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Manoukian S, Stewart S, Dancer S, Graves N, Mason H, McFarland A, Robertson C, Reilly J. Estimating excess length of stay due to healthcare-associated infections: a systematic review and meta-analysis of statistical methodology. J Hosp Infect 2018; 100:222-235. [PMID: 29902486 DOI: 10.1016/j.jhin.2018.06.003] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 06/05/2018] [Indexed: 02/09/2023]
Abstract
BACKGROUND Healthcare-associated infection (HCAI) affects millions of patients worldwide. HCAI is associated with increased healthcare costs, owing primarily to increased hospital length of stay (LOS) but calculating these costs is complicated due to time-dependent bias. Accurate estimation of excess LOS due to HCAI is essential to ensure that we invest in cost-effective infection prevention and control (IPC) measures. AIM To identify and review the main statistical methods that have been employed to estimate differential LOS between patients with, and without, HCAI; to highlight and discuss potential biases of all statistical approaches. METHODS A systematic review from 1997 to April 2017 was conducted in PubMed, CINAHL, ProQuest and EconLit databases. Studies were quality-assessed using an adapted Newcastle-Ottawa Scale (NOS). Methods were categorized as time-fixed or time-varying, with the former exhibiting time-dependent bias. Two examples of meta-analysis were used to illustrate how estimates of excess LOS differ between different studies. FINDINGS Ninety-two studies with estimates on excess LOS were identified. The majority of articles employed time-fixed methods (75%). Studies using time-varying methods are of higher quality according to NOS. Studies using time-fixed methods overestimate additional LOS attributable to HCAI. Undertaking meta-analysis is challenging due to a variety of study designs and reporting styles. Study differences are further magnified by heterogeneous populations, case definitions, causative organisms, and susceptibilities. CONCLUSION Methodologies have evolved over the last 20 years but there is still a significant body of evidence reliant upon time-fixed methods. Robust estimates are required to inform investment in cost-effective IPC interventions.
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Affiliation(s)
- S Manoukian
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK.
| | - S Stewart
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
| | - S Dancer
- Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire, UK
| | - N Graves
- Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia
| | - H Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
| | - A McFarland
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
| | - C Robertson
- Department of Mathematics and Statistics, University of Strathclyde, Glasgow, UK
| | - J Reilly
- School of Health and Life Sciences, Glasgow Caledonian University, Cowcaddens Road, Glasgow, UK
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Discrepancy Between Neurosurgery Morbidity and Mortality Conference Discussions and Hospital Quality Metric Standards. World Neurosurg 2018; 115:e105-e110. [DOI: 10.1016/j.wneu.2018.03.195] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2018] [Revised: 03/27/2018] [Accepted: 03/27/2018] [Indexed: 10/17/2022]
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Coomer NM, Kandilov AM. Impact of hospital-acquired conditions on financial liabilities for Medicare patients. Am J Infect Control 2016; 44:1326-1334. [PMID: 27174461 DOI: 10.1016/j.ajic.2016.03.025] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 03/22/2016] [Accepted: 03/22/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Hospital-acquired conditions (HACs) can increase the financial liabilities faced by patients when the HACs require additional treatment both in the hospital and in subsequent health care encounters. This article estimates incremental effects of 6 HACs on Medicare beneficiary financial liabilities. METHODS Descriptive and multivariate analyses were used to examine the differences in beneficiary liability between care episodes with and without HACs. Episodes included the index hospitalization in which the HAC occurred and all inpatient, outpatient, and physician claims within 90 days of index hospital discharge. Medicare fee-for-service patients discharged from a hospital in fiscal year (FY) 2009 or FY 2010 with severe pressure ulcer, fracture, catheter-associated urinary tract infection, vascular catheter-associated infection, surgical site infection, or deep vein thrombosis or pulmonary embolism after certain orthopedic procedures were matched by diagnosis, sex, race, and age to with patients without HACs. RESULTS Medicare patients were liable for an additional $20.5 million per year across the HAC episodes compared with what they would have owed without the HACs. Beneficiaries with HACs were also more likely to exhaust their Part A days in the index hospitalization. CONCLUSIONS HACs create significant financial burden for Medicare beneficiaries. The incremental financial liabilities are concentrated in the episode of care after the index hospitalization with the HAC. Policies and programs that reduce HAC incidence will improve Medicare beneficiaries' physical and financial health.
