The Medicare Geographic Variation by Hospital Referral Region dataset provides information for researchers and policymakers to evaluate the geographic differences in the use and quality of health care services for the Original Medicare population. The dataset includes demographic, spending, use, and quality indicators at the hospital referral region (HRR) level. Please note that CMS has decided to discontinue updates to the Fee-for-Service (FFS) Geographic Variation Public Use File by Hospital Referral Region, so the dataset is retired. Data in the FFS Geographic Variation Public Use File by Hospital Referral Region has been divided into two files: 2007-2013 data and 2014-2021 data. This was done to account for changes to the Geographic Variation methodology beginning with data year 2014. The 2007-2013 data is located under data year 2013, and the 2014-2021 data is located under data year 2021.

This dataset tracks the updates made on the dataset "Medicare Geographic Variation - by Hospital Referral Region" as a repository for previous versions of the data and metadata.

Provisional count of deaths involving coronavirus disease 2019 (COVID-19) in the United States by week of death and by hospital referral region (HRR). HRR is determined by county of occurrence. Weekly weighted counts of deaths from all causes and due to COVID-19 are provided by HRR overall and for decedents 65 years and older. The weighted counts by HRRs are based on published methods for aggregating county-level data to HRRs. More detail about aggregating to HRRs from counties can be found in the following: https://github.com/Dartmouth-DAC/covid-19-hrr-mapping https://dartmouthatlas.org/covid-19/hrr-mapping/

Analysis of ‘AH Provisional COVID-19 Deaths by Hospital Referral Region’ provided by Analyst-2 (analyst-2.ai), based on source dataset retrieved from https://catalog.data.gov/dataset/03d1e0d7-ea7f-4b7c-a9d3-1b811e2dc237 on 12 February 2022.

--- Dataset description provided by original source is as follows ---

Provisional count of deaths involving coronavirus disease 2019 (COVID-19) in the United States by week of death and by hospital referral region (HRR). HRR is determined by county of occurrence. Weekly weighted counts of deaths from all causes and due to COVID-19 are provided by HRR overall and for decedents 65 years and older. The weighted counts by HRRs are based on published methods for aggregating county-level data to HRRs. More detail about aggregating to HRRs from counties can be found in the following: https://github.com/Dartmouth-DAC/covid-19-hrr-mapping https://dartmouthatlas.org/covid-19/hrr-mapping/

--- Original source retains full ownership of the source dataset ---

This dataset tracks the updates made on the dataset "AH Provisional COVID-19 Deaths by Hospital Referral Region" as a repository for previous versions of the data and metadata.

This data package contains Medicare spending statistics for beneficiaries grouped according to their age, gender, race/ethnicity and geographical location. At the same time, it provides data about spendings taking into consideration provider specific coordinates like the Hospital Referral Region (HRR) or Hospital Service Area (HSA). The data package contains as well as spending statistics based on the payment system, like the Outpatient Prospective Payment System.

The Medicare Geographic Variation Public Use File provides the ability to view demographic, utilization and quality indicators at the state level (including Washington DC, Puerto Rico, and Virgin Islands), and at the Hospital Referral Region (HRR) level. This aggregated program data enables researchers and policymakers to evaluate geographic variation in the utilization and quality of health care services for the Medicare Fee for Service population.

This data package contains the Geographic Variation Public Use File serve as an evaluation of the utilization and quality of healthcare services according to the geographic area for the population covered by Medicare. This dataset incorporates Hospital Referral Region (HRR) level data that covers demographic, cost utilization and quality data for all ages, ages 18 to 65 and above 65 years by state and national level.

