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Duan D, Deng H, Chen Y, Wang Y, Xu W, Hu S, Liu D, Mao Y, Zhang Z, Xu Q, Han C, Zhang H. Associated predictors of prolonged length of stay in patients surviving extensive burns: A large multicenter retrospective study. Burns 2024; 50:413-423. [PMID: 37865601 DOI: 10.1016/j.burns.2023.09.019] [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: 12/30/2022] [Revised: 08/25/2023] [Accepted: 09/27/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Patients with extensive burns are critically ill and have long treatment periods. Length of stay (LOS) is a good measure for assessing treatment. This study sought to identify predictors of prolonged LOS in patients with extensive burns (≥50% TBSA). METHODS This retrospective multicenter cohort study included adults aged ≥ 18 years who survived extensive burns in three burn centers in Eastern China between January 2016 and June 2022. Epidemiological, demographic and clinical outcomes data were extracted from electronic medical records and compared between patients with/without prolonged LOS, which was defined as LOS greater than the median. Logistic regression analysis was used to identify predictors of prolonged LOS. RESULTS The study sample included 321 patients, of whom 156 (48.6%) had an LOS of 58 days (IQR 41.0-77.0). Univariate regression analysis showed that increased total burn area and increased full-thickness burn area; electrical, chemical and other burns; increased erythrocytes, leukocytes, platelets or serum creatinine within 24 h of admission; concomitant inhalation injury, pulmonary edema, sepsis, bloodstream infection, wound infection, pulmonary infection, urinary tract infection, or HB < 70 g/L during hospitalization were associated with prolonged LOS in patients with extensive burns. Increased number of surgical operations, mechanical ventilation and renal replacement therapy were also associated with prolonged LOS (P < 0.05 or P < 0.001). Multivariate regression analysis revealed that increased total burn area (ratio 1.032, 95%CI 1.01-1.055; P = 0.004), electrical and chemical or other burns (3.282, 1.335-8.073; P = 0.01), development of wound infection (2.653 1.285-5.481; P = 0.008) and increased number of operative procedures (1.714, 1.388-2.116, P < 0.001) were significant predictors. CONCLUSIONS Increased area of full-thickness burn,occurrence of electrical and chemical or other burns,occurrence of wound infection and increased number of surgeries are the best predictors of prolonged LOS in patients with extensive burns. Clarifying relevant predictors of burn patients' LOS provides a reliable reference for clinical treatment.
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Affiliation(s)
- Deqing Duan
- Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Hongao Deng
- Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yong Chen
- Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yiran Wang
- Department of Burns & Wound Care Center, Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Wanting Xu
- Department of Burn Injury, the First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - ShiQiang Hu
- Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Dewu Liu
- Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Yuangui Mao
- Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Zhongwei Zhang
- Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Qinglian Xu
- Department of Burn Injury, the First Affiliated Hospital of Anhui Medical University, Hefei, China.
| | - Chunmao Han
- Department of Burns & Wound Care Center, Second Affiliated Hospital of Zhejiang University, Hangzhou, China.
| | - Hongyan Zhang
- Department of Burns, the First Affiliated Hospital of Nanchang University, Nanchang, China.
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Garssen SH, Kant N, Vernooij CA, Mauritz GJ, Koning MV, Bosch FH, Doggen CJM. Continuous monitoring of patients in and after the acute admission ward to improve clinical pathways: study protocol for a randomized controlled trial (Optimal-AAW). Trials 2023; 24:405. [PMID: 37316919 DOI: 10.1186/s13063-023-07416-8] [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: 02/09/2023] [Accepted: 05/26/2023] [Indexed: 06/16/2023] Open
Abstract
BACKGROUND Because of high demand on hospital beds, hospitals seek to reduce patients' length of stay (LOS) while preserving the quality of care. In addition to usual intermittent vital sign monitoring, continuous monitoring might help to assess the patient's risk of deterioration, in order to improve the discharge process and reduce LOS. The primary aim of this monocenter randomized controlled trial is to assess the effect of continuous monitoring in an acute admission ward (AAW) on the percentage of patients who are discharged safely. METHODS A total of 800 patients admitted to the AAW, for whom it is equivocal whether they can be discharged directly after their AAW stay, will be randomized to either receive usual care without (control group) or with additional continuous monitoring of heart rate, respiratory rate, posture, and activity, using a wearable sensor (sensor group). Continuous monitoring data are provided to healthcare professionals and used in the discharge decision. The wearable sensor keeps collecting data for 14 days. After 14 days, all patients fill in a questionnaire to assess healthcare use after discharge and, if applicable, their experience with the wearable sensor. The primary outcome is the difference in the percentage of patients who are safely discharged home directly from the AAW between the control and sensor group. Secondary outcomes include hospital LOS, AAW LOS, intensive care unit (ICU) admissions, Rapid Response Team calls, and unplanned readmissions within 30 days. Furthermore, facilitators and barriers for implementing continuous monitoring in the AAW and at home will be investigated. DISCUSSION Clinical effects of continuous monitoring have already been investigated in specific patient populations for multiple purposes, e.g., in reducing the number of ICU admissions. However, to our knowledge, this is the first Randomized Controlled Trial to investigate effects of continuous monitoring in a broad patient population in the AAW. TRIAL REGISTRATION https://clinicaltrials.gov/ct2/show/NCT05181111 . Registered on 6 January 2022. Start of recruitment: 7 December 2021.
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Affiliation(s)
- Sjoerd H Garssen
- Clinical Research Center, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Patient Care and Monitoring, Philips Research, Eindhoven, The Netherlands
- Department of Health Technology and Services Research, Technical Medical Center, University of Twente, Enschede, The Netherlands
| | - Niels Kant
- Clinical Research Center, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Health Technology and Services Research, Technical Medical Center, University of Twente, Enschede, The Netherlands
- Department of Anesthesiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Carlijn A Vernooij
- Department of Patient Care and Monitoring, Philips Research, Eindhoven, The Netherlands
| | - Gert-Jan Mauritz
- Department of Emergency Medicine, Rijnstate Hospital, Arnhem, The Netherlands
| | - Mark V Koning
- Department of Anesthesiology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Frank H Bosch
- Department of Internal Medicine, Rijnstate Hospital, Arnhem, The Netherlands
- Department of Internal Medicine, Radboudumc, Nijmegen, The Netherlands
| | - Carine J M Doggen
- Clinical Research Center, Rijnstate Hospital, Arnhem, The Netherlands.
- Department of Health Technology and Services Research, Technical Medical Center, University of Twente, Enschede, The Netherlands.
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van der Perk CJ, van de Riet L, Alsem M, van Goudoever JB, Maaskant J. Prognostic factors influencing parental empowerment after discharge of their hospitalized child: A cross-sectional study. J Pediatr Nurs 2022; 66:e145-e151. [PMID: 35537978 DOI: 10.1016/j.pedn.2022.04.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE There is a growing number of children with medical complexity (CMC). After hospitalization, care often has to be continued at home, making transitional care very important. However, many parents do not feel empowered in their role as caregiver for the child. To move forward in this field, we explored prognostic factors associated with parental empowerment after discharge of hospitalized children. DESIGN AND METHODS In a cross-sectional study, we collected data on potential prognostic factors found in the literature and on parental empowerment by means of the Family Empowerment Scale (FES). Linear regression analyses were performed to explore the associations between the prognostic factors and the FES. RESULTS Data from 228 patients and their parents were analyzed. Out of twelve factors included in the study, three showed significant associations with parental empowerment. Parents of CMC felt more empowered compared to parents of children with less complex conditions (β = 0.20, p = 0.00). We found a positive association between the age of the child and parental empowerment (β = 0.01, p = 0.00). Employed couples felt more empowered compared to unemployed couples (β = 0.30, p = 0.00). These three variables explained 11% of variance in the FES scores. CONCLUSIONS Parental empowerment is associated with the patient's age, child's medical complexity, and parental employment status. PRACTICE IMPLICATIONS Attention should be paid to the discharge preparation of parents of children with less medical complexity. Awareness is required for parents of younger children and parental employment status, because they are at risk for lower parental empowerment.
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Affiliation(s)
- Cor-Jan van der Perk
- Amsterdam University Medical Center, University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands.
| | - Liz van de Riet
- Amsterdam University Medical Center, University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands
| | - Mattijs Alsem
- Amsterdam University Medical Center, University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands; Amsterdam University Medical Center Department of Rehabilitation Medicine, Amsterdam, the Netherlands
| | - Johannes B van Goudoever
- Amsterdam University Medical Center, University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands
| | - Jolanda Maaskant
- Amsterdam University Medical Center, University of Amsterdam, Emma Children's Hospital, Amsterdam, the Netherlands; Amsterdam University Medical Center, University of Amsterdam Department of Data Science and Epidemiology, Amsterdam, the Netherlands
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Walsh B, Smith S, Wren MA, Eighan J, Lyons S. The impact of inpatient bed capacity on length of stay. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2022; 23:499-510. [PMID: 34480667 PMCID: PMC8417615 DOI: 10.1007/s10198-021-01373-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 08/24/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE Large reductions in inpatient length of stay and inpatient bed supply have occurred across health systems in recent years. However, the direction of causation between length of stay and bed supply is often overlooked. This study examines the impact of changes to inpatient bed supply, as a result of recession-induced healthcare expenditure changes, on emergency inpatient length of stay in Ireland between 2010 and 2015. STUDY DESIGN We analyse all public hospital emergency inpatient discharges in Ireland from 2010 to 2015 using the administrative Hospital In-Patient Enquiry dataset. We use changes to inpatient bed supply across hospitals over time to examine the impact of bed supply on length of stay. Linear, negative binomial, and hospital-month-level fixed effects models are estimated. RESULTS U-shaped trends are observed for both average length of stay and inpatient bed supply between 2010 and 2015. A consistently large positive relationship is found between bed supply and length of stay across all regression analyses. Between 2010 and 2012 while length of stay fell by 6.4%, our analyses estimate that approximately 42% (2.7% points) of this reduction was associated with declines in bed supply. CONCLUSION Changes in emergency inpatient length of stay in Ireland between 2010 and 2015 were closely related to changes in bed supply during those years. The use of length of stay as an efficiency measure should be understood in the contextual basis of other health system changes. Lower length of stay may be indicative of the lack of resources or available bed supply as opposed to reduced demand for care or the shifting of care to other settings.
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Affiliation(s)
- Brendan Walsh
- Economic and Social Research Institute, Whitaker Square, Sir John Rogerson's Quay, Dublin 2, Dublin, Ireland.
