services' evaluation from the consumer viewpoint. The aim of this study was to descriptively reveal how consumers perceive medical services that they receive, focusing on inpatient medical services. We conducted semi-structured interviews with 10 adults who experienced hospitalization of five or more days. Constant comparative analysis was performed on the obtained descriptive data. We identified 1) medical procedures, 2) explanations from medical professionals, 3) behavior of medical service providers, 4) somatic sensations, and 5) self-perceived physical conditions as target factors that medical service consumers perceived during hospitalization. The response to the perceived target factors, "compared with the expectation that the consumer had before the hospitalization," suggests that it is an important medical service consumer reaction to check if the service met their expectations for perceived factors. The response to the medical services perception targets suggested that medical service consumers are involved in medical services and interested in various perception targets. The expectations that medical service consumers have prior to hospitalization can largely influence inpatient medical services evaluation.
| S-EPMC5104407 | biostudies-literature
Project description:OBJECTIVE:Weight bias can influence medical care but has not been studied in the pediatric inpatient setting. We will quantify implicit and explicit weight bias of pediatric inpatient providers and qualitatively explore providers' attitudes toward children with obesity and patient/family perceptions of weight bias in the hospital. METHODS:We performed a mixed-methods study including semistructured key informant interviews and validated tests for implicit (Implicit Association Test) and explicit (Crandall's Anti-Fat Attitudes Questionnaire) bias with pediatric hospitalists, residents, and acute care nurses. We performed semistructured key informant interviews with pediatric inpatients aged 7 to 17 years and the patient's parent(s) or guardian(s). Interviews were coded using an inductive approach to identify recurrent themes. RESULTS:We enrolled 28 pediatric providers, 12 patients, and 12 parents/guardians. In total, 71% of providers exhibited moderate or strong implicit weight bias, with generally lower scores for explicit bias. Qualitative analysis identified seven themes: the existence of weight bias, shared responsibility for a child's obesity, a potential for provider bias toward the parents of pediatric patients with obesity, possible effects of patient weight on inpatient care, importance of terminology in addressing obesity, and the possibility of addressing obesity inpatient but a preference for obesity to be addressed in the outpatient setting. CONCLUSIONS:Health care providers, patients, and families in the pediatric inpatient setting identified multiple ways that obesity could impact care, including provider weight bias.
| S-EPMC6703967 | biostudies-literature
Project description:Staphylococcus lugdunensis strain:Inpatient | isolate:Inpatient Genome sequencing
| PRJNA380629 | ENA
Project description:IntroductionAs the first step in the HIV care continuum, timely diagnosis is central to reducing transmission of the virus and ending the HIV epidemic. Studies have shown that distance from a testing site is essential for ease of access to services and educational material. This study shows how location-allocation analysis can be used to improve allocation of HIV testing services utilizing existing publicly available data from 2015 to 2019 on HIV prevalence, testing site location, and factors related to HIV in Philadelphia, Pennsylvania.MethodsThe ArcGIS Location-Allocation analytic tool was used to calculate locations for HIV testing sites using a method that minimizes the distance between demand-point locations and service facilities. ZIP code level demand was initially specified on the basis of the percentage of late HIV diagnoses and in a sensitivity analysis on the basis of a composite of multiple factors. Travel time and distance from demand to facilities determined the facility location allocation. This analysis was conducted from 2021 to 2022.ResultsCompared with the 37 facilities located in 20 (43%) Philadelphia ZIP codes, the model proposed reallocating testing facilities to 37 (79%) ZIP codes using percent late diagnoses to define demand. On average, this would reduce distance to the facilities by 65% and travel time to the facilities by 56%. Results using the sensitivity analysis were similar.ConclusionsA wider distribution of HIV testing services across the city of Philadelphia may reduce distance and travel time to facilities, improve accessibility of testing, and in turn increase the percentage of people with knowledge of their status.
