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Seal K, Richmond B, Jain S, Minor J, Lasky TM, Reading L, Samanta D. Impact of Treatment Modalities on Discharge Disposition in Blunt Splenic Injuries. Cureus 2023; 15:e45987. [PMID: 37900500 PMCID: PMC10601512 DOI: 10.7759/cureus.45987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/20/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Management of blunt splenic trauma has evolved over several decades, trending towards nonoperative management and splenic artery embolization. Extensive research has been conducted regarding the management of blunt splenic injuries, but there is little data on the association of treatment modality with discharge disposition. METHODS This is an observational retrospective study conducted at a level-one trauma center with blunt splenic trauma patients of age ≥18 years between January 2010 and December 2021. The primary outcome of unfavorable discharge was defined as discharge to an acute care facility, intermediate care facility, long-term care facility, rehabilitation (inpatient) facility, or skilled nursing facility. RESULTS Five hundred seventy-nine patients were included in the analysis, with 108 (18.7%) in the unfavorable group and 471 (81.3%) in the favorable group. Most patients were managed nonoperatively (69.3%), followed by splenectomy (25.0%) and embolization (5.7%). Due to the low number of embolizations performed during the study period, treatment modalities were grouped into two broad categories: intervention (embolization and splenectomies) and nonintervention. The treatment modality was found to have no significant impact on unfavorable discharge. Independent risk factors for unfavorable discharge included age >55 years, injury severity score (ISS) >15, hospital-acquired pneumonia, and in-hospital complications of sepsis. CONCLUSIONS This study provides an understanding of specific demographic and clinical factors that may predispose blunt splenic injury trauma patients to an unfavorable discharge. Providers may apply these data to identify at-risk patients and subsequently adapt the care they provide in an effort to prevent the development of in-hospital pneumonia and sepsis.
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Affiliation(s)
- Kimberly Seal
- Vascular Surgery, Charleston Area Medical Center, West Virginia University, Charleston, USA
| | - Bryan Richmond
- General Surgery, Charleston Area Medical Center, West Virginia University, Charleston, USA
| | - Sachin Jain
- General Surgery, Charleston Area Medical Center, West Virginia University, Charleston, USA
| | - Jacob Minor
- General Surgery, Charleston Area Medical Center, West Virginia University, Charleston, USA
| | - Tiffany M Lasky
- Critical Care, Charleston Area Medical Center, West Virginia University, Charleston, USA
| | - Landon Reading
- Trauma, West Virginia School of Osteopathic Medicine, Charleston, USA
| | - Damayanti Samanta
- Trauma, Center for Health Services and Outcomes Research, Charleston Area Medical Center Institute for Academic Medicine, Charleston, USA
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Intensive care unit strain and mortality risk in patients admitted from the ward in Australia and New Zealand. J Crit Care 2021; 68:136-140. [PMID: 34353690 DOI: 10.1016/j.jcrc.2021.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Revised: 02/05/2021] [Accepted: 07/16/2021] [Indexed: 11/20/2022]
Abstract
PURPOSE ICU strain (low number of available beds) may be associated with a delay and altered threshold for ICU admission and adverse patient outcomes. We aimed to investigate the impact of ICU strain on hospital mortality in critically ill patients admitted from wards across Australia and New Zealand. MATERIALS AND METHODS Ward patient admitted to ICU and ICU bed data at 137 hospitals were accessed between January 2013 and December 2016. ICU strain was classified as low (≤0.5 patients admitted per available ICU bed in a 6-h block), medium (0.5 to ≤1) or high (>1). Logistic regression models were used to examine the relationship between ICU strain and hospital mortality. RESULTS 57,844 ICU admissions were analysed, with the majority (64.4%) admitted to medium-strain ICUs. Those admitted to high-strain ICUs spent longer in hospital prior to ICU than medium-strain or low-strain ICUs. After adjusting for confounders those admitted to high-strain ICUs [OR 1.24 (95%CI 1.14-1.35)] or medium-strain ICUs [OR 1.18 (95%CI 1.09-1.27)], (p < 0.001) had a higher risk of death compared low-strain ICUs. CONCLUSION ICU strain is associated with longer times in hospital prior to ICU admission and was associated with increased risk of death in patients admitted from ward.
