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Syafrawati S, Machmud R, Aljunid SM, Semiarty R. Incidence of moral hazards among health care providers in the implementation of social health insurance toward universal health coverage: evidence from rural province hospitals in Indonesia. Front Public Health 2023; 11:1147709. [PMID: 37663851 PMCID: PMC10473252 DOI: 10.3389/fpubh.2023.1147709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
Objective To identify the incidence of moral hazards among health care providers and its determinant factors in the implementation of national health insurance in Indonesia. Methods Data were derived from 360 inpatient medical records from six types C public and private hospitals in an Indonesian rural province. These data were accumulated from inpatient medical records from four major disciplines: medicine, surgery, obstetrics and gynecology, and pediatrics. The dependent variable was provider moral hazards, which included indicators of up-coding, readmission, and unnecessary admission. The independent variables are Physicians' characteristics (age, gender, and specialization), coders' characteristics (age, gender, education level, number of training, and length of service), and patients' characteristics (age, birth weight, length of stay, the discharge status, and the severity of patient's illness). We use logistic regression to investigate the determinants of moral hazard. Results We found that the incidences of possible unnecessary admissions, up-coding, and readmissions were 17.8%, 11.9%, and 2.8%, respectively. Senior physicians, medical specialists, coders with shorter lengths of service, and patients with longer lengths of stay had a significant relationship with the incidence of moral hazard. Conclusion Unnecessary admission is the most common form of a provider's moral hazard. The characteristics of physicians and coders significantly contribute to the incidence of moral hazard. Hospitals should implement reward and punishment systems for doctors and coders in order to control moral hazards among the providers.
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Affiliation(s)
| | | | - Syed Mohamed Aljunid
- Department of Community Medicine, School of Medicine, International Medical University, Kuala Lumpur, Malaysia
- International Center for Casemix and Clinical Coding, Faculty of Medicine, National University of Malaysia, Cheras, Malaysia
| | - Rima Semiarty
- Faculty of Medicine, Andalas University, Padang, Indonesia
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Sachdeva M, Troup A, Jeffs L, Matelski J, Bell CM, Okrainec K. "I Had Bills to Pay": a Mixed-Methods Study on the Role of Income on Care Transitions in a Public-Payer Healthcare System. J Gen Intern Med 2023; 38:1606-1614. [PMID: 36697926 DOI: 10.1007/s11606-023-08024-7] [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: 06/01/2022] [Accepted: 12/30/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND Income disparities may affect patients' care transition home. Evidence among patients who have access to publicly funded healthcare coverage remains limited. OBJECTIVE To evaluate the association between low income and post-discharge health outcomes and explore patient and caregiver perspectives on the role of income disparities. DESIGN Mixed-methods secondary analysis conducted among participants in a double-blind randomized controlled trial. PARTICIPANTS Participants from a multicenter study in Ontario, Canada, were classified as low income if annual self-reported salary was below $29,000 CAD, or between $30,000 and $50,000 CAD and supported ≥ 3 individuals. MAIN MEASURES The associations between low income and the following self-reported outcomes were evaluated using multivariable logistic regression: patient experience, adherence to medications, diet, activity and follow-up, and the aggregate of emergency department (ED) visits, readmission, or death up to 3 months post-discharge. A deductive direct content analysis of patient and caregivers on the role of income-related disparities during care transitions was conducted. KEY RESULTS Individuals had similar odds of reporting high patient experience and adherence to instructions regardless of reported income. Compared to higher income individuals, low-income individuals also had similar odds of ED visits, readmissions, and death within 3 months post-discharge. Low-income individuals were more likely than high-income individuals to report understanding their medications completely (OR 1.9, 95% CI: 1.0-3.4) in fully adjusted regression models. Two themes emerged from 25 interviews which (1) highlight constraints of publicly funded services and costs incurred to patients or their caregivers along with (2) the various ways patients adapt through caregiver support, private services, or prioritizing finances over health. CONCLUSIONS There were few quantitative differences in patient experience, adherence, ED visits, readmissions, and death post-discharge between individuals reporting low versus higher income. Several hidden costs for transportation, medications, and home care were reported however and warrant further research.
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Affiliation(s)
- Muskaan Sachdeva
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Amy Troup
- Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Lianne Jeffs
- Lunenfeld-Tanenbaum Research Institute Sinai Health, Toronto, Ontario, Canada
| | - John Matelski
- Biostatistics Research Unit, University Health Network, Toronto, Ontario, Canada
| | - Chaim M Bell
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Lunenfeld-Tanenbaum Research Institute Sinai Health, Toronto, Ontario, Canada.,Department of Medicine, Sinai Health System, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Karen Okrainec
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada. .,Toronto General Hospital Research Institute, University Health Network, Toronto, Ontario, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. .,Department of Medicine, University Health Network, Toronto, Ontario, Canada. .,Toronto Western Hospital, 399 Bathurst Street, 8EW-408, Toronto, Ontario, M5T 2S8, Canada.
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Machine learning methods to predict 30-day hospital readmission outcome among US adults with pneumonia: analysis of the national readmission database. BMC Med Inform Decis Mak 2022; 22:288. [DOI: 10.1186/s12911-022-01995-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Hospital readmissions for pneumonia are a growing concern in the US, with significant consequences for costs and quality of care. This study developed the rule-based model and other machine learning (ML) models to predict 30-day readmission risk in patients with pneumonia and compared model performance.
Methods
This population-based study involved patients aged ≥ 18 years hospitalized with pneumonia from January 1, 2016, through November 30, 2016, using the Healthcare Cost and Utilization Project-National Readmission Database (HCUP-NRD). Rule-based algorithms and other ML algorithms, specifically decision trees, random forest, extreme gradient descent boosting (XGBoost), and Least Absolute Shrinkage and Selection Operator (LASSO), were used to model all-cause readmissions 30 days post-discharge from index pneumonia hospitalization. A total of 61 clinically relevant variables were included for ML model development. Models were trained on randomly partitioned 50% of the data and evaluated using the remaining dataset. Model hyperparameters were tuned using the ten-fold cross-validation on the resampled training dataset. The area under the receiver operating curves (AUROC) and area under precision-recall curves (AUPRC) were calculated for the testing set to evaluate the model performance.
