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Efficiency change in inpatient care provision under the DRG-based reimbursement mechanism in the Czech Republic
Jakubová, Barbora ; Bryndová, Lucie (advisor) ; Votápková, Jana (referee)
Expenses on inpatient care form the largest share of Czech health expendi- ture, which raises concerns about its efficiency. Efficiency improvement belonged to one of the motivations for the implementation of reimbursement mechanism based on diagnosis-related groups, under which hospitals are paid a fixed amount per hospital case. This thesis contributes to the existing literature on DRG by assessing the changes in efficiency of inpatient care under DRG in the Czech Republic, focusing on the length of stay as a measure of resource utilization as well as an indicator of hospital efficiency. Furthermore, it contributes to this topic by using a unique and relatively large dataset containing patient-level information from 15 Czech hospitals over 2015-2019. Employing models for count data, we observe the downward trend in length of stay over the examined period. This finding is in line with the intended effect of DRG. Moreover, the estimated result is robust when considering dif- ferent subsamples - based on hospital size (large and medium-sized) or severity level of a patient. The only group where the decline in length of stay was not estimated were the most severely ill patients with major complications and co- morbidities. Measured by the standard deviation of length of stay, the process of...
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Care for a patient intoxicated by mushrooms - preparation of simulation scenarios
KOHOUTOVÁ, Denisa
The thesis focuses on patients mushroom poisoning and preparation of simulated scenarios. The thesis is mainly theoretical with addition of two simulated scenarios, which are supported by specialised literature, magazines and Czech or foreign websites. Firstly, intoxications in general overview, symptoms, first aid and treatment are studied. In the next chapters complete overview and description of mushrooms is given, without it the thesis would be incomplete. Lastly, mushroom intoxication, its symptoms, pre-hospital care, treatment and hospital care are described. Mushroom intoxication is immediate life threatening condition, if it is not treated correctly and in time. Suicide and accident can be reasons for this type of intoxication. Early diagnoses of the toxic substance in the mushroom and early treatment are used to treat even the harshest of cases. Most common, however less serious, intoxications are caused by panther cap, this type of mushroom is easily mistaken for blusher. As the most dangerous mushrooms intoxication is considered the one caused by death angel. Death angel consists of high number of toxins and is often mistaken for blusher or champignon. The death doses of this mushroom is estimated to only few tenths of a gram - in other words to one mushroom or less. Consumption of poisonous mushroom mostly affects liver and kidneys. Blood chemistry test, urine test and test of the gastric content are important parts of diagnosing mushroom intoxication. Important step of removing and eliminating toxins from patient's body is invoked vomiting and gastric lavage with administration of bituminous coal. Hospital care provided by nurse is significant part of intoxication treatment. Nurses take care of airways, they monitor basic vital functions, assist during invasive procedure, collect blood samples based on doctor's ordination and they provide hygienic care and decubitus prevention. Diploma thesis can be provided as a textbook material for nurses and paramedics. Mostly in regard to simulated scenarios.
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Analgosedation of a child patient in pre-hospital emergency care and children's urgent care
MRÁZ, Štěpán
This bachelor's thesis is focused on the topic of analgosedation of an infant patient in pre-hospital emergency care and children's urgent care. It comprises two parts, the theoretical and the practical one. The theoretical part includes some information about pre-hospital and urgent emergency cares. Furthermore it is mainly focused on specifics of infant patients, analgosedation and last but not least on resuscitation of adults and children. For the practical part of this thesis was chosen one aim. It was to find out how urgent wards are ready to face intake of infant patients. Due to this target came out two investigative questions. The first one:"What facilities can be found in hospitals, which are ready for intake of infant patient?" The second question: "Are hospital workers prepared for infant patients within the framework of PNP and urgent care?" The research was carried by a quantitative method of gathering data through the half structuralized dialogues covering 12 questions. The research sample contained 6 paramedics of an emergency ambulance and 6 hospital employees from an urgent ward. The data obtained by this research are divided into 11 categories. After summarization of all information and data I found out that there is a high standard of facilities covering pre-hospital and hospital care, therefore an infant patient can be provided with a necessary help. Within the investigation was also proved the following fact. Hospital employees are well trained in issues of infant patient. Nevertheless they agreed that there are not so many practical training based on children emergency care organised, therefore they would really welcome them to be able to improve their practical skills in connection of this specific field.
