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Chica-Pérez A, Dobarrio-Sanz I, Correa-Casado M, Fernández-Sola C, Ruiz-Fernández MD, Hernández-Padilla JM. Spanish version of the self-care self-efficacy scale: A validation study in community-dwelling older adults with chronic multimorbidity. Geriatr Nurs 2023; 53:181-190. [PMID: 37540914 DOI: 10.1016/j.gerinurse.2023.07.016] [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: 06/10/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVE To test the psychometric properties of the Spanish version of the Self-Care Self-Efficacy Scale (SCSES-Sp) in community-dwelling older adults with chronic multimorbidity. METHODS A sample of 1013 community-dwelling older adults with chronic multimorbidity participated in an observational cross-sectional study that was carried out in 3 phases. RESULTS Confirmatory factor analysis showed that the SCSES-Sp has 4 dimensions: "self-efficacy in self-care behaviours based on clinical knowledge", "self-efficacy in self-care maintenance", "self-efficacy in self-care monitoring", and "self-efficacy in self-care management". A panel of independent experts considered the content of the SCSES-Sp valid. Convergent validity analysis showed moderate-strong correlations between all of the SCSES-Sp's dimensions and the reference criteria chosen. Reliability was good for the SCSES-Sp and all its dimensions. Test-retest reliability analysis showed that the SCSES-Sp was temporally stable. CONCLUSIONS The SCSES-Sp is a valid and reliable tool to assess self-efficacy in self-care in Spanish-speaking, community-dwelling older adults with chronic multimorbidity.
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Affiliation(s)
| | - Iria Dobarrio-Sanz
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria 04120, Spain.
| | - Matías Correa-Casado
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria 04120, Spain; Andalusian Health Service District Almeria, Almeria, Spain
| | - Cayetano Fernández-Sola
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria 04120, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago 7500000, Chile
| | - María Dolores Ruiz-Fernández
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria 04120, Spain
| | - José Manuel Hernández-Padilla
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria 04120, Spain
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Ferrari A, Giannini A, Seghieri C, Simoncini T, Vainieri M. Regional practice variation in pelvic organ prolapse surgery in Tuscany, Italy: a retrospective cohort study on administrative health data. BMJ Open 2023; 13:e068145. [PMID: 36882257 PMCID: PMC10008403 DOI: 10.1136/bmjopen-2022-068145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
OBJECTIVES To explore determinants of practice variation in both access, and quality and efficiency of surgical care for pelvic organ prolapse (POP). DESIGN AND SETTING A retrospective cohort study employing administrative health data from the Tuscany region, Italy. PARTICIPANTS All women over 40 years hospitalised for apical/multicompartmental POP reconstructive surgery (excluding anterior/posterior colporrhaphy without concomitant hysterectomy) from January 2017 to December 2019. OUTCOMES We first computed treatment rates just for women residing in Tuscany (n=2819) and calculated the Systematic Component of Variation (SCV) to explore variation in access to care among health districts. Then, using the full cohort (n=2959), we ran multilevel models for the average length of stay and reoperations, readmissions and complications, and computed the intraclass correlation coefficient to assess the individual and hospital determinants of efficiency and quality of care provided by hospitals. RESULTS The 5.4-fold variation between the lowest-rate (56/100 000 inhabitants) and the highest-rate (302/100 000) districts and the SCV over 10% confirmed high systematic variation in the access to care. Higher treatment rates were driven by greater provisions of robotic and/or laparoscopic interventions, which showed highly variable usage rates. Both individual and hospital factors influenced quality and efficiency provided by hospitals, but just low proportions of variation were explained by hospital and patient characteristics. CONCLUSIONS We found high and systematic variation in the access to POP surgical care in Tuscany and in quality and efficiency provided by hospitals. Such a variation may be mainly explained by user and provider preferences, which should be further explored. Also, supply-side factors may be involved, suggesting that wider and more uniform dissemination of robotic/laparoscopic procedures may reduce variation.
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Affiliation(s)
- Amerigo Ferrari
- Institute of Management, MeS (Management and Health) Laboratory, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Andrea Giannini
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynaecology, University of Pisa, Pisa, Italy
| | - Chiara Seghieri
- Institute of Management, MeS (Management and Health) Laboratory, Sant'Anna School of Advanced Studies, Pisa, Italy
| | - Tommaso Simoncini
- Department of Clinical and Experimental Medicine, Division of Obstetrics and Gynaecology, University of Pisa, Pisa, Italy
| | - Milena Vainieri
- Institute of Management, MeS (Management and Health) Laboratory, Sant'Anna School of Advanced Studies, Pisa, Italy
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3
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Lenardt MH, Lourenço TM, Betiolli SE, Binotto MA, Sétlik CM, Barbiero MMA. Handgrip strength in older adults and driving aptitude. Rev Bras Enferm 2022; 76:e20210729. [PMID: 36449971 PMCID: PMC9730861 DOI: 10.1590/0034-7167-2021-0729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Accepted: 08/23/2022] [Indexed: 06/17/2023] Open
Abstract
OBJECTIVE to analyze handgrip strength as a predictor of the inability to drive in older adults. METHOD a cross-sectional study conducted in traffic clinics with 421 older adults in Curitiba-Paraná from January 2015 to December 2018. A sociodemographic and clinical questionnaire, handgrip strength test, and queries from the National Registry of Qualified Drivers form were applied. RESULTS Reduced handgrip strength was not a predictor of inaptitude for vehicular driving (p=0.649). The predictors of inaptitude were: low education (p=0.011), incomplete elementary education (p=0.027), and cognition (p=0.020). CONCLUSION reduced handgrip strength was not shown to predict for loss of driving skills in older adults. Low education level and reduced cognition level are conditions that were shown to be predictors for loss of vehicular driving license.
