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Yagi M, Yamamoto T, Iga T, Ogura Y, Suzuki S, Ozaki M, Takahashi Y, Tsuji O, Nagoshi N, Kono H, Ogawa J, Matsumoto M, Nakamura M, Watanabe K. Development and Validation of Machine Learning-Based Predictive Model for Prolonged Hospital Stay after Decompression Surgery for Lumbar Spinal Canal Stenosis. Spine Surg Relat Res 2024; 8:315-321. [PMID: 38868786 PMCID: PMC11165502 DOI: 10.22603/ssrr.2023-0255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/25/2023] [Indexed: 06/14/2024] Open
Abstract
Introduction Precise prediction of hospital stay duration is essential for maximizing resource utilization during surgery. Existing lumbar spinal stenosis (LSS) surgery prediction models lack accuracy and generalizability. Machine learning can improve accuracy by considering preoperative factors. This study aimed to develop and validate a machine learning-based model for estimating hospital stay duration following decompression surgery for LSS. Methods Data from 848 patients who underwent decompression surgery for LSS at three hospitals were examined. Twelve prediction models, using 79 preoperative variables, were developed for postoperative hospital stay estimation. The top five models were chosen. Fourteen models predicted prolonged hospital stay (≥14 days), and the most accurate model was chosen. Models were validated using a randomly divided training sample (70%) and testing cohort (30%). Results The top five models showed moderate linear correlations (0.576-0.624) between predicted and measured values in the testing sample. The ensemble of these models had moderate prediction accuracy for final length of stay (linear correlation 0.626, absolute mean error 2.26 days, standard deviation 3.45 days). The c5.0 decision tree model was the top predictor for prolonged hospital stay, with accuracies of 89.63% (training) and 87.2% (testing). Key predictors for longer stay included JOABPEQ social life domain, facility, history of vertebral fracture, diagnosis, and Visual Analogue Scale (VAS) of low back pain. Conclusions A machine learning-based model was developed to predict postoperative hospital stay after LSS decompression surgery, using data from multiple hospital settings. Numerical prediction of length of stay was not very accurate, although favorable prediction of prolonged stay was accomplished using preoperative factors. The JOABPEQ social life domain score was the most important predictor.
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Affiliation(s)
- Mitsuru Yagi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
- Department of Orthopedic Surgery, International University of Health and Welfare, School of Medicine, Chiba, Japan
| | - Tatsuya Yamamoto
- Department of Orthopedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Takahito Iga
- Department of Orthopedic Surgery, Keiyu Orthopedic Hospital, Gunma, Japan
| | - Yoji Ogura
- Department of Orthopedic Surgery, Tachikawa Hospital, Tokyo, Japan
| | - Satoshi Suzuki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masahiro Ozaki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yohei Takahashi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Hitoshi Kono
- Department of Orthopedic Surgery, Keiyu Orthopedic Hospital, Gunma, Japan
| | - Jun Ogawa
- Department of Orthopedic Surgery, Japanese Red Cross Shizuoka Hospital, Shizuoka, Japan
| | - Morio Matsumoto
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Fortin M, Atsaidis Z, Hopkins B, St-Louis E, Guadagno E, Friedman D, Poenaru D. Definitive Care for Severely Injured Children in Quebec. Injury 2023; 54:173-182. [PMID: 36008174 DOI: 10.1016/j.injury.2022.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 07/26/2022] [Accepted: 08/03/2022] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Injury is the leading cause of death in children over the age of one in Canada, and remains the most common cause of death in Quebec pediatric patients. Indigenous communities are 3-4 times more likely to be affected by injuries than the national average. In Quebec, health centres can range from 30 to 1000 km away from the closest level I trauma center. METHODS Descriptive analysis and multiple logistic regression were performed for severely injured pediatric trauma patients received at the Montreal Children's Hospital (MCH) over a ten-year period. Outcomes were compared between regional groups in Quebec using forward sortation areas. RESULTS Two hundred and forty four pediatric patients presented to the MCH with major trauma between 2006 and 2016. Of those, 42% of patients resided in Montreal, 42% off-island, and 16% in Northern Quebec. Admission to the Intensive Care Unit (ICU) was required for 60% of off-island patients and 58% of Northern residents. The median length of hospital stay (LOS) was 5 days for off-island and 15 days for Northern patients. Most patients (78% off-island vs. 76% Northern Quebec) were discharged home. The overall mortality was 5%. In multiple regression analysis, residence in Northern Quebec was associated with increased incidence of longer than median length of stay compared to off-island patients (OR 2.78, 95%CI (1.12-7.29)) after adjusting for injury severity, operative intervention, age, and sex. CONCLUSION ICU admission rate was similar among Northern and off-island populations. Patients from Northern Quebec appeared to have longer-than-median hospital length of stay. In-hospital mortality was infrequent and limited to on-island and off-island populations. A further exploration of this data is required to identify the "trauma deserts" and advocate for children involved in trauma in all areas of Quebec.
