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Martins M, Mesquita A, Carvalho L, Martins F, Silva M, Leitão H, Nunes M. [Risk Factors for Delayed Discharge Due to Social Factors: A Retrospective Study]. ACTA MEDICA PORT 2023; 36:550-558. [PMID: 36780660 DOI: 10.20344/amp.18888] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Accepted: 11/29/2022] [Indexed: 02/15/2023]
Abstract
INTRODUCTION The hospital setting faces a rate of bed occupation by patients whose discharge is limited by other factors apart from clinical needs. This urges the need for an early identification of the patients at risk of delayed discharge due to social factors in order to reduce expenses and to add value that converts itself into the patient health. The aim of this study was to identify the demographic and clinical factors that may be associated with delayed discharge. MATERIAL AND METHODS Demographic and clinical comorbidity data on 582 patients of an internal medicine ward from a tertiary hospital center during the years 2018 and 2019 was analyzed. A binomial logistic regression model was used, adjusted for sex, age, and length of clinical stay, in order to identify potential risk factors associated with delayed discharge. RESULTS A total of 473 patients admitted in the internal medicine ward throughout the two years of study were included. Ninety-four (19%) of these patients had their discharge delayed beyond their clinical needs; sixty-four (68%) of these were females. The most representative age was between 75 - 89 years old (45.7%). The characteristics that significantly differed between both non-delayed and delayed discharge were female sex (OR 2.84, 95% CI 1.65 - 4.90, p-value < 0.05), prolonged clinical stay (OR 2.64, 95% CI 1.60 - 4.937, p-value < 0.05) and diabetes mellitus (OR 1.87, 95% CI 1.08 - 3.23, p-value < 0.05). Besides these, the presence of heart failure (OR 0.52, 95% CI 0.27 - 0.99, p-value < 0.05) and chronic kidney disease (OR 0.34, 95% CI 0.14 - 0.86, p-value < 0.05) were associated with a lower risk of delayed discharge. CONCLUSION Female sex, a prolonged clinical stay and diabetes mellitus were associated with a higher risk of delayed discharge, while heart failure and chronic kidney disease were associated with a reduced risk. These findings create a basis for a possible future multicentre study aimed at creating a clinical prediction rule to stratify the risk of delayed hospital discharge in the Portuguese population.
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Affiliation(s)
- Miguel Martins
- Unidade Funcional Medicina 2.3. Hospital Santo António dos Capuchos. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | - António Mesquita
- Unidade Funcional Medicina 2.3. Hospital Santo António dos Capuchos. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | - Lucas Carvalho
- Faculdade de Medicina e Ciências Biomédicas. Universidade do Algarve. Faro. Portugal
| | - Francisca Martins
- Unidade Funcional Medicina 2.3. Hospital Santo António dos Capuchos. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | - Mariana Silva
- Unidade Funcional Medicina 2.3. Hospital Santo António dos Capuchos. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
| | - Helena Leitão
- Faculdade de Medicina e Ciências Biomédicas. Universidade do Algarve. Faro. Portugal
| | - Miguel Nunes
- Unidade Funcional Medicina 2.3. Hospital Santo António dos Capuchos. Centro Hospitalar Universitário de Lisboa Central. Lisboa. Portugal
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Pellico-López A, Fernández-Feito A, Cantarero D, Herrero-Montes M, Cayón-de Las Cuevas J, Parás-Bravo P, Paz-Zulueta M. Cost of stay and characteristics of patients with stroke and delayed discharge for non-clinical reasons. Sci Rep 2022; 12:10854. [PMID: 35760829 PMCID: PMC9237047 DOI: 10.1038/s41598-022-14502-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 06/08/2022] [Indexed: 12/04/2022] Open
Abstract
Delayed discharge for non-clinical reasons (bed-blocking) is characteristic of pathologies associated with ageing, loss of functional capacity and dependence such as stroke. The aims of this study were to describe the costs and characteristics of cases of patients with stroke and delayed discharge for non-clinical reasons (bed-blocking) compared with cases of bed-blocking (BB) for other reasons and to assess the relationship between the length of total stay (LOS) with patient characteristics and the context of care. A descriptive cross-sectional study was conducted at a high complexity public hospital in Northern Spain (2007–2015). 443 stroke patients presented with BB. Delayed discharge increased LOS by approximately one week. The median age was 79.7 years, significantly higher than in cases of BB for other reasons. Patients with stroke and BB are usually older patients, however, when younger patients are affected, their length of stay is longer in relation to the sudden onset of the problem and the lack of adequate functional recovery resources or residential facilities for intermediate care.
