Patterns of hospital care and physician perspectives from an Italian, Japanese, and USA hospital.
Many studies have compared different countries' health care systems at the macro level. Less has been done to analyze care provided for patients with specific diseases and to compare physician attitudes concerning factors that influence patient care. This study compares severity of illness and length of hospital stay for patients admitted for diabetes mellitus, cholecystitis, or appendicitis at three teaching hospitals in Italy, Japan, and the United States. Physicians caring for patients with these diseases were surveyed to assess their opinions of the adequacy of resources available at their hospital, perceived administrative pressures concerning resource use, and interactions with patients and their families that relate to admission and discharge decisions. The severity of the patient mix was consistently higher in the U.S. hospital than in the Italian or Japanese hospitals. Controlling for diagnosis, severity of illness, surgery, age, and presence of co-morbid conditions, the U.S. hospital consistently had the shortest stays and the Japanese hospital the longest. Japanese physicians were more likely than U.S. or Italian physicians to report insufficient resources, such as nurses, to provide quality care, but less likely to report administrative pressures interfering with patient care. Differences in hospital utilization may reflect variation in clinical practices, availability of resources, barriers to access to care, organizational differences at the national and hospital level, and patient and family preferences.
Louis
D Z
DZ
Center for Research in Medical Education and Health Care, Jefferson Medical College, Philadelphia, Pennsylvania 19103, USA.
Taroni
F
F
Yuen
E J
EJ
Umesato
Y
Y
Gonnella
J S
JS
D000328:Adult; D001064:Appendicitis / Q000601:surgery; D001291:Attitude of Health Personnel; D002764:Cholecystitis / Q000628:therapy; D003920:Diabetes Mellitus / Q000628:therapy; D006302:Health Services Research; D006784:Hospitals, Teaching; D006801:Humans; D007558:Italy; D007564:Japan; D007902:Length of Stay / Q000706:statistics & numerical data*; D010820:Physicians / Q000523:psychology*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012720:Severity of Illness Index; D014481:United States