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Copanitsanou P, Valkeapää K, Cabrera E, Katajisto J, Leino-Kilpi H, Sigurdardottir AK, Unosson M, Zabalegui A, Lemonidou C. Total Joint Arthroplasty Patients' Education on Financial Issues and Its Connection to Reported Out-of-Pocket Costs-A European Study. Nurs Forum 2016; 52:97-106. [PMID: 27441849 DOI: 10.1111/nuf.12171] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE Total joint arthroplasty is accompanied by significant costs. In nursing, patient education on financial issues is considered important. Our purpose was to examine the possible association between the arthroplasty patients' financial knowledge and their out-of-pocket costs. METHODS Descriptive correlational study in five European countries. Patient data were collected preoperatively and at 6 months postoperatively, with structured, self-administered instruments, regarding their expected and received financial knowledge and out-of-pocket costs. FINDINGS There were 1,288 patients preoperatively, and 352 at 6 months. Patients' financial knowledge expectations were higher than knowledge received. Patients with high financial knowledge expectations and lack of fulfillment of these expectations had lowest costs. CONCLUSION There is need to establish programs for improving the financial knowledge of patients. Patients with fulfilled expectations reported higher costs and may have followed and reported their costs in a more precise way. In the future, this association needs multimethod research.
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Affiliation(s)
| | - Kirsi Valkeapää
- Adjunct Professor, Department of Nursing Science, University of Turku, Turku, Finland and Lahti University of Applied Sciences, Lahti, Finland
| | - Esther Cabrera
- Director of Health Science School, Tecno Campus, Matarό-Maresme, Spain
| | - Jouko Katajisto
- Statistician, Department of Statistics, University of Turku, Turku, Finland
| | - Helena Leino-Kilpi
- Professor, Department of Nursing Science, University of Turku, Turku, Finland and Nurse Director, Turku University Hospital, Turku, Finland
| | | | - Mitra Unosson
- Professor, Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Norrköping, Sweden
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Abstract
Diabetes often causes ulcers on the feet of diabetic patients. A 56-year-old, insulin-dependent, diabetic woman presented to the wound care center with a Wagner grade 3 ulcer of the right heel. She reported a 3-week history of ulceration with moderate drainage and odor and had a history of ulceration and osteomyelitis in the contralateral limb. Rigorous wound care, including hospitalization; surgical incision and drainage; intravenous antibiotic drug therapy; vacuum-assisted therapy; and a new room temperature, sterile, human acellular dermal matrix graft were used to heal the wound, save her limb, and restore her activities of daily living. This case presentation involves alternative treatment of a diabetic foot ulcer with this new acellular dermal matrix, DermACELL.
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Affiliation(s)
- Windy E. Cole
- Robinson Wound Care Center, 1533 S Water St, Kent, OH 44240. (E-mail: )
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Kandilov AMG, Coomer NM, Dalton K. The impact of hospital-acquired conditions on Medicare program payments. MEDICARE & MEDICAID RESEARCH REVIEW 2014; 4:mmrr2014-004-04-a01. [PMID: 25386385 DOI: 10.5600/mmrr.004.04.a01] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
RESEARCH OBJECTIVE Hospital-acquired conditions, or HACs, often result in additional Medicare payments, generated during the initial hospitalization and in subsequent health care encounters. The purpose of this article is to estimate the incremental cost to Medicare, as measured by Medicare program payments, of six HACs. STUDY DESIGN The researchers used a matched case-control design to determine the incremental increase in Medicare payments attributable to each HAC. For each HAC patient, five comparison patients were matched on diagnosis group, sex, race, and age. Using the matched sample, we estimated a hospital fixed effects log-linear regression on total Medicare payments for the episode of care, further controlling for co-morbid conditions. Care episodes included the initial hospitalization and all inpatient, outpatient, physician, home health, and hospice care that occurred within 90 days of hospital discharge. POPULATION STUDIED All Medicare fee-for-service patients discharged alive from a hospital between October 2008 and June 2010 with one of six HACs-severe pressure ulcer, fracture, catheter-associated urinary tract infection, vascular catheter-associated infection, surgical site infection following certain orthopedic procedures, or deep vein thrombosis/ pulmonary embolism following certain orthopedic procedures-were included in the sample and matched to five similar patients without the HACs. PRINCIPAL FINDINGS The multivariate analysis suggests that Medicare paid an additional $146 million per year across these HAC care episodes compared with what would have been paid without the HACs. CONCLUSIONS HACs create a significant financial burden for the Medicare program. We compare the incremental Medicare payments for these six HACs to the current and upcoming Medicare HAC payment penalties.
