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Kurihara M, Kamata K, Tokuda Y. Impact of the hospitalist system on inpatient mortality and length of hospital stay in a teaching hospital in Japan: a retrospective observational study. BMJ Open 2022; 12:e054246. [PMID: 35379623 PMCID: PMC8981289 DOI: 10.1136/bmjopen-2021-054246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine the differences in the quality of care among inpatients before and after the introduction of the hospitalist system. DESIGN A retrospective observational study. SETTING A community teaching hospital in Japan. PARTICIPANTS The inpatients admitted between the preintervention (January-December 2018) and 1-year intervention (January-December 2019) periods. There were 8508 and 8788 inpatients in 2018 and 2019, respectively. INTERVENTIONS The study compared the lengths of hospital stay and mortality among inpatients between the pre-and post-intervention (2018 and 2019) periods concerning the introduction of a hospital medicine department. OUTCOME MEASURES The primary objective was to evaluate and compare the in-hospital mortality and the length of stay (LOS) between 2018 and 2019. The secondary objective was to identify the characteristics of hospitalists and non-hospitalists in the system. RESULTS The LOS was significantly reduced after the introduction of the hospital medicine department (adjusted difference, -0.659 days; 95% CI -1.118 to -0.136, p=0.01). There were no differences in the adjusted mortalities between the two periods. CONCLUSIONS To the best of our knowledge, our study is the first involving a teaching hospital in Japan to reveal that the hospitalist system had a positive effect on the efficiency of inpatient care by shortening the LOS. Further studies are needed to clarify other benefits related to the introduction of the hospital medicine department in Japan.
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Affiliation(s)
- Masaru Kurihara
- Hospital Medicine, Urasoe General Hospital, Urasoe, Okinawa, Japan
- Patient Safetty, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Kazuhiro Kamata
- General Internal Medicine, Fukushima Medical University Aizu Medical Center, Aizu, Fukushima, Japan
- Pediatrics, Niigata University, Niigata, Japan
| | - Yasuharu Tokuda
- Muribushi Okinawa Center for Teaching Hospitals, Urasoe, Okinawa, Japan
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Predictors of thirty-day readmission in nonagenarians presenting with acute heart failure with preserved ejection fraction: a nationwide analysis. J Geriatr Cardiol 2021; 18:1008-1018. [PMID: 35136396 PMCID: PMC8782759 DOI: 10.11909/j.issn.1671-5411.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUD Acute heart failure with preserved ejection fraction (HFpEF) is a common but poorly studied cause of hospital admissions among nonagenarians. This study aimed to evaluate predictors of thirty-day readmission, in-hospital mortality, length of stay, and hospital charges in nonagenarians hospitalized with acute HFpEF. METHODS Patients hospitalized between January 2016 and December 2018 with a primary diagnosis of diastolic heart failure were identified using ICD-10 within the Nationwide Readmission Database. We excluded patients who died in index admission, and discharged in December each year to allow thirty-day follow-up. Univariate regression was performed on each variable. Variables with P-value < 0.2 were included in the multivariate regression model. RESULTS From a total of 45,393 index admissions, 43,646 patients (96.2%) survived to discharge. A total of 7,437 patients (15.6%) had a thirty-day readmission. Mean cost of readmission was 43,265 United States dollars (USD) per patient. Significant predictors of thirty-day readmission were chronic kidney disease stage III or higher [adjusted odds ratio (aOR) = 1.20, 95% CI: 1.07-1.34,P = 0.002] and diabetes mellitus (aOR = 1.18, 95% CI: 1.07-1.29,P = 0.001). Meanwhile, female (aOR = 0.90, 95% CI: 0.82-0.99,P = 0.028) and palliative care encounter (aOR = 0.27, 95% CI: 0.21-0.34,P < 0.001) were associated with lower odds of readmission. Cardiac arrhythmia (aOR = 1.46, 95% CI: 1.11-1.93, P = 0.007) and aortic stenosis (aOR = 1.36, 95% CI: 1.05-1.76,P = 0.020) were amongst predictors of in-hospital mortality. CONCLUSIONS In nonagenarians hospitalized with acute HFpEF, thirty-day readmission is common and costly. Chronic comorbidities predict poor outcomes. Further strategies need to be developed to improve the quality of care and prevent the poor outcome in nonagenarians.
