Use of risk-adjusted CUSUM charts to monitor 30-day mortality in Danish hospitals.

PubMed

Rasmussen, Thomas Bøjer; Ulrichsen, Sinna Pilgaard; Nørgaard, Mette

2018-01-01

Monitoring hospital outcomes and clinical processes as a measure of clinical performance is an integral part of modern health care. The risk-adjusted cumulative sum (CUSUM) chart is a frequently used sequential analysis technique that can be implemented to monitor a wide range of different types of outcomes. The aim of this study was to describe how risk-adjusted CUSUM charts based on population-based nationwide medical registers were used to monitor 30-day mortality in Danish hospitals and to give an example on how alarms of increased hospital mortality from the charts can guide further in-depth analyses. We used routinely collected administrative data from the Danish National Patient Registry and the Danish Civil Registration System to create risk-adjusted CUSUM charts. We monitored 30-day mortality after hospital admission with one of 77 selected diagnoses in 24 hospital units in Denmark in 2015. The charts were set to detect a 50% increase in 30-day mortality, and control limits were determined by simulations. Among 1,085,576 hospital admissions, 441,352 admissions had one of the 77 selected diagnoses as their primary diagnosis and were included in the risk-adjusted CUSUM charts. The charts yielded a total of eight alarms of increased mortality. The median of the hospitals' estimated average time to detect a 50% increase in 30-day mortality was 50 days (interquartile interval, 43;54). In the selected example of an alarm, descriptive analyses indicated performance problems with 30-day mortality following hip fracture surgery and diagnosis of chronic obstructive pulmonary disease. The presented implementation of risk-adjusted CUSUM charts can detect significant increases in 30-day mortality within 2 months, on average, in most Danish hospitals. Together with descriptive analyses, it was possible to use an alarm from a risk-adjusted CUSUM chart to identify potential performance problems.

Costs of day hospital and community residential chemical dependency treatment.

PubMed

Kaskutas, Lee Ann; Zavala, Silvana K; Parthasarathy, Sujaya; Witbrodt, Jane

2008-03-01

Patient placement criteria developed by the American Society of Addiction Medicine (ASAM) have identified a need for low-intensity residential treatment as an alternative to day hospital for patients with higher levels of severity. A recent clinical trial found similar outcomes at social model residential treatment and clinically-oriented day hospital programs, but did not report on costs. This paper addresses whether the similar outcomes in the recent trial were delivered with comparable costs, overall and within gender and ethnicity stratum. This paper reports on clients not at environmental risk who participated in a randomized trial conducted in three metropolitan areas served by a large pre-paid health plan. Cost data were collected using the Drug Abuse Treatment Cost Analysis Program (DATCAP). Costs per episode were calculated by multiplying DATCAP-derived program-specific costs by each client's length of stay. Differences in length of stay, and in per-episode costs, were compared between residential and day hospital subjects. Lengths of stay at residential treatment were significantly longer than at day hospital, in the sample overall and in disaggregated analyses. This difference was especially marked among non-Whites. The average cost per week was USD 575 per week at day hospital, versus USD 370 per week at the residential programs. However, because of the longer stays in residential, per-episode costs were significantly higher in the sample overall and among non-Whites (and marginally higher for men). These cost results must be considered in light of the null findings comparing outcomes between subjects randomized to residential versus day hospital programs. The longer stays in the sample overall and for non-White clients at residential programs came at higher costs but did not lead to better rates of abstinence. The short stays in day hospital among non-Whites call into question the attractiveness of day hospital for minority clients. Outcomes and costs

Does Day of Surgery Affect Hospital Length of Stay and Charges Following Minimally Invasive Transforaminal Lumbar Interbody Fusion?

PubMed

Hijji, Fady Y; Narain, Ankur S; Haws, Brittany E; Khechen, Benjamin; Kudaravalli, Krishna T; Yom, Kelly H; Singh, Kern

2018-06-01

Retrospective Cohort. To determine if an association exists between surgery day and length of stay or hospital costs after minimally invasive transforaminal lumbar interbody fusion (MIS TLIF). Length of inpatient stay after orthopedic procedures has been identified as a primary cost driver, and previous research has focused on determining risk factors for prolonged length of stay. In the arthroplasty literature, surgery performed later in the week has been identified as a predictor of increased length of stay. However, no such investigation has been performed for MIS TLIF. A surgical registry of patients undergoing MIS TLIF between 2008 and 2016 was retrospectively reviewed. Patients were grouped based on day of surgery, with groups including early surgery and late surgery. Day of surgery group was tested for an association with demographics and perioperative variables using the student t test or χ analysis. Day of surgery group was then tested for an association with direct hospital costs using multivariate linear regression. In total, 438 patients were analyzed. In total, 51.8% were in the early surgery group, and 48.2% were in the late surgery group. There were no differences in demographics between groups. There were no differences between groups with regard to operative time, intraoperative blood loss, length of stay, or discharge day. Finally, there were no differences in total hospital charges between early and late surgery groups (P=0.247). The specific day on which a MIS TLIF procedure occurs is not associated with differences in length of inpatient stay or total hospital costs. This suggests that the postoperative course after MIS TLIF procedures is not affected by the differences in hospital staffing that occurs on the weekend compared with weekdays.

Prediction of the intensity and diversity of day-to-day activities among people with schizophrenia using parameters obtained during acute hospitalization.

PubMed

Lipskaya-Velikovsky, Lena; Jarus, Tal; Kotler, Moshe

2017-06-01

Participation in day-to-day activities of people with schizophrenia is restricted, causing concern to them, their families, service providers and the communities at large. Participation is a significant component of health and recovery; however, factors predicting participation are still not well established. This study examines whether the parameters obtained during acute hospitalization can predict the intensity and diversity of participation in day-to-day activities six months after discharge. In-patients with chronic schizophrenia (N = 104) were enrolled into the study and assessed for cognitive functioning, functional capacity in instrumental activities of daily living (IADL), and symptoms. Six months after discharge, the intensity and diversity of participation in day-to-day activities were evaluated (N = 70). Multiple correlations were found between parameters obtained during hospitalization and participation diversity, but not participation intensity. The model that is better suited to the prediction of participation diversity contains cognitive ability of construction, negative symptoms and number of previous hospitalizations. The total explained variance is 37.8% (F 3,66  =   14.99, p < 0.001). This study provides evidence for ecological validity of the in-patient evaluation process for the prediction of participation diversity in day-to-day activities six months after discharge. Participation diversity is best predicted through a set of factors reflecting personal and environmental indicators. Implications for rehabilitation Results of in-patient evaluations can predict the diversity of participation in day-to-day activities six months after discharge. Higher prediction of participation diversity is obtained using a holistic evaluation model that includes assessments for cognitive abilities, negative symptoms severity and number of hospitalizations.

Hospital days, hospitalization costs, and inpatient mortality among patients with mucormycosis: a retrospective analysis of US hospital discharge data

PubMed Central

2014-01-01

Background Mucormycosis is a rare and potentially fatal fungal infection occurring primarily in severely immunosuppressed patients. Because it is so rare, reports in the literature are mainly limited to case reports or small case series. The aim of this study was to evaluate inpatient mortality, length of stay (LOS), and costs among a matched sample of high-risk patients with and without mucormycosis in a large nationally representative database. Methods We conducted a retrospective analysis using the 2003–2010 Healthcare Cost and Utilization Project – Nationwide Inpatient Sample (HCUP-NIS). The NIS is a nationally representative 20% sample of hospitalizations from acute care United States (US) hospitals, with survey weights available to compute national estimates. We classified hospitalizations into four mutually exclusive risk categories for mucormycosis: A- severely immunocompromised, B- critically ill, C- mildly/moderately immunocompromised, D- major surgery or pneumonia. Mucormycosis hospitalizations (“cases”) were identified by ICD-9-CM code 117.7. Non-mucormycosis hospitalizations (“non-cases”) were propensity-score matched to cases 3:1. We examined demographics, clinical characteristics, and hospital outcomes (mortality, LOS, costs). Weighted results were reported. Results From 319,366,817 total hospitalizations, 5,346 cases were matched to 15,999 non-cases. Cases and non-cases did not differ significantly in age (49.6 vs. 49.7 years), female sex (40.5% vs. 41.0%), White race (53.3% vs. 55.9%) or high-risk group (A-49.1% vs. 49.0%, B-20.0% vs. 21.8%, C-25.5% vs. 23.8%, D-5.5% vs. 5.4%). Cases experienced significantly higher mortality (22.1% vs. 4.4%, P < 0.001), with mean LOS and total costs more than 3-fold higher (24.5 vs. 8.0 days and $90,272 vs. $25,746; both P < 0.001). Conclusions In a national hospital database, hospitalizations with mucormycosis had significantly higher inpatient mortality, LOS, and hospital costs than matched

Predictors of thirty-day readmission among hospitalized family medicine patients.

PubMed

Garrison, Gregory M; Mansukhani, Meghna P; Bohn, Bradley

2013-01-01

Hospital readmissions within 30 days of initial discharge occur frequently. In studies of elderly patients receiving Medicare, readmissions have been associated with poor-quality inpatient care, ineffective hospital-to-home transitions, patient characteristics, disease burden, and socioeconomic status. Among adult family medicine patients spanning a wide age range, we hypothesize that previous hospitalizations, length of stay, number of discharge medications, medical comorbidities, and patient demographics are associated with a greater risk of hospital readmission within 30 days. A retrospective case-control study of 276 family medicine inpatients was conducted to determine the factors associated with 30-day readmission. Bivariate statistics were computed and a multivariate analysis using logistic regression was performed to determine the independent effects of each factor. Patients readmitted within 30 days had more hospitalizations, more emergency department visits, longer hospital stays, more comorbidities, and more discharge medications and were less likely to be married. Multivariate logistic regression found that hospitalization within the previous 12 months (odds ratio, 2.71) and long hospital stays (odds ratio, 2.16) were associated with 30-day readmission; being married (odds ratio, 0.54) had a protective effect. This study demonstrates that factors previously found to be associated with 30-day readmission among elderly patients receiving Medicare also apply to family medicine patients of all ages. It also demonstrates prior hospitalizations, length of stay, and marital status are useful proxies for many more complicated factors, such as disease burden, medical complexity, and social issues, that influence hospital readmission.

Predicting 7-day, 30-day and 60-day all-cause unplanned readmission: a case study of a Sydney hospital.

PubMed

Maali, Yashar; Perez-Concha, Oscar; Coiera, Enrico; Roffe, David; Day, Richard O; Gallego, Blanca

2018-01-04

The identification of patients at high risk of unplanned readmission is an important component of discharge planning strategies aimed at preventing unwanted returns to hospital. The aim of this study was to investigate the factors associated with unplanned readmission in a Sydney hospital. We developed and compared validated readmission risk scores using routinely collected hospital data to predict 7-day, 30-day and 60-day all-cause unplanned readmission. A combination of gradient boosted tree algorithms for variable selection and logistic regression models was used to build and validate readmission risk scores using medical records from 62,235 live discharges from a metropolitan hospital in Sydney, Australia. The scores had good calibration and fair discriminative performance with c-statistic of 0.71 for 7-day and for 30-day readmission, and 0.74 for 60-day. Previous history of healthcare utilization, urgency of the index admission, old age, comorbidities related to cancer, psychosis, and drug-abuse, abnormal pathology results at discharge, and being unmarried and a public patient were found to be important predictors in all models. Unplanned readmissions beyond 7 days were more strongly associated with longer hospital stays and older patients with higher number of comorbidities and higher use of acute care in the past year. This study demonstrates similar predictors and performance to previous risk scores of 30-day unplanned readmission. Shorter-term readmissions may have different causal pathways than 30-day readmission, and may, therefore, require different screening tools and interventions. This study also re-iterates the need to include more informative data elements to ensure the appropriateness of these risk scores in clinical practice.

Successful heart transplant after 1374 days living with a total artificial heart.

PubMed

Gerosa, Gino; Gallo, Michele; Bottio, Tomaso; Tarzia, Vincenzo

2016-04-01

The CardioWest Total Artificial Heart (CW-TAH) has been approved as a temporary device for bridge to cardiac transplantation and is under investigation for destination therapy by US Food and Drug Administration (FDA). We herein report the longest worldwide survival out of hospital (1374 days) of a patient supported with Cardio West Total Artificial Heart (CW-TAH). This experience is intended as a proof of concept of using CW-TAH as the destination therapy in patients with biventricular failure. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

Real association of factors with inappropriate hospital days.

PubMed

Huet, Bernard; Cauterman, Maxime

2005-01-01

Several studies of inappropriate (in the sense of the AEP) hospital days highlighted associations between two factors (rate of inappropriateness and reasons for inappropriateness, rate of inappropriateness and appropriate setting of care,..). The aim of this communication is to present a study on real associations, at constant factor, between five factors associated with hospital inappropriate days: medical management process, reason for inappropriateness, scheduled admission, rate of inappropriateness, length of stay. We used the European version of Appropriateness Evaluation Protocol for evaluation of inappropriate days and the French protocol ;for analysis of inappropriate days. The study set in three Parisian hospitals, four clinical departments, three specialities. 523 patients were included in the study, 5663 days were evaluated on a wide variety of pathologies: 27 Medical Management Processes. Results show that there are real associations (elimination of transitive associations) between five factors : medical management process and discharge processes, reason for inappropriateness, scheduled admission, rate of inappropriate days, length of stay. Multiple Correspondence Analysis on all "groups of contiguous days related with the same reason for inappropriateness" shows five profiles of queues integrating various medical management processes.

[Profitability of a day hospital: analysis of activity, cost and effectiveness].

PubMed

Hernando Ortiz, Lili; Hinojosa Mena-Bernal, Carmen; González Sarmiento, Enrique; González Guilabert, Isabel; Arana Ruiz, Jorge; Muñoz Moreno, M Fe

2012-01-01

Day hospitals are an alternative to conventional hospital care. We analyzed the functioning and profitability of the day hospital of Hospital Clínico de Valladolid, Spain, in 2009. Profitability is expressed as the provision of identical health coverage at a lower cost than that generated by conventional hospital care and with adequate quality indicators. We performed a retrospective, observational and descriptive study of the information obtained on each patient attended in the day hospital from January 1 to December 31, 2009. We studied four quality indicators: cancellation of meetings, the rate of transfusion reactions, the out-patient rate and the satisfaction index. The estimated savings for each process was calculated as the difference in the average cost of hospitalization minus the average cost of the process in the day hospital. The most frequent diseases were systemic and connective tissue diseases, accounting for 25.4% of the processes treated; of these, 17.1% corresponded to rheumatoid arthritis. Patient satisfaction was 93%. Meetings cancellations and the rate of transfusion reactions were 0%. The out-patient rate was 26%. Day hospital costs were 8.6% of conventional hospital costs, with savings of 78,390.69 euros. The day hospital is cost effective due to savings compared with conventional hospitalization and has a satisfactory quality index. Copyright © 2011 SESPAS. Published by Elsevier España, S.L. All rights reserved.

Magnitude of Anemia at Discharge Increases 30-Day Hospital Readmissions.

PubMed

Koch, Colleen G; Li, Liang; Sun, Zhiyuan; Hixson, Eric D; Tang, Anne; Chagin, Kevin; Kattan, Michael; Phillips, Shannon C; Blackstone, Eugene H; Henderson, J Michael

2017-12-01

Anemia during hospitalization is associated with poor health outcomes. Does anemia at discharge place patients at risk for hospital readmission within 30 days of discharge? Our objectives were to examine the prevalence and magnitude of anemia at hospital discharge and determine whether anemia at discharge was associated with 30-day readmissions among a cohort of hospitalizations in a single health care system. From January 1, 2009, to August 31, 2011, there were 152,757 eligible hospitalizations within a single health care system. The endpoint was any hospitalization within 30 days of discharge. The University HealthSystem Consortium's clinical database was used for demographics and comorbidities; hemoglobin values are from the hospitals' electronic medical records, and readmission status was obtained from the University HealthSystem Consortium administrative data systems. Mild anemia was defined as hemoglobin of greater than 11 to less than 12 g/dl in women and greater than 11 to less than 13 g/dl in men; moderate, greater than 9 to less than or equal to 11 g/dl; and severe, less than or equal to 9 g/dl. Logistic regression was used to assess the association of anemia and 30-day readmissions adjusted for demographics, comorbidity, and hospitalization type. Among 152,757 hospitalizations, 72% of patients were discharged with anemia: 31,903 (21%), mild; 52,971 (35%), moderate; and 25,522 (17%), severe. Discharge anemia was associated with severity-dependent increased odds for 30-day hospital readmission compared with those without anemia: for mild anemia, 1.74 (1.65-1.82); moderate anemia, 2.76 (2.64-2.89); and severe anemia, 3.47 (3.30-3.65), P < 0.001. Anemia at discharge is associated with a severity-dependent increased risk for 30-day readmission. A strategy focusing on anemia treatment care paths during index hospitalization offers an opportunity to influence subsequent readmissions.

[Day hospital in internal medicine: A chance for ambulatory care].

PubMed

Grasland, A; Mortier, E

2018-04-16

Internal medicine is an in-hospital speciality. Along with its expertise in rare diseases, it shares with general medicine the global care of patients but its place in the ambulatory shift has yet to be defined. The objective of our work was to evaluate the benefits of an internal medicine day-hospital devoted to general medicine. Named "Centre Vi'TAL" to underline the link between the city and the hospital, this novel activity was implemented in order to respond quickly to general practitioners having difficulties to synthesize their complex patients or facing diagnostic or therapeutic problems. Using preferentially email for communication, the general practitioners can contact an internist who is committed to respond on the same day and take over the patient within 7 days if day-hospital is appropriate for his condition. The other patients are directed either to the emergency department, consultation or full hospitalization. In 14 months, the center has received 213 (144 women, 69 men) patients, mean age 53.6, addressed by 88 general practitioners for 282 day-hospital sessions. Requests included problem diagnoses (n=105), synthesis reviews for complex patients (n=65), and treatment (n=43). In the ambulatory shift advocated by the authorities, this experience shows that internal medicine should engage in the recognition of day-hospital as a place for diagnosis and synthesis reviews connected with the city while leaving the general practitioners coordinator of their patient care. This activity of synthesis in day-hospital is useful for the patients and efficient for our healthcare system. Copyright © 2018 Société Nationale Française de Médecine Interne (SNFMI). Published by Elsevier SAS. All rights reserved.

Which Clinical and Patient Factors Influence the National Economic Burden of Hospital Readmissions After Total Joint Arthroplasty?

PubMed

Kurtz, Steven M; Lau, Edmund C; Ong, Kevin L; Adler, Edward M; Kolisek, Frank R; Manley, Michael T

2017-12-01

The Affordable Care Act of 2010 advanced the economic model of bundled payments for total joint arthroplasty (TJA), in which hospitals will be financially responsible for readmissions, typically at 90 days after surgery. However, little is known about the financial burden of readmissions and what patient, clinical, and hospital factors drive readmission costs. (1) What is the incidence, payer mix, and demographics of THA and TKA readmissions in the United States? (2) What patient, clinical, and hospital factors are associated with the cost of 30- and 90-day readmissions after primary THA and TKA? (3) Are there any differences in the economic burden of THA and TKA readmissions between payers? (4) What types of THA and TKA readmissions are most costly to the US hospital system? The recently developed Nationwide Readmissions Database from the Healthcare Cost and Utilization Project (2006 hospitals from 21 states) was used to identify 719,394 primary TJAs and 62,493 90-day readmissions in the first 9 months of 2013 based on International Classification of Diseases, 9th Revision, Clinical Modification codes. We classified the reasons for readmissions as either procedure- or medical-related. Cost-to-charge ratios supplied with the Nationwide Readmissions Database were used to compute the individual per-patient cost of 90-day readmissions as a continuous variable in separate general linear models for THA and TKA. Payer, patient, clinical, and hospital factors were treated as covariates. We estimated the national burden of readmissions by payer and by the reason for readmission. The national rates of 30- and 90-day readmissions after THA were 4% (95% confidence interval [CI], 4.2%-4.5%) and 8% (95% CI, 7.5%-8.1%), respectively. The national rates of 30- and 90-day readmissions after primary TKA were 4% (95% CI, 3.8%-4.0%) and 7% (95% CI, 6.8%-7.2%), respectively. The five most important variables responsible for the cost of 90-day THA readmissions (in rank order, based

Infants 1-90 days old hospitalized with human rhinovirus infection.

PubMed

Bender, Jeffrey M; Taylor, Charla S; Cumpio, Joven; Novak, Susan M; She, Rosemary C; Steinberg, Evan A; Marlowe, Elizabeth M

2014-09-01

Human rhinovirus (HRV) is a common cause of respiratory illness in children. The impact of HRV infection on 1- to 90-day-old infants is unclear. We hypothesized that HRV infection would be clinically similar to respiratory syncytial virus (RSV) infection in the hospitalized infants. We conducted a retrospective study of hospitalized infants, who were 1-90 days old, with HRV or RSV within the Southern California Kaiser Permanente network over a 1-year period (August 2010 to October 2011). We identified 245 hospitalized infants who underwent respiratory virus testing. HRV was found in 52 infants (21%) compared to 79 infants (32%) with RSV (P = 0.008). Infants with HRV infection experienced longer hospital stays compared to those with RSV (median length of stay 4 days vs. 3 days, P = 0.009) and had fewer short hospital stays ≤3 days (P = 0.029). There was a trend in infants with HRV infection to be younger (P = 0.071) and have more fevers (P = 0.052). Recent advances in diagnostics allow for identification of a broad range of viral pathogens in infants. Compared to RSV, HRV was associated with longer hospital stays. Additional studies and improved, more specific testing, methods are needed to further define the effects of HRV infection in infants 1-90 days old. © 2014 Wiley Periodicals, Inc.

Thirty-day readmission rates following hospitalization for pediatric sickle cell crisis at freestanding children's hospitals: risk factors and hospital variation.

PubMed

Sobota, Amy; Graham, Dionne A; Neufeld, Ellis J; Heeney, Matthew M

2012-01-01

Readmission within 30 days after hospitalization for sickle cell crisis was developed by The National Association of Children's Hospitals (NACHRI) to improve hospital quality, however, there have been few studies validating this. We performed a retrospective examination of 12,104 hospitalizations for sickle crisis from July 1, 2006 and December 31, 2008 at 33 freestanding children's hospitals in the Pediatric Health Information System (PHIS) database. Hospitalizations met NACHRI criteria; inpatient admission, APR DRG code 662, age < 18, discharge home, and length of stay within 2 SD of the mean. We describe 30-day readmission rates, identify factors associated with readmission accounting for patient-level clustering and compare unadjusted versus adjusted variation in readmission rates. We identified 4,762 patients with 12,104 qualifying hospitalizations (1-30 per patient). Two thousand seventy-four (17%) hospitalizations resulted in a readmission within 30 days. Significant factors associated with readmission were age (OR 1.06/year, P < 0.0001), inpatient use of steroids (OR 1.48, P = 0.01) admission for pain without other sickle complications (OR 1.52, P < 0.0001) and simple transfusion (OR 0.58, P = 0.0002). There was significant variation in readmission rates between hospitals, even after accounting for clustering by patient and hospital case mix. In a sample of free-standing children's hospitals, 17% of hospitalizations for sickle cell crisis result in readmission within 30 days. Older patients, those treated with steroids and those admitted for pain are more likely to be readmitted; simple transfusion is protective. Even after adjusting for case mix substantial hospital variation remains, but specific hospital to hospital comparisons differ depending on the exact methods used. Copyright © 2011 Wiley Periodicals, Inc.

Hospital performance measures and 30-day readmission rates.

PubMed

Stefan, Mihaela S; Pekow, Penelope S; Nsa, Wato; Priya, Aruna; Miller, Lauren E; Bratzler, Dale W; Rothberg, Michael B; Goldberg, Robert J; Baus, Kristie; Lindenauer, Peter K

2013-03-01

Lowering hospital readmission rates has become a primary target for the Centers for Medicare & Medicaid Services, but studies of the relationship between adherence to the recommended hospital care processes and readmission rates have provided inconsistent and inconclusive results. To examine the association between hospital performance on Medicare's Hospital Compare process quality measures and 30-day readmission rates for patients with acute myocardial infarction (AMI), heart failure and pneumonia, and for those undergoing major surgery. We assessed hospital performance on process measures using the 2007 Hospital Inpatient Quality Reporting Program. The process measures for each condition were aggregated in two separate measures: Overall Measure (OM) and Appropriate Care Measure (ACM) scores. Readmission rates were calculated using Medicare claims. Risk-standardized 30-day all-cause readmission rate was calculated as the ratio of predicted to expected rate standardized by the overall mean readmission rate. We calculated predicted readmission rate using hierarchical generalized linear models and adjusting for patient-level factors. Among patients aged ≥ 66 years, the median OM score ranged from 79.4 % for abdominal surgery to 95.7 % for AMI, and the median ACM scores ranged from 45.8 % for abdominal surgery to 87.9 % for AMI. We observed a statistically significant, but weak, correlation between performance scores and readmission rates for pneumonia (correlation coefficient R = 0.07), AMI (R = 0.10), and orthopedic surgery (R = 0.06). The difference in the mean readmission rate between hospitals in the 1st and 4th quartiles of process measure performance was statistically significant only for AMI (0.25 percentage points) and pneumonia (0.31 percentage points). Performance on process measures explained less than 1 % of hospital-level variation in readmission rates. Hospitals with greater adherence to recommended care processes did not achieve

Sex and racial/ethnic differences in the reason for 30-day readmission after COPD hospitalization.

PubMed

Goto, Tadahiro; Faridi, Mohammad Kamal; Gibo, Koichiro; Camargo, Carlos A; Hasegawa, Kohei

2017-10-01

Reduction of 30-day readmissions in patients hospitalized for chronic obstructive pulmonary disease (COPD) is a national objective. However, there is a dearth of research on sex and racial/ethnic differences in the reason for 30-day readmission. We conducted a retrospective cohort study using 2006-2012 data from the State Inpatient Database of eight geographically-diverse US states (Arkansas, California, Florida, Iowa, Nebraska, New York, Utah, and Washington). After identifying all hospitalizations for COPD made by patients aged ≥40 years, we investigated the primary diagnostic code for all-cause readmissions within 30 days after the original COPD hospitalization, among the overall group and by sex and race/ethnicity strata. Between 2006 and 2012, there was a total of 845,465 COPD hospitalizations at risk for 30-day readmissions in the eight states. COPD was the leading diagnostic for 30-day readmission after COPD hospitalization, both overall (28%) and across all sex and race/ethnicity strata. The proportion of respiratory diseases (COPD, pneumonia, respiratory failure, and asthma) as the readmission diagnosis was higher in non-Hispanic black (55%), compared to non-Hispanic white (52%) and Hispanics (51%) (p < 0.001). The proportion of asthma as the readmission diagnosis differed significantly by sex (6% in men and 9% in women; p < 0.001). Similarly, the proportion of asthma also differed significantly by race/ethnicity (5% in non-Hispanic white, 16% in non-Hispanic black, 15% in Hispanics, 13% in others; p < 0.001). In this analysis of all-payer population-based data, we found sex and racial/ethnic differences in the reason for 30-day readmission in patients hospitalized for COPD. Copyright © 2017 Elsevier Ltd. All rights reserved.

Reasons for Ninety-Day Emergency Visits and Readmissions After Elective Total Joint Arthroplasty: Results From a US Integrated Healthcare System.

PubMed

Kelly, Matthew P; Prentice, Heather A; Wang, Wei; Fasig, Brian H; Sheth, Dhiren S; Paxton, Elizabeth W

2018-07-01

Previous studies evaluating reasons for 30-day readmissions following total joint arthroplasty (TJA) may underestimate hospital-based utilization of healthcare resources during a patient's episode-of-care. We sought to identify common reasons for 90-day emergency department (ED) visits and hospital readmissions following primary elective unilateral TJA. Patients from July 1, 2012 through June 30, 2015 having primary elective TJA and at least one 90-day postoperative ED-only visit and/or readmission for any reason were identified using the Kaiser Permanente Total Joint Replacement Registry. Chart reviews for ED visits/readmissions included 13 surgical and 11 medical reasons. The 2344 total hips and 5520 total knees were analyzed separately. Incidence of at least one ED visit following total hip arthroplasty (THA) was 13.4% and 4.5% for readmissions. The most frequent reasons for ED visits were swelling (15.6%) and pain (12.8%); the most frequent reasons for readmissions were infection (12.5%) and unrelated elective procedures (9.0%). The incidence of at least one ED visit following total knee arthroplasty (TKA) was 13.8%, and the incidence of readmission was 5.5%. The most frequent reasons for ED visits were pain (15.8%) and swelling (15.6%); the most common readmission reasons were gastrointestinal (19.1%) and manipulation under anesthesia (9.4%). Swelling and pain related to the procedure were the most frequent reasons for 90-day ED visits after both THA and TKA. Readmissions were most commonly due to infection or unrelated procedures for THA and gastrointestinal or manipulation under anesthesia for TKA. Modifications to discharge protocols may help prevent or alleviate these issues, avoiding unnecessary hospital returns. Copyright © 2018 Elsevier Inc. All rights reserved.

Cause-Specific Hospital Admissions on Hot Days in Sydney, Australia

PubMed Central

Vaneckova, Pavla; Bambrick, Hilary

2013-01-01

Background While morbidity outcomes for major disease categories during extreme heat have received increasing research attention, there has been very limited investigation at the level of specific disease subcategories. Methodology/Principal Findings We analyzed daily hospital admissions for cardiovascular (CVD), respiratory (RD), genitourinary (GU) and mental diseases (MD), diabetes (DIA), dehydration (DEH) and ‘the effects of heat and light’ (HEAT) in Sydney between 1991 and 2009. We further investigated the sensitivity to heat of subcategories within the major disease groups. We defined hot days as those with temperatures in the 95th and 99th percentiles within the study period. We applied time-stratified case-crossover analysis to compare the hospital admissions on hot days with those on non-hot days matched by day of the week. We calculated the odds ratios (OR) of admissions between the two types of days, accounting for other environmental variables (relative humidity, ozone and particulate matter) and non-environmental trends (public and school holidays). On hot days, hospital admissions increased for all major categories except GU. This increase was not shared homogeneously across all diseases within a major category: within RD, only ‘other diseases of the respiratory system’ (includes pleurisy or empyema) increased significantly, while admissions for asthma decreased. Within MD, hospital admissions increased only for psychoses. Admissions due to some major categories increased one to three days after a hot day (e.g., DIA, RD and CVD) and on two and three consecutive days (e.g., HEAT and RD). Conclusions/Significance High ambient temperatures were associated with increased hospital admissions for several disease categories, with some within-category variation. Future analyses should focus on subgroups within broad disease categories to pinpoint medical conditions most affected by ambient heat. PMID:23408986

Total quality management in the hospital setting.

PubMed

Ernst, D F

1994-01-01

With the increasing demands on hospitals for improved quality and lower costs, hospitals have been forced to reevaluate their manner of operation and quality assurance (QA) programs. Hospitals have been faced with customer dissatisfaction with services, escalating costs, intense competition, and reduced reimbursement for services. As a result, many hospitals have incorporated total quality management (TQM), also known as continuous quality improvement (CQI) and quality improvement (QI), to improve quality care and decrease costs. This article examines the concept of TQM, its rationale, and how it can be implemented in a hospital. A comparison of TQM and QA is made. Examples of hospital implementation of TQM and problems and issues associated with TQM in the hospital setting are explored.

Hospital-Based Acute Care After Total Hip and Knee Arthroplasty: Implications for Quality Measurement.

PubMed

Trimba, Roman; Laughlin, Richard T; Krishnamurthy, Anil; Ross, Joseph S; Fox, Justin P

2016-03-01

Although hospital readmissions are being adopted as a quality measure after total hip or knee arthroplasty, they may fail accurately capture the patient's postdischarge experience. We studied 272,853 discharges from 517 hospitals to determine hospital emergency department (ED) visit and readmission rates. The hospital-level, 30-day, risk-standardized ED visit (median = 5.6% [2.4%-13.7%]) and hospital readmission (5.0% [2.6%-9.2%]) rates were similar and varied widely. A hospital's risk-standardized ED visit rate did not correlate with its readmission rate (r = -0.03, P = .50). If ED visits were included in a broader "readmission" measure, 246 (47.6%) hospitals would change perceived performance groups. Including ED visits in a broader, hospital-based, acute care measure may be warranted to better describe postdischarge health care utilization. Copyright © 2016 Elsevier Inc. All rights reserved.

Thirty-Day Readmission Rates Following Hospitalization for Pediatric Sickle Cell Crisis at Freestanding Children’s Hospitals: Risk Factors and Hospital Variation

PubMed Central

Sobota, Amy; Graham, Dionne A.; Neufeld, Ellis J.; Heeney, Matthew M.

2015-01-01

Background Readmission within 30 days after hospitalization for sickle cell crisis was developed by The National Association of Children’s Hospitals (NACHRI) to improve hospital quality, however, there have been few studies validating this. Procedure We performed a retrospective examination of 12,104 hospitalizations for sickle crisis from July 1, 2006 and December 31, 2008 at 33 freestanding children’s hospitals in the Pediatric Health Information System (PHIS) database. Hospitalizations met NACHRI criteria; inpatient admission, APR DRG code 662, age < 18, discharge home, and length of stay within 2 SD of the mean. We describe 30-day readmission rates, identify factors associated with readmission accounting for patient-level clustering and compare unadjusted versus adjusted variation in readmission rates. Results We identified 4,762 patients with 12,104 qualifying hospitalizations (1–30 per patient). Two thousand seventy-four (17%) hospitalizations resulted in a readmission within 30 days. Significant factors associated with readmission were age (OR 1.06/year, P < 0.0001), inpatient use of steroids (OR 1.48, P = 0.01) admission for pain without other sickle complications (OR 1.52, P < 0.0001) and simple transfusion (OR 0.58, P = 0.0002). There was significant variation in readmission rates between hospitals, even after accounting for clustering by patient and hospital case mix. Conclusions In a sample of free-standing children’s hospitals, 17% of hospitalizations for sickle cell crisis result in readmission within 30 days. Older patients, those treated with steroids and those admitted for pain are more likely to be readmitted; simple transfusion is protective. Even after adjusting for case mix substantial hospital variation remains, but specific hospital to hospital comparisons differ depending on the exact methods used. PMID:21674766

A comprehensive nutritional survey of hospitalized patients: Results from nutritionDay 2016 in China

PubMed Central

Zhang, Pianhong; Yu, Jianchun; Kang, Weiming; Guo, Shuli; Chen, Wei; Li, Xuqi; Wang, Shufeng; Chen, Lianzhen; Wu, Jianxiong; Tian, Zibin; Wu, Xianghua; Liu, Xiaosun; Liu, Yinghua

2018-01-01

Aims Prevalence of malnutrition is a common and serious issue responsible for the morbidity and mortality rate among hospitalized patients. We aimed to provide an actual and comprehensive situation of the nutritional characteristics, nutritional support and the risk factors for malnutrition among hospitalized patients in China. Methods We analyzed the data from nutritionDay audit 2016 in China. The international daylong cross-sectional survey was performed on November 10th, 2016 via filling out several questionnaires regarding information on patients’ illness, food intake history, weight change and nutritional care. Re-assessment of patients’ outcome questionnaire was performed 30 days later. Results Total of 781 patients from 9 hospitals and 8 kinds of departments were enrolled in this report. Of these, malnutrition rate was 29.6%. Parenteral nutrition (251/344, 73.0%) was the primary nutrition support form in Chinese hospitals. However, 41.8% (136/325) of patients at nutritional risk or already diagnosed with malnutrition did not received any form of nutritional support, whereas 34.0% (155/456) well-nourished patients did. Patients with malnutrition had extended length of hospital stay and poor 30-day outcomes compared to well-nourished patients. Nutritional support could benefit nutritional risk or malnutrition patients, rather than well-nourished patients. Moreover, major lesion types, self-related health, food intake last week were independent risk factors of malnutrition (all p<0.05). Conclusions Chinese hospital staff is generally lack of knowledge and awareness of malnutrition. Self-related health, major lesion types and food intake are associated with malnutrition. PMID:29566016

Day hospital for early intervention for individuals with psychotic disorders.

PubMed

Šago, Daniela; Filipčić, Igor; Lovretić, Vanja; Mayer, Nina

2018-06-01

In long-term outcome studies on individuals with first-episode psychosis, improved remission and recovery rates perhaps reflect the improved treatment in dedicated early intervention program. The first episode is a critical period in which individuals with psychosis, as well as members of their families, are confronted with the illness for the first time. Until nowadays, treatment of first psychotic episodes in Croatia has usually been provided in hospital setting. The day hospital provides comprehensive therapeutic approach that refers to early systematic application of all available and effective therapeutic methods in the initial phases of psychotic disorders, and aims to attain and maintain remission and recovery, as well as insight and adherence to treatment. The day hospital is a time-limited structured program that comprises diagnostic procedures, treatment and rehabilitation based on various group psychotherapy and socio-therapy approaches. It is cheaper than hospital treatment and preferred by patients and their families. The importance of involving family members along with patients in the therapeutic process is recognized. The aim of this paper is to present the first day hospital for early intervention and treatment of individuals with psychotic disorder, established within Psychiatric hospital "Sveti Ivan", Zagreb, Croatia.

Association of Hospital Costs With Complications Following Total Gastrectomy for Gastric Adenocarcinoma.

PubMed

Selby, Luke V; Gennarelli, Renee L; Schnorr, Geoffrey C; Solomon, Stephen B; Schattner, Mark A; Elkin, Elena B; Bach, Peter B; Strong, Vivian E

2017-10-01

Postoperative complications are associated with increased hospital costs following major surgery, but the mechanism by which they increase cost and the categories of care that drive this increase are poorly described. To describe the association of postoperative complications with hospital costs following total gastrectomy for gastric adenocarcinoma. This retrospective analysis of a prospectively collected gastric cancer surgery database at a single National Cancer Institute-designated comprehensive cancer center included all patients undergoing curative-intent total gastrectomy for gastric adenocarcinoma between January 2009 and December 2012 and was conducted in 2015 and 2016. Ninety-day normalized postoperative costs. Hospital accounting system costs were normalized to reflect Medicare reimbursement levels using the ratio of hospital costs to Medicare reimbursement and categorized into major cost categories. Differences between costs in Medicare proportional dollars (MP $) can be interpreted as the amount that would be reimbursed to an average hospital by Medicare if it paid differentially based on types and extent of postoperative complications. In total, 120 patients underwent curative-intent total gastrectomy for stage I through III gastric adenocarcinoma between 2009 and 2012. Of these, 79 patients (65.8%) were men, and the median (interquartile range) age was 64 (52-70) years. The 51 patients (42.5%) who underwent an uncomplicated total gastrectomy had a mean (SD) normalized cost of MP $12 330 (MP $2500), predominantly owing to the cost of surgical care (mean [SD] cost, MP $6830 [MP $1600]). The 34 patients (28.3%) who had a major complication had a mean (SD) normalized cost of MP $37 700 (MP $28 090). Surgical care was more expensive in these patients (mean [SD] cost, MP $8970 [MP $2750]) but was a smaller contributor to total cost (24%) owing to increased costs from room and board (mean [SD] cost, MP $11 940 [MP $8820]), consultations (mean [SD

Has Health Care Reform Legislation Reduced the Economic Burden of Hospital Readmissions Following Primary Total Joint Arthroplasty?

PubMed

Kurtz, Steven M; Lau, Edmund C; Ong, Kevin L; Adler, Edward M; Kolisek, Frank R; Manley, Michael T

2017-11-01

The purpose of this study was to determine whether the cost of readmissions after primary total hip and knee arthroplasty (THA and TKA) has decreased since the introduction of health care reform legislation and what patient, clinical, and hospital factors drive such costs. The 100% Medicare inpatient dataset was used to identify 1,654,602 primary THA and TKA procedures between 2010 and 2014. The per-patient cost of readmissions was evaluated in general linear models in which the year of surgery and patient, clinical, and hospital factors were treated as covariates in separate models for THA and TKA. The year-to-year risk of 90-day readmission was reduced by 2% and 4% (P < .001) for THA and TKA, respectively. By contrast, the cost of readmissions did not change significantly over time. The 5 most important variables associated with the cost of 90-day THA readmissions (in rank order) were the nature of the readmission (ie, due to medical or procedure-related reasons), the length of stay, hospital's teaching status, discharge disposition, and hospital's overall total joint arthroplasty volume. The top 5 factors associated with the cost of 90-day TKA readmissions were (in rank order) the length of stay, hospital's teaching status, discharge disposition, patient's gender, and age. Although readmission rates declined slightly, the results of this study do not support the hypothesis that readmission costs have decreased since the introduction of health care reform legislation. Instead, we found that clinical and hospital factors were among the most important cost drivers. Copyright © 2017 Elsevier Inc. All rights reserved.

Nursing Leaders' Satisfaction with Information Systems in the Day-to-Day Operations Management in Hospital Units.

PubMed

Peltonen, Laura-Maria; Junttila, Kristiina; Salanterä, Sanna

2018-01-01

Information usage in the day-to-day operations management of hospital units is complex due to numerous information systems in use. The aim of this study was to describe and compare nurse leaders' satisfaction with information systems used in the day-to-day operations management in hospital units. The design was a cross-sectional survey with five questions rated from one (disagree) to five (fully agree). The response rate was 65 % (n = 453). Respondents reported fair satisfaction with how information systems support decision-making (median 4, IQR 3-4) and improve ease of access to information (median 4, IQR 3-4). However, respondents were less satisfied with how systems improve speed of access to information (median 3, IQR 3-4). Nor did respondents think that systems were developed for them (median 3, IQR 2-4). Respondents further reported needing numerous systems daily to support decision-making (median 4, IQR 3-5). A clear need for one system, which would gather important information for display was stated (median 5, IQR 4-5). Work experience, gender and time when overseeing the unit were associated with some aspects related to satisfaction. In conclusion, information system improvements are needed to better support the day-to-day operations management in hospital units.

Eating disorders in individuals with type 1 diabetes: case series and day hospital treatment outcome.

PubMed

Colton, Patricia Anne; Olmsted, Marion Patricia; Wong, Harmonie; Rodin, Gary Michael

2015-07-01

Women with type 1 diabetes are at high risk for eating disorders (ED), a combination that can increase medical complications and mortality. As little is known about treatment response in this population, clinical presentation and treatment outcome in an extended case series were assessed. A chart review at the Eating Disorders Day Hospital Program at Toronto General Hospital identified a total of 100 individuals with type 1 diabetes assessed 1990-2012. Of 37 who attended day hospital, most experienced improvement in ED symptoms, but only 18.8% had a good immediate treatment outcome, while 43.8% had an intermediate outcome and 37.5% had a poor outcome (meeting diagnostic criteria at discharge). This is poorer than program outcomes in individuals without diabetes (χ(2)  = 12.2, df = 2; p = 0.002). Factors influencing treatment engagement and outcome must be further studied and used to improve treatment results in this high-risk group. Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.

The New York State risk score for predicting in-hospital/30-day mortality following percutaneous coronary intervention.

PubMed

Hannan, Edward L; Farrell, Louise Szypulski; Walford, Gary; Jacobs, Alice K; Berger, Peter B; Holmes, David R; Stamato, Nicholas J; Sharma, Samin; King, Spencer B

2013-06-01

This study sought to develop a percutaneous coronary intervention (PCI) risk score for in-hospital/30-day mortality. Risk scores are simplified linear scores that provide clinicians with quick estimates of patients' short-term mortality rates for informed consent and to determine the appropriate intervention. Earlier PCI risk scores were based on in-hospital mortality. However, for PCI, a substantial percentage of patients die within 30 days of the procedure after discharge. New York's Percutaneous Coronary Interventions Reporting System was used to develop an in-hospital/30-day logistic regression model for patients undergoing PCI in 2010, and this model was converted into a simple linear risk score that estimates mortality rates. The score was validated by applying it to 2009 New York PCI data. Subsequent analyses evaluated the ability of the score to predict complications and length of stay. A total of 54,223 patients were used to develop the risk score. There are 11 risk factors that make up the score, with risk factor scores ranging from 1 to 9, and the highest total score is 34. The score was validated based on patients undergoing PCI in the previous year, and accurately predicted mortality for all patients as well as patients who recently suffered a myocardial infarction (MI). The PCI risk score developed here enables clinicians to estimate in-hospital/30-day mortality very quickly and quite accurately. It accurately predicts mortality for patients undergoing PCI in the previous year and for MI patients, and is also moderately related to perioperative complications and length of stay. Copyright © 2013 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Unplanned 30-day hospital readmission as a quality measure in gynecologic oncology.

PubMed

Wilbur, MaryAnn B; Mannschreck, Diana B; Angarita, Ana M; Matsuno, Rayna K; Tanner, Edward J; Stone, Rebecca L; Levinson, Kimberly L; Temkin, Sarah M; Makary, Martin A; Leung, Curtis A; Deutschendorf, Amy; Pronovost, Peter J; Brown, Amy; Fader, Amanda N

2016-12-01

Thirty-day readmission is used as a quality measure for patient care and Medicare-based hospital reimbursement. The primary study objective was to describe the 30-day readmission rate to an academic gynecologic oncology service. Secondary objectives were to identify risk factors and costs related to readmission. This was a retrospective, concurrent cohort study of all surgical admissions to an academic, high volume gynecologic oncology service during a two-year period (2013-2014). Data were collected on patient demographics, medical comorbidities, psychosocial risk factors, and results from a hospital discharge screening survey. Mixed logistic regression was used to identify factors associated with 30-day readmission and costs of readmission were assessed. During the two-year study period, 1605 women underwent an index surgical admission. Among this population, a total of 177 readmissions (11.0%) in 135 unique patients occurred. In a surgical subpopulation with >1 night stay, a readmission rate of 20.9% was observed. The mean interval to readmission was 11.8days (SD 10.7) and mean length of readmission stay was 5.1days (SD 5.0). Factors associated with readmission included radical surgery for ovarian cancer (OR 2.87) or cervical cancer (OR 4.33), creation of an ostomy (OR 11.44), a Charlson score of ≥5 (OR 2.15), a language barrier (OR 3.36), a median household income in the lowest quartile (OR 6.49), and a positive discharge screen (OR 2.85). The mean cost per readmission was $25,416 (SD $26,736), with the highest costs associated with gastrointestinal complications at $32,432 (SD $32,148). The total readmission-related costs during the study period were $4,523,959. Readmissions to a high volume gynecologic oncology service were costly and related to radical surgery for ovarian and cervical cancer as well as to medical, socioeconomic and psychosocial patient variables. These data may inform interventional studies aimed at decreasing unplanned readmissions in

[The structural functional analysis of functioning of day-hospitals of the Russian Federation].

PubMed

2012-01-01

The article deals with the results of structural functional analysis of functioning of day-hospitals in the Russian Federation. The dynamic analysis is presented concerning day-hospitals' network, capacity; financial support, beds stock structure, treated patients structure, volumes of diagnostic tests and curative procedures. The need in developing of population medical care in conditions of day-hospitals is demonstrated.

Postoperative day 1 levels of parathyroid as predictor of occurrence and severity of hypocalcaemia after total thyroidectomy.

PubMed

Karatzanis, Alexander D; Ierodiakonou, Despo P; Fountakis, Emmanuel S; Velegrakis, Stylianos G; Doulaptsi, Maria V; Prokopakis, Emmanuel P; Daraki, Vasiliki N; Velegrakis, George A

2018-05-01

Hypocalcaemia is a common and serious complication after thyroidectomy. The purpose of this study is to assess the effectiveness of first postoperative day parathyroid hormone (PTH) measurement in order to predict the presence and severity of postthyroidectomy hypocalcaemia. One hundred consecutive cases undergoing total thyroidectomy in a tertiary referral center were prospectively assessed. Preoperative measurements of PTH were compared with postoperative levels in the first morning after surgery. All cases of hypocalcaemia were recorded and evaluated with regard to preoperative and postoperative levels of PTH. A decrease of 56% of PTH levels on the first postoperative day could accurately predict postoperative hypocalcaemia with a sensitivity and specificity of 80%. Serum PTH levels on the first postoperative day may be used as a reliable predictive marker for calcium supplementation need and even prolonged hospitalization in cases undergoing total thyroidectomy. © 2018 Wiley Periodicals, Inc.

Effect of an Indwelling Pleural Catheter vs Talc Pleurodesis on Hospitalization Days in Patients With Malignant Pleural Effusion

PubMed Central

Thomas, Rajesh; Fysh, Edward T. H.; Smith, Nicola A.; Lee, Pyng; Kwan, Benjamin C. H.; Yap, Elaine; Horwood, Fiona C.; Piccolo, Francesco; Lam, David C. L.; Garske, Luke A.; Shrestha, Ranjan; Kosky, Christopher; Read, Catherine A.; Murray, Kevin

2017-01-01

Importance Indwelling pleural catheter and talc pleurodesis are established treatments for malignant pleural effusions among patients with poor prognosis. Objective To determine whether indwelling pleural catheters are more effective than talc pleurodesis in reducing total hospitalization days in the remaining lifespan of patients with malignant pleural effusion. Design, Setting, and Participants This open-label, randomized clinical trial included participants recruited from 9 centers in Australia, New Zealand, Singapore, and Hong Kong between July 2012 and October 2014; they were followed up for 12 months (study end date: October 16, 2015). Patients (n = 146) with symptomatic malignant pleural effusion who had not undergone indwelling pleural catheter or pleurodesis treatment were included. Interventions Participants were randomized (1:1) to indwelling pleural catheter (n = 74) or talc pleurodesis (n = 72), minimized by malignancy (mesothelioma vs others) and trapped lung (vs not), and stratified by region (Australia vs Asia). Main Outcomes and Measures The primary end point was the total number of days spent in hospital from procedure to death or to 12 months. Secondary outcomes included further pleural interventions, patient-reported breathlessness, quality-of-life measures, and adverse events. Results Among the 146 patients who were randomized (median age, 70.5 years; 56.2% male), 2 withdrew before receiving the randomized intervention and were excluded. The indwelling pleural catheter group spent significantly fewer days in hospital than the pleurodesis group (median, 10.0 [interquartile range [IQR], 3-17] vs 12.0 [IQR, 7-21] days; P = .03; Hodges-Lehmann estimate of difference, 2.92 days; 95% CI, 0.43-5.84). The reduction was mainly in effusion-related hospitalization days (median, 1.0 [IQR, 1-3] day with the indwelling pleural catheter vs 4.0 (IQR, 3-6) days with pleurodesis; P < .001; Hodges-Lehmann estimate, 2.06 days; 95% CI, 1

The number of discharge medications predicts thirty-day hospital readmission: a cohort study.

PubMed

Picker, David; Heard, Kevin; Bailey, Thomas C; Martin, Nathan R; LaRossa, Gina N; Kollef, Marin H

2015-07-23

Hospital readmission occurs often and is difficult to predict. Polypharmacy has been identified as a potential risk factor for hospital readmission. However, the overall impact of the number of discharge medications on hospital readmission is still undefined. To determine whether the number of discharge medications is predictive of thirty-day readmission using a retrospective cohort study design performed at Barnes-Jewish Hospital from January 15, 2013 to May 9, 2013. The primary outcome assessed was thirty-day hospital readmission. We also assessed potential predictors of thirty-day readmission to include the number of discharge medications. The final cohort had 5507 patients of which 1147 (20.8 %) were readmitted within thirty days of their hospital discharge date. The number of discharge medications was significantly greater for patients having a thirty-day readmission compared to those without a thirty-day readmission (7.2 ± 4.1 medications [7.0 medications (4.0 medications, 10.0 medications)] versus 6.0 ± 3.9 medications [6.0 medications (3.0 medications, 9.0 medications)]; P < 0.001). There was a statistically significant association between increasing numbers of discharge medications and the prevalence of thirty-day hospital readmission (P < 0.001). Multiple logistic regression identified more than six discharge medications to be independently associated with thirty-day readmission (OR, 1.26; 95 % CI, 1.17-1.36; P = 0.003). Other independent predictors of thirty-day readmission were: more than one emergency department visit in the previous six months, a minimum hemoglobin value less than or equal to 9 g/dL, presence of congestive heart failure, peripheral vascular disease, cirrhosis, and metastatic cancer. A risk score for thirty-day readmission derived from the logistic regression model had good predictive accuracy (AUROC = 0.661 [95 % CI, 0.643-0.679]). The number of discharge medications is associated with the prevalence of thirty-day hospital

Within-Hospital Variation in 30-Day Adverse Events: Implications for Measuring Quality.

PubMed

Burke, Robert E; Glorioso, Thomas; Barón, Anna K; Kaboli, Peter J; Ho, P Michael

Novel measures of hospital quality are needed. Because quality improvement efforts seek to reduce variability in processes and outcomes, hospitals with higher variability in adverse events may be delivering poorer quality care. We sought to evaluate whether within-hospital variability in adverse events after a procedure might function as a quality metric that is correlated with facility-level mortality rates. We analyzed all percutaneous coronary interventions (PCIs) performed in the Veterans Health Administration (VHA) system from 2007 to 2013 to evaluate the correlation between within-hospital variability in 30-day postdischarge adverse events (readmission, emergency department visit, and repeat revascularization), and facility-level mortality rates, after adjustment for patient demographics, comorbidities, PCI indication, and PCI urgency. The study cohort included 47,567 patients at 48 VHA hospitals. The overall 30-day adverse event rate was 22.0% and 1-year mortality rate was 4.9%. The most variable sites had relative changes of 20% in 30-day rates of adverse events period-to-period. However, within-hospital variability in 30-day events was not correlated with 1-year mortality rates (correlation coefficient = .06; p = .66). Thus, measuring within-hospital variability in postdischarge adverse events may not improve identification of low-performing hospitals. Evaluation in other conditions, populations, and in relationship with other quality metrics may reveal stronger correlations with care quality.

Cost Determinants in the 90-Day Management of Isolated Ankle Fractures at a Large Urban Academic Hospital.

PubMed

Varacallo, Matthew; Mattern, Patrick; Acosta, Jonathan; Toossi, Nader; Denehy, Kevin; Harding, Susan

2018-05-03

To determine the independent risk factors associated with increasing costs and unplanned hospital readmissions in the 90-day episode of care (EOC) for isolated operative ankle fractures at our institution. Retrospective cohort study SETTING:: Level I Trauma Center PATIENTS:: Two hundred ninety-nine patients undergoing open reduction internal fixation (ORIF) for the treatment of an acute, isolated ankle fracture between 2010 and 2015. none MAIN OUTCOME MEASUREMENTS:: Independent risk factors for increasing 90-day EOC costs and unplanned hospital readmission rates. Orthopedic (64.9%) and podiatry (35.1%) patients were included. The mean index admission cost was $14,048.65 ± $5,797.48. Outpatient cases were significantly cheaper compared to inpatient cases ($10,164.22 ± $3,899.61 versus $15,942.55 ± $5,630.85, respectively, p < 0.001).Unplanned readmission rates were 5.4% (16/299) and 6.7% (20/299) at 30- and 90-days, respectively, and were often (13/20, 65.0%) due to surgical site infections. Independent risk factors for unplanned hospital readmissions included treatment by the podiatry service (p = 0.024), and an American Society of Anesthesiologists (ASA) score of ≥ 3 (p = 0.017). Risk factors for increasing total post discharge costs included treatment by the podiatry service (p = 0.011), and male gender (p = 0.046). Isolated operative ankle fractures are a prime target for EOC cost containment strategy protocols. Our institutional cost analysis study suggests that independent financial clinical risk factors in this treatment cohort includes podiatry as the treating surgical service and patients with an ASA score ≥ 3, with the former also independently increasing total post-discharge costs in the 90-day EOC. Outpatient procedures were associated with about a one-third reduction in total costs compared to the inpatient subgroup.

[Use of intravenous iron infusion in a gastroenterology day hospital: Indications, dosage and adverse effects].

PubMed

Dosal, Angelina; Calvet, Xavier; Moreno, Laura; López, María; Figuerola, Ariadna; Ruíz, Miquel Angel; Suárez, David; Gené, Emili; Miquel, Mireia; Villoria, Albert

2010-01-01

There are no data in the literature on the use of intravenous iron infusion in gastroenterology day hospitals. To determine the indications, dosage and tolerance of intravenous iron infusion in outpatients attending a gastroenterology day hospital. We retrospectively reviewed the medical records of patients who received intravenous iron infusion between August 2007 and July 2008. The indications, dosage, transfusion requirements, adverse effects and patients' clinical and laboratory data were recorded. During the study period, 111 patients (41% women, with a mean age of 63.8 ± 18 years) received intravenous iron infusions. The main causes of anemia indicating iron administration were portal hypertensive gastropathy (n=55), inflammatory bowel disease (n=22) and intestinal angiodysplasia (n=12). The patients received a total of 557 iron infusions with a mean dose of 1033 mg iron per patient. There were no adverse effects. Despite the treatment, 46 patients required transfusion. Iron and transfusion requirements and mortality were significantly higher in patients with liver cirrhosis than in the remainder of the study group. Intravenous iron therapy is frequently used in the gastroenterology day hospital. Most infusions were administered in patients with chronic iron loss. Patients with liver cirrhosis had the most severe anemia and underlying disease and the highest mortality.

Trends in total hospital financial performance under the prospective payment system.

PubMed

Fisher, C R

1992-01-01

In this article, the author examines trends in determinants of total hospital facility revenues, expenses, and net profits during the period 1977-89. Measures of change in transaction prices are developed, which enable an analysis of trends in real hospital outputs and total factor productivity. The main source of hospital spending growth in excess of the gross national product is identified as growth in hospital employee compensation.

Problems in the evaluation of day hospitals.

PubMed

Guy, W; Gross, G M

1967-06-01

The day hospital has been utilized as a means both to maintain and improve remission status of previously hospitalized patients and, more recently, as an alternative to inpatient treatment. Although uniformly encouraging, the reports of treatment success are ambiguous and complicated by the recency and diversity of the programs. Proposals to reduce confusion in the areas of identification of population, definition of treatment, treatment effects, and assessment procedures are discussed. The concept of therapeutic community with its emphasis on socialization processes makes symptom reduction alone an insufficient criterion of treatment success. More comprehensive measures of the permanency of remission and quality of social adjustment are advocated.

A total quality management approach to healthcare waste management in Namazi Hospital, Iran.

PubMed

Askarian, Mehrdad; Heidarpoor, Peigham; Assadian, Ojan

2010-11-01

Healthcare waste comprises all wastes generated at healthcare facilities, medical research centers and laboratories. Although 75-90% of these wastes are classified as household waste posing no potential risk, 10-25% are deemed to be hazardous, representing a potential threat to healthcare workers, patients, the environment and even the general population, if not disposed of appropriately. If hazardous and non-hazardous waste is mixed and not segregated prior to disposal, costs will increase substantially. Medical waste management is a worldwide issue. In Iran, the majority of problems are associated with an exponential growth in the healthcare sector together with low- or non-compliance with guidelines and recommendations. The aim of this study was to reduce the amounts of infectious waste by clear definition and segregation of waste at the production site in Namazi Hospital in Shiraz, Iran. Namazi Hospital was selected as a study site with an aim to achieving a significant decrease in infectious waste and implementing a total quality management (TQM) method. Infectious and non-infectious waste was weighed at 29 admission wards over a 1-month period. Before the introduction of the new guidelines and the new waste management concept, weight of total waste was 6.67 kg per occupied bed per day (kg/occupied bed/day), of which 73% was infectious and 27% non-infectious waste. After intervention, total waste was reduced to 5.92 kg/occupied bed/day, of which infectious waste represented 61% and non-infectious waste 30%. The implementation of a new waste management concept achieved a 26% reduction in infectious waste. A structured waste management concept together with clear definitions and staff training will result in waste reduction, consequently leading to decreased expenditure in healthcare settings. Copyright © 2010 Elsevier Ltd. All rights reserved.

Hospital economics of primary total knee arthroplasty at a teaching hospital.

PubMed

Healy, William L; Rana, Adam J; Iorio, Richard

2011-01-01

The hospital cost of total knee arthroplasty (TKA) in the United States is a major growing expense for the Centers for Medicare & Medicaid Services (CMS). Many hospitals are unable to deliver TKA with profitable or breakeven economics under the current Diagnosis-Related Group (DRG) hospital reimbursement system. The purposes of the current study were to (1) determine revenue, expenses, and profitability (loss) for TKA for all patients and for different payors; (2) define changes in utilization and unit costs associated with this operation; and (3) describe TKA cost control strategies to provide insight for hospitals to improve their economic results for TKA. From 1991 to 2009, Lahey Clinic converted a $2172 loss per case on primary TKA in 1991 to a $2986 profit per case in 2008. The improved economics was associated with decreasing revenue in inflation-adjusted dollars and implementation of hospital cost control programs that reduced hospital expenses for TKA. Reduction of hospital length of stay and reduction of knee implant costs were the major drivers of hospital expense reduction. During the last 25 years, our economic experience with TKA is concerning. Hospital revenues have lagged behind inflation, hospital expenses have been reduced, and our institution is earning a profit. However, the margin for TKA is decreasing and Managed Medicare patients do not generate a profit. The erosion of hospital revenue for TKA will become a critical issue if it leads to economic losses for hospitals or reduced access to TKA. Level III, Economic and Decision Analyses. See Guidelines for Authors for a complete description of levels of evidence.

Patterns of Ninety-Day Readmissions Following Total Joint Replacement in a Bundled Payment Initiative.