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Komaromy M, Bartlett J, Gonzales-van Horn SR, Zurawski A, Kalishman SG, Zhu Y, Davis HT, Ceballos V, Sun X, Jurado M, Page K, Hamblin A, Arora S. A Novel Intervention for High-Need, High-Cost Medicaid Patients: a Study of ECHO Care. J Gen Intern Med 2020; 35:21-27. [PMID: 31667743 PMCID: PMC6957626 DOI: 10.1007/s11606-019-05206-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 08/28/2018] [Accepted: 05/02/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND A small number of high-need patients account for a disproportionate amount of Medicaid spending, yet typically engage little in outpatient care and have poor outcomes. OBJECTIVE To address this issue, we developed ECHO (Extension for Community Health Outcomes) Care™, a complex care intervention in which outpatient intensivist teams (OITs) provided care to high-need high-cost (HNHC) Medicaid patients. Teams were supported using the ECHO model™, a continuing medical education approach that connects specialists with primary care providers for case-based mentoring to treat complex diseases. DESIGN Using an interrupted time series analysis of Medicaid claims data, we measured healthcare utilization and expenditures before and after ECHO Care. PARTICIPANTS ECHO Care served 770 patients in New Mexico between September 2013 and June 2016. Nearly all had a chronic mental illness, and over three-quarters had a chronic substance use disorder. INTERVENTION ECHO Care patients received care from an OIT, which typically included a nurse practitioner or physician assistant, a registered nurse, a licensed mental health provider, and at least one community health worker. Teams focused on addressing patients' physical, behavioral, and social issues. MAIN MEASURES We assessed the effect of ECHO Care on Medicaid costs and utilization (inpatient admissions, emergency department (ED) visits, other outpatient visits, and dispensed prescriptions. KEY RESULTS ECHO Care was associated with significant changes in patients' use of the healthcare system. At 12 months post-enrollment, the odds of a patient having an inpatient admission and an ED visit were each reduced by approximately 50%, while outpatient visits and prescriptions increased by 23% and 8%, respectively. We found no significant change in overall Medicaid costs associated with ECHO Care. CONCLUSIONS ECHO Care shifts healthcare utilization from inpatient to outpatient settings, which suggests decreased patient suffering and greater access to care, including more effective prevention and early intervention for chronic conditions.
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Affiliation(s)
- Miriam Komaromy
- Medical Director, Grayken Center for Addiction, Boston Medical Center, Boston University, 801 Massachusetts Ave, #1039, Boston, MA, 02118, USA.
| | - Judy Bartlett
- Division of General Internal Medicine, Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, NM, 87131, USA
| | | | - Andrea Zurawski
- University of New Mexico Health Sciences Center, ECHO Institute™, Albuquerque, NM, USA
| | - Summers G Kalishman
- University of New Mexico Health Sciences Center, ECHO Institute™, Albuquerque, NM, USA
| | - Yiliang Zhu
- Division of Epidemiology, Biostatistics and Prevention, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Herbert T Davis
- Division of Epidemiology, Biostatistics and Prevention, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | - Venice Ceballos
- University of New Mexico Health Sciences Center, ECHO Institute™, Albuquerque, NM, USA
| | - Xi Sun
- University of New Mexico Health Sciences Center, ECHO Institute™, Albuquerque, NM, USA
| | - Martin Jurado
- University of New Mexico Health Sciences Center, ECHO Institute™, Albuquerque, NM, USA
| | - Kimberly Page
- Division of Epidemiology, Biostatistics and Prevention, University of New Mexico Health Sciences Center, Albuquerque, NM, USA
| | | | - Sanjeev Arora
- University of New Mexico Health Sciences Center, ECHO Institute™, Albuquerque, NM, USA