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Gagnon MA, Bérubé M, Mercier É, Yanchar N, Cameron P, Stelfox T, Gabbe B, Bourgeois G, Lauzier F, Turgeon A, Belcaid A, Moore L. Low-value injury admissions in an integrated Canadian trauma system: A multicentre cohort study. Int J Clin Pract 2021; 75:e14473. [PMID: 34107144 DOI: 10.1111/ijcp.14473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/29/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Injury represents 260 000 hospitalisations and $27 billion in healthcare costs each year in Canada. Evidence suggests that there is significant variation in the prevalence of hospital admissions among emergency department presentations between countries and providers, but we lack data specific to injury admissions. We aimed to estimate the prevalence of potentially low-value injury admissions following injury in a Canadian provincial trauma system, identify diagnostic groups contributing most to low-value admissions and assess inter-hospital variation. METHODS We conducted a retrospective multicentre cohort study based on all injury admissions in the Québec trauma system (2013-2018). Using literature and expert consultation, we developed criteria to identify potentially low-value injury admissions. We used a multilevel logistic regression model to evaluate inter-hospital variation in the prevalence of low-value injury admissions with intraclass correlation coefficients (ICC). We stratified our analyses by age (1-15; 16-64; 65-74; 75+ years). RESULTS The prevalence of low-value injury admissions was 16% (n = 19 163) among all patients, 26% (2136) in children, 11% (4695) in young adults and 19% (12 345) in older adults. Diagnostic groups contributing most to low-value admissions were mild traumatic brain injury in children (48% of low-value paediatric injury admissions; n = 922), superficial injuries (14%, n = 660) or minor spinal injuries (14%, n = 634) in adults aged 16-64 and superficial injuries in adults aged 65+ (22%, n = 2771). We observed strong inter-hospital variation in the prevalence of low-value injury admissions (ICC = 37%). CONCLUSION One out of six hospital admissions following injury may be of low value. Children with mild traumatic brain injury and adults with superficial injuries could be good targets for future research efforts seeking to reduce healthcare services overuse. Inter-hospital variation indicates there may be an opportunity to reduce low-value injury admissions with appropriate interventions targeting modifications in care processes.
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Affiliation(s)
- Marc-Aurèle Gagnon
- Department of Social and Preventive Medicine, Université Laval, Québec, QC, Canada
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec - Université Laval (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada
| | - Mélanie Bérubé
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec - Université Laval (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada
- Faculté des sciences infirmières, Université Laval, Québec, QC, Canada
| | - Éric Mercier
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec - Université Laval (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada
| | - Natalie Yanchar
- Department of Surgery, Dalhousie University, Halifax, NS, Canada
| | - Peter Cameron
- The Alfred Hospital, Monash University, Melbourne, VIC, Australia
| | - Thomas Stelfox
- Department of Critical Care Medicine, University of Calgary & Alberta Health Services, Calgary, AB, Canada
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | - François Lauzier
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec - Université Laval (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada
- Département de médecine interne, Université Laval, Québec, QC, Canada
| | - Alexis Turgeon
- Department of Social and Preventive Medicine, Université Laval, Québec, QC, Canada
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec - Université Laval (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada
- Département d'anesthésiologie et de soins intensifs, Université Laval, Québec, QC, Canada
| | - Amina Belcaid
- Institut National d'Excellence en Santé et Services Sociaux, Montréal, QC, Canada
| | - Lynne Moore
- Department of Social and Preventive Medicine, Université Laval, Québec, QC, Canada
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du CHU de Québec - Université Laval (Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada
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Campbell M, Ramirez-Zohfeld V, Seltzer A, Lindquist LA. Training Hospitalists in Negotiations to Address Conflicts with Older Adults around Their Social Needs. Geriatrics (Basel) 2020; 5:E50. [PMID: 32937771 PMCID: PMC7555776 DOI: 10.3390/geriatrics5030050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/04/2020] [Accepted: 09/09/2020] [Indexed: 11/23/2022] Open
Abstract
Hospitalists care for a growing population of older patients with unique social needs that can often be addressed by providing caregiver help in the home. The importance of addressing social needs is well-recognized, yet older patients sometimes refuse these services. This refusal of services may result in rehospitalization and increased morbidity for patients. We aimed to overcome this refusal of social support through an innovative workshop training hospitalists in negotiation and dispute resolution. Hospitalists at a tertiary care, urban academic medical center completed a one-hour interactive workshop on negotiation and dispute resolution focused on addressing older patients' refusal of social services. One month post workshop, participants reported increased confidence in engaging patients and families in conflicts and felt empowered to negotiate in both their clinical practice and personal lives. Training hospitalists to negotiate with older adults needing social services is feasible and positively impacts the ability to provide geriatric care.
