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We study changes in age-specific diabetes-related mortality and annual health care utilization. We find that half of the estimated 16% increase of diabetic mortality falls within employable age groups. We estimate that disease combination-specific increase in case fatality has resulted in premature diabetic mortality costing $3.2 billion annually. The estimated annual direct cost of treating high-risk diabetics reaches $36 billion, of which Medicare and Other Federal Programs compensate 54%. Respiratory conditions among diabetics comprise the same proportion of high-risk diabetics as do the disease combinations including coronary heart diseases. Treating of general diabetic conditions has become more efficient as indicated by the estimated declines in per unit health care costs.

The voluntary hospital trustee has traditionally seen issues of medical care, including those of patient safety, as falling within the delegated sphere of the medical staff. This customary distancing of the trustee from direct involvement in patient safety issues is now challenged by unprecedented scrutiny of hospital safety results through voluntary disclosure or mandatory public reporting. This new climate, fostered by the Institute of Medicine's To Err is Human and the Institute for Healthcare Improvement's 100,000 Lives campaign, has complicated the role of the trustee in satisfying the traditional “prudent person” test for meeting fiduciary obligation as the trustee's breadth of involvement expands. Viewed theoretically, Mintzberg models the hospital as a case of a professional bureaucracy, in which the professional staff is responsible for standard setting and regulation. This traditional role of the professional staff is potentially assumed by others lacking technical background. Trustees are now asked to examine reports identifying physician compliance in attaining safety standards without education in the practice supporting those standards. Physician board members, whose numbers have increased in the past decade, are often sought to take the lead on interpretation of patient safety standards and results. The very public nature of patient safety reporting and its reflection on the reputation of the organization for which the trustee is ultimately accountable create a new level of tension and workload that challenges the dominant voluntary model of trusteeship in the United States health system.

Purpose – Patient safety and adverse events continue to present significant challenges to the US health care delivery system. Mandated reporting of adverse events can be a mechanism to “coerce” hospitals to identify, evaluate, and ultimately improve the quality and safety of patient care. The objective of this study is to determine if the coercion of mandated reporting impacts hospital patient safety scores.

Methods – We utilize the US News and World Report 2012–2013 Best Hospital Rankings which includes patient safety data from US teaching hospitals. The dependent variable is a composite measure of six indicators of patient safety during and after surgery. The independent variable is state mandated reporting of hospital adverse events. Three control variables are included: Magnet accreditation status, surgical volume, and the percentage of surgical admissions.

Findings – Using ordered logistic regression (n = 670 hospitals) we find a positive, but not significant, relationship between state mandated reporting and better patient safety scores.

Implications – This finding suggests that regulatory policy may not actually prompt performance improvement, and our data point to the need for further study of both formal and informal processes to manage patient safety within the hospital.

Originality – While increased reporting of adverse events has been linked to hospitals providing safer care, no research to date has examined whether or not state-level mandates actually lead to improvements in patient safety.

Peripheral arterial disease (PAD) is an occlusive atherosclerotic disease that affects blood vessels and reduces blood flow in the lower limbs. It is estimated that around 200 million people worldwide suffered from it, with a significant number of older people affected. Walking is one of the first-line therapeutic measures for intermittent claudication (IC) in patients with PAD. Supervised Exercise Therapy (SET) programs effectively increase walking distances, however, remain an underutilized tool because they are not readily available in most clinical centres, are extremely expensive, and patient participation is low mainly due to socioeconomic constraints. Home-based Exercise Therapy (HBET) programs are an effective and low-cost alternative to improve both the functional capacity and quality of life (QoL) of patients with IC, as they are performed in the patient’s area of residence and not in the hospital. The WalkingPad program conciliated a smartphone app – the WalkingPad app – with behaviour change intervention to increase walking distances and decrease walking impairment as well to improve QoL at 6 months.