PubMed

Behery, Omar A; Kester, Benjamin S; Williams, Jarrett; Bosco, Joseph A; Slover, James D; Iorio, Richard; Schwarzkopf, Ran

2017-04-01

Alternative payment models aim to improve quality and decrease costs associated with total joint replacement. Postoperative readmissions within 90 days are of interest to clinicians and administrators as there is no additional reimbursement beyond the episode bundled payment target price. The aim of this study is to improve the understanding of the patterns of readmission which would better guide perioperative patient management affecting readmissions. We hypothesize that readmissions have different timing, location, and patient health profile patterns based on whether the readmission is related to a medical or surgical diagnosis. A retrospective cohort of 80 readmissions out of 1412 total joint replacement patients reimbursed through a bundled payment plan was analyzed. Patients were grouped by readmission diagnosis (surgical or medical) and the main variables analyzed were time to readmission, location of readmission, and baseline Perioperative Orthopaedic Surgical Home and American Society of Anesthesiologists scores capturing pre-existing state of health. Nonparametric tests and multivariable regressions were used to test associations. Surgical readmissions occurred earlier than medical readmissions (mean 18 vs 33 days, P = .011), and were more likely to occur at the hospital where the surgery was performed (P = .035). Perioperative Orthopaedic Surgical Home and American Society of Anesthesiologists scores did not predict medical vs surgical readmissions (P = .466 and .879) after adjusting for confounding variables. Readmissions appear to follow different patterns depending on whether they are surgical or medical. Surgical readmissions occur earlier than medical readmissions, and more often at the hospital where the surgery was performed. The results of this study suggest that these 2 types of readmissions have different patterns with different implications toward perioperative care and follow-up after total joint replacement. Copyright © 2016 Elsevier Inc

Trends in total hospital financial performance under the prospective payment system

PubMed Central

Fisher, Charles R.

1992-01-01

In this article, the author examines trends in determinants of total hospital facility revenues, expenses, and net profits during the period 1977-89. Measures of change in transaction prices are developed, which enable an analysis of trends in real hospital outputs and total factor productivity. The main source of hospital spending growth in excess of the gross national product is identified as growth in hospital employee compensation. PMID:10120176

Skilled Nursing Facility Partnerships May Decrease 90-Day Costs in a Total Joint Arthroplasty Episode Under the Bundled Payments for Care Improvement Initiative.

PubMed

Behery, Omar A; Kouk, Shalen; Chen, Kevin K; Mullaly, Kathleen A; Bosco, Joseph A; Slover, James D; Iorio, Richard; Schwarzkopf, Ran

2018-03-01

The Bundled Payments for Care Improvement initiative was developed to reduce costs associated with total joint arthroplasty through a single payment for all patient care from index admission through a 90-day post-discharge period, including care at skilled nursing facilities (SNFs). The aim of this study is to investigate whether forming partnerships between hospitals and SNFs could lower the post-discharge costs. We hypothesize that institutionally aligned SNFs have lower post-discharge costs than non-aligned SNFs. A cohort of 615 elective, primary total hip and knee arthroplasty subjects discharged to an SNF under the Bundled Payments for Care Improvement from 2014 to 2016 were included in our analysis. Patients were grouped into one of the 3 categories of SNF alignment: group 1: non-partners; group 2: agreement-based partners; group 3: institution-owned partners. Demographics, comorbidities, length of stay (LOS) at SNF, and associated costs during the 90-day post-operative period were compared between the 3 groups. Mean index hospital LOS was statistically shortest in group 3 (mean 2.7 days vs 3.5 for groups 1 and 2, P = .001). SNF LOS was also shortest in group 3 (mean 11 days vs 19 and 21 days in groups 2 and 1 respectively, P < .001). Total SNF costs and total 90-day costs were both significantly lower in group 3 compared with groups 1 and 2 (P < .001 for all), even after controlling for medical comorbidities. Institution-owned partner SNFs demonstrated the shortest patient LOS, and the lowest SNF and total 90-day costs, without increased risk of readmissions, compared with other SNFs. Copyright © 2017 Elsevier Inc. All rights reserved.

30-day hospital readmission after robotic partial nephrectomy--are we prepared for Medicare readmission reduction program?

PubMed

Brandao, Luis Felipe; Zargar, Homayoun; Laydner, Humberto; Akca, Oktay; Autorino, Riccardo; Ko, Oliver; Samarasekera, Dinesh; Li, Jianbo; Rabets, John; Krishnan, Jayram; Haber, Georges-Pascal; Kaouk, Jihad; Stein, Robert J

2014-09-01

After CMS introduced the concept of the Hospital Readmissions Reduction Program, hospitals and health care centers became financially penalized for exceeding specific readmission rates. We retrospectively reviewed our institutional review board approved database of patients undergoing robotic partial nephrectomy at our institution and included in our analysis patients who were readmitted to any hospital as an inpatient stay within 30 days from discharge home after robotic partial nephrectomy. From March 2006 to March 2013 a total of 627 patients underwent robotic partial nephrectomy at our center and 28 (4.46%) were readmitted within 30 days of surgery. Postoperative bleeding was responsible for 8 (28.5%) readmissions. Pulmonary embolism was reported in 3 cases and retroperitoneal abscess was diagnosed in 2. Urinary leak requiring surgical intervention developed in 2 patients, pneumonia was diagnosed in 2 and 2 patients were readmitted for chest pain. Overall 9 (32.1%) patients presented with major complications requiring intervention. On multivariable analysis Charlson comorbidity index score was the only factor significantly associated with a higher 30-day readmission rate (p = 0.03). If the Charlson score was 5 or greater the chance of hospital readmission would be 2.7 times higher. Increased comorbidity, specifically a Charlson score of 5 or greater, was the only significant predictor of a higher incidence of 30-day readmission. This information can be useful in counseling patients regarding robotic partial nephrectomy and in determining baseline rates if CMS expands the number of conditions they evaluate for excess 30-day readmissions. Copyright © 2014 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

External validation of a multivariable claims-based rule for predicting in-hospital mortality and 30-day post-pulmonary embolism complications.

PubMed

Coleman, Craig I; Peacock, W Frank; Fermann, Gregory J; Crivera, Concetta; Weeda, Erin R; Hull, Michael; DuCharme, Mary; Becker, Laura; Schein, Jeff R

2016-10-22

Low-risk pulmonary embolism (PE) patients may be candidates for outpatient treatment or abbreviated hospital stay. There is a need for a claims-based prediction rule that payers/hospitals can use to risk stratify PE patients. We sought to validate the In-hospital Mortality for PulmonAry embolism using Claims daTa (IMPACT) prediction rule for in-hospital and 30-day outcomes. We used the Optum Research Database from 1/2008-3/2015 and included adults hospitalized for PE (415.1x in the primary position or secondary position when accompanied by a primary code for a PE complication) and having continuous medical and prescription coverage for ≥6-months prior and 3-months post-inclusion or until death. In-hospital and 30-day mortality and 30-day complications (recurrent venous thromboembolism, rehospitalization or death) were assessed and prognostic accuracies of IMPACT with 95 % confidence intervals (CIs) were calculated. In total, 47,531 PE patients were included. In-hospital and 30-day mortality occurred in 7.9 and 9.4 % of patients and 20.8 % experienced any complication within 30-days. Of the 19.5 % of patients classified as low-risk by IMPACT, 2.0 % died in-hospital, resulting in a sensitivity and specificity of 95.2 % (95 % CI, 94.4-95.8) and 20.7 % (95 % CI, 20.4-21.1). Only 1 additional low-risk patient died within 30-days of admission and 12.2 % experienced a complication, translating into a sensitivity and specificity of 95.9 % (95 % CI, 95.3-96.5) and 21.1 % (95 % CI, 20.7-21.5) for mortality and 88.5 % (95 % CI, 87.9-89.2) and 21.6 % (95 % CI, 21.2-22.0) for any complication. IMPACT had acceptable sensitivity for predicting in-hospital and 30-day mortality or complications and may be valuable for retrospective risk stratification of PE patients.

What is a hospital bed day worth? A contingent valuation study of hospital Chief Executive Officers.

PubMed

Page, Katie; Barnett, Adrain G; Graves, Nicholas

2017-02-14

Decreasing hospital length of stay, and so freeing up hospital beds, represents an important cost saving which is often used in economic evaluations. The savings need to be accurately quantified in order to make optimal health care resource allocation decisions. Traditionally the accounting cost of a bed is used. We argue instead that the economic cost of a bed day is the better value for making resource decisions, and we describe our valuation method and estimations for costing this important resource. We performed a contingent valuation using 37 Australian Chief Executive Officers' (CEOs) willingness to pay (WTP) to release bed days in their hospitals, both generally and using specific cases. We provide a succinct thematic analysis from qualitative interviews post survey completion, which provide insight into the decision making process. On average CEOs are willing to pay a marginal rate of $216 for a ward bed day and $436 for an Intensive Care Unit (ICU) bed day, with estimates of uncertainty being greater for ICU beds. These estimates are significantly lower (four times for ward beds and seven times for ICU beds) than the traditional accounting costs often used. Key themes to emerge from the interviews include the importance of national funding and targets, and their associated incentive structures, as well as the aversion to discuss bed days as an economic resource. This study highlights the importance for valuing bed days as an economic resource to inform cost effectiveness models and thus improve hospital decision making and resource allocation. Significantly under or over valuing the resource is very likely to result in sub-optimal decision making. We discuss the importance of recognising the opportunity costs of this resource and highlight areas for future research.

Associations of day-to-day temperature change and diurnal temperature range with out-of-hospital cardiac arrest.

PubMed

Onozuka, Daisuke; Hagihara, Akihito

2017-01-01

Background Although the impacts of temperature on mortality and morbidity have been documented, few studies have investigated whether day-to-day temperature change and diurnal temperature range (DTR) are independent risk factors for out-of-hospital cardiac arrest (OHCA). Design This was a prospective, population-based, observational study. Methods We obtained all OHCA data from 2005-2013 from six major prefectures in Japan: Hokkaido, Tokyo, Kanagawa, Aichi, Kyoto, and Osaka. We used a quasi-Poisson regression analysis with a distributed-lag non-linear model to assess the associations of day-to-day temperature change and DTR with OHCA for each prefecture. Results In total, 271,698 OHCAs of presumed cardiac origin were reported during the study period. There was a significant increase in the risk of OHCA associated with cold temperature in five prefectures, with relative risks (RRs) ranging from 1.298 (95% confidence interval (CI) 1.022-1.649) in Hokkaido to 3.893 (95% CI 1.713-8.845) in Kyoto. DTR was adversely associated with OHCA on hot days in Aichi (RR 1.158; 95% CI 1.028-1.304) and on cold days in Tokyo (RR 1.030; 95% CI 1.000-1.060), Kanagawa (RR 1.042; 95% CI 1.005-1.082), Kyoto (RR 1.060; 95% CI 1.001-1.122), and Osaka (RR 1.050; 95% CI 1.014-1.088), whereas there was no significant association between day-to-day temperature change and OHCA. Conclusion We found that associations between day-to-day temperature change and DTR and OHCA were generally small compared with the association with mean temperature. Our findings suggest that preventative measures for temperature-related OHCA may be more effective when focused on mean temperature and DTR.

Comparison of in-hospital versus 30-day mortality assessments for selected medical conditions.

PubMed

Borzecki, Ann M; Christiansen, Cindy L; Chew, Priscilla; Loveland, Susan; Rosen, Amy K

2010-12-01

In-hospital mortality measures such as the Agency for Healthcare Research and Quality (AHRQ) Inpatient Quality Indicators (IQIs) are easily derived using hospital discharge abstracts and publicly available software. However, hospital assessments based on a 30-day postadmission interval might be more accurate given potential differences in facility discharge practices. To compare in-hospital and 30-day mortality rates for 6 medical conditions using the AHRQ IQI software. We used IQI software (v3.1) and 2004-2007 Veterans Health Administration (VA) discharge and Vital Status files to derive 4-year facility-level in-hospital and 30-day observed mortality rates and observed/expected ratios (O/Es) for admissions with a principal diagnosis of acute myocardial infarction, congestive heart failure, stroke, gastrointestinal hemorrhage, hip fracture, and pneumonia. We standardized software-calculated O/Es to the VA population and compared O/Es and outlier status across sites using correlation, observed agreement, and kappas. Of 119 facilities, in-hospital versus 30-day mortality O/E correlations were generally high (median: r = 0.78; range: 0.31-0.86). Examining outlier status, observed agreement was high (median: 84.7%, 80.7%-89.1%). Kappas showed at least moderate agreement (k > 0.40) for all indicators except stroke and hip fracture (k ≤ 0.22). Across indicators, few sites changed from a high to nonoutlier or low outlier, or vice versa (median: 10, range: 7-13). The AHRQ IQI software can be easily adapted to generate 30-day mortality rates. Although 30-day mortality has better face validity as a hospital performance measure than in-hospital mortality, site assessments were similar despite the definition used. Thus, the measure selected for internal benchmarking should primarily depend on the healthcare system's data linkage capabilities.

Day Hospital and Residential Addiction Treatment: Randomized and Nonrandomized Managed Care Clients

ERIC Educational Resources Information Center

Witbrodt, Jane; Bond, Jason; Kaskutas, Lee Ann; Weisner, Constance; Jaeger, Gary; Pating, David; Moore, Charles

2007-01-01

Male and female managed care clients randomized to day hospital (n=154) or community residential treatment (n=139) were compared on substance use outcomes at 6 and 12 months. To address possible bias in naturalistic studies, outcomes were also examined for clients who self-selected day hospital (n=321) and for clients excluded from randomization…

Controlling costs without compromising quality: paying hospitals for total knee replacement.

PubMed

Pine, Michael; Fry, Donald E; Jones, Barbara L; Meimban, Roger J; Pine, Gregory J

2010-10-01

Unit costs of health services are substantially higher in the United States than in any other developed country in the world, without a correspondingly healthier population. An alternative payment structure, especially for high volume, high cost episodes of care (eg, total knee replacement), is needed to reward high quality care and reduce costs. The National Inpatient Sample of administrative claims data was used to measure risk-adjusted mortality, postoperative length-of-stay, costs of routine care, adverse outcome rates, and excess costs of adverse outcomes for total knee replacements performed between 2002 and 2005. Empirically identified inefficient and ineffective hospitals were then removed to create a reference group of high-performance hospitals. Predictive models for outcomes and costs were recalibrated to the reference hospitals and used to compute risk-adjusted outcomes and costs for all hospitals. Per case predicted costs were computed and compared with observed costs. Of the 688 hospitals with acceptable data, 62 failed to meet effectiveness criteria and 210 were identified as inefficient. The remaining 416 high-performance hospitals had 13.4% fewer risk-adjusted adverse outcomes (4.56%-3.95%; P < 0.001; χ) and 9.9% lower risk-adjusted total costs ($12,773-$11,512; P < 0.001; t test) than all study hospitals. Inefficiency accounted for 96% of excess costs. A payment system based on the demonstrated performance of effective, efficient hospitals can produce sizable cost savings without jeopardizing quality. In this study, 96% of total excess hospital costs resulted from higher routine costs at inefficient hospitals, whereas only 4% was associated with ineffective care.

Total direct cost, length of hospital stay, institutional discharges and their determinants from rehabilitation settings in stroke patients.

PubMed

Saxena, S K; Ng, T P; Yong, D; Fong, N P; Gerald, K

2006-11-01

Length of hospital stay (LOHS) is the largest determinant of direct cost for stroke care. Institutional discharges (acute care and nursing homes) from rehabilitation settings add to the direct cost. It is important to identify potentially preventable medical and non-medical reasons determining LOHS and institutional discharges to reduce the direct cost of stroke care. The aim of the study was to ascertain the total direct cost, LOHS, frequency of institutional discharges and their determinants from rehabilitation settings. Observational study was conducted on 200 stroke patients in two rehabilitation settings. The patients were examined for various socio-demographic, neurological and clinical variables upon admission to the rehabilitation hospitals. Information on total direct cost and medical complications during hospitalization were also recorded. The outcome variables measured were total direct cost, LOHS and discharges to institutions (acute care and nursing home facility) and their determinants. The mean and median LOHS in our study were 34 days (SD = 18) and 32 days respectively. LOHS and the cost of hospital stay were significantly correlated. The significant variables associated with LOHS on multiple linear regression analysis were: (i) severe functional impairment/functional dependence Barthel Index < or = 50, (ii) medical complications, (iii) first time stroke, (iv) unplanned discharges and (v) discharges to nursing homes. Of the stroke patients 19.5% had institutional discharges (22 to acute care and 17 to nursing homes). On multivariate analysis the significant predictors of discharges to institutions from rehabilitation hospitals were medical complications (OR = 4.37; 95% CI 1.01-12.53) and severe functional impairment/functional dependence. (OR = 5.90, 95% CI 2.32-14.98). Length of hospital stay and discharges to institutions from rehabilitation settings are significantly determined by medical complications. Importance of adhering to clinical pathway

Predictors of 30-Day Hospital Readmission among Maintenance Hemodialysis Patients: A Hospital’s Perspective

PubMed Central

Katsanos, Suzanne L.; Hu, Yichun; Kshirsagar, Abhijit V.; Falk, Ronald J.; Moore, Carlton R.

2016-01-01

Background and objectives Over 35% of patients on maintenance dialysis are readmitted to the hospital within 30 days of hospital discharge. Outpatient dialysis facilities often assume responsibility for readmission prevention. Hospital care and discharge practices may increase readmission risk. We undertook this study to elucidate risk factors identifiable from hospital-derived data for 30-day readmission among patients on hemodialysis. Design, setting, participants, & measurements Data were taken from patients on maintenance hemodialysis discharged from University of North Carolina Hospitals between May of 2008 and June of 2013 who received in-patient hemodialysis during their index hospitalizations. Multivariable logistic regression models with 30-day readmission as the dependent outcome were used to identify readmission risk factors. Models considered variables available at hospital admission and discharge separately. Results Among 349 patients, 112 (32.1%) had a 30-day hospital readmission. The discharge (versus admission) model was more predictive of 30-day readmission. In the discharge model, malignancy comorbid condition (odds ratio [OR], 2.08; 95% confidence interval [95% CI], 1.04 to 3.11), three or more hospitalizations in the prior year (OR, 1.97; 95% CI, 1.06 to 3.64), ≥10 outpatient medications at hospital admission (OR, 1.69; 95% CI, 1.00 to 2.88), catheter vascular access (OR, 1.82; 95% CI, 1.01 to 3.65), outpatient dialysis at a nonuniversity–affiliated dialysis facility (OR, 3.59; 95% CI, 2.03 to 6.36), intradialytic hypotension (OR, 3.10; 95% CI, 1.45 to 6.61), weekend discharge day (OR, 1.82; 95% CI, 1.01 to 3.31), and serum albumin <3.3 g/dl (OR, 4.28; 95% CI, 2.37 to 7.73) were associated with higher readmission odds. A decrease in prescribed medications from admission to discharge (OR, 0.20; 95% CI, 0.08 to 0.51) was associated with lower readmission odds. Findings were robust across different model–building approaches. Conclusions

Improving Outcomes After Hospitalization: A Prospective Observational Multicenter Evaluation of Care Coordination Strategies for Reducing 30-Day Readmissions to Maryland Hospitals.

PubMed

Hoyer, Erik H; Brotman, Daniel J; Apfel, Ariella; Leung, Curtis; Boonyasai, Romsai T; Richardson, Melissa; Lepley, Diane; Deutschendorf, Amy

2018-05-01

Patients frequently experience suboptimal transitions from the hospital to the community, which can increase the likelihood of readmission. It is not known which care coordination services can lead to improvements in readmission rates. To evaluate the effects of two care coordination interventions on 30-day readmission rates. Prospective multicenter observational study of hospitalized patients eligible for two care coordination services between January 1, 2013, and October 31, 2015. Readmission rates were compared for patients who received each care coordination intervention versus those who did not using multivariable generalized estimating equation logistic regression models. A total of 25,628 patients hospitalized in medicine, neurosciences, or surgical sciences units. Patients discharged home and deemed to be at high risk for readmission were assigned a nurse Transition Guide (TG) for 30 days post-discharge. All other patients were assigned the Patient Access Line (PAL) intervention, which provided a post-discharge phone call from a registered nurse. Two large academic hospitals in Baltimore, MD. Thirty-day all-cause readmission to any Maryland hospital. Among all patients, 14.2% (2409/16,993) of those referred for the PAL intervention and 22.8% (1973/8635) of those referred for the TG intervention were readmitted. PAL-referred patients who did not receive the intervention had an adjusted odds ratio (aOR) for readmission of 1.27 (95% confidence interval [95% CI] 1.12-1.44, p < 0.001) compared with patients who did. TG-referred patients who did not receive the TG intervention had an aOR of 1.83 (95% CI 1.60-2.10, p < 0.001) compared with patients who received the intervention. Younger age, male sex, having more comorbidities, and being discharged from a medicine unit were associated with not receiving an assigned intervention. These characteristics were also associated with higher readmission rates. PAL and TG care coordination interventions were associated

The three phases of time-limited day-hospital treatment.

PubMed

Stein, H H; Hirsch, B; Brenman, S; Bataclan, L

1990-06-01

The course of treatment in a time-limited day-hospital setting can be usefully understood in terms of three phases. Close examination of the treatment goals, difficulties, benefits, and tasks for both patients and staff for each phase provides a greater understanding of the curative process. These observations are based upon clinical work in a Veteran Administration Day Hospital and are reinforced with clinical examples from that work. Identification of these phases of treatment can be put to practical use. Knowing in which phase a patient is working helps staff members focus their thinking. Such an awareness can also help staff members cope with "burnout" over the frustrations that come with a particular phase. Information about these phases has been valuable to patients and their families in helping them understand the course of their treatment.

Utilization of Total Joint Arthroplasty in Physician-Owned Specialty Hospitals vs Acute Care Facilities.

PubMed

Chen, Antonia F; Pflug, Emily; O'Brien, Daniel; Maltenfort, Mitchell G; Parvizi, Javad

2017-07-01

The recent emergence of physician-owned specialty hospitals has sparked controversy about overutilization. Thus, the purpose of this study was to compare utilization patterns of total joint arthroplasty (TJA) between physician-specialty hospitals (PSHs) and acute care hospitals (ACHs). A retrospective study was conducted from January 2010 to August 2014 comparing primary TJA patients between a PSH and an ACH; 103 PSH patients were matched to 103 ACH patients by age, gender, BMI, and ASA classification with similar case distribution between facilities. All surgeons in the study operated at both hospitals and were shareholders of the PSH. Information on nonoperative treatments, and timing to the initial appointment, consent, and surgery were analyzed using univariate analysis. Nonoperative treatments before surgery were similar between hospitals (P = 1.00). The time from the initial appointment to consent was longer for PSH (P = .0001). However, the time from consent to the date of surgery (P = .04) and the timing from symptoms to initial appointment (P = .006) was shorter for PSH. The time from initial appointment to the day of surgery was similar between groups (P = .20). Patients were more likely to be consented for surgery on their first clinic visit when undergoing surgery at ACH (87 of 103, 84.4%) compared to PSH (61 of 103; 59.2%; P < .001). Length of stay was significantly shorter for both total knee arthroplasty (P = .001) and total hip arthroplasty patients (P = .001) at PSH. Facility ownership in PSH resulted in similar conservative treatment before TJA. The time to surgical consent after the initial appointment was longer PSH, whereas the time from consent to the date of surgery was shorter at the PSH. Copyright © 2017 Elsevier Inc. All rights reserved.

First-day newborn weight loss predicts in-hospital weight nadir for breastfeeding infants.

PubMed

Flaherman, Valerie J; Bokser, Seth; Newman, Thomas B

2010-08-01

Exclusive breastfeeding reduces infant infectious disease. Losing > or =10% birth weight may lead to formula use. The predictive value of first-day weight loss for subsequent weight loss has not been studied. The objective of the present study was to evaluate the relationship between weight loss at <24 hours and subsequent in-hospital weight loss > or =10%. For 1,049 infants, we extracted gestational age, gender, delivery method, feeding type, and weights from medical records. Weight nadir was defined as the lowest weight recorded during birth hospitalization. We used multivariate logistic regression to assess the effect of first-day weight loss on subsequent in-hospital weight loss. Mean in-hospital weight nadir was 6.0 +/- 2.6%, and mean age at in-hospital weight nadir was 38.7 +/- 18.5 hours. While in the hospital 6.4% of infants lost > or =10% of birth weight. Infants losing > or =4.5% birth weight at <24 hours had greater risk of eventual in-hospital weight loss > or =10% (adjusted odds ratio 3.57 [1.75, 7.28]). In this cohort, 798 (76.1%) infants did not have documented weight gain while in the hospital. Early weight loss predicts higher risk of > or =10% in-hospital weight loss. Infants with high first-day weight loss could be targeted for further research into improved interventions to promote breastfeeding.

The New York risk score for in-hospital and 30-day mortality for coronary artery bypass graft surgery.

PubMed

Hannan, Edward L; Farrell, Louise Szypulski; Wechsler, Andrew; Jordan, Desmond; Lahey, Stephen J; Culliford, Alfred T; Gold, Jeffrey P; Higgins, Robert S D; Smith, Craig R

2013-01-01

Simplified risk scores for coronary artery bypass graft surgery are frequently in lieu of more complicated statistical models and are valuable for informed consent and choice of intervention. Previous risk scores have been based on in-hospital mortality, but a substantial number of patients die within 30 days of the procedure. These deaths should also be accounted for, so we have developed a risk score based on in-hospital and 30-day mortality. New York's Cardiac Surgery Reporting System was used to develop an in-hospital and 30-day logistic regression model for patients undergoing coronary artery bypass graft surgery in 2009, and this model was converted into a simple linear risk score that provides estimated in-hospital and 30-day mortality rates for different values of the score. The accuracy of the risk score in predicting mortality was tested. This score was also validated by applying it to 2008 New York coronary artery bypass graft data. Subsequent analyses evaluated the ability of the risk score to predict complications and length of stay. The overall in-hospital and 30-day mortality rate for the 10,148 patients in the study was 1.79%. There are seven risk factors comprising the score, with risk factor scores ranging from 1 to 5, and the highest possible total score is 23. The score accurately predicted mortality in 2009 as well as in 2008, and was strongly correlated with complications and length of stay. The risk score is a simple way of estimating short-term mortality that accurately predicts mortality in the year the model was developed as well as in the previous year. Perioperative complications and length of stay are also well predicted by the risk score. Copyright © 2013 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

Getting through the day: exploring patients' leisure experiences in a private hospital.

PubMed

Chan, Zenobia C Y; Wu, Ching Man; Yip, Chi Hung; Yau, Ka Kin

2012-11-01

To explore the patients' leisure experience and their leisure needs and expectations during hospitalisation in a private hospital setting. Leisure plays positive roles in patient satisfaction and has functional values. However, studies on how inpatients spend their time and hospital-based qualitative studies on leisure needs and expectation among patients were rarely conducted. Through exploring patients' perspective on leisure, nurses could improve patient satisfaction from a different dimension and enhance quality of care. A descriptive qualitative study based on 12 semi-structural interviews. Applied purposive sampling to select and interview a total of 16 participants, including 12 patients and four patients' significant others in a private hospital. Semi-structured interviews were conducted at the patients' bedside in summer 2011. Interviews were recorded and transcribed verbatim. Content analysis approach was used to analyse data and to categorise themes. Four themes were developed: (1) getting through the day, which describes how patients spend their time during hospitalisation and their daily leisure activities; (2) necessity of leisure, which reveals the reasons why patients conducted the activity; (3) resources amelioration, which describes patients' needs and satisfaction on current leisure resources in the hospital; (4) nurses' roles in leisure, which is about the involvement of nurses in patients' leisure activities. As patients understand hospital is a place for recovery, they seldom discuss or request their choices of leisure activity. This study could provide some insight into patients' needs and expectation of leisure activity during hospitalisation, allowing nurses to know the importance of providing leisure activities to patients. This study suggests that clinical nursing practice should support leisure provision and hospital resources management of facilities on the effects of leisure. © 2012 Blackwell Publishing Ltd.

Facility-Level Variation in Hospitalization, Mortality, and Costs in the 30 Days After Percutaneous Coronary Intervention: Insights on Short-Term Healthcare Value From the Veterans Affairs Clinical Assessment, Reporting, and Tracking System (VA CART) Program.

PubMed

Bradley, Steven M; O'Donnell, Colin I; Grunwald, Gary K; Liu, Chuan-Fen; Hebert, Paul L; Maddox, Thomas M; Jesse, Robert L; Fihn, Stephan D; Rumsfeld, John S; Ho, P Michael

2015-07-14

Policies to reduce unnecessary hospitalizations after percutaneous coronary intervention (PCI) are intended to improve healthcare value by reducing costs while maintaining patient outcomes. Whether facility-level hospitalization rates after PCI are associated with cost of care is unknown. We studied 32,080 patients who received PCI at any 1 of 62 Veterans Affairs hospitals from 2008 to 2011. We identified facility outliers for 30-day risk-standardized hospitalization, mortality, and cost. Compared with the risk-standardized average, 2 hospitals (3.2%) had a lower-than-expected hospitalization rate, and 2 hospitals (3.2%) had a higher-than-expected hospitalization rate. We observed no statistically significant variation in facility-level risk-standardized mortality. The facility-level unadjusted median per patient 30-day total cost was $23,820 (interquartile range, $19,604-$29,958). Compared with the risk-standardized average, 17 hospitals (27.4%) had lower-than-expected costs, and 14 hospitals (22.6%) had higher-than-expected costs. At the facility level, the index PCI accounted for 83.1% of the total cost (range, 60.3%-92.2%), whereas hospitalization after PCI accounted for only 5.8% (range, 2.0%-12.7%) of the 30-day total cost. Facilities with higher hospitalization rates were not more expensive (Spearman ρ=0.16; 95% confidence interval, -0.09 to 0.39; P=0.21). In this national study, hospitalizations in the 30 day after PCI accounted for only 5.8% of 30-day cost, and facility-level cost was not correlated with hospitalization rates. This challenges the focus on reducing hospitalizations after PCI as an effective means of improving healthcare value. Opportunities remain to improve PCI value by reducing the variation in total cost of PCI without compromising patient outcomes. © 2015 American Heart Association, Inc.

Hospital Volume and 30-Day Mortality for Three Common Medical Conditions

PubMed Central

Ross, Joseph S.; Normand, Sharon-Lise T.; Wang, Yun; Ko, Dennis T.; Chen, Jersey; Drye, Elizabeth E.; Keenan, Patricia S.; Lichtman, Judith H.; Bueno, Héctor; Schreiner, Geoffrey C.; Krumholz, Harlan M.

2010-01-01

Background The association between hospital volume and the death rate for patients who are hospitalized for acute myocardial infarction, heart failure, or pneumonia remains unclear. It is also not known whether a volume threshold for such an association exists. Methods We conducted cross-sectional analyses of data from Medicare administrative claims for all fee-for-service beneficiaries who were hospitalized between 2004 and 2006 in acute care hospitals in the United States for acute myocardial infarction, heart failure, or pneumonia. Using hierarchical logistic-regression models for each condition, we estimated the change in the odds of death within 30 days associated with an increase of 100 patients in the annual hospital volume. Analyses were adjusted for patients’ risk factors and hospital characteristics. Bootstrapping procedures were used to estimate 95% confidence intervals to identify the condition-specific volume thresholds above which an increased volume was not associated with reduced mortality. Results There were 734,972 hospitalizations for acute myocardial infarction in 4128 hospitals, 1,324,287 for heart failure in 4679 hospitals, and 1,418,252 for pneumonia in 4673 hospitals. An increased hospital volume was associated with reduced 30-day mortality for all conditions (P<0.001 for all comparisons). For each condition, the association between volume and outcome was attenuated as the hospital's volume increased. For acute myocardial infarction, once the annual volume reached 610 patients (95% confidence interval [CI], 539 to 679), an increase in the hospital volume by 100 patients was no longer significantly associated with reduced odds of death. The volume threshold was 500 patients (95% CI, 433 to 566) for heart failure and 210 patients (95% CI, 142 to 284) for pneumonia. Conclusions Admission to higher-volume hospitals was associated with a reduction in mortality for acute myocardial infarction, heart failure, and pneumonia, although there was a

First-Day Newborn Weight Loss Predicts In-Hospital Weight Nadir for Breastfeeding Infants

PubMed Central

Bokser, Seth; Newman, Thomas B.

2010-01-01

Abstract Background Exclusive breastfeeding reduces infant infectious disease. Losing ≥10% birth weight may lead to formula use. The predictive value of first-day weight loss for subsequent weight loss has not been studied. The objective of the present study was to evaluate the relationship between weight loss at <24 hours and subsequent in-hospital weight loss ≥10%. Methods For 1,049 infants, we extracted gestational age, gender, delivery method, feeding type, and weights from medical records. Weight nadir was defined as the lowest weight recorded during birth hospitalization. We used multivariate logistic regression to assess the effect of first-day weight loss on subsequent in-hospital weight loss. Results Mean in-hospital weight nadir was 6.0 ± 2.6%, and mean age at in-hospital weight nadir was 38.7 ± 18.5 hours. While in the hospital 6.4% of infants lost ≥10% of birth weight. Infants losing ≥4.5% birth weight at <24 hours had greater risk of eventual in-hospital weight loss ≥10% (adjusted odds ratio 3.57 [1.75, 7.28]). In this cohort, 798 (76.1%) infants did not have documented weight gain while in the hospital. Conclusions Early weight loss predicts higher risk of ≥10% in-hospital weight loss. Infants with high first-day weight loss could be targeted for further research into improved interventions to promote breastfeeding. PMID:20113202

Toward Shorter Hospitalization After Endoscopic Transsphenoidal Pituitary Surgery: Day-by-Day Analysis of Early Postoperative Complications and Interventions.

PubMed

Shimanskaya, Viktoria E; Wagenmakers, Margreet A E M; Bartels, Ronald H M A; Boogaarts, Hieronymus D; Grotenhuis, J André; Hermus, Ad R M M; van de Ven, Annenienke C; van Lindert, Erik J

2018-03-01

It is unclear which patients have the greatest risk of developing complications in the first days after endoscopic transsphenoidal pituitary surgery (ETS) and how long patients should stay hospitalized after surgery. The objective of this study is to identify which patients are at risk for early postoperative medical and surgical reinterventions to optimize the length of hospitalization. The medical records of 146 patients who underwent ETS for a pituitary adenoma between January 2013 and July 2016 were reviewed retrospectively. Data were collected on baseline patient-related characteristics, characteristics of the pituitary adenoma, perioperative complications and interventions, and postoperative outcomes. Patients who underwent additional interventions on days 2, 3, and 4 after ETS were identified as cases, and patients who did not have any interventions after day 1 postoperatively were identified as controls. Diabetes mellitus (odds ratio [OR], 4.279; 95% confidence interval [CI], 1.149-15.933; P = 0.03), incomplete adenoma resection (OR, 2.840; 95% CI, 1.228-6.568; P = 0.02) and increased morning sodium concentration on day 2 after surgery (OR, 5.211; 95% CI, 2.158-12.579; P <0.001) were associated with reinterventions. Patients without interventions on day 1 or 2 had only an 18.6% chance of a reintervention (OR, 0.201; 95% CI, 0.095-0.424). Patients with diabetes mellitus, incomplete adenoma resection, and increased morning sodium concentration on day 2 after surgery have an increased chance on reinterventions. In addition, patients without any interventions on day 1 and 2 are at low risk for later reinterventions. These patients could be suitable candidates for early hospital discharge. Copyright © 2018 Elsevier Inc. All rights reserved.

Home Discharge and Out-of-Hospital Follow-Up of Total Artificial Heart Patients Supported by a Portable Driver System

PubMed Central

2014-01-01

To enhance ambulation and facilitate hospital discharge of total artificial heart (TAH)–supported patients, we adapted a mobile ventricular assistance device (VAD) driver (Excor) for TAH use and report on the performance of Excor-driven TAH patients discharged home. Ten patients stabilized on a TAH, driven by the CSS (“Circulatory Support System”), were progressively switched over to the Excor in hospital over 14 days as a pilot, with daily hemodynamics and laboratory parameters measured. Twenty-two stable TAH patients were subsequently placed on the Excor, trained, and discharged home. Clinical and hemodynamic parameters were followed. All pilot study patients were clinically stable on the Excor, with no decrease in TAH output noted (6.3 + 0.3 L/min [day 1] vs. 5.8 + 0.2 L/min [day 14], p = 0.174), with a trend suggesting improvement of both hepatic and renal function. Twenty-two TAH patients were subsequently successfully discharged home on the portable driver and were supported out of hospital for up to 598 days (range, 2–598; mean = 179 ± 140 days), remaining ambulatory, New York Heart Association (NYHA) class I or II, and free of readmission for 88.5% of the time of support. TAH patients may be effectively and safely supported by a mobile drive system. As such, the utility of the TAH may be extended to support patients beyond the hospital, at home, with overall ambulatory freedom. PMID:24577369

Building a dream: creating an oncology day/evening hospital.

PubMed

Fletcher, K; Painter, V

2002-01-01

The demand for inpatient beds has reached and often exceeds capacity producing waiting lists for cancer care. There is a need to explore alternative approaches to oncology treatment. The Oncology Day/Evening Hospital (ODEH), originally envisioned in 1995 as a joint project between an ambulatory cancer centre and a large teaching hospital, is an important cancer treatment initiative offering extended hours of ambulatory oncology treatment on days, evenings, weekends and statutory holidays. A review of current inpatient treatment modalities revealed that many patients receiving inpatient therapy could be safely and effectively managed in the ambulatory setting if treatment regimens were modified and if ambulatory hours of operation were extended. Healthcare improvements expected were: appropriate movement of inpatient activity to the ambulatory setting; more opportunities for patient choice in treatment time thereby allowing for maintenance of normal living; better quality of life for patients through prevention of hospitalization; decrease in treatment waiting times; consolidation of patients into an ambulatory oncology treatment setting as opposed to utilization of adult medicine units; and more rational inpatient bed utilization with reduction of admissions and intra-treatment transfers. This article describes our experience in building a dream, the challenges and lessons learned in implementing a better way to deliver oncology care in an environment of rapid change and staff shortages.

Development, Validation and Deployment of a Real Time 30 Day Hospital Readmission Risk Assessment Tool in the Maine Healthcare Information Exchange.

PubMed

Hao, Shiying; Wang, Yue; Jin, Bo; Shin, Andrew Young; Zhu, Chunqing; Huang, Min; Zheng, Le; Luo, Jin; Hu, Zhongkai; Fu, Changlin; Dai, Dorothy; Wang, Yicheng; Culver, Devore S; Alfreds, Shaun T; Rogow, Todd; Stearns, Frank; Sylvester, Karl G; Widen, Eric; Ling, Xuefeng B

2015-01-01

Identifying patients at risk of a 30-day readmission can help providers design interventions, and provide targeted care to improve clinical effectiveness. This study developed a risk model to predict a 30-day inpatient hospital readmission for patients in Maine, across all payers, all diseases and all demographic groups. Our objective was to develop a model to determine the risk for inpatient hospital readmission within 30 days post discharge. All patients within the Maine Health Information Exchange (HIE) system were included. The model was retrospectively developed on inpatient encounters between January 1, 2012 to December 31, 2012 from 24 randomly chosen hospitals, and then prospectively validated on inpatient encounters from January 1, 2013 to December 31, 2013 using all HIE patients. A risk assessment tool partitioned the entire HIE population into subgroups that corresponded to probability of hospital readmission as determined by a corresponding positive predictive value (PPV). An overall model c-statistic of 0.72 was achieved. The total 30-day readmission rates in low (score of 0-30), intermediate (score of 30-70) and high (score of 70-100) risk groupings were 8.67%, 24.10% and 74.10%, respectively. A time to event analysis revealed the higher risk groups readmitted to a hospital earlier than the lower risk groups. Six high-risk patient subgroup patterns were revealed through unsupervised clustering. Our model was successfully integrated into the statewide HIE to identify patient readmission risk upon admission and daily during hospitalization or for 30 days subsequently, providing daily risk score updates. The risk model was validated as an effective tool for predicting 30-day readmissions for patients across all payer, disease and demographic groups within the Maine HIE. Exposing the key clinical, demographic and utilization profiles driving each patient's risk of readmission score may be useful to providers in developing individualized post discharge

Educational level and 30-day outcomes after hospitalization for acute myocardial infarction in Italy.

PubMed

Cafagna, Gianluca; Seghieri, Chiara

2017-01-09

There is a growing interest in the factors that influence short-term mortality and readmission after hospitalization for acute myocardial infarction (AMI) since such outcomes are commonly considered as hospital performance measures. Socioeconomic status (SES) is one of the factors contributing to healthcare outcomes after hospitalization for AMI. However, no study has been published on education and 30-day readmission in Europe. The objective of this study is to examine the association between educational level and 30-day mortality and readmission among patients hospitalized for AMI in Tuscany (Italy). A retrospective cohort study using data from hospital discharge records was conducted. The analysis included all patients discharged with a principal diagnosis of AMI between January 1, 2011, and November 30, 2014, from all hospitals in Tuscany. Educational level was categorized as low (no middle school diploma), mid (middle school diploma) and high (high school diploma or more). Three multilevel models were developed, sequentially controlling for patient-level socio-demographic and clinical variables and hospital-level variables. Patients were stratified by age (≤75 and >75 years). Mortality analysis included 23,402 patients, readmission analysis included 22,181 patients. In both unadjusted and full-adjusted models, patients with a high education had lower odds of 30-day mortality compared to those patients with low education (OR age ≤ 75 years 0.67, 95% CI:0.47-0.94; OR age > 75 years 0.72, 95% CI:0.54-0.95). With regard to 30-day readmission, only patients aged over 75 years with a high education had lower odds of short-term readmission compared to those patients with low education (OR age > 75 0.73, 95% CI:0.58-0.93). Among patients hospitalized in Tuscany for AMI, low levels of education were associated with increased odds of 30-day mortality for both age groups and increased odds of 30-day readmission only for patients aged over 75�

Impact of hospital volume on hospital mortality, length of stay and total costs after pancreaticoduodenectomy.

PubMed

Yoshioka, R; Yasunaga, H; Hasegawa, K; Horiguchi, H; Fushimi, K; Aoki, T; Sakamoto, Y; Sugawara, Y; Kokudo, N

2014-04-01

High morbidity and mortality rates after pancreaticoduodenectomy (PD) have led to concentration of this surgery in high-volume centres, with improved outcomes. The extent to which better outcomes might be apparent in a healthcare system where the mortality rate is already low is unclear. The Japanese Diagnosis Procedure Combination database was used to identify patients undergoing PD between 2007 and 2010. Patient data included age, sex, co-morbidities at admission, type of hospital, type of PD, and the year in which the patient was treated. Hospital volume was defined as the number of PDs performed annually at each hospital, and categorized into quintiles: very low-, low-, medium-, high- and very high-volume groups. The Charlson co-morbidity index was calculated using the International Classification of Diseases, tenth revision, codes of co-morbidities. A total of 10 652 patients who underwent PD in 848 hospitals were identified. The overall in-hospital mortality rate after PD was 3·3 per cent (350 of 10 652), and for the groups ranged from 5·0 per cent for the very low-volume group to 1·4 per cent for the very high-volume group (P < 0·001). Multivariable analysis revealed a significant linear relationship between higher hospital volume and shorter postoperative length of stay compared with the very low-volume group, and between increasing hospital volume and lower total costs. A significant relationship exists between increasing hospital volume, lower in-hospital mortality, shorter length of stay and lower costs for patients undergoing PD in Japan. Centralization of PD in this healthcare system is therefore justified. © 2014 BJS Society Ltd. Published by John Wiley & Sons Ltd.

Influence of Sacubitril/Valsartan (LCZ696) on 30-Day Readmission After Heart Failure Hospitalization.

PubMed

Desai, Akshay S; Claggett, Brian L; Packer, Milton; Zile, Michael R; Rouleau, Jean L; Swedberg, Karl; Shi, Victor; Lefkowitz, Martin; Starling, Randall; Teerlink, John; McMurray, John J V; Solomon, Scott D

2016-07-19

Patients with heart failure (HF) are at high risk for hospital readmission in the first 30 days following HF hospitalization. This study sought to determine if treatment with sacubitril/valsartan (LCZ696) reduces rates of hospital readmission at 30-days following HF hospitalization compared with enalapril. We assessed the risk of 30-day readmission for any cause following investigator-reported hospitalizations for HF in the PARADIGM-HF trial, which randomized 8,399 participants with HF and reduced ejection fraction to treatment with LCZ696 or enalapril. Accounting for multiple hospitalizations per patient, there were 2,383 investigator-reported HF hospitalizations, of which 1,076 (45.2%) occurred in subjects assigned to LCZ696 and 1,307 (54.8%) occurred in subjects assigned to enalapril. Rates of readmission for any cause at 30 days were 17.8% in LCZ696-assigned subjects and 21.0% in enalapril-assigned subjects (odds ratio: 0.74; 95% confidence interval: 0.56 to 0.97; p = 0.031). Rates of readmission for HF at 30-days were also lower in subjects assigned to LCZ696 (9.7% vs. 13.4%; odds ratio: 0.62; 95% confidence interval: 0.45 to 0.87; p = 0.006). The reduction in both all-cause and HF readmissions with LCZ696 was maintained when the time window from discharge was extended to 60 days and in sensitivity analyses restricted to adjudicated HF hospitalizations. Compared with enalapril, treatment with LCZ696 reduces 30-day readmissions for any cause following discharge from HF hospitalization. Copyright © 2016 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

[Day hospitals--predictors for utilisation and quality expectations from the perspective of family caregivers of dementia patients].

PubMed

Donath, Carolin; Bleich, Stefan; Grässel, Elmar

2009-05-01

To relieve the burden on family caregivers of dementia patients, the utilisation of day hospitals should be increased. Therefore, the predictive variables for utilisation as well as family caregivers' views regarding the quality of day hospitals must be investigated. The cross-sectional study was carried out as an anonymous, written survey of family caregivers of dementia patients in four regions of Germany. Quantitative and qualitative data from 404 family caregivers was analysed using binary logistic regression analysis and qualitative content analysis, respectively. In addition, 11 day hospital managers were interviewed concerning their quality concepts. The only significant predictor for the utilisation of day hospitals is the estimate of how helpful this support is for the family caregiver's situation. Those who have already had experiences with a day hospital expressed a wish for medical and psychiatric care by "well-trained" staff and a reasonable form of occupation for the dementia patient. In order to increase utilisation, family caregivers must be convinced of the advantages of using day hospitals. A day hospital that combines both activating occupational therapy and medical care by well-trained staff is what family caregivers wish most for their care-receivers.

Challenges in assessing hospital-level stroke mortality as a quality measure: comparison of ischemic, intracerebral hemorrhage, and total stroke mortality rates.

PubMed

Xian, Ying; Holloway, Robert G; Pan, Wenqin; Peterson, Eric D

2012-06-01

Public reporting efforts currently profile hospitals based on overall stroke mortality rates, yet the "mix" of hemorrhagic and ischemic stroke cases may impact this rate. Using the 2005 to 2006 New York state data, we examined the degree to which hospital stroke mortality rankings varied regarding ischemic versus hemorrhagic versus total stroke. Observed/expected ratio was calculated using the Agency for Healthcare Research and Quality Inpatient Quality Indicator software. The observed/expected ratio and outlier status based on stroke types across hospitals were examined using Pearson correlation coefficients (r) and weighted κ. Overall 30-day stroke mortality rates were 15.2% and varied from 11.3% for ischemic stroke and 37.3% for intracerebral hemorrhage. Hospital risk-adjusted ischemic stroke observed/expected ratio was weakly correlated with its own intracerebral hemorrhage observed/expected ratio (r=0.38). When examining hospital performance group (mortality better, worse, or no different than average), disagreement was observed in 35 of 81 hospitals (κ=0.23). Total stroke mortality observed/expected ratio and rankings were correlated with intracerebral hemorrhage (r=0.61 and κ=0.36) and ischemic stroke (r=0.94 and κ=0.71), but many hospitals still switched classification depending on mortality metrics. However, hospitals treating a higher percent of hemorrhagic stroke did not have a statistically significant higher total stroke mortality rate relative to those treating fewer hemorrhagic strokes. Hospital stroke mortality ratings varied considerably depending on whether ischemic, hemorrhagic, or total stroke mortality rates were used. Public reporting of stroke mortality measures should consider providing risk-adjusted outcome on separate stroke types.

Ear, nose and throat day-case surgery at a district general hospital.

PubMed

Pézier, T; Stimpson, P; Kanegaonkar, R G; Bowdler, D A

2009-03-01

In 2000, The NHS Plan in the UK set a target of 75% for all surgical activity to be performed as day-cases. We aim to assess day-case turnover for ENT procedures and, in particular, day-case rates for adult and paediatric otological procedures together with re-admissions within 72 h as a proxy measure of safety. Retrospective collection of data (procedure and length of stay) from the computerised theatre system (Galaxy) and Patient Information Management System (PIMS) of all elective patients operated over one calendar year. The setting was a district general hospital ENT department in South East England. All ENT operations are performed with the exception of oncological head and neck procedures and complex skull-base surgery. Overall, 2538 elective operations were performed during the study period. A total of 1535 elective adult procedures were performed with 74% (1137 of 1535) performed as day-cases. Of 1003 paediatric operations, 73% (730 of 1003) were day-cases. Concerning otological procedures, 93.4% (311 of 333) of paediatric procedures were day-cases. For adults, we divided the procedures into major and minor, achieving day-case rates of 88% (93 of 101) and 91% (85 of 93), respectively. The overall day-case rate for otological procedures was 91% (528 of 580). Re-admission rates overall were 0.7% (11 of 1535) for adults and 0.9% (9 of 1003) for paediatric procedures. The most common procedure for re-admission was tonsillectomy accounting for 56% of all adult re-admissions and 78% of paediatric re-admissions. The were no deaths following day-case procedures. ENT surgery is well-suited to a day-case approach. UK Government targets are attainable when considering routine ENT surgery. Day-case rates for otology in excess of targets are possible even when considering major ear surgery.

The Checklist of Unit Behaviours (CUB): Validation within a Canadian outpatient day hospital programme.

PubMed

Taube-Schiff, M; El Morr, C; Counsell, A; Mehak, Adrienne; Gollan, J

2018-05-01

WHAT IS KNOWN ON THE SUBJECT?: The psychometrics of the CUB measure have been tested within an inpatient psychiatric setting. Results show that the CUB has two factors that reflect patients' approach and avoidance of dimensions of the treatment milieu, and that an increase of approach and decrease of avoidance are correlated with discharge. No empirical research has examined the validity of the CUB in a day hospital programme. WHAT THIS ARTICLE ADDS TO EXISTING KNOWLEDGE?: This study was the first to address the validity of this questionnaire within a psychiatric day hospital setting. This now allows other mental health service providers to use this questionnaire following administration of patient engagement interventions (such as behavioural activation), which are routinely used within this type of a setting. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Our results can enable healthcare providers to employ an effective and psychometrically validated tool in a day hospital setting to measure treatment outcomes and provide reflections of patients' approach behaviours and avoidance behaviours. Introduction We evaluated the Checklist of Unit Behaviours (CUBs) questionnaire in a novel mental health setting: a day hospital within a large acute care general hospital. No empirical evidence exists, as of yet, to look at the validity of this measure in this type of a treatment setting. The CUB measures two factors, avoidance or approach, of the patients' engagement with the treatment milieu within the previous 24 hr. Aim A confirmatory factor analysis (CFA) was conducted to validate the CUB's original two factor structure in an outpatient day programme. Methods Psychiatric outpatients (n = 163) completed the CUB daily while participating in a day hospital programme in Toronto, Canada. Results A CFA was used to confirm the CUB factors but resulted in a poor fitting model for our sample, χ 2 (103) = 278.59, p < .001, CFI = 0.80, RMSEA = 0.10, SRMR = 0.10. Questions

Risk-adjusted survival for adults following in-hospital cardiac arrest by day of week and time of day: observational cohort study

PubMed Central

Robinson, Emily J; Power, Geraldine S; Nolan, Jerry; Soar, Jasmeet; Spearpoint, Ken; Gwinnutt, Carl; Rowan, Kathryn M

2016-01-01

Background Internationally, hospital survival is lower for patients admitted at weekends and at night. Data from the UK National Cardiac Arrest Audit (NCAA) indicate that crude hospital survival was worse after in-hospital cardiac arrest (IHCA) at night versus day, and at weekends versus weekdays, despite similar frequency of events. Objective To describe IHCA demographics during three day/time periods—weekday daytime (Monday to Friday, 08:00 to 19:59), weekend daytime (Saturday and Sunday, 08:00 to 19:59) and night-time (Monday to Sunday, 20:00 to 07:59)—and to compare the associated rates of return of spontaneous circulation (ROSC) for >20 min (ROSC>20 min) and survival to hospital discharge, adjusted for risk using previously developed NCAA risk models. To consider whether any observed difference could be attributed to differences in the case mix of patients resident in hospital and/or the administered care. Methods We performed a prospectively defined analysis of NCAA data from 27 700 patients aged ≥16 years receiving chest compressions and/or defibrillation and attended by a hospital-based resuscitation team in response to a resuscitation (2222) call in 146 UK acute hospitals. Results Risk-adjusted outcomes (OR (95% CI)) were worse (p<0.001) for both weekend daytime (ROSC>20 min 0.88 (0.81 to 0.95); hospital survival 0.72 (0.64 to 0.80)), and night-time (ROSC>20 min 0.72 (0.68 to 0.76); hospital survival 0.58 (0.54 to 0.63)) compared with weekday daytime. The effects were stronger for non-shockable than shockable rhythms, but there was no significant interaction between day/time of arrest and age, or day/time of arrest and arrest location. While many daytime IHCAs involved procedures, restricting the analyses to IHCAs in medical admissions with an arrest location of ward produced results that are broadly in line with the primary analyses. Conclusions IHCAs attended by the hospital-based resuscitation team during nights and weekends have

The relationship of hospital ownership and service composition to hospital charges

PubMed Central

Eskoz, Robin; Peddecord, K. Michael

1985-01-01

The relationship of hospital ownership and service composition to hospital charges was examined for 456 general acute hospitals in California. Ancillary services had higher profit margins, both gross and net profits, than daily hospital services. Ancillary services accounted for 55.3 percent of total patient revenue. Charges per day were 23 percent higher for ancillary services than for daily hospital services. Net profits for daily and ancillary services were lowest at county hospitals. Proprietary hospitals had the highest net profits for total ancillary services and the highest mean charges. Not-for-profit hospitals had the highest profit margins for daily hospital services. Neither direct nor total costs for ancillary services were significantly different among ownership groups, although direct costs for daily hospital services were significantly higher at proprietary hospitals. PMID:10311161

Advancing Care Within an Adult Mental Health Day Hospital: Program Re-Design and Evaluation.

PubMed

Taube-Schiff, Marlene; Mehak, Adrienne; Marangos, Sandy; Kalim, Anastasia; Ungar, Thomas

2017-11-13

Day hospital mental health programs provide alternate care to individuals of high acuity that do not require an inpatient psychiatric stay. Ensuring provision of best practice within these programs is essential for patient stabilization and recovery. However, there is scant literature to review when creating such a program. This paper provides an overview of the steps an acute care hospital took when designing and implementing new programming within a day hospital program. Qualitative data was collected following initial program rollout. This data helped to inform the ongoing modification of groups offered, group scheduling and content, as well as ensuring patient satisfaction and adequate skill delivery during the rollout period and beyond. The goal of this paper is to inform health service delivery for other programs when attempting to build or re-design a day hospital program.

Every antibiotic, every day: Maximizing the impact of prospective audit and feedback on total antibiotic use

PubMed Central

Decloe, Melissa; Gill, Suzanne; Ho, Grace; McCready, Janine; Powis, Jeff

2017-01-01

Background The success of antimicrobial stewardship is dependent on how often it is completed and which antimicrobials are targeted. We evaluated the impact of an antimicrobial stewardship program (ASP) in three non-ICU settings where all systemic antibiotics, regardless of spectrum, were targeted on the first weekday after initiation. Methods Prospective audit and feedback (PAAF) was initiated on the surgical, respiratory, and medical wards of a community hospital on July 1, 2010, October 1, 2010, and April 1, 2012, respectively. We evaluated rates of total antibiotic use, measured in days on therapy (DOTs), among all patients admitted to the wards before and after PAAF initiation using an interrupted time series analysis. Changes in antibiotic costs, rates of C. difficile infection (CDI), mortality, readmission, and length of stay were evaluated using univariate analyses. Results Time series modelling demonstrated that total antibiotic use decreased (± standard error) by 100 ± 51 DOTs/1,000 patient-days on the surgical wards (p = 0.049), 100 ± 46 DOTs/1,000 patient-days on the respiratory ward (p = 0.029), and 91 ± 33 DOTs/1,000 patient-days on the medical wards (p = 0.006) immediately following PAAF initiation. Reductions in antibiotic use were sustained up to 50 months after intervention initiation, and were accompanied by decreases in antibiotic costs. There were no significant changes to patient outcomes on the surgical and respiratory wards following intervention initiation. On the medical wards, however, readmission increased from 4.6 to 5.6 per 1,000 patient-days (p = 0.043), while mortality decreased from 7.4 to 5.0 per 1,000 patient-days (p = 0.001). CDI rates showed a non-significant declining trend after PAAF initiation. Conclusions ASPs can lead to cost-effective, sustained reductions in total antibiotic use when interventions are conducted early in the course of therapy and target all antibiotics. Shifting to such a model may help strengthen the

Every antibiotic, every day: Maximizing the impact of prospective audit and feedback on total antibiotic use.

PubMed

Campbell, Tonya J; Decloe, Melissa; Gill, Suzanne; Ho, Grace; McCready, Janine; Powis, Jeff

2017-01-01

The success of antimicrobial stewardship is dependent on how often it is completed and which antimicrobials are targeted. We evaluated the impact of an antimicrobial stewardship program (ASP) in three non-ICU settings where all systemic antibiotics, regardless of spectrum, were targeted on the first weekday after initiation. Prospective audit and feedback (PAAF) was initiated on the surgical, respiratory, and medical wards of a community hospital on July 1, 2010, October 1, 2010, and April 1, 2012, respectively. We evaluated rates of total antibiotic use, measured in days on therapy (DOTs), among all patients admitted to the wards before and after PAAF initiation using an interrupted time series analysis. Changes in antibiotic costs, rates of C. difficile infection (CDI), mortality, readmission, and length of stay were evaluated using univariate analyses. Time series modelling demonstrated that total antibiotic use decreased (± standard error) by 100 ± 51 DOTs/1,000 patient-days on the surgical wards (p = 0.049), 100 ± 46 DOTs/1,000 patient-days on the respiratory ward (p = 0.029), and 91 ± 33 DOTs/1,000 patient-days on the medical wards (p = 0.006) immediately following PAAF initiation. Reductions in antibiotic use were sustained up to 50 months after intervention initiation, and were accompanied by decreases in antibiotic costs. There were no significant changes to patient outcomes on the surgical and respiratory wards following intervention initiation. On the medical wards, however, readmission increased from 4.6 to 5.6 per 1,000 patient-days (p = 0.043), while mortality decreased from 7.4 to 5.0 per 1,000 patient-days (p = 0.001). CDI rates showed a non-significant declining trend after PAAF initiation. ASPs can lead to cost-effective, sustained reductions in total antibiotic use when interventions are conducted early in the course of therapy and target all antibiotics. Shifting to such a model may help strengthen the effectiveness of ASPs in non

Comparison of surgical care deficiencies between US civil war hospitals and present-day hospitals in Sierra Leone.

PubMed

Crompton, Joseph; Kingham, T Peter; Kamara, T B; Brennan, Murray F; Kushner, Adam L

2010-08-01

Surgery is rapidly becoming a part of public health initiatives in developing countries. In collaboration with the Sierra Leone Ministry of Health and Sanitation, a team of local surgeons and surgeons from the organization Surgeons OverSeas (SOS) used the WHO Tool for Situational Analysis to Assess Emergency Surgical Care to quantify surgical capacity in Sierra Leone. These data were then compared to data collected from the Medical and Surgical History of the Civil War, a work documenting surgical care and hospitals during the US Civil War. There are 0.2 government hospital surgeons/100,000 people in Sierra Leone compared to 300 surgeons/100,000 soldiers in the Union Army. In Sierra Leone it is rare to have running water, fuel, anesthesia, and reliable X-rays. In comparison, US Civil War hospitals had reliable running water, fuel, and anesthesia. It is rare to manage open fractures, limb dislocations, amputations, and conditions requiring chest tubes in Sierra Leone, while these procedures were commonly employed in US Civil War hospitals. Government hospitals in present day Sierra Leone lack the infrastructure, personnel, supplies, and equipment to adequately provide emergency and essential surgical care. In a comparison of present day Sierra Leonean and US Civil War hospitals, the US Civil War facilities are equivalent and in many ways superior. It is hoped that such a comparison will aid advocacy efforts so that greater resources are devoted to improving emergency and essential surgical care in low- and middle-income countries.

Outpatient total elbow arthroplasty: 90-day outcomes.

