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Hsu NC, Huang CC, Hsu CH, Wang TD, Sheng WH. Does Hospitalist Care Enhance Palliative Care and Reduce Aggressive Treatments for Terminally Ill Patients? A Propensity Score-Matched Study. Cancers (Basel) 2023; 15:3976. [PMID: 37568793 PMCID: PMC10417390 DOI: 10.3390/cancers15153976] [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: 05/07/2023] [Revised: 05/19/2023] [Accepted: 08/02/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Information on the use of palliative care and aggressive treatments for terminally ill patients who receive care from hospitalists is limited. METHODS This three-year, retrospective, case-control study was conducted at an academic medical center in Taiwan. Among 7037 patients who died in the hospital, 41.7% had a primary diagnosis of cancer. A total of 815 deceased patients who received hospitalist care before death were compared with 3260 patients who received non-hospitalist care after matching for age, gender, catastrophic illness, and Charlson comorbidity score. Regression models with generalized estimating equations were performed. RESULTS Patients who received hospitalist care before death, compared to those who did not, had a higher probability of palliative care consultation (odds ratio (OR) = 3.41, 95% confidence interval (CI): 2.63-4.41), and a lower probability to undergo invasive mechanical ventilation (OR = 0.13, 95% CI: 0.10-0.17), tracheostomy (OR = 0.14, 95% CI: 0.06-0.31), hemodialysis (OR = 0.70, 95% CI: 0.55-0.89), surgery (OR = 0.25, 95% CI: 0.19-0.31), and intensive care unit admission (OR = 0.11, 95% CI: 0.08-0.14). Hospitalist care was associated with reductions in length of stay (coefficient (B) = -0.54, 95% CI: -0.62--0.46) and daily medical costs. CONCLUSIONS Hospitalist care is associated with an improved palliative consultation rate and reduced life-sustaining treatments before death.
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Affiliation(s)
- Nin-Chieh Hsu
- Division of Hospital Medicine, Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei 10051, Taiwan; (N.-C.H.); (T.-D.W.)
- Division of Hospital Medicine, Department of Internal Medicine, Taipei City Hospital Zhongxing Branch, Taipei 103212, Taiwan
| | - Chun-Che Huang
- Department of Healthcare Administration, College of Medicine, I-Shou University, Kaohsiung 84001, Taiwan;
| | - Chia-Hao Hsu
- Department of Orthopedics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80708, Taiwan
| | - Tzung-Dau Wang
- Division of Hospital Medicine, Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei 10051, Taiwan; (N.-C.H.); (T.-D.W.)
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital, Taipei 100229, Taiwan
| | - Wang-Huei Sheng
- College of Medicine, National Taiwan University, Taipei 10051, Taiwan;
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Kim HJ, Kim J, Ohn JH, Kim NH. Impact of hospitalist care model on patient outcomes in acute medical unit: a retrospective cohort study. BMJ Open 2023; 13:e069561. [PMID: 37536969 PMCID: PMC10401215 DOI: 10.1136/bmjopen-2022-069561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 07/19/2023] [Indexed: 08/05/2023] Open
Abstract
OBJECTIVE To assess a newly introduced, hospitalist-run, acute medical unit (AMU) care model at a tertiary care hospital in the Republic of Korea. DESIGN Retrospective cohort study. SETTING Tertiary care hospital in the Republic of Korea. PARTICIPANTS We evaluated 6391 medical inpatients admitted through the emergency department (ED) from 1 June 2016 to 31 May 2017. INTERVENTIONS The study compared multiple outcomes among medical inpatients from the ED between the non-hospitalist group and the AMU hospitalist group. OUTCOME MEASURES In-hospital mortality (IHM), intensive care unit (ICU) admission rate, hospital length of stay (LOS), ED-LOS and unscheduled readmission rates were defined as patient outcomes and compared between the two groups. RESULTS Compared with the non-hospitalist group, the AMU hospitalist group had lower IHM (OR: 0.43, p<0.001), a lower ICU admission rate (OR: 0.72, p=0.013), a shorter LOS (coefficient: -0.984, SE: 0.318; p=0.002) and a shorter ED-LOS (coefficient: -3.021, SE: 0.256; p<0.001). There were no significant differences in the 10-day or 30-day readmission rates (p=0.974, p=0.965, respectively). CONCLUSIONS The AMU hospitalist care model was associated with reductions in IHM, ICU admission rate, LOS and ED-LOS. These findings suggest that the AMU hospitalist care model has the potential to be adopted into other healthcare systems to improve care for patients with acute medical needs.