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DermACELL: a novel and biocompatible acellular dermal matrix in tissue expander and implant-based breast reconstruction. EUROPEAN JOURNAL OF PLASTIC SURGERY 2014; 37:529-538. [PMID: 25221385 PMCID: PMC4161921 DOI: 10.1007/s00238-014-0995-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2014] [Accepted: 07/12/2014] [Indexed: 11/03/2022]
Abstract
BACKGROUND Acellular dermal matrices present a new alternative to supporting expanders and implants for breast reconstruction in breast cancer patients following mastectomy. However, some studies have suggested that acellular dermal matrix may increase the complication rates in certain clinical settings. DermACELL acellular dermal matrix offers advanced processing in order to attempt to decrease bio-intolerance and complications. METHODS Ten consecutive patients that presented for breast reconstruction and were candidates for tissue expanders underwent the procedure with the use of an acellular dermal matrix. The patients underwent postoperative expansion/adjuvant cancer therapy, then tissue expander exchange for permanent silicone breast prostheses. Patients were followed through the postoperative course to assess complication outcomes. Histologic evaluation of host integration into the dermal matrix was also assessed. RESULTS Of the ten patients, eight completed reconstruction while two patients failed reconstruction. The failures were related to chronic seromas and infection. Histology analysis confirms rapid integration of mesenchymal cells into the matrix compared to other acellular dermal matrices. CONCLUSIONS Based on our observations, DermACELL is an appropriate adjunct to reconstruction with expanders. Histological analysis of vascularization and recellularization support the ready incorporation of DermACELL into host tissue. Level of Evidence: Level IV, therapeutic study.
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Cimiotti JP, Aiken LH, Sloane DM, Wu ES. Nurse staffing, burnout, and health care-associated infection. Am J Infect Control 2012; 40:486-90. [PMID: 22854376 DOI: 10.1016/j.ajic.2012.02.029] [Citation(s) in RCA: 441] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2011] [Revised: 02/13/2012] [Accepted: 02/13/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND Each year, nearly 7 million hospitalized patients acquire infections while being treated for other conditions. Nurse staffing has been implicated in the spread of infection within hospitals, yet little evidence is available to explain this association. METHODS We linked nurse survey data to the Pennsylvania Health Care Cost Containment Council report on hospital infections and the American Hospital Association Annual Survey. We examined urinary tract and surgical site infection, the most prevalent infections reported and those likely to be acquired on any unit within a hospital. Linear regression was used to estimate the effect of nurse and hospital characteristics on health care-associated infections. RESULTS There was a significant association between patient-to-nurse ratio and urinary tract infection (0.86; P = .02) and surgical site infection (0.93; P = .04). In a multivariate model controlling for patient severity and nurse and hospital characteristics, only nurse burnout remained significantly associated with urinary tract infection (0.82; P = .03) and surgical site infection (1.56; P < .01) infection. Hospitals in which burnout was reduced by 30% had a total of 6,239 fewer infections, for an annual cost saving of up to $68 million. CONCLUSIONS We provide a plausible explanation for the association between nurse staffing and health care-associated infections. Reducing burnout in registered nurses is a promising strategy to help control infections in acute care facilities.