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Affiliation(s)
- Mélyssa Fortin
- McGill University Faculty of Medicine & Health Sciences, 3605 Rue de la Montagne, Montreal, Quebec, Canada, H3G 2M1
| | - Zoe Atsaidis
- McGill University Faculty of Medicine & Health Sciences, 3605 Rue de la Montagne, Montreal, Quebec, Canada, H3G 2M1
| | - Brent Hopkins
- Department of General Surgery, McGill University, 1650 Cedar Ave, Montreal, Quebec H3G 1A4
| | - Etienne St-Louis
- Department of General Surgery, McGill University, 1650 Cedar Ave, Montreal, Quebec H3G 1A4; Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie Blvd, room B04.2439.1, Montreal, QC, Canada, H4A 3J
| | - Elena Guadagno
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie Blvd, room B04.2439.1, Montreal, QC, Canada, H4A 3J
| | - Debbie Friedman
- Montreal Children's Hospital Trauma Centre, McGill University Health Centre, Canadian Hospitals Injury Reporting and Prevention Program, Public Health Agency of Canada, Department of Pediatrics and Department of Pediatric Surgery, Faculty of Medicine and Health Sciences McGill University
| | - Dan Poenaru
- Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, 1001 Decarie Blvd, room B04.2439.1, Montreal, QC, Canada, H4A 3J.
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Dimla B, Parkinson L, Wood D, Powell Z. Hospital discharge planning: A systematic literature review on the support measures that social workers undertake to facilitate older patients' transition from hospital admission back to the community. Australas J Ageing 2022; 42:20-33. [PMID: 36180976 DOI: 10.1111/ajag.13138] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 07/29/2022] [Accepted: 08/29/2022] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To systematically review the literature on measures social workers undertake to facilitate discharge planning for older people in a resource-scarce environment. METHODS Systematic search of electronic databases for peer-reviewed articles published in English between January 1990 and August 2020. Articles on hospital discharge planning facilitated by social workers for older patients returning home from hospital admission were included. The Mixed Method Appraisal Tool (MMAT) was used to assess quality and risk of bias. The systematic literature review protocol has been registered with PROSPERO on 27 August 2021. RESULTS Six studies from Canada and the United States met the eligibility criteria. The most common support measures employed by hospital social workers when discharge planning for older patients were assessment, education, care co-ordination, liaison and engagement with families and providers, conflict resolution, counselling and postdischarge follow-up. Barriers to effective discharge planning were medical complexity, lack of communication, time constraints, limited family support, availability of resources and patient safety. These studies were published between 1993 and 2014 and were not within the Australian context. CONCLUSIONS There are limited studies on Social Work discharge planning within the Australian context, particularly on how this important service has been impacted by recent aged care reforms. More research on the topic is necessary to fully understand how aged care reforms such as the National Prioritisation System for Home Care Packages have influenced hospital discharge planning and how social workers have adapted their practice to this challenge.