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Affiliation(s)
- Hyun Jeong Kim
- College of Nursing, Seoul National University, Seoul, Korea (the Republic of)
- Department of Nursing, Seoul National University Bundang Hospital, Seongnam-si, Korea (the Republic of)
| | - Jinhyun Kim
- College of Nursing, Seoul National University, Seoul, Korea (the Republic of)
| | - Jung Hun Ohn
- Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam-si, Korea (the Republic of)
| | - Nak-Hyun Kim
- Internal Medicine, Seoul National University College of Medicine, Seoul, Korea (the Republic of)
- Hospital Medicine Center, Seoul National University Bundang Hospital, Seongnam-si, Korea (the Republic of)
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Kurihara M, Kamata K, Tokuda Y. Impact of the hospitalist system on inpatient mortality and length of hospital stay in a teaching hospital in Japan: a retrospective observational study. BMJ Open 2022; 12:e054246. [PMID: 35379623 PMCID: PMC8981289 DOI: 10.1136/bmjopen-2021-054246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To examine the differences in the quality of care among inpatients before and after the introduction of the hospitalist system. DESIGN A retrospective observational study. SETTING A community teaching hospital in Japan. PARTICIPANTS The inpatients admitted between the preintervention (January-December 2018) and 1-year intervention (January-December 2019) periods. There were 8508 and 8788 inpatients in 2018 and 2019, respectively. INTERVENTIONS The study compared the lengths of hospital stay and mortality among inpatients between the pre-and post-intervention (2018 and 2019) periods concerning the introduction of a hospital medicine department. OUTCOME MEASURES The primary objective was to evaluate and compare the in-hospital mortality and the length of stay (LOS) between 2018 and 2019. The secondary objective was to identify the characteristics of hospitalists and non-hospitalists in the system. RESULTS The LOS was significantly reduced after the introduction of the hospital medicine department (adjusted difference, -0.659 days; 95% CI -1.118 to -0.136, p=0.01). There were no differences in the adjusted mortalities between the two periods. CONCLUSIONS To the best of our knowledge, our study is the first involving a teaching hospital in Japan to reveal that the hospitalist system had a positive effect on the efficiency of inpatient care by shortening the LOS. Further studies are needed to clarify other benefits related to the introduction of the hospital medicine department in Japan.
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Affiliation(s)
- Masaru Kurihara
- Hospital Medicine, Urasoe General Hospital, Urasoe, Okinawa, Japan
- Patient Safetty, Nagoya University Hospital, Nagoya, Aichi, Japan
| | - Kazuhiro Kamata
- General Internal Medicine, Fukushima Medical University Aizu Medical Center, Aizu, Fukushima, Japan
- Pediatrics, Niigata University, Niigata, Japan
| | - Yasuharu Tokuda
- Muribushi Okinawa Center for Teaching Hospitals, Urasoe, Okinawa, Japan
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Rappaport LG, VanderVennen MC, Monroe KK, McCaffery H, Stewart DA. Weekend Admissions for Somatic Symptom and Related Disorders and Length of Stay. Hosp Pediatr 2022; 12:79-85. [PMID: 34889353 DOI: 10.1542/hpeds.2021-006039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES To evaluate whether admission on weekends affects the length of stay (LOS) for patients hospitalized with somatic symptom and related disorders (SSRDs). METHODS Data from 2012-2018 was obtained for all patients aged 4 to 21 years (N = 5459) with a primary discharge diagnosis of SSRDs from 52 tertiary care pediatric hospitals in the United States. We obtained patient demographics, admission date and/or time, LOS, procedure count, and comorbid conditions. We defined a weekend as 3 pm Friday to 3 pm Sunday. The Wilcoxon rank test was used for unadjusted analysis. Multiple logistic regression was used to estimate the odds of having LOS >1 day, >2 days, >3 days, and >4 days in weekend versus weekday groups. RESULTS Weekend admission significantly correlated with increased LOS (P < .001). Compared with weekdays, a weekend admission was associated with increased odds of having LOS >1, >2, and >3 days. This remained statistically significant while adjusting for the number of chronic conditions, procedures, and individuals with Black or Hispanic ethnicity compared with White ethnicity. LOS was not associated with sex or age of the patients. CONCLUSIONS Patients with SSRDs admitted on the weekend have an increased LOS compared with those admitted on a weekday. This may be due to a decrease in multidisciplinary care available during weekends. In future studies, researchers should aim to better understand the specific factors that contribute to this disparity and test interventions that may close the gap in care, including expanding to 7-day services, increasing mental health resources, and working to decrease the need for inpatient admissions.
