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1.
Medicine (Baltimore) ; 99(5): e18977, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000429

RESUMO

To address the remaining medical misconducts after the zero-makeup drug policy (ZMDP), e.g., over-examinations, China has given the priority to government supervision on medical institutions. This study evaluated the effect of government supervision on medical costs among inpatients with chronic obstructive pulmonary disease (COPD) in Sichuan province, the first province in China where the medical supervision was conducted.A linear interrupted time series (ITS) model was employed to analyze data about 72,113 inpatients from 32 hospitals. Monthly average medicine costs, diagnostic costs, and medical services costs, nursing costs from January 2015 to June 2018 were analyzed, respectively.The average hospitalization costs fell with a monthly trend of 42.90Yuan before the implementation of supervision (P < .001), and the declining trend remained with the more dramatic rate (-158.70Yuan, P < .001) after the government audit carried out. For western medicine costs, the monthly decreasing trend remained after the implementation of supervision (-66.44Yuan, P < .001); meanwhile, the monthly upward trend was changed into a downtrend trend for traditional Chinese medicine costs (-11.80Yuan, P = .009). Additionally, the increasing monthly trend in average diagnostics costs disappeared after government supervision, and was inversed to an insignificant decreasing trend at the rate of 26.18Yuan per month. Moreover, the previous upward trends were changed into downward trends for both medical service costs and nursing costs (P = .056, -44.71Yuan; P = .007, -11.17Yuan, respectively) after the supervision carried out.Our findings reveal that government supervision in Sichuan province was applicable to curb the growth of medical costs for inpatients with COPD, which may reflect its role in restraining physicians' compensating behaviors after the ZMDP. The government medical supervision holds promise to dismiss medical misconducts in Sichuan province, the experience of which may offer implications for other regions of China as well as other low- and middle-income countries.


Assuntos
Regulamentação Governamental , Hospitalização/economia , Pacientes Internados/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/economia , Garantia da Qualidade dos Cuidados de Saúde , Idoso , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
2.
Medicine (Baltimore) ; 99(1): e18506, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895785

RESUMO

BACKGROUND: Whether the occurrence of refeeding syndrome (RFS), a metabolic condition characterized by electrolyte shifts after initiation of nutritional therapy, has a negative impact on clinical outcomes remains ill-defined. We prospectively investigated a subgroup of patients included in a multicentre, nutritional trial (EFFORT) for the occurrence of RFS. METHODS: In this secondary analysis of a randomized-controlled trial investigating the effects of nutritional support in malnourished medical inpatients, we prospectively screened patients for RFS and classified them as "RFS confirmed" and "RFS not confirmed" based on predefined criteria (i.e. electrolyte shifts, clinical symptoms, clinical context, and patient history). We assessed associations of RFS and mortality within 180 days (primary endpoint) and other secondary endpoints using multivariable regression analysis. RESULTS: Among 967 included patients, RFS was confirmed in 141 (14.6%) patients. Compared to patients with no evidence for RFS, patients with confirmed RFS had significantly increased 180-days mortality rates (42/141 (29.8%) vs 181/826 (21.9%), adjusted odds ratio (OR) 1.53 (95% CI 1.02 to 2.29), P < .05). Patients with RFS also had an increased risk for ICU admission (6/141 (4.3%) vs 13/826 (1.6%), adjusted OR 2.71 (95% CI 1.01 to 7.27), P < .05) and longer mean length of hospital stays (10.5 ±â€Š6.9 vs 9.0 ±â€Š6.6 days, adjusted difference 1.57 days (95% CI 0.38-2.75), P = .01). CONCLUSION: A relevant proportion of medical inpatients with malnutrition develop features of RFS upon hospital admission, which is associated with long-term mortality and other adverse clinical outcomes. Further studies are needed to develop preventive strategies for RFS in this patient population.


Assuntos
Pacientes Internados/estatística & dados numéricos , Desnutrição/mortalidade , Apoio Nutricional/efeitos adversos , Síndrome da Realimentação/mortalidade , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Desnutrição/terapia , Pessoa de Meia-Idade , Razão de Chances , Estudos Prospectivos , Síndrome da Realimentação/etiologia , Fatores de Risco , Taxa de Sobrevida
3.
Medicine (Baltimore) ; 99(1): e18569, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895800

