Journal articles on the topic 'Hospital utilization Length of stay Victoria'
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Walsh, Thom, Tracy Onega, and Todd Mackenzie. "Variation in length of stay within and between hospitals." Journal of Hospital Administration 3, no. 4 (March 2, 2014): 53. http://dx.doi.org/10.5430/jha.v3n4p53.
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Background and objective: Variation in the delivery of health care services and the lack of association between greater utilization and higher quality care signal inefficient, low value care. The extent to which patient and hospital variables can explain variation in hospital length of stay is unclear. Methods: We examined hospital inpatient length of stay using data from 684 hospitals and 5.4 million discharges in the 2007 Healthcare Cost and Utilization Project’s Nationwide Inpatient Sample. We used a mixed effects model with a random effect for hospitals to quantify variation in length of stay due to differences within and between hospitals. Results: The interquartile range of hospital mean LOS was 3.4 days (3.3-6.7). Fifty-nine percent of the overall variation in length of stay remained unexplained after adjustment for discharge-level disease status, illness-severity, regional poverty, hospital-level contextual factors (e.g. proportion of patients from low-income ZIP-codes, proportion uninsured), and structural variables (e.g. teaching status, urban or rural location). Seventy-seven percent of the explainable variation was due to differences between hospitals. Conclusion: These findings indicate that wide variability in length of stay persists after adjustment for patient and hospital variables, signaling an opportunity for improved productivity and efficiency in the delivery of health care.
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Yu, Kaylee G., Jay J. Shen, Pearl C. Kim, Sun Jung Kim, Se Won Lee, David Byun, Ji Won Yoo, and Jinwook Hwang. "Trends of Hospital Palliative Care Utilization and Its Associated Factors Among Patients With Systemic Lupus Erythematosus in the United States From 2005 to 2014." American Journal of Hospice and Palliative Medicine® 37, no. 3 (December 3, 2019): 164–71. http://dx.doi.org/10.1177/1049909119891999.
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Objective: To investigate trends and associated factors of utilization of hospital palliative care among patients with systemic lupus erythematosus (SLE) and analyze its impact on length of hospital stay, hospital charges, and in-hospital mortality. Methods: Using the 2005-2014 National Inpatient Sample in the United States, the compound annual growth rate was used to investigate the temporal trend of utilization of hospital palliative care. Multivariate multilevel logistic regression analyses were performed to analyze the association with patient-related factors, hospital factors, length of stay, in-hospital mortality, and hospital charges. Results: The overall proportion of utilization of hospital palliative care for the patient with SLE was 0.6% over 10 years. It increased approximately 12-fold from 0.1% (2005) to 1.17% (2014). Hospital palliative care services were offered more frequently to older patients, patients with high severity illnesses, and in urban teaching hospitals or large size hospitals. Patients younger than 40 years, the lowest household income group, or Medicare beneficiaries less likely received palliative care during hospitalization. Hospital palliative care services were associated with increased length of stay (β = 1.407, P < .0001) and in-hospital mortality (odds ratio, 48.18; 95% confidence interval, 41.59-55.82), and reduced hospital charge (β = −0.075, P = .009). Conclusion: Hospital palliative care service for patients with SLE gradually increased during the past decade in US hospitals. However, this showed disparities in access and was associated with longer hospital length of stay and higher in-hospital mortality. Nevertheless, hospital palliative care services yielded a cost-saving effect.
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Kaplow, M., S. Charest, N. Mayo, and S. Benaroya. "Managing Patient Length of Stay Better Using an Appropriateness Tool." Healthcare Management Forum 11, no. 2 (July 1998): 13–16. http://dx.doi.org/10.1016/s0840-4704(10)60640-0.
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A multidisciplinary group from two medical floors at the Royal Victoria Hospital chose the Managed Care Appropriateness Program (MCAP) to evaluate the appropriateness of the days of stay for their patients. Of 100 charts of consecutive patients examined by the nurse reviewer (comprising 1,095 patient days), 33 percent of the days were deemed inappropriate. The reasons for each of these inappropriate days were documented, and strategies were implemented to address the issues. The major outcome of the study was a change in the culture of the health professionals to a more positive approach to defining and carrying out efficient patient care.
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Phillips, Leah A., Don C. Voaklander, Colleen Drul, and Karen D. Kelly. "The Epidemiology of Hospitalized Head Injury in British Columbia, Canada." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 36, no. 5 (September 2009): 605–11. http://dx.doi.org/10.1017/s0317167100008118.
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Objective:This descriptive study seeks to identify the incidence rates of head injuries in a large Canadian province, given incident cases for a ten year period. It describes cases in terms of age standardized rates, demographics, and health care utilization.Methods:The analyses were done using descriptive statistics. Incidence rates were calculated using the direct method. The indicators of hospital resource utilization were: mean length of hospital stay, number of intensive care unit (ICU) stays, and mean length of stay in an ICU.Results:In the ten year period, British Columbia saw 48,753 admissions due to an incident head injury. The most common head injury diagnosis was an “Intracranial” injury. The year with the highest total age standardized rate was 1991/92 (174.18/100 000). The mean length of hospital stay was 7.4 days. Ten percent had an ICU stay and the mean length of stay was 4.4 days (± 4.8). The diagnosis with the longest mean length of stay was a “Fractured Skull” while of the top five E-code categories; “Motor Vehicle Traffic” had the highest mean length of stay with 12.2 days.Conclusions:Our study provides a much needed analysis of the incidence of head injuries in British Columbia. These rates can be compared to other provinces using the 2001 Canadian population as the standardized population. Our results indicate that there are certain “at risk” groups that warrant attention, in particular, younger men with lower socioeconomic standing. Indicators of health care utilization presented in the study should generate policy discussions.
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Glazer, William M., and Hal Morgenstern. "The impact of utilization management on hospital length of stay and illness." Administration and Policy in Mental Health 21, no. 1 (September 1993): 41–49. http://dx.doi.org/10.1007/bf00706413.
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Deng, Aileen, and Atrayee Basu Mallick. "Healthcare utilization and costs associated with GI cancers in the United States." Journal of Clinical Oncology 36, no. 4_suppl (February 1, 2018): 361. http://dx.doi.org/10.1200/jco.2018.36.4_suppl.361.
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361 Background: In 2009, adults had 4.7 million cancer-related hospitalizations. Adult hospital stays with cancer identified as the principal diagnosis cost $20.1 billion and accounted for 6% of adult inpatient hospital costs. GI cancer-related healthcare utilization has not been well-defined. The aim of this study was to evaluate the trends in the incidence and costs of GI cancer-related hospital admissions in the U.S. Methods: We reviewed the National Inpatient Sample Database (NIS) from 1997-2014. All patients with principle discharge diagnoses of esophageal, stomach, colon, rectum and anus, liver and intrahepatic bile duct and pancreas cancer were analyzed. Temporal trends in the number of hospital admissions, length of stay, hospitalization cost and mortality rates were obtained by HCUPnet. Results: GI cancer-related hospital admissions decreased from 230,537 in 1997 to 221,220 in 2014. Although the number of hospital admissions decreased for esophageal (12,157 to 11,885), stomach (23,528 to 21,800), colon (110,939 to 90,135), rectum and anus cancer (43,807 to 40,160), it has increased for liver and intrahepatic bile duct (11,243 to 21,775, p < 0.001) and pancreas cancer (28,862 to 35,465, p < 0.001). While the mean length of stay decreased from 9.6 days in 1997 to 7.6 days in 2014, the mean hospital charges per patient (adjusted for inflation) increased 127% from $34,747 in 1997 to $78,742 in 2014. The highest increase in mean hospital charges per patient were in liver and intrahepatic bile duct ($27,128 to $74,619 (175%), p < 0.001), rectum and anus ($32,566 to $80,789 (148%), p < 0.001) and pancreas cancer ($33,562 to $75,981 (126%), p < 0.001). Conclusions: GI cancer-related hospital admissions decreased from 1997 to 2014. Despite decrease in the mean length of hospital stay, the costs of hospitalizations have increased substantially, especially in liver and intrahepatic bile duct, rectum and anus and pancreas cancer. Our study suggests that shorter length of stay alone has not reduced costs of hospitalizations in GI cancers. There remains a growing need to understand healthcare costs and to develop effective value-based interventions in GI cancer-related hospital admissions.
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Fateha, B. E. A. H. "Evaluation of the utilization management programme at Salmaniya Medical Complex, Bahrain." Eastern Mediterranean Health Journal 8, no. 4-5 (June 15, 2002): 556–65. http://dx.doi.org/10.26719/2002.8.4-5.556.
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In 1993, the Ministry of Health in Bahrain implemented a utilization management programme at the largest public hospital in the country, aimed at reducing patients’ mean length of stay from 8.3 days in 1993 to 6.0 days in 2000. Time series analysis, using linear trend modelling and the annual disparity reduction rate, were used to estimate performance towards achieving the targets. The study found that the length of stay declined consistently between 1984 and 2000, with a steeper decline in the period 1994-2000, which could be attributed to the utilization management programme. Overall, length of stay was reduced by 20.5% between the two periods, short of the target 27.8% proposed in 1993. Individual clinical departments showed mixed results, with better performance demonstrated by the Departments of Medicine and Surgery.
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Ore, Timothy. "Musculoskeletal malignant neoplasms hospitalisation in Victoria." Journal of Epidemiological Research 1, no. 1 (July 27, 2015): 33. http://dx.doi.org/10.5430/jer.v1n1p33.
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The paper describes factors associated with 2,605 hospital admissions for musculoskeletal malignant neoplasms (MMN) over oneyear. The rates per 10,000 population increased significantly (t=5.3, p<.01) with age, with men (4.5 per 10,000 population, 95% CI 4.1-5.0) at greater risk than women (3.3 per 10,000 population, 95% CI 2.8-3.7). The 30-day readmission rate was 19%, thethird highest of all admission categories. The average length of stay was significantly (t=4.5, p<.01) shorter in the metropolitanarea (8.2 days) than in rural communities (10.8 days). The age-standardised rates varied inversely (r=-0.28) with socioeconomicstatus. Communities with high MMN admission rates had high rates of heart failure admissions (r=0.35), alcohol consumption(r=0.34) and receiving Disability Support Pension (r=0.32). There was a significant (t=13.8, p<.001) monthly variability inMMN hospitalisation rates. As a leading cause of hospital readmission and disability, the condition requires closer analysis.
