A retrospective study was made of the management of abdominal aortic aneurysms in eight district general hospitals in Sweden in the period 1971-1980. The numbers of admitted cases rose steadily during these ten years, as did the numbers of operations. Most of the patients had ruptured aneurysm, though there was a manifold rise in the number of operations for asymptomatic aneurysm. The postoperative mortality increased with the level of emergency presented by the aneurysm symptoms, and was about 80% in patients with clinical shock. The results of operative treatment were essentially stable during the study period and they appeared to be similar to those obtained in patients referred to units specializing in vascular surgery. Patient age, preoperative recognition of the diagnosis, concomitance of complicating disease and magnitude of peroperative blood loss seemed to influence the results of surgery. Postoperative deaths tended to occur in the first few days and to be independent of the volume of transfused blood, although severe bleeding was a significant and often fatal postoperative complication.
Commencing on 1.1.1987, all requests for access to case records were registered prospectively in all of the Copenhagen County Hospitals. In the Copenhagen County Hospital, Nordvang, 103 requests were made for access to the case records in the course of 1987. Ninety-five requests in the adult departments resulted in complete access in 90 cases, limited access in one case while access was refused in three cases. One person making the request did not turn up. Eight requests concerning patients in the child psychiatric department resulted in complete access in one case, limited access in five cases while access was refused in two cases. This corresponds to 3.0% in the departments for child psychiatry and 2.7% in the departments for adults. No deterioration in health was observed in any of the 97 cases where access was permitted. In many cases, insight into the case records may, on the other hand, be a good therapeutic measure. On two cases only, access to the case records was given to a third person with the patient's permission, and the majority of the patients did not request a copy of the case records but accepted access to the case records in the form of the right to read the case records with assistance, if necessary. It is concluded that in the first year after introduction of the Danish legislation concerning access to the case records, this ran very smoothly with fewer difficulties than anticipated in a large psychiatric hospital in the region of the capital.
What determines access to the Voksentoppen Children's Asthma and Allergy Centre, the most specialized health care facility for asthmatic children in Norway? This publicly funded national institution is mandated to serve all segments of the population equally. The paper reports from the experiences of families with children having a confirmed diagnosis of moderate to severe asthma. The study population was selected from a national register of state cash-benefit recipients. Within this register, all families with a child under the age of 9 and with the diagnosis of asthma at the end of 1997 were selected (N = 2564). Further information about the population was gathered in a postal survey. It was found that access to the facility, measured as at least one admission during the period of the disease, was primarily determined by variations in morbidity. In particular, measures of health condition that presupposed a professional's evaluation of the child's health condition were significant. In addition, access was influenced by several factors not directly related to the need for treatment. Notably, children from families in which parents had a graduate education were over-represented among those with access to the top level of the institution's medical hierarchy. Multivariate analysis was used to search for causal mechanisms. It was found that families with a doctor in their social network had greater likelihood of access, and this in part accounted for the observed association between education and access. The pattern of access was also influenced by geographical factors, but not in a way that reduced the significance of educational background. Membership of, and participation in, patient organizations also increased the families' chances of receiving top-level professional treatment. The results depart from professional norms and officially stated health policy in Norway, which assert that health condition is the only valid criterion for allocating scarce medical goods.
To examine whether performance measures improve more in accredited hospitals than in non-accredited hospital.
A historical follow-up study was performed using process of care data from all public Danish hospitals in order to examine the development over time in performance measures according to participation in accreditation programs.
All patients admitted for acute stroke, heart failure or ulcer at Danish hospitals.
Hospital accreditation by either The Joint Commission International or The Health Quality Service.
The primary outcome was a change in opportunity-based composite score and the secondary outcome was a change in all-or-none scores, both measures were based on the individual processes of care. These processes included seven processes related to stroke, six processes to heart failure, four to bleeding ulcer and four to perforated ulcer.
A total of 27 273 patients were included. The overall opportunity-based composite score improved for both non-accredited and accredited hospitals (13.7% [95% CI 10.6; 16.8] and 9.9% [95% 5.4; 14.4], respectively), but the improvements were significantly higher for non-accredited hospitals (absolute difference: 3.8% [95% 0.8; 8.3]). No significant differences were found at disease level. The overall all-or-none score increased significantly for non-accredited hospitals, but not for accredited hospitals. The absolute difference between improvements in the all-or-none score at non-accredited and accredited hospitals was not significant (3.2% [95% -3.6:9.9]).
Participating in accreditation was not associated with larger improvement in performance measures for acute stroke, heart failure or ulcer.
Although most long-term care facilities cannot always evaluate and treat their residents during acute, intercurrent illnesses, it is possible to design systems that allow for effective care without transfer.
The Gorky N. A. Semashko Regional Clinical Hospital has the long-term experience in drawing additional means into patients' treatment at the expense of enterprises and collective farms on the strength of the agreement on cooperation. In order to expand cost accounting in public health it is necessary to determine cost indices in the work of curative and preventive facilities. Total cost of the provision of various types of medical services and that per patient have been calculated in the Gorky Regional Hospital. Besides current expenditure they involve the main funds, estimated by annual indices. Complete cost of 306 diagnostic and treatment procedures have been determined. Proceeding from the data obtained complete actual costs of diagnostic and treatment procedures per patient on 105 nosologic forms have been identified along with the expenditure on these nosologic forms that is necessary for modern diagnostic and treatment care.