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Affiliation(s)
- Leah G Rappaport
- C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | | | - Kimberly K Monroe
- C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - Harlan McCaffery
- Center for Human Growth and Development, University of Michigan, Ann Arbor, Michigan
| | - David A Stewart
- C. S. Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
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Yan Y, Naito T, Hsu NC, Shin DH, Kang HJ, Vidyarthi AR, Tazuma S, Hayashi J, Deshpande GA. Adoption of Hospitalist Care in Asia: Experiences From Singapore, Taiwan, Korea, and Japan. J Hosp Med 2021; 16:443-445. [PMID: 34197312 DOI: 10.12788/jhm.3621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 03/19/2021] [Indexed: 11/20/2022]
Affiliation(s)
- Yan Yan
- Department of Palliative Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshio Naito
- Department of General Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Nin-Chieh Hsu
- Division of Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, Hsinchu City, Taiwan
| | - Dong-Ho Shin
- Division of Integrated Medicine, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun-Jae Kang
- Department of Internal Medicine, College of Medicine, Seoul National University, Seoul, Korea
| | - Arpana R Vidyarthi
- Division of Hospital Medicine, University of California, San Francisco, California (formerly Advanced Internal Medicine, National University Health System, Singapore)
| | - Susumu Tazuma
- Department of General Internal Medicine, Hiroshima University Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
| | | | - Gautam A Deshpande
- Department of General Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
- Department of Internal Medicine, John A Burns School of Medicine, University of Hawaii, Honolulu, Hawaii
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Hsieh MJ, Hsu NC, Lin YF, Shu CC, Chiang WC, Ma MHM, Sheng WH. Developing and validating a model for predicting 7-day mortality of patients admitted from the emergency department: an initial alarm score by a prospective prediction model study. BMJ Open 2021; 11:e040837. [PMID: 33397665 PMCID: PMC7783526 DOI: 10.1136/bmjopen-2020-040837] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVES To set up a prediction model for the 7-day in-hospital mortality of patients admitted from the emergency department (ED) because it is high but no appropriate initial alarm score is available. DESIGN This is a prospective cohort study for prediction model development. SETTING In a tertiary referred hospital in northern Taiwan. PARTICIPANTS ED-admitted medical patients in hospitalist care wards were enrolled during May 2010 to October 2016. Two-thirds of them were randomly assigned to a derivation cohort for development of the model and cross-validation was performed in the validation cohort. PRIMARY OUTCOME MEASURED 7-day in-hospital mortality. RESULTS During the study period, 8649 patients were enrolled for analysis. The mean age was 71.05 years, and 51.91% were male. The most common admission diagnoses were pneumonia (36%) and urinary tract infection (20.05%). In the derivation cohort, multivariable Cox proportional hazard regression revealed that a low Barthel Index Score, triage level 1 at the ED, presence of cancer, metastasis and admission diagnoses of pneumonia and sepsis were independently associated with 7 days in-hospital mortality. Based on the probability developed from the multivariable model, the area under the receiver operating characteristic curve in the derivation group was 0.81 (0.79-0.85). The result in the validation cohort was comparable. The prediction score modified by the six independent factors had high sensitivity of 88.03% and a negative predictive value of 99.51% for a cut-off value of 4, whereas the specificity and positive predictive value were 89.61% and 10.55%, respectively, when the cut-off value was a score of 6. CONCLUSION The 7-day in-hospital mortality in the hospitalist care ward is 2.8%. The initial alarm score could help clinicians to prioritise or exclude patients who need urgent and intensive care.