Results
Of the 372,293 patients with an index hospital hospitalization for pneumonia, 48,280 (12.97%) were readmitted within 30 days. Judged by AUROC in the testing data, rule-based model (0.6591) significantly outperformed decision tree (0.5783, p value < 0.001), random forest (0.6509, p value < 0.01) and LASSO (0.6087, p value < 0.001), but was less superior than XGBoost (0.6606, p value = 0.015). The AUPRC of the rule-based model in the testing data (0.2146) was higher than the decision tree (0.1560), random forest (0.2052), and LASSO (0.2042), but was similar to XGBoost (0.2147). The top risk-predictive rules captured by the rule-based algorithm were comorbidities, illness severity, disposition locations, payer type, age, and length of stay. These predictive risk factors were also identified by other ML models with high variable importance.
Conclusion
The performance of machine learning models for predicting readmission in pneumonia patients varied. The XGboost was better than the rule-based model based on the AUROC. However, important risk factors for predicting readmission remained consistent across ML models.
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4
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Socioeconomic Characteristics of Pediatric Traumatic Brain Injury Patients. Clin Neurol Neurosurg 2022; 221:107404. [DOI: 10.1016/j.clineuro.2022.107404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/28/2022] [Accepted: 07/30/2022] [Indexed: 11/20/2022]
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Chen J, Mittendorfer-Rutz E, Berg L, Norredam M, Sijbrandij M, Klimek P. Associations between Multimorbidity Patterns and Subsequent Labor Market Marginalization among Refugees and Swedish-Born Young Adults-A Nationwide Registered-Based Cohort Study. J Pers Med 2021; 11:jpm11121305. [PMID: 34945776 PMCID: PMC8705997 DOI: 10.3390/jpm11121305] [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: 09/29/2021] [Revised: 11/19/2021] [Accepted: 11/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Young refugees are at increased risk of labor market marginalization (LMM). We sought to examine whether the association of multimorbidity patterns and LMM differs in refugee youth compared to Swedish-born youth and identify the diagnostic groups driving this association. Methodology: We analyzed 249,245 individuals between 20–25 years, on 31 December 2011, from a combined Swedish registry. Refugees were matched 1:5 to Swedish-born youth. A multimorbidity score was computed from a network of disease co-occurrences in 2009–2011. LMM was defined as disability pension (DP) or >180 days of unemployment during 2012–2016. Relative risks (RR) of LMM were calculated for 114 diagnostic groups (2009–2011). The odds of LMM as a function of multimorbidity score were estimated using logistic regression. Results: 2841 (1.1%) individuals received DP and 16,323 (6.5%) experienced >180 annual days of unemployment during follow-up. Refugee youth had a marginally higher risk of DP (OR (95% CI): 1.59 (1.52, 1.67)) depending on their multimorbidity score compared to Swedish-born youth (OR (95% CI): 1.51 (1.48, 1.54)); no differences were found for unemployment (OR (95% CI): 1.15 (1.12, 1.17), 1.12 (1.10, 1.14), respectively). Diabetes mellitus and influenza/pneumonia elevated RR of DP in refugees (RRs (95% CI) 2.4 (1.02, 5.6) and 1.75 (0.88, 3.45), respectively); most diagnostic groups were associated with a higher risk for unemployment in refugees. Conclusion: Multimorbidity related similarly to LMM in refugees and Swedish-born youth, but different diagnoses drove these associations. Targeted prevention, screening, and early intervention strategies towards specific diagnoses may effectively reduce LMM in young adult refugees.
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Affiliation(s)
- Jiaying Chen
- Section for Science of Complex Systems, CeMSIIS Medical University of Vienna, 1090 Vienna, Austria;
- Complexity Science Hub Vienna, 1090 Vienna, Austria
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden;
| | - Ellenor Mittendorfer-Rutz
- Division of Insurance Medicine, Department of Clinical Neuroscience, Karolinska Institutet, 17177 Stockholm, Sweden;
| | - Lisa Berg
- Department of Public Health Sciences, Stockholm University, 10691 Stockholm, Sweden;
- Centre for Health Equity Studies, Stockholm University/Karolinska Institutet, 10691 Stockholm, Sweden
| | - Marie Norredam
- Danish Research Centre for Migration, Ethnicity, and Health (MESU), Section for Health Services Research, Department of Public Health, University of Copenhagen, 1014 Copenhagen, Denmark;
- Section of Immigrant Medicine, Department of Infectious Diseases, University Hospital Hvidovre, 2650 Hvidovre, Denmark
| | - Marit Sijbrandij
- Department of Clinical, Neuro- and Developmental Psychology and WHO Collaborating Centre for Research and Dissemination of Psychological Interventions, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands;
| | - Peter Klimek
- Section for Science of Complex Systems, CeMSIIS Medical University of Vienna, 1090 Vienna, Austria;
- Complexity Science Hub Vienna, 1090 Vienna, Austria
- Correspondence:
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Fritz CQ, Thomas J, Gambino J, Torok M, Brittan MS. Prevalence of Social Risks on Inpatient Screening and Their Impact on Pediatric Care Use. Hosp Pediatr 2021; 10:859-866. [PMID: 32967923 DOI: 10.1542/hpeds.2020-0094] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Screening for social determinants of health in the inpatient setting is uncommon. However, social risk factors documented in billing and electronic medical record data are associated with increased pediatric care use. We sought to describe (1) the epidemiology of social risks and referral acceptance and (2) association between social risks identified through routine inpatient screening and care use. METHODS Parents of children ages 0 to 18 admitted to a general pediatric floor at an academic children's hospital completed a psychosocial screening survey from October 2017 to June 2019. The survey covered the following domains: finances, housing, food security, medications, and benefits. Patient characteristics and care use outcomes were abstracted from the electronic medical record and compared by using Pearson's χ2 or the Wilcoxon rank test and logistic regression analyses. RESULTS Of 374 screened families, 141 (38%) had a positive screen result, of whom 78 (55%) reported >1 need and 64 (45%) accepted a community resource. In bivariate analyses, patients with a positive screen result had higher 30-day readmission (10% vs 5%; P = .05), lower median household income ($62 321 vs $71 460; P < .01), lower parental education (P < .01), public insurance (57% vs 43%; P < .01), lived in a 1-parent household (30 vs 12%; P < .01), and had a complex chronic condition (35% vs 23%; P = .01) compared with those with a negative screen result. There was no difference in care reuse by screening status in adjusted analyses. CONCLUSIONS Social risks are common in the pediatric inpatient setting. Children with medical complexity offer a good target for initial screening efforts.