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Affiliation(s)
- Mobola Campbell
- Department of Medicine, Mayo Clinic, Jacksonville, FL 32224, USA;
| | - Vanessa Ramirez-Zohfeld
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA; (V.R.-Z.); (A.S.)
| | - Anne Seltzer
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA; (V.R.-Z.); (A.S.)
| | - Lee A. Lindquist
- Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA; (V.R.-Z.); (A.S.)
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Zinsaz H, Calder G, Corallo C, Gibson PR, Poojary S, Moran C. Initial experiences of an in-reach service providing iron infusions in residential aged care facilities. Australas J Ageing 2020; 39:e454-e459. [PMID: 32090443 DOI: 10.1111/ajag.12776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 01/14/2020] [Accepted: 01/18/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the feasibility of developing an in-reach parenteral iron infusion service to residents of residential aged care facilities (RACFs). METHODS An audit comparing the use of iron infusions in RACFs prior to and following the introduction of an in-reach iron infusion service. RESULTS Of the 738 inpatient iron infusions administered to inpatients ≥65 years in the 12 months prior to the in-reach service, 52 (7%) lived in an RACF, with no significant adverse events reported. After implementation of an in-reach service, a total of 37 RACF residents received parenteral iron in the first 12 months of the service, with no significant adverse events reported. CONCLUSION It is possible to safely provide parenteral iron through an in-reach service to residents in RACF. Further research is required to identify the person-level benefits achieved by this service.
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Affiliation(s)
- Hamed Zinsaz
- Department of Aged Care, Alfred Health, Melbourne, Vic., Australia.,Department of Aged Care, Monash Health, Melbourne, Vic., Australia
| | - Georgina Calder
- Mobile Assessment and Treatment Service, Alfred Health, Melbourne, Vic., Australia
| | - Carmela Corallo
- Pharmacy Department, Alfred Health, Melbourne, Vic., Australia
| | - Peter R Gibson
- Department of Gastroenterology, Alfred Health and Monash University, Melbourne, Vic., Australia
| | - Suma Poojary
- Department of Aged Care, Alfred Health, Melbourne, Vic., Australia.,Mobile Assessment and Treatment Service, Alfred Health, Melbourne, Vic., Australia
| | - Chris Moran
- Department of Aged Care, Alfred Health, Melbourne, Vic., Australia.,Department of Medicine, Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Vic., Australia.,Department of Aged Care, Peninsula Health, Melbourne, Vic., Australia
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Lee JH, Kim AJ, Kyong TY, Jang JH, Park J, Lee JH, Lee MJ, Kim JS, Suh YJ, Kwon SR, Kim CW. Evaluating the Outcome of Multi-Morbid Patients Cared for by Hospitalists: a Report of Integrated Medical Model in Korea. J Korean Med Sci 2019; 34:e179. [PMID: 31243937 PMCID: PMC6597483 DOI: 10.3346/jkms.2019.34.e179] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 06/06/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The lack of medical personnel has led to the employment of hospitalists in Korean hospitals to provide high-quality medical care. However, whether hospitalists' care can improve patients' outcomes remains unclear. We aimed to analyze the outcome in patients cared for by hospitalists. METHODS A retrospective review was conducted in 1,015 patients diagnosed with pneumonia or urinary tract infection from March 2017 to July 2018. After excluding 306 patients, 709 in the general ward who were admitted via the emergency department were enrolled, including 169 and 540 who were cared for by hospitalists (HGs) and non-hospitalists (NHGs), respectively. We compared the length of hospital stay (LOS), in-hospital mortality, readmission rate, comorbidity, and disease severity between the two groups. Comorbidities were analyzed using Charlson comorbidity index (CCI). RESULTS HG LOS (median, interquartile range [IQR], 8 [5-12] days) was lower than NHG LOS (median [IQR], 10 [7-15] days), (P < 0.001). Of the 30 (4.2%) patients who died during their hospital stay, a lower percentage of HG patients (2.4%) than that of NHG patients (4.8%) died, but the difference between the two groups was not significant (P = 0.170). In a subgroup analysis, HG LOS was shorter than NHG LOS (median [IQR], 8 [5-12] vs. 10 [7-16] days, respectively, P < 0.001) with CCI of ≥ 5 points. CONCLUSION Hospitalist care can improve the LOS of patients, especially those with multiple comorbidities. Further studies are warranted to evaluate the impact of hospitalist care in Korea.