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David F, Philipp J, Henrike AB, Nikolaos PP, Christine PH, Martin C, Oliver PR, Benjamin S. Impact of the Educational Level on Non-Fatal Health Outcomes following Myocardial Infarction. Curr Probl Cardiol 2022; 47:101340. [DOI: 10.1016/j.cpcardiol.2022.101340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 07/29/2022] [Indexed: 11/03/2022]
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Amrollahi F, Shashikumar SP, Meier A, Ohno-Machado L, Nemati S, Wardi G. Inclusion of social determinants of health improves sepsis readmission prediction models. J Am Med Inform Assoc 2022; 29:1263-1270. [PMID: 35511233 PMCID: PMC9196687 DOI: 10.1093/jamia/ocac060] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/22/2022] [Accepted: 04/12/2022] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Sepsis has a high rate of 30-day unplanned readmissions. Predictive modeling has been suggested as a tool to identify high-risk patients. However, existing sepsis readmission models have low predictive value and most predictive factors in such models are not actionable. MATERIALS AND METHODS Data from patients enrolled in the AllofUs Research Program cohort from 35 hospitals were used to develop a multicenter validated sepsis-related unplanned readmission model that incorporates clinical and social determinants of health (SDH) to predict 30-day unplanned readmissions. Sepsis cases were identified using concepts represented in the Observational Medical Outcomes Partnership. The dataset included over 60 clinical/laboratory features and over 100 SDH features. RESULTS Incorporation of SDH factors into our model of clinical and demographic features improves model area under the receiver operating characteristic curve (AUC) significantly (from 0.75 to 0.80; P < .001). Model-agnostic interpretability techniques revealed demographics, economic stability, and delay in getting medical care as important SDH predictive features of unplanned hospital readmissions. DISCUSSION This work represents one of the largest studies of sepsis readmissions using objective clinical data to date (8935 septic index encounters). SDH are important to determine which sepsis patients are more likely to have an unplanned 30-day readmission. The AllofUS dataset provides granular data from a diverse set of individuals, making this model potentially more generalizable than prior models. CONCLUSION Use of SDH improves predictive performance of a model to identify which sepsis patients are at high risk of an unplanned 30-day readmission.
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Affiliation(s)
- Fatemeh Amrollahi
- Division of Biomedical Informatics, University of California San Diego, San Diego, California, USA
| | - Supreeth P Shashikumar
- Division of Biomedical Informatics, University of California San Diego, San Diego, California, USA
| | - Angela Meier
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, San Diego, California, USA
| | - Lucila Ohno-Machado
- Division of Biomedical Informatics, University of California San Diego, San Diego, California, USA
| | - Shamim Nemati
- Division of Biomedical Informatics, University of California San Diego, San Diego, California, USA
| | - Gabriel Wardi
- Division of Pulmonary, Critical Care and Sleep Medicine, University of California San Diego, San Diego, California, USA.,Department of Emergency Medicine, University of California San Diego, San Diego, California, USA
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Socioeconomic inequity in incidence, outcomes and care for acute coronary syndrome: A systematic review. Int J Cardiol 2022; 356:19-29. [DOI: 10.1016/j.ijcard.2022.03.053] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 02/17/2022] [Accepted: 03/24/2022] [Indexed: 12/17/2022]
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7
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He Q, Zhang P, Li Y, Cai C, Wang C. The application of Gensini score and IL-1ra in assessing the condition and prognosis of patients with coronary artery disease. Am J Transl Res 2021; 13:10421-10427. [PMID: 34650711 PMCID: PMC8506997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 05/07/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE This study aimed to investigate the value of Gensini score and interleukin-1 receptor antagonist (IL-1ra) in assessing the condition and prognosis of patients with coronary heart disease (CHD). METHODS According to their condition, 175 patients were divided into stable angina group (SA, 60 cases), unstable angina group (UA, 60 cases) and acute myocardial infarction group (AMI, 55 cases). The Gensini score, GRACE score, IL-1ra and troponin (Tn) were compared in the three groups. The correlation between Gensini score and GRACE score, IL-1ra and Tn, were explored. The patients were divided into death group (21 cases), adverse cardiovascular events group (MACE, 50 cases) and good prognosis group (104 cases) according to clinical outcomes. The ROC curve with regard to Gensini score, IL-1ra and the clinical outcome was plotted. RESULTS With the exacerbation of the disease, the Gensini score, GRACE score, IL-1ra and Tn were significantly higher in patients with CHD (P<0.05). Correlation analysis showed a positive association between Gensini score and GRACE score (r=0.9751, P<0.05). IL-1ra showed a positive association with Tn level (r=0.9731, P<0.05); Gensini score and IL-1ra had an area under the curve (AUC) of 0.9350 and 0.9499 for adverse CHD outcome, respectively (P<0.001). CONCLUSION Gensini score and IL-1ra reflect better the severity of CHD in patients with CHD, and also the AUC of 0.9350 and 0.9499 (P<0.001). It can be used in the prognostic evaluation of patients with CHD.