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Affiliation(s)
- Cristin Q Fritz
- Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, Tennessee; .,Department of Pediatrics, School of Medicine, Vanderbilt University, Nashville, Tennessee
| | - Jacob Thomas
- Adult and Child Consortium for Health Outcomes Research and Delivery Science and
| | | | - Michelle Torok
- Department of Epidemiology, Colorado School of Public Health, Aurora, Colorado
| | - Mark S Brittan
- Adult and Child Consortium for Health Outcomes Research and Delivery Science and.,Children's Hospital Colorado, Aurora, Colorado; and.,Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
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Jahanihashemi H, Babaie M, Bijani S, Bazzazan M, Bijani B. Poverty as an independent risk factor for in-hospital mortality in community-acquired pneumonia: A study in a developing country population. Int J Clin Pract 2018; 72:e13085. [PMID: 29665161 DOI: 10.1111/ijcp.13085] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 03/18/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Community-acquired pneumonia (CAP) is one of the most severe lower respiratory tract infections with a high in-hospital mortality. The aim of this study was to investigate the socioeconomic and medical risk factors affecting the prognosis of acute pneumonia. The results of this study can mention the value of socioeconomic backgrounds like poverty and illiteracy in clinical practice, even in a well-known biological phenomenon (eg acute pneumonia). METHODS In this cross-sectional study, all admitted patients to a tertiary teaching hospital with a diagnosis of community acquired pneumonia in a 12-month period were enrolled. Socioeconomic and demographic characteristics, underlying conditions, clinical manifestations and para-clinical test results at admission registered prospectively. A logistic regression model was conducted using in-hospital mortality as the dependent variable. RESULTS A total of 621 patients was included in this study. Among them, 47 patients (7.6%) died during the hospitalisation period. In multiple logistic regression analysis, pleural effusion, a higher CURB-65 score, hyponatremia, hyperglycaemia and poverty (being in the lower economic class) were identified as independent risk factors for in-hospital mortality in community-acquired pneumonia. CONCLUSION Numerous factors can influence the prognosis of CAP. In addition to the CURB-65 score and some other medical risk factors, socioeconomic backgrounds can also affect the early outcome in CAP. In this study, being in the lower economic class (as an indicator of poverty) is interpreted as an independent risk factor for a poor prognosis in CAP.
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Affiliation(s)
- Hassan Jahanihashemi
- Department of Community Medicine, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Mona Babaie
- Clinical Microbiology Research Centre, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Soroush Bijani
- Clinical Microbiology Research Centre, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Maryam Bazzazan
- Clinical Microbiology Research Centre, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Behzad Bijani
- Clinical Microbiology Research Centre, Qazvin University of Medical Sciences, Qazvin, Iran
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8
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McGregor MJ, Cox MB, Slater JM, Poss J, McGrail KM, Ronald LA, Sloan J, Schulzer M. A before-after study of hospital use in two frail populations receiving different home-based services over the same time in Vancouver, Canada. BMC Health Serv Res 2018; 18:248. [PMID: 29622006 PMCID: PMC5887263 DOI: 10.1186/s12913-018-3040-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Accepted: 03/19/2018] [Indexed: 11/14/2022] Open
Abstract
Background As individuals age, they are more likely to experience increasing frailty and more frequent use of hospital services. First, we explored whether initiating home-based primary care in a frail homebound cohort, influenced hospital use. Second, we explored whether initiating regular home care support for personal care with usual primary care, in a second somewhat less frail cohort, influenced hospital use. Methods This was a before-after retrospective cohort study of two frail populations in Vancouver, Canada using administrative data to assess the influence of two different services started in two different cohorts over the same time period. The participants were 246 recipients of integrated home-based primary care and 492 recipients of home care followed between July 1st, 2008 and June 30th, 2013 before and after starting their respective services. Individuals in each group were linked to their hospital emergency department visit and discharge abstract records. The main outcome measures were mean emergency department visit and hospital admission rates per 1000 patient days for 21 months before versus the period after receipt of services, and the adjusted incidence rate ratios (IRRs) on these outcomes post receipt of service. Results Before versus after starting integrated home-based primary care, emergency department visit rates per 1000 patient days (95% confidence intervals) were 4.1 (3.8, 4.4) versus 3.7 (3.3, 4.1), and hospital admissions rates were 2.3 (2.1, 2.5) versus 2.2 (1.9, 2.5). Before versus after starting home care, emergency department visit rates per 1000 patient days (95% confidence intervals) were 3.0 (2.8, 3.2) versus 4.0 (3.7, 4.3) visits and hospital admissions rates were 1.3 (1.2, 1.4) versus 1.9 (1.7, 2.1). Home-based primary care IRRs were 0.91 (0.72, 1.15) and 0.99 (0.76, 1.27) and home care IRRs were 1.34 (1.15, 1.56) and 1.46 (1.22, 1.74) for emergency department visits and hospital admissions respectively. Conclusions After enrollment in integrated home-based primary care, emergency department visit and hospital admission rates stabilized. After starting home care with usual primary care, emergency department visit and hospital admission rates continued to rise.