RESUMO

An adverse drug reactions avoidability tool called the Liverpool ADR avoidability assessment tool (LAAT) was recently developed (for research purposes), and subsequently validated with mixed interrater reliability (IRR). We investigated the comparative IRR of this tool in an inpatient cohort to ascertain its practical application in this setting.The patient population was comprised of 44 ADR drug pairs drawn from an observational prospective cohort of patents with ADR attending a Weill Cornell Medicine-affiliated tertiary medical Centre in Doha Qatar (Hamad General Hospital). Using the LAAT, and modified Hallas tools, 4 independent raters (2 Clinical Pharmacologists, and 2 General Physicians) assessed and scored the 44 ADR-drug pairs. Agreement proportions between the rating pairs were evaluated as well individual/overall kappa statistics and intraclass correlation coefficients. We evaluated the weight of each of the 7 questions on the LAAT tool to ascertain its determinative role.Across 44 ADR-drug pairs, the overall median Fleiss kappa using the LAAT, and modified Hallas tools were 0.67 (interquartile range (IQR) 0.55, 0.76), 0.36 (IQR, 0.23-0.71) respectively. The overall percentage pairwise agreement with the LAAT and modified Hallas tools were 78.5%, and 62.2% respectively. Exact pairwise agreement occurred in 37 out of 44 (range 0.71-1), and 27 of 44 (0.53-0.77) ADR-drug pairs using the LAAT and modified Hallas tools respectively. Using the LAAT tool, the overall intraclass correlation coefficient was 0.68 (CI 0.55, 0.79), and 0.37 (CI 0.22, 0.53) with the modified Hallas tool.We report a higher proportion of "possible" and "definite" avoidability outcomes of adverse drug reactions compared with the modified Hallas, or that reported by developers of the LAAT tool. Although initially developed for research purposes, our report has suggested for the first time a potential applicability of this tool in clinical environment as well.


Assuntos
Rotas de Resultados Adversos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Adulto , Algoritmos , Feminino , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Estudos Prospectivos , Catar , Reprodutibilidade dos Testes
4.
Orv Hetil ; 160(49): 1941-1947, 2019 Dec.
Artigo em Húngaro | MEDLINE | ID: mdl-31786937

RESUMO

Introduction and aim: To analyse and classify the ocular trauma cases at the in-patient ophthalmological department of the Markusovszky University Teaching Hospital between 2014 and 2018. Method: We analysed the eye injury cases between 01. 01. 2014 and 31. 12. 2018 in the in-patient clinic of our hospital. 98 eyes of 97 patients were included in this study. To classify the injuries, we used the Birmingham Eye Trauma Terminology (BETT) and the new expanded classification of Shukla et al. Results: From the 97 patients, 16 were female and 81 male. The average age was 43.3 ± 22.5 (min.: 3, max.: 92) years; 20 patients were younger than 18 years old. 46.4% of the cases were right eyes, 52.5% were left eyes, and 1% was bilateral. The average time from the injury until the treatment was 1.3 days. The average time spent in hospital because of the injury was 5.2 days. The average observation time was 9.7 months. 95.8% of the injuries were mechanical eye injuries. From this group, 74.2% localized only to the globe, 20.4% were adnexal injuries and 5.4% were destructive eye injuries. From the globe injuries, 15 were closed globe, 60 were open globe injuries, and in 21 cases there were intraocular foreign body present. In 93% of the cases it was possible to keep or improve the best corrected visual acuity during the treatment. Conclusion: With the new classification, we could classify all of the eye injury cases easily. Depending on the type of the eye injury, with appropriate treatment we can keep or improve the visual function of the eye. Orv Hetil. 2019; 160(49): 1941-1947.


Assuntos
Traumatismos Oculares/classificação , Pacientes Internados/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Traumatismos Oculares/epidemiologia , Traumatismos Oculares/etiologia , Feminino , Departamentos Hospitalares , Hospitais Universitários , Humanos , Hungria/epidemiologia , Masculino , Pessoa de Meia-Idade , Acuidade Visual
5.
Environ Health Prev Med ; 24(1): 63, 2019 Nov 23.
Artigo em Inglês | MEDLINE | ID: mdl-31759388

RESUMO

The identification of death is critical for epidemiological research. Despite recent developments in health insurance claims databases, the quality of death information in claims is not guaranteed because health insurance claims are collected primarily for reimbursement. We aimed to examine the usefulness and limitations of death information in claims data and to examine methods for improving the quality of death information for aged persons.We used health insurance claims data and enrollment data (as the gold standard) from September 2012 through August 2015 for nondependent persons aged 65-74 years enrolled in Japanese workplace health insurance. Overall, 3,710,538 insured persons were registered in the database during the study period. We analyzed 45,441 eligible persons. Inpatient and outpatient deaths were identified from the discharge/disease status in the claims, with sensitivities of 94.3% and 47.4%, specificities of 98.5% and 99.9%, and PPVs of 96.3% and 95.7%, respectively, using enrollment data as the gold standard. For outpatients, death defined as a combination of disease status and charge data for terminal care still indicated low sensitivity (54.7%).The validity of death information in inpatient claims was high, suggesting its potential usefulness for identifying death. However, given the low sensitivity for outpatient deaths, the use of death information obtained solely from records in outpatient claims is not recommended.