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Affiliation(s)
- Amada Pellico-López
- Cantabria Health Service, Avda. Derechos de la Infancia, 31. C.P., 39340, Suances, Cantabria, Spain.,Departamento de Enfermería, Universidad de Cantabria, Avda. Valdecilla s/n. C.P., 39008, Santander, Cantabria, Spain
| | - Ana Fernández-Feito
- Departamento de Medicina, Facultad de Medicina y Ciencias de la Salud, Universidad de Oviedo, Avda. Julián Clavería s/n C.P., 33006, Oviedo, Principado de Asturias, Spain. .,Área de Investigación en Cuidados, Grupo de Procesos Asistenciales de Enfermería, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Avda del Hospital Universitario, s/n. C.P., 33011, Oviedo, Principado de Asturias, Spain.
| | - David Cantarero
- Departamento de Economía, Universidad de Cantabria, Avda. de los Castros s/n C.P., 39005, Santander, Cantabria, Spain.,IDIVAL, Research Group of Health Economics and Health Services Management-Research Institute Marqués de Valdecilla C/ Cardenal Herrera Oria s/n., 39011, Santander, Cantabria, Spain
| | - Manuel Herrero-Montes
- Departamento de Enfermería, Universidad de Cantabria, Avda. Valdecilla s/n. C.P., 39008, Santander, Cantabria, Spain.,IDIVAL, Grupo de Investigación en Enfermería, C/ Cardenal Herrera Oria s/n. C.P., 39011, Santander, Cantabria, Spain
| | - Joaquín Cayón-de Las Cuevas
- Departamento de Derecho Privado, Universidad de Cantabria, Avda. de los Castros s/n. C.P.,, 39005, Santander, Cantabria, Spain.,IDIVAL, Grupo de Investigación en Derecho Sanitario y Bioética, GRIDES, C/ Cardenal Herrera Oria s/n. C.P., 39011, Santander, Cantabria,, Spain
| | - Paula Parás-Bravo
- Departamento de Enfermería, Universidad de Cantabria, Avda. Valdecilla s/n. C.P., 39008, Santander, Cantabria, Spain.,IDIVAL, Grupo de Investigación en Enfermería, C/ Cardenal Herrera Oria s/n. C.P., 39011, Santander, Cantabria, Spain
| | - María Paz-Zulueta
- Departamento de Enfermería, Universidad de Cantabria, Avda. Valdecilla s/n. C.P., 39008, Santander, Cantabria, Spain.,IDIVAL, Grupo de Investigación en Derecho Sanitario y Bioética, GRIDES, C/ Cardenal Herrera Oria s/n. C.P., 39011, Santander, Cantabria,, Spain
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3
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Cabeza-Osorio L, Martín-Sánchez F, Varillas-Delgado D, Serrano-Heranz R. Resultados a corto plazo de los pacientes con tiempo de estancia prolongada en un servicio de Medicina Interna. Rev Clin Esp 2022. [DOI: 10.1016/j.rce.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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4
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Cabeza-Osorio L, Martín-Sánchez F, Varillas-Delgado D, Serrano-Heranz R. Short-term outcomes of patients with a long stay in an internal medicine service. Rev Clin Esp 2022; 222:332-338. [DOI: 10.1016/j.rceng.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 10/28/2021] [Indexed: 10/18/2022]
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Pellico-López A, Fernández-Feito A, Parás-Bravo P, Herrero-Montes M, Cayón-De Las Cuevas J, Cantarero D, Paz-Zulueta M. Differential characteristics of cases of patients diagnosed with pneumonia and delayed discharge for non-clinical reasons in Northern Spain. Int J Clin Pract 2021; 75:e14765. [PMID: 34473876 DOI: 10.1111/ijcp.14765] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 08/30/2021] [Accepted: 08/31/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Delayed discharge for non-clinical reasons is related to a failure to plan for discharge and a lack of availability of intermediate care resources as an alternative to acute hospitalisation. The literature concerning the relationship with pneumonia is scarce. At present, the coronavirus pandemic is a new cause of complicated pneumonias that can further affect the functionality of the most fragile patients. OBJECTIVE The aim of this study was to understand what characteristics are typical