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Kim H, Cheng SH, Yamana H, Lee S, Yoon NH, Lin YC, Fushimi K, Yasunaga H. Variations in hip fracture inpatient care in Japan, Korea, and Taiwan: an analysis of health administrative data. BMC Health Serv Res 2021; 21:694. [PMID: 34256758 PMCID: PMC8278699 DOI: 10.1186/s12913-021-06621-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 06/07/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about hip fracture inpatient care in East Asia. This study examined the characteristics of patients, hospitals, and regions associated with delivery of hip fracture surgeries across Japan, Korea, and Taiwan. We also analyzed and compared how the resource use and a short-term outcome of the care in index hospitals varied according to factors in the respective health systems. METHODS We developed comparable, nationwide, individual-level health insurance claims datasets linked with hospital- and regional-level statistics across the health systems using common protocols. Generalized linear multi-level analyses were conducted on length of stay (LOS) and total cost of index hospitalization as well as inpatient death. RESULTS The majority of patients were female and aged 75 or older. The standardized LOS of the hospitalization for hip fracture surgery was 32.5 (S.D. = 18.7) days in Japan, 24.7 (S.D. = 12.4) days in Korea, and 7.1 (S.D. = 2.9) days in Taiwan. The total cost per admission also widely varied across the systems. Hospitals with a high volume of hip fracture surgeries had a lower LOS across all three systems, while other factors associated with LOS and total cost varied across countries. CONCLUSION There were wide variations in resource use for hip fracture surgery in the index hospital within and across the three health systems with similar social health insurance schemes in East Asia. Further investigations into the large variations are necessary, along with efforts to overcome the methodological challenges of international comparisons of health system performance.
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Affiliation(s)
- Hongsoo Kim
- Graduate School of Public Health Department of Public Health Science, Institute of Health and Environment, & Institute of Aging, Seoul National University, Seoul, 08826, South Korea.
| | - Shou-Hsia Cheng
- Institute of Health Policy and Management, College of Public Health, Population Health Research Center, National Taiwan University, Taipei, Taiwan
| | - Hayato Yamana
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Seyune Lee
- Graduate School of Public Health, Department of Public Health Sciences, Seoul National University, Seoul, South Korea
| | - Nan-He Yoon
- Division of Social Welfare and Health Administration, Wonkwang University, Iksan, Jeonbuk, South Korea
| | - Yi-Chieh Lin
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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Variation in Care for Patients with Irritable Bowel Syndrome in the United States. PLoS One 2016; 11:e0154258. [PMID: 27116612 PMCID: PMC4845999 DOI: 10.1371/journal.pone.0154258] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/11/2016] [Indexed: 12/14/2022] Open
Abstract
Objectives Irritable bowel syndrome (IBS) affects nearly one in seven Americans. Significant national variations in care may exist, due to a current lack of standardized diagnosis and treatment algorithms; this can translate into a substantial additional economic burden. The study examines healthcare resource utilization in patients with IBS and in the subset of IBS patients with constipation (IBS-C) and analyzes the variation of IBS care for these patients across the United States (US). Methods Healthcare resource use (HRU), including gastrointestinal (GI) procedures and tests, all-cause and intestinal-related medical visits, GI specialist visits, and constipation or diarrhea pharmacy prescriptions for IBS patients enrolled in a large US administrative claims database (2001–2012) were analyzed for the 24-month period surrounding first diagnosis. Multivariate regression models, adjusting for age, gender, year of first diagnosis, insurance type, and Charlson comorbidity index, compared HRU across states (each state vs. the average of all other states). Results Of 201,322 IBS patients included, 77.2% were female. Mean age was 49.4 years. One in three patients had ≥3 distinct GI medical procedures or diagnostic tests; 50.1% visited a GI specialist. Significant HRU differences were observed in individual states compared to the national average. IBS-C patients had more medical visits, procedures, and pharmacy prescriptions for constipation/diarrhea than IBS patients without constipation. Conclusions This study is the first to identify considerable regional variations in IBS healthcare across the US and to note a markedly higher HRU by IBS-C patients than by IBS patients without constipation. Identifying the reasons for these variations may improve quality of care and reduce the economic burden of IBS.