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Carey K, Stefos T. Measuring the cost of hospital adverse patient safety events. HEALTH ECONOMICS 2011; 20:1417-1430. [PMID: 20967761 DOI: 10.1002/hec.1680] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2010] [Revised: 07/12/2010] [Accepted: 09/07/2010] [Indexed: 05/30/2023]
Abstract
This paper estimates the excess cost of hospital inpatient care due to adverse safety events in the U.S. Department of Veterans Affairs (VA) hospitals during fiscal year 2007. We measured adverse events according to the Patient Safety Indicator (PSI) algorithms of the Agency for Healthcare Research and Quality. Patient level cost regression analyses were performed using generalized linear modeling techniques. Accounting for the heavily skewed distribution of costs among patients having adverse safety events, results suggested that the excess cost of nine different PSIs for VA patients are much higher than previously estimated. We tested sensitivity of results to whether costs were measured by VA's Decision Support System (DSS) that uses local costs of specific inputs, or by the average costing system developed by VA's Health Economics Resource Center. DSS costing appeared to better characterize the high cost patients.
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Affiliation(s)
- Kathleen Carey
- VA Center for Health Quality, Outcomes and Economic Research, Bedford, MA 01730, USA.
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Carey K, Stefos T, Shibei Zhao, Borzecki AM, Rosen AK. Excess Costs Attributable to Postoperative Complications. Med Care Res Rev 2011; 68:490-503. [DOI: 10.1177/1077558710396378] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article estimates excess costs associated with postoperative complications among inpatients treated in Veterans Health Administration (VA) hospitals. The authors conducted an observational study on 43,822 hospitalizations involving inpatient surgery in one of 104 VA hospitals during fiscal year 2007. Hospitalization-level cost regression analyses were performed to estimate the excess cost of each of 18 unique postoperative complications. The authors used generalized linear modeling techniques to account for the heavily skewed cost distribution. Costs were measured using an activity-based cost accounting system and complications were assessed based on medical chart review conducted by the VA ‘National Surgical Quality Improvement Program. The authors found excess costs associated with postoperative complications ranging from $8,338 for “superficial surgical site infection” to $29,595 for “failure to wean within 24 hours in the presence of respiratory complications.” The results obtained suggest that quality improvement efforts aimed at reducing postoperative complications can contribute significantly to lowering of hospital costs.
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Affiliation(s)
- Kathleen Carey
- VA Center for Health Quality, Outcomes and Economic Research, Boston University School of Public Health,
| | - Theodore Stefos
- VA Office of Productivity, Efficiency and Staffing, Boston University School of Public Health
| | - Shibei Zhao
- VA Center for Health Quality, Outcomes and Economic Research
| | - Ann M. Borzecki
- VA Center for Health Quality, Outcomes and Economic Research, Boston University School of Medicine, Boston University School of Public Health
| | - Amy K. Rosen
- VA Center for Organization, Leadership and Management Research, Boston University School of Public Health
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11
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Clinical and economic analysis of hospital acquired infections in patients diagnosed with brain tumor in a tertiary hospital. Neurocirugia (Astur) 2011; 22:535-41. [DOI: 10.1016/s1130-1473(11)70108-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Karagozian R, Johannes RS, Sun X, Burakoff R. Increased mortality and length of stay among patients with inflammatory bowel disease and hospital-acquired infections. Clin Gastroenterol Hepatol 2010; 8:961-5. [PMID: 20723618 DOI: 10.1016/j.cgh.2010.07.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2010] [Revised: 07/01/2010] [Accepted: 07/23/2010] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Hospitalized patients with inflammatory bowel disease (IBD) could be at increased risk for hospital-acquired infections (HAIs). By using HAI outcome data from Pennsylvania, we examined the influence of HAIs on in-patient mortality and length of stay (LOS) in the hospital among patients with IBD. METHODS Data were generated by linking the Clinical Research Databases from CareFusion (formerly MediQual), which includes all acute care hospitals in Pennsylvania, with publicly reported HAI data from Pennsylvania. The study population included all patients discharged in 2004 with International Classification of Diseases, 9th Clinical Modification codes of 555.x or 556.x (2324 IBD cases from 161 hospitals). Controls were selected using risk-score matching with a 5:1 ratio. Mortality and LOS end points were estimated and corroborated with regression methods. RESULTS Among the IBD patients studied, there were 20 deaths and 22 reported cases of HAI. The mortality from HAI among patients with IBD was 13.6%, compared with 0.9% among controls (P = .0146, Fisher exact test). The odds ratio for mortality was 17.2 (95% confidence interval, 1.7-174.3). The median LOS for patients with IBD and HAI was 22 days, versus 6 days for controls (P < .001, Wilcoxon). Of the 22 cases with HAIs, 15 were urinary tract infections, 5 were blood stream infections, and 2 were from multiple sources. CONCLUSIONS Results from a population-based data set indicate that mortality and LOS are increased among IBD patients who develop HAIs. A majority of the HAIs were from urinary sources. Although HAIs are low-frequency events, increased vigilance to avoid HAI among patients with IBD could improve outcomes.