Assuntos
Morte , Planos de Assistência de Saúde para Empregados/estatística & dados numéricos , Formulário de Reclamação de Seguro/estatística & dados numéricos , Idoso , Estudos Transversais , Bases de Dados Factuais , Feminino , Planos de Assistência de Saúde para Empregados/normas , Humanos , Pacientes Internados/estatística & dados numéricos , Japão , Masculino , Pacientes Ambulatoriais/estatística & dados numéricos , Reprodutibilidade dos Testes
6.
Medicine (Baltimore) ; 98(48): e18113, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770235

RESUMO

The impact of vitamin D deficiency on the recovery of patients with malnutrition remains undefined. Our aim was to study the prevalence of vitamin D deficiency in a well-characterized cohort of patients with malnutrition and its association with outcomes.Within this secondary analysis of a randomized controlled trial, we examined the association of vitamin D deficiency and adverse clinical outcomes over a follow-up of 180 days in hospitalized patients at risk for malnutrition. We measured 25-hydroxyvitamin D levels upon admission and defined Vitamin D deficiency when levels were <50nmol/l. The primary endpoint was 180-day mortality.The prevalence of vitamin D deficiency in our cohort of 828 patients was 58.2% (n = 482). Patients with vitamin D deficiency had increased 180-day mortality rates from 23.1% to 29.9% (odds ratio 1.42, 95% confidence interval [CI] 1.03-1.94, P = .03). When adjusting the analysis for demographics, comorbidities, and randomization, this association remained significant for the subgroup of patients not receiving vitamin D treatment (adjusted odds ratio 1.63, 95% CI 1.01-2.62, P = .04). There was no significantly lower risk for mortality in the subgroup of vitamin D deficient patients receiving vitamin D treatment compared to not receiving treatment (adjusted odds ratio 0.74, 95% CI 0.48-1.13, P = .15).Vitamin D deficiency is highly prevalent in the population of malnourished inpatients and is negatively associated with long-term mortality particularly when patients are not receiving vitamin D treatment. Our findings suggest that malnourished patients might benefit from vitamin D screening and treatment in case of deficiency.


Assuntos
Idoso Fragilizado/estatística & dados numéricos , Fragilidade/mortalidade , Desnutrição/mortalidade , Deficiência de Vitamina D/mortalidade , Deficiência de Vitamina D/terapia , Idoso , Idoso de 80 Anos ou mais , Suplementos Nutricionais , Feminino , Fragilidade/sangue , Fragilidade/complicações , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Desnutrição/sangue , Desnutrição/complicações , Prevalência , Estudos Prospectivos , Qualidade de Vida , Resultado do Tratamento , Vitamina D/análogos & derivados , Vitamina D/sangue , Vitamina D/uso terapêutico , Deficiência de Vitamina D/complicações , Vitaminas/uso terapêutico
7.
Med Care ; 57(11): 869-874, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31634268

RESUMO

INTRODUCTION: Surgery accounts for almost half of inpatient spending, much of which is concentrated in a subset of high-cost patients. To study the effects of surgeon and hospital characteristics on surgical expenditures, a way to adjust for patient characteristics is essential. DESIGN: Using 100% Medicare claims data, we identified patients aged 66-99 undergoing elective inpatient surgery (coronary artery bypass grafting, colectomy, and total hip/knee replacement) in 2014. We calculated price-standardized Medicare payments for the surgical episode from admission through 30 days after discharge (episode payments). On the basis of predictor variables from 2013, that is, Elixhauser comorbidities, hierarchical condition categories, Medicare's Chronic Conditions Warehouse (CCW), and total spending, we constructed models to predict the costs of surgical episodes in 2014. RESULTS: All sources of comorbidity data performed well in predicting the costliest cases (Spearman correlation 0.86-0.98). Models on the basis of hierarchical condition categories had slightly superior performance. The costliest quintile of patients as predicted by the model captured 35%-45% of the patients in each procedure's actual costliest quintile. For example, in hip replacement, 44% of the costliest quintile was predicted by the model's costliest quintile. CONCLUSIONS: A significant proportion of surgical spending can be predicted using patient factors on the basis of readily available claims data. By adjusting for patient factors, this will facilitate future research on unwarranted variation in episode payments driven by surgeons, hospitals, or other market forces.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Medicare/economia , Procedimentos Cirúrgicos Operatórios/economia , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/economia , Colectomia/economia , Ponte de Artéria Coronária/economia , Cuidado Periódico , Feminino , Humanos , Masculino , Estados Unidos
8.
BMC Infect Dis ; 19(1): 870, 2019 Oct 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640578

RESUMO

BACKGROUND: Mortality is high among patients with Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection. We aimed to determine hospital mortality and the factors associated with it in a cohort of MERS-CoV patients. METHODS: We reviewed hospital records of confirmed cases (detection of virus by polymerase chain reaction from respiratory tract samples) of MERS-CoV patients (n = 63) admitted to Buraidah Central Hospital in Al-Qassim, Saudi Arabia between 2014 and 2017. We abstracted data on demography, vital signs, associated conditions presented on admission, pre-existing chronic diseases, treatment, and vital status. Bi-variate comparisons and multiple logistic regressions were the choice of data analyses. RESULTS: The mean age was 60 years (SD = 18.2); most patients were male (74.6%) and Saudi citizens (81%). All but two patients were treated with Ribavirin plus Interferon. Hospital mortality was 25.4%. Patients who were admitted with septic shock and/or organ failure were significantly more likely to die than patients who were admitted with pneumonia and/or acute respiratory distress syndrome (OR = 47.9, 95% CI = 3.9, 585.5, p-value 0.002). Age, sex, and presence of chronic conditions were not significantly associated with mortality. CONCLUSION: Hospital mortality was 25%; septic shock/organ failure at admittance was a significant predictor of mortality.


