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Jung D, Song S, Ma C. Where Patients Live Matter in Emergency Department Visits in Home Health Care: Rural/Urban Status and Neighborhood Socioeconomic Status. J Appl Gerontol 2024; 43:933-944. [PMID: 37991851 DOI: 10.1177/07334648231216644] [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] [Indexed: 11/24/2023] Open
Abstract
An increasing body of evidence highlights the importance of an individual's place of residence on their health and functional outcomes. This study is based on Outcome and Assessment Information Set data to assess the differences in emergency department visits among Medicare home health care patients by patients' residence location (rural/urban status and neighborhood socioeconomic status). Compared to urban patients, a disproportionately higher proportion of rural patients lived in more or most disadvantaged neighborhoods (83.9% vs. 41.3%). Using linear probability regression models, patients in rural areas (coefficient = .02, p < .001) and disadvantaged neighborhoods (less disadvantaged: coefficient = .02, p < .001; more disadvantaged: coefficient = .034, p < .001; most disadvantaged: coefficient = .042, p < .001) were more likely to experience emergency department visits. Policymakers should consider utilizing area-based target interventions to mitigate gaps in home health care. Also, given that the majority of rural patients reside in disadvantaged neighborhoods, neighborhood characteristics should be considered in addressing rural-urban disparities and improving home health care.
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Affiliation(s)
- Daniel Jung
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA
| | - Suhang Song
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, GA, USA
| | - Chenjuan Ma
- Rory Meyers College of Nursing, New York University, New York, NY, USA
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Salcedo-Hernandez RA, Barquet-Muñoz S, Isla-Ortiz D, Lucero-Serrano F, Lino-Silva LS, de León DC, Cetina-Perez L. Factors associated with emergency room readmission after elective surgery for ovarian carcinoma. BMC Womens Health 2023; 23:473. [PMID: 37667261 PMCID: PMC10476342 DOI: 10.1186/s12905-023-02579-7] [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: 03/14/2023] [Accepted: 07/28/2023] [Indexed: 09/06/2023] Open
Abstract
BACKGROUND Hospital readmission is a quality metric of hospital care and has been studied in ovarian carcinoma, but its evaluation has several limitations. Also, emergency room (ER) readmission is considered an adverse effect because it represents patient costs. Therefore, our objective was to determine the rate of ER readmission, its causes, and associated factors. METHODS A retrospective study of 592 patients with ovarian carcinoma who underwent upfront surgery, neoadjuvant therapy, or surgery for recurrent disease. An analysis of factors associated with ER readmission, hospital readmission, and surgical complications was performed, including multivariate analysis to assess for case-mix factors. RESULTS Of 592 patients, the median age was 51 years, and the predominant type of treatment was the neoadjuvant approach (52.9%); 46% underwent upfront surgeries and six surgeries for recurrence. The ratio to ER readmission was 11.8% (70 patients), of whom 12 patients were admitted more than once. The factors associated with ER readmission were prolonged surgery, intraoperative bleeding, extended hospital stay, the time of the day when the surgery was performed, and post-surgical complications. The hospital readmissions were 4.2%, and the overall morbidity was 17.6%. In the multivariate analysis, the only factor associated with ER readmission was the presence of surgical complications (OR = 39.01). The factors independently associated with hospital readmission were the entrance to the intensive care unit (OR = 1.37), the presence of surgical complications (OR = 2.85), and ER readmission (OR = 1.45). CONCLUSION ER readmission is an adverse event representing the presence of symptoms/complications in patients. Evaluating the ER readmission independently of the readmission to the hospital is critical because it will allow modifying medical care behaviors to prevent patients from unnecessarily returning to the hospital after a hospital discharge to manage preventable medical problems. TRIAL REGISTRATION researchregistry7882.
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Affiliation(s)
- Rosa A Salcedo-Hernandez
- Programa de Maestría y Doctorado en Ciencias Médicas, Odontológicas y de la Salud. UNAM, Mexico City, Mexico.