PubMed

Stone, Michael A; Singh, Paramjit; Rosario, Santano L; Omid, Reza

2018-05-14

Interest in outpatient arthroplasty has grown in response to increasing emphasis on the efficient delivery of safe, high-quality medical care. This study evaluated 90-day episode-of-care complications after outpatient total elbow arthroplasty (TEA). We retrospectively evaluated 28 patients discharged the same day after primary TEA for 90-day episode-of-care complications, reoperations, and readmissions. Postoperative complications and elbow range of motion measurements were recorded and evaluated at the latest follow-up. All patients were contacted and given a satisfaction survey to assess their outpatient experience. Univariate logistic regression was performed for each risk factor to evaluate the risk for major and minor complications. Statistical significance was set as P < .05. Final follow-up data were available for 28 patients at an average of 14 months. Major complications within 90 days of surgery occurred in 7.1% of patients, ulnar nerve paresthesias occurred in 42.8% of patients, and minor wound problems occurred in 39.2% of patients. Five reoperations occurred after the 90-day postoperative period. All ulnar paresthesias and minor wound complications had resolved by the latest follow-up. Univariate regression analysis revealed a significant correlation between smoking and minor wound complications (P = .038). The satisfaction survey had an 85.7% response rate, with 91.7% of patients stating they were happy they went home the same day, and 95.8% feeling more confident and in control of their lives. The risk profile of carefully selected patients undergoing same-day discharge after TEA is acceptable when combined with close follow-up. Copyright © 2018 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

For-Profit Hospital Status and Rehospitalizations to Different Hospitals: An Analysis of Medicare Data

PubMed Central

Kind, Amy JH; Bartels, Christie; Mell, Matthew W; Mullahy, John; Smith, Maureen

2010-01-01

BACKGROUND About one-quarter of rehospitalized Medicare patients are admitted to hospitals different from their original. The extent to which this practice is related to for-profit hospital status, and impacts payments and mortality, is unknown. OBJECTIVE To describe and examine predictors of and payments for rehospitalization to a different hospital within 30 days among Medicare beneficiaries in for-profit and in not-for-profit/public hospitals. DESIGN Retrospective cohort study. SETTING Medicare fee-for-service hospitals throughout the United States. PARTICIPANTS Random 5% national sample of Medicare beneficiaries with acute-care rehospitalizations within 30-days of discharge, 2005–2006 (N=74,564). MEASUREMENTS 30-day rehospitalizations to different hospitals; total payments/mortality over subsequent 30-days. Multivariate logistic and quantile regression models included index hospital for-profit status, discharge counts, geographic region, rural-urban commuting area, and teaching status; and patient sociodemographics, disabled status, comorbidities, and a measure of risk-adjustment. RESULTS 22% (16,622) of the sample was rehospitalized to a different hospital. Factors associated with increased risk for rehospitalization to a different hospital included being hospitalized within a for-profit, major medical school-affiliated, or low volume index hospital, and having a Medicare-defined disability. When compared to those rehospitalized to the same hospital, patients rehospitalized to different hospitals had significantly higher adjusted 30-day total payments (median additional $1,308/patient, p-value<0.001), but no significant differences in 30-day mortality, regardless of index hospital for-profit status. LIMITATIONS The analysis lacked detailed clinical data, and did not assess specific provider practice motivations or the role of patient choice. CONCLUSIONS Rehospitalizations to different hospitals are common among Medicare beneficiaries, more likely among those

Risk-adjusted survival for adults following in-hospital cardiac arrest by day of week and time of day: observational cohort study.

PubMed

Robinson, Emily J; Smith, Gary B; Power, Geraldine S; Harrison, David A; Nolan, Jerry; Soar, Jasmeet; Spearpoint, Ken; Gwinnutt, Carl; Rowan, Kathryn M

2016-11-01

Internationally, hospital survival is lower for patients admitted at weekends and at night. Data from the UK National Cardiac Arrest Audit (NCAA) indicate that crude hospital survival was worse after in-hospital cardiac arrest (IHCA) at night versus day, and at weekends versus weekdays, despite similar frequency of events. To describe IHCA demographics during three day/time periods-weekday daytime (Monday to Friday, 08:00 to 19:59), weekend daytime (Saturday and Sunday, 08:00 to 19:59) and night-time (Monday to Sunday, 20:00 to 07:59)-and to compare the associated rates of return of spontaneous circulation (ROSC) for >20 min (ROSC>20 min) and survival to hospital discharge, adjusted for risk using previously developed NCAA risk models. To consider whether any observed difference could be attributed to differences in the case mix of patients resident in hospital and/or the administered care. We performed a prospectively defined analysis of NCAA data from 27 700 patients aged ≥16 years receiving chest compressions and/or defibrillation and attended by a hospital-based resuscitation team in response to a resuscitation (2222) call in 146 UK acute hospitals. Risk-adjusted outcomes (OR (95% CI)) were worse (p<0.001) for both weekend daytime (ROSC>20 min 0.88 (0.81 to 0.95); hospital survival 0.72 (0.64 to 0.80)), and night-time (ROSC>20 min 0.72 (0.68 to 0.76); hospital survival 0.58 (0.54 to 0.63)) compared with weekday daytime. The effects were stronger for non-shockable than shockable rhythms, but there was no significant interaction between day/time of arrest and age, or day/time of arrest and arrest location. While many daytime IHCAs involved procedures, restricting the analyses to IHCAs in medical admissions with an arrest location of ward produced results that are broadly in line with the primary analyses. IHCAs attended by the hospital-based resuscitation team during nights and weekends have substantially worse outcomes than during weekday daytimes

Early Results of Medicare's Bundled Payment Initiative for a 90-Day Total Joint Arthroplasty Episode of Care.

PubMed

Iorio, Richard; Clair, Andrew J; Inneh, Ifeoma A; Slover, James D; Bosco, Joseph A; Zuckerman, Joseph D

2016-02-01

In 2011 Medicare initiated a Bundled Payment for Care Improvement (BPCI) program with the goal of introducing a payment model that would "lead to higher quality, more coordinated care at a lower cost to Medicare." A Model 2 bundled payment initiative for Total Joint Replacement (TJR) was implemented at a large, tertiary, urban academic medical center. The episode of care includes all costs through 90 days following discharge. After one year, data on 721 Medicare primary TJR patients were available for analysis. Average length of stay (LOS) was decreased from 4.27 days to 3.58 days (Median LOS 3 days). Discharges to inpatient facilities decreased from 71% to 44%. Readmissions occurred in 80 patients (11%), which is slightly lower than before implementation. The hospital has seen cost reduction in the inpatient component over baseline. Early results from the implementation of a Medicare BPCI Model 2 primary TJR program at this medical center demonstrate cost-savings. IV economic and decision analyses-developing an economic or decision model. Copyright © 2016 Elsevier Inc. All rights reserved.

Extensive antibiotic prescription rate among hospitalized patients in Uganda: but with frequent missed-dose days

PubMed Central

Kiguba, Ronald; Karamagi, Charles; Bird, Sheila M.

2016-01-01

Objectives To describe the patterns of systemic antibiotic use and missed-dose days and detail the prescription, dispensing and administration of frequently used hospital-initiated antibiotics among Ugandan inpatients. Methods This was a prospective cohort of consented adult inpatients admitted on the medical and gynaecological wards of the 1790 bed Mulago National Referral Hospital. Results Overall, 79% (603/762; 95% CI: 76%–82%) of inpatients received at least one antibiotic during hospitalization while 39% (300/762; 95% CI: 36%–43%) had used at least one antibiotic in the 4 weeks pre-admission; 1985 antibiotic DDDs, half administered parenterally, were consumed in 3741 inpatient-days. Two-fifths of inpatients who received at least one of the five frequently used hospital-initiated antibiotics (ceftriaxone, metronidazole, ciprofloxacin, amoxicillin and azithromycin) missed at least one antibiotic dose-day (44%, 243/558). The per-day risk of missed antibiotic administration was greatest on day 1: ceftriaxone (36%, 143/398), metronidazole (27%, 67/245), ciprofloxacin (34%, 39/114) and all inpatients who missed at least one dose-day of prescribed amoxicillin and azithromycin. Most patients received fewer doses than were prescribed: ceftriaxone (74%, 273/371), ciprofloxacin (90%, 94/105) and metronidazole (97%, 222/230). Of prescribed doses, only 62% of ceftriaxone doses (1178/1895), 35% of ciprofloxacin doses (396/1130) and 27% of metronidazole doses (1043/3862) were administered. Seven percent (13/188) of patients on intravenous metronidazole and 6% (5/87) on intravenous ciprofloxacin switched to oral route. Conclusions High rates of antibiotic use both pre-admission and during hospitalization were observed, with low parenteral/oral switch of hospital-initiated antibiotics. Underadministration of prescribed antibiotics was common, especially on the day of prescription, risking loss of efficacy and antibiotic resistance. PMID:26945712

Comparative analysis of length of stay, total costs, and treatment success between intravenous moxifloxacin 400 mg and levofloxacin 750 mg among hospitalized patients with community-acquired pneumonia.

PubMed

Friedman, Howard; Song, Xue; Crespi, Simone; Navaratnam, Prakash

2009-01-01

This study aimed to evaluate the length of stay (LOS), costs, and treatment consistency among patients hospitalized with community-acquired pneumonia (CAP) initially treated with intravenous (IV) moxifloxacin 400 mg or IV levofloxacin 750 mg. Adults with CAP receiving IV moxifloxacin or IV levofloxacin for > or =3 days were identified in the Premier Perspective comparative database. Primary outcomes were LOS and costs. Secondary outcomes included treatment consistency, which was defined as 1) no additional IV moxifloxacin or levofloxacin after > or =1 day off study drug; 2) no switch to another IV antibiotic; and 3) no addition of another IV antibiotic. A total of 7720 patients met inclusion criteria (6040 receiving moxifloxacin; 1680 receiving levofloxacin). Propensity matching created two cohorts (1300 patients each) well matched for demographic, clinical, hospital, and payor characteristics. Before the patients were matched, mean LOS (5.87 vs. 5.46 days; P = 0.0004) and total costs per patient ($7302 vs. $6362; P < 0.0001) were significantly greater with moxifloxacin. After the patients were matched, mean LOS (5.63 vs. 5.51 days; P = 0.462) and total costs ($6624 vs. $6473; P = 0.476) were comparable in both cohorts. Treatment consistency was higher for moxifloxacin before (81.0% vs. 78.9%; P = 0.048) and after matching (82.8% vs. 78.0%; P = 0.002). In-hospital treatment of CAP with IV moxifloxacin 400 mg or IV levofloxacin 750 mg was associated with similar hospital LOS and costs in propensity-matched cohorts.

What are the Rates, Reasons, and Risk Factors of 90-day Hospital Readmission After Lumbar Discectomy?: An Institutional Experience.

PubMed

Kohls, Morgan R; Jain, Nikhil; Khan, Safdar N

2018-06-07

This is a retrospective cohort study. To report the rate, reasons, and risk factors for 90-day readmissions after lumbar discectomy at an academic medical center. Several studies have reported complications and readmissions after spine surgery; however, only one previous study has focused specifically on lumbar discectomy. As the patient profile and morbidity of various spine procedures is different, focus on procedure-specific complications and readmissions will be beneficial. Patients who underwent lumbar discectomy for unrelieved symptoms of prolapsed intervertebral disk and had at least 90 days of follow-up at an academic institution (2013-2014) were included. Retrospective review of electronic medical record was performed to record demographic and clinical profile of patients. Details of lumbar discectomy, index hospital stay, discharge disposition, hospital readmission within 90 days, reason for readmission and treatment given have been reported. Risk factors for hospital readmission were analyzed by multivariate logistic regression analysis. A total of 356 patients with a mean age of 45.0±13.8 years were included. The 90-day readmission rate was 5.3% (19/360) of which two-third patients were admitted within 30 days giving a 30-day readmission rate of 3.7% (13/356). The top 2 primary reasons for readmission included back and/or leg pain, numbness, or tingling (42.9%), and persistent cerebrospinal fluid leak or seroma (25.0%). On adjusted analysis, risk factors associated with higher risk of readmission included incidental durotomy [odds ratio (OR), 26.2; 95% confidence interval (CI), 5.3-129.9] and discharge to skilled nursing facility/inpatient rehabilitation (OR, 25.2; 95% CI, 2.7-235.2). Increasing age was a negative predictor of readmission (OR, 0.95; 95% CI, 0.91-0.99). Incidental durotomy, younger age, and discharge to nursing facility were associated with higher risk of 90-day hospital readmission after lumbar discectomy. As compared with extensive

Does psychological health influence hospital length of stay following total knee arthroplasty? A systematic review.

PubMed

March, Marie K; Harmer, Alison R; Dennis, Sarah

2018-04-25

To systematically review the literature to determine if pre-operative psychological health affected hospital length of stay among adults following primary unilateral total knee arthroplasty. Systematic review. We searched six online databases for original research published until 31 st December 2016 that investigated adults undergoing primary unilateral total knee arthroplasty. Studies were included that used any measure of pre-operative psychological health and reported length of stay, irrespective of study design. We excluded studies that considered participants with cognitive impairment or substance abuse, participants who experienced revision, bilateral or hip surgery, and studies that did not have full text available in English. One review author screened 438 titles and abstracts for inclusion, with a 10% sample of excluded studies reviewed by a second author for adherence to the review protocol, with no violations observed. For all included studies, two authors independently extracted data from each study using a form designed a priori, and independently assessed study quality according to the Joanna Briggs Checklist for Cohort Studies. Due to included study heterogeneity a narrative synthesis was undertaken. Of the seven included studies, five reported statistically significant increases in hospital length of stay among those with worse pre-operative psychological health. These differences were often less than one calendar day, so the clinical significance of these results remains unknown, but the potential to reduce health care costs may still be significant. Adults experiencing worse pre-operative psychological health before total knee arthroplasty may have a longer hospital stay compared to those with unremarkable psychological health. Copyright © 2018. Published by Elsevier Inc.

Reconsidering the Affordable Care Act's Restrictions on Physician-Owned Hospitals: Analysis of CMS Data on Total Hip and Knee Arthroplasty.

PubMed

Courtney, P Maxwell; Darrith, Brian; Bohl, Daniel D; Frisch, Nicholas B; Della Valle, Craig J

2017-11-15

Concerns about financial incentives and increased costs prompted legislation limiting the expansion of physician-owned hospitals in 2010. Supporters of physician-owned hospitals argue that they improve the value of care by improving quality and reducing costs. The purpose of the present study was to determine whether physician-owned and non-physician-owned hospitals differ in terms of costs, outcomes, and patient satisfaction in the setting of total hip arthroplasty (THA) and total knee arthroplasty (TKA). With use of the U.S. Centers for Medicare & Medicaid Services (CMS) Inpatient Charge Data, we identified 45 physician-owned and 2,657 non-physician-owned hospitals that performed ≥11 primary TKA and THA procedures in 2014. Cost data, patient-satisfaction scores, and risk-adjusted complication and 30-day readmission scores for knee and hip arthroplasty patients were obtained from the multiyear CMS Hospital Compare database. Physician-owned hospitals received lower mean Medicare payments than did non-physician-owned hospitals for THA and TKA procedures ($11,106 compared with $12,699; p = 0.002). While the 30-day readmission score did not differ significantly between the 2 types of hospitals (4.48 compared with 4.62 for physician-owned and non-physician-owned, respectively; p = 0.104), physician-owned hospitals had a lower risk-adjusted complication score (2.83 compared with 3.04; p = 0.015). Physician-owned hospitals outperformed non-physician-owned hospitals in all patient-satisfaction categories, including mean linear scores for recommending the hospital (93.9 compared with 87.9; p < 0.001) and overall hospital rating (93.4 compared with 88.4; p < 0.001). When controlling for hospital demographic variables, status as a non-physician-owned hospital was an independent risk factor for being in the upper quartile of all inpatient payments for Medicare Severity-Diagnosis Related Group (MS-DRG) 470 (odds ratio, 3.317; 95% confidence interval, 1.174 to 9.371; p = 0

Organization of Hospital Nursing and 30-Day Readmissions in Medicare Patients Undergoing Surgery.

PubMed

Ma, Chenjuan; McHugh, Matthew D; Aiken, Linda H

2015-01-01

Growing scrutiny of readmissions has placed hospitals at the center of readmission prevention. Little is known, however, about hospital nursing—a critical organizational component of hospital service system—in relation to readmissions. To determine the relationships between hospital nursing factors—nurse work environment, nurse staffing, and nurse education—and 30-day readmissions among Medicare patients undergoing general, orthopedic, and vascular surgery. We linked Medicare patient discharge data, multistate nurse survey data, and American Hospital Association Annual Survey data. Our sample included 220,914 Medicare surgical patients and 25,082 nurses from 528 hospitals in 4 states (California, Florida, New Jersey, and Pennsylvania). Risk-adjusted robust logistic regressions were used for analyses. The average 30-day readmission rate was 10% in our sample (general surgery: 11%; orthopedic surgery: 8%; vascular surgery: 12%). Readmission rates varied widely across surgical procedures and could be as high as 26% (upper limb and toe amputation for circulatory system disorders). Each additional patient per nurse increased the odds of readmission by 3% (OR=1.03; 95% CI, 1.00-1.05). Patients cared in hospitals with better nurse work environments had lower odds of readmission (OR=0.97; 95% CI, 0.95-0.99). Administrative support to nursing practice (OR=0.96; 95% CI, 0.94-0.99) and nurse-physician relations (OR=0.97; 95% CI, 0.95-0.99) were 2 main attributes of the work environment that were associated with readmissions. Better nurse staffing and work environment were significantly associated with 30-day readmission, and can be considered as system-level interventions to reduce readmissions and associated financial penalties.

How satisfied are mothers with 1-day hospital stays for routine delivery?

PubMed

Klingner, J M; Solberg, L I; Knudson-Schumacher, S; Carlson, R R; Huss, K L

1999-01-01

Payers and health plans are encouraging shorter hospital stays after routine vaginal delivery. To assess the satisfaction of mothers who had 1-day or 2-day stays after routine delivery. We mailed questionnaires to mothers 7 to 9 months after delivery. The self-administered survey contained questions about the mothers' satisfaction with the care they received, clinical complications, and the mothers' preparedness after discharge. A mixed-staff, network-model managed care plan in Minnesota that encourages but does not require 1-day hospital stays after routine delivery. All plan members who delivered a baby vaginally in the first quarter of 1995 (n = 1009). 56% of the mothers responded to the survey. Of these, 202 had 1-day stays and 292 had 2-day stays. Mothers with 1-day stays were more likely than mothers with 2-day stays to report that their length of stay was "too short" (75% vs. 37%; P < 0.001), and 81% of mothers with 1-day stays would want to stay longer if they had another child. The frequency of self-reported maternal or infant complications did not differ substantially between the two groups. More mothers with 1-day stays than mothers with 2-day stays received home health care visits (44% vs. 10%; P < 0.001). Although length of stay does not seem to be related to clinical outcomes after vaginal delivery, mothers with 1-day stays are less satisfied with their length of stay.

[Long-term psychiatric hospitalizations].

PubMed

Plancke, L; Amariei, A

2017-02-01

Long-term hospitalizations in psychiatry raise the question of desocialisation of the patients and the inherent costs. Individual indicators were extracted from a medical administrative database containing full-time psychiatric hospitalizations for the period 2011-2013 of people over 16 years old living in the French region of Nord-Pas-de-Calais. We calculated the proportion of people who had experienced a hospitalization with a duration of 292 days or more during the study period. A bivariate analysis was conducted, then ecological data (level of health-care offer, the deprivation index and the size of the municipalities of residence) were included into a multilevel regression model in order to identify the factors significantly related to variability of long-term hospitalization rates. Among hospitalized individuals in psychiatry, 2.6% had had at least one hospitalization of 292 days or more during the observation period; the number of days in long-term hospitalization represented 22.5% of the total of days of full-time hospitalization in psychiatry. The bivariate analysis revealed that seniority in the psychiatric system was strongly correlated with long hospitalization rates. In the multivariate analysis, the individual indicators the most related to an increased risk of long-term hospitalization were: total lack of autonomy (OR=9.0; 95% CI: 6.7-12.2; P<001); diagnoses of psychological development disorders (OR=9.7; CI95%: 4.5-20.6; P<.001); mental retardation (OR=4.5; CI95%: 2.5-8.2; P<.001): schizophrenia (OR=3.0; CI95%: 1.7-5.2; P<.001); compulsory hospitalization (OR=1.7; CI95%: 1.4-2.1; P<.001); having experienced therapeutic isolation (OR=1.8; CI95%: 1.5-2.1; P<.001). Variations of long-term hospitalization rates depending on the type of establishment were very high, but the density of hospital beds or intensity of ambulatory activity services were not significantly linked to long-term hospitalization. The inhabitants of small urban units had

Implementation of a Total Hip Arthroplasty Care Pathway at a High-Volume Health System: Effect on Length of Stay, Discharge Disposition, and 90-Day Complications.

PubMed

Featherall, Joseph; Brigati, David P; Faour, Mhamad; Messner, William; Higuera, Carlos A

2018-06-01

Standardized care pathways are evidence-based algorithms for optimizing an episode of care. Despite the theoretical promise of care pathways, there is an inconsistent literature demonstrating improvements in patient care. The authors hypothesized that implementing a care pathway, across 11 hospitals, would decrease hospital length of stay (LOS), decrease postoperative complications at 90 days, and increase discharges to home. A multidisciplinary team developed an evidence-based care pathway for total hip arthroplasty (THA) perioperative care. All patients receiving THA in 2013 (pre-protocol, historical control), 2014 (transition), and 2015 (full protocol implementation) were included in the analysis. Multivariable regression assessed the relationship of the care pathway to 90-day postoperative complications, LOS, and discharge disposition. Cost savings were estimated using previously published postarthroplasty episode and per diem hospital costs. A total of 6090 primary THAs were conducted during the study period. After adjusting for the covariates, the full protocol implementation was associated with a decrease in LOS (mean ratio, 0.747; 95% confidence interval [CI; 0.727, 0.767]) and an increase in discharges to home (odds ratio, 2.079; 95% CI [1.762, 2.456]). The full protocol implementation was not associated with a change in 90-day complications (odds ratio, 1.023; 95% CI [0.841, 1.245]). Payer-perspective-calculated theoretical cost savings, including both index admission and postdischarge costs, were $2533 per patient. The THA care pathway implementation was successful in reducing LOS and increasing discharges to home. The care pathway was not associated with a change in 90-day complications; further targeted interventions in this area are needed. Despite care standardization efforts, high-volume hospitals and surgeons had higher performance. Extrapolation of theoretical cost savings indicates that widespread THA care pathway adoption could lead to national

Financial impact of surgical site infections on hospitals: the hospital management perspective.

PubMed

Shepard, John; Ward, William; Milstone, Aaron; Carlson, Taylor; Frederick, John; Hadhazy, Eric; Perl, Trish

2013-10-01

Surgical site infections (SSIs) may increase health care costs, but few studies have conducted an analysis from the perspective of hospital administrators. To determine the change in hospital profit due to SSIs. Retrospective study of data from January 1, 2007, to December 31, 2010. The study was performed at 4 of The Johns Hopkins Health System acute care hospitals in Maryland: Johns Hopkins Bayview (560 beds); Howard County General Hospital (238 beds); The Johns Hopkins Hospital (946 beds); and Suburban Hospital (229 beds). Eligible patients for the study included those patients admitted to the 4 hospitals between January 1, 2007, and December 31, 2010, with complete data and the correct International Classification of Diseases, Ninth Revision code, as determined by the infection preventionist. Infection preventionists performed complete medical record review using National Healthcare Safety Network definitions to identify SSIs. Patients were stratified using the All Patient Refined Diagnosis Related Groups to estimate the change in hospital profit due to SSIs. Surgical site infections. The outcomes of the study were the difference in daily total charges, length of stay (LOS), 30-day readmission rate, and profit for patients with an SSI when compared with patients without an SSI. The hypothesis, formulated prior to data collection, that patients with an SSI have higher daily total costs, a longer LOS, and higher 30-day readmission rates than patients without an SSI, was tested using a nonpaired Mann-Whitney U test, an analysis of covariance, and a Pearson χ2 test. Hospital charges were used as a proxy for hospital cost. RESULTS The daily total charges, mean LOS, and 30-day readmission rate for patients with an SSI compared with patients without an SSI were $7493 vs $7924 (P = .99); 10.56 days vs 5.64 days (P < .001); and 51.94 vs 8.19 readmissions per 100 procedures (P < .001). The change in profit due SSIs was $2 268 589. The data suggest that

Intensive care unit drug costs in the context of total hospital drug expenditures with suggestions for targeted cost containment efforts.

PubMed

Altawalbeh, Shoroq M; Saul, Melissa I; Seybert, Amy L; Thorpe, Joshua M; Kane-Gill, Sandra L

2018-04-01

To assess costs of intensive care unit (ICU) related pharmacotherapy relative to hospital drug expenditures, and to identify potential targets for cost-effectiveness investigations. We offer the unique advantage of comparing ICU drug costs with previously published data a decade earlier to describe changes over time. Financial transactions for all ICU patients during fiscal years (FY) 2009-2012 were retrieved from the hospital's data repository. ICU drug costs were evaluated for each FY. ICU departments' charges were also retrieved and calculated as percentages of total ICU charges. Albumin, prismasate (dialysate), voriconazole, factor VII and alteplase denoted the highest percentages of ICU drug costs. ICU drug costs contributed to an average of 31% (SD 1.0%) of the hospital's total drug costs. ICU drug costs per patient day increased by 5.8% yearly versus 7.8% yearly for non-ICU drugs. This rate was higher for ICU drugs costs at 12% a decade previous. Pharmacy charges contributed to 17.7% of the total ICU charges. Growth rates of costs per year have declined but still drug expenditures in the ICU are consistently a significant driver in this resource intensive environment with a high impact on hospital drug expenditures. Copyright © 2017 Elsevier Inc. All rights reserved.

Association Between Medicare Hospital Readmission Penalties and 30-Day Combined Excess Readmission and Mortality

PubMed Central

Abdul-Aziz, Ahmad A.; Hayward, Rodney A.; Aaronson, Keith D.; Hummel, Scott L.

2017-01-01

IMPORTANCE US hospitals receive financial penalties for excess risk–standardized 30-day readmissions and mortality in Medicare patients. Under current policy, readmission prevention is incentivized over 10-fold more than mortality reduction. OBJECTIVE To determine how penalties for US hospitals would change if policy equally weighted 30-day readmissions and mortality. DESIGN, SETTING, AND PARTICIPANTS Publicly available hospital-level data for fiscal year 2014 was obtained, including excess readmission ratio (ERR; risk-standardized predicted over expected 30-day readmissions) and 30-day mortality rates for heart failure, pneumonia, and acute myocardial infarction, as well as readmission penalties (as percent of Medicare Diagnosis Group payments). An excess mortality ratio (EMR) was calculated by dividing the risk-standardized predicted mortality by the national average mortality. Case-weighted aggregate ERR (ERRAGG) and EMR (EMRAGG) were calculated, and an excess combined outcome ratio (ECORAGG) was created by averaging ERRAGG and EMRAGG. We examined associations between readmission penalties, ERRAGG, EMRAGG, and ECORAGG. Analysis of variance was used to compare readmission penalties in hospitals with concordant (both ratios >1 or <1) and discordant performance by ERRAGG and ECORAGG. MAIN OUTCOMES AND MEASURES The primary outcome investigated was the association between readmission penalties and the calculated excess combined outcome ratio (ECORAGG). RESULTS In 1963 US hospitals with complete data, readmission penalties closely tracked excess readmissions (r = 0.81; P < .001), but were minimally and inversely related with excess mortality (r = −0.12; P < .001) and only modestly correlated with excess combined readmission and mortality (r = 0.36; P < .001). Using hospitals with concordant ERRAGG and ECORAGG as the reference group, 17%of hospitals had an ECORAGG ratio less than 1 (ie, superior combined mortality/readmission outcome) with an ERRAGG ratio greater

Impact of Hospital Population Case-Mix, Including Poverty, on Hospital All-Cause and Infection-Related 30-Day Readmission Rates.

PubMed

Gohil, Shruti K; Datta, Rupak; Cao, Chenghua; Phelan, Michael J; Nguyen, Vinh; Rowther, Armaan A; Huang, Susan S

2015-10-15

Reducing hospital readmissions, including preventable healthcare-associated infections, is a national priority. The proportion of readmissions due to infections is not well-understood. Better understanding of hospital risk factors for readmissions and infection-related readmissions may help optimize interventions to prevent readmissions. Retrospective cohort study of California acute care hospitals and their patient populations discharged between 2009 and 2011. Demographics, comorbidities, and socioeconomic status were entered into a hierarchical generalized linear mixed model predicting all-cause and infection-related readmissions. Crude verses adjusted hospital rankings were compared using Cohen's kappa. We assessed 30-day readmission rates from 323 hospitals, accounting for 213 879 194 post-discharge person-days of follow-up. Infection-related readmissions represented 28% of all readmissions and were associated with discharging a high proportion of patients to skilled nursing facilities. Hospitals serving populations with high proportions of males, comorbidities, prolonged length of stay, and populations living in a federal poverty area, had higher all-cause and infection-related readmission rates. Academic hospitals had higher all-cause and infection-related readmission rates (odds ratio 1.24 and 1.15, respectively). When comparing adjusted vs crude hospital rankings for infection-related readmission rates, adjustment revealed 31% of hospitals changed performance category for infection-related readmissions. Infection-related readmissions accounted for nearly 30% of all-cause readmissions. High hospital infection-related readmissions were associated with serving a high proportion of patients with comorbidities, long lengths of stay, discharge to skilled nursing facility, and those living in federal poverty areas. Preventability of these infections needs to be assessed. © The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases

Trends in hospital labor and total factor productivity, 1981-86

PubMed Central

Cromwell, Jerry; Pope, Gregory C.

1989-01-01

The per-case payment rates of Medicare's prospective payment system are annually updated. As one element of the update factor, Congress required consideration of changes in hospital productivity. In this article, calculations of annual changes in labor and total factor productivity during 1981-86 of hospitals eligible for prospective payment are presented using several output and input variants. Generally, productivity has declined since 1980, although the rates of decline have slowed since prospective payment implementation. According to the series of analyses most relevant for policy, significant hospital productivity gains occurred during 1983-86. This may justify a lower update factor. PMID:10313278

Waiving the Three-Day Rule: Admissions and Length-of-Stay at Hospitals and Skilled Nursing Facilities did not Increase

PubMed Central

Grebla, Regina C.; Keohane, Laura; Lee, Yoojin; Lipsitz, Lewis A.; Rahman, Momotazur; Trivedl, Amal N.

2015-01-01

The traditional Medicare program requires an enrollee to have a hospital stay of at least three consecutive calendar days to qualify for coverage of subsequent postacute care in a skilled nursing facility. This long-standing policy, implemented to discourage premature discharges from hospitals, might now be inappropriately lengthening hospital stays for patients who could be transferred sooner. To assess the implications of eliminating the three-day qualifying stay requirement, we compared hospital and postacute skilled nursing facility utilization among Medicare Advantage enrollees in matched plans that did or did not eliminate that requirement in 2006–10. Among hospitalized enrollees with a skilled nursing facility admission, the mean hospital length-of-stay declined from 6.9 days to 6.7 days for those no longer subject to the qualifying stay but increased from 6.1 to 6.6 days among those still subject to it, for a net decline of 0.7 day when the three-day stay requirement was eliminated. The elimination was not associated with more hospital or skilled nursing facility admissions or with longer lengths-of-stay in a skilled nursing facility. These findings suggest that eliminating the three-day stay requirement conferred savings on Medicare Advantage plans and that study of the requirement in traditional Medicare plans is warranted. PMID:26240246

Resource use and costs associated with opioid-induced constipation following total hip or total knee replacement surgery.

PubMed

Wittbrodt, Eric T; Gan, Tong J; Datto, Catherine; McLeskey, Charles; Sinha, Meenal

2018-01-01

Constipation is a well-known complication of surgery that can be exacerbated by opioid analgesics. This study evaluated resource utilization and costs associated with opioid-induced constipation (OIC). This retrospective, observational, and propensity-matched cohort study utilized the Premier Healthcare Database. The study included adults ≥18 years of age undergoing total hip or total knee replacement as inpatients who received an opioid analgesic and were discharged between January 1, 2012, and June 30, 2015. Diagnosis codes identified patients with OIC who were then matched 1:1 to patients without OIC. Generalized linear and logistic regression models were used to compare inpatient resource utilization, total hospital costs, inpatient mortality, and 30-day all-cause readmissions and emergency department visits. Of 788,448 eligible patients, 40,891 (5.2%) had OIC. Covariates were well balanced between matched patients with and without OIC (n=40,890 each). In adjusted analyses, patients with OIC had longer hospital lengths of stay (3.6 versus 3.3 days; p <0.001), higher total hospital costs (US$17,479 versus US$16,265; p <0.001), greater risk of intensive care unit admission (odds ratio [OR]=1.12, 95% CI: 1.01-1.24), and increased likelihood of 30-day hospital read-missions (OR=1.16, 95% CI: 1.11-1.22) and emergency department visits (OR=1.38, 95% CI: 1.07-1.79) than patients without OIC. No statistically significant difference was found with inpatient mortality (OR=0.89, 95% CI: 0.59-1.35). OIC was associated with greater resource utilization and hospital costs for patients undergoing primarily elective total hip or total knee replacement surgery. These results support OIC screening and management strategies as part of perioperative care management.

[Orthopaedic day surgery in Emilia-Romagna].

PubMed

Rolli, M; Rodler, M; Petropulacos, K; Baldi, R

2001-09-01

It is well known that the organizational model of day surgery, concerning surgical problems defined by the literature as minor, has the aim of optimising the use of hospital resources and facilitating patients and their families, from a psychological and social point of view, by reducing hospitalisation time and the associated complications, and ensuring the same efficacy and more appropriateness of treatment. This study is firstly aimed at analysing the impact that the healthcare policy of the Emilia Romagna Region has had on the development of day surgery practice. Secondly, it compares the patients treated in orthopaedic day surgery in the hospitals of Bologna, Modena, Ferrara, Parma, Reggio Emilia, Maggiore hospital of Bologna and Rizzoli Orthopaedic Institute of Bologna (II.OO.R). In the period 1997-2000 there was a marked increase in the number of operations carried out in day surgery in all of the above-mentioned hospitals. Also in the unispecialistic orthopaedic hospital there was a surprising increase in the percentage of operations carried out in day surgery with respect to the total number of operations performed. The aim of the Rizzoli Orthopaedic Institute and the Emilia Romagna Region is to further implement this form of healthcare, contextually potentiating the appropriateness of hospital admission and avoiding, when not necessary, other forms of healthcare.

Blood Transfusion During Total Ankle Arthroplasty Is Associated With Increased In-Hospital Complications and Costs.

PubMed

Ewing, Michael A; Huntley, Samuel R; Baker, Dustin K; Smith, Kenneth S; Hudson, Parke W; McGwin, Gerald; Ponce, Brent A; Johnson, Michael D

2018-04-01

Total ankle arthroplasty (TAA) is an increasingly used, effective treatment for end-stage ankle arthritis. Although numerous studies have associated blood transfusion with complications following hip and knee arthroplasty, its effects following TAA are largely unknown. This study uses data from a large, nationally representative database to estimate the association between blood transfusion and inpatient complications and hospital costs following TAA. Using the Nationwide Inpatient Sample (NIS) database from 2004 to 2014, 25 412 patients who underwent TAA were identified, with 286 (1.1%) receiving a blood transfusion. Univariate analysis assessed patient and hospital factors associated with blood transfusion following TAA. Patients requiring blood transfusion were more likely to be female, African American, Medicare recipients, and treated in nonteaching hospitals. Average length of stay for patients following transfusion was 3.0 days longer, while average inpatient cost was increased by approximately 50%. Patients who received blood transfusion were significantly more likely to suffer from congestive heart failure, peripheral vascular disease, hypothyroidism, coagulation disorder, or anemia. Acute renal failure was significantly more common among patients receiving blood transfusion ( P < .001). Blood transfusions following TAA are infrequent and are associated with multiple medical comorbidities, increased complications, longer hospital stays, and increased overall cost. Level III: Retrospective, comparative study.

Waiving the three-day rule: admissions and length-of-stay at hospitals and skilled nursing facilities did not increase.

PubMed

Grebla, Regina C; Keohane, Laura; Lee, Yoojin; Lipsitz, Lewis A; Rahman, Momotazur; Trivedi, Amal N

2015-08-01

The traditional Medicare program requires an enrollee to have a hospital stay of at least three consecutive calendar days to qualify for coverage of subsequent postacute care in a skilled nursing facility. This long-standing policy, implemented to discourage premature discharges from hospitals, might now be inappropriately lengthening hospital stays for patients who could be transferred sooner. To assess the implications of eliminating the three-day qualifying stay requirement, we compared hospital and postacute skilled nursing facility utilization among Medicare Advantage enrollees in matched plans that did or did not eliminate that requirement in 2006-10. Among hospitalized enrollees with a skilled nursing facility admission, the mean hospital length-of-stay declined from 6.9 days to 6.7 days for those no longer subject to the qualifying stay but increased from 6.1 to 6.6 days among those still subject to it, for a net decline of 0.7 day when the three-day stay requirement was eliminated. The elimination was not associated with more hospital or skilled nursing facility admissions or with longer lengths-of-stay in a skilled nursing facility. These findings suggest that eliminating the three-day stay requirement conferred savings on Medicare Advantage plans and that study of the requirement in traditional Medicare plans is warranted. Project HOPE—The People-to-People Health Foundation, Inc.

Hidden benefits of a peer-mentored 'Hospital Orientation Day': first-year medical students' perspectives.

PubMed

Barker, Thomas A; Ngwenya, Nothando; Morley, David; Jones, Ellen; Thomas, Cathryn P; Coleman, Jamie J

2012-01-01

Entering the clinical environment is potentially stressful for junior medical students. We evaluated first-year medical student feedback on a peer-mentored 'Hospital Orientation Day' designed to provide insight into future clinical training. Using a mixed methodology approach data were collected from first-year medical students. Responses to a questionnaire were used to develop a topic guide for focus groups held the next academic year. The questionnaire was completed by 230 first-year students and 32 second years participated in the interviews. Thematic analysis was used to draw conclusions. Analysis of questionnaire responses indicated that students gained insight into future learning. Focus groups then generated five themes: (1) entering the hospital without fear, (2) linking the present with the future, (3) understanding the culture of learning in the clinical years, (4) a 'Backstage Pass' to the clinical world and (5) peer mentors make or break the day. Using peer mentors during the Hospital Orientation Day allowed insight into future learning. We highlight the importance of student Mentors in the success of hospital orientation. To maximise the benefits for first years, we recommend a mentor selection procedure, mentor training opportunities and incentives to optimise mentor performance.

[Evaluation of Treatment of Mothers at the Family Day Hospital in Münster, Germany].

PubMed

Liwinski, Timur; Romer, Georg; Müller, Jörg Michael

2015-01-01

Evaluation of Treatment of Mothers at the Family Day Hospital in Münster, Germany. Mothers of preschool children have limited access to mental health treatment services. The Family Day Hospital for Preschool Children at the University Hospital Münster, Germany, offers therefore a specialized treatment for mothers with their preschool children. The therapy outcome of mothers is evaluated in effectiveness study by a pre-post-design. For mothers, therapy was composed of individual session and couple sessions with the partner, video-based parent-child-interaction therapy, and parent group sessions. We evaluated the psychiatric symptom burden of N = 103 mothers at admission and discharge with the Symptom Checklist-90-Revised (SCL-90-R) above the clinical cut-off ≥ 0.57. After treatment the mothers showed significant improvement on the global severity index (GSI) with an average Cohen's d = 1.64 (p0.001). We identified the following positively associated moderator variables of maternal improvement by a multiple regression analysis: the initial symptom burden, the educational level of the mother, not restricted housing conditions, and the age of the child. We conclude that especially distressed parents benefit from the treatment in the Family Day Hospital for Preschool Children.

Early enteral nutrition after total gastrectomy for gastric cancer.

PubMed

Chen, Wei; Zhang, Zheng; Xiong, Maoming; Meng, Xiangling; Dai, Fen; Fang, Jun; Wan, Hong; Wang, Miaofeng

2014-01-01

To assess the difference between early enteral nutrition (EEN group) and total parenteral nutrition (TPN group) after total gastrectomy for gastric cancer. The nutrition index, liver function, patient generated subjective global assessment (PG-SGA) score, the post-operation complications, the hospital stay and hospitalization expense of the postoperative patient after total gastrectomy, admitted to our Department of Surgery from May 2011 to May 2013 were analyzed retrospectively. A total of 72 patients including 37 cases in the EEN group and 35 cases in the TPN group were recruited. Hypoalbuminemia gradually improved in the EEN group about 3-5 days, but it did not increase until average 21 days in the TPN group. The body weight decreased in the EEN group during the first 2 weeks and recovered gradually in 21 days; body weight in the TPN group was significantly lower than the EEN group at 21 days (p<0.05). There were significant differences in both the groups (p<0.05) in nutrition indicators. The incidence of complications in the EEN group and TPN group were 8.1% and 25.7% respectively, with no significant differences (p>0.05). The days of hospital stays in the EEN and in the TPN group were up to 12.2 ± 2.5 d vs 14.9 ± 2.9 d (p<0.05) and the hospitalization expenses were 36472 ± 4833 CNY vs 40140 ± 3927 CNY (p<0.05), respectively. Compared with TPN, EEN was safe and well tolerated and can shorten the hospital stay as well as reduce costs incurred with total gastrectomy for gastric cancer.

Discharge clinical characteristics and 60-day readmission in patients hospitalized with heart failure.

PubMed

Anderson, Kelley M

2014-01-01

Heart failure is a clinical syndrome that incurs a high prevalence, mortality, morbidity, and economic burden in our society. Patients with heart failure may experience hospitalization because of an acute exacerbation of their condition. Recurrent hospitalizations soon after discharge are an unfortunate occurrence in this patient population. The purpose of this study was to explore the clinical and diagnostic characteristics of individuals hospitalized with a primary diagnosis of heart failure at the time of discharge and to compare the association of these indicators in individuals who did and did not experience a heart failure hospitalization within 60 days of the index stay. The study is a descriptive, correlational, quantitative study using a retrospective review of 134 individuals discharged with a primary diagnosis of heart failure. Records were reviewed for sociodemographic characteristics, health histories, clinical assessment findings, and diagnostic information. Significant predictors of 60-day heart failure readmissions were dyspnea (β = 0.579), crackles (β = 1.688), and assistance with activities of daily living (β = 2.328), independent of age, gender, and multiple other factors. By using hierarchical logistical regression, a model was derived that demonstrated the ability to correctly classify 77.4% of the cohort, 78.2% of those who did have a readmission (sensitivity of the prediction), and 76.7% of the subjects in whom the predicted event, readmission, did not occur (specificity of the prediction). Hospitalizations for heart failure are markers of clinical instability. Future events after hospitalization are common in this patient population, and this study provides a novel understanding of clinical characteristics at the time of discharge that are associated with future outcomes, specifically 60-day heart failure readmissions. A consideration of these characteristics provides an additional perspective to guide clinical decision making and the

Lessons learned from the total evacuation of a hospital after the 2016 Kumamoto Earthquake.

PubMed

Yanagawa, Youichi; Kondo, Hisayoshi; Okawa, Takashi; Ochi, Fumio

The 2016 Kumamoto Earthquakes were a series of earthquakes that included a foreshock earthquake (magnitude 6.2) on April 14 and a main shock (magnitude 7.0) on April 16, 2016. A number of hospitals in Kumamoto were severely damaged by the two major earthquakes and required total evacuation. The authors retrospectively analyzed the activity data of the Disaster Medical Assistance Teams using the Emergency Medical Information System records to investigate the cases in which the total evacuation of a hospital was attempted following the 2016 Kumamoto Earthquake. Total evacuation was attempted at 17 hospitals. The evacuation of one of these hospitals was canceled. Most of the hospital buildings were more than 20 years old. The danger of collapse was the most frequent reason for evacuation. Various transportation methods were employed, some of which involved the Japan Ground Self-Defense Force; no preventable deaths occurred during transportation. The hospitals must now be renovated to improve their earthquake resistance. The coordinated and combined use of military and civilian resources is beneficial and can significantly reduce human suffering in large-scale disasters.

Reducing the length of hospital stay after total knee arthroplasty: influence of femoral and sciatic nerve block.

PubMed

Carvalho Júnior, Lúcio Honório de; Temponi, Eduardo Frois; Paganini, Vinícius Oliveira; Costa, Lincoln Paiva; Soares, Luiz Fernando Machado; Gonçalves, Matheus Braga Jacques

2015-01-01

the aim of this study is to evaluate the change in length of hospital stay postoperatively for Total Knee Arthroplasty after using femoral and sciatic nerve block. the medical records of 287 patients were evaluated, taking into account the number of hours of admission, the percentage and the reason for re-hospitalization within 30 days, as well as associated complications. All patients were divided into two groups according or not to whether they were admitted to ICU or not. During the years 2009 and 2010, isolated spinal anesthesia was the method used in the procedure. From 2011 on, femoral and sciatic nerve blocking was introduced. between the years 2009 and 2012, the average length of stay ranged from 74 hours in 2009 to 75.2 hours in 2010. The average length of stay in 2011 was 56.52 hours and 53.72 hours in 2012, all in the group of patients who did not remain in the ICU postoperatively. In the same period, among those in the group that needed ICU admission, the average length of stay was 138.7 hours in 2009, 90.25 hours in 2010, 79.8 hours in 2011, and 52.91 hours in 2012. During 2009 and 2010, the rate of re-hospitalization was 0%, while in 2011 and 2012, were 3.44% and 1%, respectively. according to this study, the use of femoral and sciatic nerve blocking after total knee arthroplasty allowed significant reduction in hospital stay.

Neer Award 2016: Outpatient total shoulder arthroplasty in an ambulatory surgery center is a safe alternative to inpatient total shoulder arthroplasty in a hospital: a matched cohort study.

PubMed

Brolin, Tyler J; Mulligan, Ryan P; Azar, Frederick M; Throckmorton, Thomas W

2017-02-01

Recent emphasis on safe and efficient delivery of high-quality health care has increased interest in outpatient total joint arthroplasty. The purpose of this study was to evaluate the safety of outpatient total shoulder arthroplasty (TSA) by comparing episode-of-care complications in matched cohorts of patients with anatomic TSA as an outpatient or inpatient procedure. Thirty patients with outpatient TSA at a freestanding ambulatory surgery center (ASC) were compared with an age- and comorbidities-matched cohort of 30 patients with traditional inpatient TSA to evaluate 90-day episode-of-care complications, including hospital admissions or readmissions and reoperations. Two-tailed t-tests were used to evaluate differences, and differences of P < .05 were considered statistically significant. No significant differences were found between the ASC and hospital cohorts regarding average age, preoperative American Society of Anesthesiologists score, operative indications, or body mass index. No patient required reoperation. There were no hospital admissions from the ASC cohort and no readmissions from the hospital cohort. Minor complications in the ASC cohort were arthrofibrosis in 2 patients and mild asymptomatic anterior subluxation in 1 patient; the only major complication was in an outpatient who fell 11 weeks after surgery and disrupted his subscapularis repair. Three minor complications in the hospital cohort were mild asymptomatic anterior subluxation, blood transfusion, and superficial venous thrombosis. The complication rates (13% vs. 10%) were not significantly different. Outpatient TSA is a safe alternative to hospital admission in appropriately selected patients. Further investigation is warranted to evaluate the longer term outcomes and cost-effectiveness of outpatient TSA. Copyright © 2017 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

Effect of day of the week of primary total hip arthroplasty on length of stay at a university-based teaching medical center.

PubMed

Rathi, Pranav; Coleman, Sheldon; Durbin-Johnson, Blythe; Giordani, Mauro; Pereira, Gavin; Di Cesare, Paul E

2014-12-01

Length of hospital stay (LHS) after primary total hip arthroplasty (THA) constitutes a critical outcome measure, as prolonged LHS implies increased resource expenditure. Investigations have highlighted factors that affect LHS after THA. These factors include advanced age, medical comorbidities, obesity, intraoperative time, anesthesia technique, surgical site infection, and incision length. We retrospectively analyzed the effect of day of the week of primary THA on LHS. We reviewed the surgery and patient factors of 273 consecutive patients who underwent THA at our institution, a tertiary-care teaching hospital. There was a 15% increase in LHS for patients who underwent THA on Thursday versus Monday when controlling for other covariates that can affect LHS. Other statistically significant variables associated with increased LHS included American Society of Anesthesiologists grade, transfusion requirements, and postoperative complications. The day of the week of THA may be an independent variable affecting LHS. Institutions with reduced weekend resources may want to perform THA earlier in the week to try to reduce LHS.

Effect of Day of the Week of Primary Total Hip Arthroplasty on Length of Stay at a University-Based Teaching Medical Center

PubMed Central

Rathi, Pranav; Coleman, Sheldon; Durbin-Johnson, Blythe; Giordani, Mauro; Pereira, Gavin; Di Cesare, Paul E.

2016-01-01

Length of hospital stay (LHS) after primary total hip arthroplasty (THA) constitutes a critical outcome measure, as prolonged LHS implies increased resource expenditure. Investigations have highlighted factors that affect LHS after THA. These factors include advanced age, medical comorbidities, obesity, intraoperative time, anesthesia technique, surgical site infection, and incision length. We retrospectively analyzed the effect of day of the week of primary THA on LHS. We reviewed the surgery and patient factors of 273 consecutive patients who underwent THA at our institution, a tertiary-care teaching hospital. There was a 15% increase in LHS for patients who underwent THA on Thursday versus Monday when controlling for other covariates that can affect LHS. Other statistically significant variables associated with increased LHS included American Society of Anesthesiologists grade, transfusion requirements, and post-operative complications. The day of the week of THA may be an independent variable affecting LHS. Institutions with reduced weekend resources may want to perform THA earlier in the week to try to reduce LHS. PMID:25490016

Allocation of Internal Medicine Resident Time in a Swiss Hospital: A Time and Motion Study of Day and Evening Shifts.

PubMed

Wenger, Nathalie; Méan, Marie; Castioni, Julien; Marques-Vidal, Pedro; Waeber, Gérard; Garnier, Antoine

2017-04-18

Little current evidence documents how internal medicine residents spend their time at work, particularly with regard to the proportions of time spent in direct patient care versus using computers. To describe how residents allocate their time during day and evening hospital shifts. Time and motion study. Internal medicine residency at a university hospital in Switzerland, May to July 2015. 36 internal medicine residents with an average of 29 months of postgraduate training. Trained observers recorded the residents' activities using a tablet-based application. Twenty-two activities were categorized as directly related to patients, indirectly related to patients, communication, academic, nonmedical tasks, and transition. In addition, the presence of a patient or colleague and use of a computer or telephone during each activity was recorded. Residents were observed for a total of 696.7 hours. Day shifts lasted 11.6 hours (1.6 hours more than scheduled). During these shifts, activities indirectly related to patients accounted for 52.4% of the time, and activities directly related to patients accounted for 28.0%. Residents spent an average of 1.7 hours with patients, 5.2 hours using computers, and 13 minutes doing both. Time spent using a computer was scattered throughout the day, with the heaviest use after 6:00 p.m. The study involved a small sample from 1 institution. At this Swiss teaching hospital, internal medicine residents spent more time at work than scheduled. Activities indirectly related to patients predominated, and about half the workday was spent using a computer. Information Technology Department and Department of Internal Medicine of Lausanne University Hospital.

Early Ambulation Among Hospitalized Heart Failure Patients Is Associated With Reduced Length of Stay and 30-Day Readmissions.

PubMed

Fleming, Lisa M; Zhao, Xin; DeVore, Adam D; Heidenreich, Paul A; Yancy, Clyde W; Fonarow, Gregg C; Hernandez, Adrian F; Kociol, Robb D

2018-04-01

Early ambulation (EA) is associated with improved outcomes for mechanically ventilated and stroke patients. Whether the same association exists for patients hospitalized with acute heart failure is unknown. We sought to determine whether EA among patients hospitalized with heart failure is associated with length of stay, discharge disposition, 30-day post discharge readmissions, and mortality. The study population included 369 hospitals and 285 653 patients with heart failure enrolled in the Get With The Guidelines-Heart Failure registry. We used multivariate logistic regression with generalized estimating equations at the hospital level to identify predictors of EA and determine the association between EA and outcomes. Sixty-five percent of patients ambulated by day 2 of the hospital admission. Patient-level predictors of EA included younger age, male sex, and hospitalization outside of the Northeast ( P <0.01 for all). Hospital size and academic status were not predictive. Hospital-level analysis revealed that those hospitals with EA rates in the top 25% were less likely to have a long length of stay (defined as >4 days) compared with those in the bottom 25% (odds ratio, 0.83; confidence interval, 0.73-0.94; P =0.004). Among a subgroup of fee-for-service Medicare beneficiaries, we found that hospitals in the highest quartile of rates of EA demonstrated a statistically significant 24% lower 30-day readmission rates ( P <0.0001). Both end points demonstrated a dose-response association and statistically significant P for trend test. Multivariable-adjusted hospital-level analysis suggests an association between EA and both shorter length of stay and lower 30-day readmissions. Further prospective studies are needed to validate these findings. © 2018 American Heart Association, Inc.

Scoping review: Hospital nursing factors associated with 30-day readmission rates of patients with heart failure.

PubMed

Jun, Jin; Faulkner, Kenneth M

2018-04-01

To review the current literature on hospital nursing factors associated with 30-day readmission rates of patients with heart failure. Heart failure is a common, yet debilitating chronic illness with high mortality and morbidity. One in five patients with heart failure will experience unplanned readmission to a hospital within 30 days. Given the significance of heart failure to individuals, families and healthcare system, the Center for Medicare and Medicaid Services has made reducing 30-day readmission rates a priority. Scoping review, which maps the key concepts of a research area, is used. Published primary studies in English assessing factors related to nurses in hospitals and readmission of patients with heart failure were included. Other inclusion criteria were written in English and published in peer-reviewed journals. The search resulted in 2,782 articles. After removing duplicates and reviewing the inclusion and exclusion criteria, five articles were selected. Three nursing workforce factors emerged as follows: (i) nursing staffing, (ii) nursing care and work environment, and (iii) nurses' knowledge of heart failure. This is the first scoping review examining the association between hospital nursing factors and 30-day readmission rates of patients with heart failure. Further studies examining the extent of nursing structural and process factors influencing the outcomes of patients with heart failure are needed. Nurses are an integral part of the healthcare system. Identifying the factors related to nurses in hospitals is important to ensure comprehensive delivery of care to the chronically ill population. Hospital administrators, managers and policymakers can use the findings from this review to implement strategies to reduce 30-day readmission rates of patients with heart failure. © 2018 John Wiley & Sons Ltd.

Day hospital as an alternative to inpatient care for cancer patients: a random assignment trial.

PubMed

Mor, V; Stalker, M Z; Gralla, R; Scher, H I; Cimma, C; Park, D; Flaherty, A M; Kiss, M; Nelson, P; Laliberte, L

1988-01-01

A stratified, random-assignment trial of 442 cancer patients was conducted to evaluate medical, psychosocial, and financial outcomes of day hospital treatment as an alternative to inpatient care for certain cancer patients. Eligible patients required: a 4- to 8-hour treatment plan, including chemotherapy and other long-term intravenous (i.v.) treatment; a stable cardiovascular status; mental competence; no skilled overnight nursing; and a helper to assist with home care. Patients were ineligible if standard outpatient treatment was possible. No statistically significant (p less than 0.05) differences were found between the Adult Day Hospital (ADH) and Inpatient care in medical or psychosocial outcomes over the 60-day study period. The major difference was in medical costs--approximately one-third lower for ADH patients (p less than 0.001) than for the Inpatient group. The study demonstrates that day hospital care of medical oncology patients is clinically equivalent to Inpatient care, causes no negative psychosocial effects, and costs less than Inpatient care. Findings support the trend toward dehospitalization of medical treatment.

Association of Hospital Performance Based on 30-Day Risk-Standardized Mortality Rate With Long-term Survival After Heart Failure Hospitalization: An Analysis of the Get With The Guidelines-Heart Failure Registry.

PubMed

Pandey, Ambarish; Patel, Kershaw V; Liang, Li; DeVore, Adam D; Matsouaka, Roland; Bhatt, Deepak L; Yancy, Clyde W; Hernandez, Adrian F; Heidenreich, Paul A; de Lemos, James A; Fonarow, Gregg C

2018-06-01

Among patients hospitalized with heart failure (HF), the long-term clinical implications of hospitalization at hospitals based on 30-day risk-standardized mortality rates (RSMRs) is not known. To evaluate the association of hospital-specific 30-day RSMR with long-term survival among patients hospitalized with HF in the American Heart Association Get With The Guidelines-HF registry. The longitudinal observational study included 106 304 patients with HF who were admitted to 317 centers participating in the Get With The Guidelines-HF registry from January 1, 2005, to December 31, 2013, and had Medicare-linked follow-up data. Hospital-specific 30-day RSMR was calculated using a hierarchical logistic regression model. In the model, 30-day mortality rate was a binary outcome, patient baseline characteristics were included as covariates, and the hospitals were treated as random effects. The association of 30-day RSMR-based hospital groups (low to high 30-day RSMR: quartile 1 [Q1] to Q4) with long-term (1-year, 3-year, and 5-year) mortality was assessed using adjusted Cox models. Data analysis took place from June 29, 2017, to February 19, 2018. Thirty-day RSMR for participating hospitals. One-year, 3-year, and 5-year mortality rates. Of the 106 304 patients included in the analysis, 57 552 (54.1%) were women and 84 595 (79.6%) were white, and the median (interquartile range) age was 81 (74-87) years. The 30-day RSMR ranged from 8.6% (Q1) to 10.7% (Q4). Hospitals in the low 30-day RSMR group had greater availability of advanced HF therapies, cardiac surgery, and percutaneous coronary interventions. In the primary landmarked analyses among 30-day survivors, there was a graded inverse association between 30-day RSMR and long-term mortality (Q1 vs Q4: 5-year mortality, 73.7% vs 76.8%). In adjusted analysis, patients admitted to hospitals in the high 30-day RSMR group had 14% (95% CI, 10-18) higher relative hazards of 5-year mortality compared with those admitted to

Association Between Treatment by Locum Tenens Internal Medicine Physicians and 30-Day Mortality Among Hospitalized Medicare Beneficiaries.

PubMed

Blumenthal, Daniel M; Olenski, Andrew R; Tsugawa, Yusuke; Jena, Anupam B

2017-12-05

Use of locum tenens physicians has increased in the United States, but information about their quality and costs of care is lacking. To evaluate quality and costs of care among hospitalized Medicare beneficiaries treated by locum tenens vs non-locum tenens physicians. A random sample of Medicare fee-for-service beneficiaries hospitalized during 2009-2014 was used to compare quality and costs of hospital care delivered by locum tenens and non-locum tenens internal medicine physicians. Treatment by locum tenens general internal medicine physicians. The primary outcome was 30-day mortality. Secondary outcomes included inpatient Medicare Part B spending, length of stay, and 30-day readmissions. Differences between locum tenens and non-locum tenens physicians were estimated using multivariable logistic regression models adjusted for beneficiary clinical and demographic characteristics and hospital fixed effects, which enabled comparisons of clinical outcomes between physicians practicing within the same hospital. In prespecified subgroup analyses, outcomes were reevaluated among hospitals with different levels of intensity of locum tenens physician use. Of 1 818 873 Medicare admissions treated by general internists, 38 475 (2.1%) received care from a locum tenens physician; 9.3% (4123/44 520) of general internists were temporarily covered by a locum tenens physician at some point. Differences in patient characteristics, demographics, comorbidities, and reason for admission between locum tenens and non-locum tenens physicians were not clinically relevant. Treatment by locum tenens physicians, compared with treatment by non-locum tenens physicians (n = 44 520 physicians), was not associated with a significant difference in 30-day mortality (8.83% vs 8.70%; adjusted difference, 0.14%; 95% CI, -0.18% to 0.45%). Patients treated by locum tenens physicians had significantly higher Part B spending ($1836 vs $1712; adjusted difference, $124; 95% CI, $93 to $154

Complications, Hospital Length of Stay, and Readmission after Total Laryngectomy

PubMed Central

Goepfert, Ryan. P.; Hutcheson, Katherine A.; Lewin, Jan S.; Desai, Neha G.; Zafereo, Mark E.; Hessel, Amy C.; Lewis, Carol M.; Weber, Randal S.; Gross, Neil D.

2018-01-01

Background The purpose of this study was to describe the 30-day incidence of complications after total laryngectomy (TL) in a high-volume institution and their impact on hospital length of stay (LOS) and readmission rates. Methods A retrospective, cohort study of all patients who underwent TL at MD Anderson Cancer Center from January 1, 2010 through June 30, 2013 was conducted. Patient demographics, treatment history, LOS, and 30-day post-TL complications and readmissions were extracted from the medical record. Univariate associations were analyzed and stepwise backward selection methods were used to fit multivariate models. Results 245 patients were included. Complications occurred in 83 patients (33.9%) including 3 (1.2%) deaths. Wound complications occurred in 53 patients (21.6%), of which 34 were pharyngocutaneous fistula (PCF) (13.9% overall). 34 patients (13.9%) were readmitted within 30 days. Multivariate analysis revealed the following: wound complications were associated with former (OR 5.1, p=0.03) and current (OR 5.8, p=0.02) smokers; PCF was associated with prior wide-field radiation (OR 3.1, p=0.01) but not prior narrow-field (larynx only) radiation (OR 1.4, p=0.61); LOS was associated with type of flap (p=0.002) and post-operative hematoma (p=0.05); and readmissions were associated with pre-operative hypoalbuminemia (p=0.003) and post-operative wound complications (p<0.001). Conclusions Complications occurred in nearly one third of TL patients, particularly among patients with poor wound healing risk factors such as prior smoking and radiation. Expectedly, LOS was longer among reconstructed patients. Readmission was associated with hypoalbuminemia and post-operative wound complications. These data inform quality improvement efforts and counseling of high-risk patients undergoing TL. PMID:28026864

Incidence and predictors of 30-day readmissions in patients hospitalized with chronic pancreatitis: A nationwide analysis.

PubMed

Shah, Rushikesh; Haydek, Christopher; Mulki, Ramzi; Qayed, Emad

2018-06-01

Patients with chronic pancreatitis are prone to frequent readmissions. The aim of this study is to evaluate the rate and predictors of 30-day readmissions in patients with chronic pancreatitis using the Nationwide Readmission Database (NRD). We performed a retrospective analysis of all adult patients with the principal discharge diagnosis of chronic pancreatitis from 2010 through 2014. We excluded patients who died during the hospitalization. Multivariate Cox proportional hazard regression was performed to identify demographic, clinical, and hospital factors that associated with 30-day unplanned readmissions. During the study period, 25,259 patients had the principal discharge diagnosis of chronic pancreatitis and survived the index hospitalization. Of these, 6477 (26.7%) were readmitted within 30 days. Younger age group, males, length of stay >5 days, admission to a large, metropolitan hospital, and several comorbidities (renal failure, rheumatic disease, chronic anemia, heart failure, depression, drug abuse, psychosis, and diabetes) were independently associated with increased risk of 30-day readmission. ERCP, pancreatic surgery, and obesity were associated with lower risk. The most common reasons for readmissions were acute pancreatitis (30%), chronic pancreatitis (17%), pseudocyst (2%), and abdominal pain (6%). One in four patients with chronic pancreatitis is readmitted within 30 days (26.7%). Pancreatic disease accounts for at least half of all readmissions. Several baseline comorbidities and characteristics are associated with 30-day readmission risk after index admission. Knowledge of these predictors can help design interventions to target high-risk patients and reduce readmissions and costs of care. Copyright © 2018 IAP and EPC. Published by Elsevier B.V. All rights reserved.