of patients affected by pneumonia, compared with other cases of delayed discharge. METHODS A cross-sectional study was conducted. All cases of delayed discharge were studied at the hospitalisation units of a general university hospital in Northern Spain from 2007 to 2015. In order to compare the differential characteristics of the groups of patients with pneumonia with the total Student's T-test and Pearson's chi-square test (χ²) were used. RESULTS 170 patients were identified with a diagnosis of pneumonia and delayed discharge for non-clinical reasons during the study period. These cases accumulated a total of 4790 days of total stay, of which 1294 days corresponded to the prolonged stay. The mean age of the patients was 80.23 years. The mean DRG weight was 2.28 [SD 0.579], and 14.12% of patients with pneumonia and delayed discharge died. So, patients with pneumonia were older (P = .001), less complex (P = .001) and suffered greater deaths compared with the remaining patients (P = .001). CONCLUSIONS The sum of these factors has to do with comorbidities and complications associated with ageing and the characteristics of conditions such as aspiration pneumonia.
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Affiliation(s)
| | - Ana Fernández-Feito
- Faculty of Medicine and Health Sciences, Nursing Area, Department of Medicine, University of Oviedo, ISPA, Avda, Principado de Asturias, Spain
| | - Paula Parás-Bravo
- Faculty of Nursing, University of Cantabria, Cantabria, Spain
- IDIVAL, Grupo de Investigación en Enfermería, Cantabria, Spain
| | - Manuel Herrero-Montes
- Faculty of Nursing, University of Cantabria, Cantabria, Spain
- IDIVAL, Grupo de Investigación en Enfermería, Cantabria, Spain
| | - Joaquín Cayón-De Las Cuevas
- Faculty of Law, University of Cantabria, Cantabria, Spain
- IDIVAL, Grupo de Investigación en Derecho Sanitario y Bioética, GRIDES, Cantabria, Spain
| | - David Cantarero
- Department of Economics, University of Cantabria, Cantabria, Spain
- IDIVAL, Cantabria, Spain
| | - Maria Paz-Zulueta
- Faculty of Nursing, University of Cantabria, Cantabria, Spain
- IDIVAL, Grupo de Investigación en Derecho Sanitario y Bioética, GRIDES, Cantabria, Spain
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Pellico-López A, Fernández-Feito A, Cantarero D, Herrero-Montes M, Cayón-De Las Cuevas J, Parás-Bravo P, Paz-Zulueta M. Delayed Discharge for Non-Clinical Reasons in Hip Procedures: Differential Characteristics and Opportunity Cost. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179407. [PMID: 34502013 PMCID: PMC8431020 DOI: 10.3390/ijerph18179407] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 11/23/2022]
Abstract
Delayed discharge for non-clinical reasons shares common characteristics with hip procedures. We sought to quantify the length of stay and related costs of hip procedures and compare these with other cases of delayed discharge. A cross-sectional study was conducted at a public hospital in Spain (2007–2015) including 306 patients with 6945 days of total stay and 2178 days of prolonged stay. The mean appropriate stay was 15.58 days, and the mean prolonged stay was 7.12 days. The cost of a prolonged stay was €641,002.09. The opportunity cost according to the value of the hospital complexity unit was €922,997.82. The mean diagnostic-related groups’ weight was 3.40. Up to 85.29% of patients resided in an urban area near the hospital (p = 0.001), and 83.33% were referred to a long-stay facility for functional recovery (p = 0.001). The proportion of patients with hip procedures and delayed discharge was lower than previous reports; however, their length of stay was longer. The cost of prolonged stay could account for 21.17% of the total. Compared with the remaining cases of delayed discharge, the appropriate stay was shorter in hip procedures, with a profile of older women living in an urban area close to the hospital and referred to a long-stay center for functional recovery.