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Arantes, Aglai, Eduardo da Silva Carvalho, Eduardo A. S. Medeiros, Calil Kairalla Farhat, and Orlando Cesar Mantese. "Pediatric Risk of Mortality and Hospital Infection." Infection Control & Hospital Epidemiology 25, no. 9 (September 2004): 783–85. http://dx.doi.org/10.1086/502478.
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AbstractWe studied the association of Pediatric Risk of Mortality scores with nosocomial infections among 341 critically ill patients admitted to a pediatric intensive care unit between June 1998 and December 2000. Through stepwise logistic regression analysis, the best predictors for nosocomial infections were device utilization ratio, antimicrobial therapy, and length of stay.
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Kelso, Michael, Rick A. Weideman, Daisha J. Cipher, and Linda A. Feagins. "Factors Associated With Length of Stay in Veterans With Inflammatory Bowel Disease Hospitalized for an Acute Flare." Inflammatory Bowel Diseases 24, no. 1 (December 19, 2017): 5–11. http://dx.doi.org/10.1093/ibd/izx020.
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Abstract Background Reducing hospital costs and risk of complications by shortening length of stay has become paramount. The aim of our study was to identify predictors and potentially modifiable factors that influence length of stay among veterans with inflammatory bowel disease admitted for an acute flare. Methods Retrospective review of patients admitted to the Dallas VA with an acute flare of their inflammatory bowel disease between 2000 and 2015. Patients with a length of stay of ≤4 days were compared with those whose length of stay >4 days. Results A total of 180 admissions involving 113 patients (59 with ulcerative colitis and 54 with Crohn’s disease) were identified meeting inclusion criteria. The mean length of stay was 5.3 ± 6.8 days, and the median length of stay was 3.0 days. On multiple logistic regression analysis, initiation of a biologic, having undergone 2 or more imaging modalities, and treatment with intravenous steroids were significant predictors of longer lengths of stay, even after controlling for age and comorbid diseases. Conclusions We identified several predictors for longer hospital length of stay, most related to disease severity but several of which may be modifiable to reduce hospital stays, including most importantly consideration of earlier prebiologic testing. Future studies are needed to evaluate the impact of interventions targeting modifiable predictors of length of stay on health care utilization and patient outcomes. 10.1093/ibd/izx020_video1 izx020.video1 5732756865001
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Liu, Xibei, Yaser Dawod, Alex Wonnaparhown, Amaan Shafi, Loomee Doo, Ji Won Yoo, Eunjeong Ko, and Youn Seon Choi. "Effects of hospital palliative care on health, length of stay, and in-hospital mortality across intensive and non-intensive-care units: A systematic review and metaanalysis." Palliative and Supportive Care 15, no. 6 (February 15, 2017): 741–52. http://dx.doi.org/10.1017/s1478951516001164.
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ABSTRACTObjective:Hospital palliative care has been shown to improve quality of life and optimize hospital utilization for seriously ill patients who need intensive care. The present review examined whether hospital palliative care in intensive care (ICU) and non-ICU settings will influence hospital length of stay and in-hospital mortality.Method:A systematic search of CINAHL/EBSCO, the Cochrane Library, Google Scholar, MEDLINE/Ovid, PubMed, and the Web of Science through 12 October 2016 identified 16 studies that examined the effects of hospital palliative care and reported on hospital length of stay and in-hospital death. Random-effects pooled odds ratios and mean differences with corresponding 95% confidence intervals were estimated. Heterogeneity was measured by theI2test. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system was utilized to assess the overall quality of the evidence.Results:Of the reviewed 932 articles found in our search, we reviewed the full text of 76 eligible articles and excluded 60 of those, which resulted in a final total of 16 studies for analysis. Five studies were duplicated with regard to outcomes. A total of 18,330 and 9,452 patients were analyzed for hospital length of stay and in-hospital mortality from 11 and 10 studies, respectively. Hospital palliative care increased mean hospital length of stay by 0.19 days (pooled mean difference = 0.19; 95% confidence interval [CI95%] = –2.22–2.61 days;p= 0.87;I2= 95.88%) and reduced in-hospital mortality by 34% (pooled odds ratio = 0.66;CI95%= 0.52–0.84; p < 0.01;I2= 48.82%). The overall quality of evidence for both hospital length of stay and in-hospital mortality was rated as very low and low, respectively.Significance of results:Hospital palliative care was associated with a 34% reduction of in-hospital mortality but had no correlation with hospital length of stay.
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Worster, Brooke, Declan Kennedy Bell, Vibin Roy, Amy Cunningham, Marianna LaNoue, and Susan Parks. "Race as a Predictor of Palliative Care Referral Time, Hospice Utilization, and Hospital Length of Stay: A Retrospective Noncomparative Analysis." American Journal of Hospice and Palliative Medicine® 35, no. 1 (January 5, 2017): 110–16. http://dx.doi.org/10.1177/1049909116686733.
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Background: Palliative care is associated with significant benefits, including reduced pain and suffering, an increased likelihood of patients dying in their preferred location, and decreased health-care expenditures. Racial and ethnic disparities are well-documented in hospice use and referral patterns; however, it is unclear whether these disparities apply to inpatient palliative care services. Objective: To determine if race is a significant predictor of time to inpatient palliative care consult, patient enrollment in hospice, and patients’ overall hospital length of stay among patients of an inpatient palliative care service. Design: Retrospective noncomparative analysis. Setting: Urban academic medical center in the United States. Patients: 3207 patients referred to an inpatient palliative care service between March 2006 and April 2015. Measurements: Time to palliative care consult, disposition of hospice/not hospice (excluding patients who died), and hospital length of stay among patients by racial (Asian, black, Native American/Eskimo, Hispanic, white, Unknown) and ethnic (Hispanic/Latino, non-Hispanic, Unknown) background. Results: Race was not a significant predictor of time to inpatient palliative care consult, discharge to hospice, or hospital length of stay. Similarly, black/white, Hispanic/white, and Asian/white variables were not significant predictors of hospice enrollment ( Ps > .05). Limitations: Study was conducted at 1 urban academic medical center, limiting generalizability; hospital race and ethnicity categorizations may also limit interpretation of results. Conclusions: In this urban hospital, race was not a predictor of time to inpatient palliative care service consult, discharge to hospice, or hospital length of stay. Confirmatory studies of inpatient palliative care services in other institutions are needed.
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Wang, Chen-Yu, Chen Liu, Hsien-Hui Yang, Pei-Ying Tseng, and Jong-Yi Wang. "The Association between Medical Utilization and Chronic Obstructive Pulmonary Disease Severity: A Comparison of the 2007 and 2011 Guideline Staging Systems." Healthcare 10, no. 4 (April 13, 2022): 721. http://dx.doi.org/10.3390/healthcare10040721.
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(1) Background: This study aimed to investigate the associations between the Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging systems, medical costs, and mortality among patients with chronic obstructive lung disease (COPD). Predictions of the effectiveness of the two versions of the staging systems were also compared. (2) Purpose: this study investigated the associations between the Global Initiative for Chronic Obstructive Lung Disease (GOLD) staging systems, medical costs, and mortality among patients with COPD. Predicting effectiveness between the two versions of the staging systems was also compared. (3) Procedure: This study used a secondary clinical database of a medical center in central Taiwan to examine records between 2011 and 2017. A total of 613 patients with COPD were identified. The independent variables comprised the COPD GOLD Guideline staging of the 2007 and 2011 versions, demographic characteristics, health status, and physician seniority. The dependent variables included total medical cost, average length of hospital stay, and mortality. The statistical methods included binomial logistic regression and the general linear model (GLM). (4) Discussion: The total medical cost during the observation period for patients with COPD averaged TWD 292,455.6. The average length of hospital stay was 9.7 days. The mortality rate was 9.6%, compared with that of patients in Grade 1 of the 2007 version; patients in Grade 4 of the 2007 version had significantly higher odds of death (OR = 4.07, p = 0.02). The accuracy of mortality prediction for both the 2007 and 2011 versions of the staging was equal, at 90.4%. The adjusted GLM analysis revealed that patients in Group D of the 2011 version had a significantly longer length of hospital stay than those in Group A of the 2011 version (p = 0.04). No difference between the 2007 and 2011 versions was found regarding the total medical cost. Complications were significantly associated with the total medical cost and average length of hospital stay. (5) Conclusions: The COPD staging 2011 version was associated with an average length of hospital stay, whereas the COPD staging 2007 version was related to mortality risk. Therefore, the 2011 version can estimate the length of hospital stay. However, in predicting prognosis and mortality, the 2007 version is recommended.
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Willner, Debra M., Victoria Bengualid, Bismarck Bisono-Garcia, and Judith Berger. "56. Ertapenem Utilization: “CRE”ating Solutions for Improving Hospital Stay and Stewardship." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S49. http://dx.doi.org/10.1093/ofid/ofaa439.101.
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Abstract Background Ertapenem, a carbapenem offers advantages over other carbapenems. It is administered daily and can therefore facilitate home infusion discharges, it has a narrower spectrum of activity which could reduce resistance, and is more cost effective than meropenem. Our objectives were to determine whether ertapenem utilization decreased hospital length of stay and whether use had an impact on future meropenem resistance. Methods This was a retrospective chart review of ertapenem over 2 years for the following infections: urinary tract, skin and soft tissue (SSTI), and osteomyelitis. Evaluated pathogens, duration of inpatient therapy, discharged antimicrobials, length of discharged therapy, and positive cultures up to 90 days post treatment. Analyzed length of stay, and calculated the hospital days that were saved by discharging patients on ertapenem. Results 70 patients were analyzed, with indications and pathogens listed in Figure 1. Patients were initially placed on empiric therapies pending culture results. On average, patients received 2.9 days of empiric meropenem. Once cultures finalized, patients were switched to ertapenem. On average, patients received 6 days of inpatient ertapenem prior to discharge. 37 patients were discharged with ertapenem, totaling 937 days of discharged therapy. Of the 36 patients readmitted within 90 days, 20 had pathogens identified, of which 4 were meropenem-resistant (Figure 2). Infections, Pathogens, and Treatment Duration Conclusion In this pilot stewardship initiative, switching to and discharging patients on ertapenem saved 937 hospital days over the 2 years evaluated, with the greatest days of therapy saved in osteomyelitis and SSTIs. There were a total of 422 days of inpatient ertapenem, mostly in the SSTI and cystitis indications. Of the 20 pathogens identified on readmission, 4 (20%) were meropenem-resistant. All were Acinetobacter baumanii-often carbapenem-resistant; none of the cultures were the same pathogen as the originally identified, but this warrants further investigation. The indication associated with least days of therapy saved and the highest days of inpatient ertapenem was cystitis. 53% of the patients were discharged with ertapenem; future direction involved identifying barriers for speedy discharge across all indications. Disclosures All Authors: No reported disclosures
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McCrone, Paul, and Michael Phelan. "Diagnosis and length of psychiatric in-patient stay." Psychological Medicine 24, no. 4 (November 1994): 1025–30. http://dx.doi.org/10.1017/s003329170002910x.
