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Related Concept Videos

Hospitals-I01:28

Hospitals-I

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Hospitals offer medical and surgical care to the sick and injured, along with accommodation while they recover. At the same time, they also provide outpatient, emergency, psychiatric, and rehabilitation services to meet various community needs. In addition to providing medical care, hospitals also act as hubs for medical research and training. Hospitals use clinical procedures and evidence-based practice standards to deliver patient care. To deliver safe and efficient care, a nurse must stay up...
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Hospitals-II00:59

Hospitals-II

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Hospitals provide inpatient and outpatient services. Inpatient services provide care to patients that stay in the hospital for an extended period, ranging from days to months. Examples of inpatient services include intensive care units, hospital wards, or surgeries. Outpatient services provide care to patients who come to a hospital for a diagnostic or treatment but do not stay overnight —for example, diagnostic tests, surgical procedures, or health education.
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Health Information Technology and Healthcare Information System01:30

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Health Information Technology (HIT)
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include:
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Tertiary Healthcare System01:21

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Specialized care provided over an extended period is called tertiary care. Usually, a primary or secondary care physician will refer a patient to tertiary care. A patient's maximum physical and mental function is restored in tertiary care, which is caused due to the impact of a chronic illness or condition. Tertiary care aims to achieve the highest level of functioning possible while managing chronic illness. For example, a patient who falls and fractures their hip will need secondary care...
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Secondary Healthcare System01:11

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Secondary healthcare is offered by a specialist, generally in hospitals or clinics for patients referred by primary healthcare providers. It occurs when a person has an illness or injury that requires specific medical care. Secondary care is often referred to as acute care. Secondary care can range from uncomplicated care to repair a minor laceration or treat a strep throat infection to more complicated emergent care, such as treating a head injury sustained in an automobile accident. Whatever...
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Healthcare Associated Infections II: Preventive Measures01:22

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Essential infection prevention measures are based on the knowledge of the infection chain, the modes of transmission in healthcare settings, and the use of the best practices in all healthcare settings. Compulsory public reporting of healthcare-associated infection rates is needed to allow individuals and the community to make informed choices regarding selecting a healthcare facility.
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Hospitals and Superutilization.

Michael Howley1, Prashant Srivastava2

  • 1Department of Marketing, LeBow College of Business, Drexel University, Philadelphia, PA, USA.

Hospital Topics
|September 18, 2024
PubMed
Summary
This summary is machine-generated.

A small group of patients, known as superutilizers, drive healthcare costs. Research shows much superutilization isn't hospital-related, and hospitals face lower reimbursements for these cases.

Keywords:
Superutilizationhealth care costshealth care spendinghigh utilizationhotspotting

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Area of Science:

  • Health Services Research
  • Healthcare Economics
  • Hospital Management

Background:

  • A small percentage of patients account for a disproportionate amount of healthcare utilization and costs in the US.
  • Superutilization significantly impacts hospital resources and financial performance, yet remains poorly understood.
  • Identifying and managing superutilizers is a critical challenge for healthcare systems.

Purpose of the Study:

  • To explore the nature and impact of superutilization on US hospitals.
  • To investigate how hospitals can identify patients with superutilization patterns.
  • To analyze the relationship between superutilization, hospital care, and reimbursement.

Main Methods:

  • Exploratory research utilizing the Medical Expenditure Panel Survey (MEPS) datasets from 2019.
  • Identification of superutilization based on total charges for health services.
  • Analysis of reimbursement relative to charges for superutilization cases within hospitals.
  • Examination of demographic variables for predictive utility in identifying superutilization.

Main Results:

  • A significant portion of superutilization was found to be unrelated to hospital care.
  • Hospitals experienced reduced reimbursement relative to charges for superutilization cases.
  • Demographic factors showed limited effectiveness in predicting superutilization.
  • Analysis indicated potential superutilizers not currently accessing hospital care.

Conclusions:

  • Hospitals should develop capabilities to manage superutilization due to its high care requirements and financial implications.
  • Understanding the non-hospital drivers of superutilization is crucial for comprehensive management.
  • Proactive strategies are needed to address the financial and operational challenges posed by superutilizers.