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Affiliation(s)
- Jung Hwan Lee
- Department of Hospital Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Ah Jin Kim
- Department of Hospital Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea.
| | - Tae Young Kyong
- Department of Hospital Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Hun Jang
- Department of Hospital Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Jeongmi Park
- Department of Hospital Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Jeong Hoon Lee
- Department of Hospital Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Man Jong Lee
- Department of Hospital Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Jung Soo Kim
- Department of Hospital Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Young Ju Suh
- Department of Biomedical Sciences, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Seong Ryul Kwon
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
| | - Cheol Woo Kim
- Department of Internal Medicine, Inha University Hospital, Inha University School of Medicine, Incheon, Korea
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Meiboom AA, de Vries H, Scheele F, Hertogh CMPM. Raising enthusiasm for the medical care of elderly patients: a concept mapping study to find elements for an elderly friendly medical curriculum. BMC MEDICAL EDUCATION 2018; 18:238. [PMID: 30342513 PMCID: PMC6195977 DOI: 10.1186/s12909-018-1344-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 10/09/2018] [Indexed: 06/02/2023]
Abstract
BACKGROUND To deliver high quality of care for the growing population of older patients more geriatricians are needed. However, the interest of medical students for a career in geriatrics is lagging behind due to a lack of exposure, the nature of the work, and the low status and financial rewards. So far, only isolated interventions aimed at enhancing interest and/or attitudes with regard to geriatrics have been studied, pointing to the need for a broader-based strategy. The goal of this research is to find elements for a curriculum framework that can raise medical students' enthusiasm for the medical care of elderly patients. METHODS We used the concept mapping method developed by Trochim. This computer-assisted procedure consists of five steps: brainstorming, prioritizing and clustering with several experts, followed by processing by the computer and analysis. RESULTS The views that were generated were grouped into the following clusters: a patient-centered medical curriculum, a curriculum representative of patient population, geriatrics presented as intellectually challenging and emotionally appealing, senior-friendly role models, a clear professional perspective. The results are presented in the form of a graphic chart. CONCLUSIONS An agenda to discuss the necessary actions for drastic curricular reforms in medical schools is set. This may give some guidance to this urgent, but highly complicated issue how to make medical student enthusiastic for the medical care for elderly patients.