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Affiliation(s)
- Qian He
- Department of Cardiovascular Medicine, Taihe Hospital (Affiliated Hospital of Hubei University of Medicine) Shiyan 442000, Hubei Province, China
| | - Pu Zhang
- Department of Cardiovascular Medicine, Taihe Hospital (Affiliated Hospital of Hubei University of Medicine) Shiyan 442000, Hubei Province, China
| | - Yu Li
- Department of Cardiovascular Medicine, Taihe Hospital (Affiliated Hospital of Hubei University of Medicine) Shiyan 442000, Hubei Province, China
| | - Chao Cai
- Department of Cardiovascular Medicine, Taihe Hospital (Affiliated Hospital of Hubei University of Medicine) Shiyan 442000, Hubei Province, China
| | - Chongquan Wang
- Department of Cardiovascular Medicine, Taihe Hospital (Affiliated Hospital of Hubei University of Medicine) Shiyan 442000, Hubei Province, China
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Hudson T. The Role of Social Determinates of Health in Discharge Practices. Nurs Clin North Am 2021; 56:369-378. [PMID: 34366157 DOI: 10.1016/j.cnur.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Major risks associated with inadequate discharge preparation and execution include medication errors, adverse drug events, and hospital readmissions. Nurses must develop pertinent skills to assess how the social environment impacts patients' likelihood of a safe and healthy transition back into the community as they prepare patients for discharge. Recognition and consideration of social determinants of health are critical to minimizing health disparities, enhancing health equity and supporting positive patient outcomes. Examples of strategies for enhanced discharge practices include implicit bias assessment and training, screening for food insecurity, and assessment for quality referral sources.
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Affiliation(s)
- Tamika Hudson
- Vanderbilt University, 461 21st Avenue South, Nashville, TN 37240, USA.
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Zhang N, Shi F, Liang H, Wang H. The feasibility of using Hcy, CRP, and Cys-C to analyze AMI patients' disease conditions and prognoses. Am J Transl Res 2021; 13:2724-2730. [PMID: 34017434 PMCID: PMC8129397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 02/01/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE This study was conducted to investigate the feasibility of using the serum homocysteine (Hcy), C-reactive protein (CRP), and cystatin C (Cys-C) levels to evaluate the conditions and prognoses of acute myocardial infarction (AMI) patients. METHODS One hundred and twenty patients with AMI were enrolled as an observation group (the AMI group). Eighty patients with stable angina pectoris were included in a control group (the SA group). Eighty healthy volunteers were enrolled as a healthy control group (the NCHD group). The AMI patients were divided into groups of >20 (n = 32), 10-20 (n = 45) and <10 (n = 43) according to their APACHE-II scores. The groups were divided into a death group (n = 23) and a survival group (n = 97) according to the patients' 1-year follow-up outcomes. The differences in the serum Hcy, CRP, and Cys-C levels among the different groups, and the correlations between the serum levels were calculated. RESULTS The serum Hcy, CRP, and Cys-C levels in the AMI group were significantly higher than they were in the SA and NCHD groups (P<0.05), and the serum levels in the APACHE-II score >20 group were significantly higher than the serum levels in the 10-20 group. The dead group exhibited higher serum Hcy, CRP, and Cys-C levels than the survival group (P<0.05), and our Spearman's correlation analysis showed that the serum Hcy, CRP and Cys-C levels were positively correlated with the APACHE II scores (r = 0.9157, r = 0.8519, r = 0.8598, P<0.001). The area under curve of Hcy, CRP, and Cys-C for the AMI diagnoses were 0.9638 (95% CI: 0.9183-1.000), 0.8125 (95% CI: 0.6652-0.9598), and 0.7515 (95% CI: 0.5847-0.9184), respectively. CONCLUSION Serum Hcy, CRP, and Cys-C levels can reflect the severity of the patients' conditions.
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Affiliation(s)
- Na Zhang
- Department of Cardiology, Affiliated Hospital of Chengde Medical University Chengde City, Hebei Province, China
| | - Fei Shi
- Department of Cardiology, Affiliated Hospital of Chengde Medical University Chengde City, Hebei Province, China
| | - Hao Liang
- Department of Cardiology, Affiliated Hospital of Chengde Medical University Chengde City, Hebei Province, China
| | - Hong Wang
- Department of Cardiology, Affiliated Hospital of Chengde Medical University Chengde City, Hebei Province, China
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10
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Tuna S, Pakyüz SÇ. The effectiveness of planned discharge education on health knowledge and beliefs in patients with acute myocardial infarction: a randomized controlled trial. Ir J Med Sci 2021; 191:691-698. [PMID: 33728530 DOI: 10.1007/s11845-021-02601-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 03/11/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND To the best of our knowledge, no other studies investigated acute myocardial infarction patients' beliefs and knowledge level after the discharge education. AIMS The aim of the study was to investigate the effectiveness of planned discharge education on the beliefs and knowledge levels of CVD risk factors, medication compliance, dietary compliance, and individual follow-up in patients with acute myocardial infarction (AMI). METHODS A double-blind randomized controlled study was carried out with 100 AMI patients. All participants were randomly assigned to the intervention (n = 50) and control groups (n = 50). The first evaluation of all participants in both groups was on the day of discharge. Both groups were re-evaluated after 4 weeks. Patients' beliefs on medication, diet, and individual monitoring were assessed by the Beliefs about Medication Compliance Scale (BMCS), the Beliefs about Dietary Compliance Scale (BDCS), and the Beliefs about Individual Follow-up Scale (BIFS), respectively. The knowledge of CVD risk factors was questioned with the Cardiovascular Disease Risk Factors Knowledge Level (CARRF-KL) Scale. RESULTS The mean age of the patients was 59.10 ± 9.38 years in the intervention group and 58.86 ± 9.19 in the control group. After the planned discharge education, beliefs and knowledge levels of CVD risk factors, medication compliance, dietary compliance, and individual follow-up were significantly increased compared with the control group. CONCLUSION Planned discharge education had a positive effect on the knowledge level of cardiovascular diseases risk factors, drug compliance, nutritional compliance, and individual follow-up in patients with acute myocardial infarction.
