Relative contribution of overweight and obesity to rising public hospital in-patient expenditure in South Australia

The impact of general and central obesity for all-cause hospitalization among Iranian adults: a 20 year follow-up-results from the TLGS cohort

BACKGROUND

Few studies have examined the effect of obesity indices on total number of hospitalizations. We examined the associations between body mass index (BMI) and waist circumference (WC) and rate of all-cause hospitalizations among Iranian adult participated in the Tehran Lipid and Glucose Study cohort.

METHODS

This study included 8202 individuals (3727 men) aged ≥ 30 years, who were followed for a median of 18 years. Participants were categorized into three groups according to their baseline BMI: normal weight, overweight and obese. In addition, they were classified according to WC in two categories: normal WC and high WC. Negative Binomial regression model was used to estimate the incidence rate ratios (IRRs) and 95% confidence interval (95% CI) of all-cause hospitalizations in relation to obesity indices.

RESULTS

The overall crude rate of all-cause hospitalizations were 77.6 (95% CI, 73.9-81.2) and 76.9 (73.4-80.3) per 1000 person-year in men and women, respectively. The covariate adjusted rate of all-cause hospitalizations was 27% higher in obese men than normal weight men (IRR (95% CI): 1.27 (1.11-1.42)). Among women, overweight and obese individuals had 17% (1.17 (1.03-1.31)) and 40% (1.40 (1.23-1.56)) higher rate of hospitalization compared to normal weight women. Having high WC was associated with 18% (1.18 (1.08-1.29)) and 30% (1.30 (1.18-1.41)) higher rate of all-cause hospitalization in men and women, respectively.

CONCLUSIONS

Obesity and high WC were associated with increased hospitalization rates during long-term follow-up. Our findings suggests that successful obesity prevention programs may decrease the number of hospitalizations, particularly, in women.

What has driven acute public hospital expenditure growth in South Australia? An analysis of the relative importance of major expenditure drivers between 2006-07 and 2017-18

ObjectiveThe aim of this study was to investigate whether increasing costs of delivering care have driven real growth in acute public hospital expenditure in South Australia (SA) and what has contributed to these real cost increases.MethodsUsing published time-series data, we decomposed inflation-adjusted growth in per capita total acute public hospital recurrent expenditure into its major utilisation and cost components to evaluate their relative contribution over the 12 years to 2017-18.ResultsReal per capita total acute public hospital recurrent expenditure grew by AU$667 (45.2%) over the 12-year period; of this, 86.0% was from real growth in input costs per weighted activity unit, with real growth in the average salaries of hospital staff accounting for AU$247 or 37.0%. Hospital utilisation rates contributed a minor 14.0%.ConclusionOver the 12 years to 2017-18, real growth in average clinical salaries was a more important driver of real growth in per capita total acute public hospital expenditure than rates of hospital utilisation. This would be facilitated by improvements in the scope, accuracy, quality and consistency of published national hospital data.What is known about the topic?Public hospital expenditure is one of the largest and fastest growing areas of government expenditure in Australia. Policy narratives often centre around demand pressures from an increasingly older, overweight, and chronically ill population. Comparatively little attention has been paid to the influence of increases in real input costs within the Australian context.What does this paper add?Real salary growth has been a major driver of acute public hospital recurrent expenditure growth in SA, whereas hospital utilisation rates have played a minor role.What are the implications for practitioners?A clearer understanding of the main drivers of acute public hospital expenditure growth and the resulting benefits to population health is needed to guide the efficient and sustainable use of scarce healthcare resources.

Beyond weight: examining the association of obesity with cardiometabolic related inpatient costs among Canadian adults using linked population based survey and hospital administrative data

BACKGROUND

The global population has transitioned to one where more adults are living with obesity than are underweight. Obesity is associated with the development of cardiometabolic diseases and widely attributed to increased hospital resource use; however, empirical evidence is limited regarding obesity prevention to support hospital cost containment. This study aims to test for obesity in predicting hospitalization costs for cardiometabolic conditions among the Canadian population aged 45 and over.

METHODS

Data from the 2007-2011 Canadian Community Health Survey were linked to eight years of hospital discharge records. A cohort was identified of inpatients admitted for diabetes, hypertension, and other cardiometabolic diseases. Multiple linear regressions were used to investigate the association between obesity status and inpatient costs, controlling for sociodemographic and behavioural factors.

RESULTS

The target cohort included 23,295 admissions for cardiometabolic diseases. Although inflation-adjusted inpatient costs generally increased over time, compared with the non-obese group, living with obesity was not a significant predictor of differences in cardiometabolic-related resource use (0.972 [95% CI: 0.926-1.021]). Being female and rural residence were found to be protective factors.

CONCLUSIONS

Obesity was not found in this study to be independently linked to higher cardiometabolic hospitalization costs, suggesting that actions to mitigate disease progression in the population may be more beneficial than simply promoting weight loss. Results amplified the need to consider gender and urbanization when formulating which levers are most amenable to adoption of healthy lifestyles to reduce impacts of obesogenic environments to the healthcare system.

Activity-based funding for safety and quality: A policy discussion of issues and directions for nursing-focused health services outcomes research

Aims

A discussion of the implications and opportunities arising from the Commonwealth of Australia health care reform agenda; linking pricing with quality, with particular reference to directions for nursing‐focused health services outcomes research directed to improve the safety and quality of health care practices.

Background

National activity‐based funding in Australia is a policy‐focused development. As the relationship between cost and quality becomes apparent, the role of clinicians and their contribution to high quality care has become a pressing issue for leadership, teaching, and research.

Design

Discussion paper

Data Sources

This paper is based on seven years' experience as a member of a Commonwealth of Australia statutory committee—the Clinical Advisory Committee of the Independent Hospital Pricing Authority—and is supported by relevant literature and theory.

Implications for Nursing

To date, unravelling the linkage, especially causal relationships, between direct care nursing and patient safety outcomes has not been well established. New activity‐based funding data elements developed for national implementation in Australia provide accessible and meaningful standardised data for measurement of never events, hospital‐acquired complications, and preventable readmissions.

What is already known about this topic?

The advancement of research directed towards finding causal associations attributing nursing interventions to patient outcomes has been constrained by, amongst other things, methodological challenges

The attribution of nursing care interventions to specific patient‐related outcomes is difficult to isolate

Investigating how nursing care interventions contribute to safety and quality health care outcomes is often referred to as the “black box” of nursing‐focused health services outcomes research

What this paper adds?

Research into the impact of nursing interventions on patient outcomes, such as hospital‐acquired complications, remains immature

Activity‐based funding data provide safety and quality measures relevant to nursing‐focused health services outcomes research

Building clinical‐decision support, based on the Australian Commission for Safety and Quality in Healthcare hospital‐acquired complication outcome measures, may assist nurses engage with quality improvement as nurses are likely to act on data relevant to their practice

The implications of this paper:

The Australian Commission for Safety and Quality in Healthcare hospital‐acquired complication outcome measures have enhanced data specifications, useful to support development of nursing‐focused health services outcomes research

The potential for benchmarking of hospital‐acquired complications is high at least in Australia and in other countries that apply activity‐based funding models linked to ICD‐10‐AM codes