Assuntos
Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/mortalidade , Mortalidade Hospitalar , Adulto , Idoso , Antivirais/uso terapêutico , Estudos de Coortes , Infecções por Coronavirus/complicações , Feminino , Humanos , Pacientes Internados/estatística & dados numéricos , Interferon-alfa/uso terapêutico , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Coronavírus da Síndrome Respiratória do Oriente Médio/genética , Pneumonia/tratamento farmacológico , Pneumonia Viral/tratamento farmacológico , Pneumonia Viral/etiologia , Pneumonia Viral/mortalidade , Reação em Cadeia da Polimerase , Ribavirina/uso terapêutico , Arábia Saudita/epidemiologia , Resultado do Tratamento
9.
BMC Health Serv Res ; 19(1): 743, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651305

RESUMO

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) is an opportunistic bacterial organism resistant to first line antibiotics. Acquisition of MRSA is often classified as either healthcare-associated or community-acquired. It has been shown that both healthcare-associated and community-acquired infections contribute to the spread of MRSA within healthcare facilities. The objective of this study was to estimate the incremental inpatient cost and length of stay for individuals colonized or infected with MRSA. Common analytical methods were compared to ensure the quality of the estimate generated. This study was performed at Alberta Ministry of Health (Edmonton, Alberta), with access to clinical MRSA data collected at two Edmonton hospitals, and ministerial administrative data holdings. METHODS: A retrospective cohort study of patients with MRSA was identified using a provincial infection prevention and control database. A coarsened exact matching algorithm, and two regression models (semilogarithmic ordinary least squares model and log linked generalized linear model) were evaluated. A MRSA-free cohort from the same facilities and care units was identified for the matched method; all records were used for the regression models. Records span from January 1, 2011 to December 31, 2015, for individuals 18 or older at discharge. RESULTS: Of the models evaluated, the generalized linear model was found to perform the best. Based on this model, the incremental inpatient costs associated with hospital-acquired cases were the most costly at $31,686 (14,169 - 60,158) and $47,016 (23,125 - 86,332) for colonization and infection, respectively. Community-acquired MRSA cases also represent a significant burden, with incremental inpatient costs of $7397 (2924 - 13,180) and $14,847 (8445 - 23,207) for colonization and infection, respectively. All costs are adjusted to 2016 Canadian dollars. Incremental length of stay followed a similar pattern, where hospital-acquired infections had the longest incremental stays of 35.2 (16.3-69.5) days and community-acquired colonization had the shortest incremental stays of 3.0 (0.6-6.3) days. CONCLUSIONS: MRSA, and in particular, hospital-acquired MRSA, places a significant but preventable cost burden on the Alberta healthcare system. Estimates of cost and length of stay varied by the method of analysis and source of infection, highlighting the importance of selecting the most appropriate method.


Assuntos
Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas/economia , Idoso , Alberta , Antibacterianos/economia , Antibacterianos/uso terapêutico , Estudos de Coortes , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/economia , Infecção Hospitalar/economia , Infecção Hospitalar/prevenção & controle , Feminino , Hospitalização/economia , Hospitalização/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Tempo de Internação/economia , Tempo de Internação/estatística & dados numéricos , Masculino , Meticilina/economia , Meticilina/uso terapêutico , Pessoa de Meia-Idade , Estudos Retrospectivos
10.
Z Gerontol Geriatr ; 52(Suppl 4): 229-242, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31628611

RESUMO

BACKGROUND: Older people represent a risk group for acquiring or further development of delirium during hospitalization, therefore requiring suitable nonpharmacological delirium interventions. OBJECTIVE: This scoping review analyzed nonpharmacological intervention programs for older inpatients with or without cognitive decline on regular or acute geriatric wards to present the range of interventions. METHODS: A systematic literature search was conducted using scientific databases. A total of 4652 records were screened by two independent reviewers, leaving 81 eligible articles for full-text screening and 25 studies were finally included. Inclusion criteria were older patients ≥65 years in regular or acute geriatric wards and nonpharmacological multicomponent interventions. RESULTS: More than a half of the included studies (14, 56%) recruited patients with pre-existing cognitive decline as part of the study population and 12% focused exclusively on patients with cognitive decline. On average 11 intervention components were integrated in the programs and two programs included full coverage of all 18 identified components. CONCLUSION: Only few programs were described for older inpatients and even fewer regarding pre-existing cognitive decline. The low numbers of interventions and data heterogeneity restricted the assessment of outcomes; however, delirium incidence, as reported by two thirds of the studies was reduced by nonpharmacological multicomponent interventions.