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Hong Y, Mansour S, Alotaibi G, Wu C, McMurtry MS. Effect of anticoagulants on admission rates and length of hospital stay for acute venous thromboembolism: A systematic review of randomized control trials. Crit Rev Oncol Hematol 2018; 125:12-18. [PMID: 29650271 DOI: 10.1016/j.critrevonc.2018.02.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 01/05/2018] [Accepted: 02/21/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND There is a paucity of data available on hospitalization and length of stay (LOS) for different anticoagulant therapies. We sought to compare and summarize admission rates and LOS, and describe the frequency of reporting these two outcomes in randomized control trials (RCTs) comparing different anticoagulant therapies for venous thromboembolism (VTE). METHODS A literature search was conducted from inception to August 15, 2016 on RCTs of anticoagulant therapy for patients with VTE. Study selection, data extraction and risk of bias analysis were done by two reviewers independently. Meta-analyses were conducted for admission rates and LOS. RESULTS A total of 4064 articles were identified. There were 74 articles of 70 studies included in the analysis. Hospitalization rates and LOS were reported in 13 (18.6%) and 12 (17.1%) of the 70 included studies, respectively. Low-molecular-weight heparin (LMWH)-treated patients were 33.0% less likely to be admitted to hospitals compared to unfractionated heparin (UFH) (RR = 0.67, 95% CI [0.58, 0.78]). The mean difference in LOS between LMWH and UFH was 2.54 days in favor of LMWH (95% CI [-4.94, -0.14]). Compared to parenteral therapy, using rivaroxaban was associated with a lower admission rate for a difference of 1.4-5.1% in VTE, 2.5% in DVT and 0.2% in PE. The LOS of patients receiving rivaroxaban was significant shorter than the LOS in parenteral therapy group for a difference of 1-5 days in VTE, 3 days in DVT and 1 day in PE. CONCLUSION Admission rates were lower and LOS was shorter using LMWH compared to UFH and oral therapy compared to parenteral therapy for acute VTE treatment in RCTs, based on limited eligible RCTs. These crucial clinically relevant outcomes are underreported in the existing VTE clinical trials.
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Affiliation(s)
- Yongzhe Hong
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; The Second Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Sola Mansour
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Ghazi Alotaibi
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Department of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Cynthia Wu
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Complications following hospital admission for traumatic brain injury: A multicenter cohort study. J Crit Care 2017; 41:1-8. [PMID: 28477507 DOI: 10.1016/j.jcrc.2017.04.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2017] [Revised: 04/11/2017] [Accepted: 04/21/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the incidence, determinants and impact on outcome of in-hospital complications in adults with traumatic brain injury (TBI). MATERIALS AND METHODS We conducted a multicenter cohort study of TBI patients admitted between 2007 and 2012 in an inclusive Canadian trauma system. Risk ratios of complications, odds ratios of mortality and geometric mean ratios of length of stay (LOS) were calculated using generalized linear models with adjustment for prognostic indicators and hospital cluster effects. RESULTS Of 12,887 patients, 3.2% had at least one neurological complication and 22.6% a non-neurological complication. Mechanical ventilation, head injury severity, blood transfusion and neurosurgical intervention had the strongest correlation with neurological complications. Mechanical ventilation, the Glasgow Coma Scale, blood transfusion and concomitant injuries had the strongest correlation with non-neurological complications. Neurological and non-neurological complications were associated with a 85% and 53% increase in the odds of mortality, and a 60% and two-fold increases in LOS, respectively. CONCLUSIONS More than 20% of patients with TBI developed a complication. Many of these complications were associated with increased mortality and LOS. Results highlight the importance of prevention strategies adapted to treatment decisions and underline the need to improve knowledge on the underuse and overuse of clinical interventions.