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Affiliation(s)
- Ariadne A. Meiboom
- Department of General Practice & Elderly Care Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Henk de Vries
- Department of General Practice & Elderly Care Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Fedde Scheele
- Department of Research in Education, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
| | - Cees M. P. M. Hertogh
- Department of General Practice & Elderly Care Medicine, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
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Parke B, Boltz M, Hunter KF, Chambers T, Wolf-Ostermann K, Adi MN, Feldman F, Gutman G. A Scoping Literature Review of Dementia-Friendly Hospital Design. THE GERONTOLOGIST 2018; 57:e62-e74. [PMID: 27831481 DOI: 10.1093/geront/gnw128] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 07/31/2016] [Indexed: 11/12/2022] Open
Abstract
Purpose We report the findings of a knowledge synthesis research project on the topic of dementia-friendly acute care (D-FAC) design. This exploratory project systematically mapped what is known about D-FAC physical design in hospitals. We discuss our challenges in locating reportable evidence and the implications of such design for maximizing independent function while ensuring safety and harm reduction in older people living with dementia. Design and Methods Exploratory iterative design utilizing scoping literature review methodology. Results A total of 28 primary studies plus expert reviewers' narratives on the impact of design and architectural features on independent function of hospitalized older people with dementia were included and evaluated. Items were mapped to key design elements to describe a D-FAC environment. This scoping review project confirms the limited nature of available acute care design evidence on maximizing function. Implications Physical design influences the usability and activity undertaken in a health care space and ultimately affects patient outcomes. Achieving safe quality hospital care for older people living with dementia is particularly challenging. Evidence of design principle effectiveness is needed that can be applied to general medical and surgical units where the bulk of older persons with and without dementia are treated.
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Affiliation(s)
- Belinda Parke
- Faculty of Nursing, University of Alberta, Edmonton, Canada
| | - Marie Boltz
- Boston College, William F. Connell School of Nursing, Chestnut Hill, Massachusetts
| | | | - Thane Chambers
- JW Scott Health Sciences Library, University of Alberta, Edmonton, Canada
| | | | - Mohamad Nadim Adi
- Department of Civil and Environmental Engineering, University of Alberta, Edmonton, Canada
| | - Fabio Feldman
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Surrey, British Columbia, Canada.,Seniors Fall and Injury Prevention, Primary Care, Chronic Disease Management and Specialized Seniors, Fraser Health Authority, Surrey, British Columbia, Canada
| | - Gloria Gutman
- Gerontology Department and Gerontology Research Centre, Simon Fraser University, Vancouver, British Columbia, Canada
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Hsu NC, Huang CC, Shu CC, Yang MC. Implementation of a seven-day hospitalist program to improve the outcomes of the weekend admission: A retrospective before-after study in Taiwan. PLoS One 2018; 13:e0194833. [PMID: 29579132 PMCID: PMC5868823 DOI: 10.1371/journal.pone.0194833] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 03/09/2018] [Indexed: 11/22/2022] Open
Abstract
Objective Patients admitted during weekends may have worse outcomes than those during weekdays. Adjusting the practice of senior physicians over weekends may reduce the weekend effect. Design A controlled before-after study, with propensity score matching (PSM) for potential confounding variables, to compare outcomes between weekday and weekend admissions. Setting A 2000-bed medical centre in Taiwan Participants Hospitalised general medicine patients cared for by traditional internal medicine teams (pre-intervention cohort) and those cared for by hospitalists after introducing a seven-day hospitalist program in the first six-month (post-intervention cohort) and following three-year periods. Main outcome measures Proportion of intensive care unit (ICU) admissions, cardiopulmonary resuscitation (CPR) events, and in-hospital mortality. Results The pre-intervention cohort included 982 patients. Significantly higher mortality rates (11.3% vs. 6.2%, p = 0.032) were recorded in the case of weekend admissions, with similar proportions of ICU admission and CPR events. The post-intervention cohort included 601 patients. No significant difference was recorded in any of the main outcomes between weekday and weekend admissions. PSM for pre-intervention and post-intervention cohort showed shorter LOS after intervention, with no difference in ICU admission, CPR, and morality for the weekday and weekend admissions, respectively. The three-year cohort that followed, consisting of 3315 patients, showed no difference of outcomes between weekday and weekend admissions. After PSM, there were no significant differences in ICU admission rates (1.0% vs. 1.8%), CPR (0.3% vs. 0.2%) events and hospital mortality rates (8.1% vs. 8.5%), when weekday and weekend admissions were compared. Conclusions The seven-day hospitalist program shows potential in providing equally safe care for both weekday and weekend general medicine admissions with sustainable development.