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Affiliation(s)
- Serap Tuna
- Department of Elderly Care, Muğla Sıtkı Koçman University, Mugla, Turkey.
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Rasmussen M, Hovhannisyan K, Adami J, Tønnesen H. Characteristics of Patients in Treatment for Alcohol and Drug Addiction Who Succeed in Changing Smoking, Weight, and Physical Activity: A Secondary Analysis of an RCT on Combined Lifestyle Interventions. Eur Addict Res 2021; 27:123-130. [PMID: 33080594 PMCID: PMC8006577 DOI: 10.1159/000510608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Accepted: 07/07/2020] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Patients addicted to alcohol or drug often have additional unhealthy lifestyles, adding to the high mortality and morbidity in this patient group. Therefore, it is important to consider lifestyle interventions as part of the usual addiction treatment. OBJECTIVE The aim was to identify predictors of successful changes in lifestyle risk factors among patients in treatment for alcohol or drug addiction. METHODS We conducted a secondary analysis of a trial using a 6-week intensive integrated lifestyle intervention: The very integrated program (VIP). Patients were recruited in Addiction Centres Malmö and Psychiatry Skåne, Sweden. The primary outcome was successful changes in lifestyle, measured as quitting tobacco, exercising 30 min per day, and not being over- or underweight after 6 weeks and 12 months. RESULTS A total of 212 patients were included in the RCT, and 128 were included in this secondary analysis: 108 at 6 weeks and 89 at 12 months of follow-up. A total of 69 patients were respondents at both follow-ups. The follow-up rates were 51 and 42%, respectively. More education, having at least 2 lifestyle risk factors and having a high quality of life were predictors of a successful change in lifestyle after 6 weeks. After 12 months, the predictors for a successful outcome were having 3 or more risk factors, while an education level up to 3 years was a negative predictor. CONCLUSIONS Having several unhealthy lifestyles in addition to alcohol and drug addiction was a significant predictor of successful lifestyle changes in the short- and long term after the VIP for lifestyle interventions. Likewise, education was significant. The results should be considered in future development and research among this vulnerable group of patients.
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Affiliation(s)
- Mette Rasmussen
- Department of Health Sciences, Clinical Health Promotion Centre, WHO-CC, Lund University, Lund, Sweden,Clinical Health Promotion Centre, WHO-CC, The Parker Institute, University of Copenhagen, Copenhagen, Denmark,*Mette Rasmussen, Department of Health Sciences, Clinical Health Promotion Unit, WHO-CC, Lund University, Södra Förstadsgatan 35, SE–20502 Malmö (Sweden),
| | - Karen Hovhannisyan
- Clinical Health Promotion Centre, WHO-CC, The Parker Institute, University of Copenhagen, Copenhagen, Denmark
| | | | - Hanne Tønnesen
- Department of Health Sciences, Clinical Health Promotion Centre, WHO-CC, Lund University, Lund, Sweden,Clinical Health Promotion Centre, WHO-CC, The Parker Institute, University of Copenhagen, Copenhagen, Denmark
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Goto T, Yoshida K, Faridi MK, Camargo CA, Hasegawa K. Contribution of social factors to readmissions within 30 days after hospitalization for COPD exacerbation. BMC Pulm Med 2020; 20:107. [PMID: 32349715 PMCID: PMC7191726 DOI: 10.1186/s12890-020-1136-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 04/06/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND To investigate whether, in patients hospitalized for COPD, the addition of social factors improves the predictive ability for the risk of overall 30-day readmissions, early readmissions (within 7 days after discharge), and late readmissions (8-30 days after discharge). METHODS Patients (aged ≥40 years) hospitalized for COPD were identified in the Medicare Current Beneficiary Survey from 2006 through 2012. With the use of 1000 bootstrap resampling from the original cohort (training-set), two prediction models were derived: 1) the reference model including age, comorbidities, and mechanical ventilation use, and 2) the optimized model including social factors (e.g., educational level, marital status) in addition to the covariates in the reference model. Prediction performance was examined separately for 30-day, early, and late readmissions. RESULTS Following 905 index hospitalizations for COPD, 18.5% were readmitted within 30 days. In the test-set, for overall 30-day readmissions, the discrimination ability between reference and optimized models did not change materially (C-statistic, 0.57 vs. 0.58). By contrast, for early readmissions, the optimized model had significantly improved discrimination (C-statistic, 0.57 vs. 0.63; integrated discrimination improvement [IDI], 0.018 [95%CI, 0.003-0.032]) and reclassification (continuous net reclassification index [NRI], 0.298 [95%CI 0.060-0.537]). Likewise, for late readmissions, the optimized model also had significantly improved discrimination (C-statistic, 0.65 vs. 0.68; IDI, 0.026 [95%CI 0.009-0.042]) and reclassification (continuous NRI, 0.243 [95%CI 0.028-0.459]). CONCLUSIONS In a nationally-representative sample of Medicare beneficiaries hospitalized for COPD, we found that the addition of social factors improved the predictive ability for readmissions when early and late readmissions were examined separately.