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SynopsisThis paper examines the link between diagnosis and length of psychiatric in-patient stay. Up to now the main method of predicting the use of in-patient services has been to use diagnosis-related groups (DRGs), primarily in the USA. Previous findings have revealed that DRGs generally predict less than 10% of variation in hospital stay. Psychiatric DRGs are considered to lack homogeneity and are too broad. Nevertheless, diagnosis, as an indicator of resource utilization, is now on the agenda in the UK and a study which examines the link between service use and diagnosis per se is called for. Altogether 5482 patients were allocated to 43 diagnostic categories (DCs). These DCs covered mental disorders, drug and alcohol-related problems, diseases of the nervous system and sense organs, and other related illnesses. Age was used in an attempt to refine the model further. Coefficients of variation were calculated for the DCs, and multivariate regression analysis was performed to gauge predictiveness. The results reveal that DCs contain extremely limited homogeneity and only predict 3% of variation in length of stay. When age group is included the results are only marginally improved, although the numbers contained in some DCs are low. Diagnosis, even when clearly defined, is a poor indicator of resource utilization.
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Dharwadkar, Nitin. "Effectiveness of an Assertive Outreach Community Treatment Program." Australian & New Zealand Journal of Psychiatry 28, no. 2 (June 1994): 244–49. http://dx.doi.org/10.1080/00048679409075635.
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The purpose of this paper is to describe an Adult Community Treatment (ACT) program in Dandenong, Victoria, and its effect upon admission rates and time in hospital for 50 of the serviceapos;s most disturbed patients. The implementation of the program was associated with a reduction in the annual re-admission rate from 38% (1989–90) to 21% (1990–91); the total length of hospital stay was also significantly reduced. The results support the value of community support programs in the management of the seriously mentally ill.
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Hawkins, Robert B., Raymond J. Strobel, Mark Joseph, Mohammed Quader, Nicholas R. Teman, G. Hossein Almassi, and J. Hunter Mehaffey. "Postoperative atrial fibrillation is associated with increased resource utilization after cardiac surgery: a regional analysis of the Southeastern United States." Vessel Plus 6 (2022): 42. http://dx.doi.org/10.20517/2574-1209.2021.116.
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Aim: Postoperative atrial fibrillation (POAF) is a known risk factor for morbidity and mortality following cardiac surgery though contemporary resource utilization data is limited. We hypothesize that POAF increases the length of stay, hospital cost, and discharges to facilities, though this trend may be tempering over time. Methods: Records were extracted for all patients in a regional database who underwent coronary artery bypass grafting, aortic valve replacement, or both (2012-2020). Patients without a history of atrial fibrillation were stratified by POAF for univariate analysis. Patients were propensity-score matched to account for baseline, operative, and postoperative differences. Results: Of the 27,307 cardiac surgery patients, 23% developed POAF. Matching resulted in 5926 well-balanced pairs of patients with and without POAF. Every metric of resource utilization was higher for patients with POAF, including ICU length of stay (58 h vs. 49 h, P < 0.0001), postoperative length of stay (7 days vs. 5 days, P < 0.0001), discharge to a facility (27% vs. 23%, P < 0.0001), and readmission (11% vs. 8%). The mean additional total hospital cost attributable to POAF was $6705 by paired analysis. A sensitivity analysis of only patients without major complications demonstrated similarly increased resource utilization for patients with POAF. Conclusions: POAF was associated with an increased 9 additional ICU hours, 2 postoperative days, 18% more discharges to a facility, and 33% greater readmissions. An additional $6705 is associated with POAF. These conservative estimates demonstrate the broad impact of POAF on in and out of hospital resource utilization that warrants future efforts at containment and quality improvement.
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Katz, Alex J., Richard P. Lion, Timothy Martens, Jennifer Newcombe, Anees Razzouk, Wendy Shih, Rambod Amirnovin, and Brent M. Gordon. "Pediatric Surgical Pulmonary Valve Replacement Outcomes After Implementation of a Clinical Pathway." World Journal for Pediatric and Congenital Heart Surgery 13, no. 4 (June 25, 2022): 420–25. http://dx.doi.org/10.1177/21501351221098127.
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Background Standardization of perioperative care can reduce resource utilization while improving patient outcomes. We sought to describe our outcomes after the implementation of a perioperative clinical pathway for pediatric patients undergoing elective surgical pulmonary valve replacement and compare these results to previously published national benchmarks. Methods A retrospective single-center descriptive study was conducted of all pediatric patients who underwent surgical pulmonary valve replacement from 2017 through 2020, after the implementation of a clinical pathway. Outcomes included hospital length of stay and 30-day reintervention, readmission, and mortality. Results Thirty-three patients (55% female, median age 11 [7, 13] years, 32 [23, 44] kg) were included in the study. Most common diagnosis and indication for surgery was Tetralogy of Fallot (61%) with pulmonary valve insufficiency (88%). All patients had prior cardiac surgery. Median hospital length of stay was 2 [2, 2] days, and longest length of stay was three days. There were no 30-day readmissions, reinterventions, or mortalities. Median follow-up time was 19 [9, 31] months. Conclusions Formalization of a perioperative surgical pulmonary valve replacement clinical pathway can safely promote short hospital length of stay without any short-term readmissions or reinterventions, especially when compared with previously published benchmarks. Such formalization enables the dissemination of best practices to other institutions to reduce hospital length of stay and limit costs.
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Ni, Jonathan S., Jocelyn Kohn, and Jessica R. Levi. "Inpatient Pediatric Epistaxis: Management and Resource Utilization." Annals of Otology, Rhinology & Laryngology 127, no. 11 (September 5, 2018): 829–35. http://dx.doi.org/10.1177/0003489418797946.
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Objectives: Epistaxis is a common condition that rarely warrants hospital admission in the pediatric population, making its inpatient management difficult to study. This study aims to use a nationwide database to analyze trends in the treatment of pediatric patients admitted with epistaxis and determine factors impacting total charges. Methods: The latest (2012) version of the Kids’ Inpatient Database (KID), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality was used to identify weighted discharges with the primary diagnosis of epistaxis. Information regarding demographics, comorbidities, treatment, hospital burden, and other admission details were obtained. Linear regression was used to analyze factors suspected to increase cost. Results: Among 372 weighted discharges, the mean age was 9.68 years (SD = 5.79), and 60.0% were male. The most common comorbidities were thrombocytopenia, von Willebrand disease, and chronic sinusitis. The majority of admissions with epistaxis (56.7%) did not undergo any procedure to control epistaxis. Mean total charges was $30 208 (SD = $62 683) with a mean length of stay of 2.46 days (SD = 3.31). Independent predictors of increased charges included longer length of stay, admission from the emergency department, and median household income within the third quartile for patients’ ZIP codes. Midwest hospital region independently predicted decreased charges. Having a procedure to control epistaxis did not significantly impact cost. Conclusions: Pediatric epistaxis admissions often do not require long hospital stays or procedural control of the bleed. However, significant charges are incurred treating epistaxis. Awareness of factors impacting these charges can potentially improve resource utilization.
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KÖSE, Aslı. "EVALUATION OF HOSPITAL BED UTILIZATION EFFICINCY WITH PABON LASSO MODEL." IEDSR Association 7, no. 18 (March 18, 2022): 181–92. http://dx.doi.org/10.46872/pj.505.
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The aim of this study is to investigate the efficiency of hospital bed use with Pabon Lasso model. The study includes retrospective in 2005-2016 years. In order to determine the effectiveness of bed use in hospitals, bed occupancy rate (BOR), bed turnover rate (BTR) and average length of stay (ALS) were used as variables. According to Pabon Lasso model, low BOR and BTR, long ALS were found to be inefficient in 2005-2007 and 2010-2012. In 2008-2009 and 2013-2016, high BOR and BTR, short ALS were found to be efficient.
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Schumer, Grace, John W. Mann, Matthew David Stover, John F. Sloboda, Carol Sue Cdebaca, and Gina Moss Woods. "Liposomal Bupivacaine Utilization in Total Knee Replacement Does Not Decrease Length of Hospital Stay." Journal of Knee Surgery 32, no. 09 (October 29, 2018): 934–39. http://dx.doi.org/10.1055/s-0038-1673617.
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AbstractLiposomal bupivacaine has reportedly been used as an adjunct for perioperative pain management in total knee replacement (TKR). The purpose of our single-blind, prospective study is to show that wound infiltration with long-acting liposomal bupivacaine during TKR will shorten length of stay (LOS) as compared with standard bupivacaine injection and spinal anesthetic with or without spinal narcotic. A total of 195 patients were randomized into three groups: wound infiltration with bupivacaine and a spinal with narcotic (Group 1, N = 65), wound infiltration with liposomal bupivacaine and a spinal without narcotic (Group 2, N = 67), and bupivacaine wound infiltration with a spinal without narcotic (Group 3, N = 64). The groups were then compared with look for any benefit in using the liposomal bupivacaine with regard to LOS, pain control, function, and complications. There was a trend toward a decreased LOS (days) in the liposomal bupivacaine (Group 2) with a mean LOS of 1.83 as compared with wound infiltration with bupivacaine with spinal narcotic LOS of 2.04 (Group 1) and without spinal narcotic LOS of 1.94 (Group 3). These results were not statistically significant (p = 0.37). Patient-reported pain scores were no different between the three groups. The daily narcotic usage (morphine equivalents) during the hospitalization was statistically highest in the liposomal bupivacaine group at 77.2 versus 55.0 in Group 1 and 68.1 in Group 3 (p = 0.025). Nausea or vomiting was most common in Group 1 at 42%, followed by 28% in Group 2 and 22% in Group 3. Pruritus was most common in the spinal narcotic group at 38% versus Group 2 at 14% and Group 3 at 11%.Liposomal bupivacaine showed a trend toward a decreased LOS, but this was not statistically significant. There was no difference in pain scores reported by these patients. In conclusion, we cannot justify the extra cost of liposomal bupivacaine as compared with plain bupivacaine as an adjunct for perioperative pain management in TKR patients.