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Affiliation(s)
- Raffi Karagozian
- Division of Gastroenterology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
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Lagoe RJ, Westert GP. Evaluation of hospital inpatient complications: a planning approach. BMC Health Serv Res 2010; 10:200. [PMID: 20618943 PMCID: PMC2914724 DOI: 10.1186/1472-6963-10-200] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2009] [Accepted: 07/09/2010] [Indexed: 11/22/2022] Open
Abstract
Background Hospital inpatient complications are one of a number of adverse health care outcomes. Reducing complications has been identified as an approach to improving care and saving resources as part of the health care reform efforts in the United States. An objective of this study was to describe the Potentially Preventable Complications software developed as a tool for evaluating hospital inpatient outcomes. Additional objectives included demonstration of the use of this software to evaluate the connection between health care outcomes and expenses in United States administrative data at the state and local levels and the use of the software to plan and implement interventions to reduce hospital complications in one U.S. metropolitan area. Methods The study described the Potentially Preventable Complications software as a tool for evaluating these inpatient hospital outcomes. Through administrative hospital charge data from California and Maryland and through cost data from three hospitals in Syracuse, New York, expenses for patients with and without complications were compared. These comparisons were based on patients in the same All Patients Refined Diagnosis Related Groups and severity of illness categories. This analysis included tests of statistical significance. In addition, the study included a planning process for use of the Potentially Preventable Complications software in three Syracuse hospitals to plan and implement reductions in hospital inpatient complications. The use of the PPC software in cost comparisons and reduction of complications included tests of statistical significance. Results The study demonstrated that Potentially Preventable Complications were associated with significantly increased cost in administrative data from the United States in California and Maryland and in actual cost data from the hospitals of Syracuse, New York. The implementation of interventions in the Syracuse hospitals was associated with the reduction of complications for urinary tract infection, decubitus ulcer, and pulmonary embolism. Conclusions The study demonstrated that the Potentially Preventable Complications software could be used to evaluate hospital outcomes and related costs at the aggregate and diagnosis specific levels. It also indicated that the system could be used to plan and implement interventions to improve outcomes on an individual or multihospital basis.