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Affiliation(s)
- Margaret J McGregor
- Department of Family Practice, University of British Columbia, 713-828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada. .,UBC Centre for Health Services and Policy Research, Vancouver, Canada. .,UBC School of Population and Public Health, Vancouver, Canada. .,Vancouver Coastal Health's Research Institute's Centre for Epidemiology and Evaluation, Vancouver, Canada.
| | - Michelle B Cox
- Department of Family Practice, University of British Columbia, 713-828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Jay M Slater
- Department of Family Practice, University of British Columbia, 713-828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada.,Community Geriatric Programs, VCH, Vancouver, Canada
| | - Jeff Poss
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Kimberlyn M McGrail
- UBC Centre for Health Services and Policy Research, Vancouver, Canada.,UBC School of Population and Public Health, Vancouver, Canada
| | - Lisa A Ronald
- Department of Family Practice, University of British Columbia, 713-828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - John Sloan
- Department of Family Practice, University of British Columbia, 713-828 West 10th Avenue, Vancouver, BC, V5Z 1M9, Canada
| | - Michael Schulzer
- Pacific Parkinson's Research Centre, Vancouver, Canada.,Vancouver Coastal Health's Research Institute's Centre for Epidemiology and Evaluation, Vancouver, Canada
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Smith RW, Kuluski K, Costa AP, Sinha SK, Glazier RH, Forster A, Jeffs L. Investigating the effect of sociodemographic factors on 30-day hospital readmission among medical patients in Toronto, Canada: a prospective cohort study. BMJ Open 2017; 7:e017956. [PMID: 29237654 PMCID: PMC5728294 DOI: 10.1136/bmjopen-2017-017956] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To examine the influence of patient-level sociodemographic factors on the incidence of hospital readmission within 30 days among medical patients in a large Canadian metropolitan city. DESIGN Prospective cohort study. SETTING AND PARTICIPANTS Patients admitted to the General Internal Medicine service of an urban teaching hospital in Toronto, Canada participated in a survey of sociodemographic information. Patients were not surveyed if deemed medically unstable, receiving care in medical/surgical step-down beds or were isolated for infection control. Included in the final analysis was a diverse cohort of 1427 adult, non-palliative, patients who were discharged home. MEASURES Thirteen patient-level sociodemographic variables were examined in relation to time to unplanned all-cause readmission within 30 days. Illness level was accounted for by the following covariates: self-perceived health status, previous hospital utilisation, primary diagnosis case mix group, Charlson Comorbidity Index score and inpatient length of stay. RESULTS Approximately, 14.4% (n=205) of patients experienced readmission within 30 days. Sociodemographic factors were not significantly associated with time to readmission in unadjusted and adjusted analyses. Indicators of illness level, namely, previous hospitalisations, were the strongest risk factors for readmission within this cohort. One previous admission (adjusted HR 1.78; 95% CI 1.22 to 2.59, P<0.01) and at least four previous emergency department visits (adjusted HR 2.33; 95% CI 1.46 to 4.43, P<0.01) were associated with increased hazard of readmission within 30 days. CONCLUSIONS Patient-level sociodemographic factors did not influence the incidence of unplanned all-cause readmission within 30 days. Further research is needed to understand the generalisability of our findings and investigate whether contextual factors, such as access to universal health insurance coverage, attenuate the effects of sociodemographic factors.
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Affiliation(s)
- Robert W Smith
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kerry Kuluski
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Bridgepoint Collaboratory for Research and Innovation, Bridgepoint Active Healthcare, Toronto, Ontario, Canada
| | - Andrew P Costa
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Samir K Sinha
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- Department of Medicine, Sinai Health System and University Health Network, Toronto, Ontario, Canada
| | - Richard H Glazier
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Institute of Clinical Evaluative Sciences, Toronto, Canada
| | - Alan Forster
- Department of Medicine, University of Ottawa, Ottawa, Canada
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Lianne Jeffs
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
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10
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Gottlieb L, Ackerman S, Wing H, Manchanda R. Understanding Medicaid Managed Care Investments in Members' Social Determinants of Health. Popul Health Manag 2017; 20:302-308. [DOI: 10.1089/pop.2016.0092] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Laura Gottlieb
- Center for Health and Community, University of California, San Francisco (UCSF), San Francisco, California
- Department of Family and Community Medicine, University of California, San Francisco (UCSF), San Francisco, California
| | - Sara Ackerman
- Department of Social and Behavioral Sciences, University of California, San Francisco (UCSF), San Francisco, California
| | - Holly Wing
- Center for Health and Community, University of California, San Francisco (UCSF), San Francisco, California
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11
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Navathe AS, Zhong F, Lei VJ, Chang FY, Sordo M, Topaz M, Navathe SB, Rocha RA, Zhou L. Hospital Readmission and Social Risk Factors Identified from Physician Notes. Health Serv Res 2017; 53:1110-1136. [PMID: 28295260 DOI: 10.1111/1475-6773.12670] [Citation(s) in RCA: 106] [Impact Index Per Article: 15.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To evaluate the prevalence of seven social factors using physician notes as compared to claims and structured electronic health records (EHRs) data and the resulting association with 30-day readmissions. STUDY SETTING A multihospital academic health system in southeastern Massachusetts. STUDY DESIGN An observational study of 49,319 patients with cardiovascular disease admitted from January 1, 2011, to December 31, 2013, using multivariable logistic regression to adjust for patient characteristics. DATA COLLECTION/EXTRACTION METHODS All-payer claims, EHR data, and physician notes extracted from a centralized clinical registry. PRINCIPAL FINDINGS All seven social characteristics were identified at the highest rates in physician notes. For example, we identified 14,872 patient admissions with poor social support in physician notes, increasing the prevalence from 0.4 percent using ICD-9 codes and structured EHR data to 16.0 percent. Compared to an 18.6 percent baseline readmission rate, risk-adjusted analysis showed higher readmission risk for patients with housing instability (readmission rate 24.5 percent; p < .001), depression (20.6 percent; p < .001), drug abuse (20.2 percent; p = .01), and poor social support (20.0 percent; p = .01). CONCLUSIONS The seven social risk factors studied are substantially more prevalent than represented in administrative data. Automated methods for analyzing physician notes may enable better identification of patients with social needs.