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Affiliation(s)
- Ming-Ju Hsieh
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Nin-Chieh Hsu
- Division of Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Feng Lin
- Division of Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chin-Chung Shu
- Division of Hospital Medicine, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Wen-Chu Chiang
- Department of Emergency Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Matthew Huei-Ming Ma
- Department of Emergency Medicine, National Taiwan University Hospital, Yunlin Branch, Douliu, Taiwan
| | - Wang-Huei Sheng
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
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Tolvi M, Mattila K, Haukka J, Aaltonen LM, Lehtonen L. Analysis of weekend effect on mortality by medical specialty in Helsinki University Hospital over a 14-year period. Health Policy 2020; 124:1209-1216. [PMID: 32778343 DOI: 10.1016/j.healthpol.2020.07.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 07/16/2020] [Accepted: 07/24/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND The weekend effect, the phenomenon of patients admitted at the weekend having a higher mortality risk, has been widely investigated and documented in both elective and emergency patients. Research on the issue is scarce in Europe, with the exception of the United Kingdom. We examined the situation in Helsinki University Hospital over a 14-year period from a specialty-specific approach. MATERIALS AND METHODS We collected the data for all patient visits for 2000-2013, selecting patients with in-hospital care in the university hospital and extracting patients that died during their hospital stay or within 30 days of discharge. These patients were categorized according to urgency of care and specialty. RESULTS A total of 1,542,230 in-patients (853,268 emergency patients) met the study criteria, with 47,122 deaths in-hospital or within 30 days of discharge. Of 12 specialties, we found a statistically significant weekend effect for in-hospital mortality in 7 specialties (emergency admissions) and 4 specialties (elective admissions); for 30-day post-discharge mortality in 1 specialty (emergency admissions) and 2 specialties (elective admissions). Surgery, internal medicine, neurology, and gynecology and obstetrics were most sensitive to the weekend effect. CONCLUSIONS The study confirms a weekend effect for both elective and emergency admissions in most specialties. Reducing the number of weekend elective procedures may be necessary. More disease-specific research is needed to find the diagnoses most susceptible.
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Affiliation(s)
- Morag Tolvi
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, 00029 HUS, Helsinki, Finland.
| | - Kimmo Mattila
- Group Administration, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Jari Haukka
- Clinicum, Department of Public Health, University of Helsinki, P.O. Box 20, 00014, Helsinki University, Helsinki and Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland.
| | - Leena-Maija Aaltonen
- Department of Otorhinolaryngology - Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, P.O. Box 263, 00029 HUS, Helsinki, Finland.
| | - Lasse Lehtonen
- Diagnostic Center, Helsinki University Hospital and University of Helsinki, P.O. Box 720, 00029 HUS, Helsinki, Finland.