Healthy Life-Years Lost and Excess Bed-Days Due to 6 Patient Safety Incidents: Empirical Evidence From English Hospitals.

PubMed

Hauck, Katharina D; Wang, Shaolin; Vincent, Charles; Smith, Peter C

2017-02-01

There is little satisfactory evidence on the harm of safety incidents to patients, in terms of lost potential health and life-years. To estimate the healthy life-years (HLYs) lost due to 6 incidents in English hospitals between the years 2005/2006 and 2009/2010, to compare burden across incidents, and estimate excess bed-days. The study used cross-sectional analysis of the medical records of all inpatients treated in 273 English hospitals. Patients with 6 types of preventable incidents were identified. Total attributable loss of HLYs was estimated through propensity score matching by considering the hypothetical remaining length and quality of life had the incident not occurred. The 6 incidents resulted in an annual loss of 68 HLYs and 934 excess bed-days per 100,000 population. Preventable pressure ulcers caused the loss of 26 HLYs and 555 excess bed-days annually. Deaths in low-mortality procedures resulted in 25 lost life-years and 42 bed-days. Deep-vein thrombosis/pulmonary embolisms cost 12 HLYs, and 240 bed-days. Postoperative sepsis, hip fractures, and central-line infections cost <6 HLYs and 100 bed-days each. The burden caused by the 6 incidents is roughly comparable with the UK burden of Multiple Sclerosis (80 DALYs per 100,000), HIV/AIDS and Tuberculosis (63 DALYs), and Cervical Cancer (58 DALYs). There were marked differences in the harm caused by the incidents, despite the public attention all of them receive. Decision makers can use the results to prioritize resources into further research and effective interventions.

The Effect of Advancing Age on Total Joint Replacement Outcomes

PubMed Central

Noiseux, Nicolas; Linson, Eric; Cram, Peter

2015-01-01

Objective: To describe age-related differences in outcomes among older adults undergoing total hip arthroplasty (THA) and total knee arthroplasty (TKA). Design: Retrospective study. Participants: A total of 1792 patients who underwent primary THA or TKA at the University of Iowa Hospitals and Clinics between 2010 and 2013 were identified in the University HealthSystem Consortium Database and University of Iowa Orthopedics Joint Replacement Registry. Main Outcome Measures: Hospital length of stay (LOS), 30-day readmission rate, in-hospital mortality, number of days admitted to intensive care unit (ICU discharge disposition), in-hospital complications (pulmonary embolism, deep vein thrombosis, wound infection, hemorrhage, sepsis, or myocardial infarction), quality of life (measured using Short-Form 36 [SF-36]), discharge disposition (home, home with home health, nursing home, inpatient rehabilitation, transfer to another acute care hospital, and dead), and total patient level observed hospital cost (based on hospital charge information from each revenue code and estimated labor costs). Outcomes were compared in patients stratified by age and categorized by decade (ie, ≤50, 51-60, 61-70, 71-80, and ≥81). Results: A total of 871 THAs and 921 TKAs were performed. The mean age of our cohort was 60.5 years and 56.1% were women. In-hospital complication rates and ICU utilization progressively increased with increasing age. There was also a higher likelihood of skilled nursing facility placement and longer LOS. There was no increase in 30-day readmissions, mortality, or total cost. Improvements in patient reported outcomes (SF-36) scores were similar for all age-groups. Conclusions: Compared to younger patients, older THA and TKA recipients were more likely to experience postoperative complications, admission to the ICU, discharge to a skilled care facility, and had longer hospital LOS. Improvements in patient-related outcomes were similar across all age-groups. These

The effect of a collaborative pharmacist-hospital care transition program on the likelihood of 30-day readmission.

PubMed

Kirkham, Heather S; Clark, Bobby L; Paynter, Jacquelyn; Lewis, Geraint H; Duncan, Ian

2014-05-01

The effect of a collaborative pharmacist-hospital care transition program on the likelihood of 30-day readmission was evaluated. This retrospective cohort study was conducted in two acute care hospitals within the same hospital system in the southeastern United States. One hospital initiated a care transition program in January 2011; the other hospital did not have such a program. All patients who were discharged from either hospital to home from January 1, 2010, through December 31, 2011, were included in the study. The two key program components included bedside delivery of postdischarge medications and follow-up telephone calls two to three days after discharge. The likelihood of readmission was assessed using multiple logistic regression. Over the 2-year study period, 19,659 unique patients had 26,781 qualifying index admissions, 2,523 of which resulted in a readmission within 30 days of discharge. After adjusting for various demographic and clinical characteristics, the usual care group (i.e., patients who did not participate in the program) had nearly twice the odds of readmission within 30 days (odds ratio [OR], 1.90; 95% confidence interval [CI], 1.35-2.67), compared with the intervention group (i.e., program participants). For patients age 65 years or older, those in the usual care group had a sixfold increase in the odds of a 30-day readmission (OR, 6.05; 95% CI, 1.92-19.00) relative to those in the intervention group. A care transition program was associated with a lower likelihood of readmission and had a greater effect on older patients.

Feasibility of 30-day hospital readmission prediction modeling based on health information exchange data.

PubMed

Swain, Matthew J; Kharrazi, Hadi

2015-12-01

Unplanned 30-day hospital readmission account for roughly $17 billion in annual Medicare spending. Many factors contribute to unplanned hospital readmissions and multiple models have been developed over the years to predict them. Most researchers have used insurance claims or administrative data to train and operationalize their Readmission Risk Prediction Models (RRPMs). Some RRPM developers have also used electronic health records data; however, using health informatics exchange data has been uncommon among such predictive models and can be beneficial in its ability to provide real-time alerts to providers at the point of care. We conducted a semi-systematic review of readmission predictive factors published prior to March 2013. Then, we extracted and merged all significant variables listed in those articles for RRPMs. Finally, we matched these variables with common HL7 messages transmitted by a sample of health information exchange organizations (HIO). The semi-systematic review resulted in identification of 32 articles and 297 predictive variables. The mapping of these variables with common HL7 segments resulted in an 89.2% total coverage, with the DG1 (diagnosis) segment having the highest coverage of 39.4%. The PID (patient identification) and OBX (observation results) segments cover 13.9% and 9.1% of the variables. Evaluating the same coverage in three sample HIOs showed data incompleteness. HIOs can utilize HL7 messages to develop unique RRPMs for their stakeholders; however, data completeness of exchanged messages should meet certain thresholds. If data quality standards are met by stakeholders, HIOs would be able to provide real-time RRPMs that not only predict intra-hospital readmissions but also inter-hospital cases. A RRPM derived using HIO data exchanged through may prove to be a useful method to prevent unplanned hospital readmissions. In order for the RRPM derived from HIO data to be effective, hospitals must actively exchange clinical information

Should All Patients Be Included in Alternative Payment Models for Primary Total Hip Arthroplasty and Total Knee Arthroplasty?

PubMed

Rozell, Joshua C; Courtney, Paul M; Dattilo, Jonathan R; Wu, Chia H; Lee, Gwo-Chin

2016-09-01

Alternative payment models in total joint replacement incentivize cost effective health care delivery and reward reductions in length of stay (LOS), complications, and readmissions. If not adjusted for patient comorbidities, they may encourage restrictive access to health care. We prospectively evaluated 802 consecutive primary total hip arthroplasty and total knee arthroplasty patients evaluating comorbidities associated with increased LOS and readmissions. During this 9-month period, 115 patients (14.3%) required hospitalization >3 days and 16 (1.99%) were readmitted within 90 days. Univariate analysis demonstrated that preoperative narcotic use, heart failure, stroke, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), and liver disease were more likely to require hospitalization >3 days. In multivariate analysis, CKD and COPD were independent risk factors for LOS >3 days. A Charlson comorbidity index >5 points was associated with increased LOS and readmissions. Patients with CKD, COPD, and Charlson comorbidity index >5 points should not be included in alternative payment model for THA and TKA. Copyright © 2016 Elsevier Inc. All rights reserved.

Health literacy and 30-day hospital readmission after acute myocardial infarction

PubMed Central

Bailey, Stacy Cooper; Fang, Gang; Annis, Izabela E; O'Conor, Rachel; Paasche-Orlow, Michael K; Wolf, Michael S

2015-01-01

Objective To assess the validity of a predictive model of health literacy, and to examine the relationship between derived health literacy estimates and 30-day hospital readmissions for acute myocardial infarction (AMI). Design Retrospective cohort study. Setting and participants A National Institute of Aging (NIA) study cohort of 696 adult, English-speaking primary care patients, aged 55–74 years, was used to assess the validity of derived health literacy estimates. Claims from 7733 Medicare beneficiaries hospitalised for AMI in 2008 in North Carolina and Illinois were used to investigate the association between health literacy estimates and 30-day hospital readmissions. Measures The NIA cohort was administered 3 common health literacy assessments (Newest Vital Sign, Test of Functional Health Literacy in Adults, and Rapid Estimate of Adult Literacy in Medicine). Health literacy estimates at the census block group level were derived via a predictive model. 30-day readmissions were measured from Medicare claims data using a validated algorithm. Results Fair agreement was found between derived estimates and in-person literacy assessments (Pearson Correlation coefficients: 0.38–0.51; κ scores: 0.38–0.40). Medicare enrollees with above basic literacy according to derived health literacy estimates had an 18% lower risk of a 30-day readmission (RR=0.82, 95% CI 0.73 to 0.92) and 21% lower incidence rate of 30-day readmission (IRR=0.79, 95% CI 0.68 to 0.87) than patients with basic or below basic literacy. After adjusting for demographic and clinical characteristics, the risk of 30-day readmission was 12% lower (p=0.03), and the incidence rate 16% lower (p<0.01) for patients with above basic literacy. Conclusions Health literacy, as measured by a predictive model, was found to be a significant, independent predictor of 30-day readmissions. As a modifiable risk factor with evidence-based solutions, health literacy should be considered in readmission reduction

Health literacy and 30-day hospital readmission after acute myocardial infarction.

PubMed

Bailey, Stacy Cooper; Fang, Gang; Annis, Izabela E; O'Conor, Rachel; Paasche-Orlow, Michael K; Wolf, Michael S

2015-06-11

To assess the validity of a predictive model of health literacy, and to examine the relationship between derived health literacy estimates and 30-day hospital readmissions for acute myocardial infarction (AMI). Retrospective cohort study. A National Institute of Aging (NIA) study cohort of 696 adult, English-speaking primary care patients, aged 55-74 years, was used to assess the validity of derived health literacy estimates. Claims from 7733 Medicare beneficiaries hospitalised for AMI in 2008 in North Carolina and Illinois were used to investigate the association between health literacy estimates and 30-day hospital readmissions. The NIA cohort was administered 3 common health literacy assessments (Newest Vital Sign, Test of Functional Health Literacy in Adults, and Rapid Estimate of Adult Literacy in Medicine). Health literacy estimates at the census block group level were derived via a predictive model. 30-day readmissions were measured from Medicare claims data using a validated algorithm. Fair agreement was found between derived estimates and in-person literacy assessments (Pearson Correlation coefficients: 0.38-0.51; κ scores: 0.38-0.40). Medicare enrollees with above basic literacy according to derived health literacy estimates had an 18% lower risk of a 30-day readmission (RR=0.82, 95% CI 0.73 to 0.92) and 21% lower incidence rate of 30-day readmission (IRR=0.79, 95% CI 0.68 to 0.87) than patients with basic or below basic literacy. After adjusting for demographic and clinical characteristics, the risk of 30-day readmission was 12% lower (p=0.03), and the incidence rate 16% lower (p<0.01) for patients with above basic literacy. Health literacy, as measured by a predictive model, was found to be a significant, independent predictor of 30-day readmissions. As a modifiable risk factor with evidence-based solutions, health literacy should be considered in readmission reduction efforts. Published by the BMJ Publishing Group Limited. For permission to use (where

Reducing Cancelations on the Day of Scheduled Surgery at a Children's Hospital.

PubMed

Pratap, Jayant Nick; Varughese, Anna M; Mercurio, Patti; Lynch, Terri; Lonnemann, Teresa; Ellis, Andrea; Rugg, John; Stone, W Ray; Bedinghaus, Cindi

2015-05-01

Cancelation on the day of surgery (DoSC) represents a costly wastage of operating room (OR) time and causes inconvenience, emotional distress, and financial cost to families. A quality improvement project sought to reduce lost OR time due to cancelation. Key drivers of the process included effective 2-way communication with families, compliance with fasting rules, and decision-making on patient illness before the day of surgery. A multidisciplinary team conducted serial tests of change addressing the various key drivers. Interventions were simplified, colorful, personalized preoperative instruction sheets and text-message reminders to caregivers' cellphones, as well as a defined institutional decision-making pathway to permit rescheduling before the day of surgery in case of patient illness concerns. After initial smaller-scale testing, the interventions were implemented across all patients and sites. Data were collected from the hospital information technology system and analyzed by using control charts and statistical process control methods. Mean OR time lost due to DoSC was decreased from a baseline of 5.7 to 3.6 hours/day in testing with a subset of surgical services at the hospital's base campus, and then from 6.6 hours to 5.5 hours/day when implemented across all services at both surgical sites. By applying quality improvement methods, significant reductions were made in time lost due to DoSC. The impact can be significant by improving institutional resource utilization. Copyright © 2015 by the American Academy of Pediatrics.

Effects of rivaroxaban versus warfarin on hospitalization days and other health care resource utilization in patients with nonvalvular atrial fibrillation: an observational study from a cohort of matched users.

PubMed

Laliberté, François; Cloutier, Michel; Crivera, Concetta; Nelson, Winnie W; Olson, William H; Schein, Jeffrey; Vanderpoel, Julie; Germain, Guillaume; Lefebvre, Patrick

2015-03-01

Compared with warfarin, the new target-specific oral anticoagulant agents may have advantages, such as shorter hospital length of stay, in patients with nonvalvular atrial fibrillation (NVAF). The objective of the present study was to assess, among patients with NVAF, the effects of rivaroxaban versus warfarin on the number of hospitalization days and other health care resource utilization in a cohort of rivaroxaban users and matched warfarin users. Data from health care claims dated from May 2011 to December 2012 from the Humana database were analyzed. Adult patients newly initiated on treatment with rivaroxaban or warfarin, with ≥2 diagnoses of AF (ICD-9-CM code 427.31), and without valvular AF were identified. Based on propensity score methods, warfarin recipients were matched 1:1 to rivaroxaban recipients. The end of the observation period was defined as the end of data availability, the end of insurance coverage, death, the date of a switch to another anticoagulant agent, or day 14 of treatment nonpersistence. The total number of hospitalization days and other health care resource utilization parameters (numbers of hospitalizations, emergency department [ED] visits, and outpatient visits) were evaluated using the method by Lin et al. Matches for all rivaroxaban recipients were found, and the characteristics of the matched groups (n = 2253 per group) were well balanced. The mean age of both cohorts was 74 years; 46% were female. The estimated mean total numbers of hospitalization days were significantly less in rivaroxaban users compared with those in warfarin users (all-cause, 2.71 vs 3.87 days [P = 0.032]; AF-related, 2.11 vs 3.02 days [P = 0.014]). The numbers of outpatient visits were also significantly less (all-cause, 25.26 vs 35.79 visits [P < 0.001]; AF-related, 5.48 vs 9.06 visits [P < 0.001]). Rivaroxaban users had a lesser estimated mean number of all-cause hospitalizations compared with warfarin users (0.55 vs 0.73; P = 0.084), and a significantly

Multiple Chronic Conditions and Disparities in 30-Day Hospital Readmissions Among Nonelderly Adults.

PubMed

Basu, Jayasree; Hanchate, Amresh; Koroukian, Siran

2018-05-15

This study examines the patterns of 30-day hospital readmissions by race/ethnicity and multiple chronic conditions (MCC) burden among nonelderly adult patients. We used hospital discharge data of patients in the 18- to 64-year age group in 5 US states, California, Florida, Missouri, New York, and Tennessee, for 2009 from the Healthcare Cost and Utilization Project State Inpatient Database (HCUP-SID) of the Agency for Healthcare Research and Quality, linked to contextual and provider data from the Health Resources and Services Administration. A multilevel logistic regression model was used for data pooled over 5 states, adjusting for patient, hospital, and community characteristics. Controlling for other covariates, the study found that a higher MCC burden was associated with a higher all-cause 30-day readmission risk. We found considerable heterogeneity in levels of readmission risk among racial/ethnic subgroups stratified by chronic conditions. Among patients with a lowest MCC burden, African Americans had the highest risk of readmission, but with a higher MCC burden, the risk of readmission increased most for Hispanics.

Where are lengths of stay longer and total charges higher for pediatric burn patients?

PubMed

Myers, John; Lehna, Carlee

2014-01-01

Treatment of pediatric burn patients is costly and may require long length of stay in the hospital (LOS). Establishing where these LOS and charges are highest is warranted. The current study investigated whether pediatric burn patients had higher total charges and longer LOS when seen at teaching hospitals, when compared with nonteaching hospitals. The study reviewed inpatient admissions for pediatric burn patients in 2003, 2006, and 2009 by using the Kids' Inpatient Database, which is part of the Healthcare Cost and Utilization Project. International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes 940-947 were used to define burn injury, LOS, total charges, and type of hospital. The authors tested for differences between the LOS and total charges between children seen at three types of hospitals (pediatric, nonpediatric/teaching, nonpediatric/nonteaching) while adjusting for traditional risk factors (eg age, total burn surface area) by using generalized linear mixed-effects modeling. A total of N=28,777 children had burn injuries (n=16,115, 56.0% seen at pediatric hospitals; n=9353, 32.5% seen at nonpediatric/teaching hospitals; and n=3309, 11.5% seen at nonpediatric/nonteaching hospitals). Pediatric burn patients seen at pediatric hospitals, unadjusted, have significantly longer LOS (5.54 days vs 4.25 days and 4.00 days, P<.001) and more total charges in 2009 dollars ($31,319 vs $24,413 and $21,499, P<.001). In addition, patients seen at pediatric hospitals had significantly more total burn surface area (P<.001), more comorbidities (P=.021), and were younger (P<.001). After adjusting for total burn surface area, number of comorbidities, and age, no differences existed between teaching and nonteaching hospitals for LOS (P=.481) or total charges (P=.758). Although pediatric burn patients may have increased LOS and total charges when seen at teaching hospitals, when taking an unadjusted perspective, this may be an artifact that

Investigating the widely held belief that men and women with learning disabilities receive poor quality healthcare when admitted to hospital: a single-site study of 30-day readmission rates.

PubMed

Kelly, C L; Thomson, K; Wagner, A P; Waters, J P; Thompson, A; Jones, S; Holland, A J; Redley, M

2015-09-01

This study aims to use 30-day readmission rates to investigate the presumption that men and women with learning disabilities (LDs, known internationally as intellectual disabilities) receive poorer quality hospital care than their non-disabled peers. A 12-month retrospective audit was conducted using Hospital Episode Statistics (HES) at a single acute hospital in the East of England. This identified all in-patient admissions; admissions where the person concerned was recognised as having a LD; and all emergency readmissions within 30 days of discharge. Additionally, the healthcare records of all patients identified as having a LD and readmitted within 30 days as a medical emergency were examined in order to determine whether or not these readmissions were potentially preventable. Over the study period, a total of 66 870 adults were admitted as in-patients, among whom 7408 were readmitted as medical emergencies within 30 days of discharge: a readmission rate of 11%. Of these 66 870 patients, 256 were identified as having a LD, with 32 of them experiencing at least one emergency readmission within 30 days: a readmission rate of 13%. When examined, the healthcare records pertaining to these 32 patients who had a total of 39 unique 30-day readmissions revealed that 69% (n = 26) of these readmissions were potentially preventable. Although overall readmission rates were similar for patients with LDs and those from the general population, patients with LDs had a much higher rate of potentially preventable readmissions when compared to a general population estimate from van Walraven et al. This suggests that there is still work to be done to ensure that this patient population receives hospital care that is both safe and of high quality. © 2015 MENCAP and International Association of the Scientific Study of Intellectual and Developmental Disabilities and John Wiley & Sons Ltd.

Impact of Neuromuscular Electrical Stimulation (NMES) on 90-Day Episode Costs and Post-Acute Care Utilization in Total Knee Replacement Patients with Disuse Atrophy.

PubMed

Pal, Sarmistha; Chughtai, Morad; Sultan, Assem A; Khlopas, Anton; Sodhi, Nipun; George, Nicole E; Etcheson, Jennifer I; Gwam, Chukwuweike U; Newman, Jared M; Samuel, Linsen T; Bhave, Anil; DaVanzo, Joan E; Mont, Michael A

2017-12-22

This study evaluated differences in: 1) total episode payments, 2) probability of hospital readmission, 3) probability of inpatient rehab facility (IRF) and utilization, and 4) probability of skilled nursing care facility (SNF) utilization in patients who had disuse atrophy and underwent a total knee arthroplasty (TKA) and either did, or did not, receive preoperative home-based neuromuscular electrical stimulation (NMES) therapy. We used the Medicare limited dataset for a 5% sample of beneficiaries from 2014 and 2015 to construct episodes-of-care for TKA (DRG-470) patients with disuse atrophy who underwent a TKA during the 30 days prior to hospital admission and 90 days post-discharge. Patients were stratified into those who either did or did not receive pre- and postoperative NMES therapy. An ordinary least square (OLS) model was used to estimate the impact of NMES on total episode. Linear probability models were used to estimate the impact of NMES on SNF or IRF utilization and readmission. A $3,274 reduction in episode payments for patients who used preoperative NMES versus those who did not (p<0.001) was demonstrated. The probability of readmission was 12.7% lower for those who used preoperative NMES therapy versus those who did not (p=0.609). The probability of utilizing IRF and SNF was 56.7% (p=0.061) and 46.4% (p=<0.001) lower for those who used pre- and postoperative NMES versus those who did not, respectively. Significant reduction in total episode payments and SNF utilization for TKA patients with disuse atrophy who had NMES therapy was demonstrated.

The cost of hospitalization in Crohn's disease.

PubMed

Cohen, R D; Larson, L R; Roth, J M; Becker, R V; Mummert, L L

2000-02-01

The aim of this study was to evaluate the demographics, resource use, and costs associated with hospitalization of Crohn's disease patients. All patients hospitalized at our institution from 7/1/96 to 6/30/97 with a primary diagnosis of "Crohn's Disease" were analyzed using a computerized database. Data are presented "per hospitalization." A total of 175 hospitalizations (147 patients) were identified. Mean patient age was 36.5 yr; 61% were female; 82% Caucasian. Payer mix was most commonly contracted (57%), commercial (21%), or Medicare (13%). 57% of hospitalizations had a primary surgical procedure; the remainder were medical. Average length of stay was 8.7 days (surgical, 9.6 days; medical, 7.5 days). The average cost of hospitalization, excluding physician fees, was $12,528 (surgical, $14,409; medical, $10,020), whereas average charges were $35,378 (surgical, $46,354; medical, $20,744), including physician fees, which averaged $7,249 (surgical, $11,217; medical, $1,959). Mean reimbursements were $21,968 (surgical, $28,946; medical, $12,666) with average weighted reimbursement rates of 60.17% of hospital charges, 69.57% of physician fees. The distribution of costs across subcategories was: Surgery (39.6%), Pharmacy (18.6%), Laboratory (3.8%), Radiology (2.1%), Pathology (0.8%), Endoscopy (0.3%), and Other Hospital Costs (34.9%). Of the hospitalizations, 87% included treatment with steroids, 23% with immunomodulators, and 14% with aminosalicylates; 27% included the administration of total parenteral nutrition, which accounted for 63% of the total pharmacy costs. Surgery accounts for the majority of hospitalizations, nearly 40% of their total costs, and 75% of overall charges and reimbursements. Therapy that decreases the number of surgical hospitalizations should substantially reduce inpatient Crohn's disease costs, as well as overall costs.

Reductions in 28-Day Mortality Following Hospital Admission for Upper Gastrointestinal Hemorrhage

PubMed Central

Crooks, Colin; Card, Tim; West, Joe

2011-01-01

Background & Aims It is unclear whether mortality from upper gastrointestinal hemorrhage is changing: any differences observed might result from changes in age or comorbidity of patient populations. We estimated trends in 28-day mortality in England following hospital admission for gastrointestinal hemorrhage. Methods We used a case-control study design to analyze data from all adults administered to a National Health Service hospital, for upper gastrointestinal hemorrhage, from 1999 to 2007 (n = 516,153). Cases were deaths within 28 days of admission (n = 74,992), and controls were survivors to 28 days. The 28-day mortality was derived from the linked national death register. A logistic regression model was used to adjust trends in nonvariceal and variceal hemorrhage mortality for age, sex, and comorbidities and to investigate potential interactions. Results During the study period, the unadjusted, overall, 28-day mortality following nonvariceal hemorrhage was reduced from 14.7% to 13.1% (unadjusted odds ratio, 0.87; 95% confidence interval: 0.84–0.90). The mortality following variceal hemorrhage was reduced from 24.6% to 20.9% (unadjusted odds ratio, 0.8; 95% confidence interval: 0.69–0.95). Adjustments for age and comorbidity partly accounted for the observed trends in mortality. Different mortality trends were identified for different age groups following nonvariceal hemorrhage. Conclusions The 28-day mortality in England following both nonvariceal and variceal upper gastrointestinal hemorrhage decreased from 1999 to 2007, and the reduction had been partly obscured by changes in patient age and comorbidities. Our findings indicate that the overall management of bleeding has improved within the first 4 weeks of admission. PMID:21447331

Effectiveness of feedback to physicians in reducing inappropriate use of hospitalization: a study in a Spanish hospital.

PubMed

Moya-Ruiz, Carles; Peiró, Salvador; Meneu, Ricard

2002-08-01

To evaluate the effectiveness of feedback to medical staff in reducing inappropriate hospital days, particularly those attributable to conservative medical discharge policies. Quasi-experimental pre-test/post-test with non-equivalent control group. A publicly funded hospital in industrial belt in Barcelona (Spain), serving a predominantly urban population of 100,000. Two non-equivalent groups: control group (surgery department) and intervention group (internal medicine department). Meetings between hospital management and medical staff of the intervention group to inform clinicians of percentages and reasons for inappropriate stays in their departments. Total inappropriate hospital days and percentage attributable to physicians, measured with the Appropriateness Evaluation Protocol before, during, and after intervention. There were no relevant differences in the characteristics of the populations whose stays were reviewed during each of the periods. The total number of inappropriate stays and the percentage attributable to the doctor in the control group did not show any differences between the periods. In the intervention group, inappropriate stays attributable to the doctor decreased from 35.9% in the period to intervention to 27.7% during intervention (relative drop of 22.8%; P < 0.01), and rose to 32.7% after intervention. Differences in total inappropriate days were not significant. Providing physicians with feedback about percentage of inappropriate hospital days produced a significant reduction in the number of inappropriate stays attributable to the doctor, although the impact on overall inappropriate stays is inconclusive.

Prevalence of systemic anticancer therapy for patients within the last 30 days of life: experience in a private hospital oncology group.

PubMed

Wein, L; Rowe, C; Brady, B; Handolias, D; Lipton, L; Pook, D; Stanley, R; Haines, I

2017-03-01

In recent years, there has been a significant increase in the number of cancer treatments that have become available. However, it has remained difficult to choose the most appropriate time to cease active therapy in individual patients. To determine the proportion of patients being treated with palliative intent who received systemic anticancer treatment in the last 30 days of life. This is a retrospective cohort study conducted within the Melbourne Oncology Group at Cabrini Hospital. Patients managed with palliative intent who died between 1 January 2014 and 30 June 2014 were included. Outcomes measured were the percentage of patients who received systemic anticancer treatment in the last 30 days of life, palliative care referral status, Emergency Department presentations, hospital admissions and place of death. A total of 80 patients was included in the study. Of these patients, 21 (26%) received systemic anticancer treatment in the last 30 days of life. There was no statistically significant difference between patients who received treatment in the last month of life and those who did not in terms of the number of patients who were referred to palliative care, presented to an Emergency Department, were admitted to hospital or died in an acute ward. Although over a quarter of patients dying from advanced cancer received anticancer treatment in the last month of life, these patients did not present acutely to hospital more often and had the same extent of palliative care team involvement. © 2016 Royal Australasian College of Physicians.

Total hospital costs of surgical treatment for adult spinal deformity: an extended follow-up study.

PubMed

McCarthy, Ian M; Hostin, Richard A; Ames, Christopher P; Kim, Han J; Smith, Justin S; Boachie-Adjei, Ohenaba; Schwab, Frank J; Klineberg, Eric O; Shaffrey, Christopher I; Gupta, Munish C; Polly, David W

2014-10-01

Whereas the costs of primary surgery, revisions, and selected complications for adult spinal deformity (ASD) have been individually reported in the literature, the total costs over several years after surgery have not been assessed. The determinants of such costs are also not well understood in the literature. This study analyzes the total hospital costs and operating room (OR) costs of ASD surgery through extended follow-up. Single-center retrospective analysis of consecutive surgical patients. Four hundred eighty-four consecutive patients undergoing surgical treatment for ASD from January 2005 through January 2011 with minimum three levels fused. Costs were collected from hospital administrative data on the total hospital costs incurred for the operation and any related readmissions, expressed in 2010 dollars and discounted at 3.5% per year. Detailed data on OR costs, including implants and biologics, were also collected. We performed a series of paired t tests and Wilcoxon signed-rank tests for differences in total hospital costs over different follow-up periods. The goal of these tests was to identify a time period over which average costs plateau and remain relatively constant over time. Generalized linear model regression was used to estimate the effect of patient and surgical factors on hospital inpatient costs, with different models estimated for different follow-up periods. A similar regression analysis was performed separately for OR costs and all other hospital costs. Patients were predominantly women (n=415 or 86%) with an average age of 48 (18-82) years and an average follow-up of 4.8 (2-8) years. Total hospital costs averaged $120,394, with primary surgery averaging $103,143 and total readmission costs averaging $67,262 per patient with a readmission (n=130 or 27% of all patients). Operating room costs averaged $70,514 per patient, constituting the majority (59%) of total hospital costs. Average total hospital costs across all patients significantly

Hospitalization Costs of Total Knee Arthroplasty With a Continuous Femoral Nerve Block Provided Only in the Hospital Versus on an Ambulatory Basis: A Retrospective, Case-Control, Cost-Minimization Analysis

PubMed Central

Ilfeld, Brian M.; Mariano, Edward R.; Williams, Brian A.; Woodard, Jennifer N.; Macario, Alex

2007-01-01

Background and Objectives Following total knee arthroplasty (TKA), hospitalization may be shortened by allowing patients to return home with a continuous femoral nerve block (CFNB). This study quantified the hospitalization costs for 10 TKA patients receiving ambulatory CFNB versus a matched cohort of 10 patients who received CFNB only during hospitalization. Methods We examined the medical records (n=125) of patients who underwent a unilateral, primary, tricompartment TKA with a postoperative CFNB by one surgeon at one institution in an 18-month period beginning January 2004. Each of the ten patients discharged home with an ambulatory CFNB (cases) was matched with a patient with a hospital-only CFNB (controls) for age, gender, body mass index, and health status. Financial data were extracted from the hospital micro-costing database. Results Nine patients with ambulatory CFNB (cases) were discharged home on postoperative day (POD) 1, and one on POD 4. Of the controls, 3 were discharged home on POD 3, 6 on POD 4, and 1 on POD 5. The median (range) costs of hospitalization (excluding implant and professional fees) was $5,292 (4,326 – 7,929) for ambulatory cases, compared with $7,974 (6,931 – 9,979) for inpatient controls (difference=$2,682, 34% decrease, P<0.001). The total charges for hospitalization, the implant, and professional fees was $33,646 (31,816 – 38,468) for cases, compared with $39,100 (36,096 – 44,098) for controls (difference=$5,454, 14% decrease, P<0.001). Conclusions This study provides evidence that ambulatory CFNB for selected patients undergoing TKA has the potential to reduce hospital length-of-stay and associated costs and charges. However, the current study has significant inherent limitations based on the study design. Additional research is required to replicate these results in a prospective, randomized, controlled trial and to determine whether any savings exceed additional CFNB costs such as from complications, having caregivers

Hospital Patients Are Not Eating Their Full Meal: Results of the Canadian 2010-2011 nutritionDay Survey.

PubMed

Kent-Smith, Luiza; Eisenbraun, Corinne; Wile, Heather

2016-03-01

nutritionDay is a 1-day cross-sectional survey identifying how nutrition care is provided. This paper provides results of the first 2 Canadian nutritionDay surveys. In November 2010 and 2011, data from standardized questionnaires were collected from 193 units in Canadian hospitals consisting of unit demographics and patient information including weight history, health status, nutrition assessment, nutrition therapy, food intake and 30-day outcomes. Results indicated that overall, 46% of the 1905 patients reported weight loss in the previous 3 months, and in half of these it was greater than 5 kg. Only 50% of the units had nutrition teams and nutrition therapy was provided to less than 14% of patients. More than 50% of patients ate less than normal in the previous week and 57% ate less than half of their meal on nutritionDay. Within the next 30 days the majority of patients went home, 10% remained in hospital, and 6% were readmitted. In this study, nutritionDay provided relevant information on nutrition assessment, weight history, food intake, nutrition therapy, length of stay, and outcomes in participating Canadian institutions. Data from 2010 and 2011 can help to both reflect on current practices and define continuous improvements through benchmarking with the overall goal of mitigating suboptimal nutrition intake during hospitalization.

30-day mortality and readmission after hemorrhagic stroke among Medicare beneficiaries in Joint Commission primary stroke center-certified and noncertified hospitals.

PubMed

Lichtman, Judith H; Jones, Sara B; Leifheit-Limson, Erica C; Wang, Yun; Goldstein, Larry B

2011-12-01

Ischemic stroke patients treated at Joint Commission Primary Stroke Center (JC-PSC)-certified hospitals have better outcomes. Data reflecting the impact of JC-PSC status on outcomes after hemorrhagic stroke are limited. We determined whether 30-day mortality and readmission rates after hemorrhagic stroke differed for patients treated at JC-PSC-certified versus noncertified hospitals. The study included all fee-for-service Medicare beneficiaries aged 65 years or older with a primary discharge diagnosis of subarachnoid hemorrhage (SAH) or intracerebral hemorrhage (ICH) in 2006. Covariate-adjusted logistic and Cox proportional hazards regression assessed the effect of care at a JC-PSC-certified hospital on 30-day mortality and readmission. There were 2305 SAH and 8708 ICH discharges from JC-PSC-certified hospitals and 3892 SAH and 22 564 ICH discharges from noncertified hospitals. Unadjusted in-hospital mortality (SAH: 27.5% versus 33.2%, P<0.0001; ICH: 27.9% versus 29.6%, P=0.003) and 30-day mortality (SAH: 35.1% versus 44.0%, P<0.0001; ICH: 39.8% versus 42.4%, P<0.0001) were lower in JC-PSC hospitals, but 30-day readmission rates were similar (SAH: 17.0% versus 17.0%, P=0.97; ICH: 16.0% versus 15.5%, P=0.29). Risk-adjusted 30-day mortality was 34% lower (odds ratio, 0.66; 95% confidence interval, 0.58-0.76) after SAH and 14% lower (odds ratio, 0.86; 95% confidence interval, 0.80-0.92) after ICH for patients discharged from JC-PSC-certified hospitals. There was no difference in 30-day risk-adjusted readmission rates for SAH or ICH based on JC-PSC status. Patients treated at JC-PSC-certified hospitals had lower risk-adjusted mortality rates for both SAH and ICH but similar 30-day readmission rates as compared with noncertified hospitals.

Drug Therapy Problem Severity Following Hospitalization and Association With 30-Day Clinical Outcomes.

PubMed

Westberg, Sarah M; Yarbrough, Angela; Weinhandl, Eric D; Adam, Terrence J; Brummel, Amanda R; Reidt, Shannon L; Sick, Brian T; St Peter, Wendy L

2018-06-01

Improved understanding of how drug therapy problems (DTPs) contribute to rehospitalization is needed. The primary objectives were to assess the association of DTP likelihood of harm (LoH) severity score, as measured by comprehensive medication management (CMM) pharmacist after hospital discharge, with 30-day risk of hospital readmission, observation visit, or emergency department visit, and to determine whether resolution of DTPs reduces 30-day risk. Secondary objectives were to determine if any eventswere associated with DTPs and preventability of events. Data were collected for 365 patients who received CMM following hospitalization and had at least 1 DTP identified. Retrospective chart reviews were completed for 80 patients with subsequent events to assess associationg with a DTP and its preventability. For each 1-point increment in maximum LoH score, there was 10% higher risk of the composite end point (hazard ratio [HR]=1.10; 95% CI:0.97-1.26; P=0.13). When DTPs were resolved by the CMM pharmacist, the association was attenuated, with a HR of 1.15 (95% CI:0.96-1.38; P=0.12) when the DTP was unresolved and HR of 1.09 (95% CI:0.96-1.25; P=0.52) when resolved; for hospital readmission alone, the corresponding HRs were 1.23 (95% CI:1.00-1.53; P=0.05) and 1.05 (95% CI:0.87-1.27; P=0.60). Of 80 subsequent events, 44 were associated with a medication; 22 were considered preventable. Conclusion and Relevance: The LoH severity score was associated with risk of 30-day events. The strength of association was attenuated when DTPs were resolved by the CMM pharmacist. However, because of statistical uncertainty, larger studies are needed to confirm these patterns.

Attribution of the present-day total greenhouse effect

NASA Astrophysics Data System (ADS)

Schmidt, Gavin A.; Ruedy, Reto A.; Miller, Ron L.; Lacis, Andy A.

2010-10-01

The relative contributions of atmospheric long-wave absorbers to the present-day global greenhouse effect are among the most misquoted statistics in public discussions of climate change. Much of the interest in these values is however due to an implicit assumption that these contributions are directly relevant for the question of climate sensitivity. Motivated by the need for a clear reference for this issue, we review the existing literature and use the Goddard Institute for Space Studies ModelE radiation module to provide an overview of the role of each absorber at the present-day and under doubled CO2. With a straightforward scheme for allocating overlaps, we find that water vapor is the dominant contributor (˜50% of the effect), followed by clouds (˜25%) and then CO2 with ˜20%. All other absorbers play only minor roles. In a doubled CO2 scenario, this allocation is essentially unchanged, even though the magnitude of the total greenhouse effect is significantly larger than the initial radiative forcing, underscoring the importance of feedbacks from water vapor and clouds to climate sensitivity.

Returns to Emergency Department, Observation, or Inpatient Care Within 30 Days After Hospitalization in 4 States, 2009 and 2010 Versus 2013 and 2014.

PubMed

Nuckols, Teryl K; Fingar, Kathryn R; Barrett, Marguerite L; Martsolf, Grant; Steiner, Claudia A; Stocks, Carol; Owens, Pamela L

2018-05-01

Nationally, readmissions have declined for acute myocardial infarction (AMI) and heart failure (HF) and risen slightly for pneumonia, but less is known about returns to the hospital for observation stays and emergency department (ED) visits. To describe trends in rates of 30-day, all-cause, unplanned returns to the hospital, including returns for observation stays and ED visits. By using Healthcare Cost and Utilization Project data, we compared 210,007 index hospitalizations in 2009 and 2010 with 212,833 matched hospitalizations in 2013 and 2014. Two hundred and one hospitals in Georgia, Nebraska, South Carolina, and Tennessee. Adults with private insurance, Medicaid, or no insurance and seniors with Medicare who were hospitalized for AMI, HF, and pneumonia. Thirty-day hospital return rates for inpatient, observation, and ED visits. Return rates remained stable among adults with private insurance (15.1% vs 15.3%; P = 0.45) and declined modestly among seniors with Medicare (25.3% vs 25.0%; P = 0.04). Increases in observation and ED visits coincided with declines in readmissions (8.9% vs 8.2% for private insurance and 18.3% vs 16.9% for Medicare, both P ≤ 0.001). Return rates rose among patients with Medicaid (31.0% vs 32.1%; P = 0.04) and the uninsured (18.8% vs 20.1%; P = 0.004). Readmissions remained stable (18.7% for Medicaid and 9.5% for uninsured patients, both P > 0.75) while observation and ED visits increased. Total returns to the hospital are stable or rising, likely because of growth in observation and ED visits. Hospitalists' efforts to improve the quality and value of hospital care should consider observation and ED care. © 2017 Society of Hospital Medicine

Hospital costs of acute pulmonary embolism.

PubMed

Fanikos, John; Rao, Amanda; Seger, Andrew C; Carter, Danielle; Piazza, Gregory; Goldhaber, Samuel Z

2013-02-01

Pulmonary embolism places a heavy economic burden on health care systems, but the components of hospital cost have not been elucidated. We evaluated hospitalized patients with the primary diagnosis of pulmonary embolism. Our goal was to determine the total and component costs associated with their hospital care. We included patients hospitalized at Brigham and Women's Hospital from September 2003 to May 2010. Patient demographics, characteristics, comorbidities, interventions, and treatments were obtained from the electronic medical record. Costs were obtained using the hospital's accounting software and categorized into the areas providing direct patient supplies or care. We identified 991 hospitalized patients with acute pulmonary embolism. In-hospital mortality was 4.2%, and 90-day mortality after hospital discharge was 13.8%. The median length of hospital stay was 3 days, and the mean length of hospital stay was 4 days. The mean total hospitalization cost per patient was $8764. Nursing costs, which included room and board, were $5102. Pharmacy ($966) and radiology ($963) costs were similar. Pharmacy costs ($966) were dominated by the use of low-molecular-weight heparin ($232). Radiology costs ($963) were dominated by the use of diagnostic imaging examinations ($672). During the observation period, an average of 160 patients with pulmonary embolism were admitted each year, requiring an annual hospital expense ranging from $884,814 to $1,866,489. Pulmonary embolism has a high case fatality rate and remains an expensive illness to diagnose and treat. Nursing costs comprise the largest component of costs. Copyright © 2013 Elsevier Inc. All rights reserved.

Residents examine factors associated with 30-day, same-cause hospital readmissions on an internal medicine service.

PubMed

Moran, Jennifer; Colbert, Colleen Y; Song, Juhee; Hull, Joshua; Rajan, Sabitha; Varghees, Sunita; Arroliga, Alejandro C; Reddy, Santosh P

2013-01-01

In recent years, there has been increased interest in stemming the tide of hospital readmissions in an attempt to improve quality of care. This study presents the Phase I results of a resident-led quality improvement initiative to determine the percentage of and risk factors for same-cause readmissions (SCRs; defined as hospital readmission within 30 days of hospital discharge for treatment of the same condition) to the internal medicine service of a multispecialty teaching hospital in central Texas. Results indicate that patients diagnosed with chronic obstructive pulmonary disease/asthma or anemia may be at increased risk for SCRs. Those patients who are insured by Medicaid and those who require assistance from social services also demonstrated an increased risk for SCRs. This study appears to be the first resident-led initiative in the field to examine 30-day SCRs to an internal medicine service for demographic and clinical risk factors.

A three-month longitudinal study of changes in day/night serum total antioxidant capacity in paranoid schizophrenia.

PubMed

Morera-Fumero, Armando L; Díaz-Mesa, Estefanía; Abreu-Gonzalez, Pedro; Fernandez-Lopez, Lourdes; Guillen-Pino, Fernando

2017-01-01

Free radicals and an oxidant/antioxidant imbalance have been involved in the schizophrenia pathophysiology. The total antioxidant capacity (TAC) is a measure of the antioxidant capacity of a system. Day/night changes are a biological characteristic of hormones such as melatonin or cortisol. There is little information about TAC day/night changes in schizophrenia patients. The aim of this research is to study if there are day/night changes in serum TAC levels of schizophrenia patients. Thirty-two DSM-IV schizophrenia paranoid patients were studied. Blood was sampled at 12:00 and 00:00 h at admission, discharge and three months after hospital discharge (TMAHD). TAC results are expressed as mmol of Trolox/L. Patients did not have day/night TAC differences at admission (12:00: 0.67±0.12 vs. 00:00: 0.61±0.14, p>0.14) or discharge (12:00: 0.65±0.15 vs. 00:00: 0.65±0.12, p>0.99). At TMHD, patients had significantly higher TAC levels at midday than midnight (12:00: 0.83±0.10 vs. 00:00: 0.74±0.12, p<0.006) as it has been reported in healthy subjects. There were no significant TAC differences at 12.00 and 00:00 between admission and discharge. At TMAHD, patients had significantly higher TAC levels than at admission and discharge, both at 12:00 and 00:00 h. In conclusion, the absence of day/night serum TAC changes when clinically relapsed and the normalization of day/night serum TAC changes at TMHD can be considered as a biological marker of schizophrenia evolution.

Impact of 2015 earthquakes on a local hospital in Nepal: A prospective hospital-based study.

PubMed

Giri, Samita; Risnes, Kari; Uleberg, Oddvar; Rogne, Tormod; Shrestha, Sanu Krishna; Nygaard, Øystein Petter; Koju, Rajendra; Solligård, Erik

2018-01-01

Natural disasters pose a great challenge to the health systems and individual health facilities. In low-resource settings, disaster preparedness systems are often limited and not been well described. Two devastating earthquakes hit Nepal within a 17-days period in 2015. This study aims to describe the burden and distribution of emergency cases to a local hospital. This is a prospective observational study of patients presenting to a local hospital for a period of 21 days following the earthquake on April 25, 2015. Demographic and clinical information was prospectively registered for all patients in the systematic emergency registry. Systematic telephone interviews were conducted in a random sample of the patients 90 days after admission to the hospital. A total of 2,003 emergency patients were registered during the period. The average daily number of emergency patients during the first five days was almost five times higher (n = 150) than the pre-incident daily average (n = 35). The majority of injuries were fractures (58%), 348 (56%) in the lower extremities. A total of 345 surgical procedures were performed and the hospital treated 111 patients with severe injuries related to the earthquake (compartment syndrome, crush injury, and internal injury). Among those with follow-up interviews, over 90% reported that they had been severely affected by the earthquakes; complete house damage, living in temporary shelter, or loss of close family member. The hospital experienced a very high caseload during the first days, and the majority of patients needed orthopaedic services. The proportion of severely injured and in-hospital deaths were relatively low, probably indicating that the most severely injured did not reach the hospital in time. The experiences underline the need for robust and easily available local health services that can respond to disasters.

Impact of 2015 earthquakes on a local hospital in Nepal: A prospective hospital-based study

PubMed Central

Risnes, Kari; Uleberg, Oddvar; Rogne, Tormod; Shrestha, Sanu Krishna; Nygaard, Øystein Petter; Koju, Rajendra; Solligård, Erik

2018-01-01

Introduction Natural disasters pose a great challenge to the health systems and individual health facilities. In low-resource settings, disaster preparedness systems are often limited and not been well described. Two devastating earthquakes hit Nepal within a 17-days period in 2015. This study aims to describe the burden and distribution of emergency cases to a local hospital. Methods This is a prospective observational study of patients presenting to a local hospital for a period of 21 days following the earthquake on April 25, 2015. Demographic and clinical information was prospectively registered for all patients in the systematic emergency registry. Systematic telephone interviews were conducted in a random sample of the patients 90 days after admission to the hospital. Results A total of 2,003 emergency patients were registered during the period. The average daily number of emergency patients during the first five days was almost five times higher (n = 150) than the pre-incident daily average (n = 35). The majority of injuries were fractures (58%), 348 (56%) in the lower extremities. A total of 345 surgical procedures were performed and the hospital treated 111 patients with severe injuries related to the earthquake (compartment syndrome, crush injury, and internal injury). Among those with follow-up interviews, over 90% reported that they had been severely affected by the earthquakes; complete house damage, living in temporary shelter, or loss of close family member. Conclusion The hospital experienced a very high caseload during the first days, and the majority of patients needed orthopaedic services. The proportion of severely injured and in-hospital deaths were relatively low, probably indicating that the most severely injured did not reach the hospital in time. The experiences underline the need for robust and easily available local health services that can respond to disasters. PMID:29394265

Failure of CRP decline within three days of hospitalization is associated with poor prognosis of Community-acquired Pneumonia.

PubMed

Andersen, Stine Bang; Baunbæk Egelund, Gertrud; Jensen, Andreas Vestergaard; Petersen, Pelle Trier; Rohde, Gernot; Ravn, Pernille

2017-04-01

C-reactive protein (CRP) is a well-known acute phase protein used to monitor the patient's response during treatment in infectious diseases. Mortality from Community-acquired Pneumonia (CAP) remains high, particularly in hospitalized patients. Better risk prediction during hospitalization could improve management and ultimately reduce mortality levels. The aim of this study was to evaluate CRP on the 3rd day (CRP3) of hospitalization as a predictor for 30 days mortality. A retrospective multicentre cohort study of adult patients admitted with CAP at three Danish hospitals. Predictive associations of CRP3 (absolute levels and relative decline) and 30 days mortality were analysed using receiver operating characteristics and logistic regression. Eight hundred and fourteen patients were included and 90 (11%) died within 30 days. The area under the curve for CRP3 level and decline for predicting 30 days mortality were 0.64 (0.57-0.70) and 0.71 (0.65-0.76). Risk of death was increased in patients with CRP3 level >75 mg/l (OR 2.44; 95%CI 1.36-4.37) and in patients with a CRP3 decline <50% (OR 4.25; 95%CI 2.30-7.83). In the multivariate analysis, the highest mortality risk was seen in patients who failed to decline by 50%, irrespective of the actual level of CRP (OR 7.8; 95%CI 3.2-19.3). Mortality risk increased significantly according to CRP decline for all strata of CURB-65 score. CRP responses day 3 is a valuable predictor of 30 days mortality in hospitalized CAP patients. Failure to decline in CRP was associated with a poor prognosis irrespective of the actual level of CRP or CURB-65.

Does a chest x-ray alter the management of new patients attending a geriatric day hospital?

PubMed

Logan, J A; Vallance, R; Williams, B O; Paul, H

1997-01-01

Studies have suggested that routine chest x-ray is never indicated but all new attenders at our day hospitals have a chest x-ray carried out. Our aim was to determine if this investigation altered the clinical management of patients and to try to select those patients in whom a chest x-ray is indicated. A prospective study was carried out over a 7 month period from February to September 1995. All new patients had cardiorespiratory symptoms/signs documented and a management plan made. A chest x-ray was then carried out and change in management as a result of the x-ray report noted. Knightswood and Drumchapel Geriatric Day Hospitals, West Glasgow University NHS Trust. All new Day Hospital attenders. Of 207 new Day Hospital attenders, 53 had no clinical indication for a chest x-ray and although 70% had an abnormal film in no case was patient management changed as a result of this. A chest x-ray was indicated in 154 patients and of these 114 (74%) had an abnormal film with a resultant change in management in 23 patients (this comprised either a change in drug treatment or a further investigation.) Of those whose management was changed as a result of the x-ray report 61% had respiratory symptoms. We would recommend that chest x-ray should be performed in those patients who have a clear clinical indication and that the diagnostic yield is highest in the presence of respiratory symptoms or signs.

Effectiveness of intensive psychotherapy in a day hospital evaluated with Neurotic Personality Inventory KON-2006.

PubMed

Sobański, Jerzy A; Klasa, Katarzyna; Cyranka, Katarzyna; Mielimąka, Michał; Dembińska, Edyta; Müldner-Nieckowski, Łukasz; Smiatek-Mazgaj, Bogna; Rutkowski, Krzysztof

2015-01-01

AIM : The aim of this study was to determine the effectiveness of intensive psychotherapy in the day hospital for neurotic and behavioral disorders as well as the assessment of the usefulness of the Neurotic Personality Inventory KON-2006 for routine evaluation of psychotherapy effectiveness. The results of the questionnaires KON-2006 completed by 690 patients (women - 69%, men - 31%, mean age 29 years, SD 8 years) were analyzed. All persons have received comprehensive, mainly psychodynamic psychotherapy (group with elements of individual therapy), in the years 2004-2009 in the Day Hospital for Neurotic and Behavioral Disorders in Krakow. The vast majority of patients achieved after the end of psychotherapy beneficial changes in personality corresponding to various degrees of improvements in terms of the questionnaire KON-2006. Only a few patients deteriorated, somewhat more numerous group did not achieve significant changes or the effects are not possible for unambiguous interpretation. These results are highly correlated with those obtained in the personality questionnaire NEO-PI-R. The Neurotic Personality Inventory KON-2006 appears to be an adequate tool to assess the results of intensive, comprehensive psychotherapy, conducted in the day hospital for neurotic and behavioral disorders.

Regional Variation in 30-Day Ischemic Stroke Outcomes for Medicare Beneficiaries Treated in Get With The Guidelines-Stroke Hospitals.

PubMed

Thompson, Michael P; Zhao, Xin; Bekelis, Kimon; Gottlieb, Daniel J; Fonarow, Gregg C; Schulte, Phillip J; Xian, Ying; Lytle, Barbara L; Schwamm, Lee H; Smith, Eric E; Reeves, Mathew J

2017-08-01

We explored regional variation in 30-day ischemic stroke mortality and readmission rates and the extent to which regional differences in patients, hospitals, healthcare resources, and a quality of care composite care measure explain the observed variation. This ecological analysis aggregated patient and hospital characteristics from the Get With The Guidelines-Stroke registry (2007-2011), healthcare resource data from the Dartmouth Atlas of Health Care (2006), and Medicare fee-for-service data on 30-day mortality and readmissions (2007-2011) to the hospital referral region (HRR) level. We used linear regression to estimate adjusted HRR-level 30-day outcomes, to identify HRR-level characteristics associated with 30-day outcomes, and to describe which characteristics explained variation in 30-day outcomes. The mean adjusted HRR-level 30-day mortality and readmission rates were 10.3% (SD=1.1%) and 13.1% (SD=1.1%), respectively; a modest, negative correlation ( r =-0.17; P =0.003) was found between one another. Demographics explained more variation in readmissions than mortality (25% versus 6%), but after accounting for demographics, comorbidities accounted for more variation in mortality compared with readmission rates (17% versus 7%). The combination of hospital characteristics and healthcare resources explained 11% and 16% of the variance in mortality and readmission rates, beyond patient characteristics. Most of the regional variation in mortality (65%) and readmission (50%) rates remained unexplained. Thirty-day mortality and readmission rates vary substantially across HRRs and exhibit an inverse relationship. While regional variation in 30-day outcomes were explained by patient and hospital factors differently, much of the regional variation in both outcomes remains unexplained. © 2017 American Heart Association, Inc.

Hospital Characteristics Associated With Postdischarge Hospital Readmission, Observation, and Emergency Department Utilization.

PubMed

Horwitz, Leora I; Wang, Yongfei; Altaf, Faseeha K; Wang, Changqin; Lin, Zhenqiu; Liu, Shuling; Grady, Jacqueline; Bernheim, Susannah M; Desai, Nihar R; Venkatesh, Arjun K; Herrin, Jeph

2018-04-01

Whether types of hospitals with high readmission rates also have high overall postdischarge acute care utilization (including emergency department and observation care) is unknown. Cross-sectional analysis. Nonfederal United States acute care hospitals. Using methodology established by the Centers for Medicare & Medicaid Services, we calculated each hospital's "excess days in acute care" for fee-for-service (FFS) Medicare beneficiaries aged over 65 years discharged after hospitalization for acute myocardial infarction, heart failure (HF), or pneumonia, representing the mean difference between predicted and expected total days of acute care utilization in the 30 days following hospital discharge, per 100 discharges. We assessed the multivariable association of 8 hospital characteristics with excess days in acute care and the proportion of hospitals with each characteristic that were statistical outliers (95% credible interval estimate does not include 0). We included 2184 hospitals for acute myocardial infarction [228 (10.4%) better than expected, 549 (25.1%) worse than expected], 3720 hospitals for HF [484 (13.0%) better and 840 (22.6%) worse], and 4195 hospitals for pneumonia [673 (16.0%) better, 1005 (24.0%) worse]. Results for all conditions were similar. Worse than expected outliers for pneumonia included: 18.8% of safety net hospitals versus 26.1% of nonsafety net hospitals; 16.7% of public hospitals versus 33.1% of for-profit hospitals; 19.5% of nonteaching hospitals versus 52.2% of major teaching hospitals; 7.9% of rural hospitals versus 42.1% of large urban hospitals; 5.9% of hospitals with 24-<50 beds versus 58% of hospitals with >500 beds; and 29.0% of hospitals with nurse-to-bed ratios >1.0-1.5 versus 21.7% of hospitals with ratios >2.0. Including emergency department and observation stays in measures of postdischarge utilization produces similar results as measuring only readmissions in that major teaching, urban and for-profit hospitals still perform

Hospital mortality and thirty day readmission among patients with non-acute myocardial infarction related cardiogenic shock.

PubMed

Shah, Mahek; Patel, Brijesh; Tripathi, Byomesh; Agarwal, Manyoo; Patnaik, Soumya; Ram, Pradhum; Patil, Shantanu; Shin, Jooyoung; Jorde, Ulrich P

2018-06-10

Cardiogenic shock (CS) in absence of acute myocardial infarction (AMI) has significant morbidity and mortality. This population of patients has been excluded from prior major randomized trials and observational studies. We included patients with CS in absence of AMI from the 2013-14 HCUP's National Readmission Database. 30-day readmissions were studied and etiology for readmission was identified by using ICD-9CM codes in primary diagnosis field. Multivariable mixed effect logistic regression models were created to identify predictors of 30-day readmission and in-hospital mortality, respectively. We studied 38,198 index admissions with non-AMI CS, with an in-hospital mortality of 35.4%. Mean age, length and cost of stay were 63.6 years, 16.9 days and 69,947$, respectively among survivors of index admission. Among those discharged, 22.6% were readmitted within 30 days with >50% readmissions occurring within 11-days. Cardiovascular etiologies (42.3%), especially heart failure (24.0%) comprised the commonest reason for readmission. Among non-cardiac causes were infectious (11.7%) and respiratory (9.2%) etiologies. Older age (50-64 years odds ratio:1.29, 65-79 years, OR:1.59, ≥80 years OR:2.69), ventilator use (OR:4.25), sepsis (OR:1.12), use of short term devices (intra-aortic balloon pump OR:2.67, Impella/TandemHeart OR:4.84, extracorporeal membrane oxygenation OR:3.68) and non-ischemic cardiomyopathy(OR:0.65) were among the predictors of in-hospital mortality. Older age (65-79 years, OR:1.25, ≥80 years OR:1.41), male sex (OR:1.08), and ventilator use (OR:1.21) predicted higher 30-day readmission. Both, in-hospital mortality and 30-day readmission among those admitted for non-AMI CS were significantly elevated. The majority of readmissions were due to non-cardiovascular causes. Identifying high-risk factors may help devise strategies to improve quality of care and reduce adverse outcome rates. Copyright © 2017. Published by Elsevier B.V.

Antimicrobial consumption at Auckland City Hospital: 2006-2009.

PubMed

Ticehurst, Rob; Thomast, Mark

2011-04-15

We aimed to determine the level of antimicrobial consumption by adult inpatients at Auckland City Hospital (Auckland, New Zealand) and to compare our findings with those in other developed nations. We used the computerised records of the central Auckland District Health Board (ADHB) pharmacy to measure the amount of antimicrobials dispensed to inpatients (excluding psychiatric units, day stay units and outpatient clinics) during 2006 to 2009. The total weight of each antimicrobial dispensed was used to determine the number of defined daily doses (DDDs) dispensed. The Information Management and Technical Services department of ADHB provided data on the number of admissions and inpatient days, and these data, together with information from the 2006 census, were used to calculate antimicrobial consumption for adult inpatients measured in DDDs/100 admissions, DDDs/100 inpatient days and DDDs/1000 population. Total antimicrobial consumption by adult inpatients increased from 74 DDDs/100 inpatient days in 2006 to 80.3 DDDs/100 inpatient days in 2009. The level of consumption did not vary greatly with the season. The total level of consumption was very similar to that seen in adult inpatients in hospitals in Australia and Scandinavian countries. The level of consumption of fluoroquinolones, third or fourth generation cephalosporins, carbapenems and vancomycin (antimicrobial classes that are not available for unrestricted use in Auckland City Hospital) was comparable to or less than that seen in adult inpatients in hospitals in Australia or Scandinavian countries. Beta-lactamase susceptible penicillins (such as benzyl penicillin and phenoxymethylpenicillin) comprised a relatively small proportion of total penicillin use and beta-lactamase inhibitor combinations (predominantly amoxicillin/clavulanate) a relatively large proportion of total penicillin use, when compared with Scandinavian hospitals. The antimicrobial stewardship programme at Auckland City Hospital has

The impact of reducing intensive care unit length of stay on hospital costs: evidence from a tertiary care hospital in Canada.