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Affiliation(s)
- Tadahiro Goto
- Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua Street, Suite 920, Boston, MA, 02114-1101, USA.
| | - Kazuki Yoshida
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Mohammad Kamal Faridi
- Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua Street, Suite 920, Boston, MA, 02114-1101, USA
| | - Carlos A Camargo
- Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua Street, Suite 920, Boston, MA, 02114-1101, USA.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Kohei Hasegawa
- Department of Emergency Medicine, Massachusetts General Hospital, 125 Nashua Street, Suite 920, Boston, MA, 02114-1101, USA.,Harvard Medical School, Boston, MA, USA
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Lehn SF, Zwisler AD, Pedersen SGH, Gjørup T, Thygesen LC. Development of a prediction model for 30-day acute readmissions among older medical patients: the influence of social factors along with other patient-specific and organisational factors. BMJ Open Qual 2019; 8:e000544. [PMID: 31259284 PMCID: PMC6567955 DOI: 10.1136/bmjoq-2018-000544] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 01/21/2019] [Accepted: 05/16/2019] [Indexed: 12/23/2022] Open
Abstract
Background Readmission rate is one way to measure quality of care for older patients. Knowledge is sparse on how different social factors can contribute to predict readmission. We aimed to develop and internally validate a comprehensive model for prediction of acute 30-day readmission among older medical patients using various social factors along with demographic, organisational and health-related factors. Methods We performed an observational prospective study based on a group of 770 medical patients aged 65 years or older, who were consecutively screened for readmission risk factors at an acute care university hospital during the period from February to September 2012. Data on outcome and candidate predictors were obtained from clinical screening and administrative registers. We used multiple logistic regression analyses with backward selection of predictors. Measures of model performance and performed internal validation were calculated. Results Twenty percent of patients were readmitted within 30 days from index discharge. The final model showed that low educational level, along with male gender, contact with emergency doctor, specific diagnosis, higher Charlson Comorbidity Index score, longer hospital stay, cognitive problems, and medical treatment for thyroid disease, acid-related disorders, and glaucoma, predicted acute 30-day readmission. Area under the receiver operating characteristic curve (0.70) indicated acceptable discriminative ability of the model. Calibration slope was 0.98 and calibration intercept was 0.01. In internal validation analysis, both discrimination and calibration measures were stable. Conclusions We developed a model for prediction of readmission among older medical patients. The model showed that social factors in the form of educational level along with demographic, organisational and health-related factors contributed to prediction of acute 30-day readmissions among older medical patients.
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Affiliation(s)
- Sara Fokdal Lehn
- Department of Medicine, Holbæk University Hospital, Holbæk, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Ann-Dorthe Zwisler
- Knowledge Center for Rehabilitation and Palliative Care, University of Southern Denmark, Nyborg, Denmark
| | | | - Thomas Gjørup
- Emergency Clinic, Gentofte Hospital, Hellerup, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Kjærulff TM, Bihrmann K, Zhao J, Exeter D, Gislason G, Larsen ML, Ersbøll AK. Acute myocardial infarction: Does survival depend on geographical location and social background? Eur J Prev Cardiol 2019; 26:1828-1839. [PMID: 31126196 DOI: 10.1177/2047487319852680] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS This study described the interplay between geographical and social inequalities in survival after incident acute myocardial infarction (AMI) and examined whether geographical variation in survival exists when accounting for sociodemographic characteristics of the patients and their neighbourhood. METHODS Ringmap visualization and generalized linear models were performed to study post-AMI mortality. Three individual-level analyses were conducted: immediate case fatality, mortality between days 1 and 28 after admission and 365-day survival among patients who survived 28 days after admission. RESULTS In total, 99,013 incident AMI cases were registered between 2005 and 2014 in Denmark. Survival after AMI tended to correlate with sociodemographic indicators at the municipality level. In individual-level models, geographical inequality in immediate case fatality was observed with high mortality in northern parts of Jutland after accounting for sociodemographic characteristics. In contrast, no geographical variation in survival was observed among patients who survived 28 days. In all three analyses, odds and rates of mortality were higher among patients with low educational level (odds ratio (OR) (95% credible intervals) of 1.20 (1.12-1.29), OR of 1.12 (1.01-1.24) and mortality rate ratio of 1.45 (1.30-1.61)) and low income (OR of 1.24 (1.15-1.33), OR of 1.33 (1.20-1.48) and mortality rate ratio of 1.25 (1.13-1.38)). CONCLUSION Marked geographical inequality was observed in immediate case fatality. However, no geographically unequal distribution of survival was found among patients who survived 28 days after AMI. Results additionally showed social inequality in survival following AMI.