Authors of Costs and Clinical Quality Among Medicare Beneficiaries - Associations with Health Center Penetration of Low-Income Residents, published in Volume 4, Issue 3 of Medicare and Medicaid Research Review, report analyses to determine if increased access to primary care by the underserved had any effect on Medicare spending and clinical quality. Using data on elderly Medicare beneficiaries across U.S. geographic healthcare markets (hospital referral regions, HRRs), data from federally funded health centers, and income data from the American Community Survey, the authors calculated Medicare spending and clinical quality, and compared those outcomes in HRRs with high versus low health center penetration. HRRs with high penetration by health centers had 9.7 percent lower Medicare spending (926 dollars per person) than HRRs with low health center penetration, and no difference in clinical quality outcomes. High health center penetration among low-income populations may accrue Medicare cost savings without compromising clinical quality.

USAID/Uganda’s Strengthening Uganda’s Systems for Treating AIDS Nationally (SUSTAIN) activity supports Uganda’s Ministry of Health (MOH) to strengthen quality and comprehensive HIV/AIDS care, prevention, laboratory and tuberculosis (TB) services at selected regional referral and district health care facilities in Uganda, as well as build the capacity of the public health system to sustain these services. SUSTAIN is a six-year USAID-funded activity launched in 2010 and implemented by University Research Co., LLC (URC). SUSTAIN is one of many PEPFAR-funded activities to address the HIV/AIDS epidemic in Uganda. The main objective of the SUSTAIN program evaluation was to examine the activity’s methodology for achieving its objectives in order to inform future USAID design work. USAID noted that URC had performed well on SUSTAIN, as evidenced by its activity reports, but wanted an evaluation of the approach used by SUSTAIN to inform future program designs. SUSTAIN implementation adapted to contextual changes in the Government of Uganda's (GoU) HIV/AIDS strategy responding to a spike in new infections and people living with HIV, and major shifts in PEPFAR policy.

Indications for referral.

Multivariate models of physician networks and concentration of black residents in U. S. hospitals.

Skin and soft-tissue infections (SSTI) are common cases of hospital-acquired infections with aetiologic agents exhibiting antimicrobial resistance (AMR). We determined the prevalence, proportion of laboratory-investigated cases, AMR-profiles, and factors associated with SSTI and multi-drug resistance (MDR). This study was based on archived data of patients suspected of SSTI from 2019-2021 at Jinja Regional Referral Hospital. The analysis involved 268 randomly selected patient reports. Prevalence of SSTI was 66.4%. Laboratory-investigated cases were 14.11%. Staphylococcus aureus (n=51) was the most isolated organism. MDR pathogens explained 47% of infections. Methicillin-resistant S. aureus was up to 44%. In addition, 61% of Gram-negatives had the potential to produce extended-spectrum beta-lactamases, while 27% were non-susceptible to carbapenems. Ward of admission was significantly associated with infection (aPR=1.78, 95% CI: 1.003-3.18, p-value=0.04). Age category (19-35) was an inde..., Collected from information systems of a health facility and patients' records without identifiers. Cleaned using MS Excel. Analysed using STATA 17.0 and WHONET 2022., , # Prevalence, resistance profiles and factors associated with skin and soft-tissue infections at Jinja regional referral hospital: A retrospective Study

https://doi.org/10.5061/dryad.rjdfn2zkh

The original dataset (SSTI Dataset-JRRH.xls) and the WHONET version (SSTI Dataset-JRRH.dbf) have both been uploaded.

Description of the data and file structure

This dataset is mainly made up of rows and columns appropriately titled. Each row corresponds to one individual and respective data. This includes multiple variables including;

• Year Case-Year in which the patient sought medical care and their case recorded at the facility.
• Ward- Special medical unit for patient care
• Sex- Biological characteristics of males or females
• Age- Time spent on earth since birth (in years)
• Age group- Categories of the age
•  Hospitalized≥48Hrs- Whether a patient was admitted at the hospital for at least two days or not. N/A in this case and elsewhere indic...