PubMed

Evans, Jessica; Kobewka, Daniel; Thavorn, Kednapa; D'Egidio, Gianni; Rosenberg, Erin; Kyeremanteng, Kwadwo

2018-02-23

To use theoretical modelling exercises to determine the effect of reduced intensive care unit (ICU) length of stay (LOS) on total hospital costs at a Canadian centre. We conducted a retrospective cost analysis from the perspective of one tertiary teaching hospital in Canada. Cost, demographic, clinical, and LOS data were retrieved through case-costing, patient registry, and hospital abstract systems of The Ottawa Hospital Data Warehouse for all new in-patient ward (30,483) and ICU (2,239) encounters between April 2012 and March 2013. Aggregate mean daily variable direct (VD) costs for ICU vs ward encounters were summarized by admission day number, LOS, and cost centre. The mean daily VD cost per ICU patient was $2,472 (CAD), accounting for 67.0% of total daily ICU costs per patient and $717 for patients admitted to the ward. Variable direct cost is greatest on the first day of ICU admission ($3,708), and then decreases by 39.8% to plateau by the fifth day of admission. Reducing LOS among patients with ICU stays ≥ four days could potentially result in an annual hospital cost saving of $852,146 which represents 0.3% of total in-patient hospital costs and 1.2% of ICU costs. Reducing ICU LOS has limited cost-saving potential given that ICU costs are greatest early in the course of admission, and this study does not support the notion of reducing ICU LOS as a sole cost-saving strategy.

Total quality in acute care hospitals: guidelines for hospital managers.

PubMed

Holthof, B

1991-08-01

Quality improvement can not focus exclusively on peer review and the scientific evaluation of medical care processes. These essential elements have to be complemented with a focus on individual patient needs and preferences. Only then will hospitals create the competitive advantage needed to survive in an increasingly market-driven hospital industry. Hospital managers can identify these patients' needs by 'living the patient experience' and should then set the hospital's quality objectives according to its target patients and their needs. Excellent quality program design, however, is not sufficient. Successful implementation of a quality improvement program further requires fundamental changes in pivotal jobholders' behavior and mindset and in the supporting organizational design elements.

[Sexual health symptoms and problems in a population of patients in a day hospital for neurotic disorders].

PubMed

Sobański, Jerzy A; Müldner-Nieckowski, Łukasz; Klasa, Katarzyna; Rutkowski, Krzysztof; Dembińska, Edyta

2012-01-01

Analysis of prevalence of symptoms and problems connected with sexuality in patients admitted to a day hospital for neurotic and behavioral disorders' treatment. The results of diagnostics of 2582 women and 1347 men, admitted for psychotherapy in a day hospital, because of neurotic, behavioral and personality disorders. Symptoms from the sexuality area revealed themselves to be frequent in the population of patients entering psychotherapy in a day hospital for neurotic disorders, and they were not directly linked to sexological treatment. Also traumatic events potentially disturbing psychosexual development were reported by patients, however with a different frequency, this being higher for self-assessed lack of sexual education in childhood or forced sexual debut, and low for incest or very early commencement, and for being punished for masturbation. Psychotherapists as well as other professionals treating neurotics, should expect--besides numerous typical symptoms: anxiety, somatization etc.--complaints from area of sexual dysfunctions.

Direct hospital costs of total laparoscopic hysterectomy compared with fast-track open hysterectomy at a tertiary hospital: a retrospective case-controlled study.

PubMed

Rhou, Yoon J J; Pather, Selvan; Loadsman, John A; Campbell, Neil; Philp, Shannon; Carter, Jonathan

2015-12-01

To assess the direct intraoperative and postoperative costs in women undergoing total laparoscopic hysterectomy and fast-track open hysterectomy. A retrospective review of the direct hospital-related costs in a matched cohort of women undergoing total laparoscopic hysterectomy (TLH) and fast-track open hysterectomy (FTOH) at a tertiary hospital. All costs were calculated, including the cost of advanced high-energy laparoscopic devices. The effect of the learning curve on cost in laparoscopic hysterectomy was also assessed, as was the hospital case-weighted cost, which was compared with the actual cost. Fifty women were included in each arm of the study. TLH had a higher intraoperative cost, but a lower postoperative cost than FTOH (AUD$3877 vs AUD$2776 P < 0.001, AUD$3965 vs AUD$6233 P < 0.001). The total cost of TLH was not different from FTOH (AUD$7842 vs AUD$9009 P = 0.068) and after a learning curve; TLH cost less than FTOH (AUD$6797 vs AUD$8647, P < 0.001). The use of high-energy devices did not impact on the cost benefit of TLH, and hospital case-weight-based funding correlated poorly with actual cost. Despite the use of fast-track recovery protocols, the cost of TLH is no different to FTOH and after a learning curve is cheaper than open hysterectomy. Judicious use of advanced energy devices does not impact on the cost, and hospital case-weight-based funding model in our hospital is inaccurate when compared to directly calculated hospital costs. © 2013 The Authors ANZJOG © 2013 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.

Depressive Affect and Hospitalization Risk in Incident Hemodialysis Patients

PubMed Central

Bruce, Lisa; Li, Nien-Chen; Mooney, Ann; Maddux, Franklin W.

2014-01-01

Background and objectives Recent studies demonstrated an association between depressive affect and higher mortality risk in incident hemodialysis patients. This study sought to determine whether an association also exists with hospitalization risk. Design, setting, participants, & measurements All 8776 adult incident hemodialysis patients with Medical Outcomes Study Short Form 36 survey results treated in Fresenius Medical Care North America facilities in 2006 were followed for 1 year from the date of survey, and all hospitalization events lasting >24 hours were tracked. A depressive affect score was derived from responses to two Medical Outcomes Study Short Form 36 questions (“down in the dumps” and “downhearted and blue”). A high depressive affect score corresponded with an average response of “some of the time” or more frequent occurrence. Cox and Poisson models were constructed to determine associations of depressive affect scores with risk for time to first hospitalization and risk for hospitalization events, as well as total days spent in the hospital, respectively. Results Incident patients with high depressive affect score made up 41% of the cohort and had a median (interquartile range) hospitalization event rate of one (0, 3) and 4 (0, 15) total hospital days; the values for patients with low depressive affect scores were one (0, 2) event and 2 (0, 11) days, respectively. For high-scoring patients, the adjusted hazard ratio for first hospitalization was 1.12 (1.04, 1.20). When multiple hospital events were considered, the adjusted risk ratio was 1.13 (1.02, 1.25) and the corresponding risk ratio for total hospital days was 1.20 (1.07, 1.35). High depressive affect score was generally associated with lower physical and mental component scores, but these covariates were adjusted for in the models. Conclusions Depressive affect in incident hemodialysis patients was associated with higher risk of hospitalization and more hospital days. Future

[Dermatology day-care: between official rules and reality].

PubMed

Ingen-Housz-Oro, S; Durand-Zaleski, I; Cosnes, A; Valeyrie-Allanore, L; Moreno, J-C; Chosidow, O; Wolkenstein, P

2012-11-01

Official rules published in 2006 and 2010 concerning ambulatory care rates in France led to artificial redistribution of this activity from day-care hospitalization to consultations. In our dermatological day-care establishment, we compared the financial costs engendered for patients admitted for day-care hospitalization and those seen at consultations. From 2011/01/10 to 2011/02/04, for each patient, we prospectively analyzed the following data: day-care hospitalization or consultation, age, sex, diagnosis, laboratory and radiological examination, non-dermatological consultations, time spent with the patient by doctors (interns, senior doctors) and nurses, with timing by a stop-watch. The hospital cost was the total for medical examinations (official nomenclature), non-dermatological consultations, physicians' and nurses' salaries and establishment overheads (216 €). The hospital revenue regarding the consultation group consisted of the sum of reimbursement for medical examination, dermatological and non-dermatological consultations, and regarding the day-care hospitalization group, the dermatology rate (670 €) or chemotherapy sessions (380 €). Results were compared using a Chi(2) test and a Student's t-test (P ≤ 0.05). One hundred and twenty-seven patients were included: 67 in the day-care hospitalization group and 60 in the consultation group. Patients in the day-care hospitalization group were older and had significantly more radiological examinations and non-dermatological consultations, but the number of laboratory examinations and skin biopsies did not differ between the two groups. The mean time spent by doctors was similar in both groups but the time spent by senior doctors without the help of interns was significantly greater and longer than the time for a standard consultation. Nurses spent a mean 72 minutes with each hospitalized patient and 35 minutes with consultation patients (P = 0.007). Hospital costs were identical in both groups at around

Age-related differences in the rate and diagnosis of 30-day readmission after hospitalization for acute ischemic stroke.

PubMed

Hirayama, Atsushi; Goto, Tadahiro; Faridi, Mohammad K; Camargo, Carlos A; Hasegawa, Kohei

2018-01-01

Background Little is known about the association between age and readmission within 30 days after hospitalization for acute ischemic stroke. Aim To examine the age-related differences in rate and principal reason of 30-day readmissions in patients hospitalized for acute ischemic stroke. Methods In this retrospective, population-based cohort study using State Inpatient Databases from eight US states, we identified all adults hospitalized for acute ischemic stroke. We grouped the patients into four age categories: < 65, 65-74, 75-84, and ≥85 years. Outcomes were any-cause readmission within 30 days of discharge from the index hospitalization for acute ischemic stroke and the principal diagnosis of 30-day readmission. Results We identified 620,788 hospitalizations for acute ischemic stroke. The overall 30-day readmission rate was 16.6% with an increase with advanced age. Compared to patients aged <65 years, the readmission rate was significantly higher in age 65-74 years (OR 1.19; 95% CI 1.16-1.21), in age 75-84 years (OR 1.29; 95% CI 1.27-1.31), and in ≥ 85 years (OR 1.24; 95% CI 1.22-1.27; all P<0.001). There was heterogeneity in the age-readmission rate association between men and women (P interaction  < 0.001). Overall, 45.8% of readmissions were assigned stroke-related conditions or rehabilitation care. Compared to younger adults, older adults were more likely to present with non-stroke-related conditions (46.1% in < 65 years, 50.6% in 65-74 years, 57.1% in 75-84 years, and 62.9% in ≥ 85 years; P<0.001). Conclusions Advanced age was associated with a higher 30-day readmission rate after acute ischemic stroke. Compared with younger adults, older adults were more likely to be readmitted for non-stroke-related conditions.

Total duration of antimicrobial therapy in veterans hospitalized with uncomplicated pneumonia: Results of a national medication utilization evaluation.

PubMed

Madaras-Kelly, Karl J; Burk, Muriel; Caplinger, Christina; Bohan, Jefferson G; Neuhauser, Melinda M; Goetz, Matthew Bidwell; Zhang, Rongping; Cunningham, Francesca E

2016-12-01

Practice guidelines recommend the shortest duration of antimicrobial therapy appropriate to treat uncomplicated pneumonia be prescribed to reduce the emergence of resistant pathogens. A national evaluation was conducted to assess the duration of therapy for pneumonia. Retrospective medication utilization evaluation. Thirty Veterans Affairs medical centers. Inpatients discharged with a diagnosis of pneumonia. A manual review of electronic medical records of inpatients discharged with uncomplicated community-acquired pneumonia (CAP) or healthcare-associated pneumonia (HCAP) was conducted. Appropriate CAP therapy duration was defined as at least 5 days, and up to 3 additional days beginning the first day the patient achieved clinical stability criteria; the appropriate HCAP therapy duration was defined as 8 days. The duration of antimicrobial therapy for intravenous (IV) and oral (PO) inpatient administration, PO therapy dispensed upon discharge, Clostridium difficile infection (CDI), hospital readmission, and death rates were measured. Of 3881 pneumonia admissions, 1739 met inclusion criteria (CAP [n = 1195]; HCAP [n = 544]). Overall, 13.9% of patients (CAP [6.9%], HCAP [29.0%]) received therapy duration consistent with guideline recommendations. The median (interquartile range) days of therapy were 4 days (3-6 days), 1 day (0-3 days), and 6 days (4-8 days) for inpatient IV, inpatient PO, and outpatient PO antimicrobials, respectively. CDI was rare but more common in patients who received therapy duration consistent with guidelines. Therapy duration was not associated with the readmission or mortality rate. Antimicrobials were commonly prescribed for a longer duration than guidelines recommend. The majority of excessive therapy was completed upon discharge, identifying the need for strategies to curtail unnecessary use postdischarge. Journal of Hospital Medicine 2015;11:832-839. © 2015 Society of Hospital Medicine. © 2016 Society of Hospital Medicine.

Effects of temperature variation between neighbouring days on daily hospital visits for childhood asthma: a time-series analysis.

PubMed

Li, K; Ni, H; Yang, Z; Wang, Y; Ding, S; Wen, L; Yang, H; Cheng, J; Su, H

2016-07-01

To identify the relationship between temperature variation between neighbouring days (TVN) and hospital visits for childhood asthma in age- and sex-specific groups. An ecological design was used to explore the effect of TVN on hospital visits for childhood asthma. A Poisson generalised linear regression model combined with a distributed lag non-linear model was used to analyse the association between TVN and hospital visits for childhood asthma. All hospital visits for childhood asthma from June 2010 to July 2013 were included (n = 17,022). Daily climate data were obtained from Hefei Meteorological Bureau. A significant correlation was found between TVN and hospital visits for childhood asthma in age- and sex-specific groups. For different gender groups, the effect of TVN on childhood asthma was the greatest at 3 and 5 days lag for males and females. For different age groups, the effect of TVN on childhood asthma was the greatest at 1 and 5 days lag for 0-4 years and 5-14 years children, respectively. A 1 °C increase in TVN was associated with a 4.2% (95% confidence interval 0.9-7.6%) increase in hospital visits for childhood asthma. TVN is associated with hospital visits for childhood asthma. Once the temperature change rapidly, guardians will be urged to pay more attention to their children's health, which may reduce the morbidity of childhood asthma. Copyright © 2016 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Hospital costs fell as numbers of LVADs were increasing: experiences from Oslo University Hospital

PubMed Central

2012-01-01

Background The current study was undertaken to examine total hospital costs per patient of a consecutive implantation series of two 3rd generation Left Ventricle Assist Devices (LVAD). Further we analyzed if increased clinical experience would reduce total hospital costs and the gap between costs and the diagnosis related grouped (DRG)-reimbursement. Method Cost data of 20 LVAD implantations (VentrAssist™) from 2005-2009 (period 1) were analyzed together with costs from nine patients using another LVAD (HeartWare™) from 2009-June 2011 (period 2). For each patient, total costs were calculated for three phases - the pre-LVAD implantation phase, the LVAD implantation phase and the post LVAD implant phase. Patient specific costs were obtained prospectively from patient records and included personnel resources, medication, blood products, blood chemistry and microbiology, imaging and procedure costs including operating room costs. Overhead costs were registered retrospectively and allocated to the specific patient by predefined allocation keys. Finally, patient specific costs and overhead costs were aggregated into total hospital costs for each patient. All costs were calculated in 2011-prices. We used regression analyses to analyze cost variations over time and between the different devices. Results The average total hospital cost per patient for the pre-LVAD, LVAD and post-LVAD for period 1 was $ 585, 513 (range 132, 640- 1 247, 299), and the corresponding DRG- reimbursement (2009) was $ 143, 192 . The mean LOS was 54 days (range 12- 127). For period 2 the total hospital cost per patient was $ 413, 185 (range 314, 540- 622, 664) and the corresponding DRG- reimbursement (2010) was $ 136, 963. The mean LOS was 49 days (range 31- 93). The estimates from the regression analysis showed that the total hospital costs, excluding device costs, per patient were falling as the number of treated patients increased. The estimate from the trend variable was -14, 096 US$ (CI -3

Differences in compliance with Surviving Sepsis Campaign recommendations according to hospital entrance time: day versus night.

PubMed

Almeida, Mónica; Ribeiro, Orquídea; Aragão, Irene; Costa-Pereira, Altamiro; Cardoso, Teresa

2013-04-23

Higher compliance with Surviving Sepsis Campaign (SSC) recommendations has been associated with lower mortality. The authors evaluate differences in compliance with SSC 6-hour bundle according to hospital entrance time (day versus night) and its impact on hospital mortality. Prospective cohort study of all patients with community-acquired severe sepsis admitted to the intensive care unit of a large university tertiary care hospital, over 3.5 years with a follow-up until hospital discharge. Time to compliance with each recommendation of the SSC 6-hour bundle was calculated according to hospital entrance period: day (08:30 to 20:30) versus night (20:30 to 08:30). For the same periods, clinical staff composition and the number of patients attending the emergency department (ED) was also recorded. In this period 300 consecutive patients were included. Compliance rate was (night vs. day): serum lactate measurement 57% vs. 49% (P = 0.171), blood cultures drawn 59% vs. 37% (P < 0.001), antibiotics administration in the first 3 hours 33% vs. 18% (P = 0.003), central venous pressure >8 mmHg 45% vs. 29% (P = 0.021), and central venous oxygen saturation (SvcO₂) >70%, 7% vs. 2% (P = 0.082); fluids were administered in all patients with hypotension in both periods and vasopressors were administered in patients with hypotension not responsive to fluids in 100% vs. 99%. Time to get specific actions done was also different (night vs. day): serum lactate measurement (4.5 vs. 7 h, P = 0.018), blood cultures drawn (4 vs. 8 h, P < 0.001), antibiotic administration (5 vs. 8 h, P < 0.001), central venous pressure (8 vs. 11 h, P = 0.01), and SvcO₂ monitoring (2.5 vs. 11 h, P = 0.222). The composition of the nursing team was the same around the clock; the medical team was reduced at night with a higher proportion of less differentiated doctors. The number of patients attending the Emergency Department was lower overnight. Hospital mortality rate was 34% in patients entering in the

Is a day hospital rehabilitation programme associated with reduction of handicap in stroke patients?

PubMed

Hershkovitz, Avital; Beloosesky, Yichayaou; Brill, Shai; Gottlieb, Daniel

2004-05-01

(1) To assess whether a rehabilitation day hospital programme is associated with a reduced handicap level of stroke patients. (2) To estimate the relationship between the London Handicap Scale (LHS) and other outcome measures. (3) To examine the effect of demographic parameters (age, gender, family status, education) on LHS scores. A prospective longitudinal survey. An urban geriatric rehabilitation day hospital. Two hundred and seven elderly stroke patients admitted between December 1999 and February 2001. London Handicap Scale (LHS), Functional Independent Measure (FIM), Nottingham Extended ADL Index, timed get up and go test. LHS scores at discharge changed significantly (p < 0.008) for mobility, physical independence and occupation. The overall change in LHS score was 2.3 points (20%); effect size 0.43. A significant relationship was found between discharge score of LHS and admission score of FIM, Nottingham Index, timed get up and go and age. Multiple linear regressions did not identify a good predictor for the discharge score of LHS. Higher education was associated with higher LHS scores on admission (p = 0.016) but with less success in correcting handicap (p = 0.046). A day hospital programme is associated with reduced level of handicap in stroke patients. The LHS is a useful and simple scale for measuring change in these patients. LHS in stroke patients correlates with other outcome measures, yet they cannot be used interchangeably. A significant relationship between education and level of handicap exists.

Total expenditures per patient in hospital-owned and physician-owned physician organizations in California.

PubMed

Robinson, James C; Miller, Kelly

Hospitals are rapidly acquiring medical groups and physician practices. This consolidation may foster cooperation and thereby reduce expenditures, but also may lead to higher expenditures through greater use of hospital-based ambulatory services and through greater hospital pricing leverage against health insurers. To determine whether total expenditures per patient were higher in physician organizations (integrated medical groups and independent practice associations) owned by local hospitals or multihospital systems compared with groups owned by participating physicians. Data were obtained on total expenditures for the care provided to 4.5 million patients treated by integrated medical groups and independent practice associations in California between 2009 and 2012. The patients were covered by commercial health maintenance organization (HMO) insurance and the data did not include patients covered by commercial preferred provider organization (PPO) insurance, Medicare, or Medicaid. Total expenditures per patient annually, measured in terms of what insurers paid to the physician organizations for professional services, to hospitals for inpatient and outpatient procedures, to clinical laboratories for diagnostic tests, and to pharmaceutical manufacturers for drugs and biologics. Annual expenditures per patient were compared after adjusting for patient illness burden, geographic input costs, and organizational characteristics. Of the 158 organizations, 118 physician organizations (75%) were physician-owned and provided care for 3,065,551 patients, 19 organizations (12%) were owned by local hospitals and provided care for 728,608 patients, and 21 organizations (13%) were owned by multihospital systems and provided care for 693,254 patients. In 2012, physician-owned physician organizations had mean expenditures of $3066 per patient (95% CI, $2892 to $3240), hospital-owned physician organizations had mean expenditures of $4312 per patient (95% CI, $3768 to $4857), and

Utilization, In-Hospital Mortality, and 30-Day Readmission After Percutaneous Mitral Valve Repair in the United States Shortly After Device Approval.

PubMed

Faridi, Kamil F; Popma, Jeffrey J; Strom, Jordan B; Shen, Changyu; Choi, Eunhee; Yeh, Robert W

2018-06-01

The MitraClip device for percutaneous mitral valve repair was approved by the Food and Drug Administration in the United States in October 2013. Few studies have evaluated national outcomes after this procedure in routine clinical practice. We identified adults aged ≥18 years who received percutaneous mitral valve repair from November 2013 to December 2014 in the Nationwide Readmissions Database, a publicly available administrative claims database. Procedural volumes, number of performing hospitals, individual hospital volumes, in-hospital mortality rate, and 30-day hospital readmission rate were determined. Patient demographics, clinical comorbidities, and hospital characteristics were analyzed using logistic regression to determine risk factors for in-hospital death and 30-day readmission. We identified 879 cases performed in the first 14 months after device approval (mean age ± SD, 75.0 ± 13.1 years; 45% women). The number of performing hospitals increased by 5.7-fold (23 to 132), although mean individual hospital volumes remained small (6.2 ± 10.4 cases per hospital). In-hospital all-cause mortality was 3.3% and was associated with higher number of clinical comorbidities. The rate of 30-day readmission was 14.6%, and 6.6% of patients died during rehospitalization. Increased procedural experience was associated with a nonsignificant trend toward reduced hospital readmission after multivariable adjustment (p = 0.08). In conclusion, use of percutaneous mitral valve repair in the United States early after approval increased steadily over time, although individual hospital volumes remained low. More than 1 in 7 patients who underwent this procedure are readmitted within 30 days of discharge. Copyright © 2018 Elsevier Inc. All rights reserved.

Effects of the Length of Stay on the Cost of Total Knee and Total Hip Arthroplasty from 2002 to 2013.

PubMed

Molloy, Ilda B; Martin, Brook I; Moschetti, Wayne E; Jevsevar, David S

2017-03-01

Utilization of total knee and hip arthroplasty has greatly increased in the past decade in the United States; these are among the most expensive procedures in patients with Medicare. Advances in surgical techniques, anesthesia, and care pathways decrease hospital length of stay. We examined how trends in hospital cost were altered by decreases in length of stay. Procedure, demographic, and economic data were collected on 6.4 million admissions for total knee arthroplasty and 2.8 million admissions for total hip arthroplasty from 2002 to 2013 using the National (Nationwide) Inpatient Sample, a component of the Healthcare Cost and Utilization Project. Trends in mean hospital costs and their association with length of stay were estimated using inflation-adjusted, survey-weighted generalized linear regression models, controlling for patient demographic characteristics and comorbidity. From 2002 to 2013, the length of stay decreased from a mean time of 4.06 to 2.97 days for total knee arthroplasty and from 4.06 to 2.75 days for total hip arthroplasty. During the same time period, the mean hospital cost for total knee arthroplasty increased from $14,988 (95% confidence interval [CI], $14,927 to $15,049) in 2002 to $22,837 (95% CI, $22,765 to $22,910) in 2013 (an overall increase of $7,849 or 52.4%). The mean hospital cost for total hip arthroplasty increased from $15,792 (95% CI, $15,706 to $15,878) in 2002 to $23,650 (95% CI, $23,544 to $23,755) in 2013 (an increase of $7,858 or 49.8%). If length of stay were set at the 2002 mean, the growth in cost for total knee arthroplasty would have been 70.8% instead of 52.4% as observed, and the growth in cost for total hip arthroplasty would have been 67.4% instead of 49.8% as observed. Hospital costs for joint replacement increased from 2002 to 2013, but were attenuated by reducing inpatient length of stay. With demographic characteristics showing an upward trend in the utilization of joint arthroplasty, including a shift

An observational study: associations between nurse-reported hospital characteristics and estimated 30-day survival probabilities

PubMed Central

Tvedt, Christine; Sjetne, Ingeborg Strømseng; Helgeland, Jon; Bukholm, Geir

2014-01-01

Background There is a growing body of evidence for associations between the work environment and patient outcomes. A good work environment may maximise healthcare workers’ efforts to avoid failures and to facilitate quality care that is focused on patient safety. Several studies use nurse-reported quality measures, but it is uncertain whether these outcomes are correlated with clinical outcomes. The aim of this study was to determine the correlations between hospital-aggregated, nurse-assessed quality and safety, and estimated probabilities for 30-day survival in and out of hospital. Methods In a multicentre study involving almost all Norwegian hospitals with more than 85 beds (sample size=30, information about nurses’ perceptions of organisational characteristics were collected. Subscales from this survey were used to describe properties of the organisations: quality system, patient safety management, nurse–physician relationship, staffing adequacy, quality of nursing and patient safety. The average scores for these organisational characteristics were aggregated to hospital level, and merged with estimated probabilities for 30-day survival in and out of hospital (survival probabilities) from a national database. In this observational, ecological study, the relationships between the organisational characteristics (independent variables) and clinical outcomes (survival probabilities) were examined. Results Survival probabilities were correlated with nurse-assessed quality of nursing. Furthermore, the subjective perception of staffing adequacy was correlated with overall survival. Conclusions This study showed that perceived staffing adequacy and nurses’ assessments of quality of nursing were correlated with survival probabilities. It is suggested that the way nurses characterise the microsystems they belong to, also reflects the general performance of hospitals. PMID:24728887

Elder self-neglect is associated with an increased rate of 30-day hospital readmission: findings from the Chicago Health and Aging Project.

PubMed

Dong, XinQi; Simon, Melissa A

2015-01-01

Elder self-neglect is associated with increased morbidity and mortality. The objective of this study is to examine the prospective relationship between reported elder self-neglect and the rate of 30-day hospital readmission in a community population. We conducted a prospective population-based study of community-dwelling older adults who participated in the Chicago Health and Aging Project. Of the 7,219 participants in the Chicago Health and Aging Project, a subset of 1,228 participants was reported to the social services agency for suspected elder self-neglect. The primary predictor was elder self-neglect reported to the social services agency. The outcome of interest was the annual rate of 30-day hospital readmission calculated from the Center for Medicare and Medicaid System hospitalization data from 1993 to 2009. Poisson regression models were used to assess these relationships. The average annual rate of 30-day hospital readmission for those without elder self-neglect was 0.2 (SD 0.7) and for those with reported elder self-neglect 0.9 (SD 2.8). After adjusting for sociodemographic and socioeconomic characteristics, medical comorbidities, cognitive function, physical function, and psychosocial well-being, elders who self-neglect had a significantly higher rate of 30-day hospital readmission (rate ratio 2.50, 95% confidence interval 2.02-3.10). Greater self-neglect severity [mild: parameter estimate (PE) 1.09, standard error (SE) 0.19, p < 0.001; moderate: PE 0.84, SE 0.13, p < 0.001; severe: PE 1.24, SE 0.40, p = 0.002] was associated with increased annual rates of 30-day hospital readmission after considering the same confounders. Interaction term analyses suggest that the significant relationship between self-neglect and 30-day hospital readmission was not moderated by medical conditions, cognitive impairment, physical disability, or psychosocial well-being. Reported elder self-neglect was associated with increased rates of 30-day hospital readmission in this

Stopping the effective non-fluoroquinolone antibiotics at day 7 vs continuing until day 14 in adults with acute pyelonephritis requiring hospitalization: A randomized non-inferiority trial.

PubMed

Rudrabhatla, Pavankumar; Deepanjali, Surendran; Mandal, Jharna; Swaminathan, Rathinam Palamalai; Kadhiravan, Tamilarasu

2018-01-01

To evaluate whether stopping the effective antibiotic treatment following clinical improvement at Day 7 (Truncated treatment) would be non-inferior to continued treatment until Day 14 (Continued treatment) in patients with acute pyelonephritis (APN) requiring hospitalization treated with non-fluoroquinolone (non-FQ) antibiotics. Hospitalized adult men and non-pregnant women with culture-confirmed APN were eligible for participation after they had clinically improved following empirical or culture-guided treatment with intravenous non-FQ antibiotic(s). We excluded patients with severe sepsis, abscesses, prostatitis, recurrent or catheter-associated urinary tract infection, or urinary tract obstruction. We randomized eligible patients on Day 7 of effective treatment and assessed them at Weeks 1 and 6 after treatment completion. The primary outcome was retreatment for recurrent urinary tract infection. The prespecified non-inferiority margin was 15%. Between March 17, 2015 and August 22, 2016, we randomly allocated 54 patients-27 patients in each arm. Twenty-four (44%) patients were male, and 26 (48%) had diabetes mellitus. Escherichia coli was the most common urinary isolate (47 [87%] patients); 36 (78%) were resistant to ciprofloxacin. In all, 41 (76%) patients received amikacin-based treatment. At the end of 6 weeks, no patient in the truncated treatment arm required retreatment, whereas 1 patient in the continued treatment arm was retreated. Difference (90% CI) in retreatment was -3.7% (-15.01% to 6.15%). Upper bound of the difference (6.15%) was below the prespecified limit, establishing non-inferiority of truncated treatment. Asymptomatic bacteriuria at Week 6 was similar between the two arms (3/24 vs. 3/26; P = 1.0). Patients in the truncated treatment arm had significantly shorter hospital stay (8 [7-10] vs. 14 [14-15] days; P < 0.001) and less antibiotic consumption per patient (8.4 ± 2.8 vs. 17.4 ± 8.3 DDDs; P < 0.001). Stopping the effective non

30-Day Mortality and Readmission after Hemorrhagic Stroke among Medicare Beneficiaries in Joint Commission Primary Stroke Center Certified and Non-Certified Hospitals

PubMed Central

Lichtman, Judith H.; Jones, Sara B.; Leifheit-Limson, Erica C.; Wang, Yun; Goldstein, Larry B.

2012-01-01

Background and Purpose Ischemic stroke patients treated at Joint Commission Primary Stroke Center (JC-PSC) certified hospitals have better outcomes. Data reflecting the impact of JC-PSC status on outcomes after hemorrhagic stroke are limited. We determined whether 30-day mortality and readmission rates after hemorrhagic stroke differed for patients treated at JC-PSC certified versus non-certified hospitals. Methods The study included all fee-for-service Medicare beneficiaries ≥65 years old with a primary discharge diagnosis of subarachnoid hemorrhage (SAH) or intracerebral hemorrhage (ICH) in 2006. Covariate-adjusted logistic and Cox proportional hazards regression assessed the effect of care at a JC-PSC certified hospital on 30-day mortality and readmission. Results There were 2,305 SAH and 8,708 ICH discharges from JC-PSC certified hospitals and 3,892 SAH and 22,564 ICH discharges from non-certified hospitals. Unadjusted in-hospital mortality (SAH: 27.5% vs. 33.2%, p<0.0001; ICH: 27.9% vs. 29.6%, p=0.003) and 30-day mortality (SAH: 35.1% vs. 44.0%, p<0.0001; ICH: 39.8% vs. 42.4%, p<0.0001) were lower in JC-PSC hospitals, but 30-day readmission rates were similar (SAH: 17.0% vs. 17.0%, p=0.97; ICH: 16.0% vs. 15.5%; p=0.29). Risk-adjusted 30-day mortality was 34% lower (OR 0.66, 95% CI 0.58–0.76) after SAH and 14% lower (OR 0.86, 95% CI 0.80–0.92) after ICH for patients discharged from JC-PSC certified hospitals. There was no difference in 30-day risk-adjusted readmission rates for SAH or ICH based on JC-PSC status. Conclusions Patients treated at JC-PSC certified hospitals had lower risk-adjusted mortality rates for both SAH and ICH but similar 30-day readmission rates as compared with non-certified hospitals. PMID:22033986

Association of US Centers for Medicare and Medicaid Services Hospital 30-Day Risk-Standardized Readmission Metric With Care Quality and Outcomes After Acute Myocardial Infarction

PubMed Central

Pandey, Ambarish; Golwala, Harsh; Hall, Hurst M.; Wang, Tracy Y.; Lu, Di; Xian, Ying; Chiswell, Karen; Joynt, Karen E.; Goyal, Abhinav; Das, Sandeep R.; Kumbhani, Dharam; Julien, Howard; Fonarow, Gregg C.

2017-01-01

Importance The US Centers for Medicare and Medicaid Services Hospital Readmissions Reduction Program penalizes hospitals with higher-than-expected risk-adjusted 30-day readmission rates (excess readmission ratio [ERR] > 1) after acute myocardial infarction (MI). However, the association of ERR with MI care processes and outcomes are not well established. Objective To evaluate the association between ERR for MI with in-hospital process of care measures and 1-year clinical outcomes. Design, Setting, and Participants Observational analysis of hospitalized patients with MI from National Cardiovascular Data Registry/Acute Coronary Treatment and Intervention Outcomes Network Registry–Get With the Guidelines centers subject to the first cycle of the Hospital Readmissions Reduction Program between July 1, 2008, and June 30, 2011. Exposures The ERR for MI (MI-ERR) in 2011. Main Outcomes and Measures Adherence to process of care measures during index hospitalization in the overall study population and risk of the composite outcome of mortality or all-cause readmission within 1 year of discharge and its individual components among participants with available Centers for Medicare and Medicaid Services–linked data. Results The median ages of patients in the MI-ERR greater than 1 and tertiles 1, 2, and 3 of the MI-ERR greater than 1 groups were 64, 63, 64, and 63 years, respectively. Among 380 hospitals that treated a total of 176 644 patients with MI during the study period, 43% had MI-ERR greater than 1. The proportions of patients of black race, those with heart failure signs at admission, and bleeding complications increased with higher MI-ERR. There was no significant association between adherence to MI performance measures and MI-ERR (adjusted odds ratio, 0.94; 95% CI, 0.81-1.08, per 0.1-unit increase in MI-ERR for overall defect-free care). Among the 51 453 patients with 1-year outcomes data available, higher MI-ERR was associated with higher adjusted risk of

A comparative study of hospital admissions for respiratory diseases during normal and dusty days in Iran.

PubMed

Geravandi, Sahar; Sicard, Pierre; Khaniabadi, Yusef Omidi; De Marco, Alessandra; Ghomeishi, Ali; Goudarzi, Gholamreza; Mahboubi, Mohammad; Yari, Ahmad Reza; Dobaradaran, Sina; Hassani, Ghasem; Mohammadi, Mohammad Javad; Sadeghi, Shahram

2017-08-01

During the last century, most of people around the world moved from communicable to non-communicable diseases, mainly due to air pollution. Air pollutants and dust storm increase risk of morbidity, for cardiovascular and respiratory diseases, and increase the number of deaths. The city of Ahvaz is considered as the focal point of air pollution and dust storm in Iran. The aim of this study was to determine the number of Hospital Admission Respiratory Disease (HARD) including asthma attacks, acute bronchitis and chronic obstructive pulmonary disease attributed to PM 10 by a descriptive study during normal and dust event days in Ahvaz during the time period 2010-2012. The hourly PM 10 data was collected from the Iranian Environmental Protection Agency and Razi hospital. The annual PM 10 mean concentrations reached 282, 288 and 278 μg/m 3 in 2010, 2011 and 2012, respectively. The number of HARD attributed to PM 10 was 1438, 1945 and 1393 people, respectively, and the highest number of daily admissions was attributed to the highest daily PM 10 concentration in Ahvaz. The average number of daily HARD during dusty days was higher than normal days, and a significant positive correlation, between the number of hospital admissions and dusty days, was found. Dust had significant impact on HARD in Ahvaz.

Blood transfusion and 30-day readmission rate in adult patients hospitalized with sickle cell disease crisis

PubMed Central

Nouraie, Mehdi; Gordeuk, Victor R.

2015-01-01

Background Sickle cell disease (SCD) patients hospitalized with vaso-occlusive pain crisis tend to have prolonged length of stay (LOS) and high 30-day readmission rates. We investigated the associations of demographic characteristics, comorbidities and blood transfusion during hospitalization with these outcomes. Study Design Repeated regression analysis was used to analyze 39,324 admissions of 4,348 adults with sickle cell crisis from 2007–2012 in the Truven Health MarketScan® Medicaid Databases. Results The mean (95% range) LOS was 5.9 (1.0–19.0) days and the 30-day readmission rate was 39.6% (95% confidence interval [CI]: 39.1%–40.0%). Older age, chronic cardiopulmonary, renal or liver disease and sepsis were associated with both longer LOS and greater 30-day readmission rate. Female gender, iron overload, acute chest syndrome, acute renal failure and stroke were additional predictors of longer LOS. Simple red blood cell transfusion was administered in 31.3% of the admissions, and these patients tended to have more severe disease (chronic cardiopulmonary or kidney disease, acute chest syndrome, acute kidney or liver failure, sepsis). Nevertheless, transfusion was associated with a reduced estimated odds ratio of inpatient mortality of 0.75 (95% CI: 0.57–0.99) and a decreased odds ratio of 30-day readmission of 0.78 (95% CI: 0.73–0.83). Conclusion Our findings point to blood transfusion as a potential means to reduce the 30-day readmission rate among Medicaid patients hospitalized with sickle cell crisis. There is a need for a prospective study to examine the potential benefit and safety of simple blood transfusion for this purpose. PMID:26126756

Age trends in 30 day hospital readmissions: US national retrospective analysis

PubMed Central

Berry, Jay G; Gay, James C; Joynt Maddox, Karen; Coleman, Eric A; Bucholz, Emily M; O’Neill, Margaret R; Blaine, Kevin; Hall, Matthew

2018-01-01

Abstract Objective To assess trends in and risk factors for readmission to hospital across the age continuum. Design Retrospective analysis. Setting and participants 31 729 762 index hospital admissions for all conditions in 2013 from the US Agency for Healthcare Research and Quality Nationwide Readmissions Database. Main outcome measure 30 day, all cause, unplanned hospital readmissions. Odds of readmission were compared by patients’ age in one year epochs with logistic regression, accounting for sex, payer, length of stay, discharge disposition, number of chronic conditions, reason for and severity of admission, and data clustering by hospital. The middle (45 years) of the age range (0-90+ years) was selected as the age reference group. Results The 30 day unplanned readmission rate following all US index admissions was 11.6% (n=3 678 018). Referenced by patients aged 45 years, the adjusted odds ratio for readmission increased between ages 16 and 20 years (from 0.70 (95% confidence interval 0.68 to 0.71) to 1.04 (1.02 to 1.06)), remained elevated between ages 21 and 44 years (range 1.02 (1.00 to 1.03) to 1.12 (1.10 to 1.14)), steadily decreased between ages 46 and 64 years (range 1.02 (1.00 to 1.04) to 0.91 (0.90 to 0.93)), and decreased abruptly at age 65 years (0.78 (0.77 to 0.79)), after which the odds remained relatively constant with advancing age. Across all ages, multiple chronic conditions were associated with the highest adjusted odds of readmission (for example, 3.67 (3.64 to 3.69) for six or more versus no chronic conditions). Among children, young adults, and middle aged adults, mental health was one of the most common reasons for index admissions that had high adjusted readmission rates (≥75th centile). Conclusions The likelihood of readmission was elevated for children transitioning to adulthood, children and younger adults with mental health disorders, and patients of all ages with multiple chronic conditions. Further attention to the

In-hospital cost comparison between the standard lateral and supercapsular percutaneously-assisted total hip surgical techniques for total hip replacement.

PubMed

Gofton, Wade; Fitch, David A

2016-03-01

The purpose of this study was to compare the in-hospital costs associated with the tissue-sparing supercapsular percutaneously-assisted total hip (SuperPath) and traditional Lateral surgical techniques for total hip replacement (THR). Between April 2013 and January 2014, in-hospital costs were reviewed for all THRs performed using the SuperPath technique by a single surgeon and all THRs performed using the Lateral technique by another surgeon at the same institution. Overall, costs were 28.4% higher in the Lateral group. This was largely attributable to increased costs associated with transfusion (+92.5%), patient rooms (+60.4%), patient food (+62.8%), narcotics (+42.5%), physical therapy (+52.5%), occupational therapy (+88.6%), and social work (+92.9%). The only costs noticeably increased for SuperPath were for imaging (+105.9%), and this was because the SuperPath surgeon performed intraoperative radiographs on all patients while the Lateral surgeon did not. The use of the SuperPath technique resulted in in-hospital cost reductions of over 28%, suggesting that this tissue-sparing surgical technique can be cost-effective primarily by facilitating early mobilisation and patient discharge even during a surgeon's initial experience with the approach.

Patient Body Mass Index is an Independent Predictor of 30-Day Hospital Readmission After Elective Spine Surgery.

PubMed

Elsamadicy, Aladine A; Adogwa, Owoicho; Vuong, Victoria D; Mehta, Ankit I; Vasquez, Raul A; Cheng, Joseph; Karikari, Isaac O; Bagley, Carlos A

2016-12-01

Hospital readmission within 30 days of index surgery is receiving increased scrutiny as an indicator of poor quality of care. Reducing readmissions achieves the dual benefit of improving quality and reducing costs. With the growing prevalence of obesity, understanding its impact on 30-day unplanned readmissions and patients' perception of health status is important for appropriate risk stratification of patients. The aim of this study was to determine if obesity is an independent risk factor for unplanned 30-day readmissions after elective spine surgery. The medical records of 500 patients (nonobese, n = 281; obese, n = 219) undergoing elective spine surgery at a major academic medical center were reviewed. Preoperative body mass index (BMI) was measured on all patients. BMI that was ≥30 kg/m 2 was classified as obese. Patient demographics, comorbidities, and postoperative complication rates were collected. The primary outcome investigated was unplanned all-cause 30-day hospital readmission. The association between preoperative obesity and 30-day readmission rate was assessed via multivariate logistic regression analysis. Baseline characteristics and operative variables and complication profiles were similar between both cohorts. Overall, 8.6% of patients were readmitted within 30 days of discharge; obese patients experienced a 2-fold increase in 30-day readmission rates (obese 12.33% vs. nonobese 5.69%, P = 0.01). In a multivariate logistic regression analysis, preoperative obesity (BMI ≥30 kg/m 2 ) was found to be an independent predictor of 30-day readmission after elective spine surgery (P = 0.001). Preoperative obesity is an independent risk factor for readmission within 30 days of discharge after elective spine surgery. In a cost-conscious health care climate, preoperative BMI can identify patients at risk for early unplanned hospital readmission. Copyright © 2016 Elsevier Inc. All rights reserved.

Short Hospitalization system: a new way of interpreting day surgery care.

PubMed

Rago, Rocco; Franceschini, Francesca; Tomassini, Carlo R

2016-01-01

Today's poorer income on the one hand and the more and more unbearable costs on the other, call for solutions to maintain public health through proper and collective care. We need to think of a new dimension of health, to found a modern and innovative approach, which can combine the respect of healthcare rights with the optimization of resources. Worldwide, franchises serving millions of people every year succeed in limiting operating costs and still offer a service and a quality equal to single businesses. Let's imagine every single Day Surgery Unit (DSU), within its own hospital, as a single trade: starting a process of centralized management and subsequent affiliation with other DSUs, they would increase their healthcare offer by means of solid organization, efficiency and foresight that with a strong focus on innovation and continuous updating, thus increasing its range of consumers and containing management costs. The Short Hospitalization System (SHS) is the proposed project, which is not only a type of hospitalization which is different from the ordinary, but also an innovative clinical-organizational model, with an important economic impact, where the management and maximization of the different hospital flows (care, professional, logistical, information), as well as the ability to implement strategies to anticipate them are crucial. The expected benefits are both clinically and socially relevant. Among them: 1) best practice build up; 2) lower impact on daily habits and increased patient satisfaction; 3) reduction of social and health expenditure.

Clinical presentation, management, in-hospital and 90-day outcomes of heart failure patients in Trivandrum, Kerala, India: the Trivandrum Heart Failure Registry.

PubMed

Harikrishnan, Sivadasanpillai; Sanjay, Ganapathi; Anees, Thajudeen; Viswanathan, Sunitha; Vijayaraghavan, Govindan; Bahuleyan, Charantharayil G; Sreedharan, Madhu; Biju, Ramabhadran; Nair, Tiny; Suresh, Krishnan; Rao, Ashok C; Dalus, Dae; Huffman, Mark D; Jeemon, Panniyammakal

2015-08-01

To evaluate the presentation, management, and outcomes of patients hospitalized for heart failure (HF) in Trivandrum, India. The Trivandrum Heart Failure Registry (THFR) enrolled consecutive admissions from 13 urban and five rural hospitals in Trivandrum with a primary diagnosis of HF from January to December 2013. Clinical characteristics at presentation, treatment, in-hospital outcomes, and 90-day mortality data were collected. 'Guideline-based' medical treatment was defined as the combination of beta-blockers, angiotensin-converting enzyme inhibitors or angiotensin receptor blockers, and aldosterone receptor blockers in patients with left ventricular systolic dysfunction (LVSD). We enrolled 1205 cases (834 men, 69%) into the registry. Mean (standard deviation) age was 61.2 (13.7) years. The most common HF aetiology was ischaemic heart disease (IHD) (72%). Heart failure with preserved ejection fraction (≥45%) constituted 26% of the population. The median hospital stay was 6 days (interquartile range = 4-9 days) with an in-hospital mortality rate of 8.5% (95% confidence interval 6.9-10.0). The 90-day all-cause mortality rate was 2.43 deaths per 1000 person-days (95% confidence interval 2.11-2.78). Guideline-based medical treatment was given to 19% and 25% of patients with LVSD during hospital admission and at discharge, respectively. Older age, lower education, poor ejection fraction, higher serum creatinine, New York Heart Association functional class IV, and suboptimal medical treatment were associated with higher risk of 90-day mortality. Patients hospitalized with HF in the THFR were younger, more likely to be men, had a higher prevalence of IHD, reported longer length of hospital stay, and higher mortality compared with published data from other registries. We also identified key areas for improving hospital-based HF medical care in Trivandrum. © 2015 The Authors. European Journal of Heart Failure © 2015 European Society of Cardiology.

Effect of Social Support and Marital Status on Perceived Surgical Effectiveness and 30-Day Hospital Readmission.

PubMed

Adogwa, Owoicho; Elsamadicy, Aladine A; Vuong, Victoria D; Mehta, Ankit I; Vasquez, Raul A; Cheng, Joseph; Bagley, Carlos A; Karikari, Isaac O

2017-12-01

Retrospective cohort review. To determine whether higher levels of social support are associated with improved surgical outcomes after elective spine surgery. The medical records of 430 patients (married, n = 313; divorced/separated/widowed, n = 71; single, n = 46) undergoing elective spine surgery at a major academic medical center were reviewed. Patients were categorized by their marital status at the time of surgery. Patient demographics, comorbidities, and postoperative complication rates were collected. All patients had prospectively collected outcomes measures and a minimum of 1-year follow-up. Patient reported outcomes instruments (Oswestry Disability Index, Short Form-36, and visual analog scale-back pain/leg pain) were completed before surgery, then at 1 year after surgery. Baseline characteristics were similar in all cohorts. There was no statistically significant difference in the length of hospital stay across all 3 cohorts, although "single patients" had longer duration of in-hospital stays that trended toward significance (single 6.24 days vs married 4.53 days vs divorced/separated/widowed 4.55 days, P = .05). Thirty-day readmission rates were similar across all cohorts (married 7.03% vs divorced/separated/widowed 7.04% vs single 6.52%, P = .99). Additionally, there were no significant differences in baseline and 1-year patient reported outcomes measures between all groups. Increased social support did not appear to be associated with superior short and long-term clinical outcomes after spine surgery; however, it was associated with a shorter duration of in-hospital stay with no increase in 30-day readmission rates.

Integrating Depression Care Management into Medicare Home Health Reduces Risk of 30 and 60 Day Hospitalization: The Depression CAREPATH Cluster-Randomized Trial

PubMed Central

Bruce, Martha L.; Lohman, Matthew C.; Greenberg, Rebecca L.; Bao, Yuhua; Raue, Patrick J.

2016-01-01

OBJECTIVES To determine whether a depression care management intervention among Medicare home health recipients decreases risks of hospitalization. DESIGN Cluster-randomized trial. Nurse teams were randomized to Intervention (12 teams) or Enhanced Usual Care (EUC; 9 teams). SETTING Six home health agencies from distinct geographic regions. Patients were interviewed at home and by telephone. PARTICIPANTS Patients age>65 who screened positive for depression on nurse assessments (N=755), and a subset who consented to interviews (N=306). INTERVENTION The Depression CAREPATH (CARE for PATients at Home) guides nurses in managing depression during routine home visits. Clinical functions include weekly symptom assessment, medication management, care coordination, patient education, and goal setting. Researchers conducted biweekly telephone conferences with team supervisors. MEASUREMENTS The study examined acute-care hospitalization and days to hospitalization. H1 used data from the home health record to examine hospitalization over 30-day and 60-day periods while a home health patient. H2 used data from both home care record and research assessments to examine 30-day hospitalization from any setting. RESULTS The adjusted hazard ratio (HR) of being admitted to hospital directly from home health within 30 days of start of home health care was 0.65 (p=.013) for CAREPATH compared to EUC patients, and 0.72 (p=.027) within 60 days. In patients referred to home health directly from hospital, the relative hazard of being rehospitalized was approximately 55% lower (HR = 0.45, p=.001) among CAREPATH patients. CONCLUSION Integrating CAREPATH depression care management into routine nursing practice reduces hospitalization and rehospitalization risk among older adults receiving Medicare home health nursing services. PMID:27739067

Mortality, hospital days and expenditures attributable to ambient air pollution from particulate matter in Israel.

PubMed

Ginsberg, Gary M; Kaliner, Ehud; Grotto, Itamar

2016-01-01

Worldwide, ambient air pollution accounts for around 3.7 million deaths annually. Measuring the burden of disease is important not just for advocacy but also is a first step towards carrying out a full cost-utility analysis in order to prioritise technological interventions that are available to reduce air pollution (and subsequent morbidity and mortality) from industrial, power generating and vehicular sources. We calculated the average national exposure to particulate matter particles less than 2.5 μm (PM2.5) in diameter by weighting readings from 52 (non-roadside) monitoring stations by the population of the catchment area around the station. The PM2.5 exposure level was then multiplied by the gender and cause specific (Acute Lower Respiratory Infections, Asthma, Circulatory Diseases, Coronary Heart Failure, Chronic Obstructive Pulmonary Disease, Diabetes, Ischemic Heart Disease, Lung Cancer, Low Birth Weight, Respiratory Diseases and Stroke) relative risks and the national age, cause and gender specific mortality (and hospital utilisation which included neuro-degenerative disorders) rates to arrive at the estimated mortality and hospital days attributable to ambient PM2.5 pollution in Israel in 2015. We utilised a WHO spread-sheet model, which was expanded to include relative risks (based on more recent meta-analyses) of sub-sets of other diagnoses in two additional models. Mortality estimates from the three models were 1609, 1908 and 2253 respectively in addition to 184,000, 348,000 and 542,000 days hospitalisation in general hospitals. Total costs from PM2.5 pollution (including premature burial costs) amounted to $544 million, $1030 million and $1749 million respectively (or 0.18 %, 0.35 % and 0.59 % of GNP). Subject to the caveat that our estimates were based on a limited number of non-randomly sited stations exposure data. The mortality, morbidity and monetary burden of disease attributable to air pollution from particulate matter in Israel is of

[Cost of hospitalization by the Activity Based Costing method in the neonatal department of Principal Hospital of Dakar].

PubMed

Tchamdja, T; Balaka, A; Tchandana, M; Agbétra, A

2015-01-01

To determine the cost of hospitalization per day in the neonatal department of Principal Hospital of Dakar. This prospective study took place during the month of July 2011 in the newborn unit. The activity-based costing method was used to analyze costs. During the study period, 52 newborns were hospitalized for a total of 590 days. The cost of the human resources during that month was 9,907,832 FCFA (US $ 19,815.66), the cost of depreciation of fixed assets was estimated at 571,952 FCFA (US $ 1143.90), and supplies at 112,084 FCFA (US $ 224.17). External services cost 386,753 FCFA (US $ 773.51) and support services 6,917,380.65 FCFA (US $ 13,834.7613). The monthly expenses incurred for the hospitalization of newborns totaled 17,896,002 FCFA (US $ 35,792), for a cost per patient per day of 30,332.20 FCFA (US $ 60.66) and an average cost of hospitalization 334,153.88 FCFA (US $ 668,31). This study is the first of its kind in Senegal and neighboring countries. By applying the ABC approach, we can obtain a more detailed and precise estimate of the cost of activities and services. Process improvements and corrective actions should make it possible to identify cost drivers, such as time.

Hidden Costs of Hospital Based Delivery from Two Tertiary Hospitals in Western Nepal.

PubMed

Acharya, Jeevan; Kaehler, Nils; Marahatta, Sujan Babu; Mishra, Shiva Raj; Subedi, Sudarshan; Adhikari, Bipin

2016-01-01

Hospital based delivery has been an expensive experience for poor households because of hidden costs which are usually unaccounted in hospital costs. The main aim of this study was to estimate the hidden costs of hospital based delivery and determine the factors associated with the hidden costs. A hospital based cross-sectional study was conducted among 384 post-partum mothers with their husbands/house heads during the discharge time in Manipal Teaching Hospital and Western Regional Hospital, Pokhara, Nepal. A face to face interview with each respondent was conducted using a structured questionnaire. Hidden costs were calculated based on the price rate of the market during the time of the study. The total hidden costs for normal delivery and C-section delivery were 243.4 USD (US Dollar) and 321.6 USD respectively. Of the total maternity care expenditures; higher mean expenditures were found for food & drinking (53.07%), clothes (9.8%) and transport (7.3%). For postpartum women with their husband or house head, the total mean opportunity cost of "days of work loss" were 84.1 USD and 81.9 USD for normal delivery and C-section respectively. Factors such as literate mother (p = 0.007), employed house head (p = 0.011), monthly family income more than 25,000 NRs (Nepalese Rupees) (p = 0.014), private hospital as a place of delivery (p = 0.0001), C-section as a mode of delivery (p = 0.0001), longer duration (>5days) of stay in hospital (p = 0.0001), longer distance (>15km) from house to hospital (p = 0.0001) and longer travel time (>240 minutes) from house to hospital (p = 0.007) showed a significant association with the higher hidden costs (>25000 NRs). Experiences of hidden costs on hospital based delivery and opportunity costs of days of work loss were found high. Several socio-demographic factors, delivery related factors (place and mode of delivery, length of stay, distance from hospital and travel time) were associated with hidden costs. Hidden costs can be a

Day of Surgery Impacts Outcome: Rehabilitation Utilization on Hospital Length of Stay in Patients Undergoing Elective Meningioma Resection.

PubMed

Sarkiss, Christopher A; Papin, Joseph A; Yao, Amy; Lee, James; Sefcik, Roberta K; Oermann, Eric K; Gordon, Errol L; Post, Kalmon D; Bederson, Joshua B; Shrivastava, Raj K

2016-09-01

Meningiomas account for approximately one third of all brain tumors in the United States. In high-volume medical centers, the average length of stay (LOS) for a patient is 6.8 days compared with 8.8 days in low-volume centers with median total admission charges equaling approximately $55,000. To our knowledge, few studies have evaluated day of surgery and its effect on hospital LOS. Our primary goal was to analyze patient outcome as a direct result of surgical date, as well as to characterize the individual variables that may impact their hospital course, early access to rehabilitation, and long-term functional status. A retrospective database was generated for cranial meningioma patients who underwent elective surgical resection at our institution over a 3-year study period (2011-2014). Inclusion criteria included any patient who underwent elective meningioma resection and was discharged either home or to a rehabilitation facility with at least 6 months of follow-up. Exclusion criteria included any patient who was not discharged after resection (i.e., expired). Each patient's medical record was evaluated for a subset of demographics and clinical variables. Given that patients who undergo surgical resection of meningiomas have a national median LOS of 6 days, we subdivided the patients into 2 cohorts: early discharge (LOS < 3) and late discharge (LOS ≥ 3). Statistical analysis was performed using SPSS 21.0 to assess the significance of the results. We identified 139 (25 male, 114 female) meningioma patients who underwent surgical resection. Seventy of these patients had surgery during the early week (defined as Monday-Wednesday), and 69 had surgery in the later week (Thursday-Friday). The median age for both early and late groups was 58, and the median diameter of the tumor was 3.1 cm and 3.3 cm, respectively. Overall, 55% of the patients had public insurance and 43% had private insurance, with no significant variation between the early and late groups. The

Observed to expected or logistic regression to identify hospitals with high or low 30-day mortality?

PubMed Central

Helgeland, Jon; Clench-Aas, Jocelyne; Laake, Petter; Veierød, Marit B.

2018-01-01

Introduction A common quality indicator for monitoring and comparing hospitals is based on death within 30 days of admission. An important use is to determine whether a hospital has higher or lower mortality than other hospitals. Thus, the ability to identify such outliers correctly is essential. Two approaches for detection are: 1) calculating the ratio of observed to expected number of deaths (OE) per hospital and 2) including all hospitals in a logistic regression (LR) comparing each hospital to a form of average over all hospitals. The aim of this study was to compare OE and LR with respect to correctly identifying 30-day mortality outliers. Modifications of the methods, i.e., variance corrected approach of OE (OE-Faris), bias corrected LR (LR-Firth), and trimmed mean variants of LR and LR-Firth were also studied. Materials and methods To study the properties of OE and LR and their variants, we performed a simulation study by generating patient data from hospitals with known outlier status (low mortality, high mortality, non-outlier). Data from simulated scenarios with varying number of hospitals, hospital volume, and mortality outlier status, were analysed by the different methods and compared by level of significance (ability to falsely claim an outlier) and power (ability to reveal an outlier). Moreover, administrative data for patients with acute myocardial infarction (AMI), stroke, and hip fracture from Norwegian hospitals for 2012–2014 were analysed. Results None of the methods achieved the nominal (test) level of significance for both low and high mortality outliers. For low mortality outliers, the levels of significance were increased four- to fivefold for OE and OE-Faris. For high mortality outliers, OE and OE-Faris, LR 25% trimmed and LR-Firth 10% and 25% trimmed maintained approximately the nominal level. The methods agreed with respect to outlier status for 94.1% of the AMI hospitals, 98.0% of the stroke, and 97.8% of the hip fracture hospitals

Temporal profile of pain and other sensory manifestations in Guillain-Barre' syndrome during ten days of hospitalization.

PubMed

Karkare, K; Taly, Arun B; Sinha, Sanjib; Rao, S

2011-01-01

Focused studies on sensory manifestations, especially pain and paresthesia in Guillain-Barre' (GB) syndrome are few and far between. To study the sensory manifestations in GB syndrome during 10 days of hospitalization with clinico-electrophysiological correlation. The study included 60 non-consecutive patients with GB syndrome, fulfilling National Institute of Neurological and Communicative Disorders and Stroke (NINCDS) criteria for GB syndrome. Data especially related to clinical and electrophysiological evidence of sensory involvement were analyzed. Pain was assessed using a) visual analogue paraesthesias (Vapar), b) visual analogue for pain (Vap) and c) verbal rating scale for pain (Verp). Sensory symptoms were widely prevalent: paraesthesia in 45 (75%) patients and pain in 30 (50%) patients. Impairment of different sensory modalities included: pain in 8 (13.3%), joint position sense in 14 (23.3%), and vibration in 11 (18.3%). Electrophysiological evidence of abnormal sensory nerve conduction was noted in 35 (58.3%) patients. Pain assessment using Vapar, Vap and Verp for from Day 1 to Day 10 of hospitalization revealed that from Day 7 onwards the degree and frequency of sensory symptoms and signs decreased. On comparing various clinico-electrophysiological parameters among patients of GB syndrome with and without pain and paresthesia. Presence of respiratory distress correlated with pain and paresthesia (P=0.02). Sensory manifestations in GB syndrome are often under-recognized and under-emphasized. This study analyzed the evolution and the profile of pain and paresthesia in GB syndrome during hospitalization. Knowledge, especially about evolution of pain and paresthesia during hospitalization might improve understanding and patient care.

Sleep duration as a mediator between an alternating day and night shift work schedule and metabolic syndrome among female hospital employees.

PubMed

Korsiak, Jill; Tranmer, Joan; Day, Andrew; Aronson, Kristan J

2018-02-01

The main objective was to determine whether sleep duration on work shifts mediates the relationship between a current alternating day and night shift work schedule and metabolic syndrome among female hospital employees. The secondary objective was to assess whether cumulative lifetime shift work exposure was associated with metabolic syndrome. In this cross-sectional study of 294 female hospital employees, sleep duration was measured with the ActiGraph GT3X+. Shift work status was determined through self-report. Investigation of the total, direct and indirect effects between shift work, sleep duration on work shifts and metabolic syndrome was conducted using regression path analysis. Logistic regression was used to determine the association between cumulative shift work exposure and metabolic syndrome. Shift work is strongly associated with metabolic syndrome (OR Total =2.72, 95% CI 1.38 to 5.36), and the relationship is attenuated when work shift sleep duration is added to the model (OR Direct =1.18, 95% CI 0.49 to 2.89). Sleep duration is an important intermediate between shift work and metabolic syndrome (OR Indirect =2.25, 95% CI 1.27 to 4.26). Cumulative shift work exposure is not associated with metabolic syndrome in this population. Sleep duration mediates the association between a current alternating day-night shift work pattern and metabolic syndrome. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Total Shoulder Arthroplasty: Is Less Time in the Hospital Better?