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Affiliation(s)
- Thora Majlund Kjærulff
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Kristine Bihrmann
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Jinfeng Zhao
- Department of Population Health, Auckland University, New Zealand
| | - Daniel Exeter
- Department of Population Health, Auckland University, New Zealand
| | - Gunnar Gislason
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,Department of Cardiology, The Cardiovascular Research Centre, Copenhagen University Hospital Herlev and Gentofte, Gentofte, Denmark.,Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,The Danish Heart Foundation, Copenhagen, Denmark
| | | | - Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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15
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Adherence to diabetes care process indicators in migrants as compared to non-migrants with diabetes: a retrospective cohort study. Int J Public Health 2019; 64:595-601. [DOI: 10.1007/s00038-019-01220-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 01/23/2019] [Accepted: 02/13/2019] [Indexed: 02/02/2023] Open
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16
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Steele L, Palmer J, Lloyd A, Fotheringham J, Iqbal J, Grech ED. Impact of socioeconomic status on survival following ST-elevation myocardial infarction in a universal healthcare system. Int J Cardiol 2019; 276:26-30. [DOI: 10.1016/j.ijcard.2018.11.111] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/02/2018] [Accepted: 11/21/2018] [Indexed: 10/27/2022]
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17
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Cafagna G, Seghieri C, Vainieri M, Nuti S. A turnaround strategy: improving equity in order to achieve quality of care and financial sustainability in Italy. Int J Equity Health 2018; 17:169. [PMID: 30454018 PMCID: PMC6245858 DOI: 10.1186/s12939-018-0878-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 10/21/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Equity, financial sustainability, and quality in healthcare are key goals embraced by universal health systems. However, systematic performance management strategies for achieving equity are still weaker than those aimed at achieving financial sustainability and quality of care. Using a vertical equity perspective, the overarching aim of this paper is to examine how improving equity in quality of care impacts on financial sustainability. We applied a simulation to indicators of the heart failure clinical pathway in Tuscany (central Italy), in order to quantify the equity gaps and financial resources that could be reallocated in the absence of performance inequities. METHODS The analysis included all patients hospitalized for heart failure as a principal diagnosis in 2014. We selected five indicators: hospitalization rate, 30-day readmission, cardiology visits, and the utilization of beta-blockers, and ACE inhibitors and sartans. For each indicator, the simulation followed three steps: 1) stratification by socioeconomic status (SES), using education as a proxy for SES; 2) computation of the vertical equity indicator; and 3) assessment of the financial value of the equity gap. RESULTS All indicators showed performance gaps regarding inequities across SES-groups. For the hospitalization rate and 30-day readmission, resources could have been reallocated, if the performance of patients with a low SES had been equal to the performance of patients with a high SES, which amounted to €2,144,422 and €892,790 respectively. In contrast, limited additional resources would have been required for prescriptions and cardiology visits. CONCLUSIONS Reducing equity gaps by improving the performance of low-SES patients may be a crucial strategy to achieving financial sustainability in universal coverage healthcare systems. Universal healthcare systems, which aim to pursue financial sustainability and quality of care, are thus urged to develop performance management actions to improve equity. This approach should not only include the measurement and public disclosure of equity indicators but be part of a comprehensive evidence-based strategy for the management of chronic conditions along the clinical pathway.
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Affiliation(s)
- Gianluca Cafagna
- Health and Management Laboratory (MeS Lab), Institute of Management, Sant’Anna School of Advanced Studies, Piazza Martiri della Libertà, 24, Pisa, Italy
| | - Chiara Seghieri
- Health and Management Laboratory (MeS Lab), Institute of Management, Sant’Anna School of Advanced Studies, Piazza Martiri della Libertà, 24, Pisa, Italy
| | - Milena Vainieri
- Health and Management Laboratory (MeS Lab), Institute of Management, Sant’Anna School of Advanced Studies, Piazza Martiri della Libertà, 24, Pisa, Italy
| | - Sabina Nuti
- Health and Management Laboratory (MeS Lab), Institute of Management, Sant’Anna School of Advanced Studies, Piazza Martiri della Libertà, 24, Pisa, Italy
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18
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Lorenzoni G, Azzolina D, Lanera C, Brianti G, Gregori D, Vanuzzo D, Baldi I. Time trends in first hospitalization for heart failure in a community-based population. Int J Cardiol 2018; 271:195-199. [PMID: 29885830 DOI: 10.1016/j.ijcard.2018.05.132] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 05/22/2018] [Accepted: 05/31/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND This study aims to assess time trends in first hospitalization for heart failure (HF) in a community-based population over the period from 1977 to 2014. METHODS Population-based cohort study using resources from the "Martignacco project" started in 1977 and promoted by the WHO. Three thousand and sixty-six subjects were involved in the project with follow-up through December 2014. Estimates were made for age-specific incidence rates for the first hospitalization for HF by birth cohort, calendar period, and gender. To disentangle the effects of age, calendar period, and birth cohort on the overall temporal trend in HF, we performed an age-period-cohort (APC) analysis. RESULTS An incident hospitalization for HF was reported for 427 subjects. In the APC model, a cohort effect with a turning point in 1930 was observed. After 1930, a sharp decrease in the rate ratios (RRs) occurred in among both genders. The estimated RR in the 1940 birth cohort decreased to 0.43, (95% CI 0.19-0.92), in men and to 0.45, (95% CI 0.16-1.26), in women. A residual effect of calendar period on RR was observed with a plateau in 1995 for women and in 2000 for men, followed by a decline. CONCLUSIONS The current findings showed that HF hospitalization incidence has declined over the period considered in subjects over 65 years living in a geographically defined community in Northeast Italy. Moreover, the age of birth, calendar period of diagnosis, and birth cohort play an important role in the incidence of the first hospitalization for HF.
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Affiliation(s)
- Giulia Lorenzoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Danila Azzolina
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Corrado Lanera
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Giorgio Brianti
- Department of Prevention, ASS 4 'Medio Friuli', Udine, Italy
| | - Dario Gregori
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Diego Vanuzzo
- National Association of Hospital Cardiologists, ANMCO (Associazione Nazionale Medici Cardiologi Ospedalieri) and Heart Care Foundation (Fondazione per il Tuo Cuore) Onlus, Firenze, Italy; Center for Cardiovascular Prevention, ASS 4 'Medio Friuli', Udine, Italy
| | - Ileana Baldi
- Unit of Biostatistics, Epidemiology and Public Health, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy.