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Affiliation(s)
- Amada Pellico-López
- Cantabria Health Service, Avda. Derechos de la Infancia 31, 39340 Suances, Spain;
| | - Ana Fernández-Feito
- Department of Medicine, Faculty of Medicine and Health Sciences, University of Oviedo, Avda. Julián Clavería s/n, 33006 Oviedo, Spain
- ISPA, Nursing Research Group, Health Research Institute of Asturias, Avda. del Hospital Universitario s/n, 33011 Oviedo, Spain
- Correspondence:
| | - David Cantarero
- Department of Economics, University of Cantabria, Avda. de los Castros s/n, 39005 Santander, Spain;
- IDIVAL, Research Group of Health Economics and Health Services Management, Research Institute Marqués de Valdecilla, C/ Cardenal Herrera Oria s/n, 39011 Santander, Spain
| | - Manuel Herrero-Montes
- Faculty of Nursing, University of Cantabria, Avda. Valdecilla s/n, 39008 Santander, Spain; (M.H.-M.); (P.P.-B.); (M.P.-Z.)
- IDIVAL, Grupo de Investigación en Enfermería, C/ Cardenal Herrera Oria s/n, 39011 Santander, Spain
| | - Joaquín Cayón-De Las Cuevas
- Faculty of Law, University of Cantabria, Avda. de los Castros s/n, 39005 Santander, Spain;
- IDIVAL, GI Derecho Sanitario y Bioética, GRIDES, C/ Cardenal Herrera Oria s/n, 39011 Santander, Spain
| | - Paula Parás-Bravo
- Faculty of Nursing, University of Cantabria, Avda. Valdecilla s/n, 39008 Santander, Spain; (M.H.-M.); (P.P.-B.); (M.P.-Z.)
- IDIVAL, Grupo de Investigación en Enfermería, C/ Cardenal Herrera Oria s/n, 39011 Santander, Spain
| | - María Paz-Zulueta
- Faculty of Nursing, University of Cantabria, Avda. Valdecilla s/n, 39008 Santander, Spain; (M.H.-M.); (P.P.-B.); (M.P.-Z.)
- IDIVAL, GI Derecho Sanitario y Bioética, GRIDES, C/ Cardenal Herrera Oria s/n, 39011 Santander, Spain
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Heid CA, Khoury MK, Thornton MA, Geoffrion TR, De Hoyos AL. Risk Factors for Nonhome Discharge After Esophagectomy for Neoplastic Disease. Ann Thorac Surg 2020; 111:1118-1124. [PMID: 32866477 DOI: 10.1016/j.athoracsur.2020.06.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2019] [Revised: 05/29/2020] [Accepted: 06/09/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Esophagectomies are known to be technically challenging operations that create significant physiologic changes. These patients often require assisted care postoperatively that necessitates a nonhome discharge. The purpose of this study was to assess factors associated with nonhome discharge after esophagectomy for neoplastic disease. METHODS The 2016 to 2017 American College of Surgeons National Surgical Quality Improvement Program Esophagectomy database was queried to identify patients who underwent esophagectomy for a neoplasm. Patients were excluded if they died within 30 days of their operation, the index operation was considered emergent, or had missing data for the variables of interest. Multivariable analysis was performed to identify which factors were predictive of nonhome discharge. RESULTS One thousand seven patients were included. Of those, 121 (12.0%) had a nonhome discharge. Multivariable analysis showed that the following factors were associated with nonhome discharge: Modified Charlson comorbidity index (adjusted odds ratio [aOR], 2.04; 95% confidence interval [CI], 1.49-2.86), partially dependent preoperative functional status (aOR, 13.18; 95% CI, 1.07-315.67), urinary tract infection (aOR, 5.25; 95% CI, 1.32-20.41), and length of stay (aOR, 1.12; 95% CI, 1.08-1.16). CONCLUSIONS We identified various factors associated with nonhome discharge. Early identification of patients who are at risk for nonhome discharge is important for early discharge planning, which may decrease nonmedical delays and healthcare costs.