- Department of Economics, Trinity College Dublin, Dublin, Ireland.
| | - Samantha Smith
- Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland
| | - Maev-Ann Wren
- Economic and Social Research Institute, Whitaker Square, Sir John Rogerson's Quay, Dublin 2, Dublin, Ireland
- Department of Economics, Trinity College Dublin, Dublin, Ireland
| | - James Eighan
- Economic and Social Research Institute, Whitaker Square, Sir John Rogerson's Quay, Dublin 2, Dublin, Ireland
| | - Seán Lyons
- Economic and Social Research Institute, Whitaker Square, Sir John Rogerson's Quay, Dublin 2, Dublin, Ireland
- Department of Economics, Trinity College Dublin, Dublin, Ireland
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Yew CC, Ng MP, Khoo SE, Ling XF, Yuen KM, Tew MM. Multivariate Analysis on Orofacial Odontogenic Infection in Northern Peninsular Malaysia. J Oral Maxillofac Surg 2021; 80:736-743. [PMID: 34863695 DOI: 10.1016/j.joms.2021.11.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/04/2021] [Accepted: 11/04/2021] [Indexed: 01/22/2023]
Abstract
PURPOSE This regional 2-center study was designed 1) to analyze the clinical features of all patients with odontogenic orofacial infection as per type of visit, 2) to analyze the clinical features of diabetic patients compared with nondiabetic patients, and 3) to identify potential variables that may associate with long length of stay (LOS) of patients admitted for orofacial odontogenic infection in Northern Peninsular Malaysia. PATIENTS AND METHODS All adult patients with orofacial odontogenic infections who attended the Oral and Maxillofacial Department of Hospital Raja Permaisuri Bainun and Hospital Sultan Abdul Halim from March 2015 to February 2019 were included. Data on patients' demography, medical history, smoking status, clinical presentation, and LOS were collected. Multivariate logistic regression analysis was performed using the dichotomous dependent variable, namely, short LOS (LOS <5 days) and long LOS (LOS ≥5 days). RESULTS A total of 355 patients were reported with the mean age of 39.93 ± 15.95 years old. Multivariate analysis revealed that diabetes (adjusted odds ratio = 4.387, 95% confidence interval = 1.453 to 13.241, P value = .009) and multiple space involvement (adjusted odds ratio = 4.859, 95% confidence interval = 1.280, 18.454, P value = .020) were responsible for long LOS. CONCLUSIONS Judicious treatment is recommended when treating patients of such infection that involves multiple spaces with underlying diabetes mellitus.
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Affiliation(s)
- Ching Ching Yew
- Specialist, Oral and Maxillofacial Surgery Department, Hospital Sultan Abdul Halim, Kedah, Ministry of Health, Kedah, Malaysia
| | - Mee Poh Ng
- Resident, Oral and Maxillofacial Surgery Department, Hospital Sultan Abdul Halim, Kedah, Ministry of Health, Kedah, Malaysia.
| | - Su Ee Khoo
- Resident, Oral and Maxillofacial Surgery Department, Hospital Raja Permaisuri Bainun, Perak, Ministry of Health, Perak, Malaysia
| | - Xiao Feng Ling
- Department Head, Oral and Maxillofacial Surgery Department, Hospital Sultan Abdul Halim, Kedah, Ministry of Health, Kedah, Malaysia
| | - Kar Mun Yuen
- Department Head, Oral and Maxillofacial Surgery Department, Hospital Raja Permaisuri Bainun, Perak, Ministry of Health, Perak, Malaysia
| | - Mei Mei Tew
- Pharmacist, Clinical Research Centre, Hospital Sultan Abdul Halim, Kedah, Ministry of Health, Kedah, Malaysia
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Levin C, Rand D, Gil E, Agmon M. The relationships between step count and hospitalisation-associated outcomes in acutely hospitalised older adults - A systematic review. J Clin Nurs 2021. [PMID: 34741360 DOI: 10.1111/jocn.16085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/25/2021] [Accepted: 10/04/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND AND PURPOSE Although low ambulation among older adults has been linked to a broad range of adverse outcomes during and after acute hospitalisation, a systematic inquiry of the link between step count and these consequences is required. Therefore, the main purpose of this study is to systematically review the relationships between step count and hospitalisation-associated outcomes in acutely hospitalised older adults. METHODS The electronic databases MEDLINE, CINAHL, and Embase were searched for studies including older adults (above age 65) hospitalised in acute internal wards. The search included the following key terms: 'accelerometer', 'step count', 'hospital', 'internal ward', and 'older adults'. Step count measurement linked to short- and/or long-term outcome(s) during and/or after hospitalisation. All types of articles (except reviews) in English from 1990 to May 2020 were considered. The Newcastle-Ottawa Scale was used to assess the quality of the included observational studies. Randomised controlled trials (RCT) were evaluated using the PEDro scale. The review protocol was registered with PROSPERO International Prospective Register of Systematic Reviews. PRISMA guidelines were followed and a PRISMA checklist for reporting systematic reviews completed. RESULTS The search yielded 1340 articles, and of those, the inclusion criteria were met by 12 studies: eight prospective, three interventional (one randomised controlled trial), and one case-control. These studies included three major adverse hospitalisation outcomes associated with step count: functional decline, longer length of stay, and higher re-hospitalisation rate; however, the large heterogeneity in the studies' methodology makes meta-analysis impossible. CONCLUSIONS Daily step count during hospitalisation of older adults is negatively associated with adverse outcomes, but causation cannot be inferred due to inconsistent outcomes and various methodological limitations. More studies are needed to illuminate causal pathways and mechanisms underlying these relationships, especially to differentiate between the relative contribution of personal versus environmental factors.
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Affiliation(s)
- Chedva Levin
- Nursing Department, Faculty of School of Life and Health Sciences, The Jerusalem College of Technology-Lev Academic Center, Jerusalem, Israel
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
| | - Debbie Rand
- Department of Occupational Therapy, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Gil
- Clalit Health Services, Faculty of Medicine, Haifa and West Galilee and Carmel Hospital, Technion, Haifa, Israel
| | - Maayan Agmon
- The Cheryl Spencer Department of Nursing, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa, Israel
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Ghaed Chukamei Z, Mobayen M, Bagheri Toolaroud P, Ghalandari M, Delavari S. The length of stay and cost of burn patients and the affecting factors. INTERNATIONAL JOURNAL OF BURNS AND TRAUMA 2021; 11:397-405. [PMID: 34858720 PMCID: PMC8610821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 08/24/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Burn trauma is a significant health problem that has physical, psychological, and economic reaction on affected patients. Burn patients have different length-of-stay (LOS) due to the complexity of the injury itself. This study aimed to find factors affecting the LOS and cost of burn patients (2017-2018) in Guilan province, north of Iran. MATERIALS AND METHODS This cross-sectional study includes all 899 hospitalized burn patients who were admitted for the first time (first visit). Data about cost, LOS, and demographic variables were extracted from the hospital registry system. Data were analyzed using t-test, ANOVA, and Linear regression by SPSS 22 software. RESULTS Nearly 62% of the burn patients were male, and 38% were female. Hot liquid or vapor were the leading causes for burns hospitalization (n = 345; 39.07%). The majority of patients (n = 465; 52.31%) were at level three of burn (total thickness). The upper limb that included head, neck, shoulder, back, hand (45.44%), lower limb (38.25%), multiple or total body (11.36%) were the most organs that were affected by burning. Direct medical costs for patients varied from 0 to 18,550 US$, which was 1489 US$ on average. Patients' length of stay ranged from 1 to 47 days, which was 3.22 days on average. CONCLUSION The result showed Adverse consequences burned hot liquid and hot steam burns most common reason that it is important to take preventative methods for this type of patient. Improved patients with the third level cost more and stay longer. Other factors such as underlying disease, urbanity, used antibiotics, sex, and insurance coverage can also be decisive. The burnt percentage also has a direct and significant relationship with medical costs and length of stay. Insurance organization has a direct and significant relationship with the length of stay. Also there was a direct relationship between multiple burns and the patients' length of stay and hospitalization costs.
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Affiliation(s)
- Zeinab Ghaed Chukamei
- Clinical Research Development Unit of Poursina Hospital, Guilan University of Medical SciencesRasht, Iran
| | - Mohammadreza Mobayen
- Burn and Regenerative Medicine Research Center, Guilan University of Medical SciencesRasht, Iran
| | | | - Maryam Ghalandari
- Clinical Research Development Unit of Poursina Hospital, Guilan University of Medical SciencesRasht, Iran
| | - Sajad Delavari
- Health Human Resources Research Center, School of Health Management and Information Sciences, Shiraz University of Medical SciencesShiraz, Iran
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Beagley J, Hlavac J, Zucchi E. Patient length of stay, patient readmission rates and the provision of professional interpreting services in healthcare in Australia. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1643-1650. [PMID: 32227535 DOI: 10.1111/hsc.12989] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 01/06/2020] [Accepted: 03/10/2020] [Indexed: 06/10/2023]
Abstract
Linguistic and ethnic diversity is a feature of patient profiles at almost all public healthcare facilities in urban areas in Australia. Patients with limited proficiency in the socially dominant language - in this case Limited English proficiency (LEP) patients - commonly form a significant patient group in public healthcare settings. Communication barriers that exist between patients and healthcare professionals necessitate the provision of translation and interpreting (T&I) services. This study presents longitudinal data from Melbourne, Australia, on the provision of (T&I) services together with patient length of stay (LOS) and patient readmission rates over a 10-year period at a large, public healthcare provider. Patient LOS and patient readmission rates are key metrics for effective diagnosis and treatment of patients and commonly used to measure the performance of various aspects of healthcare provision. The augmentation of T&I services within a general policy of patient-centred care is shown to accompany decreased LOS and lower readmission rates for LEP patients.
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Affiliation(s)
- Jonathan Beagley
- Translation & Interpreting Studies, School of Languages, Literatures, Cultures & Linguistics, Faculty of Arts, Monash University, Melbourne, Australia
| | - Jim Hlavac
- Translation & Interpreting Studies, School of Languages, Literatures, Cultures & Linguistics, Faculty of Arts, Monash University, Melbourne, Australia
| | - Emiliano Zucchi
- Translation & Interpreting Studies, School of Languages, Literatures, Cultures & Linguistics, Faculty of Arts, Monash University, Melbourne, Australia
- Transcultural & Language Services, Northern Health, Melbourne, Australia
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9
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van Vliet IMY, Gomes-Neto AW, de Jong MFC, Jager-Wittenaar H, Navis GJ. High prevalence of malnutrition both on hospital admission and predischarge. Nutrition 2020; 77:110814. [PMID: 32442829 DOI: 10.1016/j.nut.2020.110814] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/16/2020] [Accepted: 03/01/2020] [Indexed: 01/12/2023]
Abstract
OBJECTIVES In Dutch hospitals malnutrition screening is routinely performed at admission, but not during follow-up or before discharge. Therefore we evaluated nutritional status during hospitalization and predischarge in a routine care setting. METHODS The Patient-Generated Subjective Global Assessment (PG-SGA) was used to assess nutritional status (PG-SGA Categories: A = well nourished, B = moderate/suspected malnutrition, C = severely malnourished) in adult patients on four wards of a university hospital at admission, day 5, day 10, and day ≥15. Because data were obtained in the context of clinical routine, not all data points are available for all patients. Last assessment before discharge (within ≤4 d) was taken as predischarge measurement. RESULTS PG-SGA data at admission were obtained in 584 patients (age 57.2 ± 17.3 y, 51.4% women, body mass index 27.0 ± 5.5 kg/m2). Prevalence of PG-SGA stage B/C was 31% at admission, 56% on day 5 (n = 292), 66% on day 10 (n = 101), and 79% on day ≥15 (n = 14). PG-SGA predischarge data were available in 537 patients, 36% of whom were PG-SGA stage B/C. Of the 91 patients assessed both at admission and predischarge, 30% of well-nourished patients became malnourished and 82% of malnourished patients remained so. CONCLUSIONS Prevalence of malnutrition in hospitalized patients is high at admission (31%) and, importantly, also high predischarge (36%). Malnutrition is more prevalent in patients with a longer length of stay. These findings underscore the importance of follow-up of nutritional status in hospitalized patients and adequate transmural nutrition care after discharge to prevent malnutrition from remaining undetected and untreated.