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Affiliation(s)
- Bernadette Dimla
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Lynne Parkinson
- University of Newcastle, Kirkwood, New South Wales, Australia
| | - Denise Wood
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Zalia Powell
- University of the Sunshine Coast, Sippy Downs, Queensland, Australia
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Cacciatore J, Thieleman K, Fretts R, Jackson LB. What is good grief support? Exploring the actors and actions in social support after traumatic grief. PLoS One 2021; 16:e0252324. [PMID: 34043716 PMCID: PMC8158955 DOI: 10.1371/journal.pone.0252324] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 05/13/2021] [Indexed: 12/04/2022] Open
Abstract
Social support seems to enhance wellbeing and health in many populations. Conversely, poor social support and loneliness are a social determinant of poor health outcomes and can adversely affect physical, emotional, and mental well-being. Social support is especially important in traumatic grief. However, the ways in which grieving individuals interpret and define social support is not well understood, and little is known about what specific behaviours are perceived as helpful. Using qualitative description and content analysis, this study assessed bereaved individuals’ satisfaction of social support in traumatic grief, using four categories of social support as a framework. Findings suggest inadequate satisfaction from professional, familial, and community support. Pets emerged with the most satisfactory ratings. Further, findings suggest that emotional support is the most desired type of support following traumatic loss. Implications for supporting bereaved individuals within and beyond the context of the COVID-19 pandemic are discussed.
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Affiliation(s)
- Joanne Cacciatore
- School of Social Work, Associate Professor, Arizona State University, Phoenix, AZ, United States of America
- * E-mail:
| | - Kara Thieleman
- School of Social Work, Adjunct Faculty, Arizona State University, Phoenix, AZ, United States of America
| | - Ruth Fretts
- Atrius Health, Medical Doctor, Boston, MA, United States of America
| | - Lori Barnes Jackson
- School of Social Work, Graduate Student, Arizona State University, Phoenix, AZ, United States of America
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Chiu RG, Murphy BE, Zhu A, Mehta AI. Racial and Ethnic Disparities in the Inpatient Management of Primary Spinal Cord Tumors. World Neurosurg 2020; 140:e175-e184. [DOI: 10.1016/j.wneu.2020.04.231] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 12/20/2022]
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Muskat B, Craig SL, Mathai B. Complex families, the social determinants of health and psychosocial interventions: Deconstruction of a day in the life of hospital social workers. SOCIAL WORK IN HEALTH CARE 2017; 56:765-778. [PMID: 28696836 DOI: 10.1080/00981389.2017.1339761] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
The roles of hospital social workers are delineated in the literature; however, their daily interventions have only been described anecdotally. This study analyzes the daily work of social workers in a pediatric hospital through a survey completed which examined factors related to interventions utilized and time spent per case over a 1-day period. Length and types of interventions were associated with the social determinants of health, time since diagnosis, biopsychosocial issues, and perception of complexity. The study offers a snapshot of the personalized expertise, provided by social workers that addresses complex contextual and biopsychosocial concerns of patient and families.
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Affiliation(s)
- Barbara Muskat
- a Department of Social Work , The Hospital for Sick Children , Toronto , Ontario , Canada
| | - Shelley L Craig
- b Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , Ontario , Canada
| | - Biju Mathai
- c Acute Care of the Elderly Unit and Inpatient Mental Health, Rehabilitation Social Worker Queensway Carleton Hospital , Ottawa , Ontario , Canada
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Khabarov D, Dimitropoulos G, McGillicuddy P. Qualitative Study: Exploring the Experiences of Family Caregivers within an Inpatient Neurology and Neurosurgery Hospital Setting. HEALTH & SOCIAL WORK 2015; 40:290-297. [PMID: 26638505 DOI: 10.1093/hsw/hlv057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The aim of this study was to further understanding of what it means for family caregivers to be included in their relatives' care and identify what type of care they are providing. This study used a qualitative research design to recruit 12 participants, who were family caregivers, from the adult neurology and neurosurgery units at a hospital located in Toronto, Ontario, Canada. The data were collected using semistructured interviews, which were conducted in person and ranged between 30 and 60 minutes in length. Analysis of the data was conducted using phenomenological guidelines and principles. Upon review, the results indicated that the participants shared common experiences that were grouped into three main themes: (1) unfamiliarity with the hospital environment and procedures, (2) identifying the hidden realities of families and caregivers, and (3) strengthening collaborative dialogues and opportunities. Overall, this study exemplified that the need to continue to recognize family caregivers' experiences and their involvement is paramount in being able to understand how and in what way patient care can be better optimized collaboratively, during treatment delivery and recovery stages.