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Affiliation(s)
- Christopher A Heid
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Mitri K Khoury
- Department of Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Department of Surgery, Division of Vascular Surgery, University of Wisconsin, Madison, Wisconsin
| | - Micah A Thornton
- Department of Statistical Science, Southern Methodist University, Dallas, Texas
| | - Tracy R Geoffrion
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas; Division of Cardiothoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Alberto L De Hoyos
- Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
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Public spending on adult social care and delayed transfers of care in England. QUALITY IN AGEING AND OLDER ADULTS 2020. [DOI: 10.1108/qaoa-11-2019-0066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to whether current public expenditure on adult social care services might be associated with the number of delayed days of care attributable to the social care system in England.
Design/methodology/approach
Panel econometric models on data from local authorities with adult social care responsibilities in England between 2013–2014 and 2018–2019.
Findings
After controlling for other organisational sources of inefficiency, the level of demand in the area and the income poverty amongst the resident older population, this paper finds that a 4.5% reduction in current spending per head on adult social care per older person in one year is associated with an increase by 0.01 delayed days per head the following year.
Social implications
Given the costs of adverse outcomes of delayed transfers of care reported in the literature, this paper suggests that budgetary constraints to adult social care services would represent a false economy of public funds.
Originality/value
This is the first paper that models the association between public spending on adult social care and delayed transfers of care due to issues originating in the social care system in England.
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Pellico-López A, Cantarero D, Fernández-Feito A, Parás-Bravo P, Cayón de Las Cuevas J, Paz-Zulueta M. Factors Associated with Bed-Blocking at a University Hospital (Cantabria, Spain) between 2007 and 2015: A Retrospective Observational Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3304. [PMID: 31505726 PMCID: PMC6765863 DOI: 10.3390/ijerph16183304] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 08/29/2019] [Accepted: 09/06/2019] [Indexed: 12/27/2022]
Abstract
Current studies on bed-blocking or delayed discharge for non-medical reasons report important variations depending on the country or setting under study. Research on this subject is clearly important as the current system reveals major inefficiencies. Although there is some agreement on the patient-related factors that contribute to the phenomenon, such as older age or a lack of functional ability, there is greater variability regarding environmental or organizational factors. This study sought to quantify the number of cases and days inappropriately spent in hospital and identify patient characteristics and healthcare service use associated with the total length of stay. All cases of delayed discharge were studied at the hospitalization units of a general university hospital in Northern Spain between 2007 and 2015. According to regression estimates, the following characteristics were related to a longer stay: higher complexity through (Diagnosis-Related Group) DRG weight, a diagnosis that implied a lack of functional ability, surgical treatment, having to wait for a destination upon final discharge or return home. After an initial increase, a reduction in delayed discharge was observed, which was maintained for the duration of the study period. Multi-component interventions related with discharge planning can favor a reduced inefficiency with fewer unnecessary stays.