- Departamento de Ginecología, Instituto Nacional de Cancerología, Mexico City, Mexico.
| | - Salim Barquet-Muñoz
- Departamento de Ginecología, Instituto Nacional de Cancerología, Mexico City, Mexico
| | - David Isla-Ortiz
- Departamento de Ginecología, Instituto Nacional de Cancerología, Mexico City, Mexico
- Division of Research, Instituto Nacional de Cancerología, San Fernando Avenue 22, 14050, ZP, Mexico City, Mexico
| | | | | | - David Cantú de León
- Dirección de Investigación, Instituto Nacional de Cancerología, Mexico City, Mexico
- Division of Research, Instituto Nacional de Cancerología, San Fernando Avenue 22, 14050, ZP, Mexico City, Mexico
| | - Lucely Cetina-Perez
- Subdirección de Investigación Clínica, Instituto Nacional de Cancerología, Mexico City, Mexico.
- Clinical Research, Instituto Nacional de Cancerología, San Fernando 22, 14050, ZP, Mexico City, Mexico.
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Ryu B, Yoo S, Kim S, Choi J. Thirty-day hospital readmission prediction model based on common data model with weather and air quality data. Sci Rep 2021; 11:23313. [PMID: 34857799 PMCID: PMC8639801 DOI: 10.1038/s41598-021-02395-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 10/29/2021] [Indexed: 12/03/2022] Open
Abstract
Although several studies have attempted to develop a model for predicting 30-day re-hospitalization, few attempts have been made for sufficient verification and multi-center expansion for clinical use. In this study, we developed a model that predicts unplanned hospital readmission within 30 days of discharge; the model is based on a common data model and considers weather and air quality factors, and can be easily extended to multiple hospitals. We developed and compared four tree-based machine learning methods: decision tree, random forest, AdaBoost, and gradient boosting machine (GBM). Above all, GBM showed the highest AUC performance of 75.1 in the clinical model, while the clinical and W-score model showed the best performance of 73.9 for musculoskeletal diseases. Further, PM10, rainfall, and maximum temperature were the weather and air quality variables that most impacted the model. In addition, external validation has confirmed that the model based on weather and air quality factors has transportability to adapt to other hospital systems.
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Affiliation(s)
- Borim Ryu
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, 172, Dolma-ro, Bundang-gu, Seongnam-si, 13605, Gyeonggi-do, Republic of Korea.,Department of Biomedical Engineering, College of Medicine, Seoul National University, 28 Yongon-Dong Chongro-Gu, Seoul, 110-799, Korea
| | - Sooyoung Yoo
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, 172, Dolma-ro, Bundang-gu, Seongnam-si, 13605, Gyeonggi-do, Republic of Korea.
| | - Seok Kim
- Office of eHealth Research and Business, Seoul National University Bundang Hospital, 172, Dolma-ro, Bundang-gu, Seongnam-si, 13605, Gyeonggi-do, Republic of Korea
| | - Jinwook Choi
- Department of Biomedical Engineering, College of Medicine, Seoul National University, 28 Yongon-Dong Chongro-Gu, Seoul, 110-799, Korea. .,Institute of Medical and Biological Engineering, Medical Research Center, Seoul National University, Seoul, South Korea.
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Kiptoo J, Yadesa TM, Muzoora C, Namugambe JS, Tamukong R. Predictors of Medication-Related Emergency Department Admissions Among Patients with Cardiovascular Diseases at Mbarara Regional Referral Hospital, South-Western Uganda. Open Access Emerg Med 2021; 13:279-290. [PMID: 34234583 PMCID: PMC8254663 DOI: 10.2147/oaem.s309508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/11/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Medication-related emergency department admissions impose a huge and unnecessary burden on the healthcare system. We sought to determine the prevalence and predictors of medication-related emergency department admissions, among patients with cardiovascular diseases at Mbarara Regional Referral Hospital, Uganda. METHODS Institutional research ethics approval was secured to conduct a cross-sectional study at the Mbarara Regional Referral Hospital emergency department, between February and September, 2020. All eligible and consenting patients were enrolled in a consecutive manner after a preliminary diagnosis was made by the attending physician. Structured questionnaire interview and comprehensive medication history reviews were used to identify medication therapy problems, in collaboration with a resident physician present on duty. We used sequential categorization for medication therapy problem(s). Descriptive and logistic regression analyses were used to determine prevalence and predictors of medication-related emergency department admissions. RESULTS Out of the 128 patients interviewed, 105 (82%) patient admissions were associated with a medication therapy problem: ineffectiveness of drug therapy (53.3%, 56), medication non-adherence (42.9%, 45), and adverse drug reactions (3.8%, 4). Out of a total of 90 incidences of medication non-adherence, 34.4% (31/90) were due to lack of understanding of patient medication regimen, and 27.8% (25/90) due to unaffordable cost of medicines. Female gender (AOR = 4.31 [1.43, 13.03 at 95% CI]; P-value = 0.010]) and a history of tobacco use (AOR = 9.58 [1.14, 80.28 at 95% CI]; P-value = 0.037) were statistically significant predictors of medication-related emergency department admissions in adjusted analysis. CONCLUSION Four in five emergency department admissions were associated with medication-related causes, majorly due to ineffectiveness of drug therapy. Knowledge gap on patient medication regimens was the most prevalent cause for medication non-adherence. Female gender and previous or current tobacco use was an independent risk factor for medication-related admissions.