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Gupta, Atul, Junaid Nizamuddin, Dalia Elmofty, Sarah L. Nizamuddin, Avery Tung, Mohammed Minhaj, Ariel Mueller, Jeffrey Apfelbaum, and Sajid Shahul. "Opioid Abuse or Dependence Increases 30-day Readmission Rates after Major Operating Room Procedures." Anesthesiology 128, no. 5 (May 1, 2018): 880–90. http://dx.doi.org/10.1097/aln.0000000000002136.
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Abstract Background Although opioids remain the standard therapy for the treatment of postoperative pain, the prevalence of opioid misuse is rising. The extent to which opioid abuse or dependence affects readmission rates and healthcare utilization is not fully understood. It was hypothesized that surgical patients with a history of opioid abuse or dependence would have higher readmission rates and healthcare utilization. Methods A retrospective cohort analysis was performed of patients undergoing major operating room procedures in 2013 and 2014 using the National Readmission Database. Patients with opioid abuse or dependence were identified using International Classification of Diseases codes. The primary outcome was 30-day hospital readmission rate. Secondary outcomes included hospital length of stay and estimated hospital costs. Results Among the 16,016,842 patients who had a major operating room procedure whose death status was known, 94,903 (0.6%) had diagnoses of opioid abuse or dependence. After adjustment for potential confounders, patients with opioid abuse or dependence had higher 30-day readmission rates (11.1% vs. 9.1%; odds ratio 1.26; 95% CI, 1.22 to 1.30), longer mean hospital length of stay at initial admission (6 vs. 4 days; P < 0.0001), and higher estimated hospital costs during initial admission ($18,528 vs. $16,617; P < 0.0001). Length of stay was also higher at readmission (6 days vs. 5 days; P < 0.0001). Readmissions for infection (27.0% vs. 18.9%; P < 0.0001), opioid overdose (1.0% vs. 0.1%; P < 0.0001), and acute pain (1.0% vs. 0.5%; P < 0.0001) were more common in patients with opioid abuse or dependence. Conclusions Opioid abuse and dependence are associated with increased readmission rates and healthcare utilization after surgery.
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Dickerson, Justin B. "The influence of episodic mood disorders on length of stay among patients admitted to private and non-profit hospitals with alcohol dependence syndrome." Mental Illness 3, no. 1 (February 22, 2011): 29–32. http://dx.doi.org/10.4081/mi.2011.e8.
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Episodic mood disorders are often associated with alcohol dependence. Few studies have explored the contribution of episodic mood disorders to length of stay among those hospitalized with alcohol dependence syndrome. Filling this research gap could improve care for patients while minimizing hospital utilization costs. This study was a cross-sectional analysis of the National Hospital Discharge Survey. ICD-9-CM diagnosis codes were used to identify those admitted to a private or non-profit hospital with alcohol dependence syndrome, and a co-morbid diagnosis of an episodic mood disorder (n=358). Descriptive statistics were used to highlight differences in key demographic and hospital variables between those with and without episodic mood disorders. Negative binomial regression was used to associate episodic mood disorders with hospital length of stay. Incidence rate ratios were calculated. Co-morbid episodic mood disorders ([.beta]=0.31, P=0.001), referral to a hospital by a physician ([.beta]=0.35, P=0.014), and increasing age ([.beta]= 0.01, P=0.001) were associated with longer hospital stays. Hospital patients with an admitting diagnosis of alcohol dependence syndrome were 36% more likely to have a longer hospital stay if they also had a co-morbid diagnosis of an episodic mood disorder (IRR=1.36, CI=1.14-1.62). Patients admitted to a hospital with alcohol dependence syndrome should be routinely screened for episodic mood disorders. Opportunities exist for enhanced transitional care between acute, ambulatory, and community-based care settings to lower hospital utilization.
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Salehiomran, Abbas, Hossein Ahmadi, Abbasali Karimi, Mokhtar Tazik, Samaneh Dowlatshahi, Mahmood Fathollahi, and Seyed Abbasi. "Transfusion associated in-hospital mortality and morbidity in isolated Coronary Artery Bypass Graft surgery." Open Medicine 4, no. 3 (September 1, 2009): 286–92. http://dx.doi.org/10.2478/s11536-009-0044-3.
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AbstractTransfusion after cardiac surgery is very common. This rate varies between institutions and has remained high despite established transfusion guidelines. We analyzed our database of patients who underwent isolated CABG (Coronary Artery Bypass Graft) to determine the predictive factors of homologous transfusion and associated postoperative morbidity, mortality and resource utilization. All 14,152 patients who underwent first-time isolated CABG, with or without cardiopulmonary bypass (CPB) who had postoperative homologous transfusion between February 2002 and March 2008 in Tehran Heart Center, were evaluated retrospectively. Overall, 16.5% of patients received transfusion. Transfused patients demonstrated a significantly higher incidence of postoperative complications (cardiac, infectious, ischemic, reoperation) and mortality (p<0.001). Homologous blood transfusion effect on mortality, morbidity and resource utilization. By Multivariable logistic regression analysis adjusted for confounders: Homologous blood transfusion effect on Mortality (30-days) (OR=3.976, p<0.0001), Prolonged ventilation hours (OR=4.755, p<0.0001), Total ICU hours (β =14.599, p<0.0001), Hospital length of stay (β =1.141, p<0.0001), Post surgery length of stay (β =0.955, p<0.0001). We conclude that the isolated CABG patients receiving blood transfusion have significantly higher mortality, morbidity and resource utilization. Homologous blood transfusion is an independent factor of increased resource utilization, morbidity and mortality.
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Smith, Brian S., Walter S. Schroeder, and Gary R. Tataronis. "Hospital Reimbursement for Adult Patients with Severe Sepsis Treated with Drotrecogin Alfa (Activated)." Hospital Pharmacy 40, no. 2 (February 2005): 146–53. http://dx.doi.org/10.1177/001857870504000206.
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Purpose Patients with severe sepsis are critically ill and use a high level of health care resources. The high resource utilization and lack of a specific diagnosis related group may lead to a significant loss in revenue for health care organizations secondary to inadequate reimbursement. The primary objective of this study is to quantify the difference in total cost and reimbursement in patients with severe sepsis treated with drotrecogin alfa (activated) (DAA) at our institution. Methods All patients between December 2001 and December 2003 diagnosed with severe sepsis and treated with DAA were evaluated. Demographic data, primary payer, diagnosis related group, hospital length of stay, length of medical/surgical stay, length of Intensive Care Unit stay, days on mechanical ventilation, total costs, and total reimbursement were determined by chart review and our institution's information systems. Results Data from a total of 71 patients were included. The total treatment cost was $6,294,590, and the total reimbursement received was $4,295,950. This represents a loss of $1,998,640 or $28,150 per patient. The primary factor contributing to this loss was Intensive Care Unit length of stay (P = 0.011). Conclusion Management of patients with severe sepsis is costly and strains hospital resources. The current reimbursement system does not allow for appropriate compensation. Therefore, in addition to efforts directed toward improved treatment strategies for severe sepsis, health care practitioners must target interventions to reduce hospital length of stay and maximize reimbursement.
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Vidula, Neelima, Emilia Kaslow-Zieve, Carolyn Qian, Isabel Neckermann, Eva Gaufberg, Charu Vyas, Richard Newcomb, et al. "Abstract P4-12-04: Healthcare utilization and symptoms among hospitalized patients with breast cancer." Cancer Research 82, no. 4_Supplement (February 15, 2022): P4–12–04—P4–12–04. http://dx.doi.org/10.1158/1538-7445.sabcs21-p4-12-04.
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Abstract Background: Patients with breast cancer generally receive most of their care in an outpatient setting, but unplanned hospitalizations may occur to help manage uncontrolled symptoms. We sought to investigate healthcare utilization and symptoms among patients with breast cancer experiencing an unplanned hospitalization. Methods: We enrolled patients with cancer and unplanned hospitalizations from 9/2014 to 2/2017. The current study focuses on the patients with breast cancer in this cohort. Following hospital admission, we assessed patient-reported symptoms using the Edmonton Symptom Assessment System (ESAS). We reviewed the electronic health record to obtain information about patient demographics, clinical characteristics, healthcare utilization, and reasons for hospital admission (elicited from primary and secondary diagnoses listed on the hospitalization discharge summary). We examined the associations among patients’ symptoms, healthcare utilization (i.e., hospital length of stay and 90-day readmissions), and survival using regression models. Results: We identified 101 patients with breast cancer (median age=60 years [range 22-86]. In this cohort, 74% had metastatic breast cancer. Primary/secondary reasons for hospitalization included fever/infection (34%), pain (18%), dyspnea (12%), gastrointestinal diagnoses (constipation, diarrhea, bowel obstruction, biliary obstruction, ascites, 10%), nausea/vomiting (7%), failure to thrive (6%), pleural effusion (5%), renal failure (4%), blood clot (3%), cardiac diagnoses (atrial fibrillation, cardiomyopathy, 3%), lightheadedness/hypotension (3%), neurologic diagnoses (altered mental status, seizure, subdural hematoma, 3%), fracture (2%), lower extremity swelling (2%), and other (i.e., rash, ptosis, SVC syndrome, fall, 1% each). Table 1 describes the baseline ESAS symptoms collected upon hospital admission. The mean length of hospital stay was 6.2 days and 90-day readmission rates were 28%. Patient disposition post hospitalization included discharge to home (76%), post-acute care facility (12%), hospice (5%), and death in the hospital (6%). We found that patients’ ESAS-physical symptoms were associated with longer hospital length of stay (B=0.08, p=0.029), greater risk of death or readmission within 90-days (OR=1.07, p<0.001), and worse overall survival (HR=1.04, p=0.001). Similarly, patients’ ESAS-total symptoms were associated with longer hospital length of stay (B=0.07, p=0.013), greater risk of death or readmission within 90-days (OR=1.05, p=0.001), and worse overall survival (HR=1.02, p=0.003). Conclusions: In this cohort of hospitalized patients with breast cancer, the majority had metastatic disease and presented with a high symptom burden. Unplanned admissions in these patients with breast cancer commonly occurred for fever/infection, pain, dyspnea, and gastrointestinal reasons. We identified novel associations among patients’ symptoms upon admission with their hospital length of stay, risk of readmissions/death, and overall survival. These findings highlight the need for timely outpatient interventions that address patient symptoms when seeking to enhance health care utilization and survival outcomes in this population. Table 1.Baseline symptom% of patients with moderate or severe symptomsMedian ESAS scoreTiredness*90%8 (Severe)Pain*78%7 (Severe)Well-being76%5 (Moderate)Drowsiness*71%6 (Moderate)Lack of appetite*68%5 (Moderate)Anxiety61%5 (Moderate)Depression52%4 (Moderate)Nausea*45%2 (Mild)Shortness of breath*45%2 (Mild)Constipation*44%0 (None)Total ESAS scoreMedian score 47 Total ESAS_physical score. . Median score 34*components included in ESAS_physical score Citation Format: Neelima Vidula, Emilia Kaslow-Zieve, Carolyn Qian, Isabel Neckermann, Eva Gaufberg, Charu Vyas, Richard Newcomb, Patrick C Johnson, Daniel Lage, Jennifer Shin, Ryan Nipp. Healthcare utilization and symptoms among hospitalized patients with breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-12-04.