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Kates SL, Shields E, Behrend C, Noyes KK. Financial Implications of Hospital Readmission After Hip Fracture. Geriatr Orthop Surg Rehabil 2015; 6:140-6. [PMID: 26328226 PMCID: PMC4536499 DOI: 10.1177/2151458515578265] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
INTRODUCTION Hip fracture is the leading orthopedic discharge diagnosis associated with 30-day readmission in terms of numbers. Because readmission to the hospital following a hip fracture is so common, it adds considerably to the costs on an already overburdened health care system. METHODS Patients aged 65 and older admitted to a 261-bed university-affiliated level 3 trauma center between April 30, 2005, and September 30, 2010, with a unilateral, native, nonpathologic low-energy proximal femur fracture were identified from a fracture registry and included for analysis. Readmissions within 30 days of hospital discharge, costs, and outcomes were collected and studied. RESULTS Of 1081 patients, 129 (11.9%) were readmitted within 30 days. The average hospital length of stay for readmissions was 8.7 ± 18.8 days, which was significantly longer than the initial stay (4.6 ± 2.3 days) (P = .03). Nineteen percent (24 patients ∼19%) died during readmission versus 2.8% during the index admission. These patients accumulated an average hospital charge of US$16 308 ± US$6400 during their initial hospitalization for compared with charges for their readmissions of US$14 191 ± US$25 035 (P = .36). DISCUSSION Readmission was usually associated with serious medical or surgical complications of the original hospitalization. CONCLUSIONS Readmission after hip fracture is costly and harmful. Charges were similar between the original fracture admission and the readmission. Patients were readmitted most frequently for medical diagnoses following their original hospital stay. Some of these readmissions may have been avoidable.
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Affiliation(s)
- Stephen L Kates
- Department of Orthopaedic Surgery, University of Rochester, Rochester, NY, USA
| | - Edward Shields
- Department of Orthopaedic Surgery, University of Rochester, Rochester, NY, USA
| | - Caleb Behrend
- Department of Orthopaedic Surgery, Carilion Clinic, Virginia, USA
| | - Katia K Noyes
- Department of Surgery, University of Rochester, Rochester, NY, USA
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Fuchs HF, Broderick RC, Harnsberger CR, Chang DC, Mclemore EC, Ramamoorthy S, Horgan S. Variation of outcome and charges in operative management for diverticulitis. Surg Endosc 2014; 29:3090-6. [PMID: 25539698 DOI: 10.1007/s00464-014-4046-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 12/11/2014] [Indexed: 12/15/2022]
Abstract
BACKGROUND Outcomes after surgery for diverticulitis are of continued interest to improve quality of care. The aim of this study was to assess variations in mortality, length of stay, and patient charges between geographic regions of the United States. METHODS A retrospective analysis of the Nationwide Inpatient Sample database was performed. Adults with diverticulitis who underwent laparoscopic or open segmental colectomy were identified using ICD-9 codes. Subset analyses were performed by state and then compared. Outcomes included mortality, length of stay (LOS), and total charges. Results were adjusted for age, race, gender, findings of peritonitis, stoma placement, Charlson comorbidity index, and insurance status on multivariate analysis. RESULTS 148,874 patients underwent segmental colectomy for diverticulitis from 1998 to 2010. Using California as the comparison state and after adjusting for covariates, in-hospital mortality was significantly higher in the State of New York (OR 1.32; 95 % CI 1.13-1.55; P < 0.05) and Mississippi (OR 2.84; 95 % CI 1.24-6.51, P < 0.02). Wisconsin had a significant lower mortality rate (OR 0.74; 95 % CI 0.59-0.94, P < 0.01). LOS was 1.4 days longer in New York and 0.54 days shorter in Wisconsin than in California (P < 0.01). Patients with age >40 years, findings of peritonitis, and without private insurance had higher in-hospital mortality and longer length of stay. Average hospital charges differed dramatically between the states in the observation period. The highest hospital charges occurred in California, Nebraska, and Nevada while lowest occurred in Maryland, Wisconsin and Utah. CONCLUSIONS Patients who undergo surgical treatment for diverticulitis in the United States have high geographic variation in mortality, LOS, and hospital charges despite adjusting for demographic and socioeconomic factors. Further analysis should be performed to identify the causes of outlier regions, with the goal of improving and standardizing best practices.
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Affiliation(s)
- Hans F Fuchs
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA. .,Department of General Surgery, University of Cologne, Cologne, Germany.
| | - Ryan C Broderick
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Cristina R Harnsberger
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - David C Chang
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA.,Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Elisabeth C Mclemore
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Sonia Ramamoorthy
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
| | - Santiago Horgan
- Division of Minimally Invasive Surgery, Department of Surgery, Center for the Future of Surgery, University of California, San Diego, 9500 Gilman Drive, MC 0740, La Jolla, CA, 92093-0740, USA
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