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Affiliation(s)
- Nin-Chieh Hsu
- Division of Hospital Medicine, Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- * E-mail:
| | - Chun-Che Huang
- Department of Family Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chin-Chung Shu
- Division of Hospital Medicine, Department of Traumatology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ming-Chin Yang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
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Aliberti MJR, Suemoto CK, Fortes-Filho SQ, Melo JA, Trindade CB, Kasai JYT, Altona M, Apolinario D, Jacob-Filho W. The Geriatric Day Hospital: Preliminary Data on an Innovative Model of Care in Brazil for Older Adults at Risk of Hospitalization. J Am Geriatr Soc 2016; 64:2149-2153. [DOI: 10.1111/jgs.14342] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Márlon J. R. Aliberti
- Division of Geriatrics; Department of Internal Medicine; University of São Paulo Medical School; São Paulo Brazil
| | - Claudia K. Suemoto
- Division of Geriatrics; Department of Internal Medicine; University of São Paulo Medical School; São Paulo Brazil
| | - Sileno Q. Fortes-Filho
- Division of Geriatrics; Department of Internal Medicine; University of São Paulo Medical School; São Paulo Brazil
| | - Juliana A. Melo
- Division of Geriatrics; Department of Internal Medicine; University of São Paulo Medical School; São Paulo Brazil
| | - Carolina B. Trindade
- Division of Geriatrics; Department of Internal Medicine; University of São Paulo Medical School; São Paulo Brazil
| | - Juliana Y. T. Kasai
- Division of Geriatrics; Department of Internal Medicine; University of São Paulo Medical School; São Paulo Brazil
| | - Marcelo Altona
- Division of Geriatrics; Department of Internal Medicine; University of São Paulo Medical School; São Paulo Brazil
| | - Daniel Apolinario
- Division of Geriatrics; Department of Internal Medicine; University of São Paulo Medical School; São Paulo Brazil
| | - Wilson Jacob-Filho
- Division of Geriatrics; Department of Internal Medicine; University of São Paulo Medical School; São Paulo Brazil
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Ding YY, Sun Y, Tay JC, Chong WF. Short-term outcomes of seniors aged 80 years and older with acute illness: hospitalist care by geriatricians and other internists compared. J Hosp Med 2014; 9:634-9. [PMID: 25044377 DOI: 10.1002/jhm.2238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Revised: 06/10/2014] [Accepted: 06/28/2014] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although acute geriatric units have improved the outcomes of hospitalized seniors, it is uncertain as to whether hospitalist care by geriatricians outside of these units confers similar benefit. OBJECTIVE To determine whether hospitalist care by geriatricians reduces short-term mortality and readmission, and length of stay (LOS) for seniors aged 80 years and older with acute medical illnesses compared with care by other internists. DESIGN Retrospective cohort study using administrative and chart review data on demographic, admission-related, and clinical information of hospital episodes. SETTING General internal medicine department of an acute-care hospital in Singapore from 2005 to 2008. PATIENTS Seniors aged 80 years and older with specific focus on 2 subgroups with premorbid functional impairment and acute geriatric syndromes. INTERVENTION Hospitalist care by geriatricians compared with care by other internists. MEASURES Hospital mortality, 30-day mortality or readmission, and LOS. RESULTS For 1944 hospital episodes (intervention: 968, control: 976), there was a nonsignificant trend toward lower hospital mortality (15.5% vs 16.9%) but not 30-day mortality or readmission, or LOS for care by geriatricians compared with care by other internists. A marginally stronger trend toward lower hospital mortality for care by geriatricians among those with acute geriatric syndromes (20.2% vs 23.1%) was observed. Similar treatment effects were found after adjustment for demographic, admission-related, and clinical factors. CONCLUSIONS For seniors aged 80 years and over with acute medical illness, hospitalist care by geriatricians did not significantly reduce short-term mortality, readmission, or LOS, compared with care by other internists.