Abstract

Prevention of HIV/ STIs as well as care and support for those living with HIV/ STIs has received considerable attention in Bhutan. The Ninth Five Year Plan provided a multi-sectoral strategy to prevent and control HIV/ AIDS. It also identified this as one of the country's most important programme in promoting healthy outcomes for women and children. Services related to prevention, treatment and care are provided at health facilities at different levels. The services include provision of Voluntary Counselling and Testing (VCT) for HIV, Syndromic Management for STIs, along with some laboratory diagnosis which ranges from simple tests in the district hospitals to a wider and comprehensive range of tests at regional and national referral hospitals. To further facilitate delivery of services, several manuals and guidelines on the Syndromic Management of STIs and VCT have been provided at health care facilities and also personnel have been trained to provide these services.

To assess the health faculties' functionality and utilization of theses services for prevention and control of STIs and HIV in the country the Research and Epidemiology Unit of the Ministry of Health carried out Health Facility Survey (HSF 2009), with financial support from the World Bank, which is representative of the health facilities in the country. The findings are very useful in planning and future programme interventions to improve these services for the population of Bhutan.

Geographic coverage

National Dzongkhag (Districts) Regions: Eastern Bhutan, Central Bhutan, and Western Bhutan

Analysis unit

-health facility

Universe

All health facilities providing STI/HIV services in Bhutan.

The health facilities providing STI/HIV services in Bhutan assessed in this survey were grouped into five categories based on the services they provided and their capacities:

1.The OPD of the JDW National Referral Hospital, at Thimphu, and two Regional Referral Hospitals, at Mongar and Gelephu, which provide services for STIs and HIV as part of an integrated health system. 2.The laboratories of the Public Health Laboratory and the JDW National Referral Hospital, both at Thimphu, are more developed and provide a wider range of diagnostic tests for STIs and HIV. 3.Thirty District Hospitals in 20 districts (with some districts having more than one hospital) - these provide services for STIs and HIV as part of an integrated system. A basic laboratory is available in each of these hospitals designed to diagnose syphilis, gonorrhoea (by gram staining) and HIV (a single rapid test). VCT is also provided as part of the package of services. 4.172 BHUs, which provide syndromic management for STIs. 5.Two standalone VCT Centers (Health Information Service Center or HISC) at Thimphu and Phuntsholing where comprehensive VCT is provided and laboratory facilities are available for three rapid tests for HIV diagnosis. Outreach services to reach the more vulnerable populations with HIV prevention information is also provided through these Centers.

Kind of data

Sample survey data [ssd]

Sampling procedure

Following health facilities were sampled:

I. The National Referral Hospital in Thimphu, Public Health Laboratory in Thimphu, two Regional Referral Hospitals in Mongar and Gelephu and two stand-alone VCT Centers (HISC) in Thimphu and Phuntsholing. II. A random selection of District Hospitals and BHUs in three regions of Bhutan (east, west and central). For the selection of these sites the sample size calculation was done based on a standard formula used for health facility surveys.

The formula provided a sample size of 13 for District Hospitals. For each region (east, west and central), the number of District Hospitals to be sampled was calculated as a proportion based on the number of District Hospitals available in the region.

The formula provided a sample size of 45 for BHUs. For each region (east, west and central), the number of BHUs to be sampled was calculated as a proportion based on the number of BHUs available in the region.

The first health facility at the district and BHU level was selected based on random number method. The subsequent facilities were selected systematically based on the sampling interval until the required sample size was met in each region.

Mode of data collection

Face-to-face [f2f] and interviewer observation

Research instrument

Different sets of questionnaires were administered to service providers (prescribers) as shown below:

1. Survey of STI and HIV services (for BHU) - the questionnaire to assess the comprehensive, integrated services for STI and HIV.

2. Survey of STI and HIV services (for BHU Grade-I, District, Regional and JDW National Referral Hospitals) - the questionnaire to assess the comprehensive, integrated services for STI and HIV diagnosis, management and referral.

3. Survey of stand-alone VCT Centers (the HISC sites in Thimphu and Phuentsholing) - the questionnaire was specifically designed to assess the VCT services available at these two sites.