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Affiliation(s)
- Iris M Y van Vliet
- Department of Dietetics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - António W Gomes-Neto
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Margriet F C de Jong
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Harriët Jager-Wittenaar
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Research Group Healthy Ageing, Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands
| | - Gerjan J Navis
- Department of Internal Medicine, Division of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Huber E, Kleinknecht‐Dolf M, Kugler C, Müller M, Spirig R. Validation of the instrument "Complexity of Nursing Care"-A mixed-methods study. Nurs Open 2020; 7:212-224. [PMID: 31871705 PMCID: PMC6917930 DOI: 10.1002/nop2.383] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 07/13/2019] [Accepted: 09/02/2019] [Indexed: 11/12/2022] Open
Abstract
Aims This study aimed to psychometrically test the instrument "Complexity of Nursing Care" and to broaden the understanding of the instrument's psychometrics and applicability. Design Embedded mixed-methods design. Methods We performed a cross-sectional study assessing all stationary patients of five Swiss hospitals daily for up to 5 days with the instrument "Complexity of Nursing Care" over a 1-month period in 2015. The scale's psychometrics were analysed using partial least square structural equation modelling. In the qualitative study section, we completed 12 case studies and analysed them case-wise and across cases. Quantitative and qualitative results were synthesized in tables. Results Structural equation modelling confirmed a reflective-formative second-order model of the instrument with good psychometric properties leading to a formula for the calculation of a complexity score. Qualitative results evolved descriptions of low and high extent of complexity. Narrative considerations of two raters deepened the understanding of the inter-rater reliability.
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Affiliation(s)
- Evelyn Huber
- Department of Nursing ScienceFaculty for HealthUniversity Witten/HerdeckeWittenGermany
| | - Michael Kleinknecht‐Dolf
- Department of Nursing and Allied Health Care ProfessionalsUniversity Hospital ZurichZurichSwitzerland
| | - Christiane Kugler
- Faculty of MedicineInstitute of Nursing ScienceUniversity of FreiburgFreiburgGermany
| | - Marianne Müller
- Institute of Data Analysis and Process DesignSchool of EngineeringZurich University of Applied SciencesWinterthurSwitzerland
| | - Rebecca Spirig
- Department of Nursing ScienceFaculty for HealthUniversity Witten/HerdeckeWittenGermany
- Department of Nursing and Allied Health Care ProfessionalsUniversity Hospital ZurichZurichSwitzerland
- Department Public HealthInstitute of Nursing ScienceUniversity of BaselBaselSwitzerland
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11
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Nowak M, Lee S, Karbach U, Pfaff H, Groß SE. Short length of stay and the discharge process: Preparing breast cancer patients appropriately. PATIENT EDUCATION AND COUNSELING 2019; 102:2318-2324. [PMID: 31427170 DOI: 10.1016/j.pec.2019.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 07/16/2019] [Accepted: 08/08/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Breast cancer is the most common cancer among women worldwide, increasing the relevance of an efficient and successful care process. As length of stay (LOS) in the hospital decreases, patients' satisfaction with the LOS varies. We hypothesize that successful discharge planning can improve this evaluation. METHODS Data of 4,390 female breast cancer patients from a cross-sectional survey was analyzed. The data was collected in 2017 in 86 German hospitals. Logistic regressions were used to test hypotheses. RESULTS The majority of included patients rated their LOS as appropriate. However, patients who felt better prepared for discharge were less likely to rate their stay as too short. A longer stay in the hospital further decreased this likelihood. The effect of LOS was moderated by patient experiences with preparation for discharge. CONCLUSION As hospital LOS decreases, one challenge in allowing patients to feel sufficiently informed and ready to go home is the reduced time for face-to-face consultations. Our results indicate, however, that a strong and thorough discharge planning makes the actual number of days for LOS irrelevant for patient's rating of LOS. PRACTICE IMPLICATIONS The study results underscore the importance of ensuring the quality and thoroughness of the discharge process.
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Affiliation(s)
- Marina Nowak
- Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR) at the Faculty of Human Sciences and the Faculty of Medicine of the University of Cologne, Cologne, Germany.
| | - Susan Lee
- Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR) at the Faculty of Human Sciences and the Faculty of Medicine of the University of Cologne, Cologne, Germany
| | - Ute Karbach
- Sociology in Rehabilitation, Faculty of Rehabilitation Sciences of the Technical University Dortmund, Dortmund, Germany
| | - Holger Pfaff
- Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR) at the Faculty of Human Sciences and the Faculty of Medicine of the University of Cologne, Cologne, Germany
| | - Sophie E Groß
- Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR) at the Faculty of Human Sciences and the Faculty of Medicine of the University of Cologne, Cologne, Germany; LVR-Institute of Health Care Research, LVR Clinic Cologne, Cologne, Germany
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12
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Estimation of Government Health Expenditures in Iran During 2006 to 2011, Using Panel Data. Health Care Manag (Frederick) 2019; 38:89-97. [PMID: 30614829 DOI: 10.1097/hcm.0000000000000252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The status of public resources in health has a positive and direct impact on this sector's outcomes because of its effect on the increase of social services. The government's ability to manage health expenditures greatly depends on identifying the determinants of these expenditures. Therefore, this study aimed to determine factors affecting the government health expenditures and estimate the related function in Iran during 2006-2011 using panel data. This was a cross-sectional and time-series study that was conducted using panel data analysis. In this study, the data were collected and categorized separately for each province from documents in the Ministry of Health and the Statistical Center of Iran. The results showed that there were positive associations between health expenditures and some factors including age group of 20 to 39 years (P = .04), the number of women (P = .001), the number of physicians, the number of hospital beds, and annual budget (P < .001). According to the results, it seems that allocating a part of health subsidies for increasing the insurance coverage of the age group of 20 to 39 years and also starting saving accounts can have an important effect on reducing health expenditures of this age group.
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Standardization of medical service indicators: A useful technique for hospital administration. PLoS One 2018; 13:e0207214. [PMID: 30485302 PMCID: PMC6261548 DOI: 10.1371/journal.pone.0207214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2018] [Accepted: 10/26/2018] [Indexed: 12/03/2022] Open
Abstract
Background Many comparability problems appear in the process of the performance assessment of medical service. When comparing medical evaluation indicators across hospitals, or even within the same hospital, over time, the differences in the population composition such as types of diseases, comorbidities, demographic characteristics should be taken into account. This study aims to introduce a standardization technique for medical service indicators and provide a new insight on the comparability of medical data. Methods The medical records of 142592 inpatient from three hospitals in 2017 were included in this study. Chi-square and Kruskal-Wallis tests were used to explore the compositions of confounding factors among populations. The procedure of stratified standardization technique was applied to compare the differences of the average length of stay and the average hospitalization expense among three hospitals. Results Age, gender, comorbidity, and principal diagnoses category were considered as confounding factors. After correcting all factors, the average length of stay of hospital A and C were increased by 0.21 and 1.20 days, respectively, while that of hospital B was reduced by 1.54 days. The average hospitalization expenses of hospital A and C were increased by 1494 and 660 Yuan, whilst that of hospital B was decreased by 810 Yuan. Conclusions Standardization method will be helpful to improve the comparability of medical service indicators in hospital administration. It could be a practical technique and worthy of promotion.
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14
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Kentischer F, Kleinknecht-Dolf M, Spirig R, Frei IA, Huber E. Patient-related complexity of care: a challenge or overwhelming burden for nurses - a qualitative study. Scand J Caring Sci 2017; 32:204-212. [PMID: 28475265 DOI: 10.1111/scs.12449] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 01/23/2017] [Indexed: 01/13/2023]
Abstract
BACKGROUND Patient-related complexity of nursing care in acute care hospitals has increased in recent years, in part due to shorter hospital stays and the increase in multimorbid patients. However, little research has been conducted on how nurses experience complex nursing care situations. AIMS The aim of this study was to gain a better understanding of how nurses experience complex nursing care situations in Swiss acute care hospitals. METHODS This qualitative study utilised focus group interviews and thematic analysis. Focus groups facilitate different perspectives of the topic. Thematic analysis is suitable for the analysis of everyday stories. Participants were 24 Registered Nurses with experience in their field, from four Swiss hospitals. The evaluation was performed in six steps according to themes. Participation was voluntary. This study was part of a multicentre research project that had been approved by the responsible ethics committees. RESULTS Three main themes regarding the experience of complex nursing care situations were found: complexity as a challenge, complexity as an overwhelming burden and mediating factors. Mediating factors included time resources and teamwork and interprofessional collaboration as contextual conditions. Additionally, nurses' individual characteristics such as their professional experience and expertise, as well as their personal and professional values and beliefs were considered as mediating factors. These mediating factors may determine whether complex nursing care situations are experienced as challenging or overwhelming. LIMITATIONS The findings from this study are limited as only experienced nurses participated in the study. CONCLUSIONS Nurses are ambivalent with regard to how they experience complex nursing care situations. The contextual conditions and the nurses' personal characteristics play a key role in whether nurses perceive complex nursing care situations as positive challenges or overwhelming burdens. These findings are important for managers, as they can support nurses to master complex nursing care situations.
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Affiliation(s)
- Felix Kentischer
- Center for Surgery, Medical Center, University of Freiburg, Freiburg, Germany.,Institute of Nursing Science, University of Basel, Basel, Switzerland
| | - Michael Kleinknecht-Dolf
- Department of Nursing and Allied Health Care Professionals, University Hospital Zurich, Zurich, Switzerland
| | - Rebecca Spirig
- Institute of Nursing Science, University of Basel, Basel, Switzerland.,Department of Nursing and Allied Health Care Professionals, University Hospital Zurich, Zurich, Switzerland.,Department of Nursing Science, Faculty for Health, University Witten/Herdecke, Witten/Herdecke, Germany
| | - Irena Anna Frei
- Institute of Nursing Science, University of Basel, Basel, Switzerland.,Practice Development Unit, Department Nursing & Allied Health Professions, University Hospital Basel, Basel, Switzerland
| | - Evelyn Huber
- Department of Nursing and Allied Health Care Professionals, University Hospital Zurich, Zurich, Switzerland.,Department of Nursing Science, Faculty for Health, University Witten/Herdecke, Witten/Herdecke, Germany
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15
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van Vliet M, Huisman M, Deeg DJH. Decreasing Hospital Length of Stay: Effects on Daily Functioning in Older Adults. J Am Geriatr Soc 2017; 65:1214-1221. [DOI: 10.1111/jgs.14767] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Majogé van Vliet
- Department of Epidemiology and Biostatistics; VU University Medical Center; Amsterdam the Netherlands
- EMGO Institute for Health and Care Research; VU University Medical Center; Amsterdam the Netherlands
| | - Martijn Huisman
- Department of Epidemiology and Biostatistics; VU University Medical Center; Amsterdam the Netherlands
- EMGO Institute for Health and Care Research; VU University Medical Center; Amsterdam the Netherlands
- Department of Sociology; VU University; Amsterdam the Netherlands
| | - Dorly J. H. Deeg
- Department of Epidemiology and Biostatistics; VU University Medical Center; Amsterdam the Netherlands
- EMGO Institute for Health and Care Research; VU University Medical Center; Amsterdam the Netherlands
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16
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Kwok CL, Lee CK, Lo WT, Yip PS. The Contribution of Ageing to Hospitalisation Days in Hong Kong: A Decomposition Analysis. Int J Health Policy Manag 2017; 6:155-164. [PMID: 28812795 PMCID: PMC5337253 DOI: 10.15171/ijhpm.2016.108] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 08/06/2016] [Indexed: 01/22/2023] Open
Abstract
Background: Ageing has become a serious challenge in Hong Kong and globally. It has serious implications for health expenditure, which accounts for nearly 20% of overall government expenditure. Here we assess the contribution of ageing and related factors to hospitalisation days in Hong Kong. We used hospital discharge data from all publicly funded hospitals in Hong Kong between 2001 and 2012.