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Affiliation(s)
- Amol S Navathe
- Division of Health Policy, University of Pennsylvania, Philadelphia, PA.,CMC Philadelphia VA Medical Center, Philadelphia, PA.,Leonard Davis Institute of Health Economics, The Wharton School, University of Pennsylvania, Philadelphia, PA.,Division of General Internal Medicine and Primary Care, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | - Feiran Zhong
- Division of General Internal Medicine and Primary Care, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | - Victor J Lei
- Division of General Internal Medicine and Primary Care, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | - Frank Y Chang
- Clinical Informatics, Partners eCare, Partners Healthcare Inc., Boston, MA
| | - Margarita Sordo
- Division of General Internal Medicine and Primary Care, Brigham & Women's Hospital, Harvard Medical School, Boston, MA.,Clinical Informatics, Partners eCare, Partners Healthcare Inc., Boston, MA
| | - Maxim Topaz
- Division of General Internal Medicine and Primary Care, Brigham & Women's Hospital, Harvard Medical School, Boston, MA
| | - Shamkant B Navathe
- School of Computer Science, College of Computing, Georgia Institute of Technology, Atlanta, GA
| | - Roberto A Rocha
- Division of General Internal Medicine and Primary Care, Brigham & Women's Hospital, Harvard Medical School, Boston, MA.,Clinical Informatics, Partners eCare, Partners Healthcare Inc., Boston, MA
| | - Li Zhou
- Division of General Internal Medicine and Primary Care, Brigham & Women's Hospital, Harvard Medical School, Boston, MA.,Clinical Informatics, Partners eCare, Partners Healthcare Inc., Boston, MA
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12
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Cisse B, Moore L, Kuimi BLB, Porgo TV, Boutin A, Lavoie A, Bourgeois G. Impact of socio-economic status on unplanned readmission following injury: A multicenter cohort study. Injury 2016; 47:1083-90. [PMID: 26746984 DOI: 10.1016/j.injury.2015.11.034] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 11/11/2015] [Accepted: 11/21/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Unplanned readmissions cost the US economy approximately $17 billion in 2009 with a 30-day incidence of 19.6%. Despite the recognised impact of socio-economic status (SES) on readmission in diagnostic populations such as cardiovascular patients, its impact in trauma patients is unclear. We examined the effect of SES on unplanned readmission following injury in a setting with universal health insurance. We also evaluated whether additional adjustment for SES influenced risk-adjusted readmission rates, used as a quality indicator (QI). STUDY DESIGN We conducted a multicenter cohort study in an integrated Canadian trauma system involving 56 adult trauma centres using trauma registry and hospital discharge data collected between 2005 and 2010. The main outcome was unplanned 30-day readmission; all cause, due to complications of injury and due to subsequent injury. SES was determined using ecological indices of material and social deprivation. Odds ratios of readmission and 95% confidence intervals adjusted for covariates were generated using multivariable logistic regression with a correction for hospital clusters. We then compared a readmission QI validated previously (original QI) to a QI with additional adjustment for SES (SES-adjusted QI) using the mean absolute difference. RESULTS The cohort consisted of 52,122 trauma admissions of which 6.5% were rehospitalised within 30 days of discharge. Compared to patients in the lowest quintile of social deprivation, those in the highest quintile had a 20% increase in the odds of all-cause unplanned readmission (95% CI=1.06-1.36) and a 27% increase in the odds of readmission due to complications of injury (95% CI=1.04-1.54). No association was observed for material deprivation or for readmissions due to subsequent injuries. We observed a strong agreement between the original and SES-adjusted readmission (mean absolute difference= 0.04%). CONCLUSIONS Patients admitted for traumatic injury who suffer from social deprivation have an increased risk of unplanned rehospitalisation due to complications of injury in the 30 days following discharge. Better discharge planning or follow up for such patients may improve patient outcome and resource use for trauma admissions. Despite observed associations, results suggest that the trauma QI based on unplanned readmission does not require additional adjustment for SES.
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Affiliation(s)
- Brahim Cisse
- Department of social and preventive medicine, Université Laval, Québec, QC, Canada; Axe Santé des Populations - Pratiques Optimales en Santé (Population Health - Practice - Changing Research Unit), Traumatologie - Urgence - Soins intensifs (Trauma - Emergency - Critical Care Medicine), Centre de Recherche du Centre Hospitalier Universitaire de Québec (CHU de Québec - Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada.
| | - Lynne Moore
- Department of social and preventive medicine, Université Laval, Québec, QC, Canada; Axe Santé des Populations - Pratiques Optimales en Santé (Population Health - Practice - Changing Research Unit), Traumatologie - Urgence - Soins intensifs (Trauma - Emergency - Critical Care Medicine), Centre de Recherche du Centre Hospitalier Universitaire de Québec (CHU de Québec - Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada
| | - Brice Lionel Batomen Kuimi
- Department of social and preventive medicine, Université Laval, Québec, QC, Canada; Axe Santé des Populations - Pratiques Optimales en Santé (Population Health - Practice - Changing Research Unit), Traumatologie - Urgence - Soins intensifs (Trauma - Emergency - Critical Care Medicine), Centre de Recherche du Centre Hospitalier Universitaire de Québec (CHU de Québec - Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada
| | - Teegwendé Valérie Porgo
- Department of social and preventive medicine, Université Laval, Québec, QC, Canada; Axe Santé des Populations - Pratiques Optimales en Santé (Population Health - Practice - Changing Research Unit), Traumatologie - Urgence - Soins intensifs (Trauma - Emergency - Critical Care Medicine), Centre de Recherche du Centre Hospitalier Universitaire de Québec (CHU de Québec - Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada
| | - Amélie Boutin
- Department of social and preventive medicine, Université Laval, Québec, QC, Canada; Axe Santé des Populations - Pratiques Optimales en Santé (Population Health - Practice - Changing Research Unit), Traumatologie - Urgence - Soins intensifs (Trauma - Emergency - Critical Care Medicine), Centre de Recherche du Centre Hospitalier Universitaire de Québec (CHU de Québec - Hôpital de l'Enfant-Jésus), Université Laval, Québec, QC, Canada
| | - André Lavoie
- Institut National d'Excellence en Santé et en Services Sociaux, Montréal, QC, Canada
| | - Gilles Bourgeois
- Institut National d'Excellence en Santé et en Services Sociaux, Montréal, QC, Canada
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van de Vijsel AR, Heijink R, Schipper M. Has variation in length of stay in acute hospitals decreased? Analysing trends in the variation in LOS between and within Dutch hospitals. BMC Health Serv Res 2015; 15:438. [PMID: 26423895 PMCID: PMC4590267 DOI: 10.1186/s12913-015-1087-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 09/21/2015] [Indexed: 12/20/2022] Open
Abstract
Background We aimed to get better insight into the development of the variation in length of stay (LOS) between and within hospitals over time, in order to assess the room for efficiency improvement in hospital care. Methods Using Dutch national individual patient-level hospital admission data, we studied LOS for patients in nine groups of diagnoses and procedures between 1995 and 2010. We fitted linear mixed effects models to the log-transformed LOS to disentangle within and between hospital variation and to evaluate trends, adjusted for case-mix. Results We found substantial differences between diagnoses and procedures in LOS variation and development over time, supporting our disease-specific approach. For none of the diagnoses, relative variance decreased on the log scale, suggesting room for further LOS reduction. Except for two procedures in the same specialty, LOS of individual hospitals did not correlate between diagnoses/procedures, indicating the absence of a hospital wide policy. We found within-hospital variance to be many times greater than between-hospital variance. This resulted in overlapping confidence intervals across most hospitals for individual hospitals’ performances in terms of LOS. Conclusions The results suggest room for efficiency improvement implying lower costs per patient treated. It further implies a possibility to raise the number of patients treated using the same capacity or to downsize the capacity. Furthermore, policymakers and health care purchasers should take into account statistical uncertainty when benchmarking LOS between hospitals and identifying inefficient hospitals. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-1087-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Aart R van de Vijsel
- National Institute for Public Health and the Environment, Richard Heijink, P.O. Box 1, 3720, BA, Bilthoven, The Netherlands.