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Vyas, Arpita K., Yiu Ming Chan, and Lavi Oud. "Variation in Utilization of Intensive Care for Pediatric Diabetic Ketoacidosis." Journal of Intensive Care Medicine 35, no. 11 (August 13, 2019): 1314–22. http://dx.doi.org/10.1177/0885066619868972.
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Objective: To examine the hospital-level variation in intensive care unit (ICU) utilization and quantify the relative contribution of patient and hospital characteristics versus individual hospital factors to the variation in ICU admission rates among pediatric hospitalizations with diabetic ketoacidosis (DKA). Methods: The Texas Inpatient Public Use Data File was used to identify hospitalizations of state residents aged 1 month to 19 years with a primary diagnosis of DKA between 2005 and 2014. Multilevel, mixed-effects logistic regression modeling was performed to examine the association of patient- and hospital-level factors with ICU admission. Risk and reliability adjustment was then performed to assess hospital-level variation in ICU utilization. Intraclass correlation coefficient was used to quantify variation in use of ICU attributable to individual hospitals. The association between adjusted rates of ICU admission and total hospital charges and length of stay was examined using linear regression. Results: Of the 23 585 DKA hospitalizations, 14 638 (62.1%) were admitted to ICU. On multilevel analysis, the odds of ICU admission progressively decreased with rising volume of DKA hospitalizations (adjusted odds ratio: 0.08 [highest vs lowest quartile]; 95% confidence interval [CI]: 0.03-0.24). The crude median (interquartile range [IQR]; range) of ICU admissions across hospitals was 82.6% (73%-90%; 11.1%-100%). The median (IQR) risk- and reliability-adjusted ICU admission rate was 81.0% (73.0%-86.9%), ranging from 11.2% to 94%. Following risk and reliability adjustment, the intraclass correlation coefficient was 0.005 (95% CI: 0.004-0.006). For each 10% increase in adjusted ICU admission rate, total hospital charges rose by 7% (95% CI: 3%-11%). There was no association between ICU admission rates and hospital length of stay. Conclusion: Although high variation in ICU utilization was noted across hospitals among pediatric DKA hospitalizations, the proportion of variation attributable to individual hospitals was negligible, once adjusted for patient mix and hospital characteristics.
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Nguyen, Christine, Brian Downer, Lin-Na Chou, Yong-Fang Kuo, and Mukaila Raji. "End-of-Life Healthcare Utilization of Older Mexican Americans With and Without a Diagnosis of Alzheimer’s Disease and Related Dementias." Journals of Gerontology: Series A 75, no. 2 (March 11, 2019): 326–32. http://dx.doi.org/10.1093/gerona/glz065.
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Abstract Background Little is known about the patterns of end-of-life health care for older Mexican Americans with or without a diagnosis of Alzheimer’s disease and related dementias (ADRD). Our objective was to investigate the frequency of acute hospital admissions, intensive care unit use, and ventilator use during the last 30 days of life for deceased older Mexican American Medicare beneficiaries with and without an ADRD diagnosis. Methods We used Medicare claims data linked with survey information from 1,090 participants (mean age of death 85.1 years) of the Hispanic Established Populations for the Epidemiologic Studies of the Elderly. Multivariable logistic regression models were used to estimate the odds for hospitalization, intensive care unit use, and ventilator use in the last 30 days of life for decedents with ADRD than those without ADRD. Generalized linear models were used to estimate the risk ratio (RR) for length of stay in hospital. Results Within the last 30 days of life, 64.5% decedents had an acute hospitalization (59.1% ADRD, 68.3% no ADRD), 33.9% had an intensive care unit stay (31.3% ADRD, 35.8% no ADRD), and 17.2% used a ventilator (14.9% ADRD, 18.8% no ADRD). ADRD was associated with significantly lower hospitalizations (odds ratio [OR] = 0.67, 95% confidence interval [CI] = 0.50–0.89) and shorter length of stay in hospital (RR = 0.77, 95% CI = 0.65–0.90). Conclusion Hospitalization, intensive care unit stay, and ventilator use are common at the end of life for older Mexican Americans. The lower hospitalization and shorter length of stay in hospital of decedents with ADRD indicate a modest reduction in acute care use. Future research should investigate the impact of end-of-life planning on acute-care use and quality of life in terminally ill Mexican American older adults.
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Juzwishin, Donald W. M. "Case Study: Assessing Laparoscopic Cholecystectomy:The GVHS Experience." International Journal of Technology Assessment in Health Care 11, no. 4 (1995): 685–94. http://dx.doi.org/10.1017/s0266462300009119.
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AbstractThis article describes the experience at the Greater Victoria Hospital Society of assessing the appropriateness of introducing laparoscopic cholecystectomy (lap chole) within the framework of an established technology assessment process. Lap chole promised to deliver cost savings; however, these could only be realized by capitalizing on the reduced length of stay by removing the surgical beds from service. A cautionary note is raised as to whether the increased use of lap chole in the population is appropriate.
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Hsueh, Kevin, Maria Reyes, Tamara Krekel, Ed Casabar, David J. Ritchie, S. Reza Jafarzadeh, Amanda J. Hays, Michael A. Lane, and Michael J. Durkin. "Effective Antibiotic Conservation by Emergency Antimicrobial Stewardship During a Drug Shortage." Infection Control & Hospital Epidemiology 38, no. 3 (December 5, 2016): 356–59. http://dx.doi.org/10.1017/ice.2016.289.
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We present the first description of an antimicrobial stewardship program (ASP) used to successfully manage a multi-antimicrobial drug shortage. Without resorting to formulary restriction, meropenem utilization decreased by 69% and piperacillin-tazobactam by 73%. During the shortage period, hospital mortality decreased (P=.03), while hospital length of stay remained unchanged.Infect Control Hosp Epidemiol 2017;38:356–359
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Weiss, Thomas W., Carol M. Ashton, and Nelda P. Wray. "Forecasting Areawide Hospital Utilization: A Comparison of Five Univariate Time Series Techniques." Health Services Management Research 6, no. 3 (August 1993): 178–90. http://dx.doi.org/10.1177/095148489300600304.
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Time series analysis is one of the methods health services researchers, managers and planners have to examine and predict utilization over time. The focus of this study is univariate time series techniques, which model the change in a dependent variable over time, using time as the only independent variable. These techniques can be used with administrative healthcare databases, which typically contain reliable, time-specific utilization variables, but may lack adequate numbers of variables needed for behavioral or economic modeling. The inpatient discharge database of the Department of Veterans Affairs, the Patient Treatment File, was used to calculate monthly time series over a six-year period for the nation and across US Census Bureau regions for three hospital utilization indicators: Average length of stay, discharge rate, and multiple stay ratio, a measure of readmissions. The first purpose of this study was to determine the accuracy of forecasting these indicators 24 months into the future using five univariate time series techniques. In almost all cases, techniques were able to forecast the magnitude and direction of future utilization within a 10% mean monthly error. The second purpose of the study was to describe time series of the three hospital utilization indicators. This approach raised several questions concerning Department of Veterans Affairs hospital utilization.
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Kelly, Yvelynne P., Kavita Mistry, Salman Ahmed, Shimon Shaykevich, Sonali Desai, Stuart R. Lipsitz, David E. Leaf, et al. "Controlled Study of Decision-Making Algorithms for Kidney Replacement Therapy Initiation in Acute Kidney Injury." Clinical Journal of the American Society of Nephrology 17, no. 2 (December 15, 2021): 194–204. http://dx.doi.org/10.2215/cjn.02060221.