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How to meet needs of seniors in hospital care.
Bláhová, Hana ; Holmerová, Iva (advisor) ; Macková, Marie (referee) ; Kisvetrová, Helena (referee)
The submitted dissertation of the PhD study programme Longevity Studies was prepared and financially supported by the project GAUK - Grant Agency of Charles University No. 760219 entitled "Met and Unmet Needs Of Particularly Vulnerable Older Patients in Home and Inpatient Care", of which I am a co-investigator. The mentioned research project is also in the intentions of the strategic plan and long-term activities of the research team CELLO (Center for the Study of Longevity and Long-Term Care), which is the scientific basis of the PhD study programme Longevity Studies. The main goal of the GAUK project is to provide a comprehensive overview of the needs of vulnerable older patients who are provided health care. The project is focused on three areas, which are: the needs of patients with dementia, the needs of geriatric patients at home and the needs of geriatric patients in hospital care. Partial goals are the exploration of current knowledge of the issue based on a review of Czech and foreign literature. The aim of the survey is to find out attitudes and opinions on satisfying needs from the perspective of patients and healthcare professionals. The practical goal is to create recommendations for good practice for the health care of these patients. The dissertation consists of a total of seven...
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Activation of a child patient in hospital care
Olejárová, Denisa ; Tomová, Šárka (advisor) ; Javůrková, Alena (referee)
The bachelor's thesis on the topic "Activation of a child patient in hospital care" is focused on finding out the activities performed in the Motol University Hospital, we focused on employees who perform the activities and what tools they use, as well as staff satisfaction with the possibilities of activities. The work is divided into theoretical and empirical part. The theoretical part is focused on the characteristics of childhood, discusses the role of the nurse in the pediatric ward, the pediatric patient and communication with the pediatric patient. At the end of the theoretical part, various possibilities of activities and the role of volunteers in the departments are described. The empirical part consists of a survey questionnaire survey, which was focused on nurses working in the Motol University Hospital in the wards in the children's section.
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Social worker as a member of the hospital palliative care team
Michalcová, Zdislava ; Křížová, Eva (advisor) ; Janečková, Hana (referee)
The bachelor thesis deals with the topic of "Social worker in the team of palliative care in hospital". The thesis consists of two parts: theoretical and practical. In the theoretical one, there is firstly covered the topic of death and dying from the Christian theology point of view. Then, the definitions of the palliative care are mentioned and is described its history both in the world and in the Czech Republic. Consequently, the thesis deals with the current state of palliative care in the Czech Republic, what kind of projects are nowadays in process to implement the care for the environment in hospital and the importance of multidisciplinary team itself. Another part is devoted to social worker in palliative care. It is deeply described how the social work has been evolving in this field as well as its position. It is also pointed to the activities of social worker and described the professional and personal credentials he or she should have. The end of theoretical part is focused on the right worker's attitude to seriously sick people and accompanying their relatives. In the practical part, the example of good practice of palliative care is described in Ústřední vojenská nemocnice in Prague. It was answered on the following questions: What was the development of palliative care in that...
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Smoking cessation among patients in residential treatment for alcohol dependence
Adamíková, Žaneta ; Štěpánková, Lenka (advisor) ; Vacek, Jaroslav (referee)
Background: In the Czech Republic, alcohol and tobacco are the most widely used addictive substances. Although use of these substances is legal for those 18 years or older, they can lead to serious health consequences. Especially among alcohol (or other drugs) dependent persons in recovery, the prevalence of regular smoking compared to the general population is much higher. Nevertheless, in these settings within the Czech Republic, tobacco smoking is often overlooked and for the staff there is no standard approach for introducing the systematic programs for quitting smoking. It is often based on theory that these patients have no motivation or interest in professional assistance with quitting smoking. Objective: The primary objective of the research was to assess the motivation of patients dependent on alcohol and tobacco, currently undergoing the residential medium-term treatment to quit smoking. A secondary objective was to highlight the issue of smoking among these patients and find out what their view is on the possibilities of tobacco dependence treatment in the setting and whether they would be interested in professional assistance with quitting smoking. Methodology: Questionnaire-based research was conducted among patients in the 5 health care services for the addiction treatment throughout...
