[Association of rehabilitation time with activities of daily living using data from a hospital bed function report system].

Objectives　The main purpose of rehabilitation is to improve the activities of daily living (ADL). Although convalescent wards are required to provide intensive rehabilitation to patients to improve their ADL, they have not been verified sufficiently. With a focus on the rehabilitation time, this study investigated the association of the amount of rehabilitation with ADL using a complete enumeration survey of a hospital bed function report system.Methods　This retrospective cohort study focusing on convalescent wards nationwide was conducted using the panel data from hospital bed function reports between 2014 and 2017. We used a fixed effects regression analysis with the improvement rate of ADL as the outcome measure and the number of rehabilitation units as the exposure variable.Results　The study sample included 2,003 wards, which were identified as having convalescent care functions from the report in 2014; a total of 437 wards (317 hospitals) were analyzed. The mean annual improvement rates of ADL were 0.601, 0.613, and 0.627 points in 2014, 2015, and 2017, respectively. The mean annual numbers of rehabilitation units provided were 6.302, 6.477, and 6.642 units in 2014, 2015, and 2017, respectively. The panel data analysis showed that the improvement rate of ADL was associated with an increase in the number of rehabilitation units (coefficient for an increase of one unit: 0.015, P=0.015).Conclusion　In the study of ward units using a national-level survey, a longer rehabilitation time was significantly associated with improvements in ADL.

Rehabilitation and convalescent hospital stay in New South Wales: an analysis of 3,979 women aged 75.

OBJECTIVES: With a rapidly ageing population, it is imperative to examine health service costs and plan appropriately for the future. This paper determines the factors related to extended hospital stay for 'Rehabilitation' or 'Convalescence', as defined by ICD-10 coding, in acute hospital settings for older women in New South Wales, Australia. METHODS: Participants were from the 1921-26 cohort of the Australian Longitudinal Study on Women's Health. For this analysis, self-reported survey data were linked to the NSW Admitted Patient Data Collection and the National Death Index. RESULTS: Of the 3,979 participants, 88% had a hospitalisation in the 13-year observation period, and 37% had either a rehabilitation or convalescence admission in an acute hospital setting. In the multivariate model, living in a regional or remote area was the only variable positively associated with having a rehabilitation or convalescence hospitalisation (AOR=1.58 [1.33, 1.87]). CONCLUSIONS: Area of residence is the determining factor for rehabilitation or convalescence hospital admissions. These long stay admissions are not necessarily inappropriate, but due to a lack of other non-acute care options. Implications for public health: Increased availability of rehabilitation and respite care in non-acute settings will not only improve older patient care, but will also reduce the burden on acute hospitals.

Incidencia y características de las caídas en un hospital de cuidados intermedios de Barcelona / Incidence and characteristics falls in a hospital intermediate care of Barcelona

Objetivo: Determinar la incidencia y las características de las caídas en los ancianos ingresados en el Hospital de Cuidados Intermedios Parc Sanitari Pere Virgili (PSPV). Metodología: Estudio descriptivo, observacional y retrospectivo. Sujetos de estudio: Pacientes mayores de 65 años ingresados en el PSPV que han sufrido alguna caída en el primer trimestre del año 2014. Recogida de datos a través de un registro de caídas del centro. Resultados y discusión: El 6,3% de los ancianos ingresados han sufrido una caída, 99 en total. No hay diferencias significativas según el sexo, excepto en mayores de 75 años que es mayor en las mujeres. Mayor incidencia en los mayores de 75 años; en el turno de mañana y de tarde, y en ancianos con patologías cardiovasculares. En el momento previo a la caída, mayoritariamente estaban en bipedestación, con desorientación y sin acompañamiento. El 75% de los que se cayeron tomaban tres o más medicamentos de riesgo. Sin lesión en más del 60% de las caídas. Conclusiones: El perfil de anciano frágil ingresado en el PSPV podría justificar la mayor incidencia de caídas frente a otros estudios a nivel hospitalario. Las consecuencias son menores y no ha habido lesión en la mayoría de ellas. Las intervenciones de enfermería en el HSPV se orientarán hacia un refuerzo de la prevención de caídas en los pacientes con patología cardiovascular y a los pacientes polimedicados y durante el turno de mañana y tarde y en aquellos momentos en que no se dispone de soporte del familiar/cuidador