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Affiliation(s)
- Yew Yoong Ding
- Department of Geriatric Medicine, Tan Tock Seng Hospital, Singapore; Health Services & Outcomes Research, National Healthcare Group, Singapore
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De Brauwer I, D’Hoore W, Swine C, Thys F, Beguin C, Cornette P. Changes in the clinical features of older patients admitted from the emergency department. Arch Gerontol Geriatr 2014; 59:175-80. [DOI: 10.1016/j.archger.2014.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Revised: 02/28/2014] [Accepted: 03/17/2014] [Indexed: 11/28/2022]
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Gonski PN, Moon I. Outcomes of a behavioral unit in an acute aged care service. Arch Gerontol Geriatr 2012; 55:60-5. [DOI: 10.1016/j.archger.2011.06.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 06/12/2011] [Accepted: 06/13/2011] [Indexed: 12/01/2022]
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Wald HL. Prevention of hospital-acquired geriatric syndromes: applying lessons learned from infection control. J Am Geriatr Soc 2012; 60:364-6. [PMID: 22332677 PMCID: PMC3321640 DOI: 10.1111/j.1532-5415.2011.03848.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Development and Evaluation of a Modified Hospital Elder Life Program. Nurs Res 2012. [DOI: 10.1097/nnr.0b013e3182447844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Hospitalists care for elderly patients daily, but few have specialized training in geriatric medicine. Elderly patients, and in particular the very old and the frail elderly, are at high risk of functional decline and iatrogenic complications during hospitalization. Other challenges in caring for this patient population include dosing medications safely, preventing delirium and accidental falls, and providing adequate pain control. Ways to improve the care of the hospitalized elderly patient include the following: screening for geriatric syndromes such as delirium, assessing functional status and maintaining mobility, and implementation of interventions that have been shown to prevent delirium, accidental falls, and acute functional decline in the hospital. This article addresses these issues with 10 evidence-based pearls developed to help hospitalists provide optimal care for this expanding population.
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Affiliation(s)
- Angelena Maria Labella
- Division of General Internal Medicine, Department of Medicine, University of Washington, Seattle, Washington 98195, USA
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Mazotti L, Moylan A, Murphy E, Harper GM, Johnston CB, Hauer KE. Advancing geriatrics education: an efficient faculty development program for academic hospitalists increases geriatric teaching. J Hosp Med 2010; 5:541-6. [PMID: 20717891 DOI: 10.1002/jhm.791] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2009] [Revised: 03/25/2010] [Accepted: 04/08/2010] [Indexed: 11/07/2022]
Abstract
BACKGROUND Hospitalists care for an increasing number of older patients. As teachers, they are uniquely positioned to teach geriatric skills to residents. Faculty development programs focused on geriatrics teaching skills are often expensive and time-intensive, and may not enhance trainee learning. OBJECTIVES To evaluate a train-the-trainer (TTT) model designed to equip hospitalists with knowledge and skills to teach geriatric topics to residents in a time-constrained, resource-limited environment. DESIGN Cross-sectional survey. SETTING Academic tertiary hospital. INTERVENTION A 10-hour geriatric curriculum, the Reynolds Program for Advancing Geriatrics Education (PAGE), cotaught by geriatricians and hospitalists at preexisting noon conferences over 1 year that consisted of exportable teaching modules. MEASUREMENTS Session leaders' and faculty participants' satisfaction, hospitalist geriatrics teaching self-efficacy, residents' self-report of frequency of geriatric teaching received, and frequency of geriatric skill use. RESULTS The curriculum was highly rated by session leaders and hospitalist faculty. Hospitalists perceived improvement in geriatric teaching skills, indicating (1: "unlikely" to 5: "highly likely") that they are likely to use these teaching tools in the future (M = 4.61, standard deviation [SD] = 0.53). Residents reported both significantly more geriatrics teaching by hospitalists (P < 0.05) and a borderline significant increase in their practice of geriatric clinical skills (P = 0.05). CONCLUSIONS A time-efficient geriatric faculty development program for hospitalists suggests improvement in the amount and quality of geriatrics teaching and skill practice among faculty and residents at an academic medical center. Concise faculty development programs within preexisting faculty meetings may be a feasible, successful method to increase geriatric skill development in the hospital setting.
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Affiliation(s)
- Lindsay Mazotti
- Department of Medicine, Division of Hospital Medicine, University of California San Francisco, San Francisco, California 94143-0131, USA.