Methods: A decomposition method was used to examine the factors that account for the change of total hospitalisation days during the two periods, 2001-2004 and 2004-2012. The five factors include two demographic factors – population size and age-gender composition – and three service components – hospital discharge rate, number of discharge episodes per patient, and average length of stay (LOS) – which are all measured at age-gender group level. In order to assess the health cost burden in the future, we also project the total hospitalisation days up to 2041, for a range of scenarios.
Results: During the decreasing period of hospitalisation days (2001-2004), the reduction of LOS contributed to about 60% of the reduction. For the period of increase (2004-2012), ageing is associated with an increase in total hospitalisation days of 1.03 million, followed by an increase in hospital discharge rates (0.67 million), an increase in the number of discharge episodes per patient (0.62 million), and population growth (0.43 million). The reduction of LOS has greatly offset these increases (-2.19 million days), and has become one of the most significant factors in containing the increasing number of hospitalisation days. Projected increases in total hospitalisation days under different scenarios have highlighted that the contribution of ageing will become even more prominent after 2022.
Conclusion: Hong Kong is facing increasing healthcare burden caused by the rapid increase in demand for inpatient services due to ageing. Better management of inpatient services with the aim of increasing efficiency and reducing LOS, avoidable hospitalisation and readmission, without compromising patient satisfaction and quality of service, are crucial for containing the rapid and enormous increases in total hospitalisation days for Hong Kong. The results would be relevant to many rapidly ageing societies in this region.
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Affiliation(s)
- Chi Leung Kwok
- HKJC Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam, Hong Kong
| | - Carmen Km Lee
- Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
| | - William Tl Lo
- Kwai Chung Hospital, Hospital Authority, Kwai Chung, Hong Kong
| | - Paul Sf Yip
- HKJC Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam, Hong Kong.,Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong
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17
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Huber E, Kleinknecht-Dolf M, Müller M, Kugler C, Spirig R. Mixed-method research protocol: defining and operationalizing patient-related complexity of nursing care in acute care hospitals. J Adv Nurs 2016; 73:1491-1501. [PMID: 27878843 DOI: 10.1111/jan.13218] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2016] [Indexed: 12/16/2022]
Abstract
AIM To define the concept of patient-related complexity of nursing care in acute care hospitals and to operationalize it in a questionnaire. BACKGROUND The concept of patient-related complexity of nursing care in acute care hospitals has not been conclusively defined in the literature. The operationalization in a corresponding questionnaire is necessary, given the increased significance of the topic, due to shortened lengths of stay and increased patient morbidity. DESIGN Hybrid model of concept development and embedded mixed-methods design. METHODS The theoretical phase of the hybrid model involved a literature review and the development of a working definition. In the fieldwork phase of 2015 and 2016, an embedded mixed-methods design was applied with complexity assessments of all patients at five Swiss hospitals using our newly operationalized questionnaire 'Complexity of Nursing Care' over 1 month. These data will be analysed with structural equation modelling. Twelve qualitative case studies will be embedded. They will be analysed using a structured process of constructing case studies and content analysis. In the final analytic phase, the quantitative and qualitative data will be merged and added to the results of the theoretical phase for a common interpretation. Cantonal Ethics Committee Zurich judged the research programme as unproblematic in December 2014 and May 2015. DISCUSSION Following the phases of the hybrid model and using an embedded mixed-methods design can reach an in-depth understanding of patient-related complexity of nursing care in acute care hospitals, a final version of the questionnaire and an acknowledged definition of the concept.
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Affiliation(s)
- Evelyn Huber
- Department of Nursing and Allied Health Care Professionals, University Hospital Zurich, Switzerland.,Department of Nursing Science, Faculty for Health, University Witten/Herdecke, Germany
| | - Michael Kleinknecht-Dolf
- Department of Nursing and Allied Health Care Professionals, University Hospital Zurich, Switzerland
| | - Marianne Müller
- Institute of Data Analysis and Process Design, School of Engineering, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Christiane Kugler
- Department of Nursing Science, Faculty for Health, University Witten/Herdecke, Germany
| | - Rebecca Spirig
- Department of Nursing and Allied Health Care Professionals, University Hospital Zurich, Switzerland.,Department of Nursing Science, Faculty for Health, University Witten/Herdecke, Germany.,Institute of Nursing Science, University of Basel, Switzerland
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18
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Dijkema MBA, van Strien RT, van der Zee SC, Mallant SF, Fischer P, Hoek G, Brunekreef B, Gehring U. Spatial variation in nitrogen dioxide concentrations and cardiopulmonary hospital admissions. ENVIRONMENTAL RESEARCH 2016; 151:721-727. [PMID: 27644030 DOI: 10.1016/j.envres.2016.09.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 09/06/2016] [Accepted: 09/09/2016] [Indexed: 05/10/2023]
Abstract
BACKGROUND Air pollution episodes are associated with increased cardiopulmonary hospital admissions. Cohort studies showed associations of spatial variation in traffic-related air pollution with respiratory and cardiovascular mortality. Much less is known in particular about associations with cardiovascular morbidity. We explored the relation between spatial variation in nitrogen dioxide (NO2) concentrations and cardiopulmonary hospital admissions. METHODS This ecological study was based on hospital admissions data (2001-2004) from the National Medical Registration and general population data for the West of the Netherlands (population 4.04 million). At the 4-digit postcode area level (n=683) associations between modeled annual average outdoor NO2 concentrations and hospital admissions for respiratory and cardiovascular causes were evaluated by linear regression with the log of the postcode-specific percentage of subjects that have been admitted at least once during the study period as the dependent variable. All analyses were adjusted for differences in composition of the population of the postcode areas (age, sex, income). RESULTS At the postcode level, positive associations were found between outdoor NO2 concentrations and hospital admission rates for asthma, chronic obstructive pulmonary disease (COPD), all cardiovascular causes, ischemic heart disease and stroke (e.g. adjusted relative risk (95% confidence interval) for the second to fourth quartile relative to the first quartile of exposure were 1.87 (1.46-2.40), 2.34 (1.83-3.01) and 2.81 (2.16-3.65) for asthma; 1.44 (1.19-1.74), 1.50 (1.24-1.82) and 1.60 (1.31-1.96) for COPD). Associations remained after additional (indirect) adjustment for smoking (COPD admission rate) and degree of urbanization. CONCLUSIONS Our study suggests an increased risk of hospitalization for respiratory and cardiovascular causes in areas with higher levels of NO2. Our findings add to the currently limited evidence of a long-term effect of air pollution on hospitalization. The ecological design of our study is a limitation and more studies with individual data are needed to confirm our findings.
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Affiliation(s)
- Marieke B A Dijkema
- Public Health Service (GGD) Amsterdam, Department of Environmental Health, Amsterdam, The Netherlands; Institute for Risk Assessment Sciences (IRAS), Division Environmental Epidemiology, Utrecht University, Utrecht, The Netherlands
| | - Robert T van Strien
- Public Health Service (GGD) Amsterdam, Department of Environmental Health, Amsterdam, The Netherlands
| | - Saskia C van der Zee
- Public Health Service (GGD) Amsterdam, Department of Environmental Health, Amsterdam, The Netherlands
| | - Sanne F Mallant
- Public Health Service (GGD) Amsterdam, Department of Environmental Health, Amsterdam, The Netherlands
| | - Paul Fischer
- National Institute for Public Health and the Environment (RIVM), Centre for Environmental Health, Bilthoven, The Netherlands
| | - Gerard Hoek
- Institute for Risk Assessment Sciences (IRAS), Division Environmental Epidemiology, Utrecht University, Utrecht, The Netherlands
| | - Bert Brunekreef
- Institute for Risk Assessment Sciences (IRAS), Division Environmental Epidemiology, Utrecht University, Utrecht, The Netherlands; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ulrike Gehring
- Institute for Risk Assessment Sciences (IRAS), Division Environmental Epidemiology, Utrecht University, Utrecht, The Netherlands.
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19
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Galenkamp H, Deeg DJH, de Jongh RT, Kardaun JWPF, Huisman M. Trend study on the association between hospital admissions and the health of Dutch older adults (1995-2009). BMJ Open 2016; 6:e011967. [PMID: 27531734 PMCID: PMC5013367 DOI: 10.1136/bmjopen-2016-011967] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 07/14/2016] [Accepted: 07/22/2016] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES An increase in hospital admission rates in older people may reflect improved access to healthcare, but also declining health trends in the older population. Owing to a lack of individual-level data, the latter possibility has received little attention. The current study examines associations between health status and hospitalisation rates of older adults in the Netherlands. DESIGN Observational individual-level data linked to hospital register data. SETTING Data from 1995 to 2009 from the nationally representative Longitudinal Aging Study Amsterdam were linked to the Dutch Hospital Discharge Register. PARTICIPANTS A total of 5681 observations of 2520 respondents across 4 measurement points (each with a follow-up of 36 months; ages 65-88 years). OUTCOME MEASURES The contribution of health, demographic, psychosocial and lifestyle characteristics to time trends in hospitalisation was assessed in multivariate models. RESULTS Between 1995 and 2009, the percentage with 1 or more overnight admissions (planned or acute) increased slightly from 38.1% to 39.7%. This was due to an increase in acute admission only (22.2-27.0%). Increased prevalences of chronic diseases, functional limitations and polypharmacy accounted for part of the observed increase in acute admissions. In addition, a more than doubled prevalence of day admissions over time was observed (12.3-28.3%), a trend that was unrelated to changes in individual characteristics. CONCLUSIONS This trend study showed a contribution of declines in population health to increases in acute hospital admissions. Since these declines did not provide a full explanation, healthcare reforms and increases in treatment possibilities in this period are likely to have contributed as well.