Assuntos
Disfunção Cognitiva/epidemiologia , Delírio/epidemiologia , Delírio/terapia , Hospitalização/estatística & dados numéricos , Pacientes Internados/psicologia , Tempo de Internação/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Disfunção Cognitiva/psicologia , Delírio/psicologia , Feminino , Humanos , Incidência , Pacientes Internados/estatística & dados numéricos , Masculino , Prevalência , Fatores de Risco , Resultado do Tratamento
11.
Health Serv Res ; 54(6): 1273-1282, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31602641

RESUMO

OBJECTIVE: To demonstrate the performance of methodologies that include machine learning (ML) algorithms to estimate average treatment effects under the assumption of exogeneity (selection on observables). DATA SOURCES: Simulated data and observational data on hospitalized adults. STUDY DESIGN: We assessed the performance of several ML-based estimators, including Targeted Maximum Likelihood Estimation, Bayesian Additive Regression Trees, Causal Random Forests, Double Machine Learning, and Bayesian Causal Forests, applying these methods to simulated data as well as data on the effects of right heart catheterization. PRINCIPAL FINDINGS: In Monte Carlo studies, ML-based estimators generated estimates with smaller bias than traditional regression approaches, demonstrating substantial (69 percent-98 percent) bias reduction in some scenarios. Bayesian Causal Forests and Double Machine Learning were top performers, although all were sensitive to high dimensional (>150) sets of covariates. CONCLUSIONS: ML-based methods are promising methods for estimating treatment effects, allowing for the inclusion of many covariates and automating the search for nonlinearities and interactions among variables. We provide guidance and sample code for researchers interested in implementing these tools in their own empirical work.


Assuntos
Cateterismo Cardíaco/estatística & dados numéricos , Simulação por Computador , Interpretação Estatística de Dados , Pacientes Internados/estatística & dados numéricos , Aprendizado de Máquina , Resultado do Tratamento , Adulto , Idoso , Idoso de 80 Anos ou mais , Algoritmos , Teorema de Bayes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Estatísticos
12.
Med Care ; 57(11): 913-920, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31609847

RESUMO

OBJECTIVE: There is limited knowledge about how general hospitals and Veterans Health Administration (VHA) hospitals fare relative to each other on a broad range of inpatient psychiatry-specific patient safety outcomes.This research compares data from 2 large-scale epidemiological studies of adverse events (AEs) and medical errors (MEs) in inpatient psychiatric units, one in VHA hospitals and the other in community-based general hospitals. METHOD: Retrospective medical record reviews assessed the prevalence of AEs and MEs in a sample of 4371 discharges from 14 community-based general hospitals (derived from 69,081 discharges at 85 hospitals) and a sample of 8005 discharges from 40 VHA hospitals (derived from 92,103 discharges at 105 medical centers). Rates of AEs and MEs across hospital systems were calculated, controlling for relevant patient and hospital characteristics. RESULTS: The overall rate of AEs and MEs in inpatient psychiatric units of VHA hospitals was 7.11 and 1.49 per 100 patient discharges; at community-based acute care hospitals, these rates were 13.48 and 3.01 per 100 patient discharges. The adjusted odds ratio of a patient experiencing an AE and a ME at community-based hospitals as compared with VHA hospitals was 2.11 and 2.08, respectively. CONCLUSION: Although chart reviews may not document the complete nature and outcomes of care, even after controlling for differences in patient and hospital characteristics, psychiatric inpatients at community-based hospitals were twice as likely to experience AEs or MEs as inpatients at VHA hospitals. While community-based hospitals may lag behind VHA hospitals, both hospital systems should continue to pursue evidence-based improvements in patient safety. Future research aimed at changing hospital practices should draw on established strategies for bridging the gap from research to practice in order to improve the quality of care for this vulnerable patient population.


Assuntos
Hospitais Comunitários/estatística & dados numéricos , Hospitais Gerais/estatística & dados numéricos , Hospitais de Veteranos/estatística & dados numéricos , Pacientes Internados/psicologia , Erros Médicos/estatística & dados numéricos , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Erros Médicos/psicologia , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Adulto Jovem
13.
BMC Health Serv Res ; 19(1): 691, 2019 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-31610790

RESUMO

BACKGROUND: The Floresco integrated service model was designed to address the fragmentation of community mental health treatment and support services. Floresco was established in Queensland, Australia, by a consortium of non-government organisations that sought to partner with general practitioners (GPs), private mental health providers and public mental health services to operate a 'one-stop' mental health service hub. METHODS: We conducted an independent mixed-methods evaluation of client outcomes following engagement with Floresco (outcome evaluation) and factors influencing service integration (process evaluation). The main data sources were: (1) routinely-collected Recovery Assessment Scale - Domains and Stages (RAS-DS) scores at intake and review (n = 108); (2) RAS-DS scores, mental health inpatient admissions and emergency department (ED) presentations among clients prospectively assessed at intake and six-month follow-up (n = 37); (3) semi-structured interviews with staff from Floresco, consortium partners, private practitioners and the local public mental health service (n = 20); and (4) program documentation. RESULTS: Interviews identified staff commitment, co-location of services, flexibility in problem-solving, and anecdotal evidence of positive client outcomes as important enablers of service integration. Barriers to integration included different organisational practices, difficulties in information-sharing and in attracting and retaining GPs and private practitioners, and systemic constraints on integration with public mental health services. Of 1129 client records, 108 (9.6%) included two RAS-DS measurements, averaging 5 months apart. RAS-DS 'total recovery' scores improved significantly (M = 63.3%, SD = 15.6 vs. M = 69.2%, SD = 16.1; p < 0.001), as did scores on three of the four RAS-DS domains ('Looking forward', p < 0.001; 'Mastering my illness', p < 0.001; and 'Connecting and belonging', p = 0.001). Corresponding improvements, except in 'Connecting and belonging', were seen in the 37 follow-up study participants. Decreases in inpatient admissions (20.9% vs. 7.0%), median length of inpatient stay (8 vs. 3 days), ED presentations (34.8% vs. 6.3%) and median duration of ED visits (187 vs. 147 min) were not statistically significant. CONCLUSIONS: Despite the lack of a control group and small follow-up sample size, Floresco's integrated service model showed potential to improve client outcomes and reduce burden on the public mental health system. Horizontal integration of non-government and private services was achieved, and meaningful progress made towards integration with public mental health services.