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Affiliation(s)
- Joshua Kiptoo
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Tadele Mekuriya Yadesa
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
- World Bank, ACE II, Pharmacy Biotechnology and Traditional Medicine Center, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Conrad Muzoora
- Department of Internal Medicine, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Juliet Sanyu Namugambe
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
- World Bank, ACE II, Pharmacy Biotechnology and Traditional Medicine Center, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Robert Tamukong
- Department of Pharmacy, Mbarara University of Science and Technology, Mbarara, Uganda
- World Bank, ACE II, Pharmacy Biotechnology and Traditional Medicine Center, Mbarara University of Science and Technology, Mbarara, Uganda
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Giunta DH, Marquez Fosser S, Boietti BR, Ación L, Pollan JA, Martínez B, Luna D, Bonella MB, Grande Ratti MF. Emergency department visits and hospital readmissions in an Argentine health system. Int J Med Inform 2020; 141:104236. [PMID: 32721852 PMCID: PMC7373686 DOI: 10.1016/j.ijmedinf.2020.104236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 06/21/2020] [Accepted: 07/19/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND AND GOAL OF STUDY The scope of health in the Sustainable Development Goals is much broader than the Millennium Development Goals, spanning functions such as health-system access and quality of care. Hospital readmission rate and ED-visits within 30 days from discharge are considered low-cost quality indicators. This work assesses an indicator of quality of care in a tertiary referral hospital in Argentina, using data available from clinical records. PURPOSE To estimate the rate of ED-visits and the hospital readmission rate (HRR) after a first hospitalization (First-H), and to identify associated factors. METHODS This retrospective cohort included patients who had a First-H in Hospital Italiano de Buenos Aires between 2014-2015. Follow-up occurred from discharge until ED-visit, readmission, death, disaffiliation from health insurance, or 13 months. We present HRR at 30 days and ED-visits rate at 72 h, using the Cox proportional-hazards regression model to explore associated factors, and reporting adjusted hazard ratios (HR) with their respective 95 %CI. RESULTS The study comprised 10,598 hospitalizations (median age was 68 years). Of these, 5966 had at least one consultation to the ED during follow up, resulting in a 24 h rate of consultations to ED of 1.51 % (95 %CI 1.29-1.72); at 48 h 3.18 % (95 %CI 2.86-3.54); at 72 h 4.71 % (95 %CI 4.32-5.13). In multivariable models, factors associated for 72 h ED-visits were: age (aHR 1.06), male (aHR 1.14), Charlson Comorbidity Index (aHR 1.16), unscheduled hospitalization (aHR 1.39), prior consultation with the ED (aHR 1.08) and long hospital stay (aHR 1.39). Meanwhile, 2345 patients had at least one hospital readmission (98 % unscheduled), resulting a 24 h rate of 0.5 % (95 %CI 0.42-0.71), at 48 h 0.98 % (95 %CI 0.80-1.18), at 72 h 1.4 % (95 %CI 1.2-1.6); at 30 days 7.7 % (95 %CI 7.2-8.2); at 90 days 13 % (95 %CI 12.4-13.8); and one-year 22.5 % (95 %CI 21.7-23.4). Associated factors for HRR at 30 days were: age (HR 1.16), male (HR 1.09), Charlson comorbidities score (HR 1.27), social service requirement during First-H (HR 1.37), unscheduled First-H (HR 1.16), previous ED-visits (HR 1.03) and length of stay (HR 1.08). CONCLUSION Priorities efforts to improve must include greater attention to patients' readiness prior discharge, to explore causes of preventable readmissions, and better support for patient self-management.