PubMed

Duchman, Kyle R; Anthony, Chris A; Westermann, Robert W; Pugely, Andrew J; Gao, Yubo; Hettrich, Carolyn M

2017-01-01

The incidence of total shoulder arthroplasty (TSA) has increased significantly over the last decade. Short-stay protocols for other highvolume procedures have been shown to be safe and effective but have yet to be fully explored for TSA. Our purpose in comparing short-stay and inpatient TSA was to determine: (1) patient demographics and comorbidities, (2) 30-day morbidity, mortality, and readmissions using a matched analysis, and (3) independent predictors of 30-day complications. The American College of Surgeons National Surgical Quality Improvement (ACS NSQIP) database was queried and all patients undergoing elective, primary TSA between 2006 and 2013 were identified. Patients were categorized as short-stay or inpatient based on day of discharge. Propensity score matching was used to adjust for selection bias. Univariate and multivariate statistical analysis was used to compare 30-day morbidity and mortality between the two cohorts. Overall, 4,619 cases were available, with inpatient admission occurring in 65.7% of patients. Prior to propensity score matching, short-stay patients were significantly younger, more frequently male, with fewer comorbid conditions. After matching, inpatient admission was associated with increased rates of urinary tract infection (1.1% vs. 0.1%; p = 0.001), blood transfusion (5.3% vs. 0.8%; p < 0.001), and total complications (4.7% vs. 1.8%; p < 0.001). Multivariate analysis identified inpatient admission as an independent risk factor for 30-day complication following TSA. Short-stay TSA is a safe option for the appropriately selected patient. Inpatient admission was an independent risk factor for complication following TSA. Level of Evidence: III.

Challenges in day-to-day midwifery practice; a qualitative study from a regional referral hospital in Dar es Salaam, Tanzania.

PubMed

Bremnes, Hanna Strømholt; Wiig, Åsil Kjøl; Abeid, Muzdalifat; Darj, Elisabeth

2018-01-01

Maternal and infant mortality rates in Tanzania have decreased over the past decades, but remain high. One of the challenges the country faces, is the lack of skilled health care workers. High fertility rates make midwives and their patients particularly susceptible to stress as a result of understaffing. This paper explores the challenges midwives face in their day-to-day practice at a regional referral hospital in Tanzania, and investigates which measures the midwives themselves find necessary to implement to improve their situation. A qualitative study design with focus group discussions (FGDs) was employed to explore which challenges the midwives experienced. Each focus group consisted of five to six midwives. A FGD topic guide covering challenges, consequences, motivation, ideal situation and possible solutions was used. These data were analyzed using Systematic Text Condensation. A total of 28 Midwives, six men and 22 women, participated in five FGDs. Four categories emerged from the collected material: Feelings of demoralization, shortage of resources, societal challenges and personal struggles. A feeling of demoralization was especially prevalent and was caused by a lack of support from the leaders and little appreciation from the patients. Shortage of resources, and shortage of personnel in particular, was also highlighted as it led to an excessive workload resulting in difficulties with providing adequate care. These difficulties were intensified by lack of equipment, facilities and a non-optimal organization of the healthcare system. The challenges revealed during the FGDs prevent the midwives from providing sufficient midwifery care. To improve the situation, measures such as supportive leadership, reduction of workload, increasing availability of equipment and increasing knowledge of reproductive health in society, should be taken.

Thirty-Day Readmission Among Patients With Non-variceal Upper Gastrointestinal Hemorrhage and Effects on Outcomes.

PubMed

Abougergi, Marwan S; Peluso, Heather; Saltzman, John R

2018-03-28

We aimed to determine the rate of hospital readmission within 30 days of non-variceal upper gastrointestinal hemorrhage and its impact on mortality, morbidity, and health care use in the United States. We performed a retrospective study using the Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project Nationwide Readmission Database for the year 2014 (data on 14.9 million hospital stays at 2048 hospitals in 22 states). We collected data on hospital readmissions of 203,220 adults who were hospitalized for urgent non-variceal upper gastrointestinal hemorrhage and discharged. The primary outcome was rate of all-cause readmission within 30 days of discharge. Secondary outcomes were reasons for readmission, readmission mortality rate, morbidity (shock and prolonged mechanical ventilation) and resource use (length of stay and total hospitalization costs and charges). Independent risk factors for readmission were identified using Cox regression analysis. The 30-day rate of readmission was 13%. Only 18% of readmissions were due to recurrent non-variceal upper gastrointestinal bleeding. The rate of death among patients readmitted to the hospital (4.7%) was higher than that for index admissions (1.9%) (P < .01). A higher proportion of readmitted patients had morbidities requiring prolonged mechanical ventilation (1.5%) compared with index admissions (0.8%) (P < .01). A total of 133,368 hospital days was associated with readmission, and the total health care in-hospital economic burden was $30.3 million (in costs) and $108 million (in charges). Independent predictors of readmission were Medicaid insurance, higher Charlson comorbidity score, lower income, residence in a metropolitan area, hemorrhagic shock, and longer stays in the hospital. Older age, private or no insurance, upper endoscopy, and prolonged mechanical ventilation were associated with lower odds for readmission. In a retrospective study of patients hospitalized for non

The Epidemiology of Primary and Revision Total Hip Arthroplasty in Teaching and Nonteaching Hospitals in the United States.

PubMed

Kowalik, Thomas D; DeHart, Matthew; Gehling, Hanne; Gehling, Paxton; Schabel, Kathryn; Duwelius, Paul; Mirza, Amer

2016-06-01

The purpose of this study was to examine the epidemiology of primary and revision total hip arthroplasty (THA) in teaching and nonteaching hospitals. The Healthcare Cost and Utilization Project Nationwide Inpatient Sample was queried from 2006 to 2010 to identify primary and revision THAs at teaching and nonteaching hospitals. A total of 1,336,396 primary and 223,520 revision procedures were identified. Forty-six percent of all primary and 54% of all revision procedures were performed at teaching hospitals. Teaching hospitals performed 17% of their THAs as revisions; nonteaching hospitals performed 12% as revisions. For primary and revision THAs, teaching hospitals had fewer patients aged >65 years, fewer Medicare patients, similar gender rates, more nonwhite patients, and more patients in the highest income quartile compared with nonteaching hospitals. Costs, length of stay, and Charlson Comorbidity Index scores were similar; however, the mortality rate was lower at teaching hospitals. This study found small but significant differences in key epidemiologic and outcome variables in examining primary and revision THA at teaching and nonteaching hospitals. Level III.

An estimate of the cost of administering intravenous biological agents in Spanish day hospitals

PubMed Central

Nolla, Joan Miquel; Martín, Esperanza; Llamas, Pilar; Manero, Javier; Rodríguez de la Serna, Arturo; Fernández-Miera, Manuel Francisco; Rodríguez, Mercedes; López, José Manuel; Ivanova, Alexandra; Aragón, Belén

2017-01-01

Objective To estimate the unit costs of administering intravenous (IV) biological agents in day hospitals (DHs) in the Spanish National Health System. Patients and methods Data were obtained from 188 patients with rheumatoid arthritis, collected from nine DHs, receiving one of the following IV therapies: infliximab (n=48), rituximab (n=38), abatacept (n=41), or tocilizumab (n=61). The fieldwork was carried out between March 2013 and March 2014. The following three groups of costs were considered: 1) structural costs, 2) material costs, and 3) staff costs. Staff costs were considered a fixed cost and were estimated according to the DH theoretical level of activity, which includes, as well as personal care of each patient, the DH general activities (complete imputation method, CIM). In addition, an alternative calculation was performed, in which the staff costs were considered a variable cost imputed according to the time spent on direct care (partial imputation method, PIM). All costs were expressed in euros for the reference year 2014. Results The average total cost was €146.12 per infusion (standard deviation [SD] ±87.11; CIM) and €29.70 per infusion (SD ±11.42; PIM). The structure-related costs per infusion varied between €2.23 and €62.35 per patient and DH; the cost of consumables oscillated between €3.48 and €20.34 per patient and DH. In terms of the care process, the average difference between the shortest and the longest time taken by different hospitals to administer an IV biological therapy was 113 minutes. Conclusion The average total cost of infusion was less than that normally used in models of economic evaluation coming from secondary sources. This cost is even less when the staff costs are imputed according to the PIM. A high degree of variability was observed between different DHs in the cost of the consumables, in the structure-related costs, and in those of the care process. PMID:28356746

Predicting all-cause risk of 30-day hospital readmission using artificial neural networks.

PubMed

Jamei, Mehdi; Nisnevich, Aleksandr; Wetchler, Everett; Sudat, Sylvia; Liu, Eric

2017-01-01

Avoidable hospital readmissions not only contribute to the high costs of healthcare in the US, but also have an impact on the quality of care for patients. Large scale adoption of Electronic Health Records (EHR) has created the opportunity to proactively identify patients with high risk of hospital readmission, and apply effective interventions to mitigate that risk. To that end, in the past, numerous machine-learning models have been employed to predict the risk of 30-day hospital readmission. However, the need for an accurate and real-time predictive model, suitable for hospital setting applications still exists. Here, using data from more than 300,000 hospital stays in California from Sutter Health's EHR system, we built and tested an artificial neural network (NN) model based on Google's TensorFlow library. Through comparison with other traditional and non-traditional models, we demonstrated that neural networks are great candidates to capture the complexity and interdependency of various data fields in EHRs. LACE, the current industry standard, showed a precision (PPV) of 0.20 in identifying high-risk patients in our database. In contrast, our NN model yielded a PPV of 0.24, which is a 20% improvement over LACE. Additionally, we discussed the predictive power of Social Determinants of Health (SDoH) data, and presented a simple cost analysis to assist hospitalists in implementing helpful and cost-effective post-discharge interventions.

Is Hospital Teaching Status a Key Factor in Hospital Charge for Children with Hip Fractures?

PubMed Central

Gao, Yubo; Pugely, Andrew; Karam, Matthew; Phisitkul, Phinit; Mendoza, Sergio; Johnston, Richard C.

2013-01-01

OBJECTIVE Proximal femur fractures cause significant pain and economic cost among pediatric patients. The purposes of this study were (a) to evaluate the distribution by hospital type (teaching hospital vs non-teaching hospital) of U.S. pediatric patients aged 1-20 years who were hospitalized with a closed hip fracture and (b) to discern the mean hospital charge and hospital length of stay after employing propensity score to reduce selec-tion bias. METHODS The 2006 Healthcare Cost and Uti-lization Project (HCUP) Kids’ Inpatient Database (KID) was queried for children aged up to 20 years that had principle diagnosis of hip fracture injury. Hip fractures were defined by International Classifi-cation of Diseases, 9th Revision, Clinical Modifica-tion codes 820.0, 820.2 and 820.8 under Section “Injury and Poisoning (800-999)” with principle internal fixation procedure codes 78.55, 79.15 and 79.35. Patient demographics and hospital status were presented and analyzed. Differences in mean hospital charge and hospital length of stay by hospital teaching status were assessed via two propensity score based methods. RESULTS In total, 1,827 patients were nation-ally included for analysis: 1,392 (76.2%) were treated at a teaching hospital and 435 (23.8%) were treated at a non-teaching hospital. The average age of the patients was 12.88 years old in teaching hospitals vs 14.33 years old in nonteaching hospitals. The propensity score based ad-justment method showed mean hospital charge was $34,779 in teaching hospitals and $32,891 in the non-teaching hospitals, but these differences were not significant (p=0.2940). Likewise, mean length of hospital stay was 4.1 days in teaching hospitals and 3.89 days in non-teaching hospitals, but these differences were also not significant (p=0.4220). Conclusions Hospital teaching status did not affect length of stay or total hospital costs in children treated surgically for proximal femur fractures. Future research should be directed at

The Benefit of Modified Rehabilitation and Minimally Invasive Techniques in Total Hip Replacement

PubMed Central

Lilikakis, Anastasios K; Gillespie, Beryl; Villar, Richard N

2008-01-01

INTRODUCTION We wished to assess if an intensive rehabilitation regimen alone, or one combined with modified anaesthetic and surgical techniques, can change the speed of rehabilitation or the length of hospital stay after total hip replacement. PATIENTS AND METHODS We compared 44 patients who had followed a traditional care pathway, with 38 patients who had rehabilitated under a new rehabilitation protocol, with 40 patients who had also received modified, minimally invasive techniques. The speed of rehabilitation was measured in terms of three specific milestones accomplished on the day after surgery. RESULTS We found a statistically significant improvement in the day after surgery each activity was possible. The length of hospital stay was reduced from 6.5 days to 5.4 days to 4.1 days, a difference which was also statistically significant. CONCLUSIONS The data support the view that a new rehabilitation protocol alone can reduce the length of hospital stay and hasten rehabilitation. The combination of modified anaesthetic and minimally invasive surgical techniques with the new rehabilitation regimen can further improve short-term outcome after total hip replacement. PMID:18634739

Effect of employment status on length of hospital stay, 30-day readmission and patient reported outcomes after spine surgery.

PubMed

Adogwa, Owoicho; Elsamadicy, Aladine A; Fialkoff, Jared; Mehta, Ankit I; Vasquez, Raul A; Cheng, Joseph; Karikari, Isaac O; Bagley, Carlos A

2017-03-01

Growing scrutiny has placed hospitals at the center of readmission prevention. The relationship between pre-operative employment status, length of hospital stays (LOS) and 30-day readmission rates after elective spine surgery remains unclear. The medical records of 360 patients (employed: n=174, unemployed: n=70, retired: n=40, disabled: n=76) undergoing elective spine surgery at a major academic medical center were reviewed. Patient demographics, comorbidities, and post-operative complication rates were recorded. All patients had comprehensive 1-year patient reported outcomes (PROs) measures. We hypothesized that employment status is associated with decreased LOS and decreased risk of 30-day readmission after elective spine surgery. All-cause readmissions within 30 days of discharge was the primary outcome variable. Baseline characteristics were similar in all cohorts. There was no difference in operative time, estimated blood loss (EBL), or number of fusion levels between all patient cohorts. There were no significant differences in peri-operative complication rates between patient cohorts. On average, the LOS was shorter for the employed compared to non-employed patients (4.89 vs. 5.26 days). The rate of 30-day readmission was 2-fold greater unemployed compared to employed patients (5.17% vs. 10%). At 1-year after surgery, employed patients were more likely to express functional improvement (change in ODI score) compared to unemployed patients (ODI: employed: 33.80 vs. unemployed: 41.93). Our study suggests that employment status may be associated with shorter duration of hospital stay, lower 30-day readmission rates and greater functional improvement. Future interventions to reduce unplanned hospital readmissions should consider pre-operative employment status.

[Short-term prognosis and treatment of patients hospitalized for acute heart failure in a regional hospital without a cardiocentre].

PubMed

Zeman, K; Pohludková, L; Spinar, J; Jarkovský, J; Littnerová, S; Dušek, L; Miklík, R; Felšöci, M; Pařenica, J

2012-04-01

Heart failure is a syndrome with increasing prevalence and poor prognosis. The aim of the article is to describe the characteristics, etiology, treatment and short-term prognosis of consecutive patients hospitalized for acute heart failure (AHF) in a regional hospital without Cardiocentre. From 1/2007 to 5/2009 in total 752 patients were hospitalized in Hospital in Frýdek-Místek with diagnosis of AHF, 18% of them were in that period re-hospitalized. Data collection was performed by doctors using the National registry of acute heart failure AHEAD. Systematic sorting of patients with heart failure was made on the basis of guidelines for the diagnosis and treatment of acute heart failure (2005). Statistical analysis was performed at the Institute of Biostatistics and Analyses Masaryk University in Brno. AHF was a reason of 9% of all hospital admissions. This represents approximately 250 hospitalizations due to AHF per 100 000 inhabitants/year. A median of hospital stay was 6.5 days. Patients with de-novo AHF formed 40.8% of all hospitalizations. The most common syndromes of AHF were acute decompensated heart failure (57.7%) and pulmonary oedema (19.8%). According to laboratory tests the incidence of renal insufficiency was in 35.6% of patients, anemia in 39.9%, blood glucose on admission above 10 mmol/l in 29.5% and hyponatremia < 135 mmol/l in 19.1%. During hospitalization, there was a significant increase in the treatment of heart failure. Diuretics were receiving 91% of discharged patients, ACE inhibitors and/or AT2 blockers 85.7% and beta-blockers 69.6% of patients. A total of 30% of discharged patients were not self-sufficient. The total 30-day mortality was 16.8%. Using univariante logistic regression factors most affecting the 30-day mortality were identified: cardiogenic shock, female gender, age over 70 years, acute coronary syndrome, hypotension on admission, atrial fibrillation, renal insufficiency, chronic obstructive pulmonary disease, anemia

Impact of a Patient Navigator Program on Hospital-Based and Outpatient Utilization Over 180 Days in a Safety-Net Health System.

PubMed

Balaban, Richard B; Zhang, Fang; Vialle-Valentin, Catherine E; Galbraith, Alison A; Burns, Marguerite E; Larochelle, Marc R; Ross-Degnan, Dennis

2017-09-01

With emerging global payment structures, medical systems need to understand longer-term impacts of care transition strategies. To determine the effect of a care transition program using patient navigators (PNs) on health service utilization among high-risk safety-net patients over a 180-day period. Randomized controlled trial conducted October 2011 through April 2013. Patients admitted to the general medicine service with ≥1 readmission risk factor: (1) age ≥ 60; (2) in-network inpatient admission within prior 6 months; (3) index length of stay ≥ 3 days; or (4) admission diagnosis of heart failure or (5) chronic obstructive pulmonary disease. The analytic sample included 739 intervention patients, 1182 controls. Through hospital visits and 30 days of post-discharge telephone outreach, PNs provided coaching and assistance with medications, appointments, transportation, communication with primary care, and self-care. Primary outcomes: (1) hospital-based utilization, a composite of ED visits and hospital admissions; (2) hospital admissions; (3) ED visits; and (4) outpatient visits. We evaluated outcomes following an index discharge, stratified by patient age (≥ 60 and < 60 years), using a 180-day time frame divided into six 30-day periods. The PN program produced starkly different outcomes by patient age. Among older PN patients, hospital-based utilization was consistently lower than controls, producing an 18.7% cumulative decrease at 180 days (p = 0.038); outpatient visits increased in the critical first 30-day period (p = 0.006). Among younger PN patients, hospital-based utilization was 31.7% (p = 0.038) higher at 180 days, largely reflecting sharply higher utilization in the initial 30 days (p = 0.002), with non-significant changes thereafter; outpatient visits experienced no significant changes. A PN program serving high-risk safety-net patients differentially impacted patients based on age, and among younger patients, outcomes varied over

Using length of stay data from a hospital to evaluate whether limiting elective surgery at the hospital is an inappropriate decision.

PubMed

Dexter, Franklin; Lubarsky, David A

2004-09-01

At hospitals without detailed managerial accounting data but with overall longer than average diagnosis-related groups (DRG)-adjusted lengths of stays (LOS), some administrators do not aggressively hire the nurses needed to maintain surgical hospital capacity. The consequence of this (long-term) decision is that day-of-surgery admit cases are delayed or cancelled from a lack of beds. The anesthesiologists suffer financially. In this paper, we show how publicly released national LOS data can be applied specifically to these cases. We applied the method to 1 year of data from two academic hospitals. Each case's LOS was compared to the United States national average LOS for cases with the same DRG. A total of 8,050 and 10,099 hospitalizations, respectively. Among all surgical admissions, mean LOS was 2.5 days longer than the national average for Hospital #1 (95% confidence interval [CI], 2.1 to 2.8) and 3.1 days longer for Hospital #2 (95% CI, 2.8 to 3.4). Among patients undergoing elective, scheduled surgery with day of surgery admission, mean LOS was 0.7 days less than average for Hospital #1 (0.6 to 0.9) and 1.2 days less than average for Hospital #2 (1.1 to 1.4). This method can be used by anesthesiologists to show that LOS are not longer than average among patients whose surgeries may be cancelled or delayed for a lack of hospital ward staff.

An administrative claims model for profiling hospital 30-day mortality rates for pneumonia patients.

PubMed

Bratzler, Dale W; Normand, Sharon-Lise T; Wang, Yun; O'Donnell, Walter J; Metersky, Mark; Han, Lein F; Rapp, Michael T; Krumholz, Harlan M

2011-04-12

Outcome measures for patients hospitalized with pneumonia may complement process measures in characterizing quality of care. We sought to develop and validate a hierarchical regression model using Medicare claims data that produces hospital-level, risk-standardized 30-day mortality rates useful for public reporting for patients hospitalized with pneumonia. Retrospective study of fee-for-service Medicare beneficiaries age 66 years and older with a principal discharge diagnosis of pneumonia. Candidate risk-adjustment variables included patient demographics, administrative diagnosis codes from the index hospitalization, and all inpatient and outpatient encounters from the year before admission. The model derivation cohort included 224,608 pneumonia cases admitted to 4,664 hospitals in 2000, and validation cohorts included cases from each of years 1998-2003. We compared model-derived state-level standardized mortality estimates with medical record-derived state-level standardized mortality estimates using data from the Medicare National Pneumonia Project on 50,858 patients hospitalized from 1998-2001. The final model included 31 variables and had an area under the Receiver Operating Characteristic curve of 0.72. In each administrative claims validation cohort, model fit was similar to the derivation cohort. The distribution of standardized mortality rates among hospitals ranged from 13.0% to 23.7%, with 25(th), 50(th), and 75(th) percentiles of 16.5%, 17.4%, and 18.3%, respectively. Comparing model-derived risk-standardized state mortality rates with medical record-derived estimates, the correlation coefficient was 0.86 (Standard Error = 0.032). An administrative claims-based model for profiling hospitals for pneumonia mortality performs consistently over several years and produces hospital estimates close to those using a medical record model.

Association between use of pre-hospital ECG and 30-day mortality: A large cohort study of patients experiencing chest pain.

PubMed

Rawshani, Nina; Rawshani, Araz; Gelang, Carita; Herlitz, Johan; Bång, Angela; Andersson, Jan-Otto; Gellerstedt, Martin

2017-12-01

In the assessment of patients with chest pain, there is support for the use of pre-hospital ECG in the literature and in the care guidelines. Using propensity score methods, we aim to examine whether the mere acquisition of a pre-hospital ECG among patients with chest pain affects the outcome (30-day mortality). The association between pre-hospital ECG and 30-day mortality was studied in the overall cohort (n=13151), as well as in the one-to-one matched cohort with 2524 patients not examined with pre-hospital ECG and 2524 patients examined with pre-hospital ECG. In the overall cohort, 21% (n=2809) did not undergo an ECG tracing in the pre-hospital setting. Among those who had pain during transport, 14% (n=1159) did not undergo a pre-hospital ECG while 32% (n=1135) of those who did not have pain underwent an ECG tracing. In the overall cohort, the OR for 30-day mortality in patients who had a pre-hospital ECG, as compared with those who did not, was 0.63 (95% CI 0.05-0.79; p<0.001). In the matched cohort, the OR was 0.65 (95% CI 0.49-0.85; p<0.001). Using the propensity score, in the overall cohort, the corresponding HR was 0.65 (95% CI 0.58-0.74). Using propensity score methods, we provide real-world data demonstrating that the adjusted risk of death was considerably lower among the cases in whoma pre-hospital ECG was used. The PH-ECG is underused among patients with chest discomfort and the mere acquisition of a pre-hospital ECG may reduce mortality. Copyright © 2017 Elsevier B.V. All rights reserved.

A Hospital Level Analysis of 30-Day Readmission Performance for Heart Failure Patients and Long-Term Survival: Findings from Get With The Guidelines-Heart Failure.

PubMed

Jalnapurkar, Sawan; Zhao, Xin; Heidenreich, Paul A; Bhatt, Deepak L; Smith, Eric E; DeVore, Adam D; Hernandez, Adrian F; Matsouaka, Roland; Yancy, Clyde W; Fonarow, Gregg C

2018-06-01

Medicare utilizes 30-day risk-standardized readmission rates (RSRR) as a measure of hospital quality and applies penalties based on this measure. The objective of this study was to identify the relationship between hospital performance on 30-day RSRR in heart failure (HF) patients and long-term patient survival. Data were collected from Get With The Guidelines (GWTG)-HF and linked with Medicare data. Based on hospital performance for 30-day RSRR, hospitals were grouped into performance quartiles: top 25% (N=11,181), 25-50% (N=10,367), 50-75% (N=8729), and bottom 25% (N=7180). The primary outcome was mortality at 3 years applying Cox proportional hazards regression adjusted for patient and hospital characteristics. The overall 30-day readmission rate was 19.8% and the 3-year mortality rates were 61.8%, 61.0%, 62.6%, and 59.9% for top 25%, 25-50%, 50-75%, and bottom 25% hospitals for 30-day RSRR performance, respectively. Compared to bottom 25% performing hospitals, adjusted hazard ratios (HR) for 3-year mortality were HR 0.96 (95% confidence interval [CI] 0.90-1.01), HR 0.89 (95% CI 0.84-0.94), HR 1.01 (95% CI 0.95-1.06) for the top 25%, 25-50% and 50-75% hospitals respectively. Median survival time was highest for the bottom 25% hospitals on the 30-day RSRR metric. Hospital performance on 30-day readmissions in HF has no or little association with risk adjusted 3-year mortality or median survival. There is a compelling need to utilize more meaningful and patient-centered outcome measures for reporting and incentivizing quality care for HF. Copyright © 2018 Elsevier Inc. All rights reserved.

The Contribution of Ageing to Hospitalisation Days in Hong Kong: A Decomposition Analysis.

PubMed

Kwok, Chi Leung; Lee, Carmen Km; Lo, William Tl; Yip, Paul Sf

2016-08-17

Ageing has become a serious challenge in Hong Kong and globally. It has serious implications for health expenditure, which accounts for nearly 20% of overall government expenditure. Here we assess the contribution of ageing and related factors to hospitalisation days in Hong Kong. We used hospital discharge data from all publicly funded hospitals in Hong Kong between 2001 and 2012. A decomposition method was used to examine the factors that account for the change of total hospitalisation days during the two periods, 2001-2004 and 2004-2012. The five factors include two demographic factors - population size and age-gender composition - and three service components - hospital discharge rate, number of discharge episodes per patient, and average length of stay (LOS) - which are all measured at age-gender group level. In order to assess the health cost burden in the future, we also project the total hospitalisation days up to 2041, for a range of scenarios. During the decreasing period of hospitalisation days (2001-2004), the reduction of LOS contributed to about 60% of the reduction. For the period of increase (2004-2012), ageing is associated with an increase in total hospitalisation days of 1.03 million, followed by an increase in hospital discharge rates (0.67 million), an increase in the number of discharge episodes per patient (0.62 million), and population growth (0.43 million). The reduction of LOS has greatly offset these increases (-2.19 million days), and has become one of the most significant factors in containing the increasing number of hospitalisation days. Projected increases in total hospitalisation days under different scenarios have highlighted that the contribution of ageing will become even more prominent after 2022. Hong Kong is facing increasing healthcare burden caused by the rapid increase in demand for inpatient services due to ageing. Better management of inpatient services with the aim of increasing efficiency and reducing LOS, avoidable

Lack of Evidence for Racial Disparity in 30-Day All-Cause Readmission Rate for Older US Veterans Hospitalized with Heart Failure.

PubMed

Kheirbek, Raya Elfadel; Wojtusiak, Janusz; Vlaicu, Sorina O; Alemi, Farrokh

Heart failure is the leading cause for 30-day all-cause readmission. Although racial disparities in health care are well documented, their impact on 30-day all-cause readmission rate is inconclusive. We examined the impact of racial disparity on 30-day readmission for hospitalized patients with heart failure. This is a retrospective secondary data analysis for a large veteran cohort in 130 Veterans Affairs Medical Centers. Propensity scores were used to reduce differences in age, gender, survival days, and comorbidities in index hospitalization among 46 524 whites and 14 124 African Americans (AA). At index hospitalization, AA patients were younger (73.04 vs 67.10 years, t = -54.58, P < .000) and less likely to have myocardial infarcts (8.02% vs 9.80%, t = -6.36, P = .000), peripheral vascular disease (15.25% vs 22.51%, t = -18.68, P = .000), chronic obstructive pulmonary disease (39.59% vs 50.05%, t = -21.89, P < .000), and complicated diabetes (23.42% vs 26.24%, t = -6.73, P = .000). AA patients had lower mortality 30 days post-index hospitalization (3.51% vs 5.69%, t = -10.23, P = .000). In contrast, AA patients were more likely to have renal disease (44.03% vs 38.71%, t = 11.32, P < .000) and HIV/AIDS (1.56% vs 0.20%, t = 19.71, P < .000). The 30-day all-cause readmission rate before adjustments was 17.82% for AA patients versus 18.72% for white patients. There was no difference in the 2 rates after adjustments (18% vs 18%; odds of readmission = 1.002, z = 0.08, P = .937). In a large Department of Veterans Affairs (VA) cohort, white and AA veterans hospitalized for heart failure had similar 30-day all-cause readmission rates after adjustments were made for age, gender, survival days, and comorbidities. However, the 30-day all-cause mortality rate was higher for white patients than for AA patients. Future prospective studies are needed to validate results and test generalizability outside the VA system of care.

Causes and Temporal Patterns of 30-Day Readmission Among Older Adults Hospitalized With Heart Failure With Preserved or Reduced Ejection Fraction.

PubMed

Goyal, Parag; Loop, Matthew; Chen, Ligong; Brown, Todd M; Durant, Raegan W; Safford, Monika M; Levitan, Emily B

2018-04-23

It is unknown whether causes and temporal patterns of 30-day readmission vary between heart failure (HF) with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF). We sought to address this question by examining a 5% national sample of Medicare beneficiaries. We included individuals who experienced a hospitalization for HFpEF or HFrEF between 2007 and 2013. We identified causes of 30-day readmission based on primary discharge diagnosis and further classified causes of readmission as HF-related, non-HF cardiovascular-related, and non-cardiovascular-related. We calculated the cumulative incidence of these classifications for HFpEF and HFrEF in a competing risks model and calculated subdistribution hazard ratios of these classifications by comparing those with HFpEF and those with HFrEF. Among 60 640 Medicare beneficiaries, we identified 13 785 unique older adults hospitalized with HFpEF and 15 205 who were hospitalized with HFrEF. Noncardiovascular diagnoses represented the most common causes of 30-day readmission (HFpEF: 59%; HFrEF: 47%), a pattern that was observed for each week of the 30-day study period for both HFpEF and HFrEF participants. In comparing readmission diagnoses in an adjusted model, non-cardiovascular-related diagnoses were more common and HF-related diagnoses were less common in HFpEF participants. Non-cardiovascular-related diagnoses represented the most common causes of 30-day readmission following HF hospitalization for each week of the 30-day postdischarge period. HF diagnoses were less common among those with HFpEF compared with HFrEF. Future interventions aimed at reducing 30-day readmissions following an HF hospitalization would benefit from an increased focus on noncardiovascular comorbidity and interventions that target HFpEF and HFrEF separately. © 2018 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.

Disposition at Discharge and 60-Day Mortality among Elderly People Following Shorter Hospital Stays: A Population-Based Comparison.

ERIC Educational Resources Information Center

Leibson, Cynthia; And Others

1990-01-01

Examination of hospitalizations for 5,854 elderly adults for 1980, 1985, and 1987 revealed significant increases in 60-day mortality and nursing home transfers after Medicare's Prospective Payment System began and hospital stays were shortened. Increases were largely explained by differences in risk factors other than length of stay (age, gender,…

Prevalence of malnutrition and associated factors among hospitalized elderly patients in King Abdulaziz University Hospital, Jeddah, Saudi Arabia.

PubMed

Alzahrani, Sami H; Alamri, Sultan H

2017-07-03

Malnutrition is a nutritional disorder that adversely affects the body from a functional or clinical perspective. It is very often observed in the elderly population. This study aimed to estimate the prevalence of malnutrition among hospitalized elderly patients and its associated factors and outcomes in terms of length of stay and mortality in King Abdulaziz University Hospital, Jeddah, Saudi Arabia. In a cross-sectional study, we evaluated the nutritional status of hospitalized elderly patients using the most recent version of the short form of Mini Nutritional Assessment (MNA-SF). A total of 248 hospitalized patients were included (70.0 ± 7.7 years; 60% female). According to the MNA-SF, a total of 76.6% patients were either malnourished or at risk of malnutrition. Malnourished patients had significantly lower levels of serum albumin (28.2 ± 7.7), hemoglobin (10.5 ± 1.8), and lymphocyte (1.7 ± 0.91). They had increased tendency to stay in the hospital for longer durations (IQR, 5-11 days; median = 7 days) and had a mortality rate of 6.9%. Malnutrition was highly prevalent among hospitalized elderly and was associated with increased length of stay and mortality.

Predicting all-cause risk of 30-day hospital readmission using artificial neural networks

PubMed Central

2017-01-01

Avoidable hospital readmissions not only contribute to the high costs of healthcare in the US, but also have an impact on the quality of care for patients. Large scale adoption of Electronic Health Records (EHR) has created the opportunity to proactively identify patients with high risk of hospital readmission, and apply effective interventions to mitigate that risk. To that end, in the past, numerous machine-learning models have been employed to predict the risk of 30-day hospital readmission. However, the need for an accurate and real-time predictive model, suitable for hospital setting applications still exists. Here, using data from more than 300,000 hospital stays in California from Sutter Health’s EHR system, we built and tested an artificial neural network (NN) model based on Google’s TensorFlow library. Through comparison with other traditional and non-traditional models, we demonstrated that neural networks are great candidates to capture the complexity and interdependency of various data fields in EHRs. LACE, the current industry standard, showed a precision (PPV) of 0.20 in identifying high-risk patients in our database. In contrast, our NN model yielded a PPV of 0.24, which is a 20% improvement over LACE. Additionally, we discussed the predictive power of Social Determinants of Health (SDoH) data, and presented a simple cost analysis to assist hospitalists in implementing helpful and cost-effective post-discharge interventions. PMID:28708848

Outpatient and Inpatient Single-Level Cervical Total Disc Replacement: A Comparison of 30-day Outcomes.

PubMed

Segal, Dale N; Wilson, Jacob M; Staley, Christopher; Yoon, Tim S

2018-06-11

Retrospective cohort study. To compare 30-day postoperative outcomes between patients undergoing outpatient and inpatient single-level cervical total disc replacement surgery. Cervical total disc replacement (TDR) is a motion sparing treatment for cervical radiculopathy and myelopathy. It is an alternative to anterior cervical discectomy and fusion (ACDF) with a similar complication rate. Like ACDF, it may be performed in the inpatient or outpatient setting. Efforts to reduce healthcare costs are driving spine surgery to be performed in the outpatient setting. As cervical total disc replacement surgery continues to gain popularity, the safety of treating patients on an outpatient basis needs to be validated. The National Surgical Quality Improvement Program (NSQIP) database was queried for patients who underwent single-level cervical disc replacement surgery between 2006-2015. Complication data including 30-day complications, reoperation rate, readmission rate, and length of stay data was compared between the inpatient and outpatient cohort using univariate analysis. There were 531 (34.2%) patients treated as outpatients and 1,022 (65.8%) were treated on an inpatient basis. The two groups had similar baseline characteristics. The overall 30-day complication rate was 1.4% for inpatients and 0.6% for outpatients. Reoperation rate was 0.6% for inpatient and 0.4% for outpatients. Readmission rate was 0.9% and 0.8% for inpatient and outpatient, respectively. There were no statistical differences identified in rates of readmission, reoperation, or complication between the inpatient and outpatient cohorts. There was no difference between 30-day complications, readmission and reoperation rates between inpatients and outpatients who underwent a single-level cervical total disc replacement. Furthermore, the overall 30-day complication rates were low. This study supports that single-level cervical TDR can be performed safely in an outpatient setting. 3.

The impact of hemodialysis schedules on the day of the week of hospitalization for cardiovascular and infectious diseases, over a period of 20 years

PubMed Central

Banshodani, Masataka; Fukuma, Shingo; Moriishi, Misaki; Shintaku, Sadanori; Tsuchiya, Shinichiro

2017-01-01

There have been no studies as yet that have evaluated how hemodialysis (HD) schedules affect the day of the week of hospitalization for cardiovascular diseases (CVDs) and infectious diseases (IDs), over a period of time. Herein, we performed a retrospective observational cohort study (1995–2014) evaluating 11,111 hospitalizations in 1,953 patients with end-stage renal disease, receiving HD 3 times a week (following either a Monday-Wednesday-Friday [MWF] schedule or a Tuesday-Thursday-Saturday [TTS] schedule) or receiving frequent HD (FHD) at least 4 times a week. Overall, hospitalization rates for CVDs and IDs were the highest on Monday in the MWF schedule and Tuesday in the TTS schedule compared to the average rates for all the days of the week. When generalized estimating equations (GEEs) were used in conjunction with robust variance estimators of each type of CVD, the risk for pulmonary edema was found to be significantly higher on Sunday and Monday in the MWF schedule and Monday and Tuesday in the TTS schedule. For both cerebrovascular and ischemic heart disease, the risks were significantly higher on Tuesday in the MWF schedule and Wednesday in the TTS schedule. Moreover, there were significant differences in the day of the week risks among the various CVD types. On trend analysis, the overall hospitalization rate for CVDs on the first HD day did not decrease (P = 0.2); however, the hospitalization rate for IDs on the first HD day significantly decreased (P = 0.02) over a span of 20 years. When GEEs were used in the case of FHD patients with severe heart failure, the hospitalization rate on the first HD day (Monday) significantly decreased after FHD initiation (P = 0.04). It was found that HD schedules affected the day of the week of hospitalization for CVDs. FHD may lower the day of the week risk. PMID:28700621

Home-Based versus Hospital-Based Rehabilitation Program after Total Knee Replacement

PubMed Central

López-Liria, Remedios; Padilla-Góngora, David; Catalan-Matamoros, Daniel; Rocamora-Pérez, Patricia; Pérez-de la Cruz, Sagrario; Fernández-Sánchez, Manuel

2015-01-01

Objectives. To compare home-based rehabilitation with the standard hospital rehabilitation in terms of improving knee joint mobility and recovery of muscle strength and function in patients after a total knee replacement. Materials and Methods. A non-randomised controlled trial was conducted. Seventy-eight patients with a prosthetic knee were included in the study and allocated to either a home-based or hospital-based rehabilitation programme. Treatment included various exercises to restore strength and joint mobility and to improve patients' functional capacity. The primary outcome of the trial was the treatment effectiveness measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Results. The groups did not significantly differ in the leg side (right/left) or clinical characteristics (P > 0.05). After the intervention, both groups showed significant improvements (P < 0.001) from the baseline values in the level of pain (visual analogue scale), the range of flexion-extension motion and muscle strength, disability (Barthel and WOMAC indices), balance, and walking. Conclusions. This study reveals that the rehabilitation treatments offered either at home or in hospital settings are equally effective. PMID:25961017

Hospital-Level Variation in Practice Patterns and Patient Outcomes for Pediatric Patients Hospitalized With Functional Constipation.

PubMed

Librizzi, Jamie; Flores, Samuel; Morse, Keith; Kelleher, Kelly; Carter, Jodi; Bode, Ryan

2017-06-01

Constipation is a common pediatric condition with a prevalence of 3% to 5% in children aged 4 to 17 years. Currently, there are no evidence-based guidelines for the management of pediatric patients hospitalized with constipation. The primary objective was to evaluate practice patterns and patient outcomes for the hospital management of functional constipation in US children's hospitals. We conducted a multicenter, retrospective cohort study of children aged 0 to 18 years hospitalized for functional constipation from 2012 to 2014 by using the Pediatric Health Information System. Patients were included by using constipation and other related diagnoses as classified by International Classification of Diseases, Ninth Revision . Patients with complex chronic conditions were excluded. Outcome measures included percentage of hospitalizations due to functional constipation, therapies used, length of stay, and 90-day readmission rates. Statistical analysis included means with 95% confidence intervals for individual hospital outcomes. A total of 14 243 hospitalizations were included, representing 12 804 unique patients. The overall percentage of hospitalizations due to functional constipation was 0.65% (range: 0.19%-1.41%, P < .0001). The percentage of patients receiving the following treatment during their hospitalization included: electrolyte laxatives: 40% to 96%; sodium phosphate enema: 0% to 64%; mineral oil enema: 0% to 61%; glycerin suppository: 0% to 37%; bisacodyl 0% to 47%; senna: 0% to 23%; and docusate 0% to 11%. Mean length of stay was 1.97 days (range: 1.31-2.73 days, P < .0001). Mean 90-day readmission rate was 3.78% (range: 0.95%-7.53%, P < .0001). There is significant variation in practice patterns and clinical outcomes for pediatric patients hospitalized with functional constipation across US children's hospitals. Collaborative initiatives to adopt evidence-based best practices guidelines could help standardize the hospital management of pediatric

An Administrative Claims Model for Profiling Hospital 30-Day Mortality Rates for Pneumonia Patients

PubMed Central

Bratzler, Dale W.; Normand, Sharon-Lise T.; Wang, Yun; O'Donnell, Walter J.; Metersky, Mark; Han, Lein F.; Rapp, Michael T.; Krumholz, Harlan M.

2011-01-01

Background Outcome measures for patients hospitalized with pneumonia may complement process measures in characterizing quality of care. We sought to develop and validate a hierarchical regression model using Medicare claims data that produces hospital-level, risk-standardized 30-day mortality rates useful for public reporting for patients hospitalized with pneumonia. Methodology/Principal Findings Retrospective study of fee-for-service Medicare beneficiaries age 66 years and older with a principal discharge diagnosis of pneumonia. Candidate risk-adjustment variables included patient demographics, administrative diagnosis codes from the index hospitalization, and all inpatient and outpatient encounters from the year before admission. The model derivation cohort included 224,608 pneumonia cases admitted to 4,664 hospitals in 2000, and validation cohorts included cases from each of years 1998–2003. We compared model-derived state-level standardized mortality estimates with medical record-derived state-level standardized mortality estimates using data from the Medicare National Pneumonia Project on 50,858 patients hospitalized from 1998–2001. The final model included 31 variables and had an area under the Receiver Operating Characteristic curve of 0.72. In each administrative claims validation cohort, model fit was similar to the derivation cohort. The distribution of standardized mortality rates among hospitals ranged from 13.0% to 23.7%, with 25th, 50th, and 75th percentiles of 16.5%, 17.4%, and 18.3%, respectively. Comparing model-derived risk-standardized state mortality rates with medical record-derived estimates, the correlation coefficient was 0.86 (Standard Error = 0.032). Conclusions/Significance An administrative claims-based model for profiling hospitals for pneumonia mortality performs consistently over several years and produces hospital estimates close to those using a medical record model. PMID:21532758

Discharge Processes and 30-Day Readmission Rates of Patients Hospitalized for Heart Failure on General Medicine and Cardiology Services.

PubMed

Salata, Brian M; Sterling, Madeline R; Beecy, Ashley N; Ullal, Ajayram V; Jones, Erica C; Horn, Evelyn M; Goyal, Parag

2018-05-01

Given high rates of heart failure (HF) hospitalizations and widespread adoption of the hospitalist model, patients with HF are often cared for on General Medicine (GM) services. Differences in discharge processes and 30-day readmission rates between patients on GM and those on Cardiology during the contemporary hospitalist era are unknown. The present study compared discharge processes and 30-day readmission rates of patients with HF admitted on GM services and those on Cardiology services. We retrospectively studied 926 patients discharged home after HF hospitalization. The primary outcome was 30-day all-cause readmission after discharge from index hospitalization. Although 60% of patients with HF were admitted to Cardiology services, 40% were admitted to GM services. Prevalence of cardiovascular and noncardiovascular co-morbidities were similar between patients admitted to GM services and Cardiology services. Discharge summaries for patients on GM services were less likely to have reassessments of ejection fraction, new study results, weights, discharge vital signs, discharge physical examinations, and scheduled follow-up cardiologist appointments. In a multivariable regression analysis, patients on GM services were more likely to experience 30-day readmissions compared with those on Cardiology services (odds ratio 1.43 95% confidence interval [1.05 to 1.96], p = 0.02). In conclusion, outcomes are better among those admitted to Cardiology services, signaling the need for studies and interventions focusing on noncardiology hospital providers that care for patients with HF. Copyright © 2018 Elsevier Inc. All rights reserved.

Customizing national models for a medical center's population to rapidly identify patients at high risk of 30-day all-cause hospital readmission following a heart failure hospitalization.

PubMed

Cox, Zachary L; Lai, Pikki; Lewis, Connie M; Lindenfeld, JoAnn; Collins, Sean P; Lenihan, Daniel J

2018-05-28

Nationally-derived models predicting 30-day readmissions following heart failure (HF) hospitalizations yield insufficient discrimination for institutional use. Develop a customized readmission risk model from Medicare-employed and institutionally-customized risk factors and compare the performance against national models in a medical center. Medicare patients age ≥ 65 years hospitalized for HF (n = 1,454) were studied in a derivation cohort and in a separate validation cohort (n = 243). All 30-day hospital readmissions were documented. The primary outcome was risk discrimination (c-statistic) compared to national models. A customized model demonstrated improved discrimination (c-statistic 0.72; 95% CI 0.69 - 0.74) compared to national models (c-statistics of 0.60 and 0.61) with a c-statistic of 0.63 in the validation cohort. Compared to national models, a customized model demonstrated superior readmission risk profiling by distinguishing a high-risk (38.3%) from a low-risk (9.4%) quartile. A customized model improved readmission risk discrimination from HF hospitalizations compared to national models. Copyright © 2018 Elsevier Inc. All rights reserved.

Laparoscopic approach for total cystectomy in treating hepatic cystic echinococcosis

PubMed Central

Li, Haitao; Shao, Yingmei; Aji, Tuerganaili; Zhang, Jinhui; Kashif, Kafayat; Ma, Qinglong; Ran, Bo; Wen, Hao

2014-01-01

Background: The laparoscopic approach has been proposed for treating hepatic cystic echinococcosis (HCE) and has already been used in clinical practice, mostly for non-radical operations. In this study, we aimed to evaluate the feasibility of total cystectomy of HCE under laparoscopy (LS). Results: A retrospective review of the medical records obtained from 22 patients diagnosed with HCE between June 2009 and June 2013 and treated with an LS approach was conducted in the First Affiliated Hospital of Xinjiang Medical University. A total of 15 patients underwent total cystectomy of HCE using LS. The average time of surgery was 174 min (160–210 min). Intraoperative bleeding was 103 mL (80–200 mL). The mean duration of hospitalization was 7 days (6–15 days). Seven patients were transferred to open surgery (OS). For these patients, the average duration of surgery was 177 min (150–230 min). Intraoperative bleeding was 237 mL (160–350 mL), and the mean duration of hospitalization was 10 days (8–15 days). The most frequent postoperative complications were hydrops in the surgical area (two cases in LS and three cases in OS), and temporary bile leakage (one patient in the LS group). Recurrence was not seen in any cases in either group with a follow-up of 6–12 months. Conclusions: Total cystectomy of HCE appears to be safe and effective in selected patients with unique, small-sized, superficially located cysts. To establish precise recommendations about the technique and its indications, prospective studies are necessary. PMID:25489977

Autologous blood transfusion in total knee replacement surgery.

PubMed

Sarkanović, Mirka Lukić; Gvozdenović, Ljiljana; Savić, Dragan; Ilić, Miroslav P; Jovanović, Gordana

2013-03-01

Total knee replacement (TKR) surgery is one of the most frequent and the most extensive procedures in orthopedic surgery, accompanied with some serious complications. Perioperative blood loss is one of the most serious losses, so it is vital to recognize and treat such losses properly. Autologous blood transfusion is the only true alternative for the allogeneic blood. The aim of this study was to to examine if autologous blood transfusion reduces usage of allogenic blood in total knee replacement surgery, as well as to examine possible effect of autologous blood transfusion on postoperative complications, recovery and hospital stay of patients after total knee replacement surgery. During the controlled, prospective, randomised study we compared two groups of patients (n = 112) with total prosthesis implanted in their knee. The group I consisted of the patients who received the transfusion of other people's (allogeneic) blood (n = 57) and the group II of the patients whose blood was collected postoperatively and then given them [their own (autologous) blood] (n = 55). The transfusion trigger for both groups was hemoglobin level of 85 g/L. In the group of patients whose blood was collected perioperatively only 9 (0.9%) of the patients received transfusion of allogeneic blood, as opposed to the control group in which 98.24% of the patients received the transfusion of allogeneic blood (p < or = 0.01). The patients whose blood was collected stayed in hospital for 6.18 days, while the patients of the control group stayed 7.67 days (p < 0.01). Autologous blood transfusion is a very effective method for reducing consumption of allogenic blood and thus, indirectly for reducing all complications related to allogenic blood transfusion. There is also a positive influence on postoperative recovery after total knee replacement surgery due to the reduction of hospital stay, and indirectly on the reduction of hospital costs.

Associations of selected lower urinary tract symptoms with biographical context in patients of a day hospital for neurotic disorders.

PubMed

Skalski, Michał; Sobański, Jerzy A; Golabek, Tomasz; Świerkosz, Agata; Klasa, Katarzyna; Przydacz, Mikołaj; Rutkowski, Krzysztof; Dembińska, Edyta; Mielimąka, Michał; Cyranka, Katarzyna; Chłosta, Piotr; Dudek, Dominika

2016-12-23

To assess the correlation of subjectively estimated biographical context and lower urinary tract symptoms reported by patients with neurotic and personality disorders. This was a retrospective analysis of the biographical context of co-existence of urinary frequency and urinary incontinence reported by 3,929 patients in a day hospital for treatment of neurotic disorders. The symptom checklists KO "0" were completed by patients prior to any treatment. Urinary frequency reported by patients in a day hospital for treatment of neurotic disorders was associated with the difficulties from their childhood and adolescence (i.e. with perception of inferiority with regard to one's family and among siblings, parents' low education level), as well as the disparities in terms of sexual education and troubled relationships. In the studied group of patients with neurotic and personality disorders, selected lower urinary tract symptoms were associated with adverse life circumstances from childhood and adolescence (which can show the tendency towards regression and protracted character to experience of family's dysfunction due to feeling of being neglected or abandoned), as well as, to a larger or a smaller degree, their consequences - dysfunctions in adulthood, relationship/marriage, functioning at work and dealing with finances. These associations indicated the probable significance of experiencing these aspects of life in patients, not only in day hospitals or psychiatric hospitals which reported "pseudo-urological complaints", but also in at least part of urological patients - going to hospitals due to neurotic disorders, particularly those occurring in a somatic form.

Ninety-day mortality after resection for lung cancer is nearly double 30-day mortality.

PubMed

Pezzi, Christopher M; Mallin, Katherine; Mendez, Andres Samayoa; Greer Gay, Emmelle; Putnam, Joe B

2014-11-01

To evaluate 30-day and 90-day mortality after major pulmonary resection for lung cancer including the relationship to hospital volume. Major lung resections from 2007 to 2011 were identified in the National Cancer Data Base. Mortality was compared according to annual volume and demographic and clinical covariates using univariate and multivariable analyses, and included information on comorbidity. Statistical significance (P<.05) and 95% confidence intervals were assessed. There were 124,418 major pulmonary resections identified in 1233 facilities. The 30-day mortality rate was 2.8%. The 90-day mortality rate was 5.4%. Hospital volume was significantly associated with 30-day mortality, with a mortality rate of 3.7% for volumes less than 10, and 1.7% for volumes of 90 or more. Other variables significantly associated with 30-day mortality include older age, male sex, higher stage, pneumonectomy, a previous primary cancer, and multiple comorbidities. Similar results were found for 90-day mortality rates. In the multivariate analysis, hospital volume remained significant with adjusted odds ratios of 2.1 (95% confidence interval [CI], 1.7-2.6) for 30-day mortality and 1.3 (95% CI, 1.1-1.6) for conditional 90-day mortality for the hospitals with the lowest volume (<10) compared with those with the highest volume (>90). Hospitals with a volume less than 30 had an adjusted odds ratio for 30-day mortality of 1.3 (95% CI, 1.2-1.5) compared with those with a volume greater than 30. Mortality at 30 and 90 days and hospital volume should be monitored by institutions performing major pulmonary resection and benchmarked against hospitals performing at least 30 resections per year. Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Unhealthy alcohol use in older adults: Association with readmissions and emergency department use in the 30 days after hospital discharge☆

PubMed Central

Chavez, Laura J.; Liu, Chuan-Fen; Tefft, Nathan; Hebert, Paul L; Clark, Brendan J.; Rubinsky, Anna D.; Lapham, Gwen T.; Bradley, Katharine A.

2016-01-01

Background Unhealthy alcohol use could impair recovery of older patients after medical or surgical hospitalizations. However, no prior research has evaluated whether older patients who screen positive for unhealthy alcohol use are at increased risk of readmissions or emergency department (ED) visits within 30 days after discharge. This study examined the association between AUDIT-C alcohol screening results and 30-day readmissions or ED visits. Methods Veterans Affairs (VA) patients age 65 years or older, were eligible if they were hospitalized for a medical or surgical condition (2/1/2009–10/1/2011) and had an AUDIT-C score documented in their VA electronic medical record in the year before they were hospitalized. VA and Medicare data identified VA or non-VA index hospitalizations, readmissions, and ED visits. Primary analyses adjusted for demographics, comorbid conditions, and past-year health care utilization. Results Among 579,330 hospitalized patients, 13.7% were readmitted and 12.0% visited an ED within 30 days of discharge. In primary analyses, high-risk drinking (n = 7167) and nondrinking (n =357,086) were associated with increased probability of readmission (13.8%, 95% CI 13.0–14.6%; and 14.2%, 95% CI 14.1–14.3%, respectively), relative to low-risk drinking (12.9%; 95% CI 12.7–13.0%). Only nondrinkers had increased risk for ED visits. Conclusions Alcohol screening results indicating high-risk drinking that were available in medical records were modestly associated with risk for 30-day readmissions and were not associated with risk for ED visits. PMID:26644137

Are neurotic personality traits and neurotic symptoms intensity associated with suicidal thoughts reported by patients of a day hospital for neurotic disorders?

PubMed

Sobański, Jerzy A; Cyranka, Katarzyna; Rodziński, Paweł; Klasa, Katarzyna; Rutkowski, Krzysztof; Dembińska, Edyta; Mielimąka, Michał; Müldner-Nieckowski, Łukasz; Smiatek-Mazgaj, Bogna

2015-01-01

Analysis of prevalence and intensity of suicidal thoughts and their associations with neurotic personality traits as well as neurotic symptoms intensity in patients participating in qualification for hospitalization in a day hospital for treatment of neurotic and behavioral disorders. The results of Symptom Checklist KO"0", Neurotic Personality Questionnaire KON-2006 and Life Inventory of 1063 patients (739 women and 324 men), admitted to psychotherapy in a day hospital because of neurotic, behavioral and personality disorders. In the population of patients coming for treatment in the day hospital, the presence of suicidal ideations (SI) was common (reaching one-third of the respondents) and was regardless of the respondents'gender associated with significantly higher global symptom level (OWK) and significantly greater global neurotic personality disintegration (XKON) as well as significantly higher values of most of the neurotic personality inventory scales. None of the neurotic personality traits reduced the risk of suicidal ideation nor was associated with low SI arduousness. Day hospital patients reporting SI are a subgroup burdened with more severe neurotic disorders and comorbid personality disorders. Thus, the persons reporting in symptom questionnaires willingness to take one's own life, although relatively frequently encountered, deserve special attention due to the greater severity of their symptoms.

Association of a Bundled Hospital-at-Home and 30-Day Postacute Transitional Care Program With Clinical Outcomes and Patient Experiences.

PubMed

Federman, Alex D; Soones, Tacara; DeCherrie, Linda V; Leff, Bruce; Siu, Albert L

2018-06-25

Hospital-at-home (HaH) care provides acute hospital-level care in a patient's home as a substitute for traditional inpatient care. In September 2017, the Physician-Focused Payment Model Technical Advisory Committee recommended implementation of an alternative payment model for a new model of HaH that bundles the acute episode with 30 days of postacute transitional care. To report outcomes of this new payment model for HaH care. Case-control study of HaH care patients with a concurrent control group of hospital inpatients recruited from emergency departments (EDs) and residences in New York City from November 18, 2014, to August 31, 2017. HaH patients were 18 years or older with fee-for-service Medicare and acute medical illness requiring inpatient-level care. Control patients met HaH eligibility but refused participation or were seen in the ED when a HaH admission could not be initiated. HaH care or inpatient care. Primary outcomes were acute period length of stay (LOS), all-cause 30-day hospital readmissions and ED visits, admissions to skilled nursing facilities (SNFs), referral to a certified home health care agency, and patient experiences with care. Analyses accounted for nonrandom selection using inverse probability weighting. Among the 507 patients enrolled (mean [SD] age, 74.6 [15.7] years; 68.6% women), data were available on all patients 30 days postdischarge. HaH patients (n = 295) were older than controls (n = 212) and more likely to have a preacute functional impairment. HaH patients had shorter LOS (3.2 days vs 5.5 days; difference, -2.3 days; 95% CI, -1.8 to -2.7 days; weighted P < .001); lower rates of readmissions (8.6% [25] vs 15.6% [32]; difference, -7.0%; 95% CI, -12.9% to -1.1%; weighted P < .001), ED revisits (5.8% [17] vs 11.7% [24]; difference, -5.9%; 95% CI, -11.0% to -0.7%; weighted P < .001), and SNF admissions (1.7% [5] vs 10.4% [22]; difference, -8.7%; 95% CI, -13.0% to -4.3%; weighted P < .001); and were also

Breakfast Dietary Patterns among Mexican Children Are Related to Total-Day Diet Quality.

PubMed

Afeiche, Myriam C; Taillie, Lindsey Smith; Hopkins, Sinead; Eldridge, Alison L; Popkin, Barry M

2017-03-01

Background: Mexico has experienced shifts in food availability and consumption patterns over the past few decades from traditional diets to those containing more high-energy density foods, resulting in the development of unhealthful dietary patterns among children and adults. However, to our knowledge it is not known whether breakfast consumption patterns contribute to the overall daily diet of Mexican children. Objective: We examined total-day diet among breakfast consumers compared with breakfast skippers, identified and investigated breakfast dietary patterns in relation to energy and nutrient intakes at breakfast and across the day, and examined these patterns in relation to sociodemographic characteristics. Methods: With the use of nationally representative dietary data (one 24-h recall) from the 2012 Mexican National Health and Nutrition Survey, 3760 children aged 4-13 y were categorized into mutually exclusive breakfast patterns with the use of cluster analysis. The association between breakfast patterns and breakfast skippers with dietary intake at breakfast and for the total day was investigated with the use of multivariate linear regression. Results: Most children (83%) consumed breakfast. Six breakfast dietary patterns were identified (milk and sweetened breads, tortillas and beans, sweetened beverages, sandwiches and quesadillas, eggs, and cereal and milk) and reflected both traditional and more Westernized dietary patterns. Sugar-sweetened beverages were consumed across all patterns. Compared with all breakfast dietary patterns, breakfast skippers had the lowest intake of several nutrients of public health concern. Nutrients to limit that were high at breakfast tended to be high for the total day and vice versa for nutrients to encourage. Conclusions: There was not a single pattern that complied perfectly with the Mexican School Breakfast Guidelines, but changes such as increasing dietary fiber by encouraging more whole grains, fruits, vegetables, and

Association between health literacy and 30-day healthcare use after hospital discharge in the heart failure population.

PubMed

Cox, Sarah R; Liebl, Michael G; McComb, Meghan N; Chau, Jason Q; Wilson, Allison A; Achi, May; Garey, Kevin W; Wallace, David

Low health literacy increases the risk for hospital readmissions. Despite this, the measurement and use of health literacy to guide discharge counseling and planning in heart failure patients is not commonly performed. A short 3-Question Brief Health Literacy Screen (BHLS) is available and takes less than three minutes to complete, but has never been evaluated to help determine whether health literacy affects healthcare use after discharge in patients with heart failure. The purpose of this study was to assess 30-day readmissions and emergency department visits based on health literacy evaluated by the BHLS in an acute care heart failure population. This was a prospective observational cohort study conducted at a large quaternary health system. Hospitalized patients with a diagnosis of heart failure were assessed for health literacy using the BHLS. Unplanned healthcare use after discharge including 30-day, all-cause ED visits and hospital readmissions was assessed using univariate and logistic regression models. Two hundred and sixty four patients aged 66.6 ± 14.3 (mean ± SD) years met inclusion/exclusion criteria of whom 175 (66.3%) had a BHLS score >9 (adequate health literacy) and 89 (33.7%) had a BHLS score ≤9 (low health literacy). Predictors of low health literacy included older age (p = 0.019), lower education level (p < 0.001) and unemployed (p = 0.048). After controlling for potential confounders, low health literacy was independently associated with 30-day healthcare use after hospital discharge (OR:1.80; 95% CI: 1.04-3.11; p = 0.035). Using a short, 3-question validated survey instrument, it was demonstrated that low health literacy was associated with increased 30-day unplanned healthcare use after discharge in this heart failure population. These results provide a clinically useful, easily incorporated tool that could identify high-risk patients at need for clinical interventions. Copyright © 2016 Elsevier Inc. All rights reserved.

Can home care for homebound patients with chronic heart failure reduce hospitalizations and costs?

PubMed

Punchik, Boris; Komarov, Roman; Gavrikov, Dmitry; Semenov, Anna; Freud, Tamar; Kagan, Ella; Goldberg, Yury; Press, Yan

2017-01-01

Congestive heart failure (CHF), a common problem in adults, is associated with multiple hospitalizations, high mortality rates and high costs. To evaluate whether home care for homebound patients with CHF reduces healthcare service utilization and overall costs. A retrospective study of healthcare utilization among homebound patients who received home care for CHF from 2012-1015. The outcome measures were number of hospital admissions per month, total number of hospitalization days and days for CHF only, emergency room visits, and overall costs. A comparison was conducted between the 6-month period prior to entry into home care and the time in home care. Over the study period 196 patients were treated by home care for CHF with a mean age of 79.4±9.5 years. 113 (57.7%) were women. Compared to the six months prior to home care, there were statistically significant decreases in hospitalizations (46.3%), in the number of total in-hospital days (28.7%), in the number of in-hospital days for CHF (66.7%), in emergency room visits (47%), and in overall costs (23.9%). Home care for homebound adults with CHF can reduce healthcare utilization and healthcare costs.

Shopping around for hospital services: a comparison of the United States and Canada.