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Affiliation(s)
- Ronald J Lagoe
- National Institute for Public Health and the Environment Bilthoven, Netherlands
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Johannes RS, Peng MM, Darin R. Diagnosis Related Group Perturbation: A New Twist on the Economics of Hospital-Acquired Infection? Am J Med Qual 2009; 24:71-3. [DOI: 10.1177/1062860608327608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Richard S. Johannes
- Clinical Research, Cardinal Health/MediQual Services, Dublin, Ohio, Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts,
| | - Michael M. Peng
- Clinical Research, Cardinal Health/MediQual Services, Dublin, Ohio
| | - Robert Darin
- Clinical Research, Cardinal Health/MediQual Services, Dublin, Ohio
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Wu BU, Johannes RS, Kurtz S, Banks PA. The impact of hospital-acquired infection on outcome in acute pancreatitis. Gastroenterology 2008; 135:816-20. [PMID: 18616944 PMCID: PMC2570951 DOI: 10.1053/j.gastro.2008.05.053] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2008] [Revised: 05/14/2008] [Accepted: 05/21/2008] [Indexed: 12/15/2022]
Abstract
BACKGROUND & AIMS Little is known regarding the impact of hospital-acquired infection (HAI) in acute pancreatitis (AP). We conducted a population-based assessment of the impact of HAI on outcome in AP. METHODS Patient data were obtained from the Cardinal Health Clinical Outcomes Research Database, a large population-based data set. Cases with principal diagnosis by International Classification of Diseases, ninth revision, clinical modification 577.0 (AP) between January 2004 and January 2005 were identified. These cases were linked with recently reported HAI data collected by the Pennsylvania Health Care Cost Containment Council. Identification of HAI was based on definitions set forth by the National Nosocomial Infection Surveillance System. We conducted a 5:1 multivariate propensity-matched cohort study to determine the independent contribution of HAI to in-hospital mortality, length of stay (LOS), and hospital charges. RESULTS From 177 participating hospitals, there were 11,046 AP cases identified. Eighty-two (0.7%) patients developed an HAI. Mortality in the overall AP population was 1.2% vs 11.4% among 405 matched non-HAI controls vs 28.4% among patients who developed HAI (chi(2) test, P < .0001). Fifteen percent of all deaths was associated with an HAI. Both average LOS and hospital charges were significantly increased among patients with HAI compared with matched non-HAI controls. CONCLUSIONS We determined that HAI had a major impact on mortality in AP. Patients who developed HAI also had significantly increased LOS and hospital charges. These differences were not explained by increased disease severity alone. Reducing HAI is an important step to improving outcome in AP.
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Affiliation(s)
- Bechien U Wu
- Division of Gastroenterology, Brigham and Women's Hospital, Center for Pancreatic Disease, Harvard Medical School, Boston, Massachusetts 02115, USA.
| | - Richard S. Johannes
- Brigham and Women’s Hospital, Division of Gastroenterology, Center for Pancreatic Disease, Harvard Medical School, Boston MA,Cardinal Health, Marlborough MA
| | | | - Peter A. Banks
- Brigham and Women’s Hospital, Division of Gastroenterology, Center for Pancreatic Disease, Harvard Medical School, Boston MA
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A population-based study of prevalence and hospital charges in total hip and knee replacement. INTERNATIONAL ORTHOPAEDICS 2008; 33:949-54. [PMID: 18612638 DOI: 10.1007/s00264-008-0612-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Accepted: 05/19/2008] [Indexed: 10/21/2022]
Abstract
The purpose of this study was to explore the increasing prevalence of factors affecting hospital charges for primary total hip replacement/total knee replacement (THR/TKR). This study analysed 37,918 THR and 76,727 TKR procedures performed in Taiwan from 1996 to 2004. Odds ratio (OR) and effect size (ES) were calculated to assess the relative change rate. Multiple regression models were employed to predict hospital charges. The following factors were associated with increased hospital charges: age younger than 65 years old; increased disease severity (Charlson comorbidity index [CCI] = 1 or > or = 2); absence of primary diagnoses of osteoarthritis (OA), rheumatoid arthritis (RA), avascular necrosis (AVN); treatment at a hospital or by a surgeon performing a high volume of operations; and longer average length of stay (ALOS). The Bureau of National Health Insurance (BNHI) should ensure that surgeons take precautionary measures to minimise complications and maximise quality of life after surgery. Use of joint prostheses from different manufacturers can reduce costs without compromising patient satisfaction.
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Hollenbeak CS, Gorton CP, Tabak YP, Jones JL, Milstein A, Johannes RS. Reductions in Mortality Associated With Intensive Public Reporting of Hospital Outcomes. Am J Med Qual 2008; 23:279-86. [DOI: 10.1177/1062860608318451] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Christopher S. Hollenbeak
- Departments of Surgery and Public Health Sciences, Penn State College of Medicine, Hershey, Pennsylvania,
| | | | | | - Jayne L. Jones
- Pennsylvania Health Care Cost Containment Council, Harrisburg, Pennsylvania
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