4. Survey of laboratories in the JDW National Referral Hospital, Public Health Laboratory and the two Regional Referral Hospitals - the questionnaires to assess the laboratory services available at these sites.

Each questionnaire was accompanied by a guideline, which was aimed at providing an understanding of the questions and what the appropriate response should be for each question. In some cases, the questions were open-ended and the guideline was designed to help the interviewer score the response although this may often have been subjective. Each question was scored and based on the score each sub-section was graded. The guideline also provided the appropriate score for each response.

The questionnaires were administered to the most senior staff at the facility and to other relevant personnel as deemed necessary. Also, in several instances direct observation were made to assess the situation and/or to corroborate responses. In those cases, the instructions provided in the questionnaire as well as the guidelines were followed. Direct observations, where conducted took precedence over response by senior staff.

Two sets of exit interviews (or client satisfaction questionnaires) were administered to the patients attending the facilities for comprehensive, integrated services for STI and HIV and with clients attending the VCT Centers. Each of these exit interview questionnaires were also accompanied by guidelines.

Cleaning operations

The entire field data and the scores were double checked on hard copies by the monitoring team before data entry. To ensure the accuracy and reliability of data, double entry of data was done using Epi Info. In addition, validity range of each response and consistency checks were incorporated in the data-entry screens. After completing double entry, data were compared using Epi Info and the entry errors were incorporated in the first entry. Further cleaning was done using Excel after which data files were converted into SPSS by using Stat transfer for analysis. Summary statistics (such as percentages, mean and median) were calculated.

Response rate

Response rate for health facilities is 100%

Data appraisal

Quality assurance of the survey was addressed by taking into consideration two issues:

1. A major concern with this survey was that several questions in the questionnaires were open-ended and scoring may have required subjective judgement. For this it was necessary to ensure that inter-interviewer variation was minimised. For this purpose, a thorough field-testing of the questionnaires after training was conducted. Any ambiguity found during the pre-testing was corrected in the guideline and the interviewers were re-trained using the corrected version.

2. In order to reduce interviewer bias, the health workers were assigned to conduct interviews in facilities, which were not their work place.

This data package contains the data about the number of individuals and of the medical procedures undergone by the individuals in a year, procedures that can be categorized as cardiac diagnosis or treatment procedures. In this data package can be found useful statistics related to cardiac procedures, crude rates and the adjusted rates of procedures at Hospital Referral Region in most of the cases and for defibrillator insertion at State, Hospital Service Areas and County level also.

Travel time surface was estimated using the cost allocation (friction surfaces) which used three primary input datasets on land surface characteristics that help or hinder travel speeds: land cover, roads and topography. This Geotiff is a 20-m spatial resolution surface where each pixel has a value which is the time in seconds to travel to the nearest hospital documented in the paper by Maina et al. (2020) doi: 10.1038/s41597-019-0142. According to the United Republic of Tanzania Ministry of Health and Social Welfare Health sector strategic plan (http://www.tzdpg.or.tz/fileadmin/documents/dpg_internal/dpg_working_groups_clusters/cluster_2/health/Key_Sector_Documents/Induction_Pack/Final_HSSP_IV_Vs1.0_260815.pdf) hospitals include (district hospital, designated hospital, regional and national referral hospitals) are found at the district level they can admit patients and provide basic medical services as well as advanced medical cares.

Assorted medicines and health supplies procured and delivered to LG units, General Hospitals, Regional Referral Hospitals ,National Referral Hospitals and specialised institutes(UBTS, UCI and UHI)