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Affiliation(s)
- Henrike Galenkamp
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Dorly J H Deeg
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - Renate T de Jongh
- Department of Internal Medicine, VU University Medical Center, Amsterdam, The Netherlands
| | - Jan W P F Kardaun
- Statistics Netherlands, The Hague, The Netherlands
- Department of Public Health, Academic Medical Center, Amsterdam, The Netherlands
| | - Martijn Huisman
- Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
- Department of Sociology, VU University, Amsterdam, The Netherlands
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20
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Timmermans MJC, van Vught AJAH, Wensing M, Laurant MGH. Erratum to: The effectiveness of substitution of hospital ward care from medical doctors to physician assistants: a study protocol. BMC Health Serv Res 2016; 16:115. [PMID: 27044303 PMCID: PMC4820881 DOI: 10.1186/s12913-016-1330-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 03/03/2016] [Indexed: 12/04/2022] Open
Affiliation(s)
- Marijke J C Timmermans
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare, Nijmegen, The Netherlands.
| | - Anneke J A H van Vught
- HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, The Netherlands
| | - Michel Wensing
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare, Nijmegen, The Netherlands
| | - Miranda G H Laurant
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Center for Quality of Healthcare (IQ healthcare, Nijmegen, The Netherlands.,HAN University of Applied Sciences, Faculty of Health and Social Studies, Nijmegen, The Netherlands
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21
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Hoogervorst-Schilp J, Langelaan M, Spreeuwenberg P, de Bruijne MC, Wagner C. Excess length of stay and economic consequences of adverse events in Dutch hospital patients. BMC Health Serv Res 2015; 15:531. [PMID: 26626729 PMCID: PMC4667531 DOI: 10.1186/s12913-015-1205-5] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Accepted: 11/30/2015] [Indexed: 11/15/2022] Open
Abstract
Background To investigate the average and extrapolated excess length of stay and direct costs of adverse events (AEs) and preventable AEs in Dutch hospitals, and to evaluate patient characteristics associated with excess length of stay and costs. Methods Data of a large retrospective patient record review study on AEs was used. A stratified sample of 20 Dutch hospitals was included. Excess length of stay and costs attributable to AEs and preventable AEs were calculated and extrapolated to a national estimate. The association between patient characteristics and excess length of stay (and costs thereof) attributable to AEs and preventable AEs was investigated through multilevel linear regression analyses. Results A total of 2975 patient records were included in the analysis, of which 325 experienced one or more AEs. Hospital patients experiencing an AE stayed 5.11 (95 % CI 3.91–6.30) more days in hospital and cost €2600 (95 % CI €1968–€3232) more compared to those without an AE. There was no significant difference in days and costs between preventable and non-preventable AEs. Extrapolated to a national level, AEs cost more than €300 million, which was 1.3 % of the national hospital care budget. Patients with hospital-acquired infections had a statistically significant longer length of stay compared to the reference group (patients with AEs on the cardiovascular system). Conclusions This study showed that AEs lead to substantial excess length of stay and increased costs. Special attention should be paid to patients with AEs due to an hospital-acquired infection.
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Affiliation(s)
- Janneke Hoogervorst-Schilp
- NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500, BN, Utrecht, The Netherlands.
| | - Maaike Langelaan
- NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500, BN, Utrecht, The Netherlands.
| | - Peter Spreeuwenberg
- NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500, BN, Utrecht, The Netherlands.
| | - Martine C de Bruijne
- Department of Public and Occupational Health & EMGO Institute for Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands.
| | - Cordula Wagner
- NIVEL, Netherlands Institute for Health Services Research, PO Box 1568, 3500, BN, Utrecht, The Netherlands. .,Department of Public and Occupational Health & EMGO Institute for Health and Care Research, VU University Medical Centre, Van der Boechorststraat 7, 1081, BT, Amsterdam, The Netherlands.
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22
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Alanazi MQ, Al-Jeriasy MI, Al-Assiri MH, Afesh LY, Alhammad F, Salam M. Hospital Performance Indicators and Their Associated Factors in Acute Child Poisoning at a Single Poison Center, Central Saudi Arabia. Medicine (Baltimore) 2015; 94:e2339. [PMID: 26717371 PMCID: PMC5291612 DOI: 10.1097/md.0000000000002339] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Admission rate and length of stay (LOS) are two hospital performance indicators that affect the quality of care, patients' satisfaction, bed turnover, and health cost expenditures. The aim of the study was to identify factors associated with higher admission rates and extended average LOS among acutely poisoned children at a single poison center, central Saudi Arabia.This is a cross-sectional, poison and medical chart review between 2009 and 2011. Exposures were child characteristics, that is, gender, age, body mass index (BMI), health history, and Canadian 5-level triage scale. Poison incident characteristics were, that is, type, exposure route, amount, form, home remedy, and arrival time to center. Admission status and LOS were obtained from records. Chronic poisoning, plant allergies, and venomous bites were excluded. Bivariate and regression analyses were applied. Significance at P < 0.05.Of the 315 eligible cases, (72%) were toddlers with equal gender distribution, (58%) had normal BMI, and (77%) were previously healthy. Poison substances were pharmaceutical drugs (63%) versus chemical products (37%). Main exposure route was oral (98%). Home remedy was observed in (21.9%), which were fluids, solutes, and/or gag-induced vomiting. Almost (52%) arrived to center >1 h. Triage levels: non-urgent cases (58%), less urgent (11%), urgent (18%), emergency (12%), resuscitative (1%). Admission rate was (20.6%) whereas av. LOS was 13 ± 22 h. After adjusting and controlling for confounders, older children (adj.OR = 1.19) and more critical triage levels (adj.OR = 1.35) were significantly associated with higher admission rates compared to younger children and less critical triage levels (adj.P = 0.006) and (adj.P = 0.042) respectively. Home remedy prior arrival was significantly associated with higher av. LOS (Beta = 9.48, t = 2.99), compared to those who directly visited the center, adj.P = 0.003.Hospital administrators are cautioned that acutely poisoned children who received home remedies prior arrival are more likely to endure an extended LOS. This non-conventional practice is not recommended.
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Affiliation(s)
- Menyfah Q Alanazi
- From the Drug Policy and Economics Center (MQA); King Abdullah International Medical Research Center (KAIMRC) (MJ, MHA, LYA, MS); Pharmaceutical Care and King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) (MJ); and Pediatrics Emergency Department (FA); King Abdulaziz Medical City, Riyadh, Saudi Arabia
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van der Meide H, Olthuis G, Leget C. Participating in a world that is out of tune: shadowing an older hospital patient. MEDICINE, HEALTH CARE, AND PHILOSOPHY 2015; 18:577-585. [PMID: 25577239 DOI: 10.1007/s11019-015-9621-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Hospitalization significantly impacts the lives of older people, both physically and psychosocially. There is lack of observation studies that may provide an embodied understanding of older patients' experiences in its context. The aim of this single case study was to reach a deeper understanding of one older patient's lived experiences of hospitalization. The study followed a phenomenological embodied enquiry design and the qualitative observation method of shadowing was used. In April 2011, one older patient was shadowed for 7 days, 5-7 h per day. To facilitate understanding in the reader the experiences are first presented in a story and subsequently analyzed by means of the lifeworld framework. The findings show that hospitalization is experienced as ambiguous safety, disconnected time, the feeling of being partially involved, and the struggle to re-attune to the body.
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Affiliation(s)
| | - Gert Olthuis
- Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
| | - Carlo Leget
- University of Humanistic Studies, Utrecht, The Netherlands
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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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Thonon F, Watson J, Saghatchian M. Benchmarking facilities providing care: An international overview of initiatives. SAGE Open Med 2015; 3:2050312115601692. [PMID: 26770800 PMCID: PMC4712789 DOI: 10.1177/2050312115601692] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 07/28/2015] [Indexed: 11/18/2022] Open
Abstract
We performed a literature review of existing benchmarking projects of health facilities to explore (1) the rationales for those projects, (2) the motivation for health facilities to participate, (3) the indicators used and (4) the success and threat factors linked to those projects. We studied both peer-reviewed and grey literature. We examined 23 benchmarking projects of different medical specialities. The majority of projects used a mix of structure, process and outcome indicators. For some projects, participants had a direct or indirect financial incentive to participate (such as reimbursement by Medicaid/Medicare or litigation costs related to quality of care). A positive impact was reported for most projects, mainly in terms of improvement of practice and adoption of guidelines and, to a lesser extent, improvement in communication. Only 1 project reported positive impact in terms of clinical outcomes. Success factors and threats are linked to both the benchmarking process (such as organisation of meetings, link with existing projects) and indicators used (such as adjustment for diagnostic-related groups). The results of this review will help coordinators of a benchmarking project to set it up successfully.
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Affiliation(s)
- Frédérique Thonon
- European and International Affairs, Gustave Roussy, Villejuif, France
| | - Jonathan Watson
- HealthClusterNet, Unit 1, Carleton Business Park, Skipton, UK
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van der Meide H, Olthuis G, Leget C. Feeling an outsider left in uncertainty - a phenomenological study on the experiences of older hospital patients. Scand J Caring Sci 2014; 29:528-36. [DOI: 10.1111/scs.12187] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 09/22/2014] [Indexed: 11/28/2022]
Affiliation(s)
| | - Gert Olthuis
- Radboud University Medical Centre Nijmegen; Nijmegen The Netherlands
| | - Carlo Leget
- University of Humanistic Studies; Utrecht The Netherlands
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Kleinknecht-Dolf M, Grand F, Spichiger E, Müller M, Martin JS, Spirig R. Complexity of nursing care in acute care hospital patients: results of a pilot study with a newly developed questionnaire. Scand J Caring Sci 2014; 29:591-602. [PMID: 25251029 DOI: 10.1111/scs.12180] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 08/01/2014] [Indexed: 01/27/2023]
Abstract
AIM The aim of this pilot study was to develop an instrument for measuring complexity of nursing care in hospitalised acute care patients as well as to examine its comprehensibility, its feasibility, the effort required for data collection, and its inter-rater reliability as well as its face validity. METHODS This pilot study was designed as a descriptive, explorative cross-sectional survey with multiple measurements of the patient-related complexity of nursing care and a supplemental qualitative questionnaire conducted on six units of a Swiss university hospital. The instrument to assess complexity of nursing care was developed on the framework of Perrow and encompasses on three subscales a total of 15 items with a 5-point Likert scale. ETHICAL CONSIDERATIONS The study was reviewed and approved by the Cantonal Ethics Committee. RESULTS In total, 866 assessments of complexity of nursing care were carried out on 234 patients. The variability of the results of the six units, from three different specialties, suggests that the sampling was suitable for capturing a wide spectrum of complexity. The results of the three subscales are consistent and the discussion of them with the participating units shows that they are also plausible. The verification of the inter-rater reliability has satisfactory to high intersubjective correlation of the values. There were also a few suggestions for improving comprehensibility as well as on how to support user application. The time expenditure for the assessment between 2 to 5 minutes per patient was accurately. CONCLUSION With the newly developed questionnaire to measure the complexity of nursing care in acute care hospitals it seems to be possible to assess and to quantify the complexity of nursing care in various acute care hospital settings. Based on the findings and the feedback of the participating users, the questionnaire needs to be improved for large-scale application.