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Wei J, Zhu Z, Qi Q, Zeng L. Patient Delay in Hospital Visiting and the Weekend Effect of Surveillance Report on Hand-Foot-and-Mouth Disease and Epidemic Parotitis in Hanzhong City, China. THE CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY = JOURNAL CANADIEN DES MALADIES INFECTIEUSES ET DE LA MICROBIOLOGIE MEDICALE 2020; 2020:7081219. [PMID: 32454917 PMCID: PMC7225908 DOI: 10.1155/2020/7081219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Revised: 02/19/2020] [Accepted: 04/21/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND We aimed at investigating the prevalence and associated factors of patient delay in hospital visiting and weekend effect of disease surveillance on hand-foot-and-mouth disease and epidemic parotitis/mumps. METHODS Daily report data on hand-foot-and-mouth disease and epidemic parotitis cases between January 1, 2014, and December 31, 2017, in Hanzhong, Shaanxi, China, were collected. The patient delay in hospital visiting was defined by the date difference between disease onset and patient's visit to hospital. Differences of delayed durations and percentages were compared by using nonparametric or χ 2 tests across gender, age, occupation, disease classification, epidemic and nonepidemic seasons, and years of disease onset. Additionally, to determine whether there existed a weekend effect of disease surveillance, the mean cases reported on weekdays and weekends were also compared. RESULTS A total of 14,814 patients with hand-foot-and-mouth disease and 4013 with epidemic parotitis were recorded, respectively. We found that 43.1% of the hand-foot-and-mouth disease and 36.5% of the epidemic parotitis patients had delayed visiting to hospital. All patients were reported through the online surveillance system on the day of visiting hospital. The percentage of delayed visiting to hospital differed significantly by years and epidemic and nonepidemic seasons and between children in and not in childcare center (all p values <0.05). In addition, the reported numbers of both diseases fluctuated on weekdays but obviously decreased on weekends regardless of the epidemic or nonepidemic seasons. CONCLUSIONS The reported cases of HFMD and epidemic parotitis had an obvious weekend effect, with an increasing tendency of cases delaying in hospital visiting over the recent years in Hanzhong, China. Parents and caregivers rather than health systems should be primarily targeted for the prevention and control of infectious diseases and their local outbreaks such as community-based education on the second-dose vaccination of mumps and/or hand hygiene.
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Affiliation(s)
- Jianjun Wei
- Center for Disease Control and Prevention, Hanzhong, Shaanxi, China
| | - Zhonghai Zhu
- School of Public Health, Xi'an Jiaotong University Health Science Center, Shaanxi 710061, China
| | - Qi Qi
- School of Public Health, Xi'an Jiaotong University Health Science Center, Shaanxi 710061, China
| | - Lingxia Zeng
- School of Public Health, Xi'an Jiaotong University Health Science Center, Shaanxi 710061, China
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Malanchini G, Stefanini GG, Malanchini M, Lombardi F. Higher in-hospital mortality during weekend admission for acute coronary syndrome: a large-scale cross-sectional Italian study. J Cardiovasc Med (Hagerstown) 2018; 20:74-80. [PMID: 30540646 DOI: 10.2459/jcm.0000000000000743] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS An increased mortality risk during weekend hospital admission has been consistently observed. In the present study, we evaluated whether the current improvement in management of acute coronary syndromes (ACS) has reduced this phenomenon. METHODS AND RESULTS We extracted data from the Italian National Healthcare System Databank of 80 391 ACS admissions in the region of Lombardia between 2010 and 2014. ICD-9 codes were used to assess the diagnosis. We performed a multiple logistic regression analysis to compare the mortality rates between weekend and weekday admissions.Mean age of the study population was 67.6 years; 30.1% of patients were women. ST segment elevation myocardial infarction (STEMI) accounts for 42.2% of admissions. The total in-hospital mortality was 3.05% and was positively predicted by weekend admission [odds ratio (OR) 1.13, P = 0.006], age and female sex. The weekend effect on mortality was only significant for STEMI (OR 1.11, P = 0.04) in comparison to non-STEMI (NSTEMI) or unstable angina.The trend of the risk of death was found to be negatively correlated with age: the risk of death was significantly higher in all age clusters younger than 75 (OR 1.22, P < 0.01) and even greater in the very young subgroup under 45 years of age (OR 2.09, P = 0.03). CONCLUSION Our data indicate that increased mortality risk is still present during weekend admissions. This phenomenon is particularly evident in younger patients and in individuals admitted for STEMI.
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Affiliation(s)
- Giovanni Malanchini
- Cardiologia, Fondazione IRCCS Ospedale Maggiore Policlinico, University of Milan, Milan
| | | | | | - Federico Lombardi
- Cardiologia, Fondazione IRCCS Ospedale Maggiore Policlinico, University of Milan, Milan
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