Assuntos
Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Adulto , Serviço Hospitalar de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços , Seguimentos , Hospitalização/estatística & dados numéricos , Hospitais Psiquiátricos/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Organizações , Avaliação de Programas e Projetos de Saúde , Queensland
14.
Artigo em Inglês | MEDLINE | ID: mdl-31540354

RESUMO

Irrational antibiotic usage not only causes an increase in antibiotic-borne diseases, but also inflicts pain on patients, as a result of inappropriate treatment. In order to resolve the hazards caused by irrational antibiotic usage, a kind of e-health service, the Rational Antibiotic Use System (RAUS), has been incorporated into the hospital information system. The RAUS provides doctors and patients with the functions of antibiotic usage monitoring, antibiotic information consultation and antibiotic prescription support. Though existing literature has already proved the usefulness of the RAUS on monitoring doctors' behavior, the effects on hospital performance from an organizational perspective has rarely been measured by empirical data. Therefore, our study has explored the effects of the RAUS on the performance of a large Chinese hospital, which has implemented the RAUS since March 2014. Through empirical research, we quantified the effects of the implementation of the RAUS on a hospital's performance from both the direct effects on the "drug income" and the spillover effect on the "treatment income". The results indicate a significant positive spillover effect on the treatment incomes of a hospital in its inpatient activities (seen as significant in the long term) and in its outpatient activities (seen as significant in both the short and long terms). In addition, this research provides certain theoretical and practical implications for the dilemma of e-health services application in irrational antibiotic usage.


Assuntos
Antibacterianos/uso terapêutico , Hospitais/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , China , Revisão de Uso de Medicamentos/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Pacientes Ambulatoriais/estatística & dados numéricos
15.
JSLS ; 23(3)2019.
Artigo em Inglês | MEDLINE | ID: mdl-31488941

RESUMO

Background: Laparoscopic surgery has become the standard of care for the most common surgical procedures performed. However, laparoscopic techniques have not reached this same penetrance in colorectal surgery. We wanted to determine the percentage of colon operations performed in Texas that were done via laparoscopic, robotic and open techniques. Methods: The Texas Inpatient Public Use Data File (PUDF) was queried using ICD-9-CM diagnostic and procedure codes to determine overall utilization of laparoscopic colectomies (LC) in Texas between 2013-14 for reporting facilities. We specifically looked at cost and the length of stay for LC, open colectomy (OC) and robotic assisted colectomy (RAC). Results: In the state of Texas between 2013-14 there were 20,454 colectomies performed. Of these 12,328 (60.3%) were OC, 7,536 (36.8%) were LC, and 590 (3.9%) were RAC. Average total cost was $117,113 for OC, $75,741.9 for LC, and $81,996.2 for RAC. Average length of stay for each technique was 10.6 days for OC, 6.1 days for LC, and 5.1 days for RAC. The risk of a postoperative complication occurring was higher in the open procedure than a laparoscopic procedure. Conclusions: LC accounted for only 36.8% of all colectomies performed in Texas between 2013-14. OC costs twice as much as LC and increased the length of stay by nearly 4 d. LC and RAC are both associated with significantly less cost and length of stay for patients undergoing surgery, while lowering perioperative complications. Disclosures: None of the authors have any relevant disclosures.


Assuntos
Colectomia/tendências , Doenças do Colo/cirurgia , Armazenamento e Recuperação da Informação/estatística & dados numéricos , Pacientes Internados/estatística & dados numéricos , Laparoscopia/estatística & dados numéricos , Laparoscopia/tendências , Procedimentos Cirúrgicos Robóticos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Colectomia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Texas , Adulto Jovem
16.
Artigo em Inglês | MEDLINE | ID: mdl-31480759

RESUMO

There is evidence of a strong correlation between inequality in health care access and disparities in chronic health conditions. Equal access to health care is an important indicator for overall population health, and the urban road network has a significant influence on the spatial distribution of urban service facilities. In this study, the network kernel density estimation was applied to detect the hot spots of health care service along the road network of Shenzhen, and we further explored the influences of population and road density on the aggregate intensity distributions at the community level, using spatial stratified heterogeneity analyses. Then, we measured the spatial clustering patterns of health care facilities in each of the ten districts of Shenzhen using the network K-function, and the interrelationships between health care facilities and hypertension patients. The results can be used to examine the reasonability of the existing health care system, which would be valuable for developing more effective prevention, control, and treatment of chronic health conditions. Further research should consider the influence of nonspatial factors on health care service access.