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Affiliation(s)
| | - Francis Grand
- Directorate of Nursing, Medical-Technical and Medical-Therapeutic Areas, Inselspital, University Hospital, Berne, Switzerland
| | - Elisabeth Spichiger
- Directorate of Nursing, Medical-Technical and Medical-Therapeutic Areas, Inselspital, University Hospital, Berne, Switzerland.,Institute of Nursing Science, University of Basle, Basle, Switzerland
| | - Marianne Müller
- Institute for Data Analysis and Process Design, School of Engineering, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Jacqueline S Martin
- Department of Nursing and Allied Health Care Professions, University Hospital Basle, Basle, Switzerland
| | - Rebecca Spirig
- Institute of Nursing Science, University of Basle, Basle, Switzerland.,Department of Nursing and Allied Health Care Professions, University Hospital Zurich, Zurich, Switzerland
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Ravangard R, Hatam N, Teimourizad A, Jafari A. Factors affecting the technical efficiency of health systems: A case study of Economic Cooperation Organization (ECO) countries (2004-10). Int J Health Policy Manag 2014; 3:63-9. [PMID: 25114944 DOI: 10.15171/ijhpm.2014.60] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 06/06/2014] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Improving efficiency of health sector is of particular importance in all countries. To reach this end, it is paramount to measure the efficiency. On the other hand, there are many factors that affect the efficiency of health systems. This study aimed to measure the Technical Efficiency (TE) of health systems in Economic Cooperation Organization (ECO) countries during 2004-10 and to determine the factors affecting their TE. METHODS This was a descriptive-analytical and panel study. The required data were gathered using library and field studies, available statistics and international websites through completing data collection forms. In this study, the TE of health systems in 10 ECO countries was measured using their available data and Data Envelopment Analysis (DEA) through two approaches. The first approach used GDP per capita, education and smoking as its inputs and life expectancy and infant mortality rates as the outputs. The second approach, also, used the health expenditures per capita, the number of physicians per thousand people, and the number of hospital beds per thousand people as its inputs and life expectancy and under-5 mortality rates as the outputs. Then, the factors affecting the TE of health systems were determined using the panel data logit model. Excel 2010, Win4Deap 1.1.2 and Stata 11.0 were used to analyze the collected data. RESULTS According to the first approach, the mean TE of health systems was 0.497 and based on the second one it was 0.563. Turkey and Turkmenistan had, respectively, the highest and lowest mean of efficiency. Also, the results of panel data logit model showed that only GDP per capita and health expenditures per capita had significant relationships with the TE of health systems. CONCLUSION In order to maximize the TE of health systems, health policy-makers should pay special attention to the proper use of healthcare resources according to the people's needs, the appropriate management of the health system resources, allocating adequate budgets to the health sector, establishing an appropriate referral system to provide better public access to health services according to their income and needs, among many others.
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Affiliation(s)
- Ramin Ravangard
- Department of Health Services Administration, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nahid Hatam
- Department of Health Services Administration, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abedin Teimourizad
- Department of Health Services Administration, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abdosaleh Jafari
- Department of Health Services Administration, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
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Gardiner C, Ward S, Gott M, Ingleton C. Economic impact of hospitalisations among patients in the last year of life: an observational study. Palliat Med 2014; 28:422-9. [PMID: 24367059 DOI: 10.1177/0269216313517284] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hospital admissions among patients at the end of life have a significant economic impact. Avoiding unnecessary hospitalisations has the potential for significant cost savings and is often in line with patient preference. OBJECTIVE To determine the extent of potentially avoidable hospital admissions among patients admitted to hospital in the last year of life and to cost these accordingly. DESIGN An observational retrospective case note review with economic impact assessment. SETTING Two large acute hospitals in the North of England, serving contrasting socio-demographic populations. PATIENTS A total of 483 patients who died within 1 year of admission to hospital. MEASUREMENTS Data were collected across a range of clinical, demographic, economic and service use variables and were collected from hospital case notes and routinely collected sources. Palliative medicine consultants identified admissions that were potentially avoidable. RESULTS Of 483 admissions, 35 were classified as potentially avoidable. Avoiding these admissions and caring for the patients in alternative locations would save the two hospitals £5.9 million per year. Reducing length of stay in all 483 patients by 14% has the potential to save the two hospitals £47.5 million per year; however, this cost would have to be offset against increased community care costs. LIMITATIONS A lack of accurate cost data on alternative care provision in the community limits the accuracy of economic estimates. CONCLUSIONS Reducing length of hospital stay in palliative care patients may offer the potential to achieve higher hospital cost savings than preventing avoidable admissions. Further research is required to determine both the feasibility of reducing length of hospital stay for patients with palliative care needs and the economic impact of doing so.
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Affiliation(s)
- Clare Gardiner
- 1School of Nursing, The University of Auckland, Auckland, New Zealand
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Spirig R, Spichiger E, Martin JS, Frei IA, Müller M, Kleinknecht M. Monitoring the impact of the DRG payment system on nursing service context factors in Swiss acute care hospitals: Study protocol. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2014; 12:Doc07. [PMID: 24696673 PMCID: PMC3972437 DOI: 10.3205/000192] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Revised: 03/17/2014] [Indexed: 11/30/2022]
Abstract
Aims: With this study protocol, a research program is introduced. Its overall aim is to prepare the instruments and to conduct the first monitoring of nursing service context factors at three university and two cantonal hospitals in Switzerland prior to the introduction of the reimbursement system based on Diagnosis Related Groups (DRG) and to further develop a theoretical model as well as a methodology for future monitoring following the introduction of DRGs. Background: DRG was introduced to all acute care hospitals in Switzerland in 2012. In other countries, DRG introduction led to rationing and subsequently to a reduction in nursing care. As result, nursing-sensitive patient outcomes were seriously jeopardised. Switzerland has the opportunity to learn from the consequences experienced by other countries when they introduced DRGs. Their experiences highlight that DRGs influence nursing service context factors such as complexity of nursing care or leadership, which in turn influence nursing-sensitive patient outcomes. For this reason, the monitoring of nursing service context factors needs to be an integral part of the introduction of DRGs. However, most acute care hospitals in Switzerland do not monitor nursing service context data. Nursing managers and hospital executive boards will be in need of this data in the future, in order to distribute resources effectively. Methods/Design: A mixed methods design in the form of a sequential explanatory strategy was chosen. During the preparation phase, starting in spring 2011, instruments were selected and prepared, and the access to patient and nursing data in the hospitals was organized. Following this, online collection of quantitative data was conducted in fall 2011. In summer 2012, qualitative data was gathered using focus group interviews, which helped to describe the processes in more detail. During 2013 and 2014, an integration process is being conducted involving complementing, comparing and contrasting quantitative and qualitative findings. Conclusion: The research program will produce baseline data on nursing service context factors in Swiss acute care hospitals prior to DRG introduction as well as a theoretical model and a methodology to support nursing managers and hospital executive boards in distributing resources effectively. The study was approved by the ethics committees of Basel, Bern, Solothurn and Zürich.
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Affiliation(s)
- Rebecca Spirig
- Department of Nursing and Allied Health Care Professions, University Hospital Zurich, Switzerland ; Institute of Nursing Science, University of Basel, Switzerland
| | - Elisabeth Spichiger
- Institute of Nursing Science, University of Basel, Switzerland ; Directorate of Nursing, Medical-Technical and Medical-Therapeutic Areas, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Jacqueline S Martin
- Department of Nursing and Allied Health Professions, University Hospital Basel, Switzerland
| | - Irena Anna Frei
- Practice Development Unit, Department of Nursing and Allied Health Professions, University Hospital Basel, Switzerland
| | - Marianne Müller
- Institute of Data Analysis and Process Design, School of Engineering, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Michael Kleinknecht
- Department of Nursing and Allied Health Care Professions, University Hospital Zurich, Switzerland
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Yip PSF, Lee CKM, Chow CB, Lo WTL. What makes the hospitalisation system more efficient? An application of the decomposition method to Hong Kong morbidity data. BMJ Open 2014; 4:e003903. [PMID: 24604479 PMCID: PMC3948574 DOI: 10.1136/bmjopen-2013-003903] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To examine the efficiency of the Hong Kong hospitalisation system based on hospitalisation days. DESIGN Retrospective study. SETTING Hospitalisation data (2000-2010) for all government-funded hospitals in Hong Kong. POPULATION Hospitalisation data for the entire Hong Kong population (7.0 million in 2011). METHODS A decomposition method was used to determine the effects on total hospitalisation days during the period 2000-2010 of the following three factors: (i) hospitalisation rate per person; (ii) the number of visits per patient; and (iii) the mean duration of stay per visit. MAIN OUTCOME MEASURES The decomposition method provides empirical measures of how the three factors contributed to the change in total hospitalisation days during the period 2000-2010 and identifies the most effective way to contain increases in hospitalisation days. RESULTS The results of decomposition analysis show that the decrease in mean duration of stay per visit (reducing from 6.83 to 4.58 days) is the most important factor in the reduction in the total number of hospitalisation days, despite increases in total population size (from 6.7 to 7.0 million), the number of individual hospital admissions (from 583 000 to 664 000) and the number of episodes (from 1.2 to 1.4 million) from 2000 to 2010. Hospitalisation days per person decreased from 1.18 in 2000 to 0.93 in 2010. The decline in the mean duration of stay per visit contributed 200.6% to this reduction but was offset by -51.1% due to a slight growth in the number of visits per patient and by -49.4% as a result of changed hospitalisation rates per person. CONCLUSIONS Better management of the duration of stay of per visit without compromising patient satisfaction levels or the quality of service is the most important factor for controlling increases in health expenditure in Hong Kong.
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Affiliation(s)
- Paul S F Yip
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong, Hong Kong
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Timmermans MJC, van Vught AJAH, Wensing M, Laurant MGH. The effectiveness of substitution of hospital ward care from medical doctors to physician assistants: a study protocol. BMC Health Serv Res 2014; 14:43. [PMID: 24472112 PMCID: PMC3909389 DOI: 10.1186/1472-6963-14-43] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Accepted: 01/24/2014] [Indexed: 11/30/2022] Open
Abstract
Background Because of an expected shrinking supply of medical doctors for hospitalist posts, an increased emphasis on efficiency and continuity of care, and the standardization of many medical procedures, the role of hospitalist is increasingly allocated to physician assistants (PAs). PAs are nonphysician clinicians with medical tasks. This study aims to evaluate the effects of substitution of hospital ward care to PAs. Methods/Design In a multicenter matched controlled study, the traditional model in which the role of hospitalist is taken solely by medical doctors (MD model) is compared with a mixed model in which a PA functions as a hospitalist, contingent with MDs (PA/MD model). Twenty intervention and twenty control wards are included across The Netherlands, from a range of medical specialisms. Primary outcome measure is patients’ length of hospital stay. Secondary outcomes include indicators for quality of hospital ward care, patients experiences with medical ward care, patients health-related quality of life, and healthcare providers’ experiences. An economic evaluation is conducted to assess the cost implications and potential efficiency of the PA/MD model. For most measures, data is collected from medical records or questionnaires in samples of 115 patients per hospital ward. Semi-structured interviews with healthcare professionals are conducted to identify determinants of efficiency, quality and continuity of care and barriers and facilitators for the implementation of PAs in the role of hospitalist. Discussion Findings from this study will help to further define the role of nonphysician clinicians and provides possible key components for the implementation of PAs in hospital ward care. Like in many studies of organizational change, random allocation to study arms is not feasible, which implies an increased risk for confounding. A major challenge is to deal with the heterogeneity of patients and hospital departments. Trial registration ClinicalTrials.gov ID NCT01835444
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Affiliation(s)
- Marijke J C Timmermans
- Scientific Institute for Quality of Healthcare, Radboud University Medical Center, Nijmegen, The Netherlands.