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Sims-Gould J, Byrne K, Hicks E, Franke T, Stolee P. "When Things Are Really Complicated, We Call the Social Worker": Post-Hip-Fracture Care Transitions for Older People. HEALTH & SOCIAL WORK 2015; 40:257-265. [PMID: 26638501 DOI: 10.1093/hsw/hlv069] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Social workers play a key role in the delivery of interdisciplinary health care. However, in the past decade, concerns have been raised about social work's sustainability and contributions in a changing health care sector. These changes come at a time when older patients are more complex and vulnerable than ever before. In this article, using a strengths-based approach, the authors examine the key contributions made by social workers working with older patients with hip fracture as they strive to achieve successful care transitions. Twenty-five interviews with health care professionals (HCPs) were conducted and then analyzed using an analytical coding framework. Although social workers are vital, they are often underused and overlooked in the care of hip fracture patients. The authors sketch the important contributions that social workers make to care transitions after hip fracture, specifically informational continuity; patient-HCP relational continuity; conflict resolution; mediation among family, patient, and HCP (for example, doctors and nurses); collaboration with family caregivers and community supports; and relocation counseling.
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Effect of a Dedicated Orthopaedic Advanced Practice Provider in a Level I Trauma Center: Analysis of Length of Stay and Cost. J Orthop Trauma 2015; 29:e225-30. [PMID: 25463429 DOI: 10.1097/bot.0000000000000261] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The objective of this study is to analyze the effect of an orthopaedic trauma advanced practice provider on length of stay (LOS) and cost in a level I trauma center. The hypothesis of this study is that the addition of a single full-time nurse practitioner (NP) to the orthopaedic trauma team at a level I Trauma center would decrease overall LOS and hospital cost. METHODS A retrospective chart review of all patients discharged from the orthopaedic surgery service 1 year before the addition of a NP (pre-NP) and 1 year after the hiring of a NP (post-NP) were reviewed. Chart review included age, gender, LOS, discharge destination, intravenous antibiotic use, wound VAC therapy, admission location, and length of time to surgery. Statistical analysis was performed using the Wilcoxon/Kruskal-Wallis test. RESULTS The hiring of a NP yielded a statistically significant decrease in the LOS across the following patient subgroups: patients transferred from the trauma service (13.56 compared with 7.02 days, P < 0.001), patients aged 60 years and older (7.34 compared with 5.04 days, P = 0.037), patients discharged to a rehabilitation facility (10.84 compared with 8.31 days, P = 0.002), and patients discharged on antibiotics/wound VAC therapy (15.16 compared with 11.24 days, P = 0.017). Length of time to surgery was also decreased (1.48 compared with 1.31 days, P = 0.37). CONCLUSIONS The addition of a dedicated orthopaedic trauma advanced practice provider at a county level I trauma center resulted in a statistically significant decrease in LOS and thus reduced indirect costs to the hospital. LEVEL OF EVIDENCE Economic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Chan WCH, Chan CLF, Suen M. Validation of the Chinese version of the Modified Caregivers Strain Index among Hong Kong caregivers: an initiative of medical social workers. HEALTH & SOCIAL WORK 2013; 38:214-221. [PMID: 24432488 DOI: 10.1093/hsw/hlt021] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Family caregivers may often experience caregiving stress and burden. To systematically assess this issue, medical social workers may need to use a brief and valid measurement in their practice. In the Hong Kong Chinese context, one additional challenge is to examine whether a measurement developed in the West is valid for Hong Kong Chinese caregivers. Thus, medical social workers in Hong Kong initiated this research study to validate the Chinese version of the Modified Caregiver Strain Index (C-M-CSI). A total of 223 Chinese caregivers of patients with various chronic illnesses were recruited for this validation study. C-M-CSI demonstrated good reliability (Cronbach's alpha coefficient = .91), concurrent validity with the Chinese version of the Caregiver Burden Inventory, and discriminant validity with the Chinese version of the Meaning in Life Questionnaire. Factor analysis yielded a single factor as the original M-CSI, which explained 49 percent of variance. Construct validity was shown by differentiating spousal and nonspousal caregivers, as well as caregivers of patients with and without behavioral problems. C-M-CSI is recommended as a brief and valid measurement that can be used by medical social workers in assessing the caregiving strain of Chinese caregivers of patients in Hong Kong.