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Affiliation(s)
- Amada Pellico-López
- Care Continuity Coordinator, Área VI SESPA, Urbanización Castañeda s/n. C.P., 33540 Arriondas, Principado de Asturias, Spain
- Research Group on Public Economics and Health, GIECONPSALUD, University of Cantabria, Avda de los Castros s/n. C.P., 39005 Santander, Cantabria, Spain
| | - David Cantarero
- Research Group on Public Economics and Health, GIECONPSALUD, University of Cantabria, Avda de los Castros s/n. C.P., 39005 Santander, Cantabria, Spain
- Faculty of Economics, University of Cantabria, Avda. de los Castros s/n. C.P., 39005 Santander, Cantabria, Spain
| | - Ana Fernández-Feito
- Nursing Area, Department of Medicine, Faculty of Medicine and Health Sciences, University of Oviedo / ISPA. Avda Julián Clavería s/n. C.P., 33006 Oviedo, Principado de Asturias, Spain
| | - Paula Parás-Bravo
- Research Group on Public Economics and Health, GIECONPSALUD, University of Cantabria, Avda de los Castros s/n. C.P., 39005 Santander, Cantabria, Spain
- Faculty of Nursing, University of Cantabria, Avda Valdecilla s/n. C.P., 39008 Santander, Cantabria, Spain
- IDIVAL, Grupo de Investigación en Enfermería. C/ Cardenal Herrera Oria s/n. C.P., 39011 Santander, Cantabria, Spain
| | - Joaquín Cayón de Las Cuevas
- Facultad de Derecho, University of Cantabria, Avda. de los Castros s/n. C.P., 39005 Santander, Cantabria, Spain
- IDIVAL, GI Derecho Sanitario y Bioética, GRIDES, C/ Cardenal Herrera Oria s/n. C.P., 39011 Santander, Cantabria, Spain
| | - María Paz-Zulueta
- Research Group on Public Economics and Health, GIECONPSALUD, University of Cantabria, Avda de los Castros s/n. C.P., 39005 Santander, Cantabria, Spain.
- Faculty of Nursing, University of Cantabria, Avda Valdecilla s/n. C.P., 39008 Santander, Cantabria, Spain.
- IDIVAL, GI Derecho Sanitario y Bioética, GRIDES, C/ Cardenal Herrera Oria s/n. C.P., 39011 Santander, Cantabria, Spain.
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Landeiro F, Roberts K, Gray AM, Leal J. Delayed Hospital Discharges of Older Patients: A Systematic Review on Prevalence and Costs. THE GERONTOLOGIST 2019; 59:e86-e97. [PMID: 28535285 DOI: 10.1093/geront/gnx028] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Indexed: 11/12/2022] Open
Abstract
PURPOSE OF THE STUDY To determine the prevalence of delayed discharges of elderly inpatients and associated costs. DESIGN AND METHODS We searched Medline, Embase, Global Health, CAB Abstracts, Econlit, Web of Knowledge, EBSCO - CINAHL, The Cochrane Library, Health Management Information Consortium, and SCIE - Social Care Online for evidence published between 1990 and 2015 on number of days or proportion of delayed discharges for elderly inpatients in acute hospitals. Descriptive and regression analyses were conducted. Data on proportions of delayed discharges were pooled using a random effects logistic model and the association of relevant factors was assessed. Mean costs of delayed discharge were calculated in USD adjusted for Purchasing Power Parity (PPP). RESULTS Of 64 studies included, 52 (81.3%) reported delayed discharges as proportions of total hospital stay and 9 (14.1%) estimated the respective costs for these delays. Proportions of delayed discharges varied widely, from 1.6% to 91.3% with a weighted mean of 22.8%. This variation was also seen in studies from the same country, for example, in the United Kingdom, they ranged between 1.6% and 60.0%. No factor was found to be significantly associated with delays. The mean costs of delayed discharge also varied widely (between 142 and 31,935 USD PPP adjusted), reflecting the variability in mean days of delay per patient. IMPLICATIONS Delayed discharges occur in most countries and the associated costs are significant. However, the variability in prevalence of delayed discharges and available data on costs limit our knowledge of the full impact of delayed discharges. A standardization of methods is necessary to allow comparisons to be made, and additional studies are required-preferably by disease area-to determine the postdischarge needs of specific patient groups and the estimated costs of delays.