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Alsirafy SA, Abou-Alia AM, Ghanem HM. Palliative care consultation versus palliative care unit: which is associated with shorter terminal hospitalization length of stay among patients with cancer? Am J Hosp Palliat Care 2013; 32:275-9. [PMID: 24301082 DOI: 10.1177/1049909113514476] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hospital length of stay (LoS) may be used to assess end-of-life care aggressiveness and health care delivery efficiency. We describe the terminal hospitalization LoS of patients with cancer managed by a hospital-based palliative care (PC) program comprising a palliative care consultation (PCC) service and an inpatient palliative care unit (PCU). A total of 328 in-hospital cancer deaths were divided into 2 groups. The PCU group included patients admitted by the PC team directly to the PCU. The PCC group included patients admitted by other specialties and referred to the PCC team. The LoS of the PCU group was significantly shorter than that of the PCC group (9.9 [±9.4] vs 17.8 [±19.7] days, respectively; P < .001). Direct terminal hospitalization to PCU is not associated with longer LoS among cancer deaths managed by a hospital-based PC service.
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Affiliation(s)
- Samy A Alsirafy
- Palliative Medicine Unit, Kasr Al-Ainy Center of Clinical Oncology & Nuclear Medicine (NEMROCK), Kasr Al-Ainy School of Medicine, Cairo University, Cairo, Egypt
| | - Ahmad M Abou-Alia
- Palliative Care Department, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
| | - Hafez M Ghanem
- Palliative Care Department, King Fahad Specialist Hospital-Dammam, Dammam, Saudi Arabia
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Shahnaz A, Parker RA, Wills S, Ross Russell RI. Assessing efficient patient care: should length of stay be calculated independently of local admission rates? Arch Dis Child 2013; 98:951-4. [PMID: 24043552 DOI: 10.1136/archdischild-2013-303863] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare the length of hospitalisation for infants with bronchiolitis across the Eastern region and to assess the impact of the varying admission rates in each hospital. DESIGN Data collection through the Hospital Episode Statistics (HES) using the ICD clinical coding for bronchiolitis across all hospitals in east of England for three winter seasons (October to March for the years 2009/10, 2010/11 and 2011/12). MAIN OUTCOME MEASURE Length of hospital stay, corrected to adjust for local population. RESULTS Seventeen hospitals across the east of England were included in this study. Overall admission rate (as a percentage of the population) for the region was 3.3% and consistent with national data, but rates within individual hospitals varied between 1.5% and 5.7% over the 3-year period. Bed days per 1000 population ('standardised bed days') per year varied almost fourfold, from 34.5 to 122.3 in different hospitals. Corrected length of stay showed high discordance when compared to average length of stay. CONCLUSIONS The average length of stay is substantially affected by admission rates, with hospitals who admit a greater proportion of infants appearing to have a shorter uncorrected length of stay. We propose that a single corrected measure for length of stay should be used when assessing the efficiency of care because it is unaffected by variations in local admission rates and is adjusted for local population size.
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Affiliation(s)
- A Shahnaz
- Department of Paediatrics, Cambridge University Hospitals NHS Foundation Trust, , Cambridge, UK
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Pouw ME, Peelen LM, Moons KGM, Kalkman CJ, Lingsma HF. Including post-discharge mortality in calculation of hospital standardised mortality ratios: retrospective analysis of hospital episode statistics. BMJ 2013; 347:f5913. [PMID: 24144869 PMCID: PMC3805490 DOI: 10.1136/bmj.f5913] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To assess the consequences of applying different mortality timeframes on standardised mortality ratios of individual hospitals and, secondarily, to evaluate the association between in-hospital standardised mortality ratios and early post-discharge mortality rate, length of hospital stay, and transfer rate. DESIGN Retrospective analysis of routinely collected hospital data to compare observed deaths in 50 diagnostic categories with deaths predicted by a case mix adjustment method. SETTING 60 Dutch hospitals. PARTICIPANTS 1 228 815 patients discharged in the period 2008 to 2010. MAIN OUTCOME MEASURES In-hospital standardised mortality ratio, 30 days post-admission standardised mortality ratio, and 30 days post-discharge standardised mortality ratio. RESULTS Compared with the in-hospital standardised mortality ratio, 33% of the hospitals were categorised differently with the 30 days post-admission standardised mortality ratio and 22% were categorised differently with the 30 days post-discharge standardised mortality ratio. A positive association was found between in-hospital standardised mortality ratio and length of hospital stay (Pearson correlation coefficient 0.33; P=0.01), and an inverse association was found between in-hospital standardised mortality ratio and early post-discharge mortality (Pearson correlation coefficient -0.37; P=0.004). CONCLUSIONS Applying different mortality timeframes resulted in differences in standardised mortality ratios and differences in judgment regarding the performance of individual hospitals. Furthermore, associations between in-hospital standardised mortality rates, length of stay, and early post-discharge mortality rates were found. Combining these findings suggests that standardised mortality ratios based on in-hospital mortality are subject to so-called "discharge bias." Hence, early post-discharge mortality should be included in the calculation of standardised mortality ratios.
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Affiliation(s)
- Maurice E Pouw
- Department of Anesthesiology, University Medical Center Utrecht, Heidelberglaan 100, PO Box 85500, 3508 GA Utrecht, Netherlands
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McDevitt J, Kelly M, Comber H, Kelleher T, Dwane F, Sharp L. A population-based study of hospital length of stay and emergency readmission following surgery for non-small-cell lung cancer. Eur J Cardiothorac Surg 2013; 44:e253-9. [PMID: 23886994 PMCID: PMC4036404 DOI: 10.1093/ejcts/ezt389] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 06/14/2013] [Accepted: 06/27/2013] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES We conducted a population-based analysis of time trends in length of stay (LOS), predictors of prolonged LOS and emergency readmission following resection for non-small-cell lung cancer (NSCLC). METHODS Incident lung cancers (ICDO2:C34), diagnosed between 2002 and 2008, were identified from the National Cancer Registry (NCR) of Ireland, and linked to hospital in-patient episodes (HIPE). For those with NSCLC who underwent lung resection, the associated hospital episode was identified. Factors predicting longer LOS (upper quartile, >20 days), and emergency readmission within 28 days of the index procedure (IP) were investigated using Poisson regression. RESULTS A total of 1284 patients underwent resection. Eighty-four (7%) subsequently died in hospital and 1200 (93%) were discharged. Hundred and nineteen of 1200 (10%) were readmitted as an emergency within 28 days of discharge. Median LOS after the IP was 13 days (inter-decile range: 7-35). Risk of prolonged LOS was significantly greater in patients >75 years, resident in an area of highest deprivation, with 2+ comorbidities, who had undergone surgery in a lower-volume hospital, and died in hospital subsequent to the IP. Emergency readmission was significantly more likely in patients who were resident in an area of highest deprivation, with 2+ comorbidities, and had Stage III disease or worse. The main reasons for emergency readmission were: pulmonary complications (29%), cardio/cerebrovascular events (21%) or infection (20%). CONCLUSIONS Half of the patients had a LOS in excess of 13 days, which was longer than any other country with published data. Patient and health-service factors were associated with prolonged LOS, while patient and tumour characteristics were associated with risk of emergency readmission. Deprivation was a conspicuous determinant of both LOS and readmission.
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van Deursen AMM, van Mens SP, Sanders EAM, Vlaminckx BJM, de Melker HE, Schouls LM, de Greeff SC, van der Ende A. Invasive pneumococcal disease and 7-valent pneumococcal conjugate vaccine, the Netherlands. Emerg Infect Dis 2013; 18:1729-37. [PMID: 23092683 PMCID: PMC3559145 DOI: 10.3201/eid1811.120329] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Disease incidence and case fatality rates declined 4 years after introduction of the vaccine.
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de Bruijne MC, van Rosse F, Uiters E, Droomers M, Suurmond J, Stronks K, Essink-Bot ML. Ethnic variations in unplanned readmissions and excess length of hospital stay: a nationwide record-linked cohort study. Eur J Public Health 2013; 23:964-71. [PMID: 23388242 PMCID: PMC3840803 DOI: 10.1093/eurpub/ckt005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Studies in the USA have shown ethnic inequalities in quality of hospital care, but in Europe, this has never been analysed. We explored variations in indicators of quality of hospital care by ethnicity in the Netherlands. Methods: We analysed unplanned readmissions and excess length of stay (LOS) across ethnic groups in a large population of hospitalized patients over an 11-year period by linking information from the national hospital discharge register, the Dutch population register and socio-economic data. Data were analysed with stepwise logistic regression. Results: Ethnic differences were most pronounced in older patients: all non-Western ethnic groups > 45 years had an increased risk for excess LOS compared with ethnic Dutch patients, with odds ratios (ORs) (adjusted for case mix) varying from 1.05 [95% confidence intervals (95% CI) 1.02–1.08] for other non-Western patients to 1.14 (95% CI 1.07–1.22) for Moroccan patients. The risk for unplanned readmission in patients >45 years was increased for Turkish (OR 1.24, 95% CI 1.18–1.30) and Surinamese patients (OR 1.11, 95% CI 1.07–1.16). These differences were explained partially, although not substantially, by differences in socio-economic status. Conclusion: We found significant ethnic variations in unplanned readmissions and excess LOS. These differences may be interpretable as shortcomings in the quality of hospital care delivered to ethnic minority patients, but exclusion of alternative explanations (such as differences in patient- and community-level factors, which are outside hospitals’ control) requires further research. To quantify potential ethnic inequities in hospital care in Europe, we need empirical prospective cohort studies with solid quality outcomes such as adverse event rates.
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Affiliation(s)
- Martine C de Bruijne
- 1 Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
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Schellings DAAM, Symersky T, Ottervanger JP, Ramdat Misier AR, de Boer MJ. Clinical cardiology consultation at non-cardiology departments: stepchild of patient care? Neth Heart J 2012; 20:260-3. [PMID: 22644999 DOI: 10.1007/s12471-012-0273-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND Although patient care in cardiology departments may be of high quality, patients with cardiac disease in other departments tend to receive less attention from cardiologists. Driven by the shorter duration of admission nowadays and the fact that consultations are often performed in between the daily work schedules, the amount of cardiac disease as well as the impact on the daily workload can be underestimated. We determined characteristics, prevalence of cardiac disease and in-hospital mortality of patients in whom cardiology consultation was requested. METHOD In this prospective, observational study, individual data of all consecutive patients admitted to non-cardiology departments in whom cardiology consultation was requested were registered. RESULTS During the study period, 264 patients were included. Mean age was 70 years. Most patients were admitted to the internal medicine ward (37 %), followed by the surgical ward (30 %). The most common reasons for cardiology consultation were: suspected heart failure (20 %), suspected infective endocarditis (15 %), suspected rhythm abnormalities (14 %) and suspected acute coronary syndrome (13 %). In 29 % of all consultations a cardiac diagnosis was found. Hospital mortality was 9.0 %. CONCLUSION Patients who are admitted to a non-cardiology department and who need cardiology consultation are particularly elderly people with a high prevalence of cardiac disease and high in-hospital mortality. For these reasons cardiology consultation is an important part of clinical cardiology deserving a structured approach.