| | - Richard Heijink
- National Institute for Public Health and the Environment, Richard Heijink, P.O. Box 1, 3720, BA, Bilthoven, The Netherlands.
| | - Maarten Schipper
- National Institute for Public Health and the Environment, Richard Heijink, P.O. Box 1, 3720, BA, Bilthoven, The Netherlands.
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Moore L, Cisse B, Batomen Kuimi BL, Stelfox HT, Turgeon AF, Lauzier F, Clément J, Bourgeois G. Impact of socio-economic status on hospital length of stay following injury: a multicenter cohort study. BMC Health Serv Res 2015; 15:285. [PMID: 26204932 PMCID: PMC4513757 DOI: 10.1186/s12913-015-0949-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Accepted: 07/14/2015] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Injury is second only to cardiovascular disease in terms of acute care costs in North America. One key to improving injury care efficiency is to generate knowledge on the determinants of resource use. Socio-economic status (SES) is a documented risk factor for injury severity and mortality but its impact on length of stay (LOS) for injury admissions is unknown. This study aimed to examine the relationship between SES and LOS following injury. This multicenter retrospective cohort study was based on adults discharged alive from any trauma center (2007-2012; 57 hospitals; 65,486 patients) in a Canadian integrated provincial trauma system. SES was determined using ecological indices of material and social deprivation. Mean differences in LOS adjusted for age, gender, comorbidities, and injury severity were generated using multivariate linear regression. RESULTS Mean LOS was 13.5 days. Patients in the highest quintile of material/social deprivation had a mean LOS 0.5 days (95 % CI 0.1-0.9)/1.4 days (1.1-1.8) longer than those in the lowest quintile. Patients in the highest quintiles of both social and material deprivation had a mean LOS 2.6 days (1.8-3.5) longer than those in the lowest quintiles. CONCLUSIONS Results suggest that patients admitted for traumatic injury who suffer from high social and/or material deprivation have longer acute care LOS in a universal-access health care system. The reasons behind observed differences need to be further explored but may indicate that discharge planning should take patient SES into consideration.
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Affiliation(s)
- Lynne Moore
- Department of social and preventive medicine, Laval University, Quebec, QC, Canada.
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du Centre Hospitalier Universitaire de Québec (CHU de Québec - Hôpital de l'Enfant-Jésus), Laval University, Québec, QC, Canada.
| | - Brahim Cisse
- Department of social and preventive medicine, Laval University, Quebec, QC, Canada.
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du Centre Hospitalier Universitaire de Québec (CHU de Québec - Hôpital de l'Enfant-Jésus), Laval University, Québec, QC, Canada.
| | - Brice Lionel Batomen Kuimi
- Department of social and preventive medicine, Laval University, Quebec, QC, Canada.
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du Centre Hospitalier Universitaire de Québec (CHU de Québec - Hôpital de l'Enfant-Jésus), Laval University, Québec, QC, Canada.
| | - Henry T Stelfox
- Department of Critical Care Medicine, Medicine and Community Health Sciences, Institute for Public Health, University of Calgary, Calgary, AB, Canada.
| | - Alexis F Turgeon
- Department of social and preventive medicine, Laval University, Quebec, QC, Canada.
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du Centre Hospitalier Universitaire de Québec (CHU de Québec - Hôpital de l'Enfant-Jésus), Laval University, Québec, QC, Canada.
- Department of Anesthesiology and Critical Care Medicine, Division of Critical Care Medicine, Laval University, Québec, QC, Canada.
| | - François Lauzier
- Population Health and Optimal Health Practices Research Unit, Trauma - Emergency - Critical Care Medicine, Centre de Recherche du Centre Hospitalier Universitaire de Québec (CHU de Québec - Hôpital de l'Enfant-Jésus), Laval University, Québec, QC, Canada.
- Department of Medicine, Laval University, Québec, QC, Canada.
| | - Julien Clément
- Department of Surgery, Laval University, Québec, QC, Canada.
| | - Gilles Bourgeois
- Institut National d'Excellence en Santé et en Services Sociaux, Montréal, Qc, Canada.