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Impacto económico de los eventos adversos en los hospitales españoles a partir del Conjunto Mínimo Básico de Datos. GACETA SANITARIA 2014; 28:48-54. [DOI: 10.1016/j.gaceta.2013.06.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 05/30/2013] [Accepted: 06/03/2013] [Indexed: 11/23/2022]
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Lagoe R, Littau S. Improving Hospital Utilization and Outcomes: Health Economics at the Community Level. Health (London) 2014. [DOI: 10.4236/health.2014.69107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lázaro M, Marco J, Barba R, Ribera JM, Plaza S, Zapatero A. [Nonagenarian patients admitted to Spanish internal medicine hospital departments]. Rev Esp Geriatr Gerontol 2012; 47:193-197. [PMID: 22884638 DOI: 10.1016/j.regg.2012.02.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 01/25/2012] [Accepted: 02/21/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To describe the demographic and clinical profile of nonagenarian patients admitted to Internal Medicine departments in Spanish hospitals, and to compare it with younger patients. METHODS We identified, through the MBDS (Basic Minimum Data Set), every patient older than 90 years admitted to Internal Medicine Departments of the Spanish National Health Service public hospitals between 2005- 2008. Hospital discharge data were obtained from the MBDS. A diagnosis-related group (DRG) was identified for every patient. The DRG 21.0 version was used. We compared this nonagenarian group with data of younger adult people. All centres submit this information to the Spanish Health Ministry. The Charlson Index (CCI) was used to determine comorbidity. All statistical analyses were performed using SPSS 14.0. RESULTS The sample included 131,434 patients over 90 years (6% of total patients admitted), with 2,222 patients being over 100 years. There were 45.3% female patients under 90 years, compared to 67.3% over 90 years (P<.001). The top ten DRGs listed in the older group included three new conditions not present in the younger one: pulmonary oedema (DRG: 87), severe urinary tract infection (DRG: 320), and severe respiratory tract infection (DRG: 540). The first 5 DRG were: pneumonia/bronchitis (541): 11.9%, heart failure (127): 8.9%, rhythm disorders (544): 7.5%, pulmonary oedema (87): 3.8%, and other respiratory diseases (89): 3.24%. In any case the incidence of these conditions was higher than those found in younger patients. Among this top ten, only COPD and angina had a higher rate in the younger group. The incidence of hospital deaths were 9.1% among the younger group, and 21.8% among the nonagenarians (P<.001). If only the first 48 hours after admission are taken into account, the rates were 2.2% vs 6% (P<.001). The majority (78.2%) of nonagenarian patients return home after discharge CONCLUSIONS 1) There are a high number of nonagenarians patients admitted in hospital Internal Medicine Departments; 2) The number of women increases with age; 3) List of diagnosis varies according with age; 4) Hospital death rates increase with age, both in first two days and total stay, and 5) The majority of these patients are able to return home after discharge.
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Affiliation(s)
- Montserrat Lázaro
- Servicios de Geriatría y de Medicina Interna, Hospital Clínico San Carlos, Madrid, Spain.
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Borghans I, Kleefstra SM, Kool RB, Westert GP. Is the length of stay in hospital correlated with patient satisfaction? Int J Qual Health Care 2012; 24:443-51. [DOI: 10.1093/intqhc/mzs037] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Barba R, Zapatero A, Marco J, Perez A, Canora J, Plaza S, Losa J. Admission of Nursing Home Residents to a Hospital Internal Medicine Department. J Am Med Dir Assoc 2012; 13:82.e13-7. [DOI: 10.1016/j.jamda.2010.12.095] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2010] [Revised: 12/16/2010] [Accepted: 12/16/2010] [Indexed: 11/24/2022]
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Lagoe RJ, Westert GP, Czyz AM, Johnson PE. Reducing potentially preventable complications at the multi hospital level. BMC Res Notes 2011; 4:271. [PMID: 21801385 PMCID: PMC3160398 DOI: 10.1186/1756-0500-4-271] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 07/29/2011] [Indexed: 11/10/2022] Open
Abstract
Background This study describes the continuation of a program to constrain health care costs by limiting inpatient hospital programs among the hospitals of Syracuse, New York. Through a community demonstration project, it identified components of individual hospital programs for reduction of complications and their impact on the frequency and rates of these outcomes. Findings This study involved the implementation of interventions by three hospitals using the Potentially Preventable Complications System developed by 3M™ Health Information Systems. The program is noteworthy because it included competing hospitals in the same community working together to reduce adverse patient outcomes and related costs. The study data identified statistically significant reductions in the frequency of high and low volume complications during the three year period at two of the hospitals. At both of these hospitals, aggregate complication rates also declined. At these hospitals, the differences between actual complication rates and severity adjusted complication rates were also reduced. At the third hospital, specific and aggregate complication rates remained the same or increased slightly. Differences between these rates and those of severity adjusted comparison population also remained the same or increased. Conclusions Results of the study suggested that, in one community health care system, the progress of reducing complications involved different experiences. At two hospitals with relatively higher rates at the beginning of the study, management by administrative and clinical staff outside quality assurance produced significant reductions in complication rates, while at a hospital with lower rates, management by quality assurance staff had little effect on reducing the rate of PPCs.
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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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