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Affiliation(s)
- D A A M Schellings
- Department of Cardiology, Isala Klinieken, Groot Wezenland 20, 8011 JW, Zwolle, the Netherlands
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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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Fifty ways to reduce length of stay: an inventory of how hospital staff would reduce the length of stay in their hospital. Health Policy 2012; 104:222-33. [PMID: 22304781 DOI: 10.1016/j.healthpol.2011.12.010] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Revised: 12/18/2011] [Accepted: 12/26/2011] [Indexed: 11/21/2022]
Abstract
PURPOSE AND SETTING In this study we present a bottom up approach to developing interventions to shorten lengths of stay. Between 1999 and 2009 we applied the approach in 21 Dutch clinical wards in 12 hospitals. We present the complete inventory of all interventions. DESIGN We organised, on the hospital ward level, structured meetings with the staff in order to first identify barriers to reduce the length of stay and then later to link them to interventions. The key components of the approach were a benchmark with the fifteenth percentile and the use of a matrix, that on one side was arranged along the main phases of the care process--the admission, stay and discharge--and on the other side to the degree to which the length of stay could be shortened by the medical specialists and nurses themselves or by involving others. FINDINGS AND CONCLUSIONS The matrix consists of a wide variety of interventions that mainly cover what we found in published research. As a bottom up approach is more likely to succeed, we would advise wards that have to reduce length of stay to make the inventory themselves, using appropriate benchmark data, and by using the matrix.
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Peiris CL, Taylor NF, Shields N. Extra physical therapy reduces patient length of stay and improves functional outcomes and quality of life in people with acute or subacute conditions: a systematic review. Arch Phys Med Rehabil 2011; 92:1490-500. [PMID: 21878220 DOI: 10.1016/j.apmr.2011.04.005] [Citation(s) in RCA: 92] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 03/21/2011] [Accepted: 04/01/2011] [Indexed: 12/17/2022]
Abstract
OBJECTIVES To investigate whether extra physical therapy intervention reduces length of stay and improves patient outcomes in people with acute or subacute conditions. DATA SOURCES Electronic databases CINAHL, MEDLINE, AMED, PEDro, PubMed, and EMBASE were searched from the earliest date possible through May 2010. Additional trials were identified by scanning reference lists and citation tracking. STUDY SELECTION Randomized controlled trials evaluating the effect of extra physical therapy on patient outcomes were included for review. Two reviewers independently applied the inclusion and exclusion criteria, and any disagreements were discussed until consensus could be reached. Searching identified 2826 potentially relevant articles, of which 16 randomized controlled trials with 1699 participants met inclusion criteria. DATA EXTRACTION Data were extracted using a predefined data extraction form by 1 reviewer and checked for accuracy by another. Methodological quality of trials was assessed independently by 2 reviewers using the PEDro scale. DATA SYNTHESIS Pooled analyses with random effects model to calculate standardized mean differences (SMDs) and 95% confidence intervals (CIs) were used in meta-analyses. When compared with standard physical therapy, extra physical therapy reduced length of stay (SMD=-.22; 95% CI, -.39 to -.05) (mean difference of 1d [95% CI, 0-1] in acute settings and mean difference of 4d [95% CI, 0-7] in rehabilitation settings) and improved mobility (SMD=.37; 95% CI, .05-.69), activity (SMD=.22; 95% CI, .07-.37), and quality of life (SMD=.48; 95% CI, .29-.68). There were no significant changes in self-care (SMD=.35; 95% CI, -.06-.77). CONCLUSIONS Extra physical therapy decreases length of stay and significantly improves mobility, activity, and quality of life. Future research could address the possible benefits of providing extra services from other allied health disciplines in addition to physical therapy.
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Affiliation(s)
- Casey L Peiris
- Musculoskeletal Research Centre and School of Physiotherapy, La Trobe University, Victoria, Australia.
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Hoonhout LHF, de Bruijne MC, Wagner C, Asscheman H, van der Wal G, van Tulder MW. Nature, occurrence and consequences of medication-related adverse events during hospitalization: a retrospective chart review in the Netherlands. Drug Saf 2010; 33:853-64. [PMID: 20812770 DOI: 10.2165/11536800-000000000-00000] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Medication-related adverse events (MRAEs) form a large proportion of all adverse events in hospitalized patients and are associated with considerable preventable harm. Detailed information on harm related to drugs administered during hospitalization is scarce. Knowledge of the nature and preventability of MRAEs is needed to prioritize and improve medication-related patient safety. OBJECTIVE To provide information on the nature, consequences and preventability of MRAEs occurring during hospitalization in the Netherlands. STUDY DESIGN Analysis of MRAEs identified in a retrospective chart review of patients hospitalized during 2004. METHODS The records of 7889 patients admitted to 21 hospitals in 2004 were reviewed by trained nurses and physicians using a three-stage process. For each hospital, patient records of 200 discharged and 200 deceased patients were randomly selected and reviewed. For each patient record, characteristics of the patient and the admission were collected. After identification of an MRAE the physician reviewers determined the type, severity, preventability, drug category and excess length of stay associated with the MRAE. Data on additional interventions or procedures related to MRAEs were obtained by linking our data to the national hospital registration database. The excess length of stay and the additional medical procedures were multiplied by unit costs to estimate the total excess direct medical costs associated with the MRAE. RESULTS In total, 148 MRAEs occurred in 140 hospital admissions. The incidence of MRAEs was 0.9% (95% CI 0.7, 1.2) and the incidence of preventable MRAEs was 0.2% (95% CI 0.1, 0.4) per hospital admission. The majority of non-preventable MRAEs were adverse drug reactions caused by cancer chemotherapy. Preventable MRAEs were most often found in relation to anticoagulant treatment administered in combination with NSAIDs. Both non-preventable and preventable MRAEs resulted in considerable excess length of hospital stay and costs. On average, MRAEs resulted in an excess length of stay of 6.2 days (95% CI 3.6, 8.8) and average additional costs of &U20AC;2507 (95% CI 1520, 3773). CONCLUSIONS This study was the first to provide detailed information on MRAEs during hospital admissions in the Netherlands, which were associated with both considerable patient harm and additional medical costs. To increase patient safety, interventions need to be developed that reduce the burden of MRAEs. These interventions should target the areas with the highest risk of MRAEs, notably antibacterials, cancer treatment, anticoagulant treatment and drug therapy in elderly patients.
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Affiliation(s)
- Lilian H F Hoonhout
- VU University Medical Centre, EMGO+ Institute, Department of Public and Occupational Health, Amsterdam, the Netherlands.
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Taylor NF, Brusco NK, Watts JJ, Shields N, Peiris C, Sullivan N, Kennedy G, Teo CK, Farley A, Lockwood K, Radia-George C. A study protocol of a randomised controlled trial incorporating a health economic analysis to investigate if additional allied health services for rehabilitation reduce length of stay without compromising patient outcomes. BMC Health Serv Res 2010; 10:308. [PMID: 21073703 PMCID: PMC2998505 DOI: 10.1186/1472-6963-10-308] [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: 08/09/2010] [Accepted: 11/12/2010] [Indexed: 01/19/2023] Open
Abstract
Background Reducing patient length of stay is a high priority for health service providers. Preliminary information suggests additional Saturday rehabilitation services could reduce the time a patient stays in hospital by three days. This large trial will examine if providing additional physiotherapy and occupational therapy services on a Saturday reduces health care costs, and improves the health of hospital inpatients receiving rehabilitation compared to the usual Monday to Friday service. We will also investigate the cost effectiveness and patient outcomes of such a service. Methods/Design A randomised controlled trial will evaluate the effect of providing additional physiotherapy and occupational therapy for rehabilitation. Seven hundred and twelve patients receiving inpatient rehabilitation at two metropolitan sites will be randomly allocated to the intervention group or control group. The control group will receive usual care physiotherapy and occupational therapy from Monday to Friday while the intervention group will receive the same amount of rehabilitation as the control group Monday to Friday plus a full physiotherapy and occupational therapy service on Saturday. The primary outcomes will be patient length of stay, quality of life (EuroQol questionnaire), the Functional Independence Measure (FIM), and health utilization and cost data. Secondary outcomes will assess clinical outcomes relevant to the goals of therapy: the 10 metre walk test, the timed up and go test, the Personal Care Participation Assessment and Resource Tool (PC PART), and the modified motor assessment scale. Blinded assessors will assess outcomes at admission and discharge, and follow up data on quality of life, function and health care costs will be collected at 6 and 12 months after discharge. Between group differences will be analysed with analysis of covariance using baseline measures as the covariate. A health economic analysis will be carried out alongside the randomised controlled trial. Discussion This paper outlines the study protocol for the first fully powered randomised controlled trial incorporating a health economic analysis to establish if additional Saturday allied health services for rehabilitation inpatients reduces length of stay without compromising discharge outcomes. If successful, this trial will have substantial health benefits for the patients and for organizations delivering rehabilitation services. Clinical trial registration number Australian and New Zealand Clinical Trials Registry ACTRN12609000973213
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Affiliation(s)
- Nicholas F Taylor
- Eastern Health, 5 Arnold Street, Box Hill, Victoria, 3128, Australia.
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Hoonhout LHF, de Bruijne MC, Wagner C, Zegers M, Waaijman R, Spreeuwenberg P, Asscheman H, van der Wal G, van Tulder MW. Direct medical costs of adverse events in Dutch hospitals. BMC Health Serv Res 2009; 9:27. [PMID: 19203365 PMCID: PMC2645386 DOI: 10.1186/1472-6963-9-27] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Accepted: 02/09/2009] [Indexed: 12/04/2022] Open
Abstract
Background Up to now, costs attributable to adverse events (AEs) and preventable AEs in the Netherlands were unknown. We assessed the total direct medical costs associated with AEs and preventable AEs in Dutch hospitals to gain insight in opportunities for cost savings. Methods Trained nurses and physicians retrospectively reviewed 7926 patient records in 21 hospitals. Additional patient information of 7889 patients was received from the Dutch registration of hospital information. Direct medical costs attributable to AEs were assessed by measuring excess length of stay and additional medical procedures after an AE occurred. Costs were valued using Dutch standardized cost prices. Results The annual direct medical costs in Dutch hospitals were estimated at a total of euro 355 million for all AEs and euro 161 million for preventable AEs in 2004. The total number of hospital admissions in which a preventable AE occurred was 30,000 (2.3% of all admissions) and more than 300,000 (over 3% of all bed days) bed days were attributable to preventable AEs in 2004. Multilevel analysis showed that variance in direct medical costs was not determined by differences between hospitals or hospital departments. Conclusion The estimates of the total preventable direct medical costs of AEs indicate that they form a substantial part (1%) of the expenses of the national health care budget and are of importance to hospital management. The cost driver of the direct medical costs is the excess length of stay (including readmissions) in a hospital. Insight in which determinants are associated with high preventable costs will offer useful information for policymakers and hospital management to determine starting points for interventions to reduce the costs of preventable AEs.
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Affiliation(s)
- Lilian H F Hoonhout
- Department of Public & Occupational Health, EMGO Institute, VU University Medical Centre (VUmc), Amsterdam, The Netherlands.
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