This study uses ethnographic data from two diabetes clinics to examine how some organizational features of medical settings are connected to the daily cognitive and interactional work of medical providers – specifically, the process of assessing patient adherence and using such assessments to make treatment decisions. I address continuity of care, scheduling and time constraints, team management, provider interaction, and medical recordkeeping as organizational-level issues that impact individual-level providers’ work. More than a top-down model of how “macro” influences “micro,” this study highlights how organizational influences are accounted for in terms of variation in patients’ behavior.

Adverse events in health care became more evident at the beginning of the 21st century, being an emerging problem worldwide and impacting the lives of people receiving health care, contributing to preventable injuries and deaths. This evidence has motivated the development of specific training in the area of patient safety with a strong focus on the education and training of health professionals, and, more recently, it also aimed at patient, informal caregiver and all citizens. In this sense, the use of digital technology for patient safety training has been an important challenge and proves to be a good solution for training and continuous learning, both for professionals and people in general. The use of multimedia, videos, games, simulators, among others, are effectively essential resources to improve people’s health literacy and safety of care.

This chapter presents a narrative review on patient safety training and the contributions of digital technology. The experience report will also be used, presenting some examples of quality improvement projects developed by Portuguese and Brazilian entities, in training contexts, highlighting the importance of investing in the health literacy of professionals, patients/informal caregivers and civil society, through applying specific techniques and using digital technology.

The purpose of this study was to assess the relationship between quality of life (QOL) and willingness to pay (WTP) for in vitro fertilization (IVF) in patients undergoing treatment for infertility. Adult women (N = 86) in treatment for infertility completed a self-administered mail survey. The Short-Form 36 was used to measure QOL and the contingent valuation method was used to measure WTP. Mean WTP for IVF was $10,277 (SD = $13,210, median $8,000) and mean total QOL was 574.6 (SD = 145.7). There was no significant difference in QOL (p = 0.70) or WTP (p = 0.20) among patients in Stages 1, 2, and 3 of infertility treatment. QOL and WTP were negatively (r = −0.05), but not significantly (p = 0.65) correlated.

We review the conceptualization of quality of life (QOL) past and present, providing a new definition that transcends the traditional approach. We discuss the importance of QOL as a mandatory assessment in patient care and clinical trials, concurring with the need for disease-specific tools and focusing on a nerve fiber-specific tool for assessing impacts of diabetic neuropathies on QOL and activities of daily living (ADLs) used in multi-center clinical trials and translated into different languages. By relating neuropathic disabilities to different nerve fibers, the Norfolk Quality of Life – Diabetic Neuropathy (QOL-DN) is able to measure impacts of nerve-fiber-specific neurotrophic therapies, providing pertinent endpoints to changes in health status and QOL.

Previous research has demonstrated that communication failure and interpersonal conflicts are significant impediments among health care teams to assess complex information and engage in the meaningful collaboration necessary for optimizing patient care. Despite the prolific research on the role of effective teamwork in accomplishing complex tasks, such findings have been traditionally applied to business organizations and not medical contexts. This chapter, therefore, reviews and applies four theories from the fields of organizational behavior (OB) and organization development (OD) as potential means for improving team interaction in health care contexts. This study is unique in its approach as it addresses the long-standing problems that exist in team communication and cooperation in health care teams by applying well-established theories from the organizational literature. The utilization and application of the theoretical constructs discussed in this work offer valuable means by which the efficacy of team work can be greatly improved in health care organizations.

The Analytical Hierarchy Process (AHP), a multicriteria decision support system that has been successfully applied to numerous decision-making situations, has been applied to patient assessment. The AHP was used with Timeslips™, a group storytelling program that encourages creative expression among dementia patients, to determine the optimal scale for pre and post assessment among the nine most common agitation and anxiety scales. The AHP used the six criteria identified by qualitative assessment of the nine scales: (1) validity/reliability, (2) observation period, (3) training required, (4) time to administer, (5) most appropriate administrator, and (6) accessibility/cost. The AHP indicated that the Overt Agitation & Anxiety Scale was optimal for use with Timeslips; the process and results are discussed.