Dataset Description: This dataset contains materials from the Smart Discharges for Mom & Baby parent study within the Smart Discharges program of research. Materials include the parent study ethics protocol and associated documents. See the Metadata section below for links to related publications and datasets. Background: In low-income country settings, the first six weeks after birth remain a critical period of vulnerability for both mother and newborn. Despite recommendations for routine post-discharge follow-up, few mothers and newborns receive guideline recommended care during this period. Prediction modelling of post-delivery outcomes has the potential to improve outcomes for both mother and newborn by identifying high-risk dyads, improving risk communication, and facilitating a patient-centered approach to postnatal care. Methods: This is a mixed-methods study to explore and map the current postnatal discharge processes in Uganda.We will conduct an observational cohort study (Phase I) to develop and internally validate our risk score and aim to recruit 7,000 mother and newborn dyads from Jinja Regional Referral Hospital and Mbarara Regional Referral Hospital. We will also engage with patients, families, and health workers through patient journey mapping and focus group discussions (Phases II-IV) to identify barriers and facilitators to inform the development of an evidence- and risk-based bundle of interventions to improve postnatal care (PNC) for dyads. The primary outcome is maternal and/or neonatal death or need for re-admission within six weeks of birth. Secondary outcomes include: 1. Post-natal care visits during the 6-week post-discharge period 2. Post-discharge health seeking practices for mothers/newborns during the 6-week post-discharge period 3. Causes of readmission/mortality among those who experience such outcomes, based on verbal autopsies and admission symptom/diagnosis questionnaires. Data Collection Methods: All data will be collected at the point of care using encrypted study tablets. These data will be uploaded to a Research Electronic Data Capture (REDCap) database hosted at the BC Children’s Hospital Research Institute (Vancouver, Canada). At admission, trained study nurses will systematically collect data on clinical, social and demographic variables. Following discharge, field officers will contact mothers at 6-weeks post-discharge, to determine vital status, post-discharge health-seeking, and readmission details. Verbal autopsies were conducted for participants who had died following discharge. Direct observation and interviews will be conducted on a sub-set of participants to collect process outcomes and barriers and facilitators to the patient's journey. FGDs will be digitally recorded, transcribed verbatim in the language spoken during the recording and analyzed for emerging themes. Ethics Declaration: Ethics approvals have been obtained from the Makerere University School of Public Health (MakSPH) Institutional Review Board (SPH-2021-177), the Uganda National Council of Science and Technology (UNCST) in Uganda (HS2174ES) and the University of British Columbia in Canada (H21-03709). This study has been registered at clinicaltrials.gov (NCT05730387). Associated datasets: Pending publication NOTE for restricted files: If you are not yet a CoLab member, please complete our membership application survey to gain access to restricted files within 2 business days. Some files may remain restricted to CoLab members. These files are deemed more sensitive by the file owner and are meant to be shared on a case-by-case basis. Please contact the CoLab coordinator on this page under "collaborate with the pediatric sepsis colab."

Xpert MTB/RIF assay is a highly sensitive test for TB diagnosis, but still costly to most low-income countries. Several implementation strategies instead of frontline have been suggested; however with scarce data. We assessed accuracy of different Xpert MTB/RIF implementation strategies to inform national roll-out.This was a cross-sectional study of 1,924 adult presumptive TB patients in five regional referral hospitals of Uganda. Two sputum samples were collected, one for fluorescent microscopy (FM) and Xpert MTB/RIF examined at the study site laboratories. The second sample was sent to the Uganda Supra National TB reference laboratory for culture using both Lowenstein Jensen (LJ) and liquid culture (MGIT). We compared the sensitivities of FM, Xpert MTB/RIF and the incremental sensitivity of Xpert MTB/RIF among patients negative on FM using LJ and/or MGIT as a reference standard.A total 1924 patients were enrolled of which 1596 (83%) patients had at least one laboratory result and 1083 respondents had a complete set of all the laboratory results. A total of 328 (30%) were TB positive on LJ and /or MGIT culture. The sensitivity of FM was n (%; 95% confidence interval) 246 (63.5%; 57.9-68.7) overall compared to 52 (55.4%; 44.1-66.3) among HIV positive individuals, while the sensitivity of Xpert MTB/RIF was 300 (76.2%; 71.7-80.7) and 69 (71.6%; 60.5-81.1) overall and among HIV positive individuals respectively. Overall incremental sensitivity of Xpert MTB/RIF was 60 (36.5%; 27.7-46.0) and 20 (41.7%; 25.5-59.2) among HIV positive individuals.Xpert MTB/RIF has a higher sensitivity than FM both in general population and HIV positive population. Xpert MTB/RIF offers a significant increase in terms of diagnostic sensitivity even when it is deployed selectively i.e. among smear negative presumptive TB patients. Our results support frontline use of Xpert MTB/RIF assay in high HIV/TB prevalent countries. In settings with limited access, mechanisms to refer smear negative sputum samples to Xpert MTB/RIF hubs are recommended.