Assuntos
Instalações de Saúde/estatística & dados numéricos , Hipertensão , Pacientes Internados/estatística & dados numéricos , População Urbana/estatística & dados numéricos , China , Acesso aos Serviços de Saúde , Humanos , Fatores Socioeconômicos , Análise Espacial
17.
Am J Occup Ther ; 73(5): 7305205050p1-7305205050p9, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31484029

RESUMO

IMPORTANCE: Adults receiving occupational therapy in inpatient rehabilitation are a heterogeneous population with differing needs, outcomes, and rehabilitation processes. Outcome studies based on what works for all clients may obscure the needs of population subgroups who benefit unequally from rehabilitation services. OBJECTIVE: To identify subgroups on the basis of client satisfaction and progress in functional self-care among a diverse rehabilitation population and to understand subgroup differences in occupational therapy and rehabilitation processes and client discharge status. DESIGN: Using an existing dataset, we used K-means cluster analysis of demographics, status at admission, and the outcomes of satisfaction and change in self-care to identify five homogeneous outcome groups. Occupational therapy and rehabilitation processes and discharge status were compared across subgroups. SETTING: Inpatient rehabilitation hospital. PARTICIPANTS: The dataset included 1,099 inpatients age 18 yr and older who received occupational therapy over a 27-mo period. MEASURES: Admission measures included the Inpatient Rehabilitation Facility-Patient Assessment Instrument and self-care items of the FIM™. The Satisfaction with Continuum of Care-Revised was administered after discharge. RESULTS: Five subgroups showed statistically different patterns of medical complications, functional self-care, rates of progress, satisfaction with intervention, and course of treatment. The profile of each group suggests differing therapeutic needs. Although all groups made significant gains in functional self-care, two groups continued to need physical assistance at discharge. CONCLUSION: and Relevance: Cluster analysis proved useful in segmenting a typical heterogeneous rehabilitation population into more homogeneous subgroups to enhance understanding of clinical needs and to potentially increase the potency of outcomes research. WHAT THIS ARTICLE ADDS: This research identified subgroups within a typical population of rehabilitation clients receiving occupational therapy and identified their unique needs and outcomes using cluster analysis techniques.


Assuntos
Terapia Ocupacional , Adulto , Análise por Conglomerados , Hospitalização , Humanos , Pacientes Internados/estatística & dados numéricos , Centros de Reabilitação , Resultado do Tratamento
18.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(8): 895-899, 2019 Aug 10.
Artigo em Chinês | MEDLINE | ID: mdl-31484250

RESUMO

Objective: To conduct a viral pathogen surveillance program on pediatric inpatients less than five years old with acute gastroenteritis in Shanghai and to better understand the pathogenic spectrum and molecular features in the target population, for setting up programs on control, prevention, medication and vaccine applications of the diseases. Methods: Fecal samples were collected from inpatients less than 5 years old who were admitted to a pediatric hospital for having acute gastroenteritis. Information related to demographic, clinical and epidemiological features of the patients was also collected. Laboratory assays including ELISA, real-time PCR and nested PCR, were performed to detect the presence of pathogens as rotavirus, calicivirus, astrovirus and adenovirus. Results: A total of 1 018 samples were collected (male 671 and 347 female), with the positive detection rate as 40.57% which peaked from autumn till winter, annually. Calicivirus and rotavirus A presented with the highest detection rates (24.75% and 13.95% respectively). The lowest detection rate was found in the 0-6 month-olds (32.20%). 65% of the patients with positive virus had received antibiotic treatment prior to the hospitalization. However, no statistically significant difference was seen, regarding the rates of antibiotic medication in the virus positive or negative populations (P>0.05). Data from the Rotavirus genotype analysis revealed that G9P[8] genotype was the predominant strain, and causing majority of rotavirus infections in all the age groups. Conclusions: Among the inpatients under 5 years of age in Shanghai, the positive detection rate for Calicivirus was higher than that for rotavirus group A, suggesting the necessity to carefully monitor the changes regarding the pathogenic spectrum and subtypes of the virus. Antibiotics should also be attentively administered, together with the development of suitable vaccine.