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Filc D, Davidovich N, Novack L, Balicer RD. Is socioeconomic status associated with utilization of health care services in a single-payer universal health care system? Int J Equity Health 2014; 13:115. [PMID: 25431139 PMCID: PMC4260253 DOI: 10.1186/s12939-014-0115-1] [Citation(s) in RCA: 84] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Accepted: 11/10/2014] [Indexed: 11/29/2022] Open
Abstract
Objectives To assess an association of Socio-economic status with utilization of health care services between years 2002 and 2008 in Israel. Methods We retrospectively analyzed the utilization of health care services in a cohort of 100,000 members, 21 years and older, of a Clalit Health Services. The research compared utilization according to the neighborhood SES status; and clinic’s location as another SES proxy. Data included: Charlson Score morbidity factor, utilization of health care services (visits to primary physicians and specialists, purchase of pharmaceuticals, number of hospitalization days, visits to ED, utilization of laboratory tests and imaging). The analysis was performed using Generalized Linear Model (GLM) technique. Results People with lower SES visited more the ED and primary physicians and were hospitalized for longer periods. People with higher SES visited more specialists, bought more prescription drugs and used more medical imaging. The associations between SES and most of the services we analyzed did not change between 2002 and 2008. However, the gap between lower and higher SES levels in ED visits and the use of prescription drugs slightly increased over time, while the gap in visits to specialists decreased. Conclusions The research shows that even in a universal health care system SES is associated with utilization of health care services. In order to improve equity in utilization of services the Israeli public health should reduce economic barriers and in parallel invest in making information accessible to improve “navigation skills” for all.
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Affiliation(s)
- Dani Filc
- Department of Politics and Government, Ben-Gurion University, POB 653, Beer Sheva, 8410501, Israel.
| | - Nadav Davidovich
- Department of Health Systems Management, Ben-Gurion University, POB 653, Beer Sheva, 8410501, Israel.
| | - Lena Novack
- Department of Public Health, Ben-Gurion University, POB 653, Beer Sheva, 8410501, Israel.
| | - Ran D Balicer
- Clalit Research Institute, Chief Physician Office, Clalit Health Services, Arlozorov 101, Tel Aviv, Israel.
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Fieldston ES, Zaniletti I, Hall M, Colvin JD, Gottlieb L, Macy ML, Alpern ER, Morse RB, Hain PD, Sills MR, Frank G, Shah SS. Community household income and resource utilization for common inpatient pediatric conditions. Pediatrics 2013; 132:e1592-601. [PMID: 24276839 DOI: 10.1542/peds.2013-0619] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Child health is influenced by biomedical and socioeconomic factors. Few studies have explored the relationship between community-level income and inpatient resource utilization for children. Our objective was to analyze inpatient costs for children hospitalized with common conditions in relation to zip code-based median annual household income (HHI). METHODS Retrospective national cohort from 32 freestanding children's hospitals for asthma, diabetes, bronchiolitis and respiratory syncytial virus, pneumonia, and kidney and urinary tract infections. Standardized cost of care for individual hospitalizations and across hospitalizations for the same patient and condition were modeled by using mixed-effects methods, adjusting for severity of illness, age, gender, and race. Main exposure was median annual HHI. Posthoc tests compared adjusted standardized costs for patients from the lowest and highest income groups. RESULTS From 116,636 hospitalizations, 4 of 5 conditions had differences at the hospitalization and at the patient level, with lowest-income groups having higher costs. The individual hospitalization level cost differences ranged from $187 (4.1%) to $404 (6.4%). Patient-level cost differences ranged from $310 to $1087 or 6.5% to 15% higher for the lowest-income patients. Higher costs were typically not for laboratory, imaging, or pharmacy costs. In total, patients from lowest income zip codes had $8.4 million more in hospitalization-level costs and $13.6 million more in patient-level costs. CONCLUSIONS Lower community-level HHI is associated with higher inpatient costs of care for 4 of 5 common pediatric conditions. These findings highlight the need to consider socioeconomic status in health care system design, delivery, and reimbursement calculations.
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Affiliation(s)
- Evan S Fieldston
- MBA, MSHP, The Children's Hospital of Philadelphia, 34th and Civic Center Blvd, CHOP North, Room 1516, Philadelphia, PA 19104.
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Impact of social factors on risk of readmission or mortality in pneumonia and heart failure: systematic review. J Gen Intern Med 2013; 28:269-82. [PMID: 23054925 PMCID: PMC3614153 DOI: 10.1007/s11606-012-2235-x] [Citation(s) in RCA: 307] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2012] [Revised: 06/20/2012] [Accepted: 09/07/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Readmission and mortality after hospitalization for community-acquired pneumonia (CAP) and heart failure (HF) are publically reported. This systematic review assessed the impact of social factors on risk of readmission or mortality after hospitalization for CAP and HF-variables outside a hospital's control. METHODS We searched OVID, PubMed and PSYCHINFO for studies from 1980 to 2012. Eligible articles examined the association between social factors and readmission or mortality in patients hospitalized with CAP or HF. We abstracted data on study characteristics, domains of social factors examined, and presence and magnitude of associations. RESULTS Seventy-two articles met inclusion criteria (20 CAP, 52 HF). Most CAP studies evaluated age, gender, and race and found older age and non-White race were associated with worse outcomes. The results for gender were mixed. Few studies assessed higher level social factors, but those examined were often, but inconsistently, significantly associated with readmissions after CAP, including lower education, low income, and unemployment, and with mortality after CAP, including low income. For HF, older age was associated with worse outcomes and results for gender were mixed. Non-Whites had more readmissions after HF but decreased mortality. Again, higher level social factors were less frequently studied, but those examined were often, but inconsistently, significantly associated with readmissions, including low socioeconomic status (Medicaid insurance, low income), living situation (home stability rural address), lack of social support, being unmarried and risk behaviors (smoking, cocaine use and medical/visit non-adherence). Similar findings were observed for factors associated with mortality after HF, along with psychiatric comorbidities, lack of home resources and greater distance to hospital. CONCLUSIONS A broad range of social factors affect the risk of post-discharge readmission and mortality in CAP and HF. Future research on adverse events after discharge should study social determinants of health.