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Background and objectivesAKI requiring KRT is associated with high mortality and utilization. We evaluated the use of an AKI Standardized Clinical Assessment and Management Plan (SCAMP) on patient outcomes, including mortality, hospital length of stay, and intensive care unit length of stay.Design, setting, participants, & measurementsWe conducted a 12-month controlled study in the intensive care units of a large academic tertiary medical center. We alternated use of the AKI-SCAMP with use of a “sham” control form in 4- to 6-week blocks. The primary outcome was risk of inpatient mortality. Prespecified secondary outcomes included 30- and 60-day mortality, hospital length of stay, and intensive care unit length of stay. Generalized estimating equations were used to estimate the effect of the AKI-SCAMP on mortality and length of stay.ResultsThere were 122 patients in the AKI-SCAMP group and 102 patients in the control group. There was no significant difference in inpatient mortality associated with AKI-SCAMP use (41% versus 47% control). AKI-SCAMP use was associated with significantly reduced intensive care unit length of stay (mean, 8; 95% confidence interval, 8 to 9 days versus mean, 12; 95% confidence interval, 10 to 13 days; P<0.001) and hospital length of stay (mean, 25; 95% confidence interval, 22 to 29 days versus mean, 30; 95% confidence interval, 27 to 34 days; P=0.02). Patients in the AKI-SCAMP group were less likely to receive KRT in the context of physician-perceived treatment futility than those in the control group (2% versus 7%; P=0.003).ConclusionsUse of the AKI-SCAMP tool for AKI KRT was not significantly associated with inpatient mortality, but was associated with reduced intensive care unit length of stay, hospital length of stay, and use of KRT in cases of physician-perceived treatment futility.Clinical Trial registry name and registration numberAcute Kidney Injury Standardized Clinical Assessment and Management Plan for Renal Replacement Initiation, NCT03368183.PodcastThis article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2022_02_07_CJN02060221.mp3
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Ortiz, Ricardo, Sezai Ozkan, Neal C. Chen, and Kyle R. Eberlin. "Firework Injuries of the Hand: An Analysis of Treatment and Health Care Utilization." HAND 15, no. 6 (March 17, 2019): 831–36. http://dx.doi.org/10.1177/1558944719829905.
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Background: Firework injuries to the hand can be devastating due to the explosive and ballistic nature of these devices. The aim of this study was to describe the injury and treatment characteristics of patients requiring surgery for firework-related hand injuries and to investigate which factors are associated with an increased utilization of health care resources. Methods: A retrospective chart review of patients undergoing surgery for firework-related hand injuries at two American College of Surgeons level I trauma centers between 2005 and 2016 was performed. Twenty cases were identified. These patients were evaluated for demographics, injury characteristics, number and types of surgical interventions, length of stay, and utilization of health care resources. Bivariate analyses were performed to investigate which factors were associated with increased consumption of health care resources. Results: Injuries ranged from digital nerve injuries to traumatic amputation. Patients underwent a median of 3 surgical operations. More than half the patients underwent flap or skin graft coverage of a soft tissue defect. The median length of hospital stay was 7 days. Factors found to be associated with an increased utilization of surgical and hospital resources included a first web space injury, thumb fracture, and traumatic amputation of any digit. Conclusions: The morbidity inflicted by firework injuries to individual patients is substantial. Patients with severe injuries undergo a median of three surgical operations and have a long duration of initial hospital stay. Knowing which factors are associated with an increased utilization of resources can help prognosticate these preventable injuries.
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Sarvepalli, Shashank, Sushil K. Garg, Siri S. Sarvepalli, Chimaobi Anugwom, Vaibhav Wadhwa, Prashanthi N. Thota, and Madhusudhan R. Sanaka. "Hospital Utilization in Patients With Gastric Cancer and Factors Affecting In-Hospital Mortality, Length of Stay, and Costs." Journal of Clinical Gastroenterology 53, no. 4 (April 2019): e157-e163. http://dx.doi.org/10.1097/mcg.0000000000001016.
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Teixeira, Pedro G. R., Kenji Inaba, Joseph Dubose, Ali Salim, Carlos Brown, Peter Rhee, Timothy Browder, and Demetrios Demetriades. "Enterocutaneous Fistula Complicating Trauma Laparotomy: A Major Resource Burden." American Surgeon 75, no. 1 (January 2009): 30–32. http://dx.doi.org/10.1177/000313480907500106.
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Enterocutaneous fistula (ECF) is an uncommon and poorly studied postoperative complication. The objective of this study was to analyze the incidence and resource utilization of patients who developed an ECF after trauma laparotomy. All patients with an ECF occurring after trauma laparotomy at a Level I trauma center were identified through a review of both the Trauma Registry and the Morbidity and Mortality reports for a 9-year period ending in December 2006. Each ECF case was matched with a control (non-ECF) that did not develop this complication after laparotomy. The matching criteria were: age, gender, mechanism of injury, Injury Severity Score, Abbreviated Injury Score, and damage control laparotomy requiring an open abdomen. Outcomes analyzed were intensive care unit (ICU) and hospital length of stay, mortality, and total hospital charges. During the 9-year period, of 2373 acute trauma laparotomies performed, 36 (1.5%) patients developed an enterocutaneous fistula, and were matched to 36 controls. Patients with an ECF were 31 ± 12 years of age, were 97 per cent male, had a mean Injury Severity Score of 21 ± 10, and 75 per cent were penetrating. Eighty-nine per cent of the ECF patients had a hollow viscus injury. The most common was colon (69%), followed by small bowel (53%), duodenum (36%), and stomach (19%). Fifty-six per cent of the ECF patients had multiple hollow viscus injuries. The development of an ECF was associated with significantly increased ICU length of stay (28.5 ± 30.5 vs 7.6 ± 9.3 days, P = 0.004), hospital length of stay (82.1 ± 100.8 vs 16.2 ± 17.3 days, P < 0.001), and hospital charges ($539,309 vs $126,996, P < 0.001). In conclusion, the development of an enterocutaneous fistula after laparotomy for trauma resulted in a significant impact on resource utilization including longer ICU and hospital length of stay and higher hospital charges. Further investigation into the prevention and treatment of this costly complication is warranted.
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Gkika, Eliona, Anna Psaroulaki, Yannis Tselentis, Emmanouil Angelakis, and Vassilis S. Kouikoglou. "Can point-of-care testing shorten hospitalization length of stay? An exploratory investigation of infectious agents using regression modelling." Health Informatics Journal 25, no. 4 (September 4, 2018): 1606–17. http://dx.doi.org/10.1177/1460458218796612.
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This retrospective study investigates the potential benefits from the introduction of point-of-care tests for rapid diagnosis of infectious diseases. We analysed a sample of 441 hospitalized patients who had received a final diagnosis related to 18 pathogenic agents. These pathogens were mostly detected by standard tests but were also detectable by point-of-care testing. The length of hospital stay was partitioned into pre- and post-laboratory diagnosis stages. Regression analysis and elementary queueing theory were applied to estimate the impact of quick diagnosis on the mean length of stay and the utilization of healthcare resources. The analysis suggests that eliminating the pre-diagnosis times through point-of-care testing could shorten the mean length of hospital stay for infectious diseases by up to 34 per cent and result in an equal reduction in bed occupancy and other resources. Regression and other more sophisticated models can aid the financing decision-making of pilot point-of-care laboratories in healthcare systems.
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Yang, Grace M., Siqin Zhou, Zhizhen Xu, Stella SL Goh, Xia Zhu, Dawn QQ Chong, Daniel SW Tan, et al. "Comparing the effect of a consult model versus an integrated palliative care and medical oncology co-rounding model on health care utilization in an acute hospital – an open-label stepped-wedge cluster-randomized trial." Palliative Medicine 35, no. 8 (September 2021): 1578–89. http://dx.doi.org/10.1177/02692163211022957.
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Background: The benefit of specialist palliative care for cancer inpatients is established, but the best method to deliver specialist palliative care is unknown. Aim: To compare a consult model versus a co-rounding model; both provide the same content of specialist palliative care to individual patients but differ in the level of integration between palliative care and oncology clinicians. Design: An open-label, cluster-randomized trial with stepped-wedge design. The primary outcome was hospital length of stay; secondary outcomes were 30-day readmissions and access to specialist palliative care. ClinicalTrials.gov number NCT03330509. Setting/participants: Cancer patients admitted to the oncology inpatient service of an acute hospital in Singapore. Results: A total of 5681 admissions from December 2017 to July 2019 were included, of which 5295 involved stage 3-4 cancer and 1221 received specialist palliative care review. Admissions in the co-rounding model had a shorter hospital length of stay than those in the consult model by 0.70 days (95%CI −0.04 to 1.45, p = 0.065) for all admissions. In the sub-group of stage 3-4 cancer patients, the length of stay was 0.85 days shorter (95%CI 0.05–1.65, p = 0.038). In the sub-group of admissions that received specialist palliative care review, the length of stay was 2.62 days shorter (95%CI 0.63–4.61, p = 0.010). Hospital readmission within 30 days (OR1.03, 95%CI 0.79–1.35, p = 0.822) and access to specialist palliative care (OR1.19, 95%CI 0.90–1.58, p = 0.215) were similar between the consult and co-rounding models. Conclusions: The co-rounding model was associated with a shorter hospital length of stay. Readmissions within 30 days and access to specialist palliative care were similar.
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Ricci, J., N. Suskin, S. Stranges, A. Pierce, T. Fair, T. Appasamy, and S. Frisbee. "AN INTEGRATED, REGION-WIDE CARDIAC REHABILITATION SYSTEM: IMPACT ON HOSPITAL UTILIZATION & LENGTH OF STAY." Canadian Journal of Cardiology 34, no. 10 (October 2018): S99—S100. http://dx.doi.org/10.1016/j.cjca.2018.07.258.
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Anderson, Brett R., Adam J. Ciarleglio, David J. Cohen, Wyman W. Lai, Matthew Neidell, Matthew Hall, Sherry A. Glied, and Emile A. Bacha. "The Norwood operation: Relative effects of surgeon and institutional volumes on outcomes and resource utilization." Cardiology in the Young 26, no. 4 (July 14, 2015): 683–92. http://dx.doi.org/10.1017/s1047951115001031.
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AbstractBackgroundHypoplastic left heart syndrome is the most expensive birth defect managed in the United States, with a 5-year survival rate below 70%. Increasing evidence suggests that hospital volumes are inversely associated with mortality for infants with single ventricles undergoing stage 1 surgical palliation. Our aim was to examine the relative effects of surgeon and institutional volumes on outcomes and resource utilisation for these children.MethodsA retrospective study was conducted using the Pediatric Health Information System database to examine the effects of the number of procedures performed per surgeon and per centre on mortality, costs, and post-operative length of stay for infants undergoing Risk Adjustment for Congenital Heart Surgery risk category six operations at tertiary-care paediatric hospitals, from 1 January, 2004 to 31 December, 2013. Multivariable modelling was used, adjusting for patient and institutional characteristics. Gaussian kernel densities were constructed to show the relative distributions of the effects of individual institutions and surgeons, before and after adjusting for the number of cases performed.ResultsA total of 2880 infants from 35 institutions met the inclusion criteria. Mortality was 15.0%. Median post-operative length of stay was 24 days (IQR 14–41). Median standardized inpatient hospital costs were $156,000 (IQR $108,000–$248,000) in 2013 dollars. In the multivariable analyses, higher institutional volume was inversely associated with mortality (p=0.001), post-operative length of stay (p=0.004), and costs (p=0.001). Surgeon volume was associated with none of the measured outcomes. Neither institutional nor surgeon volumes explained much of the wide variation in outcomes and resource utilization observed between institutions and between surgeons.ConclusionsIncreased institutional – but not surgeon – volumes are associated with reduced mortality, post-operative length of stay, and costs for infants undergoing stage 1 palliation.