Assuntos
Caliciviridae/isolamento & purificação , Fezes/virologia , Gastroenterite/virologia , Pacientes Internados/estatística & dados numéricos , Infecções por Rotavirus/diagnóstico , Rotavirus/isolamento & purificação , Doença Aguda , Pré-Escolar , China/epidemiologia , Feminino , Gastroenterite/diagnóstico , Gastroenterite/epidemiologia , Humanos , Lactente , Masculino , Infecções por Rotavirus/epidemiologia , Infecções por Rotavirus/virologia
19.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(8): 911-916, 2019 Aug 10.
Artigo em Chinês | MEDLINE | ID: mdl-31484253

RESUMO

Objective: To understand the epidemiological and pathogenic characteristics of hospitalized severe acute respiratory infections (SARI) in Shanghai, China. Methods: From 2015 to 2017, one Tertiary hospital and one Secondary hospital were chosen as the surveillance sites. Two respiratory tract specimens per case were collected from SARI cases aged 15 years and older. One specimen was tested for 22 respiratory pathogens by RT-PCR, and the other specimen was cultured for 6 respiratory bacteria. Results: A total of 287 SARI cases were enrolled for sampling and lab testing. 70.73% of the cases were aged 60 years and older, with 41.46% (119/287) were positive for at least one pathogen. Influenza virus was the predominant pathogen, accounting for 17.77% (51/287) of all SARI cases. Human rhinovirus/Enterovirus and Coronavirus were both accounting for 7.32% (21/287), followed by Mycoplasma pneumoniae (5.57%, 16/287). The positive rates of parainfluenza virus, bocavirus, adenovirus, respiratory syncytial virus and human metapneumo virus were all less than 5%. Bacterial strains were identified in seven SARI cases, including Klebsiella pneumoniae (3 strains), Staphylococcus aureus (2 strains), Streptococcus pneumoniae (1 strain) and Pseudomonas aeruginosa (1 strain). Two or Three pathogens were co-detected from 40 cases, accounting for 33.61% of 119 positive cases. The most common co-detected pathogens were influenza virus and Mycoplasma pneumoniae (10 cases). Influenza cases peaked in winter-spring and summer. Mycoplasma pneumoniae peaked in winter-spring season and overlapped with influenza. The positive rates of pathogens were not significantly different between different age groups. Conclusions: Various respiratory pathogens can be detected from SARI cases aged 15 years and older. Influenza virus was the predominant pathogen and the co-detection of influenza virus with Mycoplasma pneumoniae the most common one.


Assuntos
Bactérias/isolamento & purificação , Infecções Bacterianas/diagnóstico , Influenza Humana/diagnóstico , Pacientes Internados/estatística & dados numéricos , Mycoplasma pneumoniae/isolamento & purificação , Infecções Respiratórias , Viroses/diagnóstico , Vírus/isolamento & purificação , Doença Aguda , Adolescente , Bactérias/genética , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , China/epidemiologia , Coinfecção/epidemiologia , Hospitalização , Humanos , Lactente , Influenza Humana/epidemiologia , Influenza Humana/virologia , Pessoa de Meia-Idade , Índice de Gravidade de Doença , Viroses/epidemiologia , Viroses/virologia , Vírus/genética
20.
Medicina (Kaunas) ; 55(8)2019 Aug 13.
Artigo em Inglês | MEDLINE | ID: mdl-31412670

RESUMO

BACKGROUND AND OBJECTIVES: The Studies have suggested hypercholesterolemia is a risk factor for cerebrovascular disease. However, few of the studies with a small number of patients had tested the effect of hypercholesterolemia on the outcomes and complications among acute ischemic stroke (AIS) patients. We hypothesized that lipid disorders (LDs), though risk factors for AIS, were associated with better outcomes and fewer post-stroke complications. MATERIALS AND METHOD: We performed a retrospective analysis of the Nationwide Inpatient Sample (years 2003-2014) in adult hospitalizations for AIS to determine the outcomes and complications associated with LDs, using ICD-9-CM codes. In 2014, we also aimed to estimate adjusted odds of AIS in patients with LDs compared to patients without LDs. The multivariable survey logistic regression models, weighted to account for sampling strategy, were fitted to evaluate relationship of LDs with AIS among 2014 hospitalizations, and outcomes and complications amongst AIS patients from2003-2014. RESULTS AND CONCLUSIONS: In 2014, there were 28,212,820 (2.02% AIS and 5.50% LDs) hospitalizations. LDs patients had higher prevalence and odds of having AIS compared with non-LDs. Between 2003-2014, of the total 4,224,924 AIS hospitalizations, 451,645 (10.69%) had LDs. Patients with LDs had lower percentages and odds of mortality, risk of death, major/extreme disability, discharge to nursing facility, and complications including epilepsy, stroke-associated pneumonia, GI-bleeding and hemorrhagic-transformation compared to non-LDs. Although LDs are risk factors for AIS, concurrent LDs in AIS is not only associated with lower mortality and disability but also lower post-stroke complications and higher chance of discharge to home.


Assuntos
Isquemia Encefálica/complicações , Pacientes Internados/estatística & dados numéricos , Transtornos do Metabolismo dos Lipídeos/complicações , Alta do Paciente/estatística & dados numéricos , Acidente Vascular Cerebral/complicações , Idoso , Feminino , Mortalidade Hospitalar/tendências , Hospitalização , Humanos , Masculino , Estudos Retrospectivos , Fatores de Risco , Acidente Vascular Cerebral/epidemiologia , Inquéritos e Questionários
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