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Kuo YF, Goodwin JS. Effect of hospitalists on length of stay in the medicare population: variation according to hospital and patient characteristics. J Am Geriatr Soc 2010; 58:1649-57. [PMID: 20863324 DOI: 10.1111/j.1532-5415.2010.03007.x] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To assess how shorter length of stay (LOS) associated with hospitalist care than with care by other physicians varied according to patient and hospital characteristics and to explore whether these differences in LOS changed over time in the Medicare population. DESIGN Retrospective cohort study using data from a 5% national sample of Medicare beneficiaries. SETTING Hospital. PARTICIPANTS To examine temporal trends, 1,981,654 Medicare admissions in 2001 to 2006 at 5,036 U.S. hospitals were used. To examine the influence of patient and hospital characteristics, 314,590 admissions in 2006 were used. MEASUREMENTS Hospital LOS. RESULTS In multivariable analyses controlling for patient and hospital characteristics, differences in LOS associated with hospitalist care increased from 0.02 fewer days in 2001/02 to 0.22 days in 2003/04 to 0.35 days in 2005/06. For 2006 admissions, differences in LOS were greater in older patients and patients with a higher diagnosis-related group (DRG) weight. The differences were three times as great for medical as for surgical DRGs, with greater differences in LOS at nonprofit than for-profit hospitals and at community than teaching hospitals. CONCLUSION The shorter LOS associated with hospitalist care would appear to be greatest in older, complicated, nonsurgical patients cared for at community hospitals.
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Affiliation(s)
- Yong-Fang Kuo
- Department of Internal Medicine and Sealy Center on Aging, University of Texas Medical Branch, Galveston, Texas, USA.
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Hauer KE, Landefeld CS. CHAMP trains champions: hospitalist-educators develop new ways to teach care for older patients. J Hosp Med 2008; 3:357-60. [PMID: 18951398 DOI: 10.1002/jhm.357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Batsis JA, Naessens JM, Keegan MT, Huddleston PM, Wagie AE, Huddleston JM. Resource utilization of total knee arthroplasty patients cared for on specialty orthopedic surgery units. J Hosp Med 2008; 3:218-27. [PMID: 18570332 DOI: 10.1002/jhm.299] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The use of specialized orthopedic surgery (SOS) units in total knee arthroplasty (TKA) patients is well established. The number and costs of arthoplasty surgeries continue to increase, requiring institutions to reexamine their existing practices for financial sustainability. OBJECTIVE The objective of this study was to determine whether having elective TKA patients in SOS units affects resource utilization and outcomes. DESIGN The study was designed to retrospectively compare elective TKA patients from 1996 to 2004 admitted directly to SOS units with those admitted to nonorthopedic nursing (NON) units. SETTING The setting was an academic teaching hospital. PATIENTS Five thousand five hundred and thirty-four patients met inclusion criteria. Of these, 5082 (patients 91.8%) were admitted to SOS units and 452 (8.2%) to NON units. MEASUREMENTS The primary outcomes measured were length of stay (LOS) and costs, adjusted for age, sex, surgical year, comorbidities, and American Society of Anesthesiologists status. Secondary outcomes were 30-day mortality, readmissions, reoperations, and discharge disposition. RESULTS Mean age of the patients in SOS and NON units was 68.3 and 67.9 years, respectively (P = .50). Adjusted LOS was 0.234 days shorter in SOS units (95% CI: 0.083, 0.385). Adjusted total and hospital cost savings in the SOS unit group were $600 (95% CI: $122, $1079) and $594 (95% CI: $141, $1047), respectively. More NON-unit patients required unanticipated transfers to the intensive care unit (ICU) from the general postoperative nursing unit (3.1% vs. 1.63%; P = .023); however, the mean number of ICU days did not differ between groups. NON-unit patients were more likely to be discharged with home health care (P < .001). There were no differences in 30-day outcomes. CONCLUSIONS Patients on SOS units following elective TKA have a reduced LOS and decreased total and hospital costs. Our results should encourage hospitals to reevaluate postoperative patient flow to optimize resource utilization.
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Affiliation(s)
- John A Batsis
- Division of Primary Care Internal Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
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