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Burn-out syndrome in thepre-hospital and hospital care forparamedicalpersonnel
ŠAŠKOVÁ, Jana
The "burn out "syndrom is the state of a physical, emotional and psychical exhaustion. There is a relatively big danger of the "burn out"syndrom emergence by the paramedics and that is why there should be given a big stress to its prevention. The aim of this bachelor´s work was to find out if there is a bigger "burn out" syndrom by the paramedics than by hospital paramedics. The next aim was to find out the influence of the practice´ lenght and of the workfalling in to the psychical point of view to the paramedics. It was used the investigation of quantity through the standartised quostionnaire to find out the "burn out" level. We created a quostionnaire that contained 11 questions to find out if the paramedics have the prevention against the "burn out" syndrom. The standartised questonnaire MBI was evaluated in the area of the South Bohemian region through the charts and graphs. It was found that the hospital paramedics are more inclinating to the "burn out" syndrom than the ambulance service paramedics. Followingly the investigation, there is a bigger risk of "burn out" syndrom by paramedics with the longer practice. The most of the paramedics try to prevent the "burn out" syndrom but the prevention didn´t appear to be efficient in comparison to the number of "burn out" paramedics.
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Care for an oncology patient
NOVÁKOVÁ, Markéta
The diploma thesis addresses in detail the issue of a terminally ill individual and things closely associated with this topic including spiritual direction of the bereaved after the death of a close relative. Based on information from the literature it tries to reflect the basic conditions of approach to an oncology patient and his relatives (including the necessity of truthful communication and abidance by basic ethic rules). In order to provide a comprehensive view of the topic, the work includes research among the patient?s relatives realized in 4 out of the 14 hospice centers in the Czech Republic. On the basis of this research some positive aspects have been revealed on one hand, which are worthy acknowledgement and appreciation. On the other hand, there are areas and restraints motivating and challenging both types of healthcare centres to take steps that would lead to a better quality of care provided in the future.
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Deficit of nurse - educator in nursing profession or patients after amputation of lower limb.
BLAFKOVÁ, Šárka
My thesis deals with the deficit of educating nurses who serve post-amputation patients in nursing practice. Five goals were defined in the thesis. Some of them deal with post-amputation care of the patient and others with post-amputation education of the patient in nursing practice. Goal 1: To map nursing care of the amputation stump from a nurse's perspective. Goal 2: To find out whether nurses educate the patient after leg amputation according to the education plan. Goal 3: To find out whether obstacles exist preventing nurses from educating the patient after leg amputation. Goal 4: To find out the most common post-amputation problems according to patients. Goal 5: To find out how patients view the post-amputation education. All goals were met. Hypotheses and research questions were also defined. Three hypotheses were defined. Hypothesis 1: When caring for the patient after leg amputation, nurses adhere to the rules for amputation stump nursing - Confirmed. Hypothesis 2: When educating the patient after leg amputation, nurses utilize the education plan {--} Confirmed. Hypothesis 3: When educating the patient after leg amputation, the most common obstacle stated by nurses is a time deficit {--} Not confirmed. Three research questions were defined as well. Research question 1: What are the common post-amputation problems according to patients? Answer 1: The most common problems according to patients are movement and learning to walk. Research question 2: When do post-amputation patients require the assistance of nurses? Answer 2: Post-amputation patients require nurse assistance during physical activities, mainly during movement. Research question 3: Do patients view the post-amputation education as a benefit? Answer 3: Patients view the post-amputation education as a benefit. The benefit consists in being taught certain activities or having them explained. The result of this thesis is an education plan specifically tailored for patients after a leg amputation. It describes the individual educational steps for post-amputation patients.
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