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Kaewput, Wisit, Charat Thongprayoon, Tananchai Petnak, Wisit Cheungpasitporn, Fawad Qureshi, Boonphiphop Boonpheng, Saraschandra Vallabhajosyula, Tarun Bathini, Sohail Abdul Salim, and Tibor Fülöp. "Rhabdomyolysis among hospitalized patients for salicylate intoxication in the United States: Nationwide inpatient sample 2003–2014." PLOS ONE 16, no. 3 (March 8, 2021): e0248242. http://dx.doi.org/10.1371/journal.pone.0248242.
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Introduction This study aimed to assess the risk factors and impact of rhabdomyolysis on treatments, outcomes, and resource utilization in hospitalized patients for salicylate intoxication in the United States. Materials and methods The National Inpatient Sample was utilized to identify hospitalized patients with a primary diagnosis of salicylate intoxication from 2003–2014. Rhabdomyolysis was identified using hospital diagnosis code. We compared the clinical characteristics, in-hospital treatment, outcomes, and resource utilization between patients with and without rhabdomyolysis. Results A total of 13,805 hospital admissions for salicylate intoxication were studied. Of these, rhabdomyolysis developed in 258 (1.9%) admissions. The risk factors for rhabdomyolysis were age>20 years, male sex, volume depletion, hypokalemia, sepsis, and seizure. After adjustment for baseline clinical characteristics, salicylate intoxication patients with rhabdomyolysis required more invasive mechanical ventilation, and renal replacement therapy. Rhabdomyolysis was significantly associated with higher risk of failure of any organ systems, and in-hospital mortality. Length of hospital stay and hospitalization cost were higher when rhabdomyolysis occurred during hospital stay. Conclusions Rhabdomyolysis was not common in hospitalized patients for salicylate intoxication but it was associated with increased morbidity, mortality, and resource utilization.
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Kasi, Anup, Raed Moh'd Taiseer Al-Rajabi, Anwaar Saeed, Weijing Sun, and Saqib Abbasi. "Deaths among pancreatic cancer in-hospital, and the utilization of palliative care." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e16803-e16803. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e16803.
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e16803 Background: Pancreatic cancer has a dismal 5 year survival of 5-10%. Deaths commonly occur in-hospital as they present with acute complications. The purpose of this study is characterize this population compared to all pancreatic deaths, identify causes for admission, trends in palliative care utilization and its effect on costs and patient stay. Methods: From the years of 2002 to 2014, admissions for patients with a diagnosis of pancreatic cancer were identified using the National Inpatient Sample. Annual trends in death were compared to overalls deaths using SEER data. Trends in hospital length of stay (LOS) and total charges (TC) were assessed, as well as utilization of palliative care. The effect of palliative care utilization on hospital LOS and TC were also identified. Results: 97,389 (weighted) patient deaths occurred from 2002 to 2014, with 7,634 in 2002, compared to 7,200 in 2014. Compared to total overall deaths of 38,026 and 42,047 respectively. Signifying 25% (2002) to 21% (2014) total patients expiring in an in-patient setting. The most common billed primary diagnosis was sepsis at 15.5%, followed by acute renal failure and fluid disorder (12.5%) and liver failure (5.3%). Overall length of stay trended down from 9.0 days to 7.5 days (p < 0.001). And total charges for admission increased from $36,704 to $88,063 (p < 0.001). Palliative care consults increased from 12% in 2002 to 45% in 2014. In 2014, the TC for deaths among those who received palliative care consults was $52,612 (p < 0.001 when compared to all deaths). LOS among these patients also decreased from 7.5 days to 6.2 days. When looking at patients with sepsis who did not die, a palliative care consult decreased costs from $86,738 to $74,544 (p < 0.001). LOS was not significantly different at 8.8 days compared to 8.5 days (p = 0.15). Conclusions: A quarter of patients with pancreatic cancer die in an in-hospital setting. Palliative involvement decreased health care resource utilization. In reviewing patients who developed sepsis without in-hospital mortality, a palliative care consult decreased total charges of admission.
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Bianchi, Marco, Quoc-Dien Trinh, Maxine Sun, Malek Meskawi, Jan Schmitges, Shahrokh F. Shariat, Alberto Briganti, et al. "Impact of academic affiliation on radical cystectomy outcomes in." Canadian Urological Association Journal 6, no. 4 (February 21, 2013): 245. http://dx.doi.org/10.5489/cuaj.292.
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Background: The objective of this study was to examine the rates of blood transfusions, prolonged length of stay, intraoperative and postoperative complications, as well as in-hospital mortality, stratified according to institutional academic status in patients undergoing radical cystectomy (RC).Methods: Within the Health Care Utilization Project NationwideInpatient Sample (NIS), we focused on patients in whom RC was performed between 1998 and 2007. Multivariable logistic regression analyses were fitted to predict the likelihood of blood transfusions, prolonged length of stay, intraoperative and postoperative complications, and in-hospital mortality. Covariates included age, race, gender, Charlson Comorbidity Index (CCI), hospital region, insurance status, annual hospital caseload (AHC), year of surgery and urinary diversion.Results: Overall, 12 262 patients underwent RC. Of those, 7892(64.4%) were from academic institutions. Patients treated at academic institutions were younger and healthier at baseline (all p < 0.001). RCs performed at academic institutions were associated with fewer postoperative complications (28.8% vs. 32.9%, p < 0.001), shorter length of stay (54.0% vs. 56.2%, p = 0.02) and lower in-hospital mortality rates (2.1 vs. 3.0%, p = 0.002). In multivariable analyses, patients who underwent RC at an academic hospital were 12% less likely to succumb to postoperative complications (odds ratio=0.88, p = 0.003).Interpretation: Even after adjusting for AHC, RCs performed atacademic institutions are associated with better postoperative outcomes than RCs performed at non-academic institutions. From a public health prospective, performing RCs at academic institutions may help reduce costs associated with the management of complicationsand prolonged length of stay.
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Doyle, Michael, Brendan J. Barrett, Jackie McDonald, Jerry McGrath, and Patrick S. Parfrey. "The Efficiency of Acute Care Bed Utilization in Newfoundland and Labrador." Healthcare Management Forum 11, no. 3 (October 1998): 15–19. http://dx.doi.org/10.1016/s0840-4704(10)60665-5.
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Hospital efficiency is closely related to utilization levels and length of stay. This study determined whether inappropriate bed utilization in Newfoundland was related to inefficiency or inadequate access to alternative services. It also compared Canadian Institute for Health Information (CIHI) data to our survey to determine whether they provide comparable information for monitoring efficiency. Inappropriate acute care days were identified using a modified Appropriateness Evaluation Protocol. Average length of stay (ALOS) by service for each of the province's acute care institutions was also reviewed from 1993–94 to 1995–96 using the CIHI database. Hospital admissions were inappropriate in 14.2 percent of 2,007 cases. Of the 14,194 days of care, 22.8 percent were inappropriate, with most (16.4 percent) being avoidable with better use of existing resources. Of the inappropriate days, 49.2 percent related to physicians' functions. The provincial ALOS fell from 5.70 days in 1993–94 to 5.39 days in 1995–96, but remains 10.5 percent above the national average. CIHI national data for ALOS by service correlated with the percent of inappropriate days by service (r=0.57). Excess bed utilization remains because of the inappropriate use of existing services, and almost half of the total inappropriate days in hospital could be influenced by physicians. CIHI data on LOS can be used to target services or physicians for focused intervention.
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Montazeripouragha, A., and AM Kaufmann. "P.119 Impact of postoperative discharge destination on length of stay." Canadian Journal of Neurological Sciences / Journal Canadien des Sciences Neurologiques 46, s1 (June 2019): S45. http://dx.doi.org/10.1017/cjn.2019.212.
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Background: The aim of this study is to assess factors impacting the postoperative length of stay (LOS) for patients undergoing microvascular decompression (MVD) surgery. Methods: A consecutive series of patients undergoing MVD at the Winnipeg Centre for Cranial Nerve Disorders were reviewed. All patients were monitored in a neurosurgical stepdown unit for at least 6 hours postoperatively and when medically stable discharged at their own discretion. The hospital LOS was measured in hours from midnight after day of surgery and categorized by days in hospital. Results: The 112 patients included 53 Manitobans (MB) and 59 from out of province (OOP). The overall LOS was 38±52 hours, and not significantly different between genders, diagnosis or age. LOS was significantly shorter for OOP versus MB patients (28±23/48±71 hours; p=0.02). OOP patients were also more often discharged on the first postoperative day (59% versus 32%; p=0.02) and 85% of them stayed at the hotel within the hospital complex prior to travelling home. Conclusions: Postoperative discharge to an adjacent hotel appears to have led to shorter LOS. These patients may have been reassured by the physical proximity to medical care. The utilization of discharge to an adjacent hotel or comparable faculty may reduce hospitalization days and associated costs.
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Weingarten, Mindl M., Jon A. Cokley, Brady Moffett, Shannon DiCarlo, and Sunita N. Misra. "Trends and Costs Associated With the Diagnosis and Treatment of Infantile Spasms: A 10-Year Multicenter Retrospective Review." Journal of Pediatric Pharmacology and Therapeutics 27, no. 1 (December 22, 2021): 29–37. http://dx.doi.org/10.5863/1551-6776-27.1.29.