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19
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Martínez-García M, Vargas-Barrón J, Bañuelos-Téllez F, González-Pacheco H, Fresno C, Hernández-Lemus E, Martínez-Ríos MA, Vallejo M. Public insurance program impact on catastrophic health expenditure on acute myocardial infarction. Public Health 2018; 158:47-54. [PMID: 29547759 DOI: 10.1016/j.puhe.2018.01.025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 12/07/2017] [Accepted: 01/23/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE ST-segment elevation myocardial infarction (STEMI) has an important economic burden that poised the urgent need to evaluate its catastrophic medical expense. This study evaluates the first 5 years of the national health initiative called Popular Insurance (PI) at the National Institute of Cardiology in Mexico. STUDY DESIGN Retrospective data analysis. METHODS STEMI patients with (n=317) and without (n=260) PI were selected. Analysed variables included socio-economical context, management care, cost evaluation and three outcomes (mortality, hospital readmission and therapeutic adherence). Descriptive statistical analyses, Kaplan-Meier survival and Support Vector Machine models were used accordingly. RESULTS Treatment costs were higher for PI-covered individuals (P=0.022) and only 1.89% of them remained in debt, in contrast to 16.15% of those without PI. Statistically significant differences were found in relation to days in hospital wards (P<0.001), imaging studies (P<0.001) and surgical materials (P=0.04). Survival analysis (P=0.44) and therapeutic adherence (P=0.38) showed no differences. Hospital readmission was predicted with an 81.97% accuracy. The most important predictive variables included were stent type, number of days at the coronary care unit and hospital wards. CONCLUSIONS The PI has proven to be a successful program where no differences were found in terms of health care and survival, whereas it provides timely financial support for families facing catastrophic health challenging events.
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Affiliation(s)
- M Martínez-García
- Sociomedical Research Department, National Institute of Cardiology, Mexico City, Mexico; Ph.D. Programme in Collective Health, Practices and Policies in Healthcare, Metropolitan Autonomous University, Xochimilco, Mexico City, Mexico
| | | | - F Bañuelos-Téllez
- Planning Division, National Institute of Cardiology, Mexico City, Mexico
| | - H González-Pacheco
- Coronary Care Unit, National Institute of Cardiology, Mexico City, Mexico
| | - C Fresno
- Computational Genomics Division, National Institute of Genomic Medicine, Mexico City, Mexico
| | - E Hernández-Lemus
- Computational Genomics Division, National Institute of Genomic Medicine, Mexico City, Mexico
| | | | - M Vallejo
- Sociomedical Research Department, National Institute of Cardiology, Mexico City, Mexico.
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20
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Laffey JG, Madotto F, Bellani G, Pham T, Fan E, Brochard L, Amin P, Arabi Y, Bajwa EK, Bruhn A, Cerny V, Clarkson K, Heunks L, Kurahashi K, Laake JH, Lorente JA, McNamee L, Nin N, Palo JE, Piquilloud L, Qiu H, Jiménez JIS, Esteban A, McAuley DF, van Haren F, Ranieri M, Rubenfeld G, Wrigge H, Slutsky AS, Pesenti A. Geo-economic variations in epidemiology, patterns of care, and outcomes in patients with acute respiratory distress syndrome: insights from the LUNG SAFE prospective cohort study. THE LANCET RESPIRATORY MEDICINE 2017. [PMID: 28624388 DOI: 10.1016/s2213-2600(17)30213-8] [Citation(s) in RCA: 82] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND Little information is available about the geo-economic variations in demographics, management, and outcomes of patients with acute respiratory distress syndrome (ARDS). We aimed to characterise the effect of these geo-economic variations in patients enrolled in the Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure (LUNG SAFE). METHODS LUNG SAFE was done during 4 consecutive weeks in winter, 2014, in a convenience sample of 459 intensive-care units in 50 countries across six continents. Inclusion criteria were admission to a participating intensive-care unit (including transfers) within the enrolment window and receipt of invasive or non-invasive ventilation. One of the trial's secondary aims was to characterise variations in the demographics, management, and outcome of patients with ARDS. We used the 2016 World Bank countries classification to define three major geo-economic groupings, namely European high-income countries (Europe-High), high-income countries in the rest of the world (rWORLD-High), and middle-income countries (Middle). We compared patient outcomes across these three groupings. LUNG SAFE is registered with ClinicalTrials.gov, number NCT02010073. FINDINGS Of the 2813 patients enrolled in LUNG SAFE who fulfilled ARDS criteria on day 1 or 2, 1521 (54%) were recruited from Europe-High, 746 (27%) from rWORLD-High, and 546 (19%) from Middle countries. We noted significant geographical variations in demographics, risk factors for ARDS, and comorbid diseases. The proportion of patients with severe ARDS or with ratios of the partial pressure of arterial oxygen (PaO2) to the fractional concentration of oxygen in inspired air (FiO2) less than 150 was significantly lower in rWORLD-High countries than in the two other regions. Use of prone positioning and neuromuscular blockade was significantly more common in Europe-High countries than in the other two regions. Adjusted duration of invasive mechanical ventilation and length of stay in the intensive-care unit were significantly shorter in patients in rWORLD-High countries than in Europe-High or Middle countries. High gross national income per person was associated with increased survival in ARDS; hospital survival was significantly lower in Middle countries than in Europe-High or rWORLD-High countries. INTERPRETATION Important geo-economic differences exist in the severity, clinician recognition, and management of ARDS, and in patients' outcomes. Income per person and outcomes in ARDS are independently associated. FUNDING European Society of Intensive Care Medicine, St Michael's Hospital, University of Milan-Bicocca.