PubMed

Bell, C M; Crystal, M; Detsky, A S; Redelmeier, D A

1998-04-01

Historical comparisons indicate that US hospitals are more expensive than Canadian hospitals, but health care system reform might have changed the relative costs and timeliness of health care in the 2 countries. To estimate the price and convenience of selected hospital services in the United States and Canada for patients in 1997 had they paid out-of-pocket. Cross-sectional telephone survey conducted May 1996 to April 1997. The 2 largest acute care general hospitals from every city in the United States and Canada with a population greater than 500000. Each hospital was telephoned and asked their price and waiting time for 7 services: magnetic resonance imaging of the head without gadolinium; a screening mammogram; a 12-lead electrocardiogram; a prothrombin time measurement; a session of hemodialysis; a screening colonoscopy; and a total knee replacement. Waiting times were measured in days until earliest appointment and charges were converted to American currency. Overall, 48 US and 18 Canadian hospitals were surveyed. Median waiting times were significantly shorter in American hospitals for 4 services, particularly a magnetic resonance imaging of the head (3 days vs 150 days; P<.001). Median charges were significantly higher in American hospitals for 6 services, particularly for a total knee replacement ($26805 vs $10651; P<.001). Individual services showed no association between shorter waiting times and higher prices within each country, with the exception of a total knee replacement in the United States. US hospitals still provide higher prices and faster care than Canadian hospitals for patients who pay out-of-pocket.

Day hospital and psychosocial care center: Expanding the discussion of partial hospitalization in mental health.

PubMed

Weber, César Augusto Trinta; Juruena, Mario Francisco

2016-07-01

Since the second half of the twentieth century the discussions about mental patient care reveal ongoing debate between two health care paradigms: the biomedical/biopsychosocial paradigm and the psychosocial paradigm. The struggle for hegemony over the forms of care, on how to deal optimally with the experience of becoming ill is underpinned by an intentionality of reorganizing knowledge about the health/disease dichotomy, which is reflected in the models proposed for the implementation of actions and services for the promotion, prevention, care and rehabilitation of human health. To discuss the guidelines of care in mental health day hospitals (MHDH) in contrast to type III psychosocial care centers (CAPS III). Review of mental health legislation from 1990 to 2014. A definition of therapeutic project could not be found, as well as which activities and techniques should be employed by these health services. The MHDH and PCC III are services that replace psychiatric hospital admission and are characterized by their complementarity in the care to the mentally ill. Due to their varied and distinctive intervention methods, which operate synergistically, the contributions from both models of care are optimized. Discussions on the best mental health care model reveal polarization between the biomedical/biopsychosocial and psychosocial paradigms. This reflects the supremacy of the latter over the former in the political-ideological discourse that circumscribes the reform of psychiatric care, which may hinder a better clinical outcome for patients and their families.

Nutrition Status, Nutrition Support Therapy, and Food Intake are Related to Prolonged Hospital Stays in China: Results from the NutritionDay 2015 Survey.

PubMed

Zheng, Huijun; Huang, Yingchun; Shi, Yongmei; Chen, Wei; Yu, Jianchun; Wang, Xinying

2016-01-01

Malnutrition is a common and critical problem that greatly influences the clinical outcomes of hospitalized patients. Nutrition support therapy and food intake, in addition to disease-related factors, are also important to maintain the nutrition status of patients. In light of this, we aimed to examine the risk factors associated with malnutrition in 3 hospitals in China. This project was part of the NutritionDay audit, an international daylong cross-sectional audit investigating the nutritional intervention profiles of hospitalized patients. Seven standardized questionnaires were used, and malnutrition was defined as a body mass index <18.5 kg/m2 or unintentional weight loss >5% in last 3 months. A total of 842 hospitalized patients from 9 units in 3 Chinese hospitals participated in the project on November 19, 2015. Among them, 825 were included in the analyses. Malnutrition was identified in 29.3% of the patients and oral nutrition was the primary nutrition support therapy administered (n = 623, 75.6%). Age, nutrition support, and food intake during the past week were independent risk factors for malnutrition. Furthermore, nutrition status, nutrition support therapy, and food intake during the past week were associated with prolonged length of stay. The prevalence of malnutrition in Chinese hospitals was similar to that in European hospitals. Nutrition status was associated with age, nutrition support, and food intake, which was closely related to patients' clinical outcome, such as prolonged hospital stays as confirmed in this study. More studies are needed to determine why nutrition intake is often inadequate and to determine efficient methods for correcting the nutrition status of patients. © 2016 S. Karger AG, Basel.

Hospital Outbreaks of Middle East Respiratory Syndrome, Daejeon, South Korea, 2015

PubMed Central

Park, Jung Wan; Lee, Keon Joo; Lee, Kang Hyoung; Lee, Sang Hyup; Cho, Jung Rae; Mo, Jin Won; Choi, Soo Young; Kwon, Geun Yong; Shin, Ji-Yeon; Hong, Jee Young; Kim, Jin; Yeon, Mi-Yeon; Oh, Jong Seok

2017-01-01

From May through July 2015, a total of 26 cases of Middle East Respiratory Syndrome were reported from 2 hospitals in Daejeon, South Korea, including 1 index case and 25 new cases. We examined the epidemiologic features of these cases and found an estimated median incubation period of 6.1 days (8.8 days in hospital A and 4.6 days in hospital B). The overall attack rate was 3.7% (4.7% in hospital A and 3.0% in hospital B), and the attack rates among inpatients and caregivers in the same ward were 12.3% and 22.5%, respectively. The overall case-fatality rate was 44.0% (28.6% in hospital A and 63.6% in hospital B). The use of cohort quarantine may have played a role in preventing community spread, but additional transmission occurred among members of the hospital cohort quarantined together. Caregivers may have contributed in part to the transmission. PMID:28516865

Factors Associated With Length of Stay and 30-Day Revisits in Pediatric Acute Pancreatitis.

PubMed

Gay, Anna C; Barreto, Nicolas; Schrager, Sheree M; Russell, Christopher J

2018-05-30

Identify factors associated with length of stay (LOS) and 30-day hospital revisit for patients hospitalized with acute pancreatitis (AP). Multicenter, retrospective cohort study using the Pediatric Health Information System database. Multilevel linear and logistic regression was used to identify factors independently associated with the primary outcome variables of LOS and 30-day hospital revisit in children aged 1-18 years discharged with a primary discharge diagnosis of AP from participating hospitals between 2008 and 2013. For the 7693 discharges, median LOS was 4 days (interquartile range 3-7 days) and 30-day revisit rate 17.6% (n = 1356). Discharges were primarily female (55%), Caucasian (46%), and six years old or older (85%). On multilevel regression, factors independently associated with both longer LOS and higher revisit odds included malignant and gastrointestinal complex chronic conditions and total parenteral nutrition (TPN) use while hospitalized. Male gender was associated with both lower LOS (aLOS = -0.6 days, 95% CI = -0.8, -0.4) and decreased revisit odds (aOR 0.85; 95% CI = 0.74, 0.97). Hispanic ethnicity was associated with increased LOS (aLOS = +0.8 days, 95% CI = +0.5, +1.1) but no change in revisit odds. Certain demographic and clinical factors, including gender, ethnicity, and type of complex chronic condition, were independently associated with LOS and risk of 30-day hospital revisit for pediatric AP. Children with malignant and gastrointestinal complex chronic conditions who require TPN are at highest risk for both longer LOS and hospital revisit when admitted with AP. These patient populations may benefit from intensive care coordination when hospitalized for AP.

EARNINGS MANAGEMENT IN U.S. HOSPITALS.

PubMed

Dong, Gang Nathan

2016-01-01

This paper examines the hospital management practices of manipulating financial earnings within the bounds of generally accepted accounting principles (GAAP). We conduct regression analyses that relate earnings management to hospital characteristics to assess the economic determinants of hospital earnings management behavior. From the CMS Cost Reports we collected hospital financial data of all U.S. hospitals that request reimbursement from the federal government for treating Medicare patients, and regress discretionary accruals on hospital size, profitability, asset liquidity, operating efficiency, labor cost, and ownership. Hospitals with higher profit margin, current ratio, working capital, days of patient receivables outstanding and total wage are associated with more earnings management, whereas those with larger size and higher debt level, asset turnover, days cash on hand, fixed asset age are associated with lower level of earnings manipulation. Additionally, managers of non-profit hospitals are more likely to undertake some form of window-dressing by manipulating accounting accruals without changing business models or pricing strategies than their public hospital counterparts. We provide direct evidence of the use of discretionary accruals to manage financial earnings among U.S. hospitals and the finding has profound policy implications in terms of assessing the pervasiveness of accounting manipulation and the overall integrity of financial reporting in this very special public and quasi-public service sector.

Quality standards in a rheumatology Day-Care Hospital Unit. The proposal of the Spanish Society of Rheumatology Day Hospitals' Working Group.

PubMed

García-Vicuña, Rosario; Montoro, María; Egües Dubuc, César Antonio; Bustabad Reyes, Sagrario; Gómez-Centeno, Antonio; Muñoz-Fernández, Santiago; Pérez Pampín, Eva; Román Ivorra, Jose Andrés; Balsa, Alejandro; Loza, Estíbaliz

2014-01-01

In recent years, the Rheumatology Day-Care Hospital Units (DHU have undergone extensive development. However, the quality standards are poorly documented and mainly limited to structure items rather than including broad and specific areas of this specialty. To develop specific quality standards for Rheumatology DHU. After a systematic review of the literature and related documents, a working group (WG) involving 8 DHU-experienced rheumatologists developed an initial proposal of the quality standards, under the supervision of an expert methodologist. A second round was held by the WG group to review the initial proposal and to consider further suggestions. Once the content was agreed upon by consensus, a final report was prepared. 17 structure standards, 25 process standards and 10 results standards were defined, with special emphasis on specific aspects of the Rheumatology DHU. The proposal includes: 1) essential standards to 2) excellent standards, 3) a Rheumatology DHU services portfolio and 4) performance criteria. The proposed quality standards are the basis for developing the indicators and other management tools for Rheumatology DHU, thereby ensuring a patient-oriented practice based on both the evidence and the experience. Copyright © 2013 Elsevier España, S.L.U. All rights reserved.

Technical efficiency of selected hospitals in Eastern Ethiopia.

PubMed

Ali, Murad; Debela, Megersa; Bamud, Tewfik

2017-12-01

This study examines the relative technical efficiency of 12 hospitals in Eastern Ethiopia. Using six-year-round panel data for the period between 2007/08 and 2012/13, this study examines the technical efficiency, total factor productivity, and determinants of the technical inefficiency of hospitals. Data envelopment analysis (DEA) and DEA- based Malmquist productivity index used to estimate relative technical efficiency, scale efficiency, and total factor productivity index of hospitals. Tobit model used to examine the determinants of the technical inefficiency of hospitals. The DEA Variable Returns to Scale (VRS) estimate indicated that 6 (50%), 5 (42%), 3 (25%), 3 (25%), 4 (33%), and 3 (25%) of the hospitals were technically inefficient while 9 (75%), 9 (75%), 7 (58%), 7 (58%), 7 (58%) and 8 (67%) of hospitals were scale inefficient between 2007/08 and 2012/13, respectively. On average, Malmquist Total Factor Productivity (MTFP) of the hospitals decreased by 3.6% over the panel period. The Tobit model shows that teaching hospital is less efficiency than other hospitals. The Tobit regression model further shows that medical doctor to total staff ratio, the proportion of outpatient visit to inpatient days, and the proportion of inpatients treated per medical doctor were negatively related with technical inefficiency of hospitals. Hence, policy interventions that help utilize excess capacity of hospitals, increase doctor to other staff ratio, and standardize number of inpatients treated per doctor would contribute to the improvement of the technical efficiency of hospitals.

Heat and moisture exchanger use reduces in-hospital complications following total laryngectomy: a case-control study.

PubMed

Foreman, A; De Santis, R J; Sultanov, F; Enepekides, D J; Higgins, K M

2016-07-07

Total laryngectomy (TL) is an appropriate oncologic operation for many patients with laryngeal cancer delivering excellent oncologic outcomes, however it remains beset with significant functional consequences. Following TL, the upper and lower airways are permanently disconnected, which causes unfiltered, cold air with reduced humidity to enter the tracheobronchial tree, resulting in mucus overproduction and an increase in the viscosity of the mucus. In response to this, Heat and moisture exchangers were developed to compensate for the lost functions of the upper respiratory tract and their effect on the patients' respiratory performance in addition to their quality of life. The case records of 48 patients undergoing total laryngectomy were reviewed and data concerning demographics, surgical details, post-operative care requirements and adverse events was retrieved. Post hoc analysis of the case patients was undertaken to identify any benefit of using a heat and moisture exchanger (HME) system with particular reference to post-operative respiratory outcomes. There was no significant difference between case and control subjects based on demographics, extent of surgery or need for flap repair. 16 patients had used a HME and 32 patients had used external humidification (EH). Of those experiencing mucous plugging, only 3/24 (12.5 %) had used a HME system, in contrast to 21/24 (87.5 %) who used EH (Chi square = 9.375, p = 0.002). The odds ratio of having an adverse event if not using HME was 8.27 (CI = 1.94 - 35.71). Use of HME also significantly reduced the number of days requiring physiotherapy (1.75 days vs. 3.20 days, p = 0.034). Use of an HME system can reduce in-hospital complications, in particular episodes of mucus plugging, and post-operative care requirements. Furthermore, there is a cost benefit to using HME systems that warrants more widespread introduction of these devices in head and neck surgery centers.

Low Diagnostic Utility of Rechecking Hemoglobins Within 24 Hours in Hospitalized Patients.

PubMed

Rajkomar, Alvin; McCulloch, Charles E; Fang, Margaret C

2016-11-01

Clinicians often repeat hemoglobin tests within a 24 hour period to detect or monitor anemia. We sought to determine the percentage of hemoglobin tests repeated within a single hospital day that were at least 1.0 g/dL lower than the first test. We performed a retrospective cross-sectional analysis of hospitalized adults on medical or surgical services over 1 year at a single academic hospital. Using patient and laboratory data in the electronic health record, we analyzed the proportion of repeated hemoglobin test results that were at least 1 g/dL less than the initial hemoglobin value of that day, excluding days when transfusions were administered. A total of 88,722 hemoglobin tests were obtained from 12,877 unique patients, who contributed a total of 86,859 hospitalization days. In 12,230 (14.1%) of those days, 2 or more hemoglobin tests were obtained within a single day. In the 6969 days with 2 hemoglobin tests obtained and no transfusions given, 949 (13.5%) were ≥1 g/dL lower than the initial hemoglobin value of that day, and 260 (3.7%) were ≥2 g/dL lower. Repeated tests did not often reach transfusion thresholds: 482 (6.9%) of repeat hemoglobin values were <8 g/dL, and 64 (0.9%) were <7 g/dL. Hemoglobin tests were repeated in 14% of hospital days. For patients who had 2 hemoglobin tests obtained on the same day, 13.5% demonstrated a clinically significant drop. This information may be helpful to clinicians when considering whether repeat testing is appropriate. Copyright © 2016 Elsevier Inc. All rights reserved.

Days of heroin use predict poor self-reported health in hospitalized heroin users

PubMed Central

Meshesha, Lidia Z.; Tsui, Judith I.; Liebschutz, Jane M.; Crooks, Denise; Anderson, Bradley J.; Herman, Debra S.; Stein, Michael D.

2013-01-01

This study examined associations between substance use behaviors and self-reported health among hospitalized heroin users. Of the 112 participants, 53 (47%) reported good or better health. In multivariable logistic regression models, each day of heroin use in the last month was associated with an 8% lower odds of reporting health as good or better (OR=.92; 95%CI 0.87, 0.97, p < .05). Cocaine, cannabis, cigarettes, alcohol use, unintentional overdose, nor injection drug use were associated with health status. PMID:24045030

Start-up of a Cardiology Day Hospital: Activity, Quality Care and Cost-effectiveness Analysis of the First Year of Operation.

PubMed

Gallego-Delgado, María; Villacorta, Eduardo; Valenzuela-Vicente, M Carmen; Walias-Sánchez, Ángela; Ávila, Carmen; Velasco-Cañedo, M Jesús; Cano-Mozo, M Teresa; Martín-García, Agustín; García-Sánchez, María Jesús; Sánchez, Argelina; Cascón, Manuel; Sánchez, Pedro L

2018-05-21

The cardiology day hospital (CDH) is an alternative to hospitalization for scheduled cardiological procedures. The aims of this study were to analyze the activity, quality of care and the cost-effectiveness of a CDH. An observational descriptive study was conducted of the health care activity during the first year of operation of DHHA. The quality of care was analyzed through the substitution rate (outpatient procedures), cancellation rates, complications, and a satisfaction survey. For cost-effectiveness, we calculated the economic savings of avoided hospital stays. A total of 1646 patients were attended (mean age 69 ± 15 years, 60% men); 2550 procedures were scheduled with a cancellation rate of 4%. The most frequently cancelled procedure was electrical cardioversion. The substitution rate for scheduled invasive procedures was 66%. Only 1 patient required readmission after discharge from the CDH due to heart failure. Most surveyed patients (95%) considered the care received in the CDH to be good or very good. The saving due to outpatient-converted procedures made possible by the CDH was € 219 199.55, higher than the cost of the first year of operation. In our center, the CDH allowed more than two thirds of the invasive procedures to be performed on an outpatient basis, while maintaining the quality of care. In the first year of operation, the expenses due to its implementation were offset by a significant reduction in hospital admissions. Copyright © 2018 Sociedad Española de Cardiología. Published by Elsevier España, S.L.U. All rights reserved.

The management pattern carried out in a cataract surgery day ward.

PubMed

Lin, Jing; Fang, Xiaoqun; Wu, Suhong

2013-06-01

To evaluate the management practice and process of a cataract surgery day ward. From January to December in 2012, a portion of the cataract patients were evaluated for the pattern of day ward management. Methods were as follows: 1) Establish the cataract day ward. 2) Enroll the patients who met the following criteria: voluntary, local residents or outsiders who stayed in a hotel near the hospital, accompanied by family, and who had simple senile cataract without any systemic major diseases. 3) Establish the hospitalization process. 4) Analyze the nursing process. After cataract day surgery, the patients were followed for 2 hours and completed a questionnaire about their needs and sentiments. A total of 3971 cases were observed in this study; 49 cases were switched to a normal pattern of hospitalization because of operative complications, 1 case had a strong desire to switch to a normal pattern of hospitalization because of ocular discomfort, 8 cases went back to the hospital for treatment because of ocular pain, and 52 cases called on the phone to seek help. Overall, 3820 cases(96.2%) returned on time the next day to visit the doctor. No patients showed severe postoperative complications and 98% expressed great satisfaction with the day ward process. Only 200 cases expressed great concern about not knowing how to deal with postoperative pain, the changes in condition outside the hospital, the therapeutic effects, and the problem of expense reimburse-ment. Day ward cataract surgery is an efficient and safe mode, and has the potential to relieve the demand for inpatient beds and to ensure timely treatment of the patients. In addition, it helps the patients enjoy health care at public expense, reserving reimbursement for those who need to be hospitalized. Nurses should pay more attention to systemic evaluation of the patients, health education, and psychological guidance, and keep in close communication with doctors, which is the key to ensure the safety of day ward

Analysis of steps adapted protocol in cardiac rehabilitation in the hospital phase.

PubMed

Winkelmann, Eliane Roseli; Dallazen, Fernanda; Bronzatti, Angela Beerbaum Steinke; Lorenzoni, Juliara Cristina Werner; Windmöller, Pollyana

2015-01-01

To analyze a cardiac rehabilitation adapted protocol in physical therapy during the postoperative hospital phase of cardiac surgery in a service of high complexity, in aspects regarded to complications and mortality prevalence and hospitalization days. This is an observational cross-sectional, retrospective and analytical study performed by investigating 99 patients who underwent cardiac surgery for coronary artery bypass graft, heart valve replacement or a combination of both. Step program adapted for rehabilitation after cardiac surgery was analyzed under the command of the physiotherapy professional team. In average, a patient stays for two days in the Intensive Care Unit and three to four days in the hospital room, totalizing six days of hospitalization. Fatalities occurred in a higher percentage during hospitalization (5.1%) and up to two years period (8.6%) when compared to 30 days after hospital discharge (1.1%). Among the postoperative complications, the hemodynamic (63.4%) and respiratory (42.6%) were the most prevalent. 36-42% of complications occurred between the immediate postoperative period and the second postoperative day. The hospital discharge started from the fifth postoperative day. We can observe that in each following day, the patients are evolving in achieving the Steps, where Step 3 was the most used during the rehabilitation phase I. This evolution program by steps can to guide the physical rehabilitation at the hospital in patients after cardiac surgery.

The health of irregular and illegal immigrants: analysis of day-hospital admissions in a department of migration medicine.

PubMed

Affronti, Mario; Affronti, Andrea; Pagano, Salvatore; Soresi, Maurizio; Giannitrapani, Lydia; Valenti, Miriam; La Spada, Emanuele; Montalto, Giuseppe

2013-10-01

It is difficult to trace full details of the path which irregular or illegal immigrants follow when seeking assistance in the network of the various hospital departments and health structures. The aim of this work was to analyze the health needs of immigrant people by reviewing the types of treatment given to them in the day-hospital of our Department of Migration Medicine. Our study analyzed day-hospital admissions between 2003 and 2009. The patient charts used for managing day-hospital activity were adopted in 2002 in conformity with the "OSI project". From these it is possible to draw up a scale picture of the distribution of each pathology in the immigrant population. The sample population consisted of 1,758 subjects, representing 7.4% of potential users. More than half came from Africa, followed by Asia, and then Europe. Gastroenterological diseases ranked first, with dyspeptic syndromes most frequently diagnosed. Infections and parasitic diseases ranked second, and the most frequent diagnoses were sexually transmitted diseases. Third were diseases of the genitourinary system. Metabolic disorders ranked fourth, among them, more than half of the cases were of diabetes mellitus, in patients from south-east Asia. Diseases of the circulatory system were sixth, with hypertension the most frequent pathology. Our data confirm a marked persistence of the phenomenon known as the "healthy immigrant effect" in these types of patients, as well as the prominent role played by "social determinants" in conditioning the health of immigrants, particularly in the case of some infectious diseases.

Evaluation of days of total collection and use of internal markers in nutritional trials with small ruminants.

PubMed

da Teixeira, Catarine S C; de Carvalho, Gleidson G P; Nicory, Isis C M; Santos, Aracele V; Dos Pina, Douglas S; de Júnior, José E F; de Araújo, Maria L G M L; de Rufino, Luana M A; Cirne, Luís G A; Pires, Aureliano J V

2018-04-01

Two experiments were conducted to evaluate the number of days required for total fecal collection and the viability of using the indigestible dry matter (iDM), indigestible neutral detergent fiber (iNDF), and indigestible acid detergent fiber (iADF) internal markers to determine the fecal excretion of dry matter (FEDM) and digestibility in nutritional trials with small ruminants. Eight sheep in the first experiment and eight goats in the second experiment were distributed into two 4 × 4 Latin square designs. There were no significant differences between days of total fecal collection for FEDM; digestibility of dry matter (DM), organic matter (OM), crude protein (CP), ether extract (EE), neutral detergent fiber corrected for ash and protein (NDFap), and non-fibrous carbohydrates corrected for ash and protein (NFCap); and total digestible nutrients (TDN) in both species. The results suggest that only 1 day of total collection is sufficient to obtain the FEDM and the digestibility of the nutritional components in sheep and goats. The markers are efficient in determining fecal production and digestibility in these animal species.

Age-Related Differences in the Rate, Timing, and Diagnosis of 30-Day Readmissions in Hospitalized Adults With Asthma Exacerbation.

PubMed

Hasegawa, Kohei; Gibo, Koichiro; Tsugawa, Yusuke; Shimada, Yuichi J; Camargo, Carlos A

2016-04-01

Reducing hospital readmissions has attracted attention from many stakeholders. However, the characteristics of 30-day readmissions after asthma-related hospital admissions in adults are not known. It is also unclear whether older adults are at higher risk of 30-day readmission. To investigate the rate, timing, and principal diagnosis of 30-day readmissions in adults with asthma and to determine age-related differences. Retrospective cohort study of adults hospitalized for asthma exacerbation using the population-based inpatient samples of three states (California, Florida, and Nebraska) from 2005 through 2011. Patients were categorized into three age groups: younger (18-39 years), middle aged (40-64 years), and older (≥ 65 years) adults. Outcomes were 30-day all-cause readmission rate, timing, and principal diagnosis of readmission. Of 301,164 asthma-related admissions at risk for 30-day readmission, readmission rate was 14.5%. Compared with younger adults, older adults had significantly higher readmission rates (10.1% vs 16.5%; OR, 2.15 [95% CI, 2.07-2.23]; P < .001). The higher rate attenuated with adjustment (OR, 1.19 [95% CI, 1.13-1.26]; P < .001), indicating that most of the age-related difference is explained by sociodemographics and comorbidities. For all age groups, readmission rate was highest in the first week after discharge and declined thereafter. Overall, only 47.1% of readmissions were assigned respiratory diagnoses (asthma, COPD, pneumonia, and respiratory failure). Older adults were more likely to present with nonrespiratory diagnoses (41.7% vs 53.8%; P < .001). After asthma-related admission, 14.5% of patients had 30-day readmission with wide range of principal diagnoses. Compared with younger adults, older adults had higher 30-day readmission rates and proportions of nonrespiratory diagnoses. Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

Determinants of the direct cost of heart failure hospitalization in a public tertiary hospital.

PubMed

Parissis, John; Athanasakis, Kostas; Farmakis, Dimitrios; Boubouchairopoulou, Nadia; Mareti, Christina; Bistola, Vasiliki; Ikonomidis, Ignatios; Kyriopoulos, John; Filippatos, Gerasimos; Lekakis, John

2015-02-01

Heart failure (HF) is the first reason for hospital admission in the elderly and represents a major financial burden, the greatest part of which results from hospitalization costs. We sought to analyze current HF hospitalization-related expenditure and identify predictors of cost in a public tertiary hospital in Europe. We performed a retrospective chart review of 197 consecutive patients, aged 56±16years, 80% male, with left ventricular ejection fraction (LVEF) of 30±10%, hospitalized for HF in a major university hospital in Athens, Greece. The survey involved the number of hospitalization days, laboratory investigations and medical therapies. Patients who were hospitalized in CCU/ICU or underwent interventional procedures or device implantations were excluded from analysis. Costs were estimated based on the Greek healthcare system perspective in 2013. Patients were hospitalized for a median of 7 days with a total direct cost of €3198±3260/patient. The largest part of the expenses (79%) was attributed to hospitalization (ward), while laboratory investigations and medical treatment accounted for 17% and 4%, respectively. In multivariate analysis, pre-admission New York Heart Association NYHA class (p=0.001), serum creatinine (p=0.003) and NT-proBNP (p=0.004) were significant independent predictors of hospitalization cost. Direct cost of HF hospitalization is high particularly in patients with more severe symptoms, profound neurohormonal activation and renal dysfunction. Strategies to lower hospitalization rates are warranted in the current setting of financial constraints faced by many European countries. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Day hospital treatment for people with severe mental illness according to users' perspectives: what helps and what hinders recovery?

PubMed

Agrest, Martín; Barruti, Silvina; Gabriel, Raquel; Zalazar, Virginia; Wikinski, Silvia; Ardila-Gómez, Sara

2018-02-01

Scarce information is available about how users experience treatment at mental health day hospitals, particularly in South America. To explore users' perspectives about elements of day hospital treatment that facilitate or hinder the recovery process in a mental health facility in Buenos Aires, Argentina. Semi-structured individual interviews (n = 8) and focus groups (n = 4) were carried out with a convenience sample of users of a mental health day hospital program based on a formulation, testing and redevelopment of propositions approach. Results were analyzed through grounded theory techniques. Categories indicating recovery were: starting to do things, being able to see themselves from a new perspective, mood improvement and changes in interpersonal relationships. Aspects facilitating recovery were: activities organized by the facility, the group approach, the care provided by facility workers and the physical environment. Hindering aspects were: heterogeneity of users in terms of age, severity, diagnosis and being underestimated by staff. Being active again was considered to be the main recovery indicator in this cultural context and participating in activities led by skilled facilitators was the most beneficial factor of the program according to the users.

Hospital Nursing and 30-Day Readmissions among Medicare Patients with Heart Failure, Acute Myocardial Infarction, and Pneumonia

PubMed Central

McHugh, Matthew D.; Ma, Chenjuan

2013-01-01

Background Provisions of the Affordable Care Act that increase hospitals’ financial accountability for preventable readmissions have heightened interest in identifying system-level interventions to reduce readmissions. Objectives To determine the relationship between hospital nursing; i.e. nurse work environment, nurse staffing levels, and nurse education, and 30-day readmissions among Medicare patients with heart failure, acute myocardial infarction, and pneumonia. Method and Design Analysis of linked data from California, New Jersey, and Pennsylvania that included information on the organization of hospital nursing (i.e., work environment, patient-to-nurse ratios, and proportion of nurses holding a BSN degree) from a survey of nurses, as well as patient discharge data, and American Hospital Association Annual Survey data. Robust logistic regression was used to estimate the relationship between nursing factors and 30-day readmission. Results Nearly one-quarter of heart failure index admissions (23.3% [n=39,954]); 19.1% (n=12,131) of myocardial infarction admissions; and 17.8% (n=25,169) of pneumonia admissions were readmitted within 30-days. Each additional patient per nurse in the average nurse’s workload was associated with a 7% higher odds of readmission for heart failure (OR=1.07, [1.05–1.09]), 6% for pneumonia patients (OR=1.06, [1.03–1.09]), and 9% for myocardial infarction patients (OR=1.09, [1.05–1.13]). Care in a hospital with a good versus poor work environment was associated with odds of readmission that were 7% lower for heart failure (OR = 0.93, [0.89–0.97]); 6% lower for myocardial infarction (OR = 0.94, [0.88–0.98]); and 10% lower for pneumonia (OR = 0.90, [0.85–0.96]) patients. Conclusions Improving nurses’ work environments and staffing may be effective interventions for preventing readmissions. PMID:23151591

Return-on-Investment (ROI) Analyses of an Inpatient Lay Health Worker Model on 30-Day Readmission Rates in a Rural Community Hospital.

PubMed

Cardarelli, Roberto; Bausch, Gregory; Murdock, Joan; Chyatte, Michelle Renee

2017-07-07

The purpose of the study was to assess the return-on-investment (ROI) of an inpatient lay health worker (LHW) model in a rural Appalachian community hospital impacting 30-day readmission rates. The Bridges to Home (BTH) study completed an evaluation in 2015 of an inpatient LHW model in a rural Kentucky hospital that demonstrated a reduction in 30-day readmission rates by 47.7% compared to a baseline period. Using the hospital's utilization and financial data, a validated ROI calculator specific to care transition programs was used to assess the ROI of the BTH model comparing 3 types of payment models including Diagnosis Related Group (DRG)-only payments, pay-for-performance (P4P) contracts, and accountable care organizations (ACOs). The BTH program had a -$0.67 ROI if the hospital had only a DRG-based payment model. If the hospital had P4P contracts with payers and 0.1% of its annual operating revenue was at risk, the ROI increased to $7.03 for every $1 spent on the BTH program. However, if the hospital was an ACO as was the case for this study's community hospital, the ROI significantly increased to $38.48 for every $1 spent on the BTH program. The BTH model showed a viable ROI to be considered by community hospitals that are part of an ACO or P4P program. A LHW care transition model may be a cost-effective alternative for impacting excess 30-day readmissions and avoiding associated penalties for hospital systems with a value-based payment model. © 2017 National Rural Health Association.

Strategies that reduce 90-day readmissions and inpatient costs after liver transplantation.

PubMed

Zeidan, Joseph H; Levi, David M; Pierce, Ruth; Russo, Mark W

2018-04-25

Liver transplantation is hospital-resource intensive and associated with high rates of readmission. We have previously shown a reduction in 30-day readmission rates by implementing a specifically designed protocol to increase access to outpatient care. To determine if strategies that reduce 30-day readmission after liver transplant were effective in also reducing 90-day readmission rates and costs. A protocol was developed to reduce inpatient readmissions after liver transplant that expanded outpatient services and provided alternatives to readmission. The 90-day readmission rates and costs were compared before and implementing strategies outlined in the protocol. Multivariable analysis was used to control for potential confounding factors. Over the study period 304 adult primary liver transplants were performed on patients with a median biologic MELD of 22. 112 (37%) patients were readmitted within 90 days of transplant. The readmission rates before and after implementation of the protocol were 53% and 26% respectively, p<0.001. The most common reason for readmission was elevated liver tests/rejection (24%). In multivariable analysis, the protocol remained associated with avoiding readmission, OR=0.33, [95% CI 0.20,0.55], p<0.001. The median length of stay after transplant preprotocol and postprotocol was 8 and 7 days, respectively. A greater proportion of patients were discharged to hospital lodging post protocol, 10% versus 19%, p=0.03. 90-day readmissions costs were reduced by 55% but total 90 day costs by only 2.7% due to higher outpatient costs and index admission costs. 90-day readmission rates and readmission costs can be reduced by improving access to outpatient services and hospital local lodging. Total 90-day costs were similar between the two groups because of higher outpatient costs after the protocol was introduced. This article is protected by copyright. All rights reserved. © 2018 by the American Association for the Study of Liver Diseases.

Association between preoperative anaemia with length of hospital stay among patients undergoing primary total knee arthroplasty in Singapore: a single-centre retrospective study.

PubMed

Abdullah, Hairil Rizal; Sim, Yilin Eileen; Hao, Ying; Lin, Geng Yu; Liew, Geoffrey Haw Chieh; Lamoureux, Ecosse L; Tan, Mann Hong

2017-06-08

Studies in western healthcare settings suggest that preoperative anaemia is associated with poor outcomes after elective orthopaedic surgery. We investigated the prevalence of preoperative anaemia among patients with primary unilateral total knee arthroplasty (TKA) in Singapore and its association with length of hospital stay (LOS), perioperative blood transfusion and hospital readmission rates. Retrospective cohort study performed in a tertiary academic medical centre in Singapore, involving patients who underwent primary unilateral TKA between January 2013 and June 2014. Demographics, comorbidities, preoperative haemoglobin (Hb) level, LOS and 30-day readmission data were collected. Anaemia was classified according to WHO definition. Prolonged LOS was defined as more than 6 days, which corresponds to >75th centile LOS of the data. We analysed 2394 patients. The prevalence of anaemia was 23.7%. 403 patients (16.8%) had mild anaemia and 164 patients (6.8%) had moderate to severe anaemia. Overall mean LOS was 5.4±4.8 days. Based on multivariate logistic regression, preoperative anaemia significantly increased LOS (mild anaemia, adjusted OR (aOR) 1.71, p<0.001; moderate/severe anaemia, aOR 2.29, p<0.001). Similar effects were seen when preoperative anaemia was defined by Hb level below 13 g/dL, regardless of gender. Transfusion proportionately increased prolonged LOS (1 unit: aOR 2.12, p=0.006; 2 or more units: aOR 6.71, p<0.001). Repeat operation during hospital stay, previous cerebrovascular accidents, general anaesthesia and age >70 years were associated with prolonged LOS. Our 30-day related readmission rate was 1.7% (42) cases. Anaemia is common among patients undergoing elective TKA in Singapore and is independently associated with prolonged LOS and increased perioperative blood transfusion. We suggest measures to correct anaemia prior to surgery, including the use of non-gender-based Hb cut-off for establishing diagnosis. © Article author(s) (or their

A Comparison of Inpatient Cost Per Day in General Surgery Patients with Type 2 Diabetes Treated with Basal-Bolus versus Sliding Scale Insulin Regimens.

PubMed

Phillips, Victoria L; Byrd, Anwar L; Adeel, Saira; Peng, Limin; Smiley, Dawn D; Umpierrez, Guillermo E

2017-01-01

The identification of cost-effective glycaemic management strategies is critical to hospitals. Treatment with a basal-bolus insulin (BBI) regimen has been shown to result in better glycaemic control and fewer complications than sliding scale regular insulin (SSI) in general surgery patients with type 2 diabetes mellitus (T2DM), but the effect on costs is unknown. We conducted a post hoc analysis of the RABBIT Surgery trial to examine whether total inpatient costs per day for general surgery patients with T2DM treated with BBI ( n  = 103) differed from those for patients with T2DM treated with SSI ( n  = 99) regimens. Data were collected from patient clinical and hospital billing records. Charges were adjusted to reflect hospital costs. General linearized models were used to estimate the risk-adjusted effects of BBI versus SSI treatment on average total inpatient costs per day. Risk-adjusted average total inpatient costs per day were $US5404. Treatment with BBI compared with SSI reduced average total inpatient costs per day by $US751 (14%; 95% confidence interval [CI] 20-4). Being treated in a university medical centre, being African American or having a bowel procedure or higher-volume pharmacy use significantly reduced costs per day. In general surgery patients with T2DM, a BBI regimen significantly reduced average total hospital costs per day compared with an SSI regimen. BBI has been shown to improve outcomes in a randomized controlled trial. Those results, combined with our findings regarding savings, suggest that hospitals should consider adopting BBI regimens in patients with T2DM undergoing surgery.

Association Between Teaching Status and Mortality in US Hospitals

PubMed Central

Burke, Laura G.; Frakt, Austin B.; Khullar, Dhruv; Orav, E. John

2017-01-01

Importance Few studies have analyzed contemporary data on outcomes at US teaching hospitals vs nonteaching hospitals. Objective To examine risk-adjusted outcomes for patients admitted to teaching vs nonteaching hospitals across a broad range of medical and surgical conditions. Design, Setting, and Participants Use of national Medicare data to compare mortality rates in US teaching and nonteaching hospitals for all hospitalizations and for common medical and surgical conditions among Medicare beneficiaries 65 years and older. Exposures Hospital teaching status: major teaching hospitals (members of the Council of Teaching Hospitals), minor teaching hospitals (other hospitals with medical school affiliation), and nonteaching hospitals (remaining hospitals). Main Outcomes and Measures Primary outcome was 30-day mortality rate for all hospitalizations and for 15 common medical and 6 surgical conditions. Secondary outcomes included 30-day mortality stratified by hospital size and 7-day mortality and 90-day mortality for all hospitalizations as well as for individual medical and surgical conditions. Results The sample consisted of 21 451 824 total hospitalizations at 4483 hospitals, of which 250 (5.6%) were major teaching, 894 (19.9%) were minor teaching, and 3339 (74.3%) were nonteaching hospitals. Unadjusted 30-day mortality was 8.1% at major teaching hospitals, 9.2% at minor teaching hospitals, and 9.6% at nonteaching hospitals, with a 1.5% (95% CI, 1.3%-1.7%; P < .001) mortality difference between major teaching hospitals and nonteaching hospitals. After adjusting for patient and hospital characteristics, the same pattern persisted (8.3% mortality at major teaching vs 9.2% at minor teaching and 9.5% at nonteaching), but the difference in mortality between major and nonteaching hospitals was smaller (1.2% [95% CI, 1.0%-1.4%]; P < .001). After stratifying by hospital size, 187 large (≥400 beds) major teaching hospitals had lower adjusted overall 30-day

Analysis of Time-of-Day Energy Demand and Supply in University and Hospital

NASA Astrophysics Data System (ADS)

Shimazaki, Yoichi

The aim of this study was to estimate the time-of-day energy demand in University of Yamanashi. Our University consisted of Kofu campus (Faculty of Education & Human Sciences and Faculty of Engineering) and Faculty of Medicine campus (Faculty of Medicine and University Hospital). The energy data of 4 facilities were classified into hot water, heating, cooling and electric power demands based on electric power consumptions, city gas and heavy oil from 1996 to 2005. For 10 years, primary energy increased 1.2 times in the whole of the university. The amount of electric power consumption was 63% in the fuel classification. The amount of electric power consumption of faculty reacted to the change in temperature greatly. In 2005, it was found that thermoelectric-ratios for 4 facilities, i.e. Education, Engineering, Medicine and Hospital were 2.3, 1.5, 2.0 and 2.7 respectively. These data are very useful for the energy saving and energy management of university.

The Geriatric Day Hospital: Preliminary Data on an Innovative Model of Care in Brazil for Older Adults at Risk of Hospitalization.

PubMed

Aliberti, Márlon J R; Suemoto, Claudia K; Fortes-Filho, Sileno Q; Melo, Juliana A; Trindade, Carolina B; Kasai, Juliana Y T; Altona, Marcelo; Apolinario, Daniel; Jacob-Filho, Wilson

2016-10-01

Older adults have a greater risk of experiencing functional decline and iatrogenic complications during hospitalization than younger individuals. Geriatric day hospitals (GDHs) have been implemented mainly for rehabilitation. The goal of the current study was to expand the GDH spectrum of care to prevent hospital admissions in this population. This study details an innovative model of GDH care that offers short-term, nonrehabilitative treatment to older adults who have experienced an acute event, those with a decompensated chronic disease, or those in need of a minor procedure that would be unattainable in a regular outpatient setting. During the 6-hour visits made weekly for up to 2 months, participants receive integrated evaluations of their various health domains, education, and rapid access to examinations and procedures based on a multidisciplinary approach. In the first 6 years, 2,322 individuals attended the GDH. The analysis of a representative sample (n = 645) revealed that 81% were treated in the GDH without the need for another type of hospital care. This percentage was high for the different reasons for referral (infection, 71%; delirium, 73%; decompensated chronic disease, 81%). Between baseline and discharge, participants maintained their functional status, and their self-reported health improved. This study represents the first step in describing the role of the GDH as a possible alternative to emergency department use or hospitalization for older adults. Future studies are needed to determine the optimal individual for this model of care and to ensure its cost-effectiveness. © 2016, Copyright the Authors Journal compilation © 2016, The American Geriatrics Society.

Safety Profile during Initiation of Propranolol for Treatment of Infantile Hemangiomas in an Ambulatory Day-Care Hospitalization Setting.

PubMed

Fogel, Itay; Ollech, Ayelet; Zvulunov, Alex; Valdman-Greenshpon, Yulia; Atar-Sagie, Vered; Friedland, Rivka; Lapidoth, Moshe; Ben-Amitai, Dan

2018-03-24

Propranolol is the mainstay of treatment for infantile hemangioma. Despite its good safety profile, it is not risk-free. Guidelines for propranolol initiation and monitoring have been suggested, but protocols vary among practitioners. This study sought to assess the prevalence of adverse events and clinically significant fluctuations in hemodynamic parameters in children with infantile hemangioma during initiation of treatment with propranolol in a day-hospitalization setting. Children with infantile hemangioma treated with propranolol in a day-hospitalization department of a tertiary pediatric medical center in 2008-2014 were identified retrospectively. The pretreatment evaluation included clinical examination by a pediatric dermatologist and electrocardiography, echocardiography, and clinical examination by a pediatric cardiologist. The propranolol dosage was escalated from 0.5mg/kg/day to 2mg/kg/day, divided into 3 doses/day, over 3 days. Heart rate, blood pressure, and blood glucose level were measured before treatment onset and 60 min after the first two doses each day. The third dose was given at home. The cohort included 220 children aged 1 month to 5 years. No severe treatment-related adverse events were documented; 27 patients had minor side effects. There was a significant decrease in heart rate each day after the first two doses (p<0.001), and in systolic blood pressure, on day 2 (1mg/kg/day) after the first dose (p=0.01). Blood glucose level remained stable. The hemodynamic changes were clinically asymptomatic and did not require intervention. Propranolol treatment (2mg/kg/day in three doses) for infantile hemangioma is well tolerated and safe and may be administered and monitored in an ambulatory setting. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.

Is hospital teaching status a key factor in hospital charge for children with hip fractures?: preliminary findings from KID database.

PubMed

Gao, Yubo; Pugely, Andrew; Karam, Matthew; Phisitkul, Phinit; Mendoza, Sergio; Johnston, Richard C

2013-01-01

Proximal femur fractures cause significant pain and economic cost among pediatric patients. The purposes of this study were (a) to evaluate the distribution by hospital type (teaching hospital vs non-teaching hospital) of U.S. pediatric patients aged 1-20 years who were hospitalized with a closed hip fracture and (b) to discern the mean hospital charge and hospital length of stay after employing propensity score to reduce selection bias. The 2006 Healthcare Cost and Utilization Project (HCUP) Kids' Inpatient Database (KID) was queried for children aged up to 20 years that had principle diagnosis of hip fracture injury. Hip fractures were defined by International Classification of Diseases, 9th Revision, Clinical Modification codes 820.0, 820.2 and 820.8 under Section "Injury and Poisoning (800-999)" with principle internal fixation procedure codes 78.55, 79.15 and 79.35. Patient demographics and hospital status were presented and analyzed. Differences in mean hospital charge and hospital length of stay by hospital teaching status were assessed via two propensity score based methods. In total, 1,827 patients were nation-ally included for analysis: 1,392 (76.2%) were treated at a teaching hospital and 435 (23.8%) were treated at a non-teaching hospital. The average age of the patients was 12.88 years old in teaching hospitals vs 14.33 years old in nonteaching hospitals. The propensity score based adjustment method showed mean hospital charge was $34,779 in teaching hospitals and $32,891 in the non-teaching hospitals, but these differences were not significant (p=0.2940). Likewise, mean length of hospital stay was 4.1 days in teaching hospitals and 3.89 days in non-teaching hospitals, but these differences were also not significant (p=0.4220). Hospital teaching status did not affect length of stay or total hospital costs in children treated surgically for proximal femur fractures. Future research should be directed at identifying factors associated with variations in

North vs south differences in acute peptic ulcer hemorrhage in Croatia: hospitalization incidence trends, clinical features, and 30-day case fatality

PubMed Central

Ljubičić, Neven; Pavić, Tajana; Budimir, Ivan; Puljiz, Željko; Bišćanin, Alen; Bratanić, Andre; Nikolić, Marko; Hrabar, Davor; Troskot, Branko

2014-01-01

Aim To assess the seven-year trends of hospitalization incidence due to acute peptic ulcer hemorrhage (APUH) and associated risk factors, and examine the differences in these trends between two regions in Croatia. Methods The study collected sociodemographic, clinical, and endoscopic data on 2204 patients with endoscopically confirmed APUH who were admitted to the Clinical Hospital Center “Sestre Milosrdnice,” Zagreb and Clinical Hospital Center Split between January 1, 2005 and December 31, 2011. We determined hospitalization incidence rates, 30-day case fatality rate, clinical outcomes, and incidence-associated factors. Results No differences were observed in APUH hospitalization incidence rates between the regions. Age-standardized one-year cumulative APUH hospitalization incidence rate calculated using the European Standard Population was significantly higher in Zagreb than in Split region (43.2/100 000 vs 29.2/100,000). A significantly higher APUH hospitalization incidence rates were observed in the above 65 years age group. Overall 30-day case fatality rate was 4.9%. Conclusion The hospitalization incidence of APUH in two populations did not change over the observational period and it was significantly higher in the Zagreb region. The incidence of acute duodenal ulcer hemorrhage also remained unchanged, whereas the incidence of acute gastric ulcer hemorrhage increased. The results of this study allow us to monitor epidemiological indicators of APUH and compare data with other countries. PMID:25559836

Can home care for homebound patients with chronic heart failure reduce hospitalizations and costs?

PubMed Central

Punchik, Boris; Komarov, Roman; Gavrikov, Dmitry; Semenov, Anna; Freud, Tamar; Kagan, Ella; Goldberg, Yury

2017-01-01

Background Congestive heart failure (CHF), a common problem in adults, is associated with multiple hospitalizations, high mortality rates and high costs. Purpose To evaluate whether home care for homebound patients with CHF reduces healthcare service utilization and overall costs. Methods A retrospective study of healthcare utilization among homebound patients who received home care for CHF from 2012–1015. The outcome measures were number of hospital admissions per month, total number of hospitalization days and days for CHF only, emergency room visits, and overall costs. A comparison was conducted between the 6-month period prior to entry into home care and the time in home care. Results Over the study period 196 patients were treated by home care for CHF with a mean age of 79.4±9.5 years. 113 (57.7%) were women. Compared to the six months prior to home care, there were statistically significant decreases in hospitalizations (46.3%), in the number of total in-hospital days (28.7%), in the number of in-hospital days for CHF (66.7%), in emergency room visits (47%), and in overall costs (23.9%). Conclusion Home care for homebound adults with CHF can reduce healthcare utilization and healthcare costs. PMID:28753675

Risk of malnutrition of hospitalized children in a university public hospital.

PubMed

Muñoz-Esparza, Nelly Carolina; Vásquez-Garibay, Edgar Manuel; Romero-Velarde, Enrique; Troyo-Sanromán, Rogelio

2017-02-01

The study aimed to demonstrate that the duration of hospitalization has a significant effect on the nutritional status of children treated in a university hospital. A longitudinal study was conducted during 2014, with a non-random sampling site concentration in children from birth to 19 years who were admitted to the hospital in the past 24 hours and who met the inclusion criteria and had signed informed consent. Upon entering, at 7 days, and at discharge, anthropometric indices, including weight/age, height/age, weight/height, BMI/age, head circumference/age, triceps and subscapular skin folds, and fat percentage, were obtained. Student's t-test, U Mann-Whitney, ANOVA, chi square, Wilcoxon, and odds ratios were used to analyze the data. In total, 206 patients were included: 40% infants, 25% preschoolers, 15% schoolchildren, and 20% teenagers. Infants had a significant improvement from admission to discharge in the indices weight/length (p = 0.042) and BMI (p = 0.002); adolescents showed decreased BMI from admission to discharge from the hospital (p = 0.05). Patients with longer hospitalization (more than 10 days) had an increased deficit in anthropometric indices at admission (p < 0.05). Infants had a higher risk of deficit in the BMI index and height/age than preschoolers, schoolchildren, and adolescents between admission and discharge. When the nutritional condition of a child was critical at admission, the child remained hospitalized significantly longer. Infants come under the age group most vulnerable to malnutrition and require greater monitoring of nutritional status during hospitalization.

Analysis of steps adapted protocol in cardiac rehabilitation in the hospital phase

PubMed Central

Winkelmann, Eliane Roseli; Dallazen, Fernanda; Bronzatti, Angela Beerbaum Steinke; Lorenzoni, Juliara Cristina Werner; Windmöller, Pollyana

2015-01-01

Objective To analyze a cardiac rehabilitation adapted protocol in physical therapy during the postoperative hospital phase of cardiac surgery in a service of high complexity, in aspects regarded to complications and mortality prevalence and hospitalization days. Methods This is an observational cross-sectional, retrospective and analytical study performed by investigating 99 patients who underwent cardiac surgery for coronary artery bypass graft, heart valve replacement or a combination of both. Step program adapted for rehabilitation after cardiac surgery was analyzed under the command of the physiotherapy professional team. Results In average, a patient stays for two days in the Intensive Care Unit and three to four days in the hospital room, totalizing six days of hospitalization. Fatalities occurred in a higher percentage during hospitalization (5.1%) and up to two years period (8.6%) when compared to 30 days after hospital discharge (1.1%). Among the postoperative complications, the hemodynamic (63.4%) and respiratory (42.6%) were the most prevalent. 36-42% of complications occurred between the immediate postoperative period and the second postoperative day. The hospital discharge started from the fifth postoperative day. We can observe that in each following day, the patients are evolving in achieving the Steps, where Step 3 was the most used during the rehabilitation phase I. Conclusion This evolution program by steps can to guide the physical rehabilitation at the hospital in patients after cardiac surgery. PMID:25859866

Medicaid payer status is associated with in-hospital morbidity and resource utilization following primary total joint arthroplasty.

PubMed

Browne, James A; Novicoff, Wendy M; D'Apuzzo, Michele R

2014-11-05

Previous reports suggest that there are major disparities in outcomes following total joint arthroplasty among patients with different payer statuses. The explanation for these differences is largely unknown and may result from confounding variables. The Affordable Care Act expansion of Medicaid coverage in 2014 makes the examination of these disparities particularly relevant. The Healthcare Cost and Utilization Project (HCUP) Nationwide Inpatient Sample (NIS) database was used to identify patients who had undergone primary hip or knee arthroplasty from 2002 through 2011. Complications, costs, and length of hospital stay for patients with Medicaid were compared with those for non-Medicaid patients. Each Medicaid patient was matched to a non-Medicaid patient according to age, sex, race, type of total joint arthroplasty, procedure year, hospital characteristics, smoking status, and all twenty-nine comorbidities defined in the NIS-modified Elixhauser comorbidity measure. It was determined that 191,911 patients who underwent total joint arthroplasty had Medicaid payer status (2.8% of the entire total joint arthroplasty population), and 107,335 (56%) of these Medicaid patients were matched one to one to a non-Medicaid patient for all variables for the adjusted analysis. After matching, Medicaid patients were found to have a higher prevalence of postoperative in-hospital infection (odds ratio [OR], 1.7; 95% confidence interval [CI], 1.3 to 2.1), wound dehiscence (OR, 2.2; 95% CI, 1.4 to 3.4), and hematoma or seroma (OR, 1.3; 95% CI, 1.2 to 1.4) but a lower risk of cardiac complications (OR, 0.7; CI, 0.6 to 0.9). The length of the hospital stay was longer, total cost was higher, and discharge to an inpatient facility was more frequent for patients with Medicaid status (p < 0.01). Compared with non-Medicaid patients, Medicaid patients have a significantly higher risk for certain postoperative in-hospital complications and consume more resources following total joint

Factors associated with infant feeding practices after hospital discharge.

PubMed

Audi, Celene Aparecida Ferrari; Corrêa, A M S; Latorre, M R D O; Pérez-Escamilla, Rafael

2005-06-01

To assess factors associated with infant feeding practices on the first day at home after hospital discharge. A total of 209 women, who had a child aged four months or less and were living in Itapira, Brazil, were interviewed during the National Immunization Campaign Day in 1999. Statistical analysis was performed using the Chi-square test and a logistic regression model was used for verifying an association between dependent and independent variables. Women aged 25.5 years on average and 18.2% were teenagers. Fifty-three percent of the women delivered vaginally and most vaginal deliveries (78.5%) took place in the public hospital. The prevalence of exclusive breastfeeding on the first day at home was 78.1% and 11.6% of the infants were receiving formula at this time. The only factor associated with EBF on the first day at home was being a teenaged-primiparous mother (OR=9.40; 95% CI: 1.24-71.27). This association remained statistically significant even after controlling for type of delivery and hospital where the birth took place. Feeding formula on the first day at home was only significantly associated with the hospital (i.e., birth at the city hospital was a protective factor (OR=0.33; 95% CI: 0.13-0.86), even after controlling for vaginal delivery. On the first day at home after hospital discharge, teenaged-primiparous mothers were more likely to exclusive breastfeeding as well as those infants born in the municipal public hospital. Further studies are needed from a multidisciplinary approach.

Totally implantable central venous access ports for long-term chemotherapy. A prospective study analyzing complications and costs of 333 devices with a minimum follow-up of 180 days.

PubMed

Biffi, R; de Braud, F; Orsi, F; Pozzi, S; Mauri, S; Goldhirsch, A; Nolè, F; Andreoni, B

1998-07-01

A few data are available from analyses of the complications and costs of central venous access ports for chemotherapy. This prospective study deals with the complications and global costs of central venous ports connected to a Groshong catheter for deliverance of long-term chemotherapy. Patients with a variety of solid neoplastic diseases requiring chemotherapy who were undergoing placement of implantable ports over a 30-month period (1 October 1994 to 31 March 1997) have been prospectively studied. Follow-up continued until the device was removed or the study was closed (30 September 1997); patients with uneventful implant experience and subsequent follow-ups of less than 180 days were not considered for this study. A single port, constructed of titanium and silicone rubber (Dome Port, Bard Inc., Salt Lake City, USA), was used, connected to an 8 F silastic Groshong catheter tubing (Bard Inc., Salt Lake City, USA). Two-hundred ninety-six devices were placed in the operating room under fluoroscopic control even in the patients treated and monitored in a day-hospital setting: 37 of them were in an angiographic suite. A central venous access form was filled in by the operator after the procedure and all ports were followed prospectively for device-related and overall complications. The average purchase cost of the device was obtained from the hospital charges, based on the costs applied during the 30-month period of the study. Insertion and maintenance costs were estimated by obtaining the charges for an average TIAP implant and its subsequent use; the costs of complication management were assessed analytically. The total cost of each device was defined as the purchase cost plus the insertion cost plus the maintenance cost plus the cost of treatment of the complications, if any. The cost of removing the TIAP was also included in the economic analysis when required by the treatment of the complication. Three hundred thirty-three devices, for a total of 79,178 days in

Review of data of the patients receiving total parenteral nutrition at the intensive care unit of a university hospital.

PubMed Central

Ovayolu, Nimet; Torun, Seda; Ucan, Ozlem; Ozdemir, Perihan; Buyukhatipoglu, Hakan; Pehlivan, Yavuz; Geyik, Ramazan

2006-01-01

Parenteral nutrition is commonly administered to patients in intensive care units who cannot be fed gastrointestinally. Several problems might be encountered during parenteral nutrition. We designed this study to evaluate two years' data of the patients who received parenteral nutrition at the intensive care unit of the university hospital. Forty-five patients who were treated at this hospital between January 1, 2004 and December 31, 2005 were included in this study. Patient data were collected via questionnaires designed based on the information in the literature. Blood, urinary, oropharyngeal and catheter entry site cultures were obtained and analyzed on the third and seventh days of the treatment. We found the following results: 31.1% of the patients received parenteral nutrition due to renal insufficiency; ready-made amino acid/lipid solutions were used in 86.7% of the patients; 77.8% of the solutions were administered through a peripheral vein; 88.6% of total parenteral nutrition solutions given thorough the peripheral vein had higher osmolarities than 800 mOsmol/L; routine Fe and Fe binding capacity, prothrombin time, cholesterol and triglyceride level assessments were not performed before the initiation of treatment; and the culture tests most commonly revealed Staphylococcus epidermidis in the blood, Candido species in urine, Streptococcus in throat, and Staphylococcus aureus at catheter entry sites. Based on these results, we suggest that organizing a nutrition support team would be useful in order to improve the quality of the nursery and to provide close and rational management and follow-up of the patients receiving total parenteral nutrition. PMID:17225841

The Impact of Hospital Size on CMS Hospital Profiling.

PubMed

Sosunov, Eugene A; Egorova, Natalia N; Lin, Hung-Mo; McCardle, Ken; Sharma, Vansh; Gelijns, Annetine C; Moskowitz, Alan J

2016-04-01

The Centers for Medicare & Medicaid Services (CMS) profile hospitals using a set of 30-day risk-standardized mortality and readmission rates as a basis for public reporting. These measures are affected by hospital patient volume, raising concerns about uniformity of standards applied to providers with different volumes. To quantitatively determine whether CMS uniformly profile hospitals that have equal performance levels but different volumes. Retrospective analysis of patient-level and hospital-level data using hierarchical logistic regression models with hospital random effects. Simulation of samples including a subset of hospitals with different volumes but equal poor performance (hospital effects=+3 SD in random-effect logistic model). A total of 1,085,568 Medicare fee-for-service patients undergoing 1,494,993 heart failure admissions in 4930 hospitals between July 1, 2005 and June 30, 2008. CMS methodology was used to determine the rank and proportion (by volume) of hospitals reported to perform "Worse than US National Rate." Percent of hospitals performing "Worse than US National Rate" was ∼40 times higher in the largest (fifth quintile by volume) compared with the smallest hospitals (first quintile). A similar gradient was seen in a cohort of 100 hospitals with simulated equal poor performance (0%, 0%, 5%, 20%, and 85% in quintiles 1 to 5) effectively leaving 78% of poor performers undetected. Our results illustrate the disparity of impact that the current CMS method of hospital profiling has on hospitals with higher volumes, translating into lower thresholds for detection and reporting of poor performance.

Mental Illness Drives Hospitalizations for Detained California Youth

PubMed Central

Anoshiravani, Arash; Saynina, Olga; Chamberlain, Lisa; Goldstein, Benjamin A; Huffman, Lynne C; Wang, N Ewen; Wise, Paul H

2015-01-01

Objective To describe inpatient hospitalization patterns among detained and non-detained youth in a large, total population of hospitalized adolescents in California. Methods We examined the unmasked California Office of Statewide Health Planning and Development Patient Discharge Dataset from 1997-2011. We considered hospitalized youth aged 11-18 years “detained” if admitted to California hospitals from detention, transferred from hospital to detention, or both. We compared discharge diagnoses and length of stay (LOS) between detained youth and their non-detained counterparts in the general population. Results There were 11,367 hospitalizations for detained youth. Hospitalizations differed for detained versus non-detained youth: 63% of all detained youth had a primary diagnosis of mental health disorder (compared to 19.8% of non-detained youth). Detained girls were disproportionately affected, with 74% hospitalized for a primary mental health diagnosis. Detained youth hospitalized for mental health disorder had an increased median LOS compared to non-detained inpatient youth with mental illness (≥6 days versus 5 days, respectively). This group difference was heightened in the presence of minority status, public insurance, and concurrent substance abuse. Hospitalized detained youth discharged to chemical dependency treatment facilities had the longest hospital stays (≥43 days). Conclusions Detained juvenile offenders are hospitalized for very different reasons than the general adolescent population. Mental illness, often with comorbid substance abuse, requiring long inpatient stays, represents the major cause for hospitalization. These findings underscore the urgent need for effective, well-coordinated mental health services for youth before, during, and after detention. PMID:26208862

Improving transition of care for veterans after total joint replacement.

PubMed

Green, Uthona R; Dearmon, Valorie; Taggart, Helen

2015-01-01

Patients transitioning from hospital to home are at risk for readmission to the hospital. Readmissions are costly and occur too often. Standardized discharge education processes have shown to decrease readmissions. The purpose of this quality improvement project was to utilize evidence-based practice changes to decrease 30-day all-cause readmissions after total joint replacement. Review of literature revealed that improved discharge education can decrease unnecessary readmissions after discharge. A quality improvement project was developed including standardized total joint replacement discharge education, teach-back education methodology, and improved postdischarge telephone follow-up. The quality improvement project was initiated and outcomes were evaluated. Improving coordination of the discharge process, enhanced education for patients/caregivers, and postdischarge follow-up decreased total joint replacement readmissions.