| S-EPMC10152388 | biostudies-literature
Project description:OBJECTIVE:To contextualize inpatient sleep duration and disruptions in a general pediatric hospital ward by comparing in-hospital and at-home sleep durations to recommended guidelines and to objectively measure nighttime room entries. METHODS:Caregivers of patients four weeks - 18 years of age reported patient sleep duration and disruptions in anonymous surveys. Average at-home and in-hospital sleep durations were compared to National Sleep Foundation recommendations. Objective nighttime traffic was evaluated as the average number of room entries between 11:00pm and 7:00am using GOJO brand hand-hygiene room entry data. RESULTS:Among 246 patients, patients slept less in the hospital than at home with newborn and infant cohorts experiencing 7- and 4-h sleep deficits respectively (Newborn: 787 ± 318 min at home vs. 354 ± 211 min in hospital, p < 0.001; Infants: 703 ± 203 min at home vs. 412 ± 152 min in hospital, p < 0.01). Newborn children also experienced >2 h sleep deficits at home when compared to NSF recommendations (Newborns: 787 ± 318 min at home vs. 930 min recommended, p < 0.05). Objective nighttime traffic measures revealed that hospitalized children experienced 7.3 room entries/night (7.3 ± 0.25 entries). Nighttime traffic was significantly correlated with caregiver-reported nighttime awakenings (Spearman Rank Correlation Coefficient: 0.83, p < 0.001). CONCLUSION:Hospitalization is a missed opportunity to improve sleep both in the hospital and at home.
| S-EPMC6760863 | biostudies-literature
Project description:At independence in 2011, South Sudan's health sector was almost non-existent. The first national health strategic plan aimed to achieve an integrated health facility network that would mean that 70% of the population were within 5 km of a health service provider. Publically available data on functioning and closed health facilities, population distribution, road networks, land use and elevation were used to compute the fraction of the population within 1 hour walking distance of the nearest public health facility offering curative services. This metric was summarised for each of the 78 counties in South Sudan and compared with simpler metrics of the proportion of the population within 5 km of a health facility. In 2016, it is estimated that there were 1747 public health facilities, out of which 294 were non-functional in part due to the on-going civil conflict. Access to a service provider was poor with only 25.7% of the population living within one-hour walking time to a facility and 28.6% of the population within 5 km. These metrics, when applied sub-nationally, identified the same high priority, most vulnerable counties. Simple metrics based upon population distribution and location of facilities might be as valuable as more complex models of health access, where attribute data on travel routes are imperfect or incomplete and sparse. Disparities exist in South Sudan among counties and those with the poorest health access should be targeted for priority expansion of clinical services.
| S-EPMC5483170 | biostudies-literature
Project description:BackgroundNeonatal mortality rate in Kenya continues to be unacceptably high. In reducing newborn deaths, inequality in access to care and quality care have been identified as current barriers. Contributing to these barriers are the bypassing behaviour and geographical access which leads to delay in seeking newborn care. This study (i) measured geographical accessibility of inpatient newborn care, and (ii), characterized bypassing behaviour using the geographical accessibility of the inpatient newborn care seekers.MethodsGeographical accessibility to the inpatient newborn units was modelled based on travel time to the units across Bungoma County. Data was then collected from 8 inpatient newborn units and 395 mothers whose newborns were admitted in the units were interviewed. Their spatial residence locations were geo-referenced and were used against the modelled travel time to define bypassing behaviour.ResultsApproximately 90% of the sick newborn population have access to nearest newborn units (< 2 h). However, 36% of the mothers bypassed their nearest inpatient newborn facility, with lack of diagnostic services (28%) and distrust of health personnel (37%) being the major determinants for bypassing. Approximately 75% of the care seekers preferred to use the higher tier facilities for both maternal and neonatal care in comparison to sub-county facilities which mostly were bypassed and remained underutilised.ConclusionOur findings suggest that though majority of the population have access to care, sub-county inpatient newborn facilities have high risk of being bypassed. There is need to improve quality of care in maternal care, to reduce bypassing behaviour and improving neonatal outcome.
| S-EPMC7216545 | biostudies-literature