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Affiliation(s)
- Diego Hernán Giunta
- Internal Medicine Research Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | | | - Bruno Rafael Boietti
- Internal Medicine Research Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Laura Ación
- Instituto de Cálculo, Facultad de Ciencias Exactas y Naturales, Universidad de Buenos Aires, Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina
| | - Javier Alberto Pollan
- Department of Internal Medicine, Hospital Italiano de Buenos Aires, Ciudad de Buenos Aires, Argentina
| | - Bernardo Martínez
- Department of Internal Medicine, Hospital Italiano de Buenos Aires, Ciudad de Buenos Aires, Argentina; Emergency Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Daniel Luna
- Department of Health Informatics, Hospital Italiano de Buenos Aires, Ciudad de Buenos Aires, Argentina
| | - Maria Belen Bonella
- Department of Internal Medicine, Hospital Italiano de Buenos Aires, Ciudad de Buenos Aires, Argentina
| | - María Florencia Grande Ratti
- Internal Medicine Research Unit, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Emergency Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina; Department of Health Informatics, Hospital Italiano de Buenos Aires, Ciudad de Buenos Aires, Argentina.
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Kaya S, Sain Guven G, Teleş M, Aydan S, Kar A, Bahcecioglu AB, Firat Senturk E. Emergency department visits following discharge: Implications for healthcare management. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2020. [DOI: 10.1080/20479700.2020.1762050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Sıdıka Kaya
- Department of Health Care Management, Faculty of Economics and Administrative Sciences, Hacettepe University, Ankara, Turkey
| | - Gulay Sain Guven
- Department of Internal Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mesut Teleş
- Department of Health Management, Niğde Zübeyde Hanım School of Health, Niğde Ömer Halisdemir University, Niğde, Turkey
| | - Seda Aydan
- Department of Health Care Management, Faculty of Economics and Administrative Sciences, Hacettepe University, Ankara, Turkey
| | - Ahmet Kar
- Department of Health Care Management, Faculty of Health Sciences, Kırıkkale University, Kırıkkale, Turkey
| | - A. Begum Bahcecioglu
- Department of Endocrinology and Metabolism, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - Esra Firat Senturk
- Taşköprü State Hospital, Kastamonu, Turkey
- Present address: Cincinnati Children Hospital, Cincinnati, Ohio, USA
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LaHue SC, Douglas VC, Kuo T, Conell CA, Liu VX, Josephson SA, Angel C, Brooks KB. Association between Inpatient Delirium and Hospital Readmission in Patients ≥ 65 Years of Age: A Retrospective Cohort Study. J Hosp Med 2019; 14:201-206. [PMID: 30933669 PMCID: PMC6628723 DOI: 10.12788/jhm.3130] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Accepted: 11/20/2018] [Indexed: 01/04/2023]
Abstract
BACKGROUND Delirium affects more than seven million hospitalized adults in the United States annually. However, its impact on postdischarge healthcare utilization remains unclear. OBJECTIVE To determine the association between delirium and 30-day hospital readmission. DESIGN A retrospective cohort study. SETTING A general community medical and surgical hospital. PATIENTS All adults who were at least 65 years old, without a history of delirium or alcohol-related delirium, and were hospitalized from September 2010 to March 2015. MEASUREMENTS The patients deemed at risk for or displaying symptoms of delirium were screened by nurses using the Confusion Assessment Method with a followup by a staff psychiatrist for a subset of screen-positive patients. Patients with delirium confirmed by a staff psychiatrist were compared with those without delirium. The primary outcome was the 30-day readmission rate. The secondary outcomes included emergency department (ED) visits 30 days postdischarge, mortality during hospitalization and 30 days postdischarge, and discharge location. RESULTS The cohort included 718 delirious patients and 7,927 nondelirious patients. Using an unweighted multivariable logistic regression, delirium was determined to be significantly associated with the increased odds of readmission within 30 days of discharge (odds ratio (OR): 2.60; 95% CI, 1.96-3.44; P < .0001). Delirium was also significantly (P < .0001) associated with ED visits within 30 days postdischarge (OR: 2.18; 95% CI: 1.77-2.69) and discharge to a facility (OR: 2.52; 95% CI: 2.09-3.01). CONCLUSIONS Delirium is a significant predictor of hospital readmission, ED visits, and discharge to a location other than home. Delirious patients should be targeted to reduce postdischarge healthcare utilization.