Day-case anaesthesia for termination of pregnancy. Evaluation of a total intravenous anaesthetic technique.

PubMed

Ogg, T W; Jennings, R A; Morrison, C G

1983-11-01

An investigation was undertaken to assess the use of a total intravenous anaesthetic technique of fentanyl and methohexitone for outpatient vaginal termination of pregnancy. When compared with a technique of fentanyl, methohexitone, nitrous oxide and trichloroethylene the total intravenous method caused swifter recovery, minimal side-effects and no cardiovascular depression. However, both anaesthetic techniques produced significant postoperative reduction of memory for new facts when compared with a control group receiving no general anaesthesia. There is a need to continue the search for anaesthetic methods appropriate for day cases.

The influence of the day of the week of hospital admission on the prognosis of stroke patients.

PubMed

Barros, Juliana B; Goulart, Alessandra Carvalho; Alencar, Airlane P; Lotufo, Paulo A; Bensenor, Isabela M

2013-04-01

This study aimed to evaluate the weekday and weekend distribution of stroke case hospital admissions and their respective prognosis based on a sample from the Estudo de Mortalidade e Morbidade do Acidente Vascular Cerebral (EMMA), a cohort of stroke patients admitted to a community hospital in the city of São Paulo, Brazil. We ascertained all consecutive cases of first-time strokes between April 2006 and December 2008 and performed a subsequent one-year follow-up. No association was found between frequency of hospital admissions due to ischemic and hemorrhagic strokes and the specific day of the week on which the admission occurred. However, ten-day and twelve-month case-fatality was higher in hemorrhagic stroke patients admitted at the weekend. We also found that intracerebral hemorrhage patients admitted on weekends had a worse survival rate (50%) compared with those admitted during weekdays (25.6%, P log-rank = 0.03). We found a multivariate hazard ratio of 2.49 (95%CI: 1.10-5.81, P trend = 0.03) for risk of death at the weekend compared to weekdays for intracerebral hemorrhage cases. No difference in survival was observed with respect to the overall sample of stroke or ischemic stroke patients.

Results of a hospital waste survey in private hospitals in Fars province, Iran

DOE Office of Scientific and Technical Information (OSTI.GOV)

Askarian, Mehrdad; Vakili, Mahmood; Kabir, Gholamhosein

2004-07-01

Hospital waste is considered dangerous because it may possess pathogenic agents and can cause undesirable effects on human health and the environment. In Iran, neither rules have been compiled nor does exact information exist regarding hospital waste management. The survey presented in this article was carried out in all 15 private hospitals of Fars province (Iran) from the total numbers of 50 governmental and private hospitals located in this province, in order to determine the amount of different kinds of waste produced and the present situation of waste management. The results indicated that the waste generation rate is 4.45 kg/bed/day,more » which includes 1830 kg (71.44%) of domestic waste, 712 kg (27.8%) of infectious waste, and 19.6 kg (0.76%) of sharps. Segregation of the different types of waste is not carried out perfectly. Two (13.3%) of the hospitals use containers without lids for on-site transport of wastes. Nine (60%) of the hospitals are equipped with an incinerator and six of them (40%) have operational problems with the incinerators. In all hospitals municipal workers transport waste outside the hospital premises daily or at the most on alternative days. In the hospitals under study, there aren't any training courses about hospital waste management and the hazards associated with them. The training courses that are provided are either ineffective or unsuitable. Performing extensive studies all over the country, compiling and enacting rules, establishing standards and providing effective personnel training are the main challenges for the concerned authorities and specialists in this field.« less

Illness Representations, Treatment Beliefs, Medication Adherence, and 30-Day Hospital Readmission in Adults With Chronic Heart Failure: A Prospective Correlational Study.

PubMed

Turrise, Stephanie

2016-01-01

An estimated 5.1 million Americans have chronic heart failure, yet despite advances in its treatment, there has been no improvement in hospital readmissions among aging adult patients with chronic heart failure. The purpose of this study is to investigate the relationships among illness representations, treatment beliefs, medication adherence, and 30-day hospital readmission for heart failure exacerbation in aging adults with chronic heart failure. Using a prospective, correlational design, 96 older adults with a primary or secondary diagnosis of heart failure discharged to home from a hospital in the Southeastern United States participated in telephone surveys and follow-up telephone calls. Data analysis included correlation and logistic regression analyses. Participants were highly adherent to their medications. Individuals who did not believe their treatment was effective in controlling their HF were readmitted within 30 days of hospital discharge for HF exacerbation; that is, treatment control was inversely related to 30-day hospital readmission. In post hoc analyses, personal control was inversely related to dichotomized medication adherence and necessity-concern differential was directly related to dichotomized medication adherence. The necessity-concern differential, or the belief that medication necessity outweighed the concerns they had about their medicines, was a significant predictor of medication adherence. Nurses can use these study findings to help identify individuals who may be at risk of being nonadherent to their medications and hospital readmission. Recommendations for future research include replication with multiple sites, the addition of objective measures of medication adherence, investigation of both the cognitive and emotional pathways, and qualitative exploration of personal control in the context of medication adherence in HF.

Association Between Hospital Performance on Patient Safety and 30-Day Mortality and Unplanned Readmission for Medicare Fee-for-Service Patients With Acute Myocardial Infarction.

PubMed

Wang, Yun; Eldridge, Noel; Metersky, Mark L; Sonnenfeld, Nancy; Fine, Jonathan M; Pandolfi, Michelle M; Eckenrode, Sheila; Bakullari, Anila; Galusha, Deron H; Jaser, Lisa; Verzier, Nancy R; Nuti, Sudhakar V; Hunt, David; Normand, Sharon-Lise T; Krumholz, Harlan M

2016-07-12

Little is known regarding the relationship between hospital performance on adverse event rates and hospital performance on 30-day mortality and unplanned readmission rates for Medicare fee-for-service patients hospitalized for acute myocardial infarction (AMI). Using 2009-2013 medical record-abstracted patient safety data from the Agency for Healthcare Research and Quality's Medicare Patient Safety Monitoring System and hospital mortality and readmission data from the Centers for Medicare & Medicaid Services, we fitted a mixed-effects model, adjusting for hospital characteristics, to evaluate whether hospital performance on patient safety, as measured by the hospital-specific risk-standardized occurrence rate of 21 common adverse event measures for which patients were at risk, is associated with hospital-specific 30-day all-cause risk-standardized mortality and unplanned readmission rates for Medicare patients with AMI. The unit of analysis was at the hospital level. The final sample included 793 acute care hospitals that treated 30 or more Medicare patients hospitalized for AMI and had 40 or more adverse events for which patients were at risk. The occurrence rate of adverse events for which patients were at risk was 3.8%. A 1% point change in the risk-standardized occurrence rate of adverse events was associated with average changes in the same direction of 4.86% points (95% CI, 0.79-8.94) and 3.44% points (95% CI, 0.19-6.68) for the risk-standardized mortality and unplanned readmission rates, respectively. For Medicare fee-for-service patients discharged with AMI, hospitals with poorer patient safety performance were also more likely to have poorer performance on 30-day all-cause mortality and on unplanned readmissions. © 2016 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

Level of activity, night and day alternation, and well being measured in a smart hospital suite.

PubMed

Noury, N; Hadidi, T; Laila, M; Fleury, A; Villemazet, C; Rialle, V; Franco, A

2008-01-01

The present paper reports a study on the daily activity of elderly people in a hospital suite, with presence infrared sensors. It is an attempt to produce parameters and indicators for the predictive analysis of the daily activity of fragile persons. A relationship is proposed between well being of the patient and the night and day activities alternation.

Clinical application of immune-enhanced enteral nutrition in patients with advanced gastric cancer after total gastrectomy.

PubMed

Liu, Hua; Ling, Wei; Shen, Zhi Yong; Jin, Xin; Cao, Hui

2012-08-01

To determine whether immune-enhanced enteral nutrition (EN) was effective on nutritional status, immune function, surgical outcomes and days of hospitalization after total gastrectomy for patients with advanced gastric cancer (AGC). From August 2005 to May 2011, 78 patients with AGC who underwent a total gastrectomy were enrolled and divided randomly into three groups: immune-enhanced EN (EN + glutamine [Gln]) group, standard EN group and control group. Serum parameters including total protein, albumin, proalbumin and transferrin were examined on preoperative day 1, postoperative day 2 and day 12. Levels of immunoglobulin M (IgM), immunoglobulin G (IgG), natural killer (NK) cells, CD4⁺ and CD8⁺ T cells were also compared. The formulas were tolerated well in all the patients except 5 with mild complications. The EN + Gln and EN groups showed a faster onset of flatus and shorter hospitalization duration than the control group. On postoperative day 12, serum total protein, albumin, proalbumin and transferrin levels of the EN + Gln and EN groups were significantly higher than those of the control group (P < 0.05). CD4⁺ T cells, NK cells, IgM and IgG levels of the EN + Gln group increased prominently, and were significantly higher than those before the operation as well as those in the EN and control groups. Immune-enhanced EN can improve nutritional status and immune function for the patients with AGC after total gastrectomy. © 2012 The Authors. Journal of Digestive Diseases © 2012 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and Blackwell Publishing Asia Pty Ltd.

[Indicators of healthcare quality in day surgery (2010-2012)].

PubMed

Martínez Rodenas, F; Codina Grifell, J; Deulofeu Quintana, P; Garrido Corchón, J; Blasco Casares, F; Gibanel Garanto, X; Cuixart Vilamajó, L; de Haro Licer, J; Vazquez Dorrego, X

2014-01-01

Monitoring quality indicators in Ambulatory Surgery centers is fundamental in order to identify problems, correct them and prevent them. Given their large number, it is essential to select the most valid ones. The objectives of the study are the continuous improvement in the quality of healthcare of day-case surgery in our center, by monitoring selective quality parameters, having periodic information on the results and taking corrective measures, as well as achieving a percentage of unplanned transfer and cancellations within quality standards. Prospective, observational and descriptive study of the day-case surgery carried out from January 2010 to December 2012. Unplanned hospital admissions and cancellations on the same day of the operation were selected and monitored, along with their reasons. Hospital admissions were classified as: inappropriate selection, medical-surgical complications, and others. The results were evaluated each year and statistically analysed using χ(2) tests. A total of 8,300 patients underwent day surgery during the 3 years studied. The day-case surgery and outpatient index increased by 5.4 and 6.4%, respectively (P<.01). Unexpected hospital admissions gradually decreased due to the lower number of complications (P<.01). Hospital admissions, due to an extended period of time in locoregional anaesthesia recovery, also decreased (P<.01). There was improved prevention of nausea and vomiting, and of poorly controlled pain. The proportion of afternoon admissions was significantly reduced (P<.01). The cancellations increased in 2011 (P<.01). The monitoring of quality parameters in day-case surgery has been a useful tool in our clinical and quality management. Globally, the unplanned transfer and cancellations have been within the quality standards and many of the indicators analysed have improved. Copyright © 2013 SECA. Published by Elsevier Espana. All rights reserved.

Rural versus urban academic hospital mortality following stroke in Canada

PubMed Central

Turcotte, Stéphane; Légaré, France; Plant, Jeff; Poitras, Julien; Archambault, Patrick M.; Dupuis, Gilles

2018-01-01

Introduction Stroke is one of the leading causes of death in Canada. While stroke care has improved dramatically over the last decade, outcomes following stroke among patients treated in rural hospitals have not yet been reported in Canada. Objectives To describe variation in 30-day post-stroke in-hospital mortality rates between rural and urban academic hospitals in Canada. We also examined 24/7 in-hospital access to CT scanners and selected services in rural hospitals. Materials and methods We included Canadian Institute for Health Information (CIHI) data on adjusted 30-day in-hospital mortality following stroke from 2007 to 2011 for all acute care hospitals in Canada excluding Quebec and the Territories. We categorized rural hospitals as those located in rural small towns providing 24/7 emergency physician coverage with inpatient beds. Urban hospitals were academic centres designated as Level 1 or 2 trauma centres. We computed descriptive data on local access to a CT scanner and other services and compared mean 30-day adjusted post-stroke mortality rates for rural and urban hospitals to the overall Canadian rate. Results A total of 286 rural hospitals (3.4 million emergency department (ED) visits/year) and 24 urban hospitals (1.5 million ED visits/year) met inclusion criteria. From 2007 to 2011, 30-day in-hospital mortality rates following stroke were significantly higher in rural than in urban hospitals and higher than the Canadian average for every year except 2008 (rural average range = 18.26 to 21.04 and urban average range = 14.11 to 16.78). Only 11% of rural hospitals had a CT-scanner, 1% had MRI, 21% had in-hospital ICU, 94% had laboratory and 92% had basic x-ray facilities. Conclusion Rural hospitals in Canada had higher 30-day in-hospital mortality rates following stroke than urban academic hospitals and the Canadian average. Rural hospitals also have very limited local access to CT scanners and ICUs. These rural/urban discrepancies are cause for

Rural versus urban academic hospital mortality following stroke in Canada.

PubMed

Fleet, Richard; Bussières, Sylvain; Tounkara, Fatoumata Korika; Turcotte, Stéphane; Légaré, France; Plant, Jeff; Poitras, Julien; Archambault, Patrick M; Dupuis, Gilles

2018-01-01

Stroke is one of the leading causes of death in Canada. While stroke care has improved dramatically over the last decade, outcomes following stroke among patients treated in rural hospitals have not yet been reported in Canada. To describe variation in 30-day post-stroke in-hospital mortality rates between rural and urban academic hospitals in Canada. We also examined 24/7 in-hospital access to CT scanners and selected services in rural hospitals. We included Canadian Institute for Health Information (CIHI) data on adjusted 30-day in-hospital mortality following stroke from 2007 to 2011 for all acute care hospitals in Canada excluding Quebec and the Territories. We categorized rural hospitals as those located in rural small towns providing 24/7 emergency physician coverage with inpatient beds. Urban hospitals were academic centres designated as Level 1 or 2 trauma centres. We computed descriptive data on local access to a CT scanner and other services and compared mean 30-day adjusted post-stroke mortality rates for rural and urban hospitals to the overall Canadian rate. A total of 286 rural hospitals (3.4 million emergency department (ED) visits/year) and 24 urban hospitals (1.5 million ED visits/year) met inclusion criteria. From 2007 to 2011, 30-day in-hospital mortality rates following stroke were significantly higher in rural than in urban hospitals and higher than the Canadian average for every year except 2008 (rural average range = 18.26 to 21.04 and urban average range = 14.11 to 16.78). Only 11% of rural hospitals had a CT-scanner, 1% had MRI, 21% had in-hospital ICU, 94% had laboratory and 92% had basic x-ray facilities. Rural hospitals in Canada had higher 30-day in-hospital mortality rates following stroke than urban academic hospitals and the Canadian average. Rural hospitals also have very limited local access to CT scanners and ICUs. These rural/urban discrepancies are cause for concern in the context of Canada's universal health care system.

Physiologic Monitor Alarm Rates at 5 Children's Hospitals.

PubMed

Schondelmeyer, Amanda C; Brady, Patrick W; Goel, Veena V; Cvach, Maria; Blake, Nancy; Mangeot, Colleen; Bonafide, Christopher P

2018-06-01

Alarm fatigue has been linked to patient morbidity and mortality in hospitals due to delayed or absent responses to monitor alarms. We sought to describe alarm rates at 5 freestanding children's hospitals during a single day and the types of alarms and proportions of patients monitored by using a point-prevalence, cross-sectional study design. We collected audible alarms on all inpatient units and calculated overall alarm rates and rates by alarm type per monitored patient per day. We found a total of 147,213 alarms during the study period, with 3-fold variation in alarm rates across hospitals among similar unit types. Across hospitals, onequarter of monitored beds were responsible for 71%, 61%, and 63% of alarms in medical-surgical, neonatal intensive care, and pediatric intensive care units, respectively. Future work focused on addressing nonactionable alarms in patients with the highest alarm counts may decrease alarm rates. © 2018 Society of Hospital Medicine.

Distribution of liver disease in a cohort of immigrants in Sicily: analysis of day-hospital admissions in a migration medicine unit.

PubMed

Affronti, Marco; Affronti, Andrea; Soresi, Maurizio; Giannitrapani, Lydia; Campagna, Elisa; Tramuto, Fabio; Brunori, Giuseppe; Montalto, Giuseppe

2014-09-01

The objective of this study was to evaluate the frequency of liver disease and its aetiology in a cohort of immigrants. We retrospectively examined the hospital discharge charts of all the immigrant patients presenting at our day hospital from July 2009 to June 2013, and after evaluating the anamnestic, clinical and laboratory data on these charts we identified subjects with liver disease and its various aetiologies. The total sample population consisted of 1218 patients, of whom 112 (9.2%) had a diagnosis of liver disease. More than two-thirds of the latter (67.8%) came from Africa, while 15.2% were from Asia and 17.0% from Eastern Europe. In most patients the disease was related to HBV (44.6%), followed by alcohol (25%) and then HCV or cryptogenic disease (both 15.2%). Forty-six patients had undergone liver biopsy, which showed eight cases of varying degrees of liver steatosis, 29 cases with a variable severity of chronic liver disease, eight cases with a definite picture of liver cirrhosis and one case of alcoholic hepatitis. These data show that a significant proportion of our immigrant population has liver disease and that the most frequent cause is hepatitis B infection.

Comparing the Affordable Care Act's Financial Impact on Safety-Net Hospitals in States That Expanded Medicaid and Those That Did Not.

PubMed

Dobson, Allen; DaVanzo, Joan E; Haught, Randy; Phap-Hoa, Luu

2017-11-01

Safety-net hospitals play a vital role in delivering health care to Medicaid enrollees, the uninsured, and other vulnerable patients. By reducing the number of uninsured Americans, the Affordable Care Act (ACA) was also expected to lower these hospitals’ significant uncompensated care costs and shore up their financial stability. To examine how the ACA’s Medicaid expansion affected the financial status of safety-net hospitals in states that expanded Medicaid and in states that did not. Using Medicare hospital cost reports for federal fiscal years 2012 and 2015, the authors compared changes in Medicaid inpatient days as a percentage of total inpatient days, Medicaid revenues as a percentage of total net patient revenues, uncompensated care costs as a percentage of total operating costs, and hospital operating margins. Medicaid expansion had a significant, favorable financial impact on safety-net hospitals. From 2012 to 2015, safety-net hospitals in expansion states, compared to those in nonexpansion states, experienced larger increases in Medicaid inpatient days and Medicaid revenues as well as reduced uncompensated care costs. These changes improved operating margins for safety-net hospitals in expansion states. Margins for safety-net hospitals in nonexpansion states, meanwhile, declined.

Acceptability and impact of a partial smoking ban followed by a total smoking ban in a psychiatric hospital.

PubMed

Etter, Manuela; Khan, Aqal Nawaz; Etter, Jean-François

2008-06-01

To assess the impact of a partial smoking ban followed by a total smoking ban in a psychiatric hospital in Switzerland. In 2003, smoking was allowed everywhere in psychiatric units. In 2004, smoking was prohibited everywhere except in smoking rooms. In 2006, smoking rooms were removed and smoking was totally prohibited indoors. Patients and staff were surveyed in 2003 (n=106), 2004 (n=108), 2005 (n=119) and 2006 (n=134). Exposure to environmental tobacco smoke (ETS) decreased after the partial ban and further decreased after the total ban. Among patients, after the total ban, more smokers attempted to quit smoking (18%) relative to before the total ban (2%, odds ratio=10.1, p=0.01). More smokers said that hospital staff gave them nicotine replacement products after the total ban (52%), compared with before (13%, odds ratio=7.6, p<0.001). Many participants (55%) commented that the total ban was too strict, and most (64%) preferred the partial ban. The partial ban decreased exposure to ETS and the total ban further improved the situation and increased the proportion of smokers who attempted to quit smoking and received nicotine medications. The total ban was loosely enforced and was overall acceptable, but most participants preferred a partial ban.

The Relationship Among Heart Failure Disease Management, Quality of Care, and Hospitalizations.

PubMed

Chung, Eugene S; Bartone, Cheryl; Daly, Kathleen; Menon, Santosh; McDonald, Mark

2015-01-01

Heart failure (HF) affects 5.1 million adult patients, accounting for over 1 million hospitalizations, 1.8 million office visits, and nearly 680,000 emergency department visits annually. HF hospitalizations have been incorporated into a national measure of hospital and provider quality, with associated financial penalties based on the 30-day readmission rate after an index hospitalization for HF. However, it is not clear whether the number of HF-related hospitalizations or 30-day readmissions is consistently related to quality of care. The relationships between various measures of HF care quality and hospitalization rates were evaluated by performing a cohort study of an HF disease management program in a clinical practice setting. Following the statistical analyses assessing outcomes and survival, the conclusion was that an HF disease management program in clinical practice associated with improved utilization of evidence-based medical and device therapies tends to improve ejection fraction and survival, and reduce sex and race disparities, but not with an associated reduction in hospitalizations or total hospital days.

Occurrence of selected lower urinary tract symptoms in patientsof a day hospital for neurotic disorders.

PubMed

Sobański, Jerzy A; Skalski, Michał; Gołąbek, Tomasz; Świerkosz, Agata; Przydacz, Mikołaj; Klasa, Katarzyna; Rutkowski, Krzysztof; Dembińska, Edyta; Mielimąka, Michał; Cyranka, Katarzyna; Chłosta, Piotr L; Dudek, Dominika

2016-12-23

To assess the occurrence of selected lower urinary tract symptoms in the population of patients with neurotic and personality disorders. This was a retrospective analysis of occurrence, co-existence and severity of two selected lower urinary tract symptoms in 3,929 patients in a day hospital for neurotic disorders. The KO "O" symptom checklist was used to measure the study variables. Although the symptoms associated with micturition are not the most prevalent symptoms of neurotic disorders, neither are they the most typical ones, the prevalence of urinary frequency referring to the last week before psychotherapy evaluated among the patients of a day hospital, was approximately 50%. Involuntary micturition, a symptom with a significant implication on the self-esteem and social functioning was much less common; it was reported by approximately 5% relatively healthy and young group of patients. Major bother from urinary frequency was reported by 9-14% of patients, whereas from involuntary micturition by only 0.6%-1% of the surveyed patients. Selected urological symptoms seem to be prevalent among the patients with neurotic and personality disorders, and are independent of the specific diagnosis or patients' gender. Their co-existence with other symptoms of neurotic disorders reported by the patients indicates their strongest relationship with the somatoform, dissociative, sexual and agoraphobic disorders.

Interhospital Transfers among Medicare Beneficiaries Admitted for Acute Myocardial Infarction at Non-Revascularization Hospitals

PubMed Central

Iwashyna, Theodore J.; Kahn, Jeremy M.; Hayward, Rodney A.; Nallamothu, Brahmajee K.

2011-01-01

Background Patients with acute myocardial infarctions (AMI) who are admitted to hospitals without coronary revascularization are frequently transferred to hospitals with this capability, yet we know little about the basis for how such revascularization hospitals are selected. Methods and Results We examined interhospital transfer patterns in 71,336 AMI patients admitted to hospitals without revascularization capabilities in the 2006 Medicare claims using network analysis and regression models. A total of 31,607 (44.3%) AMI patients were transferred from 1,684 non-revascularization hospitals to 1,104 revascularization hospitals. Median time to transfer was 2 days. Median transfer distance was 26.7 miles, with 96.1% within 100 miles. In 45.8% of cases, patients bypassed a closer hospital to go to farther hospital that had a better 30-day risk standardized mortality rates. However, in 36.8% of cases, another revascularization hospital with lower 30-day risk-standardized mortality was actually closer to the original admitting non-revascularization hospital than the observed transfer destination. Adjusted regression models demonstrated that shorter transfer distances were more common than transfers to the hospitals with lowest 30-day mortality rates. Simulations suggest that an optimized system that prioritized the transfer of AMI patients to a nearby hospital with the lowest 30-day mortality rate might produce clinically meaningful reduction in mortality. Conclusions Over 40% of AMI patients admitted to non-revascularization hospitals are transferred to revascularization hospitals. Many patients are not directed to nearby hospitals with the lowest 30-day risk-standardized mortality, and this may represent an opportunity for improvement. PMID:20682917

Early inpatient calculation of laboratory-based 30-day readmission risk scores empowers clinical risk modification during index hospitalization.

PubMed

Horne, Benjamin D; Budge, Deborah; Masica, Andrew L; Savitz, Lucy A; Benuzillo, José; Cantu, Gabriela; Bradshaw, Alejandra; McCubrey, Raymond O; Bair, Tami L; Roberts, Colleen A; Rasmusson, Kismet D; Alharethi, Rami; Kfoury, Abdallah G; James, Brent C; Lappé, Donald L

2017-03-01

Improving 30-day readmission continues to be problematic for most hospitals. This study reports the creation and validation of sex-specific inpatient (i) heart failure (HF) risk scores using electronic data from the beginning of inpatient care for effective and efficient prediction of 30-day readmission risk. HF patients hospitalized at Intermountain Healthcare from 2005 to 2012 (derivation: n=6079; validation: n=2663) and Baylor Scott & White Health (North Region) from 2005 to 2013 (validation: n=5162) were studied. Sex-specific iHF scores were derived to predict post-hospitalization 30-day readmission using common HF laboratory measures and age. Risk scores adding social, morbidity, and treatment factors were also evaluated. The iHF model for females utilized potassium, bicarbonate, blood urea nitrogen, red blood cell count, white blood cell count, and mean corpuscular hemoglobin concentration; for males, components were B-type natriuretic peptide, sodium, creatinine, hematocrit, red cell distribution width, and mean platelet volume. Among females, odds ratios (OR) were OR=1.99 for iHF tertile 3 vs. 1 (95% confidence interval [CI]=1.28, 3.08) for Intermountain validation (P-trend across tertiles=0.002) and OR=1.29 (CI=1.01, 1.66) for Baylor patients (P-trend=0.049). Among males, iHF had OR=1.95 (CI=1.33, 2.85) for tertile 3 vs. 1 in Intermountain (P-trend <0.001) and OR=2.03 (CI=1.52, 2.71) in Baylor (P-trend < 0.001). Expanded models using 182-183 variables had predictive abilities similar to iHF. Sex-specific laboratory-based electronic health record-delivered iHF risk scores effectively predicted 30-day readmission among HF patients. Efficient to calculate and deliver to clinicians, recent clinical implementation of iHF scores suggest they are useful and useable for more precise clinical HF treatment. Copyright © 2016 Elsevier Inc. All rights reserved.

The Validity of Goal Achievement as an Outcome Measure in Physical Rehabilitation Day Hospitals for Older People

ERIC Educational Resources Information Center

Kneebone, Ian I.; Hurn, Jane S.; Raisbeck, Elizabeth; Cropley, Mark; Khoshnaw, Hiro; Milton, Jane E.

2010-01-01

Physical rehabilitation day hospitals are widely used community-based services designed to meet the medical and rehabilitation needs of older people. While there is evidence for the effectiveness of these services, concerns about the shortcomings of how this is measured have led to the recommendation that the achievement of individually tailored…

Hospital costs for patients with lower extremity cellulitis: a retrospective population-based study.

PubMed

Challener, Douglas; Marcelin, Jasmine; Visscher, Sue; Baddour, Larry

2017-12-01

Hospital admissions for non-purulent lower extremity cellulitis (NLEC) are common and can be prolonged and costly. Newer treatment options and preventive strategies are expected to result in cost savings before implementation, but few studies have quantified the cost of conventional treatment. Using the Rochester Epidemiology Project, the incidence of NLEC in Olmsted County, MN in 2013 was 176.6 per 100,000 persons. The subset of patients who required hospitalization for NLEC in 2013 was determined. Hospital admissions were analyzed retrospectively using standardized cost analysis within several relevant categories. Thirty-four patients had an average hospital length of stay of 4.7 days. The median total inpatient cost was $7,341. The median cost per day was $2,087, with 49% due to room and board. Antibiotics administered for treatment of NLEC contributed a median cost of $75 per day of hospitalization, and laboratory and imaging test costs were $73 and $44, respectively, per day of hospitalization. Hospitalizations for NLEC can be costly and prolonged with room and board accounting for much of the cost. Therefore, newer management strategies should seek to reduce hospital length of stay and/or avoid inpatient admission to reduce cost.

Does hospital accreditation impact bariatric surgery safety?

PubMed

Morton, John M; Garg, Trit; Nguyen, Ninh

2014-09-01

To evaluate the impact of hospital accreditation upon bariatric surgery outcomes. Since 2004, the American College of Surgeons and the American Society of Metabolic and Bariatric Surgery have accredited bariatric hospitals. Few studies have evaluated the impact of hospital accreditation on all bariatric surgery outcomes. Bariatric surgery hospitalizations were identified using International Classification of Diseases, Ninth Revision (ICD9) codes in the 2010 Nationwide Inpatient Sample (NIS). Hospital names and American Hospital Association (AHA) codes were used to identify accredited bariatric centers. Relevant ICD9 codes were used for identifying demographics, length of stay (LOS), total charges, mortality, complications, and failure to rescue (FTR) events. There were 117,478 weighted bariatric patient discharges corresponding to 235 unique hospitals in the 2010 NIS data set. A total of 72,615 (61.8%) weighted discharges, corresponding to 145 (61.7%) named or AHA-identifiable hospitals were included. Among the 145 hospitals, 66 (45.5%) were unaccredited and 79 (54.5%) accredited. Compared with accredited centers, unaccredited centers had a higher mean LOS (2.25 vs 1.99 days, P < 0.0001), as well as total charges ($51,189 vs $42,212, P < 0.0001). Incidence of any complication was higher at unaccredited centers than at accredited centers (12.3% vs 11.3%, P = 0.001), as was mortality (0.13% vs 0.07%, P = 0.019) and FTR (0.97% vs 0.55%, P = 0.046). Multivariable logistic regression analysis identified unaccredited status as a positive predictor of incidence of complication [odds ratio (OR) = 1.08, P < 0.0001], as well as mortality (OR = 2.13, P = 0.013). Hospital accreditation status is associated with safer outcomes, shorter LOS, and lower total charges after bariatric surgery.

Assessing In-Hospital Outcomes and Resource Utilization After Primary Total Joint Arthroplasty Among Underweight Patients.

PubMed

Anoushiravani, Afshin A; Sayeed, Zain; Chambers, Monique C; Gilbert, Theodore J; Scaife, Steven L; El-Othmani, Mouhanad M; Saleh, Khaled J

2016-07-01

Poor nutritional status is a preventable condition frequently associated with low body mass index (BMI). The purpose of this study is to comparatively analyze low (≤19 kg/m(2)) and normal (19-24.9 kg/m(2)) BMI cohorts, examining if a correlation between BMI, postoperative outcomes, and resource utilization exists. Discharge data from the 2006-2012 National Inpatient Sample were used for this study. A total of 3550 total hip arthroplasty (THA) and 1315 total knee arthroplasty (TKA) patient samples were divided into 2 cohorts, underweight (≤19 kg/m(2)) and normal BMI (19-24.9 kg/m(2)). Using the Elixhauser Comorbidity Index, all cohorts were matched for 27 comorbidities. In-hospital postoperative outcomes and resource utilization among the cohorts was then comparatively analyzed. Multivariate analyses and chi-squared tests were generated using SAS software. Significance was assigned at P < .05. Underweight patients undergoing THA were at higher risk of developing postoperative anemia and sustaining cardiac complications. In addition, underweight patients had a decreased risk of developing postoperative infection. Resource utilization in terms of length of stay and hospital charge were all higher in the underweight THA cohort. Similarly, in the underweight TKA cohort, a greater risk for the development of hematoma/seroma and postoperative anemia was observed. Underweight TKA patients incurred higher hospital charge and were more likely to be discharged to skilled nursing facilities. Our results indicate that low-BMI patients were more likely to have postoperative complications and greater resource utilization. This serves a purpose in allowing orthopedic surgeons to better predict patient outcomes and improve treatment pathways designed toward helping various patient demographics. Copyright © 2016 Elsevier Inc. All rights reserved.

Readmission Rates and Long-Term Hospital Costs Among Survivors of In-Hospital Cardiac Arrest

PubMed Central

Chan, Paul S.; Nallamothu, Brahmajee K.; Krumholz, Harlan M.; Curtis, Lesley H.; Li, Yan; Hammill, Bradley G.; Spertus, John A.

2014-01-01

Background Although in-hospital cardiac arrest is common, little is known about readmission patterns and inpatient resource use among survivors of in-hospital cardiac arrest. Methods and Results Within a large national registry, we examined long-term inpatient utilization among 6972 adults ≥65 years who survived an in-hospital cardiac arrest. We examined 30-day and 1-year readmission rates and inpatient costs, overall and by patient demographics, hospital disposition (discharge destination), and neurological status at discharge. The mean age was 75.8 ± 7.0 years, 56% were men, and 12% were black. There were a total of 2005 readmissions during the first 30 days (cumulative incidence rate: 35 readmissions/100 patients [95% CI: 33–37]) and 8751 readmissions at 1 year (cumulative incidence rate: 185 readmissions/100 patients [95% CI: 177–190]). Overall, mean inpatient costs were $7,741 ± $2323 at 30 days and $18,629 ± $9411 at 1 year. Thirty-day inpatient costs were higher in patients of younger age (≥85 years: $6052 [reference]; 75–84 years: $7444 [adjusted cost ratio, 1.23 [1.06–1.42]; 65–74 years: $8291 [adjusted cost ratio, 1.37 [1.19–1.59]; both P<0.001]) and black race (whites: $7413; blacks: $9044; adjusted cost ratio, 1.22 [1.05–1.42]; P<0.001), as well as those discharged with severe neurological disability or to skilled nursing or rehabilitation facilities. These differences in resource use persisted at 1 year and were largely due to higher readmission rates. Conclusion Survivors of in-hospital cardiac arrest have frequent readmissions and high follow-up inpatient costs. Readmissions and inpatient costs were higher in certain subgroups, including patients of younger age and black race. PMID:25351479

Trends and Variations in the Rates of Hospital Complications, Failure-to-Rescue and 30-Day Mortality in Surgical Patients in New South Wales, Australia, 2002-2009

PubMed Central

Ou, Lixin; Chen, Jack; Assareh, Hassan; Hollis, Stephanie J.; Hillman, Ken; Flabouris, Arthas

2014-01-01

Background Despite the increased acceptance of failure-to-rescue (FTR) as an important patient safety indicator (defined as the percentage of deaths among surgical patients with treatable complications), there has not been any large epidemiological study reporting FTR in an Australian setting nor any evaluation on its suitability as a performance indicator. Methods We conducted a population-based study on elective surgical patients from 82 public acute hospitals in New South Wales, Australia between 2002 and 2009, exploring the trends and variations in rates of hospital complications, FTR and 30-day mortality. We used Poisson regression models to derive relative risk ratios (RRs) after adjusting for a range of patient and hospital characteristics. Results The average rates of complications, FTR and 30-day mortality were 13.8 per 1000 admissions, 14.1% and 6.1 per 1000 admission, respectively. The rates of complications and 30-day mortality were stable throughout the study period however there was a significant decrease in FTR rate after 2006, coinciding with the establishment of national and state-level peak patient safety agencies. There were marked variations in the three rates within the top 20% of hospitals (best) and bottom 20% of hospitals (worst) for each of the four peer-hospital groups. The group comprising the largest volume hospitals (principal referral/teaching hospitals) had a significantly higher rate of FTR in comparison to the other three groups of smaller-sized peer hospital groups (RR = 0.78, 0.57, and 0.61, respectively). Adjusted rates of complications, FTR and 30-day mortality varied widely for individual surgical procedures between the best and worst quintile hospitals within the principal referral hospital group. Conclusions The decrease in FTR rate over the study period appears to be associated with a wide range of patient safety programs. The marked variations in the three rates between- and within- peer hospital groups highlight the

Efficacy of Multimodal Pain Control Protocol in the Setting of Total Hip Arthroplasty

PubMed Central

Lee, Kyung-Jae; Bae, Ki-Cheor; Cho, Chul-Hyun; Kwon, Doo-Hyun

2009-01-01

Background This study evaluated the benefits and safety of a multimodal pain control protocol, which included a periarticular injection of local anesthetics, in patients undergoing total hip arthroplasty. Methods Between March 2006 and March 2007, 60 patients undergoing unilateral total hip arthroplasty were randomized to undergo either a multimodal pain control protocol or a conventional pain control protocol. The following parameters were compared: the preoperative and postoperative visual analogue scales (VAS), hospital stay, operative time, postoperative rehabilitation, additional painkiller consumption, and complication rates. Results There was no difference between the groups in terms of diagnosis, age, gender, and BMI. Although both groups had similar VAS scores in the preoperative period and on the fifth postoperative day, there was a significant difference between the groups over the four-day period after surgery. There were no differences in the hospital stay, operative time, additional painkiller consumption, or complication rate between the groups. The average time for comfortable crutch ambulation was 2.8 days in the multimodal pain control protocol group and 5.3 days in the control group. Conclusions The multimodal pain control protocol can significantly reduce the level of postoperative pain and improve patients' satisfaction, with no apparent risks, after total hip arthroplasty. PMID:19885051

Overseas visitors admitted to Queensland hospitals for water-related injuries.

PubMed

Wilks, J; Coory, M

2000-09-01

To determine the number of overseas visitors admitted to Queensland hospitals for water-related injuries over three years, the causes of their injuries, the resulting conditions treated, and the type of hospitals to which they were admitted. Retrospective analysis of admissions of overseas visitors to Queensland hospitals over the three financial years 1995/96, 1996/97 and 1997/98. 296 overseas visitors admitted for water-related injuries, identified from hospital records by their usual place of residence. Number of admissions, causes of injuries, conditions treated, and bed days occupied by these patients at different types of hospitals (metropolitan, regional and rural public hospitals, and private hospitals). The 296 overseas visitors accounted for a total of 596 separate admissions, many of these the result of patients with decompression illness being admitted several times to a regional hospital hyperbaric chamber for treatment as day patients. The largest number of injuries involved the use of diving equipment. The main conditions treated were decompression illness (54.7%), fractures and dislocations (15.5%), and drowning and non-fatal submersion (14.9%). Overall, overseas visitors admitted to hospital following a water-related incident occupied 1215 bed days; 90% of these admissions were to regional hospitals. The main reason for admission of overseas visitors is for decompression illness, suggesting that the prevention of injuries among scuba divers requires further coordinated efforts by health and tourism authorities.

Economic burden associated with hospital postadmission dehydration.

PubMed

Pash, Elizabeth; Parikh, Niraj; Hashemi, Lobat

2014-11-01

Development of dehydration after hospital admission can be a measure of quality care, but evidence describing the incidence, economic burden, and outcomes of dehydration in hospitalized patients is lacking. The objective of this study was to compare costs and resource utilization of U.S. patients experiencing postadmission dehydration (PAD) with those who do not in a hospital setting. All adult inpatient discharges, excluding those with suspected dehydration present on admission (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] codes for dehydration: 276.0, 276.1, 276.5), were identified from the Premier database using ICD-9-CM codes. PAD and no-PAD (NPAD) groups were matched on propensity score adjusting for demographics (age, sex, race, medical, elective patients), patient severity (All Patient Refined Diagnosis-Related Groups severity scores), and hospital characteristics (geographic location, bed size, teaching and urban hospital). Costs, length of stay (LOS), and incidence of mortality and catheter-associated urinary tract infection (CAUTI) were compared between groups using the t test for continuous variables and the χ(2) test for categorical variables. In total, 86,398 (2.1%) of all the selected patients experienced PAD. Postmatching mean total costs were significantly higher for the PAD group compared with the NPAD group ($33,945 vs $22,380; P < .0001). Departmental costs were also significantly higher for the PAD group (all P < .0001). Compared with the NPAD group, the PAD group had a higher mean LOS (12.9 vs 8.2 days), a higher incidence of CAUTI (0.6% vs 0.5%), and higher in-hospital mortality (8.6% vs 7.8%) (all P < .05). The results for subgroup analysis also showed significantly higher total cost and longer LOS days for patients with PAD (all P < .05). The economic burden associated with hospital PAD in medical and surgical patients was substantial. © 2014 American Society for Parenteral and Enteral

The probability of readmission within 30 days of hospital discharge is positively associated with inpatient bed occupancy at discharge--a retrospective cohort study.

PubMed

Blom, Mathias C; Erwander, Karin; Gustafsson, Lars; Landin-Olsson, Mona; Jonsson, Fredrik; Ivarsson, Kjell

2015-12-14

Previous work has suggested that given a hospital's need to admit more patients from the emergency department (ED), high inpatient bed occupancy may encourage premature hospital discharges that favor the hospital's need for beds over patients' medical interests. We argue that the effects of such action would be measurable as a greater proportion of unplanned hospital readmissions among patients discharged when the hospital was full than when not. In response, the present study tested this hypothesis by investigating the association between inpatient bed occupancy at the time of hospital discharge and the 30-day readmission rate. The sample included all inpatient admissions from the ED at a 420-bed emergency hospital in southern Sweden during 2011-2012 that resulted in discharge before 1 December 2012. The share of unplanned readmissions within 30 days was computed for levels of inpatient bed occupancy of <95%, 95-100%, 100-105% and >105% at the hour of discharge. A binary logistic regression model was constructed to adjust for age, time of discharge, and other factors that could affect the outcome. In all, 32,811 visits were included in the study, 9.9% of which resulted in an unplanned readmission within 30 days of discharge. The proportion of readmissions was 9.0% for occupancy levels of <95% at the patient's discharge, 10.2% for 95-100% occupancy, 10.8% for 100-105% occupancy, and 10.5% for >105% occupancy (p = 0.0001). Results from the multivariate models show that the OR (95% CI) of readmission was 1.11 (1.01-1.22) for patients discharged at 95-100% occupancy, 1.17 (1.06-1.29) at 100-105% occupancy, and 1.15 (0.99-1.34) at >105% occupancy. Results indicate that patients discharged from inpatient wards at times of high inpatient bed occupancy experience an increased risk of unplanned readmission within 30 days of discharge.

Is the weekend effect really ubiquitous? A retrospective clinical cohort analyses of 30-day mortality by day of week and time of day using linked population data from New South Wales, Australia.

PubMed

Baldwin, Heather J; Marashi-Pour, Sadaf; Chen, Huei-Yang; Kaldor, Jill; Sutherland, Kim; Levesque, Jean-Frederic

2018-04-12

To examine the associations between day of week and time of admission and 30-day mortality for six clinical conditions: ischaemic and haemorrhagic stroke, acute myocardial infarction, pneumonia, chronic obstructive pulmonary disease and congestive heart failure. Retrospective population-based cohort analyses. Hospitalisation records were linked to emergency department and deaths data. Random-effect logistic regression models were used, adjusting for casemix and taking into account clustering within hospitals. All hospitals in New South Wales, Australia, from July 2009 to June 2012. Patients admitted to hospital with a primary diagnosis for one of the six clinical conditions examined. Adjusted ORs for all-cause mortality within 30 days of admission, by day of week and time of day. A total of 148 722 patients were included in the study, with 17 721 deaths within 30 days of admission. Day of week of admission was not associated with significantly higher likelihood of death for five of the six conditions after adjusting for casemix. There was significant variation in mortality for chronic obstructive pulmonary disease by day of week; however, this was not consistent with a strict weekend effect (Thursday: OR 1.29, 95% CI 1.12 to 1.48; Friday: OR 1.25, 95% CI 1.08 to 1.44; Saturday: OR 1.18, 95% CI 1.02 to 1.37; Sunday OR 1.05, 95% CI 0.90 to 1.22; compared with Monday). There was evidence for a night effect for patients admitted for stroke (ischaemic: OR 1.30, 95% CI 1.17 to 1.45; haemorrhagic: OR 1.58, 95% CI 1.40 to 1.78). Mortality outcomes for these conditions, adjusted for casemix, do not vary in accordance with the weekend effect hypothesis. Our findings support a growing body of evidence that questions the ubiquity of the weekend effect. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Comparison of hospital length of stay and hospitalization costs among patients with non-valvular atrial fibrillation treated with apixaban or warfarin: An early view.

PubMed

Xie, Lin; Vo, Lien; Keshishian, Allison; Price, Kwanza; Singh, Prianka; Mardekian, Jack; Bruno, Amanda; Baser, Onur; Kim, Jully; Tan, Wilson; Trocio, Jeffrey

2016-08-01

To quantify and compare hospital length of stay (LOS) and costs between hospitalized non-valvular atrial fibrillation (NVAF) patients treated with either apixaban or warfarin via a large claims database. Adult patients hospitalized with AF were selected from the Premier Perspective Claims Database (01JAN2013-31MARCH2014). Patients with evidence of valvular heart disease, valve replacement procedures, or pregnancy during the index hospitalization were excluded. Patients treated with apixaban or warfarin during hospitalization were identified. Propensity score matching (PSM) was performed to control for baseline imbalances between patients treated with apixaban or warfarin. Primary outcomes were hospital LOS (days), post-medication administration LOS, and index hospitalization costs, and were compared using paired t-tests in the matched sample. Before PSM, 2894 apixaban and 124,174 warfarin patients were identified. Patients treated with warfarin were older and sicker compared to those treated with apixaban. After applying PSM, a total of 2886 patients were included in each cohort, and baseline characteristics were balanced. The mean (standard deviation [SD] and median) hospital LOS was significantly (p = 0.002) shorter for patients treated with apixaban for 5.1 days (5.7 and 3) compared to warfarin for 5.5 days (4.8 and 4). The trend appeared consistent in the hospital LOS from point of apixaban or warfarin administration to discharge (4.5 vs 4.7 days, p = 0.051). Patients administered apixaban incurred significantly lower hospitalization costs compared to those administered warfarin ($11,262 vs $12,883; p < 0.001). Among NVAF patients, apixaban treatment was associated with significantly shorter hospital LOS and lower costs when compared to warfarin treatment.

[Prevalence of pressure sores in a university hospital in 2003].

PubMed

Daideri, G; Berthier, F; Brocker, P; Darmon, M-J; Mignolet, F; Quaranta, J-F; Staccini, P

2006-12-01

To determine the prevalence of pressure sores in a university hospital and to assess the risk of developing a pressure sore. A one-day survey was performed in all hospitalized patients, day hospital excepted. The Garches scale was used to assess the severity of pressure sores and the Braden scale was used to measure the patient's risk for the development of pressure ulcers. One thousand six hundred and eleven patients were included, mean age was 62+/-23 years and 53.3% were over 65 years old. In hospitalized patients, 64% were in acute care, 29% in intermediate medicine and long-term care and 7% in intensive care units. We have found 675 pressure sores in 268 patients, mean age of 76 years; 263 decubitus ulcers were acquired during hospitalization. The most frequent sites were heels (46%) and sacrum (26%). Stage 1 pressure ulcers showed 33% of the total. The total prevalence was 16.6%, 95% CI (14.9-18.6), the hospital acquired pressure sores prevalence was 7.5%, all stages included. A Braden score less than or equal to 15 was found in 29.1% of hospitalized patients. Standard mattresses were used in 37% of patients with pressure sores. Multivariate analysis showed that age and a Braden score less than or equal to 15 were significantly associated with pressure sores. Pressure sores are still an important problem in hospital; occurrence must be considered as an iatrogenic event and management requires a multidisciplinary approach.

Associations between nursing home performance and hospital 30-day readmissions for acute myocardial infarction, heart failure and pneumonia at the healthcare community level in the United States.

PubMed

Pandolfi, Michelle M; Wang, Yun; Spenard, Ann; Johnson, Florence; Bonner, Alice; Ho, Shih-Yieh; Elwell, Timothy; Bakullari, Anila; Galusha, Deron; Leifheit-Limson, Erica; Lichtman, Judith H; Krumholz, Harlan M

2017-12-01

To evaluate community-specific nursing home performance with community-specific hospital 30-day readmissions for Medicare patients discharged with acute myocardial infarction, heart failure or pneumonia. Cross-sectional study using 2009-2012 hospital risk-standardised 30-day readmission data for Medicare fee-for-service patients hospitalised for all three conditions and nursing home performance data from the Centers for Medicare & Medicaid Services Five-Star Quality Rating System. Medicare-certified nursing homes and acute care hospitals. 12,542 nursing homes and 3,039 hospitals treating 30 or more Medicare fee-for-service patients for all three conditions across 2,032 hospital service areas in the United States. Community-specific hospital 30-day risk-standardised readmission rates. Community-specific nursing home performance measures: health inspection, staffing, Registered Nurses and quality performance; and an aggregated performance score. Mixed-effects models evaluated associations between nursing home performance and hospital 30-day risk-standardised readmission rates for all three conditions. The relationship between community-specific hospital risk-standardised readmission rates and community-specific overall nursing home performance was statistically significant for all three conditions. Increasing nursing home performance by one star resulted in decreases of 0.29% point (95% CI: 0.12-0.47), 0.78% point (95% CI: 0.60-0.95) and 0.46% point (95% CI: 0.33-0.59) of risk-standardised readmission rates for AMI, HF and pneumonia, respectively. Among the specific measures, higher performance in nursing home overall staffing and Registered Nurse staffing measures was statistically significantly associated with lower hospital readmission rates for all three conditions. Notable geographic variation in the community-specific nursing home performance was observed. Community-specific nursing home performance is associated with community-specific hospital 30-day

Bed usage in a Dublin teaching hospital: a prospective audit.

PubMed

John, A; Breen, D P; Ghafar, Aabdul; Olphert, T; Burke, C M

2004-01-01

We prospectively audited inpatient bed use in our hospital for the first three months of this year. While 70% (mean age 54 +/- 20.8 years) of our patients went home on the day they were medically discharged, 30% (mean age 70.3 +/- 18.3 years) remained in the hospital awaiting step-down facilities. The total of 486 bed days occupied by overstaying patients would if available, have allowed treatment of 54% more patients without any increase in the hospital complement of beds, preventing the cancellation of elective procedures and preventing patients remaining on trolleys overnight. These prospective data emphasise (1) a highly inefficient use of acute hospital beds; (2) the need for step-down facilities; (3) efficient use of existing hospital beds is the highest priority both for optimal patient care and optimal use of expensive hospital resources; (4) efficient use of existing facilities should be achieved before the construction of additional facilities.

Antibiotic Use in Small Community Hospitals.

PubMed

Stenehjem, Edward; Hersh, Adam L; Sheng, Xiaoming; Jones, Peter; Buckel, Whitney R; Lloyd, James F; Howe, Stephen; Evans, R Scott; Greene, Tom; Pavia, Andrew T

2016-11-15

 Antibiotic use and misuse is driving drug resistance. Much of US healthcare takes place in small community hospitals (SCHs); 70% of all US hospitals have <200 beds. Antibiotic use in SCHs is poorly described. We evaluated antibiotic use using data from the National Healthcare and Safety Network antimicrobial use option from the Centers for Disease Control and Prevention.  We used Intermountain Healthcare's monthly antibiotic use reports for 19 hospitals from 2011 to 2013. Hospital care units were categorized as intensive care, medical/surgical, pediatric, or miscellaneous. Antibiotics were categorized based on spectrum of coverage. Antibiotic use rates, expressed as days of therapy per 1000 patient-days (DOT/1000PD), were calculated for each SCH and compared with rates in large community hospitals (LCHs). Negative-binomial regression was used to relate antibiotic use to predictor variables.  Total antibiotic use rates varied widely across the 15 SCHs (median, 436 DOT/1000PD; range, 134-671 DOT/1000PD) and were similar to rates in 4 LCHs (509 DOT/1000PD; 406-597 DOT/1000PD). The proportion of patient-days spent in the respective unit types varied substantially within SCHs and had a large impact on facility-level rates. Broad-spectrum antibiotics accounted for 26% of use in SCHs (range, 8%-36%), similar to the proportion in LCHs (32%; range, 26%-37%). Case mix index, proportion of patient-days in specific unit types, and season were significant predictors of antibiotic use.  There is substantial variation in patterns of antibiotic use among SCHs. Overall usage in SCHs is similar to usage in LCHs. Small hospitals need to become a focus of stewardship efforts. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

Lipid paradox in acute myocardial infarction-the association with 30-day in-hospital mortality.

PubMed

Cheng, Kai-Hung; Chu, Chih-Sheng; Lin, Tsung-Hsien; Lee, Kun-Tai; Sheu, Sheng-Hsiung; Lai, Wen-Ter

2015-06-01

Elevated low-density lipoprotein cholesterol and triglycerides are major risk factors for coronary artery disease. However, fatty acids from triglycerides are a major energy source, low-density lipoprotein cholesterol is critical for cell membrane synthesis, and both are critical for cell survival. This study was designed to clarify the relationship between lipid profile, morbidity as assessed by Killip classification, and 30-day mortality in patients with acute myocardial infarction. A noninterventional observational study. Coronary care unit in a university hospital. Seven hundred twenty-four patients with acute myocardial infarction in the coronary care program of the Bureau of Health Promotion were analyzed. None. Low-density lipoprotein cholesterol and triglyceride levels were significantly lower in high-Killip (III+IV) patients compared with low-Killip (I+II) patients and in those who died compared with those who survived beyond 30 days (both p<0.001). After adjustment for risk factors, low-density lipoprotein cholesterol less than 62.5 mg/dL and triglycerides less than 110 mg/dL were identified as optimal threshold values for predicting 30-day mortality and were associated with hazard ratios of 1.65 (95% CI, 1.18-2.30) and 5.05 (95% CI, 1.75-14.54), and the actual mortality rates were 23% in low low-density lipoprotein, 6% in high low-density lipoprotein, 14% in low triglycerides, and 3% in high triglycerides groups, respectively. To test the synergistic effect, high-Killip patients with triglycerides less than 62.5 mg/dL and low-density lipoprotein cholesterol less than 110 mg/dL had a 10.9-fold higher adjusted risk of mortality than low-Killip patients with triglycerides greater than or equal to 62.5 mg/dL and low-density lipoprotein cholesterol greater than or equal to 110 mg/dL (p<0.001). The lipid paradox also improved acute myocardial infarction short-term outcomes prediction on original Killip and thrombolytic in myocardial infarction scores. Low low

Parental Satisfaction with Pediatric Day-Care Surgery and its Determinants in a Tertiary Care Hospital

PubMed Central

Sam, Cenita James; Arunachalam, Pavai A.; Manivasagan, Sivamani; Surya, T.

2017-01-01

Objective: The objective is to assess the level of parental satisfaction of pediatric day-care surgery and its different determinants. Materials and Methods: This is a descriptive study performed in a tertiary care hospital in India among parents of pediatric day-care surgery patients from June 2013 to March 2015. The core questionnaire for the assessment of patient satisfaction for general day care (COPS-D) was used. Variables related to surgery, overall satisfaction, one open-ended question, and socio-demographic data were also collected. Calculated sample size was 121. Results: The mean and standard deviation of parental satisfaction were estimated in eight domains of day care (COPS-D) using Likert scale 1–5. Preadmission visit had a mean of 4.63 (0.52), day of surgery 4.65 (0.58), operating room 4.76 (0.51), nursing care 4.46 (0.79), medical care 4.89 (0.48), information 4.51 (0.68), autonomy 4.64 (0.56), and discharge 4.50 (0.72). In elder children, there was less satisfaction on the information and discharge domains. Overall satisfaction was good in 88% of patients and was less than satisfactory when they had significant pain. Conclusion: Perception of quality of pediatric day-care surgery was assessed with a questionnaire and was found to be good. Variables related to surgery such as pain may be included in the questionnaire for assessing satisfaction in the day-care surgery. PMID:28974875

Economic and clinical comparison of 2-octyl cyanoacrylate/polymer mesh tape with skin staples in total knee replacement.

PubMed

Sutton, Nadia; Schmitz, Niels-Derrek; Johnston, Stephen S

2018-04-01

To compare economic and clinical outcomes between skin staples and 2-octyl cyanoacrylate plus polymer mesh tape, Dermabond Prineo skin closure system, (SCS) among patients undergoing total knee replacement (TKR). Retrospective, observational study using the Premier Healthcare Database, which comprises hospital administrative and billing data for over 700 hospitals in the US. Patients selected for study had an elective hospital admission, with discharge occurring between January 2012 and September 2015, carrying primary ICD-9-CM procedure and diagnosis codes for TKR and osteoarthritis. Patients were classified into two mutually-exclusive groups based on billing records during the index admission: those with billing record(s) for the skin closure system (SCS group); and those with billing record(s) for skin staples (staple group). Primary outcomes were index admission's length of stay (LOS), total hospital costs, and discharge status (skilled nursing facility (SNF)/other versus home/home health-care); exploratory outcomes included operating room time (ORT) during index admission and 30, 60, and 90-day readmissions. The SCS and staple groups were propensity score matched (1:1/nearest neighbour/caliper=0.10) on patient, hospital, and provider characteristics. Multivariable regressions accounting for hospital-level clustering after matching were used to compare outcomes between study groups. Each group comprised 971 patients (1942 total patients; mean age: 65.3 years; female: 63.5%). The groups were generally well-balanced on matching covariates: mean standardised difference calculated across 49 covariates=0.049. Compared with the staple group, the SCS group had statistically significant shorter LOS (2.8 days versus 3.2 days, p=0.002), lower rate of discharge to SNF/other versus home/home health-care (26.4% versus 38.5%, p=0.011), and lower rate of 30, 60, and 90-day readmissions (30-day, 1.8% versus 4.4%, p=0.006; 60-day, 3.0% versus 5.4%, p<0.001; 90-day, 5.4% versus

The effect of real-time teleconsultations between hospital-based nurses and patients with severe COPD discharged after an exacerbation.

PubMed

Sorknaes, Anne Dichmann; Bech, Mickael; Madsen, Hanne; Titlestad, Ingrid L; Hounsgaard, Lise; Hansen-Nord, Michael; Jest, Peder; Olesen, Finn; Lauridsen, Joergen; Østergaard, Birte

2013-12-01

We investigated the effect of daily real-time teleconsultations for one week between hospital-based nurses specialised in respiratory diseases and patients with severe COPD discharged after acute exacerbation. Patients admitted with acute exacerbation of chronic obstructive pulmonary disease (AECOPD) at two hospitals were recruited at hospital discharge. They were randomly assigned to intervention or control. The telemedicine equipment consisted of a briefcase with built-in computer including a web camera, microphone and measurement equipment. The primary outcome was the mean number of total hospital readmissions within 26 weeks of discharge. A total of 266 patients (mean age 72 years) were allocated to either intervention (n = 132) or control (n = 134). There was no significant difference in the unconditional total mean number of hospital readmissions after 26 weeks: mean 1.4 (SD 2.1) in the intervention group and 1.6 (SD 2.4) in the control group. In a secondary analysis, there was no significant difference between the two groups in mortality, time to readmission, mean number of total hospital readmissions, mean number of readmissions with AECOPD, mean number of total hospital readmission days or mean number of readmission days with AECOPD calculated at 4, 8, 12 and 26 weeks. Thus the addition of one week of teleconsultations between hospital-based nurses and patients with severe COPD discharged after hospitalisation did not significantly reduce readmissions or affect mortality.

Casualty and surgical services in Perthshire general practitioner hospitals 1954-84

PubMed Central

Blair, J.S.G.; Grant, J.; McBride, H.; Martin, A.; Ross, R.T.A.

1986-01-01

The results are reported of a study of casualty and surgical services in five general practitioner hospitals in Perthshire — Aberfeldy, Auchterarder, Blairgowrie, Crieff and Pitlochry. Details of the total workload, the nature of the conditions treated and the referral rate to major hospitals are given. Figures for the Royal Infirmary, Perth, the main referral hospital for the county, are also given for comparison. The surgical service at one of the rural hospitals is described. Experience has demonstrated the usefulness of these hospitals in providing casualty and surgical services to both the local population and to visitors, and their superiority in providing these services over health centres because staff and beds are available 24 hours a day. Rural general practitioner hospitals merit a continuing share of resources and bed allocation as they spare major hospitals surgical and medical work. The general practitioners serving the hospitals studied here undertook almost 40% of the total accident and emergency workload in the Perth and Kinross area of Scotland. PMID:3735224

Readmission rates and long-term hospital costs among survivors of an in-hospital cardiac arrest.

PubMed

Chan, Paul S; Nallamothu, Brahmajee K; Krumholz, Harlan M; Curtis, Lesley H; Li, Yan; Hammill, Bradley G; Spertus, John A

2014-11-01

Although an in-hospital cardiac arrest is common, little is known about readmission patterns and an inpatient resource use among survivors of an in-hospital cardiac arrest. Within a large national registry, we examined long-term inpatient use among 6972 adults aged ≥65 years who survived an in-hospital cardiac arrest. We examined 30-day and 1-year readmission rates and inpatient costs, overall and by patient demographics, hospital disposition (discharge destination), and neurological status at discharge. The mean age was 75.8±7.0 years, 56% were men, and 12% were black. There were a total of 2005 readmissions during the first 30 days (cumulative incidence rate, 35 readmissions/100 patients; 95% confidence interval, 33-37) and 8751 readmissions at 1 year (cumulative incidence rate, 185 readmissions/100 patients; 95% confidence interval, 177-190). Overall, mean inpatient costs were $7741±$2323 at 30 days and $18 629±$9411 at 1 year. Thirty-day inpatient costs were higher in patients of younger age (≥85 years, $6052 [reference]; 75-84 years, $7444 [adjusted cost ratio, 1.23; 1.06-1.42; 65-74 years, $8291 [adjusted cost ratio, 1.37; 1.19-1.59; both P<0.001) and black race (whites, $7413; blacks, $9044; adjusted cost ratio, 1.22; 1.05-1.42; P<0.001), as well as those discharged with severe neurological disability or to skilled nursing or rehabilitation facilities. These differences in resource use persisted at 1 year and were largely because of higher readmission rates. Survivors of an in-hospital cardiac arrest have frequent readmissions and high follow-up inpatient costs. Readmissions and inpatient costs were higher in certain subgroups, including patients of younger age and black race. © 2014 American Heart Association, Inc.

The cost of the district hospital: a case study in Malawi.