Advance data
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This report presents estimates on the availability of pediatric services, expertise, and supplies for treating pediatric emergencies in U.S. hospitals. ⋯ One-half of hospitals (52.9 percent) admitted pediatric patients, but did not have a specialized inpatient pediatric ward. One-third (38.3 percent) admitted pediatric patients and had a separate pediatric ward; the remainder did not admit pediatric patients. Among those that did not admit pediatric cases, 30.4 percent were in counties that had a children's hospital. One-quarter of EDs had access 24 hours and 7 days a week to a board-certified pediatric emergency medicine attending physician. Only 5.5 percent had all recommended pediatric supplies, but one-half had greater than 85 percent of recommended supplies. Most hospitals without pediatric trauma service (90.7 percent) or pediatric intensive care units (97.5 percent) transferred critical pediatric patients to hospitals with these services. EDs in hospitals with specialized inpatient facilities for children were more likely to meet the AAP and ACEP guidelines for pediatric ED services, expertise, and supplies.
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This report describes ambulatory care visits to hospital outpatient departments (OPDs) in the United States. Statistics are shown on selected hospital, clinic, patient, and visit characteristics, as well as selected trends in OPD visits since 1993. The report highlights variation in use across the major types of OPD clinics surveyed. ⋯ During 2003, an estimated 94.6 million visits were made to hospital OPDs in the United States, about 33.1 visits per 100 persons. This rate represents a 35-percent increase since 1993, although rates have been stable since 1999. Infants under 12 months of age had a visit rate of 88.7 visits per 100 persons, a rate that increased by 23 percent since 1993. Increasing trends in OPD visit rates were found for persons 50-64 years of age (up by 30 percent), 13-21 years of age (up by 32 percent), 22-49 years of age (up by 34 percent), and 1-12 years of age (up by 71 percent). Females had higher OPD visit rates than males (39.6 compared with 26.4 visits per 100 persons), and black or African American persons had higher OPD visit rates than white persons (59.7 compared with 29.9 visits per 100 persons). Medicaid and State Children's Health Insurance Program patients used OPDs for preventive care services more frequently than private pay patients. The preventive care visit rate by Hispanic and Latino patients was twice the rate by non-Hispanic patients. Diphtheria, tetanus, and acellular pertussis (DTaP) was the most frequently provided vaccine to children under age 18 years. Between 1993-94 and 2003, the proportion of visits involving only mid-level providers increased from 5.9 to 12.6 percent of visits.
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This study examined the content of hospital terrorism preparedness emergency response plans; whether those plans had been updated since September 11, 2001; collaboration of hospitals with outside organizations; clinician training in the management of biological, chemical, explosive, and nuclear exposures; drills on the response plans; and equipment and bed capacity. ⋯ Almost all hospitals have plans for responding to natural disasters (97.3 percent). Most have plans for responding to chemical (85.5 percent), biological (84.8 percent), nuclear or radiological (77.2 percent), and explosive incidents (76.9 percent). About three-quarters of hospitals were integrated into community-wide disaster plans (76.4 percent), and 75.9 percent specifically reported a cooperative planning process with other local health care facilities. Despite these plans, only 46.1 percent reported written memoranda of understanding with these facilities to accept inpatients during a declared disaster. Hospitals varied widely in their plans for re-arranging schedules and space in the event of a disaster. Training for hospital incident command and smallpox, anthrax, chemical, and radiological exposures was ahead of training for other infectious diseases. The percentage of hospitals training their staff in any exposure varied from 92.1 percent for nurses to 49.2 percent for medical residents. Drills for natural disasters occurred more often than those for chemical, biological, explosive, nuclear, and epidemic incidents. More hospitals staged drills for biological attacks than for severe epidemics. Despite explosions being the most common form of terrorism, drills for these were staged by only one-fifth of hospitals. Hospitals collaborated on drills most often with emergency medical services, fire departments, and law enforcement agencies.
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This report presents information on the use of electronic clinical systems to support patient care in physician offices and hospital emergency and outpatient settings. Percentages of hospital emergency and outpatient departments with electronic patient medical records and automated drug dispensing systems are presented by selected hospital characteristics for 2001-02. Percentages of physicians using electronic patient billing records, electronic patient medical records, and computerized prescription order entry systems are presented by selected physician characteristics for 2003. ⋯ During 2001-03, electronic medical records were used less often in physician offices (17 percent) than in hospital emergency (31 percent) and outpatient departments (29 percent). In physician offices, information technology was more frequently used for billing patients (73 percent) than for maintaining medical records electronically (17 percent) or ordering prescriptions electronically (8 percent). Automated drug dispensing systems were available in hospital emergency departments (40 percent) more frequently than in outpatient departments (18 percent).
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This report describes ambulatory care visits made to physician offices in the United States. Statistics are presented on selected characteristics of the physician's practice, the patient, and the visit. This report also highlights visits to primary care specialties. ⋯ During 2002, an estimated 890 million visits were made to physician offices in the United States, an overall rate of 314.4 visits per 100 persons. From 1992 through 2002, the visit rate for persons 45 years of age and over increased by 14%, from 407.3 to 465.8 visits per 100 persons. The visit rate to physician offices in metropolitan statistical areas (MSAs) (337.3 visits per 100 persons) was significantly larger than the rate in non-MSAs (221.9 visits per 100 persons). For one-half of all office visits, regardless of specialty, physicians indicated they were the patient's primary care physician (PCP). Of the visits to physicians other than the patient's PCP, about one-third (31.1 percent) were referrals. New patients, representing 12.1 percent of the visits in 2002, are down 18% since 1992. Primary care specialists provided 90 percent of all preventive care visits. Essential hypertension, acute upper respiratory infection, diabetes mellitus, and arthropathies were the leading illness-related primary diagnoses. There were an estimated 104.0 million injury-related visits in 2002, or 36.7 visits per 100 persons. On average, 2.3 medications were ordered or provided at each office visit with any mention of a medication. The leading therapeutic class for drugs mentioned at office visits included nonsteroidal anti-inflammatory drugs (NSAIDs) (4.9 mentions per 100 visits) and antidepressants (4.5 mentions per 100 visits). Of primary care specialists, 25.8 percent reported not accepting new patients who are Medicaid enrollees.