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OBJECTIVE Early treatment of infantile spasms (IS) may be imperative for improvement of neurodevelopmental outcomes. Existing studies have led to inconclusive recommendations with variation in treatment. Our objective was to determine the national average cost, initial diagnostic workup, treatments, and hospital length of stay for patients with IS. METHODS This retrospective cohort study was designed to review data of patients < 2 years from 43 non-profit institutions. Data obtained included patient demographics, length of stay, admission cost, and treatments used from 2004 to 2014. Cost data were collected and adjusted to 2014 dollars, the year data were analyzed. RESULTS A total of 6183 patients met study criteria (n = 3382, 55% male). Three-quarters of patients (n = 4684, 76%) had an electroencephalogram, 56.4% had brain imaging (n = 3487), and 17% (n = 1050) underwent a lumbar puncture. Medication for IS was initiated during inpatient hospital stay in two-thirds of all patients (n = 4139, 67%). Most patients were initiated on corticotropin (n = 2066, 33%) or topiramate (n = 1804, 29%). Average length of stay was 5.8 days with an average adjusted cost of $18,348. Over time there was an 86.6% increase in cost from an average $12,534.54 (2004) to $23,391.20 (2014), a significant change (p < 0.01). This correlated with an increase in average length of stay. CONCLUSIONS Variability exists in diagnostic workup and pharmacotherapy initiated for IS, which may lead to differences in the cost of hospital stay. Further studies may help determine contributing factors to increased cost and improve health care utilization for IS patients.
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Adepoju, Omolola E., Lyoung H. Kim, and Steven M. Starks. "Hospital Length of Stay in Patients with and without Serious and Persistent Mental Illness: Evidence of Racial and Ethnic Differences." Healthcare 10, no. 6 (June 17, 2022): 1128. http://dx.doi.org/10.3390/healthcare10061128.
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Background: Prior studies have documented racial and ethnic differences in mental healthcare utilization, and extensively in outpatient treatment and prescription medication usage for mental health disorders. However, limited studies have investigated racial and ethnic differences in length of inpatient stay (LOS) in patients with and without Serious and Persistent Mental Illness. Understanding racial and ethnic differences in LOS is necessary given that longer stays in hospital are associated with adverse health outcomes, which in turn contribute to health inequities. Objective: To examine racial and ethnic differences in length of stay among patients with and without serious and persistent mental illness (SPMI) and how these differences vary in two age cohorts: patients aged 18 to 64 and patients aged 65+. Methods: This study employed a retrospective cohort design to address the research objective, using the 2018 Healthcare Cost and Utilization Project (HCUP) National Inpatient Sample. After merging the 2018 National Inpatient Sample’s Core and Hospital files, Generalized Linear Model (GLM), adjusting for covariates, was applied to examine associations between race and ethnicity, and length of stay for patients with and without SPMI. Results: Overall, patients from racialized groups were likely to stay longer than White patients regardless of severe mental health status. Of all races and ethnicities examined, Asian patients had the most extended stays in both age cohorts: 8.69 days for patients with SPMI and 5.73 days for patients without SPMI in patients aged 18 to 64 years and 8.89 days for patients with SPMI and 6.05 days for patients without SPMI in the 65+ cohort. For individuals aged 18 to 64, differences in length of stay were significantly pronounced in Asian patients (1.6 days), Black patients (0.27 days), and Native American patients/patients from other races (0.76 days) if they had SPMI. For individuals aged 65 and older, Asian patients (1.09 days) and Native American patients/patients from other races (0.45 days) had longer inpatient stays if they had SPMI. Conclusion: Racial and ethnic differences in inpatient length of stay were most pronounced in Asian patients with and without SPMI. Further studies are needed to understand the mechanism(s) for these differences.
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Castillo-Sang, Mario, Cheryl Bartone, Cassady Palmer, Vien T. Truong, Brian Kelly, Rochus K. Voeller, Jeffrey Griffin, Timothy Smith, Hilary Raidt, and Geoffrey A. Answini. "Fifty Percent Reduction in Narcotic Use After Minimally Invasive Cardiac Surgery Using Liposomal Bupivacaine." Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery 14, no. 6 (September 29, 2019): 512–18. http://dx.doi.org/10.1177/1556984519874030.
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Objective Minimally invasive cardiac surgery via a right minithoracotomy (RMT) is a common approach to different valve pathologies, tumor resection, and atrial septal defect (ASD) closure. We studied intraoperative field block using liposomal bupivacaine (LB) in these operations. Methods Consecutive 171 minimally invasive RMTs (fourth intercostal space) were studied, and patients in cardiogenic or septic shock, intravenous drug abuse, and those re-explored were excluded ( n = 12). An early cohort was treated with standard postoperative analgesia while another underwent intraoperative field block with LB immediately after incision. We compared postoperative pain level, narcotic utilization (morphine milligram equivalent), and intensive care unit (ICU) and hospital length of stay. Results The procedures included 48 isolated mitral valve replacements (MVR); 2 MVR with other procedures; 93 mitral valve repairs (MVRr); 9 MVRr with other procedures; 4 isolated tricuspid valve repairs; 2 myxoma resections; 1 ASD closure. There were 13 patients in the non-LB group and 146 patients in the LB group. Use of LB decreased mean postoperative narcotic utilization by 50% ( P = 0.003). The LB group had lower pain levels on postoperative day 1 ( P = 0.039), which continued through postoperative day 5 ( P = 0.030). We found no difference in ICU or hospital length of stay between groups. There were no complications from LB field block. Conclusions LB field block decreases postoperative pain and narcotic utilization after cardiac surgery via a RMT, but it does not reduce length of stay. The technique is safe and should be considered in all patients undergoing RMT cardiac surgery.
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Lim, Jihye, and Songhee Cheon. "Utilization of Magnetic Resonance Imaging by Comorbidity of Patients with Dementia." International Journal of Environmental Research and Public Health 16, no. 23 (November 27, 2019): 4741. http://dx.doi.org/10.3390/ijerph16234741.
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Dementia produces major clinical and social problems that have catastrophic consequences for patients and their families. Dementia also complicates clinical care for other co-existing medical conditions. Magnetic Resonance Imaging (MRI) utilization is increasingly used for diagnostic purposes, such as early diagnosis of dementia and special examination of dementia. This study analyzed the utilization status and factors affecting use of MRI examination of patients with dementia using the Charlson Comorbidity Index (CCI). We used data from the Korean National Hospital Discharge In-depth Injury Survey (KNHDS) for three years, from 2013 to 2015, investigated by Korea Centers for Disease Control and Prevention (KCDC). The subjects of the study were 643 patients whose primary diagnosis code according to the International Classification of Disease (ICD) is F00–F03 (dementia in Alzheimer’s disease, vascular dementia, unspecified dementia, etc.). As independent variables, we used sex, age, type of insurance, the admission route, length of stay, result of treatment, number of hospital beds, and the hospital’s location. In this study, the independent variables affecting MRI examination of dementia patients were length of stay, hospital location, and CCI. The ratio of MRI examination of patients with dementia in which the CCI was 1, was significantly higher by 1.757 times than in cases where the CCI was 0. Hence, it can be used to provide basic data for formulating health care policy for dementia patients by studying their overall situation.
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Han, Xueyan, Feng Jiang, Huixuan Zhou, Jack Needleman, Moning Guo, Yin Chen, Yuanli Liu, and Yilang Tang. "Hospitalization Pattern, Inpatient Service Utilization and Quality of Care in Patients With Alcohol Use Disorder: A Sequence Analysis of Discharge Medical Records." Alcohol and Alcoholism 55, no. 2 (December 17, 2019): 179–86. http://dx.doi.org/10.1093/alcalc/agz081.
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Abstract Aims To identify and group hospitalization trajectory of alcohol use disorder (AUD) patients and its associations with service utilization, healthcare quality and hospital-level variations. Methods Inpatients with AUD as the primary diagnosis from 2012 to 2014 in Beijing, China, were identified. Their discharge medical records were extracted and analyzed using the sequence analysis and the cluster analysis. Results Eight-hundred thirty-one patients were included, and their hospitalization patterns were grouped into four clusters: short stay (n = 565 (67.99%)), mean psychiatric length of stay in 3 years: (32.25 ± 18.69), repeated short stay (n = 211 (25.39%), 137.76 ± 88.8 days), repeated long stay (n = 41 (4.93%), 405.44 ± 146.54 days), permanent stay (n = 14 (1.68%), 818.14 ± 225.22 days). The latter two clusters (6.61% patients) used 37.26% of the total psychiatric hospital days and 33.65% of the total psychiatric hospitalization expenses. All the patients in the permanent stay cluster and 41.77% of the patients in the short stay cluster were readmitted at least once within 3 years. Two-hundred thirty-four patients (28.16%) were admitted at least once for non-psychiatric reasons, primarily for diseases of circulatory and digestive systems. Cluster composition varied significantly among different hospitals. Conclusion Hospitalization pattern of patients with AUD varies greatly, and while most (>2/3) hospitalizations were short stay, those with repeated long stay and permanent stay used more than one third of the hospital days and expenses. Our findings suggest interventions targeting at certain patients may be more effective in reducing resource utilization.
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Henke, Rachel Mosher, Zeynal Karaca, Teresa B. Gibson, Eli Cutler, Marguerite L. Barrett, Katharine Levit, Jayne Johann, Lauren Hersch Nicholas, and Herbert S. Wong. "Medicare Advantage and Traditional Medicare Hospitalization Intensity and Readmissions." Medical Care Research and Review 75, no. 4 (March 8, 2017): 434–53. http://dx.doi.org/10.1177/1077558717692103.
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Medicare Advantage plans have incentives and tools to optimize patient care. Therefore, Medicare Advantage hospitalizations may have lower cost and higher quality than similar traditional Medicare hospitalizations. We applied a coarsened matching approach to 2013 Healthcare Cost and Utilization Project hospital discharge data from 22 states to compare hospital cost, length of stay, and readmissions for Traditional Medicare and Medicare Advantage. We found that Medicare Advantage hospitalizations were substantially less expensive and shorter for mental health stays but costlier and longer for injury and surgical stays. We found little difference in the cost and length of medical stays and in readmission rates. One explanation is that Medicare Advantage plans use outpatient settings for many patients with behavioral health conditions and for injury and surgical patients with less complex health needs. Alternatively, the observed differences in behavioral health cost and length of stay may represent skimping on appropriate care.