Objective: To determine the incidence and characteristics of falls in the elderly admitted to the Intermediate Care Hospital Parc Sanitari Pere Virgili (PSPV). Methodology: descriptive and retrospective study. Study subjects: Patients over 65 years PSPV admitted to have been dropped in the first quarter of 2014. Data collection through a record of Middle Falls. Results and discussion: 6.3% of hospitalized elderly have been dropped, 99 in total. No significant differences by gender, except in over 75 years is higher in women. Higher incidence of over 75 years; in the morning shift and afternoon; and the elderly with cardiovascular diseases. In the run up to the fall time they were mostly in standing, with disorientation and without accompaniment. 75% of those who fell were taking 3 or more medications risk. No injury almost 60% of falls. Conclusions: the profile of frail elderly entered PSPV could justify the higher incidence of falls compared to other studies in hospitals. The consequences are lower, there being injury most of them. Nursing interventions in HSPV be geared towards strengthening the prevention of falls in patients with cardiovascular disease and patients with polypharmacy and during the morning shift and afternoon and in those times when you do not have the family / caregiver support

Prevalence of error-prone abbreviations used in medication prescribing for hospitalised patients: multi-hospital evaluation.

The use of error-prone abbreviations in prescribing is a potential cause of misinterpretation that may lead to medication error. This study determined frequency and type of error-prone abbreviations in inpatient medication prescribing across three Australian hospitals. Three hundred and sixty-nine (76.9%) patients had one or more error-prone abbreviations used in prescribing, with 8.4% of orders containing at least one error-prone abbreviation and 29.6% of these considered to be high risk for causing significant harm.

[Predictive factors of acquired methicillin-resistant Staphylococcus aureus in a rehabilitation care unit]. / Facteurs prédictifs d'acquisition du Staphylococcus aureus résistant à la méticilline dans un service de soins de suite et de réadaptation.

UNLABELLED: Controlling the diffusion of multiresistant bacteria is a priority in the campaign against nosocomial infections. Geriatric units seem to be reservoirs of methicillin-resistant Staphylococcus aureus (MRSA). OBJECTIVE: The first objective of this study was to determine if some characteristics identified on admission in a rehabilitation care unit could influence the colonization by the bacterium, and to define the rate of importation and acquired-infections. The second objective was to evaluate the preventive effects of enhanced cleaning with hydro-alcoholic solution, in comparison with our previous study made five years before. METHOD: One hundred and eighty-eight patients (mean age, 83.75 ± 7.35 years) were included. RESULTS: The rates of importation and colonization were respectively of 22.4% and 25.5%. The predictive factors of acquisition were dependence, malnutrition, presence of urinary catheter, and chronic wounds. The comparison with data collected five years earlier showed a reduction of colonization rates from 44 to 25%. COMMENTS: Our study highlights the important role of hand contamination in colonization of the MRSA especially for dependent patients, and shows the importance of hand-hygiene compliance, as well as maintaining autonomy among old patients. The use of hydro-alcoholic solution in association with the reinforcement of hospital hygiene measures led to the decrease of acquired-infection rate.

[Long-term problems associated with emergency neurological medicine].

Japanese medical care systems suffered from a number of long-term problems associated with emergency neurological medicine; moreover, with decreasing birthrate and aging society, these problems are rapidly worsening. The problems include shortage and uneven distribution of the necessary convalescent beds required for the treatment of stroke patients, scarcity of beds for treatment heavy work load of in-house healthcare staff, and shortage of human resources, furthermore, back-up emergency wards for acute treatment have not been developed. Medical facilities should be easily available to the general public; however, in a free economy, it is difficult to modify these facilities according to social needs. Moreover, presently, patients with higher brain dysfunction are supported only through nationwide system. It is necessary to recognize the current situation in which many patients have no other choice but to stay at home. In the light of this situation, the medical doctors in charge of emergency neurological medicine should discuss their future mode of action.