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Affiliation(s)
- John G Laffey
- Department of Anesthesia, St Michael's Hospital, Toronto, ON, Canada; Department of Critical Care Medicine, St Michael's Hospital, Toronto, ON, Canada; Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Department of Anesthesia, University of Toronto, Toronto, ON, Canada; Department of Physiology, University of Toronto, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada.
| | - Fabiana Madotto
- Research Center on Public Health, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Giacomo Bellani
- Research Center on Public Health, Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy; Department of Emergency and Intensive Care, San Gerardo Hospital, Monza, Italy
| | - Tài Pham
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Sorbonne Universités, UPMC Université Paris 06, Paris, France
| | - Eddy Fan
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Department of Medicine, University Health Network and Mount Sinai Hospital, Toronto, ON, Canada
| | - Laurent Brochard
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Pravin Amin
- Department of Critical Care Medicine, Bombay Hospital Institute of Medical Sciences, Mumbai, India
| | - Yaseen Arabi
- Intensive Care Department, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Respiratory Services, King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Saudi Arabia; King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Ednan K Bajwa
- Division of Pulmonary and Critical Care, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alejandro Bruhn
- Departamento de Medicina Intensiva, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Vladimir Cerny
- Department of Anesthesiology, Perioperative Medicine and Intensive Care, J E Purkinje University, Masaryk Hospital, Usti nad Labem, Czech Republic; Department of Research and Development, and Department of Anesthesiology and Intensive Care, Charles University in Prague, Prague, Czech Republic; Faculty of Medicine in Hradec Kralove, Hradec Kralove, Czech Republic
| | - Kevin Clarkson
- Department of Anaesthesia, Galway University Hospitals and National University of Ireland, Galway, Galway, Ireland
| | - Leo Heunks
- Department of Intensive Care, VU University Medical Centre Amsterdam, Netherlands
| | - Kiyoyasu Kurahashi
- Department of Anesthesiology and Intensive Care Medicine, School of Medicine, International University of Health and Welfare, Narita, Japan
| | - Jon Henrik Laake
- Division of Critical Care, Department of Anaesthesiology, Rikshospitalet Medical Centre, Oslo University Hospital, Oslo, Norway
| | - Jose A Lorente
- CIBER de Enfermedades Respiratorias, Hospital Universitario de Getafe, Universidad Europea, Madrid, Spain
| | - Lia McNamee
- Centre for Experimental Medicine, Queen's University of Belfast, Belfast, Northern Ireland, UK; Wellcome-Wolfson Institute for Experimental Medicine, Belfast, Northern Ireland, UK; Regional Intensive Care Unit, Royal Victoria Hospital A&E, Grosvenor Road, Belfast, Northern Ireland, UK
| | - Nicolas Nin
- CIBER de Enfermedades Respiratorias, Hospital Universitario de Getafe, Universidad Europea, Madrid, Spain; Hospital Español, Montevideo, Uruguay
| | - Jose Emmanuel Palo
- Section of Adult Critical Care, Department of Medicine, The Medical City, Pasig, Philippines
| | - Lise Piquilloud
- Adult Intensive Care and Burn Unit, University Hospital of Lausanne, Lausanne, Switzerland; Department of Medical Intensive Care, University Hospital of Angers, Angers, France
| | - Haibo Qiu
- Department of Critical Care Medicine, Nanjing Zhongda Hospital, School of Medicine, Southeast University, Nanjing 210009, China
| | - Juan Ignacio Silesky Jiménez
- Department of Intensive Care, Hospital San Juan de Dios, and Department of Intensive Care, Hospital CIMA San Jose, Council of Critical Medicine, University of Costa Rica, San Pedro Montes de Oca, Costa Rica
| | - Andres Esteban
- CIBER de Enfermedades Respiratorias, Hospital Universitario de Getafe, Universidad Europea, Madrid, Spain; Hospital Español, Montevideo, Uruguay
| | - Daniel F McAuley
- Centre for Experimental Medicine, Queen's University of Belfast, Belfast, Northern Ireland, UK; Wellcome-Wolfson Institute for Experimental Medicine, Belfast, Northern Ireland, UK; Regional Intensive Care Unit, Royal Victoria Hospital A&E, Grosvenor Road, Belfast, Northern Ireland, UK
| | - Frank van Haren
- Intensive Care Unit, Canberra Hospital, Canberra, ACT, Australia; Australian National University, Canberra, ACT, Australia
| | - Marco Ranieri
- Sapienza Università di Roma, Dipartimento di Anestesia e Rianimazione, Policlinico Umberto I, Rome, Italy
| | - Gordon Rubenfeld
- Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada; Program in Trauma, Emergency and Critical Care, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Hermann Wrigge
- Department of Anesthesiology and Intensive Care Medicine, University of Leipzig, Leipzig, Germany
| | - Arthur S Slutsky
- Keenan Research Centre for Biomedical Science, Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, ON, Canada; Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, ON, Canada
| | - Antonio Pesenti
- Dipartimento di Anestesia, Rianimazione ed Emergenza Urgenza, Fondazione IRCCS Cà Granda-Ospedale Maggiore Policlinico and Dipartimento di Fisiopatologia Medico-Chirurgica e dei Trapianti, Università degli Studi di Milano, Milan, Italy
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