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Wen CK, Chambers C, Fang D, Mazowita G, Hwang SW. Length of stay and hospital costs among patients admitted to hospital by family physicians. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2012; 58:290-296. [PMID: 22518905 PMCID: PMC3303656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To compare length of stay and total hospital costs among patients admitted to hospital under the care of family physicians who were their usual health care providers in the community (group A) and patients admitted to the same inpatient service under the care of family physicians who were not their usual health care providers (group B). DESIGN Retrospective observational study. SETTING A large urban hospital in Vancouver, BC. PARTICIPANTS All adult admissions to the family practice inpatient service between April 1, 2006, and June 30, 2008. MAIN OUTCOME MEASURES Ratio of length of stay to expected length of stay and total hospital costs per resource intensity weight unit. Multivariate linear regression was performed to determine the effect of admitting group (group A vs. group B) on the natural logarithm transformations of the outcomes. RESULTS The median acute length of stay was 8.0 days (interquartile range [IQR] 4.0 to 13.0 days) for group A admissions and 8.0 days (IQR 4.0 to 15.0 days) for group B admissions. The median (IQR) total hospital costs were $6498 ($4035 to $11,313) for group A admissions and $6798 ($4040 to $12,713) for group B admissions. Aftera djustment for patient characteristics, patients admitted to hospital under the care of their own family physicians did not significantly differ in terms of acute length of stay to expected length of stay ratio (percent change 0.6%, P = .942)or total hospital costs per resource intensity weight unit (percent change -2.0%, P = .722) compared with patients admitted under the care of other family physicians. CONCLUSION These findings suggest that having networks of family physicians involved in hospital care for patients is not less efficient than having family physicians provide care for their own patients.
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Affiliation(s)
- Chuck K Wen
- General Surgery Residency Program Office, McMaster University, 4E14-1200 Main St W, Hamilton, ON.
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Izquierdo C, Oviedo M, Ruiz L, Sintes X, Vera I, Nebot M, Bayas JM, Carratalà J, Varona W, Sousa D, Celorrio JM, Salleras L, Domínguez A. Influence of socioeconomic status on community-acquired pneumonia outcomes in elderly patients requiring hospitalization: a multicenter observational study. BMC Public Health 2010; 10:421. [PMID: 20633254 PMCID: PMC2916903 DOI: 10.1186/1471-2458-10-421] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2010] [Accepted: 07/15/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The associations between socioeconomic status and community-acquired pneumonia outcomes in adults have been studied although studies did not always document a relationship.The aim of this multicenter observational study was to determine the association between socioeconomic status and community-acquired pneumonia outcomes in the elderly, in the context of a public health system providing universal free care to the whole population. METHODS A total of 651 patients aged > or =65 years hospitalized due to community-acquired pneumonia through the emergency departments of five Spanish public hospitals were recruited and followed up between May 2005 and January 2007. The primary outcomes studied were: length of stay, intensive care unit admission, overall mortality and readmission. Socioeconomic status was measured using both individual and community data: occupation [categorized in six social groups (I, II, III, IVa, IVb and V)], educational level (< or = primary level or > or = secondary level) and disposable family income of the municipality or district of residence [>12,500 euro (high municipality family income) and < or =12,500 euro (low municipality family income)]. The six social groups were further categorized as upper/middle social class (groups I-IVb) and lower class (group V).Bivariate and multivariate analyses were performed. OR and their 95% confidence intervals were calculated. All statistical tests were two tailed and statistical significance was established as p < 0.05. RESULTS 17.7% of patients lived in a municipality or district with a high municipality family income and 63.6% were upper/middle social class (I-IVb). Only 15.7% of patients had a secondary education. The adjusted analysis showed no association between pneumonia outcomes and social class, educational level or municipality family income. However, length of stay increased significantly in patients in whom the factors, living alone and being a smoker or ex-smoker coincided (p < 0.001). CONCLUSIONS We measured socioeconomic status using both individual and community data and found no association between social class, educational level or municipality family income and the variables of pneumonia outcomes. The lack of differences between social classes supports the provision of universal, equitable health care by the public health system.
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Affiliation(s)
- Conchita Izquierdo
- Department of Health, Generalitat of Catalonia, Roc Boronat 81-95, 08005 Barcelona, Spain.
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Broner S, Torner N, Dominguez A, Martínez A, Godoy P. Sociodemographic inequalities and outbreaks of foodborne diseases: An ecologic study. Food Control 2010. [DOI: 10.1016/j.foodcont.2009.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Loeb M, Neupane B, Walter SD, Hanning R, Carusone SC, Lewis D, Krueger P, Simor AE, Nicolle L, Marrie TJ. Environmental risk factors for community-acquired pneumonia hospitalization in older adults. J Am Geriatr Soc 2009; 57:1036-40. [PMID: 19467147 DOI: 10.1111/j.1532-5415.2009.02259.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the risk of hospitalization for pneumonia in older adults in relation to biophysical environmental factors. DESIGN Population-based case control study with collection of personal interview data. SETTING Hamilton, Ontario, and Edmonton, Alberta, Canada. PARTICIPANTS Seven hundred seventeen people aged 65 and older hospitalized for community-acquired pneumonia (CAP) from September 2002 to April 2005 and 867 controls aged 65 and older randomly selected from the same communities as the cases. MEASUREMENTS Odds ratios (ORs) for risk of pneumonia in relation to environmental and other variables. RESULTS Exposure to secondhand smoke in the previous month (OR=1.73, 95% confidence interval (CI)=1.04-2.90); poor nutritional score (OR=1.83, 95% CI=1.19-2.80); alcohol use per month (per gram; OR=1.69, 95% CI=1.08-2.61); history of regular exposure to gases, fumes, or chemicals at work (OR=3.69, 95% CI=2.37-5.75); history of regular exposure to fumes from solvents, paints, or gasoline at home (OR=3.31, 95% CI=1.59-6.87); and non-English language spoken at home (OR=5.31, 95% CI=2.60-10.87) were associated with a greater risk of pneumonia hospitalization in multivariable analysis. Age, congestive heart failure, chronic obstructive lung disease, dysphagia, renal disease, functional status, use of immunosuppressive disease medications, and lifetime history of smoking of more than 100 cigarettes were other variables associated with hospitalization for pneumonia. CONCLUSION In elderly people, present and past exposures in the physical environmental are associated with hospitalization for CAP.
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Affiliation(s)
- Mark Loeb
- Departments of Pathology and Molecular Medicine, McMaster University, MDCL 3200, 1200 Main St. W., Hamilton, ON L8N 3Z5, Canada.
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