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Affiliation(s)
- Filipa Landeiro
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
| | - Kenny Roberts
- Department of Physiology, Anatomy and Genetics, University of Oxford, UK
| | - Alastair Mcintosh Gray
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
| | - José Leal
- Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, UK
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Modas DAS, Nunes EMGT, Charepe ZB. Causas de atraso na alta hospitalar no cliente adulto: scoping review. Rev Gaucha Enferm 2019; 40:e20180130. [DOI: 10.1590/1983-1447.2019.20180130] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 11/16/2018] [Indexed: 11/22/2022] Open
Abstract
Resumo OBJETIVO Mapear a evidência existente sobre as causas de atraso na alta hospitalar no cliente adulto. MÉTODOS Efetuada revisão da literatura do tipo scoping review. Pesquisou-se na plataforma informática da Ebscohost, na PubMed e na literatura cinzenta, consultando-se as referências bibliográficas desses documentos. RESULTADOS Dos 22 artigos analisados verificou-se que o atraso na alta hospitalar se deve a causas relacionadas com os recursos da comunidade, designadamente a falta de vagas em unidades de saúde e motivos sociais; a causas organizacionais relacionadas com os cuidados de saúde; a causas individuais, destacando-se as questões familiares e financeiras; culminando nas causas organizacionais relacionadas com a gestão hospitalar. CONCLUSÃO O atraso na alta hospitalar é multifatorial, tornando-se necessário monitorizar o processo de internação, apostando-se num planejamento de alta antecipado.
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Rashidi B, Kobewka DM, Campbell DJT, Forster AJ, Ronksley PE. Clinical factors contributing to high cost hospitalizations in a Canadian tertiary care centre. BMC Health Serv Res 2017; 17:777. [PMID: 29178870 PMCID: PMC5702126 DOI: 10.1186/s12913-017-2746-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 11/20/2017] [Indexed: 11/18/2022] Open
Abstract
Background Like much of the developed world, healthcare costs in Canada are rising. A small proportion of patients account for a large proportion of healthcare spending and much of this spending occurs in acute care settings. The purpose of our study was to determine potentially modifiable factors related to care processes that contribute to high-cost admissions. Methods Using a mixed-methods study design, factors contributing to high-cost admissions were identified from literature and case review. We defined pre- and post-admission factors contributing to high-cost admissions. Pre-admission factors included reason for admission (e.g. complex medical, elective surgery, trauma, etc.). Post-admission factors included medical complications, disposition delays, clinical services delays, and inefficient clinical decision-making. We selected a random sample of admissions in the top decile of inpatient cost from the Ottawa Hospital between January 1 and December 31, 2010. A single reviewer classified cases based on the pre- and post-admission factors. We combined this information with data derived from the Ottawa Hospital Data Warehouse to describe patient-level clinical and demographic characteristics and costs incurred. Results We reviewed 200 charts which represents ~5% of all high cost admissions within the Ottawa Hospital in 2010. Post-admission factors contributing to high-cost admissions were: complications (60%), disposition delays (53%), clinical service delays (39%), and inefficient clinical decision-making (13%). Further, these factors varied substantially across service delivery lines. The mean (standard deviation (SD)) cost per admission was $49,923 CDN ($45,773). The most common reason for admission was “complex medical” (49%) and the overall median (IQR) length of stay was 27 (18–48) days. Approximately 1 in 3 high cost admissions (29%) included time in the intensive care unit (ICU). Conclusions While high cost admissions often include time in ICU and have long lengths of stay, a substantial proportion of costs were attributable to complications and potentially preventable delays in care processes. These findings suggest opportunities exist to improve outcomes and reduce costs for this diverse patient population.
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Affiliation(s)
- Babak Rashidi
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Daniel M Kobewka
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON, Canada
| | - David J T Campbell
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alan J Forster
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada.,Department of Clinical Epidemiology, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Paul E Ronksley
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, HSC G239, 3330 Hospital Drive NW, Calgary, AB, T2N 4N1, Canada.
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