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Affiliation(s)
| | | | - Margaret Suen
- Department of Medical Social Work, Caritas Medical Centre, Hospital Authority, Shamshuipo, Kowloon
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Campbell H, Rasmussen B. Riding third: social work in ambulance work. HEALTH & SOCIAL WORK 2012; 37:90-97. [PMID: 23029976 DOI: 10.1093/hsw/hls012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This research explored the possible role of social work alongside emergency ambulance services. An ethnographic study included semistructured interviews and direct observations collected over 300 hours while riding in ambulances in an urban setting. The data suggest that social work could play a role by providing needed psychosocial care during ambulance calls. Emergency personnel were often consumed by the medical crises and further constrained by the perceived narrow parameters of their work roles. Consequently, social work's role, informed by a broader biopsychosocial perspective, is envisioned as responding to the observed gaps in service.
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Affiliation(s)
- Hilary Campbell
- Vancouver Coastal Health, Intensive Care Unit, Vancouver, BC, Canada.
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Reisch M. The challenges of health care reform for hospital social work in the United States. SOCIAL WORK IN HEALTH CARE 2012; 51:873-893. [PMID: 23151284 DOI: 10.1080/00981389.2012.721492] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
This article examines the potential impact of the Patient Protection and Affordable Care Act (ACA) of 2010 on the practice of hospital social work in the United States and its implications for social work education and training. It briefly traces the history of hospital social work, outlines some contemporary issues in the health care field, particularly those that create persistent health disparities, summarizes the major provisions of the Act that have implications for social work practice, and discusses how social workers in hospital settings might respond effectively to the changes produced by the legislation.
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Affiliation(s)
- Michael Reisch
- School of Social Work, University of Maryland, Baltimore, MD 21201, USA.
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An evidence-based case for the value of social workers in efficient hospital discharge. Health Care Manag (Frederick) 2011; 30:242-6. [PMID: 21808176 DOI: 10.1097/hcm.0b013e318225e1dd] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A study was undertaken to make an evidence-based case for the value of social workers in efficient discharge of patients from acute care hospitals and to assist hospital managers in making informed staffing decisions. Hospital administrative databases from March 1 to November 30, 2008, were used for the analysis of inpatient discharges on days when social workers were on vacation compared with days fully staffed with social workers. Two performance measures, daily discharge rate and average length of stay, were evaluated. During the study period, 1825 patients were discharged from the General Internal Medicine inpatient service. Team discharge rates were significantly lower on social work vacation Fridays versus regular Fridays. In contrast, the average length of stay for patients discharged on social work vacation Fridays was significantly shorter than that for patients discharged on regular Fridays. It was concluded that daily discharge rate better quantified the role of social work in patient discharge. More generally, these results provide preliminary support for the need for adequate social work staffing in timely and efficient patient discharge.
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