Health care systems outside

Health Care Systems Outside the United States... 

Different vaccines and immunization strategies have been evaluated in Denmark, Finland, Iceland, Norway, and Sweden (5). Few places outside Scandinavia have collected data on Hib immunization programs for so long (more than a decade has elapsed since universal Hib immunization was initiated in Scandinavia) and with similar accuracy. Phase 3 studies with PRP-D-Hib vaccine were done in Finland in the late 1980s, and PRP-D-Hib vaccine has been the only vaccine used in Iceland. HbOC vaccine was first compared with PRP-D-Hib vaccine in Finland and then reintroduced to the primary health-care system as the only Hib vaccine used. Finally, PRP-T-Hib vaccine was first temporarily used in Finland, and then as almost the only vaccine in Denmark, Norway, and Sweden. Besides the different conjugate vaccines, the immunization programs have differed in other aspects, such as immunization schedule and administration of vaccines (separate versus simultaneous administration with other vaccines, such as DT, DTP, DTaP, IPV, or MMR). 

The traditional knowledge bases that undergird the work of health care cannot provide the guidance needed to understand failure in the complexity of the health care system. To build applications that will effectively mitigate harm to patients, a distinct science of patient safety that builds on bodies of knowledge outside health care, primarily human factors and organizational analysis, is needed. 

Patient safety is a major concern in health care systems worldwide and has gained increasing attention since the Institute of Medicine published its report To Err Is Human in 1999 [1]. Based on extrapolations of study data, this report estimated that approximately 44,000-98,000 Americans die annually due to adverse events in health care. Patients with serious conditions, multimorbidity, and with intense and fragmented health care utilization, like end-stage renal disease (ESRD) patients, are at increased risk for suffering adverse events. It is thus vital that clinicians caring for ESRD patients make patient safety a top priority and cooperate on safety with their colleagues within and across other clinical specialties inside and outside the hospital. In this chapter, we will introduce the fundamental terms and concepts of patient safety and present readers an overview of essential data. We describe examples of important innovations which contribute to patient safety and briefly discuss future needs and developments. 

As a consequence of their growing numbers, prolonged care of a VAI (>30 days) in the ICU has rapidly increased the costs to the health care system in the United States, it has been estimated that patients requiring prolonged mechanical ventilation (PMV) account for as much as 40% of the ICU budget (5). Nevertheless, in 1995, a U.S. survey of 300 randomly selected acute care units reported that over 11,000 patients had received PMV at a cost of 9 million per day. Of these patients, 17% were awaiting placement outside the ICU, and 12% remained in ICU as they could not be reimbursed for care elsewhere (6). Although... 

We recently surveyed pharmaceutical companies producing antidepressant medication or central nervous system (CNS) stimulants for the European market. Approval for use of such drugs in children and adolescents is limited worldwide. Sertraline, clomipramine, and flu-voxamine have been approved for use in children (for some drugs down to the age of 6 years) for OCD in some European countries (the most wide spread approval being for sertraline in Austria, France, Hungary, Italy, Latvia, Norway, Portugal, Romania, Slovenia, Spain, Sweden, Switzerland, Turkey, United Kingdom, and Denmark) and countries outside Europe. Methyl-phenidate has been approved for the treatment of children with ADHD in a number of European and non-European countries (Novartis Health care A/S, personal communication). 

In turn, EHS will typically refer to a disaster as a natural or man-made phenomenon that results in the destruction or dysfunction of the available response infrastructure to meet the community s need for health care (ASTM F-30 Committee, 1996 Auf der Heide, 1989 Emergency Medical Services Committee, 2001 FEMA, 1992). Thus in the case of a hurricane or power outage, only a few injured people may require medical care however, because the health system infrastructure may have been destroyed, the disaster may clearly require outside assistance to meet the health care demands of the community. This type of disaster is sometimes referred to as a paralytic disaster because it has the potential to eliminate the EHS s ability to respond to any call for services, let alone extra demands for care resulting from the event. 

Special decontamination areas outside the hospital emergency department or in the field are the best locations for decontamination (7). If the decontamination area is within the hospital, its ventilation system should be separate from the rest of the hospital or turned off to prevent the spread of contamination. If it is necessary to turn the ventilation system off, the hospital should follow OSHA regulations on atmospheric monitoring, especially if health care workers are using air-purifying respirators (9,10). 

These databases have been utilized in pharmacoepidemiology research for several decades in North America and Europe. Most reflect the underlying qualities of the health-care delivery system. For example, EHR databases for a particular physician in the United States may not capture health care provided to the same patient outside of that practice, while databases from general practitioner (GP) gatekeeper systems (as in the United Kingdom) generally capture most of the patient s interactions because they must be referred and have care coordinated through the GP. 

Weeks, W. B., West, A. N., Rosen, A. K., Bagian, J. R, Comparing Measures of Patient Safety for Inpatient Care Provided to Veterans within and outside the VA System in New York, Quality in Health Care, Vol. 17,2008, pp. 58-64. 

This chapter introduces the fundamental concepts of patient safety. Research underlying the basic concepts of patient safety comes from outside health care, primarily from engineering, aviation, psychology, and sociology. These areas of inquiry replace the impoverished conceptualization of error reduction with the more robust concept of complex adaptive systems. The framing principles are ... 

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