The PedsQL Family Impact Module: preliminary reliability and validity.

BACKGROUND: The PedsQL Measurement Model was designed to measure health-related quality of life (HRQOL) in children and adolescents. The PedsQL 4.0 Generic Core Scales were developed to be integrated with the PedsQL Disease-Specific Modules. The newly developed PedsQL Family Impact Module was designed to measure the impact of pediatric chronic health conditions on parents and the family. The PedsQL Family Impact Module measures parent self-reported physical, emotional, social, and cognitive functioning, communication, and worry. The Module also measures parent-reported family daily activities and family relationships. METHODS: The 36-item PedsQL Family Impact Module was administered to 23 families of medically fragile children with complex chronic health conditions who either resided in a long-term care convalescent hospital or resided at home with their families. RESULTS: Internal consistency reliability was demonstrated for the PedsQL Family Impact Module Total Scale Score (alpha = 0.97), Parent HRQOL Summary Score (alpha = 0.96), Family Functioning Summary Score (alpha = 0.90), and Module Scales (average alpha = 0.90, range = 0.82 - 0.97). The PedsQL Family Impact Module distinguished between families with children in a long-term care facility and families whose children resided at home. CONCLUSIONS: The results demonstrate the preliminary reliability and validity of the PedsQL Family Impact Module in families with children with complex chronic health conditions. The PedsQL Family Impact Module will be further field tested to determine the measurement properties of this new instrument with other pediatric chronic health conditions.

Reforming Medicare payment: early effects of the 1997 Balanced Budget Act on postacute care.

The 1997 Balanced Budget Act (BBA) reformed payment for Medicare postacute services. This article examines postacute care use just before and immediately after implementation of the BBA for hospital discharges for five diagnosis-related groups that commonly use postacute care. Changes in treatment patterns were more beneficiaries receiving no postacute care, much less use of home health services both initially and after initial institutional postacute care, and slightly more use of rehabilitation and long-term care hospitals. But no consistent increases in adverse outcomes were observed using logistic regression models. These results demonstrate that financing changes can affect use patterns, that less use does not automatically imply poorer quality, and that the interrelationship of services should be considered when designing reimbursement methodologies.

The dynamics of local rules in hospital admission processes.

This paper reports on research into admission practices at a sub acute extended care hospital. A system dynamics simulation model of the patient flow from feeder hospitals to the hospital was built to show the impact of the local rules used by the medical registrar. Local rules are behaviours that are local, and often idiosyncratic, adaptations to the local environment. The model showed these adaptations had a significant impact on the acuity of patients being admitted as a result of the separation policies of the feeder hospitals. This patient mix in turn affected the hospital ability to meet its budget.

Post-acute service use following acute myocardial infarction in the elderly.

This exploratory study examined the extent to which factors beyond characteristics of the patient, such as discharging hospital attributes and State factors, contributed to variations in post-acute services use (PASU) in a cohort of elderly Medicare patients following acute myocardial infarction (AMI). Thirty-seven percent of this cohort received PAS within 30 days of discharge and home health care was the most common type of service used. Patient severity of illness at hospital discharge, for-profit ownership of the discharging hospital, and discharging hospital provision of home health services were shown to be important predictors of PASU. After adjusting for many patient and hospital characteristics, however, variation in PASU remained across States.

The impact of community mental health centers on the utilization of services.

The impact of community mental health centers on the utilization of psychiatric services in Monroe County, New York, was evaluated by means of data from the Monroe County Psychiatric Case Register. The catchment areas that received centers served as their own controls. In addition, yearly utilization rates were compared for areas that obtained centers with those remaining centerless. Utilization rates increased markedly in catchment areas with centers, while the percentage of patients seen at the Rochester Psychiatric Center decreased from all catchment areas. Community mental health centers increased the utilization rates of the poor, children, and young adults, while the treatment needs of patient subgroups such as alcoholics, drug addicts, and the elderly were last to be addressed. The data do not evaluate issues such as the character, quality, and effectiveness of care.