Abstract

After gaining independence in 1990, Namibia prioritized spending on social sectors such as education and health in order to address poverty and disparity in access to quality education and health care. The education and health sectors have received the highest budget allocations over the last three decades.

In order to evaluate efficiency of budget expenditures in health and education sectors, the Namibian government decided to implement Public Expenditure Tracking Survey (PETS) combined with Quantitative Service Delivery Survey (QSDS) in 2003. PETS methodology has been employed to analyze the distribution and use of financial resources at the national, sub-national and frontline service provider levels. The QSDS goes beyond tracing of funds and tries to explore the determinants of poor service delivery.

The guiding hypothesis for the survey was an assumption that actual service delivery is much worse than budgetary allocations would imply, because public funds do not reach the intended facilities as expected. As the result outcomes cannot improve. To verify this hypothesis, a sample of schools and health facilities in seven of Namibia's thirteen regions was randomly selected.

Documented here is the survey conducted in Namibia health sector. Enumerators obtained data from records from the Ministry of Health and Social Services, district health offices and health facilities. They also interviewed heads of health facilities, medical doctors, nurses and patients. Forty five health facilities in twelve districts were covered by the survey.

Geographic coverage

Hardap, Kavango, Khomas, Kunene, Omaheke, Omusati and Oshana regions

Analysis unit

• Ministry of Health and Social Services;
• regional health offices;
• health facilities;
• patients.

Kind of data

Sample survey data [ssd]

Sampling procedure

A convenient sample of seven of Namibia's thirteen administrative regions was chosen for the survey. Hardap, Kavango, Khomas, Kunene, Omaheke, Omusati and Oshana regions were selected.

The regions in Namibia are divided into health districts. The number of districts depends on the size of the region and varies between one and four. If regions had one or two health districts, all districts were part of the sample. If the number of districts was larger than two, investigators randomly chose two districts. In total, 12 districts were selected.

There were usually one hospital and one health centre in each district. Every hospital and health center in selected districts was included in the sample, while clinics were chosen randomly. Rundu, Windhoek and Aranos districts did not have district hospitals. Instead, they housed referral hospitals, specialized health facilities that cater for patients across regions and receive funds directly from the Ministry of Health and Social Services.

Overall, 48 facilities were selected: nine district hospitals, ten health centers, 25 clinics and four referral hospitals.

Researchers planned to interview the head of a health facility (clinic, health centre, hospital, referral hospital), two nurses (matrons at hospitals), two medical doctors, two patients at clinics, five patients at health centers, five inpatients and five outpatients at hospitals. However, it was not always possible to interview all of them. Since the Principal Medical Officer was the head of the hospital and was also in charge of the health district in general, enumerators interviewed him in his capacity as PMO to collect information on the district and not as head of the hospital. Instead, where possible, nurses were interviewed on general hospital matters.

All but three health facilities were covered. At one facility no one could be found, and staff at two others did not co-operate.

Mode of data collection

Face-to-face [f2f]

Research instrument

Questionnaires were developed for the Ministry of Health and Social Services, regional health directors, regional chief medical officers, principal medical officers, heads of health facilities, medical doctors, nurses and patients (both inpatients and outpatients).

A pilot survey covering six health facilities (three in Windhoek, two in Okahandja and one in Groot-Aub) was carried out to test the questionnaire. The pilot survey did not indicate any major problem with the questionnaires.