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Affiliation(s)
- Sara C LaHue
- Department of Neurology, School of Medicine, University of California, San Francisco, California
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, California
- Corresponding Author: Sara Catherine LaHue, MD; E-mail: ; Telephone: 415-476-1489
| | - Vanja C. Douglas
- Department of Neurology, School of Medicine, University of California, San Francisco, California
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, California
| | - Teresa Kuo
- Department of Medicine, Kaiser Permanente San Francisco Medical Center, San Francisco, California
| | - Carol A Conell
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - Vincent X Liu
- Division of Research, Kaiser Permanente Northern California, Oakland, California
| | - S Andrew Josephson
- Department of Neurology, School of Medicine, University of California, San Francisco, California
- Weill Institute for Neurosciences, Department of Neurology, University of California, San Francisco, California
| | - Clay Angel
- Department of Hospital Medicine, Kaiser Permanente San Rafael Medical Center, San Rafael, California
| | - Kristen B Brooks
- Department of Psychiatry, Kaiser Permanente San Rafael Medical Center, San Rafael, California
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Sheen JJ, Smith HA, Tu B, Liu Y, Sutton D, Bernstein PS. Risk Factors for Postpartum Emergency Department Visits in an Urban Population. Matern Child Health J 2019; 23:557-566. [DOI: 10.1007/s10995-018-2673-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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DuMontier C, Kim D. Continuing the Effort to Predict Risk of Future Unplanned Healthcare Use in Older Adults. J Am Geriatr Soc 2018; 66:2032-2034. [DOI: 10.1111/jgs.15514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 05/31/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Clark DuMontier
- Division of Gerontology, Beth Israel Deaconess Medical Center Harvard Medical School Boston MA
| | - Dae Kim
- Division of Gerontology, Beth Israel Deaconess Medical Center Harvard Medical School Boston MA
- Pharmacoepidemiology/Medicine Brigham and Women's Hospital Boston MA
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Chou HC, Huang HL, Chen CY, Wang CL, Shu CC, Hsu NC, Lin YF, Chen JS, Sheng WH. Receipt of Vasopressors Is Positively Associated With the Length of the Actively Dying Process in Hospitalization. Am J Hosp Palliat Care 2018; 35:1043-1049. [PMID: 29378423 DOI: 10.1177/1049909117754040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND End-of-life care is important in general hospitalization care. However, the clinical impact of using vasopressors on the length of the actively dying process is still controversial. METHODS We reviewed patients who were hospitalized in general wards and died before discharge. We classified the patients into 2 groups: those who received vasopressors (RVs) and those who did not receive vasopressors (NRV). We analyzed the factors associated with the length of hospital stay (LOS) and the length of the actively dying process. RESULTS In all, 745 participants, 10.01% of all admitted patients, were analyzed. Of them, 225 patients were RV group, and the remaining 520 were NRV group. Age and gender were comparable in the 2 groups. The use of vasopressors was associated with an admission diagnosis of sepsis and absence of Do-Not-Resuscitate consent and parenteral use of morphine. In multivariable analysis, a high Barthel index score, the absence of cancer and cardiopulmonary resuscitation (CPR), and no receipt of vasopressors were independent factors for LOS. For the length of the actively dying process, a longer duration of inotropic agent, the receipt of vasopressors, and the absence of CPR were independent factors. CONCLUSION In-hospital mortality is not uncommon during hospitalization in a general ward. The length of the actively dying process is extended by the use of vasopressors. Further prospective study is required for cautious evaluation of the pros and cons of using vasopressors at the end of life during hospitalization.
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Affiliation(s)
- Hsiao-Chen Chou
- 1 Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Hsien-Liang Huang
- 2 Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chiang-Yi Chen
- 1 Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Chuan-Lan Wang
- 1 Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
| | - Chin-Chung Shu
- 3 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Nin-Chieh Hsu
- 3 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Feng Lin
- 3 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jin-Shing Chen
- 4 Department of Surgery, National Taiwan University Hospital, Taipei, Taiwan
| | - Wang-Huei Sheng
- 3 Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
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